Biden Poised to Unleash Boosters Amid First-Shot Shortage Abroad

(Bloomberg) -- President Joe Biden is set to unveil a plan to give more Americans coronavirus vaccine booster shots to head off the delta variant, a move that is stoking criticism that the U.S. is hoarding doses while poorer nations continue to languish under the pandemic.

Under Biden’s plan, which he’s set to discuss in a speech Wednesday about the broader Covid-19 response, high-risk groups including health-care workers and the elderly may be able to get a third dose of Pfizer Inc. and Moderna Inc. vaccines as soon as September, or eight months after they received their second shot. 

The Food and Drug Administration already has signed off on boosters for those with weakened immune systems and would need to clear them for other groups. It isn’t clear how soon, or whether, boosters will be made available to all adults. 

Some doctors and observers have pointed to a lack of evidence that a third dose would create significantly more protection for people. That uncertainty, they argue, means that the doses would be better used in countries where vaccines are still scarce. 

“There is zero evidence that a booster dose is required to protect against severe disease in the foreseeable future,” said Shabir Madhi, a vaccinologist from Johannesburg’s University of the Witwatersrand, who led trials of both AstraZeneca Plc and Novavax Inc.’s shots in South Africa. 

“It speaks to the moral fiber of high-income country governments to use precious doses of Covid vaccines to prevent the sniffles, whilst allowing those out of sight to continue dying from Covid due to hoarding and misuse of the limited supply of vaccines,” Madhi said.

White House Press Secretary Jen Psaki on Tuesday said it was a “false choice” to suggest that administering booster shots in the U.S. was tantamount to denying doses abroad.

“We can do both,” Psaki said. “We will continue to be the arsenal for vaccines around the world. We also have enough supply, and we have long planned for enough supply should our booster be needed for the eligible population.”

World Health Organization Director-General Tedros Adhanom Ghebreyesus has called for a moratorium on Covid-19 booster shots through September to enable poorer countries to catch up on vaccination rates. A spokesperson for Gavi, the Vaccine Alliance, which co-leads the Covax sharing program, said that rich countries giving boosters will only exacerbate inequities and called on countries to share all excess doses with Covax.

Earlier this month, U.S. regulators cleared third doses for people with severely compromised immune systems, a small group whose protection after two doses is weaker than it is for the general population.

For those people, “there’s a clear case to be made for a third dose,” said Celine Gounder, a physician who served on a Covid advisory board during Biden’s presidential transition. Boosters may also help for those over 80 years old and nursing home residents, where outbreaks are particularly risky, she said. 

But for others, such as younger seniors and health-care workers, “there’s a much weaker case for that,” Gounder said. She said the U.S. should focus on getting first shots administered, at home and abroad.

“What will protect me best is actually not me, myself, getting that extra dose; it’s giving that extra dose, using that extra supply, elsewhere,” she said. “It’s not just humanitarian. This is not the best use of our resources from a pragmatic, cold perspective.” 

Some countries have begun issuing booster shots already, though that includes cases where mRNA vaccines -- like Pfizer and Moderna’s -- are being used as boosters for other vaccines, as opposed to giving a third mRNA shot, which is what the U.S. is proposing.

Countries’ plans for boosters are evolving quickly, and some leaders, including Mexican President Andres Manuel Lopez Obrador, are expressing skepticism.

“It’s natural for pharmaceutical companies to want to boost consumption of vaccines, and we need to acquire vaccines that are necessary, and define a policy that protects people, not a trade or commercial policy,” he said Tuesday. 

Others have focused on inequity. 

“We should give more people one dose, before giving people a third dose,” said Nicholas Crisp, the deputy director general in South Africa’s Department of Health, who is responsible for coordinating the country’s vaccine rollout.

“We can’t tell another country what to do. The U.S. has given us a pretty big donation. We would like to see more vaccines going to other African countries,” Crisp said.

Nearly 170 million people in the U.S. have been fully vaccinated, though only a fraction would become eligible in the next few months for a booster. It isn’t clear whether the 14 million people who got the single-dose J&J vaccine would also be eligible.

“We should start with the most vulnerable groups and work our way down if the data supports that,” said Howard P. Forman, director of the Health Care management program in the Yale School of Public Health. 

Still, the prospect of extra shots for such a large cohort -- as well as the potential authorization of shots for kids younger than 12 -- will claim U.S. supply that may otherwise have been donated abroad. The U.S. has donated more than 100 million doses so far and already pledged at least 500 million more. 

Even with boosters for all people aged 12 and up, the U.S. would have a surplus of approximately 608 million doses in total in 2021, according to estimates from Airfinity, a science information and analytics company. 

Krishna Udayakumar, director of the Duke Global Health Innovation Center, said new data suggests that the efficacy of vaccines gets lower after six to nine months, an important signal for considering boosters. 

“It’s understandable that some countries are considering boosters, especially for high-risk populations,” he said. “It’s not politically feasible to ask countries not to follow the science and do what might be best for their own populations.” 

Dorit Reiss, a professor who studies vaccine policy at the University of California Hastings College of the Law, said the optics of giving third doses in wealthy nations right now are “horrible.”

“I’m not sure we have good evidence that a booster for the people who are willing to take the shot would dramatically help us. Part of the problem right now is that there are people who are not taking the shot,” Reiss said. “It’s short-sighted to prioritize a third booster for the United States over waiting to get the world vaccinated.”

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