New COVID shots: Five things to know after CDC’s approval 

Americans will be able to receive an updated COVID-19 vaccine as early as Wednesday after the Centers for Disease Control and Prevention (CDC) endorsed the shot for all Americans over 6 months old. 

The new shots from Moderna and Pfizer-BioNTech will hit the market just as the U.S approaches the fall and winter respiratory virus season. They arrive along with new treatments to protect infants and older adults from respiratory syncytial virus (RSV).

Here's what to know:

The vaccine protects against current variants

Like all the other COVID-19 vaccines, the updated version is not designed to prevent infection completely, but is meant to reduce the severity of symptoms and curb the risk of "long COVID."

The updated shots were designed to target the XBB.1.5 variant, which was dominant when vaccine makers began to formulate and test a new version. 

That variant is no longer dominant and only accounts for about 3 percent of cases. But experts and administration officials have said the vaccines should still be effective at preventing severe infection against other variants that are circulating. 

A CDC expert said Tuesday that every variant circulating at any significant level is from the XBB lineage. That includes EG.5, the most prevalent variant responsible for more than 21 percent of U.S. cases, according to the CDC. 

Recently, vaccine manufacturers have also said the shots provide protection against the BA.2.86 “Pirola” subvariant. There was some concern that Pirola might cause more infections because it's highly mutated, but new studies have shown this is not the case.

The shots will be available at major pharmacies 

Both CVS and Walgreens will have vaccines available in the coming days, following the CDC endorsement.

"Eligible individuals can schedule appointments immediately following CDC recommendation, with available appointments starting nationwide on Monday, September 18," Walgreens' chief medical officer Kevin Ban said in a statement, adding that "earlier appointments may be added on a rolling basis as stores receive vaccines this week."

A spokeswoman for CVS said doses should be arriving this week. 

The demand is unclear

Just because the vaccine was recommended for every American doesn't mean that people will be rushing out to get it.

In the past year, only about 20 percent of adults received the bivalent booster shot, and experts have said they don't expect much difference with the newest version.

COVID-19 cases and hospitalizations are steadily rising, but the numbers are far below where they were at the height of the pandemic. Infections are not surging, and hospitals are far from being overwhelmed like they were at the height of the pandemic.

More than 95 percent of the U.S. population already has some level of COVID immunity, whether it’s from vaccination, infection or both. 

However, vaccines are most effective in people who are older and with weaker immune systems because of underlying conditions. According to a CDC presentation on Tuesday, most people who had been hospitalized since Jan. 2023 did not receive a bivalent booster.

Some people may have to pay

This is the first time the federal government isn't buying and distributing the shots, because the public health emergency expired in May. The COVID vaccine is now commercialized, just like the flu shot and other vaccines.

That puts the burden of ordering shots on hospitals, physician offices and pharmacies, and on the public for paying for it. 

CDC's recommendation followed the endorsement of its expert advisory panel, which should make the vaccines free for most consumers who have private and government-sponsored insurance.

There could be barriers for the estimated 25 to 30 million people without insurance. Without discounts, Pfizer said its shot will cost $120 a dose, Moderna said it will charge $129 a dose, and Novavax will charge $130 a dose. 

Uninsured or underinsured Americans will have access to free shots as part of the Biden administration’s “Bridge to Access” program, which will keep a limited supply of vaccines and therapeutics on hand to distribute free through state and local health departments, as well as pharmacies. The program is meant to be temporary, and will expire in December 2024.

The Department of Health and Human Services said vaccines will be available under the program as early as this week, rather than October as was initially forecast.  

Vaccines likely will be updated annually 

The Biden administration is refraining from calling the updated shots a booster, likely reflecting a concern that much of the public is vaccine-fatigued and has moved on from pandemic worries. Instead, it is being marketed as an annual shot, just like the flu vaccine.

People who are immunocompromised may receive an additional dose at least two months after getting the new shot.

“Barring the emergence of a markedly more virulent variant, the FDA anticipates that the composition of COVID-19 vaccines may need to be updated annually, as is done for the seasonal influenza vaccine,” the Food and Drug Administration said Monday.