A PREVENT-19 phase 3 trial volunteer receives the Novavax vaccine at a trial site in Plano, Texas.

Biotech manufacturer Novavax announced on Monday it would be able to manufacture 100 million doses of its two-dose COVID-19 vaccine every month by the end of the third quarter of 2021 and 150 million doses per month by the end of the year – once it has secured regulatory approval for its vaccine.

This follows a successful Phase 3 trial, which showed that the vaccine, NVX-CoV2373, had an overall efficacy of 90.4% and showed 100% protection against moderate and severe COVID-19 disease, according to the company.

Almost 30,000 participants across 119 sites in the US and Mexico participated in the trial. Trial participants were representative of communities and demographic groups most impacted by the disease, according to the company.

The recombinant nanoparticle protein-based vaccine acts by inducing antibodies that block the binding of spike protein to cellular receptors.

“These clinical results reinforce that NVX-CoV2373 is extremely effective and offers complete protection against both moderate and severe COVID-19 infection,” said Stanley C. Erck, Novavax President and Chief Executive Officer. 

“Novavax continues to work with a sense of urgency to complete our regulatory submissions and deliver this vaccine, built on a well understood and proven platform, to a world that is still in great need of vaccines.”

Efficacy of Over 90%

NVX-CoV2373 demonstrated overall efficacy of 90.4%. In all, 77 cases were observed: 63 in the placebo group and 14 in the vaccine group. All cases observed in the vaccine group were mild. Ten moderate cases and four severe cases were observed, all in the placebo group, yielding a vaccine efficacy of 100% against moderate or severe disease.

“NVX-CoV2373 also showed success among ‘high-risk’ populations (defined as over age 65, under age 65 with certain comorbidities or having life circumstances with frequent COVID-19 exposure): vaccine efficacy was 91.0%, with 62 COVID-19 cases in the placebo group and 13 COVID-19 cases in the vaccine group,” Novavax stated.

Regarding strains of SARS-CoV-2, the vaccine demonstrated 100% efficacy against variants not considered Variants of Interest (VoI) and Variants of Concern (VoC). 

Novavax also stated that of the sequenced cases, 35 (65%) were VoC, 9 (17%) were VoI, and 10 (19%) were other variants. Against VoC/VoI, which represented 82% of the cases, vaccine efficacy was 93.2%, achieving a key exploratory endpoint of the study. Thirty-eight of the VoC/VoI cases were in the placebo group and 6 were in the vaccine group.

Preliminary safety data also showed the vaccine to be generally well-tolerated considering serious and severe adverse events were low in number and balanced between vaccine and placebo groups. 

Adverse reactions were restricted to less than 1%. Fatigue, headache and muscle pain were the most common symptoms, lasting less than two days.

Ready to File by Third Quarter

Before the vaccine can be included in the panel of vaccines that will become available for use in the fight against the pandemic, it needs to complete the final phases of process qualification in addition to assay validation which is required for it to meet chemistry, manufacturing and controls (CMC) requirements.

According to Novavax’s estimates, it will be ready to file for regulatory authorizations in the third quarter of 2021. Of particular interest will be authorizations by the European Medicines Agency (EMA) and the World Health Organization’s Emergency Use Listing.

Even though several steps are still ahead before NVX-CoV2373 joins the list of approved vaccines for use, Gregory M. Glenn, President of Research and Development at Novavax expressed confidence that the results from the PREVENT-19 clinical trial are strong indications on the candidate vaccine making it to the end users. 

“PREVENT-19 confirms that NVX-CoV2373 offers a reassuring tolerability and safety profile. These data show consistent, high levels of efficacy and reaffirm the ability of the vaccine to prevent COVID-19 amid ongoing genetic evolution of the virus. Our vaccine will be a critical part of the solution to COVID-19 and we are grateful to the study participants and trial staff who made this study possible, as well as our supporters, including the U.S. Government,” Glenn said.

There is also a green light for the vaccine getting added to the list of vaccines that are available to countries through the COVAX Facility. In a statement, the Coalition for Epidemic Preparedness Innovations (CEPI) said Novavax’s COVID-19 vaccine will be “a critically important addition to the armamentarium”.

CEPI said it invested up to $384 million, in early research and development, in testing the potential of Novavax’s vaccine technology.

CEPI also announced agreements with its partner GAVI to supply vaccines to COVAX. As part of the agreement, Novavax will supply 350 million doses of its COVID-19 vaccine, from as soon as it has secured regulatory approval.

“A total of 1.1 billion doses of the Novavax vaccine are expected to be made available to COVAX, with the remaining volumes set to be supplied through the Serum Institute of India,” CEPI stated.

 

 

Image Credits: Matt Feldman, Novavax.

A child works in a tobacco field in Indonesia

Over the past several decades, the tobacco industry has tried to influence policy by partnering with various United Nations (UN) agencies. Many of these agencies, however, have since cut ties with the industry, thus safeguarding their initiatives and policies from Big Tobacco’s commercial interests. One notable exception remains and must be addressed: the continued membership of the tobacco industry-funded Eliminating Child Labour in Tobacco-Growing Foundation (ECLT) in the UN Global Compact (UNGC). More than 170 civil society organizations have now called on UNGC to end ELCT’s participation.

Tobacco industry benefits from UN partnerships 

The advantages the tobacco industry gains from these types of collaboration are not imagined or hypothetical. There is evidence that shows how it has benefited.

For decades, the tobacco industry nurtured its alliance with the International Labour Organization (ILO). Transnational tobacco companies financially supported the agency’s work, and Philip Morris International even displayed the ILO logo on its website. The closeness was reciprocated. In 2002, the ILO produced a glowing report about trends and prospects in the tobacco industry, and in 2017, included praise for its work with the tobacco industry in its Governing Body’s reference document.

The industry also sought to influence the Food and Agriculture Organization (FAO), positioning experts on various FAO/World Health Organization (WHO) committees and working to direct funding to research and policy groups sympathetic to the industry. And its work with United Nations International Children’s Emergency Fund (UNICEF) in the late 1990s (both directly and via front groups) on youth smoking prevention initiatives was revealed via industry documents to be a way to avoid meaningful tobacco control measures.

BAT used International Chamber of Commerce co-operation to get closer to WHO

An especially concerning example of attempted industry interference in health policy was British American Tobacco (BAT) allegedly using its ties to the International Chamber of Commerce (ICC) to influence WHO. As the “world’s largest business organization,” the ICC is regularly consulted by the UN on business issues. In 2000, then-BAT CEO, Martin Broughton, joined the ICC UK’s governing body; one of the listed membership benefits being “preferential access to the UN and its constituent organisations.”

In July 2000, the WHO published an exposé, Tobacco Company Strategies to Undermine Tobacco Control Activities, based on internal industry documents, claiming that the industry subverted its efforts to control tobacco use. 

The exposé did not stop the tobacco industry. Even as the WHO Framework Convention on Tobacco Control (FCTC) was being prepared, Broughton wrote to the ICC requesting that the organisation get involved in the negotiating process, from which the tobacco industry had been officially excluded. The WHO went on to coordinate and successfully complete the FCTC negotiations which, among other things, set the guidelines for preventing tobacco industry influence in public policy.

Other UN agencies have cut ties with the tobacco industry

In 2019, after a multitude of efforts from sustainable development and public health groups and several international non-governmental organisations, the ILO finally ended tobacco industry funding. The FAO has since moved to demand transparency and accountability from its expert consultants (an effort about which the full effect is still unknown), and UNICEF has stated that it has developed a policy on tobacco, though the policy has yet to be published on UNICEF’s website. These are all important steps in keeping the tobacco industry out of the UN.

The UNGC must end the ECLT’s membership to cut ties with tobacco industry

The UNGC is a voluntary UN initiative made up of businesses, public sector organisations, cities and non-governmental organisations committed to socially responsible business practices in the areas of human rights, labour, the environment, and anti-corruption. Recognizing that “tobacco products are in direct conflict with UN goals, particularly with the right to public health, and undermines the achievement of SDG 3,” the UNGC’s 2017 move to exclude membership from organisations that “derive revenue from the production and/or manufacturing of tobacco” was a smart one.

However, the ECLT remains a member of the UNGC. While its supposed pursuit of ending child labour (which it has yet to accomplish) looks good from the outside, the ECLT is actually an alliance of tobacco companies and growers—an industry front group—and its UNGC membership provides “the industry with the opportunity to have a seat at the policy table among respected organisations and sometimes Member State Delegations…” As we’ve seen with other UN agencies, this type of cooperation can hinder tobacco control and instead provide benefits to the tobacco industry. After two decades of ECLT’s work, child labor remains entrenched in many tobacco-growing regions.

That is why the UNGC should uphold the Model Policy for Agencies of the United Nations System on Preventing Tobacco Industry Interference, which affirms that “engagement with the tobacco industry is contrary to the United Nations system’s objectives, fundamental principles and values,” and look to FCTC Article 5.3 Guidelines for the necessary steps to prevent industry influence.

Ending child labor should not be in the hands of an industry whose supply chain allegedly benefits from practices that keep leaf prices low. A continued partnership promises to only hinder the elimination of child labor and continues to allow tobacco industry influence to stream into the UN.

The fight to eliminate tobacco industry influence within the UN system isn’t over—but UNGC excluding the ECLT would be an important step.

* Mary Assunta is Head of Global Research and Advocacy at the Global Center for Good Governance in Tobacco Control and a Partner in STOP.

 

Image Credits: Human Rights Watch.

Some of the first SARS-COV-2 cases emerged around Wuhan’s “wet markets” selling wild animals for slaughter and meat consumption; such markets can be a flashpoint for pathogen transmission to humans.

Chinese researchers have this week published two papers that shed new light into the likely bat origins of SARS-CoV2 and related foodborne risks – even as pressures from the United States and the European Union grow for a more complete investigation into the origins of SARS-CoV2. 

The US and EU are expected to issue a joint statement on the issue next week calling for “progress on a transparent, evidence-based and expert-led WHO -convened Phase 2 study on the origins of Covid-19, that is free from interference.” 

Speaking at a Thursday press conference ahead of this weekend’s G7 Summit, European Council President Charles Michel set the stage with a declaration that “the world has the right to know exactly what happened in order to be able to learn the lessons.”

Added European Commission President Ursula von der Leyen: “Investigators need complete access to the information and to the sites” to “develop the right tools to make sure that this will never happen again.”

Preemptive Chinese Moves? 

The EU statements followed this week’s release of two papers by Chinese academics in peer-reviewed journals on bat coronaviruses and Wuhan market pathogen risks.  

One study, published in the journal Cell,  reviews previously unreported data on the genome sequences of about two dozen novel coronaviruses harborned by bat species in southwestern China’s Yunnan province, including one that may be the most similar yet, genetically speaking, to SARS-CoV2.

A second paper, published in Scientific Reports highlights the poor hygiene and animal market conditions, and a range of pathogen risks associated with Wuhan’s live animal markets, which included many illegally traded species, in a survey of 47,000 live animals sold at 17 Wuhan markets between May 2017 and November 2019.  During the two-and-half years, one of the study’s co-authors conducted monthly surveys of all 17 shops in Wuhan markets that sold live wild animals for food and pets. Seven of the shops were at the Huanan seafood market, one of the first sites around which a cluster of novel coronavirus cases was first identified in December 2019 and early 2020. 

No Smoking Guns – But… 

Experts contacted by Health Policy Watched noted that papers add weight and nuance to the origins investigation, although neither resolves the polarized debate over whether the virus emerged via “natural” contact between bats and humans, or bats and another  intermediate food or animal host.  

“This shows why we should fully examine the natural spillover origin hypothesis, but it’s in no way the ‘smoking gun’ that Bob Gerry described as in the Wall Street Journal,” said Jamie Metzl, a senior fellow at the Atlantic Council. Metzl is one of the co-authors of a series of open scientific letters that have criticized the WHO-led investigation as inadequately exploring the possibility that the SARS-CoV2 could have “escaped” from the Wuhan Institute of Virology, where scientists were studying horseshoe bat coronaviruses from Yunnan Province, just prior to the pandemic.

Another scientist expressed doubt that the timing of the publications represented any kind of a trend by Beijing to drive the narrative against US and European pressures, saying other studies of bat coronavirus sequences have been published previously and: “this is just science, slowly and methodically being published. I have no doubt more will come out.” 

Twenty-four Full-Length Coronavirus Genomes 

Infographic describing research published in the journal Cell, in June 2021, which mapped the genomes of 24 coronaviruses harborned by bats in China’s Yunnan province, including four close relatives of SARS-CoV2, the virus that causes COVID-19.

The paper on the new set of bat coronaviruses, published in Cell by 15 Chinese and Australian researchers, sequenced 24 full-length coronavirus genomes out of a collection of 411 bat saliva and excrement samples collected in Yunnan province between May 2019 and November 2020 – including four novel viruses that researchers said were closely related to SARS-CoV2.  

One virus, dubbed “Rhinolophus pusillus virus” (RpYN06), was found to be the  closest relative of SARS-CoV-2 in most of its genome, among the group of viruses collected “although it possessed a more divergent spike gene. 

“The other three SARS-CoV-2 related coronaviruses carried a 41 genetically distinct spike gene that could weakly bind to the hACE2 receptor in vitro” – referring to the receptor in humans to which SARS-CoV2 attaches so effectively. 

None of the samples, however, appeared to be quite as genetically similar to SARS-CoV2 as a previously identified bat virus (Rhinolophus affinis) RaTG13 – which the researchers admitted still “shares the greatest sequence identity with SARS-CoV-2 across the viral genome as a whole (Zhou et al., 2020b).” That  coronavirus, as well, is believed to have been harbored by bats in remote parts of Yunnan province in southwestern China, bordering Myanmar. 

The study suggests that “bats across a broad swathe of Asia harbor coronaviruses that are closely related to SARS-CoV-2 and that the phylogenetic and genomic diversity of these viruses has likely been underestimated.

“Ecological modeling predicted the co-existence of up to 23 Rhinolophus bat species, with the largest contiguous hotspots extending from South Laos and Vietnam to southern China. Our study highlights the remarkable diversity of bat coronaviruses at 45 the local scale, including close relatives of both SARS-CoV-2 and SARS-CoV.” 

Market Risks Abounded – But Pangolins Not Among Species Sold 

Wuhan’s shuttered live animal markets in April 2020, including (a) Huanan Seafood market, (b) Qiyimen live animal market, (c) Baishazhou market and (d) Dijiao outdoor pet market.

The second study, conducted by scientists from the China West Normal University, as well as Oxford University and the University of British Columbia, found 47,000 live animals sold in Wuhan’s live animal markets between May 2017 and November 2019,

“Serendipitously, prior to the COVID-19 outbreak, over the period May 2017–Nov 2019, we were conducting unrelated routine monthly surveys of all 17 wet market shops selling live wild animals for food and pets across Wuhan City,” the authors report. 

“This was intended to identify the source of the tick-borne (no human-to-human transmission) Severe Fever with Thrombocytopenia Syndrome (SFTS), following an outbreak in Hubei Province in 2009–2010 in which there was an unusually high initial case fatality rate of 30%.”

“While we caution against the misattribution of Covid-19’s origins, the wild animals on sale in Wuhan suffered poor welfare and hygiene conditions and we detail a range of other zoonotic infections they can potentially vector,” lead author Xiao Xiao, from the Lab Animal Research Centre at Hubei University of Chinese Medicine in Wuhan,wrote.

No Pangolins At Wuhan’s Markets 

Significantly, while some 38 species were sold in 17 markets in Wuhan between May 2017 and November 2019, no pangolins were sold in the markets at all, the study also found.

That, the authors conclude, rules out pangolin, an endangered species known to be a carrier of coronaviruses, as a potential host of the first SARS-CoV2 virus cases transmitted to humans.  

“Circumstantially, the absence of pangolins (and bats, not typically eaten in Central China; media footage generally depicts Indonesia) from our comprehensive survey data corroborates that pangolins are unlikely implicated as spill-over hosts in the COVID-19 outbreak. This is unsurprising because live pangolin trading has largely ceased in China.”

However, badgers, porcupines, red foxes, masked palm civets, raccoon dogs, Siberian weasels, snakes, Siamese crocodiles and Chinese bamboo rats were among 38 animal species sold at the Huanan seafood and fresh produce market in central Wuhan. Almost all of the animals were “sold alive, caged, stacked and in poor condition,” and were often butchered on site, the researchers wrote.

Masked palm civets were discovered to be the host of the SARS-COV virus that caused the 2003 SARS outbreak, the authors acknowledge, warning against “false attribution” of the virus to any species, as of yet. 

“We should therefore not be complacent, because the original source of COVID-19 does not seem to have been established,” the authors wrote. “This is doubly important because false attribution can lead to extreme and irresponsible animal persecution. For instance, civets were killed en masse following the SARS-CoV outbreak, and any unwarranted vilification or persecution of pangolins and bats in relation to COVID-19 would risk undermining otherwise very successful efforts to better protect and conserve wildlife in China.”

Animals Sold at Wet Markets Kept in Poor Conditions 

Caged animals held for sale and slaughter in unsanitary conditions at Wuhan’s Huanan Seafood Market, prior to the outbreak of COVID-19, including: (a) King rat snake (Elaphe carinata), (b) Chinese bamboo rat (Rhizomys sinensis), (c) Amur hedgehog (Erinaceus amurensis) (the finger points to a tick), (d) Raccoon dog (Nyctereutes procyonoides), (e) Marmot (Marmota himalayana) (beneath the marmots is a cage containing hedgehogs), and (f) Hog badger (Arctonyx albogularis).

None of the 17 vendors in Wuhan selling the wild-caught and farmed non-domesticated species posted required origin or quarantine certificates, “so all wildlife trade was fundamentally illegal”, they said.

Along with the sale of the animals as luxury meat items,  some of the wild animals were also sold as pets – another prestige item in China, the authors noted. 

“We thus make an ethical distinction here between the subsistence consumption of bush meat in poorer nations, versus the sort of cachet attached to wild animal consumption in parts of the developed world, notably China, but also Japan,” the authors stated. 

Although the survey pre-dates the discovery of SARS-CoV2, other “potentially lethal viruses” were found in the wildlife tested, including rabies, SFTS, H5N1, as well as common bacterial infections that, nevertheless, represent a risk to human health (e.g., Streptococcus). 

Many of the earliest cases of human COVID-19 infection were linked to the Huanan seafood market, initially identified as where SARS-CoV-2 first crossed to humans. However, other early clusters of cases elsewhere in the city also suggest that the novel coronavirus did not exclusively emerge from the Huanan marketplace either. 

The study challenges some of the assumptions in a recent WHO report on its mission to Wuhan noting that: “The WHO reports that market authorities claimed all live and frozen animals sold in the Huanan market were acquired from farms officially licensed for breeding and quarantine, and as such no illegal wildlife trade was identified.” 

“In reality, however, because China has no regulatory authority regulating animal trading conducted by small-scale vendors or individuals it is impossible to make this determination.”

The authors also note the gunshot and trapping wounds found on the bodies of live animals or their carcasses following slaughter, suggesting illegal hunting and trapping of many of the species sold in the market. 

China Crackdown – But More Steps Needed

After the first COVID-19 outbreak in Wuhan, China cracked down on wildlife trafficking, banning the consumption and trading of wild animals for food in February 2020, although it still allows some animals to be reared for fur or traditional Chinese medicine.

However, the study cites a series of other measures that still may be needed, stating that: “Legislative reform is also vital to clarify unequivocally which species are considered ‘wild’ and cannot be traded legally and safely.”

Another problem, as encountered by the WHO report is that, retrospectively, it proved difficult to ascertain which species were on sale, even to the genus level, relying solely on the responsible market authority’s official sales records and disclosures. 

Sales of wild animals, including squirrels, birds and turtles, as pets, are another concern, the authors note, saying, “While not currently the vector of any major viral epidemics, it would be naive to imagine that unconventional pets do not still also pose a serious concern for public health26. This potential for disease is likely exacerbated by poor sanitary and welfare conditions.

The authors also cite physical infrastructure reforms in China’s open air markets, and other hygienic practices, in line with new WHO co-authored guidance, on “Reducing public health risks associated with the sale of live animals on mammalian species in traditional food markets’, stating that, “adopting these more responsible practices has the potential to save countless lives in the future.”

Origins of COVID-19 Unsolved: More Investigations Needed

More than a year into the pandemic, the question of the virus’s origins remains largely unresolved.

A World Health Organization-led research mission in March found that SARS-CoV-2 most likely spilled over to humans from a live animal — either directly through a bat infection, or via another mammal, possibly one sold at Wuhan’s wet markets. 

But other scientists have charged that the virus may instead have escaped from the Wuhan Institute of Virology – and calling for further exploration of that hypothesis. . 

Last month President Joe Biden administration asked US scientists to “redouble efforts” to find the origins of the virus, asking for another update in 90 days.

Image Credits: Breaking Asia, Cell.com , Scientific Reports, Nature .

Johnson and Johnson single-dose vaccine

The US Food and Drug Administration (FDA) has authorised the release of two batches of the Janssen/ Johnson & Johnson COVID-19 vaccine – about 10 million doses – manufactured at the Emergent BioSolutions facility in Baltimore, according to a statement on Friday.

However, it also “determined several other batches are not suitable for use” while “additional batches are still under review,” it added.

The rejected doses amount to around 60 million doses, according to the New York Times.

For weeks, the future of the Johnson & Johnson vaccines have been up in the air as the FDA conducted “a thorough review of facility records and the results of quality testing performed by the manufacturer”.

This follows the discovery of serious breaches at Emergent, including the cross-contamination of Johnson & Johnson and AstraZeneca vaccines and mould in the Baltimore plant.

The Emergent problems have hampered severely South Africa’s vaccine rollout, as a local company, Aspen, is contracted to fill and finish for Johnson & Johnson, and was due to supply over two million vaccines to the national vaccination programme.

It is unclear how many of the South African vaccines are affected by the FDA decision.

“The FDA’s decision to include these two batches of vaccine drug substance in the Emergency Use Authorization (EUA) for the Janssen COVID-19 vaccine means that Janssen vaccine made with this drug substance can be used in the U.S. or exported to other countries,” said the FDA.

“A condition on any export of these batches, or of vaccine manufactured from these batches, is that Janssen and Emergent agree that the FDA may share relevant information about the manufacture of the batches under an appropriate confidentiality agreement, with the regulatory authorities of the countries in which the vaccine may be used.”

The FDA has also extended the expiration date for refrigerated Janssen COVID-19 vaccines from 3 months to 4.5 months.

“These actions followed an extensive review of records, including the production history of the facility and the testing performed to evaluate the quality of the product. This review has been taking place while Emergent BioSolutions prepares to resume manufacturing operations with corrective actions to ensure compliance with the FDA’s current good manufacturing practice requirements,” said Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research. 

“Additionally, the action to extend the shelf life for the refrigerated Janssen vaccine means that jurisdictions that have doses on hand now have additional time to administer vaccine.”

 

G7 leaders pose ahead of their meeting in Cornwall

Before the G7 leaders sat down on Friday afternoon in Cornwall to discuss how to “build back better” a world devastated by COVID-19, UK Prime Minister and summit host Boris Johnson challenged the Group to accept a target of providing one billion doses to developing countries.

But the People’s Vaccine Alliance, a network of over 50 organisations, has called on the G7 to “agree on a global goal to vaccinate 60% of the world by the end of 2021, with everyone reached in the next 12 months”. 

This would mean that 4.8 billion single-dose vaccines are needed – or 9.6 billion of the two-dose vaccines such as Pfizer, AstraZeneca and Moderna.

In an article published on Thursday, Johnson urged the Group “to adopt an exacting yet profoundly necessary target: to provide one billion doses to developing countries in order to vaccinate everyone in the world by the end of next year”.

According to Johnson: “Our scientists devised vaccines against COVID-19 faster than any disease had ever been overcome before. Britain and many other countries are inoculating their populations more swiftly than anyone thought possible,” he added.

“Now we must bring the same spirit of urgency and ingenuity to a global endeavour to protect humanity everywhere. It can be done, it must be done – and this G7 summit should resolve that it will be done.”

Some 42% of G7 Residents Are Already Vaccinated

By the end of May 2021, 42% of people in G7 countries had received at least one vaccine dose, compared to less than 1% in low-income countries, according to the alliance. COVID-19 cases are surging in large parts of Latin America and Africa.

The US this week committed to donating half a billion Pfizer vaccines to the world’s poorest countries in the next year, according to a White House announcement on Thursday. Deliveries will start in August, and the US has undertaken to deliver 200 million doses this year and the remaining 300 million by mid-2022. Two doses of this vaccine are needed, so the donation will cover 250 million people.

Saturday’s agenda for G7 – which comprises the UK, US, Canada, France, Italy, Germany, Japan and the European Union – will focus on global resilience, foreign policy (including aid) and health.

Leaders are expected to get into the details of vaccine distribution in the health session that will be addressed by the Gates Foundation’s Melinda French Gates and the UK’s Chief Scientific Adviser, Sir Patrick Vallance.

India and South Africa – co-sponsors of the TRIPS waiver proposal at the World Trade Organization (WTO) – have also been invited to the summit, along with South Korea, which has significant vaccine manufacturing capacity, and Australia. 

The World Health Organization, WTO, International Monetary Fund, Organisation for Economic Co-operation and Development and World Bank Group will also be in attendance.

But the People’s Vaccine Alliance has warned that any G7 promise to vaccinate the world by 2022 will not happen if governments continue to block proposals to waive patents and transfer technology and know-how.

It also wants the Group to “support the immediate suspension of intellectual property rules and enforce the transfer of vaccine technology to all qualified vaccine manufacturers in the world” and “pay their fair share of the money needed to manufacture billions of doses as fast as possible”.

‘Fantastic” French Support for TRIPS Waiver 

French President Emmanuel Macron and UK Prime Minister Boris Johnson greet each other at the G7 Summit.

“Of the G7 nations, only the US has explicitly supported waiving patents for vaccines – though not for treatments or diagnostics – and Japan has said it will not oppose the moves if they are agreed,” according to the People’s Vaccine Alliance.

“Germany and the UK continue to vehemently oppose the plan, despite its potential to massively increase vaccine production and save millions of lives, while Canada, Italy and France remain on the fence,” it adds.

However, following a quick visit to South Africa late last month, French President Emmanuel Macron appears to have climbed off the fence and stated on Thursday that he would support the TRIPS waiver.

Oxfam’s Health Policy Manager, Anna Marriott, described this news as “fantastic”, and called on the rest of the G& countries to follow suit.

“It doesn’t make sense for the entire world to be dependent on just a handful of pharmaceutical corporations that cannot make enough vaccines for everyone,” said Marriot. 

“Developing countries do not want to be dependent on donations of leftover vaccines from rich nations, most of which won’t even be given until next year. They simply want the rights and the recipes to make these vaccines themselves as fast as possible and this is what must be agreed at the G7 summit this week.”

Ahead of the summit, the US and the UK agreed to a new effort to combat future pandemics, through a partnership between the UK Health Security Agency (UKHSA) and the US National Centre for Epidemic Forecasting and Outbreak Analysis, run by the US Centers for Disease Control and Prevention (CDC).

The partnership will bolster “disease surveillance, as well as genomic and variant sequencing capacity worldwide” and establish an early warning system to detect diseases, particularly in low and middle-income countries that do not yet have the same capabilities.

This international approach to future pandemics builds on the Prime Minister’s recent launch of a new ‘Global Pandemic Radar’ to identify emerging COVID-19 variants and track new diseases around the world.

 

Image Credits: G7/UK.

Ugandan dairy farmer Tonny Kidega takes a keen interest in preventing antimicrobial resistance (AMR) in his country.

Dairy farmer Tonny Kidega is passionate about his cattle and his country’s health systems – and has been championing the importance of limiting the use of antibiotics to curb the development of drug-resistant “superbugs” and antimicrobial resistance (AMR).

Based in the Gulu district in northern Uganda, Kidega is a veterinarian and the Managing Director of the Gulu Uganda Country Dairy Limited.

He is also a firm supporter of Uganda’s new national action plan to eliminate the use of unnecessary antibiotics in livestock farming, which is the main driver of drug resistance – which could mean that common antibiotic medicines will no longer work on humans or animals.

“If I am reckless and I do not follow the procedures within my milk production value chain, and it gets antimicrobial residues, AMR will continue in the system,” said Kidega.

The Ugandan government is one of 10 countries in sub-Saharan Africa that is rolling out a national action plan to combat AMR, with support from the USAID-funded Medicines, Technologies and Pharmaceutical Services initiative   

The initiative, led by the US-based Management Sciences for Health, aims to help low-income countries to improve the prevention, detection and control of infectious agents; optimise the use of antimicrobial medicines; and generate knowledge, surveillance and  research about AMR resistance. 

“This is focused on the one health approach and under the same thematic areas of creating public awareness, training, and education; infection prevention and control; building antimicrobial stewardship as well as research and development,” says Reuben Kiggundu, who works with the Medicines, Technologies and Pharmaceutical Services (MTaPS) program. 

“If we worked in these strategic areas and with a one health approach we would to some extent control AMR.” 

Driving Change Through Education and Safe Practices

Employees at Tony Kidega’s dairy farm have been trained on safe AMR practices.

The World Health Organization (WHO) has declared AMR one of the top 10 global public health threats facing humanity. It is estimated that by 2050, AMR will kill more people globally than all NCDs combined. A 2014 review on Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations estimates that by 2050, 10 million people will die every year due to AMR unless a global response to the problem is mounted.

If no action is urgently taken, the cost of treatment for infections will be more than double, hospitalised patients will spend more days in wards, food security will be threatened and there will be more deaths, warned Dr Freddy Eric Kitutu, a lecturer at the School of Health Sciences and a leader of the Sustainable Pharmaceutical Systems Unit, Makerere University. 

Importantly, the  UN Sustainable Development Goals (SDGs) on ending hunger and availability of sustainable management of water and sanitation will not be achieved by 2030, said Kitutu.

As one of Uganda’s farmers who is participating in the new project, Kidega has adopted a series of best practices on his farm to reduce reckless use of antibiotics and other anti-microbial agents in his herds – beginning with the choice of that animals he that buys to the management of the farm and decisions about how products get to markets.

“For a farmer like me it pays off, and for a consumer of my products there is consistency in what they buy which boosts consumer confidence,” said Kidega. “People buy the story behind the product. So we have to create a story behind the product to win over customers.”

At his 40-acre farm, Kidega records his livestock’s journey and only buys cattle that are the right breed with traceable disease and treatment history and movement. 

“The animal should be vaccinated, have a clear record from the diseases it was treated for and it should be the right breed,” he says. 

He stays away from foreign breeds that have not been acclimatized to the local environment and sticks mostly to crossbreeds.

“There are many farmers who fall for buying foreign breeds that cannot withstand local diseases, and then these livestock often fall sick requiring treatment using antibiotics – which promotes AMR,” said Kidega.

The animals that he buys must have a movement permit that traces the journeys they have made and their host farm has to implement biosecurity practices, including disinfecting all the people who enter it. A fence for animal confinement as well as an isolation centre where sick animals are removed from the herd and treated are also a must.

“We have been advocating for people to sanitise before entry to the farm, and now with COVID-19, it is easier to enforce,” said Kidega, who hopes that farmers will continue to enforce these practices beyond the pandemic to prevent the infections that could spread to his herds – including from workers and visitors

Uganda’s AMR Action Plan 

A 2014 review on Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations estimates that by 2050, 10 million people will die every year due to AMR unless a global response to the problem is mounted.

While Uganda’s national plan is being rolled out by government authorities in the Ministry of Health and Agriculture, it also needs the support of consumers and industry.  

Kiggundu explains that the “One Health” approach is essential because drug-resistant pathogens have the potential to cross between animals and humans, as well as spreading in local environments and beyond, across international borders – which makes AMR a global health security issue.

The MTaPS program in Uganda is thus a multi-sectoral initiative: “From this platform, we go out to the agricultural sector and the human sector and respond to some of their needs that contribute to their unique needs focusing on infection prevention and control and antimicrobial stewardship,” says Kiggundu.

Data Collection and Surveillance is Key to Addressing AMR

One of the ways in which governments can help to drive the change is through providing data which is done through research and surveillance, said Kiggundu. Already, medicines therapeutic committees have been set up in hospitals to provide data and ensure the correct use of antibiotics.

The Ministry of Agriculture, supported by MTaPS, has also published the essential medicine list for treatment – which shows the medicines that should be used to treat different animals as well as standard guides for treatment, importation, and procurement. 

The guidelines on the use of antibiotics in the animal sector spells out drug use for poultry, pigs, fish, cattle, sheep and goats.

“Having such standards puts a foundation in place for surveillance, intervention and management,” says Kiggundu. “The idea is that you will improve biosafety and biosecurity on the farm, making sure you prevent infection in the first place. When you get infections, you are then able to use antibiotics appropriately.” 

But there are still challenges, especially given that most of the agricultural service delivery is in the private sector while health delivery services are mostly in the public sector.

“We have a lot of data to show that antibiotics are no longer working very well. Resistance has been reported to all known antibiotics and in Uganda and the problem is perpetuated by a lot of misuse of antibiotics and poor infection and prevention control,” said Kiggundu.

“Given, the indiscriminate use of antimicrobial agents in livestock farming in this country, AMR attributable to the practice is most likely much bigger than we can imagine,” said Jackson K Mukonzo, a lecturer at the Department of Pharmacology and Therapeutics at Makerere University.  

“As a country, we have not even been able to quantify or monitor AMR attributable to the use of antimicrobial agents in livestock even if there are scientific ways it can be done,” added Mukonzo. 

But not knowing the extent of the problem does not make it go away. Uganda is now looking at creating awareness about AMR

“AMR is a very serious problem that we do not see until it happens. We need to create awareness. My action or inaction affects everybody – it affects us collectively,” says Kitutu.

“It is everyone’s responsibility to keep these medicines as effective as possible,” said Kiggundu, who wants to create a movement in Uganda in which everyone understands that stewardship of antibiotics is everyone’s responsibility. 

Kidega said very few trained veterinarians know about AMR and this needs to change: “The people pushing for it are mostly international bodies,” he said. “I am trying to put into practice everything I know about the prevention of AMR. The advantages outweigh the effort and everyone should play a part.” 

Image Credits: Tony Kidega.

A lay counsellor on the Friendship Bench in Zimbabwe

Some community-based mental health services can outperform traditional services – and are cheaper, and often more rights-based – according to a new guidance released this week by the World Health Organization (WHO).

The guidance provides two-dozen peer-reviewed examples of outstanding community-based mental health projects – including the Friendship Bench in Zimbabwe, Atmiyata in India, and a survivors’ group in Kenya.

Using “person-centered” and “rights-based approaches” to care yielded outcomes that were far better in terms of reducing people’s dependence on psychiatric drugs and easing their full reintegration into communities, the study found. 

In addition, the trained peer- and lay-workers and day community centers are also cost-effective in comparison to expensive hospitalizations. 

Stories of Success Featured at Launch Event    

Stories from Kenya, India, the United Kingdom and elsewhere were among the case studies featured in the report – and shared in a global launch attended by over 4,000 people.  

Speakers at the event, including Dr Michelle Funk, development lead of the guidance, and WHO Assistant Director-General Dr Ren Minghui, who underlined how mental health care and service delivery demands profound change in the face of poor-quality care and human rights violations. 

“Our hope is that the WHO guidance will bring urgency to policymakers around the globe to invest in community-based mental health services and give hope to better lives for the millions of people with mental health conditions and their families worldwide,” said Minghui.  

The report provides real-world examples of good practices in mental health services in diverse contexts worldwide and describes how services need to be linked to housing, education, employment and social protection sectors.  

The report will also be used to support countries in their effort to align mental health care and service delivery with international human rights standards, such as the Convention on the Rights of Persons with Disabilities (CRPD). 

India: Volunteers Have Experience With Mental Health Problems

Dr Soumitra Pathare, Director, Centre for Mental Health Law and Policy, Indian Law Society, India

Many volunteers of the India-based Atmiyata community volunteer service were motivated to join the program as a result of their own experiences with distress, promoting and championing community inclusion. 

“People who will bring about the change are going to be people with lived experience of mental health,” said Dr Soumitra Pathare, Director of the Centre for Mental Health Law and Policy at the Indian Law Society, who works with Atmiyata.

Atmiyata identifies and supports people experiencing distress in rural communities of the Gujarat state in western India.

Volunteers raise awareness in the community about mental health issues, identify people experiencing distress and provide up to six sessions of counselling. They also refer people who may have severe mental health conditions to the public mental health service and to support people in need with access to social care benefits.

In addition, Pathare emphasized that the change in mental health service will not come from technology, but from people, making it important that these programs utilize the voice of affected communities: “We need to tap into the social capital that exists in our communities.” 

Kenya: Peer-support Restoring Power, Voice and Choice

Michael Njenga, CEO of Users and Survivors of Psychiatry, Kenya

The Users and Survivors of Psychiatry in Kenya (USP-K) promotes and advocates for the rights of persons with psychosocial disabilities through peer support groups for its members and training on self-advocacy and human rights. 

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

“Peer support is built on the premise of recovery and recovery in itself recognizes and acknowledges a person’s abilities and doesn’t focus so much on the disability,” added Charlene Sunkel, Founder and CEO of Global Mental Health Peer Network.

The group supports people to become autonomous in their decision-making and day-to-day lives by helping people think through and make decisions about their employment situation, living arrangements and health care and treatment. 

Members of USP-K have been trained on the Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals, which have been the bedrock of the program, said Njenga, adding that USP-K has also been exploring alternative ways of addressing distress beyond the biomedical model. 

“This has been important in shaping the narrative towards meaningful inclusion of peer-support groups in different areas of their lives – access to government opportunities, both mainstream and disability-specific, and participation in policy and legislative reforms.” 

At the core of this, said Njenga, is the organization’s effort to support economic empowerment programs, access to social protection programs, and strengthening of support systems, which is an important aspect of living independently and being included in the community. 

“This has brought an important shift of seeing inclusion beyond the lens of mental health.” 

Zimbabwe: Problem-Solving Through Peer-Support and Community Inclusion

Zimbabwe’s Friendship Bench, derived from a Shona term which means, “bench to sit on to exchange ideas,” provides short-term problem-solving therapy for people with common mental health conditions. 

Given the scarcity of mental health services in Zimbabwe, the Friendship Bench fills an important gap and need for community mental health service provision.  

The service is delivered by lay health workers – mostly older women, who are seen as important guardians of the community and are therefore respected. 

Friendship Bench clients also can join a peer-support group, Holding Hands Together, where people can share experiences in a safe space. 

Such support groups bring people with lived experience together in a sense of solidarity, as participants support each other and create opportunities for joint problem-solving.  

Addressing Poverty, Education, Housing and Employment are Key to Mental Health 

Panelists also advocated for significant changes in the social sector, such as access to education, employment, housing, and social benefits for people with mental health conditions and psychosocial disabilities. 

“Social determinants are equally as important in mental health outcomes,” said Executive Director of Nigeria-based She Writes Woman Hauwa Ojeifo. 

Added Dr Soumitra Pathare, “Poverty and mental health go together. You cannot address mental health without addressing the issue of poverty. 

Many services featured in the guidance do attempt to address the social determinants of health. For instance, KeyRing Networks in the United Kingdom provides time-limited independent but supported living arrangements for people experiencing mental health conditions. 

Housing is either rented from local authorities or housing associations or owned by members. Each network ensures that KeyRing members take control and responsibility for their lives by living in a place of their own and contributing and being connected to their local community.

Bringing Human Rights to Mental Health During the COVID-19 Pandemic 

Panelists highlighted the importance of the guidance as the COVID-19 pandemic has had a serious detrimental impact on mental health. 

“The WHO guidance comes at the right time, in a moment when we are witnessing the devastating impact of the pandemic on the mental health of our communities and in particular, populations at risk,” said Costa Rican UN Ambassador Catalina Devandas.

Gerard Quinn, the UN Special Rapporteur on the Rights of Persons with Disabilities, said:  “The question we now ask is not what limits are placed on rights and how they can be policed. The question we now ask is how we can give life to rights.” 

 

 

Administering aspirin to critically ill COVID-19 patients does not boost their odds of surviving the virus, results from a major trial studying the commonly used painkiller and blood thinner showed this week.

In the RECOVERY study, University of Oxford scientists hoped that aspirin would work because it cuts the risk of blood clots — a common and deadly complication of the virus. COVID-19 patients are at a higher risk of blood clots forming in their blood vessels, particularly in the lungs.

Joint chief investigator Martin Landray, professor of medicine and epidemiology at the Nuffield Department of Population Health at the University of Oxford, said that there has been a strong suggestion that blood clotting may be responsible for deteriorating lung function and death in patients with severe COVID-19.

“Aspirin is inexpensive and widely used in other diseases to reduce the risk of blood clots so it is disappointing that it did not have a major impact for these patients.

“This is why large randomised trials are so important – to establish which treatments work and which do not.”

The trial –  which is looking into a range of potential treatments for hospitalised COVID-19 patients –  monitored 15,000 patients infected with coronavirus across 176 hospital sites. 

‘No Evidence’ of Reduced Deaths

A total of 7,351 patients were given one 150mg aspirin tablet each day between November 2020 and March 2021. The trial also monitored a control group of 7,541 participants hospitalised with COVID-19 who were not given the drug.

The researchers found ‘no evidence’ that aspirin reduced death, as 17% of people died in both groups and there was no obvious reduction in the aspirin group.

But the study did find that the patients who were given aspirin had a slightly shorter hospital stay – eight days versus nine days – and a higher proportion were discharged from hospital alive within 28 days (75% vs 74%).

“The data show that in patients hospitalised with Covid-19, aspirin was not associated with reductions in 28-day mortality or in the risk of progressing to invasive mechanical ventilation or death,” said Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine, and the other joint chief investigator.

“Although aspirin was associated with a small increase in the likelihood of being discharged alive this does not seem to be sufficient to justify its widespread use for patients hospitalised with Covid-19.”

The RECOVERY trial is ongoing and continually trying new treatments for patients with coronavirus.

The results of the study will be published shortly on medRxiv and have been submitted to a leading peer-reviewed medical journal.

 

Image Credits: University Health News .

Stéphane Dujarric, Spokesperson for the Secretary-General

UNAIDS hailed a new political roadmap to end HIV/AIDS by 2030 as a “major feat”, but admitted that its implementation would remain a challenge – along with devising ways to measure how inequalities in access to prevention and treatment are reduced for people and groups most at risk.

Addressing a UN press briefing on Thursday, following a two day high-level meeting, Winnie Byanyima, Executive Director of UNAIDS, said new plan geared towards actually ending the HIV/AIDS epidemic comes after decades in which major gains have been made, but sharp inequalities in access to treatment still exist. 

“We are at a critical moment in the AIDS response. HIV has been with us for 40 years now, ravaging communities. Since the start of the epidemic, more than 77 million people have been infected with HIV, and almost 35 million people have died,”  Byanyima said.

Despite opposition from Russia, UN Member States voted this week overwhelmingly in favour of the declaration which is a roadmap for combatting the disease over the coming years. Byanyima said the targets contained in the declaration were iprepared by UNAIDS using an “inequalities” lens.

“The [targets] are progressive, and will save lives if achieved. If all countries reach their targets, new infections will be reduced by 75% by 2025, the number of people dying from AIDS-related illnesses will be reduced by about 65%,” she said.

‘Business as usual will lead to failure’

Earlier this week, Health Policy Watch reported that the government of Russia, supported by Syria, Belarus and Nicaragua, had refused to support the consensus declaration — requesting additional changes on top of some 73 amendments in the text that had already been made to accommodate Russia’s concerns.  Those last-minute changes were ultimately rejected. 

Winnie Byanyima, the Executive Director of UNAIDS

Taking a veiled swipe at Russia’s demands to further delete or water down references to “rights”; the decriminalisation of sex work; and harm reduction in the context of the battle against HIV/AIDS, Byanyima said it was not easy to gain a global agreement from all countries with such diverse laws, policies and priorities. 

“But yet, this declaration is bold and ambitious. It pushes us further and asks us to measure the gaps that exist for certain groups of people, so that we can target them and close the gaps (inequalities) that prevent them from accessing the tools of science for prevention and for treatment. The targets are ambitious,” she said.

By 2025, the roadmap also aims to end mother-to-child transmission of HIV. Another target is to end legal and social discrimination against groups like sex workers and men that have sex with men, which ultimately fuels the HIV/AIDS epidemic by depriving them of access to vital preventive tools and treatment services. 

“We’re ensuring for the first time that less than 10% of countries have restrictive laws and policies that lead to the denial or limitation of access to services, that means decriminalization of same sex relationships. We want to bring it down to just 10%,” she added.

The declaration calls for a financial investment of $US 29 billion annually by 2025. Byanyima said: “We want to peak up to $29 billion by 2025. So I would say this is a bold and ambitious declaration.”

Building Community-led Health Responses

UN Press Briefing – Winnie Byanyima, first from left

In his remarks, Stéphane Dujarric, spokesperson for the UN Secretary General said that the significant achievements in the political declaration include a commitment to end all inequalities, which he said goes further than the Sustainable Development Goals (SDGs). 

“The 95-95-95 targets by 2025 for testing treatment and viral suppression, and a third significant achievement is that it is empowering communities in building community-led health responses,” Dujarric said.

He described this as “very profound and very significant” as it ensured human rights are woven through the declaration and said Russia and co’s failed attempt to remove some of the Human Rights references in the declaration was “resoundingly defeated”. 

“So, what we had with 165 member states voting for the final declaration was a very strong endorsement of a broad range of countries who were prepared to commit to a bold political declaration, which is a significant advance on the political declaration of 2016,” Dujarric said.

Image Credits: UN, WebTV UN.

Matshidiso Moeti, Regional Director of the WHO Regional Office for Africa

US President Joe Biden’s announcement today of some 500 million Pfizer doses to the African Union and 92 low- and middle-income countries elsewhere in the world could help begin to “turn the tide’’ on the continent’s pandemic battle, said WHO African Regional Director, Matshidiso Moeti. 

“The tide is starting to turn. We are now seeing wealthy nations beginning to turn promises into action,” Moeti said, speaking at a WHO press briefing on Thursday. “This comes as we see other countries such as France also making tangible deliveries via COVAX, Moeti said, adding,

“Vaccines have been proven to prevent cases and deaths, so countries that can, must urgently share COVID-19 vaccines. It’s do or die on dose sharing for Africa.” 

The White House announcement coincided with Biden’s arrival in the United Kingdom to attend this weekend’s G7 Summit. “This is the largest-ever purchase and donation of vaccines by a single country and a commitment by the American people to help protect people around the world from COVID-19,” said the White House statement. 

The help could come in the nick of time, as African health officials warned that countries are running out of vaccine doses to combat the COVID-19 pandemic – and the number of new COVID-19 cases remains on the rise for the third week running. 

Without more help soon, “nearly 90% of African countries are set to miss new global targets of vaccinating 10% of people against COVID19 by September, Moeti warned.

 

Less than 1% of Africans Vaccinated So Far 

Less than 1% of Africans have yet been vaccinated, and four countries are yet to commence vaccination at all, said John Nkengasong, Africa’s Center for Disease Control director, in a separate press briefing. 

So far, “35.9 million COVID-19 vaccine doses have been administered, which corresponds to 65% of the total supply available in Africa. Only 0.6% of the population has been fully vaccinated on the continent.” 

John Nkengasong, Director of the Africa CDC

Against that landscape, Biden’s announcement was being welcomed by global health leaders as a potential game changer that could also prod other high-income countries to make more generous vaccine donations. 

“Excellent news,” tweeted José Manuel Barroso, chairman of the board of Gavi, The Vaccine Alliance, which is the key co-sponsor with WHO and UNICEF of COVAX, the global vaccine facility, which has been the main clearinghouse for vaccines donated or sold at cost for use in low and middle income countries. 

The deal will see deliveries of the new US donations begin in August, with 200 million doses to be shipped in 2021, and a further 300 million doses by June 2022, said Gavi in a separate statement. 

According to the plan, the vaccine doses will be made available through the COVAX facility to member states of the African Union, as well as a few dozen other countries around the world that are eligible for donor-funded vaccines through Gavi’s procurement mechanisms. 

The 500 million dose donation is in addition to the plan to share 80 million doses of existing vaccines in US stocks, as part of a broader global vaccine sharing strategy detailed just last week by the Biden Administration.    

Missing COVID Vaccination Goals – Third Virus Wave Looms 

vaccine
COVID-19 Vaccination in Africa

Moeti, WHO African Regional Director noted that the delay in vaccine supply to Africa has led to nine out ten countries on the continent to miss their COVID-19 vaccination goal for September.

As of now, 47 out of Africa’s 54 countries will miss the September target of vaccinating 10% of their population, Moeti revealed. The goal could still be met, however, if the continent rapidly receives 225 million more doses, she added. 

According to WHO’s tally, Africa accounts for under 1% of the over 2.1 billion doses administered globally.  Only about 2% of the continent’s nearly 1.3 billion people have received one dose and only 9.4 million Africans are fully vaccinated.

 

That, as the continent faces a third wave of COVID-19 cases, with new case numbers rising for the third week running. 

While Africa’s cumulative case count hasn’t been lower than almost any other continent, officials there are nervously eyeing events in India, followed by Latin America, which have seen massive  new COVID waves recently. In India, those occurred in cities and regions that historically had not suffered from very high case rates – while in Latin America, they are recurring in countries already battered by previous waves of the virus. .   

“As we close in on 5 million cases and a third wave in Africa looms, many of our most vulnerable people remain dangerously exposed to COVID-19,” Moeti said.

Big Vaccine Inequalities within Africa Too  

Even within Africa, there is inequality in access, a brief assessment by Health Policy Watch Reveals.  A closer look at doses administered so far shows just five countries accounting for about 64% of all doses administered on the continent.

Those include Morocco, having administered 15.8 million doses, followed by Egypt (3.1 million), Nigeria (2.1 million),  Ethiopia (1.9 million), and South Africa, (1.4 million doses out of 2.4 million that it has available).  

On the other hand, Tanzania, the Saharawi Republic, Eritrea, and Burundi are yet to receive or administer any COVID-19 vaccines.

Along with the new US vaccine offers, some other fresh donations are finally beginning to trickle into some African countries, Nkkengasong said. 

“On 1 June 2021, Togo received 100,620 doses of the PfizerBioNTech vaccine from the COVAX facility making it the third country to receive such from the initiative. On 4 June 2021, Chad started vaccinating health personnel and the elderly with 400,000 doses of Sinopharm received on 3 June 2021,” he noted. 

Tackling Vaccine Wastage

Along with the plea for more donations, the health officials also acknowledged that African countries need to take more assertive action to avoid vaccine wastage and spoilage – challenges that will become even more significant as temperature sensitive Pfizer vaccines begin to be distributed. 

In April 2021, Health Policy Watch reported on the concerns that many African countries were inadequately prepared to quickly administer the doses before their expiry. 

Following that, Malawi’s incineration of nearly 20,000 expired doses called even more attention to the issue – even as WHO and African CDC officials said that the vaccines could still have been used beyond their expiration date. Other countries, such as the Democratic Republic of Congo, have pre-emptively returned unused doses to the African CDC, saying they could not use them in time. 

At today’s briefing, Moeti revealed that 14 African countries have used nearly all (80 — 100%) of the doses they received in the spring through the COVAX Facility, primarily temperature resilient AstraZeneca vaccines supplied by the Serum Institute of India. 

On the down side, however, 20 countries have used less than 50% of the doses received, while 12 countries have more than 10% of their AstraZeneca doses at risk of expiration by the end of August.

“We need to ensure that the vaccines that we have are not wasted because every dose is precious,” said Dr Moeti. “Countries that are lagging behind in their rollout need to step up vaccination efforts.”

She noted that countries like Côte d’Ivoire and Niger are seeing more success by adjusting their vaccine rollout strategies. 

“Where possible, WHO recommends spreading vaccinations beyond large cities into rural areas, prioritizing vaccines that are close to expiring, tackling logistical and financial hurdles and working to boost public demand for vaccines,” Moeti suggested.

Image Credits: Paul Adepoju.