Global COVID-19 deaths set to reach 2 million, with rising concerns in Africa

Just over a year since the first death due to COVID-19 was recorded on Jan. 11, 2020, in Wuhan, China, global deaths are set to reach 2 million.

It has taken the world less than four months to go from 1 million deaths on Sept. 28, 2020, to 2 million on Jan. 15, 2021.

Today, 12 out of every 1,000 people globally have been confirmed to have contracted COVID-19, and 2.5 out of every 10,000 people have died. With the roll out of vaccines, experts anticipate there will be a reduction in mortality.

“In our projections, we don’t see three million [deaths],” Ali Mokdad, professor of health metrics sciences at the Institute for Health Metrics and Evaluation, told Devex. 

But challenges in vaccine access for low- and middle-income countries, a growing rate of daily deaths in Africa, and vaccine hesitancy are a current concern.

Where the second million emerged

The United States has been responsible for almost 18% of the second-million deaths, with more than 180,000 deaths linked to COVID-19 since Sept. 28, 2020. Since the beginning of 2021, the U.S. has averaged just under 3,000 new COVID-19 related deaths daily, with total deaths now in excess of 380,000.

Brazil added over 64,000 deaths to the global total since Sept. 28, 2020, recording over 200,000 deaths to date. Mexico added over 60,000 deaths bringing its total to just under 140,000 deaths, and India added over 56,000 deaths over the last 4 months.

The death toll in Italy, home to an early outbreak of the pandemic, is now over 80,000, more than double the number in September 2020.

The European and Eastern Mediterranean regions of the World Health Organization have recorded the largest percentage growth in deaths. The European region has seen a growth of approximately 180%, and the Eastern Mediterranean region, growth of 110%. Georgia, Jordan, and Slovakia are among the countries that have seen rapid growth since Sept. 28, 2020, and the region has added more than 30,000 deaths in this time, up from 2,447, and Czechia has added more than 13,250. On Sept. 28, its death toll sat at 606.

Mokdad said the northern hemisphere winter and the new COVID-19 variant identified in the U.K. were responsible for the increase in infections and deaths. But there was also an unexpected surge in cases in South America.

“Unfortunately we expected in the southern hemisphere … that some of the countries would be in a better position right now, but we are seeing surges in Brazil and other countries,” he said, with Christmas and New Year celebrations providing opportunities to spread the virus.

Bhutan, Eritrea, Grenada, Mongolia, Saint Lucia, and Seychelles have also reported their first COVID-19 deaths since September 2020.

Rising concerns in Africa

Cases and deaths in Africa account for less than 3% of the global total, but exponential growth in COVID-19 cases is a growing area of concern.

Two million confirmed cases of COVID-19 were reported on Jan. 6 among countries part of the WHO African region, with cases fast approaching 2.3 million. At more than 50,000 deaths by Jan. 14, the case fatality rate in the region is now at 2.4% — higher than a global average of 2.1%. A total of 16 countries in the WHO African region are reporting case fatality rates above the global average. For Chad, Liberia, and Tanzania, this rate is in excess of 4%.

From Jan. 4-10, the region reported 3,407 new deaths, a 14% increase in mortality from the week prior. In terms of what’s driving the rise in COVID-19 mortality in the continent Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said in a press briefing on Thursday that as more people get COVID-19 infections during the second wave of the disease in the continent, one can expect more hospitalizations. But with “inadequate health systems to support that, you expect that mortality will increase.”

Against the backdrop of increasing deaths in the African continent, Nkengasong said training for mortality surveillance among health care workers has begun in 10 districts of Uganda, with the plan to extend the program across the continent.

3 million deaths are unlikely

In producing projections on COVID-19 cases and deaths, IHME is taking into consideration a range of factors, including reported effectiveness of vaccines, ability to produce the vaccine, rollout plans, and vaccination hesitancy data.

Speed of roll out and uptake is an important part of the IHME model on projecting higher or lower numbers, with a faster roll out expected to save more lives. Data on the availability of physicians and the capacity of health care systems help determine how many doses can be delivered daily within a country.

“Rolling out the vaccine as fast as you can is the best strategy,” IHME’s Mokdad said. “Anybody who is willing to take it, give it to them.”

But also important is the behavior of people once they get the vaccine.

In surveys that IHME is monitoring, Mokkad is seeing that of people who take the vaccine, 25% are saying that they will not wear a mask after getting the vaccine. “We’re accounting for that,” he said. And the effectiveness of the vaccines being delivered — which simply refer to its ability to prevent serious illness — is also part of the model to identify the potential of continued spread.

“About 50% will still get the disease for certain vaccines and 30% for others,” Mokdad explained. “They will get a minor [infection], but they could still be infectious and spread the virus somehow. How many could still be spreading is important to model.”

Targeting the populations hesitant in taking a vaccine will also be important in reducing global deaths, and that will require a very clear communication strategy. Mokdad said on average a quarter of the population is an “undecided voter” on whether they will take the vaccine, but this is an important population to target to achieve herd immunity.

The vaccine challenge

Almost 50 countries have started their vaccination campaigns for COVID-19, with the earliest vaccinations administered in Canada on Dec. 14, 2020. For each country, the right vaccine strategy will depend on a number of factors including the epidemiology of the disease in a given country, characteristics of the vaccine in use or a country plans to use, vaccine availability, and health system capacity to ensure the vaccines reach those more at-risk, and people’s willingness to be vaccinated.

“If availability is not a limiting factor, it may well be that the optimal vaccination strategy combines different vaccines for different target groups,” Els Torreele, visiting policy fellow at the UCL Institute for Innovation and Public Purpose, told Devex via email.

But that is far from the current reality. Low-income countries have largely been left out in the vaccine procurement race, with a number of high-income and upper-middle-income countries having secured millions of limited doses from leading vaccine manufacturers through bilateral deals. Some high-income countries meanwhile such as the U.S. are facing challenges in their vaccine rollout, while others like the United Kingdom face supply constraints.

“Modeling studies have shown that it would be more effective to roll-out vaccines everywhere gradually, starting with the most at risk/most vulnerable, and gradually expanding to a broader population, but that is not what the rich countries that hoarded vaccines doses are doing,” Torreele said.

“They chose vaccine nationalism, hoping to bring case numbers and death down in their own country – not bothering about what happens elsewhere (or maybe only after they have vaccinated their own population). That is nationalistic and populist politics, not global public health,” she added.

The African Vaccine Acquisition Task Team, established in November 2020 by African Union Chair and South Africa President Cyril Ramaphosa, announced on Wednesday that it has secured 270 million vaccine doses for the continent, with the first 50 million doses arriving in the second quarter of 2021.

The deals are welcome news for the continent in light of the growth and higher case fatality rates. Africa CDC’s Nkengasong said that any early introduction of vaccines will help ease the pandemic situation as it is expected to help prevent infection and deaths, not just in Africa but across the world. They’re hoping that in Africa vaccinations will start as soon as possible.

But he cautioned that vaccines shouldn’t be seen as a magic bullet.

“Vaccines will definitely be a game changer, but it will be a game changer over the next couple of months, and not weeks,” Nkengasong said, explaining that it will take a while for the vaccine to work, with individuals needing to wait about three to four weeks before they get their second vaccine shot.

Sara Jerving contributed to reporting.