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COVID’s Aftershocks: How HIV could be impacting COVID-19 variants


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Brutal crescendo: Ethiopia’s cases increased by more than 1,800% between July and September — signaling the start of an alarming third wave in a country grappling to contain both the virus and a devastating civil war. Nation-wide, vaccination rates stand at just 2%, but that figure is nearly non-existent in Tigray due to the myriad challenges of administering vaccines in conflict zones and the destruction of at least 70% of the region’s health centers last fall. While the military frontlines continue expanding, the compounded consequences of violence, famine conditions, and limited access to vaccines and healthcare means a third wave could hit a brutal crescendo in a country that already has the fifth-highest COVID-19 incidents on the continent.

Shipments speak louder: Only 10% of 900 million pledged COVID-19 vaccines have been shipped to low-income countries, according to the heads of leading pandemic response organizations. The G7 pledges themselves aren’t nearly enough, but the fact that only 1 in 10 has been delivered is astounding. As a result, Africa will fall 34 million vaccines short of inoculating 10% of the population by the end of September (the current rate is 2.83%). Leaders from the World Bank, WHO, IMF, and WTO urged wealthy nations to send the remaining 90% ASAP, let low-income countries cut the global vaccine production line, and eliminate trade barriers.

Recovery threat: Nigeria is struggling to seize the benefits of an oil market rebound amid the looming threat of COVID-19 variants and vaccination delays. Despite perceived risks, COVID-19’s economic crisis hasn’t deterred Chinese investment on the continent, which increased to $2.96 billion in 2020, with Nigeria as “China’s major investment destination in Africa.”

Contagion: The economic fallout of vaccine inequity doesn’t respect borders any more than the virus does. Rich countries are contending with supply chain disruptions and inflation as the cost of shipping containers has more than doubled in the past year. It seems a prediction from the International Chamber of Commerce earlier this year is coming to fruition.

Special delivery: Last week, Paul Kagame, Cyril Ramaphosa, and others met with Angela Merkel at the G20 Compact with Africa summit to discuss the $33 billion SDR allocations Africa has received. Few countries have even announced that they have received this money. One notable exception is Zimbabwe, which plans to use half to boost reserves and the rest to buy vaccines. Speaking of which, Johnson & Johnson and BioNTech announced African manufacturing plans.

Danke for doubling: German Chancellor Merkel pledged an additional 40 million vaccines for Africa, more than doubling Germany’s commitment and dropping its unused dose count below 8.7 million by the end of the year, according to ONE’s analysis. The German commitment rivals France’s 60 million dose pledge, which includes 10 million vaccines promised through a new partnership between the AU and French government.

No urgent need: Meanwhile, France is among the first EU countries to start doling out booster shots — an approach that some argue is based upon an overly cautious interpretation of study results and an under-appreciation of the risks posed by vaccine inequity. The European Medicines Agency said there was “no urgent need” for boosters, except for those who are immunocompromised.

Criminal waste: 15 million vaccines have been thrown away in the US since March — more than the vaccines available to Senegal, Nigeria, and Kenya combined. COVID-19 vaccines have a six-month shelf life (a quarter of other vaccines), which contributed to the wastage and highlights the need for greater transparency in dose manufacturing and administration. In order to prolong this timeline, manufacturers need to provide evidence on the vaccine’s extended efficacy.

New variants on the block: This week, the WHO expanded its VIP (or Variant of Interest) list to include Mu, a rising mutation against which prior infection or vaccination may not be as protective. This comes at a time when the Delta-driven third wave is beginning to stabilize in Africa, and as the spotlight increases on another variant (C.1.2) that recently emerged in South Africa. All three of these variants have markers associated with increased transmissibility, but C.1.2 has the most mutations to date.

200 days of mutations: In South Africa, experts believe that their concentration of HIV-positive people (7.7 million people) creates an environment ripe to produce such highly mutated variants. That’s because immunosuppressed individuals tend to be sick for longer — infections last more than 200 days among some people with severe HIV — and the longer that a person is infected, the more chances COVID-19 has to evolve. South Africa is making progress on its vaccinations and has fully inoculated 10% of the population, but two other HIV hotspots, Lesotho and Mozambique, have COVID-19 vaccination rates of around 2%. Another great reason to curb vaccine inequity, right? Right.

Crime most foul: DRC’s former Minister of Health Eteni Longondo stands accused of embezzling more than $7 million intended to help fight COVID-19 in the country. This would be unconscionable in any country, but the DRC has a vaccination rate of just 0.01%. It’s not just the money. Government mistrust dramatically decreases the likelihood that someone will seek out vaccination, and lowers compliance with preventive health measures.

Have you herd: Zimbabwe says that it’s on track to reach herd immunity, which they’ve pegged at around 66% inoculation, also announcing that they’ve opened vaccinations to everyone 14 and older. This is driven by a 13-million-dose purchase of Sinopharm and Sinovac vaccines, and a relatively high vaccination rate of 11%. While the Sinopharm and Sinovac vaccines are highly effective against severe illness and death, they may be relatively less effective than their counterparts against the Delta variant, which is present throughout Zimbabwe. Nevertheless, Zimbabwe announced that they will donate 20,000 vaccine doses to Namibia, in a display of regional solidarity.

Full disclosure: Zambia’s newly elected president, Hakainde Hichilema, announced this week that the country’s estimated debt burden is an astounding $12.7 billion. As the continent’s first pandemic-era sovereign defaulter, this disclosure may help secure an IMF bailout and revamp the country’s debt. President Hichilema’s short tenure is looking promising thus far, with the nation’s currency and dollar bonds surging to become the world’s best performers since his victory in mid-August.

The numbers

  • 7.5: The number of vaccinations per 100 people in Africa. Europe hit 100/100 earlier this week.
  • 173: Additional hours of childcare shouldered by women during the pandemic, three times higher than their male counterparts.
  • 30 million: The number of jobs lost in Africa due to the pandemic.

More reads

  • ONE’s Acting CEO Tom Hart joined more than 100 individuals and organizations calling on world leaders to convene a summit at the UN General Assembly to secure the commitments and actions needed to close the vaccine supply, financing, and capacity gaps.
  • Job creation, especially through value-added agriculture, is critical for Togo’s development and countering extremism. So says ONE’s Francophone Africa Director Désiré Assogbavi in an interview with the Center for Strategic & International Studies.
  • Our Aftershocks Data Journalism Fellow Gillian Nantume reported on Uganda’s hidden long COVID pandemic, and its potential to continue stressing national healthcare systems in the absence of widespread vaccinations.
  • Policy experts and researchers from African Center for Economic Transformation partnered with regional research bodies to publish a series of papers exploring the critical role of innovation in Africa’s recovery from COVID-19.
  • What is the precedent for ceasefires to create a safe environment for vaccine administration? NPR’s Madeline Dexter explores this question in light of failed attempts at public health diplomacy earlier in the pandemic.
  • Africa’s youth are contending with the pandemic, lockdowns, and associated economic downturns. Foreign Policy’s Lynsey Chutel argues that their protests haven’t garnered the attention that they deserve among the region’s leaders.

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