The director of the Centers for Disease Control and Prevention endorsed the use of Pfizer and BioNTech’s Covid-19 booster shot for workers at high risk of severe Covid-19, taking the rare step of overruling her agency’s own advisers.

The CDC’s independent vaccine advisory panel said on Thursday afternoon that the booster should be given to people 65 and older and nursing-home residents, along with people between 18 and 64 with underlying health conditions that raise their chances of severe Covid-19.

But the group, the Advisory Committee on Immunization Practices, voted against allowing the booster for those at risk because of on-the-job exposure, such as for health care workers and teachers — breaking with the Food and Drug Administration’s decision Wednesday to allow the booster for people with high-risk jobs.

CDC Director Rochelle Walensky’s decision to overrule the advisers, announced just before 1 a.m. on Friday, allows the Biden administration to expand use of the Pfizer-BioNTech booster, but falls far short of the broad rollout the White House laid out last month. The Biden team had initially aimed to begin administering Pfizer-BioNTech and Moderna boosters to most adults beginning this week, but critics in and out of the administration argued that available vaccine safety and efficacy data only justified boosters for a small slice of the adult population.

Walensky nodded to that ongoing controversy, and her unusual decision to contradict CDC’s vaccine advisory panel, in a statement on Friday.

"It is my job to recognize where our actions can have the greatest impact," she said. "In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good."

Walensky also noted that her action aligned the CDC’s recommendations for booster use with the FDA authorization, and added that the agency "will address, with the same sense of urgency," the use of Covid-19 boosters made by Moderna and Johnson & Johnson.

Moderna submitted its application for a booster shot earlier this month. Johnson & Johnson has begun submitting data on the efficacy of its booster but has not yet submitted an application.

"Walensky did the right thing," said Leana Wen, an emergency physician and public health professor at George Washington University. "ACIP came out with a shocking poor recommendation that failed the common sense test. Are we really going to deny an additional level of protection to frontline workers, many of whom got vaccinated eight to nine months ago? It makes much more sense to recommend boosters to those who clearly will benefit."

Celine Gounder, an infectious disease specialist and epidemiologist at NYU and Bellevue Hospital, said the evidence for boosters based on occupation was mixed — but there were still valid reasons to move forward with such a plan.

"Are you doing it to protect the health of the individual in those occupations or are you doing it to keep it on the job?" said Gounder, who has advised the Biden administration on Covid-19 response. "If you are asking the former, I agree with ACIP. There isn’t enough data. If you are asking the latter, if you think about health care setting for example … you’re not allowed to go to work if you have a breakthrough infection because you pose a risk to patients."

If enough health care workers in a given facility develop breakthrough infections simultaneously, that can hurt staffing levels, she said. "It’s the same thing with teachers. That is the reason to vaccinate people in those professions because it is not just for them," Gounder added.

The CDC director’s decision is the latest twist in the administration’s ongoing booster rollout. The FDA’s own vaccine advisory committee quashed the administration’s proposal for a widespread booster rollout last week when its members voted overwhelmingly against offering an additional dose of the Pfizer-BioNTech shot to people 16 and older.

Instead, the FDA panel said the booster should be permitted for people 65 and older and those at high risk of severe Covid-19 because of underlying health conditions. The panel also unofficially backed the use of the shot for people whose jobs increased their risk.

But the weeks of intense debate in and out of the administration about how far to expand the booster rollout may be for naught. Walensky’s decision allows people to "self-attest" to their eligibility for the Pfizer-BioNTech booster, rather than providing proof such as a doctor’s note. That, plus the fact that much of the population has at least one health condition that elevates their risk of severe disease, could allow millions of people to seek boosters as of Friday.

Erin Banco contributed to this report.

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