Will giving COVID booster shots make it harder to vaccinate the rest of the world?

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As people in the United States and other wealthy countries begin to line up for COVID vaccine booster shots, most people in the rest of the world are still waiting for their first dose. In many African countries, for example, less than 2% of the population, including health workers and the elderly, have received a single vaccine against COVID.

Most scientists agree that boosters can benefit the elderly, the immunocompromised, or others whose immune systems have not responded sufficiently to the original vaccine series. Some studies suggest that antibody levels in people who get vaccinated decrease somewhat about six months after they finish their primary vaccination. But there is little data showing a significant decrease in protection against serious illness in most healthy young people.

Yet officials in several wealthy countries are already encouraging booster shots for larger sections of their populations. The U.S. Centers for Disease Control and Prevention has recommended Pfizer COVID vaccine boosters not only for people 65 years of age or older, who are immunocompromised or have underlying health conditions, but also – against the opinion of its own advisory board – for all adults in general. professions defined as “high risk”. (A Food and Drug Administration panel recently voted to recommend recalls of Moderna and Johnson & Johnson’s vaccines for similar groups.) And in August, two FDA officials resigned over concerns about the Biden administration pushing health agencies to approve recalls for all vaccinated. people after eight months without much evidence that protection against serious illness significantly decreases in most people. Meanwhile, the Israeli government has approved boosters for anyone over the age of 12 or older for at least five months after their last injection. And the European Medicines Agency has said that a booster can be considered for anyone aged 18 and over after at least six months.

Given the low global vaccination rate, scientists and public health experts (including those from the World Health Organization) have condemned giving boosters to healthy people as immoral. “We are planning to distribute additional life jackets to people who already have life jackets while we let others drown without a single life jacket,” WHO director of health emergencies Mike said. Ryan, in a speech delivered on August 18 in Geneva.

Yet the debate over recall campaigns by rich countries removing doses that could be used for unvaccinated people overseas misses a key point: these countries have far more doses than they actually have. need for reminders., but governments, often mired in political and bureaucratic considerations, neither use nor give them away. The governments of rich countries have already purchased the vast majority of vaccine doses available globally and have pre-ordered the majority of future doses, possibly in case boosters are needed. Canada, for example, purchased enough doses to immunize its population five times, far more than the country would need for a booster campaign. Despite pledging to donate some excess doses to the developing world, the wealthier countries have mostly sat on their stocks, many of which are in danger of expiring. Of the 1.2 billion doses the United States has promised to give, it has only delivered about 190 million. On October 7, the WHO released a plan that would allow 40% of the world’s population to be vaccinated by the end of the year, but the agency said that would require all countries’ to commit to an equitable distribution of vaccines ”.

Recall campaigns in rich countries could potentially slow donations even further. “Everyone in global health is very dejected right now,” says epidemiologist Madhukar Pai of McGill University in Montreal. “It’s almost like the logic for giving reminders is, ‘Oh my god, we all have these millions of doses in our freezers; we have to use them. Let’s start giving everyone boosters. ‘”

There are, in theory, many doses of vaccines (existing or in preparation) so that most people around the world can complete primary school very soon. Experts predict that 12 billion doses will have been produced by the end of 2021 and that 11 billion will be enough to immunize 70% of the world.

Even though the G7 countries – the United States, the United Kingdom, France, Germany, Italy, Canada and Japan – and the European Union were giving reminders to 80% of their residents aged over 12 years, more than a billion doses are still available for donation to developing countries, according to data from analysis firm Airfinity. “I have never seen a scenario where [wealthy] countries don’t have a surplus, ”says Caroline Casey, the company’s chief COVID analyst.

But a billion doses would be far from enough to meet the WHO target of vaccinating 70% of the world by June 2022 – and this is where large-scale recall campaigns could become a problem. “I understand why a politician would want to say, ‘I want to do both’” of reminder campaigns and donations, says Brook Baker, health law expert at Northeastern University. “But to pretend that one dose in an American arm does not mean one less dose in an African arm does not make sense.” At the individual level, however, an eligible person’s decision to forgo a booster is unlikely to release a dose for an unvaccinated person overseas.

Many countries have pledged to donate surplus vaccines to developing countries and to COVAX, a collaboration between WHO and two international nonprofit organizations (the Coalition for Epidemic Preparedness Innovations and Gavi, the Vaccine Alliance) that is trained to help distribute vaccine donations fairly around the world. . COVAX had a target of delivering two billion doses by the end of this year, but the donations promised to it have been slow to materialize, and it is on track to be 30% below its target. Its administrators attribute this to various government export bans, individual agreements between suppliers and countries, production issues and regulatory delays.

It is not known why the donation process was so slow. The Biden administration still hopes to vaccinate the 21% of the US adult population who have so far refused the vaccine, and it is also saving a few doses in anticipation that vaccines will soon be licensed for children under 12. Remaining excess doses are being kept in the United States as a precaution, White House advisers recently said Politics. Analysts from the American think tank Council on Foreign Relations, meanwhile, argue that the United States is strategically giving some of its doses to countries like Indonesia and Vietnam, where it competes for influence with China.

Some experts argue that giving boosters to a large portion of the population will further slow donations and reduce supply. Pai adds that such a shortage could also fuel another dangerous situation: More deadly variants of the virus are more likely to occur in unvaccinated people globally than in people who have received a full vaccine (even without a booster).

The impending expiration dates of many vaccine doses add to the urgency. There is a risk, says Baker, “that there are literally hundreds of millions expiring in warehouses out of caution or selfishness.” Airfinity data shows that 241 million doses currently held by G7 and EU countries could expire and be lost if not used by the end of 2021. If these doses were given in addition to existing promises, 70% of the world could still be vaccinated by May 2022. But this could only happen if recipient countries had enough time to organize a vaccination campaign before doses expire. Waiting too long could make the logistics more difficult to get vaccines on people’s arms, Baker says.

Casey and Baker suggest several strategies that rich countries could follow to deal with the situation. These include canceling pre-orders or giving doses now and buying more later if boosters are needed.

Ultimately, experts say meeting global immunization goals will require increased manufacturing capacity around the world, including places, like Africa, that do not currently manufacture COVID vaccines. “You can’t rely on charity as a global public health strategy,” says Kate Elder, senior vaccine policy advisor to the Médecins Sans Frontières / Médecins Sans Frontières access campaign. But expanding production would force companies to relinquish their intellectual property rights (either voluntarily or by government coercion), allowing more manufacturers to start manufacturing vaccines. Several countries, including Germany, have blocked related intellectual property transfer agreements. And companies have been reluctant to waive those rights, although some have received funding from the U.S. government to develop a COVID vaccine.

Until there are more manufacturers, Pai says, the numbers show that boosters for everyone in rich countries should be excluded. “Whether we like it or not,” he says, “it’s kind of a zero-sum game unless the providers increase.”


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