Uganda is dealing with five different coronavirus variants that have fuelled aggressive transmission as the country enters the second wave of the pandemic.

Uganda is suffering an acute shortage of oxygen and intensive care beds as the country grapples with a deadly second wave of the pandemic that is being fuelled by five different virus variants.

Regional referral hospitals and the country’s biggest hospital, Mulago National Referral Hospital, have run out of oxygen or have reported acute shortages,  forcing medical staff to decide who gets the life-saving treatment.

At least 22 countries on the African continent are in the midst of new infection waves, with Uganda, Namibia, South Africa, Tunisia and Zambia being the worst-hit. 

On 16 June, Uganda recorded 1,564 new infections and 42 new deaths.

On Wednesday, the country received 75,200 doses of the AstraZeneca vaccine, donated by the French government through the COVAX facility.

Ugandan Health Minister Dr Jane Ruth Aceng, told a WHO Africa Region press briefing on Thursday, that her country was dealing with five major variants and that COVID-19 transmission was “very aggressive”.

Aceng said the variants registered in Uganda include Delta (B.1.617.2 first identified in India), Eta (B.1.525), Beta (B.1.351 from South Africa), Alpha (B.1.117 identified in the UK) and the local strain, which she identified as B.1.617.  These strains are on the rise and are fuelling the transmission, according to Aceng.

“We have started a robust intervention in the communities. We are handing the pandemic back to the community to take it up themselves and ensure that everybody adheres to [standard operating procedures] and account for all the infected,” said Aceng, adding that more research is being conducted into how the variants are spreading.

Last week, the WHO warned of a third wave of the pandemic across Africa, with 90% of countries likely to miss the global vaccination target of at least 10% of their populations by September.

No New Vaccinations 

Ugandan Health Minister Dr Jane Ruth Aceng (left) and French Ambassador to Uganda Jules-Armand Aniambossou (right) on 17 June received the 75,200 doses of the AstraZeneca COVID-19 vaccine donated by the French government through the COVAX facility.

The new vaccine doses delivered on Wednesday brings the total number of COVID-19 doses received in the country to 1,139,200. Uganda’s first two batches, totalling 964,000 doses, arrived in the country in March and are expected to expire by 10 July.  

By 15 June, over 812,000 people including health workers, teachers, security personnel, airport staff, the elderly and people with diabetes, hypertension and other underlying conditions had been vaccinated.

However, Aceng said that health workers, teachers and all those who got a first shot will be prioritized to get their second shots, as the demand for vaccines rises among the public.

Out of the targeted 160,000 registered health workers in the country only 69,000 have been fully vaccinated according to the Ministry of Health.  President Yoweri Museveni recently decreed that all teachers should be vaccinated before being allowed  back in the class.

“Vaccine hesitancy was real at the beginning and we opened up beyond the categories we wanted to target, but now we have more demand than we can meet. Many people are now rushing to get vaccinated,” presidential adviser on epidemics Dr Monica Musenero told reporters at a press briefing on Wednesday.  

Last week, 14,460 COVID-19 vaccine doses went to waste as they were opened, but not used. Scientists say vaccines lose their potency and effectiveness if they are exposed to temperatures outside of the required range or when exposed to light.

Once a vial’s seal is punctured, workers have only six hours within which to administer the vaccine. Each vial can vaccinate 10 to 12 people. 

Catherine Makumbi Ntabadde, UNICEF’s country communication specialist, said Uganda is expected to receive another batch of 688,000 vaccine doses in August,  which will also be administered as a second jab. The country aims to vaccinate 21 million people in a phased manner.

Acute Oxygen Shortages

Uganda’s medical oxygen demands outweigh the current supplies due to an increasing number of critically ill patients. Although the oxygen production capacity is available in the private sector and from neighbouring Kenya, Aceng said the country did not have enough cylinders. An additional 8,000 cylinders would help reduce the COVID-19 death rate.

However, according to intensive care staff, more piped oxygen is needed instead of cylinders as patients are not responding to nasal oxygen that is distributed via the cylinders.

The oxygen shortage is further fuelled by the private sector, the biggest provider of health services in the country, charging exorbitant treatment prices,

“The private sector is fleecing desperate Ugandans. Why charge for oxygen? It should be given out free of charge,” said a frustrated Aceng.

Some private providers have been caught out charging for vaccines meant to be distributed for free. Government had allowed the private sector to import and distribute COVID-19 vaccines  as they were already key players in immunisation of children on behalf of the government.

“It is not that they accessed the vaccine through the wrong route. The government gave them the vaccine to distribute on its behalf, but now there is just no truth and transparency in the distribution,” said Aceng. 

It is likely that Uganda will follow Kenya in banning private sector participation in the procurement and distribution of vaccines if the vice does not stop.

Stricter Control Measures to Help Curb the Pandemic

Last week, President Museveni instituted a ban on inter-district travel and restricted the number of people to attend weddings and burials to 20 in a bid to contain the virus.

Aceng however said the surge in new cases in Uganda was due to citizens becoming complacent after the first wave and when some schools reopened.

“When we opened up after the first strict lockdown last year, people wanted to have their normal lives and regain economic stability so they became complacent and the number of cases started rising,” said Aceng, referring to the two-month lockdown that started last March.

WHO Regional Director for Africa Dr Matshidiso Moeti, speaking at the same briefing,  warned that the continent’s third wave is gaining pace and is nearing the first wave’s peak of more than 120,000 weekly cases recorded in July 2020.

“Africa is in the midst of a full blown third wave. The sobering trajectory of surging cases should rouse everyone into urgent action. We’ve seen in India and elsewhere just how quickly COVID-19 can rebound and overwhelm health systems. So, public health measures must be scaled up fast to find, test, isolate and care for patients and to quickly trace their contacts,” Moeti said.

Image Credits: © WHO/Otto B., Health Journalist Network.

Last Ebola patients leave a treatment centre in the Democratic Republic of Congo at the end of March, marking the countdown to declaring the end of the pandemic.

The government of Guinea is a few days away from declaring the end of the country’s Ebola outbreak after 45 days of reporting no new case, World Health Organization Officials said on Thursday. 

On 14 February, a new Ebola outbreak was declared in Guinea, but four months later, the outbreak will be declared over according to Guinea’s Health Minister Dr Remy Lama.

Speaking at a WHO AFRO press briefing on Thursday, Lama attributed the country’s ability to quickly control the outbreak to swift mobilisation to organise the response to the disease and break the transmission. 

“We made a huge adjustment to involve communities in this response, so that they would accept the proposed measures. We chose as a priority to involve communities,” Lama said.

Initial challenges regarding vaccine hesitancy were quickly resolved by actively engaging communities who became aware of the reasons behind the recommended lines of action, said Lama. 

The Republic of Guinea was one of the countries at the center of West Africa’s Ebola virus epidemic that raged from 2014-2016 claiming 11,000 lives.  The DRC faced a major outbreak in 2018, which concluded a year later, but has been followed by others. During the most recent DRC outbreak in February, 12 cases were confirmed leading to six deaths – while 1,737 people were vaccinated against the virus, according to the WHO – with IFRC teams on the ground providing key support.

In the case of Guinea, the outbreak declared on 14 February 2021 in the N’Zerekore region led to 14 confirmed cases, leaving five people dead.   However, the even more worrisome aspect of the current Guinea outbreak was its apparent source – a survivor of Guinea’s previous 2014-2016 outbreak who appears to have harbored the virus for as long as five years, before infecting someone else.

Lessons learned from the Ebola response have also better positioned the country to respond to COVID-19 considering engagement with its citizens has also been crucial in encouraging vaccine adoption. 

WHO Regional Director for Africa Dr Matshidiso MoetiMoeti noted the overlap between responses to Ebola and COVID-19 and said both required political leadership, quick decision making and collaboration with various partners.

“All of this is valuable in both responding to pandemics, and in putting in place the kind of resilient health systems that we need so that next time there is a threat, we’re better positioned to respond and contain the outbreak,” Moeti said.

Image Credits: WHO African Region.

WHO Regional Director for Africa Dr Matshidiso Moeti has warned that unless Africa gets more COVID-19 vaccines immediately, the third wave the continent is currently experiencing will be deadlier than the first two waves.

Tanzania, which for months denied the existence of COVID-19 until vaccine-sceptic President John Magufuli finally succumbed to the virus in March – is now trying to belatedly join the WHO co-sponsored COVAX facility to acquire COVID vaccines. The news comes as the African continent experiences a deadly third wave of COVID-19 infections – affecting eastern and southern Africa in particular.

In a press briefing on Thursday, World Health Organization Regional Director for Africa Dr Matshidiso Moeti said that WHO is now working with the country to prepare a COVID-19 vaccine deployment plan – which is a major prerequisite to securing vaccine doses from the COVAX facility. 

“These are the preliminary steps to receive vaccines through COVAX, and we are expecting the vaccines to arrive in the country in the next couple of weeks,” said Richard Mihigo, Immunisation and Vaccines Development Programme Coordinator at WHO’s Regional Office for Africa at the briefing.

Tanzania has not requested any specific vaccines, but like other countries accessing doses through COVAX, it will be able to procure vaccines that have been issued with WHO’s Emergency Use Listing, the WHO officials said.

Beyond approaching COVAX for vaccine donations, the new government of Tanzania, led by President Samia Suluhu Hassan, has also made moves to raise funds to finance vaccine purchases, including approaches to the International Monetary Fund (IMF) for an emergency loan of $US 574 million.

The IMF has however demanded that the government first update its data on the transmission of the SARS CoV2 virus in the country.  Data on new virus cases and related deaths has not been reported since May 2020 – after the late Magufuli ordered health authorities to stop tracking cases of the disease. 

“When applying for pandemic-related emergency financing, evidence of the pandemic has to be available to substantiate the claim,” the IMF’s resident representative, Jens Reinke was quoted as saying by Reuters.

Africa’s Third Wave Could Be More Deadly Than The First Two Waves

Tanzania’s appeal for the lifesaving vaccines comes as the African continent experiences a third wave of the pandemic with Tunisia, South Africa and other southern and eastern African neighbors seeing sharp spikes in cases over the past few weeks.  Even countries such as Rwanda, which have remained “green” with very low COVID transmission, are now at risk of becoming “orange”.

South Africa on Wednesday recorded 13 246 new cases, with the percent testing positive increased to 21.7%, while Tunisia has seen one of the highest rates of new cases daily on the continent, per million people. 

Moeti warned that the continent’s third wave is gaining pace and is nearing the first wave’s peak of more than 120,000 weekly cases recorded in July 2020.

“Africa is in the midst of a full blown third wave. The sobering trajectory of surging cases should rouse everyone into urgent action. We’ve seen in India and elsewhere just how quickly COVID-19 can rebound and overwhelm health systems. So, public health measures must be scaled up fast to find, test, isolate and care for patients and to quickly trace their contacts,” Moeti said.

According to WHO data, new COVID-19 cases rose to over 116,500 in the week ending on 13 June, up from the previous week’s nearly 91,000 cases. This was after a month period of more gradual increases in case numbers that pushed the continent over the 5 million case mark. In 22 African countries, cases rose by over 20% within the same period while deaths also spiked by nearly 15% to over 2200 across 36 countries.

African countries are recording a surge in COVID-19 cases with South Africa registering 13 246 new cases on June 16.

Rwanda, which has a population of some 12.6 million people has seen a spike in new cases rising to 263 on 16 June.  That remains low in comparison to many European countries, but still of concern for the country that saw only 45 new cases daily at the start of the month.  That means the country is now approaching the all-time  peak of its second wave, of January 2021, when some 334 new cases daily were recorded.  

A Rwandan cabinet meeting on 12 June, resolved to shut down all business activities by 8pm, with residents under curfew from 9pm to 5am. Prevsiously, a curfew was in place only between 10pm to 4am.

At a separate press briefing on Thursday, Dr John Nkengasong, Director of the Africa CDC, said that a total of 15 African countries are now experiencing the third wave of the pandemic while Tunisia is already in a fourth wave.

Both Nkengasong and Moeti attributed the spike in new cases to, among other reasons, poor adherence to transmission prevention measures, including non-compliance with social distancing – which has made it difficult to suppress the spread of the pandemic.

The surge also coincides with colder seasonal weather in southern Africa, even as more contagious variants spread. The Delta variant (originally identified in India) has been reported in 14 African countries while the Alpha and Beta variants (originally identified in the United Kingdom and South Africa) have been found in more than 25 African countries.

“We expect the number of African countries in the third wave of the pandemic to increase,”  said Nkegasong. “What is very characteristic of this wave is that the peak of the third wave is normally higher than the peak of the second wave, and is more severe than the previous wave.”

Vaccines Needed Sooner Than Promised Donations Will Arrive 

Africa needs more COVID-19 vaccines immediately if the continent wants to curb the third wave.

Several initiatives have been announced to make more doses of vaccines available to African countries, including a one billion vaccine dose donation by the G7 to poorer countries and a  $US 1.5-billion COVID-19 vaccine procurement partnership between Africa CDC and the MasterCard Foundation. The U.S. government has also promised to donate 500 million doses of Pfizer’s COVID vaccine to support vaccine rollout in several low- and middle-income countries. And the potential inclusion of made-in-China COVID-19 vaccines into the COVAX Facility is also on the table. \

But Moeti and Nkengasong stressed that the continent needs vaccines even faster than those promised donations – while national governments need to step up vaccination of doses already received.

Seven African countries have already used 100% of the vaccines they received through COVAX and seven more have administered over 80% of available vaccines. On the other hand, some 23 African countries have used less than half of the doses they received so far, including about 1.25 million AstraZeneca doses on hand in 18 countries that must be used by the end of August to avoid expiration. 

“The rise in cases and deaths is an urgent wake up call for those countries lagging behind to rapidly expand vaccination sites, to reach priority groups for vaccination and to respond to community concerns. A number of African countries have shown that they can move vaccines quickly, so while we welcome the recent international vaccine pledges, if we are to curb the third wave, Africa needs doses here and now,” said Moeti.

Image Credits: Our World in Data.

The development of antibody medicines in Regeneron’s lab. The biotech company’s COVID therapy could be a valuable tool for tackling severe COVID-19 cases.

A COVID-19 antibody cocktail developed by the US-based company, Regeneron, dramatically reduced the risk of mortality and shortened hospital stays in patients who didn’t naturally produce antibodies against SARS-CoV2 in a recent large-scale trial. 

Meanwhile, the US government announced that it would invest some US$3.2 billion in developing new forms of antiviral COVID-19 treatments to reduce COVID-related hospitalizations and deaths.

The Regeneron trial, published as a pre-print on medrxiv on Wednesday, is the first to demonstrate that an antibody treatment improved survival in patients hospitalised with COVID-19. The randomized controlled trial of the therapy was conducted by researchers at the University of Oxford.

Regeneron’s monoclonal treatment, dubbed REGEN-COV™, uses a combination of two antibodies that bind to the SARS-CoV2 spike protein, neutralizing the ability of the virus to infect human cells. 

Between September 2020 and May 2021, 9,785 hospitalised patients were selected to receive usual care in addition to the antibody treatment or standard care alone. 

The standard care treatment for patients was dexamethasone, a steroid treatment, which cuts death risks up to a third for seriously ill patients by reducing dangerous over-reactions of the immune system.

Significantly, however, one-third of hospitalised participants didn’t have a natural antibody response – as compared to some 54% of patients who had a strong natural antibodies response.

And those patients whose bodies lacked a natural antibody response had a greater risk of mortality. 

“Among all patients randomized, there was no significant difference in the primary outcome of 28-day mortality between the two randomized groups,” said the authors. 

Some 20% of patients in the treatment group died, compared to 21% in the usual care group. The primary efficacy of the drug was seen when comparing those without a natural antibody response in the Regeneron group to those lacking an antibody response in the control group. 

Among those without natural antibody responses, some 24% of hospitalised patients receiving the antibody combination died, in contrast to 30% of patients in the usual care group. 

The antibody combination reduced the 28-day mortality in patients lacking an antibody response by one-fifth – as compared to those receiving usual care alone. 

Among those lacking an antibody response, the treatment also shortened the duration of the hospital stay by an average of four days and reduced the risk of needing to use invasive mechanical ventilation

For every 100 patients treated, there would be six fewer deaths, calculated the study authors. 

“It’s the first time that any viral treatment has been shown to save lives in hospitalised COVID-19 patients,” said Martin Landray, Professor of Medicine and Epidemiology at the University of Oxford and Joint Chief Investigator of the trial, in a press release. 

‘Groundbreaking’ New COVID Therapy

“It is wonderful to learn that even in advanced COVID-19 disease, targeting the virus can reduce mortality in patients who have failed to mount an antibody response of their own,” said Peter Horby, Professor of Emerging Infectious Diseases at the University of Oxford and Joint Chief Investigator of the trial. 

“These results provide hope to patients who have a poor immune response to either the vaccine or natural infection, as well as those who are exposed to variants for whom their existing antibodies might be sub-optimal,” David Weinreich, the Executive Vice President of Global Clinical Development at Regeneron, said in a press release. 

The trial also provides an important indicator that hospitalised patients who made their own antibodies likely will not benefit from the treatment. 

“Patients who have made their own antibodies to the virus do not benefit from the new treatment, which is also important information given the cost of drugs,” said Fiona Watt, Executive Chair of the UK Medical Research Council, which helped fund the study. 

“If you already have antibodies, giving you more may not make much difference,” said Horby.

This is useful for guidance on use of the treatment given its high cost, which is between £1,000 and £2,000.

The cost may render the drug only available to those in wealthy countries; in addition, the drug cocktail needs to be administered by infusions. As a result, monoclonal drugs are typically best adapted to use in  high-resource health systems, and only a few monoclonals are available in low- and middle-income countries.

“There really must be initiatives to make these drugs accessible…you have to scale up manufacturing, and they have to be affordable,” Horby told the Guardian. 

Regeneron to Request Expanded Authorization

The therapy was first granted a United States Food and Drug Administration (FDA)  emergency use authorization (EUA) in December. That  EUA was updated in early June to permit a lower 1,200 mg dose of the REGEN-COV™ treatment, based on the recent trial results (600 mg casirivimab and 600 mg imdevimab) – half the dose originally authorised. The treatment is authorised by the FDA for adults and pediatric patients with mild to moderate COVID-19 who are at a high risk of developing severe illness. 

Previous clinical trials have shown that Regeneron’s treatment reduced viral levels, shortened the duration of symptoms, and reduced the risk of hospitalisation and death in non-hospitalised patients. 

“Definitive Phase 3 trials have now demonstrated that REGEN-COV can alter the course of COVID-19 infection from prevention, to very early infection, all the way through to when patients are on a ventilator in the hospital,” said George Yancopoulos, the Chief Scientific Officer at Regeneron.

“We intend to rapidly discuss these results with regulatory authorities, including in the US, where we will ask for our EUA to be expanded to include appropriate hospitalised patients,” Yancopoulos added. 

The trial data suggests that Regeneron’s antibody cocktail could be a valuable tool for tackling severe COVID-19 cases and reducing the worst manifestations of the virus. 

“It is fantastic news that the RECOVERY trial has provided evidence to establish another lifesaving treatment against COVID-19 through this monoclonal antiviral antibody combination,” said Nick Lemoine, Medical Director at the National Institute for Health Research, which supported the trial. 

Commitment to Invest in COVID Treatments

Investment in COVID-19 research has primarily focused on the development of vaccines instead of therapeutics. The new influx of money from the US government will fund clinical trials of drug candidates, with the aim of making COVID treatment pills available within the year.

Experts are concerned that the SARS-CoV2 virus will become a perennial threat. In addition, the current inequitable distribution of vaccines likely means that herd immunity is in the distant future for much of the world. A treatment in pill form could keep people out of hospitals and save lives over the years to come.

“There will always be a threat,” said Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. “I think there’s going to be a long-range need for drugs.”

The hope “is that we can get an antiviral by the end of the fall that can help us close out this chapter of the epidemic,” Dr David Kessler, Chief Science Officer of President Biden’s COVID-19 response team, told the New York Times.

Ideally, antiviral pills would be available at pharmacies for those who test positive or develop COVID-19 symptoms.

“I wake up in the morning, I don’t feel very well, my sense of smell and taste go away, I get a sore throat,” said Fauci. “I call up my doctor and I say, ‘I have COVID and I need a prescription.'”

Investment in further research on drugs to prevent and treat SARS-CoV2 infection “could help with this pandemic and potentially provide a first line of defense for the next one,” said Mark Namchuk, Director of Therapeutics Translation at Harvard Medical School.

Image Credits: Flickr – US Navy, Regeneron.

Dr Carissa Etienne, Director of the Pan American Health Organization.

Despite the global decline in  COVID-19 cases by 12% over the last week, countries in Central and South America continue to be epicenters of pandemic, with high mortality rates and insufficient access to vaccines. 

Over 1.1 million new COVID-19 cases and 31,000 deaths were reported in the Americas over the last week, officials from the Pan American Health Organization (PAHO) announced at a press briefing on Wednesday. 

“Cases are peaking, hospitals are full, and we are home to four of the five highest death rates in the world,” said Dr Carissa Etienne, PAHO Director. 

In terms of cases and deaths per-capita, Uruguay, Argentina, Colombia and Brazil, just to cite a few examples, are still experiencing rates 4-5 times higher than new case rates in the United States and even India – despite relatively high rates of vaccination in those same Latin American countries. 

 

In Bolivia, Chile, Uruguay, and Brazil, recent surges are filling hospitals. In São Paulo, 80% of the ICU beds are occupied by COVID patients and Colombia is at its worst point yet in the pandemic, reporting a record of 577 new deaths on Tuesday. 

Against this backdrop, PAHO officials urged countries with high transmission to tighten public health measures until vaccination campaigns have accelerated further.  

“When [public health measures] are strictly implemented and monitored, they are very effective in bending the epidemiological curve and protecting the health care facilities for severe and critical patients,” said Dr Sylvain Aldighieri, PAHO’s COVID-19 Incident Manager.

Vaccination Campaigns Stall in Central and South America

Less than 10% of people in Latin America and the Caribbean, a region of 600 million people, have been fully vaccinated against COVID. 


Vaccine rollouts continue to progress slower than what is needed, said PAHO officials. Doses are urgently needed to protect the most vulnerable populations, obtain vaccine coverage, and to control transmission. 

“We welcome the announcement by the Group of Seven [G7], who pledged one billion COVID vaccine doses to countries around the world,” said Etienne. 

This commitment offers “fresh hope” to countries struggling to secure enough vaccines to protect their populations. 

PAHO officials urged G7 nations to prioritise doses for countries at greatest risk and to not delay the delivery of their donations. 

The Americas has been in crisis for months and without the support from the international community, “recovery remains in the distant future,” said Etienne. 

In countries where vaccination coverage has been high, including the US, United Kingdom, and Israel, a dramatic reduction in COVID-related hospitalizations and deaths has been seen. 

G7 Donation is Insufficient to Fully Vaccinate the Region

“Even with this generous donation, we are still a long way from protecting the more than 600 million people living in Latin America and the Caribbean,” said Etienne. 

Reaching everyone in the region will require greater vaccine sharing, financial support to secure supplies, and investment to expand the region’s vaccine manufacturing capacity. 

“No country and no region is safe until high vaccination coverage is reached,” said Dr Jarbas Barbosa, Assistant Director of PAHO. 

vaccine
Dr. Jarbas Barbosa, Assistant Director of PAHO.

“We are counting on the support of countries, of donors, and the international community to get us there as quickly as possible,” said Etienne. 

“No country has reached herd immunity, so more remains to be seen about how we can achieve population-wide protections, particularly as variants circulate,” said Etienne.

This will likely involve strengthening the capacity of surveillance systems to detect transmission, expanding the capacity of national and local governments to rapidly implement and maintain strict public health measures, and strengthening the capacity of health systems to manage the surge in severely ill patients. 

Vaccine Hesitancy Needs to be Addressed by Governments Through Communication Campaigns

While PAHO officials stressed that vaccine access is the primary issue across Latin America and the Caribbean and not vaccine acceptance, they also highlighted the need for efforts to increase confidence in vaccination campaigns. 

As vaccine campaigns will likely begin ramping up soon in light of the recent vaccine sharing commitments, governments must provide clear and transparent information about COVID vaccines to improve trust. 

“It is where there are breakdowns in information and communication, or when details are slow to arrive that misinformation takes root,” said Etienne.

Etienne called for health workers to have the information they need to answer the questions and concerns of their communities and their own families regarding vaccination.

“Health workers should receive special attention, as they’re not just at greater risk of contracting the virus, but they’re also some of the most trusted voices for vaccines,” said Etienne. 

“People naturally turn to health workers, including doctors, nurses, and community health workers for medical advice,” she added. 

Haiti Hasn’t Received COVAX vaccines

Haiti, in particular, has seen a lack of trust in the health system and distrust of vaccines.

It is the only country in the Americas participating in COVAX that hasn’t received any vaccines. The delay in deliveries was due to governmental instability and a lack of implementation of the administrative measures required to receive the vaccines. 

A shipment of 132,000 AstraZeneca vaccine doses from COVAX is scheduled to arrive in Haiti in July and the US plans to deliver doses in the near future. 

Haiti has been prioritised to receive vaccines because of the deadly wave that is hitting the country, with sharply escalating cases, hospitalizations and deaths in recent weeks. 

“We will probably face a very…challenging situation in Haiti,” said Barbosa. “It’s crucial that they adopt the public health measures, and at the same time, they get the vaccine to protect the most vulnerable groups in the country.”

A good communication strategy is “probably the most crucial part of vaccinations,” said Barbosa. “Unfortunately, the vaccine was the target of many anti-vax groups and people sharing rumours and conspiracy theories.”

“It’s very important that the national authorities in each country establish a direct chain of communication with healthcare workers, with the communities, with the population, showing the data…that vaccines can save your life and contribute to controlling this pandemic,” he added. 

Metropolitan Areas Fuel Surges 

The uptick of cases in some parts of Latin America can be attributed to socio-economic factors, said Aldighieri.

Dr. Sylvain Aldighieri, Incident Manager at PAHO.

In particular, countries with significant large metropolitan areas means that even during lockdowns, there remains a pattern of intensive, continuing close contact between citizens, which can fuel continued infections. 

From the cities, COVID-19 can be quickly amplified and spread again to more remote and rural areas where control of the virus was more successful.  

Mexico’s spike in transmission about a month ago has prompted national authorities to monitor the situation in several states, specifically in Baja California and the Yucatan peninsula. 

Recent weeks have also seen increases in Costa Rica, Guatemala, and Panama. 

“In order to have an impact on the SARS-CoV-2 transmission, countries need to find the right balance between strict implementation of public health measures for lowering transmission, and economic activities,” said Aldighieri.

Image Credits: WHO PAHO, PAHO.

Pakistan is the second Asian country after the Philippines with a rapid increase in HIV/AIDS cases. In just one year Pakistan registered 25,000 new HIV infections and 6,800 AIDS deaths.

ISLAMABAD – Faced with one of the sharpest increases in HIV/AIDS rates in Asia, Pakistan will ban the manufacture and import of conventional syringes from next month, government officials have told Health Policy Watch. 

The move is in an effort to stem a three-year increase in HIV cases – 39% of which are estimated to be due to needle-sharing among injecting drug users.

Over the past year alone, there have been 25,000 new infections and 6,800 registered AIDS deaths – one of the fastest rates of rising infections in Asia. 

As of 31 July, the country will shift over exclusively to the purchase and use of  auto-disabled syringes, said a senior government official, who asked not to be named.

“The import of conventional syringes is already stopped and now in this budget, auto disable syringes and raw materials are exempted from duties and taxes to incentivize importers and manufacturers,” the official said. 

Auto disable syringes will be imported in the open market for both public and private sectors – a major decision to help prevent hepatitis and HIV/AIDS, according to the official. 

In terms of the broader AIDS battle, health experts are  also closely watching how a recent decision by the Global Fund to Fight AIDS, Tuberculosis and Malaria giving the United Nations Development Program (UNDP) responsibility for managing millions of dollars in HIV/AIDS funding will impact the country’s fight against the spread of the epidemic.

In March,  the Global Fund suspended direct HIV/AIDS funding to all of Pakistan’s government and non-governmental stakeholders, appointing UNDP as the channel through which funding would be received and disbursed to government and NGOs. 

Informed observers say that the decision was made to ensure more direct supervision of the funding, and in particular, to stimulate more collaboration between national and NGO entities in the battle against the disease.  

The Global Fund has invested $697 million  in Pakistan since 2003 and is the country’s biggest donor for HIV/AIDS and TB.  A total of $72 million of the funding is allocated to fight HIV/AIDS. The Global Fund awarded $17,4 million  to the National AIDS Control Program (NACP) from January 2018 to June 2021. 

Pakistan’s HIV/AIDS Burden Rising More Rapidly Than Almost Any Asian Country 

Recently released data from the  Pakistan Economic Survey (PES) show that there are 197,943 people living with HIV/AIDS in Pakistan, with 25,000 new infections and 6800 registered deaths, which experts fear is a rapid increase in the number of cases in the past few years.

“Cases are increasing and in Asia, Pakistan is the second country after the Philippines with a rapid increase in HIV/AIDS cases, which is alarming,” said Asghar Satti, national coordinator for the Association of People Living with HIV (APLHIV) – a nationwide network of people living with HIV. 

Satti said above 90% of HIV/AIDS cases are from just two provinces: Punjab and Sindh.  While Satti says the data is collected by the government following validated methods, others say that the numbers could be even higher. 

Among those are Nausheen Hamid,  Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C).  

Speaking on World Blood Donor Day on Monday, Hamid suggested that the numbers could be even higher, saying, “people are getting infected with HIV rapidly, while we do not have all data on the disease”.

Lack of Government Resources and HIV-testing Pose Major Problems

People Who Inject Drugs (PWID) make up the largest share (39%) of Pakistan’s HIV/AIDS population.

Satti believes the lack of government resources for HIV testing is one of the main factors contributing towards the surge of new cases in the country.

HIV/AIDS prevention  programs are almost entirely  supported by the Global Fund, while the government’s own resources in providing services are limited.

“Lack of political commitment, awareness, domestic resources, low on priority and weak infrastructure of providing services are gradually contributing to rising cases of HIV,” said Satti.

In key populations,  People Who Inject Drugs (PWID) make up the largest share (39%) of HIV/AIDS population, while disease surveillance in Men Sex with Men (MSM), Female Sex Workers (FSW) and migrants is also increasing. HIV testing in other key at-risk populations is only estimated to be only about 5-6 %.

A senior official at the ministry of NHSR&C, speaking on condition of anonymity, told  Health Policy Watch that despite the huge financial injections made by the Global Fund to curb the spread in PWIDs, the disease surveillance rate in drug users is still high.

“In the last tranche of the $71 million grant for AIDS, 75% of the fund was given to a private NGO ‘Nai-Zindagi’ to control the infection rate in PWIDs,” said the official. “But still that NGO is looking for government’s aid and tax exemption to get auto-disable syringes.” 

Currently, the government has no program on PWIDs.

The head of the NGO ‘Nai Zindagi,  Malaika Zafar, failed to respond to a list of questions sent to the NGO by Health Policy Watch.

Failed Management in HIV Programs

The Global Fund’s decision to appoint UNDP as the managing agent for Pakistan’s HIV/AIDS programs follows extensive consultations with key stakeholders in the country.

Communication seen by Health Policy Watch from the Global Fund to members of the organisations’ Country Coordinating Mechanism (CCM) detail how the Secretariat chose UNDP as the principal recipient of funding as a last resort, following the failure of other  potential organizations that were initially considered for this role to measure up in a capacity assessment.

The Global Fund found that “the lack of collaboration between different stakeholders could have  a negative impact on finalization of grants, mirroring the risk of a gap in service provision and ultimately affect people who need this support”.

The communication, however, stresses that the UNDP role is temporary until “national capacities are sufficiently enhanced”. 

According to Satti there are only 49 HIV treatment centres around the country providing diagnostic tests and lifelong support of Antiretroviral Therapy (ART) medicines free of cost.

According to the UNAIDS data, there are currently 22, 947 Pakistani’s on ARTs and 53, 000 women (including 3,600 pregnant women) living with HIV/AIDS.

Government’s Ambition for HIV/AIDS Response – Far from Today’s Reality 

At the recent UN High Level Meeting on HIV/AIDS, the Prime Minister’s Special Assistant for the National Health Services Ministry, Dr Faisal Sultan contended that Pakistan had worked hard to overcome the setbacks of the COVID-19 pandemic, in its battle against HIV/AIDS over the past year:  

“The government of Pakistan undertook rapid steps to modify our strategy, including staffing & smart outreach, provision of PPE for all field staff and multi month dispensing of ARV treatments. 

“Resultantly, we were able to ensure uninterrupted supply of services during these unprecedented times, and we aim to continue to adhere to these revised protocols in close coordination with all partners, communities and relevant stakeholders”.

Sultan also said that Pakistan plans to integrate HIV/AIDS as part of the Community and Primary Health Care level interventions. Interventions to be covered eventually, he said, would include HIV/AIDS testing, counselling & referral for antiretroviral treatment, provision of prophylactics & syringes to high-risk groups as well as health education. 

“We believe Universal Health Coverage is crucial for ensuring rights to health for everyone without any discrimination,” he said. 

However, presently, the country’s UHC programmes remain weak, and the ambition for including HIV/AIDS interventions is far from the reality today. 

For example, Pakistan has not yet even appointed a full-time national coordinator for the government’s HIV/AIDS control programme.  Rather, the activities are being managed by a deputy national coordinator, Ayesha Esani, in addition to her other duties.  Contacted by Health Policy Watch, Esani declined to comment.   

Image Credits: Flickr, UNAIDS.

Infecting mosquitoes with Wolbachia could be an effective and self-sufficient manner of controlling dengue.

In a “groundbreaking” trial conducted in Indonesia, lab-grown mosquitoes infected with Wolbachia bacteria reduced the rate of symptomatic dengue infections by 77%, and hospitalizations by 86%, in communities where the bacteria-armed mosquitoes were released.  

The three-year study, which was led by the World Mosquito Program, provides compelling evidence for a new method of controlling dengue. The study was published in the New England Journal of Medicine last week.

Dengue is a mosquito-borne viral infection with approximately 100 million to 400 million infections recorded per year. Some 70% of the global burden of dengue is in Asia, where severe dengue has become the leading cause of hospitalisation and death among children and adults. 

The incidence of dengue has grown dramatically around the world in recent decades. 

Indonesia is a global hotspot for dengue, which is present in all provinces of the country and endemic in many large cities. 

Disease modelling studies have predicted that the Wolbachia-mediated blocking of dengue virus infection in Aedes aegypti mosquitoes could be sufficient to eliminate dengue in low or moderate transmission settings.  However, the Indonesia trial is one of the first to demonstrate efficacy in a large population setting.  

In the wake of the results of this and other trials, the World Health Organization is reportedly developing recommendations for Wolbachia mosquitoes as a method of dengue control. 

Bacteria-infected Mosquitoes Curbed Dengue Infections and Hospitalizations

Researchers infected lab-grown Aedes aegypti mosquitoes in the city of Yogyakarta with the Wolbachia bacteria, which is found naturally in many insects and blocks the dengue virus from replicating and spreading to humans.  Aedes aegypti mosquitoes are the main transmitters of dengue virus.

The city was separated into 24 clusters. Eggs of the disease-fighting mosquitoes were released in 12 of the clusters every 2 weeks for 18 to 28 weeks – while in the other half of the city the mosquito populations were not treated. 

Ten months after the releases began, the prevalence of Wolbachia among the local mosquito population in the treated clusters reached over 80%. 

The researchers then studied disease outcomes among some 6,306 people who came to primary care clinics with a fever in the treated and the untreated areas. Of the patients who lived in treated clusters, only 2.3% tested positive for dengue virus, compared to 9.4% of those in control areas. 

The incidence of symptomatic dengue cases was reduced by 77% and hospitalizations dropped by 86%. 

“This result is groundbreaking,” said Dr Katie Anders, Director of Impact Assessment at the World Mosquito Program. “We think it can have an ever greater impact when it is deployed at scale in large cities around the world, where dengue is a huge public health problem.”

In 11 of the 12 treated clusters, the proportion of participants with dengue was lower than in the control groups. 

There were 67 cases recorded among the participants residing in the intervention clusters and 318 recorded among those who lived in the control clusters. Some 13 hospitalizations for dengue were reported among participants in intervention clusters as compared to 102 hospitalizations in the control clusters.

The efficacy of the lab-grown mosquitoes was similar in reducing incidence of four dengue virus serotypes. 

“[This study] provides the gold standard of evidence that Wolbachia is a highly effective intervention against dengue,” said Oliver Brady, a dengue expert at the London School of Hygiene and Tropical Medicine, who was not involved in the study. 

“It has the potential to revolutionize mosquito control,” Brady added. 

Wolbachia as Possible New Dengue Control Measure

Following the positive trial results, the World Mosquito Program and Yogyakarta’s District Health Office deployed Wolbachia-infected mosquitoes throughout untreated areas of Yogyakarta city in January 2021. 

Releases are also now underway in the neighbouring districts of Sleman and Bantul. 

Trials are meanwhile also ongoing in Colombia, Sri Lanka, India, and countries in the Western Pacific. 

“I am confident that Wolbachia can complement other methods in controlling dengue,” said Rhamawati Ningrum, a study nurse at Puskesmas Health Center. “I expect that this Wolbachia program continues, not only in the city of Yogyakarta, but in other cities across Indonesia.”

According to the researchers, once mosquitoes are infected with the Wolbachia bacteria, the infection is maintained in the mosquito population and doesn’t need reapplication, which makes it a cost-effective strategy for controlling dengue. 

The Wolbachia method is also considered to be harmless to ecosystems, as 60% of insect species already carry the bacteria anyway. 

The results are consistent with findings from non-randomized Wolbachia deployments in northern Australia and Brazil, suggesting that the results could be replicated in different epidemiological settings. 

So far seven million people are under the protection of Wolbachia and the World Mosquito Program aims to cover at least 75 million by 2025 and half a billion by 2030. 

Wolbachia has the potential to also be effective against other diseases that Aedes aegypti mosquitoes carry, including Zika and yellow fever.

Image Credits: Commons Wikimedia.

One of the lucky few: A woman shows her vaccination card after getting the AstraZeneca vaccine.

Twenty-two African countries are experiencing a surge in COVID-19 infections, yet the vaccination rollouts on the continent have ground to a halt because of lack of supply.

African vaccination figures, as recorded by the Africa Centers for Disease Control and Prevention, are dismal. Apart from the tiny island state of Seychelles, only Morocco’s vaccination rate is in the double digits with 16.7% of its population fully vaccinated.

The next highest are Equatorial Guinea (6,26%), Tunisia (2,93%) and Zimbabwe (2,6%).

In terms of numbers, Egypt has delivered the most vaccinations, which by Monday had topped 3,3 million. But in a country with a population of over 100 million, and each person needing two vaccinations, this means that only 0,39% of Egyptians are fully vaccinated.

Meanwhile, Uganda has virtually run out of vaccines and oxygen, as COVID-19 cases increased by 2,800% in the past month. Its test positivity rate is 21.5%. Last week, the country entered a new 42-day lockdown in a bid to contain cases.

South Africa officially entered its third wave last week and is reporting over 5000 new cases per day with a test positivity rate of over 15%. On Tuesday night, President Cyril Ramaphosa announced that the country would move immediately to lockdown Level Three with a longer curfew, more limits on public gatherings and curbs on the sale of alcohol. The Democratic Republic of Congo, Namibia, Zambia and Kenya are also battling increased cases.

“The steep increase in Africa is especially concerning because it is the region with the least access to vaccines, diagnostics and oxygen,” World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told the global body’s biweekly COVID-19 briefing on Monday.

“A recent study in the Lancet showed Africa has the highest global mortality rate among critically ill COVID-19 patients, despite having fewer reported cases than most other regions,” he added.

Most African countries have relied on the COVAX-facility for vaccines, but these supplies dried up in late March when the global vaccine platform’s key supplier, the Serum Institute of India, redirected all its AstraZeneca vaccines to address India’s pandemic.

To date, COVAX has supplied 37 of the 55 African states with vaccines. Almost 60% of African countries are reliant solely on AstraZeneca, according to the Africa Centres for Disease Control, and many countries have only administered a single dose to citizens with no idea of when they will receive supplies to administer the second dose.

Countries that have been able to reach more than 1% of their populations have done so largely because they have had other vaccine sources besides COVAX – primarily China’s Sinopharm, which is available in Morocco, Egypt, Tunisia, Seychelles, Zimbabwe and Equatorial Guinea among other countries. Some of the north African countries also have access to Russia’s Sputnik V vaccine.

Two Million J&J Vaccines Destined for South Africa Have to be Destroyed

South Africa decided not to use the AstraZeneca vaccine following research which showed diminished efficacy against the Beta variant (B1.351) dominant in the country and has bought Pfizer vaccines – reportedly at great cost – as well as Johnson & Johnson vaccines.

However, South Africa’s worst fears were realised over the past weekend when all two million Johnson & Johnson COVID-19 vaccines ready for distribution in the country were found to be made from batches that the US Food and Drug Administration (FDA) ruled unsuitable last Friday.

Last week, the country officially entered a third wave of the pandemic but it has only administered 1,350,000 vaccines – which translates into 0,5% of its population being fully vaccinated as two-thirds of these are the two-dose Pfizer vaccine.

With a drip supply of the costly Pfizer COVID-19 vaccines arriving every week, doses have been strictly rationed to health workers and those over the age of 60. 

Johnson & Johnson has undertaken to replace the two million doses by the end of June – but they were expected to have been dispensed in early May, which means that the rollout is running two months behind schedule.

However, Ramaphosa said on Tuesday night that “the pace of vaccinations has steadily picked up, and we are now vaccinating around 80,000 people a day at over 570 sites in the public and private sector. This number will grow rapidly in the weeks to come, as we aim to protect as many vulnerable people as possible.”

Officially, South Africa has been the worst affected on the African continent with over 1,7million COVID-19 cases. The official COVID-19 death toll is over 57,000 but “excess deaths” of 166,794  were recorded between 3 May 2020 and 5 June 2021, according to the SA Medical Research Council (SAMRC). The peaks and troughs of these excess deaths correlate almost exactly with the COVID-19 waves.

Huge ‘Excess Deaths’ in Egypt 

Meanwhile Egypt appears to have completely under-reported the impact of COVID-19. Between March 2020 and May 2021, it claimed a death toll of little more than 13,000 – yet its excess mortality for this period was over 175,000, according to the University of Washington’s Institute for Health Metrics and Evaluation (IHME). This means that it has more deaths than South Africa, even when that country’s excess deaths are taken into account.

Egypt has the highest obesity rate on the continent, so its death rate is in keeping with global trends.

It is likely that the impact of the pandemic is much greater in a number of other African countries, but only a handful have functioning civil death registration systems – namely Egypt, South Africa, Tunisia, Algeria, Cape Verde, São Tomé and Príncipe, Seychelles and Mauritius.

In a preprint article based on the world mortality dataset, academics Ariel Karlinsky and Dmitry Kobak report that they found the highest undercounts of excess mortality in Uzbekistan (30), Kazakhstan (12), Belarus (15), Egypt (13), and Russia (6.7). 

“Such large undercount ratios strongly suggest purposeful misdiagnosing or underreporting of COVID-19 deaths,” according to the authors.

Countries Need Logistical Support to Prepare for Vaccine Rollouts

Ghaanian President Nana Akufo-Addo gets vaccinated against COVID-19 with the first COVAX vaccine to be distributed in the world.

Last Sunday, the G7 countries announced that they would be donating 870 million doses to countries in need – primarily through COVAX. However, many of these will be Pfizer vaccines that need to be stored at ultra-cold temperatures.

Dr Mike Ryan, WHO’s Director of Health Emergencies, warned that the logistics around cold chain management and vaccination rollouts was complex.

“Countries need assistance in preparing for that. A second tragedy will be to have vaccines and not be able to use them properly,” Ryan told Monday’s WHO press briefing on COVID-19.

“There is underfunding right now of basic preparedness in many, many countries. We would urge donors and others to not only just fund vaccines, but to fund the operations needed to deliver those vaccines, and to fund the agencies like UNICEF, like ourselves and other NGOs who are working very closely with governments to improve their capacity to deliver vaccines,” urged Ryan.

Meanwhile, a statement from the COVAX partners this week in response to the G7 donation also urged support for countries for rollouts.

“Facing an urgent supply gap, COVAX is focused on securing as many shared doses as possible immediately, as the third quarter of this year is when the gap between deliveries and countries’ ability to absorb doses will be greatest,” said the partners in a media statement.

“In anticipation of the large volumes available through the COVAX Facility deals portfolio later in the year, COVAX also urges multilateral development banks to urgently release funding to help countries prepare their health systems for large-scale rollout of vaccines in the coming months,” it added.

The Democratic Republic of the Congo has already sent some of 1.7 million of its COVAX-donated vaccines to other countries because it was unable to distribute them before their expiry date. Meanwhile, South Sudan intends to destroy 59,000 vaccines that have expired and Malawi earlier destroyed 20,000 expired vaccines despite being told by Africa CDC and other bodies that they could be used. 

Image Credits: WHO, WHO African region .

A new WHO study found that 18 million children, some as young as 5 years of age, are actively involved in the informal e-waste sector – and are being exposed to toxic e-waste that is endangering their lives.

Electronic waste (e-waste) is increasing at three times the pace of the world population, impacting badly on the health of those wading through electronic dump sites, according to the World Health Organization’s (WHO) landmark report – Children and Digital Dumpsites – released on Tuesday.

Led by Marie-Noël Bruné Drisse, a children’s health expert of the WHO, the report found that 18 million children, some as young as 5 years of age, are actively involved in the informal e-waste sector – and are being exposed to toxic e-waste that is endangering their lives.

In 2013, the WHO launched its e-waste and child health initiative, which led to a series of evidence gathering missions to bring together knowledge and awareness on the detrimental health impacts.

“Recycling is quite expensive,” said Drisse.  “Because it is expensive, [rich countries] circumvent the domestic recycling regulations, and it seems to be cheaper to do this than to recycle the waste themselves.”

This is triggering a crisis of e-waste health risks to millions of children globally, mostly in low and middle income countries that are recipients to the hazardous material. In East and South-East Asia alone the volume of the electronic waste increased by 63% between 2010 and 2015, according to the report.

As the wealthy citizens of the world throw out their old devices, each year about 250,000 tonnes of the 53.6 million metric tonnes of e-waste is discarded in Agbogbloshie,located in the buzzing commercial district on the Korle Lagoon of the Odaw River, in the centre of Ghana’s capital city Accra. Nicknamed Sodom and Gomorrah, Agbogbloshie is one of the world’s most prolific destinations for electronic scrap materials as hundreds and thousands of tonnes of e-waste is dumped at the site by mostly wealthy nations.

In the 2020 Global E-waste Monitor report, only 17.4 % of the 50 million figure was officially documented as formally collected and recycled.

According to the WHO, e-waste refers to any electronic equipment and components which become waste, including medical devices and toys. 

The majority of e-waste is recycled by informal waste sector workers, including children and pregnant women, exposing these populations to toxic materials including brominated flame retardants, lead, mercury and dioxins.

Children at Greater Harm

“As many as 12.9 million women are working in the informal waste sector, which potentially exposes them to toxic e-waste and puts them and their unborn children at risk,” the WHO said in a press statement on Tuesday.

“Meanwhile more than 18 million children and adolescents, some as young as 5 years of age, are actively engaged in the informal industrial sector, of which waste processing is a sub-sector.”

Young children are often used in the informal recycling sector as “they have small hands, which are useful for extracting the materials,” said Drisse.

Children working in the dump sites are more vulnerable than adults as their organs are less developed, and the toxins could “impair neurological and behavioural development” as well as other negative birth outcomes connected to the lung and respiratory function and immune system damage, said the WHO.

Beyond health, there are environmental consequences including the pollution of air, water and soil, critical for agricultural means.

The ‘Most Toxic’ Dumpsite in the World

A man from Ghana burns electronic waste to reveal the metals at the Agbogbloshie electronic waste site in Accra, Ghana(2018)

Arriving at the port of Tema, about 20 miles east of Agbogbloshie, thousands of tonnes of used electronic materials are delivered by high income nations such as those in the European Union and North America, often burdening the local waste management infrastructure.

Up to 8,000 workers wade through the discarded materials for recycling at temperatures of about 35°C without masks or personal protective equipment.

Ghana makes an estimated $105 to $268 million annually from materials sourced from e-waste and as many as 200,000 people benefit from e-waste recycling activities, according to Drisse.

“How can we ask a family who depend on informal recycling as their source of income to stop this activity?” asks Dr Julius Fobil, head of the School of Public Health at the University of Ghana, who has been researching the impact of informal e-waste recycling on health for years. 

Fobil said until alternatives jobs are offered and appropriate measures are implemented, e-waste will remain a complex issue. “Their respiratory health is impacted, they have breathing problems, back problems and sores on their skins which could lead to long-term ailments,” he explained.

Workers source the materials needed, such as copper, by burning the electronic materials. As a result, “naked fires at low temperatures are widespread, which is extremely dangerous, particularly for children as they can get burnt.” 

Also, the smoke “emanating from burning goes into the lungs of those in surrounding areas and causes environmental and air pollution, significantly impacting the air quality,” particularly for the 80,000 people living on-site and adjacent to the site.

A vibrant economy surrounds Agbogbloshie, which is home to one of Accra’s largest food markets. Livestock also graze on the waste materials, enabling toxins to enter the food chains. 

The highest ever reported levels of brominated dioxin and second- highest level of chlorinated dioxins were found in eggs in Agbogbloshie, Drisse explained. Adult chicken eggs gathered around the area have 220 times more toxins than the safety limits prescribed and, if ingested, could cause cancer, reproductive problems and interfere with hormones. With all these health warnings the practice still remains extremely difficult to curb.

Why International Conventions and Policies are not Working

The WHO report found that about 53.6 million metric tonnes of e-waste is disposed worldwide every year.

Attempting to curb the practice, international treaties like the Basel Convention (1992)  and  Bamako Convention (1998) came into force to reduce and prevent the export of hazardous waste, including radioactive materials to low-middle income countries. However, this waste still ends up in countries like Ghana.

Although both Drisse and Fobil believe these conventions are “really important” to discourage the shipment of hazardous waste, they both note their limitations. 

“These international conventions remain at the global level making it difficult to implement locally. They are signed by governments at a high level and there is a long lag between when the decision at the global level is made and implemented locally,” said Fobil.

 “In addition, when adopted at an international level they can become ineffective locally because they do not apply as the policies remain inflexible,” he added.

As part of the e-waste and child initiative a group of 10 UN agencies and international organisations have come together to increase collaboration and provide more effective support to countries to address the e-waste and adapt international policies to local contexts to ensure more successful waste management systems. 

Electronic-waste refers to any electronic equipment and components which become waste, including medical devices, toys and cellphones.

Drisse also explained that organisations such as Pure Earth and its partners are thinking of locally adapted interventions to recycle and dismantle these materials without harming people’s health – such as getting machines to strip the wires to retrieve the copper.  

As part of the ongoing efforts to offer training in safer recycling practice, a football pitch for entertainment and clinic have been located near-by, bringing together informal and formal groups on how to appropriately manage e-waste.

“The clinic is providing basic health care for e-waste workers and other residents in the area. It is also used as an onsite research centre for collecting biological samples needed to disseminate information about the health impacts of improper waste management,” Fobil explained.

Despite all these interventions, people’s appetite for electronics keeps growing, and this has detrimental and long-term effects on people like those living in Agbogbloshie.

Image Credits: WHO, EPA/CHRISTIAN, Global E-waste Monitor.

Wearing masks, social distancing, travel restrictions: the WHO plans to study social and behavioral interventions that have kept COVID-19 away.

The World Health Organization (WHO) is planning to study the public health and social measures that countries have used to keep COVID-19 at bay successfully – in case there is no quick vaccine for the next pandemic.

A special working group has been set up with the support of Norway to study these measures, WHO Director-General Dr Tedros Adhanom Ghebreyesus told Monday’s WHO COVID-19 media briefing.

“The emergence of more transmissible variants means public health and social measures may need to be more stringent and applied for longer, in areas where vaccination rates remain low,” said Dr Tedros.

“To improve the evidence base on the effectiveness of public health and social measures, WHO is collecting data from around the world on which measures are used and the level at which they are applied.”

However, he warned that it was hard to study these measures because countries typically use a range of them at the same time, and “untangling the precise impact of each individual measure can be challenging”. 

Norway’s Minister of Health and Care services, Bent Høie, told the briefing: “We have been lucky this time. The next pandemic may behave differently from COVID-19 and we may have to depend on public health and social measures for a much longer time in the next pandemic before vaccines are available.” 

Although thousands of scientific papers have been produced about the science of COVID-19, very few have examined the impact of measures such as wearing masks, social distancing, testing-and-tracing and travel restrictions, said Høie.

“Even though most countries have been using these restrictive measures extensively for more than a year, our knowledge on the precise effects of each of these measures is unclear, and the effects are difficult to research,” he added.

The WHO working group will examine the impact, social and economic costs of the different measures used, and develop better tools that can be deployed during the next pandemic, he added.

Countries Need Help with Vaccination Preparedness

People waiting to register for COVID-19 vaccines in the Pakistan Institute of Medical Science.

“Globally, the number of new cases of COVID-19 reported to WHO has now declined for seven weeks in a row, which is the longest sequence of weekly declines during the pandemic so far,” said Tedros.

However, he added that the decline masked a “worrying increase” in many countries.

“The steep increase in Africa is especially concerning, because it is the region with the least access to vaccines, diagnostics and oxygen,” said Tedros, pointing out that around 420 people would have died of COVID-19 during the hour-long briefing.

While Tedros welcomed the G7 Summit’s announcement on Sunday that it would donate 870 million vaccine doses, he stressed that “we need more, and we need them faster”.

A wide range of civil society organisations have condemned the G7 for failing to agree to the UK’s call to donate one billion vaccine doses. Former UK Prime Minister Gordon Brown told Sky News that the G7 leaders were guilty of an “unforgivable moral failure” for failing to donate the vaccines.

The majority of the vaccine donations will be Pfizer vaccines, which need to be transported and stored in ultra-cold conditions – although once they have been taken out of cold storage, they can be kept in normal refrigeration for up to three months, according to Mariangela Simao, WHO’s Assistant Director General for Access to Medicines. 

But Dr Mike Ryan, WHO’s Director of Health Emergencies, warned that the logistics around cold chain management and vaccination rollouts was complex.

“Countries need assistance in preparing for that. A second tragedy will be to have vaccines and not be able to use them properly. And there is underfunding right now of basic preparedness in many, many countries. We would urge donors and others to not only just fund vaccines, but to fund the operations needed to deliver those vaccines, and to fund the agencies like UNICEF, like ourselves and other NGOs who are working very closely with governments to improve their capacity to deliver vaccines.”

Addressing the $16 billion shortage faced by COVAX, the global vaccine platform, Ryan pointed out that this was around 1% of a year’s spending on global military defence. 

“Surely we can afford 1% of that to save lives, and bring this pandemic to an end?” asked Ryan.

Image Credits: Cross River State Primary Health Care, Nigeria , Flickr: Joseph Gage, Rahul Basharat Rajput.