Federal health officials last week authorized a new coronavirus booster, the first time the vaccine formulation has been updated. This decision was not without controversy, but is the correct one that heralds a reset for how to manage covid-19.
Up until now, vaccines have targeted the original strain of the coronavirus. Many studies have demonstrated that omicron is better at evading existing vaccines than previous strains, leading some other countries, such as Britain, to authorize omicron-specific vaccines.
Doing the same in the United States makes sense. Omicron has been dominant here since December 2021 and constitutes virtually all new cases. The BA.5 subvariant alone makes up nearly 89 percent of infections. Both Pfizer and Moderna presented compelling data that a bivalent booster, composed of the original vaccine plus a component targeted to BA.4 and BA.5, will increase the antibodies directed against omicron subvariants.
Those who oppose authorization say that not enough studies have been done to prove that the bivalent version is superior to the original one. In some ways, they are right; real-world studies are still ongoing to prove the new booster is superior. But laboratory studies on a vaccine’s ability to induce antibodies are a good proxy. We also have many years of experience from the flu vaccine, which is updated annually to match emerging mutations.
Moreover, there is a real cost to waiting for definitive results. The Centers for Disease Control and Prevention estimates that more than 1 million hospitalizations and 100,000 deaths could be averted if booster coverage reached last year’s flu vaccination levels by Oct. 31.
To me, the most crucial part of the CDC’s recommendation is that it simplified booster terminology. Now, all people 12 and older will be considered up-to-date on coronavirus vaccines if they have received this updated version.
Previously, booster recommendations were based on the number of vaccines received. For example, adults 50 and older were supposed to have two vaccines and two boosters. This was getting confusing. What about those who got the one-dose Johnson & Johnson vaccine? What if someone had covid-19, then a first booster? Does that count as two boosts? Since people received boosters at different times, tracking when patients were due for their next shot became cumbersome for clinicians.
It’s much more straightforward to give a blanket recommendation that everyone 12 and older should receive this updated version (studies are still ongoing for children under 12), regardless of number of doses received thus far. Indeed, this is similar to what’s done with the flu vaccine: It’s something to be given every year before the start of flu season. When you go get your flu shot, no one asks you how many shots you’ve received. Whether it’s your first flu shot or your 50th doesn’t matter; what matters is that you get an updated flu shot every year.
This should be the new model for the coronavirus vaccine going forward. Every fall, there could be an updated version that targets dominant variants. Everyone would receive the booster annually. People who are elderly or immunocompromised may require additional “top up” boosters in addition to the annual vaccine, but the majority of Americans could think of the coronavirus vaccine as something they get once a year.
To streamline processes even more, I hope federal regulators consider authorizing a combined influenza-coronavirus vaccine. That way, clinicians could remind patients of the coronavirus vaccine when they bring up the flu vaccine, and everyone can receive the combined shot in a single visit. Employers and schools that operate flu clinics can use existing infrastructure to provide the combined immunization.
A concurrent influenza-covid annual campaign could go a long way to increase booster uptake. Only about half of adults eligible for their first coronavirus booster have received one. Among those 50 and older, just over a third eligible for a second booster have opted for it. About 30 percent of people 65 and older haven’t received their first booster; of those who have, only 41 percent have gotten their second.
In the long term, there needs to be additional investment to develop pan-coronavirus vaccines that offer broader coverage and nasal vaccines that help curb virus transmission. I applaud the efforts by Sens. James M. Inhofe (R-Okla.) and Richard Burr (R-N.C.) to push for “Operation Warp Speed 2.0” and accelerate development of better tools for the future.
For now, the Biden administration is right to emphasize existing tools, which are very effective but tragically underutilized. Simplifying the booster process is a much-needed step to improve vaccine uptake and mitigate the continuing impact of covid.