here's what to do if you're worried about the ethics of booster shots

political conversations about who gets a covid booster shot are often framed as a debate: should people in wealthy countries like canada get added protection, or should first doses be delivered to low-income countries with limited vaccine access instead?it’s strange to be considering a third vaccination when so much of the world remains unvaccinated, and while the virus continues to mutate. but feeling badly about being able to access a booster — turning it down, even — will do nothing to help those who haven’t even had their first, says monique lanoix, a bioethicist and philosophy professor at saint paul university in ottawa.“that’s actually a false dichotomy,” she says. “if you and i were to not get booster shots, it’s not as if they would go to african countries where they’re needed. the issue is far more complex.”in fact, while refusing to get a third vaccine dose may feel like a way to support those in the world without access, lanoix says it is actually the governments around the globe that hold the power to ensure that no one is left behind — a responsibility that requires the pressure of the public by advocating for change with their support and voices, not by turning down a booster shot.

we live with ‘vaccine apartheid’: who

there’s no question that the more people around the world who are vaccinated, the better chance there is to slow the spread — and mutation — of the virus.“if everyone is vaccinated, eventually infections drop to zero and so do variants,“ dr. purvi parikh, an allergist and immunologist in new york, told healthline. “but if the virus has an easy host, such as an unvaccinated individual, then it is easy for it to mutate into a more contagious and virulent form.”the most recent iteration, omicron, is “a natural consequence of being too slow to vaccinate the world,” university of southampton senior research fellow in global health michael head told cnn. “we still have large unvaccinated populations, like we have across sub-saharan africa, and these are susceptible to big outbreaks.”as of this july, according to the journal nature, 80 per cent of the 3.2 billion doses that have been administered globally have gone to people in “high-income and upper-middle-income countries,” including canada, the u.s., the u.k., spain, portugal, south korea, china, and the united arab emirates.and while vaccination rates in those countries range from about 60 per cent (in the u.s.) to 98 per cent (the u.a.e), numbers in lower-income countries are considerably lower. the entire continent of africa, for example — with 1.3 billion people — has only a 7.8 per cent vaccination rate. that average is driven up by remote, wealthy areas like seychelles and mauritius, which have very high vaccination numbers. in south africa, the continent’s country with the highest incidence of covid cases, there’s a 42 per cent vaccination rate, while in kenya and nigeria, it’s six and 1.8 per cent, respectively. and as infections in those countries continue to rise, it’s estimated that six out of every seven cases in the continent aren’t even being detected. tedros adhanom ghebreyesus, director general of the who, went so far as to call the global situation “vaccine apartheid.”

canada’s commitment to access

in a bid to support a global effort to fight the pandemic, canada has donated 87 million vaccine doses intended for low- and middle-income countries, committing to a total of 200 million by the end of 2022.“canada understands that we don’t end this pandemic anywhere until we end it everywhere,” said prime minister justin trudeau, as part of global citizen’s vax live event in may, which aimed to promote vaccine equity. “we will continue to step up, because canada knows we need to be there for each other.”

but lanoix says it’s time to make good on that sentiment. canada has not yet endorsed what she calls “a meaningful commitment” to the idea of supporting equitable access to vaccines, such as waiving drug manufacturers’ trade-related intellectual property rights (trips) so that drug companies like pfizer and moderna wouldn’t hold patents to the covid vaccines they developed. this, in turn, would allow generic manufacturers to produce them, and increase accessibility for lower-income countries.and while lanoix calls for canadians to “pressure local mps and the government to do what they promised,” and points out that according to documents analyzed by the breach, lobbying meetings between pharmaceutical companies and the canadian government increased by 80 per cent over the last year, the government says it’s working on a way forward.canada is “participating in discussions to waive intellectual property protections particular to covid-19 vaccines under the wto agreement on trips,” a government spokesperson told healthing in an email, adding that when the wto’s trips council reconvenes on december 16, canada will “continue to support working towards a consensus-based outcome on the trips waiver.”drug companies, meanwhile, are opposed to the move. they’ve made record profits this year — two moderna executives and an early investor all become billionaires in 2021. fabien paquette, pfizer canada’s vaccines lead, says the opposition is unrelated to profits — vaccines unprotected by patents carry risk, he says.“while striving for a quick win is well-intentioned, the reality is that the real barriers to production have nothing to do with patents,” paquette said in an email. “expanding vaccine manufacturing to organizations without a proven track record and without the necessary skills, knowledge, and expertise to reliably source and manufacture vaccines could result in failures, which would further create concern and confusion about the effectiveness of vaccines.”removing patents would also “discourage the innovation that has been so important to vaccine development in record time,” he wrote, adding that export restrictions, regulatory barriers, tariffs, customs bottlenecks, and vaccine hesitancy all contribute to the low vaccination rates in low- and middle-income countries.

navigating opposition to a trips waiver

waiving trips to increase vaccine access was first proposed to the wto in october 2020, by government officials from india and south africa. the proposal asked the wto “to allow all countries to choose to neither grant nor enforce patents and other intellectual property (ip) related to covid-19 drugs, vaccines, diagnostics and other technologies for the duration of the pandemic, until global herd immunity is achieved.” it has support from united nations, amnesty international and doctors without borders, among other heavyweight groups. and in late november of this year, as omicron emerged as a potential threat, u.s. president joe biden also called to waive international patent rules, citing the importance of vaccine access around the world.“the news about this new variant should make clearer than ever why this pandemic will not end until we have global vaccinations,” he said.the u.k., the european union and switzerland, however, have all come out against the waiver.“fundamentally, we remain to be convinced how an ip waiver, if agreed, would increase the supply of covid-19 goods,” the u.k. government said in a statement in june. “to date, we have still not seen evidence demonstrating intellectual property as a limiting factor in either the production or the supply of covid-19 goods.”

when pressed in a session of parliament, secretary of state for health and social care sajid javid said, “the u.k. does not believe that waiving patent rights, intellectual property rights on these vaccines would be helpful,” adding that it would result in “a huge disincentive” for pharmaceutical companies to develop future vaccines. green mp caroline lucas asked him to “start putting the need to end this pandemic in front of the financial interests of big pharma.”drug companies “got public funding to develop these vaccines,” lanoix says, referring to the nearly usd $2 billion in funding pfizer received from the u.s. government and the german company biontech, which was itself funded by the german government and the eu.“why all of a sudden are they refusing to say, ‘we’ll we’ll take a temporary hit?’ says lanoix. “it’s mind-boggling, really.”

historical precedent for waiving ip: the aids crisis

this wouldn’t be the first time governments debated a waiver on intellectual property to quell a health crisis.in the late 1990s, when hiv and aids cases were spiking in low- and middle-income countries, the hardest-hit country, globally, was south africa. in 2001, 62 per cent of its population — that’s 28 million people — had hiv. treatment with patented medication would have cost about usd$7 billion — 27 times the south african government’s budget for healthcare. but when south africa attempted to bypass patent rules on public health grounds, the government faced lawsuits by a group of 39 drug companies including glaxosmithkline, merck, bristol-myers squibb, hoffman-roche, and boehringer ingelheim.after mounting global pressure from the public questioning the motives of highly profitable drug companies not providing accessible medication to low-income hiv patients, the drug companies relented, making it possible for south africans to buy generic hiv/aids treatment without permission from the patent holders.”we don’t exist in a vacuum,” j. p. garnier, chief executive of glaxosmithklein, told the new york times in april 2001. ”we’re a very major corporation. we’re not insensitive to public opinion.”lanoix credits public shame as the motivating factor that led the companies to drop the lawsuit.“essentially, the companies were shamed into suspending the patent right,” she says. “south africa made a real ruckus: they said, ‘pharma is basically making money off of people dying.'”

if you don’t take the booster, it’ll go to waste

while lanoix gets why some people might be tempted to boycott booster shots until vaccines are more widely available globally — some of her friends have even considered it — she stresses that the decision doesn’t help anyone.“i understand taking the stance, but i think it’s probably more effective to write to one’s mp,” she says. vaccine access “is framed as a personal dilemma, but i think that obscures a really important point, which is that pharma companies have control of this life-saving vaccine.”whether or not the governments of wealthy countries come around to agreeing that waiving intellectual property rights is the key to ending the global pandemic is yet to be seen. what we do know is that as the virus continues to mutate, as many people as possible must be vaccinated if we ever hope to see the end of covid — and in this part of the world that not only means a booster shot, but also a letter to your mp.maija kappler is a reporter and editor at healthing. you can reach her at mkappler@postmedia.comdon’t miss a thing: sign-up for healthing’s newsletter