One variant to rule them all!
by Yasir Aheer, Rahul Rao and Varun Rao
Loki, the god of mischief in Marvel’s Cinematic Universe (MCU), desires nothing more than to rule over the world. In the latest instalment of Loki, the TV series, MCU explores the philosophy of fate and destiny. It imagines a multiverse where individuals have no free will and outcomes are predetermined in the form of a “sacred timeline”. Variants, as they are called in the show, spawn when an individual’s action deviates from the sacred timeline. These variant individuals and corresponding timelines have to be “pruned”, else they wreak havoc within the multiverse. In yet another case of life imitating art, the current and future variants of COVID-19 carry similarly grave risks for us in the real world.
The World Health Organisation (WHO) is currently tracking four variants as Variants of Concern (VOC): Alpha, Beta, Gamma and Delta. The last of the four has dominated the recent news cycle and raised fresh concerns regarding the efficacy of some of the leading vaccines. There are also another four categorised as Variants of Interest (VOI), while the list labelled as Alerts for Further Monitoring seems to be growing.
Variants emerge through random mutation in the virus’ genes as it spreads within a population. The wider the spread the more likely these mutations become, risking the emergence of variants that could be more aggressive, infectious, and/or resilient to vaccines - as we are learning from the delta variant.
While some countries are celebrating initial successes in terms of their national vaccination coverage (Figure 1), it is clear that we will not rid ourselves of the pandemic until we achieve immunity at a global scale. Global transmission of the known variants has taught us that containing variants within geographical boundaries is simply not possible. Irrespective of where they originate, it is only a matter of time before they spread around the world. Tracking immunity at a national level is just not good enough.
A clear focus on achieving global immunity has to be the central objective for governments around the world. The Economist Intelligence Unit (EIU) paints a dismal picture of how far we are from global immunity (Figure 2) - widespread vaccination coverage will not be achieved globally till 2024.
Production of and access to vaccines is one of the main hurdles on the road to global vaccination coverage; the fact that certain countries have pre-ordered more doses than they actually need doesn’t help. Middle to low income economies are expected to experience the longest delays in accessing the much needed doses. With under-resourced medical systems, the virus will be allowed to spread widely within these communities continuing to take its toll on the respective populations and economies. Leaving aside the arguments around the inequitable distribution of vaccines, the current approach exposes everyone, irrespective of vaccination status, to the possibility of further more aggressive variants.
UNICEF projects that only around 5 billion doses of currently approved vaccines will be produced in 2021 (Figure 3). How these precious doses are distributed and administered around the world will be crucial in safeguarding not just against the current strains, but also mitigating the risks of more aggressive variants spawning around the world.
Effective global collaboration is paramount to ensure that our limited vaccine supplies are administered with the goal of achieving global immunity at speed. One such collaboration is the Access to COVID-19 Tools (ACT) Accelerator with an objective to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines.
Launched at the end of April 2020, ACT-Accelerator aims to improve collaboration across governments, scientists, businesses, civil society, and philanthropists and global health organizations in the fight against the pandemic. The ACT-Accelerator has four pillars of work: diagnostics, treatment, vaccines and health system strengthening.
The vaccine program of the ACT Accelerator is named COVAX and is co-led by Gavi, CEPI and WHO. COVAX’s aim is to accelerate the development & manufacture of COVID-19 vaccines, and to promote fair and equitable access for every country, irrespective of their buying power. Deliveries of doses from COVAX officially commenced in February 2021 and at the time of writing this article, the organisation had engaged with 190 countries, secured over 2 billion doses and received $7 billion in pledged funding.
However, COVAX itself is constrained by the limited access they can achieve to the precious few doses produced in 2021. The director-general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, issued a blunt warning; “the world is on the brink of a catastrophic moral failure”. According to an estimate from Science Magazine, nearly 85% of the COVID-19 vaccine doses administered at the time had gone to communities in high-income and upper middle–income countries. Further, some countries have stock-piled significant surpluses with calls intensifying for the surplus vaccines to be donated to the COVAX initiative.
Parting Thoughts
The delta variant is now considered the most contagious known variant of COVID-19. It is two to three times more contagious and is currently spreading widely around the world. The virulence of this variant has caused the US Centers for Disease Control and Prevention to recently change its masking guidelines. Even vaccinated people are now urged to resume wearing masks in high risk areas. A study from Israel shows that some of the leading vaccines are only 39% effective on the delta variant.
A lot has been said about the “moral failure” of the inequitable distribution of vaccines. However, the emergence of the highly infectious delta variant shows us that a fair and equitable global distribution of the vaccine is not just a moral consideration, but a necessity. It is the only way to safeguard us all not only against the known variants, but more importantly to reduce the risk of more aggressive variants in the future.
The question is whether we will learn from our experience with the delta variant, or continue down the path of shortsighted self interest, allowing COVID-19 and its current & future more aggressive variants to achieve Loki’s dreams and rule over the world for some more time to come.
No-one is safe until everyone is safe.
- ACT Accelerator
Disclaimer: This article is based on our personal opinion and does not reflect or represent the views of any organisation that we might be associated with.