On the eve of Diwali, the Indian festival of lights, the World Health Organization (WHO) granted an emergency use license to India’s homegrown Covaxin. United Nations (UN) backed COVAX is an initiative to distribute COVID vaccine aimed at reducing vaccine inequity, a project now in desperate need of more vaccines after failing to meet its delivery targets by the end of the year. Covaxin, an inactivated coronavirus vaccine, became the eighth vaccine to receive WHO’s green light given its increased accessibility in resource poor countries. This closely follows a recent achievement by India when it administered 1 billion shots spread over a span of 278 days overcoming supply chain bottlenecks and debilitating second wave.
In the United States, Center for Disease Control (CDC) recently expanded COVID vaccine recommendations to include children aged 5-11 aimed at covering 28 million of its vulnerable population. 78% of American adults have received at least one shot of the COVID vaccine with recent trends indicating missed shots and slowing rates. Recent studies in the US reported levels of COVID vaccine hesitancy ranging from 22%- 44.2%, strongly associated with lower income, conservative ideology, mistrust in vaccine efficacy, safety and underestimation of COVID-19 risk.
As of November 3, 2021, Global Dashboard for Vaccine Equity, a joint effort of the UN, WHO and University of Oxford notes that 1 in 18 people in low-income countries have been vaccinated compared to 1 in 2 in high income countries. It further notes that high income countries started vaccination at an average of two months earlier compared to low-income countries requiring a 0.8 percent increase in healthcare spending compared to low-income countries which are expected to increase healthcare spending by 56.6% to cover 70% of their population. As vaccine equity, affordability and access worsen for lower income countries, it increases the risk of economic deterioration in an environment dominated by lockdowns.
India’s homegrown inactivated COVID vaccine is capped at $3.987 per dose compared to Pfizer’s $19.50 and Moderna $15 per dose making it one the most affordable options to low-income countries. The vaccine further does not require high maintenance storage and can be stored in a refrigerator with ease of transportation, a plus for countries which do not have access to advanced freezing techniques. India makes quite a case for coming up with low cost, easy access technology in a record time while grappling with raw material embargo from the developed world and yet, managing to vaccinate not only its population but providing vaccines to its neighbors like Nepal, Bangladesh, Maldives and Bhutan.
While vaccinations are being ramped up across the world, newer long-term complications of COVID-19 are coming forth including chest pain, throat pain, debilitating fatigue, abnormal breathing, depression, headaches, cognitive dysfunction to name a few of the 200 or so symptoms. These long-term complications also known as Long COVID is estimated to occur in 10-30% of all patients underlining yet unknown COVID-19 infection. Many hospitals across the US have developed Long COVID clinics involving a team of cardiologists, pulmonologists, neurologists, and others, to diagnose, treat and rehabilitate patients experiencing these symptoms post COVID-19 infection. As the second wave wound down in India, COVID reared its head with similar symptoms across its infected population. While data is hard to come by and lack of sensitization regarding post-COVID complications leads to invisibility of these cases, the Indian public health departments are taking aid of trained health workers (ASHA) to spread information, provide mental health support and suggest rehabilitation in rural and remote parts of the country. The specialists and specializations needed to cater to these patients remain far and wide with care available to the selected few.
These thoughts of widespread debility and health deterioration bring me back to the times when we first encountered this pandemic. The WHO confirmed novel coronavirus as the cause of respiratory illness in Wuhan City, Hubei, China on 12 January 2020, an event which has drastically changed the world as we know it. Since then, COVID-19 has caused more than 249 million cases with estimated 5.04 million deaths worldwide and counting with some economists predicting economic and mortality costs in the range of $10-20 trillion. It begs the question, how do we prevent this scale of infection, death, and destruction from happening again? Several scientists and researchers have come up with pandemic prevention and preparedness studies. One such study reports that on an average two viruses/year spillover is noted from animals to humans with deforestation, wildlife markets and illegal animal trade accounting for most of these cases. Investing in wildlife protection, deforestation, curbing illegal animal trade and reducing human encroachment in forest areas will reduce the spillover of zoonotic diseases like COVID-19 into the human environment thereby preventing future pandemics.
Influenza is projected most likely to be the next pandemic steering us in the direction of pandemic preparedness and bio-defense. COVID-19 brought most healthcare systems to their knees but it also brought the scientific community together developing datasets, sharing virological data and eventually leading to breakthroughs in vaccine research, development, distribution and logistics, all in record time. To manage such an event in future countries and governments across the board will have to focus on developing threat-based resource allocation, restoring public trust, fortifying early outbreak alert systems, privacy assuring technologies and mass casualty surge capacity. India’s challenges in this regard stem from scarce quality, accessible and transparent public health databases. It needs to aggressively invest in collection and management of high-quality data on health outcomes with analytical insights.
The war front with COVID-19 leads on to believe that it would bring in an era of international cooperation, philanthropy and commitments. The fact that countries and governments have seem to have focused inwards and not towards the world seems contradictory when faced with an invisible zoonotic disease like COVID-19 which spreads across those very interdependent trade, commerce and travel routes. The unequal resource allocation, hoarding of vaccine ingredients and technologies trending towards nationalism remains the cause of an ongoing pandemic despite our technological advancements. Unless all of us are protected, none of us are protected. The costly lessons we have learned from the COVID pandemic should lead us to prepare the future generations against a similar dreadful event and strengthen our resilience in the face of the unknown.
(Sanghavi is MD, Mayo Clinic)