COVID confusion: Biden team needs a clearer message on boosters

The Food and Drug Administration (FDA) has finally extended its Emergency Use Authorization for Moderna and Pfizer/BioNTech vaccine boosters to all those over the age of 18. The Centers for Disease Control and Prevention (CDC) advisory committee has now voted to approve boosters for those over 18, and recommend it for those over 50. This is a big step in the right direction, coming after a long, costly delay.

But the science goes beyond this - all vaccinated people, with the exception of some who have had COVID, should get a booster as additional protection against the raging virus.

Not only that, but there is enough evidence now to show that the third shot - or recovery from COVID plus two shots - should be a standard part of the vaccine regimen six months after the second shot. Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, is right when he says almost everyone over 18 should get the booster, but he is wrong when he says that it shouldn't be considered part of being "fully vaccinated."

As I have written in these pages, I favor the Green Pass issued by Israel, which includes allowances for immunity from infection, a testing alternative, and now requires boosters after six months. Unfortunately, our own government's messaging lacks the same clarity.

At the end of August, President Biden and the White House called for boosters for all adults to begin on Sept. 20. The delay that followed was troubling and spawned public confusion and lack of confidence in the government's handling of the vaccine rollout. It was clear at the time that the president should have built a consensus among scientists before making the announcement. The resignations of two top FDA officials, Marion Gruber and Philip Krause, might have been avoided if the announcement hadn't been made when it was.

Don't get me wrong: Time, and a continued outpouring of real-world data, has proven the president to be right. Had we boosted all those under age 65 earlier, we might have avoided many thousands of so-called breakthrough infections. California, Colorado and New York City, as well as Utah and Massachusetts, should be lauded for making boosters available for all adults over 18, in advance of the FDA doing so. But the president should not have allowed these states to get ahead of the federal response.

The fact is that study after study from Israel, the United Kingdom and now the U.S. (close to 800,000 veterans studied) has shown that the protection of all three vaccines available in the U.S. wane and that boosters help bring that protection back, in terms of bolstering neutralizing antibodies and decreasing the risk of getting infected or severely ill from an infection. There is a growing body of evidence that the first two doses of the MRNA vaccines (especially Pfizer/BioNTech) have been given too close together, that one dose of the Johnson & Johnson jab is insufficient, that an additional shot is needed not as a booster but as part of the original vaccine series needed to cement immunity. The necessity of these additional shots has seemed clear for months.

The booster baby-steps that have occurred in the U.S., extending the Emergency Use Authorization to those over 65 followed by the immunocompromised and front-line workers, have been insufficient. I am glad to see the FDA approving boosters for all adults, but I believe this should have happened weeks ago.

Keep in mind that, when it comes to vaccines, there are two main purposes for taking them. The first is to alert your immune system that a circulating microscopic organism may try to infect you, so your immune system needs to be made ready. But the second reason is also important. Vaccines are also a public health tool; if the immune barrier created is sufficient, you not only won't get infected, you also are much less likely to spread the virus to others. Though there is evidence that COVID's Delta variant leads to a higher viral load and that even vaccinated people can harbor and spread it, it is for a shorter duration than for unvaccinated people.

And an important study from Israel just published in the journal Nature demonstrated that booster shots decrease this viral load. The authors wrote: "Notably, we found that the effect of BNT162b2 on reducing BTI viral loads is restored after a booster dose. These results suggest that BNT162b2 might decrease the infectiousness of BTIs even with the Delta variant, and that, although this protective effect declines with time, it can be restored, at least temporarily, with a third, booster, vaccine dose."

Since no immunity to COVID has been proven durable at this point, the more immunity you are able to generate, the better. Plus, being fully vaccinated has been shown to decrease the risk of "Long COVID" symptoms. The Biden administration needs to send a much clearer message when it comes to boosters. They should be included in the definition of being fully vaccinated.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, "COVID; the Politics of Fear and the Power of Science."