Get a COVID-19 booster shot now or wait? Many are wondering how best to survive the next wave of the pandemic


 Get a COVID-19 booster shot now or wait?  Many are wondering how best to survive the next wave of the pandemic

Gwyneth Paige refused to be vaccinated COVID-19 at first. With her health issues — high blood pressure, fibromyalgia, asthma — she wanted to see how other people fared after the shooting. Then her mother got colon cancer.

“At that point, I didn’t care if the vaccine killed me,” she said. “In order to be able to accompany my mother throughout her journey, I had to get vaccinated.”

Paige, who is 56 and lives in Detroit, received three doses. This leaves her a boost behind the federal health recommendations.

Like Paige, who said she’s not planning another refresher at this time, some Americans seem comfortable with three-shot protection. But others may be wondering what to do: jump back in with one of the original vaccines now, or wait months for promised new formulations tailored to the latest, highly contagious Omicron subvariants BA.4 and BA.5?

That rapidly mutating virus has created a conundrum for the public and a communication challenge for health officials.

“What we’re seeing now is a small information gap that’s not helping people make the right decision,” said Dr. Carlos del Rio, professor of infectious diseases at Emory University School of Medicine.

Del Rio said the public doesn’t hear enough about the value of vaccines in preventing serious diseases, even if they don’t stop all infections. Each new COVID variant also forces health officials to tweak their messaging, del Rio said, which can increase public distrust.

About 70% of Americans age 50 and older who received a first booster shot — and almost as many of those over 65 — have not received their second COVID booster dose, according to data from the Centers for Disease Control and Prevention. The agency currently recommends two booster shots after a basic series of shots for adults 50 years and older and for younger people with compromised immune systems. Several news outlets recently reported that the Biden administration was working on a plan that would allow all adults to receive second COVID boosters.

Officials are concerned about the Increase of BA.4 and BA.5that can spread easily and evade immune protection from vaccination or previous infection. A recent study published in Nature found that BA.5 is four times more resistant to mRNA vaccines than previous Omicron subvariants.

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Consistent messaging has been complicated by the differing views of leading vaccine scientists. Although doctors like del Rio and Dr. Peter Hotez of Baylor College of Medicine seeing the value of a second booster shot, Dr. Paul Offit, a member of the FDA’s Vaccine Advisory Committee, skeptical it’s needed by everyone except seniors and people who are immunocompromised.

“If experts have different views based on the same science, why are we surprised that getting the right message across is confusing?” said Dr. Bruce Gellin, head of global public health strategy at the Rockefeller Foundation and Offit’s colleague on the FDA panel.

Janet Perrin, 70, of Houston didn’t get her second booster due to scheduling and convenience issues and said she will seek information on a variant-focused dose from sources she trusts on social media. “I haven’t found a consistent leading voice at the CDC,” she said, and the agency’s comments sound like “a political jumble of words.”

On July 12, the Biden administration released its plan to manage subvariant BA.5, which it warned would have the greatest impact in parts of the country with less vaccine coverage. The strategy includes making it easier for people to access tests, vaccines and boosters, and antiviral COVID treatments.

During the first COVID White House briefing in nearly three weeks, the message from top federal health officials was clear: Don’t wait for an Omicron-tailored injection. “There are a lot of people who are at high risk right now, and waiting until October, November for their flare-up – if their risk is indeed at the moment – is not a good plan,” said Dr. Rochelle Walensky, head of the CDC.

Amid growing concerns about subvariant BA.5, on June 30, the FDA recommended drugmakers Pfizer-BioNTech and Moderna get to work producing a new, bivalent vaccine that combines the current version with a formulation that aimed at the new tribes.

The companies both say they can make millions of doses of the reformulated shots available to the US in October. Experts believe the deadline could be delayed by a few months given the unexpected problems plaguing vaccine manufacturing.

“I think we all asked ourselves the same question,” said Dr. Kathryn Edwards, scientific director of the Vanderbilt Vaccine Research Program. “What’s the benefit of getting another boost now when a bivalent vaccine comes out in the fall and you get BA.4/5 which is currently circulating? Whether it will be in circulation in the fall, however, is another question.”

The FDA on July 13 approved a fourth COVID vaccine, manufactured by Novavax, but only for people who have not previously been vaccinated. Many scientists thought the Novavax shot could be an effective booster for people previously vaccinated with mRNA shots from Pfizer-BioNTech and Moderna, as its unique design could augment the immune response to coronaviruses. Unfortunately, few studies have evaluated mix-and-match vaccination approaches, said Gellin of the Rockefeller Foundation.

Edwards and her husband contracted COVID in January. She received a second booster shot last month, but only because she thought it might be required for a Canadian business trip. Otherwise, she said, a fourth shot was kind of a waste, though not particularly risky. She told her husband – a healthy seventy year old – to wait for the BA.4/5 version.

People at very high risk of COVID complications may want to get a fourth dose, Edwards said, hoping it will temporarily prevent serious illness “while you wait for BA.4/5.”

The Omicron vaccines will contain components that target the original strain of the virus, as the initial vaccine formulations are known to prevent serious illness and death even in people infected with Omicron.

These components will also help keep the earlier strains of the virus in check, said Dr. David Brett-Major, an infectious disease specialist at the University of Nebraska Medical Center. That’s important, he said, because too much adaptation of vaccines to combat emerging variants could result in older strains of the coronavirus reemerging.

Brett-Major said news about the value of the custom shots must come from trusted, local sources — not just senior federal health officials.

“Access is local,” he said. “If your on-premises systems aren’t messaging and promoting and enabling access, that’s really problematic.”

Though some Americans are pondering when or if to get their second boosters, many people shut down the pandemic long ago, putting them at risk during the current wave, experts said.

dr Georges Benjamin, executive director of the American Public Health Association, said he doesn’t expect public interest in the vaccine to change much even as new boosters come to market and eligibility expands. Parts of the country with high vaccine coverage will remain relatively isolated from new variants, he said, while regions with low vaccine uptake may be in for a “rude awakening.”

Even scientists don’t know how to effectively adapt to an ever-changing virus.

“With COVID nothing is easy, right? It’s just a slap in the face,” Edwards said. “This morning I read about a new variant in India. It might be a non-burger, but who knows? – maybe something big, and then we ask ourselves: ‘Why did we change the vaccine strain to BA.4/5?'”

KHN (Kaiser Health News) is a national newsroom producing in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operational programs at KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the nation.

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