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Illustration: Sarah Grillo/Axios

Conflicting statements from Pfizer and the Biden administration were just the beginning of what will likely be a contentious debate over if and when vaccinated Americans need another shot to protect them against the coronavirus.

Why it matters: Making decisions based on emerging science is difficult on a good day. But until global supply outpaces global demand for the vaccine, how to allocate doses will remain a life-or-death decision.

Driving the news: Biden administration officials met with Pfizer yesterday afternoon to discuss whether new data suggests that some Americans may soon need a third shot.

  • Sources say officials agreed that they need to continue looking at the data.
  • “For those who are at risk, there may be a need for boosts…the real risk is, right now there are people who are not vaccinated," a person familiar with the discussion in that meeting said. “No one walked out of there and said boosters are needed imminently.”
  • "We appreciate the information they shared, and officials continue to engage in a science-based rigorous process to consider whether, when, or for whom a booster might be necessary," an HHS official said in a statement to reporters.

Between the lines: Not only is the science unclear, but there would also likely be a global uproar if Americans began receiving a third shot before most of the rest of the world received any.

  • Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, said yesterday that Pfizer and other vaccine makers should focus on increasing global access to first doses, not boosters, STAT reports.
  • On the other hand, some Americans — especially older ones or those with health conditions — could become increasingly nervous about the status of their protection, especially after reading warnings like Pfizer's.

State of play: Recent studies have shown that the existing vaccines work against the Delta variant, but may be less effective.

  • A study out of Israel, released by the government, found that the Pfizer vaccine is only 64% effective against Delta infections, although it remained more than 90% effective against severe disease.
  • It was this study that led Pfizer to announce it would seek authorization for a third shot, former FDA Commissioner and Pfizer board member Scott Gottlieb said this weekend.
  • But other studies have shown higher efficacy against Delta, particularly against symptomatic infections — just slightly less than against the original version of the virus.

What they're saying: Gottlieb said that people vaccinated early on in the U.S. vaccination effort — who tend to be older — would be the ones to need a boost soon, not those vaccinated more recently.

What we're watching: Politics, both domestic and international, could end up being just as prominent within the booster conversation as the science.

Go deeper

Hawaii invites fully vaccinated travelers to return from Nov. 1

Hawaii Gov. David Ige. Photo: Darryl Oumi/Getty Images

Hawaii Gov. David Ige (D) announced plans Wednesday to soon welcome back nonresidents to the island state who are fully vaccinated against COVID-19 for nonessential travel.

Why it matters: Hawaii's tourist-dependent labor market suffered one of the worst blows in the U.S. last year and the state's climb out of its pandemic-sized hole is moving slowly, Axios' Courtenay Brown notes.

Oct 20, 2021 - Health

In-N-Out refuses to follow San Francisco's vaccine mandate

Photo: James Leynse/Corbis via Getty Images

The California burger chain In-N-Out is refusing to follow San Francisco's vaccination mandate, which requires restaurants to check for customers' proof of vaccination to dine indoors, the Washington Post reports.

Driving the news: The San Francisco Public Health Department has had to remind employees multiple times to check for proof of vaccination since September, ultimately resulting in the city's only In-N-Out location getting shut down on Oct. 14. It is the only time the agency has ordered a restaurant's closure over a mandate violation, officials told the Post.

Nashville's COVID breakthrough rate remains low

Illustration: Aïda Amer/Axios

Unvaccinated people continue to account for the vast majority of COVID-19 deaths in Nashville, according to new data shared by the chair of the city's pandemic response task force.

  • There have been 27 breakthrough deaths out of a total of 1,109, task force chair Dr. Alex Jahangir tells Axios. Those numbers go back to the start of the pandemic, including well before the vaccines were widely available early this year.
  • The breakthrough mortality rate in Davidson County is 0.3% (27 out of 7,652 known cases), compared to 0.8% for unvaccinated deaths (1,082 out of 131,447 known cases).