Let’s stop saying ‘breakthrough cases’ — it isn’t helping

When historians analyze the national response to the COVID-19 health crisis, they’ll conclude the country’s public health authorities were responsible for saving millions of American lives by recommending the adoption of essential pandemic mitigation measures. Vaccines, mask wearing, social distancing and hand washing have proven their value in battling the spread of the virus. Yet these same health professionals will be criticized for their failure to communicate in a thoughtful and effective manner. The public has decided the pandemic is over, and it’s because public health communications are falling on deaf ears.   

Throughout the pandemic, public health experts have communicated critical COVID-19 guidance to the American people in ways that are confounding — and sometimes contradictory. Examples of mixed messages by public health officials since the start of the pandemic are plentiful. From mask practices to back-to-school recommendations to booster shots, confusion and ambiguity have circulated, creating uncertainty at times as to what people can do to stay safe.

The most recent example is the use of a term that has now become a household phrase: “breakthrough cases.” By now we know what it means, coined to distinguish infections in “fully vaccinated” people from those diagnosed in the unvaccinated. But words matter, and at a time when we need to encourage as many people as possible to get their shots, “breakthrough” is the wrong one to propagate. 

When the vaccine was introduced, Dr. Anthony Fauci and others said it would offer the public a strong layer of protection against COVID-19. They sought to manage expectations by saying it would lower the possibility of getting the virus, but that, like all vaccines, it wouldn’t guarantee immunity. They tried to make it clear that infection was still possible, and that the vaccine would still do its job by drastically lowering the chance of severe illness, hospitalization and death. All of this has proven true.

Fast-forward to today.

By trumpeting the term “breakthrough cases,” public health authorities are spreading the impression that these infections are novel, unique and unanticipated by the scientific community. In fact, the vaccine was designed precisely with this likelihood in mind, and it is working exactly as intended. With cases of hospitalization and death largely isolated among the unvaccinated population, it clearly shows the vaccines are doing their job and achieving the desired outcome. 

To those who have dutifully received their shots, the term “breakthrough case” leaves many wondering whether the vaccine was worth it. To the unvaccinated, it validates every bias and conspiracy theory that has fueled their hesitancy to date. What better way to dissuade these individuals from receiving their shots than by assigning a label that corroborates their own misgivings?

A golden rule in communications is to never repeat the negative. It’s why politicians on Sunday morning talk shows don’t reiterate hostile statements from critics when responding to difficult questions. Terms that confuse or distract target audiences from absorbing a prevailing viewpoint only defeat the cause. This is what words like “breakthrough” do. And, like everything these days, it’s now being used to advance opposing agendas in Washington, where some observers are calling it a “dirty word in U.S. politics.”

Public health experts have done little to challenge the term or correct its misperceptions. Quite the opposite, in fact; they’ve embraced it. The U.S. Centers for Disease Control and Prevention (CDC) even offers this definition on its website: “[a]n infection of a fully vaccinated person is referred to as a ‘vaccine breakthrough infection.’” Fauci uses it. President Biden has too. 

For leaders to lead, they need people to trust them. To build trust in the vaccine, public health officials need to be clear in how it works. They need to state that though infections can still occur, even after receiving boosters, symptoms will be mild for most Americans — and that such infections are part of the calculus in getting the vaccine, not a reason to question its efficacy. They must avoid and openly challenge terms that reaffirm preconceived beliefs, not perpetuate them in the public discourse.

We can’t forget that these professionals — many of whom are scientists by training, not communicators — were thrust into a national spotlight to lead the country in this moment. But they need to think carefully about the statements and phrases they use in articulating their positions, especially those that risk stoking fear or wariness when making the case for the one proven measure that holds the key to ending the COVID-19 crisis. 

Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.