Health officials allow Americans to choose their own booster shot
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Following days of deliberations, vaccine advisory committees for the FDA and CDC each voted unanimously in favor of allowing eligible Americans to choose their own COVID-19 vaccine booster shots.
The FDA authorized the so-called “mix-and-match” strategy and CDC Director Rochelle P. Walensky, MD, MPH, endorsed the approach in federal guidance.
“Eligible individuals may choose which vaccine they receive as a booster dose,” Walensky emphasized 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.”
Infectious Disease News Editorial Board Member Jeanne M. Marrazzo, MD, MPH, said the 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, patients’ preferences, and consideration of safety in our efforts to enhance community levels of protective antibody,” Marrazzo, who heads the division of infectious diseases at the University of Alabama at Birmingham School of Medicine, told Infectious Disease News.
“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,” Marrazzo said.
The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) endorsed the mixing strategy at the same time it amended emergency use authorizations to allow boosters of the Moderna and Johnson & Johnson vaccines
Walensky signed off on the unanimous vote by the Advisory Committee on Immunization Practices (ACIP) to recommend a booster shot for people who received the Modern or Johnson & Johnson vaccines, following a 2-day long meeting where data on both boosters was presented, as well as data on mixing and matching doses.
Robert Atmar, MD, professor of infectious diseases at Baylor College of Medicine, presented data to the ACIP from an NIH study he led, which showed safety and efficacy rates of mixing and matching COVID-19 booster doses. Another researcher, Kirsten E. Lyke, MD, an associate professor of medicine at the University of Maryland, had presented the data earlier to the VRBPAC.
The study found that, among 458 participants, people who received a booster dose of a vaccine different than the vaccine they received for their primary series experienced protection that was similar to or greater than people who received the same vaccine as a booster. This meant that the heterologous had as good or higher neutralizing antibodies following the boost as homologous vaccination, Atmar said.
Evidence from the study, which was published on the preprint server medRxiv, 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 either messenger RNA vaccines from Moderna or Pfizer.
“Personally, if I had received Johnson & Johnson, I would get a booster with an mRNA vaccine, because, from the from the mix-and-match study, the immunogenicity looks really fantastic,” Infectious Disease News Editorial Board Member Carlos del Rio, MD, said in an interview.
Experts have suggested that patients may be confused about which vaccine they are supposed to receive as a booster, and when. Del Rio said it is important to remind patients about the good news from the NIH study — “that there’s good reactogenicity and immunogenicity of mixing and matching our vaccines.”
“I think it is actually a really good idea, and I’m glad the FDA [approved] it because the reality is that this is how we’re going to be looking at some of those vaccines, right?” del Rio said. “Let’s suppose you’re getting your influenza shot, and you say, ‘Well, I always get the GlaxoSmithKline flu vaccine, so I can’t take the Sanofi flu vaccine.’ We take the vaccine that is there.”
The FDA authorizations are for a half-dose booster of the Moderna vaccine for people aged 65 years or older and younger people with health and occupational risk factors, to be given after at least 6 months, and a full booster shot at 2 months for anyone aged 18 years or older who received the Johnson & Johnson vaccine — not just certain groups.
The Moderna authorization mirrored the one issued for the Pfizer-BioNTech COVID-19 vaccine booster in September.
“The FDA, by ratifying the decision of its advisory group, followed the science of where the need for boosters actually exist,” Amesh A. Adalja, MD, senior scholar at Johns Hopkins Center for Health Security, told Infectious Disease News. “As decisions about booster vaccination doses are made, it is critical that it is a clinically driven, scientific, evidence-based, transparent process.”
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.
Infectious Diseases Society of America President Daniel P. McQuillen, MD, FIDSA, said the decision to recommend mixing booster shots “means flexibility for patients and clinicians, which can improve vaccine access and equity.”
“As FDA and CDC continue to track the data in real-time, it is expected that recommendations for who should be getting boosters may change to continue to reflect the best available information,” McQuillen said.
Noting that winter is approaching, McQuillen urged everyone who is eligible to get vaccinated.
“Whether it is a first dose or a booster shot, vaccines help maximize protection against COVID-19 infection, serious illness, hospitalization, and death,” he stated.
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