Global Pandemic Control: Where Did We Go Wrong?

Collaboration Coronavirus Covid-19 Development Emerging Infectious Diseases Global Health Global Pandemic government and politics Health Equity Health Supply Chain Management Health System Weaknesses Healthcare Equity immunization international relations

It is 18 months since the World Health Organization declared Covid-19 as a global pandemic. The global deaths now is 8467, more than what was reported in the worst days of April and May 2020. The geographic distribution of the deaths is however different. In the early days most of the deaths were in the US and several western European countries. Today the deaths are mostly from low and middle income nations and in many cases the numbers are increasing. In 2020 most of us could blame the deaths on poor implementation and individual use of simple public health methods. Today, 8 months after the Pfizer Covid-19 vaccine and subsequently other vaccines were granted EUA in the US that excuse is just hollow. Today the greatest predictor of increasing Covid-19 deaths is inadequate vaccine coverage. As the illustration below shows low and middle income countries are bearing the brunt of this pandemic due to poor vaccine coverage.

Current Global Vaccine Coverage & Covid-19 Mortality

Global vaccine coverage on the right in blue and 7-day average Covid-19 deaths by July 1, 2021 – Source: Our World in Data

One biological reason for this are the new variants which continue to emerge. In the US, reports suggest that 80% of all Covid-19 cases are now due to the delta variant. Whilst we can easily quantify how many cases are due to new variants, that is only part of the story. Epidemiologist and virologist agree that variants tend to emerge in the setting of active transmission. Poor efforts at Covid-19 control is however the primary reason for the rapid emergence of SARS-CoV-2 variants. As of July 14th only 4 states, ME, MA, CT and VT are above 60% coverage within their vaccine eligible population. On the contrary 11 states are still below 40% fully vaccinated. Most of these states being located in the Southern US. On a closer look, with the exception of Georgia Trump won all these states in the 2020 Presidential election.

In The US With No Vaccine Supply Issues Many States Are Still Below 40% Vaccinated

This CNN vaccine coverage map shows that with the exception of Georgia Trump won all the states below 40%- Source: CNN Health

Early coordinated efforts even at the point of vaccine implementation would have saved many lives globally. Beyond the ill advised policies and outbursts of Trump and his lack of support for Covax we are still far from an effective global public health response to the pandemic. Many low- and middle-income countries had better results in viral control with public health measures before vaccine became available. With vaccines roll out, unreliable supplies through Covax have significantly affected the ability of such nations to vaccinate their populations. In Africa the only country with anything close to good vaccine coverage is Seychelles with a population of 98,000. The relatively small Island nation has vaccine coverage of about 69% whilst the rest of Africa is at about 2% average.

The SARS-CoV-2 virus continues to evolve with emergence of new variants with increased transmission efficiency and virulence. All these developments are concerning and victory over Covid-19 is beginning to appear more elusive. If we lose this war it would not be due to a lack of technology and the know how to defeat it. There are just a few very important reasons why we are chasing the virus without controlling it. I would take time to address these issues briefly.

Lack of consistent and coordinated leadership

We still do not have a general who is ready to fight this global threat. Dr. Anthony Fauci has been a fierce and strong advocate for the support of science. The institute he heads at the National Institute of Health was instrumental in the development of most available Covid-19 vaccines. Fauci however does not have the power and wherewithal to help make these vaccines easily available globally. That power rests in the hands of a few world leaders including President Biden. With vaccine roll-out almost stalled in the US, President Biden may protect Americans better by shifting focus globally. President Trump screamed “America First” and and he has the blood of many Americans on his hands. Biden has the choice to lead the world out of this deadly ideology whilst saving many lives including Americans.

Politicization of Vaccine Acceptance and Persistence of Wild Conspiracy Theories

Our reliance on social media and other internet sources for information has fueled the spread of wild conspiracy theories around vaccines. These theories preceded the Covid-19 pandemic. Unfortunately, such theories spread very fast and are difficult to control once they take hold. The divisive political situation in the US over the past decade, did not spare Covid-19 control. The whole public health agenda to control this pandemic has been over politicized. This situation has resulted in US states with the most vulnerable health systems lagging behind the rest of the country in vaccination rates. This is an extremely costly situation because vaccines are cheaper than intensive care (ICU) stays. At current rates one day in a medical ICU could pay for full dose vaccination for close to 200 individuals.

Persistent Racial and Geographic Disparities in Vaccine Supplies and Accessibility

Globally vaccine availability is concentrated in high income countries in North America and Western Europe. Whilst countries like the UK, Canada and the US have vaccine coverage rates above 40% most Sub-Saharan African countries are well below 5%. As the deadly and highly transmissible delta variant spreads to above 80% of all sequences even in the US many low income countries remain effectively unvaccinated. In the US African American communities still continue to lag behind in vaccine coverage rates. Recent Kaiser Family Foundation data suggests vaccine coverage of 37% with 62% among Asian Americans and 47% among White Americans. This racial disparity in vaccine coverage is not due to vaccine hesitancy in the African American community. US census bureau survey confirms this fact. In this survey 12% of both Black and White Americans reported definitely not planning to get vaccinated.

Vaccine Coverage in Select Countries as of July 14th, 2021

As the virus evolves to be replaced in most places by the highly transmissible delta variant many in low and middle income nations remain unvaccinated. Source: Our World in Data

In this divided world split into small pieces along economic, racial, political and ideological lines the only consistent path to control lies in co-operation. The world leaders who can make this happen know this fact. The political calculus is however uncertain. The weakness of democracy lies in the fact that in certain situations the humane response may not appear politically expedient. This is why most of us love leaders who are capable in such situations to decide in favor of humanity. On that note Joe Biden won by a strong margin in 2020. So far President Biden’s promises have been encouraging and some countries in Asia have started receiving supplies of promised vaccines. Unfortunately the need is great and the later these vaccines arrive the more deaths we are going to see. Low and middle income nations with low vaccine coverage today need vaccines now to help save precious lives.

By Dr. Leonard Sowah, an internal medicine physician in Baltimore, Maryland


A physician providing primary medical care to patients across the lifespan