MANILA (BLOOMBERG) - In some of Asia's Covid-19 hot spots, powerful and wealthier citizens are nabbing 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 they 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 live stream of an event on the Presidential Secretariat's official channel. President Joko Widodo could be heard saying he has not received a booster because he was waiting for Pfizer's shot to be available.
Mr Widodo's office and the governor did not respond to requests for comment at the time, and the video has since been deleted.
Thailand is investigating a director and a doctor at two hospitals who allegedly gave Pfizer jabs meant for pregnant women and health workers to family members and aides.
Mr 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 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 Mr 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 Organisation has urged developed nations to hold off on boosters until supplies are available for poorer nations. Meanwhile, at the end of August, United States President Joe Biden said his administration was considering giving boosters five months after the second dose.
For countries in South-east Asia that are hamstrung by vaccine shortages, extra doses for the well-connected means fewer stockpiles for health professionals or 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 Dr Voo Teck Chuan, assistant professor at the Centre for Biomedical Ethics of the National University of Singapore.
"You might or might not make yourself safer by taking a booster shot," Dr 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."
South-east 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 as well as Pfizer and its German partner BioNTech.
With the exception of Singapore, which has met its goal of inoculating 80 per cent of its population, many South-east Asian nations are falling behind their vaccination goals.
Both the Philippines and Indonesia are at 13 per cent. Vietnam and Thailand are at 10 per cent and 11 per cent, respectively. The Philippines has yet to approve booster shots, unlike Thailand and Indonesia which have greenlit 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 whistle-blowers, according to crowd-sourcing platform LaporCovid-19.
In the Philippines, it is possible to register in one city as a resident and in another as an employee, with no unified database. That is helping a privileged few with better jobs and higher salaries get added jabs.
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 through the government programme 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 did not report the vaccination to his company and went on to take a round of the Moderna vaccine through the firm this August.
In Indonesia, meanwhile, the military chief, who was also seen and heard on the live stream on the Presidential Secretariat's official channel, denied getting 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 South-east Asia have resorted to travelling great distances or camping out at health centres 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 do not know how many people have been inoculated or what segments of society remain exposed, it hinders their ability to track transmission, said Prof Leonila Dans, a clinical epidemiologist at the University of the Philippines.
"Jumping the queue harms not just one or two people," Prof Dans said. "It puts the entire community at risk."