THIS WEEK we publish our estimate of the true death toll from covid-19. It tells the real story of the pandemic. But it also contains an urgent warning. Unless vaccine stocks reach the poorest countries, the tragic scenes currently unfolding in India are likely to be repeated elsewhere. Millions more will die.
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Using known data on 121 variables, from recorded deaths to demographics, we built a correlation model that allows us to fill in gaps where numbers are lacking. Our model suggests that covid-19 has already claimed 7.1 to 12.7 million lives. Our central estimate is that 10 million people have died who otherwise would live. This tally of “excess deaths” is more than three times the official tally, which nonetheless forms the basis for most statistics on the disease, including death rates and international comparisons.
The most important point of our work is that covid-19 has been harder on the poor than anyone realized. Official figures suggest the pandemic has struck in waves and the United States and Europe have been hit hard. Although South America was ravaged, the rest of the developing world seemed to be getting away with it lightly.
Our model tells another story. When you count all the bodies, you see the pandemic has spread mercilessly from the rich and connected world to poorer and more isolated regions. In doing so, the global daily death rate has risen sharply.
Death rates have been very high in some rich countries, but the overwhelming majority of the estimated 6.7 million deaths that no one has counted have been in poor and middle-income countries. In Romania and Iran, excess deaths are more than double the number officially attributed to covid-19. In Egypt, they are 13 times larger. In America, the difference is 7.1%.
India, where about 20,000 people die every day, is not an outlier. Our figures suggest that in terms of deaths per population, Peru’s pandemic was 2.5 times worse than India’s. The disease crosses Nepal and Pakistan. Infectious variants spread faster and, due to the tyranny of exponential growth, overwhelm health systems and fill morgues even though the virus is no longer deadly.
Ultimately, the way to stop this is with vaccination. As an example of collaboration and pioneering science, covid-19 vaccines are part of the Apollo space program. Less than a year after the virus was discovered, people could be protected from serious illness and death. Hundreds of millions of them have benefited.
In the short term, however, vaccines will fuel the gap between rich and poor. Soon, the only people to die from covid-19 in rich countries will be exceptionally fragile or unusually unlucky, as well as those who have denied the chance to get the vaccine. In poorer countries, on the other hand, most people will have no choice. They will remain unprotected for many months or years.
The world cannot rest while people perish for want of a stroke that costs as little as $ 4 for a two-dose course. It is difficult to think of a better use of resources than immunization. The central economists estimate for the direct value of a course is $ 2,900 – if you include factors like a long covid and the effect of impaired education, the total is much higher. The benefit of a billion extra doses provided by July would be worth hundreds of billions of dollars. Less virus in circulation means less mutation, and therefore less chance of a new variant which will re-infect the vaccinated.
Vaccine stocks are already increasing. At the end of April, according to Airfinity, an analytics company, vaccine makers produced 1.7 billion doses, 700 million more than the end of March and ten times more than January. Before the pandemic, the annual global immunization capacity was around 3.5 billion doses. The latest estimates indicate that total production in 2021 will be almost $ 11 billion. Some in the industry are forecasting a global surplus in 2022.
And yet the world is right to strive for more doses in more weapons sooner. Therefore, President Joe Biden has proposed to drop intellectual property claims on covid-19 vaccines. Many experts say that because some manufacturing capacity is begging millions of additional doses could become available if patent holders shared their secrets, including in countries that are now in the backlog. file. World trade rules allow for a derogation. When to invoke them if not in the grip of a pandemic?
We think Mr. Biden is wrong. A waiver may indicate that his administration cares about the world, but it is at best an empty gesture and at worst a cynical gesture.
A waiver will do nothing to address the urgent shortage of doses in 2021. The head of the World Trade Organization, the forum where it will be debated, warns that there may not be a vote before December. The technology transfer would take about six months, even if it started today. With the new mRNA vaccines manufactured by Pfizer and Moderna, it may take longer. Assuming the technology transfer was faster than that, experienced vaccine makers wouldn’t be available for hire, and manufacturers couldn’t get inputs from suppliers whose order books are already exploding. Pfizer’s vaccine requires 280 inputs from suppliers in 19 countries. No business can recreate this in a hurry.
Either way, vaccine makers don’t seem to be building up their technology, otherwise production wouldn’t increase as quickly. They have concluded 214 technology transfer agreements, an unprecedented number. This is not a price exaggeration: money is not the constraint of vaccination. Poor countries are not excluded from the market: their vaccines are arriving COVAX, a global distribution system funded by donors.
In the longer term, the effect of a waiver is unpredictable. This may indeed lead to a transfer of technology to poor countries; more likely, however, it will cause damage by disrupting supply chains, wasting resources, and ultimately discouraging innovation. Either way, if vaccines approach a surplus in 2022, the cavalry will arrive too late.
A needle in time
If Mr. Biden is serious about making a difference, he can donate the vaccine right now via COVAX. Rich countries ordered too much because they didn’t know which vaccines would work. Britain has ordered more than nine doses for each adult, Canada more than 13. These will be urgently needed elsewhere. It is wrong to put adolescents, who have a minimal risk of dying from covid-19, ahead of the elderly and health workers in poor countries. The rich world shouldn’t stockpile boosters to cover the population multiple times in case they are needed. Over the next six months, that could produce billions of doses of vaccine.
Countries can also improve supply chains. The Serum Institute, an Indian vaccine maker, struggled to get parts such as filters from America because exports were erased by the Defense Production Act (DPA), which puts suppliers on a war footing. Mr Biden has allowed a one-off exit, but he should focus on DPA on supplying the world instead. And better use must be made of the finished vaccine. In some poor countries, the vaccine languishes unused due to hesitation and chaotic organization. It makes sense to prioritize a shot in each vulnerable arm, before launching into the second.
Our model is not predictive. However, this suggests that some parts of the world are particularly vulnerable – for example, Southeast Asia, home to more than 650 million people, which has so far been spared mass deaths for no obvious reason. Covid-19 has not yet run its course. But vaccines have created the chance to save millions of lives. The world must not waste it. ■
All of our pandemic and vaccine related stories can be found on our coronavirus hub. You can also listen to The Jab, our podcast on the race between injections and infections, and find trackers showing the global vaccine rollout, excess deaths by country, and the spread of the virus in Europe and America.
This article appeared in the Leaders section of the print edition under the headline “Vaccinate the World”