The Centers for Disease Control and Prevention on Thursday approved booster shots for millions of elderly or otherwise vulnerable Americans and opened a major new phase in the U.S. vaccination drive against COVID-19.
CDC Director Dr. Rochelle Walensky signed a series late Thursday. Counselors said boosters should be offered to people aged 65 and older, nursing home residents and aged 50 to 64 who have risky underlying health problems. The extra dose will be given when they are at least six months after their last Pfizer shot.
Walensky, however, decided to make a recommendation, which the panel had rejected.
The panel voted against saying that people can get a boost if they are aged 18 to 64 and are health professionals or have another job that puts them at increased risk of being exposed to the virus.
But Walensky disagreed and put this recommendation back, noting that such a move is consistent. The category she included covers people living in institutional settings that increase their risk of exposure, such as prisons or homeless shelters, as well as health care professionals.
The panel had offered the option of a booster for those aged 18 to 49 who have chronic health problems and want one. But the advisers refused to go ahead and open boosters for otherwise healthy frontline health workers who do not risk serious illness but want to avoid even a mild infection.
The panel voted 9 to 6 to reject this proposal. But Walensky decided to disregard the advisory committee adviser on this issue. In a decision several hours after the panel adjourned, Walensky issued a statement saying she had reinstated the recommendation.
“As CDC director, it is my job to recognize where our actions may have the greatest impact,” Walensky said in a statement late Thursday night. “At the CDC, we are tasked with analyzing complex, often imperfect data to come up with concrete recommendations that optimize health. In a pandemic, even with uncertainty, we need to take actions that we anticipate will do the greatest good.”
Experts say getting the unvaccinated their first shot remains a top priority, and the panel struggled with whether the booster debate distracted from that goal.
All three of the COVID-19 vaccines used in the United States are still extremely protective against serious illness, hospitalization, and death, even with the spread of the extra-infectious delta variant. But only about 182 million Americans are fully vaccinated, or only 55% of the population.
“We can give boosters to humans, but that’s not really the answer to this pandemic,” said Dr. Helen Keipp Talbot from Vanderbilt University. “Hospitals are full because people are not vaccinated. We reject care for people who deserve care because we are full of unvaccinated COVID-positive patients.”
Thursday’s decision represented a dramatic cut ofto tighten their protection. Late Wednesday, the FDA, like the CDC panel, signed Pfizer boosters for a much narrower section of the population than the White House had imagined.
The Booster plan marks an important shift in the country’s vaccination drive. Britain and Israel are already giving a third round shot over strong objections from the World Health Organization that poor countries do not have enough for their initial doses.
Walensky opened Thursday’s meeting by emphasizing that vaccination of the unvaccinated is still the overarching goal “here in America and around the world.”
Walensky acknowledged that the data on who really needs a booster right away “is not perfect.” “Yet they collectively form an image for us,” she said, “and they are what we have at the moment to make a decision about the next phase of this pandemic.”
The CDC panel stressed that its recommendations will be changed if new evidence shows that more people need a boost.
What about Moderna and J&J boosters?
CDC advisers expressed concern over the millions of Americans who received Moderna or Johnson & Johnson shots early in the rollout of the vaccine. The government has still not considered boosters for these brands and has no data on whether it is safe or effective to mix and match and give these people a Pfizer shot.
Regulators are still reviewing a submission from Moderna, who last week sought permission for booster shots of his vaccine at half the dose of the first two shots, CBS News’ Alexander Tin points out. Johnson & Johnson has not yet announced an application for approval of another dose of its vaccine, though federal health officials say they expect submission soon.
In addition to concerns about equity, some of the advisers warned that the partial recommendation could pose logistical challenges for nursing homes and other ward conditions where not all residents would be eligible, Tin notes.
About 26 million Americans received their last dose of Pfizer at least six months ago, about half of whom are 65 or older. It is not clear how many more would meet the CDC panel’s booster qualifications.
CDC data show that vaccines still provide strong protection against serious illness for all ages, but there is a small decrease among the oldest adults. And immunity to milder infection seems to be waning months after people’s first immunization.
For most people, if you are not in a group recommended for a booster, “it really is because we think you are well protected,” said Dr. Matthew Daley of Kaiser Permanente Colorado.
Public health experts not involved in Thursday’s decision said it is unlikely that people seeking third doses at a pharmacy or other place will be required to prove they are qualified.
Even with the introduction of boosters, a person who has received just the first two doses would still be considered fully vaccinated, according to the CDC’s Dr. Kathleen Dooling. This is an important issue for people in parts of the country where you need to show proof of vaccination to eat at a restaurant or enter other places of business.
Among people who can benefit from a booster, there are few risks, the CDC concluded. Serious side effects from the first two doses of Pfizer are extremely rare, including heart inflammation, which sometimes occurs in younger men. Data from Israel, which has given nearly 3 million people – mostly 60 and older – a third dose of Pfizer, have not uncovered red flags.
The United States hasfor certain people with weakened immune systems, such as cancer patients and transplant recipients. Other Americans, healthy or not, have managed to get boosters, in some cases just by asking.
And CBS News’ Tin reports that when data emerged bothin the United States and from successful booster programs launched abroad, some jurisdictions have already advanced with their own booster shot programs.
Maryland began earlier this month offer booster shots to seniors in state nursing homes so residents could “self-certify” whether they were sufficiently immunocompromised to be eligible for the doses. San Francisco created headlines last month to offer recipients of the Johnson & Johnson vaccine an “additional” dose of Moderna or Pfizer.
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