Pakistan battles tsunami of Covid-19 patients with few vaccines in sight

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Keeping vigil outside the hospital ward in Karachi, Daniyal Ameen watched his father breathing through a ventilator via a live video link from the intensive care unit (ICU). He came every day to see his father, 73-year-old Muhammad Ameen, as he spent weeks on oxygen battling Covid-19. The video link was set up at the private South City Hospital in Karachi to enable relatives to feel closer to their loved ones in the ICU, as visits inside that facility are prohibited.

The screen is the closest Ameen has come to seeing his father for about 18 months. The 33-year-old flew back to Pakistan from his home in Melbourne, Australia, when his dad was hospitalized.
“Seeing him on a screen like that was pretty traumatizing for me,” said Ameen. “We told him that yes, I am here, and I want to see him healthy and smiling back again.”
But Ameen’s father didn’t survive. Instead, he became one of thousands of Pakistanis to die from the virus.

Daniyal Ameen and his father, Muhammad Ameen, at the Australian Open in 2020. Muhammad passed away from Covid-19 after being on a ventilator for two weeks in the ICU of South City Hospital in Karachi.

For many countries struggling in the Western world as winter cases surge, the arrival of vaccines has provided a light at the end of the tunnel. But in places like Pakistan, that tunnel remains in near darkness.
“The vaccine is not here in this country for the foreseeable future,” says Dr. Nashwa Ahmad, Coordinator of Covid Services and Research and Development at South City Hospital.
“That means our health care workers still have to continue to do their jobs, (and) endless hours, without the protection of the vaccine.
“A vaccine would definitely have given us the additional boost we needed to continue on with fighting the disease.”
The hospital has been overwhelmed with “a tsunami of patients,” Ahmad says. The three Covid-19 ICU wards are full, and more patients are waiting in ambulances outside.
“We are full, we have patients waiting, we have families who are suffering, we have patients at home, sick patients at home, patients who are on oxygen, we just don’t have space in hospitals,” she says.

A sign at South City Hospital, a private hospital in Karachi which has stopped taking Covid-19 patients as all its ICU beds are full.

So far, Pakistan has officially recorded more than half a million cases of Covid-19, and more than 11,600 related deaths — although health officials tell CNN that testing is not sufficient to reflect the true picture.
Pakistan has secured 1.2 million doses from China’s Sinopharm, with 500,000 expected to arrive this weekend, but they will barely make a dent in vaccinating the country’s population of 216 million. Health workers in major cities are due to start receiving shots next week, and negotiations are underway for vaccines from other manufacturers, says Asad Umar, the chief of the National Command and Operations Centre.
Pakistan’s health minister confirmed this week that his country will also receive 17 million doses of AstraZeneca’s coronavirus vaccine in 2021.
About 6 million of those doses are expected in the country in March with the remaining batches following in the second quarter of the year.

A ‘humongous logistical challenge’

Pakistan is also pinning its hopes on COVAX, the global initiative to provide up to 2 billion vaccine doses to the most vulnerable 20% of the world’s poorest populations, formed by Gavi, the Vaccine Alliance, the World Health Organization (WHO), and the Coalition for Epidemic Preparedness Innovations.
“This is an unprecedented effort,” said Aurélia Nguyen, managing director of COVAX. “We have never rolled out this number of vaccines in this short (a) time.”
The ambitious COVAX program is aimed at ensuring equitable vaccines for all, to end the “acute” phase of the pandemic. Rollouts are expected to start in February, although the exact timeline depends on regulatory approvals of vaccines in each country — as well as their readiness to administer them properly.
Such an approach presents a “humongous logistical challenge,” especially for vaccines such as Pfizer-BioNTech which require ultra-cold chain refrigeration, said Benjamin Schreiber, deputy chief of the global immunization program at the UN International Children’s Emergency Fund (UNICEF).
UNICEF will help deliver the vaccines on the ground in developing countries, where it already has a presence.
“We’ve never seen an introduction of a vaccine to so many countries in one go, that’s absolutely new, and really no vaccine has ever been deployed and introduced in so many countries so quickly,” Schreiber said.
This uncertainty is already creating anxiety in countries reliant on COVAX, he added. “Countries are looking at COVAX and don’t see yet vaccines arriving, while they see some countries are making bilateral deals, and that creates kind of a panic,” Schneider said.

Vaccine nationalism

Pakistan is one of 92 lower-income countries eligible for free vaccines from COVAX. Another 98 wealthier countries will also purchase doses through the organization, using it as a middle man to streamline negotiations with vaccine makers — and to prevent vaccine nationalism.
The concept of vaccine nationalism has become a significant global concern, highlighted by the ongoing public spat between the European Union and British-Swedish drug maker AstraZeneca, which recently informed the bloc it would not be able to supply the number of vaccines the EU had hoped for by the end of March. EU leaders are furious the company appears to be fulfilling its deliveries for the UK market and not theirs.
“I think we can expect that it’s not going to be all smooth sailing, as the vaccine manufacturing is scaled up and distribution happens,” Nguyen said. “I think it’s important for everyone to be able to be accountable to the commitments that they’ve made.”
Nguyen said it was inevitable that initial vaccine demand would outstrip supply. “This is exactly the reason why COVAX was created, to avoid a bidding war for vaccines,” she added.
“Without concerted effort, lower-income countries will be left behind because of the restrictions of their financial capabilities to be able to buy vaccines.”
COVAX has so far raised $6 billion from wealthier countries and other organizations, including a giant injection of $4 billion from the US, approved by Congress in December. The Biden administration also announced it would join the global initiative.
“That’s been a hugely welcome move on the part of the Biden-Harris administration,” Nguyen said. “I think it’s a very strong endorsement of the COVAX facility, of the aim to have a global and multilateral approach to fair and equitable access for Covid-19 vaccines.”
Vaccinating 20% of people in the world’s poorest countries, however, won’t be enough to help their populations reach herd immunity. Although COVAX plans to expand the program for as long as it is needed, analysis by the Economist Intelligence Unit suggests huge swathes of Asia and Africa will not see widespread availability of Covid-19 vaccines until 2022 or 2023.

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