Boosters

Booster shots ahead of the holidays

j.harris — Fri, 29 Oct 2021 17:26:20 +0000

Booster shots ahead of the holidays j.harris Fri, 10/29/2021 - 17:26

INSIGHTS

Booster shots ahead of the holidays

Author: Blen Biru

Most high income and upper middle-income countries have fully vaccinated more than half of their population. Portugal ranks first having covered 85% of its population followed by UAE (83%) and Spain (78%). The US ranks 18th having 55% of its population fully vaccinated. In contrast, resource limited countries such as Nigeria, Ethiopia, and Tanzania have only vaccinated less than 5% of their population.

In light of the new COVID-19 variants, countries such as the US are observing increase in cases even with having half of their population vaccinated. To curb new infections and increase immunity, vaccine candidates have developed booster shots.

Guidance on booster shots in the US has been confusing and inconsistent, with President Biden announcing the need for booster shots prior to authorization from the FDA, followed by the CDC overriding recommendations from its advisory panel (which would have excluded frontline workers). The debate within the US and other wealthy countries has primarily involved the purpose of the vaccines (preventing hospitalizations vs infections) and balancing the urgent global need for first shots vs the local need for third shots. After review and discussion, the US has granted emergency authorization to administer third shots of the Pfizer/BioNTech vaccine to people above age 65 and people with underlying conditions in order to protect against waning immunity.

The eligible priority group in the US (around 60 million people) can now receive a third Pfizer-BioNTech shot at least six months after receiving their second shot. However, it appears that people who aren’t eligible can also get a booster since the system doesn’t require authentication while signing up online or showing up at the vaccination site.

And US residents who received other COVID-19 vaccines may soon be eligible for a booster as well. The FDA is reportedly considering authorization of a half-dose Moderna booster and momentum is growing to support boosters for J&J’s vaccine. J&J recipients are concerned that booster plans for the single-shot vaccine are not clear yet, although the company has submitted clinical trial data showing booster effectiveness to the FDA.

J&J’s efficacy against the delta variant was reported to be marginally lower than Pfizer and Moderna, but early data show strong gains from a booster. Although there’s not enough evidence yet, some studies reported better immunity when booster shots are mixed and matched. However, CDC’s guidance so far is to stick with the same brand of vaccine until further evidence is available.

Side effects of the Pfizer booster vaccine are expected to be the same as the previous doses (mostly fatigue, headache, and muscle pain). The dose size is also the same at 30 micrograms. Moderna’s first two doses were 100 micrograms each, and experts believe that adding a 50-microgram booster will suffice to increase immunity without increasing side effects.

The booster shot drive in the US is coinciding with the annual push for flu vaccinations. The CDC affirms that COVID vaccines can be taken simultaneously with other vaccines, such as the flu vaccine, without additional side effects.

In addition to the US, many other countries such as the UK, Israel, Chile, and Singapore have started administering booster shots to their population. The European Medicines Agency (EMA) and Canada’s vaccine advisory body have also recommended boosters for highly vulnerable populations. Most of these countries are administering mRNA booster shots. Chile, however, is starting with a booster shot of Sinovac (which also proved effective in increasing immunity) given that most of its population (60%) took Sinovac for the original series.

Booster shots ahead of the holidays seem to be the focus the US and other high-income countries to prevent hospitalizations and further lockdowns. Given the persistent inequity in vaccine access around the world, and the related risk of new more infectious variants, it is important that these countries do not also neglect their commitments to ensure global vaccine equity at the same time.

Some of the commitments include dose donations and shipment to lower income countries that lack access to vaccines. The US is in the forefront of donations having pledged more than 1B doses through the COVAX system and bilaterally. Our dashboard on donations provides more detail on pledges countries have made and their progress fulfilling their pledges. We hope that it serves as an accountability platform, pushing wealthy countries to work towards their set goal in achieving vaccine equity not only domestically, but also globally.

INTERESTING TRENDS

Significant updates, news, and trends we saw the last two weeks:

AstraZeneca’s US trial showed a 74% efficacy, a result that the company hopes to leverage and apply for FDA approval.

Pfizer and BioNTech submitted phase 2/3 trial results in children less than 12 years old for FDA’s review.

India to produce its own home-grown mRNA-based vaccine by the end of 2021 following Pfizer’s and Moderna’s technology platform.

China’s new protein-based Clover vaccine could be game-changing for the world given that recent findings show its effectiveness against five variants and minimal refrigeration requirement.

Sanofi is abandoning its mRNA COVID-19 vaccine candidate and will focus on using the mRNA platform for other pathogens such as influenza instead, as well as continuing work on their protein subunit COCID-19 vaccine with GSK.

COVAX to modify vaccine allocation approach, not just based on population but also to consider vaccination coverage.

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

Weekly COVID Vaccine Research Update

Vaccines

Boosters

	Confirmed Vaccine Purchases	Confirmed Donations (by recipient, includes pledges)
High income countries	7 B	7 M
Upper middle income countries	2.6 B	75 M
Lower middle income countries	2.6 B	84.7 M
Low income countries	238 M	66 M
COVAX	2.5 B	945 M
WORLDWIDE TOTALS	15 B	1.2 B

Are third shots vs first shots a “false choice?” Then the US and other high-income countries should prove it

j.harris — Fri, 20 Aug 2021 22:35:02 +0000

Are third shots vs first shots a “false choice?” Then the US and other high-income countries should prove it j.harris Fri, 08/20/2021 - 22:35

INSIGHTS

Are third shots vs first shots a “false choice?” Then the US and other high-income countries should prove it.

Author: Andrea Taylor

The US has continued to advance plans for boosters since we wrote about the issue earlier this month, with an announcement that a third dose will be offered to all residents (not just the highly vulnerable), eight months after the second dose. Israel has already begun its booster campaign, while Germany, France, and the UK are expected to begin boosters for the elderly and immunocompromised next month.

Data from the US, Israel, and the UK help explain why. Despite relatively high levels of vaccination and early vaccine roll-out campaigns, all three countries (and many others) have experienced significant surges in infection over the past few months. Breakthrough infections (those occurring among fully vaccinated people) are increasing, particularly for people over the age of 60 and those with underlying conditions. While full vaccination clearly provides powerful protection against Covid-19, efficacy appears to diminish over time, particularly against Delta.

Brushing aside criticism from the WHO and other global advocates, the US government continues to say that boosters versus vaccines for the world is a false dichotomy and we can (and must) do both. The US Surgeon General Dr. Murthy echoed a frequently repeated line from government spokespeople, saying, “I do not accept the idea that we have to choose between America and the world. We clearly see our responsibility to both.”

Supply is improving

The increasingly good news on the supply front supports this view. Our estimates of manufacturing indicate that the world is now producing close to 1 billion doses of Covid-19 vaccines per month. This represents an enormous scale-up of manufacturing, across all of the vaccine platforms, since the beginning of the year.

There are also new candidates poised to enter the market with significant production capacity (including Novavax, Bio E’s Corbevax, and Medicago) which will further improve the supply picture. Even our conservative estimate indicates that the world can make 5 billion vaccine doses between August and December this year. When we consider that most wealthy countries are nearing the demand ceiling for full vaccination and have hundreds of millions of doses on hand already, this bodes well for global exports.

Can political will keep up?

But supply is only part of the equation – political will is another. Just saying that boosters vs global vaccine access is a false choice does not make it so. The US government (and other high-income nations) now have the opportunity to prove it.

The US talking points consistently include a reminder that the US is doing more than its peers. As White House Coronavirus Response Coordinator Jeff Zients said this week, “the 115 million doses that we’ve already donated is more than all the other countries combined.” But this rather misses the point. The measure of success is not “have we done more than others?” but “do all countries have enough vaccine to slow transmission?”

The gaps in vaccine access globally remain dismally wide. High-income countries have purchased nearly half of the total vaccine doses bought so far but represent only 16 percent of the world’s population. More than 80 percent of vaccines administered worldwide went to people in high- and upper-middle income countries. Meanwhile, less than 1 percent of people living in low-income countries are fully vaccinated.

If other wealthy countries are not pulling their weight (spoiler: they are not), the US can work to bring them along. As the first country to approve boosters for the general population, the US should set an example by coupling the rollout of boosters with a coordinated plan of action to get vaccine doses where they are needed most around the world. Along with other global health and policy experts, we recently proposed a specific path through which the US can demonstrate this type of necessary global leadership.

Slowing transmission of the virus everywhere is critical. We cannot stop the pandemic at home (wherever home may be) until every part of the world is able to reduce infections.

INTERESTING TRENDS

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

The US government announced that Covid-19 booster shots will be made available to the general population, eight months after the second shot, in order to combat waning efficacy. (See the post above for our take on this.)

A new study from Oxford University found that both the Pfizer-BioNTech and Oxford-AstraZeneca vaccines provide strong protection against the Delta variant but that the efficacy does wane over time.

Australia extends lockdown for Sydney until end of September

Millions of the Janssen (J&J) vaccine doses coming from the Aspen plant in South Africa are being exported to Europe, while South Africa is still waiting for its order of 31 million to be filled.

New article in Science looks at the evolution of Covid-19 variants and what we can learn from other viruses.

Also in Science this month, insights on how the “super immunity” of those who survived the 2003 SARS epidemic contribute to development of a pan-coronavirus vaccine.

WHO flags counterfeit versions of the Serum Institute’s Covishield (Oxford-AstraZeneca) vaccine in both India and Africa.

Pope Francis encouraged Covid-19 vaccination, calling it an “act of love” and stating that “vaccination is a simple but profound way of promoting the common good and caring for each other, especially the most vulnerable."

The US Centers for Disease Control and Prevention (CDC) announced a new Center for Forecasting and Outbreak Analytics, to increase the availability and use of data in public health decision making. new disease forecasting

Australia’s government faced criticism this week for ordering 500,000 doses of Pfizer-BioNTech’s vaccine from COVAX. Faced with a population suspicious of the Oxford-AstraZeneca vaccine, which was meant to form the bulk of Australia’s national supply, the government is scrambling to secure additional doses of Pfizer-BioNTech.

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

Weekly COVID Vaccine Research Update

Vaccines

Boosters

supply

High-income country confirmed dose total:	6.8 billion
Upper-middle-income country total:	2.5 billion
Lower-middle-income country total:	3.2 billion
Low-income country total:	288 million
COVAX total:	3.3 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	15 billion doses

Will booster shots prolong the pandemic?

j.harris — Fri, 06 Aug 2021 04:19:03 +0000

Will booster shots prolong the pandemic? j.harris Fri, 08/06/2021 - 04:19

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.

Weekly COVID Vaccine Research Update

Boosters

Vaccines

High-income country confirmed dose total:	6.5 billion
Upper-middle-income country total:	2.5 billion
Lower-middle-income country total:	3.2 billion
Low-income country total:	331 million
COVAX total:	3.3 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	15.8 billion doses

Three reflections from a wild week

j.harris — Mon, 03 May 2021 18:58:13 +0000

Three reflections from a wild week j.harris Mon, 05/03/2021 - 18:58

INSIGHTS

Three reflections from a wild week

Author: Andrea Taylor

There is a lot of ground to cover this week. The pandemic continues to rage throughout the world, with countries in South Asia and Latin America battling the worst surges. India has set new world records for daily infections and deaths, while eschewing a nation-wide lockdown and struggling to implement a mass vaccination campaign with limited supply.

Meanwhile, high-income countries are planning for the vaccination of children and annual boosters for the entire population. The inequities in global access to Covid-19 vaccines are starker now than ever before and the consequences of the unequal rollout across the world are beginning to be felt in terms of preventable deaths, dangerous variants, and economic loss.

We published three opinion pieces recently, in which we reflect on these developments and the implications for global equity, and provide recommendations for leaders.

In Politico Magazine, we write about why and how the US should actively support Covid-19 vaccination in other countries. As of this week, 70% of vaccinations have taken place in the US, EU, China, and India, and we face a long wait before most of the world will have enough doses to approach herd immunity. Based on analysis of our data on vaccine purchases and manufacturing, we recommend that excess does be shared immediately, rather than being stored for later use, as the global need is urgent now and speed counts. We also make the case that the US can and should lead efforts to fund development of manufacturing hubs in Africa and Asia, to improve global access to safe and effective vaccines.

In The Hill, we explore how the communication and messaging from leaders in the US and EU about potential risks from Covid-19 vaccines can have unintended and dangerous impacts in other parts of the world. We note that the risk-benefit ratio is very different for countries where Janssen (J&J) and Oxford-AstraZeneca vaccine make up the bulk of supply than for countries like the US, which have enough vaccine doses from other makers to cover the entire population. Clear communication about the factors leading to regulatory pauses or restrictions can help leaders in other countries to put these risks into perspective and help to inform their own risk-benefit calculations.

In the MIT Technology Review, we write about the factors contributing to India’s current crisis and what is needed now. While India’s export restrictions on Covid-19 vaccines are important and understandable, the country will not be able to vaccinate its way out of this surge. India urgently needs to implement national public health measures to reduce spread of the virus and buy time to manufacture and administer vaccines. International support, in the form of oxygen, medication, testing kits, and masks are also desperately needed. (The MIT Technology Review requires a subscription, but non-subscribers can read up to three articles free.)

INTERESTING TRENDS

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

US will divert supplies ordered for its own vaccine manufacturing to India, to support production at the Serum Institute. This is a great start towards equity, but there is more that the US can do (see our comments above for our take on what can and should be done).

US, EU, UK, and Russia send help to India including oxygen, ventilatiors and medication to address the Covid-19 crisis, as India registered more than 300,000 new cases daily this week.

South American countries are also seeing record-high death rates and last week accounted for 38% of Covid-19 deaths worldwide but only represent 8% of the world’s population, according to the New York Times.

Israel, which has vaccinated 62% of their population, purchased more Pfizer-BioNTech and Moderna doses this week but is still not providing vaccines to Palestinians, including those living in the West Bank.

Bharat Biotech in India reports that it will double manufacturing capacity to 20 million doses per month by June and then will reach 60 to 70 million doses per month by August.

Brazilian health regulators unanimously voted to not approve the Sputnik V vaccine, citing a lack of data on safety, quality, and effectiveness. Regulators in the Czech Republic made a similar announcement this week, saying they had not received enough documentation properly assess the vaccine. Russia has denied both claims and plans to sue Brazil’s regulator.

Pfizer is shipping doses produced in the US to Mexico, the first such global export from the company’s US production. More shipments abroad are expected to follow, as US manufacturing plants expect to have excess capacity by mid-year.

Mexico announced its Birmex firm will provide fill-finish capacity for Sputnik V, using active ingredient produced in Russia. Mexican officials hope this will speed up production and delivery of their order, which has been repeatedly delayed.

Moderna is expanding manufacturing plans in the US and Europe to increase production capacity. The company now expects to produce 800 million to 1 billion doses in 2021 and to further increase capacity up to 3 billion doses in 2022.

The WHO has approved the Moderna vaccine for Emergency Use Listing (EUL), which makes it eligible for distribution through COVAX. Decisions on Sinopharm (Beijing) and Sinovac are expected within the next week.

France is the first country to donate vaccine doses through the COVAX dose-sharing scheme, pledging 500,000 doses by mid-June. France intends to donate at least 5% of their total supply to COVAX through 2021. New Zealand and Spain have also signaled that they will donate doses through COVAX.

The EU is taking legal action against AstraZeneca for “not respecting” terms of their contract.

A new report from the IQVIA Institute for Human Data Science forecasts that global spending on Covid-19 vaccines will exceed $150 billion by 2025, including $53 billion in 2021.

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

Weekly COVID Vaccine Research Update

High-income country confirmed dose total:	4.9 billion
Upper-middle-income country total:	1.5 billion
Lower-middle-income country total:	713 million
Low-income country total:	770 million
COVAX total:	1.12 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	9 billion doses