The rapid rise of omicron’s BA.5 subvariant—with its enhanced immune evasion abilities and apparent growth advantage—has unnerved federal officials. In a flurry of activity late Monday and early Tuesday, officials doubled down on pandemic measures, renewed calls for vigilance and are considering expanding eligibility for a second booster to all adults.
At a press briefing Tuesday morning, White House COVID-19 response coordinator Ashish Jha outlined a battle plan against BA.5, which is estimated to account for 65 percent of U.S. cases to date. Jha emphasized the efforts and tools to prevent another rising wave of infection, as seen with the original omicron in January. The plan includes a stronger push to vaccinate and vaccinate Americans, plus a renewed push for testing, treatment, masking and improved indoor ventilation.
US cases of COVID-19 are currently at a high of about 117,000 new cases per day, but this is likely a significant underestimate given that many Americans are testing at home and not reporting their cases. Hospitalizations and intensive care unit hospitalizations, meanwhile, are up, up 17 percent and 21 percent, respectively, over the past two weeks, according to tracking by The New York Times. Overall, the average daily number of hospitalizations has more than doubled since late May, with the current average approaching 38,000.
Transmission levels of SARS-CoV-2 are considered high in about 90 percent of US counties, according to a red-drenched map from the Centers for Disease Control and Prevention. The agency recommends everyone wear masks in public indoors in about 21 percent of counties, based on the agency’s milder community-level COVID-19 metric.
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Current vaccines have proven highly effective in preventing severe illness, hospitalizations and death. But to date, only 67 percent of Americans are fully vaccinated against the pandemic virus. Of those fully vaccinated, only 48 percent received a booster. That means only about 32 percent of Americans have had one booster, which is available to everyone over the age of 5. Additionally, people age 50 and older or at high risk (such as immunocompromised) are currently eligible for a second booster. But only 18.7 million people received this second booster. That’s about 28 percent of people over the age of 50 who are fully vaccinated and boosted.
On Monday night, The Washington Post broke the news that the Biden administration is considering expanding eligibility for second boosters to include all adults. The report cited five unnamed officials familiar with the matter who said Jha and top infectious disease expert Anthony Fauci support the idea of expanding second boosters to all adults.
At Tuesday morning’s news conference, Fauci and Jha emphasized that only the Food and Drug Administration and the CDC have the ability to ultimately expand eligibility for a booster. The Washington Post noted that administration officials hope to receive regulatory approval for the expansion within the next two weeks. The short time frame could prevent the summer expansion of boosters from complicating the release of next-gen boosters this fall.
Zoom in now and later
The administration and FDA are currently anticipating the release of next-generation bivalent boosters this fall that will target both the parent strain and the BA.4/5 omicron subvariants. This rollout is expected to begin around October or November, or approximately three to four months from now. In the past, booster intervals were about four to six months, Jha noted.
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Jha and CDC Director Rochelle Walensky repeatedly said Tuesday that getting a booster now — or in two weeks or so — would not prevent getting a bivalent booster this fall. Their thinking is simply based on the time frame and expected interval for boosters.
“By the time we looked at the cadence of where we should have gotten stimulus before, it’s been four, five months,” Walenski said. “We anticipate it will be a similar cadence. We also really want to stress that there are a lot of people who are at high risk right now and waiting until October/November for their boost – when actually their risk is at a point – is not a good plan,” she added. “So we really want to say, ‘Now get your push.’ We have every expectation that the data will suggest that you will be eligible for [bivalent] a push in the fall. We will of course continue to evaluate this data.”
So far, there are no clinical data on the efficacy of the second booster in healthy people under 50 years of age. It’s also unclear whether a fourth dose with current vaccines — which target the ancestral strain of SARS-CoV-2 — could skew immune responses to future boosters to target variants back to the ancestral strain. But that hasn’t been a major concern for people already eligible for a second booster. Furthermore, the majority of Americans have already been exposed to options.
As such, many experts, such as Jha and Fauci, embraced the idea of expanding access to a second booster amid the BA.5 peak. That includes virologist and vaccine expert Peter Hotez, who is dean of the National School of Tropical Medicine at Baylor College of Medicine.
“We’ve already seen the benefits at 50 and over,” he told the Post. “After all, what’s true for older people turns out to be true for younger people—it just takes longer to reveal itself.”
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