Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com
We have been experiencing a winter storm in Norwich. It began on Sunday, as I started planning and writing the blog and continued up to the time it was posted. There have been Amber weather warnings for much of the south and east of the United Kingdom, with forecasts of snow and strong winds. It was not pleasant to be outside and I found myself wondering and worrying how the garden birds are faring. Hopefully, this will be the last bad winter weather for this season. It made the Covid-19 pandemic seem even bleaker.
The big news continues to be the vaccines. There are three vaccines in use in England and most of Europe. The UK’s evening ‘broadcast of doom’ used to only contain data on the number of new cases, the hospitalisations, and the deaths. It must be a relief for the news anchors to have something like ‘good’ news in the number of vaccinations that have been administered. I will talk about this in greater detail below.
It is pleasant to reflect on the fact that it is over a month since the failed insurrection and assault on the Capitol in Washington DC. That, to my mind, was the point at which Donald Trump let go of the last ounce of any real credibility he had. Joe Biden has barely had time to settle into the White House, but at least the country now has a President who listens to experts on the coronavirus, cares about the death toll of citizens, and is acting in response to the pandemic.
On Tuesday 9th February there had been over 106,500,000 cumulative Covid-19 cases recorded.1 Whilst the absolute number is high; data seems to indicate the number of new daily cases are declining. Globally they peaked (provided we ignore an outlier in early December) at 858,062 cases on 7th January, and by 8th February had fallen to 315,511. The steady decline is a pleasing trend and we must hope it is maintained. Globally daily deaths remain high. The peak, to date, was on 20th January 2021 when they stood at 17,884. It should be noted that data on confirmed cases will only be reflected in the figures for hospitalisations and deaths several weeks later. All data needs to be viewed with these lags in mind. It is also worth remembering there are consistent fluctuations during the week, with all numbers being lower over the weekends.
The United States continues to have the most cases, at just under 27 million. It is followed by India with close to 11,000,000 infections and Brazil with 9,500,000. On Tuesday 9th February, the United Kingdom was fourth on the table with 3,971,316 infections and had recorded 113,014 deaths. These figures are an absolute disgrace for a country as rich as the UK. It should, however, be noted that there have been significant declines in the number of new cases since mid-January. A possible result of the most recent lockdown. A conjecture that may help explain the mess is that the leadership does not have the bandwidth to deal with both Covid-19 and the chaos that is Brexit. Of course, when the history of this epidemic, and the failure to control it, comes to be written there is little doubt that the other unique failures will become apparent.
The countries with more than three million infections are Russia and France. Spain, Italy, Turkey, Germany and Columbia all have more than two million cases. Those that currently fall into the ‘millionaires’ club at present are Argentina, Mexico, Poland, South Africa, Iran, Ukraine, Peru, Indonesia, Czechia and the Netherlands.
The epidemic seems to have remained under control in a small number of countries: China, Taiwan, Korea, Japan, Norway, Australia and New Zealand provide examples. The data in many, particularly African, countries show low numbers of cases and even fewer deaths. This must be weighed against press reports of crowded hospitals, shortages of oxygen, and overworked medical staff. It seems there is considerable underreporting.
Essentially, my reading of the data is that there are three ways out of the pandemic. First, control is possible, as seen in New Zealand or China. But it comes at a cost, either of personal freedoms or national isolation. Second, if enough people are infected and recover, it is possible there may be a form of herd immunity. Data suggests that considerable numbers of people may fall in this category, in some countries, but the variants that are emerging may make this a forlorn hope. The third, final, and best option is immunisation.
All the evidence suggests vaccination will be critical for bringing Covid-19 under control. Although the Chinese government faces much criticism about their handling of the outbreak, their release of genetic data on 11th January gave scientists the ability to seek to develop vaccinations.3 There was a rapid increase in the number of organisations and academics engaged in this and by June 2020 there were over 125 vaccines in development.
Currently there are 10 serious contenders. The three Western developed ones already in use are:
- Pfizer/BioNTech, a US and German partnership. This is said to be 95% effective. It was first approved by the UK on 2nd December 2020 and subsequently (and to date) by Canada, the US and EU. It requires two doses and costs $20. The main disadvantage is that it requires storage at -70°C.
- Moderna was developed in the US and is said to be 95% effective. It was first approved on 18th December 2020 in the US and subsequently in Canada, the EU and the UK. It does not need any special storage and costs $32.
- AstraZeneca/Oxford was developed as a partnership between the British-Swedish company and the UK’s Oxford University. It was initially hailed as 70% effective and approved in the UK, India, and the EU. It costs the least at just $3-5. See the section on variance below.
Close to approval are the US based companies Novavax which requires two doses and is 89% effective, and the Johnson & Johnson candidate which is 66% effective and needs a single dose.
There are also three Chinese vaccines that are in use: Sinovac Biotech which is 50% effective; Sinopharm at 79% effectiveness, and CanSino Biologics at 65.7%.4 There is also a Russian vaccine Gamaleya or Sputnik which is reported to be 92% effective. These vaccines have all been administered without the trials to obtain approval demanded by western countries. As has been noted the key is to develop effective vaccines and administer them.
A major concern is the development of new variants of the virus that may be resistant to the vaccines. There are three variants currently being reported on: one from Brazil, one from Kent in the UK and the South African variant. Naming the variants in this way does not imply blame, but rather where they were recognised. The world class science and laboratory capacity in South Africa is something of a double-edged sword.
The South African variant was reported to be significantly more infectious although not necessarily more deadly. It should be noted that simple percentages mean a more infectious virus will lead to more hospitalisations and deaths. This resulted in South African health minister Dr Zweli Mkhize announcing a shift in the vaccine roll-out in that health workers will receive the Johnson & Johnson single dose vaccine or the Pfizer vaccine.
‘The shift was necessitated by the publication of what the lead investigator in the Oxford/AstraZeneca trial, Professor Shabir Madhi, said were “disappointing results” showing that the vaccine did not work well against the South African variant of the coronavirus. …. first identified in November 2020 in cases from Nelson Mandela Bay. At present, more than 90% of positive cases of coronavirus infections in SA are caused by this variant’.5
According to the Telegraph:
‘Is it a case of taking two steps forward and one step back? The Oxford-AstraZeneca vaccine may be only 10pc effective against the South African variant … The results of a new study show the jab offers virtually no protection against mild to moderate illness – meaning it is likely to allow the virus to spread. But scientists believe the jab … should protect against hospitalisation and death from the variant. The full details came to light as UK ministers sought to bolster public confidence in the vaccine programme.’6
On the other hand, in the Guardian, Health Secretary Matt Hancock downplayed the issue.7 The deputy chief medical officer for England, Jonathan Van-Tam,
‘was rather more reassuring. Yes, the South African variant was a worry because the Oxford/AstraZeneca vaccine only seemed to offer limited protection against it, but it was looking as if our very own Kent variant was actually far more transmissible. Which was a good thing because that meant there was much less chance of the South African variant becoming the dominant strain and our vaccines had been proved to be highly effective in combating the UK variant.’8
My overarching impression is that there is not enough information to make decisions or reach conclusions, this is a rapidly evolving story. Science should not be done by press release and reading a few stories can be confusing.
The Bloomberg vaccine tracker, cited in footnote 2, is a brilliant resource. One of the really interesting outcomes of this pandemic is the quality of data presentation. There does need to be a reminder here though. Good data output depends on good and honest data input. I reproduce below a graphic from Our World in Data9 on vaccine doses administered. This shows the UK is doing extraordinarily well with their vaccination programme. Certainly, I personally know an increasing number of people who have received the vaccine. It should be remembered that Israel’s great success is just in reaching Israeli citizens, not Palestinians.
Of course, there are many questions as to who will get the vaccines and when, both within and between countries. Writing in the Guardian Paul Kagame, President of Rwanda, notes
‘Until Africans get the Covid vaccinations they need, the whole world will suffer. We’re not asking for charity, but fairness – instead of the hoarding and protectionism currently in play’.10
A useful website is https://pandem-ic.com/about/ which includes an equity tracker.11 Administration of vaccines is downstream of development and distribution and requires attention.
This is an extremely complex topic and rather than go into it in any details I will highlight some core issues. There has been a huge investment of public money. In the UK the government planned to spend £100bn on expansion of its national testing programme ‘Operation Moonshot’.12 The US project was called ‘Operation Warp Speed’13. The People’s Vaccine Alliance argues that the supply of safe and effective vaccines is rationed because of the protection of exclusive rights and monopolies of pharmaceutical corporations. It
‘warned that the three biggest vaccine companies (GlaxoSmithKline (GSK), Merck and Sanofi who received over $2billion from the US as part of Operation Warp Speed… are largely sitting on the sidelines – they currently plan to produce enough COVID-19 vaccines for only 1.5 per cent of the global population in 2021.’14
I will end this week’s blog with one graphic from the Kaiser Family Foundation.15 The main cause of death in the USA in January 2021 was Covid-19. It accounted for an average of more than 3,000 deaths per day. Covid-19 is significantly higher than other leading causes of death. In the US heart disease was typically the number one cause of death, followed by cancer. This must be deeply concerning to the new administration and certainly is an indictment of the failures of Donald Trump to take the disease seriously and provide leadership.
Professor Nontombi Mary Lucy Mbelle attended Waterford Kamhlaba in Swaziland in the 1970s. She was the head of the Department of Medical Microbiology in the School of Medicine at the University of Pretoria. Rest in peace, and condolences to her family, friends and colleagues.
Thank you for reading, reposting and providing comments. What I write is public domain so please share, forward and disseminate. My contact is: firstname.lastname@example.org
- Johns Hopkins Coronavirus Resource Center, https://coronavirus.jhu.edu/map.html
- The best website is https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/
- isa Schnirring, News Editor, ‘China releases genetic data on new coronavirus, now deadly’, University of Minnesota, Centre for Infectious Disease Research and Policy, http://www.cidrap.umn.edu/news-perspective/2020/01/china-releases-genetic-data-new-coronavirus-now-deadly
- Estelle Ellis, ‘South Africa switches to J&J’s ‘silver bullet’ as AstraZeneca vaccine falters against local variant of coronavirus’, Daily Maverick 8 February 2021 https://www.dailymaverick.co.za/article/2021-02-08-south-africa-switches-to-jjs-astrazeneca-vaccine-halted
- The Telegraph, Front Page email alert, Monday 8th February 2021
- John Crace, ‘Matt Hancock almost blows it with a mention of borders and quarantine, The health secretary tries to stay upbeat despite the bad news about the South African variant’, The Guardian 8th February 2021, http://www.theguardian.com/world/2021/feb/08/matt-hancock-almost-blows-it-with-a-mention-of-borders-and-quarantine
- The Guardian https://www.theguardian.com/commentisfree/2021/feb/07/africans-covid-vaccinations-pandemic-paul-kagame
- Covid-19: Government shelves plans to invest £100bn in mass testing BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4112 (Published 23 October 2020) BMJ 2020;371:m4112