South Africa’s Health Minister Zweli Mkhize

CAPE TOWN – South Africa has secured enough COVID-19 vaccine doses for 41 million people from Johnson and Johnson and Pfizer, but only 6 million of these will be delivered by June because of “supply constraints”, the country’s health ministry announced on Friday.

Health Minister Zweli Mkhize told a civil society briefing that the vaccination of the country’s 1.25 million health workers should be completed by mid-May – although it has only vaccinated about 300,000 health workers so far because of shortages.

From 17 May, the country will start vaccinating people over the age of 60, workers over 40 and people working in “congregant settings” such as nursing homes. By July, it hopes to move to all people over the age of 40. After October, vaccinations will be opened to everyone and South Africa hopes to vaccinate 41 million of its almost 60 million citizens by February 2022 – the most ambitious rollout by an African country so far.

Secret Pfizer Negotiations ‘Took a While’

Mkhize said that the negotiations with Pfizer “took a while” and this had also prevented the country from getting the 117,000 Pfizer doses it had been allocated by the global vaccine platform, COVAX. The terms of the deal are secret, and the ministry has been unwilling to share the price it is paying or what the sticking points were in the negotiations.

However, Pfizer will start to deliver South Africa’s 20-million-dose order in tranches within 14 days after it received payment on Friday, said the Minister. These will mainly be dispensed in urban areas given that people needed two doses and they needed to be kept in very cold conditions.

Meanwhile, Johnson and Johnson (J&J) has agreed to supply the country with 31 million of its vaccine, which would be prioritised for rural and migrant populations given that they can be kept in ordinary fridges and people only need a single dose.

The J&J vaccines will be assembled in South Africa by the country’s generic producer, Aspen, which means it can be distributed fast because the regulatory safety checks would have been done at the factory, said the minister.

“Our vaccine rollout plan couldn’t be finalised until we knew the flow of the vaccines,” said Mkhize, adding that J&J had provided a schedule until the end of June while Pfizer would be “week to week deliveries”.

Pressure After June

In an earlier interview, Mkhize said he expected one million J&J doses by the end of April and a further 900,000 each in May and June, and some 6.75 million Pfizer doses by June – but this seems to have been over-optimistic.

Health department official Dr Lesley Bamford said that the “largest number of doses are expected in the second half of the year. Supply in the first half is relatively constrained and will cover about six million people”.

This means that the country will have to vaccinate almost 130,000 people a day between June and February 2022 in order to meet its vaccination target. 

To do this, the country has resolved to use a wide range of public and private vaccine sites, including health facilities, schools, churches and workplaces. 

While private doctors and private health facilities will be used, they will be provided with the vaccines by the government and all vaccines will be free.

Trade unions, civil society and faith-based organisations have been invited to join the government’s vaccine oversight committee and the five sub-committees that will assist with the process.

Africa ‘Barely Moved Beyond Starting Line’

Meanwhile, Africa’s Centres for Disease Control (CDC) reported this week that 45 of Africa’s 55 countries had received COVID-19 vaccines and 43 had started vaccinations.

“The pace of vaccine rollout is, however, not uniform, with 93% of the doses given in 10 countries,” said the Africa CDC.

“Many African countries have barely moved beyond the starting line. Limited stocks and supply bottlenecks are putting COVID-19 vaccines out of reach of many people in this region,” warned Dr Matshidiso Moeti, the World Health Organization (WHO) Regional Director for Africa. “Fair access to vaccines must be a reality if we are to collectively make a dent on this pandemic.”

Vaccine rollouts in some countries were being delayed by “operational and financial hurdles or logistical difficulties such as reaching remote locations”.

“Africa is already playing COVID-19 vaccination catch-up, and the gap is widening. While we acknowledge the immense burden placed by the global demand for vaccines, inequity can only worsen scarcity,” said Dr Moeti. “More than a billion Africans remain on the margins of this historic march to overcome the pandemic.”

Through the COVAX, 16.6 million vaccine doses – mainly AstraZeneca – have been delivered to African countries.

 

Image Credits: GCIS.

The COVAX facility aims to deliver 2.3 billion COVID-19 vaccine doses by the end of 2021.

The global vaccine delivery platform, COVAX, might only deliver 20% of its vaccine target by mid-year because of “supply constraints” but it aims to make up the backlog in the second half of the year, according to Dr Seth Berkley, CEO of the global vaccine alliance, Gavi.

“Our goal is still to try to get to 2.3 billion doses by the end of 2021 assuming that there are not any major supply disruptions with any of the manufacturers,” Berkeley told the World Health Organization’s (WHO) biweekly COVID-19 briefing on Friday.

The Serum Institute of India (SII) recently stopped its vaccine supply to COVAX in order to meet the growing domestic demand as COVID-19 cases in India surge.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said on Friday that there “remains a shocking imbalance in the global distribution of vaccines”.

“More than 700 million doses have been administered globally, but over 87% have gone to high-income or upper-middle-income countries while low-income countries have received just 0.2%. On average, in high-income countries, almost one in four people has received a vaccine. In low-income countries, it’s one in more than 500,” said Dr Tedros.

But only 14 countries were not yet ready to vaccinate their health workers and elderly, said Tedros, who had set Saturday 10 April – the 100th day of 2021 – as the global deadline for this to begin. 

Bilateral Deals and Donations Mean Less for COVAX

Seth Berkley, CEO, Gavi, the Vaccine Alliance.

Berkley called for the “continued support from governments and manufacturers because every time a bilateral deal gets done around the COVAX facility it means less doses for COVAX and for equitable distribution”.

“What we’re now beginning to see is supply constraints, not just of vaccines, but also of the goods that go into making vaccines: the filters, the bags that are necessary, the mediums,” said Berkley, whose organisation manages COVAX, along with the Coalition for Epidemic Preparedness Innovations (CEPI).

However, Berkley added that he expected donations of surplus doses from high-income countries to be “an important source of vaccines for COVAX in 2021”.

COVAX has also been working with multilateral development banks to develop mechanisms to enable low-income countries to buy additional vaccines from COVAX “through cost-sharing mechanisms”. 

So far, COVAX has delivered about 38 million vaccine doses to 105 countries.

“The problem is not getting vaccines out of COVAX. The problem is getting them in,” said Tedros. 

Tedros also condemned “vaccine diplomacy” whereby “some countries and companies plan to do their own bilateral vaccine donations by passing COVAX for their own political or commercial reasons”. 

“This is a time for partnership, not patronage. Scarcity of supply is driving vaccine nationalism and vaccine diplomacy,” he stressed.

China and Russia are the biggest culprits of “vaccine diplomacy”, and both countries have donated millions of doses of vaccines developed in their countries to strategically placed low and middle-income countries, particularly in Africa and Latin America. 

Decision on Chinese Vaccine

Meanwhile, the Chinese vaccines, Sinopharm and Sinovac, which applied for WHO emergency use listing in January, “are in the final stages of evaluation”, according to WHO’s Director of medicines Regulation and Prequalification, Rogerio Pinto de Sá Gaspar.

WHO’s technical advisory group on vaccines would discuss the application on 26 April, and possibly also at a second meeting in the first week of May when the final decision would be reached, said De Sá Gaspar.

Berkley said that there were currently seven vaccine products available, and COVAX hoped that this would be expanded to 10 to 15, but the crucial question was how to expand production.

“There is a COVAX manufacturing task force that is looking at technology transfer and how to expand production, but right now one of the worries is limitations in supplies,” said Berkley, as the global vaccine production was usually 5 billion doses but now needed to expand to 10-14 billion. 

“We don’t yet know exactly what 2022 is going to bring. Will we need new vaccines which are going to replace the existing vaccines? Will we need booster doses because of immunity waning or will we need vaccines that are specifically targeted at some of the variants?”

To finance the demand, Gavi is looking for at least $2 billion in additional funding this year and will be appealing for this at next week’s virtual investment opportunity event being hosted by the US, said Berkley.

Meanwhile, Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), described COVAX reaching over 100 countries as an innovation and manufacturing success story “with the scaling up from zero to one billion doses being produced by April 2021”.

“The COVAX public-private partnership and political leadership to equitably share surplus vaccines are the best guarantees we have that people who need the vaccines will get it whenever they live, fast enough to outpace the virus’ mutations,” added Cueni.

Image Credits: WHO, Gavi/Tony Noel.

The WHO and its member states must take swift action to enable a transparent, independent and rigorous investigation into the origins of the SARS-CoV-2 virus, said two dozen international scientists in their second open letter. 

The letter – released on Wednesday by 24 scientists and researchers across Europe, the United States, and Japan – comes on the heels of the controversial WHO-China investigation, which has been criticised for its methodological weaknesses, and for allegedly kowtowing to Chinese interests. 

“In our previous open letter, we outlined our fears that the joint international committee/Chinese government team ‘did not have the mandate, the independence, or the necessary access to carry out a full and unrestricted investigation into all the relevant SARS-CoV-2 origin hypotheses,’ said the letter on Wednesday, which was drafted by former US National Security Council official Jamie Metzl, who is a member of the WHO expert advisory committee on human genome editing.

“Having read the report entitled ‘WHO-convened Global Study of Origins of SARS-CoV-2: China part’…we have regrettably concluded that our concerns were fully justified.”

A group of scientists has called on the WHO and member states to conduct a more thorough investigation into the origins of SARS-CoV-2

WHO-Convened Study Methodologically Weak

Echoing earlier criticisms of the WHO-convened report, the letter expressed concerns that it arbitrarily discounted a key theory on the emergence of SARS-CoV-2, namely that it leaked from the Wuhan Virology Institute, a lab that is well-known for its research on bat coronaviruses that are closely related to SARS-CoV-2.

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team on Wednesday.

Instead, the WHO’s report concluded it was “possible to very likely” that the virus emerged from bats and other wildlife via an animal. It also suggested that the virus could have spread through frozen foods – even though the evidence to support either of those theories remains lackluster, warned the letter.

“No solid justification is provided for why a ‘lab-related accident’(whether a lab-leak or sampling accident) should be considered ‘extremely unlikely’, or why a natural spillover via an unknown animal host should be considered ‘likely to very likely’. At this stage there is still no direct evidence for either pathway nor any verified data or evidence sufficient to rule any one out, while historical evidence amply supports both,” said the letter.

The letter also denounced the report for containing over a dozen incorrect, imprecise, and contradictory assessments in its appendix. One of those – in the report’s Annex D7 – claims that the deaths of a handful of miners in the Yunnan province in 2012 were ‘more likely explained by fungal infections”.

That view, however, contradicts positive antibody results for a bat SARS coronavirus in 4 out 6 of the miners that fell ill, the letter said. It also seems to go against the diagnosis of Zhong Nanshan, a leading coronavirus expert who believed that the primary cause of death of the miners was a SARS-like coronavirus infection rather than a secondary fungal infection.

“The fungal infection diagnosis is however in contradiction with the diagnostic of Prof. Zhong Nanshan, the foremost Chinese SARS expert at the time, who diagnosed a most likely primary infection from a SARS-like coronavirus, with a possible secondary fungal infection in some cases (pulmonary aspergillosis),” said the letter.

“Further, the diagnosis of the ‘WIV [Wuhan Institute of Virology] experts’ also contradicts the positive bat SARS coronavirus antibody tests (IgM and/or IgG) obtained for 4 of the 6 miners (these four tests were carried out at the WIV itself and described in this PhD thesis”.

Chinese Foreign Ministry Said Open Letter Lacks Scientific Credibility  

Responding to the open letter, Chinese Foreign Ministry spokesperson Zhao Lijian questioned its scientific credibility, calling it an attempt to politicise the ‘origins’ investigation and to discredit China – claims that Metzl later rebutted on Twitter.

“These [open letter] signatories can deceive no one as to whether their letters are meant to make a true proposal for scientific and professional origin-tracing or target a specific country with presumption of guilt,” Jijian told a press conference on Thursday.

“The origin-tracing study was indeed affected by political factors, but that did not come from China, but from the United States and some other countries, who are bent on politicizing the origin-tracing issue in an attempt to disrupt China’s cooperation with WHO and discredit China, ” he added.

He also said the lab hypothesis is “extremely unlikely”, noting that the findings of the SARS-CoV-2 origins report were based on “frank” and “science-based exchanges” between WHO experts and “relevant” Chinese institutions.

“As for the lab hypothesis, experts on the mission all agreed that lab leaking is extremely unlikely, after visiting disease control centers in Hubei and Wuhan, the Wuhan Institute of Virology and various biosafety labs, and after having in-depth, frank and science-based exchanges with their Chinese peers from relevant research institutions.”

Open Letter Echoes Earlier Calls For More Robust Investigation

However, even the WHO’s director-general, Dr Tedros Adhanom Ghebreyesus, who has tried to steer a careful balance between US and Chinese geopolitical rivalries on the origins investigation, has admitted that the report’s findings are limited – and he has also told member states that the lab hypothesis should not be discarded out of hand. 

“Although the team has concluded that a laboratory leak is the least likely hypothesis, this requires further investigation, potentially with additional missions involving specialist experts, which I am ready to deploy,” he said at a closed-door briefing with member states last month.

“I do not believe that this assessment was extensive enough. Further data and studies will be needed to reach more robust conclusions.”

The letter also echoes earlier calls from a bloc of 14 countries – including the United States, Australia, Canada, Denmark, Japan, Norway, Korea and the United Kingdom – for more comprehensive studies into the origins of the virus in the future.

“It is critical for independent experts to have full access to all pertinent human, animal, and environmental data, research, and personnel involved in the early stages of the outbreak relevant to determining how this pandemic emerged,” said the joint statement from member states. 

Renewed Commitment Needed To Enable Robust Investigation 

Going forward, the WHO and member states can take three possible steps to enable a more comprehensive, independent, and transparent study into the origins of SARS-CoV-2.

The “most logical” step would involve revising the terms of reference between the WHO and China, to ensure that:

  • The composition of the expert group is determined in a transparent way by the WHO’s Executive board;
  • The selection procedure prevents conflicts of interests;
  • The group includes experts on biosafety, biosecurity and biodata;
  • The group gains greater access to sites, records and data, without requiring supervision from government authorities;

In anticipation that the revisions “cannot be agreed upon and implemented in the very near term”, the letter proposes a second option – a new resolution that could be passed at the upcoming World Health Assembly (WHA) to give the WHO the legal mandate for an “independent” and “unrestricted investigation”.

However, should a resolution fail to be ratified at the WHA, the letter suggests a third option.

Governments could come together to develop a “new and independent process”, with China’s cooperation if possible, but without it if not.

“If it should prove impossible for the Terms of Reference to be quickly revised or for a new and sufficient World Health Assembly resolution to be passed in the coming session, the best remaining alternative would be for governments…to come together to develop a new and independent process, with China’s cooperation if possible but without it if not.”

-This story was updated on Friday to reflect the Chinese Foreign Ministry’s reaction to the open letter and Jamie Metzl’s subsequent response to it.

Image Credits: CNN, New York Times.

Delays in COVID-19 vaccine deliveries to Africa will hamper public health agencies’ vaccination schedules.

The latest wave of the COVID-19 pandemic in India has delayed vaccine delivery to African countries and is expected to adversely affect vaccine roll-out programs and the continent’s response efforts until the third quarter of the year.

The Indian government’s decision to suspend exports of the vaccines from the Serum Institute of India (SII) to countries in Africa will further prevent public health agencies from maintaining specific vaccination schedules in a predictable manner, especially from mid-April to July, according to  Dr John Nkengasong, Director of the Africa CDC.

Speaking during a press briefing on Thursday Nkengasong said: “If the shipment of vaccines was not interrupted because of the situation in India, we would have had a nice coverage between now to June, and then from June or July onwards, our own deliveries will kick in and even more COVAX deliveries will come in”.

“In a good vaccination program, predictability of availability of vaccines is very, very important so that you know when and how to use your first doses and how to counsel people that have received their first doses to come in for a second dose. The situation with the Serum Institute and the government of India makes it very complicated for our vaccination program across the continent,” Nkengasong added.

India is battling a new wave of COVID-19 infections. On April 7, the pandemic reached a new peak with nearly 127,000 confirmed cases — the highest number of daily confirmed cases in the country since the pandemic began. To control the spread of the pandemic, several major cities including Mumbai and New Delhi have imposed curfews and the government aims to vaccinate as many people with doses of vaccines produced in the country within a short period of time. 

To achieve this, it directed the country’s leading vaccine producer to prioritise the country’s vaccine needs over its international commitments. Already, India has vaccinated over 90 million people against COVID-19 with more than 11.4 million people fully vaccinated. However, it has only been able to fully vaccinate 0.8% of its total population.

Dr Matshidiso Moeti, World Health Organization’s (WHO) regional head for Africa however said that despite the delay in the India shipments, more vaccine  deliveries were expected in the coming weeks from the COVAX facility to several African countries including Guinea, Guinea-Bissau, Mauritania, Niger, Cameroon and the Comoros.

Moeti said several African countries that had initially received vaccine shipments have already exhausted more than two-third of their supplies. With no information on the next shipment dates, WHO said it is guiding countries on how to optimise the national deployment of the available doses while also working with key partners to scale up Africa’s vaccine production capacities.

“But we recognize that this cannot be achieved overnight, short term solutions are needed, that prioritize vaccine equity [as] Africa is already playing COVID-19 vaccination catch up,” Moeti said.

COVAX Reaches Over 100 Economies

The COVAX facility led by Gavi announced in a statement today that it has reached 100 economies just 42 days after the first international delivery of vaccine – it expects to deliver doses to all participating economies that have requested vaccines in the first half of the year.

Gavi said over 38 million doses of vaccines from manufacturers AstraZeneca, Pfizer-BioNTech and SII have been delivered.

Dr Seth Berkley, Gavi  CEO,  said there were still several challenges with vaccine delivery as  the world seeks to end the acute stage of the pandemic. 

“We will only be safe when everybody is safe and our efforts to rapidly accelerate the volume of doses depend on the continued support of governments and vaccine manufacturers. As we continue with the largest and most rapid global vaccine rollout in history, this is no time for complacency,” Berkley said.

AstraZeneca Vaccines Benefits Outweigh the Risks

Dr Matshidiso Moeti, WHO Regional Director for Africa

The Africa CDC and the WHO said despite the latest report from the European Medicines Agency (EMA) regarding the Oxford/AstraZeneca COVID-19 vaccine, African countries can still continue to roll out the vaccine noting that the occurrence of the blood clot findings is very low and does not warrant a suspension of ongoing vaccination efforts.

“I just like to emphasize how very few people this is compared to those that have received the vaccine. So about 200 million people have received the (AstraZeneca) vaccine and about 100 to 200 cases of this manifestation have been found, so it is an extremely rare event,” Moeti said.

While WHO and its partners are analysing the date, the global health body said it will continue to recommend the vaccine because the benefits outweigh the risks.

“If you look at the millions of people that have died of COVID-19, compared to those that have been vaccinated, and a very tiny number that have manifested this side effect. We will continue to recommend its use,” Moeti said.

Nkengasong said there has  been no reported case of the side effects of AstraZeneca in Africa.

“We and others including the WHO, have also put in place a system to continue to monitor the side effects and rare occurrences of any other events across Africa,” Nkengasong said.

Vaccine Passports Will Exacerbate Huge Inequalities

The Africa CDC and WHO further expressed concerns regarding the growing calls for vaccine passports which they said could be discriminating against Africans who would have received the vaccines if enough doses were available in their countries.

Vaccine passports for COVID-19 continue to be a polarising debate across the world. Similar to a country’s national passport, holders of vaccine passports could gain entry into venues for crowded concerts, it could also be required by foreign countries as proof of vaccination against COVID-19 as another requirement for entry other than valid national passport. Even though it is considered to be likely legal, vaccine passports are on track to become the latest divide in the global fight against the COVID-19 pandemic.

Nkengasong told Health Policy Watch any imposition of a vaccination passport will create and exacerbate huge inequalities. “We already are in a situation where we don’t have vaccines, and it will be extremely unfortunate that countries impose travel requirements of vaccine immunisation certificates, whereas the rest of the world has not had the chance to have access to vaccines — not because the continent doesn’t want to be vaccinated, they just don’t have the vaccine.”

John Nkengasong, Director of the Africa Centres for Disease Control, believes vaccination passports will create and exacerbate huge inequalities.

According to him, there are African countries that have the money to get vaccines, but there are no vaccines to be acquired. “So our position is clear that we cannot at this point impose it. It will be inappropriate to impose vaccination passport requirements, given where we are in the rollout of vaccination across the continent,” he said.

Moeti is of the view that vaccine passports can only be used for vaccines that are widely and equitably available across countries. “This is not yet the situation with the COVID-19 vaccination,” she said. “We would like to encourage the imposition of vaccine passports, as a condition for people to gain entry into countries not be applied, while we work together at the global level.”

Image Credits: Felix Dlangamandla, Our World in Data, Paul Adepoju.

A health worker receives her first dose of Sinovac Biotech’s Coronavac vaccine at the Ospital ng Malabon (Hospital of Malabon).

New York City – While the Philippines ranks 50 out of the 155 countries that have administered the most COVID-19 vaccines, opposition leaders and health officials fear the collapse of the country’s healthcare system amid a surge in new infections. 

Globally, more than 704 million doses – about 4.6% of the global population – of vaccines have been administered so far, according to the Bloomberg Vaccine Tracker.

As of 5 April, the Philippines has administered 854,063 doses, placing it as the 50th highest of 155 countries, said vaccine “czar” Secretary Carlito Galvez Jr, who is also the chief implementer of the National Task Force against COVID-19 in the country.

Those vaccinated include 789,415 health workers, around 11,000 elderly, and some 7,100 people with comorbidities, he added.

But while the national government touts its successes in vaccination, what is occurring on the ground reflects a different story.

“Inconsistent” Data Underreports Full Capacity Hospitals 
ABS-CBN Data Analytics head Edson Guido

A senior data analyst flagged the “inconsistent” data reporting from the Department of Health (DOH) regarding hospital bed occupancy in the country.

ABS-CBN Data Analytics head Edson Guido said there was conflicting reporting on the occupancy rate of hospitals, particularly in Metro Manila. 

The DOH had initially reported 78% of intensive care unit beds in the region were filled, 78% of isolation beds were utilized, and 60% of ward beds were occupied. Around 60% of ventilators were also in use. 

“The reports on the ground say [bed occupancy] in Metro Manila is full and [patients] were brought to other provinces. So, there seems to be a disconnect in terms of deaths and bed occupancy that the DOH is reporting from what’s happening on the ground,” Guido said. 

A patient is seen in a hospital bed outside the San Juan Medical Center in San Juan City on Thursday.

Philippine hospitals across the country had declared full capacity and many were no longer taking patients. Some private hospitals had switched to offering home care.

The Medical City, an 800-bed hospital in Metro Manila, has three-to-10 day programs that can cost as much as 65,000 pesos (USD $1,340), which includes infection control, virtual monitoring, swabbing and blood extraction services. 

Vice President Leni Robredo, who leads the political opposition, questioned, in a Facebook post last week, these expensive “Home Care Medical Packages,” which only the richest Filipinos can afford. 

“Are there guidelines from the DOH that the Home Care Specialists have to follow to ensure the safety of the people who get sick?” she said. 

The surge is taking its toll on the healthcare workforce as well, as 117 of 180 staff tested positive at the Philippine Orthopedic Center in Manila, forcing the facility to close its outpatient department, which can serve as many as 450 patients a day. 

“When our medical front-liners are getting sick, the threat of collapse of our healthcare system is big. We must control the spread of the disease,” Opposition Senator Francis Pangilinan, in a 3 April statement, said. 

Former president Joseph Estrada spent the night in an emergency room after being rushed to a Manila hospital with COVID-19 complications on 28 March, since regular beds were occupied. Estrada was later admitted to the intensive care unit and is now on a ventilator as his pneumonia worsened, his son said in a Facebook post on Monday. 

Philippine hospitals are at overcapacity, forcing patients to receive treatments in their cars.

Others do not even have the chance to enter a hospital at all. 

“Many have already died inside tents outside hospitals, waiting to be admitted to the ERs, in an ambulance while in transit, at home without receiving any medical help,” Robredo said.

The government is currently planning to allocate more living quarters for healthcare workers in the National Capital Region Plus (NCR Plus), making arrangements with hotels and other lodging service providers. 

Pangilinan warns of a “humanitarian crisis that will overwhelm the country and wipe out families” if the government does not step up its efforts. “Step on the gas. Testing, tracing, isolation, and treatment are the four wheels of the anti-COVID ambulance. Government efforts must be toward accelerating the ambulance to outpace the infection and save all of us,” he said. 

Government Recalibrating Strategy – Vaccinations and Self-Isolation Measures
Vaccine “czar” Secretary Carlito Galvez Jr, (left) who is also the chief implementer of the National Task Force against COVID-19

In response to the continued rise of COVID-19 cases in NCR Plus, the government is recalibrating its immunization efforts towards areas with high infection rates. 

Building herd immunity in high-risks areas such as Metro Manila could address the spike in local transmissions, said vaccine czar Galvez. 

He added that inoculation of at least five million individuals in Metro Manila will jumpstart the process of achieving herd immunity and will enable the government to offset the delays in vaccine deliveries. 

Senator Pangilinan also advised free mass testing, citing Vice President Robredo’s mobile free mass testing initiative called Swab Cab. 

The Swab Cab initiative brings COVID-19 testing to communities through use of buses that were converted into mobile testing sites. The program, started with Robredo’s private sector partners, is meant to augment the government’s testing capacity. 

Both Robredo and Pangilinan highlighted the need for the government, on top of recalibrating its vaccination strategy, to ensure that the people of the Philippines were provided for during self-isolation.

“Those who go on self-isolation and their family must be assured of food,” said Pangilinan. 

Said Robredo: “Have we built a system where people who are self isolating at home would still have access to medical help when necessary? Did [the government] even fix the infrastructure?” 

Strictest Lockdown Measure Implemented In Philippines Capital Region
philippines
A delivery driver wears a mask and unloads essential items amid the COVID-19 lockdown

The Philippines’s dramatic surge in cases has forced the government to implement the toughest of 4 lockdown levels until 11 April in Metro Manila and the surrounding provinces of Bulacan, Cavite, Laguna, and Rizal. 

Health officials attribute the rising cases to the unexpected spread of more infectious coronavirus variants.

“No one could have probably foreseen how infectious these new variants are and as a result of which we have these ballooning numbers,” presidential spokesman Harry Roque told ABS CBN News.

The Philippines nationwide cases data, with recent weeks averages not computed, owing to delays in reporting

As of 8 April, there are 828,366 COVID-19 cases in the Philippines, with 9,216 new cases and 14,119 deaths, the highest totals in Southeast Asia after Indonesia. 

The national government had initially placed Metro Manila and its provinces under a General Community Quarantine (GCQ) bubble on 22 March.

A bubble setup is applied to a cluster of people restricted from going in and out of a covered area unless authorized to do so. Going in and out of NCR Plus is limited to essential workers and essential travel. 

Public transportation remains operational, with proper social distancing measures in place. 

However, the GCQ was upgraded to an Enhanced Community Quarantine (ECQ) on 29 March, and was extended to 11 April as daily infections breached 10,000. 

The ECQ limits further movement to accessing essential goods or services, or performing essential work. Religious services, including the past week’s Holy Week and Easter events for Roman Catholics, were shifted online after public gatherings were temporarily banned. 

PH Lags Behind Southeast Asia Neighbours; Temporarily Suspends Use of AstraZeneca Vaccine
Doses administered per 100 people

According to NY Times data, the country in fact lags behind the rest of its Southeast Asian neighbours, having administered 0.9 doses per 100 people as of today, compared to Indonesia’s 2.4 doses and Malaysia’s 1.1 doses. 

The country expects to vaccinate up to 70 million people this year, and has so far received 2 million COVID-19 doses from China-based Sinovac Biotech, and 525,600 vaccine doses from British-Swedish pharma company AstraZeneca. Vaccines from Russia-based Sputnik V are also expected to arrive this month. 

Vaccine deliveries will gradually increase in May and June, with a total of 10.5 million doses from Sinovac, Sputnik V, Novavax, and AstraZeneca. 

However, the announcement by the European Medicines Agency during a 7 April press conference that there appears to be a link between AstraZeneca’s vaccine and very rare cases of blood clots mainly younger women,  has resulted in the Philippines government temporarily suspended use of the vaccine in people under 60. 

“I want to emphasize that this temporary suspension DOES NOT MEAN that the vaccine is unsafe or ineffective. It just means that we are taking precautionary measures to ensure the safety of every Filipino. We continue to underscore that the benefits of vaccination continue to outweigh the risks and we urge everyone to get vaccinated when it’s their turn,” Philippines Food and Drug Administration Director General Rolando Enrique Domingo said in a statement.

Image Credits: ILO/Minette Rimando, IMF Photo/Lisa Marie David, ABS-CBN, Philippine Star/Twitter , HDetalla/Twitter, ABS-CBN, Philippines DOH, NYTimes.

In a powerful ruling that could increase transparency and thus, industry compliance, India’s National Green Tribunal has directed state and central pollution control boards to chart and openly share with the public detailed data from online continuous emissions/effluents monitoring systems (OCEMS) operating in the country’s highly-polluting industrial sector. 

These powerful industrial interests – ranging from cement to mining – account for one-third and one half of the country’s urban air pollution – and a large part of pollution of the country’s  lakes and streams, including the iconic Ganges.  

In issuing the directive on data collection and sharing, the Green Tribunal – established 11 years ago for the expeditious legal review of appeals on environmental pollution issues –  was following up on a 2017 Supreme Court order directing all states to ensure that polluting industries instal OCEMS and make industrial emissions data publicly available.

In an assessment of state inaction and industry non-compliance,  the Indian non-profit Legal Initiative for Forest and Environment (LIFE) last year reported that of the 32 state-managed pollution control boards, one-half had not even bothered to create online continuous emission monitoring portals – as per the Supreme Court directive. 

And of the 16 Indian states that had complied with the original Supreme Court judgement, only 38% allow public users to access and assess the data generated, LIFE noted. 

The rest is hidden away behind passwords, something the petitioners want to unlock to force transparency. 

In the recent case, the southern regional bench of the Green Tribunal, directed the states of Tamil Nadu, Karnataka, Andhra Pradesh, Kerala and the union territory of Bunchberry to comply with the Supreme Court  directive by April 9. 

The  petitioners now plan to approach the western, eastern and principal [national] benches of the Green Tribunal, to ensure nationwide compliance with the Supreme Court directives, environmental lawyer and LIFE founder Ritwick Dutta told Health Policy Watch this week. 

The industrial emissions monitored under the OCEMS systems and regulations include both effluents dumped into lakes and rivers, often untreated, as well as airborne emissions of particulate matter, carbon monoxide, nitrous oxides, sulphur oxides, and hydrogen fluorides – released as smokestack emissions from plants lacking effective filtering equipment. 

 

Air pollution leads to almost 1.7 million premature deaths a year in India, as a result of cardiovascular and respiratory diseases, lung and other cancers, strokes, pre-term birth, type-2 diabetes, and several other neurological and cognitive illnesses. 

Clean Air Advocates Welcome Ruling Covering Tens of Thousands of Industrial Polluters 

The ruling was welcomed by citizen scientists and clean air advocates, who said that making data on emission and effluents more transparent and accessible will help empower the public and drive change. 

“Brilliant directive,” tweeted Ronak Sutaria, data scientist and urban policy researcher who has been following this data – or lack of it – since the Indian government started monitoring industrial emissions and effluents that flow into rivers and lakes across the country in 2014.  

“Industrial pollution from notified high-polluting industries typically accounts for 30% to 50% of the total pollution experienced in most urban cities and towns,” said Sutaria, who runs urbansciences.in, a low-cost real-time air quality monitoring network. “The OCEMS systems are the last checkpoints before these pollutants escape into our environment.” 

Another issue is the overall lack of OCEMS device and thus monitoring at many industrial sites. In the heavily industrialised western state of Maharashtra, for instance, in just one region,  there are nearly 23,500 high pollution potential industries. In contrast,  the total number of OCEMS installed in the entire country is only about 4,000. This is a problem of industry compliance.

Most data generated by even these is largely inaccessible to the public, added clean air expert, Chetan Bhattacharji, a board member of the advocacy group Care for Air.  “The data the OCEMS collects—inarguably vital for public health—remains opaque. It is either faulty, insufficient, complicated or difficult to access,” says Bhattacharji. 

North India is equally non-compliant. A news story in March reported that the Central Pollution Control Board (CPCB) itself cracked the whip on the 1,631 “grossly polluting industries in the Yamuna basin,”  80% of which are non-compliant, asking them to share their pollution data and connect to the CPCB server within 3 months.

How the OCEMS Work

Seventeen categories of industries designated as highly polluting are legally mandated to instal and maintain online continuous emissions monitoring systems. These “red” categories of polluting industries include aluminium, zinc, copper plants, power and cement plants, distilleries, fertilisers, iron and steel plants, oil refineries, petrochemical and tanneries, all of which have powerful lobbies at work.

These industries are supposed to share the data they generate with the pollution control boards in the states where they are located –  uploading it in 15-minute intervals.  Those boards, in turn, are supposed to create a repository under the supervision of  the CPCB – but they don’t always do so. 

So while the monitoring equipment is owned by industry, the data it generates is intended to be shared with the government, at state level and nationally. 

The petitioners are trying to ensure that this, by default, is also shared with the public. This, they say, should also include public access to historic data, location coordinates of air quality monitoring stations, and more. Made public, such data would flow into a central repository of OCEMS data, paid for by industry, but owned by the public via the CPCB, which oversees and reports on air pollution nationally. 

Industry Conflicts of Interest Remain At Heart Of Transparency & Compliance Issues 

 

While the recent Green Tribunal ruling, issued in March, focuses on industry compliance and public accessibility of data,  what it doesn’t address is an inherent and clear conflict of interest: The commissioning and operations of the monitoring systems are left to the same industries which are themselves being monitored for their emissions. This means polluting units themselves self-monitor and upload pollution data to the pollution control boards directly.  This is akin to asking students to grade their own exam papers. 

Thus, the recent ruling only goes part-way in making most effective use of the considerable data-generation potential inherent to the OCEMS systems. But even if the ruling ends up solving the problems of compliance and accessibility, that would be a good first step. 

In fact, Sutaria and Bhattacharji have argued that these thousands of monitors be immediately brought under a transparent regime where the data can be analysed, verified and reported. The two sought greater air pollution data transparency in a report published by an Indian research foundation. 

“Understanding of city-level air quality could be strengthened if residents who live in spaces where industries are present, are able to access information about industrial emissions in their areas,” the report by Sutaria and Bhattacharji stated.

Developed countries such as the United States and countries in the European Union make similar data freely available to the public enabling citizens to track industrial air pollution across the country. In India, this is not the case, they observe. 

“The Environment Protection Agency (EPA) makes industrial emissions data from all Continuous Emission Monitoring System (CEMS) -regulated monitoring locations freely available to the public… the European Environmental Agency maintains the European Pollutant Release and Transfer Register (E-PRTR) which contains industrial pollution data from more than 34,000 facilities across 33 EU countries,” Sutaria and Bhattacharji note in their report.

“Environmental groups have used such data to identify the air polluters in a region and have held them accountable, such as the Tata Steel plant in Netherlands. Overall, in the European countries, industrial pollution emissions have steadily gone down since 2007, when the datasets were first made available across the Union.”

“This data enables citizens to track industrial air pollution data across Europe, including who the top polluters are and the spatial and temporal trends of the emissions for each of those industrial locations. If 33 countries can collaborate to do this, one country, India, should easily be able do this across all its states,” adds Sutaria.

If all the OCEMS data was publicly and transparently available, it could give enough raw data to create a robust environmental monitoring ecosystem, a first step towards transparency, accountability and control. Such a system would not just empower the populations most vulnerable to health harm from industrial pollution, but also strengthen the government’s own monitoring, helping it to geolocate where industrial pollution is coming from.

Until now, however, the government’s pollution boards in fact fail to have any impact on pollution mitigation, says one researcher, Dharmesh Shah. 

“Empirically speaking, the Central and state pollution control board across India have effectively, and for all practical reasons, abandoned the notion of “controlling” pollution,” he tweeted.

Properly Collected Industry Data Could Fill Gaps in Ambient Air Pollution Monitoring Systems

If industry shared its data cleanly and ethically, that data would also fill existing gaps in ambient air pollution monitoring systems, says Bhattacharji. The breadth of health harm triggered by air pollution makes this real-time data from these OCEMS of critical importance.

Until October 2020, the government owned just 234 continuous air pollution monitors (called Continuous Ambient Air Quality Monitoring Systems (CAAQMS)), the data that  serves as the basis for urban air quality monitoring and reporting, based on a national Air Quality Index. 

In comparing sheer numbers of monitoring devices, industrial monitoring is about ten times as dense as government-controlled ambient air quality monitoring systems, he notes, saying, “By this yardstick, it is apparent that the scale of monitoring of pollutants is bigger in the country’s industrial sector.” 

CAAQMS and OCEMS differ only insofar  as the first tracks ambient air quality levels, while the OCEMS track industrial  emissions at source. 

Health advisories are made based on CAAQMS. Industry in most places contributes anywhere from 30%  to 50% to ambient pollution, explain experts. However, at the same time, OCEMS systems are critical to identifying the actual sources of air pollution – and then acting to limit them. 

“The OCEMS network is regulated by the same regulatory body, the CPCB, and monitors similar parameters as those covered by the CAAQMS,” says Bhattacharji – arguing that the two need to be linked directly under the control of the national pollution control board.

With data as key, if such linkage was ever made, the nemesis for industry’s rampant pollution may yet be around the corner.

–

Jyoti Pande Lavakare is a journalist and author whose non-fiction memoir about the human cost of air pollution, Breathing Here is Injurious to Your Health, was published by Hachette in November 2020.

Image Credits: Flickr, Uncommonthought.com, Jyoti Pande Lavakare.

A new report has found that HIV and TB patients faced significant new barriers to access care in the COVID pandemic era.

In the past year, across all non-COVID conditions, routine health care has changed. GPs feel that acute care has been compromised due to their own changed focus, and because patients consult less frequently for non-COVID conditions. 

For HIV and TB communities, both diseases exacerbated by poverty and marginalisation, these impacts are particularly acute. The World Health Organization has estimated that 1.4 million fewer people received care for TB in 2020 than in 2019, and a recent Lancet study found that 11 out of 19 countries in Central and Eastern Europe had physicians sharing HIV and COVID-19 care duties, impacting the quality and frequency of services to HIV key affected populations. 

A new report by the Alliance for Public Health finds that in Eastern Europe, Central Asia, and the Balkans, HIV and TB patients faced significant new barriers to access care in the COVID pandemic era.  These findings are particularly significant since two of the six countries studied, Bosnia and Herzegovina and Moldova, are also among the ten top countries worldwide in terms of COVID deaths per capita. 

Findings of the study were also presented in an online discussion on 7th April 2021, on the occasion of World Health Day, attended by over 150 individuals working in the HIV and TB space across the region. The issues, likely to be seen in other high-burden HIV and TB countries as well, include:  

  • Less ability of patients to consult clinicians; 
  • Reduced access to testing and treatment, including threats of sanctions for breaches of lockdown;
  • Technological barriers to access new mobile- and e-health methods to access care. 
  • Insufficient social safety nets and direct financial support for HIV and TB communities – especially given their work in the informal economy

The study, co-authored by APH along with Matahari Global Solutions, drew upon interviews with patients, clinicians, government officials, and key informants in Bosnia and Herzegovina, Georgia, Kyrgyzstan, Moldova, Russia, and Ukraine, and sought to provide an illustrative picture of access to care for HIV and TB communities in those countries. 

25-50% Reductions of HIV Testing & TB Detection

All countries examined found reductions of HIV testing and TB detection of at least 25-50%. 

Similarly in the case of HIV treatment, comprehensive treatment in the framework of “People Living with HIV” (PLHIV) in the Eastern Europe and Central Asia (EECA) region only stood at 44% pre-COVID pandemic. In comparison, HIV testing services were reduced by 33% in Moldova, 12% in Kyrgyzstan, and by 21% in Ukraine in 2020 as compared to 2019. Similarly, antiretroviral treatment (ART) uptake in Moldova decreased by 25% over the past year, in Kyrgyzstan by 14%, and by 11% in Ukraine. 

In Georgia, the National Centre for TB and Lung Diseases sought to tackle the 25% reduction in TB detection by increasing screening via mobile X-rays equipped with artificial intelligence technology and screening each COVID-19 patient for TB, given similar symptoms. 

In Kyrgyzstan, a country already struggling with inadequate medical infrastructure, organisations working on TB in Osh, the country’s second largest city, said that X-ray machines were of low quality, and that COVID-19 rules saw long queues for access to X-rays and other necessary services for TB screening. Patients also didn’t have the financial resources to pay out of pocket for additional diagnostics. There were additional barriers caused by security guards to health facilities, whose main duties were to ensure adherence to social distancing, and did not comprehend the necessity of patients attending in person. 

An NGO leader based in Osh told us: “Doctors sent (the patient) for a CT scan, which costs about $30, and the clients do not have the financial resources for this… The security guard at the entrance asked visitors in great detail why they came to the doctor, and it took a lot of time and effort to explain everything to these guards, who, in principle, did not understand the issues and did not care about (them).” Compounding these access issues, according to one medical specialist from Bishkek, was the use of anti-TB antibiotics to treat COVID patients at the early stage of the pandemic, and concerns about rising antimicrobial resistance (AMR) and drug-resistant forms of TB. And while there are ongoing projects to tackle serious AMR issues in Kyrgyzstan via promoting the rational use of antibiotics, COVID-19 set back progress and will need urgent scale-up of AMR stewardship activities. 

A medical professional works in the temporary Covid-19 care centre Palace of Sport in Bishkek, Kyrgyz Republic in July 2020.

All countries saw the scale-up of mobile- and e-health tools to access services during the COVID-19 pandemic. In Ukraine, people living with HIV used an app to track their recent viral load counts, HIV medicine supplies, and allowed for management for appointments with clinicians. In Kyrgyzstan, ad hoc Whatsapp groups allowed patients in remote rural areas to connect with specialists from Bishkek, an opportunity not normally afforded to them. In Moldova, Georgia, Ukraine, and Kyrgyzstan, the use of video support to increase adherence to TB medication regimens increased. 

Loss of Incomes During COVID-19 Exacerbate HIV & TB Outcomes

But emerging from all countries was the sense that without income support, especially for vulnerable groups that had lost their jobs during COVID-19, treatment adherence measures would all fall by the wayside. An activist from TBPeople Ukraine told us: “We have not once spoken of the fact that people were left without support. What happened to tuberculosis? People who were on treatment for a long time but were unable to find jobs – they felt like burdens on their families. Most were just left to go home without any material or social assistance. What DOT and treatment adherence can we talk about if the person had nothing to eat?” In Moldova, ex-prisoners predominantly work as construction workers and had lost all income during the COVID-19 pandemic, and was cited as a factor for TB treatment dropout. All countries examined lacked sufficiently broad social safety nets to support individuals and families through COVID-19 income losses. 

And in Bosnia and Herzegovina, a poor transition out of Global Fund funding meant that services for key HIV populations, including men who have sex with men and people who use drugs, had serious sustainability issues, and these were amplified during COVID. In a country where stigma tow-ards gay men is high, and where clinical care for gay men is outdated, drop-in centres proved to be an important safe space where gay men could get services. After the Global Fund transition, these drop-in centres were de-funded, and COVID-19 saw a massive reduction in access to HIV and other sexual health services for this group. 

The region will need comprehensive COVID-19/HIV/TB recovery strategies, including widening of mobile HIV and TB screening services, a scale-up in HIV self-testing, scale-up of funding of programs to serve HIV and TB communities (including safe spaces for gay men in Bosnia and Herzegovina), broader social safety programmes, integration of TB and COVID-19 testing, and digital support initiatives to help bridge e-health gaps. 

Insights from the Panel Discussions 

Dr Nino Lomtadze, Head of Surveillance from the Georgian National Centre for TB and Lung Diseases.

Additionally, a number of important insights emerged from Wednesday’s discussion:  

  • Dr Andrei Dadu of the WHO European Regional Office, emphasised that people living with HIV and TB communities should be prioritised to receive COVID-19 vaccinations under second phases of vaccination programmes. 
  • Anton Basenko, of the Alliance for Public Health in Ukraine, said that the financial support for HIV and TB communities shouldn’t solely be focused on masks and sanitisers, but also on direct financial support and provision of psychosocial support. 
  • Maka Gogia, of the Georgian Harm Reduction Network, described how the pandemic-era  scale-up of sterile needle-and-syringe vending machines in Tbilisi, five-day take home doses for opioid substitution therapies, and online medical consultations with people who use drugs, had all become important adaptations to the pandemic. But there is a need for increased financial support to deliver services to remote regions of the country. 

Pavel Aksenov, summarising findings for Russia, and said that there is a need for the better  integration of community-based TB programmes and facilities with psychosocial support for patients. 

In addition, he called for a revival of high profile HIV and TB testing campaigns to recover declines in testing seen during the COVID-19 pandemic. 

Finally, there is a need to develop and integrate new remote and contactless ways for key affected populations to access necessary services, including the optimisation of online counselling. Aksenov also noted that NGOs receiving external funding may be categorised as ‘foreign agents’, so need flexibility from donors in COVID-19/HIV/TB fund reprogramming, to ensure that NGOs can cope with additional administrative and financial burdens of reporting on donor funding. 

All in all, COVID-19/HIV/TB recovery plans need to take into account best practices and findings from this report, including the urgent need to broaden social safety nets to HIV and TB communities, including direct financial support, and to facilitate access to online and mobile access to HIV and TB services. 

In the words of Dr Stela Bivol from PAS Center in Moldova, quoted in the report, “What’s not covered now is that all these vulnerable populations need more material support. They need more welfare support that is beyond the financial incentives to be on TB treatment, they need livelihood support.”

Dr Fifa Rahman

* Dr Fifa Rahman is Principal Consultant for Matahari Global Solutions, and Permanent NGO Representative on the Facilitation Council of the WHO Access to COVID-19 Tools Accelerator; Pavel Aksenov is Associate Consultant for Matahari Global Solutions; Tetiana Deshko is Director of the International Programs for the Alliance for Public Health, and Oleksandr Zeziulin is MD, MPH, Senior Researcher, Ukraine Institute on Public Health Policy

Image Credits: World Health Organization, Shutterstock.

India is wasting 6.5% of its vaccines, data released by the country’s government shows.

Pune – Despite ramping up its coronavirus vaccination drive and amidst a deadly second wave of infections, India is wasting 6.5% of its vaccines, data released by the country’s government shows.

Experts this week told Health Policy Watch that while the high vaccine wastage is also a sign of vaccine hesitancy – particularly among poor groups traditionally suspicious of government – there are other factors contributing to inefficiencies in the vaccine delivery.

“Wastage is caused due to inadequate numbers”, said Rajeev Sadanandan, chief executive officer of the New Delhi-based Health Systems Transformation Platform (HSTP) – referring to the lackluster response and no-shows that have characterized the vaccination campaign in some regions, and among some populations.

“A vial once opened cannot be recapped. Each vial is meant for 10 persons. If they do not get 10 persons per vial they have to throw away the vial. The solution is to plan the vaccination coupled with mobilisation of eligible persons.”

The data on vaccine waste, released on March 17, shows that vaccine wastage is highest in big southern states; 17.6% in Telangana and 11.6% in Andhra Pradesh. Union health secretary Rajesh Bhushan has emphasised that vaccines are invaluable commodities and public health goods and that they must be optimally utilised.

Some states have also raised concerns over supply shortage. On Wednesday, the Central Government released a scathing response, accusing the state governments of spreading “panic” among people.

India’s health minister Harsh Vardhan speaking at a meeting to review COVID situation in the country on Tuesday.

Spike in Covid-19 Cases and Vaccine Roll-out

On April 5 India reported over 100,000 new COVID cases – its highest ever tally since the pandemic began. Even at the peak of its first wave last year the country’s highest single day tally was at 97,000 cases.

Daily new Covid-19 cases have surged to an all-time high in India.So far India has delivered nearly 80 million doses of vaccines, according to government figures. Most of the earlier doses were given to healthcare workers and high-risk groups like the elderly and those above the age of 60. On April 1 the government lowered the age of those eligible for vaccines to everyone over 45 and the authorities said the aim to keep the vaccine wastage down to less than 1%.

The state of Maharashtra has requested that the age of those eligible for the vaccines be lowered further to 25. Highly urbanized, Maharashtra has densely populated cities like Mumbai, and is responsible for 58.19% of all new Covid-19 cases in India. The state that was functioning near normal at the start of the year is back to resorting to night and weekend lockdowns to slow down the spread of the virus.

India offers its residents two vaccines – the homegrown Covaxin vaccine, developed by Bharat Biotech and the Oxford/AstraZeneca vaccine, Covishield, which is being manufactured under a license by the Serum Institute of India. Those receiving the vaccine do not get to choose between the two.

There are multiple social, logistical and economic reasons why wastage is occurring. However, Gagandeep Kang, vaccine expert and professor at the Christian Medical College (CMC), Vellore explained that it is also rooted in conventional health service protocols: to improve India’s low immunization coverage for childhood vaccination, instructions were given to the staff to not worry about keeping wastage low and to focus on ensuring that every child is vaccinated.

“When the same people are now told to not waste a single dose of vaccine then it becomes challenging for them as it is different from the protocol that they are used to,” Kang said. She added that by not allowing healthcare workers to give vaccines that are about to go waste to non-priority groups, the government is trying to ensure that the vaccines were not misused in the name of wastage.

Take Vaccines to the People

Another reason why wastage is occurring is because the vaccination drives are being conducted in a few centralized locations. Travelling to a vaccine centre that is far away costs money; for some it might mean a day’s lost wages.

This issue, however, must not be confused with hesitancy, experts caution: “Unless we address that economic and social difficulty of the vulnerable population, we cannot expect the numbers to go up,” said Sadanandan, saying that vaccine sites must be made more accessible to people.

However, the poorest groups in India also do harbor significant distrust of the government generally. As a result, vaccine drives in some poor communities may yield lower than hoped for turnout – leading to wastage of the temperature sensitive doses.

Another issue, linked to vaccine hesitancy, relates to safety concerns – particularly as the Indian government was not transparent about the data about the Bharat Biotech vaccine in the early months. The AstraZeneca vaccine also has seen major concerns emerge in Europe over rare blood clots among younger groups.

Kang said that the data for vaccines is always evolving and while there can be rare safety concerns with one in every 50,000 or 100,000 people, it would only be known after millions of people are vaccinated. “If you look at the benefit and risk, the benefit of the vaccine even in the one in a million clotting event (as is being reported about the AstraZeneca vaccine) is very firmly in favour of the vaccine.”

Early on in the pandemic the World Health Organization (WHO) pushed countries to ramp up their COVID testing, using communications and advocacy strategies to convince people to get tested as well. Experts now point to the need for countries like India, that are in the process of expanding its vaccination programme, to shift to effectively communicating the benefits of getting a jab.

As the government expands coverage to a larger pool of people the wastage also could come down, experts also believe – because more people will be eligible to claim unused doses at the end of the day, avoiding wastage.

At the same time, it’s important to expand eligibility for the jabs only after sufficient supplies are assured.

“If we aggressively push (for people to take vaccines) and the vaccine is not available that will also be a problem,” said Kolandaswsmy K, former director of Public Health Preventive Medicine for the government of Tamil Nadu in southern India.

Disha Shetty is an independent science journalist based in Pune, India

Image Credits: Ministry of Health and Family Welfare, Govt of India, Ministry of Health and Family Welfare, Government of India, https://pib.gov.in/PressReleasePage.aspx?PRID=1709600.

Brazil on Tuesday recorded 4,195 COVID-19 deaths – bringing the total number of deaths in the country to 366, 000- second only to the United States.

The World Health Organization on Wednesday urged governments in the Americas Region to take decisive action to slow a surge of COVID-19 cases after recording more than 1.3 million new cases and 37 000 deaths in just the past week.

Describing the new rate of infections as “worrisome”, Carissa Etienne, director of the WHO’s regional office, the Pan American Health Organization, said health care facilities in the region were being stretched to the limit as the rate of infections continued to climb, ICU beds were nearing capacity.

Brazil alone recorded more than 4,000 deaths in its deadliest 24 hours of the pandemic so far.

“Over the last week, the United States, Brazil and Argentina were among the 10 countries in the world, registering the highest number of new infections worldwide” said Etienne, adding that “more than half of all global deaths reported last week were in the Americas.

“The United States, Brazil and Argentina were among the 10 countries in the world registering the highest number of new infections worldwide,” she noted, with many other countries in the region not far behind. 

Despite the skyrocketing numbers, people are steadily increasing their movement and travelling within and between countries. “If these trends continue, our health systems will be in deeper trouble,” warned Etienne, urging people to stay home to drive down infections.  

Infection rates Slowing in United States & Mexico 

“Cases are mounting in nearly every country. In areas of Bolivia and Colombia cases have doubled in the last week. All four countries in the southern code have been experiencing acceleration in COVID-19 cases with one interrupted community transmission in recent weeks,” she said.

Rising rates of new infections were also still being recorded in countries including Costa Rica, Honduras,  Ecuador, Guatemala, as well as in smaller islands like Martinique Bermuda and the US Virgin Islands.

The exceptions were the United States, Mexico, Salvador and Panama, where the rate of new cases was now finally slowing down. 

In the United States, US government officials said that the slowdown in the US in new cases may be attributable to the huge US vaccine drive which has seen some 60 million vaccine doses distributed so far – the most in absolute terms anywhere in the world. 

Brazil’s Grim COVID-19 Numbers – ‘A Biological Fukushima’

The Brazilian Health Ministry on Tuesday said 4,195 people had died ín the past 24 hours due to the virus – bringing the total number of deaths in the country to 366,000- second only to the United States.

Sylvian Aldighieri, PAHO incident manager for COVID, said: “Our concern at the moment is also for the Brazilian citizens themselves in this context of services that are overwhelmed by the number of severe cases to be managed”.  He added that PAHO was working with Brazil to acquire more vaccines.

Brazilian hospitals across the country are being stretched to their limits as the rate of infections continues to climb. More young people are falling ill, and needing medical care, he noted, as the current wave of the pandemic is marked by more easily transmissible strains of the virus.

“It’s a nuclear reactor that has set off a chain reaction and is out of control. It’s a biological Fukushima,” Dr Miguel Nicolelis, a Brazilian medic and professor at Duke University, was quoted as saying.  Over the course of April 2021, Brazil appears set to hit an all-time record of 200,000 deaths per month, with 50% of those due to COVID19.  It would be the first time deaths surpass births in the country, Nicolelis remarked in a tweet. 

“Never in Brazilian history have we seen a single event kill so many people in 30 days,”, added the Duke professor, who also coordinates COVID response in Brazil’s northeastern region, speaking to AFP, adding that with winter now approaching, Brazil is facing “a perfect storm.”

Speaking on local Brazilian TV, Nicolelis held President Jair Bolsonaro largely responsible – due to his pushback against mask-wearing, social distancing, and lockdown measures. 

“We’re in a dreadful situation, and we’re not seeing effective measures by either state or federal governments” to respond, epidemiologist Ethel Maciel of Espirito Santo Federal University also told the AFP.

Despite the recent surge, Brazilian officials have tried to retain an upbeat note, insisting that the country can soon return to something resembling business as usual. 

“We think that probably two, three months from now Brazil could be back to business,” Economy Minister Paulo Guedes said during an online event on Tuesday. “Of course, probably economic activity will take a drop but it will be much, much less than the drop we suffered last year … and much, much shorter.”

Economic Impact of the Pandemic

Overall for the region, however, the financial strain of this pandemic has been devastating and effectively fighting COVID-19 is impossible without addressing some of the inequalities and supporting the most vulnerable as they struggle to protect themselves, said Etienne.

“While many of us have been lucky enough to continue working during the pandemic from the comfort and safety of home, half of our workforce relies on the informal economy. Staying at home would have meant forgoing their livelihoods, “she said, adding that 22 million people fell into poverty this year in the region. 

Despite the gloom and doom, there is some good news, according to Etienne.

To date more than 210 million doses of COVID-19 vaccines have been administered across 49 countries and territories in the Americans. While the United States is leading the region and the world in its vaccine campaign, other countries, such as Chile, are also vaccinating at high rates. 

PAHO has also developed an interactive platform where countries can visualize the public health measures that were implemented. This will help countries, among others, identify peaks and mobility during specific periods such as Christmas New Year and inform pandemic responses.

“As we continue to fight this virus, we must do more than just stop COVID-19.  We must commit to working together to build a fairer healthier world, we must also take this opportunity to build a healthier region that’s better prepared to tackle the next challenge, and realises our promise of health for all,” said Etienne.

 

Emer Cooke, EMA Executive Director, at Wednesday, 7 April press conference.

Following a second meeting of the EMA’s safety committee in as many weeks, the European Medicines Agency said that there appears to be a link between receipt of the AstraZeneca vaccine and very rare cases of blood clots being seen in some people – mainly younger women – within two weeks of their jab.

The linkage, however rare, is another blow to the rollout of the vaccine which is currently the most affordable and the most widely available, the world over.

It could stimulate more hesitancy and confusion about the vaccine’s use not only in Europe but in the dozens of low- and middle-income countries that are right now almost exclusively reliant upon AstraZeneca vaccine supplies – being provided free-of-charge by the WHO co-sponsored COVAX initiative. In India, where the vaccine is being produced under license, the vaccine, produced under license by the Serum Institute, is the centerpiece of a major vaccination rollout that aims to blunt a new wave of COVID cases, which saw over 100,000 new cases reported in the past 24 hours.

“The blood clots occurred in veins in the brain (cerebral venous sinus thrombosis, CVST) and the abdomen (splanchnic vein thrombosis) and in arteries, together with low levels of blood platelets and sometimes bleeding,” noted the EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) in a statement issued on Wednesday.

Speaking at a press briefing, EMA Executive Director Emer Cooke stressed that the benefits of vaccination still outweigh the risks: “Our safety committee … has confirmed that the benefits of the AstraZeneca vaccine …. outweigh the risk of side effects. This vaccine has proved to be highly effective. It is preventing hospitalizations and saving lives.” However at the same time, she noted that “after a very in-depth analysis, the PRAC after a very in depth analysis had concluded that the reported cases of unusual blood clotting following vaccination with the AstraZeneca vaccine should be listed as possible side effects of the vaccine.”

She said that as of now, no specific risk factors had been identified that make people vulnerable to the rare condition – although the EMA statement noted that most of the cases reported have occured in women under the age of 60.

EMA Committee Stops Short of Policy Recommendations On Groups Most At Risk


At the same time, the committee stopped short of issuing a recommendation that the AstraZeneca vaccines be withheld from younger groups, or from younger women – saying there was still insufficient evdience to establish “a definite cause for these complications” or to link the cases to specific risk factors – including age or gender.

“Because of the different ways that the vaccine is being used in different countries, the commiteee did not conclude that age and gender were very clear risk factors for these very rare side effects,” said Sabine Straus, chair of the EMA’s PRAC safety committee, at the press briefing.

The EMA findings were also echoed by the World Health Organization, which issued its own statement Wednesday on the findings of the WHO Global Advisory Committee on Vaccine Safety, concluding that: “Based on current information, a causal relationship between the vaccine and the occurrence of blood clots with low platelets is considered plausible but is not confirmed. Specialised studies are needed to fully understand the potential relationship between vaccination and possible risk factors.”  However, based on the evidence so far, the WHO committee, like the EMA, did not recommend curbing vaccine administration among younger people, or younger women, at this time.

However, in the United Kingdom, regulators said on Wednesday that they would issue a new recommendation for people under the age of 30 to receive other types of vaccines.  And other Europan countries, such as Germany, recently limited the AstraZeneca vaccine to people over the age of 60.

The committee statement, however, urged that  “healthcare professionals and people receiving the vaccine [need] to remain aware of the possibility of very rare cases of blood clots combined with low levels of blood platelets occurring within 2 weeks of vaccination… People who have received the vaccine should seek medical assistance immediately if they develop symptoms of this combination of blood clots and low blood platelets.”

WHO, meanwhile, warned vaccinated individuals and their healthcare professionals to be on the lookout for specific symptoms, stating that: individuals who experience any severe symptoms – such as shortness of breath, chest pain, leg swelling, persistent abdominal pain, neurological symptoms, such as severe and persistent headaches or blurred vision, tiny blood spots under the skin beyond the site of the injection – from around four to 20 days following vaccination, should seek urgent medical attention. Clinicians should be aware of relevant case definitions and clinical guidance for patients presenting thrombosis and thrombocytopaenia following COVID-19 vaccination.

The EMA statement also stressed that risks associated to COVID remain much higher than those attributable to the vaccine: “COVID-19 is associated with a risk of hospitalisation and death.The reported combination of blood clots and low blood platelets is very rare, and the overall benefits of the vaccine in preventing COVID-19 outweigh the risks of side effects.”

The most recent data from a large scale trial conducted in the United States, Peru and Chile, suggested that the AstraZeneca vaccine, developed together with Oxford University, is 79% effective at reducing the risk of symptomatic Covid-19, rising to 80% among people over the age of 65 – and 100% effective against severe disease.

But the statement also tacitly acknowledged that member states will also decide their policies, based on the mix of vaccines available: “Use of the vaccine during vaccination campaigns at national level will also take into account the pandemic situation and vaccine availability in the individual Member State.”

Committee Conducted In-depth Review of 86 cases of Blood Clot Conditions

The Committee said that it carried out an in-depth review of 62 cases of cerebral venous sinus thrombosis and 24 cases of splanchnic vein thrombosis reported in the EU drug safety database (EudraVigilance) as of 22 March 2021, 18 of which were fatal.

As of 4 April 2021, a total of 169 cases of CVST and 53 cases of splanchnic vein thrombosis had been reported to EudraVigilance among the 34 million people had been vaccinated in the European region and the United Kingdom by that date. “The more recent data do not change the PRAC’s recommendations. The cases came mainly from spontaneous reporting systems of the EEA and the UK, where around 25 million people had received the vaccine,” the commtitee also noted.

As for the mechanism, the committee said that the current thinking is that the vaccine may trigger an immune response leading to the blod clotting condition, which is similar to a reaction some people have to the administration of the blood thinner, heparin, called heparin-induced-thrombocytopenia like disorder.

Healthcare professionals involved in giving the vaccine in the EU will receive a direct healthcare professional communication (DHPC). The DHPC will also be available.

See the complete EMA statement here and the WHO Global Advisory Committee on Vaccine Statement here.