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COVID Booster Guidance Is In Order
Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.
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It's closing in on a year since Americans in generally good health got their most recent COVID booster shots. With Labor Day and autumn approaching, guidance is needed soon for those under 65 without underlying health conditions on if or when another booster is needed.
The first updated COVID booster shot, also known as the bivalent shot because it targeted COVID's original strains as well as newer ones, rolled out last fall. That may be the last time that those in the general population have been immunized. In April, federal health officials authorized another bivalent booster for people at high risk for severe COVID — generally, the elderly or those who are immunocompromised. But they didn't advise a second one at that time outside these categories.
This fall, a new booster targeting additional variants is expected to be available. There are growing concerns about waning protections among those who got the booster last fall but weren't eligible for another booster this spring. The U.S. Food and Drug Administration (FDA) and U.S. Centers for Disease Control (CDC) have yet to issue guidance but should do so as soon as possible.
The agencies' guidance will likely focus on those at high risk for COVID complications. But federal officials should also anticipate questions that people at lower risk might have when the recommendations come out, which hopefully will happen in coming weeks.
If, for example, another booster isn't authorized for the general population, health officials should say why. A fuller explanation for the public was lacking last spring, when the second booster was recommended for high-risk groups but not others.
If the booster is widely recommended, advice on when to get it would be helpful. Would a shot later in the season be better timed to provide protection during a winter COVID surge? Is it better to wait so that higher-risk groups have access to the new booster first?
Targeted, accessible information is also critical for parents who want to protect their kids. Students will be back in school soon, where indoor conditions can fuel COVID's spread. Parents will want to know if a booster is in order. Parents with hesitancy about mRNA vaccines (the Pfizer and Moderna shots) would also benefit from more information about non-mRNA alternatives, such as Novavax.
This year, the FDA and CDC have put a priority on simplifying vaccine guidance. That's understandable, but that approach regrettably left many people with more questions than answers when updated guidelines rolled out earlier this year.
Nationally, just 17% of the U.S. Population has had a COVID booster, according to the CDC. While it appears policy is shifting toward regular boosters just for those at risk of severe COVID, clarity is still needed during this transition for everyone else and potentially could help improve booster uptake.
The pandemic may officially be at a close, but it's not yet time to let down our collective guard. The vaccine isn't a panacea, but it's certainly a potent defense. That's why it's important to stay up to date on this immunization.
"Vaccination is a key way to protect yourself from getting COVID,'' said Lynn Bahta, a Minnesota Department of Health vaccine expert. Masking and other precautions are important as well to combat COVID's spread, she added, particularly if cooler temperatures are accompanied by rising cases and hospitalizations.
Bahta also urged people who do become ill with COVID to seek out Paxlovid, a treatment that can significantly reduce the risk of hospitalization and death in those who become ill.
As of Aug. 7, the most recent CDC data available, weekly COVID hospitalizations rose 14.3% across the nation. Deaths were up 10% during the same period. Unlike the pandemic's beginning, the medical arsenal includes preventives and treatments. Clear, timely guidance for all can ensure that consumers know when and how to take advantage of them.
New CDC Director Dr. Mandy Cohen Reflects On Baldwin Roots, Boosting Trust In Agency
Dr. Mandy K. Cohen on Dec. 15, 2020, during a briefing in Raleigh, North Carolina, as secretary of the North Carolina Department of Health and Human Services. Credit: AP/Ethan Hyman
Baldwin native Dr. Mandy K. Cohen was sworn in as director of the Centers for Disease Control and Prevention last month as the agency faces a drop in trust among the public and difficulty in persuading pandemic-weary Americans to get the new COVID-19 vaccine booster early this fall.
The CDC was in the midst of the nation's culture wars during much of the pandemic. It was criticized early on for what some considered overly restrictive recommendations on masking and other precautions, and was later criticized by some public health experts for what they viewed as a premature loosening of those recommendations. Polls found that the percentage of Americans who trust the CDC fell during the pandemic.
Cohen, 44, faces the challenge of trying to restore that trust. In a recent interview with Newsday, she said she plans to do that by increasing transparency, communicating more clearly and simply, and looking for ways to forge consensus.
Cohen also talked with Newsday about her Long Island roots, how her parents and Jewish faith instilled in her the values that led her to become a doctor, and how one of her focuses will be reducing rates of chronic diseases that are significantly higher than in other wealthy countries.
As director, Cohen is the public face of the CDC. She oversees an agency that conducts scientific research, works in the United States and around the world to prevent the spread of emerging and other diseases, and communicates health information to the public. The agency has more than 12,000 employees, according to The Associated Press.
Cohen, who maintains a residence in Atlanta, is married to Sam Cohen, an attorney, and has two daughters.
This interview was edited for space, clarity and style.
What led to your early interest in health care? How much of an influence on that was your mom, Susan Krauthamer, who was an emergency room nurse practitioner?
Dr. Mandy K. Cohen: A huge, huge impact. I saw the health care system through her eyes. I would be at the supermarket and someone who she had helped in the emergency room last week, last night, would come over and thank her. I saw as a kid the impact that she was having on our community and on families that she didn't know.
I'd say also our Jewish values very much contributed to that [interest in health care]. One of the core Jewish values is tikkun olam, or to heal the world. And I watched my mom live that value and instill that in us as well.
I also want to give credit to my dad [Marshall Krauthamer]. My dad has been an educator [a guidance counselor and special education teacher in New York City schools] his whole career. It was really a combination of both of them going into careers that were service-oriented and thinking about, 'How do I fit into making this world a better place?' That was always what we talked about as a family.
You wear the Hebrew chai symbol, which means life. How important was your Judaism growing up on Long Island and in influencing your career?
It's a foundational value for me. I wear the chai, one, to connect me back to the Jewish roots, but also to connect me to my mom and to other strong women in my life. My mom gave it to me when I got into medical school.
Dr. Mandy K. Cohen, director of the Centers for Disease Control and Prevention. Credit: Lauren Bishop
Do you still visit Long Island?
Sure. My parents still live in Baldwin … and still get Newsday delivered.
We live in a very divided country. How can you confront the politicization of health care and the mistrust and distrust of not only the CDC, but of the medical establishment?
I had the opportunity to lead in North Carolina [as head of the state health department], and there we were able to build trust and build consensus on some key pieces of work to allow us to build a healthier state.
As I approach this work at the CDC, that's what I'm looking to do, to find the places of consensus and make sure that we are acting in a way that builds trust, so that we are transparent, that we are communicating in a simple and clear way, that we are performing well, that we are doing the job that we are tasked to do, and do it well.
Do you have any examples of how the CDC in the past may not have been as transparent, or may not have done as much outreach, and what would you do differently?
I led through the COVID crisis in North Carolina, and there were times where we needed to make sure that our guidance was more simple, more clear than what we were seeing from the CDC. We made sure to be on TV a ton in North Carolina, so we could answer questions so that folks could know why we were making the decisions we were doing, what data we were looking at to make these hard decisions, constantly updating folks every day. Because the hard part about the COVID pandemic was, we were learning things every single day. Things were changing. But you needed to rapidly communicate that to folks.
You'll see me do a lot of communications as head of CDC in order to build that trust and be as transparent as we can.
For example, as we are doing our work, you're going to see a lot more video explanations of what we're doing, because not everyone goes and reads the CDC website. How do we think about making products that are meeting folks where they are, simple graphics that people can understand?
There's very low uptake of vaccine booster shots, on Long Island and nationwide. A new booster is expected in a few weeks. With less trust in vaccines in general, what do you do going forward, because boosters can save lives?
I'm going to start where you ended there, which is vaccines work, they're effective and they're safe. We are going to need to live with COVID. It is still here with us. And luckily, we have tools that can protect us.
The unfortunate part is that the protection that those vaccines give does decrease over time. And so we do need to make sure that our immune system continues to be as strong as it possibly can be, which is why folks have worked on a new shot. And what you're going to see is, like we have annual flu vaccines, we are likely going to be having annual COVID vaccines. There are folks who are older or have more chronic conditions, and they may need to get a shot more than once a year.
Dr. Mandy K. Cohen, as chief of staff for the Centers for Medicare and Medicaid Services, testified on Capitol Hill in Washington in 2015. Credit: AP/Cliff Owen
How do you combat some of the mistrust and distrust of vaccines? I think it's foundational in how you build trust overall. It takes time. Some of that is the transparency, the simple communication, the good relationships, the good execution, and you build back the trust that you can.
As CDC director, you're obviously going to face harsh criticism no matter what you do. And a lot of it will be very public. Why take a job where you're in a firestorm?
I'm going to try to focus on the places of consensus and protecting folks' health. I took this role because of the incredible mission of the CDC to protect the health of this country and really the world, and what an amazing impact you can have in that kind of role.
You've met on Capitol Hill with both Republicans and Democrats. How do you sell the CDC, including to people from both parties?
I think folks understand that if we want to be a safe nation, we need an agency that is well-resourced to identify and respond to biologic threats.
At the same time, we also need to become a healthier country, in order to stay economically competitive, but also to fight off those threats. We did worse during COVID as a country because we were sicker going into COVID. Remember, COVID impacted those who had multiple chronic diseases. So if we had less chronic disease, we would have been healthier in fighting off COVID. We have to do both: Identifying and addressing threats, and preventing disease from happening.
David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.
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