Will booster shots prolong the pandemic?

INSIGHTS

Author: Andrea Taylor

Will booster shots prolong the pandemic?

A handful of wealthy countries recently announced plans to roll out booster shots in late 2021 for vulnerable populations already fully vaccinated against Covid-19. Israel has already begun providing third shots for immunocompromised people and is opening eligibility this week to everyone over the age of 60. Germany, France, the UK, and the US have indicated they will begin boosters for priority groups as early as September.

The WHO responded quickly with a reminder that most of the world is still waiting for their first two doses and we must prioritize global coverage before boosters. It looks inevitable that many of the world’s wealthiest countries will move forward with booster plans all the same. So how much of a problem will this be?

Prioritization, not supply, is the issue

We are in the midst of a shift as distribution challenges, rather than limited supply, are becoming the key barriers to global coverage. Production of Covid-19 vaccines continues to ramp up at the same time that most wealthy countries are approaching demand saturation among adult populations. Globally, manufacturers are now making many hundreds of millions of doses per month. There is enough supply projected in the next 12 months to vaccinate the world and cover boosters for high income countries.

What matters now is the order in which we do this.

The only way to end local transmission is to end global transmission and the only way to do that is to ensure distribution of effective vaccines worldwide. We are facing a global crisis and we cannot solve it with isolated local interventions. We must approach the problem in a coordinated global way. If we do not, we open the door for new, more dangerous variants that bring us back to the start and even high-income countries will be stuck circling round again.

Global solutions are less costly

The longer the acute phase of this pandemic continues, the more we all lose. These costs can be measured in economic, health, and political terms. The International Monetary Fund (IMF) estimates that a coordinated global response to end transmission of Covid-19 would cost about $50 billion USD. But continued emergence and spread of new, more infectious variants could cost $4.5 trillion in lost gross domestic product globally by 2025. That is a cost of more than a trillion dollars a year for the next four years.

Continued spread of the virus also means millions more people suffering severe illness, debilitating symptoms from long-term infections, and preventable deaths. We have already experienced this in North America, Europe, and South Asia. Now countries in Africa are reporting a surge of infections as the delta variant races across the continent, with an 80% rise in Covid-19 deaths over the last four weeks. With a vaccination rate hovering around 1.5%, the situation will likely get much worse in the coming months.

In the first half of 2021, we have distributed vaccines in such a way that some countries have surplus, most have shortages, and others have none at all. More than 80% of Covid-19 vaccinations have been given in high- and upper middle-income countries, while only about 1% of vaccinations have been administered in low-income countries. These disparities not only prolong the acute phase of the pandemic but also threaten to overwhelm health and emergency services, strain governments, and push societies to the brink. The impact of continued spread of Covid-19 will increase severe poverty and threaten geopolitical stability.

Not an either/or

Within the next year, we will have enough supply to vaccinate the world and provide booster shots in high-income economies. In the meantime, providing boosters in a tiered way to the most vulnerable in those countries is not likely to derail supply for global efforts. But we must simultaneously remain focused on the critical task at hand.

We are calling for a global target of vaccinating 70% of the world’s population by mid-2022. We will need to produce and distribute 10 billion doses globally in the next year to do this, an ambitious but achievable goal. This year, we have seen inequitable distribution of vaccine lead to the emergence of infectious variants that now threaten even highly vaccinated countries. The hard-won lessons of the past six months should prompt us to adjust course going forward. 

INTERESTING TRENDS

Significant updates, news, and trends we saw last week:

• Oxford University and AstraZeneca announced the production of 1 billion doses of their vaccine, 18 months after work on the vaccine began. The Oxford-AstraZeneca vaccine has been distributed to 170 countries.
• US government funding for domestic production of Novavax is on hold until the company strengthens quality control measures.
• The Emergent plant in Baltimore, MD (US) is expected to resume production of the Janssen (J&J) vaccine, which was stopped in April following cross contamination with materials intended for the Oxford-AstraZeneca vaccine. The plant is no longer manufacturing the Oxford-AstraZeneca vaccine.
• Pfizer and BioNTech have inked a deal with Biovac, a South African firm, which will provide fill-finish production for the mRNA vaccine, with the first doses expected in early 2022. Once at full capacity, the partner expects to produce 100 million doses per year, exclusively for distribution across Africa.
• A study in South Africa found the single shot J&J vaccine to be highly protective (91% to 96.2% protection against death, 67% efficacy against Beta variant and about 71% against the Delta variant)
• The WHO, IMF, World Bank, and World Trade Organization have launched datasets tracking vaccine supply, delivery, and administration, which incorporate some of our data.
• China announced a $100 million contribution to COVAX to support the distribution of vaccines in developing countries.
• US president Biden reported a major milestone of 110 million doses donated and shipped to 60 countries across the world, which makes the US a leader in vaccine donations.  
• Spain committed to donate 7.5 million vaccines to Latin America and Caribbean countries through COVAX; first round of shipments will be delivered to Paraguay, Guatemala, Peru, Ecuador and Nicaragua.
• The FDA is expediting its review timeline to grant full approval to the Pfizer-BioNTech vaccine in the US by early September given the rise in cases.
• Sputnik’s vaccine delivery to Argentina is delayed leaving 6 million people with just the first dose, risking contract cancellation as a result. Countries like Kenya and Ghana have also canceled Sputnik orders due to delivery issues.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.