This past Sunday, late morning, I got the new bivalent Covid booster. I’m writing about it because I thought everyone knew what that was, but in talking to a few people about it, I learned that not everybody is aware that a brand new Covid booster is now available, hot off the Pharma assembly line, to protect us from the original Covid virus—what my daughter Sophia calls “The O.G. Covid”—and Omicron variants.
Side effects: Monday I slept almost all day. I cancelled a call and a meeting, both of which I could reschedule. People were very understanding. Tuesday (yesterday) I still felt pretty tired and like my synapses weren’t working quite as well as they usually do. I also felt a little unfiltered. Add all that up, and it means this will be a short newsletter, with a slightly less professional tone than I usually strive for. Oh well.
I got the shot at my local Rite-Aid and I got my flu shot at the same time. Both were free. I now have a two page vaccine card and the cards are connected with a staple—not as elegantly high-tech as the Covid vaccine QR codes we were required to make for our African safari, but it works. You can see that I’m a Pfizer gal, which I used to think meant something in terms of better protection. I think the jury is still out on that one, though.
What does “Bivalent” mean?
Now we get to the real meat of this post: what is a “bivalent” booster and why does understanding that matter? As I said above, the new booster works against the old and new variants of Covid. Bivalent is the correct medical term for “conferring immunity to two diseases or two serotypes” (thank you Merriam Webster “Medical Definition”), but why use that word with the general public, who I’m fairly certain have no idea what it means? As my daughter Sophia also said, why not just call it a “dual booster.”
But what’s even worse is that, as one does, I went to the CDC to get information about the new booster, and the parts of the CDC website that discuss the bivalent booster are written in confusing, technical sounding prose that even I, a health care professional, had to work to understand. The term “bivalent” only sort of gets defined, and not until the last paragraph of material on the website labeled “About Covid-19 Vaccines”:
Updated COVID-19 boosters can both help restore protection that has decreased since previous vaccination, and provide broader protection against newer variants. The updated, or bivalent boosters, target the most recent Omicron subvariants, BA.4 and BA.5, that are more contagious and more resistant than earlier strains of Omicron. (CDC website—emphasis added)
If I were vaccine hesitant, the CDC website would not persuade me to get this new booster. In fact, I’m vaccine supportive and the CDC’s information left me pretty confused, in part because I also used their “Find Out When You Can Get Your Booster” link and it told me I was not eligible for the updated booster even though I certainly was—see the two page card above as proof.
This sowing of confusion matters because of an important concept known as “health literacy,” which the CDC website defines according to the context:
“Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”
According to the US Department of Education, one in five adults has “low literacy skills.” That translates into 43 million Americans who read poorly, or maybe not at all. And yet, Covid information on the CDC website does not follow common sense guidelines around health literacy. The communication gap between those 43 million Americans and information given out by the CDC is so huge that the website might as well be written in a foreign language, despite the CDC having another page in their website titled:
How to Tailor COVID-19 Vaccine Information to Your Specific Audience
Good communication helps solve problems
The heading above probably reads like an obvious maxim. It should be obvious, but the Centers for Disease Control, the supposedly premier agency for understanding and combating illness in the US, does not seem to know how to embrace this idea, even when it concerns something as important, and fraught, as communicating about Covid. My husband read Michael Lewis’s book The Premonition: A Pandemic Story about why the CDC got so much about Covid wrong and found the book revealing and dispiriting.
So, yes, there are political and historical issues at play here, but in the end what matters is whether the CDC is doing everything it can to encourage Americans to protect themselves and others from Covid, and their website shows they are not.
Solutions
The CDC needs a writer, or at least an editor, to take their muddled and overly technical Covid website and make it clear. I could do that job (seriously—I would enjoy it) and so could a lot of other people. After doing that, the CDC could aim higher, improving their overall health literacy to become a resource that average people would turn to for useful and easy to understand information relevant to a variety of health problems. It could become a positive example of the pairing of government, science and public health, which is after all the mandate of the CDC’s full name: “Centers for Disease Control and Prevention.”
Please leave a comment, or share this newsletter with a vaccine-curious friend. Also remember that my new book Healing: When a Nurse Becomes a Patient is available wherever books are sold.
You make some very good points. The bottom line being that the CDC lagged behind the virus. My husband was a CDC pox virologist for 40 years. He ran the smallpox lab for decades and was involved in the Smallpox Eradication Program. He finished his career in the Core Facility setting up and overseeing the Proteomics Lab. Along with his colleagues, he was part of the international team that handled the monkeypox outbreak of 2003 developing rapid assays, determining the efficacy of vaccines, and doing genetic sequencing to determine the degree of genetic drift of this virus. IMHO the CDC is a very different organization today than it was decades ago when it was the gold standard for infectious disease control. It was founded to combat malaria and then it came to handle infectious diseases. In the 90s it took on chronic diseases like diabetes and risky behaviors like not wearing seatbelts or obesity and lack of exercise. Suicide and drug use was also added. Almost anything that could kill you was gradually part of the CDC. Every Congressman had a constituent group that advocated for research and most of them (exception being AIDS) had nothing to do with infectious diseases. Lots of money came into the CDC but not necessarily for infectious diseases. The mission was changed as infectious diseases became a mere part of the CDC rather than the main focus. The medical profession focused on chronic diseases because that was where the money was. And most doctors considered infectious a minor part of their job. Another significant part of the problem is that we do not have a national healthcare system therefore we have a fragmented data collection system with many citizens not even able to afford participation in the medical system. It is difficult to make recommendations when you have no way of capturing enough of the data in a for profit system that does not generate revenue from infectious diseases. In addition, a vast array of independent entities are involved including competing pharmacies, insurance companies, pharmaceutical companies, appliance makers, hedge funds, hospital conglomerates, etc. Identifying the impediments to the CDC handling this pandemic is paramount for handling the next pandemic. In 2006 as he was getting ready to retire and winding down his monkeypox research, my late husband told me this was just the tip of the iceberg. He said as overpopulation continues to make humans push up against the environment, there would be greater cross species transmission, the viruses would be novel, and there would be pandemics. The problem has many layers.
You bring great clarity to this issue!