CDC Supports 2nd Booster Shots for Americans 50 and Older

TUESDAY, March 29, 2022 (HealthDay News) -- Hours after the U.S. Food and Drug Administration authorized a second booster shot of the Pfizer and Moderna coronavirus vaccines for people 50 and older, the U.S. Centers for Disease Control and Prevention announced its support for the move.

Echoing the FDA, the CDC also recommended a second booster for "certain immune-compromised Individuals."

"Boosters are safe, and people over the age of 50 can now get an additional booster 4 months after their prior [booster] dose to increase their protection further," CDC director Dr. Rochelle Walensky said in an agency statement.

"This is especially important for those 65 and older and those 50 and older with underlying medical conditions that increase their risk for severe disease from COVID-19," she added, "as they are the most likely to benefit from receiving an additional booster dose at this time."

Any adult recipient of the single-dose Johnson & Johnson vaccine is also recommended to get a second booster, the CDC said.

"Based on newly published data, adults who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least 4 months ago may now receive a second booster dose using an mRNA [Pfizer or Moderna] COVID-19 vaccine," the agency said.

Walensky hinted that general access to a second booster might be further expanded later. "CDC, in collaboration with FDA and our public health partners, will continue to evaluate the need for additional booster doses for all Americans," she said.

Dr. Peter Marks directs the FDA’s Center for Biologics Evaluation and Research. During a media briefing held Tuesday, he explained the FDA's reasoning on second booster shots.

"Recent data show that three doses of the COVID-19 vaccine retain some degree of effectiveness over time. That said, the available data also show that immunity does wane to some extent over time, and older adults and those with weakened immune systems, even if they’ve received a booster, may be more likely to experience severe outcomes if they get COVID-19,” Marks said. "To give those at highest risk of serious outcomes of COVID-19 the option for continued protection, we are authorizing a second booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccines for use in people 50 years of age or older, and those with certain kinds of immunocompromise.”

When asked why age 50 was chosen as the FDA's age cutoff for second booster shots, Marks noted that “we know that people in the age range from about 50 to 65, about a third of them have significant medical co-morbidities. By choosing age 50 and up… we felt like we would capture the population that might most benefit from this fourth booster dose.”

The CDC's support signals that second booster shots should now become available to recommended recipients.

Tuesday's move by the CDC and FDA has not come without debate, however.

Some federal health officials strongly support second boosters, while others are skeptical, but they came to the decision to offer the shots in case infections surge again before the fall, The New York Times reported. Marks said the CDC’s vaccine advisory committee will meet next week to discuss whether another booster will be recommended in the fall -- possibly involving a new vaccine targeting one of the newer COVID variants.

“It would not be surprising if there’s a potential need. I don’t want to shock anyone, but there may be a need for people to get an additional booster in the fall along with a more general booster campaign," Marks said. "We may need to shift over to another variant coverage. It may be a decision is made that rather than the vaccines we currently have, which are called vaccines against the prototype virus, that we will move to a vaccine that is either against one of the variants, whether it’s Omicron, Beta, Delta, or something else.”

“We know already that it is reasonable from this past year to give the influenza vaccine and COVID 19 vaccine at the same time," Marks noted. "It may turn out that if we decide that boosters are necessary, that our annual flu vaccine campaign -- in which usually on an average year in the United States, we give somewhere between 150 and 170 million doses of influenza vaccine -- could be paired with a COVID 19 vaccine campaign. That will be something for discussion as a possibility because of the operational efficiency that could bring and the protection that it might help bring.”

In the meantime, if a major wave of COVID-19 surfaces in the next few months, a second booster dose for older Americans could save thousands of lives and prevent tens of thousands of hospitalizations. But if there is no significant surge until the fall, second boosters could waste vaccine doses, increase vaccine fatigue and raise questions about the federal government's strategy, according to the Times.

Public health experts said they are finding it harder and harder to advise their patients on whether they should get yet another shot.

"I've been getting multiple inquiries from lay friends over the past few days: 'What does this mean, and what should I do?'" John Moore, a professor of microbiology and immunology at Weill Cornell Medicine in New York City, told the Post. "I find it increasingly difficult to tell friends what they should do. It's becoming really problematic."

The primary benefit of a fourth shot is thought to be protection against severe illness, and that risk can vary dramatically among people 50 and older. A plethora of factors — underlying health conditions, age and time since last booster dose or infection — all play a role in what a person should consider when weighing a second booster.

Meanwhile, another surge of coronavirus cases in Europe is being driven by the highly contagious Omicron subvariant BA.2. And just this week, BA.2 became the dominant variant in the United States, where it is now responsible for nearly 55% of all cases.

To date, one in 75 Americans aged 65 or older has died of COVID-19, accounting for three-fourths of U.S. deaths from the virus, CDC data show. More than 33 million (over two-thirds) of people in that age group have a first booster and would be eligible for a second, the Times said.

Opinions about second boosters for older adults vary in the wider scientific community.

"I am not persuaded there is substantial waning of protection against severe disease after the third dose," Dr. Philip Krause, a former senior regulator at the FDA, told the Times.

But while healthy younger people with one booster are protected at the moment, older people "should probably start receiving fourth shots now," Dr. Monica Gandhi, an infectious disease doctor and medical professor at the University of California, San Francisco, told the newspaper.

The fact that officials approved, but didn't recommend, a second booster could frustrate the public, according to Dr. Judith Aberg, chief of the division of infectious diseases at Mount Sinai Health System in New York City.

Approving a second booster without meetings of the FDA and CDC advisory panels — as happened with the first boosters -- could also draw criticism, another expert suggested.

"This is a complex decision that involves a pretty deep dive, and I think it would really benefit from public discussion," Dr. Jesse Goodman, a former chief scientist at the FDA, told the Times. "I would not want to see an advisory committee skipped on this."

While no advisory panel meetings on second boosters are planned, the FDA has scheduled a meeting of its advisory committee on April 6 to discuss the administration's overall future vaccine strategy.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on boosters.

SOURCES: U.S. Centers for Disease Control and Prevention, statement, March 29, 2022; U.S. Food and Drug Administration, news release, March 29, 2022; The New York Times; Washington Post