Bivalent booster news

Somewhat complicated to talk about

A couple weeks ago, some articles came out in the NEJM raising important concerns about the utility of bivalent COVID mRNA boosters in otherwise healthy people. And they didn’t get a lot of press nor have I heard anyone discussing them… so of course I wanted to write this.

Vaccines are so polarizing. And before I get into the questions, I will highlight that I appreciate the hesitancy of the media in discussing this. In the US, we are still way under-vaccinated with the primary covid vaccine series.

• 11% of 6mo to 5 year old children have received at least one dose.

• 39% of 6-12 year old children have received one dose.

• 58% of 12-17 year old children have received at least one dose.

Why is vaccine uptake so low? Enough children (millions!!) have received the vaccines and demonstrated that their safety is very certain. But the continued hesitancy to me seems to be because of the prolonged delays in approval most children had COVID before they had the opportunity to be vaccinated, decreasing the drive to pursue vaccination.

We know that protection from severe COVID and long COVID induced by infection or by vaccination doesn’t last forever and is incomplete. So there is no doubt in the scientific community that everyone should get the primary series of COVID vaccination. Whether or not your child has had COVID, the baseline vaccine series decreases their odds of getting it again, of a severe course, of long COVID and of infecting others.

The controversy is whether young healthy people (under the age of 55) should boost with the currently available bivalent booster tailored towards newer variants of COVID vaccines.

Paul Offit (Paul A. Offit, MD | Children's Hospital of Philadelphia ) wrote an opinion piece ( Bivalent Covid-19 Vaccines — A Cautionary Tale | NEJM ) expressing that he does not think this strategy makes sense. Paul Offit runs the vaccine education center at CHOP and is an internationally recognized expert in immunology and firmly pro-vaccine. So why is he recommending we slow our roll?

The bivalent booster given to individuals with prior vaccination seems to add little protection against newer variants. The theory is that the immune system reacts to the shared portion of the target that it’s already “imprinted on” rather than the new bit which we hoped would solicit a reaction. It does induce some new-variant specific immunity but the current studies suggest it’s not a lot and it may not to last. Future variant boosters could be designed differently- with a higher dose or potentially without the original variant being included to make them more effective.

He is not saying that the variant specific boosting is “over” in fact he explicitly states that our prior exposures whether from the vaccine or infection or a combination (best!) have protected us from severe outcomes from the current variants relatively well. This may not be true of future variants. But hopefully we can learn from this experience to be prepared for targeted boosters if necessary in the years to come.

The week after this article came out another study was released showing benefit of the bivalent boosters 1 month after vaccination in adults over 55 (Bivalent Omicron BA.1–Adapted BNT162b2 Booster in Adults Older than 55 Years | NEJM).

So do bivalent boosters help or not?

• We know they are safe and definitely don’t hurt. They may help some especially if it’s been more than 6 months since the last dose/infection.

• If you are high risk, any help is probably meaningful.

• Otherwise for low risk people or people recently infected or boosted, the help is relatively marginal though we may learn more about this over time.

What did I do?

• My husband and I got the bivalent booster a few months ago. I am glad we did because we had the vaccine right when it came out and our last dose had been 9 months ago.

• My son got his third dose of Pfizer in August, because he also got the first 2 doses essentially right away and it had been 9 months. Since we had just boosted him when the bivalent came out we didn’t rush and now we are going to hold off unless there is a surge or new information comes in. Maybe next fall, but we will know more by then.

• My daughter was only in the age group approved this summer and she got her 2 Moderna vaccines. She also has had COVID. I will give her the bivalent booster at some point so she’ll have a third dose too, but not sure when.

What do I tell my patients?

• If you want to boost, sure! Again it won’t hurt.

• I definitely do recommend the primary series if you haven’t yet 3 doses. 

• Please, please, please get your flu shot, perhaps more important to me than a COVID shot. It’s not too late and kids with flu have been miserable this season.

I hope you find this helpful! Drop any questions in the comments.

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Another reminder my book is up for preorder! if you want to support my work and enjoy my content please preorder Advanced Parenting today.

I am really hoping that my book has something helpful for everyone. We all deal with our children’s stuff and even if our children aren’t currently mid-challenge other parents in our communities are in the thick of it and we can better support them if we see all that happens behind the currents. 

It’s terrifying to put a book worth of content out into the universe and a heavy lift to do it on top of a full time job founding a preventive care institute… but this message made my week and is exactly why I keep on keeping on.

Yes it’s a parenting book, but “the why” is that we have to better support parents who are so alone in the hardest part of their parenting journey. If you’re looking for a speaker for an upcoming event or to support parents at your company / school / community organization also reach out, I’ll do my best to help.