St. John's bioethicist calls administration of booster shots a 'real ethical issue'

·4 min read
Daryl Pullman is Director of the Memorial University Centre for Bioethics. He says administering booster shots in developed countries is an ethical issue. (Mark Quinn/ CBC - image credit)
Daryl Pullman is Director of the Memorial University Centre for Bioethics. He says administering booster shots in developed countries is an ethical issue. (Mark Quinn/ CBC - image credit)
Mark Quinn/ CBC
Mark Quinn/ CBC

A professor of medical ethics at Memorial University says while more people are now eligible to receive a COVID-19 booster shot, getting it might be unethical considering the lack of vaccines in developing countries.

Daryl Pullman says giving out booster vaccines is an ethical dilemma.

"Here in Canada, [we] have largely had access to vaccines from the get go and … all those who want to get vaccinated have been," Pullman told CBC News Friday.

"But there are places in the world that simply haven't had access to vaccines at all … From a global justice kind of perspective, it is a real ethical issue about, how do we distribute these vaccines?"

As of Nov. 8, the province has made COVID-19 booster shots available to adults in a variety of categories, including those older than 70 years of age, anyone idenifying as Indigenous, frontline health-care workers who have in-person patient contact and whose two vaccinations were administered in an interval of less than 28 days, and people who received either two doses of the AstraZeneca/COVISHIELD vaccine or one dose of the Johnson & Johnson/Janssen (J&J) vaccine.

With this change, the province follows updated guidelines by Canada's National Advisory Committee on Immunization, which recommends administering booster shots at least six months after the person received the second vaccine. The committee also recommends using one of the two mRNA vaccines, Pfizer-BioNTech or Moderna, for booster shots.

Pullman says the problem of an unequal distribution of the COVID-19 vaccine has been well illustrated by a metaphor by Michael Ryan, head of the emergencies program for the WHO.

"He said it's like throwing another life jacket to people that already have a life jacket on when there are people in the water that don't have one at all. And that's kind of an apt metaphor perhaps for what we're dealing with here," said Pullman.

As developed nations stockpile, others starved of shots

The World Health Organization continues to plead with developed countries to halt the administration of booster shots so that developing countries can receive more of the vaccine.

At a media briefing Friday, WHO Director-General Tedros Adhanom Ghebreyesus asked developed countries to stop administering booster shots to anyone but immunocompromised people.

"It makes no sense to give boosters to healthy adults, or to vaccinate children, when health workers, older people and other high-risk groups around the world are still waiting for their first dose," said Tedros.

According to the WHO, booster shots are administered six times more often than primary doses in low-income countries each day.

"Countries with the highest vaccine coverage continue to stockpile more vaccines, while low-income countries continue to wait," said Tedros.

"This is a scandal that must stop now."

In August, Tedros had already called for a moratorium of COVID-19 booster shots throughout September, citing the unequal global vaccine distribution.

High-income countries, Tedros said on Aug. 4, had administered about 100 doses for every 100 people, while for low-income countries the rate had only been 1.5 doses per 100 people.

Many developed countries such as Germany, France and Israel had started administering booster shots to certain parts of the population at the end of the summer.

Xinhua News Agency/Getty Images
Xinhua News Agency/Getty Images

Canada followed in late September, when NACI recommended booster shots for all long-term care residents.

Aside from the moral question, adds Pullman, halting the distribution of booster shots could also be of self-interest to developed countries.

According to Pullman, the low vaccination rate in low-income countries will most likely prolong the pandemic which might in turn cause new variants to emerge that could then also affect high-income countries.

"From an evolutionary biology perspective, it's more likely that that will happen," said Pullman.

"It's possible that the vaccines that we have now won't be as effective against other variants. So far, we've been fortunate in that respect."

Pullman says while some of the vaccine distribution issues are connected to some countries' inability to adequately store vaccines or to their shortage of medical staff, developed countries have the power to help.

"One of our responsibilities in the … developed world is to be providing the kind of resources for infrastructure and so forth so that we can actually get those vaccines there in a timely manner," said Pullman.

The COVID-19 booster shot, Pullman emphasizes, is different from a third dose which is recommended by NACI to anyone who is immunocompromised.

Pullman says while many seem to be eager to receive a booster shot it might not be necessary for fully-vaccinated healthy adults.

"The evidence doesn't seem to be there yet to say that we need booster shots … The vast majority of us are safe," said Pullman.

"The biggest threat for us in Canada are people who refuse to get vaccinated. That's where we continue to have problems."

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