CDC director overrides advisory panel, recommends Pfizer COVID boosters for front-line workers

COVID-19 vaccine
The CDC's unusual move to break with its own advisers was applauded by industry groups, who say the boosters give extra protection to the nation's healthcare workers at a time when it's needed most. (Getty/Hector Pertuz)

This week the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) met to deliberate on who should or should not receive a six-month booster of the Pfizer-BioNTech COVID-19 vaccine.

The panel ultimately voted in favor of an extra shot for those aged 65 years and older or living in nursing homes (unanimous), those aged 50 to 64 years with a medical condition raising the risk of severe COVID-19 infection (13 to 2) and those aged 18 to 49 years with medical issues (nine to six).

However, a recommendation for those working in a high-risk setting, such as a hospital, was defeated in a six to nine vote—quickly drawing the ire of groups representing those individuals.

“Nurses and other health care workers were among the first to be vaccinated because of their high risk of exposure to the virus,” National Nurses United President Deborah Burger said in a Thursday night statement. “Why leave them out of booster shots? Protecting health care workers is essential to protecting public health. It is unconscionable that ACIP would not vote to keep us safer from death, severe COVID and long COVID. Leaving health care workers out is akin to early CDC guidance telling nurses that a bandana is sufficient protection while caring for a patient with COVID-19.”

In an unusual move, CDC Director Rochelle Walensky, M.D., and her agency diverged from the independent panel’s recommendations with the early morning release of its Pfizer-BioNTech COVID-19 booster shot guidance.

While it endorsed ACIP’s first three decisions, the public health agency went a step further and recommended that adults at a higher risk of COVID-19 exposure due to occupational or institutional exposure “may” receive the booster six months after their second dose “based on their individual benefits and risks.”

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“At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health,” Walensky said in a statement. “In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.

“I believe we can best serve the nation’s public health needs by providing booster doses for the elderly, those in long-term care facilities, people with underlying medical conditions, and for adults at high risk of disease from occupational and institutional exposures to COVID-19. This aligns with the [Food and Drug Administration’s] booster authorization and makes these groups eligible for a booster shot,” she said.

The CDC and FDA have not yet weighed in on booster shots for those who received the Moderna or Johnson & Johnson vaccines. Walensky said the CDC will consider boosters for these populations “with the same sense of urgency” once it has enough data. 

CDC and FDA have not given their support to booster shots for the general adult population.

The director’s decision to overrule the panel recommendation has so far been well received by healthcare industry organizations.

American Hospital Association President and CEO Rick Pollack said in a Friday morning statement that the FDA and CDC’s booster recommendation “underscores why hospitals and health systems have worked so hard to vaccinate and staff their communities.” He said his organization encourages anyone who qualifies for a booster to receive one and noted that many front-line healthcare workers are now nine months out from their initial vaccine series.

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“At a time when hospitals across the country are experiencing ongoing surges in COVID-19 hospitalizations and severe workforce shortages, all available tools—including booster shots—should be considered to keep front-line health care workers safe and safeguard access to care,” he said.

American Medical Association President Gerald E. Harmon, M.D., applauded Walensky's leadership and said that his organization believes the recommendation "is a critical step to preserve our nation’s health care capacity and prevent illness among those who have continued to put their own health and safety at risk to care for patients."

David Gifford, M.D., chief medical officer of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), similarly applauded the decision and turned his attention to the rollout of boosters to residents and staff.

“Virtually all nursing homes and some assisted living communities” already have a line to the Pfizer-BioNTech vaccine through a long-term care pharmacy, he said, but others that do not have such a relationship could benefit from additional distribution and administration support from state governments.

“Long-term care facilities are diverse, so a one-size-fits-all approach will not work for a booster shot rollout. We must consider things like the size and location of the facility, the acuity of the residents, the number of new admissions and more,” he said. “AHCA/NCAL continues to engage with public health officials to help advise and streamline the process for administering booster shots considering these factors.”