COVID-19: What’s driving Portugal’s high caseload, toll despite impressive vaccination rates?

Around 87% of Portugal’s population is fully vaccinated & over 65% received boosters 

By Taran Deol
Published: Tuesday 21 June 2022

Portugal is witnessing a downward trend in what its health ministry termed the sixth wave of COVID-19. During the surge in April and May 2022, the country recorded 19 per cent of all its infections and 6 per cent deaths since the beginning of the pandemic, according to an analysis of the tally from private aggregator Our World in Data.

The COVID-19 wave was perplexing for experts since the European country has one of the highest vaccination rates in the world and was termed a success story in 2020.  

The New York Times daily had reported in October 2021 that in Portugal “there is no one left to vaccinate”. Around 87.2 per cent of the population have completed the initial vaccination protocol, while 65.3 per cent have received the booster dose as well, according to Our World in Data.

As many as 114,410 infections and 256 deaths were recorded from June 7-13, according to the latest weekly epidemiological update. The figures have come down by 43,534 cases and 41 deaths as compared to the previous week, but are high nonetheless. 

So, what triggered the surge?

A section of experts have blamed BA.5, a sub-variant of omicron, since it is the dominant variant in the country, according to the European Centre for Disease Prevention and Control (ECDC). While vaccination rates are high, both BA.4 and BA.5 have proven their ability to evade immunity, whether it is derived naturally via infection or through inoculation. 

Moreover, pandemic restrictions have been lifted in the country with cases spiking more in tourist spots such as capital Lisbon, Porto and the Algarve region. In March, the World Health Organization (WHO) had termed removal of such restrictions as “too brutal”. 

Portugal also has a relatively older population, with a median age of 46.2 years. It is preceded by only three other countries — Japan (48.2 years), Italy (47.9) and Germany (46.6). 

But why the high death rate?

While WHO maintains that there is no change in severity with the sub-lineages of omicron, doubts emerge as Portugal’s death rate began increasing soon after the cases. “Severity indicators in Portugal (hospitalisation, ICU admissions and deaths) as of June 1 are below the levels reached in the previous omicron peak, however, week-on-week increases continue to be observed,” the ECDC noted in its June 13 update.

A quick glance at the daily COVID-19 deaths per million from Our World in Data confirmed this. On June 15, Portugal registered 3.63 deaths per million, significantly higher than Spain at 0.99, Germany at 0.81, the United Kingdom at 0.69 and France at 0.59. 

The country has the fifth highest mortality rate in the world, preceded by Oman (10.06 deaths per million), Taiwan (6.29), Aruba (4) and Saint Lucia (3.87). 

But experts are unable to figure out why deaths remain high. “The problem here is the impact on mortality, which is quite high, for a reason that is not completely known. Since the beginning of 2022, mortality has never dropped to significant levels,” Miguel Castanho, a researcher at the Institute of Molecular Medicine in Lisbon, was quoted as saying by Al Jazeera.

Currently, BA.5 has been declared dominant in two countries — Portugal and South Africa. 

The difference in how the pandemic is playing out is telling. While Portugal was hit by a deadly BA.5 wave, South Africa barely registered a blip on its caseload or death rate despite having completed the initial vaccination protocol of just 32 per cent of its total population. 

South Africa is a much younger country, with a median age of 27.3 years. Both countries saw huge omicron waves as well, but deaths increased in Portugal and remained under control in South Africa. 

Portugal’s failure in controlling the pandemic was documented last year as well, when in February 2021 it had the highest cases and death rates, surpassing both the United States and the United Kingdom. 

Resuming public activities, the emergence of the alpha variant and an understaffed healthcare system were blamed then. By then, the country was once again under lockdown. 

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