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Analysis
  |  
Coronavirus

Job One: Vaccinate the World

Wealthy nations eye booster shots while poor countries lack even first doses. That’s a recipe for rising deadly variants everywhere.

Crawford Kilian 9 Aug 2021 | TheTyee.ca

Tyee contributing editor Crawford Kilian blogs about the pandemic here.

On Aug. 4, the COVID-19 Dashboard run by the Center for Systems Science and Engineering at Johns Hopkins University — a map that tracks COVID-19 cases, deaths, vaccinations and other data in real time around the globe — recorded just over 200 million confirmed cases and more than four million deaths.

Both numbers are likely severe undercounts. India alone reports 400,000 deaths, but its true count may be as high as 4.9 million.

It’s quite a success story for SARS-CoV-2, the virus that causes COVID-19 and one that nobody knew existed two years ago.

But the virus has friends in high places around the world — politicians who downplay its seriousness, or cripple their own health-care systems’ response to it. The virus has repaid them by developing variants that are now battering even the most resistant countries, such as Vietnam, and it’s slamming Canada as well.

On Friday, Aug. 6, B.C.'s provincial health officer Dr. Bonnie Henry announced a return to restrictions in the Central Okanagan as a result of a sudden surge in COVID-19 cases. Bars, nightclubs and gyms were ordered closed and gatherings limited as the area’s COVID-19 count tripled to 1,200 cases since an outbreak was declared the previous week. Of the 464 new COVID-19 cases reported in B.C. on Friday, 275 were in Interior Health and most of those were in the Central Okanagan.

Though Henry barely mentioned it, the variant known as Delta seems to be driving this surge. According to the BC Centre for Disease Control, Delta now accounts for “about 95 per cent of positive specimens sequenced.”

Variants are the predictable consequences of the virus’s spread through hundreds of millions of human bodies. As SARS-CoV-2 copied itself in countless hijacked cells, it sometimes made errors. Most rendered the copies useless, or at best, no better than the original strain that emerged in Wuhan, China in 2019. But a few copies were even better than the original, and they flourished because they made more people sick and those people infected others.

The Delta strain, as we now call it, was first identified in India and has spread to about 100 countries. The Centers for Disease Control and Prevention has recently described it as more transmissible than the common cold and flu, as well as the viruses that cause smallpox, MERS, SARS and Ebola, and called it as contagious as chickenpox.

B.C. has tried to be kind, calm and safe for most of the past year-and-a-half, but Delta is now doubling the province’s current cases every seven to 10 days — despite the administration of almost seven million vaccine doses.

Five billion left to infect

According to Our World in Data, as of early August, Canada ranked fourth in the world in regard to the percentage of its people vaccinated. Only the United Arab Emirates, Uruguay and Chile are ahead of us. Worldwide, about 15 per cent of the globe’s people are fully vaccinated and 17 per cent are partly vaccinated.

But countries like Afghanistan, Sudan, Mozambique and Haiti have been unable to vaccinate more than a small fraction of their populations. COVID-19 variants still have some five billion people to infect globally — not to mention the vaccinated people they may be able to reinfect.

So while Canada and other rich nations define “success” as getting their own people vaccinated, COVID-19 thrives in the poor countries, spinning off variants that will eventually outwit our vaccines.

Dr. Tedros Adhanom Ghebreyesus, head of the World Health Organization, has called out wealthy countries on this inequity. While he understands why sovereign nations want to take care of their own, Ghebreyesus says a shift in priorities is crucial in the fight against the coronavirus.

“We cannot accept countries that have already used most of the global supply of vaccines using even more of it, while the world's most vulnerable people remain unprotected,” he said. “We need an urgent reversal, from the majority of vaccines going to high-income countries, to the majority going to low-income countries.”

851px version of WorldMapVaccinationPercentage.jpg
Official data collated and updated as of Aug. 8, 2021, by Our World in Data, CC BY.

Meanwhile, as the world quarrels over vaccines, variants continue to emerge. One worrisome variant is Lambda, still considered “of interest” rather than “of concern.”

Variants of interest are suspected to either be more contagious than the original strain of the COVID-19 virus, cause more severe illness, or escape protection offered by vaccines. A variant of interest can become a variant of concern if more evidence emerges that it does one or more of those things.

Lambda was first identified in Peru, where it now accounts for 81 per cent of that country’s COVID-19 infections.

As the Peruvian ministry of health said on its website in late June: “In our country, authorities report three variants of concern: Alpha, Gamma and Delta, while Lambda predominates. While still under investigation, early analysis shows that these new variants are much more contagious than the original virus, so it is recommended to strengthen protective measures to avoid community transmission.” (The Tyee’s translation).

Lambda is spreading through much of Latin America. Cases have also been identified in the U.K. and the U.S. Early in July, a team of Chilean researchers published a study of Lambda; they found that its mutations “confer increased infectivity and immune escape from neutralizing antibodies elicited by CoronaVac.”

In other words, it may be able to infect more people and to evade their immune responses, even if they’ve had the CoronaVac vaccine.

Other variants of interest — such as Kappa, Epsilon, Eta, Theta and Iota — may overtake earlier ones, just as Delta did. But so far, even the variants that infect the vaccinated are doing less harm. Vaccinated people may fall ill, but not as seriously as the unvaccinated.

The hazard is that asymptomatic cases can infect others, as the CDC warned in late July. Public Health England has reported similar findings. The CDC now recommends “universal masking in indoor public settings” — advice that has not gone down well in some American states (and Canadian provinces) eager to get kids back in school and their parents back to work.

Getting back to ‘normal’

Our preoccupation of getting back to “normal” has repeatedly got us into worse trouble as lockdowns and restrictions are lifted, only to see a resurgence of COVID-19. Even the early responders, such as Vietnam and Australia, are struggling to deal with soaring case counts by imposing more lockdowns while scrambling to secure more vaccines.

All the while, WHO has patiently advised stopping variants at the source with basic hygiene, masking and avoiding crowds — “non-pharmaceutical interventions” that are essentially the same as those recommended for the influenza pandemic of 1918-19.

That being said, WHO recognizes the need to vaccinate those most at risk.

“Priority should be given to vaccinating high-risk groups everywhere to maximize global protection against new variants and minimize the risk of transmission,” it said. “Moreover, ensuring equitable access to COVID-19 vaccines is more critical than ever to address the evolving pandemic. As more people get vaccinated, we expect virus circulation to decrease, which will then lead to fewer mutations.”

Wealthy nations however — such as Israel, Germany, France and the U.K. — have ignored this advice and are promoting booster shots for their already-vaccinated people. Politically, it’s smart. Epidemiologically, it guarantees worse trouble ahead.

The WHO’s Ghebreyesus has asked for a pause on third shots until more vulnerable populations get at least some protection with a first shot, citing the fact that high-income countries administered around 50 doses for every 100 people in May, and that number has since doubled. Low-income countries have only been able to administer 1.5 doses for every 100 people, due to lack of supply.

"I understand the concern of all governments to protect their people from the Delta variant. But we cannot accept countries that have already used most of the global supply of vaccines using even more of it,” Ghebreyesus said.

This disparity is all the more infuriating, considering the number of people in developed countries who still hesitate to get the vaccine.

In effect, rich countries like Canada are trying to protect themselves by offshoring the pandemic — downloading the burden to countries that can afford it least. The irony is that strategy will only ensure some new variant of COVID-19, or another virus altogether will emerge to inflict still more damage to us, vaccinated or unvaccinated.  [Tyee]

Read more: Coronavirus

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