Lisa Jarvis

The latest COVID vaccines from Pfizer Inc. and Moderna Inc. are hitting U.S. pharmacy shelves, raising a now-perennial fall question: Will anyone bother getting them?

In theory, the updated COVID shots couldn’t come at a better time. The U.S. is dealing with yet another summer surge, which in some parts of the country looked a lot closer in magnitude (by wastewater data standards, at least) to our last two winter outbreaks. The rising numbers have been driven by a combination of new variants and the public’s waning immunity, with an assist from an inordinately hot summer that drove many people indoors.

These trends ideally would convince people to embrace the updated shots. But with only 22.5% of adults and 14.4% of children opting in for last fall’s COVID vaccine, there is plenty of reason to doubt that there is much interest in the newest ones.

Anyone who hasn’t had COVID recently should be considering the new shot. Hospitalizations and deaths, which in the spring had dipped to their lowest levels yet, have been creeping back up in recent weeks. More than 700 people in the U.S. per week had been dying in early August, and by one count, the U.S. just had two straight weeks of more than 1,000 deaths.

Those numbers are nowhere near the horrible days in 2020 and 2021 when thousands of people were dying every day. But those thousands of deaths each month might be preventable. And while many of us aren’t at risk of the worst, COVID continues to disrupt our lives, whether that’s simply making us miserable enough to miss a few days of work or wreaking more serious havoc like long COVID (the risk of which is thankfully lower than in the early years of the pandemic but still enough of a threat to warrant caution).

Most of us have likely been exposed to COVID by now, whether through past vaccines, infection, or both. But new variants with subtle changes keep emerging. While many of us still have good protection against serious infection, those changes make us vulnerable to reinfection — particularly if it has been a while since we’ve gotten a vaccine or the virus.

The fast cycle of new variants also has made it hard to achieve a perfect match with the vaccines and made some skeptical of the value of the shots. Indeed, the Food and Drug Administration originally asked drugmakers to train the new shots against the JN.1 variant, then asked them to focus on KP.2. Now, just two months after that recommendation, yet another variant, KP.3, accounts for over half of infections.

Even so, the vaccine will still offer some protection. “It’s the safest way to get immunity against not only the current variants that are circulating, but it establishes or boosts your preexisting immunity to COVID,” says Andrew Pekosz, professor of molecular microbiology and immunology at Johns Hopkins Bloomberg School of Public Health.

The greatest focus should be on people at high risk of severe disease — those over the age of 65, pregnant women, as well as anyone with a medical condition that makes them especially vulnerable. Given the ongoing spread, those groups should make an appointment to get vaccinated as soon as possible, says Pekosz. The immunity boost won’t only help during this surge but should offer some protection against severe disease when the virus inevitably bounds back in the winter.

For everyone else, the timing can be confusing. “The really tricky thing is a lot of people got sick this summer, and they’re wondering, what does that mean for me?” says Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. Anyone who got infected during this summer’s COVID wave should probably wait three to four months before getting the vaccine. That recent infection taught their immune system how to recognize and ward off the virus. While getting the vaccine immediately afterward won’t do harm, it also won’t offer much benefit. If they are at low risk for serious infection, they may even opt to delay it until fall of 2025. (Though those folks shouldn’t forget to get their flu vaccine in October.)

People spared from the summer wave also face a difficult choice. They could opt for a COVID shot now, which might help avoid an infection as everyone goes back to school and returns to work from summer travels, or hold off until October to maximize coverage for the coming winter. The latter option makes a lot of sense, as it would allow people to neatly time their shot with a flu vaccine — a combination that at least small studies suggest could enhance the effectiveness of the COVID shot.

One thing that would help maintain or ideally improve vaccination rates would be if everyone had an easier time getting vaccinated this year. Because the public health emergency around COVID formally ended in May 2023 (and with it, the era of free vaccines, tests and treatments for everyone in the U.S.), last fall brought the first commercial rollout of COVID vaccines. It was far from perfect, with many people struggling in the early months to find appointments or being hit with surprise bills.

Those wrinkles should be mostly ironed out by now for people with health insurance, for whom the COVID shots are free. But for those without insurance, the process of finding an affordable vaccine could still be unacceptably difficult. That’s because a program launched by the Centers for Disease Control and Prevention to provide free COVID vaccines to the uninsured expired this month.

Last week, the agency said it would offer state and local health departments some $62 million to support access to vaccines for those who can’t afford them, whether they are uninsured or underinsured. That’s helpful, but it still means that plenty of people might forgo the shot.

“We should be making this as easy as possible,” Nuzzo says. As she points out, already so many disincentives to getting a vaccine exist, whether it’s worries about feeling lousy afterward or being uncertain about the benefits. Making it even the slightest bit harder to afford and find a vaccine? That’s bad for public health.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.