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.

Novak Djokovic holding the 2019 Wimbledon men’s trophy – his departure from Australia was not as glorious

A World Health Organization Emergencies Expert Committee has once again re-asserted a recommendation to abolish vaccine requirements for international travel – going well against the grain of current trends – particularly in light of the brouhaha seen over Sunday’s deportation of Serbian tennis star Novak Djokovic  from Australia.

The WHO expert group, made of some 19 representatives from different WHO regions and another dozen advisors, also recommended that all restrictions on  international travel between countries be removed –  or at least eased – saying that “they do not provide added value and continue to contribute to the economic and social stress” of various WHO member states.

While that latter recommendation is something that countries are already implementing in practice – the one regarding vaccine passports has received far less  support among WHO’s own member states so far – many of which have strengthened vaccine mandates for travel, work and leisure activities over past months, including moves by France on Sunday – stimulating more protests by anti-vax groups.

Tennis Star Case Highlights Clashing Approaches

The most vivid illustration of the starkly clashing approaches of the world health body and many of its leading donor governments was Australia’s deportation on Sunday of the vaccine-hesitant Djokovic, after he entered the country to compete in the Australia Open on the basis of his recent infection and recovery from COVID-19, only to be deported by Immigration Minister Alex Hawke after a nine-day long legal battle.

Now, it appears that the 20-time Grand Slam title holder may also be barred from attending the upcoming French Open tennis tournament, after France  tightened its travel rules to bar unvaccinated arrivals – and the Sports Ministry said Monday there would be no exemptions.

The current WHO recommendation, issued by the International Health Regulations Emergency Committee Wednesday evening, states bluntly in bold typeface that it recommends member states:

“Do NOT require proof of vaccination against COVID-19 for international travel as the only pathway or condition permitting international travel.”

But rather than concern about celebrities’ international access, the WHO expert group argues that such limitations are unfair, “given limited global access and inequitable distribution of COVID-19 vaccines.” It elaborates those concerns further in an interim paper on “considerations regarding proof of COVID-19 vaccination for international travellers.”

In addition, WHO also recommended a re-evaluation of testing and quarantine measures related to international travel, something the Agency has never supported wholeheartedly either.

The advice states: “State Parties should consider a risk-based approach to the facilitation of international travel by lifting or modifying measures, such as testing and/or quarantine requirements, when appropriate, in accordance with the WHO guidance.”

WHO experts also recommend lifting of travel bans on other countries

As for even more drastic travel bans, WHO’s recommendation is perhaps more in step with the current trends – that have seen countries lifting the bans after seeing that they failed to keep the new Omicron variant at bay.

In the WHO statement Wednesday, the Expert Committee recommended that countries, “Lift or ease international traffic bans as they do not provide added value and continue to contribute to the economic and social stress experienced by States Parties.

The Omicron wave has highlighted how such travel bans can boomerang.  Travel bans in November and December hit particularly hard and visibly against the South Africa and its neighbors – the very countries that first identified the variant – and announced it transparently to the world.  The result was global pummeling of their tourism-dependent economies and hamstrung travelers desperately trying to visit family for holidays from different corners of the globe.  Some countries imposed continent-wide bans against Africans before they were applied to Europe and the United States – even cases quickly appeared all over the world, prompting leaders like South African President Cyrus Ramaphosa to refer to “health apartheid” with respect to the travel rules, while UN Secretary General Antonio Guterres called it “travel apartheid” outright.

The WHO advice underlines those points stating that: “The failure of travel restrictions introduced after the detection and reporting of Omicron variant to limit international spread of Omicron demonstrates the ineffectiveness of such measures over time.”

That advice, however, also reiterates the Agency’s ambivalence over a range of other travel-related preventative measures as well, noting that “masking, testing, isolation/quarantine, and vaccination” should be based on “risk assessments, and avoid placing the financial burden on international travellers in accordance with Article 40 of the IHR.” It refers to the WHO advice for international traffic in relation to the SARS-CoV-2 Omicron variant for further guidance.

WHO uneasy with vaccine mandates generally

Katherine O’Brien, Director WHO Vaccines, Immunizations and Biologicals

While WHO has been adamant that every country in the world needs to get to a 70% vaccine coverage goal by mid-2022 – it has been equally reticent about using vaccine mandates domestic as well as international – as a carrot or stick to reach such ambitious vaccine goals.

In early December, WHO’s European Regional Director, Dr Hans Kluge declared that vaccine mandates even in countries with universal access to vaccines should only be an “absolute last resort, and only applicable when all other feasible options to improve vaccination uptake have been exhausted.”

Last week, in response to the Djokovic controversy, WHO’s Director of Immunization, Vaccines and Biologicals, was quoted by the Sydney Morning Herald saying that “Free and full access to safe and effective vaccines is the absolute precondition before a mandate is made and that is a grounding principle,” she said.

“It’s also a grounding reason why there is not a requirement from WHO, [there is not] a recommendation around any requirement for crossing international borders, although the status of somebody’s vaccination may be considered with respect to other conditions that may be imposed on people through the course of their travel.”

Image Credits: Wikipedia , AFP/Issouf Sanogo.

Merck laboratory that developed the new oral COVID treatment, molnupiravir

The Medicines Patent Pool (MPP) said Thursday that it had already signed agreements with 27 generic manufacturing companies for the manufacturing of the oral COVID-19 antiviral medication molnupiravir and supply in 105 low- and-middle-income countries (LMICs).

The sublicense agreements are the result of the voluntary licensing agreement signed by MPP and MSD in October 2021 to facilitate affordable global access for the new COVID treatment, one of two that has recently received approval from the US Food and Drug Administration.

In comparison with Pfizer’s Paxlovid, Monulpiravir emerged with lower efficacy ratings and more potential adverse effects, in the FDA’s final reviews of clinical trial results. This has dampened enthusiasm about the drug in some countries, including India which has so far refrained from recommending it as a COVID treatment. even though the drug is already in production with a local manufacturer.

Even so, experts also the Merck drug is still regarded as an important new tool in countries’ arsenals because it can be administered to certain patients unable to tolerate Paxlovid.

MPP licenses come even before WHO issues recommendation on use of new oral drugs

Strikingly, WHO has yet to approve either Paxlovid or monulpiravir – a step that is usually regarded as preliminary to the negotiation of manufacturing licenses by a UN-supported group like the MPP.

A WHO Guidelines Development Group meeting that is scheduled to review Paxlovid [nirmatrelvir] on 9 February, a WHO spokesperson told Health Policy Watch last week, but declined to comment on when the Merck drug will be reviewed.

The non-exclusive licenses allow generic manufacturers to produce the raw ingredients for molnupiravir and/or the finished drug itself.

In a press release, the Geneva-based MPP said that the companies that were offered the sublicense successfully demonstrated their ability to meet MPP’s requirements related to production capacity, regulatory compliance, and the ability to meet international standards for quality-assured medicines. Five companies will focus on producing the raw ingredients, 13 companies will produce both raw ingredient and the finished drug and 9 companies will produce the finished drug. The companies span 11 countries, Bangladesh, China, Egypt/Jordan, India, Indonesia, Kenya, Pakistan, South Africa, South Korea, and Vietnam.

While MSD negotiated an agreement with MPP that establishes the terms and conditions, the requests for sublicences from generic producers were reviewed solely by MPP and presented to MSD. Neither MSD nor its collaborators in the R&D at Ridgeback Biotherapeutics, nor Emory University, which invented the drug, will receive royalties from sales of molnupiravir from the MPP sublicensees while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization.

“We are encouraged by the large number of new and existing partners that have moved quickly to secure a sublicence for molnupiravir through MPP,” said Charles Gore, MPP Executive Director. “This is a critical step toward ensuring global access to an urgently needed COVID-19 treatment and we are confident that, as manufacturers are working closely with regulatory authorities, the anticipated treatments will be rapidly available in LMICs.”

“Accelerating broad, affordable access to molnupiravir has been a priority for MSD from the start, which led us to partner with MPP on a licensing agreement to expand access to quality-assured generic versions of molnupiravir, subject to local regulatory authorisation,” said Paul Schaper, Executive Director, Global Public Policy, MSD. “We are pleased to see this vision come to life, with strong geographic diversity in MPP’s selected generic manufacturing sublicensees.”

More on MPP’s licence on molnupiravir and on the sublicence agreements : https://medicinespatentpool.org/licence-post/molnupiravir-mol

Image Credits: Merck .

Surveillance for antimicrobial resistance (AMR) in Southeast Asia – much more is needed to combat rising mortality from drug resistant diseases in low-income countries.

Antibiotic-resistant bacterial infections killed 1.27 million people in the world in 2019, according to a one-of-a-kind study in The Lancet.

According to the study, led by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, with dozens of authors worldwide, the increased resistance of many common pathogens to treatment, known as antimicrobial resistance (AMR), was a leading cause of death worldwide in 2019.

AMR caused more fatalities than HIV/AIDS or malaria, which caused 860,000 and 640,000 deaths respectively, in the same time period.  More people than ever are dying from previously treatable infections since the bacteria causing such infections have become resistant to previously life-saving drugs.

Deaths from AMR were estimated to be highest in sub-Saharan Africa and South Asia, at 24 deaths per 100,000 and 22 deaths per 100,000 people respectively. Children were among those most likely to die of antibiotic-resistant pneumonia strains. In contrast, in high-income countries, the death toll from AMR was about 13 deaths per 100,000.

The study is the first to comprehensively estimate annual deaths from AMR – a global risk that so far has lacked systematic quantification, including by the World Health Organization (WHO). The study highlights how a number of common respiratory pneumonia and bloodstream infections that were previously treatable – have become antibiotic-resistant to treatment causing hundreds of thousands of deaths a year.

Action is needed now to combat the rising threat

The health impact of pathogens varied widely based on location, with deaths attributable to AMR in sub-Saharan Africa most often caused by S. pneumonia (16% of deaths) or K. pneumonia (20%) – the latter is portrayed here.

“These new data reveal the true scale of antimicrobial resistance worldwide, and are a clear signal that we must act now to combat the threat,” said study co-author Chris Murray, director of IHME.

“Previous estimates had predicted 10 million annual deaths from antimicrobial resistance by 2050, but we now know for certain that we are already far closer to that figure than we thought. We need to leverage this data to course-correct action and drive innovation if we want to stay ahead in the race against antimicrobial resistance.”

The 10 million deaths refers to data from a UK government-commissioned study. That number was a benchmark for the landmark 2019 UN report on AMR that warned of a looming crisis, called “No Time to Wait”. But it has been widely criticized inside WHO and elsewhere as lacking precise current data. The Lancet study should fill that gap. 

The study included a review of nearly 10,000 sources, including literature, lab data, household surveys and national mortality data. The research and modelling of trends extend across 204 countries and territories – thus covering virtually every place on the planet. It assessed some 88 pathogen–drug combinations. Of the 23 pathogens studied, lower respiratory and thorax infections, bloodstream infections, and intra-abdominal infections accounted for 78.8% of the deaths caused by AMR in 2019.  

While 1.27 million deaths were directly attributable to AMR, 4.95 million deaths were somehow associated with drug-resistant infections in 2019, the study also found – meaning that drug-resistant infections were a factor in morbidity, even if they could not be deemed as the cause of death.

The paradoxical reasons cited for growing resistance to treatment include both problems of excessive and inappropriate use of antibiotics, but also insufficient access to the drugs even in the same geographical areas. This is a particular problem in low-income settings where access to a wide array of medicines is more restricted. 

Which pathogens are the most resistant? 

Six pathogens were associated with the greatest burden of AMR deaths: E coli, Staphylococcus aureus, K pneumoniae, S pneumoniae, acinetobacter baumannii, and Pseudomonas aeruginosa. These collectively accounted for over 900,000 of the 1.27 million deaths caused by drug resistance in 2019. 

S.aureus and E.coli were the leading cause of deaths in high-income regions in 2019, while resistance to  S pneumoniae and K pneumoniae were the biggest killers in sub-Saharan Africa. 

Meanwhile, resistance to two main antibiotics considered the go-to responses for severe infections – fluoroquinolones and beta-lactam antibiotics, including penicillins and cephalosporins – was responsible for over 70% deaths

Global deaths (counts) attributable to and associated with bacterial antimicrobial resistance by infectious syndrome, 2019

Poorer countries have it worse  

The study also highlights the large regional disparities in the worldwide scale and spread of bacterial-related AMR.

Western sub-Saharan Africa accounted for the highest burden of such resistance with 27.3 deaths per 100,000 directly attributable to the resistance while 114.8 deaths per 100,000 were associated with bacterial AMR. Contrast this with the Australasia region which saw the lowest AMR burden in 2019 at 6.5 deaths per 100,000 attributable to AMR and 28 deaths per 100,000 associated with AMR. 

The entire sub-Saharan Africa region, and south Asia region had an estimated all-age death rate of 75 per 100,000 associated with bacterial AMR. 

All-age rate of deaths attributable to and associated with bacterial antimicrobial resistance by GBD
region, 2019

According to the study, the higher AMR burden is both a function of the prevalence of resistance as well as the underlying frequency of critical infections such as lower respiratory infections, bloodstream infections, and intra-abdominal infections –which are seen to be higher in these regions. 

“Some of the AMR burden in sub-Saharan Africa is probably due to inadequate access to antibiotics and high infection levels, albeit at low levels of resistance, whereas in south Asia and Latin America, it is because of high resistance even with good access to antibiotics,” commented Dr Ramanan Laxminarayan, founder and Director of the Center for Disease Dynamics, Economics & Policy, in Washington, DC, writing in a linked Comment.

In November, WHO’s Africa Region said that over four million Africans a year could die as a result of antimicrobial resistance by 2050. 

The way forward: Vaccines, better infrastructure and more data 

Along with more appropriate use of antibiotics, insure both access but not excessive use, vaccinations also are paramount for combating AMR, the study’s authors underlined. 

And this includes vaccines against viral pathogens like influenza, respiratory syncytial virus, and rotavirus  – which in turn reduce the risks of secondary bacterial infections and subsequent treatment, which means less dependency on inappropriate antibiotic consumption. 

At the same time, there is an urgent need to reduce the use of antibiotics as a first-line treatment for viral infections, in which case antibiotics are not effective.  

Given that AMR affects low-and-middle-income countries more than higher-income ones, the study also recommends scaling up and building stronger diagnostics infrastructure that allow clinicians to diagnose infection more accurately and rapidly.  At the same time, the study shows, maintaining investment in the development pipeline for new antibiotics, and access to second-line antibiotics in locations without widespread access is essential. 

“From being an unrecognised and hidden problem, a clearer picture of the burden of AMR is finally emerging,” Laxminarayan said in his comment, noting that spending on HIV “attracts close to US$50 billion each year. However, global spending on addressing AMR is probably much lower than that. This needs to change.

“Spending needs to be directed to preventing infections in the first place, making sure existing antibiotics are used appropriately and judiciously, and to bringing new antibiotics to market. Health and political leaders at local, national, and international levels need to take seriously the importance of addressing AMR and the challenge of poor access to affordable, effective antibiotics.”

Data gaps hinder assessment – particular in low-income countries

Testing for antimicrobial resistance among a variety of different bacterial strains

This study was funded by the Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.

But the international consortium that authored the study, the Antimicrobial Resistance Collaborators, identified serious data gaps in many low-income countries, underlining the importance of increasing laboratory capacity and data collection in these locations.

This is all the more critical insofar as resistance varies substantially by country and region – both in terms of what bacteria are more resistant and what drugs are more or lesss effective, researchers stressed.

“Improving the collection of data worldwide is essential to help us better track levels of resistance equip clinicians and policymakers with the information they need to address the most pressing challenges posed by antimicrobial resistance,” said Professor Christiane Dolecek, at Oxford University’s Centre for Tropical Medicine and Global Health and the Mahidol Oxford Tropical Medicine Research Unit.

In his comments, Laxminarayan also emphasized the need for more AMR data collection in low-income countries saying: “Progress ahead will depend on projects such as those supported by the Fleming Fund, which aim to improve laboratory capacity in LMICs while also uncovering resistance data that lie on dusty shelves and in long-forgotten hard drives.”

Report is ‘wake-up call’

Senior WHO officials, including Chief Scientist Soumya Swaminathan,  welcomed the new IHME report as filling a critical knowledge gap and highlighting the long-neglected issues around AMR.

“Lack of robust global data and evidence of the impact of drug-resistance has been a critical knowledge gap and has hampered efforts to advocate for policies and practices to control antimicrobial resistance,” said WHO in a series of tweets. “This study now clearly demonstrates the existential threat”.

Meanwhile, pharma voices described it as a ”wake up call”:

“Left unchecked, AMR could undermine the foundation of modern medicine,” said Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers and Associations.

“This is a wake-up call for us all, industry has been a first mover in finding solutions.  Now the focus has shifted to governments who must deliver new economic incentives, pragmatic antibiotic value assessments, and reimbursement reforms to enable access, that are needed to meet the needs of patients of today and tomorrow.”

  • Updated 23 January 2022

Image Credits: WHO, USAID Asia/Flickr, The Lancet, DFID – UK Department for International Development.

The WHO Executive Board discussion on the coronavirus outbreak in early February 2020 – the last full-scale face-to-face meeting in Geneva of the governing body before WHO declared an international health emergency.

One of the more complicated tasks facing next week’s World Health Organization (WHO) Executive Board (EB) is how to take forward negotiations on an ‘instrument’ to address future pandemics – and even the report to the board about this has been slashed.

The past two years of vaccine hoarding, nationalism and fights about the origins of SARS-CoV2 have made it plain that finding global agreement on how to address future pandemics might be impossible.

Although the special session of the World Health Assembly late last year agreed that the WHO would actually try to do this, the working group charged with trying to develop a negotiation plan has struggled to find consensus.

The EB report from the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGSWP) was nine pages at the start of the group’s meeting last week – but the latest version is down to six pages.

The entire clause that suggested that the WHO should have speedy access to disease outbreak sites has been removed – at the insistence of China, diplomatic sources told Health Policy Watch.

The entire clause 11 has been removed from the original report

The report identifies two key priorities to frame future pandemic response – equity and building systems and tools, including strengthening the International Health Regulations (IHR) and adopting a ‘One Health’ approach.

It proposes that IHR be tightened up to “provide clear guidance for action in the event of a public health emergency of international concern with the potential to establish immediate alerts”.

However, that is as close as it gets to the original report suggesting that the WHO might be empowered to get to outbreaks in countries as speedily as possible.

The WGSWP report, part of EB agenda item 15 on public health emergencies preparedness and response, is due to be addressed on the first day, Monday 24 January.

The board will be expected to “provide further guidance” on the report. It will also consider the creation of a Standing Committee on Pandemic and Emergency Preparedness and Response “to provide guidance and, as appropriate, make recommendations to the Board regarding ongoing work on policy proposals on pandemic and emergency preparedness and response”.

Agenda focuses on four pillars 

The agenda of EB, meeting for the 150th time, has been organised around four pillars:

  • One billion more people benefitting from universal health coverage;
  • One billion more people better protected from health emergencies;
  • One billion more people enjoying better health and well-being;
  • More effective and efficient WHO providing better support to countries. 

A significant focus of the board meeting will be on non-communicable diseases (NCDs). By Wednesday, the EB is expected to have adopted a “draft implementation road map 2023–2030” to prevent and control NCDs. 

Proposals to reduce the harmful use of alcohol, better control diabetes, improve oral health and ensure that people with NCDs can still access treatment during humanitarian emergencies form part of the draft policies.

The NCD Alliance is calling on member states to put the draft policies related to NCDs forward for adoption to the 75th WHA.

The EB will also appoint the Director-General for the next four years – and the only candidate officially nominated so far is the current office-bearer, Dr Tedros Adhanom Ghebreyesus.

 

Image Credits: HPW/Catherine Saez.

South African President Cyril Ramaphosa and US billionaire Dr Patrick Soon-Shiong

CAPE TOWN – South African-born US biotech billionaire Patrick Soon-Shiong launched a vaccine manufacturing plant in the country of his birth on Wednesday, aimed at producing “second generation” vaccines to address COVID-19 and other diseases.

Soon-Shiong, who has made his fortune from developing successful cancer treatments, has committed an initial $195 million to NantSA – the South African operation that aims to produce one billion vaccine doses a year by 2025.

Soon-Shiong said that he had been moved to invest in improving South Africa’s vaccine capacity after witnessing “vaccine apartheid” during the COVID-19 pandemic.

Unlike current vaccines that are based on stimulating the body to produce antibodies, Soon-Shiong’s approach is based on stimulating the body’s T-cell responses – something he has done successfully in cancer immunotherapy treatment.

His US company, NantKwest, has been developing “natural killer” (NK) cells used by the immune system to identify and destroy cells under stress, including cancerous or virally-infected cells.

NantKwest describes itself as “a pioneering, next-generation, clinical-stage immunotherapy company” that is focused on “harnessing the unique power of our immune system using natural killer (NK) cells to treat cancer, infectious diseases and inflammatory diseases”. It has not yet developed a commercial product based on NK cells.

‘Vaccine apartheid’ prompted investment

“We have spent 10 to 15 years trying to show that, while antibodies are important, T cells are what kill. We came from the position of cancer, and we took that same technology and have actually put it into vaccines,” Soon-Shiong told the launch in Cape Town.

But he admitted that this approach has been “really difficult for people to grasp at the regulatory level, at the science level, at the implementation level”.

“We started this in the US, but then when I saw the need, the inequities that I call vaccine apartheid, that was happening here on this continent and within the encouragement of [South African] President Cyril Ramaphosa, I said this is what we needed to do and we’ve moved our focus to South Africa.”

‘Part of Africa plan’, says South Africa’s President

Opening the facility, Ramaphosa said that the “state-of-the-art vaccine manufacturing campus” was “part of a far broader initiative to propel Africa into a new era of health science”.

“Today we are marking the establishment of a company that aims to develop next-generation vaccines that will reach patients across the continent,” added Ramaphosa.

“This new entity, we understand, will collaborate with the [World Health Organization] mRNA hub by providing RNA enzymes they need to produce vaccines.”

Ramaphosa also praised the $6.7million investment made by Soon-Shiong’s family foundation to train young Africans in biotechnology and life sciences.

Part of this investment involves the establishment of the Chan Soon-Shiong Centre for Epidemic Response and Innovation at the University of Stellenbosch, which includes the donation of two large DNA sequencers.

 “South Africa’s capabilities in genomic surveillance are recognised worldwide and have been vital in our response – and indeed the global response – to the emergence of new COVID-19 variants,” said Ramaphosa.

The event also marked the launch of the Coalition to Accelerate Africa’s Access to Advanced Healthcare (AAAH Coalition) which, together with NantSA, “aims to accelerate domestic production of pharmaceuticals, biologics and vaccines that will reach patients across the African continent”, according to the South African Presidency.

This would accelerate self-reliance and Africa’s preparedness to face the next pandemic, added Ramaphosa.

Soon-Shiong, one of the wealthiest medical doctors in the world, has also been described as a “blowhard” and a “showman” by Forbes magazine – although the magazine also quoted a patient who said that his experimental pancreatic cancer treatment had saved his life.

 

 

 

Maria van Kerkhove

World Health Organization (WHO) researchers and partners are “constantly looking at” animals’ susceptibility to COVID-19, and transmission both from humans to animals and vice versa, WHO’s Dr Maria van Kerkhove told the global body’s weekly briefing on Tuesday.

“We understand there are a number of species that can be infected with SARS-CoV2 and then there’s the possibility – we call that a reverse zoonosis – it goes from humans back to animals, and then it’s possible for the animals to reinfect humans,” said Van Kerkhove, WHO’s lead on COVID-19.

“That risk remains low, but it is something that we are constantly looking at because what we don’t want is to have, as this virus circulates you know, it has the opportunity to infect people as well as animals,” she said.

However, she added that there needed to be better surveillance of which animals are susceptible, tracking this and infected animals over time.

Working groups are researching animal-human interface

Of the seven million COVID-19 genome sequences that had been shared by scientists, around 1 500 were from animals, she added.

“This is not something we talk about very much, but we have many working groups at the looking in animals at the animal-human interface to look at the possibility of human infecting animals as well as animals infecting humans back again.”

This follows news that COVID-19 (Delta variant) had been detected in a Hong Kong pet shop owner, a customer and at least 11 hamsters, resulting in officials deciding to cull around 2000 hamsters, rabbits and other mammals, according to media reports. 

Hong Kong’s assistant director of agriculture, fisheries and conservation, Thomas Sit Hon-chung, told a press conference that while no animal-to-human transmission has been recorded, the hamsters could infect other animals and these could in turn infect humans, according to Hong Kong’s The Standard newspaper.

Not the time to make a ‘massive shift’ on COVID tests

Van Kerkhove also said that the WHO had been COVID-19 tests globally – based on nasal, throat and saliva samples – to ensure their sensitivity to the Omicron variant. 

“We do know that the tests that are in use right now remain sensitive to the Omicron variant,  including the antigen-based tests, the PCR tests, and saliva-based tests that are out on the market.”

She added that this was not the time to “make a massive shift to recommend one or the other”, but rather to “ensure that testing is accessible, affordable, and is reliable in all countries”. 

Patients being tested needed to know what to do, while governments and global organisations needed to know where the virus is and where the virus is spreading, she added. 

There was a 20% increase in recorded COVID-19 cases in the past week – around 19 million new cases – but deaths were holding steady at about 45,000.

Narrative that Omicron is mild ‘hurting response’

WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

WHO Director-General Dr Tedros Adhanom Ghebreyesus said he was concerned about the impact Omicron was having on “already exhausted health workers and overburdened health systems”.

“I remain particularly concerned about many countries that have low vaccination rates, as people are many times more at risk of severe illness and death if they’re unvaccinated,” said Tedros.

He added that while Omicron may be less severe, on average, “the narrative that it is mild disease is misleading and hurts the overall response”.

“Make no mistake, Omicron is causing hospitalizations and deaths and even the less severe cases are inundating health facilities. The virus is circulating far too intensely with many still vulnerable. for many countries, and the next few weeks remain really critical for health workers and health systems,” he added.