- An advisory committee to the CDC voted 15 to 0 to recommend Pfizer booster shots for people 65 and older and long term care facility (nursing home) residents on Thursday.
- They also voted to recommend booster shots for all adults with underlying medical conditions.
- The advisors voted 9-6 against recommending booster doses for adults who are "in an occupational or institutional setting" that puts them at higher risk of COVID-19 — a break with the FDA. The CDC later said those groups "may" get boosted, if they wish.
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An independent group of medical advisors to the CDC voted 15 to 0 on Thursday afternoon to recommend free booster shots of Pfizer's COVID-19 vaccine to millions of older adults who had their first two shots at least six months ago.
The panel also voted to recommend boosters to all adults with underlying medical conditions, but not unanimously, and there was some frustration with whether that makes the booster recommendation overly broad.
The panel voted 13-2 to recommend boosters to 50-64-year-olds with underlying medical conditions, and 9 to 6 to recommend boosters for 18-49-year-olds with underlying medical conditions.
But the advisors voted 9-6 against recommending booster doses for adults who are "in an occupational or institutional setting" which puts them at greater risk of exposure to COVID-19, like healthcare workers or teachers.
That decision marked a break with the US Food and Drug Administration, which authorized boosters for all adults who work or live in places that put them at higher risk of catching the virus on Wednesday.
"We have a really effective vaccine and it's like saying it's not working, and it is working!" Dr. Pablo Sanchez, a professor of pediatrics at The Ohio State University who is on the CDC committee, said.
CDC officials weighed in overnight with a final declaration, bridging some of the gap between the FDA and the CDC's independent experts.
For now, these final booster recommendations apply only to certain groups of people who've already been fully vaccinated with two doses of Pfizer.
What the CDC recommends:
- Adults 65 years old and over who've had Pfizer's vaccine should get a booster shot after at least 6 months
- Long term care facility (nursing home) residents who've had Pfizer's vaccine should get a booster shot after at least 6 months
- Adults ages 50-64 with underlying medical conditions who've had Pfizer's vaccine should get a booster shot after at least 6 months
The booster recommendations for younger adults are not as strong. The CDC suggests:
- Adults ages 18–49 with underlying medical conditions who've had Pfizer may get a booster after at least 6 months, based on their individual benefits and risks, and
- Adults ages 18–49 who've had Pfizer and who are at increased risk of COVID-19 exposure and transmission "because of occupational or institutional setting" (e.g. healthcare workers, prisoners, and other frontline workers) may get a booster shot of Pfizer after at least 6 months, based on their individual benefits and risks.
Boosters won't end the pandemic
The top priority for the country, experts agreed, must still be to get the more than 1 in 4 eligible Americans who have gotten zero shots so far vaccinated.
"We're fighting a pandemic, and it's not because people got two doses of vaccine," Dr. Helen Keipp Talbot, who serves on the CDC advisory committee, said during the meeting, echoing a sentiment repeated time and time again through hours of emotional comments from the committee members.
Unvaccinated Americans are far more likely to get seriously ill, hospitalized, or die from COVID-19 than people who've had one or two shots, regardless of their age, making the booster decision merely something that "may move the needle a little bit," Talbot said.
Boosters alone won't be enough to end the pandemic, she and others said. More needs to be done to get those who've had no shots vaccinated.
Lacking evidence for younger people getting boosters
During their deliberations, the CDC advisors took a look at hospitalization and infection data from around the country, and weighed the risks and benefits of giving booster doses to adults who are already fully vaccinated. The data suggested that, while the risks of boosting are low for everyone, boosting younger adults may not change much, while boosting people 65 and older could prevent a few more hospitalizations and severe cases of COVID-19.
For example, CDC estimates presented on Thursday suggest that more than 480 adults over age 65 would need to get a booster dose in order to prevent one additional hospitalization over six months. That number jumps to more than 8,000 boosters per hospitalization prevented among adults in the 18-29 year old age group.
"This isn't about who deserves a booster, it's about who needs a booster," committee member Dr. Matthew Daley from Kaiser Permanente Colorado said during the meeting.
Others agreed.
"If we can do a little bit of good by giving boosters to people over 65, I'm in favor of that," committee member Dr. James Loehr added.
In particular, adults in their 70s, 80s, and beyond who are vaccinated are not as well protected by their shots, because their immune systems are older and weaker.
Only Pfizer boosters for now
For now, only some of those people will be able to get boosters, though, since not everyone got Pfizer's vaccine initially.
That doesn't "sound like good public health policy," committee member Dr. Sarah Long said.
The issue could become especially thorny in long term care facilities, like nursing homes. (The FDA has promised that more booster doses will be on the way for Moderna and Johnson & Johnson recipients, once more data is available on boosting those vaccines.)
According to CDC estimates presented during the meeting, Pfizer boosters will bring vaccine effectiveness up to around 90% against infection, and up to 95% against hospitalization. For 18-65 year olds, that's only a very marginal improvement to the very strong vaccine protection they already have.
Some argued in favor of extra shots for healthcare workers to keep them healthy as hospitals fill up
One of the main reasons that healthcare workers were included in the final recommendations was in the hopes of keeping a strained healthcare system, near buckling under the burden of unvaccinated patients, afloat.
"We don't currently have enough healthcare workers to take care of the unvaccinated," Dr. Talbot, who works at Vanderbilt University in Nashville, said during the committee meeting.
Talbot stressed that boosters, if they help prevent more mild symptomatic infections, could keep more doctors and nurses healthy and at work, but that's mainly to take care of the "large populations which are unvaccinated."
"We are declining care to people who deserve care because we are full of unvaccinated patients," she said.
It's not clear yet whether boosters could reduce transmission of the virus from vaccinated people.
