Wide disparity in vaccine drive across the world

Covid-19 has spread so widely across the globe that policymakers, governments and health professionals are struggling to understand its roots. President Biden’s recent directive to investigate the origin is the right step in this direction. Epidemiologists are busy developing models to predict the course of the pandemic.

While models are indicative and useful, they do have many shortcomings because they are based on general characteristics such as single variant, where country-specific characteristics are ignored.

Take the case of the 1918 pandemic. Globally, the 1918–19 influenza pandemic killed more people in absolute numbers than any other disease outbreak in history. Frank Macfarlane Burnet, a leading economic historian, had estimated the death toll at 50 million, and possibly even as high as 100 million.

In India, it was known as the Bombay Fever that broke out in the city in June 1918, with one of the possible entry points being ships carrying troops returning from the First World War in Europe. It hit different parts of the country in three waves, with the second recording the highest fatality rate. The pandemic is believed to have killed 17-18 million people in the country. By early 1919, it had largely disappeared.

It is argued that since the whole world had been exposed to the virus, and had therefore developed natural immunity against it, the 1918 strain began to mutate and evolve in a process called “antigenic drift”.

Coming to the present, what are the key characteristics of Covid-19? It is useful to mention that SARS-CoV- 2 virus remains an enigma to the medical fraternity. Each wave has done more damage than the previous, mainly because of its special characteristics to undergo mutation. Each mutant is different in clinical behaviour and mortality.

Fatality rates

According to various formal and informal sources, the overall case fatality rate is estimated to be 3-4 per cent of the total admitted Covid patients in 2020 in major urban centres. And this figure is estimated to have risen to 8-10 per cent by May 25, 2021.

It is observed that bilateral pneumonitis is a powerful factor in such deaths. In addition, consequent thrombosis and embolism to cytokine storm of unimaginable nature had proved devastating. Likewise, mRNA, in itself inert, becomes lethal once it finds a host, which is the respiratory epithelium.

A patient’s immunity level and co-morbidities are considered the driving force behind his/her protection. Research shows that this virus only harms when an individual embraces it by forgetting to keep six feet distance, and avoiding masks and Covid-appropriate behaviour.

How are vaccines and the second wave of Covid related? People who have taken the full dose of the vaccine largely remained protected. Hence, it is generally accepted that the recognised vaccines create immunity among individuals and protects them from extreme situations.

According to the University of Oxford, as of May 28, 2020, more than 1.81 billion vaccine doses were administered worldwide, equal to 24 doses for every 100 people. There are already stark differences between vaccination programmes in different countries, with some yet to report a single dose.

Most countries have focussed their early vaccination efforts on priority groups like the clinically vulnerable — people in their 60s, 70s, and older; and front-line workers like doctors and nurses — due to scarcity of vaccine doses globally.

Strikingly, between continents the vaccination drive has been different. For example, Africa has the lowest vaccination rate, with some countries yet to start mass vaccination campaigns. High- and upper/middle-income countries have been the net beneficiaries, accounting for 83 per cent of the shots administered. Unfortunately, only 0.3 per cent of the doses have been administered in low-income countries.

Country-wise, as of May 28, 2021, the UAE had administered around 128 doses of the vaccine per 100 people, one of the highest rates by any country globally; Papua New Guinea had the lowest rate — 0.03 doses per 100 people reported to.

As for the percentage of the population fully vaccinated, Israel topped at 57 per cent followed by the US (40 per cent), Singapore (28), Germany (16), Russia (8), and India. China had so far administered 42 vaccine doses per 100 people as against India’s 15 doses.

Coming to the number of people vaccinated, China tops (58 crore), followed by the US (29 crore) and India (20 crore).

Now, how can India prepare for a third wave challenge? It is expected that it will be more damaging than the first two. However, our pharma companies and medical fraternity are now better prepared, and more vaccines will be available in another two or three months.

Also, preventive care, improving the medical infrastructure and immunity boosting diets will enable the country face the challenge.

Singla is Senior Visiting Consultant General and Laparoscopic Surgeon, National Heart Institute, and Banik is Professor, International Management Institute, New Delhi

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