Healthcare workers vaccinating at risk patients with the Pfizer-BioNTech COVID-19 vaccine in Lima, Peru.

Delaying the second dose of the Pfizer/BioNTech COVID-19 vaccine by 12 weeks could generate antibody responses in those over the age of 80 more than threefold, found a pre-print study published on Friday.

The study, conducted by the University of Birmingham and Public Health England, is the first to directly compare the immune response derived from the recommended three-week dosing interval with the extended 12-week interval.

Some 175 participants over 80 years of age were included in the study, 99 of whom received the second dose after three weeks and 73 had the second jab at 12 weeks. 

The peak antibody levels were 3.5 times higher in those who waited 12 weeks for their second shot, compared to those who waited three weeks. 

“The enhanced antibody responses seen after an extended interval may help to sustain immunity against COVID-19 over the longer term and further improve the clinical efficacy of this powerful vaccine platform,” said Paul Moss, Professor of Haematology at the University of Birmingham, in a press release. 

The peak T cell immune response, which plays a role in maintaining antibody production, was lower in those with the extended interval, but the responses were comparable between the two groups when measured at the same interval after the first dose. 

In addition, T cell levels rose two weeks following the second dose. Further research is required to understand the different T cell immune responses, said the authors. 

“This research is crucial, particularly in older people, as immune responses to vaccination deteriorate with age. Understanding how to optimise COVID-19 vaccine schedules and maximise immune responses within this age group is vitally important,” said Dr Helen Parry, lead author of the study, in a press release. 

“Individuals need to really complete their second dose when it’s offered to them because it not only provides additional protection but potentially longer lasting protection against COVID-19,” said Dr Gayatri Amirthalingam, Consultant Epidemiologist at Public Health England.

The “extension of interval of the second vaccine dose in older people may potentially reduce the need for subsequent booster vaccines,” said Moss, highlighting the use of the findings to develop global vaccination strategies.

Findings Useful in Optimizing Vaccinations, But Pfizer Vaccine not Available to Many Countries

While the findings are reassuring and could be useful in optimizing vaccination protocols and strategies, the results are specific to the Pfizer vaccine, which is largely not available to many low- and middle-income countries. In addition, in several countries where variants are spreading rapidly, the risk of infection may be higher after only one vaccine dose. 

In the United Kingdom, however, the study findings are supportive of the controversial approach taken by the government in late December to delay the second dose up to 12 weeks.The decision was made amid rising cases in an effort to expand partial immunity to more of the population. 

The study “provides further supportive evidence of the benefits of the UK approach to prioritise the first dose of vaccine,” said Dr Amirthalingam.

Experts Study Link Between COVID-19 Vaccines and Rare Blood Clots

The AstraZeneca vaccine being administered in Catalonia, Spain in mid-February.

In other vaccine news, scientists are investigating the possible connection between the AstraZeneca and Johnson & Johnson COVID-19 vaccines and rare blood clots, which have been reported across numerous countries in recent months. 

Both the AstraZeneca and Johnson & Johnson COVID-19 vaccines have been investigated by regulatory agencies for links to rare blood clots, known as cerebral venous thrombosis (CVT). Several countries, including the United States, the European Union, and South Africa, paused or limited the rollout of both vaccines due to reports of CVT.  

“Understanding the cause is of highest importance for the next-generation vaccines, because [the novel] coronavirus will stay with us and vaccination will likely become seasonal,” Eric van Gorp, Professor of Infectious Diseases at Erasmus University in the Netherlands, told the Wall Street Journal. 

A German research team, led by Andreas Greinacher, a transfusion medicine expert at the University of Greifswald, found that certain proteins and molecules in viral vector vaccines – which the AstraZeneca and J&J vaccines both are – could cause an autoimmune response that leads to blood clots. 

In a peer reviewed study published in the New England Journal of Medicine in April, the researchers proposed naming this type of clotting ‘vaccine-induced immune thrombotic thrombocytopenia’ (VITT).

According to Greinacher, it might be possible to reduce the risk of blood clots by removing proteins and reducing the level of the EDTA preservative in the jabs after the manufacturing process. Data would have to be collected on how this may impact the safety and efficacy of the vaccines. 

Although this is only one possible explanation for the cases of rare blood clotting and experts disagree on the exact mechanism at work, Greinacher is reportedly in communication with AstraZeneca and J&J to conduct more research on the vaccines and VITT.

“We strongly support raising awareness of the signs and symptoms of this very rare event, and we are currently exploring a potential collaboration with Dr. Greinacher,” said a J&J spokesperson. 

Image Credits: Flickr – Province of British Columbia, International Monetary Fund/Ernesto Benavides, Flickr.

WHO Director General Dr Tedros Adhanom Ghebreyusus

Being vaccinated against COVID-19 this week was a “bittersweet” moment, reflecting both a “triumph of science” and a “gross distortion” in vaccine access, World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyusus told the body’s media briefing on Friday.

Thanking health workers at the Geneva Emergency Hospital for vaccinating him on Wednesday, Dr Tedros said that his thoughts “were very much with the health workers around the world who have been fighting this pandemic for more than a year” but still could not get protected. 

“At present, only 0.3% of vaccine supply is going to low income countries. Trickle-down vaccination is not an effective strategy for fighting a deadly respiratory virus,” noted Tedros.

He described India’s COVID-19 surge as “hugely concerning”, but added that Nepal, Sri Lanka, Vietnam, Cambodia, Thailand and Egypt, were also dealing with spikes in cases and hospitalisations. 

“Some countries in the Americas still have high numbers of cases and as a region, the Americas accounted for 40% of all COVID-19 cases last week. There are also some spikes in some countries in Africa,” added Tedros.

However, he highlighted three developments that gave him hope. The first was that countries were sharing vaccines with COVAX, following Sweden’s announcement last week to share one million doses with the global vaccine platform. Norway, France and New Zealand have also pledged doses.

The second was “new deals on technology transfer, and sharing of know-how between international manufacturers to scale up vaccine production”, said Tedros.

A new WHO vaccine mRNA manufacturing training facility aims to train and develop more vaccine manufacturing professionals – who could help kickstart new vaccine facilities in LMICs.

Earlier this week, Health Policy Watch reported that WHO has already received some 42 expressions of interest from countries, institutions and biotech partners to create the hub to train professionals in vaccine manufacturing to help to jumpstart manufacturing LMICs.

The 42 expressions of interest from countries, institutions and biotech partners to create the mRNA vaccine technology transfer hub.

In addition, in the past week, COVAX unveiled a three-stage plan to enhance existing vaccine production capacity, developed by its new Supply Chain and Manufacturing Task Force as well as a new “vaccine manufacturing group” to further expand production long-term.   

The third reason for hope, said Tedros,  is the fact that more leaders, including Spanish Prime Minister Pedro Sanchez have called for the lifting of all trade barriers to address the pandemic. This follows last week’s announcement by the US that it supported text-based negotiations on the proposed TRIPS waiver, which has resulted in countries previously opposed to this to reconsider their position, including the European Union and the UK.

India Clamours for Remdesivir Despite WHO Research

WHO Chief Scientist Soumya Swaminathan

 

Amid India’s surge, the country has seen growing demand for the antiviral medicine, remdesivir – resulting in the government banning the export of the medicine or any of its active ingredients.

However, the WHO reiterated that large studies found that remdesivir had no effect on the SARS-CoV2 virus.

WHO Chief Scientist Soumya Swaminathan said that the development of therapeutics had fallen behind vaccine development, but corticosteroids showed the most promise of reducing mortality in severe COVID-19 cases.

On the other hand, the large Solidarity trial that had tested remdesivir had found that it had no impact on mortality when compared with the control group, said Swaminathan.

The Solidarity Trial, which published interim results last October, found that all four treatments evaluated – remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon – had “little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalized patients”.

However, India had already registered remdesivir for emergency use last July and continues to insist on its efficacy despite the WHO’s position. Meanwhile, the drug’s manufacturer, Gilead has been quoted in the Indian media as saying that the WHO research is potentially  “biased”.

Remdesivir is being produced by seven Indian companies and retails at over $37 per 100mg.

Swaminathan said it was important that Indian doctors were aware of the WHO recommendations, but that member states were free to make their own policies.

“Oxygen is probably the most essential and the most life-saving right now of all the drugs and all countries need to be prepared now with the oxygen supplies,” she stressed.

US Mask-Wearing Decision: ‘Very Contextual’

Maria Van Kerkhove, WHO COVID-19 Technical Lead

While wearing masks is part of the WHO’s comprehensive strategy to address the pandemic, this was “very contextual”, said Maria van Kerkhove, the WHO’s COVID-19 Technical Lead, when asked about the decision by the US Centers for Disease Control (CDC) to allow fully vaccinated people to forgo masks outdoors and in many indoor settings.

“Fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance,” the CDC announced on Thursday.

“It’s about how much virus is circulating around in the country. It’s about the amount of vaccines and vaccinations that are rolling out, it’s about the variants of interest and the variants of concern that are circulating,” said Van Kerkhove.

“We have to keep all of this in mind when thinking about how to adjust the policies associated with the use of masks, so it is contextual and all of these considerations need to be taken into account.”

While highlighting that Australia and New Zealand had been able to control the pandemic without vaccines, Van Kerkhove also cautioned that there were “uncertainties ahead because of these virus variants”. 

Mike Ryan, WHO’s executive director of health emergencies, added that any country that wanted to reduce or remove mask mandates had to consider both “the intensity of transmission and the level of vaccination coverage”.

Some countries were in a “strange period” of transition, where transmission hasn’t completely ended and people aren’t completely vaccinated. 

“And as long as we can sustain the public health measures, as long as we can keep the distance and as long as we can reduce exposure while we get vaccination levels to the highest level, then countries will be in a much stronger position when they do get to high vaccine coverage levels to start saying to people, you don’t have to wear a mask anymore,” said Ryan.

 

Image Credits: WHO.

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.

A group of 18 prominent scientists, primarily based in the United States, have called for further investigations into the origins of the SARS-CoV2 virus, including that it could have been created in the Wuhan Institute of Virology lab, in a letter published on Thursday in the journal Science. 

The letter, organised by David Relman, Professor of Microbiology and Immunology at Stanford University, and Jesse Bloom, virologist at the University of Washington, is seen as giving weight to calls to include all hypotheses about natural and laboratory spillovers.

They believe that previous “theories of accidental release from a lab and zoonotic spillover both remain viable” and were not “given balanced consideration” by an earlier joint WHO-China report.

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

As of Thursday, the COVID-19 pandemic has claimed 3.3 million lives globally, and the scientists point out that: “Knowing how COVID-19 emerged is critical for informing global strategies to mitigate the risk of future outbreak.”

Among the signatories is Ralph Baric, a virologist at the University of North Carolina and one of the world’s leading experts on coronaviruses, who has collaborated with scientists at the Wuhan Institute of Virology, the institution at the center of the lab spillover hypothesis. 

Lack of Sufficient Evidence to Rule Out Lab Leak Hypothesis

The letter echoed the statements made by the US government, the EU, several other countries, and Dr Tedros Adhanom Ghebreyesus, Director General of WHO, who said: “I do not believe that this assessment was extensive enough. Further data and studies will be needed to reach more robust conclusions.”

The scientists said: “A proper investigation should be transparent, objective, data-driven, inclusive of broad expertise, subject to independent oversight, and responsibly managed to minimise the impact of conflicts of interest.”

“Public health agencies and research laboratories alike need to open their records to the public,” the authors stated, pushing for greater scientific rigour. “Investigators should document the veracity and provenance of data from which analyses are conducted and conclusions drawn, so that analyses are reproducible by independent experts.”

Efforts to Depoliticize Origins Investigation – But Topic will be Central to Political Debates at Next WHA

The letter is the first to be published in a scientific journal. Previous letters from other scientists requesting further investigations into the origin of the virus were published in news outlets.

“Our goal in putting out a letter that was signed solely by practising scientists…and published in a scientific journal was to emphasise that this is a scientific question and it needs to be addressed in the same way we address all scientific questions,” Bloom told Seattle Times in an interview. 

“I wanted this to be addressed to my fellow colleagues, the working scientists, and use a venue they respect and see as a place for scientists to talk about science and the importance of science,” Relman told the Wall Street Journal. 

“Our message here is wherever the data takes us, thou shalt go, and only go to the degree that the data allow,” he added.

A separate group of international scientists released three letters in recent months. The latest charted a political and technical way forward, calling for more explicit language in a draft World Health Assembly (WHA) resolution, a broader mandate for the origins investigation team, and an overhaul of the methods and protocols used in the virus origins research.

The appeals for further investigations are growing, coinciding with the upcoming (WHA), set to convene from 24 May to 1 June. The 74th WHA will likely feature contentious debates among member states over how the virus origins investigation should proceed. 

Image Credits: WHO, CNN.

Ursula von der Leyen, President of the European Commission, giving the opening remarks at the civil society consultation ahead of the Global Health Summit.

A draft “Rome Declaration” to be issued at next Friday’s G-20’s Global Health Summit, co-hosted by Italy and the European Commission (21 May), makes a series of 10 sweeping commitments to ensure equitable access to vaccines; expand medicines manufacturing capacity; assure WHO access to sites posing an outbreak risk; and invest in global health systems. 

But the draft manifesto seen by Health Policy Watch, framed as a “statement of principles,” also lacks any concrete targets for COVID vaccine dose-sharing, or medicines and vaccines finance. 

WHO and other global health officials have repeatedly said that COVAX and the other ACT-Accelerator initiatives urgently need some US$18.5 billion from the world’s most industrialised nations to fund purchases of medicines and tests, as well as vaccines. WHO and other global health officials have also begged for more vaccine donations. 

That means that if any such concrete commitments are to be made, they will have to be negotiated up until, and on, the day of the meeting of G-20 leaders. Meanwhile, a placeholder text for “announcements and actions” suggests a mere mention of: “Global dose sharing through COVAX?”  

A weak outcome document would be a major setback to the very immediate concerns around getting needed COVID vaccines and medicines to areas of need in low- and middle-income countries as fast as possible, say observers, with whom the draft declaration was shared.

Key events leading up to the G20 Global Health Summit.

Sidesteps mention of WTO Waiver 

The draft declaration so far also sidesteps mention of another thorny issue – the proposed World Trade Organization (WTO) waiver on intellectual property rights for COVID products, that the United States recently said it would support, in the case of vaccine IP.  

A placeholder text, however, leaves open “{…possible references to ACT-A, WTO activity, WHO, the MPP, C-TAP, and through bilateral arrangements}.” C-TAP is the WHO-sponsored patent pool for COVID technologies – which so far has failed to garner significant support from industry. ACT-A is the still desperately underfunded initiative.

The declaration affirms the importance of supporting developing and least developed countries to “build expertise” and increasing “global, regional, and local manufacturing … and the potential for voluntary and mutually agreed knowledge and technology transfer and licensing partnerships.”

That language, as well, represents code words for encouraging voluntary measures to share COVID-related medicines and vaccines IP and technologies – which pharma voices would find reassuring and access advocates disappointing.

Draft resolution sidesteps mention of the WTO waiver to expand the manufacturing capacity of low- and middle-income countries and improve vaccine equity.

No Pandemic Treaty – Extra Investigative Powers for WHO  

The draft language takes a relatively tough line on the investigation of the origins of SARS-CoV2 and other emerging pathogen threats, saying that countries need to ensure: “international cooperation for WHO-led teams’ access to sites of potential and actual outbreak origin, in full compliance with the IHR and relevant national regulations.”

It stops short, however, of calling for a new Pandemic Treaty, as had been recommended recently by WHO, some two dozen global leaders, and the recent Independent Panel Report for Pandemic Preparedness and Response  – saying rather that countries should “support and enhance the existing international health framework for early warning, preparedness and response, prevention and detection, and recovery capacities.”

Countries also need to invest in stronger “early warning information, surveillance and trigger systems at all geographic levels, as well as laboratory capacity, for human and animal health, “including genomic sequencing capacity…rapid data and sample sharing.”

The declaration also highlights the underlying environmental drivers of pandemics and climate change, calling for a “One Health approach…to address threats emerging at the human-animal-ecosystems interface, and anti-microbial resistance.”

This “should include action to address ecosystem and biodiversity loss, habitat encroachment, illegal wildlife trade and climate change as contributing factors increasing these threats,” the statement adds. 

Fully Funded-Independent WHO 

Finally, the draft Rome declaration also calls for a stronger global health architecture with a “fully funded, independent and effective WHO at its centre”. 

That includes advancing Universal Health Coverage, stronger systems for combatting long-standing infectious diseases like HIV/TB and malaria, as well as “education and promotion of healthy lifestyles in addressing among others non-communicable diseases as factors enhancing resilience.”

That, the declaration acknowledges, requires countries to “invest in the global health workforce, in health systems strengthening to achieve resilient, high quality health systems and public health capacities in all countries, in multilateral mechanisms to facilitate capacity building and the transfer of knowledge, data and expertise, and for dedicated assistance and response capacity building, especially in fragile settings.”

Rome Declaration – Statement of Principles not Actions?

The Rome Declaration is being pitched primarily as a general statement of principles, according to the summit’s advance statement: 

“The Summit is an opportunity for G20 and invited leaders, heads of international and regional organisations, and representatives of global health bodies, to share lessons learned from the COVID-19 pandemic, and develop and endorse a ‘Rome Declaration’ of principles. 

“Principles can be a powerful guide for further multilateral cooperation and joint action to prevent future global health crises, and for a joint commitment to build a healthier, safer, fairer and more sustainable world.”  

Italy, as co-chair of the G20, is hosting the Global Health Summit on 21 May. 

“It will provide a timely opportunity to share the lessons learned during the COVID-19 pandemic. We will discuss how to improve health security, strengthen our health systems and enhance our ability to deal with future crises in a spirit of solidarity,” Italy’s Prime Minister, Mario Draghi, is quoted as saying. 

Mario Draghi, Italy’s Prime Minister, speaking at the G20 Tourism Ministers’ Meeting in early May.

The summit will include G-20 members along with Spain, Singapore and the Netherlands as guests; leaders of WHO and other related UN agencies, as well as global health actors such as Gavi, The Vaccine Alliance, the Global Fund and the Coalition for Epidemic Preparedness Innovations (CEPI), which has been investing in key aspects of COVID vaccine R&D. 

According to the statement, the preparation of the Rome Declaration’s summit principles is supposed to involve civil society consultation and debate. Indeed, a public consultation with key civil society stakeholders was held on 20 April. 

But just a week before the meeting, the draft declaration has not yet been widely circulated among civil society groups.

G20 Global Health Summit, set to commence on the 21 May.

Image Credits: European Commission, European Union, Flickr, Governo Italiano.

americas
COVID vaccination in Brazil

Though more than 114 million people have been vaccinated against COVID-19 in the Americas, the WHO Pan American Health Organization (PAHO) has warned that the pandemic is far from over. 

Last week, the region reported more than 1.2 million new COVID-19 cases and nearly 34,000 COVID related deaths – nearly 40% of all global deaths reported.

“This is a clear sign that transmission is far from being controlled here in the Americas,” said PAHO Regional Director Carissa Etienne at a briefing on Wednesday. 

She noted that while countries such as the United States and Brazil were reporting a reduction in cases, other countries such as Canada, Cuba, and Trinidad and Tobago, are seeing higher rates of infections.  

The WHO’s approval of Chinese Sinopharm vaccine offers ‘fresh confidence’ to countries in the Americas who currently use the vaccine, and ‘brings hope for expanding access to vaccines’ in the region. But Etienne stressed the dire toll the pandemic has taken on health systems – rising hospitalization rates have impacted both oxygen supplies and the health workforce. 

“Until we have enough vaccines to protect everyone, our health systems and the patients that rely on them remain in danger.” 

Countries that have begun their vaccination programmes may also have a ‘false sense of security and safety that things are improving, when in reality this is not the case at all right now’, added PAHO Director of Health Emergencies Ciro Ugarte, citing the lack of oxygen supply and increased transmission of the virus in the region. 

Vaccine Donations Urgently Needed to Supplement COVAX 

Assistant Director of PAHO Jarbas Barbosa

In light of the growing spread of COVID in the region, prompting Latin America and the  Caribbean to be labeled an epicenter of the current pandemic wave, PAHO continues seek out donations from countries that ‘already have vaccines for their own needs’, said Assistant Director of PAHO Jarbas Barbosa.

Such donations, he added, will be used to supplement vaccines offered through COVAX, in addition to the Sinopharm vaccines, which will take time to arrive in the region.  

Barbosa emphasized that in the meantime, vulnerable groups must continue to be prioritized. 

“We need to continue using vaccines in a rational fashion for the most vulnerable groups.” 

Spain has already announced that they will make donations to Latin America and the Caribbean through the WHO co-sponsored global COVAX facility, and negotiations are ongoing with the United States. 

Healthcare Capacity Needs to Expand 

PAHO Regional Director Carissa Etienne

The pandemic also has underlined the need to expand healthcare capacity, scale up oxygen production, and make needed investments in equipment, maintenance, and human resources. 

“Countries are being forced to act quickly to make up for years of underinvestment,” said Etienne. 

Across the Americas, nearly 80% of intensive care units (ICU) are filled with COVID-19 patients, with the numbers ‘even more dire’ in countries such as Chile – with 95% of ICU beds occupied by COVID patients – and Brazil, which has waiting lists for ICU beds. 

Etienne estimates that based on the increasing spread of COVID-19, 20,000 doctors and more than 30,000 nurses will be needed to manage the ICU needs of ‘just half’ of the countries in Latin America and the Caribbean. 

In response, PAHO has deployed 26 emergency medical teams across 23 countries in the Americas to provide specialized care. More than 400 emergency medical teams and alternative medical care sites have been set up to expand hospital capacity.  

Oxygen Supply Challenge in the Americas

Rising hospitalizations rates leads to lack of oxygen for COVID patients

The rise in hospitalizations has triggered an ‘unprecedented oxygen supply challenge throughout the Americas, forcing countries and governments to find urgent solutions to the supply problem. 

While hospitalized COVID patients typically require up to 300,000 liters of oxygen during a 20-day hospital stay, patients in critical care often require double that.

In response, PAHO has donated more than several thousand pulse oximeters and nearly 2000 oxygen concentrators to aid health workers in identifying when a patient needs oxygen, and to ensure that workers are equipped with the supplies to help recovery. PAHO is also working alongside Ministries of Health to ensure the availability of oxygen now and for future emergencies. 

Protecting Health Workers Through Vaccinations 

Healthcare worker in Peru preparing COVID-19 vaccines. Healthcare workers in the Americas have been hard hit by COVID.

Since the start of the pandemic, at the least 1.8 million health workers have become infected with COVID in the Americas – 12% of the estimated regional health workforce – and over 9000 have died, the majority of them women and nurses.  

Etienne urged countries to protect the 8.4 million nurses in the Americas, honoring their work, sacrifice, and contribution in commemoration of International Nurses Day, celebrated 12 May.

“Let’s invest in the nurses and ensure that they have the tools and resources that they need to do their job.” 

Quarterly reports from 18 countries in Latin America and the Caribbean show that 1.5 million health workers are vaccinated, but countries are urged to make the most of limited doses and prioritize health workers first.

Image Credits: Flickr: IMF/ Raphael Alves, PAHO, Flickr: UNICEF Ethiopia/2015/Mersha, Andres Montesinos Malpartida/Flickr.

Faisal Shuaib, Executive Director and CEO of Nigeria’s National Primary Health Care Development Agency

IBADAN – The Nigerian government has decided to move ahead with a second dose of the AstraZeneca vaccine for the nearly 2 million citizens who already received the vaccine – despite advice from Africa CDC and the World Health Organization (WHO), that vaccine-strapped African countries could also choose to administer just one vaccine dose  – so as to reach as many citizens as possible very quickly. 

The decision to shun the Africa CDC and WHO advice comes at a critical moment. On the one hand, cases in Nigeria seem to be plateauing right now. On the other, national and regional officials are eyeing nervously India’s crisis – and ramping up oxygen supplies in the event of a third wave here and imposing a lockdown for the Muslim Eid al-Fitr holiday taking place this week. 

But insofar as the country is planning to shift to the one-shot Johnson & Johnson vaccine, with deliveries, hopefully to begin by September, officials seem prepared to take a calculated risk and finish off the remaining supply of AstraZeneca doses among those who have already received the jab.  

Speaking at a press briefing on Thursday, Dr Faisal Shuaib, Executive Director and CEO of Nigeria’s National Primary Health Care Development Agency (NPHCDA), said the country would much rather ensure the full vaccination(two doses) of those who had already received the first dose of the vaccine as recommended by its manufacturer, AstraZeneca.

This means that the four million doses Nigeria received via the COVAX Facility will only reach two million people – half of what it could have reached if health authorities used the available doses to vaccinate up to four million Nigerians as recommended by the WHO and the Africa CDC.

“Nigeria’s presidential steering committee made a strategic choice to utilise our current COVID-19 vaccine supply to administer double doses rather than single doses. This will ensure that every Nigerian who receives a vaccine from our present supply receives their second dose within the recommended time frame.”

Shuaib said that administration of the two doses on time – even to a more limited group of people: “ is very important to ensure the population benefits from the vaccine.” 

A Nigerian health worker receiving a COVID-19 vaccine jab.

In April this year, Health Policy Watch reported that the Africa CDC warned that the administration of the second jab was threatened in many African countries – citing then the case of Rwanda, which had already used up all of its vaccine doses.

The shipment delivery plans of vaccines were disrupted by the government of India’s decision  to direct the Serum Institute of India (SII) to halt the export of vaccine doses as a result of the country’s burgeoning COVID-19 pandemic. 

At that point, Africa CDC recommended that countries vaccinate as many citizens as possible with their initial shipments of doses – without holding back reserves for a second dose. While Dr John Nkengasong, Director of the Africa CDC said implications of the delay in receiving the second vaccine dose was unknown, he assured recipients of the first dose that they already would have acquired some form of immune protection against the virus.

“We don’t know that delay by a couple of months or weeks, will impair the ability to boost it (immune system) when you get a second dose. I don’t think so. It’s just that it doesn’t give you that full range of your immune system reacting and getting ready to fight the virus once you get exposed to it. But they can be assured that with the first dose, they are already getting some protection from developing disease,” Nkengasong said.

The WHO’s position on maximising vaccinations with available doses is similar to that of Africa CDC. Dr Richard Mihigo, Immunisation and Vaccine Development Programme Coordinator at the WHO Regional Office for Africa, said: “African countries, I must say, took the right decision with the limited supply, to use most of their doses as the first dose with the expectation that the second dose will come quite soon.”

To date, 1,748,242 Nigerians, out of a population of 200 million, have been vaccinated with one dose of the AstraZeneca vaccine. But even though the total proportions are small, they still represent 86.9% of the high risk groups of frontline health workers and older people, particularly those with underlying conditions who were targeted first, according to Shuaib. The successful roll out of the COVID-19 vaccine could play a major role “in helping the country to better cope with the pandemic”, he said.

“We have rolled out a digitised registration and immunisation data system. This is the first of its kind in Nigeria. This is to help ensure efficiency and accountability in our initial rollout. We are continuing to optimise the system, and we are seeing its benefits,” Shuaib said.

A percentage share of people who have received at least one dose of a COVID-19 vaccine.

Steady Decline and Plateauing of the COVID Pandemic

After peaking in mid-January at around 1,400 reported cases a day, new COVID-19 infections  in Nigeria have been in a slow decline, plateauing at a few dozen new cases daily in May, with just 38 cases reported on May 10. 

Official data released by the Nigeria Centre for Disease Control (NCDC), show that 165,515 cases of COVID-19 have been confirmed in Nigeria, Africa’s most populous country, with 2,065 deaths. However, recent global estimates have documented how many cases in African countries also go under-reported, escaping  the radar of official data. 

Daily new COVID-19 cases per million people.

Risk of Imcomplete Immunisation “Too High”

Despite the reassuring statistics, Nigeria is not taking any risks, Shuaib told Health Policy Watch.

And incomplete immunisation of highly vulnerable groups that already got the first AstraZeneca vaccine dose, is one such risk that was “too high”, and which the country wants to avoid, he said. 

“What we did in Nigeria was to actually divide the four million doses we got into two compartments. We have around two million doses that we plan to give exactly the same people that have gotten their first doses.” he said.

Moreover, Nigeria had already started administering the second dose of the vaccine to those who have received the first dose – before the latest Africa CDC advance, as well as information about vaccine supplies was available, he said. Continuing one course with the plan will reinforce confidence in the overall vaccination programme, he added:  

“Nigerians have shown incredible interest in receiving the vaccine and cooperating with our health teams to have the system succeed. This is incredibly important because, to move beyond COVID-19, this must be a national effort.” 

Preparing for a Third Wave  

With a case fatality ratio of 1.3%, Shuaib said Nigeria is taking other key  measures to improve its health system’s ability to withstand a third wave of the COVID-19 pandemic, should one occur, and this includes expanding the country’s medical oxygen capacity nationwide. 

In Lagos state, which has been the epicentre of the pandemic in Nigeria, accounting for over 35% of all confirmed cases in the country, Shuaib announced up to four oxygen producing plants are being established to enable the country to combat oxygen shortage.

“There’s no doubt about the fact that we need to ramp up our capacity to provide oxygen, because this is something that can happen anytime, oxygen shortage can happen in any country,” he said.

Also speaking at Thursday’s briefing, hosted by the WHO’s African Regional Office, Nkengasong said the Africa CDC is supporting African countries to expand their oxygen supply chain as a key component of the continent’s response strategy to combating COVID-19 and ensuring that African countries do not get complacent with their disease response.

“This is part of the adaptive strategy which calls for enhanced prevention, enhanced monitoring and enhanced treatment—especially making sure that oxygen is available, and that we do not get complacent with where we are with the pandemic. We saw what happened in India,” he added.

While Shuaib was addressing journalists from his office in Nigeria’s capital city of Abuja, a development of public health importance was ongoing across the country – which was observing a public holiday to commemorate Eid al-Fitr at the end of the Ramadan fast—in a country that is home to the world’s fifth-largest Muslim population – and where Muslim’s make up about one-half of Nigeria’s population.

To avert a possible surge in the number of COVID-19 cases as a result of the Ramadan festivities, the Nigerian government reintroduced nationwide curfews and other movement and public gathering restriction measures this week. 

“We shall maintain restrictions on mass gatherings in and outside work settings with a maximum number of 50 people in any enclosed space, approved gatherings must be held, maintaining physical distancing and other non-pharmaceutical measures,” said Nigeria’s National COVID-19 Incident Manager, Mukhtar Mohammed.

 

St Peter’s Basilica in Vatican City, Italy.

Italy is pushing for the Vatican – a steadfast opponent of sexual and reproductive health rights – to have an enhanced role and greater privileges at the WHO member state meetings of the World Health Assembly and its governing Executive Board, according to a copy of a draft resolution, seen by openDemocracy.

A handful of other European countries, including conservative Hungary and Poland, are understood to be co-sponsors of Italy’s draft decision that would go before the 74th session of the World Health Assembly (WHA), the governing body of the World Health Organization (WHO), meeting from 24 May-1 June. 

The measure would give the Vatican added rights to participate directly in WHA and Executive Board debates with member states, as well as the right to “co-sponsor draft WHA resolutions and decisions that make reference to the Holy See”.

The Vatican’s right to intervention would be immediately “after the last Member State inscribed on the list”, according to the draft, and “seating for the Holy See shall be arranged immediately after Member States.”

Effectively, the proposal also formalises a decades-long ad hoc arrangement in which it has been invited to the WHA every year at the discretion of WHO’s Director-General, under the rules governing “observers of non-Member states and territories” giving the Holy See a permanent seat at the table.

The Vatican also would have speaking priority over the other entities that currently attend the WHA as observers, upon DG invitation, including:  Palestine (Palestinian Authority, the Sovereign Military Order of Malta, the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies, the South Centre, and the Inter-Parliamentary Union.  In the past, Taiwan has also been an observer; its exculsion from an invite over the past several years has prompted heated debates and sharp criticism from the United States and other allies.

Worries About Hidden Agendas On Sexual and Reproductive Health Rights

Since February, Italy has been led by a coalition that includes both the right-wing Lega party and the centre-left Democratic Party. The government’s key, stated goal is to tackle health, economic and social crises related to the COVID-19 pandemic.

But Italy’s move to advance a decision formalizing the status of the Holy See at the WHA to participate shoulder to shoulder with member states in debates and meetings, including those of policy and budget committees, has alarmed advocates of reproductive and sexual health rights. 

Jessica Stern, executive director of the LGBTIQ rights group OutRight Action International, contrasted the WHO’s mission to support the health of all people with the Vatican’s “exclusionary” position towards sexual minorities. 

“The WHO is no place for religiously-based exclusion, especially in the midst of a pandemic which has disproportionately harmed those who are most vulnerable, including LGBTIQ people and women,” she said. 

Jamie Manson, president of Catholics for Choice, said the Vatican has tried to thwart progress on women’s and LGBT rights at the UN for decades. Church doctrine on sexual and reproductive health issues, Manson added, “has life or death consequences, particularly in the poorest parts of the global south. It’s very serious.”

When Italy’s initial draft of the proposal was first shared with government delegations earlier this month, it proposed giving the Holy See the right to co-sponsor decisions on any topic whatsoever – potentially including measures referring to the right to abortion, contraception and LGBT rights.

Holy See to ‘Co-Sponsor’ Resolutions?

Italy later backtracked on that initial draft – with the current, more limited text, referring only to the Vatican’s right to co-sponsor those “[WHA] resolutions and decisions that make reference to the Holy See”. 

Effectively, the proposal also formalises a decades-long ad hoc arrangement in which it has been invited to the WHA each year at the discretion of its director-general, under the rules governing “observers of non-Member states and territories” giving the Holy See a permanent seat at the table.

The Vatican already holds a similar role at the UN General Assembly. However, rights advocates are still concerned – because of how the Vatican has used other UN bodies to “obstruct” resolutions and decisions on sexual and reproductive rights. 

Neil Datta, secretary of the European Parliamentary Forum on Sexual and Reproductive Rights (EPF), argued: “Pope Francis gives the Vatican a softer image, but its international diplomacy and the content behind it hasn’t changed.”

“With such an institutionalised status at the WHA, as opposed to courtesy invitations, the Holy See could start acting here as it does elsewhere in the UN and that could cause trouble for sexual and reproductive rights,” Datta warned. 

Italian journalist and activist Nicoletta Dentico, who heads the Global Health Programme at Society for International Development, said that while “faith-based entities should be allowed to express their points of view at UN agencies, they should “in no way play an enhanced role” as it remains unclear to whom they are accountable. 

“The Holy See should not have the same status as member states on health issues,” she added, both because of its “viewpoint on sexual and reproductive health and women’s health rights,” as well as the fact that the Vatican also serves as a private healthcare provider, with a vast network of hospitals and clinics around the world. 

Anti-rights Track Record

The Vatican has long opposed access to abortion, contraception, surrogacy and in-vitro fertilisation (IVF) – as well as marriage and adoption for same-sex couples. 

Stern at OutRight Action International cited as examples previous Vatican guidance “denying the existence and rights of transgender and intersex people”, and advocacy at the UN “against numerous gender and LGBTIQ equality initiatives”.

Gualberto Garcia Jones, the Holy See’s legal officer at the Organization of American States (OAS), is also on the board of CitizenGO – which launched a 2020 petition to defund the WHO over “promoting Communist China’s false COVID-19 information”.

Several Vatican officials were also listed as speakers in the programme of the 2019 summit of the World Congress of Families. This is a network of anti-abortion and anti-LGBT rights movements, founded by US and Russian ultra-conservatives. 

Negotiations over Italy’s resolution are ongoing behind closed doors and positions appear to be changing rapidly – both within the European Union and internationally. An informal meeting over the text was held on Thursday morning. 

None of the states believed to be co-sponsors of the resolution, including Italy, responded to requests for comment. The Holy See also did not reply. 

Additional reporting by Nandini Archer, Lou Ferreira and Elaine Ruth Fletcher

 

Image Credits: DAVID ILIFF. License: CC BY-SA 3.0, Pixabay.

The sixth meeting of the ACT-Accelerator Facilitation Council on Wesnesday.

In a rush to jumpstart more global vaccine manufacturing capacity, the global COVAX vaccine facility is now stepping into the fray. 

A new COVAX Supply Chain and Manufacturing Task Force has laid out a three-stage plan to enhance existing vaccine production capacity, as well setting up a new “vaccine manufacturing group” – to further expand production long-term.   

The plan aims to address immediate manufacturing bottlenecks, expanding existing capacity and workforce capacity limitations as fast as possible, through: 

  • Identifying and matching “fill and finish” manufacturers with  producers of active ingredient; 
  • Accelerating approvals of export permits/customs clearances;
  • Facilitating partnerships for the supply of vital vaccine inputs. 

“From the COVAX facility, the critical issue that we’re focused on as of today, is how do we get doses today to try to make a difference, and that means stopping these export bans, it means making sure that if there are surplus doses that those get shared, it means trying to accelerate the production of vaccines that are being made and to make sure that every facility that has capability can be used,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance, speaking at the session. 

According to Berkley’s vision, over the next few months, COVAX will be focused on ensuring there aren’t shortages in products or delays at existing manufacturing facilities. Over the medium-term, through end- 2022, a manufacturing workforce will be developed to maximize even more production using existing systems. 

The long-term goals of COVAX, meanwhile, include expanding production capacity in low- and middle-income countries, and particularly in Africa, through efforts such as a new mRNA vaccine technology hub, led by WHO.

The Task Force’s three-part preliminary plan to enhance and expand vaccine production capacity.

As an opening shot, a US-based foundation said it would donate some US$213 million to catalyze the expansion of manufacturing capacity in South Africa, announced Dr Patrick Soon Shiong, CEO of ImmunityBio and NantHealth, and chairman of the US-based Chan Soon-Shiong Family Foundation. 

The Foundation will provide seed funding to South African biotech partners “so that the capacity, and most importantly second generation vaccinology, second generation cell therapy, and signature delivery systems could be enabled,” said Shiong, a South African native, now living in the United States. 

“I’ve been interacting directly with my fellow South Africans for the last year and I am more and more convinced that not only do we have the science, we have the human capital, and the capacity and the desire. So South Africa could catalyze capacity building, and self-sufficiency, and most importantly the innovation for Africa and for vaccines,” said Shiong, of the partnership. 

Dr Patrick Soon Shiong, CEO of ImmunityBio and NantHealth, and chairman of the US-based Chan Soon-Shiong Family Foundation.

He was speaking at a meeting of the ACT-Accelerator’s Facilitation Council, which provides WHO member state oversight to the global COVAX vaccine facility, and its umbrella  ACT-A  initiative, dedicated to expanding equitable access to tests and medicines, as well as vaccines. 

Addressing ‘Shocking Global Disparity’

While the COVAX facility has delivered 60 million doses to 122 countries, “the shocking global disparity in access to vaccines and other COVID-19 tools remains one of the biggest risks to ending the pandemic,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the beginning of the meeting.  

Cumulative cases and deaths are double what that at the beginning of 2021, he stressed – and part of that is due to uneven rollout of vaccines. 

High- and upper-middle-income countries represent 53% of the world’s population, but have received 83% of the world’s vaccines. In contrast, over the first five months of 2021, the African continent has vaccinated under 1% of its population, Dr Tedros said. 

The same inequalities extend to diagnostics, therapeutics, personal protective equipment (PPE), and oxygen – with one million people in low- and middle-income countries (LMICs) needing over four million cylinders of oxygen per day.  The ACT- Accelerator, led by Gavi, the Vaccine Alliance, WHO and CEPI (the Coalition for Epidemics Preparedness) – are struggling to address all of these needs simultaneously.

Long-term: mRNA Vaccine Technology Transfer – Training Hub 

As a longer-term thrust, a new WHO vaccine mRNA manufacturing training facility aims to train and develop more vaccine manufacturing professionals – who could help kickstart new vaccine facilities in LMICs. 

WHO has already received some 42 expressions of interest from countries, institutions and biotech partners to create the hub – which would train professionals in vaccine manufacturing- who would then help to jump start manufacturing facilities in partner LMICs.  

The 42 expressions of interest from countries, institutions and biotech partners to create the mRNA vaccine technology transfer hub.

The approach has been used successfully in the past to stimulate the creation of capacity in LMICs to manufacture flu vaccines – beginning with the H5N1 pandemic (so-called bird flu)  scare of 2005.  While some vaccine facilities folded after a few years, once  pandemic fears declined, others manufacturers have become sustainable producers of vaccines for seasonal flu and childhood diseases – both for domestic and export consumption, WHO insiders say. 

“Manufacturing of vaccine needs capacity building, not just in the manufacturing, but also in the regulatory environment, in the clinical research environment, in ethics, in quality assurance, and a number of areas, so that will have to happen side by side,” said Soumya Swaminathan, WHO Chief Scientist.  

The hub and training center are expected to launch by 2022,  according to WHO, Gavi and CEPI officials – urging realism against the calls from LMICs to expand manufacturing capacity even more rapidly.

Timeline and vision for the WHO COVID-19 mRNA vaccine technology transfer hub.

COVAX Sets Up Manufacturing Task Force Coordination Office  

In yet another thrust, a COVAX Task Force Coordination Office will also be created to map the vaccine manufacturing ecosystem, including shortages in key vaccine raw ingredients, identifying supply gaps for the Task Force address.  

For instance, nearly 300 vaccine components and inputs, coming from different parts of the world, are required to manufacture one vaccine dose of a Pfizer mRNA vaccine – and so shortages in just one input can create a bottleneck that halts production. 

“There is this concept of having a Coordination Office where the data is collected, where the supply baseline is being done, and that really is to make sure that we’re all operating from the same point, and share that information as we work with all of those groups including new groups that will come in that have a role to play here,” said Berkley.

“The multiple work streams create a very complex set of interactions and tasks and as we have within COVAX where we coordinate across the work stream, we are also going to create a coordinating office that we’re in the process of setting up,” said Dr Richard Hatchett, CEO of CEPI.

Gavi and CEPI officials announced that they expect to have the coordination office “fully up and running very shortly,” said Hatchett.

WTO Set To Join Manufacturing Task Force 

Dr Ngozi Okonjo-Iweala, Director General of the World Trade Organization (WTO), announced that WTO would join the COVAX Supply Chain and Manufacturing Task Force at the Facilitation Council meeting on Wednesday.

“I’ve decided that WTO should join the effort that is being made on vaccine manufacturing,” said Okonjo-Iweala. “Through the pandemic, trade and supply chains have helped countries meet skyrocketing demand for medical products, like personal protective equipment.”

Dr Ngozi Okonjo-Iweala, Director General of the World Trade Organization.

“We must continue this by facilitating the cross border flow of vaccines and vaccine components,” Okonjo-Iweala added.

Expanding manufacturing capacity and addressing vaccine inequity is related to the TRIPS waiver proposed to the WTO by South Africa and India. The acceptance of this waiver would “allow for increased and diversified access to technology know-how [for the] manufacturing of vaccines, diagnostics and therapeutics,” said Okonjo-Iweala. 

“An agreement that allows access to vaccines and to manufacturing capability with some automaticity married with trying to still incentivize research and development is very important,” said Okonjo-Iweala.

“I’m convinced that if we work hard…we will be able to come to a conclusion that will be practical and beneficial for low income countries,” she added.

COVID-19 Vaccine Manufacturing Working Group – Long Term Horizon

Meanwhile, as part of a longer-term initiative – a “COVID-19 Vaccine Manufacturing Working Group”, was announced Wednesday by the ACT Accelerator Initiative. 

That high-level effort, co-chaired by Germany and South Africa, aims to address more fundamental shortages in raw materials, and opportunities for technology transfer by vaccine manufacturers – to increase the long-term stability of doses to the global vaccine facility, COVAX, and ensure the equitable distribution of vaccines by 

“It has become clear that worldwide demand exceeds existing vaccine supply by far. We therefore very much welcome the establishment of the new COVAX manufacturing and supply chain task force and the respective high level working group,” said Germany’s delegate. 

“Germany stands ready to take on responsibility and is glad to announce strong commitment to this new working group by taking on the role as co-chair alongside South Africa,” she added.

Increased Funding Required for ACT-Accelerator

In order to deliver on the promises of the ACT-Accelerator, US$18.5 billion is needed to fill the financing gap. Some US$6 billion was mobilized in 2020 and an additional US$8.5 billion was mobilized so far in 2021, however, more is needed urgently. 

“More financing is needed. That’s the only way to really deliver on what we have been talking about today, both [to address] the needs, the hardship and the difficult situations in many countries, and to deliver on full implementation in equitable manners of the technologies,” said John-Arne Røttingen, Chair of the ACT-Accelerator Resource Mobilization Working Group.

Numerous member states and WHO officials called for increased financial commitments to the ACT-Accelerator at the meeting on Wednesday. 

“We have to fully finance the ACT accelerator, as [it is] the only global solution to bring about the fastest possible end to the pandemic,” said Okonjo-Iweala. 

 

Image Credits: WHO.

Dr Ellen Johnson Sirleaf speaking at the launch of the report on Wednesday

A sweeping report on the global pandemic response has found that the World Health Organization should have taken a more “precautionary’ approach to the emerging SARS-COV2 virus in the early days of the pandemic, advising countries earlier on that it could be transmitted person-to-person — rather than only warning of such a “possibility”.

The report also says that the WHO Emergencies Committee dallied in declaring a global public health emergency – delaying a decision from its meeting on 22 January until 30 January 2020 – and losing another critical week in the first month of the pandemic battle. 

”The Panel’s view is that the outbreak in Wuhan is likely to have met the criteria to be declared a PHEIC by the time of the first meeting of the Emergency Committee on 22 January 2020,” said the final report of the Independent Panel, published Wednesday. 

“While WHO advised of the possibility of human-to-human transmission in the period until it was confirmed, and recommended measures that health workers should take to prevent infection, the Panel’s view is that it could also have told countries that they should take the precaution of assuming that human-to-human transmission was occurring. 

Air travel has exploded in past decades, increasing risks of rapid international pathogen transmission, the report notes.

“Given what is known about respiratory infections, there is a case for applying the precautionary principle and assuming that in any outbreak caused by a new pathogen of this type, sustained human-to-human transmission will occur unless the evidence specifically indicates otherwise,” states the panel report. 

The Independent Panel report, co-chaired by the former President of Liberia, Ellen Johnson Sirleaf, and Helen Clark, the former Prime Minister of New Zealand, sets out a wide-ranging set of recommendations for ending the current pandemic and preparing for the next one.  

“This must be the last pandemic to cause destruction on the scale we are seeing today,” said Sirleaf at the report’s launch. “A new deadly virus could arise tomorrow. The world was not prepared for this one. We must prepare for the next one.”

Said Clark, “almost 100,000 people died from COVID-19 last week around our world. It is a disaster which our panel believes coudl have been averted.”

In terms of ending the current pandemic, the Panel calls for a shake up in the vaccine manufacturing landscape; a World Trade Organization patent waiver; global support for establishment of new vaccine manufacturing hubs; over US$ 10 billion in new G-20 finance for medicines, tests and vaccines, and a commitment by high-income countries to provide the world’s 92 lowest-income countries with more than two billion doses by mid-2022.  

Helen Clark, former Prime Minister of New Zealand at the report launch.

Added Clark. “COVID-19 must not evolve into a neglected pandemic” where it is over in wealthy countries while poorer nations face border closures and years of wait to access vaccines,” adding that. “Covid-19 must not evolve into a neglected pandemic” where it is over in wealthy countries while poorer nations face border closures and years of wait to access vaccines.

But the long-awaited report is likely to be more scrutinized for it’s treatment of the pandemic narrative and its recommendations on preparedness for the next pandemic, when it is reviewed by the World Health Assembly, meeting 24 May- 2 June. 

Stronger & More Independent WHO

In that narrative, The Independent Panel in fact places most of the blame for a faulty, delayed, and ineffective pandemic response on WHO member states – rather than the organization or its current senior management.  

The report lays out a set of recommendations for a “stronger” and “more independent”  WHO – including extension of the Director General’s term from five to seven years  – ostensibly to protect the position from undue political influences. 

“The Independent Panel has found weak links at every point in the chain of preparedness and response. Preparation was inconsistent and underfunded. The alert system was too slow—and too meek. The World Health Organization was under-powered. The response has exacerbated inequalities. Global political leadership was absent,” the report concludes. 

COVID-19 cases as of 30 January 2020 – WHO’s global health emergency declaration came too late. .

 

COVID-19 cases as of 11 March 2020 – the date WHO declared a global pandemic.

Emergency Alert System ‘Two Worlds at Different Speeds’ 

The Independent Panel Team

Chief among the structural weaknesses exposed is infrastructure of the present emergency alert system. 

WHO responses were guided largely by the legally-binding international emergency system, the International Health Regulations (IHR), which “are a conservative instrument as currently constructed and serve to constrain rather than facilitate rapid action.’’ As a result, the “precautionary principle was not applied to the early alert evidence when it should have been,” the Panel concluded. 

To address that, the Panel calls for an overhaul of the IHR emergency alert rules – as well as a new Pandemic Framework Convention –  to make them more responsive to fast – moving pathogens and the rapid flow of modern information systems. 

“The Panel’s view is that the definition of a new suspected outbreak with pandemic potential needs to be refined, as different classes of pathogen have very different implications for the speed with which they are likely to spread and their implications for the type of response needed,” the report states. 

“The chronology of the early events in raising the alarm about COVID-19 show two worlds operating at very different speeds. One is the world of fast-paced information and data-sharing.

…. Digital tools are now core elements in disease surveillance and alert, sifting through vast quantities of instantly available information,” it notes. 

“The other world is that of the slow and deliberate pace with which information is treated under the IHR (2005), with their step-by-step confidentiality and verification requirements and threshold criteria for the declaration of a PHEIC, with greater emphasis on action that should not be taken, rather than on action that should.”

Redesign Surveillance and Alert Systems to Function at Near-Instantaneous Speed

Among a wide-ranging menu of solutions, The Independent Panel says that global, regional and national surveillance and alert systems need to be designed to ensure that “detection functions” and “relay functions – ensuring that signals are verified and acted upon” actions are synchronized. 

“Both must be able to function at near instantaneous speed,” The Independent Panel report states. 

China and Asian Pacific Countries Applauded for Early Action  

pandemic
Shoppers in Wuhan, China, post-COVID-19 lockdown

“The question we must ask ourselves is why the PHEIC declaration did not spur more action, when the impending threat should have been clearly evident? After a stuttering start to the global response in January 2020 by the end of that month it was clear that a full-scale response would be needed. It is glaringly obvious to the Panel that February 2020 was a lost month, when steps could and should have been taken to curtail the epidemic and forestall the pandemic,” the report finds. 

However, the report avoids assigning any specific blame for the failures to any single country – including China which has been widely criticized for failing to report early on the depth and breadth of the spreading virus. 

“The Panel’s analysis suggests that the failure of most countries to respond during February was a combination of two things. One was that they did not sufficiently appreciate the threat and know how to respond. The second was that, in the absence of certainty about how serious the consequences of this new pathogen would be, “wait and see” seemed a less costly and less consequential choice than concerted public health action.”

At the same time, it applauds China and a handful of other countries, mostly in the Asian Pacific region, such as New Zealand, Korea, Singapore, Thailand and Viet Nam, which recognized the threat early on and undertook an “aggressive containment strategy.”  

Seven Point Plan For Strengthening Preparedness 

Pandemic Preparedness Regional Response – The Panel’s Seven Point Plan includes a pre-negotiated platform for essential supplies.

Beyond a more agile, digitally-based alert and response system, much more also needs to be done, in terms of strengthening other aspects of pandemic preparedness – the Panel concludes, etching out seven key recommendations, including: 

Free WHO from national government controls. The report calls on the World Health Assembly to give WHO explicit authority to publish information about outbreaks with pandemic potential immediately – without requiring the prior approval of national governments, and the power to investigate pathogens with pandemic potential with short-notice access to relevant sites, provision of samples, and standing multi-entry visas for international epidemic experts to outbreak locations.

High-level political leadership. Adoption of a Pandemic Framework Convention within the next six months, as well as a United Nations General Assembly political declaration at the September 2021 meeting. 

Stronger, more independent WHO. Extend the Director General’s term to seven years, but with no option for re-election – with the same rule to apply to WHO’s six Regional Directors. “Depoliticize recruitment especially at senior levels”, prioritizing merit-based evaluation of performance. Increase WHO member state fees to two-thirds of the WHO base programme budget and abolish the “earmarking’ of donor funds so that they can be used more flexibly.  

Invest in pandemic preparedness.  Along with calls to national government to update their pandemic preparedness plans, WHO should formalize periodic peer reviews of country’s preparedness, and the International Monetary Fund should routinely undertake pandemic preparedness assessment 

Pre-negotiated Platform for supplies.  Institutionalize and transform the current Act Accelerator and COVAX platforms into a “truly global end-to-end platform to deliver the global public goods of vaccines, therapeutics, diagnostics, and essential supplies.” This would be accompanied by new donor and member state agreements to:  

  • “Secure technology transfer and commitment to voluntary licensing in all agreements where public funding has been invested in research and development.
  • “Establish stronger regional capacities for manufacturing, regulation, and procurement of needed tools for equitable and effective access to vaccines, therapeutics, diagnostics, and essential supplies, as well as for clinical trials.”

Financing pandemic preparedness and response. Create an International Pandemic Financing Facility to raise additional reliable funding for pandemic preparedness and for rapid surge financing for response in the event of a pandemic with the capacity to mobilize long term (10-15 year) contributions of approximately US$5-10 billion per annum to finance preparedness, with the ability to disburse up to US$50-100 billion at short notice in the event of a crisis

Appoint “National Pandemic” coordinators with direct line to heads of state. Heads of State and Government to appoint national pandemic coordinators who are accountable to them, and who have a mandate to drive whole-of- government coordination for pandemic preparedness and response.  

Access Advocates Laud Report’s Proposals On Vaccines & Medicines Access  

UNAIDS welcomed the report’s recommendations, particularly the “urgent need to establish at Global Health Threats Council at the highest political level in order to coordinate global action against pandemics and secure agreement between governments on aligning efforts to tackle the health, social and economic challenges of major pandemics.

“The IPPR recommendations are a wake-up call for transforming health systems across the world,” said Winnie Byanyima, Executive Director of UNAIDS, in a statement. “Health is a universal public good in this interconnected society—no one is safe until everyone is safe, so we must reimagine health to provide the same quality of care regardless of geography, income or social status.” 

Meanwhile, the advocacy group Medicines, Law and Policy, lauded the report’s “bold recommendations” including its support for the proposed waiver of intellectual property rights on Covid-19 vaccines.  

It cited Clark’s comments that the US support for the waiver, is “a game changer” and “a vital step in the right direction”noting that she also called for WHO to convene vaccine producing countries and companies to agree to voluntary licences and technology transfer for COVID vaccines immediately. 

 

Image Credits: IPPR, The Independent Panel , José Mauquer .

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

Limitations in COVID-19 testing capacity and surveillance—as well as uneven demand for testing—are likely masking the true severity of COVID-19 on the African continent, fueling the dangerous myth that much of Africa has been unscathed by COVID-19.

Test positivity rates were above 10% across many African Union (AU) member states during the second wave—substantially higher than the 5% maximum warning level suggested by the WHO and suggesting that many cases have gone undetected – says new research from the Partnership for Evidence-Based Response to COVID-19 (PERC).

A survey of 24,000 people across 19 AU member states also found that 81% of survey respondents reported challenges in accessing food, 77% reported experiencing income loss and 42% reported missing medical visits since the start of the pandemic.

The report calls for targeted public health measures for high-risk populations, increased surveillance in light of new variants, and scaled-up vaccine supply from the global community to control the pandemic in Africa.

“As case counts surge across the world, new variants emerge and vaccine rollout remains slow, it will be crucial for African Union Member States to use evidence-based strategies to manage COVID-19,” said Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention. “The PERC report provides valuable insights to countries to strategically tailor their ongoing responses.”

High Vaccine Acceptance, But Global Community Needs to Deliver Them to Africa

Though vaccine acceptance was high among survey respondents, with 67% of people saying they would get the vaccine when it’s available, there are several important caveats to consider.

At the time of the survey, access to vaccines and information about them was still being rolled out across the African Union, with lack of information the driving factor to vaccine hesitancy. Recent news about vaccine side-effects also is likely to have diminished vaccine confidence. 

“Vaccine hesitancy is driven by high levels of disinformation, misinformation, and lack of information, which erodes trust in the safety and efficacy of vaccines,” said Dr Richard Mihigo, Program Coordinator, Immunization and Vaccine Development,  WHO’s Regional Office for Africa. 

“Going forward, we must prioritize sustained and targeted campaigns which address the growing infodemic around vaccines while providing evidence-based information to dispel myths and build confidence in vaccines. Communication and engagement is key to building trust and creating a positive discourse around vaccines from the ground up.” 

The delayed rollout of vaccines and the rapidly growing threat posed by new variants does present the opportunity for African Union Member States to ramp up vaccine acceptance campaigns and logistics for efficient vaccine rollout – and continually monitor and address vaccine confidence – before vaccines arrive in the region. 

In addition, the report calls on the global community to deliver vaccines to member states as soon as possible. 

The Africa CDC recently called the United States’ reversal on the World Trade Organization Trade-Related Aspects of Intellectual Property (TRIPS) waiver a ‘positive development’, though also cautioned that the announcement did not guarantee global patent rules for COVID-19 vaccines would be lifted immediately. 

Scale-Up in Public Health Strategies to Prevent Potential COVID-19 Surge

africa
South Africa continues to drive reported COVID-19 cases in Africa; however, reported cases increased significantly in all African Union Member States during the second COVID-19 wave compared to the first

The African Union must also scale up effective testing strategies for detecting potential surges and sustaining the use of public health measures to prevent subsequent waves. 

Nearly nine in 10 respondents reported using masks near others in February 2021, but in some populous and hard hit countries, such as South Africa and Ethiopia, self-reported mask wearing trended downward, suggesting the need to redouble efforts to promote this low-cost and effective intervention in some countries. 

Overall, self-reported adherence to social distancing measures declined between August 2020 and February 2021. 

“Countries are most effective controlling the pandemic when they consider what measures people will actually follow at this stage in the pandemic and take steps to inform, partner with, and support communities,” said Dr Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies.

“Analysis of PERC data can help governments predict adherence to preventive measures, craft effective communications and mount a stronger response to COVID-19.”

Image Credits: EAC, WHO AFRICA, Partnership for Evidence-Based Response to COVID-19.