Recommended Adult Immunization Schedule, United States, 2024 | Annals of Internal Medicine

There Are 3 New COVID Vaccines, But The Way You Pay For Them Has Changed. What To Know

The US Food and Drug Administration authorized Novavax's new COVID vaccine last week for people age 12 and older. It joins Moderna's and Pfizer-BioNTech's refreshed formulas, which were authorized the week earlier. 

This means that you have three new vaccines to choose from that more closely target the strain of COVID currently making people sick. The Centers for Disease Control and Prevention has already recommended the updated COVID vaccines for everyone age 6 months and up, along with an updated seasonal flu vaccine, so people may get one as soon as they hit pharmacy shelves, as long as it's been at least two months since their last COVID shot. (For people who haven't been vaccinated before, timing and number of doses varies.) 

Summer 2024 has seen "very high" rates of COVID, according to wastewater data from the CDC. Part of the summer-surge problem may have to do with people's waning immunity from previous vaccines and infections, along with the ever-revolving door of new and contagious versions of omicron. So the availability of updated vaccines is expected to be a useful tool to stave off severe illnesses as we head into cooler months and respiratory virus season.

As COVID has moved from pandemic to endemic -- meaning COVID is still making people sick, but in more predictable ways that can be mitigated by available treatments -- officials at the CDC have streamlined guidance around vaccines and isolation to make it easier for everyone to follow when they have symptoms of a respiratory virus. Here's what to know.

When will the new COVID vaccines be available? What makes them different from last year's?  From talking fridges to iPhones, our experts are here to help make the world a little less complicated.

COVID vaccines should be available now. To see which vaccines are in stock at your preferred pharmacy, you can search on Vaccines.Gov by ZIP code, select a location and call the pharmacy. Or you can visit the pharmacy's website directly. 

All vaccines authorized by the FDA this summer -- Moderna, Pfizer and Novavax -- target a strain of virus that is a better match for the one currently circulating than the vaccine strain from last year. This is expected to provide better protection. However, there is a difference between the updated Novavax vaccine, which is a protein-based vaccine, and Moderna and Pfizer, which are mRNA vaccines. Novavax's new vaccine matches the JN.1 version of COVID; Pfizer's and Moderna's match KP.2, which is a more recent strain of the JN.1 lineage. 

From talking fridges to iPhones, our experts are here to help make the world a little less complicated. How will people pay for COVID vaccines now?

One change this time around is that the cost of COVID vaccines is no longer being covered by the federal government, though both COVID and flu vaccines should be covered by people's insurance, including Medicare. The Bridge Access Program provided COVID vaccines for free to people without health insurance, though it ended in August due to lack of funding. While new measures will be needed to make COVID vaccines free for adults, there is a separate program in effect to keep vaccines free for all children. 

Per a CDC price sheet, the private sector cost of Pfizer's vaccine is about $137, and Moderna's is roughly $142. For adults who don't have Medicare, Medicaid or other insurance, the out-of-pocket cost for a COVID vaccine may run them up to $200 after administration fees are applied. 

Pfizer said that its patient assistance program will be available later this fall and will provide "eligible uninsured individuals" age 12 and older the vaccine for free. Moderna announced a patient assistance program last year, but didn't immediately respond to a request for comment on whether it's available.  

What should I do if I test positive for COVID?

In addition to vaccine guidance that more closely resembles annual flu shots, guidance for what to do when you're sick is more generally focused on what to do while you have symptoms of a respiratory virus or feel sick, rather than on the results of a COVID test. But because treatment depends on which virus you have, it's always best to take a COVID test if you're able to do so. 

If you're at a higher risk of any respiratory virus -- which includes complications from COVID, flu or RSV -- it's especially important to find out which virus you have (through testing and seeking medical care) so you can get the right treatment, as it varies depending on which virus you're sick with.

If you're an adult in your 50s and up, or if you have a chronic condition like heart disease, high blood pressure, asthma, diabetes or something else, you're likely eligible for an antiviral medication (including Paxlovid) that will lessen the severity of the disease and reduce your risk of hospitalization. You can get it by calling your regular primary care doctor or pharmacist or by finding a Test to Treat center, where people who have Medicare or Medicaid, uninsured people and those with VA insurance or those who are receiving Indian Health Services can get free COVID-19 testing and treatment. It's important that you start taking the antiviral within the first few days of symptoms for the medication to work. 

For everyone who has COVID, or suspects they might, the CDC says to follow its general guidance for preventing the spread of respiratory viruses when you're sick. This includes staying home and away from others when you feel sick, whether or not you test.

You can "go back to your normal activities," the CDC says, as long as it's been 24 hours since your symptoms started improving overall and as long as it's been 24 hours since you've had a fever (and you haven't taken fever-reducing medicine, like ibuprofen). Then, take additional precautions for five days after you improve, which may include wearing a mask or avoiding people who are at higher risk of severe illness from COVID or other respiratory viruses.

This is a change from pandemic-era guidelines that were more specific about when and how long to isolate after an exposure to COVID-19 or a positive test result. Why is that? 

"This is an endemic virus for which there is a lot of population immunity and medical countermeasures," Dr. Amesh Adalja, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security, said in an email. "Guidance has to reflect that context and be such that people can employ it with relative ease."

New Updated COVID-19 Vaccines Are Available. When Should You Get It?

The new updated Comirnaty Pfizer COVID mRNA vaccine is seen here next to the Fluzone H,D. Influenza ... [+] vaccine at a Walgreens pharmacy in Torrance, Caifornia, on September 5, 2024. (Genaro Molina/Los Angeles Times via Getty Images)

Los Angeles Times via Getty Images

The newest, updated Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines are now available at pharmacies and clinics. The Novavax recombinant protein vaccine should be available soon. All three updated vaccines have been approved by the U.S. Food and Drug Administration—that's fully approved by the FDA and not just emergency-use authorized. So, as has been the case each time a new COVID-19 vaccine becomes available, you may have many questions. Here are answers to some of the most common ones.

Should You Get The Updated COVID-19 Vaccine?

If you are less than 6 months of age, congratulations on your ability to read and, no, you do not qualify to get any of the updated vaccines. The Moderna and Pfizer-BioNtech vaccines are FDA-approved for those 6 months and older while the Novavax vaccine is FDA-approved for those 12 years and older.

If on the other hand you are old enough to get the vaccine, the Centers for Disease Control and Prevention is recommending that you go ahead and get the updated vaccine. That's unless you have a clear, medical doctor-verified contraindication to the vaccine such having had a severe allergic reaction or a major adverse event like myocarditis after a pervious COVID vaccination. Getting the update can renew your protection against COVID-19. The immune protection offered by the vaccines tends to start waning about four to six months after vaccination. So, if you got the last updated vaccine last Fall, a lot of that protection may have gone bye-bye by now.

Plus, the vaccines from last year targeted previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants from 2023 that have since gone the way of skinny jeans and midi skirts. As you have probably figured out by now, new variants have been emerging at the rate of new fashion with a new dominant variant every several months or so.

The latest Pfizer-BioNTech and Moderna vaccines target the KP.2 Omicron variant that was dominant during the past summer months, whereas the Novavax vaccine targets the JN.1 variant that was widespread even earlier this year. None of the vaccines specifically target the KP.3.1.1 variant, which is the current alpha-dog variant. But the targets of these updated vaccines are significantly closer to what's going on now than what was targeted by vaccines from previous years. Therefore, these updated vaccines should offer stronger protection against the currently circulating variants.

It's especially important to get these updated vaccines if you are at higher risk of getting more severe COVID-19. That would be the case if you have a weaker immune system from being over 65 years of age, having a chronic medical condition or getting medical treatment that suppresses your immune system.

The protection offered by the COVID-19 vaccines tends to wane after four to six months. So if you ... [+] last got the COVID vaccine or infected with the SARS-CoV-2 before 2024, your immune protection may not be very high right now. (Photo by Patrick van Katwijk/Getty Images)

Getty Images

For most adults the protective benefits of getting the updated vaccines far, far outweigh the risks. More major side effects such as myocarditis from the vaccines have been quite rare. And by now over 5 billion people, or over 70% of the world's population, have been vaccinated against COVID. Many have gotten vaccinated multiple times.

Now, some have said that the updated COVID vaccine may not be necessary if you are less than 30 years of age and have previously been vaccinated. The argument is that the risk of death, hospitalization and more severe COVID-19 outcomes is no longer high enough for such younger people. It is true that the risk of bad stuff happening from a SARS-CoV-2 infection for anyone is significantly lower now than it was back in 2020 and 2021. That's because our immune systems are no longer so virginal to the SARS-CoV-2, given previous exposure to its spike proteins via vaccination or natural infection.

But it's not as if COVID-19 has become just like a cold. It's not even at the level of the flu yet. The risk of very bad stuff happening is still high enough to merit concern even if you are younger. So it's not as if you should be gesturing "bring it on" toward the virus.

Plus, there is the lingering risk of long COVID after you've supposedly recovered from a SARS-CoV-2 infection. Many political and business leaders may want to make it seem like COVID-19 is no longer a threat and everything is hunky-dory SARS-CoV-2-wise when it's not that way yet. Of course, the best way to avoid long COVID is to not get COVID in the first place, and evidence suggests that the vaccines may reduce your risk of getting long COVID.

When Should You Get The Updated COVID-19 Vaccine?

The answer to this question is a little tricky. Since around mid-June, we have been in the midst of a COVID surge. So, it may help to have more protection right now, especially if you aren't doing anything else, like wearing a N95 face mask to keep the SARS-CoV-2 away from your respiratory tract.

The trouble, though, is the whole "wane world" thing. Again, the protection from the vaccine tends to wane significantly after four to six months. Counting forward by four months will land you in January 2025. By then the world around you will be smack in the middle of the winter months if you are in the Northern Hemisphere. And remember, since 2020, every mid-November has seen the start of a major winter COVID surge. Who's to say this November will be different, as the colder and drier air, the movement of activities indoors and the holiday travel could once again contribute to greater SARS-CoV-2 transmission and spread.

Therefore, if you want to get maximal protection throughout much of the anticipated winter surge, it may make sense to wait until mid-October to get the updated COVID vaccine. This is the typical recommendation for the flu vaccine as well. So next month you could get the flu and COVID vaccines.

Also, if you recently got vaccinated or infected with the virus then the CDC recommendation is to wait at least until three months has passed. This could allow your immune system enough time to fully collect itself again and then deliver a more full response to the updated vaccine.

Which Updated COVID-19 Vaccine Should You Get?

The Novavax COVID vaccines use a more traditional recombinant protein approach that can serve as an ... [+] alternative for people who are hesitant about getting an mRNA vaccine. (Photo by Patrick van Katwijk/Getty Images)

Getty Images

If you are still a bit squeamish about the newer mRNA technology despite all its testing and use over the past four years, you may feel more comfortable with the more traditional approach of the Novavax vaccine. While the mRNA vaccines contain mRNA that then go into your cells and serve as blueprints for you cells to produce the SARS-CoV-2 spike protein, the Novavax vaccine includes a version of the spike protein itself. To manufacture the spike protein, Novavax uses the same process that has been long utilized for vaccines—such as the Hepatitis B vaccine—that have been around for many years.

The Pfizer and Moderna vaccines are pretty darn similar. The main difference is that the Moderna vaccines have higher doses of mRNA in them, which could mean a somewhat higher rate of side effects like fever, fatigue and body aches in the days after vaccination. The Moderna vaccines could offer a slightly higher degree of protection as a result, too. But there really isn't a slam dunk protection difference between the two mRNA vaccines.

How Will You Pay For The Updated COVID-19 Vaccine?

There is also the question of money. The government used to pay for all the vaccines, including boatloads of money to the pharmaceutical companies to develop and manufacture the vaccines. But that's no longer completely the case. Plus, Pfizer and Moderna have—surprise, surprise—since pushed up the prices of their vaccines several-fold, to over $100. So, first check to see if your insurance—if you have it— will cover the cost of your vaccine of interest. If it doesn't or if you are uninsured, you may be able to find a clinic that still offers the vaccine at low to no cost.

One final thing to remember. The vaccine's protection offered against more severe COVID-19 is not 100%, and you can still catch the virus if exposed, although your chances may be lower after vaccination.

Moreover, the chances of the virus being transmitted to you does depend on how many people around you have gotten the latest vaccines, too. Only about 22% of eligible adults got the last set of COVID-19 vaccine updates from fall 2023. That doesn't bode well for many people getting this latest set of updates, which means that the majority of people around you could end up being relatively unprotected against the COVID-19, be readily infected and, as a result, shed the virus in larger amounts.

Therefore, even if you do get the updated vaccine, it is still a good idea to take other precautions simultaneously. Remember a few years the so-called "Swiss cheese" approach of layering different protections on top of each other to cover the holes in each type of protection. Even though the COVID-19 situation has improved significantly since then, 2024 is not necessarily a hole different situation.

COVID-19 Vaccines Are No Longer Free To People Without Health Insurance

A federal program providing free COVID-19 shots to uninsured people has shut down at a time when the coronavirus is spreading at high rates across the United States and updated vaccines have just come to market.

The federally-funded Bridge Access Program was supposed to end in December, but it instead ended last month due to funding cuts. The program has provided more than 1.4 million free COVID vaccines since September 2023 to uninsured people and to others whose insurance plans did not pay for COVID shots. 

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Now, an estimated 25 to 30 million people without insurance will have to pay out-of-pocket for vaccines, which last year carried a price tag of at least $115 – and which may cost as much as $200 now, according to the Washington Post.

"What's at stake is we are reverting back to a system where a person's financial ability to be able to pay will determine their ability to be healthy," Raynard Washington, who leads the Mecklenburg County health department in North Carolina, told the Washington Post.

People covered through Medicaid, Medicare and most private insurers will still be able to get the new vaccine for free. Children 18 and younger can access free COVID vaccines through the federal Vaccines for Children program.

Updated COVID vaccines that target the current variants of the virus came out late last month. 

The Centers for Disease Control and Prevention recommends that everyone 6 months and older get an updated COVID vaccine to protect from infection, hospitalization and death. COVID infection rates surged in recent months, although COVID-related hospitalizations and deaths have remained low, according to the CDC.

The Philadelphia Department of Public Health reported an uptick over the summer in positive COVID tests, emergency department visits where people tested positive and COVID-related hospitalizations – but not an increase in deaths related to COVID.

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