This week, the FDA authorized Novavax’s updated COVID-19 vaccine. The CDC’s fall vaccine recommendations were already set up to include Novavax once it was authorized, so pharmacies and health providers can start administering it without any additional hurdles at the federal level.
Novavax’s new vaccine, like the options from Pfizer and Moderna for this fall, is designed to protect against XBB.1.5, a recently circulating variant that is closely related to most of the strains causing disease in the U.S. right now. But unlike the Pfizer and Moderna vaccines (which use mRNA technology), Novavax’s uses a piece of viral spike protein to teach recipients’ immune systems how to recognize the coronavirus.
Some scientists and health advocates I follow have been particularly looking forward to the Novavax authorization, hoping to get their shot rather than one of the mRNA options. There are two main reasons for this choice, based on my reading:
The Novavax vaccine may have fewer or easier side effects than the mRNA vaccines. This is particularly appealing for some people who had poor reactions to earlier mRNA vaccine doses (including, in some cases, long-term issues similar to Long COVID), and some people with chronic conditions.
Some experts say that “mixing and matching” different types of vaccines might lead to a more robust, long-term immune response against the coronavirus, compared to sticking with one vaccine type.
A recent article in Science goes into more detail about these considerations. Writer Jennifer Couzin-Frankel walks through scientific studies that look at Novavax compared to the other vaccine options, and explains some of the questions that we don’t have sufficient data to answer yet. For example, as fewer people have received Novavax vaccines compared to the mRNA options, it’s harder to see signals for potential rare adverse reactions. More studies are coming in that will help address these questions, but for now, many people are making personal choices about which vaccine to get this fall.
Last week, I asked you, COVID-19 Data Dispatch readers, to send me your stories of challenges you experienced when trying to get this fall’s COVID-19 vaccines. I received 35 responses from readers across the country, demonstrating issues with insurance coverage, pharmacy logistics, and more.
I’ve published the full responses in the table below. Here are a few common themes that I saw in these stories:
Pharmacies aren’t receiving enough vaccines. Several readers shared that their pharmacies had inadequate vaccine supply to accommodate all the people who made vaccination appointments, or who wanted appointments. Vaccine supply may also be unpredictable—a pharmacy may think they’re getting more shots, but in fact not receive them—leading to appointment cancellations.
Insurance providers weren’t prepared for this vaccine rollout. Despite months of advance notice that a fall COVID-19 vaccine was coming, many insurance companies apparently failed to prepare billing codes or other system updates that would allow them to cover the shots. A couple of people who shared insurance issue stories are on Medicare—representing a population (i.e. seniors) who should be at the front of the vaccine line.
Very limited, confusing vaccine availability for young kids. Several readers shared that they were able to get vaccinated, but their children under 12 have not received a vaccine yet. While the FDA and CDC have authorized this fall’s COVID-19 vaccines for all Americans ages six months and older, younger children require a different vaccine formulation from adults. And this formulation appears either entirely unavailable or very difficult to access, depending on where you live.
People living in less dense areas may need to travel. A few readers shared that, as they searched for vaccine appointments in their areas, the closest pharmacies with doses available were miles away—over 10 miles, in one case. This is a significant barrier for people fitting vaccine appointments into their work schedules.
Information may be inconsistent. Vaccine availability listed in one place (such as a pharmacy chain’s website or the federal vaccines.gov website) may be inaccurate in another. Some readers shared that they spent extra time on the phone with pharmacies or health providers to get accurate information—another barrier.
Pharmacies don’t have enough staff for this. Even readers who were able to receive COVID-19 vaccines often had to wait a long time at their pharmacies. Several shared that their pharmacies appeared to be understaffed, dealing with the COVID-19 shots along with routine prescriptions and other duties. The days of mass vaccination sites, efficiently run by public health departments, are long over.
Kaiser Permanente members face delays. One company that appears to be causing outsized problems is Kaiser Permanente, one of the biggest insurers and health providers on the West Coast. Several readers shared that Kaiser was not providing new COVID-19 vaccines until early October, and would not cover the shots if their members went to another location. That’s a big delay, and it may be further impacted by a coming strike at the company.
These vaccines are expensive. If you decide to pay for a COVID-19 shot out-of-pocket (as some readers did), it costs almost $200. Even the federal government is paying about triple the cost of last year’s COVID-19 vaccines per shot, for the doses it is covering, STAT News reports. The U.S. may have received a “bad deal” here, STAT suggests, considering all of the federal funding that’s supported vaccine research and development.
As I wrote last week, some news outlets have covered these challenges, but this issue really deserves more attention. The updated COVID-19 vaccines are basically the U.S. government’s only strategy to curb a surge this winter, and they should be easily, universally accessible. Instead, many people eager to get vaccinated are going through multiple rounds of appointments, phone calls, pharmacy lines, and more.
For every one of these readers who has persisted in getting their shot, there are likely many other people who tried once and then gave up. And those people who don’t receive the vaccine will be at higher risk of severe illness, death, and long-term symptoms from COVID-19 this fall and winter. This is a public health failure, plain and simple.
And it’s important to emphasize that this failure is not surprising. Many health commentators predicted that these challenges would arise as the federal public health emergency ended and COVID-19 tools transitioned from government-funded to covered-by-insurance. For more context on why this is happening, I recommend the Death Panel podcast’s latest episode, “Scenes from the Class Struggle at CVS.”
If you’re a reporter who would like to connect with one of the COVID-19 Data Dispatch readers who shared a story, please email me at betsy@coviddatadispatch.com. Most of the people in the database below shared an email or other contact info.
In the last week, my social media feeds have been full of stories about vaccine access issues. Even though the updated COVID-19 vaccines are supposed to be free—either covered by insurance plans or by a federal program—people keep getting bills. Or their vaccine appointments are canceled unexpectedly. Or they can’t get an appointment at all.
Some news outlets have covered these access challenges, but far more attention is needed. The new vaccines are the U.S. government’s only real strategy to curb a likely COVID-19 surge this winter, now that masks, testing, and other tools are far less available. It is absolutely crucial that as many people get vaccinated as possible, and any barriers to those vaccinations deserve front-page headlines.
The COVID-19 Data Dispatch may not have the reach of an established national media outlet, but with the help of all of you readers, we can help draw more attention to this massive problem. If you have had a hard time getting an updated COVID-19 shot, please share your experience: you can use this Google form, email me, or reach out on social media (Twitter, Bluesky, Mastodon).
You can share your vaccination experience anonymously or attach your name, location, or other details, if you’d like. (There are no required fields on the Google form.) Next week, I’ll publish the responses in a public database on the CDD website. My hope is that this compilation can show how widespread these vaccine access issues are, and can serve as a resource for other journalists who might be interested in covering the problem.
Also, a PSA: if a pharmacy or doctor’s office tries to charge you for a COVID-19 vaccine, remind them that the vaccines are free. You can refer them to the CDC’s Bridge Access Program, which will pay for any vaccinations not covered by insurance.
Public comments to the CDC about infection control measures: The People’s CDC, a public health communication and advocacy organization that seeks to fill gaps left by the federal CDC, has published a database of comments about the importance of infection control measures in healthcare settings. These comments were sent to the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC), as the committee considers changing the agency’s guidance to be more lenient about preventing infections in healthcare settings. As the CDC has not published comments publicly itself, the People’s CDC “asked people to forward us their comments to HICPAC, and created the People’s Register.” For more details about HICPAC, see this post.
Recommendations for masks, nasal sprays, other tools: In response to last week’s post discussing how nasal sprays may be used to reduce COVID-19 risk, a reader shared this video from RTHM Health, a telehealth clinic focused on Long COVID and related complex chronic diseases. “This video has a section with a good overview of different sprays and the strength of evidence for each one,” the reader wrote. The video also includes recommendations for high-quality reusable masks and respirators, along with other COVID-19 safety tools.
Wastewater surveillance for flu, RSV: A new study, published this week in the CDC’s Morbidity and Mortality Weekly Report, discusses how wastewater surveillance can complement other methods of monitoring the flu and respiratory syncytial virus (RSV). Researchers at Wisconsin’s state health department, the CDC, and other collaborators tracked flu and RSV in three Wisconsin cities’ sewage during last winter’s respiratory virus season. They found that wastewater trends “often preceded a rise” in emergency department visits for these viruses. This study follows other research that has shown wastewater surveillance can be a predictive tool for many diseases, not just COVID-19.
Better understanding coronavirus interactions with human cells: Another recent study, published in the journal Viruses, discusses how SARS-CoV-2 interacts with the proteins in human cells as it replicates. The research team (based at the University of California Riverside) identified a specific cellular process that the virus’ N protein hijacks and uses to copy its genetic material, leading to more coronavirus in the body. These findings could be used to develop new antiviral treatments that target this cellular process, both for COVID-19 and other similar diseases, the researchers said in a press release.
Limitations of prior immunity to COVID-19: One more recent paper that caught my attention: researchers at the University of Geneva in Switzerland studied how prior infection and/or vaccination can impact COVID-19 risk, based on about 50,000 cases and associated contact tracing data from the city of Geneva. The researchers found that both a recent infection and vaccination reduced the risk of getting infected from a close contact sick with COVID-19. But both types of immunity faded within a few months, leading people to remain vulnerable in the long-term. This study suggests that vaccines alone are not sufficient to control the spread of COVID-19; masks, ventilation improvements, and other interventions are needed, the authors argue.
NIH tests universal flu vaccine: Speaking of vaccines: the National Institute of Allergy and Infectious Diseases (or NIAID, one of the National Institutes of Health) announced this week that it’s starting a new trial for a universal flu vaccine. This vaccine, developed by NIAID researchers, can prompt the body to make antibodies against a wide variety of flu strains rather than focusing on one variant. The vaccine has done well in animal studies and is now ready for a phase one clinical trial. NIAID plans to test the vaccine in 24 volunteers, and will follow them closely through immune system testing to see how the vaccine performs.
Data from a CDC presentation suggest that people of all ages, including children, receive a benefit from updated COVID-19 vaccines.
We now have two new COVID-19 vaccines available for this year’s respiratory virus season, one from Pfizer and one from Moderna, which are expected to perform well against current variants. The FDA approved both vaccines this week, and the CDC recommended them for almost all Americans. A third option, from Novavax, may become available in the coming weeks as well.
The federal government aims to present this fall’s shots as the next iteration in routine, annual COVID-19 vaccines—similar to the routine we’re all used to for flu shots. In fact, I’ve seen some news suggesting that the federal health agencies don’t want us to call these shots “boosters,” instead calling them “updated” shots or annual shots.
But this fall’s vaccine rollout is likely to be anything but routine, as it’s the first rollout following the end of the federal COVID-19 public health emergencies. The government is no longer purchasing shots and distributing them for free; now, insurance companies will have to cover the shots.
As a result, many Americans—especially those without health insurance—will have a harder time accessing these vaccines than they have for previous shots. Plus, the federal emergency’s end will make it harder for us to track how the vaccines are performing, as the coronavirus continues to evolve into new variants.
With all of these complications in mind, here are ten key facts and statistics that you should know about this fall’s COVID-19 vaccines.
Pfizer and Moderna’s shots have been approved and recommended for all Americans, ages six months and older.
Despite some debates among scientists about whether younger people really need updated COVID-19 shots, the FDA has approved these vaccines—and the CDC has recommended them— for all age groups. This is important because CDC recommendations are often the basis for insurance coverage, as experts explained at a webinar hosted by the National Press Foundation on Tuesday.
The shots exclusively target XBB.1.5, a coronavirus lineage that is common in the U.S. and globally right now.
According to the CDC’s genomic surveillance program, almost all cases in the U.S. in recent weeks have been caused by XBB.1.5 or related variants from the XBB lineage. Variants like EG.5 and FL.1.5.1 are also XBB descendants, which have been given nicknames to make it a bit easier for scientists to keep track of them.
It’s also important to note that, unlike last year’s boosters, this fall’s shots are monovalent vaccines—meaning they only target XBB.1.5. The shots no longer target the original strain of SARS-CoV-2 that first circulated in 2020. Scientists generally approve of this choice, as the virus has mutated so much since that time.
Moderna’s booster led to a 17-fold increase in antibodies against XBB.1.5 and XBB.1.6.
The vaccine companies presented data to the CDC’s vaccine advisory committee on Tuesday. Moderna’s presentation included results from a study testing its new vaccine against several different variants, using blood samples from people who received the booster.
About one month after vaccination with Moderna’s booster, the participants had about 17.5 times more neutralizing antibodies against XBB.1.5, 16.7 times more against XBB.1.6, 14 times more against EG.5.1, and 10 times more against BA.2.86. Pfizer also presented data, suggesting that their vaccine should similarly perform well against current variants.
The new vaccines should lead to similar side effects as we’re used to from past mRNA shots.
Based on data that the vaccine companies presented to the CDC’s committee, this fall’s Pfizer and Moderna vaccines should lead to similar side effects—headache, fatigue, muscle pain, etc.—as many of us have expected from past rounds of COVID-19 shots. The companies, along with the CDC and FDA, will continue to monitor these vaccines for any safety issues that may emerge as people start to get them.
Young, unvaccinated children are at higher risk for COVID-19.
One of the CDC presentations focused on how this fall’s vaccines may benefit young children. Last fall and winter, hospitalization rates were higher for COVID-19 than for the seasonal flu across all young age groups, from infants (under six months) to 12-17 years old. The vast majority of the children hospialized were not vaccinated or hadn’t received last year’s booster.
For some CDC advisory committee members, these data were convincing in suggesting that this fall’s vaccine should be recommended for children, experts told STAT News. Vaccines updated to match current variants have a clear benefit for all age groups.
Long COVID remains a significant risk for Americans across age groups.
Another CDC presentation discussed Long COVID, as one of the potential adverse outcomes of a COVID-19 case. The CDC shared new data from a national survey conducted in 2022, which suggests that 9% of Americans ages 35 to 49 have experienced Long COVID symptoms (defined as symptoms lasting at least three months after a COVID-19 case). Adults ages 50-64 and 18-34 also reported high levels of Long COVID, at 7.4% and 6.8% ever experiencing symptoms, respectively.
Many studies have shown that vaccination lowers risk of Long COVID, though it does not by any means eliminate this risk. While it’s good to see the CDC incorporating Long COVID into its vaccine risk/benefit discussions, much more research is needed to better understand how to prevent this debilitating condition.
A Novavax vaccine is still in the pipeline.
Novavax also presented data to the CDC’s advisors this week, suggesting that its vaccine (also based on XBB.1.5) should perform similarly to the Pfizer and Moderna options. But unlike the Pfizer and Moderna vaccines, Novavax’s has yet to receive FDA approval. The company has said it’s still planning to distribute its vaccine this fall, but it’s unclear when the FDA may authorize it.
Some people are eager to receive the Novavax vaccine this fall, rather than Pfizer or Moderna’s, because this vaccine uses a different mechanism to boost the immune system. It may also lead to fewer side effects than the mRNA vaccine, making it a potentially good option for people who’ve had particularly strong reactions. (I know a couple of readers have sent me questions about this, and aim to do a deep-dive on Novavax in a future issue.)
Only 17% of Americans received last fall’s bivalent booster.
The booster uptake last year was low, according to the CDC. Even among seniors, only 43% received the booster. Can we do better this year?
A POLITICO/Morning Consult poll found that about 60% of respondents said they “probably or definitely” would get this year’s vaccine. (The poll included about 2,000 registered voters from across the U.S.) But it’s likely that access issues could get in the way for many people, as getting this COVID-19 vaccine will be much more challenging than it’s been in past rollouts.
HHS program should provide free vaccines for 25-30 million adults.
The Department of Health and Human Services has officially launched its “Bridge to Access” program, designed to provide free COVID-19 shots to uninsured Americans. Through this program, the HHS is essentially buying a small number of shots and distributing them to pharmacies, federally supported health centers, and other providers. You should be able to view these providers at vaccines.gov, according to the HHS. But I’ll be curious to see how well that actually works.
This year’s vaccine rollout will be much harder to track.
In the past, I’ve written about how the U.S. has failed to monitor breakthrough cases, or COVID-19 infections that occur after someone is vaccinated (and the hospitalizations, deaths, and long-term symptoms that may result). This year, not only are we failing to track breakthrough cases—the U.S. no longer has any national case data at all. We also no longer have vaccination data, as the CDC is not collecting this information from state and local health systems.
So, how will we know how this year’s vaccine rollout goes? It’ll likely be a lot of guesswork, extrapolating from a few state/local health departments, polling data, and other smaller-scale research to estimate how many people are getting vaccinated nationally. This challenge is just another example of the damage that the federal government has done in the last year by dismantling many of its COVID-19 data systems.
New funding from CDC’s forecasting center: The CDC’s Center for Forecasting and Analytics (CFA) announced a new funding opportunity for state and local health agencies to develop new disease modeling tools. CFA is a relatively new center itself; it launched last year with the goal of modernizing the U.S.’s disease forecasting capacities (see my FiveThirtyEight article about the center for more details). This funding opportunity will, I expect, enable the CFA’s growing staff to work directly with health agencies on advancing analytical methods. I look forward to seeing the results of those projects.
Experts argue to keep masks in healthcare: A new commentary article, published this week in the Annals of Internal Medicine, argues in favor of keeping mask requirements in healthcare settings. The experts (from the National Institutes of Health and George Washington University) point to real-world experience, suggesting transmission between patients and healthcare workers is less likely when everyone is wearing a mask, preferably one of high quality. This article coincides with an advocacy campaign to keep masks in healthcare, including virtual and in-person actions across the U.S.
CDC releases provisional drug overdose data for 2022: The CDC’s National Center for Health Statistics has released overdose data for 2022, reporting that nearly 110,000 Americans died of overdoses for the second year in a row. Overdoses have leveled off from 2021, but the 2022 data still represent a sharp increase from pre-pandemic trends. Some states in the South and West Coast (such as Texas, Oklahoma, Wyoming, Washington) saw the sharpest increases from 2021 to 2022, according to the CDC. These data are all preliminary and will be updated later in the year.
Pediatric COVID-19 boosters could save school days: A new modeling study, published this week in JAMA Network Open, suggests that the U.S. could have seen about 10,000 fewer kids hospitalized with COVID-19 and 5.5 million fewer school days lost during the 2022-2023 respiratory virus season, if kids received booster shots in large numbers. The researchers arrived at these estimates through a model that simulated COVID-19 booster vaccination rates at similar levels to annual flu vaccination in kids. Future booster campaigns should focus on children in addition to older adults, the authors argue.
RSV vaccine for infants moves ahead: Speaking of pediatric vaccinations: the FDA’s vaccine advisory committee met last week to discuss a new vaccine candidate from Pfizer, which would protect infants from RSV. Unlike most pediatric vaccines, this shot would be delivered to pregnant parents in order to protect their babies at birth. While the FDA’s advisors endorsed the vaccine for its effectiveness, some committee members expressed concerns over safety. Helen Branswell at STAT has more details.
COVID-19 Data Dispatch 