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Tag: flu shot

  • A new virus variant and lagging vaccinations may mean the US is in for a severe flu season

    The United States may be heading into its second severe flu season in a row, driven by a mutated strain called subclade K that’s behind early surges in the United Kingdom, Canada and Japan.Last winter’s season was extreme, too. The U.S. had its highest rates of flu hospitalizations in nearly 15 years. At least 280 children died of influenza, the highest number since pediatric death numbers were required to be shared in 2004.Now, with a new variant in the mix, experts say we’re on track for a repeat. And with flu vaccinations down and holiday travel on the way, they worry that things may look much worse in the weeks ahead.The good news: Early analysis shows that this season’s flu shots offer some protection against being hospitalized with this variant, especially for kids. The bad news is that many Americans appear to be skipping their flu vaccines this year. New data from prescription data company IQVIA shows that vaccinations are down compared to where they usually are at this point in the year.A new playerFlu activity is low but rising quickly in the United States, according to the latest FluView report from the U.S. Centers for Disease Control and Prevention.Most of the flu viruses identified this season have been an A strain called H3N2, and half of those have come from subclade K, a variant that was responsible for a rougher-than-normal flu season this summer in the Southern Hemisphere.That variant wasn’t a major player when scientists decided which strains should be in the annual flu shots, so the vaccines cover a related but slightly different group of viruses.”It’s not like we’re expecting to get complete loss of protection for the vaccine, but perhaps we might expect a little bit of a drop-off if this is the virus that sort of dominates the season, and early indications are that’s probably going to be the case,” said Dr. Richard Webby, director of the World Health Organization Collaborating Center for studies on the ecology of influenza in animals and birds at St. Jude Children’s Research Hospital.Early analysis by the U.K. Health Security Agency shows that subclade K has seven gene changes on a key segment of the virus. Those mutations change the shape of this region, making it harder for the body’s defenses to recognize.”That’s the predominant thing that our immune system targets with antibodies, and that’s also pretty much what’s in the vaccine,” said Dr. Adam Lauring, chief of the Division of Infectious Diseases at the University of Michigan Medical School.UKHSA scientists found that the current flu vaccines are still providing decent protection against subclade K viruses. Vaccination cut the odds of an emergency department visit or hospitalization for the flu by almost 75% in children. The effectiveness for adults, even those over 65, was lower, about 30% to 40% against needing to visit the hospital or ER.But the scientists offer a caveat: These results are from early in the season, before the protection from seasonal flu vaccines has had time to wane or wear off. The findings are posted in a recent preprint study, which means it was published ahead of scrutiny from outside experts.Still, some protection is better than no protection, and while subclade K is expected to dominate the season, it won’t be the only flu strain circulating. No one gets to pick what they’re exposed to. Lauring said his daughter has just recovered from the flu, but it was a B-type strain.At the same time this new variant has emerged, flu vaccinations appear to be down in the U.S. According to IQVIA, about 64% of all flu vaccinations were administered at retail pharmacies, which administered roughly 26.5 million flu shots between August and the end of October. That’s more than 2 million fewer shots than the 28.7 million given over the same time frame in 2024.”I’m not surprised,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University’s School of Public Health. Vaccine skepticism expressed by leaders of the US Department of Health and Human Services has “injected chaos into the whole vaccination system,” she said.”There’s been a lot of attention on really non-issues,” like vaccine ingredients and separating shots, that she thinks “at the best, left people confused but possibly at the worst have left people worried about getting vaccinated,” she added.Flu vaccinations have also fallen in Australia, where subclade K was the predominant virus this year. As a result, flu hit a record, with more than 443,000 cases. Flu season in the Southern Hemisphere typically runs from May to July, so infectious disease experts often look to those countries for a preview of what might be on the way to North America.”What they saw in Australia is that they had a bad season. And so it’s concerning for you and us, what’s coming,” said Dr. Earl Rubin, director of the infectious disease division at the Montreal Children’s Hospital in Canada.’This is the time we start to see the rise’It’s difficult to say whether subclade K actually makes a person sicker than other flu strains, but if it drives more cases, it will certainly drive hospitalizations too, Rubin said.”When you look at severity, the more cases you have, if the same percentage get hospitalized, obviously you’re going to have more hospitalization if you have more cases. So it sometimes will look like the severity is also worse,” he said.Lab testing data has begun to show an uptick in flu cases.”This is the time we start to see the rise,” said Dr. Allison McMullen, a clinical microbiologist at BioMerieux, which makes the BioFire test, a popular diagnostic tool for respiratory pathogens.The company anonymously compiles its test results into a syndromic surveillance tool, which can offer a glimpse of what bugs are making people sick at any given time. At the beginning of the month, less than 1% of tests were positive for type A flu. Now it’s 2.4% – still low numbers but going up briskly, which aligns with the CDC trend.”We’re going to start seeing heavy holiday travel before we know it,” McMullen added. “With the rising cases that we’re seeing the U.K. and Japan, it can definitely be a bellwether for what we’re going to see in North America.”Signals are also rising in wastewater, said Dr. Marlene Wolfe, an assistant professor of environmental health at Emory University. In October, 18% of samples in the WastewaterSCAN network — an academically led wastewater monitoring program based at Stanford University, in partnership with Emory — were positive for type A flu, Wolfe said. In November, that number had risen to 40%.”Flu is something where, when it’s not in season, we don’t detect it very frequently in wastewater,” Wolfe said. COVID, on the other hand, can be detected pretty much all the time, which makes it challenging to know if it’s going up or down, she said.The scientists can set a threshold for when they can declare that a specific area is in flu season, Wolfe says. So far, just four of the 147 sites they monitor in 40 states have reached that threshold. Those sites are in the Northeast — in Maine and Vermont — in Iowa and in Hawaii.”I am concerned, I guess, that we could have a big flu season this year based on what we’re seeing in other parts of the world, and particularly Europe and elsewhere,” Michigan’s Lauring said.”It’s not too late. Go and get your flu shot,” Lauring advised. “And be alert that it’s out there.”

    The United States may be heading into its second severe flu season in a row, driven by a mutated strain called subclade K that’s behind early surges in the United Kingdom, Canada and Japan.

    Last winter’s season was extreme, too. The U.S. had its highest rates of flu hospitalizations in nearly 15 years. At least 280 children died of influenza, the highest number since pediatric death numbers were required to be shared in 2004.

    Now, with a new variant in the mix, experts say we’re on track for a repeat. And with flu vaccinations down and holiday travel on the way, they worry that things may look much worse in the weeks ahead.

    The good news: Early analysis shows that this season’s flu shots offer some protection against being hospitalized with this variant, especially for kids. The bad news is that many Americans appear to be skipping their flu vaccines this year. New data from prescription data company IQVIA shows that vaccinations are down compared to where they usually are at this point in the year.

    A new player

    Flu activity is low but rising quickly in the United States, according to the latest FluView report from the U.S. Centers for Disease Control and Prevention.

    Most of the flu viruses identified this season have been an A strain called H3N2, and half of those have come from subclade K, a variant that was responsible for a rougher-than-normal flu season this summer in the Southern Hemisphere.

    That variant wasn’t a major player when scientists decided which strains should be in the annual flu shots, so the vaccines cover a related but slightly different group of viruses.

    “It’s not like we’re expecting to get complete loss of protection for the vaccine, but perhaps we might expect a little bit of a drop-off if this is the virus that sort of dominates the season, and early indications are that’s probably going to be the case,” said Dr. Richard Webby, director of the World Health Organization Collaborating Center for studies on the ecology of influenza in animals and birds at St. Jude Children’s Research Hospital.

    Early analysis by the U.K. Health Security Agency shows that subclade K has seven gene changes on a key segment of the virus. Those mutations change the shape of this region, making it harder for the body’s defenses to recognize.

    “That’s the predominant thing that our immune system targets with antibodies, and that’s also pretty much what’s in the vaccine,” said Dr. Adam Lauring, chief of the Division of Infectious Diseases at the University of Michigan Medical School.

    UKHSA scientists found that the current flu vaccines are still providing decent protection against subclade K viruses. Vaccination cut the odds of an emergency department visit or hospitalization for the flu by almost 75% in children. The effectiveness for adults, even those over 65, was lower, about 30% to 40% against needing to visit the hospital or ER.

    But the scientists offer a caveat: These results are from early in the season, before the protection from seasonal flu vaccines has had time to wane or wear off. The findings are posted in a recent preprint study, which means it was published ahead of scrutiny from outside experts.

    Still, some protection is better than no protection, and while subclade K is expected to dominate the season, it won’t be the only flu strain circulating. No one gets to pick what they’re exposed to. Lauring said his daughter has just recovered from the flu, but it was a B-type strain.

    At the same time this new variant has emerged, flu vaccinations appear to be down in the U.S. According to IQVIA, about 64% of all flu vaccinations were administered at retail pharmacies, which administered roughly 26.5 million flu shots between August and the end of October. That’s more than 2 million fewer shots than the 28.7 million given over the same time frame in 2024.

    “I’m not surprised,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University’s School of Public Health. Vaccine skepticism expressed by leaders of the US Department of Health and Human Services has “injected chaos into the whole vaccination system,” she said.

    “There’s been a lot of attention on really non-issues,” like vaccine ingredients and separating shots, that she thinks “at the best, left people confused but possibly at the worst have left people worried about getting vaccinated,” she added.

    Flu vaccinations have also fallen in Australia, where subclade K was the predominant virus this year. As a result, flu hit a record, with more than 443,000 cases. Flu season in the Southern Hemisphere typically runs from May to July, so infectious disease experts often look to those countries for a preview of what might be on the way to North America.

    “What they saw in Australia is that they had a bad season. And so it’s concerning for you and us, what’s coming,” said Dr. Earl Rubin, director of the infectious disease division at the Montreal Children’s Hospital in Canada.

    ‘This is the time we start to see the rise’

    It’s difficult to say whether subclade K actually makes a person sicker than other flu strains, but if it drives more cases, it will certainly drive hospitalizations too, Rubin said.

    “When you look at severity, the more cases you have, if the same percentage get hospitalized, obviously you’re going to have more hospitalization if you have more cases. So it sometimes will look like the severity is also worse,” he said.

    Lab testing data has begun to show an uptick in flu cases.

    “This is the time we start to see the rise,” said Dr. Allison McMullen, a clinical microbiologist at BioMerieux, which makes the BioFire test, a popular diagnostic tool for respiratory pathogens.

    The company anonymously compiles its test results into a syndromic surveillance tool, which can offer a glimpse of what bugs are making people sick at any given time. At the beginning of the month, less than 1% of tests were positive for type A flu. Now it’s 2.4% – still low numbers but going up briskly, which aligns with the CDC trend.

    “We’re going to start seeing heavy holiday travel before we know it,” McMullen added. “With the rising cases that we’re seeing the U.K. and Japan, it can definitely be a bellwether for what we’re going to see in North America.”

    Signals are also rising in wastewater, said Dr. Marlene Wolfe, an assistant professor of environmental health at Emory University. In October, 18% of samples in the WastewaterSCAN network — an academically led wastewater monitoring program based at Stanford University, in partnership with Emory — were positive for type A flu, Wolfe said. In November, that number had risen to 40%.

    “Flu is something where, when it’s not in season, we don’t detect it very frequently in wastewater,” Wolfe said. COVID, on the other hand, can be detected pretty much all the time, which makes it challenging to know if it’s going up or down, she said.

    The scientists can set a threshold for when they can declare that a specific area is in flu season, Wolfe says. So far, just four of the 147 sites they monitor in 40 states have reached that threshold. Those sites are in the Northeast — in Maine and Vermont — in Iowa and in Hawaii.

    “I am concerned, I guess, that we could have a big flu season this year based on what we’re seeing in other parts of the world, and particularly Europe and elsewhere,” Michigan’s Lauring said.

    “It’s not too late. Go and get your flu shot,” Lauring advised. “And be alert that it’s out there.”

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  • Commentary: Democrats crumble like cookies. Is this really the best they can do?

    Democrats just crumbled like soft-bake cookies.

    The so-called resistance party has given up the shutdown fight, ensuring that millions of Americans will face Republican-created skyrocketing healthcare costs, and millions more will bury any hope that the minority party will find the substance and leadership to run a viable defense against President Trump.

    Sunday night, eight turncoat Democrats sold out every American who pays for their own health insurance through the affordable marketplaces set up by President Obama.

    As has been thoroughly reported in past weeks, Republicans are dead set on making sure that insurance is entirely out of financial reach for many Americans by refusing to help them pay for the premiums with subsidies that are part of current law, offered to both low- and middle-income families.

    Republicans — for reasons hard to fathom other than they hate Obama, and apparently basics such as flu shots — have long desired to kill the Affordable Care Act and now are on the brink of doing so, in spirit if not actuality, thanks to Democrats.

    Trump must be doing his old-man jig in the Oval Office.

    The pain this craven cave-in will cause is already evident. Rates for 2026 without the government subsidies have been announced, and premiums have doubled on average, according to nonpartisan health policy researcher KFF. Doubled.

    Insurance companies are planning on raising their rates by about 18%, already devastating and symptomatic of the need for a total overhaul of our messed-up system. That increase, coupled with the loss of the subsidies beginning at the start of next year, means a 114% jump in costs for the folks dependent on this insurance. Premiums that cost on average $888 in 2025 will jump to $1,904 in 2026, according to KFF.

    But it’s the middle-income people who will really be hit.

    “On average, a 60-year-old couple making $85,000 … would see yearly premium payments rise by over $22,600 in 2026,” KFF warns, meaning that instead of paying 8.5% of their income toward health insurance, it will now jump to about 25%.

    Merry Christmas, America.

    Although the eight Democrats who broke from their party to allow this to happen are directly responsible (thankfully our California senators are not among them), Democratic leadership should also be held accountable.

    A party that can’t keep itself together on the really big votes isn’t a party. It’s a bunch of people who occasionally have lunch together. Literally, they had one job: Stick together.

    The failure of Democratic leadership to make sure its Senate votes didn’t shatter in this intense moment isn’t just shameful, it’s depressing. For all of the condemnation of the Republican members of Congress for failing to uphold their duty to be a check on the power of the presidency, here’s the opposition party rolling over belly up on the pivotal issue of healthcare.

    As Rep. Ro Khanna (D-Fremont) put it on social media, “Senator Schumer is no longer effective and should be replaced. If you can’t lead the fight to stop healthcare premiums from skyrocketing for Americans, what will you fight for?”

    If the recent elections had any lessons in them, it’s that Democrats — and voters in general — want courage. Love or hate Zohran Mamdani, his win as New York City mayor was due in no small part to his daring to forge his own path. Ditto on Gov. Gavin Newsom and Proposition 50.

    Mamdani put that sentiment best in his victory speech, promising an age when people can “expect from their leaders a bold vision of what we will achieve, rather than a list of excuses for what we are too timid to attempt.”

    Before you start angry-emailing me, yes, I do understand how much pain the shutdown in causing, especially for furloughed workers and people facing disruptions in their SNAP benefits. I feel for every person who doesn’t know how they will pay their bills.

    But here are the facts that we can’t forget. Republicans have purposefully made that pain intense in order to break Democrats. Trump has found ways to pay his deportation agents, while simultaneously not paying critical workers such as airport screeners and air traffic controllers, where the chaos created by their absence is both visible and disruptive. He has also threatened to not give back pay to some of those folks when this does end.

    And on the give-in-or-don’t-eat front, he’s actually been ordered by courts to pay those Supplemental Nutrition Assistance Program benefits and is fighting it. Republicans could easily band together and demand that money goes out while the rest is hashed out, but they don’t want to. They want people to go hungry so that Democrats will break, and it worked.

    But at what cost?

    About 24 million people will be hit by these premium increases, leaving up to 4 million unable to keep their insurance. Unable to go to the doctor for routine care. Unable to pay for cancer treatments. Unable to have that lump, that pain, the broken bone looked at. Unable to get their kid a flu shot.

    In many ways, this isn’t a California problem. The majority of these folks are in Southern, Republican states that refused to expand Medicaid when they had the chance. About 6 in 10 subsidy recipients are represented by Republicans, according to KFF, led by those living in Florida, Georgia and Mississippi. But Americans have been clear that we want access to care for all of us, as a right, not an expensive privilege.

    Which makes it all the more mystifying that Democrats are so eager to give up, on an issue that unites voters across parties, across demographics, across our seemingly endless divides.

    But I guess that’s just how the cookie crumbles.

    Anita Chabria

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  • Flu Boosts Short-Term Odds for Heart Attack 6-Fold

    Flu Boosts Short-Term Odds for Heart Attack 6-Fold

    By Cara Murez 

    HealthDay Reporter

    WEDNESDAY, March 29, 2023 (HealthDay News) — Getting the flu isn’t fun for many reasons, but it can also trigger a heart attack, a new study suggests.

    A heart attack is six times more likely in the week after a person is diagnosed with flu than in the year before or after, according to Dutch researchers.

    This emphasizes the need for flu patients and those caring for them to be aware of heart attack symptoms. It also underscores the importance of getting a flu shot, the authors said.

    The findings are scheduled to be presented April 18 at a meeting of the European Congress of Clinical Microbiology and Infectious Diseases, online and in Copenhagen, Denmark.

    “With the potential public health implications of an association between influenza virus infection and acute heart attacks, showing robustness of results in a different study population is important,” said researcher Annemarijn de Boer, of the Julius Center for Life Sciences and Primary Care at UMC Utrecht in the Netherlands.

    “Our results endorse strategies to prevent influenza infection, including vaccination. They also advocate for a raised awareness among physicians and hospitalized flu-patients for symptoms of heart attacks,” de Boer said in a meeting news release.

    While the findings don’t make it clear whether those with less severe flu are also at risk, de Boer said they should also be aware of the link.

    While the connection between flu and heart attacks was also made in a 2018 Canadian study, it included only hospitalized people and not those who died of heart attacks elsewhere.

    In this study, researchers relied on test results from 16 laboratories, covering around 40% of the Dutch population, along with death and hospital records.

    More than 26,000 cases of influenza were confirmed by the labs between 2008 and 2019.

    The researchers found that 401 individuals had at least one heart attack within a year of their flu diagnosis, with a total of 419 heart attacks.

    Of the 419 heart attacks, 25 were in the first seven days after flu diagnosis; 217 in the year before diagnosis; and 177 in the year after flu diagnosis but not including the first seven days.

    About one-third of the 401 patients died of any cause within a year of being diagnosed with flu.

    The researchers calculated that the individuals studied were 6.16 times more likely to have a heart attack in the week following a flu diagnosis than in the year before or after. The Canadian study found they were 6.05 times more likely to have a heart attack in those seven days.

    Excluding data from death records, as in the Canadian study, reduced the increase in heart attack risk in the first week to 2.42 times. Dutch researchers said this underscores the impact of incomplete data on study findings.

    Researchers also said that differences in testing practices in the two countries may help explain the differences. It’s less common to test for flu outside the hospital in the Netherlands than it is in Canada, according to researchers.

    The Dutch researchers said the association is still significant and that they were able to confirm that the increase in risk applies across different populations.

    The influenza virus is known to increase clotting of blood. This, along with the inflammation that is part of the body’s immune response against the virus, can weaken fatty plaques that have built up in the arteries, the authors said. If a plaque ruptures, a blood clot can form, blocking the blood supply to the heart and cause a heart attack, they explained.

    Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

    More information

    UCLA Health has more on the connections between heart disease and flu.

     

    SOURCE: European Congress of Clinical Microbiology and Infectious Diseases, news release, March 28, 2023

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  • COVID Vaccines Are Turning Into Flu Shots

    COVID Vaccines Are Turning Into Flu Shots

    For all the legwork that public-health experts have done over the past few years to quash comparisons between COVID-19 and the flu, there sure seems to be a lot of effort nowadays to equate the two. In an advisory meeting convened earlier today, the FDA signaled its intention to start doling out COVID vaccines just like flu shots: once a year in autumn, for just about everyone, ad infinitum. Whatever the brand, primary-series shots and boosters (which might no longer be called “boosters”) will guard against the same variants, making them interchangeable. Doses will no longer be counted numerically. “This will be a fundamental transition,” says Jason Schwartz, a vaccine policy expert at Yale—the biggest change to the COVID-vaccination regimen since it debuted.

    Hints of the annual approach have been dropping, not so subtly, for years. Even in the spring of 2021, Pfizer’s CEO was floating the idea of yearly shots; Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research, teased it throughout 2022. This past September, Joe Biden officially endorsed it as “a new phase in our COVID-19 response,” and Ashish Jha, the White House’s COVID czar, memorably highlighted the convenience of combining a flu shot and a COVID shot into a single appointment: “I really believe this is why God gave us two arms.”

    Still, in today’s meeting, FDA officials were pushier than ever in their advocacy for the flu-ification of COVID vaccines. “We think that simplification of the vaccination regimen would contribute to easier vaccine deployment, better communication, and improved vaccine coverage,” Jerry Weir, the FDA’s director of the division of viral products, said at the meeting. The timing is important: After renewing the U.S.’s pandemic-emergency declaration earlier this month, the Biden administration seems set to allow its expiration this coming April. That makes the present moment awfully convenient for repackaging a chaotic, crisis-caliber vaccination paradigm as a scheduled, seasonal, normal-seeming one. A once-a-year strategy, modeled on a routine recommendation, suggests that “we’re no longer in emergency mode,” says Maria Sundaram, a vaccine researcher at the Marshfield Clinic Research Institute. Or at least, that’s the message that the public is likely to hear.

    But federal regulators may be trying to fit a COVID-shaped peg into a flu-shaped hole. The experts I spoke with largely agreed: Eventually, someday, annual autumn shots for COVID “will probably be sufficient,” says Gregory Poland, a vaccinologist at Mayo Clinic. “Are we ready for that yet? I’m not sure that’s the case at all.”

    Even in the short term, COVID-vaccination tactics need a revamp. “It’s clear above all that the current approach isn’t working,” Schwartz told me. Despite abundant supply, demand for COVID boosters in the U.S. has been abysmal—and interest seems to be declining with each additional dose. Last fall’s bivalent shot has reached the arms of only 15 percent of Americans; even among adults over 65—a majority of whom sign up for flu shots each fall—the vaccination rate hasn’t yet reached 40 percent.

    For most of the time that COVID shots have been around, figuring out when to get them has been a hassle, with different guidelines and requirements that depend on age, sex, risk factors, vaccination history, and more. Pharmacies have had to stock an absurd number of vials and syringes to accommodate the various combinations of brands and dose sizes; record-keeping on flimsy paper cards has been a total joke. “I do this for a living, and I can barely keep track,” Schwartz said. Recommendations on the proper timing and number of doses have also changed so many times that many Americans have simply checked out. After the bivalent recipe debuted, polls found that an alarming proportion of people didn’t even know the shot was available to them.

    Streamlining COVID-vaccine recommendations will remove a lot of that headache, Sundaram told me. Most people would need to keep only one mantra in mind—one dose, each fall—and could top off their flu and COVID immunity at the same time. Burdens on pharmacies and clinics would be lower, and communication would be far easier—a change that could make an especially big difference for those with children, among whom COVID-vaccine uptake has been the lowest. “It’ll be more scheduled, more systematic,” says Charlotte Hobbs, a pediatric infectious-disease specialist at the University of Mississippi Medical Center. COVID shots could simply be offered at annual well-child visits, she told me. “It’s something we already know works well.”

    The advantages of a flu-ified COVID shot aren’t just about convenience. If we have to shoehorn COVID vaccines into an existing paradigm, Sundaram told me, influenza’s is the best candidate. SARS-CoV-2, like the flu, is excellent at altering itself to dodge our defenses; it spreads readily in winter; and our immunity to infection tends to fade rather quickly. All of that adds up to a need for regularly updated shots. Such a system has been in place for decades for the flu: At the end of each winter, a panel of experts convenes to select the strains that should be targeted by the next formulation; manufacturers spend the next several months whipping up big batches in time for an autumn-ish rollout. The pipeline depends on a global surveillance system for flu viruses, as well as regular surveys of antibody levels in the community to suss out which strains people are still protected against. The premise has been so well vetted by now that researchers can skip the chore of running large-scale clinical trials to determine the efficacy and safety of each new, updated recipe.

    But a seasonal strategy works best for a seasonal virus—and SARS-CoV-2 just isn’t there yet, says Hana El Sahly, an infectious-disease physician at Baylor College of Medicine. Though flu viruses tend to hop between the globe’s hemispheres, alternately troubling the north and the south during their respective cold months, this new coronavirus has yet to confine its spread to one part of the calendar. (Marks, of the FDA, tried to address this concern at today’s meeting, asserting that “we’re starting to see some seasonality” and that fall was indeed the very sensible for an annual rollout.) SARS-CoV-2 has also been spitting out concerning variants and subvariants at a faster rate than the flu (and flu shots already have a hard time keeping up with evolution). The FDA’s new proposal suggests picking SARS-CoV-2 variants in June to have a vaccine ready by September, a shorter timeline than is used for flu. That still might not be fast enough: “By the time we detect a variant, it will have ripped through the global population and, in a few more weeks, died down,” El Sahly told me. The world got a preview of this problem with last year’s bivalent shot, which overlapped with the dominance of its target subvariants for only a couple of months. A flu model for COVID would make more sense “if we had stable, predictable dynamics,” says Avnika Amin, a vaccine epidemiologist at Emory University. “I don’t think we’re at that point.”

    Murkiness around vaccine effectiveness makes this transition complicated too. Experts told me that it’s gotten much more difficult to tell how well our COVID vaccines are working, and for how long, fueling debates over how often they should be given and how often their composition should change. Many people have now been infected by the virus multiple times, which can muddy calculations of vaccine effectiveness; better treatments also alter risk profiles. And many researchers told me they’re concerned that the data shortcuts we use for flu—measures of antibodies as a proxy for immune protection—just won’t fly for COVID shots. “We need better clinical data,” El Sahly told me. In their absence, the hasty adoption of a flu framework could lead to our updating and distributing COVID shots too often, or not often enough.

    A flu-ish approach also wouldn’t fix all of the COVID vaccines’ problems. Today’s discussion suggested that, even if a new COVID-shot strategy change goes through, officials will still need to recommend several different dose sizes for several different age groups—a more complex regimen than flu’s—and may advise additional injections for those at highest risk. At the same time, COVID shots would continue to be more of a target for misinformation campaigns than many other vaccines and, at least in the case of mRNA-based injections, more likely to cause annoying side effects. These issues and others have driven down interest—and simply pivoting to the flu paradigm “is not going to solve the uptake problem,” says Angela Shen, a vaccine-policy expert at Children’s Hospital of Philadelphia.

    Perhaps the greatest risk of making COVID vaccines more like flu shots is that it could lead to more complacency. In making the influenza paradigm a model, we also threaten to make it a ceiling. Although flu shots are an essential, lifesaving public-health tool, they are by no means the best-performing vaccines in our roster. Their timeline is slow and inefficient; as a result, the formulations don’t always match circulating strains. Already, with COVID, the world has struggled to chase variants with vaccines that simply cannot keep up. If we move too quickly to the fine-but-flawed framework for flu, experts told me, it could disincentivize research into more durable, more variant-proof, less side-effect-causing COVID shots. Uptake of flu vaccines has never been stellar, either: Just half of Americans sign up for the shots each year—and despite years of valiant efforts, “we still haven’t figured out how to consistently improve that,” Amin told me.

    Whenever the COVID-emergency declaration expires, vaccination will almost certainly have to change. Access to shots may be imperiled for tens of millions of uninsured Americans; local public-health departments may end up with even fewer resources for vaccine outreach. A flu model might offer some improvements over the status quo. But if the downsides outweigh the pluses, Poland told me, that could add to the erosion of public trust. Either way, it might warp attitudes toward this coronavirus in ways that can’t be reversed. At multiple points during today’s meeting, FDA officials emphasized that COVID is not the flu. They’re right: COVID is not the flu and never will be. But vaccines can sometimes become a lens through which we view the dangers they fight. By equating our frontline responses to these viruses, the U.S. risks sending the wrong message—that they carry equal threat.

    Katherine J. Wu

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  • The FDA Wants an Annual COVID Vaccine: What You Need to Know

    The FDA Wants an Annual COVID Vaccine: What You Need to Know

    Jan. 24, 2023 – Is pivoting to an annual COVID-19 shot a smart move? The FDA, which proposed the change on Monday, says an annual shot vs. periodic boosters could simplify the process to ensure more people stay vaccinated and protected against severe COVID-19 infection. 

    A national advisory committee plans to vote on the recommendation Thursday.

    If accepted, the vaccine formula would be decided each June and Americans could start getting their annual COVID-19 shot in the fall, like your yearly flu shot.  

    Keep in mind: Older Americans and those who are immunocompromised may need more than one dose of the annual COVID-19 shot.

    Most Americans are not up to date with their COVID-19 boosters. Only 15% of Americans have gotten the latest booster dose, while a whopping nine out of 10 Americans age 12 or older finished their primary vaccine series. The FDA, in briefing documents for Thursday’s meeting, says problems with getting vaccines into people’s arms makes this a change worth considering. 

    “Given these complexities, and the available data, a move to a single vaccine composition for primary and booster vaccinations should be considered,” the agency says.

    A yearly COVID-19 vaccine could be simpler, but would it be as effective? WebMD asks health experts your most pressing questions about the proposal.

    Pros and Cons of an Annual Shot

    Having an annual COVID-19 shot, alongside the flu shot, could make it simpler for doctors and health care providers to share vaccination recommendations and reminders, according to Leana Wen, MD, a public health professor at George Washington University and former Baltimore health commissioner.

    “It would be easier [for primary care doctors and other health care providers] to encourage our patients to get one set of annual shots, rather than to count the number of boosters or have two separate shots that people have to obtain,” she says.

    “Employers, nursing homes, and other facilities could offer the two shots together, and a combined shot may even be possible in the future.”

    Despite the greater convenience, not everyone is enthusiastic about the idea of an annual COVID shot. COVID-19 does not behave the same as the flu, says Eric Topol, MD, editor-in-chief of Medscape, WebMD’s sister site for health care professionals.

    Trying to mimic flu vaccination and have a year of protection from a single COVID-19 immunization “is not based on science,” he says. 

    Carlos del Rio, MD, of Emory University in Atlanta and president of the Infectious Diseases Society of America, agrees. 

    “We would like to see something simple and similar like the flu. But I also think we need to have the science to guide us, and I think the science right now is not necessarily there. I’m looking forward to seeing what the advisory committee, VRBAC, debates on Thursday. Based on the information I’ve seen and the data we have, I’m not convinced that this is a strategy that is going to make sense,” he says. 

    “One thing we’ve learned from this virus is that it throws curveballs frequently, and when we make a decision, something changes. So, I think we continue doing research, we follow the science, and we make decisions based on science and not what is most convenient.” 

    COVID-19 Isn’t Seasonal Like the Flu

    “Flu is very seasonal, and you can predict the months when it’s going to strike here,” Topol says. “And as everyone knows, COVID is a year-round problem.” He says it’s less about a particular season and more about times when people are more likely to gather indoors. 

    So far, European officials are not considering an annual COVID-19 vaccination schedule, says Annelies Zinkernagel, MD, PhD, of the University of Zurich and president of the European Society of Clinical Microbiology and Infectious Diseases. 

    Regarding seasonality, she says, “what we do know is that in closed rooms in the U.S. as well as in Europe, we can have more crowding. And if you’re more indoors or outdoors, that definitely makes a big difference.”

    Which Variant(s) Would It Target?

    To decide which variants an annual COVID-19 shot will attack, one possibility could be for the FDA to use the same process used for the flu vaccine, Wen says.

    “At the beginning of flu season, it’s always an educated guess as to which influenza strains will be dominant,” she says.

    “We cannot predict the future of which variants might develop for COVID, but the hope is that a booster would provide broad coverage against a wide array of possible variants.”

    Topol agrees it’s difficult to predict. A future with “new viral variants, perhaps a whole new family beyond Omicron, is uncertain.”

    Reading the FDA briefing document “to me was depressing, and it’s just basically a retread. There’s no aspiration for doing bold things,” Topol says. “I would much rather see an aggressive push for next-generation vaccines and nasal vaccines.”

    To provide the longest protection, “the annual shot should target currently predominant circulating strains, without a long delay before booster administration,” says Jeffrey Townsend, PhD, a professor of biostatistics and ecology and evolutionary biology at Yale School of Public Health. 

    “Just like the influenza vaccine, it may be that some years the shot is less useful, and some years the shot is more useful,” he says, depending on how the virus changes over time and which strain(s) the vaccine targets. “On average, yearly updated boosters should provide the protection predicted by our analysis.”

    Townsend and colleagues published a prediction study on Jan. 5, in the Journal of Medical Virology. They look at both Moderna and Pfizer  vaccines and how much protection they would offer over 6 years based on people getting regular vaccinations every 6 months, every year, or for longer periods between shots. 

    They report that annual boosting with the Moderna vaccine would provide 75% protection against infection and an annual Pfizer vaccine would provide 69% protection. These predictions take into account new variants emerging over time, Townsend says, based on behavior of other coronaviruses.

    “These percentages of fending off infection may appear large in reference to the last 2 years of pandemic disease with the massive surges of infection that we experienced,” he says. “Keep in mind, we’re estimating the eventual, endemic risk going forward, not pandemic risk.”

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  • COVID, flu, RSV: The benefits of advocating for boosters in the workplace–and how to go about it

    COVID, flu, RSV: The benefits of advocating for boosters in the workplace–and how to go about it

    With a triple pandemic of COVID, flu, and Respiratory syncytial virus (RSV) hitting the U.S. hard this winter and resulting in an explosion of cases, business executives need to take the lead on promoting the newly updated, Omicron-specific boosters. Doing so will help reduce the number of sick days taken by their workers, minimize COVID outbreaks and superspreader events in their companies, reduce employee fears about returning to the office, and position executives as trustworthy participants in stakeholder capitalism.

    Research shows that the new boosters from Pfizer and Moderna, which are bivalent (they target both Omicron and the original COVID strain) are very safe, like current vaccines. They are also more effective than previous vaccines against the Omicron variants, which are prevalent in the U.S. and around the globe.

    The boosters are widely available and price is not an issue: the federal government purchased plenty of doses to give away for free to anyone approved to get one. They’re authorized for Americans aged 12 or older. The Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky stated “there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it.”

    Unfortunately, these recommendations are largely falling on deaf ears. Only 7.6 million Americans received the new booster in September, the first month it became widely available.

    Missing booster shots could have dire consequences

    The reason for low uptake stems from vaccine hesitancy and a lack of awareness. According to a Kaiser Family Foundation survey, less than a third of the targeted population intend to get the new boosters.

    This low number is not surprising, given an Ipsos poll showing that 65% believe there is a small or no risk in returning to their normal, pre-COVID life. That belief would not be a problem if we didn’t have hundreds of COVID-related deaths per day right now, and many additional deaths from flu and RSV as part of the triple pandemic. Moreover, the University of Washington’s Institute for Health Metrics and Evaluation projects a new wave of COVID in the winter that could more than quadruple the current infection rate, which aligns with projections of a major winter wave by the FDA.

    The consequences for executives and their teams can be dire. We knew since early 2022 that, according to a CDC study, the original vaccine’s effectiveness against Omicron fades quickly. Those who received two doses of Moderna or Pfizer have 71% less likelihood of being hospitalized with COVID compared to non-vaccinated people within the first month of getting the shots. However, that effectiveness fades relatively quickly to 58% after four months and continues falling off after that. Someone who received the original two doses and then a booster gets a protection of 91% against hospitalization immediately. Effectiveness falls to 78% after four months.

    By now, it’s been many months since most Americans received the original vaccine series and the booster shots. That makes us seriously vulnerable to COVID, especially the most experienced, senior staff at companies, whose age puts them in a high-risk category.

    The immediate danger of staff members being out for several weeks in a hospital, or even dying, is just part of the problem. We can’t forget about the threat of long COVID, meaning long-term symptoms of COVID infection. These symptoms can range from fatigue and brain fog to sudden heart failure and strokes in otherwise healthy young and middle-aged people.

    A CDC survey from June 2022 shows that 7.5% of Americans report having long COVID symptoms, defined as symptoms lasting three or more months after first contracting the virus. A study by the University of Southern California finds that 23% of those who get sick with COVID are likely to get long COVID symptoms.

    Per a study published in The Lancet, 22% of those who had long COVID symptoms were unable to work, and another 45% needed reduced hours. The Brookings Institution evaluated these numbers to find that long COVID is keeping anywhere from 2 to 4 million Americans out of the labor force. No wonder we’re experiencing such labor shortages!

    Nobody wants their staff–or themselves–to become part of these statistics. Yet what are executives doing about it? Not much. That’s despite serious recent outbreaks at major companies that mandated office returns, such as Google or CalPERS, the $441.9 billion California Public Employees’ Retirement System.

    By failing to take action, business leaders are falling into the omission bias. This term refers to a dangerous judgment error–a cognitive bias that downplays the costs of inaction in our minds.

    In fact, some companies are taking steps in the opposite direction in their desperation to drive staff to the office. For example, Goldman Sachs lifted vaccination requirements everywhere except in areas that have government vaccine mandates for being in the office.

    What should managers do?

    What executives should be thinking about is the long-term consequences of failing to encourage new booster shots. Given the data, we can confidently state that the more employees get shots, the fewer sick days they will take. It will also lower the chance of staff having to permanently reduce their hours or even withdraw from the labor force.

    Similarly, advocating for boosters will minimize COVID outbreaks in a company. Doing so avoids the bad PR from such outbreaks, as well as the decreased morale afflicting staff at a time when companies are trying to have their staff return to the office, as Google, CalPERS, and others have discovered.

    On a related note, to reduce employee fears about returning to the office, encouraging everyone to get the new booster is an excellent strategy. Whether a company pursues a flexible, team-led model in returning to the office as I encourage my clients to do, or a more rigid, top-down approach, many employees have fears about COVID. An internal survey my company just completed for a Fortune 500 SaaS company showed that 64% of respondents felt somewhat concerned about COVID in the office. That aligns with broader surveys, such as one by Ipsos in September showing that 57% of those surveyed feel somewhat concerned about COVID.

    Last, but far from least, comes the crucial role of executives to serve as trustworthy exemplars of what the Business Roundtable calls the new purpose of companies: stakeholder capitalism. A critical aspect of stakeholder capitalism involves “supporting the communities in which we work.”

    There’s little doubt that reducing COVID among company employees supports broader community health and well-being. According to Edelman’s trust barometer, business leaders are trusted more than the government, nonprofits, and the media. Some 86% of respondents to the trust barometer expect CEOs to speak out on issues such as pandemic impact. This makes it only more urgent for executives who wish to be on the front line of stakeholder capitalism to speak out in favor of the new boosters.

    Mandates are certainly not the right way to go about promoting new boosters, given that we are transitioning from the emergency of the pandemic into a more endemic stage of learning to live with the virus. A much better approach is creating appropriate norms and nudging employees to engage in win-win behaviors by using behavioral science-based approaches.

    To create appropriate norms, executives need to both publicly advocate for the new boosters and get the shot themselves. The CEO at one of my client organizations wrote up a blog post for an internal company newsletter about the benefit of getting the bivalent booster, accompanied by a photo of himself getting the jab. She also strongly encouraged her C-suite and mid-level managers to get the booster and discuss doing so with their team members. The company also brought in a well-respected epidemiologist to talk about the benefits of getting a bivalent vaccine booster, who answered questions and addressed concerns among staff.

    To nudge employees, this company offered paid time off for getting the shot, along with sick leave for any side effects. It also created a competition between different teams within the organization. Team members could submit anonymized proof of their shots, and the first three teams to have all their members get shots got treated to an all-expense-paid weekend getaway. The company offered the same prize through a lottery for five employees across the organization who got the booster within the first three months it became available.

    Other companies I work with have adopted similar techniques to developing norms and nudging employees, customized to their own needs. These approaches help create a context that encourages employees to protect everyone’s health without forcing them to get the shot. Doing so benefits the bottom line by reducing sick days, addressing worker resistance to coming to the office, minimizing PR fiascos, and helping executives be at the forefront of stakeholder capitalism.

    Gleb Tsipursky, Ph.D., is the CEO of the boutique future-of-work consultancy Disaster Avoidance Experts. He is the best-selling author of seven books, including Never Go With Your Gut: How Pioneering Leaders Make the Best Decisions and Avoid Business Disasters and Leading Hybrid and Remote Teams: A Manual on Benchmarking to Best Practices for Competitive Advantage. His expertise comes from over 20 years of consulting for Fortune 500 companies from Aflac to Xerox and over 15 years in academia as a behavioral scientist at UNC-Chapel Hill and Ohio State.

    The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.

    More must-read commentary published by Fortune:

    Gleb Tsipursky

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  • Will the Bivalent Booster Cause Worse Side Effects?

    Will the Bivalent Booster Cause Worse Side Effects?

    For as long as my marriage lasts, my household will be divided by reactions to vaccines.

    I am, fortunately, speaking of physical reactions rather than ideological ones; my partner and I are both shot enthusiasts, a fact we verified on our first date. But if my immune system is a bashful wallflower, rarely triggering more than a sore arm in the hours after I get a vaccine, then my spouse’s is a party animal. Every immunization I’ve watched him receive—among them, four doses of Moderna’s COVID-19 vaccine—has absolutely clobbered him with fevers, chills, fatigue, and headaches for about a full day. When he got the flu shot and the bivalent COVID jab together a few weeks ago, he ended up taking his first day off work in more than a decade. As usual, the same injections caused me so few symptoms that I wondered if I was truly dead inside.

    “Why don’t you feel anything?” my spouse howled at me from the bedroom, where his sweat was soaking through the sheets. “Sorry,” I yelled back from the kitchen, where I was prepping four days’ worth of meals between work calls after returning from an eight-mile run.

    If this is how every autumn will go from now on, so be it: A few hours of discomfort is still worth the rev-up in defenses that vaccines offer against serious disease and death. But it’s not hard to see that gnarly side effects will only add to the many other factors that work against COVID-vaccine uptake, including lack of awareness, sloppy messaging, dwindling access, and spotty community outreach. Back in the spring, when I spoke with several people who hadn’t gotten boosters despite being eligible for many, many months, several of them cited the post-shot discomfort as a reason. Now I’m getting texts and calls from family members and friends—all up to date on their previous COVID vaccines—admitting they’ve been dillydallying on the bivalent to avoid those symptoms too. “I don’t know if we’re going to continue to get strong buy-in from the public if they have this sort of reaction every year,” says Cindy Leifer, an immunologist at Cornell University.

    Read: America created its own booster problems

    The good news, at least, is that experts told me they don’t expect this bivalent recipe—or future autumn COVID shots, for that matter—to be worse, side-effect-wise, than the ones we’ve received before. It’ll take a while for data to confirm that, especially considering that more than a month into this fall’s rollout, fewer than 15 million Americans have received the updated shot. But Kathleen Neuzil, a vaccinologist at the University of Maryland School of Medicine who has studied the performance of COVID vaccines in clinical trials, pointed out to me that the mRNA shots’ ingredients have been swapped out before without altering the rate of side effects. As the alphabet soup of variants began to sweep the world in early 2021, she told me, vaccine makers started to tinker with alternate formulations, sometimes combining multiple versions of the spike protein into a single shot—“and they’re all comparable.” (If anything, early data suggest that bivalent shots containing an Omicron variant spike may be easier to take.) The same goes for flu vaccines, which are also retooled each year: When measured across the population, the frequency and intensity of side effects remain more or less the same.

    On average, then, mRNA-vaxxed people can probably expect to have an annual experience that’s pretty similar to the one they had with their first COVID booster. As studies have shown, that one was actually better for most people than dose No. 2, the most unpleasant of the injections so far. (The math, of course, becomes tougher for people getting another vaccine, such as the flu shot, at the same time.) There are probably two main reasons why side effects have lessened overall, experts told me. First, the spacing: Most people received the second dose in their Pfizer or Moderna primary series just three or four weeks after the first. That’s an efficient way to get a lot of people “fully vaccinated” in a short period of time, but it means that many of the immune system’s defensive cells and molecules will still be on high alert. The second shot could end up fanning a blaze of inflammation that was never quite put out. In line with that, researchers have found that spacing out the primary-series doses to eight weeks, 12 weeks, or even longer can prune some side effects.

    Dose matters a lot too: Vaccines are, in a way, stimulants meant to goad the immune system into reacting; bigger servings should induce bigger jolts. When vaccine makers were tinkering with their recipes in early trials, higher doses—including ones that were deemed too large for further testing—produced more side effects. Each injection in Moderna’s primary series contains more than three times the mRNA packaged into Pfizer’s, and Moderna has, on average, caused more intense side effects. But Moderna’s booster and bivalent doses contain a smaller scoop of the stimulating material: People 12 and older, for instance, get 50 micrograms instead of the 100 micrograms in each primary dose; kids 6 to 11 years old get 25 micrograms instead of 50. (All of Pfizer’s doses stay the same size across primaries and boosters, as long as people stay in the same age group.) People who switch between brands, then, may also notice a difference in symptoms.

    It’s a tricky balance, though. Sometimes, the immune system adjusts the magnitude of its protection to match the danger posed by a pathogen (or shot), a bit like titrating a crisis response to the severity of a threat—so it’s important that vaccine makers don’t undershoot. For better or worse, the mRNA-based COVID vaccines do seem to cause a rougher response than most other vaccines, including annual flu shots. One of the offending ingredients might be the mRNA itself, which codes for SARS-CoV-2’s spike protein. But Michela Locci, an immunologist at the University of Pennsylvania, told me that the mRNA’s packaging—a greasy fat bubble called a lipid nanoparticle—may be the more likely culprit. For some people, in any case, the side effects of COVID shots might be on par with those of the two-dose Shingrix vaccine, one of the most infamously reactogenic immunizations in our roster. Leifer, who has received both, told me the second dose of each “floored” her to about the same extent.

    The fact that I get fewer side effects than my spouse does not imply that I’m any less protected. A ton of factors—genetics, hormone levels, age, diet, sleep, stress, pain tolerance, and more—could potentially influence how someone experiences a shot. Women tend to have more reactive bodies, as do younger people. But there are exceptions to those trends: I’m one of them. The whole topic is understudied, Locci told me. Her own recent experience with the bivalent threw her for a loop. After her first, second, and third dose of Moderna each ratcheted up in side-effect severity, she cleared her calendar for the couple of days following her bivalent, “afraid I was going to be in bed with a fever again,” she said: “But it was a light headache for a morning, and then it was over.” She has no idea what next year will bring.

    Either way, side effects such as fevers and chills tend to be short-lived. “Very few side effects are severe,” Neuzil told me, “and COVID continues to be a severe disease.” Still, Grace Lee, a pediatrician at Stanford and the chair of the CDC’s Advisory Committee on Immunization Practices, hopes that scientists will keep developing new COVID vaccines that might come with fewer post-shot issues—including the very rare ones, such as myocarditis—without sacrificing immune protection. Lee doesn’t tend to react much to vaccines, but her daughter “always misses school the next day,” she told me. “I plan her shots for a Friday afternoon so she can lay out all Saturday.” Early on, when hardly anyone had immunity to the virus, signing everyone up for somewhat reactogenic shots was a no-brainer—especially given the hope that two doses would yield many, many years of protection. Now that we know it’s a repeated need, Neuzil said, “the equation changes a bit.”

    People aren’t totally helpless against side effects. Deepta Bhattacharya, an immunologist at the University of Arizona, had an “awful, terrible” experience with his second and third doses, which slammed him with 102- and 103-degree fevers, respectively. He weathered the side effects without intervention, worried that a painkiller would curb not just the agony, but also his protective immune response. This time, though, armed with new knowledge from his own lab that anti-inflammatory and pain-relieving drugs don’t blunt antibody levels, “the first sign I feel even the slightest bit shitty,” he told me, “I’m dosing up.”

    I’ll probably do the same for my spouse the next time he’s due for a vaccine of any kind … likely while I chill on the sidelines. Bhattacharya’s spouse, too, is kind of an immune introvert, a fact that he bemoans. “Her only side effect was she felt thirsty,” he said. “It’s just not fair.”

    Katherine J. Wu

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  • When’s the Perfect Time to Get a Flu Shot?

    When’s the Perfect Time to Get a Flu Shot?

    For about 60 years, health authorities in the United States have been championing a routine for at least some sector of the public: a yearly flu shot. That recommendation now applies to every American over the age of six months, and for many of us, flu vaccines have become a fixture of fall.

    The logic of that timeline seems solid enough. A shot in the autumn preps the body for each winter’s circulating viral strains. But years into researching flu immunity, experts have yet to reach a consensus on the optimal time to receive the vaccine—or even the number of injections that should be doled out.

    Each year, a new flu shot recipe debuts in the U.S. sometime around July or August, and according to the CDC the best time for most people to show up for an injection is about now: preferably no sooner than September, ideally no later than the end of October. Many health-care systems require their employees to get the shot in this time frame as well. But those who opt to follow the CDC current guidelines, as I recently did, then mention that fact in a forum frequented by a bunch of experts, as I also recently did, might rapidly hear that they’ve made a terrible, terrible choice.

    “There’s no way I would do what you did,” one virologist texted me. “It’s poor advice to get the flu vaccine now.” Florian Krammer, a virologist at Mount Sinai’s Icahn School of Medicine, echoed that sentiment in a tweet: “I think it is too early to get a flu shot.” When I prodded other experts to share their scheduling preferences, I found that some are September shooters, but others won’t juice up till December or later. One vaccinologist I spoke with goes totally avant-garde, and nabs multiple doses a year.

    Read: Should your flu and COVID shots go in different arms?

    There is definitely such a thing as getting a flu shot too early, as Helen Branswell has reported for Stat. After people get their vaccine, levels of antibodies rocket up, buoying protection against both infection and disease. But after only weeks, the number of those molecules begins to steadily tick downward, raising people’s risk of developing a symptomatic case of flu by about 6 to 18 percent, various studies have found. On average, people can expect that a good portion of their anti-flu antibodies “are meaningfully gone by about three or so months” after a shot, says Lauren Rodda, an immunologist at the University of Washington.

    That decline is why some researchers, Krammer among them, think that September and even October shots could be premature, especially if flu activity peaks well after winter begins. In about three-quarters of the flu seasons from 1982 to 2020, the virus didn’t hit its apex until January or later. Krammer, for one, told me that he usually waits until at least late November to dose up. Stanley Plotkin, a 90-year-old vaccinologist and vaccine consultant, has a different solution. People in his age group—over 65—don’t respond as well to vaccines in general, and seem to lose protection more rapidly. So for the past several years, Plotkin has doubled up on flu shots, getting one sometime before Halloween and another in January, to ensure he’s chock-full of antibodies throughout the entire risky, wintry stretch. “The higher the titers,” or antibody levels, Plotkin told me, “the better the efficacy, so I’m trying to take advantage of that.” (He made clear to me that he wasn’t “making recommendations for the rest of the world”—just “playing the odds” given his age.)

    Data on doubling up is quite sparse. But Ben Cowling, an epidemiologist and flu researcher at Hong Kong University, has been running a years-long study to figure out whether offering two vaccines a year, separated by roughly six months, could keep vulnerable people safe for longer. His target population is Hong Kongers, who often experience multiple annual flu peaks, one seeded by the Northern Hemisphere’s winter wave and another by the Southern Hemisphere’s. So far, “getting that second dose seems to give you additional protection,” Cowling told me, “and it seems like there’s no harm of getting vaccinated twice a year,” apart from the financial and logistical cost of a double rollout.

    Read: The strongest sign that Americans should worry about flu this winter

    In the U.S., though, flu season is usually synonymous with winter. And the closer together two shots are given, the more blunted the effects of the second injection might be: People who are already bustling with antibodies may obliterate a second shot’s contents before the vaccine has a chance to teach immune cells anything new. That might be why several studies that have looked at double-dosing flu shots within weeks of each other “showed no benefit” in older people and certain immunocompromised groups, Poland told me. (One exception? Organ–transplant recipients. Kids getting their very first flu shot are also supposed to get two of them, four weeks apart.)

    Even at the three-ish-month mark past vaccination, the body’s anti-flu defenses don’t reset to zero, Rodda told me. Shots shore up B cells and T cells, which can survive for many months or years in various anatomical nooks and crannies. Those arsenals are especially hefty in people who have banked a lifetime of exposures to flu viruses and vaccines, and they can guard people against severe disease, hospitalization, and death, even after an antibody surge has faded. A recent study found that vaccine protection against flu hospitalizations ebbed by less than 10 percent a month after people got their shot, though the rates among adults older than 65 were a smidge higher. Still other numbers barely noted any changes in post-vaccine safeguards against symptomatic flu cases of a range of severities, at least within the first few months. “I do think the best protection is within three months of vaccination,” Cowling told me. “But there’s still a good amount by six.”

    For some young, healthy adults, a decent number of flu antibodies may actually stick around for more than a year. “You can test my blood right now,” Rodda told me. “I haven’t gotten vaccinated just yet this year, and I have detectable titers.” Ali Ellebedy, an immunologist at Washington University in St. Louis, told me he has found that some people who have regularly received flu vaccines have almost no antibody bump when they get a fresh shot: Their blood is already hopping with the molecules. Preexisting immunity also seems to be a big reason that nasal-spray-based flu vaccines don’t work terribly well in adults, whose airways have hosted far more flu viruses than children’s.

    Getting a second flu shot in a single season is pretty unlikely to hurt. But Ellebedy compares it to taking out a second insurance policy on a car that’s rarely driven: likely of quite marginal benefit for most people. Plus, because it’s not a sanctioned flu-vaccine regimen, pharmacists might be reluctant to acquiesce, Poland pointed out. Double-dosing probably wouldn’t stand much of a chance as an official CDC recommendation, either. “We do a bad enough job,” Poland said, getting Americans to take even one dose a year.

    Read: America’s flu-shot problem is also its next COVID-shot problem

    That’s why the push to vaccinate in late summer and early fall is so essential for the single shot we currently have, says Huong McLean, a vaccine researcher at the Marshfield Clinic Research Institute in Wisconsin. “People get busy, and health systems are making sure that most people can get protected before the season starts,” she told me. Ellebedy, who’s usually a September vaccinator, told me he “doesn’t see the point of delaying vaccination for fear of having a lower antibody level in February.” Flu seasons are unpredictable, with some starting as early as October, and the viruses aren’t usually keen on giving their hosts a heads-up. That makes dillydallying a risk: Put the shot off till November or December, and “you might get infected in between,” Ellebedy said—or simply forget to make an appointment at all, especially as the holidays draw near.

    In the future, improvements to flu-shot tech could help cleave off some of the ambiguity. Higher doses of vaccine, which are given to older people, could rile up the immune system to a greater degree; the same could be true for more provocative vaccines, made with ingredients called adjuvants that trip more of the body’s defensive sensors. Injections such as those seem to “maintain higher antibody titers year-round,” says Sophie Valkenburg, an immunologist at Hong Kong University and the University of Melbourne—a trend that Ellebedy attributes to the body investing more resources in training its fighters against what it perceives to be a larger threat. Such a switch would likely come with a cost, though, McLean said: Higher doses and adjuvants “also mean more adverse events, more reactions to the vaccine.”

    For now, the only obvious choice, Rodda told me, is to “definitely get vaccinated this year.” After the past two flu seasons, one essentially absent and one super light, and with flu-vaccination rates still lackluster, Americans are more likely than not in immunity deficit. Flu-vaccination rates have also ticked downward since the coronavirus pandemic began, which means there may be an argument for erring on the early side this season, if only to ensure that people reinforce their defenses against severe disease, Rodda said. Plus, Australia’s recent flu season, often a bellwether for ours, arrived ahead of schedule.

    Even so, people who vaccinate too early could end up sicker in late winter—in the same way that people who vaccinate too late could end up sicker now. Plotkin told me that staying apprised of the epidemiology helps: “If I heard influenza outbreaks were starting to occur now, I would go and get my first dose.” But timing remains a gamble, subject to the virus’s whims. Flu is ornery and unpredictable, and often unwilling to be forecasted at all.

    Katherine J. Wu

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  • Should Your Flu and COVID Shots Go in Different Arms?

    Should Your Flu and COVID Shots Go in Different Arms?

    At a press briefing earlier this month, Ashish Jha, the White House’s COVID czar, laid out some pretty lofty expectations for America’s immunity this fall. “Millions” of Americans, he said, would be flocking to pharmacies for the newest version of the COVID vaccine in September and October, at the same appointment where they’d get their yearly flu shot. “It’s actually a good idea,” he told the press. “I really believe this is why God gave us two arms.”

    That’s how I got immunized last week at my local CVS: COVID shot on the left, flu shot on the right. I spent the next day or so nursing not one but two achy upper arms. Reaching high shelves was hard; putting on deodorant was worse. And it did make me wonder what would have happened if I’d ignored Jha’s teleological advice and gotten both jabs in the same arm. Maybe my annoyance would have been lessened. Or perhaps the same-side shots would have made the soreness in my left arm way worse. When I posed this puzzle to immunologists, vaccinologists, and pharmacists, I got back a lot of hems and haws. For the millions of Americans who will be getting two-shot appointments by fall’s end, they told me, the choice really does come down to personal preference in the absence of clear data: You’ve just gotta pick a side. Or, you know, two.

    On the one hand (sorry), there are the vaccine double-downers. Sallie Permar, a pediatrician at Weill Cornell Medicine, and Stephanie Langel, an immunologist at Duke University, both said they’d probably get both shots in the same shoulder; so would Rishi Goel, an immunologist at the University of Pennsylvania. “Personally, I’d rather have one arm that’s slightly uncomfortable than both,” Goel told me.

    On the other hand, we’ve got Team Divide-and-Conquer. Several experts said they’d follow the White House protocol of splitting shots left and right. Ali Ellebedy, an immunologist at Washington University in St. Louis, told me he’d prefer to have two slightly sore arms to one totally dead one. Jacinda Abdul-Mutakabbir, a pharmacist at Loma Linda University, says she generally recommends that her patients get the vaccines on separate sides “for comfort.” Last year, she opted to get the flu shot and a COVID booster within a few inches of each other, and “I wanted to chop my arm off,” she told me. “Never again.”

    Read: America’s fall booster plan has a fatal paradox

    The deciding logic here should be pretty intuitive, Permar told me. Two shots on one side might be expected to double how sore that arm will get, though the experience of each vaccine recipient will depend on a bevy of factors, including the ingredients in the shots and that person’s infection and vaccination history, as well as their immune-system health. Also, for people like my husband—who’s prone to very heavy vaccine side effects—the choice may not matter at all. He was so knocked out by the fever and chills that came with his COVID-flu-shot combo, he couldn’t have cared less which arms got the shots.

    I dug around for studies examining the consequences of the one-versus-two-arm choice and found only one: a Canadian trial from 2003, which vaccinated a few hundred sixth-graders at two dozen middle schools against group C meningitis and hepatitis B at the same time. Roughly half the kids got both shots in the same arm; the others received one on each side. (Some kids in the latter group requested that their shots be administered by a pair of nurses who could plunge both syringes at the same time.) Among students in the same-arm group, 18 percent ended up with tenderness at the injection site that they rated “moderate or severe.” But those kids fared better than the ones in the two-arm group, 28 percent of whom experienced moderate or severe tenderness in at least one arm, and 8 percent of whom had it in both arms at the same time.

    But those results apply only to that group of kids in that setting, with those two specific vaccines; there’s no telling whether the same trends would be seen with flu shots and COVID shots when given to children or adults. Michela Locci, an immunologist at the University of Pennsylvania, told me she suspects that combining flu and COVID inoculations in the same arm could actually drive extra side effects: “The overall inflammation might be higher,” she said.

    Many pediatricians, who often have to administer four or five shots to a baby at once, are habitual splitters. “If there’s more than one vaccine syringe to give to a baby, generally, two legs are used,” Permar told me. (Kids usually upgrade to arm shots sometime in toddlerhood—it’s all about finding a muscle that’s big enough for the needle to hit its mark.) Doctors also have a nerdy reason to split shots between arms or legs. “If there’s a local reaction to the vaccine,” Permar said, “you can identify which vaccine it was if you separate them by space.” (For the record, I had a more painful reaction in my left arm, where I got the COVID shot. Others I’ve spoken with have reported the same disparity.)

    Read: Families are going rogue with rapid tests

    The CDC advocates for separating vaccination shots by at least one inch of space. Per the agency, if a COVID shot is being given at the same time as a vaccine “that might be more likely to cause a local injection site reaction,” the shots should be dosed into “different limbs, if possible.” Two types of flu shots cleared for use in people 65 years and older—the high-dose vaccine and the adjuvanted one—fall into that category. But the different-limb advice doesn’t seem to apply to other flu shots, including those cleared for use in younger adults and kids.

    However someone ends up taking simultaneous flu and COVID shots, the placement is unlikely to affect how much protection the vaccines provide. There could be an argument for letting “each side focus on its own thing,” says Gabriel Victora, an immunologist at Rockefeller University. “But it probably doesn’t make a whole lot of difference.” Children routinely get combo vaccines, such as DTaP and MMR, each of which combines multiple disease-fighting ingredients in a single syringe. The triple-threat formulas work just as well as injecting their individual parts. The immune system is used to multitasking: It spends all day being bombarded by microbes, so there’s good reason to believe that with vaccines, too, our body will see simultaneous shots “as independent events,” Goel told me.

    Which arm gets picked for which shot, though, will affect where the jab’s contents end up. After a vaccine is injected, its immunity-inducing ingredients meander to the nearest lymph node, such as the ones in the armpits. There, hordes of immune cells fight over the vaccine’s bits, and the fittest and fiercest among them are selected to leave the lymph node and fight. Here, again, doubling up on one arm shouldn’t be an issue, Goel said: The immune-cell boot camps in these lymph nodes have “a good amount of real estate.”

    It might even be a good idea to stick the same limb—and thereby, the same lymph node—every time you get another dose of a particular vaccine. After immune cells in a lymph node spot a particular bit of pathogen, some of them march off into battle, but others may hang around like reserve troops, mulling over what they’ve learned. A couple of recent studies, one of them in mice, hint that repeated delivery of the same ingredients to those veteran learners could give the body a slight edge—though the extent of that advantage “might be marginal,” Victora told me. Still, Langel, of Duke, told me jokingly that because she usually gets all of her vaccines in her “non-writing” arm, the lymph node beneath it could now be especially superpowered—a “nice bonus” for her defenses on the whole.

    That said, no one should stress too much about getting a shot in the “wrong” arm. “It’s not like you’re immune on the left side and not on the right side,” Goel told me. Immune cells travel throughout the body; there is no midline DMZ. Permar even points out that getting the newly formulated COVID vaccine, which includes new ingredients tailored to fight Omicron subvariants, on the opposite side from the previous rounds could help its ingredients reach a fresher slate of cells. “I think you could convince yourself either way,” she told me. Which, honestly, leaves me totally at peace with my choice. Apart from arm achiness, I had no other side effects—and in a way, I preferred the symmetry of the one-on-each-side injections.

    With all that said, it’s worth briefly acknowledging a third option: Splitting the flu and COVID vaccines into separate visits. I was, before my most recent COVID shot, some 10 months out from my previous dose. But it felt awfully early for my flu shot, which might be better timed for peak protection if taken later in the season. Still, the allure of getting it all over with was too tantalizing, especially because I happen to have a lot of travel up ahead. In the grand scheme of things, the bigger, more important choice was opting into the shots at all.

    Katherine J. Wu

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  • Are We Really Getting COVID Boosters Every Year Forever?

    Are We Really Getting COVID Boosters Every Year Forever?

    School is in session, pumpkin spice is in season, and Americans are heading to pharmacies for what may soon become another autumn standby: your annual COVID shot. On Tuesday, the White House announced the start of a “new phase” of the pandemic response, one in which “most Americans” will receive a COVID-19 vaccine just “once a year, each fall.” In other words, your pandemic booster is about to become as routine as your physical exam or—more to the point—your flu shot. One more health-related task has been added to your calendar, and it’s likely to remain there for the rest of your life.

    From a certain standpoint, this regimen makes a lot of sense. The pandemic’s biggest surges so far have come in the winter, and a fall booster could go a long way toward mitigating the next of those surges. What’s more, the new plan greatly simplifies COVID-vaccination regimens, both for the public and for providers. “It has been bewildering in many cases to understand who is eligible for a booster, how many boosters, when, which boosters, how far apart,” Jason Schwartz, a vaccine-policy expert at Yale, told me. “I think that has held down booster uptake in some really discouraging ways.” In a sense, White House COVID-19 Response Coordinator Ashish Jha told me, the new plan just codifies the way things already worked: The last time low-risk Americans became eligible for another shot was last fall. (The elderly and immunocompromised have operated on a different schedule and will likely continue to do so, Jha said.)

    Still, some public-health experts worry that the White House is jumping the gun. Back in April, a number of them told Stat News’s Helen Branswell they were concerned that the U.S. would adopt such a policy without the data needed to support it. When the White House made its announcement on Tuesday, many felt their concerns had been vindicated. “We’ve had twists and turns and surprises every single step of the way with COVID, and the idea that we’re going to have one shot and then we’re done is not really consistent with how things have worked in the past,” Walid Gellad, a professor at the University of Pittsburgh School of Medicine, told me. The plan, in his view, glosses over considerable uncertainties.

    Read: America’s fall booster plan has a fatal paradox

    For one thing, it assumes that the virus will follow an annual schedule with peaks in the fall and winter—not unlikely, but also not a given. For another, we still don’t have a firm grasp on the magnitude or duration of the benefits offered by the new Omicron-specific vaccine. For all we know, Gellad told me, the added protection afforded to someone who gets the shot tomorrow may have largely dissipated by New Year’s Eve.

    And that’s not to mention the massive uncertainty presented by the specter of future variants. In a briefing Tuesday, Jha acknowledged that “new variant curveballs” could change the government’s plans. But the announcement itself includes no such caveats, which some public-health experts worry could cause problems if course corrections are needed down the line. For all we know, new variants could necessitate more frequent updates, or, if viral mutation slows, we might not even need annual shots, Paul Thomas, an immunologist at St. Jude Children’s Research Hospital, in Tennessee, told me.

    If the routine the White House describes sounds a lot like flu shots, that’s no accident. The announcement explicitly recommends that COVID vaccines be taken between Labor Day and Halloween—“just like your annual flu shot.” That comparison, though, is part of what concerns critics, who worry that the shift into a more flu-like framework will entail the adoption of a vaccines-only approach to COVID prevention. Many of the interventions that have proved so effective over the past two and a half years—masking, distancing, widespread testing—have not traditionally been a major part of our flu-season protocols. If we treat COVID like flu, the thinking goes, such interventions risk falling even further by the wayside. The announcement, which makes no mention of any other prevention tactics, doesn’t offer much reassurance to the contrary.

    Read: A simple rule for planning your fall booster shot

    But that reading, Jha told me, is “just clearly wrong.” Although vaccines are “the central pillar of our strategy,” he said, testing, masking, and improving indoor air quality are all important as well. But as my colleague Katherine Wu has written, the country has been relying more and more on vaccines—and less and less on the other interventions at our disposal—for some time. Even if you do read the new policy as an abnegation of masking, ventilation, and the like, it may not functionally be much of a departure from the status quo.

    For now, Thomas said, the White House’s plan makes sense—as long as it stays sensitive to changing circumstances. “We keep learning new things about this virus,” he told me. “The rate of mutation is changing. The spread through the population is changing.” And as such, he said, our response must be flexible.

    The White House announcement seems like a good-faith attempt to balance competing priorities: on the one hand, the need to communicate uncertainty and acknowledge complexity; on the other, the need to keep the message from getting so complex that it confuses people to the point that they tune it out entirely. In this case, the administration seems to have come down on the side of simplicity. That could be a mistake, Gellad says—one that public-health authorities have made over and over throughout the pandemic. “When you try and make things simple and understandable and present them without sufficient uncertainty,” he told me, “you get into trouble when things change.”

    Jacob Stern

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