Should I get a Covid-19 booster shot? Views from a teacher trying to do the right thing
Should I get a Covid-19 booster shot even though I’m young and healthy but work in an occupation that puts me at higher exposure risk? I try to answer this question as a teacher who wants to do the right thing for myself, my students, and people around the world. The short answer is yes, I will most likely get a booster shot in the future, but I will also take action to help those who cannot readily access vaccines.
Disclaimer: I am not a virologist or epidemiologist, but I have a background in biostatistics and have published several papers related to Covid-19 health policy (1, 2, 3). I am fairly certain in my views right now (55–65%); however, I point out a major way that I could be wrong in my thinking. A further update is that my workplace has recommended that faculty members get the booster.
On September 24, 2021, the Centers for Disease Control and Prevention (CDC) announced recommendations for the booster shot of Pfizer-BioNTech’s Covid-19 Vaccine. The recommendation that the elderly and immunocompromised get booster shots is relatively uncontroversial. What is controversial is that the CDC recommended that “people aged 18–64 years at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting” may get booster shots six months after their second dose. Because this category includes teachers, I thought I’d share my thinking on the issue.
As someone who teaches college students in person, I am at higher risk of Covid exposure than someone who works remotely. Although my university requires vaccines and mask-wearing indoors, many students have had breakthrough infections. I had been exposed to those who tested positive for breakthrough infections several times already, despite only one month on the job. On the other hand, I am vaccinated, young, and do not have underlying health conditions: I am very unlikely to be hospitalized if I were to get a breakthrough infection. At the moment, I am doing my best to avoid breakthrough infections (e.g., wearing N95 respirators, avoiding indoor dining), because I have seen that it can make young people — like my students — very sick for weeks.
As I try to make a personal decision, I consider the evidence from a scientific and a moral perspective.
Scientific considerations
Reading the scientific evidence thus far, I concluded that getting a booster shot will likely decrease my being infected with Covid-19 and it is safe for me to get a booster.
The two major concerns that people have regarding Covid right now are 1) waning immunity from the vaccines and 2) the Delta variant being more infectious. The most convincing evidence that the Pfizer-BioNTech boosters are effective is the recent New England Journal of Medicine article that reports a study of 1,137,804 persons 60+ in Israel. Compared with the non-booster group, the rate of confirmed infection was lower in the booster group by a factor of 11.3 and the rate of severe illness was lower by a factor of 19.5. One limitation of this study is that it focuses on those who are 60+, who have weaker immune responses. It could be that boosters are less effective at preventing infections or severe illness in those who are younger and healthier because the two doses are already highly effective for the latter.
I think it is important to consider the scientific evidence apart from the ethical considerations because governmental and medical messaging confuses the two. For scientific communication, getting these muddled messages can decrease public trust. For instance, early on in the pandemic, the US governmental message was that the public did not need to wear masks and masks were not effective at preventing Covid transmission. Public health authorities at the time were worried that the public would hoard masks that medical professionals desperately needed. But now we know that masks are effective at preventing Covid transmission! After all, if masks didn’t work, why did doctors and nurses wear them while treating Covid patients? I think public trust would not be so damaged if the CDC said from the beginning that masks work against Covid transmission but recommended that the public made or bought cloth masks as a stopgap measure.
Ethical considerations
My general reservation about getting a booster is from an ethical perspective. How ethical is it for me to get a booster shot when many people around the world are unable to get their first dose?
As the graph below from Our World in Data shows, many low-income countries have very low vaccination rates. My team’s research has found that the public in low and middle-income countries are more vaccine acceptant than the public in the US but the latter cannot readily access vaccines.
I would 100% donate my booster shot to someone who has not received a single shot yet. But unfortunately, I cannot do that because of institutional barriers (e.g., legal red tape, transport logistics) to the US/US states donating doses. Currently, some US states are throwing out thousands of expired doses of Covid-19 vaccines because of high vaccine hesitancy. This quote from the article really resonated with me:
“I’m angry, upset, disappointed,” says José R. Romero, the Arkansas secretary of health. “As a nation, we’ve worked so hard to get these vaccines out, and not to have them accepted by the public is very disappointing, very disappointing. If you look at it from a global point of view, millions of people are affected by this virus around the world and we’re throwing it away.
From an ethical standpoint, I would be less worried about getting a booster shot if the dose was one that expiring and cannot be donated. For this reason, I am considering getting a dose of the Johnson & Johnson vaccine as a booster shot because of the relatively low demand. (Although demand might increase soon now that Johnson & Johnson recently announced a second dose increases protection against COVID-19 to 94%.) Scientific evidence suggests that mixing and matching different vaccines is safe and can even give greater immunity than two doses of the same vaccine type. Germany has recommended that those who received the Oxford-AstraZeneca vaccine get an mRNA vaccine as their second dose.
One group that did not factor as much into my ethical considerations is unvaccinated people in the US. At this time, 65% of the 12+ population in the US are fully vaccinated. I have arguments that say:
- Why should we be giving out booster shots when so many living in the US are not vaccinated yet?
- Boosters will decrease people’s confidence in vaccines.
I am less worried about these arguments because unvaccinated people in the US have easy access to vaccines. Furthermore, people (particularly those who are vulnerable) should not have to risk their health to change others’ behavior. For example, when I kept wearing face masks indoors after I was fully vaccinated, some people said my behavior was undermining others’ confidence in vaccines. In retrospect, it was a smart decision because I did not get a breakthrough infection during the Delta surge. While I think that everyone in the US should get vaccinated, I do not think my getting a booster is somehow harming them.
Advocating for vaccine equity
If you have further ethical concerns about vaccine equity, I recommend that you take further financial or political action as a type of moral offsetting. In general, I recommend everyone who has received their Covid-19 vaccines advocate for vaccine equity.
In terms of donations, you can donate directly to Gavi (https://www.gavi.org/), the international organization behind the COVID-19 Vaccines Global Access (COVAX) program. COVAX coordinates efforts to buy Covid-19 vaccines for low-income countries. If you are concerned about COVAX’s effectiveness — it is behind on its doses distribution forecasts due to vaccine nationalism — you can donate to charities helping people in countries where vaccines are not readily available. GiveDirectly’s COVID-19 in Africa campaign is still short of its $160 million goal, so they are still looking for donations. Donations will go toward emergency cash relief for needy families in Kenya, Liberia, Malwai, and Rwanda. In terms of political action, you can sign petitions or contact your elected representatives calling the US to donate more doses and to expand vaccine manufacturing capacity.
Where I could be wrong
Once again, I am not 100% certain of my current position. Unlike those who received the Pfizer-BioNTech vaccine, I am not officially eligible to receive a booster as a Moderna vaccine recipient — so I’m in a more gray area.
One way I could be wrong is that the CDC allowing more groups of people to get boosters will induce demand for boosters. We certainly saw that dynamic play out during the early days of the vaccine rollout in the US when people and employers found ways to get ahead in the priority queue. If that’s the case, the increased demand (not only in the US but also in other high-income countries) would mean fewer doses to donate to other countries unless we can expand manufacturing capacity.
Several of my friends pointed out to me that saying “don’t get the booster because you’re exacerbating vaccine inequity” is similar to saying “you better finish eating your dinner because there are starving children in low-income countries.” I don’t think the metaphor is exactly comparable. We can readily grow food than we can manufacture Covid-19 vaccines right now. Furthermore, not finishing dinner is unlikely to induce such a great demand for food that people in low-income countries are unable to buy food.
Unfortunately, at the moment, the CDC has put the moral dilemma of getting a booster shot on individuals by saying that certain workers may get a booster. It is hard for me to know if my getting a booster will directly take away a dose from someone else. But at least I know I can help those who cannot yet access vaccines through my donations and political advocacy.
