CDC advisors voted in favor of Pfizer boosters for older Americans – but against extra shots for healthcare workers, in a major break with the FDA

• An advisory committee to the CDC voted 15 to 0 to recommend Pfizer booster shots for people over 65 and long term care facility (nursing home) residents on Thursday.
• They also voted to recommend booster shots for all adults with underlying medical conditions.
• The advisors voted 9-6 against recommending booster doses for adults who are “in an occupational or institutional settings” – a break with the FDA.
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An independent group of medical advisors to the CDC voted 15 to 0 on Thursday afternoon to recommend free booster shots of Pfizer’s COVID-19 vaccine to millions of older adults who had their first two shots at least six months ago.

The panel also voted to recommend boosters to all adults with underlying medical conditions, but not unanimously, and there was some frustration with whether that makes the booster recommendation overly broad.

The panel voted 13-2 to recommend boosters to 50-64-year-olds with underlying medical conditions, and 9 to 6 to recommend boosters for 18-49 year olds with underlying medical conditions.

But the advisors voted 9-6 against recommending booster doses for adults who are “in an occupational or institutional setting” which puts them at greater risk of exposure to COVID-19, like healthcare workers or teachers.

That decision marked a break with the US Food and Drug Administration, which authorized boosters for healthcare workers and teachers on Wednesday.

“We have a really effective vaccine and it’s like saying it’s not working, and it is working!” Dr. Pablo Sanchez, a professor of pediatrics at The Ohio State University who is on the committee, said.

The recommendations are expected to swiftly get the green light from CDC officials. But for now, they apply only to certain groups of people who’ve already been fully vaccinated with two doses of Pfizer. So far they are:

• Adults over 65 years old
• Long term care facility (nursing home) residents
• Adults with underlying medical conditions

The top priority for the country, experts agreed, must still be to get the more than 1 in 4 eligible Americans who have gotten zero shots so far vaccinated.

“We’re fighting a pandemic, and it’s not because people got two doses of vaccine,” Dr. Helen Keipp Talbot, who serves on the CDC advisory committee, said during the meeting, echoing a sentiment repeated time and time again through hours of emotional comments from the committee members.

Unvaccinated Americans are far more likely to get seriously ill, hospitalized, or die from COVID-19 than people who’ve had one or two shots, regardless of their age, making the booster discussion merely something that “may move the needle a little bit,” Talbot said.

Boosters alone won’t be enough to end the pandemic, she and others said. More needs to be done to get those who’ve had no shots vaccinated.

Lacking evidence for younger people getting boosters

During their deliberations, the CDC advisors took a look at hospitalization and infection data from around the country, and weighed the risks and benefits of giving booster doses to adults who are already fully vaccinated. The data suggested that, while the risks of boosting are low for everyone, boosting younger adults may not move the needle much, while boosting people over age 65 could prevent a few more hospitalizations and severe cases.

For example, CDC estimates presented Thursday suggest that more than 480 adults over age 65 would need to get a booster dose in order to prevent one hospitalization over six months. That number jumps to more than 8,000 boosters per hospitalization prevented among adults in the 18-29 year old age group.

“This isn’t about who deserves a booster, it’s about who needs a booster,” committee member Dr. Matthew Daley from Kaiser Permanente Colorado said during the meeting.

Others agreed.

“If we can do a little bit of good by giving boosters to people over 65, I’m in favor of that,” committee member Dr. James Loehr added.

In particular, adults in their 70s, 80s, and beyond who are vaccinated are not as well protected by their shots, because their immune systems are older and weaker.

Only Pfizer boosters for now

For now, only some of those people will be able to get boosters, though, since not everyone got Pfizer’s vaccine initially.

That doesn’t “sound like good public health policy,” committee member Dr. Sarah Long said.

The issue could become especially thorny in long term care facilities, like nursing homes. (The FDA has promised that more booster doses will be on the way for Moderna and Johnson & Johnson recipients, once more data is available on boosting those vaccines.)

According to CDC estimates presented during the meeting, Pfizer boosters will bring vaccine effectiveness up to around 90% against infection, and up to 95% against hospitalization. For 18-65 year olds, that’s only a very marginal improvement to the very strong vaccine protection they already have.

Some argued in favor of extra shots for healthcare workers to keep them healthy as hospitals fill up

One of the main reasons that healthcare workers were initially considered in the recommendations was in the hopes of keeping a strained healthcare system, near buckling under the burden of unvaccinated patients, afloat.

“We don’t currently have enough healthcare workers to take care of the unvaccinated,” Dr. Talbot, who works at Vanderbilt University in Nashville, said during the meeting.

Talbot stressed that boosters, if they help prevent more mild symptomatic infections, could keep more doctors and nurses healthy and at work, but that’s mainly to take care of the “large populations which are unvaccinated.”

“We are declining care to people who deserve care because we are full of unvaccinated patients,” she said.

It’s not clear yet whether boosters will reduce transmission of the virus from vaccinated people.