An expert panel advising the Centers for Disease Control and Prevention on vaccines on Wednesday recommended that people 65 and older should get an additional Covid-19 vaccine shot this spring.

If the recommendation is approved by CDC Director Mandy Cohen, as is expected, the United States will join Canada and the United Kingdom in offering a spring booster this year to people at high risk of severe disease if they contract Covid.

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This will mark the third year in a row that spring boosters will be offered, a recognition of the fact that transmission of the SARS-CoV-2 virus continues at substantial levels year round at this point. Influenza and RSV transmission bottoms out in the late spring and summer, but that is not currently the case with Covid.

CDC staff who briefed members of the Advisory Committee on Immunization Practices on the status of Covid transmission noted that while activity peaked over the Christmas period, there are still roughly 20,000 people a week hospitalized for Covid and about 2,000 deaths a week caused by the disease. Over the past year, new Covid hospitalizations have never fallen below 6,000 a week, CDC vaccine expert Megan Wallace told the committee.

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Wallace said Covid hospitalizations are most common among people 65 and older; people 75 and older are most likely to die from the infection. Only about 40% of people 65 and older have received the 2023-2024 vaccine, according to CDC data.

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The recommendation, which was approved by a vote of 11 to 1 with one abstention, is that people 65 or older who have already had a 2023-2024 Covid vaccine should get a second shot this spring, so long as at least four months have passed since the earlier immunization.

Due to a recommendation the committee approved last fall, people who are moderately or severely immunocompromised have already had the ability to get more than one booster dose in a given year. In the case of immunocompromised people, they must wait two months between doses, and additional doses are given after consultation with a health care provider.

It initially appeared that the committee would also require people 65 and older to consult a health care provider before getting an additional Covid shot, with the proposed wording of the original voting question suggesting that people who wanted an additional dose “may” get one. That wording, called a permissive recommendation, requires sign off by a health care provider.

But members of the committee balked, saying an unconditional recommendation — that people 65 and older should get another shot this spring — would be less confusing for physicians and for people who want an additional dose, especially since many people now get Covid shots at pharmacies. Camille Kotton, clinical director for transplant and immunocompromised host infectious diseases at Massachusetts General Hospital in Boston and a member of ACIP, said the public doesn’t know how to interpret a “may” recommendation.

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In the discussion that followed, it became clear that the ACIP’s Covid vaccine work group was trying to strike a delicate balance — making shots available to people who want them without sending an unintended message to people who are standing on the sidelines when it comes to getting Covid shots. The fear is that people who have stopped getting shots — which at this point is a majority of the population, even a majority of people in high-risk groups — could interpret the recommendation of yet another dose as evidence the vaccines aren’t effective long term.

“The ‘may’ sort of provides the permissiveness for people who are already very connected to vaccines and interested in vaccination,” said Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases, who added that “more absolute statements around vaccines sometimes will create a chilling effect for the folks who haven’t been vaccinated.”

But in the end, the committee opted for the stronger recommendation.

David Kaslow, a representative of the Food and Drug Administration who was sworn in as a temporary voting member for the meeting, cautioned that given that there may be a new vaccine approved for use next fall for the 2024-2025 winter season, it would not be optimal for people to get a second dose of the current vaccine later than June.