Buzz
What began as a straightforward plan for COVID protection—get a shot, return in three weeks for another—has evolved into a complex maze over the past two and a half years. The government acknowledges the confusion surrounding COVID vaccine schedules and is working to simplify them for better understanding, while also addressing how variants have impacted vaccine effectiveness. Here’s the latest update you need to be aware of.
The era of “initial series” vaccines is over
The original, straightforward vaccine regimen—two doses of either Moderna or Pfizer monovalent COVID vaccines, spaced three weeks apart—is no longer available. The FDA has phased out monovalent doses (the term for the original vaccines) as part of efforts to streamline the vaccination process. Currently, there are no monovalent Moderna or Pfizer doses in the U.S. for initial vaccination or boosters.
For healthy adults, the initial series is no longer necessary; instead, a single bivalent vaccine dose from either Moderna or Pfizer is sufficient. If you haven’t received the initial series, just one bivalent dose is now required to stay up-to-date.
If you’ve only received one of the two initial doses and have been looking for the second, you can stop searching. Instead of completing the series, you should now get the bivalent dose.
Healthy adults and children aged 6 and older only require a single dose
Previous booster recommendations created confusion about timing and requirements. To simplify, only one bivalent shot is needed now. In the future, this may become an annual vaccine, similar to the flu shot—and eventually, both vaccines might even be combined into a single dose. Currently, regardless of your vaccination or booster history, one bivalent dose from Moderna or Pfizer is all you need. If you’ve already completed the initial series and received a bivalent booster, you’re fully covered.
If you haven’t received a bivalent booster yet, it’s time to get one to stay current. If you’ve had a booster since mid-September 2022, it was a bivalent dose, as all Moderna and Pfizer boosters were updated around that time.
The good news is that for individuals who are not immunocompromised and are at least 6 years old, the process is straightforward. Regardless of your vaccination history—whether you’ve had zero, two, or even seven doses—you only need to ensure you’ve received one bivalent shot. If you haven’t, go get one, and you’re done. However, as always, there are exceptions, which you’ll find detailed below.
Immunocompromised adults and seniors aged 65 and older
The boosters you’ve been eagerly anticipating are now available. While healthy adults only require one bivalent dose, individuals in this group are eligible for two. The criteria for eligibility remain somewhat unclear, so you shouldn’t face much resistance when requesting a booster at your pharmacy. Typically, you’ll just need to sign an attestation form confirming your eligibility. This means you can simply walk into a pharmacy, inform the vaccinator that you’re immunocompromised and would like your booster. If questioned, just request an attestation form, sign it, and proceed with your vaccination.
Additional doses throughout the year are still an option, as they were previously, but the downside is that you’ll need a prescription from a doctor and a vaccinator willing to administer it. In recent years, pharmacists have often been reluctant to honor such prescriptions, but new guidelines clarify that they should. It’s still early to predict outcomes, but we remain hopeful.
For those who are immunocompromised and lack a healthcare provider, I’m optimistic that telehealth services will bridge the gap, much like they have with Paxlovid prescriptions over the past year.
The vaccination schedule for children under 6 is more intricate
For younger children, the guidelines become slightly more complicated. Their vaccines involve different dosages and timelines compared to those for adults. To assist healthcare providers, the CDC has provided a set of charts here to determine the appropriate next steps for your child’s vaccination.
Below, we’ll outline the recommendations for healthy children. However, if your child is immunocompromised, it’s crucial to consult their pediatrician to ensure they receive the correct number and type of vaccines.
Children aged 6 months to 4 years
Les bébés will still require an initial series of vaccine doses to build their immunity. This process can be complex, so careful attention is needed. When unsure, refer to the CDC chart for guidance.
If your child has not yet received a COVID vaccine, they will need one of the following options:
Two doses of the Moderna bivalent vaccine, administered four to eight weeks apart, or
Three doses of the Pfizer bivalent vaccine, with the first two doses spaced three to eight weeks apart and the third dose given at least eight weeks after the second.
If your child has started but not finished their original vaccine series:
If they received one dose of the Moderna monovalent vaccine, they need one dose of the Moderna bivalent vaccine at least eight weeks after their last dose.
If they received one dose of the Pfizer monovalent vaccine, they require two doses of the Pfizer bivalent vaccine, with the first dose given three to eight weeks after the monovalent dose and the second dose eight weeks after the first.
If they received two doses of the Pfizer monovalent vaccine, they need one dose of the Pfizer bivalent vaccine at least eight weeks after their last dose.
If your child has completed the original series and received a bivalent booster:
No additional doses are required for them at this time.
Children aged 5 years
If your child has not yet been vaccinated against COVID, they will need one of the following:
Two doses of the Moderna bivalent vaccine, given four to eight weeks apart, or
One dose of the Pfizer bivalent vaccine.
If your child has started but not finished their original vaccine series:
If they received one dose of the Moderna monovalent vaccine, they need one dose of the Moderna bivalent vaccine, administered at least four weeks after their last dose.
If they received one or two doses of the Pfizer monovalent vaccine, they need one dose of the Pfizer bivalent vaccine, given at least eight weeks after their last dose.
If your child has completed the original series and received a bivalent booster:
No additional doses are required for them at this time.
Novavax and J&J
If you’re unfamiliar with Novavax, it entered the scene later but remains significant. Unlike mRNA vaccines, it’s a traditional protein-based vaccine. While some argue it’s superior or inferior, it’s an option for those unable to receive mRNA vaccines due to medical reasons or personal concerns. However, note that if you are Hispanic or Latinx, this vaccine may be less effective. Most Novavax studies predate the Omicron variant, so while the data appears promising, it may not fully reflect effectiveness against current variants.
If you’re 12 or older and can locate a provider offering it, a two-dose Novavax regimen will count as your “initial series.” However, it’s still advised to follow up with a bivalent mRNA booster. A Novavax booster can be administered six months after completing the initial series.
J&J remains authorized but is nearly impossible to find and is only approved for “very limited circumstances.” Even if you qualify, locating a dose will be extremely challenging.
If you received the J&J vaccine, it’s recommended that you now get a bivalent mRNA booster, either Moderna or Pfizer.
Yes, vaccination is still essential
I won’t spend time debating whether we’re still in a pandemic—it feels disrespectful to the 600 individuals who lost their lives to COVID yesterday. One in ten infections (not people, but infections) leads to some form of long COVID. In a country with inadequate healthcare, no safety net for the temporarily or permanently disabled, no federal support for COVID treatment or testing, and no guaranteed sick leave, the risks are high. Most people will contract COVID multiple times in their lives, as you’ve likely already experienced. The odds are not in your favor. This is a classic case of “play with fire and get burned.”
COVID vaccines are the most extensively tested in human history, administered to 5.5 billion people globally—yes, billion. In the U.S. alone, 270 million individuals have received a dose. While pharmaceutical companies profit significantly, it’s possible for them to be profit-driven and still deliver life-saving medical breakthroughs.
Getting vaccinated is now a straightforward process, with most pharmacies offering walk-in services. You can search for nearby locations in advance. Fun fact: I know several people who met their significant other while waiting for a vaccine—statistically better odds than dating apps like Bumble. If needles or medical settings make you anxious, bring a friend for support. If transportation is an issue, contact your county COVID hotline (they’re still operational) or health board for assistance. They can arrange a home visit or help you reach a vaccination site. For those uncomfortable in unmasked environments, independent pharmacies may accommodate outdoor vaccinations upon request.
