In just about six weeks, new COVID booster shots—designed to target the many permutations of the omicron strain, including the pervasive BA.4 and BA5 subvariants—should be rolling out in Oregon and nationwide. 

That means state and local public health officials are gearing up now for another widespread vaccination campaign, the fourth such go-around for a pandemic-weary medical workforce and the public. 

Vaccination remains by far the indisputable best defense against serious complications from and hospitalizations for COVID-19. And Oregonians have complied: About 76 percent of the state’s residents got at least an initial dose of a COVID vaccine, according to the Oregon Health Authority.

But uptake decreased after that. Only 40 percent of Oregonians have received a single booster shot, though everyone over the age of five is eligible to do so. (A second booster shot is currently reserved for those 50 and over, and the immuno-compromised.) 

But in the last two and a half years, COVID has changed considerably, giving way to the delta wave, which in turn yielded to the will-it-ever-end omicron wave. In other words, the original vaccines, while still incredibly good at keeping people out of the hospital, are no longer as effective at preventing either transmission of the currently circulating version of the virus or of getting a comparatively mild illness as a result.  

That’s why the federal government has ordered nearly 170 million doses of reformulated booster shots from Pfizer and Moderna, with a goal of rolling them out by mid-September, to buffer immunity against any cold-weather surges. 

In Oregon, state epidemiologist Dr. Dean Sidelinger says that details are still being worked out, but that it is likely that pending CDC recommendations, any fall booster campaign will begin with a focus on the elderly and the most vulnerable, like those living in congregate care settings. 

“I think we would probably see an emphasis on those who are more vulnerable to complications to get this additional protection, then likely a roll-out more widely,” Sidelinger says. 

The giant mass vaccination clinics that accompanied the initial vaccine rollouts in early 2021 are unlikely to return, Sidelinger says, in part because the public demand likely won’t merit that, and in part because medical personnel are already stretched thin and staffing clinics on that scale would be a challenge. Instead, the state is likely to rely on a mix of smaller-scale, walk-in vaccine clinics sponsored by OHA like those already up and running in Beaverton, Wood Village, and Eugene, plus pharmacists and individual family doctors. 

Another wrinkle this fall is that it will be time again for people to receive their flu vaccine, which could happen at the same time as a COVID booster, Sidelinger says, though insurance coverage, timing, and individual willingness to do both at once will all have to align. 

BA5 has cut a wide swath through Oregon this summer, with about 6 percent of Oregonians currently infected or recovering, according to estimates from Oregon Health & Sciences University, though daily case counts have fallen about 22 percent over the last two weeks, and hospitalizations have also started declining. 

That means many people will go into the fall with some level of acquired immunity, which could make booster shots a tougher sell for them. Sidelinger cautions that it’s not clear how long that acquired immunity will last. After all, reinfections with BA5 among those who were previously infected with the original strain of omicron are becoming increasingly common. 

“We know that the protection following infection, as COVID has continued to evolve, isn't that robust or long lasting,” he says. “By the fall, even someone who's recovered [from BA5] could still be susceptible, and likely we will be recommending that they get a booster as well.” 

Maybe the biggest unknown is what form COVID takes next—what comes after BA5? The next mutation isn't clear, though researchers are keeping an eye on yet another omicron subvariant, this one circulating in India, though it hasn’t gained much of a toehold against BA5 in the United States. Ultimately, with COVID seemingly headed toward endemicity—it won’t ever go away, but can be controlled with vaccination, therapeutics, and other interventions—fall boosters could become a regular occurrence. 

“I think with we won't see this eradicated anytime soon,” Sidelinger says. “It’s like we will still have some sort of a booster,” in fall of 2023—we'll know more, he says, after the effects on this fall's coming booster campaign on hospitalization levels and COVID-caused deaths get clearer.