The message from Israel is clear: Covid booster shots should be standard

in the US, despite widely available vaccinations, exposes the limits of using this as the sole benchmark.

An alternative reasonable standard for assessing vaccine impact is the prevention of even clinically mild infections in order to minimise transmission within communities. The status quo of vaccinated individuals who are not optimally protected from infection and transmission, sizeable populations who are not allowed to be vaccinated, and large numbers of unvaccinated individuals have allowed Delta infections to rage.

Dramatically lowering the number of infections among people who have been vaccinated three times, one of the key outcomes of the NEJM paper, quickly reduces the number of susceptible individuals who are able to sustain the virus’s continued spread. Israel is already providing a real-world test of this concept, and thein its new cases is encouraging. Of course, such programmes need to exist alongside efforts to immunise those unvaccinated who are at the highest risk.

Second, there is an understandable worry that programmes such as Israel’s perpetuate inequality. More vaccines are undoubtedly needed for more people in more places. This alone should not preclude consideration of third-dose programmes in vaccine-experienced countries struggling with Delta outbreaks.

This does not mean that the needs of the rest of the world should be ignored. Indeed, the potential need for three vaccine doses to minimise the threat of Covid-19 globally should be a clarion call to invest immediately in sustainable

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