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September 24, 2021

The Centers for Disease Control and Prevention on Friday endorsed the distribution of Pfizer and BioNTech’s Covid-19 booster shots to older Americans and other vulnerable people, including those in high-risk occupational and institutional settings. Millions of Americans who are at the highest risk for Covid will now be able to receive a Pfizer-BioNTech booster shot to increase their protection. 

Earlier, the agency’s Advisory Committee on Immunization Practices unanimously endorsed giving third Pfizer shots to people 65 and older and nursing home residents and made other recommendations.

However, CDC Director Dr. Rochelle Walensky made a recommendation that the advisory panel had rejected. The panel voted against giving booster shots to people from 18 to 64 years old who were at a higher risk of exposure to the virus due to their workplace or institutional setting, but Walensky put that recommendation back in. Here’s what the CDC recommends:

  • people 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s Covid vaccine at least 6 months after their Pfizer-BioNTech primary series;
  • people from 50-64 years old with underlying medical conditions should receive a booster shot from Pfizer-BioNTech at least 6 months after their Pfizer-BioNTech primary series;
  • people from 18–49 years old with underlying medical conditions may receive a booster shot of Pfizer-BioNTech’s vaccine at least 6 months after their Pfizer-BioNTech primary series, depending on their individual benefits and risks;
  • people aged 18-64 years who are at increased risk for Covid-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.

“I believe we can best serve the nation’s public health needs by providing booster doses for the elderly, those in long-term care facilities, people with underlying medical conditions, and for adults at high risk of disease from occupational and institutional exposures to COVID-19,” said Dr. Walensky. The move aligns with the FDA’s booster authorization, she added.

Earlier Thursday, the CDC advisory panel struggled over a controversial proposal to give boosters to wide swath of the U.S. population, rejecting the plan by a vote of 9-6. It would have distributed the shots to nursing home staff, people who live or work in prisons and homeless shelters, front-line health employees, unpaid caregivers, and other essential workers, like teachers. “I mean, we might as well just say just give it to everybody 18 and over,” committee member Dr. Pablo Sanchez said before voting against the proposal.

Dr. Leana Wen, an emergency physician, and former Baltimore health commissioner, on Twitter, called the CDC panel’s vote to reject boosters more widely a “mistake.” “Really, we are not allowing healthcare workers, many of whom got vaccinated back in December, to get a booster? What about teachers in cramped classrooms where masks aren’t required?” she tweeted, adding CDC Director Dr. Walensky should overrule the recommendation.

The recommendation doesn’t go nearly as far as President Joe Biden wanted. His administration said it planned to start giving booster shots to people 16 and older this week. While the CDC panel’s recommendation doesn’t give the Biden administration everything it wanted, boosters will still be on the way for millions of Americans who originally received Pfizer’s shots.

The endorsement comes a day after the Food and Drug Administration granted emergency use authorization to administer third Pfizer shots to many Americans six months after they complete their first two doses. While the CDC’s committee’s recommendation isn’t binding, Walensky is expected to accept the panel’s endorsement shortly.

Walensky said, “These data are not perfect, yet collectively they form a picture for us, and they are what we have in this moment to make a decision about the next stage in this pandemic,” she said. Before the vote, some committee members said they worried that widely offering boosters could interfere with efforts to get the shots to the unvaccinated or potentially reduce confidence in the vaccines’ effectiveness. Others were frustrated that only Pfizer recipients would be eligible to get the shots, leaving out millions of Americans who got the Moderna and Johnson & Johnson vaccines.

“We can use the experience from Israel to inform our knowledge of the safety of boosters,” Oliver said, adding the country has only reported one case of a rare heart inflammation condition known as myocarditis out of nearly 3 million third doses administered.

CDC official Dr. Kathleen Dooling said data also suggests a third dose may reduce the risk of severe illness in older adults and people with comorbidities. Potential risks include myocarditis, although this risk is very rare, occurring mostly in males under 30, she said. “The third dose of Pfizer-BioNTech Covid-19 vaccine appears to have similar reactogenicity as the second dose,” she added.

The topic of who should get boosters and when has been a contentious topic among the scientific community since the Biden administration last month outlined its plan to widely distribute them.

In outlining plans last month to start distributing boosters as early as this week, Biden administration officials cited three CDC studies that showed the vaccines’ protection against Covid diminished over several months. Senior health officials said at the time they worried protection against severe disease, hospitalization and death “could” diminish in the months ahead, especially among those who are at higher risk or were inoculated during the earlier phases of the vaccination rollout.