Moderna president says 4th COVID-19 shot is probably only necessary for older and immunocompromised people

• Older adults or immunocompromised people probably need a fourth COVID-19 shot, Moderna President Stephen Hoge said Monday.
• Young, healthy people may opt out, depending on what outcome they're trying to prevent, Hoge said.

Two years into the pandemic, pharmaceutical executives are divided over whether additional COVID-19 shots are necessary for everyone.

Pfizer CEO Albert Bourla told CBS's "Face the Nation on Sunday that a fourth dose, or second booster shot, was indeed necessary, since a third dose doesn't protect well against infections and immunity wanes quickly. COVID-19 vaccines still offer strong protection against hospitalization and death.

But Moderna President Stephen Hoge told Insider on Monday that people can be more selective about boosters from now on.

"For those who are immune-compromised, those who are older adults, over the age of 50 or at least 65, we want to strongly recommend and encourage [a fourth shot], the same way we do with flu vaccines," he said.

He pointed specifically to people with cancer, for whom vaccines can be less effective.

"For those who have cancer, COVID can actually be a life-threatening disease, even post-vaccination. I don't think you want to mess around with that," Hoge said.

The rest of the public can decide whether they'd like to pursue a fourth dose, he said.

"Is it necessary? I think that's a strong word. I think it will provide a benefit to anyone who gets it," Hoge said.

"Whether or not public health continues to recommend it for everybody is a more complicated thing, because not everybody's wanting to get the first couple ones," he added.

At a White House press briefing last month, Dr. Anthony Fauci also said the need for fourth dose might depend on age or underlying health conditions.

"I don't think you're going to be hearing, if you do, any kind of recommendations that would be across the board for everyone," Fauci, the director of the National Institute of Allergy and Infectious Diseases, said. "It very likely will take into account what subset of people have a diminished, or not, protection against the important parameters such as hospitalization."

Hoge said he personally intends to get an annual booster to protect against the long-term side effects of COVID-19. Many COVID-19 patients report lingering symptoms such as fatigue, difficulty breathing, sleep problems, headaches, muscle pain, or changes in taste or smell, which can last several months or more.

"I personally will get a booster every year because I don't want to ever lose my sense of smell," Hoge said, adding, "Long COVID sounds nasty."

COVID cases could get 'gnarly' again next winter, Hoge said

Hoge said he thinks COVID-19 is both endemic and seasonal from here on out. He expects cases to decline in the spring, then rise again in the fall around the time kids go back to school.

"In December, it'll look little bit gnarly, like the flu, and then it will go back down. That is the seasonal picture for all the endemic [human] coronaviruses," he said.

The wild card, he added, is if another variant like Omicron poses an even greater challenge to our current vaccines. Hoge said he expects to see more variants of concern — strains that make the virus more transmissible, more capable of causing severe disease, or more resistant to vaccines and treatments — in the future. But he's hopeful that those variants won't be more dangerous than the ones we have now.

"I think that's reasonably likely that it will be related to Omicron or Delta," he said.

"The only thing I'm pretty sure that we're not going to face this fall is Omicron," he added, "because it would just seem a bad strategy for the virus to stop evolving."

Moderna's ideal booster targets more than one coronavirus strain

Both Pfizer and Moderna are studying boosters that specifically target Omicron in clinical trials. But Moderna is also looking at a bivalent vaccine, meaning the vaccine would target both Omicron and the original version of the virus.

Hoge said Moderna is seeing better durability over six months with a bivalent vaccine.

"We pretty strongly believe that the bivalent booster is the right answer for 2022," he said, adding, "I think if you get it in the fall, it'll provide at least six months, maybe more like nine months, of good protection."

Some vaccine experts remain skeptical of whether bivalent vaccines are the most effective, since only one coronavirus strain tends to dominate at a time. But Hoge said the goal is to "create the broadest immunity against all the circulating strains."

Moderna Chief Medical Officer Dr. Paul Burton told NBC News last week that the company's bivalent vaccine could enter human trials in the coming weeks.

The fallback option is to roll out either an Omicron-specific booster or another dose of the original vaccine, Hoge said. But Moderna is optimistic that a bivalent booster could be available this year.

"Our goal is to work with regulators to get it out for the fall," Hoge said, adding, "We have six months now, so we should be able to do it."