Who should get the updated coronavirus vaccine booster now—and who should wait?

By Katia Hetter, CNN

The US Centers for Disease Control and Prevention has this month greenlit the rollout of updated COVID-19 vaccine boosters, following the US Food and Drug Administration’s authorization. These shots will replace the boosters previously offered in the US such that, for people 12 and older, being “up-to-date” with vaccines means having the new jab.

Is the COVID-19 vaccine going to become an annual shot, like the flu vaccine? Speaking Tuesday, head of the Biden administration’s COVID-19 Response Team, Dr. Ashish Jha, suggested so, telling reporters that the vaccines and boosters are likely to become “a more routine part of our lives.”

A lot of people have specific questions about whether they should get it now or wait. Who should rush out and get the booster, and who can probably wait a little longer? Is there a benefit to delaying the vaccine so that it can be timed with winter holidays? And should parents of kids under 12 worry that they aren’t yet eligible?

To guide us through these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.

CNN: What are your major takeaways about the updated booster?

Dr. Leana Wen: One takeaway is that the booster will be an updated formulation that targets both the original strain and the Omicron subvariants. This is not unusual — it’s what’s done every year for the flu vaccine, where manufacturers anticipate what will likely be the strains in circulation and then target the vaccine accordingly.

Another important takeaway for me is that the CDC is moving away from counting the number of vaccine doses, and instead saying that people 12 and older are considered up to date on their coronavirus vaccines if they have received the original primary series — two doses of Pfizer, two doses of Moderna or one dose of Johnson & Johnson — plus this updated booster. That simplifies things a lot.

CNN: Do you think the coronavirus vaccine is going to be an annual shot, similar to the influenza vaccine?

Wen: From the time COVID-19 vaccines were first authorized, I and other public health experts have been saying this would be a possibility. We didn’t know whether the coronavirus vaccines would be a series of two, three or four shots, after which you’re done, or whether it would need to be given on regular intervals. The hepatitis vaccine, for example, is a three-dose vaccine, versus the tetanus vaccine, which requires regular boosters. And, of course, the flu vaccine is updated every year.

It’s looking like the coronavirus vaccines are more like the flu vaccine. Immunity wanes after a time, and there are also new strains that may benefit from more targeted vaccines. Federal health authorities have even signaled they may shift to an annual cadence.

Such cadence will be helpful, I think, because Americans are already used to getting a flu shot every year. Especially if the COVID-19 booster can be timed together with the flu shot, that could help improve vaccine uptake for both shots.

CNN: Friends and colleagues all have some version of this question: Should they get the new booster now? In your opinion, who should rush out and get the booster as soon as it’s available?

Wen: The CDC says that everyone 12 and older is recommended to get the updated booster, as long as it’s been at least two months since their last vaccine. To me, though, that doesn’t mean that the urgency is the same for everyone.

I think it’s most urgent for people who have not received any vaccine or not had COVID-19 in 2022 to get the updated booster. This is especially true for older individuals and those who have chronic medical conditions. About 30% of people 65 and older have not had any booster. Those individuals really should get the updated booster now.

Until this latest CDC announcement, only individuals 50 and older and those who are immunocompromised have been able to get two boosters. The uptake for that second booster has also been low, with only about 40% uptake so far among individuals 50 and older. That means there are quite a few adults who have may have had their last shot in the previous calendar year. I’d advise these individuals not to wait.

If someone has not gotten any vaccine, they need to get vaccinated with the primary series first. That means getting the two doses of the original Pfizer or Moderna vaccines (or two doses of Novavax or one dose of Johnson & Johnson). People need to complete the primary series prior to receiving the updated booster.

CNN: Who would you say could wait a little to get the updated booster?

Wen: People who recently recovered from COVID-19 can wait to get the updated booster. CDC guidelines say that these individuals could wait three months from their infection. I think this is sound advice. Reinfection is unlikely immediately after recovery, and also there could be benefit to allowing the body time to produce antibodies from infection.

The CDC also says that people are eligible to be vaccinated with the new booster if it’s been at least two months since their last vaccine. I don’t think most people need to rush out to get the booster exactly at the two-month mark. Some might decide to wait three or four months so that it’s a little bit later in the fall; that way, they could have better protection around the holidays.

CNN: I’ve been hearing from some people, like you said, who want to time the booster around winter holidays. Does that make sense to you?

Wen: I can understand why they’d want to do this. We know that the COVID-19 shots provide maximal effectiveness against infection in the several weeks after they’re given. There is sustained protection against severe illness, but the effectiveness against infection wanes somewhat over time.

It’s hard to predict the best timing the shots, though, because we don’t know what will happen this fall and winter. Right now, the case count for COVID-19 is high in a lot of parts of the country. For some people, especially those who are more vulnerable to severe illness, it makes sense to get optimal protection now. But case counts could also increase later this fall, and some others may decide to wait until a few weeks before Thanksgiving to get their booster.

In general, I’d go back to the point of last vaccine or infection. If you have not been vaccinated in 2022 and have not had a recent infection, I’d advise that you get the booster sooner rather than later. But if you recently had a booster and/or COVID-19, you could probably wait a month or so, to try to have more effectiveness against infection going into holidays.

CNN: Should parents of kids under 12 worry that they aren’t eligible yet for the update booster?

Wen: No, and I don’t think the case for boosting children is nearly as clear as it is for adults. The majority of children have had COVID-19. Recovery from infection, plus vaccination, affords them a very high level of protection against severe illness. I think it’s fine for parents of younger children to wait until an updated booster becomes available for this age group.

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