Two years after the World Health Organization declared the novel coronavirus outbreak a global pandemic on 11 March 2022, the developed world’s long-time fixation on the SARS-CoV2 virus, which has killed 6 million people, has suddenly shifted away from health to the war in Ukraine and sharply rising geopolitical tensions. 

Meanwhile high-income countries have dropped restrictions as their citizens clamour for a return to normalcy. Low-income countries, including many in Africa, are still encountering resistance to COVID vaccine campaigns. 

While African Union countries have been eager to see more technology transfer to the continent to increase medicines and vaccine production– some countries may also be quietly questioning if COVID vaccination should be prioritized over the fight against other deadly disease threats – from cholera to Lassa fever.

And at the same time, as global health leaders point out, the pandemic is not over…. yet. 

Some countries in WHO´s Western Pacific region, notably South Korea and Malaysia, are facing a surge in cases. 

And a new “recombinant” virus variant, including features both of the deadly Delta variant and the infectious Omicron, has been identified in France. More virus variants could emerge in regions where vaccination rates remain significantly lower than the global average, WHO and other experts have continuously warned.

“This pandemic is not taking a break, despite the fact that we have this war, despite the fact that many countries are facing challenges… Unfortunately, this virus will take opportunities to continue to spread,” said Dr Maria van Kerkhove, WHO’s COVID-19 lead, during Wednesday’s WHO briefing.

Ukraine conflict ‘perfect storm’ for COVID surge 

The conflict in Ukraine is likely to lead to another surge in COVID, which will be nearly impossible to track as surveillance systems fall apart, others warn.  

The “low levels of vaccination and very low levels of getting booster doses and the social disruption is just a perfect storm for seeing the surge in cases,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University Mailman School of Public Health, speaking to USA Today. 

“It will all be lost in the noise,” said Dr Eric Toner, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “Assuming that the hospitals are able to even track admission data, there’s going to be a much bigger influx of people with war injuries than there would be COVID patients.”

A surge in deadly tuberculosis could be another element of fallout from the war in Ukraine, WHO and others have warned, given the large wave of migration and the breakdown in routine surveillance and treatment systems.  Ukraine, like neighboring Russia, has a high TB burden although it has made significant inroads in the past few years in combating the disease.  

Low testing rates also create opportunities for new variants to spread 

Speaking in a press briefing on Wednesday two days ahead of the pandemic anniversary date, WHO’s Dr Tedros Adhanom Ghebreyesus noted that although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases as the virus continues to evolve.

Just as significantly, he noted that ¨we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed.”

He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID 19 should be offered in addition to professionally-administered testing services.

“This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros.

Overall, reduced testing also reduces the ability to track virus trends, including the emergence of new variants.  

In Africa, WHO, Gavi, The Vaccine Alliance and the African Union have been working to build stronger COVID vaccine uptake in countries lacking strong health systems, with some success. 

However, sources have also have told Health Policy Watch, that some countries are becoming reluctant to aggressively push ahead with COVID vaccination campaigns when they face so many other challenges. 

Meanwhile, it remains a question if wealthy donor nations, many of them European, will respond quite as positively to the new GAVI Ask for some $16.8 billion for 2022 to fund vaccine distribution and health system uptake in low-income countries, primarily Africa, now that the Russian attacks on Ukraine have evolved into such a major humanitarian crisis that will also demand billions from donors to address.

Ultimately, the Russian invasion of Ukraine, more so than COVID fatigue, could sabotage the ¨pandemic dividend¨ that WHO and other health agencies might have hoped to have obtained in terms of convincing policymakers to focus more on health investments and in building stronger health systems.   

That, despite the fact that as Howard Catton, the head of the International Council of Nurses points out in an op-ed, “health, peace, and prosperity are inseparable.”  (see related Health Policy Watch story).

Attempts to return to normalcy amidst rising cases in some regions

Meanwhile, despite rising case rates in Asia as well as in Europe, countries continued to relax their COVID-19 restrictions, with most European countries having dropped “COVID certificate” requirements for entering domestic venues such as restaurants, while states in the United States are dropping mask requirements and other restrictions . 

Ireland and Hungary -this week joined Iceland, Norway, and Slovenia in lifting all of their COVID-19 restrictions.

“From March 6, 2022, travelers to Ireland are not required to show proof of vaccination, proof of recovery, or a negative PCR test result upon arrival. There are no post-arrival testing or quarantine requirements for travelers to Ireland,” the statement of the Irish authorities reads.

Similar to Ireland, the Hungarian authorities revealed that all incoming travelers, including those not vaccinated or recovered from the virus, are now permitted entry without testing rules. 

“It is possible to enter the territory of Hungary by public road, railway, water, and air traffic – regardless of citizenship and protection against the coronavirus,” the Hungarian authorities stated.  

This followed a major relaxation of restrictions in most other countries of the European Union as well as the United States and the United Kingdom several weeks ago.

“Today is not the day we can declare victory over COVID because this virus is not going away,” UK Prime Minister Boris Johnson said on 21 February, when he announced an end to England’s remaining legal curbs and most free testing.

The UK announcement came after Johnson said the nation had passed the peak of Omicron, and could now complete the “transition back to normality” – although since then cases in the UK have begun to rise again.

Many states in the US also have decided to lift mask requirements and other restrictions, with California becoming the first state to shift to an “endemic” approach to the coronavirus. 

However, US President Biden vowed, in his State of the Union address, to never give up the fight against COVID-10.

“I know some are talking about living with COVID-19,” the president said. “But tonight, I say that we never will just accept living with COVID-19.”

Further to the east, South Korea, which has recently been reporting more than 100,000 new cases a day, has started to ask people who test positive for COVID to look after themselves at home, so the country can redirect resources to the most vulnerable. As of 10 March, the country has reported 327,549 new cases. 

Pandemic restrictions – which include a six-person cap on private gatherings, a seven-day quarantine for international arrivals, mask mandates in public spaces, and vaccine passes for a range of businesses – will remain in place until at least 13 March.

Japan has, however, announced that it is easing border restrictions to allow more international students and visa holders in the country beginning in March, while cases decline.

One of the most COVID-restrictive countries, Australia opened up its borders to international visitors for the first time in nearly two years.  Travelers must still show proof of full vaccination to enter Australia without having to quarantine in a hotel, and they must provide a negative coronavirus test that was taken within 24 hours of departure.

.COVID-19 Delta-Omicron ‘recombinant’ in Europe

Meanwhile, Dr Maria van Kerkhove said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark.

“The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said van Kerkhove.

“There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants.

“We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway.

The evidence for the Delta-Omicron recombinant virus had been shared by the France-based NGO Institut Pasteur via the research consortium Global Initiative for Sharing Avian Influenza Data (GISAID). Additional investigation and analysis is needed to determine if the recombinant originates from a single common ancestor, or multiple similar recombination events. 

Said WHO Chief Scientist Soumya Swaminathan, in a tweet: “We have known that recombinant events can occur, in humans or animals, with multiple circulating variations of SARS-CoV-2. Need to wait for experiments to determine the properties of this virus. Importance of sequencing, analytics, and rapid data sharing as we deal with this pandemic.”

Image Credits: Prachatai, Christopher Dunstan Burgh/Flickr, WHO EB 150, Sharon Hahn Darlin.