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In some of Asia’s COVID-19 hot spots, wealthier and more powerful citizens are securing booster shots even as most people remain unvaccinated, undermining the inoculation strategies of nations struggling with the highly infectious delta variant.

The growing trend in countries like Indonesia, Thailand and the Philippines is worsening inequities at a time when those same countries are grappling with vaccine shortages.

In Indonesia — where the health ministry has said boosters are only for health workers — members of the political elite, including the governor of a prominent region, were caught on camera discussing the boosters they received.

The conversation was inadvertently broadcast in a livestream of an event on the Presidential Secretariat’s official channel. President Joko Widodo could be heard saying he hasn’t received a booster because he was waiting for Pfizer Inc.’s shot to be available. Widodo’s office and the governor didn’t respond to requests for comment at the time, and the video has since been deleted.

At two hospitals in Thailand, a director and a doctor are being investigated for allegedly giving Pfizer Inc. vaccines intended for pregnant women and health workers to their own family members and aides. Ronaldo Zamora, a representative for San Juan City in the Philippines, has spoken openly at a press conference about getting four COVID-19 shots — a round of Pfizer, adding to the Sinopharm Group Co. vaccine he received last year before it was even approved by regulators. His son, a mayor of the same city, later said it was done under doctor’s orders because Zamora was immunocompromised.

The chase for added inoculations comes at a time when there is a growing global debate around booster shots — which have been shown to increase protection against the virus as the delta variant drives up cases worldwide.

The World Health Organization has urged developed nations to hold off on boosters until supplies are available for poorer nations. But at the end of August, U.S. President Joe Biden said his administration was considering giving boosters five months after the second dose.

For countries in Southeast Asia that are hamstrung by vaccine shortages, extra doses for the well-connected means fewer stockpiles for health professionals and the vulnerable. In the Philippines, Malaysia and Thailand, daily infections are near record levels, while Indonesia’s death toll is among the world’s highest.

Displacing others in the vaccine queue is “very morally questionable” and also puts the entire population at greater risk of the virus in the long run, said Voo Teck Chuan, assistant professor at the Center for Biomedical Ethics of the National University of Singapore.

“You might or might not make yourself safer by taking a booster shot,” Voo said. “But if you let the virus continue to transmit and mutate across your community, you will see more variants and more infections. Then, you’re not sure if your vaccine, no matter how many you’ve taken, will be enough.”

Family members grieve at the grave of a COVID-19 victim at the Rorotan cemetery in Jakarta on Aug. 18. | BLOOMBERG
Family members grieve at the grave of a COVID-19 victim at the Rorotan cemetery in Jakarta on Aug. 18. | BLOOMBERG

In the U.S., White House chief medical adviser Anthony Fauci said Thursday that three doses of COVID-19 vaccine may become the standard regimen for most people.

Southeast Asia is particularly emblematic of the complexities of the debate around boosters because countries like Indonesia and the Philippines relied heavily on inactivated shots made by Chinese companies, which studies have found to be less effective than the mRNA vaccines made by Moderna Inc. as well as Pfizer Inc. and its German partner BioNTech SE.

With the exception of Singapore, which has met its goal of inoculating 80% of its population, many Southeast Asian nations are falling behind their vaccination goals. Both the Philippines and Indonesia are at 13%. Vietnam and Thailand are at 10% and 11%, respectively.

The Philippines has yet to approve booster shots, unlike Thailand and Indonesia — which have greenlighted extra doses for priority groups.

Often, it is money, connections or influence that help people jump the queue for vaccines. However, the rush to distribute shots as quickly and as widely as possible has also left open loopholes for many who want to take advantage.

In Indonesia, instances of booster misuse were spotted in the government’s registry after complaints were raised by whistleblowers, according to crowdsourcing platform LaporCovid-19.

In the Philippines, it’s possible to register in one city as a resident and in another as an employee, with no unified database. That’s helping a privileged few with better jobs and higher salaries get extra doses.

A project manager in metropolitan Manila, who asked not to be named discussing his inoculations, initially signed up for a jab with his company because the Philippines allows the private sector to procure and vaccinate workers. However, with little clarity on when his vaccine would arrive this year, he chose to take two shots from China’s Sinovac Biotech Ltd. through the government program when supplies became available in a nearby city.

Still, the limited data then available on Sinovac’s effectiveness against the delta strain weighed on his mind, he said. He didn’t report the vaccination to his company and went on to take a round of the Moderna vaccine through the firm this August.

A vaccination center in Ho Chi Minh City, Vietnam, in August | BLOOMBERG
A vaccination center in Ho Chi Minh City, Vietnam, in August | BLOOMBERG

In Indonesia, meanwhile, the military chief, who was also seen and heard on the livestream on the Presidential Secretariat’s official channel, denied having received a vaccine booster and said he had used the term “booster” to refer to a stem cell treatment he had received.

Amid shortages, some in Southeast Asia have resorted to traveling great distances or camping out at health centers just to vie for a first or second shot. As governments start to ease lockdown measures for the vaccinated, crowds have swelled further — increasing the risk of infection.

Illicit booster shots undermine the government’s surveillance abilities because if authorities don’t know how many people have been inoculated or what segments of society remain exposed, it hinders their ability to track transmission, said Leonila Dans, a clinical epidemiologist at the University of the Philippines.

“Jumping the queue harms not just one or two people,” Dans said. “It puts the entire community at risk.”

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