California awaits CDC guidance before releasing state's COVID-19 vaccine booster plan

The Food and Drug Administration has authorized booster doses of the Pfizer vaccine for people 65 and older, as well as other vulnerable populations, but California health officials are awaiting a few more administrative steps before finalizing a rollout and determining who is eligible in the latter category.

The FDA authorization on Wednesday night "is an important signal, but it is the first of three steps," state Health and Human Services Director Dr. Mark Ghaly said on a call with reporters Thursday morning.

The second step: A Centers for Disease Control and Prevention advisory committee is meeting Thursday to debate who, under the age of 65, should be eligible for a third dose of the Pfizer vaccine based on risk of exposure and contracting severe illness.

Health care workers are expected to be included in that group. Less clear is whether other essential workers such as teachers or grocery store employees would be included. The advisory panel's recommendation will guide the CDC's formal guidance on boosters, likely to come shortly after the panel's vote.

The third step, Ghaly said, is that the Western States Scientific Safety Review Workgroup — the independent panel of experts assembled by the governors of California, Nevada, Oregon and Washington State — must complete its own review.

The Western States group has usually issued its recommendations within a day or two of federal guidance; the panel has yet to issue a recommendation contrary to the federal agencies.

After the FDA, CDC and Western States panel have made their recommendations, California will release an official plan for providing third doses of Pfizer, Ghaly said.

The booster doses would be available for those in eligible groups who are at least six months beyond their second dose of Pfizer.

President Joe Biden had previously said boosters would be available to all in the U.S. who want one by September. But the FDA panel that met last week declined to recommend authorizing booster doses for the general population, while voting unanimously to recommend emergency use authorization in the smaller group considered at higher risk from COVID-19.

It is yet to be determined how boosters would be handled for those who received Moderna or the single-dose shot from Johnson & Johnson.

Ghaly said it is also still being decided how the launch of booster doses will change the state's vaccine requirements. The state last month required all health care workers, in both public and private sectors, to have their second dose of a two-dose vaccine (Pfizer or Moderna) or first dose of the single-dose Johnson & Johnson vaccine by Sept. 30.

It hasn't yet been sorted whether one will need to receive a booster to remain classified as "fully vaccinated" and, if so, when the deadline would be.

The California Department of Public Health on Thursday also released a broader "Vaccine Action Plan," which addresses numerous points including increasing uptake among the already eligible; rolling out boosters using existing provider networks; and handling the expansion of eligibility to children under age 12, which is expected in the next few months.

The plan includes a model showing that the 65-plus population would reach a peak demand for 1.1 million booster doses per week, or 167,000 doses per day, by early October, based on the six-month delay from receiving second doses. CDPH as of Wednesday reported that providers in California have about 2.9 million Pfizer doses on-hand in inventory.

The plan says its modeling will be updated as federal recommendations are finalized for which workers are considered high-risk and eligible for boosters.

The CDC has already authorized third doses for those who are moderately to severely immunocompromised, doing so in August. CDPH said in the action plan that it has administered about 259,000 boosters to this group, estimated at between 700,000 and 800,000 Californians.

Ghaly expressed confidence that the state would be able to roll out boosters while balancing the need to administer more first doses.

"We can do both," he said. "In those areas where we have always had capacity to provide vaccination, just with not enough takers, we will be prepared to do both."

California Department of Public Health data show that about 78% of eligible Californians were at least partially vaccinated as of Thursday. But the rates vary widely by region; several rural counties are below 50%.

"We've seen unvaccinated Californians are eight times more likely to get infected vs. vaccinated Californians, 13 times more likely to be hospitalized and 15 times more likely to die," Ghaly said.

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