More states allow COVID vaccine boosters for all adults

Health authorities in Arkansas said on Monday they would broaden eligibility for COVID-19 vaccine booster shots to all adults, as a growing list of state and local officials look for ways to accelerate third doses in hopes of heading off a potential new wave of the virus.

“For Pfizer and Moderna, those who are 18 and over, go get the shot. There’s not any limitations on that. Obviously you should be six months after the second shot. But we want you to get the booster,” Arkansas Governor Asa Hutchinson told reporters on Monday.

That’s a significant expansion beyond the current recommendations of federal health officials. While boosters are recommended for all adult recipients of Johnson & Johnson’s vaccine, the Centers for Disease Control and Prevention allows boosters for more limited groups of Pfizer and Moderna recipients: seniors 65 and older, adults with underlying medical conditions, and those who live or work in “high-risk settings.”

The average pace of booster shots has slowed nationwide for weeks, and so far, just 16.5% of fully vaccinated adults have received a booster, according to the CDC. Among seniors, only two states — Vermont and Minnesota — have recorded a booster dose in more than half of their vaccinated adults 65 and older.

“It should be a much simpler process. We want to make sure it’s easy and accessible for everyone to get their booster shot with the minimum burden and confusion,” said Hutchinson.

Officials in Arkansas said they had informed the Biden administration of their plans. Federal authorities have been mulling whether to expand eligibility for booster shots nationwide, though officials have cautioned that a formal authorization and recommendation could still be weeks away as regulators weigh the risks of rare side effects linked to the shots. 

“You’re balancing those two things and making sure that everybody has a positive benefit from getting a booster shot,” Acting FDA Commissioner Janet Woodcock said last week, in an interview with WebMD.

However, Arkansas joins two states that last week declared all of their state’s adult residents eligible for booster shots, ahead of the federal sign-off.

Colorado and New Mexico said their entire states are “high risk” enough to need third doses, pointing to federal guidance which currently allows for adults “who work or live in high-risk settings” to receive booster shots six months after they were first vaccinated with Pfizer or Moderna. 

The CDC had initially said that this recommendation for Pfizer and Moderna boosters was intended for occupations at “increased risk of being exposed to the virus,” like first responders or teachers, or congregate settings like prisons and homeless shelters where the agency has recently tracked surges of breakthrough infections.

But a state health official confirmed to CBS News that Colorado informally consulted with the CDC to greenlight its plan to expand eligibility for all adults.

“I’ve been very frustrated with the convoluted messaging out of the CDC and the FDA. Everybody should get the booster after six months. The data is incredibly clear that it increases your personal protection level. That’s why my parents got it. I got it. My family members got it,” Colorado Governor Jared Polis told “Face the Nation” on Sunday.

A CDC spokesperson did not respond to a request for comment specifically on the move, saying only that providers “should administer vaccine in accordance” with the current FDA emergency use authorization and CDC provider agreement.

Asked about the possibility that vaccinators might face federal repercussions for doling out booster shots to all adults, authorities in New Mexico said their move “trumps CDC guidance” for providers in the state.

“Vaccinators are protected,” said Matt Bieber, a spokesperson for New Mexico’s Department of Health.

Telling providers not to deny booster doses

Other jurisdictions have also looked for different avenues to broaden access to booster shots, with New York City announcing on Monday that it was ordering providers not to turn away any adults looking for booster shots.  

While providers are generally allowed to prescribe medicines “off-label” after they have been approved by the FDA on the private market, the CDC has previously warned vaccine providers that they could face penalties, lose pandemic liability protections, and may not be reimbursed for shots if they defied the agency’s recommendations governing use of the government-purchased COVID-19 vaccine.

However, the CDC has also long urged jurisdictions to remove hurdles for vaccinations, allowing adults to “self-attest” whether they were eligible. 

Governors in West Virginia and New Jersey on Monday also urged adult residents to get booster shots, but did not announce formal policy changes to allow for the third doses.

Ultimately New York City’s order, like California’s guidance last week, may amount to codifying a vaccination policy that had been relying largely on the honor system.

“The state’s guidance on boosters is in alignment with the CDC. It is simplified to help empower more Californians to get a booster. California has asked vaccine providers to not turn anyone away who has made the self-determination that they need a booster,” said a spokesperson for California’s health department.

Should all adults get a booster shot? 

The renewed push for booster shots comes as some of the Biden administration’s top doctors have redoubled calls for the third doses, ahead of FDA and CDC decisions on whether to expand eligibility nationwide for all adults. 

“Boosting is going to be an absolutely essential component of our response. Not a bonus, not a luxury, but an absolute essential part of the program,” Dr. Anthony Fauci, the president’s chief medical adviser, told The New York Times last week

In the months since the FDA’s vaccine advisers rejected Pfizer’s initial request to license booster shots for all American adults earlier this year, a growing body of evidence has continued to suggest protection from the vaccines is waning, even as rates of cases and deaths remain far higher among the unvaccinated.

One recent study examining records from the Veterans Health Administration, published earlier this month in Science, found that as the Delta variant surged, effectiveness against symptomatic infections dropped to 58% with Moderna’s vaccine and 43.3% with Pfizer’s, though they remained highly effective at preventing deaths.

A recent CDC analysis published in JAMA found more vaccine breakthrough COVID-19 hospitalizations among Pfizer than Moderna recipients. The risk of hospitalization appeared to climb after four months for Pfizer recipients, the authors said, a sign of potential “waning of protection over time, including for severe COVID-19” from the shots.

In the United Kingdom, health officials said Monday their booster program targeting adults 50 and older saw 87.4% vaccine effectiveness against symptomatic disease after a third shot of Pfizer, compared to adults without the booster. In Canada, health authorities greenlighted booster doses for all adults this month for Moderna and Pfizer.

“It is clear, however, that revaccination will be necessary, for the same reasons that influenza revaccination is necessary: antigenic variation and waning immunity,” Dr. Arnold Monto, who has chaired recent meetings of the FDA’s outside vaccine advisers, concluded in The New England Journal of Medicine earlier this month.

So far only Pfizer has formally submitted a renewed request to expand their emergency use authorization to allow all adults to receive a booster shot, citing new data from their trials suggesting a booster “demonstrated a relative vaccine efficacy of 95%,” compared to those who did not get a third dose. 

The FDA’s advisers had previously balked at Pfizer’s initial request to license booster shots for all adults because of concerns over the risks of myocarditis — a rare type of heart inflammation linked to the shots in mostly younger, male recipients. 

To assuage concerns over myocarditis, Biden administration officials have pointed to data from Israel. The country was one of the first to roll out Pfizer’s third doses nationwide. 

“One of the concerns was, if you gave everyone across the age spectrum boosters, would you have a lot more myocarditis, which was a worry after the second dose?” Dr. Peter Marks, the FDA’s top vaccines official, told a recent webinar hosted by the Health Resources & Services Administration. 

“It is present after the second dose in the Israeli data here, but it doesn’t seem to be as big an issue after the third dose, maybe because of the longer period,” said Marks.

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