COVID-19 Cases Spike In Brazil As New Variant Spreads, While WHO Says No Need For ‘Vaccine Passport’ Yet Pandemics & Emergencies 15/01/2021 • Madeleine Hoecklin & Kerry Cullinan Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) WHO has said there is no need yet for countries to install a “vaccine passport” system for travellers. Meanwhile, a number of countries like the UK have blocked travel from Brazil following the identification of a new variant in the country. Many areas of Brazil, particularly Manaus, are experiencing worsening COVID-19 outbreaks and extremely high levels of infections, amidst news of a new variant that is spreading in the country. Brazil joins countries around the world – including those in Europe, the Americas, and some parts of Africa – that are seeing spikes in cases and the spread of numerous SARS-CoV2 variants – as the world surpassed two million deaths from COVID-19, reported World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus at a press conference on Friday. “This is because we’re collectively not succeeding at breaking the chains of transmission at the community level or within households. We need to close the gap between intent and implementation at the country and individual level,” Dr Tedros said. Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the press briefing on Friday. At the press conference, the WHO officials attempted to assuage concerns over the variants, instead highlighting the greater role played by increased social mixing, a breakdown in compliance with public health measures, and health systems already been weakened by previous infection waves. “A small proportion of [the rise in infections globally] may be due to the emergence of variants that are fitter, but the large proportion of that transmission has occurred because we are reducing our social physical distancing,” said Michael Ryan, Executive Director of WHO’s Health Emergencies Programme. “The virus is exploiting our lack of tactical commitment, our fatigue, the breaking down of our behaviour. “It’s too easy to just lay the blame on the variant and say it’s the virus that did it. Unfortunately it’s also what we did. And we have to be able to accept our share [of responsibility] as individually and as communities,” said Ryan. The variant identified in Brazil, with similarities to the highly infectious variants detected in Britain and South Africa, has led to the UK’s decision to ban the travel of individuals from several Latin American countries and Portugal, with other countries potentially following suit. Areas in Brazil with high caseloads are suspected to have “the worrisome B.1.1.28/P1 lineage. It has [several] mutations in the all-important spike; and moreover mutations in the spike’s critical binding domains,” said Eric Feigl-Ding, Senior Fellow at the Federation of American Scientists, on Twitter. “And most of all the worrisome E484K mutation that can evade antibodies.” Although several experts have raised the alarm about this particular variant due to its inclusion of the key mutations of interest – E484K and N501Y – Ryan claimed that attributing the blame for increased transmission fully on the variant is unreasonable. Mike Ryan, Executive Director of WHO Health Emergencies Programme. The WHO has recorded the deterioration of conditions in Brazil, especially in Manaus, the capital of the state of Amazonas, where hospitals are running out of PPE, beds, and oxygen. Over 4,000 new COVID-19 cases and 50 confirmed deaths have been reported per day in Manaus. The ICU has been operating at 100% capacity for the past two weeks, with 2,000 people hospitalized and 400 people with COVID-19 waiting to be hospitalized. “This is a health system under extreme pressure,” said Ryan. “If this continues, we’re going to see a wave that was greater than what was a catastrophic wave in April and May in Amazonas and particularly in Manaus, which is a tragedy in itself,” he added. “This is an unprecedented calamity,” said Jesem Orellana, a local epidemiologist, in an interview with the Guardian. “In the coming hours, Manaus is going to be the protagonist of one of the saddest chapters of the COVID-19 epidemic in the world.” The situation in Brazil is also due in part to widespread breakdowns in the health system. Mariângela Simão, WHO’s Assistant Director General of Access to Medicines and Health Products. She called on countries to learn from Brazil. “Don’t let a false sense of security bring your guard down. If you have built up infrastructure for ICU beds and oxygen distribution points…don’t shut it down because it’s not over yet. I think we need to learn from what’s happening – the terrible situation that Manaus is facing right now,” she said. WHO Setting Up Monitoring Framework To Evaluate SARS-CoV2 Variants of Concern Meanwhile, WHO is setting up a monitoring framework to evaluate the mutations of interest and the variants of concern to better understand what the mutations and variants mean and how they impact the behaviour of the virus. “We are in a race between the virus, which is going to continue trying to mutate in order to spread more easily, and humanity, which is trying to stop this spreading,” said Didier Houssin, chair of the WHO International Health Regulations Emergency Committee. The virus will continue to mutate and variants will continue to be reported, warned Maria Van Kerkhove, WHO COVID-19 technical lead. “There is pressure on this virus to change [and] the more it circulates, the more opportunities it has to change,” she said. This message has been highlighted by other experts. “The fact that we’ve observed 3 variants of concern emerge since September suggests that there are likely more to come,” warned Trevor Bedford, Associate Professor in Fred Hutch’s vaccine and infectious disease division. In addition, the simultaneous and independent evolution of the virus resulting in several common mutations is potentially a dangerous sign, as “converging evolution…[typically] means nature discovered repeatedly it works,” said Feigl-Ding. As the virus evolves and becomes better adapted to infecting humans, individuals, communities, and countries need to become more efficient at fighting the virus, stressed members of the press conference. “We still have tools that can break the chains of transmission. The interventions that have been outlined by WHO…work at breaking chains of transmission. Variants and the detection…and the emergence of variants makes it harder, but we still have some control over this virus,” said Van Kerkhove. Maria Van Kerkhove, WHO COVID-19 Technical Lead, at the press briefing on Friday. A study published by the US Centers for Disease Control and Prevention (CDC) on Friday – projecting that a SARS-CoV2 variant will become the dominant source of infection in the United States by March – echoed Van Kerkhove’s message. “Collectively, enhanced genomic surveillance combined with continued compliance with effective public health measures, including vaccination, physical distancing, use of masks, hand hygiene, and isolation and quarantine, will be essential to limiting the spread of SARS-CoV-2” and lessening the potential impact of the B.1.1.7 variant, said the authors of the study. Travelers Should Not Have To Provide a ‘Vaccine Passport’ At This Stage – WHO Emergency Committee Recommends In terms of travel policies, international travellers should not be required to provide proof of COVID-19 vaccinations for international travel at this stage because there are still “critical unknowns” about whether the vaccine can reduce transmission – and because vaccines are not widely available, WHO’s Emergency Committee recommended this week. However, this does not mean that requiring proof of vaccination from travellers “won’t be a good idea in the future,” said Ryan. “But at the moment, we are lacking critical evidence regarding whether or not persons who are vaccinated could continue to be infected, or continue to transmit disease, and because nobody in the world beyond health workers and very vulnerable people have access to the vaccine,” said Ryan. “The scientific evidence is not complete and there isn’t enough vaccine and therefore, we shouldn’t create an unnecessary restriction to travel until such time as we have the evidence and the vaccine is available.” . At the time, more coherent guidance about how people can safely travel “by air, by road [and] by sea” is needed, acknowledged Emergency Committee chairperson Didier Houssin, in reporting about the Committee’s meeting on Thursday. Didier Houssin, Chair of the WHO Emergency Committee. “One of the recommendations of the committee is that WHO takes a strong lead in order to produce a very clear guidance and scientifically-based guidance about how best to facilitate and permit the circulation of people in a safe manner,” said Houssin. Australian airline Qantas has announced that all international passengers will need to provide proof that they have had a COVID-19 vaccine in order to board its planes. ‘Have Hope’ That Vaccines are On the Way Meanwhile, Soumya Swaminathan, WHO’s Chief Scientist, appealed to those living in countries that have not yet gained access to vaccines to “have hope” that supplies will soon become available through the WHO-supported COVAX vaccine platform, which over 180 countries have joined. “We do have a guarantee of at least 2 billion doses at the moment [through COVAX], but perhaps a lot more than that by the end of 2021,” she added. Soumya Swaminathan, WHO Chief Scientist. The first vaccine doses to be acquired through the COVAX Facility – co-led by WHO, the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi, the Vaccine Alliance – will be distributed between 92 of the countries that have signed up at very low or no cost. “We anticipate that the first tranches of vaccines will start going out in the first quarter of this year, even though they may be in small volume. We also need to recognise that vaccines do need to go through the stages of testing and need to complete trials and have data on efficacy and safety, and they need to be manufactured in a quality assurance facility,” said Swaminathan. COVAX’s procurement plans include pre-orders of just one vaccine, by AstraZeneca and Oxford University, which has received regulatory approval in the USA and Europe. But others to which it has committed (Johnson & Johnson and GSK/Sanofi) have not yet submitted the results of Phase 3 trials to either WHO or a national regulatory agency for approval. “In an ideal world, we would not have the unequal access to the COVID-19 vaccine that we are currently seeing,” Simão conceded. WHO Director-General Dr Tedros Adhanom Ghebreyesus made an appeal for solidarity from wealthier countries, reminding them that when “AIDS drugs were first rolled out, they were only available in right in rich countries until a historic movement of health advocates and civil society led to the rollout of low-cost, generic versions of antiretroviral drugs. “We don’t want this to be repeated.” Image Credits: Wikimedia Commons: Nemo, WHO. 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