Experts Warn Rich Nations' Push for Boosters Could Lock in Vaccine 'Apartheid'

Scientists and public health experts are growing increasingly concerned that rich countries' pursuit of Covid-19 vaccine boosters could entrench inequities that have left billions of people in poor regions of the world without access to a single dose, denying them protection from the surging Delta variant and prolonging the deadly global pandemic.

"Anyone who thinks that vaccinating Americans with a third dose is not going to come at the expense of getting the vaccine to other places in the world... you're just kidding yourself."
--Scott Hensley, University of Pennsylvania

In an Washington Postop-ed published just hours after the Biden administration announced its plan to roll out booster shots for the entire U.S. public as soon as next month, William Parker and Govind Persad argued that "this decision is a mistake," particularly as just over 1% of people in low-income nations have received at least one vaccine dose.

"Not only does it risk depriving millions throughout the world of the vaccine, but there also is no evidence that additional shots meaningfully reduce death or hospitalization from Covid-19 for healthy Americans," wrote Parker and Persad, who respectively serve as assistant director of the MacLean Center for Clinical Medical Ethics and Greenwall Foundation Faculty Scholar in Bioethics.

To illustrate the massive inoculation gap between rich and poor countries, the pair noted that the 120 million additional mRNA doses the U.S. will likely need for its nationwide booster campaign would be sufficient "to vaccinate the population of Covid-decimated Botswana 26 times over."

"High-income countries have used bilateral contracts with vaccine manufacturers to achieve vaccination rates as much as 50 times that of low-income countries. A campaign for boosters could lock in that apartheid," the pair continued. "This profound global inequity would not only be a humanitarian disaster, but also a significant long-term risk for Americans, as scientists agree that accelerating global vaccination is the only way to prevent the formation of deadly new variants."

But officials in the U.S. and other rich nations--including Germany, France, and the United Kingdom--have thus far dismissed such warnings, rejecting the World Health Organization's urgent pleas for a moratorium on boosters and pointing to their relatively scant vaccine donations as evidence that they're taking sufficient action to help poor countries.

During a briefing earlier this month, White House Press Secretary Jen Psaki said the WHO's call for a moratorium presents a "false choice" between providing third shots to people in the U.S. and evenly distributing doses across the globe.

"We can do both," Psaki insisted.

However, experts and public health campaigners have stressed that the pharmaceutical industry's monopoly control over vaccine production--made possible by an international patent regime that rich countries are choosing to uphold--has artificially constrained global vaccine supply. When supply is limited, rich countries' hoarding of vaccines affects the number of doses available to poor nations.

According to new research from the science analytics firm Airfinity, G7 countries are on track to stockpile nearly a billion extra vaccine doses by the end of 2021. Meanwhile, if current inequities persist, many poor nations may not achieve adequate vaccination rates until 2024 or later.

"Anyone who thinks that vaccinating Americans with a third dose is not going to come at the expense of getting the vaccine to other places in the world--if that's what you think, you're just kidding yourself," Scott Hensley, a vaccines researcher at the University of Pennsylvania's Penn Institute for Immunology, toldSTAT News in response to the Biden administration's booster announcement, which represents a major profit opportunity for vaccine makers.

"In a global emergency, you do not hoard resources for yourself, stockpile extra just in case people need a boost, while others die for lack of even one shot."
--Gregg Gonsalves, Yale University

Dr. Matshidiso Moeti, the WHO's regional director for Africa, said during a news conference on Thursday that "moves by some countries globally to introduce booster shots threaten the promise of a brighter tomorrow for Africa," which has fully vaccinated just 2% of its population.

"As some richer countries hoard vaccines," said Moeti, "they make a mockery of vaccine equity."

In a joint statement on Wednesday, top officials with the U.S. Department of Health and Human Services said that "we are prepared to offer booster shots for all Americans beginning the week of September 20 and starting eight months after an individual's second dose" of either the Pfizer or Moderna vaccine.

To justify the push for boosters for the entire U.S. population--and not just individuals who are immunocompromised--the officials pointed to data indicating that "protection against SARS-CoV-2 infection begins to decrease over time following the initial doses of vaccination."

The officials were referencing studies from the Centers for Disease Control and Prevention (CDC) that suggest vaccine effectiveness may decline over time--though the shots remain extremely effective at staving off serious illness and death.

"Together, the new studies indicate overall that vaccines have an effectiveness of roughly 55% against all infections, 80% against symptomatic infection, and 90% or higher against hospitalization," the New York Timesreported.

While Biden administration officials say the CDC research provides enough evidence to move ahead with boosters, outside scientists remain unconvinced that third shots are needed for people who are not immunocompromised.

"Feeling sick like a dog and laid up in bed, but not in the hospital with severe Covid, is not a good enough reason [for boosters]," Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center, told the Times. "We'll be better protected by vaccinating the unvaccinated here and around the world."

Gregg Gonsalves, an epidemiologist at Yale University, echoed that sentiment in a series of tweets on Wednesday.

"More for me. None for you. America first. This is American Covid-19 vaccine policy now," Gonsalves lamented. "It doesn't have to be this way. In a global emergency, you do not hoard resources for yourself, stockpile extra just in case people need a boost, while others die for lack of even one shot, letting variants flourish."

This story has been updated to include comment from Dr. Matshidiso Moeti, the WHO's regional director for Africa.