As the pharmaceutical companies scramble to extend vaccination against COVID-19 to pre-teenagers and then to toddlers while preparing for third, fourth, or more shots for those already vaccinated in the developed world, in an op-ed in the New York Times physician Matshidiso Moeti urges the people of the developed world to think about Africa:
As the rich world rolls out Covid-19 booster shots, hundreds of millions of Africans remain dangerously exposed, still awaiting their first vaccine dose. This not only adds to the litany of harsh disparities we’ve seen around this virus, but it is also a scandalous injury to global solidarity and vaccine equity.
While early data on waning immunity is emerging around some vaccines, there’s no conclusive evidence to justify giving boosters to fit, healthy people. Third doses should be given only to the small number of people facing a high risk of severe illness and death, despite being fully vaccinated, including those with compromised immune systems. Boosters for the healthy are, effectively, a hopeful “why not.†Political decisions are getting ahead of science, diverting doses and leaving Africans with few options.
Giving healthy people boosters now is similar to sending a generous educational grant to a billionaire while others are scraping together their college tuition.
To date the “rich world” has been very good at promising to make vaccines available to developing countries but not nearly as good at delivering. Here’s the scorecard as of one month ago:
as reported by the Associated Press. I would think that the EU, Germany, France, Italy et all would want to ensure that people in African countries are vaccinated if only out of self-interest. Similarly, I think the U. S. focus should be on Mexico, Central America, and the Caribbean for similar reasons. To promise is good but following through on your promises is better.
Some factors to consider about “vaccinating the world”.
(1) The WHO / US / EU strategy depended heavily on India and its substantial capacity. That was knocked offline by the delta wave in India which caused the Indian government to prioritize vaccines for India. That said, India is close to finish vaccinating (before boosters through), so that bottleneck should be resolved by the end of the year.
(2) The dominant vaccines in the EU / US (mRNA aka Pfizer, Moderna) have cold chain requirements. They continue to be a poor fit in the “3rd world” where electricity is spotty. I don’t think the EU / US has substantial capacity for vaccines without cold chain requirements (AstraZeneca / J&J).
(3) The great unknown, effectiveness over time. Let’s hope we won’t have to vaccinate the entire world every 5/6 months.
With that said, I think the greatest urgent need on COVID is to develop additional vaccines; (1) that don’t have cold chain requirements (2) provide longer lasting immunity; preferably 5 years or more (3) vaccines that provide “sterilizing immunity” (i.e. highly effective at preventing spread)
I think there are others, for example,
(4) does the effectiveness of mRNA vaccines decrease progressively over time?
(5) do repeated vaccinations have adverse secondary effects?
I’m skeptical that we really have the experience to know the answers to either of those yet.
Maybe if WHO hadn’t renamed the Kentish variant, the South African variant, the Brazilian variant, and the Indian variant, there might be better appreciation of the need to vaccinate globally. Somewhat joking.
OTOH, the U.S. has committed to trying to get everyone vaccinated who can, and increasingly using mandates, so we will need to keep a certain level of domestic production. Given vaccine storage requirements, geographic disbursement of the U.S. population and reduced vaccination rates, this probably necessarily means increased waste. I don’t see much problem leaking some of the vaccines to high-risk groups.
There was an immunologist on “This Week in Virology” a couple of weeks ago who said that the studies at this point suggest immunity is stabilizing around 6 months from infection/vaccination and should last for years. Different components (antibodies and memory T and B cells) have different trajectories — the body has more Memory B cells at six months than one month. People infected with SARS seventeen years ago, still have T-cells from that exposure.
Also discussed the studies indicating that better immunity appears to come from infection + vaccination when compared to two doses. He was not recommending infection due to the risk, but infection appears to provide something that a second dose does not, presumably giving the body knowledge of where to expect infections to originate (the mucous membranes) so it can better target the response.
Epidemiologists won’t want to mention the possibility that for healthy people, the risk of infection after vaccination might have the benefit of better future immune response. In any event, nasal sprays have been tested for a while now; I don’t know how quickly they can arrive.
“Epidemiologists won’t want to mention the possibility that for healthy people,”
The reason I know about this is that epidemiologists have been talking about it quite a bit. I think it could be true but it could just be a temporary effect.
Steve