Taiwan Health Minister Shih-Chung Chen

“If we could participate in the WHO and World Health Assembly (WHA), the warning messages we would give to the organisation would receive more weight, and this would probably result in better responsive actions.”  – Taiwan Health Minister Shih-Chung Chen

Arguably, Taiwan has been repeating this statement  for decades. Yet when Chen’s mild words are matched with the COVID-19 pandemic experience, the familiar message is knife-sharp: WHO lagged for ten weeks after Taiwan started sending WHO warnings of a Chinese illness through its limited and informal channels on 31 December 2019. 

Weeks before WHO declared a pandemic on 11 March 2020, Taiwan had already implemented 124 pandemic policies other nations would have done well to emulate. 

Widely applauded for its management of the pandemic, Taiwan has one of the lowest per capita COVID-19 rates in the world and life on the island has largely returned to normal.

Taiwan’s plea to be included as an observer in the WHA and participate more actively in WHO expert consultations has become a broader topic of discussion this year  – perhaps due in part to the fact that with a population of almost 24 million, Taiwan suffered just 12 COVID-related deaths, with total reported cases only reaching 1,153 as of Tuesday. 

Even so, since 2016, after the Democratic Progressive Party won elections, Taiwan has been locked out of WHA participation, even as an observer – due to fierce objections from Beijing.  

The issue is sure to come up yet again at the upcoming World Health Assembly (24 May- 2 June), as one signal tweet by the US State Department spokesman last week, seemed to indicate. 

But the effectiveness goes beyond policy design and implementation. It reflects trusted leadership. When I returned to Taiwan in early February 2020, Minister Chen’s face was everywhere. 

From Dentistry to Pandemic  

Taiwan’s Health Minister didn’t start out as a rock star. Trained as a dentist at Taipei Medical University, Shih-Chung Chen (Chén Shízhōng) rose through the ranks of  Taiwan’s health leadership, becoming minister in 2017. He doesn’t mince words about China, but is known as the “iron minister” more for his sleep-in-the-office work ethic. Delivering hot meals to health care workers and other appearances also endeared him to the public.  

In our exclusive interview at Taiwan’s Central Epidemic Command Center, the minister who guided Taiwan through the pandemic explains how the 2003 experience with Severe Acute Respiratory Syndrome (SARS) led Taiwan to be prepared for the next threat.  

Health Policy Watch: Can you tell us the bare-bones story of Taiwan’s successful early interventions?  

Shih-Chung Chen: At the onset of the epidemic … no one really knew what was going on in China. But since we always have lots of interactions with China, we were quite attuned to relevant information, and were very alarmed when we received news [of a virus] from various sources. [Editor’s note: More than 800,000 Taiwanese live in mainland China, which is Taiwan’s primary business and export-import partner; cheap mainland labour also fills many low-end retail jobs in Taiwan.] 

We kept pursuing this topic and decided to act early on it. On 31 December 2019 we started with flight boarding inspections in the hope of stopping the virus from spreading, in case it did pose an epidemic threat. 

As a direct result from our SARS experience, the Infectious Disease Prevention and Control Act was already in place. This provided for horizontal communication between agencies during pandemics, as we knew very well that inter-agency cooperation is essential. [Based on the act], the Central Epidemic Command Center (CECC) was established on 20 January 2020. 

Three days later, when Wuhan locked down, the situation quickly escalated to alert level 2 – this mandated the multi-agency communication. On  25 February the COVID-19 Special Act was passed, and on 27 February  the CECC was established for the highest level of alert, under which all departments were required to send representatives to CECC for cooperative action. 

We collaborated closely with the Interior Ministry, since immigration, police and civil affairs are all under its jurisdiction. Because of this, we appointed the Interior Ministry’s Deputy Minister as our CECC ’s second in command.  

HP-Watch:  Can you comment on public adherence to pandemic guidelines?

S-C Chen: Every compliance requirement is hard to implement, although the actual rules themselves are not difficult. It’s easy to wear a mask and get new habits that discourage virus transmission – but to make all civilians willing to comply with these changes is hard.

Since in the longer term we want to be a trusted organisation, we decided to be transparent and start this conversation with the public using press releases and interactions through Internet platforms.  

Because the public perceives that we are transparent with policy, they have placed their trust in us and have complied well. It is because the public carried out these simple prevention practices that our first-line prevention efforts have been successful.

HP-Watch: Which Taiwan health policies do you consider most innovative? 

S-C Chen: First and foremost is our National Health Insurance (NHI), because this single-payer system is running well and has been effective in administering quality medical services with total coverage at low costs.  

The other experience we could share is how we succeeded in [pandemic] prevention while placing minimal restrictions on civilian life as a democratic country. These two aspects are what we could share most with the world, especially prevention.

Certain countries with more centralized authority were able to contain the pandemic with human rights tradeoffs. This is a contrast to Taiwan’s success as a democracy, and could be a good subject for study in the future.

Solid Privacy in Real-Time Cloud  

HP-Watch:Your high-tech, cloud-based information systems are widely praised, but outsiders often claim: they face commercial, privacy and legal issues in litigious private health systems. Have there been data breaches or other privacy nightmares with your system? 

S-C Chen: I don’t think there are data privacy controversies relating to the NHI system. . When the government centralized information on citizens, it is natural to worry that data will be used inappropriately. We should not avoid using cloud-based systems because of such concerns; instead we need laws that regulate how data can be used. 

It is two sides of the same coin  – you can only act fast when you have good information – and only have good information when data is timely. Whether the data is used for health administration or contributes to research advances and safer drug prescriptions … if you don’t get organised in those areas, then you won’t be enabled when you need them. 

Leaking of any data belongs to the realm of the law. So the law should be amended to regulate this area instead of [providing opt-out alternatives and] impairing the information system due to concerns over privacy. 

HP-Watch: What challenges do you see coming next, both in terms of COVID-19 and after Taiwan is immunised?

S-C Chen: Containment of the virus is going well currently. The next phase is vaccination. We have seen this offer encouraging results in countries like the US, Israel and UK. But we are also seeing failed attempts like Turkey and Chile, where after vaccination the pandemic got even more difficult to contain.Similar situations faced advanced countries such as Italy, Germany and Spain, with huge costs and losses. 

In relation to vaccination-related policies, civilians’ knowledge about the vaccines will be critical in determining vaccination’s ultimate ability to contain the pandemic. We will watch closely as other nations employ different vaccines and policies. There are new virus strains evolving and corresponding public worries whether vaccines will be effective; these doubts have influenced some people’s willingness to be vaccinated. 

I think we should be humble when we face the virus, but not be fearful without any limit. We should face the problem proactively, solving these issues one by one and collaborating with the world. 
Equal Isn’t Fair in Health Budget Cuts 

Another issue we are facing is the reform of NHI policy. We have a strong centralized power and fiscal policy: we have a total budget to execute and this budget dictates what we can spend. 

Our national insurance policy is run by the government based on a single-payer system. This means that adequate planning is critical… Too much centralized control created many issues, so alternatives in setting budget priorities should be discussed.  

It is not working to cut spending solely based on total budget changes. In other words, improving the health care system rather than solely suppressing medical expenses for better-looking numbers is one issue that we have to face.

 As far as the budget goes, the public wants to see how their health can benefit if more money is allocated to NHI, so we have to see how the budget can best serve people’s well-being. Since we have total coverage, everyone will share in these changes. 

Message to the World 

HP-Watch: Is there anything you wish the world understood about Taiwan’s health system and its anti-pandemic policies? Clearly both are unusually effective, yet Taiwan is often misrepresented through China’s claims when it receives global coverage at all. 

S-C Chen: For a very long time, China has used its political power and UN memberships as a roadblock to Taiwan in terms of public relations. But I think now, due to COVID-19, more countries are recognising China’s closed system and errors as well as the subsequent [health] effects from those errors.  

When global powers around the world see China’s actions and errors, this shifts the political atmosphere. Taiwan is eager to play a positive role, and especially now we should be proactive in service and exchanges. We want to be recognised globally for our policies, but also recognised for our engagement with global health and our long record of service. 

Internationally, Taiwan continues to seek ways to participate in the global health system. We also participate by providing our experience and supplying physical aid, and we will continue to help countries with health-related needs. 

However, due to our diplomatic situation and certain countries that don’t want Taiwan to serve in international organizations … we do experience setbacks. In the future, we hope like-minded countries will come to our side. This diplomatic help will allow Taiwan to help in more health-related contexts.

In the grander scale of things, future pandemics certainly can be even worse..Human disrespect for nature can bring disaster, destroy habitats and so on. 

It all comes down to what we understand: there are people who tend to think human beings are more powerful than nature. With this pandemic experience we will be more humble — knowing our limits and realising we can’t fight nature, but must co-exist with it. 

  • Val Crawford has worked in international news and scholarly publishing, and edited for United Nations University in Tokyo and the World Health Organization. She taught scientific writing, journalism and popular culture courses at Taipei Medical University from 2010 to 2019, and served as visiting professor at the University of the Philippines and Sri Ramachandra University in Chennai, India. 

 

Image Credits: Wikipedia.

India has received emergency COVID-19 supplies from several countries.

PUNE – For two weeks now Sijo Raju, along with a group of 20 young men and women, have been fielding calls from family members looking for oxygen cylinders, ventilator beds and ambulances. Finding a match can take a few hours as India’s overwhelmed health system and front-line healthcare workers try desperately to provide a semblance of care to the massive number of COVID patients.  

In the absence of a centrally coordinated response, citizens like Raju have stepped up. They verify messages posted online, guide family members to facilities with resources, and do their best to step in place of a government machinery that has effectively abandoned its citizens. 

“There is just too much information on the internet,” Raju told Health Policy Watch. While the group members, most of them in their 20s and 30s, are based in the Mumbai metropolitan area, they are now trying to help verify requests coming from across India and are among many such citizen groups that have banded together in the past few weeks.   

On 1 May, India reported over 400,000 cases – a record-high figure in the history of the COVID-19 pandemic so far. It was also the day the country officially lowered the age for those eligible for vaccines from 45 and above to 18 and above.

The government had placed orders for the additional vaccines that would be needed just two days before vaccination was to be expanded, and not surprisingly most young people aren’t able to find slots as they try to register for vaccines.  But Adar Poonawalla, whose company Serum Institute of India (SII) is responsible for supplying the bulk of the vaccines, said given that the orders were recently received, ramping up production would take still time.

Cases continue to rise in India overwhelming the country’s already fragile health infrastructure

Promoting Alternative Medicines
Meanwhile, India’s government is promoting a poly herbal drug named Ayush-64, calling it a “ray of hope”. The drug is being promoted by the Ministry of  Ayurvedic Medicines, Yoga, Unani, Siddha and Homeopathy (AYUSH). Alternative therapies are widely popular albeit not without controversy as mainstream treatments in the pandemic. 

The government said the drug has been found to be useful in mild to moderate cases. It is also promoting yoga as a way to “strengthen natural immunity”. Most COVID-19 cases are mild to moderate that require little to no treatment under normal circumstances.

“The claims made about certain AYUSH interventions in the absence of quality clinical studies and data being presented is unfortunate,” said Anant Bhan, a bioethicist and global health policy expert based in India.

“It could lead to reliance on interventions which could not be working, and take the focus away from interventions which do. As is the requirement with allopathic medicines, any claims about AYUSH interventions and utility in COVID-19 needs to be backed by data.”

Indian government’s push for alternative medicines comes at a time when Indians are in need of a planned COVID-19 response and urgent ramping up of health facilities. 

The country’s cases have been on an upward trajectory since March when Prime Minister Narendra Modi held massive election rallies in the state of West Bengal and allowed the Hindu religious event Kumbh Mela to go on that saw gathering of thousands of devotees to perform rituals by the holy river Ganges. Both these events ended up being super spreader ones and worsened the pandemic.

Restrictions continue in many high burden states in India and the popular cricket tournament Indian Premier League has also been postponed. The tournament had come under heavy criticism for continuing despite rising COVID-19 deaths. The secretary of the Board of Cricket Administration is Jay Shah, the son of India’s home minister Amit Shah, a key figure in the Modi Administration.

Aid Distribution and Vaccine Rollout

After India’s pandemic made headlines around the world, the country started receiving aid. Ireland became the most recent country to send aid and US aid has also arrived. Despite this, ordinary citizens continue to struggle for basics based on messages on social media. 

The government issued a statement saying that the aid will be distributed based on the number of cases and the need in the states – after questions were raised in the Indian media about the plans for distribution. 

This while the public waits for the Serum Institute to ramp up its production further.

India’s Supreme Court has also pulled up the Modi administration for failing to regulate the prices of the vaccines. Currently vaccine manufacturers are offering different prices to the centre and state governments, as well as private players, as Health Policy Watch reported in an earlier story.

Health experts have said this would set a dangerous precedent while policy experts have criticized the government for its handling of the vaccine distribution.  

Disha Shetty is an independent journalist based in Pune, India

Image Credits: @MEAIndia -Ministry of External Affairs, Spokesman's office , Our World In Data .

East African truck drivers will get access to one common COVID-19 testing system by mid-May.

KAMPALA – Uganda, Kenya and Rwanda have suspended passenger flights from India amid that country’s surge in COVID-19 cases and  fears that a number of African countries are on the brink of their own surges.

“All flights from India and all passengers originating from India are suspended from 1 May,” the Uganda Ministry of Health said in a statement. “All passenger flights are suspended until further notice. No travellers from India shall be allowed into Uganda regardless of the route of travel.”

Meanwhile, Kenya has suspended flights from India for 14 days, according to the Kenya Ministry of Health. Kenya Airways and Rwandair have also suspended flights from and to India.  

However, East African residents will be allowed to return home. India is a top medical tourism destination for residents in East Africa. 

The three countries are demanding that travellers who have been to India or travelled through India in the last 14 days, be in possession of a negative PCR COVID-19 test certificate that is digitally verifiable and has been conducted within 120 hours of travel. They will also undergo a PCR test upon arrival.

Uganda will allow cargo flights from India where the crew do not disembark and technical stops where travelers do not disembark. It is also allowing aircraft in a state of emergency, operations related to humanitarian aid, medical evacuation, diplomatic flights approved by the appropriate Authority.

Uganda has also advised travellers from the USA, United Kingdom, United Arab Emirates, Turkey, South Africa, and Tanzania to consider postponing non-essential travel to Uganda.

Travellers from these countries, including Ugandans, will be subjected to a PCR test upon arrival at the points of entry into the country said Dr Jane Ruth Aceng, Uganda’s Minister of Health, during a weekly briefing.  

“We should make a difference between people and the virus. The virus is the enemy, not the people. If someone has an authentic negative PCR test, they do not cause a problem,” said Dr John Nkengasong, director for Africa Centres for Disease Control and Prevention (CDC).  

Truck Drivers’ Testing is Tightened

The East African Community (EAC) is tightening up on the COVID-19 testing requirements  of interstate truck drivers, identified as vectors of the virus, amid numerous problems including forged tests 

At a recent EAC meeting, Uganda, Kenya, Tanzania, Burundi and South Sudan agreed to submit the names of accredited national laboratories for COVID-19 testing so that these could be linked to the upgraded Regional Electronic Cargo and Driver Tracking System (RECDTS), which recognises digital COVID-19 certificates for truck drivers.

The deadline for uploading all accredited COVID-19 testing laboratories in the RECDTS is 15 May. This will ensure that interstate truck drivers and other travellers test for COVID-19 in only through accredited laboratories and that all partner states take up and implement the RECDTS system.

Digital certificates are uploaded on the drivers’ smartphones through an app and are valid for 14 days. The App, which was launched in September 2020, was developed with donor funding. It provides a surveillance system to monitor long-distance truckers’ health and enables contact tracing. It also allows partner states to electronically share truck drivers’ COVID-19 test results.

The new system is aimed at resolving some of the challenges that were being experienced in the execution of health protocols including multiple testing of truck drivers at the border crossing as there lacked a framework of mutual recognition, document fraud and conflicting test results.

The interstate truck drivers also are the single largest group of people who have been identified to be carrying the variants of concern – the  B.1.351 variant from South Africa and the B.1.1.7 from the UK. From 399 samples sequenced by the Uganda Virus Research Institute (UVRI) these two variants were detected in 30 truck drivers.The Indian variant has been identified in one patient who was admitted to Mulago Hospital.

By Wednesday, the EAC Secretariat expects to have shared a detailed concept note on the development of a common regional health pass to be linked to the upgraded surveillance.

Uganda and Kenya Cases Increase

By Monday, the Ministry of Health in Kenya had reported that 369 people had tested positive for the disease, from a sample of 4,469 tested in the last 24 hours – a positivity rate of 8.3% compared to the world average of 2.2%. 

A total of 1,298 patients are in various health facilities countrywide, while 6,652 patients are in isolation at their homes and 19 had died in the 24 hours before Monday. Total confirmed positive cases are now 160,422 and cumulative tests so far conducted are 1,679,779.

Some 190 patients are in the ICU, 29 of whom are on ventilatory support and 118 on supplemental oxygen – 43 patients are on observation. 

Aceng said that Uganda was “experiencing a gradual increase in the COVID-19 cases and it is the beginning of a resurgence”. 

“This surge is already showing in districts that have remained on high alert and have been carrying out active surveillance,” said Aceng, adding that “this second wave will be worse than the first one”.

Uganda has already organised a resurgence plan which is projected to cost over $290 million and is organised around three thresholds: control, alert, and action. The alert threshold is reached when there is a 10% increase in cases while the action threshold begins when there is a 20% increase in the cases observed from the baseline in any geographical location.

“The main objective of the resurgence plan is to mitigate transmission and minimise the public health and social economic impact,” said Aceng. The resurgence plan will include enhanced surveillance, active case search, contact tracing, procurement of test kits, Personal Protective Equipment, critical care support, strengthening community engagement and risk communications, and supporting the vaccination teams but it does not include procurement of vaccines.

By 30 April, Uganda’s cumulative COVID-19 cases stood at 41,866 with 342 deaths. There are currently 444 active cases.

WHO Warns of African Resurgence

Dr Matshidiso Moeti, WHO Regional Director for Africa.

The World Health Organisation (WHO) predicts a high risk of COVID-19 resurgence in several African countries due to poor adherence to public health measures, mass gatherings, low testing and vaccination rates.

“We cannot be lulled into a false sense of security. The devastating surge of cases and deaths in India, and increases in other regions of the world, are clear signs that the pandemic is not yet over in African countries,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. 

“ A new upsurge of COVID-19 infections is a real risk in many countries even if the region’s case count in recent weeks appears to be stable,” she added. “Combatting COVID-19 fatigue appears to be the key battle in our collective response to the pandemic.”

According to the WHO analysis of 46 African countries, Kenya, Egypt, Ethiopia face a very high risk of resurgence, while a further 20 countries face a high risk and 22, moderate risk, and only one country faces low risk. 

The risk was calculated using seven indicators with data from the past four weeks, including COVID-19 cases per million people; the percentage of change in new cases; the percentage of change in new deaths; the reproductive number (the rate at which an infection spreads); the pandemic trend; the average weekly number of tests per 10 000 people; and the percentage of the population that has received at least one vaccine dose.

With more than 4.5 million confirmed cases and over 120 000 deaths to date, the continent has not experienced a surge in cases since January and the epidemic curve has plateaued for six weeks. 

But the relatively low number of cases has encouraged complacency and reduced adherence to behavioural measures to prevent the spread of the virus.

In addition, recent political rallies in Benin, Cote d’Ivoire, Guinea and Kenya caused a spike in new cases. Upcoming elections in Cape Verde, Ethiopia, Gambia, Sao Tome and Principe and Zambia could also trigger cases due to mass gatherings, said Moeti.

Of the 46 countries analysed, 31 performed fewer than 10 tests per 10,000 people per week in the past four weeks.

“Most new cases are still not being detected among known contacts. Investigation of clusters of cases and contact tracing are worryingly low in most countries in the region,” Moeti said. “We must scale up testing including through rapid diagnostic tests to enhance response to the pandemic.”

 

 

Image Credits: EAC.

A shipment of the Chinese Sinopharm vaccine reaches Peru

The World Health Organization (WHO) appears to be inching towards the approval of the Chinese Sinopharm and Sinovac vaccines as it struggles to fill a looming vaccine vacuum left by India’s Serum Institute – which has halted exports as the country continues to reel from a tragic coronavirus outbreak. 

Meanwhile, the WHO declared the latest Ebola outbreak in the Democratic Republic of Congo to be over, just three months after the first case was reported in North Kivu.

Chinese Sinopharm & Sinovac May be Approved By End of Week

Mariângela Simão, WHO Assistant-Director General for Access to Medicines

The Chinese vaccines from Sinopharm and Sinovac could be approved by the end of this week, noted the WHO Assistant Director-General for Drug Access, Vaccines and Pharmaceuticals Mariangela Simao, speaking at a WHO press conference on Monday.

“We are finalizing the assessment of Sinopharm [but] there’s still some documentation that needs to be added,” she said. “We will start the final assessment for the listing of Sinovac on the fifth [of May], so we expect both the Chinese vaccines [to] be finalized by the end of this week.”

If both vaccines receive the WHO’s green light, China could could become the world’s largest vaccine supplier, assuming that Sinovac and Sinopharm will honor their commitment to produce two billion vaccine doses this year.

Despite the lack of published data for the two vaccines, as well as their hefty price, both seem to have met the WHO’s minimum efficacy requirement of 50%, the WHO’s chairperson of Strategic Advisory Group of Experts (SAGE) said late last month.

With regards to the WHO’s approval of another vaccine frontrunner that seems to be significantly more potent and cheaper than its Chinese counterparts, Russia’s Sputnik V, the WHO expects a final decision by June or even July, said Simao. 

“WHO still does not have the entire dossier [for Sputnik], it’s not complete yet,” she said, noting that the WHO is in the process of assessing good clinical practices for Sputnik V and is set to begin evaluating manufacturing practices next Monday until early June. 

“We expect that as soon as we have the entire dossier, plus the compliance to both good manufacturing practices and the good clinical practice, the vaccine can be assessed then by the technical expert group [SAGE] and we expect that this is likely to happen [by the] end of June or probably in July.”

Ebola Outbreak in DRC Declared Over by WHO

Meanwhile, the WHO’s Director General, Dr Tedros Adhanom Ghebreyesus, hailed the DRC’s milestone in bringing an end to the twelfth Ebola outbreak in the country – a deadly disease that kills about half of the people it infects. 

“Earlier today, the government of the Democratic Republic of the Congo, announced the end of the most recent Ebola outbreak three months after the first case was reported in North Kivu,” said Dr. Tedros on Monday, emphasizing that a comprehensive public health approach was crucial in ending the latest outbreak of Ebola.

“Huge credit must be given to the local health workers and the national authorities for their prompt response, tenacity, experience and hard work that brought this outbreak under control,” added Dr Matshidiso Moeti, WHO Regional Director for Africa. She was referring to the country’s swift move to vaccinate almost 2,000 people at high-risk of contracting the virus and providing treatment as soon as the outbreak was declared in February.

However, she stressed that going forward, strong surveillance systems will be crucial to swiftly detect potential flare-ups and to fight parallel epidemics of measles, cholera and COVID-19.

“Although the outbreak has ended, we must stay alert for possible resurgence and at the same time use the growing expertise on emergency response to address other health threats the country faces.”

Image Credits: Sinopharm, Peruvian Ministry of External Affairs.

JOHANNESBURG – South Africa received its first batch of 325,260 Pfizer vaccine doses late on Sunday night, Health Minister Zweli Mkhize announced.

This follows lengthy negotiations between the South African government and Pfizer, during which the company made “difficult and sometimes unreasonable” terms including at one stage that the country put up sovereign assets as potential collateral, according to a report by the Bureau of Investigative Journalism.

South Africa’s Health Minister Zweli Mkhize

Mkhize sent a briefing letter to parliamentarians last month, saying that the government had been “relieved” when Pfizer eventually removed the “problematic term” which had put the government in the “precarious position of having to choose between saving our citizens’ lives and risking putting the country’s assets into private companies’ hands”, according to the bureau.

Samples of the Pfizer vaccines are currently undergoing quality checks by the National Control Laboratory, and will then be sent to urban vaccination centres where they will be administered to healthcare workers.

The country expects approximately the same number of doses – 325 260 – to arrive each week during May and 636 480 doses per week in June, with close to 4,5 million doses having been delivered by the end of next month.

Each person needs two doses of the vaccine, which also needs ultra-cold storage which makes it unsuitable for rural distribution.

Johnson & Johnson Vaccines Also Being Checked

South Africa has only vaccinated slightly more than 320,000 of its estimated 1.2 million health workers so far. The country opted not to use the AstraZeneca vaccine following research that showed that it had limited efficacy against the B.1.351 variant dominant in the country.

Until now, it has been vaccinating health workers with a very limited supply of the Johnson & Johnson (J&J) vaccines. However, 1.1 million more J&J vaccines are in the country undergoing safety checks that are likely to be completed in mid-May. 

“This is due to a protracted safety verification process with international regulatory agencies,” said Mkhize in a statement on Sunday. 

“This is a precautionary measure following the adverse findings during inspection of Emergent BioSolutions Bayview facility in the United States, one of the manufacturing partners of Johnson and Johnson, which prompted the authorities to extend their assessments of all Johnson and Johnson stock worldwide.”

Once through the safety checks, the J&J vaccines will be used in rural settings as they don’t require ultra-cold storage and people only need one dose.

The country plans to start vaccinating all citizens over the age of 60 from 17 May.

Meanwhile, South Africa’s National Institute for Communicable Diseases (NICD) has released modeling data last week which predicts that the country can expect a “third wave” of the pandemic in two to three months – but that this is not likely to be as severe as the second wave as long as there are no new variants.

“The most likely drivers of a third wave are behaviour change after the end of the last wave;  ongoing viral mutation; seasonal factors; and reinfection due to the waning of immunity conveyed by previous infection,” according to the NICD.

Image Credits: US Centers for Disease Control, GCIS.

Gavi will receive 500 million doses of the Moderna vaccine to help expand vaccine coverage around the world

Gavi, The Vaccine Alliance, has secured half a billion doses of Moderna’s mRNA vaccine for the COVAX global vaccine facility in a landmark agreement that will deepen vaccination coverage in poor countries around the world, Gavi said on Monday.

Meanwhile, Sweden announced that it will donate one million doses of the AstraZeneca vaccine to the global COVAX facility to help fill an urgent shortfall of 20 million doses as the world’s vaccine powerhouse, the Serum Institute of India, has diverted most of its vaccine supply to fend off a devastating outbreak in the country. The announcement came as WHO’s Director General Dr Tedros Adhanom Ghebreyesus said in a press conference that COVAX and related medicines access initiatives face an immediate funding gap of US$19 billion, along with “further needs” of US $35-$US40 billion over the coming year. 

“We will only solve the vaccine crisis with the leadership of G7 countries,” Tedros said, speaking at a WHO press conference that featured an appeal by former British Prime Minister Gordon Brown to rich countries to immediately donate more excess vaccines.

Brown, now the UN Envoy for Global Eradication, also joined WHO in an appeal to G7 nations to dedicate some US$ 20 billion a year from their combined resources to a more robust pipeline of COVID vaccines and medicines – at an upcoming G7 meeting 11 June.

“Mass vaccination is not just an epidemiological and ethical imperative. It’s an economic imperative,” stressed Brown. “But if the cost of vaccines is in billions the overall savings is in trillions of additional economic output, made possible when trade resumes in a COVID free world.”

“In the next few months we do not expect the Serum Institute of India to be able to supply the kind of [vaccine] volumes that were originally predicted. And so it would be really helpful to get [additional] doses from other countries,” said WHO Chief Scientist Soumya Swaminathan, speaking at the briefing.

Senior WHO advisor Bruce Aylward, meanwhile, said that the immediate donation of 20 million doses is needed to ensure that vulnerable populations who have already received their first dose would get a second jab as soon as possible.

Moderna Will Supply COVAX With 34 Million Doses In 2021 and 466 Million In 2022

Moderna’s latest agreement will allow COVAX to receive 34 million doses in the fourth quarter of 2021 and 466 million doses in 2022, with an option to access a vaccine jab that is adapted to emerging variants, said Gavi in its press release. 

The announcement comes a week after Moderna pledged to expand its production capacity to three billion doses by 2022 and received the WHO’s stamp of approval – making it the fifth vaccine to be approved by the global health body to date. 

“This is an important milestone as we work to ensure that people around the world have access to our COVID-19 vaccine,” said Moderna’s CEO Stéphane Bancel in a press release.

“We recognize that many countries have limited resources to access COVID-19 vaccines. We support COVAX’s mission to ensure broad, affordable and equitable access to COVID-19 vaccines and we remain committed to doing everything that we can to ending this ongoing pandemic with our mRNA COVID-19 vaccine.”

“Expanding and having a diverse portfolio has always been a core goal for COVAX, and to remain adaptable in the face of this continually evolving pandemic – including the rising threat posed by new variants,” added Gavi CEO Seth Berkley in a press release. “This agreement is a further step in that direction.”

Moderna’s latest agreement represents the largest commitment of mRNA vaccines to COVAX yet, given that Pfizer/BioNTech, another mRNA vaccine frontrunner, has committed a mere 40 million doses to the global vaccine facility. 

Unlike the vaccine from Pfizer/BioNTech which needs to be stored at temperatures as cold as -60ºC, Moderna’s vaccine can be stored in a standard fridge at 2-8 °C for one month, and potentially for up to three months, said Moderna’s CEO last week; those looser storage requirements for Moderna’s vaccine are likely to ease its distribution to low- and middle-income countries that lack the cold-chain infrastructure to store vaccines at sub-zero temperatures. 

Sweden’s Vaccine Donation Hailed as ‘Superb’ Gesture by Tedros 
WHO director-general Dr. Tedros Adhanom Ghebreyesus and Per Olsson Fridh, Sweden’s Minister for Development Cooperation, met at WHO’s headquarters on Monday.

Meanwhile, WHO’s Director-General Dr Tedros Adhanom Ghebreyesus hailed Sweden’s donation of one million vaccine doses to COVAX as a “superb gesture” and urged the rest of the world to follow suit. So far, only a handful of countries have donated doses to COVAX, including New Zealand and France, which donated 13 million and 1.6 million doses to the global vaccine facility, respectively.

“Sweden’s announcement that it will share 1 million doses of COVID-19 vaccines with COVAX is a superb gesture that must be replicated urgently, and repeatedly, by governments around the world to accelerate the equitable rollout of vaccines globally,” said Dr Tedros in a press release Monday, shortly after his meeting with Per Olsson Fridh, Sweden’s Minister for Development Cooperation.

“Such support will ensure that people in vulnerable countries, especially, in Africa, will be able to receive their second doses through the COVAX initiative,” he added.

Gordon Brown Makes US$30 Billion Year Pitch To G7 For COVID Medicines & Vaccine Finance
Gordon Brown UN Envoy for Eradication at WHO press briefing 3 May 2021

Meanwhile, in the leadup to the next G-7 meeting on 11 June, Brown said that he was joining WHO in an appeal to the Group of 7 most industrialized nations to finance some US$ 30 billion in mass vaccination, affordable tests and treatments for lower- and middle-income countries.

“The bill for mass vaccinating the world and ensuring access also to tests and treatments is affordable: a total of around US$30billions a year,” he asserted. “If spread across the richest countries – its just 25 cents a week per citizen – and it is money we cannot afford not to spend. ”

“In total over 2 years we need to raise an estimated US$60 billion, which is not only to cover vaccines, research, production and distribution to 92 lower income countries, but help pay for vital medical supplies including diagnostics and medical oxygen currently and shamefully in short supply in India and elsewhere.

“Based on ability to pay – a formula that takes into account national income, current wealth and benefits from the resumption of trade, America would pay 27% of the costs Europe 23%, the UK 5%, Japan 6%, Korea Canada and Australia 2% (each), he said,” noting that those G7 contributions alone would cover about 67% of the US$ 30 billion needed – or about US$ 20 billion.

” I say to the G7, the forum that on June 11, six weeks from now, brings together the world’s seven richest countries: you have the power and the ability to pay for nearly two thirds (of the total costs)  and secure a historic breakthrough by agreeing an equitable burden sharing formula for global health provision.”

He said the proposed measures would also include expansion of international finance for grants for low income countries, and creation of a guarantee-based finance facility for middle income countries.

“I say to the G20: with your leadership, we can cover over 80% of the costs, and you have the means to urgently donate vaccine doses to cover the gap in supply.

“I say to the richest 30 countries in the world: you can cover almost 90% of the costs. And the same burden-sharing formula can also be applied – so that instead of the familiar pandemic cycle of ‘panic now’ and neglect later, the world invests now now, when there is a shortfall, and for the future in pandemic preparedness…to ensure that even if future outbreaks happen pandemics become preventable.”

Image Credits: Gavi , WHO .

Animal parts (including from endangered species) go into the Chinese medicines sold at this market stall in Dali, Yunnan, China.

A new appeal about the course of the SARS-CoV2 virus hunt, penned by an international group of scientists, urges WHO member states to seize the moment of the upcoming World Health Assembly to adopt a much tougher mandate, with more rigorous scientific measures, to get to the truth of whether the SARS-CoV2 virus first infected humans from a natural source, a wild animal market, or in a laboratory.  

The letter praises WHO’s Director General Dr Tedros Adhanom Ghebreyesus’ recent admissions of the shortcomings of the investigation conducted by a panel of WHO-convened scientists in January and February, 2021 as a  “courageous defense of the scientific method and of the WHO’s integrity.” 

But the letter calls upon the WHO Executive Board and WHO member states to take up the gauntlet more squarely in pursuit of the real cause of the pandemic – leaving “all possible origins of the COVID-10 pandemic” on the table – including the possibility the virus first infected humans in the wild, as a result of contact with farmed wildlife, or due to a lab escape. 

In their third appeal in as many months, published Friday, the scientists also called upon China to grant unfettered access to the remote Mojiang mine in Yunnan Province, including release of confiscated samples and censored data – so that researchers can unlock the mysteries it may hold. 

The mine was the site of where a group of six miners became infected with a mysterious pneumonia-like illness in 2012. 

“To this day all the coronaviruses most closely related to SARS-CoV-2 come from that Mojiang mine,” the letter notes, asking: “Were any SARS-like coronaviruses isolated from the patient samples? What samples were taken from these six patients and sent to the WIV [Wuhan Institute of Virology] and other labs? Are any of these samples available for independent analysis?”

‘Treasure Map’ for way forward

Novel Coronavirus (2019-nCoV) Global Cases as of 28 January 2020 – just before WHO declared a global health emergency,

“It should be clear to everyone that any pandemic origins process that does not fully investigate the possibility that this crisis stems from an accidental lab leak and cover up can not be considered credible,” Jamie Metzl, a senior fellow of the US Atlantic Council, and co-organizer of the appeal, told Health Policy Watch. 

“It should deeply concern everyone that a year and a half after the outbreak, with over three million people dead and conditions worsening dramatically in many parts of the world, there is still no international process for fully investigating the origins of this pandemic. Not understanding how this crisis began leaves us at much greater risk of the same thing happening again.   

“We’re entering the era of synthetic biology where it’s easy to imagine future pandemics far more dangerous than this one. If we can’t get to the bottom of how this crisis began and address our many shortcomings, how can we possibly imagine we’ll be ready for the next one?”

“Our open letter is essentially a treasure map to help guide any credible COVID-19 origins investigation process going forward. We’ve listed some essential questions to ask and resources where critical data can be found,” said Metzl adding that the choice of directions, nonetheless, remains up to WHO member states: 

“Tedros has shown great leadership and courage by rejecting pressure to limit the scope of examination into pandemic origins and essentially risked his career by calling for a full investigation into all origin hypotheses, including a possible lab incident. The very least world leaders can do is support him and the WHO in this effort.”

https://twitter.com/JamieMetzl/status/1388099197254131717

Wild animal, farmed animal, or lab escape? All avenues need more research 

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team in early February, 2021. Critics say WIV officials did not cough up the laboratory’s secrets

Next steps into the origins issue should dig much more aggressively into all three possibilities on the table: “exclusively ‘natural’ zoonosis in the wild, human contamination in an animal farm, and a research-related accident,” the group of 26 scientists also say. 

They discounted out of hand a fourth theory propagated by Chinese authorities that the virus contamination somehow came from imported frozen foods. 

Along with further critique of what has gone wrong, the letter charts a political and technical way forward for what should happen next, including key provisions such as: 

  • More explicit language in a draft WHA resolution that acknowledges all theories – and supersedes the “reductive language” of the resolution adopted last year, which referred solely to the ‘zoonotic’ origins of the virus.  
  • Broader mandate and revised terms of reference for a team of independent experts mandating it “to conduct a full scientific and forensic investigation into all possible origins of COVID-19, be it zoonotic or not,” – as compared to the softer role assigned to it now to “recommend, help design and review scientific studies.”
  • Removal of China’s veto power of team members and revised criteria for team selection – ensuring WHO Executive Board oversight of the selection process, and inclusion of experts in biosafety and biosecurity, biodata and forensic investors in the team “as the WHO previously very successfully did following the SARS lab-leaks in Singapore and Taiwan in 2003/4.” 

Said Metzel upon the release of the letter: “The people who’ve died, are now dying & will die from #COVID19 deserve the fullest possible investigation into how this terrible pandemic began & our other failures. Our leaders, the @UN & @WHO have a sacred obligation to make that happen. #China has no legitimate right to refuse.”

Upcoming World Health Assembly debate – a key moment  

Chinese experts present their ‘frozen food’ theory for the emergence of SARS-CoV2 in Wuhan at a 9 February, 2021 press conference wrapping up the WHO -International expert mission.

In terms of the upcoming World Health Assembly debate, a 20 April copy of the draft WHA resolution that refers to the origins issue, obtained by Health Policy Watch, reflects the continuing, deep disagreements among member states over how the virus quest should be pursued. 

Proposals for a “strengthened” WHO mandate on that issue (and many others) remain up for grabs – with extensive sections still marked up as additions or deletion – rival geopolitical blocs.   

Notably, China and its allies want to water down references to WHO’s mandate to collect animal and ecosystem health data for the rapid “investigation” of public health risks and events, proposing that the reference merely be to “assessment”. (P4.2). 

China also wants to limit the obligation of countries to share pathogens and genetic sequences with the global agency – adding a caveat that this be done “in accordance with” national laws and regulations.(OP 4.3).  

Richard H. Ebright, a molecular biologist at Rutgers University said the next steps at WHO  remains a key turning point in the future of the origins research.  

“The draft resolution on strengthening WHO preparedness and response is too limited (and could be limited further by an amendment proposed by China and Russia that deletes the word ‘investigation’, and by an amendment proposed by China that nullifies the requirement for sharing samples and sequences by subjecting it to ‘national…laws and regulations’),” Ebright said. 

More rigorous methods and protocols 

Wuhan’s Huanan seafood market that has been closed since early 2020 after one of the first clusters of COVID-19 cases were detected there.

The letter’s authors, which include scientists from the US, Australia, New Zealand, Japan and India, as well as Austria, Belgium, France, Germanny and Spain, also call for a major overhaul of methods and protocols used in moving forward in the virus origins research, including far greater access to data and a much wider range of freedom for scientist-investigators, including the right to conduct confidential interviews. Specifics include:  

  • Clearly listing the possible paths for virus evolution and human infection and allocating enough time to examine all paths, without a priori assumptions;
  • Ensuring factual data supports all assumptions and steps in the analysis;
  • Guaranteeing access to required raw data (relevant records, samples, project applications, project reports, personnel information, field trip information, relevant emails, laboratory notebooks, etc.) and not solely semi-aggregated data or summaries;
  • Sharing of all relevant medical records, anonymized according to local laws for confidentiality protection, with the joint study team; 
  • Ensuring that the team of scientists and specialists is able to undertake their studies at key meetings and visits with no unnecessary presence of host government non-scientific personnel; 
  • Ensuring mission members can conduct interviews, as needed, confidentially and/or anonymously, and with assistance of translators appointed by the WHO if necessary. 

Access to Essential Financial and Technical Resources 

The appeal also notes that the joint study so far has suffered from limited access to more granular data, records and samples, including the lack of adequate access to: 

  • Anonymized data and biological samples from early COVID-19 patients, close contacts and possibly infected persons. 
  • Records of laboratories and institutions involved in coronavirus research in Wuhan. 
  • Key databases of pathogens, samples and isolates.  As for the latter, the experts also note specific password protected databases, to which WHO-mandated researchers still don’t have access, including: 62MB MySQL database  batvirus.whiov.ac.cn www.virus.org.cn portal and underlying databases:  “These databases are essential as they contain data about viruses not yet published, and some of these viruses may be closely related to SARS-CoV-2.” 
  • The full sequence of the 8 coronaviruses sampled in the Mojiang mine several years [ago, which are some of the closest relatives of SARS-CoV-2, and were mentioned in an Addendum to a Nature paper published in November 2020.  

Unfettered Access to Yunnan’s Mojiang Mine  – And Footprints of the ‘RaTG13’ Virus

Horseeshoe bats found in Yunnan province carry the viruses most similar to SARS-CoV2 found to date,

The Mojiang site in Yunnan Province is one where a group of six Chinese miners are believed to have become infected with a pneumonia-like illness in 2012, as a result of contact with a bat-borne virus, leaving three people dead.

“To this day all the coronaviruses most closely related to SARS-CoV-2 come from that Mojiang mine. Some scientists who went sampling at the mine had their samples confiscated while investigative journalists have been systematically turned away,” the scientists state.

Even so,  “unspecified samples from these patients were sent to the Wuhan Institute of Virology and other labs in 2012. Dr. Shi Zhengli [WIV chief bat virus researcher] recently announced that the WIV tested the serum samples again.” However, independent researchers never have had access to the raw data.

Independent interviews with the surviving miners were never permitted, and the miners’ unusual pneumonia cases were never reported by China CDC or to the WHO. 

One bat coronavirus, in particular that was found at the Mojiang mine site, ‘RaTG13’, holds special interest, the researchers say. They call it the virus sample closely-related to SARS-CoV-2 today.

Yet, despite the fact that it was sampled and described by researchers, the full genome sequence seems to have disappeared. Shi Zhengli and Yanyi Wang, director of the WIV, have said in interviews that there is:  ‘no more sample’ of RaTG13, so that no further sequencing is possible, and the virus was no longer ‘in our lab.’

“Based on the raw data provided, it has unfortunately not been possible to assemble the RaTG13 genome sequence,” the researchers lamented.

Even so, however, tantalizing biological footprints of the RaTG13 virus, and its components, remain – which could help unravel the mysteries of SARS-CoV2’s emergence, the scientists say. Not to mention the gene sequences of other SARS-related coronaviruses – and yet those footprints remain locked in Chinese research archives, databases, or censored publications.  

Databases Missing in Action  

One published analysis of hospital traffic in Wuhan China in autumn 2019 indicates shows high number of visitors, compared to the same time, in the year before – and before the typical flu season began.

Related to that, data bases from the WIV and sister insitutions have gone missing in action – beginning in September 2019 – which is around the same time when many experts now believe the virus was spreading silently in Wuhan. 

“Dr. Shi Zhengli has stated that Wuhan Institute of Virology virus databases were taken offline during the pandemic. However the key bat virus database was taken offline in September 2019, three months before the official start of the outbreak,” the researchers state. 

“Can Chinese officials explain this contradiction? Can Chinese officials explain why the scientific paper describing the key database…was taken offline from the corresponding Chinese journal website “China Science Data” in mid-2020?  Can Chinese officials also explain why the full website of “China Science Data”, where the database was described, became inaccessible in March-April 2021?”

The scientists also suggest that the claims by the Wuhan Virology Institute officials in March, 2020 that they had found no SARS-CoV2 cases at the institute, even in the height of the Wuhan outbreak – are disingenuous given the widespread community transmission of the disease at the time.  

“Dr. Shi Zhengli and Dr. Yuan Zhiming have both stated that ‘all staff tested negative for SARS-CoV-2 antibodies’ at the WIV in March 2020. Yet, this is statistically unlikely (roughly less than one chance in a billion) given that there are more than 590 staff and students at the WIV and about 4.4% of the Wuhan urban population tested positive at around that time. Even if only 85 people were tested, the chance of no positive test would still be less than 4%. How can this contradiction be explained?”

Tweeted Gilles Demaneuf, co-organizer of the open letter and a data scientist: “[WHO’s Peter Ben] Embarek back in March mentioned 1,000+ cases in December 19, 13 variations in the virus, all pointing to likely November cases. Today China keeps pretending that the first case was on the 8th Dec 2019. How is it possible? Who is shaping the narrative?”

All Eyes On the United States 

Ultimately, a way forward now depends on WHO member states, other co-authors of the letter said. Said one informed expert, most eyes are looking first to the US administration of new President Joe Biden, to see how Washington might lead on the issue; if it does so, it can likely depend upon support from the UK, western Pacific countries such as Australia and Japan, as well as India – all nervous about China’s outsized influence – and in the case of India, the huge toll the pandemic has exacted in human lives.   

Recently, the stance taken by the WHO DG over the incomplete nature of the inquiry so far has been welcome, said another commentator, who asked not to be named: 

 “I feel we should take Tedros at his word. My personal sense is that he believes what he’s saying but he’ll only be able to take meaningful steps forward with political backing from key states.”

 

Image Credits: Johnson&Johnson, David Stanley/Flickr, John's Hopkins CSSE, CNN, WHO, Deutsche Welle, European Medicines Agency, Nsoesie, Elaine Okanyene et al. Harvard University Pre-print Repository, .

A doctor providing essential health services to children in a refugee camp in northwest Syria during the COVID-19 pandemic.

Even as foreign aid from multiple countries arrives in India in response to its COVID-19 surge, a new epicenter of the SARS-CoV2 virus is emerging in Syria. The situation in Syria is “deteriorating extremely rapidly,” according to UN agencies and aid relief organizations. 

Although the official number of confirmed cases and deaths in Syria is extremely low as compared to its neighbouring countries, the spread of the virus in Syria is “rapid and accelerating,” warned UN officials in a briefing to the Security Council on Wednesday. That’s in comparison to data showing recent declines in new cases in countries nearby such as Turkey, Lebanon, as well as Jordan and the Israeli-occupied West Bank and Gaza – where vaccine campaigns of various degrees are now underway – albeit at a much slower pace than Israel. 

Credible data collection is a serious challenge in the conflict-ravaged country, which, combined with low testing rates, makes knowledge about the scale of the pandemic uncertain. 

But the available data suggests that cases are surging nationwide. The number of new cases recorded by the Ministry of Health in March was double the number from February and reports indicate that hospitals in Damascus are at capacity, according to UN officials.

After 10 years of war, Syria’s health system is weak and lacks the infrastructure to trace and diagnose cases and contain the spread of the virus. Approximately 90% of the population live in poverty. 

In northeast Syria, controlled by Kurdish-led forces, over 5,300 new COVID-19 cases have been confirmed in April alone, accounting for more than half of the total recorded in 2020. Some 47% of tests are coming back positive in the past week. 

In addition, two refugee camps in northern Syria, Al-Hol and Roj, have recorded cases recently, but neither have the resources to treat COVID-19 patients. 

The only COVID-19 lab in northeast Syria is at risk of suspending testing services in less than seven days because of a shortage of testing kits.

“Testing capacity in the northeast has never been sufficient, and now it may be lost altogether,” said Misty Buswell, Policy and Advocacy Director for the International Rescue Committee in the Middle East and North Africa, in a press release. 

“Currently, 83% of patients who receive invasive ventilation in the region are not surviving and we fear that things will only get worse. Treatment facilities are being forced to close due to a lack of funding, oxygen is beginning to run out, and COVID cases are reaching the highest levels seen to date,” said Buswell. 

Seven UN and NGO-funded treatment facilities have been forced to close due to a lack of funding. In March, the UK cut aid to Syria by a third in a move that aid agencies criticized as causing lives to be lost in the future.

Some 24 million people in Syria rely on aid to survive, a figure that has increased during the pandemic.

The International Rescue Committee has issued an urgent call for the UN Security Council to reauthorize the Al Yarubiyah border crossing on the Syrian-Iraqi border so UN agencies can deliver relief and support the region’s COVID-19 response. 

Cross border aid deliveries into northwest Syria are currently only authorized through a single crossing, Bab al-Hawa, on the Syrian-Turkish border. China and Russia vetoed resolutions to re-open the two other border crossings, Al Yarubiyah and Bab al-Salam, on the Syrian-Turkish border.

“The vaccine doses that reached north-west Syria were delivered, like all UN humanitarian assistance there, through the Bab al-Hawa border crossing. It is really not clear how future such deliveries could reach north-west Syria unless you confirm the reauthorization of UN cross-border access,” said Mark Lowcock, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, in a briefing to the Security Council. 

COVAX Vaccines Arrived in Syria

Syria received its first batch of AstraZeneca vaccines from COVAX on 22 April.

Syria received its first bulk of vaccines from the COVAX facility last week, with 203,000 doses of the AstraZeneca vaccine arriving in Damascus and 53,800 doses delivered to the northwest of the country. 

The distribution and administration of the jabs will begin in early May. 

“This is a milestone in our collective fight against the pandemic,” said Akjemal Magtymova, WHO Representative in Syria, in a press release. “Delivery of the COVID-19 vaccines by COVAX and partners brings us closer to vaccine equity and gives hope for the people in Syria, whose lives have been shattered by a decade of conflict and the devastating impact of the pandemic.” 

The COVAX delivery was followed by the arrival of 150,000 doses of the Sinopharm vaccine, donated by China. COVAX plans to allocate a total of 912,000 doses to Syria in the coming months, with an additional 336,000 doses intended for northwest Syria. 

In addition, a donation of 150,000 doses of China’s Sinopharm vaccine arrived in Damascus on 24 April. Healthcare workers and vulnerable populations will be prioritized in the vaccination campaign. 

Currently, it is not known when doses will reach the northeast of Syria, where supplies of oxygen are limited and testing resources are running out.

“Although they will not be a silver bullet, they cannot get there soon enough,” said Buswell. 

COVID Crisis Continues to Worsen in India

As India hit a new record high of daily COVID-19 cases on Thursday and hospitals and crematoriums are increasingly overwhelmed, emergency medical supplies arrived in Delhi from the United States on Friday. 

Amid a deadly second wave and soaring infections, India reported 386,555 new cases on Thursday – another global record – and 3,498 deaths within 24 hours. The country has surpassed 18.7 million cases recorded since the beginning of the pandemic, six million of which took place in April. 

The catastrophic rise in cases has devastated the country’s health system, with hospital beds and oxygen in dangerously low supply. Crematoriums have had to build makeshift funeral pyres to cope with the rising death toll. 

“If we get more bodies then we will cremate on the road. There is no more space here,” Jitender Singh Shanty, a crematorium coordinator in Delhi, told the Guardian. “We had to request authorities to allow us to extend the facility to the parking lot.” 

Several crematoriums in Delhi are performing over 100 funerals per day and say that the official death toll doesn’t reflect the overwhelming increase in demand for their service.

Currently families are forced to wait up to 20 hours for a funeral pyre, while the crematoriums are attempting to rapidly expand to increase capacity to complete several hundred cremations a day in the worst hit areas. 

Crematoriums have become overwhelmed by the surge in COVID-19 deaths, forcing them to quickly build makeshift funeral pyres to cope with the rising death toll.

The second wave, which has hit major cities – Delhi, Mumbai, Lucknow, and Pune – hardest, is now spreading to smaller cities and more remote villages across the country. 

In Kota, a city of 1.3 million, located in Rajasthan state, 35% of the cases recorded were from April. Over the past 24 hours, Rajasthan reported 6,147 new cases and 158 deaths. Only two of the district’s 329 intensive care units were available as of Tuesday.

Kabirdham district, in Chhattisgarh state, went from recording zero active cases on 1 March to recording nearly 3,000 in the past week. The district currently has a shortage of nurses and lab technicians.

“We are in this situation because the government didn’t plan to augment facilities in remote areas,” a doctor in Nainital, a Himalayan city in Uttarakhand state, told BBC. “I am worried that many people in remote Himalayan areas will die and we will never hear about them. They will never show up in statistics.”

Emergency Foreign Aid Arrives

A US military plane carrying over 400 oxygen cylinders, nearly one million rapid COVID-19 tests, 100,000 N95 masks, and other medical equipment landed at the Indira Gandhi International Airport in Delhi on Friday.

“Today we are proud to deliver our first shipment of critical oxygen equipment, therapeutics and raw materials for vaccine production,” Antony Blinken, US Secretary of State, wrote on Twitter. 

This is the first of several planned COVID-19 emergency relief shipments from the US. According to a State Department spokesperson, the US will deliver supplies worth over US$100 million in the coming days, including a total of 15 million N95 masks and 20,000 courses of treatment of remdesivir.

AstraZeneca manufacturing supplies have also been redirected from the US to India, which will allow the country to manufacture 20 million doses.

Over 40 countries have committed to send supplies to assist India’s hospitals, including nearly 550 oxygen-generating plants, over 4,000 oxygen concentrators, 10,000 oxygen cylinders, and 17 cryogenic tankers. 

However, experts worry that the aid will be insufficient to make a dent in India’s national COVID-19 crisis that continues to spiral out of control.

Blame for Rise in Cases Largely Placed on Modi

Criticism and blame is increasingly being directed at India’s Prime Minister, Narendra Modi, who continued to hold large election rallies throughout the pandemic and refused to cancel Kumbh Mela, a Hindu religious festival where pilgrims dip in the Ganges river, widely considered the largest religious gathering globally.

Millions of people gathered on the banks of river Ganges to celebrate Kumbh this year, which runs from February to late April. The festival is believed to be a factor that contributed to the massive surge in COVID-19 cases, along with a lack of compliance to public health measures, low vaccination rates, and the emergence of a new contagious variant. 

Tens of millions gathered to celebrate the Kumbh Mela festival in India amid surging COVID-19 cases.

Modi’s approval rating, while still high, is at its lowest point at 67% and a disapproval rating that rose eight points since early April to 28%.

Modi has been widely criticized for the government’s lack of preparedness for the second wave and the shortages of oxygen and hospital beds that accompanied it. Only a few of the 160 new oxygen plants had been installed by April, when cases began to surge. 

The government claimed to have successfully contained the virus after its first wave, going so far as to stating that India was in the “end game of the COVID-19 pandemic” in early March. 

“That illusion came to settle in the minds of most people and clouded their judgement,” Srinath Reddy, President of the Public Health Foundation of India, told the Washington Post. 

Government officials focused largely on the vaccination campaign, however, the rollout was too slow and the percentage of the population vaccinated was too low to hinder the second wave.

Only 9% of the population of 1.3 billion has received at least one dose of a COVID-19 vaccine. 

Despite the government’s plan to open up vaccinations to all adults on 1 May, several states have run out of vaccines ahead of the expansion of the inoculation drive. Vaccination centers will be closed in some cities, including Mumbai, until they receive more doses. 

With shortages in vaccine supplies being seen across India, hospitals and crematoriums will continue to bear the burden of the second wave.

Image Credits: Sky News, International Rescue Committee, UNICEF/Khaled Akasha, Sky News.

moderna

Moderna has announced new investments from Europe and the US to increase global vaccine supply, expecting to increase 2022 capacity to up to 3 billion doses of its COVID-19 vaccine. The announcement was followed by the World Health Organization’s (WHO) decision to list the Moderna vaccine for emergency use, making it the fifth vaccine to receive emergency validation from WHO. 

“As we follow the rapid spread of SARS-CoV-2 variants of concern, we believe that there will continue to be significant need for our mRNA COVID-19 vaccine and our variant booster candidates into 2022 and  2023,” said Stéphane Bancel, Chief  Executive Officer of Moderna.

The vaccine manufacturer highlighted studies that predicted waning immunity will impact vaccine efficacy within 12 months, compounding the need for variant boosters in the coming years. 

Though many agreed that variant boosters will be necessary in the future, governments were concerned about the ability to scale up production. “We are hearing from governments that there is no technology that provides the high efficacy of mRNA vaccines and the speed necessary to adapt to variants while allowing reliable scalability of manufacturing.”

But with these investments, Moderna now has the capability to scale up drug manufacturing at the company’s Switzerland and Spain-based facilities. There will also be a 50% increase of drug substances at Moderna’s facilities in the US. 

Increased Shelf-Life for Vaccines

Moderna also announced that ongoing development data related to its current COVID-19 vaccine formula could support a three-month refrigerated (2-8 degrees Celsius) shelf life in alternate formats that make it easier to distribute, such as the doctor’s office or other small settings. 

Current vaccine supply is approved for storage up to one month at refrigerated temperatures (2-8 degrees Celsius) and up to seven months in a standard freezer (-20 degrees Celsius). Moderna’s vaccine is the only authorized mRNA vaccine that does not require on-site dilution. 

The company is also working on new formulas of its COVID mRNA-1273 vaccine and a next generation of the vaccine that will extend refrigerated shelf life longer. 

Variant and Vaccine Booster Tests Underway

Stéphane Bancel, Chief Executive Officer, Moderna.

The company is raising its 2021 supply forecast to between 800 million to 1 billion doses, with production from investments expected to ramp up in later this year early 2022. 

Earlier this year it announced that it is already testing the SARS-CoV-2 variant vaccine and multivalent vaccine boosters in humans. 

Results from its ongoing variant clinical trials and develops its booster shot strategy will place Moderna in a position to better estimate the supply ranges for 2022, which will be based on product mix across single-dose boosters, primary (two-dose) vaccinations for adults, and primary (two-doses) shots for children, which may be at lower dose levels. 

The scaled-up production and manufacturing capabilities come after last week’s forum sponsored by the International Pharmaceutical Manufacturers and Associations (IFPMA).  

Bancel, at the press briefing, had said that the company is “in the final stretch to get an agreement with COVAX” for its vaccine. 

Pfizer CEO Announces COVID-19 Oral Drug Could Be Available at the End of 2021

Pfizer CEO Albert Bourla

Pfizer’s experimental oral drug for treating COVID-19 could be available at the end of 2021,  CEO Albert Bourla told CNBC on Tuesday.  

“If clinical trials go well and the Food and Drug Administration approves it, the drug could be distributed across the U.S. by the end of the year,” Bourla told CNBC. 

Pfizer, which developed the first authorized COVID-19 vaccine in the US with German drugmaker BioNTech, began an early-stage clinical trial in March testing new antiviral therapy for coronavirus. In addition to the drug, Pfizer is testing its vaccine in 6-month to 11-year-old children. 

Earlier this month, the company asked the Food and Drug Administration (FDA) to expand its vaccine authorization to adolescents ages 12 to 15 after the shot was found to be 100% in a study, with no serious side effects. 

Bourla also told CNBC that the company is ‘comfortable’ in producing at least 2.5 billion vaccine doses for 2021, noting how Pfizer had overcome the original ‘forecasted losses’. 

“We made tremendous progress in improving processes, in building the infrastructure at the speed of light and in resolving issues with third-party supplies,” he added.

Bourla noted that the ‘horrible situation’ in India and the rest of the world, where the rate of vaccinations and availability of vaccines is lower, needed to be addressed, and saw this as an ‘ethically unacceptable issue’.

“If we are not able to provide services for India or Africa, they will become a pool where the virus will replicate and generate variants.” 

India is currently facing a catastrophic second wave that accounts for 38% of global cases reported in the past week, according to the WHO. 

 

Image Credits: Jernej Furman/Flickr, WEF, CNBC.

GHC Webinar – ‘What Lessons from COVID-19 For Advancing Antibiotic R&D?
Clockwise, moderator Suerie Moon, Manica Balasegaram (GARDP), Michelle Childs (DNDi)

In the midst of the COVID-19 pandemic, a “silent pandemic” of drug resistance to mutated bacteria, viruses and parasites is gaining ground and requires major government investments in antibiotic research and development (R&D), a group of experts has warned.

“People are dying across the world from drug-resistant infections. This is a problem of today, and it’s a problem that’s getting worse,” said Manica Balasegaram, Executive Director of the Global Antibiotic Research Development and Partnership (GARDP), during a webinar on antimicrobial resistance (AMR) hosted by the Geneva Graduate Institute Global Health Centre. 

The Geneva symposium, held on Thursday, highlighted key lessons learned from COVID-19 when looking towards the future of AMR and preparing for the next public health emergency. 

Increased Investment In AMR as a Global Health Priority 

amr pandemic
An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganism they act primarily against.

Advancing antibiotic R&D requires global health to invest in AMR as a public health issue in its own right, as antibiotics are going to be a critical tool in pandemic preparedness.

One of the benefits of AMR is that, due to its extensive R&D, researchers know the pathogens behind it, which makes it a global issue that can be prepared for, Balasegaram added. 

“We have to ensure access, particularly diagnostics, treatments, vaccines, and other tools – for infection, prevention, and control. We need to see this not just in terms of AMR but as a cornerstone for pandemic preparedness,” he added.

Although there has been a lot of progress in relation to vaccines, Michelle Childs, Director of Policy Advocacy at Drugs for Neglected Diseases Initiative (DNDi), spoke of the “acute need” to invest in COVID-19 effective treatments.

Childs addressed the need to have “well-powered, adaptive, clinical trials” to see if these treatments can be successful in repurposed and novel technologies, as well as a need to hone in on specific COVID-19 treatments, especially for those with mild to moderate symptoms of the virus.

“Potentially, those treatments could not just stop progression but could offer some hope for post-COVID symptoms,” she said. “We need to invest in virus-agnostic types of treatment in the early stages and discovery, not just for COVID but also for future pandemics.” 

Innovation in Global Health Needed, Shift Away from Traditional Sources 

The World Bank only releases funds to products qualified by the FDA

Global health actors also need to set their priorities towards innovation, as they reframe the way AMR is viewed, said Childs. She added that the level of innovation demonstrated during the COVID-19 pandemic should be applied to the future. 

“We need to ensure that when we’re looking for innovations, we don’t just look in the traditional sources in high-income countries.”

Childs also addressed the need to shift away from a “dependence on stringent regulatory agencies”, citing the negative effects on funding and access with the World Bank, for example, which only releases funds to buy products qualified by the FDA. 

“We need to strengthen further and respect the growing regulatory capacity worldwide. We have to move away from just a reliance solely on the EMA and the FDA,” said Childs, raising the African Vaccine Regulatory Forum as an example.  

Inequitable Global Response Prolongs the Pandemic

A health worker wearing personal protective equipment (PPE) carries a patient suffering from COVID-19 outside the casualty ward at Guru Teg Bahadur Hospital, in New Delhi, India.

Many of the lessons of COVID-19 are still ongoing, the most prominent being lessons on inequitable global response. The US was experiencing a drop in coronavirus cases with increasing vaccinations, while countries such as India are facing their worst outbreaks of COVID-19.

“We can’t really lift ourselves out of this situation unless we have a global response and that means global access. Inequitable access to medical countermeasures will have devastating consequences, and will prolong the pandemic,” said Balasegaram.

“If we don’t fix this now, then we’re going to face this again in AMR, and every other health issue that follows.” 

Intellectual Property Restrictions – Inequitable Access

IP

 

“We can’t really talk about lessons for COVID for the innovation system without addressing the real issues that we’re facing with COVID now,” said Childs. 

One of these issues concerns intellectual property, which comes days after nearly 400 members of the European Parliament (MEPs) and national parliaments across the European Union issued a joint appeal calling for the European Commission to drop its opposition to a proposed WTO waiver on IP related to COVID-19 health technologies for the duration of the pandemic. 

“[Lifting the restrictions allows] the vaccine recipe to be shared for countries [so they are able] to support themselves, [sharing] the know-how of technologies using some of the processes that are already available. We can’t rely on business as usual, or just rely on private licensing deals, which are inadequate.”

Image Credits: Staicon Life/Flickr, GHC, Felton Davis/Flickr, Adnan Abidi/Flickr, Open Source/Flickr.