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Around the world, what does it mean to be fully vaccinated?

RACHEL MARTIN, HOST:

What does it take to be considered fully vaccinated at this point - one shot, two shots, boosters? With the emergence of highly contagious variants, like omicron, many countries are looking at how to adjust their guidance. So this morning we're going to take a snapshot of what three countries are doing - the U.S., France and Israel.

We're joined now by NPR health correspondent Rob Stein, along with correspondents Eleanor Beardsley in Paris and Daniel Estrin in Jerusalem.

Good morning to all three of you.

ROB STEIN, BYLINE: Good morning.

DANIEL ESTRIN, BYLINE: Good morning.

ELEANOR BEARDSLEY, BYLINE: Good morning.

MARTIN: Daniel, I want to start with you. Israel was the first country to get a majority of citizens vaccinated with two shots. And it was the first to roll out boosters on a wide scale. So now Israel is beginning another round of boosters - a fourth shot. Why?

ESTRIN: Right. Well, COVID cases are just exploding here. Yesterday set the record for new daily infections since the pandemic began. So they want to protect the older population. And so Israel is offering a fourth vaccine shot to people 60 and older - also to elder care homes, to immunosuppressed people and to medical teams. And Israel's conducting trials on this fourth shot. And there are some initial results that show that it increases antibodies fivefold just a week after taking the shot.

And Prime Minister Naftali Bennett is really touting this.

(SOUNDBITE OF ARCHIVED RECORDING)

PRIME MINISTER NAFTALI BENNETT: This is good news. It's preliminary information. But simply stated, the fourth dose is secure, and the fourth dose works.

ESTRIN: Now, what has not worked is convincing enough Israelis to get even two shots. Only 64% of Israelis are double-vaccinated. There is hesitancy among Palestinian Arab citizens of Israel, among ultra-Orthodox Jews, but also in the general population. For instance, many parents are hesitant to vaccinate their young kids.

MARTIN: Let's move to France. Eleanor, that country is stepping up its emphasis on boosters. What's the guidance been?

BEARDSLEY: Well, you know what, Rachel, in November, the government reduced the time between your second vaccine and the booster from six months to three, and it gave everyone over 65 until December 15 to get that booster if you want to keep your vaccine pass valid. So today if you're over 65, you're not considered fully vaccinated unless you've had those three doses. Now the booster is open to anyone over 18. And the backdrop of this is, you know, exploding cases. France just hit another all-time European record of daily infections - 270,000. It's leading the continent.

MARTIN: So, Rob, how does this approach compare to how the U.S. is looking at this? I mean, does the definition of fully vaccinated mean boosted here, at least as far as health professionals look at it?

STEIN: No, at least not yet. You know, there's been some talk about changing the official definition of fully vaccinated in the U.S. But at the moment, it's still two shots of the Pfizer or Moderna vaccine and one Johnson & Johnson shot. But, you know, the Biden administration has made boosting the vaccinated a top priority and has aggressively been expanding the pool of people eligible for boosters. In fact, the Food and Drug Administration just authorized boosters for yet another big group - you know, kids ages 12 to 15. That's because even though omicron is better at sneaking around the vaccines, the first round of shots still do a decent job of protecting people from getting really sick, even from omicron. And just one extra shot pumps the protection way back up again.

And the biggest problem the U.S. faces by far is still the unvaccinated. Thirty-five million people in the U.S. haven't even gotten their first shots. And millions of vaccinated people still haven't gotten their first booster, including lots of the most vulnerable people, like the elderly. And that's why hospitals are starting to get overwhelmed in many places in this country again.

MARTIN: So let's talk about that challenge - what it takes to get people vaccinated and boosted. Daniel, you mentioned that this is a problem in Israel. There are a lot of vaccine-hesitant populations. So what's the government there doing about it?

ESTRIN: Well, a big incentive here is that if you get vaccinated, you get what's called a green pass. And this lets you into restaurants and music concerts and all kinds of places. And they've gotten pretty strict about it. So you need a QR code on your phone. And they scan in at the door before you enter. And this green pass expires six months after your last shot because the philosophy here is that antibodies fade over time. So that is actually an incentive to get a booster. You keep your green pass valid, and you can go about your life. The thing is, Rachel, that the system still has not convinced about 30% of Israelis to even get the first shot because there are ways to get this green pass even without getting a vaccine. You can get a green pass if you've recovered from the virus within the last six months. You can get one for 24 hours if you test negative. So unvaccinated people continue to go about their lives. The one thing that we have seen move the needle a little bit is that this latest wave has convinced a little bit more of the Israeli population to get vaccinated for the first time. It's just not enough.

MARTIN: Yeah. Eleanor, France is now actually ahead of the U.S. and Israel in getting people vaccinated. How's that happening?

BEARDSLEY: Well, you know, you're right, Rachel. You know, 76% of the total French population is vaccinated. When you look at those over 18, it's 91%. That's pretty high. But the government is pushing for more - more children, more boosters. It's aiming to give 25 million vaccines in the next five weeks, which is a huge challenge. And also, President Emmanuel Macron's majority party is pushing through a strict law in parliament that's going to make it impossible to get around - you know, go to restaurants, cafes, cultural venues - with a negative test, which has been allowed until now.

But with this new law, you're going to have to show full vaccination and vaccination only. Now, this measure was on track to become law in mid-January. I say was because last night things kind of exploded when Macron gave a newspaper interview. And basically, he said he wanted to piss off the unvaccinated till the very end and make it impossible for them to do anything.

MARTIN: Was that a direct quote?

BEARDSLEY: That is actually a direct quote light because he was even more vulgar...

MARTIN: Oh, man.

BEARDSLEY: ...Was not a direct translation. Yeah. But he's clearly fed up with the 5 million French people who've had no vaccine. But it was a pretty incendiary remark. The social networks are exploding this morning. His opponents are calling him vulgar, divisive. They say he wants to make unvaccinated, you know, people second-class citizens. And even parliamentarians who support the measure are asking if it's to save French lives or to - you know, using his words - piss off the unvaccinated. The French parliament was debating this bill last night when Macron's remarks came out, and angry opponents suspended the session.

And here's what the French parliament sounded like about 1 o'clock this morning.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON: (Speaking French).

MARTIN: Intense.

BEARDSLEY: Yes.

MARTIN: So, Rob, when we look back here at the U.S., what is the bottom line? I mean, should we just expect to need to get a fourth shot soon?

STEIN: You know, I've talked with some experts who think it may be time to make another booster available to very specific groups of people in the U.S., you know, such as more people with weak immune systems, the elderly, maybe health care workers. But most of those I've been talking with and federal officials, like Dr. Anthony Fauci, see things very differently than, say, Israel. They say we're just not there yet. And that's because, as I said earlier, vaccinated and boosted people are still protected against getting really sick, even against omicron. And there are some possible downsides to launching yet another big round of boosters, like, you know, taking our eye off the ball of the main priority of getting the unvaccinated vaccinated and boosting the vaccinated.

And there's also some concern that if people get too many boosters with the original vaccine, it could kind of backfire, and the shots could start to kind of lose their punch. If yet another shot is needed, it may make more sense to go with a variant-specific vaccine. But it's far from clear we need any of that yet or ever will. All that said, the U.S. is keeping a close eye on what's going on in this country and elsewhere and not totally closing the door to yet another booster if it turns out the protection does start to get dangerously weak again and evidence emerges that another additional booster does look necessary and effective. So, you know, all things are still on the table.

MARTIN: NPR health correspondent Rob Stein, also NPR correspondents Eleanor Beardsley and Daniel Estrin. Thanks to all three of you.

STEIN: You bet.

BEARDSLEY: Thank you, Rachel.

ESTRIN: Thanks, Rachel. Transcript provided by NPR, Copyright NPR.