Feds Roll Out Plan for COVID-19 Vaccine Boosters

The Biden administration yesterday rolled out a plan to offer booster shots to people who are fully vaccinated against SARS-CoV2 with mRNA vaccines starting on Sept. 20.

Booster doses of the Pfizer/BioNTech and Moderna vaccines will be available to people aged 18 years and older. Since the booster will be given eight months after the second dose, healthcare providers, nursing home residents and people with underlying health problems — who were the first to get the initial series — will also be first in line for the third shot, White House health officials said at a press briefing.

The vaccines will be free and available to anyone regardless of insurance or immigration status at 80,000 sites, and there will be no requirement to present identification, said Jeff Zients, White House COVID-19 Response Coordinator.

The plan remains contingent on federal review of the safety and efficacy of a third dose of both vaccines, said Surgeon General Vivek Murthy during the briefing. But getting the program ready to roll is crucial, based on worrisome new immunogenicity data from both the U.S. and Israel, said Anthony Fauci, President Biden’s chief medical adviser and director of the National Institute of Allergy and Infectious Disease.

New data from both Moderna and Pfizer show that a third dose dramatically increases antibody titer, even to the Delta variant, Fauci said.

Four new studies on waning immunity, plus new transmissibility data from Israel prompted the recommendation, said Rochelle Walensky, director of the Centers for Disease Control and Prevention (CDC). The CDC’s stats make it clear that while the Pfizer and Moderna vaccines continue to protect against the worst clinical outcomes of COVID-19, their ability to stem infection is decreasing:

• From May to July, vaccine effectiveness against hospitalization in New York remained stable (92 percent to 95 percent), but the overall effectiveness against infection for all state residents significantly declined, from 91.7 percent to 79.8 percent.
• Among 80,000 fully vaccinated with either mRNA vaccine and followed from May to July, vaccine efficacy against Delta variant infection waned. Pfizer efficacy decreased from 76 percent to 43 percent and Moderna from 86 percent to 76 percent.
• Among fully vaccinated nursing home residents, efficacy against infection dropped from an initial 74.7 percent in March to May, to 53 percent in June and July, coincident with the Delta strain emergence.

“Taken together, you can see that while the exact percentage of vaccine effectiveness over time differs depending on the cohort and settings study, the data consistently demonstrate a reduction of vaccine effectiveness against infection,” Walensky said.

A bright spot, she noted, is that both vaccines continue to protect against the worst COVID-19 outcomes. A study appearing in the CDC’s Morbidity and Mortality Weekly Report looked at COVID-19 admissions in 21 hospitals located in 18 states. MRNA vaccination was 86 percent effective against hospitalization two to 12 weeks after the second vaccine, and 85 percent effective at 13 to 24 weeks. Walensky cautioned, however, that only 7 percent of the infections in this study were caused by the Delta variant.

“We also have preliminary data on more than 4,000 frontline workers in eight locations across the country that show waning effectiveness against both symptomatic and asymptomatic infection in the context of Delta,” she said.

A disturbing report from Israel also influenced the administration’s push for a booster program. About 78 percent of the population is fully vaccinated, and Delta is now the dominant strain in the country. The study examined sustained effectiveness against infection in 1.3 million people. Compared to those vaccinated in April, those vaccinated in January were more than twice as likely to experience another infection. — Michele G. Sullivan