Be Ready With Answers About Bivalent COVID-19 Boosters

Please see the FDA announcement authorizing Moderna and Pfizer-BioNTech Bivalent COVID-19 Vaccines for Use as a Booster Dose in Younger Age Groups.


You’ll need to clear up confusion about updated COVID-19 boosters.

All boosters of Pfizer-BioNTech for patients age 12 and up and Moderna for 18 and up are now bivalent...with 2 mRNA components.

They’ll still cover the original SARS-CoV-2 virus...but also Omicron BA.4/BA.5, the variants currently circulating.

Explain that human data for COVID-19 vaccines with Omicron BA.1...and animal data with BA.4/ a better immune response against Omicron versus another original monovalent booster.

If you give COVID-19 vaccines in-house, evaluate whether patients are eligible.

Offer a bivalent COVID-19 booster to all patients age 12 and up who finished the primary series or got a booster at least 2 months ago...regardless of the number of prior boosters they’ve had.

Give whichever age-appropriate bivalent booster you have in stock.

But keep in mind, UNvaccinated patients still need a PRIMARY series with the original vaccines first...before a bivalent booster.

Encourage boosters in eligible patients...especially at higher risk of severe COVID-19 (age over 65, immunocompromised, etc).

But it’s okay if a lower-risk patient prefers to wait a bit for the booster...such as 3 months after a COVID-19 infection.

For now, tell patients they need ONE bivalent booster...additional boosters aren’t recommended, even for immunocompromised patients.

Educate to expect side effects similar to the original monovalent vaccines...the total antigen dose is the same.

Limit product and dosing mix-ups. Reinforce not to rely on cap color to differentiate vials...and to closely read the label.

For example, Pfizer-BioNTech COVID-19 vials for age 12 and up have gray caps and labels for the primary series AND bivalent booster.

And Moderna’s bivalent booster has a dark blue cap...just like monovalent Moderna vials for 6 months to 5 years and 6 to 11 years.

Consider ways to differentiate vials...stickers on caps, etc.

Also be aware, Moderna’s primary series for kids 6 to 11 may say “booster doses only”...since they used to be monovalent adult boosters. Mark these “kids 6 to 11” until products with correct labels arrive.

Post our resource, COVID-19 Vaccines, for dosing, storage, etc.

Key References

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Hospital Pharmacist’s Letter. October 2022, No. 381001

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