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Eric Lee

Virtually all Americans should get an updated <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a> shot, the Centers for Disease Control and Prevention recommended Tuesday, with the vaccines expected to become available within 48 hours — as the respiratory illness season looms.

Mandy Cohen, director of the CDC, advised that anyone 6 months and older should get at least one dose of an updated shot. Her broad recommendation came after the agency’s expert advisers voted for a universal approach to seasonal coronavirus vaccination. The shots are intended to bolster defenses as the nation heads into the fall and winter virus season, <a href="https://www.washingtonpost.com/nation/2023/08/17/vaccine-flu-season-covid-rsv/" target=_blank>when influenza and RSV are also primed to be on the rise</a>.

Cohen said the reformulated vaccines can restore protection and <a href="https://www.washingtonpost.com/health/2023/06/15/coronavirus-vaccine-update-xbb/" target=_blank>provide “enhanced protection” against variants</a> currently responsible for most infections and hospitalizations in the United States. Cohen followed the lead of the agency’s vaccine experts who earlier in the day voted for the universal vaccination policy. The move paves the way for some clinicians, pharmacies and other providers to begin administering the shots by later this week. The Advisory Committee on Immunization Practices voted 13-1 to recommend updated shots from Moderna and from Pfizer and its German partner, BioNTech, for anyone 6 months and older.

“We have more tools than ever to prevent the worst outcomes from COVID-19,” Cohen said in a statement. Last season, people who received a coronavirus vaccine achieved <a href="https://urldefense.com/v3/__https:/www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-02/slides-02-24/COVID-07-Britton-508.pdf__;!!M9LbjjnYNg9jBDflsQ!Cd1LyUvvFoMqJWeZib3g6kASUaqEx9gaEsEFLadAMlUPGNpeGhRkm1TO67UuaJo_7OllRHrN6OqvlQ$" target=_blank>greater protection </a>against illness and hospitalization than those who did not receive a 2022-2023 vaccine, the CDC said.

The updated shots target an omicron subvariant called XBB.1.5 and <a href="https://www.washingtonpost.com/health/2023/09/11/covid-vaccine-new-booster/" target=_blank>were cleared Monday by the Food and Drug Administration</a>.

A third shot, made by Novavax, is still under review by the FDA. The vaccine maker said the timing of the updated version of its coronavirus vaccine for people 12 and older “is ultimately at the discretion of the FDA.” A Novavax official told the expert vaccine panel Tuesday that doses of the vaccine are “pre-positioned” and awaiting FDA action.

Several members of the advisory panel said they supported a universal recommendation because the vaccines work against current and emerging virus variants, provide benefit across all age groups, and increase access.

“There are robust benefits of vaccination on severe illness, on death, on long covid,” said Beth Bell, a global health professor at the University of Washington. “It’s important for people to have access if they want it,” she said, even though older people like herself are at higher risk of serious illness and death. “The messaging needs to make clear that for older people and those with underlying health conditions, they really need to get a booster.”

Matthew F. Daley, a senior investigator for Kaiser Permanente’s Institute for Health Research, said the most persuasive argument for the broad recommendation was data showing that half of pediatric covid-19 deaths, while rare, were in children with no underlying conditions. “Those were preventable,” he said.

But Pablo Sanchez, the sole advisory board member who sought a narrower recommendation, said the data on children and infants is too limited. “I am very much pro-vaccination in high-risk groups,” said Sanchez, professor of pediatrics at Ohio State University College of Medicine.

The CDC recommends that everyone 5 and older receive a single dose of an updated vaccine regardless of whether they have gotten a vaccine before. Children 6 months to 4 years old who have not received a coronavirus vaccine are advised to receive a primary series with two Moderna doses or three Pfizer-BioNTech doses. The doses should be from the same manufacturer. People who are moderately or severely immunocompromised and haven’t been vaccinated against the coronavirus should receive three doses of an updated vaccine.

People recently vaccinated should wait two months before getting an updated vaccine, the CDC says. Those who have been recently infected can wait three months, but they can also get it “as soon as they’re feeling better,” Megan Wallace, a CDC official, told the panel.

Sterling N. Ransone Jr., a family physician in Deltaville, Va., said he is expecting an initial rush of patients seeking updated coronavirus shots in the next several weeks before demand quickly tapers off. Then he will set aside a few minutes to pitch shots during other medical visits.

“We tell them it will probably be once a year and think about covid vaccination now like they think about the flu shot,” said Ransone, board chair of the American Academy of Family Physicians. “It’s not a plastic bubble we are putting you in that covid can’t get to you. Now that we’ve gotten back to a more normal lifestyle, you can get exposed to the virus, and we want you to have the best protection you can.”

For younger and otherwise healthy patients who are unlikely to get severely ill from covid even without an updated shot, Ransone will encourage them to get vaccinated as a way to become less likely to infect vulnerable people. Even if they still get covid, the booster could help reduce their viral loads and the odds of transmitting the virus, he said.

This is the first time the federal government is not buying all the coronavirus shots, meaning doctors, hospitals and pharmacies must order them directly. The vaccines will still be free for most Americans who have private health insurance or coverage through Medicare or Medicaid. Under <a href="https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-50.pdf" target=_blank>federal law,</a> any coronavirus vaccine must be covered by private and public insurers immediately, as soon as it receives sign-off by the FDA.

A <a href="https://www.washingtonpost.com/health/2023/04/18/coronavirus-vaccines-free-uninsured-biden-bridge-program/" target=_blank>Biden administration program to provide the shots without cost</a> to people who don’t have insurance is also expected to be in place within 48 hours of the CDC decision, agency officials said. The shots will be available at health centers, health departments and pharmacies.

Later this week, consumers should be able to go to <a href="https://www.vaccines.gov/" target=_blank>vaccines.gov</a> to locate where the updated vaccines are available.

For each dose of the vaccine, Moderna is charging $129, and Pfizer is charging $120, company officials said Tuesday. When its shot becomes available, Novavax says it will charge $130. Consumers who have insurance will not have to pay these costs. Private providers, pharmacies and insurers pay the list price or negotiate their own discount. Vaccine makers typically charge the government a discounted rate for doses purchased for programs for the uninsured. Novavax said its contract price with the CDC is $72.50 per dose.

The updated vaccines are part of a <a href="https://www.washingtonpost.com/health/2023/08/17/eris-covid-booster-rsv-vaccine-flu-season/?itid=lk_inline_manual_18" target=_blank>revamped arsenal of protections</a> designed to counter an expected increase in covid, influenza and respiratory syncytial virus, or RSV, as the weather turns cooler and people gather indoors. Flu shots and RSV immunizations for infants and adults 60 and older are already available.

The increase in covid-related hospitalizations and infections is expected by experts because protection from prior vaccinations and infections wanes over time. While covid-related hospital admissions have been on the increase this summer, rising to more than <a href="https://covid.cdc.gov/covid-data-tracker/#maps_new-admissions-rate-county" target=_blank>18,000 </a>for the week ending Sept. 2, they are still far below previous peaks. The total was <a href="https://covid.cdc.gov/covid-data-tracker/#trends_weeklyhospitaladmissions_select_00" target=_blank>more than 34,000 </a>for the same period a year ago, according to the CDC. Weekly deaths were at 658 as of Aug. 26, slightly higher than earlier in the summer, but far lower than the weekly total of more than 3,000 in August a year ago.

Critics of an annual covid shot model note the coronavirus is not seasonal like influenza and RSV, and it can also surge in the spring and summer when immunity from booster doses administered in the fall has waned. Federal officials have not decided whether to recommend a second dose of the updated vaccines for older adults and immunocompromised people, as they did for the previous booster shots.

The federal action comes at a time of increasing concern about the spread of several new variants as the virus continues to mutate. But preliminary data suggest the updated vaccine against XBB is well-equipped to protect against severe disease and death from these latest variants, including <a href="https://www.washingtonpost.com/health/2023/08/08/eris-covid-variant-eg-5-omicron/" target=_blank>EG.5, the most prevalent variant in the United States</a>, which accounts for more than 21 percent of cases, and the closely watched <a href="https://www.washingtonpost.com/health/2023/08/25/covid-variant-ba-2-86-pirola/" target=_blank>BA.2.86, a highly mutated variant</a> that some scientists initially worried could evade prior immunity from vaccines or earlier infections.

Natalie J. Thornburg, a CDC research microbiologist who studies how viral variants escape immunity, told vaccine advisory panel members Tuesday that almost all circulating viruses are related to the XBB lineage.

Health officials and experts say they are trying to balance giving clear, straightforward guidance without discouraging a covid-weary public from getting vaccinated. At the same time, they say even a mild winter of flu and RSV has the potential to strain hospital capacity. Adding a new virus into the mix increases that potential.

Some experts have said the shots should be targeted to high-risk groups, including older people, immunocompromised individuals and patients with chronic illnesses such as diabetes and heart disease. Other people probably have built up enough immunity to ward off severe illness, they say.

Ultimately, the vaccine expert panel said its covid work group members supported the recommendation for anyone 6 months and older to get a shot after a “robust discussion.” The CDC estimates there would be 200,000 more hospitalizations and 15,000 more deaths during the next two years if the recommendation targeted only those 65 and older.

The panel members based their policy recommendation on several factors. They looked at data on severe covid-19 cases in people with and without underlying medical conditions. The vast majority of the U.S.<i> </i>population has an underlying condition that puts it at high risk. More than 70 percent of adults<i> </i>are overweight or obese, according to the CDC.

It is unclear how many people will get a new vaccine this fall. A year ago, despite a broad recommendation for an updated booster, only <a href="https://covid.cdc.gov/covid-data-tracker/#vaccination-states-jurisdictions" target=_blank>17 percent</a> of the population got one, according to the CDC.

One of the most frequently asked questions is timing, and whether people can get a coronavirus shot at the same time as their flu shot. CDC officials say it’s fine to get both at the same time.

Pulitzer Prize for National Reporting for coverage of the war on terrorism, part of national reporting team, 2002

 Robert F. Kennedy journalism award, international print, 1994 

Cornell University, BS in communication

Columbia University, MA in journalism

Lena H. Sun is a national reporter for The Washington Post covering health with a special focus on public health and infectious disease. A longtime reporter at The Post, she has covered the Metro transit system, immigration, education and was a Beijing bureau chief. 

Lena H. Sun

Northwestern University, BS in journalism and political science. 

American University, MSJ in journalism. 

Fenit Nirappil is a reporter for the Health & Science team who covers public health, infectious diseases and LGBTQ issues. He previously covered local politics. 

Fenit Nirappil

CDC recommends new covid booster shots for anyone 6 months and older

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