ACIP: Third Doses for Moderately and Severely Immunocompromised People

Regulation | August 13, 2021 | by Linda Couch

On August 13, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend an additional dose of the Pfizer vaccine for those 12 and older and of the Moderna vaccine for those 18 and older following a primary series in immunocompromised people. The ACIP took the vote after reaching the conclusion that the desirable consequences of the third dose for this population “clearly outweigh undesirable consequences in most settings.”

On August 13, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend an additional dose of the Pfizer vaccine for those 12 and older and of the Moderna vaccine for those 18 and older following a primary series in immunocompromised people. The ACIP took the vote after reaching the conclusion that the desirable consequences of the third dose for this population “clearly outweigh undesirable consequences in most settings.”

The ACIP recommendations allow self-attesting moderately and severely immunocompromised people to receive a third dose. People will not need a prescription or a doctor’s signature to receive a third dose.

The ACIP set the parameters of who will be considered moderately and severely immunocompromised to receive a third dose. It is important to make a distinction between a “primary three dose series” for immunocompromised people and a booster, which denotes a waning of immunity over time.

The vote came after presentations, discussions, and a public comment period which pointed to the potential large benefit, minimal harm, and small impact on equity of a third dose for moderately or severely immunocompromised people.

A member of ACIP, during the August 13 meeting, said that the definition of moderately or severely immunocompromised does not broadly include people with diabetes or people living in long term care communities.

A slide from the August 13 ACIP meeting describes moderately or severely immunocompromised people as those with active treatment for solid tumor and hematologic malignancies, people with organ transplants who are taking immunosuppressive therapy, recipients of certain stem cell transplants, people with moderate or severe immunodeficiency, have advanced or untreated HIV, and those with active treatment with high-dose corticosteroids and other biologic agents that are immunosuppressive or immunomodulatory. Additionally, ACIP slides noted that chronic medical conditions may be associated with varying degrees of immune deficit, that a patient’s clinical team is best able to assess the degree of altered immunocompetence and the optimal timing of vaccination.

ACIP did not consider use of the Johnson & Johnson COVID vaccine for a third dose for immunocompromised people at this time. One member of the panel noted that immunocompromised people were among the first to receive a COVID vaccine before the Johnson & Johnson COVID vaccine was even available.

As for the rollout of this decision, CDC staff said they have been working with pharmacies to be prepared should the Committee vote positively today and the CDC is hoping these third doses can be rapidly implemented. The CDC will be updating its clinical guidance, which should be published by late August 13.

Asked whether moderately or severely compromised people would be considered “fully vaccinated” if they did not have a third dose, CDC staff said its current guidance on what it means be fully vaccinated will not change: two doses of an mRNA or one dose of the Janssen (J&J) vaccine.

See the slides and webcast of the August 13 ACIP meeting here.