Health Team

Boosters could come within days for 65+, other adults with underlying conditions

Vaccine advisers to the US Centers for Disease Control and Prevention argued long and hard Thursday before endorsing giving booster doses of Pfizer's Covid-19 vaccine to people 65 and older long-term care facility residents, and certain people with underlying conditions.

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By
Adam Owens, WRAL reporter,
and
Maggie Fox, CNN
CNN — Vaccine advisers to the US Centers for Disease Control and Prevention argued long and hard Thursday before endorsing giving booster doses of Pfizer's Covid-19 vaccine to people 65 and older, long-term care facility residents and younger adults with underlying conditions.

The recommendations only apply to those who got the Pfizer vaccine – not Moderna or Johnson & Johnson.

However, the advisers voted against recommending a booster dose for people whose jobs or situations put them at high risk of breakthrough infection – rejecting part of the US Food and Drug Administration's emergency use authorization.

It's a concern that Dr. C. Nicole Swiner says she hears daily at her practice, Durham Family Medicine. Patients ask for the booster, Swiner said, because of “the fear with the rising numbers, particularly with these variants that we are hearing about.”

That is why Vickie Ashman got her booster shot weeks ago. She has a condition that makes her particularly vulnerable to COVID.

“You do what is right for you. That is what I did. I did what I felt was right for me, anything to give me more immunity, more protection,” she said.

The CDC advisers voted unanimously to recommend a single Pfizer/BioNtech Covid-19 vaccine booster to people 65 or older and long-term care facility residents at least six months after they were fully vaccinated.

They also voted easily to recommend boosters to people 50 and older with underlying medical conditions that might put them at higher risk of severe disease. Such people might include patients with cancer, stroke, chronic kidney disease, chronic obstructive pulmonary disease or COPD, diabetes, heart conditions, obesity, as well as pregnant women and smokers, the CDC's Dr. Kathleen Dooling told the meeting.

Swiner said, because she considers herself to be high-risk, she's already gotten a booster too. Many others in the medical field have done the same – because of their COVID exposure on the job.

However, the advisers were divided and ultimately voted against recommending boosters for people under 50 in jobs or situations that put them at high risk of infection. It was a rare break with the FDA's advice.

"We may just as well say give it to everyone 18 and older," said Dr. Pablo Sanchez, a professor of pediatrics at Ohio State University.

"I feel very uncomfortable about this," said Dr. Wilbur Chen, a professor of medicine at the University of Maryland School of Medicine. "The implementation part of this is going to be fraught with such complexity that the people with the best health literacy will get boosters."

But ACIP chair Dr. Grace Lee, a Stanford University pediatrician, said her personal experience made her aware of the need to make boosters widely available.

"I have cared for children who have died of Covid," she said. "Their family members wish that they had extra protection for their kids."

Earlier in the day, a CDC analysis showed it was much more beneficial to give a booster dose to people 65 and older than to people in younger age groups.

The biggest risk from vaccination with Pfizer's vaccine is a rare heart inflammatory condition called myocarditis -- and just one case of myocarditis could be expected in a million people vaccinated in that age group, the CDC's Dr. Megan Wallace said.

"Even if myocarditis risk doubles -- we still see more hospitalizations prevented than myocarditis cases expected," Wallace said.

Dr. James Loehr of Cayuga Family Medicine in Ithaca, New York said he did not think adding boosters would save that many lives.

"I feel the goal is to decrease hospitalizations, and overall I think that the vaccinations will decrease hospitalizations, but I also feel that we're getting too much ahead of ourselves and that we have too much hope on the line with these boosters," he said.

"Even if we gave boosters to all 13 million people over 65 who have had the Pfizer vaccine in the past, that might be about 200 fewer hospitalizations a day, which is a lot," he added. But the bigger goal, he said should, be keeping the unvaccinated, especially children, out of the hospital.

After CDC Director Dr. Rochelle Walensky signs off on the ACIP recommendations, booster shots may be given immediately to those for whom they are recommended.

The CDC's Dr. Amanda Cohn, executive secretary for ACIP, said the committee can come back any time in the future to adjust their recommendations. "We have several meetings ahead of us," she said.

Third doses are already approved and recommended for some people who are immunocompromised and did not develop an adequate immune response from the two-dose regimen, according to the North Carolina Department of Health and Human Services.

Neither the third dose or the booster require any proof of medical condition to qualify. The boosters, like the vaccines before them, will rely on individudals to attest that they are eligible.

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