The pandemic problems that boosters won’t solve

But fully vaccinated healthy people in “high-risk” jobs, meaning that they have more chances of being exposed to the virus, aren’t necessarily at higher risk of getting sick even if they catch the virus. That’s the whole point of getting vaccinated —so you won’t get very sick even if you are exposed to the virus.

But “high-risk” job is a fluid definition. There is now a federal requirement for health care workers to get vaccinated, and more schools are requiring staff and eligible students to get vaccinated. So here is the irony: if you are already fully vaccinated, you are in a “high-risk” job mostly because your colleagues or others who come through your doors aren’t or can’t be vaccinated. Get them vaccinated, and you won’t be in a high-risk job anymore!

So it’s tricky for the CDC. The ACIP (Advisory Committee on Immunization Practices) didn’t think healthy people, regardless of where they work, need the booster dose yet to protect themselves. The protection from the vaccines against severe illnesses and hospitalization have remained high across age groups. And even though a booster dose may further increase antibody levels, it’s not clear whether that is needed to protect against severe COVID-19, and whether that would decrease viral transmission. 

We know that some people still haven’t had access to an initial course of vaccination. Does it make sense to offer boosters, when we haven’t even thoroughly vaccinated everyone who wants a shot in the US?

The booster doses won’t do much if we still have big pockets of unvaccinated people. These people should be our urgent focus. It takes resources to have community outreach to get to bring the vaccines to those who can’t take time off work, or live in more rural or low-resource neighborhoods where they don’t have access to the news or reliable scientific information.

There is already a shortage of nurses, pharmacists, and community health workers right now. Would we have the resources to plan booster doses and still reach the unvaccinated?

Can you tell us how the ethical picture has shifted since the last time we spoke in January? Does the Biden administration’s pledge to donate half a billion more vaccines change the calculus? 

It’s disheartening that more than 18 months after the pandemic was declared, we still have not reached what I call relational solidarity, for the global community to work together to promote the common good, to make sure nobody is left behind.  Donation is better than nothing, but poorer countries are left at the mercy of rich countries. Many of these 500 million Pfizer doses won’t arrive until later next year. If it is urgent for Americans who have better health care access to get vaccinated as soon as possible, or even get the booster dose, how would later next year be considered acceptable? This means that many people in poorer countries won’t be getting their first shot until more than 18 months after the US gave out its first doses. 

The disparity we create and allow is simply appalling. And the Pfizer vaccine requires special refrigeration, so the poorest countries that don’t have the storage and handling capacity may still not benefit. To solve the supply chain issues, we need to build capacity and have manufacturing plants for different vaccines spread across the globe. Pharmaceutical companies should partner with drug companies in the global south to do that. This can also help to make sure that the shots can be adapted for local variants quicker.

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