A Second Pandemic Year, in Numbers

10 vaccines have been approved for full use by the WHO. These are the mRNA vaccines produced by Moderna and Pfizer-BioNTech, the adenoviral vectored vaccines produced by Janssen and AstraZeneca-Oxford (and its equivalent produced by the Serum Institute of India), the inactivated virus vaccines produced by Bharat Biotech, Sinopharm and Sinovac, and most recently the protein-based vaccine by Novavax (and its equivalent by the Serum Institute of India).

Although these first vaccines have proved to be very safe and effective, the world still needs other vaccines which are easier to manufacture and deploy in low and middle-income countries, are adapted to new viral variants, and/or are more effective in stopping viral transmission (for example intranasal vaccines). More than 100 vaccines are currently being tested in clinical trials, over 40 of them in the latest stages. Ten have been abandoned after failing in trials.

Barely one year ago, the first COVID-19 vaccine was given in the UK, kick-starting the mass vaccination campaign worldwide. Since then, 8.78 billion doses have been administered globally (to this day). Developing, producing and administering these vaccines in such a short time is an incredible feat, but one obscured by the fact that almost 3 out of 4 doses (73%) have been administered in high and upper-middle income countries.

One of the biggest failures in this pandemic is the hoarding of vaccines by rich countries. Of the 8.78 billion doses administered globally, only 0.8% have reached low-income countries. As a result, 92,8% of people in these countries are still waiting to receive at least one vaccine dose. In Tanzania, the share of fully vaccinated people is 1.75%. And only 1 in 4 African health workers are fully vaccinated against COVID-19. COVAX estimates it will have distributed around 1.4 million doses by ends or 2021, short of the initial 2 billion target. The problem is more one of supply (not enough vaccines) and logistics (they are sent late, close to their expiration date, and/or with little notice), rather than money.

The risk of dying from COVID-19 among people aged 60 to 80 was 25 times lower if they were fully vaccinated, compared to those unvaccinated, according to recent data published by Spanish authorities. Data from other countries, including the US and the UK confirm the huge impact COVID-19 vaccines have had on reducing the risk of hospitalization and deaths by COVID-19. Almost half a million lives among people aged 60 or more were saved in 2020, in Europe alone, according to ECDC estimates. Although efficacy against infection or symptomatic disease wanes over time, vaccines remain highly protective against hospitalization and death, and a booster dose seems to restore protection even against the omicron variant.

97.1% of the 100,000 people who died from COVID-19 in the US between mid-June and early October were unvaccinated, even though the country was awash with vaccines. Most of these preventable deaths occurred in the South and many were among people under 55 years of age. This figure illustrates one of the major obstacles to ending this pandemic (in addition to vaccine inequity): vaccine hesitancy, fuelled by disinformation and, in some cases, political ideology. The US ranks second, behind Russia, on vaccine hesitancy out of 15 countries surveyed, with 1 in 5 people unwilling to get vaccinated. But vaccine hesitancy is not an problem exclusive to high-income countries, and often goes hand in hand with distrust in the government.

Within the last few months, two antiviral drugs have proven effective in reducing hospitalizations and deaths among high-risk COVID-19 patients when given within the first days of symptoms: one developed by Merck (although the final efficacy is only 30%), and another one by Pfizer (with an announced efficacy of 89%). These much-needed drugs (and other promising antiviral treatments in the pipeline) will be very useful in reducing hospitalizations, but will only make an impact if they are available and affordable in all countries, and if they go hand in hand with wide access to early diagnostic tests. Contrary to vaccines, which were developed at an unprecedented speed thanks to decades of previous research on other coronaviruses and new vaccine strategies, antiviral drugs for treating COVID-19 have taken longer to develop.

More than 90% of hospitalised COVID-19 patients in the Americas were given an antimicrobial, but only 7% actually required these drugs to treat an infection. This is further fuelling what the WHO considers as one of the biggest threats to global health: antibiotic resistance. While the pandemic’s direct impact on health is undeniable- 5.5M reported deaths (the real number may be over 15M) and a considerable (but difficult to estimate) number of people suffering from long-Covid-, its indirect health impact may be even larger in the long term. In addition to the misuse of antibiotics and other drugs, provision of routine health services has been greatly impacted. Some examples: 3 million additional infants did not receive their first measles vaccination in 2020, an estimated 100 million cancer screening tests were not performed in Europe (which means as many as 1 million Europeans could be living with undiagnosed cancer), and the number of global tuberculosis deaths rose for the first time in more than a decade.

Schoolchildren worldwide have lost 1.8 trillion hours of in-person learning during the pandemic, says UNICEF, and warns that children and young people could feel the impact of COVID-19 on their mental health and well-being for many years to come. The social and economic consequences of the pandemic have been huge and, as often is the case, children are paying the highest price. 100 million more children fell into poverty in 2020 (a 10% increase since 2019). Meanwhile, the world’s billionaires have become richer: 2020 saw the steepest increase in their wealth, and the richest 10% owns 76% of the world’s wealth, says the latest World Inequality Report.

Approximately 1.56 billion face masks may have ended up in the oceans in 2020. The total plastic waste for 2020 (and likely 2021) has at least doubled that of 2019. Part of this increase is due to public demand of face masks and gloves and to an increase in plastic packaging by takeaways services and e-commerce outlets, but a great part of plastic discharge is due to hospital waste. In this sense, a group of 50 countries committed to develop climate-resilient and low-carbon health systems at the COP26. The climate summit made important progress in a number of areas (for example, commitments to curb methane emissions), but fell short of what is needed to keep the 1.5 degrees goal alive. The United Nations calculates that current plans, as they stand, put the world on track for 2.5^oC of warming by the end of the century.

6,361,329 SARS-CoV-2 genomic sequences have been submitted to the Global Initiative on Sharing All Influenza Data (GISAID) platform. GISAID was created by the scientific community in 2008 as a non-profit online database for sharing influenza virus genomes. When the COVID-19 pandemic began, researchers started uploading SARS-CoV-2 genome sequences, and more and more countries have been submitting data since. This fast and open sharing of data has allowed to continuously track the spread of the virus and its variants, and helped to develop diagnostic kits, prototype viruses for research, vaccines, and antibodies. GISAID is living proof that open science – in which communities share socially useful knowledge, free and without charge – can work, and that open sharing of data during a pandemic is more important than ever. With this in mind, a new centre in Berlin, Germany, was launched by the WHO, with the aim of sharing data and intelligence to better assess and respond to global disease threats.