U.S. Navy photo by Mass Communication Specialist 1st Class Kegan E. Kay. Public domain photoThe FDA approved the updated Pfizer and Moderna mRNA COVID-19 vaccines Monday, and the CDC’s Advisory Committee on Immunization Practices was deliberating on Tuesday what the public recommendations should be once shots become available.
As reporters prepare stories about these recommendations, it’s crucial they work to dispel any confusion about the boosters and provide their audience with contextual information about how booster shot recommendations are made.
Health care journalists carry such great responsibility because people often make personal health decisions based on what the news media reports. That responsibility includes choosing appropriate expert sources and distinguishing between who has the expertise and who has the authority to speak on an issue. Often, people have both while other times a source only has expertise or only has authority. If an expert speaks outside their scope, journalists must leave out those quotes or contextualize them. It’s also critical that a journalist doesn’t inadvertently ascribe authority to someone who doesn’t have it.
Getting even a part of the story wrong — as some reporting on this subject has — can lead to people making poor decisions based on inaccurate or incomplete information, or to the public forming inaccurate impressions of public health advice. Even getting things partly right, but framed inaccurately or imprecisely, can cause confusion and anxiety for people who are very concerned about having access to the booster as soon as it’s available.
Key summary points
- Expert sources may have the expertise or the authority, or both. Reporters should make sure not to conflate expertise with authority.
- Some recent reporting on the COVID-19 booster shots should have clarified that a decision had not yet been made by the CDC (at the time of the article, the FDA had not even approved the boosters).
- Health reporters must be clear, accurate and precise in conveying information about public health recommendations and must provide proper context on how those decisions are made.
Part of the anxious reaction — especially on social media — comes from worries that a limited CDC recommendation might mean pharmacies won’t allow anyone who wants a booster to get one, or that insurance companies might not cover boosters for those who don’t fit into specific groups.
How vaccines and boosters are recommended
The CDC’s Advisory Committee on Immunization Practices makes recommendations to the CDC director, who makes the final decision about who should be able to receive a shot. The Committee was publicly deliberating that very question Tuesday — and some reporting appeared to jump the gun on what conclusion the committee would reach.
“The thing that maybe people don’t appreciate about [the CDC Committee] is that there’s no preliminary discussion about how we should vote,” Kevin Ault, M.D., chair of the Western Michigan University School of Medicine’s OB-GYN department and former Committee member, told me. “What you’re hearing in real time is the discussion. You’re hearing all the messiness of science, and not always with all the data you would like.”
Committee members must decide how to vote based on the data available at that precise point in time, even though more — possibly better — data will almost certainly become available later.
“One of the wonderful things about [the Committee] is that it’s actually a model of transparency,” said William Schaffner, M.D., a professor of infectious disease and health policy at the Vanderbilt University Medical Center. Anybody can tune in and watch the meeting and even take part in the discussion. Part of the meeting is reserved for public comments as long as they’re kept under three minutes and aren’t personal. (The link to watch the meeting is here.)
After the Committee votes, the CDC director makes the final decision on booster recommendations. The director nearly always follows the Committee’s recommendations, but there is a precedent for the director tweaking them. In September 2021, then-director Rochelle Walensky, M.D., M.P.H., expanded the Committee’s recommendations for boosters to people “at an increased risk for COVID-19 in an occupational or institutional setting,” including health care workers — a group the Committee had explicitly left out of their recommendation. It was a surprising move at the time, but the bottom line is that it’s not determined who boosters are “intended” for until the CDC director decides.
The public does not need all the nitty gritty details of how public health agencies make vaccine and booster recommendations, but reporters should provide enough context so their audience understands the basics: The FDA decides whether the vaccine will be available in the U.S., and the CDC director decides, based on the Committee’s recommendations, who should get the vaccines. Any other opinions are just that — the opinions of an individual expert that have no bearing on what ultimately is decided.
After the Committee makes its recommendations to CDC Director Mandy Cohen, journalists preparing their stories about Cohen’s final decision should be mindful of how even slight oversimplifications, or conflating expertise with authority, can impact their audience’s understanding of public health discussions and recommendations.
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