When the coronavirus vaccines first emerged, they were shown to have 94 to 95 percent efficacy in preventing symptomatic COVID-19.

It was a situation where the message from public health officials was fairly simple – get the shot and help prevent the spread of the disease. Vaccine mandates, passports, and other measures were all deemed smart public health policy.

But as variants of the disease began to appear and multiply, the vaccines couldn’t keep pace. Infections spread rapidly and Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center, said public health messaging couldn’t keep up.

Doron said people were told to get their child vaccinated because children were dying from COVID. But most parents never heard of a child who died from COVID or even ended up in a hospital.

Younger people were told to get vaccinated to reduce the risk of elderly relatives becoming infected. But so many young people were becoming infected by the variants that the strategy no longer made any sense.

“What they’re hearing and what they’re seeing are not jiving with each other,” Doron said on The Codcast, echoing themes from a recent CommonWealth commentary piece she co-wrote with Monica Gandhi, a professor of medicine at the University of California – San Francisco.

Doron and Gandhi called for a “campaign of honesty” around COVID-19. Doron said public health officials didn’t lie about the disease, but suggested they were not fully transparent. She fully supports the vaccines, saying they are very effective in reducing the risk of serious disease, hospitalization, and death. But she said the spread of variants – and the inability of vaccines to prevent the spread of infection — needs to be reflected in the messaging.

“The virus has been defanged by our immunity from repeated vaccination and repeated infection,” she said. “The actual infection fatality rate has dropped below that of the flu.”

For example, Doron said, the US Centers for Disease Control and Prevention initially weighed all the available evidence and concluded the risk of getting COVID outweighed the risk of myocarditis, an inflammation of the heart muscle that can be a side-effect of the vaccine, particularly in young men 16 to 30.

“But as time has moved on, we now have a situation where, essentially, almost every person in that age group has had COVID and we’re talking now about what’s your risk of a bad outcome from COVID having had COVID, having had the initial vaccination series,” she said.

She said many young men are being asked to get their fourth shot even if there’s no risk-benefit analysis for that. “That’s the nuance that’s different from some of the earlier messaging,” she said.

Doron said she understands nuance doesn’t always lend itself to public health messaging. “You have to balance simplicity against transparency, and a complex message is really hard to put out there,” she said. “But the fact of the matter is that the science on this is really complex, and to try to oversimplify it comes at the expense of full transparency and honesty.”

What Doron worries about is that the simple message – get the shot – is leading to anger and skepticism about vaccines in general from people who previously accepted them.

“What I hear again and again and again is, ‘I accepted every vaccine that my doctor ever told me to get or my child’s doctor told me to get for them, but I no longer trust public health officials. I feel like COVID-19 pulled back the curtain and that they’re not being honest,’” Doron said, quoting the people she has heard from.

“When you look at the numbers of COVID vaccination rates in terms of our country, they’re low,” she said, pointing out that less than half of those over 65 have received a second booster, it’s been single-digit uptake for children under 5, and the rate of bivalent booster updates is around 10 to 12 percent.

“We can talk about the implications of what that might be for COVID-19,” Doron said. “But I’m much more worried about what the implications of that lack of trust in public health might be for other things that public health does like its recommendations for routine childhood and other vaccinations. We’re already seeing evidence that routine childhood vaccination rates are down.”

She said there have been outbreaks of measles in Ohio and polio in New York.

“I consider it catastrophic how extreme it has become,” Doron said, noting she hears from people who are swearing off all vaccinations. “That is a disaster. If we have made people think that vaccines in general are bad because of the way we have communicated [about] COVID vaccines, we have a serious problem on our hands.”

BRUCE MOHL

NEW STORIES FROM COMMONWEALTH MAGAZINE

Someone to count on: Justin Pasquariellio, who founded Silver Lining Mentoring, gives foster children an adult they can count on as they make the difficult transition into adulthood. Read more.

Losses nearing end? State pension board looking to rebound after three quarters of losses. Read more.

OPINION

Spend it wisely: Chad d’Entremont of the Rennie Center for Education Research & Policy says schools are flush right now with cash but need a better plan on how to spend it. Read more.

Getting into retirement: Hayward K. Zwerling of Somerville recounts his personal evolution toward retirement, which came together on a trip to Alaska. Read more.

Black Twitter: Deion Scott Hawkins of Emerson College says a world without Black Twitter is hard to think about. Read more.

STORIES FROM ELSEWHERE AROUND THE WEB                    

BEACON HILL

Enforcement of the state’s new MBTA Communities zoning law, aimed at promoting multi-family housing development, is raising hackles among municipal leaders who are seeing state aid held back if they aren’t complying with the new statute. (Boston Globe)

MUNICIPAL MATTERS

Former Natick town meeting member Suzanne Ianni is sentenced to 15 days in jail for her participation in the January 6 Capitol insurrection. (MassLive)

A Roxbury activist wants to strip the names off a bridge and a City Hall meeting room named for late city councilors Jimmy Kelly and Albert “Dapper” O’Neil, citing their views on race issues that made them “Archie Bunker in the flesh.” (Boston Globe)

HEALTH/HEALTH CARE

Worcester’s chief health officer questions whether the state should be using $75 rewards to incentivize COVID vaccination. (Telegram & Gazette)

Residents in 20 legislative districts voiced support for single-payer health care in a non-binding ballot question. (Patriot Ledger)

WASHINGTON/NATIONAL/INTERNATIONAL

Labor Secretary Marty Walsh, the Biden administration’s go-to guy in building support from organized labor, helped push Congress to approve a measure last week averting a national freight rail strike, but he now must try to mend wounds with unions, which were not happy with the forced settlement. (Boston Globe)

In the latest outburst suggesting there’s no norm of democratic governance he wouldn’t bulldoze, Donald Trump saysthe Constitution should be “terminated” to install him in the presidency. (Washington Post)

Sen. Elizabeth Warren and Sen. Lindsey Graham are working together on a bipartisan proposal to regular Twitter. (Boston Herald)

ELECTIONS

Poorer communities in Massachusetts had lower voter turnout in November than wealthier ones. (MassLive)

BUSINESS/ECONOMY

A Berkshire Eagle editorial applauds local ski areas for their heavy investments in snow-making and other amenities.

EDUCATION

MassLive looks at the performance of several Western Mass school districts whose students had less pandemic-related learning loss than most of the state. A separate story digs into the performance of area charter schools.

TRANSPORTATION

The state Department of Transportation and rail companies Amtrak and CSX Corp. apply for $108 million in federal transportation money to help fund improvements along the 53 miles of railroad between Springfield and Worcester, part of the East-West rail project. (MassLive)

ENERGY/ENVIRONMENT

Historian Douglas Brinkley says capitalist industry leaders got organized in reaction to the start of the modern environmental movement in the late 1960s and early 70s and have done their best to thwart its impact. (Boston Globe)

Residents on the Cape raise concerns about the cost of new septic regulations. (WBUR)

CRIMINAL JUSTICE/COURTS

After the Supreme Judicial Court rules that urine is not a “noxious” substance as defined under a criminal statute, precluding criminal charges for someone who peed on a jail floor, Sen. Ryan Fattman files a bill to define urine as “noxious” under the law. (Eagle-Tribune)

Former Natick Town Meeting member Suzanne Ianni is sentenced to 15 days in jail. (WBUR)

PASSINGS

Gordon N. Oakes Jr., a University of Massachusetts trustee involved in building the Mullins Center and a business executive who was president of Springfield’s BayBank Valley and CEO of Monarch Capital, dies at 81. (MassLive)