Just past midnight last night, the director of the Centers for Disease Control and Prevention overruled a committee of independent advisers, allowing for use of a Pfizer/BioNTech vaccine booster dose in people with increased risk of occupational and institutional exposure to the pandemic coronavirus. That includes health care workers, front-line workers, teachers, day care providers, grocery store workers, and people who work or live in prisons and homeless shelters, among others.

Hours earlier, the CDC's Advisory Committee on Immunization Practices (ACIP) concluded a two-day meeting on booster recommendations—and voted 9-6 against recommending boosters for this group.

"As CDC Director, it is my job to recognize where our actions can have the greatest impact," Director Rochelle 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."

She further noted that the inclusion of people at high risk of COVID-19 from occupational and institutional exposure "aligns with the FDA’s booster authorization." The Food and Drug Administration last Wednesday issued an amended Emergency Use Authorization for the Pfizer/BioNTech vaccine, which allowed booster doses for people 65 and older as well as people ages 18 to 64 who are at high risk of COVID-19 either from underlying medical conditions or occupational and institutional exposures.

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Though the CDC's advisory committee was torn over endorsing that use, they ultimately decided that the need was not there—vaccine effectiveness against severe disease and hospitalization remains very strong in those under age 65. And recommending boosters for anyone with a conceivable occupational or institutional risk could create a booster free-for-all.

By taking the unusual move to overrule the ACIP's decisions, Walensky puts the booster efforts more in line with the Biden administration's preliminary plans to offer booster doses to all vaccinated adults, starting this week.

Still, the current recommendations only apply to the Pfizer/BioNTech vaccine and those who received that vaccine for their two-dose "primary series." Those who initially received two doses of the Moderna COVID-19 vaccine or one shot of Johnson & Johnson's vaccine are advised to wait for further booster data and recommendations.

For now, here are the CDC's official recommendations of who should get a Pfizer/BioNTech vaccine booster—to be given at least six months after the primary Pfizer/BioNTech series. (Emphasis added by CDC).

• people 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
• people ages 50–64 years with underlying medical conditions should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
• people ages 18–49 years with underlying medical conditions may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks, and
• people ages 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.