Fall means it’s time for just about everybody to get up to date on their flu and COVID-19 vaccines – and a lot of older adults also need protection against another risky winter virus, RSV. Yes, you can get your flu and COVID-19 shots at the same time. Don't call them boosters — they're not just another dose of last year’s protection. The coronavirus and influenza are escape artists that constantly mutate to evade your body’s immune defenses, so both vaccines are reformulated annually to target newer strains. “Right now is the best time” to get all the recommended fall vaccinations, said Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention, as she got her flu shot Wednesday. She has an appointment for her COVID-19 shot, too. It's “the single most effective thing you can do to protect yourself, your family, your community.” While they’re not perfect, vaccinations offer strong protection against a bad case of flu or COVID-19 — or dying from it. “It may not prevent every infection but those infections are going to be less severe,” said CDC's Dr. Demetre Daskalakis. “I would rather have my grandmother or my great-grandmother have a sniffle than have to go to the emergency room on Thanksgiving.” The challenge: Getting more Americans to roll up their sleeves. Last year, just 45% of adults got a flu vaccination and even fewer, 23%, got a COVID-19 shot. A survey released Wednesday by the National Foundation for Infectious Diseases shows an equally low number intend to this fall. And the coronavirus still killed more Americans than flu last year. “Maybe we believe that it’s not going to be me but let’s not take a chance,” said Dr. Michael Knight of George Washington University. “Why not get a vaccine that’s going to help you reduce that risk?” Who needs a fall COVID-19 or flu vaccination? The CDC urges both an updated COVID-19 shot and yearly flu vaccine for everyone ages 6 months and older. If you recently had COVID-19, you can wait two or three months but still should get an updated vaccination because of the expected winter surge. Both viruses can be especially dangerous to certain groups including older people and those with weak immune systems and lung or heart disease. Young children also are more vulnerable. The CDC counted 199 child deaths from flu last year. Pregnancy also increases the chances of serious COVID-19 or flu – and vaccination guards mom plus ensures the newborn has some protection, too. What’s new about the COVID-19 shots? Last fall’s shots targeted a coronavirus strain that’s no longer spreading while this year’s are tailored to a new section of the coronavirus family tree. The Pfizer and Moderna shots are formulated against a virus subtype called KP.2 while the Novavax vaccine targets its parent strain, JN.1. Daskalakis said all should offer good cross protection to other subtypes now spreading. The Pfizer and Moderna mRNA vaccines can be used by adults and children as young as 6 months. The Novavax shot is a more traditional protein vaccine combined with an immune booster, and open to anyone 12 and older. Which flu vaccine to choose? High-dose shots and one with a special immune booster are designed for people 65 and older, but if they can't find one easily they can choose a regular all-ages flu shot. For the shot-averse, the nasal spray FluMist is available for ages 2 to 49 at pharmacies and clinics — although next year it's set to be available for use at home. All flu vaccinations this year will guard against two Type A flu strains and one Type B strain. Another once-common form of Type B flu quit spreading a few years ago and was removed from the vaccine. What about that other virus, RSV? RSV, or respiratory syncytial virus, is a coldlike nuisance for most people but it, too, packs hospitals every winter and can be deadly for children under 5, the elderly and people with certain high-risk health problems. The CDC recommends an RSV vaccination for everyone 75 and older, and for people 60 to 74 who are at increased risk. This is a one-time shot, not a yearly vaccination – but only 24% of seniors got it last year. It's also recommended late in pregnancy to protect babies born during the fall and winter. And while “your arm may hurt and you may feel crummy for a day,” it's also fine to get the RSV, flu and COVID-19 vaccines at the same time, Daskalakis said. What will it cost? The vaccines are supposed to be free under Medicare, Medicaid and most private insurance plans if people use an in-network provider. Call your local health department to ask about options because in many areas, “availability of vaccine at lower or no cost is expected to trickle in over the next couple of weeks,” advised Dr. Raynard Washington, who heads the Mecklenburg County, North Carolina, health department. Check the government website, vaccines.gov, for availability at local pharmacies.