How to Know When (or If) You Need Another COVID Vaccine

What started as a simple recipe for COVID protection--get a jab, come back in three weeks and get another--became a byzantine labyrinth to navigate over the last thirty months. The government has recognized how confusing COVID vaccine schedules have become, and is trying to streamline to make it easier to understand, and to reflect the way variants have affected our vaccines. Here's the new information you need to know.

The "initial series" vaccines are kaput

That simple, original series of vaccines we got--two doses spaced three weeks apart of either Moderna or Pfizer monovalent COVID vaccines--no longer exist. The monovalent (that's what they call the original vaccine doses) have been decommissioned by the FDA as we move to a more streamlined vaccine schedule. In fact, there are no monovalent doses of Moderna or Pfizer in the U.S. anymore for an initial series or booster.

Instead of getting that initial series, if you're a healthy adult, you'll instead just get the one bivalent vaccine dose of either Moderna or Pfizer. If you never got the initial series, you now only need one dose of a bivalent to be current.

If you only got one of your two doses and have been searching for the second, it's time to stop the search. Instead of a second dose to complete that series, you'll just go get the bivalent dose instead.

Healthy adults and children ages 6 and up just need one dose

Previous advisories on boosters are what made a mess for understanding what you needed and when; to make things simpler, you only need one bivalent shot now. In the future, this will likely become a yearly shot, like the flu shot--and one day, both vaccines may even be available in a combined shot. For now, whether or not you ever got vaccinated or boosted, you need one dose of the bivalent vaccine from either Moderna or Pfizer, and then you're done. If you already got the initial series plus a bivalent booster, you're done.

If you haven't gotten a bivalent booster, you should go and get one so you'll be current. If you received a booster anytime since mid September 2022, you got a bivalent, since all Moderna and Pfizer boosters were replaced around then.

The good news is, if you are not immunocompromised and you're at least 6 years old, it really is that simple. No matter what you previously got, whether it's zero doses, two doses, or seven doses, you still just need to make sure you got one bivalent shot or go get one bivalent shot, and you're done. Which is great, because as always, there are exceptions, as you'll read below.

Immunocompromised adults and senior citizens ages 65 and up

The good news is that the boosters you've been desperately waiting for are here. While healthy adults will get one bivalent vaccine dose, people in this group can get two, and the guidance on who qualifies remains nebulous, so you shouldn't get much static asking for one at your pharmacy. You usually need to just sign an attestation form that you qualify. That means you can just walk into the pharmacy, tell the vaccinator you are immunocompromised and that you'd like your booster; if they challenge you at all, simply say, "Please provide me an attestation form," and that should be that. You sign it to say you're immunocompromised, and they keep the form.

You can also get additional doses throughout the year as we'd previously been able to, but the bad news is you'll need a script from a physician, and a vaccinator willing to fill it. Over the last few years, pharmacists have been largely unwilling to honor those scripts, but new guidance makes it perfectly clear they should. It's too early to know, but let's hope for the best.

For the immune deficient who are without a health care provider, I am hopeful that telehealth services will fill the gap the way they have with Paxlovid scripting over the last year.

Children under age 6 have a more complicated schedule

The recommendations get a little more complex for younger children. Their vaccines use different doses and schedules than the adult versions, so the CDC has a collection of charts here to help your doctor figure out what shot your child needs next.

We'll describe the recommendations for healthy kids below. However, if your child is immunocompromised, it's best to discuss their situation with their pediatrician to make sure they'll get the right number and type of vaccines.

Kids 6 months to 4 years

Les bebes are still going to need an initial series of vaccine doses to kickstart their immunity. This is complicated, so pay attention and, when in doubt, consult the CDC chart.

If your child has never received a COVID vaccine, they are going to need either:

Two doses of Moderna bivalent vaccine, spaced four to eight weeks apart, orThree doses of Pfizer bivalent vaccine, with three to eight weeks between dose one and two, and at least eight weeks between dose two and three.

If your child started but has not completed their original series:

If they got one Moderna monovalent dose, they need one Moderna bivalent dose at least eight weeks since their last vaccine dose. If they got one Pfizer monovalent dose, they need two Pfizer bivalent doses, the first three to eight weeks after their monovalent vaccine dose and then the second dose eight weeks after that.If they got two Pfizer monovalent doses, they need one Pfizer bivalent dose, at least eight weeks since their last vaccine dose.

If your child completed the original series and received a bivalent booster:

They do not need any additional doses, for now.

Kids 5 years old

If your child has never received a COVID vaccine, they are going to need either:

Two doses of Moderna bivalent vaccine, spaced four to eight weeks apart, orOne dose of Pfizer bivalent vaccine.

If your child started but has not completed their original series:

If they received one dose of Moderna monovalent vaccine, they need one dose of Moderna bivalent vaccine, at least four weeks since their last vaccine dose. If they received one or two doses of Pfizer monovalent vaccine, they need one dose of the Pfizer vaccine, at least eight weeks since their last vaccine dose.

If your child completed the original series and received a bivalent booster:

They do not need any additional doses, for now.

Novavax and J&J

If you haven't heard of Novavax, it came late to the game, but it is important, nonetheless. Instead of an mRNA vaccine, it is a traditional, protein-based vaccine. There are arguments that it is better or worse, but if you are someone who couldn't get an mRNA vaccine for a legit reason or because the word RNA freaked you out, then this vaccine is for you. Heads up, though, that if you are Hispanic or Latinx, this vaccine may be less effective. Most studies of Novavax predate the Omicron variant's appearance, so while numbers look great in studies, none of them are recent enough for our current variants.

If you are 12 or older, and you can find a place that offers it, a two-dose regimen of Novavax will be considered your "original series," but it is still recommended you get a bivalent mRNA chaser anyway. You can get a Novavax booster six months after your original series.

J&J is still authorized, but almost impossible to find and only authorized in "very limited situations." Even if you meet the requirements, you'll have a heck of a time tracking one down.

If you got a J&J, it's recommended you get a bivalent mRNA booster now, whether that's Moderna or Pfizer.

Yes, you should still get vaccinated

I will not waste breath here on whether or not we're still in a pandemic; it seems insulting to the 600 people who died of COVID yesterday. One in ten infections (that's not people, that's infections) results in some form of long COVID, and we live in a country with less than ideal health care and no real social net for the temporarily or permanently disabled, no federal reimbursement for COVID treatment or testing, or guaranteed sick leave, paid or otherwise. Most individuals will have COVID many times over their life, as you've likely already experienced. The math is not in your favor. This is a textbook "fuck around and find out" situation.

The COVID vaccines are the most tested vaccines in the history of mankind, having been injected into the arms of 5.5 billion people--that's billion, with a b. 270 million people in the U.S. alone got a vaccine. Yes, pharmaceutical companies are raking it in over them, but pharmaceutical companies can be evil and still produce medical discoveries that save lives.

Getting a vaccine is relatively easy now, with the ability to walk into almost any pharmacy to obtain one. You can look up locations nearby ahead of time. Hot tip: I know of at least five cases of people who met their partner waiting for a vaccine, and speaking only for myself, those are better odds than Bumble. If you are scared of needles or the medical establishment, phone a friend to go with you. If you don't have a ride, call your county COVID hotline (they still exist, and if not, call your county health board). They'll get a vaccinator to your home or get you to a vaccination site. If you are fearful of unmasked healthcare situations, call an independent pharmacy and ask them to jab you outside.