CDC ACIP Votes to Recommend Boosters for Seniors, Some Immunocompromised, But Not High Risk Occupations

In a series of 4 questions posed to the Advisory Committee on Immunization Practices (ACIP), the committee voted Thursday to approve the eligibility of a single Pfizer-BioNTech COVID-19 vaccine booster dose in the following populations:

• People ≥65 years and older
• People 50-64 years with underlying medical conditions
• People 18-49 years with underlying medical conditions

However, the committee decided to vote against recommending the booster doses in people who are 18-49 years who work in an occupational or institutional setting where the burden of COVID-19 infection and risk of transmission are high.

After an afternoon of presentations and discussions, ACIP decided to vote mostly along the lines of the Food and Drug Administration’s (FDA) Emergency Use Authorization (EUA) that was passed yesterday, except for people who are “in an occupation or setting where the burden of COVID-19 infection and risk of transmission. The committee members said they would consider the question at a later meeting.

Earlier in the meeting, the CDC personnel presented the benefits and risks of the booster doses, clinical considerations, and discussion. Much of the data had been previously presented in the FDA's Vaccines and Related Biologic Products Advisory Committee (VRBPAC) meeting last Friday.

One APIC committee member was concerned about the 4 tiers of high risk of severe disease and which tiers would be included. Within one of the tiers is obese people, and this can fit an overwhelming majority of Americans according to the member.

Additionally, a committee member questioned which occupations should be included.

Policy Questions

Initially, the committee was presented with 2 questions, with 1 related to seniors and the second related to both underlying medical conditions and occupational risks. They changed the second question to split it into 2 questions, one with underlying medical conditions and the other on occupational risks. After more debate, 4 policy questions were presented to the committee.

The questions that were voted upon were the following:

• A single Pfizer-BioNTech COVID-19 vaccine booster dose is recommended for persons, 65 years or older and long-term care resident at least 6 months after the primary series under the FDA’s Emergency Use Authorization

The committee voted 15-0 in favor of recommending the booster in this population.

• A single Pfizer-BioNTech COVID-19 vaccine booster dose is recommended for persons 50-64 years with underlying medical conditions at least 6 months after the primary series under the FDA’s Emergency Use Authorization.

The committee voted 13-2 in favor of recommending the booster in this population.

• A single Pfizer-BioNTech COVID-19 vaccine booster dose is recommended for persons based on individual benefit and risk who are 18-49 years with underlying medical conditions at least 6 months after the primary series under the FDA’s Emergency Use Authorization

The committee voted 9-6 in favor of recommending the booster in this population.

• A single Pfizer-BioNTech COVID-19 vaccine booster dose is recommended based on individual benefit and risk for persons who are 18-64 years who are in an occupation or setting where the burden of COVID-19 infection and risk of transmission are high at least 6 months after the primary series under the FDA’s Emergency Use Authorization

The committee voted 9-6 against recommending the booster in this population.