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The same week that Rochelle Walensky, the director of the Centers for Disease Control and Prevention, gave the green light to booster shots for Pfizer vaccine recipients over age 65, the World Health Organization reported that only 2.2% of people in the world’s low-income countries had received even one dose of a Covid vaccine.

That means millions of Americans will receive a third vaccine dose while billions around the world have not had their first.

That stark contrast of U.S. haves and global have-nots prompted one of my clinic patients to ask me, “Is it immoral for me to get a booster?”


As someone who has lived into his 70s with HIV, he had every reason to want added protection from Covid-19. At the same time, he said he did not want to “steal” a dose from someone who needs it more.

As U.S. regulators consider booster shots for Moderna and Johnson & Johnson/Janssen vaccines in the coming weeks, more and more Americans will face the same moral choice.


Here’s what Ashish Jha, a health services researcher and dean of the Brown University School of Public Health, had to say about booster shots:

This is the 2021 version of the age-old American dinner table argument about whether eating all of one’s broccoli will feed starving children on the other side of the planet: Many Covid-19 vaccine doses are already allocated to U.S. pharmacies and health systems, the argument goes, so the choice for Americans is really between using a dose or wasting it.

While refusing booster shots will not help people in low-income countries access vaccines sooner, Americans’ decisions to get booster shots are not entirely divorced from the realities of vaccine equity. Expanding booster shots in the United States — and the other wealthy countries likely to follow suit — will pull more and more vaccine doses to profitable markets and thus away from low-income countries. If the supply remains static, booster vaccine drives in the United States absolutely will delay first-time vaccination in poorer countries, and thus weaken the lifesaving effect of these vaccines.

In the U.S., booster shot recipients are indirectly culpable for the country’s decision to hoard vaccines but unable to offset that moral responsibility by refusing to get a booster shot.

Fortunately, booster shot recipients aren’t helpless in the fight for global vaccine equity. Rather, they should view as a mild and tolerable side effect of the booster shot that now they have a moral obligation to advocate for vaccine donations to low-income countries and commonsense measures to increase global vaccine supply.

It takes just a few minutes to urge one’s congressional representatives to hold the U.S. to its promises to donate more than one billion doses of Covid vaccines to low-income countries. Converting those impressive sounding promises into shots in arms ASAP can save lives in weeks.

Booster shot recipients can also advocate that the U.S. use its bargaining power with vaccine manufacturers to insist that future purchases of vaccine doses for American recipients be contingent on a portion of vaccines being sent to low- and middle-income countries.

Longer-term solutions include pushing vaccine manufacturers to follow Moderna in promising not to enforce Covid-19 vaccine patent rights in low-income countries while the pandemic continues. Relaxed patent protection is one of many steps needed to enable vaccine manufacture in low-income countries.

Booster shots will help my elderly HIV-positive patient stay safer from Covid-19. I commended him for caring about vaccine equity and told him that refusing his shot won’t help anyone. I suggested he sit down with a bottle of acetaminophen after getting his third dose and start making calls and sending emails. When my time for a booster shot comes up, I will do the same.

Tim Lahey is an infectious disease physician and vaccine researcher who leads the ethics program at the University of Vermont Medical Center.

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