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Tuesday, October 26, 2021

The prospect of booster shots is igniting a global health debate.

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As the Delta variant rages around the world, a heated debate has arisen over whether public health officials should recommend booster shots.

On one side are global health officials who contend that available vaccines would be better used to inoculate high-risk people in poor nations where few have gotten the shots.

On the other are leaders and health officials in wealthier countries, who are setting aside doses for more vulnerable people who may need additional doses to protect them from the virus.

Biden administration officials have already begun developing a plan that would roll out third shots of the Pfizer and Moderna vaccines as early as this fall, saying the logistics are too complicated to wait for scientific certainty that the extra doses are really needed.

Full vaccination is highly effective at protecting against severe disease caused by the virus, and it is not yet clear how soon additional doses might be necessary for certain groups. Some vaccines require boosters to remain highly protective.

In the United States, federal officials last week authorized a third shot of the Pfizer and Moderna vaccines for people with compromised immune systems because of organ transplants, chemotherapy or other medical conditions.

But officials at the Food and Drug Administration and the Centers for Disease Control and Prevention have said that authorizing third doses for immunocompromised people was a separate issue from whether booster doses were needed for the rest of the population.

Pfizer and BioNTech have pushed for swift authorization of third doses of their vaccine, but U.S. officials said in July that they would need more data, possibly months’ worth, before they could answer the question. On Monday, the companies announced that they have given the F.D.A. data from phase 1 of their clinical trial indicating that a third dose was safe and significantly bolstered the immune response of recipients against the virus, including the Delta variant.

Some individuals are taking matters into their own hands. Just over a million people who received a two-dose vaccine in the United States have already received a third dose, Dr. Kathleen Dooling, a C.D.C. official, said on Friday. It was not clear how many were immunosuppressed.

Some nations, including France, Germany and Israel, have authorized booster shots for older people. Israel said on Friday that it was lowering the age of eligibility for a third dose to 50.

Officials from the World Health Organization argue fiercely that booster programs will further deprive lower-income countries of desperately needed vaccines.

Leaving large swaths of the world unvaccinated, W.H.O. officials say, is wasteful, shortsighted and gives the virus enormous latitude to mutate into potentially more transmissible or virulent variants.

International vaccine distribution has been wildly unequal. Many countries in North America and Europe have at least partially vaccinated more than half of their populations, compared with barely more than 4 percent of Africa’s population, according to the Our World in Data project at Oxford University.

At a briefing this month, the W.H.O.’s director general, Dr. Tedros Adhanom Ghebreyesus, called for richer countries to stop giving third doses until the end of September. “We cannot — and we should not — accept countries that have already used most of the global supply of vaccines using even more of it, while the world’s most vulnerable people remain unprotected,” he said.

In an essay in the British newspaper The Guardian on Friday, Andrew Pollard, the director of the Oxford Vaccine Group at the University of Oxford, and Seth Berkley, the chief executive of Gavi, a global vaccine alliance, said that there was not enough evidence yet to enable a decision on boosters.

“Large-scale boosting in one rich country would send a signal around the world that boosters are needed everywhere,” they wrote. “This will suck many vaccine doses out of the system, and many more people will die because they never even had a chance to get a single dose.”

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