What to Know About the New COVID Booster Recommendations

Health officials have updated the COVID-19 vaccine schedule in preparation for the end of the national public health emergency this week, though right now the changes apply only to older adults and people who are immunocompromised. 

People age 65 and up, as well as those whose doctors agree they need added protection because they’re immunocompromised, can get another bivalent booster made by Pfizer-BioNTech and Moderna to target the omicron strains of COVID-19, now that the US Food and Drug Administration and the Centers for Disease Control and Prevention have signed off. 

Children and adults have already been able to get an updated booster, but some people have argued that older adults should be offered another shot because advanced age comes with the highest risk of developing severe disease. 

Having an immunocompromising health condition also puts people at higher risk of severe disease, and the CDC has also simplified booster recommendations to give health care providers more wiggle room in providing immunocompromised patients one or more additional boosters as they see fit.

For everyone else, there’s no new booster recommendation for now, though the FDA and CDC have followed through on their promise to simplify (at least a little bit) the vaccine strategy going forward: All vaccine doses of Pfizer’s and Moderna’s vaccine given out will be the bivalent formulas, not the original monovalent vaccines that targeted the “original” COVID-19 strain. Novavax’s or Johnson & Johnson’s vaccines will stay authorized as options for people who either don’t want an mRNA vaccine or can’t take one.

Here’s what to know about who needs a booster, and when.

Do I need another booster? 

Everyone age 6 months and older can get a bivalent COVID-19 booster. If you’ve already gotten one (the bivalent doses started rolling out last fall), whether you should get another one now depends on your age and your health status. 

If you’re age 65 or older, you can get a second boost, as long as it’s been at least four months since your last shot. If you’re immunocompromised, you can get also get another booster, as long as it’s been at least two months since your last dose, according to the FDA’s authorization announcement. The FDA’s authorization also gives “discretion” to health care providers to provide additional doses to immunocompromised patients as they see fit. To get more clarity, you can talk with your doctor. 

The new booster recommendation for young immunocompromised children is a little murky and depends on their age and what vaccine they originally received (Pfizer’s and Moderna’s vaccines for kids are a little different and have slightly different age cutoffs. If your child is immunocompromised or you’re unsure whether another dose is needed, check in with your doctor.) 

For everyone else, there will be “potential updates” to the booster recommendation this fall, according to the CDC’s announcement endorsing the booster changes. 

COVID vaccines will work like flu shots going forward

The FDA’s proposal is for COVID-19 vaccines to roll out each year, similarly to annual flu shots, where a strain is selected for optimal protection prior to the fall and winter season. The FDA’s advisory committee, which you can watch live, is scheduled to meet on June 15 to discuss updates to the vaccine for the 2023-2024 vaccine campaign that’ll likely start this fall. 

Though we don’t know what the advisors will discuss or decide on yet, if they endorse a new vaccine formula for everyone, it’s likely a new booster recommendation for a broader group of people will come ahead of or during the winter months, when respiratory viruses spread. 

Here’s what being up-to-date on COVID-19 vaccines means for your group. 

What about the nasal vaccines?

Some scientists have been pushing for more vaccine development in mucosal vaccines (including nasal vaccines), because new vaccine technologies may have the potential to offer better infection protection against COVID-19. Aside from a presentation at January’s meeting by the National Institute of Allergy and Infectious Diseases on next-generation vaccines, which touched on the benefit of mucosal vaccines, the FDA’s plan right now doesn’t appear to address new vaccine technologies. 

Getting there requires bodies of data supporting the use of such vaccines in the US, which requires funding and demand. As the government moves away from paying for everyone’s shots, “there’s just not as much incentive” to create and test new vaccines, including nasal and inhaled vaccines, Rupali J. Limaye, an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health, said in January after the FDA’s plans for the new vaccine campaign were first announced.

“It’s gonna be a little bit of an uphill battle to get a product like that on the market, unfortunately,” Limaye said. 

What’s going on with the vaccine price hikes?

Moderna was criticized earlier this spring for planning to raise its vaccine price to up to $130, roughly four times the price the federal government currently pays, once the public health emergency ends in May and the federal government will no longer cover the cost for all vaccines. Pfizer’s adult vaccine price-per-dose will also cost $110 to $130. However, Pfizer didn’t receive the same federal money or assistance for its research, according to a CNN fact-check. The taxpayer-funded element was one of the main arguments against Moderna’s price increase. 

On Feb. 15, the same day Sen. Bernie Sanders announced that Moderna’s CEO will testify in front of a Senate committee in March, the vaccine company announced that its COVID vaccine will “continue to be available at no cost” for people in the US, whether they’re insured or uninsured. For the uninsured, Moderna has a patient assistance program that’ll go into effect this spring. Moderna didn’t immediately respond to a request for additional comment on its patient assistance program or vaccine prices moving forward.

Pfizer also said it will have a patient assistance program to keep shots free for people without health insurance and that the company expects most people with insurance will continue to pay nothing out of pocket. 

However, the details on both vaccine companies’ assistance programs for the uninsured remain unclear, and insurance companies were likely to pay for vaccines regardless of price changes. For more about health care after the COVID-19 public health emergency ends, read how treatments could be affected starting this spring.