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    • Opinion
    • COVID-19

    Opinion: How many Greek letters before we learn a lesson on inequity?

    Rampant vaccine inequity is one that developed countries have, until now, stubbornly refused to address comprehensively.

    By Timothy Carey // 23 December 2021
    A health worker shows a woman a vial containing a COVID-19 vaccine at a health center in Nairobi, Kenya. Photo by: Baz Ratner / Reuters

    Omicron is the latest coronavirus variant to be detected, reported, and labeled a “variant of concern” by the World Health Organization. The global community is indebted to South Africa, its scientists, and its sophisticated detection system for not only detecting but also reporting the new variant. Mutations of viruses are commonplace and there are likely to be others. The journey of omicron and the response of the global community, even at this stage, has been instructive.

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    Initially, WHO acted rapidly to label omicron a “variant of concern.” Current indications are that it is far more contagious than other variants but perhaps less severe in its effects.

    The global community also acted swiftly. In less time than it takes to check in and clear customs, nations around the world announced travel bans on people coming from South Africa and seven other African countries. At a time when greater solidarity and cooperation is needed, the travel bans have encouraged divisiveness. Even as the bans were being announced, omicron was being reported in other countries such as Belgium and Hong Kong.

    The travel bans appear discriminatory and useless. They also reflect the broader problems in how high-income nations have addressed the virus.

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    Dr. Ayoade Olatunbosun-Alakija, the co-chair of the African Union’s African Vaccine Delivery Alliance, told the BBC that the current situation is an inevitable consequence of vaccine inequity. This rampant inequity is one that high-income countries have, until now, stubbornly refused to address comprehensively.

    Perhaps things are changing. U.S. President Joe Biden has announced that omicron’s arrival should push the global community to donate more vaccines to countries where vaccination rates are low. How determined is Biden to advance this position?

    More is needed, however, than simply donating vaccines. There must be an unrelenting and uncompromising campaign to eradicate vaccine inequity. We need to quantify vaccine inequity in the same way that the Gini coefficient measures income inequity and we need to do whatever we can to push the needle toward a flatter landscape.

    The numbers unequivocally support Biden’s stance. I compared COVID-19 prevalence data from the eight countries listed in the travel bans with eight randomly selected countries from the World Bank’s list of 69 high-income countries. These figures were correct as of Nov. 27, 2021, at the beginning of the world’s introduction to omicron. The eight  countries in the travel ban are: Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, South Africa, and Zimbabwe. The eight randomly selected high-income countries for comparison are: Andorra, Austria, Cyprus, Finland, France, Hong Kong, Singapore, and Sweden.

    First, it is informative to understand what the difference was between the two groups in the daily new confirmed cases per 1 million people when the bans were first announced. At the time of the travel bans, the daily figures were: Botswana at 27.65; Eswatini at 3.53; Lesotho at 1.06; Malawi at 0.1; Mozambique at 0.18; Namibia at 3.26; South Africa at 16.66; and Zimbabwe at 1.71. Whereas, the figures for the high-income countries were: Andorra at 980.65; Austria at 1,540; Cyprus at 367.35; Finland at 186.57; France at 350.39; Hong Kong at 0.42; Singapore at 365.94; and Sweden at 127.68.

    As of late December, these figures have changed dramatically but, interestingly, the United Kingdom, which was one of the quickest countries to put the southern African countries on a “red list” of banned countries is now one of the world leaders with more than 1,200 newly confirmed cases per 1 million people daily. As of Dec. 23, the U.K.’s figures ranked fifth in the world behind San Marino, Denmark, Andorra, Monaco, and Gibraltar. Perhaps this is the reason that the U.K. currently has no countries on its “red list.”

    The median averages of the two groups provide a powerful message. For the banned countries, the median number of new cases confirmed each day per one million people was 2.485, while it was 358.165 for the comparison countries.

    One explanation for this difference could be the different amount of testing that occurs. Testing requires resources such as personnel and infrastructure so it might be expected that less well-resourced countries would conduct less testing. The average, or median, number of new tests each day per one million people was 325 for the banned countries, and 4,480 for the comparison countries. For every 1,000 tests conducted per one million people, approximately eight cases were detected in the banned countries, but 80 cases were detected in the comparison countries. What could possibly explain a difference by a factor of 10?

    Clearly, there are lessons we could be learning from each other if we committed to understanding ourselves as one global community rather than a collection of separate countries or a division of global north and south.

    While this data is informative, the data describing inequity was the most compelling. I found inequity in the case fatality rate with the rate for the banned countries to be 2.86%, and the rate for the comparison countries at 0.94%. Although there were far fewer cases being detected in the banned countries, almost three times as many people in these countries who contract the virus were dying compared to the high-income countries.

    Could this disparity be explained by vaccine inequity? For the banned countries, the range in the total number of vaccinations per 100 people was 6.99 in Malawi to 56.42 in Botswana, whereas the range for the comparison countries was 123.74 in Hong Kong to 184.89 in Singapore. The median number of vaccinations per 100 people was 29.40 for the banned countries and 148.95 for the comparison countries.

    So the comparison countries that are high-income and well-resourced had, on average, five times as many vaccinations per 100 people than the less well-resourced banned countries.

    Will omicron be heard? Currently, some countries continue to stockpile more vaccines than they need and promote booster shots for those who are already vaccinated, while other countries have total vaccination rates per 100 people as low as 1.6 in Haiti, 0.27 in the Democratic Republic of the Congo, and 0.03 in Burundi.

    WHO is unequivocal that variants will continue to emerge and that vaccinations will not bring an end to the pandemic until the majority of the planet’s citizens are vaccinated. Omicron is the latest coronavirus offspring to bellow this message.

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    The views in this opinion piece do not necessarily reflect Devex's editorial views.

    About the author

    • Timothy Carey

      Timothy Carey

      Timothy Carey is a scientist-practitioner Fulbright scholar with a background in clinical psychology. He has over 150 publications including scientific papers, books, and book chapters. His work centers around understanding autonomous control and its importance to well-being and health and social equity.

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