This week we’re looking at countries’ responses to new coronavirus variants.
A YEAR LATER, WE’RE STILL USING HAMMERS — History tends to repeat itself, but not always this quickly.
As the United Kingdom confirmed in late December that a new, more contagious variant of the coronavirus was circulating, countries started piling on travel bans. South Africa, which identified another variant that some worry could threaten the efficacy of vaccines on the market, has gotten similar treatment, albeit to a lower degree since it’s not the major travel hub the U.K. is.
To many public health experts, it looked like a replay from last January, when countries curtailed travel, first against China and then against each other – though as we would soon learn the virus was already everywhere. Now, just as then, this blunt measure that national authorities hope will slow the spread of whatever new variant raises concerns, may be coming too late.
The U.K. identified the variant known as B.1.1.7 in September, and by December noticed that it was associated with many new cases of infections in Southeast England. South Africa identified its variant, 501Y.V2. in October, but it could have been circulating since late August.
For all those months, travel was still allowed between the U.K. and other parts of the world, although at much lower levels than before the pandemic. South Africa reopened its borders to the world in mid-November.
The variant first found in the U.K. has now been reported in more than 30 countries including the U.S, and the one from South Africa in four, according to the World Health Organization. The numbers are likely to keep growing.
What’s needed instead: Travel bans are imperfect, and infected people are bound to slip through.
That doesn’t mean that the bans last year didn’t give countries blindsided by virus time to increase hospital capacity, set up testing and start working on therapies. At the same time, countries should have also been increasing genomic sequencing capacity to both monitor for potential dangerous changes in the virus and to track its spread.
“What’s most important here is that countries are vigilant, monitoring and doing genomic sequencing,” said Meru Sheel, senior research fellow at the National Centre for Epidemiology and Population Health in Australia.
That sort of widespread surveillance hasn’t happened, though. And by the time countries discover the new variants have slipped through their borders, there’s bound to be more of it already circulating than they realize.
Not all countries can do genomic sequencing, which requires a skilled workforce such as bioinformaticians. But they can establish regional networks that can rely on countries that do have the capacities, Sheel said.
Australia, New Zealand and Taiwan do more sequencing than the rest of the world, according to a Washington Post chart, and they have reported very low case numbers compared to other rich countries. (They’ve also done well on other parts of the pandemic response.)
The United States, with more reported cases and deaths than any other country, ranks 43rd in sequencing, analyzing just 0.3 percent of cases. The Centers for Disease Control and Prevention said it’s trying to scale up those efforts now. It’s a system that is lagging behind the U.K. and needs to be upgraded so “we have an early warning system if something starts to appear that should cause us concern,” National Institutes of Health Director Francis Collins said during a Washington Post event on Wednesday.
Only five countries sequence more than 10 percent of the samples, according to the Washington Post chart. WHO boss Tedros Adhanom Ghebreyesus this week asked all countries to boost testing and sequencing to better identify variants and adjust strategies.
“If we didn’t have a wake-up call before, we have an even further wake-up call about these mutations,” said Maria Van Kerkhove, WHO’s Covid-19 technical lead.
WELCOME TO THE FIRST GLOBAL PULSE OF 2021 — Where we hope that by the end of this new year, Global Pulse will be less about combating the coronavirus and more about how the world is learning and rebuilding from it.
Global Pulse is a team effort. Thanks to Sarah Wheaton, Ashleigh Furlong, Sue Allan and my editors Jason Millman and Joanne Kenen.
THE RACE TO VACCINATE MOSTLY LOOKS LIKE A CRAWL — The clear leader early in the new year is Israel, which has so far administered almost 1.5 million doses of the Pfizer/BioNTech vaccine in a country of 9 million. Its success has been attributed to its small size, national health system and a national vaccination registry used for childhood vaccination.
The UAE and Bahrain, numbers two and three on the list, were among the first countries to approve China’s Sinopharm vaccine, even though the company has not shared the data underpinning its efficacy claims, leaving scientists with many questions. Both countries have also deployed the Pfizer/BioNTech shot. Bahrain began offering the Sinopharm vaccine to frontline health care workers in November and now allows people to schedule vaccination through a contact-tracing app and choose which shot they want.
Western countries are now consumed by debates about why vaccination is going so slowly, with officials in the U.S. and Canada acknowledging they must pick up the pace and some European Union member countries trading blame.
In South Africa, which has more cases than any country on the continent and has identified a fast-spreading virus variant, the government is facing growing calls to directly negotiate with vaccine manufacturers, including for Chinese-made jabs. Pfizer and BioNTech can only supply the entire continent of 1.3 billion people with 50 million doses for health care workers as of March, South African officials told Bloomberg.
And countries that were counting on Indian vaccine production – and who thought that they’d get it reasonably soon after India’s emergency authorization of the Oxford University-AstraZeneca shot – at first got some disappointing and confusing news. Adar Poonawalla, the boss of the Serum Institute of India, which has been contracted to produce the vaccine for developing countries, told the Associated Press on Sunday that the government will not allow exports before priority groups in India are protected. Poonwalla and an Indian foreign ministry official said a few days later that exports will be allowed, starting within weeks. India’s vaccination campaign is expected to start next week.
GRADING THE RESPONSE — As the pandemic enters its second year, we asked three experts what parts of the response haven’t received enough attention and which have been overhyped. Their answers may seem familiar – another reminder that experts have been calling for these measures all along, but we still don’t have it right.
Here’s what they said:
Underrated: Countries failed to do proper contact tracing, even though it’s a proven strategy for reducing transmission, said Philip Hill, the co-director of the University of Otago’s global health institute in New Zealand. Underfunded public health departments around the world struggled to keep pace with the rate of infections, undermining efforts to head off the next outbreaks. Focusing on identifying an infected person’s contacts as soon as possible means they can be isolated before they potentially infect someone else. Hill said shortcomings in contact tracing efforts represent “the most remarkable failure of some of the richest and previously assumed smartest countries in the world.”
Likewise, countries failed to quickly expand rapid antigen testing, said Jennifer Kates, the director of global health and HIV policy at Kaiser Family Foundation. The tests, which are being scaled up more, could quickly identify likely cases and make it easier to reopen larger parts of the economy. “Using this technology on a frequent basis and for large swaths of the population can go a long way toward interrupting the chain of transmission of the virus,” Kates said. U.S. President-elect Joe Biden is weighing a plan to use such testing to fully reopen schools, for example. The Food and Drug Administration authorized the first at-home, over-the-counter coronavirus test in mid-December.
Vytenis Andriukaitis, WHO special envoy for the European region, said leaders didn’t communicate adequately with the public about the virus risk and get their buy-in on response. He lamented the “lack of efforts to educate and actively communicate with the public through diligent and mindful risk communication and community engagement.”
What was overhyped: Conversely, Andriukaitis said the politically charged debates about mask mandates were overhyping mask wearing against all other public health measures that also help drive down transmission. It’s not enough just to wear masks, though they help plenty. There’s also social distancing, contact tracing and hand washing – but messaging about those measures could have gotten lost in the fury over masks. “A lot of people don’t understand that here we don’t have a silver bullet,” Andriukaitis said.
Kates of KFF said countries are too heavily relying on travel restrictions, which as we noted are getting a second boost now. Kates said her concern isn’t that travel restrictions can’t work, “but because they haven’t been used properly in most cases and provide a false sense of security and safety.”
Finally, Hill of the New Zealand global health institute said that testing was often overhyped because too many countries couldn’t quickly deliver results. Backlogs that stretched on for days, or even more than a week, rendered testing essentially useless in some cases, he noted. By the time test results come back “all your close contacts who are infected have already developed symptoms and passed it onto their close contacts,” Hill said. “If you can’t deliver results quickly, then as a tool its usefulness is almost entirely negated,” he said.
NPR: As it withdraws from Afghanistan, the U.S. leaves behind a country where almost half of the children are malnourished.
Global Press Journal: Pandemic lockdown could spur a jump in teen pregnancies in Uganda.
ABC Australia: Vaccination in the country could start in early March. “Australia is not in an emergency situation so we don’t have to cut corners,” Prime Minister Scott Morrison said.
Reuters: Why Indonesia is vaccinating its working population first, not the elderly.
Washington Post: Early vaccination in prisons, a public health priority, proves politically charged in Colorado.