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In a rare move, CDC overruled the recommendations of the agency's Advisory Committee on Immunization Practices (ACIP) regarding who should get a booster of Pfizer's COVID-19 vaccine (Comirnaty).

In a released early Friday, the agency said those at high risk of occupational exposure, such as healthcare workers, may receive the Pfizer booster shot at least 6 months after the two-dose primary series, based on their individual benefits and risks. On Thursday, the ACIP voted 6-9 against recommending a booster in this population.

All ACIP recommendations are not final until they appear in the Morbidity and Mortality Weekly Report, which occurs after they are signed by the CDC Director. The agency appeared to couch the reasoning for their decision based on when these workers received their initial two-dose series.

"Many of the people who are now eligible to receive a booster shot received their initial vaccine early in the vaccination program and will benefit from additional protection," the statement said.

The recommendations now align with the terms of FDA's emergency use authorization (EUA), said CDC Director Rochelle Walensky, MD, which made a booster dose available to this population.

"As CDC Director, it is my job to recognize where our actions can have the greatest impact," Walensky said in a statement. "At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good."

ACIP voted down the interim recommendation for this population, with members stating that there was no evidence that occupational exposure was a risk factor for severe COVID-19. Public health officials also said it would be a nightmare for implementation, since it was not based on clinical factors.

Gerald Harmon, MD, president of the American Medical Association, applauded the decision in a statement.

"Given that we are in the midst of a global pandemic that continues to cause widespread illness and death, we must do everything we can to protect our frontline health care professionals," he said. "We believe this recommendation is a critical step to preserve our nation's health care capacity and prevent illness among those who have continued to put their own health and safety at risk to care for patients."

The CDC endorsed the ACIP's other three recommendations on who should get a Pfizer booster: all adults ages 65 and up and those in long-term care facilities, adults ages 50 to 64 with underlying medical conditions, and adults ages 18 to 49 with underlying medical conditions based on their individual benefits and risks.

The agency added that in the coming weeks, they will be looking to address boosters for those who received the Moderna or Johnson & Johnson vaccine.

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