The Biden administration The decision to offer Covid boosters to healthy, fully vaccinated Americans has caused an unusually large and sharp backlash among researchers and policymakers. They see it as a subversion of regular decision-making, relying on data that looks more dramatic than it could, and undermining the commitments the United States has made to other countries to support the delivery of vaccines so that more of the world can be inoculated more quickly.
The Director of the World Health Organization for Africa called him “A travesty of vaccine equity”. To ethicists and scientists in the United States, it sounds like the abandonment of moral leadership in public health that was a national mark throughout the 20th century. They hope to see the decision adjusted, although it probably cannot be overturned.
“Americans have led the fight against AIDS; we led the fight to eradicate smallpox, ”says Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University. “I find it really shocking that in a truly unprecedented global crisis, we have not chosen to lead in the same way.”
To recap: The White House announced wednesday that anyone 18 years of age or older who has received two doses of Pfizer or Moderna mRNA vaccines will be eligible to receive a third, booster, eight months after their last injection. The shots will go to healthcare workers, the elderly, and residents of nursing and long-term care homes first, but they are intended to boost the immunity of anyone who chooses to take them. The campaign is expected to begin – at 80,000 vaccination sites, according to the White House – on September 20.
The trigger for the decision, according to members of the White House Covid-19 task force who spoke at the briefing, was many rooms of research published by the Centers for Disease Control and Prevention that morning. This research has shown that in several groups – inpatients, nursing home residents, and adults whose vaccinations have been recorded in multiple New York State registries – mRNA vaccines were becoming increasingly less able to prevent disease. infection with Covid-19. (The research was conducted by scientists at the CDC and academic medical groups and published in the agency’s Morbidity and Mortality Weekly Report, which is verified by researchers and editors but not officially evaluated by peers.)
Infection is the key word here. All three studies found that the vaccine’s effectiveness against infection increased from levels of 95 percent seen in clinical trials to 84 percent in previously hospitalized patients, to 79.8 percent in New Yorkers and at 53 percent among nursing home residents. But the researchers point out that the initial intention of the vaccination campaign, as captured in the clinical trials that allowed the formulas to be authorized, was to prevent serious illness, hospitalizations and death – and this new research does not establish whether these have decreased. New Yorkers in vaccine registries, for example, were 91.9 to 95.3 percent protected against developing disease severe enough to require hospitalization.
The case for recalls, in other words, could be based on preventing the type of illness that health authorities refer to as “mild,” that is, not severe enough to require hospitalization. But federal officials who introduced the recall decision predicted that vaccine protection could deteriorate further: “Even though this new data affirms that vaccine protection remains high against the worst COVID outcomes, we are concerned that this pattern of decline we are seeing continues in the coming months, which could lead to reduced protection against serious illness, hospitalization and death, ”Surgeon General Vivek Murthy said during the briefing.
The move was a slap in the face to the WHO, whose director-general called for rich countries to postpone booster injections until the end of September so poor countries could protect their most vulnerable residents first. Knowing that the decision was approaching, Mike Ryan, Executive Director of the World Health Organization’s Health Emergencies Program, described it at a press conference a few hours in advance like this: “We plan to distribute additional life jackets to people who already have life jackets, while we leave the rest to drown.” Globally, more than 5 billion people are still not vaccinated.