Should you get the retooled COVID-19 booster?

Each successive COVID-19 vaccination shot that has come out has seen fewer takers among the public, and the latest round of boosters is no exception. Some health experts have questioned the effectiveness of the new reformulated vaccines, likely adding to the lack of public enthusiasm for getting yet another shot – especially as masking and distancing precautions have all but disappeared.

But Cape Codders should take advantage of new boosters to help protect them and those around them from serious illness and death, said William Agel, MD, chief medical officer of Cape Cod Hospital and Cape Cod Healthcare.

“I certainly urge everyone who is eligible to get their booster,” he said. “As we move into the winter months, the risk of people coming into contact with people with respiratory illness is high.”

The new vaccines, approved Sept. 1 by the federal Centers for Disease Control and Protection (CDC), include coding for the spike protein of two Omicron subvariants of the SARS-Cov-2 virus that causes COVID-19. The boosters also contain messenger RNA coding for the spike protein of the original version of the virus discovered in Wuhan, China, in 2019, according to an Aug. 30 article in Science. Previous COVID vaccines and boosters targeted only this original strain and are called monovalent. Because the new boosters offer protection against both the original virus and the BA.4 and BA.5 versions of the Omicron variant, they are termed bivalent, according to the CDC. The new boosters are only intended for people who have already received at least one COVID shot.

“The vaccine also has the added target of the more recent variants. Kind of getting more bang for your buck,” said Dr. Agel, an obstetrician/gynecologist.

New COVID-19 Test Site

Meanwhile, if you suspect that you have COVID-19, testing centers in Hyannis and Falmouth continue to offer services to the public. The Hyannis site has moved from Cape Cod Hospital to 25 Communication Way in Independence Park as of Nov. 20. Drive-through testing continues to be offered at Falmouth Hospital.

Testing appointment can be self-scheduled online through the Cape Cod Healthcare MyChart patient portal, or over the phone at 508-534-7013.

Will the Boosters Work Against Variants?

The mRNA vaccines developed by Pfizer-BioNTech and Moderna work by giving your body targets for the immune system, which creates antibodies that bind to those targets, according to the CDC.

The virus keeps mutating, and different versions rise and fall. According to the CDC’s COVID-19 Data Tracker, BA.5 was the dominant version in the United States, at 39.2 percent, for the week ending Nov. 5. BA.5 and other Omicron subvariants composed 100 percent of the samples reported nationally; none of the original virus strain was detected.

While still the most common subvariant, BA.5 has dropped considerably from late August, when it peaked at 86.5 percent. The second-most common subvariant for week ending Nov. 5 was BQ.1 at 18.8 percent, trending upward. BA.4 registered a mere 0.2 percent, a decline from the end of July, when it was 8.4 percent.

Some health experts have questioned if the boosters will be effective against new emerging versions of the virus that eventually will replace the current main strains. An Oct. 14 article in Nature noted some researchers were concerned the immune system’s tendency to tailor its response to the first version of a pathogen it encounters might hobble its ability to attack later versions. However, the article reported two small studies indicate boosters may aid the immune system’s ability to adapt to new threats.

Muddying the waters were early findings by Pfizer that a monovalent booster generated a slightly better response than a bivalent one, and a review of clinical trial data at the University of New South Wales that showed little difference in response between monovalent and bivalent vaccines, Science reported.

But more recently, on Nov. 4, Pfizer and BioNTech reported new clinical trial data showing that a month after getting a bivalent booster, antibodies targeting BA.4 and BA.5 rose 13.2 times the levels they were in adults older than 55 after a monovalent vaccine. There was a 9.5-times increase in adults 18 to 55 a month after getting the new booster. The results came from a study of 900 volunteers. It’s important to note that no large-scale human studies of the bivalent boosters’ effectiveness have been completed.

Dr. Agel said the development of the new boosters resembles the process for annual flu vaccines. Scientists create the vaccines months in advance of the coming flu season based upon their estimate as to which strains of the virus will be prevalent. The resulting vaccines vary in effectiveness from year to year.

“We do this every year for flu vaccines,” he said.

“The bivalent vaccine’s much more likely to offer protection from new and emerging subvariants,” he added. “The original strain is not out there anymore.”

Who should get a booster?

Most people 5 and older should get a booster, according to the CDC. It recommends the booster be given:

• At least two months after your last COVID shot.
• If you’ve had COVID, three months after start of symptoms or a positive test.
• The Moderna shot is approved for age 6 and up and the Pfizer-BioNTech shot is approved for 5 and up.

If you have a compromised immune system, the CDC recommends you discuss with your doctor if you should get a booster and whether you might get a protective treatment called EVUSHELD.

Some doctors and health experts say you may get a stronger immune response by waiting four to six months after having COVID or the previous monovalent vaccine, according to a New York Times article updated on Oct. 20. But Dr. Agel said “I don’t think there’s any hard evidence to offer that waiting is any better or worse.”

Interest in getting another shot has been waning among all age groups, even among the most vaccinated, those 65 and older, according to the CDC. While 80.2 percent of U.S. residents have gotten at least one COVID vaccine, and 68.5 percent have received their first shot and the following monovalent boosters, only 8.4 percent have received the new bivalent boosters. In comparison, 93.4 percent of people 65 and older have received all of the previously available shots, but only 23 percent have gotten a bivalent booster.

Dr. Agel said older residents are among those most at risk of serious consequences from COVID and getting an “updated booster is probably the most prudent thing to do.” It’s good advice for most people, he said, as it will help protect the general public.

“It’s not only good for you, but good for your grandmother, good for your sister and good for your kids.”