Der Standard

A call to inoculate all, before boosters.

- MOETI Dr. Matshidiso Moeti, a physician and public-health specialist, is the World Health Organizati­on’s regional director for Africa. Send comments to intelligen­ce@nytimes.com.

As the rich world rolls out Covid-19 booster shots, hundreds of millions of Africans remain dangerousl­y exposed, still awaiting their first vaccine dose. This not only adds to the litany of harsh disparitie­s we have seen around this virus, but it is also a scandalous injury to global solidarity and vaccine equity.

While early data on waning immunity is emerging around some vaccines, there is no conclusive evidence to justify giving boosters to fit, healthy people. Third doses should be given only to the small number of people facing a high risk of severe illness and death, despite being fully vaccinated, including those with compromise­d immune systems. Boosters for the healthy are, effectivel­y, a hopeful “why not.” Political decisions are getting ahead of science, diverting doses and leaving Africans with few options.

While Africa has weathered the Covid-19 pandemic better than many people expected, we are seeing each wave drive harder and faster. The third wave has been the worst yet, and it is putting a strain on already stretched and fragile health systems. While weekly new cases are subsiding, they remain high, and the pace of the descent is excruciati­ngly slow. The continent just passed eight million reported cases, and it urgently needs vaccines to blunt the impact of a fourth wave.

Even before vaccines were approved, rich countries bought up far more doses than they needed. Nine months after the arrival of the first vaccine, just 20 percent of people in low- and lower-middle-income countries have received a first dose — versus 80 percent in many high- and upper-middle-income countries.

Perhaps no group of countries has been hit harder by this vaccine hoarding than the countries of Africa. Shipments ground to a near halt for months, as promised supplies dried up because of global shortages and export bans. Today, just 51 million people — or 3.6 percent — of Africa’s population are fully vaccinated, compared with over 60 percent in the United Kingdom and the European Union and almost 55 percent in the United States.

Shipments are picking up, and we are grateful for the internatio­nal solidarity and leadership shown by the United States and other partners in sharing millions of doses, including through Covax, which works for the fair distributi­on of vaccines globally.

Some estimates indicate that even if rich countries do approve booster shots, they will still have more than one billion excess doses by the end of 2021. But that does not mean those doses will be shared or will reach those who need them in time. Just 15 percent of the more than one billion doses pledged by high-income countries have arrived in Africa so far. Wealthy countries must let go of reserved doses and allow Covax and the African Union to buy the vaccines the continent seeks and stands ready to finance.

Export restrictio­ns, production constraint­s and delays in regulatory approvals led Covax to slash its delivery forecast for this year by about 25 percent. Other pledges may not be fulfilled before the middle of next year. Africa and other parts of the world need these vaccines. Now.

Government­s, of course, have a duty to their own people, but giving boosters to fully vaccinated individual­s goes against rich countries’ own interests. Countries with low vaccinatio­n rates could act as variant incubators, increasing the risk that more dangerous variants will emerge and enter internatio­nal travel networks.

We have seen the havoc caused by the Delta variant. Now present in 180 countries, this highly transmissi­ble variant is leading to rising deaths in many rich nations. It is also complicati­ng Africa’s response to the pandemic, driving new flare-ups and keeping case numbers high.

Reports of millions of doses being wasted or discarded in rich countries are heartbreak­ing. Like so many others, I know here in the Republic of Congo and back home in Botswana, I have lost friends and colleagues to Covid-19. Every single one of those wasted doses could have saved a life in Africa.

Global economic losses due to delayed vaccinatio­ns may, according to one estimate, run into the trillions of dollars in the coming years if lowand middle-income countries cannot quickly vaccinate their people. The Internatio­nal Monetary Fund recently cited access to vaccines as the “principal fault line” along which the global economic recovery is diverging. If vaccine inequity persists, growth rates in poorer countries may not return to prepandemi­c levels until 2024.

To help countries fully vaccinate 40 percent of their people, the World Health Organizati­on has called for a moratorium on booster shots for fit, healthy people until the end of December. Despite all of this, at least 13 countries are giving or plan to give boosters, and several more are considerin­g it. If all high- and upper-middle-income countries were to give boosters to everyone age 50 and over, nearly one billion vaccine doses would be needed annually, according to a W.H.O. analysis. With two-dose vaccines, that is enough to vaccinate nearly 40 percent of Africa’s population — the global yearend target set by the W.H.O.

The W.H.O. is working with national regulators around the world to gather data on boosters. Only a coordinate­d research effort will help us understand how much additional protection they provide. So we are not saying “never.” But now is not the time to give boosters to fully vaccinated people with fully functionin­g immune systems.

We don’t know yet how much boosters might help protect people, but we do know that their deployment will hurt the prospects of many in Africa. The people facing the most risk must be vaccinated first. Wherever they are.

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 ?? ILLUSTRATI­ON BY THE NEW YORK TIMES; PHOTOGRAPH BY YULIA REZNIKOV/MIKROMAN6, VIA GETTY IMAGES ??
ILLUSTRATI­ON BY THE NEW YORK TIMES; PHOTOGRAPH BY YULIA REZNIKOV/MIKROMAN6, VIA GETTY IMAGES

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