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Just tell everybody to go get a COVID booster

A health worker prepares a Pfizer COVID-19 booster

A health worker prepares a Pfizer COVID-19 booster shot at UCI Medical Center in Orange, California, on Aug. 19. Credit: AP/Jeff Gritchen

It looks as though the White House may have finally figured out the obvious: It’s time to roll out COVID-19 booster shots to everyone, ASAP.

Medical specialists are still debating the extent to which boosters are strictly necessary, given that one- and two-dose vaccine regimens seem to be protecting people against life-threatening disease. And there’s an ethical debate about whether it's fair to give Americans third shots when lots of people in other parts of the world are still awaiting their first.

But these debates have left behind a confusing morass of conflicting rules and blurry guidance, undercutting public health.

Evidence has been mounting since early summer that the immunity provided by the vaccines starts to wane at or before the six-month mark. In particular, the mucosal antibodies that help prevent people from catching COVID-19 seem to decline, which means that even those for whom the vaccine protects against severe disease can still become infected and spread the virus to others.

It’s not scientifically clear whether vaccinated people will be at risk of death or impairment, but why take a chance? With the U.S. having completed much of its vaccination in the spring and early summer, boosters could help avert a winter surge.

Yet so far, booster takeup has been slow. Only 15% of fully vaccinated Americans have received a booster dose so far, according to the U.S. Centers for Disease Control. The numbers in the 65-and-up group — the people most vulnerable to serious disease — aren’t good either: only 36%.

With boosters, the main problem isn’t vaccine hesitancy. It’s the confusing set of criteria the U.S. has adopted for eligibility.

It’s just too hard to parse. Some people are advised that they "should" get a booster at the six-month mark. That guidance covers anyone who received a two-dose vaccine and is 65 or older; those between 50 and 64 with certain medical conditions; and younger adults living in long-term care settings. Others are told that they "may" get a booster after six months: that’s those 18 to 49 with medical conditions, or younger people working or living in "high-risk settings." And then there are people who got the one-dose Johnson & Johnson vaccine; they’re all directed back to the clinic at the two-month mark.

With instructions that convoluted, it’s hard for Americans to figure out whether they’re eligible. And as has unfortunately been the case throughout the pandemic, public-health agencies haven’t done much to make the message clearer.

Moreover, the guidance may be lagging the actual public health situation. Cases in the U.S. are starting to tick up again, and at least five states and New York City have responded by opening up booster eligibility to all. That’s a step forward, even as it muddles the situation further by conflicting with federal guidance.

The U.S. should clear up the confusion by issuing a straightforward and simple instruction. There’s some question of the proper age and timing thresholds for booster eligibility, but the right message is more or less, "Everyone should get one."

The reality is that the U.S. is far from conquering the pandemic, with over 1,000 deaths a day, mostly among the unvaccinated, for months. That pace would produce an annual death rate on the order of six times the toll of even the worst recent flu season. Plus, to the extent that life has moved back toward some semblance of normalcy, it’s precisely because of the protection vaccines have afforded. As immunity wanes, that protection is likely to diminish.

Boosters are essential to maintaining — and hopefully improving — the status quo. And that’s especially true as people plan holiday travel.

Yes, there are reasonable questions of international vaccine equity. But the objectives of delivering boosters and speeding up global vaccination don’t have to be in conflict. It’s possible to do both at the same time. Moreover, the U.S. has already ordered booster doses for delivery, and they’ll go to waste if they aren’t administered.

When it comes to public health, complexity is counterproductive. The right way to think about boosters is also the simplest: Tell people to get them, right now.

Scott Duke Kominers is the MBA Class of 1960 Associate Professor of Business Administration at Harvard Business School, and a faculty affiliate of the Harvard Department of Economics. Previously, he was a junior fellow at the Harvard Society of Fellows and the inaugural research scholar at the Becker Friedman Institute for Research in Economics at the University of Chicago. This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.