A key vaccine advisory panel voted Thursday to recommend that children between the ages of 5 and 11 should be offered a third dose of the Pfizer-BioNTech Covid-19 vaccine at least five months after they received their second dose.
Rochelle Walensky, the director of the Centers for Disease Control and Prevention, endorsed the panel’s recommendation later that day. She noted that vaccination among this age group has lagged behind other age groups. “With over 18 million doses administered in this age group, we know that these vaccines are safe, and we must continue to increase the number of children who are protected,” Walensky said in a statement released by the CDC.
The CDC also now recommends that those who are 12 and older and immunocompromised and all people over the age of 50 should receive a second booster — that is, a fourth dose of vaccine — at least four months after their first dose. Previously, the agency had allowed those groups to get a fourth dose but had not made a clear recommendation.
The panel, known as the Advisory Committee on Immunization Practices, did not debate whether to make the vaccine booster available to children in the 5-to-11 age group. Instead, the discussion focused on whether the CDC should tell parents and doctors that these children “should” receive the vaccine, or to give what is known as a permissive recommendation, saying that children “may” receive the booster dose.
In non-pandemic conditions, that simple difference in wording can have a large impact on the extent to which vaccines are used and whether insurers cover them.
Panelists came down resoundingly on the side of “should.” The vote was 11-1, with one abstention, that the CDC should make its strongest recommendation. Helen “Keipp” Talbot of Vanderbilt University, who voted against the recommendation, was in part worried that many children have not even received their first dose of vaccine. Kevin Ault of the University of Kansas Medical Center abstained because he was not able to attend the entirety of the day’s discussion.
Most of the panelists who voted yes also noted the large number of children in the age group who had not received the Covid vaccine, but they worried that the public might interpret weaker language as saying the vaccine was not important.
“I think ‘may’ may be confusing and it may sow doubt about the need for any booster,” said Oliver Brooks, chief medical officer of Watts Healthcare in Los Angeles.
Camille Kotton, who directs treatment of infectious disease in immunocompromised patients at Massachusetts General Hospital, added: “I would like to speak in support of significant clarity of our recommendations. In my clinical experience it is confusing when we say may.”
Kotton said she is surprised by how many immunocompromised patients, who are eligible for boosters, are not up to date on their vaccinations.
The panelists viewed data that showed that the risk of myocarditis, a side effect of the vaccine, is less common in younger children. They also saw data that showed that, as with other age groups, a third dose increases the antibody response from the vaccine, which should protect recipients better at least temporarily.
Their biggest concern was the number of children who are currently not getting Covid vaccines for which they are eligible. For instance, the CDC presented data that only 25% of 5-year-olds had received their second dose of the vaccine. What’s more, those rates differed based on where children lived. The CDC said 39.8% of children ages 5 to 11 in large urban areas had been vaccinated, compared to 14.4% of those in rural areas.
The committee did not consider data on whether children younger than 5 should receive Covid shots. That decision, for both the Moderna and Pfizer-BioNTech vaccines, will first rest with the Food and Drug Administration, which considers whether vaccines should be authorized before the CDC decides whether to make a recommendation. The FDA decides whether the medicines can be given; the CDC determines whether to tell people they should take them.
But panelist Jamie Loehr, owner of Cayuga Family Medicine in Ithaca, N.Y., asked the FDA to move quickly on the decision on Covid vaccines for younger children.
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