What should I know about Novovax?
- Not mRNA: Novovax is the only non-mRNA vaccine on the US market. This may be helpful for people who continue to be skeptical of mRNA vaccines due to misinformation or a perceived lack of data.
- Two doses for unvaccinated people: Novovax is available for people aged 12 years and older and requires two doses, eight weeks apart (as opposed to the one-dose updated mRNA vaccines from Pfizer and Moderna) for those who haven’t had any other COVID-19 vaccine. Those who were previously vaccinated receive one dose.
- Still has a minor risk of myocarditis: The very small risk of myocarditis from mRNA vaccines has been mostly eliminated (see the question, “Do teenage boys who get vaccinated have a higher risk of myocarditis?” in the Children section, below) with the updated schedules. Novovax also carries a small risk of myocarditis.
- Other side effects in line with other vaccines: Pain and tenderness as the injection site, fatigue, fever, and other side effects were reported.
Who should get the updated COVID vaccine?
Anyone ages six months and older should get the updated COVID vaccine to increase their protection for the upcoming respiratory illness season. The health disparities that drove up COVID infections among migrant, immigrant, and farmworker communities are still bearing down on these communities, from poverty and food insecurity to work conditions that increase the risk of infection to higher rates of diabetes. Additionally, migrant, immigrant, and farmworker patients may encounter increased barriers to accessing the vaccine, including fear of exposing documentation status, lack of transportation, lack of educational materials or outreach in the language of their choice, lack of childcare, concern after hearing misinformation, etc.
While the federal government has covered the cost of the vaccine for uninsured people through 2024, the funding for outreach has ceased. It is critical that clinics, health departments, and other vaccine provision locations continue to connect with the historically marginalized and isolated members of their communities to facilitate vaccine access, with health fairs, mobile clinics, and partnerships with churches, farmers’ markets, and other local community groups.
Why should a patient get the updated COVID vaccine?
Anyone ages six months and older should get the updated COVID vaccine to increase their protection for this respiratory illness season. Encourage your patients to get vaccinated, and remind them that it is safe and effective. Here are the top six reasons for a patient to stay updated on their COVID vaccine:
- Get prepared for increased exposures: There have been spikes in COVID-19 infections throughout the year, and not just in the winter. As new COVID-19 strains emerge, a patient likely does not have much protection from previous vaccines or infections. With lower vaccination uptake for updated vaccines, the vast majority of the US population – even those who received vaccines earlier in the pandemic – may not have had a vaccine for a year or longer, and their antibodies have decreased.
- Avoid the emergency room: If you do contract COVID, you will likely have a shorter-duration illness if you are vaccinated, which reduces the window during which you are very sick and can spread the disease. In the fall of 2022, when 17% of the population got the ‘bivalent’ vaccine, that portion of the population saw 60% effectiveness against urgent care and emergency department visits and 65% effectiveness against hospitalization – a remarkable reduction in severe disease!
- Get evidence-backed protection: The patient has unknown protection from previous infections. The only way to be certain to increase antibodies is to get vaccinated. To visualize the risk, a patient can use the COVID-19 Immunity Estimator. (For more, see the question: “A patient who is hesitant about the vaccine asked if there’s a difference in immunity between someone who gained immunity after COVID-19 infection, versus someone who gained immunity from COVID-19 vaccines” under Basic COVID Questions.)
- Reduce risk of long COVID: People with less severe illness are at a lower risk of long COVID. (See “Does the updated vaccine protect against long Covid?”)
- Reduce the duration of transmission: Vaccination shortens illness, which in turn shortens the time during with the patient is infectious. This can be the difference between holidays with the abuelos, or staying home sick.
- Get safe and effective coverage! Remind patients that, contrary to the misinformation that is prevalent in social media, updated vaccines have been shown to have very few side effects. Additionally, many have been very effective at increasing antibodies against the newest COVID subvariants in circulation. (See questions “Do teenage boys who get vaccinated have a higher risk of myocarditis?” and “What do we know about the latest subvariants that are spreading?”)
Access the vaccine for free, for now: Private insurance is covering the vaccine. For most others without insurance, the vaccine is available for free with government funding, available at community health centers and health departments, at least through 2024.
Can a migrant patient get the COVID updated vaccine and the influenza vaccination at the same time?
Yes. Multiple studies, including a September 2023 study in JAMA Network Open, have found it is safe to get the COVID updated vaccine and the flu shot at the same time. Migrant patients who have limited access to health services may have very few opportunities to get vaccinated and it is recommended that they get both as soon as they can.
Can a patient get the flu vaccine, the updated COVID vaccine, and the new RSV vaccine at the same time?
The RSV vaccine, released in 2023, is now available for patients over 60 who consult with their doctor. The CDC supports the safety of getting the flu, RSV, and COVID vaccines at the same time, and highlights the benefits of getting them together over ending up not getting the vaccines if waiting to get them separately. Anecdotally, clinicians have been giving patients all three vaccinations in one appointment. Clinicians can consider the patient’s individual situation, particularly for migrant patients or those who struggle to get to the clinic, those who may be higher risk, or may have recently recovered from COVID. Use your judgment and your knowledge of the patient to determine the ability of the patient to get to a return appointment.
What are the pros and cons of splitting the COVID and flu (and RSV) vaccines?
Many of our patients have poor access to vaccines, due to work inflexibility and schedules, transportation, childcare, and more. The primary benefit of giving the COVID and flu shot simultaneously is that the patient won’t have to figure out how to get back to the clinic for a second shot (or a third time, if they are eligible for the RSV vaccine). This is a very serious concern, because no vaccination means no protection.
If their work schedules are more flexible and access to services is good, they may wish to split the vaccines up. Some people prefer to get the vaccines on different days, as both shots on the same day may increase side effects like headache, fatigue, fever, and pain at the injection site. Others may wish to time the COVID vaccine to have peak effectiveness over certain events or the holidays, or to time the vaccines to provide highest coverage during the historical peaks of the virus. (The historic peak of the flu, for example, is in February; RSV typically peaks in December but peaked in November during the 2022-2023 season; COVID has had multiple peaks throughout the year, but its deadliest months of each year have been January.) Additionally, studies show that coadministration of the COVID and flu shots very minimally decreases effectiveness. However, clinicians should be careful to ensure that delaying the vaccine will not result in barriers that lead to no vaccine.
What have we learned about the updated vaccines available in fall 2023 and spring 2024?
Some key aspects of the revised COVID vaccine that is now available at health centers and health departments:
- Effective: This revised vaccine targeted the XBB.1.5 subvariant of the Omicron strain of COVID. This vaccine was expected to be effective against all of the major subvariants in circulation, including JN.1.
- Cost and availability: Patients were able to see exactly what locations received the updated vaccines online on https://www.vaccines.gov/search/. Those without insurance were eligible for a free vaccine paid by the federal government. Those with private insurance were covered by their insurance.
- Language change: This vaccine was not a bivalent vaccine, as it does not target two strains of COVID, but just one – the XBB subvariants of Omicron. It also acted as the initial dose for those who have never been vaccinated for COVID, not just as a booster. This means, going forward, the language has changed – this vaccine was called “the updated COVID vaccine” or “the COVID vaccine” instead of a “booster” or a “bivalent vaccine.”
- Looking ahead, a simpler process: COVID vaccines are likely to shift to be more like the flu vaccine – one shot available in the fall, updated to best match the variants expected to dominate over the winter. Most people (the exceptions being children under six and immunocompromised people) will have just one shot to get, regardless of whether they have had an initial series or not, and the language and messaging can be simplified to reduce confusion.
How effective were the updated vaccines that we got in fall 2023?
The research is in: the fall 2023 vaccine has been highly effective! Vaccine effectiveness against symptomatic infection was at 49%. Its effectiveness against hospitalization was 52%. That’s a lot of prevented illness and hospitalizations. The vaccine gives a significant and important boost of protection to those who have already been infected or vaccinated – so it is very important that we continue to encourage our communities to get vaccinated.
Unfortunately, despite its high effectiveness and proven track record of safety, people continue to avoid the updated vaccine because of disinformation and misinformation (see the following questions), COVID fatigue (ie, many people are tired of thinking about COVID and want to “move on”), and poor access to the vaccine. Only 19% of people said their physician recommended the updated COVID vaccine. Clinicians need to share the benefits of the vaccine and encourage the community to stay up to date; clinics should continue to organize community vaccination campaigns to provide vaccine education, community connection, and easy access to vaccines.
- MCN’s new “Adults Get Vaccinated, Too!” comic book shows migrant and immigrant farmworkers learning about adult vaccines and includes an adult vaccine schedule with the COVID vaccines.
- Engage your community with MCN’s COVID Vaccine Awareness Campaign Resources along with other resources on our Community Engagement page.
- MCN’s COVID Hub has dozens more resources to help clinicians and community organizers launch education campaigns.
Who was eligible for a spring 2024 COVID vaccination? Should those who do not get the vaccine when it first is released consider getting it later in the year, even potentially during the warmer months?
In February 2024, the CDC announced that people over 65 are eligible for a second updated COVID-19 vaccine, at least four months after receiving the updated vaccine that became available in fall 2023, and three months after the individual’s last COVID infection. This is the third year when an additional spring vaccine has been introduced, and is in line with recommendations in other countries including the UK and Canada. Because COVID hospitalizations and deaths are highest in those older than 65, this high-risk population is highly encouraged to get this additional vaccine. (Immunocompromised people are also eligible for more doses; they may get another dose after two months.)
People over 65 account for 67% of COVID hospitalizations -- but only 40% of people over 65 got the fall updated vaccine. Consequently, outreach teams are strongly encouraged to provide culturally contextual education on why older individuals should get the vaccine when eligible, and providing easy access to vaccines through health fairs, mobile clinics, and flexible clinic hours.
Many patients are reporting that COVID vaccines cause death. What should I say?
Misinformation about COVID vaccines continues to spread. COVID vaccines are exceptionally safe and effective, yet the internet is abuzz with misinformed people blaming vaccines for a wide range of medical issues, with no or inconclusive data to support their claims.
For example, a new KFF poll shows a third of adults believe the COVID vaccines “caused thousands of sudden deaths in otherwise healthy people.” There is no increased risk for mortality among COVID-19 vaccine recipients, according to the CDC and numerous other studies. However, there has been “excess mortality” in recent years, meaning there were more deaths over a given period than expected based on historical figures. We can confirm for patients:
- Correlation does not equal causation – and there’s not even correlation. When looking globally at vaccine coverage with excess mortality for the fall of 2022, there was no correlation between vaccination coverage and excess mortality.
- COVID infection affects the body in many ways. Many COVID-related deaths, like from a heart attack after a COVID infection, are not reported on the death certificate, thereby masking some COVID deaths which would be counted instead as excess mortality.
- Many other factors may have contributed, like avoidance of care during lockdowns which led to delayed diagnoses, overwhelmed health systems with staff shortages, extreme summer heat waves and other climate disasters, or a lack of health insurance – it’s complicated.
- Because it’s complicated, we need to be patient as researchers tease out the concrete reasons. This doesn’t mean we should avoid COVID vaccines in the meantime. On the contrary, avoiding an illness that has verifiably caused millions of deaths is a far safer strategy.
How can I dispel the myths that young people are dying because of the vaccine?
Across social media, the persistent myth that young people are dying because of the vaccine continues to spread. For people who encounter this message – and sometimes videos of sudden deaths -- it is scary and shocking.
An April 2024 CDC report debunked the widespread myth, finding that there was zero evidence that mRNA vaccines caused fatal cardiac arrest or any other deadly heart concerns in teens and young adults. The report concluded that COVID vaccination is recommended for all people older than six months, to prevent COVID infection and its complications, including death.
One reason the concern continues to spread is that, with much of the entire world vaccinated, any death can be retroactively blamed on the COVID vaccine. This CDC report, following numerous other investigations, conclusively and scientifically assures the health community that the vaccines are safe for young people.
How can I dispel the myths that the vaccine causes or accelerates the growth of cancer?
Recently, the myth that the COVID vaccine accelerates cancer has returned to the news after Kate Middleton’s cancer diagnosis – but the claim is false. As Your Local Epidemiologist notes: “There is a kernel of truth. Cancers were more likely to be diagnosed at a later stage (ie, more aggressive) after COVID-19 hit.” But that’s because the pandemic delayed cancer screenings and many people with health concerns avoided treatment to reduce exposure to COVID in health care settings. Consequently, there was a delay in diagnosis – but not an increase in cancer. Delays in diagnosis during the early months of the pandemic led to late-stage diagnoses, which started “well before COVID-19 vaccines were rolled out, and there is no evidence to suggest COVID-19 vaccines are causing a surge in cancer.”
I want to talk to a patient about getting their initial COVID vaccines. If they start now, what series would they take?
The CDC has simplified its primary series. For an unvaccinated adult or child five years or older, one dose of the updated vaccine is used instead of the multi-dose vaccine series. For children six months to four years, more than one vaccine may be needed. See MCN’s colorful and easy-to-understand guide to help patients understand what shots they are eligible for and when, available in English and Spanish: Who Can Get the Updated COVID-19 Vaccine.
A community member’s four-year-old son recovered from COVID two weeks ago. Should he get vaccinated now, or wait?
In August 2022, the CDC updated its recommendations for vaccination after COVID infection. People who have recently recovered from a COVID infection “may consider delaying a COVID-19 vaccine dose by three months from symptom onset or positive test.” Newer studies indicate an improved immune response with the three-month delay. However, certain factors like severe COVID and community spread must be considered as well. (See the CDC for more on those factors.) For migrant and immigrant patients, it must also be determined whether a person, like this four-year-old, will have easy access to the vaccine in the preferred timeframe. In this case, the CHW or health care provider who is working with the parents can make a concrete plan including an appointment for the child to get vaccinated. If the family is migrating before the ideal vaccination window, the clinician can sign the family up with Health Network, or adjust the vaccination date to meet the needs of the family.
Make sure, however, that the family understands how important vaccination is, even if it is delayed. Many factors determine a child’s level of antibodies after a COVID-19 infection. Children infected with one variant may not produce antibodies that protect them from other variants. A mild infection may cause a smaller immune response, with fewer or no antibodies generated. With no clear measurement of how protected the child is, it is prudent to get the child vaccinated, to ensure the child has the highest level of protection from re-infection.
The CDC’s updated infographic breaks down vaccination by age group and vaccine type (Pfizer, Moderna, or Novovax).
Should a patient get a mammogram after getting the COVID-19 vaccine?
It is recommended to wait at least two weeks after the provision of a COVID-19 vaccine before receiving a mammogram or other diagnostic imaging exam. This is because the COVID-19 vaccines may cause swollen lymph nodes, which may be interpreted as cancer in such imaging exams. As a precaution, if the patient is not migrating and can delay the imaging exam, clinicians may recommend that the patient wait six to ten weeks after a dose of the COVID-19 vaccine. If a patient needs to move before that six-to-ten-week period is over, clinicians can enroll the patient in Health Network, and we can assist in guiding the patient in the new health system in their next location to schedule a mammogram or other diagnostic imaging exam.
When’s the best timing to get the updated vaccine, if the patient was just infected with COVID?
The patient is recommended to wait three months after they last tested positive, and then get the updated vaccine. Other considerations, like migration, may be taken into consideration.
Does the updated vaccine protect against long Covid?
Yes, indirectly. While the updated vaccine does not specifically protect against long COVID, long COVID occurs more often in people who had severe COVID. This vaccine reduces a person’s risk of severe COVID, which therefore reduces their risk of long COVID. The best way to not get long COVID, of course, is to never get infected with COVID in the first place. The updated vaccine reduces a person’s chance of contracting COVID.
Should a migrant patient get the COVID updated vaccine and the mpox vaccination at the same time?
No. If a patient is recommended for an mpox vaccine, the CDC recommends delaying any COVID vaccine four weeks after either mpox vaccine. However, the CDC does not presently give a recommendation about timing of an mpox vaccine after a COVID vaccine.