Analysis & Comment

Opinion | New Guidance on Booster Shots Gets Ahead of the Science

By Megan L. Ranney and Jeremy Samuel Faust

Dr. Ranney is an emergency physician and the associate dean at Brown University’s School of Public Health. Dr. Faust is a physician at Brigham and Women’s Hospital Department of Emergency Medicine.

There’s finally a decision on which Americans should get booster shots against Covid-19. Unfortunately, some of the new federal recommendations go well beyond the data and foist the decision of appropriateness onto individuals and their doctors. And by expanding booster eligibility to a huge swath of the population, the Biden administration risks undermining confidence in vaccines.

The reality is that available vaccines continue to protect almost everyone against severe illness. That means there’s still time to gather more data on the benefit of boosters for people who are not high-risk and, in the meantime, focus on decreasing the number of unvaccinated Americans, where a crisis remains.

On Friday, the Centers for Disease Control and Prevention recommended that among people who received two Pfizer-BioNTech vaccine shots over six months ago, two groups should get boosters: All people 65 or older and people 50 to 64 with underlying medical conditions. But the C.D.C. also said two additional groups “mayget boosters “based on their individual benefits and risks”: people 18 to 49 with underlying medical conditions and people 18 to 64 who are at a high risk of coronavirus exposure at work.

The second set of recommendations is premature and too vague. Here’s why.

Data from Israel, Britain and the United States show that the available Covid-19 vaccines continue to provide excellent protection against hospitalization and death for almost everyone. Exceptions include the immune-compromised (who were already authorized to get a third dose) and people age 65 and older. These two groups are at the highest risk of serious illness from infection, even if they are vaccinated.

But there is inadequate evidence to support boosters for the general, younger population, including most people with underlying medical conditions. The C.D.C.’s list of conditions that make someone eligible for a booster is remarkably long, and few if any of these conditions have been shown to carry any additional risk of severe breakthrough illness. Boosters might help some people on the list, but the overall impact is likely to be small. Many thousands of young people would need to get additional shots to prevent a single hospitalization.

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