Long Island doctors praised the Centers for Disease Control and Prevention's decision Thursday to recommend a third vaccine shot for high-risk people who'd already received two doses of the Pfizer-BioNTech vaccine.
But they also emphasized the nation should focus on persuading unvaccinated people — who make up the large majority of COVID-19 hospitalizations and deaths — to get their initial shots.
CDC Director Dr. Rochelle Walensky late Thursday endorsed booster shots for those 65 and older and those in long-term care facilities, and for people 50 and older with health conditions that put them at greater risk for severe COVID-19. The shots would be given at least six months after the second Pfizer dose.
A CDC advisory committee earlier Thursday had made the same recommendations, but Walensky disagreed with the committee’s 9-6 vote against recommending boosters for health care workers and others who are at higher risk of becoming infected because of their jobs.
With studies showing that COVID-19 vaccines’ effectiveness wanes over time, it’s wise to give an extra boost to the immune systems of those most at risk, said Dr. Alan Bulbin, director of infectious diseases at St. Francis Hospital in Flower Hill.
"I don’t think there’s a downside in boosting anyone in those categories," Bulbin said. "We know the vaccine is safe, it’s well tolerated."
What to know
- People 65 and older, nursing home residents and assisted living residents should get the Pfizer booster.
- Boosters should be given to others ages 50 to 64 with a long list of risky health problems, including cancer, diabetes, asthma, HIV infection, heart disease and people who are obese.
- People 18 to 49 who got their Pfizer shots at least six months ago with risky health problems can consider the booster based on their individual benefits and risks.
- Anyone 18 to 64 with a risky job, such as health care, can consider boosters. Prisoners and people living in homeless shelters are in this group.
- People with severely weakened immune systems were already eligible to get a third dose of Pfizer or Moderna. This group includes people taking immune-suppressing medications and those with diseases that tamp down their immune systems.
The immune systems of people 65 and older typically don’t react as strongly as those of younger people, so seniors are more likely to benefit from a booster shot, he said.
"In general, the initial upfront response may not be as vigorous, may not be as potent, and then that level may wane faster than with a younger person," he said.
The government will decide in the future whether to allow booster doses of the Moderna and Johnson & Johnson vaccines. Moderna and Pfizer boosters already are authorized for people with severely weakened immune systems.
President Joe Biden on Friday urged those newly eligible for COVID-19 booster shots to get them, and he said he would get his own booster soon.
"It’s hard to acknowledge I’m over 65, but I’ll be getting my booster shot," the president said.
Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital in Manhasset and Long Island Jewish Medical Center in New Hyde Park, said he supported Walensky’s decision to overrule the committee’s vote against including health care workers and others at higher workplace risk.
"I think they should get the booster," he said of health care workers. "It decreases the risk they will get sick, and it decreases the risk they will asymptomatically spread the infection to patients they’re taking care of, particularly in hospitals."
Farber said the split votes on the CDC advisory committee, and Walensky’s decision to overrule the committee vote, "indicates there is not enough good data to know exactly what the right answer is."
Bulbin said that "especially in the age of COVID, when the story is being written as we go," it’s reasonable for doctors to disagree about such recommendations. Data is still coming in on boosters, he said.
Dr. Bruce Polsky, chairman of medicine at NYU Langone Hospital-Long Island in Mineola and an infectious disease specialist, said, for the public, the CDC’s guidelines aligning with the FDA’s "is a good thing. To have two agencies, the FDA and the CDC, making different recommendations is very confusing to the public."
Polsky said he agrees with Walensky.
"There’s plenty of data now to suggest that immunity wanes over time in all groups," he said.
Biden last month had proposed booster shots for most vaccinated Americans eight months after they received their second shots. But the FDA rejected that plan as too expansive and adopted a plan similar to what Walensky favors.
Farber said an Israeli study on boosters showed "a dramatic decrease in infections" after people received their third shots. But, he said, "The problems with boosters are we really don’t know how long the increased protections that you clearly get will last."
Bulbin said there is not enough evidence yet showing that younger, healthy people need the extra shots.
The vaccine "has been almost perfect in terms of preventing serious disease, critical illness, hospitalization and death, even after two shots," Bulbin said. "Even in the setting of the delta variant, it still holds up. Even people who are vaccinated and get a breakthrough infection are usually having mild disease and not ending up at the doorstep of your hospital."
Despite the guidelines, Farber said, dishonest people not in authorized categories could still get a booster shot.
"There’s no checking," he said. "It’s just an attestation. So if you go into one of those pharmacies and say you have asthma or heart disease or kidney disease or pulmonary disease, and in some states — not New York — smokers [are in the high-risk category], then, yes, no one is going to stop you from getting that booster. It’s a guideline they will follow, but depending upon what you tell people, it’s strictly an honor system."
Polsky said the focus on boosters should not distract from what should be the chief priority in combating COVID-19: persuading more unvaccinated people to get the shot.
"It’s the unvaccinated who are perpetuating this pandemic," he said.
"The vast majority of people who are sick in the hospital are still unvaccinated," Bulbin said, even though the large majority of adults on Long Island are fully vaccinated.
In New York City, where a vaccine mandate goes into effect Monday covering all public school personnel, thousands of school employees remain unvaccinated and will be suspended if they don’t get a shot.
"There's been plenty of time for teachers, staff to get vaccinated," Mayor Bill de Blasio said Friday on WNYC radio. "There's all of today, there's all of tomorrow. There's all of Sunday, even into Monday to get vaccinated. So, one, the vast, vast majority of teachers and staff are making the decision to get vaccinated, be part of the solution, continue with their work …. If they don't get vaccinated, they consciously make the choice not to get vaccinated, they will be suspended without pay."
He said the void would be filled by substitute teachers and others who currently aren’t in teaching posts being redeployed to the classroom.
"We're ready, even to the tune of, if we need thousands, we have thousands," de Blasio said.
As of Wednesday, about 87% of teachers and 80% of city education department employees were vaccinated, department spokeswoman Danielle Filson said.
Meanwhile, 27 New Yorkers, including four in Suffolk, died Thursday of COVID-19, state data released on Friday shows.
Long Island’s seven-day positivity rate dropped slightly Thursday, to 3.48%, from 3.59% on Wednesday, state data shows.
There were 359 new COVID-19 cases reported on Thursday in Nassau County and 549 in Suffolk.
"We are continuing to watch the numbers in every corner of the state and are prepared to dispatch necessary resources wherever we see a spike of new infections," Gov. Kathy Hochul said in a statement. "We cannot afford to let our guard down, especially as we get deeper into the fall season and people start to spend more time indoors."
Hochul urged New Yorkers to get vaccinated. More than 5,200 Long Islanders got a first dose of vaccine on Thursday, state data shows.
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