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Despite claims that the rise in mild breakthrough cases proves COVID-19 vaccines don’t work, current data shows those whose vaccines are up to date reduce their risk of hospitalization by 90 percent. Dimensions/Getty Images
  • Evolving recommendations about the COVID-19 vaccine have led to confusion.
  • The vaccine is intended for and succeeding at reducing severe illness, hospitalizations, and death.
  • While being “up to date” on the vaccine may require additional doses of the vaccine, this is not unusual when it comes to vaccinating against infectious diseases.

As Omicron continues to cause breakthrough infections among the fully vaccinated and safety recommendations evolve, the public’s confidence in the COVID-19 vaccines has started to wane.

However, medical experts say understanding the main objective of the vaccines can break feelings of betrayal.

“There’s an expectation among many people that vaccines should be perfect, and if you’re vaccinated and boosted, that that ought to solve the problem. Some of that is not unreasonable because we have such spectacularly successful pediatric vaccines like the polio and measles vaccines,” Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville, Tennessee, told Healthline.

However, he said that communication about the vaccines was flawed from the get-go. For instance, when vaccines were first released, Schaffner said, “the communication was quite euphoric, but it wasn’t very clear. We put emphasis on the extraordinary triumph.”

Political confusion about the acceptance of the vaccine also played a part in misunderstandings, as did the emergence of variants, which required a booster.

“Because it’s an evolving story, it’s difficult for the public. There is real vaccine fatigue and frank grumpiness about it all. They want simple, clear, complete answers, and we in public health need to work on delivering that,” said Schaffner.

Because the virus may continue to evolve, as most viruses do, scientists have always known that breakthrough cases can occur in the vaccinated, said Dr. Natasha Bhuyan, family physician and infectious disease expert in Phoenix.

“[However,] these generally tend to be mild. Data shows the vaccines are working regardless of breakthrough infections because the vaccines continue to be extremely effective at preventing severe sickness, hospitalization, and death from COVID-19,” Bhuyan told Healthline.

According to recent data from the Centers for Disease Control and Prevention (CDC), hospitalizations were 16 times higher for unvaccinated adults 18 and older in December 2021.

“Remember, we told you these vaccines were 90 percent effective in keeping people out of the hospital. For the vast majority of people who are vaccinated and have a booster, if they encounter the virus, they will get a bad cold and not require hospitalizations. That’s the main goal of the vaccine,” said Schaffner.

Still, those who chose to listen to public health officials and get fully vaccinated, yet experienced a breakthrough infection, may find themselves frustrated. Bhuyan said she has heard the frustration from patients in this situation.

“But I’ve also seen this quickly turn to relief when they ended up having a mild case and recovered in just a few days,” she said.

In January, Dr. Anthony Fauci told J. Stephen Morrison, senior vice president of the Center for Strategic and International Studies, “Omicron, with its extraordinary, unprecedented degree of efficiency of transmissibility, will ultimately find just about everybody.”

However, Fauci explained that people who have been vaccinated and boosted and who get infected with Omicron will “very likely, with some exceptions, do reasonably well in the sense of not having hospitalization and death.”

Getting people to understand this requires a regular and ongoing conversation, said Bhuyan. In addition to talking with patients about how the vaccine protects them from severe illness and death, she explains how this affects society.

“Our hospitals and health systems are also currently facing a huge surge in COVID-19 cases. If we are able to reduce severe illness and death, this helps free up healthcare resources for other important health issues that people are seeking care for – ranging from strokes to heart attacks to surgeries,” said Bhuyan.

As of Jan. 16, the CDC states that “fully vaccinated means a person has received their primary series of COVID-19 vaccines.” This means 2 weeks have passed since you received the second dose of either the Pfizer or Moderna vaccines or 1 dose of the Johnson & Johnson vaccine.

However, the CDC also states that being “up to date” on vaccines “means a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible.”

“From the beginning, many of us [in infectious disease] thought people were going to need another dose after the first two doses of Pfizer and Moderna and more than one of J&J, and sure enough, that was required,” said Schaffner.

He points to other vaccines that require more than 2 doses, such as polio (4), hepatitis B (2, 3, or 4), and tetanus (5 doses, plus boosters).

Bhuyan noted that being fully vaccinated may have different definitions for different populations. For example, people who are immunocompromised need three doses of the COVID-19 vaccine to mount an adequate immune response.

In terms of using “up to date” in regards to being boosted versus changing the meaning of “fully vaccinated” to include the booster, Schaffner said there could be legal and administrative issues.

“There were a lot of institutions that put into place software for their employees that fully vaccinated meant two doses. Now that we ask everyone to be boosted, if we want to change that designation to fully vaccinated, that has all kinds of ramifications, and the world has been divided about it,” he said.

Some people in public health suggest keeping “fully vaccinated” at two doses with the recommendation to get boosted. Others believe changing “fully vaccinated” to include the booster is the best way to get the public to understand its importance.

“I don’t know which is more functional in our population. At the moment, I think we are in a transition, and we may be moving toward a new definition of what fully vaccinated means,” said Schaffner.

Regarding whether “fully vaccinated” for COVID-19 could include more doses in the future, he doesn’t think so, though he believes the vaccine may end up like the flu vaccine in that a booster is recommended periodically.

“Some of the vaccine manufacturers are already working to combine flu and COVID vaccines so that if the recommendation is annual, we’d only have to roll up our sleeves once,” Schaffner said.

When COVID-19 hit the world, it was a new infection in humankind. Schaffner said public health officials and scientists could have done more to express this to the public.

“We opened up our textbooks, and they were blank, so we had to learn this, and as we learn, we’re going to tell you more, so what we tell you will change. We should have said that every time we talked to the public,” he said.

He believes this is where the public’s annoyance, distrust, and confusion comes from, and he anticipates public frustration to continue unless people begin to understand that viruses evolve, which requires science and human behavior to evolve with it.

“If another variant of COVID shows up, people may need to get vaccinated again. From a public health/doctor point of view, the answer is simply get vaccinated; this virus kills people,” he said.

The notion that the world will have to contend with COVID-19 in some fashion and create a new “normal” of some sort in the future is daunting.

“It’s not going to be easy. We’ll have to make a sustained effort together,” he said.