COVID-19 Boosters are Coming but with a Cost

Pandemic ethics put to the test with booster vaccines in developed countries

Booster vaccines are coming to America. It’s all the news channels have been spouting for the last few days, though it seems as if all the news talks about anyways right now is COVID-19. The implications of booster vaccines are meaningful, both nationally and globally. They come with the pros of increasing protection for the immunocompromised and reinforcing the American battle against COVID-19 but continue to advance the ethical dilemma of developed countries hoarding vaccines. 

Boosters for Everyone over 18 are Coming

As of a few days ago, booster vaccines have been approved for all Americans over the age of 18 who have gotten their second dose of either Pfizer or Moderna over 8 months ago. Those who received a Johnson and Johnson vaccine will still have to wait on increased company research and approvals by the FDA before they can get a booster. In the meantime, Pfizer and Moderna recipients can begin getting their booster shot when rollout starts on September 20th. 

The booster rollout will be “beginning first with health care providers, as well as people in nursing homes, and then gradually moving forward with others, such as older Americans who were among the first to get vaccinations” according to the AP

This decision comes a week after lawmakers approved a booster vaccine for the immunocompromised, including cancer patients, HIV patients, and individuals who have had organ transplants. As boosters for the general population were being debated, the nation’s Chief Medical Advisor, Dr. Anthony Fauci, had commented that everyone would “likely” need boosters at some point considering the vaccine’s waning protection over time. On top of this, COVID vaccine manufacturers have said from day 1 that annual booster shots would be necessary for the maximum effectiveness of the vaccine. 

Biden and Fauci visit the NIH Vaccine Research Center

A Decrease in Vaccine Effectiveness with Delta and Time

The vaccine’s effectiveness decreases somewhat significantly over the course of eight months. For Pfizer, the effectiveness of the vaccine is 96% for the first two months and then drops 6% every two months. By 4 to 6 months after the second dose, the Pfizer vaccine only offers an 84% protection rate. It is important to note that this is still a significantly high rate of protection offered by the vaccines, and against severe disease, the efficacy rate remains as high as 97%. Though a slight drop in vaccination efficacy should be considered it is not the sole reason for the push for booster doses.

The main reason behind this push for booster shots goes beyond the general waning protection of vaccines and is probably the delta variant. The delta variant has decreased the efficacy of all the vaccines administered in America. Pfizer’s 95% protection rate against the COVID-19 virus decreases to 88% in face of the delta variant. The AstraZeneca vaccine’s protection against COVID-19 dropped as low as 65% when put up against the delta variant. This reduction in protection accompanied by a drop in vaccine efficacy over time most likely led to the CDC’s final decision.

The vaccine companies continue to update their vaccines and develop boosters to improve the vaccine’s response to the delta variant. This includes making sure the vaccine replicates the spike proteins of the delta variant accurately to then replicate an accurate immune response if infected later. A COVID-19 vaccine booster study by the UK is currently in the process of testing boosters for over 7 different vaccine manufacturers

Boosters may be a Distraction from Real Public Health Issues

These booster doses attempt to protect against COVID-19 “breakthrough infections” in vaccinated individuals but may distract from the real method of suppressing the delta variant, vaccinating the unvaccinated. Only 51% of the American population is vaccinated, and most new COVID-19 cases, especially those of the delta variant, have been in unvaccinated people. As the current daily case rate rises to over 100,000, unvaccinated people have become vessels for the virus’s growth. Focusing on controlling the delta variant through vaccination campaigns and outreach is more important than booster campaigns.

Even more importantly, the booster vaccinations may draw away resources from global vaccination efforts in developing countries. The American vaccination rate is actually much higher than the World Health Organization’s 40% vaccination rate target in every country. In comparison, vaccination rates in developing countries are stunningly low. Of the over 7 billion people on this planet, 3.5 billion of them that live in developing countries still have not been vaccinated. 

Sputnik V transported to Argentina from Russia by Casa Rosada licensed under CC BY 2.5 AR.

The “vaccine hoarding” behavior by developed countries puts developing countries at high risk of infection and has been discouraged extensively by the WHO. This concentration of vaccines in developed countries may mitigate some fear in these places but will not stop the development of variants in developing countries as vaccination rates remain low there. If variants continue to develop in developing countries, eventually one strong enough to overcome the vaccine’s protection may be created and spread to developed countries- restarting the entire pandemic. What happened in India with the delta variant is a prime example of this exact situation.

It is important to focus on distributing vaccines to developing countries as much as possible, facilitating transportation and costs when possible- something the WHO has been committed to.

Making a Booster Decision while Living in a Developed Country

This fear in developed countries is partially created by growing infection rates especially in the unvaccinated. As COVID-19 spreads, room for newer variants and increased vaccine resistance increases even in developed countries. This fear has manifested in activities like individuals receiving booster shots even without a government recommendation. 

Over 1% of Johnson and Johnson vaccine recipients in the United States have received an extra vaccine dose of Pfizer or Moderna as “extra protection” despite the J&J vaccine already providing a 70% efficacy rate that lasts 8 months. As underground activities like this continue, some cities have simply made this legal without recommending or requiring extra vaccine doses. San Francisco, for example, now allows J&J vaccine recipients to receive an extra vaccine dose of Pfizer or Moderna.

It is important to consider the ethical implications of getting a booster dose before getting one, understanding that every vaccine dose the United States is taking away from foreign vaccination efforts. Just last month, the United States purchased yet another 200 million doses of the Pfizer vaccine despite the existing surplus in the country already. That being said, if you are immunocompromised or in an area of high transmission rates due to low vaccination rates, it may be prudent to consider getting a booster vaccine. And to end, If you haven’t gotten even a single vaccine dose yet- GET VACCINATED!