A key panel of the Centers for Disease Control and Prevention voted to endorse booster shots for seniors and those with underlying conditions but excluded those in high-risk occupations or institutional settings.
That last vote could complicate matters with the Food and Drug Administration, which recommended boosters for those in high-risk occupations and settings on Wednesday.
The Advisory Panel on Immunization Practices voted unanimously to recommend a third dose of the Pfizer-BioNTech vaccine for people in long-term care facilities and those aged 65 and older who already received the first two doses.
FDA AUTHORIZES BOOSTER SHOTS OF PFIZER VACCINE FOR ELDERLY AND OTHERS AT HIGH RISK FROM COVID-19
ACIP also approved boosters for those ages 50-64 and 18-49 with underlying conditions. However, ACIP recommended that the benefits and risks to an individual 18-49 should be considered before receiving a booster.
The vote on those ages 18-49 was close, 9 to 6, because of concerns over the lack of evidence supporting the recommendation.
“We don’t have evidence of waning vaccine effectiveness for those with underlying conditions,” said Dr. Sarah Long, an ACIP member and professor of pediatrics at Drexel University College of Medicine.
But ACIP voted down a recommendation that those in occupations or other high-risk settings should receive boosters.
“There is lots of evidence that healthcare workers who become infected become infected in the community, and not in a healthcare setting,” said ACIP member Dr. Beth Bell.
All that remains before the booster rollout can commence is the green light from CDC Director Rochelle Walensky, which is likely to come by Friday afternoon.
Although ACIP recommended boosters for those aged 18-64 with underlying conditions, many ACIP members were concerned with the lack of evidence supporting boosters for younger people.
A presentation by Dr. Megan Wallace from CDC’s National Center for Immunization and Respiratory Diseases compared the hospitalizations that would be prevented by a booster versus the number of cases of heart inflammation, known as myocarditis, a booster would cause. In most instances, a booster would prevent far more hospitalizations than it would cause cases of myocarditis.
The one exception occurred when a booster was 95% effective at preventing hospitalizations for those ages 18-29. Under that scenario, zero hospitalizations would be prevented, while 13 cases of myocarditis would occur.
Dr. Sarah Oliver, a member of the CDC’s Epidemic Intelligence Service, presented evidence showing the benefits of a booster were considerably smaller for those under age 65 than for those who were older. For example, it would take about 400 boosters among those aged 65 and older to prevent one hospitalization, while about 8,700 of those aged 18-29 would need a booster to achieve the same result.
The CDC panel’s consensus regarding who among Pfizer-BioNTech vaccine recipients should get access to boosters will begin a rollout the Biden administration hoped would have gotten underway this week.
The booster rollout is also expected to get messy. While the FDA and CDC had already authorized extra doses of the two-dose Moderna or Pfizer vaccines for immunocompromised people, the rest of the population authorized to get a booster are only eligible for Pfizer’s. The FDA did not authorize mixing of vaccines, meaning the roughly 82.6 million adults who got the Moderna and Johnson & Johnson vaccines are not yet eligible.
Still, patients can attest to being at high risk without having to prove it. The CDC’s clinical guidelines likely won’t stop people from getting extra shots of either vaccine if they’re prepared to lie.
Meanwhile, many public health experts are worried a campaign to administer booster doses to a select portion of the population will convince those who were already hesitant to get the first round of shots that the vaccines are not as effective after all. Nearly a quarter of adults who have been fully vaccinated, meaning two weeks have passed since their second doses of Pfizer or Moderna, or their single dose of J&J, reported concerns they aren’t protected from symptomatic illness, according to the Kaiser Family Foundation.
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“The message that boosting might soon be needed, if not justified by robust data and analysis, could adversely affect confidence in vaccines and undermine messaging about the value of primary vaccination,” according to two veteran FDA officials who argued against providing extra doses for the population at large.
