This opinion piece argues in favor of the Centers for Disease Control and Prevention (CDC) limiting its recommendation for COVID-19 booster shots to high-risk groups. The author cites several factors supporting this approach:
The CDC's Advisory Committee on Immunization Practices (ACIP) discussed shifting from a universal booster recommendation to a targeted approach, focusing on high-risk groups. A CDC workgroup voted in favor of a risk-based approach, allowing individuals not deemed high-risk to still receive the vaccine if they choose. The author urges the CDC to adopt this revised policy, emphasizing that it aligns with current scientific evidence and is a preferable outcome in the current political climate.
The author notes that several other countries, including Britain, Canada, and Australia, already employ a more targeted approach to COVID-19 booster recommendations, limiting them to older adults and high-risk individuals. The World Health Organization also does not routinely recommend additional shots for children or non-elderly adults.
The Centers for Disease Control and Prevention might soon limit its guidance for who should receive a coronavirus booster shot. Such a change would be evidence-based and, if implemented correctly, might even boost uptake among vulnerable populations.
The potential shift was signaled by the CDC’s Advisory Committee on Immunization Practices, which convened last week after its February meeting was suddenly called off. To the relief of many public health experts, it was business as usual. Among the issues discussed was whether to change the coronavirus booster from a universal recommendation for everyone older than 6 months to one limited to high-risk groups.
There are four factors in favor of this more targeted approach. First, the epidemiology of the coronavirus has changed dramatically since the early days of the pandemic. In 2020, few people had prior exposure to the virus, making the disease deadly for many. By the end of 2022, more than 96 percent of people aged 16 and older had antibodies to covid from infection, vaccination or both. Far fewer people became severely ill. At the pandemic’s peak, covid-19 deaths approached 26,000 a week. This has decreased to fewer than 200 as of the week of April 5.
Second, data increasingly show that older adults are the most vulnerable population to severe covid-19. The CDC reports that 68 percent of covid-associated hospitalizations now take place among seniors (65 and up). In fact, in the 2024-2025 season, those 75 and older were hospitalized at 31 times the rate of 18- to 49-year-olds. And while infants are more susceptible to the disease (as they are to other respiratory ailments), 5- to 17-year-olds had even lower hospitalization rates than young and middle-aged adults.
The mortality data are even more striking. Between September 2023 and August 2024, nearly 89 percent of all covid-associated deaths occurred in seniors. Their death rates were 35 times that of 18- to 49-year-olds and nearly 650 times that of 5- to 17-year-olds.
Third, the main benefit of additional covid doses is protection against severe illness, not reducing infection. New CDC data show that the 2024-2025 vaccine reduced hospitalization by between 42 percent and 48 percent among seniors without immunocompromising conditions and that this effect persisted throughout the four-month follow-up. It was 35 percent effective at reducing emergency department and urgent-care visits in this age group. Among younger adults, that number fell to just 21 percent two to four months after receiving the shot.
That means older individuals should get the vaccine to reduce their chances of falling gravely ill. Younger, generally healthy people are already at very low risk for severe illness. Given the low effectiveness against infection, a blanket recommendation for them is hard to justify.
Finally, a more targeted recommendation can focus resources on the highest-risk populations. CDC staffers presented two shocking numbers: Only 30 percent of nursing home residents received the latest coronavirus vaccine, and just 26 percent of seniors who were hospitalized for covid got the booster before falling ill.
This is a failure of public health messaging. As I have argued, a population-wide policy that prioritizes simplicity over specificity wrongly suggests that vaccinating a healthy 20-year-old is the same as inoculating an 80-year-old nursing home resident. Such guidance defies common sense and erodes trust regarding other public health advice.
Other countries have long adopted a more-targeted approach. Britain, Canada and Australia recommend the booster only for older adults and some people with high-risk medical conditions. The World Health Organization similarly does not routinely recommend additional covid shots for children or non-elderly adults.
At last week’s meeting, CDC advisers did not reach a consensus on whether the United States should align its covid booster guidance with peer countries. However, 76 percent of a CDC work group comprising staff, advisers and external medical groups such as the American Academy of Pediatrics, the American Medical Association and the Infectious Diseases Society of America voted this month to change the universal recommendation to a risk-based one. Importantly, the guidance stipulated that people who were not deemed high risk could still choose to get the vaccine.
The CDC should adopt this revised policy. Not only would it comport with evolving science, but it is also far from the worst outcome under a health and human services secretary who once described the coronavirus vaccines as “the deadliest vaccine ever made.” Advocates for vaccine access should be relieved if updated covid shots remain available to all who want them.
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