The Biden administration’s push to make Covid-19 booster shots available to most fully vaccinated adults has been stymied for now by a Food and Drug Administration advisory panel’s recommendation that Pfizer boosters be made available only to those 65 and over and those at high risk of severe Covid.
However, the roiling debate over whether the shots are needed more broadly remains unsettled.
The panel of experts on Friday overwhelmingly voted not to recommend boosters for those over 16 after a tense, daylong debate that put divisions within the agency and the administration on public display.
The vote was a blow to President Biden, strengthening criticism of his effort to enhance the immunity of already vaccinated Americans at a time when most residents of poor nations have not even had first doses. The F.D.A. and the Centers for Disease Control and Prevention authorized third shots for some immunocompromised individuals more than a month ago, on the ground that the additional dose would simply lift their protection to the level other people achieve with two shots.
Some F.D.A. experts said that the data from Pfizer and elsewhere still seemed to show that two shots protected against severe disease or hospitalization for months afterward, and that there was not enough evidence that a third shot would stem the spread of infection. Some also criticized a lack of data that an additional injection would be safe for younger people.
The panel’s final recommendations left some room for the White House to argue that the core of its booster strategy remained intact. Depending on how “at high risk” is defined, tens of millions of Americans could conceivably be deemed eligible for additional shots of the Pfizer vaccine. And a small but growing number of people have stopped waiting for federal authorization and are finding ways to receive booster shots.
Before the panel met on Friday, the Centers for Disease Control and Prevention released data indicating that, for some people, the level of protection against Covid hospitalizations afforded by the Pfizer-BioNTech vaccine dropped significantly four months after full inoculation.
The C.D.C. study supported some others that suggest the Pfizer vaccine may offer less protection from hospitalization over time. The available data is far from unanimous, though so far it suggests that only older adults will need boosters. Participants in the C.D.C. study skewed older and it was unclear if the same waning of vaccine effectiveness happened among younger vaccinated people.
Other studies have shown that Pfizer’s effectiveness against hospitalization has remained above 90 percent, despite the rapid spread of the Delta variant and the passage of time. Pfizer has said that data from Israel suggests a falling effectiveness against severe disease, though it appears that Israel and the United States define “severe disease” differently.
The debate is playing out as the Delta variant continues ravaging less-vaccinated areas of the country. New coronavirus cases and Covid hospitalizations across the United States have started to show signs of decline, although they remain far higher than they were earlier in the summer. And the average number of daily deaths has been increasing since early July, from this year’s low of 175 to nearly 2,000 by the end of this week, according to a New York Times database. About one in every 500 Americans has died from the disease.
The pace of vaccinations remains relatively sluggish. Providers are administering about 775,000 doses per day on average, according to federal data, a fraction of the April peak but still more than 250,000 higher than the low point in July. About 54 percent of Americans are fully vaccinated, according to a New York Times database, the second lowest proportion among the Group of 7 wealthy nations — but Japan’s now aggressive vaccination campaign is likely to leave the United States last among the G-7 shortly.
The F.D.A. has the final word on vaccine approvals, and while it is not obliged to follow the advisory committee’s recommendations, it typically does. The agency will likely issue a decision on boosters by early next week.
Advisers to the Food and Drug Administration on Friday questioned a key assertion by researchers in Israel and by the drug company Pfizer: that its coronavirus vaccine is waning in protection not just against infection, but against severe illness and hospitalization.
The advisers met to evaluate Pfizer’s application for approval of booster vaccine doses for all Americans over age 16. Among the details that surfaced during the lively debate: Israel and the United States define severe illness differently.
In Israel, anyone with an accelerated respiratory rate and an oxygen level of below 94 percent is severely ill. By contrast, the Centers for Disease Control and Prevention considers people who are sick enough to be hospitalized as having severe disease, Dr. Sara Oliver, a C.D.C. scientist, said at the advisory committee meeting.
The discrepancy might help explain why the two countries have reported vastly different outcomes in people who are fully immunized.
Israeli researchers said they have seen large numbers of hospitalized patients who had received two doses months earlier. But in the United States, the C.D.C. has reported that vaccinated patients make up just 2 percent of people hospitalized for Covid-19.
It is just one of many scientific discrepancies that came to light this week.
On Monday, in the journal The Lancet, an international team of scientists analyzed dozens of studies and concluded that boosters are not yet needed by the general population, and that the world would be better served by using vaccine doses to protect the billions of people who remain unvaccinated.
On Wednesday, scientists at the F.D.A. posted an assessment online hinting that they, too, are unconvinced that there’s enough evidence that boosters are needed.
“Overall, data indicate that currently U.S.-licensed or authorized Covid-19 vaccines still afford protection against severe Covid-19 disease and death in the United States,” according to their executive summary.
But some F.D.A. leaders have publicly endorsed booster shots. “The need for an additional dose at six months to provide longer-term protection should not come as a surprise, as it’s likely necessary for the generation of a mature for immune response,” Dr. Peter Marks, one of the agency’s top officials, said in the meeting on Friday.
Alarmed by the rise in cases, Israeli officials have offered third doses of the vaccine to everyone older than 12. Researchers from Israel published early results from that rollout on Wednesday in the New England Journal of Medicine — but few outside scientists found the study convincing.
The team collected data on the effects of booster shots from the health records of more than 1.1 million people over age 60. At least 12 days after the booster, rates of infection were elevenfold lower — and rates of severe disease nearly twentyfold lower — in those who received a booster compared with those who had received only two doses, the researchers found.
The results are unsurprising, experts said, and do not indicate long-term benefit.
“We have known for some time that the vaccines elicit less robust immune responses in the elderly,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center and a former adviser to the Biden administration. “Recommending additional doses of vaccine for the elderly isn’t controversial.”
Vaccination remains powerfully protective against severe illness and hospitalization in the vast majority of people in all of the studies published so far, experts said. But the vaccines do seem less potent against infections in people of all ages, particularly those exposed to the highly contagious Delta variant.
The cumulative data so far suggest that only older adults will need boosters, a view underscored by the F.D.A.’s advisory committee, which voted on Friday to endorse boosters only for Americans aged 65 and older, and those who are at risk for severe illness.
Peering at a sea of white flags blanketing the National Mall, Dr. Laura A. Valleni recalled the scores of pregnant women who had contracted Covid-19 at her hospital in South Carolina. Babies have been born prematurely, mothers have died and a surge of children has overwhelmed the pediatric unit for the past two months, she said.
“I’ve been grappling with when it became OK for even one person to die of preventable illness,” said Dr. Valleni, a neonatal physician at Prisma Health Children’s Hospital–Midlands in Columbia, S.C. “There’s such tremendous grief.”
She was one of dozens who flocked to the opening on Friday morning of “In America: Remember,” an art installation of hundreds of thousands of flags planted along the mall that honor the more than 670,000 people in the United States who have died from the coronavirus.
The secretary of the interior, Deb Haaland, and the mayor, Muriel E. Bowser, were in attendance as visitors walked among the rows of white flags covering 20 acres of federal park land bordering the White House, the Washington Monument, the National Museum of African American History and Culture and the World War II Memorial.
Angelica Rivera, 33, a call center agent for a health care facility in New Jersey, dedicated a flag to a colleague, Karla Pope, a nurse who died of the virus in January. “I love you! Thank you for everything you did for all of us. My forever work mom,” she wrote.
“We were one of the first health care centers to get vaccines in New Jersey, and she was administering the shots, and then a little while later then she got sick,” Ms. Rivera said. “She got Covid and passed away. Her husband also passed away, and her kids were left without a mom and a dad.”
Other names and messages on flags paid tribute to loved ones: Marshall J. Ciccone, a dedicated husband; Bruce Allen Hutcheson, a health care hero; Betty L. Fox, whose daughter aches for her.
The artist behind the installation, Suzanne Brennan Firstenberg, planted 267,000 flags in Washington last fall to recognize what was then the death toll of the coronavirus in the United States.
Citing the success of Britain’s vaccine rollout, government authorities announced on Friday that coronavirus restrictions on international travel in and out of England would be eased beginning at 4 a.m. local time on Oct. 4.
The current three-tier, traffic-light-inspired system, which was introduced in May, caused confusion among Britons and the travel industry. The system going into place next month replaces that with a single “red” list of countries and territories that present the highest coronavirus risk, and simplified travel measures for arrivals from the rest of the world.
The changes were announced in a statement from Britain’s departments of Transport and Health and Social Care; the health secretary, Sajid Javid; and the transportation secretary, Grant Shapps. Mr. Shapps said it represented a simpler, more straightforward system, “one with less testing and lower costs, allowing more people to travel, see loved ones or conduct business around the world while providing a boost for the travel industry.”
The statement announced other changes as well: Starting on the same day, fully vaccinated passengers will no longer be required to take a coronavirus test before arriving in England from a country that is not on the red list, and that the test they must take on the second day after their return can be a rapid test, which is less expensive than the more accurate PCR test.
However, anyone testing positive will be required to isolate and receive negative results from a PCR test, which will be free to the traveler. The samples will be “genomically sequenced to help identify new variants,” the government’s statement said.
A negative test ahead of arrival will still be required for unvaccinated passengers, and they will also still be required to have PCR tests two and eight days later. Unvaccinated people arriving in England from red list countries will have to quarantine in a government-approved hotel for a mandatory 10 nights at their own cost.
And next week, eight countries will be removed from England’s red list: Turkey, Pakistan, the Maldives, Egypt, Sri Lanka, Oman, Bangladesh and Kenya.
Sixty-six percent of the population of the United Kingdom is fully vaccinated, and an additional 6 percent have received a first dose. But average daily deaths have risen 24 percent over the last two weeks.
And the pandemic is playing out differently across the four U.K. nations — England, Scotland, Wales and Northern Ireland — which operate independently on pandemic travel restrictions, as in many other areas of governance.
On Friday, the BBC reported that the government of Wales, where average daily cases are up 19 percent over the last two weeks, said it would follow England’s lead in adjusting its red list, and that it would “carefully consider” the proposed changes on testing.
Scotland, where average daily cases have fallen by 30 percent over the last two weeks, said that it was also easing travel restrictions, but would maintain the requirements for Day 2 and Day 8 PCR tests for vaccinated arrivals to minimize “the risk of importing variants of concern.”
The government of Northern Ireland website did not offer new guidance on its travel restrictions; cases are flat there. England’s cases are dropping off from a recent spike.
So far, 73 percent of people in Britain have received a single dose of a coronavirus vaccine, while 66 percent have received two doses, according to data collated by The New York Times.