Ghana, Africa
Ghanian health worker Evelyn Narkie Dowuona holds up her vaccination card after being vaccinated in March, but vaccine supplies to the continent have virtually dried up.

Africa experienced a 43% week-on-week increase in COVID-19 deaths, as the Delta variant accelerated infections for the eighth week in a row, the World Health Organisation (WHO) reported at its weekly Africa press briefing.

Hospital admissions increase rapidly and countries face shortages in oxygen and intensive care beds, as the Africa hit six million cumulative COVID cases – riding the worst wave ever of the pandemic on the continent.

New infections in Africa’s third wave outsrip previous peaks, according to the latest data from Africa Centres for Diseae Control, with southern and northern Africa as the epicenters.

Infections are now moving at an unprecedented speed, health officials warned. Over the past month, the continent registered an additional one million cases whereas it took around three months for the previous million cases to be cases to recorded.

“Deaths have climbed steeply for the past five weeks. This is a clear warning sign that hospitals in the most impacted countries are reaching a breaking point,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

Moeti noted that countries are facing dire shortages of the health workers, supplies, equipment and infrastructure needed to provide care to severely ill COVID-19 patients.

Some 20% of Namibia’s Hospital Cases in ICU

Namibian physician, Dr Ismael Katjitae

 

Namibia, South Africa, Tunisia, Uganda and Zambia accounted for 83% of the new deaths recorded in the past week. The proportion of deaths among confirmed cases reported in Africa is 2.6% against the global average of 2.2%. 

Namibian physician Dr Ismael Katjitae, told the briefing that over 20% of Namibia’s hospitalised COVID-19 cases are in intensive care units (ICU), with one-half of hospitalised patients concentrated in Windhoek, the country’s capital city.

“This has resulted in a very high bed occupancy rate that is beyond the capacity of the healthcare system. There has been an associated spike in the number of deaths, with approximately 1000 deaths in the last month,” Katjitae said.

He revealed that the Delta variant is a major contributor to the high number of COVID deaths in the country.

“With a high number of new infections within a short period of time, it has resulted in a high number of severe and critically ill patients,” he added.

Other contributors to the high number of COVID-19 deaths in Namibia, Katjitae said, also include the high prevalence of comorbidities in some communities, limited capacity of the health system in some districts and regions, and misinformation.

DRC’s Cases Rise Almost 500% in Five Weeks

Dr Jean-Jacques Mbungani Mbanda, the DRC’s Minister of Public Health

The situation in DR Congo is similar to that in Namibia, according to Dr Jean-Jacques Mbungani Mbanda, the DRC’s Minister of Public Health. Mbanda, who also addressed the WHO press briefing, noted that the country had gone from 448 cases after 21 weeks to 2,660 cases during the 25th week. 

“This is an impressive increase of 481% in five weeks. We have overtaken the peaks of the previous two waves,” the minister said.

He added that about 32% of hospitalised COVID-19 patients were severely ill and required oxygen. 

“The number one priority for African countries is boosting oxygen production to give critically ill patients a fighting chance,” Dr Moeti said. “Effective treatment is the last line of defence against COVID-19 and it must not crumble.”

She noted that insufficient quantity, disrepair or poor maintenance of production plants as well as challenges in distribution, scarcity of cylinders, personnel or technical skills were barriers to adequate medical oxygen supply in Africa.

Mbanda also revealed that comorbidities are contributing to COVID-19 deaths in the country. He said DRC has recorded over 150 patients with at least one comorbidity, or co-infection such as high blood pressure, diabetes and so on. The majority of (about 110) are in Kinshasa.

“This third wave came about after confinement measures were taken. But then, once they were eliminated, we had protection measures that were revised, and then the situation became worse because of the Delta variant,” the minister said. 

While vaccine acceptance was a challenge, demand for the vaccine was rising, said Mbanda. He called on Gavi, WHO, UNICEF and other partners to support the country with more vaccine doses to enable the country to combat the COVID-19 pandemic and reduce the pressure on the country’s healthcare system.

“Vaccination is the only way to reduce the extent of the disease, and to also limit the number of deaths and morbidity,” the minister said.

Urgent Need for Vaccines

Dr Matshidiso Moeti, WHO Regional Director for Africa.

While vaccine delivery is rising in Asia, Africa still faces woefully inadequate vaccine supplies. So far only 52 million of the continent’s 1.3 billion people have been vaccinated, since rollout began in March 2021 in South Africa and with the first deliveries of vaccines to Ghana, by the WHO co-sponsored COVAX global vaccine facility initiative. 

African vaccinations account for only 1.6% of the 3.5 billion people vaccinated worldwide, although Africans constitute 17% of the world’s population. Moreover, only 18 million people on the continent have been fully vaccinated, 1.5% of the continent’s population, although some countries in the North have fully immunised more than 50% of their people.  

 “The double barrier of vaccine scarcity and treatment challenges is seriously undermining effective response to the surging pandemic,” said Dr Moeti. “However, with the expected fresh vaccine shipments and strong preventive measures, we can still turn the tide against the virus.”

The WHO said Africa needs 190 million additional COVID-19 vaccine doses to fully vaccinate 10% of the African population by the end of September, with around 750 million more doses needed to fully vaccinate 30% of the continent’s population by the end of 2021.

Health Policy Watch recently reported that Africa will pivot sharply away from Covishield, the AstraZeneca vaccine produced by the Serum Institute of India (SII), and towards the Johnson & Johnson one-shot alternative in coming months – with a new deal to procure some 400 million J&J doses produced by the South Africa-based Aspen Pharmacare, which is due to begin deliveries in August. Along with that, US-donated Pfizer vaccines are reportedly set to reach some African countries even this month, the White House has said, although uptake of those vaccines will be limited to cities and hospitals that can manage the vaccine’s ultra-cold storage requirements. 

Image Credits: WHO.

German Health Minister Jens Spahn (centre) at the Global Health Centre, Geneva Graduate Institute.  On left, Ilona Kickbusch, founder, Global Health Centre. Right, Suerie Moon, current co-director,

Germany’s Health Minister Jens Spahn pushed back hard Thursday against voices calling for a waiver on the intellectual property of COVID-19 treatments and vaccines in a high-profile visit to Geneva. His trip coincided with German Chancellor Angela Merkel’s farewell visit to the United States, including a summit with US President Joe Biden, where protestors chanted “free the vaccines” along Merkel’s route.

In Geneva, Spahn’s day of meetings included public appearances at a WHO press briefing, followed by a panel discussion at the Geneva Graduate Institute’s Global Health Centre, Spahn said that the three companies that had developed the first COVID mRNA vaccine technologies “are startups” and should not be compelled to give up their IP.  Encouraging them to voluntarily share their know-how with developing countries would also yield more vaccines, faster, he stressed – with that being the ultimate goal.  

“This is always better to be done on a voluntary basis, as long as the companies are willing to cooperate and we are building up the capacity…” said Spahn, speaking at the Graduate Institute event, co-moderated by GHC founder Ilona Kickbusch and co-director Suerie Moon. 

Two German firms, CureVac and BioNTech, have been the frontrunners, along with Moderna, in the development of COVID mRNA vaccines. But only BioNTech has brought its COVID vaccine to market – in a collaboration with Pfizer. CureVac’s vaccine, meanwhile, showed disappointing results in its latest clinical trial – which yielded only a 47% efficacy.  

COVID mRNA Vaccine Was First Product Marketed by Startups

German Health Minister Jens Spahn at WHO briefing in Geneva

“For Moderna, CureVac and BioNTech it is the first product in their inventory, and the first time that they actually make a profit,” Spahn observed, speaking at the WHO briefing.

He added that removing their IP rights at this stage would not be effective – since the main barrier is to expanding capacity is the know-how required for complex and sensitive vaccine manufacturing – rather than patents per se. 

“I am sure that next year, we will have a surplus of production,” he added. “So if we can reach this goal without interfering with intellectual property rights, let’s do it this way, it’s even quicker.”

He stressed, however, that German government support for BioNTech and CureVac vaccine R&D process came with the understanding that the firms would voluntarily collaborate in rapidy scale up –  “with the expectation that these companies would cooperate with companies in Asia and Africa, and there are talks going on….”

However, he stopped short of saying whether either company might actually join initiatives such as he recently-announced WHO mRNA vaccine technology transfer hub – which WHO said it was creating in partnership with the South African government. 

German Position Challenged By WHO and UNAIDs, Demonstrators in DC  

Over the course of Thursday, however, Germany’s approach was being sharply challenged on various fronts.

In Baltimore protestors chanted “free the vaccine” as Merkel arrived to receive an honorary degree at Johns Hopkins University, which boasts one of the most prestigious schools of public health in the world. Later, in Washington, D.C., demonstrators were set to protest outside of the White House as Merkel and Biden met. They were calling upon the German Chancellor to stop blocking the COVID IP waiver initiative, which is currently deadlocked in talks at the World Trade Organization.  

In Geneva, meanwhile, Spahn was also being challenged for his country’s continued opposition to the IP waiver – first by WHO Director-General Dr Tedros Adhanom Ghebreyesus and later by UNAIDS Director Winnie Byanyima. 

WHO Director General Dr Tedros Adhanom Ghebreyesus contends IP waiver justified due to “market failure.”

Tedros, appearing with Spahn at the WHO briefing where a new German vaccine donation of 30 million doses also was announced, said that donations were no longer enough to stem the pandemic tide in poor countries.  He declared that the continuing unequal distribution of vaccines between rich and poor countries, pointed to a “market failure” which meant that a “limited” waiver on vaccine IP was needed.  

Referring to the talks at Geneva’s WTO, currently deadlocked between countries seeking a blanket patent waiver and high-income countries, including Germany, Japan and the United Kingdom, that are opposed, Tedros said, “When we say waiver, it is not to snatch the property of the private sector….  I think there could be a balance…. if there is an agreement in IP waiver. It could be for a limited period or instance…. It could be for a year or two, and it could be for a specific product like, like the vaccine.”

The Indian and South African sponsors of the waiver initiative had hoped to have final draft proposal ready for review by WTO’s General Council meeting at the end of the month. However, prospects for that appear uncertain. 

UNAIDS’ Byanyima Lays Down Gauntlet

Winnie Byanyima, Executive Director of UNAIDs, challenges Germany’s position on COVID IP waiver at Global Health Centre session.

In the late afternoon session at the Global Health Centre, Byanyima harkened to the history of the AIDS pandemic, when millions of Africans died before life-saving anti-retroviral treatments became accessible. 

She warned that history is now being repeated with COVID – with Africa now seeing it’s biggest COVID wave so far  – accompanied by far higher mortality rates than that seen in developed nations.   

“There was an increase of 15% in the number of new cases in Africa last week, globally it is 3 %,” said Byanyima.  “Deaths have increased by 23% in the African region, while globally it’s coming down by 7%.

“So here is my challenge, my dilemma,” she told Spahn, “People are 40 years struggling with HIV/AIDs. When antiretrovirals were first found in the west, in Europe and America, people in the south continued to die.  It was only when a global movement came to demand, it took six more years before the prices came down.

“Nine million people died, who could be alive today…. Now their survivors are now at risk of severe disease and deaths from COVID. How many years will they have to fight to have a vaccine that would protect them?

“It seems to me that the approach you’re proposing, which is that the companies who own this technology choose when and whom to share with, at the time they want to, could mean that more millions of people could die,” Byanyima continued.

And while donations, such as the one million doses committed recently at a meeting of G7 nations, “are welcome” they are not enough.

“The world needs 13 billion..every corner of the world needs this… and this means  maximizing the supply,” she asserted asking, “how can this happen without sharing the technology, and how can governments wait for profit-seekers?”

Spahn Sticks to Support for Tech Transfer, not IP Waiver

German Health Minister Jens Spahn

Responded Spahn: “I agree, it’s about sharing technology.  But the question here is how it’s shared.  And it always brings me back to this one argument, which still is valid:  just having the patent, does not make you a vaccine producer the next week. It’s far too complex.

“And when we see how long it takes to build up to set up the production side, even for experienced companies, then I would say if you really want to share it needs, cooperation, sharing tech transfer, transferring expertise.

“I do absolutely agree with you, we really need to scale-up, But we are, and they are, on the way to scale-up.  It has taken some time to produce the first 50 million doses, but we will see, I don’t know how many billion doses produced already this year, and especially next year.

“And as I said, I might be wrong, but from today’s point of view, and what I see going on worldwide, I actually see that there is an overcapacity developing for mRNA technology… which as I said is OK.  But it actually shows how different it is this time, to the experience you so rightly described of the HIV experience.”

Image Credits: Health Policy Watch.

Li Keqiang, Premier of the State Council of China, on a visit to Wuhan to inspect and guide the outbreak control and prevention work .

China came under renewed pressure from the World Health Organization (WHO) and Germany on Thursday to share data it has so far withheld in order to help determine the origin of the SARS-CoV2 virus that has cost over four million lives.

Conceding that China had not shared all the data that the WHO virus origins team had asked for, WHO Director-General Dr Tedros Adhamon Ghebreyesus appealed to the country “to be transparent, open and cooperate, especially on [sharing] the raw data that we asked for in the early days of the pandemic”.

Tedros also frankly acknowledged that the first WHO report on the virus origins had failed to give adequate attention to the theory that the SARS-Cov2 virus may first have emerged in the city of Wuhan, China, as a result of a “lab escape” from the nearby Wuhan Institute of Virology, which had been researching bat coronaviruses.

The failure of the WHO-convened team to carefully consider the possibility that a biosafety accident caused the pandemic has been heavily criticized by a group of international experts, in a series of open letters to WHO. 

“There was a premature push to refute one of the [origins] options, the laboratory theory. I was a lab technician myself, an immunologist, and have worked in the lab and lab accidents happen,” added Tedros,  speaking in the strongest terms to date about the plausibility of the lab escape theory, while addressing the WHO’s biweekly COVID-19 media briefing.

German Minister of Health Jens Spahn also appealed to China to “intensify the cooperation to examine the origin of this virus to learn for the future”, during his announcement of increased German financial support for the WHO at the briefing.

Germany has committed 260 million Euros to the WHO-supported ACT-Accelerator and confirmed that it would donate at least 30 million COVID-19 vaccines to low and middle-income countries, 80% of which would be channeled through COVAX.

The SARS-CoV2 origins team concluded Phase 1 of its investigation with the release of a report in March posing four possible hypotheses about where the virus originated from, including an accident at the Wuhan laboratory that examines coronaviruses which it described as “extremely unlikely”.

Member States Guidance Sought to Address China Challenge

WHO Director-General Dr Tedros Adhamon Ghebreyesus

However, a number of member states were unhappy with the report, as reported by Health Policy Watch, and the US described it as “insufficient and inconclusive” in late May, ahead of the World Health Assembly in Geneva. 

“We call for a timely, transparent, evidence-based, and expert-led Phase 2 study, including in the People’s Republic of China,” the US Mission in Geneva stated.

“It is critical that China provides independent experts full access to complete, original data and samples relevant to understanding the source of the virus and the early stages of the pandemic. We appreciate the WHO’s stated commitment to move forward with Phase 2 of the COVID-19 origins study, and look forward to an update from Director-General Tedros,” the US added.

This is the first time Tedros has given credence to the lab accident hypothesis and called out China for failing to give the origins team access to “raw data” from the early days of the outbreak of SARS-CoV2 in Wuhan.

Announcing that the design of Phase 2 of the origins investigation had been completed, Tedros said the WHO would be asking member states for their guidance to address the access challenges.

“Take the number of deaths alone – more than four million. I think we owe it to them to know what happened. And everybody should cooperate to know what happened, and to prevent the same crisis from happening again,” said Tedros.

The laboratory accident hypothesis could not be ruled out without “direct information on what the situation of this [Wuhan] lab was between, before and at the start of the pandemic”, added Tedros. 

IP Waiver Necessary as all Pharma Companies But AstraZeneca Have Ignored WHO Appeals

Spahn reiterated Germany’s opposition to a waiver on intellectual property on certain COVID-19 related products during the pandemic, describing the debate as “very ideological”.

However, Tedros said the IP waiver was necessary as pharmaceutical companies had ignored appeals to increase their manufacturing capacity via voluntary licensing and technology transfers to ensure fair vaccine distribution.

AstraZeneca was the one exception, entering into voluntary licensing with companies in India and Korea, and more recently with Australia, Japan and Thailand, he added.

“If the other companies have done the same thing, we could have better volume to share,” said Tedros. 

“But when we say IP waiver, it’s not to snatch the property of the private sector,” said Tedros, adding that the WHO had proposed that high income countries could offer incentives to those companies “to address any financial losses that they have”. 

Emergency Committee Rules out Vaccine Boosters

Didier Houssin, Chair of the WHO Emergency Committee, at the press briefing on Friday.

There was no scientific evidence to support vaccine boosters, Professor Didier Houssin, chairperson of the WHO Emergency Committee on COVID-19, told the briefing, following a committee meeting on Wednesday.

The committee had two main recommendations to the WHO: keep advocating for fair distribution of vaccines and provide member states with more guidance on public health measures to contain the pandemic, said Houssin.

Turning to member states, Houssin stressed that they need “to acknowledge that access to vaccines and public health measures to maintain social distancing should be taken very seriously now”.

“We should not be tempted to undertake any measures that could increase inequity. For example, the decision made by some countries to promote a booster dose, a third dose of the vaccine when in fact there is no scientific data that justifies that for the moment,” said Houssin.

The committee also urged member states not to “require proof of vaccination against COVID-19 for international travel as the only pathway or condition permitting international travel, given limited global access and inequitable distribution of COVID-19 vaccines”. 

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

It also urged member states to recognize all COVID-19 vaccines that have received WHO Emergency Use Listing in the context of international travel. 

 

Image Credits: China Government Network, WHO.

A community health worker and counsellor tests a sample of blood to ascertain whether the donor is HIV positive or negative.

People living with HIV face a significant risk of severe COVID-19 and should be prioritised in national vaccination programmes, according to research presented on Thursday ahead of  the International AIDS Society’s (IAS) HIV Science conference which starts on Saturday.

The World Health Organization (WHO) research looked at the data of 15,500 HIV positive people from 24 countries who had been hospitalised for COVID-19.

“Among patients with a known outcome, 23% died in hospital,” according to IAS.

After adjusting for age, sex and co-morbidities, the study team determined that HIV infection was associated with an increased risk of severe COVID-19 and death in hospital.

Almost 95% of cases were from South Africa, the epicentre of the world’s HIV pandemic, and researchers found that HIV positive Africans hospitalised for COVID-19 were at a greater risk of death than those from Europe and the Americas.

“This study underscores the importance of prioritising all people living with HIV in national COVID-19 vaccine programmes,” said IAS President and IAS 2021 International Co-Chair Adeeba Kamarulzaman. 

“The global community must do more to ensure immediate vaccine supply to countries with high HIV disease prevalence. It is unacceptable that as of today, less than 3% of the entire African continent has received a single dose of the vaccine and less than 1.5% have received both doses.”

Speakers at a IAS 2021 press briefing on Monday noted that previous publications on the impact of HIV on COVID were conflicting with some publications noting that HIV had no impact while this latest study showed significant contribution of HIV to the COVID-19 pandemic. 

Dr Steven Deeks, Professor of Medicine in Residence Division of HIV, Infectious Diseases and Global Medicine at the University of California San Francisco noted that the study was among people in hospital which is not the whole pandemic. He described it as a very large study, which means it has more power “to see something”, and it is global with most of the events occurring in resource-limited areas. 

“To me it is not surprising because every time we look at things carefully we can find something there. People on multi-therapy, their immune system is certainly good but is not optimal — particularly people with lower CD4 count. So one will expect what this study found. But the bottomline is because of the size of the study and global reach, this is closer to the truth than the previous studies,” Deeks said. 

Sexual Violence and HIV Exposure During Uganda’s COVID-19 Lockdown 

Research from a large Ugandan study showed that women face increased risk of gender-based violence and HIV during COVID-19 lockdowns, according to the IAS at its pre-conference media briefing.

Researchers analysed routine data from the Uganda Health Management System and the Uganda Child Helpline to correlate COVID-19 restrictions with gender-based violence reports, uptake of HIV post-exposure prophylaxis (PEP) and teen pregnancy among Ugandan women and girls. 

They compared data from six months prior to COVID-19, starting in October 2019, and the first six months of COVID-19 restrictions, starting in April 2020. 

During the first six months of COVID-19 restrictions, there was a 24% increase in post-rape reports and an 18% reduction in PEP uptake compared with the pre-COVID-19 period. More than half of those who reported for post-rape care after the recommended 72-hour PEP intervention timeframe said that lockdown restrictions had prevented them from getting treatment. 

The study team also found that among Ugandan girls, the odds of reporting sexual violence during the COVID-19 period was 1.3 times higher than in the pre-COVID-19 period. There was also a 17% increase in teen pregnancy between the two periods, but that was not found to be statistically significant. 

“There has been a lot of concern about the potential for COVID-19 lockdowns to fuel what UN Women has called the ‘shadow pandemic’ of increased gender-based violence and unintended pregnancy. This study confirms that HIV risk is also a major concern that should be taken into account when designing pandemic response plans,” Kamarulzaman said.

Improved Treatment for drug-resistant TB

But there was also some good news for improving the treatment of highly drug-resistant tuberculosis (TB). 

TB is the most common opportunistic infection to prey on people with HIV, and drug-resistant TB is notoriously difficult to cure and the drugs have significant side-effects.

Some 181 people with highly drug-resistant TB were treated for six months with daily bedaquiline and pretomanid, and daily linezolid (a combined regimen known as BPaL) starting at 1,200mg for either six or two months or 600mg for either six or two months. 

“A high relapse-free cure rate was observed in all four study arms. In addition, people who received reduced doses and/or shorter durations of linezolid were less likely to experience adverse events of peripheral neuropathy and myelosuppression,” according to the study, conducted in South Africa, Russia, Georgia, and Moldova.

The results suggest that reduced doses and shorter durations of linezolid have similar efficacy and improved safety. 

Still on TB, IAS 2021 co-chair, Prof Hendrik Streeck, noted that on Sunday 18 July, the 100th year anniversary of the first administration of the BCG vaccine will be celebrated.

“It is a vaccine that saves many lives but has very limited effectiveness. And is still the only TB vaccine we have so far. I hope this anniversary will be an opportunity to remind the world of the really urgent need for improved TB prevention and treatment options,” Streeck said.

The IAS virtual conference will be opened on Sunday by German Chancellor Angela Merkel, and includes a panel discussion on the COVID-19 and HIV pandemics with Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases. 

Kamarulzaman noted that with the HIV pandemic now in its 40th year and about 35 million lives have been lost till date, the key message at this critical juncture is to follow the science. 

“Forty years of HIV research has informed the global response to COVID-19. We now have new opportunities to adapt and enhance COVID-19 approaches and to leverage new global enthusiasm for public health, especially vaccine science,” Kamarulzaman said. 

Image Credits: Flickr, Nick Youngson.

PAHO Director Carissa Etienne

Though new COVID-19 cases are down nearly 20% from last week in the Americas, many countries are experiencing a resurgence in infections, officials from the Pan American Health Organization (PAHO) announced at a press briefing on Wednesday. 

Over 962,280 new cases were reported in the region in the past week, according to data from the WHO Epidemiological Update on COVID-19. 

The United States and Mexico, and many Central American nations, including El Salvador and Guatemala, are recording daily increases in new infections. 

Cuba has reported the highest number of weekly cases since the start of the pandemic and cases have also tripled in the British Virgin Islands just weeks after reopening to cruise ships. The country also has one of the highest numbers of new cases per 100,000 population, with 2497 new cases per 100,000 people. 

South America is a “mixed picture” in terms of COVID, according to PAHO, as numbers are dropping for hospitalization and deaths in Brazil, Peru, Paraguay, and Chile – but infections are rising in Argentina and Colombia. 

“Cases rise when complacency sets in. We are all tired. We are experiencing successive peaks of infections in the same locations. We must break the cycle by embracing public health measures, early and consistently,” PAHO Director Carissa Etienne implored. 

The region reported nearly 74 million cumulative COVID-19 cases and 1.9 million deaths from COVID this week. This accounts for more than a third of COVID cases, and more than 40% of deaths reported worldwide. 

Only 1 in 7 People Fully Vaccinated in Latin America

COVID vaccination in Brazil

Only 1 in 10 vaccines administered worldwide have been given in the Americas, and only 1 in 7 people in Latin America and the Caribbean have been fully protected, even with bilateral deals, COVAX deliveries, and recent donations from countries such as the US, said the PAHO Director. 

“Money, more than public health, has determined how quickly countries can secure the tools that they need to combat this virus. As countries that struck deals with vaccine manufacturers pull further ahead, vaccination coverage continues to linger in the single digits for much of our region,” said Etienne.

Chile has fully vaccinated nearly 58% of its population, Uruguay has vaccinated 55%, the US has vaccinated nearly half of its population, and Canada isn’t far behind.

But for other countries, the number of people vaccinated remains low. Paraguay and Jamaica have fully vaccinated only 3% of their people. Honduras and Guatemala have yet to protect even 1% of their population.

Urgent Need for Vaccine Sharing 

The US has already donated nearly 12 million COVID-19 vaccines to countries in the region, and Etienne urged more donors and countries to share them with the Americas, calling it the “only way for many countries in our region to secure the doses they need quickly.” 

“If we do not ensure a more equitable distribution of vaccines, not only in the north but also in the global south, COVID-19 could continue circulating for years to come,” warned Etienne. 

“It is the ongoing disparity in access to vaccines that continues to prevent [things from ever getting back to normal”, particularly given that despite best efforts from COVAX to secure doses, virtually all vaccines have been purchased by high-income countries.”

Many countries in the Americas have been hard-hit by hoarding of vaccines from high-income countries, making vaccine donations an “absolute lifeline.”

Etienne stressed that donations should be sent to countries with no vaccine coverage and high disease burden, as urgent priorities. 

“It is vital that we shift the conversation away from booster shots in ensuring that everyone, everywhere, and particularly healthcare workers and those most vulnerable to severe disease are protected first.” 

Cuban Vaccines an ‘Important Development’ for Latin America 

Cuba’s COVID-19 vaccines are seen as Latin America’s hope.

As of 10 July, 3,480,023 people, or 27% of Cuba’s total population, have received at least one dose of Cuba’s two vaccine candidates currently in late stages of research and development – Abdala and Soberana 2. 

Last month, Cuba announced that its three-dose Abdala vaccine was 92% effective against COVID-19, while its Soberana 2 vaccine was 62% effective with two doses, and efficacy was expected to rise with administration of the third dose.  

Assistant Director of PAHO Jarbas Barbosa called the Cuban vaccines an “important development” for other countries in Latin America.

“Latin America and the Caribbean is a very vulnerable region because we rely on empathy, not only for vaccines, but for medicines, for PPEs, for ventilators, all clinical supplies to face the pandemic.” 

For Cuba’s vaccines to be part of PAHO’s Revolving Fund, which provides access to vaccines at affordable prices for countries in the region, the vaccines must meet the criteria to be a part of the WHO Emergency Use Listing (EUL). 

Political Turmoil in Haiti Could Lead to Rise in Infections 

PAHO officials expressed their condolences following the assassination of Haitian President Jovenel Moïse early Wednesday morning.

In the midst of political turmoil following the assassination of Haitain President Jovenel Moise last week, PAHO remains concerned about the growing violence, instability, and crowded shelters in the country, which could give rise to active COVID transmission.  

Many other countries in the region are also experiencing waves of protests due to COVID, from Colombia to Brazil, as well as Cuba. 

PAHO is closely coordinating with the government of Haiti, the government of the US, and with international partners on Haiti’s vaccination campaign, which still has yet to begin.

Haiti remains the only country in the Americas yet to receive any vaccines from COVAX. 

Pandemic is Fueling Inequality 

americas
COVID cases are rising in Cuba, with the medical system in disarray.

More than 7 million companies have closed in Latin America and the Caribbean, and more than a third of people in the Americas are living in poverty, according to a new report released by the Economic Commission for Latin America and the Caribbean. 

This makes the Americas the most inequitable in the world, with the pandemic fueling inequality in the region, said Etienne.

“COVID-19 has not only ravaged health systems, it has fractured social protection programs and destabilized our economy.” 

Etienne urged countries to continue to prioritize health and social safety nets as part of their COVID-19 response. 

In highlighting the underinvestment of countries in their own health systems, Etienne called for countries to invest more in health, applying at least 6% of their GDP to health systems as they track their path to recovery.

“Health and well-being must be prerequisites for re-activating the economy in the context of COVID-19. Because if the pandemic is not brought under control, economic reactivation will be very difficult.”

Image Credits: BabaluBloggers/Twitter , PAHO, Flickr: IMF/ Raphael Alves, News Prensa Latina/Twitter, Tariq Nasheed/Twitter.

Ethiopia, India, Indonesia, Papua New Guinea and Peru are set to benefit from a US$ 25 million investment by Unitaid into a new Partnership For Vivax Elimination (PAVE), which aims to help these countries eliminate Plasmodium vivax (P. Vivax) malaria.

PAVE will also generate and consolidate evidence to support malaria-endemic countries in developing and implementing new strategies for P. Vivax malaria, a complex and persistent type of malaria that poses a risk to more than one-third of the world’s population, according to a Unitaid statement on Wednesday.

P. vivax malaria is the most common type of malaria outside sub-Saharan Africa; it accounts for between 5.9 and 7.1 million estimated malaria cases every year in countries that are close to achieving elimination goals.

It presents a major challenge because of the difficulties in eliminating hypnozoites – a form of the parasite associated with P. vivax malaria that remains in a person’s liver even after successful blood-stage treatment. This leads to repeated malaria relapses, contributing  significantly to transmission.

“With COVID-19-related interruptions threatening progress against malaria, investing in game-changing innovations remains one of our best chances to advance the frontier towards the elimination of malaria in all countries,” said Philippe Duneton, Executive Director of Unitaid:

“By accelerating the adoption of a shorter radical cure and better diagnostics, we can reduce the burden of P. vivax malaria and draw the line against this disease.” 

A number of other countries where P. Vivax malaria is a significant health problem, including Cambodia, Colombia, Lao People’s Democratic Republic and Viet Nam, will continue to receive support from PAVE to optimise P.Vivax case management according to World Health Organization (WHO) guidance and accelerate progress towards their malaria elimination goals, read the Unitaid statement.

PAVE is being led by Medicines for Malaria Venture (MMV) and PATH. It combines the new $25 million grant from Unitaid with work done under previous initiatives, including VivAccess, funded by grants from the Bill & Melinda Gates Foundation, the UK Foreign, Commonwealth and Development Office (FCDO) and MMV. 

The partnership, which also includes Australia’s Menzies School of Health Research and Burnet Institute,  will conduct feasibility studies looking further at best treatment options for P. Vivax relapse, in diverse populations and settings.

Countries Battling with P.Vivax Malaria

Papua New Guinea accounts for more than 80% of all the malaria in the Western Pacific region and has a high burden of P. vivax in children. Children are the most vulnerable to infection, and those in coastal regions experience 3 to 12 recurrent infections per child per year.

 More than 220,000 cases of malaria were reported in Indonesia in 2018, 40% due to P. Vivax and 85% in rural areas. Reducing malaria however remains a challenge for Indonesia due to its diverse population and unique geography. While 168 out of a total of 514 districts have managed to eliminate malaria, high movement between islands threatens reintroduction. Indonesia currently treats patients with an unsupervised course of the lower dose 14-day P. vivax treatment, with poor adherence and low levels of success.

Peru on the other hand has recorded a 50% reduction in P. vivax cases between 2018 and 2019 and PAVE will focus on introducing new tools in remote communities in the state of Loreto, a primarily Amazonian area that is home to 92% of all P. vivax in the country.

However, India is battling with P. vivax malaria and accounts  for nearly half of all P. vivax cases worldwide. 

In Ethiopia, there are an estimated 2.6 million clinical cases of malaria each year and it remains a leading cause of illness and death in children in the country. 

Patients in Papua New Guinea and Indonesia will receive a higher-dose combination of primaquine over seven days. The single-dose radical cure treatment, tafenoquine, has only been studied in combination with another drug, chloroquine, and both countries have very high rates of chloroquine-resistant P. vivax.

Treatment for a Complex and Persistent Malaria 

Treatment of P. vivax requires treating both the blood- and liver-stages of the infection, known as radical cure. The new partnership will scale up  a new single-dose treatment (tafenoquine), and a higher dose of a second drug (primaquine) that cuts treatment time to seven days compared to the 14-day regimen currently in use.

Patients with the genetic disorder known as glucose-6-phosphate dehydrogenase (G6PD) deficiency need to be screened because they are at risk of developing haemolytic anaemia when taking these drugs.

“We are thrilled to further expand this important work,” said Elodie Jambert, Director, Access and Product Management at MMV.

“Families and communities affected by relapsing malaria have been suffering for too long. The new paediatric treatment options, and the real-world evidence that we will generate as part of PAVE, will represent a big step forward in eliminating this disease.”

UNICEF executive director Henrietta Fore

UN Secretary-General Antonio Guterres has accepted the resignation of Henrietta Fore as executive director of UNICEF  “with deep regret” and expressed his full understanding of her decision to resign.

Through a statement released by his spokesman on Tuesday, Guterres thanked Fore her “inspiring leadership of UNICEF and for her service to improve the lives of children all around the world”. In particular, he noted UNICEF’s critical role in the global response to Covid-19 and in reimagining education.

“As a result of her leadership, UNICEF is now an organization with a broader array of public and private sector partnerships and a bolder focus on achieving the Sustainable Development Goals. She has also contributed enormously to efforts to build a UN system with a much stronger focus on inclusion and organizational culture. The secretary-general thanks Fore for her outstanding work to address the extraordinary challenges facing children and young people around the world,” the statement added.

Fore, a former head of the US Agency for International Development (USAID) was appointed to run UNICEF by Guterres in 2018, on Tuesday announced her decision to step down to deal with her husband’s ill health.

“This has been a difficult decision. Serving as your Executive Director has been a tremendous honor. To serve the world’s children is both exhilarating and fascinating. You have achieved remarkable accomplishments at an extraordinary time, and we have so much more to do. I am proud of the work that each of you do and will follow your successes in the years ahead,” said Fore.

Fore’s previous career included running several companies, serving as director of the US Mint from 2001-2005, as U.S. undersecretary of state for management from 2005-2007, and as USAID administrator from 2007-2009 during the administration of then President George W. Bush.

UNICEF has been a key logistics partner in the COVAX, the vaccine-sharing initiative, and it is not immediately clear if Fore’s resignation will affect the COVAX rollout.

She will remain in her post until her successor is appointed. She will in the meantime continue to lead on developing the agency’s Strategic Plan, and also focus on countries’ access to COVID-19 vaccines; to help the safe return to classrooms; “and further accelerate our work in both humanitarian and development contexts”, to ensure a “bright future for every child.”

World Health Organization Director-General Tedros Adhanom Ghebreyesus  said on Wednesday that it had been an “honour to  work with you for children’s health & rights as well as  #VaccinEquity. Thank you for being an outstanding leader, @unicefchief!”.

UN Secretary of State Antony Blinken tweeted “Thank you @UNICEFChief Fore for your dedication to protecting and improving the lives of children around the world. The United States is grateful for your leadership, and we send our best wishes to you and your family.”

Image Credits: UNICEF.

Bidi-bidi refugee camp in Uganda.

KAMPALA – Refugees in Uganda have had their rations slashed as aid agencies face a 70% shortfall in resources to support the largest refugee population in Africa. 

The World Food Programme (WFP) needs a total of US$220 million this year for refugees but has received only 30% of this so far, according to WFP Uganda Country Director El-Khidir Daloum. Refugees in Uganda currently receive only 60 percent of a full ration, or the equivalent in cash, due to reduced funding.

Uganda hosts the largest refugee population in Africa according to the UNHCR 2020 Global Trends Report, with some 1.4 million people mainly from South Sudan and the Democratic Republic of the Congo and over 860,000 of these are children. 

Despite pandemic-related border closures since March 2020, Uganda applied several exceptions, allowing thousands of asylum seekers to cross the border and receive protection and humanitarian assistance in line with COVID-19 screenings and protocols.

Nearly 90 percent of the refugees or 1.26 million live in 13 rural settlements and they are heavily dependent on the WFP’s continued assistance.

The WFP office is worried about the reduced support and calls for more efforts to ensure the refugees survive, especially in the second wave of Covid-19.

“We cannot play down the threat of hunger that still looms over refugees,” said Daloum. “It is important that donors continue to fund Uganda’s refugee response. If refugees are battling hunger daily, this undermines moves toward self-reliance under the Comprehensive Refugee Response Framework.”

“While the pandemic has affected all communities, refugees have been hit particularly hard. With a second COVID-19 wave in full swing in Uganda, I am very concerned that the living conditions of refugees may not only deteriorate but become untenable,” said Joel Boutroue, UN High Commission on Refugees (UNHCR) Representative to Uganda.

 

Refugees per country: UNHCR 2020 Global Trends Report

Cutting Down on Meals

COVID-19 has exacerbated food insecurity among refugees who have been forced to reduce the amount and frequency of meals eaten in a day, while others effects include survival sex and child marriages, said Daloum.

The refugee agencies are increasingly finding it harder to raise funds for the refugees as donor countries reduce their contributions due to their own economic challenges arising from the pandemic. 

 The refugees say that the cut in their food aid rations by WFP has left most of them helplessly surviving on one meal a day. Initially the refugees would wait for enough free food to be distributed, but now most of them have been forced into planting food crops like cassava, sorghum, maize and vegetables as alternative means of feeding themselves and to supplement the reduced food ration. 

Bidi-bidi hosts 270,000 South Sudan refugees, but they are struggling to access land to grow food.

Also with closed schools and bad cultural norms that depict girls as a source of wealth, parents are selling off their children and defilement cases are on the rise.

Charity Ate, 32, a refugee in Bidibidi settlement and a mother of four children told a local news agency that she is struggling to feed her household on the reduced food rations.  She had opted to farm in a neighborhood in the settlement but her efforts are being frustrated due to the lack of available land.

Bidibidi refugee leader Morris Marsuk, chairperson of one of the internal ‘villages’, said that the refugees are vulnerable and lack the power to negotiate for themselves and permanently acquire farmlands.

According to Moses Wenga, a refugee welfare council in Bidibidi base camp in Yumbe district, some parents are trying to marry off their young daughters to get access to money, and cases of sexual abuse are also high in the camps.

To make ends meet, a number of refugees, particularly in south western Uganda, work as casual labourers on farms while some lease or borrow land to grow food. Others sell vegetables at market stalls. A few volunteer with NGOs in the settlements. 

Unemployment, Lack of Access to Land

But many refugees do not have work and COVID-19 has made the situation worse as movement have been limited during lockdowns. For instance, a refugee may not be able to travel to a farm far from the settlement to cultivate their own food or work on farms of host communities, said Daloum.

The UNHCR and the World Bank, together with the Uganda Bureau of Statistics, tracked the socio-economic impacts of the COVID-19 crisis on refugees in Uganda throughout three rounds of phone surveys. 

The last round of interviews, conducted in February and March 2021, showed that 15 percent of refugee households were not receiving any social assistance at all, but in Kampala this figure was as high as 86 percent. Over a third of refugees did not have access to enough water or medicine.

In early July, the governments of Sweden and Germany donated US$5.6 million for the food needs of the refugee community in Uganda, but this has to last until 2023.

While the UNHCR commended Sweden and Germany for the contributions, the WFP said it could not rule out deeper cuts to refugee ration in the coming months.

 

 

More than 740,000 newly diagnosed cancer cases in 2020 may be linked to alcohol consumption, with men accounting for more than three-quarters of those cases, a new global study estimates.

The study published in The Lancet Oncology estimates that men accounted for 77% (568,700) of alcohol-associated cancer cases last year, compared with women, who accounted for 23% (172, 600) cases. 

The highest number of alcohol-associated cancers were found in Eastern Asia and Central and Eastern Europe, while the lowest was found in Northern Africa and Western Asia.

Globally, an estimated 4% (741,300) of all new cases of cancer in 2020 were associated with alcohol consumption, with cancers of the oesophagus (189,700 cases), liver (154,700 cases), and breast (98,300 cases) accounting for the largest number of new cases, followed by colorectal cancers and cancers of the mouth and throat. 

The authors of the first-of-its-kind study have called for greater public awareness of the link between alcohol and cancers and increased government interventions to reduce alcohol consumption in worst-affected regions.

“We urgently need to raise awareness about the link between alcohol consumption and cancer risk among policymakers and the general public,” said Harriet Rumgay of the International Agency for Research on Cancer (IARC) in France.

Rumgay said public health strategies, such as reduced alcohol availability, labelling alcohol products with a health warning, and marketing bans could reduce rates of alcohol-driven cancer. 

“Tax and pricing policies that have led to decreased alcohol intake in Europe, including increased excise taxes and minimum unit pricing, could also be implemented in other world regions. Local context is essential for successful policy around alcohol consumption and will be key to reducing cancer cases linked to drinking,” said Rumgay.

The authors estimate that there were more than 6.3 million cases of mouth, pharynx, voice box (larynx), oesophageal, colon, rectum, liver, and breast cancer in 2020.

However, they say the number of cancer cases are likely to be higher as disruptions to health care and cancer services due to the COVID-19 pandemic are likely to have affected diagnosis rates.

Other limitations to the study include not taking into account former drinking or any relationships between tobacco or obesity with alcohol. This, researchers said, could have “attributed some cases to alcohol that were actually driven by, for example, smoking”.

The study was conducted by researchers from IARC, Centre for Addiction and Mental Health in Canada, the University of Toronto, Canada, Centre for Research and Information on Substance Abuse in Nigeria, American Cancer Society,  Netherlands Comprehensive Cancer Organisation, Erasmus MC University Medical Centre, the Netherlands,Sechenov First Moscow State Medical University, Russia and Technische Universität Dresden in Germany.

More Accurate Measure of Alcohol Exposure Could Improve Health Intervention

Professor Amy C. Justice, Yale University, USA, (who was not involved in the study), notes that estimating the effects of alcohol intake on cancer rates across countries is “notoriously difficult”. She  said a quarter of alcohol purchases are not captured by government data, making it difficult to estimate accurate sales figures. 

“Achieving a solid understanding of the burden of cancer associated with alcohol use, underlying mechanisms, and how best to intervene rely on accurate measures of alcohol exposure… Until we address limitations in measurement, we might be underestimating health risks, especially cancer risks, associated with alcohol,” said Justice.

In population-based study, researchers established levels of alcohol intake per person per country for 2010 then combined it with estimated new cancer cases in 2020 to estimate the number of alcohol-associated cancers in each country.  

They could estimate how much alcohol people drank per year using estimates for alcohol intake in litres per year per adult based on alcohol production data, tax and sales data, surveys and opinion on unrecorded alcohol intake, and tourist alcohol consumption data.

Moderate drinking was classed as intake of 0·1 to 20 grams per day, the equivalent of up to two alcoholic drinks; risky drinking as 20 to 60 g per day, between two and six alcoholic drinks per day; and heavy drinking as more than 60 g per day, more than six alcoholic drinks per day. 

Small Changes to Drinking Behaviour Could Positively Impact Future Cancer Rates

The researchers used figures outlining the risk of each cancer type included from alcohol consumption (per 10 grams of alcohol consumed per day) from existing scientific reports. 

Risky drinking and heavy drinking led to the largest proportion of cancer cases at 39% (291,800 cases) and 47% (346,400 cases) respectively. However, moderate drinking was also found to be problematic, with estimates that this level of drinking accounted for 14% (103,100 cases) of the total of alcohol-caused cases.

The highest proportions (6%) of cancer cases that could be associated with alcohol were registered in Eastern Asia and Central and Eastern Europe regions. Northern Africa and Western Asia had the lowest proportions(1%).

At a country level, the proportions of cancer cases associated with alcohol were estimated to be highest in Mongolia (10%, 560 cases) and lowest in Kuwait (estimated at 0%, less than 5 cases). The UK had an estimated 4% of cancer cases linked to alcohol (16,800), with the United States at 3% (52,700), Brazil at 4% (20,500), India at 5% (62,100), China 6% (282,300), Germany 4% (21,500) and France at 5% (20,000 cases).

However, the researchers note that in some cases, including Mongolia, they may have overestimated liver cancers that could have been caused by alcohol because of a possible interaction with Hepatitis B and C virus infection. 

Amongst women, the largest proportions of cancer cases that were attributed to alcohol were in Central and Eastern Europe (3%, 21,500 cases), and Australia and New Zealand (3%, 2,600 cases). Amongst men, the largest proportions of cancer cases linked to alcohol were found in Eastern Asia (9%, 275,900 cases) and Central and Eastern Europe (8%, 49,900 cases). 

“Trends suggest that although there is a decrease in alcohol consumption per person in many European countries, alcohol use is on the rise in Asian countries such as China and India, and in sub-Saharan Africa,” said Rumgay, adding that the COVID-19 pandemic had increased rates of drinking in some countries.

“Our study highlights the contribution of even relatively low levels of drinking to rates of cancer, which is concerning, but also suggests that small changes to public drinking behaviour could positively impact future cancer rates.” said Rumgay.

The Sputnik V vaccine will increase its production globally through the new partnership with the Serum Institute of India.

The Serum Institute of India (SII), the world’s largest vaccine manufacturer, is set to begin producing Russia’s Sputnik V COVID-19 vaccine in September, paving the way to scale up globally available COVID vaccines. 

The Sputnik V vaccine, produced by Moscow’s Gamaleya Institute and marketed abroad by the Russian Direct Investment Fund (RDIF), is a two-dose adenovirus vaccine that has boasted an efficacy of 91.6% in clinical trials. 

The new agreement with SII will produce over 300 million doses of the vaccine in India every year. 

“RDIF is delighted to cooperate with Serum Institute of India, the world’s largest vaccine manufacturer,” said Kirill Dmitriev, CEO of the Russian Direct Investment Fund, in a press release.

“This strategic partnership is a major step to substantially increase our production capabilities demonstrating a perfect example of joining forces and expertise to save lives both in India and around the world,” Dmitriev added.

The cell and vector samples for the vaccine have been sent from the Gamaleya Center as part of the technology transfer process. 

“With technology transfer underway, we expect the first batches of the vaccine to be produced jointly with SII in coming months,” said Dmitriev.

RDIF currently has agreements with six pharmaceutical companies in India to produce Sputnik V, making India the hub of production for the vaccine.

Sputnik V is priced at only $10 per dose, which is only a third of the cost of its mRNA counterparts – Moderna and Pfizer/BioNTech – and it can be stored in conventional refrigerators for months.

“With high efficacy and a good safety profile, it is critical that the Sputnik vaccine is accessible in full measure for people across India and the world,” said Adar Poonawalla, CEO of the Serum Institute of India.

Study Shows Sputnik Produces Weaker Antibody Response Against Some Variants

A new study, conducted by Russian researchers and published in Vaccines journal on Monday, found that the Sputnik V vaccine was less effective against agressive new SARS-CoV2 variants.

Researchers of the study, who were involved in the development of the vaccine, used blood samples from people who had been fully vaccinated to test the vaccine-induced neutralizing antibody response against seven prominent variants.

Significant reductions in the neutralizing effect was observed against three variants of concern identified by WHO: Delta, first identified in India, Beta, identified in South Africa, and Gamma, identified in Brazil.

A 3.1 fold reduction in virus-neutralizing activity was found against Delta, 2.8 fold decrease against Beta, and 2.5 fold reduction agsinst Gamma.

Although there was a “statistically significant…reduction…Notably, this decrease is lower than reported in publications for other vaccines,” said the study.

The Gamaleya Center and RDIF are reportedly studying opportunities to develop vaccine cocktails jointly with other leading COVID vaccine producers using the first component of Sputnik V.

Sputnik Awaits Authorization from WHO and EMA

Sputnik V has been authorised for use in 67 countries, but it is still awaiting emergency use listing from WHO and authorization from the European Medicines Agency (EMA).

WHO has required additional data from the Gamaleya Center and plans to follow up on inspections of Sputnik V’s domestic production facilities, with no date set to make the final decision on authorization. 

The EMA has delayed Sputnik V’s approval following the RDIF’s failure to submit additional clinical trial data by a deadline that was initially set for early June.

Image Credits: Ministry of Defence of the Russian Federation, RDIF.