Week in Review: August 23rd, 2021

Global Edition

Cases, hospitalizations, and deaths continue to increase exponentially in the US. The big chatter right now is about booster shots among those who have already fully vaccinated because of the Delta variant. I’m all for giving boosters to those that need it. Also, should those vaccines be used in countries with only 1% vaccination rates or should they go to a 3rd dose for high-income countries with widely available vaccines? I wanted to take us through the global view of the pandemic this week because of this debate and because the gross disparities we are seeing globally highlight how we (high-income countries) are not loving our global neighbors well.

Before I get into the data, I want to remind everyone that we should.not.be.here. This could have been prevented in 2020 with better leadership, coordination, politics, and verbiage about the pandemic. The sheer fact that we have the Delta variant (and the potential for mutant variants) emerging is a direct link to the mismanagement of the pandemic in 2020 from high-income countries. It just didn’t have to be this way. The repercussions of this mismanagement, encouraging (read: not discouraging) mis/dis-information, and making public health political is shown on a global scale now. Let me show you. Why? Because this can directly affect ALL of us again with new variants.

If we do not vaccinate swiftly and equitably, we leave more room for new variants to circulate the globe again and evade our current vaccines. Then we (the world) take a few steps back again. So, let me show you where you are now in the global pandemic.

Globally, there are now more than 210 million cases. Case increases are accelerating in the past 6 weeks, largely due to Delta right now. As a world, we are averaging 600,000 cases per day - the worst the pandemic has been since May.

Where are cases and deaths rising? The Americas continue to get hit very hard with both case count and deaths. As an example, Peru has a death rate of 609 per 100,000 people - compare this to the US’s death rate of 108 per 100,000 people.

Don’t let the above fool you either in thinking that this isn’t hitting Africa. We simply do not have accurate data from low-income countries. But my colleagues and friends on the ground tell a very different story. If you look at the top 25 countries in the world with the fastest growing number of deaths (this is the first column showing how long it took for deaths to double), over half of the countries are in Africa. And, over 95% are low-income countries. Look at Tanzania - Deaths doubled in 13 days. Look at Burundi (some of my best colleagues live here) - deaths doubled in 13 days. Now it might look like the numbers are still low. For example, in Tanzania the number of deaths are low so a doubling might not look that much. But, remember we are dealing with a virus that grows exponentially and that is grossly undercounted in low-income areas where we do not have surveillance (testing/tracing) systems. So, the doubling rate (even if the COUNTED numbers are low) of 13 days indicates spread - not only spread but deaths - and we know that excess mortality in places with inadequate access to healthcare, ventilators, etc is high.

What does the 13 day doubling rate tell me? We need to put more effort in low-income countries to count, track, trace, treat, and bolster the healthcare systems. This is a ticking time bomb if we don’t. (Source here).

This brings me to vaccinations.

Globally, nearly 5 billion vaccine doses have been administered. This equates to about 65 doses per 100 people, on average.

However, these doses have been mainly restricted to high-income countries. In Africa, <1% of the population has been vaccinated.

Recently, the World Health Organization’s Director-General Tedros Adhanom Ghebreyesus said that he was “really disappointed” with the scope of vaccine donations worldwide as many countries struggle to provide even first doses.

Dr. Tedros called on countries offering third vaccine doses "to share what can be used for boosters with other countries so (they) can increase their first and second vaccination coverage.” The UN continues to ask richer nations to do more to improve access globally. Vaccine nationalism continues to be a problem in countries with the virus cases and deaths are doubling quickly. Thankfully, COVAX is working extremely hard to advocate for vaccine equity and distribute vaccines in low-income countries. You can read more about their incredible work here. But, there’s so much more work to be done. I do not think the debate is an either/or scenario - where we (as the globe) have to decide between boosters in high-income countries versus first shots in low-income countries. I think we can do both. However, it is short-sighted to think we can do both without coordinated efforts, country buy-in, and sharing. USAID, COVAX, and the Biden Administration are doing a great job leading this effort - and, I do hope we can do more to share like Dr. Tedros called for.

Loving our global neighbors continues to be a call for those of us in high-income countries. Let’s do our part - get your vaccines, mask, advocate for your neighbors.

-FNE