WHO Drops Opposition to Boosters – Recommends Third Pfizer Jab for Adults & Two Vaccines for Children Ages 5 & Up
Katherine O’Brien, WHO head of Immunization, Vaccines and Biologicals

In a stark departure from months of booster opposition, WHO on Friday recommended the wider administration of a third shot of the Pfizer-BioNTech mRNA vaccine – as well as jabs for children age 5 and older. 

The recommendation comes after over 120 countries already have booster campaigns in full-swing, some of them beginning as early as July 2021. 

The statement was accompanied by a WHO acknowledgement that global vaccine supplies are now sufficient to permit booster campaigns alongside the delivery of sufficient primary doses to some 98 low-income countries, approximately one- half of those being in sub-Saharan Africa, and where 40% or less of eligible people have yet to receive even their first or second jab.  

WHO Director General ábsent from press briefing

Alejandro Cravioto, chairman of the WHO SAGE group of vaccine experts.

The WHO press conference where the announcement was made was striking for the absence of WHO Director General Dr Tedros Adhahom Ghebreyesus, who has been one of the biggest opponents of the booster campaigns- saying that such campaigns strike at the heart of vaccine equity. Nor were WHO Health Emergencies Executive Director Mike Ryan or Chief Scientist Soumya Swaminathan present. 

Rather, the key speakers at the event included the chairman of WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), Dr Alejandro Cravioto, and Katherine O’Brien, WHO’s head of the Department of Immunization, Vaccines and Biologicals. 

They acknowledged that mounting evidence of the mRNA Pfizer vaccines’ waning immunity – along with data showing sufficiently robust global vaccine supplies – now call for the policy change. 

Recommendations ‘Booster doses starting with highest priority groups’

Updated WHO Roadmap for vaccination coverage, by priority groups.

According to the newly revised WHO “Roadmap for prioritizing COVID-19 vaccines”, booster doses are now recommended by WHO for just about any adult when sufficient supplies are available, but “starting with the highest priority-use groups (e.g. older adults and health workers), 4 to 6 months after the completion of the primary series.”

Additionally, the experts endorsed vaccination of children down to 5 years of age, with a vaccine of reduced dosage (10 µg instead of 30 µg).  There was no booster recommendation, however, for children, unless they are immunocompromised.

The SAGE group said that they were limiting their advice about boosters to the Pfizer vaccines for now, as there is sufficient safety evidence from the approvals already granted by the US Food and Drug Administration and other regulatory bodies. But the experts will be poised to issue similar recommendations for other vaccine formulations, based on similar data about waning efficacy and the third dose’s safety.  

Sufficient global supplies now for boosters – providing vaccines are distributed equitably

WHO’s O’Brien said that new WHO analysis of production trends shows that even if “all countries chose to be giving booster doses quite broadly, our projection is that there would nevertheless be sufficient global supply” – to reach undervaccinated countries. 

But that remains conditioned on an assumption that global supplies this year will be “distributed in an equitable way – and that is the biggest task, assuring that supply is getting to the places where it is needed,” she added.  That, as compared to the vaccine hoarding seen last year, when some rich countries bought up 5-10 times as many doses as they had people to vaccinate. 

O’Brien still cautioned against “unfettered use” of boosters – stressing that under-vaccinated countries need to first prioritize getting primary vaccine doses to high-risk populations – and in countries with high-vaccination rates, older people, health worker and those more at risk should first be prioritized. 

“And I’ll just remind you, that we are still in a position where there are 34 countries that are below 10% coverage at this point”. And a larger number of countries, approximately 86 countries that are below 40% coverage. 

“Now that is as a result of the accumulation of the severe supply constraints 2021. And the relief of that supply constraint has really only been in the past two and a half months. 

“And so we do see a very positive outlook for supply but only if the continuation of sharing of doses continues. And if manufacturers continue to supply COVAX (the WHO-supported global vaccine facility) with the commitments that they have made – to abide with the commitments they have.” 

Fourth Dose – evidence ‘unsettled’

As for a fourth dose of vaccine, which is being administered in only a handful of countries, O’Brien said that “there is some evidence for use in immunocompromised people but so far there is no settled science about giving a subsequent booster to a broader group of people.

“We are fully aware of the data [on 4th dose] emerging from a limited number of countries, Israel,  in particular, that we’re following very carefully, but at this time, WHO has adopted a recommendation referencing a single booster dose,” she said.  See the related Health Policy Watch story: 

Health-Worker Risks of Catching Omicron Half as Likely after Fourth Dose – Second Israeli Study Challenges Earlier Results

Projections of sufficient global supply now – a WHO turnaround 

The remarks about sufficient global supplies available today run contrary to those aired by WHO Director General Tedros on 22 December, when Tedros warned that “blanket” booster campaigns could sap supplies from rollouts in low-income countries, saying that “only later in 2022 will supply be sufficient to extensive use of boosters in all adults.” At that time, WHO only recommended boosters for “high-risk groups”

Also in December, another senior WHO official warned that low-income countries could end up 3 billion doses short in the first quarter of 2022, if booster campaigns were “aggressively” administered in the 120 high and middle-income countries that were doing so. 

But that statement was anchored in an assumption that 90% of people in all high- and middle-income countries would get at least two shots, and 70%, including children, three.  

Those projections were swiftly challenged by pharma industry leader, Thomas Cueni, director general of the International Federation of Pharmaceutical manufacturers and Associations, who said they were “not based on valid data.”

WHO never elaborated on its supply projections then – despite repeated queries by Health Policy Watch. And it did not elaborate in Friday’s press briefing either.  

70% Vaccine coverage – high but is it attainable everywhere?    

O’Brien and other WHO experts also refrained from citing a figure for what they considered to be “high” vaccination coverage for the COVID jabs.  

But it is increasingly clear that even in many middle and higher income countries, reaching the 70% vaccination goal that WHO has cited as the global ambition for mid-2022 will be a considerable challenge – due to vaccine hesitancy among large parts of the population. 

For instance in the United States, only 63% of the population has been fully vaccinated. 

Admitted O’Brien, “very few countries have been able to get above 70% vaccine coverage” for COVID vaccines – noting that refers to 70% of all people who are eligible for vaccination. 

Added Joachim Hombach, WHO Executive Secretary to the SAGE, vaccine prioritization and absolute numbers of coverage in individual countries are also highly dependent on the age of people considered to be “older” and therefore at higher risk. For instance in some countries, people aged 60 years may be considered “older” and in others it may be 65 years.  

Added, Annelies Wilder-Smith, Technical Advisor to the SAGE COVID-19 Working Group: “Every country has a different population age factor. In some countries, the proportion of people above the age of 60 is only 5% and in others, it’s far more than 20%…. And many countries are struggling to reach the older age groups – especially lower to middle income countries that do not have a programmatic approach on how best to reach older age groups. 

She said that the new WHO vaccination prioritization road map, also provides links to training resources, tools and guidance – “to help those countries we reach the older age groups and the older age groups remain the highest priority.”

Image Credits: WHO 2022 .

Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.