The Biden administration’s decision to make COVID-19 booster shots available to millions of vaccinated adults may speak more to the economics of the pandemic than the science.
For the last two months, scientists and federal officials have debated whether COVID-19 boosters are needed — right now, or at all — and, if so, who should get them.
“I think we should be preventing people from getting sick from COVID even if they don’t wind up in the hospital.”
The outcome came last week when the U.S. authorized an extra dose of BioNTech SE
and Pfizer Inc.’s
COVID-19 vaccine for people who are at least 65 years old, adults who have underlying medical conditions, and people who are at increased risk of exposure because of their jobs.
Much of the debate centered on one key issue. If preventing severe disease is the nation’s “top priority,” and clinical data demonstrate that all three of the COVID-19 vaccines available in the U.S. continue to largely protect people against hospitalization and death, why give out extra shots?
“‘The real problem is the unvaccinated. That is where all the infections are coming from. What is much easier is telling a bunch of people who already believe in a vaccine to get [a] booster.’”
— Christina Marsh Dalton, Wake Forest University
“If the scientists are concerned that this is being rushed, and the science is not behind it, I could see that policy makers could be scrambling for anything that would guarantee a normal path forward,” said Christina Marsh Dalton, an associate professor of economics at Wake Forest University. “The real problem is the unvaccinated. That is where all the infections are coming from. What is much easier is telling a bunch of people who already believe in a vaccine to get [a] booster.”
If the administration’s priorities take into account the economy, it stands to reason that shoring up immunity among the vaccinated would make sense as we head further into the school year, more employees return to the office, and families prepare to gather for the winter holidays.
“There’s a big economic case to be made for boosters,” Andy Slavitt, a former adviser to the White House’s COVID-19 response team, said in an interview. “President Biden stated this. If you bring the pandemic to an end more quickly, you open up the economy more quickly.”
Slavitt recently said that giving out boosters to people 65 and older makes sense if the sole goal is to keep people from becoming critically ill. But if the aim is something more along the lines of returning to normal, that’s a differently positioned goal post.
“Are we trying to reduce spread?” he tweeted on Sept. 18. “Symptoms? Keep schools open? Get the economy & jobs back? What about the impact on global equity?”
The economics of boosting
But vaccinated people can still infected and get sick, and they can still spread the virus, even though those so-called breakthrough cases are rarely severe and those individuals usually have smaller viral loads.
“It is an assumption that it’s okay to get infected and to get mild-to-moderate disease as long as you don’t wind up in the hospital and die,” Dr. Anthony Fauci, Biden’s chief medical officer, said Tuesday at The Atlantic Festival. “I have to be open and honest: I reject that. I think we should be preventing people from getting sick from COVID even if they don’t wind up in the hospital.”
If boosting can prevent breakthrough infections, however, that could reduce sick days and quarantine time, and it could help make up for lost productivity at work and school.
“‘President Biden stated this. If you bring the pandemic to an end more quickly, you open up the economy more quickly.’”
— Andy Slavitt
Many well-educated, white-collar workers have been able to do their jobs from home over the last year and a half and therefore aren’t at risk of exposed to the virus at a workplace on a daily basis. But workers in the service industry, for example, where working remotely typically isn’t an option, have had a much more difficult time. “The rest of the economy is not doing fine,” Dalton said.
Businesses “want the pandemic to end and they want to take steps to do it,” Slavitt said. “Otherwise, you’d have it dragging on and on and on under this slow burn and risking further disruption with further waves. And that’s not good for our health. It’s not good for our economy.”
Slavitt estimates that the U.S. could be losing 15 million working hours each week because people are sick or quarantining at home, he said. The European Central Bank’s Christine Lagarde said earlier this month that boosters would be an “add-on” to resolving the pandemic. And Federal Reserve Gov. Lael Brainard, citing government survey data, said Monday that the number of people who are “not working due to either being sick with COVID or caring for someone sick with COVID more than doubled between late July and early September.”
“A lot of policy makers understand that a healthy population is really important for economic growth,” Neeraj Sood, vice dean for research for the USC Price School of Public Policy, told MarketWatch. “If you’re not healthy, you’re unable to work. And so that would make a big difference in terms of how productive people are.”
Sood, whose work focuses on economic epidemiology, said that surges of coronavirus cases often lead to restricted economic activity.
“Consumer confidence goes down. Businesses don’t like uncertainty,” he said. “So if boosters could prevent surges, then there would be an argument for it. But I don’t know if the evidence is strong enough to suggest that boosters prevent surges.”
The limitation to COVID-19 boosters
Infectious-disease and vaccine experts have been saying for months that there isn’t enough clinical data to make the case for widely boosting the population. (To be clear, boosters are available to a much smaller group of people than had been included in President Joe Biden’s initial recommendation back in August that all adults who had received the mRNA vaccines get an extra dose.)
These experts also say that the focus should remain on the more challenging task of persuading the unvaccinated to get a shot.
Federal health officials have acknowledged that distinction.
“Boosters are important, but the most important thing we need to do is get more people vaccinated,” Biden, who is 78, said Monday as he got his booster shot.
But economists still say there are potential downsides to rolling out a booster program at this time. This could include giving another reason for concern to the unvaccinated, some of whom are worried about the speed of the authorization process, corporate pharmaceutical interests, or whether the advent of boosters signals that the vaccines don’t work. The mRNA vaccines carry a small risk of rare adverse events, such as myocarditis among men who are younger than 30. And the vaccinated could take up appointment slots, making it harder for the unvaccinated to schedule or show up for a shot.
“‘We will not boost our way out of this pandemic.’”
— Rochelle Walensky, CDC
“This means that it’s open season for boosters, and we expect vaccination centers, clinics, and pharmacies to be swamped with vaccination appointments for ‘the worried well’ in addition to the truly eligible subjects at increased risk,” SVB Leerink analyst Geoffrey Porges told investors.
The biggest concern for economists is whether the booster program slows down the campaign to get people vaccinated at a time when 25% of people who are eligible for a vaccine have not gotten a single shot and so many people in other countries lack vaccine access.
“Economists talk a lot about the idea of opportunity costs,” Marsh Dalton said. “Once we throw money at boosters, it’s not going toward the unvaccinated.”
This is another point that federal health officials have acknowledged, even as they encourage people who are eligible to get a booster shot.
“We will not boost our way out of this pandemic,” Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Friday. “Infections among the unvaccinated continue to fuel this pandemic rise.”
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