The Booster Question

Momentum around booster shots is building in some countries. Does the U.S. need them?,

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As the Delta variant continues to spread — and breakthrough infections are occurring among vaccinated people — momentum is building in some rich countries for giving additional doses of a Covid-19 vaccine to some fully vaccinated people.

Germany, following Israel’s example, said this week that it would start offering booster shots to some higher-risk citizens. France, Russia and Hungary are doing the same. Britain has already purchased 60 million extra Pfizer vaccine doses in case vulnerable people need a third shot this fall.

At the same time, billions of people around the world continue to wait for their first dose.

Do we need booster shots? Here are some answers, with help from The Times’s Apoorva Mandavilli, who has been covering the pandemic.

Scientists aren’t in agreement about whether we need boosters.

For now, the U.S. isn’t following those countries’ leads. Instead it’s saying that for people who are fully vaccinated, an additional dose is not necessary. Not yet, anyway.

Most studies indicate that immunity from mRNA vaccines, like Pfizer’s and Moderna’s, is long-lasting. Recent data from Israel suggested a decline in efficacy of the Pfizer vaccine against infection after a few months. “I would go tomorrow to get the third shot,” Dr. Gary Simon, a George Washington University infectious disease expert, told The Atlantic last week.

But the effectiveness of preventing serious illness remained extremely high, according to the data.

Preventing infections isn’t the primary aim of the vaccines, Apoorva explains, even though they protect against that as well. “They were designed to prevent hospitalization and death,” she says, “and they’re doing that very well.”

At the moment, Apoorva told me, the only people who seem to need extra shots are those who are immunocompromised. In the U.S., that is 3 to 5 percent of the population, some of whom will not produce a strong immune response from a vaccine.

“They’re not fully protected right now,” Apoorva says. A third shot could offer them the immunity most people get from two shots.

A lot of scientists believe that shots should first go to unvaccinated people in poor countries — including health care workers and older people — rather than giving boosters to people who are unlikely to get very sick. Sending shots abroad has humanitarian benefits, Apoorva explains, but also scientific ones: If fewer people around the globe get the virus, it makes it harder for new variants to evolve.

The government, too, isn’t entirely sure about the issue.

Last month, Dr. Anthony Fauci said people didn’t need boosters yet, given that more than 90 percent of people being hospitalized with Covid were unvaccinated.

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Credit…By The New York Times | Sources: Governments and health agencies; U.S. Census Bureau

But Biden administration officials increasingly think some vulnerable populations (such as people 65 and over and people with compromised immune systems) will probably need extra doses.

The administration has already bought enough vaccine to deliver third doses of Pfizer and Moderna if needed, The Times’s Sharon LaFraniere has reported. It has also sent almost 112 million shots to other countries.

Pfizer, which is a for-profit company, has been making its own case for booster shots. Last month, the company reported that the power of its two-dose vaccine wanes slightly over time, but continues to offer lasting protection against serious disease. “It’s in their interest to say third doses are required,” Apoorva says.

It’s also more profitable to sell vaccine doses to countries like the U.S., which pay more money for the shots than poorer countries could. Pfizer and Moderna both recently increased the price of their vaccines in new contracts with the E.U.

There’s also some anecdotal evidence of people getting third shots in the U.S., even though the government doesn’t recommend it at the moment. (One San Francisco hospital is offering a supplemental shot to residents who got the one-dose Johnson & Johnson vaccine.)

“I see it on social media all the time: people saying, ‘I was worried so I just went to the CVS and got a third dose,'” Apoorva told me. But, she added, right now there’s no need — so far the “evidence tells us it is not necessary.”

We will keep following the questions around booster shots, and if anything changes we will update you in a future newsletter.

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Thanks for spending part of your morning with The Times. See you tomorrow.

P.S. A fire destroyed downtown Spokane, Wash., 132 years ago. The wind-driven flames “spread with fearful rapidity. The firemen were powerless,” The Times reported.

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Lalena Fisher, Ian Prasad Philbrick, Tom Wright-Piersanti and Sanam Yar contributed to The Morning. You can reach the team at themorning@nytimes.com.

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