Putting COVID-19 boosters back on the table – and why they should be bivalent ones

Older lady pointing to a band aid after vaccine
  12 October 2023  Dr Jeannie Knapp – NWMPHN GP clinical advisor   

What is the problem?

A recent article in The Age highlighted that 4 out of 5 Australian adults have failed to get a bivalent COVID-19 vaccine booster. This includes more than half of people over the age of 65, who are most at risk from adverse outcomes from a COVID-19 infection.

Bivalent boosters have been shown to be significantly more effective than monovalent ones, with one study showing that protection against severe disease or hospitalisation was 61.8 per cent for those who received a bivalent booster dose, compared to 24.9 per cent for an older monovalent dose.

Further COVID-19 waves are inevitable in Australia. However many of us, and most of our patients, are COVID-19 jaded. So how do we restart the conversation about bivalent boosters?

What is the current COVID-19 booster recommendation?

In February the Australian Technical Advisory Group on Immunisation (ATAGI) recommended:

  • A booster dose (ideally bivalent) in 2023 to all adults over 65 years old and all adults 18 to 64 with comorbidities or complex health needs if their last COVID-19 vaccine dose or confirmed infection (whichever is the most recent) was at least 6 months ago, and regardless of the number of prior doses received.
  • Other adults aged 18 to 65 or at-risk people 5 to 17 should consider a booster.

This advice was updated in September 2023 to recommend an additional dose in 2023 for all those over 75 years old, and to consider additional 2023 doses for those over 65 years old and severely immunocompromised.

ATAGI 2023 COVID-19 Booster Advice – first and additional dose*

2023 COVID-19 booster dose (February 2023 guidance) Additional 2023 COVID-19 booster dose (September 2023 guidance)
Age At risk# No risk factors At risk# No risk factors
<5 years Not recommended Not recommended Not recommended Not recommended
5-17 years Consider Not recommended Not recommended Not recommended
18-64 years Recommended Consider Consider if severe immunocompromise^ Not recommended
65-74 years Recommended Recommended Consider Consider
≥ 75 years Recommended Recommended Recommended Recommended

Source: ATAGI

What strategies can you or your practice use to restart the booster conversation with patients?

  • Discuss the current recommendations at a team meeting so everyone is aware of what vaccinations are being recommended and to whom.
  • Adopt an “every patient every time” approach to health promotion and get in the habit of asking as many patients as possible where they are at with their COVID-19 vaccination status.
  • Identify certain consults – such as those concerning diabetes, heart disease or obesity — for targeted promotion.
  • Have a targeted SMS campaign, for instance to all patients over 65 or 75, reminding them about COVID-19 boosters. You might include where they can get their booster, if you aren’t a vaccinating practice.
  • Incorporate a COVID-19 booster discussion into health assessments, such as those for patients 45-49, diabetes, and patients 75 and over.
  • Display posters in your waiting room promoting COVID-19 booster doses and where to get them.
  • Audit your nursing home residents to ensure they are up to date with COVID-19 bivalent boosters.
  • Use the reports function in the AIR (via Proda/HPOS) to run a report and identify those who are under vaccinated. (It’s worth noting that AIR reports use Medicare data so will pick up patients vaccinated elsewhere.)

More information

HealthPathways Melbourne:

ATAGI updates on COVID-19 boosters:

Waiting room posters and social media graphics: