The appearance of the variant Omicron, a year after the world embarked on mass vaccinations to combat the pandemic caused by SARS-CoV-2 virus, has highlighted the inequities in the distribution of the vaccine in developing countries which, in the words of the director general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesu, allows the virus that causes Covid-19 to “spread and evolve in ways that cannot be predicted or prevented.”
As of the end of November, low-income countries had received only 0.6 percent of the world’s Covid vaccines, while G20 nations had received 80 percent, Adhanom noted.
During a recent special session at the UN, the WHO official stressed that “no country can vaccinate to get out of the pandemic on its own” and that “no region, no country, no community, or no individual is safe until may we all be safe ”.
From Kochi (India), the epidemiologist Said Manu Raj, assures: “Africa was asking for vaccines and none of the rich countries listened; they simply accumulated more than they needed. Any nation that lags behind in vaccination is likely to be a breeding ground for more mutations. The world will have to be more equitable or we will continue to see bad things. “
Delays in Latin America
Until December 16 of this year, and according to WHO data, a total of 8,337,664,456 vaccines had been applied worldwide. The number seems good, but inequity is its mark. 56% of the population of Latin America and the Caribbean is fully vaccinated. However, despite this vaccination coverage, Clarissa Etienne, director of the Pan American Health Organization (PAHO) warned that “millions of people in our region have not yet received a single dose.” And he completed: “The inequity around vaccines continues to divide us and, if we do not address these obvious gaps, we will not be able to control this virus.”
Guatemala, Jamaica, Saint Vincent and the Grenadines, Nicaragua and Haiti show coverage below 20 percent. “We had access difficulties from the beginning,” says Jarbas Barbosa da Silva, deputy director of the health agency. According to Barbosa, and during the early stages, rich countries monopolized all the production of the Pfizer and Moderna laboratories, ignoring COVAX, a global mechanism created to guarantee the equitable distribution of vaccines against Covid-19, led by Gavi, the Vaccine Alliance.
In addition, AstraZeneca had a significant shortage because India, the main buyer of its manufacture, suspended exports in March. “This year, Latin America should have received 80 million doses from that company, but it did not receive even 10 percent,” he said.
“COVAX could not leverage its negotiating capacity, which should have been the sum of the purchasing power of several countries,” says Felipe de Carvalho, access campaign coordinator for Doctors Without Borders.
As delays continue, Latin American countries have turned to manufacturers in Russia (Sputnik V) and China (Sinovac, Sinopharm), and PAHO is working with public and private institutions in Argentina and Brazil to develop mRNA vaccines as part of a strategy to reduce your dependency.
At the end of November, the first two cases of Ómicron were registered in Brazil, adding to concerns about the rapid spread of the new variant, especially in countries in the region with low vaccination rates.
Ómicron, a variant that has 50 mutations – most of them, more than 30, in the protein “spike” (spike) that helps the virus infect human cells – appeared in early November 2021.
According to the World Health Organization (WHO), the number of registered cases doubles every 1.5 and 3 days in those areas where there is community transmission. This led several countries to re-impose travel restrictions, strengthen surveillance, impose partial quarantines and study the vulnerability of the variant to existing vaccines.
Lessons from India
India, where the highly contagious Delta variant emerged in early 2021, learned the hard way the consequences of being late for vaccinations. That country, a major manufacturer and exporter of vaccines, reacted to Delta with free vaccines until June 21. By then, approximately four million people had died as hospitals were saturated and supplies of essential drugs and oxygen ran out.
However, the mass vaccinations carried out in the country, which are among the largest campaigns of this type in the world, had a positive effect. In a nation that recorded an average of 40,000 new cases per day during the peak months of the second wave (between April and September 2021), now the number has dropped to an average of 10,000 new cases per day and continues to decline steadily. .
Manohar Agnani, deputy secretary of the country’s Ministry of Health, said in a webinar that “almost 80 percent of the eligible adult population in India has been vaccinated against Covid-19 with a first dose, while 38 percent have been vaccinated. completely”. It is still really little, and more so with the Omicron variant, which according to preliminary studies requires the application of third booster doses.
The first cases of Omicron infection in that country – a doctor and a South African citizen – were announced at a press conference on December 1 by the Ministry of Health. “For a country where everyone is infected and most of those who remain are vaccinated, there is no need to fear,” says Raj. Extensive serological surveys in India suggest that 70 percent of the 1.3 billion population would have acquired antibodies against the SARS-CoV-2 coronavirus in April.
“Although it is inevitable that new variants will emerge, such as influenza, it is not clear if they will all present the same risk that we saw with the Delta,” says Ramanan Laxminarayan, epidemiologist, founder and director of the Center for Dynamics, Economics and Politics of Diseases in Washington DC. And he adds: “Anyway, our best bet is to increase vaccination coverage, because it protects, at least partially, also against new variants.”
Underprivileged africa
Catherine Kyobutungi, executive director of the Nairobi-based African Center for Population and Health Research, said COVAX fell short of Africa’s expectations, forcing countries to turn to donations from rich countries that had overstocks. . “These donations are unpredictable and erratic and many countries have had to deal with periods of too many doses and shortages,” he said.
According to the WHO, nine African countries, including Morocco, South Africa and Tunisia, had reached the goal of having 10 percent of their population vaccinated by early September. By the end of the month, six more countries had met or exceeded that goal. The Mauritius and Seychelles islands had more than 60 percent of their population vaccinated.
But for Kyobutungi, that target is too low to achieve herd immunity against SARS-CoV-2. “You need to have about 90 percent of the population fully vaccinated,” he specifies.
Countries such as Burkina Faso, Gambia, Democratic Republic of the Congo, Central African Republic, Madagascar, Niger, South Sudan, Sierra Leone and Uganda have less than one percent of their population fully vaccinated, he noted.
“Africa has been let down by the rest of the world. By not having its own vaccine development and manufacturing capacity, it has been left at the end of the line, ”says Kyobutungi.
Nigel Garett, head of vaccine pathogenesis and research at the Center for AIDS Research Program in South Africa, said the flaw is that African countries “are not seen as a commercial market by prominent companies, especially those that produce mRNA vaccines ”.
WHO’s new target of vaccinating 40 percent of each country’s population by the end of December has a much better chance of success in the eastern Mediterranean and Latin America regions than in Africa.
The “December Target” is considered a key step in the WHO Strategy to achieve global vaccination against Covid-19, which aims to cover 70 percent of the world’s population by mid-2022.
Of the 22 countries in the WHO Eastern Mediterranean region, seven reached the target set for the end of December ahead of time, while another seven are on track to achieve it, said Amjad Al Khouli, WHO epidemiology adviser at the Middle East region. But the other eight countries in the region are struggling to catch up, he noted.
In addition to the epidemic of fake news, which leads the population to doubt the efficacy and even necessity of vaccines, conflicts in the region were another problem. “The main reason for the situation in countries that are far from achieving the goal is the fragility of health systems, the climate of conflict and the repercussions of various emergencies,” summarizes Al Khouli.
He also blames insufficient vaccine supply due to “unfair” distribution, poor logistics, and difficulties in getting vaccine doses to unsafe geographic areas. The delays also caused vaccines to expire, which are fragile and have specific validity periods.
Ranjit Devraj, Gilbert Nakweya, Pablo Corso and Hazem Badr for SciDev
