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 recalls until 10% of people in each country are vaccinated. His advocacy comes amid growing concerns about slow progress in delivering COVID-19 vaccines to people in low-income countries.

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

Yet, as of September 14, of the 5.76 billion doses of vaccine that have been administered worldwide, only 1.9% have gone to people in low-income countries.

Meanwhile, many wealthy countries have started offering COVID-19 boosters to healthy, fully vaccinated adults.

Early evidence of the benefits of COVID-19 boosters for protecting against serious illness and death goes both ways. Some experts are touting their benefits, while others are opposed at the moment.

As a philosopher who studies justice and global bioethics, I think everyone has to grapple with another question: the ethics of whether to give boosters when people in poor countries are leaving. deprive.

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 when 58% of people in not everyone received their first vaccine.

In some countries, such as Tanzania, Chad and Haiti, less than 1% of people have received a vaccine. Meanwhile, in wealthy countries, most citizens are fully vaccinated – 79% of people in the United Arab Emirates, 76% in Spain, 65% in the UK and 53% in the US

In the United States, the Centers for Disease Control and Prevention has 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. Still, on September 17, the FDA advisory panel recommended that most Americans not give a third dose of the Pfizer vaccine, despite having approved the boosters for people over 65 years of age or at greater risk. raised.

On August 11, before the CDC allowed boosters for anyone – including people with compromised immune systems – it estimated 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 have reportedly lied to gain access to unauthorized injections, telling pharmacists – wrongly – that it was their first injection.

In addition to raising concerns about equity, the glaring disparities between the need for and the unvaccinated vaccines violate an 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 diminishing marginal utility.

For example, the original laboratory studies of the Pfizer vaccine showed 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 – perhaps less than 10% protection, according to a preliminary study.

As a recent article from 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. ‘they were used in previously unvaccinated populations than if they were used. as boosters in vaccinated populations.

Additionally, 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 each nation’s duty to protect its own people. One interpretation of this view is that countries should adopt an “influenza standard”. 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 vaccine supplies 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. Additionally, most COVID-19 vaccines have been publicly funded, mostly by governments using taxpayer dollars.

Since 1995, the World Trade Organization has called on its member states to enforce intellectual property rights, including vaccine patents. Currently, however, members of the trade organization are debating proposals to temporarily waive patents on COVID-19-related products during the pandemic.

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Some reviewers 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?

Nancy S. Jecker, Professor of Bioethics and Humanities, Faculty of Medicine, University of Washington

This article is republished from The Conversation under a Creative Commons license. Read the original article.