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CDC recommends additional COVID-19 booster for people over age 65

Experts cite waning immunity and the year round threat of infection and hospitalization

The CDC panel’s recommendation means that insurance companies will need to reimburse the cost of the additional boosters, provided CDC Director Mandy K. Cohen signs off on the recommendation.Joe Burbank/Associated Press

Americans over the age of 65 should receive a second dose of the booster shot recommended in September, a Centers for Disease Control and Prevention advisory panel voted Wednesday, noting that the extra protection has likely already begun to wane.

The 11 to 1 vote, with one abstention, by the CDC’s Advisory Committee on Immunization Practices, followed several hours of presentations from leading epidemiologists, doctors, and public health officials reviewing the latest data on infection rates, hospitalizations, and vaccine effectiveness.

Unlike influenza and other diseases, they noted, COVID-19 is not seasonal. Over the course of the previous year, weekly hospitalizations from COVID-19 have never fallen below 6,000 new admissions a week, said Megan Wallace, a CDC epidemiologist in a presentation. Last summer, there were still about 500 COVID-19 deaths a week across the nation.


“This last year we saw much lower rates of [infections and hospitalizations] in the spring and summer than we did the previous two years,” Wallace told the panel, explaining the working group’s rationale for recommending the additional booster. “But we all feel that things with COVID are still unpredictable particularly as new variants arise, I hope that we are moving in the direction of getting more flu-like in that there is a really clear [season]. But I don’t think we are there yet.”

The additional protection against hospitalizations conferred by previous boosters wears off in about 180 days, she said.

The recommendation, which was approved by CDC Director Mandy K. Cohen late Thursday, provides key guidance both to vaccine providers and patients. The recommendation means that insurance companies will need to reimburse the cost of the additional boosters.

The additional dose should be at least four months after the previous shot. That guidance applies to all three of the currently authorized COVID-19 vaccines, which include Moderna, Novavax, and Pfizer BioNTech.


In her synopsis of the evidence behind their recommendations, Wallace noted that most people in the hospital with COVID-19 have already been infected at least once. Indeed, by some estimates, as many as 98 percent of those whose blood was tested have some immunity from prior infection or vaccine.

“That means [for] most people in the hospital with COVID-19, it’s not their first infection,” Wallace said. “The vaccine gives them that extra protection, most important in those that have high-risk conditions.”

Nationwide, the number of weekly COVID-19 hospitalizations peaked during the weeks ending Dec. 30 and Jan. 6, at about 35,000 hospitalizations a week. In the week ending Feb. 17, the last week for which data is available, those numbers had fallen to around 20,000.

The extra booster is most urgent for those 75 and older, a group that’s six times more likely to be hospitalized than people between the ages of 65 to 74.

Much of the CDC’s morning session was dominated by a debate over how strongly to word the recommendations. Though the working group initially recommended language stating that those over 65 “may” receive an additional dose of 2023-2024 COVID-19 vaccine, the panel voted to strengthen the language to indicate that those over 65 “should” receive an additional dose.

Some of those who had initially argued for the softer language cited concerns over vaccine fatigue, noting that less than a quarter of Americans followed the panel’s advice to get the latest vaccine, despite science suggesting that it protects against the latest JN1 variant. The working group considered confining the recommendation to those over 75, but chose to drop it down to 65 because of higher rates of severe illnesses in some demographic groups due to racial inequities.


The panel recommended the initial booster in the fall of 2021, then followed that up in May 2022 with a recommendation for an additional dose for those 50 years and older. In the fall of 2022, the panel recommended a dose of bivalent booster, and followed that up with an “optional” additional dose for those 65 years and older in April 2023.

Dr. Camille Nelson Kotton, clinical director of the transplant and immunocompromised host infectious diseases program at Massachusetts General Hospital and a member of the panel, kept things straightforward: She says she has consistently been recommending that her immunocompromised patients receive a new booster every six months.

Adam Piore can be reached at adam.piore@globe.com.