TIJUANA, MEXICO CITY – JUNE 17: A health worker prepares a dose of the COVID-19 vaccine at the … [+] University of Baja California Mass Vaccination Center on June 17, 2021 in Tijuana, Mexico. Following Vice President Harris ’visit to Mexico, the U.S. sent a $ 1.35 million dose of Johnson and Johnson vaccine. Vaccines will be given to anyone over the age of 18 in 39 cities on the Mexican side of the U.S. border. The goal of the project is to increase vaccination rates at the level of U.S. border cities. (Photo by Francisco Vega / Getty Images)
Getty Images
The Covid-19 pandemic is far from over. As I write this, I am facing my own Covid-19 illness and fatigue. I’m not alone. Millions of people around the world become infected or re-infected with highly transmissible Omicron subvariants. The BA.5 subvariant, in particular, is causing increases in many parts of the world. BA.2.75 is another new and worrying threat.
A year ago, the virus would have hit me with a mild target. Today I am armed, fighting the virus with the best tools science has offered me: mRNA vaccines, booster, rapid testing, and treatment options, if I need them. I am painfully aware that this is far from the reality for millions of people in low- and middle-income (LMIC) countries.
A staggering 2.6 billion people, a third of humanity, mostly in LMICs, have not yet received a single dose of vaccination against Covid-19. Although 12 billion doses of Covid-19 vaccines have been administered worldwide, only 19.1% of people in low-income countries have received at least one dose, 18 months after starting vaccinations. .
Wealthy nations have been accumulating vaccines for many months and the consequences are now visible to everyone: recent data show that more than a billion vaccines against Covid have been wasted. Millions of lives could have been saved, if those doses had been shared last year, when the Delta variant killed millions of people. I can’t forget the ferocity and brutality of the Delta wave that killed millions of people in India last year. India was a terrible warning to the world and we ignored the warning.
Inequality is not just about vaccines. There is also inequality in testing and treatment. According to the WHO ACT-Accelerator, only 0.4% of global Covid-19 tests were conducted in low-income countries. Access to antiviral treatments such as Paxlovid (Pfizer) remains a major challenge in most environments. According to a recent analysis by Melissa Barber, all of Pfizer’s production capacity has already been committed to a handful of rich countries, which account for about 14% of the world’s population. The other 86% of the world will have to wait until the end of the year, if not 2023, to be able to buy Paxlovid from Pfizer.
So as my body fights the SARS-CoV2 virus, many questions run through my fevered mind: with such serious inequalities in access to new tools, as lower-income countries with already fragile health systems will face the new waves of BA.5, BA. .2.75, or other future variants? How did we end up setting such a low bar for our peers in the global south? How will the pandemic end, when we have left behind more than a third of humanity?
As Maria Van Kerkhove, WHO’s technical head of COVID-19, tweeted: “It’s not over and we’re playing with fire by letting this virus circulate at such intense levels.” Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, echoed it. “Mother nature is not trying to be shy, as long as global policymakers refuse to vaccinate the world, she will continue to launch new variants of concern,” she said.
LMICs have borne the brunt of this pandemic
In the early days of the pandemic, a myth was created: that rich nations have suffered more deaths and morbidity from Covid. This myth has been used to argue that LMICs do not need equal access to vaccines and tools.
Two years later, we now know that the truth is quite the opposite: LMICs have suffered the brunt of this pandemic and have had far less access to life-saving tools. “Official data has deceived us more than once because we view Covid-19 as a pandemic of rich countries,” said Philip Schellekens, senior adviser to the World Bank Group. His rich analysis “Has COVID-19 subverted global health?” it provides a deeper insight into this problem and is worth reading.
According to Schellekens, the myth that Covid-19 is or has never been a pandemic in rich countries is fueled by many factors, including demographic differences (i.e., the fraction of the large population), the excessive focus on rates of mortality rather than counts, and large variations in the way LMICs provide, count cases, and report deaths.
It is now very clear that LMICs have greatly underlined covid-19, as well as cases and deaths. In SCIs, the government records only one in ten deaths and only a small fraction of death records include information on the cause of death.
To illustrate this, a recent study from 47 countries in the African region used a model to estimate the number of SARS-CoV-2 infections in the African region. The model estimated that only 1 in 71 of SARS-CoV-2 infections in the region was reported, while only 1 in 3 of the estimated deaths were reported as COVID-19-related deaths. Even a middle-income nation like India did not count a staggering number of deaths for Covid. The estimated number of deaths in India is 10 times higher than the official records.
The WHO estimated an excess of global mortality associated with Covid-19 at 14.91 million in the 24 months between January 1, 2020 and December 31, 2021. Of these 14.91 million deaths in excess, high-income countries (HICs) accounted for 2.16 million. Low-income countries accounted for the largest share of excess deaths (7.9 million deaths).
The latest average estimates of The Economist’s excess mortality also suggest that, per capita, it is not the high-income world that has suffered the most. No, middle-income countries have suffered a lot more, while middle-income countries have suffered a little more.
A new meta-analysis of infection mortality rates by Andrew Levin, Gideon Meyerowitz-Katz and colleagues shows that at the beginning of the pandemic, the risk of dying from the disease was about double for people who they lived in lower-income countries than for those of rich nations. Age-specific mortality rates were approximately twice as high as in high-income countries.
The recent work of mathematical modeling by Oliver Watson, Azra Ghani, and colleagues at Imperial College London, suggests that between December 2020 and December 2021, vaccination against Covid-19 prevented approximately 19.8 million. of deaths out of a total of 31.4 million potential deaths that would have occurred. without vaccination, a 63% reduction. His model also showed that if the vaccination coverage targets set by the WHO had been met, 1 in 5 lives lost due to Covid-19 in low-income countries could have been avoided.
Beyond deaths, vaccine inequality has imposed countless other tolls on LMICs, from the long Covid, the disruption of care for tuberculosis, AIDS and malaria, to the worsening of extreme poverty and food insecurity. “The poor, no matter where they live, will suffer the most enduring weight,” wrote Joseph E Stiglitz, economist and Nobel laureate.
Double standard of care: set a lower bar for the global South
While LMICs suffered the most during the pandemic, they are the ones who have had the least access to new tools and have had to deal with another myth: that “natural immunity” is enough for LMIC people.
In my interview with the late Paul Farmer last year, we talked about the dual standards inherent in global health. We set a higher bar for whites in the global north and accepted a much lower bar for blacks and browns in the global south. This happened during the early days of the HIV epidemic, when antiretrovirals were considered too expensive for people in Africa. During the Ebola outbreak in West Africa, even the administration of intravenous fluids was considered difficult. Now we see this “logic of apartheid” playing with Covid-19, and even smallpox from the monkey.
For someone like me, privileged to live in a rich nation, access to second reinforcements, quick tests, and Paxlovid is being considered normal or standard care. For people in lower-income countries, even a two-dose vaccination course is considered unnecessary, because everyone is supposed to have already been exposed to the virus.
Yodi Alakija, special envoy, ACT Accelerator, is a passionate advocate of equity. “As rich countries offer fourth doses to their citizens and begin reinforcement programs for children with the goal of protecting them from both the immediate and long-term effects of covid, there are people who feel that those of us who are in LMIC they are not worthy of the same protection “. she said. “The myth that the natural immunity of repeated infections is sufficient for Africans and other people with CML is short-sighted and ignores the historical evidence about disease progression and the evolution of the virus,” he added.
She is also deeply disturbed by the dual standards that are so pervasive. “Are people in LMICs physiologically ‘different’ in some way from those in HICs? If people in HICs need protection from vaccines and reinforcements, why don’t we? Are we different or do we just consider ourselves expendable?” she asked.
Self-sufficiency is the key to equitable access to tools
Vaccinating the world against Covid-19 was a no-brainer even before the emergence of highly contagious Omicron subvariants. Now, with BA.5 ready to sweep the world, vaccine equity has become more urgent.
“The racist and unequal distribution of Covid-19 vaccines has killed twice as many people in low-income countries as elsewhere. We continue to demand vaccine equity,” tweeted Winnie Byanyima, UNAIDS Executive Director. .
“By tackling Omicron’s BA.4 and BA.5 subvariants that are highly contagious, protecting the most vulnerable and most at-risk people worldwide is …