Covid boosters and vaccine inequity

Mishael QadeerWeb Editor

09th Oct, 2021. 05:35 pm
vaccine-covid

KARACHI: With the pandemic still looming in Pakistan and abroad, many are looking to booster shots for raised immunity. Despite very little knowledge about the whole process and inconclusive research on the matter, rendering the whole thing a bit premature, Pakistan’s government and its citizens are not deterred from the idea of an extra jab.

The federal government issued two circulars that allowed for the administration of additional doses of Covid-19 vaccines, under the condition that those being inoculated are either travelling abroad, are citizens of a foreign country or are healthcare workers, and in all these cases the recipients must have waited at least 28 days before their last Covid-19 shot.

Following the release of these notifications, most of the buzz generated revolved around the cost of the additional dose, which was set at Rs.1270, as healthcare workers were being given the shot for free and travelers were not. Almost no news was reported on the efficacy, safety and necessity of such a shot.

This has understandably left many very confused about where to get the booster vaccines, who can get them, what they are good for and if getting them is even the right decision to make at this stage of the pandemic.

Furthermore, almost no attention was payed to the fact the second page of an the official government circular issue on August 31 read that, “the World Health Organisation (WHO) doesn’t recommend a booster dose or vaccine mix and match due to limited availability of data. Accordingly, the additional dose to international travelers will be administered only on individual request at [their] own risk and cost.”

With the data being incomplete and unknown risks involved, many are still flocking to the designated booster shot sites to get an additional Pzfizer-BioNTech shot, on top of their completed vaccinations. The reasons are for this are two-fold: This first is the need to for international travel, which is shrouded with restrictions unless one is vaccinated with Western vaccines due to second is Asian-Russian vaccine skepticism; and the second, which prompted the hurried calls for these boosters, are virus mutations.

Delta Doom

The bustle around the booster shots primarily started around the same time the Delta variant of SARsCov-2 swept into Pakistan in the early July of this year. The country had finally ebbed into a dystopian normalcy following the large-scale vaccine roll out and the new variant, which is highly contagious, threatened the country opening back up. This lead many, following the United States’ lead, looking to booster shots as the answer to their worries as they supposedly offer a higher rate of protection against mutated Covid-19 variants.

However, is there any truth to the matter? While the WHO claims that no such conclusion can be drawn at this time as “there is little evidence that a widespread COVID-19 booster shot is needed, or would be effective or safe,” according to WHO Department of Immunization, Vaccines and Biologicals director Dr Katherine O’Brien. There have been multiple studies carried out across the globe that suggest that mRNA vaccines – which includes the Pfizer-BionNTech and not the Sinopharm, Sinovac and CanSino vaccines – are more effective in providing immunity against the Delta variant.

According to Jinnah Postgraduate Medical Centre (JPMC) registrar Dr Sadia Moosa, who is in-charge of the Covid-19 vaccination centre at JPMC, “different vaccines, including Sinovac, Sinopharm and Pfizer, protect you against the virus and all its variants, however some vaccines like Sinovac and Sinopharm vaccines do not have as much efficacy against the Delta variant in comparison to Pfizer.” This also means, that if you have already gotten the two full dozes of Pfizer, you should rest easy and not pursue getting a booster shot at this stage as you are sufficiently protected against all variants of the virus.

What Does the Science Say?

So should we all be demanding booster shots? According to Dr Sadia just because mRNA vaccines have a higher efficacy against the Delta variant does not mean we dismiss the recommendations of the WHO, and we should, “lay focus on vaccinating the majority of the population as opposed to offering boosters to those who are vaccinated and move towards herd immunity instead.”

WHO spokesperson Dr Katherine O’Brien had categorically stated that, “we do see evidence [that administering a third shot increases immunity] and we would expect that to be true based on what we know about how vaccines work.”

However she added, “at the moment we should consider whether that is necessary at this stage as the evidence for such a need among the general population is not conclusive and most people have sufficient protection against the virus.” She maintained that, “the evidence shows that the vaccines that people have received are holding up really well to protect you against severe disease, against hospitalisation and against death and that’s really the primary intent of the vaccines.”

However, this level of contradictory information has left most Pakistanis confused about whether or not they should be seeking booster shots as experts seem to be claiming at the same time that booster are a good thing and will protect people but are also not something necessary at this stage.

“People are confused [about booster shots] because different researches are still going on as Covid-19 has a very short history. Therefore, we are still in the research phase,” claimed Dr Sadia, adding that new evidence has come about at a very rapid pace following the vaccine and getting a booster might not be a bad idea as “some safety is better than no safety.”

When the question of safety against the virus is brought up, many seemingly informed citizens are also left to wonder how safe the booster itself is. Earlier the Centre for Disease Control (CDC) in the United States, which has global acceptability in medicine, and the WHO had both warned profusely against mixing different vaccines. However, the booster does exactly that as most Pakistanis were vaccinated with Chinese and Russian vaccines, which have not been approved for booster shots. The only approved booster shots can be those of the Pfizer and Moderna vaccines.

Dispelling the fear around this, Dr Sadia revealed that boosters are a whole different ball game altogether. “While mixing vaccines is still not recommended, boosters have a different mode of action. As the Sinopharm, Sinovac and Cansino vaccines are not mRNA vaccines, getting a booster of such a vaccine as Pfizer can be good for you [in rasing your immunity].”

Vaccine Hierarchy

With less than half of its population being vaccinated and a 41 per cent fall in infection rates just last week, is it wise of the federal government to offer booster shots? Dr Sadia certainly thinks so. She maintains that, not everyone should be given a booster shot but the government’s decision to supply a third jab to healthcare workers and travellers is a good one. “Healthcare workers are more commonly exposed to infections and viruses and for traveling purposes, there are different rules, [travelers] have different destination and each country has their own laws, so to ease the problems of travellers the government has allowed them to get booster shots,” she stated.

The skepticism around Chinese and Russian vaccines is here to stay and has indeed made life a lot harder for the Pakistanis looking to travel abroad. Many students find themselves stuck in the country and unable to finish the degrees as they are being told they cannot enter foreign countries without being vaccinated with either a Pfizer or Moderna vaccine.

“I haven’t been able to continue my bachelors since over a year now, and after getting vaccinated I assumed I would be allowed back into the United Kingdom. However, this was not the case,” revealed Osama, a university student who received the Sinovac vaccine. “I had to get a Pfizer booster to be able to go back to New York,” revealed Saad, who is enrolled at a university in the United States.

Foreign countries including the United States, United King and Australia, have allowed foreigners to return only under the condition that they have received an approved vaccine such as the Moderna of Astra Zeneca.

Vaccine Inequity

This deliberate push towards Western vaccines is perhaps the reason why as many as 500 people have visited JPMC to get a booster shot since the government allowed the same.

However, none of this really addresses the issue at large – that we are facing a global pandemic. At the moment inequitable distribution of vaccines happens to be a major issue, with 70 per cent of developed nations being fully vaccinated, according to the Oxford University data platform Our World In Data. Conversely, the numbers of those vaccinated in the global south are nowhere close to this. In fact, Pakistan itself has a vaccination rate of 24.38 per cent, with just 10 per cent being fully vaccinated.

“The longer vaccine inequity persists, the more the virus will keep circulating and changing, the longer the social and economic disruption will continue, and the higher the chances that more variants will emerge that render vaccines less effective,” warned WHO Director General Dr Tedros Adhanom Ghebreyesus.

The WHO has repeatedly urged the global community to allocate resources to those nations that cannot vaccinate their citizens as rapidly as their developed counterparts. As many are ignoring the fact the Covid-19 remains a pandemic and if it is not globally dealt with it can never be eradicated, which may cause continued loss of lives and livelihood.

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