Which Vaccines Should You Get and Recommend This Fall?

In this video interview, Paul Offit, MD, of Children’s Hospital of Philadelphia and a member of FDA’s Vaccines and Related Biological Products Advisory Committee, gives recommendations for who should get the lineup of fall vaccines this year.

The following is a transcript of his remarks:

The goal of the COVID vaccine is to keep people out of the hospital and out of the intensive care unit. So the critical question then is: who’s getting hospitalized? Who’s getting hospitalized with COVID?

And the answer is, it generally falls into four high-risk groups. One are people who are elderly, which is to say those over 75. Two are people who are immune compromised either because they were born with certain immune deficiencies or they’re taking drugs that suppress their immune system because of cancers or rheumatologic disease. Three are people who are pregnant. And four are people who have high-risk medical conditions like obesity, diabetes, chronic lung disease, chronic heart disease. So that’s who you’re trying to keep out of the hospital.

And so if you look at the data in terms of the ability of these yearly vaccines to keep people out of the hospital, they’re about 50% to 55% effective in the first few months, assuming the strain is matched to the circulating strain. So that is valuable.

Novavax is a purified protein vaccine that has a relatively long reduction cycle, about 6 months. They had to make a decision about what strain to include earlier than the manufacturers of the mRNA vaccines, Pfizer and Moderna. So they chose the so-called JN.1 strain because that’s what was the predominant strain circulating at the time that they had to make a decision to have a September rollout.

In June, the FDA Vaccine Advisory Committee met and ultimately the decision was made to use the KP.2 strain in the two mRNA vaccines. So the Novavax [vaccine] has JN.1, the two mRNA vaccines, Pfizer and Moderna, have KP.2.

Is there a functional difference? Not really. I mean, KP.1 and KP.2 and KP.3 and KP.3.1.1 are all derivatives of JN.1, so there’s a lot of cross-reactivity. I think functionally it really doesn’t make any difference which of those two vaccines you get.

It will be interesting to see what happens with Novavax this year because Novavax has generally been slow to market, so you don’t have a lot of comparisons between Novavax and mRNA vaccines in terms of longevity of protection and also degree of protection. Hopefully, we’ll get those kind of data this year.

Influenza, like respiratory syncytial virus, is basically a winter respiratory pathogen. So it’s important to get the influenza vaccine before the winter season. Same thing with RSV, it’s important with respiratory syncytial virus to get it before the winter season. Now, the influenza vaccine is recommended for everybody over 6 months of age. I’m definitely getting my influenza vaccine before the winter starts.

The RSV vaccine is recommended for adults who are either over 75 years of age or who are 60 to 75 years of age and have high-risk medical conditions like obesity, diabetes, chronic lung disease, chronic heart disease. So that’s who the RSV vaccine is recommended for.

Those two viruses are winter viruses; therefore, you need to get that vaccine before the winter starts.

COVID has been surprising. I think everyone assumed that COVID would settle into a winter respiratory pattern, but that really hasn’t happened yet. It still occurs year-round. So if you get the vaccine before the winter, you know you’re going to be protected against what is invariably a winter peak. But that immunity will fade to some extent 4 to 6 months later, and the virus will still circulate and cause disease even in summer months.

I’m going to get an influenza vaccine probably in October. I’m not going to get an RSV vaccine because I’m not over 75 and I’m not in a high-risk group for those less than 75. I am going to get a COVID vaccine this year because I’m getting close to 75.

I really haven’t had a COVID vaccine since the Wuhan strain. I had three doses of the Wuhan strain and I’ve had one natural infection, which I think frankly gives me a high frequency of memory B and T cells, which are likely to protect me — especially memory T cells, which can then become activated and become cytotoxic T cells — and that is very much an important immunological component in protection against severe disease.

That’s my goal. My goal is to keep myself out of the hospital. I assume I’m going to get a mild or moderate infection as the years go on, but I just want to stay out of the hospital.

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