‘Nobody is safe until everyone is safe’

The world faces a ‘catastrophic moral failure’ because of unequal COVID vaccine policies. With more than 80% of the COVID vaccines being given in high and upper-middle income countries, low-income nations are left at the receiving end with just 0.5 percent.

The inequitable distribution of vaccines have left the poor nations in the lurch and if the rich countries ‘keep their vaccine promises, the pandemic can end,’ observes the Director General of WHO, Dr. Tedros Ghebreyesus.

Randima Attygalle speaks to Dr. Palitha Abeykoon, World Health Organization (WHO) Director General’s Special Envoy to facilitate the COVID-19 response in Southeast Asia, for the latest developments of the pandemic which has taken a new shape, pushing countries to deploy new management strategies. Following are excerpts:

Q: With new COVID variants emerging, what are the predictions for both the world and us in the next few weeks and months and what precautions are encouraged?

A:

Considering the factors and trends in other parts of the world, particularly in India, we can talk of certain potentials. As a country, we managed both the first and the second waves relatively well with a ‘whole of society approach’; people and the government stakeholders, particularly the frontline health workers and defense personnel working together, standing on the same side. However, with the onset of the recent festive season, this ‘whole of society’ approach was slackened leading to this spike we are experiencing right now. Even in the case of India with some mammoth super-spreader events and dropping of the guard including non-observance of simple health protocols, a spike was inevitable. We are only hoping that it is only a spike and not a surge, both locally and globally.

Here at home, if the number of infected cases does not rise rapidly in the next two weeks, our health sector will be able to manage the situation, albeit with considerable strain, but if the numbers do not come down by the middle of next week or so, it will certainly lead to a deeply worrying situation.

The evidence we have now reflects, (unlike in the first or second round), that the UK Variant of Concern (B1.117) is now established in Sri Lanka and with this virus the transmission is more efficient, more young people are infected, more serious complications are developed with more patients requiring oxygen and ICU facilities. If numbers increase, we will have a problem with capacity. The health sector is now setting up intermediate centers to isolate and treat patients, however, it will be a big strain on the system. Although we were fortunate to have vaccinated our frontline health workers and other personnel, we should not forget that they are working round the clock and are physically and even mentally exhausted. The logistical demands and shortcomings are an added burden on them.

The world still does not know enough about COVID 19 variants or the way the virus behaves, hence extreme precautions are necessary. The University of Jayewardenapura is doing a splendid job isolating the variants, particularly the variants of concern. We will need to do more sequencing which is a very expensive exercise. However, we cannot afford to neglect that also. There has been concern that some of the variants are not completely covered by some of the vaccines available; but this should not be much of a worry as the vaccines we use do give adequate protection, particularly preventing serious complications and death. Random testing in high transmission areas should also be given more muscle.

There is also this recent story in a reputed journal gaining ground that transmission is through aerosols in addition to being through droplets but research is still in process to establish it. In any event the key measures needed for preventing transmission in either case would be similar and are now well known.

Q: What lessons can we draw from India’s predicament?

A:

India is alerting us that ‘no one is safe unless everyone is safe.’ Being a large player in the drugs and pharmaceutical industry, India is today struggling to meet their health demands. With havoc in Delhi and Maharashtra, they do not have sufficient personal protection equipment, oxygen etc. We need to be mindful that the Indian situation can affect our supplies as well as we are a major importer of Indian pharmaceuticals and equipment.

Today the Indian health system is burnt out and this is an eye opener for us. We need to endeavour to prevent the Indian variant entering Sri Lanka and do more sequencing to determine if the new Indian variant (B. 1.617) which seems more virulent and produces serious complications, has entered the country.

In the past few weeks, we have been too lax and let our hair down too early and easily. The situation in India should push us to strengthen our ‘risk communication’ to the public.

Q: Do you think there is a need for tighter inter-province travel restrictions right now because despite warnings, people from ‘red zones’ such as Colombo still tend to flock into outstations?

A:

Yes, certainly there should be certain restrictions. In a country where the majority are daily wage earners, we cannot afford to go down for a long lock down risking the livelihood of thousands. What is needed is a balancing act for which selective lockdowns which are now in force and travel restrictions as indicated. There should also be other restrictions with regard to assembly, any type of gathering or ceremony and these restrictions should be strictly enforced. It is urgent that the transmission from ‘red zones’ to other ‘not-so vulnerable regions’ is suppressed. I reiterate that we cannot afford to overwhelm our health sector exceeding its capacities.

Q: What is the overall success rate of the vaccination programme world over?

A:

It is very clear that the countries which vaccinated more than 50% of their populations have demonstrated a lesser number of cases. In fact Israel has achieved nearly 85% of a roll out – the first country to achieve such a large number – and it is considered to have achieved ‘herd immunity’ and able to relax the earlier restrictions. For a while Israel has been reporting a very few cases and this is an example to the rest of the world. Even in England, the number of cases has come down, and can be attributed in some measure to the impact of the vaccination program, and so is the case in some of the states in the U.S.

Q: Many malpractices and managerial drawbacks were witnessed when the first dose of the Covax vaccine was locally administered. How important is it not to replicate these during a possible second roll out?

A:

If the programme stuck to its original mandate of vaccinating the frontline personnel and those over 60 years, it would have been much more successful because still the world over, most number of cases and deaths are reported among the elderly. With the initial mandate shifting from senior citizens, some people attempted to take advantage of the vaccination program and this was unfortunate. So prioritizing of the elderly and those with co -morbidities in the next phase of the program is still a must. We also need to prioritize factory workers and those who contribute significantly to the economy and among whom the spread of the infection is common.

Q: There is concern over the second dose with a possible shortage of vaccines. Where do we stand in this backdrop?

A:

Still there is an uncertainty about the quantity of the second doses which will be available, and whether we will receive these in time. I am aware of the efforts made by those responsible to ensure supplies for the second dose. We have already got around 600,000 doses of the Chinese Sinopharm vaccine which is awaiting WHO Emergency Use Listing which is likely to be obtained by the second week of May. (Our regulations require either WHO clearance or another similar stringent authority’s clearance for the administration of a new vaccine). We are also expecting the Russian Sputnik V vaccine in the next few weeks. With the possible arrival of these vaccines, we should be in a much better position within the next four to five weeks support the control of the spike to a limited extent and expand the vaccination program simultaneously.

Q: What are the other South East Asian countries which come under your purview that administer Chinese vaccinations and the Russian Sputnik V?

A:

The Maldives started administering the Chinese Sinopharm in small doses about two weeks ago. This vaccine was also gifted to Nepal and just a few days ago they commenced their roll out. Indonesia is using the other Chinese vaccine- Sinovac. Pakistan is using both Sinopharm and Sinovac. The Sputnik V is not yet being used in the region but it is likely that it will also soon get into the regional vaccine portfolio. Beyond the South East Asian region, the Chinese vaccines are also being used in the UAE, many South American countries and in certain parts of Africa.

Q: Bhutan is considered a model in COVID management efforts. Can you throw more light on this?

A:

It is indeed a model. Bhutan illustrates well how an enlightened leadership and a disciplined and sensible population managed to mitigate the risks and prevent the transmission and spread of the disease in the country. Bhutan prevented the infection coming into the country for a long time but it eventually did arrive there from the borders of her ‘big brothers.’ Nevertheless, they have been very successful in suppressing the virus. So far the country has only reported less than a thousand cases and just one death. It is also a country which has already vaccinated nearly 70% of their population, more than many of the developed countries. This is quite a feat.

Q: WHO Chief has expressed his concerns about the inequitable distribution of vaccines. In his recent report which appeared in the New York Times he had noted that if the rich nations ‘keep their vaccine promises, the pandemic can end.’ What are your thoughts?

A:

Although the rich countries talk of ‘One-health, universal health coverage’ etc. they have left only very few vaccines for the poor countries. More than 80% of the vaccines are found in the rich countries. This is a very sad situation and the rich countries should now ‘make a choice’ as the WHO Director General remarked. The ACT Accelerator (Access to COVID-19 Tools) was set up by a number of organizations including the WHO and European Commission and several more global bodies to enable tools such as vaccines, drugs, supplies and equipment to fight the pandemic. In fact the WHO has developed a fair allocation formula through the Covax facility. This global collaboration has worked to a large extent with regard to everything other than the vaccine distribution that was iniquitous. This is a serious problem and apart from the ethics and social justice, the rich countries should realize before it’s too late that they are not going to be safe until others are also safe. In economic terms alone too, the global economy cannot recover if there are serious disparities in vaccine coverage and it is a false economy for countries to do it alone.