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Booster Shots have Exposed Vaccine Inequality. Will COVID Treatments be Distributed Evenly?

Tedros Adhanom, the head of the WHO, said he was “appalled” after being informed by a major pharmaceutical association that “vaccine supplies are high enough to allow for both booster shots for people in well-supplied countries and first jabs in poorer countries that face shortages.” His comment comes at a time when, despite countless pledges, the poorest countries in the world are unlikely to receive a substantial number of vaccine doses until 2023.

The insistence of some wealthy countries to begin administering a third dose of the vaccine against the advice of the World Health Organization further hurts supplies of vaccines destined to poorer third-world countries. As a number of promising non-vaccine treatments against COVID begin to appear, efforts must be put in place to ensure their fair distribution around the world, with a particular focus on poor countries with a low rate of vaccinations.

The third dose and the third world

After one of the largest public health mobilizations in history, a total of 5.6 billion vaccine doses have been administered across the globe. But the manner in which those doses have been distributed has been far from equitable. Around 82% of the total number of vaccines used so far have gone into the arms of people living in high and upper-middle-income countries, while only 1.4% of the population in low-income countries received the jab.

The situation has become so dire in some parts of the world, especially in Africa, that authorities are forced to consider so-called “dose-sparing” strategies, using jabs with only a half or a third of the usual vaccine dose, in order to extend their extremely limited vaccine supplies to a wider percentage of the population. With most rich countries already heavily vaccinated, the expectations were that the gap between wealthy countries and the developing world will begin to shrink. But the decision of many rich states to go ahead with the so-called “booster shot,” a third dose of the vaccine, has stoked fears of continued shortages in the developing world.

Israel became the first country in the world to offer the booster shot, making it available for those over the age of 60 before quickly expanding eligibility. By early September, more than 2.5 million Israelis received the third jab, with the country’s health minister already instructing the population to prepare for a fourth dose. Earlier this month, France became the first large country to begin handing out booster shots to over 65s, with plans to reach as many as 18 million people by next year.

Many experts have reacted to such plans with anger and disbelief. In the U.S., two top officials of the U.S. Food and Drug Administration resigned in protest over the government’s plans to introduce booster shots, while Tulio de Oliveira, a prominent biologist who works in South Africa, described the plans as “potentially criminal.” The WHO recommends the third shot in the case of vulnerable groups but has asked Western health authorities to put a moratorium on its widespread use until more vaccine doses can reach impoverished countries.

Treating the disease

With poor countries thus left especially vulnerable, the question of using new treatments for those who contract COVID is coming to the fore. Not only would effective treatments help coronavirus patients in rich and poor countries alike, but by making the coronavirus less of a threat to vaccinated and unvaccinated populations alike, they could reduce the demand for booster doses in the richest countries and free up vaccine stockpiles for the developing world. Fortunately, several treatments are on the radar.

One such drug is Rigel’s fostamatinib, marketed under the name Tavalisse, which has shown such effectiveness in early trials that Rigel received $16.5 million in funding from the U.S. Department of Defense to support Phase III trials of the potential treatment. The drug, which is administered orally, has been shown to halve the chances of serious adverse effects in hospitalized COVID patients and significantly reduce deaths.

Crucially, the double-blind, placebo-controlled, multi-centre Phase II trial whose results were recently reported in the Clinical Infectious Diseases journal proved Tavalisse met the primary endpoint of safety. Trial subjects treated with Tavalisse had their stay in the intensive care unit reduced to three days on average, compared to seven in the placebo group. Furthermore, all three deaths that occurred during the trial were among the placebo group, with none in the segment treated with fostamatinib.

Approved for medical use in the U.S. since 2018, fostamatinib has previously been used with success to treat chronic immune thrombocytopenia, a condition characterized by an abnormally low level of blood platelets. In early 2020, it was also approved in the European Union. Hopes are high that the drug might now be used to treat COVID as well—Rigel is currently carrying out a Phase III trial on 308 patients with plans for the trial to conclude by the end of the year, while the medicine is also being examined as part of the National Institutes of Health’s ACTIV-4 trial.

AstraZeneca is also developing a treatment that seems to be effective, reducing the risk of developing any symptoms by 77% in a late-stage trial – a much-needed win for the firm after trust in its coronavirus vaccine plummeted following reports of rare blood clots. If approval is granted, the antibody cocktail which is currently known as AZD7442 would become the first long-acting drug that is not a vaccine which demonstrated prevention of the disease. According to the Anglo-Swedish company, preliminary cell studies showed the cocktail neutralized emergent viral variants, including the Delta variant.

Lessons learned?

In many parts of the world, often underreported, the pandemic rages on. In India, even the staggering official numbers pale in comparison to the estimates which put the number of COVID deaths in the country between 3 and 4.7 million. The world cannot stand by while another catastrophe on par with the second wave hits the country.

Given how developing countries were neglected in the vaccination race, it should be obvious that they must be prioritized in the distribution of coronavirus treatments. Crucial life-saving drugs like Tavalisse or AZD7442 must not be subjected to the same squeeze that allows wealthy countries to stockpile vaccines, often to the point of spoilage, while the rest of the world suffers.

In the end, there’s no way past COVID treatments, for both rich and poor countries. But until developing countries have closed the vaccination gap, they should be a priority for the distribution of treatment.