U.S. experts have been going back and forth about the need for booster doses in the U.S, with officials debating the necessity of providing third shots so quickly. Following recent recommendations from the U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) met on Sept. 23 to review the data and provide its own guidance. The panel ultimately voted to recommend booster shots for a number of U.S. adults, including those 65 and older, residents in long-term care settings, and younger adults with underlying medical conditions. But in a surprising twist, CDC Director Rochelle Walensky, MD, diverged from the committee's guidance.
The CDC released a statement following the ACIP's meeting, announcing that Walensky had endorsed the committee's recommendations for a Pfizer booster in certain populations, but the director also chose to extend the additional shots to another group: those in high-risk occupational and institutional settings.
The ACIP had voted against recommending booster doses for this group, after the FDA amended their emergency-use authorization (EUA) for Pfizer's vaccine to allow a third shot. Walensky overruled the ACIP's decision, choosing to mirror the CDC's new booster guidance after the FDA.
"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," Walensky said in a statement. "This aligns with the FDA's booster authorization and makes these groups eligible for a booster shot."
The CDC now states that "people aged 18 to 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 COVID-19 vaccine at least six months after their Pfizer-BioNTech primary series, based on their individual benefits and risk."
The extended guidance for those in high-risk settings is likely to include "health care workers, teachers and day care staff, grocery workers, and those in homeless shelters or prisons," acting FDA Commissioner Janet Woodcock, MD, explained on Sept. 22. But some ACIP members felt that this was too wide of an allowance, stating that there was little evidence to suggest that vaccinated teachers, or even health care workers, were at risk of repeated exposure to the virus, according to The New York Times.
The fear that that such a broad recommendation would essentially turn into an all-adults booster campaign is what led the committee to rule against a third dose for this group, so many were surprised when Walensky decided to break with her own agency's advisory panel. According to the NYT, the CDC director's endorsement of the committee's recommendations is typically just a formality, making this an unusual move.
"I am surprised that Dr. Walensky overturned one of the four ACIP votes today, and I believe others will be as well," Yvonne Maldonado, MD, an infectious disease expert at Stanford and the American Academy of Pediatrics liaison to the committee, told the news outlet. However, she added that the vote on boosters for frontline workers "was close" initially anyways.
"This addresses not only waning immunity, but those at high risk of exposure," Maldonado said of Walensky's decision, adding that she agreed with the director.