Kenya has secured $130 million in funding from the World Bank to buy COVID-19 vaccines and help boost the country’s vaccination drive, the Bank announced on Tuesday.

The funding comes as the Kenyan government starts to administer the second dose of AstraZeneca vaccines to citizens, amid an upsurge of infections across 13 counties in the western region of the country.

As of Monday, the East African country had recorded 182, 883 COVID-19 infections and 3, 612 deaths.

World Bank Country Director for Kenya, Keith Hansen, said the “upfront financing for the acquisition of COVID-19 vaccines will enable the government to expand access to more Kenyans free of cost”.

It will enable the country to procure more vaccines via the African Vaccine Acquisition Task Team (AVATT) initiative and COVAX, the global vaccine-sharing facility.

“This additional financing comes at a critical time when the Government of Kenya is making concerted efforts to contain the rising cases of COVID-19 infections and accelerate the deployment of vaccines to a wider population,” said Hansen. 

Part of the funds will go to boosting Kenya’s cold chain storage capacity, including establishing 25 county vaccine stores, strengthening the capacity of 36 sub-county stores, and equipping 1,177 health facilities with vaccine storage equipment. It will also be used for vaccine safety surveillance, training for health workers, and advocacy and communications activities to encourage COVID-19 vaccine uptake.

“With the increased support for a rapid COVID-19 response, the World Bank is offering the government a flexible approach to select a portfolio of vaccines that best suits local capacities, timings of delivery, and vaccine approvals,” said Jane Chuma, World Bank Senior Health Economist.

In April last year, Kenya received another World Bank loan for Covid-19 tests, isolation and quarantine centres and the purchase of personal protective gear for health workers. 

Vaccination Drive Intensifies As 13 Counties Declared COVID-19 Hotspots

So far, 1,293,004 doses of AstraZeneca vaccines have been administered with vaccination efforts being boosted by a donation of 360,000 doses from the Danish government early last week, according to the Ministry of Health.

A further consignment of 180,000 doses is expected in the coming weeks from COVAX, the global vaccine-sharing facility,  as well as a donation from the US.

Susan Mochache, Principal Secretary in the Ministry of Health, acknowledged that the vaccine donation from Denmark came at a critical time when the country was only left with 5000 doses in total. 

Administration of the second dose comes in the wake of an upsurge of infections across 13 counties in the western region of the country. 

The counties of Bomet, Bungoma, Busia, Homa-Bay, Kakamega, Kericho, Kisii, Kisumu, Migori, Nyamira, Siaya, Trans Nzoia, and Vihiga have been declared hotspots by the Cabinet Secretary of Health, resulting in a dusk-to-dawn curfew from 7pm to 4am.

According to the Ministry of Health, the 13 counties account for 60% of the total caseload in the country and a positivity rate of 21%, which is way above the 9% national average over the last two weeks.

Even though movement in and out of these counties was not banned, Cabinet Secretary for Health Mutahi Kagwe said it is “strongly discouraged.”

Funeral gatherings have been restricted to less than 50 people and burials are now supposed to take place within 72 hours following a death. Wedding gatherings are now restricted to 30 attendees. Employees have been urged to work from home and places of worship will remain closed for the next 30 days. These measures are meant to curb the spread of the virus in these counties and beyond.

The aviation sector is unlikely to recover before 2024, as new variants, stringent quarantines and costly COVID-19 tests continue to confound international travel – but airline officials have appealed for global cooperation to simplify travel requirements.

In 2020, the global aviation industry lost about $430 billion, according to Kamil Alawadi, the International Air Transport Association (IATA) Vice President for Africa and the Middle East. 

While domestic travel in the region has returned to 2019 levels, international travel is yet to recover and it may not fully do so until 2024 unless urgent actions are taken to remove the bottlenecks and regulations that include travel passes, vaccine passports, and conflicting and confusing policies on testing and quarantine.

“The recovery of international travel is very slow because of friction between borders. And looking at the situation today, I think the losses will stop or will reduce to an acceptable level by 2023,” Alawadi said. 

According to him, the airlines will only generally start to generate positive revenues and cover previous losses by the year 2024 unless things change dramatically. 

Costly Multiple Testing 

Following the resumption of international flights in Africa, Adewale Yusuf, Chief Executive Officer of TalentQL, an African talent recruitment company, travelled from Lagos, Nigeria to Kigali in Rwanda.

He told Health Policy Watch that, before leaving Nigeria, he spent NGN50,000 (over $120) on a PCR COVID-19 test and on arrival in Kigali, he paid for another COVID test ($50) in addition to incurring the cost of the mandatory hotel room for isolation until his COVID test result was available. 

Before leaving Rwanda, Yusuf had to pay for another COVID test as the Nigerian government requires every passenger arriving in the country to present a negative test.

Alawadi described this development as a major stumbling block in the aviation industry’s path to recovery.

For a single trip, travellers can spend up to $500 for COVID-19 tests alone, said Yusuf. Moreover, he said the quarantine requirement by several countries is discouraging people from travelling the most.

“We’ve done a number of surveys. Our last survey showed that 84% of the passengers will not fly if quarantine is in place. Additionally, it is unclear today, in many cases, for the average passenger to know what is needed when he travels from A to B. When does he do the PCR test, what sort of certification is needed and so on,” Alawadi said.

To address the issue of testing for travellers within Africa, the Africa Union’s Digital Vaccination Platform, Trusted Travel, was launched to try to simplify the verification of public health documentation for travellers during exit and entry across borders. 

However, countries within Africa have been reluctant to fully adopt the service, choosing instead to institute their own protocols that often compel travellers to pay for tests at each point-of-entry.

Travel passes and passports

To ensure the aviation industry fully begins to recover from the impact of COVID-19, Alawadi said more restrictions need to be removed – although the opposite is happening as countries limit travel to contain the spread of the Delta variant, according to Health Policy Watch.

“The removal of travel barriers is a big key to recovery. Right now, what is standing in the way of passengers traveling are the restrictions placed by governments,” Alawadi added.

One of the travel barriers that IATA is concerned about is the introduction of vaccine passports. The European Union’s COVID Digital Green Pass officially goes into effect 1 July. Even though its goal is to ease travel to Europe for vaccinated and recovered passengers, Health Policy Watch recently reported that it does not recognise the most widely administered vaccine in Africa, the version of AstraZeneca manufactured by the Serum Institute of India.

This policy could have a negative impact on Africa’s fragile aviation sector, which lost over $7.7 billion in 2020 alone, with massive job losses and millions more jobs threatened by uncertainties and slow return to normal.

“There are eight airlines that filed for bankruptcy in Africa due to COVID-19 and we do not want to see that continuing in 2021,” Alwadi said.

Regarding the EU Green Pass, Alawadi said the aviation industry was not in support of discrimination in the space that only favors individuals that have been vaccinated.

“We can’t have a situation where only people who have been vaccinated are able to travel internationally,” he noted.

However, he urged countries across the world to accept WHO-approved vaccines to ensure greater consistency and foster trust between governments and travellers.

Even though countries in the EU are going ahead with the vaccination passport policy, the World Health Organization (WHO) has noted that making proof of vaccination a prerequisite for travel may deepen inequities while the vaccines continue to be in such short supply.

“Decisions on vaccine passports are taken at the national level, in line with each country’s unique epidemiological, political, social and economic contexts. At the same time, they require coordination between countries, airlines and interoperable systems,” said WHO Regional Director for Africa, Dr Matshidiso Moeti.

Collaborative work to Harmonise Travel Passes

IATA has called on the global community to collaborate to ease travel bottlenecks by streamlining processes and harmonising the numerous passes.

“The focus should be collaborative work with all the stakeholders, including governments, to support the aviation industry (especially in Africa) and prevent any further damage, closure of airlines or the supporting players like the catering companies,” he said.

Willie Walsh, IATA’s Director General, has noted that the international travel metrics will improve when the world’s largest air travel markets, Australia, China, the UK, Japan, and Canada, fully open up. But for now, they remain essentially closed with no clear plans to guide a reopening. 

“Data should help these and other countries to introduce targeted policies that keep populations safe while moving towards a normality in the world with COVID-19 for some time to come,” Walsh said.

Image Credits: Paul Adepoju.

Countries (in blue) where the Delta variant has been verified (US CDC)

Countries as diverse as Russia, Portugal, South Africa and Sydney have imposed new lockdown regulations as they attempt to control the spread of Delta, the SARS-CoV-2 variant that is more deadly and infectious than any other variant.

By last Friday, the World Health Organization (WHO) reported that the Delta (B.1.617.2) variant had been detected in at least 85 countries, describing it as the “fastest and fittest” variant, likely to dominate all others in time.

The WHO also urged everyone – including those who are fully vaccinated – to continue to wear masks in the face of Delta, which was responsible for the devastating wave of COVID-19 cases in India in early May where the country recorded over 400,000 cases per day.  The WHO advice has prompted renewed debate over mask policies in countries like the United States, where the US Centres for Disease Control had recently stated that fully vaccinated people no longer needed to wear masks indoors or outside.  Even Israel, which had driven COVID cases down to nearly zero with one of the highest vaccination rates in the world, has now reinstated mask requirements for indoors spaces and mass gatherings – in the face of a Delta-driven virus resurgence.  

In Russia’s capital, meanwhile, unvaccinated Muscovites have been told to work from home and observe tighter restrictions on movement and social gatherings, as the city’s mayor told the public that Delta now accounts for over 90% of the city’s new COVID-19 cases.

South Africa moved to a Level Four lockdown on Monday, bringing a tighter curfew, the closure of sit-down restaurants, and a ban on alcohol sales for two weeks. The country has been battling a third wave, which is surging in its economic heartland – Gauteng province – which by Sunday accounted for over half the country’s 158,998 active cases. Leisure travel in and out of the province has also been restricted for two weeks.

Over the past weekend, only those who had been vaccinated or could show a negative COVID-19 test were allowed to enter or leave Portugal’s capital, Lisbon. Last Thursday, the city recorded its highest case number since February – 1556 new cases – and authorities said that 70% of these were from the new variant.

Sydney residents have been ordered to stay at home for two weeks since last Saturday (26 June) and entering or leaving the city is prohibited except for a few exceptions. New South Wales reported 130 active cases by Sunday.

Taiwan tightened border controls from 27 June, making a 14-day quarantine mandatory for all travellers. Those from seven high-risk countries – Brazil, India, the UK, Peru, Israel, Indonesia, and Bangladesh – face free quarantine in government facilities while all other travellers need to quarantine in group quarantine facilities at their own expense, according to the Taiwanese Ministry of Foreign Affairs.

The proportion of Delta cases in the US has risen exponentially in the past month and now account for almost 10% of cases, with the highest prevalence in Missouri where almost 30% of cases are due to Delta, according to the US Centers for Disease Control (CDC).

In May, 4,7% of California’s cases were from the Delta variant but this had jumped to 14.5% of cases by 21 June, according to the California Department of Public Health.

Delta Variant Associated With Higher Risk of Hospitalisation

A report on COVID-19 hospitalisations in Scotland published in The Lancet, reported that there had been twice as many hospitalisations in people infected with the Delta variant in comparison to the Alpha variant.

“Based on the available evidence, the SARS-CoV-2 Delta (B.1.617.2) variant of concern (VOC) is 40-60% more transmissible than the Alpha (Β.1.1.7) VOC and may be associated with higher risk of hospitalisation,” according to a risk assessment published by the European Centre for Disease Prevention and Control last week.

“Furthermore, there is evidence that those who have only received the first dose of a two-dose vaccination course are less well protected against infection with the Delta variant than against other variants, regardless of the vaccine type. However, full vaccination provides nearly equivalent protection against the Delta variant,” it added.

A risk assessment for Delta published last Friday by the UK government noted that  

“there are now analyses from England and Scotland supporting a reduction in vaccine effectiveness for Delta compared to Alpha against symptomatic infection” which were “more pronounced after one dose”. 

“Iterated analysis continues to show vaccine effectiveness against Delta is high after 2 doses. Current evidence suggests that [vaccine efficacy] against hospitalisation is maintained,” it added.

Europe CDC Warns Against Summer Relaxation as Africa Scrambles for Vaccines

Delta is the predominant variant in the UK and is driving a surge in cases there, and the European Centre for Disease Prevention and Control predicted that Delta would account for 90% of cases in the European Union by the end of August.

“Modelling scenarios indicate that any relaxation over the summer months of the stringency of non-pharmaceutical measures that were in place in the EU/EEA in early June could lead to a fast and significant increase in daily cases in all age groups, with an associated increase in hospitalisations, and deaths, potentially reaching the same levels of the autumn of 2020 if no additional measure are taken,” it warned, urging faster vaccination of vulnerable groups.

However, mass vaccinations are still out of the reach of many African countries that are dependent on the WHO-lead global vaccine access platform, COVAX, which has run out of vaccines for distribution.

Cases continue to surge in southern and East Africa, with Delta suspected to be driving cases in Uganda, Zimbabwe and Zambia, as well as South Africa which confirmed last Sunday that Delta was driving its third wave.

Spread of the Delta variant in South Africa

Meanwhile, a more dangerous mutation of the variant,  Delta Plus,  is driving cases in the Indian state of Maharashtra, causing the state to tighten up on restrictions there. All malls and auditoriums were closed from Monday.

Delta Plus is more transmissible than Delta, according to the Indian health ministry. Public Health England issued a briefing on Delta Plus last Friday noting that 41 cases had been detected in the UK.

Image Credits: US CDC, Department of Health, University of KwaZulu-Natal.

João Aguiar Machado, Ambassador, Permanent Representative of the European Union to the World Trade Organization.

As World Trade Organization (WTO) members continue to negotiate on ways to streamline and adapt intellectual property rules in the response to the COVID-19 pandemic, we bring you this interview with the European Union’s ambassador to the WTO, João Aguiar Machado. He discusses the different strands in the EU’s overall strategy on trade and health at the WTO in the context of this health emergency. Later this week (30 June), members head to an informal TRIPS Council meeting to discuss South Africa-India’s TRIPS Waiver proposal and elements of the EU’s alternate proposal.

Priti Patnaik: Can you explain how the three different suggestions articulated by the EU, in its communication to the WTO General Council (4 June), will come together? These include: a WTO framework on trade and health, the draft Declaration on Trade and Health and a proposal on the approach to compulsory licensing.

João Aguiar Machado: We all agree that the common global objective in this pandemic is equitable access to COVID-19 vaccines and treatments. It is certainly a top priority for the European Union (EU). We already see incredible progress in the total global production of COVID-19 vaccines with more than 10 billion doses due to be produced by the end of 2021. For comparison, the total global output of all vaccines before COVID-19 was only 5 billion doses. However, further ramping up the production and, most importantly, ensuring equitable distribution of COVID-19 vaccines, remain very essential priorities in the fight against time in this pandemic.

Setting up and ramping up the production of vaccines is a highly complex process which requires adequate facilities, trained personnel, know-how, raw materials and other inputs. It is a complex issue that cannot be solved by one simple solution. The overall strategy is not only within the WTO. The WHO, other organisations, institutions and initiatives –such as the [WHO and GAVI co-sponsored] COVAX Facility – are working on these solutions. Members of the WTO must collectively find ways to address the current delays and shortages in vaccine production to the extent that is possible in the WTO framework.

We have essentially two strands of work in the WTO: on the one hand, the proposal from a number of like-minded members (Ottawa Group) for a Trade and Health Initiative. On the other hand, the specific debate on intellectual property issues related to the proposal by India, South Africa and others to waive the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the recent EU proposal on optimising the use of licencing flexibilities provided in the TRIPS agreement. It is now time to work on all of these issues with urgency for a final comprehensive solution on health.

More concretely, the co-sponsors of the Ottawa group Declaration on Trade and Health are discussing, in particular, trade facilitation and production expansion through collaboration. As the vaccine production scale-up is related also to a smooth functioning of the supply chain, the EU proposed that this aspect is also discussed in the context of the Declaration on Trade and Health. The intention is to revise the current draft Declaration and to incorporate elements of the EU’s Communication to the WTO General Council. At the same time, the intellectual property strand is being dealt with in the TRIPS Council. Our objective is that these strands of work form a basis for a general understanding on health in the WTO General Council, at the upcoming WTO 12th Ministerial Conference.

PP: The EU proposal to the TRIPS Council has focused a lot on compulsory licensing. What is the EU’s position on other aspects of  the South Africa-India proposal including on copyrights and trade secrets as barriers to equitable access?

Machado: The EU proposes to the WTO a comprehensive approach addressing trade issues related to the actual bottlenecks that affect the manufacturing speed and the fair supply of vaccines and medicines in the current pandemic. The component on compulsory licensing as proposed for discussion at the TRIPS Council is thus only one element of this comprehensive approach. We consider that intellectual property plays an important role as an enabler that contributes to our overall objective of ramping up production of COVID-19 vaccines and medicines. However, it is not and should not be a barrier to achieve this objective. We have been clear that in a global emergency like this pandemic, if voluntary licensing fails, compulsory licensing is a legitimate tool to scale up production. This is why we propose to clarify and simplify the use of compulsory licensing in times of a pandemic.

If we examine how intellectual property can enable the production of vaccines or medicines, the focus is primarily on patents. We believe that a debate on the entire intellectual property system will only delay urgently needed action. Moreover, the intellectual property framework is already a system of checks and balances. There are relevant exceptions that could be used with regard to every intellectual property right, be it copyright, design or protection of undisclosed data. Moreover, we must be realistic as to what can be achieved with the proposed lifting of the Members’ obligations under the TRIPS Agreement. For example, in case of trade secrets, waiving Article 39 does not grant access to companies’ confidential information. It only removes certain minimum remedies against a misappropriation of that information.

PP: The proposal by the EU recognises the “urgent challenge” to ensure a rapid and equitable roll out of vaccines and therapeutics – but the proposal does not mention diagnostics. Can you elaborate why this is so?

Machado: The ongoing discussions concern the whole spectrum of essential medical goods, diagnostics tools being one of them, even if the EU Communication to the WTO focuses specifically on vaccines and therapeutics. The availability of safe and effective COVID-19 vaccines and therapeutics is now the main global priority that needs to be addressed urgently.

Diagnostic tools of course remain important for containing the pandemic. When we speak about “medicines” in the EU proposal to the TRIPS Council as regards the facilitation of compulsory licences, diagnostics as well as therapeutics fall under that term. We are looking forward to discussing the EU proposal with other WTO members and will certainly be open to clarifying the text as necessary.

PP: Some critics are of the view that the EU communication at the WTO is more driven by protectionist industrial policy than motivations to safeguard public health. How would you respond to that?

Machado: On the contrary, the EU’s commitment to the global efforts of equitable access to vaccines and therapeutics against COVID-19 cannot be put in doubt. Just to recall that the EU is a leader when it comes to deliveries of effective vaccines to the rest of the world. By now, over 350 million [COVID vaccine] doses have been exported out of the EU to the rest of the world. This equals around half of the production in the EU. We are also a major contributor to the COVAX Facility.

As already noted, the WTO can and must contribute to delivering equitable access to vaccines and medicines in this pandemic, but this complex issue needs to be addressed comprehensively. This is the reason for the EU communication. It seeks to be as concrete as possible and identify which actions should be taken. The EU proposal is very much driven by the need to ensure equity in the distribution of vaccines. While the production of COVID-19 vaccines has been increasing significantly, their distribution across the regions of the world remains unbalanced. The WTO can certainly act and ensure that this objective is unimpeded by trade barriers.

PP: How will the EU reconcile its opposition to the TRIPS waiver proposal led by South Africa and India, with the support for this proposal by the European Parliament?

Machado: The Commission has carefully analysed the resolution of the European Parliament (EP). The resolution reflects a mix of positions expressed in the EP. The Commission is in full agreement with the EP that intellectual property is an enabler rather than a barrier to vaccines availability.

The Commission also shares the view of the EP that the proposal for an indefinite waiver as proposed in the WTO would pose a significant risk to innovation and research. At the same time, the EP calls on the Commission to support text-based negotiations for a temporary waiver of the TRIPS Agreement that aims to enhance global access to affordable COVID-19-related medical products.

The Commission has engaged in all strands of work and continues to be engaged in the text-based process that has been launched in the TRIPS Council. The EU proposal submitted to the TRIPS Council on 21 June 2021 is a significant step in that direction and a constructive contribution to the debate, as underlined by several other WTO Members. While the TRIPS waiver proposal and the EU proposal represent different approaches, they seek to address the same issue of the availability of COVID-19 vaccines and medicines.

PP: How will the 1 billion dose vaccine donations announced by the G7 affect the negotiations at the WTO? Will it ease the public and civil society pressures for a sweeping waiver of IP?

Machado: Indeed, total G7 commitments since the start of the pandemic provide for a total of over 2 billion vaccine doses, with the commitments made since February 2021, including the last meeting in Carbis Bay, providing for 1 billion doses over the next year. To that, we should add the pledges of Pfizer/BioNtech, Moderna and Johnson & Johnson to provide 1.3 billion does of vaccines to low- and medium-income countries at cost or at lower prices respectively by the end of 2021. We should not forget the EU’s massive financing of the COVAX Facility to help deliver vaccines where they are most needed. Finally, we have predictions of the manufacturing capacity reaching around 10 billion doses by the end of 2021. These are all causes for cautious optimism and indications that our efforts are paying off. Of course that does not mean that we should not try to produce more – and hence our proposal to the WTO on how to increase production, ensure well-functioning supply chains, etc.

At the same time, we must also look at the future. The crisis has demonstrated the importance of diversifying and enhancing the resilience of global value chains. This is why the EU and its Member States – or “Team Europe” – committed to supporting the vaccine production in non-EU countries. The crisis opened up a window of opportunity for Africa and Europe. During the G20 Global Health Summit in May 2021, President von der Leyen announced a Team Europe initiative on manufacturing and access to vaccines, medicines and health technologies in Africa. Through this initiative, Team Europe will help create an enabling environment for local vaccine manufacturing in Africa and tackle both supply and demand side barriers. It will serve to complement existing efforts. As a first step, the initiative will be backed by €1 billion from the EU budget and European development finance institutions, such as the European Investment Bank.

PP: What, in the view of the EU, would be the cornerstones of a compromise as far as the waiver proposal is concerned? Will it be the compulsory licensing approach as suggested by the EU?

Machado: The EU is engaging in the text-based process constructively to find a way forward in this discussion on the role of intellectual property in enhancing access to affordable COVID-19 vaccines and medicines. The objective is to proceed with concrete, pragmatic short and medium term solutions to enhance universal access to COVID-19 vaccines and medicines at affordable prices.

We would like to emphasize again that the EU considers that only a multi-pronged approach addressing the identified bottlenecks such as limited manufacturing capacity and access to raw materials can bring about a real change. Intellectual property is only a part, and not the key part, of the solution.

The EU is ready to continue discussing the revised TRIPS waiver proposal although we are not convinced that the broad waiver as proposed is the best immediate response to the reach the objective of the widest and timely distribution of COVID-19 vaccines that the world urgently needs. This is why the EU included in this discussion a different and more targeted approach focusing on facilitating the use of compulsory licensing, in other words how the flexibilities in TRIPS can be used to waive certain protections.

This approach can bring legal certainty to Members that are ready to produce COVID-19 vaccines and medicines on the basis of compulsory licences, and to those that would be interested to import those. WTO Members should try to progress on this approach because it can bring solutions quickly. We hope that we will be able to convince Members that our approach, including the components that will be addressed in the [WTO] General Council, represents the best way for an effective and pragmatic short-term response to the crisis.

Adapted from the article first published in Geneva Health Files by Priti Patnaik, GHF founder and publisher.

Image Credits: International Monetary Fund/Ernesto Benavides.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Artificial intelligence (AI) has the potential to strengthen the delivery of healthcare and move the world closer towards universal health coverage, but ethical considerations and human rights must be central to the design, development, and deployment of AI technologies, according to a new report released on Monday.

The World Health Organization’s (WHO) Ethics and Governance of Artificial Intelligence for Health report, the world’s first global report on the use of AI in health, is the result of two years of consultations conducted by a panel of 20 international interdisciplinary experts in ethics, digital technology, law, human rights, and health.

“Like many new technologies, artificial intelligence holds enormous potential for improving health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, at the launch of the report on Monday. “This important new report provides a valuable guide for countries on how to maximize the benefits of AI, while minimizing its risks and avoiding its pitfalls.” 

“I hope this report will help countries to harness the power of artificial intelligence while minimizing the risk for a healthier, safer, and fairer future,” Tedros added. 

AI refers to the ability of algorithms encoded in technology to learn from data to perform automated tasks and is an exploding area of science that is being used in numerous disciplines. 

AI is “poised to strengthen healthcare, health research, drug development, improved diagnosis of infectious diseases, including COVID, as we are now seeing, and public health surveillance,” said Professor Partha Majumder, co-chair of the WHO Expert Group on Ethics and Governance of AI for Health and founder of the National Institute of Biomedical Genomics in India.

Professor Partha Majumder, co-chair of the WHO Expert Group on Ethics and Governance of AI for Health and founder of the National Institute of Biomedical Genomics in India.

The COVID-19 pandemic accelerated the willingness to use and invest in innovations, including AI, to address disease outbreaks and curb the spread of pandemics. 

“The key lesson from the pandemic is the important role technology plays in surveillance, disease detection, and treatment,” said Dr E. Osagie Ehanire, Nigeria’s Minister of Health. “[The pandemic] also highlights the potentially enormous value of digital health in improving care and outcomes.”

As innovation and development of AI continues, it could allow medical providers to make faster and more accurate diagnoses, enhancing the capabilities of health systems. 

The future of public health will increasingly become digital, with the development of technologies that “bring both promise and opportunities, but also challenges and ethical questions,” said Dr Soumya Swaminathan, WHO Chief Scientist. 

Applications of AI in Health 

In high-income countries, the use of AI has already begun to transform health systems through the prevention, diagnosis, and treatment of diseases.

Currently, AI is being used for radiological diagnosis in oncology, such as colonoscopy, mammography, and brain imaging. In addition, AI algorithms based on RNA and DNA sequence data are used to guide immunotherapy cancer treatment.

AI technologies are also being piloted for the detection, management, treatment, and care of patients with tuberculosis (TB) and those living in areas with rampant TB. 

Predictive AI systems were able to identify the risk of birth asphyxia, a condition where a newborn doesn’t get enough oxygen before or during birth, with the use of imaging technology during the labor process, according to the report. 

In Singapore, a national programme was established in 2017 to develop and support the country’s AI ecosystem, focusing on healthcare innovation. AI-driven solutions are being used to address high cholesterol, high blood pressure, and diabetes, which are prevalent in Singapore. 

Predictive modelling is used to identify those at the highest risk of developing chronic diseases for early intervention programs. The goal in using AI is to slow the progression of diseases, reduce complications in patients, and lower healthcare costs. 

Low- and middle-income countries (LMICs) have the most to gain from the transformation to health systems brought by AI, as it could fill gaps in health care delivery and services. 

Numerous LMICs face chronic shortages of health workers, a high burden of diseases, and large underserved populations. AI could provide healthcare workers with assistance in diagnostics and speed up the analysis of X-rays and pathology slides, if there is a lack of health specialists. 

A pilot programme of AI-based tools is underway in India, Kenya, Malawi, Rwanda, South Africa and Zambia to screen for cervical cancer. LMICs could also use AI to manage HIC antiretroviral therapy by predicting resistance to the drugs and helping health workers to optimize the therapy, according to WHO’s report.

Ethical Challenges of Using AI in Health Systems

While AI tools and technologies will likely play an important role in improving patient outcomes, strengthening health systems, and driving progress towards universal health coverage, several ethical challenges could emerge. 

“In as much as AI offers enormous advantages to healthcare delivery systems, there remain significant challenges and gaps in the adoption, scale up and integration into health systems,” said Dr Ehanire. 

Dr E. Osagie Ehanire, Nigeria’s Minister of Health.

“Like all new technology, artificial intelligence holds enormous potential for improving the health of millions of people around the world, but like all technology, it can also be misused and cause harm,” said Dr Tedros. 

“Artificial intelligence raises potential ethical concerns, including equitable access to technologies, data protection, and liability,” he added. 

The use of limited, low-quality, or non-representative data in AI could deepen disparities in health as predictive algorithms based on inadequate data could result in racial or ethnic bias. 

Biases based on race, ethnicity, age, or gender that are encoded into AI algorithms can be detrimental to the equitable provision of and access to healthcare services. Many data sets used to train AI models exclude women, ethnic minorities, older people, rural communities, and disadvantaged groups. 

Discrimination in health systems will be captured by machine-learning models, making their recommendations inaccurate for populations excluded from the data. 

“Machine learning technologies have been shown to harm our right to equality and non-discrimination,” said Agnès Callamard, Secretary General of Amnesty International. “There is a substantive and growing body of evidence showing that these machine learning systems have discriminatory impacts and contribute to discriminatory practices.”

Potential to exacerbate disparities

The quality and availability of data may not be adequate in LMICs, resulting in algorithms with inaccurate performances. 

In addition, it is unclear whether AI trained for use in one context can be used accurately and safely in another geographical region. 

Investments will be needed to improve the collection of data in resource-poor settings and to ensure sufficient data on vulnerable and marginalized populations. 

If AI technologies are not deployed carefully, they could exacerbate disparities in health care, cause the over-medicalization of individuals, and cause stress and stigmatization of individuals or communities, according to the report. 

Issues of equity and access could be raised through the exacerbation of the existing digital divide, which refers to the uneven distribution of access to or use of information and communication technologies, such as broadband or smartphones. 

Some 1.2 billion women in LMICs don’t use or have access to mobile internet services and the infrastructure to operate digital technologies may be limited in many countries. 

Employing AI could further marginalize those who lack access to health services and they could be left behind by healthcare systems. 

Another major ethical issue is cybersecurity and data protection. AI technologies, which hold patient health data, could be the target of malicious attacks, putting individuals’ privacy at risk.

With the involvement of the private sector in designing AI systems, concerns are raised over where data is coming from, how it is being stored, how it is being used, and who has access to it. 

To combat the ethical issues that emerge through the use of AI, transparency must be prioritized, with independent oversight and public participation in the design and use of AI in healthcare, said experts at a WHO briefing on Monday.  

AI systems have to be designed to reflect the socio-economic and racial diversity in the relevant health care setting and must be accompanied by training of healthcare workers in digital literacy. 

Principles and Recommendations for use of AI

In an effort to limit the risks and maximize the benefits of AI systems, the expert group developed six principles as a basis for AI governance in the domain of health:

  • Protecting human autonomy;
  • Promoting human wellbeing and safety and the public interest;
  • Ensuring transparency, explainability, and intelligibility;
  • Fostering responsibility and accountability;
  • Ensuring inclusiveness and equity; and
  • Promoting AI that is responsive and sustainable.

The report detailed 47 recommendations to a range of stakeholders to encourage the ethical and transparent design of AI technologies to enhance clinical decision making, mitigate workforce shortages, and increase efficiencies in health service delivery. 

“The need for international comprehensive guidance on the use of artificial intelligence for health, in accordance with ethical norms, cannot be overstated,” said Callamard. 

“There needs to be a framework that addresses some of the ethical issues, the legal issues, as well as other societal challenges, including not creating another digital divide,” said Swaminathan.

Dr Soumya Swaminathan, WHO Chief Scientist.

The recommendations called on the private sector to design AI systems with the accuracy to improve the capacity of health systems; governments to require the use of impact assessments of AI technologies; companies to adhere to national and international regulations on the development and use of AI for health systems; and governments to support the global governance of AI for health. 

“To harness the promise of artificial intelligence for health, human rights cannot be an afterthought,” said Callamard.

“Success is only possible if we collectively and deliberately place ethics and human rights at the center of the design, deployment, and use of AI technologies for health,” said Dr John Reeder, Director of WHO’s TDR, the Special Programme for Research and Training in Tropical Diseases. 

The report was created as a living document, with the opportunity to update it as research emerges on AI and as the field evolves. 

In the coming weeks and months, WHO will focus on developing an implementation plan for the report, holding mission briefings for member states to advise them on the enactment of the recommendations. 

“We should all work together so that artificial intelligence for health becomes a panacea for most of the world and…[it] can be used to meaningfully make universal health coverage a reality,” said Majumder. 

Image Credits: WHO.

Pakistani workers protest against being given Chinese vaccines.

ISLAMABAD – Thousands of Pakistani migrant labourers fear that they might lose their jobs after the governments of Saudi Arabia and the United Arab Emirates (UAE) banned entry for Pakistanis vaccinated with COVID-19 vaccines produced in China.

Meanwhile, Europe’s digital ‘Green Pass’ is not available to those vaccinated by the AstraZeneca vaccine made by the Serum Institute of India – all the COVAX recipients – as the European Medicines Agency (EMA) has only approved the Vaxzevria version of the AstraZeneca vaccine that was produced and manufactured in the United Kingdom or other sites around Europe, Health Policy Watch reported last Friday.

In the past two weeks, dozens of Pakistanis have held protests outside a mass vaccination center in Islamabad,  demanding that health authorities vaccinate them only with vaccines approved by the two countries and not any of those produced by the Chinese.

The UAE has authorised Sinopharm but Saudi Arabia has not authorised any of the Chinese COVID-19 vaccines, while most Pakistanis are vaccinated with Sinovac.

The protestors say that if they are not vaccinated with the UAE and Saudi-approved vaccines, they will not be able to return to their jobs in those countries. Those who have not been vaccinated with vaccines approved by the Gulf states either face exclusion or have to undergo a 10-day quarantine at their own expense, which is unaffordable to ordinary workers.

Last month, Saudi Arabia updated its travel restrictions to enable travellers vaccinated with the Pfizer, AstraZeneca, Moderna and Johnson & Johnson vaccines to enter the country – excluding the five vaccines produced by China, including Sinovac and Sinopharm which have been widely used in Pakistan.

Last week, the UAE lifted its ban on passengers from India, requiring them to be fully vaccinated and to undergo a PCR test on entry and remain in quarantine until the test results were known. Passengers from South Africa and Nigeria will also no longer be banned from the UAE.

Pakistan’s foreign office spokesperson, Zahid Hafeez Chaudhri, told a press briefing on 17 June that the UAE government had suspended the entry of passengers from Pakistan and some other South Asian countries in mid-May based on COVID-19 numbers.

“We hope that the UAE will review its COVID-related advisory for all Pakistanis soon. Currently, Pakistanis having diplomatic and official visas and UAE Golden visas can travel to the UAE,” he said.

“We have proposed inclusion of some of the Chinese vaccines used in Pakistan in the list of vaccines approved by the Saudi authorities. The Ministry of Foreign Affairs is actively pursuing this matter,” Chaudhri added. 

AstraZeneca to be Offered to Workers

A few days earlier, the government had buckled under the pressure from the protesting workers and amended the criteria for those eligible for the AstraZeneca vaccine from 40 years and over to anyone above 18. 

However, a spokesperson for Pakistan’s Ministry of National Health Services Regulations and Coordination (NHSR&C), Sajid Hussain Shah, told Health Policy Watch that those under 40 would only be given the AstraZeneca jab after submitting a consent form. This decision had been taken after analysing the scientific data by the authorities and considering the situation of expats working in other countries. 

“Labour class and students would have to show work and study visas to get AstraZeneca jab. The vaccine will also be administered to work permit holders in Saudi Arabia,” Shah said.

When asked about sudden change in the health guidelines of the AstraZeneca vaccine and its side effects,  NHSR&C Director General Dr Rana Muhammad Safdar said that “there is no harm at all” in administering AstraZeneca to people below age 40.

“Consent was required only as the expert committee recommended it under 40 due to limited availability of data,” said Safdar.

However, the country faces a shortage of AstraZeneca vaccines, which are no longer being exported by its main manufacturer, the Serum Institute of India.

Pervaiz Khan, one of the protesters from the north-western city of Mardan, works in a construction company in Saudi Arabia. Khan has prepared a ‘consent form’ declaring that he “has viewed the information related to adverse effects of the AstraZeneca vaccine and requests to get this vaccine”.

“Our visas are getting expired, and we will lose our jobs if we don’t get Kingdom of Saudi Arabia (KSA) approved vaccine jabs,” said Khan.

Pakistan Reneged on its Pfizer Announcement

Pakistan had announced that it would administer the Pfizer vaccine to migrant workers returning to Gulf countries, but later reneged on this due to a lack of sufficient Pfizer vaccines, Khan said.  

Workers staged their first protest on 14 June when authorities changed the vaccines to be administered back to AstraZeneca due to a lack of Pfizer supplies, but now, even AstraZeneca is said to be in short supply.

“This is a disappointing situation for low-income laborers struggling for their bread and butter in gulf countries, where Saudi Arabia does not approve Chinese vaccines, and the Pakistan government is not smoothly administering Pfizer and AstraZeneca to them,” a frustrated Khan said.

Saudi Arabia has refused to recognize any Chinese-made vaccines for visitors and migrant workers; the UAE has only allowed SinoPharm vaccine for travelers entering the Gulf states. 

Pakistan has mostly administered Chinese vaccines including Sinopharm, SinoVac and CanSino to its citizens.

Although Saudi Arabia and the UAE have imposed strict travel restrictions for Pakistani nationals, those visiting the United Kingdom (UK), European Union (EU) and the United States (US) have not faced such hurdles. The US, UK and EU made it compulsory for passengers from Pakistan to have a negative PCR COVID-19 test, but have not raised concerns about which vaccines travellers have received. 

Lower efficacy of Sinopharm and Sinovac

China has sold and donated millions of Sinopharm and Sinovac doses to low-income countries in Asia, Latin America and Africa.

However, there are concerns that the two vaccines are less efficacious than Pfizer, AstraZeneca Moderna and Sputnik-V vaccines following COVID-19 outbreaks in countries with high vaccination rates with these vaccines.

However, the World Health Organization’s (WHO) Chief Scientist, Soumya Swaminathan, told a recent press briefing that more data was needed “from well-designed studies on the efficacy of the different vaccines that are in use in different countries against the different variants.” 

Latin America and the Asia-Pacific region have bought up around 80% of the 759 million doses of Chinese vaccines sold to date. About 511 million of these are from Sinovac, and the rest from  Sinopharm. 

The WHO recently granted both vaccines Emergency Use Listing. Sinovac’s vaccine efficacy stands at 51% against symptomatic disease and 100% against severe disease, while Sinopharm showed an efficacy rate of 79% protection against mild and hospitalized disease.

Health Policy Watch recently reported a surge in COVID-19 cases in a number of African and Latin American countries that had vaccinated fairly extensively with the Chinese vaccines. This has added to concerns about the lack of follow-up surveillance of the vaccine’s  real-life impacts. 

Pakistan Reliance on Chinese Vaccines

According to the NHSR&C, the country has procured about 14 million doses of five different COVID-19 vaccines. Of these, 12 million were from China, with one million doses each of AstraZeneca and Pfizer vaccines procured through COVAX, the global vaccine-sharing facility, 

Special Assistant to Prime Minister on Health Dr Faisal Sultan said that 76% of the vaccines had been bought and the remainder were donations. A total of 10 million doses of vaccine have been administered so far this month, according to the health ministry.

Director General Safdar told Health Policy Watch that another Chinese vaccine, CanSino, was being produced in the country under the name of PakVac, with 3 million doses being produced per month.

Meanwhile Pfizer Pakistan and BioNTech SE announced an agreement last week with the Pakistan government to supply 13 million doses of their COVID-19 Vaccine (BNT162b2). Deliveries are expected during the course of 2021.

Pakistan Depends on Remittances From Labour Force in Gulf

Pakistan is considered a strategic partner to Saudi Arabia and the UAE. It provides a huge labor force to the Gulf countries, and they provide financial assistance to Pakistan’s unstable economy.

Around 2.6 million Pakistanis are working in Saudi Arabia, while 1.5 million are in the UAE, according to the International Labor Organization (ILO). 

An August 2020 report by the State Bank of Pakistan states that in  the 2019/2020 financial year, Pakistan workers’ remittances received from Saudi Arabia was US $ 821.6 million and UAE US $ 538.2 million). 

 

WHO representative in Ghana, Francis Kasolo, on left, with UNICEF’s representative, Anne-Claire Dufay as first COVAX vaccine doses arrive on 24 February in Accra, Ghana,  Most vaccine recipients won’t be eligible for an EU “Green Passport.”

The much-trumpeted European Union COVID Digital Green Pass, which launches 1 July and is meant to vastly ease travel to Europe for vaccinated and recovered passengers is being rolled out with one important hitch.

Anyone vaccinated with an AstraZeneca vaccine produced by the Serum Institute of India would not be qualified to get the pass – and that includes most citizens of low- and middle-income countries who were immunised with vaccines distributed by the WHO co-sponsored COVAX initiative. 

That’s because the EU green pass will only recognise the Vaxzevria version of the AstraZeneca vaccine that was produced and manufactured in the United Kingdom or other sites around Europe, and thus approved by the European Medicines Agency (EMA). 

In contrast, most of the COVAX facility’s global procurement and distribution was built around the “Covishield” AstraZeneca vaccine, produced by the Serum Institute of India.  

Rude Shock

Proportion of different vaccines distributed by the COVAX initiative – Africa CDC

As of 25 June, more than 89 million vaccines have been distributed by the COVAX initiative to some 133 mostly low- and middle-income countries of Africa, Asia and Latin America, according to Gavi, the Vaccine Alliance, which is administering the massive programme. 

That’s a drop in the ocean of the more than 2.6 billion doses of COVID vaccines administered so far globally, according to WHO. But, it constitutes the majority of vaccines received in many of the world’s poorest countries. 

According to the COVID-19 vaccination dashboard of the Africa CDC, over 90% of vaccine doses administered so far,  are Covishield.

Only Four EU-Approved Vaccines 

EU digital green passport

Under the EU Digital COVID Certificate system, freedom will be restored to the region for individuals that have been fully vaccinated with one of the vaccines approved by EMA, in addition to individuals that have recently recovered from the virus, and those who tested negative.

While WHO has opposed issuing COVID passports at all, a key practical bone of contention emerging is the non-inclusion of Covishield and other WHO-approved vaccines on the list of EMA-approved products that can be considered for the EU digital green pass. 

When Health Policy Watch searched for Covishield on EMA’s website, there was no record of the vaccine even though Vaxzevria, the version produced in Europe, is listed.

Traveller information issued by the authorities of the “Schenghen Zone” which includes EU countries plus several other non-EU European states like Norway and Switzerland,  also clearly states: “As the Member States reopen the borders for travel from non-EU countries for non-essential purposes, they also intend to issue EU COVID travel certificates to travellers from third countries intending to enter their territory. The Commission also intends to accept certificates issued in third countries, which are issued under the same conditions as the ones by the EU….In order for the traveller to be able to get the vaccine, he/she should be vaccinated with one of the EU-approved vaccines.” 

The advice adds, however, a caveat stating that individual: “Member States, can, however, issue the certificate even to those who have been vaccinated with other vaccines if they are willing to do so.”

In all, only four vaccines have been authorised by the EMA, and they are ComirnatyⓇ (BioNTech, Pfizer), ModernaⓇ, Vaxzevria Ⓡ (previously COVID-19 Vaccine AstraZeneca) and JanssenⓇ (Johnson & Johnson).

Covishield is not even listed among the vaccines that are under review by the agency which has listed CVnCoVⓇ (CureVac), NVX-CoV2373Ⓡ (Novavax), Sputnik V Ⓡ(Gam-COVID-Vac), COVID-19 VaccineⓇ (Vero Cell) and CoronaVac Ⓡ(Sinovac).

Even though the passport regime is expected to go into effect next week, more than ten countries in the region, including Germany, Greece and Spain are already issuing the green digital pass.  

Second Class COVID Travellers 

The double standard of EU recognition for identical AstraZeneca vaccines is beginning to send ripples across the African continent and African media – stimulating anger as well as stoking vaccine hesitancy, as reported by the French media channel, RFI.fr this week.

“When the [AstraZeneca] vaccine was received, representatives of the international community were present at Ivato airport in Antananarivo, including representatives of the European Union, to encourage people to be vaccinated,” said Emée Ratsimbazafy, vice-president of a Madagascar civil society association, told RFI.

“And then, all of a sudden, we learn that this vaccine is not recognised by the European health authorities. Why not? Many people are now wondering if this vaccine is really harmless and effective. Some people are now reluctant to be vaccinated,” he said, noting that the dual standard has raised fears that the COVAX vaccines are of inferior quality. 

Madagascar’s Minister of Health, Professor Jean-Louis Rakotovao-Hanitrala, said he was “surprised and shocked” to learn that the vaccines being distributed wouldn’t be accepted in Europe.

“This vaccine was given to us by the WHO and welcomed by the European Union and all the UN agencies,” he was quoted as saying.  That , he said “makes us wonder if there is not one vaccine for Africans and another for Europeans”.

On the other side of the continent, Nigerian health experts are also worried that the EU policy may stimulate more vaccine hesitancy – threatening the delicately built trust in the vaccine that is most widely available.

“Something is definitely fishy somewhere. We need these people to come clean and tell us what is happening. My parents received this vaccine. Should we be worried?” one Nigerian woman, who asked to remain anonymous, told Health Policy Watch. 

African countries do not have luxury of choices like European countries have and as such they need to continue to build acceptance around Covishield, stressed Oyewale Tomori, a Nigerian professor of virology and chairman of Nigeria’s Ministerial Expert Advisory committee on COVID-19. 

“This is the vaccine that we have and we will continue to encourage our people to take while ensuring that we do not find ourselves again at the mercy of the rest of the world in future pandemics,” Tomori told Health Policy Watch.

WHO Officials – Protest in Africa, Silent In Geneva 

WHO Regional Director for Africa Dr Matshidiso Moeti speaking about the EU COVID Green Pass at Thursday’s Regional press briefing,

At Thursday’s Africa Regional press briefing, WHO’s Regional Director for Africa, Dr Matshidiso Moeti, protested the double standard, telling reporters that the European green pass programme should recognize all eight vaccines that have been approved by the WHO, which include the AstraZeneca vaccines produced in India, as well as two Chinese-made vaccines, rather than only those that are EU approved. 

“Increasingly proof of vaccination permits the removal of travel restrictions, and even if it is important to secure the frontiers and prevent the propagation of the virus, African’s shouldn’t be subject to any more restrictions because they can’t access a particular vaccine,” she noted.   

“Only four of the eight vaccines recognised by the WHO are recognised by the European Medicines Agency for the digital passport system put in place by the European Union.  We hope that all countries will respect the principles of the International Health Regulations, and see to it that all vaccines are approved by the WHO and are accessible to everyone, before they can become a prerequisite for travel,” she sai.

Moeti said the WHO and EMA  use the same standards in assessing vaccines. “The safety and efficacy of all WHO emergency use listed vaccines has been proven globally in preventing severe COVID-19 illness and death.” 

Added Richard Mihigo, African regional director for immunisation and vaccines development:  “Actually, WHO is in the process of working with the European Union so that there can be a harmonisation and a recognition by all of the EU members, for all of the products that were approved by the WHO, in a general manner.”   

“What people have to understand is that the EMA only approves  products that are being used in the EU. For those [vaccines] not being used by the EU, they are not even submitted for approval to the EMA, and that is the case for AstraZeneca CoviShield, being produced by the Serum Institute of India, which was from the beginning intended to fulfil the needs for a segment of the market – the COVAX countries.

Mihigo stressed that there was “no ambiguity about the quality of this vaccine produced in India”.

“It’s strictly an administrative process, which has nothing to do with the quality of the AZ vaccine, which is being produced in several countries in Europe, the United States, India, and  South Korea.”

At Geneva’s headquarters, however, WHO officials speaking at a Friday press conference made no reference to the EU conundrum – despite protesting, in principle, the fact that COVID passports are being used at all in travel – when access remains so limited in many countries.

“WHO should not be recommending a requirement for vaccination as a condition of travel,” declared Michael Ryan, executive director of health emergencies, “and that is particularly related to the scarcity of vaccines and the fact that there is such an inequity of distribution of those vaccines –  plus uncertainties regarding the extent to which vaccination prevents infection, or transmission of the disease”.

“Any imposition of such a requirement for vaccination, around the world does, in effect, deliver a double inequality as individuals from countries who have no access to vaccines will then have no access to travel, and therefore it is very important that if we’re going to impose restrictions on the travel of individuals, we must at least attempt to do that from a level playing field of having access to vaccine,” Ryan added.

A Health Policy Watch request to WHO/HQ for comment regarding the exclusion of the Serum Institute version of the AZ vaccine from the EU green pass received no response, as of press time.

Image Credits: UNICEF, African CDC , Tourism Watch.

w
An estimated 20 million Americans were infected with COVID-19 in mid-July 2020 – 17 million more than the three milion officially recorded, a new study has found.

The United States may have experienced nearly 17 million additional COVID-19 cases in the first six months of the COVID-19 pandemic, according to a new study by the National Institutes of Health (NIH).

The NIH study,  published this week in Science Translational Medicine, suggests that for every coronavirus infection recorded until mid-2020, nearly 4.8 more asymptomatic cases went undetected.  In the United States alone, a total of 16.8 million infections with SARS-CoV2 were undected, as of mid-July 2020 – meaning that as many as 20 million Americans were infected with COVID-19 by mid-July 2020 – in comparison to the the three million cases officially recorded in that period.

“This study helps account for how quickly the virus spread to all corners of the country and the globe,” said Bruce Tromberg,  director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB), one of the NIH institutes that runs the NIH SARS-CoV-2 Seroprevalence Project, in a statement on Tuesday.

Blood samples were collected from 8,058 volunteer participants between 10 May and  31 July 2020, among people who were not previously diagnosed with COVID-19. Of the sampled blood, approximate 304 contained antibodies against COVID-19.

Based on the analysis of the data , NIH researchers estimated that for every diagnosed COVID-19 case during the spring and summer of 2020, there were 4.8 undiagnosed cases – representing an additional 16.8 million cases.

The research team observed that Black participants had the highest estimated rate of positive COVID-19 antibody tests (14.2%), followed by Native American/Alaska Native (6.8%), Hispanic (6.1%), white (2.5%) and Asian (2%) respondents. When comparing age groups, the youngest participants – those between the ages of 18 and 44 –  had the highest estimated rate, at 5.9%, the study found.  Women (5.5%) had a higher positivity rate than men (3.5%); and numbers for those living in urban areas (5.3%) were higher compared with rural participants (1.1%).

Pandemic Hallmark – Many People Infected with Few or No Symptoms

“A hallmark of the coronavirus pandemic is that there are people infected with the virus that causes COVID-19 who have few or no symptoms,” Dr Matthew Memoli, director of the Laboratory of Infectious Diseases Clinical Studies Unit at the National Institute of Allergy and Infectious Diseases, which participated in the research team, said in a statement. 

“While counting the numbers of symptomatic people in the United States is essential to contend with the impact of the pandemic and public health response, gaining a full appreciation of the COVID-19 prevalence requires counting the people who are undiagnosed.”

The research team also included scientists from the National Institute of Allergy and Infectious Diseases (NIAID), the National Center for Advancing Translational Sciences (NCATS); and the Frederick National Laboratory for Cancer Research, sponsored by the National Cancer Institute (NCI). 

The team argues that the USA’s official COVID-19 numbers should be revised upwards from the three million cases reported in mid-July 2020 to almost 20 million, once the proportion of asymptomatic positive results are included.

Said senior co-author Kaitlyn Sadtler, chief of the NIBIB Section on Immunoengineering: “This wide gap between the known cases at the time and these asymptomatic infections has implications not only for retrospectively understanding this pandemic, but future pandemic preparedness.”

The research team said they are currently following up with the study participants to evaluate the presence of antibodies after six and 12 months, as well as antibody reactivity to variants of concern, the medical research agency said

“The information will be invaluable as we assess the best public health measures needed to keep people safe, as new – and even more transmissible – variants emerge and vaccine antibody response changes over time,”  said Tromberg.

healthcare workers
Nurses celebrate Nurses Appreciation Week in New York City, 2020, at the height of the COVID pandemic.

Healthcare professionals, and particularly community health workers who have been the backbone of local and national health systems during the COVID crisis, are also unsung ‘first responders’ to the massive mental health fallout from the pandemic, now and going forward.  

That is the central theme of a webinar panel on ‘COVID-19 and Frontline Workers’, Wednesday, 30th June, 13:00 – 15:00 CET, which featuring COVID response and mental health experts from the World Health Organization, the International Council of Nurses and consumer groups.

The panel is sponsored by the Geneva-based Global Self-Care Federation with Health Policy Watch serving as media partners for the event.    

Protecting Healthcare Workers’ Wellbeing Through Inclusive Mental Health Care

While the tireless work of nurses and healthcare professionals has been championed and celebrated throughout the pandemic, those workers have, for the most part, been ‘largely absent from the mental health discourse’, said Judy Stenmark, Director-General of GSCF, in a recent blog post on mental health. 

Stenmark calls for a more ‘more inclusive approach that brings all stakeholders into the equation’ to both consider the mental health needs of health workers during the pandemic period – as well as optimising their contribution to community-based mental health response.

“Without healthcare workers, there’s no chance we will see this pandemic through. Therefore, a greater consideration of self-care for healthcare workers is essential as we learn more about the consequences of the pandemic on healthcare systems,” she said in her blog, adding: “Unless we take proactive measures to ensure staff are safe at work and have sustainable working conditions – we’re at risk of losing the means that make healthcare possible.”

WHO Action Plan Extension Receives Wide Support During WHA

The Maldives’ delegate at the 74th World Health Assembly on Monday.

Those messages also echo ones heard during last month’s 74th World Health Assembly, in which WHO Director General Dr Tedros Adhanom Ghebreyesus called for a rethinking of mental health treatment and delivery: 

“One day this pandemic will be over – but many of the psychological scars linked to the pandemic will stay with us for a long, long time,” he stated, at the Assembly, in which a special session saw WHO officials and member states acknowledging how the ‘mass trauma’ of COVID-19 has worsened mental health worldwide. 

A draft decision endorsing an updated version of WHO’s Mental Health Action Plan also was adopted during the 74th WHA. 

The updated WHO Action Plan will include a greater forums on suicide prevention, workplace mental health, universal health coverage, mental health of children, mental health across the life course, and the involvement of people with lived experience of mental health conditions. 

“It is crucial to prioritize the actions to minimize mental health consequences of the pandemic and incorporate these actions into emergency and disaster risk management strategies,” said Asim Ahmed, Permanent Representative at the Permanent Mission of the Maldives to the UN in Geneva, during the 74th WHA. 

Incorporating Mental Health into COVID-19 Response Plans 

Mental health services for children and adolescents have been disrupted due to COVID-19

During the pandemic, WHO and its Member States have also worked to incorporate mental health and psychosocial support into COVID-19 response plans.   That has included WHO’s development of a wide range of resources in collaboration with partners, including: a stress management guide for the general public; a guide for COVID-19 responders on basic psychosocial skills; and a toolkit to help older adults maintain mental well-being.

  • “Doing What Matters in Times of Stress: An Illustrated Guide” is a stress management guide aimed at equipping people with practical skills to help cope with stress, especially in the early stages of the pandemic. 
  • The Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings, co-chaired by the WHO and the International Federation of Red Cross and Red Crescent Societies, has created an illustrated guide aimed at building basic psychosocial skills among all essential workers responding to COVID-19. 
  • The group has also produced a storybook for children, “My Hero is You, how kids can fight COVID-19”, to help children of 6-11 years learn how to protect themselves, their families and friends from coronavirus, and how to manage difficult emotions during the pandemic. 
  • A sequel that addresses the concerns of children during the current stage of the pandemic is planned for the third quarter of 2021. 

New WHO Guidance on Community-Based Mental Health Alternatives

A lay counsellor on the Friendship Bench in Zimbabwe – part of an innovative community-based mental health programme rolled out in the country.

With community-based services the backbone of better mental health services, WHO has recently highlighted successful examples of person-centered and rights-based community mental health services from across the world in a new report, released on 10 June.  

The report, ‘Guidance on community mental health service: promoting person-centered and rights-based approaches’, offers over two-dozen peer-reviewed examples of mental health services around the world that demonstrated good practices that are non-coercive, incorporate the community, and respect people’s agency, or their right to make decisions about their treatment and life.  

These include examples of cost-effective initiatives in low- and middle-income countries that promote frontline health workers, social workers, trained lay experts, and guided self-care networks as a backbone of service delivery to people in need. Examples include initiatives such as the Friendship Bench in Zimbabwe, Atmiyata in India, as well as self-help groups, such as Kenya’s Users and Survivors of Psychiatry (USP-Kenya).  

These services also feature alternative methods of treatment that ireduce compulsory hospitalization, over-prescription of anti-psychotic drugs – and critically, incorporate the voices of those with their own experiences with mental health conditions and psychosocial disabilities through peer-support groups. 

“[The value of peer-support groups] has been about restoring power, voice, and choice to persons with psychosocial disabilities,” said USP-Kenya CEO Michael Njenga.

Nurses and healthcare workers are the frontline of the health workforce

 

 

Image Credits: R Santos, Raisa Santos , WHO, WHO/NOOR/Sebastian Liste, Tim Kubacki/Flick.

Directors-General of WIPO (far left) WHO (back center) and WTO (far right) discuss stepped up cooperation on combatting COVID-19 pandemic

 

In a first-ever tripartite meeting this year, the heads of the World Health Organization, the World Trade Organization (WTO) and the World Intellectual Property Organization (WIPO),  have agreed to step up their collaboration on tools and resources for fighting the COVID-19 pandemic.   The meeting was the first formal tripartite meeting since Ngozi Okonjo-Iweala was elected as head of WTO earlier this spring, following the election of Daren Tang as the new head of WIPO late last year.

In a joint statement issued after the meeting the three heads of agencies, including WHO’s Director General Dr Tedros Adhanom Ghebreyesus, pledged to collaborate more closely on a joint platform for tripartite technical assistance to member governments relating to their needs for medical technologies as well as a series of workshops – to augment capacity and information flow.

In a joint statement issued following their meeting 15 June, the three agency heads stated that they would ramp up cooperation focusing first on “the organization of practical, capacity-building workshops to enhance the flow of updated information on current developments in the pandemic and responses to achieve equitable access to COVID-19 health technologies.

“The aim of these workshops is to strengthen the capacity of policymakers and experts in member governments to address the pandemic accordingly.

“The first workshop in the series will be a workshop on technology transfer and licensing, scheduled for September. The workshop will help our members update their knowledge and understanding of how intellectual property, know-how and technology transfer work in actuality. This would be in the context of medical technologies and related products and services. This first workshop will be followed by others on related practical themes.”

A second prong of the joint initiative, will be the joint platform for technical assistance, that aims to provide “a one-stop shop that will makae available the full range of expertise on access, IP and trade matters provided by our organizations, and other partners, in a coordinated and systematic manner.”  The platform will focus, in particular, on:

  • supporting countries to assess and prioritize unmet needs for COVID-19 vaccines, medicines and related technologies, and;
  • providing “timely and tailored technical assistance in making full use of all available options to access vaccines, medicines and technologies, including through coordination between members facing similar challenges to facilitate collective responses.”

The effort would also include “periodical update” of baseline resources maintained by the three organizations, mapped in the joint publication:  “Promoting Access to Medical Technologies and Innovation: Intersections between public health, intellectual property and trade”, the statemnt said.

The initiative appears to bring WIPO closer into the circle that has already been established by WTO and WHO on pandemic response – following last year’s change of administration in the agency that maintains a critical repository of data on intellectual property on health products for manufacturers worldwide – but has been too often accused of remaining outside of the loop of practical advice on IP use to low- and middle-income countries.

 

 

Image Credits: World Trade Organization .