There are fears that high HIV/AIDS prevalence will reverse Botswana’s impressive covid-19 vaccination rates as the country battles the fifth wave of infections.
Director of Health Services in the ministry of health, Dr Pamela Smith-Lawrence when giving updates on Covid-19 last week Thursday on Btv revealed that the Covid-19 fifth wave has seen cases jump by over 150%, from 635 new cases on May 31 to 1627 new cases on June 7. “We have been doubling Covid cases every week since the beginning of May,” said Dr Pamela Smith-Lawrence adding that from 29 May to 4 June, Botswana recorded “2706 new cases which is really a doubling of the last week which showed about 1 083 new cases.”
It has also emerged that Botswana is also witnessing a spike in hospitalisation of breakthrough cases. Speaking recently at the Public Accounts Committee (PAC, Dr Pamela Smith-Lawrence, indicated that some patients who had been hospitalized had been vaccinated. “The few hospitalizations we have had involved people vaccinated when the programme began last year between March and July,” she says.
This emergence of breakthrough infections is giving credence to fears that Botswana’s fifth wave of Covid-19 infections may be riding on the country’s high HIV/AIDS prevalence.
According to findings from a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health, people with HIV have a higher rate of breakthrough COVID-19 infections after vaccination than those without HIV.
In the study published in the peer-review JAMA Network Open on June 7, 2022, the researchers analyzed anonymized health records among nearly 114,000 people fully vaccinated with either two doses of mRNA vaccines or one dose of the viral vector vaccine in late 2021.
When comparing vaccine recipients with and without HIV, the researchers found that the chance of a positive SARS-CoV-2 test result or a COVID-19 diagnosis within nine months after full vaccination, though low, was 28% higher among people with HIV.
Despite Botswana’s superior vaccination rates compared to other neighbouring countries, the country also has the third highest HIV infection rate in the world, with one in three adults infected.
Dr Lawrence highlighted that in terms of vaccination numbers Botswana had “sort of reached a plateau” adding that the “vaccination programme has sort of stagnated” because people are not coming fourth to get their shots. She also indicated that the ministry of health is mainly troubled with the booster doses which are not performing very well. “It’s actually the area we feel most concerned, especially now that we are in the winter period,” she said.
According to the Covid-19 weekly bulletin for June 7th, 2022, Botswana had 2843 active cases. The bulletin also noted that Chobe and Jwaneng were the only regions in red meaning the attack rate per 100 000 is greater than 200. Chobe with an HIV prevalence rate of 39.3% has the third highest HIV prevalence rate in the country after Selibe Phikwe and North East District which have a prevalence rate of 41.6%.
Selibe-Phikwe along with Greater Gaborone, Boteti and Lobatse are orange meaning the attack rate per 100 000 was between 100 and 200. All other zones were still green meaning the attack rate per 100 000 was less than 100.
Botswana’s approach to the pandemic has mainly been dirigisme as the state mainly plays a positive role in intervention to curb social failures. Public health officials believe that the type of wave Botswana is projected to see this winter will also determine the public health response. Some believe that a stronger wave might result in more masking and another mass vaccination campaign.
Meanwhile a report by Permanent Secretary in the Ministry of Health and Wellness Grace Muzila that was filed with the ongoing session of the PAC, highlighted that there would be a review of the mask mandate post winter. “While some Covid-19 restrictions have been lifted such as the requirement for a negative Covid-19 PCR test certificate on entry at points of entry (POE) for fully vaccinated travelers, the majority of public health and social measures including mandatory mask wearing still remain in place until a review of the accompanying legislation is conducted post the Winter period,” states Muzila in her report.