Famed magician Harry Houdini never invented any of his magic tricks, he merely perfected the execution.
The tricks came from elsewhere, from struggling magicians incapable of Houdini’s showmanship. But when Houdini performed those tricks, he executed them to perfection. And through his execution, he obtained ownership of the tricks in the enamored eyes of the public.
This phenomenon is not unique to magic tricks. We see it throughout society, from startup entrepreneurs to professional athletes. We value execution over ingenuity – the ability to do something well over the ability to invent something new.
And this most American of attributes explains our stance on COVID-19 vaccine boosters, coloring our perspective on the science, politics, and ethics of booster shots.
The science is clear, acquired immunity from the vaccine wanes over time, but there is no evidence to suggest waning immunity leads to an increase in complications comparable to an unvaccinated baseline. We make that inference.
And with all things science, the facts are colored by the politics. Political leaders know full well the optics of the pandemic – and its impact on the upcoming elections.
Politicians use the science to suggest waning immunity, along with the surging number of cases from viral variants, justifies booster shots for the American public.
A stance that prompts an ethical quandary – should Americans receive a third booster dose while many in the world have not yet received one vaccine dose?
As of August 19th, 24% of the world is fully vaccinated, as per the organization, Our World in Data. A marked increase from just weeks ago, but a percentage that pales in comparison to other parts of the world that have upwards of 50-60% vaccination rates.
The United States sits squarely at 52%, straddling an entrenched divide between those vaccinated and those unvaccinated. A divide that mirrors the growing divide around the ethics of a booster shot.
“It’s really inequitable and it’s not in our interest because you’re leaving much of the world unprotected, where you’re going to have the emergence of other variants. I feel like this is very short-term thinking. It’s very individualistic, nationalist thinking”, former Biden COVID-19 advisor Céline Gounder said.
“If we want the vaccine to protect us [United States] against symptoms and transmissions, then we do so at the cost of others around the globe & the cost of future variants,” another former Biden COVID-19 advisor Andy Slavitt tweeted.
At the heart of the ethical debate is an opportunity cost. We have a fixed amount of available vaccines, and every vaccine that goes to an American does not go to someone else in the world.
We can call out the international vaccine distribution system as being inefficient, but clearly people around the world are fully vaccinated – one out of every four people.
We can warn of heightened infectivity rates with the delta variant, but countries with higher vaccination rates, like Britain at 62%, were still ravaged by a wave of delta variants.
So it is less an issue of global access or changing infectivity, and more of an opportunity cost.
We choose ourselves – justifiably so. Self-preservation is fundamental to most ethical systems. And forms the basis through which politicians use science to justify booster shots.
Policy experts at the White House emphasize the additional transmission risks posed by the viral variants, even among the asymptomatic and mildly symptomatic – making the specious claim that additional immunity can reduce the risk of hospitalizations or of debilitating complications.
While plausibly true, the science has not shown this to be true conclusively. But in the ethics of self-preservation, it is better to be safe than sorry – even when what we perceive to be safe may not be scientifically accurate.
Ethics is circular in this regard. What we originally believe, we subsequently justify. And what we justify, we seek to prove through science. And what the contrived science says, the politicians echo.
In the end, it is less about the science, the politics, or even the ethics – it is about the execution.
Regardless of how we posture the mortality of boosters, how we execute the booster shots will determine whether we are able to curb the impending tide of variant mutations – and accordingly, how we will judge our current decisions in the future.
Per capita national health expenditures from 1960-2020
The data categorizes expenditures as national health expenditures, health consumption costs, personal health costs, administrative costs, and public health activities cost.
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group; U.S. Department of Commerce, Bureau of Economic Analysis; and U.S. Bureau of the Census.