CDC recommends older adults get 2nd updated coronavirus shot

The Centers for Disease Control and Prevention recommended Wednesday that people 65 and older get a second dose of the coronavirus vaccine made available last fall because they are at higher risk for severe disease from the virus.

“Most covid-19 deaths and hospitalizations last year were among people 65 years and older. An additional vaccine dose can provide added protection that may have decreased over time for those at highest risk,” said CDC Director Mandy Cohen in a statement after endorsing the recommendation from the agency’s vaccine advisory panel.

The 11-1 vote, with one abstention, by the Advisory Committee on Immunization Practices appeared to take some members by surprise.

A subgroup of advisers had suggested softer language that would have said older adults “may” get a second dose instead of “should.” That language, members said, would have given clinicians more flexibility and also takes into account growing vaccine hesitancy four years into the pandemic.

But Camille Kotton, clinical director for transplant and immunocompromised host infectious diseases at Massachusetts General Hospital in Boston, pushed for the stronger language so clinicians can make clearer recommendations to patients. Too many Americans are still unaware they should be getting a coronavirus vaccine, she said. Using the word “may” is “too soft, especially for the most vulnerable,” she said.

Demetre Daskalakis, who directs the CDC center overseeing respiratory infectious-disease threats, warned the panel that “more absolute statements around vaccines will create a chilling effect for folks who have not been vaccinated.”

A CDC recommendation means that those who are eligible for a second shot will have that additional dose covered by insurance. Eligible consumers should be able to get the additional dose within a day or two from pharmacies or health-care providers stocking the vaccines. There are no supply shortages, CDC officials said.

The recommendation applies only to those 65 and older. The additional dose should be given at least four months after a previous dose for healthy older adults, or at least three months after a coronavirus infection. It’s unclear whether those getting a second shot now will also need another shot for the 2024-2025 fall and winter season.

David Kaslow, a representative of the Food and Drug Administration who was sworn in as a temporary voting member for the meeting, said there may be a new vaccine approved for the 2024-2025 winter season. In that case, he said, it would not be optimal for people to get a second dose of the current vaccine later than June.

The CDC already recommended in the fall that people age 5 and older get an updated vaccine to protect against serious illness. Uptake among adults has been low - only about 22 percent of those 18 and older have received the updated vaccine. And only about 42 percent of those 65 and older have received a dose. People who are moderately or severely immunocompromised are already allowed to get additional doses of an updated coronavirus vaccine.

The recommendation Wednesday acknowledges that risk of severe illness continues throughout the year for older adults, not only during the winter months. Unlike flu and RSV, which usually occur in the fall and winter, covid surges have occurred in the spring and summer.

This will be the third year in a row that spring boosters will be offered. “Things with covid are unpredictable,” CDC expert Megan Wallace told the panel. Officials are hoping the coronavirus is moving in the direction that is more like flu, with a clear season, “but I don’t think we are there yet,” she said.

To be sure, the impact of covid-19 has changed dramatically since the start of the pandemic in 2020, with new infections causing far fewer hospitalizations or deaths. By the end of last year, 98 percent of people in the United States had disease-fighting antibodies from vaccination or prior infection - or both, for the strongest immunity.

But panel members said covid infections are still at levels similar to years past. Another shot of the vaccine would restore some degree of vaccine effectiveness that may have waned since last fall.

While hospitalization rates have fallen across all age groups, certain groups continue to be hospitalized at higher rates, including older adults, infants and people with underlying medical conditions or certain disabilities. Data presented at the vaccine advisers meeting show that 67 percent of covid-19 hospitalizations between October 2023 to January 2024 were in those 65 and older. During the first seven months of 2023, adults 65 years and older accounted for 63 percent of hospitalizations and 88 percent of in-hospital deaths from covid-19, according to the CDC. There are still roughly 20,000 people a week hospitalized for covid-19 and about 2,000 deaths a week caused by the disease.

But there are drawbacks to giving a second dose, according to data presented at the meeting. Given broad immunity in the population, there is incremental benefit of a second dose of the updated vaccine targeting one of the omicron subvariants, XBB.1.5, that was widely circulating last fall when it was approved by the FDA.

Allowing a second dose may decrease public confidence in the benefits of a single dose of the updated vaccine, the CDC said. Recommendations for an additional dose may also increase vaccine fatigue, potentially reducing uptake of the vaccine next fall.

Even though the virus has continued to evolve, the CDC says the updated coronavirus vaccines continue to be effective against different circulating variants, such as JN.1, which started to dominate in January.