The CDC’s independent vaccine advisors had voted 11-0 to allow all adults to receive Covid-19 boosters from Pfizer and Moderna shots.
The panel said that all American adults “can choose” to get a refresher depending on their individual benefits and risks, while those over 50 “should”. The difference in wording recognizes the practicality of an age-based recommendation, but also recognizes the sparse data on the benefits of promoting young and otherwise healthy adults.
The previous state booster recommendations covered everyone 65 and over, adults with certain underlying medical conditions, and adults whose jobs increase their chances of contracting or spreading Covid, as long as everyone was cleared of their second dose for at least six months. People who had received the Johnson & Johnson vaccine were eligible for a booster dose at least two months after vaccination.
The new recommendations are intended to address what many states said when they overtook the federal government on booster access: Previous criteria were so confusing that even authorized people would not schedule their recordings.
“The pursuit of precision creates confusion,” said Nirav Shah, director of the Maine Center for Disease Control and Prevention.
Even the CDCs List of framework conditions could make Covid more dangerous has changed in recent weeks as the agency adds ex-smokers and those with mood disorders to risk groups.
“I’m not sure if I can keep up with who is eligible and who is not,” said Grace Lee, chair of the advisory committee.
One of the biggest issues the CDC panel has assessed over the past five months has been the link between an inflammatory heart disease known as myocarditis and Pfizer and Moderna’s two messenger RNA vaccines. The side effect, while rare, affects predominantly adolescent and young adult men under 30, and has been the driving factor behind the in-house advisory board and the FDA’s efforts to restrict boosters to older and sicker Americans only.
FDA and CDC advisors were hesitant to give the go-ahead for all adults in September when they first received Pfizer’s inquiry. They have scaled back dosing for 16- and 17-year-olds who were already eligible for the adult dose due to a lack of safety data, and they were generally reluctant to recommend additional doses for young and otherwise healthy individuals.
But the 7-day moving average of Covid-19 cases are up 21 percent in the past two weeks, and some states openly fear their hospital systems could soon be overrun with cases during the holidays. Some Biden health officials believe the upward trend could have been stifled if more people had received their booster vaccinations sooner.
Pfizer has not reported any cases of myocarditis observed in its booster study, but Tom Shimabukuro of the CDC vaccine safety team said the agency had received 54 preliminary reports of myocarditis or pericarditis in people who received booster vaccinations, 12 of which were confirmed.
This population reflects the population eligible for boosters, Shimabukuro said, so they are more likely to be older adults than teenagers and young people who have dominated cases of inflammation after the second dose of messenger RNA vaccine. For this reason, it is too early to draw conclusions about the prevalence of myocarditis after booster administration.
While there is growing evidence that Moderna’s primary series of vaccines pose a greater risk of myocarditis than Pfizer’s, the booster dose of Moderna is half the first two doses in the series, which begs the question of whether that lesser amount comes with correlated with a lower risk for the adverse event.
Lee acknowledged that some believe the advisory committee has not acted fast enough to make vaccine recommendations, but noted that Friday’s meeting was the 22nd public deliberation on Covid vaccination, a process they believe even more important during a pandemic to build public confidence.
Earlier in the day, Colorado Democratic Governor Jared Polis, who criticized the FDA and CDC many times for making seemingly slow booster and pediatric vaccination decisions, recapitulated the process.
“While it was frustrating to see an unelected board delaying necessary boosters for Americans, I’m excited today that the FDA is finally taking the right step forward to continue protecting all Americans from COVID-19,” he said in a statement.
The CDC panel’s decision on Friday raises another question: when will they revise the recommendation to urge all adults under the age of 18 to be topped up?
“I feel like we had a moving goal post here,” said Lynn Bahta, committee member, of the Minnesota Department of Health.