Doctors Divided About Need for COVID-19 Boosters: Poll

“The evidence is definitely looking like those who are immunocompromised are needing boosters at this time,” said Priscilla Hanudel, MD, an emergency medicine physician in Los Angeles, California. These include patients older than 70 and those taking certain drugs, such as immunosuppressors or chemotherapy drugs. “It does look like antibodies are going to wane in the general population,” she said. “The general population is well protected from severe disease, but in the next few months, it will probably be worthwhile to boost everyone.”

The US Centers for Disease Control and Prevention reports that more than 14,000 breakthrough infections in vaccinated people have resulted in hospitalization or death. Gandhi says researchers need to stratify those results on the basis of age, preexisting conditions, and other immunocompromising factors. Beyond that, “population studies have not shown a decrease in protection against severe disease across multiple countries,” she said.

Among nonclinicians, a survey of 506 WebMD readers taken August 26–28 found that 59% of respondents believe the evidence supports giving boosters to fully vaccinated Americans; 20% disagreed, and 21% said they were unsure. Again, responses varied by age. Two thirds of respondents aged 45 and older believed the evidence supports boosters, but only 50% of respondents younger than 45 agreed.

When asked whether they think it’s ethical for the United States to use its stock of COVID-19 mRNA vaccines to give vaccinated Americans booster shots while many around the world have not received any vaccines, 61% of physicians said yes, 26% said no, and 12% were unsure. Nurses were more likely to say giving out boosters was unethical (36% said so) or that they were unsure (17%). Among physicians based outside the United States, 62% said it was not ethical for the United States to give mRNA vaccine boosters.

Female physicians were almost twice as likely as their male counterparts to say it was not ethical to give boosters to Americans (38% compared to 20%). Sixty-nine percent of male physicians said giving boosters was an ethical choice, in contrast to 47% of female physicians.

Gandhi says prioritizing boosters for Americans, rather than donating vaccine to other countries, isn’t the ethical decision and that, from a geopolitical perspective, the optics aren’t good. Because protection against severe infection appears to remain strong in fully vaccinated people, “there could be an argument made that we are protecting Americans from cold-like symptoms” by giving a third dose, Gandhi said. Healthcare workers and others in vulnerable settings are dying of COVID-19, she said. “The optics of that are terrible,” she noted.

In her Los Angeles emergency department, Hanudel says, they are seeing very few severe breakthrough infections among vaccinated healthcare workers despite the fact that they are regularly exposed to the virus (the healthcare workers wear masks). Anecdotally, that points to the robustness of two doses of the vaccine without a booster, she says. More important than providing a third shot for the fully vaccinated “is for the unvaccinated to get those first two doses,” she says.

Donavyn Coffey is a freelance journalist who covers health and the environment from her home in the Bluegrass. Her work has appeared in Popular Science, Insider, and SELF.