Almost every day, a country in Europe announces the relaxation of pandemic measures. Some states approach the process systematically. Exactly and on time according to set milestones, such as the United Kingdom. Other adjust measures flexibly according to which group of stakeholders “complaints” most, as is the case in the Czech Republic or Slovakia. Germany, Austria and a few others have even overcome the mini-wave after the first attempt to relax the rules in early spring.
Nevertheless, it cannot be said that the situation is the same in all countries or that they are all equally safe. The 7-day average of positive PCR cases ranges from 14 to 480 cases per million inhabitants. At one end of the imaginary continuum are countries like Iceland and Portugal. Sweden and Lithuania are located on the other, negative, end. However, differences between countries do not end with the number of cases or hospitalizations. Although the level of vaccination with the first dose in Europe, apart from the United Kingdom and Hungary, is around 25 to 35%, the structure of those vaccinated varies considerably.
The percentage vaccinated with at least one dose who is over 80 ranges from 30 to 100%, and similar variances are present in virtually every age group. Countries differ not only in the order in which people can come to get a vaccine, but also in what type of a vaccine a person receives. Although each of the vaccines registered in the EMA or FDA protects almost completely against death or severe conditions, their effectiveness ranges from 59.5% to 95%, depending on age group or other factors.
Different incidences and approaches to vaccination among countries are fundamental pillars for the gradual spread of the virus across Europe. All the third wave needs is a further relaxation of measures and opened borders even in “worse” countries and a few imported cases by keen holidaymakers. As the number of tests also decreases with the number of positives, without the introduction of systematic screening, there is a risk that we will notice the onset of the new wave only when it is too late.
If we look at the situation outside Europe, the differences and risks further grow. The peaks of the pandemic curves in Europe were shifted between countries by only a few weeks. Globally, however, we can observe all trends, from a sharp increase (India, Nepal), to a stable situation (e.g. Mexico). Why?
Many factors are involved in pandemic measures that influence the dynamics of the spread of the virus. Some differ from continent to continent, such as the time of year or several political, religious, and cultural factors. Unfortunately, India is a prime example of this.
India exceeded the 100 positives per million inhabitants for the first time in mid-April 2021, more than a year after the outbreak of the pandemic in Wuhan, China. The country even donated hundreds of thousands of vaccines to neighbouring countries, as they were convinced that they were in stable control of the situation.
However, the situation changed rapidly in April, after the Hindu festival of Kumbh Mela, which was attended by more than 9 million people. Immediately after that, a sharp increase in positive cases began, causing an increase from about 40 to 300 cases per million inhabitants. It is true that several mutations of the virus (South African B.1.351, Brazilian P.1), as well as their own mutation B.1.617, have neem circulating in India. Each of the mutations could have an effect on the spread, but Kumbh Mela was identified as a super spreading trigger.
This wave is already spreading to neighbouring countries, such as Nepal. Nepal has had an open border with India for a long time, and just as we experienced in Europe, the Indian wave rolled to Nepal. As a result, Nepal has seen an increase in infection rates in the last month from around 8 to 250 cases per million population, which is a medical disaster in Nepal’s health sector.
The riskiness of countries can be “treated” through the travel traffic light system that most of the countries used in the summer and autumn of 2020. The principle is simple. Entry into dangerous-red zone countries will be prohibited and in others, testing, quarantine, or other measures will be required. The United Kingdom announced its three-color traffic light measures effective May 17. However, as we know from the first wave, even a traffic light does not have to prevent the spread through borders, as not all countries have an effective quarantine and test enforcement system. The definition of “safe country” is also subjective, and even with a small incidence, asymptomatic transmission and outbreaks are still possible.
Nonetheless, there is a big difference compared to the previous summer. We have vaccine and ongoing vaccination campaigns. Agreed. Vaccination is the key to defeating a virus. However, as we see in the example of the Seychelles or the Maldives, the vaccination rate must be higher than originally expected and the concept of “global collective immunity” is something that needs a lot of attention.
On May 3, Seychelles recorded a peak of 1,480 cases per million inhabitants. This is more than a 3-fold increase in one month, even though 65% of people received a first dose of the vaccine by the beginning of April. Today, the percentage is around 85% and yet, the island has tightened measures again. A similar increase is also experienced by the Maldives, which a month ago had about 45% vaccination with the first dose but have risen from 230 to almost 1,200 cases since then. Their vaccination today is around 60%.
What happened to these islands? There are several factors that could explain their situation. If we look at the structure of positivity in Seychelles, almost 80% of people are unvaccinated people.
Furthermore, with the increasing vaccination rate, many stopped following the measures and 16% of all cases were tourists, which would indicate that the epidemiological measures governing entry into the country are not sufficient. The South African mutation is also present on the island. On the other hand, despite the increase in the number of cases on the islands, they do not yet show a significant increase in hospitalizations or deaths. This confirms that vaccination prevents a difficult transition to the disease.
The Seychelles and the Maldives are sad, but invaluable, examples of pandemic politics. They point out that the concept of collective immunity of individual countries does not apply in the current globalized society and if we want to prevent further waves caused by the import of positive cases and have borders opened, we must focus on achieving global collective immunity and uniform rules for entry into countries.
The pandemic has shown that even countries with strong health care cannot withstand the onslaught of the COVID wave. Medical staff is rare everywhere. Whether in Asia or Europe. In Slovakia or Spain. The pandemic has shown that healthcare sector is a critical infrastructure and often in a fragile state. Whole economies stand and fall on health systems, as we have seen around the world over the last year.
Joint action to combat the pandemic is therefore crucial. It is not just about border control, but also about a common approach to measures, testing or vaccination. This is one of the key lessons learnt from the pandemics. Only jointly we can manage the next wave.