Vaccine apartheid: the separation of the world’s poorest and most vulnerable and the birth of Omicron

Prasad, Sakshi; Shahid, Abia; Co, Edzel Lorraine; Khatri, Govinda; Cheema, Huzaifa Ahmad; Rocha, Ian Christopher N.; Bardhan, Mainak; Hasan, Mohammad Mehedi

doi:10.1177/25151355221107975

Cited by 5 publications

(6 citation statements)

References 15 publications

(23 reference statements)

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“…It was recognized early on in the COVID-19 pandemic that vaccination would offer the global community the best chance at controlling it. Though many countries were early adopters [ 45 ], Pakistan has suffered from the twin perilous ideologies of vaccine hesitancy [ 46 ] and vaccine nationalism [ 47 , 48 ]. The former has been a longstanding problem in the country and is the major reason for which it has been one of the last bastions of poliomyelitis in the world in the years leading up to the pandemic, whereas the latter has been deleterious not just for low and middle income countries such as Pakistan but for the developed world as well (despite each nation believing that it is acting in its best self-interest) [ 47 , 48 ], resulting in the development of new variant strains and lengthening the duration of the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Though many countries were early adopters [ 45 ], Pakistan has suffered from the twin perilous ideologies of vaccine hesitancy [ 46 ] and vaccine nationalism [ 47 , 48 ]. The former has been a longstanding problem in the country and is the major reason for which it has been one of the last bastions of poliomyelitis in the world in the years leading up to the pandemic, whereas the latter has been deleterious not just for low and middle income countries such as Pakistan but for the developed world as well (despite each nation believing that it is acting in its best self-interest) [ 47 , 48 ], resulting in the development of new variant strains and lengthening the duration of the pandemic. Regrettably, if these factors persist, the consequences will be much worse for Pakistan's dilapidated healthcare sector, which is in dire need of development and implementation of concrete and achievable policies for the country’s largest-ever mass vaccination campaign to achieve set targets within planned timelines.…”

Section: Discussionmentioning

confidence: 99%

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Associations of the COVID-19 pandemic with the reported incidence of important endemic infectious disease agents and syndromes in Pakistan

et al. 2022

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Background Persons in Pakistan have suffered from various infectious diseases over the years, each impacted by various factors including climate change, seasonality, geopolitics, and resource availability. The COVID-19 pandemic is another complicating factor, with changes in the reported incidence of endemic infectious diseases and related syndromes under surveillance. Methods We assessed the monthly incidence of eight important infectious diseases/syndromes: acute upper respiratory infection (AURI), viral hepatitis, malaria, pneumonia, diarrhea, typhoid fever, measles, and neonatal tetanus (NNT), before and after the onset of the COVID-19 pandemic. Administrative health data of monthly reported cases of these diseases/syndromes from all five provinces/regions of Pakistan for a 3-year interval (March 2018–February 2021) were analyzed using an interrupted time series approach. Reported monthly incidence for each infectious disease agent or syndrome and COVID-19 were subjected to time series visualization. Spearman’s rank correlation coefficient between each infectious disease/syndrome and COVID-19 was calculated and median case numbers of each disease before and after the onset of the COVID-19 pandemic were compared using a Wilcoxon signed-rank test. Subsequently, a generalized linear negative binomial regression model was developed to determine the association between reported cases of each disease and COVID-19. Results In late February 2020, concurrent with the start of COVID-19, in all provinces, there were decreases in the reported incidence of the following diseases: AURI, pneumonia, hepatitis, diarrhea, typhoid, and measles. In contrast, the incidence of COVID was negatively associated with the reported incidence of NNT only in Punjab and Sindh, but not in Khyber Pakhtunkhwa (KPK), Balochistan, or Azad Jammu & Kashmir (AJK) & Gilgit Baltistan (GB). Similarly, COVID-19 was associated with a lowered incidence of malaria in Punjab, Sindh, and AJK & GB, but not in KPK and Balochistan. Conclusions COVID-19 was associated with a decreased reported incidence of most infectious diseases/syndromes studied in most provinces of Pakistan. However, exceptions included NNT in KPK, Balochistan and AJK & GB, and malaria in KPK and Balochistan. This general trend was attributed to a combination of resource diversion, misdiagnosis, misclassification, misinformation, and seasonal patterns of each disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Associations of the COVID-19 pandemic with the reported incidence of important endemic infectious disease agents and syndromes in Pakistan

et al. 2022

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“…At study entry in January 2023, our population comprised 101 confirmed HIV negative participants with no history of prior COVID-19 vaccination (Figure 1a). Median age was 33 years (inter-quartile range: [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and comprised 51% females. To analyse population level exposure to SARS-COV-2 at study entry in January 2023 when Omicron was the dominant circulating variant of concern (VOC), we tested all participants (n=101) at study entry for IgG anti-N, IgG anti-S and IgG anti-RBD against SARS-COV-2 Wu-1 using a Luminex bead-based flow cytometric assay.…”

Section: Evidence Of Population Level Sars-cov-2 Exposure In Abuja Ni...mentioning

confidence: 99%

Immune imprinting revealed by SARS-CoV-2 Omicron infection prior to vaccination

Gupta,

Abdullahi,

Onyemata

et al. 2024

Preprint

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Immune imprinting or original antigenic sin (OAS) originally referred to a phenomenon of suboptimal immune response to a repeat exposure to a virus that was antigenically distinct from the original virus infection. OAS has been implicated in higher mortality in young people during the 2009-10 H1N1 pandemic where the elderly (H1N1 exposure in childhood) appeared relatively well protected compared to younger individuals whose first influenza infection was not H1N1. Immune imprinting is part of a rapid recall system and is highly effective against a slowly evolving virus (drifting) but not antigenically shifting viruses such as influenza and SARS CoV-2. As predicted by OAS, suboptimal neutralization responses to the highly divergent SARS-COV-2 lineage Omicron have been observed in animal models and individuals previously vaccinated with primary course of ancestral (Wu-1) vaccine. Due to the rapid scale up of vaccine before emergence of the antigenically distinct Omicron variant, it is unknown whether immunological imprinting for occurs in the context of SARS-COV-2 infection itself. We longitudinally assessed humoral responses to primary two dose Ad26.COV2.S Wu-hu-1 based vaccination in a Nigerian population following the global emergence of Omicron. At study entry in Jan 2023, we found 93% and 58% of pre-vaccination participants previously exposed to ancestral Wu-1 and Omicron virus respectively by anti-N IgG and anti-receptor binding domain (RBD) IgG Wu-1 and Omicron -specific antibodies. In participants with no evidence of prior exposure to Omicron, neutralisation against Wu-1 was significantly higher than Omicron variants as expected. However, serum neutralisation titres in participants who were anti-RBD Omicron IgG positive were paradoxically 2-fold lower for Omicron BA.1 as compared to Wu-1. This is clear evidence for imprinted immunity from the ancestral pre-omicron lineage viruses, and remarkably these old responses to Wu-1 were able to dominate over more recent, likely multiple, Omicron lineage infections. Furthermore, in these participants with prior exposure to Omicron and evidence of imprinting, we observed that further Omicron infection and Wu-1 based vaccine was associated with boosting of responses across variants with equalisation of neutralisation titres for Wu-1 and Omicron variants. However, omicron responses did not surpass ancestral responses, suggesting persistence of imprinting and only partial mitigation. Although neutralization responses at high titres were observed post dose 1 vaccination against ancestral and Omicron variants BA.1, BA.2, BA.4 in nearly all participants, neutralisation against the highly immune evasive XBB recombinant variant remained substantially lower, with a second vaccine dose providing very modest boosting. These data highlight immune imprinting against SARS-CoV-2 prior to vaccination and its persistence thereafter. In present day unvaccinated populations where serum neutralisation responses to pre-Omicron variants dominate, use of an omicron variant based vaccine should be used in preference to Wu-1 based vaccine to override imprinting and provide broader protection for vulnerable populations such as the elderly or those with compromised immunity.

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“…However, governments in most low- and middle-income countries could not vaccinate their populations so quickly as they did not have timely access to COVID-19 vaccines. 1 In some cases, vaccines were not available until 2 years after the World Health Organization (WHO) declared COVID-19 a pandemic in March 2020. The reasons for these inequities are varied.…”

Section: Introductionmentioning

confidence: 99%

An mRNA technology transfer programme and economic sustainability in health care

Dutt,

Mazzucato,

Torreele

2024

Bull World Health Organ

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The World Health Organization (WHO) set up the messenger ribonucleic acid (mRNA) technology transfer programme in June 2021 with a development hub in South Africa and 15 partner vaccine producers in middle-income countries. The goal was to support the sustainable development of and access to life-saving vaccines for people in these countries as a means to enhance epidemic preparedness and global public health. This initiative aims to build resilience and strengthen local vaccine research, and development and manufacturing capacity in different regions of the world, especially those areas that could not access coronavirus disease 2019 (COVID-19) vaccines in a timely way. This paper outlines the current global vaccine market and summarizes the findings of a case study on the mRNA technology transfer programme conducted from November 2022 to May 2023. The study was guided by the vision of the WHO Council on the Economics of Health for All to build an economy for health using its four work streams of value, finance, innovation and capacity. Based on the findings of the study, we offer a mission-oriented policy framework to support the mRNA technology transfer programme as a pilot for transformative change towards an ecosystem for health innovation for the common good. Parts of this vision have already been incorporated into the governance of the mRNA technology transfer programme, while other aspects, especially the common good approach, still need to be applied to achieve the goals of the programme.

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Vaccine apartheid: the separation of the world’s poorest and most vulnerable and the birth of Omicron

Cited by 5 publications

References 15 publications

Associations of the COVID-19 pandemic with the reported incidence of important endemic infectious disease agents and syndromes in Pakistan

Associations of the COVID-19 pandemic with the reported incidence of important endemic infectious disease agents and syndromes in Pakistan

Immune imprinting revealed by SARS-CoV-2 Omicron infection prior to vaccination

An mRNA technology transfer programme and economic sustainability in health care

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