The ethics of the vaccine booster by Angela Caldin

‘Nobody is safe until everyone is safe.’

I take that to mean that, as we’re in the middle of a pandemic affecting the whole world, it would be logical to ensure that the whole world is vaccinated, not just the wealthy bits of it.

Many developed countries, including the UK, the US and several EU member states, have rolled out booster vaccination programmes. The thinking behind the booster campaigns is that a third round of vaccination provides an extra defence against Covid-19, at a time when protection might be starting to diminish. After a third dose, a person’s risk of infection appears to drop considerably.

Life jackets for some

This seems to give the green light for giving out booster jabs wherever possible. However, the launch of these programmes has raised the question of vaccine equity. In simple terms, why should those in wealthy countries receive a third dose of vaccine when most people in poorer countries have had none?

As Dr Mike Ryan, director of the World Health Organization emergency programme put it: “We’re planning to hand out extra lifejackets to people who already have lifejackets, while we’re leaving other people to drown without a single lifejacket.”

Narrow view

While vaccination rates across the world are rising – around 50% of the global population has had at least one dose – there are huge disparities between low and high-income countries. In some parts of the world, less than 5% of the population is vaccinated, leaving millions of vulnerable people at risk of severe illness.

It’s true that some wealthy countries will derive benefit from booster doses, but that benefit fades in comparison to the lives that could be saved by redirecting doses abroad to countries with low vaccine coverage but high incidence of Covid-19. These countries risk becoming a breeding ground for new variants, which in turn may evade protection from vaccines.

Professor Schaefer of the University of Singapore says, “To the extent that vaccines can effectively limit the spread of Covid-19, distributing vaccines more widely reduces the likelihood that dangerous variants will emerge. Those variants could then spread around the world, imperilling even countries that have undertaken booster campaigns.”

A recent article published in The Lancet has argued that existing vaccine programmes continue to be effective against severe disease. This has been borne out in higher-income countries like the UK, which has seen a drop in hospitalisations and deaths, even though there are high case numbers. Arguably, since most cases are still driven by unvaccinated people, rich countries should be concentrating on addressing vaccine hesitancy.

Global view

Clearly, if I refuse a booster dose when offered, this will not induce a government to redirect that dose elsewhere. The only thing I can do is consider political action to pressure governments to change course. Governments will prioritise the needs and interests of their own people over those abroad, but in times of global crisis like this, countries should recognise there are limits to how much national priority is reasonable. Rather than directing their energies into booster campaigns, wealthy countries ought to be doing their bit to secure equitable vaccine distribution. This might include negotiating with pharma companies, waiving intellectual property rights to vaccines and supporting manufacturing and distribution capabilities in low-income countries.

A global crisis needs a global solution

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