Well, this pandemic just keeps getting more and more interesting.
After midnight last night, Walensky (CDC Director) overturned the ACIP (external scientific advisory committee to the CDC) recommendation and approved the booster for high exposure occupations, like healthcare workers and teachers. The FDA and the CDC are now in agreeance that those that should get boosters are:
Long term care residents
50-64 years with underlying condition
18-49 years with underlying conditions are recommended to weigh their individual benefits with risks
High exposure occupations
If you’re confused and/or surprised, you’re not alone. A few high-level thoughts:
This is a highly unusual move. I don’t think the CDC has ever disagreed with its own ACIP advisory committee. This step is usually just a rubber stamp. But now the CDC and FDA align, which makes things…clearer?
The CDC is a very reactive (rather than proactive) agency. They always want to wait for solid data to make evidence-based recommendations, which is great. But this approach doesn’t work when we are in the middle of a rapidly evolving pandemic. We don’t have national, coordinated, public health infrastructure in the United States to actively track the situation. So, we have to make decisions based on limited data. The limited data suggests that protection is waning for frontline workers. And limited data suggest that an additional dose will reduce transmission. So, I’m pleasantly surprised the CDC made this decision. I can only imagine how uncomfortable they are, but it was the right move.
The booster is now approved for millions of people making implementation really difficult. This will (hopefully) come at the same time of a 5-11 year old COVID19 shot. And flu shots. I feel for pharmacies who distribute 70% of COVID19 vaccines in the United States…
The exact occupations and high risk conditions should be defined soon. But if you’re on THIS list of high risk conditions seriously consider getting a booster. For occupations, this likely means healthcare workers, workers at nursing homes, first responders, workers at homeless shelters and jails, teachers, maybe even grocery store workers. If you’re unclear, it’s best to have a conversation with your primary care clinician. I also feel for clinicians that will get a million calls due to this confusing change of events…
Moderna or J&J people are not approved for a Pfizer booster. The booster is under EUA (not fully approved), so clinicians cannot prescribe you the Pfizer shot off label either. But, if you’re high risk, please have a conversation with your physician about whether the benefits outweigh risks of mixing an additional dose.