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Ethics behind who gets a booster shot first

This week alone, the president, governor of Colorado, and health officials addressed booster shoots for Americans.

DENVER — A debate around medical ethics is building; just this week alone, the president, governor of Colorado, and health officials all spoke about America moving ahead with boosters while so many people globally have yet to receive their first dose. 

Dr. Anuj Mehta with Denver Health worked with the state on Colorado's vaccine distribution plan. 

"Global pandemic ethics would suggest we should really try to get everyone in the world vaccinated," said Dr. Mehta, "It has benefits to us, for people in the U.S. We know a lot of variants come from countries were vaccination rates are a lot lower. On the flip side, just shipping vaccines to other countries when they don't have infrastructure to provide or necessary direct access to their populations is not the best idea. A lot of times if we ship vaccines it might just sit on loading docks if they don't have infrastructure."

If that's the case, Dr. Mehta said that helping countries with their vaccine distribution systems would be critical. 

So far, the federal government said they've delivered 127,735,610 to 88 countries and purchased more for the same cause. 

The doses come from the U.S. surplus supply while securing enough for Americans. 

The U.S. is also working with U.S. vaccine manufacturers to increase vaccine supplies for the rest of the world. 

But ethically, is it enough when the World Health Organization said 80 percent of doses have gone to upper and middle-income countries, while America talks booster shots. 

"We continue to do a lot at the global level and at the same time need to enhance and improve protection in the U.S.," said Dr. Bechara Choucair, the White House Vaccinations Coordinator, "That's why our public health experts and medical experts are recommending people will eventually need a booster shot. We will need to wait for the FDA and CDC for a final determination. From our perspective we have enough doses, enough distribution channels and right distribution channels. The day the FDA and CDC said we are ready, here are the people who need a booster and when, we will be ready to execute." 

The Colorado Department of Public Health and Environment said between May 21st and June 10th; the state donated 199,780 doses of Moderna and 100,620 doses of Pfizer to the federal pools of vaccines. This was from doses allocated to Colorado but not yet in the inventory. They said federal authorities decided where the doses go. 

CDPHE said the state had enough supply to meet the demand and that those doses were then redistributed nationally. 

After June 10th, states were able to order what they needed, when they needed it, and the state is using its existing inventory to meet vaccination needs across the state and don't expect a surplus. 

Professor Ricardo Gonzalez-Fisher, a professor of bioethics at MSU Denver, said the debate over vaccine equity started in 2020 as richer countries started buying and stockpiling vaccines. 

"In this moment," he said, "There is polarization in the world. It's difficult for authorities to convince people they need to share vaccines with someone else." 

Professor Gonzalez-Fisher also said this isn't his first pandemic. 

He was living in Mexico during the H1N1 outbreak in 2009. 

"We were expecting to get vaccines, where ever they came from, because we needed them," he said. 

He reflected on lessons learned and lessons that still seem to be missed. 

"We haven't learned as much as a society as we should about taking care of each other," he said. 

Dr. Mehta, who works in the ICU, said it makes a lot of sense to give boosters to people at a higher risk. 

"Providing booster shots to certain people at risk for severe disease is really high," he said, "Older individuals, people living in congregate settings like nursing homes and health care provider - it makes a lot of sense." 

But when it comes to boosters for the general public, he said those decisions should be made based on good science and will be up to the FDA and CDC, especially since being fully vaccinated does provide a lot of protection against COVID-19. 

As for immediate supplies for booster shots, Dr. Mehta said it's not a huge pool of people. 

He said if you go back six to eight months in Colorado, the initial group of highest risk folks were getting their shots, including health care workers, first responders and people living in nursing homes. 

And the general public started getting their vaccines several months later. 

In a response from CDPHE, they said: 

"Some immunocompromised people, as defined by CDC, are eligible for an "additional" dose of COVID-19 vaccine now because they likely did not mount a sufficient immune response to the initial 2-dose mRNA vaccine series. "Boosters" are additional doses administered to people who likely mounted a sufficient immune response after the completion of the initial series but whose protection may have waned over time. 

Right now, Colorado advises vaccination providers across the state to offer an additional dose of the Pfizer-BioNTech COVID-19 Vaccine or the Moderna COVID-19 Vaccine to moderately to severely immunocompromised Coloradans per FDA authorization and ACIP approval. Coloradans who are eligible for an additional dose should be able to access them immediately at enrolled state and federal vaccine providers. Coloradans may self-report their moderate to severe immunocompromising conditions to vaccine providers in order to get an additional dose. Vaccine providers who are providing additional doses to immunocompromised individuals are ordering the amount of vaccine they need to serve this particular population.

 

The state is currently in the planning stages of booster rollouts in Colorado. We are expecting more information from the federal government about boosters."

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