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 October 21, 2021 the Western States Scientific Safety Review Workgroup reviewed the evidence concerning booster doses of the Moderna and Janssen (Johnson & Johnson) COVID-19 vaccines presented at the meetings of the federal Vaccines and Related Biological Products Advisory Committee (VRBPAC) on October 14-15, 2021 and the Advisory Committee on Immunization Practices (ACIP) on October 21, 2021 and the statement released by CDC Director Rochelle Walensky on October 21, 2021. The Workgroup previously reviewed the evidence and recommendations pertaining to booster doses of the Pfizer BioNTech COVID-19 vaccine (https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Statement-on-Pfizer-Booster.aspx).
To sustain protection against COVID-19, the Workgroup concurs with CDC recommendations for a single booster dose of COVID-19 vaccine among recipients of an initial series of the Moderna COVID-19 vaccine and recipients of the Janssen (Johnson & Johnson) COVID-19 vaccine. Those who received the Moderna COVID-19 vaccine are eligible to receive a booster dose at six months or more after their initial series, while those who received the Janssen (Johnson & Johnson) COVID-19 vaccine are eligible to receive a booster dose at two months or more after their initial dose.
1. Among recipients of the Moderna COVID-19 vaccine, those who should receive a booster dose of COVID-19 vaccine include those at increased risk for hospitalization and severe disease, including those:
- Age 65 years and older
- Age 18 years and older residing in a long-term care facility, or
- Age 50 through 64 years with underlying medical conditions or at increased risk of social inequities.
2. Among recipients of the Moderna COVID-19 vaccine, those who may receive a booster dose of COVID-19 vaccine include persons:
- Age 18 through 49 years with underlying medical conditions or
- at increased risk of social inequities, or
- Age 18 through 64 years who are risk for SARS-CoV-2 exposure and transmission because of occupational or institutional setting.
3. All those age 18 and older who received the Janssen (Johnson & Johnson) COVID-19 vaccine should receive a booster dose of COVID-19 vaccine.
The Workgroup has strongly endorsed CDC’s recognition that long-standing systemic health and social inequities have increased the risk of severe illness from COVID-19. The Workgroup therefore recommends again that social determinants of vulnerability be included in the assessment of conditions that qualify individuals for booster doses.
Individuals who have previously received an initial series of any of the three COVID-19 vaccines currently approved or authorized for use in the United States are eligible for a booster dose. The Workgroup supports CDC’s decision that individuals eligible for a booster may receive either the same or a different COVID-19 vaccine as a booster dose, depending on advice from a health care provider, individual preference, availability or convenience.
The Workgroup has very carefully reviewed the evidence presented to VRBPAC and to the ACIP relating to both the efficacy and the safety of booster doses of COVID-19 vaccines. Evidence available to date supports the safety of booster doses. Because of mounting evidence of waning vaccine-induced protection against SARS-CoV-2 infection, the Workgroup strongly believes that the benefits of booster doses substantially outweigh any potential risks. The Workgroup reiterates the importance of reporting to VAERS any suspected adverse events following receipt of a COVID-19 vaccine, whether as part of an initial series or as a booster dose.
Unvaccinated persons remain at much higher risk of COVID-19 than those who have received COVID-19 vaccines. To control the pandemic, the Workgroup urges vaccination against COVID-19 for everyone who is eligible. Provision of booster doses should not interfere with vaccinating those who have not received an initial series of a COVID-19 vaccine.
The Workgroup remains very concerned that the limited global supply of COVID-19 vaccines is hampering pandemic control efforts in low resource countries thereby increasing the risk of emergence of new SARS-CoV-2 variants. The Workgroup calls for rapid expansion of donation of COVID-19 vaccine to nations in need 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
- Tomás J. Aragón, MD, DrPH, California Department of Public Health and State Health Officer
- Oliver Brooks, MD, Watts Healthcare Corporation
- Eric Goosby, MD, UCSF School of Medicine (not present at October 21 2021 Western States Workgroup meeting)
- Rodney Hood, MD, UC San Diego Alumnus and National Medical Association (not present at October 21 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
- 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
- Ihsan Azzam, MD, Ph.D., Chief Medical Officer, State of Nevada
- Karissa Loper, MPH, Health Bureau Chief, Nevada Department of Health and Human Services
- Laura Byerly, MD, Virginia Garcia Memorial Health Center
- Louis J. Picker, MD, OHSU Vaccine and Gene Therapy Institute
- John Dunn, MD, MPH, Kaiser Permanente Washington
- Edgar K. Marcuse, MD, MPH, University of Washington School of Medicine