You’ve heard, by now, that a new bivalent vaccine is available to Oregonians right now, developed to target not only the original COVID-19 strain but also newer variants. Those looking to book an appointment can find their nearest vaccine site at vaccines.gov or at getvaccinatedoregon.gov. But with questions remaining about timing, side effects, and more, we asked Dr. Dawn Nolt, an expert in infectious disease at Oregon Health & Science University's School of Medicine, to answer some of ours.

When is the best time to get the new bivalent vaccine?  

The short answer: now. That is, unless you’ve had COVID-19 in the past three months, received another vaccine, booster or otherwise, in the past two months, or never received any vaccines at all. “What I would advise people is if it’s been more than three months from their last infection or their last vaccine, I think it’s a good time to get the bivalent,” says Nolt.

But if you’re aiming for peak immunity during peak virus season, is it true that these vaccines work less well after a particular period of time?

Yes, with the previous vaccines, immunity waned after a few months. But, as Nolt points out, that didn’t mean they suddenly stopped working altogether. “They still really had good immunity against and protection against serious disease and  hospitalizations and death,” she says. “So I would say that we don't know the best protection time after the boosters, but I think it'd be best to just get it as soon as you can.” With so many questions unanswered, she cautions against trying to game it out in any way. “I wouldn't try to time it,” she says. “I would just get it whenever you are eligible to.”

Is it a good idea to get your booster with your flu shot, or should we keep ’em separate?

Nolt says there’s no reason to avoid getting your vaccines together in terms of how effective they are. “You’re not going to have a decrease in response to either vaccine if you got the other one at the same time, “ she says. And there can be reasons to do both, like convenience, less time spent driving, etc. However, she says, you can get a small ramp up in the side effects. “Anytime you get more than one vaccine at a time, whether it's COVID, flu, or children when they get more than one vaccine at a time, we would expect maybe a little more reaction. Maybe your arm would be a little more sore or you might feel a little crummy for a few hours more than if you had gotten the vaccines separately,” she says.

Speaking of side effects, what can we expect from this bivalent shot?

 So far, says Nolt, it appears that side effects generated by the bivalent vaccines are on a par with their monovalent predecessors, or even less reactogenic (setting off a reaction). “The first dose any of us ever got was probably the one that was going to give the least reaction,” she says. “The second or the third dose, those can get you a little more inflamed, because your body knows what to do … but it seems that the bivalent is no worse and probably less reactogenic than the second and third doses. So we don't expect the side effects to keep climbing up—they seem to level off or even go down.”

What if you’ve never had a booster or even an original COVID vaccine? Should you go straight to the bivalent?

Nolt says that regardless of what booster you are on, the bivalent is recommended next. However, if you have not had your primary vaccination series, the advice is different. “We want you to lay your foundation down by getting your primary, and once that foundation is laid it's a good strong foundation, but you can always bolster it up a little bit by getting the bivalent [later]. We want you to wait at least two months between whatever your last dose is and the bivalent, and but yes, we need to have your primary series done.” 

So after this booster goes in, what’s next? Another booster in three months?

According to Nolt, the CDC is trying to reduce the number of shots to one a year. “Every time a new variant ... comes around they know that the immune response blossoms and seems to be able to encompass more variants, if that makes sense,” says Nolt. “Because we know that the monovalent vaccine or booster, which was originally targeted to the original strain, continues to provide protection with subsequent variants. So now that we have two of them, maybe we can get protection more broadly. And I'm hoping, and I think the CDC hopes, that the next time they need a booster it's not till fall next year.”

Anything else you think people should know?

Nolt advises people not to forget that beyond vaccines, other measures have a role to play in keeping people healthy, including masking up and keeping away from people if we’re sick or they are sick. She also warns that in the southern hemisphere, which has a respiratory season that precedes ours by six months, they have been seeing serious flu viruses circulating. “That's why we're emphasizing to get both your flu and your COVID vaccine,” she says, adding that due to the lack of exposure to the flu in recent years, people don’t have the naturally boosted immune response they might normally have. “So if you get flu, your baseline illness may be increased. So it’s really important to get yourself vaccinated against the flu.”