Dec 10, 2021 - Health

Omicron threatens to deepen global vaccine disparities

The first two boxes have a checkmark made of a syringe, and the third box has a large X in the middle.

Maura Losch/Axios

If initial data suggesting booster shots are necessary to protect against Omicron bears out, that would mean the world needs more doses — and inequities between high- and low-income countries would almost certainly be exacerbated.

Why it matters: When parts of the world are left without adequate protection to the virus, it leaves everyone vulnerable to dangerous new variants, experts say.

Where it stands: Initial data from Pfizer suggests two doses of the vaccine don't offer much protection against the rapidly-spreading Omicron variant, but three doses do.

  • NIAID Director Anthony Fauci told CNN this week that "it's going to be a matter of when, not if" the definition of "fully vaccinated" changes from two shots of Pfizer and Moderna's vaccines
  • Fauci added he doesn't see the definition "changing tomorrow or next week," but he believes it's "going to be considered literally on a daily basis."

Between the lines: Having enough doses of vaccine to offer everyone three of them is a luxury currently enjoyed almost exclusively by wealthy countries.

  • In low-income countries, the vast majority of the population hasn't received any doses.
  • The world was already facing a vaccine shortage before Omicron, although it had been narrowing. But if billions more booster doses are suddenly added to the list of new doses needed, that will exacerbate the shortage.

What they're saying: We're currently on track to have enough vaccine supply to vaccinate 70% of the world with two doses by early next year, but changing the standard to three doses would stretch out that timeline, said KFF's Josh Michaud.

  • “We’ll need more doses and that’s a real concern," Michaud said.
  • "It just ups the complexity of distributing those doses, planning to administer those doses, making sure people are reached and shots go into arms," he added.

Yes, but: Most wealthy countries already bought booster doses, meaning they'd been accounted for in global supply calculations even before Omicron.

  • That would shrink the number of new doses needed for boosters as long as there doesn't end up being a variant-specific vaccine — and as long as health officials don't end up recommending a fourth shot, a possibility already raised by Pfizer CEO Albert Bourla. (Pfizer has a lot of money at stake in the booster debate, meaning Bourla's comments should be taken with a grain of salt.)
  • "One key variable is how well different vaccines hold up. If only some of the available vaccines prove to be effective, or if we need variant-specific vaccine, that supply is likely to be very constrained," said Krishna Udayakumar, founding director of the Duke Global Health Innovation Center.

The big picture: Vaccine production has been steadily ramping up. There will eventually be enough doses for the world, even if everyone needs three shots; the question is when, and how that timeline compares against the spread of Omicron or other variants.

  • "Increase to three doses would increase demand, but over time," Udayakumar said. "Overall supply could still be adequate so long as countries don’t keep large stocks on hand."

What we're watching: Activists had already been pushing the Biden administration and other wealthy countries to take much stronger action to increase global vaccine supply even before Omicron emerged.

  • “This may represent the next phase of vaccine apartheid. Pharmaceutical corporations will funnel hundreds of millions of third doses to rich countries, even as large parts of the world remain unable to access their first," Public Citizen's Zain Rizvi told Axios in an email.
  • "Governments must rapidly expand global mRNA manufacturing around the world, so everyone has the best tools to face new variants—not just the lucky few," he added. "That is how we end the pandemic.”
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