On August 31, 2022, the U.S. Food and Drug Administration (FDA) authorized the use of updated boosters, which target both the original strain of the COVID-19 virus as well as the omicron variant.
While COVID vaccines generally do an excellent job of preventing severe illness and keeping people out of the hospital, they do not guarantee that you won’t get COVID at all. That’s partly because the original COVID vaccines were made to combat the strain of the virus that was most prominent in 2020, and the virus has been mutating very quickly. Additionally, the immunity you get from a COVID vaccine seems to wane over time.
The updated boosters, which are also called bivalent vaccines, are expected to offer broader protection against breakthrough infections (which occur in people who have been vaccinated). They should also further reduce the risk of developing serious complications.
Additionally, getting an updated booster will extend the period in which you’re most protected. The most recent guidance from the White House suggests that most people get the updated booster soon — along with a flu shot — and then start getting both a flu and COVID vaccine each fall.
How Do the New Omicron Boosters Work?
The FDA has authorized two updated boosters: The Moderna COVID-19 Vaccine, Bivalent and the Pfizer-BioNTech COVID-19 Vaccine, Bivalent. The Moderna product is authorized for use in adults age 18 and older; the Pfizer-BioNTech one can be used in kids as young as 12.
As with the original Moderna and Pfizer-BioNTech vaccines, the updated boosters are mRNA vaccines. These kind of vaccines do not include any part of the COVID virus itself; rather they contain instructions that teach your body to make a protein or piece of a protein that triggers an immune response. That prompts your body to make antibodies against the virus so it’s better equipped to fight it if it’s later confronted with it.
The updated boosters contain mostly the same ingredients as their original (monovalent) versions; the only change is that these new (bivalent) ones have messenger RNA that codes for the original SARS-CoV-2 strain as well as for the omicron BA.4/BA.5 lineages.
Other ingredients include lipids (fats) that help the vaccine move into cells; salts that help balance acidity; and sucrose (sugar), which helps the molecules retain their shape when frozen.
What Are the Possible Side Effects?
As with older COVID vaccines, possible side effects of the updated boosters may include pain, redness, and swelling at the injection site. Some people may also experience fatigue, headache, muscle pain, chills, nausea, or fever. Remember that you cannot get COVID from the vaccine/booster itself.
How Effective Are the Updated Boosters?
Scientists believe that the updated boosters will provide better protection against COVID than the older boosters, but it’s hard to say for sure just how much of an edge they will offer. Firstly, no one knows how long Omicron will be the predominant variant. It’s also worth noting that these updated COVID boosters — unlike their predecessors — are being rolled out despite lack of testing on humans.
Of course, these shots are highly similar to the original vaccines, which have been thoroughly vetted for safety and effectiveness and already given to millions of people. But the rush to get updated boosters ready for this fall meant that manufacturers only had time to directly test them on mice. The manufacturers also analyzed clinical trial data (on humans) from a similar vaccine that targeted the original omicron strain (BA.1).
“The FDA has been planning for the possibility that the composition of the COVID-19 vaccines would need to be modified to address circulating variants,” the agency explained. “The FDA has extensive experience with strain changes for annual influenza vaccines … The public can be assured that a great deal of care has been taken by the FDA to ensure that these bivalent COVID-19 vaccines meet our rigorous safety, effectiveness and manufacturing quality standards for emergency use authorization.”
Who’s Eligible for an Updated Booster?
If you’re at least 12 years old, don’t have an active COVID infection, and it’s been at least two months since you had any booster, you’re eligible for the new (bivalent) booster. You don’t have to wait because you recently had COVID, but if you want to postpone for three months from when your symptoms started or you tested positive, that’s OK, according to the CDC. “People who have had recent COVID will have been exposed to the current circulating strains and likely have at least partial protection for a few months,” explains Michael George, MD, MSCE, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania.
To make it easier to figure out when it’s time to get boosted, the CDC has developed a simple tool that allows you to enter the following:
- Your age
- Whether or not you have a weakened immune system
- Which vaccines doses you had for your primary series
- Whether or not you’ve had an updated booster
- When you had your last COVID shot
Based on this information, the tool will tell you if you should get an updated booster now or wait.
When in doubt, of course, consult your personal health care provider for guidance. “Exactly when you might want to get the bivalent booster may vary a bit from person to person, but since protection does wane over a few months you will still likely want to get the bivalent booster sometime this fall,” says Dr. George.
How Can You Get an Updated Booster?
The updated (bivalent) boosters are rolling out right now. To find one in your area, visit vaccines.gov or consult your local pharmacy. If you have trouble getting an appointment, check back in a few days as supply should ramp up quickly.
What to Know if You’re Immunocompromised
Vaccines and boosters are especially important for people with a weakened immune system. If you have an autoimmune or rheumatic disease and/or take a medication that reduces your ability to fight infections, you’re more likely than average to contract COVID and develop serious complications.
The CDC’s “find out when you can get your booster” tool factors in whether someone is immunocompromised. It’s also wise to touch base with your health care provider. But assuming it’s been at least two months since you had a COVID booster and you don’t have an active COVID infection, chances are eligible for the updated booster now.
“I’m recommending that everyone who is eligible obtain either shot, unless they had a significant reaction or rheumatologic disease flare after previous COVID-19 vaccine doses,” says Angus B. Worthing, MD, FACP, FACR, Clinical Assistant Professor of Medicine at Georgetown University Medical Center in Washington, DC. “Those people can probably utilize Evusheld, or in case of infection use antiviral treatments on an individual basis as needed.”
- Although most people will start getting COVID boosters annually, those who are immunocompromised might need boosters more often. Stay tuned for more info from public health officials and your health care provider.
- Ask your doctor if you need to pause any of your regular medications before and/or after getting the booster. The American College of Rheumatology has issued guidance about holding specific medications; it is periodically updated.
- Ask your doctor if it’s advisable for you to get the flu shot at the same time. Public health officials are encouraging many people to get the updated COVID booster and the flu shot at the same time.
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American College of Rheumatology. COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases. August 12, 2022. https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf
CDC Recommends the First Updated COVID-19 Booster. Centers for Disease Control and Prevention. September 1, 2022. https://www.cdc.gov/media/releases/2022/s0901-covid-19-booster.html.
Coronavirus (COVID-19) Update: FDA Authorizes Moderna, Pfizer-BioNTech Bivalent COVID-19 Vaccines for Use as a Booster Dose. U.S. Food & Drug Association. August 31, 2022, https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-pfizer-biontech-bivalent-covid-19-vaccines-use.
COVID-19 Vaccines for People Who Are Moderately or Severely Immunocompromised. Centers for Disease Control and Prevention. September 2022. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html.
Press Briefing by White House COVID-19 Response Team and Public Health Officials. The White House. September 6, 2022. https://www.whitehouse.gov/briefing-room/press-briefings/2022/09/06/press-briefing-by-white-house-covid-19-response-team-and-public-health-officials-88/.
Understanding mRNA COVID-19 Vaccines. Centers for Disease Control and Prevention. July 15, 2022. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mRNA.html?s_cid=11344:how%20does%20mrna%20vaccine%20work:sem.ga:p:RG:GM:gen:PTN:FY21