Doing the same in the United States makes sense. Omicron has been dominant here since December 2021 and makes up virtually all of the new cases. The BA.5 subvariant alone makes up nearly 89 percent of infections. Both Pfizer and Moderna presented convincing data that a bivalent booster, comprised of the parent vaccine plus a component targeting BA.4 and BA.5, will increase antibodies directed against omicron subvariants.
Those who oppose the authorization say that not enough studies have been done to show that the bivalent version is superior to the original. In a way, they are right; Real-world studies are still ongoing to show that the new booster is superior. But laboratory studies of a vaccine’s ability to induce antibodies are a good indicator. We also have many years of experience with the flu vaccine, which is updated annually to accommodate emerging mutations.
Furthermore, waiting for definitive results has a real cost. 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 October 31.
For me, the most crucial part of the CDC recommendation is that it simplified the booster terminology. Now, everyone over the age of 12 will be considered up-to-date on their coronavirus vaccines if they have received this updated version.
Previously, booster recommendations were based on the number of vaccinations received. For example, adults over the age of 50 were supposed to have two shots and two boosters. This was getting confusing. What about those who received the one-dose Johnson & Johnson vaccine? And if someone had covid-19, then a first booster? Does that count as two pushes? Since people received boosters at different times, keeping track of when patients were due for their next injection became cumbersome for doctors.
It is much simpler to give a blanket recommendation that everyone over 12 years of age should receive this updated version (studies are still ongoing for children under 12 years of age), regardless of the number of doses received so far. In fact, this is similar to what is done with the flu vaccine: it is something that is given every year before the start of the flu season. When you go to get your flu shot, no one asks how many shots you’ve had. It doesn’t matter if it’s your first flu shot or your 50th; what matters is that you get an up-to-date flu shot every year.
This should be the new model for the coronavirus vaccine in the future. Every fall, there might be an updated version targeting the dominant variants. Everyone would get the booster annually. Elderly or immunocompromised individuals may need additional boosters on top of the annual vaccine, but most Americans might think of the coronavirus vaccine as something they get once a year.
To further streamline processes, I hope that federal regulators will consider authorizing a combined influenza and coronavirus vaccine. That way, doctors could remind patients of the coronavirus vaccine when they mention the flu shot, and everyone can get the combination vaccine in one visit. Employers and schools that operate flu clinics can use existing infrastructure to provide combination immunization.
A simultaneous annual influenza and covid campaign could go a long way in increasing booster uptake. Only about half of adults eligible for their first coronavirus booster have received one. Among those over 50, just over a third eligible for a second booster have opted for it. About 30 percent of people over 65 have not received their first booster; of those who have, only 41 percent have gotten 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 transmission of the virus. I applaud the efforts of Senators James M. Inhofe (R-Okla.) and Richard Burr (RN.C.) to advance “Operation Warp Speed 2.0” and accelerate the development of better tools for the future.
For now, the Biden administration is right to emphasize existing tools, which are highly effective but tragically underutilized. Simplifying the booster process is a much-needed step in improving vaccine uptake and mitigating the ongoing impact of covid.
