Should the definition of ‘fully vaccinated’ include boosters?

·Senior Editor
·6-min read

“The 360” shows you diverse perspectives on the day’s top stories and debates.

What’s happening

With the United States in the midst of another surge in COVID-19 cases driven by the Omicron variant, top health officials in the Biden administration have started rethinking the requirements that qualify Americans as being fully vaccinated — and whether booster shots should be required as part of the criteria.

President Biden and government health officials have strongly recommended that every eligible adult get a booster shot, citing evidence that the extra dose can substantially increase immune protection against the virus. But, so far, the Centers for Disease Control and Prevention still considers anyone who has had two shots of the Pfizer or Moderna vaccines or a single dose of the Johnson and Johnson vaccine to be fully vaccinated. That policy may be adjusted before long.

“I don't think anybody would argue that optimal protection is going to be with a third shot,” Dr. Anthony Fauci told CNN earlier this month, adding that he believes it’s “a matter of when, not if” the definition of fully vaccinated will change.

The debate is about more than just semantics. Changing the criteria could affect millions of people who have to prove they’re fully vaccinated to go to work, eat at restaurants, attend public events, and do countless other things. As of Wednesday, about 70 percent of fully vaccinated Americans, roughly 140 million people, had not received a booster dose.

A number of other countries, including Israel, have already established booster mandates. Several U.S. universities and private businesses have done the same. New Mexico will require all workers at schools, hospitals and congregate care facilities to be boosted starting in January. The governors of a handful of other states have said they also support redefining who qualifies as fully vaccinated.

Why there’s debate

There’s broad agreement that boosters do provide extra protection, but health experts and policymakers are divided over whether requiring them would make a substantive difference in the country’s efforts to curb the pandemic.

Supporters argue that one or two shots, in some cases administered nearly a year ago, are simply not enough to keep people safe from the constantly shifting threat of the coronavirus. Others, including the CEO of Pfizer, make the case that the third shot shouldn’t be considered an add-on at all, and instead should be treated as the completion of a three-dose vaccine regimen.

Skeptics say the evidence in so far does not show that vaccinated people who haven’t received a booster shot face a risk of disease or death serious enough to warrant mandating boosters. Some people are concerned that changing the criteria would create confusion, undermine trust and invite conflict at a time when a cohesive national pandemic strategy is critically important. Others say the debate over boosters distracts from the prime goal: reaching the tens of millions of Americans who are unvaccinated and have no protection at all.

What’s next

Fauci and other federal health officials have said it’s unlikely the federal government will change its definition of full vaccination in the near future. It appears likely, though, that more private businesses, schools and local governments will adjust their own policies in the coming weeks.



2 shots is not enough for the long-haul fight against COVID

“It was very clear that no one expected two shots to last a lifetime. I consider now that the third dose — so-called booster — is an essential part of vaccination against Covid. In order to be considered ‘fully vaccinated,’ it takes three doses for all vaccines. … In the U.S., we have more people waning every day than we have getting a new vaccine, so we’re actually losing ground.” — Eric Topol, founder and director of Scripps Research Translational Institute, to Stat

The Moderna and Pfizer vaccines should be considered incomplete without a third dose

“I’ve always said this is a three-dose vaccine. The reason is, when you get that third dose, you get a 30- to 40-fold rise in virus-neutralizing antibodies, and therefore there's more spillover protection against new variants, including Omicron. The third dose gives you 70% to 75% protection against symptomatic illness.” — Peter Hotez, professor of medicine, to CNN

The pandemic has shown that it’s always better to error on the side of caution

“If you are in a position to decide whether to create a vaccination requirement, you do not need to wait for definitive data from the Centers for Disease Control and Prevention. A decade from now, you won’t look back on the temporary disruption the same way you would if there was a superspreader event that was in your control to stop.” — Andy Slavitt, Washington Post

Updating our vaccine strategy is necessary to keep up with the fast-changing virus

“Already, in the year since our shots first rolled out and full vaccination against COVID-19 was first defined, the pandemic landscape has shifted. And in this long fight against a fast-moving, fast-morphing virus, we may never actually, truly be fully vaccinated at all.” — Katherine J. Wu, Atlantic


Reaching the unvaccinated should be the sole focus of vaccine campaigns

“It’s first and second doses that change the trajectory of the pandemic, that protect hospital capacity. It’s not boosters. Our hospitals are not getting pressure from people who are fully vaccinated and having breakthrough infections.” — Amesh Adalja, infectious disease specialist, to The Hill

We don’t know enough about Omicron yet to mandate boosters

“I’m looking for more granular data on what type of symptoms they’re preventing. Is it a day of sniffles or a week or two of significant illness? That’ll be really helpful to know.” — Emily P. Hyle, infectious disease specialist, to Los Angeles Times

Another major change to policies would undermine public trust

“In this pandemic, too much trust has been squandered on unnecessary restrictions not based on evidence, from closing parks and beaches to putting checkpoints at state borders. Political leaders wanted to do something, but not everything they did helped. … Making booster shots mandatory without powerful evidence of a community benefit could cost public trust just when it’s needed most.” — Faye Flam, Bloomberg

Changing the definition would create a logistical nightmare

“[The federal government has] tied a lot of decisions to the definition of what it means to be fully vaccinated, and changing that definition is a difficult endeavor. … So I think they’re going to be reluctant to do that.” — Former FDA commissioner Scott Gottlieb to CNBC

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Photo illustration: Yahoo News; photos: Ethan Miller/Getty Images, Getty images

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