Mpilo Central Hospital in Bulawayo, Zimbabwe, one of 130 countries that do not yet have COVID-19 vaccines.
KB MPOFU / STRINGER / GETTY IMAGES
By Kai Kupferschmidt
Science‘COVID-19 reporting is supported by the Heising-Simons Foundation.
On January 6, gastroenterologist Leolin Katsidzira receives a disturbing message from his colleague James Gita Hakim, a heart specialist and well-known HIV / Aids researcher. Hakim, chair of the medicine department at the University of Zimbabwe, fell ill and tested positive for COVID-19. He was admitted to a hospital in Harare ten days later and moved to an intensive care unit (ICU) after his condition worsened. He passed away on January 26th.
This is a crushing loss for Zimbabwean medicine, says Katsidzira. ‘Do not forget: we had a great brain drain. So people like James are people who keep the system going, ”he adds. Scientists around the world have also mourned Hakim. He was “a unique research leader, a brilliant clinical scientist and mentor, humble, welcoming and empowering,” writes Melanie Abas, a fellow at King’s College London.
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But Hakim’s death also highlights a stark reality in the global response to the coronavirus pandemic. Countries in Europe, Asia and the Americas have fired more than 175 million shots since December 2020 to protect people from COVID-19, and most countries prefer medical workers. But not a single country in sub-Saharan Africa has started vaccinations – South Africa will be the first this week – causing health workers to die in places where they are scarce to begin with.
The exact toll of COVID-19 among health workers is difficult to determine, but Hakim was one of several leading doctors who succumbed in Africa in recent weeks, having had a second pandemic wave. Just one day before him, the American doctor David Katzenstein, who moved to Harare after his retirement and led the Biomedical Research and Training Institute there, died in the same hospital of COVID-19. These losses exist for many others, says Robert Schooley, a researcher on infectious diseases at the University of California, San Diego, who has worked with Hakim for many years. “We don’t hear from many others who work in the healthcare staff behind them.”
Neighboring Mozambique has lost an anesthetist, a gastroenterologist and a urologist in recent weeks, says parasitologist Emilia Noormahomed of Eduardo Mondlane University, as well as two young general practitioners. Several others are seriously ill. Such losses have hit hard in Mozambique, with only eight doctors per 100,000 people, compared to nearly 300 in the United States. “It will literally take an entire generation to rebuild” from such losses, says Ashish Jha, dean of Brown University’s School of Public Health.
Global inequalities have existed since the onset of the COVID-19 pandemic. ICUs, fans and oxygen, for example, are scarce throughout the entire African continent. But in the early months, the basic public health measures needed to control the spread of the virus put countries more or less on an equal footing, says John Nkengasong, head of the African Center for Disease Control and Prevention. And Africa has weathered the pandemic relatively well, in part because of its young population.
But now, the deployment of vaccine rich countries has a definite advantage. Many have relied on various vaccines and signed contracts for enough doses to immunize their population several times, limiting the rest of the world. According to the World Health Organization (WHO), three-quarters of all vaccinations to date have taken place in ten countries, accounting for 60% of global gross domestic product; 130 countries still need to administer a single dose. “I do not know why there is not a big rush to do something about it,” said Gavin Yamey of Duke University’s Global Health Institute. “The world is on the brink of a catastrophic moral failure,” Tedros Adhanom Ghebreyesus, the Ethiopian – born director – general of the WHO, said in January. In a joint statement last week, he and UNICEF’s executive director, Henrietta Fore, called on governments that vaccinated health workers and those at greatest risk to share doses with other countries, and on vaccine manufacturers to get vaccines fair. to know.
The equity gap may soon extend to COVID-19 therapies as well. The first drug that has been convincingly shown to lower the mortality rate of the virus, a steroid called dexamethasone, is inexpensive and is used around the world; Hakim received it before he died. But tocilizumab, which appears to further reduce mortality in a British study released on 11 February, is an antibody that is about 100 times more expensive than dexamethasone and not widely available. “The [pandemic’s] a second wave, and possibly the third, is being fought with a combination of public health measures and biomedical interventions, which will increase inequality, ‘says Nkengasong.
Beyond the moral argument, there are good economic and public health reasons to close the gap. The vaccination of those most at risk around the world will expel hospitalizations and deaths sooner, allowing societies to reopen and the economy to recover. It can also help reduce the circulation of the virus worldwide, lowering the risk of new virus variants.
WHO and other international organizations have worked to close the gap through the COVID-19 Vaccines Global Access (COVAX) facility, a joint mechanism to obtain billions of doses of different vaccines and distribute them to participating countries. It is beginning to bear fruit, albeit slowly: On Monday, WHO issued a list of emergencies to two versions of the AstraZeneca vaccine – University of Oxford, manufactured by the Serum Institute of India and SKBio, a South Korean company. COVAX expects to deliver these shots to countries this month, sending more than 300 million doses in the first half of the year, including 1.15 million to Zimbabwe and 2.43 million to Mozambique. It is also planned to distribute 1.2 million doses of Pfizer-BioNTech vaccine.
Bruce Aylward, a senior adviser to Tedros, concedes that the initial offer is just enough to cover a small portion of the population of many developing countries. “But the reality is that we will be getting much more doses for many more people in many more places much faster than would ever have happened without the COVAX facility,” he says.
To get more vaccine sooner, African countries have formed a vaccine task force that, with funding from mobile phone company MTN Group, has already purchased 7 million doses of the AstraZeneca-Oxford vaccine. The first 1.5 million doses are to be shipped to 19 countries on February 22 so that health workers in those countries can be vaccinated by the end of the week. The overall goal is to vaccinate about 35% of the population in African countries before the end of the year and then another 25% next year, says Nkengasong. (Many Western countries hope that their entire population will be covered during the summer or fall.)
Schooley believes the United States should play a more active role in protecting health workers in countries like Zimbabwe. The U.S. president’s emergency plan for AIDS, launched in 2003, saved many lives by providing more than $ 80 billion in the fight against HIV. “We have been working with our counterparts in sub-Saharan Africa for 20 years to help them build a more resilient healthcare infrastructure,” says Schooley, “and we sit on our hands and watch it being torn apart by the coronavirus.”