Sept. 11, 2024 – Social media platforms lit up minutes after the FDA announced its authorization of the updated Novavax COVID-19 vaccine right before Labor Day weekend. It was the last of three vaccines authorized for 2024-2025, and the news was greeted with glee by many.
“That’s great!” proclaimed one Reddit user, as others posted “Yes!!” and “Bravo!” In All About Novavax, a private Facebook group of more than 1,000 members, many reposted the FDA announcement and began to compare notes about when they expect to be able to get it. Another group that had submitted petitions to the FDA, urging the agency not to delay the Novavax authorization for this year, posted, “We did it!” and “Success!” after the announcement.
In terms of doses given, Novavax trails far behind Moderna’s and Pfizer’s COVID vaccines, placing dead last. Estimates vary, but as of Aug. 10, in the U.S., more than 400 million Pfizer doses had been given, more than 251 million Moderna, and 83,047 Novavax doses, according to data researchers.
But for many, Novavax is #1 – the one and only COVID vaccine they would consider. This enthusiasm for Novavax isn’t new. As far back as 2022, news reports described a kind of Novavax fan club – a term that irritates some – and it’s still here.
What accounts for this passionate support of Novavax? It’s complicated and personal.
It’s a ‘Traditional’ Vaccine
Some say they prefer Novavax is because it’s a more traditional vaccine, compared to the Pfizer and Moderna vaccines, which are made with messenger RNA technology, said William Schaffner, MD, an infectious disease doctor at Vanderbilt University Medical Center in Nashville and a spokesperson for the Infectious Diseases Society of America.
Some people are still skeptical about the mRNA technology, he said, which they still regard as new, even though “it isn’t new anymore because we’ve given millions and millions of doses.”
Even so, “Novavax is made in a much more traditional fashion, and it’s reassuring to those who are antsy about the mRNA vaccine,” Schaffner said. “It takes a protein part of the virus, links it to an immune system stimulant, an adjuvant, and then it’s injected and stimulates the immune system.” It’s the same way flu vaccines are made.
“The mRNA vaccine is in effect a blueprint [for the protein], which is then injected into the body; the body actually makes the protein, and then the immune system responds to it.”
One of the advantages of the mRNA vaccines over traditional ones, Schaffner said, is that they are easier and faster to make. And this can let you update mRNA vaccines somewhat faster than you can update traditional vaccines, letting you better keep up with changing variants, he said.
Tradition appeals to Sam Biller, 58, of Tampa, FL, who said he is choosing Novavax this year again after first getting a Johnson & Johnson vaccine and then a previous Novavax shot because he prefers what he calls the “proven technology” of Novavax.
If the “traditional” aspect of the Novavax vaccine persuades people to get vaccinated, Schaffner said, he’s all for it, noting the lagging interest recently in getting updated vaccines. According to the CDC, only 22.9% of U.S. adults have gotten the updated 2023-2024 COVID-19 vaccine.
Plus: Fewer Side Effects
Fewer side effects in the short term, in general, is another big draw of the Novavax shot, said Peter Chin-Hong, MD, a professor of medicine and infectious disease specialist at the University of California San Francisco School of Medicine.
"For short-term side effects, like fever, myalgia (muscle pains), headache, in the studies – [although] there aren’t head-to-head comparisons – fewer participants in the Novavax studies reported those, compared to people in the Pfizer or Moderna trials.”
Other research has also found the mRNA vaccines to be the most reactive. Some researchers compared people who received an mRNA vaccine as their first booster, then got either Novavax or an mRNA vaccine as a second booster. They found the Novavax group had fewer side effects but higher rates of infection. No differences in cellular immune responses were found between the two groups.
The immune system stimulant used in the Novavax vaccine, Chin-Hong said, compared to others in “traditional” vaccines, helps explain why it produces less severe side effects.
“For traditional vaccines, it’s all about the adjuvant,” he said.
Novavax’s adjuvant is called Matrix-M, derived from compounds in the bark of a Soapbark tree. According to Chin-Hong, the Novavax adjuvant is “not as well-known for causing as many side effects” as some others, such as the shingles vaccine adjuvant.
Judy, 74, a Northern Virginia retiree who asked that just her first name be used, had seven mRNA vaccines before switching to Novavax in May.
“The first six were Pfizer,” she said in an email. “Each one partially disabled me for a couple of days,” with fatigue, a sore arm, a headache, body aches, and malaise over 2 to 3 days. The seventh shot was Moderna's after her pharmacy ran out of Pfizer doses.
“Moderna really kicked me in the behind,” she said.
She prepared once again for side effects when she went for the Novavax in May but was surprised.
“I had a very limited reaction; I had a mild temperature with a mild headache; no sore arm. I went to bed earlier than usual, and while I was tired the next day, I was up and out of bed and ready for my coffee,” she said.
Adam Van Bavel, 45, of Baltimore, said he has long COVID, and the mRNA vaccines left him dealing with symptoms for 2 to 3 days, including a high fever, chills, a headache, and congestion. The Novavax shot only left him sore where the needle went in. He calls it an “easy decision.”
Every time he got the mRNA vaccine, “I was down for a day,” recalled Paul Hennessy, 34, an entertainment project manager in Los Angeles. After he switched to Novavax twice last year, he was fine the next day, he said.
Rare Allergic Reactions: PEG
For some, it’s the risk of a serious allergic reaction linked with the Pfizer or Moderna vaccines. Both mRNA COVID vaccines use polyethylene glycol (PEG) as a stabilizer. PEG is also found in foods, cosmetics, and other products. Serious allergic reactions to PEG are rare but do happen.
While the cause of these reactions has been debated, it’s not proven, according to some research.
Even so, Moderna and Pfizer caution anyone who’s had a severe allergic reaction to any ingredient in their COVID vaccines not to get them.
Vaccine Scorecards
Discussion on social media is brisk about the “better” COVID vaccine for this year, in terms of preventing infection and targeting the “right” variant.
In early June, the FDA advised vaccine makers that this year’s formula should be monovalent vaccines targeting JN.1. The agency then said the preferred JN.1 lineage is the KP.2 strain.
This year’s Novavax targets JN.1, the “parent strain” of currently circulating variants, the company said, and “has shown robust cross-reactivity against JN.1 lineage viruses, including KP.2.3, KP.3, KP.3.11 and LB.1.”
The updated mRNA vaccines from Moderna and Pfizer target the KP.2 strain.
“Antibody data shows the Novavax JN.1 spike vaccine and the Moderna/Pfizer KP.2 vaccine have comparable virus neutralization levels of the currently circulating variants,” said Matthew Frieman, PhD, a professor of viral pathogen research at the University of Maryland School of Medicine in Baltimore. “There have been no differences in clinical protection between the mRNA and protein vaccines, demonstrating that they are all functioning to protect from severe disease and hospitalization.”
Novavax Advocates on a Mission
Don Ford, an activist in Los Angeles, has advocated for Novavax for 2 years, has organized letter-writing campaigns, and sent a petition urging the FDA and CDC to approve the Novavax vaccine for 2024-2025. Ford said he much prefers Novavax for himself and his family, which includes a cancer patient.
“We’ve been very aggressive,” he said of his efforts, writing to the Vaccines and Related Biological Products Advisory Committee (VRBPAC) of the FDA and calling in to make public oral comments when allowed.
Once the Novavax authorization came through, he pasted a “Success!” headline on the online materials.
Next Up: Finding the Shot
Soon after the authorization, those in search of a Novavax vaccine began posting on social media, asking where to find it this year and offering tips. They know from experience they often have to shop around to find it and there can be a lack of awareness about the vaccine.
Distribution, Schaffner reminds people, has nothing to do with the FDA or the CDC, but exclusively the company. According to Novavax, the vaccine will be available “in thousands of locations across the country, including retailers, regional grocers and independent pharmacies.”
Peter Liepmann, MD, 70, a family doctor in Pasadena, CA, and his wife belong to a health plan that doesn’t stock Novavax, so they decided to pay out of pocket last fall for their preferred vaccine. And they had to hunt. “We had to look around to find a small, independent pharmacy that had it,” he said. “Most of the big chains said they had it but didn’t.”
After calling half a dozen places, he found it.
