The FDA formally authorized booster shots of the Pfizer-BioNTech vaccine for adults over 65, those who are at high risk of severe Covid-19, or those who are at risk of serious complications because of exposure to the virus in their jobs. There’s a lot of ambiguity in those requirements. Now the question turns to who exactly needs a booster shot and when? The New York Times writes: “Roughly 22 million Americans are at least six months past their second Pfizer dose, according to the C.D.C. About half are 65 or older. But who exactly risks becoming severely ill? What does it mean to be exposed on the job? Do teachers count as exposed, or just frontline health care workers? And what about Americans who got the Moderna and Johnson & Johnson shots?”

One day after the FDA announcement, scientists on the C.D.C.’s Advisory Committee on Immunization Practices began tackling these complicated issues. Director Rochelle Walensky signed off on a series of recommendations, saying boosters should be offered to people 65 and over as well as those 50 to 64 years with underlying medical conditions. People with underlying medical conditions ages 18-49 may also get shots. The extra dose would be given at least six months after the last shot. But one of Dr. Walensky’s endorsements broke from the panel’s recommendation, saying people may be offered boosters if they are ages 18 to 64 years and are healthcare workers or have another job that puts them at increased risk of being exposed to the virus.

And just as the booster shot campaign begins, hospitals across the country are grappling with workforce burnout and staffing shortages. Lisa Tomasso, spokeswoman for the Hospital Association of Rhode Island, told the Boston Globe, “The healthcare workforce shortage existed prior to COVID-19. The pandemic and its protracted nature have only exacerbated that problem.” In New York, hospitals and nursing homes are bracing for the possibility that a statewide COVID-19 vaccine mandate for health care workers could lead to staff shortages when it takes effect Monday. To ensure there’s enough staff to care for all the patients, hospitals and nursing homes were preparing contingency plans that included cutting back on elective surgeries and, at one hospital, halting maternity services.

Finally, taking a novel and innovative approach to tackling health inequities, Blue Cross Blue Shield of Massachusetts will begin paying doctors more money if they close longstanding, harmful gaps in care for people of color. In an interview with WBUR, Dr. Mark Friedberg, Blue Cross Blue Shield of Massachusetts Senior Vice President of Performance Measurement and Improvement, said, “We are taking these steps to really, in an intentional way, try to improve the equity of care, because this has been a longstanding interest of the company.” Details of the financial incentives are still being worked out, but they would apply to doctors who care for Blue Cross Blue Shield members in Massachusetts and could be implemented by 2023.