The nation's top disease and vaccine experts are trying to figure out their next move against COVID-19 before it's too late.

On Wednesday, an independent advisory committee to the US Food and Drug Administration met to discuss the future of CO. It was a departure from the previous meetings of the committee, which focused more on OKing specific COVID-19 vaccine candidates for different age groups, as well as booster shots.

The committee had a discussion.

  • When the US will know it's time for a brand new COVID vaccine that targets more recent variants, or gives people broader, stronger immunity, and how best to move quickly if that happens 
  • How the government (instead of pharmaceutical companies) can drive the agenda on future vaccines, and what the vaccines should look like (nasal? multi-strain? universal?)
  • Whether there should be an annual COVID booster campaign each fall.

There is a worry that protection against severe illness won't hold up forever, according to the FDA.

The FDA and its advisers are under a lot of pressure to make sure that new shots can be used as early as this fall. The Center for Biologics Evaluation and Research is the arm of the FDA that is in charge of regulating all vaccines.

He said at the meeting that the FDA's decision in late March to authorize second booster doses for people over 50 years old was a stopgap.

The argument for new vaccines, instead of boosting with what we have

boxes of expired covid 19 vaccine dumped into garbage pit
Expired AstraZeneca COVID-19 vaccines being dumped at a garbage site in Abuja, Nigeria on December 22, 2021.
Kola Sulaimon / AFP via Getty Images

Moderna and Pfizer are two of the successful vaccine makers who have not received any direction from the federal government.

They are working on new vaccines that might target the Omicron variant. Other vaccine makers are trying out different approaches to fighting this disease, in both early and late-stage clinical trials.

The FDA committee members said that a national strategy for new vaccines is needed. Vaccine makers will miss the boat if they Tailoring vaccines too tightly to circulating variants is a futile strategy.

color coded chart showing how variants have changed over the course of months during the pandemic
The CDC presented information to the committee on how quickly variants have been replacing each other so far.
FDA VRBPAC, April 6, 2022.

Nelson suggested, instead, making changes only when we feel confident that it will lead to a longer duration of protection.

Professor Drew Weissman at the University of Pennsylvania is working on that task. Large-scale human trials of those pan-corona vaccines are likely months away.

Marks said that they have to do tremendous work in researching more advanced vaccines.

Some experts say we may not need new shots

The vaccines authorized and approved for use in the US are still very protective against infections that can lead to hospitalization or death.

The chief medical officer at the National Center for Immunizations and Respiratory Diseases of the Centers for Disease Control and Prevention asked what was enough at the meeting.

There was no evidence of vaccine effectiveness waning during the recent Omicron wave, according to data presented by the CDC. Even in highly vulnerable populations, such as older adults and those with comorbidities, vaccine effectiveness against hospitalization remains well above 80%.

I think we may have to accept that level of protection, and then use other alternative ways to protect individuals.

Either way, we need a better way to measure immunity, experts say

If we are going to create a new vaccine, experts on the committee urged the FDA to find a better way to measure COVID-19.

Marks said during the meeting that measuring antibody levels is a poor indicator of immunity against COVID.

There is no way to know if someone really needs a booster or a new shot because experts know it's imprecise.

The director of the precision vaccines program division of infectious diseases at Boston Children's Hospital suggested that the US government should create a repository where the best immunology studies from around the world could be consulted. He said that it could help drive the conversation about what the next vaccines need to do for our immune systems, and how we will know when they work well.

Advisors will meet again in summer to decide a plan for the fall

The FDA advisory committee is expected to meet again some time this summer, hopefully with more data from pharmaceutical companies about next-generation vaccine candidates they are working on. The hope is that the committee can make some informed decisions about what should happen this fall and beyond, assessing whether additional shots will be needed, and what kind.

The committee chair Dr. Arnold Monto said that the task was difficult.