Dear Colleagues!  This is Asrar Qureshi’s Blog Post #675 for Pharma Veterans. Pharma Veterans welcome sharing of knowledge and wisdom by Veterans for the benefit of Community at large. Pharma Veterans Blog is published by Asrar Qureshi on WordPress, the top blog site. Please email to for publishing your contributions here.

These posts are based on a July 28, 2022, article and the WHO living guidelines. The links appear at the end. Continued from Previous……

Paxlovid and other COVID19 therapeutics are widely available only in high-income countries. For example, in the United States, supply is more than demand, but in low-income countries, the access to these options is either severely restricted or altogether absent. The picture is the same as was seen in the case of COVID19 vaccines; the low-income countries were scrambling for vaccines while high-income countries kept sitting on surplus doses, much of which was later discarded due to expiry. It may be called criminal negligence, but this is how the world operates.

Testing for COVID19 at the laboratories never became cheaper and became multibillion business everywhere. Fortunately for most people, home testing kits started providing some relief.

Going forward, the outlook for most regions, including Europe and North America, remains relatively favorable. The levels of severe disease are likely to stay at or below recent levels. The winter of 2022-23 may see a substantial rise in the number of cases, particularly in cold countries. As per statistics, the average number of daily deaths due to COVID19 in the United States is still running two to four times higher than flu but the public has grown comfortable now.

So far, none of the new variants has completely evaded the immunity with the existing vaccines, but if it so happens, it may catapult the entire scenario. Subvariants of Omicron have shown higher transmissibility, but the dynamics of the pandemic remain the same. There is emerging evidence that BA.4 and BA.5 variants can evade immunity, however, these are still being considered as more transmissible rather than being more lethal. Moreover, the existing vaccines have been able to limit the incidence of severe disease in these cases also.

Public health authorities in various countries are considering short-term and medium-term strategies to tackle possible scenarios of COVID19 evolution. One of these is to roll out second booster – fourth dose of vaccine. The public response to the second booster is lukewarm, with majority not opting to get it. It is feared that without continued immunization, the current level of immunity will keep falling.

Since the onset of COVID19, the conspiracy theories have been circulating full force, and these have seriously dented the narrative of governments and health authorities. Credibility gap has been serious throughout, but in the initial phase, governments pushed from all angles and got the majority (?) vaccinated. Some very notable people like tennis great Djokovic still did not get even the first dose of vaccine. First booster was also pushed through official pressure, but now people are tired and not interested in getting another dose of vaccines. This also means that future variants of COVID vaccines will also face greater resistance. Public health authorities therefore may need to look at wider range of indicators to support their planning and disease management efforts.

I would like to close this post with two quotes from Mckinsey article.

[Quote] The risk that COVID-19 poses to a community at any point in time is a function of the immunity of its members. Immunity protects individuals and reduces risk for people in the community around them by reducing rates of onward transmission. It is gained through vaccination (primary series and boosters), infection with SARS-CoV-2, or both (hybrid immunity). It is lost both gradually, with the passage of time, and suddenly, when a new variant that evades the immunity afforded by vaccination or previous infection becomes dominant (as happened with the emergence of Omicron in late 2021). A community’s level of immunity is a precarious balance, constantly shifting as individuals gain and lose immunity. [Unquote] [Quote] This initial version of the McKinsey COVID-19 Immunity Index helps us make a few observations:

  • The emergence of Omicron during the winter of 2021–22 is visible as a sharp drop in immunity in multiple countries (since existing immunity was suddenly less effective against the new variant).
  • The proportion of unvaccinated people with past infections in a country is roughly correlated with its overall COVID-19 mortality, since unvaccinated but infected people have been at greatest risk of bad outcomes.
  • Vaccination remains an essential element in building immunity. Some new studies suggest that infection confers more immunity and protection against severe disease than does vaccination alone. As a result, some countries with strong vaccination records may now have lower immunity than others, such as the United States, that have experienced a large number of cases during recent Omicron waves and for which much of the population was last immunized about six months ago.
  • Even countries, such as the United States, with high McKinsey COVID-19 Immunity Index scores continue to experience many new COVID-19 cases as a result of the extremely high transmissibility of current SARS-CoV-2 variants. US mortality for COVID-19 is still higher than the historical average for flu but has fallen by 85 to 90 percent since its early 2021 peak.15
  • A successful autumn booster campaign in Northern Hemisphere countries will be important to increasing immunity levels before winter comes.


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