Definition of ‘fully vaccinated’ in flux amid boosters, omicron

You know the drill. You show up for the comedy club gig, and the doorman/woman asks not only for your ticket, but your Covid-19 vaccine card and probably your ID, too. 

You’ll plan to take your mask off to imbibe a beverage or two, maybe sample the chicken wings, so they’ve got to ask.

Soon, however, that virtual or paper card might not indicate your proof of full vaccination until it shows you received your booster dose, too.

With omicron’s recent debut in San Francisco and reports showing that, although milder, it is more transmissible than other variants, boosters are one of the ways scientists and health officials are hoping to mitigate a potential wave of infections. 

Increasingly, researchers appear to be ahead of local public health officials in describing a fully vaccinated person as one with a booster.

The San Francisco Department of Public Health told Mission Local that it is “not currently planning to change the definition of ‘full vaccination’ for the purpose of vaccination requirements in the health orders.” Per the department’s Safer Return Together Health Order, a person is fully vaccinated two weeks after completing the entire recommended series with an authorized vaccine. 

Nevertheless, officials “continue to recommend all San Franciscans to get boosted when eligible.”

Meanwhile, at University of California, San Francisco, leadership is interpreting the overarching University of California definition to include a booster dose. 

Speaking at a Dec. 3 virtual town hall, UCSF Chancellor Sam Hawgood made it clear to employees and students: “The University of California policy on mandated vaccination includes boosters. I don’t want there to be ambiguity.” Hawgood exhorted employees and students to avoid delaying until “deadlines and punitive actions” were put in place.

“I strongly encourage everyone to go out and get a booster,” he added. “Not because we have a mandatory policy, per se, but because it’s the right thing to do. It’s the smart thing to do. It’s the safe thing to do.”

UCSF’s head of infectious disease research, Dr. Diane Havlir, who has been on the frontlines of the epidemic, said that more information has become available in the last week, making the urgency greater. “Get persons boosted (and vaccinated if not yet vaccinated) to protect against Delta and Omicron,” she wrote Friday in an email. “We also need to encourage masking, and testing after contacts or prior to gatherings.”

Like Hawgood, she sees the need for changing the definition of fully vaccinated.  

“Fully vaccinated in my opinion should be defined as having two mRNA doses and a booster, and should be the definition used when vaccine mandates are applied,” she wrote, adding that two weeks ago, only the delta variant turned up at the Mission testing site. That has changed.. “There is community transmission of omicron in San Francisco,” said Havlir, including detection at the Mission testing site. 

And there’s plenty of boosting to do. As of Dec. 13, the San Francisco Department of Public Health noted that only 44 percent of residents eligible to receive a booster had done so. Among residents age 65 and older, however, that coverage jumps to 68 percent.

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Dr. Maya Peterson, head of UC Berkeley’s Division of Biostatistics and member of the Unidos en Salud/United in Health collaboration, shared a series of mathematical models on Twitter on Friday that projected the impact of omicron on hospitalizations, based on coverage and timing of vaccine coverage and underlying population immunity. 

Among her takeaways: To avoid a surge in hospitalizations, you guessed it, we need to ramp-up boosting. “The next seven days are critical. [California] needs a massive push to boost, and it needs to be now,” she wrote on the platform.

With the spread seemingly inevitable and some indication through wastewater surveillance that omicron has come to visit California and other states sooner than traditional testing surveillance would have shown, scientists are trying to understand what the situation means for vaccine efficacy by measuring available vaccines against the new variant.

Dr. Joe DeRisi, the Chan Zuckerberg Biohub director, biochemist, and another Unidos en Salud team member, said boosters are also a tool to help mitigate the concern about vaccine efficacy.

“The emerging data … supports that the two doses of the vaccine people traditionally have is not as effective against omicron as we would have hoped,” said DeRisi, referencing vaccine study data presented by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), in a press briefing on Wednesday.

The White House Covid-19 Response Team reiterated this message yesterday morning: “unlike last winter, we now have the power to protect ourselves.”

DeRisi cautioned that the new research, which hasn’t undergone peer review yet, should be “taken with a critical eye” but that ultimately “it’s a do-no-harm thing” regarding the booster. As in, there’s no harm in taking a booster dose at the recommended interval compared to becoming infected with the virus and transmitting it to others.

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“Number one … get boosted,” said DeRisi. Number two was about approaching the holidays. He still thinks that people can get together, but encourages groups to be smart about it: “Take advantage of things like over-the-counter tests to help you get to gatherings in a safe way.” 

DeRisi’s number three was familiar guidance about large public gatherings like concerts and sporting events. “Be safe, wear masks, do your best to keep your distance. Do what you’ve been doing the last year,” he said. 

“It’s a dangerous disease,” said DeRisi, clarifying his wasn’t a ‘sit back and do nothing’ approach, “but I think San Francisco is a shining example of how to do it right.”