Central Mpilo 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‘s COVID-19 reports are supported by the Heising-Simons Foundation.
On January 6, gastroenterologist Leolin Katsidzira received a worrying message from his colleague James Gita Hakim, a heart specialist and famous HIV / AIDS researcher. Hakim, head of the medical department at the University of Zimbabwe, fell ill and the test was positive for COVID-19. He was admitted to a hospital in Harare 10 days later and moved to an intensive care unit (ICU) after his condition worsened. He died on January 26.
It is an overwhelming loss for Zimbabwe’s medicine, says Katsidzira. “Don’t forget: we had a great brain drain. So, people like James are people who keep the system running, ”he adds. Scientists from around the world also mourned Hakim. He was “a unique research leader, a brilliant clinical scientist and mentor, humble, responsive and capable,” wrote Melanie Abas, a collaborator 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 administered more than 175 million injections to protect people from COVID-19 since December 2020, with most countries giving priority to medical workers. But not a single country in sub-Saharan Africa has started immunization – South Africa will be the first this week – leaving health workers dying in places where they are scarce to start.
The exact number of COVID-19 among healthcare professionals is difficult to assess, but Hakim was one of several prominent doctors to succumb in recent weeks in Africa, which has suffered a second pandemic wave. Just a day before him, American doctor David Katzenstein, who moved to Harare after his retirement and ran the Biomedical Research and Training Institute there, died of COVID-19 at the same hospital. These losses represent many others, says Robert Schooley, an infectious disease researcher at the University of California, San Diego, who worked with Hakim for many years. “We haven’t heard of many of the others who are working in the health workforce behind them.”
Neighboring Mozambique has lost an anesthesiologist, 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. These losses strongly affected Mozambique, which has only about eight doctors per 100,000 inhabitants, compared with almost 300 in the United States. “It will literally take an entire generation to rebuild” from such losses, says Ashish Jha, dean of the Brown University School of Public Health.
Global inequities have existed since the beginning of the COVID-19 pandemic. ICUs, ventilators and oxygen are scarce across the African continent, for example. But in the first few months, the basic public health measures needed to control the spread of the virus put countries more or less on an equal footing, said John Nkengasong, head of the African Centers for Disease Control and Prevention. And Africa resisted the pandemic relatively well, in part because of its young population.
But now, the launch of vaccines has put rich countries at a definite advantage. Many bet on several vaccines and signed contracts of sufficient doses to immunize their populations several times, restricting supplies to the rest of the world. According to the World Health Organization (WHO), three-quarters of all vaccinations so far have taken place in 10 countries that account for 60% of the global gross domestic product; 130 countries have not yet administered a single dose. “I don’t know why there isn’t a big outcry to do something about it,” said Gavin Yamey, of the Duke University Institute of Global Health. “The world is on the verge of catastrophic moral failure,” said Tedros Adhanom Ghebreyesus, WHO director-general born in Ethiopia, in January. In a joint statement last week, he and UNICEF Executive Director Henrietta Fore urged governments that vaccinated healthcare professionals and those most at risk to share doses with other countries, and vaccine manufacturers to distribute vaccines. equitably.
The equity gap may soon extend to COVID-19 therapy as well. The first convincingly proven drug to reduce the death rate caused by the virus, a steroid called dexamethasone, is inexpensive and used worldwide; Hakim received it before he died. But tocilizumab, which further reduces mortality in a UK study released on February 11, is an antibody about 100 times more expensive than dexamethasone and is not widely available. “THE [pandemic’s] the second wave, and potentially the third, is combated with a combination of public health measures and biomedical interventions, which will increase inequities, ”says Nkengasong.
In addition to the moral argument, there are sound economic and public health reasons to close the gap. Vaccination of people most at risk worldwide would reduce hospitalizations and deaths everywhere earlier, allowing societies to reopen and economies to recover. It can also help to reduce the circulation of the virus worldwide, decreasing the risk of new variants of the virus.
WHO and other international organizations have worked to bridge the gap through the COVID-19 Vaccines Global Access (COVAX) Facility, a joint mechanism to acquire billions of doses of various vaccines and distribute them to participating countries. It is beginning to bear fruit, albeit slowly: on Monday, WHO released an emergency use list for two versions of the AstraZeneca-University of Oxford vaccine, manufactured by the Serum Institute of India and SKBio, a South Korean company. COVAX expects to start supplying these vaccines to countries this month and to send 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 planning to distribute 1.2 million doses of the Pfizer-BioNTech vaccine.
Bruce Aylward, a senior advisor at Tedros, admits that the initial supply is just enough to cover a small part of the population in many developing countries. “But the reality is that we will receive many more doses for many more people in many more places, much faster than it would have ever happened without the COVAX installation,” he says.
To secure more vaccine earlier, African countries have formed a vaccine procurement task force that, with funding from the mobile phone company MTN Group, has already purchased 7 million doses of the AstraZeneca-Oxford vaccine. The first 1.5 million doses are due to be shipped to 19 countries on February 22, allowing health workers in those countries to be vaccinated by the end of that 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 to have their entire population covered this summer or fall.)
Schooley thinks the United States should take a more active role in protecting health workers in countries like Zimbabwe. The United States President’s Emergency Plan for AIDS Relief, launched in 2003, saved countless lives by providing more than $ 80 billion in the fight against HIV, he notes. “We have worked with our counterparts in Sub-Saharan Africa for 20 years to try to help them build a more resilient health infrastructure,” says Schooley, “and we are sitting on our hands watching this being torn apart by the coronavirus. “