Jaime Sepúlveda Amor is one of the most renowned epidemiologists in Mexico. A pioneer in the fight against HIV in the country and with five epidemics in tow in several decades of his career as a public servant, Sepúlveda Amor reveals in an interview with EL PAÍS several criticisms of the management of the coronavirus in the Government of Andrés Manuel López Obrador and what you expect from the pandemic in the next few months. After taking diagnostic tests 24 hours before dinner and receiving booster doses, Sepúlveda has met his family in Barcelona on New Years: “We are all vaccinated, including my seven-year-old grandson; unfortunately in Mexico the bad decision was made not to vaccinate children and they had to go to the United States to get vaccinated ”. The executive director of the Institute for Global Health Sciences at the University of California, San Francisco issues several warnings about the arrival of omicron to Mexican territory and calls for important adjustments to the government strategy to mitigate the impact of the new virus. This is an edited and condensed version of their responses.
Ask. The arrival of omicron has once again put us in front of daily dilemmas: take a plane or not, go to dinner or not, go out or stay at home. How cautious should we be?
Answer. Ómicron has brought us back to a point where we will have to take very serious precautions. I mean not just being well vaccinated, ideally with a third dose and messenger RNA vaccines [como Pfizer o Moderna], which are the ones that best protect against omicron. In addition to vaccinations, we have to continue with the use of face masks. This is such a contagious variant that, even in well vaccinated people, it is very likely that we will end up infected, even with three doses. That’s how contagious the omicron variant is. The good news is that with three doses of vaccine, mostly messenger RNA, the protection against severe illness, hospitalization, and death is very high. The recommendation that I would make to the Mexican government is that it use these vaccines as a booster. And, furthermore, we must forget about the concept of a complete scheme, of one or two doses.
P. Is having two doses no longer enough?
R. No, they are not enough anymore. Let’s put it like this. The arrival of omicron leads us to have one less vaccine dose compared to other variants, that is, three doses of vaccine are equivalent to omicron as two doses of delta vaccine. It is as if a dose of vaccine has been subtracted from us. For this reason, we must get used to the fact that the complete scheme will be at least three doses of vaccine in the entire population.
P. How is the delay in the application of booster doses going to affect in Mexico?
R. He is going to charge us an invoice. The complacency of the authorities in Mexico is very dangerous. Time and again we have seen that the health authorities and the president himself have minimized the severity of the pandemic in any of its previous phases. Before the first cases were presented, the severity of what was later recognized as a pandemic was already being minimized. Again, authorities are downplaying the arrival of omicron. It is a matter of time so that it is also the predominant variant in Mexico. It will be a difficult winter, as the transmission of the delta variant coexists with omicron and also the influenza virus.
P. When do you think omicron will become the predominant variant in Mexico?
R. It is a matter of weeks. Here in Europe it is already the predominant variant and the number of omicron cases doubles every two days, while Delta did so every two weeks. It is a much higher rate of growth.
P. How much of what is seen in Europe is an example of what will happen in the next few days in Latin America?
R. That is something that irritates and surprises me: how in Mexico the experience acquired in other places has not been used. Due precautions were not taken, taking advantage of the time it gave us that the epidemic was occurring mainly in other places. Two years later we continue to make the same mistakes. Neither the president’s amulets, nor the optimistic and complacent statements in the morning are going to prevent the omicron variant from reaching Mexico and it will arrive with great force. We are going to have a new wave as of next month and the necessary measures are not being taken, including vaccination as a booster with high quality vaccines.
P. How much of what happens can be attributed to the characteristics of this variant and what has not been done in the societies and governments of each country?
R. It’s complicated because all these ingredients come together almost like a perfect storm. Of course, the emergence of more contagious variants that better evade the immune response is not the responsibility of anyone in particular, it is a biological accident. Having said that, I can say with certainty that lack of anticipation is indeed human error.
Delta or omicron are not the latest variants, new ones will continue to emerge as long as we do not have universal vaccination coverage. That is a responsibility above all of the rich countries, which have hoarded vaccines. As long as not all countries are safe, no country will be safe. It is not a humanitarian issue, but a global security issue.
Within each country there are also different levels of responsibility. There are countries that have responded quickly and effectively. There are others such as Brazil, Mexico, the United Kingdom, Trump’s United States and others with populist governments that have had a high responsibility for the growth of the pandemic and high mortality. Society also influences. There are elements that are civil liability such as reluctance to get vaccinated or young people who feel immortal and who do not wear face masks.
In each country this mix of responsibility varies. There are places, such as Mexico, where most of the responsibility falls on the Government and its irresponsibility in minimizing the severity of the pandemic.
P. How has the López Obrador government failed?
R. The first very serious mistake was to minimize the use of diagnostic tests. Mexico is the country that does the least number of tests in relation to the number of cases it has on the continent. It is a shame. Then it was the matter of the mask. The president does not use it, does not set an example. The Ministry of Health has gradually modified its opinion: from the absolute denial of its usefulness to lately recommending it more. That was a second serious mistake.
The third has to do with instructing people to stay home even with symptoms, without giving them the financial support to be able to comply with that health instruction. People need to go out and earn their bread. The next mistake was that health workers were not given what they needed to perform their duties. Mexico has the highest mortality in health personnel in the world from covid, for not having their protective equipment, for not having good training.
A next issue is the extremely high in-hospital mortality in people admitted with covid. In many hospitals, being intubated was practically equivalent to dying. In the Mexican Institute of Social Security, 50% of the people who entered due to covid died. This is creepy. Public hospitals had a much higher mortality than private hospitals.
Finally, in Mexico vaccination has been delayed in all age groups that required it. And it has also been done with a multitude of vaccines, up to eight different vaccines are applied. Vaccination in Mexico has been very chaotic and very triumphant. It is argued that in Mexico City 100% of the population is vaccinated. That is not true. Statistics are being tortured to force what they want to say. But that is a lie and a lie of great responsibilities.
P. Don’t those stats add up to you?
R. Of course not. Having a dose of vaccine is not the same as being 100% vaccinated. And it is not true that the entire population of Mexico City has a vaccine, because they should include children five years and older. They are considering only adults and are making comparisons that are not valid with the rest of the countries that are reporting vaccination coverage in relation to their entire population. Torturing statistics to make them appear what they are not has a great responsibility for falsifying the data in a conscious way and making a much more positive image of the response of the authorities.
P. The president defends that here there was not the chaos or saturation that there was in other countries.
R. What you have to see is the last and most serious of the consequences: mortality. Mexico has more than 600,000 deaths from covid, admits 300,000 in official figures, although it recognizes that it is most likely double due to excess mortality. If we look at the number of deaths per 100,000 inhabitants, we see that Peru and Mexico have the highest rates on the continent by far. You have to take the metrics that matter. The most serious and sad metric is the large number of premature and unnecessary deaths that the country has had from covid. And this is due to lack of vaccination and lack of elementary public health measures. Many more deaths would have been prevented with a more energetic and earlier response to the pandemic.
P. What do you expect from the pandemic next year?
R. We have gained a lot of knowledge: effective diagnostic tests, vaccines and antivirals have been developed. Finally, we have pharmaceutical and non-pharmaceutical answers. The conjunction of one and the other will lead to the domination of the pandemic in the course of the next few months in countries that have the political will to take the appropriate actions.
I am concerned, however, that Africa and resource-poor countries in Asia and Latin America may not get the same response as in industrialized or middle-income countries. Industrialized countries will have very high vaccination coverage and will no longer have an evolving epidemic, but the pandemic will become an endemic disease such as influenza and other respiratory viruses. In Mexico, 2022 is going to be a difficult year. I anticipate a new wave with omicron and it is necessary to quickly acquire messenger RNA vaccines in the market, which by the way is heavily monopolized by rich countries, and invest in health. It seems to me an enormous irresponsibility to spend 3,800 million pesos in an exercise as useless and pharaonic as the revocation of the mandate, especially at a time when high-quality vaccines are so necessary. It is not easy to make forecasts, but I think they are going to be difficult months. If vaccines can be acquired, in 12 months we could have a happier end of the year.
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