Should I get a COVID booster now or wait for the new vaccine that targets omicron?

Dear Advice Team: I am about to turn 70 and have been twice vaccinated and twice boosted (all Pfizer). But my second booster was administered on April 20. With waning immunity and more transmissible variants, is it advisable to get a third booster and, if so, to get it sooner or wait for a new, more omicron-oriented vaccine that may become available later this fall? And if I did get another booster sooner, would that in any way impede getting the newer vaccine in the fall? Also, is there any problem in getting another COVID booster at the same time as getting the annual flu vaccination?

Dear Advice Team: My kids are 9 and 6 and have not yet had the booster. They completed the two-dose Pfizer series in December 2021. At this point, should I get them boosted with the current shot, or should I wait for the omicron-specific booster to become available? When will kids under 12 be able to get the new formulation? I keep reading that it could be only a few weeks before they ship, but it’s not clear if that will be for adults only or kids as well. If I did get them boosted now, how long would I have to wait to get them the omicron booster?

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Today, The Chronicle’s Kellie Hwang fields two inquiries about the new “bivalent” COVID vaccines and boosters expected to roll out in the coming weeks that target both earlier strains of the virus and later variants in the omicron family.

Dear readers: There are lots of good questions here about the updated COVID vaccine boosters that are expected to be available soon, in time for possible fall and winter COVID surges.

We asked infectious disease experts about your questions, and broke the replies down into a handy FAQ. While we don’t know all the answers yet, we can look to both current guidance from the Centers for Disease Control and Prevention and past rollouts of COVID vaccines to help forecast what’s to come.

How does this updated vaccine differ from the original?

The new “bivalent” version of the mRNA vaccine made by Pfizer and Moderna combines the longstanding version, which targets the original coronavirus strain, with a newer one targeting the BA.5 and BA.4 omicron strains that currently account for most COVID-19 cases in the U.S.

Those new variants have proved better able to dodge the protection against infection accorded by the original vaccines and/or previous infection, though the shots are still highly effective at preventing serious illness and death from COVID-19.

Who will be eligible to get the updated vaccine booster?

According to the CDC, the updated mRNA vaccines that target omicron coronavirus strains will be given as a single booster dose for individuals who previously completed a primary series of a COVID vaccine. That dose is not expected to vary, regardless of the number or type of prior booster doses received. Pfizer’s bivalent booster is made for adolescents and adults 12 years and older, while Moderna’s is for adults 18 and older.

By the way, here’s what’s allowed under current booster guidelines:

• Ages 6 months to 4 years: Not yet eligible for boosters.

• 5 years and up: One booster dose after completing primary vaccine series.

• 50 and older: Two booster doses after completing primary vaccine series.

• Individuals 12 and older who are moderately or severely immunocompromised: Two booster doses. Also eligible for a third primary dose.

When will the new vaccines be available?

The Biden administration has indicated it wants to roll out the vaccine in September — but the exact timing has not been announced, and the vaccine must clear several hurdles first.

Earlier this week, both Pfizer-BioNTech and Moderna said they are seeking Food and Drug Administration emergency use authorization of their updated COVID-19 vaccines, which target the currently circulating BA.4 and BA.5 omicron variants. According to CNBC, the agency could grant its approval by Labor Day.

That authorization will be needed before the drugmakers can start shipping the vaccines — though Pfizer said in a statement that manufacturers had scaled up for a September rollout “and will begin shipping immediately pending authorization.”

The Advisory Committee on Immunization Practices, which advises the CDC on how to administer vaccines, also must decide on its recommendations. The panel is expected to discuss that during a two-day meeting next week. In the past, when the committee has issued its recommendations on COVID vaccines, the CDC has adopted them within hours.

In California, a Western states advisory group and state health officials also have typically weighed in with endorsements of the CDC recommendations.

The entire process has been very quick, with vaccines delivered and distributed within days of the CDC’s sign-off. So California providers might be administering the vaccine as early as Labor Day week.

When will the bivalent vaccine be available for younger groups?

A fall vaccination planning guide released Aug. 16 by the CDC says the agency expects that at least one bivalent vaccine for children 11 and younger may be authorized shortly after the shots get the green light for people 12 and older. But the guide offers no firm timeline.

If my children age 5 to 11 have not received a booster, should we move ahead now or wait for the bivalent booster?

Since there’s no clear timeline for when children 5 to 11 will have access to the bivalent vaccine, John Swartzberg, a professor emeritus of vaccinology and infectious diseases at UC Berkeley, said parents shouldn’t wait — instead, they should make sure they are up to date on the current boosters available to the age group.

Can I get a bivalent vaccine if I recently received a booster dose?

There is some uncertainty about this question, but experts generally agree that everyone will likely be eligible to receive a bivalent booster when it becomes available, regardless of their current booster status. That guidance should be more concrete in the coming weeks.

However, there is some debate about how long you should wait between a booster with the original formulation and a bivalent booster.

“Booster vaccine recipients’ immune response wanes over two months, so I suppose they can wait about two months to get the bivalent vaccine,” said Lee Riley, an infectious disease expert at UC Berkeley.

UCSF infectious disease expert Peter Chin-Hong said you can delay even longer.

“You can safely wait four to five months after your last shot,” he said. “If there is a fall or winter surge happening, that may be a reason to get the bivalent booster sooner rather than later as it will be updated to give a little more protection against breakthrough infection from newer variants.”

He said some people may decide to wait until October to “time their protection with a winter surge.”

However, Chin-Hong added: “Regardless of what people do, the ‘old’ vaccines will still provide spectacular protection against serious disease and death even for many months after the last dose.”

What might the rollout of the bivalent vaccine look like?

Past rollouts typically have been done in phases, prioritized in order of each group’s COVID-19 health risk. This time, experts say it will again likely start with elderly individuals and those with underlying medical conditions who are at higher risk for severe illness.

Then it will open to the larger population of people who have completed their primary vaccination series, and are 12 or older for Pfizer, and 18 or older for Moderna.

Chin-Hong said manufacturing capacity will play a big part, and if supply is limited, he expects people 65 and older and immunocompromised people to be at the front of the line.

While waiting for the bivalent vaccine, can I get a third booster dose if it’s been months since I received a second booster?

There is currently no third booster recommendation for the general public, experts say. Second booster doses are available for adults 50 and older, and moderately or severely compromised people.

A third primary dose is recommended only for individuals who are moderately or severely immunocompromised.

“High risk groups may want to get the third dose, but if the bivalent vaccine is indeed going to be available this fall, it may be OK to wait,” Riley added.

Some people have already been “informally getting third boosters now,” Chin-Hong said, many for “strategic reasons” such as preparing for a trip abroad or a big in-person event.

“The only groups strictly authorized to do so are immune compromised individuals, who are recommended to get one additional shot above and beyond the general population,” he said.

Everyone else who has maxxed out on boosters, particularly those younger than 50 and healthy, can wait for the bivalent booster, he said.

Meanwhile, those who have never gotten a booster should do so as soon as possible, he said, “as that saves lives and there are still tens of millions of Americans who still haven’t received that.”

Can I get a flu vaccine and COVID bivalent booster at the same time?

According to the CDC, while data is limited on getting the two vaccines at the same time, you can safely get both at the same time and the possible side effects are generally similar.

Will the bivalent vaccines eventually replace the original vaccines?

Even though the original coronavirus strains are no longer circulating, it is not likely that the original vaccines will be phased out right away — at least not at the start of the bivalent vaccine rollout, Chin-Hong said.

“The original vaccines will be the foundation for the first two shots and then the updated boosters will be given,” he said.

But Riley said that in his opinion, “It makes sense to go forward with the bivalent vaccine and not the original doses, as we now know that the effectiveness of the original vaccines are not as high as the bivalent vaccine against the currently circulating strains.”

He added that the original vaccines can’t be stored forever, so they will eventually need to be thrown out.

“Ultimately what happens may be determined by what the health care providers decide to do at the local level,” Riley said.

Pandemic Problems is written by Chronicle Advice Team members Annie Vainshtein and Kellie Hwang, combining thorough reporting and guidance from Bay Area experts to help get answers and find a way forward.

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