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Illustration: Maura Losch/Axios

The Biden administration is expected to begin the process of expanding the booster authorization to all adults as early as this week, according to a source familiar with internal planning.

Why it matters: America's booster campaign got off to an underwhelming start, potentially leaving millions of vulnerable people at risk as the holidays approach.

The big picture: The pandemic still isn't over, and the data is clear that vaccine effectiveness has waned over time and with the rise of Delta — but also that a booster dose restores protection against the virus to remarkable levels.

Despite disagreement among experts about who needs a booster, there's broad consensus that older people and at least some with underlying health conditions should get an additional dose around six months after their first series.

  • But only 36% of Americans 65 and older have received a booster shot, according to the CDC.
  • "As every month goes by, the immunity wanes more and more. So as time goes by, you’re going to see more vaccinated people" becoming more vulnerable to the virus, NIAID director Anthony Fauci told Axios.
  • The vast majority of breakthrough cases — particularly among younger people — aren't severe. But "as is always the case, the elderly are more vulnerable, because they're more likely to have waning of protection over time," Fauci said.

State of play: The Biden administration's original plan over the summer was to recommend that most adults get a booster shot eight months after their initial round. However, the FDA and CDC ultimately recommended that more limited groups of people receive another shot six months later.

  • But some cities and states — including California, Colorado, and New York City — have gotten ahead of the FDA and have made boosters available to all adults, and some experts are arguing that it's time for the federal government to do the same.
  • Other experts are still skeptical about further broadening eligibility.

Where it stands: There isn't good national data on how many current hospitalizations and deaths are among vaccinated people, although some states are reporting rising numbers of breakthrough cases. (The number of breakthrough cases is expected to rise as more people get vaccinated.)

  • In Colorado, for example, 80% of hospitalized COVID patients are unvaccinated, Denver's 9 News reports from state data.
  • "Many of the ones who end up hospitalized after vaccination are older or have medical conditions or they’re on some sort of immunosuppressant," Jared Eddy, director of Infection Control and Prevention at National Jewish Health, told 9 News.

What we're watching: If eligibility is expanded — and thus simplified — booster uptake could increase.

  • "I believe it's extremely important for people to get boosters, and I am hoping very soon we will see a situation where there won't be any confusion about who should and should not get boosters," Fauci said.
  • "In my opinion boosters are ultimately going to become a part of the standard regimen and not just a bonus," he added.

Go deeper

How to get the COVID-19 booster in North Texas

Illustration: Annelise Capossela/Axios

The new Omicron COVID-19 variant will "inevitably" be found in America, health officials say. Cases have already been reported in several countries in the days since it was identified.

Why it matters: National health experts say it’s not time to worry, but it is time to get vaccinated if you’re not already, or get a booster shot.

14 hours ago - Health

Omicron variant lifts Moderna's stock price

Moderna's stock soared 12% Monday, putting its market cap just shy of $150 billion.

Driving the news: The Omicron variant of the coronavirus has raised a lot of questions, including whether the vaccines will remain as effective.

Tennessee braces for Omicron variant

Illustration: Annelise Capossela/Axios

It's only a matter of time before the new coronavirus variant Omicron reaches Tennessee.