Inequality in the age of the booster

Just before Christmas, the World Health Organisation (WHO) issued an ‘interim statement’ on
booster doses for Covid-19 vaccination. The WHO Director-General, Dr Tedros Adhanom Ghebreyesus,called for a moratorium on booster vaccination for healthy adults until the end of 2021 to counter the “persisting and profound inequity” in global vaccine access. While many countries were far from reaching the 40 per cent coverage target by the end of last year, other countries, including Ireland, had vaccinated well beyond this point. At the time of the interim statement on 22 December, globally about 20 per cent of Covid-19 vaccine doses, daily, were used for booster or additional dose vaccination.

“Vaccine booster dose policy decisions should be based on evidence of individual and public health benefit and obligations to secure global equity in vaccine access as a means to minimise health impacts and transmission, and thereby reduce the risk of variants and prolongation of the pandemic,” according to the WHO. The WHO roadmap on the prioritisation of vaccine use in situations of limited supply, as well as the Strategy to achieve global Covid-19 vaccination by mid-2022, define a hierarchy of public health goals in accordance with progressively increasing control
of the pandemic.

It pointed out, if it needed pointing out, that the primary global goal for the acute phase of the pandemic is to reduce deaths and severe disease due to Covid-19 and protect health systems. The level of population vaccination coverage needed to achieve this goal may differ between countries. Subsequent public health goals include the reduction of Covid-19 disease burden and of viral transmission, to restore social and economic life.

At least 126 countries worldwide have already issued recommendations on booster or additional vaccination and more than 120 have started programmatic implementation. The majority of these countries are classified as high-income, or upper middle-income. No low-income country has yet introduced a booster vaccination programme. “Of concern are broad-based booster programmes, including the booster vaccination of population sub-groups at lower risk of severe disease,” according to the Organisation.

Global supply is increasing significantly and is projected to be sufficient to vaccinate the entire adult population globally and boosters of high risk populations by the first quarter of 2022. However, projections show that
only later in 2022 will supply be sufficient for extensive use of boosters in all adults, and beyond, should they be
broadly needed.

The WHO noted that evidence on waning vaccine effectiveness, in particular a decline in protection against severe disease in high-risk populations, necessitates the development of vaccination strategies for the prevention of severe disease. This includes the targeted use of booster vaccination. People’s take-up of booster vaccines in Ireland shows that the threat posed by the pandemic, and the emergence of the Omicron variant, is being taken seriously at a population level.

But without a greater commitment by governments to global solidarity, and vaccine equity, this crisis
is unlikely to end any time soon. And if there is no such change in strategic direction, it will be poorer nations that
will suffer the most.