Of vaccines and variants
Halfway through the year, vaccines and variants have emerged as the two poles of our pandemic horizon, representing our best hopes and worst fears, respectively. Indeed, amid the uneven distribution of vaccines around the world, variants—particularly the notorious Delta variant—threaten to protract the ongoing global health crisis.
None of this is unexpected. As long as viruses keep circulating, they will keep evolving, and mutations that make them contagious are bound to spread more. Already, the Delta variant has become the dominant strain of the virus in countries like India, Indonesia, and the UK; other countries are likely to face the same picture in a matter of weeks. The Philippines seems to have prevented such a scenario thus far, but our limited genomic surveillance capabilities mean that we cannot be too sure.
Thankfully, vaccines offer some defense against the variants. In the UK where 48 percent of the population has been fully vaccinated, although cases have risen, deaths have dropped, strongly suggesting that even if vaccines cannot prevent infection, it can at least prevent severe disease and death most of the time. In Israel, too, with its 60 percent full vaccination rate, the new cases, including “breakthrough infections” (i.e. infections in those who have been fully vaccinated) have been mostly asymptomatic or mild.
However, there are questions about whether the same can be said of all vaccines. The much-reported case of fully-vaccinated Indonesian doctors dying of COVID-19 reanimates questions about Sinovac although we cannot jump to conclusions, given that breakthrough infections have been reported for all vaccines and current data indicate that they remain generally effective.
Regardless, it is clear that, then as now, a multidimensional response is required if we are to overcome this new phase of the pandemic.
First, our immunization program must be scaled up with even greater urgency. To be fair to the Philippine government, the acquisition and administration of vaccines has picked up the pace over the past weeks. However, with only 2.4 percent of the population fully vaccinated, access to vaccines remains problematic and reports of LGUs having to cancel immunization schedules remain rife. Indeed, although “vaccine hesitancy” has been played up as a major impediment—and while we do need to address people’s fears about vaccination—our major problem today remains vaccine inequity, not vaccine hesitancy.
Also on the vaccine front, it’s important to ensure sustainability, which in the future should include domestic manufacturing capacity, alongside demanding TRIPS waivers for COVID-19 vaccines. Enviably, Cuba just announced that it had developed its own vaccine—Abdala—with a 92 percent efficacy, and while these numbers must be viewed with caution especially in light of the new variants, they nonetheless speak of the potential of even relatively resource-poor countries to have their own biotechnological capacity if their governments will invest in it.
Beyond vaccination, moreover, we need to fortify other aspects of the pandemic response, including embracing ventilation as a key paradigm to infection control, strengthening genomic surveillance, and continuing to improve testing capacity nationwide. Moreover, if there’s a lesson to be learned in the aftermath of the “second surge,” it’s that we should keep raising health care capacity even when cases are declining. And if there’s a lesson to be learned throughout this pandemic, it’s that people’s overall health and well-being matters, and we need to think of how we can allow people—including children and seniors—to carry out their daily activities safely, instead of reflexively imposing restrictions on various aspects of their lives.
Unfortunately, the Philippines remains stuck with a militaristic approach, the latest iteration being President Duterte’s threat to jail those who refuse vaccination. Clearly, we need a leader with a far broader imagination than the President, whose simplistic solutions predictably revolve around violence and punishment. Clearly, too, we need government officials and experts who can stand up against misguided measures and stand for genuinely science-based decision-making.
The fact that viruses evolve is well established. Can the government response evolve faster, making use of the latest evidence to respond adequately, reasonably, equitably, and urgently? Alas, this is a question that will define our fate in the coming months and years.
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