What to know about the updated COVID-19 Vaccine for Fall/Winter 2023

The updated Moderna and Pfizer COVID-19 vaccine is approved for everyone 6 months of age or older. BCH is now administering updated Moderna COVID-19 vaccines for everyone ages 12 and older. Call your BCH primary care provider’s office directly to schedule your vaccination. If you do not have a BCH primary care provider, please call your doctor’s office or a local pharmacy for information on COVID-19 vaccination. (Please check back often for updates on scheduling vaccinations for individuals 11 years and younger.)

COVID vaccines continue to be one of the best and safest ways to protect yourself and your loved ones against severe COVID illness, hospitalization and possibly death. Recent studies show that vaccination also reduces your risk of suffering from long COVID.

In this Q&A, Amie Meditz, MD, a Boulder Community Health (BCH) infectious diseases physician at the Beacon Center for Infectious Diseases, shares details about the updated COVID-19 vaccine, including what makes it different from previous COVID-19 vaccines, who should get it and whether it’s safe to get it alongside vaccines for other fall viruses.

Q: What is different about the updated COVID-19 vaccine?

A: With the updated COVID-19 vaccine for fall/winter 2023, we're back to what we call a monovalent vaccine, meaning it contains only one variant—the Omicron variant called XBB.1.5. The vaccine was updated in a similar way that the influenza (flu) vaccine is updated annually, inserting the most up-to-date variant(s). The previous bivalent vaccine (that contained Omicron subvariants BA.4 and BA.5 and the original SARS-CoV-2 virus) is no longer available. 

Q: Is the new vaccine considered a “booster”?

A: The medical community has shifted from calling this a booster to calling it an updated COVID-19 vaccine. Calling it an updated vaccine reflects that we’re not just boosting existing immunity from previous vaccinations. Instead, the vaccine builds a new immune response to variants that are currently circulating.

Q: Who should be getting an updated vaccine?

A: Everyone 6 months of age or older is eligible for an updated Pfizer or Moderna COVID-19 vaccine. For children ages six months to five years, vaccination is recommended, but the number of vaccinations is based on which vaccine (Pfizer or Moderna) they receive, as well as their age. 

In early October, the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) authorized an updated Novavax vaccine for use in individuals 12 and older; more on that can be found below.

Individuals aged 65 years or older, or those of any age with underlying medical problems and/or immune compromised, are at the highest risk for severe outcomes and should get vaccinated.  

Those who are significantly immune compromised may receive a second dose of the updated Pfizer or Moderna vaccine at least two months from the initial updated vaccine to achieve the best immune response to vaccination, but this should be discussed with your provider.

For individuals who are pregnant, the COVID-19 vaccination remains important as pregnant persons are at increased risk for complications related to COVID-19. This year the new recommendation comes with increased ease because there’s no need to wait for a specific trimester to receive the vaccine. 

Q: When should you get the updated vaccine?

A: If you have not received a COVID-19 vaccine in the past two months, you can now get an updated COVID-19 vaccine to protect yourself this fall and winter. With the holiday season ahead of us and more indoor gatherings with the cooler weather, everyone who is eligible should get their updated COVID-19 vaccine as soon as possible for added protection.

Q: How well does the updated vaccine work against the variants currently circulating?

A: So far, studies indicate that the updated vaccine is showing good performance against evolving variants circulating in the U.S. This means that the vaccine is generating antibodies that neutralize or inactivate newer variants. Right now, variants that the updated vaccine is active against include EG.5 and others in the XBB family, as well as the BA.2.86 variant, which shows greater genetic differences from variants coming from the XBB family and may be the next dominant variant. We expect continued study in this area as new variants evolve.

Q: If you just had COVID-19, how long should you wait to get the new vaccine?

A: If you have recently had an illness due to COVID, you can wait two to three months before getting the updated vaccine, as natural illness boosts immunity as well. 

Q: Will COVID-19 vaccines become a yearly thing?

A: The U.S. may be entering a stage where getting a vaccine that protects against COVID will become an annual preventive event, like getting a flu shot. Similar to this year, the vaccine would be updated by changing the formulation to include variant(s) that are predicted to be predominant during the respiratory virus season.   

Q: Is there any difference between the manufacturers of the vaccine?

A: There is no significant difference between the updated Pfizer-BioNTech and Moderna COVID-19 vaccines, which use messenger RNA (mRNA) technology. The Novavax vaccine is the only non-mRNA technology available in the U.S. 

Compared to mRNA vaccines, which instruct the body’s cells to make spike proteins that trigger an immune response against COVID-19, the Novavax vaccine uses an older, more traditional technology and a different mechanism—it directly delivers fragments of the spike protein into the body. There is very little data directly comparing Novavax to mRNA vaccines, but preliminarily research is finding little difference in performance.

Novavax is only approved for individuals 12 years old and older and requires two doses for unvaccinated individuals and one dose for someone who is previously vaccinated. If someone is allergic to a component of the mRNA vaccines, such as allergy to polyethylene glycol, this would be an indication for Novavax. Otherwise, it is personal preference.

BCH will be exclusively carrying Moderna. The Pfizer or Novavax vaccines can be obtained at your local pharmacy.

Q: Are there any side effects to the updated vaccine that are different from previous shots?

A: The possible side effects reported for the updated COVID-19 vaccine are the same as with the previous vaccines.

Q: Can you get the COVID and flu vaccines at the same time?

A: Yes. It’s safe to receive vaccines for the COVID-19 and flu viruses at the same time. We’ve also seen that the immune response generated by each vaccine does not change based on whether they are administered at the same time or separately.

Q: Can you get the COVID, flu and RSV vaccines at the same time?

A: The respiratory syncytial virus (RSV) vaccine was recently approved for adults 60 years and older. That said, since this is the first season the RSV vaccine is available, there isn’t much data about adding the RSV vaccine to the mix at the same time. Notably, expert opinion, including the infectious diseases team at BCH, supports getting all three vaccines at the same time. The most important thing is to get these vaccines as soon as possible to protect yourself during the 2023 fall and winter virus season. 

Q: Is the updated COVID-19 vaccine free?

A: The updated COVID-19 vaccine is free for most Americans through health care coverage from private health insurance and/or Medicare. Individuals who are uninsured and underinsured can receive free COVID-19 vaccines at local health centers, pharmacies and health care providers through the Centers for Disease Control and Prevention’s Bridge Access Program.

Q: What if I still get COVID after being vaccinated?

A: At-home tests for the virus can identify infection so you can protect your family, coworkers and the general public. BCH still offers respiratory virus testing that can be ordered by your provider. If you do get COVID-19, talk to your doctor if you are a candidate for anti-viral therapies, which have been shown to reduce the risk of severe illness, hospitalization and death in certain people.