COVID is surging in the world’s most vaccinated country. Why?

Houses in the city of Victoria, the capital of Seychelles.
Shutterstock

C Raina MacIntyre, UNSWThe small archipelago nation of Seychelles, northeast of Madagascar in the Indian Ocean, has emerged as the world’s most vaccinated country for COVID-19.

Around 71% of people have had at least one dose of a COVID vaccine, and 62% have been fully vaccinated. Of these, 57% have received the Sinopharm vaccine, and 43% AstraZeneca.

Despite this, there has been a recent surge in cases, with 37% of new active cases and 20% of hospital cases being fully vaccinated. The country has had to reimpose some restrictions.

How can this be happening? There are several possible explanations:

1. the herd immunity threshold has not been reached — 62% vaccination is likely not adequate with the vaccines being used
2. herd immunity is unreachable due to inadequate efficacy of the two vaccines being used
3. variants that escape vaccine protection are dominant in Seychelles
4. the B1617 Indian variant is spreading, which appears to be more infectious than other variants
5. mass failures of the cold-chain logistics needed for transport and storage, which rendered the vaccines ineffective.

What does the country’s experience teach us about variants, vaccine efficacy and herd immunity?

Let’s break this down.

Variants can escape vaccine protection

There are reports of the South African B.1.351 variant circulating in Seychelles. This variant shows the greatest ability to escape vaccine protection of all COVID variants so far.

In South Africa, one study showed AstraZeneca has 0-10% efficacy against this variant, prompting the South African government to stop using that vaccine in February.

The efficacy of the Sinopharm vaccine against this variant is unknown, but lab studies show some reduction in protection, based on blood tests, but probably some protection.

However, no comprehensive surveillance exists in the country to know what proportion of cases are due to the South African variant.

The UK variant B117, which is more contagious than the original strain, became the dominant variant in the United States. But the US still achieved a dramatic reduction in COVID-19 cases through vaccination, with most people receiving the Pfizer and Moderna vaccines.

Israel, where the UK variant was dominant, also has a very high vaccination rate, having vaccinated nearly 60% of its population with Pfizer. It found 92% effectiveness against any infection including asymptomatic infection, and Israel has seen a large drop in new cases.

The United Kingdom has used a combination of Pfizer and AstraZeneca vaccines. More than 50% of the population have had a single dose and almost 30% are fully vaccinated. The country has also seen a significant decline in case numbers.

But there’s a current surge of cases in northwest England, with most new cases in the city of Bolton being the Indian variant. This variant is also causing outbreaks in Singapore, which had previously controlled the virus well.

Seychelles needs to conduct urgent genome sequencing and surveillance to see what contribution variants of concern are making, and whether the Indian variant is present.

If the South African variant is dominant, the country needs to use a vaccine that works well against it. Many companies are making boosters targeted to this variant, but for now, Pfizer would be an option. In Qatar, local researchers found Pfizer had 75% effectiveness against the South African variant.

---

Read more:
New COVID variants have changed the game, and vaccines will not be enough. We need global ‘maximum suppression’

---

We need to use high-efficacy vaccines to achieve herd immunity

The reported efficacy of Sinopharm is 79% and AstraZeneca is 62-70% from phase 3 clinical trials.

Our research at the Kirby Institute showed that, in New South Wales, Australia, using a vaccine with 90% efficacy against all infection means herd immunity could be achieved if 66% of the population was vaccinated.

However, using lower efficacy vaccines means more people need to be vaccinated. If the vaccine is 60% effective, the proportion needing to be vaccinated rises to 100%.

When you get an efficacy of less than 60%, herd immunity is not achievable.

However, these calculations were done for the regular COVID-19 caused by the D614G variant which dominated in 2020. This has a reproductive number (R0) of 2.5, meaning people infected with the virus on average infect 2.5 others.

But the B117 variant is 43-90% more contagious than D614G, so the R0 may be up to 4.75. This will require higher vaccination rates to control spread.

What’s more, the Indian variant B1617 has been estimated to be at least 50% more contagious than B117, which could take the R0 to over 7, and takes us into uncharted territory.

This could explain the catastrophic situation in India, but also raises the stakes for vaccination, as lower efficacy vaccines will not be able to contain such highly transmissible variants effectively.

Herd immunity is still possible, but depends on the efficacy of the vaccine used and the proportion of people vaccinated.

A UK modelling study found using very low efficacy vaccines would result in the economy barely breaking even over ten years because it would fail to control transmission. On the other hand, using very high efficacy vaccines would result in much better economic outcomes.

Vaccinating the world is the only way to end the pandemic

As the pandemic continues to worsen in some parts of the world, the risk increases of more dangerous mutations that are vaccine-resistant or too contagious to control with current vaccines.

Keeping up with mutations is like whack-a-mole while the pandemic is raging.

The take-home message for our pandemic exit strategy is that the sooner we get the whole world vaccinated, the sooner we will control emergence of new variants.

---

Read more:
3 ways to vaccinate the world and make sure everyone benefits, rich and poor

---

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Prospects of Religious Freedom Appear Grim in Islamic Maldives

Two years after political reforms, freedom of faith nowhere in sight.

MALÉ, Maldives, August 10 (CDN) — Visitors to this Islamic island nation get a sense of religious restrictions even before they arrive. The arrival-departure cards given to arriving airline passengers carry a list of items prohibited under Maldivian laws – including “materials contrary to Islam.”

After Saudi Arabia, the Maldives is the only nation that claims a 100-percent Muslim population. The more than 300,000 people in the Maldives, an Indian Ocean archipelago featuring 1,192 islets 435 miles southwest of Sri Lanka, are all Sunnis.

This South Asian nation, however, has more than 70,000 expatriate workers representing several non-Islamic religions, including Christianity.

Also, around 60,000 tourists, mainly from Europe, visit each year to enjoy the blue ocean and white beaches and normally head straight to one of the holiday resorts built on around 45 islands exclusively meant for tourism. Tourists are rarely taken to the other 200 inhabited islands where locals live.

Nearly one-third of the population lives in the capital city of Malé, the only island where tourists and Maldivians meet.

While the Maldivians do not have a choice to convert out of Islam or to become openly atheist, foreigners in the country can practice their religion only privately.

In previous years several Christian expats have either been arrested for attending worship in private homes or denied visas for several months or years on suspicion of being connected with mission agencies.

According to “liberal estimates,” the number of Maldivian Christians or seekers “cannot be more than 15,” said one source.

“Even if you engage any Maldivian in a discussion on Christianity and the person reports it to authorities, you can be in trouble,” the source said. “A Maldivian youth studying in Sri Lanka became a Christian recently, but when his parents came to know about it, they took him away. We have not heard from him since then.”

The source added that such instances are not uncommon in the Maldives.

“I wish I could attend church, but I am too scared to look for one,” said a European expat worker. “I have not even brought my Bible here; I read it online. I don’t want to take any chances.”

The British reportedly translated the Bible into the local language, Dhivehi, and made it available in the 19th century, as the Maldives was a British protectorate from 1887 to 1965. Today no one knows how the Dhivehi Bible “disappeared.”

“A new translation has been underway for years, and it is in no way near completion,” said the source who requested anonymity.

 

Religion Excluded from Rights

The 2008 constitution, adopted five years after a popular movement for human rights began, states that a “non-Muslim may not become a citizen of the Maldives.”

Abdulla Yameen, brother of the former dictator of the Maldives and leader of the People’s Alliance party, an ally of the opposition Dhivehi Raiyyathunge Party (Maldivian People’s Party or DRP), told Compass that the issue of religious freedom was “insignificant” for the Maldives.

“There’s no demand for it from the public,” Yameen said. “If you take a public poll, 99 percent of the citizens will say ‘no’ to religious freedom.”

Maldivians are passionate about their religion, Yameen added, referring to a recent incident in which a 37-year-old Maldivian citizen, Mohamed Nazim, was attacked after he told a gathering that he was not a Muslim. On May 28, before a crowd of around 11,000 Maldivians, Nazim told a visiting Indian Muslim televangelist, Zakir Naik, that although he was born to a practicing Muslim family, he was “struggling to believe in religions.”

He also asked Naik about his “verdict on Islam.” The question enraged an angry crowd, with many calling for Nazim’s death while others beat him. He received several minor injuries before police took him away.

“See how the public went after his [Nazim’s] throat,” said Yameen, who studied at Claremont Graduate University in California. When asked if such passion was good for a society, he replied, “Yes. We are an Islamic nation, and our religion is an important part of our collective identity.”

Asked if individuals had no rights, his terse answer was “No.” Told it was shocking to hear his views, he said, “We are also shocked when a nation legalizes gay sex.”

Mohamed Zahid, vice president of the Human Rights Commission of the Maldives, told Compass that the country has its own definition of human rights.

“It is to protect people’s rights under the sharia [Islamic law] and other international conventions with the exception of religious freedom,” he said. “We are a sovereign nation, and we follow our own constitution.”

Zahid and several other local sources told Compass that the issue of religious rights was “irrelevant” for Maldivians. “Not more than 100 people in the country want religious freedom,” Zahid said.

 

Politics of Religion

Former President Maumoon Abdul Gayoom, a virtual dictator for 30 years until 2008, is generally held responsible for creating an atmosphere of religious restrictions in the Maldives, as he sought to homogenize religion in the country by introducing the state version of Sunni Islam. He also led a major crackdown on Christians.

The Protection of Religious Unity Act, enacted in 1994, was an endeavor to tighten the government’s control over mosques and all other Islamic institutions. The Gayoom administration even wrote Friday sermons to be delivered in mosques.

In 1998, Gayoom began a crackdown on alleged missionary activities.

“A radio station based out of India used to air Christian programs via the Seychelles, but the government came to know about it and ensured that they were discontinued with the help of the government in the Seychelles,” said a local Muslim source.

That year, Gayoom reportedly arrested around 50 Maldivians who were suspected to have converted to Christianity and deported 19 foreign workers accused of doing missionary work. A source said Gayoom apparently wanted to regain popularity at a time when his leadership was being questioned.

When the archipelago became a multi-party democracy in October 2008, new President Mohamed Nasheed, a former journalist and activist, was expected to pursue a liberal policy as part of the country’s reforms agenda.

Although Nasheed is the president, his party, the Maldivian Democratic Party (MDP), has only 28 members and the support of four independents in the 77-member People’s Majlis (Maldives’ unicameral Parliament). Gayoom, now in his 70s and the leader of the largest opposition party, the DRP, has a simple majority – which presents difficulties in governance. Nasheed pleads helplessness in implementing reforms, citing an intransigent opposition.

Today Gayoom’s party accuses President Nasheed of not being able to protect the country’s distinct identity and culture, which the opposition says are rooted in Islam. The Gayoom-led parliament recently sought to impeach the education minister for proposing to make Islam and Dhivehi lessons optional – rather than mandatory – in high school.

To pre-empt the impeachment move, the whole cabinet of Nasheed resigned on June 29, which caused a major political crisis that led to violent street protests. The Nasheed administration allegedly arrested some opposition members, including Gayoom’s brother, Yameen. Political tensions and uncertainties continued at press time.

Now that President Nasheed’s popularity is declining – due to perceptions that he has become as authoritarian as his predecessor – it is feared that, amid immense pressure by the opposition to follow conservative policies, he might begin to follow in Gayoom’s footsteps.

 

Growing Extremism

Both the ruling and opposition parties admit that Islamic extremism has grown in the country. In October 2007, a group of young Maldivians engaged government security forces in a fierce shootout on Himandhoo Island.

Nasheed’s party alleges that Gayoom’s policy of promoting the state version of Sunni Islam created an interest to discern “true Islam,” with extremists from Pakistan stepping in to introduce “jihadism” in the Maldives. The DRP, on the other hand, says that behind the growth of extremism is the current government’s liberal policy of allowing Muslims of different sects to visit the Maldives to preach and give lectures, including the conservative Sunni sect of “Wahhabis.”

Until the early 1990s, Maldivian women would hardly wear the black burqa (covering the entire body, except the eyes and hands), and no men would sport a long beard – outward marks of Wahhabi Muslims, said the Muslim source, adding that “today the practice has become common.”

Still, Islam as practiced in the Maldives is pragmatic and unlike that of Saudi Arabia, he said. “People here are liberal and open-minded.”

As extremism grows, though, it is feared that radical Islamists may go to any extent to extra-judicially punish anyone suspected of being a missionary or having converted away from Islam, and that they can pressure the government to remain indifferent to religious freedom.

How long will it take for the Maldives to allow religious freedom?

“Maybe after the Maldivian government legalizes gay sex,” the Muslim source joked.

Report from Compass Direct News