CDC director partially overrules panel, signs off on boosters

Booster doses of Pfizer-BioNTech’s coronavirus vaccine can be administered to potentially tens of millions of people after the head of the Centers for Disease Control and Prevention (CDC) early Friday morning overruled recommendations from a key agency advisory panel.

In a rare move, CDC Director Rochelle Walensky overruled the panel and said people at risk of COVID-19 infection because of their jobs should also be eligible for a booster.

Boosters will be available six months after the completion of the second dosing for Americans over the age of 65, people in nursing homes, people with underlying medical conditions and people with jobs that put them at high risk of infection.

The shots are expected to be available at locations where the Pfizer vaccine is already being administered, including pharmacies, health departments, clinics and some doctor’s offices.

The CDC’s guidance aligns with what the Food and Drug Administration authorized on Wednesday. It avoids what was previously conflicting guidance and encompasses a wider population than what the agency’s vaccine advisory panel recommended earlier Thursday.

“As CDC Director, it is my job to recognize where our actions can have the greatest impact. At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good,” CDC Director Rochelle Walensky said in a statement.

About 26 million people received their second Pfizer dose at least six months ago, the CDC said. About half of those are 65 and older.

The CDC said an additional 23 million people are at least six months past their second Moderna shot and about 3.3 million people are at least six months past their one shot of the Johnson & Johnson vaccine.

Still, the number of people eligible for boosters is narrower than what the Biden administration initially wanted.

People who received Moderna’s vaccine and the Johnson & Johnson vaccine will not be eligible until the FDA gives those companies the green light.

Moderna submitted booster data at the beginning of September and Johnson & Johnson has not yet submitted evidence, though the company said trial and real-world evidence showed strong protection.

Walensky said the CDC “will address, with the same sense of urgency, recommendations for the Moderna and J&J vaccines as soon as those data are available.”

The path to booster authorization has not been without controversy.

Last month, President Biden and top health officials, including acting FDA Commissioner Janet Woodcock, Walensky and Surgeon General Vivek Murthy, publicly announced a booster shot program for all three vaccines would begin the week of Sept. 20, well before the FDA and CDC examined the evidence.

The administration initially wanted people to receive boosters beginning eight months after their second shot, in an effort to reduce transmission amid the spread of the delta variant.

While officials were careful to say the booster program was contingent on the FDA and CDC giving the green light, the move was criticized by scientists inside and outside the government. They argued there wasn’t enough evidence that showed protection against severe illness and hospitalization dropped to levels that warranted a booster.

“Many of the people who are now eligible to receive a booster shot received their initial vaccine early in the vaccination program and will benefit from additional protection,” Walensky said. “With the delta variant’s dominance as the circulating strain and cases of COVID-19 increasing significantly across the United States, a booster shot will help strengthen protection against severe disease in those populations who are at high-risk for exposure to COVID-19 or the complications from severe disease.”

Despite the nod from the CDC, the rollout is likely to be complicated and many questions still remain. The CDC will need to specifically define the underlying conditions that put people at high risk, as well as the jobs that will make people eligible.

While there’s no evidence about mixing a third Pfizer dose with two doses of the Moderna vaccine or a single dose of the Johnson & Johnson shot, state health officials said they will have a difficult time conveying that to a public that’s clamoring for boosters.