As recipients of the Pfizer vaccine, they became eligible for a booster dose from the end of September. Since then, millions more have been anxiously awaiting whether the United States Food and Drug Administration would also approve boosters for other Covid-19 vaccines.
Last week, one more step: FDA advisers recommended that the agency authorize additional doses of the Moderna and Johnson & Johnson vaccines for emergency use. In the first, for people 65 years of age or older, other adults at high risk of severe Covid-19, and those who live or work in a place that puts them at high risk of complications; and in the latter, for all 16 years and over.
These are important developments, but they come at a time when major challenges remain, as approximately 66 million American adults have yet to be fully immunized. Forty-six percent of whites, 49% of Hispanics, and 54% of blacks nationwide have yet to receive a single injection. While my friends were delighted to receive additional protections and invite others to dinner, much of the country remains suspicious.
To overcome the growing pandemic, we, as a nation, must now all push to close this widening gap.
Yet vaccine opponents are in fact using the push for recalls to claim that the vaccines are ineffective. The Kaiser Family Foundation recently asked Americans how they view the news that some people may need a booster. About two-thirds of all respondents said it shows scientists are still finding ways to make vaccines more effective – while a third said it shows vaccines aren’t working as well as promised. The vast majority of anti-vaccine (82%) and vaccine-hesitant (69%) saw this news as an indication that vaccines are not working as promised.
This negative perception of boosters suggests a growing divide that public health officials, doctors, and elected officials must try to correct.
Just as the SARS-CoV-2 virus is constantly changing, so too is our scientific knowledge about the evolution of the pandemic. Science is a constantly evolving business, involving inherent uncertainties. Researchers rarely know all the answers. Rather, the discovery raises more questions – just as removing the outer layers of an onion reveals more layers underneath.
Yet the Pew Research Center has found, for example, that unvaccinated individuals view the fact that public health officials have consequently changed their Covid-19 recommendations over time very negatively. While two-thirds of vaccinated people think these changes make sense, since scientific knowledge is constantly being updated, only one-third of unvaccinated individuals think so. This indicates that these changes leave 75% of unvaccinated people less confident in the statements of officials about the pandemic. And 63% of the unvaccinated end up confused.
Unfortunately, such darkness makes many people uncomfortable. Difficulties tolerating ambiguity have actually been associated with increased levels of stress among medical trainees and others.
So political leaders, the FDA, the U.S. Centers for Disease Control and Prevention, public health officials, and the vaccine manufacturers themselves need to figure out how to communicate our ever-changing knowledge about Covid and its prevention, and how science often involves uncertainties.
For example, Johnson & Johnson continued to develop a vaccine that required only one injection versus two to simplify administration logistics. It was an important strategy. Unfortunately, this single dose now appears to be less effective than Moderna’s or Pfizer’s two-step approach. The FDA advisory committee has not determined whether it would be better for Johnson & Johnson beneficiaries to now receive the same injection or a different one. More data is needed. However, communicating about these uncertainties will be essential.
Officials might point out, for example, that many vaccines require multiple injections. Vaccines against hepatitis A and chickenpox (chickenpox) always require two doses; human papillomavirus may require two or three; and hepatitis B can require up to four.
Some scientists are also not convinced that there is a definite need for a Moderna booster. While the FDA has cleared a third dose of the Pfizer vaccine, Moderna’s is notably different. Research published in the New England Journal of Medicine last month showed Pfizer to be 88.8% effective, while Moderna was 96.3% effective in healthcare workers. Moderna argues that a booster could restore immunity as it declines over time.
But, given the novelty of the pandemic, the Delta variant, and the vaccine itself, the data to support these claims has been somewhat limited. The third injections increase the antibodies, which will likely build up the body’s resistance and even reduce mild symptoms, but data showing these differences will likely take weeks or months to build up.
While we wait for what science will confirm, however, critics have also argued that Moderna has put profits ahead of global public health needs. Most of the company’s vaccines have gone to wealthy countries. The company also billed middle-income countries like Thailand and Colombia more than the United States or the European Union. (According to the New York Times, Moderna says she is doing everything she can to “make as many doses as possible as quickly as possible” and that she is “currently investing” to increase production.)
According to one report, only around 1 million doses of Moderna, compared to 8.4 million Pfizer injections and 25 million Johnson & Johnson doses, went to low-income countries. There is no doubt that an emergency use authorization for the booster would benefit Moderna’s results, especially since almost all of the research and development for the vaccine has already been done. In increasing sales and profits, Moderna needs to proceed very carefully, given the growing anti-vax sentiment.
In about six months, the companies will likely seek FDA clearance for the fourth, not just the third, a measure already in force in Israel. Since part of the public is already suspicious, companies need to be careful not to put profit before public health – to make sure the data supports their case for continuous boosters.
We also need to consider not only whether booster injections are safe enough, but also how far to push additional injections compared to other approaches – especially when we assess what else we need to achieve to ultimately beat the pandemic. . For example, how much effort and expense should federal, state, and local governments spend on getting booster shots for fully immunized people, and do those benefits and costs always outweigh those of doing so? to vaccinate unvaccinated people for the first time? Local public health officials told me they were already facing these questions.
Unvaccinated people include tens of millions of eligible Americans, as well as billions more around the world. Some critics may argue that we should, by far, prioritize getting Americans a third shot. But given how interconnected our world has become and how easily Covid-19 spreads, virulent strains that are growing elsewhere will no doubt find their way here, too.
Despite the decisions of the FDA, the challenges of the global vaccination campaign will continue, including the need to communicate and educate people on these realities.
The FDA, CDC, and political and public health leaders should get more input from media, communications, and advertising experts to craft messages as effective as possible. Those of us who have been vaccinated are also undoubtedly familiar with certain refusals of vaccination with which we should also try to dispel these misperceptions.
These totally unprecedented times require not only sound decision making, but also clear and transparent messages to help all Americans, regardless of politics. The medical community, political leaders and others must not only assess the ever-changing and ever-changing data on recalls, but determine how best to present their decisions in a way that improves the health of individuals on both sides of the world. growing vaccine divide in our country. .