After much delay, the Centers for Disease Control and Prevention issued interim guidance on Monday for what fully vaccinated people can do. While some guidance is better than no guidance, the guidelines are too timid and too limited, and they fail to tie reopening guidance with vaccination status. As a result, the CDC missed a critical opportunity to incentivize Americans to be vaccinated.
The guidelines provide little information that members of the Biden administration have not already conveyed. Anthony S. Fauci, the president’s chief medical adviser on covid-19, has been saying for weeks that vaccinated people can visit one another indoors without masks. He and others have said that it’s probably fine for vaccinated grandparents to see their grandchildren. The CDC was more explicit on this front, clarifying that a fully vaccinated household can visit an unvaccinated family so long as those unvaccinated are not at high-risk for severe outcomes from covid-19. If they are, they should see one another outdoors, with masking and distancing.
Unvaccinated people from different households still shouldn’t mingle, the CDC says. That, I agree with. What I take issue with is the CDC’s silence on activities outside the home, such as traveling, attending church services and going to restaurants, for fully vaccinated people. In fact, it says these people should continue the same precautions in these settings as unvaccinated individuals.
This fails the common-sense test. The CDC said nearly a month ago that vaccinated individuals, if asymptomatic, do not need to quarantine or get tested if exposed to someone with covid-19. If risk of infection is so low that even exposure to the virus doesn’t require quarantine, why can’t we say that vaccinated people can resume activities around people who probably don’t have covid-19?
Take flying on an airplane. The risk of infection during air travel is already very low when all passengers are masked. Surely, that risk is even lower for vaccinated people. Why can’t the CDC say that vaccinated people can travel without having to quarantine or get tested?
In fact, I think it could go further and encourage those fully vaccinated to travel. The CDC can specify that they should still be careful once they get to their destination. Don’t go to parties with people of unknown vaccination status, for example, but it’s fine to visit extended family, go to beaches and parks and tour cultural sites (while wearing masks in public places).
How about other social spaces? As is the case for most public-health decisions, there isn’t a one-size-fits-all solution. The CDC can provide nuance and risk estimates instead of taking an absolutist approach. Let’s say it’s really important for an elderly, vaccinated person to resume in-person church services. I think that person can and should go because the risk of infection is exceedingly low compared with the benefit to their mental and spiritual health. Another person might be desperate to go to a restaurant, hair salon or the gym. Vaccination means that they should regain these freedoms — with caution, including masking and physical distancing when possible. Health-care providers need to help people exercise good judgment while considering each person’s individual values, or else we lose their trust.
Public health must shift its outlook from zero risk to manageable risk that can strike the right balance of controlling infection and restoring the economy. That outlook should also involve calculated risks to take now to end the pandemic later. I’ve written before about my concern that the single biggest impediment to reaching herd immunity will be vaccine hesitancy. People need to be given incentives to get the vaccine. I know that for those desperate to be vaccinated, it’s unimaginable that someone could turn down safe and highly effective vaccines that could save their lives. The reality is that millions of Americans will not get vaccinated unless they see something in it for them. That something is the freedom to return to normalcy.
As more states lift restrictions, the Biden administration has a narrow window to tie reopening policy to vaccination. It can suggest to states, for example, that businesses do not need capacity limits for fully vaccinated people, but if businesses are not checking vaccination status, they should still limit capacity indoors. Interstate and international travel should require pre-travel testing and post-travel quarantine, which would be waived for people with proof of vaccination. Yes, there’s a risk that those vaccinated could still be low-level carriers of the coronavirus. That risk is offset by the greater risk of waiting: At some point soon, everything will be fully reopened anyway, and there will be no carrot left to offer.
To have our best chance of achieving herd immunity and ending the pandemic once and for all, vaccines should be presented as the ticket back to pre-pandemic life. Time is running out for the CDC and the Biden administration to embrace this approach.