A majority of the Centers for Disease Control and Prevention’s work group on COVID-19 vaccines now supports ending the agency’s pandemic-era recommendation for virtually all Americans to get vaccinated against the virus each year, officials said Tuesday.
Instead of the agency’s longstanding “universal” recommendation, most of the CDC’s advisers and health officials favor shifting to guidance based on people’s individual risk of more severe disease.
While a final decision has not yet been made, this could mean that only adults ages 65 years and older would still be recommended to get at least two doses every year, under a policy option laid out to the agency’s advisers, as well as people who have an underlying health condition putting them at higher risk.
Among those backing the switch, most also want “permissive language to allow anyone wanting protection from COVID-19 vaccination to receive one,” the CDC’s Dr. Lakshmi Panagiotakopoulos said at a Tuesday meeting of the panel.
A formal vote on the new guidance is expected in June by the CDC’s Advisory Committee on Immunization Practices. The panel’s votes are important because they influence ways that the federal government supports immunizations, ranging from how insurance companies are required to cover vaccines to how doctors talk about the shots.
“I’m very happy that we’re seriously considering a risk-based recommendation. I’m glad that we’re taking this as a reasonable possibility,” said Dr. Jamie Loehr, one of the members of the advisory committee.
Loehr and other advisers also acknowledged they had hesitations about the feasibility of the change. Loehr said he worried also about the message it would send.
“COVID is still a fairly dangerous disease and very, very common. We’re not talking about 10 cases of mpox. We’re talking about thousands of hospitalizations and deaths,” he said.
The agency’s work group has been wrestling since last year with the prospect of narrowing federal recommendations for COVID-19 vaccines.
In recent months, additional data was presented to the work group on prevalence of infection-induced immunity to the virus, long COVID, multisystem inflammatory syndrome and COVID-19 vaccine uptake, the agency said.
Less than a quarter of adults and around 13% of children have gotten a COVID-19 vaccination this past season, CDC data shows, despite an uptick in seniors getting a shot. That is a fraction of the nearly half of children and adults who have gotten a flu shot.
Outside medical groups have opposed scaling back recommendations for COVID-19 vaccines, citing concerns that the changes would add hurdles to getting the shots.
“The reality is most of these vaccines, certainly for adults, are being given in pharmacies. The risk-based recommendations are more difficult for pharmacists because patients have to self-declare their illnesses or the pharmacists have to check their medication list,” Dr. Sandra Fryhofer, a member of the work group and the panel’s American Medical Association representative, said at the meeting.
Analysis presented to the panel suggests that narrowing the recommendations would make little difference for many Americans. More than 74% of American adults have a condition that puts them at higher risk, ranging from asthma to obesity.
But Dr. Noel Brewer, another member of the work group, did not appear to be concerned that a narrower recommendation would worsen vaccination rates.
“There’s not clear evidence at all that risk-based approaches are less effective. It’s certainly something we’ve all talked about and something that some of the companies have shared for many years, but the data supporting that claim are not really there,” said Brewer.
The work group looked at data from 2010, when the CDC went in the reverse direction with flu shots: broadening recommendations for influenza vaccination from just people with high-risk conditions to virtually all Americans ages 6 months and older.
Vaccination coverage among adults under 50 with high-risk conditions increased slightly from 2010 to 2011, but then plateaued.
“Thereafter, no significant changes were seen among people with high risk conditions when vaccine recommendations targeted people with high risk conditions only, compared to a universal vaccine policy,” the CDC’s Panagiotakopoulos said.
