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Covid vaccination: third dose versus first dose

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The current debate over the need, cost and effectiveness of the third dose or “booster shots” for Covid is generating a lot of heat. The battle lines are clear. On one side are the pharmaceutical companies, Pfizer, BioNTech, Moderna and others who will benefit financially from the production, distribution and administration of the booster injections in the United States and other countries of the first. world. Aligned on the other side are international organizations such as WHO and UNICEF, and vaccine equity advocates.

Supporters of the recalls point out that vaccination does not offer protection against the virus forever and that a third dose boosts immunity. So far, so good! The jury is out on who needs the third dose and when. Also, with a global vaccine shortage, a thorny ethical problem has resurfaced. Would the demand for a third dose increase the price and reduce the availability for those who have not yet received their first dose?

If we take a global perspective, only a few people in low-income countries have been vaccinated. According to the Our World in Data project at the University of Oxford, only 31.7% of the world’s population has received a single dose of the vaccine, while only 23.7% of people worldwide are fully vaccinated. In developing countries, just 10 percent of people have received a single dose of the vaccine. It’s worse in Africa, where 25 people die every minute from Covid-19.

Last month, Israel became the first country to offer the coronavirus booster, fearing the vaccine’s effectiveness could wane over time. The UK has already cleared the recall, and the US and other countries are expected to follow suit, raising fears that the inequality in global vaccine distribution could grow further. The WHO urged the United States and other wealthy countries to wait until the end of this year and called for a four-month moratorium, to “give more people in other countries a chance to get a first dose of these saving blows “.

If we ignore the commercial side, the role and ferocity of the Delta variant in “breakthrough cases” and the decrease in vaccine effectiveness were the main drivers of the third firing movement. According to an article published in Science, spokesperson for the American Academy for the Advancement of Sciences (AAAS), “The greater contagiousness of the Delta variant of SARS-CoV-2 leads scientists and governments to debate whether booster injections of Covid-19 vaccines are needed in some countries given limited vaccine stocks elsewhere. “

The Science article entitled “An ethics? Useless? The debate over the recall of the Covid-19 vaccine is intensifying ”also observes that,“ as the United States reveals its plan to offer an additional dose of Covid-19 vaccine, fairness and scientific questions abound ”.

Studies show that even after five to eight months, vaccines are still very protective against serious illness, hospitalization and death. By comparison, billions of people around the world have not received a single injection due to a vaccine shortage. Therefore, one is faced with a moral and ethical dilemma. Do the less fortunate among us deserve a chance to live and avoid the inevitable fate once we are infected?

WHO, the Coalition for Epidemic Preparedness Innovations, and Gavi, the Vaccine Alliance, created Global Access to Covid-19 Vaccines (COVAX) to equitably purchase and distribute vaccines. But much of the development, production, supply and distribution of vaccines is ad hoc, generating controversy and inconsistency. Pharmaceutical companies have been criticized for hoarding knowledge, secret prices, unreasonable profits, unfair bilateral deals, and exorbitant liability claims. COVAX has been criticized for its lack of transparency and accountability and for ignoring the need for the distribution of the Covid-19 vaccine, according to a research article published in the scientific journal Lancet.

Access to vaccines for all (and I mean for all people of the world) is quickly becoming a global issue at all international meetings and has replaced climate change at the current General Assembly meeting in New York. . This comes 18 months after the start of the pandemic, because “it is clear that the world will likely be riddled with Covid-19 – and its many successors – for years to come,” according to a BBC report. “The next big question is whether two doses of each vaccine is enough” and when can we expect to have enough to immunize everyone, rich and poor.

“All indications are that [Covid-19] is going to become endemic, but the hope is that it can be managed by vaccines, ”said Flavio Torres, economic epidemiologist at the University of Cambridge. “The practical policy at this point, given the low cost, should really be to get as many people vaccinated as possible.”

In light of these sentiments, WHO Director-General Tedros Adhanom Ghebreyesus called late last month for a moratorium on recalls, questioning the need for a third vaccine and stressing the risk that “more potent” variants are emerging in countries with “low immunization coverage”.

“We don’t understand who is going to need a booster, how long after their last dose, or what combination of vaccines works best,” says physician-epidemiologist Bruce Aylward, senior advisor at WHO. “You need to understand all of this before you decide how to use boosters.”

If everyone in high-income countries got boosters, it would use up a billion doses, Aylward estimates. “You are dealing with a finite zero-sum resource,” he says. “You are reducing the supply for those who need it most.”

In my concluding remarks, I will offer some thoughts that my readers might also wish to consider. According to a report released by the Economist Intelligence Unit (EIU), “Some characteristics of the Delta variant mean that vaccines alone may not be enough to control the virus. Delta is much more transmissible than the original strain of the coronavirus (someone infected with Delta infects 5 to 9 other people, compared to 2 to 3 for the original strain.) Israel, which has one of the highest vaccination rates in the world, illustrates how Delta is a game-changer; after hoped the disease was under control, the country is now grappling with a fourth wave of cases. “

Nations around the world must address immunization disparities in order to minimize the loss of GDP and the growth of poverty in Asia-Pacific, Latin America and Africa. In a health policy article published in Lancet, leading academics and international experts point out that an effective global vaccination strategy against Covid-19 has many dimensions. The document, titled “Challenges to ensuring global access to Covid-19 vaccines: production, accessibility, allocation and deployment” believes that an ethical approach to the production and distribution of Covid-19 vaccines should satisfy four indisputable principles: optimize vaccine production, including development, testing and manufacturing; equitable distribution; durability; and responsibility.

“Having vaccines licensed is not enough to achieve global control of Covid-19: they also need to be produced on a large scale, at an affordable price, allocated globally so that they are available where it is needed. necessary and widely deployed in local communities, ”the experts said.

Dr Abdullah Shibli is an economist and information technology consultant. He is also a senior researcher at the International Institute for Sustainable Development (ISDI), a think tank based in Boston, United States.


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