New Covid vaccinations recommended for Americans 6 months and older this fall

All Americans 6 months and older should receive one of the new Covid-19 vaccines when they become available this fall, the Centers for Disease Control and Prevention said Thursday.

The recommendation comes as the nation faces a summer surge in Covid, with infection numbers rising in at least 39 states and territories.

Most Americans have acquired immunity to the coronavirus through repeated infections or vaccine doses, or both. Vaccines now offer an incremental boost, remaining effective for only a few months as immunity wanes and the virus continues to evolve.

Yet across 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 Thursday at a meeting of the CDC’s Advisory Committee on Immunization Practices.

Dr. Mandy Cohen, the agency's director, on Thursday accepted the panel's unanimous advice to recommend another round of vaccinations.

“Professionals and the general public don’t understand how much this virus has mutated,” said Carol Hayes, the committee’s liaison to the American College of Nurse-Midwives. “This year’s vaccine is needed to protect against this year’s strain of the virus.”

A vaccine from Novavax will target JN.1, the variant that dominated for months in the winter and spring. The shots to be given by Pfizer and Moderna are aimed at KP.2, which until recently seemed likely to be the dominant variant.

But KP.2 appears to be giving way to two related variants, KP.3 and LB.1, which now account for more than half of new cases. All three variants, descendants of JN.1, are nicknamed FLiRT, after two mutations in the virus' genes that contain those letters.

The mutations are thought to help the variants evade some immune defenses and thus spread more quickly, but there is no evidence that the variants cause more severe disease.

Covid-related emergency room visits in the week ending June 15 increased nearly 15%, and deaths increased nearly 17%, compared with the previous week’s totals. Hospitalizations also appear to be rising, but the trends are based on data from a subset of hospitals that still report to the CDC even though the requirement to do so expired in May.

“Covid is still around, and I don’t think it will ever go away,” Dr. Steven P. Furr, president of the American Academy of Family Physicians, said in an interview.

The biggest risk factor for serious disease is age. Adults aged 65 and over account for two-thirds of Covid hospitalizations and 82% of in-hospital deaths. However, only about 40 percent of Americans in that age group were immunized with the Covid vaccine offered last fall.

“This is an area where there is a lot of room for improvement and could prevent a lot of hospital admissions,” said Dr. Fiona Havers, a CDC researcher who presented the hospital admission data.

Although young adults are much less likely to become seriously ill, there are no groups completely free from risk, CDC researchers said. Children, particularly those under age 5, are also vulnerable, but only about 14% were immunized against Covid last fall.

Many parents mistakenly believe the virus is harmless in children, said Dr. Matthew Daley, a speaker and senior researcher at Kaiser Permanente Colorado.

“Because weight was so high in the older age groups, we lost sight of the absolute weight in the pediatric age groups,” Dr. Daley said.

Even if children don’t get sick, they can fuel the virus’s circulation, especially once they return to school, Dr. Furr said.

“They are the ones who, if exposed, are most likely to bring it home to their parents and grandparents,” he said. “By vaccinating all groups, you have a better chance of preventing the spread.”

Among children, newborns under 6 months of age were the most affected by Covid, according to data presented at the meeting. But they are not eligible for the new vaccinations.

It is “critical that pregnant women get vaccinated, not only to protect themselves but also to protect their babies until they are old enough to be vaccinated,” said Dr. Denise Jamieson, one of the speakers and dean of the University of Washington Carver College of Medicine. The University of Iowa, said in an interview.

Among both children and adults, vaccination coverage was lowest among the groups most at risk from Covid: Native Americans, Black Americans and Hispanic Americans.

In polls, most Americans who said they probably or definitely would not get the shots last fall cited unknown side effects, insufficient studies or distrust of the government and drug companies.

The CDC has said that vaccines are associated with 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 discovered, for the first time, that Pfizer's COVID-19 vaccine may have caused four additional cases of Guillain-Barré syndrome, a rare neurological disorder, for every million. doses administered to the elderly. (The numbers available for the Moderna and Novavax vaccines were too small for analysis.)

The risk may not prove to be real, but even if it were, the incidence of GBS is comparable to the rate seen with other vaccines, the researchers said.

The CDC has also investigated a potential risk of stroke after vaccination, but the results so far are inconclusive, agency scientists said. In any case, the benefits of the vaccines outweigh the potential harms, they said.

Speakers lamented a sharp decline in health care workers counseling patients about the importance of COVID-19 vaccination. Nearly half of workers said they had not recommended the shots because they believed patients would refuse them.

There has also been an increase in physical and verbal abuse in hospitals and health care facilities, said Dr. Helen Keipp Talbot, a professor of medicine at Vanderbilt University and chair of the committee.

“Some of our doctors may not recommend it because of concerns about their safety and that of their staff,” he said.

Although the speakers this time unanimously recommended Covid vaccination for people of all ages, they discussed the feasibility of universal recommendations in the future. The vaccines are much more expensive than other vaccines and are more convenient 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 up to 30 million Americans don't 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 drops, the cost of immunizing all Americans may not be sustainable, panelists said.

“As more and more of society is exposed to vaccines or diseases, it will become much less convenient,” Dr. said. Talbot. “We're going to need a less expensive vaccine to make this thing work.”

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