Are COVID-19 boosters ethical, with half the world waiting for a first shot? A bioethicist intervenes
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 on countries to impose a moratorium on boosters until 10% of the people in each country are vaccinated. His plea comes in the middle growing concerns on the slow progress in providing COVID-19 vaccines to people in low-income countries.
Still to September 14, of the 5.76 billion doses of vaccine administered worldwide, only 1.9% went to people living in low-income countries.
Meanwhile, many rich countries have started offering COVID-19 boosters fully immunized and healthy adults.
As a philosopher who studies global justice and bioethicsI believe everyone has to grapple with another question: the ethics of whether to give boosters when people in poor countries go without.
A dangerous gap
The WHO’s call for a moratorium on recalls is a call for fairness: the idea that it is unfair for rich countries to use more of the global vaccine supply while 58% of people in the world did not receive their first blows.
In some countries, like Tanzania, Chad and Haiti, less than 1% of people have received a vaccine. Meanwhile, in rich countries, most citizens are fully immunized – 79% of people in the United Arab Emirates, 76% in Spain, 65% in the United Kingdom and 53% in the United States
In the USA, the Centers for Disease Control and Prevention recommended boosters for people who are moderately to severely immunocompromised. President Biden publicly approved the offer of boosters to all Americans eight months after completing their second injection, pending approval from the Food and Drug Administration. Yet in an evaluation released on Sept. 15, FDA scientists seem cautious about whether large-scale recalls are needed, underscoring the continued protection of current vaccines.
August 11, before the CDC allowed boosters for anyone – including people with compromised immune systems – he felt that a million Americans decided not to wait and received a third vaccine. It is not known whether any of these were advised by doctors to request a booster based on, for example, age or compromised immunity. Some healthy Americans would have lied to access unauthorized injections, telling pharmacists – wrongly – that this is their first injection.
In addition to raising concerns about fairness, the glaring disparities between donated and unvaccinated vaccines violate a ethical principle of equity in health. This principle holds that the world must help those who need it most – people in low-income countries who cannot access a single dose.
There is also a purely utilitarian argument to be made for delaying boosters. Even though boosters save lives and prevent serious illness, they benefit people far less than early vaccines, a notion known as decreasing marginal utility.
For example, the original laboratory studies of the Pfizer vaccine has shown greater than 90% protection for most people against serious illness and death after the primary two-dose series. Booster shots, although they boost immunity, offer much less protection: maybe less than 10% protection, according to a preliminary study.
In a recent article in a leading medical journal, The Lancet, points out, “Even if the booster was ultimately shown to reduce the medium-term risk of serious illness, current vaccine supplies could save more lives if used in previously unvaccinated populations than if they were used as boosters in vaccinated populations. “
In addition, when rare vaccines are used as boosters, rather than the first vaccines for the unvaccinated, it allows the virus to replicate and mutate, potentially creating worrisome variants that undermine vaccine protection.
Buy it, use it?
While the ethical argument for delaying recalls is strong, critics believe it is not strong enough to override every nation’s duty to protect its own people. One interpretation of this view is that countries should adopt an “influenza norm. In other words, governments are justified in prioritizing their own residents until the risks of COVID-19 are similar to flu season. At this point, governments should send out supplies of vaccines to countries with greater needs.
One could argue that since rich countries have purchased millions of doses, they are the rightful owners of these vaccines and are ethically free to do as they wish.
Yet critics argue that vaccines do not belong to anyone, even the pharmaceutical companies that develop them. Instead, they are the last part of product development that is being made and the result of the work of many people. What’s more, most COVID-19 vaccines have been funded by the state, mainly by governments using taxpayers’ money.
Since 1995, the World Trade Organization has required its member states to enforce intellectual property rights, including patents for vaccines. Currently, however, members of the professional organization 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 boosters debate is overkill and not really about ethics at all. They simply propose to call the boosters differently: “final doses”.
But regardless of what we call boosters, the ethical question raised by the WHO Director-General remains: is giving these injections a fair and equitable way to distribute a vaccine that saves lives?