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Weekly Report - 10 June 2021 (WR-21-23)

CHILE: Still struggling with the virus

It has the highest rates of vaccination in Latin America and indeed one of the highest in the world. But Chile is still far from bringing the coronavirus (Covid-19) under control. Infections, hospitalisations, and deaths have risen sharply in recent weeks, leading authorities to extend some of the restrictions in place to slow the spread of infections. The situation has raised concerns and questions over the success of Chile’s vaccination campaign, the effectiveness of the vaccines used, and whether other Latin American countries will suffer similar problems despite ramping up their respective vaccination campaigns.

Like governments around the world, the administration led by President Sebastián Piñera maintains that the mass vaccination of the population is the best way to overcome the public health emergency and economic crisis produced by the pandemic. As a result it has spared no effort (or expense) in obtaining enough vaccines to inoculate Chile’s population (19m) and roll out a highly efficient national vaccination campaign. This has allowed Chile to have over 50% of its population already fully vaccinated (over 70% have received at least one vaccine dose). Only Israel has vaccinated a higher proportion of its population.

The success in the vaccination campaign led the Piñera administration to, as of May, begin easing some of the measures adopted to reduce the transmission of the virus, including restrictions on movement and gatherings. It even introduced a ‘Covid pass’ allowing those who are fully vaccinated to do more activities considered high risk. However, a new surge in infections has been reported in Chile since late May. On 28 May Chile’s health ministry (Minsal) reported 8,680 new cases in the previous 24 hours, the second highest daily figure since the start of the local epidemic. The number of daily reported cases has fluctuated since then but remains above 5,000 and reached a new second highest peak of 8,867 on 5 June.

  • Covid pass

The ‘Pase de Movilidad’ (‘mobility pass’) was launched on 26 May. It allows individuals that have received both vaccine doses to freely travel through areas still in quarantine and to parts of the country other from where they reside. It also allows them to go to bars and restaurants where these are now open, and public gatherings of up to 30 people outdoors and 15 indoors. All individuals are still required to wear facemasks in public and observe the national curfew enforced between 10:00pm and 5:00am. The introduction of the Pase has led to a large influx of visitors to Chile’s beaches, which health experts blame for the surge in infections.

The surge in cases has been accompanied by a sharp rise in hospitalisations. This reached a critical point on 2 June when Minsal reported that there were only 35 intensive care beds left in the Santiago Metropolitan Region (RM) and 147 nationally, equating to 99% occupation in the RM and 95% occupation nationally. Hospital occupation rates have remained practically unchanged since then. This has also led to a rise in deaths with the seven-day average of daily deaths rising above 100 in April for the first time since July 2020; and the cumulative death toll surpassing 30,000 on 7 June. The saturation of hospitals raised alarm bells and questions. These centred on whether the vaccines used in Chile were less effective than previously thought. Chile has mostly relied on the Chinese-made CoronaVac vaccine (17m doses of the 22m applied so far). Health experts have noted that this vaccine, an inactivated virus vaccine, is known to be less effective than others in preventing the transmission of the disease.

While the Pfizer vaccine, a messenger ribonucleic acid (mRNA) vaccine, the main vaccine applied in Israel, has proved to be up to 95% effective in reducing contagion, the CoronaVac vaccine was originally said to be 80% effective. But a clinical study conducted in Brazil found CoronaVac’s effectiveness in reducing transmission was only 50.3%. Since then, Chinese authorities have admitted that CoronaVac’s efficacy rate is closer to 50%, the minimum level required for a vaccine to be approved by the World Health Organization (WHO). The WHO has approved the CoronaVac vaccine for emergency use, but only did so on 1 June. The Piñera government has said that clinical studies conducted in the country show the CoronaVac jab is 65.3% effective in reducing contagion, 86% effective in preventing deaths, and 90.3% in preventing hospitalisations.

But the results of the Chilean clinical trial are now under question. “We are going to have to vaccinate three times to reach collective immunity,” José Miguel Bernucci, the secretary general of the Colegio Médico de Chile, the doctors’ union, has said. Bernucci explained that if the CoronaVac’s effectiveness in reducing contagion is 50%, then rather than having to vaccinate 75% of the population to achieve collective immunity, “we would need to vaccinate 80% of the population”. Bernucci and other local health experts have warned that the crisis in the country’s hospitals could therefore last for months until this is achieved, unless the transmission rate is reduced.

Bernucci has criticised the Piñera government for moving too quickly in lifting some of the quarantines that it had imposed, noting “We never succeeded in stabilising the pandemic nor reducing contagion to controllable levels, as they did in Israel and the US”. He and others advocate a return to temporary quarantines until the situation is brought under control. “Confinements should not last more than 21 days and mobility should not exceed 30%, which means reducing the number of activities considered to be essential”, Bernucci said.

The WHO itself has warned that the situation in Chile shows that vaccination alone will not supress the virus, and countries need to continue implementing restrictions on movement and contact between individuals to overcome local epidemics. “Chile and other countries need to consider that vaccines are a very powerful tool but they also need to apply other measures to prevent infection, reduce propagation, and stop those that have become infected from becoming seriously ill”, the WHO’s technical lead on the Covid-19 response, Maria Van Kerkhove, said in a 7 June press conference. Van Kerkhove added that vaccines take some time to take effect, and that this is not always understood, which could also lead to a rise in infections as vaccinated individuals start mixing with others.

Argentina scrambles to get more vaccines

While Chile has vaccinated over half of its population, across the Andes in Argentina, the situation is very different. The Argentine government has started to run out of vaccine doses even though it has only vaccinated less than 30% of its population of 45m (12.2m have received one dose and only 3.1m or 6.94% of the population have been fully vaccinated).

A major reason for Argentina’s vaccination campaign having fallen well behind Chile’s is that it has been slower to secure vaccines (it has only received 18.4m doses to date). With Argentina also suffering another surge in infections and deaths, the government’s failure to source more doses has been criticised by the political opposition. In particular it has called on the government to explain its inability to secure a vaccine supply agreement with Pfizer. The Argentine government authorised Pfizer to conduct phase three trials in Argentina in December 2020 and local health authorities have approved the vaccine’s use in the country. But while the government opened negotiations with Pfizer to acquire some 13m doses last year, these were suspended after it accused Pfizer of unreasonable price and contractual demands.

The fact that so many other countries signed supply agreements with Pfizer has, however, prompted questions about the government’s claims. Opposition leaders alleged that the reason no agreement was reached was because government officials had demanded kickbacks. This was denied by Pfizer and the government, which in April announced it had reopened negotiations with Pfizer. However, Pfizer has said it will not reach a deal with Argentina unless the country modifies aspects of its existing legislation that prevents the inclusion of a liability waiver clause in the vaccine supply contract (see sidebar). The government has also attributed the delay in availability of AstraZeneca and Sputnik V vaccines that are licensed to be produced in Argentina to difficulties in obtaining the required inputs, over which it has little control.   

Liability issues

Pfizer has included a liability waiver on all its supply contracts to avoid being sued over any unexpected negative, and until now, unseen side effects that its vaccine could have on individuals, or if the vaccine proves less effective than in trials. This includes limits on its liability to be sued over damages that may arise from the agreement. However, Argentine legislation stipulates that vaccine suppliers cannot elude all liability. The contract that Argentina is negotiating with Pfizer is confidential, so its exact wording is not known. But critics point out that if the likes of Brazil, Chile, Peru, Colombia, and Ecuador ultimately accepted Pfizer’s conditions, Argentina should also be able to do the same.