There was no population immunity to this new mysterious virus, which, unlike other coronaviruses, could easily be spread by people without any symptoms. That meant “This was going to beast to control,” according to Dr. Jodie Guest, a Professor at Emory University’s Rollins School of Public Health and vice chair of the Department of Epidemiology.
It sure was. And still is.
As workplaces closed and hospitals shuddered under a never-ending emergency, it was an unexpected success when life-saving vaccines were made in less than a year. The doses were initially scarce and desperately hard to get. Then demand for vaccines fell. Less than a year after the vaccine arrived, efforts to vaccinate everyone hit a wall.
Despite roughly 400 Americans dying each day from COVID, doctors, epidemiologists and health officials say we’ve reached another turning point in the pandemic. The role of vaccines is becoming less clear. The Centers for Disease Control and Prevention still recommends boosters for everyone eligible including children, but even doctors are beginning to question the benefits for people not at high risk.
Could the future be one without boosters for most people? And if it is, how should public health officials get the message out to the people who would benefit from of vaccines when so many have gone deaf to the pandemic?
“Our attention, resources, and public health campaign should really be focusing on making sure that the immunity protection for people 50 and over is as current and as high as we can get it. The value of boosting everyone is much lower for younger people who are healthy or who don’t have high-risk factors,” said Dr. Felipe Lobelo, an epidemiologist at Kaiser Permanente of Georgia.
Lobelo cited CDC data showing that, of the 427 deaths resulting from COVID-19 in Georgia from Jan. 1 through Feb. 15, all were among people 50 and over.
When the first COVID vaccines were made available, they were not only remarkably effective at preventing severe illness, they were considered a shield against even mild infection: a ticket to return to pre-pandemic life.
The reality was not so simple, and in some ways, disappointing.
Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said there was a “false hope,” created by the original studies back in 2020 that showed the vaccines offered a whopping 95% efficacy at preventing COVID — a success against not just severe infections but mild illness, too.
“There’s no way that was going to last,” said Offit in an interview with The New England Journal of Medicine’s “Intention to Treat” podcast. “I think we created this unrealistic expectation.”
He pointed to a seminal moment during the July 4th holiday in 2021 when thousands gathered in Provincetown, Mass. Most were vaccinated, but several still got COVID. Only four were hospitalized. Most experienced mild or asymptomatic infection, which the CDC labeled as “breakthrough infections.”
That, Offit said, was the wrong term.
“‘Breakthrough’ implies failure,” said Offit. “That’s not a failure. That was a moment to celebrate that vaccine. Here were people who, because they were vaccinated and then exposed to the virus, only suffered a mild illness. And I think we lost that opportunity and created this unrealistic notion that we could somehow in any long-term manner protect against mild disease, which is just not possible.”
Guest, from Emory, agreed.
“We’ve lost the messaging,” Guest said, “that these vaccines are still incredibly effective at keeping people out of the hospital and keep people from dying – and that’s the win.”
By now, millions of Georgians have caught the virus, some multiple times.
People who are vaccinated can still die from COVID. But the rate of death among the vaccinated is still significantly lower than the unvaccinated. Only 59% of the population in Georgia completed the primary series of vaccination, among the lowest rates in the country, according to data from the Georgia Department of Public Health.
Now, the virus no longer carries the same level of risk and danger for most people. It is estimated around 90% of Americans have some level of immunity due to prior infection or vaccination.
A study published in The Lancet Journal Feb. 16 found infection with coronavirus could protect against re-infection for up to 10 months for some of the variants prior to omicron. Protection against severe illness was high for all variants, based on the meta-analysis of 65 different studies. The study’s authors recommended that immunity should be considered alongside protection from vaccination.
But protection wanes over time. And one of the key questions going forward is about boosters. People who are high-risk — adults age 50 and over and people who are immunocompromised or have underlying conditions — are strongly encouraged to get an updated booster.
However, the FDA and CDC experts agreed earlier this year to add the COVID vaccine to a list of routine immunizations for children and adults, though it’s unclear if boosters are necessary for younger, healthy people. An advisory committee to the FDA raised doubts about shifting toward an annual COVID booster shot. Some advisers said they were apprehensive about recommending a vaccine every year, given the virus is still so new and unpredictable.
Early in the pandemic, the CDC didn’t recommend face masks for the public — not because they thought they wouldn’t be effective, but because they worried the demand from the public would cause a shortage of masks for health care workers.
That would become part of a pattern of the federal agency not communicating health information clearly or directly to the public.
CDC Director Rochelle Walensky has acknowledged these failings and announced last August an overhaul of the structure and operations to improve how the agency shares information, develops public health guidance and communicates with the American public.
Credit: Alyssa Pointer/Alyssa.Pointer@aj
Credit: Alyssa Pointer/Alyssa.Pointer@aj
Changes at the nation’s public health protection agency can’t come fast enough for Dr. Cecil Bennett, a Newnan-based family physician.
“From the very beginning of the pandemic all the way through to the latest booster, I have been very, very disappointed with their leadership, their messaging,” he said. “It’s been a challenge for me to double-check what I’m hearing.”
In the fall of 2021, he was a rare voice in medicine expressing concern about the push for everyone to get a booster at a time when so many people were still unvaccinated. He believed those already infected with COVID had acquired a natural boost in immunity that should have been figured in.
“We had perfectly healthy individuals with high antibody levels getting unnecessary boosters, and we took our eye off the ball,” he said. “That really bothered me.”
At the same time, misinformation about the virus thrived. What started in 2020 casting doubt on the existence or seriousness of COVID evolved into outrageous claims about microchips hidden in the vaccine. The speculation continues today. Buffalo Bill’s Damar Hamlin’s cardiac arrest on Jan. 2 following a collision with another player during a game immediately sparked unfounded rumors that the COVID vaccine was to blame. Some of the baseless tweets racked up millions of views.
“We drastically underestimated the role of social media,” said Brian Castrucci, an epidemiologist who worked for DPH before becoming head of a public health charity in Maryland. “I don’t think public health was ready to counteract online voices. Those looking to seed misinformation, they had their network ready.”
Learning from mistakes
Public health experts say now is the time to make changes and be better prepared for what comes next. Guest said the pandemic preparedness system must be more nimble and provide information clearly and quickly.
“Every time policy changes or guidelines change, we need to be explaining the reason for the change,” she said.
It’s also become clear vaccines alone are not enough to beat COVID. When the virus evades immunity from vaccines or prior infection, or when people decide not to get vaccinated, therapeutics are the best line of defense to prevent hospitalization and death. But treatments are not keeping pace with the ever-evolving coronavirus.
Credit: Christina Matacotta
Credit: Christina Matacotta
Many treatments are no longer effective, although Paxlovid, which comes in pill form, is still highly effective at preventing severe illness. Even so, it continues to be under-prescribed in the U.S. Public health experts say it’s critical for scientists and clinicians to develop more treatment options.
Guest said it’s also a time for people to recalibrate the way they live with COVID. It’s not as simple as an off-on switch, she said.
“I do think we are settling back into a more normal style of living with the virus,” said Guest. “A lot of people have the privilege of not thinking much about it on a day-to-day basis.” She advocates understanding when high-risk individuals must take extra precautions and wearing a mask when those at higher risk are nearby.
“This can’t be a masks on, masks off, everyone gets vaccinated every four months or everyone does not. It’s a little more nuanced than that. And that’s the place we now are.”