Administration of Booster Shots: Justified or Selfish?

Pfizer-BioNTech COVID-19 Vaccine. Photo courtesy of Wikimedia Commons.

The Food and Drug Administration’s (FDA) approval of COVID-19 vaccines has exacerbated existing health inequities, with high-income countries controlling the vaccine market. This inequity is further augmented by the FDA’s authorization of COVID-19 booster shots, which are almost exclusively available to wealthy nations. The COVID-19 vaccine was first approved in December 2020. As of November 19, 2021, the FDA authorized booster shots for all adults over the age of 18, regardless of their health status, following the policies of many other countries. The booster shot contains the same genetic formula as the original vaccine but, in the case of the Moderna shot, differs in the dosage quantity. It is recommended to help protect against new strains. Besides the United States, countries that are rolling out boosters also include France, Germany, Israel, and Canada. According to the Director General of the World Health Organization (WHO), “six times more boosters are being administered globally than first doses in low-income countries.” Furthermore, although 72 percent of individuals in wealthy countries have been inoculated with at least one dose of the COVID-19 vaccine, only around 4 percent of those in poorer countries have received at least one shot. It is morally unethical for wealthier countries to administer COVID booster shots to all adults while poorer countries continue to struggle to administer first doses of these vaccines. This type of distribution exacerbates existing global structural health inequities, reduces vaccine availability to lower-income countries, and may even prolong the pandemic. 

Although each country’s government has a right to protect its citizens, it should not come at the expense of widening the vaccination gap and exacerbating health inequities. Rich countries should not monopolize health resources solely because their economic resources allow them to; the pandemic is a global crisis that requires worldwide collaboration. Hoarding boosters, which creates an inequitable distribution of resources, is an act of selfishness that further burdens struggling healthcare systems. The Canadian government, for example, has bought enough vaccines to vaccinate a population at least four times their size. The vaccination gap is staggering; in Burundi, less than 0.1 percent of the population has been vaccinated with their first dose. In Israel, on the other hand, those that are older than 12 years old can receive their third vaccine shot. Many of the people in Burundi who have yet to be vaccinated include healthcare workers, which is especially dangerous considering their occupation increases their likelihood of catching COVID. Given the loose eligibility requirements for booster shots in many high-income countries, many of these children and adults that are accessing these third shots are at a much lower risk than the healthcare workers in Burundi. Although it would be ideal to focus on both vaccinating individuals in countries with greater barriers to access and bolstering the health of people in high-income countries, as health law expert Brook Baker says, “to pretend that a dose in an American arm doesn’t mean one less dose in an African arm doesn’t make sense.” Wealthy countries have the resources and money to pay vaccine manufacturers the highest amount, allowing them to control the vaccine market and deprive lower income countries of the ability to protect their people’s health. 

The resulting health outcomes then are rooted in structural wealth inequality that can be traced back to generations of colonization, violence, and theft. Many of these wealthy countries are part of Western society and continue to uphold the colonial status quo, using their financial resources to protect those in the Western hemisphere and endangering those of lower socioeconomic status. This historical inequity has manifested and been made worse by the administration of booster shots in wealthy countries. 

Although some wealthy countries have donated vaccines to countries struggling with vaccine administration, problems still lie within such donations and more action is required to mitigate the vaccination gap. Many lower-income countries lack the resources to effectively roll out these doses because of structural inequities. Vaccines have a relatively short shelf life, yet many of the vaccines that are given to lower-income countries are near the end of their viability. For example, in May of 2021, Malawi threw away 20,000 doses of the vaccine because the country lacked adequate resources and infrastructure to administer the vaccines before they expired. Additional barriers arise due to the required storing of the vaccines. For the doses to successfully work, they must be stored at a temperature lower than the capabilities of standard refrigerators, and building such cooling infrastructure requires time, energy, and resources that low-income countries may not be able to afford. 

Beyond ethical considerations, resources should be invested towards vaccinating those who have yet to receive their first shot in order to shorten the pandemic. Although boosting vaccinated individuals’ immune systems can slow COVID-19 infection, the World Health Organization posits that even more progress could be made if we prioritize injecting those who have yet to receive doses, especially in low-income countries. Unvaccinated people can act as variant incubators as there are more opportunities in low-income countries for the coronavirus to mutate into more dangerous variants. Variants would inevitably travel across the globe, affecting even those who have received their booster shots. Furthermore, those who are unvaccinated and become infected with coronavirus can spread the virus for longer periods of time than infected, vaccinated individuals. Thus, the administration of booster shots is a band-aid solution for wealthy countries to return to normal life because one healthy country alone cannot eliminate a global pandemic. Unless nations with high vaccination rates completely ban international travel, new variants will continue to spread and COVID will remain a persistent issue. Dr. Bruce Aylward, the senior adviser to the WHO director-general, said that “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.”

It is unethical for wealthy countries to administer booster shots to all adults while most individuals in low-income countries, healthcare workers included, have yet to receive their first vaccination shot. Wealthy nations are depriving other countries of their right to healthcare equity and have the resources to do so because of long standing structural global inequity that they helped create. High-income countries should be investing resources towards increasing manufacturing capacity globally and aiding with the rollout, rather than solely the distribution, of vaccines in these nations. Wealthy countries’ actions are unethical, raise the barriers to access for low-income countries, and may also prolong the pandemic. 

Alyssa Sales is a CPR staff writer, a junior in Columbia College, and a pre-med student majoring in Neuroscience and Behavior. You can usually find her talking about healthcare equity or on an adventure in SoHo, appreciating New York fashion.