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Vaccination is especially important for those who have a greater risk of developing serious complications from viruses like COVID-19. This includes people living with underlying medical conditions, like autoimmune and inflammatory rheumatic diseases (AIIRD), that may weaken the immune system due to disease or medications. Because of that, researchers are looking into understanding the patient perspective on receiving vaccines.

During the 2022 annual meeting of the American College of Rheumatology (ACR) Convergence, research on vaccine hesitancy uncovered the concerns of rheumatology patients who had not yet received the COVID-19 vaccine. Their primary worry revolved around the lack of available long-term safety data. Furthermore, the research revealed that among those who had received the initial vaccination but had not yet received a booster dose, the most prevalent reason cited was the absence of a recommendation from their health care provider.

Now, a new study, presented at ACR 2023, titled “COVID-19 Vaccine Uptake, Hesitancy, and Flare in a Large Rheumatology Practice Network,” looks into the factors contributing to COVID-19 vaccine hesitancy among patients with rheumatic diseases. Additionally, it explores the risk of disease-related flare-ups following vaccination in this population.

“We wanted to see what COVID-19 vaccine and booster uptake was like among patients with AIIRD compared to patients without these conditions, and what possible reasons for vaccine hesitancy might be,” says study author Kelly Gavigan, MPH, Director of Data Management and Analytics at the Global Healthy Living Foundation (GHLF). This data holds significant relevance because individuals with AIIRD “are at a greater risk of infection in general as well as COVID-19 related complications because of their conditions and the medications they take to treat their conditions,” she continues.

The study focused on rheumatology practices who were members of the Excellence Network in RheumatoloGY (ENRGY) practice-based network who treat patients with autoimmune and inflammatory rheumatic disease.

About the Study

Study participants completed a tablet-based survey that included questions about COVID-19 vaccine status and why they might not receive a vaccine or booster. Based on their answers, they were then asked more questions about why they did not get a vaccine, or their plans to get additional shots. This information was then analyzed to understand the differences between vaccination status and vaccine/booster hesitancy while also comparing AIIRD to non-AIIRD patients.

Key Findings on Vaccine Hesitancy

Out of the more than 61,000 participants in the study, 89 percent reported having received at least one dose of the COVID-19 vaccine, and 68 percent reported having received at least one booster shot.

Patients with AIIRD were found to be 32 percent less likely to have received the initial vaccine dose and 10 percent less likely to have received a booster shot compared to individuals without AIIRD. Among those who expressed hesitancy, their concerns primarily centered around safety (28 percent) and potential side effects (23 percent). The primary reason for booster hesitancy among this group was the absence of a recommendation from their health care provider.

It’s important to note that not all individuals who initially expressed vaccine hesitancy remained hesitant. Among those who were initially hesitant about receiving the vaccine, 12 percent ultimately went on to receive a dose, and for those who were initially hesitant about getting a booster shot, 39 percent later reported receiving one.

Gavigan encourages open conversation between patients and their providers about vaccination. “It’s important for patients with AIIRD to speak with their doctor about their vaccine concerns,” she says. “Among the people who were booster hesitant, the top concern was that they had not been told by their doctor to get a booster dose, so it’s also important that doctors are initiating these conversations with their patients as well.”

Key Findings on Disease-Related Symptoms Post Vaccine

The researchers also aimed to better understand the patient experience following a vaccination, specifically whether the vaccine triggered any disease-related symptoms. Among those who received the COVID-19 vaccine, 23 percent reported experiencing a flare-up of their disease. The study’s findings also revealed that there were no heightened odds of a flare-up or worsening symptoms observed, regardless of whether individuals had a rheumatic disease or not.

“It was encouraging to see from this data that AIIRD patients did not have an increased likelihood of reporting a flare or worsened disease activity after receiving a COVID-19 vaccine or booster compared to non-AIIRD,” says Gavigan, noting that concern about the vaccine causing a flare was a top concern among people who were hesitant about getting the vaccine.

What This Means for You

Research like this provides important information to improve future vaccination efforts to better understand and protect patients.

Talk to your doctor if you have questions about vaccine safety or efficacy. “Shared decision-making with your doctor is very important when it comes to vaccines among AIIRD patients,” says Gavigan. “It’s important for the patient and the doctor to talk through the pros and cons, the concerns, and the data so that a decision is made that is informed and best suits the needs of that unique patient.”

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In big vaccine news this week, fall COVID-19 boosters will be available in the coming days. The U.S. Food and Drug Administration (FDA) gave the green light to the updated Moderna and Pfizer/BioNTech vaccines for COVID-19. The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts who guide vaccination recommendations in the U.S., also met to vote on recommendations for who should get the vaccines.  

On September 12, 2023, they met to review the COVID landscape and discuss clinical recommendations on who should consider an updated COVID-19 vaccine, especially focusing on specific groups like immunocompromised and older individuals.  

Dr. Mandy Cohen, Director of the Centers for Disease Control and Prevention (CDC), also acknowledged the other viruses circulating this season and our preparedness level. “We are in a different place than we were in the beginning of the pandemic, we are in our strongest position to fight COVID as well as flu and RSV,” said Dr. Cohen, during the meeting. “We have tools against all three of these virus pathogens.” 

For many of us living with chronic illnesses or weakened immune systems, the threat of a COVID-19, flu, and RSV feels especially close to home. Being informed about the latest COVID vaccination updates and trends in data can help you work with your care team and support system to stay protected.  

FDA Approvals and Authorizations

A day before the ACIP meeting, the FDA gave updated approvals and authorizations for the mRNA COVID vaccines: 

• Individuals 5 years of age and older regardless of previous vaccination are eligible to receive a single dose of an updated mRNA COVID-19 vaccine at least 2 months since the last dose of any COVID-19 vaccine.
• Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of an updated mRNA COVID-19 vaccine (timing and number of doses to administer depends on the previous COVID-19 vaccine received).  
• Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated authorized Moderna COVID-19 vaccine.

The ACIP voted in line with the FDA updates above and recommended: 

• Everyone ages 5 and older is recommended to receive one dose of a 2023–2024 mRNA COVID-19 vaccine. 
• Children ages 6 months to 4 years should complete a multi-dose initial series (two doses of Moderna or three doses of Pfizer-BioNTech mRNA COVID-19 vaccine) with at least one dose of the 2023–2024 COVID-19 vaccine. 
• People who are moderately or severely immunocompromised should complete a two-dose initial series with at least one dose of the 2023–2024 COVID-19 vaccine and may receive 1 or more additional 2023–2024 COVID-19 vaccine doses at least two months after. 
• Bivalent mRNA COVID-19 vaccines are no longer recommended in the United States. 

Here is a look into the data and discussions that took place to get to this decision. 

Available data from the COVID-19 vaccine manufacturers presented at the meeting included clinical trial data (on 101 randomized patients) for the Moderna vaccine and preclinical data (on mice) for the Pfizer-BioNTech vaccine. Conclusions from the data found that the monovalent XBB containing COVID-19 vaccines increases the immune system response again the currently circulating variants and no new safety concerns were identified. 

In the ACIP meeting, a question arose about the Novavax vaccine and what we can expect with authorization for that vaccine. The FDA spokesperson said we know there is interest in alternative to mRNA vaccines and we look forward to potential authorization of the updated vaccine.  

The original Novavax COVID-19 vaccine remains authorized for use as a two-dose primary series. It can be given as a booster in limited situations to: 

• People ages 18 and older who previously completed primary vaccination using any FDA-approved or FDA-authorized COVID vaccine 
• Have not received any previous booster dose(s) 
• Are unable or unwilling to receive an mRNA vaccine and would otherwise not recieve a booster dose 

The bottom line: We are waiting for the FDA to review and potentially authorize the 2023-2024 Novavax vaccine.  

The Current Landscape of COVID

Dr. Natalie Thornburg, lead research microbiologist at the CDC, reviewed the U.S. data from May 27-September 2, 2023 and shared that greater than 90 percent of the circulating viruses are all XBB lineages. While COVID-19 burden is currently lower than at previous points in the pandemic, the absolute number of hospitalizations and deaths is still high.  

Hospitalizations Among Those with Underlying Conditions

The data presented showed that hospitalization rates across all groups have been rising steadily since July 2023. Fifty four percent of children hospitalized had underlying conditions with the most popular being premature, neurologic disorders, and asthma. 

The COVID-NET data from January-June 2023 shows that for adults, rates of hospitalizations were highest among adults older than 75. The most prevalent underlying conditions among adults ages 18 and older hospitalized for COVID include cardiovascular disease, neurologic disorders, diabetes, obesity, asthma, and chronic lung disease.  

Long COVID

As part of the landscape of COVID discussion, long COVID was addressed. The data reviewed showed the prevalence of long COVID was highest among 35 to 49 –year olds. Other noteworthy data points: 

• One in four people  with long COVID symptoms report significant activity limitations  
• Groups associated with a higher likelihood of developing long COVID: 
  • Female sex 
  • Older age 
  • Severity of COVID-19 illness 
  • Underlying health conditions prior to COVID-19 infection 
  • Lower socio-economic status 
  • Did not get COVID-19 vaccine 

• There is accumulating evidence that COVID-19 vaccination reduces post-COVID conditions among both children and adults 

Vaccine Effectiveness in Immunocompromised

During the section of the meeting that focused on COVID-19 vaccine effectiveness, the reviewed data showedthat people who are immunocompromised may have reduced protection after COVID-19 vaccination, compared to those who are not immunocompromised. This aligns with seen in the data throughout the pandemic, where COVID vaccine effectiveness has been lower and waned more quickly for adults with compromised immune systems compared to adults without immunocompromise.  

Because of this, immunocompromised may be able to get additional doses of the vaccine to bolster immune response. 

“In individuals who are immunocompromised, the protection of prior vaccines and infections wanes overtime, and they become susceptible to severe disease again,” says Amesh A. Adalja, MD, FIDSA, FACP, FACEP, Senior Scholar, Johns Hopkins Center for Health Security. “This new vaccine can help enhance immunity to continue protection against severe disease.”  

What This Means for You

For those with compromised immune systems, it’s recommended to get the new COVID vaccine as soon as it’s available. Dr. Adalja points out, “a person can get the RSV vaccine today, the COVID vaccine next week, and the influenza vaccine in October.” While it’s generally advisable to wait until October for the flu shot to ensure coverage throughout the season, should scheduling challenges arise, all three vaccines can be administered together. But, Dr. Adalja warns, anticipate “a sore arm.”

Most critically, your vaccination decisions should be in alignment with the guidance from your health care provider, especially if you’re on specific medications. “People should consult their rheumatologist about the timing,” urges Dr. Adalja. “Ideally, there should be a gap of about four months since their last booster or infection to derive the maximum benefit from the vaccine.”

To find a COVID-19 vaccine near you, visit https://www.vaccines.gov/. With the end of the public health emergencies, it is important to double check your insurance coverage and make sure you are getting the vaccine in network. 

If you are uninsured, there are CDC programs to get vaccinated: 

• Uninsured children will be able to receive COVID-19 vaccines through the existing Vaccines for Children (VFC) program 
• Adults who are uninsured or underinsured will be able to receive no-cost COVID-19 vaccines through the temporary Bridge Access Program for COVID-19 Vaccines 

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If you’re high-risk for severe COVID-19, here’s promising news: The U.S. Food and Drug Administration (FDA) has amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 bivalent mRNA vaccines to make a booster available for high-risk groups.

Those who are 65 years of and older who have already received a single dose of the bivalent vaccine (which was created to target Omicron variants of the COVID-19 virus) may receive an additional dose at least four months after the initial bivalent dose.

Those with weakened immune systems can get the additional dose two months after the first dose. After that, they can receive additional doses based on intervals their doctors recommend. For immunocompromised children ages 6 months to 4 years, eligibility for additional doses will depend on the vaccine they previously received.

Data show that almost all of the U.S. population age 5 and older have antibodies as a result of either vaccination or infection against SARS-CoV-2.

The second bivalent dose for those 65 years of age and older is supported by data showing the waning of immunity in this population over time and its replenishment by the additional dose. Previous studies have also shown that immunocompromised individuals may require additional doses, per the FDA.

Individuals who are eligible for the extra boosters may be able to get them as soon as this week, per The Washington Post. As a next step, vaccine advisers for the U.S. Centers for Disease Control and Prevention (CDC) are scheduled to discuss the second booster today — and it’s expected that CDC Director Rochelle Walensky will approve quickly.

There are two updated bivalent boosters: one from Moderna and one from Pfizer. While they are mRNA vaccines like the original vaccines, which teach your body to make protein that triggers an immune response, they are different in that they have messenger RNA that codes for the original SARS-CoV-2 strain and the omicron BA.4/BA.5 lineages. For more on this, here’s everything you need to know about the bivalent Omicron booster.

A January CDC report found that the updated bivalent shots decreased the risk of infection from the XBB.1.5 subvariant, which is currently causing most cases in the United States, by nearly half. Meanwhile, a recent study in The Lancet found that they reduced the risk of hospitalization in people 65 and older by 72 percent. More research is needed to determine the effects of receiving two doses of the bivalent booster.

The amendment also stated that the initial mRNA vaccines (monovalents) are now retired in favor of the updated bivalent shots. That means anybody who is unvaccinated will receive a single updated shot going forward.

So far, only 16.7 percent of the U.S. population has received the updated (bivalent) dose, compared to 69.4 percent of the population that completed the initial primary series, per the U.S. Centers for Disease Control and Prevention.

If you believe you may be eligible for a bivalent booster, talk to your doctor. Staying up-to-date on vaccines can help you lower your risk of severe COVID-19, even if you’re immunocompromised.

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If you’ve felt overwhelmed juggling the COVID-19 shots and various boosters you need as an immunocompromised individual over the past few years, good news may be ahead: Vote by vote, experts are working toward a more simplified vaccine strategy.

Recently, members of the U.S. Food and Drug Administration’s vaccine advisory committee unanimously voted on a proposal to make all future COVID-19 vaccines interchangeable. Whether you’re getting your first dose or a booster, the vaccines would all have the same formulation to target the same viral strain or strains — regardless of who the manufacturer is, per NPR.

“This vote was to ensure that boosters and primary series are aligned,” says infectious disease physician Amesh A. Adalja, MD, a Senior Scholar at Johns Hopkins Center for Health Security. “[The idea] is to change the formulation of the primary series so that it includes BA.4 or BA.5 [omicron subvariants], and not just the ancestral strain. It wasn’t a very big surprise — I think most people knew that the ancestral strain of the virus is really extinct.”

The vote was unanimous at 21-0. Of course, each manufacturer will still have a different list of ingredients since each company has its own technology, but the vaccines will all target the same viral strain or strains.

Experts believe this is one step toward creating an annual COVID-19 shot for most Americans. In another proposed new plan, an annual vaccine dose would be matched to circulating strains of the SARS-CoV-2 virus, similar to the flu shot, per STAT News. Two doses would be given to immunocompromised individuals, older people, and children.

However, the FDA has not held a panel vote on this proposed plan yet.

“There still needs to be a lot more discussion about what the best strategy is, because COVID and the flu are two different viruses and vaccines,” says Dr. Adalja. “It shouldn’t be that they force COVID vaccinations into a flu vaccine paradigm. There are still a lot of questions.”

For instance, there may be some people who don’t need any new doses of the COVID-19 vaccine each year because they’re protected against severe disease, adds Dr. Adalja. Meanwhile, there may be some people who need an annual shot and some people who need two annual shots.

“I don’t think it should be a one-size-fits-all,” says Dr. Adalja. “It should be tied to an individual person’s risk for severe disease.”

Eventually, a simplified vaccine plan that experts agree on could make it easier for Americans — especially those who are high-risk and in need of multiple shots — to stay up-to-date with their vaccines. Currently, only 15 percent of Americans are vaccinated with the updated booster dose, per the U.S. Centers for Disease Control and Prevention.

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In two new studies presented at ACR Convergence 2022, the annual meeting of the American College of Rheumatology, a team of researchers hone in on two important topics: vaccine hesitancy in autoimmune patients and priority research topics for vaccine uptake in this group.  

We spoke to a few of the researchers from the Global Healthy Living Foundation for their key takeaways from these studies — and what they mean for you.  

COVID-19 Vaccine Uptake and Reasons for Hesitancy in Rheumatology Patients

Key Takeaways

• Most rheumatology patients who have not been vaccinated against COVID-19 cite not enough long-term safety data — or that they’re planning to wait and see if it’s safe — as reasons for not getting the jab. 
• For those who have been vaccinated but have not received boosters, the most common reason cited was that they had not been told by their doctor to get an additional dose. 
• Keeping an open line of communication with your doctor about your questions and concerns, while checking your sources of information for credibility, is key to understanding the benefits and risks of vaccines.  

Many rheumatologists and other providers are concerned about sub-optimal COVID-19 vaccine uptake by patients with autoimmune conditions. That’s understandable, given adults living with autoimmune disease have nearly twice the risk of vaccine-preventable infections compared to the general population.  

Because of that, researchers wanted to better understand which patients are receiving vaccines and why some are not. To do so, they surveyed a large sample of patients from a network of 101 rheumatology practices in a new study. A tablet-based, electronic survey was used to collect answers from 86,540 patients between September 2021 and June 2022.  

 Patients were asked to provide: 

• COVID-19 vaccine status for both the primary vaccine series and vaccine booster 
• A time estimate on when they planned to start or complete their vaccination series
• Reasons why they might not receive their COVID-19 vaccine or booster 

Of the patients surveyed, 76 percent reported that they had been fully vaccinated with the primary series (meaning they either received two COVID-19 shots or the one-dose Johnson & Johnson vaccine). Seventy percent of fully vaccinated patients said they had received the booster.  

Another 2 percent reported being partially vaccinated (meaning they still had a shot remaining in their primary series) and 6 percent said they had not received their first vaccine yet, but planned to. The remaining 16 percent of patients noted that they did not intend to get a COVID-19 vaccination at this time.  

 Reasons for this varied, but most patients cited concerns about vaccine safety or side effects. The patients who didn’t plan to receive the primary vaccine series provided for COVID-19 vaccine hesitancy gave these responses: 

• Not enough long-term safety data/plan to wait and see if it’s safe: 34% 
• Concerned about side effects: 24.8% 
• Concerned the vaccine will cause a flare of health condition: 13.6% 
• The vaccine could give me COVID-19 infection: 10.1% 
• I don’t believe I need a vaccine or another dose: 7.2% 
• I don’t trust COVID-19 vaccines: 6.8% 
• The vaccine may not be effective for people like me: 2.6% 
• I am concerned that the COVID-19 vaccine could modify my DNA: 0.4% 
• I am concerned that the COVID-19 vaccine might affect me being able to have healthy children: 0.4%  

“Because patients, including me, are so scared about going into a flare, providers need to anticipate patient fears and provide possible solutions to them in advance,” says study author Shilpa Venkatachalam, PhD, Director, Patient-Centered Research Operations and Ethical Oversight, at the Global Healthy Living Foundation, who has inflammatory arthritis. “Tell the patient, for example, ‘If you do go into a flare, here is our plan of action.’” 

To address the effectiveness and safety of the vaccine, providers sometimes tell patients we don’t have enough data quite yet — and this transparency is important. But they may also be able to encourage patients to understand how the vaccine took years of research and development, which could surprise some hesitant patients.  

“They can talk about how the vaccines went through a rigorous safety screening process and how it took over 10 years to research this [mRNA] technology,” says Dr. Venkatachalam. “How we communicate risk to patients is really important.”  

For instance, before the COVID-19 pandemic, an mRNA flu vaccine was already in clinical trials, per Penn Medicine.  

Providers can also remind patients to get their COVID-19 vaccine booster. Among study participants who cited hesitancy in receiving the booster, concerns about safety (21 percent) and side effects (15 percent) were still noted, but the biggest reason cited was that they had not been told by their doctor to get an additional dose (33 percent).  

What This Means for You

If you’re concerned about the safety or effectiveness of the vaccine, go to your doctor with a list of your specific questions and concerns. Diseases act differently in every patient, so conversations about benefits and risks need to revolve around your specific situation (how active your disease is right now, if you’re experiencing a flare, etc.), adds Dr. Venkatachalam.  

You might find comfort in speaking with other people living with autoimmune diseases who have gotten vaccinated — and ensure you’re avoiding misinformation online by going to credible sources to get facts, like the U.S. Centers for Disease Control and Prevention or the World Health Organization. If someone tells you something about a vaccine that sounds troubling, be sure to ask for their source.   

And finally, even if your doctor hasn’t recommended a COVID-19 booster, ask about it. Most people with an autoimmune disease would benefit from the extra layer of protection a booster provides.  

Priority Research Topics for Vaccine Uptake Among Adults with Autoimmune Conditions

Key Takeaways

• Patients, patient advocates, clinicians, researchers, policy makers, regulators, and vaccine manufacturers rank how well a vaccine works for adults with autoimmune conditions as a top research priority.
• Patients and patient advocates also prioritize research around how myths or misinformation about vaccines affect vaccine uptake.
• Topics prioritized by key stakeholders can inform future research efforts to decrease vaccine hesitancy and improve the uptake of relevant vaccines for adults with autoimmune conditions. 

Adults living with autoimmune disease are a high-priority vaccination group, which is why Global Healthy Living Foundation researchers wanted to prioritize topics for future patient-centered research in a new study that will be presented at ACR.  

The ultimate goal: to reduce vaccine hesitancy and increase the uptake of vaccines for conditions like pneumococcal pneumonia, influenza, zoster, human papillomavirus, and SARS-CoV-2 (the virus that causes COVID-19) among adults with autoimmune conditions.  

Researchers brought together a steering committee of a dozen clinicians and patients representing rheumatic diseases (psoriatic arthritis, rheumatoid arthritis, and vasculitis), inflammatory bowel disease, and multiple sclerosis. The members identified 33 vaccine uptake and hesitancy research topics through a literature review and iterative discussions.  

“Part of what we talked about in iterative discussions is that there are individual-level concerns and there are system-level concerns,” says study author Ben Nowell, PhD, Director, Patient-Centered Research, at the Global Healthy Living Foundation. “We tried to make sure we were casting a wide enough net to represent most of the types of research questions or concerns in this area.” 

Next, a larger group of 34 stakeholders. including patients and patient advocates; clinicians and researchers; and policy makers, regulators, and vaccine manufacturers. rated each topic on a nine-point scale in two separate rounds. The first round included 33 topics and the second round included 34 topics, after one of the raters proposed an additional topic.

Overall, six topics were rated as critical by more than 90 percent of stakeholders:   

• How well a vaccine works for adults with autoimmune conditions  
• How beliefs about vaccine safety affect vaccine uptake  
• How myths or misinformation about vaccines affect vaccine uptake  
• How trust in the health care system/provide affects the uptake of vaccines 
• How barriers to health care access affects vaccine uptake
• How vaccine safety profile affects vaccine uptake 

In particular, the group of patients and patient advocates unanimously rated three topics as critical: 

• How myths or misinformation about vaccines affect vaccine uptake 
• How source of information about vaccines affects vaccine uptake 
• How perceived transparency of information about vaccines affect vaccine uptake 

“Patient and patient advocacy group are aware of what patients are hearing about vaccines and how those myths and misinformation affect whether they ch0se to get a recommended adult vaccine,” says Dr. Nowell.  

These topics can inform future research efforts to decrease vaccine hesitancy and improve the uptake of relevant vaccines for adults with autoimmune conditions. 

“It’s valuable to make sure the patient perspective is reflected in the peer-reviewed literature,” says Dr. Nowell, “especially at a conference like ACR where there are thousands of providers and researchers from around the world.” 

What This Means for You

Talk to your doctor if you have questions about myths or misinformation regarding vaccines, transparency of information about vaccines, or any other topic that’s keeping you from getting vaccinated. Remember, if you’re living with an autoimmune disease, you’re in a high-risk group for vaccine-preventable infections. 

Plus, you’re not the only one with questions: These topics are top priorities that other patients and patient advocates want to address, too. (Read our latest resources on COVID vaccine news and information here.) Researchers are hopeful that future studies will take these concerns into account and eventually provide solutions to reduce vaccine hesitancy and increase the uptake of vaccines in this high-risk group.  

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A new study has found that three doses of the Moderna or Pfizer COVID-19 vaccine are highly effective at preventing hospitalization due to COVID-19 in patients who are taking immunosuppressive drugs — providing further reason to get fully vaccinated, even if you’re immunocompromised.

The findings, published in The Lancet Rheumatology, were based on data collected from 168,414 electronic health records and immunization data. Three percent of the study population (5,609 people) were taking immunosuppressive medications.

Patients who were taking immunosuppressive DMARDs or glucocorticoids — or who had a history of organ or bone marrow transplantation — had a higher risk of hospitalization due to COVID-19 than the general population. However, the findings show that Pfizer and Moderna vaccines analyzed still remain very effective within this group.

In patients receiving immunosuppressants, three doses of the Pfizer vaccine had an effectiveness of 50 percent in preventing COVID-19 and three doses of the Moderna vaccine had an effectiveness of 60 percent. Notably, three doses of either vaccine had an effectiveness of 87 percent against hospitalization due to COVID-19 in these patients.

This rate of effectiveness for immunosuppressed individuals against hospitalization is similar to the 92 percent effectiveness found in immunocompetent individuals who receive two doses and a booster, note the researchers.

“This might seem surprising given immunogenicity studies showing lower antibody levels after vaccination in immunosuppressed individuals,” says lead study author Malcolm Risk, MA. “However, we would note that these individuals also have a weakened immune system at baseline, so antibody levels might not directly reflect change in level of overall immune protection, which is what vaccine effectiveness measures.”

In other words, antibody levels are not the only measure of immune protection. (Read more on what you should know about antibody testing if you’re immunocompromised, and why experts don’t necessarily recommend taking these tests yourself.)

Most of the prescriptions for glucocorticoids in the data were for prednisone (73 percent). Given the limited sample size, the researchers did not assess medications individually.

It’s also worth noting that this study reported on the effectiveness of two full doses and the half-dose booster of the Moderna vaccine (the primary doses and booster shots of the Pfizer vaccine, on the other hand, are all full doses). Policy announcement regarding a three-dose primary series for immunocompromised individuals — in this case, three full doses make up the primary series, which is then followed by a booster or fourth shot — came months after most vaccinated people actually received their primary series. Because of that, very few individuals in the study’s data followed this course of treatment, but rather received “boosters.”

What This Means for You

The study results demonstrate the importance of getting vaccinated and getting subsequent boosters as they become available.

“There have been a lot of concerns about vaccine effectiveness among immunosuppressed individuals, but our results indicate substantial effectiveness, particularly in terms of preventing hospitalizations,” says Risk. “Vaccines are particularly important for this group, as they are at much higher risk than immunocompetent individuals prior to vaccination.”

Remember, there is a new COVID-19 booster available now designed to help restore protection that may have waned since your last vaccination and to target variants that spread and evade immunity more easily.

Need to get your flu shot, too? Here’s how to time your latest COVID-19 booster and annual flu shot. 

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The time of year in which the flu season collides with COVID-19 activity in the United States is quickly approaching. But luckily, you have tools to protect yourself as an immunocompromised patient: the new bivalent COVID-19 booster shot, updated in an effort to guard against newer variants, and your annual flu shot.  

While the spread of COVID-19 has become more manageable and predictable since its onset, the disease is still taking its toll and causing imaginable hardship for many.  

This summer, COVID-19 has caused the death of 40,000 Americans, per The New York Times — and while hospitalizations are shrinking (they’ve declined by 14 percent over the past two weeks), more than 400 deaths are still reported per day on average. That’s more than twice the daily deaths seen in a high-activity flu season.  

As the spread of COVID-19 and the seasonal flu coincide, it’s important to take every step available to you to protect yourself. A key part of that: Staying up to date on your vaccines.   

How to Time the COVID-19 Booster and Flu Shot

Now that you have two vaccines on your to-do list, let’s start with the timing for the flu shot.  

Signs for the flu shot typically go up in pharmacies in August, but if you haven’t gotten yours yet, don’t worry: Many experts recommend getting your flu shot in October so the protection lasts through the months of February (when flu usually peaks in the United States), March, and April.  

“August and September really are too early to get the flu shot,” says William Schaffner, MD, professor of infectious disease at Vanderbilt University Medical Center. “Rather, aim for some time in October or drifting into those first couple of weeks in November, before Thanksgiving. That’s when we should all make time to get our flu vaccine.”  

If, for whatever reason, you can’t get your flu shot until later in the season, don’t abandon it altogether. It can still offer protection during the flu activity later in the season. 

“If you find yourself in December without a flu shot, run — do not walk — to get your flu vaccine,” says Dr. Schaffner. “It’ll take about 10 days for it to have its full effect.” 

Secondly, consider the new COVID-19 bivalent booster: The U.S. Food & Drug Administration (FDA) authorized bivalent formulations of the vaccines (bivalent means a vaccine works by stimulating an immune response against two different antigens) for use as a single booster dose at least two months after a primary or booster vaccination. Just as with the flu shot, now is a great time to get your latest COVID-19 booster. 

“The COVID-19 vaccines, including boosters, continue to save countless lives and prevent the most serious outcomes (hospitalization and death) of COVID-19,” FDA Commissioner Robert M. Califf, MD, said in a statement. “As we head into fall and begin to spend more time indoors, we strongly encourage anyone who is eligible to consider receiving a booster dose with a bivalent COVID-19 vaccine to provide better protection against currently circulating variants.” 

Boosters will give you more protection heading into the colder months, especially if you’re immunocompromised. And as we’ve seen in previous years, COVID-19 activity may very well tick up this fall and winter. 

“If you skip the vaccine, you and your loved ones are at higher risk for infection and complications,” says Richard Zimmerman, MD, Vice Chair for Preventive Medicine Research at the University of Pittsburgh. “I would seek a COVID-19 bivalent booster as soon as possible.” 

It’s important to get both shots, because the flu shot does not provide protection against COVID-19 (and vice versa). You can get both the flu shot and the COVID-19 booster at the same time to save yourself an extra trip to the pharmacy.  

If you’ve been infected with COVID-19 recently, the U.S. Centers for Disease Control and Prevention (CDC) recommends waiting 90 days before you receive a booster shot for a better immune response. Reinfection is less likely in the weeks or months after infection. That said, certain factors like personal risk of severe disease or local COVID-19 spread could be reasons to get a booster as soon as you’re eligible to, per Yale Medicine. If you have questions about timing your COVID-19 booster, talk to your doctor.   

Potential Side Effects of the COVID Booster and Flu Shot

According to the FDA, commonly reported side effects of the bivalent vaccine are similar to what you might experience with the flu shot, including:

• Pain, redness, and swelling at the injection site
• Fatigue
• Headache
• Muscle pain
• Joint pain
• Chills 

However, the chance of experiencing side effects after receiving both shots at the same time is similar or only slightly higher than when receiving the COVID-19 vaccine alone, per research presented at a CDC Advisory Committee on Immunization Practices (ACIP) meeting.  

“It’s perfectly okay to get them both, though you may get two sore arms for a day or so,” says Dr. Schaffner.  

If you’re concerned about that, you may opt to get your COVID-19 booster and flu shot a day or two apart. However, you should only do this if you can commit to returning to the pharmacy for your second vaccine.  

“There’s an old adage that the vaccine deferred is often the vaccine never received,” says Dr. Schaffner. 

If you opt to get both vaccines at once, your clinician will likely opt to give one shot in each arm (rather than doubling up on one arm). “You can get them in the same arm, but then they have to be separated by an inch or inch and a half,” says Dr. Schaffner. “Most inoculators would prefer to give one in each arm — they think that’s more secure.”   

The shots need this separation to avoid the vaccines interfering with each other in the immune cells that are in and beneath the skin. Injecting them an inch or so apart helps the immune system “see” each vaccine separately and respond optimally to it.  

How the New COVID-19 Booster Is Different

The CDC recommends getting the updated COVID-19 bivalent booster from Pfizer (for those ages 12 and older) or Moderna (for those ages 18 and older). Although these booster shots are from Pfizer and Moderna, you can still receive them if you got a Novavax or Johnson & Johnson primary series. 

“I have already received the bivalent COVID booster, as has my wife and two of our children,” says Dr. Zimmerman. 

Also known as “updated boosters,” the bivalent COVID boosters contain the original SARS-CoV-2 strain and another strain common between the BA.4 and BA.5 lineages of the omicron variant, per the FDA. The Ba.4 and Ba.5 lineages of the omicron variant are causing the most COVID-19 cases in the U.S. right now and are predicted to circulate the fall and winter. 

The current vaccine formula is an effort to help restore protection that may have waned since your last vaccination and to target variants that spread and evade immunity more easily. More research will be needed to confirm how these boosters perform differently in real-world settings than the original vaccine, but for now, many experts agree that these boosters are most important for those at high-risk for severe COVID-19 infection.  

The original Pfizer and Moderna vaccine formulations can no longer be used as boosters, though they’ll continue to initiate the vaccination series for those who haven’t received a jab yet, per The University of Texas Medical Branch.  

It’s worth noting that in a recent opinion piece for the The Wall Street Journal, FDA Vaccine Advisory Committee member Paul A. Offit, MD, said it makes sense to boost those at greatest risk of hospitalization with COVID-19 — but that experts should be careful about overselling the bivalent vaccine as something better than the existing vaccine until more data are available.  

In other words, the new COVID-19 booster shot isn’t a cure-all for managing the spread of the virus this winter and may not be necessary for everyone. However, if you’re immunocompromised, it can be one more important tool in your arsenal to protect yourself.  

“Once we all go indoors in the winter and it gets chilly, we do expect COVID-19 to surge again — not nearly the way it has in the past, but there will probably be an upswing this winter,” says Dr. Schaffner.  

Why the Flu Shot Is Important

Everyone who is six months of age and older should get an influenza (flu) vaccine every season, with rare exceptions, per the CDC. Vaccination is especially important for those who have a greater risk of developing serious flu complications, which includes people with a weakened immune system due to disease or medications, adults 65 years and older, and those who are pregnant.  

“My family is vaccinated every year to protect ourselves and to protect our loved ones,” says Dr. Zimmerman. “We have a family member with cancer and none of us wants to be the one to bring the flu to them. If you skip the vaccine, you and your loved ones are at higher risk for infection and complications.” 

For this flu season, the CDC and ACIP have recommended particular types of flu vaccines for those ages 65 years and older that may be more effective. “Seniors should receive a second-generation vaccine, such as Flublok, Fluad, or high-dose Fluzone,” says Dr. Zimmerman. “These vaccines appear to work better in seniors than do older, standard vaccines. They induce a stronger immune response against the virus.” 

It’s true some medication may impact how well the flu shot works, but that doesn’t mean you should skip it or stop taking your meds to get it. If you are unsure about when to get the flu shot with your current treatment, talk to your rheumatologist or pharmacist.

It’s difficult to predict the severity of an upcoming flu season, but data from the southern hemisphere (which had its winter during our summer) shows that flu activity may be high this season. 

“Australia had a moderately severe flu season,” says Dr. Schaffner. “There’s not always a correlation, but if there’s anything that gives a note of caution, that should be it — and should, if we need more motivation, give us resolve to get immunized against influenza.”   

Other Precautions to Take if You’re Immunocompromised

Both the flu and COVID-19 can coincide with pneumonia, an infection of the lungs that may cause mild to severe illness. Both the COVID-19 and flu vaccines can help prevent infection by some of the bacteria and viruses that can cause pneumonia, per the CDC.  

Your provider may also recommend the pneumococcal vaccine (in particular, pneumococcal conjugate vaccines PCV15 or PCV20) if you’re 65 years or older or if you’re age 19 through 64 with certain medical conditions or risk factors, according to the CDC. If you receive PCV15, it should be followed by a dose of the pneumococcal polysaccharide vaccine (PPSV23).  

CDC data showed that in the United States during 2018, 1.5 million people were diagnosed with pneumonia in an emergency department and approximately 44,000 people died from it. 

But like COVID-19 and the flu, pneumonia is preventable — largely by getting vaccinated, but also by other healthy living practices. Overall, you can avoid respiratory infections this winter by washing your hands regularly, cleaning and disinfecting surfaces that are touched a lot, limiting contact with cigarette smoke or quitting smoking, and managing medical conditions like asthma, diabetes, or heart disease. 

Also speak to your doctor about preventive medication like Evusheld, which can be taken before exposure to COVID-19 and may provide an extra layer of protection for those who didn’t mount a full immune response to the vaccine.  

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On August 31, 2022, the U.S. Food and Drug Administration (FDA) authorized the use of updated boosters, which target both the original strain of the COVID-19 virus as well as the omicron variant.

While COVID vaccines generally do an excellent job of preventing severe illness and keeping people out of the hospital, they do not guarantee that you won’t get COVID at all. That’s partly because the original COVID vaccines were made to combat the strain of the virus that was most prominent in 2020, and the virus has been mutating very quickly. Additionally, the immunity you get from a COVID vaccine seems to wane over time. 

The updated boosters, which are also called bivalent vaccines, are expected to offer broader protection against breakthrough infections (which occur in people who have been vaccinated). They should also further reduce the risk of developing serious complications.

Additionally, getting an updated booster will extend the period in which you’re most protected. The most recent guidance from the White House suggests that most people get the updated booster soon — along with a flu shot — and then start getting both a flu and COVID vaccine each fall.   

How Do the New Omicron Boosters Work?

The FDA has authorized two updated boosters: The Moderna COVID-19 Vaccine, Bivalent and the Pfizer-BioNTech COVID-19 Vaccine, Bivalent. The Moderna product is authorized for use in adults age 18 and older; the Pfizer-BioNTech one can be used in kids as young as 12.  

As with the original Moderna and Pfizer-BioNTech vaccines, the updated boosters are mRNA vaccines. These kind of vaccines do not include any part of the COVID virus itself; rather they contain instructions that teach your body to make a protein or piece of a protein that triggers an immune response. That prompts your body to make antibodies against the virus so it’s better equipped to fight it if it’s later confronted with it.  

The updated boosters contain mostly the same ingredients as their original (monovalent) versions; the only change is that these new (bivalent) ones have messenger RNA that codes for the original SARS-CoV-2 strain as well as for the omicron BA.4/BA.5 lineages.  

Other ingredients include lipids (fats) that help the vaccine move into cells; salts that help balance acidity; and sucrose (sugar), which helps the molecules retain their shape when frozen.  

What Are the Possible Side Effects?

As with older COVID vaccines, possible side effects of the updated boosters may include pain, redness, and swelling at the injection site. Some people may also experience fatigue, headache, muscle pain, chills, nausea, or fever. Remember that you cannot get COVID from the vaccine/booster itself.    

How Effective Are the Updated Boosters?

Scientists believe that the updated boosters will provide better protection against COVID than the older boosters, but it’s hard to say for sure just how much of an edge they will offer. Firstly, no one knows how long Omicron will be the predominant variant. It’s also worth noting that these updated COVID boosters — unlike their predecessors — are being rolled out despite lack of testing on humans. 

Of course, these shots are highly similar to the original vaccines, which have been thoroughly vetted for safety and effectiveness and already given to millions of people. But the rush to get updated boosters ready for this fall meant that manufacturers only had time to directly test them on mice. The manufacturers also analyzed clinical trial data (on humans) from a similar vaccine that targeted the original omicron strain (BA.1).  

“The FDA has been planning for the possibility that the composition of the COVID-19 vaccines would need to be modified to address circulating variants,” the agency explained. “The FDA has extensive experience with strain changes for annual influenza vaccines … The public can be assured that a great deal of care has been taken by the FDA to ensure that these bivalent COVID-19 vaccines meet our rigorous safety, effectiveness and manufacturing quality standards for emergency use authorization.” 

Who’s Eligible for an Updated Booster?

If you’re at least 12 years old, don’t have an active COVID infection, and it’s been at least two months since you had any booster, you’re eligible for the new (bivalent) booster. You don’t have to wait because you recently had COVID, but if you want to postpone for three months from when your symptoms started or you tested positive, that’s OK, according to the CDC. “People who have had recent COVID will have been exposed to the current circulating strains and likely have at least partial protection for a few months,” explains Michael George, MD, MSCE, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania. 

To make it easier to figure out when it’s time to get boosted, the CDC has developed a simple tool that allows you to enter the following: 

• Your age 
• Whether or not you have a weakened immune system 
• Which vaccines doses you had for your primary series 
• Whether or not you’ve had an updated booster 
• When you had your last COVID shot 

Based on this information, the tool will tell you if you should get an updated booster now or wait.

When in doubt, of course, consult your personal health care provider for guidance. “Exactly when you might want to get the bivalent booster may vary a bit from person to person, but since protection does wane over a few months you will still likely want to get the bivalent booster sometime this fall,” says Dr. George. 

How Can You Get an Updated Booster?

The updated (bivalent) boosters are rolling out right now. To find one in your area, visit vaccines.gov or consult your local pharmacy. If you have trouble getting an appointment, check back in a few days as supply should ramp up quickly.   

What to Know if You’re Immunocompromised

Vaccines and boosters are especially important for people with a weakened immune system. If you have an autoimmune or rheumatic disease and/or take a medication that reduces your ability to fight infections, you’re more likely than average to contract COVID and develop serious complications.  

The CDC’s “find out when you can get your booster” tool factors in whether someone is immunocompromised. It’s also wise to touch base with your health care provider. But assuming it’s been at least two months since you had a COVID booster and you don’t have an active COVID infection, chances are eligible for the updated booster now.  

“I’m recommending that everyone who is eligible obtain either shot, unless they had a significant reaction or rheumatologic disease flare after previous COVID-19 vaccine doses,” says Angus B. Worthing, MD, FACP, FACR, Clinical Assistant Professor of Medicine at Georgetown University Medical Center in Washington, DC. “Those people can probably utilize Evusheld, or in case of infection use antiviral treatments on an individual basis as needed.” 

Also note: 

• Although most people will start getting COVID boosters annually, those who are immunocompromised might need boosters more often. Stay tuned for more info from public health officials and your health care provider.
• Ask your doctor if you need to pause any of your regular medications before and/or after getting the booster. The American College of Rheumatology has issued guidance about holding specific medications; it is periodically updated. 
• Ask your doctor if it’s advisable for you to get the flu shot at the same time. Public health officials are encouraging many people to get the updated COVID booster and the flu shot at the same time.  

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The best way to reduce the risk of becoming severely ill with COVID, aside from staying away from those who are infected, is to get vaccinated and stay on top of recommended boosters. If you’re immune-compromised, getting a preventive monoclonal antibody treatment (Evusheld) is also a good idea. (Double check with your doctor.) But you may be surprised to learn that vaccines designed to fight other types of respiratory infections might also give your immune system a little boost in the fight against COVID.  

Although vaccines are developed to combat a specific virus or bacteria, scientists have long suspected that they may boost the immune system in a broader way that translates to some added protection against other pathogens. This kind of protection is most likely to kick in when it comes to germs that are related (for example, those that are respiratory viruses).  

Recently, two different studies have found that people who were given the BCG vaccine, which protects against tuberculosis (TB), were less likely to get sick with COVID.  

These findings hardly mean that you should run out and get the TB vaccine, cautions Robert Popovian, PharmD, Chief Science Policy Officer at the Global Healthy Living Foundation (GHLF). For starters, COVID-specific vaccines protect far better against COVID. Plus, the TB vaccine isn’t routinely given in the U.S. 

That said, these studies are interesting, as they suggest there might be a role down the line for using the TB vaccine in combination with COVID vaccines, perhaps to bolster stronger protection or to extend the time that protection lasts. A lot more research is needed before we get to that point, however, says Dr. Popovian. 

The first study, published in Cell Reports Medicine, was a randomized trial of adults with type 1 diabetes. Ninety-six people were randomly assigned to get the TB vaccine; another 48 were assigned to get a placebo. Fifteen months later, 12.5 percent of those who got the placebo had contracted COVID, versus only 1 percent of those who had gotten the TB vaccine.  

The other study, published in Frontiers in Immunology, focused on older adults in Greece with underlying health issues like heart or lung disease. About 300 were randomly assigned to get the TB vaccine or a placebo; the researchers found that those who had gotten the TB vaccine had a 68 percent relative reduction in the risk of getting COVID.  

While these findings are interesting, they don’t directly prove that the TB vaccine protects against COVID. The studies were fairly small — COVID vaccine trials, for comparison, have included tens of thousands people — says Popovian, plus we don’t know what other protective measure (such as social distancing) those in the study might have been taking.  

Additional studies on this topic are already underway, including a large study that will follow health care workers in several countries.  

The most interesting information we have so far, says Popovian, is the fact that the TB vaccine might offer some longer-lasting protection against COVID. The research published in Cell Reports Medicine suggests that the TB vaccine might offer some protection for several decades. 

“COVID is mutating so quickly; people are blaming the lack of efficacy on the [COVID] vaccine, but the problem is the mutation rate of the virus,” he says. “Long-term, the [TB] vaccine might have potential because it has longer-lasting effects.” 

While getting the COVID vaccine is crucial, the TB vaccine — pending outcomes of future studies — could one day be used in combination with it to further reduce serious complications. “The death rate from COVID is very low right now, but more people are still dying annually from COVID in this country than they are from breast cancer,” says Popovian.  

How exactly the TB vaccine might help with COVID isn’t totally clear. But the authors of the Frontiers in Immunology study explained that two immunological processes, called heterologous T-cell immunity and trained immunity, might be responsible.  

“Heterologous T-cell responses often rely on antigenic mimicry [imitation], and recently, it has been suggested that heat shock protein 65 from BCG has sequence similarities with S-protein from SARS-CoV-2,” they wrote. Trained immunity, they added, refers to changes to the innate immune system that lead to “an increased antimicrobial activity of host defense mechanisms.” 

What This Means for You

Most people living in the U.S. do not need the TB vaccine at this time, but it’s still important to stay on top of this research and future studies that follow. In the meantime, make sure you’re working with your health care provider to stay up to date on all recommended vaccines, including the flu, pneumonia, zoster (shingles), and COVID vaccines. Read more about new vaccination guidelines for people with rheumatic disease.  

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If you’re immunocompromised, you know the breadth of calculations that comes with getting boosted for vaccines or medication.

Take the COVID-19 vaccine: First, you may need to get a three-dose primary series for an mRNA shot, rather than a standard two-dose series. Then, you need to follow it up with multiple boosters at the correct time intervals and perhaps schedule your medication around it. (Here’s everything you need to know about the fifth COVID-19 dose.)

Needless to say, it can start to feel complicated quickly. However, there may be a future in which vaccines release a bump in protection whenever you need it, without the need for an extra jab.

Researchers at the Massachusetts Institute of Technology (MIT) have developed microparticles that could one day create self-boosting vaccines, per a new study published in the journal Science Advances and funded by the Bill & Melinda Gates Foundation. 

How the Microparticles Work

Think of these microparticles as coffee cups: They have lids that, when opened, can spill out coffee (or, in this case, drugs).

“We have a hole or cavity at the center of these particles that enables us to fill it with various therapeutic particles such as vaccines — but also other types of medications,” says Morteza Sarmadi, PhD, lead author of the study. “Basically, we end up with a storage cell that protects the therapeutic cargo at the center.”

The vaccine material is dried and combined with sugars and other stabilizers before being added to the cups. These mini “cups” are made with various polymers, or substances, that break down at different rates. You’ve probably already seen polymers like these used in other medical applications, like dissolvable stitches, per MDedge.

At a certain point, the lids would break and the vaccine within would be released. Scientists could determine the release time of the vaccine by the polymer they choose, since some materials take longer to break down than others. It could be days or months after the initial injection.

Researchers are still looking for ways to make the vaccine material more stable once it’s released, since the environment around the cups becomes more acidic as the particles open up (which could damage the often pH-sensitive drugs within). This will be an important part of preserving very sensitive vaccines.

How It Could Benefit the Immunocompromised

The original intent of this technology was to eliminate the need for multiple visits to health care providers in developing countries, where poor health care infrastructure can pose a challenge for adherence to multiple-dose vaccines. But having one-shot technology could benefit those in developed countries as well — particularly the immunocompromised or those living with chronic disease.

For instance, self-boosting vaccines could offer more protection to those who may not get high antibody responses from one dose of the COVID-19 vaccine. (More research is needed to determine how the timing of immunosuppressive medications like rituximab would work with these vaccines, says Sarmadi.)

But the benefits go beyond COVID-19: This technology could be used for a wide range of medications, which would save an immense amount of time and effort for those with chronic disease who require regular doses.

“In general, this is a platform technology, meaning it has a broad range of applications,” says Sarmadi. “A lot of chronic diseases need daily or weekly treatments, and we envision that this system can be really helpful and could make a daily treatment a monthly one, for example.” More research is needed to determine this type of application.

When Self-Boosting Vaccines Will Be Available

The research team plans to test self-boosting polio and hepatitis vaccines in animals with bodies similar to human bodies.

“The next step for this technology is to test these particles in large, non-human primates to make sure they are safe and advantageous,” says Sarmadi. “If this technology is successful, then there is a huge opportunity to move it into phase 1 clinical trials in humans, and then move on to phase 2 or phase 3.”

The researchers are also looking into the potential of self-boosting mRNA vaccines in smaller animal models.

When taking animal tests and clinical trials into consideration, technology like this is likely still about five to seven years from going to market, says Sarmadi. However, it provides an exciting glimpse of a future in which vaccines, cancer therapies, hormones, and biologics can be delivered in an efficient way that reduces trips to the doctor’s office — and ideally, increases adherence to and protection from prescribed drugs or vaccines. 

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