Surfeit for some; shortages for everyone else

Beyond the Curve: Dr. Peter Lurie's COVID-19 Blog

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Last week, the Biden administration announced that it would likely be recommending booster shots for prior recipients of the Pfizer/BioNTech and Moderna vaccines beginning at the end of September. The administration had previously recommended boosters for immunocompromised people. But it went further by recommending boosters for the general population, this in the context of the widening spread of the delta SARS-CoV-2 variant and as emerging data indicate that antibody levels for those who have already received two doses of the two vaccines appear to wane over time. In addition, the vaccines appear to convey less protection against infection with delta than the variants that were prevalent when the clinical trials supporting their use were conducted. There is, as yet, no clear evidence that the vaccines have diminished effectiveness against serious COVID-19 due to delta. In effect, administration officials argued that it was better to get ahead of the curve than to wait to see whether there is reduced protection against delta-induced serious illness, the ultimate purpose of vaccination.

My purpose here is not to challenge this scientific rationale. Rather it is to ask, as others have done, whether this is the best use of a scarce resource. And, make no mistake, while the US experiences vaccine excess, in part due to ongoing hesitancy particularly in southern parts of the country, the global situation is one of acute shortage and widespread disparities. This map from the New York Times today says it all:

Global map of doses administered per 100 people

                                                                                        New York Times, August 23, 2021

 

While some smaller countries like Malta and the United Arab Emirates have fully vaccinated well over 70 percent of their populations, dozens of countries, primarily in Africa, have been able to vaccinate less than 1 percent. Despite snapping up enough vaccine to vaccinate its population two-and-a-half times over, the U.S. has managed to vaccinate only 51 percent of its population. Clearly, we are no longer in shortage in the U.S.

Administration officials like to say that this is not a zero-sum game: that we can both provide boosters to our own population while providing vaccine to other parts of the world. (Indeed, the administration has pledged to donate 600 million vaccine doses by next year.) But, in a world with an overall shortage in which every day counts, every shot injected into a U.S. arm is one not injected in another country that is even further from herd immunity than we are. That means, that shot-for-shot, an injection in an under-vaccinated country with a significant background rate of COVID-19 will save more lives than a booster injected here. That is why the World Health Organization has called for a moratorium on booster shots.

I get it: the administration was elected to protect the health of people in the U.S. But it is not too late for it to do more to assure greater global vaccine availability. The federal government could ship vaccines that are nearing their expiration dates but going unused in the states to countries in need. The United States – and others that have reserved more vaccine than they have population – should also consider trading their places in line for particular vaccines with those with insufficient supply. But at present, the administration of boosters in the U.S., instead of initial vaccine doses where needs are greater, is a global misallocation of a scarce and life-saving resource.