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Covid-19: WHO urges countries to plug immunity gaps as global infections rise

BMJ 2022; 378 doi: (Published 07 July 2022) Cite this as: BMJ 2022;378:o1685
  1. Luke Taylor
  1. Bogotá

Senior World Health Organization officials have warned that the global increase in covid-19 infections is likely just the beginning and that nations must plug immunity gaps quickly before they are exploited by new sub-lineages of SARS-CoV-2.

Officials told a media briefing on 6 July that poorer nations are particularly vulnerable to a surge driven by the new lineages of the omicron variant, as many of those countries have still not reached WHO’s vaccination targets or gained access to antivirals.

Some 4.6 million covid-19 infections were reported globally for the week from 27 June—the fourth consecutive week of increases. The number of infections had been declining throughout March, April, and May.

Reported cases have risen almost 30% in the past two weeks and increased in four out of six WHO regions.

In Europe and America, sub-lineages BA.4 and BA.5 are driving a wave of infections, WHO director general Tedros Adhanom Ghebreyesus said.

BA.4 and BA.5 are becoming dominant in many countries, likely because of their increased ability to evade immune protection from prior infection or vaccination.1

In India a new sub-lineage of BA.2.75 has been detected and is being closely monitored by WHO.

“Tip of the iceberg”

The number of new weekly cases increased most in the eastern Mediterranean, South East Asia, and Europe, where infections grew 29%, 20%, and 15% respectively.

Those numbers are likely an undercount as the increase in infections coincides with a global decrease in testing, officials said.

The increases in infections driven by new variants are expected to spread across the globe and have upended expectations in Europe that the warm summer weather would draw people outside and reduce contagion.

Mike Ryan, executive director of WHO’s health emergencies programme, said, “It’s important to recognise that we’re seeing the tip of an iceberg of transmission. Certainly, in Europe. And we’ll see that happen on other continents as well.”

Vaccine immunity is so far preventing the number of covid-19 intensive care admissions and deaths from rising. But Bruce Aylward, senior adviser to the WHO director general, said that trend would likely cease once the wave of infections spreads to less wealthy countries with inferior vaccine immunity.

“Where people are highly protected we are seeing a decoupling of disease and death—but that is a phenomenon in the north,” Aylward said. “There are huge parts of the south where vaccination rates are in the teens.”

“The plea is to policymakers and political leaders. We have vaccines and now is the time to make the case to your populations to get the primary series and get boosted,” Aylward added. “The virus is telling you that right now there is a window of opportunity. And any resurgence of a virus like this, this early, with so much of the world still unprotected, is serious.”

An “abundance” of vaccines

The Covax scheme, co-led by WHO, has an “abundance” of vaccines available to any country who requests them, Aldwyn stressed.

Ryan added that all nations, irrespective of their income or vaccine immunity, must identify their immunological weak spots to prevent the wave of infections causing fatalities and added strain on health services.

“Be it because of previous waves of infection, vaccination levels, marginalised groups, people who are under vaccinated, or high proportions of vulnerable people, each country has gaps in its readiness, gaps in its preparedness, and gaps in its surveillance,” Ryan said.

Countries should strive to boost protection against covid-19 in these groups with vaccines and if necessary ensure they can easily access testing, treatment, and drugs to minimise the risk of long covid and deaths.

Hospitals should also have strong triage systems in place and governments regular surveillance and sequencing of the virus to stay ahead of any trends in its transmission or mutations.

“This isn’t about shutting anything down. This is about adapting to these new realities that we face,” Ryan told the press conference.

Access to antivirals

Tedros said WHO was in talks with Pfizer to secure access to antivirals for low and middle income countries, but said those talks are delaying the supply of life saving drugs.

WHO is working with the Global Fund and the UN Children’s Fund to ensure countries have antivirals when they become available.

In total, 20 countries have secured future access to molnupiravir and 43 have expressed an interest in obtaining nirmatrelvir-ritonavir, Tedros said. But many countries will probably opt to wait for a cheaper, generic version of the antiviral, which is unlikely to be available before early 2023.

“This will cost lives,” Tedros said. “I call on Pfizer to work closely with health agencies and countries to ensure its new oral antiviral is available quickly and effectively.”

The WHO director general urged people in countries where covid-19 cases are rising to adopt tried and tested public health practices to protect themselves and others. “If you’re in a crowded place or inside and there’s poor ventilation, put on a mask,” he said. “And if you’re sick, and you can, stay home.”

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