Why CDC recommends new boosters for all
Everyone over the age of 6 months should get the latest COVID-19 booster, a federal expert panel recommended Tuesday after hearing an estimate that universal vaccination could prevent 100,000 more hospitalizations each year than if only older adults were vaccinated.
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted 13-1 for that advice after months of debate about whether to limit its recommendation to high-risk groups. A day earlier, the FDA approved the new booster, stating it was safe and effective at protecting against the COVID-19 variants currently circulating in the U.S.
After the last booster was released, in 2022, only 17% of the U.S. population got it — compared with the roughly half of the nation who got the first booster after it became available in fall 2021. But those who did get the shot were far less likely to get very sick or die, according to data presented at Tuesday’s meeting.
The virus sometimes causes severe illness even in those without underlying conditions, causing more deaths in children than other vaccine-preventable diseases, as chickenpox did before vaccines against those pathogens were universally recommended.
The number of hospitalized patients with COVID-19 has ticked up modestly in recent weeks, CDC data show, and infectious disease experts anticipate a surge in the late fall and winter.
The shots are made by Moderna and by Pfizer and its German partner, BioNTech, which have decided to charge up to $130 a shot. They have launched national marketing campaigns to encourage vaccination. The advisory committee deferred a decision on a booster produced by Novavax because the FDA hasn’t yet approved it.
Here’s what to know:
Who should get the COVID-19 booster?
The CDC advises that everyone over 6 months old should, for the broader benefit of all. Those at highest risk of serious disease include babies and toddlers, older adults, pregnant women, and people with chronic health conditions including obesity. The risks are lower — though not zero — for everyone else. The vaccines, we’ve learned, tend to prevent infection in most people for only a few months. But they do a good job of preventing hospitalization and death, and by, at least diminishing infections, they can slow spread of the disease to people whose immune systems might be too weak to generate a good response to the vaccine.
Pablo Sánchez, an Ohio State University pediatrics professor who was the CDC panel’s lone dissenter, said he was worried the boosters hadn’t been tested enough, especially in kids. The vaccine strain in the new boosters was approved only in June, so nearly all the tests were in mice or monkeys. However, nearly identical vaccines have been given safely to billions of people worldwide.
When should you get it?
The vaccine makers say they’ll begin rolling out the vaccine this week. If you’re in a high-risk group and haven’t been vaccinated or been sick with COVID-19 in the past two months, you could get it right away, said John Moore, an immunology expert at Weill Cornell Medical College. If you plan to travel this holiday season, Moore said, it would make sense to push your shot to late October
or early November, to maximize the period in which protection induced by the vaccine is still high.
Who will pay for it?
When the CDC panel recommends a vaccine for children, the government is legally obligated to guarantee kids free coverage, and the same holds for commercial insurance coverage of adult vaccines. For the 25 million to 30 million uninsured adults, the federal government created the Bridge Access Program. It will pay for rural and community health centers, as well as Walgreens, CVS, and some independent pharmacies, to provide COVID-19 shots for free. Manufacturers have agreed to donate some of the doses, CDC officials said.
Will this new booster work against the current variants of COVID-19?
It should. More than 90% of currently circulating strains are closely related to the variant selected for the booster earlier this year, and studies showed the vaccines produced ample antibodies against most of them. The shots also appeared to produce a good immune response against a divergent strain that initially worried people, called BA.2.86. That strain represents fewer than 1% of cases currently. Moore calls it a “nothingburger.”
With new COVID-19, flu and RSV vaccines, how many shots should I expect to get this fall?
People tend to get sick in the late fall because they’re inside more and might be traveling and gathering in large family groups. This fall, for the first time, there’s a vaccine — for older adults — against respiratory syncytial virus. Kathryn Edwards, a 75-year-old Vanderbilt
University pediatrician, plans to get all three shots but “probably won’t get them all together,” she said. COVID-19 “can have a punch” and some of the RSV vaccines and the flu shot that’s recommended for people 65 and older also can cause sore arms and, sometimes, fever or other symptoms. A hint emerged from data earlier this year that people who got flu and COVID-19 shots together might be at slightly higher risk of stroke. That linkage seems to have faded after further study, but it still might be safer not to get them together.
Pfizer and Moderna are both testing combination vaccines, with the first fluCOVID-19 shot to be available as early as next year.
Has this booster version been used elsewhere in the world?
Nope, although Pfizer’s shot has been approved in the European Union, Japan and South Korea, and Moderna has won approval in Japan and Canada. Rollouts will start in the U.S. and other countries this week.
Unlike in earlier periods of the pandemic, mandates for the booster are unlikely. But “it’s important for people to have access to the vaccine if they want it,” said panel member Beth Bell, a University of Washington public health professor.
“Having said that, it’s clear the risk is not equal, and the messaging needs to clarify that a lot of older people and people with underlying conditions are dying, and they really need to get a booster,” she said.
Panel member Sarah Long, a pediatrician at Children’s Hospital of Philadelphia, voted for a universal recommendation but said she worried it isn’t enough. “I think we’ll recommend it, and nobody will get it,” she said. “The people who need it most won’t get it.”