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Close to 40 million people in the UK have had two COVID vaccine doses. This gives Britain one of the highest rates of coverage in the world, with nearly 60% of the population fully vaccinated. And with vaccines soon to be rolled out to 16- and 17-year-olds, this is going to increase further still.
Expanding vaccination into younger age groups has an array of benefits, says Alex Richter, professor and honorary consultant in clinical immunology at the University of Birmingham. Although severe disease is rare in young people, long COVID is a problem, and allowing the virus to move unchecked through young people disrupts their and their loved ones’ lives. Vaccinating younger people also lessens the risk that they’ll pass the virus on to elderly relatives, who may be vulnerable despite being vaccinated.
But despite these benefits, some – including the World Health Organization – argue that these vaccines would be better given to vulnerable people in countries where coverage is low, as this is where they would have the greatest impact. The WHO has made a similar argument regarding vaccine boosters: that rich countries shouldn’t be offering some people a third dose – even if they are vulnerable – when many elsewhere are yet to receive a first.
Nevertheless, the UK government seems to be set on prioritising its domestic vaccination programme. This is despite there being a “powerful altruistic argument” behind the WHO’s stance, as Jonathan Pugh, Dominic Wilkinson and Julian Savulescu at the University of Oxford have argued.
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If Britain’s booster programme does go ahead, one group that may be prioritised are those with weakened immune systems. We’re still building a picture of how effective COVID vaccines are in this group, but a growing body of evidence shows that vaccines work less well in the immunocompromised, writes Steven Smith, a senior lecturer in biomedical sciences at Brunel University. Hence the need for a top-up.
What makes things more complicated is that immunocompromised people are not a uniform group. There are many reasons why someone may have poor immune function, and the varying reasons behind this appear to affect vaccine performance. Some immunocompromised people may really benefit from a booster dose – but some appear not to respond to COVID vaccines at all.
Thanks to the increased transmissibility of the delta variant, experts have declared that vaccine-induced herd immunity is probably now out of sight. This is a blow, but in the UK we should keep in mind that it’s a privilege that we’re even considering herd immunity. In Africa, for instance, limited vaccine supplies, distribution difficulties and hesitancy mean that achieving the sort of coverage needed for population-wide protection is way off, write Edina Amponsah-Dacosta and Benjamin Kagina of the University of Cape Town.
Would making vaccines mandatory help? Possibly a little bit. In South Africa, enforcing uptake among everyone who is medically able would save lives, use limited resources efficiently, and build social cohesion and public trust in vaccines, argues Keymanthri Moodley, director of the Centre for Medical Ethics and Law at Stellenbosch University. Not only that, but South Africa has the laws and constitutional rules in place that would allow for such a policy.
But even if this were to solve the issues of hesitancy and distribution, the question of limited resources remains. This returns us to the question of whether countries such as the UK – with their plans for boosters and adolescent vaccine programmes – are doing what’s best for the world with their supplies.
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