Pfizer’s and Moderna’s bivalent boosters, which are now available to many age groups, offer protection against the original COVID-19 virus plus the BA.4 and BA.5 omicron subvariants. Is the nation ready for yet another COVID-19 vaccine shot?
Given that many people have already received a vaccine series and booster, the Centers for Disease Control and Prevention deftly created step-by-step guidelines, including an easy-to-follow flow chart, on what people should do if they wish to add a bivalent booster to their personal arsenal of protection.
Do people have sufficient trust to get yet another shot? Testing of the bivalent boosters was done primarily on animals, not people, though there is no reason to believe that they are unsafe. What remains less clear is their potential effectiveness in the field.
Vaccine uptake has been persistently dropping, as many have become vaccine-fatigued. Though the number of COVID-19 cases, hospitalizations and deaths continue to be somewhat high, they have declined over the past two months and continue to show an encouraging downward trend.
At the same time, most people have adapted to the new normal of living with the virus, accepting the risks of infection and the associated health outcomes. Some continue to wear face masks and limit their exposure to high-risk environments.
The best way to assess how the new boosters may be accepted is by focusing on the most at-risk people, those 65 years old and older. They are most vulnerable to severe COVID-19 and the risk of hospitalization and death.
More than 92% people in this age group in the U.S. have received a complete vaccine and are classified as fully vaccinated. At least 70% have received their first booster, and more than 41% have received their second booster, according to the CDC.
Some of these people may have not taken their second booster in anticipation of an omicron-specific booster. However, the downward trend in vaccine uptake suggests that getting these people vaccinated with the new omicron-specific booster will be an uphill battle.
The vaccine uptake numbers drop for younger groups. For example, only about a third of people 50 to 64 years old have gotten their second booster, CDC data shows.
The White House has indicated that an annual COVID-19 vaccine is likely to be needed, given how the virus continues to mutate. Such mutations are already happening today, as the proportion of each subvariant circulating continues to evolve. The BA.5 omicron subvariant has been dominant since mid-June. More recently, the BA.4.6 subvariant has established a growing presence in the population. Will the new booster provide adequate protection against this subvariant if it becomes the dominant circulating virus?
To further exacerbate the situation, the annual flu vaccine is now available just as the new bivalent boosters are being rolled out. It remains unclear how the simultaneous availability of two vaccines will affect people’s willingness to receive both.
The most pressing challenge now is not whether boosters will provide the best protection available against COVID-19, but rather pervasive vaccine fatigue and questions of trust. Those who have stayed up to date on vaccinations over the past two years have received five COVID-19 shots and two flu shots. People are still getting a tetanus shot every 10 years, and for those older than 50, the two-dose shingles shot. Shot overload for some is real.
Then there are those who remain vaccine-resistant. If they have survived COVID-19 infections so far without vaccination, they are far less likely to receive a vaccine now. Moreover, for them to get the new booster would require receiving a primary vaccine series, which such people have demonstrated an unwillingness to take. Is such an obstacle really necessary — requiring the primary vaccine series to qualify for the bivalent booster?
Welcome to the new normal of living with a novel virus. The one bright light over the past eight months is that the omicron virus has remained somewhat stable, though subvariants have emerged. Other new variants, however, remain a possibility.
For the time being, new vaccines will continue to be developed, and everyone will be given the opportunity to be vaccinated. How many will avail themselves of this opportunity is uncertain.
The data suggests that many will continue to be cautious, taking a wait-and-see approach.
Sheldon Jacobson is a professor of computer science at the University of Illinois at Urbana-Champaign. Dr. Janet A. Jokela is senior associate dean in the Carle Illinois College of Medicine at the U. of I. She is an infectious disease and public health physician.
