Necropolitics in the Amazon

Eduardo Gudynas

During these pandemic times, everything seems to indicate that the socio-environmental crisis is getting worse in Latin America, especially in regions like the Amazon. This is not always recognized or adequately addressed, as the Covid-19 emergency takes center stage and other problems are put on the back burner.

Governments, the private sector and many other actors are using the pandemic as an excuse to justify harmful practices.  These actors are pushing extraction strategies, such as mining and oil concessions and agricultural expansion, in order to re-start economic growth.

As usual, the Amazon is on the frontlines of the war for the appropriation of the natural world. Most people when they hear ‘Amazon’, think only of Brazil. And while the situation in that country certainly is alarming, the battlefields of the Amazon region span northern Bolivia, various departments of Peru, several areas of Ecuador and southern Colombia and Venezuela.

In all parts of the Amazon, the indigenous populations are the first to be affected. The Amazon region is not empty space; it is their home. Extractive activities destroy their environment, pollute their food supply and cause additional suffering and violence, ranging from displacement, to persecution or assassination. Some groups, like the Yanomami in Brazil, face risk of genocide, fueled by both legal and illegal extraction activities.

This is how the extraction of natural resources operates, especially in virgin areas and protected lands, affecting indigenous territories or reserves, environmental protection areas, or high biodiversity sites.

Multiple interlinking factors exacerbate this dynamic. Pressures imposed by national companies or local subsidiaries of foreign corporations, aligned with discourse from local politicians, academics and even trade unions, reinforce the usual narrative that the Amazon region is either empty space or an area to be exploited for export.

International pressures determined by factors such as the global demand for raw materials, international prices, or investors’ interests also determine what happens to the Amazon. These conditions are the result of globalization dominated by transnational corporations and are much more intense than national or local factors.

For example, as the international price of gold increases, mining spreads across the Amazon and up the slopes of the Andes. In some cases it is formal, carried out by transnational corporations or even local cooperatives (as in Bolivia), but in others it is informal or illegal, feeding contraband networks (as in Colombia or Peru). Its consequences include the deforestation of the forest and mercury contamination in rivers. This environmental degradation destroys the livelihoods of indigenous peoples.  These situations are rampant where extraction activities occur.

The pandemic has only aggravated the situation. Many countries in the Amazon region have redoubled their extraction strategies in hope of increasing exports of their natural resources as a response to the economic crisis. They have reduced social and environmental controls, leading to extreme measures to ease agrochemical regulation  in Brazil and new threats to protected areas in Bolivia. There is no difference between the extractive activities carried out by Jair Bolonaro’s extreme right in Brazil, and the progressive governments of Boliva and Argentina.

This situation can be characterized as ‘necropolitics’–the policy of letting people and the environment die off. Sadly, this phenomenon is becoming normalized for a growing number of citizens. The Covid19 crisis, along with the accompanying diminishing health of people, has caused a vast majority to live with death on a daily basis.

Necropolitics has now reached the Amazon region. By the end of 2020, there were already more than 1.5 million indigenous people affected by Covid19 in the Amazon region, with an estimated 37,747 deaths. In Brazil alone, an estimated 26,000 died.

Human rights defenders, who already were facing many restrictions, were further weakened under these necropolitics.  Governments applied all kinds of restrictions and abused military or police controls already in place. They failed to adequately deal with the pandemic, and left indigenous populations to face the crisis alone.  Jair Bolsonaro shamelessly declared that faced with the health crisis, Brazil’s indigenous people would be fine if they just drank tea.

While all the world’s attention was focused on Covid19, violence increased in the Amazon. The Coordinator of Indigenous Organizations of the Amazon Region (COICA), representing more than 500 indigenous people, stated it would declare a violation of rights emergency.  In 2020, on average, one indigenous leader was assassinated every two days.

Concurrently, citizens’ distrust of politics and elected officials has deepened. Peru presents arguably one of the most extreme cases, facing a succession of political crises that has been going on for years and has led people to believe this is  the country’s institutional norm.  The recent national elections revealed the level of mistrust: about half of Peru’s voters either rejected all candidates outright, or were simply not interested in voting at all.  Of the slightly more than 25 million eligible voters, about 10 million either submitted blank, null or absentee ballots.

Politics as an exercise in dialogue and deliberation is quickly fading away. This only serves to benefit the imposition of more extractive activities, as this retrenchment circumvents the processes of disseminating information and collaboration. Channels for addressing complaints or criticizing impacts are disappearing, and human rights are being violated. If politics crumble, alternatives to these extraction activities will not have a way to be presented or discussed.  It is as if necropolitics has devoured what politics truly used to be.

While it is true that prior to 2020, indigenous peoples’ rights were repeatedly ignored, marginalized and violated, after more than a year of this pandemic, the situation has become even more dire. This is true for indigenous populations and for the environment as a whole.

Today, the Amazon region is in the center of the battle between the policies of death and alternatives that emphasize  health and life. Even at this difficult time, this contrast deserves to be highlighted and addressed.

Why the Approval of That Alzheimer’s Drug Is So Disturbing

Tim Requarth

Last week, the Food and Drug Administration ignored the advice of its own expert advisory committee and approved the first new treatment for Alzheimer’s in 18 years.

Called Aduhelm, it carries a substantial risk of painful brain swelling and bleeding, requires monthly infusions, and comes with an eye-popping list price of $56,000 per year.

These caveats might be fine if the drug, which is manufactured by Biogen, miraculously restored the memories lost by the 6 million Americans with Alzheimer’s—or at least measurably improved the lives of patients in some meaningful way.

But according to even the FDA’s own statisticians, the clinical data fail to show the new drug can slow Alzheimer’s devastating cognitive decline.

The FDA’s surprise approval has ignited a firestorm within the medical community. People are justifiably angry about the felonious cost for a risky drug that may offer little, if any, benefit. Aduhelm is, for now, a confusing and foregone conclusion; Biogen is slated to ship the drug starting next week.

But a closer look at the FDA’s approval process reveals a deeper scientific issue at stake about what constitutes adequate evidence for desperately needed treatments. How the Aduhelm saga played out could have far-reaching implications not just for Alzheimer’s patients, but for anyone taking a drug approved by the FDA in the future.

To understand why the FDA approved the drug, and why this approval is so problematic beyond Aduhelm itself, it’s helpful to understand a bit about how clinical studies are designed.

Some drugs are approved based on real-world outcomes, such as whether they prevent death. But others are approved based on so-called surrogate outcomes, such as whether they, say, suppress an abnormal heartbeat. If the surrogate outcome (abnormal heartbeat) is meaningfully associated with the real-world outcome (death), it follows that a drug suppressing the abnormal heartbeat should help prevent life-threatening heart attacks. Aduhelm doesn’t seem to show much benefit to patients according to a clinical dementia rating scale (a real-world outcome, approximately—some researchers say it’s not quite as firm as an outcome like “death”). But the drug does do one thing well—it removes some of the amyloid plaques that build up in the brains of Alzheimer’s patients (a surrogate outcome). It’s seemingly on the basis of this surrogate outcome that the FDA saved Aduhelm from joining a long list of failed Alzheimer’s treatments.

Approving drugs based on the surrogate-outcome approach, in principle, offers huge advantages. It’s easier, cheaper, and faster to design a clinical study that measures a drug’s effect on abnormal heartbeats than to wait for enough people to suffer a heart attack and die. Drug approvals based on surrogate outcomes have indeed proved to be lifesaving in the past. In 1992, in the midst of the HIV crisis, the FDA created a special “Accelerated Approval” program to fast-track urgently needed treatments based on surrogate outcomes alone. (The only catch was companies had to perform post-approval confirmatory studies to assess real-world outcomes like sickness and death, or the FDA could withdraw the drug.) The first wave of treatments approved in this program were HIV drugs, brought to market based on improving surrogate outcomes such as levels of a type of white blood cell. These drugs were later proved to prevent sickness and death from AIDS, which wasn’t surprising because scientists had established a tight linkage between white blood cell count and disease progression. The surrogate-outcome approach was considered a success.

Aduhelm now joins this group of drugs that merely fiddle with the body’s physiology but potentially leave patients worse off and much poorer for it.

 

But HIV drugs are among the only unqualified successes for surrogate approvals. Joseph Ross, a professor of medicine and public health at Yale University, studies the FDA regulatory process and notes that apart from the HIV drugs, “in almost every other instance, surrogates have proven to be far more fallible.”

Several diabetes drugs have been approved because they lower hemoglobin A1c, a measure of average blood sugar levels. That might seem clearly useful.

 However, these drugs have wildly different effects on diabetic complications and overall mortality. At least one drug is thought to increase heart attacks.

Cancer drugs with astronomical price tags might reduce tumor size but fail to prolong life or improve its quality. The list goes on: Blockbuster drugs lower cholesterol but fail to prevent cardiovascular disease. Osteoporosis drugs improve bone density but fail to decrease fractures. And in some cases, these drugs have damaging side effects only discovered years later.

In fact, the writing has long been on the wall that the surrogate-outcome approach can be a bit dicey. Take the heartbeat example above—which is actually real.

In the mid-’80s, two class IC antiarrhythmics were brought to market largely based on the evidence that they suppressed abnormal heartbeats. Yet, no one had ever done a clinical study to confirm the drugs actually prevented death.

When such a study was conducted years later, it had to be stopped midway through: It turns out these drugs actually increased the chance of death.

Although the human toll is impossible to know, the surrogate-outcome approach in this case may have caused thousands of unnecessary deaths.

Although the link between abnormal heartbeats and death was plausible in theory, it turned out quite differently in the real world.

There’s a clear lesson from using surrogate outcomes to evaluate a drug. Without strong evidence of a link between the surrogate outcome and the clinical outcome, the FDA should be wary to greenlight treatments based on surrogate outcomes alone. For HIV drugs, this link was already established, and the drugs panned out. For the heart drug, this link was less established, and the drug did not pan out.

Aduhelm now joins this group of drugs that fiddle with the body’s physiology but potentially leave patients worse off and much poorer for it.

Recall that with this drug, about 30–40 percent of study participants experienced either brain swelling or bleeding. Not to mention the $56,000 annual price tag—much of which Medicare is required to cover—could be a fiscal catastrophe for American health care.

No one disputes that amyloid plaques appear in the brains of Alzheimer’s patients, and no one doubts Aduhelm can clear amyloid plaques (by a respectable 30 percent), but how valid of a surrogate outcome are amyloid plaques for the real-world outcomes Alzheimer’s patients care about? Given the pent-up demand, the worrisome side effects, and the steep price, you’d hope the amyloid hypothesis is a slam-dunk. Unfortunately, it’s not even close.

What amyloid plaques mean—and in turn, what Aduhelm’s actual effect on people might be—is still a hotly debated scientific question. Do they cause Alzheimer’s? Do they worsen it? Are they incidental? Are they protective?

Scientists have made reasonable cases one way or another, but it’s very far from settled that amyloid plaques are a valid surrogate outcome for Alzheimer’s. What’s worse, the amyloid hypothesis doesn’t have a great track record with regard to therapeutics.

Several drugs targeting amyloid plaques have been developed and then fizzled during clinical trials because not a single one had any effect on dementia. And yet, when approving Aduhelm, the FDA relied almost entirely on the amyloid hypothesis.

What makes the FDA’s decision so baffling is that surrogates are used when researchers can’t, or don’t, collect data that better reflects the real-world outcome of interest—in this case, slowing or preventing cognitive decline due to Alzheimer’s. But that’s exactly the data that Biogen submitted.

The two clinical studies—which looked at cognitive decline, something that patients and doctors definitely care about—showed almost no benefit. One study was a total dud, and the other raised a score on a cognitive scale by a minuscule amount. Although that improvement reached statistical significance, it is almost certainly not going to make a difference in the lives of patients. “The effect sizes are trivial from a clinical point of view,” said Chiadi Onyike, a professor of psychiatry and behavioral sciences at Johns Hopkins and a member of the 11-person committee of outside experts tapped by the FDA to review the data. “They are meaningless—no different from the ebb and flow a patient might show from week to week.”

Not a single member of the FDA’s outside advisory committee recommended approval. The fallout has already been widespread. So far, three members of the FDA’s advisory committee have resigned, one of them calling the process a “sham.”

Doctors who helped run Biogen’s clinical studies are speaking out, and others are penning editorials that they won’t be prescribing Aduhelm until they see evidence of effectiveness. But no one should hold their breath.

When the FDA greenlit Aduhelm for use, it told Biogen it had nine years to run the confirmatory studies necessary to prove Aduhelm’s effectiveness. Nine years of people taking this drug that existing data suggests might not do anything meaningful.

 With Aduhelm poised to become among the biggest blockbuster drug in history—analysts estimate annual revenues could peak at $10 billion—Biogen probably isn’t in a hurry.

But they might not even have to collect that extra data at all (for its part, Biogen said in an email to Slate, “We are working diligently to initiate the confirmatory trial”).

Ross, the Yale FDA regulatory expert, looked at FDA approvals from 2005–12, and found that post-market confirmatory studies—ones that truly verified the clinical value of a surrogate outcome—only took place about 10 percent of the time.

Despite this dismal compliance rate, according to Ross, the FDA has never fined a company for failing to do a confirmatory study and rarely uses its power to withdraw a drug later shown to be clinically ineffective.

In an email to Slate, the FDA did not offer comment on whether it would use its power to withdraw Aduhelm should the drug ultimately prove clinically ineffective but “will carefully monitor trial progress and support efforts to complete this trial in the shortest possible timeline.”

What specifically caused the FDA to approve Aduhelm based on such a shaky outcome and over the protests of its own committee is anyone’s guess, even in the context of the FDA’s frequent reliance on surrogate outcomes—nearly 45 percent of all drugs, according to the agency’s own analysis.

(In a press release acknowledging the contention around the decision, the FDA explained that it ultimately decided “the benefits of Aduhelm for patients with Alzheimer’s disease outweighed the risks of the therapy.”)

Aduhelm may well help fuel a trend in leaning too heavily on surrogate outcomes: Because the Aduhelm example is so egregious, it establishes a far-reaching precedent that some believe could undermine the regulatory process.

“Presumably,” says Ross, “[companies] could look at what just happened with this product and say, ‘Hey, you have to treat me the same way.’ ”

In other words, when a company fails to show a drug actually works, why not try for back-door approval based on an unproven idea of how the drug is supposed to work. This might seem grim, and it is.

But there’s a lesson you can take as a patient: just because a number goes up or down at the doctor’s office—whether it’s cholesterol, blood pressure, or even weight—that doesn’t necessarily mean you’re better or worse off for it.

Because of the FDA’s widespread endorsement of surrogate metrics, it’s been all too easy for patients—and doctors—to believe these metrics for health are health itself.

With a false sense of understanding comes a false sense of hope, a false promise of control. That’s the true tragedy of the Aduhelm approval.

‘Epic Failure of Humanity’: Global Displaced Population Hits All-Time High

Jake Johnson

A report released Friday by the United Nations Refugee Agency finds that more than 82 million people across the globe were forcibly displaced by war, persecution, the climate crisis, and other factors by the end of 2020, a record high that one international aid group called “an epic failure of humanity.”

The U.N.’s annual Global Trends in Forced Displacement (pdf) assessment estimates that girls and boys under the age of 18 account for 42% of the 82.4 million people who have fled their homes in search of safety and basic human dignity. Nearly a million children were born as refugees between 2018 and 2020, the report shows.

“Behind each number is a person forced from their home and a story of displacement, dispossession, and suffering. They merit our attention and support not just with humanitarian aid, but in finding solutions to their plight,” said Filippo Grandi, the U.N. high commissioner for refugees (UNHCR). “The tragedy of so many children being born into exile should be reason enough to make far greater efforts to prevent and end conflict and violence.”

Though the deadly coronavirus pandemic led countries around the world to close off their borders to refugees and asylum-seekers, many people still fled across national lines in 2020, the ninth consecutive year in which the number of forcibly displaced people has reached a record high.

According to the new U.N. report, 26.4 million people were living as refugees in 2020, and more than two-thirds of those who fled abroad came from just five countries: Syria (6.7 million), Venezuela (4 million), Afghanistan (2.6 million), South Sudan (2.2 million) and Myanmar (1.1 million).

The U.N. figures show that in addition to those who were forced by circumstance to leave their home countries, 48 million people were internally displaced by the end of last year, up from 45.7 million in 2019.

“Climate change is driving displacement and increasing the vulnerability of those already forced to flee,” the report states. “Forcibly displaced and stateless people are on the front lines of the climate emergency. Many are living in climate ‘hotspots’ where they typically lack the resources to adapt to an increasingly inhospitable environment. The dynamics of poverty, food insecurity, climate change, conflict, and displacement are increasingly interconnected and mutually reinforcing, driving more and more people to search for safety and security.”

The COVID-19 pandemic brought the world to a standstill.

But wars didn’t stop.

A record number of people were forced to flee their homes by the end of 2020. We need peace now more than ever. pic.twitter.com/4p3vyRM6hF

— UNHCR, the UN Refugee Agency (@Refugees) June 18, 2021

Jan Egeland, secretary general of the Norwegian Refugee Council, said in a statement that “despite the staggering statistics, world leaders have been inept to resolve the greatest emergency of our generation.”

“Far more people are on the move today than anytime during World War II, yet we say we live in an unprecedented era of global peacetime,” Egeland added. “We need to rewrite tomorrow’s history books to reflect today’s reality, that we live in an unprecedented era of persecution and suffering.”

Absent dramatic action from the international community to end conflicts, combat the climate crisis, and mitigate other major factors driving forced displacement, the U.N. report warns that “forecasts for 2021 are equally worrying, with some of the world’s worst food crises—including in displacement-affected countries such as South Sudan, Syria, and the Central African Republic—at risk of turning into famine.”

“The question is no longer if forced displacement will exceed 100 million people—but rather when,” the report states. “Clearly, the need for preventing conflicts and ensuring that displaced people have access to solutions has never been more pressing than now.”

Vaccine Nationalism

Rajan Menon

Fifteen months ago, the SARS-CoV-2 virus unleashed Covid-19. Since then, it’s killed more than 3.8 million people worldwide (and possibly many more). Finally, a return to normalcy seems likely for a distinct minority of the world’s people, those living mainly in the United States, Canada, the United Kingdom, the European Union, and China. That’s not surprising.  The concentration of wealth and power globally has enabled rich countries to all but monopolize available vaccine doses. For the citizens of low-income and poor countries to have long-term pandemic security, especially the 46% of the world’s population who survive on less than $5.50 a day, this inequity must end, rapidly — but don’t hold your breath.

The Global North: Normalcy Returns

In the United States new daily infections, which peaked in early January, had plummeted 96% by June 16th. The daily death toll also dropped — by 92% — and the consequences were apparent. Big-city streets were bustling again, as shops and restaurants became ever busier. Americans were shedding their reluctance to travel by plane or train, as schools and universities prepared to resume “live instruction” in the fall. Zoom catch-ups were yielding to socializing the old-fashioned way.

By that June day, new infections and deaths had fallen substantially below their peaks in other wealthy parts of the world as well. In Canada, cases had dropped by 89% and deaths by 94%; in Europe by 87% and 87%; and in the United Kingdom by 84% and 99%.

Yes, European governments were warier than the U.S. about giving people the green light to resume their pre-pandemic lifestyles and have yet to fully abolish curbs on congregating and traveling. Perhaps recalling Britain’s previous winter surge, thanks to the B.1.1.7 mutation (initially discovered there) and the recent appearance of two other virulent strains of Covid-19, B.1.167 and B.1.617.2 (both first detected in India), Downing Street has retained restrictions on social gatherings. It’s even put off a full reopening on June 21st, as previously planned. And that couldn’t have been more understandable. After all, on June 17th, the new case count had reached 10,809, the highest since late March. Still, new daily infections there are less than a tenth what they were in early January. So, like the U.S., Britain and the rest of Europe are returning to some semblance of normalcy.

The Global South: A Long Road Ahead

Lately, the place that’s been hit the hardest by Covid-19 is the global south where countries are particularly ill-prepared.

Consider social distancing. People with jobs that can be done by “working from home” constitute a far smaller proportion of the labor force than in wealthy nations with far higher levels of education, mechanization, and automation, along with far greater access to computers and the Internet. An estimated 40% of workers in rich countries can work remotely. In lower- and middle-income lands perhaps 10% can do so and the numbers are even worse in the poorest of them.

During the pandemic, millions of Canadians, Europeans, and Americans lost their jobs and struggled to pay food and housing bills. Still, the economic impact has been far worse in other parts of the world, particularly the poorest African and Asian nations. There, some 100 million people have fallen back into extreme poverty.

Such places lack the basics to prevent infections and care for Covid-19 patients. Running water, soap, and hand sanitizer are often not readily available. In the developing world, 785 million or more people lack “basic water services,” as do a quarter of health clinics and hospitals there, which have also faced crippling shortages of standard protective gear, never mind oxygen and ventilators.

Last year, for instance, South Sudan, with 12 million people, had only four ventilators and 24 ICU beds. Burkina Faso had 11 ventilators for its 20 million people; Sierra Leone 13 for its eight million; and the Central African Republic, a mere three for eight million. The problem wasn’t confined to Africa either. Virtually all of Venezuela’s hospitals have run low on critical supplies and the country had 84 ICU beds for nearly 30 million people.

Yes, wealthy countries like the U.S. faced significant shortages, but they had the cash to buy what they needed (or could ramp up production at home). The global south’s poorest countries were and remain at the back of the queue.

India’s Disaster

India has provided the most chilling illustration of how spiraling infections can overwhelm healthcare systems in the global south. Things looked surprisingly good there until recently. Infection and death rates were far below what experts had anticipated based on the economy, population density, and the highly uneven quality of its healthcare system. The government’s decision to order a phased lifting of a national lockdown seemed vindication indeed. As late as April, India reported fewer new cases per million than Britain, France, Germany, the U.K., or the U.S.

Never one for modesty, its Hindu nationalist prime minister, Narendra Modi, boasted that India had “saved humanity from a great disaster by containing Corona effectively.” He touted its progress in vaccination; bragged that it was now exporting masks, test kits, and safety equipment; and mocked forecasts that Covid-19 would infect 800 million Indians and kill a million of them. Confident that his country had turned the corner, he and his Bharatiya Janata Party held huge, unmasked political rallies, while millions of Indians gathered in vast crowds for the annual Kumbh Mela religious festival.

Then, in early April, the second wave struck with horrific consequences. By May 6th, the daily case count had reached 414,188. On May 19th, it would break the world record for daily Covid-19 deaths, previously a dubious American honor, recording almost 4,500 of them.

Hospitals quickly ran out of beds. The sick were turned away in droves and left to die at home or even in the streets, gasping for breath. Supplies of medical oxygen and ventilators ran out, as did personal protective equipment. Soon, Modi had to appeal for help, which many countries provided.

Indian press reports estimate that fully half of India’s 300,000-plus Covid-19 deaths have occurred in this second wave, the vast majority after March. During the worst of it, the air in India’s big cities was thick with smoke from crematoria, while, because of the shortage of designated cremation and burial sites, corpses regularly washed up on riverbanks.

We may never know how many Indians have actually died since April. Hospital records, even assuming they were kept fastidiously amid the pandemonium, won’t provide the full picture because an unknown number of people died elsewhere.

The Vaccination Divide

Other parts of the global south have also been hit by surging infections, including countries in Asia which had previously contained Covid-19’s spread, among them Malaysia, Nepal, the Philippines, Sri Lanka, Thailand, and Vietnam. Latin America has seen devastating surges of the pandemic, above all in Brazil because of President Jair Bolsonaro’s stunning combination of fecklessness and callousness, but also in Bolivia, Columbia, Chile, Paraguay, Peru, and Uruguay. In Africa, Angola, Namibia, South Africa, and the Democratic Republic of the Congo are among 14 countries in which infections have spiked.

Meanwhile, the data reveal a gargantuan north-south vaccination gap. By early June, the U.S. had administered doses to nearly half the country’s population, in Britain slightly more than half, in Canada just over a third, and in the European Union approximately a third. (Bear in mind that the proportions would be far higher were only adults counted and that vaccination rates are still increasing far faster in these places than in the global south.)

Now consider examples of vaccination coverage in low-income countries.

• In the Democratic Republic of the Congo, Ethiopia, Nigeria, South Sudan, Sudan, Vietnam, and Zambia it ranged from 0.1% to 0.9% of the population.

• In Angola, Ghana, Kenya, Pakistan, Senegal, and South Africa, between 1% and 2.4%.

• In Botswana and Zimbabwe, which have the highest coverage in sub-Saharan Africa, 3% and 3.6% respectively.

• In Asia (China and Singapore aside), Cambodia at 9.6% was the leader, followed by India at 8.5%.  Coverage in all other Asian countries was below 5.4.%.

This north-south contrast matters because mutations first detected in the U.K., Brazil, India, and South Africa, which may prove up to 50% more transmissible, are already circulating worldwide. Meanwhile, new ones, perhaps even more virulent, are likely to emerge in largely unvaccinated nations. This, in turn, will endanger anyone who’s unvaccinated and so could prove particularly calamitous for the global south.

Why the vaccination gap? Wealthy countries, none more than the United States, could afford to spend billions of dollars to buy vaccines. They’re home as well to cutting-edge biotechnology companies like AstraZeneca, BioNTech, Johnson and Johnson, Moderna, and Pfizer. Those two advantages enabled them to preorder enormous quantities of vaccine, indeed almost all of what BioNTech and Moderna anticipated making in 2021, and even before their vaccines had completed clinical trials. As a result, by late March, 86% of all vaccinations had been administered in that part of the world, a mere 0.1% in poor regions.

This wasn’t the result of some evil conspiracy. Governments in rich countries weren’t sure which vaccine-makers would succeed, so they spread their bets. Nevertheless, their stockpiling gambit locked up most of the global supply.

Equity vs. Power

Tedros Adhanom Ghebreyesus, who leads the World Health Organization (WHO), was among those decrying the inequity of “vaccine nationalism.” To counter it, he and others proposed that the deep-pocketed countries that had vacuumed up the supplies, vaccinate only their elderly, individuals with pre-existing medical conditions, and healthcare workers, and then donate their remaining doses so that other countries could do the same. As supplies increased, the rest of the world’s population could be vaccinated based on an assessment of the degree to which different categories of people were at risk.

COVAX, the U.N. program involving 190 countries led by the WHO and funded by governments and private philanthropies, would then ensure that getting vaccinated didn’t depend on whether or not a person lived in a wealthy country. It would also leverage its large membership to secure low prices from vaccine manufacturers.

That was the idea anyway. The reality, of course, has been altogether different. Though most wealthy countries, including the U.S. following Biden’s election, did join COVAX, they also decided to use their own massive buying power to cut deals directly with the pharmaceutical giants and vaccinate as many of their own as they could. And in February, the U.S. government took the additional step of invoking the Defense Production Act to restrict exports of 37 raw materials critical for making vaccines.

COVAX has received support, including $4 billion pledged by President Joe Biden for 2021 and 2022, but nowhere near what’s needed to reach its goal of distributing two billion doses by the end of this year. By May, in fact, it had distributed just 3.4% of that amount.

Biden recently announced that the U.S. would donate 500 million doses of vaccines this year and next, chiefly to COVAX; and at their summit this month, the G-7 governments announced plans to provide one billion altogether. That’s a large number and a welcome move, but still modest considering that 11 billion doses are needed to vaccinate 70% of the world.

COVAX’s problems have been aggravated by the decision of India, counted on to provide half of the two billion doses it had ordered for this year, to ban vaccine exports. Aside from vaccine, COVAX’s program is focused on helping low-income countries train vaccinators, create distribution networks, and launch public awareness campaigns, all of which will be many times more expensive for them than vaccine purchases and no less critical.

Another proposal, initiated in late 2020 by India and South Africa and backed by 100 countries, mostly from the global south, calls for the World Trade Organization (WTO) to suspend patents on vaccines so that pharmaceutical companies in the global south can manufacture them without violating intellectual property laws and so launch production near the places that need them the most.

That idea hasn’t taken wing either.

The pharmaceutical companies, always zealous about the sanctity of patents, have trotted out familiar arguments (recall the HIV-AIDS crisis): their counterparts in the global south lack the expertise and technology to make complex vaccines quickly enough; efficacy and safety could prove substandard; lifting patent restrictions on this occasion could set a precedent and stifle innovation; and they had made huge investments with no guarantees of success.

Critics challenged these claims, but the bio-tech and pharmaceutical giants have more clout, and they simply don’t want to share their knowledge. None of them, for instance, has participated in the WHO’s Covid-19 Technology Access Pool (C-TAP), created expressly to promote the voluntary international sharing of intellectual property, technology, and knowhow, through non-restricted licensing.

On the (only faintly) brighter side, Moderna announced last October that it wouldn’t enforce its Covid-19 vaccine patents during the pandemic — but didn’t offer any technical assistance to pharmaceutical firms in the global south. AstraZeneca gave the Serum Institute of India a license to make its vaccine and also declared that it would forgo profits from vaccine sales until the pandemic ends. The catch: it reserved the right to determine that end date, which it may declare as early as this July.

In May, President Biden surprised many people by supporting the waiving of patents on Covid-19 vaccines. That was a big change given the degree to which the U.S. government has been a dogged defender of intellectual property rights. But his gesture, however commendable, may remain just that. Germany dissented immediately. Others in the European Union seem open to discussion, but that, at best, means protracted WTO negotiations about a welter of legal and technical details in the midst of a global emergency.

And the pharmaceutical companies will hang tough. Never mind that many received billions of dollars from governments in various forms, including equity purchases, subsidies, large preordered vaccine contracts ($18 billion from the Trump administration’s Operation Warp Speed program alone), and research-and-development partnerships with government agencies. Contrary to its narrative, Big Pharma never placed huge, risky bets to create Covid-19 vaccines.

How Does This End?

Various mutations of the virus, several highly infectious, are now traveling the world and new ones are expected to arise. This poses an obvious threat to the inhabitants of low-income countries where vaccination rates are already abysmally poor. Given the skewed distribution of vaccines, people there may not be vaccinated, even partially, until 2022, or later. Covid-19 could therefore claim more millions of lives.

But the suffering won’t be confined to the global south. The more the virus replicates itself, the greater the probability of new, even more dangerous, mutations — ones that could attack the tens of millions of unvaccinated in the wealthy parts of the world, too. Between a fifth and a quarter of adults in the U.S. and the European Union say that they’re unlikely to, or simply won’t, get vaccinated. For various reasons, including worry about the safety of vaccines, anti-vax sentiments rooted in religious and political beliefs, and the growing influence of ever wilder conspiracy theories, U.S. vaccination rates slowed starting in mid-April.

As a result, President Biden’s goal of having 70% of adults receive at least one shot by July 4th won’t be realized. With less than two weeks to go, at least half of the adults in 25 states still remain completely unvaccinated. And what if existing vaccines don’t ensure protection against new mutations, something virologists consider a possibility? Booster shots may provide a fix, but not an easy one given this country’s size, the logistical complexities of mounting another vaccination campaign, and the inevitable political squabbling it will produce.

Amid the unknowns, this much is clear: for all the talk about global governance and collective action against threats that don’t respect borders, the response to this pandemic has been driven by vaccine nationalism. That’s indefensible, both ethically and on the grounds of self-interest.

As COVID-19 variant continues to spread, World Health Organization warns “we expect things to only get worse”

Bryan Dyne

The more infectious and deadly Delta variant of the coronavirus, first detected in India last October, is now present in at least 80 countries, according to the World Health Organization (WHO). It is expected to overtake the Alpha variant, first detected in the UK, in the coming months as the dominant variant of the coronavirus worldwide.

In countries such as India and the United Kingdom, it has already become the dominant variant of the coronavirus, with at least 90 percent of all new cases caused by the Delta variant. In countries such as the United States, it accounts for at least 10 percent of all new cases and will “probably” become the dominant variant in the country, Centers for Disease Control and Prevention Director Rochelle Walensky warned Friday on Good Morning America.

A driver in protective suit in a school bus assigned to take people who tested positive for coronavirus to a referral hospital in Jakarta, Indonesia, June 18, 2021 [Credit: AP Photo/Dita Alangkara]

In Lisbon, Portugal, authorities ordered a weekend lockdown of the entire region after more than 1,300 new cases were recorded in the past 24 hours, of which roughly half were of the Delta variant. In Moscow, local health authorities have determined that the Delta variant is now the most prevalent COVID-19 variant in the city, making up 89.3 percent of all new cases.

And in India, while cases and deaths have continued to decline, with confirmed counts currently standing at two-month lows of 69,000 and 1,600 respectively, experts are concerned that such figures greatly undercount the true toll the Delta variant took on India when it began to spread like wildfire in late February and early March.

There are also surges of the Delta variant across Africa and South Asia, including countries such as Namibia, Sierra Leone, Liberia and Rwanda, Myanmar, Zambia, South Africa, Bangladesh, and Indonesia. As a result of the spread of the disease, the global decline in new cases since the beginning of May, largely a result of mass vaccination campaigns in the world’s wealthier countries, has slowed.

Worldwide, the number of new cases on Thursday totaled just over 367,000, just 20,000 less than new cases reported seven days previously. In contrast, the decrease in daily new cases from two weeks ago to one week ago was more than 71,000. Similar changes were detected in the trajectory of the world’s daily new coronavirus cases in the weeks leading up to the emergence of the Alpha variant as the dominant form of the coronavirus, which helped to fuel the skyrocketing cases this past December and January. Daily deaths remain above 9,000 internationally.

World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus further warned on Friday, “Every region has countries that are now facing a steep increase in cases and deaths. Many countries in Latin America have rapidly increasing epidemics, and others have plateaued at a high level. In Africa, cases have increased by 52% just in the past week, and deaths have increased by 32%. And we expect things to only get worse.”

Spikes in the Delta variant are particularly happening in the countries and regions that have the lowest vaccination rates. “It's a trajectory that is very, very concerning,' said Dr. Mike Ryan, the World Health Organization’s executive director. “The brutal reality is that in an era of multiple variants, with increased transmissibility, we have left vast swathes of the population, the vulnerable population of Africa, unprotected by vaccines.”

The emergence of the Delta variant as dominant is even more concerning given how dangerous it has shown itself to be. It is up to 60 percent more infectious than the Alpha variant, and thus up to 2.5 times more infectious than the original wild variant. It also causes more than 4 times as many hospitalizations as the wild variant. And while those fully vaccinated are largely protected from the Delta variant, most of the world remains extremely vulnerable.

As Dr. Tedros noted, “More than half of all high- and upper-middle income countries and economies have now administered enough doses to fully vaccinate at least 20% of their populations. Just 3 out of 79 low- and lower-middle income countries have reached the same level.” He also made explicit that, “Vaccines donated next year will be far too late for those who are dying today, or being infected today, or at risk today,” before calling for further increases in vaccine production and for their more equal distribution around the world.

Moreover, data from Public Health England tracking the Delta variant has revealed that this particular mutation of the coronavirus can “escape” immunity granted by those that have only received their first dose of the two-dose mRNA vaccine regimen developed by Moderna, Pfizer and others. Thousands have gotten sick as a result.

These dangers are compounded by the fact that as the virus is allowed to spread among those partially vaccinated, there is every possibility that, under the selective pressure of partial immunity, it will evolve to evade the immunity of those fully vaccinated.

In a world where public health measures such as masking, testing and contact tracing are largely being abandoned, such a development would reignite the pandemic in an even more explosive form. Vaccination is in many areas the only form of protection against the coronavirus, and if it fails, cities could once again resemble the horrors of Wuhan, Italy and New York City in the early days of the pandemic.

And in many ways, this evolution of the pandemic would be even worse. Records from the UK indicate that children are more susceptible to the Delta variant, meaning that reopened schools are not just vectors of transmission but also have the potential to become charnel houses for the youth that attend them. More broadly, the increased infectiousness of the Delta variant indicates that, if it was not stopped by vaccines, a dozen people infected could become millions inside a month.

There is no shortage of warnings about just how bad the pandemic could become, even in countries with high vaccination rates like the United States. To date, nearly 4 million lives have been lost. On the other hand, there are still 7.8 billion lives which can be saved from premature death caused by the coronavirus.

The capitalist class which controls society’s resources, however, is more concerned with making profits than human lives. Only token amounts of funds are directed towards vaccines and next to nothing for other life-saving public health measures. The real solution to the pandemic is not medical or scientific, but social and political, the international working class taking the immense wealth hoarded by the bourgeoisie and using it to end the mass death inflicted on the world over the past 18 months.