Biden administration officials on Wednesday strongly recommended booster shots for Americans who received the Pfizer-BioNTech and Moderna coronavirus vaccines eight months after receiving their second doses, starting Sept. 20.
The officials made clear that booster shots will depend upon a determination by the Food and Drug Administration that third shots are safe and effective — a ruling expected in the coming weeks. And they offered reassurance that the vaccines continue to protect against severe disease and hospitalization.
But they said new data shows that vaccine efficacy against infection and mild disease wanes over time, and said they are concerned that the vaccines’ protection against serious disease could also decrease in coming months.
“Here’s what you need to know: If you are fully vaccinated, you still have a high degree of protection from the worst outcomes of Covid-19 — severe disease, hospitalization and death,” Dr. Vivek Murthy, the surgeon general, said at a White House briefing. “We are not recommending that you go out and get a booster today.”
The officials said data from a number of sources, including from the Israeli government, indicates that people will need a boost to their immunity starting this fall. Dr. Murthy said “there’s nothing magical” about the eight month timeline for allowing boosters, but said that was the best judgment of health experts.
First in line for extra shots will be health care workers, nursing home residents and other older adults, followed by the rest of the general population.
Officials cited the additional shots are needed because of dual trends: the growing evidence that the vaccines’ protection against virus infection fades over time, combined with the particular force of the Delta variant.
Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, cited one study that suggests that vaccine efficacy against the Delta variant decreased regardless of when people were inoculated. That suggests that the vaccines might work less well against Delta variant than against its predecessors, she said.
But she added that the latest data “confirm that while protection against infection may decrease over time, protection against severe disease and hospitalization is currently holding up pretty well.”
Dr. Anthony S. Fauci, an infectious disease expert at the National Institutes of Health, said studies show that third shots of the Moderna and Pfizer vaccines can boost the levels of antibodies that fight the virus ten-fold, an increase he called “dramatic.”
People who received the Johnson & Johnson vaccine may also require additional doses. But Johnson & Johnson’s vaccine was not rolled out until March, and a plan to provide boosters for those individuals will be made after reviewing new data expected over next few weeks, officials said. Only about 14 million Americans received the Johnson & Johnson vaccine, compared to about 150 million who have been fully vaccinated with either the Pfizer or Moderna vaccines.
Among other data, Dr. Walensky cited three studies, which the C.D.C. released on Wednesday, as evidence that booster shots of the two mRNA vaccines would be needed in the coming months.
One analyzed the effectiveness of vaccines among residents of nearly 4,000 nursing homes before the Delta variant’s U.S. emergence, and nearly 15,000 nursing homes when the variant dominated new infections in the country.
The vaccines’ effectiveness at preventing infections dropped from about 75 percent to 53 percent between those dates, the study found. It did not evaluate the vaccines’ protection against severe illness.
Some experts immediately pushed back against the booster strategy, saying only some older adults and people with weakened immune systems needed extra protection. Last week federal regulators cleared an additional dose for certain people with weakened immune systems who had already received the two-dose vaccines made by Pfizer-BioNTech or Moderna.
“These data support giving additional doses of vaccine to highly immunocompromised persons and nursing home residents, not to the general public,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center and a former adviser on the pandemic to the administration.
Boosters would only be warranted if the vaccines were failing to prevent people from ending up hospitalized with Covid-19, she said.
The World Health Organization has asked that wealthy countries defer distributing booster shots until the end of September, and reiterated earlier on Wednesday that they thought third shots for populations beyond a relatively small number of people with weakened immune systems were premature, and an ineffective use of the limited pool of available vaccines.
Dr. Tedros Adhanom Ghebreyesus, the director general of the W.H.O., said at a news conference before the White House’s briefing that the organization had brought together 2,000 experts from around the world to weigh the available data on boosters. The consensus was that protecting the unvaccinated before administering booster shots was critical, he said. He did praise the United States for donating many doses and encouraged other countries to follow the country’s example.
“Vaccine injustice is a shame on all humanity and if we don’t tackle it together, we will prolong the acute stage of this pandemic for years when it could be over in a matter of months,” he said.
Dr. Michael Ryan, the executive director of the W.H.O.’s health emergencies program, said booster programs at this point amounted to handing out “extra life jackets to people who already have life jackets, while we’re leaving other people to drown without a single life jacket.”
Jeff Zients, the White House pandemic coordinator, said at the White House briefing that the administration is on its way to donating more than 600 million doses of vaccines to other countries.
“We’re going to do both,” he said. “We’re going to both protect the American people and we’re going to do more and more to help vaccinate the world. ”
Before Americans can begin to receive boosters, the F.D.A. must first authorize third doses, and an advisory committee of the C.D.C. must review the evidence and make recommendations.
Daniel E. Slotnik contributed reporting.
The Centers for Disease Control and Prevention released three studies on Wednesday that federal officials said provided evidence that booster shots of the Pfizer-BioNTech and Moderna coronavirus vaccines would be needed by all Americans in the coming months.
But some experts said the new research did not support the decision to recommend booster shots for all Americans.
Taken together, the studies show that although the vaccines remain highly effective against hospitalizations, the bulwark they provide against infection with the virus has weakened in the past few months.
It’s unclear whether the decline in protection against infection is the result of waning immunity, a drop in precautions like wearing masks, or the rise of the highly contagious Delta variant — or a combination of all three.
“We are concerned that this pattern of decline we are seeing will continue in the months ahead, which could lead to reduced protection against severe disease, hospitalization and death,” Dr. Vivek Murthy, the surgeon general, said at a White House news briefing on Wednesday.
Citing the data, federal health officials outlined a plan for Americans who received the two vaccines to get booster shots eight months after receiving their second doses, starting Sept. 20.
Some scientists were deeply skeptical of the new plan.
“These data support giving additional doses of vaccine to highly immunocompromised persons and nursing home residents, not to the general public,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center and a former adviser on the pandemic to the administration.
Boosters would only be warranted if the vaccines were failing to prevent people from ending up hospitalized with Covid-19, she said.
“Feeling sick like a dog and laid up in bed, but not in the hospital with severe Covid, is not a good enough reason,” Dr. Gounder said. “We’ll be better protected by vaccinating the unvaccinated here and around the world.”
It’s unclear whether a third dose would help people who did not produce a robust response to the first two doses, said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.
The recommendation for boosters may also end up undermining confidence in vaccines, he warned: “A third shot will add to skepticism among people yet to receive one dose that the vaccines help them.”
Together, the new studies indicate overall that vaccines have an effectiveness of roughly 55 percent against infections, 80 percent against symptomatic infection, and 90 percent or higher against hospitalization, noted Ellie Murray, an epidemiologist at Boston University.
“Those numbers are actually very good,” Dr. Murray said. “The only group that these data would suggest boosters for, to me, is the immunocompromised.”
The drop in protection against infection could be the result of increased exposure to a highly contagious variant during a period of unfettered social interactions, she added: “This seems to me like a real possibility, since many early vaccinated were motivated by a desire to see friends and family and get back to normal.”
Dr. Murray said boosters would undoubtedly boost immunity in an individual, but the benefit may be minimal — and obtained just as easily by wearing a mask, or avoiding indoor dining and crowded bars.
The administration’s emphasis on vaccines has undermined the importance of building other precautions into people’s lives in ways that are comfortable and sustainable, and on building capacity for testing, she and other experts said.
“This is part of why I think the administration’s focus on vaccines is so damaging to morale,” she added. “We probably won’t be going back to normal anytime soon.”
Before people can begin to receive boosters, the Food and Drug Administration must first authorize a third dose of the mRNA vaccines made by Pfizer-BioNTech and Moderna, and an advisory committee of the C.D.C. must review the evidence and make recommendations.
One of the new C.D.C. studies analyzed the effectiveness of vaccines among residents of nearly 4,000 nursing homes from March 1 to May 9, before the Delta variant’s emergence, and nearly 15,000 nursing homes from June 21 to Aug. 1, when the variant dominated new infections in the country.
The vaccines’ effectiveness at preventing infections dropped from about 75 percent to 53 percent between those dates, the study found. It did not evaluate the vaccines’ protection against severe illness.
Nursing homes were required to report the number of immunized residents only after June 6, which “makes comparisons over time very challenging,” Dr. Murray said. “It’s fully possible that the vaccine effectiveness reported here hasn’t actually declined over time.”
The decline in effectiveness also could have resulted from the spread of the Delta variant, Dr. Gounder said.
“It makes sense to give an extra dose of vaccine to vaccinated nursing home residents, but what will have an even bigger impact on protecting those nursing home residents is to vaccinate their caregivers,” she said. Many heath aides in long-term care facilities remain unvaccinated.
A second study evaluated data from New York State from May 3 to July 25, when the Delta variant grew to represent more than 80 percent of new cases. The effectiveness of vaccines in preventing cases in adults declined from 91.7 percent to 79.8 percent during that time, the study found. But the vaccines remained just as effective at preventing hospitalizations.
During those weeks, New York recorded 9,675 breakthrough infections — roughly 20 percent of total cases in the state — and 1,271 hospitalizations in vaccinated people, which accounted for 15 percent of all Covid-19 hospitalizations.
Although fully immunized people of all ages got infected with the virus, vaccine effectiveness showed the sharpest drop, from 90.6 percent to 74.6 percent, in people aged 18 through 49 years — who are often the least likely to take precautions and the most likely to socialize.
Data from Israel has suggested that immunity against infection has waned in vaccinated adults who are 65 or older. But in the New York data, the effectiveness of the vaccines in that group barely budged.
Adults ages 65 or older were more likely to be hospitalized than other age groups, regardless of vaccination status. But the vaccines did not show a decline in effectiveness against hospitalizations in any of the age groups.
The third study from the C.D.C. found that the vaccines showed 90 percent effectiveness against hospitalizations in the country, “which is excellent,” Dr. Gounder noted.
The vaccines were less protective against hospitalization in immunocompromised people. “But not all immunocompromised persons will respond to an additional dose of vaccine,” Dr. Gounder noted.
To protect these vulnerable individuals, everyone around them should be vaccinated and should continue to wear masks, she added.
The vaccines may appear to be less effective than they did in the clinical trials because the trials were conducted before the emergence of the highly contagious Delta variant. The vaccines can also seem to lose effectiveness as more unvaccinated people become infected with the virus and gain natural immunity.
If preventing infection is the goal, it would be wiser to offer a booster of a nasal spray vaccine, which is better at inducing immunity in the nose and throat, where the virus enters, Dr. Gounder said.
Gov. Greg Abbott of Texas tested positive for the coronavirus on Tuesday and is receiving an antibody treatment, though he has no symptoms, the governor’s office announced.
An ardent opponent of mask and vaccine mandates, Mr. Abbott, a Republican, has taken his opposition to such requirements all the way to the State Supreme Court. Mr. Abbott, who is fully vaccinated, will now be isolated in the Governor’s Mansion while receiving monoclonal antibody treatment, which can help patients who are at risk of getting very sick.
“The governor has been testing daily, and today was the first positive test result,” the statement said. “Governor Abbott is in constant communication with his staff, agency heads, and government.”
The announcement came less than a day after Mr. Abbott appeared at a crowded indoor political event hosted by a Republican club in Collin County, a hotly contested area of the fast-growing suburbs north of Dallas.
In the images and in videos posted by the governor’s campaign, Mr. Abbott could be seen smiling and shaking hands with supporters who were largely unmasked. “Collin County is fired up to keep Texas RED,” the governor’s campaign posted.
According to the The Houston Chronicle, Mr. Abbott told those gathered that masks were optional — a stance that he has taken across Texas even as cases have risen sharply and some hospitals are filling to at or near capacity. The governor’s office did not respond to questions about the event.
At least 10 other sitting governors — four Democrats and six Republicans — have contracted the virus since the pandemic began, according to reports compiled by Ballotpedia, a political information site. So have four lieutenant governors, all Republicans.
Vaccination rates in Texas lag those of many other U.S. states, and deaths are rising, though far more slowly than in prior waves, given that a majority of the state’s oldest and most vulnerable residents are now vaccinated. The state has averaged more than 15,000 new cases a day as of Tuesday, up from an average of more than 10,000 cases a day two weeks earlier, according to a New York Times database.
Mr. Abbott, 63, has faced criticism as available intensive-care beds have dwindled in Austin and in other cities. But he maintained his ban on mask mandates, which prohibits local officials from imposing restrictions in their communities.
Fear and frustration over the course of the pandemic in Texas, the nation’s second-most populous state, come as schools were preparing to reopen, raising worries about further spread of the virus.
Last month, the Centers for Disease Control and Prevention issued new guidance recommending that even fully vaccinated people should wear a mask indoors in high-risk areas and that everyone should wear one in schools, regardless of vaccination status. Mr. Abbott, though, doubled down in the opposite direction. He issued an executive order that stopped local governments and state agencies from mandating vaccines and reaffirmed decisions to prohibit officials from requiring that students wear masks.
Across the United States, most counties are experiencing either “substantial” or “high” transmission, according to the C.D.C.
Last week, after Mr. Abbott’s ban suffered at least three legal setbacks, the state attorney general, Ken Paxton, said that he was taking the issue to the State Supreme Court. The setbacks were in areas with Democratic leaders, rampant cases and rising hospitalizations.
The State Supreme Court sided with the state on Sunday, ruling that schools could not make masks mandatory.
Because of an editing error, an earlier version of this item referred incorrectly to guidance recently issued by the Centers for Disease Control and Prevention. The guidance said that everyone, including fully vaccinated people, should wear masks in public indoor settings, not that the fully vaccinated did not need to do so.
Since Americans first began rolling up their sleeves for coronavirus vaccines, health officials have said that those who are immunized are very unlikely to become infected, or to suffer serious illness or death. But preliminary data from seven states hint that the arrival of the Delta variant in July may have altered the calculus.
Breakthrough infections in vaccinated people accounted for at least one in five newly diagnosed cases in six of those states and higher percentages of total hospitalizations and deaths than had been previously observed in all of them, according to figures gathered by The New York Times.
The absolute numbers remain very low, however, and there is little doubt that the vaccines remain powerfully protective. This continues to be “a pandemic of the unvaccinated,” as federal health officials have often said.
Still, the trend marks a change in how vaccinated Americans might regard their risks.
“Remember when the early vaccine studies came out, it was like nobody gets hospitalized, nobody dies,” said Dr. Robert Wachter, chairman of the department of medicine at the University of California, San Francisco. “That clearly is not true.”
The figures lend support to the view, widely held by officials in the Biden administration, that some Americans may benefit from booster shots in the coming months. Federal officials plan to authorize additional shots as early as mid-September, although it is not clear who will receive them.
“If the chances of a breakthrough infection have gone up considerably, and I think the evidence is clear that they have, and the level of protection against severe illness is no longer as robust as it was, I think the case for boosters goes up pretty quickly,” Dr. Wachter said.
The seven states — California, Colorado, Massachusetts, Oregon, Utah, Vermont and Virginia — were examined because they are keeping the most detailed data. It is not certain that the trends in those states hold throughout the United States.
In any event, scientists have always expected that as the population of vaccinated people grows, they will be represented more frequently in tallies of the severely ill and dead.
“We don’t want to dilute the message that the vaccine is tremendously successful and protective, more so than we ever hoped initially,” said Dr. Scott Dryden-Peterson, an infectious disease physician and epidemiologist at Brigham & Women’s Hospital in Boston.
“The fact that we’re seeing breakthrough cases and breakthrough hospitalizations and deaths doesn’t diminish that it still saves many people’s lives.”
The C.D.C. declined to comment on the states’ numbers. The agency is expected to discuss breakthrough infections, hospitalizations and vaccine efficacy at a news briefing on Wednesday.
Most analyses of breakthrough infections have included figures collected through the end of June. Based on the cumulative figures, the C.D.C. and public health experts had concluded that breakthrough infections were extremely rare, and that vaccinated people were highly unlikely to become severely ill.
The states’ data do affirm that vaccinated people are far less likely to become severely ill or to die from Covid-19.
A group of small businesses is suing New York City, hoping to stop the city’s first-in-the-nation vaccine mandate for restaurants, gyms and other indoor public venues.
The lawsuit, filed on Tuesday in Richmond County Supreme Court, has the support of prominent Republican elected officials, including Representative Nicole Malliotakis and Joe Borelli, a City Council member; both represent Staten Island.
The city is requiring patrons and employees of restaurants and certain other businesses to show proof of vaccination. The plaintiffs say the city is unfairly targeting businesses that are struggling during the pandemic, and that there should be exemptions for people with certain medical conditions or religious beliefs.
Mayor Bill de Blasio has argued that the vaccine mandate and other measures are needed to curtail a troubling rise in coronavirus cases, driven in part by the more contagious Delta variant, and to encourage more New Yorkers to get vaccinated. New cases in the city have surged to an average of more than 1,700 a day, from about 250 a day in early July. About 68 percent of adult residents in the city are fully vaccinated.
The city’s vaccine mandate took effect on Tuesday, and applies to a variety of businesses.
“The executive order has rendered it impossible for anyone who chooses not to be vaccinated, for whatever reason, to work in the designated industries, wholly depriving them of their livelihood,” the lawsuit says.
Andrew Giuliani, a Republican who is running for governor, said he supported the lawsuit and that businesses should be able to set their own rules.
I applaud the Independent Restaurant Owners Association lawsuit again de Blasio’s vaccine mandates!
Every private business and their customers should choose the terms of their patronage, NOT government and certainly not the incompetent de Blasio! https://t.co/Ndh1FUDkyr
— Andrew H. Giuliani (@AndrewHGiuliani) August 18, 2021
The plaintiffs include Deluca’s Italian Restaurant in Staten Island, Pasticceria Rocco in Brooklyn and Staten Island Judo Jujitsu.
New York City’s mandate is similar to one approved in France last month that prompted large protests. Enforcement by city health officials will not start in New York until Sept. 13, the day when the city’s public schools are expected to reopen.
The lawsuit argues that the mandate unfairly applies to restaurants but not other indoor locations like hair salons, office buildings or houses of worship. Republicans also say the rules are too challenging for small businesses to enforce.
“It is beyond ridiculous that the government is mandating these already struggling small business owners to be the city’s ‘vaccine police,’” Ms. Malliotakis said in a statement.
Mr. de Blasio said on Wednesday that he was confident that his executive order would withstand a legal challenge.
“I’ve had the conversation with the Law Department — tremendous confidence that we’re in a very strong legal position,” Mr. de Blasio said. “We’re in a global pandemic still. The decisions that have been taken have been taken with the leadership of our health officials who have been fighting this battle from the beginning.”
Global Roundup
Getting vaccinated against Covid-19 is “an act of love,” Pope Francis says in a public service ad started circulating online and on television on Wednesday.
The ad shows the pope, speaking in Spanish with English subtitles, with church officials from Brazil, Mexico, the United States and other countries describing vaccination as a moral responsibility.
“Thanks to God’s grace and to the work of many, we now have vaccines to protect us from Covid-19,” the pope says in the ad, which was produced with the Ad Council, an American nonprofit.
In centers of faith, efforts to counter vaccine hesitancy have often been fraught.
Many religious Americans who are hesitant have told researchers that faith-based arguments could persuade them to get the shot.
Pastors in Black communities, where congregants skeptical of the Covid-19 vaccines cite a history of medical mistreatment, have publicly rolled up their sleeves to get inoculated. Orthodox Jewish rabbis have taken to YouTube and Zoom to endorse vaccination. During the Islamic holy month of Ramadan, Muslim groups issued statements emphasizing that the shots were halal, or permissible to use.
Still, the message from some religious leaders has struggled to counter vaccine misinformation. On WhatsApp, recordings of rabbis making unproven claims about the vaccines’ effects on fertility have circulated among Orthodox Jewish communities. And on Instagram, TikTok and YouTube, some churches and Christian influencers have spread conspiracy theories linking vaccines to microchips or blaming those who get a shot for not trusting God’s will.
In other news around the world:
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Japan announced late Tuesday that it was extending a state of emergency in Tokyo and Osaka and expanding it to seven additional prefectures as the country struggles to bring under control its worst outbreak of the pandemic. Nearly 20,000 new cases and 47 deaths were documented in Japan on Tuesday, with Osaka hitting a daily record of 1,856 cases and Tokyo reporting 4,377. The extension of the state of emergency in the capital, which had been scheduled to end on Aug. 31, means that the entire Paralympics, which start on Tuesday, will be held under the emergency declaration.
The summer is supposed to be the quietest part of the school year. But not this time.
As summer fades into fall, many of the major issues dividing the country — masks, transgender rights, critical race theory — have dropped like an anvil on U.S. schools.
Schools were already facing a crisis of historic proportions. They must reopen just as a highly contagious Delta variant of the coronavirus is tearing through communities.
And for many of the country’s 56 million schoolchildren, it has been a year of lost learning and widening inequities.
But at this critical moment, many school officials find themselves engulfed in highly partisan battles. The tense environment comes amid a growing movement to recall school board officials, over everything from teachings on race to school closures. Nationwide, there have been at least 58 recall efforts targeting more than 140 officials so far this year, more than the previous two years combined, according to Ballotpedia.
As a superintendent in Albany, Ore., Melissa Goff first noticed pushback when her district closed classrooms during the pandemic, and a slate of candidates ran for school board largely on a platform to open schools.
But by the time students returned this spring, a new flash point had emerged: Should police officers welcome students back to campus? Though it was a local tradition, some parents said that their children, sensitive after a year of Black Lives Matter protests, felt afraid.
Then, in May, Ms. Goff said, she came under fire for a plan to hold vaccine clinics at local high schools. Though she said the clinics were intended to reach families without much access to health care, Ms. Goff said that some people had seen the effort as “making kids get vaccines.”
As the highly contagious Delta variant fuels a rise in cases around the United States, more indoor mask mandates are returning or being extended: for Chicagoans, New Mexicans and, now until next year, anyone in the country using public transportation or visiting an airport.
Chicago and New Mexico’s mandates, which apply regardless of vaccination status, begin on Friday.
The new rules, announced on Tuesday, come after the Centers for Disease Control and Prevention recommended last month that everyone in communities with growing caseloads wear masks indoors regardless of vaccination status.
Officials said the mask requirements were needed to help stop the spread of the virus. Over the past week, the United States has been reporting about 139,800 new coronavirus cases each day on average, an increase of 52 percent from two weeks ago. The number of new deaths reported is up 87 percent, to an average of 696 deaths per day.
Hawaii, Louisiana, Oregon and Puerto Rico have also implemented indoor mask mandates, as have San Francisco and Washington, D.C.
Though cases have risen eightfold in Cook County, which includes Chicago, since early July, the outlook remains far better than in much of the rest of the country. On a per-capita basis, Cook County is averaging fewer than half as many new cases as the country as a whole. An average of 17 cases per 100,000 residents is emerging each day in Cook County, compared to 43 cases per 100,000 people nationally and 138 cases per 100,000 people in Florida.
Chicago’s new mask mandate extends to bars and restaurants, clubs and common areas of residential buildings, according to the department of health.
Dr. Allison Arwady, Chicago’s health commissioner, said, “I don’t expect that this will be an indefinite, forever mask requirement.”
In New Mexico, Gov. Michelle Lujan Grisham said on Tuesday that masks would be required in all public indoor places starting on Friday and continuing until at least Sept. 15.
New Mexico had previously dropped its mask mandate for people who were fully vaccinated, the Las Cruces Sun-News reported.
“This surge is a terrifying indicator of moving absolutely in the wrong direction,” Ms. Lujan Grisham said at a news conference. “We’re in a terrible place for health care services and for protecting our health care workers.”
Ms. Lujan Grisham also announced that teachers and all workers at public, private and charter schools in the state would have to be vaccinated or face regular testing. That mandate goes into effect on Monday.
The Transportation Security Administration said on Tuesday that it was extending its mask mandate for airports, airplanes and public transportation in the United States through Jan. 18, 2022. Travelers under the age of 2 and those with certain disabilities are exempt, Sari Koshetz, a spokeswoman for the agency, said.
Requiring masks has become a hot-button political issue, and Republican governors like Ron DeSantis of Florida and Greg Abbott of Texas have banned local governments and school districts in their states from imposing mask mandates.
That has not stopped districts in those states from trying, and legal battles about the requirements are still playing out.
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