Rising Covid-19 Cases and Rising Vaccinations - Where is the Gap and What is the Solution?
Despite having nearly 77% fully vaccinated population and 83% of people over the age of 5 with at least one dose, Canada surpassed 40,000 new COVID-19 infections in a single day as of December 31 2021 [1,2]. The continuation of a streak of rapid infection growth is taking place amid tighter public health restrictions by the federal government and provinces/territories. The Omicron strain of COVID-19 is the dominant strain in Canada now. The majority of reported new infections have come from Canada’s most populous provinces, Quebec and Ontario. In Ontario, 97% of the new caseload is attributed to Omicron [3].
The new virus strain was first detected by researchers in South Africa in early November 2021 and by end of the month, November 26, the World Health Organization (WHO) declared Omicron a variant of concern. Efforts were made quickly by scientists and researchers to understand if the current vaccines will offer same protection against the new variants. A trial study shows that the booster shot of the Johnson & Johnson COVID vaccine was 85% effective in preventing serious illness in areas where Omicron was dominant in South Africa. Another study found that while two doses of the Pfizer vaccine was only 50-70% effective against hospitalization with the Omicron COVID-19 variant, it was previously shown to have 95% vaccine effectiveness against COVID-19 [4]. Recent data from another study from a group of researchers from the United States show the three doses of Pfizer vaccines are more effective in creating antibodies than those who received only two dose, especially against the Omicron variant [5].
While the high-income countries are pushing efforts for boosters or third doses, low- and middle-income countries are struggling to provide even a first dose of vaccines to their population. The United Nations Development Program (UNDP) has warned nations about the effects of a slower and delayed global vaccination rollout which would leave many nations vulnerable to COVID-19 variants [6]. The WHO has also highlighted that the global failure to share vaccines equitably is taking its toll on some of the world’s poorest and most vulnerable people. The rising number of ‘new variants of concern’ means that the risks of infection and mutation have and will further increase in all countries, especially for those who are not yet protected by vaccination [7]. The WHO also warns that Europe and Central Asia could face another 700,000 COVID-19 deaths by March 1 2022 [8], if appropriate efforts are not taken.
The Global Response
Safe and effective vaccine development proved to be a game-changing moment in the pandemic, and equitable access to vaccines was agreed globally to be critical to ending the spread of COVID-19. Countries came together to respond to the global pandemic challenge through the COVID-19 Vaccine Global Access Facility (COVAX) initiative. Established in April 2020, COVAX is the vaccine pillar of the Access to COVID-19 Tools (ACT) Accelerator, which is a global initiative to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines.
The COVAX initiative aims to ensure fair access to COVID-19 vaccines worldwide. The program goal was to vaccinate at least 20% of countries' populations and aimed to secure and deliver at least 2 billion doses by the end of 2021 [10]. At the end of 2021, nine billion vaccine doses had been administered worldwide, with countries and regions with the highest incomes getting vaccinated more than 10 times faster than those with the lowest. Public health experts say goals of global vaccine equity have fallen considerably short. In Africa, 87% of the population is still waiting to receive their first vaccine shot (Figure 1) [1].
The WHO’s target to achieve an overall 40% vaccination rate for all countries has also not been achieved [12].
Figure 1: Share of the global population vaccinated against Covid-19.
Source: Our World in Data
As of 31 December 2021, only 8.5% of people in low-income countries (ie. having a Gross National Income (GNI) per capita below US $1,045) have received at least one vaccine dose, compared to 76% in high-income nation-states (GNI per capita above US$ 12,696) (Figure 2) [10].
Figure 2: Share of population vaccinated against Covid-19 among country income groups.
Source: Our World in Data
COVAX Pledges, Issues and Current Situation
As the global mechanism for equitable access to COVID-19 vaccines, the COVAX program has delivered over 910 million doses to 144 countries since February 2021 [13]. The program, however, has fallen short of its original goal to deliver 2 billion vaccines by the end of 2021 [14]. The WHO has set a further target of 70% coverage for all countries by June 2022, but this could also be missed [15].
The purchasing and administration of Covid-19 vaccines have been unequal globally. There are several reasons for not reaching the set target by the end of December 2021.
High-income countries started vaccinating their populations on average two months earlier than low-and middle- income countries, and access to vaccines in low-income countries remained strikingly low [11].
While the WHO has encouraged donations to go through COVAX, several countries have also donated directly to countries, raising questions about whether geopolitics have taken precedence over need and equity [12]. Some of the vaccines have also been donated too close to their expiration date, making them unusable. In early January, Nigeria discarded 1 million expired AstraZeneca vaccines [16]. Other issues include delays in manufacturing, supply chain and cold storage issues, infrastructure-related issues with difficulties in delivering the vaccines to high-need areas, and hesitancy among some populations. Then there are countries like US, Canada and other European nations who preferred to provide booster shots and vaccinate children under 5, diverting the vaccine supply for in-country use.
The WHO Strategic Advisory Group of Experts on Immunization (SAGE) and WHO’s Director General have expressed serious concerns about mass booster programs by countries who can afford them because these efforts will further exacerbate vaccine inequity [17]. According to the WHO, the blanket COVID-19 vaccine booster programs will not bring a definite end to the global pandemic, but prolong it, as poorer countries struggle to vaccinate their populations because of unequal access to immunizations [18]. Despite the repetitive warnings and guidance, booster programs are being implemented in many countries (Figure 3). As of December 31, 2021, the United States had administered nearly 70 million booster vaccines, the United Kingdom, 33 million, Germany, 31 million and Canada had administered more than 6.5 million booster shots [1].
Figure 3: COVID Vaccine boosters administered in selected high-income countries. Source: Our World in Data.
Canada’s COVAX Response
Canada has expressed its commitment to a comprehensive and global response to the pandemic and its support to the COVAX initiative. Canada pledged to donate its surplus vaccine doses primarily via the COVAX program to ensure efficient distribution and to maximize impact [19]. Canada has committed to donating the equivalent of at least 200 million doses to the program by the end of 2022.
Canada’s COVAX response has been below par and controversial. Some of the donations from Canada through COVAX arrived in African countries just weeks before their expiration dates [20]. Earlier, Canada also withdrew from the COVAX supply to bolster the vaccination campaign at home, which received serious backlash from the international community [21,22]. As of December 21, 2021, only 11.8 million surplus vaccine doses have currently been delivered through the COVAX facility as per the Government of Canada website. Canada has also shared 762,080 AstraZeneca doses through direct, bilateral arrangements with countries in Latin America and the Caribbean [19]. To achieve its targeted goals towards vaccine equity and match the pledges made, Canada has to donate more than 35 million vaccines by 2022.
Concluding Thoughts
With the increased risk of new mutations and variants disproportionately impacting non-vaccinated populations, the recommended path to control the pandemic is to ensure global vaccine equity. The virus is moving and mutating faster than the global efforts on vaccine distribution, but the world has enough doses of vaccines to bring virus transmission down, save hundreds of lives and achieve global economic recovery. This only can be possible if the vaccines reach populations that need them most. Canada should play its role as one of the global leaders to promote vaccine equity, increase its COVAX contribution and work with other world leaders to ensure global herd immunity is achieved.
Hammad Durrani (MBBS, MSc) is currently a PhD student in Health Services Research at the Institute of Health, Policy, Management and Evaluation, University of Toronto (UofT). He is also completing a Collaborative Specialization in Global Health (CSGH) at Dalla Lana School of Public Health, UofT. His key interests are digital health, global health policies, scale of health services and impact measurement. Prior to undertaking on the PhD studies Hammad worked in multiple senior positions at the Aga Khan University in Pakistan and Afghanistan, the Centre for Global Child Health at SickKids Hospital and consulted for organizations like the World Vision Canada, The Citizens Foundation, Tech4Life in areas of strategy development, partnerships and business development in Health and Education.
References
[1] Our World in Data. (2020). Coronavirus (COVID-19) Vaccinations. Retrieved January 1, 2022, from https://ourworldindata.org/covid-vaccinations
[2] Vasquez-Peddie, A. (2021, December 31). Canada surpasses 40,000 daily cases of COVID-19. CTV News. https://www.ctvnews.ca/health/coronavirus/canada-surpasses-40-000-daily-cases-of-covid-19-1.5725012
[3] Ontario COVID-19 Science Advisory Table. (2021). Ontario Dashboard Tracking Omicron. Retrieved October 15, 2021, from https://covid19-sciencetable.ca/ontario-dashboard/#riskbyvaccinationstatus
[4] Collie, S., Champion, J., Moultrie, H., Bekker, L.G., & Gray, G. (2021). Effectiveness of BNT162b2 Vaccine against Omicron Variant in South Africa. The New England Journal of Medicine, 386, 494-496. https://doi.org/10.1056/NEJMc2119270
[5] Schmidt, F., Muecksch, F., Weisblum, Y., Da Silva, J., Bednarski, E., Cho, A., Wang, Z., Gaebler, C., Caskey, M., Nussenzweig, M. C., Hatziioannou, T., & Bieniasz, P. D. (2021). Plasma Neutralization of the SARS-CoV-2 Omicron Variant. The New England Journal of Medicine, 386, 599-601. https://doi.org/10.1056/NEJMc2119641
[6] UNDP Data Futures Platform. (n.d.). Global Dashboard for Vaccine Equity. https://data.undp.org/vaccine-equity/
[7] World Health Organization. (n.d.). Vaccine equity. https://www.who.int/campaigns/vaccine-equity
[8] Euronews. (2022, January 14). COVID in Europe: Netherlands to reopen shops, gyms, and hairdressers. https://www.euronews.com/2021/12/01/covid-19-spike-felt-across-europe-as-vaccination-remains-stagnant
[9] World Health Organization. (n.d.). COVID-19 vaccines. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines
[10] Loft, P. (2022, January 11). Covax and global access to Covid-19 vaccines. UK Parliament House of Commons Library. https://commonslibrary.parliament.uk/research-briefings/cbp-9240/
[11] UNDP Data Futures Platform. (2022). Vaccine Access. Retrieved from https://data.undp.org/vaccine-equity/accessibility/
[12] Stepansky, J. (2021, December 22). The world has failed at vaccine equity. Will 2022 be different?Al Jazeera News. https://www.aljazeera.com/news/2021/12/22/will-low-income-countries-be-vaccinated-against-covid-in-2022
[13] UNICEF. (n.d.). COVID-19 Vaccine Market Dashboard. https://www.unicef.org/supply/covid-19-vaccine-market-dashboard
[14] World Health Organization. (2021, May 27). COVAX Joint Statement: Call to action to equip COVAX to deliver 2 billion doses in 2021. https://www.who.int/news/item/27-05-2021-covax-joint-statement-call-to-action-to-equip-covax-to-deliver-2-billion-doses-in-2021
[15] Mwai, P. (2021, December 31). Covid-19 vaccinations: African nations miss WHO target. BBC News. https://www.bbc.com/news/56100076
[16] Dress, B. (2021, December 29). WHO chief warns wealthy nations against prioritizing booster shots amid “tsunami of cases”. The Hill. https://thehill.com/homenews/coronavirus-report/587597-who-chief-warns-wealthy-nations-against-prioritizing-booster
[17] United Nation. (2021, December 22). WHO warns against blanket boosters, as vaccine inequity persists. UN News. https://news.un.org/en/story/2021/12/1108622
[18] Voice Of America. (2021, December 22). WHO Chief Warns COVID Booster Programs May Prolong Pandemic. VOA News. https://www.voanews.com/a/who-chief-warns-covid-booster-programs-may-prolong-pandemic/6365386.html
[19] Government of Canada. (n.d.). Canada’s international vaccine donations. Retrieved from https://www.international.gc.ca/world-monde/issues_development-enjeux_developpement/global_health-sante_mondiale/vaccine_donations-dons_vaccins.aspx?lang=eng
[20] Goldhill, O. (2021, October 8). “Naively ambitious”: How COVAX failed on its promise to vaccinate the world. Statnews. https://www.statnews.com/2021/10/08/how-covax-failed-on-its-promise-to-vaccinate-the-world/
[21] Oxfam Canada. (2021, February 4). Oxfam reaction to Canada taking COVID-19 vaccines from COVAX program. https://www.oxfam.ca/news/oxfam-reaction-to-canada-taking-covid-19-vaccines-from-covax-program/
[22] CBC News. (2021, February 5). What is COVAX and why is Canada getting backlash for receiving vaccines from it? https://www.cbc.ca/news/canada/covax-explainer-canada-backlash-1.5902072 (2021).