COVID-19: Pandemic of the unvaccinated, and what it means

Dubai: If you've had your double dose of COVID vaccines, and perhaps even a “booster” shot, you’re extremely lucky — 98.9% of people in less-developed countries have yet to get even their first shot.

Today, there's solid proof that approved coronavirus jabs are safe and effective. Vaccines embody human advancement. Various clinical data sets show vaccines help prevent severe infections.

Giant scientific strides 

More than 18 months since the pandemic first erupted, experts and clinicians’ understanding about the threat has advanced tremendously. There are today at least 19 COVID vaccines approved.

Moreover, there are monoclonal antibody (mAb) therapies proven to help patients from age 12 and above who had encountered severe COVID, the same drug given to Donald Trump, and which he later trumpeted as a COVID-19 "cure". Also, antiviral drugs, as well as the game-changing dexamethasone, have become part of standard care of COVID-19 patients.

Vaccines vs vaccinations

Vaccines have advanced much, with some countries achieving high levels of inoculation against SARS-CoV-2. But vaccines do not solve a pandemic; rather, it’s vaccinations that do. The world now faces a huge challenge: only 1.1% of people in less-developed countries have received even their first shot.

A powerful anti-vax lobby hyperactive on social media embodies human folly. Combined with the highly transmissible Delta variant, this folly turns into a double punch. Add to that the uneven distribution of vaccines — 78% of the world is yet to get even the first dose — is yet another serious challenge.

The pandemic response, so far, has been defined by and within national borders. The virus, however, knows no bounds. Given the “pan” — all — nature of the threat ("demos" is Greek for people), the WHO has warned that only an immediate collective action, and avoidance of risk of transmission, will decide our future.

Yet, at the moment, given the "triple whammy" hammering the world, getting to the desired future seems an insurmountable task.

The WHO has warned that only an immediate collective action, and the level of avoidance for risk of transmission, will decide our future. Yet, at the moment, given the "triple whammy" hammering the world, getting to the desired future seems an insurmountable task.

The 'triple whammy'

In the face of this “triple whammy” — the growing power of the anti-vax camp, viral mutation and vaccine shortfalls in less developed countries — could end up dulling our edge over the virus.

Consider the following:

Today (July 27, 2021), more than halfway through 2021:

I think one can make a reasonable assumption, based on the level of virus in the nasopharynx, that it would be less likely that that vaccinated breakthrough person would transmit compared to an unvaccinated person.

- Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases

What do scientists say about the implication of these numbers?

Scientists and doctors are convinced vaccinations are the only way out of the coronavirus pandemic. In the US, in particular, they were vehement in the criticism of people who refuse vaccinations and the general vaccine hesitancy after data showed that 99% of deaths last month had been among unvaccinated Americans.

“I think one can make a reasonable assumption, based on the level of virus in the nasopharynx, that it would be less likely that that vaccinated breakthrough person would transmit compared to an unvaccinated person,” Fauci added.

What’s the lowdown on the threats to unvaccinated people?

The Centers for Disease Control and Prevention (CDC) reported on Friday that more than 97% of people hospitalised with COVID-19 hadn’t received vaccines. The US is now dealing with a “pandemic of the unvaccinated,” CDC Director Rochelle Walensky said at Friday’s briefing of the White House COVID-19 Response Team.

“Our biggest concern is we are going to continue to see preventable cases, hospitalisations and sadly deaths among the unvaccinated. We are seeing outbreaks of cases in parts of the country that have low vaccination coverage because unvaccinated people are at risk, and communities that are fully vaccinated are generally faring well,” Walensky said.

Only around 150 of the more than 18,000 COVID-19 deaths in May were of fully vaccinated people. That is about 0.8 per day, or five deaths per day on average.

“Each COVID-19 death is tragic, and those happening now are even more tragic because they are preventable,” said Jeff Zients, the White House COVID-19 response coordinator.

Infectious disease experts worry that unvaccinated people could become “variant factories” since variants evolve in the body of a person infected with the coronavirus. If there are fewer infections, the chances of mutants are also less.

“Unvaccinated people are potential variant factories,” William Schaffner, a professor in the Division of Infectious Diseases at Vanderbilt University Medical Center, told CNN. “The more unvaccinated people there are, the more opportunities for the virus to multiply,” he added.

“When it does, it mutates, and it could throw off a variant mutation that is even more serious down the road,” Schaffner said. His concerns were echoed by Vivek Cherian, an internal medicine physician in Baltimore, US.

How dominant is the Delta variant? It is able to infect vaccinated people?

Studies show vaccines continue to prevent fully immunised people from becoming severely ill. Clinical data, at least from India and the US, underlines the value of vaccination and the need to continue with COVID-appropriate behaviour (masks, social distancing, good hygiene practices).

Genome sequencing of recent samples from across India and the US shows the Delta variant continues to be the dominant lineage behind new COVID-19 infections.

However, the data suggests a strong correlation between vaccination and lesser severity — that means the jabs offer a high level of protection, according to the Indian SARS-CoV2 Genomics Consortium (INSACOG). The Delta variant — which has high transmissibility and is more virulent as compared to others — contributed to a majority of clinical cases in vaccine breakthrough (infections post vaccination).

But very few cases needed hospitalisation, a latest study by the Indian Council of Medical Research (ICMR) shows. Only 9.8% cases required hospitalisation and fatality was as low as 0.4%.

In the UK, new research suggests that two doses of Pfizer's or AstraZeneca's vaccine are 88% and 67% effective, respectively, at preventing symptomatic COVID-19 from the Delta variant.

Given the Delta variant, what’s the worst that could happen?

“The worst-case scenario is if Delta mutates into something completely different, a completely different animal, and then our current vaccines are even less effective or ineffective,” Cherian told the Business Insider last month.

Vaccine hesitancy: Why is it high, what is the ultimate result?

“Health misinformation has cost us lives,” said Vivek Murthy, the US surgeon general, at a recent briefing. Last week, Murthy issued a surgeon general’s warning about misinformation online and urged social media companies to do more to combat the spread of conspiracies.

Vaccine hesitancy is at the heart of the problem as viral mutations continue. Misinformation and conspiracy theories have resulted in a poor vaccination rate in the US, a country with adequate supplies of vaccines. Hesitancy is highest among rural residents, Republicans and those with a high school education or less, according to ABC News/Washington Post’s latest poll.

“Even though we have a surplus amount of vaccines at this time, we are only seeing 50% to 55% completely vaccinated patients,” Vino K. Palli, a specialist in emergency medicine, internal medicine and urgent care, told the Associated Press. “The scientific data has honed in on one thing — vaccines are effective in preventing hospitalisations, ICU admissions, ventilations and deaths,” he added.

“There are people who still doubt the severity of COVID-19 and the effectiveness of the vaccine … This is still a serious illness. The vaccines are highly protective against these severe outcomes. This is real,” William Moss, executive director of the International Vaccine Access Centre at the Johns Hopkins Bloomberg School of Public Health, told the Washington Post.

“The fact that only 0.8% of COVID-19 deaths are in the fully vaccinated should persuade those people still hesitant about vaccination,” says Hugh Cassiere, medical director of Respiratory Therapy Services at North Shore University Hospital in Manhasset, New York.

Do vaccines become less effectively against new viral strains?

New strains haven’t blunted the vaccines, although their efficacy is reduced. A study published in Nature on July 8, 2021 shows that individuals who are fully vaccinated (two doses) generated a neutralising response against Delta (B.1.1.617) in 95% of cases. Researchers led by Delphine Planas of the Virus and Immunity Unit, Department of Virology, Institut Pasteur in Paris, stated though that titres among fully vaccinated individuals were 3 to 5-fold lower against Delta than Alpha. They explained that this shows one thing: Delta variant spread is associated with an escape to antibodies targeting non-receptor binding domain (RBD) and RBD Spike epitopes.

“What we’re seeing is that these variants don’t seem to affect T-cell immunity all that much and they [the T-cells] seem to be as effective in recognising these variants as they do the original virus,” Galit Alter, professor of medicine at Harvard Medical School, said. “What that means is that we actually have very important backup mechanisms built into our vaccines that will continue to provide protection against these newly emerging variants,” she said in a report in the Harvard Gazette.

Is a return to 'normal' possible?

Countries with robust vaccination programmes have been able to reduce the rate of transmission. And that’s enough reason to be optimistic. When a sufficient percentage of a country’s population is inoculated to achieve herd immunity, a return to the normal is possible. The UK and some US states that have opened up are some examples of this, though it remains unclear whether a fresh outbreak would lead to new lockdowns.

https://gulfnews.com/opinion/op-eds/england-covid-19-restrictions-ease-but-caution-remains-1.80800341

Is herd immunity possible? What should be minimum vaccination rate target?

The herd immunity threshold is not a fixed target, experts say, as it could range from 70% to 90% depending on the efficacy of the vaccines. That means, given the 1.1% vaccination rate in poor countries, and only 13.8% is fully vaccinated overall, humanity has a long way to go to deal with SARS-CoV-2. 

Why is access to vaccines a major issue?

For much of the world, COVID-19 vaccination is a mirage. When a country like Australia struggles to inoculate its residents and have resorted to lockdowns to keep out the virus, the underdeveloped countries have no hope of achieving herd immunity through vaccinations any time soon. Vaccine alliances like Gavi and Novax have been working to supply vaccines to less-affluent countries, but there’s still a long way to go. Wealthy nations, on the other hand, should be able to reach herd immunity faster if they can overcome vaccine hesitancy. Some countries that high vaccination rates would emerge from the pandemic sooner.

What are the major vaccination challenges today?

1. A billion COVID-19 vaccines could kill other health goals

Vaccinating at least 60% of the world by March 2022 requires about 4.75 billion vaccine courses, estimates a World Bank report. At present, there are at least 10 vaccines in production line with publicly available research data showing the efficacy of 50% and above against COVID-19. Many countries have adopted these vaccines as this level of efficacy offers sufficient protection against hospitalization and death in case of a COVID-19 infection.

So what would be the production requirement? Gavi, the international vaccine alliance, says 14 billion doses of COVID-19 vaccines are needed by the end-2021. This is roughly three times the global annual supply of all vaccines combined in the pre-COVID-19 era.

Such a massive production gap, specifically focused on one vaccine alone, would invariably have serious knock-on effects on all other healthcare products. This would seriously hamper the future of our ability to successfully battle all other diseases, basic health care and other sectors, to say the least. The cumulative impact of this can be measured only in years to come.  Highlights from a WHO report out earlier in July could gives you an idea about the impact on immunisation programmes alone:

2. Rich vs poor divide

Most rich countries have now vaccinated more than half of their population and are in the process of reopening, although with some setbacks in the face of Delta variant outbreak. Most of the middle and lower-income countries are still struggling with limited access to vaccines while the high-income ones have pre-purchased more than enough vaccines to cover their entire population. Only 1.1 % of people in low-income countries have received at least one dose of the COVID-19 vaccine, according to Our World in Data.

In Canada, 55.4% of the people have been fully vaccinated while an estimated 71.2% received at least one dose, Reuters says. Corresponding US figures are 49.7% and 57.4%, respectively. Compare this with some of the least vaccinated countries, Liberia or Cameroon where only 0.2% have been fully vaccinated. In Chad, the figure is less than .1 per cent.

When will the whole world get vaccinated?

At the current pace of immunisation, it will take until the middle of next year to achieve a high level of global immunity and bring the pandemic under control, a Bloomberg report said. With more research and a greater understanding of the coronavirus and its variants, the vaccines can only get better.

There’s lingering concern: even if the world manages to end the pandemic, the SARS-CoV-2 will become endemic, possibly with more mutations every year. Much like flu and viral fever. That would mean newer and improved versions of the vaccines each year. So an annual COVID-19 shot could well be the reality. A return to normal could be at least another year away. So it’s not yet time to ditch the mask.

SITUATIONER:

Southeast Asia: Struggling with COVID cases and lack of vaccines

Hospitals across Southeast Asia from Indonesia to Thailand, Malaysia and Myanmar are overwhelmed with COVID-19 patients, fuelled by the Delta variant. Unfortunately, most of these countries are still struggling to fully roll out vaccines.

Vietnam has vaccinated less than 1 per cent, Thailand around 5 per cent and Indonesia 5.5 per cent, according to Oxford University’s COVID-19 Our World in Data.

Nearly 10,000 COVID-19 infections are being recorded in Thailand a day and in Vietnam it has surged past 2,000 a day, close to 10 times more than in early June.

“Millions of people in Asia are living on the cruel and sharp edge of a global vaccine divide between richer countries that have a steady supply and most nations in Asia that are struggling to access sufficient doses to keep their populations safe. There is mounting evidence that COVID-19 vaccinations are already saving tens of thousands of lives around the world,” said Alexander Matheou Asia Pacific Director, International Federation of Red Cross and Red Crescent Societies.

“It is encouraging that a number of richer countries have made generous pledges and donations of vaccines to countries in Asia in recent weeks,” said Matheou. “We need to speed up the delivery of these lifesaving doses so that we can get them into people’s arms, giving us a genuine shot at containing this pandemic once and for all.” Drugmaker AstraZeneca recently said it was on schedule to meet its commitments for supplying coronavirus vaccines in Southeast Asia, after some initial delays in regional production and delivery.

Australia: Just over 11% of the population is fully vaccinated

A year and a half into the pandemic, some 13 million Australians are under hard lockdown, with a sluggish immunisation program. Just over 11% of the population is fully vaccinated.

The main vaccine in the government's arsenal, developed by AstraZeneca Plc, has been recommended for use only for people aged over 60 due to a remote risk of blood clotting, while a vaccine made by Pfizer Inc has been restricted to over-40s due to limited supply. Under mounting pressure, PM Scott Morrison said on Wednesday (July 21, 2021) that he took responsibility for both "regrettable" delays in the country's vaccination rollout, but also for the solutions to make up for lost ground.

"Those delays are regrettable, we all know they're the result of many factors," Morrison told reporters in Canberra. "I take responsibility for the problems that we have had, but I am also taking responsibility for the solutions we're putting in place and the vaccination rates that we are now achieving." He said his government has asked its independent expert panel, the Australian Technical Advisory Group on Immunisation, to relax its conservative advice on the use of the AstraZeneca vaccine.

Africa: Slowest vaccination rate

Among all the continents, Africa has the slowest vaccination rate. Some African countries have yet to start mass vaccination campaigns. COVID-19 caused a severe socio-economic impact in Africa, which led to GDP contraction in 2020. For example, South Africa, the most affected country on the continent, experienced the sharpest decline, at -7%, followed by Central Africa at minus 2.7%. The pandemic also hit most of Africa’s key economic sectors.

Nigeria, the continent’s leading oil-exporting country, witnessed a sharp drop in crude oil trade in 2020, while the shrinking number of tourist arrivals led to a loss of over 12 million jobs in Africa’s travel and tourism sector. The number of people living in extreme poverty was estimated to increase by around 30 million in 2020, according to Statista.

As of July 24, 2021, Seychelles posted the highest coronavirus (COVID-19) vaccination rate in Africa, with 142 doses were administered per 100 individuals. Since the population of Seychelles is extremely small, below 100,000 inhabitants, the country managed to vaccinate a large part of the population in a limited period. In continental Africa, Morocco had a vaccination rate of 58 doses per 100 people, the highest number of inoculations. In South Africa, the vaccination rate reached only 10.6 per 100 population.

The continent uses several types of vaccines. African nations are both purchasing new doses and receiving them from other countries. Donations came from all over the world, such as China, the UAE, India, and Russia. The UN-led COVAX initiative already provided Oxford/AstraZeneca and Pfizer/BioNTech doses to some African countries.

Within this program, the continent would receive a total of 600 million doses by December 2021, to vaccinate 60% of the African population by June 2022. Moreover, the start of the vaccination campaign has also been an occasion for intra-African solidarity. Senegal has, for instance, donated vaccines to the Gambia, while in January 2021, Algeria announced that it would have shared its supply with Tunisia.

According to the supply forecast made in March 2021, the African continent would receive around 600 million doses of vaccines against the coronavirus (COVID-19) by the end of 2021 under the COVAX initiative. The UN’s COVAX program aims at providing vaccines to all countries of the world. The objective is to at least immunise the most-susceptible population in each country, including the elderly and the health care workers.

Latin America, Caribbean

Just 15% of people in Latin America and the Caribbean have been fully vaccinated, with some countries like Honduras and Haiti yet to reach even 1% inoculation. Cases are accelerating in much of Central America and on smaller Caribbean islands, while cases and deaths are spiking in Cuba and hot spots persist in Amazonian regions of Colombia and Peru.

The Pan American Health Organisation (PAHO) has warned that the only way to stop a spike in coronavirus cases is through vaccination. With nearly 4.7 million doses, Uruguay has the highest COVID-19 vaccination rate. As of July 2021, the South American country reported having administered 134.24 doses per 100 inhabitants. The country has had 380,584 cases and 5,936 deaths.

Nicaragua, on the other hand, registered 6.27 doses per 100 population. But its COVID-19 figures have also remained low – 9,108 cases and 194 deaths.  Brazil has — and continues to have — one of the world's worst outbreaks, driven by new variants, low vaccinations and misinformation. About 18 per cent of Brazil’s population has been fully vaccinated. But the country has had 19.7 million COVID-19 cases and 551,000 deaths.

“Everything that you should not do, Brazil has done,” said professor Pedro Hallal, an epidemiologist leading Brazil’s largest COVID-19 study, told BBC. The average number of new daily cases in Brazil remains above 37,000 cases, as per Our World in Data. Similar to Colombia and Brazil, Argentina’s recent devastating wave of COVID-19 has finally begun to subside even as the country continues to record a high number of cases and deaths. Last week, the country passed the grim milestone of 100,000 coronavirus fatalities.

US and Canada

Canada had a sluggish start with vaccinations. But as of July 19, more than 49% of eligible people in Canada were fully vaccinated, and 70% had received at least one dose of vaccine, according to figures from the Our World in Data project. The rates in the United States are about 48% and 55.5%, respectively. The pace of US vaccinations has spiked significantly in the first six months of 2021, but remained relatively flat in recent weeks.

In a renewed push, President Joe Biden asked employers to set up clinics at work and to offer paid time off for workers to get vaccines. After a sharp drop in virus cases, the highly contagious Delta variant is now fueling infections among the unvaccinated. Outbreaks have emerged in some parts of Texas, Arkansas and Missouri. Canadian Prime Minister Justin Trudeau stated the country could be ready to accept fully-vaccinated US citizens and permanent residents across its border for non-essential travel from mid-August.