The Biden administration is recommending that adults receive Covid-19 booster shots eight months after completing their first round of vaccination.
“We are prepared to offer booster shots for all Americans beginning the week of September 20 and starting 8 months after an individual’s second dose,” top administration health officials said in a statement Wednesday, attributing the change to the rise of the highly contagious Delta variant.
“Based on our latest assessment, the current protection against severe disease, hospitalization and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout,” added the group, whose members include President Joe Biden’s chief medical adviser, Anthony Fauci, and the heads of the Centers for Disease Control and Prevention, Food and Drug Administration and National Institutes of Health.
The policy will apply to people over 18 who have received the Moderna or Pfizer vaccines, and is contingent on authorization from the FDA and a review by CDC’s vaccine advisory committee. The administration officials said they anticipate offering booster shots to people who received the one-shot Johnson & Johnson vaccine but are waiting for further data before officially making that recommendation.
The announcement comes after weeks of intense debate inside the top echelons of the Biden administration’s Covid-19 task force about whether new data on vaccine effectiveness over time suggested Americans needed booster shots. The deliberations coincided with a push by the administration to continue donating doses to lower- and middle-income countries that are still struggling to complete a first round of vaccinations.
In a meeting Sunday, Biden administration officials reviewed vaccine data collected by the CDC that showed protection from vaccines declined in recent months as the Delta variant took hold and infections began to rise across the country. A study tracking adults in New York found that vaccine effectiveness against infection declined from 91.7 percent in early May to 79.8 percent by late July, according to a private administration briefing held for public health experts on Wednesday morning. During the same period, the state saw a rise in infections attributable to the more transmissible Delta variant.
The agency released the analysis, which included information on vaccinated and unvaccinated people gathered by city and state reporting systems, on Wednesday.
During a private administration briefing Wednesday morning for public-health experts, CDC Director Rochelle Walensky also cited data collected by the Mayo Clinic on the decreased effectiveness of the Pfizer and Moderna vaccines against infection from the Delta variant. The effectiveness of the Pfizer vaccine dropped from 76 percent against earlier versions of Covid-19 to 42 percent against Delta. The Moderna vaccine's effectiveness dropped from 86 percent to 76 percent against Delta.
Officials have also studied similar data from Israel which showed vaccine effectiveness against infection declined from about 95 percent in June to 64 percent in July as the Delta variant took over.
While the New York study found that vaccines still work well to prevent severe disease and hospitalizations, the data from the U.S. and abroad convinced Biden officials that Americans need boosters beginning this fall to complement other public health measures, such as masking and social distancing.
“I am strongly in favor of this booster strategy, and hope that what it will herald is a phase in the pandemic where we will empower patients, in consultation with their physicians, to make the best choices for themselves,” said Leana Wen, an emergency physician and public health professor at George Washington University. “Some may be comfortable with the level of protection against severe disease afforded by the existing vaccines; others will want to reduce symptomatic infection by getting a boost. People need to consider their own medical circumstances, exposures, and risk tolerance when it comes to booster doses.”
Other experts, and the World Health Organization, have pushed back against the plan given the intense unmet need for Covid-19 vaccines in much of the world. The WHO this week urged wealthy countries to refrain from offering boosters until late September, to help meet its goal of vaccinating at least 10 percent of people in every country. But several nations, including Israel, France and Hungary, have started offering boosters to portions of their population or plan to do so soon.
“We're planning to handle extra life jackets to people who already have life jackets, while we're leaving other people to drown without a single life jacket,” said Mike Ryan, executive director of the WHO Emergencies Programme, during a briefing Wednesday.
During the private administration briefing on Wednesday, several outside public health experts sharply questioned the administration’s strategy, according to multiple people on the call, telling officials they were unconvinced the scientific data justified distributing boosters.
They also aired concerns about the potential impact it could have on the global vaccination effort, while criticizing the abrupt rollout of the administration’s plan after weeks of top health officials downplaying the prospect that boosters would be needed imminently.
“I still don't understand why the administration is moving forward with extra doses of vaccine for the general population,” Céline Gounder, an infectious disease specialist and former Covid-19 adviser to the Biden transition, tweeted Wednesday, in a reflection of the private frustrations many health experts have directed toward the Biden team in recent days.
Even as the administration lays out plans for a second round of shots, more than 40 percent percent of the American population over the age of 12 is still not vaccinated. It’s not clear how the federal government will convince large portions of the country to not only sign up for their first set of shots but to return for a booster.
Biden officials did not provide details about how the booster shots would be distributed, but they stressed that vulnerable populations, including frontline health care workers and nursing home residents, should be at the front of the line. Both those groups were among the first to be vaccinated when shots became available late last year.
A second CDC study released Wednesday showed vaccine effectiveness among residents of nursing homes who received the Pfizer or Moderna vaccine was around 75 percent before the emergence of Delta and 53 percent during Delta’s spread.
A total of 100 million doses of the Pfizer and Moderna vaccines are available now, according to two senior officials with knowledge of the situation. The government has contracted for an additional 400 million to be distributed as needed.
Adam Cancryn and Carmen Paun contributed to this report.
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