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Health care workers left out of COVID-19 vaccine booster recommendation

September 24, 2021

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The Centers for Disease Control and Prevention’s (CDC’s) vaccine advisory committee voted Thursday not to recommend COVID-19 vaccine boosters for health care workers and other adults with occupational exposures.

However, the Advisory Committee on Immunization Practices (ACIP) gave the green light to boosters for people who are 65 years and older, people who live in long-term care facilities and people ages 18-64 years who have underlying medical conditions.

The recommendations still must be approved by the CDC director. If that happens, boosters could be given to eligible people six months after they complete their primary series. Boosters would be available only to people who received the Pfizer-BioNTech vaccine for their primary series. The same vaccine would be used for the booster.

People who don’t receive a booster still will be considered fully vaccinated two weeks after their second shot of the Pfizer-BioNTech or Moderna vaccines or a single dose of the Johnson & Johnson vaccine, according to the CDC.

The boosters are meant to address waning vaccine effectiveness against infection seen primarily in people ages 65 and older. These older adults also have seen some waning protection against hospitalization.

There are less data on waning protection for people with underlying medical conditions. ACIP made a distinction between boosters for adults with these conditions. Boosters are recommended for all people ages 50-64 years with an underlying condition, while people ages 18-49 with an underlying condition should weigh their individual risks and benefits. For males under age 30 especially, that may include the rare side effect of myocarditis.

The Food and Drug Administration (FDA) previously also gave emergency use authorization for Pfizer-BioNTech boosters for adults at high risk of serious complications of COVID-19 due to institutional or occupational exposure, including health care workers. ACIP member Helen Keipp Talbot, M.D., associate professor of medicine at Vanderbilt University, said the inclusion of health care workers largely would be to maintain hospital staffing levels.

“We don’t have enough health care workers currently to take care of the unvaccinated,” Dr. Talbot said. “They just keep coming even though we have to turn many of them away because there are just not enough beds. When we have beds, we’re often missing staff.”

But the language the committee voted on also included other people who may have occupational exposures, and some felt it was too broad.

“These are properly vaccinated people,” said ACIP member Sarah S. Long, M.D., FAAP, professor of pediatrics at Drexel University College of Medicine. “We know their risk of breakthrough is very low. We know their likelihood of being severely ill is very low. And we know these are groups with which there is some unknown risk of adverse events associated with the vaccine.”

Six members voted in favor of boosters for people with occupational exposures while nine voted against. ACIP Executive Secretary Amanda Cohn, M.D., said because the vaccines are being distributed by the federal government, vaccine providers must follow ACIP recommendations.

While there was considerable debate about who should receive boosters, most ACIP members agreed the primary focus needs to be vaccinating the unvaccinated. About 64% of people who are eligible for a vaccine are fully vaccinated, according to CDC data.

“We’re fighting a pandemic and it’s not because people got two doses of the vaccine, it’s because people are unvaccinated,” Dr. Talbot said. “… In all honesty, we could give boosters to people, but that’s not really the answer to this pandemic. … I feel like we’re putting lipstick on frogs.”



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