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The world faces new challenges of “anti-epidemic fatigue”

  South Africa, where the mutant strain of the new coronavirus Omicron was discovered for the first time in November 2021, announced on April 29, 2022 that the number of infections had risen rapidly again, entering a new wave of outbreaks. This wave of infection was caused by subline variants BA.4 and BA.5 of Omicron.
  The researchers preliminarily determined that BA.4 and BA.5 can avoid the immunity formed by infection with the original strain of Omicron, so they spread rapidly in South Africa, where herd immunity reaches 90%, and were infected by the original strain in 2021. of people have recently been re-infected, and the arrival of a new wave of outbreaks is 1 to 2 weeks earlier than the May-June estimates by infectious disease experts.
  On May 12, the European Center for Disease Control and Prevention also issued a statement stating that considering that BA.5 is rapidly becoming the main transmission strain in Portugal, BA.4 and BA.5 were reclassified as “mutant strains of concern”. According to preliminary statistics, BA.5 currently accounts for 37% of the total number of infected cases in Portugal, and covers the BA.2 strain with a daily growth rate of 13%. It is estimated that it will become the most important infection strain in Portugal by May 22.
  Omicron is the first familial mutation of the new coronavirus mutant strain. The European Center for Disease Control and Prevention initially believes that BA.4 and BA.5 will not cause more serious infections than the most primitive BA.1 of Omicron. Symptoms, but whether the original strain of Omicron will cause a new round of pandemic around the world is becoming the focus of infectious disease experts.
  Although the mutated strain of the new coronavirus still poses a threat to the global community, more and more countries can’t wait to bid farewell to the epidemic after several waves of epidemic peaks in more than two years. Denmark became the first country to lift all anti-epidemic measures from February 1, 2022, followed by other countries loosening restrictions on gatherings in public places at different speeds, and the Albanian government lifted all COVID-19 measures from May 1. Due to the control measures, Turkish people no longer need to wear masks since April 26.
  Countries subsequently further opened their borders and no longer require incoming passengers to provide proof of vaccination or negative nucleic acid tests. The European Center for Disease Control and Prevention and the Flight Safety Agency also issued a statement on May 11 stating that starting from May 16, it is no longer mandatory to wear masks when flying in the European Union.
  The World Health Organization (WHO) and some global infectious disease experts are concerned that the unpredictable development of the new coronavirus may pose risks as more and more countries move away from mandating the wearing of masks, screening and vaccinations. WHO Secretary-General Tedros Adhanom Ghebreyesus emphasized on April 26 that most countries have stopped screening, which has led to the WHO’s dilemma of “flying in the dark” and unable to obtain sufficient information on the transmission mode and mutant strains of the new coronavirus. According to estimates, from the first quarter to the second quarter of this year, the total number of global screening tests dropped by about 70%-90%.
  ”The world is entering an unprecedented large-scale experiment.” Fifa Rahman, consultant of the “ACT-Accelerator”, a global collaboration mechanism established by the WHO in response to the new crown pneumonia epidemic, told Caijing reporters, “Research has shown that humans will be infected again and again.”
Africa starts ignoring coronavirus

  From January 2020 to December 31, 2021, 14.9 million people worldwide died directly or indirectly from COVID-19. However, after more than two years of social epidemic prevention and control, an “infectious disease fatigue syndrome” has emerged in the global society.
  In terms of WHO’s control policy on the global epidemic, the loosening steps should be carried out under certain conditions, including high vaccination rate, high screening rate and social distancing. Especially in terms of vaccination rate, the WHO set in June 2021 that if the goal of vaccinating 70% of the world’s population is completed by June 2022, the new crown pneumonia epidemic will be relatively controlled globally. However, while the goal is doomed to be unattainable, many countries have also relaxed restrictions on screening and social distancing.
  Githinji Gitahi, global CEO of African non-governmental medical organization Amref Health Africa (hereinafter referred to as Amref) and director of the African Centers for Disease Control and Prevention, explained to Caijing reporters that in the past two years, the epidemic has affected life and the economy. The impact of the activities, especially the shutdown of certain industries such as tourism and trade, and the unemployment of employees, put many governments under pressure to unblock or loosen restrictions.
  For countries that have completed large-scale vaccination, the infection of Omikron did not lead to large-scale severe infection from February to April this year, and the number of infections declined. Appropriate unblocking is considered to be the first step towards the post-infectious disease era. However, since the mass vaccination of the world began in 2021, the global society has actively hoarded vaccines against the background of unequal political economy and high-income countries, resulting in a large number of unvaccinated people in Africa. WHO statistics show that although about 60% of the world’s population has been vaccinated, and most people in high-income countries have even completed three doses, only 11% of low-income countries have been vaccinated.
  In African countries, which have been suffering from vaccine shortages since 2021, only 12.8% of the population had completed two doses of the vaccine by March 27 this year, compared with 57.5% of the global population who completed two doses of the vaccine. Among the 54 African countries, except for Mauritius and Seychelles, which have exceeded 70% vaccination rates by the end of 2021, other countries are still struggling to promote vaccine popularization, and 13 countries, including the populous Congo and Nigeria, have not exceeded 10%.
  To the surprise of epidemiologists, despite the lack of mass vaccination, two-thirds of the African population already has antibodies to Covid-19. According to WHO tracking, as of September 2021, the actual number of infections is 800 million, but the official count is only 8.2 million, and the actual number of infections in the African population may be nearly 100 times the officially announced figure. According to this figure, the actual proportion of the infected population in Africa is 65%.
  Since the spring of 2022, because the Omicron strain has not caused a large number of severe cases and deaths, the attitude of African countries towards the new crown pneumonia epidemic has also changed. COVID-19 is not the only infectious disease that is prevalent locally. For example, Nigeria is facing an epidemic of malaria at the same time. The HIV infection rate in the entire African continent will only drop to 43% by the end of 2021. Therefore, when the diagnosis and severe rate of COVID-19 declines in early 2022, these countries are unavoidable. There needs to be a focus on fighting other, more prevalent infectious diseases.
  Gitahi further explained that after the first wave of the epidemic caused by the first generation of Omicron, the decline in the diagnosis rate and severe disease rate led to the neglect of the new crown vaccine by African countries and people, but behind the unvaccinated population hides such a fact , that “any large-scale infection could put more people at risk of severe illness, hospitalization or death. Unvaccinated also means they are perfect hosts for variants that pose risks to the global community.”

The last mile of universal vaccination

  Tulio Oliveira, a health expert who first participated in the identification of the Omicron variant, pointed out on social media on May 8 that BA.4 and BA.5 can avoid the immunity generated by infection with BA.1 , but the antibodies produced by the vaccine still have some resistance to it. “If South Africa and other countries want to avoid waves of infections, we need to increase the vaccination and booster vaccinations, including those who are already infected.
  ” Africa generally lacks medical resources. After Africa overcomes the shortage of vaccines by the end of 2021, the new challenges in 2022 will evolve into mismatches of supply and demand, lack of cold chain transportation and insufficient medical personnel. In addition, many African people are afraid of vaccines, and untrue rumors continue to circulate. Some people believe that “drinking hot water” and “taking a hot bath” can prevent infection; inoculating vaccines on the arms of residents of low-income countries is considered to be It is the last mile challenge for global vaccine universalization.
  On the one hand, several African countries complained that the donated vaccines are “flooding them”. On the other hand, as of March 27, only 54.9% of the vaccines delivered to African countries have been used, and 24 countries have not even used half. Krishna Udayakumar, founder of the Duke University Health Innovation Center, pointed out that when the supply of vaccines finally meets the demand, the new challenge faced by the global vaccine work is insufficient distribution and demand.
  Ritu Sharma, vice president of Care, a charity that promotes vaccinations in more than 30 countries around the world, pointed out that donating vaccines to low-income countries is like donating fire trucks to countries with water shortages.
  The lack of specialized medical staff is another reason why African countries are unable to vaccinate quickly. 63% of African doctors usually choose to immigrate to Europe and the United States for higher salaries after completing their training. Most doctors who stay there choose to live in cities. Taking Kenya as an example, 46% of Kenyan doctors live near the capital Nairobi. , while less than one-fifth of the country’s population lives in the region, resulting in 51 percent of Kenya’s capital’s residents being vaccinated, but only 10 percent in remote Mandela.
  In order to improve the lack of cold chain, the WHO estimates that helping low-income countries to complete vaccine universalization will require US$6 billion to purchase refrigeration equipment, train personnel and establish supply chains, but only US$1 billion has been raised so far.
  However, WHO and Amerf will focus on assisting countries by the end of 2021 in selected countries with lower vaccination rates. Amerf cooperates with WHO to actively promote vaccine programs in the region, such as launching special vehicles with refrigerated equipment for vaccines and medicines in remote areas of Kenya; the United States has assisted Uganda, which only completed the first dose of 14% of the population in November last year, to establish a cold chain in Uganda. .
  Uganda has accelerated vaccination since the end of 2021. As of April 30, 22.4% of the population had been fully vaccinated and 33.2% had been partially vaccinated. Considering that the public refused to be vaccinated out of fear, it began to study and introduce a mandatory vaccination law in early 2022. of people fined or imprisoned.
  The Uganda government’s concerns come from its neighbor, South Africa. Patrick Kagurusi, the representative of Amref Uganda, pointed out to Caijing reporter that the proximity of Uganda and South Africa means a high frequency of cross-border flow of people and goods, and also said that the new crown virus may at any time in Uganda’s population has not been vaccinated in a sufficient proportion The previous outbreak, “people who have not been vaccinated are at risk”, coupled with the government and society’s relaxation of epidemic prevention, the medical system that was hit hard by the epidemic before is still in a fragile state, these reasons may lead to a new round of large-scale epidemic.
  Gitahi stressed that countries and NGOs around the world should join together to help spread vaccines in Africa, “because time is running out.”
cost-effective strategy

  WHO believes that vaccination of 70% of the global population is still an important target for epidemic prevention, but some experts believe that it is time to admit that a single target cannot be applied to the international community with different economic conditions. The resources and infrastructure of low-income countries cannot support these countries with high-income countries. The country’s vaccination rate vaccinates its own people.
  More and more epidemiologists believe that until the 70% vaccination target cannot be reached temporarily, concentrating epidemic prevention resources on the elderly and high-risk groups is the method with the highest proportion of investment and effect.
  The Kenyan Medical Research Institute compared the epidemic prevention effects brought by different vaccination ratios (30%, 50% and 70%) and concluded that in the context of Kenya’s still low vaccination rate, vaccination of young people is already cost-effective. way of doing. Ensuring that the elderly and other high-risk groups are vaccinated quickly can maximize the economic cost of investment to create immunity, said Edwine Barasa, director of the agency, who hopes to use this research to help policymakers in African countries “to establish long-term, effective and low-cost cost-effective anti-epidemic mechanism”.
  The United Nations Children’s Fund (UNIEF) pointed out that African countries need to integrate the new crown vaccine into the routine medical system, and African residents need to be vaccinated in the community at any time, so as to continue to maintain the basic monitoring and vaccination of the new crown epidemic in these countries.
  Rahman explained that in practice, for example, when pregnant women go to the clinic for an ultrasound examination, the hospital can ask if they are willing to do a new crown screening; when people go to collect HIV reagents or screen for malaria, medical staff can provide the new crown virus by the way. Screening or asking if you are willing to be vaccinated against the new crown, especially if the patient has symptoms of pneumonia, provide a new crown screening. She emphasized that considering the different cultural backgrounds of each country, epidemic prevention measures cannot be universal. In densely populated places in Africa, it is not realistic for family members to sleep separately because of infection. Consider how to provide different means of epidemic prevention so that people can choose, for example, rapid antigen screening should be available at any time, so that they can choose to self-isolate.
  No matter how difficult, most infectious disease experts agree that the goal of completing global vaccinations cannot be relaxed. Tedros emphasized that trying to get 70% of the people in each country to complete the vaccination is still an important goal to control the epidemic, especially medical personnel, the elderly and high-risk groups need to be given priority for vaccination. “I’m surprised by the opinion of some global health experts that 70% vaccination coverage should not be the priority. If high-income countries are enjoying the benefits of high coverage, why can’t low-income countries?”
Access to medicines is in trouble again

  For African countries, the unfair treatment brought about by the new crown epidemic is not only about the availability of vaccines. The supply of new crown pneumonia treatment drugs has once again fallen into the predicament of high-income countries taking the lead for their own use, and pharmaceutical companies only seeking profits.
  Considering that Africa is ostracized by high-income countries when receiving vaccines, the WHO and the Union of African States believe that Africa should take this opportunity to develop the ability to manufacture vaccines in the region. The vaccine grows to a target of 60% self-produced by 2040; WHO also announced in February that six African countries, including Kenya, Egypt, South Africa, Tunisia, Senegal and Nigeria, were selected as the first countries eligible to receive mRNA technology.

  However, Africa’s self-produced vaccine has challenges after taking the first step. After the South African pharmaceutical company Aspen and Johnson & Johnson of the United States reached an agreement to become the first pharmaceutical company to produce a new crown vaccine in Africa, they immediately faced the dilemma of no orders. Since mid-May, Yaspan, while seeking help from African countries, also said that if there are no orders, he will be forced to close the production line in South Africa. South African President Ramaphosa also called on international agencies and NGOs to place orders with Aspen on May 12.
  Kagurusi, the representative of Amerf Uganda, pointed out that because the epidemic caused by Omicron weakened from February to April, African countries felt that it was unnecessary to continue to invest in epidemic prevention, so Aspen faced financial difficulties instead. Biovac, another South African pharmaceutical company that signed an agreement with Pfizer in the United States and BNT in Germany, had expected to start producing 100 million annual doses of the new crown vaccine for Africa this year, but the predicament facing Aspen has made Biovac worried about future development.
  Gitahi believes that the main problem at present is that the Global Vaccine Alliance (GAVI) has not insisted on purchasing vaccines from African pharmaceutical companies such as Yaspan. If the direction is not adjusted, the future African vaccine manufacturing plan will be doomed to fail. After all, it has been in operation for many years. The global market is used to purchasing vaccines under a fixed structure, and African countries have received free vaccines donated from other regions for many years. Driven by old habits, these countries have no reason to particularly support their own local manufacturing.
  Kagurusi emphasized that compared with other regions, Africa needs to build the capacity to produce vaccines, because not only the new crown pneumonia, but also the Ebola and Marburg viruses are also threats to Africa. Quickly fight the epidemic caused by the virus.” John Nkengasong, director of the African Center for Disease Control and Prevention, also recently called on African countries to support pharmaceutical companies that manufacture vaccines locally. He emphasized that these companies also need to develop other vaccines to meet the local medical needs in Africa. He pointed out that it would be short-sighted for African countries to rely only on donated vaccines without supporting local pharmaceutical companies.
  But Africa’s challenges in fighting infectious diseases don’t stop there. After the difficulties of obtaining a new crown vaccine, Africa is facing the same difficulty again in obtaining medicines to treat the new crown pneumonia.
  At present, the main oral drugs used in Europe and the United States for the treatment of new coronary pneumonia are Pfizer’s ritonavir (Pexlovid) and Merck’s monupiravir (Molnupiravir). In addition, the data shows that the oral drug developed by Shionogi Pharmaceutical Co., Ltd., which is suitable for the treatment of mild symptoms, has not been approved by the Japanese Ministry of Health, Labor and Welfare in February. In April, it negotiated with the US Food and Drug Administration for clinical trials. arrange.
  The high prices marked by Pfizer and Merck have made it difficult for African countries to obtain these drugs at present, and generic drugs will not be available until 2023 at the earliest. Under pressure, both companies signed agreements with UNICEF, promising to supply millions of doses to low- and middle-income countries at reasonable prices, but insisting on keeping prices secret.
  Pharmaceutical companies are too focused on profit, which directly causes people in different countries to be treated differently. The WHO has no way of knowing which countries have successfully obtained the medicines and how much they have paid. The WHO has even publicly criticized Pfizer’s opaque practices in this regard.
  For more infectious disease experts and doctors, the differentiated approach of pharmaceutical companies to high- and low-income countries reminds them again of the predicament that African countries face when the HIV virus spreads without drugs. Felipe Carvalho, Médecins Sans Frontières Latin America coordinator, said, “To this day, our world still treats the rich and the poor differently… 20, 30 years after the HIV crisis, we still need to try Convince businesses to do the right thing.”

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