The U.S. government’s Covid-19 vaccine funding may have to shift from a model of free shots for all to one in which the government only subsidizes boosters for targeted populations, public health analysts say.
Annual Covid-19 boosters for all Americans, tailored to the prevalent virus strain, would cost billions of dollars each year and may not be the most sustainable and effective path in responding to future variants. Analysts say reserving booster recommendations to those most at risk would be more cost-effective.
“Given the much greater expense of Covid boosters compared to flu shots and the time needed to revise and manufacture Covid vaccines, we need to hope we won’t need annual shots,” said Diana Zuckerman, founder and president of the National Center for Health Research.
It “would make sense to prioritize by focusing efforts to persuade and administer boosters to those most likely to benefit,” she said.
If the Biden administration were to purchase enough second-round booster doses for all eligible Americans, it would need to secure as much as $9.4 billion in additional funding, according to a Kaiser Family Foundation analysis.
A $10 billion request from the White House to purchase additional vaccines and therapeutics is stalled in the Senate amid objections to the Biden administration’s decision to reopen the U.S.-Mexico border to asylum-seekers. The funding impasse is expected to remain at least until Congress returns at the end of April following a two-week recess.
Booster Price Tag
Targeted booster campaigns could help better prepare for a situation in which boosters switch to a payment model similar to the one used for flu shots, analysts say, in which insurance covers it or those who are uninsured pay out of pocket.
“The provision of vaccines on a long-term basis is probably going to devolve back to our fractured private and public sectors, instead of being paid for exclusively by the federal government,” said Brook Baker, a professor at Northeastern University School of Law and a senior policy analyst at Health GAP, an advocacy group focusing on equity in access to HIV medications.
Health policy watchers say the general population could need additional boosters if more infectious and deadly variants emerge. But existing evidence on booster efficacy and the price tag for shots in every American arm means the federal government should prioritize updated vaccines for older and immunocompromised people, and vulnerable populations elsewhere, they say.
The FDA announced late last month that adults ages 50 and older, and certain immunocompromised individuals, could get second booster doses of the Covid-19 vaccine from
Members of the Food and Drug Administration’s vaccine advisory panel said in a meeting April 6 that the agency’s future plans for responding to additional Covid-19 variants could include routinely reviewing the epidemiology of new variants in the U.S., as well as consulting with drug manufacturers and public health agencies to provide clinical data on the need for additional shots.
Research reviewed by the FDA and its vaccine advisory panel showed that there is a roughly 20% chance of another “omicron-like” event in the next 12 months. Pfizer and Moderna are currently working on
Lower infection severity among younger populations, and waning enthusiasm for additional shots support an approach of prioritizing older and other higher-risk Americans in booster campaigns, analysts say.
“We are likely to only boost those who are vulnerable every year against COVID-19, unless we get a more deadly variant, in which case we will all need a booster shot that year,” Monica Gandhi, an infectious disease doctor and professor at the University of California, San Francisco, said in an email.
Gandhi argued that the U.S. should follow the example of countries like Germany and Sweden, which have only recommended fourth doses for adults ages 70 years and older. She cited an Israeli study that didn’t show a fourth dose substantially benefited health-care workers under the age of 65.
“The need for further doses of the vaccine to boost antibodies will depend on clinical characteristics of the individual that may predispose to severe breakthrough infections,” like underlying health conditions, Gandhi said.
Only 45% of fully vaccinated Americans have received a first booster dose so far, according to CDC data. “The administration should not assume that everyone needs boosters now or will get them even if they need them,” Zuckerman said.
Purchasing doses at levels higher than existing demand would also mean unnecessary waste, Gandhi said. “Shots do expire, so purchasing them and having them go to waste is a waste of taxpayer money,” she said.
Instead, the administration could wait on additional research on multi-variant vaccines in development before recommending additional boosters to lower-risk people, Baker said.
“It’s a question of balancing current risks and against the possible benefits of recalibrated vaccines,” Baker said.
Policy analysts also see a situation in the future in which the federal government no longer purchases doses directly from Pfizer and Moderna.
Providing boosters via health insurance, though, could exacerbate existing health inequities, said Leighton Ku, director of The George Washington University’s Center for Health Policy Research. “What’s terrible about Covid, and frankly speaking so many diseases, is people who are poor and vulnerable get hit the hardest.”
“I’ve always worried that the people who are uninsured are people who are low income and who are more vulnerable in so many ways,” Ku said.
A more effective response to future variants should also prioritize speeding up vaccination campaigns around the world where high transmission can lead to new variants emerging, policy watchers say.
“The administration has to support broad, accelerated vaccinations globally to help prevent the development of future variants,” Baker said. He added that the White House “also has to help support test-to-treat strategies globally.”
“There is new evidence that antiviral treatment lowers the viral load and shortens the period of infectivity, reducing both the risks of disease transmission and the risk of new variants mutating within infected people,” Baker said.
The International Monetary Fund estimated that in order to keep Covid-19 in an endemic state, the international community should devote $10 billion annually to fighting pandemics and strengthening health systems across the globe.
Even if health officials determine boosters are not needed for everyone right now, the Biden administration should be ready well ahead of time to respond to future variant surges, Ku said.
“It’s smart to be prepared for these things and to have adequate resources and ongoing research and sort of manufacturing plans set up to do that distribution,” he said.