Newsletter: The Road to Recovery

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The Biden administration is set to launch a scaled-back version of its booster programme after the top public health agency’s director endorsed a third jab for the elderly and other people whose jobs or health issues put them at high risk of severe illness from Covid-19.

The vaccine committee advising the US Centers for Disease Control and Prevention voted unanimously on Thursday to recommend booster doses of the BioNTech/Pfizer vaccine to people aged over 65 years and care home residents, and 13-2 to approve boosters for people aged 50-64 with underlying medical conditions.

It also voted 9-6 to offer boosters to people aged over 18 with underlying health conditions, a group comprising at least 50m people, according to CDC data. However, the panel rejected endorsing a third jab for those working in jobs with high risk of exposure to Covid, a large group that includes retail and healthcare workers, in a 9-6 vote.

But late on Thursday, Rochelle Walensky, head of the CDC, overruled the panel. In a statement, she said people working in jobs with high risk of Covid exposure “may receive a booster” based on their individual benefit and risk situation.

“This aligns with the FDA’s booster authorization and makes these groups eligible for a booster shot,” she said.

The Biden administration had planned to launch a widespread programme for all Americans over the age of 16 starting next week, even before regulators had given the go-ahead. The announcement infuriated some government scientists and resulted in the retirement of two top Food and Drug Administration officials earlier this month.

An FDA advisory panel this week declined to endorse BioNTech/Pfizer boosters for everyone over age 16, and instead recommended a third dose for a more limited group of older and at-risk individuals.

The FDA heeded that recommendation on Wednesday night, authorising a third dose for people aged 65 and over and adults at high risk of severe Covid-19 as well as those working in jobs where they are frequently exposed to the virus.

The split between the CDC expert panel and its director underscore the ongoing debate in the scientific community about the benefits of an extra dose versus potential risks of rare heart-related side effects, especially in younger people.

“The science shows that we have a really effective vaccine and we aren’t making a decision for the unvaccinated, we’re making a decision for the vaccinated,” said Helen Talbot, associate professor of medicine at Vanderbilt University and a member of the CDC panel.

“I don’t think we have the data in these younger age groups to make a decision for the booster dose,” she added.

Third doses will be available six months after full vaccination only for people who initially received BioNTech/Pfizer jabs. Several scientists questioned the logistics and fairness of this and voiced frustrations about the scarcity of data on a booster dose of the single-shot Johnson & Johnson vaccine.

“I just don’t understand how we can say to people 65 years and up ‘you are at severe risk of hospitalisation . . . but only half of you can protect yourselves right now’,” said Sarah Long, paediatrics professor at Drexel University College of Medicine.

The group debated the extent to which people should be able to assess their own eligibility because boosters can be administered based on a person’s own attestation, which has allowed some people to receive unauthorised boosters.