Supporting the vaccination of emerging nations is an opportunity not only to aid humanitarian efforts, but also to mitigate COVID-19’s global economic impact, says Prachi Patkee
COVID-19 continues to have a devastating effect on millions of people. The approval of vaccines brought renewed hope for a return to normality in 2021, but with demand far outstripping supply, the gap between rich and poor countries has widened even further.
In addition to the humanitarian case for investing in vaccination of emerging nations, there is a strong economic incentive to support a collective pandemic recovery.
A study produced by the US National Bureau of Economic Research concluded that full post-pandemic economic recovery would depend on securing equal access to vaccines in all countries. Without this, the uncontrolled infection rates in emerging markets have the potential to destabilise the vaccination efforts of developed regions.
India’s second wave
In April 2021, battling a second wave, India consistently reported rising infection numbers and mortality on an unparalleled scale, with record highs of more than 400,000 cases and 4,000 daily deaths. As the official death count passed 300,000, there were concerns – based on findings from crematoria – that the figures were being obfuscated and that the true death toll could be up to eight times higher than officially recorded.
Worryingly, the second wave appears to be claiming more lives among healthier and younger cohorts (those aged 20-40) when compared to the first wave last year, which mainly claimed the lives of the elderly and the clinically vulnerable. It is so far unclear whether this is due to the variant affecting younger ages to a greater degree, or simply a function of the much higher toll that this wave is taking.
The longer the SARS-CoV-2 virus remains in global communities, the more opportunity there is for it to evolve. While the emergence of a variant is expected in the lifecycle of a virus, the worrying features are the mutations they carry.
The Delta (B.1.617.2) variant is likely responsible for the recent unprecedented explosion of cases in India. Public Health England (PHE) identified this novel variant in samples taken in February 2021.
It carries two mutations of immunological significance (E484Q and L452R). They alter spike proteins, the feature that allows the virus to bind with human ACE2 receptors and infect a host cell. Both mutations have been observed independently in other SARS-CoV-2 variants, but were identified together for the first time in India. These mutations appear to heighten transmissibility and, from PHE data, reduce the effectiveness of several key vaccines in use around the world, creating additional challenges for the vaccinated population.
Vaccinating the masses
The mammoth task of vaccinating the Indian population relies on supply of the Oxford/AstraZeneca and the Bharat Biotech vaccines. As demand exceeds production capacities, the world’s largest manufacturer of vaccines, the Serum Institute of India, is balancing overwhelming domestic demand with its contracted international orders. In March 2021, India was forced to suspend exports of the Oxford/AstraZeneca vaccine as the government attempted to take stock of the national crisis. Recent government reports indicate that India has shipped 60m doses so far and is responsible for the supply of vaccines to 74 countries.
There are many hurdles on the path to equitable vaccine distribution, including global supply chain fragility, raw materials shortages, complex vaccine storage requirements, convoluted distribution networks and trade restrictions. Currently, the world produces 5bn doses across all vaccines annually; the challenging circumstances of the past year and a half have meant that production had to be ramped up to deliver 9.5bn doses. As a key player in global vaccine production, much rests on India’s ability to contain COVID-19 spread, lest it impact international supply.
Redirecting resources to this degree to increase manufacturing capacity, and the continued strain on Indian production chains due to the pandemic, threatens the production of other key medications. This has resulted in a parallel, ‘silent’ medical crisis: production of routinely prescribed vaccines for diseases such as measles and pneumonia, along with critical therapeutic cancer drugs such as monoclonal antibodies, have been delayed.
Vaccine inequities
The rush to vaccinate the populations of more developed countries contrasts starkly with the numbers reported in poorer nations. Compared to Europe and North America, which (at the time of writing) have so far administered at least one dose to 22% and 44% of their populations respectively, just 1% of people in Africa and 4.4% in Asia have received a dose of their vaccine.
The world’s richest countries have been accused of ‘vaccine hoarding’ by securing and reserving vast volumes of vaccines that are several times larger than their populations. A vaccine supply shortage is perhaps the biggest stumbling block in the vaccination pipeline. Cost is another issue: due to global demand for the Oxford/AstraZeneca and Pfizer/BioNTech vaccines, and the purchasing power of wealthier nations, poorer governments have been increasingly reliant on COVAX (a UN-backed global vaccine procurement scheme for equitable distribution), sourcing vaccines from manufacturers that are not favoured by richer countries, relying on donated vaccines and financing, or indeed developing their own formulations.
In April 2021, the World Bank announced it had approved US$2bn financing for the purchase and distribution of 19 vaccines for 17 countries, as part of the US$12bn ringfenced over 24 months to help developing regions. Collectively, COVAX and various countries have donated 73.4m doses to the developing world, with COVAX aiming to ship an additional 238m doses by mid-2021. These figures only account for a single jab for 1% of the world’s population, rising to 3% after the additional shipments.
Why should the rest of the world be interested?
Globalisation, interconnected economies and extensive trading networks mean that an economic or public health shock in one country can ripple across others.This could be through supply chain disruption, or the spread of a new variant leading to delays in the reopening of another country’s economy.
A report commissioned by the International Chamber of Commerce’s Research Foundation projected a loss of US$9.2trn in the global economy if governments fail to secure COVID-19 vaccines for developing economies by the end of 2021. Gavi, the vaccine alliance responsible for helping to co-ordinate the COVAX scheme, warns that stagnant vaccine rollouts across the developing world could result in advanced economies bearing US$4.5trn in additional economic loses. If developing countries were able to vaccinate half of their populations by the end of 2021, total losses could be minimised to US$4.4trn, with GDP losses in advanced economies more than halved to US$2trn.
“The global economy could lose US$9.2trn if governments fail to secure COVID-19 vaccines for developing economies by the end of 2021”
Impact on life and health insurance
The second wave coursing through India has shown that the pandemic is indiscriminate, affecting the young and the ageing, the wealthier and less well-off, the insured and the uninsured. As some countries start to emerge from the pandemic, secondary COVID-19 impacts will start to reveal a clearer picture of the disease’s long-term health effects, which could lead to a rise in disability insurance claims. Delayed surgical treatments and cancer screening programmes may result in increased critical illness claims; cancer patients are a particular cause of concern among the insured population, who may now present with more aggressive cancers that could lead to excess mortality.
There are lessons to be learnt from the experiences of countries that are beginning to ease their restrictions. Earlier this year, the Chilean vaccination drive garnered praise as it inoculated more than a third of its population in record time, racing ahead of the rest of South America and lagging behind only the impressive Israeli rollout. However, this positivity was short-lived as authorities, riding the high of their vaccine numbers, hastily relaxed national restrictions – resulting in a surge of new infectious cases and forcing the government to plunge Chile into another lockdown.
A high number of vaccines have been administered since December 2020 in the UK, and slow easing of social distancing measures commenced in March 2021. However, as parts of the country experienced hot spots of rising infection spurred by the Delta variant, the government paused the ending of lockdown restrictions for a month to enable more people to get vaccinated.
As variants continue to emerge, the long-term closing of borders will be an unsustainable measure for protecting a country from future surges. Restricted global mobility, employment losses and a substantial decline in expenditure across multiple sectors of industry have caused a deterioration of economic conditions.
A balance must be struck between financially detrimental lockdowns and the continued implementation of targeted public health measures. The primary exit strategy for many countries will continue to be high vaccination rates in conjunction with phased re-opening of societies. As such, there is a growing need to support the vaccination efforts of the global community, in order to shield our collective selves from looming health and financial crises.
Prachi Patkee is a life and health R&D analyst at Swiss Re and has a PhD in clinical neuroscience from King’s College London
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