Countries such as Bangladesh have to find multiple sources for the vaccine
When Covid-19 first grabbed the headlines in early 2020, the predictions were that the global South would suffer a catastrophic number of infections and fatalities. Paradoxically, it was the industrialized West that suffered the most from the pandemic, with the US leading the way in both infections and fatalities. This trend continued right up to January 2021 when the number of infections and fatalities in the West were at an all-time high.
Meanwhile in South Asia, the number of infections and fatalities had dropped to some of the lowest levels since the beginning of the pandemic. This led to a sense of complacency and lowering of precautions just when new and more infectious Covid-19 variants started circulating.
By April 2021, there was a catastrophic rise in infections and fatalities in India. From a low of around 8,600 cases on Feb 1 2021, India experienced a high of more than 400,000 cases on April 30 2021, during which time fatalities increased from around 90 to about 3,500 (Johns Hopkins University).
From January to April 2021, the US started a very extensive vaccination campaign and by the end of April had fully vaccinated 31% of its population (CDC).
In the same time period, the UK had fully vaccinated 27% of its population that were 18 years or older (coronavirus.data.gov.uk). In contrast India has only managed to fully vaccinate 2% of its population. The situation is not much better in the rest of South Asia and South East Asia (ourworldindata.org/).
New and more infectious Covid-19 variants such as B.1.1.7 from the UK, B.1.135 from South Africa, and P1 from Brazil have entered the scene. The UK variant is widespread in the US and UK. It is of concern because in addition to being 50% more transmissible than the original strain, it may result in a more severe infection (CDC). The South African strain is also 50% more transmissible and vaccines seem to be less effective against this strain.
The UK and South African variants have been detected in Bangladesh. Another variant B.1.617 has been found in India, and is of concern for Bangladesh.
So what should the global South do now? Obviously, the answer is to vaccinate as many people as quickly as possible.
The development of vaccines has been an incredible success story the world over. Vaccines have been developed at breakneck speed.
Unfortunately, the availability of vaccines has fallen prey to geopolitics and intellectual property rights. The distribution of vaccine doses has been the all too familiar story of the West hoarding many of the doses, and the South being left to fend for itself.
In addition, only certain vaccines have been given prominence in the Western media. The mRNA vaccines developed by Moderna and Pfizer have been hailed as game changers, but the Pfizer vaccine needs to be transported at -70 C, making it difficult for countries in the South to maintain that cold chain. In any case, most of the doses of the mRNA vaccines have already been bought up by the rich countries.
Supposedly, the Oxford-AstraZeneca (AZ) vaccine was a solution for poorer countries due to its price as well as easier cold storage requirements. Unfortunately, AZ has been beset with multiple problems.
A study conducted in South Africa, showed that the efficacy of the AstraZeneca vaccine was only 10% for mild to moderate Covid-19 infection from the B.1.135 strain. South Africa started deploying the Johnson and Johnson (J&J) vaccine which was shown to have an efficacy of 57% against moderate to severe inflections from the B.1.135 strain.
At first glance, J&J seems to be far more effective, but the two numbers are not immediately comparable. The AZ study looks at mild to moderate infections in the study population, the J&J looks at moderate to severe infections (www.nejm.org/doi/10.1056/NEJMoa2102214).
Even the Moderna and Pfizer vaccines have reduced effectiveness against the B.1.135 strain (www.nature.com/articles/s41586-021-03398-2_reference.pdf).
AstraZeneca has also been plagued by production problems. India was supposed to be producing it on a large scale for export to other countries, but since it is now battling a raging pandemic it has stopped exporting vaccines. This has left other countries in the South with a gap in their vaccination rollouts.
What has been left out in all these discussions are the Russian (Sputnik V) and Chinese (Sinovac, Sinopharm) vaccines, undoubtedly due to geopolitical rivalries. But in the absence of AstraZeneca, it is only natural that countries should look at whatever vaccines they can get their hands on, particularly since Russia and China have shown their willingness to step into the gap.
Are the vaccines effective in controlling the extent of the disease? The following chart shows the timeline in the UK of the percentage of the population, 18 years and older, who are vaccinated and the number of daily Covid-19 cases. The number of daily cases drops dramatically once 40% of the population has had at least one dose of the vaccine.
Getting vaccinated as quickly as possible is imperative and in order to bring Covid-19 under control the whole world needs to be vaccinated. Therefore, countries such as Bangladesh have to find multiple sources for the vaccine.
Furthermore, it is time to start building facilities for manufacturing vaccines so that we are prepared for the future.
Even though there is talk of waiving intellectual properties rights on vaccines, relying on the West to provide the South with vaccines has proved to be disappointing so far.
In the meantime, we need to
1. Get vaccinated as quickly as possible.
2. Wear a mask when we go out even after getting vaccinated.
3. Wash our hands.
4. Avoid large gatherings especially indoors.
5. Minimize complacency and covidiocy.
Dr Riaz Khan is a mathematician and development professional.