Toward More Nimble, Equitable Vaccination and Pandemic Response

The U.S. Food and Drug Administration’s call to include an omicron component in vaccines that will be used for boosters in the U.S. beginning in fall 2022 could once again exacerbate global vaccine inequities, providing some high-income countries new vaccine options that likely won’t reach other parts of the world for months or years. The move comes even as the most recent waves of omicron, BA.4/5, which now dominate in the U.S., are proving even more contagious, more adept at evading both natural and vaccine-induced immunity, and producing disease that is not responding as well to some therapies, especially monoclonal antibodies. There also is some evidence that these variants could invade lung tissue in a way not seen in other omicron variants.

All of this shows that the world is falling even farther behind in its effort to get in front of this pandemic and bring it fully under control. With a tepid global response losing further momentum, it is time to set clear priorities and goals that reflect today’s reality.

Vaccine targets are one area ripe for reconsideration. More than 100 countries missed the World Health Organization goal of 70%  primary vaccine coverage by the end of June 2022, and few have met even their own national targets. Given the continuing threat and the enduring power of vaccines to stave off severe disease and death, WHO and others, including COVID GAP, are putting particular emphasis on fully vaccinating, including with boosters, key high-priority populations—those over 60, health care workers, and those with underlying conditions. Boosters are particularly important with research showing significant levels of protection with a four-shot series.  As large parts of the world have yet to receive even a single dose, serious effort is required to address the combination of insufficient political commitment, financial and operational deficiencies, and weak demand, that have slowed vaccine distribution to many areas and people who need it most.

In one bright spot, WHO’s Regional Office for Africa reports intensified efforts across the continent to vaccinate high-risk populations resulting in “some promising signs”: June data from 31 countries shows significant increase in full vaccination of health workers and seniors since December 2021. Especially given Africa’s youthful population, a characteristic that has spared the continent some of the worst of the COVID pandemic, WHO is encouraging countries to redouble efforts geared toward the most vulnerable. Thirty-one countries are planning mass vaccination campaigns through the end of the year, with WHO recommending mobile team deployments to target vaccination to high priority groups. Vaccination also should be offered as part of primary care and by units treating those with HIV, diabetes, cardiovascular diseases, and cancer.

Even so, most of this effort involves trying to provide low-income countries with vaccine access that has been available in most high- and upper-middle-income countries for more than a year and a half. Many vaccine manufacturers are chasing the latest variant, and even that too slowly, and vaccine distribution remains a daunting challenge for much of the world.  The following can guide a reconsideration of goals and targets for global vaccination and broader COVID response efforts.

• Greater effort should be devoted to identifying and replicating successful efforts that are systematically reaching high priority populations with a full complement of vaccines including boosters.

• Given the evolving nature of new variants and our current arsenal of countermeasures, effort is needed to revise priorities and targets/metrics of success, especially for access to vaccinations, boosters, and test-and-treat for high-risk populations, moving beyond national coverage progress.

• Identifying effective approaches to integrating vaccination efforts and the broader COVID response into existing health systems is required to strengthen primary health care and other critical capacities for current and future responses.

The COVID-19 pandemic has repeatedly outrun the world’s alert and response capabilities since its initial identification in December 2019. As variants continue to spread and other potentially pandemic diseases, such as monkeypox are emerging, response mechanisms need to become quicker and more nimble. Moving in that direction starts with reconsidering priorities, funding allocations, and targets.