An advisory committee to the US Centers for Disease Control and Prevention voted Thursday to recommend booster doses for recipients of Pfizer's COVID-19 vaccine who are 65 and older and those who live in long-term care facilities. The committee also voted to recommend boosters for people ages 18 to 64 with underlying medical conditions.
On Friday, CDC Director Dr. Rochelle Walensky accepted the recommendations by the committee for these groups butbecause of "occupational or institutional" risk. That includes health care workers, teachers, people who work in crowded settings and others whose jobs or circumstances put them at high risk of COVID-19 infection and transmission. That's in line with what the Food and Drug Administration recommended earlier this week.
Pfizer's booster, to be administered at least six months after a person's second dose, is only for those who received Pfizer for their first two shots. Booster shots for people who are fully vaccinated withand aren't authorized yet.
While the US rolls out its booster plan, a little over 2% of people in low-income countries have received any COVID-19 vaccine, according to Our World in Data.
Like all three coronavirus vaccines available in the US, Pfizer's booster will be free regardless of immigration or insurance status, White House Coronavirus Response Coordinator Jeff Zients said at a briefing Friday.
In its recommendation, the CDC draws a line between Pfizer recipients that "should" get a booster -- everyone age 65 and older, long-term care facility residents and adults ages 50 to 64 with underlying medical conditions -- and those who "may" get a booster -- adults ages 18 to 49 with health conditions and those whose jobs put them at risk of COVID-19.
This slight difference in guidance incorporates some of the arguments that members of the CDC advisory committee made Thursday, that there wasn't a clear benefit to boosters for many younger adults, while there is data to show a strong increase in protection for older adults. When the committee voted Thursday, it recommended that adults 18 to 49 consider their personal benefits and risks before opting for a booster. During Friday's briefing, Walensky said that data on the potential increase for severe COVID-19 infection from underlying medical issues is "harder to parse out" because there are so many conditions that could increase risk.
Allowing boosters for people at risk of COVID-19 because of their work or institution will also allow more protection for people in minority communities, Walensky said, who have been disproportionately affected by COVID-19 compared to white people. At Thursday's meeting, some committee members discussed that determining how old someone needs to be in order to be considered at risk for severe COVID-19 may also depend on their race.
Third doses of mRNA vaccines have been recommended for moderately or severely immunocompromised individuals who received Moderna or Pfizer since August.
The CDC's recommendation is now in line with the FDA's Wednesday decision to give emergency use authorization for a booster dose of Pfizer's vaccine for some people at least six months after their second dose. The authorization, which is of its vaccine, came after a lengthy debate by an FDA committee that rejected boosters for the general population. The FDA panel cited a lack of data on the benefits of a booster for most people, where Moderna, Pfizer and Johnson & Johnson's vaccines remain protective against severe disease caused by COVID-19.
At the CDC committee meeting, members reiterated the importance of vaccinating the unvaccinated as the top goal of the pandemic.
Unvaccinated people are about 10 times more likely to get hospitalized with COVID-19 and 10 times more likely to die from the disease than fully vaccinated people, according to a CDC report earlier this month.
In a presentation shared by a committee member, a poll found that a third of unvaccinated people said that COVID-19 boosters would make them less likely to get vaccinated at all. Committee member Dr. Helen Keipp Talbot said boosters weren't the answer to the pandemic, and that giving them out while others remain unvaccinated may be like "lipstick on hogs."
"We will not boost our way out of this pandemic," Walensky said Friday, adding that providing extra protection against the coronavirus for people who need it will not distract from the important goal of vaccinating more people. The decision to allow boosters was about "providing, rather than withholding," Walensky said.
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