A harvard health expert's advice: require the covid-19 vaccine — not universal masking

COVID "I DON'T THINK THE PATH OUT OF THIS PANDEMIC — OR EVEN THROUGH THIS SURGE — IS MASKING THE VACCINATED." Amid a sharp increase in COVID-19 cases and hospitalizations in

Massachusetts amid the holiday season, a growing number of local disease experts are calling on Gov. Charlie Baker to reimpose a statewide indoor mask mandate. But not all of them. Joseph

Allen, a professor at Harvard’s T. H. Chan School of Public Health and an expert on disease exposure, says state and local officials should be taking more aggressive action to require the

vaccine, rather than requiring universal masking, even with COVID-19 rates at their highest levels since last winter. “I don’t think the path out of this pandemic — or even through this

surge — is masking the vaccinated,” Allen told reporters during a conference call Tuesday. Advertisement: “Let’s be clear: masks work,” he said. “I’ve been a big proponent of universal

masking for a long time. I think the vaccines changed that.” Allen says he would advise officials in Massachusetts to follow in the footsteps of New York’s recently implemented policy

requiring masks only in indoor public places that do not require proof of vaccination for entry. “The vaccine mandates are something that we’ve been really far behind on,” Allen said. “We

should have been doing it several months ago. I absolutely think we should be doing it right now.” But so far, none have. While dozens of cities and towns — including Boston — require masks

in all indoor public places regardless of vaccination status, none have implemented policies requiring individuals to show proof of vaccination for indoor venues like restaurants, gyms, and

theaters. Advertisement: Some individual businesses have implemented the policy themselves, and Boston Mayor Michelle Wu has said her office is internally discussing a potential citywide

vaccination requirement for restaurants and other indoor venues. However, Gov. Charlie Baker has stood opposed to the policy at the statewide level (Baker also said Monday that there are no

plans to reimpose any statewide mask mandate). Even in the face of more transmissible variants, preliminary research indicates that the two-shot mRNA vaccines remain largely effective at

preventing severe disease from COVID-19. Allen notes that individuals who have gotten an additional booster shot face a “much lower risk of any infection.” While unvaccinated individuals

should continue masking, Allen doesn’t think it’s necessary in a fully vaccinated environment (the Baker administration’s current guidelines take a similar individual-based approach,

recommending indoor masking for the unvaccinated and other high-risk groups, like the elderly). “If you’re vaccinated and boosted, there’s little additional benefit to masking,” Allen said.

“I don’t think that’s going to be the policy lever that’s most important at this point.” For that reason, he thinks the Centers for Disease Control and Prevention’s guidelines for universal

indoor masking are “really deeply flawed.” “They’re solely tracking cases and percent positivity,” Allen said, noting that those numbers don’t distinguish between a vaccinated 20-year-old

and an unvaccinated 80-year-old, who have extraordinarily different risk levels. Advertisement: Similar to COVID-19 wastewater data, Allen says the infection rate measurements are a good

indicator of “community spread,” but not “community risk.” “Some of these metrics are just not appropriate for the moment,” he said. Instead, Allen says the most important risk determinants

are age and vaccination status. While about 73 percent of the entire Massachusetts population is fully vaccinated, unvaccinated individuals account for 70 percent of the state’s COVID-19

hospitalizations. The average age of all COVID-19 fatalities in Massachusetts is 75 years old. “Anyone who wants to wear masks should absolutely continue to wear a mask,” Allen said. “The

benefits of masks are not only when everyone’s wearing a mask; if you’re wearing a high efficiency mask, you’re very well protected. So I think we’ve reached that moment that might feel

uncomfortable for a lot of people and that some of this individual decision-making really is going to matter. And I understand people being reluctant at different points to pull back on

controls. But we have the tools to keep people safe.” Vaccines aren’t the only tool. Allen, who literally wrote a book about making indoor spaces healthier, says officials should be doubling

down on improving ventilation and air filtration, including with cheap, short-term tools like portable air purifiers. He also says rapid tests should be more cheap and accessible,

especially in low-income communities. Advertisement: But Allen returns to vaccine requirements as the most impactful policy (he also echoes other top health experts’ opinion that “fully

vaccinated” will eventually include boosters). Allen points to worker mandates — like ones enforced by the U.S. military or New York City — that increase vaccination rates among employees to

around 90 percent. “I think every organization should be doing it,” Allen said, noting that states have “routinely” required vaccines for various employees and students long before

COVID-19. “It’s good public health, and it’s good business health,” he said. “I mean, look around. Look what this pandemic has done to lives, livelihoods, the economy. Entire sectors have

been absolutely devastated. We have been given a tool that can end this.” NEWSLETTER SIGNUP Stay up to date on all the latest news from Boston.com