COVID-19 booster vaccines will be available in the U.S. beginning the week of Sept. 20, health officials announced on Wednesday.

People will become eligible for the booster eight months after they received the second dose of the Pfizer or Moderna vaccines.

The concern for waning vaccine immunity has been growing since mid-summer, leading to the formulation of plans for making booster shots available.

In early July, the U.S. purchased another 200 million doses of the Pfizer vaccine, and on Aug. 12, the Food and Drug Administration (FDA) authorized a third vaccine dose for immunocompromised individuals, such as patients receiving chemotherapy or recent solid organ transplants.

The Israeli Health Ministry reported on July 5 that the Pfizer vaccine’s symptomatic effectiveness dropped to 64% but was still 93% effective at preventing hospitalizations and death.

Albert Bourla, Pfizer’s CEO, reported on July 28 that their mRNA vaccine’s effectiveness dropped from 90% to 84% after six months, emphasizing that it was still extremely effective at preventing hospitalizations.

Russia and Indonesia were the first nations to provide booster shots. In early July, Indonesia began providing them to health care workers and Russia started offering them to individuals who were vaccinated at least six months prior.

Israel has been administering a third dose to people over 60 since Aug. 1, while the U.K. and Germany are expected to begin giving booster shots in September. Finland, France, Switzerland and South Korea are all expected to follow suit.

All of this is happening in spite of the World Health Organization’s plea for a booster shot moratorium among wealthy nations so as to distribute vaccines to countries whose citizens still need to receive a first dose.

The move toward widespread use of booster shots presents two problems.

First, the science is not clear.

For patients who are not immunocompromised, it is unclear how long the Pfizer and Moderna vaccines impart immunity, or how much immunity a booster shot would provide.

This decline in symptomatic effectiveness parallels the rise of the Delta variant in Israel and the rest of the world. Based on this, it is difficult to confirm that the issue is waning immunity or the rise of a new variant.

Therefore, it is unclear that a booster shot not tailored to the new variants would impart additional immunity to an individual with a normal immune system or how much more effectiveness it would provide.

As the vaccines are still highly effective at preventing hospitalizations and death, all of this seems premature. Therefore, more research and data analysis needs to be done.

Second, 80% of the over four billion vaccine doses administered so far have gone to high income countries that comprise only half the world’s population.

These countries have given at least one dose to over half their citizens – and in some countries, like the U.S., vaccine resistance, not availability, is the main concern. By contrast, low-income countries have been able to distribute fewer than 1.5 doses per 100 people.

Many wealthy nations are already ordering doses for 2022, even while they have stockpiles of vaccines about to expire. Meanwhile, in lower-income nations, they have been unable to begin mass vaccination, illustrating a grave injustice caused by the hoarding of affluent nations and by those who refuse to be vaccinated with the available supplies.

Nature reported in July that 11 billion doses would be needed to vaccinate 70% of the world’s population. At the current rate, the world would be vaccinated no sooner than late 2023.

Meanwhile, COVID-19 is running rampant through poor countries.

The Republic of Congo saw cases rise 40% in the middle of July. Other African countries, like Uganda and Ethiopia, are facing their own surges.

Nations in Africa collectively only received 18.2 million of the 66 million doses that were pledged to the non-profit organization COVAX. This is nowhere near what is needed for the continent of 1.3 billion people.

For the U.S. to talk about booster shots when we have already consumed over 350 million doses and when thousands of doses are being thrown away as they expire is insulting to those who have been unable to receive their initial vaccinations.

Herein lies the moral dilemma: Is it appropriate for affluent countries to already be acquiring booster vaccines not yet proven to impart additional immunity when so many people have not received their initial vaccination against COVID-19?

From both a pragmatic and a moral perspective, the answer is clearly, “no.”

This is intensified when we are reminded that even if the mRNA vaccines are less effective at preventing symptoms of the Delta variant, they still are over 90% effective at keeping people alive and out of the hospital.

Affluent countries often forget how wide the disparities are in health care systems.

For example, when we talk about a nursing shortage, we are often referring to low nurse to patient ratios. When poor countries talk about a nursing shortage, they are talking about no nurse for 15 miles or more.

We assume that when we go to the emergency room that there will be enough ventilators, dialysis machines and surgical staff. We complain when we have to drive an hour for treatment or wait too long to receive care.

Poor countries lack adequate supplies, such as antibiotics, and frequently patients will have to walk for hours to seek help. For that matter, many of the poorest countries cannot assume there is even a hospital or emergency room anywhere nearby.

For lower-income nations, vaccines are more valuable than they are for rich nations where booster shots are primarily about avoiding symptoms. For poor nations, they’re seeking initial vaccines to save lives.

It is greedy, and shameful, for rich nations to focus on booster shots without considering how valuable those doses are to the rest of the world.

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