To: Governors of California, Nevada, Oregon, and Washington State

• Governor Gavin Newsom, California
• Governor Steve Sisolak, Nevada
• Governor Kate Brown, Oregon
• Governor Jay Inslee, Washington
  

From: Arthur Reingold, MD, Chair, Western States Scientific Safety Review Workgroup

At its meeting on January 5, 2022, the Western States Scientific Safety Review Workgroup carefully reviewed the data presented at the U.S. C.D.C. Advisory Committee on Immunization Practices (ACIP) meeting held the same day concerning the recommendation that children ages 12-15 years who received a two dose primary series of Pfizer BioNTech COVID-19 vaccine should be given a booster dose five months after the second dose.

The Workgroup also reviewed the recommendations made by CDC on January 4, 2022 that:

1. The minimum interval between completion of a two dose primary series of the Pfizer BioNTech COVID-19 vaccine and eligibility for a booster dose be shortened from six months to five months for those 12 years of age and older and
2. For immunocompromised children 5-11 years of age, a third dose of the Pfizer BioNTech COVID-19 vaccine be added to the primary series.
   

The Workgroup discussed the data presented at the ACIP meeting concerning the current surge of infection with the Omicron variant of SARS-CoV-2 in the United States; the numbers of COVID-19 cases and hospitalizations in various age groups, including children 5-11 years of age; the evidence of waning immunity following receipt of an initial two dose series of Pfizer BioNTech COVID-19 vaccine; the effectiveness of a booster dose of the vaccine in increasing protection against COVID-19; and the evidence available to date concerning the incidence of myocarditis and other adverse events following receipt of a first, second, and booster dose of the Pfizer BioNTech COVID-19 vaccine.

The Workgroup concluded that the available data supported the conclusion that the benefits of giving a booster dose of the Pfizer BioNTech COVID-19 vaccine to those 12-15 years of age substantially outweigh the risks.

The Workgroup also concluded that the CDC recommendations to shorten the permissible interval between receipt of the second dose and the booster dose of the Pfizer BioNTech COVID-19 vaccine in those over 12 years of age and to give a third dose of the vaccine to immunocompromised children 5-11 years of age are reasonable and appropriate. As a result, the Workgroup unanimously supported these changes to the recommendations concerning the use of the Pfizer BioNTech COVID-19 vaccine.

The Workgroup calls on our states to continue to provide COVID-19 vaccines to those who have not yet been vaccinated and to provide booster doses of a COVID-19 vaccine to all who have received an initial COVID-19 vaccination series, in accordance with ACIP and FDA recommendations and CDC guidance and eliminating disparities in vaccine coverage.

The Workgroup recognizes the important contributions of various U.S. systems for monitoring the safety of vaccinations, including COVID-19 vaccines and their central role in guiding vaccination policy. The Workgroup continues to urge all healthcare providers and vaccine recipients to report any suspected adverse events following receipt of a COVID-19 vaccine to the Vaccine Adverse Events Reporting System (VAERS) and vaccine recipients to participate in the v-safe system.

Respectfully submitted: Members of the Western States Scientific Safety Review Workgroup: 

• Arthur Reingold, MD, Chair, UC Berkeley School of Public Health 
  

California Members:

• Tomás J. Aragón, MD, DrPH, California Department of Public Health and State Health Officer

• Oliver Brooks, MD, Watts Healthcare

• Eric Goosby, MD, UCSF School of Medicine
  

• Rodney Hood, MD, UC San Diego Alumnus and National Medical Association (not present at Western States meeting on January 5, 2022)

• Nicola Klein, MD, Ph.D., Kaiser Permanente Northern California

• Grace M. Lee, MD, MPH, Stanford Children's Health and Stanford University School of Medicine

• Bonnie Maldonado, MD, Stanford University School of Medicine and Stanford Children's Health

• Mark H. Sawyer, MD, UC San Diego School of Medicine and Rady Children's Hospitals

• Robert Schechter, MD, California Department of Public Health

• Peter G. Szilagyi, MD, MPH, UCLA Health and David Geffen School of Medicine

• Matt Zahn, MD, Orange County Health Care Agency 

Nevada Members:

• Ihsan Azzam, MD, Ph.D., Chief Medical Officer, State of Nevada

• Karissa Loper, MPH, Health Bureau Chief, Nevada Department of Health and Human Services (not present at Western States meeting on January 5, 2022)
  

Oregon Members:

• Laura Byerly, MD, Virginia Garcia Memorial Health Center (not present at Western States meeting on January 5, 2022)

• Louis J. Picker, MD, OHSU Vaccine and Gene Therapy Institute 

Washington Members:

• John Dunn, MD, MPH, Kaiser Permanente Washington

• Edgar K. Marcuse, MD, MPH, University of Washington School of Medicine