Low vaccination rate in poor countries creates breeding ground for coronavirus mutations

In early March, Cameroonian virologist John Nkengasong made a dire prediction about the global vaccination drive against Covid-19. “Europe is trying to vaccinate 80% [of its population.] The United States is trying to vaccinate everybody. They will finish vaccinating, impose travel restrictions and then Africa becomes the continent of Covid,” he said in an interview with African news publication Mail & Guardian, at a time when the vaccination rate for Europe and the US was around 70% and 69%, respectively.

On Friday, the European Union announced that flights to southern Africa would be suspended due to the detection of a new coronavirus variant called omicron in Botswana and South Africa. Nkengasong was right. The world shut its door on Africa, while global stock prices plummeted.

In the world’s poorest countries, only three in every 100 people are fully vaccinated against Covid-19, according to Oxford University’s statistical repository Our World In Data. This is despite the fact that safe and effective vaccines have been available for nearly a year. Just 7% of the population of Africa is fully vaccinated, but this figure is close to zero in some countries, such as Burundi (0.00025%), the Democratic Republic of Congo (0.06%) and Chad (0.42%).

The global epidemiological situation is also a powder keg for the world’s richest counties. The virus continues to mutate: when it creates copies of itself, errors can sometimes emerge which lead to new mutations. This means every infected person, who can carry up to one trillion copies of the coronavirus inside their body, increases the likelihood of more contagious and virulent strains of the coronavirus emerging by chance. Officially, more than three million coronavirus cases are reported each week across the globe. The World Health Organization (WHO), however, warns that in Africa, it is likely that only one in seven infections is being detected due to the fact that the continent has a very young population, meaning many cases are asymptomatic, and to the lack of testing and tracking.

Ethiopian biologist Tedros Adhanom Ghebreyesus, who is the director-general of the WHO, has been criticizing the unequal rollout of the Covid-19 for months. “Every day, there are six times more boosters administered globally than primary doses in low-income countries. This is a scandal that must stop now,” he said on November 13. “It makes no sense to give boosters to healthy adults or to vaccinate children, when the health workers or older people and other high-risk groups around the world are still waiting for their first dose.”

Nicksy Gumede-Moeletsi, a senior virologist at WHO’s Regional Office for Africa in Brazzaville in the Democratic Republic of Congo, warns that the uncontrolled spread of the coronavirus is the perfect breeding ground for “very concerning” new variants. “While we continue to have such low vaccination coverage, especially in Africa, we will be providing an opportunity for the variants to spread,” she said. “Africa needs vaccines.”

The Covid-19 immunization drive in Africa has been hindered by weak healthcare systems and logistical problems with sending out vaccines in optimal conditions. But a large part of the problem is also due to the fact that developed countries are stockpiling vaccines, according to the WHO. The world’s leading economies have promised to donate around two billion doses via the Covax initiative, which is aimed at guaranteeing equitable access to vaccines across the globe. The US has offered to donate 1.1 billion doses, the EU, 500 million, while the United Kingdom and China have promised 100 million each, according to an analysis by the US think tank Council on Foreign Relations. But these 2 billion doses are a meager sum if 70% of the world’s population is to be fully vaccinated. What’s more, only one in every five doses promised has been delivered, according to the latest data from the Council of Foreign Relations, which was updated a month ago.

Meanwhile, the controversy about whether the patents for the Covid-19 vaccines should be waived has still not been resolved months after the issue was first raised, with the World Trade Organization unable to reach an agreement due to the opposition of some of its members such as the EU, the UK, Norway and Switzerland. With no progress on the patent waivers, the WHO launched in June a consortium aimed at boosting vaccine production in South Africa. Currently, the continent depends on factories in India, China, the US and the EU, which are tied up fulfilling contracts with wealthy countries.

The South African company Afrigen Biologics, with the support of the WHO, will try to copy the vaccine formula of the US pharmaceutical company Moderna, which has been criticized by the White House for not lifting its patent despite having received nearly $10 billion in taxpayers’ money. Afrigen Biologics, however, has said that it will not have its first vaccines ready until September 2022. In a message on Twitter, Tom Frieden, the former director of the US Centers for Disease Control and Prevention (CDC), went so far as to say that “two companies hold the world hostage,” in reference to Moderna and Pfizer-BioNTech, which are resisting pressure to temporarily lift the patents for their respective Covid-19 vaccines. These vaccines are based on mRNA technology, and are considered the most effective against the virus.

The delta variant of the coronavirus, which was first detected in India a year ago, changed the course of the pandemic, as it contained mutations that made it twice as contagious as earlier strains. The omicron variant has several of the same mutations in the delta strain, as well as others identified in the variants alpha, beta and gamma, which were first identified in the UK, South Africa and Brazil, respectively. Others have never been seen before. Many of the more than 30 concerning mutations in the omicron variant are linked with greater transmissibility and a certain ability to escape human defenses – be they antibodies developed through recovery from Covid-19 or from the vaccines. But it may be weeks before the real danger of the new variant can be confirmed.

In either case, the way to curb the spread of the variant is clear, says virologist Isabel Sola. “It’s not a question of doing anything radically new, but rather of stepping up the measures already available to limit the spread of the virus: face masks, ventilation, limited contacts, distance…Vaccination also limits infections from spreading, which should help contain it,” explained Sola, who is the co-director of an experimental Covid-19 vaccine at the National Biotechnology Center in Madrid. “To prevent the appearance of new variants, it’s essential to limit infections, so that the virus doesn’t have an opportunity to multiply and change.”

Tulio de Oliveira, the director of the Centre for Epidemic Response and Innovation (CERI) in South Africa, who is leading one of the groups that detected the omicron variant, called on wealthy countries not to punish southern Africa with travel restrictions. In a message on Twitter, the bioinformatics expert pointed out that the countries that identify new variants are the ones that have invested the most in analysis laboratories – not necessarily the ones where the mutations are emerging.

“The world should provide support to South Africa and Africa and not discriminate or isolate it! By protecting and supporting it, we will protect the world!” he wrote on Thursday. His plea was not successful. The next day, the president of the European Commission, Ursula von der Leyen, announced plans to suspend travel to the southern Africa region, despite the fact that a case of the omicron variant had been detected in Belgium. Other European countries, including Portugal, Italy and the Netherlands, have also reported cases of the new strain, but air travel to these nations has not been restricted.

Biologist Iñaki Comas, from the Biomedical Institute in Valencia, applauds the work of the South African scientists. “What’s important is that countries have the ability to detect these variants and communicate it quickly, as South Africa did,” he said. “Not to create alarm, but rather to increase our vigilance and so we can really assess if it is a variant that could change the face of the pandemic, as happened with delta.” He added: “That’s why it’s important that we invest in all of these countries, because identifying [new variants] there is preventing [them] here.”