protest fine
Tens of thousands of people protested against COVID-19 vaccine passes across France

France’s newest measure to tackle COVID-19 – requiring a certificate of vaccination at public places such as restaurants, cafes, cinemas, and long-distance trains – was approved by its parliament on Sunday. 

With lawmakers in the lower house of parliament voting 215 to 58 in favour, the law is set to be enforced in coming days.

President Emmanuel Macron told Le Parisien paper in an interview this month that he wanted to “piss off” unvaccinated people by making their lives so complicated they would end up getting the COVID vaccine. 

“The unvaccinated, I really want to piss them off. And so we’re going to continue doing so until the end. That’s the strategy,” said Macron.

Currently, unvaccinated people can enter these places with recent proof of a negative COVID-19 test. 

The new law is part of a string of mandates that have been implemented across the European Union (EU) in an effort to quell the rise in cases. Greece, Italy, and Austria have begun to implement fines or mandatory vaccinations for adults. 

France is experiencing its fifth COVID-19 wave, with daily cases hitting record highs of over 300,000. However, the number of serious hospitalizations is much lower than compared to the first wave in March and April 2020. 

Unvaccinated Greeks to pay monthly fines

Individuals 60 and over will be fined if they do not receive their COVID vaccination in Greece.

Greeks over the age of 60 who have not yet scheduled an appointment to get their first jab against COVID-19 will be fined every month, starting on Monday, o boost lagging vaccination rates and reduce pressure on healthcare in Greece.  

The monthly fine will be 50 euros ($57) in January, but will rise to 100 euros ($115) in subsequent months.

Speaking on Greece-based Skai Television, Health Ministry General Secretary Marios Themistocleous said there would be no extension to the rule for those over 60: “Whoever does not get vaccinated will pay the fine every month,” he said.

This decision follows a rise in cases as Omicron sweeps through Greece, with 20,409 new cases reported in the last 24 hours. 

Authorities have also decided to extend other COVID-19 measures, including midnight curfew for bars, restaurants and cafes; no music at venus; and mandatory high-protection masks at supermarkets and on public transport until 23 January. 

Prime Minister Kyriakos Mitsotakis told seniors that the simplest way to avoid the fine is to get vaccinated. Greek authorities say the non-vaccinated remain at high risk for hospitalization from coronavirus.

Some 90% of COVID-19 related deaths have been among people 60 and above, while 70% of those hospitalized from the virus are over 60, and of those 80% are unvaccinated. 

Over 50 fined in Italy without booster shot 

Italy is implementing a similar fine with its population – people 50 and over could be fined 100 euros ($115) if they fail to get their booster shot, according to the country’s latest COVID restrictions.

The government’s 5 January decree now requires people over 50 to have a ‘super green pass’ health certificate showing that they are either vaccinated or recently recovered from COVID, in order to enter the workplace. Anyone in this age group, employed or not, is also at risk of being fined 100 euros if they do not get vaccinated by 1 February. 

In addition, those who do not get their booster shot also could face a 100 euro fine.  

“We are working in particular on the age groups that are most at risk of being hospitalized,” said Italian Prime Minister Mario Draghi. 

This new mandate applies to anyone currently 50 or over living in Italy, or anyone due to turn 50 by 15 June. 

The fines will be collected by Italy’s Agenzie delle Entrate (Inland Revenue-Recovery Agency). 

People notified they are in violation will have ten days to communicate to their local health office, the reason for their vaccination status. 

COVID-19 vaccinations to become mandatory for 18 and over in Austria 

Protests in Vienna, Austria over compulsory vaccination.

Austria plans to make COVID-19 vaccinations mandatory from February for Austrian residents 18 and older, the government confirmed on Sunday. 

Presenting the final version of a draft law at a press conference on Sunday, Chancellor Karl Nehammer sought to reassure Austrians that the vaccine works.

“It’s not about fighting the vaccinated against the unvaccinated,” but rather to underscore that “vaccination is the best guarantee that we can live together in freedom.” 

The mandate will apply to Austrian residents 18 and older, with exemptions for pregnant women and people who cannot receive the vaccine due to medical reasons. 

While the law will take effect 1 February, police checks won’t be carried out until 15 March. Unvaccinated people then face a penalty of around 600 euros (US $684) and up to 3600 euros (US $4105). 

Those noncompliant with the mandate will be fined up to four times a year; however, the fine will be dropped if the recipient is vaccinated within two weeks of receiving the penalty notice.

Though the Austrian parliament still has to vote on Thursday on the vaccination mandate, the law is expected to pass. Around 74% of Austria’s population is vaccinated against COVID. 

Image Credits: akilligundem/Twitter, John Perivolaris/Flickr, Ama Bushman/Twitter.

On 24 February 2021, a plane carrying the first shipment of COVID-19 vaccines distributed by COVAX landed in Ghana.

Rwanda became the recipient of the one-billionth COVID-19 vaccine delivered by COVAX, the global platform set up to ensure equitable access to the vaccines,announced last Friday.

After numerous supply problems – most seriously when its key supplier, the Serum Insitute of India, was banned from exporting its vaccines by the Indian government – COVAX was forced to slash its 2021 delivery target from two billion to 930 million doses.

However, since mid-December, COVAX delivery has escalated substantially, and 100 million vaccine doses were delivered in the last week of December alone.

“COVAX is leading the largest vaccine procurement and supply operation in history, with deliveries to 144 countries to date,” said the World Health Organization (WHO) over the weekend.

“But the work that has gone into this milestone is only a reminder of the work that remains. As of 13 January 2022, out of 194 Member States, 36 WHO Member States have vaccinated less than 10% of their population, and 88 less than 40%,” said the WHO.

“COVAX’s ambition was compromised by hoarding or stockpiling in rich countries, catastrophic outbreaks leading to borders and supply being locked. And a lack of sharing of licenses, technology and know-how by pharmaceutical companies meant manufacturing capacity went unused.”

Dr Seth Berkley, CEO of Gavi – the vaccine alliance that manages COVAX – said he was “proud that nearly 90% of the first billion doses COVAX has delivered have been fully-funded doses sent to the low and lower-middle countries supported by the Gavi COVAX Advance Market Commitment (AMC)”.

 

This had been made possible thanks to donations of over $10 billion to COVAX, added Berkley.

“Inequality in vaccination is enormous with 41% of the world not yet vaccinated with even one dose,” added Berkley. “In 2022, Gavi will be fundraising to make sure lower-income countries are able to access variant-adapted vaccines, boosters or additional doses as needed. COVAX will be focusing on supporting lower-income countries’ vaccination objectives – that means also raising money to ensure tailored support for preparedness and delivery, particularly for the highest-risk countries, to increase their ability to absorb the doses delivered as rapidly as possible.”   

Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations (CEPI), which is a COVAX partner, also welcomed the milestone, but warned that while supply constraints had eased, “booster programs and the potential production of Omicron-specific vaccines may yet create pressure on supply”.  

Meanwhile, Eva Kadilli, director of UNICEF’s supply division, which carries out the COVAX deliveries, also welcomed the billionth delivery and thanked her teams throughout the world.

 

 

 

 

 

Image Credits: WHO, UNICEF.

“Swabbing” a sewage bore near the beach in Israel for SARS-CoV2 – could sewage be the best indicator yet of the spread of Omicron and other viruses?

Two years into the COVID-19 pandemic, monitoring sewage for evidence of disease – in this case COVID-19 – may be on the verge of becoming mainstream. 

At least that is what some trend-setting researchers are hoping to detect rising SARS-CoV2 infections early and set policies based on data even before swab testing can provide it. 

The virus spreads from person-to-person via droplets expelled from the mouth and nose. But it is also shed by infected people every time they go to the bathroom – though there is no evidence to date that anyone has become sick with COVID-19 because of direct exposure to treated or untreated wastewater, according to the United States Centers for Disease Control and Prevention (CDC). 

Wastewater epidemiology – turns human waste into a ‘data asset’

In fact, tracking the evolution of new pathogens through sewage is not a new tactic. It’s been used by researchers to probe the expansion of antibiotic resistant bacteria in  Africa and South-east Asia as well as by some national health ministries for more routine surveillance of relatively rare but deadly diseases like polio.

But the overwhelming pace of Omicron’s spread- which has made it impossible for health experts to keep up the traditional, individually-based testing and surveillance tactics – could help transform such approaches into more of a trend.

Along with high income countries like the United States, Canada and Israel, South Africa is on the cutting edge of such surveillance, while pilot projects are underway in several Latin America countries.  And now, a loose network of researchers and universities, called the COVID-19 WBE Collaborative have taken the idea to the next level – creating a global map of wastewater-based COVID monitoring sites in some 58 countries worldwide.  The is funded by the University of California at Berkeley’s CITRIS and Banatao Institute’s tech innovation hubs.

“Wastewater epidemiology turns human waste into a data asset that can improve the health and safety of populations,” explained Casey McGinley, chief of staff of Massachusetts-based Biobot Analytics, which also is conducting tests in Mexico, and piloting new surveillance projects with the World Bank in Uruguay and Ecuador.

“Wastewater analysis data is a great complementary tool to traditional public health surveillance methods that rely on clinical testing. Results can be used for different purposes and have a unique role to play at each stage of the pandemic, from early detection to detection of resurgence.”

Undercounting of Omicron cases makes wastewater-based surveillance more relevant

Ari Goldfarb, founder and director general of Kando

McGinley told Health Policy Watch that wastewater-based disease surveillance has become increasingly relevant since the start of the Omicron wave, partially because “due to incredibly high demand, availability of testing is very limited and there are long delays in reporting clinical testing results” and because “many individuals are expecting mild symptoms and resorting to at home tests which are not reported in official statistics.

“Against this backdrop of undercounting cases, wastewater data is a very important data set that gives a comprehensive overview of the magnitude of infections,” she said.

In Israel, Kando, a company that uses AI and Big Data to sample and analyze wastewater to improve management in sites around the world, just launched a partnership with the Health Ministry and several leading universities to apply its technology in hundreds of communities across the country to monitor for Omicron and any future SARS-CoV2 variants. 

According to the plan, towns of more than 20,000 people will be monitored twice a week using a series of sensors and control units placed in municipal sewage systems.  The samples collected will be sent to laboratories at Ben-Gurion University where PCR tests suitable for wastewater are conducted. In the event that the results received are positive, an additional test is carried out to quantify the Omicron variant and other variants. Sample results will be feed into a national computer data base that can analyze the results based on big data models and AI.

The entire process takes about 24 hours – from sample to results – but in this case for an entire neigborhood or town – rather than just one individual.

“You can look at wastewater as gigabytes of data running just under the city,” Kando CEO Ari Goldfarb told Health Policy Watch.

An important complementary tool – particularly in light of the increased reliance on rapid tests

Wastewater testing has become even more immediately relevant for tracking COVID, as countries pivot to greater reliance on rapid antigen tests, while gold-standard PCR tests are reserved for older people, those at higher-risk or with more serious symptoms. With people using less accurate at-home tests, which they also often fail to report, sewage surveillance could fill valuable missing holes of data.  

Better data on the relative proportions of Omicron versus other variants is another benefit of such initiatives, explained McGinley of Biobot. 

Her company reports the concentration of all SARS-CoV-2 variants detected in wastewater samples, including Omicron. In addition, Biobot is doing R&D work to detect and measure the percentage of the Omicron variant in wastewater through genomic sequencing. That can help decision-makers know how dominant Omicron has become, in relation to its more deadly but less contagious cousin, the Delta variant. 

“This information helps decision-makers in the current COVID-19 surge to understand the scale of infections, since case data has become significantly less reliable, tailor public health messaging around mask wearing and indoor gatherings, and lastly plan hospital resources accordingly,” McGinley said. 

In the US model, Biobot is sending internally devised wastewater sampling kits to public sector and corporate customers – containing everything needed to collect, package and safely ship the wastewater back to the company’s lab in Cambridge. Once received,  the company screens the samples to identify the presence and amount of the virus in each sample. The results are processed through Biobot’s data pipeline and reports are generated and sent back to the customers. 

Biobot’s open source sewage surveillance in the United States.  Surveillance curve parallels clinical case reports – but with higher absolute levels of disease incidence.

Its customers have included sites in all 50 states, as well as Canada and Mexico. Currently, Biobot’s National Monitoring Network reports data from approximately 200 communities in more than 20 US states. 

Through a partnership with the World Bank, Biobot has also worked on capacity building for wastewater monitoring for COVID-19 in Ecuador and Uruguay. 

US CDC – Stepping up COVID Wastewater Surveillance

CDC, however is now stepping into the scene with it own COVID wastewater surveillance program, which aims to provide a systematic, national network of pathogen-hunting sites, as well as guidance to communities about how to undertake sampling, said Brian Katzowitz, a health communications specialist from the CDC’s Division of Foodborne, Waterborne and Environmental Diseases.

“CDC just began funding a commercial wastewater testing contract which will provide twice weekly SARS-CoV-2 wastewater testing to 500 sites nationwide,” Katzowitz told Health Policy Watch. “With the emergence of Omicron, we were able to include Omicron tracking specifically into the contract. In addition, we are updating our data system to be able to receive, analyze and report Omicron-specific data to health department partners.”

He cautions, however, that “variant detection with wastewater is a little bit tricky” and as a result, “variant tracking data has to be interpreted carefully” – using sophisticated modeling techniques

“Sequencing samples from wastewater cannot confirm the presence of a specific variant because SARS-CoV-2 RNA decays quickly in wastewater,” he explains.  “Instead, variant-specific wastewater sampling looks for specific mutations, and the methods used cannot detect if all of the variant-defining mutations are present on a single genome.”

South Africa, Latin America, Canada and others joining the wastewater Omicron search

Multiple other countries are also using sewage surveillance to help crack Omicron- as evidenced by the proliferation of new projects on the COVID19WBEC.org dashboard.  

Researchers in South Africa, where virus hunters in Tshwane (Pretoria), were able to detect how the Omicron wave there, where it was first identified, was reaching a peak equal to that of the earlier Delta variant in late November – only days after the variant had first been announced and named by WHO.

Similar programmes have been reported by public health departments in Australia, Canada – and beyond.  

In Ottawa, Canada, wastewater collected by the Robert O. Pickard Environmental Center is being measured for coronavirus genetic material.

 “In essence, we are conducting a very broad COVID-19 survey to which we all contribute including those who are not getting tested themselves and those who may not even know they are infected,” Ottawa Public Health’s website explained. It added that wastewater is collected and transported to a laboratory five days per week where viral RNA levels are immediately tested, and results reported the next morning.

“It is very exciting that we can do these things to improve public health,” Goldfarb said. 

Image Credits: Kando , Biobot .

COVID patient in hospital
COVID patient in hospital

Two new treatments for COVID-19 were recommended on Thursday by the World Health Organization’s Guideline Development Group of international experts – one for severely ill patients and the other for those patients who are not severely ill but most likely to develop severe disease.

The recommendations were announced Friday morning in the BMJ. Both drugs, however, are patented and could be expensive and lack accessibility for some low- and middle-income countries, some advocates warned.

The first drug, baricitinib – a type of drug known as a Janus kinase (JAK) inhibitor – was “strongly recommended” for patients in severe or even critical condition from COVID-19. The drug has been used to treat rheumatoid arthritis and it is recommended that four milligrams be given once daily for 14 days in addition to previously-recommended corticosteroids.

“The strong recommendation is based on evidence that it reduces mortality, shortens hospital stays and reduces the risk of requiring mechanical ventilation, with no observed increase in adverse effects,” explained François Lamontagne, Professor of Medicine at the Université de Sherbrooke, who sits on the panel, in an interview with Health Policy Watch.

He explained that JAK inhibitors modulate the body’s response to an infection.

The WHO experts noted that two other JAK inhibitors – ruxolitinib and tofacitinib – should not be used to treat patients with severe disease because “low certainty evidence from small trials failed to show benefit and suggests a possible increase in serious side effects with tofacitinib.”

COVID-19 treatments and vaccines
COVID-19 treatments and vaccines

‘Uncertain’ effectiveness against Omicron

The second treatment that the panel recommended is a monoclonal antibody called sotrovimab, which is meant for patients with non-severe COVID-19 but who are at risk for developing severe disease.

Sotrovimab, Lamontagne said, consists of antibodies directed against a specific part of the virus that prevents entry of the virus into cells. This drug is given intravenously, requiring one infusion.

Lamontagne noted, however, that the panel only provided a “weak” recommendation of the treatment because the effectiveness of sotrovimab against Omicron is still uncertain.

The recommendations are based on evidence from four trials (three for baricitinib and one for sotrovimab) involving several thousand people, Lamontagne said. WHO noted that “the panel considered a combination of evidence assessing relative benefits and harms, values and preferences and feasibility issues.”

Baricitinib and sotrovimab join a concise list of drugs recommended by WHO experts, including the use of interleukin-6 receptor blockers and systemic corticosteroids for patients with severe or critical COVID-19, and conditional recommendations for the use of casirivimab-imdevimab in selected patients. WHO has recommended against the use of convalescent plasma, ivermectin and hydroxychloroquine.

No formal recommendation yet from WHO on new oral drugs – Paxlovid and monulpiravir

Significantly, WHO has not yet made a formal recommendation on the two new oral drug treatments that have now come on the market – Pfizer’s Paxlovid or Merck’s Molnupiravir. This is despite the fact that both drugs have been approved by the US Food and Drug Administration, and the Medicines Patent Pool has also contracted with Pfizer and Merck to produce generic versions of each drug for low-income countries.  Countries around the world are rushing to secure doses of Paxlovid, in particular, due to its high efficacy and safety profile in the FDA reviews – where it has been reported to be 90% effective in preventing severe disease when administered early in the course of infection.

Asked why the Organization had not yet made a recommendation on either drug, a WHO spokesperson pointed to a WHO Guidelines Development Group meeting that is scheduled to review Paxlovid [nirmatrelvir] on 9 February.

“Based on an assessment of the totality of the evidence, WHO will make a recommendation,” the spokesperson said, saying that safety monitoring, affordability and access all need to be considered in any WHO recommendation on either drug.

The WHO spokesperson, also stressed that “even if proven safe and effective, these drugs will not be an alternatives to vaccines.”

The spokeperson also stressed that any new oral drugs also “should be made available and affordable in all countries”.

Access advocates have complained that the current generic production arrangements for Paxlovid, aimed at 95 low-income countries, still leaves many gaps in affordability and access among lower-middle and middle-income countries which cannot afford the high prices of patented versions.

‘Baricitinib example of why TRIPS Waiver urgently needed’

Similarly, the cost and availability of both of the newly WHO-recommeded drugs could still also be barriers to their use in low- and middle-income countries, Lamontagne said.

“These additional therapies are newer, not produced on the same scale [and some other drugs], not as available and are more costly,” Lamontagne said. “The panel that makes those favorable recommendations is aware of this and is aware there is a risk that these interventions won’t be available similarly everywhere and that this could worsen the differences in access to healthcare.

“But at same time, in making those recommendations and stating that those are potentially life-saving and important therapies, the panel hopes to stress how important it is to strive to improve the accessibility of these emerging therapies across the board – in lower income areas just like in higher income areas,” he continued.

Médecins Sans Frontières/Doctors Without Borders (MSF) reacted to the recommendations by calling on governments to “take immediate steps to ensure that patent monopolies do not stand in the way of access to this treatment.”

The organization said that in many countries, generic baricitinib will not be available as the drug is under patent monopoly, including in some countries hit hard by the pandemic, such as Brazil, Russia, South Africa and Indonesia. In most cases, the patents do not expire until 2029.

“Baricitinib is another example of why the TRIPS Waiver is urgently needed,” MSF said in a statement.

“As new treatments emerge, it will be simply inhumane if they remain unavailable in resource-limited settings, just because they are patented and too expensive,” stressed Dr.  Márcio da Fonseca, an infectious disease medical advisor who spoke on behalf of MSF. “With these proven therapeutics recommended by the WHO, it’s time now for low- and middle-income countries to finally access these therapies that are already in routine use in many high-income countries.”

Image Credits: Wikimedia Commons, Bicanski on Pixnio.

Dr Abdou Salam Gueye, Director of Emergency Preparedness and Response, WHO Regional Office for Africa

COVID-19 vaccination in Africa may be shifting from a supply challenge – to one of effective vaccine distribution, declared  a senior World Health Organization official in the African Region on Thursday. 

African countries will have adequate access to COVID-19 vaccine supplies in 2022, said Dr Abdou Salam Gueye, Director of Emergency Preparedness and Response, WHO Regional Office for Africa. 

However, significant challenges remain in ensuring that available doses are administered efficiently, and vaccine hesitation is overcome, Gueye stressed. 

“We can tell you that in 2022 in Africa, the countries that express the need to receive vaccines will receive it, and they will receive enough vaccines,” he said at a press briefing hosted by the Africa Regional Office, based in Brazzaville. 

https://twitter.com/i/broadcasts/1kvJpAlZmZZxE

 

“The problem will be though what we are doing regarding operationalizing those vaccines in the countries. From taking them from the capital cities to where they are needed including at the sub-regional level,” Gueye told Health Policy Watch.

In Geneva, however, WHO’s Director General, Dr Tedros Adhanom Ghebreyesus sounded a somewhat different note.  He warned a meeting of WHO’s emergency committee that so far some 1 billion Africans, 85% of the continent’s population, have yet to receive a single vaccine dose, and  “ending the inequitable distribution of vaccines, therapeutics and diagnostics remains the key to ending the pandemic.” 

Need for the right mix of strategies to promote vaccine uptake 

A vaccination site in South Africa, co-sponsored by USAID.  Vaccines are now more available to African countries – the challenge now is for efficient distribution and uptake.

According to Gueye, however, there are now many vaccines within the delivery pipeline for Africa – and countries are now being offered more from various suppliers every day. 

So finding the right strategy in order to provide vaccines to all the people who are demanding vaccines is now a higher priority for the continent considering several studies showed largely wide acceptance of the vaccines among Africans.

“In a World Bank-sponsored study, more than 80% of African participants demanded and accepted the vaccines when they were offered the vaccination. There is a positive side if the governments are working toward a good operationalization of  vaccination,” he added.

Treatment also is now a priority

Gueye stressed that treatment options now need to be reinforced, as well, in the African context. 

“COVID is the first pandemic in our lifetime of this level and it has so much impact but it is not the only pandemic that existed and testing, treating were pivotal resources used to fight those diseases (HIV). I do believe also that in the third year of COVID-19, testing, caring for patients and treating them will be an important pillar to develop in all countries,” he said.. 

“It will not be only for cases that are severe or critical, it will be for almost all the cases where something may be done. If the treatment is done appropriately and on time, it might limit the infection of other patients. This is why testing, caring and treating are the priorities for WHO and we are working with countries already in order to do the best to scale it up.

Race for Paxlovid

Africa CDC Director Dr John Nkengasong

At an earlier briefing Thursday by the Africa CDC, the Director John Nkengasong, told journalists that talks with Pfizer are underway to assure African countries access to the company’s new Paxlovid treatment.

“We are in really close discussions with Pfizer to see what can be done to make the drugs available on the continent and accessible on the continent, that is, the Paxlovid drugs,” said Nkengasong.

In clinical trials, the treatment has demonstrated a 90% success rate in prevention of severe disease if taken at early stages of infection. 

Already approved by the US FDA and the United Kingdom’s Medicines and Healthcare products Regulatory Agency, the global race for the pills is already underway.

The United States government alone has signed an agreement for 10 million courses of the drug at $530 per course.  

And according to other reports, a handful of rich countries have already secured most of Pfizer’s own supply of the new drug. 

This means that low-income countries will need to rely up generic versions that are to be produced royalty-free, under the terms of a recent licensing agreement between Pfizer and the Medicines Patent Pool – with the first such license with Bangladesh struck just this week. 

https://twitter.com/RebeccaDRobbins/status/1480633419528687617

However, Pfizer’s new agreement with MPP coveres only 95 of the lowest income countries. It thus leaves many lower-middle and middle-income countries out in the cold –  and potentially unable to secure either the discounted generics or the higher-priced Pfizer versions of the pill. 

Is the shift to a focus on treatment – also a reflection of the failure of vaccination campaigns? 

Dr Anita Graham, internist, University of Witwatersrand, South Africa

Meanwhile, Dr Anita Graham, an internist at the University of Witwatersrand in South Africa noted that the decision to commence conversations in Africa around treatment implies failure to protect Africans against severe infection, in addition to dealing with a predominantly unvaccinated population.

“So once we have failed and we are dealing with a population who now has severe disease, we need to think about pharmaceutical management and there definitely are agents like the new Pfizer drug that has a therapeutic advantage — decreases the chance of death or ICU admissions and these drugs have been shown with early evidence to work. H

Hwever, they come with contingencies, and this is mostly cost and availability,” Graham told Health Policy Watch.

“So I don’t think that is an isolated solution, although I do think it is part of the plan, and part of the way forward in treating severe COVID,” Graham said.

Omicron hospitalization in South Africa – unvaccinated cases seem to predominate

With Omicron now accounting for up to 95% of new cases in South Africa, Graham provided said that most of the patients that she has admitted and treated for COVID-19 were largely unvaccinated – or in some cases vaccinated over a year ago. 

“Anecdotally, I can say that I have not had a single patient that is fully vaccinated, hospitalized,” she said, adding, “The patients that were hospitalized are those who are unvaccinated, partially vaccinated, patients who have been vaccinated more than a year ago whose immunity might have waned, and patients who have severe comorbidities,” she said.

For patients with comorbidities, Graham noted that those with comorbidities that are fully vaccinated but are hospitalized are often hospitalized for non-COVID-related disease.

“For instance, they are admitted for cancer and they coincidentally swabbed positive for Omicron,” she said.

Graham also noted that while all answers are not yet available, what is increasingly becoming important is the duration of the first infection to ascertain whether a previously infected individual would have some protection against new infections.

“With time, there is natural waning of immunity and with time there will be no leftover residual antibodies to fight a new variant. However, with a seroprevalence of more than 70% in some parts of Cape Town in South Africa, this high seroprevalence may be contributing to why we are having a less severe fourth wave. But my belief is that it is multifactorial — natural seroprevalence together with vaccination and the Omicron variant possibly being less virulent,” she added.

COVID Infections rising in North & West Africa; waning in South; high test positivity rates reflect under-reporting 

While COVID cases in southern Africa have now plateaued or are declining, those in West Africa and North Africa are now rising at worrisome rates – and overall deaths rose by 64% in the first week of January, the Orgaization said. 

“South Africa, where Omicron was first reported, saw a 9% fall in weekly infections. East and Central Africa regions also experienced a drop. However, North and West Africa are witnessing a rise in cases, with North Africa reporting a 121% increase this past week compared with the previous one,” WHO’s Gueye stated.

Nkengasong also revealed that the case fatality rate (CFR) of COVID-19 in Africa is 2.3% which is higher than the global average of 1.8%. Africa also accounts for 4.3% of deaths reported globally – disproportionate to the number of overall cases reported. 

Regarding testing, Africa has conducted over 91 million COVID tests with a cumulative positivity rate of 11.1%.  That high positivity rate also suggests high levels of under-reporting of overall infections, experts say. 

60% of African-acquired doses have been distributed while expired dose donations from rich countries also remain an issue 

Some 241 million unused COVID-19 vaccine doses purchased by the G7 and EU will expire by March, 2022 – Airfinity.

As of now, Africa CDC reports that a total of 563 million COVID-19 vaccine doses have been procured by 54 Member States out of which 340 million doses have been administered (60.4% of Africa’s total supply). So far only 10.1% of the African population has been fully vaccinated.

On Thursday, the global health analytics firm Airfinity estimated that 241 million COVID-19 vaccine doses purchased by the G7 and EU will go unused and will expire by March 2022. Airfinity said its forecast is based on analysis of G7 and EU vaccine supply while accounting for doses administered, boosters for everyone over 12 years-old, vaccine hesitancy and donations.

Rasmus Bech Hansen, Airfinity’s co-founder and CEO said the numbers illustrate, once more, how vaccinating the world is now largely a distribution problem, rather than a supply issue. 

“Even after successful booster rollouts, there are surplus doses available that risk going to waste if not shared very soon. The emergence of Omicron and the likelihood of future variants shows there is no time to waste,” Hansen said in a press release.

In a separate interview, Seth Berkley, the CEO of Gavi, the Vaccine Alliance and a leader of the WHO co-sponsored COVAX global vaccine facility, also underlined the distribution challenges faced. He said that by July 2022, it is possible for the world to produce vaccine doses sufficient to immunize 70% of the global population, as per WHO’s global target for 2022.

He added that there are “between 20 and 25 coutries that have been problematic on absorption. And those are getting special attention.”  

“In terms of the number of doses that will exist in the world, it is possible in terms of what we have visibility on. But at the end of the day, we don’t know what’s going to happen with Omicron, boosters, new variants, manufacturing problems, etc.,” he told Politico.  “The critical issue is what does each country want? At the end, we will serve what the countries want…”

Image Credits: Paul Adepoju, USAID, Airfinity .

At a WHO press briefing, the organization’s Director General described the grim status of the health and humanitarian crisis in Ethiopia’s conflict-torn Tigray region.

The leadership of the World Health Organization (WHO) has slammed Ethiopia’s “complete blockade” on health and humanitarian aid to Ethiopia’s Tigray region, saying it has been unable to deliver life-saving medications for nearly six months – in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. 

“Humanitarian access even in conflict is the basics. Even in Syria, we had access, even during the worst of conflicts in Syria. In Yemen, we have the same access. We delivered medicines. Here [however], it’s a complete blockade especially since mid-July. Nothing. This is six months without medical support, without food without all the rest of the things I have said. It’s been impossible,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus who hails from the Tigrayan region himself.

The region  is at the heart of the ongoing civil war that began on 3 November 2020, displacing hundreds of thousands of people. Despite recent Ethiopian government signals that it might now consider peace talks with Tigrayan rebel forces, WHO’s attempts to deliver health and humanitarian relief to the war-torn region continue to be denied for nearly six months now, said Tedros and WHO’s Executive Director of Health Emergencies, Mike Ryan at a Wednesday press briefing.  

‘Insult to humanity’

Mike Ryan, WHO Executive Director of Health Emergencies

Ryan noted that the government of Ethiopia has refused the global health body access to the Tigray region to deliver basic insulin, other oral antidiabetic drugs, and drugs for other diseases since last summer. He said that the region is quickly running out of essential health care commodities, including IV fluids.

“Our access has not improved and quite frankly, it’s very upsetting. In fact the situation is getting worse” Ryan said. “They’re running out of IV fluids for managing diabetic ketoacidosis. The doctors and nurses can’t even manage the more severe complications of a disease like diabetes which has catastrophic, immediate health consequences for people. The politics of it are beyond me. 

“Whatever the cause of that situation, those who have no access to the very basic life-saving interventions that we in the West, that we’re sitting here in Geneva, would expect immediately, instantly,” Ryan added.

“This is an insult to humanity to allow a situation like this to continue. To allow no (zero) access. Access is the lifeblood, the starting point for humanitarian intervention and we simply do not have that access. Access for our staff access to the field, getting basic medical supplies in there.” 

He called on all parties involved in the situation in the region to  find a solution to allow humanitarian and healthcare workers, including doctors and nurses, to do their jobs which he said is to treat patients and save lives.

WHO DG: Tigray under “complete blockade” since mid-July – barring humanitarian relief 

A family from Samre, in south-western Tigray, walked for two days to reach a camp for displaced people in Mekelle.

Confirming the impasse, Tedros added that the situation in the region is getting more complicated and deteriorating – despite recent talk about peace overtures between the government and rebel troops. 

The region with a population of seven million people – about equal to that of Norway and Estonia combined – has been under a humanitarian blockade for more than a year – which has only worsened in past months with the denial of health emergency relief too, he said. 

“Imagine a complete blockade of seven million people for more than a year and there is no food, no medication, no medicine, no electricity and no telecommunication. No media, nobody can report and when there is no telephone, I think accessing families is difficult. No cash, no bank service. Imagine the impact of all of these. 

“Lack of medicine has a direct impact and people are dying, but lack of food also kills,” the Director General said. 

Apart from the Tigray region, other areas of Ethiopia also are being impacted by the crisis, including the Amhara Region and Afar regions. However, while WHO has been granted access to the other regions – it has not been allowed to bring supplies or support to Tigray.

“Since July, no medication was allowed from WHO, none whatsoever. We have approached the prime minister’s office, we have approached the Foreign Ministry. 

“We have approached all relevant sectors, but no permission. So there is a blatant measure which has been taken that is blockade and siege against more than 7 million people,” the DG added.

A few weeks ago, the Ethiopian government did finally allow UNICEF to provide measles vaccines to the Tigray region.

But the WHO DG noted that the measles vaccine alone cannot significantly improve the overall health and humanitarian crisis. He described that as “unprecedented” considering that the global health body was granted access during previous worse wars.

“Humanitarian access even in conflict is the basics. Even in Syria, we had access, even during the worst of conflicts in Syria. In Yemen, we have the same access. We delivered medicines. Here [however], it’s a complete blockade especially since mid-July. Nothing. This is six months without medical support, without food without all the rest of the things I have said. It’s been impossible,” he added.

Meanwhile, African Centers for Disease Control officials have also been unable to access the region for nearly a year now, Africa CDC Director, Dr John Nkengasong, said in a separate briefing on Thursday.

A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer – since then a blockade on all health supplies has devastated the region even more.

State of the War

In December the Geneva-based Human Rights Council agreed to set up an international probe on the Tigrayan conflict, after the Deputy High Commissioner for Human Rights Nada Al-Nashif said that an estimated 400,000 people in Tigray were living in famine-like conditions.

Official accounts traced the commencement of the war to minutes before the clock chimed at midnight on 3 November 2020. Tigray Special Forces and allied local militia attacked the Ethiopian National Defense Force (ENDF) Northern Command headquarters in Mekelle, the Fifth Battalion barracks in Dansha, and other Northern Command bases. Several people were killed and the Tigray People’s Liberation Front (TPLF) claimed the attack was carried out in self-defense or preemptive self-defense.

According to Human Rights Watch, all sides in the war have committed war crimes during the conflict with the war creating a deepening humanitarian crisis. More than 10,000 people have died since war began, and rape has reportedly been used as a weapon.

In December Ethiopian government officials sent out an olive branch, saying they would pause at their current positions.  And just last week, the Ethiopian government announced it was exploring political dialogue to end the war, starting with the release of some opposition leaders.

“The key to lasting peace is dialogue,” the Ethiopian government stated.

Image Credits: UNICEF/Christine Nesbitt, Paul Adepoju, UNOCHA/Saviano Abreu.

A child with disability plays oin Brazil.People with disabilities have been some of the biggest silent sufferers in the COVID-19 pandemic, according to speakers at the Pre-Summit of the Global Disability Summit 2022 on Wednesday.

“Now, more than ever, if we want to be ready for a new pandemic, we need to ensure that disability inclusion in the health sector becomes a reality,” said Yannis Vardakastanis, President of the International Disability Alliance. “Nothing about us, without us.”

This pre-summit was co-hosted by the governments of Norway and Ghana and the International Disability Alliance, in collaboration with the World Health Organization (WHO) ahead of the summit on 16-17 February, which is expected to see participants commit to the inclusion of disabilities in the health sector. 

“In many low and middle-income countries, persons with disabilities are among the most marginalized people in the world. They are also often the last to gain access to health care,” the Prime Minister of Norway Jonas Gahr Støre said.

He added that while poverty and disabilities are mutually reinforcing, the pandemic has only compounded the situation more for the marginalised communities. “We must take steps to safeguard the health and well being of persons with disabilities including mental health.” 

Over a billion people suffer from disabilities 

WHO Director-General Dr Tedros Adhanom Ghebreyesus highlighted at the pre-summit that the way individuals with disabilities suffered during the pandemic was “unacceptable”, particularly considering that over a billion people in the world have some form of disability.

“Recognizing what needs to be done is only the first step; the second step is committing to building a disability-inclusive health sector,” he said. He added that such inclusion makes it easier for people with disabilities to access the health services they need and work with other sectors to foster greater inclusion in society more broadly.

The conversation at this pre-summit was more around making the health sector more inclusive. This is in tandem with the adoption of a landmark World Health Assembly resolution on achieving the highest attainable standard on health for persons with disabilities in January 2021. The resolution called on countries and health sector partners to move away from an exclusively medical approach to disability towards adopting a comprehensive people-centred and human rights-based approach.

Females  With Disabilities Are More Affected 

According to Dr Natalia Kanem, Executive Director of the United Nations Population Fund, nearly one-fifth of women have disabilities, and these women are up to 10-times more likely to experience gender-based violence.

Kanem said that for women and girls with disabilities, the right to health is not just about being able to obtain health services without judgment or discrimination also about the right to make their own decisions about their own bodies and sexuality, free from coercion or violence. 

Healthcare Inclusion is a privilege for many 

People with disabilities and rehabilitation need more attention and have different needs but the country’s healthcare system and its recognition of these needs matters.

“Rehabilitation often does not have high priority within the health systems,” said Dr Tom Shakespeare, Professor of Disability Research at the London School of Hygiene and Tropical Medicine.

He believes this is because it is seen as “less attractive” by funders due to the nature of rehabilitation being enabling a better life rather than curing. 

He said that his condition of dwarfism was recognised in the UK and it enabled him to get free vaccination and booster shots for COVID-19, but those with intellectual disabilities may have lost out on this and perished.

“Globally, many people both with my condition, and many, many others don’t have access to needed health care or rehabilitation. And that violates article 25 of the Convention on the Rights of Persons with Disabilities,” said Shakespeare.

Israel has tried to make its hospitals more inclusive during the pandemic which is in accordance with legal obligations in the country to make medical services accessible at all levels, said Nitzan Horowitz, Israel’s Minister of Health.

He added that information was presented in sign language, transparent masks were worn at hospitals so that people with hearing difficulties were able to understand and communicate with their physicians. 

However, that is not the case in many countries which do not prioritise or include disabilities in all aspects. Individuals with disabilities need to be included at the table while policies are being designed.

“If a health system is not inclusive and accessible for people with disabilities prior to a crisis, it’s not likely to be enough when a crisis hits,” said Robert Mardini, Director-General, International Committee of the Red Cross.  

Image Credits: clipper round the world .

WHO’s Dr Bruce Aylward

Over 15 million new cases of COVID-19 were reported globally in the past week – by far the most cases ever reported – but deaths have remained constant since last October at about 48,000 a week, according to World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus.

“While the number of patients being hospitalised is increasing in most countries, it’s not at the level seen in previous waves. This is possibly due to the reduced severity of Omicron as well as widespread immunity from vaccination or previous infection,” said Tedros, addressing the WHO’s weekly COVID-19 briefing on Wednesday.

However, he stressed that while Omicron may cause less severe disease than Delta, it remains a dangerous virus particularly for those who are unvaccinated. 

Referring to the statement made on Tuesday by the WHO’s Europe director, Dr Hans Kluge,  that 50% of Europeans would be infected with Omicron in the coming weeks, WHO lead on COVID-19, Dr Maria van Kerkhove, said this was based on modelling.

“This variant is that it transmits incredibly efficiently between people,” said Van Kerkhove, but stressed that people could still protect themselves through vaccinations, masking and physical distancing.

Van Kerkhove added that the new cases were literally off the charts – the WHO had to readjust the scale of its latest graph to accommodate the explosion of cases.

WHO COVID-19 cases (11 January 2022)

WHO special advisor and COVAX representative Dr Bruce Aylward described the case increase as “absolutely staggering”. 

“We have not, in 30 years working on infectious diseases, seen an epidemic curve like this before, certainly not with a pandemic-prone virus,” he said.

“In the face of a staggering upsurge in a disease, we’re hearing two responses. One group is saying,’ Gosh, throw in the towel, let this thing immunise the world’. While the other group, led by Maria [van Kerkhove], is saying: wear a mask and get vaccinated. And the first response is the wrong choice.”

Kluge reported that there were over seven million new cases of COVID-19 in the first week of January, more than doubling over a two-week period.

“As of 10 January, 26 countries report that over 1% of their population is catching COVID-19 each week,” said Kluge.

“At this rate, the Institute for Health Metrics and Evaluation (IHME) forecasts that more than 50% of the population in the Region will be infected with Omicron in the next six to eight weeks.”

Main barriers to vaccine rollouts

Dr Kate O’Brien

Thirty-six countries have vaccinated less than 10% of their populations while 90 have not reached 40%, said Tedros.

Dr Kate O’Brien, WHO Director of Immunisation and Vaccines, said the “foundational issue” hampering these countries was the constrained and uncertain supply of vaccines.

However, O’Brien cited a number of other issues including lack of financing to roll out vaccines, weak health services, conflict and other humanitarian emergencies.

Aylward decried the “dangerous narrative” emerging in many high-income countries that some lower-income countries can’t use the vaccines or did not want them.

“If you look at the map of polio or measles [elimination] and you see that the same countries that have gotten very low coverage for COVID-19 have eliminated or eradicated polio or eliminated measles or achieve very high routine immunisation for some other diseases,” said Aylward.

“We’ve made it twice as hard or three times as hard for low-income countries to be able to achieve high coverage. We did not share vaccines for six, seven, eight months. What we did share was a lot of misinformation, a lot of bad practice, a lot of false problems.”

COVAX had recently been able to increase its vaccine deliveries to low and middle-income countries and has delivered 980 million doses.

Aylward also criticised vaccine donations with short expiry dates “which make them very, very difficult to use in complex environments”.

“These countries know how to run vaccination at scale. It’s a really tough environment they’re operating in right now. How do we fix that? Number one, we have to provide full support for the financing, for the delivery, the information support, the right products, right time frames.”

A Medical Diagnostic staff member works on the antigen tests.

CAPE TOWN – A locally produced COVID-19 rapid antigen test that was recently approved by South Africa’s medicines regulator is able to detect Omicron, according to its developer.
This follows some controversy about whether antigen tests were able to detect Omicron, and suggestions that throat swabs might be more effective than nasal swabs as Omicron affects the upper respiratory tract rather than the lungs.
But Dr Lyndon Mungur, COO of Medical Diagnostech, said that his company’s antigen test has been able to detect every COVID-19 variant, including Omicron.
“Most antigen tests detect the nucleoprotein and not the spike protein. There are only two mutations on the nucleoprotein for the Omicron variant, and both mutations are embedded in the centre of the protein, and not on the antigenic sites,” explained Mungur, a biotechnologist who helped with the research and development of the local antigen test.
“We have an ongoing clinical study program so that we can be abreast of new variants as they become evident. Our antigen tests were able to detect every one, and we also compare results to PCR tests on the same specimens,” said Mungur, adding that the Medical Diagnostech test used nasal swabs.

Cheaper than imported tests

“If current tests were able to detect at a lower sensitivity, this would only affect the very beginning and very end stages of infection. There is a very small window at the start and at the end in terms of low viral load.”
The Medical Diagnostech test is likely to be around 35% cheaper than imported tests, and it was approved by the South African Health Products Regulatory Authority (SAHPRA) in December.
Company CEO Ashley Uys said that his company “has a production capacity of 20 million units per annum”.
The company received funding from the South African Medical Research Council (SAMRC) to develop its test.
Medical Diagnostech had already developed a prototype antigen detection test, but required support to increase its sensitivity and complete the testing and approvals for market entry, according to SAMRC official Dr Michelle Mulder,
“The local ownership and manufacture of these test kits will not only increase South Africa’s self-sufficiency in a time of high demand, but also contribute to reducing the trade imbalance with respect to medical devices and local economic development and job creation,” added Mulder.
“This [antigen test] not only benefits the country but will also be made available to the rest of Africa,” said Dr Phil Mjwara, Director-General of the Department of Science and Innovation.

A few months earlier, the country’s regulator approved a locally produced PCR test.

Image Credits: MedicalDiagnostic.

WTO Director-General Ngozi Okonjo-Iweala addresses the meeting alongside General Council Chair Ambassador Dacio Castillo

The European Union (EU) has described India’s call for an urgent meeting of the World Trade Organization (WTO) Ministerial Conference to discuss the body’s response to the COVID-19 pandemic, including a proposed waiver of relevant intellectual property protections, as “premature”.

Addressing the WTO General Council informal meeting on Monday, EU Ambassador João Aguiar Machado said that while the pandemic response was important, it “must not lead to a loss of momentum on the other key components” – including “the fisheries subsidies negotiations, agreeing on a way forward on agriculture, and finalising the Ministerial Declaration with a strong commitment on WTO reform”.

General Council Chair Ambassador Dacio Castillo (Honduras) had convened the 10 January virtual meeting in response to India’s recent proposal – sent in a letter to the WTO last month. 

India and South Africa tabled a proposal well over a year ago to waive certain provisions of the TRIPS Agreement for COVID-19-related vaccines, therapeutics, and diagnostics.

At Monday’s meeting, WTO Director-General Ngozi Okonjo-Iweala urged member states to urgently step up their efforts, suggesting that “with the requisite political will, members can in the space of the coming weeks reach multilateral compromises on intellectual property and other issues so that the WTO fully contributes to the global response to COVID-19 and future pandemics”, according to a WTO statement.

“More than two years have passed since the onset of the pandemic. The emergence of the Omicron variant, which forced us to postpone our Twelfth Ministerial Conference, reminded us of the risks of allowing large sections of the world to remain unvaccinated,” said Okonjo-Iweala.

“We at the WTO now have to step up urgently to do our part to reach a multilateral outcome on intellectual property and other issues so as to fully contribute to the global efforts in the fight against COVID-19,” she added.

‘No better time than now’

The Director-General also updated members on her efforts, together with Deputy Director-General Anabel González, “to support an informal group of members to converge around a meaningful acceptable outcome that can be built upon by the wider membership to bring a successful conclusion to the intellectual property issue.” 

“It is slow but steady progress, and we are hopeful that this approach can help us together find the direction we need,” she said. “There is no better time to build convergence than now.” 

She noted that while pandemic response remained the most urgent endeavour facing WTO members, many members had reached out to her to emphasise the importance of other items on the WTO agenda, including fisheries subsidies, agriculture and WTO reform. She stressed that these areas remained priorities for outcomes, and expressed hope “that we can all agree on getting results as soon as possible.”

Describing the meeting as “useful,” General Council Chair Ambassador Castillo said he would continue to hold consultations with members on the Indian proposal, underlining “the urgency and importance of reaching a meaningful outcome.” A common WTO response to COVID-19 “remains an urgent priority for the membership,” he said.

However, the EU Ambassador Machado said that “before any decision to call a virtual Ministerial meeting and topics to be decided, we believe the WTO Director-General and the Chair of the General Council should hold consultations with Members, to assess the way forward on all four issues that I referred to”.

“Any virtual Ministerial should take place only once there is a consensus both on intellectual property rights and on the Declaration and Action Plan on the wider pandemic response,” he added.

“Only a comprehensive trade response to the pandemic can make a difference and address the identified bottlenecks as regards the production and distribution of COVID-19 vaccines such as restricted access to raw materials and other inputs as well as complex supply chains.”