CDC chief overrules advisory panel, okays boosters for people based on job risk

Stefani Reynolds/The New York Times via AP, Pool

For reasons I don’t understand apart from the partisan impulse to ding her with a gotcha, Rochelle Walensky is taking heat this morning for allegedly not “following the science” in deciding to overrule the CDC’s advisory panel. The panel okayed boosters yesterday for senior citizens and people 50-64 with health problems, and advised those aged 18-49 with medical conditions to at least consider a third dose. But they rejected boosters for those who stand a high risk of being exposed to COVID on the job, like doctors, nurses, teachers, and other frontline workers. That proposal went down on a 9-6 vote.

Which was foolish.

So Walensky exercised her authority and ignored them, making those high-risk workers eligible for shots after all. Good for her.

Dr. Walensky’s decision to go against her own agency’s advisers came as a surprise to at least some of her staff members: The C.D.C. director’s endorsement of the advisory committee’s recommendations is typically just a formality. Hours before her statement, agency insiders predicted she would stick with the usual protocol because doing otherwise would undermine the process and upset the advisers as well as her own staff.

But experts outside the C.D.C. said Dr. Walensky may have had no choice but to align herself with the F.D.A.’s decision. “There’s a complexity here, because Dr. Walensky was part of the White House announcement” on boosters, noted Dr. Ashish Jha, dean of the Brown University School of Public Health…

Dr. Walensky’s decision revealed the continuing divisions and confusion among federal regulators and outside advisers about how to contain the virus nearly two years into the pandemic.

It’s true that Walensky has been erratic in the great booster debate, initially supporting Biden’s decision to roll out third doses on September 20, then backing off to give the CDC and FDA more time to crunch the data, and now opposing her own advisory panel on boosting people due to professional hazards. Does that prove that her decision to overrule them was based on politics rather than science? Well, no. The FDA’s own advisory panel “specified that health care workers, emergency responders and others whose jobs put them at special risk should also be eligible for the booster shots,” a recommendation which the agency later formalized.

Walensky ended up agreeing with them and the six members of the CDC panel that supported boosting people at special risk on the job. So who failed to “follow the science” here? All of them, or the nine CDC advisors who opted against boosters based on occupational hazards?

How about the fact that various well-known doctors criticized the advisory panel’s decision to omit job-based boosters and cheered Walensky this morning for overruling them?

All seem to think that “the science” in this case broke in favor authorizing boosters based on job risk. So did Anthony Fauci, who told Politico, “Dr. Walensky made a good judgment and showed good leadership in making that decision. I totally agree and support that decision she made.” Bear in mind too that the advisory panel refused to support Pfizer shots for people who have already received Moderna or Johnson & Johnson even though it means tens of millions of Americans — including frontline workers — are locked out of a booster at the moment even though their immunity may be starting to wane. (That’s especially risky for J&J people, who’ve had only one dose.) That illustrates how cautious, even overly cautious, the panel was about endorsing boosters. Why let that degree of over-caution deprive frontline workers of a needed extra dose?

It’d be one thing if the panel thought there was a safety risk to giving out third doses based on job risk, or if they reasoned that medical professionals, teachers, cashiers, and others who have likely been face to face with infected people for months are already naturally immune and don’t need a boost. (Although in that case, why not authorize boosters for them and let them decide with their doctors whether to get one? Not every frontline worker has already been infected.) But that’s not why the panel voted against third doses for people with high-risk jobs. They did it because they were practicing pop psychology, trying to anticipate how the public — especially the unvaccinated segment of the public — would react to a broad-based booster authorization based on employment.

Privately, administration officials had hoped the booster recommendations would be as expansive as possible and include workplace exposure, Lena and Laurie write. But some on the CDC’s advisory panel were afraid to allow workers to get the booster, worried it would essentially open the door too wide.

“We might as well just say give it to anyone 18 and over,” Pablo J. Sanchez, a professor of pediatrics at Ohio State University, said at yesterday’s meeting. “We have a really effective vaccine, and it is like saying that it is not working, and it is working.”

They’re afraid of “underselling” the vaccine to the unvaccinated. If they authorize a third dose for people who are at risk while at work, the unvaxxed may conclude that two doses aren’t sufficient to keep people out of the hospital despite the fact that they are. But (a) the hardline anti-vaxxers will always find an excuse not to get their shots (authorizing boosters for any segment of the population will give them a pretext to claim that first two doses don’t work as advertised) and (b) a third dose for people in high-risk jobs may be beneficial to the public at large by keeping the recipients from having to miss work if they’re infected. A nurse or a teacher with two doses probably won’t end up in the ER but they may need a week or two off to recuperate, which would mean hospitals and schools going understaffed. A third dose might mean a much quicker recovery. The more critical workers can be kept on the job this winter, the more others will get the services they need and the faster the economy will revive.

And remember, the jury remains out on whether a third dose might actually provide durable protection against COVID and future variants to an extent that two doses don’t. The worst-case scenario for boosters is that they increase one’s antibodies for a few weeks or months and then fade, a fleeting temporary benefit. The best-case scenario, which Fauci has mused about, is that they’ll elicit a more mature immune response to future encounters with the virus, reducing the severity of infections for years. There could be a big payoff to being more liberal with boosters now, in other words, producing more durable immunity throughout the population.

Here’s Walensky defending her decision.