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Second Bivalent COVID Boosters Approved for Older Adults, Immunocompromised

People 65 and older can get another bivalent shot

spinner image vial of the Moderna Covid-19 vaccine, Bivalent, at AltaMed Medical clinic in Los Angeles, California, on October 6, 2022.
RINGO CHIU/AFP via Getty Images

Adults 65 and older who received what’s known as a bivalent COVID-19 booster at least four months ago are eligible for a second dose, following authorization from the U.S. Food and Drug Administration (FDA) and sign off from the Centers for Disease Control and Prevention (CDC).

People with compromised immune systems have also been cleared for a second jab of the bivalent shots.

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The bivalent boosters from vaccine makers Moderna and Pfizer-BioNTech first became available in September 2022. They target both the original strain of the coronavirus and subvariants BA.4 and BA.5 of the omicron strain, which has been circulating globally for more than a year.

Even though BA.4 and BA.5 have been eclipsed by other omicron subvariants, studies show the bivalent shots still provide protection against currently circulating strains. Federal data from January 2023 shows that individuals who received this updated shot are almost eight times less likely to die from COVID-19 than unvaccinated individuals, and they’re 1.7 times less likely to die from the illness than vaccinated individuals who did not get the bivalent booster. Hospitalization rates are also lower for people who received the bivalent booster compared with those who didn’t.

Research shows, however, that the strength of the vaccine’s protection against infection and illness wanes some over time. In an April 18 call with reporters, Peter Marks, M.D., director of the FDA’s Center for Biologics Evaluation and Research, said that “barring the development of a radically new [coronavirus] variant,” the data suggests that a six-month interval between shots is reasonable for older individuals, who are at higher risk for severe illness from a coronavirus infection. More than 93 percent of people who have died from COVID-19 have been 50 or older.

People who are immunocompromised can get a second bivalent booster two months after their first bivalent vaccine, health officials said in the most recent updates, and any additional doses can be administered at the discretion of their health care provider.

Simplifying the vaccine schedule

People under 65 and individuals who do not have an immune-compromising health condition are not eligible for an additional bivalent shot. The FDA said it will decide about future vaccination plans and intervals after its advisory committee meets in June. This year, the agency proposed making COVID-19 boosters an annual vaccine for most Americans, much like the flu shot.


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Health officials hope a few other changes will simplify the COVID-19 vaccine process. The FDA announced on April 18 that most unvaccinated people who want to get a COVID-19 vaccine will need just one dose of the bivalent vaccine, instead of two shots of the original (monovalent) mRNA vaccine. (Kids under 6 may need a few shots of the bivalent vaccine, depending on their age and vaccination status.)

Marks said in a news release that the FDA believes simplifying the use of the vaccines “will help encourage future vaccination.” Though roughly 70 percent of the American population is fully vaccinated, only 16.7 percent of Americans have gone back for a bivalent vaccine, CDC data shows. When it comes to adults 65 and older, nearly 43 percent have rolled up their sleeves for the bivalent vaccine.

“COVID-19 continues to be a very real risk for many people, and we encourage individuals to consider staying current with vaccination, including with a bivalent COVID-19 vaccine,” Marks said. “The available data continue to demonstrate that vaccines prevent the most serious outcomes of COVID-19, which are severe illness, hospitalization, and death.” 

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