U.S. Backs Boosters for All in Bid to Blunt Virus Resurgence

(Bloomberg) -- Millions more Americans can now receive Covid-19 booster shots from Pfizer Inc. and Moderna Inc., after U.S. officials broadened what many state and local leaders and health-care providers had said were confusing initial eligibility guidelines.

Centers for Disease Control and Prevention Director Rochelle Walensky on Friday signed off on guidance that makes boosters available to all adults 18 and up who received a second dose of one of the messenger RNA vaccines at least six months earlier. 

Walensky said in a statement that boosters are “an important public health tool to strengthen our defenses against the virus as we enter the winter holidays.”

The new guidelines received unanimous backing from a CDC advisory panel, who also strengthened existing recommendations to say that all people 50 and over should get a booster shot. The Food and Drug Administration signed off on the wider use of boosters earlier in the day.

Previously, U.S. officials had recommended boosters for those 65 and older, and adults 18-64 with underlying medical conditions or work or living situations that made them more likely to develop severe Covid-19. Regulators had taken a slower approach in light of mixed data on how quickly vaccines might be losing efficacy and who was left most exposed as a result.

However, those standards left many people unsure whether they qualified. Four in 10 vaccinated adults are uncertain whether they are eligible for a booster dose, according to an October survey by the Kaiser Family Foundation.

Numerous states and New York City decided to widen eligibility on their own in recent weeks out of concern that limiting access could leave a valuable tool for combating infections on the shelf at a time when virus cases are rising across the U.S. The onset of the holiday season, when many families will gather indoors, increased the urgency to act.

Parsing Guidelines

“Individuals who are right now absolutely eligible for boosters may not be able to parse the guidelines,” said Nirav Shah, director of the Maine Center for Disease Control and Prevention and president of the Association of State and Territorial Health Officials, at the advisory panel meeting. “Our concern is eligible individuals are not receiving boosters right now because of this confusion.”

Under FDA guidelines, any of the three authorized shots -- including one from Johnson & Johnson -- can be used as a booster, regardless of which vaccine a person received initially.

Grace Lee, the committee’s chair and a professor of pediatrics at Stanford University School of Medicine advocated for the recommendation that all adults 50 and over should get booster vaccines so they wouldn’t have to peruse a long and confusing list of risk factors to see whether they were eligible.

“I am not even sure I can keep up with who is eligible and who is not,” she said in the meeting.

The earlier recommendations may have only served to further roil what’s already been a contentious vaccine campaign, according to Walid Gellad, director of the University of Pittsburgh’s Center for Pharmaceutical Policy and Prescribing.

“We have been very careful this entire rollout of vaccines and therapeutics to make sure we follow the science and abide by the scientific deliberations of groups like FDA and CDC,” he said in an interview. “What is happening now – with governors deciding on their own to expand access to a therapy beyond what FDA and CDC intended – is troubling and not what we should be applauding.”

The Biden administration has been eager to use the highly effective vaccines to keep the pandemic at bay and maintain economic and educational activity. Shots have been cleared for children as young as five. 

Waning Effect

However, data from drugmakers and researchers indicates that the impact of the initial two-shot regimes from Moderna and the partnership of Pfizer and BioNTech SE is fading. Surveillance also shows that Covid immunity can be restored with boosters. 

So far, of 195 million fully vaccinated Americans, about 32 million have received a booster shot. While a wider recommendation may simplify health messages for the public, it may be interpreted by some in unintended ways, said Monica Gandhi, an infectious disease expert at the University of California, San Francisco.

“I am very worried that this decision to approve boosters for everyone will make the unvaccinated question the effectiveness of the vaccines,” Gandhi said in an interview.

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