‘Fully vaccinated’ and the other shifting sands of pandemic language

Last week—after Colin Powell died of complications from COVID-19 and early news reports mentioned that he was “fully vaccinated,” without also noting that he had received treatment for a type of blood cancer that weakens the immune system—I started to contemplate what those words actually mean at this stage of the pandemic. Earlier in the year, it was relatively clear that a person (in the US, at least) was “fully vaccinated” two weeks after their second dose of the Pfizer or Moderna vaccine, or first dose of the Johnson & Johnson vaccine—the maximum number of shots authorized per person at the time. Since then, however, we’ve entered a murkier moment, with “booster” shots now recommended, but only for some people based on factors including age, health, and occupation. Powell had been scheduled for a booster prior to his death, but it’s not clear that even that would have saved him, given the weakness of his immune system. Was he “fully vaccinated” when he died? Could he ever have been?

It turned out that James Hamblin, a medical doctor and writer, had a similar response to the Powell coverage. The term “fully vaccinated” is “inappropriate in many cases, primarily because there is no consensus on what it means,” Hamblin wrote, in an op-ed for the Washington Post. “Most of us fall into a gray area between the 21-year-old Olympic decathlete in no need of more doses and the 90-year-old with emphysema who sings in an unvaccinated choir and would quite benefit from boosting. All of this boils down to, essentially, an ongoing attempt to define ‘fully vaccinated.’ Who is ‘fully vaccinated’ against COVID-19, and for how long? The honest answer is that the target is moving before our eyes.”

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As Hamblin notes, the pandemic has taught us that “precision of language and transparency in delineating the known and the unknown are key to any effective public health response”—but as I’ve often written in this newsletter, people, not least journalists, have often struggled with both imperatives in the face of immense novelty and uncertainty; in the early days of the pandemic, for instance, many news outlets treated case counts as definitive statistics even though testing was highly inadequate and many very real cases were going uncounted. (As I wrote in May 2020, “confirmed cases” was then, and remains now, a more useful phrase.) Recently, Katherine J. Wu, a science writer at The Atlantic, compiled some other common pandemic terms that are slippery or just plain wrong. The list includes “fully vaccinated” but also “asymptomatic” (you might actually be pre-symptomatic, and in any case, what counts as a symptom?), “mild COVID-19” (which can be a sniffle or disease so bad you only narrowly avoid hospitalization), and even “COVID-19” itself. (The latter term is supposed to be reserved for the symptomatic disease that follows some infections with the virus SARS-CoV-2, which is what tests detect; Wu points out that there’s actually “no such thing as a COVID test, and there’s no such thing as asymptomatic COVID.”) As Elena Semino, a linguist, told Wu, the pandemic has seen a great deal of “linguistic leakage,” where jargon that was previously used only within a professional community has become universal, often without the (hopefully) clarifying intermediate work of journalism.

Often, new terminology becomes more widely understood over time. But it strikes me that many of the confusions of pandemic language have not only persisted, but worsened—mirroring the broader ways in which, as I wrote over the summer, the pandemic itself has somehow only become harder to understand and explain, with the science of viral transmission still murky, data visibility still imperfect, and mass vaccination having diminished the appropriateness of blunt, society-wide restrictions and increased the salience of much more complicated collective and individual risk calculations. In some cases, terms we thought we clearly understood, like “fully vaccinated,” have become fuzzier. In other cases, meaning has been flipped on its head. If you’d told me a year ago that you’d had a “vaccine breakthrough,” I’d likely have hailed a miracle of cutting-edge medical technology. Tell me that today and I’d ask you to stay well away from me.

Some pandemic language is hard to pin down because it skates atop complex philosophical questions that lack a right answer. In August, as concern about “breakthrough infections” increasingly made (often misleading) headlines, The New Yorker’s Dhruv Khullar asked what actually constitutes an “infection”—a “breakthrough infection” could manifest as “symptomatic” illness in a “fully vaccinated” person (you can see how tricky this is getting), or it could just mean that a highly sensitive test found viral matter in your nose while your vaccine-pumped immune response was working, just as it should, to fight it. “Technically, some cells got infected and the virus started to replicate,” Angela Rasmussen, a virologist, told Khullar. “But the immune system prevented you from getting sick and shedding copious amounts of virus that can go on to infect someone else.” As well as the scientific, there are social and political dimensions to such conundrums, of course: whether it makes sense to define the latter scenario as an “infection,” for example, is in part tangled up with questions around the behaviors we expect of infected people, and the risk calculations that inform those expectations. “Fully vaccinated” invites similar questions. To many people, “full” connotes total, one-hundred-percent protection, which is an impossible expectation that can nonetheless lead to a loss of confidence if/when it isn’t realized. Others might understand fullness as lifting them above an acceptable risk threshold for daily life. One person, in other words, might see their immunity as half empty; another as half full.

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All of this matters beyond pedantry. Our collective understanding of language informs our collective understanding of the pandemic, which in turn informs how we behave in almost all aspects of our lives; to reverse this causality somewhat, when the pandemic eventually “ends” and our behavior changes, our understanding of pandemic language may have to change, too. (Will an “infection” always trigger “isolation”?) The “fully vaccinated” example, and attendant debate over boosters, offers a glimpse of this. Over the summer, as that debate ground into gear, it was quite common to hear concerns about vaccine equity in media coverage, with reporters and experts asking if it’s fair to give some Americans a third shot before millions of people in poorer countries have had the chance to get one. Now that boosters are a reality, it seems to me that those concerns, while still present in much coverage, have generally been overshadowed by a narrower discussion about logistics. (Who gets a booster? And which one?)

As Wu has pointed out, the word “booster” itself plays into this dynamic, insofar as it carries a connotation that sounds both overwhelmingly positive and additive of immunity; other languages, Wu notes, instead use words that translate more closely as “reinforcement” or “recollection,” which sounds more like replenishing something that some people have lost and less like “inviting people for third helpings at a buffet line when some people are still starving outside the restaurant.” Hamblin, for his part, argues that the inequitable distribution of shots isn’t just a matter of equity, but of efficacy: if being “fully vaccinated” is a useful thing to aim for, it’s more at the level of the community, and less at the level of the individual. Asking whether a person or a planet is “fully vaccinated” can lead to very different conclusions about where to prioritize sending shots. Colin Powell was “fully vaccinated” in a country that very much is not.

Journalists aren’t—and shouldn’t want to be—the language police; Wu noted that her list of linguistic gripes was likely a futile exercise, since “the words have already slipped through my fingers like so much semantic sand.” Still, journalists can control the language that they use, and have some power to enforce their own standards of precision and clarity. And sometimes, pandemic language can shift at the mass level in helpful ways. In late May, the World Health Organization renamed coronavirus variants that had previously been identified by their country of discovery (“British,” “South African,” “Brazilian,” “Indian”) by assigning them Greek letters instead; this was, to some extent, an arbitrary exercise, but the WHO’s aim was also to remove toxic stigma around the variants, in part so that governments wouldn’t fear the reputational consequences of reporting vital new knowledge about the virus. At the time, I was skeptical that the Greek letters would catch on, but they have become the default, including in media coverage. By the time the “Indian variant” was widespread in the US, it was “Delta.”

Again, journalists should scrutinize language policing: the WHO is a powerful institution that is far from infallible; the Indian government, for its part, co-opted opposition to the “Indian variant” as part of a broader crackdown on online speech. But the overall effect of the switch to Delta has been positive. And top-down linguistic changes don’t usually catch on when they serve to confuse, rather than clarify. In August, after Pfizer’s COVID vaccine won formal approval from US regulators, the company moved to market it under the new name “Comirnaty.” Me neither.

Below, more on the pandemic and language:


A programming note, and an invitation:
Two weeks from now, I’ll be writing this newsletter from inside COP26, the vital global climate summit in Scotland, reporting and commenting on the media stories surrounding both the conference and the climate crisis itself. If you or your news organization is headed to COP, I’d love to hear about your coverage plans (especially if you’re lining up something innovative) or just to say hi. If you aren’t heading to COP, I’d love to hear about what you’re looking for from others’ coverage of the conference, or any thoughts you may have on the state of climate journalism generally. You can reach me at [email protected]cjr.org.


Other notable stories:

  • Writing for Nieman Lab, Alex Kantrowitz—who runs an independent newsletter about big tech, and was recently invited to join the consortium of major news organizations with access to leaked documents from inside Facebook—argues that the consortium should be dissolved and its documents released to the public; there are privacy, safety, and even national-security concerns around dumping the documents online, Kantrowitz says, but these “can be assuaged with responsible redaction—which we all know how to do—and with, gulp, forward-thinking lawyers.” Elsewhere, Charlie Warzel assesses the possible fallout from the consortium’s reporting, and asks, “What the hell happens now?”
  • Recently, The Atlantic reported that Stewart Bainum, Jr., a Maryland hotel magnate, was finetuning his ambitious plan to launch the Baltimore Banner, a nonprofit news site that will open with an annual operating budget of fifteen million dollars and fifty journalists. The Post’s Sarah Ellison now has more details: after prioritizing building out the business side of the operation, the Banner announced its first editorial hire, naming Kimi Yoshino, a managing editor at the LA Times, as its top editor; Imtiaz Patel, a veteran of the Wall Street Journal, will be CEO and publisher, and David Simon will write a monthly column.
  • Sara Fischer reports, for Axios, on the launch of Good Information Inc., a public benefit corporation that aims “to fund and scale businesses that cut through echo chambers with fact-based information,” including by investing in local news. The entity will be backed by George Soros and Reid Hoffman, and led by Tara McGowan, a former Democratic Party strategist. It will also acquire Courier Newsroom, McGowan’s local-news network that has drawn scrutiny for not being fully transparent about its backing and political activity.
  • A week from today, Slow Burn, Slate’s hit history podcast, will launch its sixth season, focused on the acquittal of the four Los Angeles police officers who beat Rodney King, and the unrest that followed. Hosted by Joel Anderson, the season will focus, in part, on media coverage of the unrest, and will feature the last known interview with George Holiday, who filmed the King beating and recently died of COVID. Variety has more.
  • The National Center on Disability and Journalism updated its style guide—which previously advised journalists to use person-first language (like “person with a disability”) as the “default” when writing about the disability community—to reflect the fact that many within the community prefer identity-first language (like “disabled person”). NCDJ now advises journalists to ask subjects how they wish to be referred to. Poynter has more.
  • Yesterday, YouTube took down the channel of Novara Media, a left-wing news outlet in the UK, without any prior warning or explanation. The platform reinstated the channel a couple of hours later amid an outcry, but has still not specified what prompted the initial takedown; a spokesperson said simply that the channel was “flagged,” though did also concede that YouTube made “the wrong call.” Press Gazette’s Charlotte Tobitt has more.
  • On Monday, journalists in Abuja, the capital of Nigeria, marched on the city’s police headquarters in solidarity with Tordue Salem, a reporter for Vanguard, an independent newspaper, who disappeared after leaving Nigeria’s National Assembly building two weeks ago and hasn’t been seen since. Salem’s colleagues believe that he was targeted by the security forces, and have accused police of “foot-dragging.” AFP has more.
  • Over the weekend, El Mercurio, a conservative newspaper in Chile, ignited a firestorm of criticism after running an article about the life and times of Hermann Göring, a Nazi war criminal, in its “society” pages; the German embassy expressed concern, while a Jewish community organization decried the piece as an “apology for Nazism.” On Monday, El Mercurio said it “deeply regretted” that the piece had been interpreted as offensive.
  • And The New Yorker’s Eliza Griswold explores the afterlife of Rachel Held Evans, an influential writer on Christianity who died, aged thirty-seven, in 2019, and whose final book will come out next month. The book “offers few firm conclusions; it seems to simply stop, mid-exploration,” Griswold writes. “The challenge and poignancy of the collection is that its essays mark both the evolution of a consciousness and its abrupt end.”

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Jon Allsop is a freelance journalist whose work has appeared in the New York Review of Books, Foreign Policy, and The Nation, among other outlets. He writes CJR’s newsletter The Media Today. Find him on Twitter @Jon_Allsop.

TOP IMAGE: 3D print of a SARS-CoV-2 virus particle. Courtesy of NIH.