The Washington Post

The confusion over booster shots

When and why should Americans get them?


WHEN THE Biden administra­tion first announced plans for booster shots, the rollout was to begin the week of Sept. 20. Now it appears that not all the scientific research and regulatory reviews are in place, and delay is likely. The public is confused about the reasons and the timetable for boosters. An administra­tion that champions sciencebas­ed decision-making needs to mount a strong new effort to communicat­e clearly with the American people.

In the announceme­nt in August, Surgeon General Vivek H. Murthy said, “Recent data makes clear that protection against mild and moderate disease has decreased over time. This is likely due to both waning immunity and the strength of the widespread Delta variant.” The Centers for Disease Control and Prevention has published a series of reports suggesting that MRNA vaccine efficacy against covid-19 infections is waning. The administra­tion’s initial plan was to give boosters eight months after inoculatio­n, but the optimal timing has yet to be determined.

Overall, there’s a consensus that boosters may be wise for those with compromise­d immune systems and the elderly — they were the ones who got the early shots. But some experts have raised questions about whether a booster is necessary now for the general population. One argument, advanced by the World Health Organizati­on and others, is that added shots would be better utilized to meet global vaccine shortages, slowing the pandemic and the rise of new variants. We have disagreed that it is either/or; both boosters for Americans and expanded production abroad should be possible. Another argument questions the interpreta­tion of the reports on waning immunity. The reports generally document a weakening protection against infection, while the vaccines protect against severe disease, hospitaliz­ation and death. Thus, the argument goes, the vaccines are working against the worst outcomes. These experts say that some amount of continued infection is to be expected, and that the virus can never be eradicated.

Everyone rejoiced at the initial clinical trial result of the two-shot MRNA vaccines showing 95 percent efficacy against infection. But real-world performanc­e is often different from that seen in clinical trials. Now, many are rightly wondering if they need a booster, or not. The administra­tion should spell out clearly the science and reasoning behind the booster plan for the general population, including whether and how additional shots will provide longer and stronger immunity. President Biden has pledged to put the boosters through the Food and Drug Administra­tion and CDC review processes. The government must also come up with a booster plan for the 14 million recipients of the single-dose Johnson & Johnson shot. No one should be alarmed if this takes somewhat more time. It is better to get the decisions right than to cut corners.

The administra­tion has been discipline­d and consistent in its overall message that vaccines are the best tool to stop the pandemic. But there are anecdotes surfacing lately of people going to get boosters on their own — a sign of lack of confidence in and patience with the government. The confusion should be cleared up quickly and persuasive­ly.

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