The obesity pandemic is in “the same room” as the COVID pandemic in terms of its threats to health – putting people at greater risk of premature death from multiple causes, including SARS-CoV-2, the virus that leads to COVID-19. And ever since stay-at-home measures became routine, people have gained even more weight – up to 1.5 pounds a month according to one recent US study. Yet countries have the tools to address obesity, note Trish Cotter and Dr. Nandita Murukutla at Vital Strategies, a global public health NGO. We spoke to Ms. Cotter and Dr. Murukutla to find out more: 

Health Policy Watch (HPW): A third of the global population now suffers from overweight, and rates of obesity are growing across the world, including in poor countries. How can we explain these trends? 

Vital Strategies (VS): Over the last 40 years, obesity rates around the world have ballooned. High-income countries, like the United States, were the first to experience substantial weight gains of their populations, but the 21st century has seen that phenomenon spread to all parts of the globe. Now, the average adult is three times as likely to be overweight as the average adult in the 1970s.

There are a number of reasons for this alarming trend, which began well before COVID-19, starting with the environments in which people live, as well as poverty, discrimination, increasing availability of unhealthy foods in schools, dwindling levels of physical activity, and a lack of knowledge of unhealthy diets and products.

However, the fundamental reason is the rapid change in our diets and the broader food environment. Ultra-processed products or “junk food”, such as soft drinks, ice creams, or prepared frozen dishes, are one of the key drivers of growing obesity worldwide. They are high in sugar, salt and fat and, unfortunately, widespread in most societies. Yet their harmful effects are poorly understood.

One in three people worldwide are overweight

HPW: Why are ultra-processed foods so ubiquitous? 

VS: They are cheap, easily available, and because of additives and preservatives, they have a long shelf-life. They’re made to feel and look attractive, and they’re made to taste good. Importantly, they’re also hyper-marketed by the food industry. 

Advertising campaigns are very good at making unhealthy products seem part of the fabric of society: unhealthy foods are made to seem crucial to family gatherings and entertainment, so they become part of the social norm that normalizes unhealthy foods. And much of the advertising around unhealthy foods is so enticing that it gets children hooked at a young age.

In what ways is advertising of ultra-processed products misleading? 

Unhealthy products are often marketed cleverly as convenient substitutes for healthy, minimally processed options that include whole grains, fruits and vegetables. They are marketed as convenient breakfast foods, snacks, juices, and sometimes they are also marketed as being more sanitary than fresh fruits and vegetables. But that’s misleading, because current evidence demonstrates that ultra-processed products result in worse diets and ultimately overweight and obesity, which exacerbates the risk of contracting a range of chronic diseases as well as suffering poorer outcomes from infectious diseases like COVID-19. Claims that ultra-processed products are healthy alternatives are untrue. 

 Can you give a concrete example of a strategy that misleads customers into thinking they’re buying healthy products? 

Labels on the front and back of food packages are often really hard to accurately decode. And many of these labels use clever algorithms to hide unhealthy levels of sugar, salt, and saturated fat. Customers may not always realize that the product they are buying is unhealthy.  

Late last year, you co-authored a guide to help policymakers introduce clear, yet highly effective warning labels on foods and beverages to nudge customers away from unhealthy foods. How do these warning labels work?

Front-of-Package (FOP) nutrient labels, sometimes called warning labels, tell consumers immediately, on the front of products, and simply when a product contains high levels of unhealthy nutrients. That means customers don’t need to spend several minutes trying to work out whether each product is healthy or not. This system is simple, visual, and easy to understand. And it is effective, as seen from studies across the world, in triggering immediate behavior change.

The front-of-package labels serve as behavioral nudges, protecting people from making unintended unhealthy purchases. In other words, the warning labels work by reminding consumers that the products they are purchasing are unhealthy, thus nudging them to make healthier choices. But they also have important knock-on effects: they help change social norms around unhealthy eating.   

Example of warning labels on food products in Chile to nudge customers away from unhealthy foods. Translation from top-left to bottom-right: high in calories; high in sugars; high in sodium; high in saturated fats. Source: Ministry of Health of Chile.

You mentioned that warning labels can help change social norms that promote the consumption of unhealthy foods. Can you unpack that?

One study found that children pestered their parents to buy healthier products that did not have warning labels, partially because teachers at school would not accept unhealthy snacks. In some cases, teachers would even confiscate unhealthy snacks brought by children. This suggests that something as simple as a warning label can challenge the idea that ultra-processed products are desirable, and start to change the social norm.  

It’s also important to reiterate that warning labels are a highly cost-efficient approach because you’re able to target consumers rapidly, constantly, and at the point of decision making to make a purchase or not, with little to no cost to the government. 

And the costs of not addressing obesity during the pandemic could amount to $US 7 trillion by 2025, according to the latest review by the World Obesity Federation. Furthermore, out of a total of 2.5 million deaths from COVID reported as of February, 2021, 2.2 million were in countries where over half of the population is overweight. 

Countries with high proportions of overweight people had coronavirus death toll that were ten times higher than those with low proportions of overwheight people

So far, six countries including Chile have legally mandated warning labels, although many have put in place “voluntary” systems. How well do the voluntary systems work ?

The voluntary systems, which do not legally mandate warning labels on every single food product, are not effective. As warning labels may reduce sales of unhealthy foods, the food industry is unlikely to take them up. That’s why mandatory regulations on warning labels are crucial if we want to make a real dent into obesity and overweight. We’ve seen these warning labels work very well in Chile where they contributed to a decrease in the consumption of sugar-sweetened beverages by almost 25%. This was achieved through a comprehensive approach to addressing obesity, which also included: restrictions on child-directed marketing of unhealthy foods and beverages on the radio, television, cinema, and internet; a ban of unhealthy foods and beverages in schools and daycare; and a tax on sugary drinks.

 What kinds of labels work best?  

There are two broad categories of labels. The first category, the so-called “reductive” labels, outline how much of each nutrient is contained in foods, but they don’t help the consumer decide whether the product is healthy or not. These labels are less effective. The second category of labels, the so-called “interpretive” labels, are much more effective. They draw attention to the nutrients of concern or summarize the overall healthfulness of the product. Thus, they can help consumers distinguish between healthy and unhealthy products immediately through clear visual cues. 

The so-called “interpretive” labels can help consumers quickly identify nutrients of concern in food products to make healthier decisions

What are the challenges to getting countries to act? 

Although a number of high-level commitments have been made to fight obesity, including the inclusion of a target in the SDGs , The UN High-Level Meetings on NCDs as well as the UN Decade of Action on Nutrition, a lot more can and needs to be done. But that said, there is very strong industry pushback, and that’s also not surprising. We have seen decades of this with regard to other issues like tobacco control. Industry pressure cannot be underestimated and industry interference is often what holds governments back. However, governments should not feel powerless to take on food policy. The tools are out there to help them do this effectively and cheaply.  

Are there any other policies that can be used alongside mandatory warning labels to cut obesity and overweight?  

Sugary drinks taxes are among the most effective and cost-efficient ways to reduce access to unhealthy foods. Marketing restrictions and the removal of misleading advertising, especially in schools and environments in which children reside, is crucial. Bans on unhealthy products in schools can also help. 

We also need to ensure that healthy food becomes the default option by making sure that it’s easily available and cheap enough to buy – and at the same time ensure that unhealthy foods like ultra-processed foods are less available. 

And as mentioned earlier, it’s important to change those social norms around unhealthy foods so that they’re not associated with what marketers want you to associate them with – families, warmth, love, sports –  and all of the things that bring people together. 

Where do we go from here? And let’s be honest that food labels are not a panacea – what about access to healthier diets generally, which are often more expensive than unhealthy diets. And what about environments where people can be physically active?

With more than one-third of the world’s population overweight or obese, and the COVID-19 pandemic revealing deep structural inequities in food environments, the push to combat obesity has become more urgent than ever. Many individuals are powerless in the face of food shortages and the over-availability of cheap ultra-processed foods. The onus is on governments to act, and to act now. There were a number of factors, from environmental, structural to social, that brought us where we are today, and we will likewise need a concerted and cohesive set of actions to reverse these trends. FoP warning labels are a strong place to start.

Read more here on Vital Strategies’ new guide to help policymakers design and implement warning labels on foods and beverages.

Trish Cotter, MPH, Global Lead, Food Policy Program and Senior Advisor, Vital Strategies
Dr. Nandita Murukutla, Vice President for Global Policy and Research, Vital Strategies

Image Credits: University of Michigan, World Obesity Federation, Vital Strategies, Food Standard Agency, Vital Strateggies, Vital Strategies.

The Nigerian government has ditched the AstraZeneca COVID-19 vaccine and will soon shift to the Johnson & Johnson’s one-shot vaccine.

 

EXCLUSIVE – IBADAN – The Nigerian government has quietly ditched the AstraZeneca COVID-19 vaccine meant to vaccinate tens of millions of citizens, and will gradually shift to the Johnson & Johnson’s one-shot vaccine, saying it is easier to administer.

Documents from the Nigerian Primary Healthcare Development Agency (NPHCDA) obtained by Health Policy Watch show that the agency intends to begin rolling out the J&J vaccine to almost 30 million people as soon as it can obtain the vaccine supplies. 

While denying that safety concerns are an issue, the Nigerian government’s move also comes amidst growing global concerns about AstraZeneca’s efficacy against the SARS-CoV2 virus variant first identified in South Africa, as well as safety concerns that have led to the suspension of AstraZeneca vaccines for people under the age of 60 in Germany, and elsewhere (see related story).  

Nigeria had already commenced the rollout of  the AstraZeneca vaccine, with vaccines supplied by the WHO co-sponsored COVAX initiative. The country was meant to get more AstraZeneca supplies though the African Medical Supplies Platform (AMSP) – having already placed the largest order on the continent through the AMSP, as previously confirmed by the Africa Centres for Disease Control (CDC).

However, according to the documents, the AstraZeneca vaccine doses reserved through the AMSP will be replaced with Johnson & Johnson vaccines. “Based on this, Nigeria’s total allocation is now 29,850,000 of Johnson & Johnson (Janssen) COVID-19 vaccine which is one dose shot to cover 29,850,000 eligible Nigerians as originally planned,” the agency stated. That would be enough to cover about 15% of Nigeria’s population of 200 million people.  

Government Says J&J ‘One Jab’ Vaccine, not Safety Worries, Are Behind Shift 

Government officials in Nigeria attributed the shift to J&J’s to the vaccine’s single jab technology – which will make it much easier to administer as compared to AstraZeneca’s two-dose shot – as well as ensuring the vaccine coverage stretches even further. They denied that it was linked to issues of safety and efficacy. 

However, behind the scenes, another factor is the J&J vaccine’s documented efficacy against the B.1351 virus variant identified in South Africa – and now spread to some 16 other countries on the continent, including nearby Ghana. 

South Africa on Monday announced that it has secured 30 million J&J vaccines after a small  clinical trial and genomic surveillance showed the AstraZeneca vaccine was not strongly effective against that variant. 

In an earlier advisory, the Africa CDC stated that African countries where the B.1351 variant is the predominant SARS-CoV-2 strain should consider swapping the AstraZeneca vaccine for others that have shown more efficacy.

Neither the AMSP or the Africa CDC could confirm when the J&J doses will become available.  A recently announced J&J commitment to supply some 400 million vaccines to Africa is only scheduled to get into motion in the third quarter of 2021. Meanwhile, the continent continues to call for vaccine equality, fair distribution and local vaccine production.

Nigerian Regulator’s Nod

Government officials have continued to assure citizens of the safety of the vaccine despite global concerns – as  it continues to roll-out the available AstraZeneca doses while it awaits the J&J vaccines.  

On Feb 18, just a few days after Nigeria received its first shipment of the AstraZeneca vaccine, the country’s drug regulator, the National Agency for Food and Drug Administration and Control (NAFDAC) approved the vaccine for emergency use. 

“The recommendation for Emergency Use Authorization was based on rigorous scientific considerations,” NAFDAC stated.

Addressing a recent webinar on COVID-19 Vaccines, Dr. Faisal Shuaib, Executive Director/CEO of NPHCDA, acknowledged that the controversy around the vaccine’s safety, but urged countries in Europe and globally to continue vaccine administration as it is safe and effective.

Prof Mojisola Christianah Adeyeye, NAFDAC’s Director General added that safety of the vaccine is primary to the agency and that it would be using its Med Safety App for Active Pharmacovigilance of the vaccine. 

Immunisation Drive Continues

As at March 31, over 718,000 Nigerians had received the first doses of the available AstraZeneca vaccine supplies; coverage ranges from an over-the-top 104% target of priority patients reached in Kwara state to none at all in Kogi state – where a vaccine-hesitant  government is only just now succumbing to pressure to allow citizens to receive the vaccine. 

But a cross section of health experts speaking at the recent Nigerian Academy of Science webinar said the bad publicity around the AstraZeneca vaccine might also have harmed vaccination in general. Recent news emanating from Europe has made the general public more suspicious of the potential lethal effects of the jabs – in addition to widespread misinformation circulating on social media. 

Dr Yahya Disu, Head of Risk Communication at the Nigeria Center for Disease Control (NCDC), said recent surveys show broad acceptance of vaccines among Nigerians and this is expected to ensure the country quickly achieves herd immunity – provided sufficient vaccines are made available.  Disu said 86% of respondents of the surveys said they would still continue preventive measures such as wearing face masks, handwashing and social distancing even after receiving the vaccines.

Pfizer and its German partner BioNTech say their COVID-19 vaccine is safe and protective in children as young as 12.

The Pfizer-BioNTech COVID-19 vaccine is safe and protective in children as young as 12 with no serious side effects in adolescents who received the vaccination, the company said on Wednesday.

Interim results of a recent clinical trial of some 2,260 adolescents ages 12-15 years old was published by the pharma company – although it has not yet undergone peer review. The adolescents who participated in the trial produced strong antibody responses and experienced no serious side effects, the company said, saying the vaccine had demonstrated “100 % efficacy”.

Pfizer and its German partner BioNTech plan to ask the U.S. Food and Drug Administration and European regulators to allow emergency use of the shots among adolescents, beginning at age 12. Pfizer’s vaccine is already authorised by regulatory authorities for teens ages 16 and older.“We share th e urgency to expand the use of our vaccine,” Pfizer CEO Albert Bourla said in a statement. He expressed “the hope of starting to vaccinate this age group before the start of the next school year” in the United States.

Pfizer isn’t the only company seeking to lower the age limit for its vaccine. Results also are expected soon from a U.S. study of Moderna’s vaccine in 12- to 17-year-olds. Another vaccine study of safety and efficacy in children ages 6 months to 11 years is also underway, but that has yet to yield preliminary results.

See the full release here.

German Health Minister Jens Spahn and German Chancellor Angela Merkel during a joint press conference announcing the suspension of the use of the AstraZeneca COVID-19 vaccine.

Germany has suspended the use of the AstraZeneca coronavirus vaccine for people under the age of 60 amidst fresh concerns of unusual blood clot cases among some people receiving the vaccine, particularly women, and leading to the deaths of nine people in all. 

German Chancellor Angela Merkel and Health Minister Jens Spahn made the announcement on Tuesday after the country’s Standing Committee on Vaccination (STIKO) reviewed more data on emerging cases of rare blood clots in people immunised with the vaccine, produced by the Anglo-Swedish drug maker.

Germany’s medical regulator made the call after researchers at the federal government’s  Paul Ehrlich Institute, said they had recorded 31 cases of rare blot clot abnormalities, among the 2.7-million Germans who have thus far received the AstraZeneca vaccine. 

All cases were younger than 63, and all but two were women. The cases involved cerebral venous thrombosis (CSVT), a rare clot in blood draining from the brain, but also related to abnormally low levels of platelets, which help blood clot, and bleeding near the site of vaccination.  

“The experts of the Paul-Ehrlich-Institut now see a striking accumulation of a special form of very rare cerebral vein thrombosis (sinus vein thrombosis) in connection with a deficiency of blood platelets (thrombocytopenia) and bleeding in temporal proximity to vaccinations with the COVID-19 vaccine AstraZeneca,” said a news release of PEI, the Federal Institute for Vaccines and Biomedicines.

Several German regions — including the capital Berlin and the country’s most populous state, North Rhine-Westphalia — had already suspended use of the shots in younger people  earlier on Tuesday. 

Merkel said that the government “cannot ignore” STIKO’s  recommendation or the data about blood clots developing following shots with the vaccine.

Germany Has Other Vaccine Options For Younger People

Germany has suspended the use of the AstraZeneca vaccine in people under 60 years of age.

“We all know that vaccination is the most important tool against the coronavirus,” said Merkel, adding there were other options for younger people. “We are not faced with the question of AstraZeneca or no vaccine,” she said. “Instead we have several vaccines at our disposal.”

Spahn said the vaccine would only be administered to people aged 60 or older, unless they belong to a high-risk category for serious illness from COVID-19 and have agreed to take the vaccine despite the small risk of a serious side-effect.

“In sum it’s about weighing the risk of a side effect that is statistically small, but needs to be taken seriously, and the risk of falling ill with corona,” Spahn said during a press briefing.

He said the decision was taken “on the basis of currently available data on the occurrence of rare, but very serious thrombosis-related side-effects.” The commission said that it would issue guidelines on what to do for adults under 60 who had received a first AstraZeneca shot and were due another by the end of April.

Suspension – A Blow To Germany’s Vaccine Roll-out

The decision to suspend use of the vaccine for under-60s was “without doubt a setback” for the vaccination campaign, in which the AstraZeneca vaccine was a centrepiece, Spahn acknowledged.

It comes as Germany, along with other European countries, scrambles to ramp up its vaccine programme, which lags far behind those in Britain and the United States. By Monday, some 13.2 million people in Germany, a country of some 83 million people, had received at least one dose of one of Europe’s approved vaccines, while only 4 million had received two vaccine doses.

Germany is due to receive 15 million more AstraZeneca doses in the second quarter of 2021. Spahn said the new supply would be made available to people over 60 who might otherwise have had to wait longer, reducing their risk of falling seriously ill with COVID-19.

Germany’s U-turn On AstraZeneca

Use of the AstraZeneca vaccine was temporarily halted in Germany, as well as in several other European countries, earlier this month when concerns about occurrences of the rare blood clots first emerged. 

Then, just under two weeks ago, the European Medicines Agency said that the vaccine is safe and that its benefits outweigh the risks, and the vaccine rollout in Germany and elsewhere in Europe resumed.

Paradoxically, earlier in the vaccine rollout, Germany had refrained from administering the AstraZeneca vaccine to people 65 and over, citing insufficient evidence of its efficacy in that age group at the time. 

Other Countries Restrict Use of AstraZeneca

On March 29, Canada’s vaccination committee also recommended suspending the AstraZeneca jab for people under 55, citing reports coming out of Europe of blood clotting incidents.

France limited its use to people older than 55. Norway, where regulators say four people died of blood clots among about 120,000 people who received the AstraZeneca jab, has also suspended the vaccine. Sweden has resumed AstraZeneca use for people older than 65.

The vaccine is not yet cleared for use in the United States. An independent panel of medical experts overseeing the US trials took the unusual move last week of accusing the company of providing an “incomplete view” of efficacy data in its U.S. trials.

On Monday, Canada also recommended halting the use of the jab for people under 55 “pending further analysis”.

Researchers Find Association with Clots; AstraZeneca says Vaccine is “safe and effective”

The suspensions also come in the wake of a March 28 pre-print report from researchers in Germany, Canada and Austria, including a scientist at the Paul-Ehrlich-Institute, which linked the vaccine to the development of a blood clotting disorder.

However, some academics have said that the paper’s implication of a causal association isn’t backed up by evidence.

In a statement ahead of the announcement, AstraZeneca said tens of millions of people worldwide have received its vaccines.

The company said it would would analyse its own records to understand whether the rare blood clots reported occur more commonly “than would be expected naturally in a population of millions of people.”

 

Image Credits: Clemens Bilan.

The most important takeaway about the just-released WHO report on the origins of the SARS-CoV2 virus that has infected over 100 million people to date may not be its initial findings, which need to be held under the microscope, but the fact that it has been issued at all. 

Speaking at a press conference on Tuesday, WHO’s Peter Ben Embarek, who coordinated the politically fraught WHO mission to Wuhan, China in January and the report produced after the visit  – stressed that it was the beginning of a process  – and a quest. It will take much more time for the 17 members of the international expert committee – and the world – to unravel.  

Glass Half Full – Half Empty 
WHO press briefing Tuesday with members of the international team tasked with tracing the origins of SARS-CoV2

The weaknesses of the report are already apparent, say experts, whose views were shared confidentially with Health Policy Watch.  The committee’s methodology for ranking some scenarios, like transmission through food products, as very likely, while ranking others, like a laboratory biosafety incident, as “extremely unlikely”  was foggy, with no real objective criteria measurement cited.  

The team discounted too rapidly the possibility that the virus could have emerged from a lab biosafety accident at the Wuhan Virology Institute – world-famous for its study of bat coronaviruses that are the closest known relatives of SARS-CoV2.  

WHO’s Peter Ben Embarek, head of the SARS CoV2 origins task team.

Asked at the press briefing, how the team decided to rank the probability of the four different theories it considered, Ben Embarek said that the method was debate and discussion among the team members until they reached a consensus. 

And so it was also no surprise that WHO DIrector General Dr Tedros Adhanom Ghebreyesus, was already walking back on one of the report’s key conclusions.  In a closed-door briefing to WHO member states, that preceded the report’s public release, the WHO Director General stated:

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

Significantly, Tedros himself also did not appear at the WHO media briefing – but rather let Ben Embarek, a WHO food safety expert who coordinated the mission by the international expert team to China, appear as the single WHO interlocutor on the public stage. 

And not long after the press conference was finished, some 14 governments led by the United States, Australia and Canada, but also including Denmark, Japan, Norway, Korea and the United Kingdom, issued a joint statement expressing, “shared concerns regarding the recent WHO-convened study  in China, while at the same time reinforcing the importance of working together towards the development and use of a swift, effective, transparent, science-based, and independent process for international evaluations of such outbreaks of unknown origin in the future.”

The group of 14 member states complained about the fact that the study was “significantly delayed and lacked access to complete, original data and samples”, stating that going forward, there is a need for “further studies of animals to find the means of introduction into humans.

“Going forward,” the member states added,”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. With all data in hand, the international community may independently assess COVID-19 origins, learn valuable lessons from this pandemic, and prevent future devastating consequences from outbreaks of disease.”

Half Empty -missing and incomplete data

Among the specifics being raised by experts and observers in the wake of the report’s release are the following: 

  • Weak rationale for the team’s dismissal of a coronavirus laboratory escape.  As the international team members admitted themselves in the WHO press briefing, they lacked the competencies to carry out a ful-fledged laboratory investigation.  The Wuhan Virology Institute staff, told the WHO team that although researchers at the institute had sequenced the genome of the RaTG13 horseshoe bat virus, which is the closest known relative to SARS CoV2, researchers did not maintain live samples of the virus on hand at the institute.  that claim sounds disingenuous, because such samples were indeed collected by the institute in 2013 from a horseshoe-bat colony in Yunnan province, where a group of miners had died in 2012 from a mysterious SARS-like illness.  And the institute’s research into those same coronaviruses is a matter of scientific record. In addition, the WHO team did not have access to raw data on the virology institute’s inventory samples or to data on the health status of institute employees, or serological testing, was made available to the investigators.    
  • Early spread of the coronavirus in Wuhan – the WHO-mandated team did not get full access to clinical patient data from the earliest known patients, or to the genomic sequences of the viruses with whch they were infected.  Serological data available from blood banks, which could have been examined in retrospective studies similar to those carried out on Italy to identify asymptomatic virus carriers, also was not made available by the Chinese authorities. Such data would be critical to understanding where and how widely the virus was circulating prior to December 2019.  Despite that, as team member Marion Kooperman’s noted at the WHO press briefing – data that the team did access suggested that as of December, there were already several coronavirus strains circulating in the city. 
  • Spread through the food cold chain – the theory touted by the Chinese government of virus spread through imported frozen food products is termed as a “possible pathway” in the report – when in fact little real evidence exists that such contamination could have triggered the Wuhan pandemic, and the conclusion that it is even “plausible” lacks analytical rigour.   
  • Evidence about spread through an intermediate wild animal host -while highly plausible as a theory, remains very incomplete, with the mapping of animal supply chains and products only at the initial stages. 
Half Full – Key insights gleaned 
Dr. Peter Daszak – President of the EcoHealth Alliance

Despite the shortcomings, committee members at the briefing stressed the new evidence that they had gathered, which provides a basis to push ahead with more studies. 

Chief among those is a direct line of supply chain provision of wild animal products from regions such as Yunnan province, which are known to harbour bat coronaviruses similar to the SARS-CoV2 – to the Huanan Market in Wuhan – where the most intensive cluster of initial cases first appeared. 

virus
Mapping of stalls in Wuhan’s Huanan market that sold farmed wildlife products from rural regions that are coronavirus hotspots.

“Some of the market stalls in the (Huanan Seafood) market in Wuhan were selling [wild animal] foods foods originating from wildlife farms in known coronavirus hotspots” elsewhere in China, said Ben Embarek, citing what is perhaps one of the most important findings of the study. 

“From the animal side, … the events began to fit together when we looked at the molecular data the epi data and the animal data – they all seemed to fit to form a big picture story about what likely happened, and I think that’s quite exciting,” added Peter Daszak, a leading team member and president of the EcoHealth Alliance.   

“From the outside, it would have been incredible to have a bat with the exact same lineage of viruses, we didn’t see that yet –  that will come in the future I think.

“What we did see on the animal side is clear evidence… that there was a pathway to that market and animals that we know are Coronavirus carriers, from places where the nearest related viruses are. What that does is it shows you there is a pathway, that this virus could have taken to move  800-1000 miles from the rural parts of South China, Southeast Asia, into this market, that was exciting to see.” 

Those insights are all the more critical as the world grapples with a rapid pace of ecosystem deterioration, and more industrialized forms of animal food production, which present considerable risks of virus emergence that need to be better understood by the public at large.

Dr. Marion Koopmans, Dutch virologist and epidemiologist

On the patient side, despite the Chinese authorities’ fragmented provision of patient and epidemiological data, the evidence culled by the team still remains clear. Already in December 2019, there were diverse strains of the SARS-CoV2 virus already circulating in the city – suggesting that that the infection had already made its way into the city’s population some time before. 

Said Marion Koopmans, a Dutch virologist and epidemiologist: “The SARS CoV-2 virus was circulating in the Wuhan market market in December 2019, but it was also circulating elsewhere in the city, in cases unrelated to each other,” she noted at the press briefing. .

The team also noted that despite the multiple restrictions and barriers put up by Chinese governmental authorities – the atmosphere between scientists remained positive – creating what Ben Embarek called a “space” for the scientists to do their work.  And despite considerable pressure from China to point the finger abroad, the team’s testimony makes it clear that the next research steps on the virus trail must be taken in Wuhan, China as well as in rural areas that harbor bat coronaviruses – rather than more far-flung parts of the world. 

Moving Ahead – Balancing Political and Scientific Pressure  

What remains is a long road ahead, requiring investment in more rigorous, and as some team members rightly noted – more expensive studies – based upon evidence-driven demands and requests to Chinese authorities for more detailed data – on both the food safety as well as the human epidemiological side of the virus coin. 

In light of the WHO Director General’s comments about the inadequate analysis of the laboratory biosafety risks – it is also likely that WHO member states in Europe or the Americas (read USA), may demand a fresh query into that hypothesis – involving actual biosafety experts who were not members of the original virus origins team.     

Ultimately, It will be up to the WHO member states that mandated the report, informed by outside, independent experts and observers, to nurse the origins study  – or studies – through to more significant, and final conclusions. In that quest, Europe, the United States and their allies will need to steer a delicate course between exertion of the right amount of political pressure on the one hand – and alienating attacks that only foster anger and geopolitical tensions of the kind visibly on display during the era of former US President Donald Trump. 

And from the point of view of scientists – It is a process that may require months, if not several years – WHO’s Ben Embarek warned. 

“”How long will it take? That is always difficult to predict.” he said, pleading with the world to “please be patient.”   Although, despite the heat that the WHO team has received, his appeal was shadowed with appreciation for the fact that a certain amount of vigilance – may also be constructive:  

“It’s an exciting adventure that I hope the whole world will continue to follow.. it’s a fascinating journey and a critical one because it’s the only way we can understand what happened, and more recently tried to prevent something similar for happening again.”  

Image Credits: Sputnik, WHO.

Charles Michel, President of the European Council

After the COVID-19 pandemic exposed fundamental flaws in the global health architecture, a proposal for a new pandemic treaty that could strengthen the world’s capacity to contain the current pandemic and prepare for future ones, is gaining momentum.  

That was a key message at a World Health Organization (WHO) launch of an open letter by 25 global leaders calling for the world to negotiate such a treaty, featuring Charles Michel, President of the European Council, and two dozen other global leaders that are now backing the treaty initiative. 

Other signatories now include the United Kingdom’s Boris Johnson, Germany’s Angela Merkel, France’s Emmanuel Macron, along with the leaders of Indonesia, Kenya, Rwanda and South Africa’s Cyril Ramaphosa. But China, the United States and Russia have yet to sign the call. 

“Today, we are calling for an international treaty on pandemics [to] foster a comprehensive approach to better predict, prevent and respond to pandemics,” said Michel, who has championed the treaty since late last year saying that the treaty would support the principle of “health for all”.

If ratified, the treaty will give the WHO the political clout to better carry out part of its mandate in terms of improved pandemic alert systems, better investments in coronavirus research, and sharing of crucial data on infectious pathogens, vaccine supply chains and vaccine formulas.

WHO’s director-general Dr. Tedros Adhanom Ghebreyesus echoed Michel’s sentiments, saying: “The time to act is now”.

“The world cannot afford to wait until the pandemic is over to start planning for the next one. We cannot do things the way we have done them before and expect a different result. Without an internationally coordinated response…we remain vulnerable,” said Dr Tedros.

Pandemic Treaty Rooted In WHO Constitution 

The treaty “would be rooted in the constitution of the World Health Organisation, drawing in other relevant organizations key to this endeavour,” said the letter, also signed by the heads of: Albania, Chile, Costa Rica, Greece, Korea, Trinidad and Tobago, the Netherlands, Senegal, Spain, Norway, Serbia, Indonesia, and Ukraine.

“Existing global health instruments, especially the International Health Regulations, would underpin such a treaty, ensuring a firm and tested foundation on which we can build and improve.”

The Pandemic Treaty Will Strengthen WHO’s Mandate 

According to Michel, “Such a treaty [could] play an interesting role in order to make sure that we have more transparency on the supply chains [and] on the level of productions of vaccines and of tests; it will mean more rust and better cooperation.” 

Michel suggested that the treaty could also be used to expand vaccine production by facilitating  technology transfer in low- and middle-income countries, referring to the “third way” initially proposed by the World Trade Organisation’s (WTO) new chief Ngozi Okonjo-Iweala. 

“Certainly there is a debate in the international community about how to improve our vaccine production capacities to improve vaccine coverage, particularly in the African continent,” said Michel, adding that “we are closely following the debate at the WTO for the ‘third way’ voiced by Ngozi”.

 US and China Didn’t Sign Call – But Sent Positive ‘Comments’   

WHO’s director-general Dr. Tedros Adhanom Ghebreyesus

Although China and the US did not sign Tuesday’s op-ed, Dr Tedros said that that both countries had voiced “positive” comments during informal discussions with Member States – and that it was not necessarily an issue that the op-ed had only been signed by two dozen countries.

“It doesn’t need to be all 194 countries [to write an op-ed],” said Dr. Tedros. “I don’t want it to be seen as a problem, it wasn’t even a problem. When the discussion on the global pandemic treaty starts, all Member States will be represented.”

The Pandemic Treaty Will  Synergize With The International Health Regulations

Meanwhile, Mike Ryan, WHO’s Director of Emergency Programmes, emphasised that the treaty would “by no means” undermine the existing global framework that governs WHO countries’ behaviour during health emergencies – the legally binding International Health Regulations (IHRs). These regulations set out the mandates under which countries are obliged to report on disease outbreak risks, and share epidemic information, with WHO and other member states.

Rather, the pandemic treaty would generate the necessary political commitment to ensure that the IHRs are implemented; and bolster global pandemic preparedness and response by covering a broader set of issues than those covered by the IHRs, such as the sharing of crucial data.  

“The IHRs…is a really really good instrument,” said Ryan. “But in itself [it] is a piece of legislation that is without meaning unless countries are fully committed to its implementation.”

“IHR only works if we have trust, if we have transparency, if we have accountability. Such a treaty would provide that political framework in which we in public health can do our work much more effectively.”

“The proposed treaty will definitely bring strong political commitment and support for the IHR implementation,” added Jaouad Mahjour, WHO Regional Director for the Eastern Mediterranean region, who also spoke at Tuesday’s press conference.

In an initial response to the initiative, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that pharma partners should play a role in shaping such a treaty. The statement reflected IFPMA concerns over preserving what it described as the patent “incentive system” for developing new vaccines and medicines.

“The discussions around a possible International Pandemic Treaty need to take into account the important role played by the innovative biopharmaceutical industry and its supply chain in fighting the virus,” said the IFPMA statement.  

“It will be important to acknowledge the critical role played by the incentive system in developing tests, therapeutics, and vaccines to contain and defeat the coronavirus. We hope that the discussions on an International Pandemic Treaty will address enablers for future pandemic preparedness – the importance of incentives for future innovation, the immediate and unrestricted access to pathogens, and the importance of the free flow of goods and workforce during the pandemic – in addition to continuing the multi stakeholder approach undertaken in ACT-A and COVAX.”

WHO’s Peter Ben Embarek, head of the origins task team, at the release of the report on Tuesday.

The international team assembled by the World Health Organization (WHO) to investigate the origins of SARS-CoV-2 has identified animal transmission – through an elusive ‘Animal X’ – as the most likely route of infection.

The long-awaited report was released on Tuesday after the 17-person expert team, together with a 17-person team of Chinese scientists, visited Wuhan and its surroundings during January and February to examine evidence about the virus, which was first identified in 174 people in Wuhan in December 2019, and has since infected over 128 million people and caused 2.7 million deaths.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the report advances the world’s understanding in important ways, but it also raises questions that will need to be addressed by further studies. 

“As far as WHO is concerned, all hypotheses remain on the table,” said Dr Tedros. “This report is a very important beginning, but it is not the end. We have not yet found the source of the virus, and we must continue to follow the science and leave no stone unturned as we do.” 

Tedros added that no single research trip could provide all the answers, as “finding the origin of a virus takes time and we owe it to the world to find the source so we can collectively take steps to reduce the risk of this happening again”. 

What follows is a summary of the report’s key points, which the team described as a “work in progress”.

The team examined four main scenarios for introduction: 

  1. Direct zoonotic transmission from a host animal to humans
  2. Indirect zoonotic transmission, involving the virus first infecting a host animal, then adapting through an intermediate host animal, before infecting humans
  3. Introduction through the cold/ food chain, particularly frozen wild animals sold at Wuhan markets
  4. Introduction through a laboratory incident.
Horsehoe bats carry viruses most similar to SARS-CoV-2

1. Direct zoonotic introduction:

Finding: possible to likely. 

Hypothesis: Transmission of SARS-CoV-2 (or very closely-related progenitor virus) moves from an animal reservoir host to human, and is followed by direct person-to-person transmission.

Arguments in favour 

  • The majority of emerging diseases originate from animal reservoirs and most of the current human coronaviruses have originated from animals. 
  • Surveys of the bat viromes conducted after the SARS epidemic in 2003 found SARSr-CoV in various bats, particularly Rhinolophus (horseshoe) bats. 
  • Viruses with a high genetic similarity to SARS-CoV-2 have been found in these bats in China, Japan, Thailand, and Cambodia. 
  • Two distinct types of SARSr-CoV were recently detected in Malayan pangolins. 
  • Minks have shown to be highly susceptible to SARS-CoV-2 and cannot be ruled out as the primary source of SARS-CoV-2. 
  • Antibodies to bat coronavirus proteins have also been found in humans with close contact with bats. 

Arguments against 

  • Although the closest genetic relationship to SARS-CoV-2 was a bat virus, more detailed analysis found “several decades” of evolutionary space between the viruses. 
  • Few of the identified bat virus genomes showed the ability to bind to human cells. 
  • Contact between humans and bats or pangolins is not as common as contact between humans and livestock or farmed wildlife. 
  • Despite the consumption of bats and other wild animal meat in some countries, there is no evidence for transmission of coronaviruses from such encounters. 

Information still needed: Detailed trace-back studies of the animal supply chain of Wuhan markets have provided some credible leads to survey potential reservoir hosts. 

2. Introduction through intermediate host followed by zoonotic transmission 

Finding: possible to likely 

Hypothesis: SARS-CoV-2 is transmitted from an animal reservoir to an animal host, followed by spread within that intermediate host (“spillover host”), and then transmitted to humans. 

Arguments in favour

  • Although the closest related coronaviruses have been found in bats, SARS-CoV-2 has evolved by an estimated “several decades”, which suggests a missing link. 
  • Similar viruses have also been found in pangolins, suggesting cross-species transmission from bats, but again with considerable genetic distance. 
  • Bats and pangolins have infrequent contact with humans, and an intermediary step involving an “amplifying host” has happened in a number of viruses, including influenza and MERS. 
  • SARS-CoV-2 adapts relatively rapidly in susceptible animals (such as mink). 
  • The increasing number of animals shown to be susceptible to SARS-CoV-2 includes animals that are farmed in sufficient densities to allow the potential for viral circulation. 
  • There was a large network of domesticated wild animal farms, supplying farmed wildlife to Wuhan. In high-density farms, there often are connections between farms, leading to complex transmission pathways that may be difficult to unravel. 

Arguments against 

  • SARS-CoV-2 has been identified in an increasing number of animal species, but genetic and epidemiological studies have suggested that these were infections from humans, rather than other animals. 
  • There is no evidence of repeated early SARS-CoV-2 strains of animal origin in humans in China. 
  • There was no genetic or serological evidence for SARS-CoV-2 in tests of a wide range of domestic animals (where large-scale screenings took place) and wild animals, where screening was more limited. 

Information still needed: Further surveys, including a wider geographic range. Studies of the supply chain of Wuhan markets have not found any evidence of infected animals but provided information for follow-up studies, including targeting supply chains from wild-life farms in provinces where the higher prevalence of SARSr-CoVs have been detected in bats. 

Animal products from outside Southeast Asia, where more distantly related SARSr-CoVs circulate, should not be disregarded.

A market in Wuhan, Hubei, China

3. Introduction through the cold/ food chain 

Finding: Possible

Hypothesis: SARS-CoV-2 is introduced or amplified through the cold/ food chain. This could involve direct zoonotic transmission, or spillover through an intermediate host. 

Arguments in favour 

  • The arguments are similar to those listed for zoonotic introduction, but with an emphasis on the potential for initial introduction through food animals or cold/ food chain products or the contamination of food and food containers (for instance by animal waste). 
  • Since the near-elimination of SARS-CoV-2 in China, the country has experienced some outbreaks related to imported frozen products in 2020. 
  • Screening programmes have found limited evidence for the presence of SARS-CoV-2 by nucleotide acid tests in different batches of unopened packages and containers in different cities. For example in an outbreak in Qingdao, the live virus was isolated from the outer package of imported frozen products. 
  • Foodborne outbreaks with enteric viruses are common, but contamination of food with human viruses usually comes from sewage or contaminated water for irrigation. 
  • Sewage treatment typically does not remove all infectious viruses prior to the release of wastewater in the environment. These processes have been investigated widely for non-enveloped viruses but far less for enveloped viruses in the food chain, but there is widespread evidence of  SARS-CoV-2 nucleic acid in sewage. 
  • There is some evidence that the oral route could lead to infection for SARS-CoV-2 from hamster infection experiments, and the virus replicates in gut organoids. 
  • Food animal handlers had an increased prevalence of SARS-CoV-specific antibodies. 
  • Humans infected with SARS-CoV-2 shed virus through faeces and can have gastrointestinal symptoms, suggesting the involvement of the gastrointestinal tract. 
  • Humans can also be exposed to contaminated objects. 

Arguments against 

  • There is no conclusive evidence for foodborne transmission of SARS-CoV-2 and the probability of cold-chain contamination with the virus from a reservoir is very low. 
  • While there is some evidence of the possible reintroduction of SARS-CoV-2 through handling imported contaminated frozen products in China since the initial pandemic wave, this would have been extraordinary in 2019 where the virus was not widely circulating. 
  • Industrial food production has high levels of hygiene criteria and is regularly audited. 
  • Most viruses have been found in 2020 in low concentrations and are not amplified on cold-chain products. It is not clear what the infection route would be (possibly oral, touch, or aerosol). 
  • There was no evidence of infection in animals tested following the Wuhan outbreak. 
  • The risk of foodborne transmission of SARS-CoV-2 through pathways such as objects is very low in comparison with respiratory transmission. 

Information still needed: Case-control studies of outbreaks, in which the cold chain product and food supply are positive, would be useful to provide support for cold chain products and food as a transmission route.

There are some preliminary reports of SARS-CoV-2 positive testing in other parts of the world before the end of 2019. 

There is also evidence of more distantly related SARSr-CoV in bats outside Asia. Some producers in these countries were supplying products to the markets. 

If there are credible links to products from other countries or regions with evidence for circulation of SARS-CoV-2 before the end of 2019, such pathways should be followed up. 

If there are leftover frozen products from the Huanan market from December 2019, particularly frozen animal products from farmed wildlife or linked to areas with the early circulation of SARS-CoV-2, these should be tested. 

4. Introduction through a laboratory incident 

Finding: Extremely unlikely.

Hypothesis: SARS-CoV-2 is introduced through a laboratory incident, reflecting an accidental infection of staff from laboratory activities involving the relevant viruses. We did not consider the hypothesis of deliberate release. The deliberate bioengineering of SARS-CoV-2 for release has been ruled out by other scientists following analyses of the genome. 

Arguments in favour 

  • Although rare, laboratory accidents do happen, and different laboratories around the world are working with bat CoVs. 
  • Humans could become infected in laboratories with limited biosafety, poor laboratory management practice, or through negligence. 
  • The closest known animal coronavirus strain (96.2%) to SARS-CoV-2 detected in bat anal swabs have been sequenced at the Wuhan Institute of Virology. 
  • The Wuhan CDC laboratory moved on 2 December 2019 to a new location near the Huanan market. Such moves can be disruptive for the operations of any laboratory. 

Arguments against 

  • SARS-CoV-2 from bats and pangolin are evolutionarily distant from SARS-CoV-2 in humans. 
  • There is no record of viruses closely related to SARS-CoV-2 in any laboratory before December 2019, or genomes that in combination could provide a SARS-CoV-2 genome. 
  • Prior to December 2019, there is no evidence of circulation of SARS-CoV-2 among people globally and therefore the risk of accidental culturing SARS-CoV-2 in the laboratory is extremely low. 
  • The three laboratories in Wuhan working with coronavirus diagnostics, isolation and vaccine development all had high-quality biosafety level (BSL3 or 4) facilities that were well-managed. 
  • A staff health monitoring programme showed no reports of COVID-19 compatible respiratory illness before or during December 2019, and no serological evidence of infection in workers through SARS-CoV-2-specific serology-screening. 
  • The Wuhan CDC lab which moved on 2 December 2019 reported no disruptions or incidents caused by the move. They also reported no storage nor laboratory activities on CoVs or other bat viruses preceding the outbreak. 

Information still needed: Regular administrative and internal review of high-level biosafety laboratories worldwide. Follow-up of new evidence supplied around possible laboratory leaks. 

At the end of the report, the team called for “a continued scientific and collaborative approach to be taken towards tracing the origins of COVID-19”, something that has been echoed by WHO.

 

Image Credits: CGTN, Arend Kuester/Flickr.

A healthcare worker in France monitoring a COVID-19 patient in critical condition in April 2020.

European countries are experiencing soaring COVID-19 infection and death rates. With a third wave sweeping across Europe, hospitals are at risk of becoming overwhelmed and governments are facing increasing public opposition to continued lockdowns and social distancing restrictions.

The WHO European Region, which includes 53 member states, has recorded an upward trend in cases for four consecutive weeks, with a 13% increase in new cases since mid-March. France, Germany, and Poland are among those worst hit.

The newly reported and cumulative COVID-19 cases and deaths by WHO Region, as of 21 March 2021.

Europe has recorded 1.4 million new cases in the last seven days, as of 21 March, accounting for 44% of global new cases. Compared to countries with high rates of vaccinations, including Israel, the United Kingdom and the United States, several countries in the European region, especially in central Europe, have reported much higher infection rates. 

The current surge in cases is likely due to the more transmissible B.117 variant, first identified in Britain, making this wave “harder to curb” than previous surges in cases, according to German health officials.

In the midst of critiques over the slow rollout of COVID-19 vaccines and the rising infection rates, some leaders are encountering an increasingly restive public. Last week, German Chancellor Angela Merkel walked back a strict lockdown planned for the Easter weekend (2-4 April) following widespread public opposition. French President Emmanuel also came under fire for his refusal to take responsibility for the recent surge in cases – after failing to implement a national lockdown in late January. 

France’s Hospitals May Have to Decide Which Patients Get Limited Resources

Over a dozen regions in France, including Paris, have been put under partial lockdown, but infections continue to soar, with 37,014 new cases reported nationally on Sunday. Some 20 million people are living in ‘high-infection zones’ and are under strict travel restrictions.

A healthcare worker in France caring for a COVID-19 patient in critical condition in April 2020.

In an article published on Sunday in Le Journal du Dimanche, 41 critical care doctors in Paris warned that “the current measures will be insufficient to quickly reverse the alarming curve in infections.”

In the coming weeks, the doctors predict an unprecedented situation for the French public health system – of triaging what seriously ill patients may receive intensive care.

“We have never seen such a situation, even during the worst moments of these last years,” the Paris-based group of physicians wrote.

“In this catastrophic situation, where there is a discordance between needs and available resources, we will be obliged to triage patients, in order to save as many lives as possible. This triage will concern all patients, COVID and non-COVID, in particular adult patients in critical care,” the doctors wrote. 

The number of patients in intensive care in France is already nearing the level seen during the last big COVID wave in the autumn of 2020. On Sunday, the number of patients in ICUs was 4,872, almost reaching the 4,919 ICU cases that were recorded during the country’s worst point in the pandemic so far.

France’s ICU beds were at 90% capacity, with the majority of cases linked to the B.117 variant. According to French healthcare workers, those with severe COVID illness are also younger than patients seen in the previous waves. Currently, a large portion of hospitalized patients are between 30 and 65 years of age.

“For the past year, French people have been bombarded with data and daily death tolls. And we don’t always realize what these figures mean: 300, 400 deaths every day – that’s like a plane crashing every day…We must not get used to these numbers, because if we do, the fight is lost,” Benjamin Clouzeau, an ICU doctor at Bordeaux Hospital, told Euronews. 

Germany Risks Nearing “Breaking Point” – Cases Could Reach 100,000 Per Day

Germany recorded 16,378 new cases on Sunday, up from 8,365 on 9 March. In total, the country has reported 2.7 million confirmed cases and 75,913 deaths. 

“The forecasting shows that if the measures are as they are now, the [new case] numbers could reach 100,000 per day…if this situation is not contained,” Lothar Wieler, President of the Robert Koch Institute – the governmental agency leading Germany’s pandemic response – said at a press conference on Friday. 

“At the moment, the figures are rising too fast and the variants are making the situation especially dangerous,” said Jens Spahn, the German Health Minister, at the joint press conference with Wieler. “If this continues unabated, we run the risk of our healthcare system reaching its breaking point during the month of April.” 

Jens Spahn, the German Health Minister, at a press conference on Friday.

Angela Merkel, Germany’s Chancellor, threatened to centralize Germany’s pandemic response, enabling the government to implement a strict national lockdown. Currently, the decision to impose a lockdown is up to the 16 federal states, several of which are refusing to put in place restrictions to curb the rising infection rates. 

“We need action in the federal states,” Merkel said in a televised interview on the public broadcaster ARD’s Anne Will talkshow on Sunday. “We need to take the appropriate measures very seriously. Some states are doing it; others are not yet doing it.”

Several states have plans to reopen despite the worsening public health situation.

“If we look at the numbers, including the developments today, we need another 10-14 days, at least, of properly driving down contacts and movements, a lockdown if you want to call it that,” Spahn said.

Central Europe Hit by Third Wave

Hungary, Estonia and Poland are also experiencing record high infection rates, among the worst in the world. The rapidly rising infections are forcing governments to tighten restrictions in an effort to halt the third wave.

Hungary recorded 7,263 new cases on Monday, making the total number of cases 641,124. Last week, Hungary claimed the grim record of having the world’s highest daily deaths per capita. 

In spite of the worsening situation, the government has plans to shorten the overnight curfew and extend the hours stores are allowed to remain open. Hungary’s Prime Minister, Viktor Orban, insisted there will be a “free summer” without restrictions on national radio on Friday. Virologist Miklós Rusvai predicted that Hungary would see the peak of the third wave in the coming days, while others speculate that the wave will be much bigger than expected. 

Hungary is largely relying on its vaccination campaign to combat the current surge in cases. Some 1.9 million people – 19.9% of the population – have received at least one COVID vaccine dose. Restrictions will ease once 2.5 million people have received the first dose.

Estonia became the country with the world’s highest COVID-19 infection rate in mid-March, with 886 daily new confirmed cases per one million people. On Sunday, Estonia recorded 1,175 new cases and 8 deaths.

Despite having several restrictions in place, Estonia saw infections rise by 10% in those over the age of 65 last week. Government officials warned that the country may have to go under a comprehensive lockdown over the summer if the spread of COVID cannot be curbed. 

Poland tightened restrictions over the weekend, closing kindergartens and hair salons and limiting the number of people allowed to attend church services, but stopping short of implementing restrictions on movement and imposing a nationwide lockdown.

“We have recorded a 25% growth of new infections week on week,” said Wojciech Andrusiewicz, a spokesperson for Poland’s Ministry of Health, on Monday. “For the time being, we have to expect bad scenarios, a growth of new infections, and, unfortunately, a growing number of deaths.”

Poland will increase the number of COVID-19 beds in hospitals by 3,000 this week, followed by another 3,800 next week. Over the past two weeks, the country has increased COVID beds by 10,000, including 1,000 equipped with ventilators. 

“We are a step away from the point when health services will be unable to treat patients properly…And we have to do all we can to avoid this scenario,” said Mateusz Morawiecki, Poland’s Prime Minister, at a press briefing on Thursday.

Image Credits: Euronews, WHO, Bundesministerium für Gesundheit.

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team. WHO team members say they have discounted a lab escape theory – other critics say their conclusions are too hasty.  WHO’s Director General says all hypotheses remain on the table.

All four original chains of query remain on the table in terms of the origins of the SARS-CoV2 virus, said WHO Director General Dr Tedros Adhanom Ghebreyesus at a press briefing on Monday. 

But his comments appear to contradict the leaked conclusions of the investigation which point towards a natural cause for the virus emergence among farmed wildlife. 

This is in contrast to the hypothesis that the virus had escaped from the Wuhan Virology Institute, an international centre for the study of bat coronaviruses – which critics have asserted should remain on the table until China provides more data.  

“All hypotheses are open, from what I read from the report, so I would suggest that… we wait until the international experts… face the public tomorrow,” said Tedros, speaking after a meeting with Gerd Müller, the German Minister for Development Cooperation.  

“The report of course was sent… under embargo to member states based on their request, because we will have a mission briefing tomorrow with member states,” Dr Tedros added, noting that a media briefing will follow Tuesday’s briefing to member states. 

“We will read the report and discuss, digest its content and next steps with member states. But as I have said all hypotheses are on the table and warrant complete and further studies, from what I have seen so far,” Tedros added.

The long-awaited report, due to be released Tuesday, is the fruit of an investigation by a group of international experts into the origins of the SARS-CoV2 virus, which included a mission to China by the 17 international team members in late January and early February – working in tandem with a 17-member Chinese team, designated by the government. 

WHO Team Members Have Different View

Wholesale markets in China traditionally sell wild animals, captured or bred, for food consumption, and which provide a breeding ground for viruses and virus variants dangerous to humans.

However, a leading member of the WHO investigative team said on Monday that the report pointed to the Chinese wildlife trade as the most likely source of the virus leap to humans – discounting a lab biosafety accident as a factor that is “extremely unlikely” according to the WHO report.  

“What we found is evidence of a way the virus could have emerged from rural China into a big city like Wuhan… at the end of the report, both the China team of experts & the WHO experts all felt this was the most likely pathway that the virus took,” said Peter Daszak, president of the EcoHealth Alliance, just ahead of the report’s formal presentation Tuesday before WHO member states. 

“One key recommendation… is to go to those farms & interview the owners, their relatives & test people to look for evidence on whether they were infected with Covid-19 earlier than the first known patients in Wuhan,” Daszak added. 

Large commercial farms that breed wildlife animals for human food consumption have been developed over the past years in remote Yunnan Province, near the Myanmmar border, with Chinese government support.  These same areas are home to horseshoe bats harbouring coronaviruses that genetically most resemble the SARS-CoV2 virus. These farms also supply wild foods – in fresh and frozen – to markets like those in Wuhan city where clusters of the virus first appeared. 

Other Critics –  Its  Premature To Discount Lab Escape Theory 

But another international expert told Health Policy Watch that it is far too early to rule out the possibility that the virus might have escaped from the Wuhan Virology Institute, which has been studying bat coronaviruses for years. 

Richard H. Ebright, a professor at Rutgers University, underlined that the hypothesis of a biosafety accident – or lab escape – should still remain on the table because there is as of yet insufficient evidence to either prove or discount it as China had limited the investigative team’s access,

“Zoonotic spillover occurring at a wildlife farm is one of several plausible scenarios under the zoonotic spillover hypothesis,” said Ebright, a professor of chemical biology. “At this point in time, there is no secure basis to assign relative probabilities to the natural-accident hypothesis and the laboratory-accident hypothesis,” Ebright told Health Policy Watch, adding that:   

“All scientific data related to the genome sequence of SARS-CoV-2 and the epidemiology of COVID-19 are equally consistent with a natural-accident origin or a laboratory-accident origin.” 

Ebright was one of some 26 scientists who signed an open letter in early March calling for a new, and more independent, investigation into the virus origins. The letter by a group of international experts stated the WHO mandated team did not have access to sufficient original data either from the Virology Institute, the first Wuhan patient clusters, or wildlife sources to make an independent determination about the virus origins.  

Virus Likely Originated From A Horseshoe Bat – But From Where? 

Ebright said he agreed that a coronavirus originating in horseshoe bats is the most likely progenitor of the virus.  But how the virus made the leap into the human body is another question. 

“The genome sequence of the outbreak virus indicates that its progenitor was either the horseshoe-bat coronavirus RaTG13 (collected by Wuhan Institute of Virology in 2013 from a horseshoe-bat colony in a mine in Yunnan province in which miners had died from a SARS-like pneumonias in 2012; partly sequenced by Wuhan Institute of Virology in 2013-2016; fully sequenced by Wuhan Institute of Virology in 2018-2019; published by Wuhan Institute of Virology in 2020) – or a closely related bat coronavirus,” Ebright told Health Policy Watch.  

“Bat coronaviruses are present in nature in multiple parts of China. Therefore, the first human infection could have occurred as a natural accident, with a virus passing from a bat to a human, possibly through another animal. There is clear precedent for this: the first entry of the SARS virus into the human population occurred as a natural accident in a rural part of Guangdong province in 2002,” Ebright continued.

However, terms of the possibility the virus escaped from a laboratory, he also notes that: “Bat coronaviruses are collected and studied by laboratories in multiple parts of China – including the Wuhan Institute of Virology.  Therefore, the first human infection also could have occurred as a laboratory accident, with a virus accidentally infecting a field collection staffer, a field survey staffer, or a laboratory staffer, followed by transmission from the staffer to the public.  

“There also is clear precedent for this: the second, third, fourth, and fifth entries of the SARS virus into human populations occurred as a laboratory accident in Singapore in 2003, a laboratory accident in Taipei in 2003, and two separate laboratory accidents in Beijing in 2004.”

Some other WHO international team members have also complained bitterly that politics took precedence over science on key aspects of the mission, and that Chinese authorities won’t turn over critical patient data that would allow the team to ascertain the breadth of the virus circulation in December 2019, as well as exploring the circumstances around likely cases in Wuhan that occurred earlier. 

US also Expresses Concerns About Transparency Of Report 

On Sunday, US Secretary of State Anthony Blinken also said that the US has “real concerns about the methodology and process” of the report, including the fact that Chinese government experts “apparently helped write it”. Blinken was speaking on CNN’s State of the Union. 

This follows last Friday’s comments by White House Press Secretary Jen Psaki that the US was concerned about the international team’s lack of access to data needed to evaluate the various scenarios that have been considered, including direct infection by an original source, such as a bat; infection of humans by an intermediate wild animal source; infection by a semi- or frozen food source; or the escape of the virus from a laboratory. 

“We’ll have to take a look at it and make sure we have access to the underlying information, Psaki said in a White House press briefing, criticizing the “lack of transparency from the Chinese.”

Meanwhile, Anthony Fauci, the chief medical advisor to the Biden Administration, took more of a wait-and-see attitude. “What I would like to do is to first see the report,” Fauci told CBS’s Face the Nation. “You’re getting a lot of conjecture around what they did and what they were allowed to do or not.”  But he added, “If, in fact, obviously there was a lot of restrictions on the ability of the people who went there to really take a look, then I’m going to have some considerable concern about that.”

Possible China Bias an Issue Since Beginning  

WHO’s Peter Ben Embarek, third from right, at 9 February Wuhan press conference on origins of the COVID-19 virus.

The possible “China bias” of the report, drafted by 17 international expert team members together with 17 Chinese experts, has been an issue since the team concluded its work in Wuhan in early February.  

At a joint press conference on 9 February, China’s team leader attempted to promote the idea that the virus had been imported into Wuhan via frozen foods, something that the WHO team coordinator Peter Ben Embarek later dismissed as unlikely. 

However, Ben Embarek suggested that wild animals arriving in Wuhan, either alive or in semi-frozen form, may very well be the virus source, and that the WHO needed more information about possible infection chains coming from farmed wildlife sources.  

Ben Embarek also said that over a dozen SARS-CoV2 virus strains were circulating in Wuhan in December 2019.  “The virus was circulating widely in Wuhan in December, which is a new finding,” he said.

He has since admitted that the WHO-led international team was still seeking Chinese government permission to access some 200,000 samples from Wuhan’s blood donor bank, which, if tested for virus antigens, could shed far greater light on the true prevalence of the virus in that period. 

“There are about 200,000 samples available there that are now secured and could be used for a new set of studies,” Ben Embarek told CNN. “It would be fantastic if we could [work] with that.”  

However, Chinese authorities have resisted sharing that data, claiming that they are only allowed to be used for litigation purposes. Said Ben Embarek. “There is no mechanism to allow for routine studies with that kind of sample.”  

The WHO team members also did not visit or obtain samples from the wildlife farms where the virus may have emerged naturally.

Image Credits: @PeterDaszak, CNN, Peter Griffin/Public Domain Pictures, CGTN.

CAPE TOWN – Johnson & Johnson (J&J) will deliver its COVID-19 vaccine to Africa from October after reaching an agreement with the African Union to supply the continent with up to 400 million doses over the next two years. 

However, Africa may still be struggling to obtain vaccine supplies for some months following last week’s decision by the Serum Institute of India (SII) to scale back its delivery of the AstraZeneca vaccine to the WHO co-sponsored COVAX global vaccine facility – in order to address domestic demand as COVID-19 cases soar in India. 

To date, the AstraZeneca vaccine has been the backbone of the COVAX facility’s ambitious roll-out of vaccines to dozens of low- and middle-income countries. But the SII suspension would interrupt the planned March and April delivery of some 90 more vaccine doses at a time when some countries have already used up their allotted supplies, and another 10 countries in Africa and 20 worldwide have yet to receive any vaccines at all.    

J&J CEO Alex Gorsky

 J&J CEO Alex Gorsky announced the deal with the AU’s “African Vaccine Acquisition Trust (AVAT)” on Monday saying that his company has been “committed to equitable, global access to new COVID-19 vaccines” from the start of the pandemic.

“Our support for the COVAX Facility, combined with supplementary agreements with countries and regions, will help accelerate global progress toward ending the COVID-19 pandemic,” he added.

AVAT can order up to 220-million doses this year and an additional 180 million doses in 2022, according to the company.

Single Dose and Efficacious Against Variant

The J&J vaccine only requires one dose, it can be stored in a normal fridge for up to three months.  It has been tested in diverse populations and it has shown be able prevent death and severe illness – even in the case of the more infectious B.1351 (501Y.V2) variant first identified in South Africa. 

J&J has also committed to providing its vaccine on a not-for-profit basis for emergency use during the pandemic.

The vaccine was granted Emergency Use Listing from the World Health Organization (WHO) on 12 March, Conditional Marketing Authorization from the European Commission on 11 March and Emergency Use Authorization by the US Food and Drug Administration on 27 February. The single-shot COVID-19 vaccine has also been granted Interim Order authorization in Canada on 5 March.

It is also being used to vaccinate South African health workers as part of an implementation study. The country abandoned its original plan to roll out the AstraZeneca vaccine after a small trial showed that vaccine was ineffective in preventing mild and moderate infection by the B.1351 variant.

South Africa announced on Sunday that it expected 2.8 million J&J doses at the end of April to expand its vaccination programme. It also announced that it had secured an order of 30 million doses from the company but did not divulge the expected delivery date of the bulk of its order.

J&J Tested on Diverse Populations

So far, the J&J vaccine is in fact the only vaccine to have been rigorously clinically trialled on the B.1.1351 variant that first emerged in South Africa and has now reportedly spread to some 16 other countries. 

Those states reporting on the presence of the B.1.351 variant, namely Angola, Botswana, Cameroon, Comoros, DR Congo, Eswatini, Gambia, Ghana, Kenya, Malawi, Mauritius, Mozambique, Namibia, Rwanda, South Africa, Zambia and Zimbabwe, according to the Africa Centers for Disease Control (CDC).

“The availability of the vaccine candidate is subject to its successful approval or authorization by the national regulatory authorities of AU member states,” according to the company’s press statement.

The J&J vaccine has been tested on almost 44 000 people from four continents, including 7,000 South Africans, most of whom were exposed to the B.1351 variant. The vaccine showed 57% protection against moderate disease, 85% protection against severe disease and 100% protection against death.

Globally, the J&J vaccine demonstrated a 67 percent reduction in symptomatic COVID-19 disease in participants who received the vaccine in comparison to participants given the placebo. 

In addition, South Africa’s Aspen Pharmacare will assist to manufacture the vaccine and support shipments to the AU member states, according to the company.

Gavi in Talks With Indian Government Over SII supplies

Meanwhile, lat last week the global vaccine alliance, Gavi, announced that COVID-19 vaccines produced by the Serum Institute of India to lower-income economies that as part of COVAX “will face delays during March and April as the government of India battles a new wave of COVID-19 infections”.

“COVAX and the Government of India remain in discussions to ensure some supplies are completed during March and April,” added Gavi

According to the agreement between Gavi and SII, the company is contracted to provide COVAX with the SII-licensed and manufactured AstraZeneca vaccine to 64 lower-income economies participating in the Gavi COVAX AMC, alongside its commitments to the Government of India.

 

Image Credits: NBC News.