OFFICIALS: FDA POISED TO APPROVE 2ND BOOSTERS FOR 50 AND OLDER

Extra shots will be not be explicitly recommended

The Biden administration is planning to give Americans age 50 or older the option of a second booster of the Pfizer or Moderna coronavirus vaccine without recommending outright that they get one, according to several people familiar with the plan.

Major uncertainties have complicated the decision, including how long the protection from a second booster would last, how to explain the plan to the public and even whether the overall goal is to shield Americans from severe disease or from less serious infections as well, since they could lead to long COVID.

Much depends on when the next wave of COVID infections will hit, and how hard. Should the nation be hit by a virulent surge in the next few months, offering a second booster now for older Americans could arguably save thousands of lives and prevent tens of thousands of hospitalizations.

But if no major wave hits until the fall, extra shots now could turn out to be a questionable intervention that wastes vaccine doses, deepens vaccination fatigue and sows doubt about the government’s strategy. The highly contagious Omicron subvariant BA.2 is helping to drive another surge of coronavirus cases in Europe and is responsible for about one-third of new cases in the United States, but health officials have said they do not anticipate a major surge caused by the subvariant.

Federal health officials have hotly debated the way forward, with some strongly in favor of a second booster now and others skeptical. But they have apparently coalesced around a plan to give everyone age 50 and up the option of an additional shot, in case infections surge again before the fall. In the fall, officials say, Americans of all ages, including anyone who gets a booster this spring, should get another shot.

The Food and Drug Administration could authorize a second booster as early as Tuesday, according to multiple people familiar with the deliberations.

After the FDA acts, Rochelle Walensky, director of the Centers for Disease Control and Prevention, is expected to issue a statement saying second boosters are available for eligible individuals interested in receiving them but not to explicitly recommend that.

People will be able to get a second booster at least four months after receiving the first booster. Currently, second boosters are recommended only for people whose immune systems are impaired, which can hamper an effective response to the vaccine.

A second booster is at best a stopgap measure. Many experts argue that the existing coronavirus vaccines need to be modified because the virus’ variants are diminishing their power; the question is how to reconfigure them. A surge in the fall is considered highly likely, whether it comes in the form of the Omicron variant, a subvariant like BA.2 or a new lineage entirely.

More than a dozen studies are under way to find the next generation of vaccines, with the first results expected in May or June. If all goes well, that would allow enough time to produce new doses before the fall. One major hitch is that the Biden administration says it does not have the money it needs to reserve its place in line by paying vaccine manufacturers for doses in advance.

On the plus side, data from the CDC indicates that four to five months after a third shot, the Pfizer and Moderna vaccines remain about 78 percent effective against hospitalization due to COVID-19. That might even be an underestimate, given the study’s limitations.

On the other hand, 78 percent is still a drop from the 91 percent effectiveness that was found after two months, and the vaccines’ potency may fall further with more time. If a new wave hits in the coming months, even a somewhat modest decline in protection against hospitalization could have a huge impact, especially among the roughly 55 million Americans 65 or older, who have borne the brunt of the pandemic so far.