- Millions of Americans who received the Pfizer-BioNTech vaccine are now eligible for boosters.
- The FDA and CDC are expected to review data later on boosters for the Moderna and Johnson & Johnson vaccines.
- The CDC has recommended that people 65 years old and older and those at high risk of contracting the virus receive the Pfizer-BioNTech vaccine booster shots.
Millions of people in the United States fully vaccinated with the Pfizer-BioNTech COVID-19 vaccine are eligible for a booster dose now that the Centers for Disease Control and Prevention (CDC) has green-lighted its use in specific high-risk groups.
This aligns with the Food and Drug Administration’s update this week of the vaccine’s emergency approval. But it partially goes against a decision made Sept. 23 by the CDC’s vaccine advisory committee.
In a Sept. 24 announcement made well past midnight, the CDC
- People 65 years old and older and residents of long-term care facilities.
- People ages 50 to 64 years old with
underlying medical conditions that put them at higher risk of severe COVID-19.
The agency also said the following people fully vaccinated with Pfizer-BioNTech might choose to receive a booster at least 6 months after their second dose, based on their benefits and risks:
- People ages 18 to 49 years old with underlying medical conditions that put them at higher risk of COVID-19.
- People ages 18 to 64 years old who are at higher risk of acquiring the coronavirus or passing the virus due to their job or the institution in which they live.
“I believe we can best serve the nation’s public health needs by providing booster doses [to these groups],” CDC Director Dr. Rochelle P. Walensky said in a news release.
“This aligns with the FDA’s booster authorization and makes these groups eligible for a booster shot.”
This recommendation applies only to people who have received two doses of the Pfizer-BioNTech vaccine.
The FDA and CDC are expected to review data later on boosters for the Moderna and Johnson & Johnson vaccines.
The CDC director’s decision matches the
However, it partially goes against the recommendation of the CDC’s vaccine advisory group, which on Sept. 23 approved all but the last of the booster categories.
After a two-day meeting, the Advisory Committee on Immunization Practices (ACIP) voted unanimously to approve boosters for people 65 years old and older and residents of a long-term care facility.
Although data on the benefits of COVID-19 vaccine boosters is limited, it is clearest for older adults, especially those with chronic medical conditions.
The ACIP also approved the following two categories — adults younger than 65 years old with underlying medical conditions — but with some members voting against each of these recommendations.
The category involving occupational and institutional risk resulted in the most disagreement among committee members. This vote was defeated by a 9-to-6 vote.
Some members felt healthcare workers, who are exposed to COVID-19 patients daily, should be able to get a booster.
“[Healthcare workers] are critical and cannot be forgotten,” said Dr. Helen Talbot, an associate professor of medicine at Vanderbilt University in Nashville.
Providing this group with greater protection would also help maintain the health system’s capacity, which is facing a surge of unvaccinated patients with COVID-19.
However, healthcare workers with underlying medical conditions would fall under one of the other categories, which would protect the most vulnerable among this group.
Other ACIP members were more concerned about the impact that the broad wording of this last category would have on booster rollout.
Dr. Sarah Long, a professor of pediatrics at Drexel University College of Medicine in Philadelphia, felt the category was too “open-ended,” given the lack of data to support boosters in healthy younger people, even those exposed to the virus.
Dr. Pablo Sánchez, a professor of pediatrics at The Ohio State University–Nationwide Children’s Hospital, agreed.
“We might as well say give [the booster] to everyone 18 and over,” he said.
Sánchez was also concerned that recommending boosters so broadly would send the wrong message about the COVID-19 vaccines.
“We have a really effective vaccine,” he said. “[This is] like saying it’s not working, but it is working.”
One member expressed concern that because people in the last category could decide on their own if they needed a booster, those with good health literacy would be more likely to gain access to the additional dose.
The committee also reviewed survey data during the meeting that showed people who have already received a third dose of the vaccine were more likely to be white.
Several ACIP members seemed to suggest that decisions on boosters should be held off until additional doses are available for all three vaccines being used in the United States.
Fifty-five percent of people in the United States are fully vaccinated, according to the CDC.
Of these, an estimated 26.4 million of the more than 100 million people who received the Pfizer-BioNTech vaccine would be potentially eligible for a booster on Sept. 27, according to data presented at the ACIP meeting. This includes 13.6 million people 65 years old and older.
However, another 23.4 million people who received the Moderna-NIAID vaccine and 3.3 million people who received a single dose of J&J would be at least 6 months since their last dose on this date.
These people would not be eligible for a booster until the FDA and CDC have reviewed the data.
Rolling out Pfizer-BioNTech boosters before the other two could also be difficult to implement in specific settings.
In long-term care facilities, residents vaccinated with Pfizer-BioNTech would be eligible for a booster, while others would have to wait.
Several committee members reiterated that the most significant impact on the pandemic in the United States would come from increasing vaccine coverage.
The majority of people hospitalized and dying from COVID-19 in the country are unvaccinated.
In addition, one-quarter of people in the United States eligible for a vaccine have not received a single dose, according to the CDC.
Millions of people in the United States have not yet received the second dose of an mRNA vaccine, leaving them only partially protected.
Given the large number of unvaccinated people, Ellie Murray, ScD, an epidemiologist at Boston University School of Public Health, who is not an ACIP member, cautioned against thinking boosters alone would be enough.
“Vaccines are one of the best inventions humanity has ever made, [in my opinion],” she wrote on Twitter. “But don’t be surprised when boosting the 55 percent of Americans who are fully vaccinated doesn’t end the pandemic.”
