Americans ‘may choose’ their own booster, CDC director emphasizes
The director of the CDC signed off on her vaccine advisory committee’s recommendations to allow booster doses of the Moderna and Johnson & Johnson COVID-19 vaccines and emphasized that Americans can now choose their own booster shot.
“Eligible individuals may choose which vaccine they receive as a booster dose,” Rochelle P. Walensky, MD, MPH, said in a statement. “Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots.”
Walensky endorsed the Advisory Committee on Immunization Practices’ unanimous vote to recommend a booster shot for people who received the Modern or Johnson & Johnson vaccines, as authorized by the FDA. Booster doses of the Pfizer vaccine have been available since last month.
People who received two doses of the Moderna vaccine are eligible for a booster after at least 6 months if they are aged 65 years or older or between 18 and 64 years with certain risk factors, like an underlying medical condition or a job that puts them at risk.
Anyone who received Johnson & Johnson’s one-shot vaccine — not just certain groups — can receive a booster dose after at least 2 months.
Evidence from an NIH study suggests that people who initially received the Johnson & Johnson shot, which has not demonstrated levels of protection as high as the other vaccines, are better off receiving a booster dose of the messenger RNA vaccines made by Moderna or Pfizer. The study found that heterologous booster regimens performed as well as homologous regimens.
“The people who received the J&J vaccine [should] be excited because they will be permitted to mix and match,” Infectious Disease News Editorial Board Member William Schaffner, MD, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, told Healio.
Boosters are now authorized for all three vaccines 2 months after President Joe Biden announced a plan to offer them to all Americans amid a nationwide surge in cases due to the delta variant. Under that original plan — which was not supported by data, some experts argued — boosters would have been available on Sept. 20, beginning 8 months after the completion of the primary series.
According to the CDC, 66.2% of all Americans have received at least one dose of a COVID-19 vaccine, 57.2% are fully vaccinated, and more than 11.6 million have already received a booster dose.
More than 730,000 Americans have died because of complications of COVID-19 and more than 45 million cases have been reported in the U.S., including more than 73,000 cases in the last week.
“The unvaccinated remain at highest risk for severe disease, and we must continue efforts to deliver primary vaccination to the unvaccinated,” Kathleen M. Neuzil, MD, MPH, director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine, told Healio.
References:
CDC. COVID data tracker. https://covid.cdc.gov/covid-data-tracker/#datatracker-home. Accessed Oct. 22, 2021.
Perspective
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The navigation of the booster shot world is going to be challenging for patients because there are a lot of moving parts. The bottom line is that those aged older than 65 years will benefit most from a booster vaccination because it will prevent them from having any severe breakthrough infections.
For those healthy and aged younger than 50 years, the data are less compelling because the risk of severe disease is so low.
It appears that data also support Johnson & Johnson being augmented with a booster for everyone with a promising mix-and-match option available.
As we move forward in this pandemic, it will be important to have data-driven decisions regarding boosters specifically focused on where their benefit may be greatest. At the same time, it will be critical to be continuously integrating and updating recommendations with newer vaccines, dosing regimens and other research that will be forthcoming.
Perspective
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The CDC’s decision opens the door to administering SARS-CoV-2 boosters with more flexibility and ease. It means that we can factor in local vaccine availability and distribution options, patient’s preferences, and consideration of safety in our efforts to enhance community levels of protective antibody. This is especially important as we head into the winter season and anticipate the potential not only for increased indoor transmission of SARS-CoV-2 among unvaccinated people, but the appearance of our usual winter respiratory viruses, including influenza. The process worked as it should have — open, transparent and detailed discussion of the pros and cons of this approach.
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