Feds slow-walk change in the definition of ‘fully vaccinated’

The Biden administration is resisting calls to update what it means to be “fully vaccinated,” even though its own rhetoric and mounting data suggest an extra dose is needed to fight infection and the surging omicron variant of COVID-19.

The mismatch is prompting colleges and arts groups to act on their own, adding boosters to their mandates instead of waiting for federal officials to grapple with shifting definitions that could dissuade the unvaccinated from coming forward at all.

Georgetown University, American University and George Washington University all said faculty, staff and students who report to their Washington campuses and are eligible for a booster must get the shot by various deadlines in late January and early February, a position that other colleges are likely to follow.

The Metropolitan Opera in New York City said it will require boosters for audience members and staff as of Jan. 17. The mandate applies to people who are eligible for the extra shot, and there is a grace period in which audience members who are not boosted can attend a performance if it falls within two weeks of when they become eligible for the extra shot.

New York Democratic Gov. Kathy Hochul also said she intends to change the state’s formal definition but isn’t quite ready to mandate booster shots as she reviews the data on extra doses.

The push for a new standard comes at a perilous juncture in the COVID-19 fight. Wintry weather, holiday gatherings and the fearsome omicron variant are putting a premium on getting the fullest protection available from the shots.

Lab data show a third shot received at least six months after an initial vaccine series should give robust protection against symptomatic infection from the new variant.

Dr. Anthony Fauci, the government’s lead spokesman on fighting the virus, said Friday that redefining what qualifies as fully vaccinated is “on the table” but said the debate is largely one of semantics, with an extra dose clearly beneficial while the two-dose definition applies to existing mandates.

“There’s no doubt that optimum vaccination is with a booster,” Dr. Fauci, the director of the National Institute of Allergy and Infectious Diseases, told CNBC’s “Squawk Box.”

As it stands, the Centers for Disease Control and Prevention defines fully vaccinated as one shot of the Johnson & Johnson version or two doses of the Pfizer-BioNTech or Moderna vaccines. About a quarter of eligible Americans haven’t come forward for any doses, and officials are focusing on getting them some level of protection while shoring up people who got vaccinated long ago.

“Whether or not the CDC is going to change that, it certainly is on the table and open for discussion,” Dr. Fauci said. “I’m not sure exactly when that will happen. But I think people should not lose sight of the message that there’s no doubt [that] if you want to be optimally protected, you should get your booster.”

President Biden has been promoting booster shots nonstop since early fall, yet only 28% of fully vaccinated Americans have received a booster dose, according to federal data.

The message might not be penetrating because the existing, two-dose standard makes a booster sound optional or like “dessert after the meal,” said Arthur Caplan, director of the division of medical ethics at the New York University Grossman School of Medicine.

“It makes it sound like the people promoting vaccination don’t know what they’re talking about,” he said. “I really intensely dislike the mixed messaging.”

He said data showing a three-course regimen is effective against omicron gives the administration a plausible foundation for changing the definition to three doses.

“I think the vaccines were clearly never tested in terms of what is the best interval to get maximum efficacy, which made sense because they were desperate at the time,” he said of the original two-dose regimen, spaced just a few weeks apart. “Now we’re seeing immunity is fading and it’s clear this is a three-shot vaccine.”

Negative fallout

There are some clear reasons why the administration might want to slow-walk changes even as institutions demand boosters for entry to their venues: Polling suggests booster talk has a negative impact on the attitude of vaccine holdouts.

In September, when the government started to authorize extra doses, the Kaiser Family Foundation found the conversation around boosters to be a “net positive for people who are already vaccinated, but a net negative for the unvaccinated.”

“Most unvaccinated adults see the booster discussion as a sign that the vaccines are not working as well as promised, while most vaccinated adults see it as a sign that scientists are continuing to find ways to make vaccines more effective,” the foundation said.

The poll found 71% of the unvaccinated saw the push for vaccine boosters as a sign that shots weren’t working as well as promised compared to 22% who thought it showed scientists were working to make vaccines more effective. Vaccinated persons were easier to persuade, with 78% saying it showed the science was evolving compared to 19% who thought the shots were falling short.

There are also technical reasons for resisting a new definition.

Former Food and Drug Commissioner Scott Gottlieb said it will be difficult for the federal government to change the standard while the vaccines are under the current “emergency use” authorization. Pfizer’s vaccine is fully licensed but its boosters are authorized only for emergency use and the other brands are operating under similar status across the board.

“Changing that definition is a difficult endeavor,” Dr. Gottlieb told CNBC. “Local governments are going to do it well before the federal government and a lot of private businesses are going to be doing that. Colleges are already doing it.”

Georgetown cited evidence of the vaccines’ decreasing power in issuing its requirement that faculty and students get boosted by Jan. 21, or whenever they become eligible.

“Evidence available at this time suggests that vaccines continue to be very effective in preventing severe disease and death due to COVID-19 and all its variants, but that immunity wanes after about six months, and that booster shots can further enhance protection,” the university said.

Governors around the country have been calling for weeks for a change in the definition, and fear of the omicron variant is fueling calls to formalize a three-shot regime both in the U.S. and abroad.

“We certainly are encouraging all those that are eligible at present for the third dose to get theirs and we’ll be following the immune protection of a third dose against omicron to understand what immunologically represents the best protection against omicron,” Kieran Moore, the top government doctor in Ontario, Canada, said this month. “That may change the definition of what is fully immunized.”

Ms. Hochul signaled Thursday that New York’s definition will be updated shortly, a change that would send a clear message to state residents who see the third shot as a luxury.

“At some point, we have to determine that fully vaccinated means boosted as well,” the Democratic governor said. “And we’ll give people a sufficient time frame to make that happen.”

Likewise, CDC Director Rochelle Walensky said to be patient as data rolls in — even if some places aren’t waiting.

“We are continuing to follow that science and it is literally evolving daily,” Dr. Walensky told reporters last Wednesday. “As that science evolves, we will continue to review the data and update our recommendations as necessary.”

For more information, visit The Washington Times COVID-19 resource page.