COVID Vaccination Inequity: Likelihood of Severe Cases Highest in Africa and South America

Published on 3rd August 2021

Apart from COVID-19 responses informed by sound research and proof, everything else about the global pandemic remains opinion — a daring experiment in adventure and luxury. So far, the lowest probabilities of developing severe COVID-19 cases have been established in Europe and North America. In Kenya, the new trend of infections in late July leaves little room to be lacklustre or lackadaisical about pronouncing the emergence of the earlier predicted fourth wave.

Key Highlights

  •  In July 2021, the proportional measures of COVID-19 cases had reached a point of relative stability in the continental shares, in terms of total cases, severe (serious or critical) cases, and COVID-19 deaths.
  •  Asia, the most populous continent with almost 60% of the world’s population, has been leading in the share of global cases at 31%, followed by Europe (26%), North America (22%), South America (18%), Africa (3%), and lastly Oceania (less than 1%). Going by the population sizes of the continents, the much lower COVID-19 testing capacity in Africa, the second most populous continent after Asia with more than 17% of the global population, becomes evident in these revealing statistics.
  •  But Asia has also posted the lowest case fatality rate (1.4%) as South America (3.1%) and Africa (2.5%) receive the worst hit on this metric.
  • Only Europe and North America are the continents whose shares of severe COVID-19 cases globally fall below the corresponding shares of the total cases globally. This is a bold outcome confirming that their leading vaccination rates are substantially reducing severe cases of COVID-19.
  • Henceforth, the fluid metric worth monitoring closely as new waves and variants arise is the probability of developing severe cases of COVID-19, by region and country. This will help inform the adequate pace and measures for containment, case management, and vaccination rates towards herd immunity.

Global Overview

As of August 2, 2021, the total COVID-19 cases globally had exceeded 199.5 million with more than 6.8 million cases in Africa. In July, the common measures expressed as case fatality rates or shares of cases and deaths remained more or less steady. This can be seen in the graphical plots of the relative shares as of July 5 and July 30, 2021. 

Enveloped in these revealing statistics of proportional shares, which evidently go against the population shares of the continents, is the glaring message of wide differences in testing capacity and the timeliness or overall efficacy of case reporting and case management and containment including COVID-19 vaccination rates.

Which COVID Metric Needs Emphasis from August 2021 and Why?

The common metrics outlined above have almost stabilised by continent and country. The probability of developing severe cases out of the reported cumulative cases has, however, been more fluid. This nature qualifies it as the metric deserving more emphasis on monitoring from August 2021 onwards. Europe (below 0.02%) and North America (0.038%) are the regions that have remained safely below a probability of 0.04% in developing severe COVID-19 cases over the same period. 

As a strong policy message, the probability of developing severe COVID-19 cases should be tracked more keenly as new waves and variants of concern emerge. A country like Kenya, for example, is arguably entering a vicious fourth wave as this modelling series had earlier predicted in May 2021.

Though the probability of developing severe COVID-cases increased substantially in Oceania, from 0.04% as of July 5 to 0.11% as of July 31, South America and Africa remained on a high score of between 0.06% and 0.09% throughout July on this measure. Their overall case fatality rates have also remained higher than the other continents’ and the global average of about 2%. The lower vaccination rates in these continents must be a compelling part of the explanation of this severity.

The Rising Likelihood of Severe COVID Cases in Kenya and across Africa

With 204,271 cases as at August 2 and only about 3% of the population vaccinated by then, Kenya has been posting positivity rates at an all-time high with double digits, hitting 15.6% on July 31. This modelling and study series had predicted that the fourth wave in this East African country ravaged by the Delta variant would pick up the pace in the second half of July. The latest developments are enough to justify the dreaded reality of a fourth wave developing in the country.

Furthermore, the probability of developing severe cases of COVID-19 in Kenya has risen to more than 0.09%, up from 0.06% where it had stayed in the first half of July. This was above Africa’s average of 0.06% as of July 31, 2021. In East Africa over the second half of July, Kenya’s neighbours of Uganda and Rwanda were even posting more worrying probabilities on this metric, at 0.70–0.96% and 0.14% respectively. As of July 5, Cameroon had a probability of 0.19% and Madagascar 0.08% . South Africa had 0.02% and Morocco 0.05% by the same date.

Conclusion

The analysis presented here has shown the wide disparity in COVID-19 outcomes across regions and countries. As the other metrics stabilise and become more predictable, the probability of developing severe COVID-19 cases remains the compelling parameter to monitor so as to inform the policy and strategic responses needed for effective containment, case management, and herd immunity through expedited vaccination.

As the map of COVID-19 vaccine inequity evolves, Africa and South America remain the key regions of concern in terms of case fatality rates and the likelihood of developing severe cases, which require HDU and ICU care. These regions need more determined support from the global community to bridge the gap in vaccination outcomes.

For Kenya, the new trend of infections from late July leaves little room to be lacklustre or lackadaisical about pronouncing the emergence of the earlier predicted fourth wave.

From August 2021 onwards, the key decision makers in Africa and South America must wake up to the reality that they are late in the race against time towards herd immunity. Redoubling efforts in research and proven containment measures and every decisive action towards the desired end are urgent and justified. Apart from such responses informed by sound research and proof, everything else about the global pandemic remains opinion and a daring experiment in adventure and luxury.

By Nashon Adero

Nashon Adero is a lecturer in the School of Mines and Engineering at Taita Taveta University, Kenya. He is the Founder of Impact Borderless Digital, a youth mentorship programme focused on lifelong skills development and global citizenship. 


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