New COVID-19 boosters are coming — here’s what you need to know

Editor's note: This story was updated Sept. 12, 2023, to reflect the CDC's recommendations regarding COVID booster shots.

If you’re bracing yourself for the start of respiratory virus season, take heart. A key CDC advisory committee made its recommendations for COVID-19 booster shots on September 12, 2023. Use the following guide to help discuss the vaccine developments with your patients. 

Earlier this summer, the US Federal Drug Administration (FDA) issued a directive to vaccine manufacturers Pfizer, Moderna, and Novavax to develop an updated vaccine specifically to target the XBB.1.5 variant of COVID-19. 

The FDA approved the updated vaccines on Monday, September 11, 2023. The Advisory Committee on Immunization Practices (ACIP), a panel of independent experts advising the Centers for Disease Control and Prevention (CDC), evaluated the safety and effectiveness of the new shots on September 12 and formulated recommendations for administering them. Those on the panel overwhelming voted to recommend that Americans 6 months and older receive the new vaccine.

The vaccines are expected to be ready for distribution and administration within 48 hours.

The three new vaccines include mRNA vaccines from Pfizer and Moderna, as well as a protein subunit vaccine made by Novavax. The FDA granted full approval for the Pfizer and Moderna vaccines.

Mandy Cohen, director of the CDC, advised that anyone 6 months and older should get at least one dose of an updated shot.

Experts anticipate that the new versions of the vaccine will continue to protect against the most severe strains of existing newer variants, such as the prevalent EG.5.1 variant, known as "Eris," as well as the recently identified BA.2.86 variant, known as "Pirola." The BA.2.86 variant, in particular, has earned notoriety within the scientific community due to its number of mutations, although the CDC acknowledges that it’s still unclear whether this mutation will lead to an increased incidence of severe illness. 

In earlier stages of the pandemic, COVID-19 vaccines were widely available and paid for by the government. The release of the new vaccines will be the first time the vaccines will be delivered through the commercial marketplace. Under the Affordable Care Act, most insurance plans are required to cover the full cost of vaccines, without co-pays.

Unfortunately, the lack of a co-pay might not be enough of an incentive to get vaccinated for many patients. While COVID burnout is a serious problem in healthcare, there are signs that the general population is dealing with fatigue, too. For example, Pfizer anticipated that 100 million doses of its vaccine would be administered in 2023, yet just over 12 million doses were given in the first 6 months of the year. Ultimately, only about 25% of US adults and only 18% of adolescents have received the bivalent boosters. 

Effectively communicating about the risks associated with emerging SARS-CoV-2 variants and the role of the new vaccines in protecting against severe disease is critical to ensuring your patients make informed decisions. If you’re concerned that your patients might forgo a booster shot due to a lack of information or even concern, use the strategies below to talk with your patients.

Building trust is important as a medical professional, and one of the best ways to do so is to be honest and direct. If you have patients who are uninterested or unwilling to get a vaccine for which they are eligible, ask them about their hesitancy. If they cite personal anecdotes or non-verified news sources, acknowledge their concerns. Don’t argue.

Instead, provide clear, accurate and fact-based information about emerging COVID-19 variants, the new vaccines, and the government’s public health guidelines. Use plain language and visuals when necessary to enhance understanding and have resources on hand for them to read and consider.

Emphasize the benefits of vaccination not only for individual protection, but also for broader community well-being. Make sure that your patients understand that the vaccine might not prevent them from contracting the disease entirely, but that it will lessen the severity of symptoms and shorten the duration of their illness — and that this translates to fewer missed days of work or school. 

If your patient expresses concerns about the safety of the vaccines, take their fear seriously and offer reassurance. Explain the rigorous safety measures in place for vaccine development and monitoring and explain that adverse events are rare and significantly outweighed by the benefits.

Above all, be up front about the limits of your individual knowledge about the vaccine, as well about the limits of the scientific community’s understanding. Patients are more likely to follow recommendations from healthcare providers they trust and admitting that you don’t necessarily know everything can be a good way to demonstrate your willingness to listen and consider their concerns. 

Use this list of FAQs your patients may have to guide your discussion about the new COVID-19 vaccine. 

Yes, new variants of the COVID-19 virus are continually being identified as the virus evolves and community transmission continues unchecked. Monitoring and research on these variants are ongoing to determine their impact on transmission and vaccine effectiveness.

In August 2023, EG.5 emerged as the predominant variant within the US, replacing XBB 1.5 that the upcoming vaccines are targeting, while BA.2.86 remains far less widespread and constitutes only a small fraction of reported cases. 

While the potential for severe illness in older adults and individuals with underlying health conditions is a perpetual concern, as is the risk of long COVID-19 in those who become infected, the ongoing race between variants can lead to lack of protection from one another and reports of patients getting infected in quick succession, sometimes within weeks following a COVID-19 infection.

The need for booster shots and their specific composition may vary over time and depend on factors like your vaccination history and the prevalence of new variants. Let’s talk about your concerns and whether a booster shot would benefit your health. 

Eligibility for a COVID-19 booster dose can change over time and may depend on your age, vaccination status, and risk factors.

Vaccine effectiveness against specific variants may vary. Research is ongoing, and vaccines are adapted as needed to address emerging variants. I’m monitoring directions from the CDC and will continue to follow vaccination guidelines.

In some cases, mixing and matching COVID-19 booster shots may be recommended based on your initial vaccination series and availability. Let’s discuss which vaccines you've received in the past and determine the best course forward. 

The time it takes for a booster to provide optimal protection may vary from one person to the next, depending on immune status and the date and type of last immunization or active COVID-19 infection. In general, it takes a few weeks for the immune system to respond fully after receiving a vaccine. 

Booster dose timing may vary based on factors like which vaccine you received initially and the date of your last immunization or active infection with COVID-19. It’s best to follow the CDC recommendations. 

The CDC, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine currently recommend COVID-19 vaccination during pregnancy, as well as booster doses when appropriate. COVID-19 is particularly dangerous during pregnancy and can lead to outcomes such as miscarriage. Vaccines remain the single best way to protect both the parent and the fetus.

Side effects of the new booster shots are generally expected to be similar to those of the initial vaccines and may include soreness at the injection site, fatigue, fever, and muscle aches. These side effects are usually mild and short-lived.

Individual responses to vaccines can differ significantly. While some people may experience only mild discomfort and can easily carry on with their usual routines, others might experience side effects that temporarily hinder daily activities. Fortunately, these side effects typically resolve within a few days.

Even if you do not notice any immediate side effects, your body is still working hard to develop immunity against the virus responsible for COVID-19. Serious side effects are rare but can cause long-term health problems. They usually happen within 6 weeks of getting a vaccine.

The approval earlier this year of a new vaccine to prevent infection from respiratory syncytial virus (RSV) is great news and many people are wondering if they can be vaccinated against the flu, RSV and COVID-19 at the same time. 

Since the RSV vaccine is relatively new, scientists do not have a lot of data about the risks or benefits of receiving all 3 vaccines at the same time. While the CDC has indicated that it’s safe to receive the COVID-19 vaccine and flu shot at the same time, you may want to schedule your RSV vaccination for a different time until the interaction between the 3 vaccines is better understood. However, there is some data suggesting that influenza and RSV vaccinations could interfere and reduce immune response, so you may choose to separate these vaccines by a month.

Booster shots enhance your protection against severe disease and lower your risk of developing long COVID, but mask-wearing and other preventive measures may still be necessary, especially if you or someone you live with is immunocompromised. Wear a tight fitting, high-quality mask, especially in high-risk settings or when visiting areas with increased transmission. 

Vaccines are vital tools in preventing and controlling infectious diseases, protecting individuals and communities. They help reduce the severity of illness, shorten the length of hospitalizations, and reduce the number of deaths, while also contributing to herd immunity.