Fall 2023: Updated vaccinations for ALL available now
Amid ongoing viral spread, don't delay in getting your updated vaccines
Disclaimer: The following is general information provided for public health educational purposes and is not intended as individual medical advice. If you have individual medical questions, please consult your personal doctor or healthcare provider.
Update 9/3/2024: See my fall 2024 update for the latest information, or continue reading for info from fall 2023.
Here in the US, it’s a big win for vaccine advocacy that the updated COVID vaccines are now available for all ages 6 months and up!1 🎉 This is great, because it is now crystal clear that all of us need updated protection. If you haven’t had a COVID shot within the last 2 months, you are eligible for these updated boosters and should get one.
All three updated vaccines are now authorized—Pfizer (Comirnaty), Moderna (Spikevax), and Novavax (Nuvaxovid). If you have specific medical concerns that may impact timing or choice of vaccines, consult with an individual medical provider.
Everyone needs updated COVID protection
Up-to-date vaccination with the latest boosters is our best chance to reduce the risk of many consequences of COVID, ranging from missed work to hospitalization, death, and long-term disability.
The immunity from COVID vaccination wanes significantly over time, and is particularly low 4-6 months after vaccination and beyond.2 Vaccination reduces the risk of Long COVID3 in addition to reducing the risk of being infected, having symptoms, or developing severe disease.
The benefits and safety of COVID vaccination are very clearly established.4 It has been 3.5 years since the start of the first COVID vaccine trial within the US,5 which began in March 2020. Moderna and Pfizer’s original strain vaccines were FDA authorized in December 2020,6 and Novavax was FDA authorized in July 2022.7 Millions of vaccine doses have been administered. The updates for the XBB.1.5 are very minor and extremely unlikely to impact safety—from a safety perspective, this is similar to our approach to updated influenza vaccines. Once the safety of a vaccine approach has been established, minor changes can be introduced without the need for extensive human clinical trials, which improves the speed of releasing updates and allows better matching of the vaccine to the currently circulating viral variants.
Updated vaccination is crucial for kids
Children, especially those who attend daycare or schools, continue to face a high risk of COVID exposure. Both acute COVID infections and Long COVID can have significant impacts in kids. Long COVID can occur in previously healthy kids and can happen after a mild illness.8 I strongly recommend updated vaccination for kids aged 6 months and up.
Pediatric vaccine schedules can be headache-inducing, but it’s important to know that if your child hasn’t gotten a COVID vaccine in the last 2 months, they are eligible for the updated vaccine. Kids who haven’t been previously vaccinated may need more than one dose. Also, mixing and matching different vaccine types is OK for kids age 5 and up. Kids age 12 and up are eligible for any of the three vaccine types—Pfizer, Moderna, or Novavax. Ages 5-11 are eligible for Pfizer or Moderna only. Here is some helpful information from the American Academy of Pediatrics.9
Timeline: Now is the time!
As we find ourselves in a time of sustained COVID transmission, time is of the essence. If you haven’t had a COVID shot within the last 2 months, you are eligible for these updated boosters. Although 2 months sounds like a short timeframe, this is the same timeframe that was used for the bivalent booster eligibility last fall, and there are no safety concerns with getting another COVID vaccine 2 months later. This update is particularly important because COVID variants now are quite different than those covered by the bivalent boosters (original strain and BA.4/BA.5). All of the updated vaccine boosters are based on the XBB.1.5 variant, and I expect all to provide good protection.
Updated vaccination is recommended for all of us. It doesn’t matter how many shots you’ve had in the past, or what type they were. It doesn’t matter if your vaccine card is full! If you aren’t sure when your last shot was, you may be able to check on a state immunization registry, such as the Wisconsin Immunization Registry. Unless advised by a trusted medical provider to seek a specific vaccine type or follow a different timeline, I strongly recommend getting any of the updated vaccine options available, without delay.
Vaccination after infection: Consider sooner after recovery rather than later
I recommend considering COVID vaccination soon after recovery from a COVID infection. We have multiple variants circulating, and reinfection can occur very soon after a previous infection. Up-to-date vaccination is particularly important given the greater health risks with repeated infection. Antibodies from a previous infection may not necessarily provide reliable protection from currently circulating variants, and people who have been previously infected face greater risks of organ system damage with repeated infections.10
The CDC suggests that you may consider waiting up to 3 months to get vaccinated following an infection,11 but there are no safety concerns in getting vaccinated sooner. Notably, some sources on social media are confusing the CDC’s guidance with a minimum waiting period following infection, which is not included in CDC’s guidance or supported by existing scientific literature. There is no safety concern for those who choose to wait to be vaccinated following an infection; however, multilayered precautions are especially recommended to avoid reinfection (and of course recommended for everyone regardless of infection status).
The contagious window varies with current variants, so I recommend waiting at least 2 weeks since the start of symptoms or your positive test, and ideally you should be testing negative and should be feeling well at that time of your vaccination appointment. If you continue to have lingering symptoms after infection, consult a medical provider.
COVID vaccination at the same time with flu and RSV vaccines is safe and recommended
Unless you have a medical reason to space out your vaccines, it is perfectly safe and recommended to get the updated COVID boosters at the same time with influenza and RSV vaccinations that are also important to get this fall.12 Getting multiple vaccines in one visit is convenient, reduces delays in vaccination, and does not negatively impact the immune response. Influenza vaccination is recommended for everyone 6 months of age and older (same age eligibility as the COVID vaccines). RSV vaccination is available for adults age 60 and older, and also available to pregnant people.13 Last fall, I received my COVID and influenza vaccines at the same time. It went well, and I’m doing the same thing this year.
Separate vaccine facts from hype in considering vaccine choices
Social media is awash in overhype involving vaccine options. All three options are safe and effective; none of them are a silver bullet! All of us can be misled by false claims, especially when they may come from sources that seem supportive of COVID precautions or that we have found useful in the past. Here are some common false claims to watch out for.
Watch for claims about one vaccine type having lower rates of side effects or improved safety. All of the available vaccine options have very similar side effect profiles. You can expect side effects to resolve within a few days, and the side effects should be similar to previous vaccinations.
Watch for claims that one vaccine type may last significantly longer than others. Unfortunately, none are proven to last longer than others, and we expected significant waning across all types within 4-6 months following vaccination.
Watch for claims that one vaccine type has significantly higher efficacy than others. All three vaccines are good options. Head-to-head studies are the best way to compare vaccines especially when patient populations and variants will change from one study to the next. These studies have been limited, but based on original stain vaccines, mRNA vaccines (Pfizer and Moderna) slightly outperformed Novavax in terms of both efficacy14 and laboratory studies of immune system components.15 I find it likely that these differences may not truly be clinically significant, but there is currently no convincing evidence to support that one of the vaccine types is drastically more effective than the others. Don’t get caught up in the uncertainty—choose any of the available options that is convenient for you.
Watch for claims about a specific (particularly delayed) timing of vaccination is needed for an “optimal” response or to avoid adverse effects. The safety profiles of the available vaccine options are well-established, and these updated formulations are the best match to current variants now. Delaying vaccination puts people at risk.
Watch for claims that a better vaccine is about to be released. Nasal vaccines and other vaccine approaches are still in the research phase, so it could be years before any such approaches are available outside of a clinical trial, if they ever make it the public. Certainly, all of us hope for advances in vaccine research. We must use the options that are available to us in the here and now, which include the three updated vaccine options.
Watch for claims that we should “wait for the data” regarding safety, efficacy, or Long COVID risk reduction. Following a precautionary approach, it is best to keep our immunity as up-to-date as possible. Given the timeframe of vaccine updates, waiting for long-term studies would make it impossible to get vaccinations as previous formulations are discontinued. The vaccines have been well-proven to be safe and the new vaccine boosters represent only a slight update. “Waiting for data” puts people at risk unnecessarily.
Watch for claims that COVID variants cause more severe disease in vaccinated people. This originated from a CDC statement that was somewhat ambiguously worded. The statement intended to note that BA.2.86 may be more likely to cause infection in vaccinated people than other variants due to greater immune evasion.16 There is no COVID variant that causes more severe disease in vaccinated people than in unvaccinated people.
Vaccine access challenges
The vaccine roll-out under the new commercialized distribution model creates unnecessary barriers to access. Despite the fact that anyone could have anticipated that millions of people would need to be vaccinated this fall, I have heard numerous stories of people facing difficulties ranging from canceled appointments, sites running out of vaccine, lack of insurance coverage at local pharmacies … the list goes on. There are no easy answers, but getting the vaccine this time around may require more homework. It’s a good idea to find out ahead of time what vaccination sites are covered by your health insurance or prescription drug insurance. If you do not have insurance that covers vaccination, check out the Bridge access program, which provides temporary coverage for COVID vaccines through December 2024.17 If you plan to get vaccinated at a public health vaccination site, check the eligibility requirements. Pediatric vaccinations have been particularly difficult to find.18 It should not be this hard. In the meantime, I encourage you to be persistent, get vaccinated, and help your friends and family to get vaccinated too if possible.
The ongoing pandemic needs science-based vaccine approaches
I hope this post has helped clarify the need for all of us to get the updated COVID vaccines. Up-to-date vaccination is a critical part of a multilayered approach to COVID protection.19 We know that COVID is not seasonal, and an annual-only approach does not provide sufficient protection—vaccination at least every 6 months is needed, ideally with updated vaccines to match current variants.20
If you support improved access to vaccination in the ongoing pandemic, please consider writing to your elected officials to let them know.21
Thank you for taking the time to learn more about the importance of getting the updated COVID vaccines!
Stay safe and get vaccinated, precautionary friends. 😷
Marra AR, Kobayashi T, Suzuki H, et al. The effectiveness of coronavirus disease 2019 (COVID-19) vaccine in the prevention of post–COVID-19 conditions: A systematic literature review and meta-analysis. Antimicrobial Stewardship & Healthcare Epidemiology. 2022;2(1):e192. doi:10.1017/ash.2022.336
Thaweethai T, Jolley SE, Karlson EW, et al. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA. Published online May 25, 2023. doi:10.1001/jama.2023.8823
https://www.nih.gov/news-events/news-releases/nih-clinical-trial-investigational-vaccine-covid-19-begins This clinical trial for Moderna’s then-vaccine candidate mRNA-1273 (now known at Spikevax) opened in Seattle in March 2020.
News article summary: https://medicine.wustl.edu/news/repeat-covid-19-infections-increase-risk-of-organ-failure-death/
Peer-reviewed journal article: Bowe B, Xie Y, Al-Aly Z. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nat Med. 2022;28(11):2398-2405. doi:10.1038/s41591-022-02051-3
Liu B, Stepien S, Qian J, et al. Comparative effectiveness of four COVID-19 vaccines, BNT162b2 mRNA, mRNA-1273, ChAdOx1 nCov-19 and NVX-CoV2373 against SARS-CoV-2 B.1.1.529 (Omicron) infection. Vaccine. 2023;41(38):5587-5591. doi:10.1016/j.vaccine.2023.07.050
Summary: Waltz E. COVID vaccines: head-to-head comparison reveals how they stack up. Nature. Published online March 29, 2022. doi:10.1038/d41586-022-00885-y
Research article: Zhang Z, Mateus J, Coelho CH, et al. Humoral and cellular immune memory to four COVID-19 vaccines. Cell. 2022;185(14):2434-2451.e17. doi:10.1016/j.cell.2022.05.022