The Booster Dilemma (02/11/2021)

Swissmedic, the Swiss medicines regulator, has just given the green light for the third shot of Pfizer and Moderna vaccines against Covid-19. Available in mid-November, the boosters will target people over 65 who have already had two shots. The justification for the boosters is that evidence shows that immunity has lessened for those vaccinated many months ago; the risk of catching a severe form of Covid increases over time with the most vulnerable obviously at higher risk.

For those over 65 and who have not had Covid-19, the Swissmedic announcement is most welcome. A good friend of mine of a certain age who was fully vaccinated in February has just tested positive. Hopefully, the booster will help senior citizens like him from becoming severely ill. We are told that the booster will be available six months after the second vaccine. It will be a half-dose for those who were injected with Moderna, and a full dose for those injected with Pfizer.
All is not good news. The Swissmedic announcement poses a real dilemma.  
The Swiss population first had to choose whether to be vaccinated or not. In all, 63% of the population have made that choice. Now, those who are fully vaccinated will have to choose whether to get the booster or not. This second choice is less obvious than the first.
Within Switzerland there have been sufficient supplies of vaccines. Individuals choosing not to be vaccinated did so based on their personal choice. The supply was there; the demand was missing.
What about those living in countries where there has been little distribution of any vaccine? What about the global situation where the demand is there but not the supply?
In mid-September, the head of the World Health Organization reported that more than 5.7 billion Covid-19 vaccine doses have been administered globally, but only 2% of them in Africa. “That’s not because African countries don’t have the capacity or experience to roll out Covid-19 vaccines,” he said. “It’s because they've been left behind by the rest of the world.” Just 31% of India’s population has been fully vaccinated, half of Switzerland’s percentage.
The new dilemma is: Should people in the West who want a booster be able to be vaccinated while the rest of the world waits for more supplies? Can we profit from a third vaccine while a large percentage of the world’s population has been “left behind”?
When the pandemic broke out, consideration was given to equitable global vaccine distribution. The global initiative COVAX, Covid-19 Vaccines Global Access, was designed to do just that. But with nationalist pressure, countries concentrated on their own population. An international, equitable distribution of vaccines has not taken place. And now that the vaccine efficiency has shown to be limited in time, the demand for greater supplies will only increase in the West, leaving Africa and India even further behind.
Classical economics has clear descriptions of supply and demand. If the supply of vaccines is limited, should they go to people in the wealthier countries for boosters before they go to other countries with limited resources and distribution capacities? In my view, the answer is to increase the supply. How? Rather than counting on Western countries to supply vaccines, efforts must be made to allow all countries the technology and capacity to manufacture vaccines. While pharmaceutical companies may be hesitant to supply the necessary information, it should be a development priority to help improve local health infrastructures. This should and must be a priority in fighting this pandemic and future ones. Equitable global health is in everyone’s interest.
The rest of the world should not be forgotten. Now that the third shots have been recommended by Swissmedic, those who have been fully vaccinated will have the choice to take the booster or not. Will considerations about those who have had no vaccinations be taken into account? This is a new choice for those who believe in vaccinations. There is something inequitable about our having the possibility of three injections while many around the world have had none.
We cannot refuse a booster and insist that the vaccine we didn’t use go to Africa or India. That’s not possible. But we can insist that development aid focus on health infrastructure so that the dilemma between “us” and “them” is eliminated. Just as global wealth should be more equitable, so should global health.



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