The CDC has officially signed off on COVID boosters for kids ages 5 to 11.

CDC Director Rochelle Walensky, MD, signed off Thursday evening on an advisory panel's recommendation that children ages 5 to 11 years should receive a Pfizer-BioNtech COVID vaccine booster dose at least 5 months after receiving their first shots.

The CDC Advisory Committee on Immunization Practices (ACIP) voted 11-1 Thursday afternoon, with one person abstaining, on a question about whether it recommended these additional shots in this age group.

The news comes after the FDA on May 17 amended the emergency use authorization (EUA) for the Pfizer COVID vaccine to cover a single booster dose for children ages 5 to 11.

At the request of CDC staff, ACIP members considered whether there should be a softer wording for this recommendation, stating that children in this age group “may” receive a booster. This kind of phrasing would better reflect uncertainty about the course of COVID in the months ahead and would allow flexibility for a stronger recommendation in the fall.

ACIP panellists and members of key groups argued strongly for a “should” recommendation, despite the uncertainties.

They also called for stronger efforts to make sure eligible children received their first COVID shots. Data from November to April show only 14.4% of children ages 5 to 11 in rural areas have received at least one dose of the COVID vaccine, with top rates of 39.8% in large urban communities and 36% in larger suburban regions, CDC staff said.

They also said nearly 40% of parents in rural areas reported that their children’s pediatricians did not recommend COVID vaccinations, compared with only 8% of parents in urban communities

“People will hear the word ‘m-a-y’ as ‘m-eh’,” said Patricia Stinchfield, RN, who served as the liaison for National Association of Pediatric Nurse Practitioners to ACIP. “I think we need to add urgency” to efforts to increase use of COVID vaccinations.

Voting no on Thursday was Helen Keipp Talbot, MD, of Vanderbilt University in Nashville, TN. She explained after the vote that she is in favor of having young children vaccinated but is concerned about the low rates of initial uptake of the COVID shots.

“Boosters are great once we’ve gotten everyone their first round,” she said. “That needs to be our priority in this.”

Sandra Fryhofer, MD, the American Medical Association's (AMA) liaison to ACIP, stressed the add-on benefits from more widespread vaccination of children against COVID. Fryhoner said she serves adults in her practice as an internal medicine doctor with many of her patients being at high risk for complications from COVID.

Too many people are assuming the spread of infections in the community have lessened the risk of the virus, Fryhofer said.

“Not everyone's had COVID yet and my patients will be likely to get COVID if their grandchildren get it. We're going through pandemic fatigue in this country,” she said. “Unfortunately, masks are now more off than on. Winter's coming. They're more variants” of the virus likely to emerge.

The data emerging so far suggested COVID vaccines will become a three-dose medicine, as is already accepted for other shots like hepatitis B vaccine, Fryhofer said.

Data to date show the vaccine decreases risk of hospitalization for COVID and for complications such as multisystem inflammatory syndrome in children (MIS-C), she said.

“The bottom line is children in this age group are getting COVID,” Fryhofer said of the 5- to 11-year-olds. “Some do fine. Some are getting real sick. Some are hospitalized, some have died.”

At Thursday’s meeting, CDC staff cited data from a paper published in the New England Journal of Medicine in March showing that vaccination had reduced the risk of hospitalization for COVID among children 5 to 11 years of age by two thirds during the Omicron period, and most children with serious COVID were unvaccinated.

COVID led to 66 deaths among children ages 5 to 11 in the October 2020 to October 2021 timeframe, said ACIP member Matthew F. Daley, MD, of Kaiser Permanente Colorado during a presentation to his fellow panel members.

Parents may underestimate children’s risk from COVID and hold off on vaccinations, stressed AMA President Gerald E. Harmon, MD, in a statement issued after the meeting.

“It is concerning that only 1 in 3 children between the ages of 5 and 11 in the United States have received two doses of the vaccine, in part because parents believe them to be at lower risk for severe disease than adults,” Harmon said. “But the Omicron variant brought about change that should alter that calculus.”

So far, about 18.1 million doses of Pfizer COVID vaccine have been administered to children ages 5 to 11 years in the U.S.