Rejecting the Covid-19 booster shot does not save the lives of poor countries.This is the reason

The call for Americans to receive the mRNA Covid-19 vaccine for the third time has sparked lively and sometimes fierce debate among scientists, bioethicists, and health policy professionals. Many have questioned the need for booster shots. Others emphasize potential vaccine inequality. Some ask if this behavior could interfere with our ability to stop the pandemic.

On Wednesday, World Health Organization director Tedros Adhanom Gebreyes called on wealthy countries with high coronavirus vaccines to refrain from providing booster shots until the end of the year.

I believe that in order to move forward, we need to better understand the need for third shots while looking at the wider global landscape of what is needed to vaccinate the world.

First, the rationale for boosters. The White House’s Covid-19 response team has informed the public that vaccine protection has declined over time, causing a significant number of breakthrough infections. Patients who received either the Pfizer-BioNTech or Modern RNA vaccine twice last winter will be provided with a third immunization. Ultimately, all Americans who have been vaccinated with the mRNA will need three doses to maintain protection, and another recommendation for the Johnson & Johnson vaccine will be published.

Evidence of weakened immunity comes from studies in Israel, perhaps with reduced efficacy against delta mutants (among the first adopters of the Pfizer vaccine). These studies report that the protection of the Covid-19 vaccine has been halved from over 90% to about 40% to 50%. US studies, including those from the Mayo Clinic and the New York State Department of Health, also show reduced vaccine protection.

The evidence that these reductions also lead to significant groundbreaking hospitalizations and deaths is less clear, but the White House has expressed concern that this is unavoidable. In some states, 4% of hospitalizations occur among vaccinated patients. However, anecdotally, some hospital managers and doctors say they have seen vaccinated patients account for up to 20% of inpatients.

Many aspects of booster recommendations make sense. Up to 3,000 Americans died each day when the two mRNA vaccines were launched in January. At that time, Covid-19 was the leading cause of death on a daily basis. The two-dose schedule, placed at 3-week (Pfizer) or 4-week (Moderna) intervals, was aimed at quickly immunizing Americans, especially the vulnerable elderly in nursing homes and healthcare professionals.

It worked and many lives were saved.

However, the short intervals have their drawbacks. It is not ideal for maximizing immunity or ensuring long-term, durable protection. For example, most pediatric vaccines have a recommended dosing interval of at least 8 weeks, followed by a longer interval for booster immunization. Larger intervals help maximize immunological memory and antibody response. For example, for a diphtheria-tetanus-whooping cough (DTaP) vaccine given to an infant, a fourth dose is recommended 6-12 months after 3 rapid immunizations, followed by a 5th dose 3 years later. Inoculation is recommended.

Hib meningitis and inactivated polio vaccines, as well as the new Mosquirix malaria vaccine for Africa, have similar interval requirements. It makes sense that additional boosters will be needed after a few months to deploy an emergency Covid-192 dose in winter and spring. From the beginning, the mRNA Covid-19 vaccine may have been the most effective triple-dose vaccine, even without pressure from the delta mutant.

Experts, including the Centers for Disease Control and Prevention’s Immunization Implementation Advisory Board, should review supporting data before implementing the Three-Shot Policy. There are many unanswered questions. What is the actual goal of the third immunization: to prevent hospitalization or to prevent breakthrough infections as a means of stopping viral infections? What is the evidence that a third immunization achieves these goals? Is there a downside to the third dose? Can it increase the risk of myocarditis, heart inflammation among the young population (very rare after two doses)?

Second, there is an important issue of fairness. Up to 90 million vaccine-eligible Americans remain untreated with a single dose of the vaccine, primarily due to refusal or hesitation. Bridging the gap between these vaccines remains a top priority.

Globally, things are much worse. Many African and Asian countries are overwhelmed trying to fight the Delta variant. They are desperate to administer a high quality vaccine.

Pandemics need to be addressed globally, both for humanitarian reasons and for our self-interest in preventing the emergence of other variants. But so far, the U.S. government has not moved fast enough to set a strategy for vaccination the world, in addition to modest donations of vaccine doses and relaxation of patent restrictions. ..

At a minimum, you must promise to pay and donate your mRNA vaccine for each American booster shot. This sends an important message that we are committed to the health and fairness of the world.

However, this alone is almost not enough. If you are serious about staying ahead of the world’s surge in delta variants, you will need 4-5 billion vaccines to immunize the world’s low- and middle-income countries by the end of 2021. ..

So far, this does not seem to be feasible with mRNA vaccines. As with any new technology, it takes time to learn how to make these complex vaccines on a multi-billion scale scale. This will eventually be possible, but not yet. Therefore, it is necessary to consider immunization with vaccines that can be produced on a large scale at present. A WHO spokesman said: “The world needs multiple vaccines that work in different populations.”

For example, the Texas Children’s Hospital Vaccine Development Center at Baylor Medical College has developed a low-cost recombinant protein vaccine technology for Covid-19 to transfer to vaccine producers in low- and middle-income countries. Biological E, one of India’s leading vaccine manufacturers, plans to use this technology to produce 100 million vaccines a month. The Biden administration is funding the expansion of Biological E’s manufacturing capacity, but more support is urgently needed. Texas Children’s Hospital technology is also licensed to Indonesia’s BioFarma and Immunity Bio. It is led by the executive chairman of Dr Patrick Soon-Shiong, a surgeon and businessman. Times – For South Africa and other regions.

In fact, fully immunizing Americans with three mRNA vaccines is not the same as refusing to give the vaccine to other parts of the world. Instead of competing for a limited supply of vaccines, we simply have to produce more vaccines. This can be done. Costs are modest compared to the financial consequences of an endless health crisis, and this is the surest way to end a pandemic. — Los Angeles Times / TNS

Peter Hotez is a professor of pediatrics, molecular virology and microbiology and dean of the National School of Tropical Medicine at Baylor College of Medicine.