CDC plagued by confusing messaging, critics say

WASHINGTON — On Oct. 22, Dr. Anthony Fauci, the top medical adviser to President Biden, sat for a CNN interview that touched on coronavirus booster shots. The host of the program, John Berman, asked Fauci if people should seek out booster shots of the same brand of vaccine they’d initially received.

“It’s generally recommended that you get the booster that is the original regimen that you got in the first place,” Fauci said. He conceded that mixing different types of vaccines was allowable but reiterated that brand loyalty was best.

About two hours after that interview aired, the White House pandemic response team held a briefing for the press. A reporter asked Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, the same question about mixing vaccines. “We will not articulate a preference,” Walensky said, seeming to contradict what Fauci had just said on CNN.

He had, in fact, added that there was no danger in mixing vaccine types, but a casual observer might have been led to believe that the federal government didn’t know its own plan. “I’ve been a nurse for 40 years and I am confused,” Donna Gallipeau wrote that day on Twitter, describing how she had gone into a Publix supermarket for a booster, only to be turned away.

A health care worker receives a booster shot
A health care worker receives a COVID booster shot at a hospital in Miami. (Lynne Sladky/AP)

The disconnect between Fauci and Walensky was a minor matter. But critics say that the CDC has struggled to communicate clearly to the American people the fine points of late-stage pandemic policy, in particular when it comes to mask guidance and the need for booster shots.

“It is a challenge — and can be challenging — to communicate clearly,” a CDC official conceded to Yahoo News, speaking on the condition of anonymity in order to express what the official described as their own views on the pandemic. “I think we tried our best to address the nuance,” the official added.

There has been marked improvement in consistency, to be sure. President Biden does not routinely contradict the CDC as Donald Trump did in unpredictable press briefings and interviews. At the same time, plenty of disagreements remain, each one of them a potential land mine for the CDC: Are booster shots even necessary? If boosters are necessary, how does that effort square with the ongoing push for millions to get their initial vaccine jabs? What about masks for fully vaccinated people? For that matter, what does fully vaccinated mean, now that some people have been boosted?

Aside from these specific questions is a broader one that, some believe, needs to be frankly addressed: Is the pandemic becoming endemic, or will we be in a state of high emergency for many months to come? That is, are we finally near the end?

These questions play out in full view, at press briefings, on cable news and during Zoom meetings of advisory boards. And though the CDC is only one of several agencies involved in pandemic decision making, it is the one tasked with translating scientific research for the public, making sense of the inevitable scientific ambiguity or inconclusiveness.

The CDC is failing in that regard, critics say. The headline of a New York Times opinion essay by Zeynep Tufekci, a University of North Carolina sociologist who has gained a large following for her coronavirus-related observations, put the matter bluntly: “The C.D.C. Needs to Stop Confusing the Public.”

A sign at the Heaven Cafe
A sign at a cafe in Provincetown, Mass., encourages customers to wear masks until seated. (Craig F. Walker/Boston Globe via Getty Images)

A lot of the confusion began with a July 4 outbreak in Provincetown, Mass., that seemed to suggest that the Delta variant was rapidly proliferating across the United States and had a greater ability to infect vaccinated people than previously thought. In response to Provincetown, Walensky reinstituted an indoor masking guidance, which the CDC had lifted in mid-May. Now even the vaccinated were advised to wear masks indoors again. The CDC reimposed a guidance for masking in schools, as well.

Walensky and other top public health officials labored to remind a newly frightened populace that the vaccines remained exceptionally effective, at both preventing infection in the first place and keeping people out of the hospital. “As we look at our hospitalizations and as we look at our deaths, they are overwhelmingly unvaccinated people,” Walensky said during an Aug. 5 press briefing.

Yet the Delta outbreak required that high-vaccination communities return to the kinds of measures they’d been taking before the availability of vaccines. A CDC public affairs officer told Yahoo News that the agency stood by “a layered prevention strategy, including vaccination and mask wearing in areas of substantial and high community transmission. These measures, which we often talk about in tandem and as complementary, are proven to slow the spread of the virus.”

Pro-Trump personalities in conservative media outlets seized on the return of indoor masking in late July to argue that the medical establishment had exaggerated the efficacy of coronavirus vaccines. Many of these anchors and hosts have never forgiven public health officials for the initial reversal on masks in the early days of the pandemic, when masking went abruptly from unnecessary to mandatory, with little explanation accompanying the change.

“There’s still an awful lot we don’t know. These are, after all, experimental drugs, and they’re behaving like it,” Tucker Carlson of Fox News said in a monologue rife with exaggerations and untruths. “The bottom line is that a huge number of vaccinated people are getting COVID, and some of them are getting very sick, even dying.”

CDC Director Rochelle Walensky
CDC Director Rochelle Walensky speaks during a House Select Subcommittee on the Coronavirus Crisis. (Amr Alfiky/New York Times via AP, Pool)

In fact, very few people die from COVID-19 after having been vaccinated. “We put vaccines on a pedestal,” the CDC official acknowledges. “They are not going to prevent every single infection."

Former Baltimore Health Commissioner Leana Wen told Yahoo News in an email that “it would be helpful if the CDC can specify what conditions masks are no longer needed — for example, if everyone in a workplace or school is vaccinated and tested, or if everyone is vaccinated and the community transmission is below a certain level.”

Wen added that doing so would “set expectations for employers and school administrators, assist families and friends who want to get together safely and add an additional incentive for vaccination.”

By the end of the summer, there was not only Delta to contend with but increasing worries that vaccine protection was waning, necessitating booster shots for people who had received their second doses in early 2021. Those worries were compounded by a spike in Israel, which had been the first nation in the world to vaccinate its population in early 2021. Now its vaccine firewall appeared to be petering out.

“The time to lay out a plan for COVID-19 boosters is now,” said Surgeon General Vivek Murthy in mid-August. “Recent data makes clear that protection against mild and moderate disease has decreased over time.”

Some federal regulators disagreed, with two top scientists at the Food and Drug Administration resigning over what they described as pressure over approving boosters for the general population, an action they felt the science — to which the Biden administration had vowed unfailing adherence — did not justify. Eventually, a key CDC advisory panel said that only immunocompromised people and those over the age of 65 should receive booster shots — only to be overruled by Walensky, who said that some people exposed to elevated risk by their occupations should also be eligible.

Firefighters
Firefighters rally outside New York Mayor Bill de Blasio's residence to protest a COVID vaccine mandate for city workers. (Jeenah Moon/AP)

Some medical experts argued that it was wrong to shift the government’s focus away from the unvaccinated — who continued to account for the vast majority of new infections — to those who had been vaccinated but might want or need the protection afforded by a third shot (or, in the case of the single-dose Johnson & Johnson vaccine, a second one). The booster talk muddles the conversation, these critics charge.

“We have a really effective vaccine, and it is like saying that it is not working, and it is working.” the Ohio State pediatrician Pablo J. Sanchez said during the booster debate.

In a statement to Yahoo News, the CDC public affairs officer said that the agency’s “recent recommendations on boosters has not distracted from the critical work of ensuring that unvaccinated people take the first step and get an initial COVID-19 vaccine.”

At the heart of the debate is the question of just how close we are to the end of the pandemic. Whereas the full return to normal life seemed close in May, it seems impossibly distant now. Asked in mid-October if the nation were “turning the corner” on the Delta surge, Walensky both acknowledged and downplayed the drop in infection rates, hospitalizations and deaths.

“We absolutely need to stay focused on continuing to get COVID under control around the country, especially as we head into the fall and winter season — respiratory virus season,” Walensky said, sounding very much as if it were the winter of 2020, not the fall of 2021.

The White House no longer discusses needing to hit a specific vaccination benchmark, despite touting such benchmarks for much of the spring and early summer. The talk of a “pandemic of the unvaccinated” has also subsided, despite that still being an accurate, if bracing, framing of the current state of affairs.

President Biden
President Biden receiving his COVID vaccine booster shot. (Liu Jie/Xinhua via Getty Images)

Vaccinated people may benefit from booster shots, but the nation would benefit as a whole if the unvaccinated people got their first shot. Walensky knows this, of course, but her powers as a public health official are limited. Many of the vaccine holdouts are in pro-Trump areas of the country, where some conservatives refuse to acknowledge Biden’s legitimacy as president. The White House can’t write them off, but it also can’t persuade them. Resistance to coronavirus vaccines has become a core part of many people’s political identity.

The intractability of that divide helps explain why vaccinated people are still wearing masks. Some continue to do so outside, presumably as a show of how seriously they still take the pandemic. And yet more than 60 million eligible Americans have not been vaccinated at all. Reaching them is urgent, but difficult.

Dr. Vinay Prasad, a University of California at San Francisco oncologist who has emerged as a widely followed pandemic contrarian, believes that boosters and masks distract from the sole factor that will help end the pandemic: first-time vaccinations. “Everything else is diminishing returns,” Prasad told Yahoo News in a recent interview.

“I find their messaging, and their strategy, problematic and even to some degree self-defeating.” Prasad said of the CDC’s approach, which he argues fails to address the main challenges at this stage of the pandemic.

Walensky had been inching towards the goal of returning to normal throughout May and June. The feeling of “impending doom” she had expressed in March waned as vaccination rates rose throughout the spring.

A diver
A diver at MacMillan Pier in Provincetown, Mass., August 2021. (Craig F. Walker/Boston Globe via Getty Images)

June saw COVID-19 deaths per day dip below 300 for the first time in a year. “We were all hopeful that either things would settle into a low simmer or really kind of peter out,” the CDC official said.

Then came Delta.

By the time Walensky reinstituted the mask mandate, many vaccinated Americans had been ready to get on with their lives, only to be yanked back into a state of emergency. At the same time, Republican governors in Florida, Texas and other states mounted a new campaign against masks and vaccines, reviving culture wars that had appeared to be receding only weeks before. Some Republican governors and state legislators worked to ban local governments from implementing mask and vaccine mandates meant to blunt Delta’s spread.

“We are in a perfect storm of viral changes and behavioral changes,” University of Texas biologist Lauren Ancel Meyers told the Washington Post in the first week of September, as daily deaths jumped back up to 1,500, the grim but predictable result of a wave centered on the Southeast and lower Midwest, where the Delta variant raged without evident hindrance, helped along by low vaccination rates, lack of mask mandates and, in some cases, the rise of misinformation.

Inside the CDC, there is a feeling of exhaustion and exasperation, both with an unpredictable pandemic and the persistent stream of misinformation, much of it coming from conservative media, that has frustrated attempts at clarity, nuance and flexibility.

“Everything is just really loaded,” the CDC official said. “Everybody’s tired of this."

Protesters call for administrators to mandate masks and vaccination at a
Protesters at Georgia State University. (Jeff Amy)

Even as the Delta variant subsides, Walensky has made no suggestion that mask guidances will be revised, at least on the federal level. She has made clear that the CDC will continue to recommend masking in schools, too, even as children between the ages of 5 and 11 stand to receive their inoculations in November.

“We are acting like it was before we had vaccines,” said Dr. Monica Gandhi, an infectious disease expert at the University of California at San Francisco, in an interview with Yahoo News.

Walensky has said she is worried about the arrival of colder weather, which could lead to yet another spike in cases as people spend more time indoors and gather for winter holidays. It may simply be easier to stay the course than to keep revising CDC guidance. “Look at the U.K,” said Dr. Kavita Patel, referencing a surge now building across the United Kingdom. “She does not want that,” Patel said of Walensky.

The danger is that people will conclude that nothing will change, which will give them little incentive to follow guidance, whether for masking, vaccination or other measures, like indoor occupancy limits.

In a late October cable news appearance, Walensky did allow that Halloween would be safe this year. “Put on those costumes, stay outside and enjoy your trick-or-treating,” she said. This time, her message echoed neatly what Fauci had said in mid-October: “Go out there and enjoy Halloween,” he said, adding that vaccinations would make the holiday even safer.

Maybe it wasn’t much, but it was still progress.

Explore how the Delta variant correlates with the national political landscape in this 3D experience from the Yahoo Immersive Team.

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