The Biden administration’s plans to offer a third COVID-19 shot to Americans fully vaccinated with the two-shot regimen starting next month is premature and too broad, according to two Massachusetts infectious-diseases specialists who say the US should donate more doses to countries with low vaccination rates.
The doctors acknowledged that it’s likely the more than 155 million people who since December have received the two-dose vaccines made by Pfizer-BioNTech and Moderna will eventually need booster shots because of waning immunity and the threat of the Delta variant.
But at this point, they said, boosters should go to a much narrower group. Federal regulators last week allowed Pfizer and Moderna to offer a third shot to certain immunocompromised people and are expected to start debating a rollout for most Americans later this month. For now, the doctors said, there’s insufficient evidence that anyone else needs boosters, except older patients and perhaps health care workers who have direct contact with people infected with COVID-19.
“We have an obligation ― both an ethical obligation and a medical obligation ― to more rapidly deploy the vaccines that we have to get it to countries that don’t have it,” said Dr. Shahin Lockman, a physician at Brigham & Women’s Hospital and associate professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health.
President Biden said Wednesday the US has already donated 115 million vaccine doses to efforts abroad ― more than all other countries in the world have provided combined ― and has pledged to send more than 600 million vaccine doses to other countries.
“The United States government has done a phenomenal amount globally, but it’s still not sufficient,” Lockman said. She cited Africa, where only 2 percent of the continent’s 1.3 billion people are fully vaccinated, and added that “the whole world urgently needs vaccine now.”
Lockman was one of hundreds of physicians and public health advocates who signed a July 20 letter to Biden saying that Pfizer and Moderna were delivering 17 million doses of messenger RNA vaccines each week to states, but only 7 million doses were being used. The US had 55 million doses in storage, according to the letter, which said the country could immediately donate 10 million doses a week overseas.
Even with those donations, Lockman said, the US would still have enough doses to roll out boosters for the 1.4 million residents of nursing homes, who are particularly vulnerable to COVID-19. She would also offer them to health care workers who have direct contact with such patients.
Even after that, she said, the country would still have enough doses to provide shots to the millions of Americans who remain unvaccinated.
Dr. Nahid Bhadelia, founding director of the Boston University Center for Emerging Infectious Diseases Policy and Research, sounded a similar theme. She said a growing body of research indicates that immunity induced by the mRNA vaccines wanes over time.
“I do think we will probably need to get a boost at some point, but it’s not an emergency,” she said.
Bhadelia treats patients at Boston Medical Center. Like Lockman at Brigham and Women’s, Bhadelia said Delta-driven COVID-19 hospitalizations have increased recently, but are nowhere near the high levels they reached in the winter.
Although Biden’s plans to roll out booster doses starting in September surprised some public health experts, Bhadelia said it appears the administration is “trying to be proactive, and it’s tough to fault them.” But, she said, it does raise a moral question: Should Americans start getting boosters when billions of people haven’t gotten their first shots?
Bhadelia said that the US has enough vaccine doses on hand to donate more to the world, inoculate unvaccinated Americans, and provide boosters to Americans who need them most. “I don’t think it’s a zero-sum equation,” she said.
Federal health officials have vowed to offer boosters to mRNA vaccine recipients eight months after they received their second shot. For now, Bhadelia said, she would limit those shots to people 65 and older; those individuals were near the front of the line when they received prime doses and are among the most likely to have waning immunity.
But the focus, she said, should remain on vaccinating people who haven’t received any shots ― in the US and abroad ― because they are more likely to fuel the rise of new variants.
“There’s a bigger public health impact with first doses than third doses, in my mind,” she said.
Jonathan Saltzman can be reached at firstname.lastname@example.org.