Should lupus patients receive the 4th shot (2nd booster) now versus waiting for the Moderna bivalent vaccine?

We know that the BA.4 and BA.5 are starting to circulate in Canada. These variants are even more contagious than previous omicron variants, and as a result, some regions of Canada are already seeing another wave. While it is unclear how effective a booster with the current vaccines will work against these variants, it is expected that they will still provide protection against severe disease.
The National Advisory Committee on Immunization (NACI) recommends an interval of 3-6 months from the last dose of COVID-19 vaccine, based on several factors, including maximizing vaccine effectiveness and minimizing health risks. Some people with lupus have extra risks like immunosuppressive medications, or heart or lung disease, etc. For people with extra risks, especially if someone lives in an area with increasing COVID, or has a high risk of exposure to COVID, a 4th dose should be considered, especially if 6 or more months from the last dose.

A new vaccine that is likely more effective against Omicron subvariants is currently being reviewed by Health Canada and could be authorized for use before fall. Receiving a booster dose now could delay being eligible to receive the new vaccine because of NACI’s recommended minimum interval of 3-6 months between doses. BUT, we do not know for sure when or if the new vaccine will become available, how effective it will be, how much vaccine stock Canada will get and what the roll out will look like (who will be eligible first). So if choosing to delay a booster, in the hopes of getting the new vaccine, it may be wise to reassess frequently to see if there have been any changes in either COVID levels or updates on availability of the new vaccine.

It is recommended to wait 3 months after a COVID infection before getting a booster.

Christine A. Peschken MD MSc FRCPC
Professor of Medicine and Community Health Sciences
Rady Faculty of Health Sciences
Head, Section of Rheumatology
University of Manitoba
Chair, Canadian Network for Improved Outcomes in Systematic Lupus Erythematosus