Double Check: Why Does The Most Vaccinated Country Still Have COVID?

In the first week of May, stories about the rising number of cases in Seychelles — one of the world’s most vaccinated countries — started surfacing. 

This country’s increase in COVID-19 cases led to speculation about the efficacy of the COVID-19 vaccines, as well as straightforward anti-vax narratives. Anti-lockdown and anti-vaccine websites published articles citing the situation in Seychelles as a reason to dismiss the COVID vaccines. Far-right libertarian financial blog, Zero Hedge, published an article questioning the effectiveness of “India-made and China-made vaccines.” On May 15, the right-wing news outlet, Swarajyamag, published an article on the rising number of COVID-19 cases in Seychelles and suggested that the reason behind this increase was because the majority of Seychelles’ population received China’s Sinopharm vaccine. (By April 19, 59 percent of the doses given in Seychelles were Sinopharm, while the rest were Covishield — the Indian name for the Oxford-AstraZeneca shot.)

Perhaps unsurprisingly, messaging like this contributes to vaccine hesitancy, but also vaccine nationalism, where geopolitical allegiances are used to argue for or against the use of different vaccines. 

This tweet had a global reach of 124,454. image: Twitter/Kristina Gildejeva

This tweet had a reach of 51,382. image: Twitter/Kristina Gildejeva

This Telegram repost of the Zero Hedge article had 44,900 views. image: Telegram/Kristina Gildejeva

As of May 17, Seychelles has reported a total of 9,184 COVID cases, with over 2,000 active cases and 32 deaths. Of the current active cases, 37 percent are among those who have been fully vaccinated, according to Seychelles Ministry of Health. And of all the positive cases, the health ministry said 63 percent had either not been vaccinated at all or else had only received one dose.

Anyone with a negative test within the last 72 hours was allowed in the country without the need to quarantine. 

There is no denying the fact that the country is experiencing a COVID-19 outbreak despite vaccinating a large proportion of its population. Though the situation in Seychelles is a reminder that a country may not be out of the woods, it is unwise to jump to conclusions that can contribute to vaccine hesitancy.

Statistics show that Seychelles is well ahead in its mission to vaccinate the population. image: Our World in Data/Devika Khandelwal

The pandemic in Seychelles 

Seychelles relies heavily on international travel and tourism. Unsupringing, the COVID-19 pandemic hit the island nation’s economy hard. As CNN reported, “Tourist arrivals were down by 70% last year and the sector's 2020 revenues dropped by around $368 million.” 

In an effort to reopen the economy, the island started vaccinating its population from January. Subsequently, on March 25, Seychelles lifted restrictions for all visitors other than those traveling from South Africa. At this time, anyone with a negative RT-PCR test (taken within 72 hours before their departure) was allowed in the country without the need to quarantine. 

By this point, the country had reported 3,882 cases and 18 deaths since the start of the pandemic. Since then, however, total cases have more than doubled to 9,184 cases and 32 deaths, out of a total population of 98,000.

Although it is not yet clear why there has been a rise in cases, the country’s minister for foreign affairs and tourism, has said “the virus had likely been in the country all along and had spread as vaccination made people more complacent.” 

WHO has said that it would review coronavirus data from Seychelles and its director of immunization, vaccines and biologicals, Dr. Kate O’Brien, said in a briefing that the WHO was in direct communication with the Seychelles’ health ministry and that the situation was a “more complicated situation than the top-line messages.”

Putting cases into context 

It is important to note that no vaccine guarantees that a person will not be affected by COVID-19. Vaccine experts and researchers have repeatedly stated that COVID-19 vaccines can help individuals overcome the virus and prevent COVID symptoms from becoming severe, but that it is still possible to contract the virus even when vaccinated.

To date, none of the patients who have died with COVID-19 has been fully vaccinated.

Also, factors such as mutations and variants can play a role. The B.1.351 variant, first identified in South Africa late last year, was found in Seychelles in February 2021. The AstraZeneca/Covidshield vaccine appears to be less effective against this variant. Indeed, South Africa has halted its plans to use it. 

Seychelles health ministry has also noted that, of the patients who have required hospital treatment, 80 percent had not been vaccinated and tended to be people with comorbidities. It added that “almost all” of the critical and severe cases requiring intensive care treatment had not been vaccinated either. To date, none of the patients who have died with COVID-19 has been fully vaccinated. The ministry further noted that it is unclear whether people who received both the doses Covishield or Sinopharm are testing positive for the virus. 

WHO’s Director of Immunization, Vaccines and Biologicals, Dr. Kate O’Brien, sums it up thus: 

“As was noted, the vaccines are highly efficacious against severe cases and deaths. Most of the cases which have occurred are mild cases. However, what is also important is that a substantial fraction, over 80% of the population, has been vaccinated. But as we know ... some of the cases that are being reported are occurring either soon after a single dose, or soon after a second dose, or between the first and second doses.” 

Seychelles' vaccine program

Seychelles is using two vaccines: the Sinopharm vaccine and Covishield. The Sinopharm vaccine was developed by the Beijing Institute of Biological Products subsidiary, and has since been approved by 42 countries including Seychelles. 

On May 7, the WHO Strategic Advisory Group of Experts on Immunization issued interim recommendations for use of the Sinopharm vaccine, stating that a multi-country trial has shown that two doses, administered at an interval of 21 days, have an efficacy of 79 percent against symptomatic COVID-19, 14 or more days after the second dose.

However, it added that the Sinopharm vaccine “has not yet been evaluated in the context of circulation of widespread variants of concern,” noting that the trial was not designed and powered to demonstrate efficacy against severe disease in persons with comorbidities, in pregnancy, or those over the age of 60. WHO also added that women were underrepresented in the trial.

Zhong Nanshan, a Chinese epidemiologist, said in April that current inactivated vaccines (Sinopharm being one of them) are less effective against the B.1.351 variant first found in South Africa. He also said that China is accelerating the development of new vaccines against the variants.

The Covishield vaccine, on the other hand, has an efficacy of 63.09 percent against symptomatic COVID-19. Longer dose intervals within the 8 to 12 weeks range are associated with greater vaccine efficacy. 

A small study of 2,000 people in South Africa has shown that the AstraZeneca/Covishield vaccine offers very little protection against mild cases of the B.1.351 variant. The study, which was based on people of an average age of 31, shows that protection may be as low as 10 percent. Other research suggests that the vaccine is still likely to reduce severe cases and deaths from the B.1.351 variant.

Though there is no immediate question regarding efficacy of these vaccines, new mutations and strains can reduce their efficacy, and there is a need to study the dominant virus variant(s) causing the rising cases in Seychelles and examine how well the Sinopharm or the Astrazeneca shot work against these variants.

That said, comparison of the Sinopharm and Covishield vaccines with Moderna and Pfizer is futile, since studies showed that antibodies made in response to Pfizer and Moderna vaccines are less effective against the South African variant. The WHO has also said that “We cannot compare the vaccines head-to-head due to the different approaches taken in designing the respective studies, but overall, all of the vaccines that have achieved WHO Emergency Use Listing are highly effective in preventing severe disease and hospitalization due to COVID-19.”

So what's going on?

Undoubtedly, the rising number of coronavirus cases in Seychelles is a matter of concern. However, questioning the efficacy of vaccines without gathering all the information is a risky business.

The key things to keep in mind here are that variants are still very much unknown quantities when it comes to vaccine efficacy, and that while Seychelles’ vaccination program is advancing fast, not everyone has been vaccinated, and many of those who have are still awaiting their second dose. A large proportion of cases since the vaccination program began are in patients who are not yet fully vaccinated or not vaccinated at all. The country’s decision to allow travel within quarantine may also be a factor, but while cases have risen, not a single fully vaccinated person has died in the country. Perhaps this is a vaccine success story after all.