COVID-19

Following FDA, ACIP recommends COVID-19 booster shots

Americans aged 65 and older who received the two-dose Pfizer-BioNTech vaccine should get a third booster dose of that vaccine if it has been at least 6 months since completing their vaccination series.

That was the recommendation the Food and Drug Administration (FDA) made late yesterday, and it was echoed today during a meeting of the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP).

In addition to those 65 and older, the FDA authorized booster doses of the Pfizer vaccine for people 18 through 64 who are at high risk of severe COVID-19 or whose institutional or occupational exposure puts them at high risk of severe COVID-19. ACIP agreed with recommending a booster for the first group but not the second.

“The FDA amended the [emergency use authorization] for the Pfizer-BioNTech COVID-19 Vaccine to allow for a booster dose in certain populations such as health care workers, teachers and day care staff, grocery workers and those in homeless shelters or prisons, among others,” said Acting FDA Commissioner Janet Woodcock, MD, in a press release.

Addressing ACIP this morning, CDC Director Rochelle Walensky, MD, MPH, said she supported the FDA’s decision, and used the example of a young emergency department physician as someone who would benefit from a booster dose.

Will boosters reduce hospitalizations?

During the ACIP meetings, however, many experts presented on whether waning protection warranted boosters in otherwise healthy Americans under the age of 65. The goal, they argued should be reducing hospitalizations, not preventing breakthrough infections.

Members also discussed the problematic logistics of recommending a third dose: Would being fully vaccinated, if over 65, now mean three shots, or just two? And what about Americans over 65 who received the Moderna or Johnson & Johnson vaccines? And does a board recommendation of boosters signal—falsely—that the current vaccines are ineffective?

At the end of the meeting today, the committee voted on four questions. They agreed that vaccine boosters should be used for those 65 and older, and for those 50 to 64 who have underlying medical conditions that make them prone to severe COVID-19.

Heated discussion, however, broke out over the third and fourth recommendations.

Debate over potentially at-risk adults

The third recommendation the committee considered was a booster for those 18 to 49 based on individual benefit and risk given underlying medical conditions.

The fourth and final consideration was for those 18 and older who worked in an occupational setting that put them at more risk for COVID-19 infections, including frontline workers, people who live in congregate settings, and caregivers for the immunocompromised.

Those who voted nay said these terms were too broad, and allowed for too much gray area in who should get a booster.

“We are letting individuals decide vaccine policy,” said Sarah Long, MD professor of pediatrics at Drexel University.

In the end the third recommendation passed 9-6, and the fourth did not pass, by a 6-9 vote.

The discussion of how and if to implement boosters comes as CDC data show that the United States last week had its slowest week of first-dose vaccinations since mid-July. According to the Washington Post, on Sep 21 only 21,000 people got their first dose, the lowest daily number since December of 2020.

The CDC COVID Data Tracker shows 54.9% of Americans are fully vaccinated, and 64% have received at least one dose of COVID-19 vaccine.

Yesterday the nation reported 132,903 new COVID-19 cases, and 2,785 deaths, according to the Johns Hopkins COVID-19 tracker. The 7-day average of new cases is 130,592, with 2,075 deaths, according to the New York Times tracker.

Other US developments

  • The pandemic has exacerbated teacher and staff shortages in the nation’s public schools, the Associated Press reports.
  • Florida Gov. Ron DeSantis yesterday announced a new “symptom-based” quarantine rule that allows children who’ve been exposed to COVID-19 in classrooms but aren’t showing any symptoms to be sent back to school by parents, according to CNN.
  • The latest survey from the American Health Care Association/National Center for Assisted Living shows 99% of nursing homes and 96% of assisted living facilities in the country are facing staffing shortages.

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