CDC Clears COVID-19 Vaccine Booster Shots for 65-Plus

In a rare move, CDC director overrules advisory panel and OKs shots for those at risk from their job

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By:

Dena Bunis

En español

Published September 24, 2021

Adults age 65 and older and residents of long-term care facilities who received two doses of the Pfizer-BioNTech COVID-19 vaccine should get a third "booster" shot, the director of the Centers for Disease Control and Prevention (CDC) decided just before midnight on Sept. 24. The agency chief also accepted several other recommendations of her advisory committee, including one that encourages an extra shot for people ages 50 to 65 with underlying medical conditions.

But in a highly unusual move, CDC Director Rochelle Walensky went against the panel's strong rejection of allowing a third shot for people whose job puts them at high risk for getting or transmitting COVID and said those Americans may get a booster.

"As CDC Director, it is my job to recognize where our actions can have the greatest impact," Walensky said in a statement accompanying her decision. "At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good."

Who Qualifies for Pfizer’s Booster Shot?

The CDC recommends the following people get a COVID-19 booster at least six months after getting shots one and two in the Pfizer-BioNTech series.

People 65 years and older and residents in long-term care settings
People aged 50–64 with underlying medical conditions
People aged 18–49 with underlying medical conditions, based on their individual benefits and risks
People aged 18-64 who are at increased risk for COVID-19 exposure and transmission because of their occupation (e.g., health care workers, teachers, grocery store employees), based on their individual benefits and risks

Walensky did accept a suggestion by the agency's Advisory Committee on Immunization Practices (ACIP) that people ages 18 to 49 with underlying medical conditions could also get a booster, depending on their individual risk of getting COVID and the benefit another shot could provide. People with compromised immune systems have already been cleared to get a third shot of the Pfizer or Moderna vaccines.

Taken together, Walensky's decisions make it possible for a wide swath of Americans to get a third shot of the Pfizer vaccine. The boosters will be available immediately to people in these categories if it's been at least six months since they got their second Pfizer shot. The Biden administration announced several weeks ago that pending approval from the U.S. Food and Drug Administration (FDA), all adults would be able to get a booster eight months after their second shot beginning the week of Sept. 20.

Experts debated extent of boosters

At its meeting on Sept. 24, members of the CDC's advisory committee struggled for several hours, debating whether to include health care workers, other frontline employees, those who take care of people at risk for severe COVID-19, and those with underlying conditions that make them more vulnerable to the virus.

"If we can do a bit of good by giving [the booster to] people over 65, I'm in favor of that," said James Loehr, a family physician from Ithaca, New York. CDC officials estimated that 27 million Americans over age 65 who have been fully vaccinated with the Pfizer product would be eligible for the booster. More than 182 million Americans — 55 percent of the population — have been fully vaccinated.

A number of panel members questioned whether the boosters would do anything to quell the pandemic and also pointed to the lack of data on the safety and effectiveness of a third shot, especially in those under age 65.

"We're fighting a pandemic, and it's not because people got two doses. It's because people are unvaccinated," said Helen Talbot, an associate professor of medicine at Vanderbilt University in Nashville. Giving people boosters, she added, "is not going to solve the pandemic."

Vaccine supply is not an issue

Committee chair Grace Lee, a professor of pediatrics at Stanford University School of Medicine, stressed that providing boosters to more Americans will not affect people's ability to get their first two shots. "Supply of the Pfizer vaccine is not an issue right now," she said. According to the CDC, 70 percent of vaccines are currently being administered in pharmacies.

The CDC panel was deliberating the day after the FDA amended the emergency use authorization (EUA) for the Pfizer vaccine to include the booster shots. Under the FDA criteria, these shots would be available to people age 65 and older, younger adults who are at high risk for severe COVID-19, and those "whose frequent institutional or occupational exposure" to the virus puts them at high risk for getting very sick. While it's the FDA's responsibility to set the overall parameters for the use of a booster, it's the CDC's job to say exactly who should get it. The committee members advise Walensky, who can choose to accept any or all their recommendations, something the CDC director typically does.

Panel members stressed that their recommendations are interim, and they expect to revisit the booster issue and other matters regarding the COVID vaccines soon.

"This isn't about who deserves a booster, but who needs a booster," said Matthew Daly, a pediatrician with Kaiser Permanente in Colorado. He said if someone does not qualify for a booster based on these recommendations, it's because the panel thinks their initial shots have left them well protected against COVID.

One concern raised by several on the panel involved those who have been vaccinated with the two-dose Moderna and one-dose Johnson & Johnson (J&J) vaccines. The FDA authorization applies only to the Pfizer vaccine, and CDC officials stressed that mixing and matching vaccines when it comes to boosters is not yet on the table. CDC guidance suggests that when getting a second dose of an mRNA vaccine (Pfizer or Moderna), people should get the same product as their first dose. However, if they don't remember the brand of their first dose or if the one they took isn't available, they can get the other product.

Moderna has submitted data to the FDA for booster authorization; J&J is expected to do so soon.

Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the “Medicare Made Easy” column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.