Aug 18, 2021 - Health

The case for coronavirus booster shots for Americans

Illustration of a syringe bent into the shape of a number three

Illustration: Annelise Capossela/Axios

The Biden administration's decision to offer booster shots of coronavirus vaccine to most Americans comes down to staying ahead of declining vaccine effectiveness — especially if effectiveness against severe disease eventually begins to drop.

Why it matters: Even with more than half of the population fully vaccinated — well above most of the rest of the world — the coronavirus is still causing a domestic crisis, and the administration is determined to avoid worst-case scenarios.

“No one wants to have decreasing vaccine efficacy against severe disease when you’re seeing it decrease against mild to moderate disease. You want to get ahead of that," a senior Biden official told Axios.

Driving the news: The White House coronavirus team will today address the subject of boosters in a briefing, and the president will speak after, White House Press Secretary Jen Psaki said yesterday.

  • Multiple news outlets, including Axios, reported Monday night that the administration is coalescing around a plan to give most Americans booster shots around eight months after their first round of vaccines.
  • New CDC data showing a drop in vaccine effectiveness over time — viewed by the administration's COVID task force over the weekend — ultimately prompted the decision, Politico reported yesterday.

The big picture: New data released by other countries and non-governmental researchers has shown a significant decline in the vaccines' effectiveness against infection.

  • However, no data has yet shown a big decline in their effectiveness against severe disease, and the vast majority of Americans currently hospitalized are unvaccinated.
  • It's unclear whether the decline is because of the vaccines' effectiveness waning over time, against the Delta variant, or both. Breakthrough cases are more dangerous for some populations, like the elderly, than others.

What they're saying: “Effectiveness against severe disease may have held, but you don’t know how long it’ll hold," said a source close to the administration. "If you know effectiveness declines and you know you can increase your immunity, why wouldn’t you?”

  • “You are conservative in your planning or else you risk a lot of bad outcomes in vulnerable people," the source added.

Between the lines: The administration's decision balances competing longer-term risks. On one hand, it's possible vaccine effectiveness against severe disease does wane in the future.

  • On the other hand, the virus is still spreading much more rampantly among the unvaccinated, including in pockets of the world that still don't have access to shots. That could easily become America's direct problem if it results in a new variant that can evade vaccine protection.
  • Experts are generally much more concerned with the latter.
  • "If we want the vaccine to protect us against symptoms and transmissions (in the first world), then we do so at the cost of others around the globe & the cost of future variants," former Biden coronavirus advisor Andy Slavitt tweeted.

Boosters could also slow the spread of the virus, which could help protect millions of unvaccinated Americans and those at high risk if they do develop a breakthrough case.

  • "The political realities favor the kind of choice we’ve been seeing made all pandemic. Protect well off first to the nth degree before we consider others," Slavitt wrote.

The bottom line: The decision to boost most adults' protection against the virus may not be morally sound in the eyes of many epidemiologists or the World Health Organization, nor is it guaranteed to be the best decision for Americans in the long term. But politically? It's a no-brainer.

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