September, October prime time for flu vaccines and COVID-19 boosters

The American Academy of Family Physicians (AAFP) has endorsed the recent federal authorization of updated booster shots against COVID-19 this fall.

Sterling N. Ransone Jr., MD, FAAFP
_{Photo courtesy of AAFP}

Last week, the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices gave their stamps of approval for the bivalent vaccines. Pharmaceutical makers Pfizer-BioNTech and Moderna are making vaccines and boosters with the mRNA that fights the original virus strain and the omicron BA.4 and BA.5 subvariants, now the dominant strains in the United States.

On Sept. 2, AAFP’s Commission on Health of the Public and Science supported those federal actions. Medical Economics sat down with Sterling N. Ransone Jr., MD, FAAFP, to discuss the Academy’s affirmation, COVID-19 boosters, patient responses, and the fall flu vaccine season.

The following transcript was edited for length and clarity.

Medical Economics: What should primary care physicians know about the AAFP’s decision?

Sterling Ransone: We use our commission to review data and we put them through a very rigorous review process before we give it the stamp of yes, we agree with it, or no, we don't agree with it. Our commission has looked through the data regarding the COVID-19 boosters at this time, and have come out recommending that everyone who is eligible to receive the COVID-19 booster, receive it. We know that the vaccines are safe. We know that they're effective, we know that they save lives. And we know that family physicians, we're a trusted source of information. Having the Academy's stamp of approval, and knowing that it's an independent review process, hopefully it will help our members and other physicians realize that this data has been looked at from by multiple different groups, the data is good, and that it's supportive of our patients so we can keep them as healthy as we can.

ME: Relating to COVID-19, a lot of patients may say, either I had COVID, or, I got my vaccines, or both, so I have antibodies against the virus. It seems with the new variants, people are not getting as sick and I'm a pretty healthy adult, so why do I need a new shot?

SR: There are several layers to the answer to that question. The original series of vaccines with the boosters have been shown to reduce the incidence of severe ailments. And there were an extra couple of weeks ago, there were some really good data that came out that showed that looked at death rate, versus folks who had one, two, three or four of the initial COVID vaccines and there was a huge discrepancy between people who weren't vaccinated and people who had one, two, three or four. And with each of them we saw that with the greater number of vaccines, meaning the initial series and then one or two boosters, the death rate went down substantially with each additional booster.

When we look back over the pandemic, one of the errors the medical community made initially when the vaccines came out, was saying that we will do these boosters, and then we'll be good. And a lot of people, I think, took that to me that we get these vaccines and we'll never have to worry about COVID again. Well, that's obviously not what happened. I think this is more along the lines of what we've seen with the flu. The flu that goes through every year is a variant of the flu that killed millions in the influenza pandemic in 1918 when it came through. We know there are variants that develop over the year and our CDC looks to see which variants they think will come into the United States each year and we adjust our flu shot accordingly. And that's what we're immunized against to help decrease the incidence of influenza in the United States.

That's where we're headed with COVID and we're starting to see these variants come in. We know what we can do to increase the number of antibodies that are out there to help us fight off the disease and lower the risk of severe disease, hospitalization, or death. Now, that doesn't mean that we won't potentially get it, but the cases we get should be milder and less likely to cause some of the worsened outcomes.

ME: What advice would you offer to primary care physicians, what are some techniques, or how do you broach this topic with your patients? What should physicians say when they get in the examination room?

SR: I asked every one of my patients at every office visit – at least I have for the last month or so – if they plan on getting a flu shot and if they plan on getting a COVID booster this fall, and I lay the groundwork early – you know, when you get your flu shot this year, you should consider getting a booster for your COVID and I'll kind of explain what I just explained to you. What I would tell most of the physicians is, bring it up. There's a lot of subtlety to the message. If you come across as too aggressive about, “Why haven't you been boosted yet?” a lot of people will recoil from that thinking, “You know, the doctor thinks that I should have done something that I haven’t done.” If you suggest and guide them and explain why you think it's a good idea for them to be boosted, I find that I have a lot greater uptake. If I do that they don't immediately get defensive about not having having received the fourth shot or second booster. And I can explain why I think now would be the time to do their next booster and explain the science of the new booster that's coming out and why I think it's important for them to get it. So I try to be nonjudgmental when I ask the patients the question.

The other thing that I have been doing is telling everybody, when you get your flu shot this year, we'll get your COVID vaccine at the same time and just kind of offering them both together. I have had very few people who wish to separate them. I've had a few that say, well, I like to separate myself. OK, well, then the next one we probably should wait two weeks between administration of the vaccines, or we can go ahead and get them both done today. It's been shown to be safe and effective. I did this last year with COVID vaccine and flu shots. My patients handled it quite well. And I think that having the patient in the office to get vaccinated, getting them both at the same time, really is a good public health practice.

ME: What questions do moms and dads have when they come in for their own checkups with you? Are they asking you questions about getting their children vaccinated?

SR: As you go down in age the numbers of unvaccinated go up quite a bit and a lot of parents I think have some concerns because they're immunizing their child. We kind of normalize the COVID vaccine, we put it in with the other vaccines that we do on a routine basis and just talk with the parents about any concerns they might have with it. I had a talk today actually with a grandparent about that who said, well, I don't think I'm going get my school-aged child boosted. Why did you decide that you don't want to do that? Well, her immune system is great, I don't think she'll get that. So I said, well, about other people in her class, are any of them immune-suppressed? Well, they all get the cold. You know, when one gets a cold in the classroom, they all get the cold. True. And you know, I think that if one gets COVID, there's a good chance that they'll all get COVID as well. She thought about that – yeah, I guess you're right. She hadn't really thought about it. A lot of times they think just about their own child and rightfully so. You also need to think about the other folks in the classroom because if someone else in the classroom gets it, it’s very likely to spread and we want to keep our children in the school room so they can learn, they can play sports, they can do all of this. And the best way to keep them in school and socializing and playing sports is to get them vaccinated. So if they get exposed, either they won't have symptoms or will have minimal symptoms and they can get back to the learning process a lot faster.

ME: Looking at the calendar, what are you telling your patients for timing? Is there is there an ideal time to get a booster shot?

SR: I recommend September or October for flu shots and COVID vaccines. It all has to do with when we see these viruses come through. Now again, we don't have as much experience with COVID. We know that in our area, into December and into January the last two years we've had the big peaks of COVID, which coincided with people going indoors and turning on their heating systems drying out the air a little bit. Typically in our area we see the flu pop up late December and our flu season goes through March. That's why I generally like to get people vaccinated September-October-ish so that we still have some protection for flu at that time of the year. I worry about getting flu shots too early. So September-October is the timeframe that I recommend getting it and since we're doing both at the same time, getting a COVID vaccine. The September-October time frame will likewise help us help protect us against any surge we might see in the December timeframe. The last thing I read was the folks of the CDC are predicting that we'll get a December surge. In a perfect world, I'd get all my patients and get them their flu vaccine and the COVID vaccine by the end of October. If I could do that, I really think we'll be doing some good.