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 Walensky, director of the
Centres for Disease Control and Prevention, said 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. “CDC is crystal clear on what people should do: If
they’re eligible for a boost, they should get boosted.”
With omicron’s sharp rise, some experts
think the moment for change has arrived. “I think the time is now,” said Dr
Georges Benjamin, 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, executive vice president of
KFF, a nonprofit organisation that focuses on health issues.
The CDC currently defines “fully
vaccinated” as those who have received two doses of the Pfizer-BioNTech or
Moderna shots, or one dose of the Johnson & Johnson shot.
Although experts continue to believe that
these regimens protect against hospitalisation and death, the vaccines’
effectiveness against infection with the virus wanes over time. What had been
considered full vaccination is substantially less effective against infection
with omicron, which is able to partially evade the body’s antibodies.
A booster dose is likely to shore up the
immune system’s defences against the variant, reducing the odds of breakthrough
infections, emerging research suggests — one reason boosters have become a
pressing public health priority. Israel is now testing a fourth dose, or a
second booster, in health care workers.
“The presence of a variant that is pretty
smart at evading our vaccination has changed the game in a way that I just
don’t think that the federal authorities have had time to process,” said Dr
Robert Wachter, chair of the department of medicine at the University of
California, San Francisco.
“The guidance has to change when the
science changes,” he added.
Although 62% of Americans qualify as fully
vaccinated under the CDC’s current definition, just one-third of those people
have also had a booster dose, including 58% of people 65 years and older,
according to agency data. Only those who are 16 or older are eligible for
boosters.
(Tracking the exact number of boosters can
be tricky, and the CDC has warned that some boosters may be misclassified as
first doses.)
Changing the definition of “fully
vaccinated” could leave roughly 140 million Americans who are vaccinated but
not boosted in limbo about where they stand and what they are eligible to do.
Many schools, businesses, governments and
other institutions have relied on the CDC’s definition of “fully vaccinated” to
establish mandates, requiring people to complete their primary vaccine series
in order to attend school, dine out or remain employed.
But in the new omicron-dominated landscape,
requiring just the initial vaccine series is no longer enough, Wachter argued.
“It’s just nonsensical to have that mandate
coupled with a state of vaccination that we know is markedly less effective
than you could achieve with a completely safe and easy-to-take additional
intervention: one more shot,” he said.
Redefining “fully vaccinated,” and thus the
mandates that rely on it, would be the most effective way to ensure that the
public actually gets the booster shots that officials have been urging, he
added.
The Biden administration has considered
scrapping the term altogether and replacing it with language to the effect that
vaccinations should be “up-to-date,” a phrase that may offer more flexibility
as vaccine requirements change. (It is used to describe other vaccine
regimens.)
The administration was leaning toward
making such a move soon, according to two officials with knowledge of the
discussions.
Defining what it means to be fully
vaccinated depends on defining the public health goal for vaccinations
generally, said Dr Paul Offit, director of the Vaccine Education Center at
Children’s Hospital of Philadelphia.
Boosters are likely to provide the best
protection against infection with omicron. But for most healthy young people,
the original two-shot series — or one dose of Johnson and Johnson — should be
sufficient to prevent hospitalization and death, Offit said. If that’s the
purpose of vaccination, then “these vaccines continue to hold up,” Offit said.
Dr Philip Krause, a former top vaccine
regulator at the Food and Drug Administration who retired last month, called
efforts to redefine full vaccination a “distraction” from other public health
priorities, adding that large vaccine efficacy studies and the CDC’s own data
show two doses protecting strongly against severe COVID-19.
“The place where the risk is highest —
among the elderly, the immunocompromised, people with comorbidities — those are
the people accounting for almost all of the severe disease among the
vaccinated,” he said. “We should be concentrating on finding those people” for
booster shots, in addition to getting first doses to the unvaccinated, he
added.
Changing the definition of “fully
vaccinated” also is likely to intensify legal challenges to vaccination
requirements, said Levitt, of KFF. The Biden administration’s attempt to
mandate that large employers require employees to be vaccinated is already
bogged down in the courts.
And requiring all workers to be boosted
soon may be untenable in industries that are already struggling with labour
shortages, he said.
“With so few Americans boostered at this
point, it would be chaos in workplaces to all of a sudden require a third
shot,” Levitt said, noting that for people who received the Pfizer-BioNTech or
Moderna vaccines, boosters are not recommended until six months after the
primary vaccine series. “It would take quite a bit of lead time to even
implement a requirement for boosters.”
That has not stopped some companies and
state officials from pressing ahead with booster requirements.
Goldman Sachs, which called most workers
back to the office in June, will mandate booster shots for all eligible
employees by Feb 1. And Jefferies, the investment bank, told its staff that
people returning to the New York office and attending the bank’s events will be
required to have boosters by the end of January.
“This will not just be about Jefferies, as
we anticipate that health authorities will soon consider only boosted
individuals as ‘fully vaccinated,’ ” the company’s CEO, Rich Handler, and its
president, Brian Friedman, wrote in a memo to staff.
The University of Oregon will require
students, faculty and staff to get boosters by Jan. 31 or 30 days after they
become eligible, joining a growing list of institutions with similar
requirements. The University of Massachusetts issued a similar requirement
Wednesday.
Omicron is surging in the Northeast, and
Gov Kathy Hochul, Democrat of New York, has said she plans to alter the
definition of “fully vaccinated” to include having a booster shot. Gov Ned
Lamont, Democrat of Connecticut, said in November that residents should not
consider themselves vaccinated unless they had had boosters.
But booster recommendations like those may
need frequent revision as new variants appear and time passes, and it may not
make sense for employers to require each new recommended shot, said Dr Camille
Kotton, an infectious disease physician at Massachusetts General Hospital and
an adviser to the CDC.
And although changing the definition could
encourage some Americans to get boosters, it could also harden opposition to
vaccination among those who have not yet received any doses, experts
acknowledged.
“People start questioning the science,
questioning whether or not we really know what we’re doing — questioning, you
know, am I gonna have to do this every six months?” said Benjamin, who supports
changing the definition despite these challenges.
A redefinition would also lump together two
very different groups: those who have received their primary shots and those
who have received no doses at all, said Keri Althoff, a public health
researcher at the Johns Hopkins Bloomberg School of Public Health.
Collapsing these groups into a new
unvaccinated-partially-vaccinated category could make it more difficult for
researchers to track important public health data or for officials to target
their vaccine messaging, she said.
Ensuring that 38% of Americans who have not
completed their primary vaccine series do so should remain the top priority,
she said: “We cannot lose sight of that group.”
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