Public Health vs ‘The Science’
The CDC is weighing changing the definition of "fully vaccinated."
NYT (“As Omicron Spreads, Officials Ponder What It Means to Be ‘Fully Vaccinated’“):
Goldman Sachs and Jeffries, the investment banks, are demanding that employees get booster shots. The University of Oregon and other institutions are requiring that students and staff members get boosters. New York State has said it plans to stop considering residents fully vaccinated unless they’ve gotten the shots.
As the highly transmissible Omicron variant spreads from coast to coast, corporations, schools, governments and even sports leagues are reconsidering what it means to be “fully vaccinated.”
Now federal health officials, too, have taken on the question. Although top policymakers want to encourage Americans to get three doses, some would like to avoid changing the definition of a phrase that has become pivotal to daily life in much of the country, according to officials who spoke on condition of anonymity to describe internal deliberations.
Dr. Rochelle P. Walensky, the C.D.C. director, said in an interview on Tuesday that she and other health officials were “working through that question” now.
“There really isn’t debate here in what people should do,” she added. “C.D.C. is crystal-clear on what people should do: If they’re eligible for a boost, they should get boosted.”
With Omicron’s sharp rise — more than 488,000 new cases were reported on Wednesday alone — some experts think the moment for change has arrived. “I think the time is now,” said Dr. Georges C. Benjamin, the executive director of the American Public Health Association. From a medical perspective, he said, receiving that additional booster dose “is really what we should be thinking of as fully vaccinated.”
Redefining “fully vaccinated” could lead to enormous logistical challenges, as even supporters of the idea concede, and it is likely to incite political backlash. Tens of millions of Americans who thought of themselves as vaccinated might discover that without boosters, they could lose access to restaurants, offices, concerts, events, gatherings — any place where proof of vaccination is required to enter.
Moreover, the change risks undermining trust in public health officials after two years of shifting recommendations, experts said. Some Americans may feel that the goal posts have been moved again, and too suddenly.
“While a determination of what constitutes full vaccination may be grounded in science, it does have significant political and economic ripple effects,” said Larry Levitt, the executive vice president of KFF, a nonprofit organization that focuses on health issues.
This reinforces several interrelated points I’ve been making since quite early in this pandemic.
First, while public policy in this area should be very much be grounded in “the science,” it can’t be made by scientists. While epidemiologists and other experts have expertise that needs to be folded into decisions, weighing the competing priorities involving such things as school and business closures, vaccine and mask mandates, and all manner of complicated choices that all carry substantial downside risk is ultimately the job of elected officials.
Second, this is all complicated by the very nature of science. We’ve known from the very beginning—two years ago now—that we were dealing with a “novel” coronavirus. By definition, that meant that our knowledge would evolve quickly but, alas, painfully as the disease spread and trial and error increased our information. Which, from a non-expert standpoint, means that the scientists will be “wrong” a lot in full view of the public. For the scientists, that’s completely normal. Best practices simply evolve as we know more. But, for the public, it comes across as the experts not knowing what they’re doing.
Third, and directly related to the first two, those in charge of health policy have to shade their recommendations with an eye to public opinion even if that means policies are suboptimal compared to the best scientific understanding. It does no good to issue edicts that aren’t going to be followed. And incentives matter.
I’ve supported the idea of vaccine passports because the small tradeoff in freedom of having to prove one’s vaccination status would encourage the hesitant to do what’s good for the public health while at the same time helping get economic and social activity back to normal. I was skeptical of the CDC decision that gave those who were vaccinated the green light to resume normal activity sans implementation of a passport system because it encouraged free riding.
It’s rather obvious at this point that being “fully vaccinated” means an mRNA booster on top of whatever initial regime one has had. My wife and I got ours soon after being eligible and our three over-18s will get theirs soon. (The 13-year-old isn’t eligible and the 10-year-old just received her second Pfizer jab yesterday.) Whether the negative externalities of being unboosted are sufficient to mandate boosters for most people is another story. And whether raising the bar from two shots to three will make it less likely that the hesitant but not defiant crowd will get their initial shots is another one.