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August 31, 2021

How should the US approach booster shots? Here's what a CDC panel said.

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    As recent poll numbers suggest vaccine hesitancy is at an all-time low, CDC's Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend the Pfizer-BioNTech Covid-19 vaccine for people age 16 and older and floated the idea that the United States take a risk-based approach to distributing booster shots.

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    Vaccine hesitancy at an all-time low

    According to the latest installment of a poll by Axios and Ipsos, which was conducted between Aug. 27 and Aug. 30, vaccine hesitancy is at its lowest since the poll began in March.

    According to the poll, 72% of respondents said they've already been vaccinated, while another 8% said they're likely to get vaccinated. The remaining 20% said they're either not very likely or not at all likely to get vaccinated—a total that represents a new low for the poll, down from 34% in March and 23% two weeks ago.

    The poll found that one of the driving forces behind vaccine acceptance is mandates. While one in three respondents said FDA approval of a vaccine would make them likely to get vaccinated, 43% said their boss requiring a shot would make them likely to do so, compared with 33% a month ago.

    "Schools, organizations, companies, governments implementing mandates are forcing people to deal with them," Cliff Young, president of Ipsos U.S. Public Affairs, said. "That's what's going on."

    ACIP votes to recommend Pfizer-BioNTech vaccine

    Meanwhile, ACIP on Monday voted unanimously to recommend the use of Pfizer-BioNTech's Covid-19 vaccine in people age 16 and older. (The panel in December 2020 issued an interim recommendation for the vaccine; however, the panel had to reconvene to consider recommendation again since the vaccine received full FDA approval last week.)

    During the meeting, scientists presented data to ACIP showing that, for every 1 million doses, the vaccine prevents almost 12,000 hospitalizations and ICU admissions related to Covid-19 in adults ages 16 through 29.

    Data also showed that while both the Pfizer-BioNTech and Moderna vaccines come with a small risk of heart problems in younger men, these cases were uncommon and generally mild. ACIP said the benefits of the vaccine outweighed the risk.

    "I can't think of a vaccine where we've had more efficacy and effectiveness and adverse event data," said Sarah Long, an ACIP member from Drexel University. "This vaccine is worthy of a recommendation for what it does today and worthy of the trust of the American people."

    In addition, Sara Oliver, a scientist at CDC, presented unpublished data from Covid-Net, a hospital surveillance system, showing that all three Covid-19 vaccines used in the United States are at least 94% effective at preventing hospitalizations in adults under age 75 and more than 80% effective at doing so in adults over 75.

    However, the data found that protection against mild Covid-19 appears to have declined recently. "These reasons for lower effectiveness likely include both waning over time and the delta variant," Oliver said.

    ACIP floats risk-based strategy for booster shots

    ACIP on Monday also said they believe booster shots may be needed to increase Covid-19 vaccine effectiveness and prevent severe disease amid the delta surge. However, they fell short of endorsing President Joe Biden's plan to make booster shots available to all Americans eight months after their second dose, pending CDC recommendation and FDA approval. ACIP instead floated a preliminary plan that booster shots be given to long-term health care residents and essential health care workers before offering them to the general population.

    Beth Bell, an ACIP member from the University of Washington in Seattle, said getting unvaccinated people vaccinated should be the highest priority.

    "We've got lots of vaccine. At the moment, we don't have a lot of evidence of reduced vaccine effectiveness … based on the current data," Bell said.

    Similarly, Oliver said planning for booster shots "should not deter outreach for delivery of primary series to unvaccinated individuals."

    However, Grace Lee, chair of ACIP from Stanford University, said offering booster shots and encouraging unvaccinated people to get vaccines doesn't have to be an "either/or situation."

    She added, "Where we are in the pandemic, it makes sense to prevent severe disease, hospitalization, and death," which would be achieved by vaccinating those people who are currently unvaccinated and providing booster shots to vulnerable populations.

    Lee said the committee would meet later to consider booster shots for the general population. (Talev, Axios, 8/31; Cohen, Roll Call, 8/30; Anthes, New York Times, 8/30; Weixel, The Hill, 8/30; Walker, MedPage Today, 8/30; Gardner, Politico, 8/30)

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