Thanks, great list. In the past, FDA restricted Novavax to individuals 18 years and older "for whom mRNA bivalent booster vaccines is not accessible or clinically appropriate" or "who would otherwise not receive a booster vaccine dose."
This language was very confusing to pharmacies, so many of the larger ones (like Costco) "complied" by turning away people seeking vaccines and boosters.
Will there still be restrictions on Novavax this fall? With all the mRNA shots I've received, I'd like to mix it up this time.
This is a great question, and i wish i made it clearer in this post! Novavax is still under EUA. It’s unlikely the FDA will change things for this fall. So it will still be challenging to get, if you’ve already had one booster.
Thanks for your reply. But I guess I still don't understand: when Pfizer and Moderna were under EUA, they weren't as severely restricted as Novavax currently is. So why does Novavax's EUA status matter?
If FDA/CDC truly cared about increasing the number of people who opt to get the booster, they would routinely survey and listen to "customer" concerns - and address them!
Novavax has full authorization in the Europe Union (see link below) - so why not here?
We can always "play up" our severe reaction to the mRNA vaccine - but any system that requires good people to stretch the truth is based on a bad design.
Yep…my other alternative is to continue on without a booster. I have not received one since November 2021. It is really inexcusable that the system is the way it is.
Well, they can always force us to take the vaccine/booster. If we refuse to submit to their mandates, they can take away our jobs, our income, and our rights to occupy public spaces.
Oh wait! They tried that already. It backfired miserably.
I have one employee who still thinks the mRNA shots have microchips and only took the J&J shot. Even after the warning for her age group. This makes the Novavax a welcome option when I urge vaccination in my office!
Frustrating: those who are most needy, such as with autoimmune diseases, can have flares from vaccines. More studies there would be helpful one of these days. IBD, RA, PsA, etc.,. Obviously infection can as well. But vaccine effectiveness in those taking one of the myriad of medications so often advertised would also be welcome. These are the individuals most likely to want and need the vaccine to participate in the world and life.
You mentioned that a negative for the Novavax shot was "Negative: Novavax produced significantly lower levels of a specific antibody called IgG". I'm not sure what this means. What does this antibody do? How can we understand how this might affect us?
Good question! Does lower IgG mean Novavax has more breakthrough infections vs mRNA?
I'd like to pick the booster vaccine that is most protective against breakthrough infections for the duration of the 12 months. I don't want to get sick, plus, I don't want to make others sick, especially my elderly parents.
I understand it’s safe to get the Covid and flu vaccines together. But is it optimal? Is there advantage to spacing them out? For many like me, going repeatedly to get vaccinated is very very easy because the pharmacy is in the grocery store where we go regularly anyway. If it’s even slightly better to space them out I would.
the advantage is timing it better to coincide with the waves (so fly in october), especially since the flu and covid vaccine wane pretty quickly. there is no internal immune advantage to spacing
RSV was unusually early last year (like, it started around now), and it appears to have been early again this season in the southern hemisphere, so for elderly people it is recommended to get that one now.
Biggest question yet to be answered goes to the point YLE dropped in a previous post: What is the optimum timing between infection and updated shot for those with hybrid immunity? Previous post said “at least 6 months” and promised more detail soon? Dr. Katelyn, would love this detail and some way to assess risk/reward as we do our best to plan to maximize protection (including planning travel, winter gatherings with family, etc.).
Or those who are immunocompromised. I’m still in the thick of a rebound infection right now, and who knows how long it will drag on? It seems I should get the newer booster as soon as recovered but haven’t seen any guidance.
Wow, this is so helpful no so clearly set out! Thank you so much. I’ll add (or this might duplicate) a three questions:
1) can you explain a little more the negative bout Novovax? I am also inclined to get that, to avoid the side effects I’ve experienced with the Moderna and Pfizer.
2) for those of us who had the 6th booster earlier this year (for me 6/15), do you have a recommendation re how long to wait before getting the new monovalent? Allied with that, any thoughts on how effective it will be v. the newest variants?
2) I recognize they are likely rare, but I am leery of getting the RSV vax until more is known. (I am older, but also continue to take more precautions than most--a good mask is my best friend, eg--and will continue to do that, so I am hoping I can get by without that one this year.) if you have any thoughts on how to assess risk benefit, they would be welcome.
I’ve said this before, and I’m sure I’ll say it again, but THANK YOU. I am so very grateful for clear, concise information and advice that I can trust.
I am a physician, yet have difficulty finding good information on the V Zoster/ shingles vaccine for seniors. Since this vaccine consideration factors into all the other vaccines recommended for seniors which you have discussed, please include discussion of Shringrix co-administration, side-effect profile and the best numbers available on the potential neurological side effect of GBS.
Yeah, I’m actually recommended for the shingles vax as I’m newly immunocompromised. I was scheduled for my first shingles dose when I fell ill with COVID, and 10 days later, I’m still in rebound. So I appreciate your question since I’ll now have to navigate 2 doses of that along with likely 3 other vaccines (still haven’t heard for sure from my dr about the RSV.)
Will there be restrictions to receiving Novavax this fall? It's availability is very limited in my area, and without clear language to pharmacies, it is likely that many pharmacists will refuse to give it to those of us who have had the mRNA series.
Re BA.2.86, which is a troubling variant due to it's 30+ mutations:
"It's drastically different" than the dominant variants circulating now, says Katelyn Jetelina, a scientific adviser to the CDC and author of YLE newsletter.
Later: Jetelina says she hypothesizes that if the variant spreads widely, it would be able to escape the neutralizing antibodies we have from vaccines and previous infections, making it easier to get infected, but might not be as successful with our immune system's second line of defense, the T-cells, which protect against severe disease.
I had trouble getting insurance coverage at a pharmacy for RSV although eligible. My insurance company lmk that if if the provider enters the MEDICAL number on my card rather than pharmacy number, it will be approved. Perhaps where a shot is initiated also makes a difference (my doctor would seek approval through the medical side of things). I’ll see later today.
Update. I could not in NYC obtain a medically based RSV vaccine; only pharmacies provide, and an attempt to get a prescription to bridge the gap did not work. I called my insurance company and they are working on a single waiver, just for me. This seems silly. Updates as I have them.
- From what you're describing your insurance is working on figuring out how to pay for the shot using a single case agreement. Basically everyone involved will be regarded as being in network for the purpose of this claim
- One of the important things that Obamacare gave us is requiring health insurance companies to maintain at least an 80% "medical loss ratio" - 80% of their expenses are supposed to be on paying out claims (vs say paying admin costs or CEO salaries). Paying for vaccines shots is low hanging fruit!
Regarding the RSV vaccine. Has RSV recently become more prevalent or dangerous, or is it just a matter of a vaccine now being available? Given the uncertainty about whether there is a safety issue, would you recommend a healthy older adult, who is already being relatively cautious regarding masking, etc., get the vaccine now or wait for further safety data?
Can you please do a deeper dive into immunological imprinting (starting with what it is, for a layperson!) and how it might be impacted by not only multiple boosters, but also getting vaccines after an infection? TYIA
Here’s a link to an abstract which states we shouldn’t be using the bivalent booster vaccines anymore due to imprinting (which I don’t fully understand, either):
Great questions and very helpful answers! Thanks so much for doing this, Dr. Jetalina. It feels like the FDA/CDC have been taking their time getting to this point, since we have a wave of sorts right now, but your point about winter having a worse one is well made. Those of us under 65 are now on an annual basis for the Covid vaccine, too, so I’m sure getting their ducks in a row for a fall roll out puts this right on target.
I’m 62 and have had four Moderna Covid shots and one Pfizer (the bivalent). I know you’ve discussed this before, but is there any new information on getting additional benefit from going with Novavax this time, beyond what you’ve outlined here?
Also, will we know before the upcoming ACIP meeting how the three new boosters fare against BA.2.86?
Thanks, great list. In the past, FDA restricted Novavax to individuals 18 years and older "for whom mRNA bivalent booster vaccines is not accessible or clinically appropriate" or "who would otherwise not receive a booster vaccine dose."
This language was very confusing to pharmacies, so many of the larger ones (like Costco) "complied" by turning away people seeking vaccines and boosters.
Will there still be restrictions on Novavax this fall? With all the mRNA shots I've received, I'd like to mix it up this time.
This is a great question, and i wish i made it clearer in this post! Novavax is still under EUA. It’s unlikely the FDA will change things for this fall. So it will still be challenging to get, if you’ve already had one booster.
Thanks for your reply. But I guess I still don't understand: when Pfizer and Moderna were under EUA, they weren't as severely restricted as Novavax currently is. So why does Novavax's EUA status matter?
If FDA/CDC truly cared about increasing the number of people who opt to get the booster, they would routinely survey and listen to "customer" concerns - and address them!
Novavax has full authorization in the Europe Union (see link below) - so why not here?
https://ir.novavax.com/press-releases/2023-07-06-Novavaxs-Nuvaxovid-TM-Receives-Full-Marketing-Authorization-in-the-EU-for-the-Prevention-of-COVID
So, really not an option for many folks. And so frustrating for those of us that don’t want Moderna or Pfizer again.
We can always "play up" our severe reaction to the mRNA vaccine - but any system that requires good people to stretch the truth is based on a bad design.
Yep…my other alternative is to continue on without a booster. I have not received one since November 2021. It is really inexcusable that the system is the way it is.
Well, they can always force us to take the vaccine/booster. If we refuse to submit to their mandates, they can take away our jobs, our income, and our rights to occupy public spaces.
Oh wait! They tried that already. It backfired miserably.
Ridiculous statement.
I have one employee who still thinks the mRNA shots have microchips and only took the J&J shot. Even after the warning for her age group. This makes the Novavax a welcome option when I urge vaccination in my office!
Frustrating: those who are most needy, such as with autoimmune diseases, can have flares from vaccines. More studies there would be helpful one of these days. IBD, RA, PsA, etc.,. Obviously infection can as well. But vaccine effectiveness in those taking one of the myriad of medications so often advertised would also be welcome. These are the individuals most likely to want and need the vaccine to participate in the world and life.
9/12, noted and thank you!!
You mentioned that a negative for the Novavax shot was "Negative: Novavax produced significantly lower levels of a specific antibody called IgG". I'm not sure what this means. What does this antibody do? How can we understand how this might affect us?
Good question! Does lower IgG mean Novavax has more breakthrough infections vs mRNA?
I'd like to pick the booster vaccine that is most protective against breakthrough infections for the duration of the 12 months. I don't want to get sick, plus, I don't want to make others sick, especially my elderly parents.
But, also, the protection waned less quickly. So, that is appealing. It seems antibodies don’t mean much. At least, we don’t yet understand them.
There is no vaccine now that confers 12 months, not even the flu does that. I wouldn't anticipate anything for COVID like that either.
Duration between annual shots = 12 months
I understand it’s safe to get the Covid and flu vaccines together. But is it optimal? Is there advantage to spacing them out? For many like me, going repeatedly to get vaccinated is very very easy because the pharmacy is in the grocery store where we go regularly anyway. If it’s even slightly better to space them out I would.
the advantage is timing it better to coincide with the waves (so fly in october), especially since the flu and covid vaccine wane pretty quickly. there is no internal immune advantage to spacing
Thank you! So flu vax in October, Covid vax November? When for RSV? In terms of coinciding with waves?
RSV was unusually early last year (like, it started around now), and it appears to have been early again this season in the southern hemisphere, so for elderly people it is recommended to get that one now.
If a person is still being careful (masks at market, on planes) - do we even need an RSV vaccine? It seems less contagious than covid.
That is my plan and sequence also. Just got the Flu vax. Aiming at 10-14 day intervals - no scientific basis, though.
Biggest question yet to be answered goes to the point YLE dropped in a previous post: What is the optimum timing between infection and updated shot for those with hybrid immunity? Previous post said “at least 6 months” and promised more detail soon? Dr. Katelyn, would love this detail and some way to assess risk/reward as we do our best to plan to maximize protection (including planning travel, winter gatherings with family, etc.).
I would like to know this as well! I’m currently recovering from COVID an am unsure when I should get the new booster.
Or those who are immunocompromised. I’m still in the thick of a rebound infection right now, and who knows how long it will drag on? It seems I should get the newer booster as soon as recovered but haven’t seen any guidance.
Wow, this is so helpful no so clearly set out! Thank you so much. I’ll add (or this might duplicate) a three questions:
1) can you explain a little more the negative bout Novovax? I am also inclined to get that, to avoid the side effects I’ve experienced with the Moderna and Pfizer.
2) for those of us who had the 6th booster earlier this year (for me 6/15), do you have a recommendation re how long to wait before getting the new monovalent? Allied with that, any thoughts on how effective it will be v. the newest variants?
2) I recognize they are likely rare, but I am leery of getting the RSV vax until more is known. (I am older, but also continue to take more precautions than most--a good mask is my best friend, eg--and will continue to do that, so I am hoping I can get by without that one this year.) if you have any thoughts on how to assess risk benefit, they would be welcome.
I’ve said this before, and I’m sure I’ll say it again, but THANK YOU. I am so very grateful for clear, concise information and advice that I can trust.
I am a physician, yet have difficulty finding good information on the V Zoster/ shingles vaccine for seniors. Since this vaccine consideration factors into all the other vaccines recommended for seniors which you have discussed, please include discussion of Shringrix co-administration, side-effect profile and the best numbers available on the potential neurological side effect of GBS.
Yeah, I’m actually recommended for the shingles vax as I’m newly immunocompromised. I was scheduled for my first shingles dose when I fell ill with COVID, and 10 days later, I’m still in rebound. So I appreciate your question since I’ll now have to navigate 2 doses of that along with likely 3 other vaccines (still haven’t heard for sure from my dr about the RSV.)
I haven't looked, but try clinicaltrials.gov and see if a search will uncover some answers.
Will there be restrictions to receiving Novavax this fall? It's availability is very limited in my area, and without clear language to pharmacies, it is likely that many pharmacists will refuse to give it to those of us who have had the mRNA series.
I am concerned about this, as I won’t get Moderna or Pfizer so will be out of luck.
Dr Jetelina - Nice quote in today’s Wall Street Journal! 🌟
https://www.wsj.com/articles/covid-variant-fall-2023-pirola-4839517f
Paywall, could you quote the quote?
Sure - here's a summary:
Re BA.2.86, which is a troubling variant due to it's 30+ mutations:
"It's drastically different" than the dominant variants circulating now, says Katelyn Jetelina, a scientific adviser to the CDC and author of YLE newsletter.
Later: Jetelina says she hypothesizes that if the variant spreads widely, it would be able to escape the neutralizing antibodies we have from vaccines and previous infections, making it easier to get infected, but might not be as successful with our immune system's second line of defense, the T-cells, which protect against severe disease.
Given what we know about secondary attack rates, could there be any benefit to staggering within a household?
I had trouble getting insurance coverage at a pharmacy for RSV although eligible. My insurance company lmk that if if the provider enters the MEDICAL number on my card rather than pharmacy number, it will be approved. Perhaps where a shot is initiated also makes a difference (my doctor would seek approval through the medical side of things). I’ll see later today.
Update. I could not in NYC obtain a medically based RSV vaccine; only pharmacies provide, and an attempt to get a prescription to bridge the gap did not work. I called my insurance company and they are working on a single waiver, just for me. This seems silly. Updates as I have them.
Good luck. Two reasons to be optimistic:
- From what you're describing your insurance is working on figuring out how to pay for the shot using a single case agreement. Basically everyone involved will be regarded as being in network for the purpose of this claim
- One of the important things that Obamacare gave us is requiring health insurance companies to maintain at least an 80% "medical loss ratio" - 80% of their expenses are supposed to be on paying out claims (vs say paying admin costs or CEO salaries). Paying for vaccines shots is low hanging fruit!
Keep us posted.
Regarding the RSV vaccine. Has RSV recently become more prevalent or dangerous, or is it just a matter of a vaccine now being available? Given the uncertainty about whether there is a safety issue, would you recommend a healthy older adult, who is already being relatively cautious regarding masking, etc., get the vaccine now or wait for further safety data?
Can you please do a deeper dive into immunological imprinting (starting with what it is, for a layperson!) and how it might be impacted by not only multiple boosters, but also getting vaccines after an infection? TYIA
Here’s a link to an abstract which states we shouldn’t be using the bivalent booster vaccines anymore due to imprinting (which I don’t fully understand, either):
https://www.researchgate.net/publication/370632242_Deep_immunological_imprinting_due_to_the_ancestral_spike_in_the_current_bivalent_COVID-19_vaccine
Great questions and very helpful answers! Thanks so much for doing this, Dr. Jetalina. It feels like the FDA/CDC have been taking their time getting to this point, since we have a wave of sorts right now, but your point about winter having a worse one is well made. Those of us under 65 are now on an annual basis for the Covid vaccine, too, so I’m sure getting their ducks in a row for a fall roll out puts this right on target.
I’m 62 and have had four Moderna Covid shots and one Pfizer (the bivalent). I know you’ve discussed this before, but is there any new information on getting additional benefit from going with Novavax this time, beyond what you’ve outlined here?
Also, will we know before the upcoming ACIP meeting how the three new boosters fare against BA.2.86?
As always, thanks for everything that you do!
Thank you for the update!
Has there been any study regarding which Covid vaccine is best against the new variant?