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States brace for confusion as the Biden administration begins rolling out booster doses of Pfizer’s COVID-19 vaccine.
The chaotic and sometimes disparate messages from health officials in the administration over the past month have resulted in a complicated set of recommendations on who should get booster shots and why.
A Centers for Disease Control and Prevention (CDC) advisory group on Thursday recommended an additional dose of Pfizer vaccine for people aged 65 and older and residents of nursing homes, as well as those between 18 and 64 with ailments underlying health problems.
The panel looked into whether people in potentially high-risk occupations should be given a booster, but ultimately decided not to recommend it.
Panel members indicated that they wanted to avoid giving too broad a recommendation, because there was not enough evidence that vaccinated people under 50 lost their protection against serious illness and hospitalization.
But in a decision announced after midnight Friday morning, the CDC director Rochelle Walensky
Rochelle WalenskySunday preview: Pelosi announces the date of the infrastructure vote; Administration defends immigration policies Israel says US decision on recalls justifies vaccination strategy Overnight Healthcare – Brought to you by Indivior – Walensky gives green light for recalls MORE broke with the advisory committee and signed a broader policy.
Starting now, anyone between the ages of 18 and 64 who is at increased risk of exposure and transmission to COVID-19 due to a work or institutional setting can receive a third dose.
Experts said Walensky’s decision will make boosters available to healthcare workers, teachers, grocery store workers and other frontline workers. President Biden
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But essentially, anyone who wants a third dose can get one, even if it’s not technically permissible.
“There is going to be some confusion. If we are going to create guidelines that make the vaccine accessible to almost everyone, the easiest solution is to make it accessible to everyone,” said Celine Gounder, specialist in infectious diseases and epidemiologist at NYU and Bellevue Hospital. “The best public health programs are those that are simple, easy to understand and understand, and the more complexity you build in, the harder it is to deploy. “
Gounder, who has advised Biden’s transition team on COVID-19, criticized the administration’s fervor for the recalls, and said the evidence for a third occupation-based dose was mixed at best.
“You have to take a step back and ask the question, why are we vaccinating people in high risk environments? Is it because they are as high risk individuals, or is it because it would disrupt the workplace, ”Gounder said. noted.
Peak infections can be disruptive, especially for health workers. But while the purpose of a recall is primarily to allay the fears and anxieties of frontline workers, Gounder said, “there is simply no data to prove that a healthy young healthcare worker health is really in danger “.
The extension of the use of the Pfizer-BioNTech booster to frontline workers is even more limited than the administration envisioned.
Last month, Biden and senior health officials including Acting Food and Drug Administration (FDA) Commissioner Janet Woodcock, Walensky and the Surgeon General Vivek Murthy
Vivek MurthyCDC director partially cancels panel, approves boosters CDC panel clears COVID-19 vaccine boosters for people at high risk, those over 65 announced that a booster program for all adults would begin the week of September 20, well before the FDA and CDC reviewed the evidence.
The administration initially wanted people to receive boosters as early as eight months after their second injection, in an effort to reduce transmission amid the spread of the delta variant. But the scientific advisory committees decided on six months.
While officials were careful to say that the recall program depended on the green light from the FDA and CDC, the move was criticized by scientists inside and outside of government. They argued that there was not enough evidence to show that protection against serious illness and hospitalizations had dropped to levels that warranted a recall.
During a White House briefing on Friday, Walensky admitted that there was no way for states or the federal government to ensure people adhere to the eligibility criteria.
“What we are doing now is self-attestation,” she said.
In deciding to give recalls based on occupation, Walensky aligned CDC policy with FDA clearance. But no agency has specifically defined who is considered a high-risk worker.
Marcus Plescia, chief medical officer of the Association of State and Territory Health Officials, said states are not expecting additional clarity from the federal government.
“It’s going to get complicated, because it’s not clear. I think everyone knows that healthcare workers are part of this mix… but there are all kinds of other professions or institutional frameworks” who might respond. to the definition, Plescia said.
Adding even more confusion, a third dose of Moderna and Pfizer vaccines was authorized in mid-August for people with severely weakened immune systems.
The administration’s original plan called for boosters for all three vaccines to begin at the same time, but it was not clear until recent weeks that only Pfizer would be able to submit clinical evidence on time.
States prepared for the green light from the federal government, but Plescia said it would have been easier if all three injections were allowed at the same time, or if states had the option of mixing injections from different drug makers.
While there is no evidence to mix a third dose of Pfizer with two doses of the Moderna vaccine or a single dose of the Johnson & Johnson vaccine, Plescia said state health officials will struggle to forward it to members of the public requesting recalls.
These excessive promises now create a messaging challenge, as state and federal officials must manage expectations.
“It’s much easier to make a political announcement than it is to do the hard work of analyzing the science and making evidence-based recommendations,” said Richard Besser, former acting director of the CDC.
“The fact that we don’t have recommendations for people who got a Moderna and a J&J because the companies didn’t get the data… it’s going to cause heartburn everywhere,” said Besser, who is now President and CEO. of the Robert Wood Johnson Foundation.
“People had no choice but to which vaccine they were given. They are all effective, but only one of them can be boosted at this time.”
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