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Covid-19 will never be eradicated, but society has a chance to end the public health emergency in 2022, a senior WHO official has said. Speaking at the World Economic Forum’s virtual Davos Agenda event on Tuesday, Michael Ryan, executive director of the WHO Health Emergencies Programme, said.
“It’s the death, it’s the hospitalizations, it’s the disruptions that cause the tragedy, not the virus. The virus is a vehicle.”
However, he expressed some optimism that it was possible for this year to mark a turning point in the pandemic. “Yes, we have a chance to end the public health emergency this year,” he said, noting that this could only be done by addressing longstanding inequities in various areas of society, such as fair access to vaccines and health care. “It won’t end if we don’t [address these issues], this tragedy will continue,” he added.
“Endemic malaria, endemic HIV kill hundreds of thousands of people every year — endemic does not mean ‘good,’ it just means ‘here forever,’” he said. “What we need to do is get to low levels of disease incidence with maximum vaccination of our populations where no one has to die. That’s the end of the emergency in my view, that’s the end of the pandemic.”
Throughout the panel discussion, vaccine inequity was painted as a barrier to progress against Covid. Last year, governments of wealthy nations faced criticism from the WHO for their decisions to roll out third doses of Covid vaccines to their entire adult populations while vulnerable people in poor countries were still waiting for their first shot.
In December, WHO Director-General Tedros Adhanom Ghebreyesus warned that blanket booster programs risked prolonging the pandemic and increasing inequality, telling a press conference that “no country can boost its way out of the pandemic.”
“Blanket booster programs are likely to prolong the pandemic, rather than ending it, by diverting supply to countries that already have high levels of vaccination coverage, giving the virus more opportunity to spread and mutate,” he told reporters. “And boosters cannot be seen as a ticket to go ahead with planned celebrations, without the need for other precautions.”
In official guidance on booster vaccines, the WHO expressed concern that mass booster programs in wealthier countries would exacerbate vaccine inequity by leaving behind the countries that struggled to afford or access doses.
Many high and upper-middle-income countries have rolled out booster programs, while poorer nations are yet to make progress on immunizing their people with the initial two-dose course. In the U.K., for example, 63% of the population (above 12 years old) has received a booster shot and 83% of people are fully vaccinated. In Kenya, 0.1% of the population has received a third shot, and just 8.5% of people are fully vaccinated against Covid.
In high-income Israel, authorities have gone a step further, offering a fourth dose to health care workers and society’s most vulnerable individuals. However, Israeli doctors have cast doubt on fourth doses providing sufficient immunity against the highly transmissible omicron variant.
The focus should be on the most vulnerable
However, Ryan noted on Tuesday that ending vaccine inequity did not mean stopping people in high-income countries from receiving more doses. “We need to focus on those most likely to [cope] the worst with getting infected or reinfected,” he said.
“There are those in high-income countries who will require a third dose. It doesn’t matter what country you’re in, everyone should be able to get that primary course. As knowledge develops, we may end up in a future where the primary course for a vulnerable person will be three or four doses to get long-lasting, robust immunity.”
Ryan added that prioritizing vulnerable people in Africa for Covid vaccinations while also prioritizing vulnerable people in high-income nations were “not opposing problems.”
“A vulnerable person living in an industrialized country has an equity issue too, because their chance of dying is high,” he told the panel.
Globally, there is not yet a consensus on whether fourth doses will be necessary. The U.K.’s vaccination authority has said there is “no immediate need” to introduce a second booster, although the issue remains under review. The U.S. Centers for Disease Control and Prevention recommends that people who are severely immunocompromised should be given an additional dose in their primary series of vaccines, as well as a booster shot later on.
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