Tuesday, September 28

For most of humanity the pandemic is not over

The delta variant of the Sars-CoV-2 virus is causing major problems around the world. It is estimated to be at least twice as contagious as the original virus, and it is defying the measures that governments took in 2020. Thailand and South Korea see an increase in cases and deaths, after having successfully managed the pandemic in their respective countries last year. New Zealand and Australia have chosen to order a lockdown.

Low- and middle-income countries are struggling to prevent their hospitals from collapsing. The delta variant has changed the game radically – it’s pretty much like dealing with an entirely new virus.

However, while most of humanity continues to fight the pandemic, in the UK it seems that we are almost back to normal. In London, nightclubs are full of people who party and have fun without any worries. The festival schedule has been maintained with tens of thousands of revelers. Following incessant daily media coverage, the pandemic has now disappeared from the front pages, taking a back seat. Observing this, it seems that for most citizens the pandemic is already history.

Vaccination has marked the before and after. When the results of the first vaccine trials were reported, the efficacy of the treatment was found to be much higher than expected. And early studies in Scotland indicated that Pfizer’s vaccine was even effective in stopping transmission. This gave real hope of using a vaccine to suppress the virus or to reach a threshold of “herd immunity” at which the virus would stop circulating.

It is true that the delta variant has changed the landscape again. Although vaccines remain incredibly effective in curbing deaths and the most serious cases, those who are doubly vaccinated can continue to be infected with the delta variant and pass it on to their contacts. But the important metric is case conversion – the number of COVID-19 cases in the community that translate into hospital admissions.

When the virus broke into China, the estimates were around 20%. The expansion of tests to detect asymptomatic cases reduced it to 13%, and vaccines have managed to reduce it even more, to 3-4%.

However, these problems are minimal when compared to the disaster in countries like Indonesia, India, Nepal, Peru and Brazil. Hospitals have collapsed in various regions, beds are only available if someone dies, and oxygen shortages are causing generally preventable deaths even in young people.

In June, 30 patients in a Ugandan intensive care unit were reported to have died overnight as the oxygen supply ran out. Thousands of people have died in their homes, and teams of civilian volunteers have been formed to help remove their bodies and support the families of the deceased.

What can be done to help and support these countries? In the short term, it is vital to reach countries with health resources such as specialized personnel, oxygen, respirators and more beds. In addition, institutions such as the World Bank have financially supported countries that decreed confinement measures with financial aid for those who cannot work. But these are short-term measures again, as the delta variant will continue to spread.

The most important issue is that these countries need more vaccines to be able to protect first their health and social workers, then their elderly and vulnerable groups, and finally move to the large-scale protection of their populations. Basically, they need to replicate the UK strategy, but in a context of billions of people, not millions. And they have to do it in the face of a rapidly evolving virus that is wreaking havoc with each passing day.

The main bottleneck to achieving this right now is in the supply chain. The solution proposed by rich countries and pharmaceutical companies is a donation mechanism: rich countries pledged to donate money and doses to an international initiative, Covax, which then distributed them around the world. Alternatively, rich countries could directly donate the doses to their country of choice.

As is widely recognized, this philanthropic model has failed. In a context of vaccine shortages, rich countries kept their doses and did not share them. This is now being repeated with the decision to give booster doses (third doses) in rich countries, while poorer countries are still waiting for the first doses. And no wonder: whether with past Ebola or swine flu epidemics, rich countries always take care of themselves first, then take care of the rest of the world.

What does this mean for the future? It means that we have to move away from the charity model and towards one in which regions can produce enough supply for their own populations, ideally from local production centers.

This means setting up factories in strategic locations around the world, making the necessary investments in technology transfer and human capacity, and being prepared to pass emergency intellectual property exemptions so that manufacturing can be done without the usual patent protection. The World Bank, and richer countries, should help these countries become self-reliant, rather than remain in the 20th century model of dependency.

If we look at the remainder of the year, we see a different story emerging in parallel for two pandemics. The rich countries have advanced to reality and make it appear that the pandemic is over. Poor countries have been ignored, once again, and are struggling to see how to end the year without continually losing lives and making the disaster bigger.

Devi Sridhar is Professor and Chair of the Global Public Health Unit at the University of Edinburgh.

Translation by Emma Reverter.