The Vaccine-Booster Mistake

Only equitable vaccine distribution, not booster shots, can end the pandemic.

A picture of vaccine vials on a conveyor belt over an image of women waiting to get vaccinated
Alexandre Schneider / Getty; Diptendu Dutta / AFP / Getty; The Atlantic

For a while, a COVID-19 crisis in India seemed to have taught the world a valuable lesson: that an uncontrolled coronavirus outbreak anywhere poses a threat everywhere and, crucially, that without more equitable vaccine distribution, there can be no hope of getting this pandemic under control.

Other countries, recognizing their responsibility to help India, sent essential aid, including much-needed oxygen and the raw materials required to produce COVID-19 vaccines. The United States committed to donating 60 million doses to countries needing them (the figure has nearly doubled since), an example that other governments followed.

But as the Delta variant spreads across the globe—threatening the newfound freedoms of widely vaccinated populations that have seen their pandemic restrictions lifted, and testing the long-term efficacy of COVID-19 vaccines—several wealthy countries, including the United States and parts of Europe, have announced plans to begin administering booster shots to offer extra protection against Delta. Israel, which last month became the first country to offer a third dose of the Pfizer vaccine, has already extended eligibility to people as young as 30. At the same time, the majority of the global population has yet to receive even one dose of a COVID-19 vaccine.

This is more than just an ethical problem. Individual governments, of course, have a responsibility to protect their own citizens, and that is what richer countries have sought to do. But there are broader implications in administering booster shots before most of the rest of the world has been vaccinated, ones that will ultimately undermine these countries’ goals to control the coronavirus and bring back some sense of normalcy. More fundamentally, the decision is a testament to the fact that more than a year into a pandemic that has proved the perils of vaccine nationalism, wealthy countries are repeating prior mistakes.

Thus far, high-income countries have dominated global vaccine supply, and have overwhelmingly targeted those doses (understandably) at their domestic populations. This has come, however, at the expense of lower- and middle-income countries, many of which can’t afford to order multiple vaccine candidates to the extent that their wealthier counterparts have. Because of this, countries such as the U.S., Britain, and Israel have been able to fully vaccinate as much as 51 percent, 61 percent, and 63 percent of their population, respectively—a level of protection that has enabled them to lift many of their public-health restrictions. But it’s also why many more countries remain at the back of the vaccine line: Although one-third of the world’s population has received at least one dose of a COVID-19 vaccine, those individuals are largely concentrated in high-income countries. Less than 1 percent of people in low-income countries are fully vaccinated.

This clear discrepancy explains why some richer nations’ decision to administer booster doses—one driven by evidence of waning vaccine efficacy against Delta, as well as the threat of future lockdowns—has been received so poorly by the global health community. The World Health Organization called on countries to postpone boosters until at least the end of September to allow the rest of the world to catch up. One official likened the boosters to giving life jackets to people who already have them while leaving others to drown.

Implicit in this argument is the belief that every booster shot represents a dose that could have instead gone to someone who has yet to receive any vaccine protection at all. And, in some ways, that’s true: Although vaccine-manufacturing capacity has improved since the pandemic began, the world does not yet have enough doses for everyone. According to Nature, an internal analysis by the WHO estimates that if all high- and upper-middle-income countries were to provide boosters for all their citizens over age 50, they would use more than 850 million doses of the world’s available vaccine supply. Other health experts project that the practice could divert anywhere from 1 to 2 billion doses over the next year. To put these figures into context, approximately 11 billion doses will be needed to vaccinate just 70 percent of the global population. As things stand, the world will have to wait until at least 2023 before supply of doses meets global demand.

Still, vaccine production has scaled up—so much so that researchers at the Duke Global Health Innovation Center, which tracks global vaccine procurement, have found that distribution challenges are slowly overtaking limited supply as the key barrier to ending the pandemic. “Our best estimates are that the world is producing close to a billion doses a month now, and we think that will continue to increase,” Andrea Taylor, the center’s assistant director for programs, told me. “There is still a supply issue, but it’s shrinking.”

This is part of the reason that the U.S. government has presented the WHO’s condemnation of its booster program as a “false choice,” arguing, in effect, that wealthy countries don’t need to choose between prioritizing their citizens and aiding the rest of the globe, because enough vaccines will soon be available for both. But the key word here is soon. For the time being, there aren’t enough doses to go around, which inevitably raises the question: Who should be prioritized?

For now, the answer coming from wealthy countries appears to be their own population. There is nothing wrong with governments wanting to safeguard their citizens. But if Delta has taught the world anything, it’s that protecting one’s own populace at the expense of the rest of the world is a loser’s game—one that results in more transmission, more variants, and more Band-Aid solutions. Boosters alone won’t be enough to shield those who receive them from new and dangerous variants that might emerge elsewhere.

If the goal is to end the pandemic, “what we need to do is prioritize ending global transmission,” Taylor said. “If we don’t do that by pushing out first and second doses around the world, we will just continue to need more boosters in high-income countries … That’s not solving the problem; it’s just kicking the can further down the road.”

Another crisis like India’s or another variant shouldn’t be necessary for wealthy countries to learn from their early pandemic mistakes. If they don’t heed the lessons of Delta, they’ll almost certainly be doomed to learn the rest of the letters in the Greek alphabet, and all the lessons that come with them.