Doctors have warned that a move by the federal government to include COVID-19 vaccine boosters in the standard definition of “fully vaccinated” would have enormous unintended consequences for guidance, restrictions, and mandates, as well as for private businesses.
“To suddenly say, up and down from federal to local, wait a minute, we’re now going to redefine things, that you need three doses to be fully vaccinated … it just becomes on the simple, practical side an enormous amount of work, which would lead to a lot of confusion,” said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center.
The Biden administration has gone back and forth on the question of whether to change the standard for full vaccination in adults 18 and up to include an extra “booster” dose, especially given increasing fears that the new omicron variant could evade some of the protection afforded by vaccines. For instance, Dr. Anthony Fauci, President Joe Biden’s chief medical adviser, said last week that “it’s going to be a matter of when, not if” the administration revises the definition of “fully vaccinated.” For now, a person is considered fully vaccinated after receiving both doses of the two-shot Pfizer or Moderna vaccines or the single-shot Johnson & Johnson vaccine.
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Concerns over the highly transmissible omicron variant have mounted in recent weeks. The strain went from being a nameless mutation at the tail end of November to a variant of concern that has reached at least 57 countries today. The Centers for Disease Control and Prevention has fallen under increased pressure to update the definition to reflect the importance of boosters. Connecticut Gov. Ned Lamont, for example, has already told his constituents that they cannot call themselves fully vaccinated until they have received their booster shots, for which all adults are eligible either six months after completing the Pfizer or Moderna vaccination regimen or two months after getting the J&J shot. New Mexico Gov. Michelle Lujan Grisham, meanwhile, believes that three shots should be the standard and has already updated some statewide vaccine mandates to require a booster shot.
“Some jurisdictions will have defined it as two doses, others will have defined it as three doses. And that will create an interim confusion and that interim could last months,” Schaffner said.
Existing federal vaccine requirements would require an overhaul if the definition were to change, a nightmare scenario for the Biden administration, whose mandates for private companies and many healthcare workers continue to be tied up in the courts. The updated standard would also be difficult to enforce. Movie theaters, restaurants, and other businesses that ask that their guests be vaccinated before entering have no way of verifying a person’s vaccination status. Unless the patron is able to produce the small rectangular card from the CDC marking the time and place of their vaccinations, verifying that the person actually got the booster shot is impossible.
Public health experts have argued that convincing people who have yet to get a single shot to get one should remain as the administration’s top priority.
“Being unvaccinated is still the problem,” said Georges Benjamin, the executive director of the American Public Health Association. “Let’s strongly encourage boosters. The [revised] definition of ‘fully vaccinated’ will follow.”
Pandemic fatigue, or the nationwide feeling of exhaustion after roughly two years of dealing with COVID-19 stress, is also expected to hold many people back from getting their booster shots. Many people who have willingly been vaccinated per the CDC’s definition will not look forward to getting another shot.
Scientists are trying to understand the new omicron variant, but they have concluded that it spreads at least twice as fast as the delta variant, which remains the dominant cause of COVID-19 in the United States. They have not concluded whether the strain will cause more severe illness than previous strains, though.
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“There’s just not enough data on real-world outcomes of people who have either gotten two doses or got a booster,” said Dr. Thomas Giordano, an infectious disease expert at Baylor College of Medicine in Texas. “I agree with the push to try to get third doses in people, but I don’t think we’re at the point where we know enough to say that that’s a requirement for someone to be considered fully vaccinated.”
Federal tracking data show that more than 202 million people, nearly 61% of the U.S. population, have been fully vaccinated. The CDC measures booster doses administered but with some big caveats. The federal data underestimate the true number of people who have gotten the booster while overestimating the number of people to have gotten their first shot. Because the agency removes all personal information before entering the vaccination records into the database, it is impossible to connect the two doses given a few weeks apart and a third booster given to the same person six months later at a different location. Booster doses are often counted as first doses. The CDC, though, estimates that at least 27% of adults have received a booster shot.
