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Does your job make you eligible for a COVID-19 booster shot?

If you’re wondering whether your job puts you in line for a booster shot, some public health experts say you shouldn’t expect a detailed answer to that question any time soon.

The U.S. Centers for Disease Control and Prevention on Friday recommended a third Pfizer/BioNTech shot six months after the second one for people who face an “increased risk for COVID-19 exposure and transmission because of occupational or institutional setting.”

The recommendation followed a Food and Drug Administration authorization earlier in the week for a third shot to Pfizer/BioNTech vaccine recipients who face a “high risk of serious complications” due to their “frequent institutional or occupational exposure.”

President Joe Biden said Friday that includes “those who are at increased risk of COVID-19 because of where they work, or where they live, like health care workers, teachers, grocery store workers.”

The green light on a third shot also applies to people with jobs in places like day care centers, homeless shelters and prisons, Dr. Janet Woodcock, the Food and Drug Administration’s acting commissioner, said in a statement earlier this week when the FDA announced its approval.

But what about rideshare drivers and food delivery workers? Would airline workers, people in retail and bank tellers also be in line for the third shot? And how about the adults who live with these people but work from home, or at an office?

All these people could conceivably be in line for a third shot, according to Dr. Robert Murphy, executive director of the Institute for Global Health at Northwestern University Feinberg School of Medicine.

But the news on booster shots and jobs has some of Murphy’s patients stumped. In fact, he had already received more than 10 emails on Friday from patients who were asking if their jobs qualified them for a shot, he said.

“I really don’t how to even answer that question, nor does anybody,” said Murphy, who says boosters are “necessary” and tells his patients to use their best judgment.

Any forthcoming instructions from federal and state public health authorities are “going to be purposefully vague,” Murphy anticipates.

Public health authorities in August authorized third Pfizer
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-BioNTech
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shots for people with weakened immune systems. Along with the green light this week on boosters in connection to jobs, the FDA also approved the third shot for senior citizens and people with high health risks.

The Moderna
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application for a third shot following its two-dose vaccine is under FDA review. As of Friday, 2.4 million people received an additional shot, according to the CDC.

Clarity — or the lack of it — on the topic of who is eligible matters because it hits at public confidence and confusion over vaccination at a moment when almost one-quarter of America’s adult population still hasn’t received one shot.

“We might as well just say ‘give it to everybody 18 years and older,’” Dr. Pablo Sanchez, a professor of pediatrics at the Ohio State University – Nationwide Children’s Hospital, said Thursday at a CDC advisory panel meeting.

Sanchez was part of the nine-vote majority against a recommendation for a booster shot depending on the line of work. CDC Director Dr. Rochelle Walensky ultimately decided to recommend the booster in connection to occupation. “It was a decision about providing, rather than withholding, access,” she said during a Friday press briefing.

(The CDC recommendation said people with higher risk occupations “may” get the additional shot. Senior citizens and older people with underlying health conditions “should” get the third shot, the recommendation said.)

To be clear, the government does know how to detail the many sorts of jobs that are out in the field — and potentially running a higher risk to COVID-19 infection.

One slide from Thursday’s advisory panel meeting links to a Department of Homeland Security agency report about the jobs that comprise the “essential critical infrastructure workforce.” They run from cafeteria workers to staff at nuclear refueling operations, according to the document. It’s just not clear if any booster shot guidance will match that detail.

A CDC spokesman declined to comment.

Giving flexibility to state officials

Like Murphy, Dr. Fazal Khan, a public health law professor at the University of Georgia School of Law, isn’t predicting many specifics. “One of the virtues of being purposefully vague is giving flexibility to state officials,” he said.

Typically, federal agencies develop guidance on public health matters and then it’s up to the states to implement their own rules, Khan noted. But if there’s many particulars here, that could open up a whole different issue about attempting to verify who is and who is not in a particular line of work.

“It really is on the honor system, unless states choose to implement some type of verification system,” he said. But checking — and essentially putting up barriers — isn’t worth the time or hassle because of how much vaccine is in supply, Khan said.

The changing implications of being an ‘essential worker’

Early in the pandemic, attention turned to the specific roles counting as essential. At that point, lockdown measures tried to create social distancing in order to slow COVID-19’s spread and increase health care capacity. “There, specifics mattered because you needed to let people know who should be staying at home,” Khan said. “You needed a skeleton crew to make society run.”

The context is different now. The ample supply of vaccine means officials might not have to be as laser-focused on who is and isn’t in line for a third shot.
At the CDC advisory panel meeting on Thursday, the topic came up on how to possibly try proving job status.

“Any booster would require self-attestation and not any additional onus of documentation,” Dr. Amanda Cohn, senior advisor for vaccines at the CDC’s National Center for Immunization and Respiratory Diseases, said at the meeting. Cohn serves as the panel’s executive secretary.

People are already moving ahead of formal rules and guidance to get their third shot.

One reporter made the point to Biden at the president’s Friday press conference.
Biden noted the latest announcements on booster shots aren’t going to be the last ones. “I would just say it’d be better to wait your turn in line,” Biden replied.

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