No excuse not to end the acute stage of pandemic globally

Shobha Shukla / Bobby Ramakant *

Is it not shocking that after more than two years into the pandemic (when we know how to protect ourselves from getting infected, and have had vaccines for more than a year now), by far the highest-ever number of corona virus infections in a single week were reported in the second week of January 2022? This is an unacceptable failure to save lives and unnecessary human suffering.

More than 15 million new cases of COVID-19 were reported globally in the second week of January 2022. And even this high number is an underestimate. But a silver lining - in the dark clouds dominated by the Omicron variant of the current wave of COVID-19 - is that the number of weekly reported deaths has not increased. Rather, they have remained stable since October 2021 (at an average of 48,000 deaths a week). But the number of patients being hospitalized is increasing in most countries, even though it is much lower than the hospitalizations we saw during the COVID-19 wave dominated by Delta variant last year.

But let us be clear that while Omicron causes less severe disease than Delta, it remains a dangerous virus, particularly for those who are unvaccinated. Almost 50,000 deaths a week is 50,000 deaths too many. Learning to live with this virus does not mean we can, or should, accept this huge number of deaths.

WHO-approved vaccines against COVID-19 may not stop all infections and transmission but they remain highly effective in reducing hospitalisations and deaths due to this virus. So, alongside getting vaccinated, public health and social measures- like wearing of well-fitting masks, distancing, avoiding crowded places, and improving and investing in ventilation are important for limiting transmission of the virus.

Undeniably, most people admitted to hospitals around the world due to COVID-19 are unvaccinated. Dr Bruce Aylward, who leads the Access to COVID-19 Tools (ACT) Accelerator of the World Health Organization (WHO) said “Vaccines reduce the risk of severe disease and hospitalisation. Up to 90% of the patients with severe disease of COVID-19 are those who are unvaccinated. So, clearly these vaccines are having a huge impact.”

Vaccines are also protecting the young from serious outcomes of COVID-19. 99% of the youngsters aged 12-18 years who are getting admitted in ICUs for COVID-19, are unvaccinated. “About 1% of ICU admissions for COVID-19 among patients ages 12-18 were fully vaccinated, according to a new study. Vaccines are extremely safe, and they are remarkably effective against severe illness, including in adolescents” tweeted Dr Tom Frieden, former head of Centers for Disease Control and Prevention (CDC).

COVID-19 can become a vaccine preventable disease, only if we act equitably, with a sense of purpose and urgency.

Ending acute stage of COVID-19 is an imperative

It is possible to end the acute stage of COVID-19 because “…we have the tools to do that. It is how we distribute them,” said Dr Bruce Aylward.

“To end the acute stage of the pandemic, the highly effective tools science has given us need to be shared fairly and quickly with all countries of the world. Vaccine inequity and health inequity overall were the biggest failures of last year” stressed Dr Tedros Adhanom Ghebreyesus, Director General, WHO.

While some countries have had enough personal protective equipment, reliable tests, and vaccines to stockpile throughout this pandemic, many countries do not even have enough to meet basic baseline needs of its people.

“Vaccine inequity is a killer of people and jobs, and it undermines a global economic recovery. Alpha, Beta, Delta, Gamma and Omicron variants of COVID-19 reflect that in part, because of low vaccination rates, we have created the perfect conditions for the emergence of virus variants” said Dr Tedros.

Dr Ishwar Gilada, a noted infectious disease expert agrees: “In a deeply inequitable world with a global population of 7.8 billion people, we have administered over 9 billion vaccines doses against COVID-19. Had we used these vaccines judiciously with the aim to protect the most vulnerable globally, we would be closer to ending the acute stage of the pandemic. Failure to do so is resulting in more unvaccinated people falling seriously sick with COVID-19. Besides, the threat of new variants looms large too.” Dr Gilada further told CNS (Citizen News Service) that “Two billion doses are stockpiled by rich and mighty countries, which they could have offloaded to benefit lower and middle-income countries.”

For example, on one hand we have countries that have had over 80% of their populations fully vaccinated since months, and now getting booster doses, on the other hand, we have countries in Africa where more than 85% of people are yet to receive a single dose of a vaccine. There are more booster doses administered daily in rich nations than those who get a single shot on the African continent.

Some countries are moving toward vaccinating citizens a fourth time over (fourth booster dose) such as Israel and Germany, while others have not even had enough regular supply to vaccinate their frontline health workers and those most at risk.

“Booster after booster in a small number of countries will not end the pandemic, while billions remain completely unprotected. But we can and must turn it around. In the short term we can end the acute stage of this pandemic while preparing now for future ones” said Dr Tedros of WHO.

Agrees Dr Maria Van Kerkhove, WHO Technical Lead for COVID-19: “We cannot end the pandemic and have the virus become ‘endemic’ in one country while the rest of the world deals with the pandemic.”

A vaccination strategy based on repeated boosted doses of the original vaccine composition is unlikely to be sustainable, say WHO experts. They emphasize that while some countries recommend boosters the immediate priority for the world is to accelerate access to primary vaccination, particularly for groups at greater risk of developing severe disease.

We cannot end the acute phase of the pandemic unless we close the gap

“Everybody now is acutely aware of the costs of failing to vaccinate equitably. It is the arrival of new variants and new challenges. So, the sooner we get the equitable distribution the sooner we get out of this pandemic” said Dr Bruce Aylward.

WHO is calling upon all governments worldwide to fully vaccinate at least 70% of their population by the end of June 2022. At the current pace of vaccine roll-out, 109 countries would miss out on meeting this deadline. More alarmingly, 36 countries have not been able to vaccinate even 10% of their population as yet (a goal that was set for September 2021).

Dr Kate O’Brien, WHO Director for immunization, vaccines and biologicals, shares several reasons why countries are failing to fully vaccinate their populations fast enough. Many countries face bottlenecks in different areas, such as leadership and coordination, supply chain management, short shelf life of donated vaccines, cold chain capacity, vaccine hesitancy, health workers' shortage, competing priorities, shortage of essential health supplies such as syringes, among others. Financing COVID-19 vaccination has also been a challenge. Moreover, many of these countries have weak health systems or are in conflict or fragile settings facing humanitarian emergencies/ crises.

Pointing fingers on the countries with low vaccination rate against COVID-19 is not correct because many of these nations have demonstrated success in rolling out other vaccine programmes- such as for polio or measles and even achieving disease elimination. These nations must get reliable and predictable vaccine supplies, and full support so that they can ensure these vaccines reach the people most at risk and all those who are eligible in a timely manner.

Failure to prevent infection transmission, also means dealing with more avoidable hospitalizations due to COVID-19 and deaths that could have been averted. It also means more people off-work, including teachers and health workers, and also increases the risk for another variant emerging that is even more transmissible and more deadly than the currently circulating strains of the virus. The sheer number of cases also means more pressure on the already overburdened and exhausted health workers.

Let us not forget that even before the pandemic struck us, health systems in most parts of the world were very overwhelmed with a mountainous disease burden. Preventing infection transmission of corona virus, as well as making COVID-19 a vaccine preventable disease, is an absolute must if we are to strengthen health security worldwide. It is indeed high time we walk the talk on ensuring health for all.