C.D.C. Panel Meets on Who Will get Booster Pictures After F.D.A. Determination

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Scientific advisors from the Centers for Disease Control and Prevention faced a delicate challenge on Thursday: Who qualifies for the new Pfizer BioNTech coronavirus booster and why?

On Wednesday evening, the Food and Drug Administration approved a booster of the vaccine for people over 65 who had received their second at least six months earlier. The agency also approved boosters for adult Pfizer BioNTech recipients who are at high risk of severe Covid-19 or who are at serious work complications from exposure to the virus.

About 22 million Americans have had their second dose of Pfizer at least six months, according to the CDC, and about half are 65 years or older.

But who exactly is at risk of becoming seriously ill? What does it mean to be exposed in the job? Do teachers count as exposed or just frontline healthcare workers? And what about Americans who got the Moderna and Johnson & Johnson recordings?

These are questions that scientists from the CDC’s Advisory Committee on Vaccination Practices will discuss Thursday, and their decisions will shape the guidelines of the federal government. The committee’s recommendations are not binding, and civil servants sometimes implement their own criteria. Still, his decisions are likely to affect who gets the booster shots in practice.

In its deliberations on Wednesday, the CDC Advisory Committee answered open questions.

A third dose will undoubtedly increase antibody levels, the experts concluded. However, it is so far unclear how long this increase will last, whether it represents a useful additional protection against serious diseases and whether it can significantly reduce the transmission of the virus.

Scientists on the committee also noted the lack of safety data, especially among younger people. And several consultants said the goal of the boosters should be to prevent serious illness, hospitalizations, and death, rather than fighting off infection.

“I don’t think vaccines like the one we have will prevent infection after the first, maybe a couple of weeks, that you have these extraordinary immediate reactions,” said Dr. Sarah Long, pediatric infectious disease expert at Drexel University College of Medicine in Philadelphia.

The advisors also struggled with the practicalities of advocating a booster vaccine from Pfizer, but not from Moderna or Johnson & Johnson. Recipients of these vaccines may hear that a booster dose is needed – but they may not be able to get it yet.

Understand US vaccination and mask requirements

    • Vaccination rules. On August 23, the Food and Drug Administration fully approved Pfizer-BioNTech’s coronavirus vaccine for people aged 16 and over, paving the way for increased mandates in both the public and private sectors. Private companies are increasingly demanding vaccines for employees. Such mandates are legally permissible and have been confirmed in legal challenges.
    • Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in public places indoors in areas with outbreaks, a reversal of the guidelines offered in May. See where the CDC guidelines would apply and where states have implemented their own mask guidelines. The battle over masks is controversial in some states, with some local leaders defying state bans.
    • College and Universities. More than 400 colleges and universities require a vaccination against Covid-19. Almost all of them are in states that voted for President Biden.
    • schools. Both California and New York City have introduced vaccine mandates for educational staff. A survey published in August found that many American parents of school-age children are against mandatory vaccines for students, but are more likely to support masking requirements for students, teachers and staff who are not vaccinated.
    • Hospitals and medical centers. Many hospitals and large health systems require their employees to have a Covid-19 vaccine, due to rising case numbers due to the Delta variant and persistently low vaccination rates in their communities, even within their workforce.
    • New York City. Proof of vaccination is required by workers and customers for indoor dining, gyms, performances, and other indoor situations, although enforcement doesn’t begin until September 13. Teachers and other educational workers in the city’s vast school system are required to have at least one vaccine dose by September 27, without the option of weekly testing. Municipal hospital staff must also be vaccinated or have weekly tests. Similar rules apply to employees in New York State.
    • At the federal level. The Pentagon announced that it would make coronavirus vaccinations compulsory for the country’s 1.3 million active soldiers “by mid-September at the latest. President Biden announced that all civil federal employees would need to be vaccinated against the coronavirus or undergo regular tests, social distancing, mask requirements and travel restrictions.

“This is a major public health panic that we want to avoid,” said Dr. Long.

Moderna has applied for FDA approval for booster syringes, but at half the dose stated in the first two.

Mixing the first few shots of the Moderna vaccine with a Pfizer booster – or vice versa – is untested territory, and federal agencies are always reluctant to take steps that the evidence doesn’t specifically support.

Some global health experts have criticized the Biden government for pushing booster injections, even though much of the world has not yet received a first dose. But on Wednesday, the White House press secretary Jen Psaki argued that it was a “wrong decision.”

On Wednesday morning, President Biden said the United States would buy 500 million more doses of the Pfizer BioNTech vaccine to donate worldwide, with purchases doubling in July.

“We are now donating three shots worldwide for every shot we give an American, and we continue to believe we can do both,” said Ms. Psaki. “Our view remains that frankly the rest of the world needs to do and do more.”

Sharon LaFraniere and Noah Weiland contributed the coverage from Washington. Daniel E. Slotnik contributed the reporting from New York.

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