Get the new Covid vaccine now or wait?

By Arthur Allen and Eliza Fawcett, Healthbeat and Rebecca Grapevine, Healthbeat

The FDA has approved an updated Covid vaccine for everyone 6 months and older, leaving Americans with what has become an annual dilemma: Should they get vaccinated now as the latest Covid outbreak sweeps the country, or should they hold off on getting the shot for the winter surge?

The new vaccine should provide some protection for everyone, but many healthy people who are already vaccinated or who are immune due to common Covid-19 infections may want to wait a few more months.

Covid has become commonplace. For some, it is a mild illness with few symptoms. Others are confined to bed for days or weeks with fever, cough and fatigue. A much smaller group – mostly elderly or chronically ill people – have to go to hospital or die.

It is important for people in high-risk groups to get vaccinated, but the protection from the vaccine wears off after a few months. Those who get the new vaccine may be more likely to get sick in the next wave this winter, says William Schaffner, professor of infectious diseases at Vanderbilt University School of Medicine and spokesman for the National Foundation for Infectious Diseases.

On the other hand, major variants may have mutated by late fall, making the vaccine less effective, Peter Marks, the FDA's top vaccine official, said at an Aug. 23 briefing. He urged all eligible people to get vaccinated, noting that the risk of long Covid disease is greater among those who are unvaccinated or undervaccinated.

Of course, if the rollout of the Covid vaccine last year is any guide, few Americans will follow his advice, even though the surge this summer has been unusually severe and the concentration of the Covid virus in wastewater suggests that infections are just as widespread as they were in the winter.

The Centers for Disease Control and Prevention is now focusing on wastewater, as fewer people are reporting their test results to health authorities. The wastewater data shows that the epidemic is worst in the western and southern states. In New York, for example, levels are considered “high” – compared to “very high” in Georgia.

Hospitalizations and deaths due to Covid have also risen. But unlike infections, these rates are not nearly as high as they were during the winter surges or in previous summers. In July, more than 2,000 people died of Covid – a high number, but only a small fraction of the at least 25,700 Covid deaths in July 2020.

This relief is due to partial immunity built up through vaccinations and previous infections. A new study suggests the current variants may be less virulent – in the study, one of the recent variants did not kill mice exposed to it, unlike most previous Covid variants.

Public health officials point out that despite higher case numbers this summer, people appear to be treating their illness at home. “While we have seen a slight increase in case numbers, this has not had a significant impact on the number of hospitalizations and emergency room visits,” Connecticut Health Commissioner Manisha Juthani said at an Aug. 21 press conference.

Unlike flu or common cold viruses, Covid seems to thrive outside of the cold months, when germ-laden schoolchildren, dry air and indoor activities favor the spread of airborne and saliva-borne viruses. No one knows exactly why.

“Covid is still very contagious, very new, and people gather in air-conditioned spaces in the summer,” said John Moore, a virologist and professor at Weill Cornell Medicine College at Cornell University.

Or “maybe Covid is more tolerant of humidity or other environmental conditions in the summer,” said Caitlin Rivers, an epidemiologist at Johns Hopkins University.

Because viruses evolve as infections surge, the CDC recommends updated Covid vaccines each year. Last fall's booster shot targeted the omicron variant that will be circulating in 2023. This year, Moderna and Pfizer's mRNA vaccines and Novavax's protein-based vaccine — which still needs FDA approval — target a newer omicron variant, JN.1.

The FDA concluded that the mRNA vaccines strongly protected people from severe illness and death, even if earlier variants of JN.1 had since been replaced by others.

Public interest in Covid vaccines has waned. Since last September, only one in five adults has been vaccinated, compared to about 80% who received the first dose. New Yorkers have been slightly above the national vaccination rate, while in Georgia only about 17% have received the final shot.

Vaccine willingness is lower in states where the majority voted for Donald Trump in 2020, as well as among people who have less money and education, less access to health care, or less time off from work. These groups are also more likely to be hospitalized or die from the disease, according to a 2023 study in The Lancet.

While the newly developed vaccines are better targeted at the circulating Covid variants, uninsured or underinsured Americans may have to hurry if they hope to get a free vaccine. A CDC program that provided booster shots to 1.5 million people last year has run out of money and will end on August 31.

The agency has raised $62 million in unspent funds to pay state and local health departments to administer the new vaccines to those who aren't covered by insurance. But “that's probably not going to go very far” if the vaccine costs the agency about $86 per dose, as it did last year, said Kelly Moore, CEO of Immunize.org, a vaccine advocacy organization.

People who pay out of pocket at the pharmacy can expect higher prices: CVS plans to sell the updated vaccine for $201.99, said Amy Thibault, a spokeswoman for the company.

“Price can be a barrier, access can be a barrier” to vaccination, said David Scales, assistant professor of medicine at Weill Cornell Medical College.

Without an access program that makes vaccines available to uninsured adults, “we will see inequities in health outcomes and disproportionate outbreaks of disease among the working poor who can ill afford to stay home from work,” Kelly Moore said.

New York state has about $1 million to fill the gaps when the CDC's program ends, said Danielle De Souza, a spokeswoman for the New York State Department of Health. That could buy about 12,500 doses for uninsured or underinsured adults, she said. There are about 1 million people without health insurance in the state.

Last year, experts from the CDC and FDA decided to recommend an annual fall vaccination against Covid and flu and a one-time vaccination against respiratory syncytial virus for some groups.

It would be impractical for vaccine makers to change the Covid vaccine formula twice a year, and offering the three vaccines during one or two doctor visits seems to be the best way to increase acceptance of all vaccines, said Schaffner, who advises the CDC's policy-setting Advisory Committee on Immunization Practices.

At its next meeting in October, the committee will likely urge vulnerable people to get a second dose of the same Covid vaccine in the spring to protect themselves from the next summer wave, he said.

If you're in a vulnerable population and are waiting until just before the holidays to get vaccinated, Schaffner says it's a good idea to wear a mask and avoid large crowds. You should also get tested if you think you have Covid-19. If the result is positive, people in these groups should see a doctor, as the antiviral pill Paxlovid could ease their symptoms and keep them from needing hospitalization.

For others who feel they are sick and don't want to spread the Covid virus, the best advice is to get tested once and if they get a positive result, try isolating for a few days and then wearing a mask and avoiding crowded spaces for several more days. Retesting after a positive result is pointless because virus particles can linger in the nose for days without indicating a risk of infecting others, Schaffner said.

The Department of Health and Human Services will provide four free Covid tests to anyone who requests them through covidtest.gov starting in late September, said Dawn O'Connell, assistant secretary for preparedness and response, at the Aug. 23 press conference.

The government is focusing its fall vaccination campaign, called “Less Risks, More Life,” on older people and nursing home residents, HHS spokesman Jeff Nesbit said.

Maybe not everyone really needs a Covid booster shot in the fall, but “there's nothing wrong with giving people options,” John Moore said. “The 20-year-old athlete is less at risk than the 70-year-old overweight guy. It's that simple.”

###

KFF Health News correspondent Amy Maxmen contributed to this report. Healthbeat is a nonprofit public health newsroom published by Civic News Company and KFF Health News. KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF – an independent source of health policy research, polling and journalism.