Prepared by Denise Li, Student Research Assistant, Research Center for Epidemic Prevention, National Yang Ming Chiao Tung University
Booster COVID-19 vaccine shots for higher-income countries despite WHO’s call for equitable global vaccine distribution (Aug 13)
On Aug 13, the US CDC officially recommended the administration of a booster shot of COVID-19 vaccine to fully vaccinated immunocompromised people in the US.  The recommended vaccines are Moderna and Pfizer-BioNTech–both being mRNA vaccines. Providing extra protection for the high-risk groups is not peculiar in the global community, especially among those higher income countries, as multiple countries have either announced or implemented their plans to inoculate their high-risk population with booster shots.
Israel, for instance, has announced on July 30 its plan to administer a third dose of COVID-19 vaccine to its citizens over 60 years of age.  The extra booster shot of Pfizer-BioNTech is perceived as a response to the recent rising number of infections in the country, mostly of the delta variant. The Israeli authority suggested that the booster shot could provide its elder citizens extra protection as immunity built up on previous shots might drop over time. Elder Israeli citizens need to be fully vaccinated at least 5 months ago before they can get the third dose.
Countries which relied on Chinese vaccines at the early stage of their vaccination programs also had similar roll-out recently. Turkey started administering a 3rd shot to the healthcare workers and citizens over 50 years old in early July ; while Chile will start this week, but allegedly mixing an AstraZeneca or Pfizer-BioNTech booster shots in addition to previous shots of Sinovac. 
The issue of administering COVID-19 vaccine booster shots sparked controversy since many developing countries are still waiting for enough vaccines to inoculate their citizens for the first time. International organizations such as the World Health Organization (WHO) have been advocating for an equitable distribution of COVID vaccines as many lower-income countries suffered unequally in the pandemic.  They criticized the idea of vaccine nationalism, which refers to higher-income countries hoarding the coveted vaccines instead of sharing them to countries with urgent needs.
On Aug 4, the WHO called for a halt on COVID-19 vaccine boosters in high-income countries to ensure an equitable global vaccine distribution.  However, the effort seemed to be in vain as France and Germany announced their plans to administer booster shots on the subsequent day.  France and Germany bypassing the appeal was a sign of the distrust built up between the WHO and its member states since the beginning of the COVID-19 pandemic. Many countries were discontented with the organization’s failure to take timely precautions and contain the pandemic at an earlier stage.  The friction has caused former US President Trump to once stop US’s funding to the WHO. Although the policy was later reversed by the current US President Biden , the tension between WHO and some of its member states remains unsettled.
Table 1. Examples of countries that have announced plans of COVID-19 booster shots
|Country||Target Population||Recommended Vaccine|
|USA||• Immunocompromised people||Moderna/Pfizer|
|Isreal||• People over 60 years old||Pfizer|
|Turkey||• People over 50 years old|
• Healthcare workers
|Chile||• People over 55 years old||AstraZeneca/ Pfizer|
|France||• People over 75 years old|
• Immunocompromised people
|(Did not specify)|
|Germany||• Immunocompromised people|
• Residents of care homes
• Elderly Moderna/Pfizer
|UK||• People over 70 years old|
• Immunocompromised people
• Residents of care homes
• Healthcare workers
|(Did not specify)|
In light of the tense relationship between the WHO and some of its member states, it would not be surprising to see any unsynchronized move between the WHO and its member states in the future. Instead of negotiating and cooperating through the WHO, many countries in the pandemic bypassed the WHO and relied largely on transnational and regional cooperation. A recent example would be Australia purchasing 1 million surplus Pfizer vaccines from the government of Poland directly  and there were numerous examples of transnational vaccine donations [11,12,13] that did not involve the WHO.
In the past, these transnational efforts might be supplemental to the WHO’s work; however, they became increasingly important as the pandemic developed. This trend may shed light on future global cooperation in public health. Also, with the current US-China tension in sight, it would be interesting to see how these powers would leverage their respective alliance networks to grapple with future global health challenges.
The United States has a history of sharing medical essentials such as vaccines to their alliances since the US-Soviet Cold War. Until today, the U.S. Agency for International Development (USAID) is still one of the largest official aid agencies in the world.  The US also initiated other global efforts on public health, including the Global Health Security Agenda (GHSA) in 2014. The Agenda, while cooperating with the WHO, aspires to include non-state actors and other parties that are excluded from the WHO, like Taiwan. 
China, on the other hand, has launched the program of Health Silk Road (HSR or 健康絲綢之路) in 2015 under its Belt and Road Initiative (BRI or 一帶一路). HSR aimed at establishing a “human public health community” (打造人類衛生健康共同體) by providing medical assistance to developing countries. It is perceived as one of China’s attempts to expand the country’s international influence.  The program gained its momentum soon after the beginning of the COVID-19 pandemic, where China exported “over 179 billion masks, 1.73 billion protective suits, and 543 million testing kits”  ; 2 billion COVID-19 vaccines are expected to be exported under this program by the end of 2021. 
In an increasingly dynamic world, the US and China are not the only countries providing medical essentials, specifically vaccines in the COVID-19 pandemic, to the world. India, for instance, is one of the largest vaccine manufacturing countries. They also provided vaccines for countries in need and were aware of their participation in vaccine diplomacy.  India’s participation in vaccine diplomacy set an example of how other countries, besides the US and China, take opportunities to contribute to global health amid the seemingly bipolar world. It is foreseeable that transnational and regional cooperation will gain their significance even in the post COVID-19 era.
As for the WHO, which has been criticized for excluding important public health actors in the decision making process, the Organization needs to work hard to win back the confidence of its member states in the rest of the pandemic—including to settle down political differences and carry out a thorough scientific investigation into the origin of the SAR-CoV-2 virus.  If the WHO fails to demonstrate its competence, many of its member states would be curious about whether the current WHO paradigm is the best in mitigating future global health crises. And this would definitely undermine its significance in the future of global public health cooperation.
- “COVID-19 Vaccines for Moderately to Severely Immunocompromised People”, Centers for Disease Control and Prevention, 13 Aug 2021, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html
- “Israel Is Offering Its Older Citizens A 3rd COVID-19 Shot As Infections Rise”, National Public Radio, 29 July 2021, https://www.npr.org/sections/coronavirus-live-updates/2021/07/29/1022334531/israel-covid-booster-shot-vaccine-coronavirus
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