States rush ahead of feds on boosters

Faced with rising coronavirus infections, some states are pushing ahead of the federal government and making booster shots available to anyone who wants one, turbocharging the rollout in hopes of blunting a potential winter spike. 

This week, Colorado Gov. Jared Polis (D) signed an executive order declaring everyone over the age of 18 eligible for a booster dose. Hospitals in the state are once again full of COVID-19 patients, and officials are scrambling to slow the spread of the virus before winter.  

According to the Centers for Disease Control and Prevention (CDC), only about 45 percent of fully vaccinated adults 65 and older in Colorado have received a booster shot.  

In California, where cases are also rising, health officials are encouraging boosters for everyone who has been vaccinated for at least six months. Only about 34 percent of people over age 65 have received a booster in the state. 

“If you think you will benefit from getting a booster shot, I encourage you to go out and get it,” California Health Secretary Mark Ghaly said during a press conference. 

New Mexico also opened boosters to all adults on Friday amid a surge in cases that has overwhelmed hospitals in the state.

“I strongly encourage every New Mexican to register for a booster today — we have appointments available and are ready to get shots in arms,” New Mexico Gov. Michelle Lujan Grisham (D) said in a statement.

The current federal guidance for boosters is fairly broad — the people who should get a booster are those over age 65 and anyone at high risk because of work, where they live or those with an underlying medical condition.   

Vaccine providers are not supposed to ask questions or turn anyone away, relying on self-attestation for eligibility. Still, the Food and Drug Administration and the CDC stopped short of recommending boosters for everyone, which puts Colorado and California at odds with federal guidance.

Monica Gandhi, an infectious disease expert and professor of medicine at the University of California, San Francisco, said federal health officials haven’t been clear. 

Chaotic and at times disparate messaging from administration health officials over the past two months culminated in a complicated set of recommendations about who should be getting booster shots and why. 

“We have the CDC director saying one thing, [Anthony Fauci] saying another thing, the president saying another thing, and that is causing massive confusion, and that’s why public health officers are taking it upon themselves,” Gandhi said. 

“In my mind, the data is very clear. Get it if you’re over 65, get it if you’re immunocompromised, and then otherwise I think we don’t have good evidence for it,” she added.

The Biden administration has promised and encouraged booster doses for months, and federal officials are currently evaluating a request by Pfizer to authorize a booster dose for all adults over the age of 18.

When asked during a press briefing if other states should follow California and Colorado, CDC Director Rochelle Walensky demurred, stating they are encouraging everyone eligible for a booster to get one, but the agency’s goal is to make sure everyone gets their primary doses.

White House Press Secretary Jen Psaki on Friday said local officials should continue to follow federal guidelines. 

“This isn’t currently the guidance that’s being projected by our health and medical experts, and we would continue to advise leaders across the country to abide by public health guidelines coming from the federal government,” she said.

Celine Gounder, an epidemiologist and infectious diseases specialist at New York University and Bellevue Hospital, said states ought to be following the federal recommendations, but it’s a problem when the administration hasn’t articulated why boosters are necessary.  

“This is really only going to have an impact at that population level. It doesn’t make sense to have this individual free for all, which is the situation …  the California and Colorado governors are reinforcing,” Gounder said.

Gounder, who advised the Biden transition team on COVID-19, said she thinks health officials are searching for anything to try to improve protection since there are still so many people who aren’t vaccinated. 

“I think where this is coming from is this feeling that they’re really frustrated,” Gounder said. “They’ve done everything possible to try to encourage unvaccinated people to get vaccinated, starting with incentives and then incrementally moving towards mandates. … It’s sort of an act of desperation where it’s like, well, what else are we supposed to do?”

Experts and federal officials agree that boosters are not going to end the pandemic.  

But when only about 70 percent of people over the age of 18 are fully vaccinated, boosters may be the only thing they can do.  

In Colorado, officials argued that because transmission is so widespread, everyone is at risk of infection, and so everyone is eligible for a booster shot. 

“Because disease spread is so significant across Colorado, all Coloradans who are 18 years of age and older are at high risk and qualify for a booster shot,” Polis said in his order. 

During a press briefing on Friday, Polis also noted that if vaccinated people can get a booster, it will decrease the risk of a breakthrough infection spreading to someone older and vulnerable. 

But Gounder said boosters won’t help Colorado’s overwhelmed hospitals, and any additional protection may just be temporary. A concentrated effort to get boosters in nursing homes, she argued, would help a lot more. 

“Your risk as a vaccinated person is still proportional to the level of transmission in the community,” Gounder said. “And so the best protection is actually from getting the unvaccinated vaccinated, not by getting additional doses.”

— Updated at 10:11 p.m.