The Global case-fatality rate of COVID-19 has been declining disproportionately between top vaccinated countries and the rest of the world

Globally 58.83% human population received at least one dose of the COVID-19 vaccines as of 5 January 2021. COVID-19 vaccination rollout is progressing at varied rates globally and data on the impact of mass vaccination on infection and case-fatality rates require definition. We compared the global reported cumulative case-fatality rate (rCFR) between top-20 countries with COVID-19 vaccination rates (>125 doses/100 people) and the rest of the world, before and after commencement of vaccination programmes. We considered the 28th day of receiving the first vaccine in the world as a cut-off to compare the pre-vaccine period (Jan 1, 2020 - Jan 5, 2021) and the post-vaccine period (Jan 6, 2021-Jan 5, 2022). We used a Generalized linear mixed model (GLMM) with a beta distribution to investigate the association between the CFR and potential predictors of each country and reported the relative risk (RR) of each variable. The mean rCFR of COVID-19 in the top-20 countries with vaccination rates was 1.83 (95% CI: 1.24-2.43) on 5 Jan 2021 and 1.18 (95% CI: 0.73-1.62) on 5 Jan 2022. The CFR for the rest of the world on 5 Jan 2021 was 2.32 (95% CI: 1.86-2.79) and 2.20 (95% CI: 1.86-2.55) on 5 January 2022. In Sub-Saharan Africa, the CFR remained roughly unchanged at 1.97 (95% CI: 1.59-2.35) on 5 Jan 2021 and 1.98 (95% CI:1.58-2.37) on 5 Jan 2022. The GLMM showed vaccination (/100 population) (RR:0.37) and Stringency Index (RR:0.88) were strong protective factors for the countrys COVID-19 CFR indicating that both vaccination and lockdown measures help in the reduction of COVID-19 CFR. The rCFR of COVID-19 continues to decline, although at a disproportionate rate between top vaccinated countries and the rest of the world. Vaccine equity and faster roll-out across the world is critically important in reducing COVID-19 transmission and CFR. Key Questions What is already knownO_LIVaccination can reduce the case-fatality rate of COVID-19. Globally, the COVID-19 vaccination rollout is progressing at varied rates. C_LI What are the new findingsO_LIIn the top-20 countries with vaccination, >200 doses of vaccines are given per 100 people on 5th Jan 2022, In the rest of the word, the figure is 105, and in Sub-Saharan Africa (SSA) only 15.72 C_LIO_LIAfter the introduction of COVID-19 vaccination the reported case-fatality rate (rCFR) of COVID-19 has reduced by 35% in the top-20 countries with vaccination, 8% in the rest of the world roughly unchanged in SSA. C_LIO_LIThe doses of COVID-19 vaccines (/100 people) and rCFR has a negative correlation on 5 Jan 2022 (r=-0.296, p<0.001). C_LIO_LIThe COVID-19 vaccination and Stringency Index are strong protective factors for the countrys COVID-19 rCFR indicating that both vaccination and lockdown measures help in reduction of COVID-19 rCFR. C_LI What do the new findings implyO_LIThe disproportionate case-fatality rate of COVID-19 between top vaccinated countries and the rest of the world demand fast and equitable vaccine rollout globally to reduce COVID-19 transmission and CFR C_LI

Lockdown measures in response to COVID-19 in Sub-Saharan Africa: A rapid study of nine countries

Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. This paper defines the term lockdown and describes the design, timing and implementation of lockdown in nine countries in Sub Saharan Africa: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. It also discusses the manner in which lockdown is enforced, the need to mitigate the harms of lockdown, and the association between lockdown and the reported number of COVID-19 cases and deaths. While there are some commonalities in the implementation of lockdown, a more notable finding is the variation in the design, timing and implementation of lockdown measures across the nine countries. We found that the number of reported cases is heavily dependent on the number of tests done, and that testing rates ranged from 9 to 21,261 per million population. The reported number of COVID-19 deaths per million population also varies, but is generally low when compared to countries in Europe and North America. While lockdown measures may have helped inhibit some community transmission, the pattern and nature of the epidemic remains unclear. Of concern are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic harms. This paper highlights the need for inter-sectoral and trans-disciplinary research capable of providing a rigorous and holistic assessment of the harms and benefits of lockdown.