People 65 and older, at risk of severe COVID eligible for Pfizer vaccine booster, FDA says

As more data becomes available, the FDA and CDC may recommend boosters for other priority groups.

Lindsey Leake
Treasure Coast Newspapers
  • It is normal for vaccine-induced immunity to wane over time
  • Immunocompromised people have been eligible for boosters since August
  • Recipients of Moderna, J&J shots may eventually need boosters too

People 65 and older, or at high risk of severe COVID-19 infection, are now eligible for a third dose of the Pfizer vaccine.

The Food and Drug Administration granted emergency use authorization for the additional shot Wednesday evening, after a meeting of the Advisory Committee on Immunization Practices, part of the Centers for Disease Control and Prevention. 

The CDC meeting continued Thursday, when the committee voted to uphold most of the FDA’s recommendations. CDC Director Dr. Rochelle Walensky on Friday overruled the committee, so that the agency’s recommendations fully lined up with those of the FDA.

► FDA advisory panel: No Pfizer booster for people 16–64 yet

► ‘Your protection can wane’: The case for COVID booster shots

► Pfizer: Low-dose COVID vaccine safe for kids 5–11

Registered nurse Dawn Fessel prepares a dose of the Pfizer COVID-19 vaccine Wednesday, March 24, 2021, at the Fort Pierce Recreation Center in Fort Pierce, Fla.

The FDA’s Vaccines and Related Biological Products Advisory Committee on Sept. 17 recommended the two priority groups receive a third dose at least six months after their second. 

Pfizer initially sought booster approval for everyone 16 and older. Cindy Prins, an epidemiologist at the University of Florida College of Public Health and Health Professions, wasn’t surprised the FDA committee voted in favor of more vulnerable populations.

“It was a happy medium between not doing boosters or doing boosters for everyone,” she said. “Let’s start with the folks who have been, probably, vaccinated the longest and who also may be more likely to have some waning immunity.”

What happened to boosters for all the week of Sept. 20?

About a month ago, it appeared a lot more people would be getting boosters in the early fall. 

“A booster shot will be needed to maximize vaccine-induced protection and prolong its durability,” the Department of Health and Human Services said in a joint statement Aug. 18. “We are prepared to offer booster shots for all Americans beginning the week of Sept. 20.”

People would become eligible eight months after their second dose, the department said, and recipients of the Moderna vaccine were included. 

However, the agency also said its distribution plan hinged on FDA evaluation and recommendations from the CDC advisory committee.

Perry Brown, an epidemiologist in the Institute of Public Health at Florida A&M University, understands why the public may interpret the evolving vaccine guidance as conflicting and confusing. But health officials haven’t wavered from following the science, he said.

“There are different (political) perspectives and desires that sometimes can’t be fulfilled based on what we know is the data,” he said.

The FDA's authorization isn’t the end of the booster discussion, Brown stressed. As more long-term data accumulates, additional shots could be recommended for younger age groups.

Who is eligible for a Pfizer booster shot?

The FDA deemed these populations eligible for a third Pfizer dose, at least six months after their second:

  • People 65 and older
  • People 18-64 at high risk of severe infection
  • People 18-64 “whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19.”

The latter group includes “health care workers, teachers and day care staff, grocery workers and those in homeless shelters or prisons, among others,” Acting FDA Commissioner Dr. Janet Woodcock said in a statement Wednesday.

In a 9-6 vote Thursday, the CDC declined to include the third group in its interim recommendations. But Walensky’s endorsement sided with the FDA, recommending Pfizer boosters for these populations:

  • Should receive booster
    • People 65 and older
    • Residents of long-term care facilities
    • People 50-64 with underlying medical conditions
  • May receive booster
    • People 18-49 with underlying medical conditions
    • People 18-64 “who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting.”

Floridians 65 and older were among the prioritized during the initial vaccine rollout that began in December, as part of Gov. Ron DeSantis’ “Seniors First” campaign.

About 88% of people 65 and older had been at least partially inoculated through Sept. 16, according to the Florida Department of Health — more than any other age bracket.

Can I get a booster if I'm immunocompromised?

Immunocompromised individuals — regardless of whether they got the Pfizer or Moderna vaccine — have been eligible for a second booster, or third overall dose, since mid-August. 

They need only wait 28 days after their second dose to receive a third. The trio of doses should be by the same manufacturer, but it’s OK to mix and match the third dose if necessary, the CDC said.

People with these conditions are considered moderate to severely immunocompromised, according to the agency: 

  • Organ transplant
  • Primary immunodeficiency
  • Active cancer treatment
  • Untreated or advanced HIV
  • Stem cell transplant within last two years
  • Active treatment with high-dose corticosteroids.

Nearly 278,000 immunocompromised Floridians had received a third dose through Sept. 16, health department records show.

People who are homebound may call 866-779-6121 or email homeboundvaccine@em.myflorida.com to request a vaccine. An online form is also available.

If I need a COVID booster shot, is the vaccine not working?

Depending on which vaccine you got and when, the degree to which you’re protected against the virus probably isn’t quite as strong as it once was — and that’s normal.

Booster shots aren't new. Antibody responses to viruses typically decline over six to eight months, said Edwin Michael, an epidemiologist at the University of South Florida College of Public Health.

“The booster is a hedge to counter any waning of immunity,” he said. “Any boosting will lead to further diversification of the immune response, meaning that this diversity will be important to counter new mutants.”

The highly transmissible delta strain, the most prevalent variant in the U.S., arrived in Florida in June, when the health department recorded 280 cases. By the first week of September, there were over 26,000. 

Delta wasn’t around when Floridians 65 and older became eligible for vaccination.

“As people age, even without immunizations, our immune system becomes less efficient,” said Brown, of FAMU. “It’s a natural process, it’s not a statement about whether the vaccine works.”

The vaccine does work, said Dr. Richard Rothman, institute chair of hospital medicine for Cleveland Clinic Florida.

“We have seen how effective the vaccine can be,” he said. “The majority of our patients who have required hospitalization due to COVID-19 are unvaccinated. … This is the best protection we have.”

Dr. Richard Rothman, institute chair for hospital medicine at Cleveland Clinic Florida, gives a status update of CCF properties during a briefing Friday, Aug. 20, 2021. Because of the recent surge in hospitalization of severe COVID-19 patients, the Surgical Intensive Care Unit at Cleveland Clinic Indian River Hospital in Vero Beach has been converted to treat only COVID-19 patients. All 28 patients in the SICU are on ventilators.

What if I skip the COVID booster shot?

If you’re eligible for a third Pfizer dose, seize the opportunity. 

That’s the advice of nurse practitioner Laurie Grissman McCuen, who’s witnessed the “nightmare” of dying COVID patients.

“I would rather have the third dose and not get COVID than have a second dose and possibly get COVID, even though I wouldn’t die,” said McCuen, president of Mobile Medical Associates in Palm City. “I don’t want COVID — ever.”

Just as the unvaccinated population is largely responsible for the enduring, mutating virus, people who skip their third dose can contribute to community transmission, she said. 

“Therefore, the pandemic takes longer to eliminate,” McCuen said. “I don’t think it’s about death as much as it’s a worry about decreasing COVID in the world.”

Prins, of UF, doesn’t anticipate much booster hesitancy among the priority groups.

“These are folks who are pretty clued into the fact that if they get a breakthrough infection, it still could be one that could hospitalize them,” Prins said, “one that could even be worse than that.”

Will Moderna and J&J recipients get a booster shot?

People who completed the two-dose Moderna vaccine series or got the single Johnson & Johnson shot may soon be eligible for boosters. 

“This is definitely [in] the cards, and a good thing,” said Michael, of USF. 

Moderna has submitted booster data to the FDA for evaluation, the company announced Sept. 1. Increased protection was observed in a study of patients who got a booster six months after their second dose — especially among those 65 and older.

Company data also showed “robust antibody responses against the delta variant,” CEO Stéphane Bancel said in a statement.

Earlier this week, J&J reported its studies showed a 12-fold increase in antibodies when a booster was given six months after the first dose. J&J provided the data to the FDA.

Lindsey Leake is TCPalm's health, welfare and social justice reporter. She has a master's in journalism and digital storytelling from American University, a bachelor's from Princeton and is a science writing graduate student at Johns Hopkins. Follow her on Twitter @NewsyLindsey, Facebook @LindseyMLeake and Instagram @newsylindsey. Call her at 772-529-5378 or email her at lindsey.leake@tcpalm.com.