An influential panel of advisers to the Centers for the Disease Control and Prevention grappled Wednesday with the question of which Americans should get COVID-19 booster shots, with some members wondering if the decision should be put off for a month in hopes of more evidence. The doubts and uncertainties suggested yet again that the matter of whether to dispense extra doses to shore up Americans’ protection against the coronavirus is more complicated scientifically than the Biden administration may have realized when it outlined plans a month ago for an across-the-board rollout of boosters. The rollout was supposed to have begun this week. Much of the discussion at the meeting of the CDC’s Advisory Committee on Immunization Practices focused on the possibility of a scaled-back booster program targeted to older people or perhaps health care workers. But even then, some of the experts said that the data on whether boosters are actually needed, precisely who should get them and when was not clear-cut. “What would be the downside” of simply waiting a month in hopes of more information? asked Dr. Sarah Long of Drexel University. Read: Top doctors say not so fast to Biden’s boosters-for-all plan The two-day meeting had been scheduled to resume on Thursday, but it was not immediately clear whether that would happen. The meeting came days after a different advisory group — this one serving the Food and Drug Administration — overwhelmingly rejected a sweeping White House plan to dispense third shots to nearly everyone. Instead, that panel endorsed booster doses of the Pfizer vaccine only for senior citizens and those at high risk from the virus. While the COVID-19 vaccines continue to offer strong protection against severe illness, hospitalization and death, immunity against milder infection seems to be dropping months after vaccination. “I want to highlight that in September of 2021 in the United States, deaths from COVID-19 are largely vaccine-preventable with the primary series of any of the three vaccines available,” said CDC advisory panel member Dr. Matthew Daley, a researcher at Kaiser Permanente Colorado. And the public must understand that no matter how good a COVID-19 vaccine is, when it comes to milder infections, “it is unlikely that we will prevent everything,” said Dr. Helen Keipp Talbot of Vanderbilt University. Several panelists said another concern is the public confusion that could result if they recommend a booster only for certain recipients of the Pfizer vaccine. That could leave people vaccinated with Moderna or Johnson & Johnson shots wondering what to do. The meeting was devoted to Pfizer booster shots only. Moderna’s application to dispense third doses is not as far along in the process. And a major U.S. study on whether mixing-and-matching booster doses is safe and effective isn’t finished. Read: US panel backs COVID-19 boosters only for seniors, high-risk Many experts are torn about the need for boosters because they see the COVID-19 vaccines working as expected, even amid the spread of the highly contagious delta variant. It is normal for virus-blocking antibodies to be highest right after vaccination and then wane over the following months. “We don’t care if antibodies wane. You care what is the minimum” needed for protection, Long said. Yet no one knows the antibody level threshold below which someone’s risk for infection suddenly jumps. Even then, the body has backup defenses. Antibody production and even those backup defenses don’t form as robustly in older people. But it’s impossible to pinpoint the age at which that becomes a problem, CDC microbiologist Natalie Thornburg told the committee. Ultimately the committee must decide who is considered at high enough risk for an extra dose. CDC officials presented data from several U.S. studies, saying there is growing evidence of a decline in the effectiveness of both the Pfizer and Moderna vaccines in preventing new COVID-19 infections in some groups, most notably people 65 and older and health care workers who got shots early in the vaccination campaign. There’s also a hint that at age 75, there may be some decline in protection against hospitalization. But the CDC said there is little information on waning immunity in younger people with chronic medical problems. Some panelists also wondered about boosters for health care workers who can’t come to work if they get even a mild infection. Read: Global vaccine disparity gets sharper amid talk of boosters “We don’t have enough health care workers to take care of the unvaccinated. They just keep coming,” Talbot said. Another question was how many months after the second shot the booster should be given. Scientists have talked about six months or eight months. As for booster safety, serious side effects are exceedingly rare with the first two doses. And Pfizer pointed to 2.8 million booster doses given in Israel, mostly to people 60 and older, with fewer reports of annoying side effects like pain or fever with the third dose than with the earlier shots. There was one report of a rare risk, heart inflammation, that is sometimes seen in younger men. In the U.S., more than 24,000 people who have volunteered for a CDC vaccine safety tracking system have reported getting an extra dose, and likewise have reported no red flags.

Malaysia shut down a mass vaccination center in its worst-hit state Tuesday after more than 200 medical staff and volunteers tested positive for the coronavirus. The closure was the first of a vaccination center and came as the country’s new confirmed infections breached five figures Tuesday, hitting a record 11,079. Science Minister Khairy Jamaluddin stressed that swift government action had contained the cluster at the Ideal Convention Center in central Selangor state. Khairy, who is in charge of the national immunization program, said he ordered the testing of all 453 workers at the center after two volunteers were confirmed to have the virus. Khairy said the 204 whose results were positive had low viral loads, meaning the amount of virus in their bodies was small. Read:Immunized but banned: EU says not all COVID vaccines equal This could be because 88% or 400 of the workers have already been vaccinated, he said. The center was shut for deep sanitization and all its workers are being isolated. Khairy said it will reopen Wednesday with a new team of medical workers. He urged people who were vaccinated at the center since Friday to isolate themselves for 10 days and be tested if they develop symptoms. He declined to say how many people had visited the center since Friday. It has the capacity to deliver up to 6,000 shots a day. “This is the first time we had to shut down a (vaccination center) because of positive cases but we acted fast. By shutting it down today and by taking corrective measures ... we hope the disruption is only one day and that this will not hamper the vaccination process,” Khairy said. Read: FDA adds warning about rare reaction to J&J COVID-19 vaccine He said it would be safe to visit the center starting Wednesday for vaccinations. Khairy said health measures at all other vaccination centers will be tightened, but didn’t order other workers to be tested. Selangor, the country’s richest state bordering Kuala Lumpur, is the worst hit by the pandemic. It accounted for nearly half of Tuesday’s new cases, partly because of increased virus screening amid a tight lockdown. The government has struggled to contain the pandemic, which has worsened despite a lockdown since June 1. Total confirmed cases have soared by 50% since June 1 to 855,949, while deaths have more than doubled to over 6,200. Read: South Africa ramps up vaccine drive, too late for this surge Hospitals especially in Selangor have been overwhelmed, with some patients reportedly being treated on the floor due to a lack of beds, and corpses piling up in mortuaries. Vaccinations have picked up, with 11% of the population now fully inoculated. At least a quarter of the country’s 32 million people have received at least one dose of vaccine. The daily vaccination rate surpassed 420,000 doses on Monday, the national Bernama news agency quoted Prime Minister Muhyiddin Yassin as saying, He expressed confidence that the fast pace of vaccination would help stem the outbreak.

Malawi has burned nearly 20,000 expired AstraZeneca vaccines, amid conflicting advice over what to do with the doses. Health Minister Khumbize Kandodo Chiponda put some of the vials of the expired doses into an incinerator to start the destruction Wednesday at Kamuzu Central Hospital in Lilongwe, the capital. “We are destroying (these vaccines) because as government policy no expired health commodities are to be used,” she said. “Historically under the expanded immunization program of Malawi no expired vaccine has ever been used.” She said burning the vaccines will build public confidence that all vaccines used in Malawi are good. Read: US going to be largest sharer of vaccines with 80mn additional doses: Official “We are destroying publicly in order to stay accountable to Malawians. The vaccines that expired are not being used during the vaccination campaign,” she said. “On behalf of the government, I assure all Malawians that no one will be given an expired COVID vaccine.” The burned vaccines were the remainder of 102,000 doses that arrived in Malawi on March 26 with just 18 days until they expired on April 13. All other doses of the shipment, donated by the African Union, were successfully administered, she said. The health minister thanked WHO, the African Union and India for donating the vaccines. “This has made it possible for Malawi to embark on the COVID vaccination campaign currently underway,” she said. Last month the World Health Organization urged African nations not to destroy expired doses of the AstraZeneca vaccine after several countries received doses from India with a very short shelf life. But this week, WHO reversed its position and said that the vaccines should be destroyed. “Any vaccine that has passed its expiry date ... should not be administered,” said WHO in a statement dated May 17. “While discarding vaccines is deeply regrettable in the context of any immunization program, WHO recommends that these expired doses should be removed from the distribution chain and safely disposed.” Read: India to begin clinical trials for Covd-19 vaccine in children WHO said that in March, the African Union’s African Vaccine Acquisition Task Team redistributed 925,000 doses of the AstraZeneca vaccine produced by the Serum Institute of India with an expiry date of April 13 to 13 African countries. “The bulk of these vaccine doses were administered, but some countries have unused doses remaining,” said the WHO statement. Malawi, a small southern African country of about 20 million people, had already decided to destroy its expired vaccine doses, ministry of health spokesman Joshua Malango told The Associated Press. “We had stopped observation of proper storage mechanisms and the vaccines would have still been damaged in one way or the other,” he said. The destruction of the vaccines was witnessed by several top officials “in order to enhance transparency,” health secretary Charles Mwansambo said. Malawi will still have adequate stocks of COVID-19 vaccines in both public and private health facilities, he said. The government has not said where it will get more vaccines. Malawi’s got its first consignment of 360,000 AstraZeneca doses in early March from the U.N.-backed COVAX initiative which is providing vaccines to low- and middle-income countries. The country received another batch of 50,000 AstraZeneca doses from the Indian government. With the AU donation, Malawi had a total of 512,000 AstraZeneca doses. So far 212,615 doses have been given in Malawi. The country has 34,216 confirmed cases, including 1,153 deaths, according to the Africa CDC. Read:Biden boosting world vaccine sharing commitment to 80M doses Currently, the country is seeing a decrease in the disease, with the 7-day rolling average of daily new cases in Malawi dropping from 0.07 new cases per 100,000 people on May 4 to 0.04 new cases per 100,000 people on May 18. Official deaths from COVID-19 are also declining, according to statistics from Johns Hopkins University. Malawi, like many other African countries, has relied on the AstraZeneca vaccine that has been distributed by COVAX and the African Union. But now supplies of the vaccine have become more scarce because India, the main supplier of vaccines to COVAX, has stopped exports until it has adequately vaccinated large numbers of its population of 1.4 billion people. The Serum Institute of India says it hopes to start delivering coronavirus vaccines to COVAX and to other countries by the end of the year. The delay will significantly set back global efforts to immunize people against COVID-19. India’s Serum Institute is the world’s biggest vaccine-maker. The company said in March that it was postponing all exports of coronavirus vaccines to deal with the explosive surge of cases on the subcontinent. At the time, the World Health Organization said it expected COVID-19 vaccine deliveries from India to resume by June and the interruption would affect about 90 million doses.