The Biden administration should make infection severity a focus of its Covid-19 booster campaign as limited efficacy data and cost-shifting threatens to hinder uptake of the latest shot, infectious disease doctors and policy analysts say.
Federal regulators last week cleared the two omicron-targeting shots from Moderna Inc. and Pfizer Inc. after a panel of outside vaccine experts recommended them in two 13-1 votes. The Centers for Disease Control and Prevention cited a joint survey with the University of Iowa and the RAND Corporation that found 72% of eligible adults said they “definitely” or “probably” will get an updated booster.
But the CDC acknowledged that the incremental benefits are unknown, as well as the estimated duration of protection. Uptake of a first booster shot based on the original Covid-19 strain has also been relatively low, with nearly 49% of Americans ages 5 and older having received one so far, according to CDC data.
These factors could harm the administration’s new booster campaign, especially as it plans to stop purchasing and providing Covid-19 shots as soon as January due to lack of funds from Congress. Focusing the campaign less on total infection rates and more on keeping severe infections at bay could help improve uptake, health policy watchers say.
“We are working against the tide of Covid fatigue, misinformation, and the government’s broken promises that the end is right around the corner,” said Brook Baker, a professor at Northeastern University School of Law and a senior policy analyst at Health GAP, an advocacy group focusing on equity in access to HIV medications.
“Many people have become numb to the risks of Covid-19,” he added. “We need to continue to press the individual and communal benefits of increased vaccinations and boosters.”
CDC Director Rochelle Walensky said when endorsing the latest boosters that they “can help restore protection that has waned since previous vaccination and were designed to provide broader protection against newer variants.”
Federal health officials have also stressed the importance of getting ahead of an anticipated fall and winter surge in Covid-19 infections. President Joe Biden has urged Americans ages 12 and older who are already vaccinated to “get the new COVID-19 shot this fall,” adding that Covid shots would likely shift to an annual vaccination similar to the flu shot.
The CDC didn’t immediately respond to a request for further comment on its messaging plans.
Some policy watchers say that limited clear clinical data on the long-term benefit of the omicron-targeting shots could hinder broad uptake.
The CDC’s survey findings revealed most who were unsure or not intending to get an updated booster said they either believed previous doses provided enough protection, or had doubts about an updated vaccine’s efficacy. Federal health officials have cited the success of earlier boosters from both Pfizer and Moderna to indicate that the updated versions will be safe and effective.
Pablo Sanchez, a pediatrician and professor at Ohio State University, was the only member of the committee to vote against recommending the booster shot, though several others sympathized with his argument that “we need the human data” on the bivalent vaccines and that the recommendation vote “was a bit premature.”
Monica Gandhi, a professor and associate chief of the Division of HIV, Infectious Diseases, and Global Medicine at the University of California, San Francisco, said she agrees with Sanchez, “given the level of mistrust in the public towards public health.”
“Although we do use mice data for updating flu shots every year, this is the first time that the mRNA booster has been updated,” she said. “Getting human data will increase confidence.”
In an ideal situation, “there would have been enough time for long-term testing of the refined vaccines to make sure they were safe and effective,” said Gary Kreps, director of the Center for Health and Risk Communication at George Mason University. But he argued that the threat of a fall and winter surge has left “a compelling competing need to get the new vaccines out in a timely manner to protect the public.”
Forthcoming plans for Americans to start accessing Covid-19 shots and therapeutics via health insurance could also present obstacles for some populations hardest hit by the virus.
US health officials announced Aug. 30 that the administration would need to stop buying Covid-19 shots as soon as January without additional funds from Congress, where bipartisan talks on additional pandemic funds have stalled for months.
“It would be an extraordinary failure of public policy for Congress not to reauthorize funding to extend government supported access to vaccines, boosters, tests, and therapeutics,” Baker said.
“The consequence is that many people in the US, people who are uninsured, unhoused, disabled, and in rural communities will have reduced and perhaps no pragmatic access to bivalent boosters,” he said.
Baker added this will also “be true for communities-of-color that have already experienced delayed and reduced access to vaccinations, tests, and treatments.” As of Aug. 31, 46% of Black Americans had gotten a first Covid booster dose, compared to nearly 60% of White Americans, according to the CDC.
But continuing to offer the shots for free doesn’t necessarily mean significantly more people will get them, said Syra Madad, an infectious disease epidemiologist and senior director of the New York City hospital system’s Special Pathogens Program. She cited CDC data showing just over half of eligible US adults 18 and older have gotten a first booster based on the initial strain.
To improve public acceptance of the new boosters, “the Biden administration must clearly communicate current evidence about new vaccine safety and effectiveness,” and “explain why the booster shots are needed now” to prevent surges, Kreps said.
The Biden administration should also target booster campaigns to those most likely to be impacted by severe infection, including those over the age of 65 and people who are immunocompromised and could “benefit from an antibody boost during times of high viral circulation,” Gandhi said.
She added that “the administration could be more motivating about the power of the vaccines to restore normalcy at this point in the pandemic.”
“The White House’s confusing messaging on the need to mask after vaccination and that life does not go back to normal negatively affected vaccine uptake,” Gandhi said. She cited the success of vaccination campaigns in countries like Denmark and Switzerland, which she said “messaged more optimism about the vaccines and have gone back to normal life after high rates of vaccination.”
The CDC has long faced critiques over its surveillance and public health communication systems since SARS-CoV-2 was first detected in the US in 2020. Walensky said Aug. 17 that the agency would undergo a revamp of its operations after an internal review found that the CDC took too long to publish scientific findings that were used to make policy decisions during the pandemic. It also found that guidance to the public on masking and vaccines was often confusing.
Overall, Madad said putting the threats of future infections in a context that will resonate with Americans can fuel more willingness to get updated boosters.
“Just casting numbers out there, like ‘we can avert 100,000 hospitalizations or X amount of deaths,’ doesn’t really mean anything to people unless you put it into context,” Madad said. It’s important to show “what this means to the average person, to them, their family, their loved ones, their community, and to the overall pandemic.”
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