What are the best ways to make sure the indifferent protect themselves from COVID: vaccine passes for public places, pop-up clinics or Deliveroo discounts? How do you tackle outright scepticism? Should 13-year-olds be offered doses? When will older or vulnerable people start receiving booster shots?
These kinds of questions are now at the fore in many countries. Across high-income nations, around half the population has been vaccinated, allowing life to return to something approaching normality. In the UK, where almost three-quarters of adults have received both doses, hospitalisation figures are currently better than anticipated, despite high infection rates. But the situation is precarious. The public’s caution may not last; schools will return in September; we are relaxing travel restrictions; and there is a marked slowdown in vaccination. The new chief executive of NHS England, Amanda Pritchard, warns that more than one-fifth of people admitted to hospital with COVID-19 are aged between 18 and 34, urging the young not to delay getting vaccinated. Around a third of that age group have yet to receive a dose. Vaccines will now be offered to all 16- and 17-year-olds, and some would like them to be extended to younger children.
These are important issues. The bigger one, however, is ensuring that the rest of the world is adequately protected – especially as travel restrictions are loosened. Vaccines reduce but do not eliminate transmission; unless they are very widespread, we not only abandon many countries to the worst but also risk our own gains in the process. Internationally, four million cases were reported to the World Health Organization recently and around 9,000 people are dying each day. The more widely that the virus can circulate, the greater the risk of new, more dangerous and vaccine-resistant variants emerging.
Covax, the vaccine-pooling scheme, had planned to make at least 640m doses available worldwide by now; it has so far delivered 163m. Its target was to ensure each nation could protect at least 20% of its population – health workers and high-risk groups – by the end of this year. But in low-income countries, only around 1.3% of people have been vaccinated, according to the United Nations Development Programme. For many places, the main obstacle to vaccination remains supply, not demand. While richer nations agonise over how to cajole or induce those at low risk from COVID to protect themselves and others by having vaccines, they are denying doses to high-risk people elsewhere – even at the risk of wasting doses entirely.
The WHO urged wealthier nations to delay using booster shots, saying a moratorium could allow it to meet the very modest goal of vaccinating at least 10% of every country’s population by the end of September. The Biden administration called this a false choice, declaring that the US can do both. Yet, while its purchase of 500m Pfizer doses for Covax is welcome, it is diverting funding from vaccination drives in poorer countries to buy them. Wealthier nations need to stump up more for both purchase and delivery of doses. They also need to share the vaccines that they have hoarded and waive intellectual property rights to boost the supply.
Vaccines present us with difficult practical and moral choices. Domestic political imperatives will always guide governments. But if we look only to narrow national interests, we will not just betray the most vulnerable; we may all pay the price.