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Second boosters? CDC advisory panel grapples with the data

In a meeting of the medical and public health experts who advise the Centers for Disease Control and Prevention, parents and physicians said the priority should be on vaccine recommendations for children under 5.

(CN) — No vote was taken in a meeting of the Advisory Committee on Immunization Practices that lasted for 5 1/2 hours Wednesday, leaving only those 50 and older and those who are immunocompromised as the two groups of people who are recommended to re-up their Covid-19 vaccine boosters.

An estimated 4.3 million people in the U.S. above age 50 have received already a fourth dose of a Covid-19 vaccine, said Dr. Sara Oliver, lead for the Covid-19 vaccines ACIP Work Group, who presented slides Wednesday for the consideration of the panel of experts that advises the Centers for Disease Control and Prevention. 

Pointing to data from Israel, which already has a fourth dose program, Oliver noted that the benefits of receiving a fourth dose are lower than those associated with initial vaccination and a first booster.

“In summary, data from Israel demonstrate an increased immune response after the fourth dose that were higher rates of infection or severe illness, seen in the three dose recipients,” Oliver said.

Still, she noted that the biggest jump in hospitalization prevention occurs after primary series vaccination.

“Overall, to prevent a [single] hospitalization, we would need to vaccinate five to nine times as many persons with booster doses, compared to the primary series,” Oliver explained.

For immunocompromised patients, a second booster would actually be a fifth shot since the CDC recommended last summer that those who are immunocompromised receive three doses as part of their primary series.

She noted, however, there were some limitations to the data’s benefit risk assessment. 

“Hospitalization rates among unvaccinated persons tend to have larger increases during times of increased transmission, than those seen among the vaccinated persons,” she said. “Therefore the relative benefits of a primary series compared to booster will likely be larger during times of higher transmission.”

Oliver said Wednesday that those who have recently contracted Covid-19 may want to wait before getting boosted a second time, which prompted a question from ACIP member Veronica McNally, asking about people who think they had Covid-19 but aren’t sure.

The group’s clinical guidelines lead, Elisha Hall, answered Wednesday that the current recommendation, like those who have positively identified that they had Covid-19, is to wait for three months since their last symptoms.

The meeting is happening at a critical time in the pandemic, where many companies and individuals in the U.S. are dropping safeguards meant to protect against virus transmission. Earlier this week, a Florida federal judge threw out a mandate requiring masks on public transit. The Justice Department announced Tuesday that it will only appeal the judge’s decision to toss the mandate if an ongoing review by the Centers for Disease Control finds the rule is necessary to protect public health.

Oliver noted Wednesday that data does not support any concerns that giving additional doses of Covid-19 vaccines will lead to lower antibody levels. She said the known benefits of the fourth booster would include added prevention of Covid-19 related hospitalizations and deaths, prevention of post-Covid conditions, and the prevention of virus transmission.

Oliver also noted that, according to a recent survey done by the Harris Poll, 6 in 10 Americans said they would receive another booster if it's recommended, while just under one quarter of Americans said they would only receive a second booster if a new variant arises or if there's a surge in their area. Just 18% have no plans to get a booster at all. The survey polled around 2,000 U.S. adults between March 25 and 27.

The poll also indicated that 86% of respondents “definitely or probably” would get a second booster if it protected against new variants. 

Oliver noted that the goal of the Covid-19 vaccine program is to prevent severe disease, and that secondary goals include maintaining workforce and healthcare capacity, reducing infection rates, improving mental health with more social interactions, and preventing  post-Covid ailments.

“Current recommendations that individuals may receive this Covid-19 vaccine second booster really reflect the current conditions in the pandemic,” Oliver noted Wednesday. “We have wide availability of Covid vaccines, high protection against severe disease from the primary series and that first booster, low rates of COVID cases and hospitalization as well as use of antivirals and monoclonal antibodies. Overall, this is incredibly encouraging information and will continue to closely monitor but even as we've seen slight increases in cases in recent days, we've not yet seen increases in hospitalizations or deaths.”

Both Moderna and Pfizer have started offering fourth doses to older Americans.

While the agency is not required to follow the advisory panel’s recommendations, it usually does.  

During a portion of the meeting reserved for public comments, several parents and physicians urged the panel to act more quickly on an authorization for the 20 million U.S. children under 5 years old, who are not yet eligible for vaccination. A mother of a young boy who spoke to the panel said she felt like her son has been left completely unprotected as Covid-19 precautions disappear. She said he's been isolation and deprived of a normal life where he could go on playdates or get pictures with the Easter Bunny. 

“I've done everything in my power to keep my son for being infected, but this strain of Covid feels almost impossible to dodge, given how contagious, it is,” she said. “And everyone has stopped masking.”

A physician who spoke to the panel during public comments meanwhile noted that this population is also one that’s most at risk without communal masking, as “most children under 5 are unable to mask effectively or at all.”

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