Dr Rawiri Taonui | The Largest Pandemic in History and the Race for a Vaccine between the Rich and the Poor

Photo images supplied / Dr Rawiri Taonui

Dr Rawiri Taonui | The Largest Pandemic in History and the Race for a Vaccine between the Rich and the Poor

The Largest Pandemic in Human History

By the end of this year, Covid-19 will be the largest pandemic in human history. Today the world total passed 60 million cases with 1.4 million deaths. On the current 7-day trend there will be 82 million cases and 1.8 million deaths before the end of the year.

The real numbers are much higher. Earlier this year, The Economist summarised over 100 serological surveys testing populations across the globe for antibodies to Covid-19. This identifies undetected positive cases, which facilitates estimating any shortfalls in official figures. The results show that the actual number of Covid-19 cases worldwide is 15x to 25x higher than official figures.

A similar formula emerges when comparing official figures with ‘excess deaths’, where overall death rates are higher than in previous years. These show that the actual number of deaths worldwide to be 3x to 5x higher than official figures.

Applying mid-range factors of 20x for total cases and 4x for total deaths, there have been 1.2 billion Covid-19 cases and 5.6 million deaths worldwide.

With the official number of cases reaching 82 million cases by the end of the year, the actual numbers will be 1.6 billion cases making Covid-19 the largest pandemic in human history passing the 1.4 billion cases from the 2009/2010 Swine Flu Pandemic. With 1.7 million official deaths by the end of the year, the actual toll will be closer to 7.2 million deaths. This is less than the Spanish Flu of 1918, nevertheless, Covid-19 will be the largest pandemic in human history.

The Acceleration

The pandemic is running out of control in many parts of the world. Today’s 60 million milestone took 17 days, three days faster than the 50 million benchmark and twice as fast as it took to pass 40 million.

Daily cases are accelerating upward. From the beginning of the year, it took 182 days to reach 200,000 new cases per day in June, 105 days to reach 400,000 per day in October and just 21 days to reach 600,000 cases per day in November.

Daily deaths are reaching new heights. Deaths peaked at 8,500 per day in April before falling to 4,000 per day in May/June. During a mid-year peak in July/Aug deaths reached 7,400 per day before again falling. Over recent weeks, peaks and troughs have merged into a single upward trajectory with several records, one every four or five days this month.

Geographic Regions

A lack of trans-regional cohesion and coordination between adjacent countries in Europe, and states and counties in the United States, is a main driver of the Covid-19 upsurge. Different jurisdictions apply different policies and regimes at different times without overall coordination. Some restrict travel, others are more open; a few test arrivals at airports, most do not; some require mandatory managed isolation others self-isolation. Non-compliance, resistance often the name of ‘freedom’ often accompanied by conspiracy theories and Covid-19 fatigue is the second main factor, especially in Western countries.

The result is uncoordinated chaos. Europe took 208 days to record its first 5 million cases and just 33 days to record a second 5 million. The USA now has over 11 million cases and is reporting 150,000+ new cases and 2,000 deaths per day.

Compliance is higher in Asian countries like China, Taiwan, and Vietnam whose responses are among the strongest in the world and whose cases per million of population are the lowest.

Driven by inequality, poverty, brittle health infrastructure and weak contact tracing regimes, South America accounts for 30% of all daily deaths.

Numbers are significantly lower in Africa, in part because there has been less travel to and from spreader Western countries, and the average demographic is much younger than Europe. However, concern remains that the small number of cases reflect poor health provision, including a lack of testing capacity.

The Risks of Travel, Travel Bubbles, Tourism and Seasonal Workers

Opening international travel to stimulate economies through tourism, holidays, multi-country bubbles or bring in workers for seasonal work has been a third disastrous factor driving the new surge.

During the northern summer, Britain allowed people to holiday in Spain and France leading to surges in all three countries.

Slovenia imposed a first lockdown two weeks before New Zealand and gained control over Covid-19 by late April. June case numbers were about the same as New Zealand. Slovenia then opened its borders. Today, they have 67,000 cases and over 1,100 deaths.

Slovakia closed their borders earlier than New Zealand and was the first European country to adopt mandatory mask-wearing. In May, case numbers were the same as New Zealand. Slovakia opened its borders. Today, they have 97,500 cases and over 700 deaths.

After a late March lockdown, Tahiti eliminated Covid-19 in eastern French Polynesia. In July, the borders were reopened to stimulate tourism, today there are 12,000 cases, mainly among the indigenous community.

In April, Latvia, Lithuania, and Estonia also had similar case numbers to New Zealand. In late-May, they opened a 3-country Baltic travel bubble. The Baltic states now have 73,000 cases and 2,000 deaths combined.

Indigenous Peoples

Data on the Covid-19 situation of the world’s indigenous peoples is concerningly scarce. We know many are suffering in parts of Latin America, Asia, and Africa where health support is either weak or has been withheld, such as the Amazon in Brazil. Covid-19 is also taking a dreadful toll where it makes its way into indigenous regions via workers in energy, mining, and deforestation in remote areas like the Amazon, Siberia, and parts of Asia.

Pressure from the upsurge of Covid-19 is also biting into previously virus-free Pacific islands. The Solomon Islands and the Marshall Islands recorded their first Covid-19 infections last month, neighbouring Vanuatu reported their first case two weeks ago, and last week Samoa their first. As a result, Nauru, Tonga, Kiribati, Micronesia, Palau, and Tuvalu are the only remaining countries not to have reported any Covid-19 cases.

The situation of indigenous peoples in former British colonies is mixed. Those living in or closer to European urban centres, for example, in Manitoba Canada and the Navajo Nation in the USA, have higher rates of infection and death.

Those living in remote areas, autonomous regions and on reserves are faring better, particularly where they been able to restrict access to their lands with the support of their governments. In Canada, the current rate of infection for First Nations living on reserves is half the rate for the general population, and in Australia very few cases in remote communities.

Those whose communities have exhibited extraordinarily strong community responses have also fared well. Māori are 9% of cases in New Zealand, half their demographic.

Racial Discrimination

Combinations of comorbidities, poverty, poor health provision, poor housing and low paid work in vulnerable jobs has also created a racial differential. In Britain, all non-white groups are more likely to contract and to die from Covid-19 than whites. In the United States, the rates of infection and death are higher for African Americans and Hispanics than whites, and higher still for Pacific Island communities.

The Race for a Vaccine

One certain thing is that worldwide universal vaccination is central to defeating Covid-19. There are 140 vaccine projects of which 50 are working through clinical trials on human subjects: Phase-1 tens of subjects, Phase-2 hundreds of subjects, and Phase-3 thousands, before moving to approval.

China and Russia have approved six vaccines between them. The West has expressed concern about the safety of these projects. However, one of the Chinese vaccines, Sinopharm, had completed Phase-3 trials on 60,000 people in 10 countries and 56,000 nationals travelling overseas with a 94.5% success rate. As of this month, Sinopharm has now being administered to 1 million people.

Russia has also been administering their vaccines for some weeks, so far with no reported issues. Yesterday, Russia’s Sputnik V vaccine reported 91.4% efficacy from a second Phase-3 trial of more than 18,000 people and is about to test a cohort of 40,000.

In the West, 12 projects are at Phase-3. Seven are the most advanced: Pfizer-BioNTech project, Moderna, AstraZeneca-Oxford University, Novavax, Sanofi-GlaxoSmithKline (Sanofi-GSK), Johnson & Jonson, and Medicago

Last week Pfizer-BioNTech announced it has completed two human trials of 30,000 and 43,000 subjects with a 95% success rate. Moderna quickly followed, announcing their vaccine had completed trials with a 94.5% effectivity. The AstraZeneca-Oxford University project is expected to announce its data shortly.

With final approvals pending, there is widespread expectation that Britain, Germany, and the United States could begin distribution by the second week of December.

That several vaccines are coming online is positive. This is the best opportunity to halt the pandemic. We also need options because there is no clear picture of whether all vaccines work, suit people of all ages, how many will require two shots, how long immunity will last and whether there will be a need for annual boosters like the flu.

A Race between the Rich and the Poor

The principal vaccine issue in the search and distribution of a successful vaccine will be a race between rich and poor countries. For a vaccine to be effective, coverage will need to be universal.

Earlier this year, GAVI (the Vaccine Alliance), a partnership between the WHO, UNICEF, World Bank, and the Gates Foundation, established the COVAX programme to deliver Covid-19 vaccines to poorer countries. Using funding from richer countries, COVAX has secured about 500 million dosages from different projects. While progressive, that will not provide full coverage for the developing world.

The typical scenario is that countries have made donations to COVAX then spent much more purchasing vaccines, and in advance, meaning they will expect first access over poor countries. In once instance, the European Union donated $200 million to COVAX while Britain and Germany each purchased vaccines worth $1 billion,

Earlier this year, the United States, by far the most aggressive when it comes to pre-purchasing vaccines, launched Operation Warp Speed, a multi-agency commitment of $10 billion to identify and secure at least 100 million vaccines from each of the seven most promising projects with the option of 400 to 500 million more if required.

Similarly, Canada has pre-purchased over 400 million vaccines from the seven main projects. Australia has secured 140 million vaccine doses from three of the main projects and a local CSL/University of Queensland vaccine.

Rich Western countries have pre-ordered and/or reserved well over 4 billion vaccine doses with options for several hundred million more. With an upper limit on production capacity of between 0.5 to 1.5 billion doses of each vaccine in the first year, 2021 looms as a race with the wealthy winning the best vaccines and more of them, and the poor receiving the not so good vaccines, fewer of them, and kind Western pity.

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