CDC Recommends Second Dose of COVID-19 Vaccine for Adults 65 and Older
The Centers for Disease Control and Prevention (CDC) has issued a new recommendation urging adults aged 65 and older to receive a second dose of the COVID-19 vaccine. This recommendation comes as a response to the higher risk of severe disease that older adults face from the virus. CDC Director Mandy Cohen emphasized the importance of additional protection for this vulnerable population, stating, “An additional vaccine dose can provide added protection that may have decreased over time for those at highest risk.”
The recommendation was endorsed by the agency’s vaccine advisory panel, although it took some members by surprise. Initially, a subgroup of advisers suggested using softer language that would have stated that older adults “may” receive a second dose instead of “should.” However, Camille Kotton, clinical director for transplant and immunocompromised host infectious diseases at Massachusetts General Hospital, argued for stronger language to ensure clearer recommendations to patients. Kotton expressed concern over the number of Americans who are still unaware that they should be getting vaccinated, stating that using the word “may” is “too soft, especially for the most vulnerable.”
Demetre Daskalakis, director of the CDC center overseeing respiratory infectious-disease threats, cautioned against making absolute statements about vaccines, as it could create a chilling effect for those who have not yet been vaccinated. Despite this concern, a CDC recommendation means that eligible individuals will have the additional dose covered by insurance. The CDC officials also assured that there are no supply shortages, and eligible consumers should be able to receive the additional dose within a day or two from pharmacies or healthcare providers.
It is important to note that this recommendation only applies to individuals aged 65 and older. The additional dose should be administered at least four months after the previous dose for healthy older adults or at least three months after a coronavirus infection. However, it remains unclear whether those receiving a second shot now will also require another shot for the 2024-2025 fall and winter season.
David Kaslow, a representative of the Food and Drug Administration (FDA), mentioned the possibility of a new vaccine being approved for the upcoming winter season. If this occurs, it would not be optimal for people to receive a second dose of the current vaccine later than June. The CDC had already recommended in the fall that individuals aged 5 and older receive an updated vaccine to protect against serious illness. However, the uptake among adults has been low, with only about 22 percent of those 18 and older and 42 percent of those 65 and older receiving a dose.
The recommendation acknowledges that the risk of severe illness from COVID-19 persists throughout the year for older adults, not just during the winter months. Unlike flu and respiratory syncytial virus (RSV), which typically occur in the fall and winter, coronavirus surges have been observed in the spring and summer as well. This will be the third consecutive year that spring boosters are offered, reflecting the unpredictable nature of COVID-19. CDC experts are hopeful that the virus will eventually follow a clear seasonal pattern like the flu, but they believe that we have not reached that point yet.
While the impact of the coronavirus has changed significantly since the start of the pandemic, with fewer hospitalizations and deaths due to new infections, panel members emphasized that coronavirus infections are still occurring at levels similar to previous years. A second vaccine dose would help restore some degree of vaccine effectiveness that may have waned since the fall. Hospitalization rates have decreased across all age groups, but certain groups, including older adults, infants, and individuals with underlying medical conditions or disabilities, continue to be hospitalized at higher rates.
Data presented at the vaccine advisers meeting revealed that 67 percent of COVID-19 hospitalizations from October 2023 to January 2024 were among those aged 65 and older. Additionally, adults aged 65 and older accounted for 63 percent of hospitalizations and 88 percent of in-hospital deaths from COVID-19 during the first seven months of 2023. Despite the progress made, approximately 20,000 people are still being hospitalized for COVID-19 each week, with about 2,000 deaths occurring weekly.
However, there are potential drawbacks to allowing a second dose. The CDC highlighted that with broad immunity in the population, the incremental benefit of a second dose targeting a specific variant may not outweigh the potential decrease in public confidence in the benefits of a single dose. Furthermore, recommendations for an additional dose may contribute to vaccine fatigue and reduce uptake in the fall.
The CDC reassures the public that the updated coronavirus vaccines remain effective against different circulating variants, such as JN.1, which began dominating in January. As the situation continues to evolve, it is crucial for individuals to stay informed and follow the guidance provided by health authorities to protect themselves and others from COVID-19.
