CDC Director: Recommending Booster Doses for At-Risk Occupations

In a departure from the independent APIC advisors, CDC Director Rochelle Walensky, MD, has decided to recommend boosters for people in high-risk occupations.

The Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, MD, has announced a recommendation for a booster dose of the Pfizer-BioNTech COVID-19 vaccine to people ages 18 to 64 who are in occupations or institutional settings where the burden of COVID-19 infection and risk of transmission are higher.

The specificity of which workplaces posed a higher risk of infection was not discussed, but certainly positions where people are working with the public and health care workers are two industries that would likely be eligible.

Yesterday, the Advisory Committee on Immunization Practices (ACIP) committee members voted 9-6 against recommending the booster doses for people in at-risk occupations. Wallensky’s departure from the ACIP vote yesterday was due to concerns of the pandemic and wanting to consider the public’s greater good.

"As CDC Director, it is my job to recognize where our actions can have the greatest impact,” Walensky said in a statement. “At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good."

Walensky did also take ACIP’s other recommendations and included them as well. ACIP voted to recommend booster doses for the Pfizer-BioNTech COVID-19 vaccine 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

The expectation is that these eligible populations will be able to get the booster doses soon, and play a major role as part of the COVID-19 strategy by the Biden Administration for this fall and winter.

"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,” Walensky said. “This aligns with the FDA's booster authorization and makes these groups eligible for a booster shot.”

During yesterday's meeting, the ACIP members did not believe there was enough data to support people in occupations with an increased risk and that the vaccines were affording protection to people in the occupational category.

However, they did acknowledge that future data and the evolving science might change the booster dose recommendations, and that they would be meeting again to discuss the topic.

Walensky noted there would be future booster discussions for ACIP for other EUA vaccines. “Today, ACIP only reviewed data for the Pfizer-BioNTech vaccine. We will address, with the same sense of urgency, recommendations for the Moderna and J&J vaccines as soon as those data are available.”