COVID
Despite Concerns About ‘Vaccine Fatigue,’ CDC Recommends Extra COVID Boosters, Including for Some Infants
Advisers to the CDC on Wednesday also lowered the age recommendation for Pfizer and Merck’s pneumococcal conjugate vaccines, designed to protect against meningitis and pneumonia, from age 65 to age 50.
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Advisers to the Centers for Disease Control and Prevention (CDC) on Wednesday recommended two COVID-19 boosters during the 2024-2025 season for people ages 65 and older and for younger people who are moderately or severely immunocompromised.
The Advisory Committee on Immunization Practices (ACIP) also recommended that immunocompromised people ages 6 months and older take “additional doses” of the shot — three or more — based on shared clinical decision-making between doctor and patient.
The vote for all three new COVID-19 vaccine recommendations was unanimous.
The committee also voted 14-1 to recommend Pfizer and Merck’s pneumococcal conjugate vaccines — designed to protect against meningitis and pneumonia — for all adults who have never received the vaccine ages 50 and older, lowering the recommended age from 65.
The U.S. Food and Drug Administration in June approved Merck’s Capvaxive for prevention of invasive pneumococcal disease and pneumococcal pneumonia in adults.
The vote expands the market for both companies, who will now be able to market their vaccines to millions more eligible adults, boosting their annual revenues by hundreds of millions of dollars, FiercePharma reported.
CDC Director Mandy Cohen endorsed the recommendations after the meeting, making them official CDC recommendations.
“CDC will continue to educate the public on how and when to get their updated vaccinations so they can risk less severe illness and do more of what they love,” Cohen said.
“ACIP loves advising that people receive the most vaccines possible,” internist Dr. Meryl Nass told The Defender.
She added:
“When ACIP talks about shared decision-making, what they mean is this: ‘We lack the data to recommend this vaccine for this group, so we could be criticized (or worse) for making an unscientific recommendation. But we really want you to have it.’
“So we think the patient and doctor (who is much less educated about the minutiae regarding the vaccine than the ACIP members are) should together decide whether the patient should get it. That way we protect ourselves while maximizing the number of jabs.’”
Nass said that if ACIP members were serious about shared clinical decision-making, “They would put all their thoughts down so clinicians could become educated and then jointly evaluate the risks and benefits with patients.”
The committee also voted unanimously to add high-dose and adjuvanted flu vaccines to the Vaccines for Children Program — which provides free vaccines to children whose families can’t afford them — for transplant recipients taking immunosuppressive medications.
ACIP is described as an independent, nonfederal expert body of professionals with clinical, scientific and public health expertise. The committee decides which vaccines should be recommended to the public, who should take them and how often.
In practice, most members have financial ties to vaccine makers that they don’t consider to be conflicts of interest. For example, in Wednesday’s meeting, paid Merck consultant and researcher Noel Brewer, Ph.D., declared “no conflict” before voting to recommend Merck’s vaccine.
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More recommendations may ‘exacerbate existing vaccine fatigue’
The CDC said that in the 2023-2024 COVID-19 season, only 8.9% of people over age 65 and 5.4% of immunocompromised adults age 18 and older had received two boosters.
The presenter, Dr. Georgina Peacock, said there was “obviously a need for additional education and recommendations,” but raised concerns that additional recommendations “may also exacerbate existing vaccine fatigue.”
Ruth Link-Gelles, Ph.D., presented COVID-19 vaccine efficacy data that provided the rationale for the new recommendations. Efficacy is affected by time since the last booster dose, changes in COVID-19 variants and the time since someone was last infected with COVID-19, she said.
Link-Gelles said those are hard to disentangle, especially given that all adults have high rates of infection-induced immunity. Infection-induced immunity rates ranged from 72% for people over age 65 to 89% for those ages 16-49 and 84% for those ages 50-64.
In adults over 65, she said protection waned to zero against emergency room visits and hospitalization by four to six months and was somewhat more effective against critical illness.
She also said that additional education alone wasn’t effective in increasing uptake.
Waning efficacy: an argument for more shots or proof of natural immunity?
Link-Gelles presented a slide that showed COVID-19 vaccine effectiveness waned significantly among people ages 18-64, beginning at 30% and dropping to negative 15% by six months post-vaccination.
When pressed on how to interpret the negative efficacy, she said, “There is no biological plausibility for the vaccine increasing your risk of disease.”
Vaccine effectiveness data is relative, meaning it’s a measure of how much more protection a vaccinated person has than an unvaccinated one, she said. Therefore, “what we think is happening” is that unvaccinated people were getting natural immunity during that time, giving them more robust immunity and skewing the baseline for comparison.
Because vaccine efficacy is a comparison of the disease in the vaccinated versus the unvaccinated, if the efficacy is negative, “then the unvaccinated have more protection than the vaccinated,” Karl Jablonowski, Ph.D., senior research scientist at Children’s Health Defense, told The Defender.
Jablonowski pointed out that Link-Gelles suggested the unvaccinated are exposed to wild-type COVID-19 and then gain immunity, compared with the vaccinated who would not gain that same wild-type immunity.
“What Dr. Link-Gelles is not entertaining, that which she sees ‘no biological plausibility,’ is the possibility of diminishing immune health of the vaccinated,” he said.
Jablonowski added:
“Both scenarios reduce the infections in the unvaccinated relative to the vaccinated. Either scenario points to the same conclusion, that the unvaccinated have superior long-term (180-299 days) immune health when facing the COVID-19 pandemic.
“More broadly, you cannot present VE [vaccine efficacy] analysis as a valid assessment of how well a vaccine works and then disregard the analysis when it shows the vaccine is not working.
“It is clear, from CDC’s own data and presentation, that the vaccinated had a higher long-term incidence of disease than the unvaccinated.”
Watch the Oct. 23 ACIP meeting here:
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