By Ezio Di Nucci.

Make no mistake: boosters work – if ‘working’ means significant reduction in infection, hospitalization, and death in those individuals who receive third doses of an mRNA COVID-19 vaccine. The data out of Israel is so obvious even philosophers can read it.

Let us therefore not confuse calls to avoid or delay boosters like those from the WHO with epistemic considerations about the evidence for boosters’ effectiveness. Pretending that the evidence on boosters is preliminary or incomplete is in fact less progressive than stating the simple truth, namely that we should prioritize those in the global south who have yet to receive any dose over vulnerable patients in rich countries who have already got two doses; and that we should do so despite boosters’ effectiveness.

The alternative suggestion – namely that we should wait with boosters because we can’t yet be confident of their effectiveness (and safety) and in the meantime use spare doses in the global south – is less progressive for the simple reason that it leaves logical room for the conclusion that, were boosters effective, we shouldn’t prioritize the global south; which is normatively absurd whether or not you are a globalist. Let’s just tell it like it is, without mixing ethics with epistemology: for once, neither is very complex, really.

Here there is a not-very-well-hidden lesson on the difference between the liberal left and progressive left: the former sees better chances for obtaining/retaining power in dodging fundamental normative questions. In this particular case, arguing against boosters on epistemic grounds (lack of evidence) rather than moral grounds (prioritizing those most in need).

What the liberal left continues to misunderstand is that Trump didn’t win despite his radical positions but because of them: and that was especially true of big normative questions such as the moral equivalence between one’s fellow citizens and foreigners. The irony being that it was exactly the normativity of both his campaign and presidency that propped up what was easily the most unethical of presidents.

Enough of the politics: going back to boosters, I’ve got the sneaking suspicion that this artificial dilemma between first doses for the third world versus third doses for the first world isn’t the whole story. The early data out of Israel also points towards a fall in the northern hemisphere where even boosters won’t be enough: we will probably need a combination of booster shots and new (old) restrictions. And that is ethically even more embarrassing for the privileged because it points not towards a choice between many people’s lives and some people’s lives but rather towards a choice between many people’s lives and some people’s life-styles – which is just sad.

Was that too quick? Here we go again: there is an established principle of necessity in non-consequentialist moral theory. For example, the doctrine of double effect sometimes allows for unintended harm – given some worthy intention/goal – but only on the condition that there is no comparative alternative; the unintended harm must, in this sense, be necessary. When you apply this principle to boosters ethics, you get the following: boosters might be effective at reducing infection, hospitalization and death without being either necessary or sufficient, which means that deciding to offer boosters to all adults – as the US and other rich countries just did – doesn’t just amount to prioritizing the survival of some of your citizens over the survival of many non-citizens. It amounts to prioritizing freedom for your citizens over the survival of non-citizens. A long winter indeed.

Author: Ezio Di Nucci

Affiliation: Centre for Medical Science and Technology Studies, University of Copenhagen

Competing interests: None declared