The Centers for Disease Control and Prevention
(CDC) has recommended that Americans aged 65 and older receive another round of
Covid vaccinations this spring. This recommendation underscores the importance
of providing additional protection to older adults who may be at increased risk
of severe illness or complications from Covid-19.
he Centers for Disease Control and Prevention (CDC) announced on February 28, 2024, that Americans aged 65 and older should receive an additional dose of the latest Covid vaccine during the spring. This additional shot would serve as a second dose of the most recent version of the Pfizer-BioNTech, Moderna, or Novavax vaccines, which were introduced in the fall. It's worth noting that individuals who are immunocompromised are already eligible for additional doses of the vaccine
During a meeting of the agency’s Advisory Committee on Immunization Practices earlier on the same day, federal researchers presented preliminary data indicating that the latest vaccines have an effectiveness of approximately 40 to 50 percent against symptomatic infection or hospitalization. However, estimates of effectiveness against currently circulating variants were based on small numbers.
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The data also revealed that in October and November, adults who received a fall dose accounted for 4 percent of Covid-related hospitalizations. Conversely, those who received a booster in the fall of 2022 but did not receive the updated vaccine in the fall accounted for 25 percent of Covid-related hospitalizations.
Indeed, according to modeling presented at the
meeting, administering a second dose of the latest Covid vaccine in the spring
would not be deemed cost-effective for adults aged 18 to 64 years old. This
decision is based on the understanding that individuals in this age group
generally face a lower risk of severe illness and hospitalization compared to
older adults. Therefore, the focus remains primarily on prioritizing additional
doses for older adults, who are at higher risk of severe Covid-19 outcomes.
The advisers concluded that older adults and individuals with weakened immune systems due to illnesses or medications would benefit the most from receiving a spring dose of the Covid vaccine.
Dr. Camille Kotton, a physician
at Massachusetts General Hospital and a member of the scientific advisory
panel, expressed her support for the additional dose, stating, “I was impressed
with data supporting the need for an additional dose of vaccine for those 65
years and older.” She emphasized the severity of the disease in this
population, saying, “Given the risk of severe, even life-threatening, disease,
I would encourage those who are moderately to severely immunocompromised to
take the opportunity for another dose.”
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The data presented highlighted
that adults aged 65 and older accounted for two-thirds of all hospitalizations
related to Covid between October 2023 and January 2024, with those aged 75 and
older representing nearly half of these hospitalizations. Additionally, adults
in this age group were the most likely to have received the fall shot.
The data indicates
significant variation in vaccination rates across different demographic groups
in the United States. Specifically:
More than 43 percent
of Americans aged 75 and older received the fall shot, demonstrating relatively
high uptake in this age group.
In contrast, fewer
than 10 percent of adults aged 18 to 29 years opted for the vaccine, indicating
lower vaccination rates among younger adults.
Vaccination rates were
lowest among Native Americans, Alaska Natives, and individuals residing in
rural areas.
Among pregnant women,
fewer than 13 percent chose to receive the vaccine.
Data from the National
Immunization Survey in January revealed that nearly half of those who did not
plan to get vaccinated expressed concerns about unknown serious side effects.
Other factors contributing to the low uptake included initial vaccine
availability issues and confusion regarding insurance coverage for the shots.
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The decision-making
process regarding recommending the shots for the fall was constrained by timing
issues. The agency’s advisers met in September to discuss recommendations,
leaving limited time for vaccine manufacturing and distribution before the
anticipated fall peak of infections.
Dr. Lakshmi
Panagiotakopoulos, an infectious disease physician and CDC researcher,
presented a revised plan for decision-making regarding next fall’s Covid shot.
The proposal involves CDC advisers meeting in June to make recommendations
regarding who should receive the vaccine. A meeting of advisers to the Food and
Drug Administration (FDA), which precedes CDC guidance, is already scheduled
for May 16. This timeline aims to ensure adequate preparation and distribution
of vaccines ahead of the fall season.
At the meeting on Wednesday, C.D.C.
advisers wrestled with whether to suggest that older adults “may” opt to get a
spring Covid vaccine in consultation with their health care providers, or to
recommend more emphatically that they “should” do so.
Some panelists said the softer
recommendation would be more palatable to Americans, and less likely to
contribute to vaccine fatigue. Others argued that stronger language would make
it clearer to those at high risk from the virus that a vaccine would afford
them protection through the spring.
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The advisers ultimately voted to
recommend that Americans ages 65 and older “should” receive a spring shot. Dr.
Cohen, the C.D.C. director, accepted the recommendation later in the day.
“I hope that clarity of the need for a
second dose may encourage vaccination and protection in both those who have not
yet had a first vaccine and those who would benefit by a second vaccine,” Dr.
Kotton said.
Apoorva Mandavilli is a reporter
focused on science and global health. She was a part of the team that won
the 2021 Pulitzer Prize for Public Service for coverage of the pandemic. More about Apoorva Mandavilli