You may have heard that there have been changes to the types and number of COVID-19 vaccine you need. And maybe you’re wondering, do I need another COVID-19 booster shot?

The quick answer is that current recommendations say that everyone should get a bivalent dose of the COVID-19 vaccine – but if you have one already, you probably don’t need another one.

Here's everything you need to know about the latest dosing recommendations, including when and if you need a bivalent dose.

What’s changed with COVID-19 vaccine recommendations

Spring 2023 brought many changes to COVID-19 vaccination guidelines. Most of these relate to the bivalent vaccine.

The bivalent COVID-19 vaccines were originally approved by the U.S. Federal Drug Administration (FDA) the Fall of 2022 as bivalent booster doses. But in April of 2023, the FDA made it so the bivalent vaccines can be used for all doses as a way "to simplify the vaccination schedule for most individuals."

As part of this update, the FDA changed their recommendations for the number of doses that people need. Based on the updated guidelines most people are fully vaccinated after a single dose of a Pfizer or Moderna bivalent vaccine. However, younger children, older adults and those who are immunocompromised may need additional doses of the bivalent vaccine.

So, it’s no longer a question about whether you’ve gotten your second booster, third booster or fourth. Instead, the question usually is: have you had a dose of the bivalent COVID-19 vaccine?

What is a bivalent vaccine?

The bivalent vaccine is a newer type of vaccine for COVID-19 that’s based on two strains of the coronavirus. There is a Pfizer bivalent vaccine and a Moderna bivalent vaccine.

So how are the bivalent vaccines different than previous COVID-19 vaccines? The answer is that older vaccines are monovalent instead of bivalent.

Monovalent vaccines include the first Pfizer and Moderna vaccines and the current Novavax and the Johnson & Johnson vaccines. The Pfizer and Moderna monovalent vaccines have been deauthorized, meaning that they’re no longer approved for use in the United States. Other monovalent vaccines may be available on a limited basis.

Monovalent vaccine vs. bivalent vaccines

So, what exactly does monovalent and bivalent mean? Both words describe the vaccine’s ability to provide immunological protection against the coronavirus.

The differences between the two words comes in the prefix (the first half of the word). “Mono” means one and “bi” means two. Monovalent vaccines are based on one strain of the coronavirus and bivalent vaccines are based on two strains.

The original COVID-19 vaccine (and booster shots) were monovalent and are only made with one strain of the coronavirus – the original Wuhan strain.

The bivalent vaccine is made with components from both the original Wuhan strain of the coronavirus and the Omicron strain to offer more protection against newer strains of the coronavirus. Specifically, the new bivalent boosters include components of BA.4 and BA.5, the subvariants of Omicron that currently account for the most COVID-19 cases.

Bivalent vaccines: The recommended choice

Currently most COVID-19 cases are caused the Omicron strain of the virus. So, it’s no wonder that that the bivalent vaccine provides increased protection against COVID-19 since it has been updated based on components of the Omicron virus.

According to February 2023 data from the Centers for Disease Control and Prevention (CDC), people with the bivalent booster were 1.4 times less likely to die from COVID-19 compared to those who had only received the monovalent vaccine. Compared to people who were unvaccinated, people who had gotten a bivalent dose were six times less likely to die.

Who can get the COVID-19 bivalent vaccine?

Everyone 6 months old and older can get a bivalent vaccine. But, you may not need another dose if you’ve already had one.

Most adults, teens and older kids only need one dose of a bivalent vaccine to be considered fully vaccinated. But younger children, older adults and people who are immunocompromised may need more than one bivalent dose.

Bivalent vaccine doses for adults

It’s recommended that all adults get one or more bivalent doses. You can get either the Pfizer or Moderna bivalent vaccine.

How many doses you need depends on your age and health. Most adults who have already receive a bivalent dose as a booster don’t need another bivalent dose. However, it’s possible you may need a bivalent dose if:

  • You’re over the age of 65 years old.
  • You’re immunocompromised.

Bivalent vaccine doses for children

Depending on age, vaccination status and health, your child may need one or more bivalent doses. Here’s what you need to about COVID-19 vaccines for infants, kids and teens.

  • 6-month-old to 4-year-olds: If your child received one or more monovalent doses, they should get the bivalent that matches their initial vaccine to complete their series.
  • 5-year-olds: If your child is 5 years old and received the Pfizer monovalent vaccine, they should get the Pfizer bivalent. But if they got the Moderna monovalent vaccine, they could get either the Pfizer or Moderna bivalent vaccine.
  • Kids ages 6 and older: Older kids and teens may get either bivalent vaccine.
  • Children who already had a bivalent dose: If your child already got a bivalent dose, they may not need another one. If you’re not sure if your child should get a bivalent dose, ask your child’s doctor.

Bivalent COVID-19 vaccine doses for people who are immunocompromised

For most people, receiving one dose of the bivalent COVID-19 vaccine causes enough of an initial immune system response to protect them from COVID-19.

But for people with weakened immune systems, one dose of the bivalent vaccine may not produce enough protective antibodies to prevent them from getting sick. In these cases, people may need an additional dose of the bivalent COVID-19 vaccine for greater protection.

You may be considered immunocompromised if you:

  • Had an organ transplant
  • Had stem cell transplants within the past two years
  • Have severe primary immunodeficiency
  • Are being treated for active cancer
  • Have advanced or untreated HIV
  • Are being treated with drugs that may suppress your immune system, such as high-dose corticosteroids

If you’re immunocompromised (or think you might be) make a primary care appointment to talk to your doctor.

Bivalent dose timing

The timing of your bivalent vaccine varies based on the type of vaccine, age and how it’s been used. Here’s the basic timing for some common situations:

  • When completing a child’s vaccination schedule: Timing is the same when using the bivalent vaccine to complete a vaccine series. So, if your child had an appointment for a second or third dose of a vaccine, keep that appointment. The bivalent vaccine will be given instead of the monovalent vaccine.
  • If you’re fully vaccinated: Wait at least two months after your last dose.
  • If you’re over 65 years old: You can get a second bivalent dose 4 months after your previous dose.
  • If you’re immunocompromised: You can get a second bivalent dose, given 1-2 months after your previous dose. Your doctor may also recommend additional bivalent doses based on your health.

Will you need a yearly bivalent vaccine?

There have been a lot of questions about whether you’ll need another COVID-19 vaccine in the future. For example, will you need an annual COVID-19 vaccine in the same way that you get a yearly flu shot? At this point, we simply don’t know.

The FDA and CDC are still determining the best way to ensure continued protection against the coronavirus. It’s possible that the FDA may recommend periodic COVID vaccine. But it’s also possible that the FDA may determine that no additional doses are needed.

Possible side effects of the COVID-19 bivalent vaccines

Do you remember the side effects that you had with your initial vaccine dose(s)? Chances are that your side effects will be very similar this time around. But there’s also a chance you’ll have fewer side effects if you were previously vaccinated or if you previously had COVID-19.

For most people, the common side effects are usually fatigue and feeling pain around where they got the shot. Less commonly, people experience headache, muscle pain, chills, fever and nausea. These side effects usually only last a couple days.

Monovalent vaccines: When they’re used

While the bivalent vaccines are more effective and considered the preferred option, the Novavax monovalent vaccine is a good choice for people who are unable or uninterested in getting a bivalent vaccine because it’s made with mRNA. Dosing is as follows:

  • Initial series for people 12 and older: Two doses, given 3-8 weeks apart.
  • Additional dose for people: 18+: One additional dose, given 6 months after initial series.

Does the need for bivalent doses mean that the original COVID-19 vaccine wasn't safe and effective?

Absolutely not. The need for bivalent vaccines is not a reflection of the safety and efficacy of the COVID-19 vaccines.

There’s no denying that monovalent vaccines saved countless lives during the pandemic – and continue to reduce the chance of severe illness. But it’s also true that current strains of the coronavirus are a lot different that the strain that the original vaccine was based on.

Since the new bivalent vaccine includes components based on Omicron variant, it should offer even better protection against the COVID-19 in your community.

How do you know if you’ve gotten a COVID-19 bivalent vaccine?

If you received a Pfizer or Moderna booster shot since the Fall of 2022, it was likely a bivalent dose. But if you haven’t received a booster, or your booster was earlier in 2022 or in 2021, you probably haven’t gotten a bivalent dose.

You should be able figure out which vaccines you got by looking your COVID-19 vaccination record card. HealthPartners can see which vaccines they got by viewing their “COVID-19 status” under “My Care” in the app or in online portal.

Get the best protection against COVID-19 with a bivalent dose

Since the COVID-19 vaccine has been available, the recommendations on the number and timing of doses you need for the best protection have changed over time. These changes are a good thing because as vaccine experts have learned more about the coronavirus and its variants, they've been able to make improvements.

If you have been putting off getting vaccinated, now is a perfect time since most people are fully vaccinated after one bivalent dose. And if you’ve already been vaccinated, getting a bivalent dose will help ensure the best protection against the current variants of the coronavirus.