The newest COVID-19 vaccine was approved this week. State Health Director Dr. Elizabeth Tilson wants North Carolinians to know, first and foremost, that this is not a booster.
"This will be called the COVID 23-24 vaccine. So, kind of getting away from that concept of booster," Tilson said. "Because you won't have to have an initial series in order to get this."
Tilson said to not even think about COVID-19 or flu or RSV as needing separate attention. Instead, she’s encouraging people to think of it as respiratory disease season.
"So, thinking about staying up to date on your COVID vaccine, and your flu vaccine. And you can go ahead and do those together," Tilson said. "It is the best protection against severe illness, hospitalizations, and death."
Tilson says it's important for people to remember a vaccine does not guarantee someone will not get sick. But it does lower the risks associated with illness.
The rollout for this vaccine will look a good bit different from the last ones. Before, the federal government bought millions of doses from drug manufacturers and gave them out for free. This time around, Tilson said it will resemble the rollout of traditional flu vaccines, including at local health departments or primary care offices.
"And really pharmacies," she said. "The majority of people have been accessing vaccines in pharmacies."
Already, CVS and Walgreens have begun scheduling appointments. The first slots are for Monday morning.
For most people with private insurance or Medicare, the new COVID-19 vaccine will come with a $0 co-pay. Tilson said that's the first big way in which people can access the new vaccine.
"Our other big channel is what's called the Vaccine for Children Program," Tilson said. "This provides free vaccines for children covered by Medicaid, our uninsured children, and underinsured children."
But of course, that leaves a gap. There are still nearly 1 million adults in North Carolina without health insurance, according to census estimates. When the state expands Medicaid, that will extend coverage to 600,000 people in the state. But that's on hold while lawmakers hash out a budget. Because of the delay, it might not go live until early next year.
These folks do have some options. County health departments and some community health centers will have free doses of the new vaccine. The Biden Administration is calling this the Bridge Access Program.
"The federal government will send a supply directly to pharmacies," Tilson said. "And so there will also be a free supply in our pharmacies as well. Which again is what we're finding, that's where people are seeking care."
Getting that message out will become the next hurdle, especially as vaccine uptake has already fallen sharply. More than two-thirds of all North Carolinians got at least one dose of the initial vaccine, including nearly every adult aged 65 and older. But less than one-quarter of all North Carolinians got the latest booster, which came out about a year ago.
Dr. Cameron Wolfe, an infectious disease specialist at Duke Health, said there's an unfortunate correlation with health literacy, insurance coverage, financial capability, and worse COVID outcomes.
"And I think you'd be foolish to predict that that mis-association will not continue to be the case," Wolfe said. "Which should be a call for all of us to be in fact more proactive towards getting a vaccine message to the people who are going to need it the most. They are often the people who are uninsured."
A Census survey of unvaccinated people nationwide found that 42% said they don't trust COVID-19 vaccines. The survey found that 35% said they don't trust the government. But UNC Greensboro social epidemiologist Jennifer Toller Erausquin said there are other people with reasonable questions like vaccine safety, effectiveness, why it's a good idea, and potential for side effects.
"There are folks who have those kinds of questions that if they could get those questions respected and then answered, then they would make the decision that's right for them and they would feel good about it," Erausquin said.
The virus is circulating more widely now than at any point since last winter. And while severe illness isn't up as much, hospitalizations in North Carolina are at their highest point since March.
Erausquin said this is in part because the virus has again mutated and the most recent new vaccine is now a year old.
"If you look at the longer-term vaccine effectiveness, even as short as 180 days, so about six months, a lot of that vaccine effectiveness seems to wane," Erausquin said.
This new vaccine more closely targets the XBB.1.5 variant, which was dominant when the vaccine was first developed. An even newer variant, called EG.5, also now seems to be spreading through the country. But knowing exactly which one someone has is hard to count, because so few people take the detailed test which lists the specific strain. Plus, Erausquin said the newest vaccine should still offer good protection.
"There's lots of speculation of, you know, how bad could it get?" she said. "But it does look like it has similar enough features to the X variants that the updated fall 2023 vaccine should also provide some protection against that."
The Food and Drug Administration approved the new vaccine Monday. On Tuesday, the Centers for Disease Control and Prevention recommended the vaccine for everyone six months and older.
