Jun 15, 2023 - Health

The strain COVID vaccines might target next

Illustration of syringes as darts missing a target made to look like a health plus.

Illustration: Aïda Amer/Axios

Food and Drug Administration advisers on Thursday will vote on whether the next round of COVID-19 shots should target XBB, a subvariant of omicron that’s driving the majority of new infections in the U.S.

Why it matters: The FDA is on a tight deadline to make a decision so drugmakers can manufacture the new vaccines in time for the fall and winter, even as polls show most Americans have put the pandemic behind them.

Details: FDA staff this week recommended focusing on XBB and not including the original coronavirus strain in updated shots, saying the new subvariants are highly likely to evade immune protection from past infections and COVID shots.

  • The agency's scientists suggested moving toward a new monovalent vaccine, with additional boosters available for immunocompromised people and other high-risk groups.
  • This would fall in line with a report from the World Health Organization last month, which said updating vaccines to target the variant most likely to be mutated in “the near term” is needed to better protect against symptomatic disease.
  • The growing consensus indicates the expert panel is likely to agree, too, said Jason Schwartz, an associate professor at the Yale School of Public Health.
  • "Frankly," Schwartz told Axios. "I don't anticipate a lot of fireworks or heated debate at Thursday’s meeting."

Yes, but: The discussion is underway at a time when the majority of Americans view the pandemic as over and don't believe COVID infections pose a major risk to their health.

  • Most are never masking in public, and less than 1 in 5 people in the U.S. have received an updated booster, per CDC data updated in May.
  • That means it’s unclear how much chasing new variants will benefit a population that might not think they need another shot, especially as vaccine costs shift to the private sector.

Between the lines: The end of the COVID public health emergency has also cut off a thoroughfare of data that once gave insights into how the virus was spreading, which means it’s difficult to gauge the accuracy of the downward trend in cases, hospitalizations and deaths.

What they're saying: Tailoring the booster strategy to those at greatest risk of severe disease will be critical, said Ofer Levy, director of the Precision Vaccines Program at Boston Children's Hospital and voting member on the FDA panel.

  • But, "how sustainable is it to ask somebody ... to go every year? Three, four or five times to get a shot?" Levy told Axios. "Can we develop vaccines with single shot protection? Could we develop vaccines that give pan-coronavirus protection against any variants?"
  • "Hopefully, the CDC will be better this time in targeting the vaccine to those who are in high risk groups and not everyone because not everyone needs it," said Paul Offit, a voting a member of the FDA committee and director of the Vaccine Education Center at Children's Hospital of Philadelphia.
  • "Because the goal is not protection against mild disease. You're never going to protect against mild disease for this kind of virus. Never," Offit told Axios. "And we just have to get used to that."

What we're watching: Pfizer, Moderna and Novavax will all present at Thursday's meeting, which Yale's Schwartz said could signal how soon the drug manufacturers are able to produce the new doses, get them out to the public and jumpstart the next round of vaccinations.

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