​To: Governors of California, Nevada, Oregon, and Washington State

• Governor Gavin Newsom, California
• Governor Steve Sisolak, Nevada
• Governor Kate Brown, Oregon
• Governor Jay Inslee, Washington

From: Arthur Reingold, MD, Chair, Western States Scientific Safety Review Workgroup

At its meeting on November 19, 2021, the Western States Scientific Safety Review Workgroup reviewed the statement from the U.S. F.D.A. on November 19, 2021 concerning booster doses of COVID-19 vaccines and information presented at the meeting of the Advisory Committee on Immunization Practices (ACIP) on November 19, 2021 as well as the statement of CDC Director Rochelle Walensky on November 19, 2021.

To sustain protection against COVID-19, especially among those at increased risk for hospitalization and severe disease, the Workgroup concurs with FDA and CDC recommendations concerning COVID-19 vaccine booster doses, given under FDA Emergency Use Authorizations:

• Among recipients of an initial mRNA COVID-19 vaccine (i.e. Moderna or Pfizer BioNTech) two dose series:
• Those who should receive a booster dose of COVID-19 vaccine: Adults age 50 years and older, or at least 18 years of age and residing in a long-term care facility;
• Those who may receive a booster dose: Adults age 18 through 49 years.
• For recipients of an mRNA COVID-19 vaccine, the booster dose should be administered at least six months after the second dose of the primary series.
• All adult recipients of an initial dose of the Johnson & Johnson COVID-19 vaccine should receive a booster dose, which should be administered at least two months after the initial dose.
• Any of the three COVID-19 vaccines currently available for use may be administered as a booster dose, regardless of which vaccine was used for the primary series.

Because unvaccinated persons remain at much higher risk of COVID-19 than those who have received COVID-19 vaccines, the Workgroup continues to strongly support vaccination against COVID-19 for everyone 5 years of age and older to control the pandemic.

While there is no evidence that reactions or adverse events following immunization, such as myocarditis, occur more frequently following booster doses of COVID-19 vaccines than in recipients of a primary series, the Workgroup supports continued monitoring of such adverse events in the rigorous ongoing national safety surveillance of COVID-19 vaccines. The Workgroup strongly advises registration in the V-safe system and urges that all suspected adverse events following receipt of the vaccine be reported to the Vaccine Adverse Event Reporting System (VAERS).

The Workgroup remains very concerned that the limited global supply of COVID-19 vaccines is hampering pandemic control efforts in low resource countries and increasing the risk of emergence of new variants of SARS-CoV-2 that could spread worldwide. The Workgroup applauds the donation to date of supplies of COVID-19 vaccine doses to nations in need and continues to call for an expansion of these efforts to protect our global community.

Respectfully submitted: 

Members of the Western States Scientific Safety Review Workgroup:

• Arthur Reingold, MD, Chair, UC Berkeley School of Public Health

California Members:

• Tomás J. Aragón, MD, DrPH, California Department of Public Health and State Health Officer
• Oliver Brooks, MD, Watts Healthcare (not present at November 19, 2021 Western States Workgroup meeting)
• Eric Goosby, MD, UCSF School of Medicine
• Rodney Hood, MD, UC San Diego Alumnus and National Medical Association (not present at November 19, 2021 Western States Workgroup meeting)
• Nicola Klein, MD, Ph.D., Kaiser Permanente Northern California
• Grace M. Lee, MD, MPH, Stanford Children’s Health and Stanford University School of Medicine
• Bonnie Maldonado, MD, Stanford University School of Medicine and Stanford Children’s Health
• Mark H. Sawyer, MD, UC San Diego School of Medicine and Rady Children’s Hospitals (not present at November 19, 2021 Western States Workgroup meeting)
• Robert Schechter, MD, California Department of Public Health
• Peter G. Szilagyi, MD, MPH, UCLA Health and David Geffen School of Medicine
• Matt Zahn, MD, Orange County Health Care Agency

Nevada Members:

• Ihsan Azzam, MD, Ph.D., Chief Medical Officer, State of Nevada
• Karissa Loper, MPH, Health Bureau Chief, Nevada Department of Health and Human Services

Oregon Members:

• Laura Byerly, MD, Virginia Garcia Memorial Health Center
  
• Louis J. Picker, MD, OHSU Vaccine and Gene Therapy Institute

Washington Members:

• John Dunn, MD, MPH, Kaiser Permanente Washington
• Edgar K. Marcuse, MD, MPH, University of Washington School of Medicine (not present at November 19, 2021 Western States Workgroup meeting)