Is the Novavax COVID Vaccine Really “better”?

This is the first time many people are hearing about Novavax , the fourth COVID vaccine in the US, but it has been authorized for use as the main vaccine series since early 2022. Previously, it was only available to those who had not received the vaccine. An mRNA vaccine is an alternative for those who were unable or unwilling to receive an mRNA vaccine. That news recently changed when the updated Novavax was approved for use in the U.S. as a booster shot for everyone 12 years of age and older, regardless of previous doses of mRNA. Since all COVID vaccines are now purchased directly from manufacturers rather than through the government, you’re also seeing ads for these vaccines for the first time, including Novavax. This has left many people wondering how Novavax is different, whether it is better than the mRNA vaccines, and how they could get it if they wanted it.

Like many immunocompromised people, I was extremely excited about this approval and hoped for its increased effectiveness. While researching this article, I was disappointed that there was not more scientific evidence to support the public’s expectations. It has been found to be a viable alternative to mRNA vaccines with approximately the same effectiveness and some potential extension in the future if properly mixed and matched with mRNA vaccines.

Novavax does some of the body’s homework during the vaccination process

Novavax is a protein adjuvanted vaccine, meaning that a protein and an additive are used to trigger an immune response in the body. In this case, moth cells were used to produce the protein, and the adjuvant was based on a chemical compound found in the bark of the soap tree ( isn’t that amazing from a scientific perspective? ).

The protein in the vaccine is the COVID spike protein, which itself does not cause COVID. The body sees the spike protein and (hopefully) begins to produce antibodies in response that will help your body neutralize the SARS-CoV-2 virus when your body encounters it in the future. Neutralize enough of the virus and you won’t get COVID-19. Even if you don’t neutralize enough to prevent COVID infection, each viral cell neutralized means a smaller viral load in your body, which is why vaccines reduce severe illness and hospitalizations.

The main difference between Novavax and the vaccines we’ve heard more about (Moderna and Pfizer, both mRNA vaccines) is that Novavax includes the fully formed spike protein, not just the mRNA that encodes it. The Moderna and Pfizer vaccines try to stimulate the body to make the spike protein itself, while Novavax skips that step and simply says, “Here you go, enjoy the spike protein, please tip your waiter.” (A third vaccine, from Johnson & Johnson, was canceled last year and has not been replaced.)

So is Novavax “better” than mRNA vaccines?

The most honest answer: “It’s hard to say yet.” Novavax’s first large real-world study suggests little difference between its effectiveness and that of Moderna and Pfizer. All three were created to combat XBB COVID strains, and none were tailored specifically for later strains such as Eris or Pirola , so there is no perceived advantage of one vaccine over another in terms of matching the circulating virus. A recent study found that during the Omicron wave, Novavax was about 55% effective in preventing symptoms and 28% effective in preventing infection overall, which is comparable to what we’re seeing with Moderna and Pfizer.

Another way to look at this question is to look at the efficacy rates provided by the FDA to issue emergency use authorization for the initial batch of vaccines. Since then, people have received boosters, been infected, been exposed, and sometimes mixed and matched those boosters and received more or fewer boosters, making it impossible to compare effectiveness with each other. Since COVID strains have also evolved through mutation, it can be argued that these numbers from the original series are also no longer relevant. For context, Novavax was 90% effective against infection overall, compared to 95% for Pfizer and Moderna (94.1%) . Notably, the effectiveness of Novavax was lower in the Hispanic population for unexplained reasons, as well as in the elderly population , especially at risk.

However, if you have never received a COVID vaccine and will only receive Novavax, it is 14 times better than not receiving the vaccine at all.

Getting a Novavax booster shot if you previously received the Pfizer or Moderna vaccines.

Instead of the original serial vaccinations, which are no longer available even in the old two-dose series , most of us are interested in booster vaccinations. This is why so many people are enthusiastic about Novavax: There has been some evidence that mixing and matching doses of the vaccine provides longer-lasting protection, so common logic might dictate that mixing the vaccine with an entirely different protein delivery system would be a good idea. .

What would be extremely useful right now is a study that showed efficacy against existing variants for people who received a Novavax booster dose on top of the primary mRNA series, compared to those who received an mRNA booster dose instead. There is a study currently underway in Australia that is looking at this issue, but the results won’t be available until 2025.

The most interesting data is this: A 2022 study found that a dose of mRNA followed by a dose of protein may have the best longevity of all. It was based on those who received the J&J vaccine and then later switched to the mRNA booster. While this information won’t benefit you now if you’re about to get Novavax for the first time, it may benefit you the next time you get your booster shot if you switch back to mRNA.

How is the Novavax experience different?

One of the reasons many people are interested in Novavax is the possibility of fewer side effects from the vaccine itself. A number of articles have suggested that this may be true, largely based on the clinical trials Novavax conducted to obtain emergency authorization from the CDC and FDA. But these studies, which show a lower incidence of short-term side effects such as nausea, headache, myocarditis and pericarditis, are not conclusive. Without a controlled head-to-head study comparing the two studies, there are too many subjective variables—such as who is evaluating these results, how many participants were involved, and their COVID infections and vaccinations—to make a direct comparison. While experts are hopeful, it is too early to draw a firm conclusion.

It’s worth noting that these are usually temporary conditions, and the risk of most of these conditions occurring in humans is that side effects from COVID infection are much higher than those from vaccination.

How to get Novavax if you want?

Now that all boosters are purchased commercially, they are a little harder to find than before. A good place to start is vaccine.gov, and limit your choices to Novavax. As of mid-October, Costco had it in stock at pharmacies across the country, and CVS began receiving shipments.

If you’re uninsured, you can still get Novavax through the Bridge Access program, but there may be additional hurdles, so your best option is to go to a large pharmacy chain like CVS, which handles all the paperwork at its discretion. parties through a pre-existing agreement with the government.