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Adults ages 65 and older should receive an additional dose of the 2023-2024 COVID-19 vaccine this spring, according to CDC's Advisory Committee on Immunization Practices (ACIP).

Eleven members of the committee voted in favor of the recommendation, one member voted no, and one abstained from voting.

Shortly after the meeting, CDC Director Mandy Cohen, MD, MPH, endorsed the recommendation.

"There are still roughly 20,000 people a week hospitalized for COVID and about 2,000 deaths a week caused by the disease," Megan Wallace, DrPH, MPH, of the CDC's National Center for Immunization and Respiratory Diseases (NCIRD), told committee members on Wednesday, during the first of a 2-day ACIP meeting.

Over the past year, new COVID hospitalizations have never fallen below 6,000 a week, she noted. Persons ages 65 and older have the highest COVID hospitalization rates, and those ages 75 and older have the highest COVID mortality rates.

Christopher Taylor, PhD, also of the NCIRD, highlighted the fact that patients ages 65 and older made up about two-thirds of the population who were hospitalized for COVID from March 2020 to January 2024. Notably, the vast majority of patients hospitalized were unvaccinated or had not received the most up-to-date vaccine.

Another area of concern was that 2023-2024 COVID vaccination coverage has remained low. "While most Americans still consider COVID-19 vaccines to be safe and important, vaccine confidence has declined," said Kevin Chatham-Stephens, MD, MPH, of the NCIRD.

He reported that just 21% of adults had received the latest monovalent booster: 24% were white, 16% were Black, 13% were Hispanic, 11% were American Indian/Alaska Native, and 14% were Native Hawaiian or other Pacific Islander. Adults with health insurance, higher levels of income, and those living in urban areas were all more likely to be vaccinated, he noted.

The vote came after a prolonged discussion among ACIP members about the original language of the recommendation -- that adults ages 65 and older "may" get an additional 2023-2024 booster dose. Ultimately, committee members voted to change the language to read that those ages 65 and older "should" get an additional vaccine dose, a key nuance that struck a chord with committee members.

"I'm wrestling with this 'should' versus 'may' because I'm thinking that there's actually a fair amount of benefit here" to giving an additional dose of the vaccine, said ACIP member Jamie Loehr, MD, of Cayuga Family Medicine in Ithaca, New York. "I can see lots of reasons why the 'may' [recommendation] makes sense, including cost-effectiveness, seasonality ... but if you're asking my personal opinion, I would probably give [another dose] again in February or March for those people who are particularly high risk, those over 75, those who are immunocompromised, those who have high-risk conditions."

Camille Kotton, MD, of Massachusetts General Hospital in Boston, pointed out that only a minority of adults had received the first 2023-2024 COVID-19 vaccine. "From my perspective, as an active clinician in the field, many people did not even know that they should have had an updated vaccine" last fall, she said. "If we say 'may' -- for me, that's too soft."

Oliver Brooks, MD, of Watts Healthcare Corporation in Los Angeles, had a differing opinion. "We still have to get the population vaccinated. We're having more vaccine hesitancy," he said. "And there is concern about vaccine fatigue ... I think that allowing the flexibility of 'may' versus 'should' in the end may get more people vaccinated."

The ACIP COVID Vaccines Work Group presented key evidence to support the recommendation that included the latest data on COVID hospitalizations, vaccination status, cost-effectiveness of the vaccines, and next steps for the COVID vaccine program.

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