The FDA is proposing a step up in annual COVID shots. Some experts worry that it is too easy, and too simple of a method

An FDA advisory committee is expected to discuss the possibility of a simplified COVID vaccination schedule—as well as the decision-making process on the composition of future boosters—on Thursday, according to a briefing document. posted by the federal agency.

But it may soon commit to an annual booster for everyone, some experts told Fortune. The virus has not fully settled into a seasonality pattern and may not. COVID spikes tend to occur in the winter, along with the flu, due to factors driving both, such as cold weather and increased indoor gatherings. But waves of COVID can and do occur throughout the year, as new variants emerge.

The timing of the waves aside, those at high risk of COVID—due to age and/or health conditions—may continue to need more frequent doses, they warn.

Dr. Amesh Adalja, an infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security, doesn’t think a “one-size-fits-all booster policy” is justified at this point in the pandemic. , he told Fortune .

“Not everyone is at equal risk,” he advises.

Dr. Michael Merson, visiting professor at New York University’s School of Global Public Health, agreed with Adalja that a blanket policy may not be the best approach. And it might not be the most cost-effective, he advises.

“Maybe we need to develop a strategy for the elderly and others who are most at risk of serious illness,” he recommended.

A World Health Organization paper published Wednesday in The Lancet encourages governments to develop strategies that promote vaccination, even for those who have experienced the disease. “Hybrid immunity” from vaccination and prior infection provides better protection against severe disease and hospitalization than immunity from prior infection alone, the researchers found.

Mass vaccination campaigns could be conducted before an unexpected annual surge, such as in winter, the paper’s authors suggested. They caution against creating nuanced vaccine guidance that is difficult to understand and may reduce uptake.

Moving to an annual booster is a logical next step, because the virus will be with us for the foreseeable future, Dr. Georges Benjamin, head of the American Public Health Association, told Fortune. Evidence shows that while antibody resistance against COVID begins to wane after five or six months, protection against hospitalization, severe illness, and death remains intact for a year for most.

In addition, “people are more likely to get vaccinated if we offer it every year,” he said, adding that some, including the immunocompromised, will need regular boosters.

Dr. Bruce Y. Lee, professor of health policy and management at the City University of New York School of Public Health, agreed with Benjamin, saying that getting everyone on board to receive multiple COVID boosters in one year would be endless. hard, otherwise. impossible, task.

But while the annual COVID booster is a laudable goal, there are many questions that need to be answered before work begins, Lee said. Among them: Can other vaccine technologies be used to provide better and longer-lasting protection? And how will an unexpectedly violent strain that requires an extra tailored booster be addressed?

“One of the ongoing issues throughout the pandemic is the lack of clarity and consistency in the message that’s been missing,” he said of the COVID vaccination guidance. “You don’t want to set expectations for the public before you know you can deliver.”

While the FDA may recommend switching to an annual vaccine, the US Centers for Disease Control and Prevention will make the final decision, Benjamin said.

The FDA committee met in April and June last year to consider the composition of what could be a booster of Omicron, which was launched in the US around Labor Day.

Soon, healthy Americans may need only one COVID vaccine each year, without the need for boosters in between, Dr. Ashish Jha, the White House’s COVID response coordinator, and Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said. in September.

“Without a different variant, we would likely go down a path with a vaccination cadence similar to the annual flu vaccine, with annual, updated COVID-19 shots paired with current circulating strains for the majority of the population,” Fauci said at the time.

The prediction was met with criticism by some public health experts, including Dr. Eric Topol, professor of molecular medicine at Scripps Research and founder and director of the Scripps Research Translational Institute.

“To give a false impression of year-round protection ([against] serious illness and death) with data at hand is unacceptable,” he said via tweet at the time.

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