CDC starts debate on who gets the booster

After approval for all over 65 and those who are ‘high-risk,’ talks begin on application of those standards in practice

Scientific advisers to the Centers for Disease Control and Prevention are taking up a thorny challenge Thursday: Who qualifies for the new Pfizer-BioNTech coronavirus booster and why?

On Wednesday, the Food and Drug Administration authorized booster shots of the vaccine for people older than 65 who received their second at least six months earlier. The agency also authorized boosters for adult Pfizer-BioNTech recipients who are at high risk of severe COVID-19, or who are at risk of serious complications because of exposure to the virus in their jobs.

Roughly 22 million Americans are at least six months past their second Pfizer dose, according to the CDC. About half are 65 or older.

But who exactly risks becoming severely ill? What does it mean to be exposed on the job? Do teachers count as exposed, or just frontline health care workers? And what about Americans who got the Moderna and Johnson & Johnson shots?

Those are questions scientists on the CDC Advisory Committee on Immunization Practices are debating Thursday, and their decisions will shape the federal government’s guidance. The committee’s recommendations are not binding, and state officials sometimes implement their own criteria. Still, its decisions are likely to influence who gets the booster shots in practice.

At the start of Thursday’s meeting, Dr. Rochelle Walensky, director of the CDC, described the types of patients she hoped would benefit from booster shots — an attempt, perhaps, to outline the categories of people whom the agency’s leadership wants to receive the additional doses.

Notably, she mentioned not only older Americans and those at high risk of severe COVID-19 but also the example of a 35-year-old pregnant emergency room doctor. That is the kind of person whose high-risk job, the FDA has suggested, should make her eligible for a booster shot. In authorizing the boosters, the FDA included health workers, teachers, grocery workers and people in homeless shelters and prisons among those who should now be eligible for additional shots.

“You’re tasked with difficult decisions, weighing the risks and benefits, extrapolating from sometimes a wealth and sometimes a paucity of data available,” Walensky told the committee members. She urged them to consider equity, their own frontline experiences and above all their “commitment to follow the science.”

After the panel’s other recommendations on COVID-19 vaccines, Walensky has endorsed the committee’s guidance.

In its deliberations Wednesday, the CDC’s advisory committee zeroed in on unanswered questions.

A third dose undoubtedly amps up antibody levels, the experts concluded. But it is unclear how long that increase lasts, whether it translates to meaningful extra protection against severe disease and whether it can significantly decrease transmission of the virus. Several advisers said they believed the goal of the boosters should be to prevent severe illness, hospitalization and death, rather than stave off infection.

“I don’t think there’s any hope that vaccines such as the ones we have will prevent infection after the first, maybe, couple weeks that you have those extraordinary immediate responses,” said Dr. Sarah Long, a pediatric infectious disease expert at Drexel University College of Medicine in Philadelphia.