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The U.S. Centers for Disease Control and Prevention on Thursday recommended booster shots of Pfizer's coronavirus vaccine for millions of older and high-risk Americans, kicking off a new chapter in the national effort to protect the vulnerable from severe disease.
First, an expert CDC advisory panel called for COVID-19 booster shots for those over 65, nursing home residents and other Americans who are at high risk because of underlying health conditions. Those recommendations came just one day after the U.S. Food and Drug Administration authorized boosters for several vulnerable groups at least six months after getting a second shot.
Hours after the panel made its recommendations, CDC Director Dr. Rochelle Walensky approved the panel's recommendations but added one more critical category to the mix: Americans who are vulnerable to COVID-19 because of their occupations. This includes teachers, health care workers and grocery store employees.
Walensky's reasoning for her decision? The CDC panel's recommendations did not match up exactly with the FDA's broader authorization.
"At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health," Walensky said in a statement released early Friday morning. "In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.
"I believe we can best serve the nation's public health needs by providing booster doses for the elderly, those in long-term care facilities, people with underlying medical conditions, and for adults at high risk of disease from occupational and institutional exposures to COVID-19. This aligns with the FDA's booster authorization and makes these groups eligible for a booster shot," Walensky added.
Although the CDC's vaccine advisory panel only looked at the Pfizer vaccine, the CDC "will address, with the same sense of urgency, recommendations for the Moderna and J&J vaccines as soon as those data are available," Walensky noted.
The CDC panel, in a 13 to 2 vote, did endorse a third dose for people aged 50 to 64 who would be at risk for severe COVID-19 because of medical conditions, The New York Times reported.
"I am surprised that Dr. Walensky overturned one of the four [CDC panel] votes today, and I believe others will be as well," Dr. Yvonne Maldonado, an infectious disease expert at Stanford and the American Academy of Pediatrics liaison to the panel, told the Times.
But the CDC panel's vote on boosters for occupational risk "was close," Maldonado noted. The panel voted 9 to 6 against including the category, the Times reported.
"This [recommendation] addresses not only waning immunity, but those at high risk of exposure," she added.
After a long discussion, the CDC advisers also decided to allow those aged 18 to 49 who have underlying medical conditions to choose to get a booster based on their own benefits and risks, the Times reported. Certain people with weakened immune systems, including cancer patients and transplant recipients, were already authorized to get booster shots.
In a statement released on Wednesday, American Medical Association President Dr. Gerald Harmon praised the CDC panel for its "thoughtful deliberations and recommendations." Still, with hospitalization rates 10 to 22 times higher among the unvaccinated than among the vaccinated, "our top priority should remain reaching those individuals who remain unvaccinated against COVID-19," he added.
Even with Thursday's approvals, there still is no booster option for people who received the Moderna and Johnson & Johnson shots.
The CDC advisers expressed their concerns during their deliberations.
"I just don't understand how, later this afternoon, we can say to people 65 and older, 'You're at risk for severe illness and death, but only half of you can protect yourselves right now,'" Dr. Sarah Long, of Drexel University in Pennsylvania, told the Associated Press.
Moderna has applied for authorization of a booster carrying half the dosage given in the first two shots. Authorization could happen in a few days or weeks, the Times reported.
CDC data presented at the meeting showed that the vaccines still offer strong protection for all ages, with a slight drop in the country's oldest adults. But immunity against milder infection appears to be waning months after people's initial vaccination, the AP reported.
For most people, if you're not in a group recommended for a booster, "it's really because we think you're well-protected," said Dr. Matthew Daley, of Kaiser Permanente Colorado, according to the AP. "This isn't about who deserves a booster, but who needs a booster."
During the Thursday meeting, the CDC advisors discussed whether the booster shot debate is detracting from the need to vaccinate the unvaccinated, the AP reported. Only 55% of America's total population are fully vaccinated, according to the U.S. Centers for Disease Control and Prevention.
"We can give boosters to people, but that's not really the answer to this pandemic," Dr. Helen Keipp Talbot, of Vanderbilt University in Nashville, Tenn., told the AP. "Hospitals are full because people are not vaccinated. We are declining care to people who deserve care because we are full of unvaccinated COVID-positive patients."
The World Health Organization has more on COVID-19.
SOURCES: U.S. Centers for Disease Control and Prevention, news release, Sept. 24, 2021; American Medical Association, news release, Sept. 23, 2021; The New York Times, Washington Post; Associated Press
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