COVID-19 vaccines that protect against the latest strains are expected to be available soon in Minnesota, perhaps this week or next week.

Moderna and Pfizer versions gained approval Monday from the U.S. Food and Drug Administration. An advisory committee of the Centers for Disease Control and Prevention recommended the vaccines on Tuesday for all people six months and older. Doses are expected to be available in pharmacies and clinics within 48 hours of the CDC director's final sign-off on the recommendation.

Who should get the vaccine?

The vaccine is broadly available, but the need is most urgent for senior citizens and people with compromised immune systems who are at greatest risk of severe COVID, said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy.

"People 75 years of age and older are really at highest risk for serious illness, with the next level being 65 and older and people who are immune compromised," Osterholm said. "So we really want to focus on that group."

As with earlier COVID vaccines, the latest versions appear to offer strong protection against severe illness, hospitalization and death but not against infection itself or mild illness.

While the urgency might be lower for children and younger adults, Osterholm said the vaccine will offer them the same protective benefits. COVID caused only 2% of U.S. pediatric hospitalizations earlier this summer, but that rate recently jumped to 6%.

Where can I get the vaccine?

Clinics, hospitals and pharmacies will provide vaccinations as normal, but will be buying their own supplies this time and may be conservative on the number of doses they order.

"They are risking some financial loss if they over-order, so there is going to be a balance there," said Jessica Monroe, who leads the vaccine distribution team for the Minnesota Department of Health. That could result in some delays and limited appointments early on, but she said "we have been assured there will be enough vaccine for everyone."

Major chains such as Walgreens planned to start scheduling appointments in mid-September. HealthPartners "paused scheduling for COVID vaccine appointments until the new vaccine arrives, and we expect more details about shipment in the next day or so," said David Martinson, a spokesperson for the Bloomington-based health care provider.

The state health department won't reopen its mass vaccination sites at the Mall of America and other locations, but will work with health care providers and nonprofit agencies to schedule smaller community clinics.

Will I have to pay for the vaccine?

Recipients didn't have to pay for COVID-19 vaccines during the pandemic emergency, and that will remain true for most. Two of Minnesota's largest insurers, Medica and Blue Cross and Blue Shield of Minnesota, said on Monday that the vaccines are preventive services that qualify for 100% coverage when patients receive them from in-network providers.

Getting vaccinations from out-of-network providers could result in patients sharing in the roughly $130 cost of the Moderna or Pfizer shots.

"It would be important that folks check their coverage for details if looking to receive the vaccine at an out-of-network provider," said Hannah Fairman, a spokeswoman for the Minnesota Council of Health Plans.

Clinics in partnership with the state will provide free vaccine for children and for uninsured or underinsured adults. A federal Bridge Access Program will provide free shots at pharmacies and other locations as well.

Will there be a shortage of vaccine like there was earlier in the pandemic?

An uptick in vaccine interest is expected, but a rush on supplies is not. Only 27% of Minnesotans are considered up to date with federal COVID vaccine recommendations — meaning they took advantage of the prior boosters formulated against older omicron coronavirus strains. Appointments and supplies of prior versions of the vaccine have been abundant for months.

COVID infections increased in Minnesota in the past month but only to the low levels that the state experienced in May. Even so, COVID deaths increased from a low of 24 in July to 37 in August — mostly among seniors. COVID hospitalizations in Minnesota reached a low of 41 on July 3 but increased to 171 on Sept. 5.

"Even though we think in our minds that COVID is dying off, it is still causing a lot of very sick people and a lot of death," said Lynn Bahta, a state health immunization consultant who serves on the federal advisory committee and voted in favor of the latest recommendations.

Should I wait to see if COVID levels worsen before getting the shot?

Immunity waned in the months after people received prior versions of the vaccine, and that is expected to happen with the latest shots. Even so, Osterholm said there is no proof globally of a seasonal pattern with COVID and no reason to wait to see if it gets worse.

"The only thing that makes this seasonal is that it happens in all four seasons," he said. "So I would get (the vaccine) now. The activity level is increasingly rapidly. ... We're seeing a number of schools where we're seeing substantial transmission in kids, which of course then brings the virus home to mom or dad or grandpa and grandma."

Should I get it at the same time as my flu shot?

Influenza usually emerges in winter, which makes vaccine guidance different. People might consider waiting a bit for flu shots, because they lose about 2% to 12% of their protection each month after vaccination, Osterholm said. There has been minimal flu activity in Minnesota so far.

Are the approved shots booster doses?

Most adults will receive single doses of the new vaccine whether as a booster or as a first-time COVID shot.

Adults with compromised immune systems must have received three COVID vaccine doses to be considered up to date, including one dose of the new vaccine. Eligible preschool children will similarly be considered up to date if they have received two smaller doses of Moderna vaccine or three smaller doses of Pfizer, including one dose of the new vaccine.

The Moderna and Pfizer vaccines were formulated to boost immunity against the XBB.1.5 variant, which was a dominant cause of COVID this spring but only made up 17% of infections in Minnesota in late July, according to state surveillance.

Two other XBB variants have become more prevalent along with an EG.5 variant of the coronavirus, but the FDA in its approval stated that the vaccines will offer heightened protection against them as well.

"It will boost people's immunity, and it will be a better match to the currently circulating variants," said Dr. Susan Kline, a U of M infectious disease specialist.