An independent committee of experts advising the Centers for Disease Control and Prevention voted Thursday to recommend a booster dose of the Pfizer/BioNTech mRNA vaccine for individuals 65 and older; residents of long-term care facilities who are 18 years of age and older; and those aged 50 to 64 who have underlying medical conditions that put them at higher risk.
Additionally, the committee recommended that people aged 18 to 49 with such underlying medical conditions should have the option of receiving a booster dose after weighing their individual benefits and risks.
The Pfizer/BioNTech Booster is recommended for at least six months after the first two doses. And they’re only intended for people who received the initial series of two Pfizer/BioNTech vaccines—not people who received either Moderna or Johnson & Johnson vaccines.
The committee’s recommendations—the Advisory Committee on Immunization Practices, or ACIP—now head to CDC Director Rochelle Valensky for sign-off before becoming official federal policy.
Notably, the ACIP committee voted against To recommend a booster dose for people 18 years of age and older at high risk based on occupational or institutional exposure to pandemic coronavirus. This category would include health care workers, front-line workers, teachers, day care providers, grocery store workers, and those in prisons and homeless shelters.
that wide range of people actually includes in language from the Food and Drug Administration, which issued an emergency authorization for the booster late Wednesday. That authorization comes in the form of an amendment to the Pfizer/BioNTech vaccine’s emergency use authorization. And it allowed boosters to go to individuals whose “persistent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19, including severe COVID-19.” puts in.”
But in a broad debate today, the CDC committee ultimately voted that the group was too large and that such a recommendation would essentially become a booster free-for-all. Additionally, such a massive booster recommendation could send the message that vaccine efficacy is failing—when in fact, it is not. During the two-day meeting, the committee reviewed data showing that the initial two-dose Pfizer vaccine continues to provide strong protection against serious illness and death in people under the age of 65.
Teastil, the decision was not easy. The advisors shared personal stories of health care providers who are overwhelmed by the increase in COVID-19 patients and could benefit from any additional protections. A booster, some argued, would help keep them healthy and working. Others spoke of treating children who could not be vaccinated who had contracted severe cases of COVID-19. Others said that fostering adults around those children could help them avoid that disease.
But, on a population-wide scale, a narrow majority of the committee felt that the data did not guarantee additional increases for those not at direct risk. In a 9-6 vote, the committee voted against boosters for those with occupational or institutional exposure.
The committee voted unanimously, however, that those 65 and older and living in long-term care facilities should get the booster. The data shows that these groups have an increased risk of serious illness and death – as are people with underlying medical conditions.
CDC experts at the meeting did not provide a full list of underlying medical conditions that would warrant a booster dose. But, they offered a partial list, including: cancer, cerebrovascular disease, chronic kidney disease, COPD (chronic obstructive pulmonary disease), diabetes mellitus (type 1 and type 2), heart conditions (such as failure, coronary artery disease, or cardiomyopathies), obesity (BMI 30 kg/m2), pregnancy and recent pregnancy, and smoking (current and former).
For people with these conditions in the 18 to 49 age group, the committee refrained from issuing a full-blown recommendation to receive a booster dose. Instead, they favored a more flexible option, in which booster doses are recommended for each individual after weighing the benefits and risks. Those benefit and risk assessments can be hairy for younger groups, especially young men between the ages of 18 and 29. This group is at a higher relative risk of developing inflammation of the heart (myocarditis) as a side effect of vaccination. The risk is small, but potentially – there are benefits from a third vaccine dose in an age group that is at relatively low risk of serious consequences even without vaccination.
While ACIP members were puzzled about who should and should not get a booster dose, they also lamented the limited benefit. Any Booster will be provided. ACIP voting member Helen “Keep” Talbot, an infectious disease specialist at Vanderbilt University, spoke of hospitals full of non-vaccinated patients sickened with COVID-19. “On the whole, we can give people boosters, but it’s not really the answer to this pandemic,” Talbot said. “I think we’re putting lipstick on frogs. It’s not going to solve the pandemic.”
The committee’s recommendations now go to the desk of CDC Director Valensky. If they are adopted (which they are likely to be), vaccine providers will need to follow them. This is because vaccines are paid for and distributed by the federal government, which requires providers to comply with FDA’s EUA language And ACIP recommendations.
However, as CDC officials noted several times in today’s meeting, the current booster recommendations are only “interim” recommendations. ACIP and US officials expect more boosters and new recommendations to emerge in the coming weeks.