The CDC panel is skeptical of the fourth Covid shot for all, saying the US needs a clear vaccine strategy

Registered Nurse Orlyn Grace (R) administers a COVID-19 booster vaccination to Diane Cowdrey (L) at a COVID-19 vaccination clinic on April 6, 2022 in San Rafael, California.

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The CDC’s panel of independent vaccine experts signaled a reluctance to support the fourth Covid shot for the wider U.S. population until the agency adopts a clear strategy.

The group, in a five-hour meeting on Wednesday, largely agreed that repeated deployment of boosters to prevent infection is not a realistic goal with the current generation of shots.

The CDC’s Advisory Committee on Vaccination Practices discussed the US vaccination strategy ahead of an expected fall wave of infection. It was the committee’s first meeting since the CDC approved a fourth dose of Pfizer or Moderna for people aged 50 and over at the end of March, as well as a fifth dose for those 12 and older with weakened immune systems.

Dr. Sarah Long, a committee member, said public health agencies need to abandon the idea that vaccines can prevent Covid infections. She said they should instead let the public know that the main goal is to prevent serious illness, hospitalization and death.

Chasing rainbows

“With the vaccines currently available, we should not chase the rainbows in the hope that these vaccines could prevent infection, transmission and even mild illness, because we have learned that this is simply not possible,” said Long, professor. in Pediatrics at Drexel University College of Medicine. “We just have to give it up with these vaccines and focus on preventing serious illness and preventing death.”

Long criticized the CDC for removing the fourth shot for older adults without consulting the committee, saying the decision has created public confusion and could lead to booster fatigue. She said a full public discussion in the committee on vaccine recommendations would help restore public confidence.

Pfizer’s and Moderna’s vaccines have been shown to be very effective in preventing hospitalization from Covid, but protection against infection and mild disease diminishes rapidly over time, a challenge exacerbated by the rapid development of the virus. Vaccine manufacturers developed the shoots to target the tip protein from the virus that appeared in Wuhan, China, in 2019. The virus uses the tip to invade human cells, and as this protein has mutated over the past two years, it has become more difficult to that the vaccines block infections.

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65% effective against mild disease

Data presented by CDC officials on Wednesday showed that three doses of Pfizer’s or Moderna’s shots were 79% effective in preventing hospitalization and 94% effective in preventing critical illness or death among adults with healthy immune systems during the unprecedented wave of omicron infection. over the winter. Three doses were about 65% effective in preventing mild disease.

Dr. Beth Bell, director of the National Center for Emerging and Zoonotic Infectious Diseases, said it is not a sustainable public health strategy to ask people to get booster shots every four to six months. She said such an approach could undermine confidence in the vaccination campaign. Bell said a two-shot primary vaccination series and a booster dose provide adequate protection right now for people who have a healthy immune system.

“I’m just very concerned that we need to meet and consider additional doses for a smaller and smaller yield and create the impression that we do not have a very effective vaccination program,” said Bell, who is also a clinical professor at the University of Washington’s School of Public Health.

Dr. David Kimberlin of the American Academy of Pediatrics said the CDC should adopt a more long-term vaccination strategy now to avoid having to respond to the next crisis. The CDC should clearly communicate that most Americans need three doses initially and then will need a booster once a year to maintain protection against serious illness, Kimberlin said.

Long Covid worries

However, committee chairman Dr. Grace Lee that the United States needs to invest in developing vaccines that are effective in preventing infection, pointing out that even mild infections can result in long-lasting Covid with potentially disabling health consequences.

“If we focus on hospitalization and death in the acute illness, you do not think about the long-term consequences of Covid, and it can occur even in mildly symptomatic individuals,” said Lee, a professor of pediatrics at Stanford University School of Medicine. Lee said that lack of work or school due to infection is a major challenge, especially for communities that do not always have easy access to health care.

While three doses may be sufficient for healthy adults, people with compromised immune systems remain vulnerable to serious illness, according to Dr. Camille Kotton, a specialist in infectious diseases at Massachusetts General Hospital. They are at risk of infection even after full vaccination, boosting and preventative treatment with monoclonal antibodies, Kotton said.

“In some ways, they’re the ones left behind in the pandemic,” Kotton said. “I just want to ask that we maintain a significant focus on immunocompromised patients,” she said.

FDA meeting

The CDC committee meeting comes after the Food and Drug Administration’s independent advisers met earlier this month to develop a framework for selecting new vaccines targeting mutations that the virus has developed during the pandemic. The public health authorities expect another wave of infections in the autumn and are worried that a new variant may emerge that undermines the current vaccines.

Dr. Peter Marks, who heads the FDA’s department responsible for vaccine safety and efficacy, told the Drug Advisory Committee that the United States has until June to choose a new formula for the vaccines to have them ready by the fall. Marks said declining immunity from the vaccines could make the United States vulnerable to yet another increase as people move inside during the colder months. FDA committee members were also skeptical about asking the wider population to be repeatedly boosted until clear data shows it is necessary to prevent serious illness.

“I think we are very much on board and with the idea that we simply can not boost people as often as we are,” Marks told the committee. “I’m the first to acknowledge that this additional fourth booster dose that was approved was a stopover measure until we got things in place for the potential next booster given the new data,” Marks said.

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