New York City and 3 states offer COVID-19 booster shots to all adults, bypassing CDC guidance

• California, Colorado, New Mexico, and New York City are telling healthcare providers to offer COVID-19 boosters to all adults.
• The guidance bypasses the CDC's current restrictions on booster shots.

Any adult who wants a COVID-19 booster shot at least six months after they're fully vaccinated can get one in three states, plus New York City.

Dave Chokshi, commissioner of the New York City Department of Health and Mental Hygiene, told healthcare providers on Monday not to deny boosters to New Yorkers ages 18 and up. Public-health officials in California, Colorado, and New Mexico issued similar recommendations in the last month — a decision largely driven by rising COVID-19 cases and hospitalizations in several parts of the US.

Their guidance bypasses the Centers for Disease Control and Prevention's current restrictions on booster eligibility.

The CDC said last month that adults who got their second Pfizer or Moderna shot at least six months ago should seek a booster if they're 65 years or older, live in a long-term care setting, have an underlying medical condition, or work or live in a high-risk setting, such as a school or hospital. The CDC also recommended boosters for adults who received Johnson & Johnson's vaccine at least two months ago.

New Mexico's acting health secretary, David Scrase, said Friday that New Mexico's high transmission rates qualify the entire state as a high-risk setting. New Mexico's daily COVID-19 cases have risen 48%, on average, over the last two weeks — from around 900 to 1,300 infections per day. The number of people currently hospitalized with COVID-19 has also risen 29% in that time — from around 400 to 500 people.

"I strongly encourage every New Mexican to register for a booster today," New Mexico Gov. Michelle Lujan Grisham said in a Friday press release.

California's public health department similarly directed healthcare providers last week to give boosters to any adult who asks for one. More boosters in arms could help prevent COVID-19 hospitalizations from rising this winter, California Health and Human Services Secretary Mark Ghaly said at a news conference.

"Get that added protection for Thanksgiving gatherings that you may attend. Certainly going into the other winter holidays, it is important," Ghaly said. "What we are seeing is more cases among those who were vaccinated early. We're concerned about what it means for hospitalizations and pressure on our healthcare delivery system, but ultimately for your safety and protection."

California's state public-health officer, Tomás Aragón, told local healthcare providers that residents could "self-determine their risk of exposure" in a letter on November 9.

Both California and New Mexico are following Colorado's lead on boosters. Jill Hunsaker Ryan, the Colorado public health department's executive director, issued a similar booster recommendation in late October.

"COVID-19 vaccine providers shall, as vaccine supply permits, accept any individual seeking an additional or booster dose of COVID-19 vaccine," Ryan wrote.

Colorado Gov. Jared Polis signed an executive order last week expanding booster eligibility to all adults on the grounds that residents were at high risk of COVID-19 exposure or transmission. The state's daily COVID-19 cases have risen 11%, on average, over the last two weeks — from around 2,900 to 3,200 infections per day.

Public-health experts are divided on whether boosters are necessary for all

The CDC's current booster recommendation encompasses tens of millions of Americans, but more than 150 million Americans were fully vaccinated at least six months ago.

Studies have shown that coronavirus antibodies may wane significantly after six months. Antibodies aren't the only form of immunity, though: Vaccines also spur the body to produce T-cells, which help prevent disease. A study published last month in The Lancet also found that Pfizer's shot was just 47% protective against a coronavirus infection after five months — though the vaccine was still 93% effective against hospitalization for up to six months.

Still, some public-health experts see boosters as critical to preventing another wave of COVID-19 cases this winter. Already, daily COVID-19 cases are rising in Europe — by 14%, on average, in the last week. Average daily deaths in Europe have also risen 7% in that time.

"We have a choice as we look into the winter," David O'Connor, a pathology professor at the University of Wisconsin, recently told Insider. "Down one path, we have being reluctant and living with waning immunity, living with cases and the problems that brings with it. Down the other path, we have something that looks more like Israel, where a large fraction of the population is highly protected from being infected in any way with Delta. I don't know why you would choose the first path when the second path is right in front of us."

Other public-health experts are waiting for more data to decide whether boosters are necessary for everyone.

The Washington Post reported Thursday that CDC Director Rochelle Walensky is still wary of a general booster recommendation, citing several unnamed officials familiar with the situation. But senior health officials in the Biden administration — including Anthony Fauci and Surgeon General Vivek Murthy — support boosters for all adults, people familiar with those officials' views told The Post.

Some experts remain concerned that booster shots could increase the risk of myocarditis, or inflammation of the heart muscle, among young adults — particularly young men ages 18 to 29. To recommend boosters for this group, CDC officials would need to be confident that the benefits of an additional shot "clearly and definitively outweigh the risk," Paul Offit, a vaccine expert at Children's Hospital of Philadelphia, told The Post.

For now, he added, "all the evidence" suggests that young men are protected from severe illness if they're fully vaccinated.