Bloomberg Law
Free Newsletter Sign Up
Bloomberg Law
Advanced Search Go
Free Newsletter Sign Up

Complex Booster Plan Muddies Vaccine Message for Weary Public (1)

Oct. 21, 2021, 10:49 PMUpdated: Oct. 22, 2021, 1:35 AM

Federal clearance of Moderna and Johnson & Johnson Covid-19 boosters, and signoff on mixing and matching doses, add complexity to an already struggling government messaging campaign—but the advice may be simpler than it appears.

Rapidly-changing guidance from health and policy officials and the ensuing spread of misinformation, particularly via social media, has plagued the government’s push for Americans to get their first Covid-19 vaccine doses.

Now, authorization from the Food and Drug Administration and signoff from the Centers for Disease Control and Prevention put additional doses on the table for millions of Americans who received J&J and Moderna as first jabs—with different eligibility conditions for each vaccine. Even acting FDA Commissioner Janet Woodcock told reporters that the booster rollout could prove confusing.

“People are always being told to follow the science and do what the scientists tell us,” said Keith Holyoak, a UCLA psychology professor who studied public perceptions of Covid-19.

With boosters, he said, “The problem is people have the sense of what they’ve been told is, `I get my two Pfizer shots and I’m done, I’m safe for life, but now you’re saying I should go back and get shot number three. Where did that come from?’”

CDC advisers on Thursday unanimously backed a recommendation for a booster dose six months after a Moderna series for those ages 65 and older and people with underlying health conditions, and a booster dose for people ages 18 and older who received a J&J shot at least two months post-vaccination. Many committee members also indicated support for mixing and matching the three different booster doses.

The unanimity of those recommendations could be a boon for messaging. CDC Director Rochelle Walensky endorsed them late Thursday, paving the way for a broad booster rollout.

“In some ways this simplifies the message. If you need a booster, you can get it using any available U.S. authorized COVID vaccine. If you use a different vaccine than your first vaccine your response might be stronger,” said Lynn Goldman, dean of the Milken Institute School of Public Health at the George Washington University.

Wendy Parmet, director of Northeastern University’s center for health policy and law, said the government could encourage more people to get boosters by pressing a broad “anyone can get anything” message.

By contrast, “Requiring everyone to get the perfect match might just keep people, including people who really should have the booster, from getting it, because it’s just too complicated,” Parmet said.

‘Riddled With Uncertainty’

Public confusion began well before the initial vaccine rollout.

Evolving safety guidance for businesses and the public, closings and re-openings, and shifting restrictions left the public wary as scientists struggled to learn Covid-19’s ins and outs as it wreaked havoc on the country.

Particularly pronounced in the pandemic’s earliest days was confusion over masks. “That reversal,” Holyoak said, “set the stage for a sense of, ‘Why should I believe what you tell me today, because it may not match what you’re telling me tomorrow.”

“Real science both in epidemiology and behavioral science is just riddled with uncertainty,” Holyoak said. But “people really like certainty.”

How the administration tackles the next steps in booster communications could have a significant impact on doctors and other health-care providers.

For those “doing the shots” and conducting face-to-face appointments, “operations are about to get much more complicated,” said Julie Swann, a North Carolina State professor. One complication will be dolling out doses preferred by patients that may not be supported by different vaccine inventories.

And, under the present communication structure, there remains a risk to “repeat some of the issues around equity and access” that plagued the initial vaccine rollout.

“It takes a lot of resources to do outreach to lower income populations and to make access really easy for them,” Swann said, noting that hesitancy may even linger for some who “had an okay experience the first time around” with vaccination.

“There is still some distrust of the health system,” Swann said. “And you might’ve been forced to get a vaccine because of your job. But you’re not forced to get a booster.”

Clear Messaging

Nevertheless, more Americans are getting jabbed.

As of now, nearly 190 million Americans are fully vaccinated—that’s 57% of the overall population. Meanwhile, around 219 million have at least one dose, while a little over 6% of the fully vaccinated have gotten boosters, according to CDC data.

There remains a portion of the population that is unlikely to get jabbed.

But reaching individuals that are open to first shots or boosters and “making it easier for them is probably more important than trying to vaccinate the adamantly opposed,” said Parmet.

Despite public perceptions, messaging has to follow the science on the virus as it develops, Holyoak said.

“The information is evolving with the virus,” he said, and people never had a reason to believe with absolute certainty that two vaccine doses were all they would ever need. “As the facts evolve, the advice evolves,” he said. “And we react accordingly.”

(Updated with CDC director signoff in the third and seventh paragraphs.)

To contact the reporters on this story: Ian Lopez in Washington at; Celine Castronuovo at

To contact the editors responsible for this story: Alexis Kramer at; Melissa B. Robinson at