Mix-and-Match: Why We Need More Flexibility in COVID-19 Vaccination Protocols

Many countries, including Bolivia, have extremely rigid COVID-19 vaccination protocols. These were developed based on the original trial data for each vaccine. The first vaccine you get is pretty much randomly assigned to you, based on which one is available at the time and location, when your age group is eligible to receive it. This seems to work pretty well. However, the second shot must be from the same provider, and you should get it within a short window of time, as determined by the protocol; which can be a logistical challenge both for people and health systems.

In Bolivia, for example, we just received a big shipment of Sinopharm vaccines, but people are clamoring for their Sputnik-V second dose, which for many is due now, according to the first shot vaccination certificate they received. At this time, Bolivia has a stock of more than 1 million COVID-19 vaccine doses, but it is a huge challenge to get them to the right people, at the right place, at the right time, according to the protocols.

It could potentially speed up the global vaccination roll-out if we allowed people to get their second shot from a different provider, which is why many clinical trials are currently underway testing the effects of mixing vaccines. Below we will provide a short overview of the evidence to date.

 

Scientific Evidence on Mixing and Matching COVID-19 Vaccines

The mix-and-match strategy, formally known as “heterologous prime and boost”, makes theoretical sense as it stimulates the immune system in different ways. The strategy has been widely used for the administration of HIV vaccines, and has been shown to increase the intensity and breadth of immune responses. Experiments in mice using different combinations of Chinese COVID-19 vaccine candidates indicated that heterologous sequences stimulated stronger antibody and T-cell responses than when applying the same type of vaccine twice. An adenovirus vectored vaccine followed by an mRNA vaccine provided a particularly strong antibody response in this trial (1).

The CombiVacS trial carried out in Spain was the first to test and publish results on this mixing strategy in humans. They found that the adenovirus vectored AstraZeneca vaccine followed by the Pfizer-BioNTech mRNA vaccine showed a very strong immune response with no alarming side effects (2). A small study in Germany also found this sequence to be safe and at least as potent as the homologous vaccination regiments (3).

The much larger ongoing randomized controlled Com-COV trial led by the Oxford Vaccine Group in the UK just came out with their first mixed schedule immunogenicity results this week. They found that the heterologous sequences (AZ-Pfizer and Pfizer-AZ), with a 28-day interval between prime and boost, produce far more antibodies than two AZ doses with the same interval, but not as many as two Pfizer doses (4). They are continuing to test the results of longer prime-boost intervals, and have also added other vaccines into the mix, including those more accessible for poorer countries, and more results will be coming out over the next few months.

It is worth pointing out that Sputnik-V was actually designed as a heterologous prime and boost vaccine, exactly because that makes theoretical sense. It uses two different recombinant adenovirus carriers (Ad-24 for the first shot and Ad-5 for the second one) in order to avoid that the primed immune system eliminates the carrier too quickly during the second shot, thus interfering with the immune response. This has shown to be a very effective strategy, and the use of two different vectors can also help overcome problems of pre-existing adenovirus immunity in the population (5).

 

Vaccine Mixing in Other Countries

Several European countries (e.g. Germany, France, Sweden, Norway, and Denmark), are already recommending that people who received the AstraZeneca vaccine for their first shot, should receive another vaccine for the second one. That is mainly due to the concern over rare side-effects of the AstraZeneca vaccine, but now it also appears that the mixing strategy produces a better immune response.

Given how important vaccine mixing could be in speeding up the global vaccine roll-out, I hope authorities are paying close attention to the results of these mixing trials, and will update protocols accordingly. If more experiments are needed, I will happily volunteer to mix my first AstraZeneca shot with any other available COVID-19 vaccine.

 

Referencias

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009122/

[2] https://www.isciii.es/Noticias/Noticias/Paginas/Noticias/Presentaci%c3%b3n-resultados-preliminares-CombivacS.aspx

[3] https://www.medrxiv.org/content/10.1101/2021.05.30.21257971v1

[4] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3874014

[5] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00191-4/fulltext

 

* SDSN Bolivia.

The viewpoints expressed in the blog are the responsibility of the authors and do not reflect the position of their institutions.

Tourism as a Key Driver of Sustainable Development in Bolivia

Before the pandemic, tourism was one of the fastest growing industries in the world. According to the World Tourism Organization, in 2018 the number of international tourist arrivals worldwide reached 1.4 billion [1]. Likewise, 2018 was the seventh consecutive year where tourism exports growth (+ 4%) exceeded merchandise exports growth (+ 3%). Additionally, the travel and tourism industry accounted for 10.4% of the global GDP, and a similar share in employment in 2018, showing the industry’s vital role in the global economy.

 

Tourism in Bolivia

The numbers above show how promising this industry is globally. In the case of Bolivia, despite limited public investment, the outlook is even better. Graph 1 shows that the income generated by inbound tourism in Bolivia has increased at a rate greater than 10% annually between 2006 and 2019.

 

Graph 1: Spending by foreigner visitors in Bolivia, 2006 – 2019 (millions of dollars)

Source: Authors’ elaboration based on official data from the National Statistics Institute (INE) (https://www.ine.gob.bo/index.php/estadisticas-economicas/turismo/gasto-de-turismo-receptor-y-emisor-introduccion/). Note: Preliminary.

 

In 2019, international tourism was the fourth most important export product in the country, after natural gas, gold and zinc, and above soy and its derivatives (see Graph 2).

 

Graph 2: Inbound Tourism Income Compared to Top Ten Export Products, 2019 ($ million)

Source: Authors’ elaboration based on official data from the National Statistics Institute (INE) (http://web3.ine.gob.bo:8082/comex/make_table.jsp)

 

Graph 3 shows that the number of foreign visitors has increased from 529,601 in 2008 to 1,239,281 in 2019, which corresponds to an average annual growth rate of 8.0%.

 

Graph 3: Arrival of foreign visitors to Bolivia, 2008-2019 (number of people)

Source: Authors’ elaboration based on official data from the National Statistics Institute (INE) (https://www.ine.gob.bo/index.php/estadisticas-economicas/turismo/estadisticas-de-flujo-de-visitantes-introduccion/) Note: Preliminary

 

Combining the information from Graphs 1 and 3, we calculate that the average spending per foreign visitor rose only slightly from USD 656 to 676 between 2008 and 2019.

According to UDAPE, only 15% of the spending is on accommodation, while 63% is on services such as transportation, food and recreation. The remaining 22% is spent on goods such as souvenirs, handicrafts, clothing and/or gifts [2].

The hotel and gastronomic offers have increased dramatically in the last 10 years. In 2010 there were 5,209 formal companies registered at Fundempresa in the hotels, catering and tourism sector, yet currently this number has almost quadrupled, corresponding to an average annual growth rate of 14%.

The supply has grown faster in Pando and Tarija, but the greatest increase was in Santa Cruz, where 4,636 new companies were established in the area during the last 10 years (see Graph 4).

 

Graph 4: Number of companies registered in accommodation and food services activities, by department, 2010-2020

Source: Authors’ elaboration based on data from Fundempresa (https://fundempresa.org.bo/estadisticas/)

The investment of private actors in tourism has been carried out in a context in which Bolivia faces both advantages and disadvantages. Among the advantages, the latest Travel and Tourism Competitiveness Report [3] mentions that Bolivia is the country in the region that has improved the most in the Travel and Tourism Competitiveness Index (TTCI) between 2017 and 2019, rising in the ranking from position 99 to 90 out of 140 countries evaluated.

 

The areas where Bolivia has the most advantages are:

– Natural resources (# 27)

– Cultural resources and business travel (#50)

– Price competitiveness (#61)

 

On the other hand, Bolivia faces challenges in:

– Human resources and labor market (#114)

– Prioritization of travel & tourism (# 116)

– Ground and port infrastructure (# 127)

– Business environment (#139)

 

Tourism and the Sustainable Development Goals

The 2030 Agenda mentions tourism in several of the Sustainable Development Goals. In SDG 8 (Decent Work and Economic Growth), Target 8.9 seeks to “devise and implement policies to promote sustainable tourism that creates jobs and promotes local culture and products.” This target exists because the tourism sector is particularly dynamic and transversal, with multiplier effects on different areas such as: the food and beverage industry, textiles, jewelry, handicrafts, transportation, construction, entertainment, and communication. For this reason, it can become a great catalyst of development for local economies.

In Bolivia, tourism already generates more jobs than the mining and natural gas industries combined [4]. It not only generates a wide variety of jobs, compatible with many different types of skills, but it also tends to provide better working conditions than traditional sectors, such as mining or agriculture. Furthermore, in terms of SDG 5 (Achieve gender equality and empower all women and girls), the tourism sector has a lot of potential, since more than 70% of the population employed in tourism are women [4].

The geographical and cultural diversity of Bolivia create potential competitive advantages in the areas of eco-tourism as well as adventure, cultural, and culinary tourism. These types of tourism are characterized by low environmental impacts and well as attention to the well-being of local populations.

For all these reasons, tourism can become a key driver of sustainable development, contributing to economic growth, employment creation, gender equality, and improved living conditions of the local inhabitants through increased coverage of basic services, in addition to promoting environmental protection.

Although tourism is one of the sectors most adversely affected by COVID-19 across the world, the particular characteristics of the type of tourism activities that Bolivia offers (eco-tourism, adventure tourism, extreme sports, etc.) make a quick recovery more likely, as they involve mostly young people being outdoors in nature.

References

[1] World Tourism Organization (2019), International Tourism Highlights, 2019 Edition, UNWTO, Madrid, DOI: https://doi.org/10.18111/9789284421152

[2] Unidad de Análisis de Políticas Sociales y Económicas (2016), Tomo V Turismo. Diagnósticos Sectoriales. En: http://www.udape.gob.bo/portales_html/diagnosticos/diagnostico2018/documentos/TOMO-V-Turismo-10.07.18.html

[3] Calderwood, L. U., & Soshkin, M. (2019). The Travel & Tourism Competitiveness Report 2019. In World Economic Forum. Disponible en línea: http://www3.weforum.org/docs/WEF_TTCR_2019.pdf. Ver también página web interactiva: http://reports.weforum.org/travel-and-tourism-competitiveness-report-2019/rankings/?doing_wp_cron=1607099161.9970541000366210937500#series=TTCI

[4] AnálisisReal-Latinoamérica (2018) El Sistema Económico de los Sistemas Locales: el potencial de los 339 municipios de Bolivia. La Paz, Bolivia: AnálisisReal-Latinoamérica y Fundación Jubileo. Junio.

 

* SDSN Bolivia.

The viewpoints expressed in the blog are the responsibility of the authors and do not reflect the position of their institutions.

Learning from the Best and the Worst: Lessons from the First Six Months of the COVID-19 Pandemic

The SARS-CoV-2 virus is washing over the world in waves, with surprisingly different impacts. Some countries were hit incredibly hard, completely overwhelming health systems and catapulting COVID-19 to easily become the main cause of death (e.g. Peru, Bolivia and Ecuador). Other countries experienced widespread infection hardly noticed by the infected despite several structural disadvantages. For example, Tokyo, with the world’s oldest population and extremely high population densities, experienced very low COVID-19 mortality rates, as did slums in India, with extremely poor people without access to basic services and without any possibility of social distancing. Yet other countries managed to contain the virus through thorough testing, tracing and isolating the infected people.

With many countries now entering their second wave, and governments starting to panic at the prospect of the cool weather huddling people indoors where the virus spreads much more efficiently, it is important to learn as much as possible from the first wave.

A new working paper, recently published by the Institute for Advanced Development Studies in Bolivia, evaluates the impacts the pandemic’s first six months on deaths and on the quality of life, in 124 countries. Changes in quantity of life are measured as life years lost to COVID-19, including excess deaths not officially reported as COVID-19 deaths. Changes in quality of life are proxied by the average change in daily mobility, compared to a pre-COVID baseline. The paper finds a significantly negative correlation between the two, meaning that the countries with the largest reductions in mobility are also the countries with the highest number of years of life lost.

The results suggest that even the strictest lockdowns during many months, with no school, nor public transportation, social activities, and only absolutely essential work -with police and military in the streets to enforce restrictions- cannot prevent the spread of the virus. It therefore seems optimistic to believe that the half-hearted lockdowns currently implemented in some European countries will have any chance of significantly reducing infection rates.

The paper calculates the total loss of life years during the first six months of the pandemic at 15 million years, corresponding to 0.006% of all expected remaining life years in the world. For comparison, at least thrice as many life years are lost every six months due to children dying of diarrhea. About 28 million new years of life are created every day from babies being born, so, globally, in six months the pandemic set us back about 14 hours in terms of quantity of life.

The setbacks in terms of quality of life are several orders of magnitude larger. Some countries have suffered more than 50% reduction in mobility sustained over half a year, with many devastating effects on quality of life. Globally, the equivalent of 400 million full-time jobs were lost. GDP is estimated to have been set back about three years, poverty about five years, and the tourism industry about 20 years. The already large inequalities in access to quality education have been further widened, leaving hundreds of millions of disadvantaged children farther behind. Even countries that managed the pandemic relatively well are suffering large economic contractions due to the negative spillover effects from other countries.

COVID-19 is bad, but it is important not to make things even worse by imposing ineffective or counterproductive policies. Most countries missed the early opportunity of eradicating the virus, so their best options are to: i) slow the spread of the virus, so that it is manageable, and ii) reduce its lethality.

To slow the spread of the virus, the paper recommends cheap and sustainable behavioral changes, such as physical distancing, hand washing, mask wearing, good ventilation, avoiding crowds, meeting with as few different people as possible, working from home when possible, walking or cycling instead of using public transportation, reducing the amount of in-person classes in schools and universities, and of course staying at home when sick or potentially infected. Risks vary tremendously from person to person, from place to place, and over time, so it is best to let individuals decide, together with their family members, colleagues and friends, how strictly to apply these measures in any given situation. Every decision involves costs and benefits, and it is impossible for a central authority to make these very complicated calculations.

What to do about schools is a particularly challenging decision, however, as these community hubs integrate people with vastly different risks. Clearly, a variety of options should be available for students, but cancelling school altogether is a very bad decision, as it disproportionately and permanently harms disadvantaged children, and it doesn’t even save teachers. Bolivia cancelled the entire school year, and no teacher has been in contact with students since the beginning of the pandemic. Still, at least 10 times more teachers have died from COVID-19 in Bolivia, than in Sweden, where primary school education has continued without any modifications.

To reduce the lethality of the virus, the authors of the paper recommend that everybody maximizes their immune system, by a healthy diet, making sure they are not deficient in any crucial vitamins and minerals, getting daily exercise and fresh air, and avoiding stress, so that if or when they get exposed to the virus, the immune system can easily defeat it. Lockdowns have the exact opposite effect, especially on relatively disadvantaged people.

For more details, please download the full paper here.

* SDSN Bolivia.

The viewpoints expressed in the blog are the responsibility of the authors and do not reflect the position of their institutions.

Democracy Versus Health: 7 Suggestions for Safe Elections in Bolivia During a Pandemic

Por: Lykke E. Andersen, Ph.D.*

 

 

 

 

Bolivia is currently in a democratic limbo, without an elected president and with a politically, geographically and ethnically polarized society. An interim government was installed last November, which was put in charge of organizing democratic, fraud-free presidential elections as soon as possible. The General Election was first scheduled for March, then, due the COVID-19 pandemic it was postponed to May, and the current plan is September 6th 2020.

Nobody has been proven good at predicting the evolution of this pandemic, but given the current trends in Bolivia, it is obvious that there will be a high number of people infected with SARS-CoV-2 in Bolivia around September 6th, so carrying out elections is going to be a huge challenge.

In this blog, I hope to provide useful suggestions on how to organize election-day so as to minimize the risk of contagion, while maximizing peaceful, democratic participation.

 

  • Better outdoors than indoors

It is well-known that infection is much more likely to occur in closed, poorly ventilated spaces than outdoors, so voting tables should ideally be located outdoors on patios or soccer fields, shielded from the sun, but otherwise as open as possible.

 

  • Physical distancing, masks, and hand sanitizing

Soccer fields are ideal, as they provide plenty of space for physical distancing. Voters should maintain a 2-meter distance to other voters at all times, and wear a mask. They should be provided with alcohol or gel to sanitize their hands both before and after casting their vote.

 

  • The most vulnerable should vote first

Voting should be distributed as evenly as possible on the voting day, starting with the most vulnerable. An ideal schedule would look something like this:

 

Hour Voting Group
08:00 – 09:00 65 years or older (plus an accompanying person, if necessary)
09:00 – 10:00 Pregnant women, and women with children under 5 years of age
10:00 – 11:00 54 – 64 year-olds
11:00 – 12:00 46 – 53 year-olds
12:00 – 13:00 40 – 45 year-olds
13:00 – 14:00 34 – 39 year-olds
14:00 – 15:00 29 – 33 year-olds
15:00 – 16:00 25 – 28 year-olds
16:00 – 17:00 21 – 24 year-olds
17:00 – 18:00 18 – 20 year-olds

 

This schedule takes into account the age distribution of the voting population in Bolivia, and secures an approximately equal number of voters in each time slot. The exact age composition will differ from community to community, but it would be too complicated to have specific rules for each table.

Health personnel should be allowed to vote during any time slot, and their shifts should be organized so that they are off work at least part of the Election Day.

 

  • The pool of potential jurors should be restricted to young people under the age of 30

While risk to voters is minimal as long as they comply with the physical distancing, mask and hand sanitizing measures, the risk to the election jurors is significant, since they will be near hundreds of different people all day long. The risk would be similar to a supermarket worker or a bus driver, but Election Day is fortunately only one day, not every day.

Still, in order to minimize the risk of subsequent severe illness among election jurors, these should be the youngest and healthiest available. They should all be below the age of 30, and should be able to excuse themselves if they are pregnant or have young children, if they have any of the underlying medical conditions that are known to cause a more severe COVID-19 disease (obesity, diabetes, hypertension, cancer, asthma, etc.), or if they feel the least bit sick.

They should obviously be equipped with adequate protective equipment and cleaning supplies, and should be allowed to take various breaks during the day.

 

  • Strict lockdown during the two weeks before the election may be a good idea

Unless infection rates are already coming down rapidly due to the natural cause of the pandemic, a strict lockdown during the two weeks before the election may be a good idea. This would help secure as little virus circulation as possible during Election Day, and thus reduced risk.

 

  • Clear communication

The electoral authorities need a carefully thought-through communication strategy, with the three following main goals: i) secure that all voters understand when and how they will be casting their votes, ii) convincingly demonstrate that all necessary precautions are being taken to make voting safe, and iii) combat misinformation that could cause confusion among voters on Election Day.

 

  • Voting should not be mandatory during the pandemic

While voting is usually mandatory in Bolivia, this rule should be eased during the pandemic. Anybody who is sick should obviously stay at home to avoid spreading disease, and people who feel particularly vulnerable should not be forced to vote.

 

Participation is still expected to be high, though, since people are very much aware that every vote counts, and there seem to be few indifferent voters in Bolivia.

 

* SDSN Bolivia.

The viewpoints expressed in the blog are the responsibility of the authors and do not reflect the position of their institutions. 

Banning GM crops is a mistake

By: Joaquín Zenteno Hopp*.

Bolivian researcher, PhD candidate: “Responsible Innovation”.

Mohnsenteret, HVL Norway.

 

 

Confusion, misinformation, and heightened emotions are to be expected in any debate on society, science and technology. Genetically modified crops (referred to as GM crops or GMOs throughout the article) are no exception. Yet, what fascinates me is that while a staunchly anti-GMO stance is still in vogue among highly educated social circles concerned with ethical and environmental issues, the scientific community is in outcry arguing there is no reason for their ban. This is a curious phenomenon and in my opinion, a fantastic one to study.

Underscoring the complexity of this topic, I would like to share four important ideas. I do this based on my experience with academic and field studies of GM soy in several Latin American countries and in Norway. My main message is that the negative impacts associated with GMOs are not caused by GMOs themselves, but by external factors that influence the way GMOs are used by farmers and perceived by society. In this sense, I believe it is necessary to restate basic concepts of applied biology and agriculture, clarify the problem of chemical contamination, revalue critical voices, and conduct a systematized bibliographic review. Taking into account these four points, I consider that it is a mistake not to allow the use of GM crops in Bolivia. I hope that this article will clarify why.

 

Gene transfer, a key concept in applied biology 

It is understandable that there is resistance to biotechnological products that seem to trample on the natural order. This makes even more sense if one judges GMOs (Genetically Modified Organisms, also called transgenics) from religious perspectives or if one takes issue with the concept of reshaping the essence of life. But a close look at the molecular dynamics that occurs within a transgenic organism (when the cell’s genetic code is slightly modified) shows that there is no significant difference between a transgenic and a non-transgenic plant or animal. In other words, the transfer of genes between two cells without human interference (natural transfer) versus the transfer of a gene made in a lab (induced transfer) is technically the same. An objective assessment would describe the natural world as an open laboratory that constantly creates “new genetic mixes”. This is called “mutation” and it is the engine of evolution, a constant genetic experimentation that produces new forms of life that are better adapted to an adverse environment (Custers et al., 2019).

Of course the problem is that GM crops are human creations; creatures created in a lab. This generates, and rightly so, great skepticism. It is true that nature prefers genetic changes that take into account the contextual evolutionary and ecological history of a cell -but this is not the only natural way to bring about genetic changes. Gene transfer between cells in nature is primarily random and spontaneous and therefore more likely to have unforeseen effects than gene transfer in a lab. The changes made in a GM crop are minimal, highly controlled and also tested over several years. Therefore, GMOs are induced mutations that imply a statistically lower risk than natural mutations. This is of course a sweeping statement, so it is always important to carry out independent evaluations to determine the risk in each case. Nevertheless, the main idea is that GMOs are not alien products compared to their natural counterparts. It is therefore a mistake to speculate on possible risks GMOs might pose that are inherently different from those of any other natural being, plant or animal.

It should be stressed that there are other genetic techniques used for food production (such as induced mutagenesis by radiation) where the randomness of changes in genes is much greater than that which occurs in nature. This implies that the possibility of risk of causing undesirable ecological effects is relatively greater. Some of the best known techniques are mutagenesis, triploidization and cell fusion. However, the products of these techniques are not considered to be transgenic and there are no (or minimal) national or international restrictions on their use. This is because they are products (and techniques) that have been used for several years, sometimes decades, and their social acceptance is very broad – many of these products are even considered organic! Therefore, if the ecological risk of GMOs were considered high, most conventional and organic products would have to be regulated with equal or greater rigor than GMOs. Obviously this is not practical, logical, or necessary.

 

The problem of chemical contamination

Those who are aware of the environmental damage caused by the use of chemicals spread by the GM technology package (glyphosate) will be surprised that I promote their use. They would even tell me, with good reason, that the biggest problem is that the majority of GMOs are produced by corporations who seek, first and foremost, to satisfy their economic interests. I am also irritated; to say the least, that GMOs have been monopolized by a chemical-dependent industry that promotes monocultures. It is unpleasant to think of plants that are resistant to a chemical designed to kill everything else. It is even more provocative to state that the expansion of the agricultural frontier is intrinsically tied to the model propagated by GMOs. This is outrageous! But beware -here’s a topic that many misunderstand.

GMOs (and their related inputs) are the part of the package that comes with the expansion of the agricultural frontier, which happens for reasons external to the technology. The agricultural frontier advances because there is an avid and lucrative market for a given product (be it soybeans, corn, coca, palm oil among others) and therefore the advance occurs with or without GMOs. Furthermore, transgenic production is technically more efficient than conventional production and thus is a decision taken after production has begun. Therefore, the priority for avoiding deforestation and degradation of non-agricultural land should be focused on coherent and ethical policies for land use that preserve the advance of the agricultural frontier itself, and not on whether production is GM or not. This approach also applies to the widely held argument that GMOs take away space for the production of other foods that are more important for Bolivia’s food security. The type of food produced will depend more on how land use is delimited and the direct commercial incentive given to each crop. Moreover, the fact that GMOs allow for more efficient production reduces the amount of land required to produce an equivalent amount of a conventional crop. It is in this sense that the debate on the advance of the agricultural frontier, type of agricultural production and the preservation of biodiversity should focus on the generation of specific policies on land use, productive diversity and conservation areas. While the debate on whether or not to produce GMOs, should focus on first defining what type of technology is most beneficial for working land already allocated to producing cash crops.

In general terms, the switch from conventional to GM production means an average reduction in toxicity of 37% and a reduction in costs due to lower pesticide use of 39% (Klümper and Qaim, 2014). This means an increase in production of 22% per area. In this sense, every farmer can increase her or his profits by up to 68% on average. This occurs not only because it is possible to produce more, but also because there is a reduction in costs due to less use of chemicals, farm machinery and labor. For countries like Bolivia, where small farmers do most of the production, the net social benefit is significant -even taking into account the impact of job loss for day laborers. In addition, the use of GMOs compared to conventional production worldwide has meant a 14% reduction in carbon emissions (Mahaffey, Taheripour, and Tyner 2016). This is because  herbicide-resistant GMOs (mainly glyphosate)  help to reduce the need to prepare the land with tractors, which also benefits the quality of the soil by generating less compaction (Belgian Research Institute VIB, 2016).

Now, the damage caused by glyphosate is concerning (obviously, it is a plant poison), and therefore I understand that there is social resistance to this chemical -but there is one very important detail that must be understood. Glyphosate is less toxic when compared to chemicals that would substitute it were it is banned ([i]). In other words, banning glyphosate immediately and directly encourages the use of even more harmful herbicides. This is because, as I have already mentioned, industrial production of commercial crops (e.g. soybeans) takes place regardless of whether or not GMOs are permitted. The point is that many transgenics have the main function of decreasing the need for application of agrochemicals to which crops need to be exposed to manage pests, diseases and weeds. This is important to ensure a lower impact on the environment and the health of farmers, even when taking into account that glyphosate was classified as a possible carcinogen by the WHO in 2015 (along with many other everyday chemicals!). How ironic! Many of those who resist GMOs do so because they are concerned about the levels of toxicity in agriculture. Yet in the agricultural world, the main reason why a professional agronomist advises adopting the use of GMOs (in addition to the economic one)… is precisely to decrease the use of toxic chemicals!

It can be argued that the push should be to encourage a less chemical-dependent model of agricultural production altogether and that, therefore, the focus should be on limiting the use of any type of technology that depends on herbicides.  Moreover, an agricultural model that promotes monocultures should be avoided, as this is the greatest threat to the biodiversity of our land. This would certainly be very good, but how realistic is it to be able to produce the large amount of biomass (food, animal feed, cotton for clothes, or even wine) that the world market demands without the use of chemicals and without large-scale production? Very few professionals in the field would take such an illusion seriously. Ask a wine or avocado producer if he/she would be willing to abandon his monoculture and rotate crops to benefit biodiversity. But if we were to take the issue seriously, the discussion should focus on how to avoid the use of chemicals and monocultures in all types of production, not just in GM production.

 

The focus should be on regulating conventional production as this is where the greatest environmental impact is generated (The Royal Society, 2016). This is not only due to toxicity, but also because of soil compaction and CO2 generation. The technical benefits of GMOs are precisely that they represent a way to produce more on less land and at a lower environmental cost. In addition, it is important to note that there are several dozen GM crops designed for use without any type of chemicals. These are GM crops that could be considered “transgenic organic“: crops with genetic characteristics that allow them to fight diseases without the need for external agents such as virus-resistance papaya in Hawaii or insect-eggplant in Bangladesh and India. I personally believe that the path towards a more sustainable and responsible agricultural model could be made viable with the help of this technology. 

 

A revaluation of critical voices 

There are alarming reports that denounce negative effects of GMOs on health, the economy and the environment. For the Bolivian context, some of the best known studies compiling these facts include: McKay y Colque (2015), Catacora-Vargas (2007), Seralini (2012) and all the reports, presentations and websites made by Vía Campesina, Greenpeace and  Friends of the Earth. The most striking case is the well-known “Monsanto Tribunal”, an international civil society mobilization in 2016-2017 organized to force Monsanto to account for crimes against humanity and ecocide. Given this background, it is critical to listen to and study these allegations, and above all to understand why they occur and how they originate.

A first observation is that these published reports are coordinated and financed by organizations that represent groups who consider themselves adversely affected by GMOs. This is unsurprising, but also means these stakeholders work primarily in organizations whose priority is safeguarding human rights. Therefore, their professional competence tends to be within the human and/or social sciences. They view as part of their mission to denounce and be critical of widespread social inequality in rural areas, the over-empowerment of agricultural corporations, and the increasing loss of ancestral/cultural knowledge of artisanal or subsistence agriculture. This perception turns even stronger as GMOs are a tool strongly supported by large landowners and agro-industrial companies.

Stakeholders with large investment capital are the most determined to adopt a technology that has clear technical and economic benefits. Large agricultural companies with a wide network of contacts and greater access to scientific and agronomic information lead the adoption of new agricultural technologies in developing countries (Trigo et al., 2013). Thus, the use of GM crops becomes more frequent the larger the investment. Obviously, this is because it is a technology that creates greater benefits at a larger scale of production. This however, does not mean that GMOs do not benefit smallholder farmers (Quaim & Kouser, 2013). In this context, and taking into account Bolivian history, it is not surprising that the debate on GMOs will become one more chapter in the symbolic struggle between smallholder producers and large wealthy farmer owners.

Moreover, activist organizations tend to get involved after there are indications of possible negative effects on the environment caused by any given production system. This implies that the baseline for their studies is the prevailing agricultural model at the time of sampling. Therefore, their work consists of first documenting the observed impact and then tracing the origin of that impact. Although this is methodologically valid, it leads to the simplified conclusion that the original problem is the type of technology implemented at the time of sampling, disregarding what happened previously. This is evidenced by the Argentine experience, where reports of negative effects caused by glyphosate took hold several years after GMOs had taken over almost the entire production system (Zenteno et al, 2015). The importance of taking this into account is that, once again, the benefits of GMOs become evident only when they are compared with the effects of other production systems, and not if they are evaluated in isolation or without the proper contextualization.

Far from wanting to discredit these civil organizations (or Non-Government Organizations, NGOs), I believe the objective should be to use their experience and knowledge to impact Bolivian agriculture more efficiently and positively. Their skills are essential, and in fact, uniquely positioned to foster responsible agricultural management. Civil society organizations have a key role to play in monitoring the agro-industrial sector and serving as a watchdog, and to express concerns about risks related to new technologies and production systems. However, instead of criticizing GMOs per se, objections should be directed at questioning issues of corruption and   land trafficking, land use policies, industrial agricultural models that abuse agrochemicals (as doctors  and vets may abuse antibiotics in human and animal health), the tendency to propagate monocultures and its propensity to degrade soils. In my opinion, the real problem lies in how international markets encourage our farmers to produce cash crops at such an intense and unbridled rate. That is the root issue that must be corrected and where these organizations have the power to generate change.

 

The need for a systematized bibliographic review 

Research carried out by the world’s best universities, science academies, and government regulatory agencies with top scientific credentials have produced hundreds of studies and reports with one clear and consistent message: “there is no reason to ban GMOs”. One of the greatest efforts to determine possible risks associated with GMOs is complied in a report from the European Commission (2012), which after 25 years of research carried out by 130 independent scientific projects including more than 500 research groups from recognized European universities and regulatory agencies states that it finds no risk to health or the environment (Tagliabue, 2017). Thus, the scientific consensus arguing that GMOs do not represent any greater risk than other forms of production is 95% (Landrum, Hallman, y Jamieson 2019). Even more important to consider is the letter signed by 110 Nobel Prize winners in 2012 that states: “Scientific and regulatory agencies around the world have repeatedly and consistently found that crops and foods improved through biotechnology are safe, if not safer (Pacher-Zavisin 2016, p1.) Finally, it is worth reading the various FAO reports on this subject.

For non-specialized readers, distinguishing the quality of scientific studies in this area is obviously very difficult. It takes years and a high degree of specialized training to distinguish which studies are reliable and which are not. This becomes even more difficult in a reality of mass misinformation. In the well-known “Post truth era,” dis-informants may not only be government agents and agro-industrial companies, but also civil society organizations and other apparently impartial groups. There is an expected aggressive corporate agro-industrial lobby promoting GM production -so one needs to be careful. To believe otherwise would be naive. But by the same token, one must beware of an equally, if not more aggressive anti-GMO lobby, which has an efficient media machinery that is well-financed and organized by mainly environmental lobbies from European governments, environmental NGOs and the organic industry, ready to discredit GMOs. The irony here is that GMOs could be organic agriculture’s best ally, if it were not for its ideological aversion to it.

Over the years, the European Network of Scientists for Social and Environmental Responsibility (ENSSER) has led the way in the scientific production critical of GMOs. Another important organization is GenØk, a biosafety center in Norway known for its critical stance on GMOs and its active and interfering involvement in anti-GMO activities in developing countries like Brazil, Bolivia and Zambia. Its website reads: “GenØk works both nationally and internationally, and specifically aims to offer developing countries training and advice related to risk assessments of genetically modified organisms”. Far from having modest funding, these organizations receive generous support from key stakeholders and closely coordinate each other’s anti-GMO activities. GenØk is directly funded by the Norwegian government and supports activities relating to the precautionary and politicized Cartagena Protocol on Biosafety, part of the UN Convention of Biological Diversity.

Specifically, GenØk has directly influenced Brazil’s and Bolivia’s biosafety regulation and funds prolific anti-GMO soy activities. A GenØk member (of Bolivian nationality) became a senior advisor to the Bolivian Ministry of the Environment, directly reporting to the Environment Vice Minister during the administration of Evo Morales (2006-2019). This GenØk member, advised by Europe’s elite set of anti-GMO activists also represented our country in international fora and became a highly vocal and opinionated Focal Point and main spokesperson for the Bolivian delegations to the Meetings of the Parties (MOPs) of the Cartagena Protocol from 2008-2018 (MM Roca, personal communication 2020[ii]).

There are also several key industries that support the anti-GMO perspective. These are not only environmental lobbyists and stakeholders of organic agriculture, but also corporations such as pesticide producers that lose markets with GMO production given that is more efficient and thus cheaper than other agricultural production systems. It is also important to consider that large corporations that develop GM crops are not necessarily against anti-GMO lobby. This irony lies in the fact that the greater the restrictions to commercialize GMOs and the higher the costs and requirements of biosafety regulations are, the less competition there is from public and private universities, research centers and small biotech entrepreneurs. In other words, the anti-GMO movement indirectly promotes the pro-GMO corporate monopoly! This is serious because it limits non-commercial biotechnology development focused on humanitarian objectives (such as the golden rice) and negatively impacts agricultural production. This is especially true for developing countries who need to increase their agricultural yields by developing their own tools and/or adopting the best technology available to face climate change and the many other challenges of biomass production (food, feed, biomaterials, biofuels).

It is therefore necessary not to fall into politicized literature. In my personal experience, this effort has taken me several years and great frustrations, but I have learned several valuable lessons. The main one has been to distinguish that the few studies made by scientific entities used as a basis to discredit, vilify or ban GMOs, account to about 5% of the total published literature; they repeat the same issues and cite each other. Often they slip into ideological value judgments about corporations and their negative role in society, demand social justice and invoke a utopian rural past. A clear example is the document written by UCCSN-AL  (a Latin American version of the European Network of Scientists for Social and Environmental Responsibility (ENSSER) or by Greenpeace in response to the letter signed by the aforementioned Nobel Laureates. Another even more alarming example is that of Food & Water Watch, which contradicts that there is scientific consensus on the safety of GMOs with bibliographic references that state the opposite. This is important to take into account because as Nicolia et al. (2014), Perdue University or PennState University indicate: the scientific references in favor of GMOs include hundreds of reviews studies and meta-analysis (an analysis of many studies on the same subject) compiled under strict standards of independence and scientific rigor. What must change is the way in which this scientific information is communicated, since most of it is isolated from the public, written in highly technical language and not focused on highlighting key impacts.

 

It’s a mistake to be against GM crops 

Being against GMOs may seem logical and ethical because of specific values people hold relating to life and society, which flawlessly resonate with the type of message delivered by activist organizations that look to safeguard human rights and the environment. People generally trust these organizations, specially NGOs, and mistrust governments and big corporations, or even the use of new technology, so the message gets easily entrenched in the collective mindset of informed individuals (eg. educated and liberal), gullible people who get simplistic information from social media, or downtrodden and vulnerable rural society. It is true that these NGOs have providing a real and effective response to other socio-environmental problems such as climate change or plastic pollution, so their truthiness of their message is not doubted. Moreover, their expertise is precisely in communicating to strategic groups of society and creating a large political influence. This is not generally the case for agronomic associations or representatives of scientific institutions, which due to their specialty and training produce material for a type of public with very specific interests. This exacerbates as academics need to comply with certain “publishing rules” not needed in informal social media outlets. In my opinion, these are the main reasons why the anti-GMO vision and propaganda is still in vogue among social circles considered highly educated, liberal and concerned with ethical and environmental issues.

But banning GM crops is a mistake! I understand that the way the current government is trying to approve GMOs in Bolivia does not follow the procedures of popular debate and protocols that are recommended for these particular issues. There are many legal elements that must be addressed and resolved, especially regarding land trafficking, land use and inefficient and industrial agricultural production systems. Nevertheless, I believe that it would be a mistake not to support the approval that the government is enacting. The popular debate should rather be directed towards a long and comprehensive list of factors that impact agricultural production in Bolivia. They include, among others, better support for small farmers, agricultural laborers and rural communities: 1) Access to micro-finance for smallholders and agricultural loans or subsidies.  2) Agro-climate insurance.  3) Access to relevant scientific and technical information and any good technology including use of biological control and more rational  use of pesticides and fertilizers, improved seeds, access to  precision agriculture (such as use of artificial intelligence, robots, drones and sensors connected by the Internet of Things). 4) Improved infrastructure such as roads, ports, silos, processing plants, cold-chain.  5) Timely and efficient information about markets. Bolivia also needs better biosafety regulation, better policies for land use, better registration of tax payments and better control of black markets.

That is a much more sound recipe for supporting our Bolivian farmers! 

 

Works cited 

Belgian Research Institute VIB. 2016. «Effect of genetically modified crops on the environment». Fact Series. Rijvisschestraat 120, 9052 Gent, België Retrieved from: http://www.vib.be/en/news/Documents/vib_fact_genetisch%20gewijzigde%20gewassen_EN G_2016_LR.pdf

Catacora-Vargas, Georgina, Rosa Binimelis, Anne I. Myhr, y Brian Wynne. 2018. «SocioEconomic Research on Genetically Modified Crops: A Study of the Literature». Agriculture and Human Values 35 (2): 489-513

Custers René, Casacuberta Josep M., Eriksson Dennis, Sági László, Schiemann Joachim. 2019. Genetic Alterations That Do or Do Not Occur Naturally; Consequences for Genome Edited Organisms in the Context of Regulatory Oversight. Frontiers in Bioengineering and Biotechnology.

Eduardo Trigo Nicolás Mateo César Falconi. 20130 Innovación Agropecuaria en América Latina y el Caribe: Escenarios y Mecanismos Institucionales. Banco Interamericano de Desarrollo División de Medioambiente, Desarrollo Rural y Administración de Riesgos por Desastres.

European Commission. 2012. «Innovating for Sustainable Growth: A Bioeconomy for Europe». COM European Commission: Brussels, Belgium; p. 9.

Klümper, W and Qaim M. 2014. A Meta-Analysis of the Impacts of Genetically Modified Crops https://doi.org/10.1371/journal.pone.0111629

Landrum, Asheley R., William K. Hallman, y Kathleen Hall Jamieson. 2019. «Examining the Impact of Expert Voices: Communicating the Scientific Consensus on Genetically-modified Organisms». Environmental Communication 13 (1): 51-70. https://doi.org/10.1080/17524032.2018.1502201.

Mahaffey, Harry, Farzad Taheripour, y Wallace E. Tyner. 2016. «Evaluating the Economic and Environmental Impacts of a Global GMO Ban». AgEcon Search. 2016. https://doi.org/10.22004/ag.econ.235591.

McKay, B & Colque, G. 2016. Bolivia’s soy complex: the development of ‘productive exclusion’. The Journal of Peasant Studies. Volume 43. Issue 2: Soy Production in South America: Globalization and New Agroindustrial Landscapes.

Mesnage, R and Antoniou MN. 2017. Facts and Fallacies in the Debate on Glyphosate Toxicity. Front Public Health. 2017; 5: 316. doi: 10.3389/fpubh.2017.00316

Nicolia, Alessandro. Alberto Manzo. Fabio Veronesi and Daniele Rosellini. 2014. «An Overview of the Last 10 Years of Genetically Engineered Crop Safety Research». Critical Reviews in Biotechnology 34 (1): 77-88. https://doi.org/10.3109/07388551.2013.823595.

Pacher-Zavisin, Margit C. 2016. «Bio-bites!» Bioengineered 7 (6): 393-94. https://doi.org/10.1080/21655979.2016.1227206.

Quaim, Matin &  Kouser Shahzad, 2013. Geneticallly Modified Crops and Food Security. PLoS ONE 8(6): e64879 Available at https://doi.org/10.1371/journal.pone.0064879

Séralini, G.E. Clair, E.  Mesnage, R. Grss, S. Defarge, N.  Malatesta, M. Spiroux de Vendômois J. 2012. RETRACTED: Long term toxicity of a Roundup herbicide and a Roundup-tolerant genetically modified maize. Food and Chemical Toxicology. Volume 50, Issue 11, November 2012, Pages 4221-4231.

Tagliabue, Giovanni. 2016. «The EU legislation on “GMOs” between nonsense and protectionism: An ongoing Schumpeterian chain of public choices». GM Crops & Food 8 (1): 57-73. https://doi.org/10.1080/21645698.2016.1270488.

The Royal Society. 2016. GM plants: Questions and answers. Dirección: https://royalsociety.org/topics-policy/projects/gm-plants/

Zenteno, J; Hanche-Olsen, E; Sejenovich, H. (2014). Argentina: government-agribusiness elite dynamics and its consequences on environmental governance. In: Elite dynamics, the left tide and sustainable development. Environmental Politics in Latin America. Bull, B and Støen, CM (ed.). Earthscan Routledge Sustainable Development Series, UK.

[i] Although it is true that after some years there is a tendency for having to have a more intensive use of glyphosate in GMO crops, and even having to use other herbicides as complements, this is due to the resistance that any crop develops as a consequence of bad agricultural practices. This means that it also occurs with any other type of production where chemicals are used and good agricultural practices are not followed. Consequently, this is not a problem with glyphosate or from GMO crops, it is a problem of education. Despite that there are some studies affirming that the specific use of glyphosate has tended to generate higher resistance to herbicides, this is precisely because of its low toxicity (Mesnage y Antoniou, 2017). The use of glyphosate enables irresponsible farmers to keep with bad agricultural practices for further time than what it would have been possible with other herbicides. This is also a reason for which bees can be affected. A correct use of chemicals and land rotation does not generate chemical intensification and does not affect the ecosystem.

[ii] Personal interview PhD. Maria Mercedes Roca. Professor of Biotechnology, regulatory specialist. Executive Director, Consult MRS; Senior Fellow ISGP. Date of interview: June 2020.

* The views expressed in the blog are the responsibility of the author and do not necessarily reflect the position of SDSN Bolivia or his institution.

Índice Municipal de Vulnerabilidad al Cambio Climático

Por: Lykke E. Andersen* y Juan Carlos Ledezma**

En 2015, Conservación Internacional publicó el Atlas de Cambio Climático en Bolivia, el mismo incluye un análisis municipal de la vulnerabilidad al cambio climático, entendida como la vulnerabilidad al cambio respecto al balance hídrico, variable muy importante que podría derivar en el cambio de varias condiciones ambientales y sobre todo de la disponibilidad de servicios ecosistémicos. Asimismo, la capacidad de respuesta dada por las condiciones socio económicas de cada municipio, como sus condiciones ambientales, se tomaron en cuenta para definir el grado de vulnerabilidad que se tiene respecto a la potencial amenaza por mayor o menor disponibilidad futura de agua, todo ello según los escenarios futuros del clima de acuerdo con el Cuarto Reporte del Grupo Intergubernamental de Expertos sobre el Cambio Climático.

Utilizamos este análisis para desarrollar un Índice de Vulnerabilidad al Cambio Climático (IVCC), con el fin de incluirlo en el análisis del Objetivo de Desarrollo Sostenible N° 13 (Acción por el clima) en la próxima publicación de SDSN Bolivia: El Atlas Municipal de los ODS en Bolivia.

En este blog describimos la metodología aplicada para desarrollar el IVCC. De acuerdo al IPCC, la vulnerabilidad se define como una función de la exposición, la sensibilidad y la capacidad adaptativa. Para el Atlas de Cambio Climático en Bolivia se aplicó la siguiente fórmula:

 

 

Para el cálculo de cada uno de los 3 componentes de este índice se utilizaron distintas variables como indicadores cuantificables que proveen información sintetizada de la realidad, como se muestra en el Gráfico 1:

 

Gráfico 1: Indicadores que entran en los índices de exposición, sensibilidad y capacidad adaptativa, respectivamente

Fuente: Conservación Internacional – Bolivia (2015) Atlas de Cambio Climático Bolivia.

 

Uniendo toda esta información a nivel de píxeles, se creó el siguiente mapa de vulnerabilidad municipal al cambio climático para el escenario climático A2 (el escenario más fuerte).

 

Mapa 1: Mapa de vulnerabilidad municipal al cambio climático para el escenario climático A2.

Fuente: Conservación Internacional – Bolivia (2015) Atlas de Cambio Climático Bolivia.

 

Como se puede ver en el mapa, pueden existir diferencias en el nivel de vulnerabilidad dentro del mismo municipio. En este caso, para obtener un Índice de Vulnerabilidad al Cambio Climático (IVCC) único por municipio usamos la distribución porcentual de áreas de Alta, Moderada, Baja y Muy Baja vulnerabilidad dentro de cada municipio y lo multiplicamos con pesos según la siguiente fórmula:

El Gráfico 2 muestra el procedimiento para el caso del municipio Macharetí del departamento de Chuquisaca.

 

Gráfico 2: Cálculo del Índice Municipal de Vulnerabilidad al Cambio Climático para el caso de Macharetí.


Fuente: Elaboración de los autores en base a información de Conservación Internacional – Bolivia (2015) Atlas de Cambio Climático Bolivia.

 

Con este procedimiento llegamos a un Índice que va desde 0 (cuando todo el municipio tiene vulnerabilidad Muy Baja, como por ejemplo el municipio de La Paz) hasta 3 (cuando todo el municipio tiene vulnerabilidad Alta, como en el municipio Todos Santos en el departamento de Oruro). En general, la vulnerabilidad es mayor en el Altiplano y en el Chaco y menor en las ciudades capitales de departamento.

El IVCC es un indicador relevante para el Atlas Municipal de los ODS en Bolivia, y los municipios pueden reducir su nivel de vulnerabilidad durante la próxima década reduciendo varios factores de exposición y aumentando varios componentes de su capacidad de respuesta. Para reducir la exposición, es particularmente importante mantener/aumentar la cobertura boscosa y áreas naturales para absorber precipitaciones fuertes y almacenar la humedad en los suelos para así moderar los ciclos hidrológicos exagerados que vienen con el cambio climático. Para aumentar la capacidad de respuesta, la educación de la población y el nivel de gobernabilidad son factores clave.

 

Fuentes:

[1] Hijmans, R.J., Cameron, S.E., Parra, J.L., Jones, P.G., Jarvis, A., 2005. Very high resolution interpolated climate surfaces for global land areas. International Journal of Climatology, 25,1965-1978.

[2] Tabor, K. and J. W. Williams, 2010. Globally downscaled climate projections for assessing the conservation impacts of climate change. Ecological Applications 20, 554-565. http://futureclimates.conservation.org

[3] DiMiceli, C.M., M.L. Carroll, R.A. Sohlberg, C. Huang, M.C. Hansen, and J.R.G. Townshend. 2011. Annual Global Automated MODIS Vegetation Continuous Fields (MOD44B) at 250 m Spatial Resolution for Data Years Beginning Day 65, 2000–2010, Collection 5 Percent Tree Cover. University of Maryland, College Park, MD, USA.

[4] Farr, T. G., et al. 2007. The Shuttle Radar Topography Mission. Rev. Geophys. 45. RG2004.   doi:10.1029/2005RG000183.

[5] Ministerio de Desarrollo Rural y Tierras. 2012 Mapa de Amenaza de Inundación 2011 Atlas de Riesgo Agropecuario y Cambio Climático para la Seguridad Alimentaria. Unidad de Contingencia Rural.

[6] Instituto Nacional de Estadística. 2012. Censo de Población y Vivienda 2012

[7] Interpolación en base a INE 2012

[8] Nowicki C., Sommer H., A. Ley & P.L. Ibisch. 2004. Mapa de riqueza absoluta de especies. FAN. Santa Cruz. Bolivia.

[9] Servicio Nacional de Áreas Protegidas. 2005. Mapa de las áreas protegidas de Bolivia. La Paz. Bolivia.

[10] Instituto Nacional de Reforma Agraria. 2008. Mapa de Territorios Indígenas Titulados. La Paz. Bolivia.

[11] Ministerio de Autonomía. 2010. Índice de Gobernabilidad Municipal (2005 – 2009) Dirección General de Planificación. Observatorio Bolivia Democrática.

[12] Autoridad de Supervisión del Sistema Financiero. 2014. Puntos de Atención Financiera. Entidades Financieras.

[13] Conservación Internacional Bolivia. 2008.  Mapa de accesibilidad.  Base de datos geográfica. La Paz. Bolivia.

* SDSN Bolivia

** Conservación Internacional – Bolivia

 

Los puntos de vista expresados en este blog son responsabilidad de los autores y no necesariamente reflejan la posición de las instituciones. Estas publicaciones forman parte del proyecto “Atlas municipal de los ODS en Bolivia”, el cual está siendo desarrollado por la Red de Soluciones para el Desarrollo Sostenible (SDSN) en Bolivia.

Bolivia is Incredibly Heterogeneous – Let’s Take Advantage of That When Fighting COVID-19

By: Lykke E. Andersen, Ph.D.*

 

“The only way to avoid ‘groupthink’ and blind spots is to ensure representatives with diverse backgrounds and expertise are at the table when major decisions are made.”
Devi Sridhar, Chair of Global Health at the University of Edinburgh Medical School

 

Bolivia is an amazingly diverse and heterogeneous country in every way. Within a million square kilometers we find both steamy Amazon jungle, large modern cities, mosquito infested swamps, melting glaciers, huge salt flats, and picturesque cloud forests. Some people live pretty much as their ancestors did hundreds of years ago, while others enjoy all the luxuries of the most advanced countries. According to our upcoming Municipal Atlas of the SDGs in Bolivia, the differences between municipalities within Bolivia are larger than the differences between all the countries in the world in terms of the Sustainable Development Index (SDI). And as within countries, there are also large inequalities within each municipality in Bolivia.

In this blog, I will argue that we should take advantage of this heterogeneity to reduce the mortality rate of COVID-19 in Bolivia.

 

Good News of the Week

About a month ago, the World Health Organization (WHO) came out with a worrying statement saying that “there is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection” [1]. If this were true, it would be very bad news for the many countries, including Bolivia and its neighbors, that have failed at containing the virus, have no test-trace-and-quarantine capacity, and whose only option to get through this pandemic therefore is to achieve herd immunity.

The good news out of the Korean Center for Disease Control (KCDC) last week was that the 263 people in Korea who tested positive for the disease a second time after previously being declared recovered and virus-free, was not due to re-infection nor re-activation of the SARS-CoV-2 virus. Rather, it was due to the PCR tests picking up old, inactive, and harmless virus RNA still present in the body a couple of months after the original infection. According to KCDC, the process in which COVID-19 produces a new virus takes place only in the cytoplasm of the host cells and does not infiltrate the nucleus. This means it does not cause chronic infection or recurrence, unlike viruses like HIV [2].

Thus, it seems that the herd immunity strategy might be viable after all. Once 60-70% of the population has become immune, the virus will die out, as it becomes difficult for it to find new hosts in which to multiply. The question now is how to apply that strategy with the least number of deaths and collateral damage possible.

 

Optimizing the Herd Immunity Strategy

I previously estimated that we will likely “end up with an Infection Fatality Rate (IFR) of around 1% for Bolivia (meaning anywhere between 0.3% and 2%, given the still high uncertainty). If 60% of 11.6 million people get infected, and 1% of those die, we would end up with about 70 thousand COVID-19 deaths in Bolivia” [3]. While this is an awful lot of deaths, the 1% IFR is a realistic estimate considering the age distribution of the population, underlying health conditions, the quality of the health care system, typical housing and work conditions, in addition to the level of education and trust in the population. It looks like the most likely outcome if we let the virus burn slowly through the population (through appropriate physical distancing measures) in a random way until reaching herd immunity after 12-18 months, and if we don’t actively make things worse than they have to be.

However, the IFR can be lowered considerably if we take advantage of the fact that the population is not homogeneous. Some people have far lower risk of dying from COVID-19 than others, so if we could secure that the first 60% to get infected are the ones least likely to suffer severe complications, then we could potentially reduce the total number of deaths considerably.

In the rest of this blog I will outline the main dimensions to consider when optimizing the herd immunity strategy.

 

1. The Demographic Dimension

The evidence from all over the world shows unequivocally that the risk of death from COVID-19 is higher in older people. In Italy, for example, until May 18th, only 4 people under 20 years of age had died, while the number of deaths of people over the age of 50 was almost 30,000 (see Figure 1).

Figure 1: COVID-19 deaths in Italy as of May 18, 2020, by age group


Source:
Istituto Superiore di Sanità (via Statista 2020).

 

There is also overwhelming evidence that men are almost twice as likely to die from COVID-19 compared to women. Figure 2 shows the case fatality rates observed in Italy to date, disaggregated by age and gender.

 

Figure 2: COVID-19 death rates in Italy as of May 2020, by gender and age group


Note:
The case fatality rates in this figure do not reflect the real Infection Fatality Rates, as there are errors
in both the nominator (un-counted COVID-19 deaths) and denominator (un-identified COVID-19 cases).
However, the overall pattern by age and gender is likely to reflect the actual differences in IFRs by age and gender.
Source: Istituto Superiore di Sanità (via Statista 2020).

 

Given this pattern, and similar patterns from all other countries with age and gender disaggregated COVID-19 death statistics, we can make the following rough demographic risk classification:


If we apply this classification to the population pyramid of Bolivia, it looks as shown in Figure 3.

 

 Figure 3: Population Pyramid for Bolivia, with risk categories


Source:
Author´s elaboration based on data from PopulationPyramid.net 

 

Based on just these basic demographic factors, 77% of the Bolivian population is at Low Risk of dying if contracting COVID-19; 16% is at Medium Risk; and 7% is of High Risk.

But there are more risk dimensions to take into consideration.

2. The Geographic Dimension

While age and gender are important determinants of risk, there are factors in the surrounding community that can either amplify or moderate the risk for each individual.

  • It is safer to live in a disperse rural area where you interact with few different people, than to live in a dense urban area touching public surfaces that thousands of other people touch every day.
  • It is safer to live alone, rather than in a three-generation extended household.
  • It is safer to live in a place that is not simultaneously plagued by other health threats, such as Dengue, Malaria, Tuberculosis and HIV.
  • It is safer to live in an area where there are basic water and sanitation services available.

In last week’s blog we developed a Municipal Vulnerability Index to COVID-19 [4], and while it is a continuous indicator, we can roughly divide it into Low, Medium and High Risk municipalities, with some admittedly arbitrary cut-offs. If we consider all municipalities with a Vulnerability Index higher than 36.7 High Risk, and lower than 31.7 Low Risk, then we get a municipal risk list as shown in Figure 4.

 

Figure 4: Municipal level COVID-19 Vulnerability Index, with risk categories.


(Click here to see details)
Source: Between a Wall and a Nasty Virus [4].

 

This Vulnerability Index only considers structural variables, and not actual infection rates, which would also be important to consider, but these suffer daily changes, and due to the limited testing capacity, many cases go undetected.

 

3. Occupational Dimension

Even for people of the same age and gender, living in the same municipality, risk will vary substantially depending on the kind of activities each of them engages in. The risk will be extremely high if you work as a dentist, but extremely low if you collect Brazil nuts alone in the forest.

In general, solitary outdoor activities are much safer than working indoors with lots of different people cramped together. The highest risk occupations would be those where you must be very close to many different, potentially infected people every day, such as dentists, doctors, and nurses. If you work at, or frequent, indoor locations where people are singing, screaming or breathing heavily, such as night clubs, karaoke places, churches, and gyms, you are also at high risk, as the virus spreads very effectively in this kind of places.

 

4. Individual Risk Factors

Apart from all the above mentioned risk variations, there will be additional personal risks that can be either permanent or temporary. For example, anyone who suffers from high blood pressure, diabetes or asthma would automatically and permanently move to a higher risk category than the one suggested by their age, gender, location, and occupation.

Likewise, anybody who presents COVID-19-like symptoms, irrespective of their age, gender, location, and occupation, should immediately consider themselves at High Risk and take every precaution to protect themselves and others.

Individual risk factors should also take into account other people in the same household. One individual might be young and healthy, but if they live together with a High Risk person, their risk category increases, because their actions might carry risks not to themselves, but to their loved ones.

 

Central Planning is Unlikely to Work

From the analysis above it is obvious that risks vary by several orders of magnitude from place to place and from person to person. This makes centralized decisions extremely difficult, and uniform rules will likely be both inefficient and harmful.

The initial strict quarantine measures have served to educate people about the dangers of this virus and about the hand-washing and physical distancing measures that can help control contagion. But these strict measures are clearly not sustainable over the many months that this pandemic is likely to last [5], and it is time for a more nuanced approach.

 

Decentralization of Decisions and Responsibilities

If our goal is to reach herd immunity with the least number of deaths and collateral damage possible, then we need to decentralize decisions considerably. Each department, each municipality, each business, each school, and each family need to analyze their strengths and weaknesses in this new global context, and make a plan on how to get through the following 24 months with the slightest possible damage. Damage not only includes COVID-19 deaths, but also loss of education, income, freedom, agency, joy, and happiness; so everybody needs to engage in quite a holistic analysis, which is not easy. It will take patience, communication, collaboration, and many iterations.

The need for decentralization of decisions and responsibilities is even greater now that the central government is facing a precipitous decline in revenues from all sources (especially IDH, IVA, IT, IUE, ICE, and RC-IVA), and thus will have much fewer funds available for distribution to departments, municipalities, and individuals.

We need to recognize that there are no right answers. Nobody knows the best way to get through this, and there is no one-size-fits-all solution. Nobody knows what the world is going to look like on the other side. This is a good time to be flexible, think out-of-the-box, and try out new ways of learning, working, and living.

Learning quickly is more important than ever, and learning is only possible if we try different strategies and learn from their different results. The best way to do that is to let municipalities pursue different strategies and record results more or less in real time.

 

The Need for Timely, Geographically Disaggregated Data on Deaths from All Causes

Since we have extremely limited testing capacity all over the world, and especially in Bolivia, reported COVID-19 cases and deaths rarely reflect reality. It is more feasible and useful to simply register the total number of deaths (by age and gender) per week from all causes, and compare that to the expected number of deaths per week in each territory.

According to INE, we expected 66,760 deaths in Bolivia this year without the COVID-19 pandemic [6], corresponding to 1,284 deaths per week in the whole country. This data can be disaggregated to the department level by applying the departmental crude deaths rates calculated by INE to the population of each department (see Table 1).

 

Table 1: Expected weekly deaths, 2020, by department


Source: INE and https://www.covid19bo.com/

 

According to this data, Beni is the only department in Bolivia that has a serious COVID-19 outbreak at the moment, probably because it is particularly vulnerable to a COVID-19 outbreak (due to high levels of obesity, low coverage of water and sanitation, crowded housing, simultaneous Dengue, Malaria, Tuberculosis, and HIV outbreaks, and low local government capacity), as we showed in our blog a couple of weeks ago [4]. However, the real number of COVID-19 deaths is likely far higher, since only people with a positive COVID-19 tests are counted. The dedicated COVID-19 cemetery in Trinidad (Beni), for example, a few days ago held 148 deceased, of which only 57 were confirmed COVID-19 deaths, while 91 were suspected [7].

In the table above, there are question marks in the last column concerning the number of deaths from all causes. This information is currently not available from any government entity in Bolivia. My recommendation to the National Statistical Institute of Bolivia (INE) would be to quickly build up a system to record number of deaths in each municipality each week by age and gender.

Weekly, geographically disaggregated information on all deaths by age and gender is necessary to carefully monitor local outbreaks and take adequate precautions in the right places [8].. A fine-tuned, decentralized response to this pandemic, requires timely disaggregated data. It is well worth the effort to set up the information gathering and reporting system, as it can save tens of thousands of lives and avoid a lot of unnecessary economic costs and human suffering.

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Footnotes:

[1] https://time.com/5827450/who-coronavirus-antibodies-reinfection/

[2] http://m.koreaherald.com/view.php?ud=20200429000724. See John Campbell’s video for an easy-to-understand interpretation of the findings: https://www.youtube.com/watch?v=uATMbGK__Tg&t=1200s. See MedCram for a much more detailed, intracellular, explanation of the same thing: https://www.youtube.com/watch?v=01Rftnxbi6w.

[3] https://www.sdsnbolivia.org/en/english-forty-days-of-quarantine-what-have-we-learned/

[4] https://www.sdsnbolivia.org/en/entre-la-pared-y-un-terrible-virus/

https://live.worldbank.org/coronavirus-impact-pandemic-women-and-girls?cid=ecr_fb_worldbank_en_EXTP&fbclid=IwAR0chR9dC6VBVWSzd1M0qkZWKTg0yYjghbeKR1vYKh0aFabdT7o_SIN4GaA

[5] The World is still in the very early phases of this pandemic, with even hard-hit countries still having a long way to go before reaching herd immunity.  By early May, it was estimated that Belgium was the country closest to herd immunity, with 6.4% of the population having been infected, while in other European countries the immune population is still less than 5%. In certain hot-spots, like Madrid, the rate is much higher, but still nowhere near immunity (https://www.ft.com/content/f7d08906-b5c5-4210-b2c6-0ec95d533bc6).

[6] https://www.ine.gob.bo/index.php/censos-y-proyecciones-de-poblacion-sociales/#

[7] This page by Our World In Data provides a collection of sites monitoring excess mortality (https://ourworldindata.org/excess-mortality-covid). The Economist, Financial Times, the New York Times and EUROMOMO all provide excellent examples of how this data can be presented in user-friendly ways.

* SDSN Bolivia.

The viewpoints expressed in the blog are the responsibility of the authors and do not reflect the position of their institutions. These posts are part of the project “Municipal Atlas of the SDGs in Bolivia” that is currently carried out by the Sustainable Development Solutions Network (SDSN) in Bolivia.