Is the US COVID Booster Program Ethical?

key takeaways

  • With millions of people yet to receive their primary COVID-19 vaccine series, some experts say the Biden administration’s booster program is unethical.
  • Experts stress that giving booster doses could exacerbate global vaccine inequalities and affect public trust.
  • Instead, they recommend governments increase vaccine supply and production capacity in countries with low vaccination coverage to prevent the emergence of new variants.

Recent studies suggest that booster shots are needed to maximize and prolong the vaccine’s protection against the COVID-19 virus. Given the data, the FDA and CDC have given the green light to boosters for three COVID vaccine makers, Pfizer, Moderna and Johnson & Johnson. Those 12 and older who completed the initial COVID-19 vaccine series are now eligible for booster doses.

With much of the world — especially low- and middle-income countries — still unvaccinated, the booster program quickly raised ethical questions. Experts predict that boosting vaccinations will further widen the vaccination gap between rich and less wealthy countries.

White House: Most Americans need booster shots 8 months after vaccination

Primary COVID-19 vaccine still prevents severe cases

During an Aug. 18 White House briefing, Rochelle P. Walensky, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), cited several studies that have found that vaccine protection against COVID-19 infection increases with time. weakened over time.

However, the data also showed that the vaccines were still effective against severe illness, hospitalization and death, even taking into account the Delta variant.

Dr. Richard Reithinger, vice president of global health at RTI International, told VigorTip, “There is currently only limited data to suggest that the immune response elicited by an available vaccine is waning after six to eight months.”

Reithinger also said, “Most of the data is about infections, not hospitalizations or deaths. The data also don’t take into account the use of non-drug interventions, such as wearing masks and social distancing.”

Extra doses with boosters

People with moderately to severely compromised immune systems may not be able to develop the same level of immunity to a two-dose vaccine series compared to people who are not immunocompromised. Therefore, people five years of age and older should receive another dose of the mRNA COVID-19 vaccine at least 28 days after the second dose.

“From a public health perspective, the private sector is increasingly asking its employees or customers for the vaccine due to the proliferation of Delta variants in the U.S., and the recent FDA approval of the Pfizer-BioNTech vaccine is encouraging,” Reithinger said.

Are boosters common in vaccines?

Is it ethical to distribute booster doses now?

With hundreds of millions of people from low- and middle-income countries still waiting for their first doses of the vaccine, many wealthy countries, including the United States, are already pushing ahead with booster doses, against the wishes of the World Health Organization (WHO).

According to the World Health Organization, about 4 billion doses of vaccines have been administered globally, but more than 80% of vaccines have gone to high- and upper-middle-income countries, even though they are home to less than half the world’s population.

Dr. Nancy S. Jecker

The problem we face is one of human-made problems. We don’t distribute vaccines fairly, and as a result more people die.

— Nancy S. Jecker, Ph.D.

“There is a need for us to significantly increase the supply and access of vaccines globally in terms of ethics, ethics and public health,” Reithinger said.[We need to increase access] Especially targeting low- and middle-income countries to prevent more cases and deaths, to prevent the collapse of health systems and socioeconomic structures, and to prevent the potential for more pathogenic and virulent strains to generate even more cases and death, and socioeconomic dislocation. ”

In a press conference earlier this month, WHO Director-General Dr Tedros said that while many vulnerable groups remain around the world, the use of more vaccines in countries that have used up most of the world’s vaccine supplies is a priority. unacceptable. Not protected.

“Biden’s call for boosters is a missed opportunity for moral leadership,” Dr. Nancy S. Jecker, a professor of bioethics and humanities at the University of Washington School of Medicine and a Fulbright American scholar in South Africa, told VigorTip.

Jecker added, “Our moral responsibility is for everyone to achieve a minimum level of vaccine protection.”

Citing research from Duke University, Jecker said it was an achievable goal, “by the end of 2021, we could produce about 12 billion doses of vaccine, far exceeding the 11 billion needed to vaccinate about 70 percent of the world’s population.” — Assuming two doses of vaccine remain the norm.”

WHO asks rich countries to delay COVID-19 booster shots

How Boosters Affect Vaccine Equity and Confidence

Experts say the Biden administration’s plan to distribute booster doses in the fall could affect vaccine inequity and confidence.

Exacerbating global vaccine inequity

“The problems we face are man-made,” Jack said. “We didn’t distribute vaccines fairly and as a result more people died.”

According to Jecker, one way to translate ethical responsibility into policy is to follow WHO recommendations and ensure that at least 10% of people in each country are vaccinated before boosters are given. Boosting immunity in individual countries is critical, but priority should also be given to increasing global vaccination coverage through major vaccination series.

“Biden’s decision was not to build a global community, but to serve narrow nationalist goals,” Jack said. “On an individual level, receiving a third shot appears to be a benefit. However, on a larger scale, boosters make the world a less safe place for each of us as the virus continues to spread and mutate in unprotected areas. .”

Report: Rich countries are buying COVID-19 vaccines, causing shortages

New variants are more likely to appear in unvaccinated populations — such as the Delta variant in India or the Lambda variant in Peru — and they can spread rapidly regionally and globally, Reithinger said.

“Unless there is a significant increase in resources, for example, in terms of vaccine production capacity, human resources and financial resources, to divert attention away from people who have not yet received their first dose – both in the U.S. and globally – this will mean Efforts to increase vaccine coverage in this population may suffer,” Reithinger said. “This will maintain and further exacerbate the current vaccine inequity.”

undermine public trust

Strengthening recommendations could confuse people and reduce confidence in vaccines — especially if the rationale and evidence behind these rapid changes are not well explained to the public.

“The biggest challenge with boosting injections is public trust,” Ryan Nash, MD, director of the Ohio State Center for Bioethics and Medical Humanities, told VigorTip. “In the early days of the pandemic, experts said we didn’t need masks, then said we needed them after all. Then there was the debate about which type of masks worked. Some skeptics and lack of trust saw the change.”

A poll conducted by the Kaiser Family Foundation found that almost 25 percent of vaccinated adults have heard of booster shots and worry that they may not be well protected against COVID-19.

“Some say this type of flip is political, but the reality is that the science is behind the change,” Nash said. “We only have a year of vaccine data and research continues. The challenge is that if we switch to boosters too early, and a study three months later shows that we really don’t need them, it has the potential to create a lot of mistrust .”

Health officials are reportedly preparing to change the booster rollout plan if new data calls for it.

Find the COVID booster here

How can the government help other countries?

While helping all communities around the world get a vaccine is ideal, protecting your own community makes sense, Nash said. That said, if a Biden administration chooses to do so, it could still play a role in increasing vaccine supplies in low- and middle-income countries.

“Increasing the number of manufacturers globally will not only help low- and middle-income countries, but all countries,” Jecker said. “Instead of hoarding vaccines, the U.S. should share licenses to manufacture vaccines so that more people can reach them. Sharing know-how, technology and raw materials to build drug manufacturing capacity in other countries is critical to containing this and future epidemics important.”

However, supporting the abandonment of intellectual property (IP) protection for COVID-19 vaccines and scaling up production to donate excess doses is only a short-term solution.

To increase global vaccine supply, wealthier countries can incentivize and finance complex technology transfer, support the development and/or expansion of vaccine production facilities in low- and middle-income countries, and facilitate the availability of equipment and raw materials.

Patent exemptions not enough to increase global vaccinations, experts say

“To really get ‘ahead’ of the virus and prevent the emergence of new SARS-CoV-2 variants, we need to focus our attention on increasing vaccine coverage in the U.S., especially in low- and middle-income countries,” Reithinger said. “Only then can we prevent more cases and, more importantly, serious illnesses that require hospitalization and death, and put this pandemic firmly in our rearview mirror.”

The information in this article is current as of the date listed, which means that you may have updated information as you read this article. For the latest updates on COVID-19, visit our Coronavirus news page.