Aug 6, 2021 - Health

The CDC's booster messaging mess

Illustration of a syringe popping a speech-bubble shaped balloon

Illustration: Sarah Grillo/Axios

The Biden administration — already under fire for its handling of masking guidance — is losing control of the narrative surrounding coronavirus vaccine booster shots.

Why it matters: The vast majority of vaccinated Americans don’t need to worry about their level of protection against the virus, at least not yet. But the void of information from the federal government about what should be expected going forward is being filled by drug companies, other countries and nervous Americans themselves.

The science increasingly suggests that some people — particularly the immunocompromised — need booster shots. Other vulnerable populations may also need them in the coming months.

  • Amid all the chatter, some Americans are taking it upon themselves to go and get a booster shot without any official guidance.
  • “We’re just following. We’re not leading, and this is really a problem here," said Eric Topol, executive vice president of Scripps Research, adding he thinks “we will be moving toward booster shots.”

The big picture: Vaccine makers have been making the case for months that boosters will be necessary for at least some people, other countries have started giving a third round of shots to some populations, and Biden officials are saying that boosters are increasingly likely.

  • However, the public message from the CDC and other federal health officials has been that boosters aren’t necessary now. And if they do become necessary, the U.S. has enough doses.
  • This may be true, but it’s not answering people’s increasingly anxious questions about how long they should expect their vaccine protection to last as Delta continues to spread.
  • “I think they should be clear that the vaccines work and are clearly effective, but over time we’re going to need boosters for the more vulnerable people who got vaccinated early,” said a source close to the administration.
  • “[The CDC has] lost control of the narrative. You’re seeing people make decisions without looking to their guidance or from other sources,” the source added.

Driving the news: Moderna offered a contradictory message Thursday, saying a booster “will likely be necessary prior to the winter season” even though “emerging data also confirms effectiveness against variants of concern,” including Delta.

  • Pfizer has made similar claims. But neither is a very good messenger.
  • “We have Pfizer and Moderna making pronouncements that boosters are necessary when they have an overt conflict of interest. And then to add to the mess, we have people going into drugstores and lying” to get a third shot, Topol said. “This is just chaotic.”

Zoom out: Only a narrow subset of vulnerable people — including the immunocompromised, people older than 80 and nursing home residents — likely need boosters now, said Celine Gounder, an infectious diseases professor at NYU.

  • The administration is expected to recommend a booster shot for certain immunocompromised people soon.
  • But everyone may need another dose eventually, Gounder said.
  • “I think we have to mentally prepare people for that, because I think people like to have some certainty…and they don’t like the ground shifting under their feet too much. It’s scary.”

Between the lines: The messaging problem is compounded by a lack of data.

  • The CDC is tracking vaccine effectiveness over time among specific groups of people, including health care workers and older adults. But that data hasn’t been made public since March — well before Delta became dominant in the U.S. — making Americans reliant on research put out by other countries or the drug companies.
  • “Health England and the Israeli government are putting out substantial information, so unfortunately we’re taking our lead from them," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy.
  • Experts have also been critical of the CDC’s lack of data collection on breakthrough cases.

Recipients of the one-shot Johnson & Johnson vaccine are among the most concerned about protection against Delta. But the data about boosters for J&J recipients just isn’t available yet.

  • The results of clinical trials investigating boosting the initial shot with another dose of J&J as well as with an mRNA vaccine haven’t been published yet, although they’re expected to be released soon.
  • Some J&J recipients didn’t wait and took it upon themselves to get another dose already. And some experts support their decision.
  • This week, San Francisco health officials began allowing patients who got the J&J shot to get another 'supplemental' shot made by either Pfizer-BioNTech or Moderna.
  • “In my opinion, it is now time for J&J vaxxed to get a 2nd dose,” Shane Crotty, a professor at La Jolla Institute for Immunology, tweeted yesterday.

What we’re watching: Clear-eyed communication about who is at risk and who should get a booster will only become more necessary once the vaccines are fully approved by the FDA.

  • Doctors will then have discretion in how they prescribe additional vaccine doses.
  • “Right now, people are lying to get the vaccine booster. A month from now, they’ll have a doctor’s prescription for it,” Topol said. “We’re heading to booster mania.”
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