5 things you need to know about COVID, flu and RSV vaccines this fall

By Eleanor Laise

Updated shots and shifting recommendations change the seasonal vaccination routine

New and updated vaccines, revised recommendations on who should get certain shots, and accessibility challenges: They're all part of a shifting immunization landscape as the U.S. heads into respiratory-virus season this fall.

The Centers for Disease Control and Prevention currently forecasts that this winter's total peak hospitalizations for COVID-19, flu and respiratory syncytial virus will be similar or a bit lower than last year. But that picture could change quickly if vaccine uptake is lower than expected or if COVID evolves to cause more severe illness, CDC director Mandy Cohen said during a press briefing Friday.

"The best plan going into this winter is for everyone to remain vigilant, to use the tools we have - vaccines, testing, treatment - against the illnesses responsible for the majority of fall and winter deaths and hospitalizations," Cohen said.

Behind the fall vaccination push are public-health officials who fear that simultaneous surges of COVID, flu and RSV could overwhelm the healthcare system, particularly if large swaths of the population haven't had any recent shots.

"We could get to a place where there might not be room in hospitals for people. That's the kind of horrific scenario we want to avoid," Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, said during a press briefing Wednesday.

Health officials urging the public to get their shots are prepared to meet some resistance, amid signs that political divides have fueled growing vaccine skepticism. Just four out of 10 people in the U.S. say it's extremely important for parents to have their children vaccinated, according to a Gallup poll conducted in July. That's down from 58% in 2019 and 64% in 2001 - with Republicans and Republican-leaning independents accounting for most of the decline, according to Gallup.

And as of May, only 22.5% of U.S. adults had received last year's updated COVID shot, according to CDC data - leaving many people at higher risk of more severe illness.

Here's what you need to know now to protect yourself from respiratory viruses this winter.

Updated COVID shots will be available in the coming days - but some people may want to wait a few months

The Food and Drug Administration on Thursday approved updated COVID-19 shots from Moderna Inc. (MRNA) as well as Pfizer Inc. (PFE) and its partner BioNTech (BNTX). The timing provides a critical jump-start on preparations for the fall respiratory-virus season, as nationwide, the wastewater viral-activity level for COVID has been rising throughout the summer and is now at "very high" levels, according to the CDC. Rates of positive COVID tests, emergency-department visits and hospitalizations are all elevated, especially among older adults and children under age 2, according to CDC data.

For many people, September or October may be a good time to get an updated shot - but "the important part is getting it done," Cohen said Friday.

If you just had COVID, however, you don't need to race to get the updated vaccine, some health officials say. People who were part of COVID's summer wave and don't feel strongly about getting the vaccine right away might consider waiting several months from the time they had the virus and getting the shot before the holiday season, Manisha Juthani, commissioner of the Connecticut Department of Public Health, said during the state health officials' briefing Wednesday.

People who are 65 and older or immunocompromised are still at greater risk of getting more severe infections, so they should talk to their doctors about the best timing for fall vaccinations, Sameer Vohra, director of the Illinois Department of Public Health, said during the briefing.

Most people can still get COVID vaccines for free, and free tests are making a comeback

People with health insurance generally face no out-of-pocket costs for COVID-19 vaccines, but uninsured people may have a tougher time finding free shots this fall.

While the federal Vaccines for Children program still provides free vaccines to uninsured kids, the CDC's Bridge Access Program, which was launched last year to provide free COVID shots to uninsured adults, has now ended. The CDC has identified an additional $62 million for state and local immunization programs to buy COVID vaccines this season and boost access for uninsured adults, Cohen said Friday. People who don't have coverage can check with local and state health departments or federally qualified health centers for help accessing the shots, public-health officials said. (Find a health center near you at findahealthcenter.hrsa.gov.)

In late September, the federal government will reopen its free COVID test delivery program, Dawn O'Connell, assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, said during the press briefing Friday. Families will be able to order up to four free tests at COVIDTests.gov, O'Connell said.

Vaccination can slash your odds of getting long COVID

People sometimes overlook the fact that "the only way you get long COVID is by having COVID," Peter Marks, director of the FDA's Center for Biologics Evaluation and Research, told reporters Friday. A growing number of studies, he added, are demonstrating how vaccination can reduce the risk of developing the long-term condition. In one major study published earlier this year, for example, vaccines cut the risk of developing long COVID by 30% to 50%.

"I have tremendous empathy, having seen people struggle with long COVID in their 30s and 40s - people who you might think were otherwise low-risk," Marks said. If a vaccine can cut that risk by 50%, he said, "I would want to, at least personally, avail myself of the benefits of vaccination."

RSV vaccine recommendations have shifted since last year

Last year, immunizations were available for the first time to help protect people at risk for severe RSV, including babies and older adults. But the CDC in June updated its RSV shot recommendations for older adults, saying that everyone age 75 and older should get the vaccine. That replaced a previous recommendation that people 60 and older get the shot, if discussions between the patient and their doctor support the decision. Under the updated recommendations, people age 60 to 74 should still get the RSV vaccine if they have certain chronic conditions, such as heart or lung disease, or live in a nursing home, the CDC said.

Unlike the flu shot, the RSV vaccine is not an annual immunization. If you got an RSV shot last year, you don't need to get another one this year.

GSK PLC (GSK), Pfizer and Moderna all have FDA-approved RSV vaccines for older adults. So which one should you get? "Whatever you can get your hands on" is a reasonable vaccine to take, Juthani said.

Some younger people may need RSV vaccines, too

RSV can also be severe for babies, and the CDC recommends either a maternal RSV vaccine or infant immunization with monoclonal antibodies. For pregnant people, the only recommended RSV vaccine is Pfizer's Abrysvo, which should be administered September through January during weeks 32 through 36 of pregnancy, the CDC said.

Alternatively, babies younger than eight months entering their first RSV season can get one dose of Sanofi (SNY) and AstraZeneca PLC's (AZN) Beyfortus, a monoclonal antibody approved by the FDA last year to prevent RSV in newborns and infants.

-Eleanor Laise

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08-24-24 0829ET

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