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The Ethics of a Third Dose: Covid-19 Vaccinations

By: Jade Ellis

What is it?

The third dose of the mNRA COVID-19 vaccine is chemically identical to the previous two doses. The aim of the third dose is to help protect those with severely weakened immune systems, who did not receive sufficient protection and still remain vulnerable after the first two doses. This is available to eligible persons as little as 28 days after the second dose has been administered.

Note: The mNRA vaccines are a new type of vaccine that triggers an immune response through the creation of spike proteins, rather than using the live COVID virus. Currently Pfizer and Moderna are the only company’s creating this new vaccine type.

The difference between the Covid booster and the third dose:

In contrast, the Covid booster shot is an additional vaccine given, when immunity from the initial dose(s) has started to show signs of waning. The booster shot is seen as a ‘top-up’ to help maintain immunity levels for longer, whereas the third dose is counted within the regular vaccine series for immunocompromised persons.

For healthy individuals, the initial two doses would provide a sufficient level of protection against the COVID strain, with the only issue being the decreasing immunity levels overtime. Currently, only Pzifer, AstraZeneca and Moderna have been approved as booster vaccines

Who is eligible?

In the UK:

The Joint Committee on Vaccination and Immunisation has recommended that those above the ages of 12 with; severe immunosuppression, leukemia, aggressive lymphomas, recent cell transplant recipients, and individuals undergoing immunosuppressive therapies or other high doses of steroid medication, should receive a third vaccine to strengthen their protection against the Covid-19 virus.

The JCVI has predicted that there will be around half a million people in the UK who will qualify for this third dose.

Professor Wei Shen Lim, Covid-19 chair for JCVI issued a statement declaring that: ‘younger adults will not be given a third dose, having only just received their second dose in the summer’, but this decision may be reviewed at a later date according to other sources from the JCVI.

In the US:

The US began administration of the third dose of the COVID-19 vaccine, as of August and an estimated 1.1 million immunocompromised US citizens have already received this third dose. Similarly to the UK, the CDC is recommending citizens with weakened immune systems, who don’t receive the same level of protection from two Covid vaccine doses, to go forward with a third.

The Controversy

The recent announcement of UK and US third dose rollouts have sparked controversy among medical bodies and the public.

Predictions from the World Health Organisation warn that almost 90 percent of African countries are set to miss the global target of vaccinating 10 percent of their population by September. Afghanistan reports show that only 2% of their population has received a first Covid vaccine dose. Additionally, Nations such as Taiwan, while remaining relatively steady throughout the pandemic, have struggled to obtain vaccines as a result of previous blocks from China.

In contrast, the US government announced earlier this year, the purchase of 1.5 billion doses of the Covid-19 vaccine, enough to fully immunise three times the US adult population of 199.7 million people.

The fairness of vaccine stockpiling and the provision of third dose vaccinations in developed countries, amidst the current global shortages of Covid-19 vaccines, seems to undermine the equitable mitigation of the Covid-19 virus worldwide, seeing richer developed countries coming out on top, with much higher immunisation rates and far fewer deaths as a proportion, while other developing Nations struggle to stay afloat, facing overcrowded hospitals, high mortality rates and lack of sufficient healthcare equipment.

The WHO has also contributed to the debate, recommending developed countries to consider the necessity of third dose Covid vaccinations in regard to global availability and the fair distribution of Covid-19 vaccines.

This stark contrast between richer and poorer countries in their ability to deal with the pandemic calls into question the morality of protecting those already protected, while millions remain entirely vulnerable.

The Argument For Third Dosages:

However, politicians and advocates for third doses of the Covid vaccine argue for the protection and safety of individuals within their own country. With the spread of the new Delta variant, countries have seen a surge in the severity of those infected, with greater risks of hospitalisation and death. It has been argued that leaders have a duty to protect their own citizens and people first before offering aid to foreign Nations.

Advocates further argue for the domestic equity of vaccine distributions. Countries have stressed that only individuals who face immunological vulnerability should receive an additional third dose, providing them with a level of protection equal to that of healthy individuals with two vaccine doses.


In summation, the basis of this argument centers on the debate of personal autonomy and preservation over a utilitarianist welfare approach. Whether countries should be rolling out third doses of the Covid vaccine, must be answered from an equity-focused standpoint, considering both the care and protection of medically vulnerable individuals within a country, as well as that of citizens of foreign countries, who equally deserve the right to protection against the Covid 19 virus.



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