We’ve seen second COVID-19 boosters recommended for older adults and people with underlying health conditions — but what about the general population? Will another booster shot be recommended for everyone in the fall to fend off a winter surge? Or will the next booster campaign be geared to those most at risk for developing severe disease?
These are the key questions vaccine experts are considering right now. The Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee recently met to discuss the next round of boosters. The panel voted 19-2 in favor of fall booster shots tweaked to target omicron variants; the decision will now go onto the FDA, which usually follows the committee’s recommendation. The final green light will then come from the Centers for Disease Control and Prevention.
The decision follows news that both Pfizer and Moderna’s updated booster shots offer a strong immune response against omicron and its subvariants. The preliminary results found an increase in antibodies and added protection.
Infectious disease experts generally agree that developing a booster strategy is a complicated task.
“The solution isn’t just throwing vaccines at everybody. It’s actually having a meaningful understanding of what are the goals of the vaccine program and what can we expect the vaccines to do,” Isaac Bogoch, an infectious disease physician and scientist at the University of Toronto, told HuffPost.
Experts expect COVID boosters will be recommended for some before the fall
Bogoch said in order to determine if, when and how boosters will be needed, it’s crucial to first look at the goals.
The current shots have waning protection against infection and onward transmission, Bogoch explained, but they continue to be safe and very effective at preventing severe outcomes like hospitalizations and death.
Health officials will need to decide if they want boosters to prevent hospitalization and death (which the initial shots still do in most people) or to prevent symptomatic COVID (a harder feat), according to Arjun Venkatesh, a Yale Medicine emergency medicine doctor and associate professor at Yale School of Medicine.
The effectiveness of vaccines varies between people. Immunocompromised individuals and older people’s antibody levels wane earlier, which makes these people strong candidates for booster doses, Venkatesh said.
“The reason we want to boost older adults first is because in many ways, the vaccine — their first two doses — didn’t work as well as it worked in younger people,” Venkatesh said. That second booster has helped at-risk groups be “as vaccinated” as healthier individuals who got only two doses.
It’s reasonable to expect that the next round of boosters will be recommended for vulnerable individuals before the next wave of the pandemic this fall, Bogoch said.
Venkatesh also believes we will see booster campaigns targeting at-risk populations more than blanket booster recommendations. It’s not uncommon for booster campaigns to roll out for select groups — we already do this for shingles, pneumonia and flu shots.
When will the general population get another booster?
Trials have shown that a fourth dose of the currently available vaccines doesn’t provide much more protection against mild or asymptomatic infections than a third dose in healthy people under 50, according to Supriya Narasimhan, the division chief of infectious diseases and hospital epidemiologist and medical director of infection prevention at Santa Clara Valley Medical Center.
“The increase in vaccine efficacy was small and short-lived, therefore the benefit of an additional dose is not thought to be great,” Narasimhan said, noting that the benefits of a fourth dose were much more pronounced in people over 60.
As of now, it’s unclear if and when the general population should get an additional booster dose anytime before the fall. “That’s going to be based, largely, on when we start seeing young, healthy people being at risk for hospitalization or death — because that’s the outcome we’re trying to prevent — or when we see young, healthy people have waning levels of antibodies” that put them at risk, Venkatesh said. That would suggest it’s time for everybody to get another shot.
What’s most likely is another shot later this year. As mentioned above, Moderna announced its omicron-specific booster was well tolerated and demonstrated a more robust antibody response against omicron variants than the original COVID shot. If authorized, the shots will be available in late summer, with booster options in the fall.
Pfizer is also working on a fall booster, and announced Saturday their shot also elicited a strong immune response against omicron. The FDA recently recommenced authorization for the Novavax vaccine’s primary series, but the shot is still being studied as a booster.
Venkatesh suspects that, like the flu, we will eventually have annual vaccines for COVID. At some point, we may pivot to different types of vaccines — like intranasal vaccines that can help fight transmission and pan-coronavirus vaccines that can target various types of coronaviruses at once. But we won’t see these in 2022, Bogoch noted.
For right this moment, experts want to tread carefully when it comes to boosters and prioritize them for the people who need them most while tracking how the current shots hold up in the rest of the population.
“It is important that we are timely and cautious in deploying additional boosters for the general population because the increase in protection is likely to be small and short-lived, especially in those who have hybrid immunity due to infection and vaccination,” Narasimhan said.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.