There’s been a lot of confusion since the U.S. Food and Drug Administration approved the updated COVID-19 vaccine formula late last month.
Alongside the approval, the FDA issued guidance that limits access to the vaccine to those 65 years or older and those with certain high-risk conditions, including diabetes, HIV, heart conditions and more.
But the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has not yet weighed in with recommendations for the new vaccine formulation. Their next meeting is scheduled for September 18 and 19.
Nathan Koffarnus is the assistant bureau chief with the Bureau of Communicable Disease at the Missouri Department of Health and Senior Services. He spoke about the current level of COVID-19 in the state and what changes to vaccine guidance could mean for Missourians.
This interview has been edited for length and clarity.
Rebecca Smith: So, Nathan – September 2025, and we're still talking about this, but what's the current covid landscape look like in Missouri right now.
Nathan Koffarnus: There have been some concerns about, you know, a national kind of late summer wave. I will say this, you know, having followed this from 2020 on – it is not unusual to see a little spike right around the time kids go back to school.
Covid is weird, right? So, for lack of a better term – it's not seasonal, truly seasonal, like, what we think of flu.
So, I think from the very beginning, we've kind of wanted to pigeonhole it like, “Oh, it'll act like flu does,” and it just really doesn't.
We've seen, you know, early summer, mid-summer waves pretty regularly. It doesn't follow that cold weather seasonality – some years it does, some years it doesn't.
And, actually, if you look at the wastewater surveillance for the whole country, Missouri is, in the most recent data, was the only state in the country that's marked as “very low” for COVID.
Certainly, we're not going to complain about that, right? But sometimes that means that you just haven't been hit yet and you’re next up, and sometimes it means that you got hit first, and you're now on that downward trend.
Our peak really wasn't that impressive in early August, so I don't quite know what to expect to be honest.
Rebecca Smith: So, can you tell me a little bit about this current variant, the stratus variant?
Nathan Koffarnus: So, we've been dealing with omicron for years now, and so, you could think of it as, like, all the variants we've seen for the past three plus years are kind of in this one family, and so they're all fairly closely related. They're spin offs from each other.
And so, the good news there is that if you had a recent infection, it probably wasn't that different than what's circulating now. You probably have better protection.
And if you had a vaccine recently, it's also not that different from what's circulating, and so, it should provide pretty good protection.
Rebecca Smith: So, there have been some changes from the guidance, or to the guidance from the FDA. And so I'm just wondering, for listeners who have been hearing things about the changes and are concerned, what should they know?
Nathan Koffarnus: Sure. So, I think the first thing, I’d just say is that we acknowledge the concern, and it can be confusing for us too.
And I think the other thing is to keep in mind that not all of those recommendations are finalized yet, and so, all of this is subject to change. So, we're still kind of waiting for guidance from ACIP [Advisory Committee on Immunization Practices], which is part of CDC, that makes those official recommendations.
There have been some developments in that, as far as FDA approval goes for the newest, you know, 25-26 vaccine, they seem to be moving toward – it's approved for those over 65 and those with risk factors.
And so, that doesn't mean that other people can't get the vaccine, but there may be a few more hurdles or limitations, or just it may be a little bit more take, a little more doing.
And so, I think, in general, the best guidance or the best recommendations we could give to people right now when we're kind of in this in between phase, where we don't quite know, is if you're interested, and you don't fall into one of those easy groups, you know, and even with those with risk factors – that's not really clearly delineated – so probably the best thing is just to talk to your physician and let them know you're interested, and they can help with that.
