It has been just over a year since COVID-19 was declared a global pandemic and almost every country in the world imposed restrictions. These measures were intended to slow down the spread of SARS-CoV-2 so that governments and public health leaders could figure out how best the pandemic could be managed. The emphasis for most countries and the World Health Organisation (WHO) was to minimise mortality and morbidity by decreasing community spread, whilst ensuring that health systems were not overrun.
A year on and thanks to science, there are several vaccines available that are effective. More importantly, there is increasing evidence that, amongst vaccinated populations in Israel and the United Kingdom, these vaccines are disrupting the transmission of infection. Gratifying as this news may be, the world is at a point where a third wave is on the horizon. Countries such as Kenya, France, Germany, and many in the European Union (EU), have in the last few days indicated that they are seeing exponential growth of new infections. Further, the information points to the fact that this new wave is being driven by mutant strains that are more contagious, with the potential to erode any gains that countries have made in their fights against the virus.
In the last 24 hours, the German government has claimed that there is a risk of 100,000 new cases a day occurring, should the current trend not be reversed. These new predictions will be even higher than the daily reported cases at the peak of the first wave in the aforementioned countries. We are of the view that this must bother the world as a whole. This is because community spread is known to be the main driver of viral mutation with the emergence of strains that are not susceptible to the current vaccines available.
As at the time of writing, there was evidence that the mutant strain first identified in South Africa, was less susceptible to the vaccine developed jointly by scientists from Oxford University and AstraZeneca. Since the preliminary information, most other strains of concern e.g., the Brazilian strain have not been found to exhibit significant resistance against the vaccines available. Pleasing as this information is, the world cannot afford the indiscriminate mutation of this virus. The economic and public health consequence of such a gamble must not be underestimated. According to Statista, the global GDP loss for 2020 was 4.5%. To put this in context, the global GDP was estimated at around $87.55 trillion in 2019 and the 4.5% drop in economic growth amounted to approximately $3.94 trillion. We cannot ignore the reality that the world cannot afford another year of such losses. To prevent this, the global approach moving forward must be collaborative to ensure that long term preventative measures are rolled out at pace.
Sadly, in the last few weeks, the world has experienced the opposite with the likelihood of a global vaccine war on the horizon. This was initially triggered by the intervention of the EU in blocking vaccine exports to Australia; and their subsequent threat to prevent vaccine exports to countries with higher vaccination coverage than their member countries. On the surface, one could see these steps as reasonable since leaders owe a duty of care to their citizens. However, we are of the view that this duty of care provisions go beyond national or sub-regional borders since protection against this virus cannot be conferred in silos. The majority of the problem with the EU vaccine rollout can be traced to the level of ambition they showed at the start of vaccine development; investing next to nothing at the initial stage. Further, even when evidence of efficacy became apparent, their leaders were about three months behind with the ordering of their vaccine stocks compared to the United Kingdom and the United States.
￼Image Courtesy of Chris Stringfellow
If a three-month lag can cause this much disruption, one can only imagine the plight that could befall lower and lower-middle-income countries that have not even obtained any bilateral memoranda of understanding with vaccine manufacturers on their own or as part of a negotiating block. Already, with India experiencing an uptick in new cases and their insistence that Serum Institute of India (SII) increase the proportion of vaccines that are retained locally, supplies to COVAX have been constrained. This is concerning as some countries that signed up onto this platform have not received their first delivery of vaccines.
These developments compelled WHO to issue updates, on the 25th of March, to COVAX participatory countries regarding delays to deliveries of doses from SII which will result in delayed supplies in March and April. These delays will affect approximately 90-million doses (40 million doses that were expected in March, and up to 50 million doses in April). Further guidance was also issued by WHO on optimizing the national deployment of doses of the AstraZeneca-Oxford vaccine in a constrained supply environment. These issues must be resolved within the next 12 weeks so that COVAX countries that received early supplies will have enough vaccines for the administration of second doses. Unless there is a de-escalation across the board, our view is that the situation is only going to get worse.
Some have suggested that a solution to this will be the authorisation of local manufacture of vaccines in countries with production capabilities to help augment supplies. Though this is feasible on paper, we see some challenges. Primarily is the lack of production capability in Africa due to the non-availability of human as well as infrastructural resources. Then there are the patent considerations for vaccines made by the likes of Pfizer and Moderna and their unwillingness to forgo their profits in the quest to bring this pandemic under control. If their intention to raise the base prices of their vaccines is anything to go by, the chances of this happening are low. These challenges could be circumvented if Chinese and Russian vaccine manufacturers were willing to franchise out the production of their vaccines. This option could also be tricky as these countries may want to exert maximum geopolitical and soft power leverage even though they lack the production capacity to meet the current global demand for vaccine doses.
Much as lower and lower-middle-income countries are caught in the middle of these squabbles, their governments need to study the factors that have contributed to the current predicament. It will be unfortunate if the assumption is made that these countries had little option as this is not entirely accurate. A look at the top five countries with the highest COVID-19 vaccination coverage will reveal that two (United Arab Emirate with 76.9% and Chile 49.2% of their population receiving at least one dose) may seem out of place. However, these countries put themselves in pole position by engaging with manufacturers such as AstraZeneca, Johnson & Johnson, Sinovac, and CanSino to hold phase III trials in their countries. The result is that Chile has ordered 88 million doses of vaccine, enough to fully vaccinate more than double its 19 million people. This is what many lower and lower-middle-income countries failed to do and why they are at the mercy of supply chain disruptions. In the meantime, EU leaders should know that this bulls-in-a-china-shop behaviour will only make matters worse.