The Reason Why COVID Booster Policy in the U.S. Differs from Other Countries


In the wake of ongoing discussions and debates on the utility of another shot of COVID-19 booster, it’s common to compare the healthcare policies between the United States and other countries.

For instance, the U.S. and Canada have adopted an extensive approach to COVID-19 vaccination this fall, recommending the booster to all ages above 6 months. This is in stark contrast to the U.K.’s and Australia's more focused strategy to recommend boosters to the older population (Figure 1).

This divergence in policy isn’t limited to COVID-19 vaccines but extends to flu vaccines, as well as isolation and testing protocols for COVID-19.

It’s natural to ponder the reasons behind such divergent strategies. After all, high-income countries have access to similar vaccines and data. So, why a disparity in conclusions drawn by public health officials across borders?

Dr. Katelyn Jetelina, an assistant professor of epidemiology, proposed the answer lies in the unique health landscapes inherent to each country.

These landscapes, shaped by distinct socio-economic and health variables, necessitate varied country-level policy decisions. The implications of health threats differ, and thus, the strategies to combat them must be tailored to the specific needs and circumstances of each nation.

The U.S. healthcare system, marked by its inaccessibility, administrative inefficiencies, and inequities, has been ranked as suboptimal compared to other high-income nations. A 2021 study by the Commonwealth Fund placed the U.S. at the bottom of the list, highlighting the pressing need for preventive measures to combat infectious diseases and mitigate adverse outcomes.

The voluntary nature of health insurance in the U.S. creates a fragmented coverage system, necessitating a more inclusive approach to interventions like vaccinations. The Centers for Disease Control and Prevention (CDC) estimates that universal vaccination could avert an additional 200,000 hospitalizations and 15,000 deaths compared to vaccinating only those aged 65 or older.

The limited healthcare capacity in the U.S. underscores the urgency to minimize hospital admissions. With hospital bed availability below the average of the Organisation for Economic Co-operation and Development (OECD) countries, the U.S. must intensify efforts to reserve hospital beds for non-preventable medical needs, especially during pandemics and severe flu seasons.

Moreover, in the U.S., CDC recommendations determine who will pay for the vaccine. By adopting a broad recommendation strategy, private and public insurers have to cover vaccines for all enrollees.

In contrast, the U.K., with its single-payer system, has opted to allocate vaccines to high-risk individuals and opted not to pay for the vaccine for all, weighing cost-benefit considerations.

The absence of robust support systems in the U.S., such as federally guaranteed sick pay, exacerbates the spread of viruses, as individuals are compelled to work while sick. This, coupled with the overall poorer health status of Americans, necessitates broader preventive measures, particularly for infectious diseases like COVID-19 that intensify pre-existing health conditions.

So, the U.S. operates within a constrained framework, characterized by limited healthcare access, diminished social support, reduced healthcare capacity, and suboptimal health. Therefore, the implementation of expansive preventive measures, like universal vaccine recommendations, is imperative.

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