Braces now or wait? Many people wonder how to navigate

At first, Gwyneth Paige did not want to get vaccinated against Covid-19. With her health issues, high blood pressure, fibromyalgia, asthma, she wanted to see how other people were doing. Then his mother was diagnosed with colon cancer.

“At that point, I didn’t care if the vaccine killed me,” he said. “To stay with my mother throughout her odyssey, I had to get vaccinated.”

Page, who is 56 and lives in Detroit, received three doses. That leaves him with a booster below federal health recommendations.

Like Paige, who said she doesn’t plan to get another booster right away, some Americans are comfortable with the safety of three doses. But others are wondering what to do: Get a brace now? Or wait for new formulations that attack BA.4 and BA.5, the most infectious Omicron sub-variants?

The rapidly changing virus has created a puzzle for the public and communication challenges for health officials.

“What we’re seeing right now is an information vacuum that’s not helping people make the right decisions,” said Dr. Carlos Del Rio, professor of infectious diseases at Emory University School of Medicine.

Del Rio says the public doesn’t hear enough about the value of vaccines in preventing serious illness, even if they don’t prevent all infections. Each new form of Covid forces officials to revise their messages, Del Rio said, which can increase public mistrust.

About 70% of Americans age 50 and older who received the first COVID-19 booster shot, and nearly as many age 65 and older did not receive a second, according to data from the Centers for Disease Control and Prevention. Disease Prevention (CDC).

The agency currently recommends two booster doses after the primary vaccination for adults age 50 and older and for younger people with weakened immune systems. A few days ago, multiple media outlets reported that the Biden administration was working on a plan to allow all adults to receive a second Covid booster.

Officials are concerned about the emergence of BA.4 and BA.5, which spread easily and may escape immune protection from vaccinations or previous infections. A recent study published in Nature showed that BA.5 is four times more resistant to currently available mRNA vaccines than previous omicron subvariants.

The consistent messages are complicated by the differing opinions of leading scientists. While doctors like Del Rio and Baylor College of Medicine’s Dr. Peter Hotez see value in getting a second booster, Dr. Paul Offitt, a member of the Food and Drug Administration’s (FDA) Advisory Committee on Vaccines, is skeptical. Individuals are elderly or immunocompromised.

“When experts have different opinions based on the same science, why are we surprised by the confusion?” said Dr. Bruce Gehlin, head of global public health strategy at the Rockefeller Foundation and an Offit fellow on the FDA panel.

Janet Perrin, 70, of Houston, did not receive her second booster because of a conflict with her practice and said she would seek information about a specific dose targeting new variants from Internet sources she trusts. “I haven’t found a consistent guiding voice from the CDC,” he said, adding that the agency’s statements sound like “political word salad.”

On July 12, the Biden administration revealed its plan to administer the BA.5 subvariant, which it warned would have the greatest impact in parts of the country with the lowest vaccination coverage. The strategy includes making it easier for people to access tests, vaccines and boosters and antiviral treatment against Covid.

During the White House’s first Covid briefing in nearly three weeks, the message from top federal health officials was clear: There is no vaccine developed for the Omicron variant. “There are a lot of people who are at high risk right now, and are waiting until October or November to get their booster, when really their risk is now. It’s not a good plan,” said Dr. Rochelle Walensky, director of the CDC.

Because of concerns about the emergence of the BA.5 subvariant, the FDA recommended on June 30 that Pfizer-BioNTech and Moderna go to work developing a new bivalent vaccine that combines the current version with a formulation targeting the new strain.

Both companies said they could make millions of doses of the reformulated vaccine available in October. Experts believe that the deadline could be pushed back by several months due to unforeseen problems that could affect vaccine development.

“I think we’re all asking ourselves the same question,” said Dr. Catherine Edwards, scientific director of Vanderbilt’s vaccine research program. “What’s the point of getting another booster now when what’s coming out in the fall is a bivalent vaccine against BA.4/5, which is currently being promoted? Whether it will air in the fall is another question, though.

On July 13, the FDA approved a fourth Covid vaccine, made by Novavax, but only for people who have not yet been vaccinated. Many scientists thought the Novavax dose could be an effective booster for people previously vaccinated with Pfizer-Biontech and Moderna mRNA because its unique design could boost immunity to coronaviruses. But unfortunately, few studies have evaluated the combined vaccination approach, says the Rockefeller Foundation’s Zelin.

Edwards and her husband were diagnosed with Covid in January. He got a second booster in June, but only because he thought it might be necessary for a business trip to Canada. He felt that the fourth dose was wasteful, though not particularly risky. She asked her husband, a healthy septuagenarian, to wait for the version against BA.4/5.

People at high risk for complications from Covid may want to go ahead and get a fourth dose, Edwards said, hoping it will temporarily prevent serious illness “while they wait for BA.4/5.”

Vaccines against Omicron will contain ingredients that target the original strain of the virus because early vaccine formulations are known to prevent serious illness and death even in people infected with Omicron.

Dr. David Brett-Major, an infectious disease specialist at the University of Nebraska Medical Center, said these ingredients would help keep earlier strains of the virus under control. That’s important, he said, because too much tailoring of vaccines to fight emerging variants allows older strains of the coronavirus to reemerge.

Brett-Major said messages about the value of vaccines must come from trusted local sources, not just top federal health officials.

“Access happens locally,” he said. “If local systems don’t enable messaging, dissemination and access, it’s really problematic.”

While some Americans are wondering when or if they will get their second booster, many people were cut off long ago by the pandemic, putting them at risk during the current wave, experts said.

Dr. Georges Benjamin, executive director of the American Public Health Association, said he doesn’t expect the level of public interest in the vaccine to change much, even if there are new boosters and eligibility increases. Areas of the country with high vaccine coverage would be relatively safe from any new strains emerging, while areas with low vaccine uptake could face a harsher wave, he said.

Even scientists don’t know how to effectively adapt to mutating viruses.

“Nothing is easy with Covid, right?” Edwards said. “I read about a new variant in India. Maybe it’s nothing, but who knows? Maybe that’s a big issue, and then we ask ourselves, ‘Why did we change the target strain of the vaccine to BA.4/5?’”

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