As COVID-19 evolves, our behavior must evolve with it
President Biden’s order to make third booster shots available to all Americans starting Sept. 20 may have been a well-intended move to try and strengthen immunity against the increasing threat of the delta variant. But the recent resignations of two top U.S. Food and Drug Administration (FDA) vaccine officials do not inspire confidence that the White House has removed politics from public health.
Many public health experts say the data supporting the efficacy of a third shot just isn’t there. Pfizer’s late-stage clinical trial data on the matter won’t be available until next year. Moderna’s research features a sample of just 344 volunteers and hasn’t been peer-reviewed. It’s created “booster confusion,” as one news outlet characterized.
Biden’s announcement raises yet another question that has not been explained: How many shots are now required to be “fully vaccinated”? The answer has far-reaching implications. “Fully vaccinated” has become a universal term upon which employers and governments, federal and state, are basing their return-to-work policies. Will this definition now require three shots instead of two for those who received either the Moderna or Pfizer vaccines? And for those who received the single Johnson & Johnson shot, what will it mean for them?
“That’s a very good question,” said Dr. Anthony Fauci when NBC Nightly News’s Lester Holt pressed him on this very point. Dr. Fauci’s uncertainty is telling — and completely understandable. It captures the challenge public health experts are facing today. They don’t have all of the answers. We shouldn’t expect them to.
If we know one thing about COVID-19 it’s that the virus is constantly changing as it fights to try and stay alive. Public health officials want the pandemic to be over just as much as the public does. But they aren’t working from a how-to manual — and we can’t take their recommendations as declarations set in stone that will never change. We need to evolve, just as the virus is evolving. We must change our mindset in how we view the guidance from public health professionals doing their best to follow the science.
An example: the U.S. Centers for Disease Control and Prevention (CDC) was widely criticized for “reversing course” earlier this month by reinstating the mask mandate. One could argue this wasn’t a reversal at all. The CDC lifted the mask order in the spring because the data at the time supported the decision. The delta variant wasn’t part of the conversation then.
Today, delta is raging in certain parts of the country and overwhelming hospital systems. It’s especially prevalent today in children where over 250,000 new cases were reported the week many returned to school. New data and patterns of the disease require we accept changing public health recommendations aimed at reducing the spread of the virus.
Similarly, many have criticized the unvaccinated, expressing anger toward them that we now have to mask up again “to protect those who don’t want to be protected.” This thinking is not helpful; there will always be a portion of the population that will choose not to be vaccinated, whether out of skepticism, laziness or as a form of political expression. We need to accept this reality and be solution-oriented in how we address it.
It’s why the public health community is working double-time to communicate the facts about vaccine safety. We are shouting from rooftops that the FDA has fully approved the Pfizer vaccine to encourage the unvaccinated to get their shots. The FDA’s decision to change the Pfizer vaccine status from emergency use authorization to full approval also gives companies, schools and municipalities the confidence to impose vaccine mandates to further arrest the spread of the virus.
Public health experts don’t have all the answers on COVID-19 because we are not in control of COVID-19. The safety protocols being recommended today to protect ourselves and those around us may be entirely different from those that will be recommended six months from now. As the pandemic changes, we must adapt accordingly by listening, following, and trusting the data.
But the ability of public health professionals to do their job becomes infinitely harder when elected leaders make proclamations and statements on matters, such as a third booster shot, when the data is still being analyzed. Let’s let science prevail, and give the experts the chance to interpret the results and provide guidance.
And if public health experts have to change certain recommendations in a few weeks or months should a new variant or development materialize, cut them a little slack.
Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.
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