As we head towards the second anniversary of the emergence of Covid-19, media coverage in high-income countries has started to glimpse the finishing line, with references appearing to Covid being “in retreat” and a “post-pandemic” era. This mindset is not only premature, it is deeply worrying. Government in both high- and low-income countries still have much to do to bring the pandemic under control, let alone to an end.
It is understandable why governments around the world are homing in on vaccines. Vaccination is ultimately the path out of the pandemic and a return to normality. But as long as supply remains constrained and uptake remains lower than population immunity thresholds in many countries, the virus will continue to spread.
As a result, governments cannot lose sight of addressing existing gaps in their pandemic response. High-income countries must focus their efforts simultaneously on improving global vaccine equity and supporting the strengthening of disease management and health systems in lower-income nations. Lower-income countries must focus their efforts simultaneously on procuring vaccines and developing robust absorption capacity while mitigating weaknesses in their pandemic response and health systems. If these gaps aren’t closed, governments will continue to face setbacks through the emergence of more potent variants and resulting new waves of infection.
The World Health Organisation is currently tracking over 20 variants, four of which (Alpha, Beta, Gamma and Delta) are considered “variants of concern” (VOCs) given their heightened risk to public health relative to the others. Delta in particular carries a 235 per cent higher risk of admission to an ICU compared to the original virus and has impacted the efficacy of vaccines. There are two “variants of interest” (VOIs) (Lambda and Mu) which have mutations similar to some of the VOCs but more data are needed to determine whether they carry an elevated risk. There are 15 additional “variants under monitoring” (VUM) which have genetic mutations that may pose a future risk and so warrant further data collection and assessment.
These lists are fluid, regularly updated by the WHO based on new data from genomic sequencing and surveillance. In spite of this, the world is not sequencing the virus nearly enough. Health authorities recommend that at least 5 to 10 per cent of cases be sequenced, but the world has collectively sequenced fewer than 2 per cent of confirmed cases. Africa has sequenced approximately 0.5 per cent of cases on the continent. This leaves a dangerous blind spot in identifying new variants before they significantly spread.
The longer it takes to vaccinate the world, the higher the risk that a new variant – or variants – will surface that poses an even greater risk to public health, either through increased transmission, heightened virulence or resistance to antibodies. For this reason, it is in the interest of high-income countries to address current global inequities in vaccine access. Supporting vaccination programmes in other countries is not so much an act of foreign assistance as it is a matter of national security. And imposing travel restrictions has been proven futile in preventing transmission.
Recent commitments by the United States and other countries to dose-sharing and increased funding for supplies are essential and welcome, and this financing should reach beyond procurement to urgently strengthening vaccine absorption capacity. All these efforts will accelerate global vaccination rates.
Yet, even with more equitable distribution and increased funding, the world will not be vaccinated overnight.
Investments must therefore extend to tackle pre-existing gaps in the health response in lower-income countries. Many lower-income countries are still not equipped to respond to a spike in hospitalisations caused by a new outbreak, especially one driven by a more severe variant.
For example, several drugs have now been approved by the WHO for the treatment of severe and critical Covid-19 cases, including the combination of interleukin-6 receptor blockers and corticosteroids. However, the manufacturers of these drugs continue to price them at levels that are unaffordable for many lower-income countries – many of the same countries without widespread access to vaccines. Inadequate supply of oxygen has been another major challenge causing preventable deaths. Some countries lack commercial oxygen facilities, and many hospitals do not have their own plants. Infrastructure weaknesses further impact on the ability to transport cylinders to where they are needed.
Early-warning systems must be enhanced, especially in countries with lower vaccination coverage. Genomic sequencing is a critical tool in the rapid identification and control of variants. Testing, contact tracing and other traditional forms of viral surveillance are essential to breaking the chain of transmission. Risk-communication strategies and community engagement, both to ensure adherence to public-health measures, like mask-wearing, and to combat vaccine hesitancy, must be stepped up.
Nearly two years into the pandemic, many countries still lack sufficient investment in these key mitigation tools. If the world has any hope in bringing an end to the pandemic phase of Covid-19 soon, these response measures must be strengthened with as much urgency as vaccination efforts. We must be equipped to combat new variants and unexpected complications presented by the virus.