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America's decentralized, underfunded reporting system hampers efforts to combat the coronavirus--Analysis .

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The contentious and confusing debate in recent weeks over coronavirus booster shots has exposed a fundamental weakness in the United States’ ability to respond to a public health crisis: The data is a mess.

How many people have been infected at this point? No one knows for sure, in part because of insufficient testing and incomplete reporting. How many fully vaccinated people have had breakthrough infections? The Centers for Disease Control and Prevention decided to track only a fraction of them. When do inoculated people need booster shots? American officials trying to answer that have had to rely heavily on data from abroad.

Critically important data on vaccinations, infections, hospitalizations and deaths is scattered among local health departments, is often out of date and hard to aggregate at the national level, and it is simply inadequate for the job of battling a highly transmissible and stealthy pathogen. ...

The dearth of timely, comprehensive data impaired the ability of the nation’s top public health officials and infectious-disease experts to reach a consensus on the need for booster shots. The experts looked at conflicting data from Israel, Britain and the United States and came up with a bewildering set of recommendations. The debate seemed to confuse more than clarify arguments for the necessity of an additional shot.

“We are pulling data in from all different sources,” said a senior administration official who spoke on the condition of anonymity because the person was not authorized to discuss the issue publicly. “We’re trying to put it all together to see … what is the vaccine efficacy? And there’s this wide divergence. It’s not reconcilable.” ...

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