Eighteen months into the pandemic, Paul Rogers sees a stark contrast between the complacency setting in among countries with successful rapid vaccination programmes and large areas of the world experiencing a devastating third wave. Vaccine nationalism, hoarding and export controls threaten not just the unvaccinated as dangerous new viral mutations develop.
Back at the end of December 2019, Taiwan began health checks on incoming passengers from the city of Wuhan in China, following reports of the rapid spread of a respiratory infection. Next month therefore marks a year-and-a-half since the first transnational action was taken against what rapidly became known as a corona virus, COVID-19. By late-May 2021, seventeen months on, the virus has already killed over 3.5 million people worldwide, with close to 170 million cases diagnosed, according to conservative official estimates from the World Health Organisation (WHO). Vaccination started exactly a year after suspicions about Wuhan began and, as of 21 May, 1.4 billion vaccine doses have been administered world-wide.
Despite the impressive progress made in the past six months in developing, producing and distributing vaccines, the virus is persisting and spreading to the extent that the WHO is warning of another deeply problematic year following a failure to learn rapidly enough from experience. A few politicians are now arguing for the need to expand the global vaccination programme rapidly, but progress is slow and, meanwhile, new variants are appearing.
Following on from a briefing two months ago, this note looks specifically at why progress is slow, what the impact of that is proving to be and what factors might improve the response.
The earlier briefing summarised three critical issues fifteen months into the pandemic:
“One is the risk of the evolution and spread of dangerous new variants and a second has been the failure of some political leaders to act quickly, not least Trump, Bolsonaro and Johnson. Much more important in the long term is the growing evidence that a deep impact of the pandemic, whatever its future path, will be to exacerbate socio-economic divisions world-wide, making it even more necessary for a change in economic thinking and action.”
The socioeconomic aspect is already becoming more evident. The persistent public demonstrations in Colombia in recent weeks have been put down with considerable force by the government but protesters are determined, with their predicament made worse by the impact of COVID-19 on poorer people. More generally, there has been an increase in people desperate to get into the United States from Latin America because of the pandemic:
“They are people arriving in ever greater numbers from far-flung countries where the coronavirus has caused unimaginable levels of illness and death and decimated economies and livelihoods. If eking out an existence was challenging in such countries before, in many of them it has now become impossible”Miriam Jordan, “Covid drives new wave of migrants to distant U.S.”, New York Times, 19 May 2021
At the other end of the scale, further evidence of the rapid acquisition of wealth among ’ultra-high net worth individuals‘ mentioned in the March briefing has been provided by the 2021 edition of the Sunday Times Rich List. This reported the number of billionaires in the UK rose by 24 to 171 and the combined wealth of billionaires increased by more than 20 per cent during the COVID year.
In relation to the pandemic itself, a degree of complacency has emerged in countries that have curbed recent waves through a combination of social behaviour and mass vaccination programmes, but there are also too many examples of expanding waves of illness and of new outbreaks in countries that previously had confidence in their performance. India and Brazil have been centres of attention, each with its own highly transmissible variant and a total death toll between them of well over half-a-million.
A more recent example is Argentina. There, a short total lockdown, including a 6 pm to 6 am curfew, has been imposed as record levels of deaths and new cases have been experienced This is also the case in neighbouring Uruguay which had been regarded as one of the most successful countries in South America but is reportedly now experiencing the highest death toll per capita in the world.
In South East and East Asia a number of previously successful countries have been affected by sudden changes, including Vietnam and Cambodia, with people trying to escape the violence in Myanmar adding to problems in Thailand. In all three states the numbers are still very low but the worry for health authorities has been the rapidity of recent increases and the stark comparison with what appeared to be virtually complete control.
Even in Singapore, with its advanced public health system, a sudden upsurge from a very low base resulted in all primary and secondary schools and junior colleges and special education schools moving to home-based learning for 10 days from 17 May.
Perhaps of greatest concern has been the recent experience in Taiwan, where its earlier handling of COVID-19 was widely considered exemplary. Having taking precautions from the very beginning, it experienced a few cases in April 2000 and then appeared to have something approaching overall control for a full year until now. The past month, though, has accounted for something approaching 90% of its diagnoses and deaths in the whole pandemic. Numbers remain tiny but it is an example of a pattern that is causing concern in many low-incidence countries across the world, confirming the belief of some specialists that we may still be in the early stages of the pandemic as a world-wide problem.
Global phenomenon vs. vaccine nationalism
One of the unknowns of the pandemic is the risk of new variants emerging and in the past two months much of the focus has been on the Brazil variant, especially its spread across much of South America, and even more so the Indian variant. Neither appears, so far, to involve any significant increase in lethality, but each has proved to be significantly more transmissible than previous variants.
Early indications are that the Indian variant is rather more resistant to the impact of vaccination but not to a disastrous extent. That variant is spreading rapidly in several Asian countries and is in the early stages of spreading across Europe. The UK government is focusing on a series of local hotspots from Northwest England through to London, with mixed messages from government raising questions of competence.
One consequence of the Indian experience is that, as the world’s largest vaccine producer, it is cutting exports to the rest of the world, not least the Global South, to enable it to increase national vaccination. This creates a major short-term bottleneck in supply. Other big producers, particularly the United States, already have restrictions on vaccine exports while their populations undergo vaccination. Indeed, the US has even prohibited export of equipment and components needed to manufacture vaccines elsewhere, like in the EU, which exports about half its own production. Others, like the UK, hedged their bets in 2020 by pre-ordering far more vaccine doses than they could use and are so far reluctant to release these hoarded stocks to those in greater need.
A hidden toll
All this is in the context of growing evidence that the pandemic is having a much greater impact worldwide than the published figures suggest. Three sources are relevant here. Work in the United States at the University of Washington’s Institute for Health Metrics and Evaluation has concluded that, as of the beginning of May, there had been 6.93 million deaths worldwide with 2.5 million more anticipated in the next five months. The overall death toll is therefore twice as high as official WHO figures.
A separate assessment from The Economist, which uses a combination of direct data on excess mortality combined with detailed modelling where insufficient data is available, gives a 95% probability that global deaths range from 7.1 to 12.7 million with a central estimate of 10.2 million.
In compiling its official figures, the World Health Organisation fully accepts that it is dependent on available statistics, which are of highly variable reliability, especially in countries that have limited health services, especially in public health. While still publishing the available figures (as quoted in the introduction) WHO’s assistant director Dr Samira Asma has stated that as many as 6 to 8 million people may have died from COVID-19 so far, around twice the WHO’s published figure.
Overall, it should therefore be taken as read that the pandemic is far worse than commonly recognised, meaning far greater immediate human costs and far deeper impacts on socio-economic environments. Of immediate significance, this implies a much larger global “pool” of the virus at any one time and therefore a greater probability of new and more potent variants evolving.
Until now, new variants have been broadly similar to the early examples except for some with greater rates of transmission or rather more resistance to vaccines. What has not yet been seen is a variant that might be more lethal, might affect younger people or persist longer. Given the size of the viral pool that the new estimates indicate, it is essential to plan for this likelihood now, rather than respond too late.
Among immediate responses would be prioritising provision of vaccines and other assistance to non-manufacturing countries, removing intellectual property rights that restrict vaccine production in additional countries wherever relevant, and substantially increasing financial aid, both multilateral and bilateral, to Global South states in immediate need.
In many respects the rapid development of vaccines has been the one remarkable achievement of the coronavirus era so far, but it parallels many inadequate national responses and weak transnational collaboration. In the face of a continuing and substantial virus pool, the greatest risk at present may well be complacency. It will require much improved national and international political leadership to avoid a further crisis and this can be enhanced by vigorous public pressure, especially in terms of immediate responses, to which we can all contribute. Without it, it is a question of when, not if, a more dangerous strain of the virus returns to ravage this country as so many others.
The views and opinions expressed in posts on the Rethinking Security blog are those of the authors and do not necessarily reflect the position of the network and its broader membership.
Photo Credit: PubAffairs Bruxelles.