While many Americans are trying to get on with their lives two years after the COVID-19 pandemic, U.S. health officials are debating the best way to use a vaccine to stay ahead of the coronavirus.

A panel of U.S. vaccine experts met Wednesday to discuss key questions about future COVID-19 booster campaigns. The FDA’s vaccine advisers won’t make any binding decisions during the virtual meeting, but their recommendations could shape the administration’s approach for years to come.

Dr. Peter Marks, the FDA’s vaccine chief, told reporters last week that it wouldn’t be surprising if the agency authorized another booster dose in the fall to protect most Americans from the latest coronavirus mutation. He warned at the start of Wednesday’s meeting that waning vaccine protection, new variants and colder weather could increase the risk of more surges later in the year.

“All of this together leads us to conclude that a general discussion of booster vaccination against COVID-19 is warranted at this time so that we can potentially intervene,” Marks said.

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Some of the key questions discussed by the group:

How should the US decide when to launch future rounds of boosters? Who should get them?

Last week, the FDA authorized additional Pfizer or Moderna vaccines for anyone 50 or older and some young adults with severely compromised immune systems. This is an effort to get ahead of another possible surge.

Only about half of Americans who were eligible for a third shot got one. Some independent experts disagree about the need for additional protection even in healthy individuals because of limited evidence for this benefit or how long it might last.

The last American wave was driven by the omicron variant. Federal scientists reported that during that surge, two doses were nearly 80 percent effective against needing a ventilator or death, while a booster boosted that protection to 94 percent. In the U.S., COVID-19 cases have fallen to low levels, but health officials are cautiously watching the omicron siblings, who now account for the majority of cases.

read more:
Who really needs a second COVID booster?Here’s what to know
FDA approves another Pfizer, Moderna COVID booster for those 50 and older

What is the process for updating vaccines to deal with new variants?

All COVID-19 vaccines now in use in the U.S. are based on the original coronavirus version that emerged in late 2019. Updating a vaccine will be a complex task requiring coordination between the FDA, manufacturers and global health authorities.

The process of updating the annual flu vaccine provides a possible model for dealing with mutations. The FDA panel is expected to discuss the advantages and disadvantages of taking this approach.

Twice a year, World Health Organization experts recommend updating flu vaccines to target emerging strains. The FDA then submits the recommendations to its own vaccine panel, who vote on whether they make sense for the U.S., laying the groundwork for manufacturers to tweak the vaccine and begin mass production.

But COVID-19 has yet to settle into a predictable pattern like the flu. Vaccine makers may need more time to conduct additional research on their COVID-19 vaccines, which have a different record of safety and efficacy than flu vaccines.