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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

To Have and Have Not: Could Boosters Prolong Global Pandemic?

By Gary Evans, Medical Writer

President Biden recently announced that the Federal Emergency Management Agency (FEMA) will stand up vaccination clinics all across the country specifically to give booster shots to those who have completed the standard two-shot regimen. The third-shot booster dramatically increases immune response for the Pfizer and Moderna COVID-19 vaccines.

Meanwhile, Israel is deploying a fourth shot — or second booster — because of signs of waning immunity in its third dose. The nations Pandemic Response team ruled that medical workers and anyone older than 60 years of age could receive a fourth dose of the Pfizer coronavirus vaccine. The shot will be available four months after receiving the third dose.

But some have raised the question of whether booster shots are unethical from a global perspective, and even counterproductive to ending the pandemic because highly mutated variants will continue to arise in unvaccinated patients. One of the critics of booster programs is Tedros Adhanom Ghebreyesus, PhD, director general of the World Health Organization (WHO).

Blanket booster programs are likely to prolong the pandemic, rather than ending it, by diverting supply to countries that already have high levels of vaccination coverage, giving the virus more opportunity to spread and mutate, he said in a Dec. 22, 2021, address. Its important to remember that the vast majority of hospitalizations and deaths are in unvaccinated people, not un-boosted people.

Some 3.5 million people died of SARS-CoV-2 in 2021, exceeding the deaths due to HIV, malaria, and tuberculosis combined in 2020, he said. Globally, the pandemic virus is killing about 50,000 a week.

Its frankly difficult to understand how a year since the first vaccines were administered, three in four health workers in Africa remain unvaccinated, Tedros said. While some countries are now rolling out blanket booster programs, only half of WHOs member states have been able to reach the target of vaccinating 40% of their populations by the end of the year, because of distortions in global supply.

Infectious disease clinicians and researchers in South Africa warn that the scarcity of COVID-19 vaccination on the continent and a large population of immune-compromised HIV patients — 8 million of whom are not receiving antiretroviral treatment to fend off full-blown AIDS — sets the stage for continued mutation and global spread of SARS-CoV-2.

Indeed, the prevailing theory is that omicron grew and mutated over months and months in an unvaccinated patient with uncontrolled AIDS in South Africa. Thus, the world’s failure globally to extinguish the AIDS pandemic — to leave it burning among the impoverished and untreated — now compounds our risk against another pandemic of a highly mutable virus.

It would be of great global benefit if richer nations helped Africa prevent and treat COVID-19 and HIV simultaneously, the South African researchers emphasized. A top priority in such an endeavor would be to “vaccinate Africa” for COVID-19, they said.

“Over and above the ethical arguments to address vaccine nationalism and reduce deaths globally, the available data strongly indicate that vaccinating people in Africa will help to reduce transmission rates globally, limit the emergence of new variants, and accelerate global control of the pandemic,” they said.

For more on this story, see the next issue of Hospital Employee Health.

Gary Evans, BA, MA, has written numerous articles on infectious disease threats to both patients and healthcare workers. These include stories on HIV, SARS, SARS-CoV-2, pandemic influenza, MERS, and Ebola. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.