Could Boosters Make the Pandemic Worse?

US health agencies are clashing with the World Health Organization on the question.

Yesterday, as had been anticipated for a while, the US government issued a recommendation that those fully vaccinated against COVID-19 with one of the mRNA formulations should get booster shots after eight months.

The statement is attributable to Dr. Rochelle Walensky, Director of the Centers for Disease Control and Prevention (CDC); Dr. Janet Woodcock, Acting Commissioner, Food and Drug Administration (FDA); Dr. Vivek Murthy, U.S. Surgeon General; Dr. Francis Collins, Director of the National Institutes of Health (NIH); Dr. Anthony Fauci, Chief Medical Advisor to President Joe Biden and Director of the National Institute of Allergy and Infectious Diseases (NIAID); Dr. Rachel Levine, Assistant Secretary for Health; Dr. David Kessler, Chief Science Officer for the COVID-19 Response; and Dr. Marcella Nunez-Smith, Chair of the COVID-19 Health Equity Task Force:

“The COVID-19 vaccines authorized in the United States continue to be remarkably effective in reducing risk of severe disease, hospitalization, and death, even against the widely circulating Delta variant. Recognizing that many vaccines are associated with a reduction in protection over time, and acknowledging that additional vaccine doses could be needed to provide long lasting protection, we have been analyzing the scientific data closely from the United States and around the world to understand how long this protection will last and how we might maximize this protection. The available data make very clear that protection against SARS-CoV-2 infection begins to decrease over time following the initial doses of vaccination, and in association with the dominance of the Delta variant, we are starting to see evidence of reduced protection against mild and moderate disease. Based on our latest assessment, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout. For that reason, we conclude that a booster shot will be needed to maximize vaccine-induced protection and prolong its durability.

“We have developed a plan to begin offering these booster shots this fall subject to FDA conducting an independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines and CDC’s Advisory Committee on Immunization Practices (ACIP) issuing booster dose recommendations based on a thorough review of the evidence. We are prepared to offer booster shots for all Americans beginning the week of September 20 and starting 8 months after an individual’s second dose. At that time, the individuals who were fully vaccinated earliest in the vaccination rollout, including many health care providers, nursing home residents, and other seniors, will likely be eligible for a booster. We would also begin efforts to deliver booster shots directly to residents of long-term care facilities at that time, given the distribution of vaccines to this population early in the vaccine rollout and the continued increased risk that COVID-19 poses to them.

“We also anticipate booster shots will likely be needed for people who received the Johnson & Johnson (J&J) vaccine. Administration of the J&J vaccine did not begin in the U.S. until March 2021, and we expect more data on J&J in the next few weeks. With those data in hand, we will keep the public informed with a timely plan for J&J booster shots as well.

The folks at Pfizer had been signaling that this need would arise for weeks now, so this comes as no surprise. The World Health Organization’s response, however, does. NPR (“Why A Push For Boosters Could Make The Pandemic Even Worse”):

Officials at the World Health Organization said Wednesday that it strongly opposes booster shots for all adults in rich countries because the boosters will not help slow down the pandemic. By diverting doses away from unvaccinated people, booster shots will help drive the emergence of more dangerous mutants, the WHO doctors said.

“I’m afraid that this [booster recommendation] will only lead to more variants. … And perhaps we’re heading into an even more dire situation,” WHO chief scientist Dr. Soumya Swaminathan said.

The problem with a call for boosters, she said, is that the virus is primarily circulating in unvaccinated people — not in the fully vaccinated.

There’s no doubt that, to get this pandemic under control, we need to get vaccines out to the whole world. Not to mention our own under-12 population. But these aren’t necessarily mutually exclusive options.

In defending the U.S. booster decision, Dr. Vivek Murthy, the surgeon general, said on Wednesday: “I do not accept the idea that we have to choose between America and the world. We clearly see our responsibility to both, and we believe we have to work on both fronts as we have been.”

Federal officials said they have sent more than 100 million doses overseas and plan to donate 500 million doses.

Of course, the world population is just shy of 8 billion, so even 500 million doses—of a two-dose vaccine, no less—is barely a drop in the bucket.

The WHO estimates 11 billion doses are needed to bring the pandemic under control. Billions of people have not received even one dose of the vaccine, said Dr. Bruce Aylward, senior adviser to the WHO director-general. In most low-income countries, less than 5% of the population is immunized. The unvaccinated include many health care workers and people at high risk of death and severe disease. In many middle-income countries, including most of Latin America, only about a third of the population has received shots.

To stop the evolution of new variants, the world needs to focus on immunizing these populations before handing out extra protection to low-risk individuals in rich countries, Aylward said. “The problem is not enough people have been vaccinated. So our first priority is relatively simple: Get as many of the unvaccinated with two doses before you move beyond that.”

The problem, alas, is that public policy is stovepiped at the national level and politicians in rich countries are quite naturally going to prioritize their own citizens, even if it’s actually bad for said citizens. But it’s one thing to prioritize my 12-year-old daughter, who was already at negligible risk of serious consequences from the pandemic, over healthcare workers and old folks in the developing world. It’s another, entirely, to have the vaccines sitting around unused because most of those who are eligible for vaccines and haven’t gotten them are simply refuseniks. Or to provide booster shots of marginal expected utility.

FILED UNDER: COVID-19, Health, World Politics
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Jen says:

    This pandemic is shining a bright light on many issues.

    I understand the WHO’s concerns.

    I understand the desire to increase protection for those who are most vulnerable in our population (the piece I linked to in the open thread from the NYT points to the elderly as the vaccinated population experiencing the most issues with hospitalization despite being vaccinated, as would be expected).

    My hunch is that vaccines for the 6-12 age cohort are likely coming soon. I’ll have to see if I can track it down, but apparently part of the delay is that there weren’t enough voluntary participants of very young kids in the age trials, which is presenting an issue for vaccination data/recommendations.

    Refuseniks will continue to be a problem, and that is the issue. Once there’s FDA approval, there will need to be vaccination mandates. It’s the only way we’re going to stop this from presenting ever-more problematic strains. Note I did not say ‘eradicate the virus’–we’re well beyond that.

    6
  2. KM says:

    Split the difference for now as you’ll never get the American public to accept giving away all the excess.

    Give the unvaxxed a public choice – there’s 2 vials reserved for them. If they officially decline them, one will go to the booster pile and the other will be sent out to needy countries who actually wants them for free. Taxpayers eat the cost but hey, we’re saving the world and you didn’t want them anyways. If later on you change your mind, TS buddy you gotta pay for it because we gave yours away. It won’t be cheap FYI. If there’s no more available, then you’re just outta luck period and are at the back of the line for the next chance. No, you can’t opt out as silence will be taken for assent and we’ll just assume your anti-vaxxer ass was cool with it. You’re not allowed to waste a fungible product being petulant and we shouldn’t keep holding it in reserve waiting for you to come to your senses. That’s just bad business sense and a waste of taxpayer money, you know?

    And if that official declaration get used later as proof of refusal by insurance companies to decline payments or companies to deny access along with vaccine passports, oh well. It’s what you wanted after all! We’ll save the people who want to be saved and if they’re not Americans, meh what do you care if they get 5G chips or magnetized? What do you care if older folks get the booster or a Kenyan doesn’t have to live in fear of a disease you think is fake?

    15
  3. CSK says:

    @KM:
    I’m reminded by your comment of the price of a real vaccine card versus a forged one:
    1. Real card: free.
    2. Fake card: $400.

    That’s a rather expensive way to own the libs.

    18
  4. gVOR08 says:

    I’ve never given any thought to the morality of dropping the atomic bombs. Given the situation, if we had them, we were going to use them. End of story. No president would have decided otherwise.

    Similarly, the WHO is right, better to get two shots into as many arms as possible before passing out third shots. Better for the rest of the world and better for us. But no president, even one willing to take the heat for Afghanistan, is going to say he’s prioritizing vaccinating foreigners over Americans.

    Using another military history analogy, the Luftwaffe had a huge argument about fighter escort for bombers. Keep the fighters close to the bombers, where they break up more attacks and the bombers can see them, or allow them to operate more freely, where they will attrit more enemy fighters? We eventually solved that problem by having enough fighters to do both, and strafe the German fighter airfields as they were taking off. I’ve read that mRNA production is readily scalable. I hope we’re putting serious money into producing enough vaccine for booster shots here and initial shots everywhere.

    I see headlines that we’re giving away 500 billion doses and I wonder where the other 15.5 billion are coming from. But half a billion to five billion is only an order of magnitude, hopefully we’re stepping up.

    4
  5. KM says:

    @CSK:
    Freedom ain’t free, you know.

    Also, only $400? I’d be soaking them for a grand at this point. Anyone willing to pay for them realizes how valuable the document is and has the money to waste.

    2
  6. gVOR08 says:

    @CSK: DeSantis is pushing Regeneron treatment. He’s got some sort of task force wandering the state administering it. He’s failing to mention that the feds provided the doses, or that there aren’t near enough. But it inoculates him against the charge he’s doing nothing. So instead of taking a free “experimental” vaccine that has only an emergency use authorization, Floriduh man now has the choice to get deathly ill and receive an experimental treatment that has only an emergency use authorization. That’ll own the libs. I need an emoji for shaking ones head side-to-side slowly and sadly.

    2
  7. gVOR08 says:

    @gVOR08: Oopsie. No edit.@gVOR08: The 500 “billion” in the last paragraph should, obviously, be million. Note to self, proofread, you idiot, proofread.

  8. KM says:

    @gVOR08:
    Regeneron is claiming it’s a “free” treatment for all “patients who qualify under the Emergency Use Authorization parameters (just like the vaccines are)” but what does that really mean? The wording deliberately tries to imply it’s totally free for everyone since the shots are but I seriously doubt it considering how expensive it is. Can someone be charged for a treatment if they don’t qualify and how easy is it to disqualify someone?

    1
  9. R.Dave says:

    The WHO’s objections here seem ridiculous to me. If the US donating 500 million doses is a drop in the bucket of what’s needed to vaccinate the rest of the world – which it is – then the US using 200 million doses for boosters here at home is an even smaller drop. So small, in fact, that it’s basically a rounding error when it comes to global vaccinations.

    5
  10. KM says:

    @R.Dave:
    The objection is rooting more in the impression of selfishness rather than hard practicality – why should you get a third when someone else hasn’t had a first? It’s also based on an ideal world where resources are allocated according to greatest need rather than places that actually have the info structure to support it – after all, the refrigeration issue is still in play and I doubt the amount of coolers necessary has made it to where they need to go. What’s the point of sending something fungible out to a place that can’t maintain it? We had this discussion months ago and the facts on the ground haven’t changed all that much.

    It’s like when your mother told you children were starving in Africa / China/ Third world nation and she should send your uneaten veggies there. Nice idea in theory but practically? Nope, it’s not worth it. At best we could send all the shelf-stable single shot stock exclusively to needy nations and keep the cold stuff for the third boost.

    6
  11. CSK says:

    On Fox last night, Trump said that Pfizer is promoting the booster shot purely as a money-making operation.

    I’m sure that’s exactly what he’d do if he were running a pharma company, being the classic snake oil salesman himself.

    4
  12. Stormy Dragon says:

    Big piece left out of this puzzle: at the margin is lack of availability what’s driving the low vaccination rates in developing countries? If not reserving more vaccines for them won’t help

    2
  13. Argon says:

    Short answer, probably not.

    With ~30% of the US population unwilling to get a first shot, that suggests their two unused doses per person could provide most of the third doses for those others that have been inoculated.

    Should the US and other wealthy nations also ensure that other countries also can get vaccines? Yes. Absolutely. Is a third shot for about 200 million in the US truly coming at the expense of vaccine availability
    for 7 billion elsewhere? I’m not so sure. I’d like to know current stocks, production capacity, distribution rates and on-the-ground innoculation capabilities.

    Then again, given that much of the third world might not have a strong Murdoch news media outlet, they might not have as much innoculation interference.

    1
  14. Mu Yixiao says:

    @KM:

    If they officially decline them, one will go to the booster pile and the other will be sent out to needy countries who actually wants them for free.

    It’s not that easy.

    Logistically, it’s simple to distribute from a single source to a wide user base. Going the other direction… not so much.

    There’s also the fact that a lot of these poor countries lack the logistics and infrastructure to distribute the vaccines–which, remember, require specific storage factors.

    The good news is that Vaxart just complete Phase I and is moving on to Phase II of testing for its COVID vaccine pill.

    Atwill Medical Solutions (can’t link or I’ll trip the moderation alarm) in southern Wisconsin is ready to start producing 1 billion doses a year as soon as it’s authorized, and are currently expanding production capacity to 2 billion doses per year.

    The Vaxart pills require zero special handling, so they’re perfect for poor, remote, or underserved areas.

    4
  15. Stormy Dragon says:

    @Argon:

    On the other hand, how many of them have governments who see COVID19 as a tool of political control, much like famine is used.

    1
  16. Mike says:

    I’ve noticed that the local anti-vax nut at my gym no longer wears her conspiracy theory t-shirts with Dr. Fauci’s face on them. Of course everyone knows her as “Dr. Fauci”. I wonder if she has finally been shamed enough to keep her ideas to herself. We don’t have too many anti-vaxxers in my area but in the past few weeks, I haven’t seen any.

  17. Lounsbury says:

    @KM: I believe this is broadly pragmatic. And as a private equity investor in cold chain (that is, refrigerated logistics), it’s really not a trivial challenge lower income markets. Lower-middle income countries (to use the World Bank definition) are already something of a challenge. Lower income it’s really heroic logistical spend for the vaccines requiring deep cooling.

    The single jab vaccines, while imperfect are pragmatic for lower income countries logistics, and the ordinary cooling (single or double).

    There is further the pragmatic calculation that panicking and unconfident populations tend not to be terribly generous – the chimp genetic template remains – so pragmatism on boosters of the anyway hard-to-deploy high-end vaccination and spending like mad on providing lower income world with the more basic vaccines that are more tolerant as well of logistical chains of mixed quality is wise.

    2
  18. CSK says:

    @Stormy Dragon:
    That’s interesting, because the Trumpist anti-vaxxers see the pandemic as a whole and the vaccines in particular as the means for the U.S. government–the Deep State–to impose total control over us.

    2
  19. Kathy says:

    The Delta variant first ravaged India back in April 2021. While India has by now administered over 500 million doses, they have a population of over 1 billion people. Therefore the rate of fully vaccinated is still low.

    In April, it was even lower. It wasn’t the lack of vaccines alone that allowed Delta to spread in the subcontinent, but mostly the relaxation of preventive measures, the holding of mass rallies (aka superspreader events), and so on.

    I’ve said this a number of time: vaccine or no vaccine, you can’t let your guard down in the face of COVID. When we do, infections spike.

    Yes, more among the unvaccinated, but that much virus circulating puts us vaccinated ones at higher risk.

    5
  20. Just nutha ignint cracker says:

    @CSK: Was that during the FAUX NEWS PRIMETIME show segment called Following the “Science”? (And tell me again how the “real” news people and shows are different from Sham Hannity and F#cker Carlson.)

  21. Michael Reynolds says:

    I think herd immunity is a fantasy. If we managed to vaccinate 80% of the human race, there would still be well over a billion people acting as petri dishes for new strains.

    Obviously we should, as a simple matter of decency, try to vaccinate as many people as possible, but sending out vaccines that will likely spoil because there’s no local infrastructure, is absurd posturing. As noted up-thread, it’s the logistics, stupid.

    2
  22. CSK says:

    @Just nutha ignint cracker:
    It was on Fox Business, where Maria Bartiromo let him harangue her. I didn’t watch it myself, but a number of news outlets reported the transcript and had embedded clips.

  23. Jen says:

    @Michael Reynolds: This is true.

    The best we can hope for is decreased effects. I read somewhere recently that the 1918 flu strain is still technically circulating, but the variations are such that it’s no longer as deadly.

    @Mu Yixiao: I am glad to hear of an oral delivery vaccine. I wonder how many people are needle-averse and therefore avoiding vaccination.

  24. Mu Yixiao says:

    @Jen:

    I wonder how many people are needle-averse and therefore avoiding vaccination.

    I doubt it’s a huge number, but it’s definitely a factor for some. There was a story on NPR about one of the pop-up vaccination sites where they were interviewing “hesitant” people (not full-on anti-vaxxers), and one of them was a woman who had a huge fear of needles. I can’t remember the exact quote, but it was something like. “I’m terrified of needles, but I need to do this. And I told my husband ‘You’re gonna be right there next to me. I ain’t doin this alone!'”

    🙂

    4
  25. Stormy Dragon says:

    @CSK:

    I meant in the sense that denying vaccines, treatment, and aid to areas that aren’t in your political faction as method of weakening opposing factions as well as collectively punishing their supporters.

  26. Stormy Dragon says:

    @Michael Reynolds:

    I think the long term “stable” solution is basically going to end up being that every fall instead of getting our yearly flu vaccine, we get our yearly FluCo vaccine that has the updated influenza and coronavirus variants in a single shot.

    3
  27. Mu Yixiao says:

    @Stormy Dragon:

    Are you sure those two microchips are compatible?

    3
  28. Jen says:

    @Mu Yixiao: I totally agree it’s likely not a huge number, but I know a handful of people who are terrified of needles, which led me to wonder how many of them are in the “I am going to hope that everyone ELSE gets vaccinated so I don’t have to”* column, which I think may be a bigger group than might be expected.

    I can’t stand seeing other people receive shots, but think they are NBD myself, which is sort of a weird reverse of that.

    * I consider these people to be herd-immunity free riders and think they are one of the most pernicious groups out there. These are the people who have been lulled into a false sense of “bulletproofness” on childhood diseases because herd immunity works so well.

    4
  29. Stormy Dragon says:

    @Jen:

    I wonder how many people are needle-averse and therefore avoiding vaccination.

    You mean as opposed to the majority of the population that enjoys being stabbed with sharpened metal spikes? /sarc

    1
  30. Mu Yixiao says:

    @Stormy Dragon:

    You mean as opposed to the majority of the population that enjoys being stabbed with sharpened metal spikes?

    Have you seen the under-30 crowd? 😛

    8
  31. KM says:

    @Mu Yixiao:
    I’m terrified of needles yet I sucked it up. I did what I do when I donate blood – “this is more important than my fear and it’s never as bad as I think it will be.” It’s always an ordeal where I’m convinced I’m having a panic attack and then poke – it was all in my head and the pain’s gone in a flash. There was another woman there with the same fear I talked through – she was waiting the chair but needed that last little encouragement to say “go ahead”. She just need that reassurance that pain in momentary but gain is longterm. You are correct in there are some who are likely putting it off but it becomes a cold calculation in the end. The hospital will stab me with many more needles if I get sick but this is only once.

    @Stormy Dragon:
    Fear of needles is a thing I’ve seen cause many a rational person turn down needed medical care. It’s irrational but present and it’s more than just “omg sharp thing”. We don’t make fun of people with a fear of heights since everyone dislike falling so the snark’s a bit much. It’s a real existential dread sense that’s not the same as say fear of scarping your knee on a bike. I’ve put off tenatus shots until I was *made* to get them and have kicked at least one nurse who surprised me with a shot in the knee fairly hard. I never got flu shots due to fear and the exact rationale @Jen gave – herd immunity will be enough to protect me so I don’t need to be stabbed. COVID however is a different beast….. and I still hesitated to roll up my sleeve when it was time.

    3
  32. Stormy Dragon says:

    @KM:

    We don’t make fun of people with a fear of heights since everyone dislike falling so the snark’s a bit much.

    As one of those people, yes, you all do. =P

    And if you meant people with actual Trypanophobia, there’s a big difference between that and just being “needle adverse”.

    1
  33. Jen says:

    @Mu Yixiao:

    Have you seen the under-30 crowd?

    This made me literally laugh out loud. Well done.

    As far as the phobia vs. needle adverse–I mean both. A small segment of the population has a genuine fear of needles and it’s going to be very hard for this group to voluntarily receive a shot (and, nicely done @KM:, I am glad you went ahead despite the fear).

    I don’t *enjoy* getting shots, but it’s not really anything I think too much about, it’s just something that has to be done. This is understandable, I think, given my background. You live abroad and your parents work for the government, you’re going to get vaccinated. Frequently. It becomes pretty routine.

    There are plenty of people who fall in between those two extremes, the “EEEW SHOTS” types who don’t have a true phobia, but aren’t just going to put their head down and do what needs doing.

  34. Mu Yixiao says:

    @Jen:

    This made me literally laugh out loud. Well done.

    Yay!

    Interesting anecdote:

    About 25 years ago in a moment of being severely overworked and not thinking, I ran my hand through a table saw. It shattered the end of my right middle finger. So… off to emergency. It was summer in Virginia, so I’m wearing shorts–letting my full-leg tattoo show. The PA comes in, takes a look at my leg and says “Well… I guess you’re not afraid of needles.”

    Fast forward to this spring. I’m at the clinic getting my first COVID jab, and the nurse asks me “are you afraid of needles?” I chuckled and said “I thought the tattoos would have given it away.”

    Her response surprised me. “You wouldn’t believe the number of people I see with full-arm tattoos, that are afraid of needles.”

    1
  35. CSK says:

    @Stormy Dragon:
    Oh, I know. The MAGAs don’t want the vaccine because it’ll control them. Sort of the inverse.

  36. Just nutha ignint cracker says:

    @CSK: Thank you. I was at the gym and could see Faux News but not listen. (Forgot my earbuds in the car.) The Following the “Science” segment made almost exactly the right (no pun intended) dog whistle for the audience, in my never quite humble enough opinion.

  37. Just nutha ignint cracker says:

    @Mu Yixiao: My understanding is that the combined vaccine will go with only ONE microchip from which all the stakeholders will SHARE the data. (How this “share the data” thing is going to work with Bill Gates as a stakeholder seems problematical, but not my first world problem–as the saying goes.)

  38. Just nutha ignint cracker says:

    @Jen: “because vaccination misunderstood to be herd immunity works so well.

    FTFY.

  39. Jen says:

    @Just nutha ignint cracker: You are correct. Thanks for the repair.

  40. steve says:

    “Her response surprised me. “You wouldn’t believe the number of people I see with full-arm tattoos, that are afraid of needles.””

    This is incredibly common and seems to be more likely when they have more tattoos. A lot of us also believe that the presence of the tramp stamp means more painful labor.

    Steve

  41. Barry says:

    @Mu Yixiao: “Are you sure those two microchips are compatible?”

    When they upgrade to 6G, yes.