All Americans aged 6 months or older should get one of the COVID-19 vaccines that become available this fall, scientific advisers to the Centers for Disease Control and Prevention said Thursday.
The recommendation comes as at least 39 states and territories across the country are seeing rising cases and the country is on the brink of a summer wave of COVID-19 infections.
Most Americans have developed multiple layers of immunity to the coronavirus through repeated infections, vaccinations, or both. Vaccines are currently providing incrementally more effective protection, but the protection only lasts for a few months as immunity wanes and the virus continues to evolve.
And yet, data presented at a meeting of the CDC's Advisory Committee on Immunization Practices showed that the vast majority of Americans hospitalized with COVID-19, across all age groups, never received even one dose of the vaccine offered to them last fall.
“Experts and the public don't understand how much this virus has mutated,” said Carol Hayes, the committee's liaison for the American College of Midwives. “We need this year's vaccine to protect us against this year's strain.”
The vaccine made by Novavax targets the JN.1 variant that circulated for months through the winter and spring, while the vaccines made by Pfizer and Moderna target the KP.2 variant that until recently appeared to be dominant.
But KP.2 appears to be being replaced by two related mutations, KP.3 and LB.1, which now account for more than half of new infections. These three mutations, descendants of JN.1, are collectively nicknamed FLiRT, after the occurrence of two mutations containing these letters in the virus's genes.
The mutations are thought to allow the variant to evade immune defenses and spread faster as a result, although there is no evidence that the variant causes more severe disease.
In the week ending June 15, emergency room visits related to COVID-19 were up about 15% from the previous week's totals, and deaths were up about 17%. Hospitalizations also appear to be increasing, though this trend is based on data from a small number of hospitals that are still reporting numbers to the CDC despite the mandate ending in May.
“COVID-19 is still here, and I don't think it's going to go away,” Dr. Stephen P. Pharr, president of the American Academy of Family Physicians, said in an interview.
The biggest risk factor for severe illness is age: adults over 65 account for two-thirds of hospitalized COVID-19 cases and 82% of hospital deaths. But only about 40% of Americans in this age group were immunized by the COVID-19 vaccines offered to them last fall.
“This is an area where there is a lot of room for improvement and where many hospitalizations could be prevented,” said Dr. Fiona Havers, a CDC researcher who presented the hospitalization data.
While younger adults are much less likely to become seriously ill, no group is completely at risk, CDC researchers said. Children, especially those under 5, are also susceptible to infection, but only about 14% of children were vaccinated against COVID-19 last fall.
Dr. Matthew Daly, a panelist and senior research scientist at Kaiser Permanente Colorado, said many parents mistakenly believe the virus is harmless to children.
“The burden has been so great in the oldest age groups that we've lost sight of the absolute burden in younger children,” Dr Daly said.
Dr Farr said even if children don't get sick themselves, they could still increase circulation of the virus, especially once they return to school.
“If they get it, they're more likely to bring it back to their parents and grandparents,” he said. “If we vaccinate all groups, we have a better chance of preventing the spread.”
Data presented at the conference showed that children under the age of six months are the most affected by COVID-19, yet they are not the target group for the new vaccines.
“It's important for pregnant women to get vaccinated, not only to protect themselves, but also to protect their infants until they're old enough to be vaccinated,” panelist Dr. Dennis Jamieson, dean of the University of Iowa Carver College of Medicine, said in an interview.
Among both children and adults, the lowest vaccination rates were among Native Americans, Black Americans and Hispanic Americans — groups at highest risk for COVID-19 infection.
In the survey, most Americans who said they probably or definitely would not get vaccinated last fall cited unknown side effects, a lack of sufficient research and distrust of the government and drug companies.
While the CDC has said there are only four serious side effects from the vaccine, thousands of Americans have sued for other medical injuries they claim were caused by the shot.
At the conference, CDC researchers said they had detected for the first time that Pfizer's COVID-19 vaccine may have caused four additional cases of Guillain-Barré syndrome, a rare neurological disorder, per 1 million doses administered to older adults. (Numbers for the Moderna and Novavax vaccines were too small to analyze.)
This risk may not actually exist, but even if it did, the incidence of GBS would be similar to rates observed with other vaccines, the researchers said.
The CDC has also looked into the potential risk of stroke after getting the vaccine, but agency scientists said the results are inconclusive so far. In any case, they said the benefits of the vaccine outweigh any potential harms.
Panelists lamented the sharp decline in health care workers advising patients about the importance of getting the COVID-19 vaccine, with almost half of health care workers saying they were not encouraging patients to get vaccinated because they believed they would refuse the shot.
Dr. Helen Cape Talbot, a professor at Vanderbilt University School of Medicine and chair of the committee, said physical and verbal abuse in hospitals and health-care settings is also on the rise.
“Some physicians may not recommend this out of concern for their own safety or that of their staff,” she said.
The panelists unanimously recommended COVID-19 vaccination for all age groups this time, but there was debate over whether it could be recommended for everyone in the future. The vaccine is much more expensive than other shots and is most cost-effective when given to older people.
At the individual level, the Affordable Care Act requires insurers, including Medicare and Medicaid, to cover at no cost any vaccines recommended by the advisory committee, but up to 30 million Americans lack health insurance.
The Bridge Access Program, a federal initiative to provide vaccines to underinsured and uninsured Americans, is set to end in August.
Unless vaccine prices come down, the cost of vaccinating all Americans may not be sustainable, panelists said.
“As more and more of society becomes infected with the vaccine and the disease, it's going to become less and less cost-effective,” Dr. Talbot said. “We're going to need cheaper vaccines to make this happen.”