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‘Fully vaccinated’ is suddenly a much less useful phrase

The definition of full vaccination against COVID-19 has been somewhat difficult to determine since the winter. It takes one dose of Johnson & Johnson, but two doses of an mRNA vaccine. The CDC considers you fully vaccinated as soon as you get your last shot, but tells you that you will not be fully vaccinated until two weeks afterwards. People find it difficult to know exactly when it is safe for them to enter restaurants, wedding venues or mask-free offices.

Now, in the age of booster shots and breakthrough cases, the phrase has become even more obscure. early this morning, the CDC officially supported booster shots for tens of millions of Americans six months past their second dose of Pfizer: those over 65, those in long-term care facilities, and all adults with an underlying medical condition that puts them at high risk for severe COVID-19 or who are at high risk for become ill from occupational or institutional exposure to the coronavirus.

At a two-day meeting of the CDC’s Advisory Committee on Immunization Practices this week, the CDC’s Sara Oliver advised the committee that the agency’s definition of fully vaccinated wouldn’t change – at least for now. That makes it much less useful as a category: Will some fully vaccinated people be vaccinated more than others? And it leaves open the possibility that the definition could change as more information becomes available: If you’re fully vaccinated now, could you be incompletely vaccinated in a few months? These questions go beyond semantics. As more and more Americans are mandated to get “fully vaccinated” in order to work – see here, here, and here, for example – continued clarity about what that category means and who belongs in it will be critical.

Fully vaccinated did not originate with the coronavirus. The term has been used for other vaccine series that require multiple injections, such as those for: the measles, hepatitis B, and HPV. Currently, the CDC considers people to be: Complete vaccination completed against COVID-19 “2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine.” The agency’s website has a caveat: For immunocompromised people, being fully vaccinated may not be the same as being fully vaccinated. protected, so a third shot is a good idea.

Part of the problem is that the difference between full vaccination and full protection has been less than perfectly explained to the American public. The truth is that no one is 100 percent protected against the coronavirus after vaccination, no matter how healthy their immune system is; that’s just not how vaccines work, especially in the context of a pandemic virus that hasn’t stopped evolving. “You can’t say definitively, until we finally defeat the virus or get it to the point where it doesn’t kill people anymore, that you [fully] protected,” said Ruqaijah Yearby, a health law expert and co-founder of the Institute for Healing Justice and Equity at Saint Louis University.

Even before booster shots were a common possibility, the concept of full vaccination could lead people to develop what Saskia Popescu, an infectious disease epidemiologist at George Mason University, calls a “Superman complex.” After receiving their J&J shot or their second mRNA dose, some people immediately feel invincible, she told me, as if nothing they do is dangerous to themselves or those around them. The ongoing discussion about boosters could be an opportunity to undo the Superman complex by adding some nuance and reminding the public that no vaccine is perfect and that we all need to work together to get the pandemic under control. Such a rethink could even go beyond COVID vaccines. “Maybe we need to rethink how we communicate vaccines in general,” Popescu said.

However, a sudden injection of nuance can confuse many people and even discourage some from getting their first chance by making the process seem particularly complicated or arduous. It would likely be a nightmare for schools, businesses and other institutions that have introduced vaccine requirements in recent months. If getting two injections doesn’t guarantee you’re fully vaccinated, who should be allowed to work? Should schools interview every teacher vaccinated before April about their medical history?

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Now that the CDC has recommended that a select segment of the population receive a third dose to prevent them from getting sick and spreading the virus, institutions that require full vaccination will be faced with some tough choices. Should they demand that immunocompromised 40-year-olds get a third shot, when asking nothing more from 40-year-olds with healthy immune systems? Should they require proof of booster injections from only those who have received the Pfizer vaccine, because they are the only ones for whom boosters have been approved so far? Or would it make more sense for companies to stick to the definition of? fully vaccinated which they have used so far?

Seema Mohapatra, a visiting law professor at Southern Methodist University, told me that instituting different rules for different people probably wouldn’t create legal obligations for the mandate holders, but it could lead to “practical, administrative problems.” For example, restaurants and theaters have no way of verifying the health status of their customers, so they can’t know who is in a booster-eligible category. HR departments would have a hard time keeping track of which vaccine Carol got from accounting, how long it’s been since her last dose, and how that equates to her 65th birthday.

There are also ethical issues to consider: Even if it’s legal, is it really fair to ask essential workers and immunocompromised people to get more doses than others to earn a living, or even just eat out? Since many underprivileged communities still struggle to access the photos, they even ask more of the most vulnerable among us—without accompanying policies to get them shots where they live and work, guarantee them paid time off and offer them risk money—would be hard to justify.

According to Jason Schwartz, a vaccine policy expert at the Yale School of Public Health, the problem lies not only in updates that affect different people differently, but also in constant, complicated policy changes. If employers and schools update their mandates with each incremental change to the CDC’s recommendations, he told me, their adjustments could backfire and discourage vaccination. It’s better to wait for the CDC to recommend universal boosters and then update the rules for everyone at once.

At the national level, mandates are unlikely to change much for the foreseeable future. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease and chief medical adviser to Joe Biden, told The Atlantic Ocean this week that for at least the next few weeks, “all vaccine mandates should match the original vaccine regimen.” Paul Offit, who directs the Vaccine Education Center at the Children’s Hospital of Philadelphia and serves on the FDA advisory committee that last week recommended allowing third doses of Pfizer for a select group, told me that as far as a three-dose mandate is concerned : “I just don’t think it’s right now.”

Continued clarity about who is considered fully vaccinated wouldn’t just help employers set rules. It would also give researchers more precise language to investigate breakthrough infections and the efficacy of vaccines. Popescu pointed out that a reworked definition of fully vaccinated can have multiple definitions of partially vaccinated at. Do those who didn’t get their second mRNA dose really fall into the same category as those who got their second shot more than six months ago but haven’t received a booster yet? Should a breakthrough infection in the first group be given the same weight as one in the second group, to assess how well the injections are working or who can safely be invited to your dinner party?

A common criticism of the pursuit of boosters is that it has no limits, that we might need a fourth booster for the rest of our lives, or a fifth, or an injection every six months. “I think in a year or two the endgame will probably be a vaccination program that updates the vaccine regularly and is administered on a set schedule for everyone,” Schwartz said. COVID shots can even be combined with annual flu shots.

When that happens, employers and schools will have to make new choices about mandates, such as whether or not to inject their employees annually and whether or not to deliver those injections locally. The longer we live with endemic COVID, and the more normal and predictable boosters become, the easier these conversations will be.

Katherine J. Wu contributed to the report.