The Problem with Booster Shots
U.S. Navy Hospital Apprentice Shamia Nesbeth preparing a COVID-19 shot. Photo by Jessica J. Mazzamuto.
Amid this winter’s Omicron surge, U.S. health officials gave two big messages: first, get the vaccine, and then, get the booster. Luckily, for most Americans who wanted it, taking that advice was as easy as walking into their neighborhood pharmacy. Indeed, in many of the world’s wealthier nations, boosters quickly became commonplace this fall once research showed them to be safe. Colleges and universities are mandating third doses for the spring semester, restaurants are requiring indoor diners to show proof of booster shots, and New York Governor Kathy Hochul has changed the state’s definition of fully vaccinated to include the third booster shot.
In most of the developing world, though, the vaccine picture looks starkly different. Data show that among low-income countries, where gross national income was less than $1,045 per capita in 2020, only 13% of the population has received at least a first dose, compared to 63.1% globally. This pattern can be seen regionally, too. Africa is the continent with by far the lowest overall vaccination rates. Less than 16% of the population is vaccinated, and only a tiny fraction of a percent have been boosted. It’s alarmingly obvious that, over a year since it began, vaccine distribution is still happening almost entirely in the global north, leaving the rest of the world behind.
The issue with this disparity is that it creates a two-world pandemic. For some of the world’s populations, readily-available vaccines make it possible for life to start going back to normal. For the rest, COVID-19 is just as much of a public health threat as it was two years ago.
The problem for vaccine distribution, at this point, isn’t supply. Pharmaceutical companies are producing almost 1.5 billion doses every month—that should be enough to immunize far more of the global population. The problem lies in the allocation of those doses. Wealthy countries have more vaccines than they need, while poorer nations are left in the dust.
In this light, wealthy nations encouraging their whole populations to get the booster seems selfish. The booster provides additional protection against new variants like Omicron, and it will likely play an important role in turning COVID-19 into a relatively harmless, endemic illness. But two shots alone can do quite a lot of good, too. For those who have received only two doses of a COVID-19 vaccine, without a booster, the protection against hospitalization from Omicron infection is still 70%. This number is not insignificant; it represents a huge improvement in the public health situation compared to the spring of 2020, and it means that far fewer people are getting seriously sick and dying.
What matters more than blanketing better-off nations with the extra layer of third doses, then, is making sure that more of the global population can get at least that basic layer of protection a first cycle of vaccines can provide. Putting first and second doses in the arms of those countries with the lowest vaccine rates does more for public health than giving third doses in a select few nations.
To be clear, those at highest risk of contracting, spreading, or becoming seriously sick from COVID-19 should by all means receive booster shots. For healthcare workers, the immunocompromised, and the elderly, the extra protection of a third dose is incredibly important for health and well-being, and fully protecting these groups makes full reopenings far safer. However, countries like the US or the UK, with plenty of doses available, should focus on sharing those doses with low-vaccine-rate nations before they worry about boosting every healthy person.
To some extent, this sort of vaccine-sharing is already happening: COVID-19 Vaccines Global Access, or COVAX, for short, was set up in the fall of 2020 by the World Health Organization (WHO) and other public health NGOs to fairly distribute vaccines to low- and middle-income countries. Some hundreds of millions of doses have been donated so far–yet it still just isn’t enough.
In September of 2021, COVAX had to cut its forecast for donated doses for the year, in part due to vaccine hoarding by wealthier nations–the organization also struggled with production problems and export bans. This summer, WHO urged moratoriums on booster doses until more of the world’s population could receive at least a first dose, to no avail; countries with the doses needed were quick to make boosters available to the general public in those nations. Vaccine sharing is much needed, and the infrastructure for it is there. But, so long as high-income countries continue to hoard boosters for their low-risk residents rather than distributing the shots to nations with more need, the doses that are already being produced will not go where they’re most needed.
The implications for this continued vaccine inequity are far-reaching. Without widespread global immunity, COVID-19 poses far more of a public health threat. While countries with high vaccine rates are looking forward to the future of an endemic virus, much like the flu, where life can go on as normal with only rare cases of severe illness, areas with low vaccine rates still face the threat of mass shutdowns, overcrowded hospitals, long-haul side effects, and ultimately, high death tolls.
It’s easy to see how this two-virus world would become more firmly entrenched in its pre- and post-COVID inequities, too. In countries that already can’t afford to purchase and distribute massive amounts of vaccine doses, the continued spread of COVID-19 will only further limit economic development and rejuvenation. More immune countries will make a full return to business as normal and, thanks to this economic recovery, likely continue receiving the lion’s share of global investment. Countries with higher rates of illness, closures, and death will continue to face worsening disruptions to daily life and more social turmoil, the likes of which can often lead to political strife and instability. Beyond the social and political implications, if the virus is free to pass back and forth between more unvaccinated people, the virus has more chances to mutate into more dangerous, more transmissible variants—variants that could make their way into highly vaccinated countries, too.
Boosters have a role to play in ending this pandemic, to be sure. But until more of the global population receives at least a first layer of protection, wealthier nations need to do their part to ensure an equitable recovery, starting by putting universal boosters on hold and sharing their extra doses.
Avery Lambert (BC‘25) is a staff writer at CPR. She plans on majoring in Medieval and Renaissance Studies & Political Science.