The Irish doctor leading the World Health Organisation’s (WHO’s) response to Covid-19 has questioned the need for booster vaccinations in the wealthy world while impoverished counties remain without any protection against the virus.
Dr Mike Ryan, executive director of the WHO’s emergency programme, said the prospect of boosters being given to people who already had two shots raised ethical questions.
Developing and low-income countries had received only 0.3 per cent of vaccine supplies, he told an online forum at NUI Galway on Saturday.
“It is a tragedy that we still have doctors and nurses in front-line situations in low-income countries who are not protected against Covid,” he said.
The pandemic has “stabilised at a really high worrying level” with the Delta variant by far the dominant strain. Between four and five million new Covid cases were still being recorded weekly – one million of them in Europe – and 70,000 died in the past week.
“The idea that fit and healthy people who currently have two doses require a booster dose, at this point, we don’t have the evidence to support that,” Dr Ryan said.
“Apart from that, there’s the ethical argument. How can we do that?”
While some people may need a third shot for health reasons, giving boosters to the healthy was akin to giving two life jackets to some people on the Titanic.
“You can argue that two life jackets are better than one but what you need to recognise in isolating that argument – here’s two life jackets – is that there’s someone standing next door in a developing country who has no life jacket.
“We have to trade that off. We have to look at equity in the context of that. We have to be very, very careful and prudent around the whole idea of boosters.”
Face masks
In a wide-ranging discussion with Prof Michael Kerin of NUI Galway, Dr Ryan said the wearing of face masks to help prevent the disease spreading “will probably extend for a very, very long time”.
Asked about the risk of potential super spreader events, he said: “I still worry that we have to be very, very careful with large-scale indoor events where we have to have proper ventilation, proper space.”
Still, vaccinations meant the force of infections was becoming decoupled from hospitalisations, intensive care admissions and deaths.
“All the studies show the vaccines remain very effective, though against the target that we designed,” he said.
“The primary target of vaccines was to prevent hospitalisation, prevent severe disease and prevent deaths and if you measure the vaccines against that parameter they’ve been fantastically successful… In that sense that vaccine has done exactly what it said on the tin.”
But vaccines were less successful at preventing the disease from spreading, particularly as coronavirus evolves “becoming fitter and fitter” from human transmission.
“Our public health response is fighting against that natural evolutionary process – and we’re right on that cusp now, where the virus has become much more efficient,” he said.
“Our vaccines are not as efficient at preventing mild infection and transmission. So you see that in countries with high levels of vaccination continue to see very high rates of disease transmission particularly amongst the unvaccinated.”
