(CNN) Is it time for another Covid-19 vaccine booster? That’s the question a lot of people are asking their doctors, given what happened last week – the US Food and Drug Administration changed its authorization to allow a second bivalent booster for certain people. more vulnerable to the severe consequences of Covid-19. The US Centers for Disease Control and Prevention later approved the FDA update and added additional clinical considerations to guide healthcare providers and patients.
I have lots of questions. Who is eligible for the second bivalent boosters? Is the composition of the booster the same as before? If someone gets the booster now, can they get another one in the fall? What if someone is not in one of these high-risk groups, but lives with a high-risk family member? And how has the advice changed for people who have not yet received the first booster and those who are still unvaccinated?
To find answers, I reached out to CNN medical analyst Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.
CNN: Can you update us on any major updates? Who is now eligible to receive the second bivalent booster?
Dr AS Leana Wen: There are two groups that can now receive a second bivalent booster.
These are primarily people aged 65 and over. Since the very beginning of the pandemic, we have known that the elderly are among the most susceptible to the serious consequences of Covid-19. These people can now receive their second bivalent booster if it has been at least 4 months since their first bivalent vaccine.
Second, there are immunocompromised people. The new CDC guideline is that anyone 6 years and older with moderate or severe immunosuppression can receive a second bivalent booster if it has been at least two months since the first. They should also consult their doctor; depending on their specific medical situation, they may be able to receive the bivalent booster as frequently as every two months.
CNN: Is the composition of the booster the same as before?
Magnifying glass: The bivalent booster I am referring to is the updated booster that first became available in fall 2022, which targets both the original strain of coronavirus as well as the BA.4/BA.5 subvariants omicron. Studies have shown that this booster continues to be effective against commonly circulating strains on important severe disease reduction endpoints. New eligible for their second injection would again receive this bivalent booster. It is not possible to select the original monovalent fire, and no other type of booster is available.
CNN: If someone gets the booster now, can they get another one in the fall?
Magnifying glass: It is possible that an updated version of the booster will be available in the fall and will more specifically target the dominant variants in circulation. Those newly eligible to receive the second bivalent booster are vulnerable people who would almost certainly be the same groups first eligible to receive another Covid-19 vaccine in the fall. All this to say that people should not be deterred from getting vaccinated now thinking that it will prevent them from getting another vaccine later.
CNN: What if someone is not in one of these high-risk groups, but lives with a high-risk family member?
Magnifying glass: This person would not be eligible themselves. Covid-19 vaccines are very effective in reducing the risk of hospitalization and death for the person being vaccinated. For a short time, it reduces the risk of infection, but this effect is dulled and temporary. Federal health officials did not allow family members or caregivers of high-risk individuals to receive the second bivalent booster, and I believe this is the right decision based on scientific evidence.
There are other ways to reduce your risk of contracting Covid-19 and passing it on to someone close to you. These methods include regular testing, especially when symptomatic or after exposure to an infected person, and wearing a high-quality mask in crowded indoor spaces.
CNN: How has the advice changed for people who have not yet received the first booster and those who are still unvaccinated?
Magnifying glass: He has actually changed a lot. The CDC aims to simplify vaccine recommendations and has made several important changes.
To begin with, the bivalent vaccine will be the only vaccine made available. The original monovalent vaccine will no longer be used, even in people who have not yet been vaccinated. This will help simplify vaccine administration, as pharmacies no longer need to keep both types of vaccines in stock.
Additionally, unvaccinated individuals 6 years of age and older will be considered up-to-date on their vaccines if they have received only one dose of the Pfizer-BioNTech or Moderna bivalent booster. The idea here is that most unvaccinated people in this age group have already contracted Covid-19, and one dose of the updated booster is sufficient to provide additional protection.
People who have already received coronavirus vaccines will still need at least one bivalent booster dose to be considered up-to-date. That is, even if an individual has received three or more doses of the original monovalent vaccines, they are still not considered current unless they have received at least one bivalent dose. This is an important point, as CDC data shows that less than one in five people eligible to receive the first bivalent dose received it; that means, under their new definition, less than one in five Americans previously considered fully vaccinated are actually up to date on their Covid-19 vaccines.
CNN: What’s the bottom line: should people newly eligible for boosters do so immediately?
Magnifying glass: I think people who are newly eligible should discuss with their doctor what is right for them. The CDC has issued what’s called a permissive recommendation, which means people can choose to get this extra booster if they want. A generally healthy 65-year-old man who recently had Covid-19 might choose to wait until the fall to get another booster. But an 89-year-old with kidney disease and a history of stroke and heart attack, and who isn’t eligible to take the antiviral treatment Paxlovid, may want every level of protection possible, including included with the additional reminder.
In my view, this permissive approach to additional reminders is consistent with the current situation of the Covid-19 pandemic: people should choose the level of protection that is best for them, based on their individual medical situation.