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National Center for Immunization and Respiratory Diseases
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Evidence to Recommendations Framework:
Additional Dose of 2023-2024 Formula COVID -19 Vaccine in Older Adults
Megan Wallace, DrPH, MPH
ACIP Meeting February 28, 2024
Should persons ages 65 years and older be recommended for an additional dose of
2023- 2024 Formula COVID -19 vaccine?
–Additional dose should be at least 4 months after previous updated (2023 -2024)
COVID -19 vaccine dose.
Authorized and approved 2023 -2024 Formula COVID -19 vaccines:
–Moderna COVID -19 vaccine
–Novavax COVID -19 vaccine
–Pfizer -BioNTech COVID -19 vaccineEvidence to Recommendations (EtR) Framework
Policy Question
2
3Timeline of additional dose recommendations
Sept – Nov 2021 COVID -19 vaccine
booster doses
recommended
for persons ages
≥18 years
May 2022 Additional COVID -19
vaccine booster dose
recommended for
persons ages ≥50 years
(should recommendation)
Sept – Oct 2022 Bivalent COVID -19
vaccine dose
recommended for
persons ages ≥5
years
April 2023 Optional additional
bivalent COVID -19
vaccine dose
recommended for
persons ages ≥65 years
(may recommendation)
Sept 20232023- 2024 COVID -
19 vaccine doses
recommended for
persons ages ≥6
months
People who are moderately or severely immunocompromised:
Have the option to receive 1 additional dose of updated (2023 -2024 Formula) COVID -
19 Vaccine at least 2 months following the last recommended updated (2023 -2024
Formula) COVID -19 vaccine dose.
Further additional dose(s) may be administered, informed by the clinical judgement of
a healthcare provider and personal preference and circumstances. Any further additional doses should be administered at least 2 months after the last updated (2023- 2024 Formula) COVID -19 vaccine dose.Current recommendations for additional doses of updated
(2023 -2024 Formula) COVID- 19 vaccine
Note: Children aged 6 months –4 years need multiple doses of COVID -19 vaccines to be up to date, including at least 1 dose of updated COVID -19 vaccine. 4
EtR Domain:
Public Health Problem
66Weekly number of COVID -19 hospitalizations, United States,
January 1, 2023 – February 17, 2024
CDC COVID Data Tracker. National Healthcare Safety Network (NHSN). https://covid.cdc.gov/covid -data -tracker/#trends_weeklyhospitaladmissions_select_00 . Accessed February
23, 2024
77Weekly population -based rates of COVID -19-associated
hospitalizations, by age group — COVID -NET , January 1, 2023 –
February 24, 2024
Dashed lines indicate potential reporting delays and interpretation of trends should exclude these weeks.
CDC COVID Data Tracker. https://covid.cdc.gov/covid -data -tracker/#covidnet -hospitalization -network . Accessed February 23, 2024
88Weekly population- based rates of COVID -19-associated
hospitalization among adults ages ≥65 years, by age group—
COVID -NET, January 1, 2023 – January 27, 2024
Thin dashed lines on the far right indicate potential reporting delays and interpretation of trends should exclude these week s.
CDC COVID Data Tracker. https://covid.cdc.gov/covid -data -tracker/#covidnet -hospitalization -network . Accessed February 6, 2024
99Weekly number of provisional COVID -19 deaths reported to
CDC, United States, January 1, 2023 – February 17, 2024
The most recent 3 weeks of mortality counts are shaded grey because NVSS reporting is <95% during this period.
Provisional data are non -final counts of deaths based on reported mortality data in NVSS. Deaths include those with COVID- 19, coded as ICD– 10 code U07.1, on the death certificate.
Death data are displayed by date of death (event).
CDC COVID Data Tracker. National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS). https://covid.cdc.gov/covid- data -tracker/#trends_weeklydeaths_select_00 .
Accessed February 23, 2024
1010Monthly rates of provisional COVID -19 deaths by age group,
United States, January 1, 2023 – January 31, 2024
Provisional data are non -final counts of deaths based on reported mortality data in NVSS. Deaths include those with COVID- 19, coded as ICD– 10 code U07.1, on the death certificate.
Death data are displayed by date of death (event).
Source: Provisional data from the CDC’s National Center for Health Statistics (NCHS) National Vital Statistic System (NVSS); CDC COVID Data Tracker. https://covid.cdc.gov/covid- data -
tracker/#demographicsovertime . Accessed February 23, 2024
1111Weighted U.S. SARS -CoV-2 seroprevalence by vaccine and
infection history and age, based on blood donations
Seroprevalence definition: The percentage of people with antibodies against a virus in their blood is known as seroprevalence .
Methodology available at https://covid.cdc.gov/covid- data -tracker/#nationwide -blood -donor -seroprevalence -2022 9
14
2635
26
1454
59
581
2
2
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%30 to 49 years
50 to 64 years
65 years and olderJuly 1st – September 30th, 2023
Vaccination-only seroprevalence Infection-only seroprevalence
Hybrid Immunity Neither past infection nor vaccination
1212Pool of naïve T cells diminishes with age
Source: de Candia P , Prattichizzo F, Garavelli S, Matarese G. T Cells: Warriors of SARS- CoV-2 Infection. Trends Immunol. 2021 Jan;42(1):18- 30. doi: 10.1016/j.it.2020.11.002.
Epub 2020 Nov 13. PMID: 33277181; PMCID: PMC7664351Immunosenescence refers to age-associated immune decline that may result in an inefficient immune response to
novel antigens and an inability to develop proper immunity against infections and upon vaccination.
1313Adaptive immunity includes cellular and humoral responses
Source: Rey, Gertrud. T Cell Responses to Coronavirus Infection are Complicated. https://www.virology.ws/2020/11/05/t -cell-responses -to-coronavirus -infection -are-complicated/Insufficient pools of naïve T
cells impacts ability to generate:
•Neutralizing antibody responses
•Cytotoxic T cells
1414Weekly percent of tests positive for COVID -19, Influenza, and
RSV, United States, October 1, 2022 – February 17, 2024
Preliminary data are shaded in gray.
Sources: COVID -19 and RSV: National Respiratory and Enteric Virus Surveillance System (NREVSS), a sentinel network of laboratori es located through the US, includes clinical, public health
and commercial laboratories; additional information available at: https://www.cdc.gov/surveillance/nrevss/index.html. Influen za: Clinical laboratory test results from NREVSS and U.S. World
Health Organization collaborating laboratories; more details about influenza virologic surveillance are available here: https:// www.cdc.gov/flu/weekly/overview.htm.
CDC Respiratory Virus Activity Levels. https://www.cdc.gov/respiratory -viruses/data -research/dashboard/activity -levels.html . Accessed February 6, 2024
1515
Weekly hospitalization rate per 100,000 population, United
States, October 1, 2022 – February 17, 2024
Preliminary data are shaded in gray.
Dashed line represents the nadir for COVID- 19 hospitalization rates.
CDC Respiratory Virus Activity Levels. National Healthcare Safety Network. https://www.cdc.gov/respiratory -viruses/data -research/dashboard/illness -severity.html. Accessed
February 23, 2024
Domain Equity Question:
Does the problem impact all populations equally?
1717Age-adjusted cumulative COVID -19 hospitalizations per 100,000
population by race and ethnicity — COVID -NET , October 2022 –
September 2023
CDC COVID Data Tracker. https://covid.cdc.gov/covid -data -tracker/#covidnet -hospitalization -network . Accessed February 23, 2024
1818Number of chronic conditions by age among Asian, Black, Latino/Hispanic,
and White adults in the National Health Interview Survey, 1999 to 2018
Source: Caraballo C, Herrin J,
Mahajan S, et al. Temporal Trends in
Racial and Ethnic Disparities in Multimorbidity Prevalence in the United States, 1999 -2018. Am J Med .
2022;135(9):1083- 1092.e14.
doi:10.1016/j.amjmed.2022.04.010
COVID -19 hospitalizations peaked in late December/early January, however there are still
approximately 20,000 new hospital admissions and 2,000 deaths due to COVID -19 each week.
Persons ages ≥65 years have the highest COVID -19 hospitalization rates.
–Hospitalization rates within this age group increase with increasing age.
Persons ages ≥75 years have the highest COVID -19 mortality rates.
Immunosenescence and higher prevalence of vaccine-only immunity in older adults compared
to younger adults suggest that more frequent doses may be needed to maintain protection in
this population.
While there are increases in COVID -19 during respiratory virus season, COVID -19
hospitalizations and deaths continue throughout the year due to ongoing circulation of SARS -
CoV-2.
Inequities in COVID -19 hospitalizations by race and ethnicity continue and should be
considered in the context of an age-based recommendation.Summary
Public Health Problem
19
Public Health Problem
Work Group Interpretation
Is COVID -19 disease among persons ages 65 years and older of public health
importance?
oNooProbably no oProbably yes oYesoVaries oDon’t know
EtR Domain:
Benefits and Harms
Updated (2023- 2024) COVID -19 vaccination provided increased protection against
symptomatic SARS- CoV- 2 infection and COVID -19-associated ED/UC visits and
hospitalizations compared to no updated vaccine dose.
Receipt of updated (2023 -2024) COVID -19 vaccine provides protection against JN.1 and
other circulating variants.
These early vaccine effectiveness estimates show no substantial waning; however,
waning is expected.2023 -2024 Formula COVID- 19 vaccine effectiveness
ED: Emergency department | UC: Urgent care 22
23VISION: Absolute VE of original monovalent and bivalent booster doses
against hospitalization among immuno competent adults, by age group –
September 2022 – August 2023
VE estimates adjusted for age, sex, race and ethnicity, geographic region, and calendar time. Updated from: Link -Gelles et al., MMWR, https://www.cdc.gov/mmwr/volumes/72/wr/mm7221a3.htm
* These estimates are imprecise, which might be due to there being a relatively small number of persons in each level of vacc ination or case status. This imprecision indicates that the actual VE
could be substantially different from the point estimate shown, and estimates should therefore be interpreted with caution. A dditional data accrual could increase precision and allow more precise
interpretation.mRNA Dosage PatternTotal
testsSARS -CoV -2-
test -positive,
N (%)Median interval
since last dose,
days (IQR)Adjusted VE
(95% CI)
18-64 years
Unvaccinated (ref) 13,089 803 (6) -- Ref
Original monovalent doses only 19,799 1,129 (6) 455 (333 -575) 15 (6 to 23)
Bivalent booster, 7 -59 days earlier 1,208 45 (4) 33 (21 -45) 61 (46 to 71)
Bivalent booster, 60- 119 days earlier 1,248 87 (7) 87 (73 -102) 15 (-8 to 33)
Bivalent booster, 120- 179 days earlier 1,075 59 (6) 147 (134 -163) -1 (-35 to 24)*
≥65 years
Unvaccinated (ref) 12,015 1,688 (14) -- Ref
Original monovalent doses only 37,001 4,216 (11) 402 (288 -555) 25 (20 -30)
Bivalent booster, 7 -59 days earlier 4,607 328 (7) 35 (21- 48) 67 (62 -71)
Bivalent booster, 60- 119 days earlier 5,252 490 (9) 88 (73 -104) 53 (48 -58)
Bivalent booster, 120- 179 days earlier 4,482 415 (9) 149 (134 -164) 28 (18 -36)
-40 -20 0 20 40 60 80 100
Vaccine Effectiveness (%)
24VISION: Absolute VE of original monovalent and bivalent booster doses
against hospitalization and critical illness among immuno competent adults
aged ≥18 years – September 2022 – August 2023
Critical illness defined as admission to intensive care unit or death; case -patients were persons admitted to ICU or who experie nced death associated with COVID -19, and control
patients were persons hospitalized without COVID -19. VE estimates adjusted for age, sex, race and ethnicity, geographic region, and calendar time. Updated from: Link -Gelles et
al., MMWR, https://www.cdc.gov/mmwr/volumes/72/wr/mm7221a3.htm mRNA Dosage PatternTotal
testsSARS -CoV -2-
test -positive,
N (%)Median interval
since last dose,
days (IQR)Adjusted VE
(95% CI)
Hospitalization
Unvaccinated (ref) 25,104 2,491 (10) -- Ref
Original monovalent doses only 56,800 5,345 (9) 420 (306 -563) 22 (17- 26)
Bivalent booster, 7 -59 days earlier 5,815 373 (6) 34 (21 -47) 65 (61 -69)
Bivalent booster, 60- 119 days earlier 6,500 577 (9) 87 (73 -103) 48 (42 -53)
Bivalent booster, 120- 179 days earlier 5,557 474 (9) 149 (134 -164) 22 (13- 30)
Critical illness
Unvaccinated (ref) 23,140 527 (2) -- Ref
Original monovalent doses only 52,352 897 (2) 422 (306 -564) 32 (23- 40)
Bivalent booster, 7 -59 days earlier 5,504 62 (1) 34 (21 -47) 69 (59 -77)
Bivalent booster, 60- 119 days earlier 6,023 100 (2) 87 (73 -103) 50 (36 -60)
Bivalent booster, 120- 179 days earlier 5,144 61 (1) 149 (134 -164) 46 (28 -60)
-20 0 20 40 60 80 100
Vaccine Effectiveness (%)
No clinical trial immunogenicity data of an additional dose of 2023 -2024 COVID -19 vaccine.
Initial dose of 2023 -2024 COVID -19 vaccine elicits robust neutralizing antibodies and provides
protection against JN.1 and other circulating variants.1,2
Effectiveness of an additional dose in older adults has been demonstrated by past additional
doses
–Among adults aged ≥50 years eligible to receive a second original monovalent mRNA COVID- 19
vaccine booster dose, VE for COVID- 19–associated ED/UC encounters during the BA.2/BA.2.12.1
period was 32% at ≥120 days after the third dose but increased to 66% ≥7 days after the fourth dose.
VE against COVID -19–associated hospitalization was 55% ≥120 days after the third dose but increased
to 80% ≥7 days after the fourth dose.3
–In a large cohort of nursing home residents, r eceipt of a second original monovalent mRNA COVID -19
booster dose during circulation of SARS- CoV-2 Omicron subvariants was 74% effective at 60 days
against severe COVID -19–related outcomes (including hospitalization or death) and 90% against death
alone compared with receipt of a single booster dose.4Effectiveness of an additional dose of COVID -19 vaccine
1.https://www.biorxiv.org/content/10.1101/2023.11.26.568730v2
2.https://www.cdc.gov/mmwr/volumes/73/wr/mm7304a2.htm
3.https://www.cdc.gov/mmwr/volumes/71/wr/mm7129e1.htm
4.https://www.cdc.gov/mmwr/volumes/71/wr/mm7139a2.htm 25
26Microsimulation modeling study compares frequency of
COVID -19 vaccine by risk group
https://www.medrxiv.org/content/10.1101/2023.07.10.23292473v4
HJ Park…NC Lo. Accepted at Nature Communications (2024) .Step 1 : Assign to risk group
•Age group: 18-49, 50- 64, 65- 74, 75+ years
•Immune status: immunocompetent,
immunocompromised (mild, moderate/severe)Step 3 : Calibrate model to data
•Epidemiologic data: COVID -19 severe incidence, seroprevalence
•Calibrated to ~September 2022
Computer
simulation
Step 2 : Simulate vaccine -induced or hybrid protection
•Vaccine: number doses, timing of last dose
•Prior infection: yes/no, timing of last infection
•Vaccine/hybrid protection data: level of protection and waning curves Step 4 : Run simulation of different vaccine strategies
•Vaccine strategies: One -time (1 dose); Annual (2 doses), Semi -annual (4
doses); Simulate over 2 -years
•Simulate person- level waning of protection and COVID -19 at each time step
(static infection model)
•Primary study outcome: Absolute annual risk of severe COVID -19
3 Month
06 1
27Annual and semiannual COVID -19 vaccine doses likely to have largest benefit
in people ages ≥65 years and people who are immunocompromised
Absolute annual risk of
severe COVID -19
(cases per 100,000;
uncertainty interval)Annual risk reduction of severe
COVID -19 NNT to avert
severe
COVID -19 case Absolute risk (cases
per 100,000)Relative risk
(%)
One -time booster
18-49 years 98 (85 - 125) -- -- --
50-64 years 199 (185 - 238) -- -- --
65-74 years 524 (499 - 562) -- -- --
75+ years 1,398 (1,332 - 1,501) -- -- --
Immunocompromised (mild) 1,290 (1,205 – 1,403) -- -- --
Immunocompromised (moderate/severe) 1,367 (1,266- 1,503) -- -- --
Annual booster
18-49 years 84 (74 - 106) 14 14% 3,534
50-64 years 171 (159 - 202) 28 14% 1,806
65-74 years 446 (425 - 475) 78 15% 642
75+ years 1,198 (1,144 - 1,272) 199 14% 251
Immunocompromised (mild) 1,180 (1,088 - 1,316) 110 9% 456
Immunocompromised (moderate/severe) 1,183 (1,091- 1,307) 184 13% 273
Semiannual booster (every 6 months)
18-49 years 72 (64 - 90) 26 27% 1,916
50-64 years 147 (136 - 171) 52 26% 968
65-74 years 382 (365- 404) 142 27% 353
75+ years 1,030 (988 - 1,088) 368 26% 136
Immunocompromised (mild) 1,095 (987 - 1,255) 195 15% 257
Immunocompromised (moderate/severe) 1,057 (966- 1,183) 310 23% 162
https://www.medrxiv.org/content/10.1101/2023.07.10.23292473v4
HJ Park…NC Lo. Accepted at Nature Communications (2024) .NNT: number of persons needed to follow vaccine strategy
to prevent one severe COVID -19 case over 2- year period
Severe COVID -19 case: defined as being hospitalized
28COVID -19 vaccines have a favorable safety profile as demonstrated by robust safety
surveillance over 3 years of COVID -19 vaccine use.
–Anaphylactic reactions have been rarely reported following receipt of COVID -19 vaccines.
–Rare risk of myocarditis and pericarditis, however this is predominately in males ages 12 -39
years.
–No new safety concerns have been identified for the 2023 -2024 Formula COVID -19 vaccine.
Reactogenicity symptoms have been reported following COVID -19 vaccines.
–Local: Pain at the injection site; less commonly, redness and swelling at the injection site
–Systemic: Fever, fatigue, headache, chills, myalgia, arthralgia, and diarrhea
–Overall, symptoms less frequent and severe among older adults compared with adolescents
and younger adults.COVID -19 vaccine safety
29A statistical signal for ischemic stroke after Pfizer- BioNTech bivalent mRNA COVID -19
vaccine was detected in CDC’s Vaccine Safety Datalink in persons aged ≥65 years during
fall 2022; information was presented at prior ACIP meetings and efforts have been underway to evaluate the signal.
2
Available data do not provide clear and consistent evidence of a safety problem for ischemic stroke with bivalent mRNA COVID -19 vaccines when given alone or given
simultaneously with influenza vaccines.
–Variable and inconsistent results were obtained in some analyses of the risk of ischemic
stroke following bivalent mRNA COVID -19 vaccination, simultaneous bivalent mRNA COVID -
19 and influenza vaccination, and influenza vaccination alone.
–Most study results have not shown an association between vaccination and ischemic stroke, and no clear pattern demonstrating increased risk has emerged.Review of COVID -19 vaccine and ischemic stroke1
1https://www.cdc.gov/vaccines/acip/meetings/downloads/slides -2023- 10-25-26/01- VaxSafety -Shimabukuro -508.pdf
2 https://www.cdc.gov/vaccines/acip/meetings/downloads/slides -2023- 02/slides -02-24/COVID -02-Shimabukuro -508.pdf and
https://www.cdc.gov/vaccines/acip/meetings/downloads/slides -2023- 04-19/03- COVID -Shimabukuro -508.pdf
30Any real or theoretical risk needs to be placed in the context of the known benefits of
COVID -19 vaccination in preventing COVID- 19 disease and the potentially serious
complications, including stroke.
Among adults aged ≥65 years, a recent bivalent mRNA COVID -19 vaccine dose helped
provide protection against COVID- 19-related thromboembolic events compared with
more distant receipt of original monovalent doses alone.1Review of COVID -19 vaccine and ischemic stroke
1. https://www.cdc.gov/mmwr/volumes/73/wr/mm7301a4.htm
Domain Equity Question:
Are the desirable and undesirable anticipated effects
demonstrated across all populations equally?
There is no evidence to suggest that COVID- 19 vaccine effectiveness varies substantially
by race/ethnicity.1,2
–Differences in vaccine hesitancy/uptake, crowding, access to care, and prior infection could
impact vaccine effectiveness and these factors may also differ by race/ethnicity.
There is no evidence to suggest that COVID- 19 vaccine safety profiles vary by
race/ethnicity, however risk has been shown to differ by age and sex.
–Risk for myocarditis is highest in adolescent and young adult males.
Benefits and harms for the U.S. population are best assessed when clinical trial and
study populations are optimally representative of the U.S. population. Are the desirable and undesirable anticipated effects
demonstrated across all populations equally?
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9619452/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9763212/ 32
2023-2024 Formula COVID -19 vaccination provided increased protection against symptomatic
SARS -CoV -2 infection and COVID -19-associated ED/UC visits and hospitalizations compared to
no updated vaccine dose.
–COVID -19 vaccine effectiveness from previous vaccine formulations has waned over time but
appears more durable against critical illness.
An additional dose of 2023 -2024 Formula may restore vaccine effectiveness which is expected
to wane, providing additional protection until the next updated vaccine is available.
COVID -19 vaccines have a favorable safety profile.
–Local and systemic symptoms have been reported following receipt of COVID -19 vaccines;
however, symptoms are less frequent and severe among older adults compared with
adolescents and younger adults.
–Available data do not provide clear and consistent evidence of a safety issue for ischemic
stroke with bivalent mRNA COVID -19 vaccines either when given alone or given
simultaneously with influenza vaccines.Summary
Benefits and Harms
33
Benefits and Harms
How substantial are the desirable anticipated effects?
•How substantial are the anticipated effects for each main outcome for which
there is a desirable effect?
oMinimal oSmall oModerate oLarge oVaries oDon’t know
Benefits and Harms
How substantial are the undesirable anticipated effects?
•How substantial are the anticipated effects for each main outcome for which
there is an undesirable effect?
oMinimal oSmall oModerate oLarge oVaries oDon’t know
Minority opinion Majority opinion
Benefits and Harms
Do the desirable effects outweigh the undesirable effects?
•What is the balance between the desirable effects relative to the
undesirable effects?
oFavors intervention (Additional dose of 2023-2024 Formula COVID -19 vaccine)
oFavors comparison (no vaccine)
oFavors both
oFavors neither
oUnclear
EtR Domain:
Values
3838Key attitudes and experiences among adults 18 years and older, December 2023
National Immunization Survey -Adult COVID Module (NIS -ACM)
The December estimates are based on data collected November 26 through December 30.
CDC. COVID -19 Vaccination Coverage and Vaccine Confidence Among Adults. https://www.cdc.gov/vaccines/imz -managers/coverage/covidvaxview/interactive/adults.html
Accessed February 7, 2024COVID -19 Vaccination Key Attitudes and Experiences by Age Group
Among Adults Age ≥18 Years, NIS -ACM, December 2023
Adults ages 65 years and older were more
concerned about COVID -19 disease and had
higher confidence in vaccine safety and
vaccine importance; those ages 18 – 49 years
and 50 – 64 years were less concerned and
confident.265365
355367
416578
0102030405060708090
Concerned about COVID-19 disease Confidence in COVID-19 vaccine safety Confidence that COVID-19 vaccine is
somewhat or very important to protect
mePercent
18 - 49 years 50 - 64 years 65+ years
3939Half of adults say they are taking precautions because of
COVID -19 during the fall and winter months
The survey was conducted October 31 - November 7, 2023, online and by telephone among a nationally representative sample of 1,301 U.S. adults.
KFF COVID -19 Vaccine Monitor (Oct. 31- Nov. 7, 2023) KFF COVID -19 Vaccine Monitor November 2023: With COVID Concerns Lagging, Most People Have Not Gotten Latest Vaccine
And Half Say They Are Not Taking Precautions This Holiday Season | KFF Accessed November 17, 2023501819253035
0 10 20 30 40 50 60 70 80 90 100Any of these precautionsTaking a COVID-19 test before visiting with friends or familyAvoiding dining indoors at restaurantsAvoiding travelWearing a mask in crowded placesAvoiding large gatherings
PercentPercent who say they are taking each of the following precautions because of
COVID -19 this fall and winter:
40Similar shares of younger and older adults reported plans to take at least one
precaution during the fall and winter.
However, four in ten ( 41% ) adults ages 65 and older said they plan to avoid large
gatherings, compared to a third ( 33% ) of those under the age of 65.
While younger adults were less likely to say they will avoid large gatherings, 21% of
those <65 years say they will take a test for COVID -19 before spending time with friends
or family compared to 10% of those ages 65 and older.Precautions against COVID -19 during fall and winter by age
The survey was conducted October 31 - November 7, 2023, online and by telephone among a nationally representative sample of 1,301 U.S. adults.
KFF COVID -19 Vaccine Monitor (Oct. 31- Nov. 7, 2023) KFF COVID -19 Vaccine Monitor November 2023: With COVID Concerns Lagging, Most People Have Not Gotten Latest Vaccine
And Half Say They Are Not Taking Precautions This Holiday Season | KFF Accessed November 17, 2023
Domain Equity Question:
Is there important variability in how patients or
populations value the outcome?
4242Key attitudes and experiences among adults 18 years and older, December 2023
National Immunization Survey -Adult COVID Module (NIS -ACM)
AI/AN: American Indian or Alaska Native; NH/PI: Native Hawaiian or Other Pacific Islander
The December estimates are based on data collected November 26 through December 30.
CDC. COVID -19 Vaccination Coverage and Vaccine Confidence Among Adults. https://www.cdc.gov/vaccines/imz -managers/coverage/covidvaxview/interactive/adults.html
Accessed February 7, 2024COVID -19 Vaccination Key Attitudes and Experiences by Race & Ethnicity
Among Adults Age ≥18 Years, NIS -ACM, December 2023
295573
305765
415078
347185
334967
313354
304757
0102030405060708090
Concerned about COVID-19 disease Confidence in COVID-19 vaccine safety Confidence that COVID-19 vaccine is
somewhat or very important to protect
mePercent
Hispanic White, non-Hispanic Black, non-Hispanic
Asian, non-Hispanic NH/PI, non-Hispanic AI/AN, non-Hispanic
Other or multiple races, non-Hispanic
4343Precautions against COVID -19 during fall and winter by race
and ethnicity
The survey was conducted October 31 - November 7, 2023, online and by telephone among a nationally representative sample of 1,301 U.S. adults.
KFF COVID -19 Vaccine Monitor (Oct. 31- Nov. 7, 2023) KFF COVID -19 Vaccine Monitor November 2023: With COVID Concerns Lagging, Most People Have Not Gotten Latest Vaccine
And Half Say They Are Not Taking Precautions This Holiday Season | KFF Accessed November 17, 2023391312171727
682436434749
723433365953
0 10 20 30 40 50 60 70 80 90 100Any of these precuationsTaking a COVID-19 test before visiting with friends or familyAvoiding dining indoors at restaurantsAvoiding travelWearing a mask in crowded placesAvoiding large gatherings
PercentPercent who say they are taking each of the following precautions because of
COVID -19 this fall and winter:
Black Hispanic White
Adults ages 65 years and older were more concerned about COVID- 19 disease and had
higher confidence in vaccine safety and vaccine importance than those <65 years.
–Black adults were more concerned about COVID -19 disease than people of other racial and
ethnic groups.
–Confidence in COVID -19 vaccine safety and importance varied by racial and ethnic group.
Half of adults reported plans to take precautions because of COVID- 19 during the fall
and winter months, with 41% of adults ages ≥65 years planning to avoid large
gatherings.
–Larger proportions of Black and Hispanic adults report they plan to take precautions against
COVID -19 than White adults. Summary
Values
44
Values
Criteria 1:
Do older adults feel that the desirable effects are large relative to undesirable
effects?
•How do older adults view the balance of desirable versus undesirable effects?
•Would older adults feel that the benefits outweigh the harms?
oMinimal oSmall oModerate oLarge oVaries oDon’t know
Values
Criteria 2:
Is there important uncertainty about, or variability in, how older adults value
the main outcomes?
•Is there evidence that the variability is large enough to lead to different decisions?
oImportant uncertainty or variability
oProbably important uncertainty or variability
oProbably not important uncertainty or variability
oNo important uncertainty or variability
oNo known undesirable outcomesMajority opinion
Minority opinion
EtR Domain:
Acceptability
4848Percent vaccinated with 2023 -24 COVID- 19 vaccine
National Immunization Survey -Adult COVID Module (NIS -ACM)
COVID -19 Vaccination Coverage with 2023- 24 Vaccine
Among Adults ≥18 Years, NIS- ACM
0.010.020.030.040.050.0Vaccinated with 2023 -24 COVID -19 vaccine (%)
Week end dateAll adults 18+
75+
65-74
50-64
40-49
30-39
18-29
4949Top COVID -19 vaccination concerns and issues among adults ≥65 years of
age, by status/intent, Omnibus Surveys, January 5 – 29, 2024 (N=882)
Other response options included: "Too busy or kept forgetting," "Cost/time concerns," "Unsure if eligible," "Fertility issues ," "HCP recommended against," "Other concern."
*Option not offered to those who already received the vaccine.
Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability -based panels to survey a nationally representative sample of U.S. adults aged 18
years and older. CDC fields questions about vaccination status, intent, knowledge, attitudes, beliefs, and behaviors on each survey for 2 waves each month, for a combined sample size of ~4,000 respondents. These slides present results
from January (N=4,287). Data were weighted to represent the non -institutionalized U.S. population and mitigate possible non- resp onse bias. All responses are self -reported. 6.1%
5.5%
5.0%
2.8%
2.7%
2.6%
1.3%
1.2%
0 25 50 75 100Effectiveness
Unknown serious
side effects
Mild side
effects
Do not trust
gov. or pharma
Not enough studies
(human trials)
Heart -related
issues
Hard to get
appointment
Impact of side effects
on work/school
Weighted % (95% confidence interval)Received/definitely wi ll get
(N=450)
83.8% reported "No concerns or issues"15.6%
12.6%
11.7%
10.6%
10.0%
9.1%
8.7%
8.0%
0 25 50 75 100Unknown serious
side effects
No provider
recommendation
Effectiveness
Not enough studies
(human trials)
Mild side
effects
Perceived natural
immunity*
Had enough
vaccines*
Heart -related
issues
Weighted % (95% confidence interval)Probably will get/unsure
(N=157)
47.1% reported "No concerns or issues"53.2%
49.6%
48.6%
41.9%
37.7%
17.5%
13.2%
10.2%
0 25 50 75 100Unknown serious
side effects
Do not trust
gov. or pharma
Not enough studies
(human trials)
Effectiveness
Heart -related
issues
Had enough
vaccines*
Perceived natural
immunity*
Mild side
effects
Weighted % (95% confidence interval)Probably/definitely will NOT get
(N=275)
9.6% reported "No concerns or issues"
5050Key attitudes and experiences among adults 18 years and older, December 2023
National Immunization Survey -Adult COVID Module (NIS -ACM)
The December estimates are based on data collected November 26 through December 30.
CDC. COVID -19 Vaccination Coverage and Vaccine Confidence Among Adults. https://www.cdc.gov/vaccines/imz -managers/coverage/covidvaxview/interactive/adults.html
Accessed February 7, 2024COVID -19 Vaccination Key Attitudes and Experiences by Vaccination Status
Among Adults Age ≥18 Years, NIS -ACM, December 2023
19% of adults received a healthcare provider
vaccine recommendation; highest among
adults who were vaccinated or definitely plan
to get vaccinated.1931
26
1415
05101520253035
Healthcare provider recommended I get a COVID-19 vaccinePercent
Overall Vaccinated with 2023-24 COVID-19 vaccine
Definitely will get vaccinated Probably will get vaccinated or unsure
Probably or definitely will not get vaccinated
5151Key attitudes and experiences among adults 18 years and older, December 2023
National Immunization Survey -Adult COVID Module (NIS -ACM)
The December estimates are based on data collected November 26 through December 30.
CDC. COVID -19 Vaccination Coverage and Vaccine Confidence Among Adults. https://www.cdc.gov/vaccines/imz -managers/coverage/covidvaxview/interactive/adults.html
Accessed February 7, 2024COVID -19 Vaccination Key Attitudes and Experiences by Age Group
Among Adults Age ≥18 Years, NIS -ACM, December 2023
Healthcare provider recommendation was
highest among adults ages ≥65 years. 152227
051015202530
Healthcare provider recommended I get a COVID-19 vaccinePercent
18 - 49 years 50 - 64 years 65+ years
5252Intent to receive additional COVID -19 vaccine dose among adults ≥18 years
of age who received a dose since September 14, 2023, Omnibus Surveys,
November 30, 2023 -January 16, 2024 (N=1,331)
*Labels for estimates <4% not shown. †NORC and Ipsos base urbanicity on different, but comparable measures. NORC uses Census tract -based RUCA (Rural -Urban -Commuting A rea) codes, whereas Ipsos uses Office of Management and
Budget's CBSA (Core Based Statistical Area) classification. §Includes plans purchased through employer, insurance companies, marketplaces, military insurance, Medicare, Medicaid, VA, IHS , and "other.“
Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability -based panels to survey a nationally representative sample of
U.S. adults aged 18 years and older. CDC fields questions about vaccination status, intent, knowledge, attitudes, beliefs, an d behaviors on each survey for 2 waves each month, for a combined sample size of ~4,000
respondents. These slides present results from January (N=4,287). Data were weighted to represent the non -institutionalized U.S. population and mitigate possible non -response bias. All responses are self -reported. 62.9 5.6 31.5
63.4
62.44.3
6.932.3
30.7
59.1
59.9
68.47.3
5.0
4.433.6
35.1
27.2
63.7
61.3
64.1
57.311.2
14.832.9
27.5
21.1
40.1
0 25 50 75 100Overall (N=1,331)
Female (N=629)Male (N=702)
Age 65+ (N=493)Age 50-64 (N=387)Age 18-49 (N=451)
Other, non -Hispanic* (N=114)Hispanic (N=129)Black, non -Hispanic (N=90)White, non -Hispanic* (N=998)
Weighted %66.3
60.9
60.86.6
7.330.0
32.5
31.8
57.0
62.7
65.3
62.911.1
6.4
4.4
5.331.9
30.9
30.3
31.9
58.8
60.0
65.1
65.14.7
6.5
6.2
4.936.5
33.5
28.7
30.0
63.1
53.25.6
9.831.2
37.0
0 25 50 75 100Rural (N=170)Suburban (N=654)Urban*†(N=507)
$75,000+ (N=837)$50,000- $74,999 (N=227)$25,000- $49,999 (N=180)Income $24,999 or less (N=87)
West (N=387)South (N=383)Midwest (N=340)Northeast (N=221)
Uninsured (N=33)Insured§(N=1,250)
Weighted %
Domain Equity Question:
Is the intervention equally acceptable across all
populations?
Among adults age ≥18 years responding to the NIS -ACM during Nov. 26 – Dec. 30, 2023:
Vaccination coverage differed by race/ethnicity.
–Coverage was highest among White, non-Hispanic adults and lowest among American
Indian/Alaska Native and Native Hawaiian/Other Pacific Islander adults.
Vaccination coverage was higher in urban and suburban areas compared with rural
areas.
Adults with health insurance had significantly higher vaccination coverage than adults without insurance.
Vaccination coverage increased with increasing household income.Is the intervention equally acceptable across all populations?
NIS-ACM: National Immunization Survey -Adult COVID Module 54
5555Intent to receive additional COVID -19 vaccine dose among adults ≥18
years of age who received a dose since September 14, 2023, Omnibus
Surveys, November 30, 2023 -January 16, 2024 (N=1,331)
*Labels for estimates <4% not shown. †NORC and Ipsos base urbanicity on different, but comparable measures. NORC uses Census tract -based RUCA (Rural -Urban -Commuting A rea) codes, whereas Ipsos uses Office of Management and Budget's CBSA (Core Based
Statistical Area) classification. §Includes plans purchased through employer, insurance companies, marketplaces, military insurance, Medicare, Medicaid, VA, IHS , and "other.“
Omnibus Surveys: Data for this analysis were collected through the Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys, which use probability- based panels to survey a nationally representative sample of U.S. adults aged 18 years a nd
older. CDC fields questions about vaccination status, intent, knowledge, attitudes, beliefs, and behaviors on each survey for 2 waves each month, for a combined sample size of ~4,000 respondents. These slides present results from January
(N=4,287). Data were weighted to represent the non -institutionalized U.S. population and mitigate possible non -response bias. Al l responses are self -reported. 62.9 5.6 31.5
63.4
62.44.3
6.932.3
30.7
59.1
59.9
68.47.3
5.0
4.433.6
35.1
27.2
63.7
61.3
64.1
57.311.2
14.832.9
27.5
21.1
40.1
0 25 50 75 100Overall (N=1,331)
Female (N=629)Male (N=702)
Age 65+ (N=493)Age 50-64 (N=387)Age 18-49 (N=451)
Other, non -Hispanic* (N=114)Hispanic (N=129)Black, non -Hispanic (N=90)White, non -Hispanic* (N=998)
Weighted %66.3
60.9
60.86.6
7.330.0
32.5
31.8
57.0
62.7
65.3
62.911.1
6.4
4.4
5.331.9
30.9
30.3
31.9
58.8
60.0
65.1
65.14.7
6.5
6.2
4.936.5
33.5
28.7
30.0
63.1
53.25.6
9.831.2
37.0
0 25 50 75 100Rural (N=170)Suburban (N=654)Urban*†(N=507)
$75,000+ (N=837)$50,000- $74,999 (N=227)$25,000- $49,999 (N=180)Income $24,999 or less (N=87)
West (N=387)South (N=383)Midwest (N=340)Northeast (N=221)
Uninsured (N=33)Insured§(N=1,250)
Weighted %
As of February 2024, v accination coverage with 2023 -2024 COVID -19 vaccine was
highest among older adults ages 65 – 74 years and 75+ years, compared to younger age
groups.
–Disparities in COVID -19 vaccine coverage are observed across many demographic factors,
including race, ethnicity, insurance status and rurality.
Adults who were vaccinated or definitely plan to get vaccinated were more likely to
report that a healthcare provider recommended they get a COVID- 19 vaccine.
–Adults ≥65 years were more likely to report a healthcare provider recommendation than
younger adults.
Among adults ≥65 years of age who had already received a 2023 -2024 Formula COVID -
19 vaccine dose, 68.4% reported they definitely will get an additional dose of 2023 -
2024 Formula COVID -19 vaccine if it is recommended for them.Summary
Acceptability
56
Acceptability
Would recommending an additional dose of 2023 -2024 Formula COVID -19
vaccine for older adults be acceptable to key stakeholders?
•Are there key stakeholders that would not accept the distribution of benefits
and harms?
•Are there key stakeholders that would not accept the undesirable effects in the short term for the desirable effects (benefits) in the future?
oNooProbably no oProbably yes oYesoVaries oDon’t know
Minority opinion Majority opinion
EtR Domain:
Feasibility
59COVID -19 vaccines are now available on the commercial market.
–COVID -19 vaccines are covered by private and public insurance and available through
the Bridge Access Program and Vaccines for Children for those that are uninsured or
underinsured.
ACIP recommendation would be needed for insurance coverage of an additional dose of 2023- 2024 Formula COVID -19 vaccine.
–Insurance coverage generally required under either a “should” or “may” recommendation.Financial Barriers
60Additional dose recommendation would be for same formula (2023 -2024) of COVID -19
vaccine that is currently available.
–Existing COVID -19 vaccine administration infrastructure and product can be used.
–Age-based recommendation would not be overly burdensome to implement.
Additional dose recommendation in those ≥65 years would add complexity to COVID-
19 vaccine recommendations which have been getting simpler.
–Frequent changes to vaccine recommendations can lead to vaccine fatigue.
–Systems are already planning for next season, and adding more recommendations for this
year could add additional burden to an already fatigued system.
–Minimum interval of 4 months used for additional dose recommendations may confuse providers accustomed to 2 month interval from the fall dose.
–Providers would need to consider anticipated availability of updated vaccine next fall when considering providing vaccine doses during the summer months.Implementation and vaccine access
Domain Equity Question:
Is the intervention equally feasible to implement
across all populations?
Past reports of sites being unaware of additional dose recommendations or requiring
documentation to prove eligibility for additional vaccine dose.
–Wide communication of any change in recommendations and that self -attestation is
appropriate will be important to decrease barriers.
The Bridge Access Program was designed to remove patient barriers to COVID -19
vaccines, however disparities in vaccine uptake by insured status continue.
To the extent that existing disparities in vaccine uptake by characteristics such as race/ethnicity, urbanicity, and income are driven by differences in vaccine access, additional dose recommendations may further increase those disparities.
–Access issues may be increased during a time when there are fewer off -site vaccination
clinics, which are more common during fall vaccine roll -outs.
In the absence of an ACIP recommendation, additional doses might be an out- of-pocket
cost, therefore those able to pay for an additional dose may have access while others do not.Implementation equity considerations
62
COVID -19 vaccines currently on the commercial market and an ACIP recommendation
(should or may) would be needed for insurance coverage of an additional dose.
Additional dose recommendation would leverage existing infrastructure and vaccine
product; however, it would add complexity to the current recommendations which could enhance vaccine and system fatigue.
Access related barriers to COVID -19 vaccines and disparities in vaccine uptake remain
and additional dose recommendations may further heighten those inequities, but lack of recommendation limits access to those able to pay for vaccine out -of-pocket.Summary
Feasibility
63
Feasibility
Is an additional dose of the 2023-2024 Formula COVID -19 vaccine feasible to
implement among older adults?
•Is the 2023- 2024 Formula COVID -19 vaccine program sustainable?
•Are there barriers that are likely to limit the feasibility of implementing the 2023 -
2024 Formula COVID -19 vaccine or require considerations when implementing it?
•Is access to the 2023- 2024 Formula COVID -19 vaccine an important concern?
oNooProbably no oProbably yes oYesoVaries oDon’t know
EtR Domain:
Resource Use
66Scenario analysis: probability of hospitalization1, societal
perspective
ICER ($/QALY)
Age
groupStrategy Base case ¼ base case ½ base case 2x base case 3x base case 4x base case
65+ yUpdated Covid- 19 vax, 1 dose $11,936 $93,904 $52,541 Cost saving Cost saving Cost saving
Updated Covid- 19 vax, 2 doses $255,122 $624,028 $433,533 $120,341 $64,599 $34,133
ICER=Incremental cost effectiveness ratio; QALY=Quality -adjusted life year
1 From Ko et al 2021. Adjusted risk of hospitalization by underlying condition: chronic obstructive pulmonary disease: 0.9, his tory of stroke: 0.9, coronary artery disease: 1.3,
asthma: 1.4, hypertension: 2.8, obesity: 2.9, diabetes: 3.2, chronic kidney disease: 4.0, severe obesity: 4.4.
Domain Equity Question:
Is the intervention a reasonable and efficient
allocation of resources across all populations?
An additional dose of COVID- 19 vaccine is most cost -effective in older adults in which
disease burden is highest compared to younger adults.
An additional dose of COVID- 19 vaccine is likely more cost -effective in populations with
a higher prevalence of risk factors, such as underlying conditions, which increase their
probability of hospitalization due to COVID- 19.Is the intervention a reasonable and efficient allocation of
resources across all populations?
68
The cost effectiveness of an additional dose in older adults is highly sensitive to COVID-
19-associated hospitalization rates and anticipated rates in the coming months are
uncertain.
–COVID -19-associated hospitalization rates in older adults that are higher than those seen last
year would increase the cost effectiveness, however lower COVID -19 hospitalization rates
would decrease the cost effectiveness.
Estimates that approximate cost- effectiveness for those with high- risk conditions such
as underlying conditions or advanced age are more favorable.Resource Use
Summary
69
Resource Use
Is an additional dose of the 2023-2024 Formula COVID -19 vaccine in older
adults a reasonable and efficient allocation of resources?
•What is the cost- effectiveness of the 2023 -2024 Formula COVID -19 vaccine?
•How does the cost- effectiveness of the 2023 -2024 Formula COVID -19 vaccine change
in response to changes in context, assumptions, etc.?
oNooProbably no oProbably yes oYesoVaries oDon’t know
Summary and Work Group Interpretations
–Greatest benefit of a vaccine dose would be in those who have not yet received a
2023- 2024 Formula dose, particularly older adults and those with underlying medical
conditions.
•Data presented today emphasized the importance of any dose of updated (2023 -
2024 Formula) COVID -19 vaccine in older adults.
–Risk of severe illness due to COVID- 19 continues throughout the year and is highest in
those ≥65 years.
•Within the ≥65 -year age group, risk increases with increasing age.
–Receipt of 2023- 2024 Formula COVID -19 vaccine provides protection against JN.1 and
other circulating variants, however vaccine effectiveness is expected to wane.
•In the past, we have seen greater durability in the protection against critical illness.Summary and Work Group Interpretations
72
–“May” recommendation would provide flexibility for older adults to obtain an
additional dose if they or their healthcare provider feel they would benefit.
•Most benefit would likely be in those with underlying medical conditions, advanced age, or circumstances that may increase risk (e.g., nursing home resident).
–Additional dose in adults ≥65 years may restore protection that has waned.
•Smaller, incremental benefit on top of the protection still being provided by the initial 2023 -2024 Formula COVID -19 vaccine dose.
–Cost effectiveness of an additional dose depends on COVID- 19 hospitalization rates in
the coming months and the patient risk factors for severe illness due to COVID- 19.
–As COVID -19 epidemiology changes with time, additional dose recommendations
may not be needed in the future. Summary and Work Group Interpretations
73
7474Considerations for an additional dose recommendation
Pros Cons
•“May” recommendation would provide
flexibility for those ≥65 years to get an additional dose if they or their healthcare provider feel they would benefit.•Smaller, incremental benefit compared to that from initial 2023 -2024 COVID -19
vaccine dose in the fall.
•Restore vaccine effectiveness that may have waned since the initial 2023 -2024
COVID -19 vaccine dose.•May decrease vaccine confidence in the benefits of a single dose of 2023 -2024
COVID -19 vaccine.
•Acknowledges that risk of severe illness due to COVID -19 continues throughout
the year for older adults, despite upticks during winter months.•Additional recommendations may increase vaccine fatigue, potentially reducing uptake of vaccine next fall.
75EtR Domain Question Work Group Judgments
Public Health
ProblemIs COVID -19 disease among persons ages 65 years and older of
public health importance?Yes
Benefits and HarmsHow substantial are the desirable anticipated effects? Moderate
How substantial are the undesirable anticipated effects? Small
Do the desirable effects outweigh the undesirable effects? Favors intervention
ValuesDo older adults feel that the desirable effects are large relative
to undesirable effects?Large
Is there important uncertainty about, or variability in, how older adults value the main outcomes?Probably important uncertainty
or variability
AcceptabilityWould recommending an additional dose of 2023 -2024 Formula
COVID -19 vaccine for older adults be acceptable to key
stakeholders?Probably yes
FeasibilityIs an additional dose of the 2023 -2024 Formula COVID -19
vaccine feasible to implement among older adults?Probably yes
Resource UseIs an additional dose of the 2023 -2024 Formula COVID -19
vaccine a reasonable and efficient allocation of resources?Probably yes
76Evidence to Recommendations Framework
Summary: Work Group Interpretations
Balance of
consequencesUndesirable
consequences
clearly
outweigh
desirable
consequences
in most
settingsUndesirable
consequences
probably
outweigh
desirable
consequences
in most
settingsThe balance
between
desirable and
undesirable
consequences
is closely
balanced or
uncertainDesirable
consequences
probably
outweigh
undesirable
consequences
in most
settingsDesirable
consequences
clearly
outweigh
undesirable
consequences
in most
settingsThere is
insufficient
evidence to
determine the
balance of
consequences
77Evidence to Recommendations Framework
Summary: Work Group Interpretations
Type of
recommendationWe do not recommend
the interventionWe recommend the
intervention for individuals
based on shared clinical
decision -makingWe recommend the
intervention
ACIP recommends that persons ≥65 years of age may receive an
additional dose of 2023 -2024 Formula COVID- 19 vaccineProposed ACIP Voting Language
78
People ages 65 years and older may receive 1 additional dose of any updated (2023 –2024
Formula) COVID -19 vaccine (i.e., Moderna, Novavax, Pfizer- BioNTech), informed by the
clinical judgement of a healthcare provider and personal preference and circumstances.
Considerations for the additional dose may include a person’s risk for severe COVID- 19
due to age and the presence of underlying medical conditions. The additional dose is administered at least 4 months following the previous dose of updated (2023 –2024
Formula) COVID -19 vaccine. Proposed Clinical Considerations
Note: For initial vaccination with Novavax COVID -19 Vaccine, the 2 -dose series should be completed before administration of the additional dose. 79
Acknowledgements
80Lakshmi Panagiotakopoulos
Monica Godfrey
Danielle Moulia
Katherine Fleming -Dutra
Ruth Link -Gelles
Sarah Meyer
Elisha Hall
Jennifer Kriss
Kayla Calhoun
Kevin Chatham- Stephens
Susan Goldstein
Mary Chamberland
JoEllen Wolicki
Lauren Roper
Karen Broder Evelyn Twentyman
Sierra Scarbrough
Natalie Thornburg
Jefferson Jones
Aron Hall
Dave Wentworth
COVID -NET
University of Michigan COVID -19 Vaccination Modeling
Team
Immunization Safety Office
Immunization Services Division
Coronavirus and other Respiratory Viruses Division
National Center for Immunization and Respiratory
Diseases
For more information, contact CDC
1-800- CDC- INFO (232 -4636)
TTY: 1 -888 -232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.
Thank you