An expert committee that advises the Centers for Disease Control and Prevention on vaccines voted 11-to-0 on Friday to recommend Covid-19 booster shot eligibility be thrown open to all adults 18 and older.
The Advisory Committee on Immunization Practices also recommended, by the same vote, that the CDC lower the age for adults who should be urged to get a booster, changing it from age 65 and older to age 50. These changes pertain to the messenger RNA vaccines made by Pfizer and Moderna; people who received these vaccines can get a booster shot six months or more after receiving their second dose of vaccine. People who received the one-dose Johnson & Johnson vaccine have already been cleared to receive a booster shot two months after their original jab.
CDC Director Rochelle Walensky quickly signed-off on the changes, which will vastly simplify delivery of Covid boosters.
“Booster shots have demonstrated the ability to safely increase people’s protection against infection and severe outcomes and are an important public health tool to strengthen our defenses against the virus as we enter the winter holidays,” Walensky said in a statement. “Based on the compelling evidence, all adults over 18 should now have equitable access to a Covid-19 booster dose.”
Until now, eligibility for the Moderna and Pfizer booster shots has been determined by a complex formula involving a variety of age cutoffs as well as health conditions and exposure risks. For some of the people who are eligible, the recommendations have been more strenuous, suggesting they “should” be boosted. For others, the recommendation has been what’s termed as permissive — that designated people “may” get boosted if they wish.
The new recommendations state that people between the ages of 18 and 49 who have no risk factors may get a booster if they wish. All other people should get a booster. From now on health personnel administering booster doses will need to ask two simple questions of people who received one of the mRNA vaccines as their primary Covid series: Are you 18 or older? and Has it been six months or longer since you received your second shot?
The ACIP meeting started just hours after the FDA broadened the eligibility criteria spelled out in the emergency use authorizations for the Pfizer and Moderna boosters. The meeting was called on such short notice — it was announced Tuesday — that only 13 of the committee’s members were able to attend. When the meeting went longer than scheduled, two members had to leave without voting.
Friday’s proceeding brings to full fruition the Biden administration’s goal of offering all vaccinated adults booster shots. The policy, announced in mid-August, initially drew ire from some in the scientific community. Not everyone believed the evidence supported a need to boost all people who had been vaccinated, especially at a time when many low-income countries have yet to secure first doses for most of their citizens. Also, the decisions on boosters before the FDA, the CDC, and their respective advisory committees raised questions about the administration’s commitment to “follow the science.”
At a September meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee, the expert panel indicated it felt Pfizer boosters should be offered to a narrower band of people. The FDA defined that as those 65 and older, people 18 to 64 with health conditions that raise their risk of severe Covid infection, and people 18 to 64 whose jobs or living conditions put them at increased risk of contracting Covid. Later the same criteria were applied to the Moderna booster shot.
Initially that latter group — those at risk because of where they lived or worked — was described as people such as health care workers, teachers, prison guards and prisoners, as well as people who work and stay in homeless shelters. More recently, though, more than a dozen states, including Massachusetts, California, and Colorado, decided not to wait for the FDA and CDC to broaden eligibility criteria. They declared that because of high local transmission rates, everyone 18 and older meets the threshold for a booster.
The recommendations have been difficult to operationalize, ACIP members were told on Friday. The CDC presented polling data that showed that significant portions of the population didn’t know if they were eligible for a booster or not. Some ACIP members noted that the long list of health conditions that made people under the age of 65 eligible for a booster was not something doctors would know off the top of their heads. The guidelines, “though well intentioned and thoughtful, generate an obstacle to uptake of boosters,” Nirav Shah, president of the Association of State and Territorial Health Officials, told the committee as he made a plea for simpler booster guidance.
States “are strongly in support of expanding, clarifying and simplifying the eligibility guidance in the manner that’s been discussed and proposed,” said Shah, who is director of Maine’s Center for Disease Control and Prevention and a non-voting representative to the ACIP. “There was not a single state that voiced opposition to this move.”