‘Recognition of failure’: A shift urged in global vaccination strategy


Global health organizations are considering changing their Covid-19 vaccination pledges — a move that could leave millions of people without first shots as countries reprioritize at-risk groups in the coming months, according to four people familiar with the matter.

In June 2021, the World Health Organization initially proposed that 70 percent of the world population be vaccinated by mid-2022 to protect against new variants and help ensure people in poorer countries had equal access to the shot. But 47 countries still have inoculation rates below 20 percent.

Now, many health organizations involved in the global vaccination effort aim to immunize 90 percent of vulnerable populations in every country — a move that seems to undercut the WHO’s 70 percent target.

A change in strategy would mark a significant turn in the global pandemic response. It comes as the Omicron subvariant BA.2 is spreading across the world and Congress debates how much to spend on the Biden administration’s world vaccination campaign.

“I don’t think there’s so much a shift of thinking on 70 percent so much as it is a recognition of failure,” said Gayle Smith, the CEO of the ONE Campaign and the former coordinator for the State Department’s global Covid-19 response. “The 70 percent target is still smart. But the practical reality is that there are not going to be sufficient vaccines plus the resources that are necessary to deliver them to get to 70 percent at the same pace that we’ve been able to do in wealthier countries.”

Prioritizing vulnerable populations — health care workers, elderly individuals and those with comorbidities — could undermine the global push to prevent variants if it reduces the total number of vaccinated people, some experts said. But facing the reality that the 70-percent-vaccination goal by mid-2022 is virtually doomed, some health groups working on the global vaccination effort are focusing on letting countries set targets according to their abilities and advising them to first target vulnerable populations.

“At a minimum, we believe every country should vaccinate their high-risk populations, no question about that,” said Seth Berkley, the CEO of Gavi, the vaccine alliance. “Now there are new recommendations, for example, to give boosters to high-risk populations four to six months after they have gotten their primary series. The point is what we need to do is be responsive to what countries need in this next period.”

Meanwhile, WHO officials are still adamant that the world needs to stick to its original 70 percent goal even if that means prioritizing vulnerable populations in the short term. Officials said walking back the original goal would deprive poorer countries of the chance to protect their people from future surges.

“Striving to vaccinate 70 percent of the population of every country remains essential for bringing the pandemic under control — with priority given to health workers, older people and other at-risk groups,” WHO Director-General Tedros Adhanom Ghebreyesus told reporters at a press conference Wednesday. “I’m surprised that there are some in the global health community who see the 70 percent target as no longer relevant. If the world’s rich are enjoying the benefits of high vaccine coverage, why shouldn’t the world’s poor?”

So far, the Biden administration — leading a country where about 80 percent of people have had at least one dose of the vaccine — and COVAX haven’t addressed whether they’d change how they prioritize vaccinations across the world. The U.S. Agency for International Development — the agency that oversees global Covid-19 vaccinations — declined to comment.

But at a conference this week, Raj Panjabi, the senior director for global health security and biodefense at the National Security Council, gave some insight into the administration’s thinking, saying the world can still maintain its 70 percent target while at the same time focusing on vaccinating the vulnerable.

“There’s an opportunity for countries to really think about expanding their national vaccination plans so that they don’t only aim at achieving 70 percent of their general population being vaccinated but would also fully vaccinate their at-risk populations,” Panjabi said.

In recent weeks, the global health community messaging has indicated that refocusing on vulnerable populations would ensure that those most at risk receive first shots as vaccines prove less effective against new variants like Omicron.

“We’ve got to kind of go back to the basics,” Smith said. “Remember when the vaccine campaign started here, the goal was to vaccinate the most vulnerable.”

The COVID Global Accountability Platform, led by Duke University and COVID Collaborative, highlighted the 90 percent target in a report this week. The Rockefeller Foundation — which funded the study with the Bill & Melinda Gates Foundation — supports the new targets. The strategic change is among one of four steps Duke recommends global public health organizations take to “shift from emergency crisis management to a sustainable control strategy.”

Krishna Udayakumar, lead author of the report, said the findings may have been misinterpreted, which led the researchers to change it. The report’s target isn’t to throw out the 70 percent benchmark, he said — just to set a more actionable, immediate goal and let countries create their own benchmarks beyond that.

The initial report said global health organizations need to “shift the immediate global vaccination goal from 70 percent population coverage to country-set targets that prioritize fully vaccinating (including boosters) high-risk populations and health and other essential workers, with the aim of quickly reaching 90 percent coverage of those most at-risk.”

Then, just days later — after the WHO publicly criticized the move away from the original goal — the report was updated to emphasize the need of “recognizing the global goal of 70 percent primary vaccination coverage, immediately prioritize fully vaccinating (including boosters) high-risk populations and health and other essential workers, with the aim of quickly reaching 90% coverage of those most at-risk.”

Still, Udayakumar said it was important to set more immediate, realistic goals — even though those goals could also be challenging, depending on funding, hesitancy and supply chain issues in countries with already weak health systems.

“If we lived in an ideal world with the resources available, we should absolutely try to vaccinate as many people as possible,” he said. “All we’re describing here is an actionable pathway that phases the availability of access in ways that can save the most lives most quickly.

The push to change the immediate goal on the worldwide vaccination target is ruffling feathers among some in the global health world, including those at the WHO who say a focus on vaccinating and boosting at-risk groups should not negate the goals set for all populations.

“The U.N. target of vaccinating 70 percent of populations in every country by mid-year still holds,” Ann Lindstrand, unit head for the WHO’s Essential Programme on Immunization, said at a global vaccine conference Tuesday. “However, there is an important shift in the focus and the work that we’re all dedicating towards shifting focus to priority in reaching the highest risk groups.”

Others at the WHO have taken more aggressive stances. Gabby Stern, the organization’s communications director, quoted the Covid-19 Global Accountability Platform’s report advocating a move away from the 70 percent target for all populations and called the approach “grotesque” in a tweet.

“It has taken a lot of time to build commitment toward the 70 percent target,” Udayakumar said. “And my sense is anything that even tangentially addresses that target creates potential political risk or reduces the urgency of vaccination — which is certainly not our intent.”


One thought on “‘Recognition of failure’: A shift urged in global vaccination strategy

  1. ‘But 47 countries still have inoculation rates below 20 percent’….so that could be 1% to 19%
    Now they will be going for those ‘most at risk’ which translated means the people most at risk to succumb to the jab (kill shot)

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