Booster shot debate intensifies on global stage

The debate over booster shots of the COVID-19 vaccine is heating up as some public health experts warn countries against moving forward with plans to offer third doses.

France, Germany and Israel are taking steps to deliver additional shots of the vaccine to vulnerable groups such as the elderly and people with compromised immune systems. Moderna said Thursday that it thinks booster shots will likely be needed before the winter, following a similar statement from Pfizer last month.

But some experts say the broad push for boosters is premature and that while certain small groups such as the immunocompromised need a third jab, there is no evidence that widespread booster shots are needed at this time.

The Biden administration is caught in the middle and faces a balancing act. It does not want hesitant people to think talk of booster shots is an indication that the existing vaccine regimen is insufficient. Administration officials also say they are committed to helping vaccinate the world while being careful not to shortchange the needs of Americans.

The World Health Organization (WHO), meanwhile, is calling on wealthy countries to hold off on giving third doses to allow more people around the world to get their first shots.

Asked about the WHO’s message, White House press secretary Jen Psaki said it was a “false choice” and that the U.S. can provide boosters domestically while also donating doses abroad.

“We believe we can do both, and we don’t need to make that choice,” she said.

Craig Spencer, director of global health in emergency medicine at Columbia University Medical Center, pushed back on Psaki’s comments, saying vaccines are in fact a “zero-sum game at the moment” given that there simply are not enough doses for everyone in the world.

“It’s not a false choice; it’s a deliberate choice by wealthy nations,” he said, adding that most Americans should not be getting third doses before health care workers around the world receive their first.

But Spencer also said it would be reasonable for much smaller groups of particularly vulnerable Americans to get boosters, such as the immunocompromised or people in nursing homes.

There are signs that booster shots could begin soon in the U.S., at least for some groups.

Last month, the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) quickly pushed back in a rare joint statement after Pfizer suggested booster shots, saying they were not currently needed.

But since then, health officials have left the door open a little wider.

Anthony Fauci, the government’s top infectious diseases expert, said Thursday that booster shots for immunocompromised people are a “very high priority” and that the administration was working to move forward “as quickly as possible.”

While action for immunocompromised people could come sooner, Peter Marks, a top FDA vaccine official, said this week that the agency could release more general information on booster recommendations in September.

“I suspect again by sometime in September we’ll be able to make some more coherent statement about what the recommendation will be,” Marks said at an event hosted by the COVID-19 Vaccine Education and Equity Project.

He emphasized that the possibility of boosters is not evidence the vaccines don’t work properly.

“I don’t think that we want to think that these vaccines have somehow failed us,” Marks said. “It may simply be that to get the kind of really good immunity against COVID-19 that we get with some other vaccines, it may take a series of three vaccinations.”

Paul Offit, a leading vaccine expert at the Children’s Hospital of Philadelphia, said he does not think there is evidence yet that boosters are needed, except for immunocompromised people.

“For now, I don’t think we’re there,” he said, noting that the number to watch is the percentage of vaccinated people who are hospitalized.

For now, that number remains very small.

“The problem in this country is not boosting those who are already vaccinated,” he said. It’s getting unvaccinated people to take the shots.

Some experts also point out that vaccine makers such as Pfizer and Moderna have a financial incentive to sell more doses to wealthy countries and to say that boosters are needed.

Spencer said most Americans do not need boosters, “regardless of what the pharmaceutical company tries to tell you.”

He said the vaccines have gone through a “credibility crisis” recently, with new announcements from the CDC on masks and scary-sounding headlines. But the reality is that the vaccines are still working very well, he said.

A study released last month showing the efficacy of the Pfizer vaccine dropped to 84 percent after six months raised some eyebrows. But Spencer said other studies have put the efficacy higher; British data put efficacy at 88 percent, even against the delta variant.

Effectiveness is higher still against severe disease and hospitalization, which experts emphasize as the most important factor when it comes to COVID-19 vaccines.

Fauci said this week, however, that the recommendation for a broader swath of the population could change quickly as more data comes in.

“That could change, and that’s the reason why we’re following it really carefully on a week-by-week basis,” he said.

Asked at the event, hosted by the Center for Strategic and International Studies, if the change could come on a “fast trigger,” Fauci responded, “Absolutely.”