Science
Should you get the new COVID booster? The CDC is about to decide
A small percentage of Americans got the most recent COVID-19 booster shot, and even fewer probably realize the federal government is preparing to recommend yet another shot as early as Tuesday.
Until a week or two ago, Dr. William Schaffner read that indifference as a sign the Centers for Disease Control and Prevention should advocate vaccinating only those most at risk from the virus.
But then Schaffner, an infectious disease specialist at Vanderbilt University Medical Center, changed his mind.
Members of the CDC’s Advisory Committee on Immunization Practices won him over to the argument that the vaccine be recommended for all Americans above 6 months of age, he said in an interview. The committee, which sets U.S. vaccination policy and helps determine insurance coverage for vaccines, will vote on the question Tuesday after it weighs the benefits of updated vaccines from Pfizer, Moderna and Novavax.
Not all vaccine experts see it quite as Schaffner, a nonvoting liaison representative to the ACIP, does.
“I don’t plan to get it myself,” said Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. He’s had two boosters and got COVID-19 last year. Another vaccine might increase his protection against mild infection for a few months, but like most Americans’ immune systems, his is already familiar enough with the virus to protect him from serious disease, Offit believes.
Some of Schaffner’s scientific colleagues argue the government should be recommending the shot only for frail, older, sick and immunocompromised people. Over 95% of the U.S. population has some immunity to COVID-19 through vaccination, infection or both, and the risks of serious illness for healthy younger people are not great.
Schaffner doesn’t disagree. But lots of not-necessarily-vulnerable Americans do want the shot for themselves and their children, and, without a CDC recommendation, insurance companies wouldn’t have to pay for the vaccine.
It’s “pretty awful” that Pfizer and Moderna, the two main COVID-19 vaccine producers, have decided to charge up to $130 a shot, compared with $30 last year for the booster, which was produced under government contract, said Dr. Kathryn Edwards, a professor of pediatrics at Vanderbilt and a member of an ACIP working group on COVID-19. (Pfizer spokesperson Amy Rose said the price was “consistent with the value delivered” and reflected higher expenses to provide the shots commercially.)
But a partial recommendation could leave the very groups who suffered most during the pandemic — minorities and other disadvantaged groups — unable to get vaccinated if they want but can’t afford to.
“The last thing we need are financial barriers that would enhance disparities,” Schaffner said.
A 1993 law requires the federal government to pay for childhood vaccines recommended by the ACIP, and more recent legislation requires coverage of adult vaccines within 15 days of an ACIP recommendation.
Pfizer and Moderna continue to make billions of dollars in sales of COVID-19 vaccines, although they are producing fewer doses. Moderna CEO Stéphane Bancel told investors in August that the company expected its global COVID-19 vaccine sales to be $6 billion to $8 billion this year, depending on uptake in the U.S. Pfizer expects about $14 billion this year.
Within a few years, both companies expect to be producing combination vaccines protecting against influenza, COVID-19 and possibly respiratory syncytial virus, or RSV. About 170 million flu vaccines were distributed last flu season in the U.S., so a combination product could lock in a large market for COVID-19 vaccines as well.
Despite broad recommendations for the updated COVID-19 booster shot released last fall, only 17% of the U.S. population got it, including about 43% of those over 65. How many will get the vaccine this season is uncertain, as is the benefit of the shot.
A preliminary study of the new Moderna vaccine showed that while it increased antibodies to various coronavirus strains, it provided roughly the same protection against them as last year’s booster shot, which was given again to the control group.
Christopher Ridley, a Moderna spokesperson, said the updated vaccine was well matched to current viral strains.
But John Moore, a professor of microbiology and immunology at Weill Cornell Medical College, said the new vaccine is “not remotely a game changer.”
For healthier adults and children, “it’s a boost in protection for a few months,” Moore said. Who exactly will benefit most is impossible to predict because the U.S. is “not a cookie-cutter population.” Its people have by now been exposed to a bewildering combination of vaccines, boosters and different strains of the virus.
Fearmongering has distorted the threat of the virus, Moore said. He is skeptical of the significance of the recent uptick in COVID-19 hospitalizations, and criticized social media posters who have raised fears about new viral strains that don’t seem to pose any fundamental challenge to the new vaccines.
“Editorial FOMO drove summer surge worries,” Moore said, using an acronym for “fear of missing out.” Despite worrying comments and tweets by physicians such as Dr. Eric Topol, director of the Scripps Research Translational Institute, about a new coronavirus variant called BA.2.86, “it turned out to be a real nothingburger,” Moore said.
Even Dr. Ashish Jha, who coordinated the Biden administration’s COVID-19 response before returning to his post as dean of the Brown University School of Public Health this year, agrees there is some ambiguity in the issue. While he recommends that 20-year-olds get the booster, “a reasonable person” could disagree.
Unfortunately, such discussions in the current environment are clouded by “nonsense and bad information” that causes confusion and hurts people, he said in a recent podcast interview.
Whether truly needed or not, the vaccines, proponents say, are safe enough that even the small benefit of taking them will outweigh the risks. The major, though rare, serious side effect of the Pfizer and Moderna vaccines — myocarditis, which particularly affected men in their teens and 20s — appears mainly to have occurred during the first two-shot series.
Paradoxically, those who most need protection from COVID-19 are often likely to have weakened immune systems that fail to generate the hoped-for response to vaccination.
So the vaccine is arguably most relevant for healthy people who come in frequent contact with vulnerable individuals. With that in mind, England has announced the new booster would be offered only to people who are 65 or older, in nursing homes, or immunologically vulnerable — or who work or live with members of those groups.
“Any efforts to promote the new boosters should focus squarely on those at high risk,” said Dr. Norman Hearst, a family physician in San Francisco. While recommending the vaccine for older patients, he said he wouldn’t advise a booster for young males because of the rare risk of myocarditis and the negligible benefit. “The question is all the other people in between.”
In a commentary last November, Dr. Shira Doron and Dr. Monica Gandhi said vaccination campaigns should be radically honest about the limited value of vaccines for long-term protection against infection. Such a campaign might advocate vaccinating children because even though it won’t protect durably, “it might prevent the rare case of severe disease,” the infectious disease doctors wrote.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
Science
Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County
A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.
The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.
The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.
Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.
The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.
After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.
As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.
Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.
The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.
Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.
Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.
The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.
Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.
While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.
Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.
Science
Political stress: Can you stay engaged without sacrificing your mental health?
It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.
“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”
Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.
Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.
The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.
That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.
In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.
“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”
Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).
The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.
For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.
Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.
“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.
Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.
There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.
“Politics is many forms of stress all rolled into one,” Ford said.
Weinschenk observed this firsthand the day after the election.
“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”
That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.
Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.
“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”
Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.
“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”
On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”
“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.
Genessa Krasnow has been seeing a lot of that since the election.
The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.
“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.
“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”
That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.
“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.
Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.
“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”
Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.
“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.
The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”
“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”
Science
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