“I’m 73 and have always been in good health,” Doris from New York writes. “I eat right and exercise regularly. High blood pressure, osteoporosis and thyroid disease are all well-managed. I am not immunocompromised. I have had mild covid once. I continue to mask in crowds. Should I get the second booster now or just wait for the fall?”
Both are reasonable options for someone who isn’t high-risk for covid. If Doris receives the bivalent shot now, she’d be eligible to receive the XBB-specific vaccine in late October. On the other hand, she could also wait until the end of September, when the updated vaccine is expected to be released.
My advice is different for Joseph from Maryland. He is in his late 80s and a kidney transplant recipient on immunosuppressants. His last coronavirus vaccine was in November. He asks, “My doctor says I should get the bivalent vaccine now. Do I really need it?”
Compared with Doris, Joseph is at much higher risk for severe outcomes due to covid, so I’d strongly recommend that he follow his physician’s advice. People with moderate or severe immunocompromise can receive coronavirus vaccines as often as every two months, in consultation with their health-care provider.
Many readers want to time their booster for optimal protection. Marilee from Washington is 68 and “in good health with a couple of risk factors” for severe covid. She had one bivalent vaccine in September 2022. “I will be going on a cruise this August and had planned to have a booster three weeks before. If I do that, will I be eligible for the new booster in the fall, or should I not have the booster now and wait for the fall?”
Marilee’s timing is sensible because the vaccine is most effective roughly two weeks to a month after getting the shot. After a month, protection against infection begins to drop. If she gets the second bivalent booster in mid-July, she could get the new XBB-targeted vaccine mid-November.
She should also keep in mind that vaccine effectiveness against infection is not high. A recent report from the Centers for Disease Control and Prevention shows that effectiveness against symptomatic XBB infection was just 43 percent among those 65 and older. People wishing to avoid infection should take additional measures, including masking in crowded indoor spaces and practicing good hand hygiene. I’d also encourage Marilee to have Paxlovid on hand in case she contracts covid-19 on the cruise.
My advice is similar for Mary from Georgia, who is 85 and in good health. “I had covid in August 2022 after a European river cruise, and my last booster was in November 2022,” she writes. “I’m leaving in late August for a 14-day cruise around the British Isles. Should I get a booster early in August before I leave? I really want to have the new booster before the holidays.”
Good news: Mary’s plan can work. Knowing that the cruise presents a higher risk of covid transmission, she could get the second bivalent vaccine two weeks or so before departure, in early August. Like Marilee, she should have Paxlovid on hand in case she contracts covid while on the cruise. Then, in early December, she can receive the new vaccine, just in time to be maximally protected for the winter holidays.
What about people who recently had the coronavirus? Jo from D.C. had the first bivalent booster and then got covid at the end of April 2023. She writes, “I have a daughter getting married in California in September and a trip to Europe planned in October. What should my booster schedule look like?”
Assuming Jo is 65 or older (since younger people are not eligible for a second bivalent booster unless they are immunocompromised), she has the option of receiving the second bivalent booster ahead of her daughter’s wedding. I don’t think it’s needed, as she probably still has excellent protection from her recent infection.
Though the CDC says people who have had covid can receive their next booster if it has been three months since recovery, I think they could wait longer, especially because hybrid immunity — the combination of vaccination and prior infection — seems stronger than vaccination alone. Jo should be fine to wait until late September, when the new vaccine comes out, so that she could receive it before going to Europe.
“Will there be a combined flu and covid vaccine this fall?” asks David from Virginia. Likely not this year, but I hope the recommended timing is such that people can get both together. The uptake for both would almost certainly be higher if people can visit their doctor’s office or pharmacy once to get the two vaccines simultaneously. A KFF survey found that about half of adults say they are likely to get an annual coronavirus vaccine if it’s offered in the same time frame as a flu vaccine, a much higher proportion than the 20 percent who have received even one bivalent shot.
Readers sent in many more questions that are specific for their individual circumstances. I will aim to get to as many as I can next week. In the meantime, the general theme is what I wrote in my column: More than three years into covid, how we think about desired protection depends heavily on each person’s medical situation and risk tolerance. Just like frequency of testing, vaccination timing should be tailored to the individual and decided in consultation with their health-care provider.
