The Policy on Third Doses Is Confused Because the Agencies Disagree: Thoughts on ‘Following the Science’

And those disagreements also occur within the agencies too. A while ago, I wrote something admittedly very cryptic:

Anyway, I’m worried we’re starting to see a Public Health Blob, akin to the Foreign Policy Blob (which after twenty years of disaster finally received a setback). It holds to Things We All Know Yet Are Not True and Things We Have No Idea If They’re True Or Not, and it has different normative values from those who fund their positions and their research (or at least some of them).

This excellent Politico article (it happens) describes a very important dynamic among (and within) the HHS agencies (boldface mine):

The Biden team’s deliberations have intensified in recent days, as officials scrutinize the incomplete and sometimes conflicting data on vaccines’ performance. One group, including some scientists at the Centers for Disease Control and Prevention and the Food and Drug Administration, argues that boosters aren’t capable of blocking all infection, the sources said. They think additional vaccine doses should be given only as needed to reduce cases of severe illness and death. Another group — including Biden’s chief medical adviser, Anthony Fauci — says the government should not rule out using boosters to help stave off even mild Covid-19 infections that can keep people out of work for weeks.

In fairness, the ‘anti-booster’ camp also thinks that we could use other measures (masking, ventilation improvements, and testing) to control COVID-19. It also holds that it is both unethical and short-sighted to withhold doses from undervaccinated nations (‘fighting COVID over there, so we’re not fighting it here’). That said, it’s not clear–and that’s being incredibly generous–that the U.S. will adopt those measures widely enough to control infection. Actually, we’ve been living through this for over a year and a half, and it’s pretty fucking clear what will happen. And if it turns out a third shot is effective over the long term, I think a lot of people in public health et alia would be surprised who turns on them if they argue for sending doses abroad.

The ‘pro-booster’ camp looks at things differently:

Through it all, Fauci has been vocal about his thinking on boosters, saying Israeli data is clear: Vaccine efficacy against mild and moderate illness is decreasing, and boosters are the solution. He argues that the U.S. should not reserve third shots as protection against severe disease, bucking the FDA and CDC’s latest recommendations.

“It seems like [the advisory groups] were saying it is okay as long as you don’t wind up in the hospital and die,” Fauci said in a recent interview with conservative radio talk-show host Hugh Hewitt. “I don’t feel that way. I feel we need to protect not only from getting people in the hospital … but we don’t want people to get sick. You can also get pretty sick and not necessarily have to go to the hospital.”

If those who argue getting the first and second shots is difficult because taking time off from work (“we’re not Denmark!” Remember that?) to recover from vaccination is a problem, imagine what being knocked flat on your ass for a week or two–and unplanned no less–does for many American workers.

That said, the potential flaw here is obvious (though I’m very cautiously very optimistic about third shots):

But federal officials do not have solid data, particularly domestic data, that spells out exactly how long boosters last and which populations would benefit. That muddies any risk-benefit calculations.

And, of course, we also would need more vaccine uptake–you can’t get your third dose without your first and second doses (interesting number theory notwithstanding, that’s how ordinal values work).

There are both policy and scientific ‘unknowns’ going on here, along with (often implicit) normative assumptions: none of this will be resolved by intoning ‘Follow The Science.’

While this conflict doesn’t align easily on the U.S. political spectrum (since Republicans seem to be the COVID appeasement party), I hope this doesn’t become ‘politicized’ with both sides digging in and unwilling or unable to change their minds. I also hope contingency planning is happening that assumes non-vaccine interventions are needed as well as planning for how to increase vaccination uptake (including a third dose).

We’re definitely not Denmark though.

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2 Responses to The Policy on Third Doses Is Confused Because the Agencies Disagree: Thoughts on ‘Following the Science’

  1. hipparchia says:

    Actually, we’ve been living through this for over a year and a half, and it’s pretty fucking clear what will happen.

    word.

    i not only live in ron desantis’ state, i live in matt gaetz’s congressional district, which also means that my next door neighbor is kay ivey’s alabama.

    back when the vaccines first became available, i would have happily gone along with a “first shots first” strategy, but at this point in time, i’m going to be angry (and scared) if they send my third shot to an under-vaccinated, third-world country.

    putting feelings aside and following (some of) the science for a moment, don’t we already have some 3-shot vaccination series, and haven’t we already started recommending 2nd flu shots 4-6 months after the first one each fall for senior citizens?

  2. Pingback: Very Cautiously Very Optimistic About a Third Vaccination | Mike the Mad Biologist

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