Gwyneth Paige initially 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 fared after the shots. Then his mother was diagnosed with colon cancer.
“At that point, I didn’t care if the vaccine killed me,” he said. “To accompany my mother throughout her journey, I had to vaccinate.”
Page, who is 56 and lives in Detroit, received three doses. That puts him one booster short of federal health recommendations.
Like Page, who said he doesn’t currently plan to get another booster, some Americans are comfortable with the protection of three shots. But others may wonder what to do: boost again now with one of the original vaccines, or wait months for the promised new formulations made for the latest, highly infectious Omicron subvariants, BA.4 and BA.5?
The rapidly changing virus has created a puzzle for the public and a communication challenge 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 isn’t hearing enough about the value of vaccines in preventing serious disease, even if they don’t stop all infections. Each new Covid variant forces health officials to change their messaging, Del Rio said, which can increase public mistrust.
According to data from the Centers for Disease Control and Prevention, nearly 70% of Americans age 50 and older who received their first booster shot — and nearly as many age 65 and older — did not receive their second Covid booster dose. The agency currently recommends two booster shots after the initial vaccination series for adults 50 and older and for younger people with weakened immune systems. Last week, multiple news 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 an increase in BA.4 and BA.5, which are easily spread and can escape immune protection from vaccinations or previous infections. A recent study published in Nature found that BA.5 is four times more resistant to currently available mRNA vaccines than the earlier Omicron subvariants.
Consistent messaging has been complicated by the differing opinions of leading vaccine scientists. Although doctors like Del Rio and Baylor College of Medicine’s Dr. Peter Hotez see value in getting a second booster, Dr. Paul Offit, a member of the FDA’s vaccine advisory committee, is skeptical that it’s necessary for seniors and those who have it. Immunocompromised
“When experts have different opinions based on the same science, why are we surprised that getting the message right is confusing?” Head of Global Public Health Strategy at the Rockefeller Foundation and Offit’s colleague on the FDA panel. Bruce Galin says.
Janet Perrin, 70, of Houston, did not get her second booster because of scheduling and convenience, and said she would seek information about alternative-targeted doses from sources she trusted on social media. “I haven’t found a consistent guiding voice from the CDC,” he said, adding that the agency’s statements sounded like “a 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 low vaccine coverage. The strategy includes making it easier for people to access tests, vaccines and boosters and Covid antiviral treatment.
During the first White House Covid briefing in nearly three weeks, the message from top federal health officials was clear: Don’t wait for the Omicron-tailored shot. “There are a lot of people who are at high risk right now, and waiting until October, November for them to increase — to actually increase their risk right now — is not a good plan,” said CDC chief Dr. Rochelle Walensky.
With concerns about the rise of the BA.5 subvariant, the FDA on June 30 recommended that drugmakers Pfizer-BioNTech and Moderna work to develop a new, bivalent vaccine that combines the current version with a formulation that targets the new strain.
Both companies say they could make millions of doses of the reformulated shots available to the U.S. in October. Experts believe that the deadline could be pushed back by several months due to unforeseen obstacles in the production of the plague vaccine.
“I think we’re all asking the same question,” said Dr. Catherine Edwards, scientific director of the Vanderbilt Vaccine Research Program. “What’s the point of getting another booster now when what comes out in the fall is a bivalent vaccine and you’re getting 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 those who have not yet been vaccinated. Many scientists thought the Novavax shot could be an effective booster for people previously vaccinated with mRNA shots from Pfizer-Biontech and Moderna because its unique design could amplify immunity to coronaviruses. Unfortunately, few studies have evaluated mix-and-match vaccination methods, says the Rockefeller Foundation’s Zelin.
Edwards and her husband got Covid in January. He got a second booster last month, but only because he thought he might need it for a Canadian business trip. Otherwise, he said, he felt the fourth shot was kind of a waste, though not particularly risky. She told her husband — a healthy septuagenarian — to wait for the BA.4/5 version.
People at high risk for Covid complications may want to go ahead and get a fourth dose, which Edwards said will temporarily prevent severe disease “while you wait for BA.4/5.”
Omicron vaccines will contain ingredients that target the original strain of the virus because the first vaccine formulations are known to prevent severe 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 creating too many vaccines to fight emerging variants allows older strains of the coronavirus to reemerge.
Brett-Major said messages about the value of the appropriate shots need to come from trusted, local sources — not just top federal health officials.
“Access happens locally,” he said. “If your local systems aren’t messaging and promoting and enabling access, that’s really problematic.”
While some Americans are wondering when, or if, they will get their second boosters, many people have secured the pandemic long ago, 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 public’s interest in the vaccine to change much despite the release of the new booster and expanded eligibility. Parts of the country with high vaccine coverage will be relatively immune to new forms, he said, while areas with low vaccine uptake could be set for a “rude awakening”.
Even scientists are at a bit of a loss for how to effectively adapt to the changing virus.
“Nothing is easy with Covid, right? It’s just a mole,” Edwards said. “This morning I read about a new variant in India. Maybe it’ll be a nothingburger, but — who knows? — maybe something bigger, and then we’ll think, ‘Why do we call the vaccine strain BA.4/ Changed to 5?’”
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