Archived: Don’t call it a booster: What NYC should know about COVID vaccines this year

As much as no New Yorker wants it to be true, COVID-19 is still around and making people sick. After a bump in cases and hospitalizations this summer, health experts now say it’s time to get ready for a potentially disruptive autumn and winter.

Their advice on the most effective way to prepare? Get the new COVID vaccination this fall.

Earlier vaccinations and infections have granted us some degree of protection, explained Dr. Peter Chin-Hong, an infectious disease specialist and professor of medicine at the University of California, San Francisco. But there’s a loss of immunity over time. Meanwhile, if you’ve had COVID before and didn’t feel too bad, that’s not necessarily what will happen the next time you get sick because of new variants, he explained.

“The only thing predicted about COVID is that it’s unpredictable,” Chin-Hong said.

The new vaccine will likely be one shot and available in mid-to-late September, “pending regulatory action by the FDA and recommendation from the CDC,” explained Belsie González, a senior public affairs specialist with the Centers for Disease Control and Prevention, over email.

On Sept. 12, the CDC’s Advisory Committee on Immunization Practices will meet to discuss the new vaccine. This group is tasked with advising the CDC on whether or not to move forward with using the updated formula. Once the advisory committee votes and the CDC's Director Dr. Mandy Cohen approves it, the dispersal of the vaccine will likely happen rapidly.

“I imagine that we’ll be able to start to get needles into arms by late September,” said Dr. Andrew Wallach, a primary care physician and the ambulatory care chief medical officer at New York City Health and Hospitals.

In the intervening weeks before the new vaccine is available, one of the best ways you can protect yourself while you wait is by wearing a mask, especially around large crowds, advised Wallach. And if you feel sick, “please stay at home.”

Tired: “Booster” … Wired: “Annual COVID vaccine”

It’s time to stop thinking of new COVID vaccines as boosters, explained Wallach, and instead view them like the annual flu vaccine—an updated formula that targets what’s circulating at the time.

Unlike last year, the fall vaccine is a monovalent vaccine, meaning that it was designed based on one version or variant of SARS-CoV-2, the coronavirus that causes COVID-19. If you didn’t get boosted in the past, you are still eligible for the fall monovalent vaccine.

This fall’s COVID vaccines developed by Pfizer, Moderna, and Novavax all target XBB1.5, a spinoff of the omicron variant that’s been circulating as one version or another since autumn 2021.

The boosters from last September were bivalent vaccines. They targeted two versions of the virus: the original strain from the end of 2019 and earlier versions of omicron known as BA.4 and BA.5.

When a germ spreads, it gets many opportunities to change or adapt over time through small changes in its genetic code. A coronavirus with one or more mutations becomes a variant of the original, and hundreds of variants of SARS-CoV-2 have been identified since the original virus was discovered.

But only a handful of variants have been noteworthy — meaning they’ve accumulated a set of mutations to shift the speed or severity at which they move through communities. Omicron represented a major shift in the speed of transmission, and its spinoffs — like XBB1.5 — have dominated all the while.

Starting this year, the FDA hopes the move to an annual monovalent vaccine will not only provide the protective immunity people need but will result in more people getting vaccinated overall because of simplicity in messaging. In New York City, though 81.2% of residents completed the primary series, just 16% received the bivalent dose after the rollout a year ago.

Manufacturers are currently updating the COVID vaccines for fall, explained González.

“These vaccines will be updated with the goal of providing the best protection against circulating strains,” she said by email. “CDC will make recommendations and communicate their use should they be authorized or approved for use by the FDA.”

Teens and adults can have their pick of a Moderna, Pfizer, or Novavax vaccine—it doesn’t matter which manufacturer made your previous dosage. During a June meeting, the CDC’s advisory experts said it’s possible that children under the age of 2 will be recommended a Pfizer or Moderna vaccine.

What are the benefits of the new vaccine?

Vaccines aren’t developed to completely prevent infection, explained Wallach. But they can keep you from feeling like crap — both in terms of basic symptoms and severe hospitalizations no matter how old you are.

The most recent studies show last year’s bivalent shots reduced critical illness among adults and nursing home residents as well as emergency department visits among children. These shots also dropped the chances of developing symptoms — aka those crappy feelings — by approximately 50% in adults, and full vaccination lowered the odds by a similar amount in children. The CDC tracks how the vaccines are performing here.

“But if you do get infected, it will definitely thwart or blunt your body’s response to the infection and you’ll have a much more mild course,” he said.

Dr. David Boulware is a professor of medicine at the University of Minnesota and a practicing infectious disease physician. His research suggests that vaccines become less effective over time, because of new variants and waning antibodies. However, if you get vaccinated again, you’ll have less severe symptoms and they’ll go away faster, Boulware explained.

Being up to date on the COVID vaccination is especially important for immunocompromised people and those over the age of 65, said Boulware. These individuals are more at risk of developing severe disease and being hospitalized.

For those younger than 65 and without major health problems, the advantage of getting the new vaccine is being less sick for less time.

“Personally, I’m not worried about getting hospitalized, but I certainly don’t want to get sick,” said Boulware. “And I’d like to be sick as short as possible.”

Because vaccines decrease disease severity, they’re also another layer of protection against the possibility of developing long COVID. Ultimately, being immunized lowers your odds of getting chronic conditions. Scientists think this is because vaccines help the immune system respond quickly and are associated with lower viral loads—the amount of virus in the body. Lower viral loads are also why vaccinated people are less likely to pass on the illness to others.

“One of the things that I really share with my patients when I’m counseling them about vaccination is that it is a way to help prevent long COVID,” said Wallach.

Research also suggests up to date COVID vaccines can outperform our old ones. In a study published in February in the journal "Clinical Infectious Diseases," Boulware and colleagues examined three groups and how severe their COVID symptoms were during the alpha, delta and omicron waves: unvaccinated people, people who only received the first vaccination series, and a vaccine-boosted group. Overall, the vaccine-boosted group had the least serious symptoms when sick and the unvaccinated group had the worst symptoms.

However, during the omicron wave, a specific trend emerged: While the boosted group was the least sick, there wasn’t a difference in symptom severity between the unvaccinated group and those who only got the first two-dose vaccination series.

“During that omicron period, those who’d gotten the primary vaccine in early 2021 — by the time 2022 rolled around — really didn’t have much protection as far as the symptomatic benefit that was notable with boosters,” said Boulware.

Ultimately, immediately after getting vaccinated, you’re more likely to be protected against infection. As time goes on, your chance of getting sick increases, but you remain protected from a more severe course of illness.

Will the vaccine work against the new variants?

Focusing the vaccine on XBB1.5 may seem confusing because media reports are increasingly talking about other variants. In August, EG.5 became the dominant variant in the U.S. Another variant, BA.2.86, is also circulating and interests scientists because its multiple mutations mirror what happened with the emergence of omicron — though it’s too soon to know if its mutations mean it will end up being especially transmissible, or if it will even circulate for very long.

But it’s difficult to create vaccines at the same pace that the virus is mutating. Regulators made the decision to focus on XBB1.5 in June. As Gothamist previously reported, an updated vaccine would ideally be released every six months to keep up with coronavirus mutations, but such a plan would come with logistical hurdles.

Chin-Hong isn’t concerned about the vaccine not being a match for the newer variants because the differences between them are small: EG.5 and BA.2.86 are descendants of omicron, just like XBB1.5.

Early research also suggests the vaccine will be effective against some of the new arrivals. In a press release on Aug. 17, Moderna said it had preliminary clinical trial data suggesting the new vaccine creates a robust immune response against EG.5, along with another variant called FL1.5.1. The company announced Wednesday that its monovalent vaccine also generates a strong immune response against BA.2.86, though it was weaker than the reaction against XBB1.5 that the company reported to federal regulators in June.

“Even if it’s not a perfect match,” for future variants, “it’s still going to provide some protection,” said Boulware. That’s because it’s going to raise antibody levels, and antibodies protect the body from disease.

New Yorkers are still recommended to bring their CDC COVID vaccination record card when they go to get their new vaccine so that they have an on-hand record of their vaccination history. If you’ve lost your card, you can’t get a replacement card but you can get an official record noting you’ve been vaccinated.

When should you get the new COVID vaccine?

If you’re more than six months out from your last dose, it’s time to think about getting the new vaccine, NYC Health Commissioner Dr. Ashwin Vasan told "All Things Considered." Boulware’s research and studies by other groups suggest the vaccine is most protective in the six months or so after you’ve been vaccinated.

A conservative estimate for when the vaccine will start to offer protection is two weeks, explained Chin-Hong. But for most people, its buffer will start sooner because of their previous COVID vaccinations and exposures — their immune system is already primed to recognize the virus.

Another factor to consider when figuring out when to get your shot is whether or not you’ve recently had COVID — a possibility as the number of cases continues to increase. The CDC recommends that you at least wait to get vaccinated until you complete your isolation period.

But the agency also notes that “Additionally, you may consider delaying your next vaccine by three months from when your symptoms started, or, if you had no symptoms, when you received a positive test.”

Wallach’s personal recommendation is to wait about four weeks after the resolution of your COVID illness.

“I think myself and some other clinicians feel like in that immediate period, within the first four weeks, your own innate immune system has procured very protective antibodies,” Wallach said.

Where to get vaccinated in NYC

COVID vaccines are much more available today than they were during the first rollout.

“Our recommendation, just like any vaccine, is that the best way to get vaccinated is to go to a trusted source,” said Wallach.

Maybe that’s a retail pharmacy like CVS or your primary care physician. New Yorkers can find where they can get vaccinated through the NYC Vaccine Finder website.

While you’re getting your COVID vaccines, you might want to consider getting your flu vaccine at the same time. It’s safe to go for the double-whammy, though you may end up with a bit more fatigue and muscle soreness.

“You can combine it with a flu shot — get it the same day — to get the biggest bang for your buck,” said Chin-Hong.

This fall, people over the age of 60 and women in the late stages of pregnancy might also want to consider getting vaccinated against respiratory syncytial virus, said Wallach. But because there are no definitive studies yet showing it’s safe to get all three vaccines at the same time, Wallach recommends people receiving the RSV vaccine wait two to four weeks after their other vaccinations before getting the shot.

This story has been updated with a new announcement from Moderna.