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Updated COVID booster vaccines have now officially been authorized and recommended by the FDA and CDC. There is a Pfizer booster for ages 12 and up, and a Moderna booster for ages 18 and up. The new shots replace the existing boosters for those age groups, and there is a new set of rules to figure out whether you should get one—there’s no more counting how many doses you’ve already had.
The last step of the process was a meeting Thursday by the CDC’s Advisory Committee on Immunization Practices, at which experts discussed the evidence and voted in favor of recommending the new boosters for everyone in eligible age ranges. The CDC director then officially issued the recommendation, and bivalent booster appointments should be available as soon as pharmacies can get the new shots in stock.
Boosters are now bivalent (essentially two vaccines in one)
COVID vaccines haven’t changed their formulation at all since they were first tested and then authorized. While the virus mutated into new variants, like Delta and Omicron, the vaccines are all still based on what’s being called “ancestral” SARS-CoV-2. That changes with this fall’s booster shots.
The new boosters include mRNA of the ancestral spike proteins, and mRNA from the Omicron spike protein. The spike protein is the part of the virus that our immune system can most easily recognize, and mRNA is a sort of blueprint for building that protein.
We have more on how mRNA vaccines work here, and Gizmodo has more on the specific formulation that’s being used for this season’s boosters. The variants known as BA.4 and BA.5 have spike proteins that are identical to each other, so you may hear these vaccines being described as targeting “BA.4/BA.5” variants.
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Having two different mRNAs in the same shot means your immune system will get introduced to (or reacquainted with) both forms of the spike protein. One of the experts in yesterday’s CDC meeting mentioned that the combination may actually be easier for our immune system to “read” than if it encountered each type separately.
If the idea of combining different variants sounds familiar, it may be because that’s how flu shots are formulated. Every year, several flu strains are chosen to go into that season’s vaccine. All of the flu shots available this year are quadrivalent, meaning there are four different flu variants included. The COVID boosters cover two variants, so they’re being called bivalent.
It no longer matters how many total shots you’ve had
It’s OK if you’ve lost track of how many COVID vaccine shots you’ve had. It’s gotten pretty confusing, with two boosters recommended for people at risk and one for others, plus an additional dose for people who are immunocompromised...and that’s without getting into age-specific recommendations.
The CDC is now declaring a “fall reset” on the booster count. No matter how many shots you got before, you are now recommended to get one bivalent booster this season, as long as it has been two months or more since your last dose. The old boosters will no longer be used in adults. (As of this writing, the CDC’s website has not yet been updated with the new information, but you can read about the planned updates here.)
In short: if you have had your primary series, with or without any number of boosters, you are eligible to get a bivalent booster this fall, as long as it has been at least two months since your last COVID vaccine. This applies to people ages 12 and up; booster updates for younger children are still in the works.
Your “primary series” is your initial set of COVID vaccines. That means two doses of Pfizer or Moderna, or one dose of Johnson & Johnson, if you are not immunocompromised.
If you are immunocompromised, your primary series is three doses of an mRNA vaccine—two doses of Novavax, or a dose of J&J, plus a dose of an mRNA vaccine. By the way, you may also want to ask your doctor about EVUSHELD, an antibody shot that can provide extra protection against COVID for immunocompromised people.
The bivalent shots aren’t being used for primary doses, only for boosters. If you have not yet had your primary series—that is, if you haven’t been vaccinated against COVID yet—you need to get that before you can get your fancy updated booster.
Were these boosters tested in humans?
The original COVID vaccine authorizations involved lengthy clinical trials in thousands of people. The boosters did not go through the same process. There were studies in mice showing that the boosters result in a similar immune system response as the original vaccines. Small studies in humans also showed that the side effects of a BA.1 variant vaccine were equivalent to the original vaccines. (The BA.1 plan was eventually scrapped in favor of BA.4/5.)
For some experts, the lack of human data is potentially concerning; but others point out that we don’t do full human clinical trials on each year’s flu shot. Once we understand how a vaccine works, small adjustments like these aren’t likely to make a meaningful difference in safety or effectiveness. It’s worth mentioning that after this was discussed in yesterday’s meeting of the Advisory Committee on Immunization Practices, the members voted 13-1 in favor of recommending the boosters.
Ultimately, this change in the evidence required is what you’d expect as we move toward treating COVID boosters like flu shots: something that gets updated every year to keep up with the variants that are circulating. If it helps, the evidence is convincing enough to me. I plan to get one of the new bivalent boosters.
What if I’ve already had COVID?
If you’re one of the many, many people who caught and recovered from COVID this summer, a booster can still help you. But some experts have suggested that you probably have a decent amount of protection from that infection, so you don’t have to get your booster right away.
The CDC says that you “may consider delaying” any COVID vaccine, including your booster, until three months after the start of symptoms. So if you got COVID in July, you may want to plan on getting your booster in October.
Can I get my COVID booster and my flu shot at the same time?
Yes. COVID vaccines can now be given alongside almost any other vaccine. (Monkeypox vaccine is one notable exception; if you’re getting the monkeypox vaccine, ask your provider about timing.)
For your COVID booster, timing is as described above: two months or more after your last COVID shot, maybe longer if you had a recent infection. For flu shots, you usually want to get them by Halloween so you’re protected well before winter. If those schedules line up for you, feel free to get a flu shot and a COVID booster at the same appointment.
The CDC does recommend that if you’re getting a high-dose or adjuvanted flu shot, you should get it in the opposite arm as your COVID vaccine. This is because both shots are capable of causing local reactions like redness and arm pain. It would be uncomfortable to have both going on in the same arm at the same time, and if you have a more severe reaction, it would be good to know which vaccine is causing the issue.
