By Nancy S. Jecker
Should countries that can afford COVID-19 booster vaccines offer them to residents if scientists recommend them?
The director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, has made his position clear, calling for countries to impose a moratorium on boosters until 10% of people in every country are vaccinated. His plea comes amid mounting concerns about the slow progress getting COVID-19 vaccines to people in low-income countries.
Like the WHO, some ethicists, including me, have argued that the world must stand together in solidarity to end the pandemic.
Yet as of Sept. 14, of the 5.76 billion doses of vaccine that have been administered globally, only 1.9% went to people in low-income countries.
Meanwhile, many wealthy countries have begun offering COVID-19 boosters to fully vaccinated, healthy adults.
Early evidence on the benefit of COVID-19 boosters to protect against severe disease and death cuts both ways. Some experts tout their benefits, while others argue against them for now.
As a philosopher who studies justice and global bioethics, I believe everyone needs to wrestle with another question: the ethics of whether to offer boosters while people in poor countries go without.
A dangerous gap
The WHO’s call for a moratorium on boosters is an appeal to fairness: the idea that it’s unfair for richer countries to use up more of the global vaccine supply while 58% of people in the world have not received their first shots.
In some countries, such as Tanzania, Chad and Haiti, fewer than 1% of people have received a vaccine. Meanwhile, in wealthy nations, most citizens are fully vaccinated – 79% of people in the United Arab Emirates, 76% in Spain, 65% in the U.K., and 53% in the U.S.
In the U.S., the Centers for Disease Control and Prevention has recommended boosters for moderately to severely immunocompromised people. President Biden has publicly endorsed offering boosters to all Americans eight months after they complete their second shots, pending Food and Drug Administration approval. Yet on Sept. 17, the FDA’s advisory panel recommended against a third dose of the Pfizer vaccine for most Americans, though they did endorse boosters for people over age 65 or at higher risk.
On Aug. 11, before the CDC had authorized boosters for anyone – including immunocompromised people – it estimated that 1 million Americans had decided not to wait and got a third vaccine. It is unclear whether some of them were advised by doctors to seek a booster shot based on, for example, age or compromised immunity. Some healthy Americans have reportedly lied to gain access to unauthorized shots, telling pharmacists – falsely – that this is their first shot.
In addition to raising concerns about fairness, gross disparities between vaccine haves and have-nots violate an ethical principle of health equity. This principle holds that the world ought to help those who are most in need – people in low-income countries who cannot access a single dose.
There’s also a purely utilitarian case to be made for delaying boosters. Even if boosters save lives and prevent severe disease, they benefit people far less than first shots, a notion known as diminishing marginal utility.
For example, the original laboratory studies of the Pfizer vaccine showed more than 90% protection for most people against severe disease and death after the primary, two-dose series. Booster shots, even if they boost immunity, give much less protection: perhaps less than 10% protection, according to a preliminary study.
As a recent article in a leading medical journal, The Lancet, points out, “Even if boosting were eventually shown to decrease the medium-term risk of serious disease, current vaccine supplies could save more lives if used in previously unvaccinated populations than if used as boosters in vaccinated populations.”
Moreover, when scarce vaccines are used as boosters, rather than as first shots for the unvaccinated, that allows the virus to replicate and mutate, potentially creating variants of concern that undercut vaccine protection.
Buy it, use it?
While the ethical argument for delaying boosters is strong, critics think it is not strong enough to override every nation’s duty to protect its own people. According to one interpretation of this view, countries should adopt an “influenza standard.” In other words, governments are justified in prioritizing their own residents until the risks of COVID-19 are similar to the flu season’s. At that point, governments should send vaccine supplies to countries with greater needs.
One could argue that since rich countries have bought millions of doses, they are the rightful owners of those vaccines and are ethically free to do as they wish.
Yet critics argue that vaccines are not owned by anyone, even by the pharmaceutical companies that develop them. Instead, they represent the final part of product development that is years in the making and the result of many people’s labors. Moreover, most COVID-19 vaccines were publicly funded, principally by governments using taxpayer dollars.
Since 1995, the World Trade Organization has required its member states to enforce intellectual property rights, including patents for vaccines. Currently, however, the trade organization’s members are debating proposals to temporarily waive patents on COVID-19-related products during the pandemic.
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Some commentators suggest that the whole debate over boosters is overblown and not really about ethics at all. They propose simply calling boosters something else: “final doses.”
But regardless of what we call boosters, the ethical question the WHO’s director-general raised remains: Is giving these shots a fair and equitable way to distribute a lifesaving vaccine?
Nancy S. Jecker is Professor of Bioethics and Humanities at the School of Medicine, University of Washington.
The Conversation arose out of deep-seated concerns for the fading quality of our public discourse and recognition of the vital role that academic experts could play in the public arena. Information has always been essential to democracy. It’s a societal good, like clean water. But many now find it difficult to put their trust in the media and experts who have spent years researching a topic. Instead, they listen to those who have the loudest voices. Those uninformed views are amplified by social media networks that reward those who spark outrage instead of insight or thoughtful discussion. The Conversation seeks to be part of the solution to this problem, to raise up the voices of true experts and to make their knowledge available to everyone. The Conversation publishes nightly at 9 p.m. on FlaglerLive.
shy guy says
Ask China, they started this mess and we as a country do nothing but complain while they sit back and enjoy it.
C’mon man says
Perhaps if the government wasn’t beating getting this vaccine more would get it. I personally know several people who were interested in getting it until the constant bombardment caused them to become more concerned
OK. . . perhaps the fundamental question about why people “still” refuse to take the “fully approved” vaccine for a highly contagious, lethal virus is this: Does your intellect/education/thinking ability control your personal decision making. . . or, do your (sometimes childish) emotions? Ask yourself this: Have I allowed FOX/Facebook/trump to hijack my decisions by appealing to my “baser emotions”?
Really look at this. . . study that possibility. . . answer yourself honestly. Then, decide what you are going to do about it. Your decision is vital and directly effects each of us in several different ways:
. Your personal life and health
. Your personal responsibility to keep us all safe and healthy
. The huge costs of Covid health care ( estimates are 3.7 BILLION for the month of August alone)
. The impact on our economy
. The impact on safety in our schools
. The impact on safety in the work place and traveling . . . etc. etc. etc. . . . the ripple effects are enormous!
Please, join us in the reality of scientific facts. “Together” we can beat this pandemic and create a brighter future for us all!
Dedicated American says
Sherry, first of you being so anti President Trump along with all that agree with you should reset your thought . First of all do you actually believe Biden is actually an honest and reliable president for our Republic? Are you happy with the prices of gas going up, are you happy with the taxes you are going to be paying, are you happy with the way Biden handled Afghanistan, the wide open borders, the trillions in spending and the vaccine mandate of which we still do not know what is in each vaccine from all pharmaceutical companies, taking away your 1st and 2nd amendment. Do you realize this is the ONE WORLD GOVERNMENT that is being ushered in now. The corrupt politicians, Republicans, Democrats, Libertarians, going back to Socialist President Woodrow Wilson, and George H. W. Bush’s one World Government speech to the CORRUPT UNITED NATIONS in 1990 regarding the One World Government . All these socialists hate President Trump because he loves his country and was going to DRAIN THE DEEP STATE SWAMP . Please reference your computer the facts I just printed. We can agree to disagree but one should have the correct facts.
Brach the Economist says
As an anarchist who doesn’t consume any right wing or left wing propaganda without a fistful of salt: You are what you describe others to be.
I have no responsibility to you or any other person other than those whom I choose to keep safe or healthy.
The costs of Covid health care is called revenue when you are in the medical industry.
The impact on THE economy (not sure what “our” economy means) has been done by a novel reaction to a less than novel occurrence. The economy is a abstract term describing the occurrence of each and every action. That the economy is down is a reflection of the actors who otherwise would have been participating in it changing their behaviors. Economists have been, as had I been, since before the first lockdowns occurred, explaining that these aberrant responses and extreme authoritarian overreaches into the private actions (the economy) of private actors (the economy) would result in greater suffering than any contagion could cause. The marginal utility of the collectivist actions “meant to save lives” was negative. In fact, if any Western lives were saved at all by the economy destroying actions, it was at the (proven) direct cost of magnitudes of more lives lost around the world with more fragile economic conditions. Millions of people, including millions of children, have starved to death in the last year. So much for caring about human lives.
The impact of safety on “our” “schools”. Maybe for the older teachers. The children are fine. They’ve been fine the entire pandemic. They have been fine through every outbreak dating back 60 years. If anything should have been cause for alarm it would have been the uptick in school children dying from the flu pre-Covid. That number was actually approaching 1% of infections. Alas, being mortal means that life is always trying to kill us. I argue that less deaths overall is absolutely a good thing. We should get back to the important works of having a growing global economy lifting masses of people from poverty year over year as had been the trend for our millennia. I believe the safest means to promoting the healthiest long term outcomes for school aged children would be to end the deprivation of opportunities causal by a failed public education system. I would say the same of higher institutions as well, end all subsidy and allow them to thrive on merit again.
As to the impact of safety on the work place and travel…
The work place is easy. If it is a private business, as opposed to one funded by theft or graft (see most the largest corporations in the world who made trillions between them this year while displacing the greatest amount of small businesses ever lost world-wide), then you have no say. They can choose for themselves. Either they are private businesses, or they are slaves. It really is that simple. And for travel. If you fear the rain, stay inside or don a cloak. Standing inside and moaning at the clouds is quite the childish baser emotion. Worse than this though is the bully child acting from the basest of fearful emotions who demands everyone else act upon their preferences.
I’m perfectly okay with the fact that I just recently got my 3rd vaccine shot. The way I look at it is there are so many people right here in FL that for one reason or another are not vaccinated, and I am just taking one of the jabs that could have gone to one of them had they been so inclined. And since we do have quite a few unvaccinated people locally, especially here in Flagler Co. where our most recent infection rate was around 24%, those of us who believe in medical science need all the protection we can get from the ones who are running around in society and causing other people, some of whom cannot yet get vaccinated, to become infected with a potentially deadly virus. No, I don’t feel bad about getting my 3rd shot at all!
I think we can live (literally) with the reality of some people staying safe, even if other people refuse to do what they need to do, if we have to.
In the case of nations whose governments are so corrupt that they won’t do what they need to do to help their own people–as well as bloated, ineffective and corrupt global agencies like the WHO (and United Nations, in general), that refuse to do THEIR jobs properly–THEY are the ones who should be ashamed. And THEY are the ones who should be doing more–not demanding that others do less form themselves…until they MAYBE get around someday to doing more.
Right On Skibum! I was so relieved to get my Moderna booster, as I am now immune compromised.
“If” everyone in our community, and country would just cooperate in taking care of themselves and each other by getting the vaccine, we could have easily reached herd immunity by now and this virus would be much more under control.
Still, I feel we have a responsibility to consider the innocent millions in other countries who are not as fortunate as we are. We certainly should not be squandering vaccine that could potentially save millions of lives in less privileged places. It’s a balancing act.
The WHO and United Nations are trying to make sure that the innocent people in poorer are taken into consideration. Blasting them without personally and directly completely understanding their organization and their efforts is patently unfair. Such broad brush characterization smacks of hate filled talking points from a media outlet with an agenda to disenfranchise the poor. How unworthy of any reasonable, caring American.
The Daytona News Journal has a front page story about Ashley Smith, a 30 year old woman, who died from COVID after a 34 day struggle to survive. She was 13 weeks pregnant and the fetus she was carrying also is dead. According to CDC statistics, 5.4 million people in the 30 to 39 year old age group have gotten COVID and only 7,672 have died. That is just one out of every 700. Now her husband, Chris, is trying to raise some $9,000 for her funeral. Heaven knows how he is going to pay for her hospitalization, which even with health insurance will be staggering. It costs a lot to pay for a month in intensive care.
According to the CDC, 2.3 million people in my age group have contracted COVID and 118,355 have died. That is about one out of every 20. As an elderly person, fully vaccinated, but potentially eligible for a booster vaccination, I will certainly get it if possible.
The COVID vaccines are FREE. They have been paid for with our tax dollars. A long hospital stay is NOT FREE. Young people are at low risk of getting seriously ill and dying of COVID, but it is not zero. It is instead about 1/700 of dying and 1/300 of becoming seriously ill. So in the words of Dirty Harry, “Do you feel lucky,…?”
Palm Coast Citizen says
Spreading it out will only dilute the efficacy of global spread. The booster for immune compromise people is because they likely didn’t get the full immune response, meaning they may not be fully protected. For people 6 months out from their vaccine, they may no longer have enough antibodies to fight it. What good is it if it doesn’t protect us as a society?
There’s a strong case for us to keep this course for those wanting to remain fully vaccinated here while attempting to help it in other countries.
Please read the details of this heart breaking story. . . and then “think” again about getting vaccinated:
Karen Curry says
I’m sorry Sherry, none of this 52 year old Florida guy’s story brought tears to my eyes, neither did the plights of the 15 or so relatives of his who also were not vaccinated and became infected, in turn infecting how many others? I am very unhappy that he took up a ECMO machine & a staffed ICU bed 1200 hundred miles away in CONNECTICUT from someone else who probably didn’t get the treatment they needed because this guy refused to get vaccinated. If there is any justice he will be billed fully for the month he spent in the ICU in Florida, the special medical flight arranged to get his “ I really regret now not getting the shot” sorry ass to Connecticut & the month+ he took up the ECMO machine & ICU bed in CONNECTICUT! It’s time that these unvaccinated hordes start paying for the Covid treatments whatever they are. Maybe some of these hard heads will wake up once they know they’ll be hit in the bank account. There was no mention of anyone in this article getting the Regeneron either-he got exposed over the 4th of July for God’s sake, why not get that? I had no qualms about following the science & common sense reasoning regarding the vaccines, I got my first Moderna dose in Feb, 2nd in March and was fortunate & elated to get the booster this month while on a wait list for the immune compromised over 65 when there was a cancellation. Sorry but not sorry, my patience & empathy ran out when Delta hit & vaccination rates bottomed out.
I had a good friend from high school end up with severe pneumonia back in April. He almost died, but after a couple weeks he made a full recovery. He was 32 at the time.
He didn’t have Covid.
If vaccines are owned by no one then nothing is owned by anyone! So who is first in line and who decides who is first in line? The strongest, the weakest, the richest, the poorest, whites, blacks or male or female? 50% of each country or 100% of a single country? Who is last in line? Who decides? Democrats or Republicans? What would Jesus do?
@dedicated . . . Sure, if you would just post “credible” FACTS instead of right winged talking points, I would be happy to discuss them. Otherwise, your comments are so emotionally charged and all over the place I have no response.
You have excellent points Karen. While my compassion has me heart broken over those needlessly suffering and dying, my intellect sees this situation as becoming “Darwinian”.
Wishing I had a “magic wand” to rescue those who have given over their moral code and individual “thinking” processes to the FOX/FACEBOOK/OAN/NEWSMAX/trump “cult”. . . resulting in the needless/unnecessary, tragic pain and suffering, and loss of life of thousands due to their selfish, stubborn stupidity.
What in the hell is it going to take to break up that horrific CULT?
People in glass CULTS shouldn’t throw stones.
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