番茄社区

Now that bivalent Omicron BA.4/5 COVID boosters are becoming more widely available, 番茄社区 asked about a dozen physicians if and when they're planning to get the latest COVID shots.

Many said they would take their boosters right away, but a few had other plans -- including not taking a booster at all.

Here are their responses, some of which have been lightly edited for length and clarity.

Peter Hotez, MD, PhD, Baylor College of Medicine in Houston

My general recommendation on the new COVID booster is to get it as soon as you are eligible, given that transmission of BA.5 is high now but may not be prevalent in a month or more from now. Now is the crunch time when you need protection. Given that protections versus hospitalizations for these boosters may not exceed 4-5 months, yet another immunization may be required for a potential winter 2023 wave. However, there is no way to know if that will look like BA.5 or something totally different, in which case the CDC may make new recommendations.

Paul Offit, MD, Children's Hospital of Philadelphia

I have received three doses of the ancestral strain vaccine and contracted a mild case of COVID in May. As a result, all the evidence suggests that I have high frequencies of virus-specific memory B and T cells, which should protect me against severe disease this winter.

I do not plan to get another dose of SARS-CoV-2 vaccines until it is clear that people who have been primed, boosted, and naturally infected are nonetheless at high risk of serious illness when encountering the virus.

John Moore, PhD, Weill Cornell Medicine in New York City

As in much of my life, I'm not "cookie-cutter" in respect of my vaccine history, so to put what I say into context, here goes.

I'm not a physician, I'm a researcher (not that that matters), age 65 and in good health. I have never had COVID-19, despite living and working "normally," if perhaps not recklessly, throughout the pandemic.

I was in the Novavax phase III trial and had two active doses of that vaccine in the spring of 2021. Solely to get vaccine-passport-related documentation for travel (Novavax was not then recognized as even existing), I had two Pfizer doses around September 2021. I have not been vaccinated again since then -- so about a year has elapsed since my last dose.

I do not intend to get an mRNA bivalent booster. I am waiting for Novavax to receive its emergency use authorization (EUA) for use as a booster. It's immaterial to me whether the version is the standard or the BA.4/5 bivalent version; I'll accept what's available first. If the EUA process drags on for too long (which may well be the case given FDA/Novavax interactions), I may "find a way" to get a Novavax standard dose anyway. I'll make that call in a month or so. I do have a vacation (foreign travel) coming up in mid-November, and I might factor that into my decision as to the timing, without obsessing over it.

As to whether a booster is "unnecessary" in certain age groups, I think we're at the point where people need to make their own decisions. If you feel like you need a booster for medical reasons (include the psychology of worrying excessively and being unhappy), then get one. But, clearly, a booster is more important to people who are in the older age ranges and/or with pre-existing health conditions. That's long been the case, and nothing has changed.

Katelyn Jetelina, MPH, PhD, Your Local Epidemiologist

I'm getting one right away! I haven't been eligible for a booster since November 2021 and have yet to be infected, so my immune system needs boosting. I'm also traveling to France in the next few weeks, so I'm trying to get all the protection I can get before then.

Robert Wachter, MD, University of California San Francisco

Yes, I'll get it right away. My last one was in early April, so my immunity has waned significantly. I don't see a point in waiting and generally think it's a bad strategy to try to "time the market."

I haven't had COVID yet (that I know of) and I was exposed to my wife (who had it) a few weeks after my last booster and managed to avoid getting it. That's what happens when you wait to be covered for holiday season, or the next surge, or whatever.

I think it's useful in all age groups – the risk is near zero and the benefit is strong. Even for young people at low risk of hospitalization, long COVID is a real threat and the vaccine lowers the chance of that. So as long as people are more than 3 months out from infection or case, I think everybody should get it.

Robert Schooley, MD, University of California San Diego

My last booster (the second one) was in March. I did manage to "connect" with COVID at the end of June with a bout of BA.5 and, thus, very likely had a bit of a boost at that point. Having said that, I'm planning to get vaccinated sometime between now and the end of the month when I hit about 3 months past my bout of infection.

Leana Wen, MD, George Washington University in Washington, D.C.

I appreciate efforts by the Biden administration to simplify the coronavirus booster schedule so that it becomes an annual shot, similar to the flu vaccine. People who are particularly vulnerable to severe illness, such as the elderly and immunocompromised, may need more frequent boosters, but most Americans could anticipate an annual vaccine going forward. I hope there could be consideration to having a combined flu-COVID vaccine; that could further streamline processes and increase uptake of both vaccines.

As to whether and when people should get the booster this year, I think the most urgent would be for those who have not received any vaccine and have not had COVID-19 in 2022. Those individuals should look to get the updated booster as soon as possible. People who recently have had a booster, and definitely those who recently recovered from the coronavirus, can probably wait and time their next shot to before the holidays.

I'll give you an example from my family. My husband, who is 47, is vaccinated with Pfizer and had his last booster in 2021. He had COVID-19 in 2020 (not recently). He'll get the booster in the next couple of weeks or so, when it's readily available in our area. I will probably wait a little bit. I received the Johnson & Johnson one-dose vaccine and then a Pfizer booster in October 2021. I didn't have a second booster, because I had COVID in May. If I didn't have COVID in 2022, I would get the booster now. Because I had COVID pretty recently, I'll look to get the updated booster probably in early-mid October to time it closer to the holidays.

My husband and I are generally healthy. I'd give very different advice to my father and my husband's mother, who are both in their late 70s. They should get the updated booster as soon as possible, in the next week if it's available to them then, because of their age and underlying medical conditions.

David Aronoff, MD, Indiana University School of Medicine in Indianapolis

I am waiting to be 3-6 months out from my last booster. Unless I contract COVID-19, in which case I will wait another 3-6 months later.

I have already had two boosters. I do not think I have had COVID-19. As pointed out in , boosters may become an out-of-pocket expense, so getting them while they are freely provided could be a motivating factor. Immunocompromised persons and older adults should be prioritized.

Anees Chagpar, MD, MPH, Yale University School of Medicine in New Haven, Connecticut

Yes, I plan to get the bivalent booster.

I'm not really timing it. I will likely get it in the fall when it is more widely available and when we are likely to see another resurgence of COVID/other respiratory viruses. I've gotten my two shots, two boosters, wear two masks, continue to be vigilant, and, no -- unlike many of my colleagues -- I have not (yet) gotten COVID (knock on wood).

I'm a fan of vaccines and general public health measures. We often talk about prevention and how it would be wonderful to prevent diseases rather than suffering with them and then trying to treat the consequences. It's just sad that when we have decent preventive measures, there is so much reticence.

David Boulware, MD, MPH, University of Minnesota in Minneapolis

Bivalent booster? Absolutely sign me up, as I would prefer some long-term protection against Omicron BA.4 and BA.5. As with any vaccination, a second and third exposure helps drive long-term memory B and T cells. Do I need any more memory B cells for the Wuhan variant? Probably not. Omicron -- yes.

Both my spouse (who is a fabulous primary care med-peds doctor who makes up her own mind regarding all things COVID-19, pretty much regardless of what I say) and I will be signing up. We just have to find the time.

I'll time my own booster for about 3 months after my first, uneventful run-in with Omicron, which was about 2 months ago.

Eric Feigl-Ding, ScD, Federation of American Scientists

Yes, I plan to get the booster shot soon, though I have a few considerations -- BA.5 is the dominant strain now but not necessarily in the winter. Since the BA.5 booster is optimally tailored against BA.5, it's better to get it sooner. Then again, BA.5 will provide more boost against whatever the winter strain will be, and boosting closer to wintertime starting October could be advantageous too. The tie breaker may be if you previously got infected in the last 4-6 months, in which case waiting until October is okay, or if you have kids under 12 at home who are not eligible for the new BA.5 booster and thus your shot could be an extra safeguard for them.

All in all, make sure you get the new booster -- even if you've had past infection or vaccination before -- because the BA.5 booster is definitely the shot that I've been long waiting for. I even encourage people from other countries who do not have the BA.5 booster available yet in their country to consider flying to the U.S. to get it.

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