Annual COVID Vaccine: U.S. Tries 'New Approach' With Omicron Boosters

If the new strategy works, COVID boosters could start to look more like your yearly flu shot.

African-American man getting covid vaccine close-up
Photo: Getty Images

The U.S. may be "moving towards" a plan that involves doling out COVID-19 vaccines on a yearly basis, similar to how people receive annual flu shots, the White House announced on Tuesday.

The news comes as new COVID booster shots—bivalent vaccines made to protect against the original SARS-CoV2 virus and Omicron subvariants—are becoming available to the public.

"We are launching a new vaccine—our first in almost two years—with a new approach," President Bident said in a statement. "For most Americans, that means one COVID-19 shot, once a year, each fall."

In an earlier press briefing, Anthony Fauci, MD, Biden's chief medical advisor, also weighed in on the new strategy.

"Looking forward with the COVID-19 pandemic, in the absence of a dramatically different variant, we are likely moving towards a path with a vaccination cadence similar to that of the annual influenza vaccine, with annual, updated COVID-19 shots matched to the currently circulating strains for most of the population," said Dr. Fauci.

Here's what we know about why these new boosters may provide a whole year of protection, if some people may need more than one shot, and when might be the best time to get vaccinated.

Bivalent Vaccines Can Provide Protection for Longer Periods of Time

Experts are betting that these new vaccines will provide longer lasting protection largely because the virus is less volatile now than it was before.

Over the course of the pandemic, COVID has continued to evolve, presenting new variants and subvariants every few months. This is why vaccines need to be continually updated—so that they can protect us from the virus in its current form.

"If [the virus] hadn't changed, we wouldn't have been running through this game of getting boosters all the time," Peter Chin-Hong, MD, professor of medicine and infectious disease specialist at the University of California, San Francisco, told Health. "But because it's changed, it makes sense that you'd want to update it."

But unlike in years past, COVID doesn't seem to be changing as dramatically right now. If Omicron and its subvariants continue to be dominant in the U.S.—as the strains have been since December 2021—then these new vaccines should continue to be able to protect against severe infections for longer periods of time.

In the press conference, Dr. Fauci explained the concept as "influenza adrift," or antigenic drift. The term refers to flu viruses, but could apply here as well, Dr. Fauci explained.

The premise is that drifting viruses continue to evolve and change—but not to the extent that the body can't recognize new iterations as a threat. If this theory is true for COVID, the protection we get from the bivalent vaccines should be enough to stay protected for longer, even as small variations of Omicron come and go throughout the year.

"The original vaccines do a great job with kicking the enemy out once it gets into the bloodstream," Dr. Chin-Hong said. "But what the new vaccines will do is stop the enemy at the front door, we hope, or at least decrease the chances that the enemy will gain entry inside the body."

The big caveat to the White House's announcement is that the virus is unpredictable, and we don't know for sure whether virus evolutions will be minimal—or if we'll see an entirely new variant at some point.

"Of course, there's a little asterisk," William Schaffner, MD, professor of infectious diseases at Vanderbilt Medical Center, told Health. "We have to keep our eye on the virus and if the virus makes a sudden shift to yet another variant that's not included in the vaccine, we might have to come up with an updated vaccine earlier. But we hope that's not the case."

The second asterisk comes for the immunocompromised and elderly, according to Drs. Schaffner and Chin-Hong. Because protection from vaccines naturally wanes over time, it's unlikely that just one COVID vaccine annually will provide enough protection to prevent severe illness.

Instead, these groups may need to get vaccines every six months, Dr. Chin-Hong said, though the official recommendation won't be clear until there's more data about the bivalent vaccine as time goes on.

Simplifying the Vaccination Process With an Annual Shot

Potentially making the COVID booster an annual shot should help streamline guidance and make things a bit more predictable for Americans, according to Ashish Jha, MD, the White House's COVID response coordinator.

"I know over the past 18 months figuring out what you need and when you need it hasn't always been super simple. That all changes. These new vaccines make it easy for us to think differently," Dr. Jha said in the press briefing. "So here's the simple version: If you're 12 and above and previously vaccinated, it's time to go get an updated COVID-19 shot."

That's not to say that getting shots into arms will be easy—there may still be some vaccine hesitancy and disparities in access. But the Department of Health and Human Services (HHS) is working with multiple agencies and organizations to ensure the process is as simplified and accessible as possible, HHS Secretary Xavier Becerra said during the press briefing.

Another issue could be a lack of funding. According to the HHS, without more COVID funding from Congress, the department could be unable to purchase and distribute vaccines by January.

Despite the hurdles and uncertainty, this White House adds to growing sentiments in the U.S. that we need to learn to live with the virus. Managing people's expectations and alerting them that they'll likely have to get an annual COVID shot should give people some hope, Dr. Chin-Hong said—it makes the virus and our response to it seem more manageable and predictable.

"People aren't into the business of getting a shot every six months. So you want to focus on the people who are most vulnerable for potentially more frequent [shots], and allow people the chance of getting less frequent shots so they actually get it," Dr. Chin-Hong said. "Because there's no use of having a shot available if everyone's fed up and [they] don't want to get anything."

If Eligible, Get Your COVID Booster and Flu Shot ASAP

Heading into the fall and winter, it's likely that there'll be an increase in the number of COVID cases, Dr. Schaffner explained, just like we've seen in the past few years. This is especially true as protection provided by the first booster shot is probably waning now, he said.

In order to get the population's immunity back up, Dr. Shaffner said that most people should go in and get a booster of the bivalent vaccine this fall, along with their flu shot.

"We're going to have to get, this year, two separate vaccinations to protect ourselves against these really two bad winter respiratory viruses," Dr. Schaffner said. "This year, as I like to quip, everybody's going to have to roll up both sleeves."

There are no issues with getting the COVID vaccine and the flu vaccine at the same time, Dr. Schaffner explained, other than two sore arms.

"There's certainly no immunological, no scientific reason you can't get the two," he said. "The adverse events don't sum in any way and the effectiveness is just as good as if you got the vaccines on separate days, on separate occasions."

The Centers for Disease Control and Prevention (CDC) recommends getting your flu shot in September or October, which helps ensure that you have a lot of robust antibodies before peak flu season between December and February. With COVID though, Dr. Chin-Hong said, it's much harder to predict when the worst surge might come. But getting the shot as soon as possible—especially if you're older or immunocompromised—is probably a good idea, he added.

People who were recently infected with COVID or just received a booster shot less than two months ago will have to wait to get the new bivalent shot. But for those who are eligible, Dr. Schaffner said that they should get the COVID vaccine starting now, whenever it's most convenient for them.

The timeline won't be the same for everyone, but it's good to set people's expectations that getting a COVID booster could be an annual thing, Dr. Chin-Hong said.

"Barring those variant curveballs, for a large majority of Americans, we are moving to a point where a single annual COVID shot should provide a high degree of protection against serious illness all year. That's an important milestone," said Dr. Jha.

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