When should you receive your fourth dose of the COVID-19 vaccine?

(CNN) – More people can now get a second booster dose of the COVID-19 vaccine after US federal health officials announced that they will allow a larger group to receive the fourth dose of two RNA vaccines against the coronavirus. Moderna.

Adults 50 years of age or older who have received three previous doses of the mRNA vaccine may receive a second booster dose if it has been at least four months since the first booster dose. All people who received two doses of the Johnson & Johnson vaccine can also receive an additional dose of mRNA four months after the last booster dose.

Many people ask: Does this mean that everyone will need an annual booster dose of the COVID-19 vaccine? Do we need booster doses more often? Will it be combined with the flu vaccine? Will new vaccines be developed that target new variants? And should they wait to get the booster if they qualify or get it now?

To help answer these questions, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at George Washington University’s Milken Institute of Public Health. She is also the author of Life Lines: A Doctor’s Journey in the Fight for Public Health.

Kyrie Irving will finally be able to play in New York 2:36

CNN: Will everyone need a fourth dose of the Covid-19 vaccine every year?

stave. Lina One: We don’t know yet. There are a lot of variables here, and only time and constant research will tell.

First, we don’t know how long the immune protection from the first vaccine and booster will last. There is plenty of evidence that the first booster dose is very important. During the time when Omicron was the dominant alternative, the effectiveness of the three doses against serious diseases remained high, at 94%, according to a study by the US Centers for Disease Control and Prevention (CDC). If this protection starts to diminish significantly, it will be a sign that another booster is needed.

Second, there may be new variables that develop over time. The influenza vaccine is given annually after it is reconstituted each year to detect new mutations. Current vaccines work well against omicron sub-variants, but if there are future variants that avoid vaccine-induced immunity, this is another reason for additional vaccines.

Third, we must monitor the spread of COVID-19. For now, it’s still prevalent worldwide, but if it does end up working out, regular booster doses may not be needed. As Dr. Anthony Fauci, chief medical advisor to President Joe Biden, told CNN, “Is it eventually going to drop so low that we might not even need a booster dose every year?” It is possible, but we don’t know yet.

Fourth, we need to know if there is clear seasonality in future COVID-19 outbreaks. Other coronaviruses that cause colds are more prevalent in winter, as are other respiratory viruses such as RSV (respiratory syncytial virus) and influenza. SARS-CoV-2 is also likely, and spikes occurred during the winter months. However, this part has not yet been seen in the upcoming fall and winter.

Finally, there are logistical considerations to think about. Adding an annual vaccination is a big task. Uptake of the influenza vaccine is already low; Only about half of Americans get it each year. With the misinformation and polarization surrounding covid-19, boosting this level of frequency will be challenging.

CNN: Currently, a second booster is already allowed four months after the first, which means the current frequency is more than once a year. Could reinforcements be needed even more than once a year?

Wen: It’s possible. I want to emphasize that there are many things we do not know, simply because we do not have the ability to predict the future.

There are two different scenarios that can occur. One is that certain groups of people may need more frequent vaccinations. Remember that people who have been moderately or severely immunosuppressed for months have been advised to get an extra booster dose. In the future, it may be recommended that some of the most vulnerable populations be vaccinated more frequently than the general population.

In addition, contingencies will also be required if a new variant appears that circumvents previous immunity. There must be an option to rapidly develop, manufacture and distribute different types of vaccines. If this happens, it may end up recurring more than once a year for a certain period of time.

In the future, we should also consider the availability of other treatments and mitigation measures. For example, Evusheld is an antibody infusion that, when given to immunocompromised people, is very effective in reducing the possibility of progression to severe disease. Antiviral tablets and monoclonal antibodies are effective treatments when given early in the course of the disease. Other preventive measures, including wearing masks and testing for COVID-19 before gatherings, can also reduce risks.

Is a fourth dose of the COVID-19 vaccine necessary? 2:53

CNN: If the Covid-19 vaccine is given annually, does it make sense to combine it with the flu vaccine?

Wen: In theory, yes, but we don’t know if the covid-19 vaccine should be an annual injection.

There are other vaccines that last longer. The Tdap (tetanus-diphtheria) vaccine, for example, requires a booster dose every 10 years. The polio vaccine is a four-dose vaccine: you get four doses and you’re good to go. Hepatitis B is a three-dose vaccine.

Covid-19 may be three or four doses, and that’s it, or it may need to be updated as often as the flu. Again, we don’t know yet. If it ends up being a yearly thing, and the seasonal pattern looks similar to the flu, it would make sense to get a combination vaccine, or at least get it at the same time as the flu shot.

CNN: Why aren’t there specific vaccines that target the omicron variant?

Wen: Scientists are working on these vaccines now. They are testing certain vaccines and boosters against Omicron to see if they are more effective than the original vaccines, which targeted previously dominant variants.

One consideration is the potential for additional variants to emerge, and scientists need to consider whether certain Omicron vaccines or the original vaccine, or some combination, would be more effective against potential variants in the future. This was one of the many topics discussed by the US Food and Drug Administration (FDA) advisors at their meeting this week.

CNN: If people are eligible for a booster dose now, should they get it now or should they wait?

Wen: It depends on a person’s medical conditions and how willing they are to give it up to avoid Covid-19, as I reported on CNN Q&A last week. A person over 65 years of age and/or immunocompromised will likely get the additional booster vaccine for COVID-19 now.

On the other hand, someone who is between 50 and 65 years old, does not have medical problems, and has recently had an omicron infection, is likely to wait. Some people may postpone an additional booster dose as long as they are well protected from serious illness. Others want to avoid any infection, even a mild, asymptomatic one. These are all personal decisions that should be made in consultation with your medical provider.

CNN: What’s your booster advice for people under 50? Should people get their first booster dose? Should they go for the second one?

Wen: Everyone should get their first booster dose if they are eligible. The issue of the second reinforcement is more complicated. If the person is under 50 and has moderate or severe immunodeficiency, they should also receive a second booster dose. The other group that should get a second booster dose, even if they are under 50, are those who have received two doses of Johnson & Johnson, and at least four months have passed since the last dose. All other groups under 50 are not eligible to receive a second booster at this time and you should not choose a second group.

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