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The growing division between Biden’s team and outside health experts over recalls threatens to disrupt a key source of support the administration has relied on to sell its vaccination campaign to the American public. Biden, who took office with a pledge to ‘follow the science’, until recently enjoyed enthusiastic support from prominent doctors and researchers as he tried to crush Covid-19 and revive the US economy . But the White House’s overall vision for boosters has weakened those ties.
Now, even some experts who support the president’s broad recall strategy say the White House has fumbled its messages on the matter, confusing the public as Biden’s team tries to limit further outbreaks of infection during the winter. .
“It undermines credibility not only for [federal health] agencies but for the administration as a whole, ”said Irwin Redlener, director of the Pandemic Resource and Response Initiative at Columbia University. “Someone needs a lesson in communication. Maybe a lot of people do.
The White House did not respond to a request for comment. A spokesperson for the Department of Health and Human Services said the administration “regularly engages[s] stakeholders outside the medical community with a wide range of views for their comments “on the administration’s pandemic policies.
“We are doing everything possible to provide Americans with the maximum protection offered by vaccines, including constantly working to increase the number of primary vaccinations and ensuring that boosters are available for all who are eligible,” said the holder. word.
The White House has held regular informal calls with health experts since Biden took office, often to preview major announcements or push his talking points, three of the people familiar with the talks said. They are typically headed by Surgeon General Vivek Murthy and other senior administration officials including Fauci, CDC Director Rochelle Walensky and Acting FDA Commissioner Janet Woodcock. Dozens of prominent scientists and doctors participated.
Now, as the FDA prepares to clear the boosters from Moderna and Johnson & Johnson, senior federal health officials have reached out to surrogates in the administration to promote the government’s approach. Biden’s team stresses the importance of using boosters to prevent breakthrough infections, even mild cases.
The discussions took place amid continuing tensions between CDC and FDA scientists and other federal officials working on the Covid-19 response over the administration’s public messages on vaccine effectiveness and recalls, given the data gaps.
The September 27 call was originally scheduled for the previous week. The White House abruptly rescheduled it after the CDC’s independent vaccine advisory committee recommended that the Pfizer-BioNTech booster be reserved for high-risk groups, including the elderly.
The rescheduled call was the most tense yet, according to the three people with information about the talks. Fauci argued that the CDC committee’s position – that science does not support giving reminders to all adults – was incorrect. And he rejected suggestions that the administration had to choose between a massive recall campaign in the United States and donating vaccines to countries in need.
The president’s chief medical adviser also told outside experts that boosters could and should be administered widely to reduce the spread of the coronavirus rather than just to prevent serious illness or death.
Fauci’s remarks sparked disagreement over the appeal, the five people familiar with the matter said. Several participants were left perplexed as to the goal of the government’s vaccination campaign.
“It was very tense,” said one person. “More than anything, it was as if Fauci felt he had to make a point.”
Since the FDA and CDC cleared limited use of the Pfizer-BioNTech booster in late September, senior health officials in the administration have publicly stated that they will follow the scientists’ recommendations in planning the booster’s deployment.
But hours after the Pfizer-BioNTech decision, Biden predicted that the booster shots would soon be available “across the board.”
“In the short term, we’ll probably open this up,” the president said.
Fauci, Walensky and other leaders in the administration’s Covid-19 response have also publicly questioned FDA and CDC decisions to restrict the Pfizer-BioNTech recall to high-risk seniors and youth due to their underlying job or health condition.
The dichotomy between Team Biden’s Booster For All philosophy and the targeted use endorsed by health agencies and their independent advisory boards has frustrated some of the nation’s top doctors.
Many – including Celine Gounder, an infectious disease specialist at Bellevue Hospital in New York who served on the Biden Transition Covid-19 advisory board, and Megan Ranney, emergency physician and associate dean at the School of Public Health at the Brown University – argue the US should focus on convincing refractories at home to get their initial injections and shipping more doses overseas to reduce the risk of emergence of dangerous new viral variants . Craig Spencer, director of global health in emergency medicine at Columbia University Medical Center, has also publicly opposed the administration’s thinking on boosters.
“There are some advantages to reducing transmission with boosters. But this advantage is marginal compared to the advantage of vaccinating people in areas of the country that are not vaccinated, never received a dose to begin with, ”said Nahid Bhadelia, director of the Center for Emerging Infectious Diseases Policy and Research at Boston University. “Even with the booster, the antibodies can come down. And as long as there is a group of unvaccinated people in the community, I will not be 100 percent protected.
Others say that with the pandemic shutting down in its third year and with no end in sight, the administration must make tough decisions about boosters without complete data.
A former Harvard Medical School professor and founder of the university’s cancer and HIV / AIDS research departments, William Haseltine, said those who oppose a large recall deployment “are pushing their hopes against it. ‘unknown “.
“If you don’t have a high level of antibodies and you rely on [immune cell] memory, it will not prevent you from getting sick. It can keep you from dying, but it will not stop transmission, ”Haseltine said. “They guess how well memory will protect you. This is something they will regret. If you are in a situation like the one we are in now, is it better to prepare for the worst or to prepare for the best? “
The public health community’s split with Biden comes at a particularly important time: Over the next month, officials could face decisions on Moderna vaccines, and Johnson & Johnson should receive boosters, if people can receive doses of two different Covid-19 vaccines and whether to approve the Pfizer-BioNTech vaccine for children under 12 years of age.
Administration officials have already started telegraphing their confidence in children’s vaccines in addition to widespread booster shots and privately argue that science will eventually justify their positions. Upcoming data on the effectiveness of the so-called mix-and-match method of giving people two different types of Covid-19 vaccines is encouraging, they said – potentially paving the way for a wider range of people. for early recalls, as only Pfizer-BioNTech is available now.
The public health community continues to believe the administration is honest and straightforward in its decision-making, four outside experts said. Yet the booster saga has deeply divided him. Some argue that Biden’s team is taking the most informed action possible with the limited information available in order to respond to the emergency at the moment.
“Part of what we’re working on here is how to use these vaccines, and we shouldn’t be surprised that we don’t have all the answers,” said Michael Osterholm, an epidemiologist who advised Biden’s transition team and supports the booster push. “Too many people see this as a dose of luxury. It’s not.”
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