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.

Countries will have a full agenda at the upcoming climate conference in Glasgow, facing pressure to take drastic action before the ravages of global warming become irreversible.

This year’s 26th UN Climate Change Conference of the Parties (COP26), will be a critical moment of decision on climate policies, as the clock runs down before the more severe ravages of global warming become irreversible.

Against the panoply of issues under debate, health is getting more attention from this year’s COP26 organisers as a potentially powerful motivating factor for action – although it remains to be seen if that can also translate into more concrete climate commitments from countries. 

“The COP26 presidency has for the first time ever in the history of climate negotiations put a special emphasis on health – and developed a dedicated Climate Health Programme specifically for COP,” Marina Maiero, a Technical Officer in Partnership and Advocacy as part of WHO’s Climate Change and Health team, told Health Policy Watch.  

“Health and the health sector will be more powerfully represented at this COP than ever before,” adds Josh Karliner, International Strategic Director of the global NGO Health Care Without Harm – which promotes greening the healthcare sector.

“While health has never been, and may never be, at the center of the climate negotiations, per se, due to the very technical nature of these talks, protecting people’s health from climate change is increasingly central to the climate conversation in and around the COP,” said Karliner in an interview with Health Policy Watch. 

“In the lead up to COP 26, COVID-19 has heightened awareness of the intimate connections between climate change and health for climate negotiators and health policy makers alike. Indeed, the UK COP Presidency has made health a scientific priority,” he said.

‘Belated recognition’ – but still not a central theme  

Health advocates have long maintained that placing human health at the heart of climate negotiations is critical to mobilising the political will required to meet the 2015 Paris Agreement target of keeping global warming under 1.5°C.

Even so, the health and climate nexus still remains on the sidelines of the formal  conference proceedings – with nary a mention on the COP26 programme to date.  

That reflects the long road yet ahead to convince most countries to take up health-related climate commitments, says Sir Andrew Haines, professor of environmental change and public health at the London School of Hygiene and Tropical Medicine. 

“There is a belated recognition of the importance of health in the climate change agenda – although it’s not one of the official themes,” Haines told Health Policy Watch. 

“The UK Government is becoming more interested, although its main focus is on decarbonisation of the health care sector, building on the NHS Commitment to achieve net zero emissions by 2040 for direct and 2045 for indirect emissions,” he points out. 

“Though the UK government, which serves as the incoming president of the COP, has a number of initiatives focused on health, health does not yet have a strong role in the negotiations,” Dr Jeni Miller, Executive Director of the Global Climate and Health Alliance, told Health Policy Watch.

Already in November 2020, just before the Glasgow COP26 conference was postponed due to the COVID pandemic, the UK Government produced a series of key messages, case studies and essays on climate change and health – drawing on contributions from WHO, Wellcome Trust, LSTHM, and the Global Climate and Health Alliance (GCHA).   

Health and climate change COP26 campaign aims of the UK COP26 Presidency.

Promoting Health & Climate Nexus  

In fact, environmental health experts in WHO, academia and the NGO world, have spent years promoting the health and climate nexus as integral to the climate narrative. 

The fruits of those efforts are evident in the recent Intergovernmental Panel on Climate Change (IPCC) report, which refer in more detail than ever to the impacts of climate change on human health and well-being. See related story:

Climate Scientists Issue ‘Red Alert’ for Humanity – and Health 

The findings of the report are a “big red neon sign” alerting those in the traditional “climate camp” that health is becoming a more salient climate issue, says Dr Kim Knowlton and Dr Vijay Limaye, of the Natural Resources Defense Council (NRDC).  

“Hopefully there will be a lot of energy around climate-health adaptation, given the findings of the Working Group I report that’s just come out,” they told Health Policy Watch. 

“It finds that many climate impacts are already ‘locked in’ and that makes adaptation – finding ways to limit the health-harming effects of climate change that are already occurring and hammering frontline communities – even more critical,” said Knowlton and Limaye. 

The authors of the IPCC report project an increase in extreme heat exposure, heavy rainfall, drought, fire weather, and warming oceans.

Strong country responses to climate & health threats still lacking 

Cycling in Fortaleza, Brazil – the city strengthened its active transport plans as part of a WHO co-sponsored Healthy Cities Partnership. Cycling also reduces carbon emissions from transport.

However, so far, responses fall far short of the mark in most countries –  which continue to develop and subsidize polluting fossil fuel-based energy sources that create air pollution as well as climate emissions, and build unhealthy cities that lack access to green spaces, healthy mobility, housing, and foods. 

“There are major gaps in considering the health effects of climate change and health in adaptation policies or the co-benefits of GHG mitigation [in countries’ NDCs],” said Haines.  

He points to a recent analysis of the Nationally Determined Commitments (NDCs) of 40 nations – that looked at how governments’ national climate commitments recognise and respond to the linkages between climate change and health.

The “climate and health scorecards” point to gaps in all three policy domains: assessing the health effects of climate change; integrating plans for more climate resilient health systems into climate adaptation strategies, and choosing climate mitigation strategies that also optimise “health co-benefits.” 

Such co-benefits are huge, ranging from healthier plant-based diets to shifting urban transport systems to walking and cycling to stimulate physical activity, reduce climate emissions and air pollution – which kills over 7 million people a year. 

In the 15 countries with the highest greenhouse gas emissions, the health impacts of air pollution alone are estimated to cost over 4% of GDP. And yet most countries have yet to recognise in their NDCs how the health gains from investments in clean energy will reduce air pollution deaths.  

Health care services – 4.4% climate footprint, pollution & waste 

Essential health care procedures generate huge amounts of disposable waste.  Portrayed here are preparations for COVID vaccine administration in Argentina.

Along with that, there is enormous pollution and waste produced by health care services as such – from plastic disposables to energy intensive building operations.  All of that leaves a climate footprint – responsible for some 4.4 % of global climate emissions. And yet Argentina is the only country so far to explicitly include health care emissions reductions in its revised 2021 NDC strategy. 

“We can conclude that national governments’ understanding of climate change as a threat to health is quite limited but probably greater amongst low-income nations,” said Haines.

“Some countries have shown some progress [on achieving their climate targets] and some have integrated health, which is positive news,” agrees Maiero. “But it’s not enough.”

At the broader level, even the most updated commitments made so far by countries are insufficient “to really have global action that will allow the world to keep global temperature rises below 1.5 degrees Celsius”, WHO and other experts point out.

“The overall concern is that none of [the NDCs] are ambitious enough,” Maiero observed. 

The projected changes in extremes are larger in frequency and intensity with every additional increment of global warming, finds the IPCC Working Group I report.

Climate change leading to more & more deaths 

Against the political indifference, however, a growing body of evidence has sharpened our appreciation of how climate change is directly increasing mortality – from factors like extreme heat and extreme weather – not to mention more indirect issues like food insecurity.  

“Recent findings [show] that between 1991-2018, over a third of global heat-related deaths could be attributed to climate change,” said Knowlton and Limaye. “The [IPCC] report [demonstrates that] avoiding half a degree Celsius (0.9°F) of average warming could mean avoiding those deaths – that is, we could see far fewer heat-related health harms globally, plus fewer illnesses and deaths from more severe wildfires, hurricanes, floods, and other climate change-fueled extremes.”

“That’s a safer, healthier world that we need to fight for and demand from our global leaders,” said Knowlton and Limaye. 

“It’s also a world in which people, families, businesses and governments are less burdened by healthcare-related expenses tied to hospital care and emergency room treatment of health problems triggered by these climate-fueled hazards,” they said. 

Hopes from COP26 – health more prominent in NDCs and carbon markets 

The 26th UN Climate Change Conference of the Parties, will be a critical moment of decision on climate policies.

This year, once more, WHO will be asking UN member states at COP to include explicit references to health and equity in their NDC climate commitments – in line with WHO’s guidelines for a green and healthy recovery from COVID-19. 

“Our straightforward hope is that…everything negotiators and policy makers will do, they will do it in the name of health, because they recognise that taking action on the climate means improving the wellbeing and health of their population,” said Maiero.  

“We want to make sure that going forward, health and equity are the guiding compass of the Paris regime,” she adds. “We want to convey the clear message that health benefits from climate action…[and] investing in climate will improve health and actually compensate [countries].”  

COP26 also is a key moment to finalise the Paris Rulebook, the guidelines for  implementation of the Paris Agreement. Clear guidance to countries regarding the strengthening of national climate plans, and their implementation, will help transform the landmark agreement into a functioning system. 

And health needs to be central to the discussions surrounding the Rulebook – to ensure that rules governing carbon prices and markets yield co-benefits to health, and not more harmful impacts.  

Climate commitments also lack mechanisms for monitoring, tracking – and most of all – funding 

Another key area of concern  is the current lack of monitoring and tracking of countries’ NDC commitments, once they are made. 

At present, NDCs are largely a “wish list” of countries’ planned climate actions, however, there is no mechanism to enforce implementation, or even to monitor progress, Maiero and others say.  

“My personal concern is how we are really going to monitor data,” said another member of WHO’s climate team. “There is no system in place that can force the country to implement [its NDC].”

The climate system is also falling behind in terms of financing climate action in developing countries. 

“It’s great to have these plans and commitments to potentially do something, but we have noticed that…there is a massive gap for developed countries to commit finance and there’s a massive gap for developing countries to receive it,” say the WHO sources. 

Gaps in climate finance need to be filled to enable low- and middle-income countries to take vital action to both reduce and adapt to climate change – in line with their NDC/ climate commitments. 

Low- and middle-income countries heavily depend on climate finance to achieve their climate plans. 

This massive discrepancy is “extremely worrying for WHO, knowing that even though a lot of vulnerable countries now have these climate plans in place, there are no funds for them to actually achieve these plans,” said a member of WHO’s climate team. 

Donors and rich industrialised countries committed to raise at least US$100 billion in climate finance annually at the COP15 in Copenhagen more than 10 years ago. 

In 2018, an estimated US$78.9 billion in climate financing was mobilised – coming close to the goal. In other years, the world has fallen dismally short. 

Only 2% of all climate finance goes to health-related climate adaptation plans, such as making health systems more climate-resilient. 

And none of the key financial institutions, such as the World Bank and Green Climate Fund, that contribute to climate financing have dedicated funds for the health sector. 

The climate system lacks an “agile institution that’s really looking at accelerating disbursement,” says Maiero. And ministries of health lack any intermediate institution that can help health ministers access financing.

“These are the obstacles at the moment, maybe COP26 will actually help sort out all of these problems finally.”

COP26 ‘Health Programme’ focuses on green & climate resilient health systems

“The COP26 Health Programme is one of the three COP26 flagship science projects, alongside work on the Climate Risk Assessment and Vision for Net Zero,” said Maiero. “It is not yet visible on the COP26 agenda, but there will be special health events within the science and innovation day.”

In terms of the COP26 Health Programme, which bears the logo of the COP26 Presidency, the key priorities are focused more narrowly on health systems, including calling upon countries to invest in building greener and climate resilient health systems.  

Right now, only 50% of countries have a national health and climate change strategy, and half of those enforce its implementation, WHO’s climate team members note.

“[The Health Programme] is an important complement to the IPCC report, because it points to the urgency of taking swift action,” point out Knowlton and Limaye. 

“The health sector is increasingly participating in UN climate action, stepping up to do its part to implement the ambition of the Paris Agreement,” asserts Karliner.  

“Not only are health sector non-state actors representing thousands of hospitals from every continent taking concrete actions and committing to net zero health care through their participation in the UNFCCC Climate Champions’ Race to Zero, we are also expecting significant commitments to health care climate resilience and decarbonization from several national governments over the next couple of months as part of the COP 26 Health Programme. 

“This brand new initiative, a collaboration between the UK COP Presidency, WHO and Health Care Without Harm, is engaging with ministries of health from around the world to secure agreement for aligned action,” said Karliner. 

Health sector responsible for 4.4% of global greenhouse emissions

With responsibility for 4.4% of climate emissions, reducing the carbon footprint of health-care services is critical, Karliner and other backers of the COP26 Health Programme underline.

Countries are urged to create a roadmap to developing more sustainable and low carbon health systems – with the goal of achieving net zero emissions for health by 2050. 

Embedding sustainability involves everything from the planning and development of more efficient building energy systems, better waste management and medicines procurement – strategies that Health Care Without Harm is promoting around the world.   

“The sooner sustainable, low carbon health services are developed, the more cost effective they can be: reducing air pollution and therefore the ensuing demand for healthcare, by avoiding becoming locked into high carbon service delivery; and by not having to retro-fit sustainable solutions later,” states the concept note for the Health Programme. 

However, the ‘commitments’ will be made as non-binding declarations by health ministries – leaving questions about how much follow-up will really occur. 

Health side events at COP26

The 2021 Global Conference on Health & Climate Change will convene at the margin of the COP26 UN climate change conference.

Alongside the formal events, WHO and a number of partners are also hosting a Global Conference on Health and Climate Change to call on countries, businesses, and institutions to drive a “green, healthy and resilient recovery from COVID-19.”

The conference, scheduled for 6-7 November will feature thematic sessions on health related aspects of: biodiversity, food systems, sustainable infrastructure, clean energy, cities – and health as part of NDC commitments.  

“Weighing in both the impacts of health-damaging business-as-usual policies and the massive health co-benefits of ambitious climate policy, drives climate policies that are more ambitious and health-promoting,” states a press release for the conference, being held in collaboration with the Global Climate and Health Alliance (GCHA) and the UK Health Alliance on Climate Change.

WHO Special COP26 Report – Health Argument for Climate Action

For COP26, WHO also is developing a special report on health and climate change, ‘The Health Argument for Climate Action,’ that will be submitted to the COP26 presidency at the beginning of the summit.   This follows on from a series of high-level statements made by WHO Director General Dr Tedros Adhanom Ghebreyesus  during May’s World Health Assembly and last year, on the importance of climate action and a “green recovery” from COVID-19.

“The risks posed by climate could dwarf that of any single disease. … there’s no vaccine for climate change,” Tedros has repeatedly pointed out. 

The WHO Special Report will present the latest evidence on the health impacts of climate change, provide scientific findings on the health co-benefits of taking climate action, and offer ten high-level recommendations to climate change policy makers at COP26.

A public consultation of a draft version of the report is underway to receive action-oriented comments on the health recommendations. The report “hope[s] to represent the unified voice of the global health community at the COP26 UN climate conference in Glasgow,” said WHO. 

“This year is crucial for international climate action, with far-reaching consequences for the long-term health and resilience of communities and societies,” WHO said in announcing the consultation earlier this month. 

“The COP26 Special Report hopes to place health and equity front and center at COP26.

“WHO and the global health community are calling on governments to commit to more ambitious climate action, to place health and social justice central, and to commit to a healthy recovery from COVID-19.”

“While there is still much to be done to integrate health into the various areas under negotiation at the UNFCCC [UN Framework Convention on Climate Change],…this year marks a turning point for health sector engagement in the intergovernmental process from which there will be no turning back,” said Karliner. 

“Health care climate action in these global negotiations, national policy and local government will only grow. And it is none too soon,” he added.

Image Credits: IPCC, Commons Wikimedia, UK COP26 Presidency, City of Fortaleza, Gobierno de Provincia de Neuquen, Argentina, IPCC, COP26, WHO.

Experts address WHO’s meeting on vaccines, 13 August 2021.

As wealthy countries opt to give third COVID-19 vaccine booster doses to vulnerable citizens, some researchers have called instead for “fractional doses” to stretch the scarce resources.

“If you have two million doses of vaccine, you can give that as two doses to one million people. But what about if you gave fractional doses?” asked Dr Ben Cowling of Hong Kong University’s School of Public Health.

“If you gave half doses, you could spread the same amount of vaccines to two million people, and if half a dose gives you more than half the level of protection compared to a full dose, then you end up with better outcomes at the population level,” Cowling told Friday’s World Health Organization (WHO) meeting on vaccine research.

“Fractionation was used very successfully for the yellow fever vaccine five or six years ago in West Africa when antigens were in short supply,” added Cowling. 

His comments came hours after the US Food and Drug Administration (FDA) announced that “immuno-compromised people” should receive third vaccine booster shots, joining the Israel and Germany.

 

‘Herd immunity’ seems unachievable

Professor Alejandro Cravioto, chairperson of the WHO Special Advisory Group of Experts (SAGE) on immunisation, said it had advised the global body to seek more evidence from a wider group of experts on the need for boosters.

“While countries have hoarded a huge amount of the available vaccines developed for the control of SARS-Co-V2 virus, other parts of the world are still waiting to receive a small share of these products to protect at least their health force and the most vulnerable groups of their population,” said Cravioto.

“This inequity is what hinders the possibility of a worldwide control of infection… The idea that we’ll achieve a level of herd immunity by immunising a defined percentage of the population seems to be a moving target towards an unachievable goal.”

As a result, said Cravioto, SAGE had advised WHO Director-General Dr Tedros Adhanom Ghebreyusus to “consult a larger group of experts and come up with new science-based actions that can make sure that there are sufficient vaccines available to help defeat the pandemic virus”. 

“One of these actions is to determine whether there is a need for booster doses and to assess whether it is more sound to use these products to immunise the same population again, or to use them more reasonably to help protect those that remain to receive their first doses of the available vaccines.” 

All but one vaccine manufacturer that addressed the meeting made the case for boosters. Only the Janssen/ Johnson and Johnson representative said the company did not yet have evidence that its vaccine needed a booster.

The manufacturers of Moderna, Pfizer, Sinovax, Novavax, Covaxin (Bharat) all presented studies to show how immunity against COVID-19 waned over time and how a third booster increased immunity.

Moderna’s booster agenda
Sinovac presents its evidence for boosters.

But Larry Brilliant of Ending Pandemics in the USA called for a move away from “mass vaccinations” to targeted vaccinations based on epidemiological research.

Professor Helen Rees, chairperson of South Africa’s medicines regulatory authority, noted that a “two-tier research agenda” appeared to be developing, one for wealthy countries and another for poorer countries. She also questioned the basis on which countries were opting for boosters, saying the decisions appeared to be based on “immunogenicity data” rather than clinical data.

Larry Brilliant proposes a research agenda not based on mass vaccination.

Meanwhile, Peter Figuero, from the WHO’s Americas office, the Pan American Health Organisation (PAHO) called on governments to share in the profits of pharmaceutical companies.

“Governments should preserve a share in the patents of pharmaceutical companies when their support has made a tangible contribution to the development of the product being patented,” said Figuero.

Moderna had received $957million in public funds and Pfizer had received $445million, and gone on to make billions in profits, said Figuero. If governments that had invested in the R&D of these vaccines also received a share of their profits, this could be re-invested in global vaccine acquisition, he added.

Image Credits: Sky News.

wildfire
Wildfires in western US may be linked to increased COVID-19 cases and deaths in 2020

While the US was contending with the COVID-19 pandemic, huge wildfires that swept across the country in 2020 may have contributed to thousands of COVID cases and deaths, according to a US study on fine particulate matter (PM 2.5) air pollution from wildfires and COVID-19. 

The study, conducted by researchers at the Harvard Chan School of Public Health, found that the cumulative total of COVID-19 cases and deaths attributable to daily increases in PM 2.5 from wildfires was 19,700 and 750, respectively.

Wildfires produce high levels of fine particulate matter, which has been linked to several negative health outcomes, including premature death, asthma, chronic obstructive pulmonary disease, and other respiratory illnesses.

The study used monitoring data on PM 2.5 air concentrations at a county- and daily-levels, wildfire satellite data, and the number of COVID-19 cases and deaths in 92 countries, representing 95% of the population across California, Oregon, and Washington – three states that bore the brunt of the 2020 wildfires.  

“The convergence of the pandemic and wildfires across the western US,” noted Francesca Dominici, senior author of the study at the Harvard Chan School, has brought “unimaginable challenges in public health.” 

“In this study, we are providing evidence that climate change – which increases the frequency and the intensity of wildfires – and the pandemic are a disastrous combination,” added Dominici. 

‘Hazardous’ levels of fine particulate matter attribute to increased cases and death 

Several counties in the three states experienced levels of PM 2.5 deemed “hazardous” by the US Environmental Protection Agency. High levels of PM 2.5 were attributable to a substantial percentage of total COVID-19 cases and deaths in these areas.

Researchers found that wildfires amplified the effect of exposure to fine particulate air pollution on COVID-19 cases and deaths, up to four weeks after the exposure. On average, a daily increase of PM 2.5 was associated with an 11.7% increase in COVID-19 cases and an 8.4% increase in COVID-19 deaths.

Looking at individual wildfire days and at individual counties, they found that Butte, California and Whitman, Washington, had the highest percentage of total COVID-19 cases attributable to high levels of PM 2.5, 17.3% and 18.2% respectively. 

Two counties in California, Butte and Calaveras, also had the highest percentage of COVID-19 deaths attributed to high levels of PM 2.5 during wildfires – 41% and 137.4% respectively.

Cascading effect of climate change on health 

The link between COVID-19 and the PM 2.5 released from wildfires is further supported by a recent major report by the Intergovernmental Panel on Climate Change (IPPC) that confirms climate change as an existential health problem that overshadows all others. 

Dominici hopes that this study will prompt policymakers to take urgently needed action. 

“Climate change will likely bring warmer and drier conditions to the West, providing more fuel for fires to consume and further enhancing fire activity. This study provides policymakers with key information regarding how the effects of one global crisis—climate change—can have cascading effects on concurrent global crises—in this case, the COVID-19 pandemic,” she said.   

Image Credits: Daria Devyatkina/Flickr.

Teachers aged 50 years and above were the first to get the COVID-19 vaccine in Kenya, but now all civil servants are compelled to get vaccinated.

The Kenyan government’s decision to compel its workers to be vaccinated against COVID-19 has received the support of Dr John Nkengasong, Director of the Africa Centre for Disease Control (CDC).

“I support policies that get citizens of Africa to go out there and get vaccinated whenever they have an opportunity to have access to vaccines. They’re saving themselves, their loved ones and protecting their community and country,” Nkengasong told a media briefing this week. 

Kenya’s Head of Public Service, Joseph Kinyua, told the briefing that COVID-19 vaccination has become mandatory for civil servants in the country. They have until 23 August to get vaccinated and may face disciplinary action if they fail to do so.

“It was observed that some public servants have deliberately avoided being vaccinated so that they can stay from work under the disguise of working from home. This has negatively affected service delivery to the public,” Kinyua said.

Nkengasong described COVID-19 vaccination as a best shot at ending the pandemic on the continent. He noted that vaccines have been instrumental in eradicating smallpox and in tackling other diseases too.

“The right behavior is to go out there, get the vaccine whenever you have access to vaccines. We don’t even want to get to a point where the government is requiring that you get vaccinated,” he added.

Huge increase in COVID cases in Ethiopia 

Africa is still on the crest of its third COVID-19 wave, according to the World Health Organisation (WHO). This week, the continent surpassed seven million confirmed cases with numbers still rising.

“Weekly COVID-related deaths also reached another record peak this week, with nearly 6,600 deaths reported. Vigilance remains crucial,” WHO stated.

In the past week, cases have increased in several African countries including Ethiopia where there has been a 62% average increase in new cases, Nigeria (56% increase), Kenya (30% ) and the Democratic Republic of Congo (6%).

New deaths also increased by an average of 108% in Nigeria, 56% 30% in Kenya and 6% in DRC.

Tanzanian and US officials celebrate the arrival of the first COVID-19 vaccines in the country last month as, part of a donation from the US.

Africa CDC and the WHO have described COVID-19 vaccination roll-out as the largest vaccination exercise ever conducted on the continent. 

After a long pause owing to delays in shipments of Covishield from the Serum Institute of India, African countries are starting to receive Johnson and Johnson (J&J) vaccines, which are being filled and finished by Aspen, the South African pharmaceutical company. 

The African Vaccine Acquisition Trust (AVAT) is facilitating these vaccines, and 10 African countries have received their first J&J vaccine deliveries although only 1.5 million doses have been delivered. 

Egypt received the largest shipment (261,000 doses), while Angola (165,000 doses), Ghana (177,600), Tunisia (108,000), Cameroon (158,000), Mauritius (108,000), Togo (117,600), Lesotho (108,000), Botswana (108,000) and Nigeria (177,000) also received deliveries. 

The doses are part of a total of 400 million doses agreed to by the African Union, AVAT and Johnson & Johnson.

A total of 23 African countries have also received their US government dose donations which totals 9,244,000 doses. Ethiopia got the largest shipment of J&J vaccine doses, receiving 1.6 million doses followed by Tanzania (one million). 

Three African countries received US-donated Pfizer doses: South Africa (9.2 million doses), Rwanda (300,000 doses) and Botswana (81,000 doses). 

WHO recently announced that, in spite of the delays, COVAX still aims to deliver 520 million doses to Africa by the end of 2021. 

“Almost 90 million of these doses have now been allocated to African countries and will be delivered by the end of September,” WHO stated.

However, the facility still relies on vaccine donations from countries with abundant doses. Canada announced on Thursday that it would be donating 10 million doses of J&J vaccine to COVAX.

Addressing a joint press event, Canada’s minister for international development, Karina Gould, and the country’s procurement minister, Anita Anand, disclosed the donation is from Canada’s advance purchase agreement with the vaccine manufacturer. However, Canada has yet to deliver on previous promises to donate doses  .

COVAX has also had to expand its bouquet of vaccines. On Wednesday, it delivered the first tranche of six million doses of Sinopharm vaccines to Pakistan.

In late March, Health Policy Watch reported that the Nigerian government was pivoting to J&J vaccine for its COVID vaccination plans. Although the country’s health authorities still maintain additional doses of Covishield will soon be available in the country for citizens that got the first dose but are yet to receive the second dose, Nkengasong revealed that Covishield doses are not expected anytime soon in Africa.

“Doses of Covishield are not expected anytime soon. What we are having now are J&J vaccine doses,” Nkengasong said.

John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC).

Test for vaccine hesitancy

As more vaccine doses become available, this is expected to uncover the level of vaccine hesitancy in Africa. 

However, Nkengasong expressed confidence COVID vaccine uptake improving in Africa as more doses become available on the continent. 

“Vaccine hesitancy is not static at all,” he said. “We have seen countries where initially there was a lot of resistance, and then, as campaigns were made and information sessions were organized, the situation changed.”

He noted that in Ivory Coast, during the early days of the vaccination exercise, few people turned up for vaccination. But with the government and the Ministry of Health conducting awareness campaigns, the vaccines were gone in no time. Initially, uptake in Senegal was slow but the country is now they are doing about 50,000 vaccinations a day. 

Image Credits: Wish FM Radio, Africa CDC.

The WHO visiting Wuhan’s Huanan seafood market on January 31, 2021, as part of their investigations into the origins of COVID-19.

The World Health Organization (WHO) has called on China to provide it with access to raw data so that the global search for the origins of SARS-CoV2 can move forward.

The WHO made the call on Thursday while asking member countries for nominations to the Scientific Advisory Group for Origins of Novel Pathogens (SAGO).

While countries such as Italy, where the virus had hit hard and early, had been cooperating with the WHO, China needed to do the same by “sharing raw data and giving permission for the retesting of samples”, said the WHO.

Doing this would be a reflection of “scientific solidarity” to “ advance the studies of the origins quickly and effectively,” the WHO added.

But last month, China said that it would be “impossible” for it to cooperate with the next phase of the origins research.

“We will not accept such an origin-tracing plan as it, in some aspects, disregards common sense and defies science,” said Zeng Yixin, Vice Minister of the National Health Commission, at the press conference organized by the Chinese State Council Information Office. 

In January, after months of stalling, China finally allowed an international scientific team into the country – but it refused to give the team access to certain key raw data, including the hospital records of patients in the greater Wuhan area, where SARS-CoV-2 was first identified.

The team finally produced a phase one report which considered four key hypotheses about the origins of the virus, including that it could have escaped from the laboratory in Wuhan that is studying coronaviruses.

China questions ‘lab hypothesis’

“China and a number of other Member States have written to WHO regarding the basis for further studies of the SARS-CoV-2 ‘lab hypothesis,” said the WHO this week.

But, the WHO added, it could only address the ‘lab hypothesis’, if it had “access to all data”.

A number of countries that “have reported detection of SARS-CoV-2 in samples from stored biological specimens from 2019” had been working with the WHO. In Italy, this had included “the blind retesting of pre-pandemic blood samples”. 

“Sharing raw data and giving permission for the retesting of samples in labs outside of Italy reflects scientific solidarity at its best and is no different from what we encourage all countries, including China, to support so that we can advance the studies of the origins quickly and effectively,” the WHO added.

Refuting claims from China that it had been put under political pressure to act, the WHO stressing that “there was insufficient scientific evidence to rule any of the hypotheses out”. 

“WHO’s priority is for scientists to build on the first phase of studies, implement the recommendations outlined in the March 2021 report and accelerate scientific efforts on all hypotheses,” said the body.

“Searching for the origins of any novel pathogen is a difficult process, which is based on science, and takes collaboration, dedication and time.” 

No blame or finger-pointing

It stressed that the search for the origins of SARS-CoV-2 “should not be an exercise in attributing blame, finger-pointing or political point-scoring” but that it was vital to understand how the pandemic started for “future animal-human spillover events”. 

“Countries have a collective responsibility to work together in the true spirit of partnership and to ensure scientists and experts have the space they need to find the origins of the worst pandemic in a century,” stressed the WHO.

“Building on what has already been learned, the next series of studies would include a further examination of the raw data from the earliest cases and sera from potential early cases in 2019. Access to data is critically important for evolving our understanding of science and should not be politicised in any way.”

SAGO is being set up to advise the global body on how to “study the emergence of future emerging pathogens with pandemic potential”, and its first task will be to “support the rapid undertaking of recommended studies” outlined phase one of the virus origins study.

By issuing an open call for nominations to SAGO, WHO hopes to provide “a transparent foundation for the new scientific advisory group that we expect all Member States will engage with”. 

WHO added that it hoped for continuity from “previous missions to China for SARS-CoV-2, as well as other missions studying the origins of, for example, SARS-CoV, MERS-CoV, avian influenza, Lassa and Ebola”.

“This open call aims to ensure that a broad range of scientific skills and expertise are identified to advise WHO on the studies needed to identify the origins of any future emerging or re-emerging pathogen of pandemic potential.”

Image Credits: South China Morning Post.

PAHO is supporting vaccinations of indigenous people

As the Delta variant continues to fuel COVID-19 cases and deaths across the Americas, the Pan American Health Organization (PAHO) is becoming more proactive in procuring vaccines for its members.

PAHO announced this week that its Revolving Fund, which provides access to vaccines at affordable prices, is now open for requests from member states for COVID-19 vaccines for the last three months of 2021 and for 2022. 

The new initiative aims to make available tens of millions of COVID-19 vaccine doses, “beyond the 20% that COVAX offers”, PAHO Director Carissa Etienne told a media briefing on Wednesday.

“It is an initiative that will benefit every country in the region, but especially those that lack the resources and the negotiating power to secure the doses that they need to protect their people,” she said.

More than 20 countries in the Americas have formally expressed interest in the Revolving Fund offer, which consolidates regional demand so that vaccines can be procured in bulk and also procures syringes, cold-chain equipment, and other supplies.

But the region is still short of doses needed to turn the tide of the pandemic, said Etienne, calling for “a significant influx of vaccines and a more equitable process of distribution”.

The Revolving Fund has been working in three key areas to increase access to COVID-19 doses: through purchase and delivery of vaccines on behalf of the COVAX facility; supporting bilateral donations; and providing complimentary access to vaccines in order to achieve high coverage to control the pandemic.

Cases increase in North America, decrease in Brazil

Over 1.3 million COVID-19 cases and 19,000 COVID-related deaths were reported in the Americas in the past week, PAHO announced at a press briefing on Wednesday. 

Canada, Mexico, and the United States are reporting increases in infections and deaths. 

Cases are falling in Panama and Costa Rica, but rising in Honduras and Belize, with a 30% increase reported in El Salvador. 

However, South America is reporting an overall decline in cases, including in the Andean region and Brazil, and substantial drops in Colombia, Paraguay, Uruguay, and Bolivia. 

Etienne noted that though there is a surge in cases, this also presented  “good evidence that wherever vaccines are available, they limit severe illness and save lives.’

“That is why increasing access to vaccines remains our top priority, not just for some countries, but for all countries.” 

PAHO concerned over anti-vax protests in Caribbean

Amid a number of vaccine related-protests in Antigua and Barbuda and other Carribean countries and territories, PAHO expressed concern over the rise in vaccine hesitancy and limited hospital capacity in the region. 

Police used teargas to break up a demonstration against a government decision that frontline workers in Antigua and Barbuda need to be vaccinated. 

Meanwhile, at a protest against mandatory vaccination in St. Vincent and the Grenadines, Prime Minister Dr Ralph Gonsalves was injured when a protester threw an object at his head.

Etienne expressed deep concern over these protests and urged caution in order to control the spread of the pandemic, making a special appeal to her fellow Caribbean residents.

“It is really foolhardy to not adhere to public health measures and not be vaccinated in a situation where [hospital] capacity is limited. We are playing with our lives. My appeal is to wake up from that slumber, wake up from that dream, because we know that vaccines are safe.”   

Supporting indigenous communities in vaccination campaigns 

PAHO is also involved in increasing vaccine access to remote and vulnerable communities, such as the indigenous communities of Central and South America.

More than 134,000 indigenous people have been fully vaccinated across Guatemala, and more than 312,000 have completed their vaccinations in Brazil. 

Seventeen countries in the Americas have listed indigenous peoples as a priority group for COVID vaccinations and vaccination campaigns are underway in those and  other countries.

But there is not enough data for every country on the vaccination rates of indigenous groups, leading PAHO to call for more data collection in order to resolve the challenges faced by this vulnerable minority. 

“We must ensure that our strategies are designed by, for, and with the communities they are intended to serve. Countries must engage indigenous groups as they design pandemic policies and adjust their COVID responses to ensure that they align with their needs and customs,” said Etienne recently.  

PAHO is working with groups that represent indigenous people in the region, such as the Fund for Development of Indigenous Peoples in Latin America and the Caribbean (FILAC), to issue culturally appropriate recommendations in countries across the region and supporting cross-border vaccination campaigns to reach indigenous communities in the Amazonian regions of Colombia and Ecuador.

‘Climate-smart’ health facilities needed to mitigate climate change 

PAHO Director Carissa Etienne

PAHO officials have called for more investment in prevention to mitigate the impact of climate change following a major report released by the Intergovernmental Panel on Climate Change (IPPC), that announced climate change as an existential health problem overshadowing all others.

Only 3% of health resources are invested in prevention and health promotion related to climate change, a number Etienne called ‘totally insufficient’. 

Etienne advocated for ‘climate-smart’ health facilities that can continue to be functional in the face of changing climate and extreme events.

“We need to build strong, resilient systems with the capacity to respond during emergencies, whether they are linked to climate change or pandemics. We need to prevent future pandemics that are linked to the disruption of our natural systems while maintaining the ability to keep us healthy and thrive as societies.” 

PAHO is now coordinating projects with partners to receive and implement funds from the Green Climate Fund, a platform built to limit or reduce greenhouse gas emissions in developing countries, and also other donors in order to increase the ability of health systems to better anticipate, prepare, respond, and recover from climate events. 

 

Image Credits: PAHO.