How many Covid-19 booster shots do we need? Three says, US medical czar Anthony Fauci who’s a firm believer in giving out booster shots.

UK Prime Minister Boris Johnson’s also a convert to booster shots. He says booster shots will be on offer for all UK citizens by end January.

Pfizer chief Albert Bourla goes a few steps further and says the emergence of Omicron means we may need a third jab and then a fourth before next winter.

Closer home virologist T. Jacob John says we only have to look at what’s happening in other countries around the world. “The whole world thinks the booster dose is the best defence of the individual against the infection.”

But the government doesn’t buy the booster argument. It’s stalling on calls to give the go-ahead to a third shot, prompting warnings that if it leaves the decision too long, it will be too late.

Playing for time, Prime Minister Narendra Modi’s government has instead tossed the ball back to the National Technical Advisory Group on Immunisation (NTAGI) and says the committee is looking at the evidence. “We are keeping an eye on global scientific studies in this regard,” says Dr V. K. Paul, Niti Aayog Member (Health).

But Jacob John says: “By the time you do studies and find it is an excellent defence against the Omicron, it will be too late." He adds: “We have to learn to build the boat while we sail it.” Another eminent virologist, Dr Shahid Jameel, said that the “immunocompromised must get boosters on priority.”

Around 60 countries are now going ahead with giving out booster doses to their citizens, including the US and most European countries. Pfizer said a third dose of its vaccine offers protection against the Omicron, increasing the level of virus-neutralising antibodies by a factor of 25 compared to the two jab-regimen.

Bourla also says annual jabs may become necessary to keep Covid-19 variants at bay. “Ensuring as many people as possible are fully vaccinated with the first two-dose series and a booster remains the best course of action to prevent the spread of Covid,” he said.

Tests from a South African lab appeared to show that people who had received the Pfizer vaccine had 40-times fewer antibodies to fight against the Omicron variant than are available to fight against other Covid-19 lineages. BioNTech chief executive Dr Ugur Sahin said this showed that by comparison with Beta, Omicron is a “much stronger antibody escape variant.” BioNTech originally developed the vaccine now being marketed by Pfizer.

South African doctors have also suggested that a third booster dose might be needed immediately to keep Omicron at bay. The UK has begun rolling out booster doses three months after giving out the second dose.

Pfizer moved very fast after the Omicron variant appeared and began developing a vaccine to specifically fight it on November 25, Bourla said. He said the company which has become the global leader in Covid-19 vaccines because of its production skills, will have millions of doses of a tweaked vaccine ready by March 2022 if the current vaccines are not working efficiently against Omicron.

India has over 30 cases of people suffering from the Covid-19 Omicron variant. So far, however, all the cases have been relatively mild. Maharashtra has 11 cases including one man who had come from Africa and was stopped on his way to his home in the densely populated Dharavi area. So far all reported cases in India have been mild, according to health experts.

The pressure for booster vaccinations has intensified because Serum Institute of India, which has produced around 88 per cent of the country’s vaccines that have gone into people’s arms, says it may have to slash production by half because of slowing demand in India and extremely low demand from African countries where only a small percentage of the population has so far been vaccinated. Serum Institute has applied to the Drug Controller of India to be allowed to give booster doses.

Still, the government appears keen to block the demand for booster vaccines. Dr Paul told a press conference: “WHO is warning against the decline in mask usage. The global scene of Omicron is disturbing. We are now operating at a risky and unacceptable level. We have to remember that both vaccines and masks are important.”

Paul said no advice had been received from WHO on booster doses. However, he added that, “WHO has clearly highlighted the need for completing primary vaccination as the most important priority. Our thinking is also aligned with this approach that we have to complete the task of vaccinating all individuals with both doses.”

Indian health expert Rijo M. John echoes this view and points out that out of 345 million people over 45 eligible for vaccinations 40 million have not received a single jab yet. And 145 million people above 45 have not received two jabs.

Alongside the debate about booster doses, the question around vaccinating children under 18 is also assuming greater importance. Says Jacob John: “The whole segment under-18 should be covered with vaccinations. They will be a chunk of the population and a reservoir of the virus.”

The booster dose controversy gained traction a few days ago when Serum Institute’s CEO Adar Poonawalla said that, “We have got so much vaccine now that we’ve got more than we can vaccinate on a monthly basis in India.”

Poonawalla also said he was surprised at the lack of demand from African countries. However, the leader of the African Vaccine Acquisition Task Team John Nkengosong on Saturday accused Poonawalla of acting unprofessionally and pulling out of talks even before India banned exports. He said his team had decided to buy $400 million worth of Covid vaccines from Johnson & Johnson.

However, all studies on Omicron are still at a very preliminary level. The Daily Mail reported that a pre-print study not yet peer-reviewed discovered that Omicron could evade many vaccine-triggered antibodies. The study’s authors. however, pointed out that antibodies are only one part of the body’s fighting response to the virus. As antibodies against the variant diminish, scientists believe the immune system may still be primed by the body’s T-cells to recall the virus and fight against it. So far, doctors in South Africa which suffered the first big outbreak of omicron, report that cases appear to be relatively mild but hospitalisations and deaths can happen weeks later.

Jacob John believes that above all else, the government must move quickly. He says: “If you look for evidence it will be far too late and many people will die. We must create the evidence as we go forward. That would be the best thing.”