Driven by Omicron, Africa is facing a steep wave of new COVID infections – last week reporting the fourth highest number of cases ever recorded in a single week, said WHO Director General Dr Tedros Adhanom Ghebreyesus on Monday. 

He was speaking at an exclusive media briefing in Geneva behind closed doors to a handful of international media outlets with UN-accredited Geneva bureaus.

The rambling two-hour long briefing, released a day later on YouTube, excluded Geneva-based health media as well as most African, Asian, and Latin American media across the world – which the UN press office in Geneva does not recognise or credential. 

While some reporters linked up online, the in-person gathering with reporters hosted by the UN Office at Geneva occurred at a time when Switzerland is facing one of the highest infection rates in the world – and other mass gatherings in Switzerland, such as the World Economic Forum’s 2022 meeting in Davos, have recently been cancelled. 

“Africa is now facing a steep wave of infections, driven largely by the Omicron variant,” said the Director General in the briefing, shared only a day later with Geneva health media, as well as other national and regional media worldwide.  

“Just a month ago, Africa was reporting its lowest number of cases in 18 months. Last week, it reported the fourth-highest number of cases in a single week so far,” he said. In fact, while Africa’s rates remain low overall, due to what experts attribute to a complex range of factors include a younger population and widespread underreporting, new infection rates in southern countries like Botswana, Eswatini and South Africa have now soared to worrisome highs. Per capita reported new infections in those states, where Omicron was first discovered, are comparable to those in the most infection-wracked countries of Europe, including Switzerland and Germany. 

“There is now consistent evidence that Omicron is spreading significantly faster than the Delta variant,” said the DG, in a wide-ranging briefing with senior staff, which looked at the pace of Omicron spread, booster campaigns, and new vaccines under review or approval – as well as reviewing WHO’s record for the year 2021.

Given the fast pace of Omicron’s spread, the WHO Director General urged people preparing for the upcoming Christmas and New Years’ holidays to cancel or delay mass events and social gatherings, in order to slow the variant’s advance. 

“All of us are sick of this pandemic. All of us want to spend time with friends and family. All of us want to get back to normal,” the Director-General declared.  

But given Omicron’s unique ability to avoid previously acquired immunity, “it is more likely that people who have been vaccinated or have recovered from COVID-19 could be infected or reinfected,” he added. 

And faced with that reality, “there can be no doubt that increased social mixing over the holiday period in many countries will lead to increased cases, overwhelmed health systems and more deaths.  

“The fastest way to do that is for all of us – leaders and individuals – to make the difficult decisions that must be made to protect ourselves and others. 

“In some cases, that will mean canceling or delaying events – just as we have had to cancel the reception we planned to have with you today,” he said, referring to a social event that had been planned for the journalists who had gathered physically at WHO headquarters, following Monday’s briefing.  

“But an event canceled is better than a life canceled. It’s better to cancel now and celebrate later, than to celebrate now and grieve later,” he added.  

Walking back on opposition to boosters 

The Director General, as well as senior members of his team, also walked back some of their previous messaging opposing booster vaccines- admitting that there is growing evidence about their potential medical value – particularly for older people.  

“Clearly there is increasing evidence that those most vulnerable will benefit from an additional dose.  Yes, there is a role, but we want to ensure the right programme and vaccinate in the right order,” said Dr Bruce Aylward, WHO senior advisor. 

Aylward and other senior staff stressed that WHO remained opposed to mass booster campaigns on equity grounds – due to fears this will divert potential doses needed by  the more than 90 low-income countries which will miss the 40% vaccination coverage target set by WHO for the end of this year.  

“Remember what we are seeing in some places is not just a booster for those at highest risk but a booster for everyone in the population,” said Aylward. 

“And again, that would make a real demand on vaccines in an environment where they simply are not available to everyone who needs them at this time.”

However, Aylward later contradicted himself somewhat saying that in the first quarter of 2022:  “there will be enough vaccines to vaccinate 40% of the population of every country in the world, plus give a third dose to everybody over 50 years old. So we are very quickly getting into a situation where the production capacity is sufficient.

“The challenge is making sure the right products get  to the right places,.. optimising the allocations to get to where its needed .. to these countries that have been starved of vaccines for so long. everyone in high-income countries over the age of 50 as well as to distribute sufficient doses in low-income countries to meet the WHO 40% goals.”

Added Tedros, “There is new evidence emerging now of the benefits for elderly, over 65, so if it [booster] is going to be used, it’s better focusing on those groups. 

“But some countries are doing boosters very aggressively while their hospitals are filled with people who are not vaccinated. 

So the best would be for countries to convince those who are not vaccinated, convince them to be vaccinated and make sure that they are safe.  Their energy should be spent on finding the unprotected and protecting them.” 

He added: “Instead of boostering a child in high income countries, it’s better to vaccinate the elderly in counties who have not been vaccinated even with the primary vaccines. So the equity issue will also come into play.”  

Data on boosters’ impacts on global supplies lacks transparency

So far, WHO has not come up with detailed data around the likely impact of booster campaigns on global supplies for low- and middle-income countries – despite repeated requests by Health Policy Watch for more clarification of the data and its statements.  

An interview with one senior WHO official, published last week in the Financial Times, claimed that mass boosters in higher income countries could leave global supply chains 3 billion doses short of what is needed for developing regions in the first quarter of 2022.   

But those estimates are based on a presumption that 90% of people in high income countries would accept boosters – when in fact not even 70% have received their first and second jabs. 

Conversely, in a pharma-sponsored briefing last week, the data forecasting firm Airfinity claimed that boostering 70% of the population in G-7 countries would not significantly dent supplies needed by LMICs – since the world is now producing over 1.5 billion vaccines a month.  

That assessment, however, was based only on projected estimates of booster needs for seven of the world’s richest economies – and not the three dozen or so high- and upper-middle income countries that have already initiated booster campaigns. 

In response to yet another query by Health Policy Watch, Airfinity said it was trying to update its projections to include all G-20 countries – but had not yet completed the analysis as of the time of this publication.  

What is really needed, said Aylward in Monday’s briefing is more “transparency” that ensures manufacturers prioritize their deliveries of doses to the COVAX global vaccine facility – ahead of more deliveries to rich countries.

Aylward also warned about relying too much on vaccine dose donations, saying that while some 1 billion vaccine doses have been donated so far, only about 15% of those have actually been delivered.

“There is a danger that we create a perverse incentive if we keep encouraging donations,” he added, noting that donations come with many strings attached – including deliveries too close to their expiration date and a lack of choices for low-income countries about which vaccine to receive and when.  

How frequent boosters?

In terms of how frequently boosters might be needed in the future, and for what vaccines, “the fact is that we don’t know,” added  Dr Soumya Swaminathan, WHO Chief Scientist. 

She said that key driving factors include: “The biology of the individual, the age, how strong the immune system is. 

“There is some data now to show that there is a slippage due to the protection in different vaccines at six months or so. But with Omicron, the initial data is showing that it is very successfully able to evade immune responses and therefore needs higher levels of antibodies.  

“For now, we believe boosters may be needed for people who have weaker immune systems, the older individuals who are more vulnerable. 

“And whether there will be a need for additional vaccines every year, like influenza, it’s too early to say and we really need to follow the science on that.”  

Good news on new vaccines being rolled out  

Meanwhile,  the list of WHO-approved vaccines expanded once more on Tuesday with the Agency’s Emergency Use Listing of the European-made version of Novavax’s new Nuvaxovid™ vaccine. The WHO moved followed just after approval by the European Medicines Agency (EMA) earlier Tuesday. 

The new vaccine was developed by Novavax along with the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI), and is the originator product for the Covovax™ vaccine, produced by the Serum Institute of India, that had received WHO emergency use listing last week.

Both two-dose vaccines are made using the same technologies –  using an engineered baculovirus that delivers the gene of a modified SARS-CoV-2 spike protein into the body to provoke an immune response.  The technology, while novel, is more comparable to the traditional vaccines that deliver dead or inactivated viruses rather than to the mRNA models that deliver “instructions” to the body to produce an antibody response – without delivering any part of the virus itself.   

Significantly, the Novavax vaccines remain stable at 2 to 8 °C refrigerated temperatures – making them particularly relevant for vaccine campaigns in countries with poor cold chains.

The global COVAX vaccine facility has pre-purchased hundreds of millions of doses of the new two-dose vaccine, which is based upon has scored high marks in clinical trials. 

“This new vaccine is part of the COVAX portfolio, and we hope that it will play an important role in achieving our global vaccination targets,” said Tedros. 

Sputnik V – another review in early 2022

WHO officials at the briefing also said that the Agency’s long-delayed review of Russia’s Sputnik V vaccine would hopefully move ahead early next year, providing that the Russian-based Gamaleya Institute submits updated clinical trial data, by the end of this month.   

“Providing all information is available by the end of December, we will be able to perform GMP (Good Manufacturing Practice) inspections locally on Sputnik in February,” said Dr Rogerio Pinto de Sa Gaspar, who heads WHO’s “prequalification” activity.

Reported problems in some of the Sputnik vaccine facilities earlier this year stalled the approval processes for the vaccine, which has lagged well behind Chinese, Indian, European or American counterparts. 

In November, Sputnik’s developers have reported comparative results of its vaccine efficacy in Europe – but the studies have yet to be transformed into peer-reviewed papers. 

BREAKING: A unique 5-vaccine comparative nation-wide study of 3.7 million people in EU member Hungary shows that Sputnik offers best protection (98%) vs mortality from COVID. Also #SputnikV and Moderna lead other vaccines on efficacy vs COVID infection.
👇https://t.co/JmaVFwrnZ4 pic.twitter.com/SuuHjGnYOV

— Sputnik V (@sputnikvaccine) November 25, 2021

Image Credits: The Financial Times .