33: Booster Votes Explained

ASTHO Chief Medical Officer Dr. Marcus Plescia explains several votes taken by the CDC’s Advisory Committee on Immunization Practices Thursday, including one against COVID-19 booster shots for people with occupational or institutional risks; Dr. Ed...

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NOTE: CDC Director Dr. Rochelle Walensky announced late Thursday that booster shots would be available to frontline and health care workers, overruling the ACIP vote against covering those groups. This decision was announced after Morning Edition's deadline.

ASTHO Chief Medical Officer Dr. Marcus Plescia explains several votes taken by the CDC’s Advisory Committee on Immunization Practices Thursday, including one against COVID-19 booster shots for people with occupational or institutional risks; Dr. Ed Ehlinger, former commissioner of health from Minnesota, gives his take on the state of infant health in the United States; and we report on a new ASTHO guide for states and territories considering a gap analysis to assess administrative policies and procedures.

CDC Webpage: Advisory Committee on Immunization Practices

CDC Webpage: Infant Mortality Month

ASTHO Resource: State home visiting approaches improve early childhood outcomes and systems

ASTHO Blog Article: The importance of family engagement in breastfeeding programs

ASTHO Resource: Guide on conducting an administrative policy assessment and gap analysis

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This is Public Health Review Morning Edition for Friday, September 24th, 2021. I'm Robert Johnson.

Here's today's news from the Association of State and Territorial Health Officials.


COVID-19 booster shots for at-risk populations—those over 65 and people with medical conditions—approved again, first by the FDA and its panel of experts, and now by the CDC's Advisory Committee on Immunization Practices.

ASTHO's chief medical officer, Dr. Marcus Plescia, monitored the two-day meeting. He tells us what happened and what's next in today's morning conversation.

Explain for us the various votes that were taken by the ACIP committee last night.


So, there were several votes that were held. The first vote established a recommendation from ACIP that people over the age of 65 should be offered a booster dose of the COVID vaccine.

Then, there were two votes that got at the same thing basically. Out of those two votes, we got a recommendation that people age 18 to 64 who have an underlying medical condition that might put them at risk also were recommended to have access to the booster.

And then, the fourth vote was a little bit of a surprise. That was a vote on whether people who have occupational institutional risks—so, groups like healthcare providers. The ACIP actually voted against that recommendation. So, the ACIP has stated that that particular population, they are not recommending a booster shot.

And that's counter to what had come out of the FDA—the FDA had also included that group in what they approved the vaccine for.


What was the debate over that third group?


There were a number of things that came up. There's a whole issue of, you know, how much data do we really have that a booster is helpful in that group. There were quite a few people who spoke to that.

But there was a very important issue that came up—and actually, it was raised by our member, Dr. Nirav Shah, who is the state health official from Maine—he raised the issue that the way that this occupational institutional risk was worded, it was very vague.

And so, it was going to be very, very difficult to determine, well, what is an occupational risk? What is an institutional risk? And, in some ways, anybody could come in and say they have an occupational institutional risk.

So, Nirav was quite strong in his concerns about that, and I think that may have been one of the things that tipped the boat in the way that went.


So, we have the ACIP decision on this issue. It's different than the FDA's decision on this issue.

What happens next?


Well, our understanding from the guidance that was given on the call is that, on this particular issue, the ACIP has final word.

So, although the FDA approved the vaccine, that just means that it's scientifically okay to use it. But as far as what should be clinically recommended, the ACIP decides that.

So, as things stand right now—barring further changes—it looks like it's just going to be available for people who are over 65 and people who are younger and have medical conditions that put them at risk.


So, that's enough guidance for states and territories to get going.


Yes, I think states and territories will be in a good position to get going.

You know, the challenge for states and territories is going to be that you have a group, this occupational risk group—which would include providers and school teachers, some of whom may really feel like they need a booster dose because they are at slightly higher risk—and potentially we're now put in the position that we're going to have to tell those people, "No."


Do you feel like this issue will come back soon?


It may very well.

There was quite a bit of discussion on the ACIP meeting that this is where we are now and that there's so much more data coming in. It could very well be that the ACIP will convene again and reconsider some of these different groups based on new data that emerges.

And I think that may have influenced some people's votes. They weren't quite ready to take a stance and make a recommendation, but they might change their mind as we know a little bit more.


And that's been the story of the pandemic and vaccines, right? It's been coming in pieces as we know more, as we feel confident that what we're doing is safe and effective.

Just another chapter in this ongoing story.


Yeah, it really is.

I mean, this was a little bit of a surprising twist, but you know, that's the process we have. And I think the most important thing is that we do have that process and we followed it.


The advisory committee's recommendations now go to CDC director, Rochelle Walensky, for her consideration.


September is Infant Mortality Month, as you know, and the reason we have Infant Mortality Month in the first place is that babies are not doing well in our country.

You know, we have some of the highest infant mortality rates among high-income countries, and the racial disparities in infant mortality rates in our country persist at a shameful level; so, in general, babies are not doing well.


That's Dr. Ed Ehlinger, former state health official for Minnesota and a pediatrician, on the health of babies in the United States.

He discusses the impact of the pandemic on infants and the steps states and territories can take to improve their health, coming up on Monday's morning conversation.


Finally today, ASTHO has a new guide available for states and territories thinking about launching an assessment of gaps in administrative policies and procedures. The guide includes tips and tools for conducting a gap analysis.


Find a link to the guide, along with links to other stories mentioned today, in the show notes.


Also, remember to follow us on Apple Podcasts or Spotify, or listen on Alexa or Google assistant.

And, if you have a minute, please take time to leave us a rating and a review.


Join us Monday morning for more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition.

Edward Ehlinger MD MSPH

Acting Chair at HHS Secretary's Advisory Committee on Infant Mortality

Marcus Plescia MD MPH

Chief Medical Officer, ASTHO