Dr Rawiri Taonui Covid Māori | A 4th Mega-Wave, Vaccines vs Variants, the Rich vs the Poor, and Annual Vaccinations

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Despite more than 860 million vaccinations delivered in over 200 countries, the world total has passed 140 million cases and three million deaths. Driven by new variants, a 4th Mega-Wave of Covid-19 that is now sweeping the globe threatens to be the largest since the virus left Wuhan.

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The Third Wave

Between September last year to mid-January this year, a large third wave struck the United States, Britain, Europe, and Latin America. Growing at a staggering 20 million new cases per month, the third wave peaked at over 845,000 cases per day in early January. The 3rd Wave abated for about a month, as countries introduced stronger lockdowns and stricter travel rules, and began mass vaccination programmes. Daily cases halved to 370,000.

The third wave brought with it the potential for something more destructive with the emergence of new hyper-infectious strains of Covid-19. These variants made their way around the world because the pre-departure negative test certificate requirement most countries had introduced to counter the third wave largely failed. The absence of encrypted certificates and airline check-in staff having neither the training, the means nor the time to check the authenticity of certificates led to widespread fraud.

In February, the European Police Agency (Europol) issued an international warning about fraudulent negative test certificates. There were arrests in Britain, Span, France, Germany, Canada, Brazil, Slovenia, and the Czech Republic. In one instance, Italy suspended entries from Bangladesh, authorities later charging a lab owner with selling 4,200 false certificates. Three weeks ago, cybersecurity company Checkpoint found 1,200 sites on the dark web selling fraudulent certificates, including one entrepreneur offering buy-two get-one-free.

The 4th Mega-Wave

The 4th wave that is sweeping through countries with weaker health defences in the developing world will become much larger and run longer than the 3rd Wave.

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India is driving up numbers in South-East Asia; Brazil is the centre of increasing cases in South America; Indonesia, the Philippines and Papua New Guinea are hubs of new cases in the Western Pacific, and Turkey, France, Germany, and East European countries increasing cases in Europe.

New cases worldwide have topped 800,000 three days in a row. On 15 April, there were 845,128 new cases, the second-highest daily total since the pandemic began. Unchecked, we could see one million cases per day within a fortnight. The world total is racing toward 200 million by June/July.

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Variants of Concern

The battle against new variants will run into 2022. Covid-19 is mutating all the time. The more a virus spreads, the greater the opportunity for further mutations. Multiple variants have appeared around the world throughout the pandemic. Most are minor and of little consequence. Every so often, the virus will change in a way that helps it survive and reproduce. Variants that evolve in this direction have a greater chance of infecting more people. Over time, they can become dominant. Early in the pandemic, there was a change named D614G. The D614G strain was more infectious and became the dominant worldwide strain by the middle of 2020.

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Since the last quarter of 2020, new variants often descendant extensions of the D614G change have appeared that are more infectious, produce more severe sickness, can evade antibodies, and have higher fatality rates. The World Health Organisation, Centers for Disease Control and Prevention (CDC, USA) and Public Health England (PHE, Britain) track five strains called Variants of Concern (VOCs) where research confirms they have these attributes. The table below outlines the numbered lineage name of each variant, the number of countries with the strain, and a summary of research findings.

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B117 is the emerging dominant world strain. This might be because flights from London’s Heathrow Airport reach more destinations around the world than any other country. As they become more mobile, the P1 strain from Brazil and B1351 from South Africa might yet surpass B117.

Variants of Interest

The CDC and PHE also track nine Variants of Interest (CDC) or Variants under Investigation (PHE). These have genetic markers suspected (but not yet proven) of having the same characteristics as VOCs.

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There is also concern that one or more of the Variants of Interest has features that could become future dominant. The B117+E282K Bristol variant appears to combine mutations found in both the B117 British and B1351 South African strains. The B1617 variant from India combines the E384K South African change and the L452R change found in the Californian strains. The Nigerian B11318 strain has an estimated fatality rate double that of the B117 variant.

Vaccines vs Variants

Concern also exists that the Covid-19 vaccines have reduced efficacy against the new variants. The Pfizer-BioNTech vaccine used in New Zealand is still reasonably effective against B117 but markedly less effective against B1351 and P1.

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That vaccines are only slightly less effective against the dominant B117 strain offers hope. The PHE has estimated that there were 10,000 fewer deaths in Britain in February because they have vaccinated a sizeable percentage of the over-65 age group. The United States, where B117 has just become dominant, says the substantial number of over-65s vaccinated possibly explains why there are more cases in younger age groups. The CDC estimates that new cases among the first 66 million-plus Americans vaccinated are less than one in ten thousand. Israel, which leads the world in cases vaccinated, and where B117 is also dominant, has seen hospitalizations decline by 36% and 29% fewer patients severely ill with Covid-19.

The Rich vs the Poor

What happens in the developing world will decide the outcome of the race between vaccines and variants. On 9 March, the WHO reported that almost the entire supply of the best vaccines, Pfizer-BioNTech and Moderna, had gone to 75 richer countries while 115 other countries had received very few vaccines. The UN has reported that ‘most poor countries had been unable to administer a single dose of a Covid-19 vaccine, while rich nations had vaccinated their citizens at a rate of one person per second over the last month’.

Poor countries will see the arrival of vaccine doses in the coming days from the WHO administered COVAX programme set up to supply equal access to Covid-19 vaccines. However, the amounts available mean that poor countries can only vaccinate 3% of their people by mid-year, and at best only 20% by the end of 2021.

The dynamics, of wealth, privilege and entitlement are also playing out between the rich and the poor in Western countries. Los Angeles provides an example in adjacent middle-class and working-class residential areas. In the middle-class area, 25% of residents caught Covid-19 last year, 75% have received vaccination. In the working-class area, 75% had caught Covid-19 last year, this year 25% have received vaccination. There are examples around the world of people paying to queue jump. In New Zealand, we have seen non-front line Auckland District Health Board members queue jump to receive a vaccination. There is a black market in vaccines; some sell genuine vaccinations, many do not.

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There is a clear risk that the differential in vaccinations between rich and poor countries will see the ascendancy of variants like B1351 and P1 or newer hypervirulent strains from under-vaccinated developing countries. Either scenario will have consequences for the effort to vaccinate the world’s population.

Completing vaccination in rich countries will take until the end of 2021. Pfizer-BioNTech and Moderna are developing vaccines for a second round of inoculation in 2022 to combat the new variants. Should new virulent strains appear, the world will need a third round of vaccination. At that stage, annual Covid-19 vaccinations are likely as we face seasonal bouts of the cold, flu, and the more deadly Covid-19.

Kia noho haumaru

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