CDC committee recommends COVID-19 booster for kids aged 5 to 11 years

The CDC’s vaccine advisory committee voted Thursday to recommend that children aged 5 to 11 years receive a booster dose of the Pfizer-BioNTech COVID-19 vaccine.

Members of the Advisory Committee on Immunization Practices (ACIP) voted 11-1, with one abstention, to recommend that children in this age group “should” receive a booster shot at least 5 months after the primary two-dose series.

CDC Director Rochelle P. Walensky, MD, MPH, later endorsed the recommendation, making it official.

ACIP chair Grace Lee, MD, professor of pediatrics at Stanford University School of Medicine and associate chief medical officer for Stanford Children's Health, discussed data that showed the vaccine’s waning effectiveness.

“The more and more we look at this data, the more I'm starting to think perhaps it should have been a three-dose vaccine,” Lee said.

“In addition,” Lee continued, “I'm just going to state that based on what we're seeing about the [current variants], this really to me behaves more like flu. I don't know what the future holds, but it is feeling like it is reasonable to think of this more in the framework of a flu vaccine, rather than to assume that we will have permanent immunity over time.”

There was one abstention from a member who signed on late. The ACIP member who voted against recommending the booster was Helen “Keipp” Talbot, MD, MPH, an associate professor of medicine at Vanderbilt University Medical Center. Talbot also was the only ACIP member to vote against Pfizer’s booster for children ages 12 to 17 during a January meeting, citing the risk for myocarditis in that case.

“I want it known that I really do want children to be vaccinated,” Talbot said following Thursday’s vote. “But I think it’s only 30% [of this age group] who have received one [dose], and I think we really need to spend our time and effort on educating the 70% who have not been [vaccinated]. Boosters are great once everyone receives their first round, and I think that needs to be a priority.”

The ACIP voted 2 days after the FDA amended an emergency use authorization to OK the booster shot.

A real-word study published in MMWR in March demonstrated that the vaccine protects children aged 5 to 11 years, and Pfizer and BioNTech released data last month showing that a booster shot elicited a 36-fold increase in neutralizing titers against the omicron variant of SARS-CoV-2 with no new safety signals.

Pfizer still has the only vaccine authorized for U.S. children or adolescents of any age, although Moderna has asked for EUAs covering children as young as age 6 months. Moderna’s EUA application for kids aged 12 to 17 years — originally filed in June 2021 — is still on hold because of concerns related to myocarditis.

As of May 11, the CDC reported that approximately 8.1 million children aged 5 to 11 years in the U.S. had received two doses of the Pfizer-BioNTech vaccine, representing just 28% of that population. An additional 1.7 million received one dose.

According to the AAP, more than 93,000 new pediatric COVID-19 cases were reported in the U.S. during the week ending May 12 — a 73% increase from 2 weeks prior. It was the fifth week in a row that cases increased among children in the U.S.

At the start of the meeting, Lee commented on the recent, “sobering” news regarding over 1 million deaths due to COVID-19 in the U.S.

“I had never thought in December 2020, when the ACIP first examined vaccines, that we would be where we are today,” Lee said. “I had not anticipated we would be meeting on nearly a monthly cadence, looking at every single decision and trying to review every single piece of data coming in. I have found this experience to be absolutely humbling.”

“We all feel we are here to protect the health of every individual, and we have good tools in hand, but I do think we're going to continue to need better tools,” Lee continued. “We are going to continue to need to adapt our approach to protect the population, because this virus continues to evolve and change. I was wishing this could be one simple answer back in December 2020. But COVID clearly won't let us do that, so I really appreciate our committee being willing to come together and to continue to address these really difficult questions.”