All Americans 6 months of age and older should receive one of the new Covid-19 vaccines when they become available this fall, the Centers for Disease Control and Prevention announced Thursday.
The recommendation comes as the nation faces a summer Covid surge, with the number of infections rising in at least 39 states and territories.
Most Americans have developed immunity to the coronavirus from repeated infections or vaccine doses, or both. Vaccines now offer a gradual boost, remaining effective for only a few months as immunity wanes and the virus continues to evolve.
But in every age group, the vast majority of Americans hospitalized for Covid did not receive one of the vaccines offered last fall, according to data presented at a Thursday meeting of the CDC’s Advisory Committee on Immunization Practices.
Dr. Mandy Cohen, the agency’s director, accepted the committee’s unanimous advice Thursday to recommend another round of vaccinations.
“Professionals and the public generally don’t understand how much this virus has mutated,” said Carol Hayes, the committee’s liaison to the American College of Nurse-Midwives. “You need this year’s vaccine to protect against this year’s strain of the virus.”
A Novavax vaccine will target JN.1, the variant that prevailed for months in the winter and spring. Pfizer and Moderna’s plans are aimed at KP.2, which until recently appeared to be the dominant variant.
However, KP.2 appears to be giving way to two related variants, KP.3 and LB.1, which now account for over half of the new cases. All three variants, descendants of JN.1, are collectively nicknamed FLiRT, after two mutations in the viral genes containing those letters.
The mutations are thought to help the variants evade some immune defenses and spread more quickly as a result, but there is no evidence that the variants cause more severe disease.
Covid-related emergency department visits in the week ending June 15 rose by nearly 15 percent and deaths by nearly 17 percent, compared to the previous week’s totals. Hospital admissions also appear to be rising, 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 out there, and I don’t think it’s ever going to go away,” Dr. Steven P. Fuhr, president of the American Academy of Family Physicians, said in an interview.
The biggest risk factor for serious illness is age. Adults aged 65 and over account for two-thirds of Covid hospitalizations and 82 percent of in-hospital deaths. However, only about 40% of Americans in this age group were vaccinated with a Covid vaccine offered last fall.
“This is an area where there is a lot of room for improvement and could prevent many hospitalizations,” said Dr. Fiona Havers, a CDC researcher who presented the hospitalization data.
Although younger adults are much less likely to become seriously ill, there are no groups without risk, CDC researchers said. Children — especially those under 5 — are also vulnerable, but only about 14% were vaccinated against Covid last fall.
Many parents mistakenly believe the virus is harmless to children, said Dr. Matthew Daly, a panelist and senior researcher at Kaiser Permanente Colorado.
“Because the burden was so high in the older age groups, we missed the absolute burden in the pediatric age groups,” Dr. Daley said.
Even if children don’t get sick themselves, they can fuel the circulation of the virus, especially when they go back to school, Dr. Fuhr said.
“They’re the ones who, if exposed, are more likely to bring it home to their parents and grandparents,” he said. “By immunizing all groups, you are more likely to prevent the spread.”
Among children, infants under 6 months have been hit hardest by Covid, according to data presented at the meeting. But they are not eligible for the new downloads.
It is “critical that pregnant women get vaccinated, not only to protect themselves but also to protect their infants until they are old enough to be vaccinated,” said Dr. the University of Iowa, he said in an interview.
In both children and adults, vaccine coverage was lowest among the groups most at risk from Covid: Native Americans, Black Americans, and Hispanic Americans.
In surveys, most Americans who said they probably or definitely wouldn’t get the vaccines 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 claims for other medical injuries they say were caused by the shots.
At the meeting, CDC researchers said they had, for the first time, found that Pfizer’s Covid vaccine may have led to four additional cases of Guillain-Barré syndrome, a rare neurological condition, per one million doses given to older adults . (The numbers available for the Moderna and Novavax vaccines were too small to analyze.)
The risk may not be real, but even if it is, the incidence of GBS is comparable to that seen with other vaccines, the researchers said.
The CDC has also investigated a possible risk of stroke after vaccination, but the findings so far are inconclusive, agency scientists said. In any case, the benefit of vaccines outweighs the potential harm, they said.
Panelists bemoaned the sharp decline in healthcare providers counseling patients on the importance of the Covid vaccination. Almost half of the providers said they did not recommend the shots because they thought their patients would refuse.
There was also increasing physical and verbal abuse in hospitals and health care facilities, said Dr. Helen Keipp Talbot, professor of medicine at Vanderbilt University and chair of the committee.
“Some of our doctors may not recommend it because of safety concerns for them and their staff,” he said.
Although panelists 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 vaccines and are more cost-effective when given to older adults.
At the individual level, the Affordable Care Act requires insurers, including Medicare and Medicaid, to cover vaccines recommended by the advisory committee at no cost. But as many as 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.
Unless the price of vaccines comes down, the cost of immunizing all Americans may not be sustainable, the panelists said.
“As more and more of society is exposed to either vaccines or disease, it will become much less cost-effective,” Dr Talbot said. “We will need to have a less expensive vaccine for this to work.”
