If you’ve struggled to convince people in your life to get vaccinated against COVID-19—or even struggled to keep up with the ever-changing booster recommendations yourself—take heart: On Thursday, an advisory committee for the Food and Drug Administration (FDA) voted unanimously to streamline the COVID vaccination process in the United States.
The federal agency’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) considered the details of a new vaccine strategy after the FDA released a document outlining potential changes to the country’s COVID immunization recommendations on Monday.
The big news: The committee agreed that people in the US should only receive the updated bivalent vaccines in the future, regardless of whether a person is receiving the COVID vaccine for the first time or getting a booster dose. The committee also recommended that vaccine manufacturers Pfizer/BioNTech, Moderna, and Novavax should be directed to update their primary formulas so they match the bivalent vaccines, according to Kaiser Health News.
The committee also discussed—but didn’t vote on—whether most people in the US should get just one annual COVID-19 vaccine moving forward, like the recommended flu vaccine schedule. Below, experts weigh in on the proposed changes.
Why do experts recommend switching to the bivalent vaccines?
Right now, anyone getting their first dose of a COVID vaccine series receives the original formula developed to target the first strain of SARS-CoV-2, the virus that causes COVID, Thomas Russo, MD, an infectious disease expert at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences, tells SELF.
But we’ve come a long way since the height of the pandemic, and the 2020-era vaccines weren’t designed with new variants in mind like the bivalent vaccines were, William Schaffner, MD, professor of medicine in the division of infectious diseases at Vanderbilt University Medical Center, tells SELF.
Yet, very few people have gotten a bivalent booster, even though it better targets the highly infectious omicron subvariants, as well as the original strain of SARS-CoV-2: Only about 15.5% of the US population has received the updated shot, per the Centers for Disease Control and Prevention (CDC). And less than half of people aged 65 and older (about 40%), who are more likely to develop severe COVID-19 disease should they get infected, have received it.
The data we have so far support the recommendation to make the switch, Dr. Russo says, even though newer variants have gained some traction since the bivalent boosters were approved. A recent report from the CDC found that adults who’d received a bivalent booster were almost half as likely to develop a symptomatic infection caused by the XBB.1.5 variant, which is currently responsible for just above 60% of reported COVID infections in the US, per the CDC.
Will you only need one annual COVID vaccine in the future?
The committee also considered a proposed shift to a once-a-year COVID vaccine schedule, similar to the annual flu vaccine. The FDA has been criticized by health experts for ineffectively communicating vaccine recommendations to the public, and the document released Monday said that annual shots could contribute to “fewer vaccine administration errors…leading to improved vaccine coverage rates, and, ultimately, to enhanced public health.”
Getting one annual shot could potentially be more palatable to pandemic-weary people, Dr. Russo says. The vaccine rollout has been “haphazard,” he explains, and the public has often been unclear about which COVID vaccines they should get and when.
The thinking goes that, with a simple annual vaccine schedule, people will better understand how to protect themselves—and actually get the shots they need. “‘When do I get my next booster?’ is a very, very common question,” Dr. Schaffner says. This proposed shift will hopefully “relieve the vaccine fatigue that’s out there.”
However, certain folks may still need extra protection each year. The FDA’s document suggested that older and immunocompromised people—two groups who face a higher risk of severe disease from COVID—as well as “the very young,” who may not have had previous exposure to the virus, may need two shots a year, but it’s unclear what this schedule would look like.
During Thursday’s meeting, some committee members expressed hesitation in scaling back. “We need broader protection,” Pamela McInnes, DDS, the former deputy director of the National Center for Advancing Translational Sciences at the National Institutes of Health, said during the discussion, per NBC. “We don’t want to be chasing the virus.”
Dr. Russo says that giving most people one annual shot could, in fact, be risky at this stage in the pandemic. “Immunity—whether from prior infection or vaccination—wanes over four to six months,” he says. “You gain extra protection by boosting in that time frame.” While respiratory viruses generally circulate more during the fall and winter months, COVID-19 cases can rise during warmer months, though the spikes are usually less severe. (For example, cases significantly increased during the summer of 2021, when the delta variant first hit.)
If and when COVID becomes a seasonal illness, the likelihood of dealing with a wave of infections during spring and summer will likely be less of a concern, Dr. Russo explains. That said, the possibility of contracting COVID at any time still lingers, and we now know that long COVID, which can spur potentially debilitating symptoms, can affect anyone who is infected—even those who initially had a “mild” illness.
Will the COVID vaccine formula change as new variants emerge?
The committee members also recommended that the bivalent vaccines be updated this year ahead of the start of the 2023–2024 cold and flu season, so the formula provides the best protection possible as the virus mutates, per NPR. They suggested the FDA meet in May or June of this year to discuss the proposed updates, which would allow for new shots to be available in the fall.
The process of tweaking the bivalent vaccines each year may eventually look similar to the routine we have in place for the flu vaccine, Dr. Schaffner says: “[Global health authorities] update the influenza vaccine twice a year in an organized fashion, [once for] the northern hemisphere and once for the southern.” That’s not currently the case for the COVID vaccines, which “are different and varied” from country to country, Dr. Schaffner says.
There’s also the question of how often health authorities should meet to assess circulating strains of SARS-CoV-2, Dr. Schaffner says, explaining that one of the biggest questions experts have right now is: “What happens if we get a new variant of concern” outside the proposed timeframe for updating the vaccines? Smoothing out this process will be one piece of the puzzle that helps slow the spread of the virus, he explains.
The VRBPAC’s recommendation to switch to the bivalent vaccines won’t be established immediately, Dr. Russo says. FDA officials first have to decide whether or not they’re in agreement. “They almost always go along with the committee, but not always,” Dr. Russo says. Then, an advisory committee to the CDC will make its own recommendations, and the agency will have to make a similar final decision. After that, it all comes down to CDC Director Rochelle P. Walensky, MD, MPH, who makes the final call on what is officially recommended to the public, Dr. Russo says.
Of course, there are still many unknowns. Even if an annual COVID vaccine is eventually adopted, this schedule could change again as our technology evolves, Dr. Russo says—for instance, if more effective vaccines, or nasal vaccines, are developed. “Maybe we’ll learn that, for certain groups, they [will] only need something every two, three years,” he says. For now, though, the FDA’s decisions are based on the data and vaccines currently available, he adds: “We’re still on a learning curve, but you’ve got to start somewhere with the process.”
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