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Is a COVID booster protection, or profiteering?

Critics call possibility of a third shot for everyone a "moral scandal" and short-sighted with other countries still unvaccinated

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Photo by Gustavo Fring from Pexels
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ROCHESTER, Minn. — The reports on Tuesday , Aug. 17, that the Biden administration may soon recommend universal COVID-19 booster shots has drawn criticism, with some saying that third shots for the healthy would be unnecessary, short-sighted and unethical.

Citing a rising danger and the ethics of global vaccination inequities, the World Health Organization earlier this month called for a moratorium on booster shots among the healthy, a pause until 10% of all other countries have been vaccinated.

“We need an urgent reversal from the majority of vaccines going to high-income countries to the majority going to low-income countries," director general Dr. Tedros Adhanom Ghebreyesus said in a statement released Aug. 4. The White House termed that "a false choice."

In an editorial published Monday, Aug. 16, the influential medical journal BMJ turned up the heat on boosters, saying their sale would constitute "pandemic profiteering" from drugmakers, creating a "vaccine apartheid," and "moral scandal ... tantamount to a crime against humanity."

"Where is the grassroots mobilization of scientists and health workers to fight for fair access to vaccines?" the editorial asked.

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Refuting any knowledge of universal boosters, Minnesota health officials on Tuesday raised similar concerns.

"I would just add, you can look at vaccine equity a little more globally " said Dr. Nathan Chomilo, COVID-19 Vaccine Equity Director for the Minnesota Department of Health, during a media call Tuesday, Aug. 17.

"I don't believe we are going to additional-dose or booster our way out of the pandemic," Chomilo said. "It is really going to prolong the pandemic for us all."

The health official's remarks echoed other calls to direct vaccines globally first, in order to reduce the risk of variants being created in countries without protection from COVID-19.

"Variants are threatened by the vaccine and will mutate the more unvaccinated people exist," said former Biden COVID-19 advisor Andy Slavitt in a tweet published late Monday, before news of the universal booster broke. "If we keep giving the same people the vaccine, we won’t get there."

Like many critics of third dosing, W.H.O. does not oppose the use of boosters among the immunocompromised.

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Last week the Centers for Disease Control and Prevention called for boosters among those who never developed immunity after a standard round of vaccination, a move Mayo Clinic infectious disease specialist Dr. Andrew Badley views as warranted.

Speaking before this week's news, Badley pointed to recent University of Toronto research showing the effectiveness of boosters in raising antibodies among the immunocompromised.

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Dr. Andrew Badley speaks during a press conference after U.S. Sen. Amy Klobuchar toured Mayo Clinic’s COVID-19 labs and received updates on the latest COVID-19 testing, research and innovation Friday, June 26, 2020, on the Mayo Clinic campus in downtown Rochester. (Joe Ahlquist / jahlquist@postbulletin.com)

Badley says that those with certain illnesses are but one of three subsets of breakthrough infections, however, with the others arising among vaccinated persons "who get symptoms of mild illness and test positive," and a third being "asymptomatic vaccinated persons who are given a positive COVID-19 diagnosis after screening of some sort."

"These are not what the vaccines are designed to protect against," Badley said of persons who get breakthroughs and never show illness. "It would be prudent for them to mask and social distance."

The sudden call for boosters comes at a confusing time over the extent and significance of breakthrough infections, with positive diagnoses among the vaccinated sowing fear.

For some, asymptomatic breakthroughs could suggest a so-called "endemic" future for COVID-19 , one in which the virus is a seasonal infection that does not confer long-lasting immunity, but which is not for most a cause for hospitalization.

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Boosters in this view, overextend the job expected of vaccines badly needed for prevention of variants.

"If we think the job of the vaccines should be to protect against severe illness and the development of more dangerous mutations," Slavitt wrote, "then we would boost only most at-risk people."

"People who've not yet gotten their first and second dose, that needs to be the priority along with this very specific group of immunocompromised individuals for whom that third dose is really important to increase their protection," said MDH Commissioner Jan Malcolm on Tuesday.

"For the rest of us, it is not the same level of priority to get the booster ... You can actually do yourself a disservice if you get the booster prematurely, because you'll be wasting protective time for the vaccine's effectiveness."

"We want to make sure we are taking full advantage of the immunity that the first two doses provide people," said MDH Infectious Disease Director Kris Ehresmann.

"This third dose (for the immunocompromised) is different from a booster," she said. "It's not intended to address waning immunity, it's intended to provide an additional dose because these individuals didn't respond to the first two doses."

State health officials stressed they have heard nothing from federal health officials at this time about an anticipated recommendation for a universal third dose.

Paul John Scott is the health reporter for NewsMD and the Rochester Post Bulletin. He is a novelist and was an award-winning magazine journalist for 15 years prior to joining the FNS in 2019.
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