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Omicron has led to a rush in wealthy nations for boosters. On Sunday evening, British Prime Minister Boris Johnson said the country would aim to offer all eligible adults a booster shot by the end of the year, citing the exponential spread of the new variant.
“A tidal wave of omicron is coming,” Johnson told the nation, “And I’m afraid it is now clear that two doses of vaccine are simply not enough to give the level of protection we all need.”
Other high-income countries are also pushing ahead with boosters, overcoming earlier hesitation about offering extra doses outside of the standard one- or two-dose regimen initially approved, depending on the manufacturer.
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“We’re getting booster shots to 1.1 million Americans a day — more people boosted per day than ever before,” White House covid-19 response coordinator Jeff Zients said told reporters Monday.
But while these extra shots are being administered faster than ever, many people in poorer nations are still waiting for their first doses. Roughly 54 million booster shots had been administered in the United States as of Sunday, compared with 64 million doses administered in total in low-income nations, according to Our World in Data. And that gap may soon close: While the pace of vaccination in low-income nations is increasing, all together they have only administered more than a million shots a day three times so far.
According to the World Bank, roughly 665 million people live in countries classified as low income, which means they have a per capita gross national income of less than $1,045 (around 60 times lower than that of the United States). The vast majority of these countries are in sub-Saharan Africa. War-torn nations like Yemen and Afghanistan also fall into this category.
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Boosters have long been held up as a symbol of inequitable access to vaccines. Of the more than 360 million booster shots administered around the world, almost all have been in high-income and upper-middle-income nations. Under 8 million have been administered in lower-middle-income nations, while the number administered in low-income nations is either zero or so close to it that it is negligible.
The booster dichotomy mirrors the wider divide on vaccinations. Just 3.4 percent of the population of low-income nations and 30 percent of lower-middle-income nations are considered fully vaccinated, lagging far behind wealthy nations like the United States and Britain where roughly 60 percent and 70 percent of people have had the full regimen of doses, respectively.
Global efforts to beat vaccine hoarding and inequality have struggled. Covax, an effort backed by the World Health Organization that was designed to pool money to ensure vaccine supply for poorer nations, initially aimed for 2 billion doses to be available in 2021. It is now racing to deliver a far-diminished target of 800 million doses, as I reported last week.
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Omicron has raised new questions about how far even these doses can go. Given the variant’s apparent ability to evade the antibodies created by vaccinations, some experts are suggesting that the definition of being “fully vaccinated” should include booster shots. Even those who have received vaccines that were highly effective against other variants, such as Pfizer/BioNTech and Moderna, both of which use advanced mRNA technology, are being told by Britain’s Johnson and other figures they may need additional doses to be fully immunized against omicron.
It may not stop there. Executives at pharmaceutical giant Pfizer said last week that the new variant could increase the likelihood that people will need a fourth vaccine dose. So far, U.S. officials have not changed the definition of “fully vaccinated.”
“Right now I don’t see that changing tomorrow or next week,” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said during an interview with CNN on Sunday. But he later added: “It’s going to be a matter of when, not if.”
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The World Health Organization (WHO) — which had called for a moratorium on booster shots until poor countries gain wider access to initial doses — continues to vocally oppose the additional shots, even as omicron spreads.
“The boosters are, unfortunately, probably not the solution to this,” WHO chief scientist Soumya Swaminathan said during a press briefing last week, stating that the majority of people who die around the world from covid-19 continue to be those who have had no vaccine at all.
The WHO has suggested, however, that individuals who received the less effective Sinovac and Sinopharm should receive an extra dose, as should those who have weakened immune systems.
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Key figures in the Covax initiative have warned that booster campaigns will strain a system in which doses are already sparse.
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If extra doses are required to protect against omicron, that means “the world that we characterize as immunized is effectively less immunized than it was before, and so it consumes more doses,” Orin Levine, a vaccinations expert at the Bill & Melinda Gates Foundation, a key backer of the Covax scheme, told me this week.
For now, it may be a theoretical argument. Despite the speed at which omicron is spreading, the vast majority of cases worldwide are still linked to the delta variant. But that could change fast: British officials have warned that omicron could soon overtake delta, as Johnson confirmed Monday that one death had been linked to omicron.
Even the world’s most vaccinated places are worried. In Brazil’s S？o Paulo, where officials claim to have vaccinated roughly 100 percent of its adult population, my colleagues Gabriela Sá Pessoa and Terrence McCoy report that the new variant is being eyed cautiously.
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“What we hope, especially with our high rate of vaccination, is that, even in the worst-case scenario, there will only be an increase in the number of cases” and not hospitalizations and deaths, Alexandre Naime Barbosa, head of the epidemiology department at S？o Paulo State University, told The Post.
But the world’s least-vaccinated places have the most to fear. In the British Medical Journal, Fatima Hassan, Leslie London and Gregg Gonsalves argue that the emergence of omicron in southern Africa is tied to “uneven and slow access to covid-19 vaccines” that allowed the virus to spread in largely unvaccinated countries.
And that’s not the only problem, they write: “The health and socio-economic burden of covid-19 cases, hospital admissions, and deaths will fall disproportionately on these countries” — the countries where the struggle is for doses, not boosters.
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