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CDC recommends COVID-19 booster shots for all Americans

U.S. health officials announced a plan on Wednesday to recommend that all Americans, but particularly those who are elderly or otherwise at risk of serious infection from COVID-19, obtain booster shots to better withstand an ongoing surge of the virus's more infectious Delta variant.

“Based on our latest assessment, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout,” the U.S. Department of Health and Human Services explained in a joint statement with medical and public health experts. “For that reason, we conclude that a booster shot will be needed to maximize vaccine-induced protection and prolong its durability."

Pending federal authorization, adults 18 years and older will be eligible for a COVID-19 vaccine booster eight months after receiving their second dose of Pfizer or Moderna shots, beginning the week of Sept. 20 with vulnerable populations and frontline workers. Further recommendations for youth ages 18 and below are also under review.

A formal recommendation remains contingent on the results of an independent analysis from the Food and Drug Administration evaluating the safety and effectiveness of a third Pfizer or Moderna mRNA vaccine, health officials explained in a news conference. A booster for the Johnson and Johnson vaccine is also being evaluated.

The announcement is based on data indicating SARS-CoV-2 protection decreases over time, in conjunction with the surge of the virulent Delta variant. U.S. health officials recommended just days earlier that people with underlying health conditions obtain boosters, and Pfizer submitted data for a third shot to the Food and Drug Administration on Monday, emphasizing its effectiveness against Beta and Delta variants.

“If you wait for something bad to happen before you respond to it, you find yourself significantly behind where you need to be to respond,” explained Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to the president. “You don’t want to find yourself falling behind and playing catch-up."

Fauci noted in the Wednesday press conference that vaccine boosters may be needed to raise antibody protection because antibody levels decline over time and higher levels of antibodies offer better protection against the Delta variant.

U.S. Surgeon General Vivek Murthy likewise called the booster plan a proactive step to stay ahead of the virus.

“We have been fortunate to have safe, effective vaccines that offer protection even against the widespread Delta variant," Murthy explained.

“Our plan is to protect the American people and to stay ahead of this virus,” Murthy added. “This is a plan for the future. We have said from the beginning when we see a signal from the data, we will tell you, and that is what we are doing.”

The decision is based on part on research published in the New England Journal of Medicine, a Mayo Clinic analysis released as a preprint before peer review, and data from the international community, including Israel, which recently expanded vaccine booster eligibility to people 50 years of age and older.

According to CDC data, 51% of the U.S. is fully vaccinated against COVID-19, including 81% of people over 65 years of age and 62% of people 18 years and older. The majority of COVID-19 infections are among the unvaccinated population.

Jeff Zients, the White House Covid-19 response coordinator, said the U.S. is prepared to distribute vaccine boosters for free among Americans while continuing to distribute vaccines internationally.

“To end this pandemic, we have to protect the American people, and we have to do more to vaccinate the world,” Zients said. "We are already proving we can protect Americans while helping others."

Zients anticipates donating 200 million vaccines internationally while vaccinating 100 million Americans in the fall.

Members of the medical community are hardly surprised to see vaccine boosters under analysis, particularly with the rise of the delta variant.

“People seem to be treating this idea of a coronavirus booster as though this is an entirely novel concept in the world of vaccinology. It's been going on for the last 150 years, so it's really nothing new,” said Ross Kedl, professor of immunology at the University of Colorado Anschutz School of Medicine.

“What we really want is delta-specific immunity, and it turns out one more shot does an amazing amount to broaden your immunity, to give you that additional protection specifically against that variant, so everybody would benefit from that,” Kedl said. “If you're elderly and your immune response wanes much more quickly — if you have an immunocompromised circumstance, your immunity probably didn't start out that high — so for anybody over the age of 60, I would say a booster would be a really, really good idea.”

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And while the Delta variant is making infections worse today, Dr. Kevin J. Gibbons, senior associate dean for clinical affairs at the Jacobs School of Medicine and Biomedical Sciences in Buffalo, New York, noted that a future variant could still emerge.

“One concern is from the fact that when viruses replicate, they can mutate on and those mutations can result in variants as we've seen with this virus — it's developed variants that are much more contagious,” Gibbons said.

Gibbons noted that he encourages patients to get vaccinated against COVID-19.

“When I talk to individual patients, and they say, ‘you know, I've haven't done it yet,’ and I just ask why, and they say, ‘well, I don't quite understand the risk.’ There it's easy for me to explain the risk of getting infected with this variant. Now, it is you're either going to be vaccinated, or you're going to get infected,” Gibbons said. “I think people need to understand that this vaccine is really a triumph of science and industry.”

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