Image: In the ICU ward at the Hospital das Clinicas in Porto Alegre, Brazil, on 19 March. AP, SMH 19
The race to vaccinate the world is not keeping pace with accelerating rates of transmission driven by viral variants of concern writes Burnet’s Professor Mike Toole AM and Professor Brendan Crabb AC in the Sydney Morning Herald.
Two seemingly incompatible statistics were released on Friday. The number of COVID-19 vaccine doses administered worldwide reached 878 million and more than 832,000 new infections were reported.
That is more than double the number reported just two months ago and the second highest on record. In this third global surge, no region has been spared. Most European countries are experiencing massive third waves, far worse than previous waves. In Canada and the American midwest, cases are surging and Latin America is once again the global epicentre of the pandemic. Brazil is reporting an average of 71,000 cases and more than 3000 deaths a day. Even in Chile, where the vaccination rate is third highest in the world, new cases have doubled since late February.
In the Asia-Pacific region, India is spiralling out of control, reporting more than 250,000 cases daily. Pakistan, Bangladesh, the Philippines, Cambodia and Thailand also have second or third waves. Closer to home, Papua New Guinea and Timor-Leste are experiencing major surges.
So what’s going on?
Firstly, it’s important to be clear that the portfolio of eight vaccines available to the world is excellent at preventing severe disease and – going by trends in Israel and Britain – infection. The problem is that the global rollout of vaccines is not equitable, nor is it keeping pace with accelerating rates of transmission drive by viral variants of concern, young people’s increased vulnerability, and complacency around suppression measures.
The distribution of vaccines has been highly uneven: 39 per cent of doses have been given in the world’s 27 wealthiest countries and a further 35 per cent in China and India.
The world’s poorest 85 countries have received just 1.3 per cent of the vaccine doses. At this pace, most of the world’s population will remain unprotected at least until mid-2022.
This has major implications. New variants – which are more infectious and cause more severe disease – are driving the surges in cases across the world. The UK variant is now the most common form of the virus in the United States. In Canada transmission is being driven by the UK and Brazilian variants. The South African and Brazilian variants also seem to evade the immunity induced by vaccines. This means that even as vaccine coverage improves, the vaccines may be less effective than necessary to achieve herd immunity.
Reports from many countries indicate that these variants are also causing more severe disease in young people. This is in part due to the fact that older people are gradually being vaccinated and are therefore well protected. In Brazil, COVID-19 cases among people younger than 60 are up by more than 500 per cent since the beginning of January. In Michigan, hospitalisations among people in their 30s have climbed by more than 600 per cent.
Complacency and the premature easing of restrictions in many countries have allowed the virus to spread rapidly in entertainment, retail and sporting venues. The fact that younger people are more mobile and engaging in more activities may partly account for an increased proportion of cases in younger age groups.
Given these realities, a global “vaccine-plus” strategy is needed – vaccines alone are not enough.
All countries need to heed the advice of the World Health Organization that the easing of restrictions must be based on protecting human health (and as we now know, the same strategy protects the economy too), and guided by what we know about the virus and how it behaves. “Aggressive suppression” control measures are needed wherever infection rates are high and can only be lifted once rates are reduced if the right public health measures are in place, including capacity for contact tracing. Britain and Israel are entering this phase now.
The other urgent need is a co-ordinated global effort to vaccinate as many people as possible.
This requires a multi-pronged strategy, including greater investment in the global COVAX facility, which is behind schedule in delivering two billion doses this year. Other initiatives could include vaccine donations, voluntary licensing by vaccine companies to increase production and the temporary waiver of their intellectual property rights. Australia has a major advocacy role to play in this effort – through diplomacy, advocacy at the WTO and by good example.
The surge in COVID-19 cases is not the fault of vaccines, it is that simply having them widely available in a few wealthy countries is not enough to end the pandemic.
Their timely and equitable delivery to everyone is crucial, as is a parallel program to aggressively suppress transmission without vaccines. One uncomfortable truth is that surging COVID-19 cases promote new variants that threaten the very vaccine programs that are meant to be the world’s exit strategy. Without simultaneously adopting both widespread vaccination and public health suppression, COVID-19 will not be defeated by anyone. The longer we delay doing this, the longer COVID-19 will dominate the world’s health and economic status.
Professor Mike Toole AM is a leading epidemiologist at Burnet Institute and Professor Brendan Crabb AC, is Burnet’s Director and CEO.