Mass vaccination of those at minimal risk, with a vaccine that does not reduce transmission, is poor public health practice. Where this diverts financial and human resources from diseases of greater burden, it becomes a public health negative. This is orthodox, normal, and should not be controversial.
While the West is absorbed in its internal fights over vaccine mandates, masks and freedom, there seems one thing upon which all agree: ‘Vaccine Equity’- Ensuring those in low- and middle-income countries have the same access to Covid-19 vaccines as high-income populations. Even those skeptical of mass vaccination have been promoting the transfer of stocks to low-income populations, in preference to Western booster programs. Giving stuff to the poor is a good thing – that no good person could oppose – it shows we really care. A “global good.”
The World Health Organization (WHO), Gavi Alliance, CEPI, the World Economic Forum and governments globally are flying the humanitarian flag under the ‘COVAX’ umbrella, echoing the catchphrase “No one is safe, unless everyone is safe.”
A beguiling slogan, one that perfectly underlines the fallacy that is this entire charade and the shrewdness of its selling. If the vaccine is protective, the vaccinated are safe. If this is not true, if all remain unsafe, then this vaccine is not fit for this particular purpose. An international program costing many billions of dollars is based on empty, incoherent jargon.
To emphasize the absurdity, UNICEF has joined the rush to sell and implement this program whilst simultaneously recording the unprecedented harms the mono-virus focus of the Covid-19 response has caused to the children whose welfare UNICEF is supposed to protect. Humanity, and particularly those who claim humanitarian ideals and principles, need to pause, analyze this phrase, and then ponder a little deeper. Complacency is a betrayal of ourselves and others. Let us consider calmly, here, taking the countries of sub-Saharan Africa and their 1.3 billion people as an example.
The global health community knows how to measure disease burden – in metrics that take both mortality, age of death and disability (ie. ‘life-years lost’) into account such as Disability-Adjusted Life Years (DALYs). Applied to Covid-19, which overwhelmingly targets the elderly and those with chronic metabolic diseases (diabetes mellitus, hypertension, renal failure, obesity), these produce a relative burden even lower than that suggested by mortality alone – less than 4% of each of malaria, tuberculosis and HIV/AIDS across most sub-Saharan countries.
This skewing of Covid-19 mortality towards the elderly was clear from March 2020 and has not changed. Half of sub-Saharan Africa’s 1.3 billion people are below 19 years of age and less than 1% are over 75 years. Only South Africa, with its older and more obese population, comes close to the Covid-19 mortality of European countries.
Adequate vitamin D levels from outdoor lifestyles and sun exposure will likely have contributed further to mitigating severity in rural populations, together with preexisting T cell cross-immunity. African populations have not, however, been protected from SARS-CoV-2 exposure, with serology indicating high levels of post-infection immunity across multiple countries. Two years in, and with the highly transmissible Omicron variant originating in Africa, there must be relatively few people still to gain immunity.
Waning vaccine efficacy in Western countries is requiring boosters to maintain measurable efficacy against severe Covid-19. So this African population, intrinsically at low risk from SARS-CoV-2 by age, lacking major comorbidities and with many already having broad acquired immunity as effective as the vaccine, will be subject to a recurrent vaccination program that will not significantly reduce transmission. The protective effect of the first injections will have waned in those first vaccinated before the program has even reached many of their compatriots.
This is nonsense. At best, vaccination may reduce severe disease in a small vulnerable elderly group who happen to have thus far escaped infection, with their vulnerability returning before the initial round of vaccination has finished chasing the rest of the population who can receive little to no benefit.
Paying the fiddlers while the city burns
Africa CDC estimates $10 billion will be required to cover just 60% of these 1.3 billion people with the initial 2 doses. For context, the annual global budget of WHO is less than $3 billion, while the Global Fund, the largest international funder of infectious disease, provides less than $4 billion per year for malaria, HIV/AIDS and tuberculosis combined, globally. Now, $10 billion for a single round of intervention is a sum never on the table for these far more serious diseases. This scale of resource diversion, largely tax dollars originating from the struggling economies of donor countries, needs to be understood. Money, however, is just a small part of the story.
Mass vaccination on such a scale has never before been attempted. In countries where a single health worker commonly serves thousands of people, the inevitability of neglect of other disease programs through focus on Covid-19 vaccination is obvious. Child malaria deaths rose by 60,000 in sub-Saharan countries in 2020 and tuberculosis management is regressing amidst growing poverty and malnutrition. Further neglect will sacrifice young lives en masse for the sake of ‘equitable’ access to a short-term vaccine from which few can benefit.
At a higher level, the lockdown-induced economic recession in sub-Saharan Africa in 2020 and increasing foreign debt through the Covid-19 period will have significantly reduced local capacity to maintain core public health programs, such as childhood vaccination – 80 million children are thought to have missed infant vaccination, many in sub-Saharan countries. With traditional donors reducing budgets and diverting funds to Covid vaccine manufacturers, a reduction in external support seems likely. The least focused public health program in the history of these nations is being implemented just when funds for deteriorating essential programs are expected to decline.
Colonialism thrives on delusion
The push to mass vaccinate sub-Saharan populations has power and influence behind it, and there is a clear reluctance, even among those skeptical of Western Covid-19 public health responses, to raise a voice of opposition. It is dangerous to oppose ‘equity.’ However, this program will produce net harm by any normal public health calculus. A flow of Western taxpayer dollars will swell the accounts of vaccine manufacturers, whilst the mother of a febrile malnourished child in Niger or Malawi will be offered a pharmaceutical irrelevant to herself and her child.
Whether the vaccine has direct adverse effects, or prevents a small number of severe Covid-19 cases, will be lost in the noise of poverty and malnutrition. The reality of disenfranchisement and subjugation of communities to external pharma-driven priorities will be lost in the same media hypocrisy that has made such light of the decimation of African education and women’s rights over the past 2 years. Such stories no longer please those who determine the news agenda. So the poor will be poor, the rich (mostly elsewhere) will get richer, and the precedent will have been set for the future pandemic-based global health paradigm that the WHO is currently negotiating.
If the past 2 years are a guide, the rest of the global health industry of non-government organizations and advisors, heavily dependent on centralized funding, will dutifully fall in line. The humanitarian community will tout rising vaccination numbers divorced from disease burden and pat themselves on their collective backs. Considerable amoral servitude and self-delusion will be necessary to maintain this, but supplies of such delusion have proved plentiful. Colonialism, paternalism and arrogance come in many colors.
Is there sufficient courage left?
Whether madness on a global scale, or a stunningly large business deal, the success of this program depends on continued apathy and ignorance on the part of the taxpayers in donor countries, compliance by the recipient populations, and collaboration of humanitarian organizations and their staff. Low vaccine uptake by African populations seems the only likely driver toward a more rational approach.
Two years ago, I would have held hope that a reasonable mass of the staff of WHO, the Global Fund, Gates Foundation and other ‘humanitarian’ organizations would have stood up. Having worked for 20 years with these organizations, I know that staff and leadership understand the harm these policies are imposing on the people whose welfare they claim to serve.
Unfortunately for the victims, job security and money appear to be trumping ethics and training. Keeping the head down and the pension intact whilst waiting for others to blow the whistle is complicity, and cowardice. Perhaps the principled ones have already left.
In the end, this is about truth, and speaking it. The mass media, sharing ownership with key pharmaceutical companies, is no longer able to speak truth to power.
COVAX is a vehicle by which a very powerful and wealthy group seeks to impose a new paradigm on global public health, with centralized, pharma-based interventions replacing community-driven healthcare and national health sovereignty. We cannot afford to leave it as a side issue to the local battles that we face, or our successes will be pyrrhic. The corporatist, centralized health paradigm that COVAX epitomizes is a fog of delusion that seeks to ensnare us all.
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