Dr Cleopa Mailu, Kenya’s Ambassador to the UN in Geneva and a former health minister, speaking at the WHO Executive Board meeting on Monday

Unless a future pandemic ‘instrument’ is properly financed and legally binding, it will not be able to prevent health emergencies, numerous member states told the World Health Organization’s (WHO) 150th executive board meeting on Monday.

Speaking on behalf of Africa’s 47 member states, Kenya’s Dr Cleopa Mailu said there should be a “radical disruption” of the WHO’s programme budget, calling on the board to “take bold steps” to adopt recommendations that will improve the WHO’s financing place it “on a more stable footing as the lead UN agency for coordinating global health”.

The WHO secretariat has requested an increase of $480 million for the emergency programme alone, he noted.

Speaking on behalf of the European Union, France agreed that sustainable financing needs to be at the heart of strengthening the WHO. 

“We cannot ignore the chronic underfunding of the organisation, something that hampers its ability to step up to member state expectations,” said France’s Professor Jerome Salomon.

France also called for the WHO to operate with “increased efficiency through streamlined governance, accountability, and an executive board that is committed to increasing transparency and swift decision making”. 

Even Japan, which has been resistant to an increase in member states’ contributions to the WHO, stated its commitment to “strengthening sustainable financing of WHO”.

However, Japan also called for a “simultaneous in-depth conversation between member states and WHO to further strengthen its financial discipline and transparency”.

Limited changes to International Health Regulations 

In the past, some countries and civil society organisations have stressed that it would be more effective to strengthen the International Health Regulations (IHR) rather than creating a new structure.

Russia appears to favour this approach, asserting that the IHR – the only global legally binding rules that govern countries’ responses to health emergencies – “must remain the cornerstone of preparedness and response to health emergencies”.

However, the EU believes that stronger IHR will complement a new pandemic instrument. It is supporting a US-sponsored  resolution to the board that calls for limited amendments to the IHR to address “specific and clearly identified issues, challenges, including equity, technological or other developments, or gaps that could not effectively be addressed otherwise but are critical to supporting effective implementation and compliance of the IHR”.

Meanwhile, Germany welcomed the proposal from the WHO Secretariat for a Universal Periodic Review mechanism to monitor IHR implementation and compliance, describing it as a “potential game-changer”.

Negotiating a pandemic ‘instrument’

Austria’s Dr Clemens Martin Auer

Negotiating such an international pandemic response instrument would not be easy or quick, but it was urgent and “indispensable”, Austria’s Dr Clemens Martin Auer told the board.

Austria stressed that this instrument – also called a pandemic treaty – should be “legally binding to have full impact”, and have ”strong mechanisms” to share information and technology, especially vaccines. 

But Auer stressed that, in creating such “a new global architecture, we should avoid any motion of further fragmenting the responsibilities and competencies.” 

“When it comes to deal with matters of health emergency, we don’t need additional structures, especially when we would lose inclusivity for all member states and transparency,” said Auer.

Late last year, a special session of the World Health Assembly resolved to set up an inter-governmental negotiating board (INB) to take forward these negotiations.

France’s Salomon, speaking for the EU,  said that a pandemic treaty would provide member states with a “a common roof” to organise multi-sectoral pandemic preparedness and response.

France added that the Dutch Director of International Affairs in the Ministry of Foreign Affairs would lead European negotiations at the INB. 

“The EU and its member states look forward to the establishment of the INB, and to its first meeting in February, and for the working draft to be developed and submitted before the second meeting this [European] summer,” said Salomon.

The US and Germany both supported the inclusion of civil society in pandemic instrument negotiations – something that is opposed by Russia and China.

Katherine O’Brien, WHO director of Vaccines, Immunizations and Biologicals at the Executive Board Technical Brief.

With the delivery of its one billionth dose last week, COVAX, the WHO co-sponsored vaccine facility, has established itself as the main pillar of vaccine supplies to the world’s 92 poorest economies – providing 82% of the vaccines those nations have received so far.  

But even as vaccine supplies now ease up, huge disparities persist in vaccine uptake rate among low-income countries – with some accelerating their vaccine drives and others stagnating due both to logistical and bureaucratic barriers and slack vaccine demand.  

And even while most of the focus had been put on vaccine delivery – equally large disparities exist in COVID testing capacity – with clusters of low capacity in parts of central Africa. And that increases the risks that new variants could emerge, under the radar, later spreading to the world.  

Those were among the main messages at a WHO technical briefing to the Executive Board, holding it’s 150th meeting this week in Geneva. 

More shipping in last ten weeks than in previous ten months 

COVAX’s one billionth vaccine dose delivery signals that months of  efforts to ramp up vaccine production, procurement and delivery are finally showing results on the ground. Over the past 10 weeks, more vaccines than in the previous 10 months combined, said Kate O’Brien, WHO’s Director of its Department of Immunization, Vaccines and Biologicals, at the briefing.

But multiple challenges are still hindering the effective rollout of vaccine doses globally, she pointed out.

Some 31 countries, including many in Africa and South East Asia, are showing upward trends in vaccination rates, while another 28 remain stable.  However another 20 countries in both regions are even showing declines in vaccination rates, including countries such as Algeria, Angola and Ethiopia. 

 

“Vaccine supply has substantially improved but challenges remain around short shelf life, doses, transparency from manufacturers on the timing, the variant vaccines and whether their prioritization will be offered to all countries, and the planning on donations,” O’Brien said. 

She added accelerating vaccine delivery capacity, combining intensified efforts and focusing on those left behind are crucial in turning vaccines into vaccination. 

With the unvaccinated still at high risk of falling seriously ill from COVID-19, as well as at risk of incubating more variants, she noted that vaccine demand and confidence are a limiting factor in the impact of vaccines worldwide in all countries. She therefore noted that boosting vaccine confidence remains at the heart of the COVAX roadmap and at the top of individual country’s priority lists. 

“The unvaccinated everywhere remain at highest risk. So vaccine demand and confidence are a limiting factor in the impact of vaccines worldwide in all countries,” O’Brien said.

She also called for an improvement in vaccine products which are presently unable to prevent infections, except for severe diseases.

“There is the need to improve vaccine products to enhance the impacts of the current vaccines. [They] are working especially against the severe end of the disease spectrum. These vaccines will reduce the risk (of severe illnesses) but don’t prevent all transmission or infections,” she added.

Inequity goes beyond vaccines

The staggering inequities in distribution are not limited to vaccines considering there are extraordinary differences across countries regarding COVID-19 testing rates, added Dr Bruce Aylward, Senior Advisor to the WHO Director-General Dr Tedros Adhanom Ghebreyesus.  While rates of vaccination in most of central Africa remain particularly low, so do test rates, he pointed out, citing recent data from accross the world. 

Vaccine rates per capita are lowest throughout central and south-central Africa (in red). Similarly, clusters of low COVID testing capacity persist in parts of the same African regions and Latin America.

“Without addressing these gaps, we cannot understand the pandemic, we cannot direct a treatment and we cannot exit the pandemic,” he said.

Despite its drawbacks, the joint donor-supported ACT-Accelerator initiative remains the only mechanism that is addressing those gaps in the global response to the COVID pandemic, Aylward stressed. Alongside the COVAX vaccine facility, the Act-A’s lesser known initiatives include arms for delivery COVID tests, treatments, and for strengthening health systems, including delivery of essential personal protective equipment (PPE) to health care workers.

“The ACT Accelerator is already making a difference. You can see the big numbers: a billion doses of vaccines, 200 million tests out, 140 Oxygen plants, half a billion dollars worth of PPEs out to countries,” Aylward said.

Act-Acclerator: summary of challenges and strategies to overcome them.

 

Going forward, he noted that the ACT-A is not only addressing inequity, it’s addressing issues of access in hard-to-reach conflict zones and corners of the world. 

“The accelerator is crucial to the goal of equitable access in exiting this pandemic. This highlights the crucial importance of the accelerator in getting tools to where they’re needed.”

Through the Global COVID-19 Access Tracker, it is also now possible to transparently track progress towards the global targets for access to COVID-19 vaccines, treatments, tests and delivering PPE, Aylward stressed.

US $20 billion is cost of exit ticket out of pandemic – but journey may not be direct

Aylward called upon donors to step up to the bat  in 2022, by responding to the new ACT-A ask for some US$ 20 billion – to fill the requirements of its new strategic plan, issued last autumn. That plans calls for resources to meet the WHO goal of 70% vaccine coverage – along with higher testing and treatment rates – and consistent access to tools like oxygen and healthworker PPE. 

Act-A strategic plan: a $20 billion pricetag

“That is the cost to exit the pandemic [and] that is less than the monthly cost of the pandemic and obviously the trillions of dollars that have gone into its management and consequences so far,” he added.

But success for the accelerator would also require the continued application of more pressure on vaccine manufacturers, Aylward said – restating a longstanding point that reliance on donations of vaccines and supplies from rich countries is unpredictable and inefficient.

The COVAX facility, crippled by the loss of AstraZeneca supplies from India last spring during the Delta wave, now has an increasingly rich array of vaccines in the pipeline – as long as history doesn’t repeat itself.

“We need your support with pressure on manufacturers, let’s be honest, to get access to the new antivirals and specific vaccines that every country in this room wants, to be able to exit the pandemic.”

Meanwhile, Mike J. Ryan, Executive Director of WHO’s Health Emergencies Programme, added that although the pandemic response plans are more robust today than a year ago, they need to remain flexible and adaptive to changing circumstances. 

“Remembering that there are real dangers with virus evolution, real dangers with the emergence of new variants, this may not be a direct A-to-B journey. We must always be ready to change and adjust our strategies to take account of the situation,” Ryan said.

Image Credits: Gavi , WHO/Act Accelerator .

WHO Director General Dr Tedros Adhanom Ghebreyesus addresses the opening of the 150th session of the WHO Executive Board Monday, 24 January

Even though the end is not yet in sight for the COVID pandemic, the world can end it as a global health emergency in 2022, says WHO DG at the opening of the 150th sesssion of the World Health Organization Executive Board.

While the world will be living with COVID for the foreseeable future, countries can end the acute phase of the pandemic this year, said WHO’s Director General Dr Tedros Adhanom Ghebreyesus Addressing the opening session of a week-long WHO Executive Board meeting in Geneva, the DG warned that the world will need to learn to manage the virus through a sustained and integrated approach to acute respiratory diseases –  which will also provide a platform for preparing for future pandemics.

“Learning to live with COVID cannot mean that we give this virus a free ride. It cannot mean that we accept almost 50,000 deaths a week from a preventable and treatable disease. It cannot mean that we accept an unacceptable burden on our health systems when everyday, exhausted health workers go once again to the frontline. It cannot mean that we ignore the consequences of long COVID which we don’t yet fully understand. It cannot mean that we gamble on a virus whose evolution we cannot control nor predict,” Tedros said.

He added that it is dangerous to assume that Omicron will be the last variant or that the world is in the end game for the pandemic while on the contrary, globally, the conditions are ideal for more variants to emerge.

And he appealed to WHO member states to agree on a fromulat to increase their regular, fixed payments to WHO according to a proposed 5-year scale-up plan, that would give the Agency a greater ability to plan and budget rationally, warning that, if the current funding model, dependent on voluntary contributions continues “WHO is being set up to fail.  A paradigm shift in world health that’s needed must be matched by a paradigm shift in funding.”

Germany now WHO’s largest donor – says US$ 20 billion needed for vaccines, tests and treatments in low-income countries

Svenja Schulze, German Minister for Economic Cooperation & Development

The WHO Director General spoke shortly after holding a joint press conference with Germany’s new Economic Cooperation and Development Minister, Svenja Schulze, where he told reporters that Germany was now WHO’s largest donor.

“As you all know, Germany has been an important friend and longstanding partner to WHO and in fact it is now WHO’s largest donor,” said Tedros Adhanom , speaking alongside Schulze who assumed her post in Germany’s new government elected late last year.

Traditionally the United States has been WHO’s largest financial backer, contributing about US$250 million a year in “voluntary contributions” alongside about about $115 million in regular “assessed contributions” – the paid by virtually all 194 member states, according to a fixed and scaled formula.  But that was outpaced by Germany, which was contributing to the tune of about $560 million a year as of the third quarter of 2021 – most of it in voluntary contrbutions.

But Germany has emerged as one of the strongest political backers of WHO over the course of the pandemic.  Last year, Germany opened a WHO Hub for Pandemic and Epidemic Intelligence in Berlin – to step up surveillance.

And it is also leading the charge for a deeper change in the Organization’s financing formulas. According to that proposal, fixed, “assessed contributions”  by WHO member states would gradually rise to 50% of WHO’s US$ 3.5 bilion-a-year budget to ensure more predicatable funding.  Germany, along with European and other African states have been pushing hard for a clear signal on the measure at this week’s EB, but that is unlikely in light of the continued resistance from several other rich and middle-income countries, including Japan, the United States, Argentina and Brazil. See related story here.

As WHO Executive Board Meets – Handful of Countries Stall Plans to Reform WHO Finance

In the pre-EB press conference, Schulze also said she’d use Germany’s new G-7 leadership role to ensure sufficient pandemic response funding was available to low-income countries in 2022 – noting that some US$ 20 billion would be needed from donors.

“We know that around $20 billion will be needed this year to supply the poorer countries with vaccines, tests, and therapeutics. The G7 will play an important role in that organization for the world. We will be pushing for the world’s bigger economies to contribute their fair share of that financing,” she said, adding that the world needs a “massively accelerated truly global vaccination campaign – along with stronger health systems overall.

But she admitted that Germany remains opposed to a proposed World Trade Organization waiver on COVID-related intellectual property, contending that voluntary licensing of available know-how is a better way to jump start more manufacturing efforts in low- and middle-income regions.

“We are convinced that patent protection encourages innovation; it led to the development of these vaccines,” she said, adding that the world, “will need further innovations in order to deal with the further variants of COVID, but also the many other diseases that we have in the world, where we will need vaccines.” 

Dangerous to assume Omicron will be the last variant or the end game

Executive Board 150 – The 34 members of WHO’s governing body and obserers meet in Geneva in a hybrid session.

Speaking later at the EB Opening, Tedros warned that while “there are different scenarios for how the pandemic could play out…. it’s dangerous to assume Omicron will be last variant or we are in the end game. On the contrary, globally conditions are ideal for more variants to emerge.

“To change the course of the pandemic, we must change the conditions that are driving it. We recognize that everyone is tired of this pandemic,” he added.

But even if the virus becomes endemic, the world can end the pandemic in 2022 – and reduce the risks of new variants emerging with more universal COVID vaccine coverage, and the deployment of other public health measures. 

“If countries use all of these strategies and tools in a comprehensive way, we can end the acute phase of the pandemic this year,” Tedros said.

“We can end COVID-19 As a global health emergency, and we can do it this year.” 

He restated the aim of vaccinating 70% of the eligible population of every country by mid-2022 – with a focus on the most at risk groups.  COVID mortality can be reduced by enshrining strong clinical management beginning with primary health care, and equitable access to diagnostics oxygen and new oral antiviral drugs at the point of care. 

Other essential elements include the need to further increase COVID testing and genetic sequencing of virus samples globally to track the virus closely – and monitor the emergence of new variants.  Identification of new variants early on will improve countries’ ability to calibrate the use of public health and social measures when needed – as happened in South Africa with the early identification of Omicron. 

But as the world enters what is now the third year of the pandemic, a renewed focus also needs to be placed on other long-neglected health services, he emphasized.

“It [also] means restoring and sustaining essential health services. And it means learning critical lessons and defining new solutions now, not waiting until the pandemic is over. We can only do these with engaged and empowered communities,” the WHO DG said.  

Progress despite COVID

An infant receiving the RTS,S malaria vaccine in Ghana in 2019. New malaria vaccines, which hold promise of significantly reducing childhood infections and severe malaria, are now being rolled out more widely in Africa.

Despite the strains on global health as a result of COVID-19, the WHO DG noted that several giant strides were still recorded on several health issues in different parts of the world.

 WHO issued a historic recommendation for widespread use of the world’s first malaria vaccine, which Tedros said could save tens of thousands of young lives each year. 

“China and El Salvador were certified by WHO as malaria free last year, and the Islamic Republic of Iran recorded three consecutive years of zero in cases of malaria,” he added, noting the continued progress against elimination of what remains the world’s most deadly parasitic disease. 

He added that eight countries achieved “90-90-90” percent targets for testing, treatment access and viral suppression of HIV by the end of 2020, while a further 20 countries are close. 

Moreover, a total of 15 countries have eliminated mother-to-child transmission of HIV and/or syphilis with Botswana in 2021 becoming the first high burden country in Africa to achieve Silverchair certification on the path to elimination of mother to child transmission of HIV.

Progress was also recorded in the global fight against hepatitis, neglected tropical diseases and eradication of wild polio, he pointed out.

Health is not a byproduct of development

The WHO DG noted that the COVID-19 pandemic has shown the world that health is not merely a byproduct of development nor an outcome of prosperous societies — or a footnote of history.

“It’s the heartbeat, the foundation, the essential ingredient without which no society can flourish,” the DG said.

Considering health is dependent upon the fullest cooperation of individuals and the states, WHO DG warned that the continuing inequitable pace of development in different countries, with respect to the promotion of health and control of disease, remains a common danger for everyone.

Beyond that, he underlined that reaching “the highest attainable standard of health is one of the fundamental human rights of every human being” – echoing the vision set out in the original WHO Constitution.

Rising Tensions with Ethiopia

The DG’s speech received a positive receiption from most WHO member states – but with the notable exception of Ethiopia.

Ethiopia’s EB representative took the floor in an attack on Tedros’ his statements about the health and humanitarian situation in the countriy’s blockaded Tigray region, saying that the WHO DG was “using his office to adance his personal political interests.”

But he was cut off by EB Board Chair Patrick Amoth of Kenya who said that he was out of order since the EB had decided to set aside a  “note verbale” on the allegations, which had earlier been submitted by Ethiopia to the board. Amoth declined to disclose the full contents of the note verbale, saying it was “complicated” and fraught with legal and political implications.  

There has been a rising chorus of Ethiopian government media and social media mudslinging against Tedros and other UN groups, recent accusations against the DG of misconduct.

That comes as WHO and DG Tedros protested the Ethiopian government’s months-long blockade of the rebel Tigray region – asking officials to permit entry to humanitarian aid for medicines and other basics like insulin.  In a recent press briefing, the DG noted that the current ban on the entry of international relief workers is unprecedented even in the annals of the world’s most bitter civil conflicts.

WHO Slams Ethiopia’s ‘Blockade’ on Health Relief to Tigray Region as ‘Catastrophic’ and ‘Unprecedented’ Even in Conflict Zones

The WHO stance and DG’s comments have been widely echoed by other UN and humanitarian groups, confirming the dire situation that has left hundreds of thousands of people on the verge of starvation, as well as unable to acces medical care. But the fact Tedros is Tigrayan, as well as the sole WHO candidate running for re-election to head the agency, have left him open to personal political attack, observers say.

European Union officials recently charged that the Ethiopian state-controlled media also have been circulating “Fake News” about European humanitarian aid efforts and the WHO.

At the EB in Geneva, Kenya’s Ambassador to the UN in Geneva, speaking on behalf of WHO’s African group, also gave Dr Tedros tacit backing, saying that WHO should remain focused on it’s main health mission.

“The African member states wish to underscore the importance of WHO maintaining focus on the needs of those most vulnerable through providing the required support to member states at the country level in pursuit of their national, global commitments and the SDGs,” said Dr Cleopa Mailu, who is also a former Kenyan Health Minister.

Dr Cleopa Mailu, Kenya, speaking at the WHO Executive Board meeting on Monday

–Elaine Fletcher Ruth contributed to this story. 

Image Credits: WHO.

People wear face masks to prevent the spread of coronavirus as they commute inside a metro station amid the COVID-19 pandemic.

Experts are divided on whether or not Omicron could offer a COVID-19 reprieve.

As the Omicron wave hits its peak in parts of the world, leaving more people infected than in any previous outbreak, some scientists believe that respite is on the way, while others argue another variant could emerge that will be even more infectious or deadly than Omicron.

In the more hopeful camp, scientists say that the accumulation of population immunity – including a high percentage who will have “hybrid immunity” from vaccination and infection – could slow the pandemic at least for a while, if not forever. These experts think that after Omicron, COVID-19 could be reclassified from an epidemic to an endemic disease – a regularly circulating respiratory virus like the flu.

“We have to evaluate the evolution of COVID from pandemic to an endemic illness,” Spanish Prime Minister Pedro Sanchez said last week in an interview with a local radio station that was widely reported by English-speaking media.

On Friday, America’s Dr Anthony Fauci predicted in a White House briefing that background immunity, updated booster shots and new therapies will mean that even if a new variant developed it would “not disrupt us as much as we would have been disrupted” – a sentiment shared by Pfizer CEO Albert Bourla, who told Israeli TV over the weekend that the world should return to “near-normal” within the next few months.

Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, in an interview with NBC's Today Show in mid February.
Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, in an interview with NBC’s Today Show in mid February.

Prof Stephen S. Morse, a professor of epidemiology at Columbia University Mailman School of Public Health, told Health Policy Watch that a pandemic reprieve after Omicron crashes is not only possible but “even seems likely.”

“Omicron has proved highly transmissible,” said Morse. “Its current progress suggests that almost everyone who is susceptible will be exposed fairly soon. At that point, there won’t be enough susceptible people left to keep the infection going.”

Infection is driven by infected people who come in contact with susceptible individuals, he explained. So, the number, or relative proportion of susceptible people is a key factor.

“Once susceptibles are reduced below a certain threshold, which depends mostly on how contagious the virus is, it’s much harder for the virus to find new people to infect, and the rate of infection slows down dramatically,” Morse explained. “This is the promised land of ‘herd immunity’ we often hear about.”

There are already four known endemic human coronaviruses, which surface around the same time as the flu each year, and “we don’t know what the initial introduction of a new human endemic coronavirus looked like, but I suspect it may have been similar to what we’re seeing now with SARS-CoV-2,” Morse said. “With its high transmissibility, Omicron could well be a step on the road to SARS-CoV-2 becoming another endemic coronavirus. Historically, that seems to be how these respiratory virus pandemics ‘end.’”

He said that although immunity to respiratory coronaviruses usually does not last exceptionally long, reinfection often causes only mild or even asymptomatic disease.

“Fingers cross, but there are no guarantees,” Morse said.

‘No law dictating a virus must become milder’

Others are less optimistic.

In a nine-part tweet, Antoine Flahault, director of Geneva’s Institute of Global Health, explained that “endemic refers to a disease that is constantly present in a certain area, irrespective of severity [and] future severity remains a big unknown.

“There is no law dictating that a virus must become milder over time,” he continued. “It is very hard to predict the evolution of virulence.”

“If there is one word every scientist and policy maker must embrace right now it is humility,” Dr Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) in Minnesota, told Health Policy Watch.

He said he agrees with the idea that the world could go three to five months after Omicron with limited activity like it did last spring after the big January surge. However, he recalled how just as the world started to declare victory, along came Delta and now Omicron.

This could happen again, he said.

“We could see another variant emerge that could evade the current vaccines and could be highly transmissible,” stressed Osterholm, “we just have to be prepared for that too.”

He said the world would be better off to put its money and efforts behind better vaccines and new treatments that could manage future pandemic waves.

CIDRAP is working on a research and development roadmap for better, more effective coronavirus vaccines, though in the meantime Osterholm said getting the world vaccinated with existing jabs plays a key role.

White House Coronavirus Response Coordinator Jeffrey Zients said during Friday’s briefing that fully vaccinated individuals are 16 times less likely to be hospitalized from COVID compared to those who are unvaccinated.

Moreover, according to Centers for Disease Control and Prevention Director Rochelle Walensky, protection against infection and hospitalization with the Omicron variant is highest for those who are up to date with their vaccination, meaning those who are boosted when they are eligible.

A study released Sunday by Israel’s Health Ministry claimed a fourth dose of the Pfizer vaccine for people over the age of 60 protects three times more against serious illness and about two times more against infection compared with people who had only three doses.

Israel's Health Ministry said Sunday that people over 60 who received a fourth shot were two times more protected against Omicron infection than people who received three doses of the Pfizer coronavirus vaccine.
Israel’s Health Ministry said Sunday that people over 60 who received a fourth shot were two times more protected against Omicron infection than people who received three doses of the Pfizer coronavirus vaccine.

But Osterhold stressed, “if we have to keep boosting, we are in trouble.”

Even in the US, where booster doses are readily available, only about a third of those who got two shots are willingly getting the extra jab.

‘Hope is not a strategy’

He said that developing a universal vaccine could take years, however, so in the meantime the focus should be therapeutics.

“We need to do much more in the way of developing a global system for very rapid testing and then making it very clear that these results are returned within hours to individuals and make drugs readily available to people at high risk for developing severe disease,” Osterholm said. “This is something we could do globally and that could occur very quickly – even within a few months.”

The World Health Organization has so far approved a handful of drugs for various stages of COVID-19 and has developed a roadmap for the evaluation and approval of several others. Merck’s oral COVID-19 antiviral medication molnupiravir, which has already been approved by the US Food and Drug Administration, has already signed agreements with 27 generic manufacturing companies to make the treatment readily available in 105 countries, including middle- and low-income countries, the Medicines Patent Pool said last week.

Pfizer’s Paxlovid, which is being widely administered in the US, has also proved to stop severe infection in around 90% of high-risk patients if administered within the first five days of diagnosis.

But in the meantime, Osterholm said, “hope is not a strategy.”

And even those who are hopeful must still be cautious, Morse added.

“We can’t afford to get complacent.”

Image Credits: Flickr: IMF Photo/Joaquin Sarmiento, NBC, Israeli Health Ministry.

WHO Executive Board discussions of the novel coronavirus on February 5, 2020 – the last full-scale, in-person meeting in Geneva headquarters, just after an  International Public Health Emergency was declared.

As the World Health Organization’s executive board meets this week, two major issues – reforming its finances and pandemic response – continue to defy easy consensus.  

A handful of powerful countries, including but not limited to the United States, remain hesitant over a plan to bolster the World Health Organization’s (WHO) finances by increasing member states’ fixed annual contributions – thus reducing is reliance on the whims of voluntary donations.

WHO Budget by type of contribution. “Assessed” contributions by member are only about 16-17% of the total budget – with most WHO operations supported by “voluntary contributions” from member states and other donors that can vary wildly from year to year

But US domestic politics, more than geopolitics, may be the bigger hitch for Washington in the negotiations, diplomatic sources in Geneva told Health Policy Watch, rebutting media reports that US hesitancy centres around fears that finance reform could somehow increase China’s influence in the organisation.

On the eve of a critical WHO governing board meeting in Geneva that begins Monday, the US is engaging “constructively” over the proposed move to scale up fixed annual contributions by member states so that they eventually account for half of the organisation’s funding needs, the sources said. 

But any US agreement to raise the WHO’s fixed contributions, however modest, would have to win Congressional approval at a precarious time when President Joe Biden’s Democratic majority is razor thin. 

(left) World Health Organization Headquarters in Geneva; White House in Washington, DC

“And it’s not just the United States; I wouldn’t flash out only the US,” that remains opposed to the funding reforms, one source, speaking on condition of anonymity, said.  

“The US is constructively engaging,” the source added, “But I think it’s mostly tricky for the US because they have a strict policy on assessed contributions, Congress, I think needs to provide the green light – and WHO does not have a great standing in the US general public opinion.

WHO executive board likely to punt on two hard decisions – finance reform and a framework for a pandemic accord

The WHO’s 34-member Executive Board, which meets twice a year, firstly to set the agenda for the World Health Assembly in May, and again after the WHA, appears likely to delay making a decision on two critical issues: the first on sustainable WHO finance and a second move to toughen the pandemic response.  

In light of the lack of consensus, typically required for member state decisions, the board will likely defer making any clear recommendations, leaving hard choices to be hashed out before the WHA, which brings together all 194 member states.  

Efforts to strengthen the WHO’s response to future pandemics also face an uphill battle.  Last week, China demanded the deletion of critical language that would support giving the WHO faster access to outbreak sites from a document that etches a way forward for negotiations over a new international pandemic accord.

At a special World Health Assembly session in November, WHO member states agreed to start negotiations on the new pandemic accord, which could take the shape of a convention or other multilateral legal instrument.  

But if key clauses about access to outbreak sites, pathogen sharing, and other aspects of pandemic preparedness and response, are watered down or deleted, the resulting international agreement, that will take several years to negotiate, could wind up diluted of real clout or meaning. 

Pandemic accord and finance scale-up: linchpins in bigger reform package

Colin McIff, co-chair of the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR)

The new pandemic accord, as well as a scale-up in assessed contributions are viewed as the lynchpins in a series of broader reforms to the WHO proposed by a number of recent external reviews of global pandemic response  – including an Independent Panel co-chaired by Helen Clark and Ellen Johnson-Sirleaf, former heads of New Zealand and Liberia respectively. 

In the wake of those scathing reviews, initiating negotiations on a pandemic accord and reforming WHO’s finance, became flagship causes for a large bloc of European and African member states, with the support of like-minded countries in Latin America and Asia. The reforms are seen by supporters as critical to maintaining WHO’s central role in global health guidance and decision-making, post pandemic. 

The US served as the co-chair of the Working Group on Pandemic Preparedness and Reform – with career health and human services diplomat Colin McIff reportedly playing a key role in swinging US administration support behind a proposal to negotiate a pandemic accord. 

But that left countries such as China in stark opposition to some key provisions of the draft framework that would strengthen multilateral responses and most specifically the rapid outbreak access clause.

Europe and African Union key leaders in reforming ‘fundamentally rotten’ finance structure 

Björn Kümmel, Germany’s deputy head of global health in the Ministry of Health, called WHO’s finance structure “fundamentally rotten”.

On finance, in contrast, proposed reforms that have received support, officially, from over 90 countries, led by Germany. German diplomat Björn Kümmel, head of the Sustainable Finance Working Group, described WHO’s current structure as “fundamentally rotten” at a public meeting in December, due to its excessive dependence on just a handful of rich countries and a few private donors.

Although opposition to the finance plan may be narrowing, a handful of influential nations, including the United States, Japan, Brazil and Argentina continue to resist.

“Russia apparently is now in favour of an AC (assessed contributions) increase, and India apparently,” one source said on the eve of the EB meeting. 

“But on the others, I think that hasn’t changed much. So, I just think there needs to be a further discussion, and we will have to see where there can be consensus or a middle ground.” 

Sources, however, downplayed recent reports that Chinese-US tensions may be guiding Washington’s considerations: “The influence of China or others, economically and politically, will not be decided in the WHO.

“And rather, if we are not putting UN agencies on a stable footing, with regards to independence and integrity, then we get a problem, I think, in the future.”

Assessed contributions paid by all 194 member states currently amount to only about 16-17 per cent of WHO’s annual budget – with the rest of the funding coming from so-called “voluntary contributions” by member states, with the United States the WHO’s leading donor followed by the Bill and Melinda Gates Foundation. 

Finance assessments would only increase gradually 

Top contributors to WHO’s Budget (2018)

According to the draft proposal that emerged from a WHO member state Working Group on Sustainable Finance, but failed to gain full consensus, the move to boost regular contributions to a 50% level would be made gradually  beginning in 2023-24 and scaling up to the full 50 per cent by the 2028-2029 fiscal year. 

For the US, in fact, the absolute amount of the assessed contribution would rise from about $115 million  in 2022-2023 to about $240 million by 2028-29.   That, however, is relatively negligible in light of the US voluntary contributions which were more than $300 million in 2019, according to the WHO finance dashboard – also suggesting that the obstacles are more political than financial. 

WHO’s budget is about US$ 3 billion a year, although the WHO has not updated its budget dashboard to display member state contributions for the 2021-2022 budget year.   

Some mid-size and middle-income countries like Argentina and Brazil, are also reportedly concerned over absorbing new assessments in light of the economic toll of the pandemic. 

At the same time, the investments required are small in comparison to the trillions of dollars lost to the pandemic. The increased allocations would amount to only about $600,000 a year for all 194 member states by 2028-29, observers say.  

“If you look at the actual proposal, many of the bigger jumps come at a later stage, I really hope there is not a crunch in 2028,” said one source. “It’s not about funding, it’s about the question of control…I guess the issue is a matter of principle… How much do you trust the WHO that they will do something sensible with the money?” 

China concerns

While European decision-makers also say they have, at times, shared US fears over expanding Chinese influence on the WHO “the greater fear is that of the WHO being incapable of doing its job in the next pandemic,” as one observer put it.   

Conversely, the Organization could likely function more independently and “do their job better – if they get more assessed funding and don’t have to run around to beg and shop around and hire temporary experts all of the time.”

From wild animal markets to DRC sexual abuse scandal: other topics on the agenda 

Wholesale markets in China and other parts of Asia traditionally sell wild animals captured or bred for food consumption – better regulation is considered key to presenting future escape of dangerous viruses into human populations.

This week’s EB meeting, which lasts through Saturday, will also consider over two dozen other issues in the WHO’s three strategic priority areas. Those are: health emergencies, universal health coverage, and “healthier populations”, which includes preventive health and climate and environment measures.

With respect to preventing future pandemics, the EB will also review new recommendations by the WHO, UN Environment Programme and the World Organization For Animal Health (OIE) – aimed at “ reducing public health risks associated with the sale of live wild animals of mammalian species in traditional food markets”.

Despite the unresolved debate over whether the SARS-CoV2 virus originated from a lab biosafety incident or in the food chain, there is widespread expert agreement about the huge  risks that wild animal breeding, slaughter, trafficking and sale in traditional markets pose generally in triggering future pathogen escapes from the wild, and pandemics. 

The executive board will also review a report on WHO’s implementation of recommendations by an independent commission that examined allegations of sexual exploitation and abuse during WHO’s deployment to the Democratic Republic of Congo between 2018 – 2020, along with broader recommendations on strengthening WHO’s policies with regards to the prevention of sexual abuse. 

The recommendations propose engaging an independent audit of WHO’s management of the issue, among other steps. News of the sex abuse scandal first came to light in 2020 as a result of a joint investigative report by the New Humanitarian and Thompson Reuters Foundation. 

In September 2021,  WHO-appointed independent commission issued findings confirming the sex abuse reports and recommending an overhaul of the Agency’s sex abuse prevention and education practices. 

Surveillance for Ebola Virus a the border between Democratic Republic of Congo and Uganda during the 2018-2020 outbreak.  Some 83 emergency responders,  including 21 WHO employees and consultants, likely abused dozens of Congolese women, obtaining sex in exchange for promises of jobs, a WHO inquiry found.

 Other issues on the agenda 

The EB also will consider the possibility of extending the lifespan of a Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, due to expire this year, as well as proposals for reform in the way civil society and other “non-state actors” engage with WHO, including at the EB and WHA debates. 

Finally, the governing body will review the terms of a revised contract fixing the WHO Director General’s salary at US$ 259,553 gross, plus a US$21,000 discretionary allowance for the period 2022-2027 – with an option to join the United Nations pension fund – or make his own pension arrangements. Director General Dr Tedros Adhanom Ghebreyesus is the sole candidate standing for the DG position, and thus is expected to be re-elected to another five-year term at the May 2022 WHA.

Image Credits: US Mission in Geneva / Eric Bridiers via Flickr, Elaine Fletcher , WHO/P. Virot; Obama Whitehouse Archives , WHO , Peter Griffin/Public Domain Pictures, WHO Afro, Matt Taylor.

Masked travelers in a metro in February 2021. Two years after the start of the pandemic, the war against COVID-19 is still not over.

As the WHO Executive Board resumes talks this week on a much-discussed Pandemic Accord, and other preparedness measures, three noted infectious disease experts chart a course for “eliminating” SARS-COV2 – warning that will take more sustained global coordination and determination than what has been seen so far.

At the outbreak of World War 1 in August 1914, enthusiastic patriots on both sides were assured it would be over by Christmas. At the declaration of the COVID-19 pandemic in January 2020, there was a general assumption that life would be back to normal by Easter. In neither case did events pan out that way. War-weariness and its modern equivalent, pandemic-weariness, have set in.

Each time there is a new wave of the pandemic, there is a strong desire to believe that if we can just get past this crisis, things will be better, the pandemic will come to an end and we can return to a normal life.

Those hopes have peaked again recently with predictions from some quarters of a “reprieve” after the peak of the Omicron crisis passes.

Reality check

A health worker wearing personal protective equipment (PPE) carries a patient suffering from the coronavirus disease (COVID-19) outside the casualty ward at Guru Teg Bahadur hospital, in New Delhi, India in April 2021, at the height of the Delta variant surge.

Unfortunately, as pointed out by Dr Anthony Fauci, Chief Medical Advisor to the US President, at the World Economic Forum on Tuesday, this optimism is not well-founded. Empirical evidence about the course of the pandemic and evolution of the SARS-CoV-2 virus show that this wish is not likely to become a reality.  It is time to look beyond the current crisis towards an endgame for this pandemic. We propose here a “vaccine plus” strategy that is based on three pillars – current and new tools, embracing the central importance of preventing airborne transmission and a major shift in attitude to equity.

There is a widespread view that extensive transmission of the currently dominant Omicron variant of SARS-CoV-2 will bring an end to the pandemic by harmlessly inducing herd immunity. This is unjustified and dangerous thinking. It does not provide a sound basis for immediate or long-term pandemic management.

Omicron and outcomes

Intubated Covid-19 patients in Brazil in June 2021. Omicron has fewer lower respiratory effects – but new variants may yet appear.

Although Omicron is less prone to cause pneumonitis (lung inflammation) and as a result has lower fatalities and number of people on ventilators, it causes severe consequences in some people – especially those who are vulnerable due to co-morbidities or other factors that impair the efficacy of vaccination, such as need for immunosuppressive therapy. With very high numbers of people contracting COVID-19, even relatively uncommon bad outcomes (death or permanent disability) will occur in large numbers, including in people without underlying health conditions. This is why, right now, hospital systems the world over are overwhelmed.

Immunity and reinfection

SARS-CoV2 under the microscope

Natural infection does lead a temporary immune response, including an immune response boost in those with pre-existing immunity due to vaccination or previous infection. This usually leads to recovery in the affected individual and eventually the end of the wave in the affected community. However, there have been four waves of COVID-19 over two years. Reinfection is known to occur and there is evidence that neither natural infection with SARS-CoV-2 nor vaccination leads to sustained protection against COVID-19. Hence, long-term protective herd immunity cannot be achieved by “letting it rip”. Over time the community will again become susceptible to the next wave.

There are two secondary issues here. Some infections, or vaccinations, such as measles, chickenpox, and polio, do induce long-lived immunity but others, like influenza, the common cold virus and SARS-CoV-2 do not.

With SARS-CoV-2, early evidence also suggests that the best vaccines seem to be more effective than natural infection alone at inducing an immune response and, of course, the vaccines induce that response with a hugely lower risk of adverse effects and death. 

Scientist conducting coronavirus vaccine research at the United States NIAID’s Vaccine Research Centre, Moderna’s original collaborator on the SARS-CoV-2 vaccine.

Moderna and Pfizer have indicated that their new Omicron-specific vaccines will be ready to present to regulators in March this year. The current rapid spread of Omicron may be due to immune evasion rather than any innate increase in transmissibility. If this is the case, then an Omicron-matched vaccine would have substantial impact. So, although widespread natural infection can induce an immune response, it will not produce sustained widespread protective immunity and does result in substantial harm. Vaccination is the only route to achieving herd immunity, and the pipeline is dynamic with many innovations to come.

Risk of COVID-19 variants

Massive numbers of people affected in non-immune populations, together with chronic infection in some immunosuppressed individuals, increase the risk of new variants emerging. Natural selection, the biological basis of evolution, means that variants that are “successful” will be even more transmissible than the current dominant strains. Whenever uncontrolled transmission is occurring somewhere in the world, new SARS-CoV-2 variants that can escape from existing immunity and cause a further global wave of COVID-19 disease will continue to arise across the world.

The only sustainable solution is to reduce the number of people getting COVID-19 and to do it everywhere. Even reducing the global burden by half would substantially reduce the likelihood of a new variant of concern appearing in a given time period.

Elimination of COVID-19

South Africa launched COVID-19 vaccination drives in schools in December 2021 as one response to the spread of the highly-infectious Omicron variant.

COVID-19 cannot be eradicated, but we can stop sustained community transmission. This status is known as “elimination”. In this situation outbreaks may still occur, but they do not become overwhelming. We have achieved this with measles.  We have no chance of even making progress toward this goal with COVID-19 without concerted and globally coordinated action. That action needs to achieve a low rate of transmission (R­eff < 1) simultaneously across the world.

We may not even have all the right tools just yet although some are on the way. Easy to administer tools (such as nasal sprays) as well as transmission blocking vaccines which are on the horizon and pan-coronavirus vaccines that are active against current and future variants and are currently in pre-clinical evaluation would greatly improve the feasibility of progress towards elimination. Many minds and skillsets will need to come together to consider the biology, epidemiology and technological solutions.

Equitable vaccination

COVID-19 vaccination, Democratic Republic of Congo

Clearly, the backbone of the response needs to be effective, equitable and acceptable vaccination regimens. Work will need to be done to optimise vaccine effectiveness and to overcome major barriers to distribution, including supply, cost and acceptance. It is worth noting that humanity lived with smallpox for centuries. Only a concerted global effort to vaccinate the world resulted in smallpox eradication and that took 20 years to achieve.

Some slippages in either the effectiveness of vaccination (such as the level of neutralising antibodies, population coverage due to refusal to accept the vaccine, etc) can probably be accommodated by implementation of additional measures to reduce airborne transmission. These measures include universal use of well-fitted N95 masks indoors and in close-contact outdoor environments, effective ventilation and filtration of indoor environments, and effective implementation of testing, tracing, isolation and quarantine (TTIQ) procedures using sophisticated AI-enabled tools. A tragic consequence of the sluggishness of national and international health authorities in accepting the singular importance of airborne transmission of the virus is that, two years into the pandemic, these simple and effective non-pharmaceutical interventions, and other actions to promote safe indoor air, still have not been universally adopted.

Global solidarity

We will need international cooperation at the highest level to design and implement this “vaccine plus” strategy, simultaneously, across the planet. Some global cooperation mechanisms exist, most notably the ACT-Accelerator. With a commitment to global elimination, we will need a quantum advance in supporting such a multi-lateral approach. Living with COVID-19 is not working.

A commitment to reducing numbers is our only way out. The longer we wait to shift gears and raise ourselves from our pandemic-weariness, the harder it will be. We need to look beyond the current wave. Rather than cross our fingers with a one-dimensional-vaccine only strategy, and a grossly inequitable one at that, we need to do the hard work to end the pandemic. The benefits of an elimination approach will come much quicker than people think; just halving COVID-19’s impact would change the world.

Guy Marks, Scientia Professor of Respiratory Medicine, University of New South Wales, the President of the International Union Against Tuberculosis and Lung Disease.

Brendan Crabb AC, Professor, University of Melbourne, is an infectious disease researcher, and Director/Chief Executive Officer of the Burnet Institute, which has played a major role in the COVID-19 pandemic, advising governments and advocating strongly for public health action. He is Chair of the Australian Global Health Alliance and the Pacific Friends of Global Health.

 

 

Raina MacIntyre is Professor of Global Biosecurity at The Kirby Institute, University of New South Wales.

 

Image Credits: Flickr: IMF Photo/Joaquin Sarmiento, Adnan Abidi/Flickr, Ninian Reid/Flickr, NIAID, Gauteng Department of Health, Gavi/2021/STARRY.

IDABAN, Nigeria – The decision of the World Health Organization (WHO) to drop its opposition for COVID-19 vaccination booster shots has raised concerns in Africa about the potential depletion of COVID-19 vaccine doses available to African countries. 

On Friday, Health Policy Watch reported WHO recommended the wider administration of a third shot of the Pfizer-BioNTech mRNA vaccine – as well as jabs for children age 5 and older.

In its statement, the global health body said it was recommending boosters for most adults because in the short-term, “a third dose (booster dose) may fully or partially restore vaccine effectiveness”.

WHO also stressed that its new recommendation came after updated projections that should ensure ample supplies for Africa through COVAX, the global vaccine facility and bilateral deals to accommodate low-income countries, even with widespread administration of boosters.

Along with sharply increased vaccine production by end 2021, the reduced severity of Omicron may also reduce vaccine purchases in high-income countries – further easing supply pressures, according to a report by the forecasting firm Airfinity on Friday.

However, Nigerian public health consultant, Ifeanyi Nsofor told Health Policy Watch the WHO’s new position still has provoked concerns about COVID-19 vaccination efforts in Africa after months of scarcity.

“I’m absolutely worried that the new prioritization for boosters is going to affect Africa’s vaccine shipments with everyone now going for boosters,” he said.

He added, however, that insofar as many low- and middle-income countries have already stockpiled vaccines for booster campaigns, then using the doses for boosters could also prevent wastage.

“Giving boosters in low- and middle-income countries (LMICs) makes sense because of the likelihood of vaccines expiring thereby preventing wastage. Beyond that, full vaccination is no longer two doses. It is now plus a booster dose. So, LMICs have to be in line with global practice,” he told Health Policy Watch.

Moreover, the global health body’s new position on boosters also provides a signal to low-income countries that can thus prime their health systems accordingly, with support from COVAX and donors – and that will help citizens avoid future discrimination, e.g. in international travel. 

More foot-dragging on boosters, he added, could have further put LMICs at a disadvantage because of the changing definition of ‘fully vaccinated’ in many high-income countries to mean three jabs – regardless of WHO’s positions.  “People from the global south could be denied entry to western countries because they have not been boosted,” he told Health Policy Watch. 

COVID cases, deaths drop in Africa

Dr Matshidiso Moeti, WHO Regional Director for Africa

Meanwhile, the WHO this week reported that both COVID cases and deaths are now in decline across the continent – effectively concluding Africa’s shortest upsurge yet, lasting just 56 days.

Addressing journalists on Thursday, Dr Matshidiso Moeti, WHO Regional Director for Africa said weekly COVID-19 cases in Africa have now dropped significantly and deaths dipped for the first time since the peak of the fourth pandemic wave that was propelled by the Omicron variant.

“Newly reported cases fell by 20% in the week to 16 January, while deaths dropped by 8%. The decrease in deaths is still small and further monitoring is needed, but if the trend continues the surge in deaths will also be the shortest reported so far during this pandemic,” Moeti told journalists.

In South Africa where the highest number of COVID-19 cases and deaths have been reported in Africa, and where the continent’s first sequence of the Omicron variant was reported, the country has now recorded a downward trend over the past four weeks. 

“Only North Africa reported an increase in cases over the past week, with a 55% spike. Cases fell across the rest of Africa, where, as of 16 January, there were 10.4 million cumulative COVID-19 cases and more than 233 000 deaths,” Moeti said.

Africa is yet to turn the tables on the pandemic

Regarding the severity of the Omicron variant, the data from Africa has shown that like elsewhere, the recent wave resulted in the lowest cumulative average case fatality ratio of the pandemic. The proportion of deaths to confirmed cases—to date in Africa stands at 0.68%, in comparison with the three previous waves during which the case fatality ratio was above 2.4%.

In spite of the comparatively more favorable outcomes for the continent regarding the Omicron variant, and the COVID-19 pandemic in general, Moeti urged prudence.  

“Impact has been moderate, and Africa is emerging with fewer deaths and lower hospitalizations. But the continent has yet to turn the tables on this pandemic,” she told journalists.

The slow pace of vaccine roll out on the continent continues to increase the chance of more virus mutations emerging, putting the continual effectiveness of available tools at risk.

“So long as the virus continues to circulate, further pandemic waves are inevitable. Africa must not only broaden vaccinations, but also gain increased and equitable access to critical COVID-19 therapeutics to save lives and effectively combat this pandemic,” she said.

Adequate testing kits available for Africa – Africa CDC 

Dr John Nkengasong, Director, Africa CDC

While the continent still has a wide gap in COVID-19 vaccination, the continent’s public health stakeholders told Health Policy Watch that the continent is not in short supply of antigen testing kits – a problem that has been seen recently in some rich countries as a result of the huge Omicron surge. 

Consequent shortages of PCR tests forced the UK government to revise aspects of its COVID-19 testing policy, pivoting to more rapid tests – a strategy adopted in many other countries as well. But the surging reliance on rapid tests then created bottle necks and shortages of rapid tests with both pharmacies and manufacturers running short of supplies.  In the United States, US President Biden finally intervened last week to buy a billion tests and distribute them freely to Americans, beginning on 19 January.   

On the contrary, Africa is not faced with such shortage, John Nkengasong, head of the Africa Centres for Disease Control and Prevention (Africa CDC) told Health Policy Watch.  

“For rapid antigen tests, we have not yet seen a situation on the continent where we have a shortage of those tests,” he told Health Policy Watch.

That is perhaps due to the fact that even before the Omicron wave, Africa had begun stockpiling the rapid COVID tests, which are less expensive and easier to administer, creating a robust supply chain. 

Dr Abdou Salam Gueye, Regional Emergency Director at the WHO Regional Office for Africa also told Health Policy Watch that the global health body is continually working with African countries to improve their testing plans.

“COVID-19 is the first pandemic of this magnitude in our lifetime and we are working with countries already in order to do the best to scale it up,” he said.

In 2022, Nkengasong said efforts will be geared towards expanding testing across the continent, in addition to helping countries to quickly rollout vaccines.

“There are three things that we will be emphasizing in 2022, scaling up testing, scaling up vaccination and making sure that we work hard to have access to new drugs for treating COVID-19,” he said.

Image Credits: Paul Adepoju , WHO AFRICA.

Katherine O’Brien, WHO head of Immunization, Vaccines and Biologicals

In a stark departure from months of booster opposition, WHO on Friday recommended the wider administration of a third shot of the Pfizer-BioNTech mRNA vaccine – as well as jabs for children age 5 and older. 

The recommendation comes after over 120 countries already have booster campaigns in full-swing, some of them beginning as early as July 2021. 

The statement was accompanied by a WHO acknowledgement that global vaccine supplies are now sufficient to permit booster campaigns alongside the delivery of sufficient primary doses to some 98 low-income countries, approximately one- half of those being in sub-Saharan Africa, and where 40% or less of eligible people have yet to receive even their first or second jab.  

WHO Director General ábsent from press briefing

Alejandro Cravioto, chairman of the WHO SAGE group of vaccine experts.

The WHO press conference where the announcement was made was striking for the absence of WHO Director General Dr Tedros Adhahom Ghebreyesus, who has been one of the biggest opponents of the booster campaigns- saying that such campaigns strike at the heart of vaccine equity. Nor were WHO Health Emergencies Executive Director Mike Ryan or Chief Scientist Soumya Swaminathan present. 

Rather, the key speakers at the event included the chairman of WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), Dr Alejandro Cravioto, and Katherine O’Brien, WHO’s head of the Department of Immunization, Vaccines and Biologicals. 

They acknowledged that mounting evidence of the mRNA Pfizer vaccines’ waning immunity – along with data showing sufficiently robust global vaccine supplies – now call for the policy change. 

Recommendations ‘Booster doses starting with highest priority groups’

Updated WHO Roadmap for vaccination coverage, by priority groups.

According to the newly revised WHO “Roadmap for prioritizing COVID-19 vaccines”, booster doses are now recommended by WHO for just about any adult when sufficient supplies are available, but “starting with the highest priority-use groups (e.g. older adults and health workers), 4 to 6 months after the completion of the primary series.”

Additionally, the experts endorsed vaccination of children down to 5 years of age, with a vaccine of reduced dosage (10 µg instead of 30 µg).  There was no booster recommendation, however, for children, unless they are immunocompromised.

The SAGE group said that they were limiting their advice about boosters to the Pfizer vaccines for now, as there is sufficient safety evidence from the approvals already granted by the US Food and Drug Administration and other regulatory bodies. But the experts will be poised to issue similar recommendations for other vaccine formulations, based on similar data about waning efficacy and the third dose’s safety.  

Sufficient global supplies now for boosters – providing vaccines are distributed equitably

WHO’s O’Brien said that new WHO analysis of production trends shows that even if “all countries chose to be giving booster doses quite broadly, our projection is that there would nevertheless be sufficient global supply” – to reach undervaccinated countries. 

But that remains conditioned on an assumption that global supplies this year will be “distributed in an equitable way – and that is the biggest task, assuring that supply is getting to the places where it is needed,” she added.  That, as compared to the vaccine hoarding seen last year, when some rich countries bought up 5-10 times as many doses as they had people to vaccinate. 

O’Brien still cautioned against “unfettered use” of boosters – stressing that under-vaccinated countries need to first prioritize getting primary vaccine doses to high-risk populations – and in countries with high-vaccination rates, older people, health worker and those more at risk should first be prioritized. 

“And I’ll just remind you, that we are still in a position where there are 34 countries that are below 10% coverage at this point”. And a larger number of countries, approximately 86 countries that are below 40% coverage. 

“Now that is as a result of the accumulation of the severe supply constraints 2021. And the relief of that supply constraint has really only been in the past two and a half months. 

“And so we do see a very positive outlook for supply but only if the continuation of sharing of doses continues. And if manufacturers continue to supply COVAX (the WHO-supported global vaccine facility) with the commitments that they have made – to abide with the commitments they have.” 

Fourth Dose – evidence ‘unsettled’

As for a fourth dose of vaccine, which is being administered in only a handful of countries, O’Brien said that “there is some evidence for use in immunocompromised people but so far there is no settled science about giving a subsequent booster to a broader group of people.

“We are fully aware of the data [on 4th dose] emerging from a limited number of countries, Israel,  in particular, that we’re following very carefully, but at this time, WHO has adopted a recommendation referencing a single booster dose,” she said.  See the related Health Policy Watch story: 

Health-Worker Risks of Catching Omicron Half as Likely after Fourth Dose – Second Israeli Study Challenges Earlier Results

Projections of sufficient global supply now – a WHO turnaround 

The remarks about sufficient global supplies available today run contrary to those aired by WHO Director General Tedros on 22 December, when Tedros warned that “blanket” booster campaigns could sap supplies from rollouts in low-income countries, saying that “only later in 2022 will supply be sufficient to extensive use of boosters in all adults.” At that time, WHO only recommended boosters for “high-risk groups”

Also in December, another senior WHO official warned that low-income countries could end up 3 billion doses short in the first quarter of 2022, if booster campaigns were “aggressively” administered in the 120 high and middle-income countries that were doing so. 

But that statement was anchored in an assumption that 90% of people in all high- and middle-income countries would get at least two shots, and 70%, including children, three.  

Those projections were swiftly challenged by pharma industry leader, Thomas Cueni, director general of the International Federation of Pharmaceutical manufacturers and Associations, who said they were “not based on valid data.”

WHO never elaborated on its supply projections then – despite repeated queries by Health Policy Watch. And it did not elaborate in Friday’s press briefing either.  

70% Vaccine coverage – high but is it attainable everywhere?    

O’Brien and other WHO experts also refrained from citing a figure for what they considered to be “high” vaccination coverage for the COVID jabs.  

But it is increasingly clear that even in many middle and higher income countries, reaching the 70% vaccination goal that WHO has cited as the global ambition for mid-2022 will be a considerable challenge – due to vaccine hesitancy among large parts of the population. 

For instance in the United States, only 63% of the population has been fully vaccinated. 

Admitted O’Brien, “very few countries have been able to get above 70% vaccine coverage” for COVID vaccines – noting that refers to 70% of all people who are eligible for vaccination. 

Added Joachim Hombach, WHO Executive Secretary to the SAGE, vaccine prioritization and absolute numbers of coverage in individual countries are also highly dependent on the age of people considered to be “older” and therefore at higher risk. For instance in some countries, people aged 60 years may be considered “older” and in others it may be 65 years.  

Added, Annelies Wilder-Smith, Technical Advisor to the SAGE COVID-19 Working Group: “Every country has a different population age factor. In some countries, the proportion of people above the age of 60 is only 5% and in others, it’s far more than 20%…. And many countries are struggling to reach the older age groups – especially lower to middle income countries that do not have a programmatic approach on how best to reach older age groups. 

She said that the new WHO vaccination prioritization road map, also provides links to training resources, tools and guidance – “to help those countries we reach the older age groups and the older age groups remain the highest priority.”

Image Credits: WHO 2022 .

Russia’s Sputnik V demonstrated more than two times higher virus neutralizing activity against the Omicron variant in comparison to the Pfizer coronavirus vaccine, according to a study of blood samples, released Thursday by the National Institute for Infectious Diseases Lazzaro Spallanzani in Italy and Russia’s Gamaleya Center.

The research was prepared by a team of 21 Russian and Italian scientists and published on the preprint health sciences website MedRxiv. It has not yet been peer-reviewed.

The study tested neutralizing antibodies performance against Omicron in 31 samples from people who had been twice vaccinated with Sputnik against 51 samples from people twice vaccinated with the Pfizer mRNA vaccine, over different points in time.

The study, if validated by a peer review, would contribute to some emerging claims that certain types of more “conventional” vaccines could in fact provide more durable protection over time  against a constantly mutating virus than the cutting edge mRNA versions – although this remains a point of emerging debate.

Sputnik V is a vaccine cocktail that combines two adenoviruses – human adenovirus serotype 26 and human adenovirus serotype five to deliver the gene for the SARS-CoV2 spoke protein into the body in a double-stranded DNA – as compared to the Pfizer which uses single-stranded messenger RNA.

It was the world’s first coronavirus vaccine to be approved by a national regulatory authority – Russia’s – for domestic use in August 2020, even before it completed large-scale clinical trials.  And it has since been sold in dozens of countries around the world.

But the vaccine has not yet been approved for use by the World Health Organization.

Study conducted at Rome’s Spallanzani Institute

The independent, comparative study specifically was conducted at the Spallanzani Institute on comparable sera samples from individuals vaccinated with Sputnik V and Pfizer and with a similar level of IgG antibodies, three months after vaccination.

It showed that two doses of Sputnik V provided 2.1 times higher geometric mean titers, or virus neutralizing antibodies to the Omicron variant, than two doses of the Pfizer vaccine.  As another measure, there was a significantly smaller reduction of virus neutralizing activity against Omicron, as compared to the original Wuhan variant, for the Sputnik vaccine, when compared to Pfizer.

Sputnik V vs. Omicron
Sputnik V vs. Pfizer’s performance against the Omicron variant

The study was the second one comparing Sputnik V and Omicron, to be produced in collaboration with Italian researchers, following another real-word study of nearly 19,000 people in November in the Republic of San Marino, a landlocked microstate in northern Italy, that declared Sputnik’s vaccine to be more effective in providing long-term protection than its mRNA counterparts – six to eight months after the second jab. But that study was shortly before the Omicron variant emerged.

mRNA vaccine protection against Omicron ‘only partial’

mRNA vaccines require ultra-cold storage which has been a drawback in their delivery and use in many developing countries, lacking appropriate refrigeration.

The release comes as an increasing pool of data is showing that Pfizer vaccine effectiveness wanes quickly – between three and six months – and that the vaccine, even when a fourth shot is administered, does not stop Omicron infection at anywhere near the levels of efficacy seen against the original Wuhan strain of the virus that first spread from China across the world in late 2019 and early 2020.

For instance, one American study among people 65 and older showed the decrease in mRNA vaccine effectiveness against the Delta variant accelerated after month four, reaching a low of approximately 20% in months five through seven. A similar Swedish report found that Pfizer’s vaccine efficacy fell below 30% against Delta after six months.

Regarding Omicron, the United Kingdom Health Security Agency said that those who had received three doses of Pfizer’s vaccine saw their protection against symptomatic illness caused by Omicron variant drop to 45% within 10 weeks. Moreover, new preliminary data released Monday in Israel suggested that even a fourth shot of the Pfizer vaccine is just not performing against the variant at levels seen previously.

“Despite a significant increase in antibodies after the fourth vaccine, this protection is only partially effective against the Omicron strain, which is relatively resistant to the vaccine,” Sheba Medical Center’s Prof Gili Regev-Yochay told a press briefing.  “We see many infected with Omicron who received the fourth dose,” the researcher added. “Granted, a bit less than in the control group, but still a lot of infections.”

Although a second study released Thursday suggested somewhat better performance of the fourth jab, the evidence remains tentative.

Sputnik V’s advantage: A heterologous prime-boost vaccination regimen, Russia says

Sputnik V costs about one-third of the mRNA vaccines, and can be stored in conventional refrigerators, making attractive in low-income settings.

Sputnik V’s advantage is the use of the spike protein without proline-stabilization and other modifications and the use of a heterologous prime-boost vaccination regimen, according to a release by the Russian and Italian research team.

“The Pfizer vaccine utilizes the spike protein in a proline-stabilized form in contrast to Sputnik V,” the release explained. “Proline-stabilization and other modifications may move an immune response predominantly to the actively mutating receptor-binding domain of spike protein. In the Omicron variant, a substantial number of mutations were registered precisely in RBD, which is why such a significant drop in neutralizing activity against this variant may be observed in the sera of Pfizer-vaccinated.”

When looking at the top quartile of individuals with high RBD-specific IgG antibodies, 100% of those vaccinated with Sputnik V were able to neutralize the Omicron variant in comparison to 83.3% of individuals vaccinated with Pfizer. Among all samples, the study showed, 74.2% of Sputnik V-vaccinated sera were able to neutralize Omicron compared to 56.9% for Pfizer-vaccinated.

100% of those vaccinated with Sputnik V were able to neutralize the Omicron variant
100% of those vaccinated with Sputnik V were able to neutralize the Omicron variant

‘The future of vaccines is about cocktails’ – or is it?

Already back in November, Russian Direct Investment Fund (RDIF), which pays for and partnered with the Gamaleya Center to produce Sputnik V, shared data suggesting that its vaccine still demonstrated 80% efficacy six to eight months after the second dose based on real-world data from the Health Ministry of the Republic of San Marino.

This research was also not peer reviewed.

Moreover, the RDIF has been pushing what they call “Sputnik Light,” a booster shot that it claims has shown a robust neutralizing antibody response to the SARS-CoV2 virus, including the Omicron variant, when given after an mRNA or other vaccine.

“We believe the future of vaccines is about cocktails. It’s about combining different vaccines to help prolong immunity,” RDIF CEO Kirill Dmitriev said in the November press briefing. “We are pro-boosters, but we believe the combination of vaccines should be explored much more.”

Kirill Dmitriev, CEO of the Russian Direct Investment Fund
Kirill Dmitriev, CEO of the Russian Direct Investment Fund

Assorted other studies, including ones conducted in Argentina, the United States and other places have also suggested that “boosting” a Pfizer vaccine with the single shot Sputnik Ad26-based vector vaccine (Sputnik Light) produces more durable protection against Omicron with four times higher increase in Omicron-specific T-cells and 2.4 times in neutralizing antibody titers vs Pfizer booster.”

The Argentinian study, first published on the pre-print server MedRxiv, has been accepted for publication in mBiom, while peer-review of the second study, which includes researchers from Harvard, MIT, University of North Carolina, and Boston’s Beth Israel Deaconess Medical Center, is still pending.

However at a press conference in Geneva on Friday,  a WHO vaccine expert cautioned that in fact, the evidence about mixing and matching vaccines does not suggest that a Sputnik Light boost of an mRNA vaccine would be superior to that of the mRNA vaccine boosters themselves.

Although people who were originally vaccinated with an adenovirus vector-based vaccine, such as Sputnik, might benefit from getting an mRNA booster, there is so far no evidence of an advantage of the reverse, said Joachim Hombach, WHO Executive Secretary to WHO SAGE expert vaccine group, during a WHO press briefing Friday. That is the essence of WHO guidance on vaccine mix-and-match released in December, 2021. However most of the data upon which this guidance is based pre-dates the Omicron wave.

WHO slow to approve Sputnik V

Sputnik V has been approved in 71 countries and Sputnik Light in more than 30, however, it has still not received Emergency Use Listing by WHO, which last year flagged a number of concerns with its manufacturing processes.

Earlier this week, on Wednesday, a report by the Russian website Tass said that a visit of WHO experts to Sputnik V manufacturing sites in the country is “pending approval.”

“They were to arrive within a month or two; this matter is on approval,” said Deputy Director of Russia’s Gamaleya Center Denis Logunov, according to Tass.

In addition, the Sputnik team has still not provided certain information that WHO requested to receive certification, Kremlin spokesperson Dmitry Peskov was quoted as telling reporters last month, “because we had a different understanding of what information it had to be and how it should be provided.”

WHO said it expects to receive the missing information sometime this month and will then reconsider approval.

Image Credits: Gamaleya Center , Flickr – Province of British Columbia, RDIF, Sputnikvaccine/Twitter.

Israeli couple receives fourth dose of COVID vaccine in Israel
Israeli couple receives fourth dose of COVID vaccine in Israel

In still evolving data, yet another Israeli study has found that health workers who received a fourth dose of a Pfizer mRNA vaccine were half as likely to contract Omicron seven days after receiving the shot in comparison to people who only got three doses.  The study released Thursday came less than one week after another major hospital research center cast doubt on the effectiveness of the extra jab after providing it to several hundred health workers in a controlled clinical trial.

The evolving data reflects some of the ongoing debate among experts the world over over the effectiveness of additional doses of the same vaccine against the current variant wave – something few countries and hospitals have tested so far outside of Israel.

Tel Aviv Sourasky Medical Center released data from its real-world study of 6,863 medical workers who were vaccinated with a third dose of the Pfizer coronavirus vaccine between August and December 2021 and had not previously been infected with corona, including 1,316 workers who received the fourth dose as of January 3, 2022. During this period, 608 workers tested positive – but only 42 of them were diagnosed with the virus seven days or more after receiving the fourth vaccine.

From the analysis of the data using a regression model, the hospital concluded that “the risk of contracting the virus is twice as low seven days after receiving the fourth dose.”

Tel Aviv Sourasky Medical Center reveals real-world results of fourth dose campaign
Tel Aviv Sourasky Medical Center reveals real-world results of fourth dose campaign, showing that medical workers who took the shot were half as likely to contract COVID after seven days.

However, Sourasky added in a press release, these results “must be interpreted with caution” due to the short follow-up period of just 15 days after innoculation.

Other trial tested both Pfizer & Moderna

Sourasky’s report comes only days after Sheba Medical Center at Tel Hashomer shared preliminary results of its Helsinki-approved fourth shot clinical trial, indicating that a fourth dose of Pfizer or Moderna does not provide enough of a boost to significantly protect against Omicron.

Prof Gili Regev-Yochay, who is leading Sheba’s research on the matter, told reporters on Monday that two weeks after receiving a fourth Pfizer vaccine and one week after receiving a fourth Moderna jab that “the increase in antibodies is nice” but not enough to stop infection.

Some 154 medical workers from Sheba are participating in a trial of the a fourth Pfizer vaccine and another 120 in the Moderna arm of the experiment.

Although Regev-Yochay would not share numbers, she said that only slightly fewer people who received the fourth dose caught coronavirus than those in a control group, who were fully vaccinated with two shots and a booster.

Majority of seriously ill or hospitalized people continue to be those who are unvaccinated at all

In all cases, the researchers have stressed that while Omicron might break through the vaccines more than previous strains, the vaccines continue to stop severe disease. Regev-Yochay said that none of the study participants who got Omicron developed a severe or life-threatening case and the majority of serious patients in Israeli hospitals continue to be unvaccinated or people vaccinated with only two shots more than six months ago.

Israel’s Health Ministry approved giving a fourth shot for immunocompromised people in late December and soon after expanded its decision to include people over the age of 60 and medical workers. So far, more than half-a-million citizens have taken the fourth dose.

A handful of other countries have also approved offering its citizens fourth doses, including Greece, Chile and Brazil, though no other countries have started full campaigns nor released research on the effectiveness of the protocol.

The World Health Organization has spoken out against fourth shots, saying earlier this month that “a vaccination strategy based on repeated booster doses of the original vaccine composition is “unlikely to be appropriate or sustainable.”

But WHO’s Chief Scientist Dr Soumya Swaminathan also has said that more studies are needed to understand the duration of protection in different population groups after vaccines and boosters.  And, rather than pursuing boosters or vaccines for each new variant, she has called for R&D into vaccines that can hit at all “beta-coronaviruses”.

And rather than develop more variant-specific vaccines, Swaminathan and other leading vaccine experts, such as Peter Hotez of Texas Children’s Hospital have said work should be focused on more broadly neutralizing beta coronavirus vaccine – hitting not only at SARS-CoV2 but other SARS or SARS-like viruses that are circulating in the wild and likely to emerge at a later date.

https://twitter.com/PeterHotez/status/1460596460026748938

Image Credits: Maccabi Health Services, Tel Aviv Sourasky Medical Center.