On Friday, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention (CDC) defended her decision to split with an advisory panel in recommending COVID-19 booster shots for people who work or live in high-risk settings.

The CDC’s Advisory Committee on Immunization Practices voted Thursday to recommend third doses of the Pfizer-BioNTech vaccine for people who are 65 and older, as well as younger adults who have underlying medical conditions. In making the agency’s final determination, Walensky endorsed both of those votes. 

The panel, however, voted 9-6 against recommending boosters to adults who have jobs that might put them at an increased risk for infection or those who live in institutional settings, such as prisons and homeless shelters. Some members of the advisory committee expressed concerns that recommending third doses for such a wide range of people — a group that includes health care workers, teachers and grocery store employees, to name a few — would effectively open the door for the vast majority of U.S. adults being able to receive the shots.

In a highly unusual move, Walensky went against the advisers’ wishes and also recommended booster shots for people who work or live in high-risk settings. Her decision put the CDC’s recommendations more in line with the Food and Drug Administration’s approval earlier this week for Pfizer boosters.

“As CDC director, it's my job to recognize where actions can have the greatest impact in a pandemic,” she said during a White House COVID-19 response team briefing Friday. “We most often take steps with the intention to do the greatest good, even in an uncertain environment, and that is what I'm doing with these recommendations.

“I must do what I can to preserve the health across our nation,” Walensky added.

The CDC director noted that frontline workers were also prioritized in the initial rollout of the vaccines. She called them “everyday heroes of our society.”

Walensky also said the pandemic has had a disproportionate impact on racial and ethnic minorities and that “many of our frontline workers, essential workers and those in congregate settings come from communities that have already been hardest hit.”

“Withholding access for boosters from these people and communities would only worsen the inequities that I have committed to fight against,” she said.

Walensky insisted she did not “overrule” the advisory committee. She said she listened intently to the advisers’ debate and called the issue a “scientific close call.”

“In that situation, it was my call to make,” she said. “If I had been in the room, I would have voted yes, and that’s how my recommendations came out after listening to all of their scientific deliberations.”

When asked whether she was concerned that her decision to go against the committee’s advice might shake public confidence in the process, Walensky answered: “I would say they should listen to the deliberations themselves. We did it publicly, we did it transparently, and we did it with some of the best scientists in the country.”

The CDC director also said she suspects the need for booster shots will expand to larger swaths of the population over time and that she’s committed to updating the CDC’s guidance accordingly.

Regulators have not yet met to discuss authorizing booster shots for the Moderna and Johnson & Johnson vaccines. Surgeon General Dr. Vivek Murthy said Friday the FDA is working closely with those vaccine makers to review their data as quickly as possible with the goal of making recommendations in the coming weeks. He called it a “high, high priority.”

“Your health matters just as much as other vaccine recipients, and we want to make sure that your protection against COVID is strong and reliable as well,” Murthy said, directing his comments to those who have been vaccinated with the Moderna and J&J shots.