Q&A: What physicians should know about the latest COVID-19 vaccines

Key takeaways:

• An expert noted that the predominant SARS-CoV-2 strain does not appear to cause more severe disease.
• He also discussed RSV, influenza, and the timing of vaccinations this fall.

The CDC recently recommended updated versions of the Moderna and Pfizer-BioNTech COVID-19 vaccines aimed at omicron XBB subvariants of SARS-CoV-2, following their approval by the FDA.

The monovalent vaccines are expected to become available to the public this week, amid rising hospitalizations and deaths from COVID-19 in the United States.

William Schaffner, MD, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, spoke with Healio to discuss the recent wave of infections, how the new formulations of the COVID-19 vaccines compare with older versions, and more.

Healio: There’s been a recent uptick in cases in the U.S. Are you concerned, especially given that the new school year has started? What’s driving the increase right now?

Schaffner: The increase, I think, has at least three reasons. The first is that the omicron variants that are out there and spreading now are very contagious. And so, they're taking advantage of that.

The second thing is that many of us were boosted or had experience with COVID many, many months ago, and our protection now is beginning to wane, and so that contributes to the spread of the virus.

The third reason is that we’re out there. We are going back to school. We're going to religious services. We're travelling. We're visiting the grandparents, going to basketball games. And so, we're providing many opportunities for this virus to spread amongst us.

Healio: Can you tell us about the predominant SARS-CoV-2 variant that’s driving cases in the U.S.? Is there any evidence that it poses a greater danger than previous variants?

Schaffner: It doesn't look as though circulating variants are producing a more severe disease.

Healio: Can you tell us about the updated monovalent COVID-19 vaccines and what advantages they might have compared with older formulations?

Schaffner: As with influenza vaccine, we have to be aware that this virus mutates, and so we want to keep up to date. The previous vaccines that we used protected against the original strain, the Wuhan strain and of course the delta strain. They're no longer circulating. We now have the omicron strain and its children and grandchildren — these subvariants.

And so, this vaccine is focused on them. It's monovalent. It's been tested in the laboratory against a whole series of these omicron subvariants that are out there circulating at the present time, and it looks as though we have good cross coverage for these variants. So, I think we are well positioned to protect ourselves as a population against the further increase that will occur this winter.

Of course, we're well positioned if we accept the vaccine. As a friend of mine likes to say, vaccines don't prevent disease. Vaccination prevents disease. You have to get it out of the refrigerator and into your arms, right? And we'll see whether we can efficiently provide access to the vaccines and whether the public will respond by rolling up their sleeves.

Healio: What’s the best way for physicians to explain the updated vaccines to their patients?

Schaffner: I would do it just as I have been doing it in this conversation, making an analogy with influenza. Vaccines make sense. Let's keep up with the virus. We've changed the vaccine. And now, just before the most serious season that we anticipate, we're going to provide the vaccine to update our immune system and remind our immune system to get busy and provide the antibodies that will be circulating in our blood stream that can fight off this virus and prevent serious disease.

I think doctors will also have to remind patients that the virus has not disappeared, particularly in high-risk groups. It can still put people in the hospital, and it’s doing so as we speak.

Healio: Let’s talk about influenza. When should people get their shots? And how does their age factor into the decision?

Schaffner: Influenza will return this year as it always has, and we have an influenza vaccine that, let's be very candid about this, is good but not perfect. These vaccines against respiratory viruses... they're not so good at preventing mild disease. They're much better at keeping us out of the hospital, and that's how we should measure their impact.

Every year the influenza vaccine is demonstrably good in keeping us out of the hospital. So, we're now toward mid-to-late September. The ideal time to get your influenza vaccine is in the month of October. That way, the protection you get from the vaccine should carry us over until about March through the winter season.

Healio: How about RSV? Assuming the physician and patient both agree that an RSV vaccine is the right choice , then when should they get their shot? And does it matter which one — GSK or Pfizer?

Schaffner: They're very similar, and the CDC considers them entirely equivalent. I do, too, so use the one that your provider has.

It is recommended that people aged 60 and older talk to their doctors about whether RSV [vaccination] is appropriate for them. Here are some considerations to have. The first is with increasing age, your risk from RSV goes up. So, those aged 70 years will have more risk than those aged 60 years, etc.

Also, if you're an older person who has a chronic underlying illness that involves the heart, the lung... if you have diabetes, for example, that increases your risk further. Any of those conditions should make you more interested and receptive to receiving the RSV vaccine.

You can get this vaccine at any time. The early data would indicate that this vaccine should not only carry us through this season of winter, but that protection may extend into next season.

Now, the data are preliminary, but they really do look pretty good, which means that we don't have to be quite as careful about when we get the RSV vaccine. If you're eligible, you can get it any time, and you can get it along with any of the other COVID-19 or influenza vaccines.

Healio: Anything else to add about vaccines as we head into the fall season?

Schaffner: The single thing that continues to concern me is the vaccine hesitancy or fatigue that the population has had, and that makes the challenge this year of providing more than one vaccine in preparation for our winter tune-up.

This is a big challenge, not only for the providers. but for the general public. How can we arrange things so that we can efficiently, effectively, comfortably, reassuringly provide these vaccines to this large population?

We'll be learning this season, and I anticipate we'll do even better next year. But let's get started this year. And everyone, please have it on your mind. Your to-do list this fall is to get ready for winter.

Reference:

• United States COVID-19 hospitalizations, deaths, emergency department (ED) visits, and test positivity by geographic area. https://covid.cdc.gov/covid-data-tracker/#maps_new-admissions-rate-county. Accessed Sept. 13, 2023.