All Americans 6 months and older should receive one of the new COVID-19 vaccines as soon as they become available this fall, the Centers for Disease Control and Prevention said Thursday.
The recommendation comes as the nation faces a summer surge in Covid, with infection numbers rising in at least 39 states and territories.
Most Americans have acquired immunity to the coronavirus through repeated infections or vaccine doses, or both. Vaccines now offer an incremental boost, remaining effective for only a few months as immunity wanes and the virus continues to evolve.
Yet across every age group, the vast majority of Americans hospitalized for Covid did not receive one of the vaccinations proposed last fall, according to data presented Thursday at a meeting of the CDC’s Advisory Committee on Immunization Practices.
Dr. Mandy Cohen, the agency's director, on Thursday accepted the group's unanimous advice to recommend another round of vaccinations.
“Professionals and the general public don’t understand how much this virus has mutated,” said Carol Hayes, the committee’s liaison to the American College of Nurse-Midwives. “This year’s vaccine is needed to protect against this year’s strain of the virus.”
A vaccine from Novavax will target JN.1, the variant that dominated for months in the winter and spring. The shots to be given by Pfizer and Moderna are aimed at KP.2, which until recently seemed likely to be the dominant variant.
But KP.2 appears to be giving way to two related variants, KP.3 and LB.1, which now account for more than half of new cases. All three variants, descendants of JN.1, are nicknamed FLiRT, after two mutations in the virus' genes that contain those letters.
The mutations are thought to help the variants evade some immune defenses and thus spread more quickly, but there is no evidence that the variants cause more severe disease.
Covid-related emergency room visits in the week ending June 15 increased by nearly 15% and deaths by nearly 17%, compared to the previous week's totals. Hospitalizations also appear to be increasing, but the trends are based on data from a subset of hospitals that still report data to the CDC even though the requirement to do so expired in May.
“Covid is still around, and I don’t think it’s ever going to go away,” Dr. Steven P. Furr, president of the American Academy of Family Physicians, said in an interview.
The biggest risk factor for serious disease is age. Adults aged 65 and over account for two-thirds of Covid hospitalizations and 82% of in-hospital deaths. Yet only about 40% of Americans in that age group have been immunized with a COVID-19 vaccine offered last fall.
“This is an area where there is a lot of room for improvement and it could prevent many hospital admissions,” said Dr. Fiona Havers, a CDC researcher who presented the data on hospital admissions.
Although young adults are much less likely to become seriously ill, there are no groups completely free from risk, CDC researchers said. Children, particularly those under age 5, are also vulnerable, but only about 14% were immunized against Covid last fall.
Many parents mistakenly believe the virus is harmless in children, Dr. said. Matthew Daley, panel member and senior researcher at Kaiser Permanente Colorado.
“Because weight was so high in the older age groups, we lost sight of the absolute weight in the pediatric age groups,” Dr. Daley said.
Even if children don't get sick, they can still fuel the circulation of the virus, especially once they return to school, Dr. Furr said.
“They are the ones who, if they get exposed, are most likely to bring it home to their parents and grandparents,” he said. “By immunizing all groups, the spread is more likely to be prevented.”
Among children, infants younger than 6 months have been hit hardest by Covid, according to data presented at the meeting. But they are not eligible for the new vaccinations.
It is “critical that pregnant women get vaccinated, not only to protect themselves but also to protect their babies until they are old enough to be vaccinated,” Dr. Denise Jamieson, one of the speakers and dean of the Carver College of Medicine at the University of Iowa.
Among both children and adults, vaccination coverage has been lowest among the groups most at risk from Covid: Native Americans, African Americans, and Hispanic Americans.
In polls, most Americans who said they probably or definitely would not get the shots last fall cited unknown side effects, insufficient studies or distrust of the government and drug companies.
The CDC has said the vaccines are linked to only four serious side effects, but thousands of Americans have filed compensation claims for other medical harms they believe were caused by the shots.
At the meeting, CDC researchers said they had discovered, for the first time, that Pfizer's COVID-19 vaccine may have caused four additional cases of Guillain-Barré syndrome, a rare neurological disorder, for every million. doses administered to the elderly. (The numbers available for the Moderna and Novavax vaccines were too small for analysis.)
The risk may not prove to be real, but even if it were, the incidence of Guillain-Barré syndrome is comparable to the rate seen with other vaccines, the researchers said.
The CDC has also studied a potential risk of stroke after vaccination, but the results so far are inconclusive, agency scientists said. In any case, they said, the benefits of vaccines outweigh the potential harms.
Speakers deplored the sharp decline in healthcare workers advising patients on the importance of Covid vaccination. Nearly half of providers said they did not recommend the injections because they believed patients would refuse them.
There has also been an increase in physical and verbal abuse in hospitals and health care facilities, said Dr. Helen Keipp Talbot, a professor of medicine at Vanderbilt University and chair of the committee.
“Some of our doctors may not recommend it because of concerns about their safety and that of their staff,” he said.
Although the speakers unanimously recommended Covid vaccination for people of all ages this time, they debated the feasibility of universal recommendations in the future. Vaccines are much more expensive than other shots and are more convenient when given to older adults.
At the individual level, the Affordable Care Act requires insurance companies, including Medicare and Medicaid, to cover vaccines recommended by the advisory committee at no cost. But up to 30 million Americans do not have health insurance.
The Bridge Access Program, a federal initiative that makes vaccines available to underinsured and uninsured Americans, will end in August.
Speakers said if vaccine prices don’t drop, the cost of vaccinating all Americans may not be sustainable.
“As more and more society is exposed to vaccines or diseases, these will become much less cost-effective,” Dr. Talbot said. “We will need a less expensive vaccine to make this work.”