The Centers for Disease Control and Prevention (CDC) on Thursday recommended the Moderna and Johnson & Johnson COVID-19 booster vaccines for certain populations. The decision follows the Food and Drug Administration (FDA)’s authorization of the two booster shots and guidance from a CDC advisory panel.
Under the new recommendations, anyone initially receiving an mRNA COVID-19 vaccine from Pfizer or Moderna, 65 and older, with underlying conditions, works in high-risk settings, or resides in long-term care settings is eligible for a booster of any vaccine six months after their second dose.
All people 18 and older who initially received a Johnson & Johnson single-shot vaccine are eligible for a booster dose of any vaccine at least two months after their initial vaccination. The Pfizer and Johnson & Johnson booster will be administered with the same dosage as the initial vaccine, while Moderna’s will be a half dose at 50 mcg.
The new recommendation will expand booster access to millions of Americans, particularly those who didn’t receive Pfizer as their original shot.
As of October 19, 10.9 million Americans have already received a booster dose or third shot, according to the CDC panel.
Monica Medina McCurdy, PA-C, vice president of healthcare Services at Project HOME’s Stephen Klein Wellness Center in Philadelphia, says that the approval of Modena and Johnson & Johnson boosters will benefit her patients and staff, many of whom were ineligible for the Pfizer booster before this week.
“The booster for Moderna and Johnson & Johnson is going to hopefully increase our demand a lot more than it is now,” McCurdy tells Verywell.
Due to logistical challenges with Pfizer’s stricter storage requirements for its vaccines, in which thawed vials could only be stored for up to five days, McCurdy’s wellness center opted for mainly Moderna and Johnson & Johnson.
Project HOME also works with people who are homeless or financially vulnerable. And the single-dose Johnson & Johnson vaccine has been prioritized for these groups because it was more accessible and didn’t require a second shot.
At the CDC panel on Thursday, Kathleen Dooling, MD, MPH, suggested approving Johnson & Johnson boosters for equity reasons.
“At present, only recipients of Pfizer-BioNTech COVID-19 vaccine primary series have been recommended to receive a booster, thus creating an inequity for recipients of Moderna or Janssen,” Dooling said. “Moreover, Janssen COVID-19 vaccine may have been used more commonly for outreach to homeless or medically underserved communities.”
Risks and Benefits of a Johnson & Johnson Booster
CDC panelists had mixed thoughts on whether Johnson & Johnson recipients should receive a booster of the same vaccine or try out an mRNA shot.
Panelist Pablo J. Sanchez, MD expressed hesitancy towards boosting with the Johnson & Johnson vaccine due to its risk of triggering autoimmune disorder Guillain Barre Syndrome (GBS) in men and blood clots in women under 50.
“I remain very concerned about a second dose of the Janssen product,” Sanchez said, adding that he supports mixing and matching boosters, particularly for Johnson & Johnson recipients.
Panelists advised young women who initially received the Janssen shot, or those who developed blood clots after their first shot, to look for another vaccine as their booster dose.
Nearly 15 million people in the U.S. have received an initial dose of the Johnson & Johnson vaccine. Since the CDC doesn’t require people to get the same booster dose as their initial vaccination, those who have a preference for an mRNA vaccine may seek one out instead.
How Necessary Are Boosters?
Some CDC advisers stressed that the COVID-19 vaccines are largely effective against hospitalizations despite waning efficacy against infection.
“We don’t want to be confused by protection against infection, as that is not the goal of this vaccine,” Sara S. Long, MD said at Thursday’s meeting.
According to data presented at the CDC panel, the Moderna vaccine’s efficacy against infection was shown to have dropped from 94% to 80% with the presence of the Delta variant. But its efficacy against hospitalizations remained higher than 96%.
There are fewer studies on the Johnson & Johnson vaccine’s effectiveness against the Delta variant, but it’s shown to offer less protection against infection and hospitalization than the mRNA vaccines, panelists said. Global data showed Janssen’s various efficacy levels—which range from 60% to 85% against severe disease and as wide as 12% to 95% against symptomatic infection.
Continued Precautions Against COVID-19
Wilbur H. Chen, MD, MS reiterated the importance of non-vaccine protection measures against the virus, highlighting the ongoing requirements for mask use and social distancing in some areas.
“I’d like to remind the American public now that there are other non pharmaceutical interventions, that we need to all have a multi-layered approach.” Chen said. “We’re not just gonna vaccinate ourselves out of this situation.”
Back in Philadelphia, McCurdy says she feels optimistic about the growing booster rollout. Battling vaccine hesitancy among those who have yet to get an initial series, however, is a more daunting task.
“I think everyone that we gave Moderna or Johnson & Johnson to will be highly interested in getting the booster shot,” McCurdy says. “Where we continue to struggle is just trying to reach folks who are still on the fence.”
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