Variants, Misinformation, and ‘Brain Drain’ — The COVID-19 Vaccine Experience in Brazil, India, and Africa

COVID-19 is likely to be with us for some time, despite the rollout of effective vaccines. The Delta variant is outpacing global vaccination efforts, and several countries — even those with ample vaccine supply — could be grappling with surges this summer. While life may be returning to so-called “normalcy” for those fully vaccinated in the U.S., the outlook is different elsewhere.

“When it comes to vaccines, there’s access and there’s supply. Then there’s the question ‘Will people take it?’” said Chicago Trust CEO Helene Gayle during a recent National Academy of Medicine (NAM) COVID-19 Conversations event, held in partnership with the American Public Health Association. Gayle, who also chaired a recent NAM study on equitable COVID-19 vaccine allocation, moderated the discussion with experts from Brazil, Africa, and India. They examined the social consequences of COVID-19 and the persistent public health challenges in their respective countries, and compared their experience to the U.S. experience.

One common theme they all agreed on: Rampant misinformation and fake news are not issues unique to the U.S.

“The first vaccine was given in 1796 … and the first anti-vaccine group likely formed in 1796,” said panelist Bill Foege, professor emeritus at Emory University’s Rollins School of Public Health and co-chair of the NAM report.  “It’s just the way people are. And you have to find the people that they trust in order to change that.”

What’s most alarming is that often, doctored videos and fake interviews feature seemingly credible scientists, added panelist Gagandeep ‘Cherry’ Kang, clinician scientist and professor at Christian Medical College in India. Many of them hawk “miracle cures” or spread misinformation about the vaccine and fertility.

“We cannot ignore vaccine misinformation in lower- and middle-income countries, because we’re a global community,” she said. “The messages spreading in our communities are many of the same messages you see in the U.S. They circulate on WhatsApp and YouTube, and as soon as YouTube takes them down, they appear on other sites and are dubbed in other languages,” said Kang.

Even among those who are trying to get vaccinated, there’s a digital divide, said Kang.

“You had people in urban areas registering in rural areas and returning to the city … when rural residents didn’t even know there was a vaccine drive going on in the first place.”

In Brazil, the pandemic — and an anti-science environment — has accelerated “brain drain,” an exodus of the country’s scientists and intellectuals, said Beatriz Grinsztejn, infectious disease physician at the Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation.

“The pandemic has implications for Brazil’s educational future,” said Grinsztejn. “Even before COVID-19, we saw dramatic cuts in research funding, and the dismantling of scientific institutions. We’re at risk of losing a generation of Brazilians who are contributing to our scientific, social, and economic development.”

Grinsztejn added that the prolonged pandemic in Brazil has set back poverty reduction goals by 13 years, and a food insecurity crisis is unfolding as well.

“If the vaccine rollout doesn’t scale up in Brazil, the disease will continue to proliferate. And the populations that experience poverty and social inequality will suffer the most.”

Salim Abdool Karim, director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), expressed concern that Africa is at “the back of the queue” when it comes to vaccine access and coverage.

While some African countries have secured enough doses of the vaccine, they can’t administer them in a timely manner. In South Africa, just 2.4 doses are available for every 100 people — while Canada has 10 doses for every one of its citizens, Abdool Karim said.

“Some countries are vaccinating children, who are low risk, when Africa has not even completed health care worker vaccinations,” he added.

Variants have also complicated matters, since vaccines that would otherwise be efficacious are not in certain countries. Access to whole-genome sequencing is also limited, which makes it difficult to understand the genomic landscape as new variants emerge.

“When you have low vaccine coverage and high transmission, that leads to new variants. So low vaccination coverage in Africa requires global solutions.”

Although panelists stressed the need for a shared mission and global solidarity to fight COVID-19 — similar to the HIV/AIDS movement — they warned against the notion of “vaccine diplomacy.”

“The term ‘vaccine diplomacy’ is one that’s driven by politics, versus the proper public health planning that we need to achieve vaccine equity,” said Abdool Karim.

Rather than promoting a return to “normalcy,” said Foege of Emory University, the global community should use this tragedy to fight against racism, gender inequity, and other social factors that make life unfair for so many. Echoing other panelists, he emphasized that we can’t live with vaccine stock concentrated in countries that already have control of the pandemic.

“Global solidarity needs to be in place so that all of us become safe,” he said. “It’s not enough for countries to control their situation if all of us don’t get the opportunity to do it together.”

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