This is the second in a series of newsletters, offering the expert insight of Lalita Panicker – consulting editor, views, Hindustan Times, New Delhi – into some of the most pressing health issues of the day. To read the first, click here.
Booster shots: To boost or not to boost
Faced with a rising tide of COVID-19 cases, the U.S., UK, and European Union countries have announced that they will begin giving booster shots in September to people who were declared fully vaccinated eight or more months ago.
Echoing others the White House says the initiative is a response to rising infections from the Delta variant and evidence that the protectiveness of the vaccines fades.
The blowback has been predictable in the ongoing rich vs. poor debate on vaccines. Leading the charge on behalf of the deprived many, the World Health Organization (WHO) has criticised countries for giving booster shots even as front-line health care workers in poor nations still haven’t been vaccinated. “We’re planning to hand out extra life jackets to people who already have life jackets and leaving other people to drown,” Dr Mike Ryan, head of WHO’s health emergencies program, said at a news conference on Wednesday.
However, the WHO recently called for a pause on booster jabs at least until the end of September. They aruge that a pause would allow for at least ten percent of the population in every country to be vaccinated. The booster jabs in question are planned for September and given the pace of approvals still required, not far from the end of that month in any case.
“We can take care of America and help the world at the same time,” U.S. president Joe Biden said in early August. He pointed out that the US had already donated 115 million doses to fortify immunisation efforts abroad .
The COVAX facility was created last year to ensure COVID-19 vaccines were made available around the world, with richer countries subsidising costs for poorer nations. Ghana was the first country to receive COVAX vaccines in February 2021. Since then, more than 4.95 billion doses have been delivered across more than 183 countries around the world. 24.4 percent of the total population in the world has been fully vaccinated – almost entirely in better-off countries.
COVAX has been criticised for the slow pace of its rollout. Some initial targets were missed, partly as a result of the poor health infrastructure in many of the recipient countries and partly because of vaccine hesitancy. Many thousands of vaccine doses have been destroyed in African countries because they exceeded their expiry dates.
Oddly enough, the U.S. is far from fully vaccinated with 51.5 percent of Americans having received the full dose leaving the rest waiting for more. Despite this, U.S. health administrators are looking beyond. “We know that even highly effective vaccines become less effective over time,” U.S. Surgeon-General Vivek Murthy said at the briefing. “It is now our clinical judgment that the time to lay out a plan for COVID-19 boosters is now.”
Given the 18-month experience of the pandemic and the way in which the virus left all governments and nations flatfooted and health systems overwhelmed, it’s now become a race to try and stay ahead. “It has been an almost reproducible phenomenon with COVID-19. If you wait for something bad to happen before you respond to it, you find yourselves considerably behind,” said president Biden’s authoritative advisor and long-time director of the National Institute of Allergy and Infectious Diseases Dr Anthony Fauci. “Better stay ahead of it than chasing after it.”
COVID-19 has created a vaccine-polarised world. On the one side there are the poorer nations having to make do with the COVAX system that’s clearly bedevilled by short supplies, infrastructure ranging from bad to non-existent, vaccine hesitancy like elsewhere, and picky national governments like South Africa rejecting vaccines while waiting for the best to turn up. On the other hand, there are the comparatively well-off nations with the shadow of the past looming large, panic-stricken in case they’re caught off guard once again, thinking it’s better to be safe than sorry. On the one side there’s a call for a greater democratisation of the vaccine distribution process and on the other there’s the dynamics of individual national democracies that tend to be unforgiving if the incumbent administration is found wanting. As the Buddha would have said, the True Path lies somewhere in between.
Polio: has the programme been eradicated?
The polio eradication programme seems to have rushed past all deadlines and come up against a dead-end. Or has it? An article in the authoritative British Medical Journal suggests that it has. Published in the 28 July edition of BMJ, the article by journalist Robert Fortner reveals that the World Health Organization (WHO) has already fired 500 staff on the polio programme, “perhaps ending a decades-long, multibillion dollar crusade engineered by some of the most powerful actors in global health.” According to Fortner, not even the Bill & Melinda Gates Foundation – the top funder of polio initiatives and behind only the United States government as the largest funder of WHO – knew about these plans.
Since the effort to eradicate polio began in 1988, the Global Polio Eradication Initiative (GPEI) has pushed polio to near annihilation, reducing cases by 99.99 percent.
Fortner goes on to say “two of the three serotypes of the wild poliovirus have been declared eradicated worldwide, leaving only type 1, which has been cornered in just two countries, Afghanistan and Pakistan, which had a total of 140 cases last year.”
To a considerable extent the GPEI could have become an unintended victim of the battle against COVID-19, the piano player in a bar room shootout so to speak. It is possible that the world cannot afford to sustain two intense eradication campaigns simultaneously either financially or in terms of sheer human effort.
Confronted by the seemingly inexhaustible COVID-19 pandemic the WHO has either shut down some of the GPEI projects or refashioned them to bring them into the battle against COVID-19 and other immunisation programmes.
The COVID-19 pandemic put polio efforts on hiatus for several months in 2020. Then in December 2020, WHO decided to speed up integration of the polio programme into existing immunisation services – something that for decades has been considered anathema.
This was followed by WHO’s regional office for Africa firing some 500 polio programme staff, surprising GPEI’s partner groups and donor nations, including the United Kingdom’s Foreign, Commonwealth & Development Office and the U.S. Agency for International Development (USAID).
The GPEI explicitly separated polio from routine immunisation because eradication requires very high coverage rates – ninety percent or more. Yet some argue that the money lavished on polio has left millions of children vulnerable to other, often deadly, vaccine-preventable diseases, such as measles.
The decision, reportedly originating from WHO deputy director-general Zsuzsanna Jakab, effectively ended the GPEI as a monolithic entity possessed of all the means necessary to achieve eradication. (The WHO did not respond to The BMJ’s request to interview Jakab).
The Gates Foundation has also chosen to remain silent…so far.
Watch this space for more.