Team Biden’s recall division deepens as risk of winter virus wave looms

But waiting for definitive results before making the injections widely available could come at its own cost, said Leana Wen, an emergency physician and professor of public health at George Washington University.

“I don’t think the federal government should be concerned with telling people what is valuable to them. I don’t need the federal government telling me that I shouldn’t worry about infecting vulnerable young members of my family, ”she said. “That’s why the CDC meeting last week was so frustrating, because they were basically saying, ‘We know better than you what is important to you about prevention or prevention. “”

And the difficulty of predicting how the outbreak will behave in the United States over the next few months increases the political challenge facing the Biden administration. Senior federal officials are basically trying to predict the unknowable. The big question for many members of Biden’s Covid team is whether the United States should give boosters to otherwise healthy Americans to help reduce transmission and infection, limit boosters until get most of the world to their first dose or try to do both at the same time. The answers vary widely.

“I don’t think anything is open and closed right now. I think things are suggestive, ”said Craig Spencer, an emergency physician at New York University, of the data on the effectiveness of the vaccine. “Will [boosters] be justified? I think it depends on what you think we should do with our vaccines. We are sitting on hundreds of millions of doses that could be immediately used in places to stop the spread and prevent people from dying from a largely vaccine-preventable disease. “

The Biden administration faced an immediate backlash in August when it announced it would start offering booster shots in September. Health experts and international officials have said the United States should do more to help immunize the rest of the world before moving forward with an extra dose for Americans. Medical and public health experts with ties to the White House, including former members of Biden’s transition team, also argued that available data shows vaccines still do a good job of preventing serious illnesses and deaths, although their power to prevent mild infections diminished.

This review has started a series of conversations within the White House and among Biden Covid-19 officials about how best to forestall a possible outbreak as the pandemic nears the end of its second year.

Scientists from the CDC and the FDA, as well as the agencies’ external advisers, have made it clear in recent presentations that the recalls will not necessarily prevent a mild infection. They argued that injections should be used to protect the elderly and other groups for whom vaccination was becoming less effective to avoid hospitalization and death.

Through it all, Fauci expressed his thoughts on boosters, saying the Israeli data is clear: the effectiveness of vaccines against mild and moderate illness is decreasing, and boosters are the solution. He argues that the United States should not reserve third injections as protection against serious illness, going against the latest recommendations from the FDA and CDC.

“It seems like [the advisory groups] were saying you’re fine until you end up in the hospital and die, ”Fauci said in a recent interview with conservative radio talk show host Hugh Hewitt. “I don’t feel like that. I think we need to protect ourselves not only against hospitalizations … but we don’t want people to get sick. You can also get very sick and not necessarily have to go to the hospital. “

Fauci added that his approach did not conflict with Biden’s goal of helping to immunize the world, noting that the administration “is committed to doing even more” on this front.

Walensky also noted the importance of finding a way to treat mild infections, even though his agency decided in May to only track cases that resulted in hospitalization. If a healthcare worker becomes ill with a breakthrough infection “it could be an intensive care bed that cannot be filled because there is no manpower,” she said. recently stated at the Atlantic Ideas Festival.

But Walensky also said at a press conference last week that receiving booster shots is a “walk, not run” situation, stressing that increasing the overall immunization rate is also a powerful method to protect vulnerable people.

The administration’s internal fight over boosters continues to spill over into public opinion as pundits search for ways to prevent a repeat of last winter’s devastating wave.

“There is a reluctance to use third jabs in this country, although they could help a lot to basically get all of those people who are vaccinated early to get them back fully protected,” Topol said. “We are starting to deny the importance of infections. And this is not good. The other thing that I think is being ruled out is the long history of Covid. The only prevention of long Covid is to prevent infection. “

For others like Spencer, the New York City emergency doctor, any decision to distribute boosters on a large scale now would overlook the fact that the United States still lacks good data on the benefits of the vaccine. – and the potential risks.

“Are we ever going to be able to stimulate people enough to have sterilizing immunity, which means they can’t get infected?” Spencer said. “For someone like me or someone younger… we don’t know what is the risk of a third dose of a vaccine. What is the impact on my arthritis? We don’t know. we know that before we can make broad policy recommendations, which could ultimately undermine our efforts to scale up vaccines. ”

The administration has started discussing what other strategies it can recommend or encourage to prevent a spike in infections during the upcoming holiday season. Possible approaches include revising guidelines for wearing a mask and increasing access to rapid tests for Covid-19.

“If we were all doing rapid antigen tests every day or every other day, we would know, but here we have a blind guide to help them navigate through it,” Topol said.

Rapid tests are still relatively expensive in the United States and are not widely available. Without widespread use of strict public health measures like frequent testing, and in light of the country’s relatively low vaccination rate, officials said they still struggle to develop a long-term pandemic strategy. .

“The question for society is what level of death are we willing to accept? And what is the price we are prepared to pay? said Wen. “I think there are people who might say, ‘Hey, it’s a win if we can make Covid like the flu. But even then we are talking about double the flu. So the question becomes, what price are we willing to pay for reducing the level of Covid? Do we really want to reduce the burden of suffering even more if it means wearing masks every winter? Are people prepared to pay this price? “