Life has been tough over the last 12 months for all of us oncologists and our patients worldwide. Return to normal life may be a reasonably achievable hope in countries that are hard hit by the COVID-19 pandemic if they have adequate resources, efficient governance, and compliant people who follow CDC/WHO/regional/national recommendations for wearing masks, distancing, washing hands, and sanitization in order to be able to slow down and stop the spread of coronavirus, and the ability to vaccinate 80% to 90% of their citizens. However, many countries had to resort to lockdowns to reduce the spread of the coronavirus, and reduce hospitalizations and the burden and overwhelming of their health systems, physicians, nurses, staff, ambulance, and other essential workers. This has been successful in some countries, but not in many others, especially those with already limited resources, which are also unable to vaccinate their citizens fast enough.
COVID-19 remains pandemically superspreading. The great hard work of collaborative scientific basic and clinical research, academic and pharmaceutical, administrative and political entities support has led to the extraordinary fast and record-breaking achievement and approval in the U.S. and Europe of 3 vaccines already, Pfizer BioNTech, Moderna, and Oxford-AstraZeneca, and additional promising ones are on the way but still in clinical trials. Two other vaccines, Sinopharm and Sputnik, were approved in some countries, and Johnson & Johnson has a promising single-dose vaccine. With more strict application of masks and of physical and social distancing, as well as necessary periodic lockdowns, we hope we can return to normal life by the end of 2021.
Our experience in Lebanon, which is a country of over 6 million people (4 million Lebanese citizens, 2 million Syrian refugees, and 600,000 Palestinian refugees) has been very difficult and disturbing. Lebanon has been for years classified as an “upper-middle income” country by the World Bank; however, the Lebanese economy is in severe crisis, the financial system is collapsing, there is devaluation of the Lebanese currency and hyperinflation because of poor governance, corruption, political instability, regional wars, and more recently the massive destructive explosion of ammonium nitrate at the Beirut Port and the COVID-19 pandemic.
According to new World Bank reports, more than 50% of people in Lebanon live below the poverty line. To ensure compliance with COVID-19 prevention lockdowns, governments should give people economic incentives to stay home. This is not happening in Lebanon nor in other low- and middle-income countries (LMICs) because people need to work to make money for their daily living, therefore coronavirus transmission continues.
Rising COVID-19 infections overwhelm medical facilities and already limited hospital systems in most LMICs. Lebanon has a very good hospital infrastructure, but equipped hospitals are full. At our 360-bed American University of Beirut Medical Center (@AUB_Lebanon) we have an average of 60 patients with COVID-19 waiting in the emergency room for a regular or ICU bed. It is an enormous stress on our frontline health care workers, patients, and their families. Similar experiences are happening at other major hospital centers. Beds are not available. Supplies are short or missing. Medications are not readily available. Vaccines are planned but in very limited amounts. We lobby to include eligible patients with cancer for priority for vaccinations.
Countries with delays in vaccination carry the risk of herd immunity by the coronavirus rather than by the vaccines—which could mean tens of thousands of more deaths, more suffering, and health care system collapse. Treatment delays for patients with cancer, postponement of early detection, and shortages of diagnostic supplies and anticancer drugs because of damaged economies and unaffordable costs have become daily issues burdening all of us physicians. International support for all LMICs is crucial to get over the COVID-19 pandemic and its consequences. The faster people can have vaccines all over the world, the better!