US to recommend COVID vaccine boosters at 8 months

Federal health officials have been looking at whether extra shots for the vaccinated would be needed as early as this fall, reviewing case numbers in the U.S. as well as the situation in other countries such as Israel, where preliminary studies suggest the vaccine’s protection against serious illness dropped among those vaccinated in January.

An announcement on the U.S. booster recommendation is expected as soon as this week, according to two people familiar with the matter who spoke to The Associated Press on the condition of anonymity to discuss internal deliberations.

Doses would only begin to be administered widely once the Food and Drug Administration formally approves the vaccines, which are being dispensed for now under what is known as emergency use authorization. Full approval of the Pfizer shot is expected in the coming weeks.

Last week, U.S. health officials recommended boosters for some people with weakened immune systems, such as cancer patients and organ transplant recipients, citing their higher risk of catching the virus and evidence that the vaccines' effectiveness wanes over time.

The director of the National Institutes of Health, Dr. Francis Collins, said Sunday the U.S. could decide in the next couple of weeks whether to offer booster shots to Americans this fall.

Among the first to receive them could be health care workers, nursing home residents and other older Americans, who were some of the first to be vaccinated once the shots were authorized last December.

Since then, more than 198 million Americans have received at least one dose of a vaccine, according to the Centers for Disease Control and Prevention, with more than 168 million fully vaccinated.

Still, the country is experiencing a fourth surge of virus cases as a result of the more contagious Delta variant, which is spreading aggressively through unvaccinated communities but is also responsible for an increasing number of “breakthrough infections” of fully vaccinated people.

Israel, which exclusively administered the Pfizer shot, has been offering a booster to people over 60 who were vaccinated more than five months ago in an effort to control its own surge in cases of the Delta variant.

On Tuesday, European medical regulators said they are talking with vaccine developers about the need for boosters but haven’t made any decisions.

On Monday, Pfizer and its partner, BioNTech, announced they submitted data to the FDA to support authorizing a booster shot for the general public. Pfizer said a small study showed people who received a third dose had higher levels of antibodies against several strains of the coronavirus, including the Delta variant. The company is working on a larger study, the results of which will soon be submitted to regulators.

Studies show the shot remains highly protective against severe COVID-19, but results released last month suggested the effect wanes about six months after the second dose. Its effectiveness against symptomatic infection dropped gradually, from a peak of 96% two months after study participants got their second dose. Four months later, it was down to 90%, and by six months, it was about 84%.

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Americans who received the earliest doses of Pfizer's vaccine – mainly health care workers and nursing home residents – are approaching the eight-month mark from when they received their second dose.

“There is a concern that the vaccine may start to wane in its effectiveness,” the NIH's Collins said. “And Delta is a nasty one for us to try to deal with. The combination of those two means we may need boosters, maybe beginning first with health care providers, as well as people in nursing homes, and then gradually moving forward” with others.

He said because the variant only started hitting the country hard in July, the next couple of weeks of case data will help the U.S. make a decision.

"You don’t want it to really peter out before you start giving people boosters," Wohl said. "I think the Biden administration is hedging its bets that probably a year is too long, so why not start at eight months – because we know six months is fine – and start covering more people, especially as the Delta variant pops up.

"Probably higher levels of antibodies help protect us against the Delta variant than lower levels of antibodies," he added.

That added protection is vital for people in nursing homes, said Lauren Zingraff, director of the advocacy group Friends of Residents in Long-term Care.

"Not all of our residents are vaccinated. Some of our residents are medically fragile and immune-compromised," Zingraff said. "So, even with being fully vaccinated, they do still stand the risk of having breakthrough infections or being more susceptible to receiving this Delta variant."

"I’m willing to do whatever it takes to protect my family and my co-workers," said Sheila White, who works in health care and plans to get a booster.

"One, I don’t want to get sick," said White, whose immune system is weak after undergoing chemotherapy for breast cancer. "Two, I work with a lot of clients, the mentally ill, that I interact with quite a bit that could be COVID-positive, and I don’t want to take it home to my family."

The Pfizer and Moderna vaccines are administered in two doses. Officials are continuing to collect information as well about the one-shot Johnson & Johnson vaccine, which was approved in the U.S. in late February, to determine when to recommend boosters.

"I think the FDA and the CDC are letting people who got J&J down," Wohl said. "We told people, 'Get J&J. It’s going to be fine. It’s a good vaccine,' and now we don’t have a booster strategy for them.'

He said that he would recommend giving Johnson & Johnson vaccine recipients boosters of the Moderna or Pfizer vaccines.

"They should address this and fix this as soon as possible because we really did make a commitment to our folks who got Johnson & Johnson that they were getting a good vaccine – and they did. But now that we’re boosting other people, we should boost them, too," he said.

The White House has said that, even though the U.S. has begun sharing more than 110 million vaccine doses with the world, the nation has enough to deliver boosters to Americans.

Global health officials, including the World Health Organization, have called on wealthier and more-vaccinated countries to hold off on booster shots to ensure the supply of first doses for people in the developing world.

"We have a lot of vaccine, so we should use it," Wohl said. "I know there are a lot of efforts to make sure there is equitable vaccine distribution all over the world, but I think we could probably do both."