Why we need more vaccines to achieve more vaccinations in the war against COVID 

As we head into our annual flu season, the COVID-19 pandemic emergency remains thankfully behind us. Yet, SARS-COV2 as a serious virus remains a threat. How do we know this? For one, we are seeing rising hospitalizations for COVID-19 in all areas of the world that track this metric.

Recognizing this, in the last weeks, national drug regulators in the U.S. and other countries have approved the updated Pfizer-BioNTech COVID-19 vaccine and public health officials worldwide are rolling out booster campaigns to prevent a repeat of surges in cases, deaths and incidence of long COVID. The problem with this campaign is that it is being built with a toolbox with fewer and fewer tools in it. In the U.S. and globally, we are focused on vaccines based on mRNA technology. But there are equally clear signs that we will need more than just these innovative vaccines for COVID and other infectious diseases. 

First and foremost, a variety of vaccine choices must be available if we are going to manage unprecedented levels of vaccine hesitancy. News reports in the U.S. highlight consumer concerns with our current set of vaccines as major contributors to low COVID vaccination rates at all ages, particularly for young adults and children. A recent report from UNICEF notes unprecedented levels of hesitancy in COVID vaccines globally, with proliferation of misinformation and conspiracy theories on new vaccine technology as a top reason. These same reports cite the importance of providing communities a choice of vaccines as a key element toward rebuilding long-term trust in public health and vaccination.  

While vaccine hesitancy is a complex issue, mRNA vaccines have faced a high level of pushback in many circles, largely based on a lack of relevant clinical trials data. At the height of the pandemic, the vaccine tracker of the World Health Organization had over 300 vaccines in the pipeline in a wide range of platforms, which included mRNA but also more traditional platforms similar to those used for a majority of childhood diseases (protein-based, for example.). Yet, despite the need for optionality in vaccine choice, the European Union has announced the purchase of over 325M mRNA doses with no announcements for other platforms.  

Globally, the number of non-mRNA vaccines available this fall is virtually nonexistant, given production constraints and the unfortunate possibility that companies with effective COVID-19 vaccines outside of the mRNA platform may decide to drop out. 

Adding to this are consumer concerns about the side effects of booster shots. While rare, serious side effects from COVID-19 vaccines do occur, cardiovascular events were the most common complication from published studies for mRNA vaccines overall. Affected individuals can have symptoms such as severe headache, dizziness, visual disturbances, fever and shortness of breath. More commonly, patients with mRNA vaccinations experience soreness at the injection site, fatigue, headache, muscle soreness or chills. None of these are life-threatening, but for busy adults or adolescents, having to stay at home with any of these symptoms only further discourages people from getting boosted.  

Continuing to improve our existing vaccines and offering individuals a choice of vaccines with fewer side effects will both better protect patients at higher risk of blood clots and other heart issues, as well as encourage higher vaccination-seeking behavior. 

If trust is the foundation for a sustained rebuilding of global vaccination, then the structure we can build on this foundation must consist of long-lasting vaccines. At present, we are seeing rising case numbers and rising hospitalizations from COVID from Japan and China to Western Europe to North America. Part of the reason for this is the diminished community level protection across these countries, from vaccines delivered earlier in 2023 and late 2022. Most of the data examining durability from our existing set of mRNA vaccines notes that protection starts to deteriorate as early as two months after vaccination. We simply must continue to develop additional vaccine platforms that offer longer-term protection if we are to continue to pursue the plans set by most countries of “annual” booster shots.  

Finally, any global effort to protect long-term against a resurgence of COVID and rebuild global immunization must be based not just on better vaccines but on delivering those vaccines into arms. During COVID, we spent tens of billions of dollars on vaccine development and only a few hundred million on the vaccination programs at national and local levels around the world to deliver those vaccines. This was the case both from national governments like the U.S., France and United Kingdom, as well as global health agencies like WHO, GAVI and their teams at global COVID coordination effort COVAX. Alarmingly missing was adequate spending and effort for key vaccination program inputs like health workers and syringes for vaccination. As WHO prepares for a major effort to rebuild levels of vaccination globally, our focus should be on vaccinations completed, not vaccine doses only. 

We have the tools to address a new wave of COVID coming globally over the next two years. We just need to keep the entire toolbox with us to address it.  

Edward Kelley is former director of integrated health services for the World Health Organization and helped lead WHOs response team to the COVID-19 pandemic. He now leads global health for Apiject.