Insights^

Right now, “fully vaccinated” means two shots of an mRNA vaccine or one shot of the Johnson & Johnson vaccine.  But that could change.  In a recent interview, NIAID Director Dr. Anthony Fauci said the definition of fully vaccinated could change from two to three mRNA doses as mounting evidence shows waning efficacy of a two-dose regimen over time.  With the administration now recommending all US adults to get their COVID-19 booster shots, is it just a matter of time until the definition of fully vaccinated changes from two to three doses?

The Evidence for One More Shot

Evidence shows that the immunity against infection from COVD-19 does wane over time, including cases that are asymptomatic or mildly symptomatic.  A study from the Centers for Disease Control and Prevention (CDC) published in September found effectiveness against infection among adults in New York fell from 92% to 75% between May and July 2021.  Additionally, a study based on data from the Veterans Health Administration (VHA) found effectiveness against infection among veterans fell from 88% to 48% between February and October 2021.

However, evidence suggests that vaccine effectiveness against severe disease and hospitalization remains strong, despite declining protection against infection  The New York study found vaccine effectiveness in preventing hospitalization only declined from 95% to 90% over the three-month period, while a study in the Netherlands found vaccine effectiveness against hospitalization remained unchanged at 94% between July and October 2021.

New Variant, New Urgency

Concerns that the new Omicron variant is both more transmissible and may be somewhat resistant to immunity from vaccines or prior infection is underscoring an emphasis from the Biden administration on booster shots.  On November 29, the CDC updated its COVID-19 booster recommendations to say everyone ages 18 and older “should” get a booster shot as added protection against the new variant.  A few days later, President Joe Biden announced a new plan to ensure that the nearly 100 million eligible Americans who have not yet received their booster shots do so as soon as possible.  The plan includes:

• Sending texts, calls, and emails to eligible Americans.
• Launching a new public education campaign.
• Expanding pharmacy availability through December 2021.

While it’s too early to tell how much protection current vaccines will offer against the Omicron variant, experts say the higher antibody response generated by a booster shot could provide broad protection against new variants.  Experts are also keen to stress that Delta remains the dominant variant in the US, and it remains unknown if Omicron will eventually become the new dominant strain.  With the Delta variant already contributing to a rise in cases nationwide, booster shots remain as important as ever.

If booster shots are so important regardless of which variant is circulating, then why doesn’t the administration just change the definition of fully vaccinated from two shots to three?  First of all, some public health experts fear changing the definition suddenly could spark confusion.  The FDA and CDC only authorized booster shots for all American adults just before Thanksgiving, and new changes could be problematic given the current administration’s challenges in communicating public health information and guidelines.

More importantly, changing the definition of fully vaccinated to three shots could undermine efforts to reach Americans who have yet to receive their first two shots.  Only about 60% of American adults have been fully vaccinated, and some public health experts believe efforts to reach the unvaccinated would be more effective in preventing a spike in hospitalizations than convincing young, health Americans to get a third dose.  Still as evidence on waning immunity mounts and concerns over the Omicron variant rise, it remains a possibility that the federal government could revise its definition of fully vaccinated some time next year.

Biden Outlines Plan to Combat COVID-19 through Winter

On December 2, President Joe Biden announced a new strategy aimed at preventing a winter surge of COVID-19 as concerns loom over the newly discovered Omicron variant.  Key components of the plan include requiring travelers entering the US by air to test negative for COVID-19, launching a public education campaign to encourage booster shots, extending the requirement for masks to be worn on public transit and airplanes, and requiring health insurers to completely reimburse the cost of at-home tests for COVID-19.  While Biden stopped short of recommending shutdowns of schools or businesses, he did warn that case numbers are likely to rise in the coming weeks as temperatures drop, and more people gather indoors.

FDA Panel Narrowly Recommends Merck’s COVID-19 Antiviral Pill

On November 30, the Food and Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) narrowly voted 13-10 to recommend an emergency use authorization (EUA) for Molnupiravir, Merck’s oral antiviral to treat COVID-19.  While initial clinical trial results showed Molnupiravir was 50% effective in reducing the risk of hospitalization or death, a new data set released by Merck last week showed the drug was only 30% effective in preventing hospitalization, sparking discussion among the advisers on Molnupiravir’s efficacy.  VRBPAC members also discussed concerns that the drug could potentially create immune-resistant variants and whether the drug posed any risk to pregnant women.   While most advisers agreed the benefits of oral COVID-19 antiviral treatment outweigh the risk, the FDA could be compelled to write a narrower EUA than initially expected.

Congress Passes Stopgap Funding Bill through February 18, Averts Shutdown

On Thursday, the House approved by a 221-212 vote a continuing resolution to ensure government funding through February 18, 2022.  Notably, the stopgap funding measure does not address looming cuts to Medicare that are scheduled to go into effect next year, although a Democratic aide has reportedly said that lawmakers intend to address the Medicare cuts in a separate bill before the end of the year.  Later that evening, the Senate passed the continuing resolution in a 69-28 vote.   Initially, several Republican Senators threatened to hold up debate on the spending measure in protest of the administration’s vaccination mandate for employers.  However, Senate leaders eventually ended the stalemate by allowing Republicans to take a simple majority vote on an amendment to defund the vaccine mandate that ultimately failed along a party line vote.

Oregon Congressman Peter DeFazio Announces Retirement

On December 1, Rep. Peter DeFazio (D-OR) announced he will not seek reelection in 2022, thus ending his 36-year career in Congress. DeFazio represents a competitive district in eastern Oregon that President Biden won by only four points in 2020, fueling concerns among Democrats that Republicans are poised to retake the majority in the House in 2022. The Oregon Congressman currently chairs the Transportation and Infrastructure Committee, which he has served on since 1987.  Since DeFazio’s retirement announcement, Reps. Eleanor Holmes Norton (D-DC) and Rick Larsen (D-WA) have declared their candidacy for the top Democratic spot on the committee.

ICYMI: White House Hosts 99^th National Christmas Tree Lighting

On Thursday night, the White House hosted its 99^th National Christmas Tree lighting on the Ellipse in President’s Park.  The event was hosted by LL Cool J and featured performances by Billy Porter, H.E.R., Keb’ Mo’, Maren Morris, Patti Labelle, and the Howard Gospel Choir.  The event will be broadcast on TV Sunday December 5, and the tree will be open to the public from Saturday, December 4 until January 1, 2022.  The National Christmas Tree is separate from the official White House Christmas Tree, which is displayed annually in the Blue Room of the Executive Mansion.

First Lady Jill Biden kicked off the holiday season in Washington when she accepted the White House’s official Christmas tree on November 22c– an 18.5-foor Fraser fir hailing from Jefferson, North Carolina.  Christmas trees have a long tradition in the White House that, like many presidential traditions, have no clear point of origin and speak to the rich history of America’s most important residence.

Origins and Development of a Tradition

For much of the 19^th Century, Christmas was observed privately in the White House, a far cry from the ceremonious tradition observed today.  President John Adams and his family celebrated the first White House Christmas in December 1800, just two months after the second President moved into the newly constructed Executive Mansion, as it was originally known.

It’s not entirely clear who was the first president to display a Christmas tree in the White House.  Some sources point to President Franklin Pierce, who was in office from 1853 to 1857, while others say President Benjamin Harrison was the first to bring in a tree in 1889.  According to accounts, Harrison displayed the tree in the Yellow Oval Room on the second floor, which was used as a library and parlor for the First Family at that time.  Since electricity had yet to be installed in the White House, wax candles were used to light the tree.  Lights with electric bulbs didn’t appear on the White House Christmas tree until 1894 under President Grover Cleveland.

Over the course of the 20^th Century, various presidents developed and formalized the traditions of the White House Christmas tree.  In 1924, the District of Columbia Public Schools gifted the White House a “National Christmas Tree” that was erected on the Ellipse south of the White House, and President Calvin Coolidge led a lighting ceremony on Christmas Eve with a separate tree that was donated from Middlebury College in Vermont.

In 1929, President Henry Hoover placed a Christmas tree in the Blue Room, which has since been home to the official White House Christmas tree.  First Lady Jaqueline Kennedy began the tradition of themed decorations in 1961 by including characters from the “Nutcracker Suite” ballet as ornaments.  Other themes for decorations displayed over the years include First Lady Bird Johnson’s gingerbread men decorations, and in 2013, First Lady Michelle Obama featured holiday greeting cards from military servicemembers.  For 2021, the First Family selected a “gifts from the heart” theme that honors military service members and COVID-19 first responders.

Christmas Tree Selection

Since 1966, the National Christmas Tree Association (NCTA) has selected and presented the White House with its official Christmas tree.  Each year, tree growers, industry experts, and consumers vote in a national contest held by the NCTA to select the tree grower who will provide that year’s official White House tree.  To qualify for the contest, growers must first win state or regional competitions.  The most selected type of tree is fir, with spruces being a distant second.Since the NCTA formalized the selection process over a half-century ago, 13 trees have come from North Carolina, 10 have come from Pennsylvania, and eight have hailed from Wisconsin.