U.S. considers expanding eligibility for 2nd COVID booster
A Northwell Health nurse fills a syringe with COVID-19 vaccine in April 2021. The Biden administration is reportedly discussing whether to expand eligibility for a second COVID-19 booster to adults under 50. Credit: AP/Mary Altaffer
Top federal health officials Tuesday said the Biden administration is discussing whether to expand eligibility for a second COVID-19 booster to adults under 50, as they urged older people to get the additional shot amid a new wave of cases of the most infectious coronavirus subvariant yet.
Long Island infectious disease experts said although they hope federal agencies authorize a second booster for all adults, it isn't needed for everyone.
“For a healthy 20-year-old, I would not push it," said Dr. Bruce Farber, chief of public health and epidemiology for Northwell Health. "For a 45-year-old with hypertension, I think it’s reasonable.”
Dr. Ashish K. Jha, the Biden administration’s coronavirus response coordinator, said during a White House COVID-19 response team briefing Tuesday that the Food and Drug Administration and the Centers for Disease Control and Prevention are weighing whether to expand second-booster access to people under 50.
What to know
The Food and Drug Administration and Centers for Disease Control and Prevention are considering whether to expand access to second COVID-19 booster shots to all adults under 50, federal health officials said Tuesday.
Most adults 50 and over, who have been eligible for the second booster since March, have not received the shot, according to federal statistics. Yet CDC data shows that a second booster dramatically reduces the chances of dying of COVID-19.
Long Island infectious disease experts said they hope federal officials authorize a second booster for adults under 50. But they said even though they would advise a second booster for adults under 50 with certain health conditions, it may not be needed for many young, healthy adults.
“I know the FDA is considering looking at this, and I know CDC scientists are thinking about it and looking at the data as well,” Jha said. “The decision is purely up to them.”
BA.5 subvariant: 65% of U.S. cases
The highly contagious BA.5 omicron subvariant has been spreading quickly in recent weeks and represented 65% of cases nationwide during the week ending Saturday, according to CDC data released Tuesday. The BA.4 omicron subvariant — also highly infectious — comprised about 16% of cases, data shows.
Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine, said if the booster is authorized for adults under 50, people should talk to their doctors about whether they should receive it.
Dr. Alan M. Bulbin, director of infectious disease at St. Francis Hospital & Heart Center in Flower Hill, said "it's all about risk assessment."
He'd advise a second booster to people with health conditions that put them at higher risk for severe COVID-19, because the vaccine is safe and greatly reduces the risk of hospitalization.
“If you’re anywhere close to that higher risk, then there’s no downside to another shot — a fourth shot, a fifth shot even," he said.
Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine. Credit: Randee Daddona
Nachman said she'd recommend a second booster for healthy younger adults living with people who are more vulnerable to severe COVID-19, and for those who will be in risky situations.
"If you are going to go traveling, I’d say yes, get your booster two weeks before you’re going, because the last thing you want to do is get sick some place where you have to go for medical care," she said.
BA.5 and BA.4 are better able than previous variants to evade the immunity protection provided by vaccines and by previous infection. Jha said new vaccines that specifically target those subvariants may be ready as early as October. But, he emphasized, “getting vaccinated now will not preclude you from getting a variant-specific vaccine later in this fall or winter.”
Dr. Bruce Farber, chief of public health and epidemiology for Northwell Health. Credit: Danielle Silverman
Farber said variant-specific vaccines “will be helpful. But they won’t be a panacea.”
“This is quite a clever, diabolical virus in terms of its ability to constantly bend, change and evade the immune system, and evade the antibodies we’ve acquired through vaccination or infection,” he said.
That means people are much more easily able to get reinfected with BA.5 within a few months of a prior COVID-19 case than they were early in the pandemic, Farber said.
Once variant-specific vaccines are released in the fall or winter, a new subvariant could emerge and become dominant, he said.
But Nachman said even if there is a new subvariant, as long as it is an omicron subvariant, a new vaccine targeted at BA.5 and BA.4 will be more effective against it than the original vaccine now in use.
It would have "more significant relatedness to the variants we have now and would be much more likely to be much more protective," she said.
Dr. Ashish K. Jha, the Biden administration’s coronavirus response coordinator. Credit: Getty Images/Kevin Dietsch
Jha said even though boosters are less effective than in the past at preventing infection — although they still make infection less likely — a second booster "dramatically lowers your risk" of severe illness or death if you're 50 or older.
'Many people ... at high risk right now'
CDC Director Dr. Rochelle P. Walensky displayed a chart that showed that people 50 and older with one booster dose were four times more likely to die of COVID-19 than people of that age with two booster doses. Unvaccinated people that age were 42 times more likely to die.
The FDA and CDC in March authorized second boosters for people 50 and older, and for those 12 and older who are moderately or severely immunocompromised.
Walensky noted CDC data that shows that only 27.7% of those 50 and older with a first booster shot have received their second, and that only 34.4% of those 65 and over have.
“There are many people who are at high risk right now, and waiting until October, November, for their boost when in fact their risk is in the moment is not a good plan,” she said.
She said the required time between a second booster and a variant-specific booster likely will be about the same four-month interval that exists now between the first and second booster.
Bulbin said although people at higher risk should get a second booster, the priority should be on getting more first boosters into arms. Fewer than half of Americans eligible for a first booster have received one, CDC data shows.
"The foundation is ensuring everybody has had three shots," Bulbin said.
David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.
