Fully Vaccinated is Suddenly a Much Less Useful Phrase

The definition of full vaccination against COVID-19 has, since the winter, been somewhat difficult to nail down. It takes one dose of Johnson & Johnson, but two doses of an mRNA vaccine. The CDC counts you as fully vaccinated as soon as you get your last shot, but tells you that you won’t be fully vaccinated until two weeks after that. People have a hard time knowing exactly when it might be safe for them to venture into restaurants, wedding venues, or mask-free offices.

Now, in the age of booster shots and breakthrough cases, the phrase has gotten even murkier. Early this morning, the CDC officially backed booster shots for tens of millions of Americans who are six months past their second Pfizer dose: those over 65, those in long-term-care facilities, and all adults who have an underlying medical condition that puts them at high risk of severe COVID-19 or who are at high risk of getting sick from occupational or institutional exposure to the coronavirus.
During a two-day meeting of the CDC’s Advisory Committee on Immunization Practices this week, the CDC’s Sara Oliver advised the committee that the agency’s definition of fully vaccinated would not change—at least for now. That makes it much less useful as a category: Will some fully vaccinated people be more vaccinated than others? And it leaves open the possibility that the definition could change as more information becomes available: If you’re fully vaccinated now, could you become un-fully vaccinated a few months down the line? These questions go beyond semantics. As more and more Americans are mandated to be “fully vaccinated” in order to work—see here, here, and here, for example—continued clarity on what that category means, and who belongs in it, will be crucial.
Fully vaccinated didn’t originate with the coronavirus. The term has been used for other vaccine series that require multiple shots, such as those for measles, hepatitis B, and HPV. Currently, the CDC considers people to have achieved full vaccination against COVID-19 “2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine.” The agency’s website does include a caveat: For the immunocompromised, being fully vaccinated might not be the same as being fully protected, so a third shot is a good idea.
Part of the problem is that the difference between full vaccination and full protection has been explained less than perfectly to the American public. The truth is, no one is 100 percent protected from the coronavirus after vaccination, regardless of how healthy their immune system is; that’s simply not how vaccines work, especially in the context of a pandemic virus that hasn’t stopped evolving. “You cannot definitively say, until we have finally beat the virus or gotten it to a point where it is no longer killing people, that you are [fully] protected,” says Ruqaiijah Yearby, a health-law expert and co-founder of Saint Louis University’s Institute for Healing Justice and Equity.
Even before booster shots were a mainstream possibility, the concept of full vaccination could lead people to develop what Saskia Popescu, an infectious-disease epidemiologist at George Mason University, calls a “Superman complex.” After getting their J&J shot or their second mRNA dose, some people feel immediately invincible, she told me, as though nothing they do is dangerous to themselves or the people around them. The ongoing discussion about boosters could be an opportunity to undo the Superman complex by adding some nuance, reminding the public that no vaccine is perfect and that we all must work together to get the pandemic under control. Such a rethinking could even go beyond COVID vaccines. “Maybe we need to reimagine how we communicate vaccines in general,” Popescu said.
A sudden injection of nuance could confuse a lot of people, though, and even discourage some from getting their first shot by making the process seem especially convoluted or onerous. For schools, businesses, and other institutions that have implemented vaccine requirements over the past few months, it would likely be a nightmare. If getting two shots doesn’t guarantee that you’re fully vaccinated, then who should be allowed to come to work? Will schools need to interview every teacher who was vaccinated before April about their medical history?