World Health Organization officials, concerned about the easing of precautions meant to stop the spread of the coronavirus even as the most contagious variant to date has emerged, are urging even fully vaccinated people to continue wearing masks and to keep taking other measures to prevent infection.
In May, the U.S. Centers for Disease Control and Prevention said fully vaccinated Americans no longer needed to wear masks indoors or maintain a distance of 6 feet from other people. The agency also eased advice about testing and quarantine after suspected exposure to the virus.
Asked on Monday about the cautions expressed by the WHO -- the world's largest public health organization -- a CDC spokesperson pointed to the existing guidance and gave no indication it would change.
The highly infectious delta variant, first detected in India, has been identified in at least 85 countries. In the United States, where its prevalence has doubled in the past two weeks, the variant is responsible for 1 in every 5 covid-19 cases. Dr. Anthony Fauci, the nation's top infectious disease expert, has called it "the greatest threat" to eliminating the virus in the United States.
The rise of new variants "makes it even more urgent that we use all the tools at our disposal to prevent transmission," including consistent use of vaccination and of public health and social measures, Dr. Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a news briefing Friday.
Dr. Mariangela Simao, the WHO's assistant director-general for access to medicines, vaccines and pharmaceuticals, emphasized at the briefing that even vaccinated people should continue to consistently wear masks, avoid crowds and maintain social distance from others; make sure they are in well-ventilated spaces; wash their hands frequently; and avoid sneezing or coughing around other people.
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"What we're saying is, 'Once you've been fully vaccinated, continue to play it safe, because you could end up as part of a transmission chain.' You may not actually be fully protected," said Dr. Bruce Aylward, a senior adviser to the WHO.
He added, "I think the first message we want to be careful about is saying, 'Once you're vaccinated, you can just go ahead and do whatever.'"
The comments were made in the context of broader statements criticizing the inequitable distribution of vaccines around the globe and the lack of access to vaccination in many parts of the world where the virus is spreading.
Covax, the WHO program that poor countries rely on for vaccines, has "zero doses" of the AstraZeneca or Johnson & Johnson vaccine, or those made by the Serum Institute of India, available for distribution, Aylward said. While less than 2% of the population in Africa is vaccinated, some countries are purchasing doses for young people who are at relatively low risk from the virus, he noted.
Even in countries where there are ample supplies, full vaccination rates are lower than they could be, Aylward said.
Though fully vaccinated people are largely protected from symptomatic and asymptomatic infections, studies suggest the Pfizer-BioNTech vaccine's efficacy against the delta variant is slightly lower than against other variants; the efficacy is significantly lower for individuals who have received only one dose.
Countries with relatively high vaccination rates have seen an uptick in infections driven by the delta variant.
Britain, despite roughly two-thirds of the population having received at least one dose of the Pfizer-BioNTech or AstraZeneca vaccine and just under half having received two doses, is grappling with a sharp rise in infections from the variant.
In Israel, which has one of the highest vaccination rates in the world, a rise in cases attributed to the delta variant has led the government to reimpose mask mandates indoors and at large outdoor gatherings.
Given how pernicious and fast-moving the variant is, "the vaccine approach is not enough," said Eric Feigl-Ding, senior fellow at the Federation of American Scientists in Washington. "We're not at the level of vaccinations where we can release the brakes on everything else and herd immunity will grind transmissions to a halt."
Other scientists disagreed, saying guidance has to be more nuanced and tailored to communities, varying according to vaccination and infection rates.
"The WHO is looking at a world that is largely unvaccinated, so this makes sense," said Dr. Ashish Jha, dean of the Brown University School of Public Health.
In parts of the United States with low vaccination rates, masks may be appropriate, and recommendations should be tailored, he added. "If I were living in Missouri or Wyoming or Mississippi, places with low vaccination rates, I would not be excited about going indoors without wearing a mask -- even though I'm vaccinated," Jha said.
VACCINES' PROTECTION
Meanwhile, scientists reported Monday that the vaccines made by Pfizer-BioNTech and Moderna set off a persistent immune reaction in the body that may protect against the coronavirus for years.
The findings add to growing evidence that most people immunized with the mRNA vaccines may not need boosters, so long as the virus and its variants do not evolve much beyond their current forms -- which is not guaranteed. People who recovered from covid-19 before being vaccinated may not need boosters even if the virus does make a significant transformation.
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"It's a good sign for how durable our immunity is from this vaccine," said Ali Ellebedy, an immunologist at Washington University in St. Louis who led the study, which was published in the journal Nature.
The study did not consider the coronavirus vaccine made by Johnson & Johnson, but Ellebedy said he expected the immune response to be less durable than that produced by mRNA vaccines.
Ellebedy and his colleagues reported last month that in people who survived covid-19, immune cells that recognize the virus lie quiescent in the bone marrow for at least eight months after infection. A study by another team indicated that so-called memory B cells continue to mature and strengthen for at least a year after infection.
Based on those findings, researchers suggested that immunity might last for years, possibly a lifetime, in people who were infected with the coronavirus and were later vaccinated. But it was unclear whether vaccination alone might have a similarly long-lasting effect.
Ellebedy and his colleagues recruited 41 people -- including eight with a history of infection with the virus -- who were immunized with two doses of the Pfizer-BioNTech vaccine. From 14 of the participants, the team extracted samples from the lymph nodes at three, four, five, seven and 15 weeks after the first dose.
Ellebedy's team found that 15 weeks after the first dose of vaccine, a specialized structure called the germinal center that forms in lymph nodes was still highly active in all 14 of the participants, and the number of memory cells that recognized the coronavirus had not declined.
The results suggest that a vast majority of vaccinated people will be protected over the long term -- at least against the existing variants. But older adults, people with weak immune systems and those who take drugs that suppress immunity may need boosters; people who survived covid-19 and were later immunized may never need them at all.
CRUISE POSTPONED
Separately, Disney Cruise Line announced Monday that it is postponing its first test cruise since the pandemic brought the industry to a standstill, after a handful of participants had inconsistent test results for covid-19.
The Disney Dream had been scheduled to set sail today from Port Canaveral, Fla., with 300 employees who had volunteered for the simulation cruise. But the trip was postponed until next month, pending approvals, because a small number of employees had inconsistent results for covid-19, "which is considered positive by the CDC," Disney said in a statement.
The CDC had approved the cruise line's request to conduct a two-night test cruise.
The federal government is starting to allow cruises to sail again, but only if nearly all passengers and crew members are vaccinated against the virus. Florida Gov. Ron DeSantis, a Republican, signed a bill banning business from requiring proof of vaccination, so cruise lines must prove the effectiveness of their safety protocols on test cruises.
Last weekend, Celebrity Edge departed Fort Lauderdale, Fla., becoming the first cruise ship to leave a U.S. port in 15 months. Saturday's sailing kicked off the cruise lines' return to business, with Carnival vessels already scheduled to depart from other ports next month.
Celebrity Cruises, one of Royal Caribbean Cruise's brands, said 99% of the passengers were vaccinated, well above the 95% requirement imposed by the CDC.
Information for this article was contributed by Roni Caryn Rabin and Apoorva Mandavilli of The New York Times, and by staff members of The Associated Press.
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