The Biden administration intends for the COVID-19 public health emergency to end in May, while some lawmakers in Congress wish to end it immediately. The World Health Organization has declared we’re on the verge of a turn for the better in the global pandemic crisis, which makes widespread vaccination crucial as the U.S. Food and Drug Administration prepares to set new standards for COVID-19 vaccines.

Lisa M. Lee,  a professor of public health at Virginia Tech, provides perspective on the FDA decision. Lee is an epidemiologist, a bioethicist, and an ethics educator. For more than 25 years, she has worked in public health and ethics, including 14 years at the Centers for Disease Control and Prevention.

The FDA plan suggests that individuals receive a single COVID-19 shot each year (just like flu shots) and the vaccines would be bivalent, meaning they are made using components from two different strains of the virus, thus offering more protection against variants.

Q: How does setting a standard of a single annual COVID-19 vaccine shot help to fight the virus?

“If enough people get an annual COVID-19 vaccine in time for the annual winter surge of infections, we will see less transmission and fewer hospitalizations and deaths during that period.  Given that current COVID-19 vaccines are effective for a matter of months, not years, and the speed with which the virus mutates, annual vaccination will be an important disease prevention tool.  As we continue to learn more about the virus and effective ways to engineer vaccines against it, that could change.”

Q: Will this do enough to address the latest Omicron variant, XBB.1.5, nicknamed “Kraken”?

“Unfortunately, the variants circulating now are even more contagious than the highly contagious versions we were dealing with last year.  In order for the annual vaccine to be effective against new variants, we must continue public health surveillance efforts to keep tabs on what new variants are circulating and adjust vaccines to ensure they stay effective against them.  This is what we do every year with the annual flu vaccine, so we have some good experience with this approach.”

Q: What is the advantage in exclusively using a bivalent COVID-19 vaccine?

“The bivalent vaccines are more effective against the Omicron variants of COVID-19 virus because they are designed to provide protection against the newer variants.  Because the virus has changed so much since the initial cases in early 2020, the older monovalent vaccines, which were effective for the earlier versions of the virus, might not be quite as effective against the newer ones.  Even though some people who get the bivalent vaccine can still get COVID-19, they are much less likely to be hospitalized with severe disease or to die from it.”

Q: How much further do we need to go to achieve herd immunity?

“Herd immunity — the point at which so many people in a population are protected that the virus eventually dies out from not having any more susceptible people to transmit to — is an enormous challenge in the case of COVID-19.  It is challenging because the virus is so highly contagious, it is transmitted by breathing, and it mutates rapidly.  Still, we must strive to vaccinate as many people as possible so that people whose immune systems cannot fight off the virus even with vaccine are surrounded by a protective layer of people who will not bring the virus, which can be deadly for vulnerable people, to them.”

Q: What might the upcoming years bring as we continue to fight this pandemic?

“Even though we’ve learned a lot about COVID-19 and the virus that causes it, we will need to stay on our toes and pay attention because it continues to surprise us with its ability to mutate, become more contagious, and cause suffering.  Luckily, our ability to create effective vaccines continues to advance rapidly as well.  A conversation about COVID-19 vaccines in five years will likely be very different than the one we are having today.”  

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