Booster shots for us while the world waits for first vaccines
The clamoring we expected to see for COVID-19 booster shots, akin to the mad rush for first doses last winter, has not materialized even in vaccine-hungry Connecticut.
You might say that’s right and good considering what’s happening across the planet. Rich countries’ populations were 55 percent fully vaccinated as of Sept. 8, according to the journal Nature. The poorest countries? Barely more than one-half of 1 percent.
Those shameful numbers led President Joe Biden a couple of weeks ago, under pressure from the World Health Organization, to call for a global effort to vaccinate 70 percent of the world’s population in the next 12 months; and to crank up the United States’ commitment to 1.1 billion doses for poor countries through 2022.
Noble goals. But talk is cheap. The stark fact remains, even as we’re living through a medical triumph, that the worldwide distribution of vaccines is a disgrace on a historic scale. This is nationalism at its ugliest.
That’s especially true for the mRNA formulations from Moderna and from Pfizer, the latter of which was partly developed here in Connecticut and is approved for U.S. boosters.
So what are we to do about it here in the richest state in the richest nation? The answer seemed easy to me not long ago: Don’t take a booster even if I’m eligible. Then maybe the dose that had my name on it would go instead to a palm oil farm worker in Malaysia, perhaps.
Even setting aside the outrage factor, lopsided global distribution threatens our own health because variants such as delta arise in places with poor public health and low vaccination rates, then the stronger virus makes its way here.
So it would be a moral violation for me as a healthy American to sit for a booster, I figured — and the World Health Organization, calling for a moratorium on boosters, agreed.
Unfortunately, it’s not that simple. I spoke with four medical ethics experts who spend a lot of time thinking about these things: two at Yale, one at New York University and one at Weill Cornell Medical College in New York. They were unanimous.
Denying ourselves the protection that public health experts say we need — if there’s a clear scientific case for boosters — does not help the rest of the world.
‘We’re in a world war’
The two needs, boosters here in the land of plenty and initial inoculations in poor countries, are not competing, these ethics experts argued.
“It’s not an either-or, it’s an all-of-the-above approach,” said Jason Schwartz, associate professor at the Yale School of Public Health, who studies vaccine policy.
“I think for the individual, the decision to take a vaccine dose, to take a booster dose, can be done in clear conscience because of those unique responsibilities we have to the people around us,” Schwartz said. But he added, “When we shift our lens though to that government and U.S. policy, then it does become more fraught.”
It’s fraught for lots of reasons, chiefly that it’s not enough for our president to sign off on donating a billion vaccines and ring up FedEx to deliver them. A supply chain of material and trained people to inoculate the world doesn’t exist.
And with a need for perhaps 10 billion doses of a two-dose vaccine, diverting the few million boosters coursing into U.S. arms is not, unfortunately, the answer.
“We should be doing all of it,” said Dr. Sarah C. Hull, a cardiologist, who is an assistant professor at the Yale School of Medicine and associate director of the Program for Biomedical Ethics at Yale.
“We always seem to find adequate funding for military efforts in which we want to engage,” she said. “We’re in a world war against a global pandemic and we need to treat it accordingly.”
Big Pharma’s role
Hull, who spoke with me a few weeks ago, worries that criticism of the boosters will fuel vaccine hesitancy, a separate crisis that’s delaying the pandemic’s decline. As early steps in cause of global distribution, she suggests rich countries stop hoarding doses. And Americans eligible for the vaccine should take it when their turn comes, she said, “but you shouldn’t lie to jump your turn in line.”
Some places give booster shots to people just for asking. A friend of mine, traveling with her kids, marched into a Connecticut pharmacy, asked for boosters and received them with few questions asked, even before the Centers for Disease Control and Prevention authorized the shots for vulnerable people. That shouldn’t happen but it’s common.
This global crisis of fairness raises political, strategic, logistical, financial and legal issues, all of them daunting. Why should Pfizer, for example, harvest profits from its BioNTech joint venture as if the companies had developed the vaccine at their own risk?
The U.S. Department of Health and Human Services paid several pharma companies a total of $15 billion — Pfizer was assured at least $2 billion in sales — as part of the 2020 ramp-up.
“This is not the time for Big Pharma to make money, this is the time for Big Pharma to promote the public good,” said Dr. Joseph Fins, chief of medical ethics at Weill Cornell Medical College. “Intellectual property should be shared.”
That’s all the more true considering the mRNA technology has “a provenance of public support,” Fins added.
Fins, like Hull, used the war analogy, calling for “a global effort led by the countries that have the resources.”
Political pressure needed
Okay, but can a global effort work even if we agree on doing it for real?
“There’s no disease, you name it, measles, mumps, where we’ve had success worldwide,” said Arthur Caplan, professor of bioethics at New York University Grossman School of Medicine and founding director of NYU’s medical ethics division.
For example, Caplan, a Ridgefield resident, said, “For 30 years we’ve been trying to get rid of polio worldwide . ... It works but it’s a huge investment.”
And that’s with sugar cubes handed out to children, often without official consent. With COVID vaccine injections, he said, “You’d better be ready for refusal.”
I can easily picture a global vaccine infrastructure in a world where Indonesia has 21 million registered cars and trucks. But as all four of these experts said, we’re not doing it and it’s not an easy feat. That makes the core moral question about boosters all the more complex.
Caplan is critical of the simple argument that we shouldn’t take boosters until the world is vaccinated. “They’re getting away with what I’d say are cheap morals,” he said.
In late 2020, he co-wrote a paper on vaccine distribution, in which the authors described the imperative for communities to take care of their own needs , balancing the ethic of equal access across the world. “This means that there are moral reasons both to allocate the vaccine in a nationally self-interested way and to pursue its global distribution,” they wrote.
These ethics experts are not saying the science of boosters is settled, and it isn’t. They’re saying if and when public health authorities agree you need a booster, take it.
“I still want folks to follow that guidance even if at the same time they write to Rosa DeLauro,” Jason Schwartz at the Yale School of Public health told me, referring to the powerful U.S. Congresswoman from New Haven, “and say, ‘We’re doing this but you damn well better continue to strengthen what we’re doing for the rest of the world.’”
This global vaccine crisis is on us, boosters or none.