The True Solution to the Booster Debate
There has been a considerable amount of news this week surrounding the future of COVID-19 vaccines in the United States. On Monday, Pfizer announced that their vaccine had been shown to be effective for children between the ages of five and eleven. This finding places the Pfizer vaccine on the fast track to Emergency Use Authorization for those younger ages, with benefits for parent anxiety, child health, and keeping schools open. There was also the news last Friday that a government advisory panel was only recommending a vaccine booster for those over the age of 65 or with underlying health conditions. The implication was that the vaccines people have already taken will be enough to protect them from the Delta variant of COVID-19. But the announcement also touched off a fierce debate about the role of these vaccines in the country moving forward, one that is unpredictable and complex compared with most of the nation’s current conflicts.
Vaccine boosters are a fraught question for many reasons. Supporters argue that they may be necessary to curb reductions in efficacy over time. The COVID-19 vaccines were introduced and tested so quickly that there is some uncertainty over what the perfect dose is to maintain immunity for as long as possible. There is a chance that the ideal regime is three shots spread out over an extended period of time. A third shot (or second in the case of the Johnson and Johnson vaccine) may end up being vital to protecting the unvaccinated and finally curbing the impact of the Delta variant in hospitals and greater society.
But a wide variety of opponents have statistical arguments of their own. There are two key points of criticism. One is the possibility of side effects from a third shot, which may be damaging to recipients and harm the vaccine’s already fraught popularity among large swaths of the public. But more commonly, critics of a booster frame the question as one of international equity. Why should Americans receive a third shot when so much of the world has not yet received a first? The World Health Organization (WHO) has argued that the world’s richest countries owe the poorer countries hundreds of millions of vaccines and that the focus should be on distributing vaccine surpluses before worrying about boosters.
This debate is unique in that it is one of the few that transcends contemporary political divides. There is no clear liberal or conservative stance on the question. Many liberals support boosters as part of their general desire to end the pandemic by any means necessary. They are opposed by more internationally focused leftists and the WHO, which see low vaccination rates in Africa and Asia as related to American imperialism. At the same time, anti-vaccine conservatives obviously disagree with the need for a booster shot, while conservatives who believe the pandemic poses a serious risk to Americans would find more in common with liberals than conservative anti-vaxxers.
The debate over boosters is one of the few that will not be decided in the United States. Instead, it will be decided in Israel. The dynamics surrounding vaccines in the United States are substantially different than those in Israel. Both anti-booster constituencies are small in that country. Israel has shown itself to be resistant to the calls for self-sacrifice in service of vaccinating the entire world. It is also not particularly concerned about side effects from the vaccines. Most of the country is united around the idea that vaccines will solve the pandemic and that a country should make any vaccine decision it deems necessary to save its population.
To that end, Israel has begun introducing booster shots for much of its population. Availability for the shots has spread to the rest of the population outside of vulnerable groups. While the program is still relatively new, preliminary reports show that boosters reduce the chances of infection to a much lower number than the original vaccines do in the context of the Delta variant.
The Israeli experience will be the strongest determining factor for whether or not the United States ends up introducing boosters for non-vulnerable populations. There will likely be a control group in Israel that has only received the first set of doses and an experimental group that has received the booster. By tracking the performance of these groups, researchers can make a case regarding whether the booster helps overcome the pandemic in Israel. A number of positive news stories about boosters, plus authoritative studies, would put immense pressure on Joe Biden to overrule critics at the FDA and implement a booster regime in the United States. Pressure from Democratic leaders and business groups will be immense and will likely overcome any uncertainty from liberal critics of boosters.
The booster debate will continue to play out in this country. Research from vulnerable groups receiving the boosters may play a role. But there is always the likelihood that boosters turn Israel into a haven of minimal cases and a full, maskless reopening. In that case, liberal supporters of international vaccine distribution may need to focus on other approaches to getting vaccines to the developing world. The political debate will be decided by a desire by American voters, those whom Biden will be counting on to deliver him a second term, to end the pandemic once and for all. Biden simply will not have a choice.
This piece first appeared on the author’s Medium page