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Family Health

THE UPDATED COVID VACCINES ARE HERE: 9 THINGS TO KNOW

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BY KATHY KATELLA February 29, 2024

The new shots are designed to protect against XBB.1.5 and should also protect
against more recent virus strains.

Yale Medicine experts answer 10 questions about the updated (2023–2024 formula)
COVID vaccines, which are expected to keep more people from getting seriously
ill with the virus through the winter, when infections and hospitalizations tend
to tick upwards.

Credit: Getty Images

[Originally published: Oct. 2, 2023. Updated: Feb. 29, 2024.]

Note: Information in this article was accurate at the time of original
publication. Because information about COVID-19 changes rapidly, we encourage
you to visit the websites of the Centers for Disease Control & Prevention (CDC),
World Health Organization (WHO), and your state and local government for the
latest information.

There has been better protection against severe disease, hospitalization, and
death from COVID-19 since newly updated (2023–2024 formula) mRNA COVID vaccines
became available last fall. Shots are available to protect everyone 6 months and
older from serious illness, hospitalization, and death from the disease.

The Food and Drug Administration (FDA) and the Centers for Disease Control and
Prevention (CDC) approved the updated vaccines by Pfizer-BioNTech and Moderna
for everyone 6 months and older, and authorized an updated Novavax vaccine for
those 12 and older in the fall of 2023. In February of this year, the CDC
recommended an additional dose for adults ages 65 and older.

The vaccines target XBB.1.5, a subvariant of Omicron that dominated the United
States—and the world—from November 2021 until last year. The CDC says the
updated vaccines should also work against currently circulating variants of the
SARS-CoV-2 virus—many of which descended from, or are related to, the XBB
strain. The vaccine is also expected to protect against JN.1, the current
dominant strain in the U.S.

While COVID-19 has been causing mostly mild illness recently, Yale Medicine
infectious diseases specialist Onyema Ogbuagu, MBBCh, reminds people that the
disease can still lead to hospitalization and death. “Infections can have
long-term consequences,” Dr. Ogbuagu says, adding that even healthy people can
develop Long COVID—a condition in which new, continuing, or recurring (and
sometimes debilitating) symptoms are present four or more weeks after an initial
coronavirus infection.

Below, Yale experts tell you what you need to know about the updated COVID
vaccine.

1. WHY WOULD ANOTHER COVID VACCINATION HELP?

The updated vaccines are not expected to prevent all cases of COVID, including
those causing mild illness; rather, their aim is to reduce severe illness,
hospitalization, and death from infection. According to the CDC, COVID is still
a major cause of serious respiratory illness, with more than 200,000 reported
deaths since January 2022. That figure includes more than 600 deaths in
adolescents and children ages 19 and younger.

Older people (especially those ages 50 and older) are more likely than younger
people to get very sick from COVID. Immunocompromised people and those with
chronic medical conditions, such as diabetes or heart disease, are at the
highest risk of severe disease and death, but some young, healthy people have
also gotten very ill and died from COVID. In addition, the CDC recommends the
vaccine for pregnant women to protect both mother and baby.

An analysis by the CDC suggested that making its vaccine recommendation
universal could prevent 400,000 hospitalizations and 40,000 deaths in the U.S.
over the next two years.

2. HOW IS THE UPDATED COVID VACCINE DIFFERENT FROM THE PREVIOUS ONE?

The bivalent booster, which is no longer available, was introduced in the fall
of 2022. It targeted the BA.4 and BA.5 Omicron subvariants and the original
SARS-CoV-2 virus. The updated vaccine is monovalent, designed to prevent severe
disease from the Omicron XBB.1.5 subvariant. By September 2023, the long-running
XBB.1.5 accounted for only about 3% of cases in the U.S., but most of the
strains circulating now are descended from (or closely related to) it.

That’s a good example of how the virus has evolved—and it’s still evolving—so
rapidly that it may be impossible to match each new vaccine update to the
variants circulating at the time it is released, explains Scott Roberts, MD, a
Yale Medicine infectious diseases specialist. “But we know from experience that
the vaccines hold up very well, even against multiple variants, unless there is
a significant shift like we saw with Delta to Omicron in the winter of 2021,” he
says. “Basically, if you have some immunity to a variant and are exposed to a
new offshoot of it, you’ll have some protection.”

3. WHY ISN’T THE NEW COVID VACCINE CONSIDERED A BOOSTER?

The FDA is calling the new shots “updated vaccines” in anticipation of needing
to provide updated formulas annually, similar to the flu shot, which changes
each year.

A booster shot gives a “boost” to the recipient's existing immunity from a
previous vaccination. Updated vaccines are different in that they are expected
to provide protection against currently circulating variants, helping the body
build a new response to those variants. “Barring the emergence of a markedly
more virulent variant, the FDA anticipates that the composition of COVID-19
vaccines may need to be updated annually, as is done for the seasonal influenza
vaccine,” the FDA noted in its approval and authorization of the new vaccine.

“I think we're going to fall into a pattern very similar to the flu, where every
year the virus is going to mutate slightly, and the vaccine formulation for the
fall will be an educated guess,” says Dr. Roberts. “We will make a vaccine
targeted against whatever we predict or whatever is currently circulating and
hope our vaccines are a good match, because we will be developing them before we
know what variants will be circulating in the fall."

4. HOW SAFE IS THE UPDATED COVID VACCINE?

COVID vaccines are safe and effective, according to the CDC. The safety of COVID
vaccines has been rigorously monitored and evaluated since their emergency use
authorization (EUA) in December 2020. According to the CDC, the updated mRNA
COVID vaccines for 2023-2024 are manufactured using a similar process to the
previous vaccines.

The benefits of the COVID vaccine continue to outweigh any potential risks, and
serious reactions after COVID vaccination are rare, according to the CDC. The
agency cited a study showing the risk of cardiac complications, including
myocarditis (an inflammation of the heart muscle) was significantly higher after
a COVID infection for both males and females in all age groups.

5. ARE THERE ANY SPECIAL COVID VACCINE RECOMMENDATIONS FOR CHILDREN?

The FDA approved the updated mRNA vaccines for adolescents and teenagers ages 12
and older and authorized them for emergency use in children ages 6 months
through 11 years.

Children are less likely to get seriously ill with COVID, but some still do,
says Magna Dias, MD, a Yale Medicine pediatric hospitalist. She tells parents
who are still not sure whether they should get the vaccine for their children to
talk to their pediatrician, especially if their child is immunocompromised. “In
that case, I think it’s a no-brainer to protect them,” she says.

6. IS THERE AN UPDATED COVID VACCINE FROM NOVAVAX?

The FDA authorized an updated version of a vaccine Novavax developed to target
the XBB.1.5 strain. Individuals 12 and older previously vaccinated with a
COVID-19 vaccine (and who have not already been vaccinated with a recently
updated mRNA COVID-19 vaccine) are eligible to receive one dose; unvaccinated
individuals can receive two doses.

According to the FDA, the updated vaccine addresses currently circulating
variants to provide better protection against serious consequences of COVID-19,
including hospitalization and death.

The Pfizer-BioNTech and Moderna vaccines use messenger RNA (mRNA) technology,
which instructs the body’s cells to make proteins that trigger an immune
response against COVID-19. The Novavax protein-based vaccine uses an older, more
traditional technology and a different mechanism—it directly injects the spike
protein (formulated in a laboratory) and another ingredient into the body,
leading to the production of virus-fighting antibodies and T cells. The Novavax
vaccine is the only non-mRNA COVID-19 vaccine available in the U.S.

7. WHEN SHOULD I GET THE UPDATED COVID VACCINE?

People 5 years and older may get one dose of the updated vaccine at least two
months after the last dose of any previous COVID vaccine. Babies and young
children usually need more doses than older children and teens. Anyone who
recently had COVID-19 may consider delaying their vaccine by 3 months.

8. SHOULD I GET THE UPDATED COVID VACCINE AND OTHER SEASONAL SHOTS AT THE SAME
TIME?

The CDC considers it safe to get the COVID shot and annual flu vaccine
simultaneously. There is even research in progress to explore the effects of
administering both vaccines in a single shot.

But the respiratory syncytial virus (RSV) vaccines for older adults and pregnant
women (who can pass the antibodies along to their newborns) are brand new this
fall, and there isn’t data to say for sure whether giving those at the same time
as the other two shots is the best strategy.

9. WHERE CAN I GET THE UPDATED COVID VACCINE?

As with previous COVID-19 vaccines, this one will be available at participating
pharmacies and provider offices. To find a location near you that carries the
vaccine and to schedule an appointment, go to Vaccines.gov. You can also call
1-800-232-0233 (TTY 1-888-720-7489). Be aware that current distribution and
insurance issues may delay availability of the vaccines temporarily in some
places.

According to the CDC, the vaccines are covered by insurance, including private
insurance, Medicare plans, and Medicaid plans. Uninsured children and uninsured
adults also have access through the Vaccine for Children Program and Bridge
Access Program, respectively.

Information provided in Yale Medicine articles is for general informational
purposes only. No content in the articles should ever be used as a substitute
for medical advice from your doctor or other qualified clinician. Always seek
the individual advice of your health care provider with any questions you have
regarding a medical condition.

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