As States Defy U.S. on Boosters, Health Experts Raise Concerns

(Bloomberg) -- Nine states in the U.S. are now offering booster shots to all adults, contradicting federal guidance and reigniting the national debate on eligibility for supplemental vaccine doses.

Currently, booster shots in the U.S. should be limited to those with pre-existing medical conditions and people 65 or older, according to guidelines from the Centers for Disease Control and Prevention. But so far, health departments in New York, New Jersey, California and six other states have independently broadened access to Covid-19 boosters, and that number is expected to grow. The diverging guidance has some health experts worried.

“I think that it is a very bad idea and precedent for states and localities to jump the gun,” said Jesse Goodman, a professor of medicine at Georgetown University and former Food and Drug Administration chief scientist. “Even if well intentioned, acting locally injects politics and undermines the national system of expert and transparent vaccine assessment.”

Those who received a Pfizer Inc. or Moderna Inc. vaccine at least six months ago and are 65 and older are eligible for a booster, as are people 18 or older who are at a higher risk of severe Covid, under the CDC guidelines. All adults who received the Johnson & Johnson vaccine more than two months ago are also eligible for a booster dose. So far, of the 195 million people who are fully vaccinated in the U.S., 31 million have received a booster shot, including 37% of those 65 and older.  

The controversy, at least for Pfizer boosters, could be short-lived with changes in federal guidance expected soon. Pfizer earlier this month asked regulators to sign off on an expansion of booster-shot eligibility, and a decision is expected within days. A panel that advises the CDC on vaccination policies will meet Friday to discuss the proposal. 

With winter arriving and delta variant infections on the rise, health officials are eager to get more supplemental doses into arms. New York Governor Kathy Hochul on Tuesday urged anyone who lives in counties experiencing high transmission rates to get a booster. She also encouraged people to start avoiding large indoor gatherings.

A week ago, just one New York region had more than 50 infections per 100,000 residents. Now five do, she said. The 7-day average positivity rate was 3.4% statewide, but Western New York and the Finger Lakes regions topped 8%. “I’m concerned,”  Hochul said.

End Run

President Joe Biden in August announced a plan to offer booster shots for all vaccinated U.S. adults. But that was before the FDA and CDC had fully vetted the proposal. 

“Already the administration was going around the process,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “It does upset me that states are acting ahead of the CDC’s recommendations.”

Some scientists, including at the FDA, have questioned evidence supporting the need for a third dose. Others argue the doses would be better used if distributed to nations struggling to secure vaccines for their populations. That argument was bolstered by a September review in the Lancet Journal by an all-star, global panel of scientists, concluding that Covid-19 vaccines work well without boosters.

What’s more, advisers to the CDC and FDA had previously expressed concern that expanding booster eligibility to younger people could increase the risk of myocarditis, a potentially deadly inflammation of heart tissue.

“Two doses has been shown to be adequate in protection against serious illness,” Offit said. “What’s the benefit of a third dose knowing that there’s a risk in boys and men 18 to 29 years old?”

Meanwhile, confusion persists around who is eligible for a booster, said Theresa Chapple-McGruder, an epidemiologist and health department director in Oak Park, Illinois. Chapple-McGruder said the waning efficacy of the vaccine supports the argument for boosters for all adults and she favors widening eligibility. Until that happens, though, people are likely to simply seek boosters on their own. 

“I get calls from people multiple times a day with a simple question: Do I qualify for a booster?” Chapple-McGruder said. “Others are lying in order to get the booster.”

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