COVID boosters: Wise or wasteful?

“The 360” shows you diverse perspectives on the day’s top stories and debates.

What’s happening

The rapid spread of the Delta variant and increasing reports of breakthrough coronavirus infections are raising questions about whether fully vaccinated people should receive an additional vaccine dose to boost their immunity.

The Food and Drug Administration on Thursday authorized an additional dose of the Pfizer and Moderna vaccines for certain people with compromised immune systems. Booster shots for the general population — starting with the elderly — are likely to be needed “sooner or later,” according to Dr. Anthony Fauci, the nation’s top infectious disease experts.

Some other nations are being more aggressive when it comes to boosters. Israel became the first country to administer extra shots to citizens over 60. The United Kingdom, Germany and France have announced similar plans to give boosters to the elderly and people with certain health conditions.

Those moves run counter to guidance from the World Health Organization, which called for a moratorium on booster shots in wealthy countries at a time when vaccination rates in many poor nations are so low. “We cannot accept countries that have already used most of the global supply of vaccines using even more of it, while the world's most vulnerable people remain unprotected,” WHO Director-General Tedros Adhanom Ghebreyesus said.

Why there’s debate

Most experts agree that booster shots of coronavirus vaccines will eventually become a reality in the United States. The debate currently centers on how soon they should be administered, with some arguing that it should be an urgent priority and others warning of the potential harm of moving too hastily.

Supporters of starting boosters right away point to preliminary research suggesting immunity provided by the vaccines may be decreasing over time. That slow degradation of protection, along with the increased danger from Delta and possible future variants, means vaccinated people can’t count on the same protection they enjoyed just a few months ago, supporters argue. Others say the U.S. has enough vaccine supply to provide boosters to the vaccinated while also ensuring that there are plenty of doses for the unvaccinated, both at home and around the world. “We can do both,” White House press secretary Jen Psaki said last week, while highlighting that the U.S. has already donated 110 million doses to global vaccine efforts.

Critics say there’s no scientific rationale for giving boosters to fully vaccinated people other than the immunocompromised. Even though breakthrough infections have increased, they argue, the vaccines are still proving to be extraordinarily effective at their primary purpose: preventing severe illness and deaths from COVID-19.

Global health experts say that, beyond the obvious moral implications, it’s a terrible strategy for ending the pandemic to give vaccinated people in rich nations a marginal boost in immunity while billions of people in developing countries are completely unprotected.

What’s next

Boosters could become more readily available once the vaccines have received full authorization from the FDA, a step that could happen as soon as the end of August.



Vaccines simply aren’t effective enough right now

“The two-dose vaccinated individuals may have primed immune systems that can make neutralizing antibodies against SARS-CoV-2, but the enemy is coming at them in such massive numbers, and surging inside their bodies so rapidly, that some six to eight months after completing vaccinations, they may be unable to muster adequate defenses to prevent illness, even long-haul COVID-19.” — Laurie Garrett, Foreign Policy

The U.S. has the capacity to do boosters and first vaccine doses at the same time

“Sure, job number one is to get as many people as humanly possible fully vaccinated. But we all know boosters are coming. I for one am prepared to line up now. I suspect I’ll have a lot of company.” — Rachelle G. Cohen, Boston Globe

Boosters are a necessary element of any plan to get COVID under control

“The very concept of herd immunity is fragile and elusive, and the barrier could be eroded by new variants that are more contagious and lethal. No miracle will stop the pandemic, only a well-grounded realism, and tools that work, including masks, vaccines — and boosters.” — Editorial, Washington Post

Boosters could be tailored to stop emerging variants if the approval process is sped up

“Our medical researchers and pharmaceutical companies have amazing abilities to come up with vaccines that can tackle both the original version and mutated versions of COVID-19. But in addition to vaccine hesitancy, we have the problem of getting the updated versions of the vaccines out to people while they’re still useful. No one wants to cut corners on the process of ensuring that a vaccine is safe. But this process is moving far too slow to be effective.” — Jim Geraghty, National Review

Those with compromised immune systems need extra protection right now

“As the Delta variant threatens to produce another wave of COVID-19 cases, we should not allow immunocompromised Americans to go unprotected when there is an easy solution: Allow a third shot now for those who need it.” — Jennifer Mnookin and Robert Mnookin, Los Angeles Times

People who’ve received the Johnson & Johnson vaccine should get boosters

“The intentions behind developing a one-dose Covid-19 vaccine were noble. … But as variants like Delta emerge, there are questions among scientists around whether a single dose will be sufficient for everyone over the long term. It’s not clear from the data so far, but it’s likely that certain groups who received the Johnson & Johnson vaccine will need more than the single dose.” — Céline Gounder, John P. Moore and Carlos del Rio, New York Times


Boosters will have little impact on the overall course of the pandemic

“If countries like Germany, like the US, like the UK choose to roll out booster shots before we have ensured that all communities worldwide have access to the first two doses of the vaccine, we're not really solving the problem. ... It's a little bit like putting a Band-Aid over a gaping hole." — Andrea Taylor, global health researcher, to CNN

Breakthrough cases are not what’s driving the current outbreak in the U.S.

“The current surge in numbers of individuals with Covid-19 is directly related to individuals declining to be vaccinated, not the need for more vaccines to those who already have been vaccinated.” — Judith Aberg and George Baehr, infectious disease experts, to STAT

Vaccine manufacturers have a profit incentive to overstate the need for boosters

“We have Pfizer and Moderna making pronouncements that boosters are necessary when they have an overt conflict of interest.” — Eric Topol, executive vice president of Scripps Research, to Axios

Fully vaccinated people still face very little risk of severe COVID infections

“Shots clearly still offer a substantial degree of protection against even mild disease. And they are holding up exceptionally well on the most crucial measures: protection against severe disease, death and hospitalization.” — Max Nisen, Bloomberg

Dangerous new variants could develop if rich countries hoard vaccines

“Right now, our destiny relies on distributing vaccines so that continued transmission doesn’t occur. We don’t want to be chasing our tail in terms of new variants.” — Nahid Bhadelia, infectious disease expert, to Nature

It’s far too early to determine whether boosters are needed

“We need more data. I don’t think we have anything yet we can act upon. Our antibodies do wane over time, but we still need to find out how protected patients are even when the antibodies start to decrease.” — Manu Jain, critical care specialist, to Chicago Sun-Times

Boosters in rich countries will inevitably hold back the global vaccine rollout

“Some critics have labelled the WHO’s call for a moratorium a ‘false choice’ – they claim that it is possible to roll out booster programmes while also ensuring that lower-income countries receive the vaccine supplies they need. But that seems fairly implausible given finite vaccine production and existing shortfalls.” — Jonathan Pugh, Dominic Wilkinson and Julian Savulescu, Conversation

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Photo illustration: Yahoo News; photos: Octavio Jones/Reuters, Getty Images