What Vaccines Can I Get this Fall?
Probably most of them, but maybe for the last time. Get them while you can.
It’s almost time for kids to go back to school and seasonal respiratory viruses to start circulating again in the northern hemisphere. CSL-Seqirus, a major manufacturer of flu vaccines based in Australia, announced last week that it was laying off 15% of its workforce and restructuring the company due to “unprecedented volatility” in the US market. A friend with upcoming travel reached out to ask me if he should get a COVID vaccine now or wait a month or two for updated shots—or if there would even be updated shots. Journalists in general have been asking me, in light of US Health and Human Services Secretary Robert F. Kennedy, Jr.’s multi-front war on American vaccination, whether vaccines will even be available and how this will affect countries outside the US. Will we have vaccines this fall?
The answer to this is mostly yes, Americans will have access to most vaccines this fall, but maybe not COVID. Other countries should not be affected, with some caveats. That’s not great news, but it’s also not “no vaccines.” Unfortunately, that applies to this year only. While Kennedy’s attempt to destroy population immunity in America is unprecedented, it is working. The impact of these policies will not be felt for some time, since outbreaks require a critical mass of susceptible people to take off.
Often, congregate settings with a lot of unvaccinated people are where epidemics are amplified. Daycares and schools are prime locations for a virus to take hold in a population and spread outward into the community, hence the requirements for vaccination. People are understandably concerned and confused about vaccine access, especially for their kids. I’ll try to provide some clarity.
COVID-19
Kennedy came for COVID-19 vaccines first, probably because uptake is relatively low, in part because of all the disinformation about these vaccines. A competent HHS secretary would try to improve updated COVID vaccination rates, since COVID vaccines work and are safe. Kennedy wants to tank them even further, taking us further down the slippery slope of eliminating as many vaccines as possible. In May, Kennedy recorded a video, flanked by henchmen FDA Commissioner Marty Makary and NIH Director Jay Bhattacharya, proclaiming that COVID vaccines were unsafe for children and circumvented normal review processes to cancel the existing CDC recommendation that everyone over the age of 6 months should have updated COVID shots. The Daily Beast reported MAHA Action myocarditis grifter Aseem Malhotra’s assertion that Kennedy plans to pull COVID vaccines within months.
Makary and his minion CBER Director Vinay Prasad wrote a policy declaration in the New England Journal of Medicine stating their intent to regulate COVID vaccines off the market by requiring them to undergo unnecessary clinical trials, supposedly in the pursuit of “evidence” they are safe for kids and they work. There is already a lot of evidence to show that they are safe and they do work. COVID does still kill people. Everyone over the age of 6 months old should get one.
Prasad nonetheless unilaterally overrode experts and rejected two updated COVID vaccines, Moderna’s next-generation COVID mRNA shot and updated Novavax, citing insufficient data and invented safety concerns. Prasad resigned in July after deranged MAGA influencer Laura Loomer attacked him as a woke interloper and a Wall Street Journal headline screamed that he was a “Bernie Sanders Acolyte in MAHA Drag,” but he returned to FDA two weeks later like a herpes reactivation.
A few weeks back, Kennedy announced that he was axing BARDA’s entire portfolio of mRNA vaccines. Although this doesn’t impact existing mRNA vaccines, it bodes very poorly for their future. Vaccine legend Peter Hotez and I broke down why this is a bad decision for the CBC here:
Last week, the American Academy of Pediatrics (AAP), a professional organization of American board-certified pediatricians, recommended that children should, in fact, get updated COVID vaccines. This didn’t go over very well with Kennedy, who took to his favorite social media hellsite to rage that AAP was a corporate mouthpiece for Big Vaccine.
As usual, he neglected to mention that he has personally cashed in on suing Merck. Although he has promised to divest his earnings from those lawsuits, he reportedly transferred them to his son, who is a lawyer at the personal injury firm suing Merck. To my knowledge, there is no proof that he has even done this, in contradiction to his accusation that AAP is corrupted because vaccine manufacturers donated to a professional pediatrics society.
Kennedy invoked the 1986 National Childhood Vaccine Injury Act. This is a subtle reference to the Vaccine Injury Compensation Program (VICP), or “vaccine court,” which Kennedy has promised to “fix,” except by “fix” he means “destroy.” The VICP is a way of expediting compensation for vaccine injuries that won’t force manufacturers to stop vaccine production altogether, since vaccines are not very profitable and a shitstorm of lawsuits is a big disincentive to making them. Kennedy’s version of “fixing” will probably be breaking it while simultaneously producing bought-and-paid-for evidence that vaccines cause autism, bankrupting the VICP and opening the door for catastrophic anti-vax litigation against manufacturers. Kennedy’s remark that health care providers are not “shielded from liability” is a veiled threat of ruinous legal action.
So where does that leave this season’s updated COVID shots? They haven’t yet been approved, although that should happen any day now based on when these approvals occurred in the past few years. Per the standard processes, the Advisory Committee on Immunization Practices (ACIP) would review evidence and vote on a recommendation for CDC Director Susan Monarez to sign. The previous expert ACIP was fired in June and replaced with a cohort of anti-vaxxers including noted mRNA technology haters Retsef Levi and Robert Malone. Kennedy kicked AAP off ACIP work groups to ensure that no inconvenient experts might point out the evidence shows COVID vaccines are safe and effective for kids. Levi, a beponytailed management expert with no background in vaccines or infectious disease who has previously claimed falsely that mRNA vaccines kill people, is in charge of an ACIP review team to investigate mRNA vaccine safety. Thus I think it’s unlikely that vaccines will be approved for everyone over 6 months old. When Levi’s review inevitably concludes incorrectly that mRNA vaccines are unsafe, they will be pulled from the market altogether.
If the updated shots aren’t approved, then Americans will only be able to access the 2024-2025 shots, which are in short supply as providers clear out old stock in anticipation of the updated vaccines. Currently FDA recommends that the updated shot should be a monovalent (targeting only 1 strain) JN.1 variant. Current COVID mRNA vaccines target the KP.2 variants. Both JN.1 and KP.2 are both Omicron (as is all SARS-CoV-2 since 2021) and they aren’t that different. The “old” shots will still provide a lot of protection this fall and winter, but not approving any new shots signals no updated shots for the foreseeable future. As SARS-CoV-2 continues to evolve (which it will do faster now as fewer people are vaccinated and protection wanes), the 2024-2025 vaccines will be less and less protective. Americans will gradually lose access to COVID vaccines altogether.
Status: Uncertain. Dependent on FDA approval and ACIP recommendation of updated shots. If approved, likely only high-risk groups (elderly people and/or people with health conditions predisposing them to severe COVID).
Outlook: Grim, considering the administration has used multiple tactics to restrict COVID vaccine access and has signaled the goal is to remove them altogether.
Flu
On Inauguration Day, US President Donald Trump signed an Executive Order to withdraw from the World Health Organization (WHO). In February, my colleagues and I were increasingly concerned that CDC scientists were going to be prohibited from attending the annual WHO northern hemisphere strain selection meeting. To select strains for the upcoming flu season, you have to guess which ones are circulating, which is done by all the WHO member countries submitting epidemiologic and surveillance data about the strains currently spreading. Based on these collaboratively assembled and analyzed data, strains are recommended to formulate the next season’s flu vaccine. If the US didn’t submit data or attend the meeting, they risked a bad match for everyone, since the American data are crucial for understanding patterns of influenza circulation.
Fortunately CDC was allowed to attend by Zoom at the last minute. However, around the same time, DOGE layoffs devastated the CDC workforce and the government halted a flu vaccine campaign meant to increase uptake. The FDA halted a meeting of the Vaccines and Related Biological Products Advisory Committee (VRBPAC), which is analogous to ACIP and makes recommendations to FDA about what should be approved. The VRBPAC meeting was not rescheduled, but FDA and CDC held a closed-door meeting in which the vaccine was recommended for approval. It has since been approved and recommended by ACIP. Manufacturers began shipping the updated flu vaccines last month.
Considering last flu season was the most severe since the 2009 pandemic, there is a real need to increase vaccine uptake as much as possible. Everyone over 6 months old should get a flu shot. Older people should get a higher dose to compensate for waning immunity. There are two kinds of flu vaccines and both are trivalent formulations targeting 3 flu strains: H1N1, H3N2, and influenza B. The standard inactivated split-virion vaccines are easiest to access and that’s usually what I get. These are the vaccines grown in eggs or cell culture, then inactivated, the virus particles are broken up, and injected intramuscularly. There is also FluMist, which is a live-attenuated vaccine you can take by nose spray at home. You should get either kind, just so long you get it. Generally it’s a good idea to try to get your flu vaccine sometime in October, as that timing allows for the highest antibody titers at peak flu season.
And because I know people will ask, these are seasonal flu vaccines and they don’t protect against bird flu. However, they do elicit immune responses, specifically to the H1N1 component, that have cross-protective effects against H5N1 on the basis of the shared N1 subtype. Besides, seasonal flu vaccines reduce transmission, reduce infection risk, and lower the likelihood of reassortment in a human co-infected with a seasonal virus and H5N1. This is especially important, because gutting mRNA vaccines means we are stuck with technology that is slower and more dangerous to manufacture. H5N1 is definitely still around in animals and it probably is in dairy and poultry workers too. As seasonal flu picks back up, it is really important to reduce the risk of co-infections, to reduce the likelihood of a bird flu pandemic.
Flu vaccines are safe and effective. Last season, so many kids died from seasonal flu it set a record for pediatric mortality in a non-pandemic year. Get your flu shot.
Status: Approved and recommended.
Outlook: Uncertain but pessimistic. There’s no guarantee the US will participate in future strain selection meetings or use WHO-selected strains. Defunding mRNA vaccine research for flu means our technology is stagnating and we will be less prepared to respond to emergent subtypes like H5N1.
Respiratory syncytial virus (RSV)
RSV is a really nasty paramyxovirus that kills a lot of kids and elderly people. Fun fact: my first-ever lab experience was in high school at the Fred Hutchinson Cancer Research Center, where I developed an immunohistochemistry assay to assess whether some bone marrow transplant patients with severe pneumonia had RSV (they didn’t). I also worked at a nephrologist’s clinic answering phones and filing patient charts (for money, since my research was voluntary and I didn’t get paid), and when I told him about my research he called it “RCV”. My inner spelling bee champion broke out and I corrected him and spelled “syncytial” when he argued with me. He didn’t really like me after that. So began my long and mostly fulfilling career in pissing off men with seniority and power by correcting their virology errors.
Anyway, RSV is a pretty pathogenic respiratory virus that for many years had no vaccine. An inactivated vaccine developed in the 1960s was a catastrophic failure, because it actually enhanced RSV disease and made recipients sicker. This led to decades of slow-moving vaccine development, due to concerns for safety.
However, innovations in structural vaccine design resulted in the development of safe RSV vaccines and there are now 3 options on the market. Not everyone needs RSV vaccines, but generally people should get it if they are older or over age 50 with conditions predisposing them to severe disease. There is a separate vaccine approved for pregnant people, to protect them and their babies. Passive immunization via maternal antibodies results in 6 months of protection for babies when they are most vulnerable to infection and severe illness. There is also an antibody injection for babies to protect them during respiratory virus season. These can be used in older children with high risk, as well. However, there is still a need for vaccines in young children. Vaccines are easier to administer than antibodies and their protection is much more durable, as the antibodies will eventually degrade after a few months. With RSV’s fraught history, however, and the current administration’s hostility to vaccines, I doubt this will happen.
Status: Approved and recommended.
Outlook: Probably no new RSV vaccine development for kids in the foreseeable future.
Measles-Mumps-Rubella (MMR)
Schools have typically required MMR vaccination for enrollment. This is how measles, despite being one of the most infectious viruses in the game, was eliminated in the US. But because measles is so contagious, when the vaccination rate dips even a little bit, it can come roaring back. The measles outbreak in West Texas that has now extended to Mexico showed exactly what happens when measles takes off in an unvaccinated population, especially when combined with an ineffective outbreak response and an insufficient immunization campaign: thousands of cases and multiple deaths, predominantly in young children. Mumps and rubella are also potentially deadly. Congenital rubella syndrome, which occurs when a baby is born to a mother infected with rubella virus during pregnancy, causes lifelong blindness and deafness, as well as heart and brain damage.
These viruses are all highly transmissible in unvaccinated populations and can spread like wildfire in schools or daycare settings. The MMR vaccine provides nearly complete protection against all of them. It is the only way to prevent measles, mumps, and rubella, diseases for which there are no known alternative treatments. Make sure your child has the full 2 dose series. If it’s been several decades since your last MMR, you may want to get your antibody titers checked. I did this in 2019 in preparation for travel to countries with active measles outbreaks. In a testament to the durability of this vaccine, I had titers for anti-measles IgG (antibodies) that were well within the protective range more than 30 years after my second MMR dose. It’s a great vaccine that provides enduring protection against these three terrible pathogens.
Status: Approved and recommended. Get it on schedule.
Outlook: Uncertain but pessimistic. Kennedy hates MMR more than any other vaccine. Martin Kulldorff has already signaled that the ACIP might take the MMRV vaccine (MMR + chickenpox) off the market. If successful (they probably will be), I expect them to go after MMR next. Vaccinate your family while you still can.
Tetanus-Diphtheria-Pertussis (TDaP/DTP/DTaP)
Although most kids get vaccinated for this as infants, it’s worth making sure your kid is current. You should get a booster, as well. There have been outbreaks of pertussis (whooping cough) in multiple states and kids are especially vulnerable. Kennedy has floated going after these vaccines because of his invented fantasy that aluminum salt adjuvants are dangerous.
This is a 5-shot series given over the course of life, from around 2 months of age to 4-6 years old. Although most kids hopefully began their series on time, delays in vaccine schedules mean that some kids have not gotten vaccinated. All three of these diseases are terrible and kill children. Pertussis can spread rapidly in settings like schools or daycare. Make sure you update the series and get a DTaP booster yourself if it has been awhile.
Status: Approved and recommended. Get it on schedule.
Outlook: Uncertain but pessimistic. Kennedy has signalled he might take this one away.
Polio
I realize that there has not been an outbreak of polio in the US in decades. However, polio is the virus whose return I fear the most. It is non-enveloped, extremely hardy, and remains infectious in sewage for days. Most people have never seen poliomyelitis. I did my PhD in a polio lab and I still think a lot about how horrible polio looks in experimental lab mice. I can’t imagine what type of moral barrenness of the soul leads anyone to take polio vaccines away from actual human children.
The inactivated (Salk) polio vaccine used in the US and other countries where polio has been eliminated is a 4 dose series of shots given between 2 months to 4-6 years of age. It’s important to get the entire series, because while it’s very effective at preventing poliomyelitis (paralytic disease), it doesn’t prevent infection. Poliovirus causes poliomyelitis when it gets out of the gut into motor neurons and the vaccine prevents that from happening, but vaccinated people can still get infected and still asymptomatically shed infectious poliovirus. This can endanger unvaccinated people.
Poliovirus is transmitted by the fecal-oral route and has to travel through stomach acid. It can tolerate huge changes in temperature and pH, and it can persist in the environment for much longer than most viruses. If polio vaccination rates decline, we will begin to see polio cases. If Kennedy manages to tank aluminum salt adjuvants, then polio vaccines may not be available at all. Poliovirus destroys motor neurons, which do not grow back. When you lose these motor neurons, you lose the ability to control your muscles. Paralysis from polio is permanent and irreversible. If it impacts the motor neurons that control the diaphragm, you will never breathe on your own again. To prevent your child from living out their life in an iron lung, make sure they are fully vaccinated against polio.
Status: Approved and recommended. Get it on schedule.
Outlook: Uncertain but pessimistic. But do not mess around with polio.
Bad things come to those who wait (to vaccinate)
I’m very relieved that most of these vaccines are still available in the US, but am very concerned about the future. You should take advantage of that while you still can. Kennedy and his medical disinformation squad are throwing the legal, regulatory, and pseudoscientific kitchen sink at immunization. Most of his tactics are working. There is a very strong likelihood that some of these vaccines won’t be available next year.
I never imagined facing an administration that would systematically destroy America’s national immunization program. Vaccines have saved millions of lives. They keep people healthy with very little effort. They are scientific miracles. Unfortunately, many will only recognize this when the consequences from losing access to vaccines become apparent, namely children suffering and dying in droves. A future without these vaccines is bleak. Get your family immunized now, while you still can.
Thank you. You are a treasure.
“like a herpes reactivation” 😂🔥