The Biden administration may be shifting its Covid-19 booster strategy, focusing on accelerating a fall booster campaign with next-generation shots that target more dominant strains of the virus rather than offering second booster shots to all adults.

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A shift in booster priorities

Earlier this month, the Biden administration said it was considering expanding the eligibility for second Covid-19 boosters to all adults, instead of just those 50 and over, to combat a growing number of new infections and hospitalizations.

However, some experts expressed concern over this plan, saying that boosting more people with the original vaccine could interfere with their eligibility to receive an updated version of the shot this fall.

The Biden administration has now decided to shift its Covid-19 booster strategy to focus on accelerating a fall vaccination campaign with updated shots that target more dominant strains of the virus.

Vaccine makers Moderna and Pfizer-BioNTech are already working to develop updated bivalent boosters that target the original strain and the more dominant omicron subvariants BA.4 and BA.5.

According to federal officials, FDA hopes the companies will be able to make updated shots available as soon as early to mid-September, instead of the original goal of October or November.

If the bivalent boosters can be made available by this expedited timeline, FDA will likely wait for the new omicron doses to be released this fall to expand booster eligibility instead of authorizing second booster doses of the original vaccine for those younger than 50 this summer.

However, health officials are currently waiting for additional information from vaccine makers to determine whether there would be a sufficient supply of reformulated doses for an early fall campaign. FDA said it will weigh all available evidence before making a final decision.

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Some experts support shifting away from universal second boosters.

"I do think [a second booster shot] does make sense for certain groups, but a universal boosting strategy doesn't make sense," said Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia and an outside advisor to FDA. "At some level, we're going to have to get used to mild illness and moderate illness as part of this virus — which is going to be with us for the rest of my life, the rest of my children's lives, the rest of their children's lives." 

In addition, some experts have noted that encouraging people to boost this summer then again in the fall could cause confusion, potentially discouraging their desire to get boosted at all.

"We can't give a booster now and then again in 1.5 months or two months — that will decrease trust," said Monica Gandhi, a professor of medicine at the University of California, San Francisco (UCSF).

Other experts have also said that administering two doses too close together could be counterproductive.

"I think this is the right call," said Celine Gounder, a senior fellow at the Kaiser Family Foundation. "If you get a booster now with the original formulation of the vaccine, this may in fact be counter-productive. It may prevent the second booster dose given this fall from taking and from you developing an immune response to that booster."

However, some experts have said the updated booster may not be significantly better than the original booster. "People should not regard [new vaccines] as some sort of magic bullet that gives them super-strong protection," said John Moore, an immunologist at Weill Cornell Medicine. "These are not going to be magic bullet game-changers because they're not that much better than the already available vaccine boosters."

Ultimately, it is still unclear whether updated boosters will be ready by early fall. "I don't see the benefit waiting for a BA.5-specific booster since BA.5 may be in the rearview mirror and well past us by the time that's available," said Peter Hotez, dean of the Baylor College of Medicine National School of Tropical Medicine.

According to some experts, individuals under the age of 50 should be given the option to protect themselves with a second booster now—especially with the rising number of cases.

"You're talking about you know literally hundreds of millions of people who are at a higher risk than they need to be for months," said Robert Wachter, chair of the department of medicine at UCSF.

"And that will mean potentially millions of preventable infections, certainly thousands of preventable hospitalizations, and probably hundreds of preventable deaths," he added. (Bean, Becker's Hospital Review, 7/26; Stein, "Shots," NPR, 7/26; McGinley et al., Washington Post, 7/22)