Why I’m Embarrassed to Receive a COVID Booster

I ought to be pleased that I am eligible for a COVID booster shot—being an old-enough citizen of one of the world’s highest-income countries. But my first and lasting reaction to the new availability of boosters in the US is to be embarrassed to be an American. Embarrassed that my country is moving to boosters while huge majorities of people in lower-income countries cannot get a first shot, and chagrined that my mostly liberal friends and neighbors—even those acutely concerned about injustices here at home—are not registering the deep injustice of our country’s vaccine nationalism. Embarrassed that the Biden Administration apparently decided to go ahead despite the plea of the WHO in September that rich countries delay administering boosters until the end of the year.

Obviously, an ethical vaccine distribution would start with a far more equitable sharing of vaccines between rich and less-rich nations. More pragmatically, the current huge imbalance in the global distribution of shots invites another outbreak of a new variant, against which the US and other high-income countries cannot insulate themselves.

Like my colleagues, family members, neighbors, and friends, I’m deeply worried about the state of America: the attacks on voting rights, the persistent resistance to vaccination against COVID within some quarters; our flawed criminal justice system; our high rates of child poverty; our world-topping emissions, in per capita terms, of greenhouse gases.  

I just wish they and other Americans could manage at one and the same time to worry about the challenges we face at home and the continuing suffering and loss of life (and livelihoods) that COVID is bringing to the great majority of the world’s poor people living in the developing world. If more Americans were worrying about suffering abroad, there would be greater pressure on the Biden administration to share our vaccine good fortune.

It’s not that I’m a better person. It’s that as the first president of the Center for Global Development, I’ve been thinking about the human and economic costs of nationalism for a long time. Since its founding, CGD has nudged the US and other high-income countries to do better for the world’s poor and vulnerable living in low-income countries. For me, vaccine nationalism is just one more symptom of our nationalist instincts.

It is also another reminder of the risks to America our nationalism entails. Twenty years since 9/11, even with Afghanistan again in the news, most Americans haven’t connected the dots— that what happens out there can come back to haunt us here. Americans who feel embarrassed about leaving Afghans who counted on US promises in the lurch don’t see the connection to the risks of our vaccine nationalism—nor to the risks of failing to help India and South Africa switch out of coal to solar much faster—for our sake.

Here are the facts on vaccine sharing. Only about 4 percent of people in Africa have been fully vaccinated. In July of this year, only 1 percent of people in the World Bank-classified lowest-income countries had received their first shot, and “most people in the poorest countries will need to wait another two years” before being vaccinated, even taking into account pledges by higher countries of new money and vaccines.

The Biden administration has contributed $4 billion to COVAX, the international program to ensure low- and middle-income countries get help with vaccine purchases, and pledged this year to provide one billion doses (two doses for 500 million people), and $750 million toward the costs of distributing vaccines in the next two years. But COVAX has not had the market power to compete with national procurement programs like the $12.4 billion Operation Warp Speed, and donations of doses by developed countries have as yet been insufficient to meet COVAX’s initial goals.

Moreover, these contributions are in the tradition of the US government resorting to “aid.” Aid is a band-aid that covers up the deep structural injustice that an unequal global system perpetuates; that the powerful US pharmaceutical industry prefers the profits they are piling up selling booster shots to the US government and other rich country purchasers. Our fundamentally nationalist mindset means the Biden administration has no appetite, beyond “aid,” to push for a truly global agenda to vaccinate the world.

A global agenda would mean pressing for intellectual property waivers, to push US vaccine producers to share their property rights and know-how with manufacturers in countries such as India, Brazil, and South Africa, and encouraging those countries to issue compulsory licenses, as allowed by the WTO, for use of those rights. (Pfizer and BioNTech have an arrangement to coproduce vaccines with Brazil, but will not share their RNA technology.) It would mean not hoarding at home the capacity to manufacture vaccines as well as the vaccines themselves. Manufacture of the new RNA vaccines can be copied; waivers and licensing, by reducing legal and regulatory uncertainty in middle-income countries, would speed up development of local capacity to do so.

Of course there are arguments for doing boosters at home. Recent data from Israel suggests notable percentage reductions in infections and severe disease for people who received boosters versus those who have not. But those benefits pale compared to the benefits in lives saved and livelihoods restored across all countries of making two doses available, by sharing the intellectual property rights, fixing supply chain problems, and providing technical support to local public health officials in low- and middle-income countries in building the infrastructure of rapid implementation of vaccine programs.

The benefits might well pale even taking the selfish, narrow, “nationalism” approach, given the risk of new COVID variants arising in huge unvaccinated populations, as with the Delta variant, that could come back to haunt the US itself.

I’ll get the booster; my not getting it wouldn’t result in one more dose being sent abroad. But I can’t help feeling selfish and unduly privileged. That’s the rub.