Despite the growing deployment of coronavirus vaccine boosters in many wealthy countries, including the United States, many poorer nations are unlikely to see extra shots in the near future as they struggle to administer initial doses, according to one of the architects of Covax, a World Health Organization-backed initiative to share doses around the globe.

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       Seth Berkley, a U.S. medical epidemiologist who serves as chief executive of the GAVI vaccine alliance and helped set up Covax, told The Washington Post on Thursday that he expected some extra doses to be given out through Covax eventually, but that supply issues limited any near-term possibilities.

       “We’ll be in a little bit of a supply scarcity situation into the first quarter, maybe going into the second quarter, and so in that circumstance, you want to make sure you’re getting it to the right people,” Berkley said when asked if Covax could administer boosters, or extra doses that are part of a vaccine regimen, in 2022. “If we end up in a situation we’re in supply excess, then we can have those conversations.”

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       Many low- and lower-middle-income nations had relied on Covax for substantial portions of their vaccine supplies.

       Barkley was speaking in an interview Thursday, one day before federal regulators authorized Pfizer-BioNTech and Moderna coronavirus vaccine boosters for all adults in the United States. Booster shots are also available for parts or all of the populations in a number of countries, including Britain, Israel and China.

       The WHO, under Director General Tedros Adhanom Ghebreyesus, has called for a moratorium on booster shots in wealthy countries, noting that they are using the majority of doses that manufacturers are able to produce, administering boosters even to those at comparatively low risk, as poor countries struggle to vaccinate even their most vulnerable.

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       Six times fewer first doses are being administered in low-income countries than boosters administered globally, Tedros said last week, calling the inequality “a scandal that must stop now.”

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       Berkley said Covax was not distributing boosters or extra doses out of practicality. “The question is not are boosters helpful,” he said. “The question is, in a situation where you still have critical people that haven’t gotten primary doses, should you be [injecting] very low-risk people with boosters?”

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       Governments should prioritize “a health-care worker that hasn’t been vaccinated” over “an 18-year-old or 15-year-old that has very little risk of severe disease if they do get it,” he added.

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       While there are already some recommendations regarding third doses for certain vaccines, such as those that use an inactivated version of the virus, including Johnson & Johnson, or for patients who were immunocompromised, he could not say when Covax might be able to provide those doses across the board.

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       Citing new data in October, the WHO recommended extra doses for anyone with a weakened immune system but said that these should be considered part of an initial regimen and not a booster. “That’s a distinct thing from giving additional doses, booster doses, to people who have had an adequate primary response to vaccination,” WHO vaccine director Kate O’Brien told reporters.

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       Covax was started to pool money from nations to buy doses, effectively ensuring that wealthy nations helped subsidize doses for poorer nations. But the program has struggled, initially with funding and the fact that wealthy nations had stepped in with enormous preorders, but later with delivery issues and an export ban in India, where many Covax doses were being created.

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       The Covid Global Accountability Platform issued an analysis this week that indicated that nearly all low-income countries, including most African countries, were at high risk of not reaching a globally set 40 percent vaccination target by the end of 2021.

       Speaking this week, Berkley said he hoped that supply would become routinized in 2022, allowing Covax to ensure that it is getting doses to the countries where they are most needed.

       “Hopefully, by the end of the year, we will have covered most of the high-risk people across the world. We should get close to the 20 percent we originally called for,” Berkley said, referring to the low-end of a target for vaccinations in poorer nations the organization previously set.