Learn from past pandemic mistakes and authorize second boosters for all

The U.S. is experiencing a surge in COVID-19 cases, driven by the highly transmissible BA.4 and BA.5 variants. We need to use all the tools available to protect ourselves from severe disease and death and to protect our health care systems from becoming overwhelmed as hospitalizations increase. That’s why I am calling for the Biden administration, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) to authorize and recommend second boosters for all Americans. A fourth dose of the mRNA vaccines is one tool that can be deployed swiftly to save lives and hospital beds.         

Reports from early July state that several top officials, such as Dr. Ashish Jha, the White House’s coronavirus response coordinator, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, support this initiative, citing that immunity from booster shots received in 2021 is waning. Yet critics say there is not enough data to support the decision, and by recommending second boosters now, the CDC may weaken its argument for reformulated booster shots in the fall.     

Unfortunately, this narrative reminds me of the bungled messaging on masks. In March 2020, the CDC unequivocally advised the public not to wear masks, fearing that many would hoard them, resulting in a shortage of masks for health care workers. When it became impossible to ignore the role of asymptomatic transmission, the CDC changed its guidance, but the damage was done, trust was lost and confusion was wrought in the earliest days of the pandemic.                     

The same mistakes were made again in May 2021 when the CDC prematurely announced a sweeping relaxation of face mask guidelines for those who were fully vaccinated to encourage uptake of the vaccine, leaving many vulnerable to the delta surge. We then witnessed the same scenario with a delayed booster rollout and omicron in December 2021.    

Rather than trying to predict how the public will react to public health recommendations, we must give them equitable access to the tools to protect themselves and their communities. This is how we rebuild trust in public health recommendations after several years of confusion, in which public health agencies often gave conflicting recommendations. Empower the public with facts about the benefits of second boosters and let them make the decision for themselves.                                  

An ongoing randomized clinical trial in the United Kingdom found that the fourth dose of the mRNA vaccines can both boost cellular and antibody-mediated immunity as effectively as the third dose. Recent data from the CDC suggest that the risks of dying from COVID is reduced 29-fold for those over 50 years old who have had two booster shots.         

The difficult reality of life with COVID-19 means we are forced to make a myriad of risk assessments each day, especially as protective measures and mandates are rolled back around the globe. Fortunately, the calculus involved in getting a second booster is simple. With new data about the risk of death, blood clots and other negative health outcomes doubling with COVID-19 reinfection and the disabling symptoms associated with long COVID, we must take every opportunity to protect ourselves.

Dr. William Haseltine is the author of “A Family Guide to Long Covid” and several other books on COVID-19. He is president of the think tank ACCESS Health International and a former professor at Harvard Medical School and School of Public Health.