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Lucete Fortes

COVID-19 pandemie in Cabo Verde

Cabo Verde map Covid-19
map: © Reitmaier / Fortes www.bela-vista.net

20%, 70% or 100% Vaccination - percentages of what?

Chanceler Angela Merkel in her speech "We must break the 3rd wave of the pandemic" stated as a target:
We want to offer a vaccination to everyone by summer.

  • Does this mean 100% of the population will be covered?
  • What is the previsible impact on the number of new cases, the severity of patients falling sick, their need of hospitalization and intensive care - and mortality?

A first vaccination plan published by the Government of Cabo Verde stated as target:
20% of the population per year will be vaccinated over 3 years.

  • What would this mean in terms of vaccination coverage?
  • What is the previsible progress in building up immune response in the population - when and where?
  • Will this create an environment of partly immunized high density-quarters, where immune-escape mutations emerge?

Meanwhile, a revised vaccination plan for Cabo Verde states a new target:
70% of the population will be vaccinated by the end of 2021.

  • Nevertheless it remains unclear, what would this mean in terms of vaccination coverage and protection.
  • The progress in building up immune response in the population - when, where and in the different risk- and agegroups.

In the last months, in international statistics and communications by national health authorities another term pops up:
FULLY VACCINATED.

  • In Community Public Health in ressource constraint settings, starting in the 1960s when dozens of african countries reached independence and health services wanted to provide preventive and curative care to a maximum of people, a fully vaccinated child was defined as a child having received the complete set of immunizations, recommended by the national immunization programm - some call it vaccination calender - for its age.
  • In Cabo Verde in the early 1980s, with a per capita GDP of about 500 $US, the cost of 15 $US per fully vaccinated child, was a heavy but manageable burden and a key- element in fighting infant- and Under-Five Mortaltiy.

Let us have a critical look at the most recent international summary statistics:

Cabo Verde Covid-19 immunization progress

Financial times compares vaccination data of countries and regions status: 24.04.2021 12:00

  • Gibraltar has given 200 doses per 100 residents and reports 94% as fully vaccinated. As there is no vaccine available for minors, the adult population has reached immunity, but unprotected pouches in kindergarden- and school age remain unsolved. Commuters from Spain who flow in and out daily have also been vaccinated and incidences have dropped from 7day levels around 2000 in early January to near zero in early May 2021.
  • Israel has given 115 doses per 100 residents and reports 55% as fully vaccinated, and as the high risk groups were served first, mortality and hospitalizations have shown the expected decline. Israel has an Organization of Health services different from european countries. A handful of compulsory health insurance companies, in part none-profit, run their own health facilities, hospitals, clinics and huge high-standard laboratories. This gives them the administrative capacity to inform and call-in any insured person or groups of insured within hours. An electronic vaccination document was introduced allowing more freedom to vaccinated citizens.
    Anyhow, the problem of unprotected pouches in religious minorities remains unsolved.
    To date, only two more arquipelagos, the Falkland Island (Malvinas) and the Seychelles have given over 100 doses per 100 residents.
  • The UK (reino unido) shows faster progress (68 / 100) than most EU-countries (29 / 100), never the less can consider only 18% as fully vaccinated.
  • Cabo Verde has started vaccinations on 18.03.2021 and the number of doses given per 100 residents meanwhile find their way into international summary statistics. On 21.04.2021 the value reporterd was (2.4 / 100) By the time when all vaccine doses available to date will be given, it may reach 4 to 5,3 per 100 residents.
An interesting country to compare with is:
  • Bhutan, a landlocked parlamentary constitutional monarchy in the Eastern Himalayas. sandwiched between China and India, quite similar in agestructure, total population (754000) and GDP per capita to Cabo Verde, with extreme access problems to remote rural populations. In winter they can not be reached and a few weeks later, when the snow melts and all rivers are high, even less. So vaccinations started on 27.03.2021 provided with 550000 Doses produced in India and the Ministry of Health of Bhutan reports 479686 (63 / 100) doses applied in its first campain of a few days.

Let us have a critical look at those indicators:

  • Doses per 100 residents sounds like a simplification of vaccination-indicators, but gives a wrong impression concerning the protection provided.
    To laypersons it may suggest that 100% is a target.
  • Fully vaccinated is a rather well-sounding term in this context, meaning, for the time being, nothing more than "2nd dose given" and suggesting "fully protected" to laypersons.
    Misunderstandings and problems of registration and evaluation are foreseeable. There are vaccines already on the market (Johnson & Johnson) requiring one dose only. How will those one-shot vaccinations be registered and reported? By the time vaccination recommendations will change, e.g. a third dosis adapted to new virus variants, how to register, report and evaluate?
    And how will the population react when people declared "fully vaccinated" must learn that this is no more valid when recommendations have to be updated?
  • Commonly, Public Health indicators start from the population, the geographic distribution, agestructure and needs. Part of the population uses the services spontainously, others after being invited and reminded. This is reflected by indicators of access, affordability, acceptability and availability, registering service-user contacts and activities performed, calculating use, extent of use, intensity of use, utilization of facilities, equipment and personnel, and finally studying ouput and outcome. When it is about immunization programmes, the central indicator is the Immunizaton Coverage, the number of people having received the vaccine in comparison to the number of all (estimated from demographic data or in a representative study sample) who according to the immunization recommendations should have received.
    To be meaningful, Immunization or Vaccination Coverage is calculated separately for all vaccine-preventable diseases, the different doses, first, second, third and reforce, by gender- and agegroups and even for smaller groups, defined by geography, cultural caracteristics and populations in institutions (e.g. old age homes, prison, psychatric wards, public and religious schools, military ...) to understand the situation and re-adapt the programme.

All information to the best of our knowledge and belief but without guarantee. !

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updated: 06.05.21
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