Understanding Fall 2023 COVID-19 Vaccine Recommendations

Understanding fall 2023 COVID-19 vaccine recommendations

Paul Offit, MD: Hi, my name is Paul Offit. I'm talking to you today from the Vaccine Education Center. It's Monday, September 18th, 2023. What I want to talk about is something that happened a few days ago. The Centers for Disease Control and Prevention, or the CDC, recommended that everybody over 6 months of age receive a booster dose of the current vaccine.

So, the current vaccine is a monovalent vaccine, meaning that it contains just one strain, and that strain is the so-called XBB.1.5 strain. And that's one of the strains that's currently circulating in the United States. It's a variant of the omicron lineage.

So, why did they make that recommendation? I think probably it makes more sense to target those who are at highest risk. And by those who are at highest risk, I mean people who are over 75 years of age and people who have comorbidities, meaning health problems that put them at high risk of serious disease like chronic lung disease or heart disease or liver disease or kidney disease or diabetes or obesity. Also, people who are immune compromised, typically because they're taking medicines that suppress their immune system, and pregnant people.

And the reason I say that is that if you look back at early 2022 when omicron entered the United States, the CDC did a series of studies trying to answer the question, did a booster dose or booster doses help decrease the risk of hospitalization? Because that's the goal of this vaccine — keep people out of the hospital, keep them out of the intensive care unit, and keep them from dying. And what they found was that it did. That a third dose did decrease hospitalization. That a fourth dose also, to a lesser extent, did decrease hospitalization, but not everyone benefited. Those who were most likely to benefit were those who were in highest risk groups.

So, I think that also applies today that those who are most likely to benefit are in highest risk groups. And although healthy young people could reasonably choose to get this vaccine if, for example, they work in a nursing home, or if they have someone who's immune compromised that lives in the home, that's certainly a reasonable and important choice to make. But at this point, if one has already received say three doses of the vaccine or two doses of the vaccine plus a natural infection, so-called hybrid immunity, you're likely if you're healthy and young to be protected against severe disease for a long time.