Confused about COVID boosters? Here’s what science and experts say about the new generation of pickups.

As we head into the third winter of the pandemic, only about 13% of American adults — less than 11% of Americans overall — have received a bivalent booster dose for COVID-19.

Only about 34 million adults in the US have opted in 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 forms of the virus currently circulating.

Medical experts say the lackluster interest in the new boosters is due to several factors: pandemic fatigue, mixed messaging from public health officials, confusion about how the new boosters differ from previous shots, and the government’s decision to allow updated boosters without the first. Obtaining clinical data in humans.

“It’s hard for people to go through that,” said Robert Wachter, MD, chair of the department of medicine at the University of California, San Francisco. “Some of them raise their hands and say, ‘I’ve been vaccinated, and that’s all I have to do.’ Which unfortunately it isn’t.”

A lot has changed since 2020. We now have vaccines that do a very good job of preventing most people from getting sick until they end up in the hospital or die. You can now get home tests from pharmacies, and there are antivirals that help treat COVID and may help prevent COVID for a long time, as symptoms can linger long after infection. And now we also have the updated boosters, which is another way to stave off the worst of the virus.

However, these boosters don’t confer full protection against getting sick, leading some people, particularly those who are otherwise healthy and young, to wonder: Why get one, then?

With new variants like BQ.1 and BQ.1.1 now the dominant strains circulating in the United States, and with upcoming holidays bringing more people together to spend time socializing indoors with friends and family, it’s important to understand that your immunity, both from infection and or grafting, it fades within four to six months. In fact, immunity to all coronaviruses wanes over time “for reasons we don’t fully understand,” Kami Kim, director of infectious disease research at Tampa General Hospital’s Global Institute for Emerging Diseases, told me.

If you’ve been in the past three months [after vaccination or infection]”You don’t want to count on getting a BA.5 infection, because BQ.1.1 can still infect you,” said Eric Topol, MD, chief 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 booster and the shots that were available last year?

Previous boosters were just smaller additional doses of the original vaccine. But there are now two bivalent COVID-19 boosters available in the United States: mRNA,
mRNA-1273.222 and bivalent BNT162b2 from BioNTech BNTX,
Pfizer PFE,

Both shots are designed to protect against the original strain of the virus as well as the BA.4 and BA.5 omicron sub-variants. The bivalent boosters are designed to better protect people against the forms of the virus currently circulating, as well as future variants. It’s a similar approach to the way influenza strains are chosen for influenza vaccines each year.

It’s exactly the same as mRNA technology [as the original vaccine]but each dose now contains half [original] said Jennifer Pym Dodd, an epidemiologist and professor of demography and population health at the University of Oxford in the United Kingdom.

In June of this year, the FDA required drug companies to design the next generation of COVID boosters using this formulation. (In Europe, regulators took a slightly different approach, first choosing bivalent boosters that protected equally against the original virus and the BA.1 variant of omicron before adding a recommendation for the same bivalent formulation 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, as far as BA.4/BA.5, the virus is going to mutate more,” said Kim of Tampa General Hospital. .”

Until last week, BA.5 was the dominant variant in the United States, but as of Friday, BQ.1 and BQ.1.1, two subspecies of BA.5, make up the majority of new infections in the United States, according to the Centers for Disease Control. and prevention.

This is not all bad news. BQ.1.1 is closely related to BA.5, according to Dowd, meaning that many of the protective qualities of the bivalent booster will also protect against new variants.

2. What does the science say about new enhancers?

There is preliminary data on both bivalent enhancers that seem to indicate that they work against BQ.1.1 as well as BA.5. However, scientists and clinicians say they are still waiting to see peer-reviewed research from clinical trials to fully measure the effectiveness of both shots.

  • Moderna Booster: Early clinical data shows that Moderna’s bivalent booster produced a 5- to 6-fold increase in neutralizing antibodies against BA.4 and BA.5 variants in about 500 previously vaccinated and boosted adults, according to a Nov. 14 press release. The Phase 2/3 clinical trial compared the response of the new booster to the company’s original booster. Moderna also said that the bivalent shot increased antibodies that protect against BQ.1.1, but not to the same extent as it did 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 to 6 times the protection against BA.5, that’s good,” Topol said.

  • BioNTech and Pfizer booster: 1.1 after 30 days, compared with the original booster’s 1.8-fold increase against the same variant. The study evaluated immune responses in adults age 55 and older who had been previously vaccinated and boosted, regardless of history of infection.

3. What if I catch COVID this year? Does it matter when I get the booster?

Most of the experts interviewed for this story say immunity can last anywhere from three to six months, although the official Centers for Disease Control and Prevention (CDC) recommendation is that bivalent boosters should be given three months after infection. with a COVID infection or 2 months after the individual’s last shot.

“We used to say, ‘Just go ahead and get vaccinated as soon as you’re recovered,'” Dowd said. But there was later evidence to suggest that it was slightly better to wait at least three months. Not that it’s harmful to get it sooner, but you really won’t get much benefit from this boost. reach the ceiling.”

There are other considerations as well. The timing of your last infection doesn’t matter if you have an idea of ​​what variants were circulating when you got sick. If you had an omicron infection last winter, you likely need a booster shot. If you have been sick for the past month or so, most likely with BA.5 or one of its sub variants, you may want to wait a month or two.

“As good as a vaccine and well-protective after infection, immunity and protection diminish over time,” Dr. Anthony Fauci, chief medical adviser to President Joe Biden, 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 greater risk for severe disease, and how concerned you are about prolonged COVID.

“Most of the deaths we will see from COVID could have been prevented if people had stayed up to date on their boosters,” said Wachter of the University of California. And many long-term COVID cases can do that [also] They were prevented if people were kept up to date on their boosters.”

Finally, if you’re planning to spend Christmas with the family or take a trip at the end of December, remember that it takes a few weeks for antibodies to build up from new shots.

4. Do I really need to take a booster shot if I am young and healthy?

We are long past the pandemic phase when the vaccination approach was a one-size-fits-all approach, and not all medical experts believe young, healthy people need a booster shot right now.

Dowd said that people who are “younger and otherwise healthy” can wait up to six months after a previous infection to get another shot.

“If we go to the CDC data or the UK data, the people who appear to benefit from the booster fall into three categories: people who are immunocompromised, elderly people – mostly over 75 – and people with very severe medical conditions. said Paul Offit, director of the Center for Vaccine Education at the Children’s Hospital of Philadelphia.

It’s unclear if this thinking influenced people’s decisions about getting an augmented substance. But the bivalent shots have been available to children older than 5 and to all adults in the United States for several months, and that availability hasn’t generated much interest.

For the same reason that 19,500 people flocked to the Wells Fargo Center [in Philadelphia] “To watch the six play, screaming without a mask,” Offit said. “They don’t feel obligated to get a booster shot.”

This may partly be due to the fact that hospitalizations and deaths from the coronavirus have remained largely stable. There is no longer the kind of urgency that made people book appointments for the original vaccine or wear masks. With the annual peak of COVID cases occurring during the first two weeks of January in 2021 and 2022, the question now is: Will the comfort level change as winter and the holiday season approach?

People want [a booster] It’s like flipping a switch, like if you’re 100% protected or not,” Dodd said, “but we know from the first couple of years that when the vaccine is well compatible with the variants BA.5 is decent right now, it reduces transmission.” The infection is very high and the chances of getting infected at all. We should take advantage of that.”

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