Going on a trip? A COVID booster could be part of your plans

Q & A with UW Medicine experts in immunology and microbiology offers a summer outlook on COVID protection.

Media Contact: Leila Gray - 206-475-9809, leilag@uw.edu

According to the Centers for Disease Control and Prevention, adults 65 and older and people with weakened immunity should have a second dose of the bivalent COVID-19 vaccine.  Two University of Washington School of Medicine vaccine response researchers, Deborah Fuller, professor of microbiology, and Marion Pepper, professor and chair of the Department of Immunology, discuss the latest on COVID protection as the disease takes its tenure in the respiratory infections landscape. 

With summer vacation travel predicted to reach pre-COVID levels, is it time for those who are 65 and older or immune-compromised to consider the federal recommendation to get another booster shot?

Marion Pepper: Yes, for individuals who are 65 and older or immune-compromised, if you are more than six months beyond your last vaccine or infection and are going to be significantly exposed via travel, a booster is not a bad idea, as it will enhance your immune protection. Additionally, masking in enclosed spaces like an airport or airplane is still a really good idea, especially for at-risk individuals. Together, these protective measures will help to prevent infection.

Deborah Fuller: The older you are, the quicker your immunity wanes. If it’s been over six months since you were boosted, then you definitely should get a booster immunization. Immunity really starts to wane in three to six months. If you haven't gotten a bivalent booster at all, it would be important to get that. It would enhance immunity against the current circulating strains out there. Until we know what the virus does to our body, it’s best to avoid getting infected with this virus.

The World Health Organization and the White House have ended their COVID health emergency declarations. Are you concerned that the public may think that COVID is essentially is over? 

Marion Pepper: Obviously, COVID isn’t completely “over.” Everybody knows someone who’s been infected with Covid-19 over the last few months. However, we are in a very different phase of this pandemic than we were even a year ago. In addition to vaccines that largely prevent severe illness and death, we also have effective antivirals like Paxlovid. So I think it is important to highlight that while the COVID health emergency is over, it is still OK to take precautions to keep yourself healthy. 

Deborah Fuller:  There are people left and right still getting COVID. If you don’t want to have that happen, you’re best off maintaining antibodies against it at least every six months with an immunization.

People are used to getting an annual flu shot. But federal recommendations now allow older adults and those who are immune-compromised to get COVID shots more frequently. Could you explain why?

Deborah Fuller: The annual flu shot is timed to boost your immunity against flu right before flu surges. With COVID, surges in infection are occurring less predictably than the flu. If you are immune-compromised or elderly, you will develop weaker antibodies following vaccination. Your immunity will wane more quickly. So it’s really important if you’re in one of these groups to get more frequent vaccinations to sustain your immunity against COVID until it becomes more like flu, with predictable seasonal surges

Marion Pepper: For older adults and those who are immune-compromised, it is relatively more difficult to maintain high levels of protective immunity by vaccination or infection than in younger people. In terms of creating an extra layer of defense, especially with greater travel and people being more relaxed about masking and being indoors more consistently, it’s not a bad idea to get a booster now to enhance that protection.

Do you think there are any valid concerns about the immune response declining in effectiveness with additional doses of COVID vaccinations?

Marion Pepper: I don't think we’ve seen any evidence of immune response declining in response to COVID vaccinations. We would see that in the epidemiological data and increased hospitalization rates and deaths. If you look at trends over time, that’s not what’s happening. That evidence is not there.

Would getting a booster shot now prevent people from getting an updated booster shot to protect against newer COVID variants in the fall, if one is available then?

Marion Pepper: The overall length of time people are seeing significant protection is about six months.  It doesn’t mean in late fall or early spring you couldn’t get that next booster. I think it’s reasonable to get the bivalent booster we have now if you feel like you are at risk or far out from your last vaccine or infection.

We’ve previously been told that whatever current vaccine is available, it will provide some protection for the newest variant. Do you think that continues to be the best advice for protection for new variants?

Marion Pepper: Yes, I think that is true. The way your immune system develops, it creates an enhanced response to viruses it’s seen before. Of course the virus changes over time to escape this immune response, but it can’t change everything all at once. So far, it seems like there is enough similarity between variants that certain parts of the immune response get reactivated every time it sees the virus.

Deborah Fuller: This is a subject that is still being studied, but boosting your immune responses with the bivalent vaccine will provide you better immunity than if you don’t get boosted. Do we need to continue to update the COVID vaccine? Possibly. Researchers are still working on figuring that out. 

What is your perspective on where we are with COVID now? How is COVID changing?

Deborah Fuller: What we’ve been living with are unpredictable waves of new COVID variants. We still don’t know if or when another wave may come.  But we’re getting very close to where we may start seeing COVID surges more predictably, like the flu. Once that happens, it will be more manageable.

Marion Pepper: I think there are a lot of reasons to be optimistic, with the antiviral drug Paxlovid and with vaccines preventing hospitalizations and serious disease. We’re in a much, much, better place than we have been. Hopefully, that will continue.

Do you foresee a time when there will be annual boosters for COVID like there are for flu shots?

Deborah Fuller: In certain respects, this is the goal. COVID is becoming endemic, which means it’s no longer a pandemic. But it is still here and can still cause significant health issues, especially for the most vulnerable populations like the elderly and immune-compromised.

Endemic COVID can be better managed. Annual booster immunizations, similar to flu, will be an important part of that management to spike our immunity just before an expected surge. All respiratory infections transmit more easily in the colder weather.

There are researchers working on dual vaccines for COVID and flu. Eventually, we may have a single vaccine, similar to the MMR shot for measles, mumps, and rubella that you get every year and protects against both COVID and flu in a single annual dose.

What questions are you and other researchers asking about COVID?

Deborah Fuller:  We’ll be studying COVID for decades. There are big questions about long COVID. How does the virus impact our bodies? I think it may be years until we know how this pandemic will impact our health in the long term.

Even with moderate cases of Covid, there have been reports showing there can be significant changes to our bodies. Will this be long-term or temporary? There’s a lot of research trying to understand the long-term effects of Covid on the population so we can develop new therapies to treat them.

This news item was written by Sharon Salyer.

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