Why the new COVID shot is a game-changer (and why the term ‘booster’ is obsolete)

Unlike earlier in the pandemic, when the initial vaccines were followed by a seemingly never-ending stream of boosters, the recently updated COVID vaccine is simple: a single shot.

Developed by Pfizer-BioNTech and Moderna and approved on September 11 by the U.S. Food and Drug Administration (FDA), the new COVID vaccines have arrived just as the latest strain of the virus is causing a spike in hospitalizations and death rates. Last week, for instance, COVID-19 deaths in the United States rose by 8 percent from the previous week, and the number of hospitalizations hit 19,079—up by nearly 4,000 from the same week the month before.

The primary reason for the rise “is because immunity is waning for many people,” says William Schaffner, an infectious disease specialist at Vanderbilt University School of Medicine. Waning immunity occurs when protective antibodies and cellular defenses that were first stimulated by vaccine or infection diminish over time. In the case of COVID-19, it takes an average of about seven months for such waning to occur from one’s last COVID infection and about nine months following one’s last COVID vaccine.

It’s why the U.S. Centers for Disease Control and Prevention (CDC) encourages people to stay up to date on their COVID vaccines.

Schaffner explains that these updated vaccines are like the annual flu shot in that we are getting closer to needing only one COVID jab a year—rendering the term “booster” obsolete. “For more than 40 years, flu shots have been updated annually to protect against new strains of influenza and we’re now updating our COVID vaccines the same way.” 

Vaccination versus infection 

Although some still believe getting infected with the virus confers greater immunity than a COVID shot, the data continues to suggest otherwise. Though research does show that so called “natural immunity” that occurs after a previous COVID infection is as protective as getting vaccinated against the virus, it is a much riskier and dangerous.

“We have ample data going back three years now showing that gaining immunity through vaccination is far safer than getting it by infection,” explains John Moore, a microbiologist and immunologist at Weill Cornell Medicine.

Schaffner points out that those who are nervous about getting the vaccine should consider that more than 600 million doses of the COVID shots have been safely administered in the U.S. (more than 12 billion globally), while the risk of hospitalization or death from a COVID infection remains. What’s more, emerging research has shown that multiple COVID infections can lead to chronic health issues such as diabetes, kidney disease, organ failure, and even mental health problems. Long COVID symptoms are also troubling and include brain fog, fatigue, chest pain, dizziness, and diminished taste or smell.

The CDC says that vaccination remains one’s best chance of reducing the risk of long COVID symptoms, chronic conditions, and hospitalization or death—a point echoed by research scientists.

“Even if someone doesn’t end up suffering hospitalization or chronic conditions as a result of a COVID infection,” Moore says, “at the very least the disease will make their life quite unpleasant for a week or longer as they deal with many disruptive symptoms. Isn’t that alone worse than a potential sore arm and a one-day headache that some experience after getting the vaccine?”

Why the new shot is prudent 

Though previous COVID vaccines provided life-saving protection against the original strain of the virus and its many subsequent variants, the latest strains of the virus, including the most common, EG.5, “carry lots of mutations that may help them evade any immunity we currently have,” says Erin Abner, an epidemiologist at the University of Kentucky College of Public Health.

The new shots, now available at pharmacies across the country, have been engineered to specifically target the Omicron subvariants circulating today.

“The most important message is for Americans to get this newly available annual immunization since it specifically targets these new (Omicron) XBB subvariants and their derivatives,” advises Peter Hotez, a physician and co-director of the Texas Children’s Hospital Center for Vaccine Development.

Who should get the new COVID vaccines and when? 

The CDC recommends that anyone six months and older receives the latest COVID shot. Leana Wen, an emergency physician and public health professor at the George Washington University Milken Institute School of Public Health, says that older adults and immunocompromised individuals should be at the front of the line: “For them, this vaccine is especially essential.” 

One area where opinions differ, however, is when to get the new shot.

Though the CDC recommends getting this vaccine if it’s been two months since one’s last COVID vaccine or infection, many epidemiologists and primary care physicians think people can wait until four to six months have passed since their last COVID vaccine or infection.

“It’s not unsafe to get it any sooner, just thought to be unnecessary so close to an earlier infection or vaccine dose,” Moore says. “It may be wise to space them out a bit more to spread out protection.”

But that’s only a question of timing. “It does not matter whether or not you got an earlier version of the vaccine be it the primary series, booster, or any COVID vaccine, the new vaccine can help protect you,” says Scott Ratzan a physician based in New York City and a lecturer at CUNY Graduate School of Public Health.

“(The new vaccine) will not provide complete protection from infection,” adds Abner, “but (it) will drastically reduce the risk of severe illness, hospitalization, and death.”

It’s also worth noting that these latest shots are “generally a one-and-done vaccine, regardless of past COVID vaccine history,” says Elizabeth Jacobs, a chronic disease epidemiologist at the University of Arizona Cancer Center. The exception is kids under the age of five who have never been vaccinated. For them, their initial vaccination should comprise of more than one dose. “Individuals who are immunocompromised may also need more than one dose.” 

Can you get the COVID shot and flu shot together? 

The CDC says, and the experts agree, that it’s okay to get both the influenza and COVID vaccines at the same time. “By now, we’ve seen plenty of data showing there are no harms associated with getting both shots together,” says Schaffner.

One consideration the experts pointed out regarding potentially spacing them apart, however, is whether you have had any kind of negative response to either vaccine in the past such as a headache, nausea, or a particularly sore arm, and whether you’d prefer spacing out those short-term side effects over two trips to the pharmacy “or suffering through just one maybe especially insufferable day,” says Moore. He adds that “by now, most people know how their body reacts to either a flu or COVID vaccine, so whatever your past short-term response to each one has been, this time will probably be similar.”

One other thing Ratzan says to consider regarding the timing of both vaccines is that “some people are waiting to get the flu vaccine in later October or November for maximum effectiveness during flu season, though they should schedule to get the latest COVID vaccine now.”

Who shouldn’t get the COVID vaccine? 

Because of age, health conditions, or other factors, the CDC sometimes advises certain groups against getting some vaccines, but that isn’t the case for COVID shots.

Currently, the only people for whom these shots are not recommended are those who have had a rare but severe allergic reaction to an earlier dose of the vaccine, or individuals with a history of myocarditis or pericarditis within three weeks of receiving any COVID-19 vaccine.

All other groups, including pregnant women, children six months and older, and those with chronic medical conditions are advised to get the updated COVID jab. In fact, for many such people, the risk of adverse effects from a COVID-19 infection makes doing so especially important.

Is the new COVID vaccine still free? 

Pfizer and Moderna have priced their updated COVID vaccines at about $125. Since the end of the public health emergency in May 2023, the U.S. federal government is no longer covering the cost of these vaccines.

Now, health insurance companies are expected to pick up the tab. There have been reports of coding issues and some hiccups with some insurances not covering the cost of the vaccines, but “hopefully these issues will get ironed out very soon,” says Hotez.

In the meantime, and for those who are uninsured or underinsured, the CDC is providing a Bridge Access Program to cover the cost of the shot through December 31, 2024. “In addition, local health departments may have some free or reduced-cost COVID vaccines available,” says Jacobs.

Both Pfizer and Moderns’a vaccines “are thought to be equivalent, so get whichever one your provider has available,” advises Schaffner. “If you are vaccinated against these latest strains of COVID during October, you should receive optimal protection through the winter.”