In December, Michael Mina of Harvard’s T.H. Chan School of Public Health and I called for a trial, to assess the viability of dose-sparing strategies like delaying second shots, to make vaccines available to more people earlier. Britain, Canada and other countries delayed second shots during the Alpha surge, though there was no trial, so it was harder to pursue such strategies globally even as so many people lost their lives.
To assess the need and effectiveness of boosters, especially for the elderly, a trial could have begun in May or June, when the protective effect of early vaccinations might have begun to wane. By now, we’d have real data rather than a news release from the U.S. Health and Human Services Department announcing that boosters will be available to all vaccinated Americans as early as September, while at the same time saying that is subject to evaluation by the Food and Drug Administration and the Centers for Disease Control and Prevention. If there’s data proving the need for boosters, where is it? If not, why did federal officials issue the news release?
All of this is not to say that boosters are useless, or that we should always wait for perfect data before acting, particularly in offering boosters to high-risk groups like the immunocompromised or the elderly. However, announcing that a third Moderna or Pfizer dose will be offered soon even to young, healthy Americans when millions around the world have yet to receive a single dose, requires more than a news release. And ordinary people should not be reduced to trying to decipher such issues by following debates between individual scientists online.
Plus, while extensive data still shows that the vaccines remain remarkably effective against severe disease and hospitalization despite the spread of Delta, social media focuses wildly on vaccinated people with nasty breakthroughs, like those laid up in bed for a week. Even before Delta, we knew some breakthroughs were possible. It’s a lack of systematic data that makes these anecdotes harder to interpret and prevents scientists from knowing whether such infections have become more common and dangerous.
Misinformation, which has caused so much damage, thrives under conditions of confusion and uncertainty, particularly when the relevant authorities lose credibility and aren’t seen as timely. To this end, systematic and extensive data collection is an investment as necessary as ones for vaccines and therapeutics.
It’s not surprising that some of the best data has come from Britain. Britain has a national health care system that makes bigger trials and systematic data collection easier. This epidemiological rigor also speaks to the vision of British scientists who started planning early. It’s sadly not a coincidence that the United States, with our fractured, privatized, bureaucratic and bloated health care systems, is so lagging.
Clearly, the Trump administration’s negligence and incompetence have put us in a difficult spot, and this is not a problem a new administration can solve in a few months. However, it is one that continues to hinder our pandemic response. For example, compounding the C.D.C.’s failure to track all breakthrough infections, many states that send data to the agency can’t determine how many of their hospitalized Covid patients had been vaccinated, Politico has found, making it hard to assess how dangerous breakthrough infections can be.