Vox - Covid-19 vaccines: News and updateshttps://cdn.vox-cdn.com/community_logos/52517/voxv.png2023-01-06T13:10:00-05:00http://www.vox.com/rss/stream/213340052023-01-06T13:10:00-05:002023-01-06T13:10:00-05:00How the latest Covid-19 variant is shaping the course of the pandemic
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<img alt="Masked pedestrians walk past a US flag in a streetfront window in New York City on December 12, 2022." src="https://cdn.vox-cdn.com/thumbor/BLEaMCNc8D3CoL_ViLAW2JKElek=/596x0:3900x2478/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71833205/GettyImages_1245567509a.0.jpg" />
<figcaption>Masked pedestrians in New York City in December. The XBB.1.5 subvariant of omicron is driving a rise in Covid-19 cases in the US. | Fatih Aktas/Anadolu Agency via Getty Images</figcaption>
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<p>XBB.1.5, a subvariant of omicron, is gaining ground in the US, but deaths can still be avoided.</p> <p id="CNENOA">XBB.1.5, the latest rising version of the virus that causes Covid-19, is following an all-too-familiar pattern: It’s yet another branch off the omicron variant of SARS-CoV-2, and it’s even more transmissible than past versions, gaining traction as people huddle indoors for the winter.</p>
<p id="35WBRc">In the United States, XBB.1.5 is rapidly growing, causing almost 28 percent of new Covid-19 cases nationwide as of January 6, according to the <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">Centers for Disease Control and Prevention</a>. That’s up from just 4 percent of cases at the beginning of December. The new subvariant is driving the majority of reported infections in places like <a href="https://www.cbsnews.com/newyork/news/doctors-new-omicron-subvariant-xbb-1-5-responsible-for-75-of-new-covid-cases-in-northeast/">New York and New Jersey</a>, and the rest of the country is poised to follow. It’s also been found in at least 29 countries. </p>
<p id="jmOQZW">“It is the most transmissible subvariant that has been detected yet,” Maria Van Kerkhove, an epidemiologist who serves as the World Health Organization’s technical lead for Covid-19, <a href="https://www.youtube.com/watch?v=ne5ezgPRTI8">told reporters this week</a>. “We are concerned about its growth advantage.” </p>
<p id="At0KaP">It’s alarming and frustrating that yet another slippery variant has emerged. But XBB.1.5 is unlikely to lead to a massive rise in hospitalizations and deaths, as seen in prior winters, now that the vast majority of people in the US have some degree of protection against the virus. </p>
<p id="lvWYTf">Nonetheless, the new subvariant is still concerning. <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">More than 42,000 people</a> are hospitalized with Covid-19 now and more than 2,700 people are dying per week on average, according to the CDC. There are likely thousands more infections going undetected and unreported. These are the highest Covid-19 levels since January 2022 and the numbers are trending upward, but they’re still far, far below that massive spike last year fueled by the original omicron variant. Back then, more than 17,000 people were dying per week. </p>
<p id="R24sl8">What’s different now is that there is much more immunity to Covid-19 across the population between vaccinations, <a href="https://www.vox.com/science-and-health/23284234/second-booster-covid-19-vaccine-bivalent-pfizer-moderna">bivalent boosters</a>, and prior waves of infections. There are also effective treatments for Covid-19. Meanwhile, XBB.1.5 isn’t all that different from its omicron siblings, so immunity to <a href="https://www.vox.com/23100593/covid-subvariant-omicron-ba-2-4-5-vaccine-paxlovid">subvariants like BA.5</a> still provides protection. </p>
<p id="OevyLN">“We do not expect a major increase in hospitalizations from this variant since it is similar to the previous ones,” said <a href="https://www.healthdata.org/about/ali-mokdad">Ali Mokdad</a>, a professor of health metrics sciences at the Institute for Health Metrics and Evaluation at the University of Washington, in an email. </p>
<p id="ywifzW">But Covid-19 isn’t the only health worry this season, as other infections like <a href="https://www.vox.com/2022/12/6/23494948/flu-influenza-rsv-covid-vaccine-chart-tripledemic-tridemic">influenza and RSV</a> are also filling hospital beds. And as tracking cases gets more difficult, it will be harder to stay ahead of the next form of SARS-CoV-2. That said, much of the ensuing harm of hospitalizations and deaths from Covid-19 can still be avoided if people take steps to prevent infection, get updated vaccines, and seek treatment if ill. </p>
<h3 id="KWn1UM">What makes XBB.1.5 different from other subvariants</h3>
<p id="SScuuR">XBB, the predecessor of XBB.1.5, was actually first identified in <a href="https://www.who.int/news/item/27-10-2022-tag-ve-statement-on-omicron-sublineages-bq.1-and-xbb">October last year</a>. It’s a recombinant version of the virus, meaning it blends traits from two existing variants rather than branching off of just one. Those attributes allow it to spread more easily than any other known version of SARS-Cov-2.</p>
<p id="kvT4Sg">Like all viruses, SARS-CoV-2 mutates as it replicates, though most mutations are harmless or detrimental to the virus. XBB.1.5, however, has <a href="https://www.ecdc.europa.eu/en/news-events/update-sars-cov-2-variants-ecdc-assessment-xbb15-sub-lineage">mutations in its spike protein</a>. That’s the part of the virus most readily recognized by the immune system and the part that attaches to human cells to begin the infection process. These changes make the virus harder to detect and better at reproducing. Older adults and people who are immunocompromised remain at <a href="https://www.vox.com/science-and-health/23316450/covid-19-death-rate-vaccine-booster-elderly">highest risk of dying from SARS-CoV-2</a>. </p>
<p id="xZNiqY">Since XBB.1.5 draws on parts of older versions of the virus, protection against older variants likely still provide shielding against the worst effects of this new threat. In particular, the bivalent Covid-19 vaccine boosters contain the tools to target the original version of SARS-CoV-2 as well as the BA.4 and BA.5 subvariants of omicron.</p>
<p id="ZX0cbx">“The vaccines and the booster are still highly effective against hospitalizations and deaths,” Mokdad said. As of this week, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop5">15 percent of Americans over the age of 5</a> have received a bivalent Covid-19 vaccine booster. </p>
<p id="lJ7GgH">At the same time, the public health landscape around Covid-19 is changing. Face mask mandates and social distancing rules are all but gone. Fewer people are bothering to get tested at all, and many of those who do are testing at home, so public health officials have less insight into the spread of the disease. The CDC is now reporting cases on a weekly rather than daily basis. Hospitalizations now are the best indicator of Covid-19’s trajectory, according to Mokdad. Health officials are also using <a href="https://www.vox.com/23005271/sewage-wastewater-surveillance-covid-19-biobot-analytics-pandemic">wastewater surveillance</a> to anticipate future infection surges. </p>
<p id="ybIffv">There are effective treatments for Covid-19, like the antiviral drug Paxlovid. But <a href="https://www.vox.com/science-and-health/23495149/covid-19-treatment-monoclonal-antibody-therapy-drug">there are no more monoclonal antibodies</a>, previously a key backup treatment, that are authorized for use against the new subvariants. The loss of monoclonal antibody treatments is especially concerning for people at high risk of severe Covid-19 and people who can’t take Paxlovid because of its interactions with other medicines. </p>
<p id="x71vsT">It’s also important to remember that hospitalizations and deaths are the worst Covid-19 outcomes, but not the only problems the disease can cause. Many people who faced even a mild course of the illness continue to suffer lasting respiratory and neurological symptoms, a condition known as long Covid. Scientists are still sorting out the <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00501-X/fulltext">long-term effects of the virus</a>. And the more the virus spreads, the more likely it is to mutate in a dangerous way, so it’s worth preventing infections in the first place. </p>
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<p lang="en" dir="ltr">What you can do (continued)...<br><br>4. Work to improve ventilation/filtration in indoor spaces<br><br>5. If you have symptoms: test right away and avoid hanging out with high risk folks<br><br>6. If you do get Covid – immediately get evaluated for treatments. They are lifesavers.<br><br>9/n</p>— Ashish K. Jha, MD, MPH (@AshishKJha46) <a href="https://twitter.com/AshishKJha46/status/1610648619996303363?ref_src=twsrc%5Etfw">January 4, 2023</a>
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<p id="AYVPKY">Some parts of the country are now <a href="https://www.daytondailynews.com/local/mask-mandates-are-back-at-dayton-metroparks-public-health/GVPWSTDG5ZB7DJUUWMNVYUNHRY/">bringing back mask requirements</a>. Improving <a href="https://www.vox.com/the-highlight/23377638/buildings-indoor-air-quality-pollution-toxic-sick">indoor air quality</a> is another key tactic for preventing infection. These tactics have the added advantage of slowing other respiratory infections. Influenza rates have already <a href="https://www.vox.com/2022/12/6/23494948/flu-influenza-rsv-covid-vaccine-chart-tripledemic-tridemic">broken records this winter</a>, with hospitalizations at four times the typical levels last month. Fortunately, influenza and RSV rates are declining, but they still remain high and are stressing hospitals, <a href="https://www.cdc.gov/flu/weekly/index.htm">according to the CDC</a>. </p>
<p id="B0AhLK">With Covid-19 rising again, patients could still have a hard time finding relief. Similar patterns could emerge again next season, so it’s important to keep pandemic tools sharp. </p>
<p id="Q4PoH3">“Covid will be with us for a while, like flu, from now on,” Mokdad said. “We will have a bad season and not so bad, depending on the variant.”</p>
<p id="tTlye3">On its own, XBB.1.5 is unlikely to be the massive disruptor its ancestors were. But keeping it in check still demands vigilance and effort, which in turn can prevent harm from other diseases. </p>
https://www.vox.com/science-and-health/23542148/xbb-covid-19-cases-variant-omicron-vaccine-pandemic-treatmentUmair Irfan2022-11-03T06:30:00-04:002022-11-03T06:30:00-04:00Your free pandemic health perks are on the way out
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<img alt="US President Joe Biden smiles before receiving a booster dose of the Covid-19 vaccine targeting the omicron BA.4/BA.5 subvariants in the Eisenhower Executive Office Building in Washington, DC, on October 25, 2022." src="https://cdn.vox-cdn.com/thumbor/nFHLa_5L4vreHRsB2NzsacGB41o=/343x0:5676x4000/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71578600/GettyImages_1244218443.0.jpeg" />
<figcaption>President Joe Biden receives a bivalent booster dose of the Covid-19 vaccine. Federal funding for Covid-19 tests, treatments, and vaccines will soon run out. | Al Drago/Bloomberg via Getty Images</figcaption>
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<p>The privatization of the Covid-19 response is well underway as federal funding runs out.</p> <p id="bS741U">Federal funding for Covid-19 response measures like tests, treatments, and vaccines is drying up just as <a href="https://www.vox.com/science-and-health/23393321/covid-vaccine-bivalent-booster-pfizer-moderna">cases are poised to rise again</a>, raising another barrier for some of the most vulnerable Americans. </p>
<p id="P3d475">Several key factors are different in this go-around, however: The vast majority of people in the US have already been infected or vaccinated, so most have at least some protection from the disease. There are also several effective treatment options, like the antiviral drug Paxlovid, so even those who do get sick have a way to get better. </p>
<p id="ynYsSJ">But most public health measures to limit infections in the first place like wearing face masks and social distancing are gone as well. Tracking the pandemic is getting harder too, with most Covid-19 tests now occurring at home and going unreported. Last month, the <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/faq-surveillance.html#Surveillance-4-answer">Centers for Disease Control and Prevention</a> announced it was shifting from daily to weekly reports of cases and deaths. Currently, <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">more than 2,600 people in the US are dying per week</a> from Covid-19. </p>
<p id="PkYr3f">Now the government is turning over some of the Covid-19 response to the private sector. Throughout the pandemic, the federal government spent billions of dollars on these measures and provided them for free to the public under its public health emergency powers. The emergency declaration has to be renewed every 90 days, and the current round expires in 2023. If the government doesn’t renew the emergency declaration at that time, Americans <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/commercialization-of-covid-19-vaccines-treatments-and-tests-implications-for-access-and-coverage/">may end up paying out of pocket</a> for some or all of the tools needed to cope with the pandemic.</p>
<p id="fSETUj">This funding rollback will likely play out differently depending on the measure. With vaccines, manufacturers are preparing to raise prices. Pfizer announced last month that it’s planning to <a href="https://www.axios.com/2022/10/21/pfizer-hike-cost-covid-shot">raise the price of its Covid-19 vaccine</a> next year, from the roughly $30 per dose it charges the US government now to at least $110 per dose. </p>
<p id="OpmNNv">However, the US government has a stockpile of Covid-19 vaccines, including new <a href="https://www.vox.com/science-and-health/23284234/second-booster-covid-19-vaccine-bivalent-pfizer-moderna">bivalent boosters</a> that target more recent variants of the virus that causes Covid-19. With booster rates still in the <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop5">single digits</a>, the US isn’t running out of Covid-19 vaccines anytime soon. When prices do go up, health insurers will be required to offer them to their customers for free under most plans. </p>
<p id="DNl3Gi">“Almost everybody will still be getting free vaccines,” said <a href="https://www.kff.org/person/jennifer-kates/">Jennifer Kates</a>, senior vice president at the Kaiser Family Foundation, a health policy think tank. “The only group that’s out of luck there are uninsured adults.”</p>
<p id="3r4Gbk">Tests are a different story. The government’s <a href="https://www.covid.gov/tests">free at-home test program</a> ended in September because Congress didn’t appropriate more money to order more kits. Insurers are still require to <a href="https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free">reimburse part or all of the cost</a> of home Covid-19 test kits as well as more robust PCR tests, but when the public health emergency ends, policyholders will likely end up paying more out of pocket. And again, people without health insurance will likely end up paying the most. </p>
<p id="AqB010">Americans may also end up paying more for Covid-19 treatments like antiviral drugs and monoclonal antibodies. These therapies have been <a href="https://www.nature.com/articles/d41586-022-01735-7">crucial in reducing the death rate</a> from the disease, and the government <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/07/12/fact-sheet-biden-administration-outlines-strategy-to-manage-ba-5/">has them stockpiled</a>. But as the emergency ends and supplies run out, people on private health plans and on Medicare will likely have to share more of the costs. </p>
<p id="YKo6rR">What effect will these funding rollbacks have? Are they premature?</p>
<p id="frthy5">“The data doesn’t tell me that it’s time for us to pull back, but it’s kind of where we are,” said <a href="https://sph.tulane.edu/hpm/thomas-laveist-phd">Thomas LaVeist</a>, dean of the school of public health at Tulane University.</p>
<p id="ukbZKW">On one hand, Covid-19 cases, hospitalizations, and deaths are far below their peak, many people have largely checked out from taking precautions, and there are still supplies left. The people who are at greatest risk of severe illness and death from Covid-19 even now are those who are unvaccinated, but the overall vaccination rate is unlikely to budge now. </p>
<p id="p3ZgHO">“At this point, it’s not clear to me that we’re going to get many more people vaccinated who are unvaccinated,” said LaVeist. </p>
<p id="0ecJQn">At the same time, Covid-19 cases are projected to rise again this winter, along with other infections like <a href="https://www.vox.com/policy-and-politics/2022/10/27/23421344/covid-19-flu-rsv-symptoms-vaccines-2022">RSV and influenza</a>, again stressing the health care system. Any increases in costs will push already low vaccine, testing, and treatment rates even lower, adding more strain to already exhausted health workers and hospitals. </p>
<p id="gPcn4G">Eventually, funding for some of these pandemic measures does have to taper off, but the looming rollbacks are more abrupt than some policymakers wanted. “Waiting to provide funding once we’re in a surge will be too late,” according to a <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/15/fact-sheet-consequences-of-lack-of-funding-for-efforts-to-combat-covid-19-if-congress-does-not-act/">March 15 statement</a> from the White House warning Congress about the dangers of a sudden loss of Covid-19 funding. </p>
<p id="8k5q50">“The hope is that this transition is done as a smooth, balanced one and not a cliff,” Kates said. </p>
<p id="mRMqeY">But with an upcoming election and Republicans poised to gain seats in the House, it will likely be harder to get any more money for tests, treatments, and vaccines. “There is a political aspect to this as well: Because people are fatigued, policymakers don’t want to continue these measures because they’re being pressured not to,” LaVeist said. </p>
<p id="0qyB0U">Nonetheless, the worst effects of Covid-19 can still be contained. Wearing face masks and improving ventilation can reduce infections in the first place, vaccine boosters can lessen the chances of falling severely ill, and treatments can still save lives. Preventing another spike in deaths is a matter of availing these tools, especially while they’re still free. </p>
https://www.vox.com/science-and-health/23433714/covid-19-vaccine-price-test-treatment-free-pfizer-paxlovidUmair Irfan2022-10-13T14:15:00-04:002022-10-13T14:15:00-04:00The best thing you can do to quash a deadly Covid-19 surge this winter
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<figcaption>People wait in line for a Covid-19 test at the beginning of the coronavirus pandemic in the Bronx, New York, in April 2020. | Timothy A. Clary/AFP via Getty Images</figcaption>
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<p>Redesigned Covid-19 vaccines could save thousands of lives, but few are getting them.</p> <p id="1qPodQ">Another winter, another wave.</p>
<p id="isWK8x">With the leaves changing color, temperatures dropping, and people spending more time indoors, health officials are warning of a spike not just in Covid-19 cases but other infections as well.</p>
<p id="WKWMuj">“The challenge with holiday seasons every year is it’s also a time where contagious respiratory viruses — like influenza, RSV, and, again this year, Covid — spread much more quickly,” said Ashish Jha, the White House Covid-19 response coordinator, during a <a href="https://www.whitehouse.gov/briefing-room/press-briefings/2022/10/11/press-briefing-by-press-secretary-karine-jean-pierre-and-covid-19-response-coordinator-dr-ashish-jha-5/">press conference on Tuesday</a>. </p>
<p id="WsMZbx">Covid-19 cases are already <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/europe-likely-entering-another-covid-wave-says-who-ecdc-2022-10-12/">rising in Europe</a>, a trend that has preceded waves of infection in the US in the past. The key question: Just how deadly will Covid-19 be this winter?</p>
<p id="T1rkn2">Jha said that Covid-19 is not the same disruptive threat it was in the past two years. It’s likely that cases will increase again, but that they won’t cause the towering spike of hospitalizations and deaths experienced last winter, which were fueled by the <a href="https://www.vox.com/coronavirus-covid19/2022/1/4/22864934/covid-19-us-omicron-cases-hospitalizations-deaths-2022">omicron variant</a> of the SARS-CoV-2 virus that causes Covid-19. In January, more than <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/past-reports/01282022.html#:~:text=COVID%2DNET%20Data-,Deaths,-The%20current%207">2,000 people per day</a> died from Covid-19. Currently, about 300 people are dying every day in the US from the disease. </p>
<p id="Rnl9Wj">What’s changed is that far more people have been vaccinated and exposed to Covid-19 by now, so “basically, no one is seeing this virus for the first time at this point,” said <a href="https://sph.unc.edu/adv_profile/justin-lessler-phd/">Justin Lessler</a>, a professor of epidemiology at the University of North Carolina who develops Covid-19 models. That means most people now have some degree of protection against the disease, which lowers the likelihood of dying from it. </p>
<p id="8ur5MJ">But that’s not enough to absorb another wave of misery. Protection from Covid-19 exposure or vaccination fades over time. Some groups, like older adults and immunocompromised people, <a href="https://www.vox.com/science-and-health/23316450/covid-19-death-rate-vaccine-booster-elderly">remain at higher risk</a> of severe illness and death from Covid-19 even with vaccines. The virus itself is continuing to change in ways that make it easier to spread and harder to counter. And while most US adults have received at least one dose of a Covid-19 vaccine, only a tiny fraction are up to date on their boosters. </p>
<aside id="vVy05G"><div data-anthem-component="readmore" data-anthem-component-data='{"stories":[{"title":"Why Covid-19 death rates remain stubbornly flat","url":"https://www.vox.com/science-and-health/23316450/covid-19-death-rate-vaccine-booster-elderly"}]}'></div></aside><p id="T4ckXT">Treatments for those infected with the virus also have caveats: Not everyone is getting this care after they’re infected. And some therapies, like monoclonal antibodies, which counter the virus in early stages of the disease, are becoming less effective against the new variants. </p>
<p id="WqI0Ss">What’s clear is that Covid-19 can continue to surprise, confound, and frustrate, but our actions now can limit much of its potential harm. </p>
<p id="NXtNqo">“What happens in the weeks and months ahead will have a large impact on how the winter goes,” Jha said. “And really what happens in this winter is largely up to us, as the American people.”</p>
<h3 id="hd283p">One of the biggest factors shaping the course of Covid-19 is within our control</h3>
<p id="r5lBdJ">The Centers for Disease Control and Prevention now recommends that <a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html">all people over the age of 5</a> get a booster dose of a <a href="https://www.vox.com/science-and-health/23341417/booster-bivalent-covid-19-vaccine-shot-new-pfizer-moderna">bivalent Covid-19 vaccine</a> after completing their initial vaccine regimen. These reformulated mRNA vaccines — from Moderna and Pfizer/BioNTech — are optimized to target the original version of the SARS-CoV-2 virus, as well as some of the newer omicron subvariants. </p>
<p id="9xlocc">Boosters ramp up immune protection and reduce the likelihood of severe Covid-19 cases. The problem is that few people are getting boosted. Almost <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-additional-dose-totalpop">80 percent of the US population</a> has had at least one Covid-19 vaccine dose. Yet since regulators gave bivalent boosters the green light last month, less than 4 percent of eligible Americans have received the new shots. Even among people over the age of 65, one of the highest-risk groups for severe Covid-19, less than one-third have gotten the bivalent booster.</p>
<p id="9B68Rx">If rates remain this low, that could lead to more hospitalizations and deaths this winter. The <a href="https://www.commonwealthfund.org/blog/2022/fall-covid-19-booster-campaign-could-save-thousands-lives-billions-dollars">Commonwealth Fund</a>, a nonprofit health research group, mapped out different scenarios for booster uptake. At current vaccination rates, they estimated the US could see upward of 1,200 deaths from Covid-19 per day by this coming March. </p>
<p id="D9kgts">However, if Covid-19 bivalent booster rates matched that of the influenza vaccine last year — about <a href="https://www.cdc.gov/flu/fluvaxview/coverage-2021estimates.htm">50 percent uptake</a> — daily deaths would continue declining, reaching around 200 per day. By spring 2023, the reformulated vaccines would avert 75,000 deaths. If 80 percent of eligible people get their bivalent shots by the end of the year, deaths would decline even further, saving 90,000 lives by the spring. </p>
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<img alt="A graph showing Covid-19 death rate projections for winter 2022 and spring 2023 under three different vaccine booster scenarios." data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/Pfl9Z_w20BK3ahiYo9MBQTfoO7c=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24105935/Screen_Shot_2022_10_12_at_3.30.42_PM.png">
<cite><a class="ql-link" href="https://www.commonwealthfund.org/blog/2022/fall-covid-19-booster-campaign-could-save-thousands-lives-billions-dollars" target="_blank">Commonwealth Fund</a></cite>
<figcaption>Thousands of deaths could be avoided if more people received Covid-19 vaccine boosters.</figcaption>
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<p id="y3lThm">The key is to get as many people boosted as possible now, though the benefits may take a while to manifest in lower cases and deaths. </p>
<p id="BY70X5">“Today’s boosters won’t necessarily cause or not cause a surge tomorrow, but this slow buildup of immunity in the population will affect what happens two, three, four months from now,” said <a href="http://www.bio.utexas.edu/research/meyers/LaurenM/index.html">Lauren Ancel Meyers</a>, director of the Covid-19 Modeling Consortium at the University of Texas in Austin, who was not involved with the Commonwealth Fund study. </p>
<p id="r5biYU">The trouble is that many people in the US don’t grasp the stakes of the current rounds of vaccination. A poll last month from the <a href="https://www.kff.org/coronavirus-covid-19/press-release/half-of-public-has-heard-little-or-nothing-about-the-new-covid-19-booster-aimed-at-omicron-many-dont-know-if-the-cdc-recommends-that-they-get-the-new-booster/">Kaiser Family Foundation</a> showed that half of Americans had heard little or nothing about bivalent Covid-19 vaccines. Only one-third of adults said they had received the new booster or were planning to get it as soon as possible. </p>
<p id="5BtxZK">So before shots can go into arms, health officials will have to raise the dismal levels of awareness of the new vaccines. </p>
<h3 id="8SqSE1">Treatments and testing remain critical as well</h3>
<p id="3ySGMn">One of the biggest uncertainties this winter is how the virus itself will change. “What the virus does and how it evolves is very key to what’s going to happen in the next few months,” Meyers said. </p>
<p id="YQlAcr">Already, SARS-CoV-2 has mutated in ways that frustrate the response to it. The latest major variant, omicron, has spawned its own subvariants. Right now, about 80 percent of Covid-19 cases in the US are caused by the <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">BA.5 subvariant</a>, but another subvariant, BA.4.6, is gaining ground. Early reports show that <a href="https://www.gavi.org/vaccineswork/another-new-covid-variant-spreading-heres-what-we-know-about-omicron-ba46">BA.4.6, a descendant of BA.4, is even better at evading the immune system</a> than BA.5. It also appears to reproduce faster.</p>
<p id="IRBNfA">While the bivalent vaccine boosters target BA.4 and BA.5, the virus could mutate further and render the vaccines less effective. Mutations can also undermine treatments like monoclonal antibodies, which are designed to attach to specific parts of the virus. If those regions change, the antibodies are less effective at slowing infections.</p>
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<img alt="White House COVID-19 Response Coordinator Dr. Ashish Jha speaks at the daily press briefing at the White House on October 11, 2022 in Washington, DC." data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/Q4TdeQk0hF7dnqznaSVMne6SXks=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24106377/GettyImages_1432637165.jpeg">
<cite>Kevin Dietsch/Getty Images</cite>
<figcaption>White House Covid-19 Response Coordinator Ashish Jha emphasized bivalent Covid-19 vaccine booster doses could prevent thousands of deaths.</figcaption>
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<p id="Zv4g5z">There are emerging complications with other treatments as well. Antiviral drugs like <a href="https://www.vox.com/the-highlight/22968986/covid-drugs-paxlovid-molnupiravir-health">Paxlovid</a> are less affected by changes in the virus, but they have to be administered early in the course of a Covid-19 infection. That’s getting tougher to do as testing rates drop off and people have a harder time finding infections before they show symptoms. Such therapies have been an important tool to decouple Covid-19 cases from deaths, helping more people who were infected survive. But Covid-19 drugs only work if people know about them and can get them in time.</p>
<p id="gyIRhz">Changes in Covid-19 testing are also making it harder to get a handle on how the disease is spreading. Many Covid-19 tests are administered at home these days, and most aren’t monitored by health officials. Among the tests that are tracked, states are <a href="https://coronavirus.jhu.edu/data/state-reporting-frequencies">reporting them less frequently</a>. The CDC has switched from daily to weekly <a href="https://www.cbsnews.com/news/covid-19-cases-deaths-cdc-ends-daily-reporting-weekly-updates/">Covid-19 data reports</a>. </p>
<p id="kMI2bK">For researchers, that’s making it harder to track the ebb and flow of the disease, and some are looking at other metrics. “I have switched my focus from cases to hospitalization,” Lessler said. Scientists are also monitoring <a href="https://www.vox.com/23005271/sewage-wastewater-surveillance-covid-19-biobot-analytics-pandemic">wastewater</a> to anticipate new spikes in cases. <a href="https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance">Virus levels in wastewater</a> are on the rise in some parts of the US now, like the Midwest and Northeast. </p>
<h3 id="sYWMgo">Covid-19 is confounding, but how we react still matters</h3>
<p id="HtdaZs">Even though it’s hard to predict exactly where Covid-19 will go, the models and forecasts show that “how we respond will impact the severity, the timing, the size of that new wave,” Meyers said. </p>
<p id="CBXZog">Getting booster rates up is likely the most impactful tactic. However, there is little political appetite for vaccine mandates, and a number of states are proposing preemptive legislation to <a href="https://www.vox.com/policy-and-politics/2022/10/6/23389145/covid-19-anti-vaccine-legislation">prevent vaccines from being required</a>. </p>
<p id="pcUFf2">Besides vaccines, getting infected people treatments for Covid-19 is crucial. Preventing infections in the first place with social distancing and wearing face masks remains effective as well, but the will to do these things is all but gone. That’s one of the biggest changes this winter compared to the last one. Meyers said it would be useful to develop guidelines and trigger points for masking, testing, and isolation recommendations, depending on factors like hospitalization rates.</p>
<p id="0YMeAP">And Covid-19 isn’t the only bug in the air. As people travel for the holidays and as the few restrictions left continue to be relaxed, other infections like influenza could also take advantage of the season. Hospitals are facing <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2022/03/25/health-worker-shortage-forces-states-to-scramble">staffing shortages</a> after two exhausting years of the pandemic. The workers who remain will likely have their hands full, so keeping people out of beds remains critical to avoid overwhelming the health care system. </p>
<p id="XSufhV">There may still be more surprises in store when it comes to Covid-19, but depending on how we respond, this winter doesn’t have to be so grim. </p>
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https://www.vox.com/science-and-health/23393321/covid-vaccine-bivalent-booster-pfizer-modernaUmair Irfan2022-09-08T07:00:00-04:002022-09-08T07:00:00-04:00When, why, and how to get a new Covid-19 booster shot
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<img alt="A theater marquee bears the message, “Boost: Let’s avoid another 2020.”" src="https://cdn.vox-cdn.com/thumbor/kdobiyvQeqfkmPk97z6H55XJACU=/0x0:3900x2925/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71337814/AP22047767319473a.0.jpg" />
<figcaption>A man walks underneath a marquee bearing a message urging people to get Covid-19 booster shots in Glendale, California, in January, when the original omicron variant was rapidly spreading. | Chris Pizzello/AP</figcaption>
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<p>Answers to your questions about the updated omicron variant vaccines.</p> <p id="EeQNJy">The wait is over: Updated versions of Covid-19 booster shots have received a green light from the Food and Drug Administration, and the Centers for Disease Control and Prevention now recommends them for all Americans age 12 and older. </p>
<p id="bnwoH1">This push for new, updated boosters is coming at a good time. Health officials are warning of another likely spike in Covid-19 transmission this fall as people head back indoors once again. </p>
<p id="vCEyqQ">The reformulated booster doses of the mRNA vaccines from Pfizer/BioNTech and Moderna are “bivalent.” That means they target the original version of SARS-CoV-2 as well as the newer omicron variant. The hope is that when administered as boosters, these new shots will increase protection against the latest mutations in the virus, and head off a rise in hospitalizations and deaths. </p>
<p id="sZoGl2">With new vaccines come new questions about what makes them better, who’s eligible, and when to get one. To help people understand when, why, and how to get their booster doses, we’re answering some of those questions here. </p>
<p id="dl3bJa">Let’s get into it.</p>
<h3 id="siFQQ5">Who’s eligible for the new coronavirus boosters?</h3>
<p id="qc1iB7">According to the CDC’s recommendations, everyone 12 and older should get an updated booster shot. People 18 and over can get either a Pfizer or Moderna shot, while teens between 12 and 18 should get a Pfizer shot, as the FDA hasn’t reviewed Moderna data for younger teens yet. The CDC’s <a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html">guidance</a> suggests that getting either booster, regardless of what prior vaccines you received, is fine, although there’s no hard data yet on mixing and matching.</p>
<p id="8qoLl0">The CDC’s Advisory Committee on Immunization Practices did not recommend updated boosters for kids younger than 12 because manufacturers haven’t yet submitted data on these age groups for the FDA’s review. That will likely happen later this fall. Meanwhile, younger kids (between 6 months and 12 years) can get the original formulation of the vaccines. </p>
<h3 id="Q9KjCq">How will I know if my booster is updated for the omicron variant? </h3>
<p id="XAyQXR">As the bivalent boosters roll out, the older, monovalent boosters will become unavailable, so you won’t have to decide whether to get one or the other. </p>
<p id="jTNWMA">For people 12 and older, it’s all bivalent boosters for now — at least, <a href="https://www.vox.com/science-and-health/23316936/covid-19-pandemic-spending-cost-effective-vaccines-ventilation-filtration-air-quality">until next-generation vaccines</a> (like universal coronavirus vaccines and intranasal vaccines) become available in the US, and that’s unlikely to happen in the next few months.</p>
<h3 id="t0OFoP">How long after my last vaccine (or a recent Covid-19 infection) should I get a new booster shot? </h3>
<p id="CKqzU8">Covid-19 infection and vaccination both provide some level of protection against future infections, which can last for a few months. During those months, your memory B cells — your immune system’s antibody factories — don’t respond as robustly to Covid-19 booster shots, perhaps because they’re busy <a href="https://www.nih.gov/news-events/nih-research-matters/covid-19-immune-response-improves-months-after-vaccination">fine-tuning</a> the quality of the antibodies they’re producing in response to the original infection or vaccine. </p>
<p id="zaoH1P">Whatever the reason, this means that if you were recently infected with or vaccinated for Covid-19, you should take a beat before getting your bivalent booster shot. </p>
<p id="9zVzc8">How many months? Regardless of whether you were recently boosted or recently got Covid, the guidance is similar. The data supporting this guidance is pretty scant, though, so while we’ve summarized it below, it’s worth knowing there’s no perfect time interval. </p>
<p id="qSBGX6"><strong>If you’ve recently had Covid-19,</strong> you’ll probably want to wait at least three months to get a booster shot (even though you technically can<em> </em>get a booster shot as soon as your symptoms are gone). A recent <a href="https://www.medrxiv.org/content/10.1101/2022.08.30.22279344v1?utm_source=substack&utm_medium=email">preprint (i.e., non-peer-reviewed) study</a> suggested that receiving a booster within two months of infection doesn’t really add much protection, and CDC guidance suggests waiting even longer to get vaccinated — <a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#infection">three months</a> after symptom onset — to improve the immune system’s response to the booster shot. </p>
<p id="sLi97q">“A Covid infection in a vaccinated person — essentially that functions as a booster,” said Andrew Pekosz, a professor of microbiology and immunology at Johns Hopkins University, in a late-July interview. </p>
<p id="6ZCbzI"><strong>If you’ve recently been boosted,</strong> the CDC offers a <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html?">tool</a> to help people determine when they are eligible for a booster. The timeline of your eligibility can change slightly based on age and individual risk factors, with people at higher risk being prioritized. But note: The CDC’s tool doesn’t include a question about recent infection. You can think of a recent infection as basically equivalent to a vaccine for the purposes of using the tool, or you can talk to your health care provider if you’re not sure what to do. </p>
<p id="sKwLSd">Generally, epidemiologist Katelyn Jetelina suggested in a recent issue of her newsletter, healthy people should <a href="https://yourlocalepidemiologist.substack.com/p/considerations-for-your-fall-booster">wait four to six months</a> after an infection or vaccination to get a booster — a bit longer than the CDC’s recommendations. She also suggests shortening that wait to three to four months for people at high risk for severe infection or who plan to attend an event where the infection risk is high (like a wedding), and stresses that, broadly speaking, there’s some uncertainty about the ideal interval between doses.</p>
<p id="WDooUu">Bottom line: Although there are no firm rules about how soon to get a bivalent booster after infection or vaccination, you’re likely to get the most bang for your vaccine buck if you give it at least three months. </p>
<h3 id="Pa5mB0">What makes these booster shots different? </h3>
<p id="zhXFwD">You might remember that mRNA vaccines are different from conventional vaccines: Rather than delivering a whole inert virus or a fragment of it, mRNA vaccines give human cells the genetic instructions for making pieces of the virus. </p>
<p id="792zOf">In the case of the Covid-19 vaccines, the vaccines serve as an assembly manual for the spike protein of the virus. The bivalent vaccines from both Moderna and Pfizer/BioNTech that have been <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-pfizer-biontech-bivalent-covid-19-vaccines-use">authorized for use in the US</a> contain mRNA instructions for making the spike protein of the original version of SARS-CoV-2 and the spike protein common to the BA.4 and BA.5 omicron subvariants. </p>
<p id="kAQUYH">After you get a vaccine, your immune system revs up and starts making antibodies, which are proteins that bind to the virus and can stop it from causing an infection. If you have high levels of antibodies that can neutralize a virus, this usually means you’re well protected against infection. Antibody production, however, tapers off over time, so a vaccinated individual may be vulnerable to an infection after a few months. A booster shot ramps antibody production back up.</p>
<p id="SLUoWR">But antibodies attach best to very particular sites on the virus. If those sites mutate, as they have with the recent SARS-CoV-2 variants, antibodies become less effective at blocking infection. The bivalent vaccines restore some of this protection by training the immune system on both a newer version and an older version of the spike.</p>
<h3 id="2DH6Pi">How effective are these boosters?</h3>
<p id="AWLUJZ">Although clinical trial data suggests the bivalent boosters offer some improvement over the older monovalent boosters, the size of the step up isn’t as big as some researchers would like it to be. </p>
<p id="MvnrGO">(A caveat here: These studies reported findings on a vaccine designed to target the BA.1 omicron variant. But the US has decided to go ahead with a vaccine that targets the more current BA.4 and BA.5 variants in the hope that it will provide more protection. European and Canadian authorities are using vaccines aimed at the spike protein found in the BA.1 subvariant. It’s a trade-off between having more human data, as with the BA.1 vaccine, versus a more timely match to the current variant, as with the BA.4/5 vaccine.) </p>
<p id="yiHBiz">The new vaccines raise antibody levels less robustly than the original boosters did — <a href="https://www.medrxiv.org/content/10.1101/2022.06.24.22276703v1">twofold</a> compared to <a href="https://www.medrxiv.org/content/10.1101/2021.11.19.21266555v1.full">25-fold</a> — and it’s not yet clear they offer much improvement in preventing severe disease or death compared with <a href="https://www.vox.com/23272815/covid-19-universal-vaccine-long-term-immunity-antibodies-b-cells">immune system memory cells</a> — B cells and T cells — trained on an earlier version of the virus. </p>
<p id="KRvlA8">Additionally, there are multiple effective treatments for Covid-19 now available. The risks of the worst forms of Covid-19 disease are in decline. Some experts have argued the money spent on bivalent vaccines would be better spent on other investments, like next-generation vaccines.</p>
<p id="EYPuGx">“We’ve spent $3 billion on these bivalent vaccines. Is that really how you’re going to best spend your money, given how uncomfortably scant those data were?” said Paul Offit, director of vaccine education at the Children’s Hospital of Philadelphia. “There are, I think, other strategies out there,” including developing intranasal vaccines that could help prevent infection. </p>
<p id="SWHXIn">But many feel the bivalent vaccines are a great step forward. For starters, the BA.4/5-targeted bivalent boosters being rolled out in the US will likely reduce the risk of transmission in the people who receive them, although that benefit is theoretical until human trial data on these vaccines becomes available — probably not for a few more weeks.</p>
<p id="B3HEET">During an Infectious Diseases Society of America briefing on Wednesday, Kathryn Edwards, scientific director of the Vanderbilt Vaccine Research Program, expressed hope that surveillance systems for detecting new viral variants and determining changes in vaccine effectiveness would simplify further iterations of booster shots. “I’m optimistic that we have a technology that allows us to rapidly change and make vaccines for different kinds of viruses,” she said. The goal is for the vaccines to follow the model of annual flu shots, with scientists making adjustments aimed at protecting people from the viral variant most likely to be circulating at any given moment. </p>
<h3 id="4faLoz">How often will we need boosters?</h3>
<p id="5QAhRS">At a White House <a href="https://www.whitehouse.gov/briefing-room/press-briefings/2022/09/06/press-briefing-by-white-house-covid-19-response-team-and-public-health-officials-88/">briefing</a> on Tuesday, chief medical adviser Anthony Fauci said Covid-19 boosters would likely go from being needed every four to six months to becoming an annual shot, much like the flu shot. Whether that actually happens depends on how things go in the coming months.</p>
<p id="4GmTPP">The indicators experts will be watching include signs that in healthy adults, protection from severe disease wanes sooner than a year after getting a booster shot. They’ll also be watching for signs that the virus is evolving unpredictably in dangerous ways. A “variant curveball” could change the plan for annual vaccination, said Ashish Jha, the White House Covid-19 response coordinator, in the same White House briefing.</p>
<p id="dF8y3C">“We’ll have to see how long the booster persists,” said Edwards during Wednesday’s briefing. “As more people throughout the world get vaccinated, we may find that there’s fewer changes to the virus,” making it easier to predict the most effective formula for future booster shots, she said.</p>
<p id="6Hh0DH">Even if next year’s Covid-19 trajectory turns out to support an annual vaccination plan, severely immunocompromised people may need more frequent booster shots because their immune systems mount a weaker response to vaccines.</p>
<h3 id="ZpAErd">Can I get a Covid-19 booster and a flu shot at the same time?</h3>
<p id="tscHYS">Yes. The CDC says <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html#:~:text=You%20can%20get%20a%20COVID,timing%20of%20other%20vaccines.">there’s no difference</a> in vaccine effectiveness or side effects whether a person gets a Covid-19 vaccine alone or with another vaccine.</p>
<p id="wAeEEe">Earlier on, before there was much “real-world” experience with Covid-19 boosters, it made sense to allow some time between these boosters and other vaccinations. That way, if people experienced adverse events after one of the vaccinations, providers could more easily identify which of the vaccines had caused the problems. But now, there’s more than enough experience with Covid-19 boosters to make the wait unnecessary.</p>
<h3 id="JiCuKs">Where do I get one of the new bivalent booster shots?</h3>
<p id="0GcADr">The US government has already purchased <a href="https://www.hhs.gov/about/news/2022/07/29/biden-harris-administration-secures-66-million-doses-modernas-variant-specific-covid-19-vaccine-booster-for-potential-use-in-fall-winter-2022.html">more than 170 million doses</a> of bivalent Covid-19 vaccines. Many of the same places that offered original booster shots will simply be replacing them with the bivalent boosters, but where those places are depends on where you live. The <a href="https://www.vaccines.gov/search/?gclid=Cj0KCQjwguGYBhDRARIsAHgRm49FEuaX4vvug-xxuXyMBwHQkXrXgjN9hOu2F0UjbzNiAZWluPiWu2YaAvTZEALw_wcB">vaccines.gov</a> website is a great way to find a location nearest you.</p>
<p id="T9Mg12">State and local health departments have vaccination sites, and many retail pharmacies, health centers, and doctor’s offices are also offering Covid-19 boosters. This morning, my local CVS had bivalent booster appointments open as soon as this Friday.</p>
<h3 id="FoJfDy">What happens if too few people get boosted?</h3>
<p id="M7rk6x">For booster shots to be effective at reducing both transmission and illness, as many people as possible need to get them. So far, just <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-additional-dose-totalpop">49 percent of people</a> eligible for a first booster in the US have gotten one. If that trend continues with the reformulated shots, boosted individuals will likely be protected, but the virus will continue spreading. That will give it more opportunities to mutate in dangerous ways.</p>
<p id="ISO60z">However, vaccines are not just a tool to protect individuals, but a way to protect the population at large, since they lower rates of transmission and relieve burdens on the health system. This extends beyond the US. As the pandemic has demonstrated over and over, problems in other countries don’t stay in other countries.</p>
<p id="up6rx3">“We have to think of Covid-19 as a global disease [and] really have to make an even stronger effort here in the US to get vaccines out into the world,” said Pekosz.</p>
<p id="cU3pjC">Otherwise, we risk repeating the same patterns of new variants causing renewed surges in cases, hospitalizations, and deaths.</p>
<h3 id="S4yWbo">Does getting a booster come at the expense of someone in a low-income country?</h3>
<p id="bY1zIU">Given the need to vaccinate the world and the ongoing vaccine inequities leaving many of the most vulnerable unprotected against Covid-19, it’s reasonable to ask whether there’s an opportunity cost to getting a fourth shot when nearly one-third of humanity has yet to receive their first.</p>
<p id="bWIexA">But experts say that your booster shot isn’t the main problem. Closing international vaccination gaps requires strategy and action from the government, not individuals.</p>
<p id="kQN9Oc">“Once a vaccine gets into your local pharmacy, it’s really not going to be pulled back and sent someplace else,” Pekosz said. “The US government needs to realistically assess what the needs are for vaccines here and send surplus vaccines directly to other countries as opposed to stockpiling them here in the US.” </p>
https://www.vox.com/science-and-health/23341417/booster-bivalent-covid-19-vaccine-shot-new-pfizer-modernaKeren Landman, MDUmair Irfan2022-08-31T12:15:00-04:002022-08-31T12:15:00-04:00New Covid-19 vaccine boosters are coming
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<img alt="A health care worker prepares a vial of the Covid-19 vaccine at a vaccination site in Times Square, New York, the United States, on June 22, 2022. A small child in a mask is in the background watching the vial be handed from one worker to another." src="https://cdn.vox-cdn.com/thumbor/MEYtYvZ7EIlcMBh0ZshAQfggQz8=/13x0:4489x3357/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71307507/GettyImages_1241466562.0.jpeg" />
<figcaption>The FDA just authorized revised Covid-19 vaccines designed to target the BA.4 and BA.5 variants. | Michael Nagle/Xinhua News Agency via Getty Images</figcaption>
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<p>The FDA just approved Covid-19 vaccines that have BA.5 in their crosshairs. Will people roll up their sleeves?</p> <p id="xYb1IN">The <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-pfizer-biontech-bivalent-covid-19-vaccines-use">Food and Drug Administration</a> on Wednesday authorized new Covid-19 vaccines for emergency use for the first time since the original vaccines were approved in December 2020, with the Center for Disease Control approving it on Thursday. The new boosters from Pfizer/BioNTech and from Moderna are targeted at the BA.4 and BA.5 subvariants of the omicron variant. They’re also the engine of a new vaccine booster campaign in the United States as health officials brace for another surge in cases.</p>
<p id="ga922I">“As we head into fall and begin to spend more time indoors, we strongly encourage anyone who is eligible to consider receiving a booster dose with a bivalent COVID-19 vaccine to provide better protection against currently circulating variants,” said FDA Commissioner Robert M. Califf in a statement.</p>
<p id="T3Hx0B">“Bivalent” refers to the fact that the vaccines contain genetic instructions for the immune system to target the original version of the SARS-CoV-2 virus that causes Covid-19, as well as the main variants in circulation now. The <a href="https://www.vox.com/23200811/covid-19-omicron-ba5-reinfection-vaccine-paxlovid">BA.4 and BA.5 subvariants</a> are notorious for evading prior immunity to Covid-19, although older Covid-19 vaccines are still preventing hospitalizations and deaths from newer versions of the virus. </p>
<p id="WkSg2S">Before those shots can start going into arms, the Centers for Disease Control and Prevention has to weigh in and come up with guidelines for how to distribute these new shots. <a href="https://www.cdc.gov/vaccines/acip/index.html">Advisers to the CDC</a> are met and approved the boosters. They announced that the shots will be available to anyone above the age of 12. Meanwhile, the US government has already ordered 170 million doses. </p>
<p id="wfMD4K">As for who is eligible, the Moderna bivalent vaccine is available to anyone over the age of 18 as a first booster or a second booster, provided it’s been at least two months since the last shot. The Pfizer/BioNTech vaccine follows the same criteria except that it’s open to people ages 12 and up. </p>
<p id="KOxEW6">For both boosters, it does not matter which vaccine you had as your initial doses. However, the bivalent vaccines are only authorized as boosters, so at the moment, they don’t replace the original vaccines for people who are completely unvaccinated. </p>
<p id="TybF8W">Officials didn’t specify whether the eligibility window is different for people who were recently infected with Covid-19, but researchers have found that surviving an infection can increase protection against reinfection. “A Covid infection in a vaccinated person — essentially, that functions as a booster,” <a href="https://publichealth.jhu.edu/faculty/1972/andrew-stanley-pekosz">Andrew Pekosz</a>, a professor of microbiology and immunology at Johns Hopkins University, told Vox earlier this month. “So you probably don’t need to get a booster for anywhere from three to six months after your Covid infection.”</p>
<p id="XYYsdP">While the rate of Covid-19 deaths in the US has fallen sharply from its peak this past winter, deaths <a href="https://www.vox.com/science-and-health/23316450/covid-19-death-rate-vaccine-booster-elderly">are still holding steady</a> at roughly 400 per day. That’s because mask mandates and social distancing measures are all but gone, allowing more opportunities for the virus to spread. The latest variants are especially adept at jumping between people. The largest share of deaths comes from people with weaker immune systems, like older adults and those with certain preexisting health conditions, including some who are vaccinated. Shielding from vaccines also wanes over time, and with so many people months out from their last dose, millions could be susceptible to another infection. </p>
<aside id="z0QyXj"><div data-anthem-component="readmore" data-anthem-component-data='{"stories":[{"title":"Should you get another Covid-19 vaccine booster now or wait for the new shots?","url":"https://www.vox.com/science-and-health/23284234/second-booster-covid-19-vaccine-bivalent-pfizer-moderna"}]}'></div></aside><p id="rZyMck">Health officials hope that the new boosters formulated to target the latest variants will keep a lid on hospitalizations and deaths this fall. But boosters are only effective if people actually get them, and it’s clear not everyone is ready to roll up their sleeves. About one in five people in the US have not received any dose of a Covid-19 vaccine, and among those who are vaccinated, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-additional-dose-totalpop">less than half are boosted</a>. If the uptake of the bivalent vaccines is similarly low, they may not do much to stem the losses of another Covid-19 surge. And as long as the virus spreads, it mutates, increasing the chances of another dangerous variant emerging.</p>
<p id="eLRNA5">Some researchers have pointed out that the reformulated vaccines are only marginally better than the original versions of the shots, so they question whether it was <a href="https://www.medpagetoday.com/opinion/faustfiles/100026">worth holding out for them</a>. Again, while the original versions of Covid-19 vaccines don’t hold off infections as well from the new variants, they still prevent most hospitalizations and deaths. </p>
<p id="xrVUw7">It’s also not clear yet whether vaccines will need to be revised on a regular basis. That hinges on changes to the virus itself and its public health impacts. Scientists are also studying <a href="https://www.vox.com/23272815/covid-19-universal-vaccine-long-term-immunity-antibodies-b-cells">universal Covid-19 vaccines</a> that could potentially protect against future variants. Those vaccines are likely years away, but they could become the last shot most people would need. </p>
<p id="qvOf7x"><em><strong>Update, September 3, 2022, 10:50 am ET:</strong></em><em> This story was updated to include information on the CDC approving the boosters. </em></p>
https://www.vox.com/science-and-health/23330675/covid-19-booster-vaccine-pfizer-moderna-fda-ba5-variant-omicronUmair Irfan2022-08-31T11:10:00-04:002022-08-31T11:10:00-04:00Why Covid-19 death rates remain stubbornly flat
<figure>
<img alt="Funeral home transporter Morgan Dean-McMillan prepares to transport a suspected Covid-19 positive body in a hospital’s morgue in Baltimore, Maryland on December 23, 2020 during the Covid-19 pandemic." src="https://cdn.vox-cdn.com/thumbor/S6swfexZes9afXYHfld5M6J1p18=/196x0:4259x3047/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71307079/GettyImages_1230294814.0.jpeg" />
<figcaption>Covid-19 death rates have fallen to about 400 per day, but health experts say that needs to drop further. | Andrew Caballero-Reynolds/AFP via Getty Images</figcaption>
</figure>
<p>Hundreds are still dying of Covid-19 every day. It doesn’t have to be this way. </p> <p id="MYU7lX">Deaths from Covid-19 are at some of their lowest rates in the United States since the start of the pandemic, but they’re still alarmingly high, according to some health officials. </p>
<p id="zVq7Yq">The <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">Centers for Disease Control and Prevention</a> reported this week that, on average, close to 400 people are dying of the disease every day. The total number of cases, hospitalizations, and deaths is trending downward, albeit at an agonizingly slow pace. And as summer gives way to fall, <a href="https://www.washingtonpost.com/health/2022/05/06/fall-winter-coronavirus-wave/">federal health officials are bracing for another spike</a> in cases. </p>
<p id="6nBRxz">The good news is that it’s unlikely the Covid-19 surge expected this fall will rack up tolls anywhere near those last year or the year before, given how much immunity is now present throughout the population. More than <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-additional-dose-totalpop">79 percent of Americans</a> have had at least one dose of a Covid-19 vaccine, 67 percent have had two, and 33 percent have had three. Add to that the protection from surviving prior waves of infection, and there are few people left whose immune systems are completely naive to the virus. Multiple <a href="https://www.vox.com/future-perfect/22841852/covid-drugs-antibodies-fluvoxamine-molnupiravir-paxlovid">effective treatments</a> are available for the disease now as well. </p>
<p id="bVUhBY">Yet despite the widespread exposure to the disease, there are still millions of people who are at risk of severe illness or death from Covid-19. “It’s really the people who have somehow managed to go without any vaccination at all,” said <a href="https://mghbwhid.hms.harvard.edu/faculty/kuritzkes/">Daniel Kuritzkes</a>, head of the infectious diseases division at Brigham and Women’s Hospital. Right now, one in five Americans haven’t received any doses of a vaccine. These people face the highest death rates, especially if they have preexisting health conditions or are older adults. They die at a rate <a href="https://covid19.ca.gov/state-dashboard/">6 to 11 times that of people who received their shots</a>. </p>
<figure class="e-image">
<img alt="US daily Covid-19 deaths from January 2022 through August 2022" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/h9yXP8rMv6YHY6x07YZMRfGBum0=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/23984894/us_state_trends.png">
<cite>Centers for Disease Control and Prevention</cite>
<figcaption>Daily Covid-19 deaths are down from their winter peak but remain flat. </figcaption>
</figure>
<p id="ALlWD5">But some vaccinated people are facing rising risks from Covid-19 as well. In fact, the number of Americans who have been vaccinated are <a href="https://www.washingtonpost.com/health/2022/04/29/covid-deaths-unvaccinated-boosters/">comprising a growing share of deaths</a>, even though their overall mortality rate remains lower than that of unvaccinated people. The latest figures show that people with multiple risk factors, like older adults who live in nursing homes, remain at high risk for complications and fatalities. Add to that waning immunity and a more transmissible version of the virus, and you have an increasing number of people becoming vulnerable again. </p>
<p id="RVOprY">“This is a pretty sad reality,” said <a href="https://www.hopkinsmedicine.org/profiles/details/sean-leng">Sean Leng</a>, a professor at Johns Hopkins University School of Medicine who studies geriatrics. “Older individuals still shoulder the majority of deaths.” </p>
<p id="TqHliC">Three years into the pandemic, Covid-19 is still one of the <a href="https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm">leading causes of death</a> across the US, but many people — individuals, businesses, even public health officials — have moved on and largely resumed life as normal. That’s making it harder to contain the spread of the disease. </p>
<p id="PPIKQQ">However, there are ways to prevent more deaths from Covid-19, even among the people who are most susceptible. These tactics demand a comprehensive public health strategy including limiting transmission of the virus, reformulating vaccines to counter the latest variants, and mounting an aggressive campaign to lift vaccination and booster uptake rates as high as possible. </p>
<p id="gjl3jT">That’s why the upcoming fall booster campaign with redesigned vaccines is so critical: The number of people who get their shots will shape the rising wave of infections and, ultimately, how many more people will die from Covid-19. </p>
<h3 id="MUjVQF">Why so many are still at risk of severe illness and death from Covid-19</h3>
<p id="2uI7gi">There are <a href="https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2020ProfileOlderAmericans.Final_.pdf">54 million adults</a> over the age of 65 in the US. Older adults also have some of the highest vaccination rates. More than 90 percent of those over the age of 65 in the US have completed their initial vaccine regimen, and more than 65 percent have received a booster. But older adults still account for most Covid-19 deaths. </p>
<p id="llWdrw">In fact, older adults are making up an even larger share of deaths now than earlier in the pandemic. Take Los Angeles County, for example. It’s the largest county by population in the US and has reported the <a href="https://coronavirus.jhu.edu/us-map">largest number of Covid-19 deaths</a>. Health officials have been tracking how these deaths have changed over time, and they found that the share of deaths among older adults had grown in recent months.</p>
<p id="evMtkH">“A higher proportion of the deaths were younger adults a year ago than this year,” said <a href="https://ph.ucla.edu/faculty/simon">Paul Simon</a>, chief science officer at the Los Angeles County Department of Public Health. From May through July of this year, 53 percent of deaths were in people ages 80 and up, and 27 percent were in people 65 to 79.</p>
<p id="7aC4fx">Several factors are at play here. One is that vaccines were rolled out by age group, with the oldest at the front of the line. For months, younger adults had to wait for their shots and continued to face Covid-19 without protection. As younger people became eligible, their share of the death toll began to shrink relative to older adults. </p>
<p id="pW2lcw">Meanwhile, older adults experience problems that leave them at greater risk than younger people, even when they’re vaccinated. As people age, their immune systems weaken or may become poorly regulated. More infections can take root or lead to dangerous overreactions. People also accumulate more chronic health conditions, like diabetes and high blood pressure, later in life. Treatments for diseases such as cancer can compromise the immune system. This further impairs the body’s ability to corral an invader, even with vaccines and boosters.</p>
<figure class="e-image">
<img alt="Karen Klink, of Hermosa Beach, visits her 86-year-old mother Cynthia Tachner at Silverado Beach Cities Memory Care in Redondo Beach on Monday, March 8, 2021." data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/6DeEAD1gV8WgmlEyL4Nzmejf2Ts=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/23984829/GettyImages_1306063897.jpeg">
<cite>Sarah Reingewirtz/Los Angeles Daily News via Getty Images</cite>
<figcaption>Some older adults still face high Covid-19 risks despite being vaccinated. </figcaption>
</figure>
<p id="3psLBg">Aging affects how well vaccines work, too. In response to a vaccine, the immune system produces antibodies, proteins that can bind to the virus and prevent it from causing an infection. Antibody levels ramp up after vaccination, but in older adults, it doesn’t always reach levels as high as in younger people. Production also tapers off faster in older adults, sometimes in less than six months, leaving them <a href="https://academic.oup.com/cid/article/75/Supplement_1/S61/6590987">more vulnerable to breakthrough infections</a>. </p>
<p id="P1UIBO">Boosters do bring antibody levels back up, but <a href="https://theconversation.com/low-vaccine-booster-rates-are-now-a-key-factor-in-covid-19-deaths-and-racial-disparities-in-booster-rates-persist-187272">uptake has been slow</a> across the US, even in people over 65. It doesn’t help matters that the virus that causes Covid-19 has continued to mutate, and the latest <a href="https://www.vox.com/science-and-health/2022/7/15/23206836/ba5-variant-covid-south-africa-portugal">subvariants of the highly transmissible omicron variant</a> are especially adept at evading the immune system. Antibodies produced from the first generation of vaccines have a more difficult time attaching to newer variants, rendering them less effective at preventing infection and illness. </p>
<p id="fKX5aZ">Public health measures meant to limit the spread of the virus are also all but gone. The CDC has relaxed <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html">Covid-19 testing and isolation</a> guidelines. Face mask mandates and social distancing regulations have disappeared throughout the country, and many people have resumed their lives and interactions as before, increasing the chances of the virus jumping from person to person. </p>
<p id="wBuLqs">But older adults are not the only ones dying. Although younger people face far lower chances of developing severe Covid-19, they also have the lowest vaccine uptake rates. During the initial omicron wave this past winter, people under the age of 18 accounted for up to a <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-06-17-18/02-covid-fleming-dutra-508.pdf">quarter of new cases</a>, with spikes in hospitalizations and deaths following thereafter. Children also experienced more opportunities for infection during the winter and spring of this year as schools reopened and gatherings resumed. </p>
<p id="xXqxDG">The continuing spread of the disease in children also poses problems for adults. Children can transmit the virus to grown-ups, including those who are more likely to experience dangerous complications. And the more that Covid-19 circulates, the greater the chances that the virus acquires mutations that make it more transmissible, more elusive, or more dangerous. </p>
<h3 id="C3MXQE">Deaths can, and should, continue to decline</h3>
<p id="8LhO3q">Covid-19 deaths are far below their peak, and while the virus is not likely to ever go away, the current death rate could still fall further. So far this year, about 4,700 people have died from Covid-19 in Los Angeles County, making the virus second only to heart disease, which killed 11,000, in terms of mortality. </p>
<p id="NdZ8fr">“Despite that lower mortality, we’re still seeing numbers that are far too high,” Simon said. “This shouldn’t be viewed as normal.”</p>
<p id="FabQPh">But deaths won’t decline on their own; it will take deliberate effort. The first step is to ensure that everyone — but particularly the most vulnerable — has their immunity topped up. </p>
<p id="GeZUDQ">The Food and Drug Administration <a href="https://www.politico.com/news/2022/08/29/fda-authorize-moderna-pfizer-biontech-omicron-boosters-00054108">is poised to authorize</a> new versions of Covid-19 vaccines from Moderna as well as Pfizer/BioNTech that are targeted against newer variants to be deployed as boosters. These reformulated doses may provide better protection against the latest versions of the virus than the original vaccines, and will be the pillar of the next booster campaign this fall. </p>
<aside id="XV0m04"><div data-anthem-component="readmore" data-anthem-component-data='{"stories":[{"title":"Should you get another Covid-19 vaccine booster now or wait for the new shots?","url":"https://www.vox.com/science-and-health/23284234/second-booster-covid-19-vaccine-bivalent-pfizer-moderna"}]}'></div></aside><p id="vVjl3u">However, improved vaccines only work if people are willing to get them, so health officials also need to come up with ways to convince more people to get their shots. </p>
<p id="ZOaH4S">“The mantra I always have is, ‘<em>Vaccination</em> saves lives, not the vaccines,’” Leng said. “You can produce all the vaccines you want and put them onto shelves and not into people’s arms, and it won’t do much good.”</p>
<p id="expOXy">And the strategy has to go beyond vaccinating the vulnerable to vaccinating the people they encounter, like family members, health workers, and staffers in care facilities. “Just as important is creating what I call a cocoon around seniors to protect them, making sure that everybody around them is also fully vaccinated,” said Simon. </p>
<figure class="e-image">
<img alt="Sr. Gloria Cote uses a her walker to carry her lunch in the cafeteria at St. Chretienne Retirement Residence, a home for Catholic nuns in Marlborough, MA on August 19, 2020. " data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/nPgBQ-fA8k3dtlsAF1wBptROp4c=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/23984972/GettyImages_1228785119.jpeg">
<cite>Craig F. Walker/Boston Globe via Getty Images</cite>
<figcaption>Vaccinating and boosting older adults and the people around them is critical to preventing more Covid-19 deaths. </figcaption>
</figure>
<p id="qS7XvO">For those who do fall ill, there are now effective treatments for Covid-19, like the antiviral drug <a href="https://www.vox.com/the-highlight/22968986/covid-drugs-paxlovid-molnupiravir-health">paxlovid</a>. That’s helped reduce the death rate from severe Covid-19, especially in older adults. However, there are still a number of hurdles ahead of getting the drug that could stop the people who need the treatment from getting it. First, you have to have a positive Covid-19 test and be aware that treatment is available. Then you have to seek out treatment in the early days of an infection and hope that the drugs are available in your area. </p>
<p id="QRtG7V">“I think that overall that immunity is probably playing a bigger role than treatment in preventing death and other severe consequences, but certainly therapeutics have played an important role in those who become infected despite vaccination,” Kuritzkes said.</p>
<p id="exfOpj">Preventing Covid-19 deaths also hinges on curbing transmission of the virus. That’s increasingly difficult as the virus continues to evolve in ways that make it more transmissible and evasive of the immune system while the patience for mask mandates and distancing evaporates. That means individuals will have to be proactive about testing themselves, isolating if they test positive for the virus, and wearing masks and distancing in high-risk settings. Another benefit of slowing the spread of the virus is that it limits the opportunities it has to mutate in dangerous ways. </p>
<p id="o0IgII">The virus itself is unlikely to go away entirely. That hundreds of people are still dying every day from this disease means the crisis is not yet over. But it’s clear that there are many ways to reduce its harm, with the most effective tactic being vaccination using the most up-to-date shots, especially for those who have yet to receive their initial course of immunizations. </p>
<p id="bZKGKe">Americans may have to live with Covid-19, but they don’t have to die from it. </p>
<p id="9j3QlA"></p>
<p id="gf1Xmy"></p>
https://www.vox.com/science-and-health/23316450/covid-19-death-rate-vaccine-booster-elderlyUmair Irfan2022-08-04T08:30:00-04:002022-08-04T08:30:00-04:00Should you get another Covid-19 vaccine booster now or wait for the new shots?
<figure>
<img alt="Two cartoon characters in white lab coats hold up medicine vials in celebration." src="https://cdn.vox-cdn.com/thumbor/hyPfSVBdv7CvH-4VQlAKXUW53U0=/417x0:7084x5000/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71207491/GettyImages_1387208392.0.jpg" />
<figcaption>Getty Images/iStockphoto</figcaption>
</figure>
<p>Covid-19 cases are rising again, but redesigned vaccines are on the horizon.</p> <p id="xHSNUd">You counted the days until your vaccine appointment, posted a selfie with a bandage on your arm, and diligently came back weeks later for the follow-up shot, already making plans to enjoy <a href="https://www.vox.com/the-goods/22336425/summer-2021-post-pandemic-vaccine-hot-girl">hot vax summer</a>. But new Covid-19 variants stepped out of the shadows, and health officials recommended that everyone get a booster dose. You got yours and thought you were done. Then omicron spawned its own subvariants that started infecting people even if they already had Covid-19 and their boosters.</p>
<p id="6LcrPU">So, do you need another Covid-19 shot?</p>
<p id="EjU2Cd">For many people, right now, the unsatisfactory answer is “it depends.”</p>
<p id="ikaHzE">Last week, the US government announced it was buying <a href="https://www.hhs.gov/about/news/2022/07/29/biden-harris-administration-secures-66-million-doses-modernas-variant-specific-covid-19-vaccine-booster-for-potential-use-in-fall-winter-2022.html">66 million doses</a> of Moderna’s variant-specific Covid-19 vaccine booster, adding to the 105 million doses of reformulated vaccines purchased from Pfizer earlier. The companies say they will likely be available in October and November. </p>
<p id="R2M9ST">“We must stay vigilant in our fight against COVID-19 and continue to expand Americans’ access to the best vaccines and treatments,” wrote Health and Human Services Secretary Xavier Becerra in a statement. “As we look to the fall and winter, we’re doing just that.”</p>
<p id="ElOHFI">But federal officials also said that they weren’t yet changing the eligibility guidelines for a fourth dose. Currently, they’re recommended only for people over the age of 50 and people who are immunocompromised. Everyone else will likely have to wait until the fall to get the go-ahead from regulators. </p>
<p id="MwZrcU">Some experts, though, think it might be worth getting a second booster now if you face a high risk of Covid-19 exposure or if your previous dose was ages ago. The rise of BA.5 has spooked many of them, despite evidence the virus causes <a href="https://covid.cdc.gov/covid-data-tracker/#hospitalizations-severity">less severe disease now</a> than at any other point during the pandemic. And despite the surge in cases, <a href="https://covid.cdc.gov/covid-data-tracker/#trends_dailydeaths_select_00">death trends have hardly moved</a>, indicating that the previous crop of vaccines is still doing its main job of preventing severe illness for most people. </p>
<p id="GF3QMM">Adding to the confusion is that public health measures like face mask mandates and social distancing requirements are disappearing, increasing the chances of exposure. So managing the risks and response to Covid-19 is almost entirely up to you, the individual, and that can be tricky when there are so many moving parts. </p>
<p id="BJq8IE">To add a little clarity, here are answers to some key questions about Covid-19 vaccine boosters.</p>
<h3 id="amS9WX">Who needs to get boosted and when? Should I get the original now or wait for the remix?</h3>
<p id="YKWMHE">The current <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html">Centers for Disease Control and Prevention guidelines</a> recommend a first booster shot for everyone 5 years old and up to be administered at least five months out from the initial doses of mRNA Covid-19 vaccines — the vaccines made by Pfizer/BioNTech and Moderna. People who received the one-dose Johnson & Johnson vaccine should get an mRNA booster at least two months out from the initial dose.</p>
<p id="a0rRwQ">As for second boosters, if you’re over 50 or immunocompromised and the timing from your first doses works out, you should get the shot right away, says <a href="https://publichealth.jhu.edu/faculty/1972/andrew-stanley-pekosz">Andrew Pekosz</a>, a professor of microbiology and immunology at Johns Hopkins University. “A booster now is going to help you avoid the hospital, and it’s something you need to do,” he explained.</p>
<div class="c-float-right c-float-hang"><aside id="ha03Kl"><q>If you’re not in a high-risk group — under 50 and pretty healthy — there’s no need to rush</q></aside></div>
<p id="7sbW72">If you're not in a high-risk group — under 50 and pretty healthy — there's no need to rush, according to Pekosz. Severe disease rates in people without other preexisting health conditions are extremely low. "I don’t think, right now, there’s a good reason to have relatively healthy individuals get a booster,” said Pekosz. </p>
<p id="vMraPQ">US <a href="https://www.nytimes.com/2022/07/28/us/politics/covid-booster-shots.html">health officials were concerned</a> that if someone in this lower-risk category gets boosted now, they may have to wait longer to get a newer vaccine, since the minimum interval between boosters is several months. Getting booster shots too close together may not lead to an effective immune response and could also raise the risk of rare complications like myocarditis. </p>
<p id="2ROCeY">Because they’re expecting a larger spike in cases later this year, health officials want to allocate more resources to a fall vaccination campaign rather than trying to get younger people boosted now. </p>
<p id="L2WMyL">However, other researchers said that depending on an individual’s risk and exposure to Covid-19, it might make sense to get topped up right away. “I think there should be flexibility and permissiveness,” Anthony Fauci, chief medical adviser to the president, told the <a href="https://www.nytimes.com/2022/07/28/us/politics/covid-booster-shots.html">New York Times</a>. </p>
<p id="TmTktr">One factor is that the revamped vaccines offer better protection against the newer variants than the original formulations (more on that below), but the improvement may not be worth waiting for. </p>
<p id="lFDhPm">“To people asking, ‘Should I take the fourth dose now or wait for the new one,’ it’s not so much better that I would wait, because we’re in the middle of a wave. You should take what you can get now,” said <a href="https://immunology.utoronto.ca/faculty/tania-watts">Tania Watts</a>, a professor of immunology at the University of Toronto. But while the bivalent vaccine isn’t perfect, it offers enough advantages to make it a preferred choice when it does become available. “I’ll probably take the bivalent vaccine when it’s available, because even if it’s incremental, it’s what we have,” she said.</p>
<h3 id="EIkKYX">What makes the booster shots different? How effective are they?</h3>
<p id="Hs0DKD">The reformulated booster doses of the mRNA vaccines from Pfizer and Moderna that the government is preparing to distribute this fall are “bivalent.” That means they contain the tools to target the original version of SARS-CoV-2 and its omicron variant. </p>
<p id="DrgfYm">Rather than delivering a whole inert virus or a fragment of it as conventional vaccines do, mRNA vaccines give human cells the genetic instructions for making pieces of the virus. In the case of the Covid-19 vaccines, they serve as an assembly manual for the spike protein of the virus. The bivalent vaccines from Moderna contain mRNA instructions for making the spike protein of the original version of SARS-CoV-2 and the spike protein common to the BA.4 and BA.5 subvariants. The Pfizer/BioNTech bivalent vaccine contains spike instructions for the original and BA.1 versions of the virus. </p>
<aside id="G8GcQu"><div data-anthem-component="readmore" data-anthem-component-data='{"stories":[{"title":"Why BA.5 is cause for concern, but not alarm. Yet.","url":"https://www.vox.com/science-and-health/2022/7/15/23206836/ba5-variant-covid-south-africa-portugal"}]}'></div></aside><p id="TKAjYq">After you get a vaccine, your immune system revs up and starts making antibodies, which are proteins that bind to the virus and can stop it from causing an infection. If you have high levels of antibodies that can neutralize a virus, this usually means you’re well protected against infection. Antibody production, however, tapers off over time, so a vaccinated individual may be vulnerable to an infection after a few months. A booster shot ramps antibody production back up. </p>
<p id="Ja1z2J">But antibodies attach best to very particular sites on the virus. If those sites mutate, as they have with the recent SARS-CoV-2 variants, antibodies become less effective at blocking infection. The bivalent vaccines restore some of this protection.</p>
<p id="QGSHq1">In clinical trials, the bivalent vaccines from Moderna and Pfizer/BioNTech did increase the level of neutralizing antibodies to omicron subvariants by less than two-fold compared to the original versions of their boosters. But the first round of booster shots raised antibody levels <a href="https://www.medrxiv.org/content/10.1101/2021.11.19.21266555v1.full-text">25-fold or more</a>, a result that’s led some researchers to say the bivalent shots aren’t a big enough improvement over the existing formula. That’s part of why there is some debate over getting boosters now to protect against the rising BA.5 wave versus waiting for a more targeted shot later this year. (Researchers have also noted that the results arose from trials of several hundred individuals, whereas the initial vaccines were tested in tens of thousands of people.)</p>
<div class="c-float-left c-float-hang"><aside id="soA3dY"><q>Getting Covid-19 shots too close together can interfere with how your immune system recognizes new variants</q></aside></div>
<p id="XcLPWI">One issue with deploying bivalent Covid-19 vaccines in the fall is that by the time they’re widely available, another variant or subvariant will likely be in circulation. That could erode their advantage over the original shots. </p>
<p id="19vd7l">Another is that antibodies are not the whole story. They do decline and can leave an opening for infection, but other parts of the immune system can readily switch back on and stop an infection from causing too much damage. So far, researchers have found that the <a href="https://www.vox.com/23272815/covid-19-universal-vaccine-long-term-immunity-antibodies-b-cells">immune system’s memory cells</a> — B cells and T cells — are still holding strong against the new variants in most people, even though they were trained with an earlier version of the virus. </p>
<p id="psvruP">And from a public health standpoint, the biggest concern isn’t preventing infection but preventing severe disease, where the virus causes enough damage to send people to the hospital or kill them. The initial Covid-19 vaccines still do the job of preventing severe disease well. A second round of boosters could blunt another surge of infections, but it’s not clear if that alone would be worth the money and effort, especially when tactics like face masks and social distancing also prevent infection. The risks from disease are also declining. There are now multiple effective treatments for Covid-19, too, so getting sick isn’t as dangerous as it used to be. </p>
<p id="H4lmZi">“We’ve spent $3 billion on these bivalent vaccines. Is that really how you’re going to best spend your money, given how uncomfortably scant those data were?” said Paul Offit, director of vaccine education at the Children’s Hospital of Philadelphia. “There are, I think, other strategies out there.”</p>
<h3 id="Go2Ayy">What if I just had Covid-19?</h3>
<p id="6dtz4c">With the recent surge of the <a href="https://www.vox.com/23200811/covid-19-omicron-ba5-reinfection-vaccine-paxlovid">BA.5 omicron subvariant</a>, lots of people who were previously infected or vaccinated are getting infected again, especially since many received their first booster more than six months ago. But surviving an infection can also boost protection against Covid-19 for a period of time. </p>
<p id="X1ldWm">"A Covid infection in a vaccinated person — essentially that functions as a booster,” Pekosz said. “So you probably don’t need to get a booster for anywhere from three to six months after your Covid infection."</p>
<p id="ywtDAt">Some researchers showed that “<a href="https://www.science.org/doi/10.1126/sciimmunol.abn8014">hybrid immunity</a>” from vaccination and infection in an individual could boost the overall immune system response and prevent future infections. But omicron subvariants like BA.5 have <a href="https://www.sfchronicle.com/bayarea/article/COVID-hybrid-immunity-omicron-17281211.php">managed to evade even this heightened protection</a> in some people. </p>
<p id="qUVb8x">This isn’t just due to changes in the virus and waning immunity. People are also letting their guards down. Schools, offices, stores, and public venues are reopening to full capacity while fewer people are masking and distancing, so the likelihood of being exposed to the virus has gone up. </p>
<p id="bPBV7n">In general, though, the timing of your last infection or booster is a better gauge of when you need another shot than the specific formulation of the next booster, according to Pekosz. </p>
<p id="YXG5x1">“I say that carefully because that’s kind of against some of the CDC guidelines,” he said. “But I think the scientific community is appreciating the fact that infection of vaccinated persons functions as a booster.”</p>
<p id="BQo1Zq">That said, there are no firm rules about <a href="https://www.nytimes.com/2022/02/03/well/live/booster-after-covid.html">how soon to get boosted</a> after recovering from Covid-19. If you haven’t had a booster dose, some health experts recommend getting it <a href="https://www.cedars-sinai.org/blog/covid-booster-after-having-covid-19.html">as soon as you are no longer contagious</a>. </p>
<h3 id="re3Y1v">Will we need a new one every year?</h3>
<p id="wMTgOy">It’s hard to say. Again, the original vaccines still do a good job of preventing deaths from Covid-19, and recent studies show that the immune system’s <a href="https://www.vox.com/23272815/covid-19-universal-vaccine-long-term-immunity-antibodies-b-cells">long-term memory</a> still holds up well against the newer variants. </p>
<div class="c-float-right c-float-hang"><aside id="Bg6IJi"><q>Scientists are working on vaccines that could cover the spectrum of current and future coronavirus variants</q></aside></div>
<p id="BB2nNY">But the virus is also changing. If a new variant arises that leads to a spike in severe disease or death, then it may be necessary. Given the current pace of mutations and patterns of immunity, that could become an annual development. “The way we are with vaccines now, I see us probably needing these bivalent or multivalent vaccines every year for the coronavirus season,” said Watts. </p>
<p id="dqaziH">At the same time, scientists are working on vaccines that could cover the spectrum of current and future coronavirus variants and investigating techniques that build up durable and longer-lasting immunity. It’s possible that a future universal Covid-19 vaccine could end up being the last one needed for most people (more on that below). </p>
<h3 id="FlOvzU">Is the testing and approval process any different?</h3>
<p id="19Rinc">With billions of doses of Covid-19 vaccines already administered around the world, there is a massive trove of information available about the safety and efficacy of the shots. So health regulators are using a more streamlined approval process for boosters that could get them into arms sooner. The <a href="https://www.theverge.com/2022/7/1/23191165/covid-variant-trials-vaccine-booster-fda">Food and Drug Administration</a> said it will not require new clinical trials for boosters targeting the most recent SARS-CoV-2 variants. This approach is similar to how influenza vaccines are reformulated year to year. </p>
<h3 id="76tmHK">What happens if too few people get boosted?</h3>
<p id="8T9Bx5">So far, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-additional-dose-totalpop">34.5 percent of people</a> who are eligible for boosters in the US have gotten them, so the uptake has been low. If that trend continues with the reformulated shots, individuals will likely be protected, but the virus will continue spreading. That will give it more opportunities to mutate in dangerous ways. </p>
<p id="xg7Xjm">However, vaccines are not just a tool to protect individuals, but a way to protect the population at large since they lower rates of transmission and relieve burdens on the health system. This extends beyond the US. As the pandemic has demonstrated over and over, problems in other countries don’t stay in other countries. </p>
<p id="2pSiCO">“We have to think of Covid-19 as a global disease [and] really have to make an even stronger effort here in the US to get vaccines out into the world,” said Pekosz.</p>
<p id="zwuiJQ">Otherwise, we risk repeating the same patterns of new variants causing renewed surges in cases, hospitalizations, and deaths. </p>
<h3 id="cFcnPE">Should I hold out for a universal vaccine?</h3>
<p id="oJYLvd">Universal Covid-19 vaccines are an exciting prospect, but they’re likely years away. These vaccines coach the immune system to target parts of the virus that rarely mutate or they serve up a sampler platter of potential viral mutations, allowing the immune system to practice responding to a spectrum of threats. </p>
<p id="mu0w93">“It represents areas that have to be high priorities for research, but are probably not going to be the immediate solutions to our current SARS-CoV-2 problems,” Pekosz said. </p>
<aside id="Qy0KUO"><div data-anthem-component="readmore" data-anthem-component-data='{"stories":[{"title":"The key to universal Covid-19 vaccines lies in your bones ","url":"https://www.vox.com/23272815/covid-19-universal-vaccine-long-term-immunity-antibodies-b-cells"}]}'></div></aside><p id="eHdefO">But what if we sprayed a firehose of money at universal vaccines the way we did with the first Covid-19 vaccines?</p>
<p id="Da1XYl">“What Operation Warp Speed taught me was that you could do this,” said Offit, referring to the US government’s $11 billion Covid-19 vaccine research initiative that funded dozens of vaccine approaches and guaranteed purchases of doses even if they didn’t work. </p>
<p id="81Ly9N">Offit argued that a <a href="https://www.vox.com/22876661/universal-covid-19-vaccine-variants-omicron">universal vaccine</a> should be a higher priority than simply remixing Covid-19 vaccines as boosters. “I think that’s money much better spent than on a questionable bivalent strategy,” he said. Even so, the research is still in early phases and plenty of laboratory and clinical testing lies ahead. </p>
<h3 id="dRODKr">Does getting a booster come at the expense of someone in a low-income country?</h3>
<p id="9ejCiX">Given what we said earlier about the need to vaccinate the world and the ongoing vaccine inequities leaving many of the most vulnerable unprotected against Covid-19, it’s reasonable to ask whether there’s an opportunity cost to getting a fourth shot when nearly one-third of humanity has yet to receive their first. </p>
<p id="HHmPwZ">But experts say that your booster shot isn’t the main problem. Closing international vaccination gaps requires strategy and action from the government, not individuals. </p>
<p id="cDnB9J">“Once a vaccine gets into your local pharmacy, it’s really not going to be pulled back and sent someplace else,” Pekosz said. “The US government needs to sort of realistically assess what the means are for vaccines here and send surplus vaccines directly to other countries as opposed to stockpiling them here in the US.”</p>
<h3 id="qHQo1q">What’s stopping me from getting more shots if I want them?</h3>
<p id="8FsoP2">Nothing, really. With the widespread availability of Covid-19 vaccines, you can get a shot free at most pharmacies and clinics, and there isn’t a robust way to check how many doses you’ve had. There have been tales of <a href="https://www.cbsnews.com/news/man-allegedly-up-to-90-covid-vaccine-shots-vaccination-card-sales/">people</a> <a href="https://www.tribuneindia.com/news/nation/84-year-old-bihar-man-gets-covid-vaccine-12-times-says-every-shot-made-him-feel-better-358740">around</a> <a href="https://www.fox5ny.com/news/man-gets-vaccinated-up-to-10-times-in-single-day">the world</a> getting vaccinated a dozen times or more. </p>
<p id="2q8bwp">But for the reasons outlined above, it’s a bad idea. Getting Covid-19 shots too close together can interfere with how your immune system recognizes new variants, and it can raise the risks of some rare side effects. </p>
<p id="DpTXMx">Whether or not you should get a shot now depends on your specific risk level: how much you’re exposed and how vulnerable you are if you get sick. If you’re under 50 but pregnant, diabetic, obese, asthmatic, or have another risk factor for severe Covid-19, talk to a health professional about the best timing for you. </p>
https://www.vox.com/science-and-health/23284234/second-booster-covid-19-vaccine-bivalent-pfizer-modernaUmair IrfanKeren Landman, MD2022-07-29T10:54:19-04:002022-07-29T10:54:19-04:00The key to universal Covid-19 vaccines lies in your bones
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<img alt="" src="https://cdn.vox-cdn.com/thumbor/8pMoiY96IArICTTcvA0QMPB9UzM=/25x0:3900x2906/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71187228/GettyImages_1300247443.0.jpg" />
<figcaption>Ruchi Srivastava, PhD, isolates human white blood cells from Covid-19 infected blood samples inside a bio safety cabinet at the University of California Irvine, in February 2021. A team there is testing a “universal” vaccine that works against many types of coronaviruses, including those not researched or discovered yet. | Leonard Ortiz/MediaNews Group/Orange County Register via Getty Images</figcaption>
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<p>Scientists are designing vaccines that could potentially cover all Covid-19 variants. </p> <p id="EYsuqm">This week, the White House held a <a href="https://www.youtube.com/watch?v=C_A3NdnCBbY">summit on the future of Covid-19 vaccines</a> that brought together scientists and vaccine manufacturers to discuss new vaccine technologies. Officials said that new vaccines are an urgent priority as US Covid-19 cases and hospitalizations are rising once again, vaccination rates are hitting a plateau, Covid-19 funding is running low, and the virus itself is <a href="https://www.vox.com/23200811/covid-19-omicron-ba5-reinfection-vaccine-paxlovid">continuing to mutate</a>. </p>
<p id="Jg377a">But in recent months, scientists have also learned that the immune cells that provide lasting protection — known as memory B cells and T cells — can keep the worst effects of the most recent versions of the virus at bay, even if they were trained to corral older strains of SARS-CoV-2. Vaccine researchers are expanding their focus from antibodies to these memory immune cells as the new discoveries open a path toward universal coronavirus vaccines. </p>
<p id="RKedi6">Universal vaccines, however, are still a long way off — possibly years — drawing on approaches never used before. “That’s a scientific challenge,” said Anthony Fauci, chief medical adviser to the president, during the summit. </p>
<p id="Zu30mz">The good news is that far fewer people are dying from the disease compared to the wave of cases this past winter spurred by the omicron variant of SARS-CoV-2, the virus that causes Covid-19. The first round of Covid-19 vaccines is still holding death rates down to around 360 per day, according to the <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">Centers for Disease Control and Prevention</a>. Still, health officials want to do better. </p>
<p id="PPxq61">“While the vaccines are terrific, hundreds of Americans, thousands of people around the world are still dying every day,” Ashish Jha, the White House Covid-19 response coordinator, said Tuesday. “Building a new generation of vaccines will make an enormous difference to bringing this pandemic to an end.” </p>
<p id="x6DGYi">The National Institutes of Health is already funding several research teams developing Covid-19 vaccines that elicit protection against many different versions of the virus, shield against future changes to the virus before they arise, and protect against other coronaviruses. </p>
<p id="4fX0bp">From there, health officials are aiming not just to develop vaccines that provide more durable protection against a wider array of threats, but also rethinking the vaccination strategy overall. With a better understanding of long-term immunity, more robust vaccines, and a comprehensive public health approach, health officials say they have a better shot at restoring normalcy. </p>
<h3 id="raHQxo">B cells and T cells hold the keys to long-lasting immunity</h3>
<p id="1qdU2L">Much of the discussion around vaccines and immunity to Covid-19 centers on antibodies, proteins produced by the immune system that attach to the virus. And indeed, they are important. </p>
<p id="bZQWOT">Antibodies that prevent the virus from causing an infection in the first place are called neutralizing antibodies. A high concentration of antibodies in the body that blocks SARS-CoV-2 is a key indicator of good protection against reinfection. Antibodies can also serve as a way to mark intruders so that other immune system cells can dispose of them.</p>
<p id="35Hj7r">But making large quantities of antibodies takes a lot of resources from the body, so their production tapers off with time after an infection or a vaccination. Another concern is that antibodies are very particular about where they attach to the virus. If the virus has a mutation at that attachment site — called an epitope — antibodies have a harder time recognizing the pathogen. That’s why some <a href="https://www.cidrap.umn.edu/news-perspective/2022/07/newest-omicron-subvariants-can-evade-boosters-antibody-therapies">antibody-based treatments for Covid-19</a> are a lot less effective at stopping the omicron subvariants. </p>
<aside id="pNwTU5"><div data-anthem-component="readmore" data-anthem-component-data='{"stories":[{"title":"This is what long-term immunity to Covid-19 might look like","url":"https://www.vox.com/22878133/omicron-coronavirus-covid-19-immunity-antibodies-vaccine"}]}'></div></aside><p id="RLLRIq">Fortunately, the immune system has other tools in its chest. Inside bone marrow lie stem cells that differentiate to become B cells and T cells. Together, they form the core of the adaptive immune system, which creates a tailored response to threats. After a virus invades a cell, it hijacks its machinery to make copies of itself. White blood cells known as cytotoxic T cells, a.k.a. killer T cells, can identify the wayward cell and make it self-destruct. This mechanism doesn’t prevent infections, but it stops them from growing out of control. </p>
<p id="oYKFOa">Another type of T cell, called a helper T cell, acts as an “on” switch for B cells, which are the cells that manufacture antibodies. After an infection is extinguished, some T cells and B cells turn into memory cells that stick around in parts of the body, ready to rev up if a virus dares to show up again. </p>
<h3 id="JEl1it">What do we now know about the adaptive immune response to Covid-19?</h3>
<p id="irDtkS">So far, the adaptive immune system seems to hold up pretty well. The first round of Covid-19 vaccines was targeted against the earliest versions of the virus, so plenty of vaccinated people have had breakthrough infections, especially from the newer variants. But only a tiny fraction of those immunized have fallen severely ill or have died. </p>
<p id="2mjdIf">That likely means that their immune systems couldn’t keep the virus out entirely, but their immune cells were able to spool up once an infection took root.</p>
<p id="4C29oq">“Someone’s neutralizing antibodies may not be up to the task, but if they have the T cell response, that may make all the difference with severe disease,” said <a href="https://med.umn.edu/bio/lab-med-and-pathology-faculty/stephen-jameson">Stephen Jameson</a>, a professor of microbiology and immunology at the University of Minnesota. </p>
<p id="geRPch">In just the past year, many studies have borne out the significance of memory B cells and T cells for long-term Covid-19 immunity and answered critical questions about whether they can respond to new variants. </p>
<p id="AUOsKV">Researchers have found that <a href="https://www.embopress.org/doi/full/10.15252/emmm.202115227">lower levels of memory B cells</a> were associated with a greater risk of breakthrough infections from the delta variant. On the other hand, <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2021.740708/full">B cells induced by Covid-19 vaccines</a> could reactivate months out from the initial vaccine doses to churn out antibodies. </p>
<p id="hAUayR">Similarly, scientists found that T cells generated by vaccines were able to recognize SARS-CoV-2 variants like omicron months later. “These data provide reasons for optimism, as most vaccine-elicited T cell responses remain capable of recognizing all known SARS-CoV-2 variants,” scientists wrote in a March paper in the journal <a href="https://www.sciencedirect.com/science/article/pii/S0092867422000733#!"><em>Cell</em></a>. </p>
<p id="ch9IT6">Another study showed that Covid-19 vaccines generated strong T cell memory that protected against the virus even without neutralizing antibodies. “I think the immunological memory which is induced by vaccines is pretty good and is actually sustained,” said <a href="https://www.vetmed.wisc.edu/people/sureshm/">Marulasiddappa Suresh</a>, a professor of immunology at the University of Wisconsin-Madison who co-authored the study, published in the <a href="https://www.pnas.org/doi/full/10.1073/pnas.2118312119"><em>Proceedings of the National Academy of Sciences</em></a> in May. </p>
<p id="l04vF0">Whether this protection will hold up over the course of years remains to be seen. Experiences with past coronaviruses like MERS showed that <a href="https://www.sciencedirect.com/science/article/pii/S1198743X21003281">antibodies to the virus can last for four years</a>. Covid-19, however, is spreading at much higher levels and mutating more than MERS did during its initial outbreak. Future protection against the disease hinges on the immune system as well as how much the virus itself will change, and scientists are closely watching both. </p>
<h3 id="WR2SYn">How scientists are approaching universal Covid-19 vaccines</h3>
<p id="H6laMW">Most vaccines to date are designed to counter one or a handful of versions of a given virus. They present the immune system with a target that allows it to prepare its defenses should the actual virus ever invade. </p>
<p id="9ECJT3">In the case of Covid-19, most vaccines coach the immune system to target the spike protein of the SARS-CoV-2 virus, which it uses to start the infection process. This helps the immune system generate strong neutralizing antibodies. But the spike protein is one of the fastest mutating parts of the virus, making it a moving target. </p>
<aside id="PduJCS"><div data-anthem-component="readmore" data-anthem-component-data='{"stories":[{"title":"Could a universal Covid-19 vaccine defeat every variant?","url":"https://www.vox.com/22876661/universal-covid-19-vaccine-variants-omicron"}]}'></div></aside><p id="HU1bKC">The fact that B cells and T cells have managed to hold off newer variants hints that it may be possible to target the virus in other ways. Rather than just making neutralizing antibodies that attach to the spike, the adaptive immune system could also produce non-neutralizing antibodies that bind to other regions of the virus that mutate very little, if at all. While these antibodies may not block an infection from taking root, they may be able to provide more durable protection against severe illness that holds up against future SARS-CoV-2 variants.</p>
<p id="xMaFcR">Another approach is to present the immune system with a variety of different potential mutations of a virus, allowing white blood cells to prepare a response to a spectrum of threats and fill in the blanks. </p>
<p id="TwhXeg">Universal vaccines have not been deployed before, so researchers are in uncharted territory, and the shots likely won’t be ready ahead of a potential fall spike in Covid-19 cases. But developing such a vaccine could eventually reduce the need for boosters and give health officials a head start on countering future outbreaks. </p>
<p id="B9ZQgI">In the meantime, US health officials are planning to distribute <a href="https://www.nytimes.com/2022/07/28/us/politics/covid-booster-shots.html">vaccines reformulated to target newer Covid-19 variants</a> by September, but it’s not clear yet what the optimal strategy will be to deploy them given the wide range of immune protection across the population. Between infections and vaccinations, the majority of people in the country have had some exposure to the virus, granting some degree of protection. And since the adaptive immune response to Covid-19 seems to be robust in most people, it may not be necessary for everyone to get an additional shot. </p>
<p id="uBmsZy">One option is to seek out those with weaker immune systems for boosters. Researchers have now developed a <a href="https://www.nature.com/articles/s41587-022-01347-6">rapid test to measure T cell responses to Covid-19</a> that could identify people who are more vulnerable to reinfections or breakthrough infections. </p>
<p id="ciU98Y">Though vaccines are absorbing the most severe consequences from Covid-19, infections are still proving disruptive. Covid-19 outbreaks are contributing to staffing shortages at hospitals, schools, and airlines, leading to delays and cancellations. And the more the virus spreads, the more opportunities it has to mutate in dangerous ways. Stopping this threat requires limiting infections, which in turn still demands measures like social distancing and wearing face masks. </p>
<p id="yb0NHl">So as good as the next generation of vaccines may prove to be, they are only one element of a comprehensive public health strategy for containing a disease. </p>
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https://www.vox.com/23272815/covid-19-universal-vaccine-long-term-immunity-antibodies-b-cellsUmair Irfan