Over the past two weeks, there were numerous heated deliberations among advisers to the Food and Drug Administration and the Centers for Disease Control and Prevention over boosters. Experts pored over many sets of scientific data that generally showed the same results: The coronavirus vaccines, though they still do well to protect against hospitalization and death, have waning immunity against symptomatic disease, especially in older and more vulnerable individuals. A third dose, given at least six months after the initial series, increases antibody response and reduces the likelihood of breakthrough infections.
The data themselves weren’t in contention. Rather, nearly the entire debate centered on broader value judgments that should not fall under the sole purview of federal scientific agencies.
Take, for instance, the question of whether the goal of vaccination is to reduce hospitalization or disease. Many FDA and CDC advisers contended that the vaccines were developed to essentially turn covid-19 from a deadly contagion to a mild flu-like illness. If vaccinated people still become infected but most don’t end up in the hospital, the vaccines are doing their job — and therefore boosters aren’t needed.
Others insisted that preventing symptomatic illness is an important goal, too. A lot of people don’t want to get covid-19 and potentially suffer long-term consequences. Also, an illness short of hospitalization could still be a miserable experience that results in substantial inconvenience for a single parent or worker who can’t afford to be out sick. Others want to avoid infection because they don’t want to spread the virus to their children or elderly relatives.
This is not a scientific question as much as one of personal values. Should academics and bureaucrats really be the sole arbiters in making such sweeping societal policy as to deny boosters to people who want to better protect themselves? Similarly, scientists shouldn’t be the only people to weigh in on whether the United States should be prioritizing boosters to our own citizens vs. vaccinating people in other countries.
Who should decide, then? I believe it should be the American people. According to a poll presented at the CDC advisory meeting, about 2 out of every 3 vaccinated Americans said that they would want booster shots as soon as they are available. Only 2 percent said they would “definitely not” receive a booster. A Reuters-Ipsos poll found a whopping 76 percent of those vaccinated would want a booster.
Imagine the outrage if the CDC had gone against the clear wishes of the public to forbid third doses, even to health-care workers treating covid-19 patients and to teachers surrounded by unvaccinated and unmasked students. Yet, that’s exactly what the advisers voted to do. Thankfully, CDC Director Rochelle Walensky took the necessary step to overrule her own experts.
The FDA and CDC ultimately came to the reasonable decision to recommend boosters for older and medically vulnerable individuals and to allow a much broader group — including those in high-risk occupations — to weigh their own risks and benefits. The process was made far more muddled than it should have been, not because President Biden got ahead of scientists, as some critics claim, but because he didn’t set the expectation of who should be making this call.
As I’ve noted previously, the Biden administration has confused “follow the science” with ceding policymaking to scientific agencies. Of course, the White House shouldn’t manipulate research or prevent studies from being published, as the Trump administration was accused of doing. But when a decision rests on not just the science but also the interpretation of it, it’s entirely appropriate — and indeed necessary — for the public, through our elected leaders, to determine the outcome.
Biden did exactly the right thing in August in asserting that most Americans would need boosters. He should have said then that the role of the FDA and CDC is to review for safety and effectiveness and that it was up to the White House, in consultation with the scientific agencies, to decide whether, when and how Americans would access that additional protection. That’s not playing politics or disregarding science. Rather, it’s listening to constituents and respecting their values, which is what people elect leaders to do.
In the coming months, the Biden administration will face many consequential decisions around vaccines, masks and what it means to live with covid-19. The administration would do well to clarify that public health is about much more than getting the science right. Sound health policy should be informed by science but must also take into account the will of the people. After all, public health hinges on public trust, and its effectiveness depends on winning over hearts and minds.