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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 May 19, 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 5-11 years who received a primary series of Pfizer BioNTech COVID-19 vaccine should be given a booster dose at the same intervals recommended for persons 12 years and older.

The Workgroup discussed the data presented at the ACIP meeting concerning the current situation regarding infection with 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 very low incidence of myocarditis and other adverse events following receipt of a first, second, and booster dose of the Pfizer BioNTech COVID-19 vaccine. In children with moderate or severe immunocompromise, the initial series is comprised of three doses, and the booster dose will be a fourth dose of the 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 5-11 years of age substantially outweigh the risks, particularly in light of the data presented to ACIP concerning the significant but often unappreciated burden of COVID-19-related illnesses, hospitalizations and deaths in children in this age group. ACIP: May 19, 2022

In accordance with ongoing guidance from FDA, ACIP, CDC, the Workgroup calls on our states to strengthen efforts to provide COVID-19 vaccines to those who have not yet been vaccinated, provide booster doses to those not yet boosted, and eliminate disparities in vaccine coverage. The Workgroup also strongly encourages our states to expand their efforts to educate healthcare providers and the public about the benefits of COVID-19 vaccination in children and adults.

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 (not in attendance at Western States meeting on May 19, 2022)
• Rodney Hood, MD, UC San Diego Alumnus and National Medical Association (not in attendance at Western States meeting on May 19, 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 (not in attendance at Western States meeting on May 19, 2022)
• 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 (not in attendance at Western States meeting on May 19, 2022)
• Kyle Devine, Bureau of Child, Family and Community Wellness
• Kristy Zigenis, COVID-19 Vaccine Manager

Oregon Members:

• Laura Byerly, MD, Virginia Garcia Memorial Health Center (not in attendance at Western States meeting on May 19, 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