The rapid rise of the Omicron subvariant BA.5—along with its enhanced immune-concealing capabilities and demonstrable growth benefits—is keeping federal officials on edge. In a flurry of activities 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 .
In a press briefing on Tuesday morning, White House COVID-19 response coordinator Ashish Jha outlined a battle plan against BA.5, which, to date, accounts for 65 percent of cases in the US. Jha highlighted the efforts and tools to prevent another large wave of infections, as seen with the original Omicron in January. The plan includes a strong push to vaccinate and promote Americans, as well as renewed incentives to test, treat, mask and improve indoor ventilation.
US COVID-19 cases are currently pegged at a high of about 117,000 new cases per day – but that’s a significant estimate given that many Americans are testing at home and not reporting their cases. Hospitalizations and admissions to intensive care have been on the rise, with increases of 17 percent and 21 percent, respectively, over the past two weeks, according to tracking by The New York Times. Generally speaking, the daily average of hospitalizations has more than doubled since the end of May, with the current average close to 38,000.
According to a red-soaked map from the Centers for Disease Control and Prevention, SARS-CoV-2 transmission levels are considered high in nearly 90 percent of U.S. counties. The agency is recommending that everyone wear a mask in public indoor settings in about 21 percent of counties, based on the agency’s gentler COVID-19 community-level metrics.
Current vaccines have proven to be highly effective in preventing serious illness, hospitalization, and death. But to date, only 67 percent of Americans have been fully vaccinated against the pandemic virus. Of the complete vaccinations, only 48 percent have received a booster. That means about 32 percent of Americans have a booster, which is available to everyone age 5 and older. Additionally, people age 50 and older or at high risk (such as the immunocompromised) are currently eligible for a second booster. But only 18.7 million people got that second booster. It is about 28 percent of people over the age of 50 who have been fully vaccinated and outnumbered.
On Monday evening, The Washington Post broke the news that the Biden administration is considering expanding eligibility for a second booster to include all adults. The report cited five unnamed officials with knowledge of the case, who said Jha and top infectious disease expert Anthony Fauci support the idea of expanding the second booster to all adults.
In a Tuesday morning press briefing, Fauci and Jha stressed that only the Food and Drug Administration and the CDC have the capacity to expand booster eligibility. The Washington Post noted that administration officials expect regulatory signatures on the extension within the next two weeks. The accelerated deadline could prevent a summer booster expansion from complicating the rollout of the next generation of boosters this fall.
Boost now and later
Currently, the administration and the FDA are anticipating the rollout of a next-generation, bivalent booster this fall that will target both the parental strain and the BA.4/5 omicron subvariant. This rollout is expected to start around October or November, or about three to four months from now. In the past, the booster interval has been around four to six months, Jha said.
Jha and CDC Director Rochelle Valensky repeatedly said Tuesday that getting a booster in now or two weeks won’t get a bivalent booster this fall. Their thinking is simply based on the time limit and the anticipated interval for the booster.
“It’s been four, five months as we’ve seen the cadence where we need to boost first,” Valensky said. “We anticipate it’s going to be a similar cadence. We also really want to emphasize that there are many people who are at high risk right now, and are waiting until October/November for their boost.” are—when in fact, their risk is the moment—not a good plan,” she said. “So, we really want to say ‘Get your boost now. We every hope the data suggests you’ll be eligible for a [bivalent] decline boost. Of course, we will continue to evaluate those figures.”
For now, there are no clinical data on the efficacy of the second booster in healthy people under 50 years of age. It is also unclear whether the fourth dose with existing vaccines—which target the parental strain of SARS-CoV-2—can skew immune responses when future variant-targeted boosters return to the parental strain. But it has not been a significant concern for those already eligible for a second booster. Additionally, most Americans have already been exposed to the variant.
As such, many experts such as Jha and Fauci have embraced the idea of extending the second booster access between BA.5 spikes. That includes virologist and vaccine expert Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
“We’ve already seen benefits in those 50 and older,” he told the Post. “Eventually what is true for older people becomes true for younger people—it takes longer to manifest itself.”