On June 15th, the FDA asked drugmakers to update the COVID Booster to target XBB 1.5 and no longer target the Wuhan strain. This monovalent mRNA vaccine has already been field tested by Pfizer and Moderna and should be available by early September. Novavax will also have their booster available this Fall. This monovalent booster vaccine will replace the current bivalent booster.

Now is the time to work with your bivalent vaccine providers to ensure you have teams scheduled to provide the vaccine to your SNF residents and staff this Fall. As part of the “roll-out”, informed consent will need to be obtained, for which I recommend the VIS (vaccine information statements) from Immunize.org Vaccine Information Statements - VISs - CDC information sheets for patients (immunize.org) . Unfortunately, vaccine hesitancy has become a major issue with every vaccine “roll- out.” To overcome this hesitancy, conversations should be started soon on the safety and effectiveness of this booster. The CDC has a COVID-19 Vaccine Communication Resources Page (Communication Resources for COVID-19 Vaccines | CDC), which will have information on this new vaccine that provides resources for minimizing vaccine hesitancy among your residents, families, and staff. Even though we don’t anticipate a mandate this year for staff to obtain this booster, we know from current vaccine experience that persons under age 60 are much more likely to have a robust and prolonged vaccine response, which translates into a lower risk of acquiring and exposing our vulnerable residents to COVID. This also means less sick day absences and better protection for the older adults and others in their family and community gatherings. 

On May 12, the CDC updated its guidance on COVID-19 vaccines to simplify the process for initiating and updating COVID vaccines. Because the original Wuhan variant is no longer a threat anywhere in the world, the original COVID vaccine is no longer recommended. Instead, the bivalent mRNA vaccine from Pfizer and Moderna or the Novavax vaccine are now recommended for those starting the immunization process. For those updating their COVID immunization, the bivalent booster is recommended with a second booster option for those > 65 y/o after > 4 months from the prior booster. Janssen’s COVID vaccine was removed as it is no longer available in the USA. The full interim guidance can be found at Interim Clinical Considerations for Use of COVID-19 Vaccines | CDC and the simplified recommendations at: CDC simplifies COVID-19 vaccine recommendations, allows older adults and immunocompromised adults to get a second dose of the updated vaccine | CDC Online Newsroom | CDC

Your annual Flu immunization program can be run simultaneously with your COVID program, since their vaccines can be safely given at the same time. In addition, in California, we have a mandate for all staff without a waiver to receive this vaccine. Last year, the CDC recommended the more immunogenic versions of the injectable flu vaccine. Since the mRNA COVID vaccine cold storage requirement usually requires the support of an outside pharmacy, now may be a good time to bundle your flu vaccination program with your COVID program.

With the COVID Public Health Emergency declaration over, payment for both vaccines will likely be through traditional means. How this works for your staff and residents should be clarified with your vaccine providers.

I hope that our readers’ vaccine “roll-out” this fall is turn-key with minimal chaos and maximal effectiveness.