Virus World

In a highly unusual decision, the C.D.C. director, Rochelle Walensky, reversed a move by agency advisers to endorse additional doses of the Pfizer-BioNTech vaccine for older Americans but not for health care workers or teachers.  The director of the Centers for Disease Control and Prevention on Friday overruled a recommendation by an agency advisory panel that had refused to endorse booster shots of the Pfizer-BioNTech Covid vaccine for frontline workers. It was a highly unusual move for the director, Dr. Rochelle Walensky, but aligned C.D.C. policy with the Food and Drug Administration’s endorsements over her own agency’s advisers. The C.D.C.’s Advisory Committee on Immunization Practices on Thursday recommended the boosters for a wide range of Americans, including tens of millions of older adults and younger people at high risk for the disease. But they excluded health care workers, teachers and others whose jobs put them at risk. That put their recommendations at odds with the F.D.A.’s authorization of booster shots for all adults with a high occupational risk. Dr. Walensky’s decision was a boost for President Biden’s campaign to give a broad swathe of Americans access to boosters. The White House had come under criticism for getting ahead of the regulatory process. The C.D.C.’s statement arrived well past midnight, a sign of the complicated and confusing decision-making surrounding the boosters. The C.D.C. advisers similarly spent two days debating who should get boosters and when, and could not agree on whether occupational risk should qualify as a criterion.

 

“I am surprised that Dr. Walensky overturned one of the four A.C.I.P. votes today, and I believe others will be as well,” said Dr. Yvonne Maldonado, an infectious disease expert at Stanford and the American Academy of Pediatrics liaison to the committee. But the vote on boosters for occupational risk “was close,” Dr. Maldonado said, and agreed with Dr. Walensky’s decision. “This addresses not only waning immunity but those at high risk of exposure,” Dr. Maldonado added. Minutes before Dr. Walensky’s statement, Dr. Amanda Cohn, who oversaw the two-day meeting of the panel, tried to prepare the advisers for the director’s decision. “Dr. Walensky is reversing the decision to not recommend use of a booster dose in persons at high risk for occupational or institutional exposure,” Dr. Cohn wrote in the email. “I am hoping to share this news with you before you see it in the press.” Dr. Walensky’s decision to go against her own agency’s advisers came as a surprise to at least some of her staff members: The C.D.C. director’s endorsement of the advisory committee’s recommendations is typically just a formality. Hours before her statement, agency insiders predicted she would stick with the usual protocol because doing otherwise would undermine the process and upset the advisers as well as her own staff.  But experts outside the C.D.C. said Dr. Walensky may have had no choice but to align herself with the F.D.A.’s decision. “There’s a complexity here, because Dr. Walensky was part of the White House announcement” on boosters, noted Dr. Ashish Jha, dean of the Brown University School of Public Health. Dr. Walensky said providing booster shots to health care workers and others who risk contracting the disease on the job would “best serve the nation’s public health needs.”