South America’s Covid Nightmare Underscores the Need for Comprehensive Pandemic Management

In the wake of India's nightmarish spring Covid surge, prompted by the emergence of the highly contagious 'Delta' strain, the 'Gamma' and 'Lambda' variants are driving health systems in South America to the brink of collapse.

Scientists at the World Health Organization (WHO) are particularly concerned over the Lambda variant, first detected at the end of last year in Peru. The strain is apparently responsible for more than 80 percent of new Covid-19 cases in the country- which has the world's highest coronavirus mortality rate-as well as accounting for almost a third of new cases in neighbouring Chile.

Moreover, it's thought that the variant has spread to more than two dozen other countries around the world, including the UK. Public Health England (PHE) is investigating Lambda due to its 'notable mutations'. Encouragingly, there is no evidence so far to suggest that the variant results in more severe symptoms or is resistant to existing vaccines. Still, the chaos roiling South American healthcare systems has cast a renewed light on the need to use every available tool-from social distancing to vaccines to therapeutics which reduce the risk of severe consequences for those who test Covid positive-to minimise the pandemic's effects on our lives.

Facing a long battle

South America has been hit hard by the pandemic. Home to just 5 percent of the world's population, the region now accounts for a quarter of the international death toll, with per-capita fatalities eight times the global average. Even countries lauded for their Covid response in the early days of the pandemic have experienced unchecked surges that are outpacing the continent's fastest vaccination rates.

Uruguay is struggling to control a fresh wave of infections from more transmissible variants. In 2020, Uruguay recorded less than 20,000 Covid cases, with just 180 deaths. This year, the coronavirus has already infected more than 340,000 and claimed over 5,000 deaths, in a country of just 3.5 million.

Street protests have been seen in Paraguay, where the spread of the virus has exacerbated existing inequities in a chronically underfunded health service. Meanwhile, in Peru, the political turmoil that saw three successive presidents take office in a single week last year, has also undermined the vaccination program. Colombia is drowning in a third wave of Covid: 40,000 people have lost their lives to the virus in the last three months alone - many in younger, unvaccinated demographics.

In Argentina - a country that was once seen as a model for coronavirus management - Covid has overtaken heart disease and cancer as the country's main killer, causing more than 500 deaths a day in recent weeks.

Virus variants challenge vaccine rollout; suggest need for treatments

The sharp uptick in cases in recent weeks which saw Chile forced to lock down its capital, Santiago, despite having fully vaccinated roughly 60 percent of its population has cast doubt on how effective the Chinese Sinovac vaccine is against new variants. Given that Chile has relied heavily on the Chinese jab, Chilean health officials are currently weighing up the possibility of administering a third 'booster' dose of the vaccine in September.

Beyond the questions raised about any particular vaccine, South America's alarming Covid crisis this summer has emphasized the need for a shift in policymakers' attitude towards the virus. Vaccines are vital in controlling the epidemic, but with new variants emerging and widespread vaccine hesitancy around the world, it's clear that people will continue getting infected with Covid-19 for years to come. In addition to scaling up vaccine drives as rapidly as possible, public health authorities also need to look at granting emergency-use authorization to promising medicines which could reduce the risk of complications for those already infected with Covid.

Encouragingly, there have been a number of exciting trials in recent weeks. Sargramostim, developed by Partner Therapeutics under the brand name Leukine, is a drug designed to boost the production of the body's immune defence cell. The medication has already been approved by medical regulators for other uses, such as stimulating the immune system in patients with cancer or bone marrow transplants.

A recent study, carried out across 11 American hospitals and supported by the US Department of Defense, found that inhaled Leukine was safe and well tolerated for hospitalised Covid-19 patients. Moreover, the study found that coronavirus patients treated with Leukine showed significant improvement in lung function over patients treated with standard of care therapies alone. The American study only confirmed the findings of an earlier Belgian trial, suggesting that the medicine could significantly improve oxygenation in hospitalized coronavirus patients with acute hypoxic respiratory failure.

Although more experimental, another potential breakthrough has recently been announced by a group of Australian scientists who believe they've discovered a gene editing treatment that could shut down early Covid while it's still in the nose. The findings, published in the prestigious Nature Communications journal by researchers from the Peter Doherty Institute and Peter MacCallum Cancer Center show that Covid cells can be prevented from populating human cells using a gene editing approach. Unlike vaccines that target the virus's protein 'spike', this method attacks Covid's genetic blueprint - RNA - which should make it equally effective against variants. The treatment would be self-administered via a nasal spray, activating immune cells inside the nasal passages to stop viral infections entering the body. Further trials are planned.

A comprehensive approach to the Covid threat

With Covid cases surging as part of a global third wave, even in regions with relatively successful vaccine rollouts, it's clear that defeating the virus will require a comprehensive strategy.

Investment in research, development and innovation is key to informing public health policy and should support the most promising therapeutics from clinical trials through to market authorisation. Swift approval of clinical trials will help expedite the development of therapeutics, but governments will also need to develop flexible regulatory approaches to their approval, as well as considering the international cooperation necessary to make medicines available to all.