Nov 19, 2021 - Health

The new COVID war: Redefining vaccinated

Illustration of crosshairs targeting a syringe
Illustration: Annelise Capossela/Axios

As health officials push COVID booster shots, a debate is quickly emerging around whether the definition of "fully vaccinated" should be changed to include an additional dose of the vaccine.

Why it matters: Booster shots provide remarkably strong protection against coronavirus infections, at least for a period of time. But getting the majority of Americans to stick out their arm again would be extremely challenging.

Driving the news: Two governors said this week that they don't consider people who haven't received a booster shot to be fully vaccinated.

  • "We're 11 months into the vaccination program. In my view, if you were vaccinated more than six months ago, you’re not fully vaccinated," Connecticut Gov. Ned Lamont said yesterday.
  • "We are analyzing what we can do to create those incentives — and potentially mandates — for making sure that people are fully vaccinated, which means three vaccines," New Mexico Gov. Michelle Lujan Grisham said Wednesday.
  • The New Mexico state health secretary told the AP that changing the definition of fully vaccinated is being discussed, and that he expects a new public health order to be released in the next few weeks.
  • The U.K. will adjust the definition to include booster shots, Prime Minister Boris Johnson said Monday.

Reality check: Only 17% of U.S. adults have received a booster shot, according to the CDC, although many of those people haven't received their primary series within the last six months and are not yet eligible.

Between the lines: NIAID director Anthony Fauci told Axios earlier this week that changing the definition federally "hasn't been on the table yet," but didn't rule it out in the future.

  • That means a patchwork set of definitions could emerge across the country, at least in the short term.
  • And given the growing number of vaccine mandates in place, formally changing the definition of fully vaccinated could be much more significant than a simple change in rhetoric.

The other side: Changing the definition "would have major implications across many aspects of the pandemic, in some cases making it more difficult to control," said Walid Gellad, a professor of medicine at the University of Pittsburgh.

  • "We haven't thought through all the implications to start saying this casually. It's premature," he added.

State of play: The FDA is expected to OK booster shots for all adults at least six months out from their first round of Pfizer or Moderna. The CDC will also begin considering the change today.

  • J&J recipients are already eligible for a booster.
  • Although the federal government currently only recommends booster shots for certain mRNA recipients who are vulnerable to infection or severe disease, many states have plowed ahead and already made all adults eligible six months after their primary round.

The bottom line: Most vaccinated people — particularly younger, healthier ones — are still well protected against severe disease and death with only two doses.

  • But boosters dramatically increase protection against infection, which can help reduce the spread of the virus. They also restore protection against serious infections among vulnerable people.
  • And officials are making the case that merely protecting against hospitalization and death shouldn't be our only goal with vaccines.
  • "I don't know of any other vaccine that we only worry about keeping people out of the hospital," Fauci said at a briefing earlier this week. "I think an important thing is to prevent people from getting symptomatic disease."
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