Of Birds and Viruses

I have officially been retired since Saturday 1st January, or perhaps, to be pedantic, since midnight on 31st December 2021. I must confess to feeling a little uncertain as to what the future holds. There needs to be a plan, budget, and cash flow projection, all but the first can be done quickly. The Covid crisis has made planning difficult. I really want to do some travelling, but it is hard to book tickets with any confidence. This is changing slowly though. It is hard to believe that the world began this seismic shift just two years ago. I became aware of this new disease in January 2020. I had no idea how rapidly and far it would spread, or the incredible disruption it would cause. More on this later.

One thing I am really enjoying is the birdlife in the garden in Norwich. I did not realise how having a cat and a dog reduced the visits from the birds, even though they (the cat and dog) were not hunters and chasers. Both have been gone for over two years. While they are greatly missed, there are some benefits in terms of the other creatures we are seeing. The most common visitors are blackbirds, up to 15 at peak, all squabbling individuals. Second are blue tits who feed from the hanging feeders. The other regulars are gold finches, magpies, robins, dunnocks and the occasional jay. The pigeons are ubiquitous, they are large bullies and, in my eyes, don’t count. Sadly, although there are delicate doves in the suburb, we are not on their feeding route.

To encourage the birds, we have bird feeders; spread seed on the garden every morning; and have fat balls hanging on the bushes and on the ground (in metal cages). To my amusement a couple of the blackbirds try to act like hummingbirds. They attempt to hover in front of the feeders, flapping and pecking furiously. They do not have any comparative advantage in this activity. We are not surprised to see the squirrels getting chubby, despite having to get the food through the mesh.

About once a week a sparrowhawk makes a pass over the suburb, much to the alarm of the rest of the gang. Today, though, it was perched in a tall tree at the end of the garden waiting for the food to be spread. Perhaps it saw this as a breakfast buffet, not the seed but the birds! It was spotted because of the unusual behaviour of the blackbirds; they were perched nervously in one of the bushes, unwilling to go down to the ground.

I won’t turn into a ‘twitcher’, but I love seeing and hearing the birds. Just one more bird related observation. While the garden has a rich variety of birds, there are sparrows and starlings living on our road, perhaps 200 yards away. They do not ever seem to come to our end. Are we in the ‘better’ or ‘worse’ neighbourhood? Is there no space for them in the micro-environment? I would love to see sparrows in our hedges, they are such cheerful little creatures.

In 2013 I left Durban, cleared out my office and kept some papers and books, shipping them to Canada. After 30 years it was a herculean task. Earlier this year I did the same for my office and my flat in Waterloo, this time shipping boxes to Norwich. Over the next few weeks, I will go through my home office and attempt to rationalise it. The criteria: will I ever read this again? If the answer is no it can go. There are whole canons of papers and books that have little relevance now. The best place to donate books of all types is Oxfam. They seem to sort out and deliver to places where most obscure material can be sold or recycled, and this includes academic material.

The books are relatively easy to deal with. As I work though my office it is apparent that papers and reports will be more problematic. I have a considerable stack of these too, and they can be kept or recycled. There is also the question of confidentiality, some are sensitive and should be destroyed rather than put in a wastepaper bin. At the end of this process, which might take another month, since I am doing it in phases, I will need to deep clean and perhaps refit. And then there are still the CDs to be sorted out, and there must be 200+ of these.

Covid: an incomplete update (4th January 2022)

This month marks an important anniversary of the pandemic. It has been two years since it emerged and swept across the world. In March 2020 I began blogging on Covid-19. The first blog stated:

“I am expected to know something about epidemics and pandemics, and their causes and consequences. Many friends and colleagues have been asking me about Covid-19. Here is a quick ‘fact sheet’ as of 4 March – what we know, what we don’t know, and what we need to know”.

The blog was initially published every week then in 2021 less frequently. By the middle of 2021 I was unable to keep going. The reasons for ending it were:

“it was surprisingly time consuming; the situation with regard to the science, numbers and response is increasingly complex; and it was getting too depressing to keep going.”

The last blog was on 11th August 2021. Before Christmas I sat down to write an update but did not get very far, so let me try again.

The numbers and epidemiology

There are excellent, accessible data websites.1 As of 4th January there had been 292,567,808 cases and 5,449,575 deaths globally. There had been 9,214,046,229 vaccine doses administered. At the end of 2021 and in early 2022 the number of new cases had risen from about 5 million per week to over 10 million. At the peak, a year ago, there were just over 100,000 deaths per week, currently there are about 42,000. Vaccination rate stands at over 250 million per week.

The top three countries on 4th January were the US with 56,191,733 cases and 827,749 deaths; United Kingdom with 13,497,515 cases and 149,367 deaths; and France with 6,667,511 cases and 89,573 deaths. The OECD countries dominate the pandemic. In Africa, South Africa leads the pack at 3,475,512 cases and 91,312 deaths. In South America Argentina has the most cases, 5,739,326 and deaths, 117,245. In Asia it is India that leads with 34,960,261 cases and 482,017 deaths. China – where this all began has recorded 115,597 cases and 4,849 deaths, with new outbreaks being reported over the past few days. The Chinese data seem remarkably low.

The take home message is that waves of infection are inevitable and seemingly unstoppable. The UK is in its third (or possibly fourth wave), the USA is in the third major wave. In South Africa, at the beginning of January, the Cabinet stated:

“All indicators suggest the country may have passed the peak of the fourth wave at a national level.”2

However, these are waves of infections, the numbers of hospitalisations and deaths, while following the same pattern with lags, are very much lower. There is consensus that prevention messages have been heard and populations have adopted and maintained these without governments necessarily forcing them to do so. Vaccinations have given a measure of immunity, although these have not been made available equitably. In addition, the idea of herd immunity seems to have come back into play in some settings, simply because so many people have been infected. The surge may appear contradictory, but it can be primarily attributed to Omicron. The fall in illness and death is due to vaccination and advances in medicine.

Over the past two months a new variant has come to dominate. Omicron, as it is officially named, was first identified in Southern Africa. It spread with amazing rapidity across the world and quickly overtook Delta as the dominant strain. There is much that is not known about this variant and scientists are generally unwilling to commit themselves. Early indications are that it is very much more infectious than any other variant. It seems consequent illness is generally mild. The problem is that if under normal circumstances 100 people are infected and five percent need medical attention, only 5 patients need care. With Omicron, 1,000 people are infected and only one percent need care, that is 10 patients. Nonetheless there is cautious optimism that the Covid crisis will be over soon.

Vaccines

The incredible advances in science meant vaccines had been developed within the first year and could be rolled out in the second year. There was not just one vaccine, but three from the OECD countries (Oxford-AstraZeneca, Pfizer, and Moderna), two from China and one from Russia. Progress continues with potential additional vaccines being developed and being trialled. Existing ones are being improved. There may be new variants but there is optimism that vaccination will keep pace with this. Vaccines are however highly political at many levels.

There has been a great deal of coverage on the inequity of vaccine distribution and administration. The wealthy countries were able to make vaccinations available to most of their populations very quickly. In many poorer countries governments have been unable to acquire the necessary doses, despite numerous grandiose sounding proclamations about ‘leaving no one behind’.

The consensus is that three doses are required to provide immunity. Originally two doses of most vaccines were prescribed, then a booster dose was added. It would be more honest to simply say it is a three-dose course. What we do not know is how quickly the immunity will decay.

“Now Sir Andrew, the head of Britain’s vaccine body, has warned that fourth Covid jabs should not be offered until there is more evidence they are effective, as he said giving boosters to the whole population every six months was “not sustainable”.”3

I believe Covid will be like with a shot needed every year.

A challenge in the OECD countries is vaccine hesitancy, people who are not willing to be vaccinated. Some news programmes have featured doctors expressing frustration. To paraphrase:

“Of course we will treat everyone who needs it, but when you have a Covid patient who has not been vaccinated and now says they wish they had, then we wonder.”

All the evidence is that vaccination makes a huge difference and prevents adverse outcomes, data can be found in the footnoted article.4 However vaccination alone will not halt the pandemic. It might happen that, where resources are scarce, access will be rationed by willingness of people to come forward. It makes some sense but is probably impossible to operationalise for equity and ethical reasons.

Treatment5

At the beginning of the pandemic there were no drugs specifically available for Covid. This is not surprising as the disease was new. Initially some drugs were repurposed, some successfully. By January 2022 the New York Times reported there were 33 drugs: one with FDA approval, seven widely, and five with promising evidence. One potential bottleneck is that drugs must go through an approval process which may differ from country to country. One of the advantages of the European Union is centralised drug approval.6 Vaccines will mean fewer people are infected, develop serious illness, need hospitalisation and die of Covid. Drugs mean some can be treated at home and won’t need in-patient care while, for those unlucky enough to be admitted, the prognosis is much better.

Consequences

Since Covid appeared I have warned of the economic, social, psychological and political effects. They are still unfolding and need more time and space if I am to do them justice. I can talk from the OECD perspective. The 5th January was the first day of the new school term in the UK. The news has been dominated by the fears of educationalists that they will not be able to provide education because of staff absences. The National Health Service (NHS) is in a similar position as so many staff are absent. These people are generally not sick but have had a positive Covid test or been in close contact with an infected person.

It is not just the public sector that is facing these challenges. British commuters have been warned that staff absences mean services on many trains to and from London (and other cities) have been cancelled.

“Around 8,000 flights were cancelled worldwide between Christmas Eve and Boxing Day – approximately 3,000 of which were due to go to or from the US.”7

“Public sector leaders have been asked to prepare for “worst case scenarios” of 10%, 20% and 25% absence rates, the Cabinet Office said.”8

The ‘Consequences of Covid’ may be the research project I take up in retirement. It needs people I can work with, and ideally some funding for them. If anyone has ideas let us talk.

We should not underestimate the divisiveness of this issue. The BBC reported French MPs as saying they received death threats when they debated a Covid-19 pass. The law would require people to show proof of vaccination to access public venues and transport.

“On Sunday Agnès Firmin Le Bodo of the centre-right Agir party tweeted an email she received containing graphic threats to kill her over her support for the vaccination pass. “Our democracy is in danger,” wrote Ms Firmin Le Bodo, who is also a pharmacist and vaccinates people against Covid.”9

What to watch out for10

Increasingly the discourse is that we cannot eliminate Covid so will have to learn to live with it. Despite the astonishingly high case rates reported in a number of countries at the moment, it is generally believed they will not turn into unmanageable hospitalisation and death rates. I am prepared to stick my neck out and predict that in OECD countries the pandemic will be under control by the end of 2022. There may be continued restrictions to life such as facemasks on public transport, but these will be limited and not too invasive. The situation in poorer countries will probably be more Covid, but the demographics will remain protective.

The rules change and it may be for political reasons. The advisors in England have been keen to stress they ‘advise’ not instruct. It is up to the government to set rules and make decisions. At the moment in England a person must self-isolate if they develop symptoms or receive a positive test result. The period has been reduced from ten to seven days. Two negative lateral flow tests (LFTs) are required to end self-isolation.11 We need to monitor the restriction of liberty and not be afraid to challenge it, but as David Spiegelhalter and Anthony Masters said in an Observer column “beware of people who use the line: ‘I have done my own research’.”12

Above all we need to ask how to help those who have been disadvantaged by the events of the past two years, this includes material and mental impact. Along with the climate crisis, Covid shows it can not be business as usual.


  1. https://coronavirus.jhu.edu/map.html and https://ourworldindata.org/coronavirus
  2. https://www.theguardian.com/world/2021/dec/31/omicron-fuelled-fourth-covid-wave-has-passed-says-south-africa-as-it-eases-restrictions
  3. The Telegraph, ‘Vaccine expert says jabs will need to be restricted’, 4th January 2022 http://m.email3.telegraph.co.uk/nl/jsp/m.jsp
  4. https://www.medscape.co.uk/viewarticle/hospitalisation-risk-omicron-variant-around-third-delta-2022a10000kc
  5. New York Times, Coronavirus Drug and Treatment Tracker, accessed 3rd January 2022 https://www.nytimes.com/interactive/2020/science/coronavirus-drugs-treatments.html
  6. Although this blog is primarily about Covid this is yet another reason to rue the day the referendum voted for Brexit. It is painful to realise how much the UK lost.
  7. https://news.sky.com/story/covid-19-christmas-travel-disruption-as-omicron-hits-rail-and-airline-staffing-12504644
  8. https://www.bbc.co.uk/news/uk-59848109
  9. https://www.bbc.co.uk/news/world-europe-59860058
  10. Nature, COMMENT, “Two years of COVID-19 in Africa: lessons for the world”, 03 January 2022 https://www.nature.com/articles/d41586-021-03821-8
  11. BBC News, ‘What are the Covid self-isolation rules now?’ 31 December 2021 https://www.bbc.co.uk/news/explainers-54239922
  12. David Spiegelhalter and Anthony Masters, “Can you capture the complex reality of the pandemic with numbers? Well we tried…”. The Observer 2nd January 2022

Lovely Lisbon and Demonstrating in Norwich

I went to my first conference in nearly two years last month. It was fantastic for many reasons: a chance to get out of the UK; visit a new country and city; meet with colleagues; catch up with developments in the field; and above all be reminded of what we had lost. My word I enjoyed myself. The primary purpose of the trip was to attend the International Association of Providers in AIDS Care’s (IAPAC) Fast-Track Cities 2021 Conference.

To their credit the conference organizers included Covid-19 in the programme. My presentation, which I shared with Corey Prachniak-Rincon, an IAPAC staffer, was on ‘Exploring Legal, Public Policy, and Finance Dimensions of Health Responses.’ The take-home messages were not encouraging, until Covid is on the decline, HIV will not be a priority, even though it (HIV) is not going away. The number of HIV infections continues to rise.

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The clock ticks

I was shocked to see it has been over a month since I last posted. I have two countdowns going on in my life. The first, at the end of 2021 I will get my last salary cheque. Apart from a few short ‘student type’ jobs, since 1980 I have always had someone paying me a regular income. The short jobs in Swaziland included working for a school book supplier one holiday, and a week as a ‘hanger round’ at the Central News Agency in Mbabane. In the UK I spent a week packing bulbs (tulips and daffodils) etc. in a warehouse, ironically in the industrial site near where we live. I was fired for being too bolshy. I also spent three summer months as a warehouseman in Her Majesty’s Stationery Office. The second milestone is, in March 2022, on my 66th birthday, I become eligible for a British State pension.

Most young people, certainly those under 40, see people aged 50 to 80 here as an exceptionally fortunate generation. This is true for a high proportion of us. We had access to free university education, jobs, and many will get a state pension that, while not hugely generous, is significant. We were able to travel widely. We only became aware of the appalling damage we have wrought on the world, in terms of over exploitation and environmental damage, as we were doing it.

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What’s next, I ask?

Welcome to the first of my monthly, meandering blogs, put on my website, and emailed to everyone who signed up to receive my news. Let me begin with a warning, this is not primarily about Covid, so you may wish to take yourself off the list. Obviously, I am still following Covid, but no longer closely, and certainly not enough to write regular posts. Having said that here is something everyone should read – “How the risk of side effects could change with Covid-19 vaccine boosters” – we are all, probably going to offered these soon.

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And, finally, for now

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

On 4th March in 2020 I started posting a ‘Covid-19’ blog to replace my normal monthly meanderings. It began:

“I am expected to know something about epidemics and pandemics, their causes and consequences. Many friends and colleagues have been asking me about Covid-19.

Here is a quick ‘fact sheet’ as of 4 March – what we know, what we don’t know, and what we need to know. I include hot links. Please feel free to send it on.”

Initially I used red text to indicate where figures or information would change, and bold text to show key points. I managed to keep up a weekly report for over a year. I then reduced it to every two weeks, but gaps increased and I am afraid I lost steam.

More than a month after I previously posted my Covid blog, this is the last. If you are getting it as someone who signed up for the Covid update you might want to ‘unsign’. If you do not, you will continue to receive my monthly personal blog. This is about what I am doing, books I am reading, ideas, and the minutiae of daily life – there is a lot about flights, airports and aircraft. The first of this new series will be posted in a couple of weeks.

As to the reasons for me ending this blog, the main ones are: it was surprisingly time consuming; the situation with regard to the science, numbers and response is increasingly complex; and it was getting too depressing to keep going. There are plenty of other people doing what I was trying to do. Nonetheless there are still areas that are ripe for research and writing. In particular the consequences of the pandemic, its economic, social, psychological and political effects. They are, of course, still unfolding.
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Announcement: The Next and Last Pandemics – The Consequences of COVID-19 and its Impact on the HIV/AIDS Response

The University of the West Indies, HEU, Centre for Health Economics, International AIDS Economic Network (IAEN), and the Pan Caribbean Partnership against HIV and AIDS (PANCAP), invite you to participate in a virtual discussion on “The Next and Last Pandemics – The Consequences of COVID-19 and its Impact on the HIV/AIDS Response”, Wednesday, 21 July 2021 from 9:00 AM – 11:00 AM Eastern Time.

You can register for the virtual discussion by clicking here.

Poster for "The Next and Last Pandemics: The Consequences of COVID-19 and its Impact on the HIV/AIDS Response" virtual discussion

Fatigue

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

Regular readers will have noticed that it is three weeks since I last posted a blog. I am planning to write one more piece after this and will then end regular posts on Covid-19. I will still blog once a month but it will be a more general article. There are several reasons for this: preparing and writing is time consuming; the situation with regard to the numbers and response is increasingly complex, it might be possible to focus on one continent, but globally the situation is ever more diverse; it has dawned on me how incredibly disruptive and damaging the pandemic is, frankly it is too depressing to keep going; and finally there are many other resources available. Among them is pandem-ic.com:

‘This personal site provides data analytics on the COVID-19 pandemic through the lens of the World Bank country income classification – hence “pandem-ic”.’

It is produced by Philip Schellekens, a Senior Economic Advisor at the World Bank Group, but is a personal blog.1
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Are we winning? Yes and no!

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

I finished my quarantine in my Waterloo apartment a week ago. I had three days confined in an airport hotel and then 11 more in Waterloo. The government was efficient at checking up on me. Every day I got an automated email with a weblink, and had to complete a form online. There were at least two phone calls and one visit from a private investigator, who had been repurposed as a quarantine inspector, complete with stab proof vest. He came to the door of the apartment, but said he was not allowed to enter it – which somewhat defeats the objective of checking.

The whole of the post-hotel quarantine depends on the honesty of individuals entering Canada. The press has reported, with outrage, of people flying to American airports and crossing the border by road, thus avoiding some of the more intrusive processes. I must be honest and say it was not too bad, though the current lockdown is wearing. Friends made sure I was well supplied with the essentials (food and wine), and so my incarceration went by reasonably quickly. But then I have a large apartment with a great view. I am privileged and I recognise it.

My overarching impression in Ontario is of a province on its knees, and an overwhelming weariness with the whole process. The smiles are becoming fixed, that is when you can see them because people wear masks outside. The problem is the lack of clarity and consistency. As I understand the situation, rules are enforced at the local level. Where I am, it is enforced by Region of Waterloo Public Health. They work closely with Public Health Ontario, the relevant section of the provincial government, which sets policy, and at the national level, with the Federal Ministry of Health. The lockdown is tight; people should only leave their homes for essential reasons, socialising is not allowed, and currently schools are closed. This last regulation has, as in Europe, had an extremely detrimental effect on children and their parents.

A large part of the problem is the Provincial Government, run by the Progressive Conservative Party of Ontario under the leadership of Doug Ford. The world over, conservative governments have reduced public health expenditures and services, and Ontario is no exception. Indeed, Ford was forced into a humiliating climb down when he attempted to announce that the provincial police would enforce his regulations,1 only to have various forces announce the next day that they would not be doing this.2 The numbers in the province are coming down slowly. There is a decent website3 giving data for the province. The citizenry needs clear guidance and, above all, to know the nightmare will end soon, but this is lacking.

The little mall across the road has a security officer at a desk at each entrance. Their task: to ask each customer if they have any Covid symptoms as they enter. It would take a pretty stupid individual to admit to having signs of Covid. I suppose it is important to be seen to be doing something, and this has certainly created employment. Interestingly most of the security officers seem to be recent immigrants from Southeast Asian countries. That probably indicates that these are minimum wage jobs.
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Vaccination: the way ahead

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

This is being written as I quarantine in my Waterloo apartment. Getting here was surprisingly easy, despite a great deal of bureaucracy. The story began in December 2019 when I travelled from Waterloo to the UK for a year’s sabbatical. I planned a busy year, with visiting fellowships at two German and a British University, and visiting status with two English Universities. It was set to be a full, productive, and fun year. And then Covid-19 arrived, and everything was put on hold. I did not leave Norwich for over a year but making a trip to Canada was increasingly urgent. Travel was not easy, cheap or pleasant.

The first step was getting permission to leave the UK. International travel was not allowed until 17th May, unless the traveller has good reason. There is, of course, a government website. The “Declaration for International Travel” has a drop-down menu of about 10 reasons, from ‘Work’ to ‘Other reasonable excuse – please specify’. I dutifully completed and printed it. No one asked to see it at any point. There were no flights for my preferred route (Norwich, Amsterdam, Toronto) so I booked from Heathrow. There is extensive guidance on travelling to Canada on the Canadian government website. Only four airports accept international flights: Calgary, Montreal, Toronto, and Vancouver. At the moment, there is no recognition in the terms of travel and restrictions of vaccine status. I am fully vaccinated and have a flimsy little record card to prove it. I made photocopies for officials. No one asked or showed an interest.

To enter Canada (and various other countries) a traveller has to have a negative Covid test within three days of boarding. In the UK, private laboratories produce a “Fit to Travel Certificate for SARS CoV-2/Covid-19 Testing”. At a price of course. Also required is an arrival form to allow border officials to track you.

“Speed up your arrival process in Canada and spend less time with border and public health officers. Use ArriveCAN1 to provide mandatory travel information… Help … keep Canadians safe and healthy.”

The aircraft, a Boeing 787 Dreamliner, seats about 250 people. I booked myself in the premium economy section for more room. What a waste of money, there were only 19 passengers! There was a full complement of very bored cabin crew and consequently we had excellent service and some interesting conversations. Clearly, they had time to check the passenger list, halfway through the journey they began addressing me as Professor!

On arrival getting through the Canadian formalities was straightforward. The test is a nasal swab. There was no interest in my vaccination status – but there were a few comments on Canada’s failure to roll out a vaccine. Mind you I was on an empty plane; the next scheduled flight from Manila had 350 passengers. The government requires you to pay for three days’ quarantine in a hotel. My choice was a bog-standard business hotel, where the confinement included three meals brought to the door in large brown paper packets. I understand Pavlov’s dogs better now. Within 24 hours I recognized the rustle from the moment the delivery person exited the lift. There was nothing to get excited about on the menu though.

At Heathrow I bought a couple of bottles of duty-free wine and when I checked into the hotel, I asked for a third. The clerk said that he was glad I asked before he checked me in. He is not allowed to send alcohol to the quarantine rooms! There was no corkscrew in the room and the desk said they had none so here are some tips.
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The Gap Widens

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

On 2nd May I had my second Covid-19 vaccination. It was my decision to have it earlier than the prescribed 12 weeks to acquire when I travel later in the month. The programme is so efficient, as before. The vaccination centre is in the food court of a major shopping mall in the city. At 4 pm on Sunday I walked in, and 5 minutes later, walked out newly vaccinated. I had the Oxford/AstraZeneca vaccine. It is incredible how rapidly the programme has been scaled up. This probably cannot be maintained so a question is: how often booster shots will be needed? We simply do not know; my guess is it will be annual.

Although I and many readers live in countries where immunisation programmes are moving rapidly, we need to remind ourselves that the Covid-19 pandemic is not over. At the moment there are parts of the world where it seems to be under control: notably the UK and USA. There are places where progress has been and continues to be made: most of Europe falls into this category. Parts of Asia (China and South Korea) and New Zealand and Australia have managed to keep the incidence of Covid-19 cases to exceptionally low levels. Much of South America is in the grip of an expanding pandemic. In Africa, except for South Africa, numbers seem low. The news, though, is dominated by events in India.1

On Saturday, April 17, the world passed three million reported deaths due to Covid-19. The true total of cases and deaths may never be known: cases because many people have no or slight symptoms, and deaths because of under reporting in many countries. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) warns the world is

“approaching the highest rate of infection”

so far in the pandemic, and several countries are facing

“a severe crisis, with high transmission and intensive care units overflowing with patients and running short on essential supplies, like oxygen.”2

In addition, there is the question of Covid variants, where are they emerging, how fast, and how should the global community respond?3

The health, social, and economic impact of the pandemic is still to be felt in its true magnitude. The only good news is the speed with which vaccinations are being delivered, although there is unevenness in the pace with which populations are reached, both between and within countries. This is the Matthew effect from the verse in Matthew Chapter 25,

“For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.”4

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