One dose of either vaccine resulted in 65% reduction of infections. There was greater impact against symptomatic infections (72%) than infections without reported symptoms (57%). 2 doses were even more effective against symptomatic infections (90%, and gave similar level of protection as prior infection.

COVID-19 infections fell significantly – by 65% percent – after a first dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccine in a study of more than 373,000 British residents who received one of the two jabs. 

The first in a series of two new studies, published by the University of Oxford, found that the reduction in new COVID-19 infections was similarly dramatic following either the first dose of the Oxford/AstraZeneca or Pfizer-BioNTech vaccine.

“We found very similar, significant reductions in infections [rates] after the first rounds of either [Oxford/AstraZeneca] and [PfizerBioNTech] vaccines,” said Dr Koen Pouwels, senior researcher in Oxford University’s Nuffield Department of Population Health, during the press briefing.

The studies, which used data from the COVID-19 Infection Survey, a partnership between the University of Oxford, the UK’s Office of National Statistics (ONS), and the Department for Health and Social Care (DHSC), analyzed 1,610,562 test results from nose and throat swabs taken from 373,402 study participants between 1 December 2020 and 3 April 2021. 

First Study Focused on Infection Reduction Rates
Clockwise, left to right: Dr David Eyre, Dr Sarah Walker, moderator Fiona Lethbridge, Dr Koen Pouwels

The first study focused on infection reduction rates following a single shot of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines. Twenty-one days after a single dose of either vaccine, with no second dose, the rates of all new COVID-19 infections had dropped by 65%, symptomatic infections by 74%, and infections without reported symptoms by 57%. 

One dose of either of the two vaccines also were similarly effective against the B.1.1.7 variant, which was first identified in the UK. Vaccination was just as effective in individuals aged 75 or older with underlying health conditions as it was in those under 75 or without health conditions. 

Two doses of the Pfizer-BioNTech vaccine, meanwhile, reduced asymptomatic infections by 70% and symptomatic infections by 90%.

During the press briefing, Dr Sarah Walker, Professor of Medical Statistics and Epidemiology at the University of Oxford and Chief Investigator and academic lead for the COVID-19 Infection Survey, stated that she was ‘pleasantly surprised’ by these results. 

“The benefits are greater for people with high viral load and for people with symptoms, both of who have probably got the greatest chance of transmission, was really not necessarily something I was expecting.” 

However, too few people had yet received two doses of Oxford-AstraZeneca to assess the final degree of protection obtained from that vaccine, the researchers concluded.

In the press release, Dr Koen Pouwels said: ‘The protection from new infections gained from a single dose supports the decision to extend the time between first and second doses to 12 weeks to maximise initial vaccination coverage and reduce hospitalisations and deaths.”

“However, the fact that we saw smaller reductions in asymptomatic infections than infections with symptoms highlights the potential for vaccinated individuals to get COVID-19 again, and for limited ongoing transmission from vaccinated individuals, even if this is at a lower rate. This emphasises the need for everyone to continue to follow guidelines to reduce transmission risk, for example through social distancing and masks.”

Antibody Responses High After Second Pfizer Vaccination 
pfizer
Antibody responses after receiving either AstraZeneca or Pfizer COVID-19 vaccines

The second study compared how antibody levels changed after a single dose of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines, as compared with two doses of the Pfizer-BioNTech vaccine, generally given 21-42 days apart. 

Antibody levels were comparatively lower with a single dose of either vaccine, particularly at older ages. But while the size of the immune response differed, there was no group of individuals who didn’t respond at all to either vaccine. 

There was, however, a small percentage of people – 5% – who had low responses to both vaccines, which makes it essential to monitor responses to a second vaccination. 

Antibody responses to a single dose of either vaccine also were generally lower in older individuals, especially over 60 years – unless they had had a prior COVID infection.

Antibody responses to two doses of the Pfizer-BioNTech vaccine were high across all ages, and particularly increased in older people – reaching levels similar to those who had received a single vaccine dose after a prior infection. 

David Eyre, Associate Professor at the Big Data Institute at the University of Oxford, said that while the findings still highlighted the importance of people getting a second vaccine dose degrees of protection different by age:  

“In older individuals, two vaccine doses are as effective as prior natural infection at generating antibodies to the SARS-CoV-2 virus that causes COVID-19. In younger individuals a single dose achieves the same level of response.”

Walker also emphasized the importance of vaccinations to control the spread of COVID. “Vaccines are clearly going to be the only way that we are going to have a chance to control this long term. WIthout vaccines, I don’t think getting close to zero [infections] is really feasible,” she said, during the press briefing. 

The findings come on the heels of recent  announcements by Pfizer CEO Albert Bourla that in fact a third booster jab of the vaccine may be necessary “somewhere between six and 12 months.” 

Risk of Blood Clot from AstraZeneca Vaccine Doubles, UK Still Says ‘Benefits Outweigh Risks’ 
A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine.

Meanwhile, new UK government data suggested that the risk of serious blood clots from AstraZeneca jabs was greater than had previously been reported at national level. 

The most recent survey found 168 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA). The estimated number of first doses of AstraZeneca COVID-19 vaccines administered in the UK was 21.2 million by 14 April, giving an overall case incidence of 7.9 such events per million doses – or one person in every 125,000.  

Out of these cases, which occurred in 93 women and 75 men, 32 deaths occurred (19%). Previously, there had been 79 cases and 19 deaths reported in the UK.  

The UK government’s regulatory agency, however, continues to emphasize that the benefits still outweigh the risks. 

“On the basis of this ongoing review, the advice remains that the benefits of the vaccine outweigh the risks in the majority of people,” the MHRA said. 

Image Credits: University of Oxford, Flickr.

A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19.

The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks.

The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch.

Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective.

Multi-hazard Warning System Will Predict Potential Outbreaks

In a related development,  the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. 

Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance,  as a result of unusually heavy desert rainfall – creating significant disruptions in food production.  

The multi-hazard warning system will be instrumental in predicting such potential outbreaks of  environment and climate related and health events, critical in mobilizing resources for effective response efforts. 

A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict.

“Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview.

The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present.

New Initiatives To Complement Existing African Risk Capacity  

The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters.

So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth.

He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. 

One Health Approach – Urgent Action Needed Now

The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. 

“If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch.

Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done.

The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative.

Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. 

“IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre.

Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent.

“That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals.

Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria.

Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. 

The forum Reaching Zero: Virtual Forum on Malaria Elimination  saw the launch of a new new initiative – E2025 –  to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria.

Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. 

https://twitter.com/endmalaria/status/1384871850338131972

The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria.

Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020.

The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event.

“These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. 

Zero Malaria Initiative

In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria.

Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. 

In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. 

The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. 

Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. 

The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. 

“Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. 

Dr Pedro Alonso, Director of the WHO Global Malaria Programme.

The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. 

A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. 

In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. 

Challenges to Reaching Zero Malaria

Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. 

Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality.

Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. 

In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers.

E-2025 Initiative

The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. 

“At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. 

The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. 

The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. 

The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. 

“Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.”

Impact of COVID-19 on Malaria Programmes
Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued.

During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. 

However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision.

“Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. 

In addition, more children than ever before received seasonal malaria chemoprevention last year. 

The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. 

“We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw.

“[But] of course we’re not out of the woods yet,” she added. 

Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria.

More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey.

Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. 

“Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. 

The current biggest challenge is keeping the political focus on malaria, said the speakers. 

“We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. 

RTS,S Malaria Vaccine is a “Promising Additional Tool” 

Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti.

Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday.

The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%.

“This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. 

Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. 

Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria.

“We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.”

“And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. 

In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months.

While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said.

“For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. 

The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually.

Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. 

The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. 

Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria

Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. 

While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti.

As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight.

“Every year that we let malaria continue to spread, health and development suffer,” Moeti said.

Image Credits: WHO, WHO.

Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry.

Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19,  health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. 

But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away –  with additional checks to ensure that those getting the jabs are bonafide health workers.   

Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30.

“To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. 

Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website.

Pakistan Medical Association Protests

As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch.

The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs.  

Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. 

Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the  vaccine drive that began in early February of this year. 

The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. 

Prioritise the Vaccination of HCWs

In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers.

In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said,  is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic.

“It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. 

“We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded.

According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic.  That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. 

Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies

In an interview with Health Policy Watch, Sajjad said that he  believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. 

“Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered.

Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch.

Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received  the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. 

Punjab, the country’s most populous province has so far vaccinated 156,158  health workers, 56%, while  Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. 

That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). 

Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began.  

She contended that health worker registration remained open, but turnout has been very low.

“Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. 

However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. 

“The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. 

The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. 

Boys play on a beach in Kiribati, one of the Pacific island states most threatened by rising sea levels due to climate change.

Climate activists have high hopes that at this week’s Leaders Summit on Climate, hosted by US President Joe Biden with forty other heads of state, climate change will be framed as a health issue that is exacerbating the risk of future pandemics, as well as causing seven million deaths a year right now as a result of air pollution and reducing already fragile crop yields critical to nutrition and food security.  

Climate activists are pinning these hopes on the Biden administration’s recent appointment of two well-known advocates of the health card in climate change negotiations – John Kerry, the U.S. Special Presidential Envoy for Climate, and Gina MacCarthy, the White House climate advisor. 

“At the Leaders’ Climate Summit, I think we’ll see the US framing their climate commitments at least in part in terms of health,” said the head of Global Climate and Health Alliance Jenny Miller, in an interview with Health Policy Watch. “The US Climate Advisor Gina McCarthy is very knowledgeable about the health impacts of climate change and the health benefits of climate solutions.” 

Even during the Trump years, Kerry was pounding the pavement of climate meetings and interacting with health advocates. Pictured here with WHO’s former Assistant Director General Flavia Bustreo at the 2019 Madrid climate conference of parties (COP 25) – the last in-person meeting before the COVID pandemic.

Indeed, Gina McCarthy has been a regular on the podium of numerous health and climate events, dating back at least to the 2014 UN Climate Summit, when she headed the work of the US Environmental Protection Agency, under the Obama Administration. Kerry, US Secretary of State in the Obama Administration who led the US team negotiating the 2015 Paris Climate Accord, remained active on the climate issue in the dark days of Trump’s climate denial policies, including meetings with climate and health advocates. Last week, just ahead of the climate summit, Kerry shuttled to Shanghai for the first meeting by a senior Biden Administration figure with Chinese officials, and President Xi Jinping later confirmed he would attend the virtual summit meeting. 

Health, however, is not formally on next week’s agenda, and there is concern that a more traditional positioning of climate action as a solution that benefits economies and businesses could detract from a strong health case, Miller warned.

“While I do think that health may come up during the Summit, it’s not actually on the official agenda,” she said, adding. “If you’re talking about climate change and you’re not talking about the impact on people, you’re missing the boat.”

“At the Summit, I’m concerned that with a more narrow focus on economies, businesses, and on new technologies, rather than on making sure the solutions we pursue really deliver benefits for people, we won’t actually get those health benefits we could see,” she said. She added that a stronger representation of health ministers in future climate conferences, such as the UN COP 26, due to be hosted by the United Kingdom in Glasgow at the end of 2021, could help position climate change as an opportunity to improve health.

Climate change has increased droughts and water scarcity, reducing crop productivity and pastureland; increased food insecurity; and driven local conflicts and migration in Africa’s Sahel and beyond.

Still, a handful of countries have begun to draw more explicit links between climate change and health in their policies, such as Canada, which recently put health front and centre in its climate adaptation plan. In the United Kingdom, meanwhile, the National Health Service recently committed to carbon neutrality by 2040. And in Latin America, countries such as Argentina are moving to integrate health into their national climate commitments, made under the 2015 Paris Agreement.

But “most” countries still have a long way to go, Miller notes, emphasizing the urgent need for bolder commitments across the board. In even the more health-and-climate conscious countries, carbon emissions have continued to increase in past years, she noted.

Concretely, the White House Summit aims to firm up a stronger consensus among the world’s largest greenhouse gas emitters, including the US and China, to limit the earth’s warming to no more than 1.5 C. In one hopeful sign, other leading state actors on the climate front, including India, the United Kingdom and Russia, have also confirmed their attendance. And while the final list of attendees hasn’t been published, it is expected that most other countries among the 40 invitees from Europe, Latin America, Africa, The Middle East, and Asia will follow suit.

Ahead of the summit, the United States and China released a historic joint statement, calling on countries to raise their level of ambition in fighting climate change, and cooperate on reaching carbon neutrality.

At the Summit, the White House has already said that the Biden administration will unveil an “ambitious 2030 emissions target” for the US, as well, to move towards the 1.5 °C goal, reversing four years of inaction under the former administration of Donald Trump, who backed out of the Paris climate agreement, bolstered the fossil fuel industry and relaxed regulations on climate and environmental pollution. Not coincidentally, Thursday’s opening session, 22 April, also coincides with the annual celebration of Earth Day.

Climate Change Is A Health Issue 
Maria Neira, WHO WHO Director of Environment, Climate Change and Health

Given that seven million people a year die from air pollution every year – mainly from the burning of fossil fuels – it makes sense to position climate change as a health issue, emphasized Maria Neira, WHO’s director of environment, climate change and health, who has previously said that “fossil fuels are literally killing us”. That framing, she argues, can help accelerate action on the climate front.

“If you care about your lungs, you better care about climate change,” she said. “If we want to speed up action on the climate front, the most powerful argument is about health.” 

Tackling the causes of climate change, she stressed, has “enormous” health benefits, because the same dirty fuels that cause pollution in households, cities and rural areas also contribute one way or another to climate change. So curbing air pollution can both rapidly reduce some of the key climate change drivers, as well as reducing risks of cardiovascular, respiratory diseases and cancers, she pointed out.

In the wake of the COVID-19 pandemic, too, it is becoming increasingly clear that cllimate change has seeded the “ideal” conditions for more frequent and more devastating pandemics – increasing human encroachment on wilderness areas, leading to the release of new pathogens that previously circulated only among animal species in the wild. 

 “Today, up to 75% of all emerging diseases come from animals,” warned teenage climate activist Greta Thunberg earlier this week at a WHO press conference. “And as we are cutting down forests and destroying habitats. We are creating the ideal conditions for diseases to spill over from one animal to another, and then to us,” she said, adding: “We can no longer separate the health crisis from the ecological crisis, and we cannot separate, separate the ecological crisis from the climate crisis. It’s all interlinked, in many ways.”

Polluting Industries Must Pay The Real Price For Carbon Emissions 

Looking ahead to the COP26 climate conference in Glasgow, planned to take place 1-12 November, climate advocates must ensure that polluting industries pay a “serious” price for the carbon they are releasing into the atmosphere, added former spokesperson for the Paris Agreement of 2015, Nick Nuttall, who is co-hosting the Exponential Climate Action Summit-Financing the Race to Zero on Thursday as well. The event brings together thought leaders from the private sector, labour unions and civil society to talk about ways in which climate action can be accelerated, while creating more jobs and global development payoffs. 

“We need a proper price on pollution to make sure that people who continue to pollute like oil companies, and like heavy industries, actually have to pay a serious price for the carbon that they’re putting out into the atmosphere – as a way of generating finance for those that are doing the right thing,” said Nuttall, in an interview with Health Policy Watch. 

The income generated from pricing carbon, he added, would both encourage dirty industries to quickly reduce their emissions and help generate the working capital to support national and regional governments and cities that are working towards reducing their emissions.

There also needs to be a “clear message from people that have pensions and have investments in pension funds that we will no longer tolerate investment in those pensions in the shares and the stocks of companies that are causing harm to our planet,” he said, noting that some of the public motivation for that kind of divestment will come from growing public awareness about the health impacts of climate change. 

He said that the last three years have finally seen the finance sector tipping into “real action” on investments into more low-carbon and greener development. “Now it needs to achieve the required velocity to first halve emissions by 2030 and then net zero by 2050.”

Ultimately, the financial arguments are also linked to the health card as well: “We need to address climate change to protect human health, and this won’t happen if we don’t finance the transition, and fast… to protect our ecosystems [needed for health], and breathable, productive cities.” 

Image Credits: UNDP, WHO, Flavia Bustreo , Flickr – EU Civil Protection and Humanitarian Aid, Maria Neira.

There is a “possible link” between the Johnson & Johnson COVID-19 vaccine and very rare cases of blood clots, but the benefits of the single-dose vaccine outweigh the risks, the European Medicines Agency (EMA) has announced.

In a statement released on Tuesday, the EMA safety committee said that the rare, but serious blood clot disorders, should be listed as “very rare side effects” of the vaccine. The EMA statement followed a similar decision with respect to the AstraZeneca vaccine, just two weeks ago. 

The European regulator had reviewed eight reports of “serious cases of unusual blood clots associated with low levels of blood platelets”, one of which was fatal – among seven million who received the jab in the United States. 

No cases of deaths associated with the J&J vaccine have so far been reported in the European Union, said EMA executive director Emer Cooke – but vaccine administration on the continent is also far less advanced.

Along with Europe, South Africa and the US had also announced a pause in J&J vaccinations over the blood clot reports in response to reports of a rare cerebral blood clot disorder that combines clots with low blood platelets (CVST).  Since then, vaccines in South Africa have resumed, but in the US, they remain on hold.  

Announcing its decision, the EMA said the risks associated with the virus itself are still higher than the vaccine.

“Covid-19 is associated with a risk of hospitalisation and death,” it said. “The reported combination of blood clots and low blood platelets is very rare, and the overall benefits of [the Johnson & Johnson] Covid-19 vaccine in preventing Covid-19 outweigh the risks of side effects.”

European Commission President Ursula von der Leyen welcomed “the announcement on the safety of the Johnson & Johnson vaccine”.

“This is good news for the roll-out of vaccination campaigns across the EU,” she tweeted.

Johnson & Johnson Rare Blood Clotting Cases

The cases of clotting in the US “occurred in people under 60 years of age within three weeks after vaccination, the majority in women”, the EMA regulator said in its statement. 

“One plausible explanation for the combination of blood clots and low blood platelets is an immune response, leading to a condition similar to one seen sometimes in patients treated with heparin called heparin induced thrombocytopenia, HIT,” it said. Heparin is a blood thinner given to people with clotting disorders.

The EMA said healthcare workers and those who have received the vaccine should be aware of potential symptoms of these rare blood clots. They include shortness of breath, chest pain, leg swelling, abdominal pain, headache, blurred vision or tiny blood spots under the skin.

The early intervention of a specialist can change the outcome for the patient, Cooke said.

‘Similarities’ with AstraZeneca

Emer Cooke, EMA Executive Director.

The cases reported with  J&J’s vaccine were similar to the rare blood clot cases linked to the AstraZeneca vaccine, EMA also noted.

Earlier this month, the EMA made the same recommendation for the Covid-19 vaccine produced by Oxford-AstraZeneca.

That recommendation, made on 7 April, came after 86 people, out of 25 million Europeans who had received the jab, developed the unusual blood clots. Germany has since halted administration of the vaccine to people under the age of 60, the UK has ceased giving the vaccine to people under age 30, and Denmark has halted it altogether. 

Both vaccines use a disabled, or inactive adenovirus vector [viruses that typically cause colds or flu-like symptoms] to deliver a double stranded DNA containing the genetic instructions for part of the SARS-CoV2 characteristic spike protein. That stimulates the body’s immune system to develop antibodies to the virus.

However, Sabine Straus, chairperson of EMA’s evaluation committee of risks and pharmacovigilance (PRAC) noted there were differences between both vaccines since Johnson & Johnson’s vaccine uses an inactivated human adenovirus as the “vector” to deliver the spike protein DNA, while AstraZeneca’s is chimpanzee-based. Both vaccines also target a different part of the SARS-CoV2’s spike proteins, she said.

Considering that the Russian-made Sputnik-V vaccine also uses adenovirus vectors to deliver its jab (in this case different ones for first and second jabs), the EU regulator will “pay close attention” to the issue of rare blood clots as it reviews the vaccine, she added.

According to the latest available data, a total of 287 cases of unusual blood clots have been  reported following the administration of the AstraZeneca vaccine; 25 in the case of the Pfizer-BioNTech vaccine and 5 for the Moderna vaccine, the EMA officials told reporters.

The first-ever informal meeting between civil society groups, WHO officials and WHO member states was held on Tuesday ahead of the formal 74th   World Health Assembly, 24 May-1 June. 

The World Health Organization (WHO) and member states have an obligation to listen to stakeholders in a “sympathetic and respectful manner” as non-state actors (NSAs) play critical roles in supporting global health work generally – and more immediately addressing COVID-19 and its impacts on communities.

That call was made by Mara Burr, director of multilateral relations at the United States Department of Health and Human Services/Global Affairs, during a first-ever informal meeting between civil society groups, WHO officials and WHO member states ahead of the formal 74th   World Health Assembly, 24 May-1 June. 

While civil society groups have expressed fears that novel format of a separate forum for more detailed discussions between NGOs and member states could also undermine their standing at the formal WHA – the presence of some leading WHO donors and member states, such as the United States, Germany and France – in at least some of the sessions  – seemed to indicate that countries are taking the new model seriously.   

“WHO needs to ensure it has the ability to engage directly with non state actors, including civil society and the private sector… who can make strong contributions that is vital to any type of success against the pandemic,” said Burr on Tuesday, the first day of the 3-day virtual meeting, adding that it is “critically” important to ensure the participation of so-called “non-state actors” (NSAs) in WHO governing bodies and that such participation be in a “transparent and accountable manner, with an open door” to allow input from all stakeholders, including the private sector.

She underlined how the COVID-19 pandemic has demonstrated the critical role NSA’s and the private sector play, in everything ranging from addressing pandemic fallout at the community level to the development of vaccines and supply chains. 

Mara Burr, director of multilateral relations at the United States Department of Health and Human Services/Global Affairs.

“We all know that the COVID 19 pandemic has worsened inequalities and threatens decades of hard won gains in childhood vaccination coverage, fighting HIV, tuberculosis, malaria, malnutrition, maternal and child mortality sexual and reproductive health and rights, property, and much more.NSAs have played critical roles, not just in addressing the direct effects of COVID-19, but also in focusing on the secondary impacts in communities across the globe.”

Other actors, however, said that they would have liked to have seen greater member state presence – and in all of the sessions – rather than only in two half day sessions – out of the three full days. Although most of the sessions during the three day event are being broadcast publicly, WHO also said it had no list of what civil society and private sector groups, as well as member states, actually had attended the informal sessions.  

WHO Reforms, Finance And Other Key Issues Raised

However, in the session on public health emergencies, preparedness and response, in which Member States also were invited on Tuesday, the opening day, leading countries such as US took the opportunity to air preliminary views on the more controversial issues that will come before the full World Health Assembly (WHA) when it meets in just a month’s time. 

Those include a proposed “Pandemic treaty” that could strengthen the legal mandates around emergency response; a more sustainable system for WHO finance; vaccine production, distribution and equity; and series of independent reviews both into the functioning of WHO’s own health emergency system, the broader global pandemic response of member states and the functionality of the international health emergency system during the crisis – with recommendations for reform.  

“It is very important that member states have the ability to review those reports, in a way that allows us to really digest the information and discuss with member states the way forward,” Burr said.  

“I think we are a bit concerned that there are proposals that are presupposing a path forward without allowing the member states to actually have a discussion and determine what path makes the most sense.”

With respect to new resolutions and political instruments such as a treaty, however, her remarks seemed to express some hesitations.  

“There are there just not enough hours in the day to negotiate several different instruments at the same time,” she said. “And so we want to make sure the path we choose is the best way forward, based on the overwhelming consensus of the member states. We are analyzing everything. We appreciate all of the inputs, but I think it’s time for us to carefully consider these recommendations before we decide on a way forward.”

NGOs Play Key Role in WHO’s Work

During opening remarks earlier in the day, WHO director general Dr Tedros Adhanom Ghebreyesus said the organisation valued the “longstanding and fruitful collaboration” it shared with NSAs in official relations.

“Nongovernmental organizations have been working with WHO since its creation, and continue to play a key role, especially on technical collaboration. Philanthropic foundations have long been strong supporters of WHO’s work, said Tedros, highlighting the support given for the COVID-19 Solidarity Response Fund. In a conciliatory remarks clearly aimed at pharma industry leaders, whom he has repeatedly slammed over past months, Tedros added that “international business associations also provide a vital link between the private sector and WHO in finding common ground in public health goals”. 

Future Emergency Response: Needs Stronger Political Commitment From All 

Jaouad Mahjour, WHO acting Regional Director for the Eastern Mediterranean

Jaouad Mahjour, WHO acting Regional Director for the Eastern Mediterranean, said engagement with all NSAs is integral to moving forward on a new global framework for pandemic preparedness and response at the WHA and beyond. 

That includes a proposed treaty on pandemic preparedness and response, which gained the support of some 25 global leaders in an open letter launching the WHO initiative just last month.

“The aim would be to garner higher local political commitment to ensure and interconnect the global system to prevent predictable response to epidemic and pandemics,” Mahjour said.

There is currently a group of countries, including the United Kingdom, Germany, France, Indonesia, Kenya, Rwanda, and South Africa, co-sponsoring a draft decision on the treaty at the WHA. The decision would mandate WHO to create an intergovernmental working group to start working through the treaty specifics. 

Mahjour stated that civil society’s role in supporting such a treaty would be “most important”: 

“We know that community readiness and resilience are essential for effective all hazard approach.”

“But we’re hoping that we go out from this pandemic with strong political commitment, that will protect the world in the future and also the best legacy to our new and future generation.”

Added Gaudenz Silberschmidt, WHO director for health and multilateral partnerships, who moderated portions of the meeting:  “It’s also a call for all of you. It won’t happen on its own. It’s also your intervention and your support which will make a difference.”

The Importance of Maintaining Essential Health Services 

At the Tuesday session, WHO referred to the importance of maintaining essential health services – pointing to the role that civil society can plan in supporting that. 

The WHO has produced operational guidance to maintain essential health services, determining which services are the ones that “absolutely need to be maintained,” said Sylvie Briand, Director of the Global Infectious Hazard Preparedness Department.

Sylvie Briand, Director of the Global Infectious Hazard Preparedness Department.

The document recommends practical actions that countries can take at national, subregional, and local levels to reorganize and safely maintain access to high-quality, essential services in the pandemic context. 

Essential services include support for chronic diseases such as diabetes, HIV, and reproductive health, and also services that reduce suffering are “extremely important,” Briand added. 

Many countries find their health system capacities have been reduced by 50%, leaving their hospitals unable to provide support, noted Altaf Musani, director of health emergency interventions.  The global health workforce currently is suffering from brain drain in many countries, and a displacement of the essential health workforce does not enable refresher training for essential care; lack of accessibility of services in fragile, conflict, and vulnerable settings.

“Access is something that has to be negotiated. Access is something that often gets reduced,” said Musani.

Supporting Youth During Emergencies 

Civil society groups also  emphasized the importance of supporting youth during COVID-19, and also during future health emergencies. 

“You cannot do proper community engagement without the youth. It is really important in public health emergencies to include all segments of the population,” said Dr Ibrahima Soce Fall, Assistant Director General, Emergency Response.

Claire Beck, Director Humanitarian health nutrition and WASH, pointed out that health services, especially during humanitarian crises and pandemics, focus on certain life-saving issues for mothers and childrens, but there are more health needs that also need to be addressed as well. “Services are not youth-friendly, she said, “[They] are not open to meet the needs of youth during an emergency – reproductive health needs and listening to concerns they have.”

“It is important that the WHO not only look at the training of health workers in dealing with disease but training them to have a sympathetic and youth-friendly way of working with youth.”

But traditional health practitioners also have an important role to play during this pandemic, said Briand.

“First, they have the trust of the population, [making them] good communication channels]. If they are properly informed and they have the right message, they can help the community to protect themselves. They have a role to play in health as well.” 

Upcoming Sessions 

While Tuesday’s sessions were focused on COVID-19 response and health emergencies more generally, Wednesday and Thursday sessions will trace the steps of the wider range of issues that will also be addressed in May’s formal World Health Assembly.

Those will include sessions on the other two “pillars” of the WHO’s current strategic plan, including: one billion more people getting access to universal health coverage and one billion more people enjoying better health and well being.  

As part of that, civil society, WHO officials and (in some sessions) member state representatives will look at initiatives to address interpersonal violence; expand access to medicines, vaccines and treatment for rare diseases, and increase transparency around medicines markets; address health workforce issues; and create a framework for more sustainable finance for WHO.

Image Credits: WHO.

Encouraged by how fast vaccines have been developed for COVID-19, tuberculosis advocates launched a “TB vaccine roadmap” on Tuesday and aim to use lessons from the pandemic to jumpstart the quest for a TB vaccine.

The purpose of the roadmap, said Frank Cobelens of the Amsterdam Institute for Global Health and Development, is to provide “key actionable priorities” to develop affordable vaccines for use in low and middle income countries.

TB vaccine research and development (R&D) needs to focus on “diversifying the vaccine pipeline, accelerating clinical development, and ensuring public health impact,” he added.

But Willem Hanekom, head of the African Health Research Institute, warned that implementation of the roadmap was key, pointing out that a similar “TB blueprint” had been published 10 years ago.

“We need to establish COVID-19 as a global crisis,” said Hanekom, adding that TB deaths in India, Indonesia and South Africa exceeded COVID-19 deaths.

He also called for more investment in TB, pointing to $78.6-billion spent on R&D for COVID-19 vaccines whereas $1-billion is spent annually on TB vaccine development.

Rethinking and Repurposing

Delivering the keynote address at the TB Vaccine Conference, South Africa’s Professor Helen Rees said that COVID-19 had taught researchers the importance of “rethinking and repurposing”.

“Everyone is rethinking how we have traditionally done clinical trials,” said Rees. “What do we do to bridge from the pre-clinical to clinical development phases that is innovative and much stronger than what we already have?

“What biomarkers can be used to support and accelerate decisions? When we move from phase two to phase three trials, what kind of trial designs and very innovative, adaptive and seamless designs can be  introduced?” she asked.

The HIV field was looking at the development of mRNA vaccines “backwards”, to see whether the same approach could be applied to HIV, added Rees, who chairs the SA Health Products Regulatory Authority (SAHPRA).

She also said drugs were also being repurposed for COVID-19 and this was also the case for TB.

“We’ve been doing a lot of rethinking about [the TB vaccine] BCG, and there have been a number of trials, for example, in adolescents, seeing whether the use of a BCG booster will have an impact on disease outcome for TB. 

“There have also been trials looking at different timing of offering BCG to newborns. So this is taking an existing technology and saying, can we adapt it and do something different with it and get a better outcome?”

Studies were also looking into whether BCG could be “repurposed” for COVID-19. 

“Can we use the BCG vaccine phenomenon that is known to induce both humoral and adaptive immunity, that it has this nonspecific immune response that can be used to boost the immune system?” she asked.

Affordability and Access

Rees added that the COVID-19 pandemic had highlighted issues of “access and affordability”, reminding the conference that the Coalition for Epidemic Preparedness Innovation (CEPI) had been set up in 2017 as a public health innovation and funding mechanism in response to  Ebola “to enable equitable access of these vaccines for affected populations during outbreaks”. 

“CEPI has definitely been thrown into the forefront in terms of COVID,” said Rees, who chairs the initiative’s scientific advisory committee.

“Vaccine innovation and introduction is something that COVID has just revolutionised. The timeline between identification of a vaccine and registration was under a year – unprecedented,” said Rees. 

“If there are good things to come out of COVID-19, one of them is to say how important vaccines are in terms of control and elimination of diseases.

“If we want to eliminate TB, we desperately need better vaccines and the clock is ticking.”

 

Image Credits: Socios en Salud .

DELHI – In a twin bid to get ahead of a surging COVID-19 epidemic, the Indian government said that it will make “advance payments” totally some US$ 550 million to domestic COVID-19 vaccine makers – as well as opening up the market to private sector import and sales of other approved COVID-19 vaccines. 

Under the plan, the Serum Institute of India, which is producing the AstraZeneca vaccine (Covishield) will be given an advance of Rs 300 billion rupees (US $400 million) and Bharat Biotech, the Hyderabad-based company producing an India-made vaccine, called Covaxin, will receive a 150 billion rupees ($US 200 million) advance.  

At the same time, domestic vaccine manufacturers will be able to sell up to 50% of the vaccines that they produce on the private market – to further incentivize the production ramp-up, the government said.  

And imported vaccines by other manufacturers can also be imported and sold privately – after the government fast-tracks emergency approval.  

Finally, the Indian government said it would change its vaccine eligibility policy – allowing for all adults to be vaccinated as of Monday – as another measure to accelerate vaccinations. 

India has a population of 1.38 billion, including about 966 million adults over the age of 18 – but so far only about 127 million vaccine doses have been administered – with only about 17 million people receiving two doses.  And until this week, only  health workers, essential workers, and people over the age of 45 had been allowed to get the vaccinations. 

Incentive to Vaccine Makers – Private Market Sales 

As per the new policy, the Indian government said that domestic vaccine makers may supply up to 50% of their doses for India to the open market or to individual state governments within India. Half the doses will be earmarked for the Central Indian government. 

Foreign-manufactured vaccines, including those approved by United States and European regulatory agencies (as well as the recently Indian-approved Sputnik) may also be allowed to be sold in the private market. Both the vaccine makers and private hospitals can fix their prices for the doses sold in the open market – apparently without government controls, although they must be reported transparently. 

The Indian government said that the liberalized pricing policies have been made to incentivise vaccine-makers and boost vaccine production as well as imports. The government press release said that this policy “would augment vaccine production as well as availability, incentivising vaccine manufacturers to rapidly ramp up their production as well as attract new vaccine manufacturers, domestic and international.”

Just a couple of weeks ago, the Serum Institute’s Adar Poonawala had lamented in an interview given to NDTV that the company was unable to  make “super-profits” via exports – and the consequent lack of capital was hampering the capacity of the institute to scale up its production. He clarified that he was making profits selling vaccines (about 2 dollars per dose) to the Indian government, but the profit margin was not big enough. The Serum Institute had earlier sold the vaccine doses to the Uganda government for three times more than European Union.

R Ramakumar, a professor at the Centre for Study of Developing Economies in Tata Institute of Social Sciences, Mumbai questioned this move in an editorial for Scroll.in and said that this policy will drive up the price of vaccines “excluding millions of (Indian) people from voluntarily coming forward to take the vaccine.”

On Wednesday, just after getting permission to sell vaccines on the private market, the Serum Institute posted the new prices that it would charge for the AstraZeneca vaccine – equal to about US$ 8 a dose in private hospitals and US $5 a dose for Indian state government facilities. In comparison, the central government will still pay the original price of $US 2 per dose.

The vaccine price hikes prompted an immediate backlash from social and health advocates on social media.

“This is unacceptable” said one comment. The Centre [central government] must buy vaccines and distribute in a transparent, equitable manner free to states.  For 70 years India always had a free, universal vaccine programme.”

“Is the Serum Institute setting vaccine policy now?” tweeted Malini Aisola, co-convenor of All India Drug Action Network (AIDAN). She noted that SI had set the price without even engaging in a procurement process with the State governments.

Serum Institute CEO Warns Again That Supplies To COVAX Will Be Delayed 

Poonawala said that he will be able to renew vaccine supplies to COVAX by June or July,  provided he is able to ramp up production. SII had sought funds from the Indian government to increase its monthly capacity from up to 65 million currently to more than 100 million doses per month. 

He attributed the delay in ramping up the production due to the massive fire at Serum Institute’s facility in Pune and the sudden increase in demand by India owing to a massive surge of cases. At the time of the fire, Poonawala had earlier claimed that the damaged unit was a brand new facility which was to be used for future production of BCG and Rotavirus vaccine.

In order to provide the new support for domestic vaccine production, the Indian Finance Ministry offered credit to the two Indian manufacturing companies without the usual guarantee requirements, the Indian Express reported. 

India is currently seeing more than 200,000  COVID-19 cases per day. Many cities of the country have experienced stock outs of vaccines. In addition to halting COVAX supplies, the Indian government has also delayed bilateral vaccine exports to other countries, on account of the shortfall of vaccines in India.

Delay in Supply to COVAX

As of Monday, some 38.7  million doses had been distributed through the COVAX facility, said senior WHO advisor Bruce Aylward in a press conference Monday evening. These were mostly sourced from India’s Serum Institute in February and March before the current infection surge – although he acknowledged continuing uncertainty about when SII exports through COVAX could fully resume.

But, Serum Institute’s Poonawala said that their company is giving its entire capacity of production to India. 

“It has been difficult to explain to other countries that for a temporary period of two months we need to prioritise the needs of India over contractual obligations,” Poonawala told CNBC-TV-18 in the first week of April.

“The severe and sheer burden in cases in India, demands that we service the needs of our nation first. At least for two months and then we review the situation going forward,” Poonawala said.

Poonawala had also sought lifting of embargo of raw material exports from the US, including filters and cell culture media which are relevant for the COVID-19 vaccines. 

Poonawala explained to CNBC that while these materials do not affect the production of Covishield, they would affect the production of the vaccine Covovax which SII developed jointly with  the American company Novavax. He said that Covovax is being produced at 50% capacity for stockpiling from April- May in case the ban on raw materials is not lifted.

Public Health Experts Critique COVAX

Indian public health experts, however, have criticised both the Indian government, and international agencies for not anticipating vaccine shortages of this kind.  – leading to stock outs in several parts of India and a shortfall of doses promised to other developing countries that were reliant on Serum Institute’s stocks of the AstraZeneca vaccine. 

Rohit Malpani, a public health consultant based in Paris said that there is always a risk inherent to the structuring of the international vaccine market in such a way that a large proportion  of the vaccines destined for low and middle income countries, provided by COVAX or bilaterally,  come  from India.

“There was always a possibility or risk that eventually India would in itself require vaccines from its domestic production.” said Malpani, who also represents non-governmental organisations on the Board of Unitaid.

High income governments have felt the pinch as well. The UK government bought 5 million Covishield (the locally produced AstraZeneca vaccine) doses in the first week of March. However, the Serum Institute could not supply 5 million more after the Indian government delayed SII exports. The UK government then claimed that their vaccine roll out had been hampered as a result – although Indian observers said this is unjustified insofar as the UK has so far managed to vaccinate some 30% of its eligible population. The Canadian government also  bought about 5 million doses from Serum Institute early March. 

“The COVAX initiative did not anticipate that companies would go to the highest bidder [to sell vaccines]. They expected countries to share the vaccines. This has turned out wrong,” said Malpani. 

In an op-ed in The Guardian, access to medicine Indian activists Achal Prabhala and Leena Menghaney blamed the production shortage firstly on the decision of Oxford University to reneg on an earlier commitment to keep their vaccine technology as open-source, and sign over exclusive rights to AstraZeneca, “acting on advice from the Gates Foundation.”   

“Oxford University should have stuck to its plans of allowing anyone, anywhere, to make its vaccine. AstraZeneca and Covax should have licensed as many manufacturers in as many countries as they could to make enough vaccines for the world,” the op-ed by Prabhala and Menghaney stated.

In a recent interview, a senior Gates official denied that charge – saying that while the Foundation had assisted Oxford in finding a suitable pharma partner to scale up R&D – it had not intervened on the details of the license that Oxford signed with AstraZeneca.  

Malpani said that the international agencies need to think about what changes can be put in place to ensure that we do not have similar problems of inequitable distribution of vaccines again in the future.

He said, “If we do not make changes in the way the market is structured, how vaccines are produced..if we do not learn from these problems then criticism is very much warranted.”

–Updated 21 April 2021

An advertisement in favour of a tax on sugary drinks run in South Africa as part of a campaign by advocacy group Health Living Alliance (HEALA)

CAPE TOWN – South Africans are consuming fewer sugary drinks since their government introduced a tax on these in 2018 – but powerful multinational food and beverage companies are inhibiting neighbouring countries from following suit, according to research published on Tuesday.

South Africa was the first African country to impose a tax of approximately 10% on the sugar in sweetened soft drinks in an attempt to curb rising obesity and related diseases including diabetes and hypertension.

Last week, the Lancet published a four-year study that looked at the sugar consumption of 113,000 South African households and found per capita daily sugar consumption dropped from 16.25g before the tax was announced to 10.63g in the year after the tax was implemented.

But research published on Tuesday by the Global Health Action on seven other countries in southern and east Africa found that the path to introducing a similar tax is being blocked by industries.

There was little information in the seven countries about citizens’ consumption of sugary drinks, taxes or the industry itself, yet sub-Saharan Africa has been identified as a “growth market” for soft drinks, according to the research.

Sugary Drinks are ‘Vectors of Disease’

Professor Karen Hofman

“Obesity and its related diseases are escalating like a tidal wave across the continent of Africa,” said Professor Karen Hofman, director of Wits University’s Centre for Health Economics and Decision Science (known as Priceless). 

“It is fueled by colonisers in the guise of the processed food and beverage industry, and their associates in the advertising and marketing industries, who see our continent as a final growth market and who, for many decades have ensured that even our children are brainwashed to buy the products, because it will make them feel cool,” Hofman told the virtual launch of the research

She described ultra processed food and beverages as “vectors of disease” available at local supermarkets and transmitting “diabetes, cancer, and high blood pressure”.

Although a number of the seven countries – Botswana, Namibia, Zambia, Uganda, Kenya, Rwanda and Tanzania – do tax soft drinks, none target the sugar content or do so for health reasons.

Uganda has a general excise tax on soft drinks but despite NCDs now accounting for one-third of the country’s deaths, there is “limited recognition” of the link between sugary drinks and NCDs, according to the Uganda research.

“The soft drink industry has been influential in framing the taxation debate, and the Ministry of Finance previously reduced taxation of sugar-sweetened beverages,” according to the report.

Tension Between Economic and Health Considerations

In 2018, the Ugandan Finance Ministry proposed to cut the tax on non-alcoholic drinks from 13% to 10% – apparently because investment from Coca-Cola was contingent on this. After objections from the health ministry, the tax was reduced by to 12%, but the agreed plan of action is to gradually reduce the tax to 10%. 

After the tax was cut, Coca-Cola Uganda’s CEO is quoted as saying: “This $15 million investment was made on a promise of reducing taxes (on soft drinks), from 13% excise duty to 12% in the 2018/19 financial year, and we are glad it was implemented. This is confirmation that a favorable tax regime can attract more investment for the industry.”

While taxing sugary drinks in Kenya “has been identified as an effective mechanism to address nutrition-related non-communicable diseases”, the country is not yet committed to this.

“Government has competing roles: advocating for industrial growth, such as sugar and food processing industries to foster economic development, yet wanting to control nutrition-related non-communicable diseases,” according to the report.

An unnamed representative from the Kenyan Ministry of Health told researchers that “the Kenya Association of Manufacturers come out guns blazing whenever any of the clients is subjected to scrutiny in terms of ‘we need to tax ‘or ‘what is the health of this product’.” 

Another health official conceded that “unfortunately there’s a lot of industry interference with policy” on taxing sugary drinks, and that  it was not simply a decision about health but  [“an industrialisation issue and also a manufacturing practice issue … an industry like that, of course, has a lot of policy interference because they have big money they can compete with us.” 

Proliferation of Unhealthy Food

Botswana and Zambia appear better prepared and more interested in taxing sugary drinks, according to research presented at the launch.

However, said Zambian researcher Mulenga Mukanu, “The priority of most African governments is towards economic growth, as evidenced by policies that encourage the growth of industries that produce unhealthy commodities like sugar-sweetened beverages. This context should not be ignored.”  

Researcher Safura Abdool Karim said the growing problem of NCDs in sub-Saharan Africa “is partly due to the nutrition transition and proliferation of unhealthy foods across the continent, coupled with a lack of regulation and a lack of enforcement of existing policies”. 

But Abdool Karim concluded: “There are a number of cost-effective population-level interventions that can be implemented, particularly in low and middle-income countries, including regulating food labels, regulating marketing to children, and adopting taxes on sugary beverages.”

South Africa succeeded in introducing a tax, she added, because it based its campaign on robust local evidence, key policy-makers had political will, there was support from civil society advocacy organisations and “industry interference was neutralised”.

 

Image Credits: Kerry Cullinan.