CDC Director Overrules Panel to Include Frontline Workers in Booster Rollout

In a rare move, the director of Centers for Disease Control and Prevention (CDC) on Friday overruled an advisory panel’s recommendation by including frontline workers in the Pfizer booster vaccine rollout.

“It is my job to recognize where our actions can have the greatest impact,” CDC Director Rochelle P. Walensky, MD, MPH said in a press statement.

Under the new designation, the CDC now recommends a third Pfizer shot for people over 65, residents in long-term care facilities, all adults who have underlying medical conditions, and people who are at occupational risk of COVID-19 transmission such as healthcare workers and teachers.

The Advisory Committee on Immunization Practices (ACIP), a CDC panel, had excluded frontline workers from the booster campaign in a 9-to-6 vote. The decision received heavy backlash from healthcare groups and advocates, who stressed the need for additional protection among first responders.

National Nurses United (NNU), the largest union of registered nurses, condemned the ACIP’s vote, noting that healthcare workers are at high risk of exposure to the COVID-19 virus.

“It is unconscionable that ACIP would not vote to keep us safer from death, severe COVID, and long COVID,” NNU President Deborah Burger, RN said in a press release. “Leaving healthcare workers out is akin to early CDC guidance telling nurses that a bandana is sufficient protection while caring for a patient with COVID-19.”

Following Walensky’s decision to overrule the panel’s recommendation, NNU issued a new statement praising her approval.

“We applaud this bold decision-making that prioritizes the health and safety of workers on the front lines of this ongoing crisis, and we know that her decision will absolutely save lives,” Burger said.

More than 3,600 U.S. healthcare workers died in the first year of the pandemic, and 32% of them were nurses, according to an investigation by The Guardian and Kaiser Health News. Due to the devastating toll on this population, policy experts and union leaders have called on the Biden administration to track hospitalizations and deaths among healthcare workers.

Most People May Still Need a Booster Shot Later

Jonathan Baktari, MD, CEO of e7health, says the decision to approve or withhold boosters from certain populations has to do primarily with the logistics of a vaccine rollout and public health discussions. He adds that the CDC’s change reflects the agency’s struggle to balance a booster rollout while figuring out how to combat vaccine hesitancy for the initial series.

“It's pretty clear from the studies that it's just a matter of time before everybody's going to need a booster,” Baktari tells Verywell. “Why it's so muddy is because they're struggling with how to phase it in. I think in three months, all of these minor nuances will be less important.”

As studies show that antibodies from the mRNA vaccines declined after around six months, it’s only a matter of time before boosters will be available to the general population, he adds.

“Today's booster could be tomorrow's three-shot series, potentially,” Baktari says.

He adds that the main purpose of boosters is to strengthen an individual's immune system. Whether or not boosters can also reduce community transmission of COVID-19 is understudied and unclear, he says. 

The ACIP panelists who voted against approving boosters for frontline workers argued that the recommendation was too broad and could falsely imply the initial series of the vaccines were not working as is. Some said they worried too broad of an approval could distract the agency from its top priority, which is to make sure as many people as possible are vaccinated.

Baktari says he doubts the booster rollout will change people’s vaccine decisions. Not much will convince the “remaining large portion of the vaccine hesitancy group,” he adds.

Some panelists expressed equity concerns about the booster rollout, as the current recommendation only applies to people who received an initial series of Pfizer’s vaccine. From a public health standpoint, Baktari says the rollout may be more successful if the vaccines were authorized simultaneously. He expects the designation can create awkwardness and confusion among providers and recipients.

But it’s unclear how closely these CDC guidelines will be followed. Panelists at ACIP’s meeting noted that some people from unapproved groups have already sought out and received boosters since the White House announced its booster plan in August.

Now with a wider authorization, the decision of who should and shouldn’t get a booster may be dictated by providers that are administering the shot.

“I’ll be curious to see how the frontline people handing out the vaccines address that,” Baktari says.

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