A Plan for Booster Doses, Pediatric Hospitalizations Rates Going Up

Earlier this week, health officials from the Biden Administration announced that all Americans would be eligible for a booster dose of the mRNA COVID-19 vaccines starting the week of September 20.

The new plan is for both the Pfizer-BioNTech and Moderna mRNA vaccines only, and applies to people 8 months after their second dose.

On the same day it was announced a joint statement from Department of Health and Human Services (HHS) public health officials was released. The statement was attributed to the following officials: Rochelle Walensky, MD, director of the Centers for Disease Control and Prevention (CDC); Janet Woodcock, MD, acting commissioner, Food and Drug Administration (FDA); Vivek Murthy, MD, US surgeon general; Francis Collins, MD, director of the National Institutes of Health (NIH); Anthony Fauci, MD, chief medical advisor to President Joe Biden and director of the National Institute of Allergy and Infectious Diseases (NIAID); Rachel Levine, MD, assistant secretary for Health; David Kessler, MD, chief science officer for the COVID-19 Response; and Marcella Nunez-Smith, MD, chair of the COVID-19 Health Equity Task Force.

“The available data make very clear that protection against SARS-CoV-2 infection begins to decrease over time following the initial doses of vaccination, and in association with the dominance of the Delta variant, we are starting to see evidence of reduced protection against mild and moderate disease,” the joint statement read. “Based on our latest assessment, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout. For that reason, we conclude that a booster shot will be needed to maximize vaccine-induced protection and prolong its durability.”

The plan is subject to the FDA approval, which is expected to be coming in the next few weeks, and will also coincide with an official review of the Pfizer-BioNTech vaccine for full FDA approval.

“The FDA’s unofficial deadline is Labor Day or sooner, according to multiple people familiar with the plan. The agency said in a statement that its leaders recognized that approval might inspire more public confidence and had “taken an all-hands-on-deck approach” to the work,” according to a report in the NY Times.

This booster eligibility does not extend to the Johnson & Johnson vaccine yet, as officials said they need to review further data.

“We also anticipate booster shots will likely be needed for people who received the Johnson & Johnson (J&J) vaccine,” the statement read. “Administration of the J&J vaccine did not begin in the US until March 2021, and we expect more data on J&J in the next few weeks. With those data in hand, we will keep the public informed with a timely plan for J&J booster shots as well.”

Increased COVID-19 Hospitalization Rates in Children

With the addition of booster doses and a full approval of at least one vaccine on the federal government's docket, September expects to be busy. This is happening simultaneously as hospitalizations go up for the pediatric population.

The CDC has been tracking hospitalizations through its COVID-NET, which is a population-based surveillance system that collects data on laboratory-confirmed COVID-19-associated hospitalizations for both children and adults at 250 hospitals in 14 states.

It is important to note, this is a snapshot and not a complete analysis of the overall US statistics.

According to COVID-NET, the rate of hospitalizations in kids 0-4 years of age was 0.2 in rates per 100,000 population the week ending June 26, 2021. In the week ending August 7, the rate went up significantly to 1.6. There were 31 new hospitalized cases ending that same week.

Although the total number does not appear to be a large number, it is the most hospitalized cases reported since the end of December 2020, when there were 52 cases.

In the 5-17 age group, the hospitalization rate is also increasing but not quite as pronounced as the younger population. The rate of hospitalizations in kids 5-17 years of age was 0.4 in rates per 100,000 population the week ending June 26, 2021. In the week ending August 7, the rate went up to 0.8. There were 31 new hospitalized cases ending that same week.

Last Saturday, there were 1902 children in US hospitals because of either confirmed or suspected COVID-19, according to data from HHS.

"This is not last year's COVID. This one is worse and our children are the ones that are going to be affected by it the most," Sally Goza, former president of the American Academy of Pediatrics, told CNN on Saturday.

Everyone would agree the numbers are trending in the wrong direction for the pediatric population, and when you add into this mix in-person learning for schools is happening now and will be over the next few weeks, the debate on mask-wearing in schools, and a large part of the pediatric population (children under 12) is not eligible for the COVID-19 vaccine, these factors suggest the potential for more cases in the coming weeks and months.