In the face of rising infections and an expected increase in vacation travel, the Centers for Disease Control and Prevention on Friday approved booster shots of the coronavirus vaccines for all Americans over 18.
The recommendation fulfills President Biden’s commitment in August to make the additional doses available to all adults and crowns months of scientific debate over whether most people really need boosters. The vaccines are already available in many pharmacies, doctor’s offices and vaccination centers.
The CDC said Americans over 50, as well as those 18 and over living in long-term care facilities, “should” receive booster shots of Pfizer-BioNTech or Moderna vaccines. All other adults over 18 “may” receive booster doses, the agency said.
Recipients of the Johnson & Johnson single-dose vaccine have already been allowed a booster at least two months after the initial shot.
Earlier on Friday, the Food and Drug Administration cleared booster shots for all Americans over 18. But the CDC generally sets the clinical guidelines adopted by the medical profession.
A panel of scientific advisers approved the expansion of eligibility earlier on Friday, and the agency’s director, Dr Rochelle Walensky, approved the recommendation in the early evening.
Many experts feared that most adults would not need extra doses to prevent serious illness and death, and that a call for boosters could restrict global vaccine supplies even as people in many poor countries fail. have not received their first doses.
But infection rates are rising again in the United States and skyrocketing in much of Europe. After registering more than 14,000 new infections on Thursday, Austria will enter a nationwide lockdown on Monday and impose a coronavirus vaccination mandate in February, the first such mandate in a Western democracy.
Health officials in many of those countries, and now the United States, see booster shots as a way to bolster defenses against a stubborn enemy and gain the upper hand in the pandemic. France, for example, has made reminders mandatory for people over 65 who wish to obtain a health passport allowing access to public places.
“Look at what other countries are doing now to adopt a recall campaign for virtually everyone,” Dr Anthony S. Fauci, the Biden administration’s top Covid adviser, said at a conference Tuesday. “I think if we do it, and we seriously do it, I think by spring we can have some pretty good control of it.”
In the United States, infections have increased by 33% on average over the past two weeks, to 94,000 per day. The CDC’s decision landed just as Americans prepare to spend the vacations with family and friends, gatherings that have the potential to accelerate the trend.
Injections can help prevent at least some infections, especially in older people and those with certain health problems. But many experts, including some who advise federal agencies, are skeptical that boosters alone can turn the tide.
The additional injections are unlikely to provide much benefit to adults under 65, who remain protected against serious illness and hospitalization with the initial vaccination, experts said.
“Overall protection remains high in severe illness and hospitalization,” CDC epidemiologist Dr. Sara Oliver told the science advisers meeting on Friday.
What’s more, tens of millions of Americans haven’t even received the first dose of a coronavirus vaccine. In the United States, as in Europe, deep pockets of vaccine-resistant adults are likely to prolong the pandemic, no matter how well protected their neighbors are.
Many Americans seem unresponsive to the sudden surge in boosters. Over 85 percent of the adult population has become eligible when the CDC added depression and other mental illnesses to the list of conditions that qualify people for an extra dose of the vaccine.
Corn only about 18 percent of those 18 and over chose to get one. And these may not be the people who need the extra protection the most.
The most effective strategy for administration would be to speed up the booster doses to residents of nursing homes and long-term care facilities, said Dr. Céline Gounder, an infectious disease specialist at Bellevue Hospital Center. Adults are the most likely to benefit.
At present, fully vaccinated whites are more likely to have received booster shots, compared to other racial and ethnic groups, according to data compiled by the Kaiser Family Foundation.
At the panel meeting, several experts noted that overly complicated eligibility criteria can confuse many Americans and tax healthcare providers.
Americans who have opted for the recalls “tend to be of higher socioeconomic status and more educated, and generally have more access to medical care,” said Dr. Gounder. “It’s not necessarily who is actually at risk for serious illness, hospitalization or death, so I think you’re going to have limited impact on public health.”
The Biden administration intends to provide booster shots in long-term care facilities and nursing homes, and to work with community health centers to reach people with limited access to health care. said Ian Sams, spokesperson for the Department of Health and Human Services.
There is reason to believe that more people may choose to receive reminders in the coming weeks. While additional injections of the Pfizer-BioNTech vaccine have been available since late September, Moderna and Johnson & Johnson vaccine boosters were cleared about four weeks ago.
And every week, more Americans will become eligible when they cross the six-month mark since their initial vaccinations.
Although federal officials have chosen to double the booster shots as the best hope of ending the pandemic, scientific questions about their effectiveness are far from settled.
Dr Fauci and other officials argue that vaccine protection is now waning over time, in all age groups, even against serious illness and hospitalization.
Israeli health officials are seeing a decline in immunity “not only against infection, but against hospitalizations and, to some extent, death,” Dr Fauci recently told The Daily podcast. The trend, he added, “is now starting to involve all age groups – it’s not just the elderly.”
But other experts disagree, pointing to studies showing that vaccines remain very effective against serious illnesses in adults under 65. The apparent decrease in protection against infection may only result from the fact that vaccinated people take less precautions, they say, and the contagious Delta variant.
Although they did not offer much additional protection to most adults, booster shots would still be helpful if they helped to stop the transmission of the virus. Federal health officials argued so much, citing the decline in the number of cases in Israel following its recall campaign.
But in the United States, for reasons that are poorly understood, infections began to decline in September, said Dr Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and an adviser to the FDA. before starting the booster doses, ”he said.
A booster should prevent people from getting infected and limit their infectivity to some extent. Yet some household studies indicate that vaccinated people are about half as likely as unvaccinated people to transmit the Delta variant, but the protective effect seems to decrease over the following weeks.
The administration’s time and effort would be better spent getting the unvaccinated people vaccinated, said Virginia Pitzer, an epidemiologist at the Yale School of Public Health. “In most places,” she said, “unvaccinated people are still the ones who drive a lot of the transmission. “
Most experts agree that booster shots benefit adults over 65 and people with weakened immune systems. But in the weeks after the boosters were authorized, only 32% of older people received additional doses of the vaccine.
“I see a lot of people who would benefit from a third dose or a booster dose who have not yet received their dose,” said Dr. Camille Kotton, infectious disease physician at Massachusetts General Hospital and advisor to the CDC.
“It is partly fatigue, another is not due to understanding the new guidelines,” she added. “It is very difficult to understand for whom a booster dose is recommended at this point. “
In Mississippi, Judy Spencer, 76, said she was in good health and did not plan to receive a booster because she had already received two doses of the Moderna vaccine. “I took the blow, I’m glad I did, but I’m done with it,” she said.
The situation for adults under 65 is confusing, and some experts balked at the idea of additional doses because it was not clear whether the benefits would outweigh the potential risks. Men and boys under the age of 30, in particular, are slightly increased risk develop rare and mild heart problems related to the Pfizer-BioNTech and Moderna vaccines.
Experts said the low rate of recalls to date could be at least in part blamed on confused messages from the administration. In previous recommendations, the CDC has specified groups of people who should receive boosters because of their age, occupation, or underlying medical risks.
“The CDC speaks Latin,” Ned Lamont, governor of Connecticut, said Thursday at a press conference. “I can’t figure out who is eligible, who is not.”
Dr Ashish Jha, Dean of Brown University School of Public Health, said: “It has been very frustrating watching the national conversation on boosters. ”