Despite Recent Sharp Declines in New Cases, Global COVID Situation “Remains Highly Unstable,” Says WHO
Public health measures, including physical distancing, mask wearing, and hand hygiene, will continue to be necessary as the world is still in the “deepest part of this pandemic,” according to WHO officials.

The number of pandemic-related cases and deaths have rapidly accelerated in the first four months of 2021, said WHO officials on the second day of the 74th World Health Assembly – and despite sharp declines seen in almost every region over the four weeks, the situation remains “fragile.”

The “highly unstable” global epidemiological situation, combined with the slow global vaccine rollout, requires continued enforcement of public health measures worldwide, said Mike Ryan, WHO Executive Director of Health Emergencies. 

As of Tuesday, 167 million cases and 3.47 million deaths have been recorded since the beginning of the pandemic, although these figures are likely under-representative, according to WHO.

Cases have doubled since late December, and 2021 so far has seen a death toll of 1.6 million, compared to 1.82 million in all of last year.

Peaks in cases in all WHO regions were seen in late 2020 and into the first four months of 2021, fueled by increased social mixing, relaxation of public health measures, emergence of more transmissible SARS-CoV2 variants, and inequitable vaccine distribution. 

The rise in cases has burdened health systems, with ICUs operating at capacity and a shortage of beds, oxygen and therapeutics. 

“Recent weeks have shown an overall decline in reported cases, but the global situation remains fragile and volatile, with significant outbreaks in countries across all regions of the world,” said Ryan.

The global number of new weekly COVID-19 cases since the beginning of the pandemic, separated by WHO region.

According to the WHO COVID dashboard, sharp declines were reported in the past two weeks. As of May 17, new cases weekly appeared to have declined to 4.19 million globally – as compared to a peak of 5.69 million at the all-time pandemic peak on April 26.

This past week has seen the number of new cases drop further to roughly one million, according to WHO figures. However, the data may be incomplete as of May 24.

Despite the high numbers of deaths cumulatively – amounting to 3.5 million deaths so far reported to WHO and possibly far more in terms of unreported deaths – overall mortality rates also have declined over time. Ryan attributed that to earlier clinical care, effective use of oxygen and the steroid dexamethasone, and the fact that more health systems have gained experience in treating COVID cases, including during surges.  

The proportion of critically ill COVID-19 patients that died declined from nearly 40% early in the pandemic to approximately 16%.  

Public Health Measures Remain Essential to Curb Transmission

Although countries have learned from a year of experiences with containing the virus, contact tracing, and treating severely ill patients, the world remains “in the deepest part of this pandemic,” Ryan said. 

“Current estimates suggest that over 80% of our communities need to have immunity to stop or interrupt transmission. However, data from serologic studies around the world indicate that no countries have acquired this level of natural immunity. A substantial proportion of the world’s population remains susceptible to infection,” Ryan said. 

While COVID-19 vaccines could close the immunity gap, their distribution continues to be uneven and unfair. Some 83% of the 1.6 billion doses administered globally have been used in high- and upper-middle-income countries, which account for just half the world’s population. 

The difference in the number of doses administered per 100 people between high-income and low-income countries is more than 75-fold.

Now, however, countries that have conducted rapid an intensive vaccination campaigns – such as Israel, the United Kingdom and the United States – are seeing the rollout begin to slow – as all of those wishing to be vaccinated have done so.

Approximately 62.9% of Israel’s population have received at least one dose, but the country’s daily vaccines administered per 100 people dropped from 2.14 in late January to 0.05 in late May. 

Those countries have also seen very sharp declines in cases. However Ryan cautioned against over-optimism about what vaccines could achieve more broadly in light of the slower vaccine rollouts going on elsewhere – and the ongoing dearth of vaccines in many low- and middle-income countries.

As a result, “it is unlikely that many communities will achieve the very high levels of herd immunity required to control transmission anytime soon,” said Ryan. 

Public health measures that are the mainstay in controlling transmission will thus continue to be critically important for months to come. These include physical distancing, mask wearing, hand washing, robust testing, contact tracing, quarantining, and clinical care of cases. 

“We must stay the course while striving to increase vaccination coverage,” Ryan said. “Continuing to suppress viral transmission and dissemination is vital everywhere, regardless of vaccination rates – and is all the more critical given that the SARS-CoV2 virus continues to evolve.”

Dr Mike Ryan, WHO Executive Director of Health Emergencies Programme, at the World Health Assembly on Tuesday.

Currently, four variants of concern and six variants of interest are being monitored and examined for links to heightened transmissibility, more severe disease, and reduced vaccine efficacy. 

Evidence suggests that the available vaccines remain effective against the variants of concern, and that public health measures are able to control the variants’ spread. 

Short-term priorities include implementation of effective public health measures and enhanced national, regional and global surveillance and monitoring. Over the medium term, production and equitable distribution of vaccines, therapeutics and diagnostics need to be scaled up, and health systems’ resilience and capacities should be strengthened.

WHO Pandemic Initiatives Facing Funding Shortage

The Access to COVID-19 Tools (ACT) Accelerator, a global collaboration to speed up the development and distribution of diagnostics, therapeutics and vaccines, faces a US$18.5 billion financing gap. 

The ACT Accelerator is poised to deliver over two billion vaccine doses, 900 million rapid tests, and 100 million treatment courses in the coming year if funding challenges are overcome, said Dr Bruce Aylward, Accelerator lead and senior advisor to the director general. 

The diagnostics, vaccines and therapeutics delivered by the ACT Accelerator over the past year.

The COVAX Facility, one pillar of ACT-A, has shipped 72 million doses to 123 countries; 32 of those countries were only able to start their vaccination campaigns due to COVAX. 

“There’s no question that COVAX works. The challenge is getting the vaccines into the facility through the cooperation and support of countries and companies to be able to address the increasing inequity in distribution,” Aylward said. 

The equity gap extends beyond vaccines to tests and treatments, with high-income countries conducting 125 times more tests per day than low-income countries. 

“If you can’t see the virus, you can’t manage your outbreak, and you can’t understand the gravity of the situation – until it’s too late and you’re faced with catastrophic consequences,” Aylward said. 

Low- and middle-income countries, including India and Brazil most recently, have an oxygen shortage of 3.3 million cylinders per day currently needed to treat COVID-19 patients. 

“Inequities are prolonging the impact and duration of the pandemic,” said Ryan. “Urgent action is required not only to address inequitable access to health care and to vaccines, but to ensure that countries have the capacity to translate vaccines into vaccination, diagnostics into effective surveillance, and therapeutics into treatment.”

Nearly US$14.6 billion has been pledged to ACT-A, but the funding gap will have to be closed to carry out procurement and equitable rollout of critical tools. 

“Without that financing, we are unable to manage the response, roll out the vaccines, ensure we are testing, keep health care workers safe with PPE [personal protective equipment], and treat those with severe disease with oxygen and steroids,” Aylward said. “With financing alone, we cannot access doses because the vast majority are contracted through the end of this year.” 

Dr Bruce Aylward, Senior Advisor to the WHO Director General and lead for the ACT Accelerator.

Integrating and Financing WHO’s Pandemic Plan is Next Step in Closing Equity Gap

Fully funding and integrating WHO’s COVID-19 Strategic Preparedness and Response Plan for 2021, which was launched in February, within ACT-A will be crucial for the delivery of COVID products, stressed Aylward.

The Strategic Preparedness and Response Plan translates the knowledge from the global response to the pandemic in 2020 into strategic actions and guides coordinated measures. The Plan for 2021 is requesting US$1.96 billion to fund WHO’s efforts to end the acute phase of the pandemic. 

“If we want to expand now from the product development work, which has been so successful, to in-country delivery work, there has to be a strong WHO coordinating capacity,” said Aylward.

“We have the tools, [now] we got to have the capacity to support in-country uptake and use,” Aylward added.

The Plan currently has a funding shortfall of over 70%, which leaves “the organization in real and imminent danger of being unable to sustain core functions for urgent priorities,” said Ryan. 

More than 90% of the US$576.1 million received by WHO have been earmarked and just 8% of the funding is flexible. 

“This underfunding and earmarking of funds risks paralyzing WHO’s ability to provide rapid and flexible support to countries and is already having consequences for current operations,” said Ryan.

Some member states supported and joined the call for more flexible funding at a World Health Assembly session on Tuesday.

“We urge the member countries to consider predictable, sustainable and unearmarked financing to enable WHO to deliver on the functions entrusted to it under the International Health Regulations 2005,” said Shanchita Haque, Bangladesh’s delegate.

Shanchita Haque, Deputy Permanent Representative at the Permanent Mission of the People’s Republic of Bangladesh to the United Nations.

“Sweden remains a strong supporter of unearmarked funding to WHO and calls on member states to take responsibility,” said Sweden’s delegate. “We cannot expect WHO to deliver extensively without the means to do so.”

Member States Called Upon to Donate Doses 

The sharing of doses will be a crucial part of WHO Director General Dr Tedros Adhanom Ghebreyesus’ plan to vaccinate a quarter of a billion more people in the next four months, which he laid out in his opening remarks at the World Health Assembly. 

“Today I am calling on Member States to support a massive push to vaccinate at least 10% of the population of every country by September, and a ‘drive to December’ to achieve our goal of vaccinating at least 30% by the end of the year,” said Tedros on Monday.

Some 10 countries have recently announced plans to share over 150 million doses, but more will be needed in May and June to reach the goal by September, Aylward said. 

Image Credits: Flickr: IMF Photo/Joaquin Sarmiento, WHO.

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