The Waiting Is the Hardest Part: Booster Shots Revisited

So here is the report from The New York Times we all could have guessed we’d find ourselves reading one of these mornings.

While it is premature to conclude that the pause and retrenchment on government approval of booster vaccines will prove to be a permanent one, I’d be remiss if I didn’t point out the following:

In the time since I first ran numbers on COVID prevalence, vaccination rates, and national economic standing, the US has had both absolute increases in COVID infections (now above 50 per 100,000) and has risen in relative prevalence compared to other countries in the world. There are now 154 million unvaccinated Americans (down from 161 million), and the sum total of all unvaccinated individuals in all countries meeting criteria (a), (b), and (c) from my earlier post is 30 million (down from over 90 million). This number still includes Cuba. In the time since mid-August, the US has passed Iran.

Re the preceding NYT article, it’s worth noting the not-so-subtle shift in terms between the last sentence of the third paragraph and the first sentence of the fourth paragraph: In the former, you have a White House official saying the administration would follow “the advice of government scientists”; in the latter, another official says they would follow “the science,” the two being used interchangeably. The advice of scientists is not the same as science. In any case, there is no such thing as a scientific study whose hypothesis is whether or not a government should approve a vaccine. The way the administration is using the buzz phrase “follow the science” for political cover effectively removes all meaning from the phrase.

For each day that the administration pauses on the approval of boosters, it has decided not to deploy boosters to the population, and ought to be held accountable for that as an affirmative decision. There are currently 1,500 COVID deaths a day in the US with cases and deaths both on a rising trend. The data that officials are claiming they need to review before deciding are not all new in the last week or two, before which their position was the opposite. In that time, schools throughout the country have returned to session. In the time it takes the officials to review the data they now say they need to review, more data will have rolled in. No one has given a straight answer about how much science we need to have before we get to call it Science, and what the relationship is or will be between having scientific data and making a policy decision.

As of right now, I would say that the administration has a moral obligation to make an affirmative argument identifying and quantifying the actual harm that would be caused by proceeding with boosters without further delay. Failing that, it needs to make an affirmative argument that identifies the specific more beneficial action that will be taken involving every single US vaccine dose if not put to use in a booster program, starting right now.

For a country that is supposedly sitting on billions of doses of unused vaccine, and which promised to proceed at a pace of 2 million vaccinations per day until it reached herd immunity, our actual vaccine progress in the last 16 days (since I last ran numbers) has been about 400,000 doses per day. In that same time, we’ve been seeing 160,000 reported COVID cases per day. Biden has continued to escalate promises to fund global vaccination. Each time Biden pledges something, he’s criticized by global health officials for not having pledged something else that they’ve decided they want more. No one seems to be giving a straightforward accounting of how many doses the US has made, has in storage, has on order, or are being manufactured either domestically or globally, at the present time. (If I reported my income to the IRS the way public health officials report on vaccine supply, I’d be in jail.)

The press has been quoting for months his donation of 600 million doses to countries in need. No one, as far as I can tell, has reported on where those doses are, what has happened to them, or if they are even real, manufactured, stockpiled vaccines in vials, as opposed to a “pledge” of vaccine in the abstract.

None of this “vaccine equity” rhetoric makes a compelling case against mobilizing current supply to provide boosters, but if such a compelling case exists, then let’s get busy mobilizing that supply to vaccinate someone else without delay. At this point no one is saying it out loud, but it is impossible to imagine that most doses held back from use as a boosters are doing much else but sitting idle.

That’s just me looking at the dots, but no one in the official global health community seems to have bothered enough to connect them. To me, the worst crime global health crime possible is to have vaccine and not use it as days pass, and the virus tears through unvaccinated populations. Compared to that, a dose given that is later proved to have marginally less than optimal efficacy in the individual who received it, or a marginal uptick in adverse reactions to vaccine, or a dose given amid a shifting data field, does not rate as a real global threat.

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