Updated: This story, which originally reported on the CDC vaccine panel’s recommendation that school staff members not be eligible for COVID-19 boosters, has been updated to reflect CDC Director Rochelle Walensky’s overruling of that decision.
Hours after a federal vaccine advisory committee voted against recommending a booster shot for essential workers, including K-12 school staff, the director of the Centers for Disease Control and Prevention overruled the decision.
Teachers and other school workers who received the Pfizer-BioNTech COVID-19 vaccine can receive a Pfizer booster dose at least six months after the completion of their second shot. The CDC says they should base their decision on an assessment of their individual benefits and risks, a phrase that typically means having a conversation with their doctor.
The unusual reversal by CDC Director Rochelle Walensky happened after midnight Friday, hours after the agency’s advisory committee on immunization practices voted to recommend a booster dose of the Pfizer-BioNTech COVID-19 vaccine for people ages 65 and older and those ages 50 and older with underlying medical conditions. The committee also voted, more narrowly, to allow people ages 18 to 49 years old with underlying medical conditions to get a booster shot based on an assessment of their individual benefit and risk.
But in a close vote of 9 to 6, the committee declined to recommend that adults younger than 65 who live or work in settings where the burden of COVID-19 infection and risk of transmission are high—including schools—receive a booster dose based on an assessment of their individual benefit and risk.
In a statement, Walensky said she thinks booster shots will help protect this group.
“As CDC Director, it is my job to recognize where our actions can have the greatest impact,” she said. “At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.”
The committee deliberated for hours on the question of whether essential workers needed a booster shot.
“I really think this is a solution looking for a problem,” said Dr. Jason Goldman, a nonvoting committee member and an affiliate assistant professor of clinical biomedical science at Florida Atlantic University.
Committee members were concerned that there were no clear data yet showing that healthy adults needed a booster shot, regardless of their occupation. Opening the door to allowing millions of essential workers to get a booster shot would be complicated, they said, and it wouldn’t make a significant dent in curbing the pandemic.
Evidence presented to the committee showed that while vaccine effectiveness against infection has waned over time, the vaccines remain effective against preventing hospitalization and severe disease, especially among adults younger than 65.
The CDC committee’s vote came a day after the U.S. Food and Drug Administration amended Pfizer’s emergency use authorization to allow for a single booster dose for people ages 65 and older, adults who are at high risk for serious COVID-19 complications, and adults in high-risk settings, including health care workers, teachers and day care staff, grocery workers, and those in homeless shelters or prisons.
State health departments generally follow the CDC’s recommendations on vaccine eligibility.
Some teachers have been waiting for a booster
Many teachers were hopeful that the emergency authorization meant they would soon receive additional protection from contracting COVID-19 at work, and were angry when they heard of the CDC committee’s decision.
“If we want to prioritize in-person learning, we have to have teachers as protected as possible,” said Sarah Mulhern Gross, a high school English teacher in Lincroft, N.J.
Gross said she knows teachers who have had breakthrough infections, and she wants to avoid even a mild case of COVID-19. Having a booster shot would make her feel more comfortable at work, she said.
“I can’t control our ventilation, I can’t control that my building doesn’t have operable windows, but I can control my masking, and I can control my vaccination status,” she said.
The risk level of teaching in person varies, said Gigi Gronvall, an immunologist and senior scholar at the Johns Hopkins Center for Health Security, and there’s still ambiguity about who needs a booster shot at this time.
Vaccinated teachers who are working in school settings that have safety measures in place—such as mask requirements, regular testing, and improved ventilation—are likely not at higher risk for infection than the average person. But teachers who are working in schools with poor ventilation that do not require masks may benefit from a booster shot, she said.
Still, members of the CDC committee were concerned about the broad nature of the category of occupational or institutional risk. Also, only recommending booster shots for people who have received the Pfizer shot makes for a murky public health message, several members said. The committee has not given the OK to mix and match vaccines.
Dr. Anthony Fauci, the nation’s chief epidemiologist, said on NBC News’ “Meet the Press” Sunday that data about booster shots for those who received the Moderna or Johnson & Johnson vaccines is “literally a couple to a few weeks away.”
Members of the committee also expressed concern about focusing on booster shots when nearly all hospitalizations and deaths due to COVID-19 are occurring among unvaccinated people.
“The reality is, we have a lot of unvaccinated people, and that’s our problem, and that forces the conversation about boosters,” said Gronvall, who is not on the committee. “If you’re not having these people breathing virus into the air, then you wouldn’t have to take your vaccine out for a spin to see how it works.”
Most teachers are vaccinated
The FDA had approved the booster shot to be administered any time after six months following the second dose. Teachers in a dozen states, plus Puerto Rico and the District of Columbia, became eligible for the COVID-19 vaccine nearly nine months ago, and many received the shot as soon as they could. Teachers in eight more states became eligible in February, and on March 8, teachers across the country became eligible to receive the vaccine under the Federal Retail Pharmacy Program.
At this point, most teachers across the country are vaccinated against COVID-19. A nationally representative EdWeek Research Center survey found that in late July and early August, 87 percent of educators said they were partially or fully vaccinated.
Policymakers and district officials are now trying to persuade the remaining holdouts to get vaccinated through incentives and requirements. Washington state and Oregon—along with several big-city school districts like New York City, Washington, D.C., and Los Angeles—have ordered all teachers to get vaccinated. Another seven states have said teachers must get vaccinated or undergo regular testing.
And President Joe Biden has called on the Occupational Safety and Health Administration to create an emergency rule requiring vaccination or weekly testing that will apply to public schools in 26 states with OSHA-approved safety plans. That rule has yet to be drafted.
In the meantime, many teachers are applauding Walensky’s decision to approve boosters.
“Count me first in line” for a booster, said Haley Lancaster, an English teacher in Vincennes, Ind., who received her first Pfizer shot in late December due to a surplus of vaccines in her county. “I’m the person who gets my flu shot every year because I know these things don’t last forever. To me, it’s a no-brainer.”
A version of this article appeared in the October 06, 2021 edition of Education Week