COVID-19 Data Dispatch

Tag: booster shots

  • Data considerations for the new Omicron-specific booster shots

    Data considerations for the new Omicron-specific booster shots

    We don’t have data yet on the BA.4/BA.5 vaccines in humans, but studies in mice have been promising. Screenshot from Moderna slides presented to CDC ACIP this week.

    This week, the FDA and CDC authorized new booster shots from both Pfizer and Moderna that are tweaked to specifically target Omicron BA.4 and BA.5. The vaccines will start becoming available at pharmacies and doctors’ offices across the country in the coming days.

    Much of the media coverage of these new boosters has focused on the fact that they’re the first COVID-19 vaccines derived from a newer variant, as opposed to the original Wuhan strain. BA.5 and BA.4.6, a sublineage of BA.4, are causing almost all COVID-19 cases in the country right now; some experts hope that a booster campaign targeted to these versions of the coronavirus will lead to actual decreases in transmission, not just severe disease.

    While this is an important milestone, I’d like to focus on a couple of reasons these shots are notable from a data perspective. First, the Omicron boosters are the first COVID-19 vaccines authorized in the U.S. without data from human trials. During vaccine development, companies typically start with lab studies, then test the vaccine in animal models, then in humans. Because the BA.4/BA.5 shots were designed so recently, Pfizer and Moderna haven’t had time to test them in humans yet.

    From a safety and efficacy perspective, this lack of data isn’t a huge concern because the new vaccines are very close to BA.1 versions that have been tested in humans. As Katelyn Jetelina explained in a Your Local Epidemiologist post about the new vaccines:

    Literally the difference of a few amino acids—like a few letter edits on a Word document. We aren’t changing the number of words in the paper (like dosage of RNA), or the content of the paper, or the platform (like Word to Excel). Because of the minimal change, we are confident that BA.1 bivalent safety data will accurately reflect BA.5 safety.

    Another important piece of context here is that flu vaccines—which are updated each year to reflect currently circulating versions of the virus—are typically not tested in humans before they’re rolled out in annual flu campaigns. So, the new COVID-19 shots are following an existing process; future vaccine adjustments for new variants going forward will likely happen in a similar way.

    Second, the Omicron boosters are the first COVID-19 vaccines authorized in the U.S. before they’ve been tested in other countries. For previous booster campaigns, effectiveness data from countries with better-organized health systems that started using new rounds of shots before we did (such as the U.K. and Israel) have been key for U.S. regulators making authorization decisions. 

    But the BA.4/BA.5 boosters haven’t been rolled out anywhere else yet. Several other countries (the E.U., the U.K., Canada, Switzerland, Australia) have authorized Omicron BA.1 boosters—those that have gone through more clinical testing. The U.S. is the first to try the BA.4/BA.5 option. It will be interesting to see whether there are significant differences in how these countries’ fall booster campaigns mitigate potential surges.

    And third, these boosters are likely to be the last COVID-19 vaccines authorized while they’re still covered by federal funding. Recent announcements from officials like Ashish Jha have suggested that, in 2023, the government will stop buying vaccine supplies in large quantities to distribute for free. Instead, COVID-19 vaccines will start to be privately-purchased, health insurance-mediated products like other vaccines.

    While some local governments and large health institutions will likely still organize free vaccine distributions for future rounds of shots, the lack of federal supplies will be a major shift. It will make COVID-19 vaccination harder to access, especially among people without health insurance—likely leading to even lower uptake. We need to make this last free booster campaign count.

    Going forward, here are a few questions I’ll be tracking as these boosters get rolled out:

    • How will public health agencies track the effectiveness of these new vaccines? We’ll want to see how the BA.4/BA.5 shots compare to prior boosters at preventing infections, hospitalizations, and deaths. Data on breakthrough cases is already pretty limited in the U.S., so we may have to rely on specific local health departments and health systems that have better infrastructure for this.
    • What additional boosters might be needed in the future? As we examine how well these Omicron-specific boosters work, we will need to keep track of the potential need for more shots. Will immunocompromised people or older adults need second rounds of Omicron shots, for example?
    • What new variants will come on the scene? Also impacting the potential need for further vaccine shots: the arrival of new variants, either continued Omicron mutations or something else entirely. Wastewater surveillance may be particularly helpful for variant tracking as PCR testing continues to be less available.
    • How will the privatization of vaccines impact tracking? If COVID-19 vaccines are no longer purchased and distributed by the federal government after 2022, will this impact the CDC’s ability to track vaccinations? We’re already seeing more vaccine distribution at private pharmacies and doctors’ offices as opposed to publicly-run clinics; I wonder how this trend may continue.

    For more information on the new boosters, check out: 

    More vaccine coverage

  • We need more data for fall booster decisions

    We need more data for fall booster decisions

    At the FDA advisory committee meeting this week, Pfizer presented data from different options of Omicron-specific booster shots.

    This week, the FDA’s vaccine advisory committee met to discuss fall booster shots, in anticipation of another COVID-19 surge next winter. The discussion demonstrated the U.S.’s continued failure to provide the data that are really needed to make these decisions.

    I have written a lot about this topic in the past, so to avoid being too repetitive, I’ll link to a couple of past articles:

    But here’s the TL;DR: due to the fractured nature of America’s public health system, it’s difficult for researchers to connect data on different health metrics. For example, a state might have one database with vaccination records and another database with case records, and the databases might not easily link to answer questions about breakthrough cases.

    Some state health departments have figured out how to make these links, but the process is not uniform. And the breakthrough case data we do have generally aren’t linked to information on variants, or demographic data, or outcomes like Long COVID.

    The more specific the vaccine effectiveness question, the more complicated it becomes to answer. This is a bigger problem now as the FDA considers fall boosters, because the agency needs to determine the best vaccine candidate and identify priority populations for shots—while operating in a politcal climate where vaccine funding is less popular than it was a year ago.

    Here are a few questions that the FDA is trying to answer, drawing from the STAT News meeting recap:

    • Should the fall booster be a monovalent vaccine, meaning it only includes Omicron-specific genetic material? Or should it be bivalent, meaning it includes both Omicron and the original, Wuhan strain? Pfizer and Moderna presented different options; some experts say a bivalent vaccine may provide more long-term protection.
    • Should the booster shot be specific to BA.4 and BA.5? The panel agreed that it should, as these strains are now dominant in the U.S., but there’s a timing trade-off as vaccine companies have yet to do clinical trials (or provide substantial data) for a subvariant-specific vaccine.
    • Should the booster shot be another type of vaccine entirely? In addition to Pfizer and Moderna, the FDA panel also heard from Novavax. This company has developed a protein-based vaccine that hasn’t yet received FDA authorization, but panelists were impressed by its potential for long-term protection.
    • How well do the vaccines provide non-antibody-based protection? As in past advisory committee meetings, the vaccine companies primarily presented data based on antibodies generated from their shots. Experts wanted to see more data about T cells and other aspects of immunity which are harder to measure, but may be more important in the long term.
    • Who would most benefit from another booster? If the federal government isn’t able to buy enough shots for everyone, priortization will need to happen. Will Omicron-specific boosters be most useful for seniors, or for people with certain health conditions? These groups will likely get priority again, though we could still be collecting more data on how the vaccines fare for them.

    Of course, despite the dearth of data and cautions from some members of the FDA advisory committee, the U.S. government seems to be going full-speed ahead with fall boosters. The Biden administration has placed a $3.2 billion order from Pfizer for 105 million doses of whichever Omicron-specific vaccine the FDA chooses to authorize.

    More vaccine reporting

  • Sources and updates, June 26

    Sources and updates, June 26

    A new chart from the CDC shows booster shot eligibility and uptake by age. Retrieved on June 26.
    • CDC report on Paxlovid distribution: A major study from the CDC’s Morbidity and Mortality Weekly Report this week: researchers at the CDC and collaborators studied the distributions of antiviral COVID-19 drugs Paxlovid and Lagevrio (also called Molnupiravir) by ZIP code, comparing ZIP codes with the CDC’s Social Vulnerability Index. More than one million prescriptions were dispensed between late December 2021 and late May 2022, the study found. But, by the end of that period, prescription rates were twice as high in low- and medium-vulnerability ZIP codes as in high-vulnerabilty ZIP codes—indicating that these antivirals are not reaching the people who most need them.
    • CDC booster shot data update: The CDC has added a new chart to its “COVID-19 Vaccinations in the United States” page, showing booster shot eligibility and uptake by age. The chart includes two rounds of boosters for seniors; according to the data, 64% of eligible seniors have received their first booster, but only 21% have received their second booster. The data are also available for download.
    • COVID-19 vaccinations among children: I also recently learned about this CDC page focused on kids’ vaccinations, including vaccination coverage by demographic factors such as poverty status, parents’ education level, and insurance. The data come from a national survey previously used to monitor flu vaccinations among children. Data are updated monthly, and don’t yet include figures for children under 5; but existing data for children ages 5-17 affirm that vaccine uptake for kids has been low so far.
    • Guide to finding government COVID-19 documents: The Digital Public Library of America has released a free ebook with an archive of over 3,000 government documents related to the pandemic response. These documents were collected by the COVID Tracking Project during its year of work, and have been meticulously categorized and indexed in true CTP fashion. CTP alum Jennifer Clyde was the project’s editor.
    • Commonwealth Fund report on improving our public health system: A new report from healthcare-focused foundation The Commonwealth Fund provides recommendations for improving the country’s public health system. It focuses on organizing local agencies, providing more funding, improving trust, and other key topics.
    • History of exposure notification apps: Jenny Wanger, whom I interviewed about COVID-19 exposure notification apps back in spring 2021, sent me this paper she wrote about the technology, which was published earlier in June. The paper provides a report of how exposure notification protocols were developed, how states used the technology, and how limited data made it difficult to assess the technology’s success.

  • Nine areas of data we need to manage the pandemic

    Nine areas of data we need to manage the pandemic

    PCR testing has greatly declined in recent months; we need new data sources to help replace the information we got from it. Chart via the CDC.

    Last week, I received a question from my grandmother. She had just read my TIME story about BA.4 and BA.5, and was feeling pessimistic about the future. “Do you think we’ll ever get control of this pandemic?” she asked.

    This is a complicated question. And it’s one that I’ve been reflecting on as well, as I approach the two-year anniversary of the COVID-19 Data Dispatch and consider how this publication might shift to meet the current phase of the pandemic. I am not an infectious disease or public health expert, but I wanted to share a few thoughts on this; to stay in my data lane, I’m focusing on data that could help the U.S. better manage COVID-19.

    The coronavirus is going to continue mutating, evolving past immune system defenses built by prior infection and vaccination. Scientists will need to continue updating vaccines and treatments to match the virus, or we’ll need a next-generation vaccine that can protect against all coronavirus variants.

    Candidates for such a vaccine, called a “pan-coronavirus vaccine,” are under development by the U.S. Army and at several other academic labs and pharmaceutical companies. But until a pan-coronavirus vaccine becomes available, we’ll need to continue tracking new variants and the surges they produce. We also need to better track Long COVID, a condition that our current vaccines do not protect well against.

    Eventually, COVID-19 will likely be just another respiratory virus that we watch out for during colder months and large indoor gatherings, broadly considered “endemic” by scientists. But it’s important to note—as Dr. Ellie Murray did in her excellent Twitter thread about how pandemics end—that endemicity does not mean we stop tracking COVID-19. In fact, thousands of people work to monitor and respond to another endemic virus, the flu.

    With that in mind, here are nine categories of data that could help manage the pandemic:

    • More comprehensive wastewater surveillance: As I’ve written here and at FiveThirtyEight, sewers can offer a lot of COVID-19 information through a pipeline that’s unbiased and does not depend on testing access. But wastewater monitoring continues to be spotty across the country, as the surveillance can be challenging to set up—and more challenging for public health officials to act on. Also, current monitoring methods exclude those 21 million households that are not connected to public sewers. As wastewater surveillance expands, we will better be able to pinpoint new surges right as they’re starting.
    • Variant surveillance from wastewater: Most of the U.S.’s data on circulating variants currently comes from a selection of PCR test samples that are run through genomic sequencing tests. But this process is expensive, and the pool of samples is dwindling as more people use at-home rapid tests rather than PCR. It could be cheaper and more comprehensive to sequence samples from wastewater instead, Marc Johnson explained to me recently. This is another important aspect of expanding our wastewater monitoring.
    • Testing random samples: Another way to make up for the data lost by less popular PCR testing is conducting surveillance tests on random samples of people, either in the U.S. overall or in specific cities and states. This type of testing would provide us with more information on who is getting sick, allowing public health departments to respond accordingly. The U.K.’s Office for National Statistics conducts regular surveys like this, which could serve as a model for the U.S.
    • More demographic data: Related to random sample testing: the U.S. COVID-19 response still needs more information on who is most impacted by the pandemic, as well as who needs better access to vaccines and treatments. Random sampling and surveys, as well as demographic data connected to distributions of treatments like Paxlovid, could help address this need.
    • Vaccine effectiveness data: I have written a lot about how the U.S. does not have good data on how well our COVID-19 vaccines work, thanks to our fractured public health system. This lack of data makes it difficult for us to identify when vaccines need to be updated, or who needs another round of booster shots. Connecting more vaccination databases to data recording cases, hospitalizations, and Long COVID would better inform decision-making about boosters.
    • Air quality monitoring: Another type of data collection to better inform decision-making is tracking carbon dioxide and other pollutants in the air. These metrics can show how well-ventilated (or poorly-ventilated) a space is, providing information about whether further upgrades or layers of safety measures are needed. For example, I’ve seen experts bring air monitors on planes, citing poor-quality air as a reason to continue wearing a mask. Similarly, the Boston public school district has installed air monitors throughout its buildings and publishes the data on a public dashboard.
    • Tracking animal reservoirs: One potential source for new coronavirus variants is that the virus can jump from humans into animals, mutate in an animal population, and then jump back into humans. This has happened in the U.S. at least once: a strain from minks infected people in Michigan last year. But the U.S. is not requiring testing or any mandatory tracking of COVID-19 cases in animals that we know are susceptible to COVID-19. Better surveillance in this area could help us catch variants.
    • Better Long COVID surveillance: For me personally, knowledge of Long COVID is a big reason why I remain as cautious about COVID-19 as I am. Long COVID patients and advocates often say that if more people understood the ramifications of this long-term condition, they might be more motivated to take precautions; I think better prevalence data would help a lot with this. (The Census and CDC just made great strides in this area; more on that later in the issue.) Similarly, better data on how the condition impacts people would help in developing treatments—which will be crucial for getting the pandemic under control.
    • More accurate death certificates: The true toll of the pandemic goes beyond official COVID-19 deaths, as the Documenting COVID-19 project has discussed at length in our Uncounted investigation. If we had a better accounting of everyone whose deaths were tied to COVID-19, directly or indirectly, that could be another motivator for people to continue taking safety precautions and protecting their communities.

    If you are working to improve data collection in any of these areas—or if you know a project that is—please reach out! These are all topics that I would love to report on further in the coming months.

    More federal data

  • Sources and updates, May 8

    • CDC adds second boosters to its vaccine dashboard: In the latest update to the CDC’s COVID Data Tracker, you can now find a national tally of Americans who have received second booster shots on the “COVID-19 Vaccinations in the United States” page. About 10 million people have received these additional shots as May 6, about one-tenth the number of first booster recipients. The CDC has yet to add state-by-state or demographic data for second boosters.
    • KFF updates COVID-19 Vaccine Monitor: This week, the Kaiser Family Foundation published the latest update of its Vaccine Monitor, a long-running project tracking Americans’ attitudes towards COVID-19 vaccines and related issues. One notable finding from the April update: just 18% of parents with children under age five are “eager to get their child vaccinated right away,” compared to 27% who say they will “definitely not” get their child vaccinated. This report also includes survey findings on mask-wearing, COVID-19 in the workplace and in schools, and future booster shots.
    • Biobot on GitHub: I recently learned that Biobot Analytics, the leading COVID-19 wastewater surveillance company, publishes its underlying data on GitHub. This repository includes coronavirus concentrations in wastewater treatment plants monitored by Biobot across the country, along with regional wastewater data, national data, and COVID-19 case numbers for comparison.
    • TON’s Guide to Tracking Source Diversity: Not directly COVID-related, but a resource that I thought readers may find useful: The Open Notebook (TON) has published a detailed guide for journalists seeking to track the diversity of sources interviewed for their stories. While TON is geared towards science writers, this guide is broadly applicable to any reporter who spends a lot of time seeking out and talking to experts.

    All featured sources

  • Sources and updates, March 27

    • New report on pandemic-related workplace violence for public health officials: A new study, published last week in the American Journal of Public Health, shares the results of a survey that included hundreds of public health officials across the U.S. During the study’s time frame (March 2020 to January 2021), the researchers identified about 1,500 instances of harassment against public health officials, and found that over 200 officials left their jobs. And public health has only become more polarized in the year since this survey period ended. See this article in STAT News for more context on the study.
    • Health insurance plans available through the federal insurance marketplace: This one isn’t directly COVID-related, but it seemed like an interesting data source to share: the Centers for Medicare & Medicaid Services (CMS) publishes a series of data files on health insurance plans available through the federal Health Insurance Exchange. The files include health benefits, coverage limits, cost-sharing potential, provider networks, anonymized insurance claims, and much more. (H/t Data Is Plural.)
    • At-home COVID-19 test use exacerbates inequities: This week, the CDC published a new MMWR study discussing rapid at-home test use. The authors used an online survey to estimate at-home test use among about 400,000 U.S. adults between August 2021 and early March 2022. Its findings provide additional evidence for the popularity of these tests during the Omicron surge, as well as for the way that these tests exacerbate health inequities in the U.S.: “at-home test use was lower among persons who self-identified as Black, were aged ≥75 years, had lower incomes, and had a high school level education or less,” the authors reported.
    • Considering another round of mRNA booster shots: Will the U.S. authorize a fourth round of shots for Americans who received the Pfizer and Moderna vaccines? At the moment, signs point to yes: countries like Israel and the U.K., which U.S. regulators watch for their vaccine efficacy data, are providing fourth doses to seniors. And the Biden administration is planning fourth doses for U.S. adults over age 50, the New York Times reported on Friday. Data so far suggest that these additional doses may be useful for older adults, but provide less of an immunity boost in younger age groups; Dr. Katelyn Jetelina’s Your Local Epidemiologist post on the subject provides a helpful overview of the evidence.
    • New data on Moderna vaccine for young children: As we consider additional boosters for seniors, the youngest Americans may soon be eligible for vaccination! Finally! After a lot of back-and-forth on the potential of Pfizer’s vaccine for kids under age five, Moderna released data this week suggesting that the company has found a dosage of its vaccine that significantly reduces the risk of severe COVID-19 symptoms for children between six months and six years old. Effectiveness against any symptomatic coronavirus infection was only about 40% in this trial—but that result is in line with vaccine efficacy for adults during the Omicron wave, when Moderna’s trial was conducted.

    All featured sources

  • Sources and updates, March 20

    Data sources and data-related updates for this week:

    • APM Research Lab relaunches Color of Coronavirus tracker: From April 2020 to March 2021, the American Public Media (APM) Research Lab compiled state-level data on COVID-19 deaths by race and ethnicity, in order to present a picture of which U.S. populations were most hard-hit by the pandemic. The project relaunched this week, now utilizing CDC mortality statistics instead of compiling data from states. One major finding from the updated data: “Indigenous Americans have the highest crude COVID-19 mortality rates nationwide—about 2.8 times as high as the rate for Asians, who have the lowest crude rates.”
    • CDC might take back hospital data reporting responsibilities from HHS: As longtime readers may remember, back in summer 2020, the Department of Health and Human Services (HHS) developed a new data system for hospitals to report COVID-19 patient numbers and other related metrics. At the time, the HHS was taking over responsibility for these data from the CDC; this inspired some political posturing and concerns about data quality, though the eventual HHS dataset turned out to be very comprehensive and useful. (This original data switch was the subject of my very first CDD issue, and I followed the HHS data system closely throughout 2020.) Now, Bloomberg reports, the CDC wants to take back hospital data reporting from the HHS. More political posturing and data quality concerns are, it seems, inevitable—this time tied to the CDC’s challenges in modernizing its data systems.
    • Hospitalizations among young children, by race/ethnicity during Omicron surge: Two MMWR studies that caught my attention this week: one examined hospitalization rates among young children, ages 0 to 4, between March 2020 and February 2022. This study found that COVID-19 hospitalization rates among children in this age range were five times higher at the peak of the Omicron surge compared to the Delta surge. The second report examined hospitalizations by race and ethnicity, finding that, during Omicron’s peak, hospitalization rates among Black adults were nearly four times higher than rates among white adults. Both reports clearly demonstrate who is still vulnerable to COVID-19 as the U.S. abandons safety measures.
    • Pfizer and Moderna both seeking EUAs for additional booster shots: POLITICO reported this week that first Pfizer, then Moderna have requested Emergency Use Authorization for fourth doses of their COVID-19 vaccines. Pfizer’s request is specifically for people age 65 and over, while Moderna’s is for all adults. Notably, Pfizer’s request is based on data from Israel suggesting that immunity from an initial booster wanes after several months—just as Pfizer’s initial case for boosters in the fall was also based on Israeli data.
    • Global COVID-related deaths may be three times higher than official records: Throughout the pandemic, researchers have used excess mortality (i.e. the deaths occurring in a given region and time period above what’s expected) to determine the true toll of COVID-19. A new study, published this week in The Lancet, took this approach for 191 countries and territories from January 2020 to December 2021. The researchers estimate that about 18 million people died worldwide due to the pandemic—including not just direct COVID-19 deaths but also others caused by COVID-related disruptions. That’s three times higher than the 6 million COVID-19 deaths that have been officially reported in this time period.

    All featured sources

  • Sources and updates, December 12

    • CDC adds booster shot trends to its dashboard: One significant update to the CDC’s COVID-19 dashboard this week: the agency has added daily booster shot administration trends to its Vaccination Trends page. Now, you can see how many booster shots are being given each day in your state; in New York, for example, I see clear jumps when eligibility opened to all adults, and when Omicron was identified after Thanksgiving.
    • Global Health Security Index: Back in fall 2019, a group of public health and national security researchers put out an index that ranked 195 countries around the world on their capacity to respond to future health threats. The U.S. was ranked number one—a ranking that soon became laughable as the country proved to be incredibly unprepared for the COVID-19 pandemic. This week, the organization released their 2021 update to that index… and the U.S. is, somehow, still number one. Yet despite this, the researchers say, “no country is fully prepared for future pandemic or epidemic threats.”
    • COVID Collaborative: Hidden Pain report: The COVID Collaborative is a team of health, education, and economic experts aiming to develop recommendations for U.S. leaders. Their recent Hidden Pain report focuses on children who lost parents or caretakers to COVID-19—a group that, the report estimates, includes over 167,000 children across the country.
    • State Alcohol-Related Laws During COVID-19: The Alcohol Policy Information System has compiled a database of alcohol-related state laws during the pandemic, including rules about drinking both inside and outside of bars and restaurants. The database allows you to see when a specific state allowed restaurants to open or close, restrictions for take-out only, shortened hours, and more. (H/t Data Is Plural.)

    All featured sources

  • Sources and updates, November 28

    • State vaccination data: This weekend, I updated my annotations on state and national vaccination data sources in the U.S. A few more states are now reporting information on booster shots, and several states have adjusted their vaccine coverage metrics to reflect vaccine eligibility for children in the 5 to 11 age group. Notably, since my last update, Alaska, D.C., Utah, and Vermont’s health agencies have all started reporting some demographic information regarding booster shot recipients in their states.
    • Moral injury among healthcare workers during COVID-19: There have been a lot of headlines recently about burnout among healthcare workers. This study, based on a survey of 1,300 healthcare workers and published this week in JAMA Network Open, provides some statistics to underlie the trend. See the supplemental materials for sample quotations from the survey respondents, demonstrating their feelings of fatigue, isolation, and betrayal.

    All featured sources
  • Boosters for all adults: Why eligibility expanded, and what it means for you

    Boosters for all adults: Why eligibility expanded, and what it means for you

    As of November 20, almost 35 million Americans have received a booster shot. That number is likely to shoot up in the coming weeks with expanded eligibility. Chart via the CDC.

    On Friday morning, the FDA authorized booster shots of Pfizer’s and Moderna’s COVID-19 vaccines for all adults in the U.S., six months after their first two doses. The CDC’s vaccine advisory committee voted to support this expanded booster eligibility that afternoon, and CDC leadership signed off on it a few hours later.

    Although the Biden administration has supported boosters for all adults since August, this specific federal eligibility expansion was preceded by several state and local leaders. Prior to Friday, the governors of Colorado, New Mexico, California, and other states said that any adult living in their jurisdictions could go get a booster, even if they didn’t fit the current national criteria. New York City leaders made a similar announcement this past Monday.

    Perhaps spurred on by these state decisions, the FDA and CDC moved quite quickly to authorize booster shots for a larger group of Americans. The FDA was originally just considering the move for Pfizer’s vaccine, then added Moderna to the mix just this week (when Moderna sent in a formal application).

    And the CDC’s vaccine advisory committee meeting had somewhat less time for deliberation than this committee typically tends to take. As Helen Branswell wrote in STAT News:

    The meeting was called on such short notice — it was announced Tuesday — that only 13 of the committee’s members were able to attend. When the meeting went longer than scheduled, two members had to leave without voting.

    I discussed expanded booster shot eligibility this week in a FiveThirtyEight Chat with editor Chadwick Matlin and science writer Maggie Koerth. Today at the COVID-19 Data Dispatch, I’d like to expand on the ideas in that chat piece, and attempt to answer a couple of other questions.

    Why expand booster eligibility to all adults?

    The short answer here is 1) more compelling evidence that boosters provide additional protection against coronavirus infection and 2) cases are rising in the U.S., and boosters might help make the surge less severe. Also, so far, very few cases of severe side effects have been reported following booster shots.

    Since the last FDA and CDC booster shot deliberations, more evidence has rolled in showing their efficacy. One notable study, from the Imperial College of London, was published this past Wednesday; the report suggests that people who’ve received two COVID-19 vaccine doses are more than twice as likely to test positive than those who’ve received three doses.

    While the study hasn’t yet been peer-reviewed, it’s part of a long-running surveillance project in the U.K. that examines COVID-19 prevalence in the entire population—including all age groups and comparing those who received Pfizer and AstraZeneca vaccines. “What they found is very, very strong data showing that as soon as 7 days after a third COVID-19 vaccine dose, the risk of infection is cut in half when you look at the entire population,” wrote Dr. Jorge Caballero in a Twitter thread summarizing the study. 

    https://twitter.com/DataDrivenMD/status/1461167298102784001

    At the same time, cases are going up in the U.S.—appearing to indicate a new winter surge. It’s no coincidence that Colorado and New Mexico, two of the states that were among the first to expand booster eligibility to all adults, are also among the states with the highest COVID-19 case rates.

    When Delta hit Israel this past summer, the country started administering booster shots: first to seniors at the end of July, then for younger and younger age groups until all adults were able to get the shots. Data from the country’s national health agency suggest that these booster shots played a key role in driving down case numbers among both vaccinated and unvaccinated Israelis.

    Personally, I am still a bit skeptical that Israel’s drop in cases was thanks to booster shots alone, as the data don’t necessarily show causation. But for a lot of U.S. leaders, the Israeli data provide a compelling model: it seems like booster shots can potentially drive down a case surge. This fits nicely into the national strategy that the Biden administration has already been preaching for months, which I call “vaccinate out of the pandemic.”

    Here’s how I explained it in the FiveThirtyEight chat piece:

    Listening to the advisory-committee meetings, I noticed that there seems to be this tension between the scientific experts who want to make robust evidence-based decisions — and the sense that, here in the U.S., our overall pandemic strategy is basically “vaccinate our way out of the pandemic.” If we had better masking, distancing, contact tracing, ventilation, rapid tests and everything else, we would not need boosters to stop people’s mild cases. But we’re not doing a great job at any of those other things, so … we kinda need boosters.

    Maggie Koerth also pointed out that booster shots are also politically easier for a lot of leaders than some of the other COVID-19 strategies I mentioned. We already have the shots stockpiled, so it’s just a matter of telling people to go get them—unlike, say, expanding contact tracing, which would take a huge investment in hiring and training people.

    In addition, the eligibility expansion solves communication and logistics challenges: now, every adult in the U.S. can just go get a booster shot, once enough time has passed from their first two doses. Almost 90% of vaccinated Americans were eligible already, but a lot of people were confused about whether they fit the criteria; the situation became much simpler after Friday.

    Should you get a booster shot?

    If you’re over 65 or you have a health condition that makes you particularly vulnerable to severe COVID-19 symptoms, answering this question is easy: YES. Go get a booster shot, as soon as you’re able to do so.

    If you live or work in a setting that puts you at risk of contracting the coronavirus—or if you live or work in a setting with other people who are more vulnerable than you—then you also have a pretty solid argument towards getting a booster shot.

    Even if you’re very unlikely to have a severe case of COVID-19 thanks to your initial vaccination, a mild case could still disrupt your work, your household, and others in your community. A teacher with breakthrough COVID-19 might cause their classroom to shut down for a week, for example, while a parent with breakthrough COVID-19 may interrupt their kids’ lives if those kids are too young to be vaccinated themselves.

    For those who don’t fall into these categories (like me!), the situation is a bit more complicated. But after following all of the news this week, I’ve decided that it does make sense for me to get my booster shot.

    Here’s why: much as I wish that national leadership and my own local leaders in NYC were investing in other measures to control COVID-19 cases, I don’t foresee widespread mask mandates, rapid tests, contact tracing, or any other safety overhauls anytime soon. Instead, my public health leaders are asking me (and those around me) to get booster shots in order to potentially lower case rates. So, I’ll do my part to contribute to that “vaccinate out of the pandemic” strategy, though I don’t necessarily agree with it.

    It’s also important to note here that vaccinating the people who are still unvaccinated is much more important for lowering overall case counts—and for keeping people out of the hospital—than boosters. That includes kids in the 5 to 11 age group. As Maggie Koerth said in our chat:

    If you’re under 65 and you’re not immune compromised, it almost certainly matters more to get your kiddos vaxxed the first time than to get yourself a booster. That’s my parent-centric takeaway from all this reading.

    And, of course, to end the pandemic on a global scale, we need to get first and second doses to everyone in the world. Right now, booster shots are hindering global vaccination: according to the WHO, there are about six times more boosters administered daily in wealthy nations right now than there are first and second doses administered in low-income nations.

    The U.S. has already chosen to stockpile millions of doses for boosters, so refusing a booster shot on an individual level doesn’t have any impact on the global situation. But there are other options for people who want to take action about vaccine inequality: for example, you can contact your congressional representatives about the issue.

    What happens after a lot of Americans get booster shots?

    Someone asked me this question on Twitter earlier this week. Do booster shots lead to other loosening COVID-19 restrictions, or something else?

    It’s difficult to answer that right now, because the U.S. is still close to the beginning of our booster shot rollout. Within a couple of months—and millions more doses—we’ll have some data on whether booster shots here lead to a drop in cases, like what we saw in Israel. At the same time, many European countries are similarly offering booster shots to wide swaths of their populations; we can also watch what happens in those nations.

    The U.S. is still likely to face a case surge this holiday season, I think, simply due to cold weather combined with travel and gatherings. But perhaps booster shots will mean that hospitalizations don’t rise as much as cases do, or that a higher share of the cases are mild. We’ll have to see.

    Looking beyond this winter, we could see three shots become standard for COVID-19 vaccines. (Several other vaccines, such as HPV, are three-shot series.) We could also see annual boosters for COVID-19, similar to flu shots. More study of the booster shots’ effectiveness and of long-term COVID-19 immunity in general will help scientists figure this out.

    Finally, I couldn’t end this post without pointing out the continued data gaps here. The U.S. is still not tracking breakthrough cases in any kind of comprehensive manner, and a lot of information is missing on who’s getting booster shots—the CDC and most states are not reporting demographic data on booster recipients.

    To quote Dr. Katelyn Jetelina from her recap of Friday’s CDC advisory committee meeting:

    And this is it. This [three small studies] is all the data the CDC presented today. Which is insane— the United States does not have a real-time, comprehensive picture of our vaccines, nor the number of breakthrough cases, nor who’s more likely to have a breakthrough case or not. I cannot emphasize enough of how detrimental this is to our public health response. Bad data produces (potentially) bad policy. We are flying blind.

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