Why There Should Be a Moratorium on COVID-19 Booster Shots Until Low-Income Countries Get Vaccinated

“I got my first shot and am yet to receive the second. The situation was tough for the last two months, where over 2000 people died, including health workers. We hope that vaccines will be able to reach different parts of the country and that people will be responsible and go for vaccination. COVID is spreading, though people are now moving to work in order to earn a living, since the majority depend on hand to mouth.”

This was part of an email we received last week from a midwife in Ugandan, Harriet Nayiga. It reinforces how difficult life is in parts of the world where Delta and other highly transmissible variants are ripping through populations, which remain largely unprotected due to extremely low vaccine coverage.

To date, 10 countries have administered more than 75% of the world’s vaccines, while low-income countries have received just over 1%—nowhere near enough to fully vaccinate their health workers, older populations and others at highest risk of severe disease and death.

Despite this searing inequity, some rich countries have announced plans to administer “booster” doses to populations that have already received a full course of vaccination. Not only is this ethically objectionable, when considering the hundreds of millions of people who have not yet received a single dose in the world’s poorest countries, the scientific data to support such a major policy intervention, which will have dramatic effects on global vaccine supply, is still being gathered.

Health workers in low-income countries must be reaching for their dictionaries to look up the meaning of solidarity.

The data we do have from high-income countries now clearly demonstrates that solving this gross inequity is a life or death situation for lower income countries. We are still in the midst of one pandemic, but increasingly it has two starkly different tracks. Countries with high coverage are seeing a decoupling of cases and deaths, whereas countries that cannot access vaccines are seeing high cases drive with steep rises in mortality.

For these reasons, WHO has called for a global moratorium on COVID-19 booster shots, at least until the end of September, to enable progress towards vaccinating at least 10% of the population of every country. So far, just over half of the countries in the world have reached that target, almost all of them high- and upper-middle income or vaccine-producing countries.

I understand that every government has the mandate and the responsibility to protect its people. As a health minister and foreign minister, that’s what I did, too. But as counter-intuitive as it may seem, that national, domestic objective is better achieved by vaccinating health workers and the most at-risk people in all countries before moving to younger populations at much lower-risk and booster shots.

With supply limited, more vaccines for people who have already been vaccinated means fewer doses for people who have not. Furthermore, the more people who remain unvaccinated globally, the more opportunity the virus has to spread and evolve into potentially more dangerous variants, which increases the risk for everybody

We are living through a global crisis, but rhetoric is outpacing action. I’ve heard political and industrial leaders talk about the need to vaccinate the world because “no one is safe until everyone is safe.” At the same time, these leaders are signing bilateral deals that further exacerbate the gap between the haves and have nots.

Political and corporate leaders must make a choice. Do the handful of countries and companies that control supply really want to run the risk of new variants appearing globally and unnecessary waves of death, job losses and insecurity everywhere?

Or, do they want to end the pandemic and drive a truly global recovery?

What needs to happen? First, countries that have vaccinated the majority of their high-risk populations need to share vaccine doses—unearmarked—now with COVAX and other entities, like the African Union, which has established its African Vaccine Acquisition Trust, to give countries with low coverage the means to catch up. Some countries have started sharing doses but we need more and faster sharing to curb this fast moving virus. This isn’t charity; this is the best way to protect fragile gains everywhere. As part of this effort, we must document and report on all donations of doses, which is essential for understanding needs and effectively sharing and distribution of vaccines going forward.

Second, companies that produce vaccines must for the next six months commit and ensure that the majority of their product goes to COVAX and low-income countries whose coverage—from all sources—is not on track to achieve the global goals of 10% coverage in every country by end-September and 40% by end-December.

Third, there must be an increase in vaccine manufacturing capacity in all regions, starting with those with the least production capacity. I’m pleased that WHO’s first mRNA vaccine manufacturing hub is moving forward in South Africa with partners from the private and public sector. We will be establishing further hubs in other regions of the world too.

But it would move even faster if pharmaceutical manufacturers shared their licenses, technology and know-how.

There’s little to be gained by a small number of companies making big profits if the world continues to lose trillions of dollars by going in and out of severe restrictions on their populations.

A year ago, India and South Africa put forward a proposal for the World Trade Organization to temporarily suspend patent rights on the tools needed to battle COVID-19. Most countries now support the idea, but a small number that have already vaccinated the majority of their populations are still blocking it on the basis that voluntary licensing is the fastest way forward. Fine, but if other companies had followed AstraZeneca’s lead by sharing their licenses, know-how and technology and more effectively mass producing vaccines, or sharing them through WHO’s public health driven platform—the COVID-19 Technology Access Pool (C-TAP)—we might not be having this discussion.

I’m not against the private sector being incentivized to make new products; far from it. I would be happy to see them succeed for next generation tests, treatments and vaccines to be developed quickly and be well rewarded.

But it’s unconscionable that some vaccine-producing companies are reporting record profits, and some countries are offering boosters, while so many people remain unprotected.

For the future, an international treaty on pandemic preparedness and response will be crucial for ensuring there are clear “rules of the game” that will help to ensure such shocking inequities are not repeated.

In the meantime, to ensure all health workers like Harriet and in countries like Uganda, and those at most risk of severe COVID-19 disease are protected, a temporary moratorium on boosters is a necessary and sorely-needed statement of solidarity that would help save the most lives and help end the acute stage of this pandemic everywhere.