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Illustration: Sarah Grillo/Axios

We now know some people in the U.S. are going to get additional doses of COVID vaccines after the CDC and FDA signed off on shots for the immunocompromised last week.

The big picture: As Andrew Badley, chairman of Mayo Clinic's COVID-19 research task force, put it to Axios: "It’s not the end of the story."

  • "The question that’s on everyone’s mind — and studies are underway is — is there a role for booster vaccines to augment waning immunity" for everyone else?
  • NIH Director Francis Collins told Fox News' Chris Wallace on Sunday the Biden administration is looking closely at that question about boosters for the broader U.S. population, but there isn't enough data yet.
  • But he did say concern the vaccine may start to wane in its effectiveness over months "may mean we need to begin with health care providers as well as people who are in nursing homes" in the next few months.
  • Stephen Hoge, president of Moderna, told Fox News' Maria Bartiromo on Sunday that breakthrough cases are emerging differently across vaccines as a result of the Delta variant after six to nine months. "I think that suggests we are going to need booster vaccines to get through the winter."

Officials made a distinction between a third shot for those who are immunocompromised and a "booster" dose that addresses waning immunity in healthy individuals.

  • The third shot is aimed at those undergoing active or recent cancer treatments, those who've received a solid organ transplant, or have advanced HIV infection. It may also include those undergoing treatment with high-dose corticosteroids, alkylating agents, antimetabolites or tumor-necrosis (TNF) blockers, and certain chronic conditions such as renal disease.
  • They're estimated to comprise 2.7% of U.S. adults, or about 7 million adults.

What we're watching: If it turns out we all need boosters, it raises some complex questions. For instance, who will be first in line? Will individuals be required to get the same brand of shot they got in their first series and, if so, how will they get it?

  • "We're looking at it on a daily and weekly basis in cohorts not only in the United States, but in other countries to determine if, when and to whom we should be giving this," NIAID Director Anthony Fauci told CBS News over the weekend.
  • The first boosters would likely be prioritized for those vaccinated early in the rollout of the COVID-19 vaccinations including nursing home residents, those 65 years and older and health care personnel, according to CDC materials distributed Friday.
  • "So if it turns out as the data come in, we see we do need to give an additional dose to people in nursing homes, actually, or people who are elderly, we will be absolutely prepared to do that very quickly."

But, but, but: The CDC workgroup said the greatest health impact will continue to come from the primary series of the vaccine. Decisions for boosters need to focus on the prevention of hospitalization and death, including ensuring global vaccine availability.

  • "What really matters for a vaccine is preventing symptomatic disease, hospitalization and death. And the currently approved vaccines in the U.S. do that very, very well," Badley said.

Go deeper

Updated Oct 19, 2021 - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Vaccines: Mix-and-matching gains momentum — Boosters overtake first doses in U.S. — Pfizer to vaccinate Brazilian cityPanel endorses J&J booster.
  2. Health: Age is still a huge coronavirus risk factor — Unvaccinated 11x more likely to die from COVID — 5x more police officers died from COVID than guns.
  3. Politics: Over 30 states limited public health powers — Pope Francis calls on companies to release vaccine patents — Melbourne, "world's most locked-down city," to lift stay-at-home orders.
  4. Education: Education secretary reveals limits to Biden’s mask push on states — LA extends deadline for school employee vaccinations — Parent sues Wisconsin school district after child tests positive.
  5. Variant tracker: Where different strains are spreading.
24 hours ago - Health

Supreme Court declines to block Maine health care workers vaccine mandate

A Maine health care worker prepares vaccine dose. Photo: Gregory Rec/Portland Press Herald via Getty Images

The U.S. Supreme Court on Tuesday declined to hear an emergency appeal of a vaccine mandate for Maine health care workers.

The big picture: The mandate, which was announced in August by Democratic Gov. Janet Mills, says that Maine health care workers need to be vaccinated by Oct. 29 or risk losing their jobs and not qualifying for unemployment benefits.

24 hours ago - Health

Puerto Rico leads U.S. COVID vaccination rates

A mass vaccination event at the Puerto Rico Convention Center in San Juan, Puerto Rico, on March 31. Photo: Ricardo Arduengo/AFP via Getty Images

Puerto Rico has the highest percentage of people fully vaccinated against the coronavirus in the United States as of Oct. 19, according to data from the Centers for Disease Control and Prevention.

Why it matters: The island has managed to accomplish such feats amid frequent power outages, earthquakes and high dependence on imports of health technologies from outside the region.