Vaccine booster shots.

What does it mean for you?
Isaac Saul Aug 19, 2021
️I’m Isaac Saul, and this is Tangle: an independent, ad-free, subscriber-supported politics newsletter that summarizes the best arguments from across the political spectrum — then “my take.” You can read Tangle for free or subscribe for Friday editions, and you can reach me anytime by replying to this email. If someone sent you this email, they’re asking you to sign up. You can do that by clicking here.

Today’s read: 13 minutes.

The big news on vaccine boosters (and an unusual Tangle format). Plus, reader feedback, the winners from yesterday’s competition, a story about mask mandates and a question about the recall in California.

Photo by Joshua Hoehne on Unsplash

The guessing game.

Yesterday’s newsletter ended with a chance to win free merchandise by guessing where I was from a single photo (if you didn’t read until the end, you missed it!) Hundreds of responses came in, but only two readers accurately guessed Wellfleet, Massachusetts, in Cape Cod, just minutes apart: Geoff from Boston, Massachusetts (hometown advantage) and Maxim from Manhattan, New York. I’m not telling you which beach it is, though. Secret spot.

Shoutout to the many of you who did guess Cape Cod or beaches on Cape Cod, and especially to those of you who guessed North Fork, Long Island (clearly, you’ve been paying attention). Also a shoutout to the two readers who were furthest off: one who guessed Seoul, South Korea, and another who guessed Japan! That was a lot of fun. We’ll do it again sometime soon.


Reader feedback.

Thomas from Mountain View, California, wrote in to push back on our coverage of the California recall. “I don't know how you could have possibly made it appear more like this was paid for by Newsom if you tried,” he said. “You give the briefest mention of the primary reason the recall succeeded, link it for no apparent or logical reason to Republicans early pointless and failed effort to have him recalled (as you mentioned a few paragraphs earlier, this happens with every governor and basically always fails), give zero information about who it was he was meeting in that maskless indoor meeting, nor any information about the larger context of Democratic leaders across the state consistently getting caught doing the same thing — flouting their own unnecessarily heavy-handed lockdowns while preaching otherwise.

“Nor [do you mention] the high unemployment rate and small business struggles linked to those reactive and unscientific and poorly thought out and implemented lockdowns. Nor is it mentioned that he [Newsom] initially lied and said the meeting was outdoors,” Thomas added. “Then you go and make an absurd argument that the recall is invalid because none of the front-running candidates ‘represent California values.’ But Newsom does? Hard to make that case when nearly half the state wants him out, despite him being a Democrat in an overwhelmingly Democratic state. Hypocrisy is not a Californian value nor an American one. When an important value is violated, that takes precedence.”


Quick hits.

  1. In Afghanistan, anti-Taliban protests are sweeping the country. Some are being met with violence from the Taliban, whose leaders have said they plan to institute Sharia Law. 12 people have been killed at the Kabul airport since Sunday. (The latest)
  2. President Biden said U.S. troops will stay in Afghanistan until all Americans are evacuated — beyond the August 31 deadline if needed. (The promise) Biden was interviewed on ABC last night, where he defended his decision and said chaos was “unavoidable.” (The controversy)
  3. Israeli prime minister Naftali Bennett is scheduled to meet with President Biden on August 26. (The meeting)
  4. Rep. Lauren Boebert (R-CO) disclosed that her husband made $478,000 working as a consultant for an energy firm last year, information she did not reveal during her Congressional campaign. (The new information)
  5. The U.S. Capitol Police Chief who was in charge of intelligence before the Jan. 6 riots has returned to the same role. (The announcement)

What D.C. is talking about.

Booster shots. On Wednesday, the Centers for Disease Control and Prevention released three studies that supported the idea that booster shots were necessary for the Pfizer-BioNTech and Moderna Covid-19 vaccines. The Biden administration said it would make booster shots available in September for people eight months after they became fully vaccinated, and instructed all nursing homes to fully vaccinate their entire staffs or risk losing Medicare and Medicaid funding.

The studies released suggest that the vaccines remain highly effective at preventing hospitalizations or death, but that they are losing their efficacy at preventing infections or spread of the virus — especially the new Delta variant, which is almost exclusively responsible for the current wave of rising infection rates across the country, especially among the unvaccinated.

The study comes just days after The New York Times published a story which used data from seven states that showed breakthrough infections were also rising among the vaccinated, and that hospitalizations had also gone up slightly among the vaccinated in July. Authors of the study pointed to three potential causes for the rise in cases among the vaccinated: a lack of precautions among the general public (vaccinated and unvaccinated), the rise of the Delta variant, and waning vaccine efficacy.

Some experts were critical of the announcement, though. Dr. Céline Gounder, an infectious disease specialist at Bellevue Hospital Center, said the new data supported booster shots for the immunocompromised and nursing home residents, but not for the general public. Dr. Esther Choo, a professor at the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University, expressed dismay that wealthy nations would move to booster shots before much of the world receives initial vaccine doses.

While vaccines, mandates and Covid-19 have all become very political, I’d prefer not to reinforce those divides in today’s issue. So instead of breaking the newsletter into “left” and “right,” we’re going to examine arguments from the critics and the supporters of booster shots, who come from both sides.


What the supporters say.

Supporters argue that it’s clear many Americans will need booster shots, and we should make them available as soon as possible.

The Washington Post editorial board said the boosters have the same goal as the first shots: survival and resilience.

“Nothing lasts forever — not even the benefits of the amazingly effective vaccines that have saved millions of lives during the pandemic,” the board said. “Data disclosed Wednesday suggests that robust protection the vaccines provided against infection at the outset is starting to wane, although they still work well against hospitalization and death… Two studies published by the Centers for Disease Control and Prevention show the efficacy of the mRNA vaccines was declining just as the delta variant was spreading in the United States.

“One study, based on databases of New Yorkers from May 3 to July 25, found vaccine efficacy against infection fell from 91.7 percent to 79.8 percent,” they added. “In a second report, looking at nursing home residents nationwide from March 1 to Aug. 1, vaccine efficacy against infection dropped from 74.7 percent to 53.1 percent. These findings are consistent with recent results from Israel. Still, the vaccines remain potent. In New York, new infections among the fully vaccinated remained rare, with 9,675 infected out of 10.1 million people. The rate of new infections over the period was eight times higher among the unvaccinated. A third study from the CDC confirmed that vaccines are still shielding against hospitalization and death.”

The Wall Street Journal editorial board gave “three cheers” for vaccine boosters.

“Give the Biden Administration credit for endorsing Covid booster shots in defiance of the World Health Organization scolds who have been wrong on nearly every major public health issue during the pandemic,” the board said. The data “should be mostly reassuring to vaccinated individuals, but a more worrisome study found that mRNA vaccines were only 75 percent effective against infection among nursing home residents from March to May and 53 percent in June and July… But younger people no doubt would prefer to avoid flu-like illness too, and boosters could help reduce economic disruptions from workers getting sick this fall and winter.

“The Administration is right to give Americans the option to protect themselves, though it was lambasted by WHO Director General Tedros Adhanom Ghebreyesus on Wednesday for ‘vaccine nationalism.’ Hold on—the U.S. has already shipped some 110 million Covid shots to developing countries, most of which are being distributed by the WHO-backed Covax program,” the board said. “The U.S. is planning to donate another 500 million doses and has committed up to $4 billion to Covax. Yet many developing countries are struggling to deliver the mRNA shots to their people… The WHO is presenting a false choice between the U.S. protecting Americans and assisting the billions of unvaccinated folks around the world.”

Dr. Dorry Segev, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, said we’ll all need a booster — some sooner than others.

“Sadly, there are millions of people in the United States who have not been able to celebrate the magic of COVID-19 vaccines,” Segev wrote. “Disheartening evidence has been mounting since March that solid organ transplant recipients have suboptimal responses to COVID-19 vaccines. While the vaccines are generally considered safe and recommended in this population, only 17 percent of transplant recipients had detectable anti-spike antibodies after a first dose of mRNA vaccine (in stark contrast to 100 percent of people with normally functioning immune systems), only 54 percent had detectable antibodies after a full 2-dose series of mRNA vaccine, and only 17 percent had detectable antibodies after receiving the Janssen adenovirus vaccine.

“Not everyone needs a supplement booster, but it is very likely that everyone will ultimately need a durability booster: a reminder to our immune system to keep up the good work protecting us from COVID-19, a confirmation that we're not done with this virus any time soon,” Segev added. “When the strong initial immune response will wane, and in whom and at what point we need a re-up, remains a very active area of study… It is also very possible that the virus will mutate to the point that the original vaccines are less relevant, and at that point we may need a variant booster: a vaccine redesigned to detect and attack a new protein sequence that better characterizes a new variant. Fortunately, the current vaccines seem to remain quite powerful against the Delta variant, but other variants are no doubt around the corner.”


What the critics say.

Critics say we’re still protected from death or serious illness, and we should prioritize getting vaccines to places in the world that are still unvaccinated.

William F. Parker, an assistant professor of pulmonary and critical care medicine at the University of Chicago, and Govind Persad, an assistant professor at the University of Denver Sturm College of Law and Greenwall Foundation Faculty Scholar in Bioethics, said booster shots for immunocompromised would be smart, but for the general population would be a “mistake.”

“U.S. health officials ought to heed the warning from Tedros Adhanom Ghebreyesus, director general of the World Health Organization, that the world had fallen into a state of ‘vaccine apartheid.’ High-income countries have used bilateral contracts with vaccine manufacturers to achieve vaccination rates as much as 50 times that of low-income countries,” they said. “A campaign for boosters could lock in that apartheid. This profound global inequity would not only be a humanitarian disaster, but also a significant long-term risk for Americans, as scientists agree that accelerating global vaccination is the only way to prevent the formation of deadly new variants.

“The administration points to recent reports from the Centers for Disease Control and Prevention showing that the efficacy of the vaccines against mild infection is waning to justify boosters,” they added. “This is an important concern, but the same reports demonstrate full vaccination is still highly protective against severe covid-19 disease. The United States should address this issue with the same thoughtfulness and regulatory scrutiny as initial vaccine approval. That means booster shots should be subject to a randomized, controlled trial comparing three doses to two doses with power to detect significant differences in hospitalizations or deaths… In fact, Pfizer has just such a trial ongoing, the Food and Drug Administration should require they complete it before amending the vaccine Emergency Use Authorization.”

In CNN, Robert Klitzman said “more data is needed to show the need for boosters for everyone.”

“Data from the Ministry of Health in Israel suggests that people who got vaccinated earlier in the past year were more likely to later test positive for the virus than were people vaccinated more recently,” he wrote. “But the data has sparked controversy, since individuals may test positive but not get serious symptoms. In addition, people who tested earlier were more likely to be either health care workers, who are at higher risk of viral exposure, or wealthier and able to travel abroad, requiring that they undergo tests. The data, thus, appears to have biases.

“Moreover, most of the world still lacks vaccines,” he said. “Ultimately, if everyone in the U.S. and other wealthy countries who wanted a booster got one, far fewer doses would be available for the rest of the world. Some people may dismiss these poorer countries' needs. But Covid is showing us how, in both getting the virus and preventing it, we are all tightly interconnected. In our globalized economy, countries have generally failed painfully in sealing their borders. No wall has stopped this airborne microbe. The more people are unvaccinated around the world, the more likely it is that highly resistant variants will emerge and appear here. Hence the belief that low vaccination rates in other countries don't affect us is false.”

In The New York Times, Drs. Céline Gounder, John P. Moore and Carlos del Rio wrote that “boosters” weren’t the right terms for what is needed.

“We think ‘booster’ isn’t the right terminology to describe these additional doses because, for many people, the word might imply yearly booster shots, as are given for the flu,” they said. “We do not believe that everyone will need yearly Covid-19 vaccinations. The crucial questions are whether people are getting the right dosage of vaccine for the best protection and whether multiple doses are better than one… The only vaccine people receive as a single dose is for yellow fever. People get two doses of vaccines for measles-mumps-rubella, chickenpox, hepatitis A, meningitis and human papillomavirus. They get three or more doses of the polio and diphtheria-tetanus-pertussis vaccines. In adults, we mix and match two types of pneumonia vaccines.

“Once the F.D.A. fully approves the Covid-19 vaccines, health care providers and public health agencies would be free to recommend additional doses for off-label use,” they said. “However, giving additional shots to already vaccinated persons must not come at the expense of doses going to the unvaccinated and most vulnerable, which would save the most lives. Only 0.3 percent of all vaccine doses have been administered in low-income countries… Making sure all people worldwide have vaccine access should be the highest priority, because population immunity is the best way to protect individuals, too. Only then should additional doses be given to already vaccinated people. But we should be prepared to accept that some groups may eventually need an additional dose for full protection.”


My take.

While researching this piece, my opinion on what was right waffled back and forth.

On the one hand, the case prioritizing global vaccines seems obvious. One stunning statistic from William Parker and Govind Persad is that the 120 million mRNA doses the U.S. would need by end of 2021 is enough to vaccinate the population of Botswana 26 times over. From an ethical standpoint, can we really justify that with only a few hundred deaths a day in the states, and so many of those among people choosing not to get vaccinated? Probably not.

On the other hand, there are millions of Americans who will need these third shots — the organ donor recipients, the immunocompromised, and so on — just to activate their immune systems like the rest of us. And some 50 million shots are just sitting in freezers across the U.S., already ordered and distributed and ready to go. It seems as if we should make that a top priority and get those shots to the people who want them as soon as possible.

Ultimately, the thing that makes me land where I think I’m landing is a combination of two things: 1) We’re still seeing clear, consistent and strong protection against serious illness or death with the current two-dose regimen. 2) Epidemiologists seem to be fairly certain that the longer we wait to stamp out Covid-19 completely, the more numerous and dangerous the variants will become. In other words: if we leave the rest of the world unvaccinated, we’re going to be screwed long-term when scarier variants come that — for instance — could be far more dangerous and infectious for children. If, on the other hand, we slow the spread globally, we can likely reduce the odds of those variants developing in the first place.

Those two things make me think we should be full throttle ahead on purchasing vaccines and vaccinating the rest of the world first before we try to give boosters to all 120 million people who want them in the U.S. We have some 50 million in storage for those who need a third dose to develop immunity, and we should use them. But — and I suppose this is a major but — I should also say that I’d be one of the first in line if (or seemingly, when) the boosters here become available. If this is the path the U.S. takes I’m going to get on board, because even though I know I’m almost certainly safe from getting very ill or dying, I also know that getting infected is — at minimum — going to be a major disruption in my life, put unvaccinated family and friends at risk, and probably leave me holed up in some hotel or isolating at home for 10 days. All of which I’d like to avoid, if possible.


Tomorrow!

For the last few months, Tangle has been employing an intern named Sydney. Tomorrow is her last day, and as part of her goodbye I told her she could write about anything she wanted, and I’d publish it as a Friday edition. So, tomorrow, I’ll be sharing the piece Sydney wrote. But remember: Friday editions are for paying subscribers only, so you’ll have to become a member to receive it!

You can subscribe by clicking here.


Your questions, answered.

Q: Regarding the recall in California, it's interesting that Republicans are ok with using mail for a recall which would benefit them politically but are working nationally to suppress voting rights. I stopped following the political back and forth after the Inauguration but is this being highlighted anywhere in the media? That, as you mention, the recall process in CA is bonkers but election security can take a back seat in this instance because we are recalling a Democratic governor?

— Matt, Houston, TX

Tangle: It’s funny you ask this because it’s actually Democrats who made sure the recall election would be done by mail! Earlier this year, Gov. Newsom signed legislation that would require county officials to mail absentee ballots to every voter for any elections that were held in 2021. Not only that, but the bill passed with a supermajority vote, so it took place immediately, and not a single Republican voted for it.

In other words: Republicans didn’t actually support or insist this recall election be held by mail, they’re just stuck with the mail system because the guy they’re trying to recall signed a bill making it so.

Now, much like Republicans trying to change voting laws in Texas, I think it’s clear the legislation Newsom signed is going to help him politically. If every voter is getting a ballot, the odds of him preventing the recall go up dramatically in a state where registered Democrats outnumber registered Republicans nearly 2 to 1. But, as I’ve said before, I also think mail-in voting is safe, secure, and probably something that should be expanded in most states (so long as they also implement the infrastructure to sort and count votes as they come in, and not start that process only after the election’s over).

You can reply to any email and write in with your own question. Just tell me where you’re writing from and whether it’s okay to post your name. You can also fill out this form.


A story that matters.

The mask wars are about to heat up. President Biden is using a federal civil rights office to prevent states from banning universal masking in classrooms. In Miami and Tampa Bay, two of the largest school districts in Florida are directly defying Gov. Ron DeSantis by putting mask mandates in place and risking their own funding. In Texas, schools are making masks part of their dress code in order to evade a mask mandate ban put in place by Gov. Greg Abbott. These moves together show that school systems in Republican-led states across the country are gearing up for a fight against their governors, who have signed laws to prevent them from making masks mandatory in classrooms.


Numbers.

  • 62%. The percentage of adults who said the war in Afghanistan was no longer worth fighting, according to a new AP poll.
  • 35%. The percentage of adults who said the war in Afghanistan was still worth fighting, according to a new AP poll.
  • $1 trillion. The estimated worth of natural deposits of minerals like lithium in Afghanistan, which are now controlled by the Taliban.
  • 72%. The percentage of adults in the U.S. who have at least one dose of a Covid-19 vaccine.
  • 140,893. The average number of new daily Covid-19 cases in the U.S. over the last week.
  • Zero. The number of ICU beds that are currently available in Alabama as the state faces another wave of Covid-19 cases.

Reminder…

Tangle is free for everyone Monday-Thursday. But our Friday editions only go to paying subscribers. Tomorrow’s will be a piece written by our summer intern, who I said could write about whatever she wanted.

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Have a nice day.

A waste collection agency in Ohio says it found $25,000 in cash hidden inside a freezer that somebody had thrown out. Gary Capan, who runs a landfill in Oberlin, said some 4,500 tons of waste are brought to the site six days a week. And last week, things took a bizarre turn when a frantic customer called to say she had thrown out something extremely valuable: “They were cleaning out their house for their grandmother and they cleaned out the refrigerator, threw out all the garbage, grabbed all the freezer stuff and put it in a bag,” Capan said. “And then the grandma was like, ‘Hey, there's an envelope with $25,000 in there, don't lose that,’ and she's like, ‘Grandma, I already lost that, it's in the garbage!’” Fortunately, when Capan’s team began looking for the fridge, they realized it had not been dropped and flattened in the landfill yet, and were able to find and return the cash to the woman’s family. (ABC5 has the story)

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Isaac Saul

I'm a politics reporter who grew up in Buck County, PA — one of the most politically divisive counties in America. I'm trying to fix the way we consume political news.

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