Are COVID-19 boosters ethical, with half the world waiting for a first shot? | Kiowa County Press

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People are lining up to receive a COVID-19 vaccine in Belgrade, Serbia on August 17, 2021. Serbia and other countries have started giving booster doses. Meanwhile, more than half of the world’s population has not received a first dose. AP Photo / Darko Vojinovic

Nancy S. Jecker, Washington University

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.

Like the WHO, some ethicists, including me, argued that the world must stand together to end the pandemic.

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.

Early evidence of the benefits of COVID-19 boosters for protecting against serious illness and death goes both ways. Some experts tout their benefits, while others are arguing against them for now.

As a philosopher who studies global justice and bioethics, I believe that everyone has to grapple with another question: the ethics of whether to give boosters when people in poor countries go without them.

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, such as 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 on September 17, the FDA Consultative Committee recommended against a third dose of the Pfizer vaccine for most Americans, although they have approved the boosters for people over 65 or at higher risk.

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 the haves and have-nots of the vaccine 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. Although 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.

Medical staff prepare a vial of the Pfizer / BioNTech Comirnaty COVID-19 vaccine in Erfurt, Germany, September 15.
Booster vaccinations are underway across Germany for elderly patients, who were among the first to receive injections during the initial vaccine rollout. Many countries have started giving boosters, although half the world is still waiting for a first injection. Jens Schlueter / Getty Images News via Getty Images

Buy it, use it?

While the ethical argument for delaying recalls is strong, critics believe it is not strong enough to override each 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 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 has been going on for years and the result of the work of many people. What’s more, most COVID-19 vaccines have been publicly funded, 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?

The conversation

Nancy S. Jecker, professor of bioethics and human sciences, Faculty of Medicine, Washington University

This article is republished from The conversation under a Creative Commons license. Read it original article.


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