The definition of Full vaccination against COVID-19 has been a bit difficult to pin down since winter. It takes a Johnson & Johnson dose, but it takes two doses of an mRNA vaccine. The CDC will count you as fully vaccinated as soon as you receive your last vaccination, however told that you will not be fully vaccinated until two weeks later. People find it difficult to know exactly when it is safe for them to go to restaurants, wedding venues or mask-free offices.
Now, in the age of booster vaccinations and breakthrough cases, the term has become even more opaque. Early today, the CDC officially supported booster shots for tens of millions of Americans six months after their second dose of Pfizer: those over 65, those in long-term care facilities, and all adults who have an underlying medical condition that puts them at high risk or who are at high risk for severe COVID-19 to fall ill due to occupational or institutional exposure to the coronavirus.
During a two-day meeting of the CDC’s Advisory Committee on Vaccination Practices this week, CDC’s Sara Oliver informed the committee that the agency’s definition of fully vaccinated wouldn’t change – at least for now. That makes it much less useful as a category: will some fully vaccinated people be more vaccinated than others? And it leaves open the possibility that the definition might change as more information becomes available: if you are fully vaccinated now, could you not be fully vaccinated in a few months? These questions go beyond semantics. As more and more Americans are required to be “fully vaccinated” in order to work – see here, here, and here, for example – continuous clarity about what this category means and who belongs in it will be crucial.
Fully vaccinated does not come from the coronavirus. The term has been used for other series of vaccines that require multiple vaccinations, such as: measles, Hepatitis B., and HPV. Currently, the CDC considers people to be Full vaccination achieved against COVID-19 “2 weeks after your second dose in a 2-dose series, such as the Pfizer or Moderna vaccine, or 2 weeks after a single-dose vaccine, such as the Janssen vaccine from Johnson & Johnson”. The agency’s website has a caveat: for the immunocompromised, full vaccination may not be the same as full vaccination protectedso a third shot is a good idea.
Part of the problem is that the American public has not been fully explained the difference between full vaccination and full protection. The truth is that no one is 100 percent protected from the coronavirus after vaccination, regardless of how healthy their immune system is; That’s just not how vaccines work, especially in the context of a pandemic virus that is constantly evolving. “You can’t definitely say until we finally defeat the virus or have brought it to the point that it no longer kills people that it is you” [fully] protected, ”says Ruqaiijah Yearby, health law expert and co-founder of the Institute for Healing Justice and Equity at Saint Louis University.
Even before booster vaccination was a common option, the concept of full vaccination could lead people to develop what Saskia Popescu, an infectious disease epidemiologist at George Mason University, calls a “Superman Complex.” After their J&J syringe or their second dose of mRNA, some people immediately feel invincible, she told me, as if nothing they do is dangerous to themselves or the people around them. The ongoing discussion about boosters could be an opportunity to undo the Superman complex by adding a few nuances and reminding the public that no vaccine is perfect and that we must all work together to bring the pandemic under control. Such rethinking could even go beyond COVID vaccines. “Maybe we need to rethink how we communicate vaccines in general,” said Popescu.
However, a sudden splash of nuance could confuse a lot of people, and even prevent some from getting their first shot, by making the process particularly tangled or onerous. For schools, businesses, and other institutions that have introduced vaccine requirements in the past few months, this would likely be a nightmare. If two vaccinations do not guarantee that you are fully vaccinated, who should be allowed to come to work? Do schools need to interview every teacher who was vaccinated before April about their medical history?
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Now that the CDC has recommended that a select segment of the population receive a third dose to prevent them from falling ill and spreading the virus, institutions that need full vaccination will face some difficult decisions. Should they require 40-year-olds with a weakened immune system to have a third shot, while not asking for anything more from 40-year-olds with a healthy immune system? Should they only require proof of booster vaccination from those who received the Pfizer vaccine because they are the only ones who have been approved to booster? Or would it make more sense for companies to stick to the definition of? fully vaccinated that you have used so far?
Seema Mohapatra, a visiting law professor at Southern Methodist University, told me that establishing different rules for different people would likely not create legal obligations for the mandating party, but could create “practical administrative problems.” For example, restaurants and theaters have no way of checking the health of their guests, so they can’t know who falls into a booster-eligible category. Human Resources would have a hard time keeping track of what vaccine Carol received from the accounts department, how long it has been since her last dose, and how that relates to her 65th birthday.
There are also ethical issues to consider: even if it’s legal, is it really fair to ask important workers and immunocompromised people to be given more doses than others to make a living or just to go out to eat? Given that many underserved communities are still struggling to access the footage, they even ask more the weakest among us – without accompanying guidelines that allow them to be shot at their homes and workplaces, guarantee them paid time off and offer them severance pay – would be difficult to justify.
According to Jason Schwartz, a vaccination policy expert at the Yale School of Public Health, the problem isn’t just with updates that affect different people differently, but with constant, complicated changes in policy. If employers and schools update their mandates with each incremental change in the CDC’s recommendations, he told me, their optimizations could backfire and discourage vaccinations. It would be better to wait for the CDC to recommend universal boosters and then update the rules for all of them at once.
At the national level, mandates are unlikely to change much in the near future. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease and Joe Biden’s senior medical advisor, said The Atlantic this week that at least for the next few weeks “any vaccine mandates must be in line with the original vaccine regime”. Paul Offit, who directs the Vaccine Education Center at Children’s Hospital of Philadelphia and is a member of the FDA Advisory Committee, who last week recommended the approval of third doses of Pfizer for a select group, told me that about a three-dose mandate , “I just don’t think it’s right now.”
Continuous clarity on who is considered fully vaccinated would not only help employers set rules. It would also give researchers more accurate language to study breakthrough infections and vaccine effectiveness. Popescu pointed out that a revised definition of fully vaccinated could allow multiple definitions of partially vaccinated even. Are those who didn’t get their second dose of mRNA really in the same category as those who got their second injection more than six months ago but haven’t been given a booster yet? Should a breakthrough infection be weighted the same in the first group as one in the second to assess how well the syringes are working or who is safe to invite to your dinner party?
A common criticism of boosting promotion is that there is no limit to how we could need an injection for the rest of our lives for a fourth or fifth, or every six months. “I think the endgame is likely to be a vaccination program in a year or two that has the vaccine updated regularly and given to everyone on a set schedule,” Schwartz said. COVID vaccinations can even be combined with annual flu vaccinations.
When this happens, employers and schools will have to make new decisions about mandates, such as whether to require their employees to inject each year or to provide these recordings on-site. The longer we live with the endemic COVID and the more normal and predictable boosters we become, the easier these conversations will be.
Katherine J. Wu contributed to the coverage.
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Reference: www.theatlantic.com
