Here in the UK, we have been feeling pretty good about ourselves recently, with (at the time of writing) over 35 million adults having been partially vaccinated and more than 18 million fully vaccinated. In other words, more than two-thirds of the adult population has been at least partially vaccinated (nearly 55 million people), and we are well on target to vaccinating almost all adults against COVID-19 by the beginning of July. Furthermore, the UK has the start of a programme to offer booster vaccines against new variants in the autumn, with money pumped into researching which vaccines work best against new strains, as well as extensive genomic sequencing (arguably the best in the world) to track down new variants and their likely risks.
Infection rates are at the lowest since August 2020, and death rates are heading towards single figures – after peaking at over 1,200 per day around 19-20 January.
So well have we done that some are arguing it has tilted the vote towards the governing Conservative Party in recent local, municipal, and devolved national elections across the UK. Many are now arguing that we should be coming out of lockdown measures much faster than the government’s cautious, gradualist approach.
At this point, I am reminded of Jesus’ parable of the rich fool who thought a good harvest ensured his security, little realising he would die before his plans saw fruition. We have done well, and we have much to rejoice in, but we are naïve to think that all is secure.
We are beginning to learn the lessons from the last wave of the pandemic in the UK, and more importantly, what is happening elsewhere in the world. The ways that Chile and Israel have come out of lockdowns with high vaccination rates are often being cited as contrasting examples arguing for a more gradualist approach. Israel, with the world’s highest rate of vaccination, and Chile with its seventh, are going in very different directions. Israel has come out of a third lockdown much more slowly and flexibly this time around, and with close monitoring of local infection rates. The result has been that society has unlocked safely, with no significant infection spikes. On the other hand, Chile unlocked rapidly with a still relatively low vaccination rate and immediately went into another spike of infections.
There are debates around this; Israel used the Pfizer BioNTech vaccine, which has a 95%+ efficacy rate, while Chile predominantly used the CoronaVac vaccine, produced by the Chinese firm Sinovac. CoronaVac has had a much lower efficacy rate in trials and real-world data, at around 50.4%. Furthermore, Chile eased restriction when most people had only had the first dose, and there are questions about whether variant strains resistant to vaccines are more common in Latin America as a whole.
Nevertheless, the comparison of Israel’s and Chile’s experiences does suggest a more cautious, multi-pronged approach makes more sense.
There is another recent example to consider. India fared incredibly well in the first wave, and there was confidence that the pandemic had largely swept past the most populous nation on earth. Instead, it has now been hit with the worst outbreak yet seen in the world (in absolute numbers), with in excess of 400,000 new cases and between 3,000 and 4,000 deaths per day. It has vaccinated around 150 million people with at least one dose of vaccine, but that is still only about 11.5% of the population. India has the largest vaccine manufacturing capacity of any single nation and hoped to get cheaply produced vaccines, such as Astra Zeneca’s, to the most impoverished nations as part of the UN’s COVAX scheme. Faced with this massive health crisis and the need to start vaccinating their way out of it, the Indian government has temporarily stopped all exports and instead focused all production on the domestic vaccination programme.
In an inversion of the UK situation, the Indian government’s handling of the crisis has been blamed for the ruling BJP party losing votes in recent state elections. How a government has been seen to be handling the pandemic has real political ramifications, which in turn can have real impacts on public health – for good or ill.
We now know that India is in part suffering because of several new virus strains that have emerged and are now cropping up in other countries. So far, these variants seem no more resistant to vaccines than the original Wuhan strain, but at least one is more transmissible and is now being researched as a matter of genuine concern. It is a sobering reminder that where infection rates soar, so the opportunities for new, potentially more dangerous strains of the SARS-CoV-2 virus to emerge increase dramatically. Until the population of India are all effectively vaccinated and the current outbreak brought under control, the risk of yet more deadly variants emerging cannot be ruled out.
This story also illustrates how vulnerable global vaccination programmes are to political and health issue in different nations. Even developed, wealthy countries are vulnerable – consider the problems in Europe with supplies of the main licensed vaccines in recent months, and the ways vaccine access and exports have exacerbated political strains between the EU and UK.
But more concerning than all of this is that so many parts of the world have little or no chance of getting a significant vaccination programme underway while global supply chains and production capacity remain so strained and where vaccine nationalism hoards the supplies in the wealthier nations. The UK and Israel have led the world in vaccination programmes in large part because they bought up large stocks of vaccines before they were even licensed.
Recent moves to suspend intellectual property rights, supported by the US and many developing nations but opposed by most of Europe and the pharmaceutical industry, may offer hope of increased production and supply of vaccines in the coming years. But they are controversial – with many arguing that forcing pharmaceutical companies to suspend their patents will disincline them to step up in future crises. The UK has suggested encouraging voluntary licensing arrangements between drug companies and manufacturers in other parts of the world, such as Astra-Zeneca’s agreements with the Serum Institute in India, might be a better way forward.
However, such steps will do little in the short term, even should a global agreement be reached in the near future. The waiving of intellectual property rights would merely open up access to the basic structure of each vaccine – there would be no details of the necessary ingredients or manufacturing steps needed. And even if the details of how to manufacture the vaccines are shared far and wide, the skills, technology, and material required to create them are not so easily acquired. It could take even wealthy nations months, if not years, to create the production capacity needed, and at considerable cost. Furthermore, the logistics of getting vaccines in cold chains from the factory to the arms of the people are immensely complex. Even if most countries already have the infrastructure to deliver other vaccine programmes, the scale of vaccination needed to control COVID-19 is an order of magnitude greater than anything previously envisioned.
Vaccines do offer hope and are a vital tool in the anti-Covid toolkit, but as these stories show, they are not the sole answer, and for the time being, they are not solving the problems in many parts of the world at all. We need to ensure that the poorest nations have the means to suppress the virus, lest yet more virulent and more deadly strains of Sars-CoV-2 emerge to reinfect the world. To do this, we need to ensure that the production, distribution, and utilisation of vaccines is globally efficient. We will need to ensure the test, track, trace, and isolate strategies are in place to ensure societies remain as open as possible without increasing transmission risks. And to do that, we need to share not only resources but know-how. Taiwan, Singapore, China, and South Korea have all showed the world that there are other ways to control the virus than by stop-start mass lockdowns – we need to learn from them.
More than ever, we need to be working across nations, not just retreating into our own enclaves, and guarding only our own national interests. Until all are safe from this virus, none are safe. Tackling this pandemic will take more than money, vaccines and lockdowns – it will take us genuinely learning to love our neighbours as ourselves. Because in a globalised, pandemic world, everyone is our neighbour.