BRUSSELS — European nations have been among the most successful in the world at getting their residents vaccinated against the coronavirus. Now, some will be among the first to dole out booster shots.
The small but growing group that is planning additional jabs for the fully inoculated includes some of the continent’s richest and most populous countries, potentially setting a precedent and marking a new phase of the vaccination campaign.
But as COVID-19 continues to infect and kill at alarming rates across the Global South, where vaccination levels remain catastrophically low, the decision by wealthy countries to give booster shots to their own people rather than donating those doses to poorer nations is deeply controversial.
Advocates and experts, including at the World Health Organization, have called the move immoral, and the European Union’s foreign policy chief criticized the bloc for its “insufficient” vaccine shipments to countries in Africa and Latin America.
“It fits into the pattern of decisions we’ve seen from wealthy countries since the beginning of the pandemic,” said Andrea Taylor, who is leading research into global vaccine distribution at Duke University. “The wealthy countries are going to allow their citizens to go through the buffet and get seconds while half the world is still starving.”
Those concerns have not stopped a handful of countries from moving ahead, and more may soon follow.
On Monday, Germany announced it would begin offering booster shots in September to the elderly, immunocompromised and anyone who received a full regimen of the AstraZeneca or Johnson & Johnson shots, which may not be as highly protective as mRNA vaccines.
“We want to protect particularly at-risk groups as best as possible in fall and winter,” Germany’s health minister, Jens Spahn, said in a statement. “The risk of declining vaccination protection is greatest for those people.”
Infectious-disease specialists have cautioned against seeking out booster shots until more data becomes available, and scientists continue to disagree about whether and when the additional jabs will be necessary. The latest guidance from Europe’s health authorities says it is “too soon” to make a call on boosters.
Yet the highly transmissible delta variant has changed the calculus for some countries. With new virus cases on the rise across Europe, leaders hope that booster shots can help stave off another cold weather COVID-19 wave.
In France, those who were the first to receive the vaccine — residents of nursing homes, those over the age of 75 and people with severe health conditions — will be eligible for boosters in September, President Emmanuel Macron said last month.
In Britain, officials at the Department of Health and Social Care said they are preparing to offer booster jabs in September, but are awaiting guidance and confirmation from the country’s expert advisory panel. The booster program would ensure “millions” of people maintain protection “ahead of the winter and against new variants,” a spokesperson said.
Hungary — which has authorized a wider range of coronavirus vaccines than its neighbors, including formulations from Russia and China — is offering booster shots to everyone, regardless of age or health status, recommending people wait at least four months after their second dose.
And top officials in Spain and Italy have said residents will very likely need a booster, but concrete plans have not emerged.
Booster campaigns have also been underway in Russia and in Israel, where adults over 60 years old are now eligible. Prime Minister Naftali Bennett compared it to the flu vaccine, “which needs to be re-administered from time to time.”
A booster campaign could be coming in the United States, as well. The U.S. Centers for Disease Control and Prevention has said it is exploring ways to get additional vaccine doses to immunocompromised individuals.
So far, U.S. regulators have approved only a two-dose regimen of the Pfizer and Moderna vaccines, or a single dose of Johnson & Johnson. But the country’s top infectious-disease doctor, Anthony Fauci, said a recommendation for booster shots in certain populations is “likely.”
But the global supply of vaccines is still limited, and every dose used as a booster is one that cannot be sent to countries desperate for shots.
The Biden administration celebrated on Tuesday that the United States had shipped more than 110 million doses of the coronavirus vaccines to more than 60 countries. Yet distributions to needy countries are nowhere near the 11 billion doses that the WHO says are essential to “truly end the pandemic.”
And while the European Union has made ambitious promises about vaccine donations, the bloc and its countries continue to lag the United States, according to officials, reports and publicly available data.
Josep Borrell, the European Commission vice president, said the EU is falling far short of the 200 million doses it promised would be shared by the end of the year.
“Yes, but when?” Borrell told a university class in Spain on Friday, according to Politico Europe. “The problem isn’t just the commitment but the effectiveness.”
According to EU figures from Monday, the bloc has donated 7.1 million doses to other countries, including nearly 1.59 million through COVAX, a WHO-backed effort to equitably distribute vaccines.
A spokesperson said the EU’s institutions and member states have also provided about $3.5 billion to COVAX and have raised nearly $50 billion in pandemic recovery aid to other countries, with more than a quarter of that earmarked for countries in Africa and Latin America.
“The EU has played and is playing an important role,” the spokesperson told The Washington Post. “But we need to do more. We have made the commitments and created the channels to deliver to our partners, now it’s time to deliver.”
European leaders have also pointed to their exports of tens of millions of vaccine doses (most of those sold to wealthy countries) and to their support of local vaccine manufacturing across Africa.
Taylor, the Duke researcher, said it’s unclear if EU countries will have the capacity to both administer booster shots to residents and fulfill their philanthropic pledges, which could have global implications if vaccination rates worldwide remain low.
Last week, the EU’s vaccination campaign surpassed that of the United States. Roughly 60% of people in the bloc have received at least one dose. In African countries, however, just 3.6% of people have been partially vaccinated and less than 2% are fully inoculated.
This lack of protection is already leading to unchecked spread, allowing the virus more chances to mutate, as happened in India, where the delta variant was first detected.
“It would be wise for us to learn that lesson quite quickly and not make those same mistakes again,” Taylor said. “We are sitting on a time bomb. We are just sitting, waiting for disaster to happen.”
The science on booster shots is also far from settled.
Elena Petelos, of the umbrella European Public Health Association, said additional shots — either targeting current or new variants — will eventually be needed for certain groups, such as those with compromised immune systems. But she said more studies must be done on the dosage and types of booster vaccines. She added that boosters at this stage of the crisis will not have as significant an impact as vaccines in countries with low coverage.
“What we’ve been seeing is local thinking for a global problem, which is not going to work,” she said.
In statements to The Post, the European Centre for Disease Prevention and Control and the European Medicines Agency reiterated their July guidance, saying they are awaiting more data on the length of vaccine protection before recommending a booster.
“It is currently too early to confirm if and when a booster dose for COVID-19 vaccines will be needed,” EMA spokesperson Rebecca Harding said.
Studies have shown that two doses of the mRNA-based Pfizer or Moderna vaccines offer significant protection, even against the delta variant. But Pfizer has said booster shots will still be needed.
The European Commission has already purchased the rights to more than two billion additional doses in preparation for the possibility of booster shots or new variants.
Germany’s vaccine advisory commission, known as Stiko, has not officially recommended booster shots. The commission’s head, Thomas Mertens, did not criticize governments for beginning to administer boosters, but on Friday he said the necessary scientific evidence was not yet available to endorse the approach.
Some have suggested that with German national elections next month, the decision to prioritize booster shots is more political than evidence-based. Clemens Schwanhold, at the German chapter of the ONE Campaign, a nonprofit that fights poverty and disease, said the country’s leaders should limit booster shots to only the most vulnerable and pledge to donate all leftover doses.
“This shouldn’t be a political decision to win more votes,” he said. “It should be a decision backed by science.”
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Brady reported from Berlin. The Washington Post’s Karla Adam in London contributed to this report.