If I’m not mistaken, all we’re waiting for now is Rochelle Walensky and her team to rubber-stamp these recommendations and third doses can start going into arms. The FDA approved boosters last night. The only step left was for the CDC and its advisory panel to refine the guidance on who qualifies.

The advisory panel met this afternoon and rendered its verdict. Doctors, nurses, and teachers who are under 65 and in good health? Not eligible. Adults who got Moderna or Johnson & Johnson? Not eligible.

If you’re at risk because of your job, or because you’re elderly or in poor health but made the mistake of getting a vaccine other than Pfizer’s, you’ll just have to be patient. The CDC will get back to you.

The Advisory Committee on Immunization Practices, or ACIP, recommended by a 15 to 0 vote that adults 65 and older should be offered booster jabs and by a vote of 13-2 that a booster dose should be offered to individuals 50-64 with underlying health conditions.

In a separate vote, the panel left the door open to 18- to 49-year-olds with underlying medical conditions obtaining a booster shot, based on an assessment of “benefit and risk,” a phrase traditionally meant to suggest a conversation between individuals and their health care providers.

The committee voted against recommending a booster to anyone 18-64 who is in an occupational or institutional setting where burden of Covid-19 infection and risk of transmission is high. A vote in favor would have cleared the way for all health care workers to get an additional dose of vaccine.

The FDA okayed boosters based on occupational risk, understandably. The CDC panel said nope. Some scientists are pissed:

We are now entering a 3rd shot/booster confusional state in the US with different recommendations between FDA and CDC [the latter ridiculously not supporting healthcare workforce, teachers, etc]. Plus all these uncertainties below.
This is the last thing we need right now. https://t.co/ZYsm14sJiR

— Eric Topol (@EricTopol) September 23, 2021

Some Moderna and J&J recipients are quite reasonably pissed too. “I just don’t understand how, later this afternoon, we can say to people 65 and older, ‘You’re at risk for severe disease and death, but only half of you can protect yourselves right now,’” said one doctor at today’s panel meeting. Another added, “We just cannot continue to ignore the Janssen (ie J&J) product… I just don’t think we can continue to ignore that population.” To the FDA and CDC, it’s a simple matter of data. They have lots of data on Pfizer boosters via Israel but little data on Moderna or J&J so they’re stuck withholding judgment on the latter until the numbers come in. For Moderna people, that’s not too burdensome since Moderna seems to have the longest-lasting protection of any of the three vaccines:

12. On the issue of waning, it seems that not all vaccines are created equal. Check the difference between Pfizer and Moderna. #ACIP pic.twitter.com/aMptT1H7YG

— Helen Branswell (@HelenBranswell) September 23, 2021

The story is different for J&J, as you can see. Some who got Johnson & Johnson now regret it because they’ve received only a single dose and have been left adrift, without formal guidance about whether to get a second.

Thus far, the FDA appears to believe that boosters for anyone under 65 aren’t really necessary, so we won’t have to endure the spectacle of all our friends and country people gallivanting off to Walgreens while we sit at home watching our antibodies wane. But after months of confusion, there remains more or less radio silence on the J&J question from those famously effective communicators at the CDC and FDA.

Never mind that a growing body of evidence shows that we could use another dose more than the Pfizer Pfanatics or Moderna Mafia — that breakthrough infections are at least somewhat more common among one-dose recipients than our smugly double-dosed compatriots, even if hospitalizations remain exceedingly rare. The small size of our cohort, plus the timeline of U.S. vaccine approvals (J&J was last on that score, natch), meant that data was scarce for large swathes of this spring and summer. And despite being in real need of some direction, it has often felt as if we’ve been cast out of the pandemic narrative altogether — like we’re the Generation X of vaccine recipients. Even insentient systems treat us shabbily: A J&J-dosed co-worker reported that New York’s Excelsior app didn’t recognize his vaccination site as legitimate until he called a confused-but-ultimately-helpful human to complain.

One obvious solution would have been to okay Pfizer boosters today for all vaccinated adults, including those who received Moderna or J&J initially, but the FDA and CDC refuse to consider “mix-and-match” until they see the results of studies on whether that strategy would be safe and effective. (Good question from Stat’s Helen Branswell: “Why does the lack of data impede this but not impede boosting broadly?”) In the meantime, I wouldn’t fault any J&J recipient at this point for strolling into the pharmacy and blithely assuring the tech that they’re unvaccinated and would like their highly effective second dose of Johnson & Johnson now, please.

Branswell asked another good question today:

16. This I do not understand. If we need a booster at 6 months, how is this NOT a 3-dose vaccine? Why does receipt of 2 doses still qualify as fully vaccinated? #ACIP pic.twitter.com/iIZSIWDaQa

— Helen Branswell (@HelenBranswell) September 23, 2021

Calling people (or at least senior citizens) “fully vaccinated” after just two doses smells like a political decision in light of today’s ruling on boosters. The CDC panel may be thinking that it would anger people who live in areas where vaccine passports are commonly required if they woke up tomorrow to discover that, despite having had two shots, they’re no longer “fully vaccinated” and therefore ineligible to be in indoor public spaces. But if that’s what happened here, it’s politics, not science.

Here’s one more good question via a Twitter pal from a few days ago: Aren’t the experts following different priorities for masks and vaccines? With vaccines, we’re told that the thing to worry about is severe illness, not infection. That’s why only seniors and middle-aged people with health issues are being boosted right now. The vaccines are still protecting everyone else from the sort of dire sickness that might land them in the hospital. They’re not holding up as well against infection, but oh well. As long as you’re not at risk of needing to go to the ER, the experts are fine with you getting COVID.

But if infection doesn’t matter, why are they still so eager for vaccinated people to wear masks? Is there any hard evidence that masking prevents (or at least decreases the risk of) severe illness? There’s a theory that masks might lead to milder infections simply by reducing the amount of viral particles that the wearer might inhale, but it’s just a theory. The point of masking, supposedly, is to reduce the risk of infection — the very thing the experts seem unconcerned with when it comes to vaccination.

How do we square that circle? Infection is irrelevant for vaccination policy but crucially important for masking policy?

I’ll leave you with this, a transmission from Earth 2 where European kids haven’t spent most of the pandemic unmasked and doing just fine.

CNN’s @DrLeanaWen: “We are nowhere near” letting kids attend school without facemasks pic.twitter.com/PYldsXJp5B

— Tom Elliott (@tomselliott) September 23, 2021