Should you get that bivalent booster shot?

October 4, 2022 • 12:00 pm

My primary-care physician, Dr. Alex Lickerman, discusses the question everyone’s asking: should you get that bivalent booster? (For most people it would be their third booster and the fifth Covid shot). You can access Alex’s post by clicking on the screenshot below. (Be sure to look at the graphs and read it all.)

Alex always looks at the science before he decides what’s to recommend, and by that I mean the primary literature. When I first asked him about whether to get a booster, he said he didn’t know because the data hadn’t been published, and all the existing studies were on antibody levels in mice. Now he looks at more data. I’ll give his conclusion below but do have a look at his post.

My own decision was to get the booster simply because I’m traveling tomorrow, but, as always, consult your own doctor or decide from the data themselves. People tend to get covid on airplanes these days (a friend who just returned from Boston said only 5% of the passengers on her Southwest flight wore masks), and Alex said that it couldn’t hurt me to get one before traveling—but it might not help me much, either.

CONCLUSION: Should you get the bivalent booster? In the absence of human trial data, we might think about this question as follows: We can be reasonably certain that the bivalent booster will produce a level of neutralizing antibodies that diminishes the risk of infection from COVID. We don’t know how long that protection will last, but a fair guess would be from 3 to 6 months. If there is some reason you feel the need to reduce your risk over the next 3 to 6 months, say, for travel, getting the bivalent booster would seem reasonable. On the other hand, if in addition to being vaccinated, you’ve had COVID recently (meaning you’ve been infected with an Omicron variant), likely the same level of protection accrues, obviating the need for the bivalent booster. If your main concern is dying from COVID and you’ve already received the primary series and one or two boosters, your risk is so low that getting another shot would seem superfluous. If you are at high risk for dying from COVID, while there is no data to suggest the bivalent booster might further reduce your risk beyond levels afforded by the primary series and one or two boosters, there is also likely little risk of getting it. In the absence of data to guide us, this would then be a personal decision.

Often Alex answers questions in the comments, so if you have any, put them below. I’ll tell him that he might look at the comments.

30 thoughts on “Should you get that bivalent booster shot?

  1. Thanks for the info. I always like to read what Dr. Lickerman has to say.

    I got the Pfizer booster 3-weeks ago when it was first available. Like the other 4 shots, no side-effects except a bit of a sore arm. I haven’t contracted Covid (that I know of), so I don’t see a downside. I got the flu vaccine last week, so I’m good to go this upcoming “sick season”.

  2. I received my fifth Covid vaccination, the bivalent one, three weeks ago. I have not come down with Covid so far. I followed up with the flu shot a week later and scheduled a Shingrix first vaccination the day after tomorrow.

  3. Thanks!

    My own experience/calculations went like this:

    Last fall I’d had two shots – AZ/Pfizer, and then got a Pfizer booster in December. Unfortunately I became infected with COVID about 5 days after the booster. That left the question as to whether I should consider myself having had two shots and infection, or 3 shots and infection – i.e. did having COVID right after the booster negate the full benefits of the booster (and hence full benefits of hybrid immunity as well)?

    There was finally a study not long ago – I think it came from, or was linked by, Prof Shane Crotty – which indicated that there are indeed cancellation features to getting COVID or a booster too close to one another – that a booster too soon after infection would negate much of the booster, and visa versa.

    With that in mind, and 9 months out from my infection, I wanted to get the new bivalent booster to be more sure.

    However another wrench thrown in was that I’ve had Long Covid since my infection. And that raised the question “what are the effects of having a booster on Long Covid?”
    There is maddeningly little scientific information on this. A small study or two suggested that a small portion can have their LC symptoms improve after a booster, many having a neutral response, and another small portion report relapse/increase of LC symptoms! There’s quite a number of people reporting relapses from COVID shots in the LC reddit forum. So that made me pretty nervous.

    But since I was going to be forced in to spending time in enclosed spaces with other folks for my work this fall, and I really wanted to feel more confident about fending off a really bad case of COVID, I rolled the dice and got the BA.1 Moderna Bivalent booster offered in Canada, about 10 days ago.

    Thankfully, no increase in LC symptoms. No improvement either. But I’ll take that, as it eases my fears about getting future booster shots, should I still have LC symptoms.

    1. Yeah Canada isn’t offering the one the US has right now. I got the regular booster in July and I’ve decided to wait on the bivalent even though I could get it in October. Then I can decide if I want it around Dec or Jan when I’m closer to my 6 months or see if the other, more specific one is available and decide on it. I hate getting the shots as all but one has resulted in a migraine and when I get 8 a month an extra one robs you of that bit of pain free time so I want to choose wisely.

      Incidentally I think all my troubles with migraines and fatigue happened after two very bad flus and for years after, getting flu shots made me very ill after so I stopped getting them for a decade or so. I can get them again now but this comports with the long COVID findings.

  4. Got mine, all set. Pretty minimal side effects. Never had COVID. Not sure why anyone wouldn’t want it, even if the only impact is to lessen severity if you do get it. I’ve had a few healthy friends get quite sick recently. To me it’s the same consideration as getting a flu shot.

  5. Yes to the Covid booster. We’ve had the windows open all summer, but by November we’ll have to close everything up. I’m not sharing stale air with customers with no protection. I will probably start masking again, too.


    1. I’m a weirdo who masks in public closed spaces. And if work requires me to travel or come into an office I will probably be the only one masked. But I’ve gotten so very ill in the past that I don’t want to deal with an infectious disease, even the flu. The last flu I got was just before coronavirus started being talked about and I was sick severely for 3 weeks and still unwell for months after so much so that I half jokingly kept telling people I had coronavirus.

      1. I still wear a KN95 mask in stores etc. I went out for a small restaurant gathering sans mask for the second time just the other day. The first time was at a wedding reception end of July. Luckily I didn’t catch anything. I’ll be sticking with my family circle this Winter.

        When did you catch that flu, Diana? I think COVID had landed in Canada by (if not before) Sept. of 2020. That was when I learned of people getting unusually bad ‘flu’.

        1. Sadly also a colleague of mine got influenza A and died. He was diabetic and they confirmed in was the flu. I wasn’t in contact with him at the time.

  6. Isn’t there an easier way for Bill Gates to upgrade the operating system? What if I’m happy with Windows 11?

  7. Thank you, Dr. Lickerman. I have questions, but I will try to narrow it down to one: I regularly get a very strong reaction against most vaccines. Flu shots, the shingles shots … all have been generally bad. All 4 of my Covid shots have left me curled up in a fetal position, with all-over body aches and chattering teeth. Ibuprofen takes a bit of the edge off, but it still sucks and I rather dread getting my next booster. But I think I should it bc I have a bit of a risk issue from Covid and I want all protections I can get.
    My question is: are there any treatments in the pipeline that can dampen these strong side effects?

    1. Unfortunately, no. Advil and/or acetaminophen are your best weapons against post-vaccination reactigenicity.

  8. Airplanes generally have very good air circulation. That is more important than masks. At least in TB, but I doubt it would be very different in Covid. You are more likely to contract Covid in your local supermarket, or indeed airport, than during your flight.

  9. Good article. Thank you for posting it. And, thank you Dr. Lickerman for taking the time to write the article.

    My wife and I got the bivalent Pfizer booster within days of it becoming available. Moderna wasn’t available, even though we had Moderna shots all the other times. The CDC said that either Pfizer or Moderna would suffice, regardless of which we got before. It’s interesting that Pfizer came out with a bivalent version when the monovalent version was more effective. Go figure. Maybe they decided that people had been anticipating a bivalent version, so they didn’t want to create confusion.

    Our rationale for getting boosted was that the bivalent vaccine might help and that the risk was minuscule. So, our cost-benefit analysis came out as a probable net benefit, however small. We’re both 65 or over, which also was part of the calculus. Side effects: slightly sore arms for two days. No noticeable systemic effects. Fewer side effects than with the prior doses.

  10. I’ll be getting my bivalent (and fifth) COVID vaccination this week. My mother is over 90 y.o., and will get hers in a couple weeks. I’ll do whatever I can to avoid carrying COVID into her house or unwittingly exposing other family members. One nephew is undergoing chemotherapy for cancer and so is immunocompromised and in isolation.
    Mitigation, mitigation, mitigation.

    1. The bivalent we are getting here is different than the US one but good to get if you’re eligible. I’m only 3 months past my regular booster.

  11. Well I got the bivalent vaccine as soon as it was available (after two Pfizer shots plus two boosters), because I was giving lectures in a classroom of 170 students where no masks were required or worn. I was feeling bulletproof, but two weeks later I got my first Covid infection. Not from the class, as it turns out.

  12. Very bad vertigo immediately after driving home in bright sun and dark shade, right after the bivalent Pfizer booster. This may be an odd reaction or might be mere coincidence .

  13. Got my bivalent booster (Moderna’s) on Sunday, at my first opportunity. As with my first three vaccinations (I’m young enough to have only now qualified for a second booster) my only side-effect was soreness in my arm.

  14. “As of this writing, there exists no data on human subjects. All data on both the Moderna and Pfizer bivalent boosters have come from studies in mice.”

    The article doesn’t mention that there are two kinds of bivalent boosters: one adapted to omicron BA.1 and another one adapted to omicron BA.4/5. Concerning the former, as far as I know, there are (promising) data on human subjects. Concerning the latter, here are new results: “Exposure to BA.4/BA.5 Spike glycoprotein drives pan-Omicron neutralization in vaccine-experienced humans and mice”:

    By the way, a week ago I (52) got the bivalent Biontech/Pfizer Original/Omicron BA.1 vaccine as second booster, and my parents (80/81) got the same vaccine as second booster today. We’re still alive and well!

  15. I teach undergrads and I know at least one of my students was infected last semester. My courses involve a lot of one-on-one interaction over several hours. So I waited until just before the semester started and got the new vax.

    Based on my reading, Stempels is correct about flying. Airplanes have excellent air exchanges and passengers are not breathing stale recirculated air. I would still mask up on a plane due to the close adjacencies.

    Thank you for giving us another informed pov re vaccinations

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