Brief problem summary: Under current plans, millions of adults in the UK this winter will be unable to get a covid booster, even if they are willing to pay for it, because there will be no option for them to take the vaccine in the NHS rollout, and they will not be allowed to pay privately for a bivalent booster. That means overall population immunity will be lower and will lead to more covid cases than otherwise, which will increase the strains on NHS services this winter. 

This is an area in which EAs might have a potentially very large impact for small investment by creating a simple website to encourage people who would be willing to pay for a booster to give their email address. That list could then be used to convince Pfizer or another company to choose to make covid booster vaccines privately available in the UK, just as they will be in the US from January 2023 and as flu vaccines currently are in the UK.

The Issue

Pfizer's bivalent vaccine (vaccinating against both the original covid and Omicron variants) is being rolled out in the UK via the NHS. The original vaccination and initial booster programme in the UK started with the most vulnerable and frontline health workers, and expanded down risk profiles until all adults in the UK had been offered the opportunity to have a vaccine and a booster. 

However, the plan is more limited for Pfizer's bivalent booster vaccine. This winter the UK has opted for a policy which will see only the most vulnerable and frontline health workers being offered the vaccine. Unlike flu vaccines, where anyone can walk into a pharmacy and pay a small fee for a flu vaccine if they are not entitled to a free vaccine, that will not be possible for covid boosters. To put this in perspective:

Number of people who were vaccinated in the UK:

  • First dose: ~54M
  • Second dose: ~51M
  • Booster: ~40M

Those to be offered a bivalent booster:

  • Estimated total to be offered a bivalent booster: 26M

In other words, even with 100% uptake of the booster, this leaves a potentially willing 28M adults without even the option of a booster from the NHS or privately.

It is of course entirely right to start rollouts to the most vulnerable – and to expand those groups as widely as possible. The issue is that there is no option, other than travel to the US, for the majority of willing UK adults to receive a bivalent vaccine. It is clear that, all other things being equal, more population immunity is better. Waning immunity in millions of UK adults will reduce ongoing pandemic mitigation. That is particularly a problem when the winter burden of covid and flu on the NHS is expected to be large, impairing outcomes for treatment of other illness.

I understand that there is no longer any shortage of vaccines; vaccine takeup in the UK has been lower than expected. Although it might be better for the NHS to provide boosters free of charge to all who want them, the Government has decided not to do that. But in any case, it would be strictly better for all concerned, including those who do not get a booster, if the number of covid cases were reduced by making it possible for people to pay a modest fee for a booster if they are not entitled to a free one.

Pfizer has stated that it will be selling vaccines in the US from 2023 when the US Government stops providing them free of charge. In the UK flu vaccines are sold privately and are administered in pharmacies by trained staff members. Currently, there is no public argument or expectation that the bivalent vaccine should be available for purchase in the UK. 

However, there may be a solution. Based on confidential discussions with sources that I cannot name but who I believe to be in a position to know, I understand that it is already lawful for pharmacies to sell and administer the booster in the UK to willing individuals. But Pfizer believes that there would be insufficient demand in the UK for this to make commercial sense. I think there are serious reasons to doubt this, and that there would be substantial demand. If we can demonstrate that demand, we could hugely increase UK covid booster vaccine uptake this year.

I believe this is a highly tractable opportunity that the EA community can meaningfully impact, with little investment and potentially huge gains. This is particularly the case for interested coders, graphic designers and social media engaged EAs. Pfizer currently intends to sell the vaccine in the US for around $110-130 per dose; UK costs should be lower given lower labour and healthcare costs. I believe there are significant numbers of UK adults who would be willing to pay for a booster now - over 12 months since their last vaccines with no other way to get a booster.


A small group of coders, graphic designers and social media engaged EAs could produce a website, appealing to the general population of the UK, to 1) make clear the advantages of continued vaccination for Autumn for the adult population at large - not just those in high risk categoriesin order to 2) compile a list of email addresses of UK adults willing to pay for a bivalent vaccine (Autumn Booster).

I suspect that a simple landing page with a signup form and sharing mechanisms would achieve more signup than a simple google form. A shareable, appealing information campaign could gather signups at very low cost. I would also suggest A/B testing and the simultaneous use of a google form, and/or use of other petitioning sites. I suggest the goal should be to get the most UK signups, with email addresses, by exposing this to the most UK adults not currently within the booster categories.

A project of this kind can be done incredibly quickly by the people with the right skill sets (code, graphic design, social media reach), and could plausibly have significant upsides in lives saved and health outcomes improved with minimal investment. News could be spread by EAs and others through social media and private sharing.

Next Step: Form the Group

For anyone interested, and with the right or relevant skill set, can you please post below (preferably) or contact me individually so I can put you in contact with one another. This is not a project I feel I am the best to run and handle. I am convinced there are members of the community better suited for that than I am, but I would be very willing to help form the group to then step back (although of course please do feel free to do this within the comments below and cut me out entirely!).


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16 comments, sorted by Click to highlight new comments since: Today at 12:36 PM

I'd be happy to be on the team and do what I can on social media.

That's excellent - thank you!

The issue is that there is no option, other than travel to the US, for the majority of willing UK adults to receive a bivalent vaccine.

FWIW if we're resorting to "vaccine tourism", it may be possible to get it from Europe rather than the US. I think some people attending the Prague Fall Season were able to buy a vaccine there.

Other places in Europe will certainly provide it.

Yes this is true - that might be a very viable option.

"Pfizer currently intends to sell the vaccine in the US for around $110-130 per dose"
Just to check – this is the sticker price, where the cost is (mostly) covered by insurers (and possibly bargained down from this), right? Not the out-of-pocket cost to most US consumers? This would be another reason to expect lower costs for the UK than this.

Really love this idea, and would encourage you to evaluate additional barriers to getting vaccines in arms.Maybe this could be via basic surveys or interviews or via browsing some medical publications and talking to vaccine clinic organizers.

Also curious if there is an existing ( or soon to exist) non profit that might be able to assist financially. Global vaccine shortage and insufficient public health tools amidst a pandemic seems like an important, tractable cause. I’d be interested in helping out if it makes sense.

Personally I’d be super excited about a “vaccines for all” type program with initial focus on increasing access to — and delivery of —vaccines against pandemic agents with aims to expand globally . Does anyone know what orgs are doing that? I’d also love to see an org that distributed public health tools like masks and provide materials for and potentially hosted local community sessions to assemble lower cost filtration devices like Corsi-Rosenthal boxes. With the amount of air pollution in much of the world now, this could be helpful for mitigating airborne spread of pandemic pathogens as well as harmful air pollution.

Supply very well could be the main vaccine bottleneck in the UK. In the US, a significant percentage of the population ( I’m forgetting the specifics) has yet to get the bivalent vaccine despite it being free.

When I got my variant booster it was at the same time as a flu shot and that was convenient and offering a twofer might appeal to some, though it may be a bit late for this year.

Another issue in the US is with delivery: healthcare systems here are generally overwhelmed and understaffed. Anecdotally it seems like pharmacies are too. In some places, the paucity of available vaccinators is likely contributing to lower vaccine uptake. Hoping the UK healthcare system is more aptly prepared.

Thanks for sharing and really appreciate that you’re thinking about this .

My understanding is that the NHS isn't perfect, but is pretty good at prioritization. If they're not making the booster available to all, my interpretation is that they don't think it passes their QALY bar.

Is your view that they're wrong and the death/suffering avoided by additional covid vaccination is pretty high, that individuals should be much more willing to pay for their own protection than the NHS is, or something else?

For some extra context, the NHS offers a free seasonal flu vaccine to vulnerable groups (similar eligibility to the Covid booster), and healthy adults can choose to purchase a seasonal flu vaccine at a pharmacy for about £10. Some people do this, and some employers pay for their employees to get vaccinated. So there is precedent for this kind of thing, and although I doubt it would get rolled out this year, this is a good time to plan for next year.

Many individuals are not subject to the same tight resource constraints of the NHS, so I don’t understand why we wouldn’t expect a fraction of individuals to be willing to deploy their own resources to pay for a booster? The efficient frontier for them is simply different.

I very much doubt the reason it’s won’t be made privately available is due to Pfizer thinking it wouldn’t be worth it. More likely it’s down to sufficient stock being available in the NHS for the cohort that will be receiving it, and the government not wanting to add more demand, which would increase the cost per dose for the NHS.

It’s perverse, but a likely consequence of the Beveridge style universal healthcare system used in the U.K.

The suggestion is to treat the COVID vaccine like the flu vaccine, and make it free for those who need it most, and available to buy for those who don't. Making it available for sale doesn't increase costs to the NHS.

Is it now possible to sign up?

This petition may be a substitute for the OP plan:

A better outcome would increase the NHS rollout, so more people benefit. A (different) successful petition on the above government platform could help with that.

If the OP is correct in suggesting that selling the vaccine is already legal and it's just a matter of consumer demand, then I don't see how petitioning the government will help.

The way you are assessed for eligibility for a seasonal COVID booster in the UK is a short online questionnaire. I ticked that I "thought I might be at high risk of COVID" (I don't, but I want a booster) and was able to book one without being asked for any extra supporting evidence.

Now, this could be bad if the NHS relies on survey response data to estimate how many people  are actually  at risk (this seems very unlikely to me, given that they must have much higher quality data on disease rates in the UK). It could also be bad if the UK is constrained on supply of vaccines - but again this seems unlikely to me. 

All in, as a very mild act of civil disobedience, I think it's net-positive, and worth it for me. I'd buy a dose if I was allowed to, but the UK gov won't allow me to...

wow...seems based...i can't see a reason not to do this!