CDC advisers recommend Moderna and J&J boosters

WASHINGTON — Advisers to the Centers for Disease Control and Prevention on Thursday unanimously recommended the Moderna and Johnson & Johnson boosters for tens of millions of Americans deemed vulnerable because of their age, health or occupation to bolster their protection against the coronavirus.

The panel also said that consumers should be allowed to choose from any of the three boosters now authorized in the United States, no matter which vaccine they first received. Members directed the CDC to provide further guidance to consumers and clinicians about who might benefit from choosing one booster over another, noting that the risks and benefits vary based on age and sex, among other factors.

“I think the opportunity for these [mix and match] boosts [is] priceless,” said Helen Keipp Talbot, an infectious-disease doctor at Vanderbilt University and panel member.

CDC Director Rochelle Walensky is expected to sign off on the recommendations later Thursday evening, allowing clinicians and pharmacies to begin giving booster doses of the Moderna and Johnson & Johnson vaccines, in addition to the already authorized Pfizer-BioNTech shots, to nearly 100 million eligible Americans.

Action by Walensky — following a green light Wednesday from federal regulators — would largely fulfill the administration’s promise to make boosters of all three vaccines available to Americans, albeit a month later than promised and for a smaller group. The administration’s focus on boosters came as the highly contagious delta variant sickened millions and killed tens of thousands, and also reflected concern about waning immunity from the vaccines.

A CDC sign-off on the additional boosters as well as the flexibility to mix and match the shots would give greater leeway not just to consumers, but to clinicians and pharmacies offering them to vulnerable populations. Health officials have repeatedly sought ways to make it easier for people to get another dose, especially those who have had side effects from one brand, or who worry about risks associated with a particular shot.

The availability of boosters would be particularly welcome to the 15 million recipients of the Johnson & Johnson vaccine, many of whom have been particularly fearful of breakthrough infections given that shot’s lower level of protection compared with the messenger RNA vaccines.

“I agree that those who received a [Johnson & Johnson] vaccine should receive a second dose - I would prefer that those individuals get an mRNA vaccine” rather than a second Johnson & Johnson shot, said panel member Pablo J. Sanchez, a pediatrician at Ohio State University.

Interchangeability of shots is also likely to speed booster vaccination in nursing homes and other institutional settings where residents received different shots during the early rollout. The Pfizer-BioNTech booster is already in use since it was authorized and recommended last month.

The advisory panel’s recommendation was similar to Wednesday’s action by the Food and Drug Administration. The FDA did not take a position on whether people should stay with the original vaccine or switch to another one, saying it did not have the data to make such judgments. CDC advisers and agency officials are still working out whether to recommend that people stick to their original vaccine, if possible. The agency plans to release guidance early next week with more detailed information to assist in decisionmaking.

On Wednesday, the FDA also authorized a third shot of Moderna or Pfizer-BioNTech for anyone 65 and older, or any adult at high risk of severe illness because of underlying conditions or job exposure, who has gone at least six months since their second dose. It broadened eligibility much further for those who received the single-shot Johnson & Johnson vaccine: Anyone 18 and over who has gone at least two months since getting J&J’s shot can get a booster criteria reflecting the lower protection afforded by that vaccine compared with the others.

Mixing and matching booster shots may appeal to consumers concerned about possible risks associated with their first vaccine, panel members said.

“A lot of what our efforts are centered around is trying to mitigate risk as much as possible, both from disease as well as vaccination,” said Grace Lee, a professor of pediatrics at Stanford University School of Medicine and chair of the panel.

More data on the safety of booster shots for different groups may help determine “whether or not a different boost would be appropriate, for example, for young women” who first received Johnson & Johnson, Lee added.

Some questioned administering a second Johnson & Johnson shot to women of childbearing age, for instance, because of the rare but serious risk of blood clots. Analyses of vaccine data for those who have received that shot suggest an increased risk of a rare type of clot, especially for women 18 to 49 years old.

For people who develop the rare blood clot after getting a first Johnson & Johnson shot, the advisers and the CDC do not recommend getting a Johnson & Johnson booster.

More than 11 million people have received a booster or an additional dose of a vaccine to date.