The new COVID-19 vaccine is here!

September 15, 2023

The Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has recommended the new COVID-19 vaccine for all those from ages 6 months and up, and the CDC Director endorsed this recommendation Tuesday evening. New COVID-19 injections from Pfizer and Moderna are expected to be available as soon as today, although the Food and Drug Administration (FDA) has not yet approved the new Novavax injection. This vaccine, designed for the XBB strain that is currently in wide circulation, is likely to be effective against the BA.2.86 strain with multiple mutations which epidemiologists worry could cause a surge of infections this fall and winter. These new vaccines will replace all previous vaccines for either initial vaccinations or for boosters. The CDC’s recommendation includes the Novavax vaccine when it receives its FDA approval.

ACIP reviewed data and found that last fall’s booster was 60% effective at preventing urgent care and emergency department visits and 65% effective at preventing hospitalizations, although the effectiveness against hospitalization waned over six months. The vaccine was also highly effective at preventing ICU admissions, and those who were vaccinated were less likely to get Long COVID. Nonetheless, only 17% of Americans received the bivalent booster vaccine.

The ACIP also looked at incidence of side effects from the last set of COVID-19 boosters and found that the incidence of myocarditis is no longer elevated, possibly because of a longer time period between vaccinations. They found that the benefits exceeded harms from booster vaccination for all age groups, with infants and the elderly gaining the largest benefit. I’m indebted to Katelyn Jatelina’s Your Local Epidemiologist newsletter for reporting from the ACIP meeting.

Implications for employers:

-        The COVID-19 vaccination will be available at pharmacies and some medical providers as early as today. However, many physician offices are likely not to offer the vaccine, as there are large minimum orders and the vaccine is no longer provided free by the federal government.

-        Employer sponsored health plans will pay the cost of the vaccines (around $120 each), and there is no member cost sharing because this is recommended by ACIP.

-        Employers should cover this booster both through the pharmacy benefit and the medical benefit so that members can get the vaccines wherever it is most convenient for them.

-        Plan members can choose to get influenza and COVID-19 vaccinations in different arms at the same time. This increases convenience and makes it less likely someone will get infected while they are waiting to get the other vaccination.

-        Those over 60 are also recommended to get the RSV (respiratory syncytial virus) vaccination. I got mine last week. It’s best not to get the RSV vaccine with the other two as this is a new vaccine, as people don’t know whether they will be especially sore or achy, or if immune response to any of these vaccines are impacted.

-        Those who had COVID-19 over the summer should wait at least 3 months after their infection; those who had the old bivalent booster this summer should space their booster out at least 2 months from the last vaccination.

-        Relatively few employers will offer COVID-19 vaccinations (or RSV vaccinations) onsite, so members should seek these at local pharmacies or from their providers.

-        There is currently no influenza-COVID-19 combination vaccine; Novavax is testing one, and hopefully that will be available next year. The RSV vaccine is also not available in a combination injection.

With COVID-19 rates continuing to climb, the availability of the new booster and evidence that it is likely to be effective against the BA.2.86 strain, with multiple mutations, is good news. I’m also happy to see that even with intensive attention the evidence of vaccine safety continues to grow. I’ll be getting flu and COVID-19 vaccinations over the next two weeks so that I am protected against all three respiratory viruses.

Have a great weekend, and a happy new year to those celebrating Rosh Hashanah this weekend.

Monday: Recovery Friendly Workplaces

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Illustration by DallE