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.

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 A. Offit, the 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, Dr. Offit said. If that’s the purpose of vaccination, then “these vaccines continue to hold up,” Dr. Offit said.

Dr. Philip R. 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 C.D.C.’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.

Changing the definition of “fully vaccinated” also is likely to intensify legal challenges to vaccination requirements, Mr. Levitt, of KFF, said. 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 labor 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,” Mr. 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.”

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’d 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 C.D.C.

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 Dr. 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, an epidemiologist 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 percent 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.”

Emma Goldberg contributed reporting.



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