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The Centers for Disease Control and Prevention (CDC) on Wednesday endorsed a recommendation that adults 65 and older get an extra dose of the updated 2023-2024 COVID-19 vaccine.
The CDC Advisory Committee on Immunization Practices (ACIP) recommended the additional dose for seniors, acknowledging their increased risk of severe outcomes from COVID-19 infection.
CDC Director Mandy Cohen said the recommendation allows older adults to “receive an additional dose of this season’s COVID-19 vaccine to provide added protection.”
She cited statistics showing that over half of COVID-19 hospitalizations late last year were among adults 65 and older, who also accounted for most deaths.
According to the CDC, the extra vaccine dose will restore protection that may have waned in older adults “at highest risk” since the previous fall booster shots.
The U.S. Food and Drug Administration in September recommended the “updated” COVID-19 vaccine targeting the XBB.1.5 strain for everyone 6 months and older.
Yet as one user on X (formerly known as Twitter) pointed out, the XBB.1.5 strain is now rarely found in circulation:
The CDC recommended today that everyone ≥65 get an additional dose of the updated 2023-24 COVID booster which “targets the XBB lineage of the Omicron variant.” Yet the CDC’s own prevalence data shows that the XBB lineage had, as of mid Feb, all but disappeared from circulation. https://t.co/xhCbHe4BLp pic.twitter.com/2G48P8C520
— Don Wolt (@tlowdon) February 28, 2024
The CDC on Feb. 23 issued an update on the changing threat of COVID-19, noting that while hospitalizations and deaths from COVID-19 were decreasing, “risks continue to be higher for older adults, infants and people with pre-existing medical conditions.”
“CDC recommends that everyone aged 6 months and older get an updated 2023-2024 COVID-19 vaccine,” the update stated — including “pregnant people … at any time during pregnancy.”
Vaccine fatigue clouds new booster guidance
The CDC’s move to endorse another COVID-19 vaccine booster for seniors comes amid intensifying “vaccine fatigue” among the public and medical experts.
According to The Associated Press, the ACIP committee engaged in a “lengthy discussion about whether to say older people ‘may’ get the shots or if they ‘should’ do so,” reflecting an ongoing debate about the necessity of additional boosters.
Some advisory panel members pushed for the more forceful “should” language to prod doctors into actively recommending the extra shot.
However, other doctors argued protection from the 2023 updated boosters has not significantly declined, citing recent studies that found no substantial waning immunity over six months post-booster.
COVID-19 vaccine uptake has steadily dropped with each offering, AP reported, citing CDC statistics showing only about “13% of U.S. children have gotten the shots and about 22% of U.S. adults” have received the updated booster. Vaccination rates reached just 42% among seniors 65 and older.
“People are tired of getting all these shots all the time,” Dr. David Canaday, a Case Western Reserve University infectious diseases expert who studies COVID-19 in older people, told AP. “We have to be careful about over-recommending the vaccine.”
CDC survey data show the public’s biggest concern is whether the shots will be effective, according to AP.
Fauci paper affirms limitations of mRNA vaccines
Amid the debate over appropriate COVID-19 booster recommendations, James Lyons-Weiler, Ph.D., in an article published on his Substack today, cited a paper by Dr. Anthony Fauci and colleagues that renewed questions about the fundamental limitations of mRNA vaccines against respiratory pathogens.
Published in January 2023, the paper highlighted the ongoing challenges of developing effective and long-lasting respiratory virus vaccines.
The authors stated, “The limitations of influenza and SARS-CoV-2 vaccines remind us that candidate vaccines for most other respiratory viruses have to date been insufficiently protective for consideration of licensure.”
“Vaccines have failed against respiratory viruses,” Lyons-Weiler wrote, paraphrasing the authors’ admission. “Pardon me while I pick up my jaw from the floor.”
The paper noted such viruses spread swiftly after initial lung infection, often before the body’s immune defenses fully respond. They transmit through the mucosa rather than triggering full-blown immune responses.
The viruses also have evolved strategies to moderately infect without causing immune system overreactions.
Fauci and co-authors pointed to knowledge gaps around tissue-specific and mucosal responses, immunologic memory, managing mutation-prone viruses like influenza and coronaviruses, and tailoring vaccines to diverse risk groups.
Lyons-Weiler suggested mRNA technology likely falls short if:
- Eliciting mucosal immunity is vital, yet current vaccines only induce systemic immune responses.
- Durability concerns demand frequent boosters.
- “Original antigenic sin” caused by prior vaccines compromises immune responses to later strains.
“According to Fauci, vaccines that focus on systemic immunity do not fully address the unique requirements for combating respiratory viruses,” he wrote.
“Where were these concerns prior to 2020? Why did policy not reflect this reality?” Lyons-Weiler asked.
Lyons-Weiler lamented that Fauci’s paper failed to cite his or other scientists’ papers warning that “spike-only vaccination would yield temporary, shallow [and] misfocused immunity.”
