Is a ‘Boosters for All’ Strategy the Best Approach?

The resources used to implement a “boosters for all” COVID-19 strategy may be better invested in promoting initial vaccine uptake or increasing access to rapid testing, experts argued.

“Boosters for all” is a costly strategy with comparatively less benefit than alternate strategies to combat the pandemic, such as investment in getting more people vaccinated, expanding rapid testing, or shipping booster doses overseas, wrote Ameet Sarpatwari, PhD, JD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues, in an opinion piece in the Annals of Internal Medicine.

With recent media reports that Pfizer may be applying to the FDA for an emergency use authorization (EUA) for COVID boosters for all adults, Sarpatwari’s group characterized existing booster data as “preliminary and limited.”

“The probability of higher booster uptake in regions with high initial uptake suggest that the magnitude of additional societal benefit with a booster-for-all policy will be small,” they said.

In addition, they noted that while adverse effects of boosters appear to be small, data are limited in younger populations, where the risk/benefit balance may be slimmer.

The group also claims that the U.S. government does not have the resources for “boosters for all,” vaccinating the unvaccinated in the U.S., and global vaccine deployment.

“Tradeoffs are inevitable in both scope and speed of action given limited resources,” they added. “Frequent changes to booster eligibility and requirements also divert resources from simpler strategies that could be more effective for pandemic control.”

While Sarpatwari and colleagues only examined data on boosters for Pfizer recipients, they estimated that 100 million doses will be needed, and the federal government has agreed to purchase 200 million more doses for $24 per dose.

Instead, they proposed the resources be used on a choice of three alternative programs:

Expanding promotion of initial vaccine uptake. Sarpatwari’s group noted that 20% of eligible adults were unvaccinated, and 30% were partially vaccinated. They proposed allocating resources towards “guaranteed paid time off, supporting employer vaccine requirements, and combating misinformation,” adding that, “increasing first or second administered doses will provide greater population-level protection against severe infections and transmissions than boosters.”

Increase access to rapid testing. The authors lamented the current shortage and cost of testing kits, noting how Europe has comparable vaccination rates as well as access to rapid testing. They also pointed out limitations to the testing, such as false-negative results, false positives, and those who test positive not sticking to “recommended precautions.”

Global vaccine deployment. Here, Sarpatwari’s group commented that by distributing the doses reserved for boosters internationally, “the benefits of improving vaccination rates globally would redound to Americans by reducing cross-border spread of COVID-19 and potentially slow the emergence of COVID-19 variants,” they wrote. They also touted potential improvements in global economic activity, helping to reduce “spikes in the cost of food and manufactured goods, and enable travel,” Sarpatwari added.

Mainly, the authors lamented that policymakers have not been inclined to truly assess the costs and benefits of each of these approaches.

“When embarking on any major health program, it is important to consider not only that program’s immediate medical consequences but also the social and economic consequences of that program compared with alternative courses of action,” they wrote.