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The CDC embraces the power of the vaccines

Why the agency now says vaccinated people can mostly shed their masks.

Rochelle Walensky in December, after Joe Biden picked her as the director of the Centers for Disease Control and Prevention.
Chip Somodevilla/Getty Images

Over the past few months, the Centers for Disease Control and Prevention (CDC) was criticized for playing it too cautiously with its Covid-19 guidance. The agency had recommended people wear masks outdoors, even kids in the outdoor heat of summer camp. It has overestimated the risk of outdoor spread and surface transmission. It was too slow to tell the fully vaccinated that they can go about their lives, living closer to normal.

So experts argued that the CDC was failing to seize on a moment of victory: Vaccines are triumphing over the virus. The US needs more people to get the shots — and needs to encourage them to do so with the promise of a light at the end of the tunnel.

But on Thursday, the CDC leaped ahead of the criticisms — announcing that it no longer recommends the vaccinated mask up, even in most indoor settings. The agency named a few specific exceptions for health care settings, public transportation, prisons, jails, and homeless shelters. And people should continue to follow local and state laws. But the overall message was unambiguous: Vaccinated Americans can start getting back to normal.

“The science is clear: If you are fully vaccinated, you are protected, and you can start doing the things that you stopped doing because of the pandemic,” the CDC said in a statement.

With the news, the CDC snapped out of its cautious ways, moving faster than widely expected, given that the majority of Americans still aren’t fully vaccinated. And it finally embraced the power of the Covid-19 vaccines.

For months, some experts have lamented that the vaccines were being undersold. Clinical trials and real-world evidence have found the shots are very effective, nearly eliminating the risk of severe disease, hospitalization, and death. Recent research, including from the CDC, also found that the shots seem to stop the vaccinated from transmitting the virus to others. And data from Israel, as well as early signs in the US, suggests that mass vaccination truly causes Covid-19 cases and deaths to plummet.

As vaccination rates in America began to plateau then fall, it seemed more urgent for the agency to signal that vaccines will let people return to normal by dangling a huge incentive — a normal post-pandemic life — in front of unvaccinated people. It’s that pressure, along with the mounting evidence of vaccines’ effectiveness, that seems to have led the CDC to change course.

A big question with the CDC’s new guidance is how it will be carried out in the real world. In public settings, are people simply supposed to trust that the maskless are vaccinated? Will businesses start asking for proof of vaccination before someone can shed the mask? Will there be any enforcement at all, or will the assumption be that the unvaccinated are left to fend for themselves? All of that remains to be seen.

Still, this is a big step for America toward a post-pandemic normal. As CDC director Rochelle Walensky told reporters on Thursday, “We have all longed for this moment — when we can get back to some sense of normalcy. Based on the continuing downward trajectory of cases, the scientific data on the performance of our vaccines, and our understanding of how the virus spreads, that moment has come for those who are fully vaccinated.”

Yes, the Covid-19 vaccines are that amazing

The CDC is acting on mounting evidence that the vaccines are truly effective, including against variants.

The initial clinical trials put the efficacy of the two-shot Moderna and Pfizer/BioNTech vaccines at 95-plus percent and the one-shot Johnson & Johnson vaccine at more than 70 percent. All three vaccines also drove the risk of hospitalization and death to nearly zero.

The real-world evidence backed this up, too. Data from Israel, which has the most advanced vaccination campaign in the world, found that the Pfizer/BioNTech vaccine was 90 percent effective at preventing Covid-19, with better rates for symptomatic disease, hospitalization, and death. Israel has seen this effectiveness firsthand: Since reopening in March, after most people in the country got at least one dose, daily new Covid-19 cases have fallen by more than 95 percent and daily deaths now number in the single digits or zero.

A hint of these results is visible in the US figures, too. As the country has vaccinated more people, daily new Covid-19 cases in America have dropped by nearly 50 percent since mid-April, with hospitalizations and deaths trending down as well. The remaining serious cases are also all among the unvaccinated, with the Cleveland Clinic estimating 99.75 percent of its Covid-19 patients between January and mid-April weren’t vaccinated.

One lingering concern is that the vaccines might be less effective against the coronavirus variants that have popped up across the world, some of which seem to be better at evading existing immunity. But the research has shown that the vaccines approved in the US are really effective against the variants, too, preventing the risk of serious illness and death.

There have been some breakthrough cases of Covid-19 among the vaccinated. But these tend to be milder infections, less likely to transmit, and far from common. “This is less than 0.01 percent of the vaccinated,” Akiko Iwasaki, an immunologist at Yale, previously told me, citing CDC data. “So extremely rare!”

There were also some concerns that a vaccinated person could spread the virus. But over the past few weeks, some studies have indicated that the vaccines also stop vaccinated people from spreading the virus. The CDC summarized one such real-world study for the Pfizer/BioNTech and Moderna vaccines, showing the vaccines stop not just symptoms but overall infections and, therefore, transmission:

Results showed that following the second dose of vaccine (the recommended number of doses), risk of infection was reduced by 90 percent two or more weeks after vaccination. Following a single dose of either vaccine, the participants’ risk of infection with SARS-CoV-2 was reduced by 80 percent two or more weeks after vaccination.

Some experts have recently cited this growing evidence to embrace old freedoms after getting vaccinated.

“I am fully vaccinated and have resumed normal activities,” Monica Gandhi, an infectious diseases doctor at the University of California San Francisco, previously told me. “I have gone indoor dining, went to my first movie theater, and would go to a bar if there was an opportunity!”

The CDC is now adopting this attitude. On top of its change to its mask guidance, the agency said it will review its other recommendations to make sure they line up with the current understanding of the evidence. Overall, it’s signaling the vaccinated should be confident they are safe.

“The science demonstrates that if you are fully vaccinated, you are protected,” Walensky said. “It is the people who are not fully vaccinated in those settings who are not protected.”

US policy now focuses on getting more people vaccinated

With the news, America has entered a new phase in its Covid-19 response, in which it’s all-in on the vaccines.

It’s a reflection of the current reality: Now that the vaccines are widely available and more than half of US adults have gotten at least one dose, it’s less tenable to continue asking the vaccinated to make huge sacrifices. At the same time, the unvaccinated remain at risk of a deadly virus, and policymakers should do everything they can to make sure as many people as possible get the shot.

Much of the country had already moved to reopen, with 14 states already doing away with mask mandates entirely. The CDC’s guidance will likely nudge states further, perhaps causing them to, at the very least, find ways to let the vaccinated evade mask mandates.

Meanwhile, President Biden’s administration has emphasized that it’s now focused on vaccinating as many people as possible, adopting strategies to boost access, encourage the skeptical to get the shot, and reward those who do get inoculated. The administration has set a goal of vaccinating 70 percent of adults by July 4 — with the promise that at that point, much of the country can truly return to normal.

Ohio is a recent example of this kind of shift. This week, Gov. Mike DeWine (R) announced the state will rescind Covid-related health orders, including its mask mandate, in June. At the same time, he unveiled a lottery in which five vaccinated people will have a chance to win $1 million each.

The CDC’s announcement offers yet another incentive, with the promise that if you are vaccinated, in most cases you no longer have to worry about the risk to your health and can shed the mask.

This is what a return to normal looks like. By embracing the vaccines, America is now able to slowly but surely put Covid-19 — and all the changes it forced on our lives — behind us.