Mismanaging Messages

person facing many winding roads

There was never going to be flawless public communication around Covid-19, a new illness that raised an array of novel scientific and sociological issues. Even with this lens, communication about the pandemic has been particularly fraught. The Trump presidency was characterized by repeated lies, and more recently the Biden presidency has demonstrated premature optimism, offering first a “freedom summer” when we were to be largely over Covid-19, only to see the delta wave sweep the nation, and in the fall of 2021, sweeping and premature scientific statements about booster vaccines.

In August, President Biden announced that a Covid-19 vaccine booster should be administered to all Americans already vaccinated. “Just remember as a simple rule, eight months after your second shot, get a booster shot,” Biden said, promising a booster roll-out in a month. Federal health agencies then weighed in, and their opinions had to be shoehorned into the basic shape Biden had offered so as not to contradict his original statement. Yet a month later, when the vaccine was to be available “to all,” only one type of booster had been approved, and only for the elderly, persons with workplace exposure to Covid-19, nursing home residents and immunocompromised people who had received that type of vaccine originally.

The confusion about whether boosters should be taken, and by whom, reflects what happens when policy makers jump to too simple conclusions from still unsettled science. When Biden made his announcement no one really knew the connection between antibody responses (which the booster promised to increase) and duration of human protection. Whether boosters would actually protect against infection, or re-infection, was simply not clear. This then complicated our thinking around boosters, why we may need boosters to begin with. Was the aim of a booster to reduce ongoing viral spread by curbing, at least temporarily, milder infections? After all, the initial vaccinations were continuing to limit the worst effects of Covid-19 in the United States. Would a booster, urgently delivered, save lives? And should we have been focusing on additional vaccinations for Americans before the elderly and health workers in many low-income countries could receive a single dose?

Another month went by, and then came the staggered approval and release of the Pfizer and Moderna boosters, along with different timing of boosters and sizing of doses made any message difficult. The mix and match strategy that would allow physicians to administer a different Covid-19 vaccine as a booster than the one patients initially received, was a boon to vaccine recipients but its own confusion. Even health care providers and pharmacies would need charts to help them keep things straight. Meanwhile, the very need for boosters gave the ever-eager anti-vaxxers new ammunition that vaccines were not working. The message around the implementation and roll-out of original vaccines in December 2020 was far simpler: vaccination will save lives. Yet 30% of the American public remains unvaccinated. It is hard to see how this proportion will not be much higher for boosters recipients given the more convoluted messaging around their roll-out.

It’s difficult to hit all the right notes. The credibility and consistency of federal messages remains foundational to our best public health efforts. State health officials rely on federal precision to promote and support local efforts where vaccinations actually get implemented. Public health efforts require clear messaging, the admission of uncertainty, and the avoidance of overly pat solutions. Perhaps we can chalk this up to yet another set of lessons emerging from this pandemic.


Michael Stein & Sandro Galea

As we re-emerge from the pandemic, 2021 stands to be a turning point year for public health. In The Turning Point’s weekly essays, we reflect on what we learned during 2020, and what we are learning during 2021, that can guide us to the creation of a better, healthier world.

Please note, this week’s The Turning Point does not include a video.

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