The US shouldn't prioritize vaccinating teens over donating shots abroad if it wants to get back to normal, experts say

• The US is expected to expand its vaccine rollout to teens as soon as Thursday.
• Meanwhile, low and middle income countries haven't vaccinated their most vulnerable people.
• To get back to normal, the US need to both immunize teens and send doses abroad, experts told Insider.

In January, Dr. Tedros Adhanom Ghebreyesus, the director-general at the World Health Organization (WHO), warned that the world was on the "brink of a catastrophic moral failure" by not giving enough vaccines to poorer countries. "It is not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries," he said.

Five months on, more than half of Americans have had at least one COVID-19 vaccine dose, US vaccine supply has outstripped demand, and 12-year-olds could be offered Pfizer's shot as early as Thursday.

Meanwhile, vaccines remain scarce in low- and middle-income countries and many of the most vulnerable people in those nations haven't yet received a shot, a WHO spokesperson told Insider. In India, where millions are dying and the virus has mutated, less than 10% of people have had at least one vaccine dose, according to Oxford University's Our World in Data.

Some experts see this disparity as a moral dilemma. "You don't need to vaccinate all the way down, say, to your teen population … before you send out vaccine doses to COVAX," Melinda French Gates, co-chair at the Gates Foundation, said May 9. COVAX is the WHO-backed initiative that aims to get more vaccines to low and middle-income countries.

To get itself - and the world - back to normal, the US needs to both vaccinate its young people and send more shots abroad, some experts told Insider. Others went further, and said that it doesn't make sense to vaccinate low-risk populations, such as kids, when vulnerable people abroad are at risk abroad.

Fauci: We need to do both

Dr. Anthony Fauci, President Biden's chief medical advisor, has said that immunizing young people is essential to achieve herd immunity, which is when enough people are vaccinated that the virus can no longer spread from person to person.

But Fauci has also advocated sending doses abroad to curb the virus' spread.

"[India has] got to get their resources, not only from within, but also from without, and that's the reason why other countries need to chip in to be able to get either supplies for the Indians to make their own vaccines or to get vaccines donated," Fauci told ABC News Sunday.

A spokesperson from US President Joe Biden's administration told Insider that it had committed 60 million AstraZeneca doses to countries in need, once cleared by the Food and Drug Administration (FDA).

Read more: How coronavirus variants called 'escape mutants' threaten to undo all our progress

Kathleen Neuzil, professor in vaccinology at the University of Maryland School of Medicine, told Insider that vaccinating teens and sending doses abroad via COVAX were not "necessarily mutually exclusive."

Neuzil said that she'd witnessed more younger people from ethnic minorities and with chronic conditions getting sick with COVID-19 in the US, who needed access to vaccines. But she said a coordinated response was required between nations. "No single country alone can beat this pandemic."

Dr. Erlinda Ulloa, a pediatrician studying the safety and efficacy of COVID-19 vaccines in kids at the University of California Irvine, told Insider that fair vaccine distribution and immunizing teens in the US were separate issues.

Ulloa said that 12 to 15 year-olds should get vaccines if and when it's recommended. "It's remarkably safe and effective in this age group," she said. But from an ethical perspective, if there's opportunity to support vaccination efforts abroad then the US should do it, Ulloa said.

Getting back to normal

Janet Englund, professor of pediatric infectious diseases at Seattle Children's Hospital, told Insider that if US teens weren't immunized the virus would continue to spread in younger age groups. "To get back to 'normal,' we need to immunize our younger people," she said.

"But if we don't take care of the rest of the world, it's going to be a temporary fix," she added. "All these variants will eventually escape our vaccine and the best way to handle that is to vaccinate [the US and the rest of the world]."

Englund said the coronavirus vaccine co-developed by Pfizer and BioNTech - the shot that has been authorized for US teens - might be technically difficult to use in low and middle income countries right now as it requires very cold storage temperatures, although the groups are working on a vaccine that can be stored in a normal fridge. Other vaccines from AstraZeneca and Johnson & Johnson (J&J) could be more useful as they can be stored at normal temperatures already, and J&J's shot is just one dose, she said.

Prioritize vulnerable adults abroad, two experts say

Russell Viner, professor of adolescent health at University College London, told Insider in a statement that the "key risk" for society was the "diversion of vaccines" to low risk groups while vulnerable adults in other countries remain unvaccinated.

Viner said very few children and teenagers ended up in intensive care with COVID-19 disease, and almost all of these were the same children that are vulnerable to winter viruses every year. It's difficult to argue that vaccination benefits healthy teens, given our current knowledge, he said.

Viner said there was undoubtedly a very small group of teenagers who were clinically extremely vulnerable and should be vaccinated. Teenagers also play a role in transmission so if they remain unvaccinated they could act as a reservoir of infection, he said.

Adam Finn, professor of paediatrics at the University of Bristol, told Insider in a statement that giving vaccines to adolescents wasn't a priority, at least for now.

Finn explained that most children who catch coronavirus don't get seriously ill. "Indeed, most don't get sick at all," he said.

Finn said that at this point in the pandemic, when there are global shortages of vaccines, and lots of vulnerable people who haven't got a shot, the priority was to prevent large epidemic waves, like the one in India.

"Those outbreaks pose a global threat as they drive the evolution of vaccine-resistant variants and their dissemination around the world," he said.