Thank heavens the self-proclaimed adults are back in charge, gang. The administration's COVID "booster" shot policy is scheduled to be implemented next week, but multiple reports suggest that significant divisions exist within the Biden administration and public health bureaucracy. You'll recall that two FDA regulators resigned in protest after the White House announced a forthcoming recommendation for basically all Americans to receive booster shots down the road. The upshot of their complaint was that the regulatory agency hadn't completed its work before they were big-footed by the president's team. We've also seen a moving target on the timeline for the additional jab, with rumors that the eight-month guidance could be shaved down to just six months. Then there was the somewhat abrupt quasi-reversal on universal boosters altogether, kneecapping what Dr. Fauci had just said on national television. What is going on here? The clock is ticking, and the Powers That Be are reportedly not on the same page, and sparring behind closed doors:
Top Biden Covid-19 officials are increasingly clashing with the Centers for Disease Control and Prevention as the administration pushes to begin distributing booster shots widely by Sept. 20. In meetings and conversations over the past month, senior officials from the White House Covid-19 task force and the Food and Drug Administration have repeatedly accused CDC of withholding critical data needed to develop the booster shot plan — delaying work on the next step of President Joe Biden’s vaccination campaign and making it more difficult to set clear expectations for the public. One particularly frustrating episode occurred last month, two officials said, when the agency appeared to publicly reject the administration’s plan to offer boosters to all adults. CDC Director Rochelle Walensky had joined other top Biden health officials in signing a high-profile statement on Aug. 18 endorsing the approach. But less than two weeks later, when it came time for CDC to make the case for boosters to an influential advisory panel, senior agency officials argued that priority should be given to nursing-home residents and frontline health workers before expanding access to other groups based on their vulnerability.
"The new approach blindsided senior health officials across the federal government, further straining the tenuous relationship between the White House and the CDC," the Politico story reports, citing ten anonymous sources. "The infighting comes as the administration seeks new approaches to quash the Delta variant and win back Americans’ trust after two months of setbacks and missteps." A major, confounding about-face from the CDC and its leader shouldn't be the least bit surprising, in light of recent events, but the ongoing disarray is disturbing nonetheless. If the White House is keen on getting the CDC to change its position on something (would that not constitute politicizing science?), have they considered asking a few senior teachers union bosses to place a hostile phone call or two? I'm only half joking. Question, though: Fauci is apparently on board for opening up booster shots ASAP, but a new review from a group of experts (including the aforementioned, recently-departed FDA officials) argues that universal boosters aren't medically necessary. Who's right? The New York Times reports:
None of the data on coronavirus vaccines so far provides credible evidence in support of boosters for the general population, according to a review published on Monday by an international group of scientists, including some at the Food and Drug Administration and the World Health Organization. The 18 authors include Dr. Philip Krause and Dr. Marion Gruber, F.D.A. scientists who announced last month that they will be leaving the agency, at least in part because they disagreed with the Biden administration’s push for boosters before federal scientists could review the evidence and make recommendations. The Biden administration has proposed administering vaccine boosters eight months after the initial shots. But many scientists have opposed the plan, saying the vaccines continue to be powerfully protective against severe illness and hospitalization. A committee of advisers to the F.D.A. is scheduled to meet on Friday to review the data. In the new review, published in The Lancet, experts said that whatever advantage boosters provide would not outweigh the benefit of using those doses to protect the billions of people who remain unvaccinated worldwide. Boosters may be useful in some people with weak immune systems, they said, but are not yet needed for the general population.
If the American public writ large could truly benefit from booster shots, and we very well might, then we should see the data on when and why. Whether they're needed and appropriate to maintain strong immune response against COVID is a separate question from prudential judgments about allocating "booster" doses versus initial doses to unvaccinated people around the world. I once again find myself agreeing with Nate Silver, who writes, "There's still very little evidence that the supply of vaccine doses is finite as opposed to being responsive to increased demand...I want these experts to weigh in on the immunological benefits and risks of booster doses. That's where they're in a unique position to add insight." September 20 is days away. Where is the official guidance? And when it officially arrives at some point, what is it based upon? Meanwhile, this piece addresses the active reality that millions of Americans have apparently gone rogue and scheduled their own boosters using less than above-board methods:
This piece has reinforced my belief that given present supplies the federal government is behaving unethically by restricting third doses for those who want them, and also behaving unethically by failing to donate more doses that are getting thrown away
— Conor Friedersdorf (@conor64) September 13, 2021
https://t.co/veVP19icrr
Trust and credibility are in short supply, so a lot of people are freelancing. We cited Dr. Scott Gottlieb twice yesterday, and I'll do so again here. He's one of the few big players I genuinely believe at this stage. And he's among those seriously grappling with what a realistic and sustainable endgame could look like, while openly acknowledging the reality that eradicating COVID ain't it:
This should change how we approach the risk of respiratory diseases in the winter. It doesn’t require a reordering of life but it will necessitate heightened vigilance around the public health measures needed to reduce the threat of respiratory viruses.
— Scott Gottlieb, MD (@ScottGottliebMD) September 12, 2021
Here's another stab at thinking through that thorny dilemma:
This might be the most important piece you'll read on covid now. We need explicit answers to:
— Aaron Astor (@AstorAaron) September 12, 2021
1) What is the goal at this point?
2) Are the goals different regionally? If so, because of different risk tolerance or other reasons?
3) What are the off ramps?https://t.co/p47LTJ2gpz
I'll leave you with the latest indication that the Delta wave in warm-weather hotspots is blessedly subsiding, followed by one medical expert wondering if President Biden's new mandate announcements may have actually slowed vaccinations, at least initially:
Wow-number hospitalized covid patients declines by 503 from yesterday. https://t.co/LPFCKpH2Pl
— Alicia Smith (@Alicia_Smith19) September 12, 2021
Was hoping not to see this. Since the vax mandate announcement, vaccination rates are down. So far the the buzz of a requirement is not helping the cause. While well-intended, we have to consider to real-world perception of mandates and how it may polarize some. Carrot>>Stick?? pic.twitter.com/648F9kREoZ
— Marty Makary MD, MPH (@MartyMakary) September 13, 2021
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