Spain celebrates having beaten the mark of 70% of the population with the
complete schedule of vaccination against covid-19. In Israel, 68% of thepopulation already has both doses and in the United States the percentage is
already 61%. Meanwhile, in the Democratic Republic of the Congo less than 0.1% of
the population has received some dose and in neighboring Angola it is barely more
than 3%, like Gabon or Kenya, which are already close to 3.5%. ---- With just a
brushstroke of these data, collected by the Our World In Data website , an uneven
vaccination map is drawn that remains latent in the background, while the great
powers strive to reach another goal for which there are still no conclusive
studies or clear positions of the regulatory agencies: the administration of a
third dose.
Israel has been inoculating this triple pattern since July, while the United
States has set a date of September 20 to start with it. For its part, the World
Health Organization (WHO) asked in early August for a moratorium on the
administration of this third dose until 10% of the population is vaccinated. But
countries like Canada, the United Kingdom, Germany or France turn a deaf ear and
have already announced that they will expand their vaccination schedule.
"Two doses for 3,500 million inhabitants of countries with less income, would
mean 7,000 million euros; a third dose for 1.5 billion people in high-income
countries can amount to 30 billion euros. From a commercial point of view, the
choice is clear "
On this side of the border, the Minister of Health, Carolina Darias, who
announced at the end of July that she had signed a contract with Pfizer for 1,800
million euros and with Moderna, for 480, in pursuit of the third dose, has
qualified her position. During yesterday afternoon, and in line with the opinions
of the expert panel, it declared that this third dose will only be for
immunosuppressed people due to transplantation or undergoing cancer treatment.
At the same time, the ECDC (European Center for Prevention and Control) in a
joint statement with the European Medicines Agency (EMA) assured that some
studies report that a dose can improve the response in this group of individuals.
Commercial vs health purposes
For Fernando Lamata, an expert in Public Health and Health Policies, the spread
of the third dose, rather than health purposes, seeks commercial purposes. "The
need for a booster dose has not yet been demonstrated," the former Minister of
Health of Castilla La Mancha told El Salto. "The most important factor that is
driving rich countries to buy third doses for their populations, is commercial"
says Lamata who laments that the large pharmaceutical companies continue to
direct the global vaccination policy, achieving abusive prices of 15 or 20 euros
for a dose that costs less than one euro. "Let's see: two doses for 3,500 million
inhabitants of countries with less income, would mean 7,000 million euros; a
third dose for 1.5 billion people in high-income countries can amount to 30. 000
million euros. From a commercial point of view, the choice is clear, "he says.
Miriam Alía, head of vaccination and response to epidemics at Doctors Without
Borders, describes the vaccine sales strategy. "The pharmaceutical companies have
tried to get the WHO to recommend a third dose and with the data that they have
contributed about the potential decrease in protection, it has not validated
them. They have been asked to continue these studies and to include people with
specific risk factors, with immune problems, "he says. "As they have not obtained
the support of the WHO, they are pressuring public opinion to create this need
and negotiating with the states so that it is approved at the national level."
Meanwhile, Alías adds, they increase the prices for these new contracts. "It may
be that at a given moment we know that after 12 months it is necessary to
vaccinate people at higher risk, or it may be that we need a different vaccine.
It is being seen that by combining different mechanisms we can have a better
immune response. Maybe a third dose is needed, but maybe it doesn't have to be
from that vaccine ", he adds.
"Some studies suggest that the response to the vaccine may decline over time, but
perhaps not as much as is being claimed. A study with data in Israel indicates
that it could drop from 94% to 82%, but they continue to protect very well "
Not enough studies
For the Professor of Immunologist, Africa González Fernández, it is interesting
that studies are being carried out and that we have more information to decide on
a hypothetical need for a third dose. "Some studies suggest that the response to
the vaccine may decline over time, but perhaps not as much as is being claimed. A
study with data in Israel indicates that it could drop from 94% to 82%, but they
still protect very well. In the United Kingdom, it has been analyzed in
residences and there has not been a significant decrease in protection ", he
tells El Salto.
On the other hand, this immunologist adds that a new vaccine could be considered
against the new delta variant, instead of a third dose. "If we had vaccines
against delta variants or even against new ones such as lambda, it would be
optimal, but they are not yet available, unfortunately." "In any case," he adds,
"current vaccines continue to protect at high levels against the variants. In
addition, the immune system is able to improve, to adapt to the virus, and even
if it changes a little and the response decreases, it will never be zero ".
Therefore, it is also a priority for González to vaccinate the largest number of
the population before starting with new doses.
"We must join forces to stop the disease in all places. If we do not stop it,
potentially new, more complex variants may appear that make the vaccines we have
now not so effective "
"A third dose is selfish and inefficient in terms of public health," says Carlos
Mediano, president of Medicus Mundi. "We must join forces to stop the disease in
all places. If we do not stop it, potentially new, more complex variants may
appear that make the vaccines we have now not so effective ", explains who
considers that proposing a third dose only for immunosuppressed patients should
also be well studied. "We would have to see if the immunity in these people
really decreases. There are two types, the immunity that shows the presence of
antibodies, but then there is another type of immunity, that of the memory of
lymphocytes. Studies of this type would be lacking in order to make a decision.
And we also have to ask ourselves what is most necessary for these people,
For Fernando Lamata, vaccinating only the immunosuppressed is a way of opening
the door to a third dose for everyone. "Experience tells us that, through the
door of an authorization from the agencies for limited indications, then
generalizations for other groups enter, and, finally, for the entire population.
And it is that, with a well-studied marketing pressure, public opinion can begin
to ask governments to give us all the third dose ". This was the case in Israel,
where the third dose began in groups of immunosuppressed people and eventually
spread to the entire population.
"In this sense, it would be good if Minister Darias promised that only
immunosuppressed people would be vaccinated, and that a third dose would not be
applied to the rest of the population, until all people in all countries had been
vaccinated. And it would be highly desirable for the government of Spain to put
pressure on the World Trade Organization (WTO) to suspend patents on vaccines and
promote technology transfer to increase production, "adds Lamata.
Solution: release patents
The experts consulted consider that the solution to the inequity in the supply of
vaccines around the world is to release patents. While high-income countries have
received 1.1 billion doses, upper-middle-income countries 2 billion,
lower-middle-income countries about 700 and low-income countries only 10 million,
a proposal to release patents launched by India and South Africa makes already 11
months and presented to the Council for Agreements on Intellectual Property
Rights with Trade (TRIPS) - made up of all the member countries of the WTO -
remains blocked.
On November 20, the United States, Japan and the EU countries, including Spain,
blocked the request. But, since then, there has been progress and there are
already 104 countries that support patent liberalization, including the United
States. Spain also issued the Spanish Non Paper document , a strategy in favor of
the proposal of India and South Africa, to accelerate the procurement of vaccines
through mechanisms to share knowledge, increase production and accelerate
distribution.
On the other hand, "the public responsibility at this time is to make the best
decisions for the entire population and that can only be done by investing in
public health studies. We must invest in independent research, it cannot be that
the pharmaceutical companies are telling us the effectiveness of their products
", adds Carlos Mediano.
"In a shipwreck, the third dose is to give an extra lifeline to people who are
already protected, compared to people who have none"
"The solution: is to increase production, release patents, the EU must stop
blocking the exemption to patents," says Miriam Alía, from Doctors Without
Borders, for whom this increase must be linked to a relocation of production and
thus the supply fill in the remaining gaps on the map. "Most low-income countries
have yet to get a second dose of their toilets, especially in Central Africa. In
a shipwreck, the third dose is to give an extra lifeline to people who are
already protected, compared to people who have none ", he says.
Related link ElSaltoDiario.com (09/01/2021).
https://www.sasmadrid.org/index.php/noticias/7053-tercera-dosis-de-la-vacuna-contra-el-covid-intereses-comerciales-e-inequidad-03-09-2021
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