In an effort to bolster the nation’s waning immunity against the surging COVID-19 virus, U.S. Centers for Disease Control and Prevention director Dr. Rochelle P. Walensky recommended the Pfizer-BioNTech vaccine “booster” for people who are at risk of disease due to age, underlying medical conditions or jobs in high-risk jobs and institutional settings.
California vaccine providers are gearing up to begin administering the third dose as soon as the recommendation is approved by the Western States Scientific Safety Review Workgroup, which is likely to be imminent.
“We, along with our local and community partners, have been actively preparing for the possibility of administering booster doses and will be ready to administer immediately if approved,” according to a statement issued by California Health and Human Services Agency Secretary Dr. Mark Ghaly and State Public Health Officer Dr. Tomás Aragón.
As expected, the CDC endorsed one of the major recommendations — boosters for anyone age 65 and older — made on Thursday by its own independent panel, the Advisory Committee on Immunization Practices. Also eligible for boosters are people who live in an institutional setting, such as a state hospital, jail or prison.
But it diverged from the panel in its other recommendations, instead sticking more closely to criteria used by the U.S. Food and Drug Administration in its authorization on Wednesday.
Of people with underlying medical conditions, only older people ages 50 to 64 years should receive a booster shot, the CDC said. Its language was softer for younger people ages 18 to 49; they may choose get a booster, based on their personal assessment of their risk.
Significantly, the CDC expanded the eligibility list to include people who are at increased risk of disease because of their job, such as health care professionals, first responders and frontline essential workers.
The CDC’s panel had voted against this expansion. Members said there was no evidence of waning immunity in this group and worried that verification of employment would be too challenging.
Eligible people must be at least six months past their second dose of the vaccine to receive a booster. Of the 182 million Americans who are fully vaccinated, an estimated 27 million are at least six months past their second Pfizer dose and would be eligible, according to the CDC. Of these, about half are age 65 or older.
“If you’re not in a group that is universally recommended for boosters, it’s because we think you’re well protected,” said ACIP member Dr. Matthew F. Daley, a senior clinician investigator at Kaiser’s Institute for Health Research. “The decision we’re making today will be reevaluated as circumstances change.”
The two-dose regimen remains extraordinarily safe and effective in preventing severe disease, hospitalization and death. The pandemic is a disease of the unvaccinated: During the CDC’s two-day, 30-hour meeting, about 2,500 unprotected Americans died of COVID-19.
But there is emerging evidence that immunity begins to fade after five to six months, especially in elders. A Sept. 17 CDC report showed that four months after recipients got their second dose of the Pfizer vaccine, the effectiveness in preventing hospitalization fell from 91% to 77%. Effectiveness of the Moderna vaccine remained stable, falling from 93% to 92%. While not enough participants had received the one-shot Johnson & Johnson vaccine, it has been 71% effective in preventing hospitalization.
A third-dose booster dramatically increases the level of protective antibodies, providing a four- to 10-fold increase in immunity, according to Pfizer data presented at the meeting.
Here are the critical impacts of the CDC decision:
• Only certain groups are eligible for the booster, including:
People age 65 or older. These elders were prioritized because they show the most dramatic dropoff in immunity six months after their second dose, so face the greatest risk of severe illness and death. But this age cutoff means that many at-risk Black people and Latinos aren’t eligible, according to Stanford University infectious disease epidemiologist Dr. Yvonne Maldonado. About 39% of Latino deaths and 31% of Black deaths occurred in those under age 65, as compared to 15% in whites, she said.
People with underlying illnesses that put them at risk of severe COVID-19, such as cancer, cerebrovascular disease, heart disease, diabetes, lung disease or kidney disease.
People who live in long-term care facilities or other group institutions such as homeless shelters or prisons.
People who work in high-risk settings, such as health care professionals, teachers, day care staff, and grocery workers.
• Younger and healthier people aren’t eligible:
That’s because they are still protected from serious illness by the vaccine, the panel agreed. Additionally, most of these people haven’t yet hit their six-month mark since their second vaccine.
Their immunity will also likely wane over time, the experts agreed. But even if they suffer mild or moderately “breakthrough” infections, they will remain well protected from serious illness.
• There was no decision on “mixing and matching”:
The CDC panel did not vote on whether people who received the Moderna or Johnson & Johnson vaccines could get the Pfizer vaccine. At this point, there is insufficient evidence to prove the safety and efficacy of this strategy, it said.
The FDA is still awaiting submission of J&J booster application. It is reviewing Moderna’s application; there is no date yet for a decision. If you are older or at risk, you can ask your doctor about getting a Pfizer booster.
• Pharmacies and medical providers are gearing up to offer boosters:
People will be able to sign up online through the state’s MyTurn site, and some counties, such as Santa Clara, will allow residents and people who work or study in the county to sign up through their own online or phone-based systems.
“We’re ready once the final approval comes from the CDC,” said Jennifer Tong, associate chief medical officer for Santa Clara Valley Medical Center.
People will also be able to get a booster shot through pharmacies such as CVS and health care providers such as Kaiser Permanente and Stanford. On Thursday morning, Gov. Gavin Newsom’s office said MyTurn will also send text message alerts to Californians when they are eligible for a booster shot.
Kaiser said it will also reach out to eligible groups after the CDC committee makes its recommendations.
Boosters will require only self-verified ‘attestation’ that you meet the criteria due to age or health status. Be prepared to show your vaccine card to prove that six months have passed since your second dose. If you don’t have it, it is likely stored in the state, pharmacy or health care provider database.
• There will be plenty of vaccines left for the unvaccinated:
“Supply for Pfizer vaccine is not an issue right now,” said the CDC’s Dr. Sara Oliver. “There is plenty of vaccine to continue to give the primary series, as well as the booster dose.”
The CDC’s first priority will continue to be on getting people their initial series, she said.
• There’s no rush:
You don’t need to get your booster at precisely six months, said the CDC’s Oliver. While protection starts to wane, most people are still very protected.
Staff writer Emily DeRuy contributed to this story.