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Is the U.S. COVID Booster Plan Ethical?

An illustration of a gloved hand injecting a globe with a syringe; there are red COVID virus particles on a light red background.

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Key Takeaways

  • Because millions of people have yet to receive their primary COVID-19 vaccination series, some experts say that the Biden Administration’s plan for booster shots is unethical.
  • Experts emphasize that administering booster doses may exacerbate global vaccine inequity and affect public trust.
  • Instead, they suggest the administration increase vaccine availability and manufacturing capacity in countries with low vaccination coverage to prevent the emergence of new variants.

Recent research suggests that a booster shot is needed to maximize and prolong vaccine-induced protection against the COVID-19 virus. In light of this data, the FDA and CDC have given the green light to boosters from all three COVID vaccine manufacturers: Pfizer, Moderna, and Johnson & Johnson. All adults who completed their initial COVID-19 vaccine series are now eligible for a booster dose.

Because much of the world—especially low- and middle-income countries—remains unvaccinated, the booster plan quickly raised ethical concerns. Experts predict that administering booster doses will widen the vaccination gap between affluent and less wealthy countries even more.

Primary COVID-19 Vaccines Still Protect Against Severe Cases

At a White House briefing on August 18, Rochelle P. Walensky, MD, MPH, the director of the Centers for Disease Control and Prevention (CDC), cited several studies that found vaccine-induced protection against COVID-19 infection waned over time.

However, data has also shown that the vaccines remained effective against severe disease, hospitalization, and death—even when factoring in the Delta variant.

Richard Reithinger, PhD, vice president of global health at the RTI International, tells Verywell that right now, "there is only limited data available that an immune response that was primed by available vaccines is waning after six to eight months."

Reithinger also says that "most of the data is on infection, rather than hospitalization or death. The data also does not account for the use of non-pharmaceutical interventions, such as masking and social distancing.”

Additional Dose Versus Boosters

People with moderately to severely compromised immune systems may not build the same level of immunity to two-dose vaccine series compared to people who are not immunocompromised. Therefore they should receive an additional dose of mRNA COVID-19 vaccine at least 28 days after the second dose.

“From a public health perspective, the recent uptick in vaccine coverage in the previously unvaccinated due to the surge of the Delta variant across the US, the increasing push by the private sector to require vaccines by its employees or customers, as well as the recent FDA approval of the Pfizer-BioNTech vaccine are encouraging developments,” Reithinger says.

Is It Ethical to Distribute Booster Doses Now?

As hundreds of millions of people from low- and middle-income countries are still waiting for their first dose, many affluent nations—including the U.S.—are already moving ahead with booster doses, which is against the World Health Organization's (WHO) wishes.

About 4 billion vaccine doses have already been administered globally, but more than 80% went to high and upper-middle-income countries despite these places accounting for less than half of the world’s population, according to the WHO.

Nancy S. Jecker, PhD

The problem we face is one of human making. We are not distributing vaccines equitably, and as a result, more people are dying.

— Nancy S. Jecker, PhD

“We have an ethical, moral, and public health imperative to dramatically increase vaccine availability and access across the globe," Reithinger says. "[We need to increase access] specifically for lower-and-middle income countries, in order to prevent more cases and deaths, prevent health systems and the socio-economic fabric to collapse, and prevent the probability of a more pathogenic and virulent strain to emerge, which then would create even more cases and deaths, and socio-economic disruption."

At a press conference earlier this month, the director-general of the WHO, Tedros Adhanom Ghebreyesus, PhD, said that it's unacceptable for countries who used up most of the global vaccine supply to use more of it while many vulnerable populations around the world remain unprotected.

Nancy S. Jecker, PhD, professor of bioethics and humanities at the University of Washington School of Medicine and Fulbright U.S. Scholar for South Africa, tells Verywell that "Biden's call for boosters is a missed opportunity for moral leadership."

Jecker adds that it's "our moral duty is to bring everyone up to a minimal level of vaccine protection."

Citing research from Duke University, Jecker says that this is an achievable goal, and that "we can manufacture about 12 billion doses of vaccine by the end of 2021, which is well over the 11 billion needed to vaccinate roughly 70% of the world's population—assuming the 2-dose vaccine remains the norm.”

How Boosters Can Affect Vaccine Equity and Confidence

Experts say that the Biden Administration’s plan to distribute booster doses in the fall will likely affect vaccine inequity and confidence.

Exacerbating Global Vaccine Inequity

“The problem we face is one of human making,” Jecker says. “We are not distributing vaccines equitably, and as a result, more people are dying.”

According to Jecker, one way to translate moral duty into policy is to follow the WHO's recommendation and ensure that at least 10% of the people in every nation are vaccinated before offering boosters. Boosting the immunity of individual nations is crucial, but increasing global vaccination coverage with the primary vaccination series should also be prioritized.

“Rather than building global community, Biden's decision serves narrow nationalist goals,” Jecker says. "At an individual level, receiving a third shot may seem like a benefit. In the big picture, however, boosters make the world less safe for each and every one of us because the virus continues to circulate and mutate in unprotected regions.”

Reithinger says new variants are more likely to emerge in unvaccinated populations—such as the Delta variant in India or the Lambda variant in Peru—which can spread quickly both regionally and globally.

“Unless there is a substantial increase in resources, for example, in terms of vaccine production capacity, human resources, and financial resources, diverting attention from administering vaccines from those that have yet to receive their first dose—whether in the US or globally—will mean that efforts to increase vaccine coverage in that population will likely be impacted,” Reithinger says. “It will maintain and further exacerbate current vaccine inequity.”

Diminishing Public Trust

The booster recommendation may confuse people and reduce vaccine confidence—especially if the rationale and evidence behind these rapid changes are not explained well to the general public.

“The biggest challenge with the booster shots is public trust,” Ryan Nash, MD, the director of The Ohio State University Center for Bioethics and Medical Humanities, tells Verywell. “Early on in the pandemic, experts said we didn’t need masks and then said we needed them after all. Then there were the debates about what type of masks were effective. Changes like these are seen by some with skepticism and lack of trust.”

A poll conducted by the Kaiser Family Foundation found that almost 25% of vaccinated adults who have heard about booster shots worry that they might not be well-protected from COVID-19 after all.

“Some say this type of flip-flopping is political, but the reality is that science is behind the changes,” Nash says. “We’ve only got one years’ worth of data on the vaccine, and studies are continuing. The challenge is that if we move to boosters too soon and three months later a study comes out showing we really don’t need them, it has the potential to create a lot of mistrust.”

Health officials are reportedly prepared to change the booster rollout plans should new data require it.

How Can the Administration Help Other Countries?

Nash says that although assisting all global communities in getting access to the vaccine is ideal, it’s defensible to be protective of your own community. That said, the Biden Administration can still play a role in increasing vaccine availability for low- and middle-income countries—should it choose to do so.

"Increasing the number of manufacturers globally would not only help low- and middle-income countries but all countries," Jecker says. "Rather than hoarding vaccines, the U.S. should share licenses to manufacture vaccines so that they reach more people. Sharing know-how, technology, and raw materials to build drug manufacturing capacity in other nations will be crucial for containing this and future pandemics."

However, supporting the waiver of COVID-19 vaccines’ intellectual property (IP) protections and scaling up manufacturing to donate excess doses are only short-term solutions.

To increase global vaccine supply, wealthier nations can incentivize and fund complex technology transfers, support the development and/or expansion of vaccine manufacturing facilities in low- and middle-income countries, and facilitate the supply of equipment and raw materials.

“To truly ‘stay ahead’ of the virus and prevent the emergence of new SARS-CoV-2 variants, we need to focus our attention on increasing vaccine coverage in the US and particularly in low- and middle-income countries,” Reithinger says. “Only then, will we prevent further cases and—more importantly—severe disease requiring hospitalization and deaths, and firmly put this pandemic in our rearview mirror.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. COVID-19 vaccine booster shots. Updated November 19, 2021.

  2. The White House. Press briefing by White House COVID-⁠19 response team and public health officials. Published August 18, 2021.

  3. World Health Organization. COVID-19 virtual press conference transcript - 4 August 2021. Published August 4, 2021.

  4. Kaiser Family Foundation. KFF COVID-19 Vaccine Monitor: July 2021. Published August 4, 2021.

  5. U.S. Department of Health & Human Services. Joint statement from HHS public health and medical experts on COVID-19 booster shots. Published August 18, 2021.