米ＦＤＡ、新型コロナワクチン接種を６５歳以上・高リスク者に限定へ

【ワシントンＡＦＰ＝時事】米食品医薬品局（ＦＤＡ）は２０日、新型コロナウイルスワクチンの追加接種を６５歳以上、または深刻な基礎疾患がある人に制限する方針を示した。６５歳未満で基礎疾患のない個人に関しては、ワクチンを製造する製薬会社に新たな臨床試験の実施を義務付けるとしている。（写真は新型コロナウイルスワクチンの案内をする薬局。米ニューヨークで）
　ＦＤＡのマーティン・マカリー局長とビナヤク・プラサド氏は、ニューイングランド・ジャーナル・オブ・メディシン誌への寄稿で、この政策転換は「エビデンスに基づいた」ものと位置付け、米国を欧州の指針に近づけると主張している。
　米国ではワクチン懐疑論者のロバート・Ｆ・ケネディ・ジュニア厚生長官が、連邦公衆衛生政策の改革を推進している。
　ケネディ氏は以前、予防接種プログラムを批判する非営利団体を率い、新型コロナの感染拡大時期には、頻度としてはまれだが、ワクチン接種後に心筋炎や心膜炎などを発症することを理由に、新型コロナワクチンの承認を取り消すようＦＤＡに要請していた。
　マカリー・プラサド両氏は、初期の新型コロナワクチン接種は「科学・医学・規制上の成果」だと称賛する一方、低リスクの個人へのワクチン追加接種の利点は不確実だと主張。
　年齢や健康状態に関係なく、すべての成人に追加接種を推奨した米国の手法は、国民の信頼を築くどころか裏目に出て、麻疹（はしか）など、子ども向けの予防接種に対するワクチン懐疑論を助長したとしている。
　ＦＤＡは、６５歳以上、または生後６か月以上で基礎疾患が少なくとも一つある場合の追加接種については、臨床試験を基に承認。生後６か月から６４歳までの健康な個人への接種に関しては、無作為化臨床試験のデータを要求するとしている。
　ＦＤＡは一方で、新たな枠組みの下で追加接種を受けられなくなるかもしれないとの懸念を払拭（ふっしょく）するため、疾病対策センター（ＣＤＣ）のリスク要因の定義は「広範囲で、肥満や、うつ病などの精神疾患も含まれる」として、１億人から２億人の米国民が依然として追加接種の資格を得られる可能性があると指摘している。【翻訳編集ＡＦＰＢＢＮｅｗｓ】
〔ＡＦＰ＝時事〕（2025/05/21-19:02）

The United States will limit Covid-19 boosters to people over 65 or those at risk of serious illness, while requiring vaccine makers to run fresh clinical trials before offering shots to younger and healthier individuals, officials said Tuesday.
Writing in the New England Journal of Medicine, the Food and Drug Administration's Vinayak Prasad and Commissioner Martin Makary framed the policy shift as evidence-based and would align the United States more closely with guidance in Europe.
But it comes as Health Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic, pushes to remake federal public health policy.
Kennedy previously led a nonprofit that was critical of immunization programs, and during the pandemic petitioned the FDA to revoke Covid vaccine authorizations, citing rare side effects including heart inflammation.
Prasad and Makary praised the initial Covid-19 vaccine rollout as a major scientific, medical, and regulatory accomplishment, but argued that the benefits of repeated boosters for low-risk individuals are uncertain.
They criticized the US approach of recommending boosters for all adults regardless of age or health status, calling it a one-size-fits-all model based on the mistaken belief that Americans couldn't handle more nuanced, risk-based advice.
Rather than building public trust, they wrote, it had backfired -- fueling vaccine hesitancy that has spilled over into skepticism toward childhood shots, including those for measles.
The FDA said it would rely on lab test results to approve boosters for people who are over 65, or over six months old with at least one underlying condition.
But for healthy individuals between six months and 64 years, regulators will now require data from randomized trials.
We simply don't know whether a healthy 52-year-old woman with a normal BMI (body mass index) who has had Covid-19 three times and has received six previous doses of a Covid-19 vaccine will benefit from the seventh dose, they wrote.
Some infectious disease experts welcomed the shift.
Amesh Adalja of Johns Hopkins University said it matched with the approach taken by other countries in a population that already carries significant immunity.
For lower-risk individuals, the goal has always been less clear, as protection against infection is transient and they don't have a high risk of severe disease, he told AFP.
But others voiced concern about the practical consequences. Paul Offit, a leading vaccine expert at the Children's Hospital of Philadelphia, said it could limit access for people who still want boosters.
Any use, say in a healthy 35-year-old, would be considered off-label, and you wonder whether an insurance company would pay for it, he told AFP.
- Not like annual flu shot -
Under the revised framework, companies like Pfizer and Moderna will be encouraged to test updated boosters in adults aged 50 to 64.
These studies should measure whether the vaccines reduce symptomatic infections, hospitalizations and deaths.
Rather than comparing new shots to earlier formulations, Prasad and Makary suggested placebo-controlled trials -- with saline as the comparator -- to better evaluate both benefit and potential side effects.
The proposal, first floated by Kennedy earlier this month, has proved divisive. Critics argue that using a placebo -- when authorized vaccines already exist -- could expose participants to unnecessary harm.
Imagine if there was a death or two in the placebo group, said Offit. I don't see how you conscience that.
Supporters of continued Covid-19 boosters often draw parallels to annual flu shots.
But Makary and Prasad pushed back on that comparison, arguing the genetic changes in Covid variants haven?t been significant enough to justify automatically updating the vaccine each year.
The FDA officials also sought to reassure Americans concerned they might lose access to boosters under the new framework.
The Centers for Disease Control and Prevention's (CDC) definition of risk factors is vast, including obesity and even mental health conditions such as depression, they wrote, noting that between 100 million and 200 million Americans would likely still qualify.