You can go to the movies in a real theater. You can get vaccinated — and buy a gallon of milk — at the supermarket. Elsa has welcomed guests back to Disneyland, California has the lowest COVID-19 case rate in the continental United States and locals might be forgiven if a springtime Zip-a-Dee-Doo-Dah animates their steps.
Why not? In the United States, more than 43% of adults have received at least one vaccine dose, Europe is opening its arms to fully vaccinated visitors and the pandemic seems to — finally! — be moving to the rear-view mirror.
But not so fast. In India, where hospitals are overflowing and bodies can’t be cremated quickly enough, only about 10% of the population has received at least one shot.
In Brazil, where people are begging for food, fewer than 20% of adults have received at least one shot. In Mexico, it’s less than 14%; Kenya, 1.6%; South Africa, 0.5%.
“The virus multiplies every second. The more human bodies it multiplies in, the more chance it has of mutating,” said Dr. Akshat Jain, director of the Inherited Bleeding Disorders and Hemoglobinopathies Program at Loma Linda University School of Medicine.
And it’s happening. Double-mutant and triple-mutant variations are wreaking havoc in India and Brazil, where deaths are spiking. In the U.S. and elsewhere, new variations are proving more threatening to children.
In addition to being more infectious, variants also are developing mutations on the surface spike protein — the target of today’s vaccines — that might evade the immune system as well as current testing, he said.
“The need of the hour is to vaccinate as many people around the world as we possibly can, to stop community transmission and multiplication and mutation,” Jain said. “The variants in China traveled all over the world a year ago. It’s only a matter of time until these variants hit our shores.”
Creating ‘viral factories’?
One of the most daunting and urgent challenges facing the world is ensuring broad access to vaccines, “without which it will be impossible to achieve needed levels of global population immunity,” said a recent study by the Kaiser Family Foundation.
“To date, the majority of vaccine doses (56%) have been purchased by high-income countries, who only represent 16% of the global population, locking in much of the market.”
Namibia, like many less-prosperous nations, paid millions to secure vaccine but waited months as early doses went to richer countries. “COVID apartheid is now prevailing,” President Hage Geingob said in early April.
Public health officials have worried since the start of the pandemic that vaccinations would not be equitably distributed around the world, and the data appears to be confirming those fears as developed nations are vaccinating their populations far faster than less developed countries, Johns Hopkins University said.
Data from the Duke Global Health Innovation Center show that, of 8.6 billion vaccine doses purchased:
- High-income countries bought up 53% of them (4.6 billion doses).
- Upper-middle-income countries (such as Brazil, Indonesia and China) bought 17% (1.5 billion doses).
- Lower-middle-income countries bought 8% (691 million doses).
- Low-income countries bought 8% (670 million doses).
- The World Health Organization’s COVAX initiative, which aims to distribute vaccine more fairly, bought 14% (1.1 billion doses).
Unvaccinated people “are potential viral factories and these factories will spew out variants,” said Dr. John Swartzberg, clinical professor emeritus in the Division of Infectious Diseases & Vaccinology at UC Berkeley. “The variants will not respect the borders of countries. If they are able to dodge the immunity we have from vaccination or previous infection, they will spread worldwide.”
All for one, one for all
COVAX is the international partnership led by the Coalition for Epidemic Preparedness Innovations, the Vaccine Alliance and the World Health Organization to address this challenge. Its goal is to distribute 2 billion doses to the most vulnerable by the end of this year.
Another effort, the Access to COVID-19 Tools ACT-Accelerator, aims to speed up development, production and access to COVID-19 tests, treatments and vaccines across the world.
But it’s a race against time.
“Viruses biologically are designed to mutate, so the more there is continued spread of the virus, the more chance there is that the virus will discover some new way of spreading or evading the vaccines,” said Dr. Kevin Schulman, professor of medicine at Stanford University.
“Up until December, it was remarkable how stable the virus was. It wasn’t mutating. And once these variants started appearing, that just shifted. The British variant, the vaccine is totally effective against it. The South African and Brazilian variants — less effective. Vaccination still may prevent hospitalization — hopefully — but I think there’s a realization that the virus is not contained and that what happens outside the U.S. is as important as what happens inside the U.S.,” he said.
Like many of the wealthiest nations, the U.S. has been accused of “vaccine nationalism” — concentrating first on vaccinating as many of its own citizens as possible, before sharing the bounty with the more vulnerable overseas. Pressure to share is ratcheting up: The U.S. has sent millions of doses to Canada and Mexico, and President Joe Biden said Central American nations could get help soon as well. On Monday, April 26, the U.S. announced it would share up to 60 million doses of the AstraZeneca vaccine with other nations.
This is not just a matter of charity, experts stressed. It’s vital, enlightened self-interest.
“I think we’re still very much in the phase where nations focus on getting their own taken care of, with little time or ability to be thinking about international benevolence,” said Richard Carpiano, a public health scientist and medical sociologist at UC Riverside. “But no man is an island.”
Carpiano expects to see nonprofits and nongovernmental organizations move forcefully into this space to address fairness issues, but complicated debates on vaccine patents, generic versions and expanding overseas production remain to be addressed.
And vaccine hesitancy will be an issue overseas, just as it is in the U.S.
Mass manufacturing to boost the global supply is going to be a key to getting the world vaccinated, Jain said, and getting the world vaccinated is key to stopping the pandemic.
“We have to learn from history — how we eradicated smallpox and polio,” Jain said. “Mass vaccination will get us out of this.”
Source: Orange County Register
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