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

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

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

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

Increased Investment In AMR as a Global Health Priority 

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

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

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

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

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

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

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

Innovation in Global Health Needed, Shift Away from Traditional Sources 

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

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

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

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

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

Inequitable Global Response Prolongs the Pandemic

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

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

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

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

Intellectual Property Restrictions – Inequitable Access

IP

 

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

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

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

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

Sanitizing public areas in Itapevi, Brazil

While India’s COVID-19 pandemic continues to burn through that country’s health system, concerns are mounting that Latin America may become the next global pandemic flashpoint — issues that the World Health Organization (WHO) is rightly trying to highlight to its broad global constituency of policymakers, influencers, and the general public.

All the more reason why it was surprising that the WHO chose to underscore the dimensions of Latin America’s plight by featuring Brazil’s new, and controversial, health minister Marcelo Querioga at its biweekly media briefing. 

The move set off a storm of social media commentary over what appeared to effectively showcase an alliance with the government of President Jair Bolsonaro – who has personally denied the dangers of COVID-19 and chalked up one of the worst global records for managing the pandemic. 

Not only is the track record abysmal, but  Bolsonaro has consistently ignored or undermined basic WHO advice on measures such as mask-wearing in public.  He has advocated the use of drugs discredited by WHO, such as hydroxychloroquine, as well as the importance of vaccines – which Brazil only belatedly began to aggressively seek out and acquire – despite its scientific and economic means. 

The catastrophe has been such that it has given rise not only to a huge death toll – but also the rise of a new, and dangerous variant.  That, in turn, has cast a shadow over the rest of Latin America, as observed in a New York Times article: “living side-by-side with Brazil, a country of more than 200 million whose president has consistently dismissed the threat of the virus and denounced measures to control it, helping fuel a dangerous variant that is now stalking the continent.”

Querioga On Centre Stage

Brazilian health minister Marcelo Queiroga

Granted the WHO stage, Queiroga, the fourth health minister to have been appointed in the past year, was at pains to say that he is now trying to bolster his country’s vaccination drive since taking office on 23 April.

“First, I have committed myself to ensuring there is an acceleration in vaccination across the country and this has been done by increasing the access to doses of vaccines and ensuring that there is better efficacy in the distribution of the vaccines,” Queiroga told the WHO briefing.

He added that the country had procured 500 million vaccine doses and by Monday will have administered more than 60 million vaccine doses – although that amounts to only about 18 doses per 100 people – a record that  pales in comparison to that of Chile, which has administered 73 doses for every 100 people.

Indeed, Brazil’s Fiocruz Institute is providing fill-and-finish services for AstraZeneca vaccines, while its Butantan Institute is doing the same for the Chinese vaccine, Sinovac, said Queiroga. But outside experts say that that can be credited more to the long scientific record of Fiocruz and other Brazilian instiutes, than any recent government moves. 

Queiroga did, however, provide new support for “clear and objective” guidance on “non-pharmacological measures that need to be followed in the fight against COVID-19, such as using masks, hand hygiene, and respecting social distancing.” 

That was in stark contrast to Bolsonaro’s statements railing at mask-wearing as recently as late February during the height of the country’s second wave. And so it remains to be seen if the president also will heed the advice of his new health minister. 

MOH Still Plans to use discredited drug treatments  

Queiroga also did not mention at the briefing that his ministry is preparing a protocol for the use of Ivermectin and hydroxychloroquine against COVID-19, treatments that are favoured by Bolsonaro – even though WHO has explicitly discouraged their use after large-scale studies found them ineffective.

Along with a social media storm, the appearance also sent ripples through WHO’s ranks – which has a significant constituency of Brazilian and Latin American technical staff posted not only in the region, but across the worldwide organization.  

As one senior WHO scientist told Health Policy Watch: “I am nauseated. What has been done right in this pandemic in Brazil has been done despite the national government.”

He added that there was a parliamentary inquiry into the role of the president in the pandemic, but “it looks like WHO is backing the government. Why? It only makes our work more difficult”. 

Meanwhile, Queiroga failed to answer most of the questions from the media and left the press briefing early.

Offers ‘Olive Branch’ on Vaccine Access 

WHO Director-General Tedros Adhanom Ghebreyesus reported that “Brazil is scaling up the domestic production of COVID-19 vaccines and has joined the World Trade Organisation (WTO) initiative to increase vaccine production through technology transfer.”

In terms of access to vaccines, still sorely lacking in most of lower-income Latin America, Queiroga appeared to offer an olive branch to critics, saying:

“We are looking at the discussions that are currently underway in the WTO on protecting intellectual property.  We defend that there should be access to vaccines and that they should be made available immediately because they should be considered a public good.” 

That statement was striking, insofar as Brazil has been one of the only developing countries to oppose the India-South Africa proposal for a WTO waiver on intellectual property for the duration of the pandemic. Brazil’s opposition to the waiver has also triggered widespread internal criticism. Brazilian parliamentarians  penned an open letter recently saying that the position flails in the face of Brazil long tradition of supporting public access to essential medicines.  

Quieroga did not reverse the country’s stance on that matter at his briefing, but rather appeared to be seeking a middle ground on the polarizing issue. He stressed that Brazil was in favour of “reaching a consensus” on the way forward, adding that existing flexibilities in IP and trade rules need to be used more effectively:

 “Brazil understands that the TRIPS agreement does have a number of flexibilities regarding innovation, which are included in the Doha Declaration on TRIPS and public health, and this includes the principle of what is in the public interest to fight health crises.”

He also called on pharmaceutical manufacturers to “ensure that agreements for licensing and technology transfer are facilitated as well as facilitation of expertise and know-how”. 

“We need to identify any commercial barrier to producing and distributing these products, including anything linked to intellectual property,” he added.

Cases In Many Latin American Countries Continue To Rise With Few Vaccines in Sight

Brazil has reported over 14,5 million cases of COVID-19 and over 420,000 deaths since the pandemic started. Its cases increased by 2% in the past week, and most ICU beds have been full during April. 

The P.1 variant first identified in Brazil is 2.5 times more contagious than the original wild type virus and became the dominant strain in the country in just seven weeks, sweeping through the 200 million strong population from early November. 

Brazil’s reluctance to impose restrictions on its citizens has exacerbated the spread of the variant, which is now believed to be driving case increases in the region.

Ciro Ugarte, director of health emergencies in the WHO region of the Americas and the Pan American Health Organisation (PAHO), told the briefing that most countries in South America were starting to experience case increases. 

These range from a 54% increase in Ecuador, to 19% in Honduras, 13% in Bolivia and single-digit increases in Uruguay, Peru and  Colombia, according to Worldometer.

But even a modest weekly increase of 3% in Colombia has meant that “ICU beds are running out in major metropolitan cities like Bogota and Medellin”, said Ugarte.

“Several countries in our region are reporting increases in COVID-19 cases in their younger populations. These are linked to increased exposure and no vaccination in these groups, as most countries have few vaccines and are applying them to vulnerable older groups and health care workers.” 

COVAX has only been able to deliver 7.3 million doses of vaccines in Latin America and the Caribbean so far. 

“Many countries cannot afford large bilateral deals with producers and are relying on COVAX for vaccines, but the outlook is not optimistic for increased supplies soon,” added Urgarte.

Image Credits: Pedro Godoy/ExLibris/PMI.

The UK government has been slammed for cutting millions in aid for family planning which will also lead to several job losses

The UK government has been accused of “using tactics reminiscent of the Trump era” after cutting millions in aid for family planning.

Boris Johnson’s government is set to slash its commitment to the United Nations Population Fund (UNFPA) by 85% – from an expected contribution of £154m to just £23m – in an enormous blow for women and girls in the poorest countries where health services have already been decimated by COVID-19.

News of the cuts, which were announced earlier this week, has left aid leaders seething. “By breaking its manifesto commitments with tactics reminiscent of the Trump era, the UK government will undo years of progress and investment,” Dr Alvaro Bermejo, the director general of the International Planned Parenthood Federation (IPPF), said. 

The IPPF said the loss of funding represents “one of the most significant funding losses for IPPF since 2017 when former US President Donald Trump reinstated and expanded the Mexico City Policy, also known as the Global Gag Rule”, a policy that blocked US federal funding for non-governmental organisations providing abortion advice, counselling or referrals. 

The IPPF, the UNPFA’s lead partner in providing family planning services, is set to lose out on £72m ($100m) as a result of the UK’s actions. Bermejo added this was “just another example of the UK government stepping back when it is needed most”.

Without additional funding, IPPF says it will be forced to close services in Afghanistan, Bangladesh, Zambia, Mozambique, Zimbabwe, Côte D’Ivoire, Cameroon, Uganda, Mozambique, Nepal and Lebanon, while services in an additional nine countries are under threat.

An internal memorandum sent to UNFPA, says that no staff cuts are expected yet – but insiders say this will be hard to avoid. However, agency partners contracted to deliver services will be less fortunate. IPPF will have to cut at least 480 staff over the next 90 days.

Manuelle Hurwitz, IPPF’s director of programme delivery and capacity, warned that “millions of the world’s most vulnerable women and girls in some of the poorest and most marginalized communities will pay the price” for the UK government’s decision.

“The fallout will force many girls out of school before they are even 16 and further contribute to an increase in unintended pregnancies, a rise in maternal deaths and an increase in unsafe abortions,” said Hurwitz.

The UK’s contribution would have prevented “around 250,000 maternal and child deaths, 14.6 million unintended pregnancies and 4.3 million unsafe abortions,” according to UNFPA director Natalia Kanem.

Kanem described the UK’s “retreat from agreed commitments” as “devastating for women and girls and their families across the world”.

Unnecessary Deaths

Rose Caldwell, CEO of Plan International UK, the global children’s charity described the decision as “shameful”, and would “result in the unnecessary deaths of tens of thousands more women and girls during pregnancy and childbirth”. 

“For decades, the UK has fought for the fundamental rights of women and girls to have control over their own bodies, and now is not the time to renege on our commitments,” said Caldwell.

“COVID-19 is fuelling a hidden pandemic of gender-based violence and we are likely to see a steep rise in early and unwanted pregnancies. This is already a leading cause of death for adolescent girls around the world, as well as one of the main reasons why girls drop out of school early.”

Urging the UK government to “come to its senses and reinstate funding for these vital services”, Caldwell added that “this is not the ‘Global Britain’ we want the world to see”.

Another programme set to lose out is WISH (Women’s Integrated Sexual Health), which delivers life-saving contraception and sexual and reproductive health services for women and girls in some of the world’s poorest and most marginalized communities.

Since its launch in October 2018, WISH has prevented an estimated 11.7 million unintended pregnancies, 4.3 million unsafe abortions and 34,000 maternal deaths, according to IPPF.

Luka Nkhoma, WISH programme project director in Zambia, said she is “scared for the futures” of the girls and women in the country who will no longer have access to contraception. By the age of 19, almost 60% of Zambian girls have fallen pregnant – mostly because of lack of health services in rural communities.

“When WISH came along, we helped expand much-needed contraception and sexual health services in [rural] areas, including services for youth with integrated HIV support, treatment for sexually transmitted infections and cervical cancer screening,” said Nkhoma. 

“For many women, it was their first time using contraception and the first time they’ve ever had complete control over their bodies and fertility. WISH also helps girls stay in school to finish their education, giving them control over their futures.”

When WISH closes, the community outreach in rural areas will end and the only way women will get contraception is by making long, costly trips to clinics.

“I don’t know what these women and girls will do. Just because there is a global pandemic, women’s needs don’t suddenly stop, and if they can’t access safe services, an unsafe abortion might be the only option,” said Nkhoma.

The UK is also cutting its contribution to UNAIDS, the UN’s HIV/AIDS programme by 80%, from  £15m to £2.5m this year.

“These cuts couldn’t have come at a worse time for the HIV pandemic. AIDS remains the number one killer of women of reproductive age and 1.7 million people acquired HIV in 2019,” said STOPAIDS, a UK network of agencies working to end HIV globally.

The cuts come days after the news that the UK had slashed aid to the Global Polio Eradication Initiative by 95%.

A Foreign, Commonwealth & Development Office spokesperson said: “The seismic impact of the pandemic on the UK economy has forced us to take tough but necessary decisions, including temporarily reducing the overall amount we spend on aid. 

“We will still spend more than £10bn this year to fight poverty, tackle climate change and improve global health. We are working with suppliers and partners on what this means for individual programmes.”

* Co-published with openDemocracy

Image Credits: United Nations Population Fund.

Several African countries struggling with vaccine rollout programs are forced to donate COVID-19 vaccine doses to other countries before the lifesaving drugs expire, the Africa CDC revealed on Thursday.

Details of the “donations” are sketchy, but Africa CDC director John Nkengasong, during a media briefing, disclosed how one African country, the Democratic Republic of Congo (DRC), was forced to return 1.3 million doses of vaccines received via the COVAX Facility for redistribution to other countries, including to Caribbean countries, that can expedite its rollout before expiry dates.

“DR Congo returned 1.3 million doses of vaccines to the COVAX mechanism and they are working with UNICEF to get them redistributed within 5 weeks,” said Nkengasong.

There is high vaccine hesitancy in DRC. Africa CDC revealed that in a study it carried out, only 59% of the people there are willing to get vaccinated. So far, the country has recorded nearly 30,000 confirmed cases and 763 deaths.

Africa CDC could not provide a list of other countries who had to redistribute their vaccines, but together with the World Health Organization on Thursday further admitted African countries are struggling with rolling out the vaccines at scale and at speed.

The developments however casts doubts on the true state of preparedness for COVID-19 vaccine roll out in many African countries that once accused the Global North of hoarding doses.

Inability to quickly administer the vaccine doses were however not the sole reason for the return of the life saving drugs – delays in initial deliveries of the shipments to the continent also contributed to the short period left before the vaccines expired.

Some of the doses redistributed were the AstraZeneca doses initially procured by South Africa, but were not rolled out again after the country decided to pause the vaccination exercise and switch to J&J’s vaccine.

Then, delays in sorting out new indemnification arrangements prevented the Africa CDC from quickly distributing the doses that were made available by telecommunications giants MTN, to interested African countries early enough to give sufficient time for vaccination.

According to the WHO, the short life span of vaccines (six months after production) further shortened by the pause of the vaccine rollout in countries like DRC, also contributed to the redistribution. The Serum Institute of India has said that vaccines can be used for up to nine months from its manufacture date, rather than the prescribed six months. But, some African countries, including Malawi and South Sudan, are refusing to administer the expired vaccine doses even though they are being encouraged to still administer them.

The WHO however said that a number of countries, including Togo and The Gambia, were able to administer the doses before their expiry date.

Africa Runs Successful Vaccination Programs, but Need Help With COVID-19 Vaccines

Dr John Nkengasong

While admitting the shortcomings in COVID-19 vaccine rollout programs, Nkengasong said the latest developments in no way suggest that Africa has a poor vaccination system. “Africa knows how to vaccinate and has been vaccinating its citizens for a long time. Ethiopia alone, within the COVID-19 pandemic, has vaccinated over 12 million children with the measles vaccine. That suggests that if the vaccines are available, the countries will administer them,” he said.

For COVID-19 vaccination in general, Nkengasong acknowledged that African countries needed more support to speed up vaccination rollouts. “We need support to scale up vaccinations and commodities including Personal Protective Equipment and others. That is what we need as a continent. The know-how is there. But for COVID-19, we are not just vaccinating the children, we are vaccinating the entire population. This is where the challenge is,” he said.

But with little or no vaccine shipments coming from India, which is dealing with an alarming surge in the number of COVID-19 cases, the WHO has urged African countries to use shipment delays to improve their logistics.

India has decided to use all doses of vaccines produced in the country as the country experiences a devastating second wave. Over 18.8 million cases of COVID-19 have been confirmed with over 208,000 deaths. On April 29, the country recorded its highest number of confirmed cases in a single day (386,555). Nearly 124 million people have received at least one dose of vaccine in the country, representing just 9.1% of the country’s population. And nearly 2% of the population (about 25.5 million people) have been fully vaccinated.

“We are advising African countries to use this pause to tighten their planning so that whatever doses they can get will be rolled out most efficiently,” said Nkengasong.

Africa‘s Vaccine Rollout Programs

Despite the flaws or lack of efficient rollout programs, the continent has successfully administered more than half of all COVID-19 vaccine doses it has received, said Dr Phionah Atuhebwe, WHO Vaccines Introduction Medical Officer for Africa.

“Many countries have not been able to prepare adequately before the vaccines arrived in the country and that is one of the reasons we have seen a slow pace overall,” she said.

In addition to the slow pace of rollouts, vaccine hesitancy due to myths and rumours and insufficient operational funding were also contributing factors.

Atuhebwe believes more doses than reported may have been administered in Africa as limited data could mask the true state of vaccine rollouts.

“It is easier to get this information links at the national level because most of these systems are now internet-based. So we are having issues with getting that data. We know for sure more vaccines are given than we receive on a daily update on the live dashboard,” she said.

Learning from India

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

Health experts are concerned about the surge in India spilling over to Africa as the major drivers of the pandemic in India are still present in several African countries where public health measures are no longer being enforced and large gatherings are being held.

Matshidiso Moeti, WHO’s regional director for Africa, said that while the situation in India is “sad”, it is also a wakeup call for African countries to take the COVID-19 response more seriously. “We should look at the situation in India and see what we can learn about it and how we can better prepare for any upsurge of cases in Africa,” she said.

According to her, religious ceremonies, gatherings and mass gatherings at electoral activities were super spreader events.

“There is also a circulating variant [of the virus] that is causing difficulty in terms of its transmissibility. The lesson there for Africa is to anticipate that such a wave is possible in different countries and to look at the driving factors. So, African countries that will have elections where mass gatherings will occur should be on the lookout,” she urged.

She pleaded with religious leaders in Africa to sustain the COVID-19 measures they adopted at the outset of the pandemic. “We are seeing in African countries the drop of wearing of masks particularly. In some countries, the proportion of people not wearing masks has gone up nearly 80% against 17% in the early days of the pandemic,” Moeti said.

Maximising Available Vaccine Doses and Securing More

India’s continued suspension of COVID-19 vaccine exports other countries  have resulted in them defaulting in meeting global agreements and putting delivery of second doses for many Africans in doubt. The WHO on Thursday urged African countries to maximise the available doses to cover as many people as possible instead of keeping doses to provide second doses for those that have received the first doses.

“We have advised our countries to cover as many people as possible as far as the first doses are concerned. We will have to see what will happen as far as getting other supplies so that countries can provide the second dose,” Moeti said.

Regarding expired vaccine doses, Atuhebwe said the global health body is working with the manufacturers to develop a guidance on how they should handle them considering the manufacturer’s recommendation that the doses can still be used until July if they are properly stored.

WHO was evaluating all the evidence and data from the Serum Institute of India to ensure the potency and stability of the vaccine.

“An extension of shelf life is about the stability and potency of the vaccine during the stated time frame, and does not affect the safety of the vaccine.. Then we will get to each individual country and see how they have stored their doses. We are working with the countries to help them to see how to destroy this vaccine. We have a waste management protocol for all vaccines. But let’s wait for the guidance that should be out as early as Monday,” Atuhebwe said.

For countries like Malawi that have removed some doses from their cold chain, WHO said those doses cannot be used and will therefore be destroyed.

Image Credits: WHO AFRICA, Paul Adepoju, Sky News.

A new study of stroke patients  hospitalized during the COVID-19 pandemic, has found a higher rate of young and healthy stroke victims, as compared to averages before the pandemic began.

The researchers in 136 hospitals across 32 nations found that some 25% of stroke patients who had also been sick with COVID-19, were under the age of 55,  as compared to onlky 10-15% percent of stroke patients in that age group prior to the pandemic.

The study released in the peer reviewed journal “Stroke” also found that aside from being COVID-positive some 25% of the stroke patients studied had no other obvious risk factors such as high blood pressure, diabetes or smoking. And many of the stroke victims had asymptomatic COVID cases.

The study results correlate with a growing body of anecdotal observations that COVID appears to be an added risk factor for stroke due to the tendency of the virus to stimulate blood clotting, among other pathological responses to the disease.

The study analyzed data from patients who tested positive for the coronavirus after they had been hospitalized for stroke and other serious brain events. Of the 136 different medical centres participating, at least 71 reported a patient who had a stroke during their hospitalization for coronavirus or shortly thereafter.

Of the 432 COVID-positive patients studied, 323 (74.8%) had acute ischaemic stroke, which is the most common kind, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis.  Most troubling was the high occurrence of ischaemic strokes in younger patients with no known existence of the types of ‘classical’ risk factors that contribute to the onset of stroke, the study’s co-authors stated.

The research should help doctors to better understand “the connection between the coronavirus and strokes in younger patients, as a result of blockages in larger blood vessels,” said one of the study co-authors, Professor Ronen Leker, of the Hebrew University of Jerusalem, in a Hebrew University press release.

Equally worrisome, 144 of the COVID-positive stroke victims had had no recognizable symptoms from the virus, such as cough, fever; so the COVID diagnosis came only after they were admitted to the hospital for stroke.

Leker added that: “Going forward, we recommend performing COVID testing on all younger patients with strokes, particularly those with no known pre-existing conditions.  I am hopeful and confident that this study will be instrumental in providing a better understanding of the link between COVID-19 and stroke, and provide direct therapeutic benefits to patients.”

 

Image Credits: GJBrainResearch/Twitter, STROKE .

PAHO Regional Director Carissa Etienne welcomed recent announcements of vaccine donations from the US as well as Spain, but urged other countries to donate surplus vaccine doses to Latin America and not hoard the life-saving vaccines in “warehouses” .

While aid is rushed to India, WHO’s Pan American Health Organization (PAHO) has called out rich countries to donate more “desperately needed” coronavirus vaccines to Latin America and the Caribbean – in the face of persistently high levels of COVID-19 infections in that region, which has consistently been one of the hardest hit by the pandemic.

The call from PAHO came as the WHO European Region (EURO) on Thursday reported a significant decline in new cases, hospitalisation and deaths for the first time in a month – a bright spot that may be due to the growing impact of expanding vaccination campaigns.

At a briefing on Wednesday, PAHO Regional Director Carissa Etienne welcomed recent announcements of vaccine donations from the US as well as Spain – the latter directing surplus doses to Latin America. But she also urged other rich countries to stop hoarding life-saving vaccines in “warehouses” and follow suit.

“No vaccines should be sitting in warehouses where they can be promptly used to save lives,” she said, adding that: ““This pandemic is not only not over, it is accelerating,” she warned. “Our region is still under the grip … in several countries of South America the pandemic in the first four months of this year was worse than what we faced in 2020.”

Vaccine supplies to the region continue to “languish behind our urgent need for more doses… That’s why we urge countries with extra doses to consider donating a significant portion of these to the Americas, where these life-saving doses are desperately needed and will be promptly used,” she said.

“Significant portions” of donated vaccines also are needed for vulnerable populations, including migrants,” she stressed, adding, “expanded vaccination will also ensure that all people and economies can begin to reopen, rebuild and recover.”

Vaccine Donations So Far

The Spanish government last week announced that it would donate 5-10% of its vaccine doses to Latin American and Caribbean countries – once Spain a reaches 50% immunisation rate.

“The announcement from Spain is a show of solidarity, and your contributions to the well being of all,” said Etienne, adding, “WHO also congratulates the United States government for their announcement earlier this week that they will share up to 60 million doses of the AstraZeneca vaccine.

“We urge other countries to pick similar components,” she said.

The US government has said its excess vaccine doses will go to WHO co-sponsored COVAX global vaccine facility. A large portion of those vaccines, observers say, are likely to go to crisis-ridden India – although some may find their way to Latin America.

In addition, France has announced that it will donate 500,000 vaccine doses to the COVAX initiative by mid-June – although those appear mostly earmarked for west African neighbours with which France has close ties. Indeed the first batch of 105,000 donated AstraZeneca vaccines began arriving in Mauritania in April.

New Zealand also will redirect 1.6 million doses of AstraZeneca vaccines pre-purchased through COVAX to low- and middle-income countries, after deciding in March that it will vaccinate its population with only the Pfizer vaccine, due to its higher efficacy. At least some of New Zealand’s surplus is expected to go to neighbouring Western Pacific island states.

Latin America Remains Hard-Hit Region In Acute Need

New Coronavirus cases by WHO region, as of 28 April 2021

That leaves Latin America, one of the world’s regions hardest hit by the pandemic in need of still more big vaccine infusions.

In PAHO, where a 1.1 % increase in new cases was recorded on Wednesday, many health systems are “struggling to cope” with an influx of COVID-19 patients, especially the younger population who are less frequently vaccinated and more often exposed, said Etienne at the briefing.

Increased exposure, a shortage of vaccines has led to an increase in hospitalisation she added, and have also resulted in increased consumption of critical inputs, including oxygen, intubation drugs, personal protective equipment and infusion pumps.

“Nearly every country in Central America is reporting a rise in infections. Hospitalisations are at an all time high in Costa Rica, and we expect more patients will require care as the country reported a 50% jump in cases,” she said.

Infections also remain high across other parts of South America, she added. In Colombia ICU beds are running out in major metropolitan cities, such as Bogota. Similar situations exist in hard-hit Peru, Bolivia and Argentina.

“It’s no surprise then that many countries in our region have tightened public health measures by extending curfews, limiting re-openings, and imposing new stay-at-home orders,” she said. “These decisions are never easy, but based on how infections are surging, this is exactly what needs to happen. We know these measures work, and I commend leaders across our region for putting health first.”

Vaccine Alone Won’t End Pandemic

WHO PAHO regional director Dr Carissa Etienne said significant portions of donated vaccines are needed for vulnerable populations in the region, including migrants.

More than 317 million doses of COVID-19 vaccines have been administered in the Americas, but more than 70% of these have been distributed in the United States.

Along with bilateral vaccine deals, Latin America and Caribbean nations, have received seven million doses in the first allotment procured through COVAX, the global partnership to ensure equitable distribution of vaccines. A second shipment of vaccines through the COVAX facility is due between May and June.

However, so far vaccine rates range from highs of 73 doses per 100 people in upper-income Chile and 46 doses/100 in Uruguay; to 17 doses or less/100 in about 18 other Latin American countries, including Brazil, Argentina, Colombia, Peru, Ecuador, Mexico and El Salvador.

In the Caribbean, access varies widely from a high of 30 doses/100 people in Antigua to lows of 1/100 in Trinidad. In Paraguay, Nicaragua, Guatemala, Venezuela and Honduras, authorities have administered just one dose or less. Central America 1 dose or less in the Caribbean and Central America.

Etienne said, adding that PAHO is able to “quickly” deploy vaccines to countries in the Latin American region that are heavily impacted by the pandemic – citing its 100% implementation rate so far, with available supplies. .

In order to disburse available vaccines efficiently, countries have organised drive-thru vaccination and door-to-door campaigns to reduce the chance of transmission.

“Thanks to these efforts, our region has administered nearly every COVAX dose it has received thus far,” Etienne said. “Our region has demonstrated that it can successfully distribute COVID-19 vaccines quickly and effectively.”

Etienne however cautioned that particularly in light of the limited supplies, vaccines alone would not put an end to the pandemic. She encouraged social distancing, wearing of masks and washing of hands to help reduce the spread of the virus:

“We will only overcome this pandemic with a combination of rapid and equitable vaccine access and effective preventive measures.”

In Europe, COVID-19 Numbers Drop Significantly for First Time

WHO EURO regional director Dr Hans Kluge said COVID-19 vaccines are saving lives and will change the course of the pandemic and eventually help end it.

Meanwhile in Europe, infection numbers seem to be finally dropping sharply – even though only 12.5 % of Europe’s population has been fully vaccinated or recovered from COVID-19, said WHO’s European Office on Thursday.

“Based on numbers of confirmed cases, 5.5% of the entire European population have now had Covid-19, while 7% have completed a full vaccination series,” WHO EURO Dr Hans Kluge said at a briefing, adding that new cases “fell significantly” last week for the first time since 1 April, when new cases peaked at over 300,000 in 24 hours. “Yet, infection rates across the region remain extremely high,” he pointed out. On April 28, there were 180,000 new confirmed cases across the region.

To date, some 215 million doses of vaccine have been administered in the WHO European region’s 53 member states, which include Turkey, Israel and central Asian states of the former Soviet Union.

Approximately 16% of the region’s population has had a first vaccine dose, and 81% of health workers in 28 countries have had a first dose.
“Where vaccination rates in high-risk groups are highest, admissions to hospitals are decreasing and death rates are falling,” said Kluge, citing that as evidence that the vaccines are already having an impact. “Vaccines are saving lives, and they will change the course of this pandemic and eventually help end it,” he said.
However, vaccinations alone will not “end the pandemic”, he, too, warned, also emphasising the need for continued testing, quarantine, contact tracing and social distancing measures.

“Without informing and engaging communities, they remain exposed to the virus. Without surveillance, we can’t identify new variants. And without contact tracing, governments may need to reimpose restrictive measures.”

Image Credits: WHO PAHO, WHO , PAHO.

The implementation of COVID-19 restrictions and social distancing measures in South Korea in early March 2020.

A handful of five countries that forcefully acted to eliminate COVID-19 transmission fared better over the duration of the pandemic than others – experiencing far fewer deaths, faster economic recovery, and the preservation of a greater range of personal liberties, according to a sweeping review, published in The Lancet on Thursday. 

The review of policies adopted by the 37 member states of the Organisation for Economic Co-operation and Development (OECD) compared COVID-19 deaths, gross domestic product (GDP) growth/contraction, and severity of lockdown measures during the first year of the pandemic – which was declared in March 2020. 

Countries that took the maximum action to curb community transmission and contain SARS-CoV2 – including Australia, Iceland, Japan, South Korea, and New Zealand – had an average death rate that was 25 times lower than those countries that implemented restrictions in a more stepwise, targeted manner, according to the group of French, British and Spanish  researchers. 

COVID-19 deaths, GDP growth, and strictness of lockdown measures for OECD countries choosing SARS-CoV-2 elimination versus mitigation.
Economic Growth Rebounded in Early 2021

Just as importantly, GDP growth returned to pre-pandemic levels in the five “elimination” countries in early 2021, while economic growth for the other 32 OECD countries that pursued a mitigation approach remained negative until the end of the study period in early March 2021, according to the review, co-authored by a number of senior UN and national government policy advisors, including Ilona Kickbusch, founder of the Geneva Graduate Institute’s Global Health Centre, and Devi Sridhar of the University of Edinburgh.

Civil liberties also were most strictly constrained in countries that chose mitigation. By contrast, swift measures taken in the early weeks of the pandemic were categorized as less strict on a ‘stringency scale’ applied by the researchers, lasting for a shorter duration. 

Life in New Zealand is back to normal after strict travel limits and one lockdown eliminated the virus on the island nation.

Countries that chose SARS-CoV2 mitigation included Germany, France, Israel, Poland, the United Kingdom, and the US. Most of these countries were forced to impose new national lockdowns in the first quarter of 2021 following renewed surges in cases. 

“Countries opting for elimination are likely to return to near normal: they can restart their economies, allow travel between green zones, and support other countries in their vaccination campaigns and beyond,” the authors state. 

Assessment Ends Before Vaccination Campaigns Kick In

The assessment, however, ended just before the impacts of mass vaccination campaigns began to kick in over the course of March and April in Israel, followed by the United Kingdom and the United States. 

In Israel, for instance, which had recorded one of the  world’s highest infection rates, per capita, in January, with over 7,000 new cases daily, new infections dropped to about 120 daily in late April, when 60% of the population had either vaccine- or infection-related immunity. A rapid economic recovery, meanwhile, has seen it leap ahead of Canada to become one of the top 20 richest OECD nations, based on per-capita GDP – following economic contraction in 2020.  

It remains to be seen, however, how rapidly disease burden will decline and economies reignite in other OECD countries as vaccine rates tick upwards – and what will become of low- and middle-income countries where vaccines have yet to even reach large proportions of the population.  

Maintaining Other Public Health Measures Will Remain Essential, Even With COVID Vaccines

According to the authors, a swift path to elimination is easier now than ever over the past year due to the existance of COVID-19 vaccines and better testing.

But while COVID-19 vaccines are critical to ending the pandemic, they cannot be the sole tool to contain the virus due to their uneven and inequitable rollout, the time-limited immunity, and the emergence of new variants, which could threaten the efficacy of the vaccines, the authors stated:

“History shows that vaccination alone can neither single-handedly nor rapidly control a virus and that a combination of public health measures are needed for containment.” 

And so other public health measures will remain critical to preventing new waves of infections, a rise in mortality, and the proliferation of new SARS-CoV2 variants. 

“With the emergence of variants of concern, the more likely (if not the only) path to elimination is to combine several potent tools,” Bary Pradelski, co-author of the article and Professor of Economics at the French National Centre of Scientific Research, told Health Policy Watch.

The elimination of the SARS-CoV2 virus also will require a more coordinated international strategy, as opposed to separate government COVID-19 responses that have led to varying outcomes, since the pandemic is only going to end anywhere once it is under control everywhere. The authors concluded by stating: 

“National action alone is insufficient and a clear global plan to exit the pandemic is necessary.”

Image Credits: Wikimedia, The Lancet, Mona Masoumi.

A South African man demonstrates the use of the HIV self-test, waiting a few minutes for his results.

JOHANNESBURG – A new agreement to slash the price of HIV self-tests in half could ultimately assist eight million people estimated to be unaware of their HIV status to know they are infected – and get them on treatment. 

The agreement announced on Wednesday between the Geneva-based international health agency, Unitaid, and the US-based global healthcare company, Viatris, will see poorer countries dramatically increase their access to the blood-based HIV self-tests made available for under $2 across 135 low and middle-income countries.

Unitaid said the deal follows a request for proposals launched by Unitaid and Population Services International (PSI) in 2020 to drive forward equitable access to these tests. 

The self-tests are seen as important tools to help people more easily discover their status and move towards the treatment they need, and thus reducing the HIV burden globally.

This is particularly relevant in poorer countries, where concerns around stigma and difficulties accessing healthcare can create significant barriers, said Unitaid.

“HIV self-testing is a crucial factor in helping people learn their status – it is one of the key ways in which the global goals for HIV will be achieved. This announcement today will have a concrete impact on the ability of countries to access affordable self-testing, a foundation of people-centred healthcare in which Unitaid has led the way,” said Unitaid Director of Programmes Robert Matiru.

Access to HIV- self-tests has been recognised as a key factor in meeting the global goal of 90% of people knowing their HIV status,” said the agency.

In just the past six years, that rate has nearly doubled, from 45% to 81%, it added.

However, achieving even higher testing rates has been hampered by the fact that the market for HIV self-tests in low- and middle-income countries have been dominated by a single affordable oral HIV test, the OraSure.

That test is sold in a limited number of poorer countries for $2, but elsewhere the price is higher, and other options have cost significantly more.

HIV Self-tests Deal Announced at the Right Time

The World Health Organization (WHO) welcomed the availability of the HIV self-testing kits to increase access to testing.

“This announcement is particularly timely now, as HIV self-testing has become an important choice during COVID-19, allowing people to test when other options are difficult to access or restricted,” Dr Meg Doherty, WHO Director of Global HIV, Hepatitis and STI said.

The self-test will be a vital tool in the fight against HIV/Aids in South Africa which has one of the largest burdens of HIV in the world with 7.9 million people living with HIV.

With over two years of implementing HIV self screening in SA, the country has seen the positive impacts of the intervention.

Said Dr Thato Chidarikire, Director of HIV Prevention Strategies at the National Department of Health of South Africa:  “We have managed to reach men, women between 19 and 24 years old, as well as [other] key populations.

Following on that, he said that the news of the price reduction “is very well-received by South Africa, as we are currently procuring the tests using domestic funding. Lower prices translate to more quantities and expansion of the programme to reach more untested and test-averse populations, contributing to the country reaching the 95-95-95 targets.”

Unitaid said another recently developed blood-based HIV self-test from US-based health care company Abbott Laboratories, which is currently undergoing regulatory review; it is also set to become part of the expanded Unitaid programme, which would see around one million self tests distributed “to stimulate in-country demand”.

How the HIV Self-test Works

Husband and wife demonstrate use the HIV self-test kit in the privacy of their own home.

HIV self-testing (HIVST) is a process whereby a person collects his or her own specimen using a simple rapid HIV test and then performs the test and interprets the results themselves.

An innovative WhatsApp interactive digital solution is used to support consumers by offering a platform to guide them through the HIVST experience with clear, concise and individualized instructions on how to properly administer the HIVST and accurately interpret the results. Based on the results, the WhatsApp platform informs the consumer of the appropriate next steps to link them to care and prevention services according to the outcome of their test.

Linkage to confirmative testing and care and treatment after an HIV positive self-test is crucial.

Over 3 million people in South Africa have used HIV self-test kits so far, either as oral fluid or blood-based kits.  SA’s Department of Health in collaboration with Unitaid and PSI’s  HIV Self-Testing Africa (STAR) Initiative project will further scale up HIVST to make it available wherever people want to access it, including through vending machines and online ordering or through peer-to-peer distribution.

To date, Unitaid investment has resulted in 5 million kits being distributed, with 21 million kits set to be procured by countries between 2020 and 2023. Additionally, self-testing protocols have been embedded in the health policies of more than 85 national governments.

Image Credits: ©PSI-Dogsontherunphotography, Dogsontherunphotography:.

Tens of millions of Hindu worshippers gathered in April to celebrate the Kumbh Mela festival in India – a factor believed to have contributed to a massive surge COVID-19 cases.

ISLAMABAD, PAKISTAN – Pakistan and its three estranged neighbouring countries – India, Iran and Afghanistan – are all struggling to restrain their large populations from attending deeply rooted and centuries-old cultural, religious festivals – so as to curb the spread of COVID-19 in the region. 

The cultural, political, and religious gatherings in all four developing countries have emerged as a major challenge for governments as people continue celebrating festivals with cultural and religious zeal and zest. 

The four countries share common borders with porous passages through rural and mountain areas where the virus can easily pass, regardless of official restrictions or closures in place. 

With a cumulative population of 1.69 billion, the four countries have recorded a total of 21.2 million COVID-19 cases and 291,847 deaths since the beginning of the pandemic. 

India is currently facing a catastrophic second wave, accounting for 38% of global cases reported in the past week, according to the World Health Organization (WHO). However, important, although lesser noticed surges of varying degrees also are occurring in neighbouring Iran, Pakistan and Afghanistan – with new cases daily in Iran per million population approaching Indian levels. 

And those, too, appear heavily linked to the season’s ritual mass gatherings, health experts and authorities told Health Policy Watch in an exclusive set of interviews. The events include the recent “Nowruz” New Year celebrated in Iran and parts of Afghanistan, the ongoing Islamic month of Ramadan, and the February-April Hindu celebrations of Kumbh Mela, where pilgrims dip in the Ganges in what has been described as the largest religious gathering in the world. 

Whatever their national affiliations, health experts from Pakistan, India and Iran believe that the situation in the region will deteriorate further if human interaction is not more controlled. 

WHO has noted the lack of compliance to public health measures, low vaccination rates, and mass gatherings have combined to cause a “perfect storm” in the case of India’s surge. 

However so far WHO’s public messages have fallen short of specifically calling out the mass gatherings, related to sensitive cultural and religious moments, as a key cause of the rising case loads – even though health officials privately say that this may be one of the biggest drivers both in India as well as throughout the region. 

“The extent to which these virus changes are responsible for the rapid increase in cases in the country remains unclear, as there are other factors such as recent large gatherings that may have contributed to the rise,” said Tarik Jašarević, WHO spokesperson at a press briefing Tuesday. 

Hindu & Muslim Holidays Have Seen Surge of Mass Gatherings 
Hindu celebrations of Kumbh Mela, where pilgrims dip in the Ganges, drew millions together.

As around 25 million people gathered on the banks of river Ganges in India to celebrate the Hindu festival of Kumbh, which runs from February to late April, people in Iran and northern areas of Afghanistan were preparing for, and celebrating ‘Nowruz’ festival (New Year) over the latter two weeks of March. 

Meanwhile, the holy month of Ramadan, which began on 12 April, is in full swing for Muslims across the region, which is marked by daytime fasting but evening break-fast and social gatherings. Pakistani health authorities are trying to toe a strict line, but they fear that over the even more intensive gatherings that mark the end of Ramadan and Eid-al-Fitr holiday, the country could see a further rise in cases, especially if the public doesn’t comply with the national Standard Operating Procedures (SOPs) for COVID-19.  

Pakistan, India and Iran imposed partial lockdowns over the past two weeks in an attempt to curb transmission in the worst affected cities. However adherence to the restrictions has been mixed – and government leadership in some instances has also been wanting – for instance in India where State election campaigns have also seen big mass gatherings organised by the government’s leading political parties. 

According to Dr Zafar Mirza, a former high-ranking official in the WHO Office for the Eastern Mediterranean Region, which covers Pakistan, Iran and Afghanistan, human interaction at religious, cultural and political gatherings in Pakistan, India and Iran have indeed contributed to the regional rise in cases.

The only real solution to the virus is immunity – either acquired from natural infection or vaccines, stressed Mirza.

Accessing COVID-19 vaccines, however, has been a challenge for low- and middle-income countries, as high-income countries “over-booked” the available vaccines through bilateral deals with pharma companies. This has left low- and middle-income countries with two equally difficult choices: 

“Either develop their own vaccine and end their 100% vaccine import dependency or strictly follow COVID-19 SOPs, minimizing the human interaction to save maximum lives,” said Mirza. 

Mirza feared that if human proximity is not controlled throughout the region, there is a high chance that the dire situation being seen in India could further deteriorate. 

Pakistan Takes Steps to Enforce Domestic Restrictions

Eying with worry developments among neighbours, Pakistan’s government has recently further tightened COVID-19 restrictions, and even deployed army troops to help the civil administration with their implementation during the latter half of Ramdan. 

The country’s Interior Minister, Sheikh Rashid Ahmed, announced that the ministry issued a notification enabling provincial governments and federal territories to seek the help of the army to enforce standard operating procedures for curbing the spread of the coronavirus. 

The government’s moves have received strong backing from the Chairman of the Council of Islamic Ideology (CII) in Pakistan, Qibla Ayaz, said in a press briefing that the third wave of COVID-19 was more dangerous than the previous two and the religious segments of society had a serious responsibility to follow the precautionary SOPs and spread the message among the citizens.

He said in the press briefing that prayers can be performed at home and the public needs to  adapt some of its traditional practices, as recommended by health experts to prevent the deadly virus from spreading.

Ayaz also stressed that there is nothing in Islamic tradition requiring observant Muslims to  shake hands or embrace when they do meet or assemble, saying that embraces should be avoided for the time being and replaced with verbal greetings, such as the traditional “Assalamalaikum” – meaning “peace be with you”. 

According to the National Command and Operations Center (NCOC) – a forum established to lead the national effort to tackle COVID-19 – the confirmed cases in Pakistan have reached 804,939, some 17,329 deaths have been reported, and 5,075 COVID-19 patients are in critical condition. 

Nearly two million people have been vaccinated in Pakistan, mainly using China’s Sinopharm vaccine.

People waiting to register for COVID-19 vaccines in the Pakistan Institute of Medical Science.

Pakistan Proffers Aid to Beleaguered India 

In response to the rising cases in India, the government of Pakistan banned the entry of travelers from India from arriving at land crossings, which operate in the disputed Kashmir region and elsewhere. 

At the same time Prime Minister Imran Khan extended an olive branch to the Indian people, writing on Twitter: “Our prayers are for all those suffering from the pandemic in our neighbourhood.”

And Pakistan’s Foreign Minister Shah Mehmmod Quershi also offered ventilators, personal protective equipment, and other supplies as a gesture of solidarity with India.  

India – Virtual Religious and Political Events Could Have Helped Avoid Crisis 

India has meanwhile seen an outpouring of aid offers from countries ranging from the United States and the United Kingdom to Saudi Arabia and Bhutan – but the question remains whether supplies can arrive in time and whether they can make a sufficient dent, quickly enough, in the ongoing crisis in the country, which now recorded the largest numbers of new cases daily, yet to be seen in any country during the pandemic. 

Medical supplies from the UK landed in Delhi on Tuesday morning, which included 100 ventilators and 95 oxygen concentrators. Later on Tuesday, Thailand airlifted four cryogenic oxygen tanks to India, Singapore sent 256 oxygen cylinders, Mauritius donated 200 oxygen concentrators.

Resources from European countries are expected to arrive in the coming days, with Germany providing an oxygen production plant, France shipping oxygen concentrators and respirators, and several others pledging support.

In terms of the factors leading up to the crisis, Anant Bhan, Professor in the Department of Community Medicine at Yenepoya University in Mangaluru, said that at least some of the surge in cases could have likely been avoided if stricter measures had been taken earlier on, to control or restrict mass gatherings.  

“Any large congregations are a major risk factor as we know for COVID-19. Given this, it would have been ideal to conduct any religious or political events only symbolically or use online virtual platforms for these. Failure to do so could have led to events which helped in the spread of the disease,” Anant told Health Policy Watch. 

Instead, mass gatherings have not only continued unhindered, but they have been marked by a lack of adherence to COVID-19 precautions, especially mask wearing. In addition, the period has seen an increasing number of social gatherings such as marriages and cultural events, which were a factor in the spread. 

Although India is making a major effort to vaccinate its population, the challenge remains the sheer size of the country and the population – and meanwhile social distancing, mask wearing and other preventive measures remain critical, he said.  

“The current spread has reinforced the need for a rapid increase in coverage with the vaccines, but supply might be a constraint,” Anant added.  

While the surge is national, Anant pointed out that some states in India are experiencing a comparatively higher burden of cases, including Maharashtra, Karnataka, Chhattisgarh, Chandigarh, Madhya Pradesh, Delhi, Haryana, Uttar Pradesh. And those, indeed are among the same states that have seen particularly large social and religious gatherings recently. 

According to the Indian Health Ministry, the number of active cases has risen to 2.9 million, with over 300,000 new cases being reported for the seventh day in a row, and a total of 201,187 deaths. 

Iran Also Sees Infection Surges  

Meanwhile, per capita, Iran was seeing almost as large a surge in new cases as India – although it has received far less attention. 

A medical doctor in Mashad, Dr Ali Zaday, who spoke to Health Policy Watch under a pseudonym due to government restrictions on speaking to foreign media, said that the COVID-19 cases began to spike after the New Year’s festival of Nowruz, which was celebrated for two weeks beginning on 20 March. 

Last year, festival restrictions were highly restricted, he noted, as Iran became one of the biggest epicenters for the virus during the first wave. This year, however, restrictions were much more was celebrated in a restricted way last year but this year the celebrations were in violation of the COVID-19 SOPs by the public. 

“Now there are partial lockdowns and daily above four hundred people are dying,” said Dr Zaday. 

However, a doctor in Tehran, Mustafa Zareef (also speaking under a pseudonym) said that from what he saw, Nowruz celebrations were comparatively modest, and government officials are trying to preserve adherence to COVID-19 restrictions.

Mosques were closed in Tehran during “Nowruz,” the Iranian New Year, and public celebrations were cancelled. 

Even so, the country has still seen a sharp increase in cases since the end of March. 

He also viewed that comparatively low gatherings were held during the last two years for the Nowruz festival, which is usually celebrated on a large scale. 

“To a large extent SOPs [COVID standard operating procedures] were also followed during Nowruz,” he said, noting, as one example, that important shrines remain closed – although prayer goers and pilgrims can visit outside. 

The Iranian Health Ministry reported that over 2.4 million people in the country have now been infected with the virus, with 21,713 new cases recorded on Thursday and 5,287 patients in critical condition – in the country of some 82.9 million people. 

According to the health ministry statistics more than 700,000 people have been vaccinated with a first dose of vaccines, using the AstraZeneca, Russia’s Sputnik V, and China’s Sinopharm vaccine.

Afghanistan Witnesses Slight Rise in Cases

Afghanistan has so far largely avoided the negative effects of COVID-19 faced by its neighbouring countries, however, health officials warn that if the current rise in cases is accompanied by a continued disregard of public health measures, the country could suffer the same fate as India.

Afghanistan’s acting Minister of Public Health Waheed Majrooh announced at a press conference this week that Afghanistan had already entered the third wave of the pandemic, which is more threatening than the first or second.

According to Majrooh, if people don’t follow health recommendations, don’t pay attention to social distancing and don’t wear masks, there is a fear that Afghanistan will experience a catastrophic situation similar to India’s. 

Kabul-based physician, Dr. Obaid Ullah, told Health Policy Watch that people were reluctant to follow most COVID restrictions until recently. Weddings, religious gatherings and other routine activities have been continuing in full swing. 

But the deadly surge of COVID-19 cases in India have left more people worried, leading to better compliance with public health measures and greater vaccine acceptance as well. 

“You would be surprised to know that many were reluctant to get vaccinated and the donated doses of vaccines were reaching expiry date, but that too has begun to change with more and more people going to get the jabs,” said Ullah, whose country is mainly using AstraZeneca vaccines donated by the WHO-supported COVAX initiative. 

Some 169 new COVID-19 cases were reported on Tuesday across 20 provinces, bringing the cumulative total number of cases to 59,370. Over the past 24 hours, 13 deaths were recorded. Kabul, the capital city, has been the hardest hit. 

Afghanistan Launches Campaign With Support of Religious Scholars 

Just this week, Afghanistan launched a nationwide campaign with the support of religious scholars to convince people to adhere more closely to preventive public health measures – warning the public that if they failed to do so, they could suffer the same fate as India. 

On Tuesday, the country’s Minister of Hajj and Religious Affairs, Mohammad Qasim Halimi, called on religious scholars to educate the people about the threat of coronavirus and encourage them to follow the guidelines of the Ministry of Public Health.

Ayaz, Chairman of the CII, told Health Policy Watch that a ‘Fatwa’ declaration – an interpretation on an aspect of Islamic law – had been given by religious scholars on religious practices during the pandemic, which stated that gatherings should be avoided and religious services should be held at home.

Image Credits: Sky News, Rahul Basharat Rajput, Press TV.

Pakistan health workers getting vaccinated with Sinopharm.

As India restricts COVID-19 vaccine exports to address its domestic surge, the World Health Organization (WHO) is poised to give the Chinese vaccine, Sinopharm, emergency use listing (EUL) this week – potentially catapulting China into becoming the biggest global supplier of COVID-19 vaccines for low- and middle-income countries (LMIC).

However, Sinopharm is reported to be one of the most expensive vaccines on the market, with the most recently reported price $36 a dose paid by Hungary – in comparison to $2.15 for AstraZeneca.

Global vaccine alliance Gavi, on behalf of the COVAX Facility, confirmed to Health Policy Watch on Thursday that it is “in dialogue with several manufacturers, including Sinopharm, to expand and diversify the portfolio further and secure access to additional doses for Facility participants. We will provide updates on any new deals in due course.”

After delivering over 49 million vaccines to 120 countries, the vast majority of which were AstraZeneca vaccines manufactured by the Serum Institute of India (SII), COVAX deliveries have ground to a halt because of domestic demand in India – causing panic in LMICs reliant on COVAX.

China joined COVAX late last year and announced in February that it would be donating 10 million vaccine doses to the facility – but this cannot happen until the WHO grants the vaccines EUL.

WHO Decision on Sinopharm This Week

A decision on Sinopharm is expected by the end of the week, but late last month Alejandro Cravioto, the chairperson of WHO’s Strategic Advisory Group of Experts (SAGE), told a media briefing that both Chinese vaccines, Sinopharm and Sinovac, have presented efficacy data that meets WHO requirements. 

“The information that the companies shared publicly at the [SAGE] meeting last week clearly indicates that they have levels of efficacy that would be compatible with the requirements that WHO has asked for this vaccine,” Cravioto told the briefing.

The WHO has set 50% efficacy against the virus as the lowest bar for EUL, and its decision is based on a risk-benefit analysis. 

The decision on the other Chinese vaccine, Sinovac, is expected next week, but reports indicate that it has lower efficacy than Sinopharm. 

A decision on the Moderna vaccine is expected on Friday, but the WHO has already issued interim recommendations on the use of Moderna and no impediments are expected for it.

“We are on track to make a billion doses this year, and potentially to have up to 1.4 billion doses for 2022,” said Moderna CEO, Stephane Bancel told a press briefing last week, adding that the company is also “in the final stretch to get an agreement with COVAX,” for distribution of the mRNA vaccine.

However, Moderna, like the Pfizer vaccine, needs ultra-cold storage which precludes its use in many low income countries.

COVAX Searching for New Vaccine Suppliers

COVAX confirmed last week that 90 million AstraZeneca vaccine doses it had expected the Serum Institute to deliver in March and April have been kept for use in India, which is facing a massive surge in cases.

Seth Berkley, CEO, Gavi, the Vaccine Alliance.

Seth Berkley, CEO of vaccine alliance Gavi, acknowledged last week that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. Gavi co-leads COVAX with the WHO and CEPI.

He confirmed that COVAX was “waiting for when supplies will resume [from India], and we’re looking at other options at the same time”.

Berkley also said that COVAX was “in early days on discussions on dose sharing”.

“We had an announcement last Friday from French President Macron that he would be sharing up to a half a million doses and we’ve also had an announcement from New Zealand, that they would be sharing 1.6 million doses and we’ve heard from the Spanish Prime Minister that they would be sharing doses, so we’re beginning to see engagement from many on dose sharing,” explained Berkley.

A Gavi spokesperson explained to Health Policy Watch that dose-sharing can happen “through the transfer of vaccine doses purchased by self-financing participants to the COVAX AMC economies, as pioneered by Norway and followed by New Zealand, or by donating own doses purchased for domestic consumption to COVAX AMC economies, in line with the recent French announcement”. 

“We welcome commitments of intention to share doses from other countries, including Spain, and continue to be in close dialogue with these countries who have expressed interest. We expect further announcements on this to take place over the coming weeks and months,” added the spokesperson.

Sinopharm To Produce One Billion Doses This Year

In contrast to the vaccine shortage in India, Sinopharm’s manufacturers claim that they have already sent 50 million vaccines to other countries, according to a report published last week.

By the end of February, China said that it had supplied 69 countries with vaccines – some as donations as some as sales. Recipients include Zimbabwe, Guinea, Egypt, Pakistan, Serbia, the Maldives, and the United Arab Emirates.

Meanwhile, Botswana announced this week that it had bought 200,000 Sinopharm doses to supplement a donation of the same amount.

Bangladesh also turned to China this week after being forced to suspend its vaccination programme when India told the country that it could not deliver its second batch of AstraZeneca vaccines to it any time soon. Six million Bangladeshis have already received one dose of the AstraZeneca vaccine.

China has offered to give Bangladesh 600,000 doses as a donation and the country will buy the rest. However, the cost of Chinese vaccines could cripple LMICs. 

On Tuesday, China’s foreign minister, Wang Yi, hosted a virtual meeting of the foreign ministers of Afghanistan, Pakistan, Nepal, Sri Lanka and Bangladesh at which the ministers “agreed to deepen cooperation as South Asian countries are facing a new wave of the COVID-19 pandemic”, according to the Chinese media agency.

According to Wang, China is willing to “promote vaccine cooperation” in South Asia through “flexible methods such as free aid, commercial procurement, and filling and production of vaccines”, to ensure “more diversified and stable vaccine supplies”.

India was invited but did not attend the meeting, but Wang said that “China is ready to provide support and assistance to the Indian people at any time according to the needs of India”.

Yu Qingming, chairman of Sinopharm Group, indicated last month that the state-owned pharmaceutical group expected to produce over one billion doses of its vaccine, according to Chinese state media.

Yu added that the annual output of the vaccines could reach three billion doses “in the future”.

The UAE and Serbia have also signed contracts with China to produce Sinopharm while Egypt has signed an agreement with China to produce Sinovac.

Yin Weidong, CEO of Sinovac’s producer, Biotech, said last week that his company was producing six millions doses a day, had sent at least 156 million doses to other countries, and could produce two billion doses this year.

In China itself, by Tuesday over 230 million doses of COVID-19 vaccines had been administered across China, according to Chinese health authorities. But the most populous country in the world estimates that it will be able to cover all 1,4 billion citizens by early next year.

Little Data About Chinese Vaccines

However, both Chinese vaccines are viewed with skepticism in many parts of the world because virtually no independent scientific information is available – only company information.

Sinopharm has claimed efficacy of 79.3% – 86% in multi-country trials, but these results are unpublished. 

Sinovac has also failed to publish peer reviewed results, but company announcements of Phase 3 results in four different countries have also yielded wildly varied efficacy scores ranging from 50.3% – 91.3%, according to Health Policy Watch research.

Researchers at Brazil’s independent Butantan biomedical centre said that Sinovac  displayed 50% efficacy in its clinical trial in Brazil.  

Interestingly, Serbia recently reported results in which it compared the antibodies of 10,000 citizens vaccinated with Pfizer, Sputnik and Sinopharm – all the vaccines currently in use in the country. 

With Pfizer and Sputnik, good antibody responses were noted after the first jab. But people vaccinated with Sinopharm only developed antibodies around two weeks after getting their second dose, and men over the age of 65 did not generate a strong antibodies response. The Sinopharm-vaccinated also showed a faster decline in antibodies than those vaccinated with the Pfizer and Sputnik vaccines.

US AstraZeneca Vaccine 

On Monday, the US announced that it would pass 60 million doses of AstraZeneca vaccines on to countries in need “as they become available”, according to Andy Slavitt, White House Senior Advisor on COVID-19.

However, it is unclear when these vaccines will become available as they are supposed to be manufactured by Emergent BioSolutions, the company that recently had to destroy millions of contaminated AstraZeneca and Johnson & Johnson vaccines.

It is also unclear who will receive the doses or how they will be delivered. Gavi would not comment on whether COVAX would receive any of the 60 million US AstraZeneca vaccine doses. A Gavi spokesperson simply said: “We welcome the US Government decision to share surplus doses as a positive step towards addressing the pandemic on a global scale. We will not be safe anywhere until we are safe everywhere.”

Image Credits: 中国新闻网, Gavi/Tony Noel.