Eleven African countries will this weekend start receiving their portion of the first batch of 400 million COVID-19 vaccines from Johnson and Johnson (J&J), the Africa CDC announced on Thursday.

Recipients include Togo, Lesotho, Ghana, Tunisia, Angola, Cameroon, Egypt, Botswana, Nigeria, Ethiopia and Mauritius, and they are part of pool purchasing facilitated by the African Union (AU) and African Vaccine Acquisition Trust (AVAT) to AU member states. Six Carribean communities including Jamaica, Barbados, Guyana, St Kitts & Nevis, Trinidad &Tobago and the Bahamas will also have doses delivered next week.

The delivery of the lifesaving drug comes as 32 of the continent’s 55 countries are battling a third wave of COVID-19 infections, 25 of which are experiencing a “severe third wave”.

However, the target of vaccinating 60% of Africa’s population by the end of 2022 might not be enough to protect the continent, Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC), said during the centre’s weekly COVID-19 briefing.

Africa will now need to vaccinate 75% to 80% of people, taking into consideration several factors, including the different virus variants and the continent’s population structure, according to Nkengasong. The initial target of 60% was partly based on the assumption that 40% of the population was 18 and under and that they would not need to be vaccinated as they will “immediately come down with a disease.”

“We now know that anybody is vulnerable now… those young people are falling sick and they are dying and that needs to be factored into a new projection,” said Nkengasong. However, he said that the continent will in the meantime aim for the 60% target after which a possible adjustment will be made based on “the biology and the pathogenesis of the variants”.

Major vaccine announcement expected in the coming days

Strive Masiyiwa, the African Union’s (AU) Special Envoy on COVID-19 and the co-ordinator of the AU Vaccine Acquisition Task Team (AVATT)

Giving a breakdown of the vaccine deliveries, Strive Masiyiwa, the African Union’s (AU) Special Envoy on COVID-19 and the co-ordinator of the AU Vaccine Acquisition Task Team (AVATT), said that the J&J vaccine had been chosen because it is a single-dose vaccine, partly manufactured in South Africa, has a long shelf-life and it was the only vaccine available in large volumes.

This month, more than six million doses will be shipped to countries that have fulfilled all the AVAT requirements, including loan agreements with the World Bank and other global lenders. The deliveries will increase exponentially over the following months, with 10 million doses to be delivered from September until December. From January 2022, J&J has undertaken to deliver 25 million doses per month until the order is completed in September 2022.

A $2 billion loan facility provided by African Export-Import Bank (Afreximbank), which is the guarantor of the deal, has enabled African countries to purchase the J&J vaccines.

Said Nkengasong in a statement released on the rollout of the vaccines: “During the last months, we have seen the vaccination gap between Africa and other parts of the world widen, and a devastating third wave hit our continent. The deliveries starting now will help us get to the vaccination levels necessary to protect African lives and livelihoods.”

Masiyiwa said other vaccines will come from global vaccine facility COVAX, and bilateral donations from countries including the United States. He let slip that other donor governments have stepped up and that a “very good announcement” from a “major government” will be made in the next few days.

COVAX needs to improve its operation and be held accountable for its failures

COVAX
COVAX vaccine deliveries in Africa.

In the past week, Africa has recorded 273,000 new COVID-19 infections – a 14% average increase of new cases. Recorded deaths stood at 6,454, a slight decrease of 4%. As of 2 August, a total of 103 million vaccine doses have been procured in 53 member states of which 70.6 million have already been administered.

However, Nkengasong said only 1.58% of Africa’s population have been fully vaccinated with two doses.
Masiyiwa said that the continent would have had greater vaccination numbers if COVAX had honored its promises. “They (COVAX) told us in December they would have delivered 700 million doses, being 27% of our population [by August],” said Masiyiwa.

According to Masiyiwa, Africa was then going to pick up vaccine deliveries from August 2021 to September 2022.
This did however not happen, and around 79 million doses have been delivered to Africa so far by COVAX.
“And this is where the crisis is for us. This has not happened. We can all debate about how, where, who did what, how many committees, how many task forces, how many accelerators, you can create all those things, but this is where the rubber hits the road,” said Masiyiwa.

Asked whether the AU would call for the disbandment of the COVAX facility, Masiyiwa said they are seeking an improvement of “the way things are done” and for accountability from the facility.

Africa CDC agrees with WHO’s call for a moratorium on booster shots

Africa CDC director Dr John Nkengasong

Nkengasong, who got vaccinated in April and who is currently recovering from a COVID infection, said the organization supported the WHO’s call for a moratorium on a third booster vaccine shot until at least the end of September to ensure that vaccines reach those who need them most.

His stance is “vaccinate as many people as possible with the available vaccines”, before looking into booster shots. “We run the risk of creating more variants, maybe because we continue to accept sub-optimal pressure on the virus and it will mutate and then even continue to infect those who have received their vaccinations,” said Nkengasong.

“I’m a good example. I received a full dose of the vaccine in April, and look, I have a breakthrough infection. So again, the only way to stop this pandemic is to vaccinate many people…,” said Nkengasong.

Image Credits: WHO AFRICA, UNICEF/Khaled Akasha, UNICEF.

Raisa’s mother, Maria Isabelle Santos, (second from the right) at a nurses appreciation week in 2020.

#COVIDReporting: For the past 18 months, Health Policy Watch global reporters have covered the COVID-19 pandemic. But they have not been immune from its impacts on their personal lives – and the virus has wreaked havoc with their lives. Over the next few weeks, we will bring you their stories.

NEW YORK – I turned 24 a few weeks before New York City was shut down. 

I turned 25 a few weeks after the first vaccines were being rolled out. 

They say that your twenties are the most important, the most fun part of your life. When New York was hit by the first wave of the pandemic and was forced to lockdown, a year of my life was put on pause. 

Acceptance dinners for grad school, traveling with my friends, all on hold. 

I cannot say that it’s resumed in the exact way since then. There’s a hyper-awareness in all of us that things cannot be ‘back to normal’, despite what everyone likes to believe.

My parents, both nurses, were directly on the front lines of the pandemic. They were exposed to the constant suffering and death in their respective hospitals and departments, without any reprieve.  

My grandma was the most social person pre-COVID-19, with birthday parties and events numbering almost a hundred per gathering. Now my family and I fret over her constantly, worrying if it’s even okay for her to be in crowded spaces or go back to hosting parties.

And I’ve become hyper-aware that it has become increasingly unsafe to walk through the city that has been my home since I was born. 

I don’t just carry my mask with me when I walk through the boroughs. I have to carry pepper spray, and a perpetual apprehension that sets throughout my body, that I may be attacked because of my race.

Asian American attacks have increased by nearly 150% over the course of the pandemic. It’s disconcerting to cover news globally, and yet be exposed to a flood of articles on attacks and shootings, one right after another, that take place in my own city.

And some articles don’t even match the face to the name, reporting our deaths and our hurt without any empathy. 

How can America go back to normal after all of this, patting itself on the back and assuring the public that it’s safe now for everyone?

It wasn’t that our ‘normal’ was stalled when the pandemic hit. COVID-19 changed our sense of normalcy. We’re not given time to process the past year. We’re just cogs in a machine, working constantly from home or in the hospital, expected to push ourselves right up on our feet the moment the tiniest resemblance of the old life, pre-COVID, slips in. 

I’ve reported a lot on hidden pandemics, because COVID-19 uncovered many. But the hidden pandemic of mental health is a neglected one that shouldn’t be swept under the rug any longer. 

If only America realized that we need our time to grieve, especially when the truth is, the pandemic is far from ending.

It’s worsened by the fact that American exceptionalism knows no bounds. Reporting on COVID-19 from the global perspective for the past year has made me all-too aware that this exceptionalism extends to vaccinations and social distancing and what even is happening in other countries. 

Do anti-vaxxers who refused COVID vaccines know that the rest of the world is suffering? That my relatives in the Philippines have to travel here to get vaccinated, that thousands of people come here to get their shots when their own countries don’t have as many vaccines? Americans believe in their right to refuse something they label a preposterous conspiracy. The rest of the world doesn’t have that luxury. 

Most privileged Americans live in a bubble of selfishness, rushing to get back to their version of normal. But it isn’t that easy. 

Raisa Santos, who reports from New York City.

Raisa is pursuing her Masters in Public Health at the Columbia Mailman School of Public Health. As a daughter of Filipino immigrants, she has a special interest in immigrant health and international policy. In her free time, she reads and blogs about books, and enjoys writing fiction. 

 

This is part of our #COVIDReporting series:

See also: COVID in Delhi: ‘I was More Afraid of Suffocating Than of Dying’

An unprecedented surge in climate-related disasters, including wildfires and flooding, has been recorded since 2019. 

A new study, conducted by an international group of scientists, found that key indicators of the state of the climate crisis were reaching critical tipping points. 

The study, published in the journal BioScience, measured some 31 planetary vital signs, ranging from coal, oil, and gas consumption to carbon dioxide emissions to ocean acidity to fossil fuel subsidies. 

The researchers compiled a set of global time series related to human actions that affect the environment and climatic responses, which include sea level change and surface temperature change. 

Out of the 31 planetary vital signs tracked, 18 were at new all-time record lows or highs. 

“There is growing evidence we are getting close to or have already gone beyond tipping points associated with important parts of the Earth system,” said Dr William Ripple, Professor of Ecology at Oregon State University and co-author of the study, in a statement.

In the past two years, there has been an unprecedented surge in climate-related disasters, with extreme flooding in South America, Southeast Asia, and Europe, record-breaking heatwaves and wildfires in Australia and western US, and devastating cyclones in Africa, South Asia, and the Western Pacific.

According to the study’s authors, governments have consistently failed to address the “overexploitation of the Earth,” which is the root cause of the current crisis.

Trends in potential drivers of climate change

Carbon dioxide, methane, and nitrous oxide all set new year-to-date records for atmospheric concentrations in 2020 and 2021. In April 2021, carbon dioxide concentrations reached 416 parts per million, the highest monthly global average concentration ever recorded. 

In addition, the year 2020 was the second hottest year on record. The top five warmest years have all occurred since 2015. 

The study also found that glacier thickness set a new all-time low in 2020 and minimum Arctic sea ice was at its second smallest extent on record. Glaciers are currently losing 31% more snow and ice per year compared to 15 years ago. 

Time series of climate-related responses, which include sea level change and surface temperature change.

Ocean pH reached its second-lowest yearly average value on record, threatening marine life with increased acidification. The ocean absorbs approximately 30% of the carbon dioxide that is released in the atmosphere, which has far-reaching impacts on aquatic ecosystems, human health, and food systems. Billions of people worldwide rely on food from the ocean as their primary source of protein.

Another concerning pattern noted was that the annual forest loss rate for the Brazilian Amazon reached a 12-year high of 1.11 million hectares destroyed in 2021.

Among the numerous worrying trends, there were a few bright spots in the study’s findings.

Fossil fuel energy consumption has decreased since 2019, along with carbon dioxide emissions, and air transport, likely due to the COVID-19 pandemic. Although projections for 2021 estimate that these measures will rise again.

Solar and wind power consumption increased by 57% between 2018 and 2021.

Fossil fuel divestment increased by US$6.5 trillion between 2018 and 2020, while fossil fuel subsidies dropped to a record low of US$181 billion in 2020.

Time series of climate-related global human activities, which include fertility rate and fossil fuel subsidies.

Calls for ‘transformational system changes’

“The updated planetary vital signs we present largely reflect the consequences of unrelenting business as usual,” said Ripple. “A major lesson from COVID-19 is that even colossally decreased transportation and consumption are not nearly enough and that, instead, transformational system changes are required.”

Priorities at the national and international level must focus on enacting immediate and drastic reductions in greenhouse gas emissions, particularly methane. Methane is emitted during the production and transport of coal, natural gas, and oil and it results from livestock and agricultural practices. 

The authors call for changes in six areas:

  • eliminating fossil fuels and shifting to renewable energy sources;
  • cutting black carbon, methane, and hydrofluorocarbons;
  • restoring and protecting the Earth’s ecosystems to restore biodiversity;
  • switching to mostly plant-based diets, reducing food waste, and improving cropping practices;
  • moving from overconsumption to ecological economics and a circular economy; and
  • stabilising population growth by providing voluntary family planning and supporting education and rights for women and girls

“By halting the unsustainable exploitation of natural habitats, we can simultaneously reduce zoonotic disease transmission risks, conserve biodiversity, and protect carbon stocks,” said the study. “So long as humanity’s pressure on the Earth system continues, attempted remedies can only redistribute this pressure.”

“Given the impacts we are seeing at roughly 1.25°C warming, combined with the many reinforcing feedback loops and potential tipping points, massive-scale climate action is urgently needed,” said the study. 

The world may have already lost the opportunity to limit warming to 1.5°C, a goal set out in the Paris Agreement, said the authors.

In the context of the major upcoming climate conference – the 26th UN Climate Change Conference of the Parties (COP26) – the authors recommend a three-pronged approach at the international level.

First, the world needs the global implementation of a significant carbon price, secondly, there needs to be a global phase-out and eventual permanent ban of fossil fuels, and the third intervention is the development of climate reserves to protect and restore natural carbon sinks and biodiversity, said the authors. 

“Implementing these three policies soon will help ensure the long-term sustainability of human civilization and give future generations the opportunity to thrive,” said the study. The study was a follow-up to one published in 2020, which nearly 14,000 scientists have signed across 153 countries, calling for urgent action to tackle the climate emergency.

Image Credits: UNDP, BioScience.

Palestinian medics attend to a young man injured during clashes with Israeli security forces in Jerusalem on 10 May

More than 700 healthcare workers and patients have died, and more than 2000 have been injured in attacks on health facilities across 17 emergency-affected countries and fragile settings since December 2017, according to a new WHO report released on Tuesday. 

Countries at risk included Ethiopia, Yemen, Syria, Mozambique, Nigeria, occupied Palestinian territory, Myanmar and the Central African Republic. 

“We are deeply concerned that hundreds of health facilities have been destroyed or closed, health workers killed and injured, and millions of people denied the healthcare they deserve,” said Altaf Musani, WHO Director of the Health Emergencies Interventions, in a Tuesday briefing on the report. 

This three-year analysis is based on data from the WHO’s Surveillance System for Attacks on Healthcare (SSA), which monitors attacks on healthcare workers, patients, facilities, and healthcare transport, the resources that they affected and their immediate impact on health workers and patients. 

The Surveillance System for Attacks on Health Care recorded data across 17 emergency-affected countries and fragile settings.

One out of six incidents leading to loss of life for health worker or patient in 2020 

The surveillance reported a record-high 1029 attacks on health care in 2019, with the number of reported attacks during the first quarter of 2020. 

But despite fewer reports of incidents in 2020, these incidents were associated with a higher proportion of deaths than in previous years, with the proportion of attacks on health care resulting in at least one loss of life reaching 17% (one in six incidents resulting in deaths).

This year, there have been 603 attacks on healthcare workers in 14 countries with emergencies, resulting in 115 deaths and 281 injuries of healthcare workers and patients. 

Overall, health personnel is the most frequently affected health resource. In 2018 and 2019, attacks on health care impacted health personnel in about two thirds of reported incidents. In 2020, reported attacks affecting health personnel were less frequent than in previous years, while attacks affecting health facilities became more frequent.

‘Ripple effect’ on health workers and health system

The changes in fragile, conflict-affected, and vulnerable (FCV) settings were related to different contexts.For example, attacks in the Deomocratic Republic of the Congo’s (DRC) were related to the country’s second largest Ebola outbreaks in 2018 and 2020. Meanwhile, the 2018-2019 demonstrations in the occupied Palestinian territories’ (oPt) Gaza Strip accounted for two thirds of all reported attacks in 2019. 

Following these crises, reports on attacks on health care became markedly less prevalent. 

The impact of these attacks “reverberates on health workers’ mental health and willingness to report to work, on the communities’ willingness to seek healthcare and also drastically reduces resources for responding to health crises, among others,” noted Musani. 

The “ripple effect of a single incident is huge”, he said, and has “long-term consequences for the health system as whole.”

While the tireless work of health care workers has been championed during the pandemic, these workers have been, for the most part, largely absent from the mental health discourse.

The analysis has shown that healthcare workers are the most affected resource, with over two-thirds of attacks in 2018 and 2019 and over half in 2020 affecting health personnel, rather than facilities or supplies.  

This “worrying data”, says Musani, “goes well beyond claiming lives.”  

COVID-19 shifted pattern of health facility attacks 

The COVID-19 pandemic has further compounded the challenges faced in these FCV settings, causing a shift in patterns of violence. 

Attacks affecting health facilities, transport, and patients have become more frequent after the onset of the COVID-19 crisis.

This has brought unprecedented attention to the acts of violence health response is exposed to, with the report emphasizing that “changes in patterns of attacks on health care are to be expected whenever a major event or crisis of any kind occurs.” 

WHO calls on relevant parties in conflicts to “ensure the establishment of safe working space for the delivery of healthcare services, and equitable, safe access to healthcare, free from violence, threat or fear.”

“During the COVID-19 pandemic, more than ever, health care workers must be protected and respected, and hospitals and health facilities and transportation, including ambulances, should not be used for military purposes – essential conditions for the continued delivery of critical health services,” said Musani. 

 

Image Credits: www.laprensalatina.com, WHO.

Director-General Dr Tedros Adhanom Gheybreysus

The World Health Organization (WHO) has called for a moratorium on COVID-19 vaccine boosters until at least the end of September to enable a minimum of 10% of the population of every country to be vaccinated.

Making the appeal at the WHO’s COVID-19 media briefing on Wednesday, Director-General Dr Tedros Adhanom Gheybreysus said support for the moratorium from the G20 countries was vital as they are “the biggest producers, the biggest consumers and the biggest donors of COVID-19 vaccines”.

Israel started to offer third booster shots to people over the age of 60 this week, while Germany and the UK intend to do so soon. Bahrain, the United Arab Emirates and Thailand already offer boosters to fully vaccinated people.

“It’s no understatement to say that the course of the pandemic depends on the leadership of the G20 countries,” said Tedros, as he called on these countries to “make concrete commitments to support WHO’s global vaccination targets”.

Tedros called on “everyone with influence – Olympic athletes, investors, business leaders, faith leaders, and every individual in their own family and community – to support our call for a moratorium on booster shots until at least the end of September”.

https://twitter.com/NCEMAUAE/status/1422588310388723718

Not enough evidence for boosters

WHO special adviser Dr Bruce Aylward described the moratorium as a call for “global solidarity around the goal of catching up with the rest of the world” with immunisation.

“The entire world is in the middle of this pandemic and, as we have seen from the emergence of variant after variant, we cannot get out of it unless the whole world gets out of it together,” added Aylward. “With the huge disparity in vaccination coverage, we’re simply not going to be able to achieve that. By now going into third, fourth doses or whatever in areas that already have high coverage, we just will not be able to catch up.”

However, Aylward said organ transplant recipients were an “exceptional case” and boosters could be considered to be part of their “primary series’ vaccinations as their level of immunity was still low after two doses.

Meanwhile, Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals, said that while a few countries had started to administer boosters, a number of others were contemplating this – despite the lack of evidence to support boosters.

“We don’t have a full set of evidence around whether this is needed or not,” said O’Brien.

“We need instead to focus on those people who are most vulnerable, most at risk of severe disease and death to get their first and second doses, and then we can move on to how to advance programmes as the evidence gets stronger, and as supply is assured and we have much higher coverage for those first doses in much greater percentages of populations in every country around the world.”

A number of trials are underway at present to test boosters, including Pfizer vaccines that have been tweaked to address the Delta variant.

Health Policy Watch has produced a three-part series on vaccine boosters looking at the global country positions on boosters, boosters in immuno-compromised people and the need for field-based evidence to balance laboratory evidence.

Dr Mariangelo Simao, WHO Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals

Pfizer, Moderna price increases are in response to ‘demand not costs’

Commenting on the news that both Pfizer and Moderna had increased their COVID-19 vaccine prices, Dr Mariangelo Simao, WHO’s Assistant Director-General for Access to Medicines and Vaccines, said this appeared to be demand-driven rather than related to production costs.

“Both manufacturers, Pfizer and Moderna have increased their manufacturing capacities. They have diversified manufacturing plants, and we understand that they have also increased efficiency in the production lines,” said Simao.

“This would, in a normal market situation, lead to a decrease in price not an increase in price. So what we have is clearly a market where the demand is very high in comparison with the production,” added Simao.

“The WHO urges companies to keep prices down. There are many countries around the world that cannot afford any higher price. It’s urgent that we think about this in terms of affordable pricing in times where there is increased manufacturing from those two mRNA, producers, and more efficient production lines as well.”

Over the weekend, the Financial Times reported that Pfizer had increased its price per shot from around $18.50 to $23, while Moderna doses had increased from around $22.60 to $25.50.

 

Dr Faisal Shuaib, NPHCDA’s Executive Director, inspects the US donation of four million COVID-19 vaccines.

IBADAN – On Sunday 1 August, two planes carrying four million doses of the Moderna vaccine from the US touched down in Abuja, Nigeria’s capital city. 

With the arrival of the new doses, Nigeria will be able to resume its COVID-19 vaccination programme which was suspended on 22 July when the Nigeria Primary Healthcare Development Agency (NPHCDA) announced it had exhausted the four million doses of Covishield (Oxford/AstraZeneca COVID vaccine) the country got via the COVAX facility. 

Even though Nigeria’s delivery was the largest shipment by COVAX at the time, it was a drop in the ocean that did not do much in closing the vaccination gap in Nigeria, which has a population of over 211 million people.

At present, only 1.4 million people are fully vaccinated, which represents 0.68% of the population. 

“We are excited that this [delivery] presents another opportunity for us to advance the protection of Nigerians against the COVID-19 virus, especially against the Delta variant,” said Dr Faisal Shuaib, NPHCDA’s Executive Director.

The rollout plan is re-started

According to Shuaib, the Moderna vaccines will first be tested by country’s regulatory agency to ascertain they are up to the country’s standard as established by the regulator.

“Random samples of the vaccines have been taken and are being tested. Within 48 hours they will give us feedback on whether we are good to go,” Shuaib told journalists in Abuja.

When the vaccines become certified, NPHCDA said it will then activate its comprehensive logistic deployment plan at sub-national level in partnership with the Coalition Against COVID-19 (CACOVID), a private sector-led organization.

“This is particularly important because we are already experiencing a third wave and there is no need for the vaccine to be at the national level while they are needed by our citizens,” Shuaib said.

Through the CACOVID partnership, vaccines will be distributed and transported to the respective states via the distribution channels that were utilised for the first set of doses received. When these get to their destinations, local health authorities will then redistribute them to centers where the doses will be administered, while still maintaining a cold chain.

Nigerians who want to be vaccinated need to complete an online registration on a dedicated platform operated by the NPHCDA. From the platform, an appointment date for the vaccination exercise is obtained when the individual is expected to visit the health center.

But the reality of the first phase of the vaccination showed appointment dates and locations were not enforced as vaccination officers only required proof of online registration to give vaccine doses to recipients.

After receiving a vaccination, an individual is given a vaccination card that contains the date and details of the administered vaccine. It also contains the expected date for the second dose if the person receives a two-dose vaccine.

Even though there is growing evidence to support mixing vaccine types, the Nigerian government is still reluctant to direct citizens that received Covishield (AstraZeneca) as first dose to get  Moderna as second dose as it argues that additional Covishield vaccine doses will soon be available in the country.

“For those who have taken the first dose of the AstraZeneca vaccine, within the next week or so, an additional consignment of AstraZeneca vaccine will be delivered. We expect that by mid-August, we will get up to 3.9 million doses of AstraZeneca vaccine,” Shuaib said.

In spite of Nigeria’s extensive COVID-19 vaccination rollout plans, there are still concerns about how the country will track the side effects of the vaccines which appear to hinge on patients presenting to government hospitals with symptoms. Experts described this as inadequate but admitted that the unprecedented pressure on the health authorities to quickly roll out vaccines may have limited the available options.

“Don’t forget that nothing as huge as this one has never been done. It’s not too much to ask that when there are scenarios, such are taken to government hospitals where they can be escalated and tracked,” Bimbo Ibukunoluwa, a primary healthcare worker in Ibadan southwest Nigeria, told Health Policy Watch.

A slowly rising third wave?

 

Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control

When Dr Chikwe Ihekweazu, Director-General of the Nigeria Centre for Disease Control (NCDC), spoke to Health Policy Watch in late June 2021, the country’s COVID-19 epicurve suggested the pandemic was under control. 

However, the latest epicurve suggested that a third wave is gradually emerging in the country, although this varies from one state to another.

In Lagos, Nigeria’s commercial epicenter, there are indications that a third wave is already underway with recent cases already reaching reported figures for the peak of the first wave. But in Abuja, the number of daily cases remains very low in comparison with the first and second waves.

But the true case load is hard to ascertain as testing remains inadequate. Over a year after the first case was confirmed, Nigeria has only conducted about 2.5 million tests so far.

“At the moment, about 20% to 30% of all the tests we do a week are rapid diagnostic tests. So we do about 40 000 to 50 000 COVID-19 tests every week,” Ihekweazu told Health Policy Watch.

There is also an unequal distribution of testing among Nigeria’s 36 states. According to NCDC’s COVID-19 situation report, while states like Lagos have tested over 626,000 people since the pandemic began, Kogi state which is inhabited by about five million people has only conducted about 6,000 COVID tests as at 25 July.

 But this is not peculiar to Nigeria. Dr John Nkengasong, Director of the Africa CDC, told Health Policy Watch that Africa is still not conducting enough tests. 

“The continent is not testing enough. We would like to see a steady increase over time because the foundation for fighting any infectious disease is good testing. And we have to test at scale all the time and maintain that level of testing,” he said. 

Furthermore, only eight African countries have a system to measure excess mortality and Nigeria is not one of them – so it is hard to see whether the pandemic causing abnormally high deaths.

https://www.worldometers.info/coronavirus/country/nigeria/

Unready for vaccination exercise?

Ihekweazu and Shuaib expressed confidence in Nigeria’s response to COVID and preparedness for the massive rollout of millions of doses of different vaccines requiring different conditions, respectively.

But the country’s health minister Dr Osagie Ehanire said Nigeria’s relatively weak health system is also threatening the country’s COVID response – in addition to vaccine inequity.

“I do not believe that all African countries are prepared, there are countries that require some support,” the minister said.

“We are very worried because of our population, and the similarity with India – with high population density and the fervor for politics and religion, which lead people very often to ignore the public health advisories that we have put in place.” 

He added that Nigeria’s COVID response, including vaccine rollout, will benefit from risk communication and community engagement.

“I don’t think that this can be done in a very short time but there’s absolutely a lot of emphasis and pressure put on governments across Africa, to wake up to the risks,” he said.

Compounding difficulties with the rollout, doctors in Nigerian state hospitals have begun a strike over pay, benefits and poor working conditions. The strike is organised by the National Association of Resident Doctors, which represents about 40% of doctors in the country.

A health worker gets vaccinated with the first donation via COVAX.

Nigeria’s vaccine pipeline 

Nigeria is expecting doses of vaccines from COVAX, the African Union’s COVID-19 Vaccine Acquisition Task Team (AVATT), and donations from various sources including this week’s US donation.

From August, Enahire said Nigeria is expecting over 29 million doses of J&J vaccine through AVATT.

In addition, the country is also expecting over three million doses of Oxford/AstraZeneca vaccine and 3.5 million doses of Pfizer COVID vaccine.

“From the end of July through August, and beyond, we are going to have more doses, and more varieties,” the minister said.

Furthermore, Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC) has also issued authorisation for the AstraZeneca, Johnson & Johnson, Pfizer and Moderna vaccines while Enahire expressed confidence in the country’s ability to meet the storage requirements of the various vaccines, including those that require ultracold chain, and those that require direct refrigeration.

Even though he said there are ongoing collaborations to ensure the doses are quickly distributed and administered, he noted that emphases are being placed on states that are considered as the hotspots of the pandemic in the country.

“We are looking to scale up the vaccination capacity right across the whole country, with a little bit of emphasis on those areas that are already the hotspots,” Enahire said. 

With expanded vaccine access the main goal of Nigeria’s endgame for COVID, Ihekweazu said attention should be on sustaining the gains and securing more doses.

“So the key thing now is to hold on to the fragile successes that we’ve had, [and] continue pushing for more vaccines so that we can get more shots into the arms of our people as quickly as possible,” Ihekweazu told Health Policy Watch.

The Delta variant conundrum

Nigeria is one of the 21 African countries where the Delta variant of the SARS-CoV-2 virus has been reported. Ihekweazu told Health Policy Watch that the variant is becoming worrisome for the country’s public health officials. 

He described quick access to vaccines as a major way through which Nigeria can limit the impact of the pandemic on its people. 

“The good thing is that the variant is still very susceptible to the vaccines. So as we increase our vaccine coverage rates, we will continue to protect ourselves even against the Delta variant,” Ihekweazu said.

With reports of health systems in several African countries becoming overwhelmed and overrun by the Delta variant, Nigerians who were initially reluctant to get vaccinated are now more interested, including a nurse on a psychiatry ward at Nigeria’s first teaching hospital, the University College Hospital in Ibadan.

Initially, Nurse Shade (name changed to protect her identity) refused to be vaccinated because her church pastor, inspired by US-based right wing anti-vaccine messages, preached against the vaccine to his Nigerian congregation.

But with daily reports of deaths due to the Delta variant among the unvaccinated, Shade became afraid and was anxious to quickly receive the jab. However, registration had closed and she would now wait until vaccination resumes.

“Since I heard that one is more likely to die of COVID if one is not vaccinated, I’ve felt very stupid for failing to receive the vaccine when I could easily get it. Now I daily listen to news for updates on when the next round will begin,” she told Health Policy Watch.

Nkengasong also revealed the success of vaccine rollout in many African countries has also shore up confidence for the exercise among the people considering healthcare workers were the first to receive the doses.

“People are seeing that nothing happened to those who received the vaccines against what the misinformation made them to believe. It has been shown that if the vaccines are available, Africans will receive the vaccine,” Nkengasong said.

Image Credits: USAID.

This article is the third in a three-part series on COVID-19 booster vaccines, which is an evolving discussion as more evidence emerges about the performance of vaccines against variants.

Alongside the heated policy debate over the disproportionate consumption of COVID vaccines in rich countries, a handful of senior scientists are pushing back against the scientific rationale of offering booster vaccines to healthy people who are already fully vaccinated.  

They argue that a key metric touted by booster shot proponents – lab-based antibody counts in the blood – is not a watertight proxy for the real-life performance of vaccines. 

Dr Francis Collins, the Director of the US National Institutes of Health (NIH), has recently argued in his blog that immunity against SARS-CoV-2 and variants like Delta could even last “for years”.

At the heart of this scientific debate is the question of whether the “neutralizing antibody” counts in blood are an accurate proxy of immunity against COVID-19. Like warriors, these antibodies latch onto foreign invaders such as the SARS-COV-2 virus and block their entry into human cells, preventing them from wreaking havoc in the body. But they also are not the only factor in the body’s immune response, experts told Health Policy Watch.

The debate continues to rage even as Pfizer/BioNTech prepare to submit a request to the US Food and Drug Administration for approval of a third booster, based primarily on just that kind of neutralizing antibody data. 

Neutralizing antibodies (green) can latch onto viruses like SARS-CoV-2 and prevent them from entering human cells

Lab antibody responses are not a proxy for immunity

But until more robust evidence emerges, antibody responses from the lab can’t yet be used as a simple benchmark to boil down a complex immune response or to estimate the extent to which a person is protected to SARS-CoV-2, Dr Michael Osterholm, Director of the US Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, told Health Policy Watch in an interview.

“You can do all the lab studies you want, but if you can’t demonstrate in humans that antibody responses are the core of their protection against SARS-CoV-2, then the question is what are you measuring?” said Osterholm. “You can have the most amazing immunological response you want, but if that’s not what’s protecting you, what good is it?”

Surprisingly, early-stage clinical trials for mRNA vaccines have revealed that people are well protected against SARS-CoV-2 within three weeks of their first jab, yet their antibody counts are very low at that point, said Osterholm. This indicates that antibodies on their own can’t fully explain or predict immunity to COVID, at least for now, he added.

“During the early mRNA trials [of Pfizer and Moderna vaccines], the antibody response was not at all correlated with very rapid protection from the vaccines, even at three weeks post first dose, where we already saw a trend towards protection,” explained Osterholm.

“I am not totally convinced that there is perfect parallelism between measures of antibodies and immune response,” added Dr Antoine Flahault, Director of Geneva University’s Institute of Global Health. “There is a lot of evidence in the past history of infectious diseases where such parallelism did not exist.”

It is also a well-known fact among immunologists that antibody counts naturally wane over time following a natural infection or vaccination, but upon re-exposure to a pathogen like SARS-CoV-2, the immune system will mount a quicker and more robust response. This includes massive antibody production that will help neutralize the pathogen, researchers told Health Policy Watch.

Robust immunity may last ‘for years to come’

Last month, NIH director Collins asserted that robust immunity against SARS-CoV-2 could persist “for years”, even against rapidly spreading variants.

Collins was citing an NIH-supported study of 14 fully vaccinated individuals, which revealed that the “germinal centres” in lymph nodes – the training camps where an army of diverse immune cells learns to fight off threats like the SARS-CoV-2 virus – were highly active several months after vaccination, including in people infected with Alpha and Beta (the variants first discovered in the UK and South Africa, respectively). 

“Germinal center reactions that persist for several months or longer usually indicate an extremely vigorous immune response that culminates in the production of large numbers of long-lasting immune cells, called memory B cells,” said Collins.

“Some memory B cells can survive for years or even decades, which gives them the capacity to respond multiple times to the same infectious agent….vaccine protection looks really good right now, including for the delta variant that has all of us concerned.”

Israel set to be world’s guinea pig on booster shots 

Meanwhile in Israel, where cases are rising rapidly even though the country’s vaccination coverage is one of the highest in the world, Dr Eyal Leshem stressed that robust clinical data is still lacking about the real-life benefits of boosters in fully vaccinated people.

“We cannot rely on surrogate markers like seroconversion or neutralizing antibodies to provide a general recommendation for a booster dose,” emphasized Leshem, who is at the helm of the Center for Travel Medicine and Tropical Diseases at the Sheba Medical Center in Israel. “This must be proven clinically, it cannot be based on hunch.”

His comments come as Israel prepares to offer a third booster shot to anyone aged 60 and over this week as a precautionary move in light of a sharp increase from about 200 daily cases in early July to almost 3 000 a day by early August. 

Israel is also concerned about data revealing that the efficacy of two-doses of the Pfizer/BioNTech vaccine has dropped from over 90% to around 40% for the prevention of infection.

That data has sparked concerns that people over the age of 60, who tend to have weaker immune systems and more pre-existing conditions than younger people, need stronger protection, even if 90% of them are already fully vaccinated.

Leshem added that boosters would only be warranted if they were shown to substantially improve primary clinical outcomes like severe disease and hospitalization, rather than secondary outcomes like infection and mild disease – or even results from lab-based studies like antibody counts.

Based on his assessment, the data to support boosters in healthy people appears to be lackluster for now – insofar as two shots of Pfizer confer more than 95% protection against severe COVID-19, even against variants like Alpha, Beta, and most recently Delta.

“The bulk of epidemiologic evidence supports real-life effectiveness of vaccines against severe disease and hospitalization,” emphasized Leshem. “Studies by Public Health England suggest 95% effectiveness against hospitalization against Delta.”

Soon, more large-scale clinical data about the benefits of boosters will become available, as Israel starts administering boosters to people over 60 in the next few months.

While Israeli experts acknowledge that they are taking a gamble with boosters – initial results suggest that they are at least not harmful in people who receive them, based on the lack of adverse effects seen among immuno-compromised people who have already received boosters in France and Israel.


The United Kingdom, which has currently seen some of the highest case counts worldwide even though over half of the population is fully vaccinated, may soon follow with boosters in high-risk groups, as well as Germany, Spain, and Italy.

Meanwhile, in the United States, where regulatory authorities are holding back against a booster for now, there are concerns that people will seek a third shot on their own. This is possible given the fragmented nature of the US health care system, which enables people to receive their third jab at a different clinic or pharmacy than the one that they used for their first two – at least in theory.

Such behavior will be challenging to track in the US, as the country lacks a centralized database of who has been vaccinated, when, and with how many doses – unlike Israel, which has a detailed database that can track the vaccination status of virtually every citizen and resident in the country.

Pfizer pushes US for booster shots in general population 

Pfizer/BioNTech, meanwhile, is already pushing the US drug regulatory agency to consider boosters in the general population and developing an updated booster to target the Delta variant, citing “encouraging” lab-based data to support the move.

“Pfizer and BioNTech have seen encouraging data in the ongoing booster trial of a third dose of the current BNT162b2 vaccine,” said a recent statement by Pfizer/BioNTech. “Initial data from the study demonstrate that a booster dose given 6 months after the second dose has a consistent tolerability profile while eliciting high neutralization titers against the wild type and the Beta variant, which are 5 to 10 times higher than after two primary doses,” said Pfizer.

According to booster shot proponents, antibody counts are sometimes directly linked to the level of protection against SARS-CoV-2. For that reason, they have argued that reductions in antibody counts over time are “likely to be important”.

“The levels of circulating antibodies are likely to be an important part of protection so their waning is likely to be important,” Dr Andrew Hayward, Director of the UCL Institute of Epidemiology and Health Care, told Health Policy Watch. 

“In many infections, we find a direct relationship between levels of circulating antibody and level of protection which is why some public health bodies measure levels of antibodies in the population to inform vaccination booster programmes.

“There is also some data that suggests higher circulating antibody levels are associated with greater protection across variants, which is an important consideration,” said Hayward, who has tracked how antibody counts change over time.

At the same time, scientists from Pfizer, as well as Hayward, have acknowledged that other components of the immune system – like T cells, B cells, or interferon-gamma – need to be further studied to understand the full breadth of the immune response to vaccines (and to SARS-CoV-2 infection).

“Early protection against COVID-19 without robust serum neutralization indicates that neutralizing titers alone do not appear to explain early BNT162b2-mediated protection from COVID-19,” said a recent study supported by Pfizer. This refers to the fact that people already have some degree of protection against SARS-COV-2 several weeks after their first jab, even though their antibody levels are low at that point.

“Other immune mechanisms (e.g., innate immune responses, CD4+ or CD8+ T-cell responses, B-cell memory responses, antibody-dependent cytotoxicity) may contribute to protection,” the study added.

Known to be a cornerstone of immunity, T cells and interferon gamma are known to be vigorously activated following the Pfizer jab, several studies have revealed.

A marriage between data from the bench and the field 

Going forward, researchers need to marry lab-based data with clinical data from the field to shed light on what is often considered to be the holy grail of immunity: the so-called “correlates of immunity”.

Dr Michael Osterholm, Director of the US Center for Infectious Disease Research and Policy (CIDRAP)

Identification of such correlates would allow scientists to be certain that the metrics they use – like neutralizing antibodies – are an accurate benchmark of the immune response to SARS-CoV-2. 

In addition, such correlates would allow researchers to quickly evaluate how well vaccines are working, for who, and for how long – supercharging COVID-19 R&D and allowing more lives to be saved.

“With regard to what we can say right now about the correlates of protection: they’re clearly inadequate,” said Osterholm. “We don’t know the answers to these questions yet. In the natural history of COVID-19, we are still in the early days.”

“If I had a bag of pixie dust, I would cast it upon the world and marry the immunologic data with data from the field. That will be the ultimate proof of the pudding.”

However, such large-scale studies will take time, he warned. 

“What people have to understand is we’re actually building this plane at 30,000 feet. And that’s hard for people to understand because people want the pandemic to be over.”

Third in a series on COVID-19 booster vaccines. See the second article, COVID Vaccine Boosters in Immuno-compromised People – Could They Also Help Curb Development of New Variants ?

Image Credits: International Monetary Fund/Ernesto Benavides, NIH, CIDRAP.

 

Sixteen countries have pledged more than 610 million COVID-19 vaccine doses for 2021-2022 through COVAX, the global vaccine sharing facility, and low and middle income countries have already received 37.7 million donated doses.

The United States under President Joe Biden is leading the pack with a total pledge of 260 million doses, followed by team Europe (France, Germany, Italy, Spain, Portugal, Norway, Belgium, Sweden, and Denmark)  which is donating more than 200 million vaccine doses over the next few months.

Canada (30.7m), Japan (30m), United Kingdom (80m), Switzerland (4m), New Zealand (1.6m), and United Arab Emirates (1m) have also donated vaccines via COVAX.

This and other COVID-related data is now readily available on a new interactive website which serves as a platform for COVID-19 vaccine information.

It provides information per country income classification and has eight categories including vaccine supply, and deliveries, dose donation to COVAX and financing gaps.

Launched on 30 July, the website is a collaboration between the International Monetary Fund (IMF), World Bank Group, World Health Organization (WHO), and World Trade Organization (WTO).

Announcing the launch of the website, the agencies called on countries with advanced COVID-19 vaccination programs “to release as soon as possible as much of their contracted vaccine doses and options as possible to COVAX, AVAT, and low and low-middle income countries.”

Citing “acute and alarming shortage”, the four agencies said less than 20% of the necessary vaccines are scheduled for delivery to low- and middle-income countries through COVAX, AVAT, or bilateral deals, with fewer than 5% of pre-purchased vaccine doses having been delivered. 

The agencies urged COVID-19 vaccine manufacturers to  “redouble their efforts to scale up production of vaccines” and called on richer countries to eliminate barriers to the export of vaccines.

Biden Announces New Donations

The newly launched interactive website shows that 1.1 billion of the world’s population have been fully vaccinated, 2 million short of the 3.1 billion target for the end of 2021.

On Tuesday, just days after the launch of the website, President Biden announced  his latest donation and shipment of more than 110 million doses of vaccines to more than 60 countries, which according to a statement by the White House is: “A major milestone that cements the United States as the global leader in COVID-19 vaccine donations.”

“These more than 110 million doses – that are already saving lives around the world – are just the beginning of the Administration’s efforts to provide vaccines to the world. Starting at the end of this month, the Administration will begin shipping half a billion Pfizer doses that the United States has pledged to purchase and donate to 100 low-income countries in need,” the statement reads.

Biden’s announcement comes as a new wave of COVID-19 infections fuelled by the deadly Delta variant is currently striking countries worldwide. Just last week the WHO announced a special global initiative to respond to the Delta variant, as COVID-19 cases are expected to reach 200 million within the next week, calling for countries to intensify their vaccine roll-out programs.

The data on the new website gives a detailed breakdown of, among other, vaccine administration and vaccine shortages per country.

Rich countries including the US and the UK are streaks ahead of low-and middle-income countries in their vaccination programs.

Biden’s donation announcement comes as the Centers for Disease Control and Prevention announced that 70% of US adults have had at least one shot of a COVID vaccine.

Almost 56% of the UK’s population have been fully vaccinated, with 68.4% having received at least one jab.

African countries lagging with vaccine roll-outs

 

African countries, including South Africa, Kenya, Uganda, and Nigeria are lagging with the vaccination programs largely due to access to vaccine doses.

To date, South Africa has only vaccinated 5.4% of its more than 59 million population with the 8,243,908 vaccine doses delivered to the country. Only 4.78% of SA’s population is fully vaccinated, while 9.98% have received at least one dose.

Less than 1% (0.68%) of Nigerians have been fully vaccinated, while 1.23% have at least received one dose. Uganda and Kenya have vaccinated 0.01% and 1.59% of their populations respectively.

Image Credits: World Bank: Mohamed Azakir.

pregnant
The Delta variant is particularly dangerous for pregnant women.

Unvaccinated pregnant women infected with the Delta variant run a greater risk of contracting severe COVID-19, according to a UK study of 3371 pregnant women admitted to the hospital with symptomatic COVID-19. 

The study, conducted by the UK Obstetric Surveillance System (UKOSS), found that 24% of pregnant women admitted in the first wave had moderate or severe disease, compared to 36% of those infected with the Alpha variant and 45% with the Delta variant. 

The number of unvaccinated pregnant women admitted to the hospital has been on the rise, which Marian Knight, Professor of Maternal and Child Population Health, University of Oxford and chief investigator of the study called ‘concerning’. 

“Around 200 pregnant women were admitted to hospital with COVID-19 last week. I cannot emphasise more strongly how important it is for pregnant women to get vaccinated in order to protect both them and their baby,” said Knight.

Worsening illness and post-birth complications for mother and baby  

Babies born to mothers in the Alpha and Delta periods of the pandemic were more likely to require admission for neonatal care compared to the first wave.

Pregnant women are particularly vulnerable to becoming severely ill from COVID-19 compared to non-pregnant women of a similar age, according to the WHO. Around one in ten women admitted to the hospital with symptoms of COVID-19 require intensive care, and one in five pregnant women give birth prematurely. 

Women admitted during the period when the Alpha variant was dominant in the UK were more likely to require respiratory support, have pneumonia, and be admitted to intensive care than women admitted in the first wave. 

Women admitted during the Delta period had an even further increase in risk, compared to those in the Alpha period, with a greater proportion having pneumonia.

Babies born in the Alpha period were more likely to require admission for neonatal care compared to the first wave, with a similar proportion for babies born to mothers in the Delta period.

Vaccinating pregnant women offers effective protection against COVID-19 

Women in Bongouanou, Côte d’Ivoire, during a prenatal medical consultation.

Protecting both mothers and babies with the vaccine does have its benefits, with data from the study showing that COVID-19 vaccinations offered effective protection for pregnant women against severe illness and other risks. 

Vaccination data has been collected since 1 February 2021. Of the 742 women admitted since that date, only four had received a single dose, and none had received both doses. 

This means that more than 99% of pregnant women admitted to the hospital with symptomatic COVID-19 are unvaccinated. In comparison, 60% of the general population admitted to the hospital with COVID-19 are unvaccinated.

During this time, at least 55,000 pregnant women received one or more doses of a COVID vaccine in the UK. 

‘It is extremely good news that so few vaccinated pregnant women have been admitted to hospital with COVID-19,” said Knight, who advised unvaccinated pregnant women to remain cautious and continue social distancing measures.

 “Until they are vaccinated, pregnant women must continue to be extremely attentive to social distancing measures including mask-wearing, 2m distancing and meeting outdoors where possible,” she added.

“This study shows that very few pregnant women are admitted to hospital with COVID-19 after they have received a vaccine,” said Nicola Vousden, first author of the study. “Other studies have shown that women who have received a vaccine pass on antibodies to their babies, so the benefits of vaccination to both pregnant women and their babies are clear.”

The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives recommend that unvaccinated women who are pregnant or considering pregnancy get their vaccine as soon as possible, and book their second doses once eligible. 

UK trial to explore optimal vaccination schedule

Meanwhile, a UK clinical trial has been launched in order to alleviate concerns about the vaccine and determine an optimal vaccination schedule to protect pregnant women against COVID-19. 

The clinical trial, called Preg-CoV, will help determine the best gap between doses for pregnant women and explore in greater detail the potential side effects and impact on babies, which researchers hope will offer reassurance for expecting mothers and those thinking of becoming pregnant.  

“We really do need to make sure that when we are vaccinating pregnant women we are doing so in the most optimal way to ensure they are best protected,” said Paul Heath, chief investigator of the trial and professor of paediatric infectious diseases at St. George’s University of London.

In the first phase of the Preg-CoV trial, the team hopes to recruit 600 pregnant women between the ages of 18 and 44 across 13 sites in England. 

Two groups of 200 unvaccinated women at different gestation times will be randomized with either a Moderna or Pfizer vaccine and will be given their second dose four to six weeks or at 8-12 weeks after the first dose. 

Participants will not know which COVID jab they are given, added Heath. 

A third group of 100 pregnant women will be given one dose of a COVID shot at 28-34 weeks gestation, with the second dose of the same vaccine after delivery. 

The fourth group of 100 pregnant women will have already had their first dose of any COVID vaccine before or very early in pregnancy, and will get their second dose of the same vaccine during the trial. 

All women recruited will have follow-up visits and blood tests, and will fill in an electronic diary to help researchers monitor any adverse side effects. The team will also track outcomes for the babies up to 12 months of age to explore safety and impact on their development.

Experts note that there is no evidence of harm to babies, as the shots are beneficial in reducing chances of pre-term birth or stillbirth, and the antibodies can cross the placenta, protecting the child against COVID. 

Pregnant women should be included in future vaccine trials  

Heath said the trial would “fill in the gaps” in current knowledge about vaccinating pregnant women.

While the UK COVID vaccination program has been a success, uptake has been slow among pregnant women. 

“Pregnant women are still concerned because pregnant women were not included in initial COVID vaccine trials,” said Asma Khalil, lead obstetrician for the trial.

“I think there will be some lessons learned from this pandemic. And one of them is that we should consider including pregnant women at a relatively early stage for vaccine trials.”

 

Image Credits: Elizabeth Poll/MMV, USAID/Flickr, UN Photo/Hien Macline.

The Wuhan Institute of Virology, guarded by police officers during the visit of a WHO-led team of scientists in early February, 2021.

A “preponderance of evidence” proves that the SARS-CoV2 virus escaped from the Wuhan Institute of Virology (WIV), the Chinese research institute studying bat coronaviruses, concluded a report by US Congressional Republicans, released on Monday. 

“As we continue to investigate the origins of the COVID-19 pandemic, I believe it’s time to completely dismiss the wet market as the source of the outbreak. Instead, as this report lays out, a preponderance of the evidence proves that all roads lead to the WIV,” Representative Michael McCaul, Lead Republican on the House Foreign Affairs Committee, said in a press release. 

The report, published ahead of a planned report by the Democratic administration of US President Joe Biden, due to be completed by the end of August, is sure to add a partisan political dimension to the questions hanging over the origins quest.  And that, on top of an already charged triangle of tensions between Washington, Beijing and the World Health Organization in Geneva – over how to proceed with the origins investigation after China last month rejected out-of-hand WHO suggestions that that the lab escape theory should be revisited, along with requesting Beijing to supply for more data and information.

Report cites “ample evidence” that WIV researchers were working to modify coronaviruses – to be even more infective

The report cites “ample evidence” that WIV researchers, aided by US experts and funded by the Chinese and US government, were working to modify coronaviruses to improve their ability to cause disease – ostensibly for vaccine research.

“Much of this research was focused on modifying the spike protein of coronaviruses that could not infect humans, so they could bind to human immune systems. The stated purpose of this work was to identify viruses with pandemic potential and to create a broad-spectrum coronavirus vaccine,” the report said.

But this risky research was taking place in unsafe biosafety conditions, according to the report. 

“With dangerous research like this conducted at safety levels similar to a dentist’s office, a natural or genetically modified virus could have easily escaped the lab and infected the community,” said the report. 

“It is our belief the virus leaked sometime in late August or early September 2019,” said McCaul.

Alleges Chinese, World Health Organization & EcoHealth Alliance coverup

Then, in the wake of the virus escape, the Chinese Communist Party (CCP) embarked on a massive cover-up, detaining doctors and journalists to silence them, destroying lab samples, and hiding evidence of human-to-human transmission, the report claimed, adding that the World Health Organization was compliant in the cover-up. 

“The CCP and the World Health Organization (WHO) went to great lengths to cover up the initial epidemic,” said the report, adding that WHO Director General Dr Tedros Adhanom Ghebreyesus “parroted CCP talking points” and “act[ed] as a puppet of General Secretary Xi.”  

WHO Director-General Dr Tedros Adhanom Ghebreyesus at the biweekly WHO press conference on Friday.

“This was the greatest cover-up of all time and has caused the deaths of more than four million people around the world, and people must be held responsible,” said McCaul.

The report further charges that in the wake of the outrage over the pandemic, researchers at the WIV, along with Dr Peter Daszak, President of EcoHealth Alliance and a member of the joint WHO-China origins investigation team, covered up the real nature of the research being conducted. 

WIV and Daszak singled out for “misleading the world”

Authors of the report claim that scientists at WIV and Daszak misled the world, lied about the research being conducted, and bullied other scientists who questioned whether the virus could have leaked from a lab.

Dr Peter Daszak, President of EcoHealth Alliance and member of WHO’s investigative team.

Top scientists from the WIV, along with Daszak, were “misleading the world about how a virus can be modified without leaving a trace and…directly lying about the nature of the research they were conducting, as well as the low-level safety protocols they were using for that research,” said the report.

“These actions not only delayed an initial investigation into the possibility of a lab leak, costing valuable time, but provide further proof the virus likely leaked from the WIV. These actions also call into question the way in which U.S. government grants are used in overseas labs and call for more oversight of those grants,” the report said. 

“Now is the time to use all of the tools the U.S. government has to continue to root out the full truth of how this virus came to be. That includes subpoenaing Peter Daszak to appear before the House Foreign Affairs Committee to answer the many questions his inconsistent – and in some instances outright and knowingly inaccurate – statements have raised,” said McCaul, in his statement.

The report, authored by the House Foreign Affairs Committee Minority Staff, also calls upon the US Congress to: 

  • Institute a ban on conducting and funding work that includes gain-of-function research, which genetically alters an organism to enhance its biological functions, until international standards are set;
  • Sanction the Chinese Academy of Sciences, which runs the WIV;
  • Financially sanction the leadership of the WIV to block their assets and prohibit US citizens from dealing with them; and
  • Authorize new sanctions for academic, governmental, and military bioresearch facilities that fail to implement the appropriate levels of safety and information sharing.

Daszak, who is a member of the “Lancet COVID-19 Commission Task Force on the Origins, Early Spread of COVID-19, and One Health Solutions to Pandemics,” recused himself from the Commission’s work on the origins of the pandemic in late June.  This decision was made to remove any question over whether there were conflicts of interest with his research ties with the WIV. He continues to work on analysis of the early spread of SARS-CoV2 and One Health solutions.

Republican report comes in wake of recent study linking deleted SARS-CoV2 gene sequences more closely to bat viruses 

The new US report comes on the heels of a recent study posted on the pre-print server Biorxiv.org that unearthed a deleted data set of SARS-CoV2 virus gene sequences circulating in Wuhan in late 2019, in variants “that made it more similar to SARS-CoV-2’s bat coronavirus relatives” – than those circulating in the Huanan Seafood Market. 

The Seafood Market was the first site to be publicly identified as the epicenter of the new virus, when clusters of infection linked to market workers or patrons were first publicly identified in December 2019 and January 2020.  

However, it has since become evident that other virus variants were already circulating in clusters outside of the market in December, and likely well before.  

“At first, we assumed the seafood market might have the virus, but now the market is more like a victim,” Dr George Fu Gao, Director General of the Chinese Centers for Disease Control and Prevention, admitted in May 2020. “The novel coronavirus had existed long before.”

In the new Biorxiv.org study, the lead author Dr Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Research Center, recovered virus sequences that were deleted from US data repositories from a Google cloud. 

 

His study reports on 34 of some 241 SARS-CoV2 genetic sequences that were collected at Renmin Hospital of Wuhan University early in the Wuhan outbreak, and later posted, then deleted from, the US National Institutes of Health’s Sequence Read Archive (SRA) data repository. 

Using raw sequence data from the recovered samples, Bloom was able to reconstruct partial sequences for 13 of the samples.

Most ‘perplexing finding’

Bloom’s most “perplexing” finding was that among the early SARS-CoV2 sequence samples, those collected from people or areas outside of the Wuhan market have a closer relationship to bat coronaviruses – which are presumed to be the animal origins of the virus. 

This suggests that the market sequences, which were initially the focus of the joint WHO-China origins investigation’s epidemiological work, are not really representative of the viruses that were circulating in late 2019. 

“We’d expect the first SARS-CoV2 sequences would be more similar to bat coronaviruses, and as SARS-CoV2 continued to evolve it would become more divergent from these ancestors. But that is *not* the case!” Bloom tweeted on 22 June. 

Samples collected later in other areas of China and other countries were more similar to bat coronaviruses than samples from early Huanan Seafood Market cases. All sequences associated with the market differed from RaTG13, the bat coronavirus with the highest full-genome sequence identity to SARS-CoV2, by at least three more mutations compared to subsequent sequences collected. 

This is “a fact that is difficult to reconcile with the idea that the market was the original location of spread of a bat coronavirus into humans,” said the study. 

Deleted files reported to be back online now

Last week, the New York Times reported that the missing viral genome sequences were back online – after quietly being uploaded in early July to a China National Center for Bioinformation database, overseen by the government following publication of Bloom’s report. 

Speculation by Bloom that the sequences had been deliberately deleted was countered by Chinese government statements that the sequences had gone missing as the result of an editorial error, noted by a German scientific journal. 

Bloom has been involved in the policy decisions around virus origins debate 

Bloom has been involved in the debate over the virus origins, joining 17 other prominent scientists to author a letter in Science critiquing the joint WHO-China origins report. 

According to the authors, “theories of accidental release from a lab and zoonotic spillover both remain viable” and were not “given balanced consideration” by the report.

In the letter, they demand that the two hypotheses “be taken seriously…until we have sufficient data.”

According to Bloom, “these data provide no direct evidence to favor either a lab accident or a natural zoonosis. However, they do indicate the importance of continuing to seek new data about the origins and early spread of SARS-CoV2.”

Bloom’s study “indicate[s] that we probably have not exhausted all relevant data,” he told the Washington Post. 

“Scientists need to stay focused on data-driven study SARS-CoV2 origins/early spread,” Bloom tweeted on 22 June. “After spending 4 months studying this closely, I am cautiously optimistic that additional relevant data are still likely to come to light.”

“We should therefore avoid dogmatic arguments about SARS-CoV2 origin/early spread, and instead focus on following two questions: (1) How can we get more data? (2) How can we better analyze the data we have?” he continued. 

Findings add to previous evidence of earlier virus circulation – with no link to Huanan Seafood Market

Several other studies have also found that many early COVID cases also had no connection to the Huanan Seafood Market. Those include: 

  • A study published in the Lancet in late January 2020, conducted by a large group of Chinese researchers, discovered that the earliest reported case had no link to the market and “no epidemiological link was found between the first patient and later cases.” Only 66% of the patients in the study had direct exposure to Huanan Seafood Market. 
  • In a separate study conducted by researchers at the Jinyintan Hospital in Wuhan, 49% of the 99 patients with COVID-19 had a history of exposure to the market.
  • Researchers from the University of California San Diego used molecular dating tools and epidemiological simulations to identify the first case of SARS-CoV2. In the study, published in the journal Science in April 2021, the researchers estimated that the virus was likely circulating undetected for at most two months before the first human cases of COVID-19 were identified in Wuhan.

Genetic tracking may help determine virus origins  

Regardless of the narrative around the sequences’ disappearance, more knowledge about the genetic sequences of early virus mutations is critical in tracking the virus origins, other scientists agree. 

“This line of inquiry may help us determine the origin of the virus and reconstruct how it spread in the earliest days of the pandemic,” Dr. W. Ian Lipkin, Professor of Epidemiology at Columbia University’s Mailman School of Public Health, told USA Today. 

During the WHO-mandated origins investigation in Wuhan in January and February of 2021, the team gathered evidence that there were diverse strains of the SARS-CoV2 virus already circulating in the city in December 2019. 

“The SARS CoV-2 virus was circulating in the Wuhan market market in December 2019, but it was also circulating elsewhere in the city, in cases unrelated to each other,” Marion Koopmans, a Dutch virologist and epidemiologist and a member of the joint WHO-China origins investigation, acknowledged at a press briefing in early March.

“The analysis of recovered sequences does not fundamentally change our current understanding of early SARS-CoV2 evolution, but it does make the hypothesis of a single-source wet market outbreak implausible,” Dr Sergei Pond, Professor of Biology at Temple University in Pennsylvania, tweeted.

 

“The progenitor of all known SARS-CoV-2 sequences could still be downstream of the sequence that infected patient zero – and it is possible that the future discovery of additional early SARS-CoV-2 sequences could lead to further revisions of inferences about the earliest viruses in the outbreak,” said the study.

“We should be prepared, however, to revise these ideas and hypotheses further if and when more early sequence data emerge,” Pond tweeted.

Image Credits: CNN, Sputnik.