The pandemic problems that boosters won’t solve


The US booster program is about to get underway, after the CDC backed additional shots for a large swath of the American public.

The agency now recommends that people aged 65 years and older, adults in long-term care, and those over 50 with underlying medical conditions get a third Pfizer-BioNTech shot. (Those whose first shot was Johnson & Johnson or Moderna will have to wait a little longer.) Frontline workers or those with a higher risk of infection will also get the chance to get a booster, categories added when the CDC’s director, Rochelle Walensky, overruled her committee.

But the decision has been contentious, not least because the vaccines are still doing a great job at protecting people from serious illness and hospitalization. Many experts believe that the priority should be getting more people vaccinated in the US, and sending much-needed doses to low-income countries where a little more than 2% of the population has been vaccinated.

Earlier this month, the World Health Organization called for a moratorium on boosters until at least 10% of every country has been vaccinated. But several rich countries, including the UK, France, Israel, and now the US, are plowing ahead with a booster program regardless.

The fraught debate around access to boosters raises some complex ethical questions for public health officials, politicians, and bioethicists. Is it justifiable for citizens of richer countries to get a third dose when so much of the world is awaiting its first? And how do agencies like the CDC decide who should get them?

So we decided to speak with Anita Ho, an associate professor in bioethics and health services research at the University of British Columbia and the University of California, San Francisco. Ho has spoken with us before about the US vaccine rollout and inequality. We asked her how the picture has changed at this point in the pandemic. 

The interview has been edited for length and clarity.

What are some ethical considerations of offering booster doses to just some Americans? I’m particularly curious about the idea of offering them to people in high-risk jobs.

In some ways, the ethical considerations are similar to late last year when the vaccines first became available. If there is a limited supply and more people need it, you want to promote the greatest good without sacrificing equity, and start with those who would be at the highest risk of getting very sick if they don’t get the booster dose soon.