The impetus to vaccinate the world against Covid is losing steam

In the middle of last year, the World Health Organization started advance an ambitious goal, one necessary to end the pandemic: fully immunize 70% of the population in every country against Covid-19 by June 2022.

Now, it is clear that the world will not reach that goal ahead of time. And it is increasingly being dismissed by public health experts that high rates of Covid vaccination coverage may never be achieved in most lower-income countries, because of the capital needed. Essentials from the United States dried up and both government and donors turned to other priorities.

Dr Isaac Adewole, Nigeria’s former Health Minister and now an adviser to the Africa Centers for Disease Control and Prevention, said: “The reality is that it’s losing momentum.

Only a few in the world 82 poorest countries – includes Bangladesh, Bhutan, Cambodia and Nepal – has reached the 70 percent vaccination threshold. Many people are under 20 percent, according to aggregated data from government sources by Our data world project at the University of Oxford.

For comparison, about two-thirds of the world’s population richest country reached 70 percent. (US is 66%.)

The consequences of giving up on achieving high rates of immunization coverage around the world can be dire. Public health experts say that abandoning the global effort could lead to the emergence of dangerous new variants that threaten the world’s precarious efforts to live with the virus.

Dr. Seth Berkeley, chief executive officer of Gavi, the nonprofit that runs the Covax global vaccine clearinghouse program.

Countries in different parts of the world, including some in Eastern Europe and the Middle East, have seen their vaccination rates stagnate in recent months. at a third or less of their populations. But Africa’s vaccination rates are still among the lowest.

Less than 17 percent of Africans have received the primary Covid vaccine. Almost half Vaccine doses shipped to the continent so far have not been used. Last month, the number of doses injected on the continent 35 percent off compared to February. WHO officials say the drop due to the mass vaccination push has been replaced by smaller-scale campaigns in some countries.

Some global health experts say last year the world missed a key opportunity to deliver vaccines to lower-income countries, as the public became more fearful of Covid and motivated to get vaccinated. .

“There was a time when people wanted to get vaccinated, but there was no vaccine. And then they realized that without a vaccine, they didn’t die,” said Dr Adewole, who wants to see countries continue to pursue the 70% target.

The remaining momentum in the global vaccination campaign has been hampered by a lack of funding for the equipment, transportation and human resources needed to vaccinate.

In the United States, a major funder of the vaccination effort, lawmakers have stripped $5 billion in global pandemic aid from a coronavirus response package expected to be put to a vote in the next few days. next week. Biden management official said that without funding, they would not be able to support the supply of vaccines to more than 20 unvaccinated countries.

Some public health experts point to optimistic reasons that the global vaccination campaign is still slightly off. Although down from the February peak, the number of Covid vaccinations performed each day in Africa is still near the pandemic high. And Gavi earlier this month drew an important new round funding pledges, securing a $4.8 billion pledge, although it fell short of its $5.2 billion goal.

There is also hope that a Global Covid Summit The White House’s plans to co-host next month could be an opportunity for momentum and funding.

But the drop in community demand has led some health officials and experts to quietly, and in some cases, outright question whether the 70% immunization target is feasible or even reasonable. or not.

Reported deaths from Covid-19 remain relatively low in sub-Saharan Africa, despite have a debate about what percentage of this reflects poor data tracking. However, in many countries in the region it is recognized that the disease does not pose a serious threat, certainly not as dangerous as other common health problems that require attention with scarce health care resources.

Many low-income governments are shifting their focus to their economies and other health issues such as HIV, said Fifa Rahman, civil society representative. Group launched by WHO coordinate the global Covid response. “There’s a sense of multiple competing priorities, but that’s a sign the momentum is gone. Because when motivated, everyone asks, ‘Where are our vaccines?’ “

For example, in rural areas of the Democratic Republic of the Congo, where the reported mortality rate from Covid is very low, there is an increase in the number of measles cases that threaten 20 million children. Christopher Mambula, medical director of Doctors Without Borders in East Africa, said the government said it could not devote resources to providing additional vaccines for measles this year. In such a context, it makes no sense to continue to shift resources to widespread vaccination against Covid, he said.

As African governments receive more vaccines from rich countries and struggle to distribute even those supplies, their interest in ordering more doses has waned.

The African Union still aims to vaccinate 70% of the population by the end of 2022. But with countries slow to run out of donated vaccines, the bloc has not exercised its options to order more doses. from Johnson & Johnson and Moderna.

South African drugmaker Aspen Pharmacare earlier this year completed a deal bottle and market Johnson & Johnson vaccines across Africa, a deal seen as a first step towards Africa’s development of a robust vaccine manufacturing industry. Stephen Saad, Aspen’s chief executive, said that Aspen was already in production, but no buyers, including the African Union and Covax, had placed an order yet.

Serum Institute of India, the world’s largest vaccine producer, stop production of Covid injected last December, when its stockpile had grown to 200 million doses; Bharat Biotech, another Indian company that is a major producer, also stopped producing vaccines due to low demand. The companies said they have had no further orders since their contract with the Indian government ended in March.

After the WHO began promoting the 70% vaccination target, many low-income governments adopted the target for their populations. The Biden administration also confirmed last September, setting a deadline of September 2022.

At the time, the two doses of Pfizer and Moderna’s vaccines were understood to offer very strong protection against even mild illness, and there was hope that vaccine coverage would be achieved. Xin Cao will control the virus. But the emergence of new variants and the spread of the virus in Africa changed the calculus.

Vaccine regimens are planned for developing countries provide little protection against infection with the Omicron variant. And as sub-Saharan African countries stopped distributing vaccines for much of last year, more and more Africans are being protected against the virus from natural infection, which studies have shown to be effective. as well as two doses of mRNA in preventing infection. New WHO data shows that at least two-thirds of Africans were infected with the virus before the Omicron wave.

Given these factors, some public health experts in Africa argue that the broad 70% target no longer makes sense. “It has very little value. In fact, we’ll get a lot more out of it when we reach more than 90% of people over the age of 50,” said Shabir Madhi, professor of immunization and chair of the department of health sciences at the University of the Witwatersrand in Johannesburg. About two-thirds of South Africans over the age of 50 are now fully immunized.

Dr Madhi says South Africa could close mass vaccination sites and instead redouble their efforts to find the most vulnerable at church services and in offices The government pays a monthly pension.

Katherine O’Brien, who directs WHO work on vaccines and immunization, said the agency encouraged countries to focus on their most vulnerable citizens rather than vaccinating “a random group of people”. 70%” of their population. The aspiration, she says, has always been “100% of healthcare workers, 100% of older people, 100% of pregnant women, 100% of those in those highest risk groups.”

Of course, countries can make decisions about which health goals they want to prioritize, Dr O’Brien said, but limited resources shouldn’t be an obstacle to getting vaccinated against the coronavirus. “The world has enough resources to do this, if countries want to do it,” she said. “And that really has to be the North Star.”

Some public health experts say that while the 70% immunization threshold is clearly unattainable by the initial deadline, it would be unwise and unethical to abandon that goal for a period of time. longer time. They expressed frustration at the growing gap between rich countries that immunize young children and provide a fourth dose of the vaccine to healthy adults, and areas where the majority of people are still unvaccinated. dose.

“Why do we make it a target for high-income countries and a target for low-income countries?” Dr Ayoade Alakija, co-chair of the African Union’s vaccine distribution programme.

She said that although many people in sub-Saharan Africa have been infected, additional protection is still needed from the high level of vaccination coverage.

The modest coverage of vaccination, she said, “isn’t considered good enough protection in the UK, it’s not good enough protection in the US. How not to aim for the maximum, the maximum that we can? Aim for the sky and reach the treetops. ”

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