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The Vaccines Have Not Yet Beaten the Virus in the Maldives. Let Me Offer an Explanation and How We Could Change This Unfortunate Situation.

June 4, 2021 Coronavirus (Covid-19) No Comments
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The Maldives, along with Dubai, the Seychelles, the United Kingdom, and Israel, are among the most vaccinated countries on Earth. But whilst Israel and the U.K. are seeing the virus almost disappear, the Maldives, Dubai, and the Seychelles are witnessing the opposite, with cases skyrocketing.

Here in the Maldives, the number of cases has risen from a low of 19 per day in December to over 2,000 in late May, the number of deaths, 45, represents one third of all deaths that we have suffered since the beginning of the pandemic. This is in spite of the fact that 58% of the population has received one vaccine shot, and 30% has received both.

These graphs show the relative performance of the U.K., Israel, and the Maldives in terms of new COVID-19 cases:

The Human and Economic Toll

The recent rise in cases in Male’ has led to hospitals overflowing with patients, and a tragic rise in deaths. Out of the 125 COVID-19 deaths in the Maldives, 45 occurred during the past month. While the fatality rate remains extremely low (0.2% of people who caught COVID in the Maldives have died), that statistic doesn’t provide much solace to those who have lost loved ones.

The high case load in recent weeks has also inflicted economic damage. Out of the top ten markets this year, four are no longer able to travel. Indians (the number two market this year) are no longer permitted to visit the Maldives. Germany, the U.K., and France (markets number three, seven, and nine) have put the Maldives on their red lists. In the U.K., citizens returning home from the Maldives have to quarantine in a miserable hotel for 14 days.

According to the Maldives Inland Revenue Authority (MIRA), U.S. Dollar revenues collected in January 2021 were U.S. $ 46 million — just 1% down on January 2020. But in January, things were looking good. Now many countries’ citizens cannot travel here, and revenues in May and June will likely be similar to October 2020 – 58% down on the year earlier. On an annualized basis, this could cost the Government as much as USD 250 million in lost revenues.

Why are the Maldives, the Seychelles, and Dubai seeing cases explode when they enjoy comparable vaccine penetration as countries such as the UK and Israel?

The answer might be the choice of vaccine. The first vaccine Israel used was the Pfizer-BioNTech. They also have an excess supply of Moderna. Dubai and the Maldives had a similar vaccination program using a combination of the Oxford AstraZeneca vaccine and Sinopharm. The Seychelles is the most vaccinated country in the world but has relied almost exclusively on Sinopharm.

At Soneva, we consulted six leading infectious disease experts from around the world to assist us with our COVID strategy. Last week I consulted some of them again. Unfortunately, the feedback on the Chinese vaccine was not great, as one of the experts said:

“The mRNA vaccines (Moderna and Pfizer) are the only ones with published data showing high performance even against the new virus variants”. 

“The Chinese vaccines that are being used in many parts of the world appear to be only weakly protective, from the limited amount of information available… The problem is that we do not have reliable data on the Chinese vaccines.”

Sonu

Another expert told me:

“Sinopharm, unlike the vaccines noted above, is more of a “classical” vaccine design (i.e. inactivated whole virus) – the kind of vaccines which have been trialed (and failed) for decades for combating seasonal Coronavirus. Although the Sinopharm licensing studies suggest the vaccine has 80% effectiveness, the trials had very few people over 60 years and I have concerns about Sinopharm’s effectiveness in older individuals in particular. Whether Sinopharm will provide more or less resilience to emerging COVID variants, such as the ‘Indian’ variant(s) remains unclear.”  

When one considers the relative performance of countries using different vaccines, as well as the feedback of these experts, it would seem that Sinopharm may not be as effective as we have been led to believe.

There is a difference between protecting a patient from catching the virus and protecting the patient from getting seriously ill

All data shows that whilst some vaccines are more effective in preventing you from catching the virus, all the vaccines are generally effective in preventing serious illness and, most importantly, death. As one of the experts consulted said:

“Even the weakly protective vaccines may be quite helpful in preventing serious disease or death.” 

Whilst the number of cases have spiked, and last month, 5 out of 45 fatalities were from people who had already received a second dose of the vaccine, the performance in the Maldives in terms of fatalities is amongst the best in the world. A few months ago, the survival rate here was 99.7%. It is now 99.8%. This is second to Singapore at 99.95%. It is also a commendable performance when compared to India (98.88%), the U.S. (98.21%), Germany (97.6%), and the U.K. (97.16%). The Seychelles at 99.65% is slightly behind the Maldives. So, whilst the vaccines might be less effective in preventing one from getting the virus, they are generally protective against serious disease and death. There are more deaths in Male’ at the moment simply because there are many, many more cases.

A need for perspective

This is an article focused on the benefits and drawbacks of different vaccines. It is however important to remember that the experience in the Maldives, is that if one gets COVID, one has a 99.8% chance of survival.

Furthermore, it is important to remember to boost one’s immunity. At our resorts, as soon as anyone tests positive for the virus, we immediately put them on an immune-boosting diet, rich in foods including garlic, turmeric, cardamon, cinnamon, ginger, and red onions. We also give them the popular Ayurvedic herb, Andrographis Paniculata. Fortunately, we have had no fatalities at all among the people who tested positive.

I quote below, the message from Dr. Abdul Slocum, a Turkish Oncologist who treated his cancer patients that caught COVID:

“I’m not a front line COVID physician but unfortunately when some of our cancer patients got COVID I treated them together with my colleagues. We used anti-coagulants, anti-biotics, anti-virals as conventional therapeutics together with high dose vitamin C, Andrographis, Thyme extract etc. as complementary therapies and all of our patients have gotten better with such treatment.”

So, irrespective of whether one has had the vaccines or not, maintaining a healthy lifestyle is still very important to ensure that one does not succumb to this disease.

 A way forward

Whilst the vaccines generally protect against serious illness or death, unfortunately, because of the rise in cases, the Maldives is still suffering economically. As Raina MacIntyre, who heads the biosecurity program at the Kirby Institute of the University of New South Wales, Australia, said:

“You really need to use high efficacy vaccines to get that economic benefit, because otherwise, they are going to be living with the disease long-term… The choice of vaccine matters.” 

It seems clear from the example of Israel that the Pfizer-BioNTech vaccine is extremely effective at both preventing the onset of the virus and deaths. There are also other alternatives:

An article in the Lancet’s online publication on the 2nd of February this year claims that the Russian Sputnik vaccine is 91% effective just 21 days after the first dose. The Sputnik vaccine is unique, in that it is using a heterologous recombinant adenovirus approach. The first dose has the adenovirus 26, and the second one, the adenovirus 5. In other words, each dose has a slightly different virus to create immunity. The Moscow institute that made it, the Gamaleya Research Institute of Epidemiology and Microbiology, used a similar approach for an earlier Ebola vaccine.

As the Lancet article concludes:

“The development of the Sputnik V has been criticized for unseemly haste, corner-cutting, and an absence of transparency. But, the outcome reported here is clear, and the scientific principle of vaccination is demonstrated…” 

The Sputnik V is a more traditional vaccine based on the time-tested approach of giving the patient some exposure to the virus in order to build their immunity. This option may give some solace to those that have concerns about mRNA vaccines.

 Mixing and Matching Vaccines 

If the Maldives wants to get both the health and economic long-term benefits of its vaccine roll-out, it might consider changing the brand of vaccines it uses for second shots. There is little information on the effects of combining Sinopharm with other vaccines. However, a recent article in the Lancet finds that pairing the Pfizer-BioNTech and AstraZeneca vaccines appears to increase the likelihood of mild to moderate side effects, but no serious outcomes were reported. In fact, the article goes on to say that:

“MIT Technology Review reports that such an approach could become more common if mixing and matching COVID-19 vaccines is proven to boost the overall level or duration of immunity – as tantalizing, early evidence suggests might be the case.”

“Several trials …… have been launched to examine the question MIT Technology Review reports, including a study in Spain assessing the viability of mixing a first doses of AstraZeneca’s vaccine with a second dose of Pfizer-BioNTech, as well as a study between AstraZeneca and Russia’s Gamaleya Institute examining how AstraZeneca’s vaccine works in combination with Russia’s Sputnik V vaccine.”  

Early evidence suggests that it is possible to combine vaccines and change course.

The Pfizer vaccine is considerably more expensive than other options. Covishield is generally available for somewhere between USD 2-4 per vaccine (if you can get hold of the shots, that is). The cost of the Pfizer vaccine is approximately USD 25. Israel was the first to receive a large amount of Pfizer because they offered the company 23 Euros vis-a-vis the 12 Euros the E.U. countries were offering. It is my understanding that Dr Reddy’s Laboratories, the Indian manufacturer of the Sputnik V vaccine, proposed a price of USD 14 for the vaccine.

However, as I mentioned earlier, we are starting to see a big drop in tourism as a result of the spike in cases. The economic consequences could affect MIRA’s revenues by as much as USD 10 million to USD 20 million per month – considerably more than the cost of more expensive vaccines.

Now might be the time cut our losses and buy the more expensive, but more effective, vaccines.

By Sonu Shivdasani

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