It has now been 18 months since the SARS-CoV-2 virus was first sequenced in China. Within a month, the World Health Organization had issued its highest possible global alert, declaring the COVID-19 outbreak a Public Health Emergency of International Concern. Weeks later, the WHO declared a pandemic. Yet we are nowhere near the end of the crisis. On the contrary, we have entered a dangerous new phase in its evolution.
While complacency sets in among richer, more vaccinated countries, a cloud of despair has descended on lower-income countries that lack the means to fight new variants of the virus. And, after reporting declining numbers of new infections for seven consecutive weeks, the WHO is now recording an increase in confirmed cases practically everywhere. In its weekly epidemiological update on July 6, for example, it found that there had been a 30% increase in COVID-19 incidence in Europe, even though the European Union had delivered enough vaccine doses to immunize 70% of all adults.
The reason for this global resurgence is well known. The Delta variant, now identified in 111 countries, is significantly more contagious than previous strains of SARS-CoV-2, and it is spreading very fast. The rise of new variants serves as a reminder that we are dealing with a living organism that can and will evolve in response to the measures (and half-measures) that we deploy to fight it.
While the Alpha and Beta variants were somewhat less problematic, the Delta variant has proved ruthless, and it is anyone’s guess what future mutations will bring. The only certainty is that with the virus raging around the world, new variants are inevitable.
With a growing share of the population receiving vaccines in Europe and North America, lockdowns, mask mandates, and other measures are being eased, leading to unfortunate but predictable results. Dutch Prime Minister Mark Rutte recently had to apologize for his country’s rapidly rising infection rate, and he is unlikely to be the last leader who finds himself or herself in that position.
Worse, rich countries remain reluctant to step up and help. After multiple G7 and G20 meetings, the international community still has not closed the $16 billion funding gap for the Access to COVID-19 Tools Accelerator (ACT-A), the international coordinating mechanism for equitable access to vaccines. That sum is miniscule compared to the trillions of dollars being spent to support national economies.
While rich countries become complacent, many others are growing desperate, owing to a lack of vaccines, respirators, oxygen, and testing and sequencing supplies. With the rise of the Delta variant, they are essentially flying blind. On July 6, the WHO’s technical lead on COVID-19 warned that there are more than 20 countries “with exponential growth in cases … in all regions of the world.” And because many of these countries have low vaccination rates, a higher death toll is sure to follow.
All told, nearly one-quarter of the global population has been vaccinated. That might sound impressive; but the distribution has been grossly and immorally skewed toward richer countries. Moreover, the WHO estimates that 70% of the world will need to be vaccinated to end the pandemic. That means there is still a long way to go.
Yes, vaccine production is increasing fast, and pharmaceutical industry leaders are talking about producing 11 billion doses (the number needed for a 70% global immunization rate) this year. But that supply would come on top of the 3-4 billion annual vaccine doses that the world already needs to fight other diseases. And make no mistake, producing the COVID-19 vaccines is a complicated process. The Pfizer/BioNTech vaccine requires 280 inputs from suppliers in 19 countries. Boosting its production has required an unprecedented 200 new technology-transfer agreements.
While new efforts are underway at the WHO and the World Trade Organization to facilitate more of these kinds of arrangements, trade restrictions and vaccine nationalism remain a serious problem. The WTO recently noted that while the number of trade restrictions affecting vaccines has fallen from 109 at the beginning of the pandemic, there are still 53 provisions slowing down the hoped-for production increase.
In the meantime, more oxygen is urgently needed to avoid a repeat of the tragedy we witnessed in India. Multilateral institutions and NGOs have brokered important agreements with key global suppliers, but more must be done to keep up with the rising need across Africa and in parts of Asia.
Testing and sequencing supplies are also critically important, both for managing outbreaks and for detecting and quickly understanding new variants. In addition to the four current “variants of concern,” the WHO is monitoring four other “variants of interest,” one of which – the Lambda variant – has now been found in 29 countries.
The variant problem attests to the global nature of this crisis. Though the virus was first identified in China, the four variants of concern were identified far afield, in South Africa, Brazil, the United Kingdom, and India. Lambda was first uncovered in Peru. Because the next variant could come from anywhere, this is no time to ease our response. If we are going to avoid successive waves of new variants, we must redouble global vaccination efforts.
This is a test of political leadership. All governments must take seriously the dictum that no one is safe until everyone is. National successes in beating back the pandemic could easily be unraveled by national failures to fight it elsewhere. Let’s not learn that the hard way.