It’s now been more than six months since the bivalent COVID-19 shot was authorized for use in adults in the U.S. The updated formula targets the original virus strain and the highly contagious omicron variant.
But since it’s now been available for a considerable amount of time, many folks who got the shot when it was first available in September are worried about waning protection, especially since the initial vaccine had a decrease in protection about four months after getting the jab. So do you need another dose to protect yourself from getting very sick?
“This is a good and increasingly common question,” said Dr. Mark Loafman, the chair of family and community medicine at Cook County Health in Chicago.
In March 2022, the Food and Drug Administration did authorize a fourth coronavirus vaccine dose for certain populations. Earlier this winter, Canada and the United Kingdom updated their vaccine guidance to allow high-risk folks to get a second bivalent booster.
However, for the general U.S. adult population, “the FDA has not given us an emergency use authorization for a second bivalent booster,” said Dr. William Schaffner, a professor of preventive medicine in the department of health policy at Vanderbilt University Medical Center in Nashville.
Will this eventually happen here in the U.S.? And do you actually need a second bivalent booster? Below, experts weigh in on what to know:
Why isn’t a second dose available?
“Considerations for a second dose arise from studies showing that protective antibody levels from the booster vaccine diminish over time, just as we experienced with the initial COVID mRNA vaccine,” Loafman said.
Experts are still seeing good protection against severe disease and hospitalization in those who got the bivalent booster. “As long as that holds out, we are not likely to have recommendations for a second booster dose,” Loafman added.
Many people think it’s like a light switch, Schaffner explained. They think when they reach six months they’re not protected at all, but that is not the reality. “You still have substantial residual protection,” Schaffner said.
There’s talk of immunocompromised folks getting a second dose, but nothing is decided.
According to Schaffner, the latest he’s heard is there is discussion now about potentially authorizing a second dose for immunocompromised people, but there is no decision yet.
“Now, how they wind up defining [immunocompromised] will be interesting, but that’s where we are at the moment,” he added.
Since this is still in the works, immunocompromised folks cannot try to get their second bivalent booster just yet — a decision is necessary before that.
It’s not clear if a second bivalent booster will be available across the board.
“At the moment, the Food and Drug Administration seems directed at creating an annually updated booster. That’s what they’ve been talking about, that’s what their expert advisory committee has been speaking about and has been supporting. And they’re moving in that direction,” Schaffner said.
He added that there may be developments throughout the summer months before fall, which is when experts think there will be a new updated booster available. A new booster would target the dominant strains come fall.
Do not sneak in an extra bivalent booster dose.
A second bivalent booster dose has not been studied as much as experts would like, Schaffner said. This means you should not try to finagle a second jab.
“We don’t like to make recommendations on the basis of no data,” he noted. “And I think that goes to the heart of why the FDA hasn’t been more assertive in this regard.”
While it’s scary to be immunocompromised during the COVID pandemic (when an infection can mean severe outcomes), if you sneak in another dose, you could put yourself at risk. FDA authorization is necessary before that second shot. To keep yourself safe, you should wear a mask indoors, wash your hands, use hand sanitizer and test before gatherings, Schaffner said.
Very few Americans have actually taken advantage of the bivalent booster.
The majority of Americans have not received this updated booster shot, which strongly protects against hospitalization and death. In fact, only 1 in 5 people have received the bivalent booster, according to Loafman.
“From every perspective I can imagine ― science, public health, use of health care resources, compassion, respect for life, getting back to a real sense of normalcy, etc. ― the low rate of booster dose uptake is an epic-level, heartbreaking tragedy,” Loafman said.
“A safe, simple way to stop most of this death and suffering is at our fingertip — and yet so far away. Imagine if only 1 in 5 of us wore a seat belt?” he added.
According to Schaffner, if you compare unvaccinated people with those who got the bivalent booster, you’ll see that unvaccinated people are 17 times more at risk for hospitalization. When compared with people who are partially vaccinated, those who did not finish the vaccine series are 2.5 times more at risk.
If you haven’t gotten your first bivalent booster, you can still get the shot — and it’s currently free, which could change for some folks when the United States’ public health emergency declaration ends in May. There’s an online database you can use to find your nearest vaccination location.
Everyone 5 and older is eligible for a bivalent booster as long as you finished your primary vaccine series at least two months prior, according to the Centers for Disease Control and Prevention. This guidance is straightforward for those 5 and over, but it’s a little more complicated for younger children.
“Booster dose recommendations for children … is dependent on which primary series they have had,” Loafman said.
Children ages 6 months to 5 years old who got Moderna for their primary vaccine series, which is two shots, are eligible for a Moderna bivalent booster.
Pfizer’s COVID vaccine for those ages 6 months to 4 years is a three-dose primary series. Children who are in the process of completing their primary Pfizer series and had two doses of the original Pfizer vaccine can get the bivalent shot as their third dose. Kids who are at least two months out from their three-dose primary series are now also able to get the bivalent Pfizer booster. For additional guidance, reach out to your pediatrician or look at the CDC’s guidelines.
If you have had the bivalent booster shot, hold tight for more news on a potential second dose or an updated booster in the coming months.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.