“Critical point”: The global fight against Covid is slowing down

“We are at a pretty critical juncture in terms of the fight against Covid. And I can’t say I’m particularly optimistic about how things are going,” said Mihir Mankad, MSF’s senior policy advisor. “It has almost always been the case that countries have taken care of themselves first and foremost during the course of the pandemic. Now that’s only going to get amplified, especially because… the deadly threat of Covid has gone down in the places with higher coverage rates.”

The intensity and urgency with which the global health community has fought Covid-19 over the past two years is fading, even as millions remain unvaccinated. And it’s not clear that the fervor will return if wealthier countries decide the pandemic threat is dissipating. That concern has been seeping through to the World Health Organization and other groups – namely those serving the populations of Africa – for months.

“The vaccines remain incredibly important in getting those who are most at risk in all countries because they continue to save lives,” Maria Van Kerkhove, the WHO’s technical lead on Covid-19, told reporters earlier this month. “But they can only save lives among the people who receive them.”

Other public health advocates argue that Covid-19 should no longer be viewed as a public health emergency, as prior infection and vaccination have provided sufficient basic immunity to handle hospitalizations. As they continue to encourage increased immunizations and improve therapeutic disbursements to fight the pandemic, the organizations are focused on raising funds for pandemic preparedness – with a focus on stopping the next Covid.

The diverging strategies have left a global health community at odds over how to handle the next step in the fight against Covid-19. And this reality has led people in African countries to look for clues as to whether additional funds or aid are coming. Even in Ghana, where the government has recently received significant funding for vaccinations – more than many other countries in the region – the prospect of losing the attention of the global health community is frightening, especially when the world’s health systems and infrastructure promise to help have improve are at risk.

Meanwhile, Covid infections and hospitalizations are increasing in Europe and China as Omicron and its subvariants spread and vaccination rates, including booster shots, stagnate in many parts of the world. As vaccine effectiveness wanes and other public health containment measures end, WHO officials say vaccinations are more important than ever and nations should keep their promises to help low- and middle-income countries vaccinate their populations.

“There’s not enough attention at all to what it actually takes to scale up immunization programs primarily to adults, for which, by the way, we really don’t have global models for vaccinating an entire adult population over an extended period of time,” said Ernest Darkoh, co-founder of the Broad Research Group, a non-profit organization dedicated to expanding the African healthcare system. “It’s not something to retreat from now.”

Covid-19 cases and hospitalizations are now at manageable levels in much of the western world and in Ghana. But many Ghanaians worry about what would happen if another outbreak hits this West African nation. Large parts of the population of more than 31 million do not live close to a hospital and depend on care from local community centers, most of which do not have adequate tools to treat Covid-19. While the Ghanaian government has procured tens of millions of doses, it is still struggling to get syringes into guns. And officials here say they need help with the last mile effort.

This is true in many low-income countries, especially in Africa. Still, sections of the global health community have changed course, focusing on vaccinating 90 percent of each country’s vulnerable populations, rather than 70 percent of the total population — the original target set by the WHO last year. And the international consortia that help deliver vaccines to low- and middle-income countries, including COVAX, the global vaccine facility, are taking a country-led approach: each nation deciding how many doses to order and where to send it. That means many younger people living in rural areas may not get the vaccine.

The WHO has launched a messaging campaign to oppose a slowdown in the response, with officials urging wealthier countries to meet their commitments to facilitate immunization in regions like Africa.

Meanwhile, lawmakers on Capitol Hill are still trying to fund international efforts on Covid-19 but are finding it difficult to win the votes and devise a mechanism for raising additional funds. The White House is also preparing to host a global Covid-19 summit, with plans to urge other nations to allocate more money to scale up last-mile efforts. However, according to two people familiar with the matter, senior Biden officials are not optimistic that the May 12 event will yield significant financial commitments, especially if the US is unwilling to make its own.

In countries with low vaccination rates, there is hope that community spread, particularly the spread of Omicron’s subvariant BA.2, will remain limited – although this is not certain. Even in regions with high vaccination rates, leading health authorities worldwide are concerned about declining vaccine immunity and the ability of boosters to keep Covid-19 cases and hospitalizations at manageable levels in the long term. That has prompted people like Anthony Fauci, President Joe Biden’s chief medical officer, to contemplate a short-term Covid-19 strategy without a vaccine that not only doesn’t block infection, but becomes less effective against it over time serious illnesses.

“I don’t think we’re going to be able to vaccinate people every four months,” Fauci said. “[But] I think it’s likely we’ll settle for an intermittent boost until we get a vaccine that offers a sustained level of protection, be it mRNA followed by a protein boost or mRNA followed by a nanoparticle boost.”

In Ghana, very few people, including those in Accra, have received their booster dose – and many may choose not to, officials here said, largely due to hesitant vaccination, which has occurred specifically on the third dose. As a result, countries like Ghana may soon have part of the population with dwindling immunity and a population refusing to receive third vaccinations. In these cases, booster campaigns are unlikely to help protect against future upside moves. Even in countries with higher immunization rates like Canada, people are not enrolling en masse for booster shots.

“About 80 percent of all Canadians got two doses. Despite all of this, we are in a fifth wave with a large number of hospitalizations across the country,” said Jean-Yves Duclos, Canada’s health minister. “One concern for us is that only about 48 percent of all Canadians have received a third dose. It is imperative that we increase our booster dose rates if we are to maintain adequate overall preparedness.”

What’s next? Fauci’s response: It’s not a surefire outcome, but most likely the world will enter a phase of the pandemic where enough people are immune from immunizations and past infections that the average number remains relatively low.

“It’s going to essentially establish where most people have some level of protection, just as we have some level of protection from a lot of other respiratory diseases that we come into contact with, so you don’t have as much morbidity, as much mortality that she dominates society,” Fauci said.

Still, officials like Fauci and Duclos are concerned that the virus will continue to mutate and elude immunity in the coming months until more durable vaccines are developed. Several drug companies are working on shots that protect against certain variants and others that protect against more than one, but it’s unclear when these will hit shelves.

“From an epidemiological perspective, there is a high level of uncertainty about what happens next,” Mankad said. “It seems very likely that this will haunt us as it has for the past two years.” “Critical point”: The global fight against Covid is slowing down

Fry Electronics Team

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