As we enter the pandemic’s third winter, only 13% of American adults — less than 11% of Americans overall — have received the bivalent COVID-19 booster.
Only about 34 million adults in the U.S. chose to get the new shot, which became available in September. The bivalent boosters, developed by Moderna and BioNTech/Pfizer, are designed to better protect people against currently circulating forms of the virus.
Medical experts say the lack of interest in the new boosters is due to several factors: pandemic fatigue, mixed messages from public health officials, confusion about how the new boosters differ from previous shots and the government’s decision to allow the updated boosters without first obtaining clinical data in humans.
“It’s hard for people to deal with,” said Robert Wachter, MD, chair of the department of medicine at the University of California, San Francisco. “Some of them just throw their hands up and say, ‘I’ve been vaccinated and this is what I have to do.'” Which, unfortunately, is not the case.”
A lot has changed since 2020. We now have vaccines that do a good enough job of preventing most people from being hospitalized or dying. You can now get home tests from pharmacies, and there are antiviral medications that help treat COVID and help prevent long-term COVID, where symptoms can last long after infection. And now we have updated boosters, another way to protect against the worst of the virus.
However, these boosters don’t completely protect against getting sick, leading some people, especially those who are young and healthy, to ask: Why do you buy them?
With new variants such as BQ.1 and BQ.1.1 now being the dominant strains in the United States and the upcoming holidays bringing more people together to spend time indoors with friends and family, it is important to understand that your immunity depends on infection or vaccination, four -decreases within six months. In fact, immunity to all coronaviruses wanes over time “for reasons we don’t understand,” Kami Kim, director of infectious disease research at Tampa General Hospital’s Institute for Global Emerging Diseases, told me.
“If you are past three months [after vaccination or infection]you don’t want to rely on having a BA.5 infection because BQ.1.1 can still hit you,” said Eric Topol, head of innovative medicine at Scripps Research in La Jolla, California.
Here are answers to some common questions about COVID.
1. What is the difference between this amp and the ones available last year?
Previous booster shots were simply additional, smaller doses of the original vaccine. But there are now two bivalent COVID-19 enhancers available in the US: Moderna’s MRNA,
MRNA-1273.222 and BNT162b2 Bivalent from BioNTech BNTX,
and Pfizer PFE,
Both shots are designed to protect against the original strain of the virus in addition to the omicron subvariants BA.4 and BA.5. Bivalent boosters are designed to better protect people from currently circulating forms of the virus, as well as future variants. This is a similar approach to the selection of flu strains for the flu vaccine each year.
“It’s the same mRNA technology [as the original vaccine]but each dose now has half [original] option,” said Jennifer Beam Dowd, an epidemiologist and professor of demography and population health at the University of Oxford in the United Kingdom.
In June of this year, the US Food and Drug Administration asked drug manufacturers to develop a new generation of COVID boosters using this formula. (Regulators in Europe took a slightly different approach, favoring bivalent boosters that were equally protective against the original virus and OMicro’s BA.1 subvariant first before adding a recommendation for the same bivalent formula used in the US)
“Part of the rationale for keeping the old version and BA.4/BA.5 is that if you put all your eggs in the basket until BA.4/BA.5, then the virus will evolve into something more. like the original version,” said Kim of Tampa General Hospital. “It’s hedging your bets.”
BA.5 was the dominant variant in the US until last week, but as of Friday, BA.5’s sublineage BQ.1 and BQ.1.1 now account for the majority of new infections in the US. To the Centers for Disease Control and Prevention.
It’s not all bad news. According to Dowd, BQ.1.1 is closely related to BA.5, which means that many of the protective qualities of the bivalent amplifier will also protect against new variants.
2. What does science say about new reinforcers?
There are preliminary data on both bivalent enhancers that show that they work against BQ.1.1 and BA.5. However, scientists and doctors say they are still waiting to see peer-reviewed studies from clinical trials to fully measure the effectiveness of both shots.
- Moderna’s amplifier: Preliminary clinical data show that Moderna’s bivalent booster produced a 5- to 6-fold increase in neutralizing antibodies against BA.4 and BA.5 variants in nearly 500 previously vaccinated and boosted adults. A phase 2/3 clinical trial compared the response of the new booster to the company’s original booster. Moderna also said the bivalent shot increased protective antibodies against BQ.1.1, although not as much as against BA.4 and BA.5, based on an analysis of about 40 participants in the same study.
“It’s not an order of magnitude more protection, but at least 5-6 times more protection against BA.5, which is good,” Topol said.
- BioNTech and Pfizer enhancer: In a preprint published Nov. 17, the two companies reported that their bivalent booster induced an 8.7-fold increase in neutralizing antibodies against BQ.1.1 after 30 days, compared with a 1.8-fold increase in antibodies against the same subvariant of the original booster. The study evaluated immune responses in previously vaccinated and boosted adults 55 years or older, regardless of history of infection.
3. What if I had COVID this year? Does it matter if I buy an amplifier?
Most experts interviewed for this story say immunity can last three to six months, though the official CDC recommendation is that bivalent boosters should be given three months after a COVID infection or two months after a person’s last shot.
“We’ve been saying, once you’ve recovered, go ahead and get vaccinated,” Dowd said. “However, there is evidence to suggest that waiting at least three months afterwards is slightly better. Not that it’s bad to get it sooner, but you won’t get much out of that boost. You hit a ceiling.”
There are other considerations. The timing of your last infection is important if you have an idea of what variants are circulating when you get sick. If you had an omicron infection last winter, you should probably get a booster. If you have been sick within the past month, possibly with BA.5 or one of its subvariants, you may want to wait a month or two.
“No matter how good the vaccine is and how good the post-infection protection is, immunity and protection wane over time,” Dr. Anthony Fauci, President Joe Biden’s chief medical adviser, told reporters at a White House briefing on Tuesday.
You should also assess your underlying immune status, whether you have medical conditions that put you at risk of severe illness, and how worried you are about prolonged COVID.
“Most of the deaths we’re going to see from COVID could have been prevented if people had come forward with their boosters,” said the University of California’s Wachter. “And there can be many cases of prolonged COVID [also] prevented if people came up with their boosters.”
Finally, if you are planning to spend Christmas with your family or travel in late December, remember that it takes several weeks to collect antibodies from new shots.
4. If I’m young and healthy, should I really be getting a booster?
We’re long past the pandemic phase where the one-size-fits-all approach to vaccination and not all medical professionals think young and healthy people need a booster right now.
People who are “younger and healthier” can wait up to six months after a previous infection to get another shot, Dowd said.
“If we look at the CDC data or the UK data, the people who benefit from the increase fall into three categories: immunocompromised people, older people — mostly over 75 — and people with high-risk medical conditions,” said Paul Offit, director of the Center for Vaccine Education at the Children’s Hospital of Philadelphia. said.
It’s not clear whether this thinking affects people’s decision to buy boosters. But bivalent shots have been available for children 5 and older and all adults in the United States for months, and that availability hasn’t sparked much interest.
“It’s the same reason 19,500 people flocked to the Wells Fargo Center [in Philadelphia] Watching the Sixers play without a mask, screaming,” Offit said. “They don’t have to take a booster shot.”
This may be due in part to the fact that COVID hospitalizations and deaths have remained stable. There is no longer any urgency that prompts people to book an appointment for the original vaccination or wear masks. With the annual peak of COVID cases occurring in the first two weeks of January in 2021 and 2022, the question now becomes: Will this level of comfort change as we approach winter and the holiday season?
“People want it [a booster] It’s like flipping a switch like I’m 100% protected or not,” Dowd said, “but we’ve known from the first few years that if you adapt now when the vaccine is well-matched with decent variants of BA.5, it really reduces transmission and your chance of infection in general. reduces to a degree. We should take advantage of this.”