COVID booster vaccines have gained traction in several countries – US, Israel, Germany, UK, and others, but low- and middle-income countries lag significantly behind in shots.

As the Delta variant spreads across Africa and with the anticipation of a fourth COVID-19 wave later this year, the World Health Organization’s Africa head has called out rich countries that are now offering booster vaccine shots – even as much of the continent’s population waits for their chance at the first shot.

WHO regional director for Africa, Matshidiso Moeti, on Tuesday warned that moves by some wealthy countries to introduce booster shots threaten the African continent’s ability to fight the devastating pandemic. Richer countries should share their vaccine supplies with low-income countries instead of hoarding the drugs, she told delegates at the 71st Session of the WHO Regional Committee for Africa’s virtual meeting on public health in Africa.

The COVID-19 vaccine roll-out had demonstrated the huge gaps in international solidarity, said Moeti. “We believe the priority should be for the most oppressed populations in all countries to be fully vaccinated. To have the greatest impact in curbing transmission, saving lives, and bringing about an end to this pandemic, as quickly as possible,” she said, adding that 75% of vaccine doses globally had been administered in just 10 countries.

The United States, Israel, United Kingdom and Germany are among a growing number of wealthy countries planning to offer COVID-19 booster shots to their populations from September. This, at a time when some of the world’s poorer nations are struggling to get even one jab of the life-saving vaccines into their peoples’ arms. 

“High-income countries have administered 62 times more doses than low-income countries, potentially worsening this divide,” warned Moeti, stressing that: “We’ve advocated for wealthy countries to share their doses.”

Moeti was echoing the call by WHO Director-General, Tedros Adhanom Ghebreyesus, who last week again fiercely denounced the booster policies. “The divide between the haves and have nots will only grow larger if manufacturers and leaders prioritize booster shots oversupply to low- and middle-income countries,” Dr Tedros said.

The director-general had previously warned that diverting global vaccine supplies to boosters could foster the spread of dangerous variants in vaccine-poor countries elsewhere.

Africa’s vaccine roll-out lagging behind

Matshidiso Moeti, Regional Director of the WHO Regional Office for Africa

Dr Tedros, who also addressed the meeting, said he was concerned that only four countries in Africa had reached the targeted vaccination of at least 10% of their populations. Globally, some 140 countries have already reached this target.

“I don’t need to tell you that the distribution of vaccines has been terribly unfair. More than 4.8 billion doses of vaccine have been administered globally. Just 87 million doses have been administered in the African region – less than 2 % of the global total.” Dr Tedros said.

More than 44 million doses have been distributed to 40 African countries through the global vaccine-sharing facility, COVAX.

“We have also made progress towards increasing production in Africa, through the recent establishment of a technology transfer hub for mRNA vaccines in South Africa, and through our work with many countries including Rwanda & Senegal to boost local production.” Dr. Tedros said.

More than 5.4 million COVID-19 cases have been reported from the African region, and about 130,000 deaths reported.  “We know that these numbers are under-reported.” Dr Tedros added.

Currently, the Delta variant is present in 44 African countries, the Beta in 39, Delta in 30, and Gamma in four.

Africa’s COVID-19 challenges and proposed actions

Governments on the African continent have faced several challenges since the start of the pandemic last year, said WHO’s Regional Emergency Director Dr Abdou Salam Gueye.  These include the lack of multi-sectoral coordination of the pandemic response, weak health systems, limited funding, low public awareness, and low vaccination rates, and vaccine hesitancy.

Added to this was the misinformation at all levels, including political leadership, health workers, and communities, which Gueye said made “the work harder”.

Most shockingly, according to Gueye, is that many African countries are not clear about which variant they are dealing with due to, among other, poor genomic sequencing technology, gaps in surveillance, and data and information management.

“Critical data was not sufficiently shared and used and GIS capabilities are not explored,” said Gueye.

Other challenges include concerns over the negative effects of COVID-19 vaccines, low public trust in leadership, and the negative impact of social media on preventative measures.

WHO AFRO has however proposed specific action to deal with the challenges which include advocating for local vaccine production, increasing vaccine doses beyond existing programs, and ensuring that operational funding from multilateral development banks is available for vaccination programs.

Learning from the COVID-19 pandemic

Matshidiso Moeti, Regional Director of the WHO Regional Office for Africa

On Tuesday Moeti  emphasised the need to learn from the COVID-19 pandemic and called for significant resources to be dedicated to research, development, and innovation.

“COVID-19 presents both an opportunity and a stark warning of the need to rethink systems that reinforce justices, and to invest more in building a healthier, fairer world,” she said.

Stressing the importance of sharing both the knowledge gained and the benefits to “protect the world”, Moeti said: “Promising homegrown solutions have emerged, and more needs to be done to test harness, and promote these globally, including African traditional medicines and digital technologies.”

She also called on the continent to ramp up local production of essential medical supplies, including vaccines, and for increased investment in health systems that have for decades been underfunded.

This year’s Regional Committee focuses on ways to scale up the COVID-19 response, renew the efforts to end all forms of polio, eliminate cervical cancer as well as enhance the use of health technologies. The meeting which is being held over three days until August 26 will also discuss measures to improve healthy ageing on the continent as well as reinforcing the fight against tuberculosis, HIV, sexually transmitted infections and hepatitis, and defeating meningitis by 2030 among other key health priorities.

Image Credits: Marco Verch/Flickr.

One billion children – almost half the world’s children – live in 33 countries that are at an “extremely high-risk” from the impacts of climate change including heatwaves, cyclones, air pollution, flooding and water scarcity.

This is according to UNICEF’s Children’s Climate Risk Index (CCRI) which provides the first global comprehensive view of children’s exposure and vulnerability to the impacts of climate change.

“This report examines for the first time exactly how many children live in areas that experience multiple, overlapping climate and environmental risks that trigger, reinforce and magnify each other combined with data on the availability and quality of essential services such as healthcare, education and water and sanitation to give a true insight into the impact of the climate crisis on children,” according to UNICEF executive director Henrietta Fore.

Fore added that “almost every child on earth” was exposed to at least one climate shock, but that the survival of the one billion children in high-risk countries “is at imminent threat from the impacts of climate change”.

The worst countries worst for children to live in for climate change threats.

Twelve of the 15 worst affected countries are in Africa, with the Central African Republic, Chad and Nigeria ranked the three worst-affected countries. Pakistan, Afghanistan and Bangladesh are the only non-African countries in this group.

Meanwhile, the safest three countries for children are Iceland, Luxembourg and New Zealand.

The least affected countries, which are safest places for children.

“Addressing the climate crisis requires every part of society to act,” said Fore,  appealing for greenhouse gas emissions and environmental pollutants to be reduced dramatically.

Crossing ‘key boundaries’ 

“We are crossing key boundaries in the Earth’s natural system, including climate change, biodiversity loss, and increasing levels of pollution in the air, soil, water and oceans,” according to the report.

“As these boundaries are breached, so too is the delicate natural balance that human civilization has depended upon to grow and thrive. The world’s children can no longer count on these conditions, and must make their way in a world that will become far more dangerous and uncertain in the years to come.”

According to the report, the climate crisis is creating multiple crises that threaten children’s very survival. They are more vulnerable physically to floods, droughts, severe weather and heatwaves and physiologically to pollution and climate-related diseases such as malaria and dengue.

According to the recent IPCC report, global greenhouse gas emissions need to be halved by 2030 and cut to zero by 2050 to avoid the worse impacts, but most countries are not on track to meet these targets.

“Only with such truly transformative action will we bequeath children a liveable planet,” according to the report.

According to Nkosi Nyathi, a young climate change activist from Zimbabwe: “What keeps me on the frontline for climate justice is the notion that I don’t only represent my nation but my entire generation because climate justice concerns our future.

“I have dedicated my voice as a voice of the voiceless, to call for immediate action and there is no better time for acting than now. Take a closer look at the unpredictability and uncertainty of weather patterns, the rise in sea levels, frequent cyclones, hot temperatures and heatwaves – honestly, how am I expected to attend school under a scorching sun?”

 

 

Image Credits: UNICEF.

In a milestone event that was also long-awaited, The United States Food & Drug Administration issued a final authorization for the Pfizer-BioNTech COVID19 vaccine – the first such vaccine to receive permanent FDA approval status – following the receipt of an Emergency Use Listing on 11 December.

The definitive FDA approval is expected to bolster both public willingness to voluntarily get the jab – as well as more vaccine mandates.  As one of the first such mandates to be issued in the wake of the announcement, the US Pentagon said that some 1.4 million armed forces personnel around the world would be required to be vaccinated against COVID-19, with guidelines to be issued shortly. Private companies, health care providers and universities across the United States are also grappling with vaccine mandates.

New York City Mayor Bill de Blasio followed, announcing that all New York City school staff would be required to get vaccinated – the largest school system in the United States to have imposed such a mandate. In New Jersey, Governor  Phil Murphy announced that all state employees would have to be vaccinated by 18 October.  That follows moves by California requiring teachers to get vaccinated two weeks ago.  Dozens of private schools and colleges around the country also have instituted vaccine mandates. Some public universities and individual school boards in vaccine hesitant states like Florida are also enacting vaccine and/or mask mandates – despite attempts to bar them from doing so by state authorities.

At the same time, US health officials were clearly hoping that vaccine-hesitant people, who had expressed doubts about the speed of the emergency approvals, might be swayed to get the jab now that the authorization is permanent.

“While millions of people have already safely received COVID-19 vaccines, we recognise that for some, the FDA approval of a vaccine may now instil additional confidence to get vaccinated,” said the FDA’s Acting Commissioner, Janet Woodcock, in announcing the move.  “Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S.”

For now, the final approval, however, remains limited to people age 16 and over, with vaccines for younger groups, aged 12-15, being administered under the pre-existing EUA.  Increasingly, infections are also being seen among younger adults and teens in North America and worldwide as social gatherings regain steam and schools reopen – accelerating the spread of the highly-infectious Delta variant.

Other countries slower on mandates

Teachers aged 50 years and above were among the first in Kenya to get COVID-19 vaccine in March.

Other countries are carefully eyeing the US vaccine mandate moves – even if most, including high-income Europe, have been much slower to consider mandates for civil servants and in schools – although  COVID passes for international travelers, large gatherings and high-risk groups such as health workers are being implemented more widely.

In Kenya, however, the government recently mandated that its civil servants be vaccinated by 23 August – a decision that also reflects the slowly expanding vaccine access in some parts of the continent. The move received the support of John Nkengasong, Director of the Africa Centre for Disease Control (CDC), who said “they’re saving themselves, their loved ones and protecting their community and country.”

“We’re going to move forward, making that vaccine mandatory. We’re preparing the guidance to the force right now. And the actual completion date of it, in other words, how fast we want to see it get done, we’re working through that guidance right now,” said Pentagon Press Secretary John Kirby, at a press briefing on Monday.

Approval also triggers new calls for wider vaccine access

Meanwhile, Médecins Sans Frontières, issued a renewed call to Pfizer/BioNTech and other COVID vaccine manufacturers to share their vaccine technology more widely, in order to boost global supplies – and particularly in Africa where COVID vaccine coverage continent-wide remains under 2%.

MSF called on the pharma firm to begin cooperating with a new World Health Organisation mRNA vaccine tech hub in South Africa  – which has declared that it will train LMIC professionals in the development and manufacture of mRNA vaccines on an open-access platform.

In a parallel move, Pfizer/BioNTech recently announced a vaccine production deal with the Cape Town-based firm Biovac – but the company has so far deferred from joining the WHO collaboration.

“With only 1.7% of Africa’s population fully vaccinated against COVID-19, increasing and diversifying production and supply of mRNA vaccines through additional manufacturers, beginning with those based in countries on the African continent, offers an opportunity to urgently and sustainably address vaccine inequity during this pandemic, and in the future,” said an MSF statement.

“Médecins Sans Frontières/Doctors Without Borders (MSF) called again on Pfizer and BioNTech to immediately share the vaccine technology and knowledge with manufacturers on the African continent that could help boost global vaccine supply. They should do this via the World Health Organization’s (WHO) mRNA vaccine technology transfer hub hosted in South Africa.”

Image Credits: International Monetary Fund/Ernesto Benavides, Wish FM Radio.

Some 300,000-400,000 Afghans have been forced from their homes in the past two months alone, says WHO and UNICEF.

KABUL – As the Taliban blitzed through towns and villages of Afghanistan finally capturing Kabul August 15, the war-ravaged country’s fragile health system was also crumbling, leaving the sick and vulnerable in despair. 

Over the past week, the health ministry’s previously daily updates of coronavirus infections, vaccinations and other key updates on public health have ceased to exist.

As per the last official figures, Afghanistan was grappling with mounting rates of COVID-19 infections, driven by the Delta variant, amid shortages of vaccines and oxygen. Health experts believe the situation has taken a sharp turn for the worse in the week since the Taliban took charge of the capita. 

Continuing health services a priority for the new regime 

Within days of entering Kabul, the Taliban leaders went to the Health Ministry to highlight the importance in their eyes of this key sector, and particularly the continued engagement of female doctors and health workers.

A Health Ministry official who asked not to be named told Health Policy Watch that the Taliban representatives, along with the acting Health Minister, Dr. Wahid Majrooh, were collaborating closely together in order to steer the public health sector out of uncertainty.

“They are working hard and no drastic changes have emerged in the Ministry.  It is hoped soon things will return to normalcy”, said the official. 

In a series of tweets,  Majrooh also expressed his commitment to working with WHO and other global health partners, returning basic health services to the country – stressing the importance of continued engagement with female health professionals. 

Other sources within the government, however, say that many doctors and health workers, and particularly female nurses, doctors and members of COVID vaccination teams, remain too anxious to return to their duties – out of fear of the new government. 

WHO & UNICEF call for “humanitarian airbridge 

In statements Wednesday,  WHO Director General Dr Tedros Adhanom Ghebreyesus and Dr Ahmed Al-Mandhari, Regional Director for WHO’s Eastern Mediterranean Region, also affirmed that WHO is committed to remaining in Afghanistan and working constructively with the new regime.   

But they also warned of large, looming health risks as a dire humanitarian situation continues to unfold in Afghanistan. 

This includes increasing cases of diarrhea, malnutrition, and COVID-19-like symptoms, as well as reproductive health complications being seen nationwide – and particularly among displaced populations who have fled to larger cities like Kabul, to escape conflict zones.  

On Sunday, amid the continuing airport chaos, WHO and UNICEF called jointly  “for the immediate establishment of a humanitarian airbridge for the sustained and unimpeded delivery” of much-needed medicines and supplies to “millions of people in need of aid, including 300,000 people displaced in the last two months alone.”

Said the statement: “While the main focus over the past days has been major air operations for the evacuation of internationals and vulnerable Afghans, the massive humanitarian needs facing the majority of the population should not – and cannot – be neglected. 

“With no commercial aircraft currently permitted to land in Kabul, we have no way to get supplies into the country and to those in need.  Other humanitarian agencies are similarly constrained,” said the statement. 

Even prior to the events of the past weeks, Afghanistan represented the world’s third largest humanitarian operation, with over 18 million people requiring assistance.\

Displaced populations adds to challenges in Kabul and elsewhere  

Afghan families fleeing conflict in Kunduz and other southern Afghan provinces have now crowded into Kabul

In its statement last week, WHO noted the urgent need for reproductive, maternal, newborn and child health (RMNCH) services to be provided to newly displaced people in Kabul and other cities, calling on “all parties to swiftly address disruptions to medical supplies and equipment being shipped into and across the country so as to plug gaps in needs at health facilities.” 

The Kabul capital’s iconic Shahr-e-Nau commercial district, which was once a population destination for leisure, outings and shopping for the newly-emerging middle class of Afghanistan, is now flooded with war-affected displaced men, women and children from the north and south of the country.

With no proper accommodation, hygiene and food mechanism in place, the vulnerable women and children in particular can be seen in despair in the nearby park here under scorching summer heat.

Begging for food, one mother of three minor children, who identified herself as Hajira said all of her children are ill, hungry and restless. “Where can I go? What can I do for these children? Nothing is in my control? I am hopeless!” she sighed, clearing her tears with her dusty and torn veil.

Some two million Afghan children are malnourished, The World Food Program said this week. “The combined effects of drought and the coronavirus pandemic, on top of years of conflict, look set to worsen the food security situation,” the organization said.  

For the second time in three years, the country saw a second devastating drought, destroying crops and livestock. A harsh winter could make things even worse said Mary Ellen McGroarty, WFP Afghan country director.

Over 260,000 Afghanis were displaced by drought in the country’s western provinces in 2018 – and drought has now struck again in 2021.

Questions loom over future of COVID vaccine drive 

Behind the scenes, health experts also are worried about whether the new regime will move forward aggressively in the COVID vaccination drive that had been gaining steam  recently.  They point to the long struggle the country has undergone to root out polio virus, with vaccinations – which met with chronic opposition in some parts of the country. 

Prior to the latest turmoil, Afghan officials told Health Policy Watch that the administration of vaccines had gained momentum – following the sudden rise of infections and corresponding deaths since April. Up to 40,000 people were getting the jabs on a daily basis across the country with the government aiming to take it up to 100,000 per day, health officials say.

Now, however, due to the disruptions in health services, the pace of COVID vaccines has slowed dramatically or even halted, officials say, as well as delaying other routine childhood immunizations, which could lead to secondary health emergencies. 

As per the UN estimates, vaccination rates remain extremely low in Afghanistan, with less than 4-5% of the population vaccinated overall. The virus continues to deeply affect the lives of the most vulnerable children and families across the country as they face the compounded impacts of the pandemic, conflict and longstanding drought.

Southern Afghanistan Worst Affected Region

A mother and her child in the Haji camp for internally displaced people in Kandahar, southern Afghanistan.

Dr. Kabeer Ahmad, a former health ministry official, said the country’s restive south, particularly Helmand province, as well as the Kunduz province in the far north, are currently the worst affected overall by the acute shortages of medicine supplies and public health services.

“These two provinces in particular have been literally the frontlines throughout the 20 years of war, and it got worse there (Kunduz, Helmand) in the past couple of months when the foreigners (US and NATO) left,  and fighting intensified”, he told Health Policy Watch. 

That has included various attacks on health care facilities and personnel, which humanitarian groups say continue to strain an already fragile health system. 

Provinces of Afganistan – regions in the far northern province of Kunduz, and Helmand province in the south, are among the hardest hit by conflict – and displacement.

“All parties must respect neutrality of health interventions and ensure safety of health workers, patients and health facilities”, said the WHO in its recent statements, adding unimpeded and sustained access to humanitarian assistance, including essential health services and medical supplies, is a critical lifeline for millions of Afghans, and must not be interrupted.

The WHO has called for  additional funding of US$ 6.6 million for the urgent health response following the escalation of conflict.

Image Credits: Hesamuddin Hesam, © UNHCR/Edris Lutfi, Photo: Enayatullah Azad/NRC, © UNICEF Afghanistan.

Yemen’s ruined health system struggles to cope with COVID alongside other diseases.

The Delta variant is finding fertile ground to spread – and claim lives – around the Middle East and North Africa. The New Humanitarian, a nonprofit newsroom covering crises around the world, provides a snapshot of COVID-19 across the region.

After months of relative calm, COVID-19 has again been coursing through much of the Middle East and North Africa, posing a major challenge for countries with low vaccination rates and healthcare systems that were often in bad shape even before the pandemic hit.

This is not entirely unexpected: The World Health Organisation warned in mid-July that infections were rising, with the particularly contagious Delta variant spreading fast. And that was before the Muslim holiday of Eid al-Adha, which this year ran from 19-23 July and traditionally includes large gatherings.

Since then, infections have shot up in Libya, Morocco, Lebanon, and Iran – where on Monday COVID-19 deaths hit a daily high of 665 – as well as in places like Tunisia and Algeria, where the numbers have since dropped off but have already had serious consequences.

Vaccination rates are low almost across the board, and for a variety of reasons: limited deliveries from the UN-backed COVAX facility, scepticism of the jabs, and the inability of many countries to purchase doses after their economies were hit hard by the pandemic. Israel (but not, for the most part, occupied Gaza or the West Bank) and the Gulf countries are notable exceptions.

In early August, Dr. Haytham Qosa, head of health in the Middle East and North Africa for the International Federation of the Red Cross and Red Crescent Societies (IFRC), cautioned that vaccine inequity is a serious threat in a region already dealing with a litany of problems.

“Leaving countries behind on vaccines will only serve to prolong the pandemic, not just in the region, but globally,” Dr. Qosa said. “Many countries are facing other vulnerabilities, including conflict, natural disasters, water shortages, displacement, and other disease outbreaks. This makes people even more vulnerable to the devastating impacts of COVID-19. This alone should be a reason enough for global solidarity to ensure equitable vaccine access in the region.”

Below, The New Humanitarian presents snapshots from five Middle Eastern and North African countries confronting the impacts of COVID-19.

Libya: Soaring caseload amidst supply shortages

COVID in Libya has come on top of protracted conflict, meaning that relief efforts must juggle health services with distribution of food and other essentials to vulnerable household.

COVID cases: 286,894 – Deaths: 3,956 – Vaccinations: 764,233 doses – Percentage of population vaccinated*: 5.6%

As cases soar, health workers in Libya say they’re still struggling with the same overarching obstacle they faced at the start of the pandemic: a decade of armed conflict and chaos has crippled the country’s healthcare system.

“In our hospital, we have outdated and broken medical equipment. You can find dusty ventilators locked in a room. Nobody is able to use them,” said Dr. Nasser, a physician at Tripoli Central Hospital – the Libyan capital’s second largest.

Dr. Nasser, who asked that his surname not be published, said many doctors aren’t being regularly paid by the country’s six-month-old interim government, and that 17 months on from Libya’s first confirmed coronavirus case, “there is still a severe shortage [at his hospital] of lifesaving medicine and supplies, including gloves and masks.” Libya has not yet confirmed an official case of the Delta variant, but the WHO says it is “suspected” because of its presence in neighbouring Tunisia and Libya.

Libya, which has a population of around seven million, has so far received around 2.7 million doses of vaccine, including 292,890 doses of AstraZeneca and Pfizer vaccines via COVAX, as well as a reported 900,000 doses of Russia’s Sputnik V from third countries and two million doses of China’s Sinopharm. It has administered more than 764,000 doses so far, in a country of around seven million people.

Several Libyans told The New Humanitarian they were frustrated at how the government has organised the vaccination campaign. “My family and I signed up to get the vaccine, but we never heard back,” said a recent medical school graduate from the second city of Benghazi who asked not to be named.

Dr. Tamadur Almahdi, who works for Speetar, a Libyan telemedicine platform that offers online consultations, said “a lot of people are asking about the vaccine’s safety, efficacy, effectiveness, and protection.”

COVID-19 vaccination is even harder for the more than 600,000 migrants, refugees, and asylum seekers in Libya, with discrimination in accessing healthcare services a longstanding barrier for this population, who also face detention, torture, rape, and other abuses.

Mohammed Mussa, a Sudanese refugee from Darfur who lives in Surman, a town in northwestern Libya, said getting vaccinated is just not his top priority. “If I look at my situation, I don’t see where the importance of the vaccine fits in,” he told The New Humanitarian. “Right now, I don’t even have enough money for food, rent, or medical care.

Sara Creta, long-time reporter on Libya, currently in Darfur/The New Humanitarian

Lebanon: Lights out, economic worries

Nurse takes tempature of child suspected of COVID symptoms in a Lebanese public health centre

COVID cases: 584,896 – Deaths: 7,988 – Vaccinations: 2,221,656 – Percentage of population vaccinated*: 16.4%

With its economy in tatters and some hospitals now running out of electricity and medications because of subsidy cuts, Lebanon is barely able to respond to new COVID-19 cases, which have been increasing at a fairly steady rate since late June.

Two weeks ago, Dr. Abdulrahman Bizri, the head of Lebanon’s COVID-19 vaccination committee, said the new Delta variant had been identified in 60 percent of new cases.

Lebanon’s financial crisis, which began before the pandemic but was worsened by it, has been disastrous: The local currency has lost 90 percent of its value since September 2019, and food prices are up 400 percent, among the highest worldwide. Today, about half the population lives in poverty.

That may be among the reasons the country’s COVID-19 policy has mostly focused on mitigating the economic effects of the pandemic: Unemployment skyrocketed following its first lockdown in March 2020, and there have been few subsequent lockdowns despite rising cases. The government largely allowed the country to stay open in the summer and winter of 2020, when tourists poured in, and restaurants, nightlife, and hotels were allowed to function at almost full capacity.

This temporarily helped breathe life into the economy, but it also allowed for intermittent surges in cases, including this one – the largest since December 2020. “We never put into place an effective long-term strategy,” Dr. Jade Khalife, a Lebanese physician who specialises in health systems, told The New Humanitarian. “You have repetitive cycles of surges every five or seven months… with yo-yo partial or full lockdowns.”

Doctors and hospital administrators have cautioned that they would be unable to cope with a full-on Delta variant wave, should current trends continue. When cases skyrocketed last January, some hospitals treated patients on stretchers used as makeshift beds, and had to reallocate other wards for coronavirus cases. Due to the lack of capacity and oxygen shortages, patients with less severe symptoms were sent home.

Lebanon’s vaccine rollout has been slow, and one vaccination drive was postponed due to electricity issues, but rates are relatively high for the region: Just over 32 percent of the population registered for the vaccine, and less than 21 percent of the population is fully vaccinated (other sources put this number closer to 16 percent). According to data from UNICEF, Lebanon’s cash-strapped government has secured a total of 2.64 million vaccine doses, including 292,800 of the AstraZeneca vaccine from COVAX, and 588,510 doses of Pfizer. Some of the Pfizer doses have come from COVAX and most thanks to money from the World Bank, which reallocated $34 million in emergency funding from an existing healthcare project to pay for them.

Meanwhile, Russia’s Sputnik V vaccine is available through a private distributor, which has mostly been selling them to businesses. There may be more Sputnik V available soon: A Lebanese pharmaceutical company announced in early August it had signed a deal to produce the vaccine locally.

Dr. Khalife says Lebanon can’t just rely on travellers and sick people self-isolating, especially as mass vaccination hasn’t happened yet. “The weakness of over-relying on vaccines has been exposed already, because our access to vaccines was already quite weak, and we started later than other countries,” he said. “We need to focus on preventing cases, and adopt a policy of containment and move towards elimination.”

Kareem Chehayeb, Beirut, Lebanon/The New Humanitarian

Tunisia: A deadly wave abating?

Tunisia faced dire shortages of COVID supplies, as it hit its catastrophic third wave – which now seems to be abating after massive national and international mobilization.

COVID cases: 626,750 – Deaths: 22,025 – Vaccinations: 4,690,354 – Percentage of population vaccinated*: 20.3%

Tunisia’s dramatic third wave of COVID-19 became so catastrophic by late July that it sent protesters into the streets, with the country’s president dismissing the country’s then-prime minister and suspending parliament in a move denounced by critics as a coup.

President Kais Saied said his actions were necessary to fix the country’s faltering economy, and to put a stop to a coronavirus death toll and caseload that had soared to new heights: Morgues had been filling up, hospitals were overwhelmed and running out of oxygen, and grave-diggers were working around the clock.

While cases have since dropped off, Tunisia has the highest recorded death rate per capita in the Middle East and North Africa, with 22,025 deaths in a country of around 12 million. In early August, the WHO said more than 90 percent of the country’s infections were due to the Delta variant, and “being fuelled by low adherence to public health and social measures, as well as low vaccination coverage”.

Since then, the country has kicked off a massive vaccination drive, having received – or been promised – several million doses from Saudi Arabia, the United Arab Emirates, Turkey, and Algeria (which has been struggling with its own wave). Tunisia has also received 1.9 million doses of Pfizer, AstraZeneca, and Moderna vaccines from COVAX.

Tunisia and neighbouring Algeria have also been forced to allocate limited resources to fight devastating wildfires in soaring summer temperatures. “Climate change is here. It impacts people across the globe every day,” Anne Leclerc, from the International Federation of Red Cross and Red Crescent Societies, said in a statement last week. “Combined with the recent surge of COVID-19 cases in the region, we are tackling multiple crises simultaneously. The combination of these is stretching already strained healthcare systems to their limits.”

-The New Humanitarian

Iraq: A third wave, and concern for the next one

A doctor at Baghdad’s Medical City health complex analyses COVID-19 test results, on 1 August 2021.

COVID cases: 1,793,372 – Deaths: 19,815 – Vaccinations: 2,102,550 – Percentage of population vaccinated*: 2.7%

In Iraq, health workers told The New Humanitarian they had been taking major risks to treat the sick throughout multiple waves of the virus, and that even the start of vaccinations hadn’t necessarily reduced their fears.

That’s because its public healthcare system – marked by dilapidated infrastructure, chronic underfunding, a shortage of medical staff, and a serious lack of trust – was recently hit by two deadly fires at facilities treating coronavirus patients. An April fire at a Baghdad hospital killed at least 82 people, and the death toll from a July hospital blaze in a COVID-19 isolation ward in the southeastern city of Nasiriyah is at least 92.

Iraq has received 2.9 million vaccine doses from COVAX, including 1.1 million doses of AstraZeneca and 500,000 Pfizer via COVAX, plus 550,000 more doses of Pfizer from other countries or agreements. It also has 750,000 of Sinopharm. Vaccination campaigns are mostly taking place in major cities and hospitals, which has raised some concern about crowding and the possibility of infection at these centres.

Noor Hazem, a nurse in Baghdad, told The New Humanitarian she has been constantly terrified about bringing the virus home. “I’m in direct contact with the infected, so since the start of the pandemic I’ve been preparing myself to say goodbye to my family forever.”

While Hazem said “the vaccine saved my life”, she added that the April and July disasters had raised new worries for her: “I now wonder about how to avoid getting burned in the hospital where I work.”

Not everyone has been as willing as Hazem to take the vaccine. Ali Kareem, 30, a doctor at Baghdad’s al-Yarmouk hospital, told The New Humanitarian that a worrying number of people have declined to be vaccinated. “We are still facing the height of the third wave, due to people refusing to be vaccinated,” he said. “The situation will get worse,” he added. “We don’t have enough beds for patients, and we’re unlikely to be able to provide them with oxygen or care” as the wave progresses.

The situation is not helped by rumours that the vaccines cause infertility and are a way for Western countries to spy on the population. However, the recent increase in infections and the government’s insistence that people entering official institutions show a vaccine card appears to have increased uptake.

One aid worker, who requested anonymity to speak freely, said the aid community was trying to immunise the more than 248,000 refugees and asylum seekers and 1.3 million internally displaced people in Iraq; but she said refusal rates had been high (although it’s hard to know the actual vaccination rates among these groups because they can’t register independently for the jabs). “We are working hard through awareness sessions about the virus,” the aid worker said. “The infection inside the camps is considered a time bomb… [because] people share cooking tools, food, and bathrooms.”

Health workers were also concerned they would see more cases of the Delta variant because of Muharram, a month that has particular significance for Shia Muslims and began this year on 10 August. This period sees tourists flock to Iraq from Iran and Pakistan, a millions-strong pilgrimage to the southern city of Karbala, and gatherings elsewhere in the country.

Sanar Hasan, Baghdad, Iraq/The New Humanitarian

Yemen: A divided country and COVID denial

Makeshift COVID treatment centre in Aden, Yemen, operated by the International Committee of the Red Cross (ICRC)

COVID cases: 7,308 – Deaths: 1,405 – Vaccinations: 311,483 – Percentage of population vaccinated*: 0.5 %

Yemenis have suffered at least two serious waves of COVID-19, with treatment options extremely limited by a healthcare system that has been decimated by six years of war, and fear of seeking help compounding the problem.

Officially, infections and deaths in both the Houthi rebel-run north (including the capital city of Sana’a) and the internationally recognised government-run south are relatively low and stable at the moment. But recent reports say the Houthis have opted to keep the real case numbers secret (they suggest that releasing this information would generate unnecessary fears), and when vaccines arrived in the country – 360,000 doses of the India-produced Covishield (licensed by AstraZeneca) via COVAX in March – they allowed only 1,000 doses into the part of Yemen they control.

Dr. Abdurrahim al-Murri, who works at the COVID-19 isolation centre at Sana’a’s al-Kuwait hospital, said what appeared to be a second wave had slowed by the end of Ramadan – on 12 May – but had begun to rise again by the start of Eid al-Adha, on 19 July. He said it’s hard to know exactly how many people have died because the Houthis haven’t released any data, but “we think it’s higher than at this time last year”.

The centre where he works closed temporarily in October because admission rates were so low, but now it is full. Dr. al-Murri said it has enough supplies, and that the “main challenge now seems to be the virus’ mutating nature”.

Still, he said, the local community doesn’t trust isolation centres, in part because of widespread rumours last year that Houthi-run hospitals were killing patients on purpose with a lethal injection.

“Most patients arrive too late; we can’t help them survive [at that point],” said Dr. al-Murri, adding that when he asks patients why they waited so long to get help, they mention the lethal injection rumour.

In the south of the country, where in April and May 2020 Aden was believed to be one of the cities with the highest infection rates in the world, cases also appear to have been rising since Eid al-Adha. Dr. Yaser Alwai, director of the COVID-19 isolation centre at Aden’s al-Sadaqah hospital, said that while he has more cases than this time last year, “the team is a bit more organised and prepared.”

Still, he’s concerned about another wave, what the Delta variant will mean for Yemen, and an ongoing shortage of ICU supplies. As in the north, he said, patients often “arrive too late for treatment”.

Dr. Alwai said that when vaccinations began – targeted at health workers and people who need to travel outside Yemen – people were reluctant to get their jabs. “The common person, even some medical staff, were concerned about possible side effects and complications [from the vaccine]. A lot panicked.” Uptake increased, he said, when Saudi Arabia began requiring people who work in the country to show proof that they had been vaccinated.

Still, Dr. Alwai said, misinformation and rumour remains a problem: “A significant portion of the population is denying that COVID even exists. They also have a great deal of fear of seeking treatment at isolation units, until they experience it firsthand.”

​​Shuaib Almosawa, Sana’a, Yemen/The New Humanitarian

Edited by Annie Slemrod.

__________________________

This article was originally published in The New Humanitarian, a non-profit newsroom covering crises around the globe.

*Numbers for percentage of population vaccinated use the assumption that every person needs two doses.

Data source for reported infections, deaths, and vaccinations.

Image Credits: Sanar Hasan/The New Humanitarian, ReliefWeb, The protracted conflict in Libya had forced thousands of people to leave their home, where ICRC distribute food and other essential household items to the most vulnerable. Credit: Fares ELABEID/ICRC, UNICEF , World Bank Group , ICRC.

A young man stands outside a row of buildings destroyed by a 7.2 magnitude earthquake in Haiti followed by a storm surge from Tropical Depression Grace

COVID cases across most countries of South America are now declining,  after months in which the region was the epicenter of the pandemic. 

But in the seesawing trends that the pandemic continues to see, infections are rising again throughout central and North America – as well as the Caribbean – where earthquake torn Haiti faces special risks. 

Haiti has only vaccinated about 21,000 people – after receiving its first shipment of COVID vaccines only last month, said PAHO’s assistant director, Jarbas Barbosa, speaking at a PAHO press briefing: “We are working with the ministry of health to expedite the process, despite all the challenges that Haiti is facing,” he said.

Risks of COVID transmission are rising as thousands of displaced people in Haiti’s southwestern pennisula crowd shelters or seek refuge with extended family members. Two dozen health facilities in the area have been damaged and are struggling to regain services in the hardest hit provinces of Grand’Anse, Nippes and Sud, the PAHO officials said at a Wednesday press briefing. Those factors, combined with already poor COVID testing capacity, will make case reporting and tracking even more difficult in the wake of the natural disaster.   Over 1.5 million people, including 540,000 children have been impacted by the earthquake, according to UNICEF.

On a brighter note, in Brazil, hospital occupancy has dropped by an average of 80% across all states for the first time since November, said Dr Carissa Etienne, Director of the Pan American Health Organization, which is responsible for WHO’s Americas Region, at the briefing.

But at the same time, COVID infections are now rising across Mexico and the United States, fueled by the highly infectious Delta variant.   

 “In Mexico, more than two thirds of states have been deemed at “high” or “critical” risk as hospitals fill with COVID patients,” she said.

Cases and deaths also are rising in Central America, including countries such as in Costa Rica, where vaccine drives have been fairly successful.  Likewise, infections and deaths are increasing across the Caribbean, including in Cuba. Dominica, Guadalupe, Jamaica, Martinique, and Puerto Rico, where cases rose by 49% and deaths increased by 70%. In Trinidad and Tobago, weekly deaths continued to rise, said PAHO officials.

Appeal for aid to earthquake-struck Haiti

Epicentre of 2021 Haiti earthquake

Meanwhile, groups ranging from USAID to the European Union were rushing aid to Haiti, where at least 1,300 people have been killed by the 7.2 magnitude quake that struck early Saturday morning.  Another 5,700 people have been injured, said Médecins Sans Frontières, which said that a complete mapping of the disaster in remote areas remained challenging.

“Many patients are outside or in tents, not to mention all the Haitians who have lost their homes, said Michael Olivier Lacharité, MSF head of emergencies.  Heavy rains from tropical storm Grace and landslides damaging access roads were further challenging relief workers – who were resorting to helicopter and sea travel when feasible.

WHO Appeals to International Community for Aid

People search through the rubble of what used to be the Manguier Hotel after the earthquake in Les Cayes. Haiti, 14 August, 2021.

Etienne called on the international community to meet the country’s “immense” need for medical aid, including health workers, medicines, equipment and transport vehicles. 

“What we need is health personnel, supplies and equipment to treat patients with trauma, injuries, acute illnesses, chronic diseases and mental issues,” she said at a Wednesday briefing. “There is an urgent need to restore health services mainly in the most affected areas and to ensure adequate water and sanitation to prevent increases of diarrheal, respiratory, and skin diseases.”

“Our hearts go out to the people of Haiti, and rest assured that we are doing everything possible to assist Haitians in these difficult and hard times,” added Etienne, paying special homage to PAHO public health emergencies specialist, Dr. Ousmane Touré, who perished in the earthquake. 

‘Moment in history of extreme fragility’

Her comments were echoed in Geneva by Dr Tedros Adhanom Ghebreyesus, noting that on the occasion of World Humanitarian Day, observed Thursday August 19, world was facing unparalleled challenges from health and humanitarian response efforts in corners of the world as diverse as Haiti and Afghanistan – compounded by the overarching challenges of the COVID pandemic.

“I can honestly say that I have never seen so many emergencies happening simultaneously. This moment in history is one of extreme fragility,” Tedros said.

The Haiti earthquake was the latest in a series of natural and political disasters to have struck the island nation, also one of the poorest in the world.  The earthquake hit along the same fault lines that triggered another 7.0 magnitude earthquake in 2010 killing as many as 300,000 people in and around the capital city of Port-au-Prince.  

While this time the capital city escaped relatively unscathed, the tremor’s epicenter in remote rural regions also made relief and rescue operations more difficult. And it was a particularly traumatic blow for people who had relocated to the penninsula just a decade ago in order to get away from earthquake risks – only to find themselves homeless once again, the New Humanitarian noted. 

Image Credits: UNICEF/Georges Harry Rouzier, US Geological Survey/Google Maps, Médecins sans Frontières.

booster
COVID booster vaccines have gained traction in several countries – US, Israel, Germany, UK, and others, but low- and middle-income countries lag significantly behind in shots.

US Health officials confirmed on Wednesday that the country will begin to offer a third COVID ‘booster’ vaccine, beginning the week of September 20, to Americans who were vaccinated earliest in the vaccination rollout.

It’s now “very clear” that immunity starts to fall after the initial two doses, and with the dominance of the Delta variant, “we are starting to see evidence of reduced protection against mild and moderate disease,” according to the US CDC statement announcing the move, and signed by Director Dr. Rochelle Walensky, acting FDA Commissioner Dr. Janet Woodcock, White House chief medical advisor Dr. Anthony Fauci and other U.S. health leaders.

Boosters will be administered 8 months after an individual’s second dose on a rolling basis, the statement said.

The officials said that the plan to offer a third Pfizer or Moderna mRNA vaccine is still “subject” to review and evaluation by the US Food and Drug Administration (FDA) of “safety and effectiveness” along with the CDC’s Advisory Committee on Immunization Practices (ACIP).  But with the FDA having recently  authorised booster shots for severely immunocompromised people – that new layer of FDA approval appears to be almost a foregone conclusion.

Recipients of Johnson & Johnson’s single-shot vaccine will also likely need boosters, the officials said. But they are awaiting more data in the next few weeks before making a formal recommendation.

“Our top priority remains staying ahead of the virus and protecting the American people from COVID-19 with safe, effective, and long-lasting vaccines especially in the context of a constantly changing virus and epidemiologic landscape. We will continue to follow the science on a daily basis, and we are prepared to modify this plan should new data emerge that requires it,” the joint statement read.

Fresh data from Israel shows boosters’ efficacy

The new US push came as fresh data from Israel suggested that a third shot of the coronavirus vaccine is 86 percent effective in preventing COVID-19 infection among people aged 60 and older. The Maccabi Healthcare Services study, the first of its kind in the world, provided the first large-scale data on booster efficacy.

The study surveyed 149,144 people who received a third booster shot against a control group of 675,630 people who received only the two-course series, in January or February, 2021.

Among those receiving the booster,  only 37 people tested positive with the SARS-CoV2 virus, as compared with 1,064 in the group vaccinated with just two doses in a survey a week after the test group receive the third dose.

Israel is currently battling with the fourth highest rate of COVID-19 infections per capita in the world – exceeded only by Georgia, Dominica and Cuba – and well ahead of other former hotspots like the United States, the United Kingdom, India, and Brazil.  Although protection of older people against severe COVID with just two vaccine doses was still 5-6 times higher than among those not vaccinated- that was still not enough to stem the sharply rising stream of intensive care cases, in light of the unprecedentedly high infection rates, the government said.

Now, however, the boosters- which some 1 in 9 Israelis and a total of 1 million people over the age of 50 have now received in just the past two weeks, – seems to be finally bending the curve of serious cases at least, said former Director General Gabi Barbash on an Israeli news channel Tuesday evening.

And that could make the difference between a manaegeable case load and the “tragedy” of hospitals soon becoming overwhelmed with more serious cases than they can handle, he asserted.

US infections ‘vertical’ with widespread vaccine hesitancy

Vaccine coverage across the US – % of population with at least one dose.

While US infections lag well behind Israeli rates for now, they are on a similar trajectory. Experts such as Peter Hotez, of Texas Children’s Hospital, have pointed to an almost “vertical” pattern of increasing infections in the US – particularly in areas where widespread vaccine hesitancy has left coverage levels at 30% or less.

“This [pandemic] is really raging,” he added, noting the new cases are almost as bad as the pandemic had been earlier this year, in January and February.

“We’re pushing up to 150,000 new cases a day. This will probably soon be up to 200,000 cases a day,” he said in an interview Tuesday on CNN. Hotez spoke in favor of booster shots, alongside additional public health measures, as a way to defeat the pandemic.

“As a nation, we have to figure out a way to do both, [getting booster shots and getting unvaccinated people vaccinated].”

Outcry Among WHO officials

WHO Director-General Dr Tedros Adhanom Ghebreyesus

Despite the growing evidence of efficacy, the new booster policies have been fiercely denounced by WHO, led by Director General Tedros Adhanom Ghebreyesus.

Over the weekend and again on Wednesday, Tedros renewed his appeals for a “moratorium” on third jabs until more people in low- and middle-income countries could get their first shots.

“Last week, WHO brought together 2,000 experts from all around the world and debated the available data on COVID-19 boosters. What is clear is that it’s critical to get first shots into arms and protect the most vulnerable before boosters are rolled out,” Tedros stated in a press briefing.

“The divide between the haves and have nots will only grow larger if manufacturers and leaders prioritize booster shots over supply to low- and middle-income countries,” he added.

That followed warnings by Tedros over the weekend that diverting global vaccine supplies to boosters could foster the spread of dangerous variants in vaccine-poor countries elsewhere.

Boosters – Like Handing out ‘Second Life Jackets’

Dr Mike Ryan, WHO Head of the Health Emergencies Programme.

“The fundamental ethical reality is we’re handing out second life jackets while leaving millions and millions of people without anything to protect them,” WHO’s Executive Director of Health Emergencies, Mike Ryan added, noting that around  58% of people in high-income countries have received at least one vaccine dose as compared to just 1.3 % percent in Africa.

Ryan and other WHO officials, such as Chief Scientist Soumya Swaminathan, also maintain that the science so far remains undecided about whether boosters are actually needed.

“It is the right thing to do”  to wait for the evidence to determine who might need boosters, Swaminathan said.

Dorit Nitsan, WHO European Region’s head of Health Emergencies, and herself an Israeli, called on Israel and other rich governments administering boosters to at least share more of their vaccine stocks with poorer countries.

“I’ve raised this issue repeatedly in the past, and others have also raised it recently, but the issue never took center stage,” said Nitsan in an interview on Sunday with Israel’s liberal news daily, Ha’aretz.  Nitsan proposed that for every dose administered in Israel, the country should donate “one dose, half a dose or some other number to the world.”

‘I disagree’ Biden Pushes Back at WHO

President Joe Biden at White House briefing on COVID vaccinations Wednesday evening.

Speaking at a press conference in Washington DC a few hours later, US President Joe Biden pushed back at the WHO statements, saying: “There are some world leaders who say  America shouldn’t get a third shot until other countries got their first shot. I disagree.

“We can take care of America and help the world the same time, in June and July America administered 50 million shots during the United States. And we donated 100 million shots to other countries. That means that America has donated more vaccine to other countries, and every other country in the world combined.

“During the coming months, fall and early winter. We expect to give out another about 100,000 boosters, and the United States will donate more than 200 million additional doses to other countries. This will keep us on our way to meeting our pledge, more than 600 million vaccine donations over half a billion. I said as I said before, we’re going to be the arsenal of vaccines to beat this pandemic as were the arsenal of democracy to win World War II.”

Israel’s Mission in Geneva, meanwhile responded saying that Israel’s precedent-setting vaccine moves are informing policies elsewhere: “Israel will continue to share data, findings and knowledge with the scientific community world-wide. Throughout the pandemic we have seen that knowledge transfer and accumulation are critical to fighting the pandemic,” a spokesperson said.

“Scarcity Trap’ or Not?

In contrast to governments, the WHO appeals for a moratorium have gained greater traction among global health experts concerned with vaccine equity:

“No, Boosters are NOT good pub health policy now. Not when most of world hasn’t gotten 1st shot & policymakers insist on monopolized production leading to global shortage of doses. If you want to end the pandemic @DrTedros is right, booster moratorium,” said Matthew Kavanagh, a professor of global health at Georgetown University, on his Twitter feed.

Others, however, have observed that the real problem is vaccine scarcity – and the lack of broader access to the most effective vaccine technologies.

“I sympathize with the booster moratorium, yet I wonder whether it falls into the scarcity trap. With the right rules & ambition, there are enough vaccines at the right price & the right dose for everyone. Abundance over scarcity. That has been our demand from the beginning. Non?” said Jon Cohen, Director of New York-based Open Society Health.

Added Lawrence Gostein of the O’Neill Institute at Georgetown Law,”Offering a 3rd dose to the entire US pop will create even more global scarcity, robbing low income countries of lifesaving doses for health workers & the vulnerable. It’s a slap in the face to WHO which called for a booster moratorium.”

Instead, said Gostin: “Biden should limit 3rd doses only to the most vulnerable, including health workers, nursing home residents & the elderly.”

He also should pledge a major global vaccination campaign including billions of donated doses & ramping up global vaccine supplies.”

He further added, in a follow-up tweet regarding CDC’s data on waning protection: “We can’t just view this from a US perspective. Each dose we use in the US is not available to save a life in a low resource country. It’s also tone deaf to the mounting deaths globally & defies WHO’s pleas against boosters.”

US FDA Authorization likely to set off a trend

Israel was the first country in the world to begin offering booster shots 29 July to people over the age of 60 that had received the highly efficacious Pfizer or Moderna mRNA vaccines, even before the US Food and Drug Administration initially authorized an additional vaccine dose for certain immunocompromised individuals.

The US CDC’s most recent authorization for boosters for those vaccinated earliest, which now includes many health care workers, nursing home residents, and other seniors, is now likely to set off an even wider trend of booster shots in other rich countries fearful of a Delta virus onslaught this fall – or already experiencing one this summer.

The United Kingdom’s National Health Service has been given the green light to start planning a COVID vaccine booster program, beginning 6 September, including some 32 million booster doses.

Germany also plans to begin offering booster shots to vulnerable persons beginning in September, including people over age 50 as well as younger people employed in geriatric and health institutions, and those suffering from underlying conditions.

German Health Minister Jens Spahn at WHO briefing in Geneva

During a high-level visit to Geneva in July, German Health Minister Jens Spahn asserted that there should be “no contradiction” between offering booster shots – and getting more vaccines to low- and middle income countries.

“I think we should be able to do both [administer boosters and vaccinate high-risk groups in other countries]. I want both to be possible for us to be able to provide a third vaccination, while also providing our first vaccination to everyone around the world…One shouldn’t come on the account of the other,” he said at an event at the Geneva Graduate Institute, adding that he expected vaccine surpluses, rather than shortages, by 2022.

Fractional doses – for the vaccine impoverished

However, the reality remains that vaccine doses are only beginning to trickle into Africa again now – and at far lower levels than appeals launched by WHO over the summer.

So as some wealthy countries plan booster shots, researchers in poor countries are even calling for “fractional dose” administration to stretch scarce resources.

Meanwhile, European and US officials – while supporting vaccine equity in principle- still have not come up with a formula for ensuring vaccine sharing at the levels that WHO says are needed.

That leaves little chance now that the ambitious WHO goals for achieving a 10% vaccination goal in all countries by end-September will actually be met.

Image Credits: Marco Verch/Flickr, CDC, WHO.

afghanistan
Afghan women health workers are vital to health services response, including reproductive health issues, says WHO.

WHO has affirmed that it is staying in Afghanistan and providing emergency aid to the tens of thousands of recent victims of conflict and displacement – even as staff in some NGOs go into hiding or desperately seek to leave the country for fear of their lives.  

“The World Health Organization (WHO) is committed to staying in Afghanistan and delivering critical health services and calls on all parties to respect and protect civilians, health workers, patients and health facilities. During this difficult time, the well-being of all civilians — as well as the safety and security of our staff — in Afghanistan is paramount,” said Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean Region, to which Afghanistan belongs, in a statement Wednesday morning. 

“We cannot backslide on two decades of progress,” WHO Director General  Tedros Adhanom Gheybreysus said in a Wednesday press conference in Geneva. “Our staff remain in the country and are committed to delivering health services to the most vulnerable.”

Tedros said that he had spoken personally to the acting health minister of Afghanistan, Wahid Majrooh: “He is in Kabul working to avoid disruptions and keep essential health services moving. I reassured him that WHO and staff will continue to support the country.” 

“I call on the international community and all actors to prioritize their access to all health services and to safeguard their futures.” Tedros added. 

These comments were made in light of the upcoming World Humanitarian Day on 19 August, as Tedros noted that many emergencies were occurring simultaneously, including the earthquake in Haiti.

“The humanitarian system is being pushed to its absolute limit – and beyond – by the climate crisis, natural disasters, conflict, and the COVID-19 pandemic.”

Mass casualty response, trauma care and diarrhoeal disease are priorities 

The violence in Afghanistan has taken a toll on an already fragile health system.

Supplies and support for mass casualty response, trauma care, cholera and diarrhoeal disease prevention and management, are among the top priorities, WHO has said.

Addressing the needs of displaced populations – including malnutrition, high-blood pressure, COVID and reproductive health, are also critical priorities, Al Mandhari stressed in his statement, also emphasizing the need to ensure women access to female health workers. 

“Months of violence have taken a heavy toll on Afghanistan’s fragile health system, which had already been facing shortages in essential supplies amid the COVID-19 pandemic,”  Al-Mandhari said.  

“As a result of the recent conflict, trauma injuries have increased, requiring scaled up emergency medical and surgical services. In July 2021, some 13 897 conflict-related trauma cases were received at 70 WHO-supported health facilities, compared to 4057 cases in July 2020,” he said. 

Displaced populations & women’s health key priorities 

Women’s health in Afghanistan remains a key priority for WHO

WHO also pointed out an “immediate need” for sustained humanitarian access and health services in Afghanistan, placing special emphasis on women’s health and displaced populations.

“In areas where people have fled to seek safety and shelter, including Kabul and other large cities, field reports indicate that there are increasing cases of diarrhoea, malnutrition, high blood pressure, COVID-19-like symptoms and reproductive health complications,” continued Al-Mandhari in his statement. 

“Delays and disruptions to health care will increase the risk of disease outbreaks and prevent some of the most vulnerable groups from seeking life-saving health care. There is an immediate need to ensure continuity of health services across the country, with a focus on ensuring women have access to female health workers.”  

“Furthermore, attacks on health care remain a major challenge. From January to July 2021, 26 health facilities and 31 health care workers were affected; 12 health workers were killed. ”

COVID vaccines anyone? 

Both Tedros and Al-Mandhari, however, avoided addressing questions around the fate of Afghanistan’s COVID-19 vaccine drive  – although a WHO spokesperson in Geneva, Tariq Jaresevic, confirmed on Tuesday that vaccinations, as well, had been interrupted by the violence, and expressed concerns about the future of vaccine efforts. 

It’s unclear if the new Taliban rulers will in fact allow the campaign to proceed – particularly in light of the past responses to polio vaccine campaigns. Those campaigns have met, at times, with resistance in rural areas where militants long had influence and control.  Afghanistan remains one of the few countries of the world still battling with wild polio virus.  

Al-Mandhari referred to vaccines only in passing, saying: “WHO continues to work with partners to respond to COVID-19 with a focus on diagnosis and testing, surveillance, clinical care, infection prevention and control, vaccination, and referrals for recently displaced people in major cities.”  

United Nations & International Rescue Committee also says it’s staying  

Along with WHO, the International Rescue Committee, and UN humanitarian staff say that they’re committed to staying in the country to assist displaced and vulnerable populations – while further operations for other organizations seem more uncertain. 

We’ve worked under multiple regimes, we’ve worked through multiple cycles of crisis, and we’ve always found a way to work with different actors in order to serve the people of Afghanistan,” said Ciaran Donnelly, Senior Vice President for Crisis Response Recovery and Development, IRC, in an interview on CNN on Tuesday. 

“That’s really our mission we’re focused on helping all of the millions of Afghans in need of humanitarian assistance, and we’re hopeful that we’ll have access to do so we’ll be able to work alongside our humanitarian partners, and all of the authorities on the ground, to be able to deliver assistance.”

The ongoing COVID-19 pandemic, in addition to the escalating humanitarian crisis, requires continued assistance, he pointed out. 

“We can’t forget that the COVID pandemic is still affecting Afghanistan; it’s still the public health measures in particular and to keep people safe in times of displacement that are also high on our list.”  

He called on international donors to “redouble their efforts” in supporting humanitarian aid inside Afghanistan. 

“I think the national responsibility to the people of Afghanistan doesn’t end with the international presence, the presence of international forces on the ground. There’s a humanitarian commitment that must be maintained to support the people of Afghanistan.”

UN to ‘stay and deliver’ in Afghanistan

“I urge all countries to receive Afghan refugees, and refrain for any deportations” — UN chief Secretary General Antonio Guterres said at an emergency Security Council meeting on Afghanistan. UN has reaffirmed its commitment to remain in the country.

Meanwhile, Ramiz Alakbarov, Resident and Humanitarian Coordinator of the UN in Kabul said in a statement that the UN staff would “stay and deliver” aid during this time, though some UN personnel have been relocated. 

“The humanitarian community – both the UN and non-governmental organizations – remain committed to helping people in Afghanistan. While the situation is highly complex, humanitarian agencies are committed to supporting vulnerable people in Afghanistan who need us more than ever.” 

UN Geneva spokesperson Rheal LeBlanc has also noted that no UN staff has evacuated Kabul. 

“It’s clear that the Taliban and other authorities have the responsibility to protect and ensure the safety of UN staff whether they be national or international and to do whatever they can to ensure their safety.”

Countrywide, the UN employs approximately 3,000 national personnel and 720 international staff members in Afghanistan – although more than half were already remotely  outside the country because of the pandemic. Along with relief and development, a UN political mission, called Unama (UN Assistance Mission in Afghanistan), led by the Canadian, Deborah Lyons. Unama was established in 2002 to support the national government established after the initial United States invasion of the country, in response to the 9/11 attacks on the US. As of Sunday, Lyons was said to be in Kabul and working, and UN Secretary-General António Guterres is reported to be seeking an even stronger role for the mission as Afghanistan transitions to a new government, reported PassBlue. Unama’s base in Herat was attacked, however, by the Taliban on July 30, killing a local security official. 

NGOs – negotiating with Taliban

For other agencies and NGOs, staff safety will rely upon the outcomes of sensitive negotiations with Taliban officials. 

Said one aid worker in Kabul, interviewed anonymously in The New Humanitarian, these negotiations haven’t begun. 

“We would just be waiting for [the Taliban’s] NGO representative to reach out to us. We’re not sure who that is at present,” the aid worker was quoted as saying.

In other parts of the country, Taliban officials have reportedly reached out to NGOs, with indeterminate outcomes so far, NHM reported. 

While some Taliban officials have asked aid workers to continue their operations, in areas where the fighting is more violent, Taliban has taken charge of NGO offices, leaving the overall situation very unclear. 

“They approached us. They went to our office, and asked us what kind of organisation we are,” a senior official at another NGO, which has suspended its programmes in northern Afghanistan, pending more clarity on whether their operations could be authorized to continue.

Image Credits: WHO Eastern Mediterranean Regional Office , British Red Cross/Twitter, Paul Hudson/Flickr, The UN Times/Twitter.

who
The WHO-led ACT-Accelerator appeals for US $11.5 billion towards vaccines, testing, and much needed PPE.

With more COVID-19 cases reported in the first half of 2021 than in the whole of 2020, despite high vaccination rates in some countries, the WHO-led Access to COVID-19 Tools Accelerator (ACT-Accelerator) has mounted a US $11.5 billion appeal to stem the surge of dangerous variants and save lives. 

Called the Rapid ACT-Accelerator Delta Response (RADAR), the first US $7.7 appeal, if funded, would enable ACT-Accelerator to urgently: scale up testing and surveillance to protect against new variants; address acute oxygen needs to save lives; rollout COVID-19 tools needed for effective deployment of vaccines; and protect frontline healthcare workers with necessary PPE. 

The ACT-Accelerator is a global umbrella mechanism for collecting and distributing tests and treatments through the vaccine facility COVAX.

WHO Director-General Tedros Adhanom Ghebreyesus has called investment for RADAR “urgently needed.” 

“This investment is a tiny portion of the amount governments are spending to deal with COVID-19 and makes ethical, economic and epidemiological sense. If these funds aren’t made available now to stop the transmission of Delta in the most vulnerable countries, we will undoubtedly all pay the consequences later in the year.”

In addition to the US$ 7.7 billion appeal, there is an opportunity to reserve a supply of 760 million doses of vaccines in the fourth quarter of 2021, ensuring a continued supply of doses for delivery by COVAX in 2022. 

On delivery, these 760 million doses will cost an additional US $3.8 billion, though WHO did not specify which vaccines were to be reserved. 

Low- and middle-income countries lag behind in vaccinations 

As of July 7, whereas more than half of individuals (51%) have received at least one dose in high-income countries (HICs), only 1% of the population in LICs, 14% in LMICs, and 31% in upper middle-income countries (UMICs) have received at least one dose.

WHO’s appeal has highlighted the inadequate testing and low vaccination rates that has exacerbated disease transmission, with low- and middle-income countries (LMIC) lagging significantly behind the rest of the world when it comes to vaccination.

So far only 14% of the population in LMICS have received at least one dose of the vaccine, while more than half of individuals (51%) in high-income countries have been vaccinated at least once. 

Only 1% of individuals in low-income countries have been vaccinated.

If these trends continue, LMICs are unlikely to meet vaccination targets by the end of the year. 

Inequity in vaccine distribution – “West’s Failure” 

Such inequities in vaccine distribution have been called a “shocking symbol of the west’s failure to honor its promise”, by former UK Prime Minister Gordon Brown, in an op-ed published today in The Guardian. 

“Vaccine nationalism – and Europe’s neocolonial approach to global health – is dividing the world into rich and protected people, who live, and those who are poor, unprotected and at risk of dying.”

This vaccine nationalism is evident as Brown points out that 10 million single-shot Johnson & Johnson vaccines produced in South Africa will be exported to Europe, at a time when Africa is grappling with its deadliest wave of COVID-19 seen to date. 

Even though 77.3 million doses have been administered across Africa’s population, this number pales in comparison to the 496 million vaccines that have been administered across the European Union. 

Europe remains the continent with the highest coverage in vaccine distribution (40%), while Africa is the lowest (2%).

At a time when wealthy countries, such as the US, Israel, and Germany, have already begun to authorize or administer booster shots for immunocompromised or elderly populations, Brown called for “global coordination”, which has so far been absent among G7 and G20 leaders. 

This means that countries with excess supply of vaccines should release them to Africa, and provide at least US $50 billion in financial support through COVAX. 

“G7 leaders”, said Brown, “must now step in to ensure the supplies go where they are need most.” 

He added that ensuring vaccines to African populations is “not just an imperative for Africa. It’s all in our enlightened self-interest.” 

“The biggest threat we all face is COVID spreading and mutating uninhibited in unvaccinated countries.”

Image Credits: Gavi , KFF.

ebola ivory coast
WHO is helping to coordinate cross-border Ebola response activities and procure Ebola vaccines from Guinea.

The Ivory Coast has confirmed this Sunday its first case of Ebola since 1994 – in a case that was apparently imported from Guinea. That is despite the fact that Guinea’s outbreak was formally declared as over by WHO in June – reflecting the way the deadly virus can lie dormant in some individuals, only to erupt at a later date.

Ivorian health officials found samples of Ebola virus disease from a patient who was hospitalized in the commercial capital of Abidjan, after arriving from Guinea. The patient had travelled to the Ivory coast by road, arriving in the city on 12 August. The patient has since been admitted to the hospital after experiencing a fever and is currently receiving treatment. 

Neighboring Guinea had recently experienced a four-month outbreak of Ebola, in which there were 16 confirmed and 7 probable cases reported, and among these cases, 12 deaths. Although the outbreak was supposed to have concluded in June, recent evidence has documented how infections can linger asymptomatically in some people for months, and even years – only to reappear at a later date.   

The Ivory Coast is the third country to experience an Ebola outbreak in 2021, following on from Guinea and the Democratic Republic of the Congo (DRC), whose outbreak in the eastern province of North Kivu also was quickly squashed with a vaccine drive and declared over in May. 

But this is the first time an outbreak has occurred in a large capital city such as Abidjan since the 2014-2016 West African Ebola outbreak. That, WHO has said, is a big concern because of the potential for just one individual to infect others in close proximity.

“It is of immense concern that this outbreak has been declared in Abidjan, a metropolis of more than 4 million people,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. 

Immediate WHO Response 

Despite this, Moeti remains confident that Africa’s hard-earned lessons in treating Ebola cases and tracking contacts will prove effective once more in containing the deadly disease. 

“Much of the world’s expertise in tackling Ebola is here on the continent and Cote d’Ivoire can tap into this experience and bring the response to full speed,” she said in a press statement. ” The country is one of the six that WHO has supported recently to beef up their Ebola readiness and this quick diagnosis shows preparedness is paying off.”

WHO is helping to coordinate cross-border Ebola response activities, with 5000 Ebola vaccine doses that were used to fight the outbreak in Guinea now being transferred to the Ivory Coast, following an agreement between the countries’ health ministries. 

An aircraft will be departing Abidjan to collect the vaccines that will be used to immunise people at high risk, including health workers, first responders, and contacts of the confirmed case and any others that emerge. 

The Ivory Coast has declared an outbreak in line with the International Health Regulations, and WHO currently does not advise any travel restrictions to and from the country, the Organization said.

Image Credits: WHO AFRO/Twitter.