Africa CDC director John Nkengasong

Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC) has told Health Policy Watch that the continent is not in short supply of COVID-19 test kits. According to him, every African country that is in need of the test supplies can get it if they want.

An open letter dated 31 January that was written by concerned members of civil society, clinicians, advocates, and communities affected by COVID-19, to the World Health Organization (WHO) urged it to rapidly recommend self-testing for COVID-19.

While calling on the global health body to expedite the finalisation and release of a self-testing guideline for SARS-CoV-2 infection that includes a strong recommendation in favour of widespread access to self-testing, they noted that low- and middle-income countries (LMICs) represent nearly 85% of the global population but that only 40% of tests for COVID-19 have been used in LMICs. 

“As a result, the reported average daily testing rate of high-income countries is, per capita, nearly 10 times higher than that of middle-income countries and close to 100 times higher than that of low-income countries,” the letter stated.

In Africa, according to the experts, citing WHO AFRO region, said 85% of COVID-19 infections are going undetected. 

“This inequity in access to the diagnostic tools that trigger life-saving individual and public health measures is part of the same ‘medical apartheid’ that has plagued the rollout of COVID-19 vaccines,” the experts noted.

But on Thursday, Nkengasong noted that Africa has seen a remarkable change and improvement in access to testing. 

“We are here in the middle of the African Union (AU) Summit and we are characterizing it as a COVID-free summit, which means every day we conduct testing on all the delegates, and those are thousands of people that are tested. We have not run out of tests,” Nkengasong said.

He said if countries follow the guidelines that the Africa CDC has given them, they will be able to access testing. 

Prioritising testing at the country level

He argued that the major determining factor for closing the COVID-19 testing gap in Africa is at the country level — enjoining governments to prioritise testing as a major cornerstone of their pandemic response.

While the continent’s testing data fluctuates from one week to another, it does not suggest that the continent is in short supply of testing kits, he added, describing the trend as a reflection of the priorities of the governments concerned.

“Testing will continue to be key. We see the test numbers fluctuate. Some weeks you have a very high increase in testing and then the following week you see a decrease. But that doesn’t necessarily reflect a lack of tests. 

Instead, he said the trend could suggest that countries actually engaged in testing or they are doing selective tests — “which most of the cases is about people who have symptoms or people that are trying to travel, not really systematic testing going on”.

In May 2020, the WHO published criteria in which it described a positive rate of less than 5% as an indicator that the epidemic is under control in a country. While this data for several African countries is not available, available data showed positive rates on the African continent ranging from 0.64% in Rwanda to 37.4% in Tunisia.

WHA’s Special Session resolved on 1 December 2021 to negotiate a new global pandemic instrument.

Representatives from Brazil, Egypt, Japan, Netherlands, South Africa, and Thailand are to make up the World Health Organization (WHO) Intergovernmental Negotiating Body (INB) on a future pandemic instrument, according to Knowledge Ecology International. 

The countries each represent a different region of the WHO, namely Africa (South Africa),  the Americas, known as the Pan-American Health Organisation (Brazil), the South-East Asian Region (Thailand), Europe (Netherlands), the Eastern Mediterranean (Egypt) and the Western Pacific (Japan).

South Africa confirmed that it had been chosen to represent Africa at the INB at last week’s WHO executive board meeting, while the European Union announced that it would be represented by an official from the Netherlands.

Last year’s World Health Assembly (WHA) Special Session resolved to start intergovernmental negotiations “to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response”.

According to the WHA resolution, the first INB meeting shall be held no later than 1 March to “elect two co-chairs, reflecting a balance of developed and developing countries, and four vice-chairs, one from each of the six WHO regions” as well as “define and agree on its working methods and timelines”.

The resolution also directs the INB to “first identify the substantive elements of the instrument and to then begin the development of a working draft to be presented, on the basis of progress achieved, for the consideration of the INB at its second meeting, to be held no later than 1 August 2022”.

The INB has until the 77th WHA next year to present a draft of the instrument, but needs to present a progress report to this year’s WHA.

 

african medicines agency
Ambassador Samate Cessouma Minata, AU Commissioner for Health, Humanitarian Affairs and Social Development (HHS)

Some 21 countries have now ratified the African Medicines Agency treaty – well beyond the 15 ratifications reached in November 2021, which allowed the AMA treaty instrument to formally take effect.

Egypt, Africa’s third most populous country, is the most recent state to have both ratified and deposited the treaty – marking a significant milestone in the efforts to get the continent’s bigger players on board.

Altogether, 19 African countries have both ratified and deposited the AMA treaty instrument to the AU secretariat, said Cessouma Minata Samate, African Union Commissioner for Health, Humanitarian Affairs and Social Development, at a press briefing on Thursday. She was speaking at a briefing on the margins of the 35th African Union Summit, which takes place this weekend.

Two more countries,  Morocco and Saharawi, have also ratified the treaty – but are yet to deposit it – rounding out the 21.

Another nine countries have signed the treaty, but are yet to ratify it – including Equatorial Guinea and Comoros, which signed over just the past week, said Samate.

All in all, that makes for a total of 30 countries that are formally on board with the treaty through signature, ratification, or both – while 25 still remain uncommitted.

The new agency is supposed to provide a streamlined regulatory authority that would improve quality medicines access, and combat substandard imports, backers say.

“The AMA will also guide the regulation of medicines, and facilitate access to quality medicines on the continent,” underlined Samate.  

Africa’s biggest economies still hold out

 

Despite that promise, the 25 countries that have not yet signed the treaty include most of Africa’s population and economic powerhouses — such as Nigeria, South Africa, Kenya and Ethiopia.

Responding to queries regarding the fence-sitters, Samate deferred, attributing the delays to  variations in respective countries’ signing and ratification procedures. 

“I do not want to answer why Ethiopia did not sign; I am not part of the government. But each country has its procedure. There are several procedures involved. There is a whole process for it to arrive at the Parliament which will ratify it, and it depends on each country,” she said. 

“Each country has its rules for signing and ratifying treaties,” she said.

She however added that since the treaty is new, sufficient time has to be given to Member States to sign and ratify it. Ultimately, however, all member states recognise it is in the best interest of citizens on the continent. 

“I am sure that all the countries are committed.” 

AMA will improve medicines regulation and access on the continent

State of play as of 2 February in the alignment of 30 AU member states around the AMA treaty. Another 25 states have yet to sign or ratify.

Samate noted that the AMA will be important in coordinating between the continent’s sub regional blocs, which have different economic alliances, also affecting trade and thereby medicines regulations.  

“The agency will coordinate the actors at the level of our subregional economic communities, and will work with AU Member States to enable us to have efficient health systems to treat our various populations.” 

“It’s important for us to have an agency for ourselves – to serve as a regulator for medicines issues on the continent,” she said. 

Others have emphasized that the AMA could help speed access to medicines – by conducting reviews and issuing recommendations on new treatments, which could take counties much longer to tackle individually.  And it could help bring down some medicines prices by facilitating regulatory harmonization – which permits more bulk imports.  

In addition, it is hoped that the agency can play a role in fighting substandard and fake medicines. Currently WHO’s African Region suffers from the highest rates of reports of fake and substandard medicines in the world, according to both the WHO and AU officials.  

 Timeline for setting up the new agency 

The next step in transforming the AMA from a treaty to an actual institution is to decide on a host country for the agency’s headquarters, Samate told journalists. 

This is not expected to be completed at the AU Summit – insofar as the criteria and process are yet to be announced. But she affirmed that the process would get underway “very shortly.”

“There will be a process to allow the member states to decide, very shortly, which African country will host the AMA,” she told journalists. 

Sources, however, told Health Policy Watch that the process of assessing countries vying to host the AMA may not really begin until April. 

However an initial meeting of the AMA Conference of State Parties (CoSP) is scheduled for May – where an assessment report will be presented for discussion on recommendations for AMA host country. 

Following that, the terms of reference for the AMA Director-General will then be considered by the CoSP – to pave the way for recruitment of an agency head. Lastly, the site for the proposed AMA headquarters is expected to be adopted by the AU Assembly to be held in July 2022.

Meeting ambitious goals

The AMA treaty document was first approved by the African Union in 2019. At a two-day meeting of the Partnership for Africa Vaccine Manufacturing (PAVM) hosted by Rwanda in December 2021, panellists described the AMA as critical to Africa achieving the set goal of producing 60% of vaccines on its own soil by 2040.

Ahead of the African Union Summit held over the past weekend, the African Medicines Agency Treaty Alliance (AMATA), an alliance that represents patients, academia, civil society, and industry set up to advocate for the ratification and implementation of the AMA, applauded the momentum reached so far.

They called for a set of key steps to be taken in order to operationalise the Agency, including setting up a secretariat and choosing its location, adequate human resource capacity to operationalise its mandate and a sustainable funding model to ensure short- and long-term stability.

AMATA also stressed the importance of recognizing patients as key partners in the development of the Agency – as part of a framework of engagement with non-state actors, including academia, research bodies, private sector and other civil society groups. 

They also appealed to all other African countries to ratify the AMA to “strengthen the continent’s capacity and preparedness to deal with future pandemics”, foster a spirit of cooperation to enable the development of medicines and vaccines, and safeguard the health of the continent and to protect citizens of Africa from fake m.

Image Credits: African Union .

Hans Kluge, WHO European Regional Director

Cancer services remain backlogged in many parts of the world due to the effects of the two-year-long COVID pandemic – even as Europe hopes a pandemic “ceasefire that could bring us enduring peace” , said WHO’s European Regional Director Hans Kluge Thursday on the eve of World Cancer Day.  

Meanwhile, in Latin America, routine childhood immunizations are down by around 10% as a result of setbacks from the COVID-19 pandemic, leaving the region at very “high-risk” for new and re-emergent vaccine-preventable diseases, said Carissa Etienne, Regional Director of the Pan American Health Organization in a briefing Wednesday evening.

Both WHO regions, which include some of the world’s highest income countries, as well as middle income nations, alongside low-income states, continue to face striking regional imbalances in vaccine distribution, top officials in the two regions also stress – with some countries reaching 70% COVID vaccine countries or more – while others only have reached about 30% of eligible adults with jabs, both Etienne and Kluge stressed in separate press briefings. 

And that still leaves some countries disproportionately vulnerable to the ongoing effects of the Omicron variant – as well as to risks of new emerging variants. 

Cancer – knock-on effects will last for years 

cancer
Cancer services were disrupted up to 50% in the WHO Europe region.

The two-year ongoing pandemic has had “catastrophic” effects on people with cancer, said Kluge, in his remarks – “going far beyond the disease itself.”

One in four people in WHO’s European Region will receive a cancer diagnosis at some point in their lives – and cancer accounts for more than 20% of morbidity and mortality in the WHO region that extends from the Central Asian republics to the United Kingdom, he noted. 

In the European region, cancer diagnosis and treatment services saw disruptions of up to 50% in the early stages of the pandemic he noted. 

And while many EU countries have since rebounded, the picture remains uneven regionally and around the world.

The latest WHO Global Pulse survey on disruptions in essential health service found that in the last quarter of 2021, countries worldwide were still experiencing disruptions in cancer screening and treatment services of between 5-50%, Kluge said. 

“The knock-on effects of this disruption will be felt for years,” Kluge added, noting that 44% of countries worldwide were reporting backlogs in cancer screening in the second half of 2021. 

Any post-Omicron ‘respite’ must be used to restore other essential health services 

Problems are compounded, he added, by the fact that the “health workforce is overstretched and exhausted – after being repurposed to address the direct impact of the virus.  

“Any respite the widespread immunity provides, thanks to vaccination and in the wake of the less severe Omicron, together with the coming spring and summer season, must be used immediately to enable health workers to return to other important health care functions, in order to bring backlogs for chronic care services down. 

“As we go forward, maintenance of essential health services, including services along the journey of cancer care, from prevention, early detection, diagnosis, treatment and quality of care will be a component of emergency planning and response,” he said. 

Americas also struggling to overcome disruptions in routine childhood vaccinations 

A child receives a routine vaccination in Cuba, which is a world leader in childhood immunization.

Meanwhile, speaking from Washington DC, PAHO’s Etienne sounded a similar theme. 

But her message was focused around pandemic-related setbacks in childhood vaccinations across the WHO’s Americas’ region – which includes the affluent USA and Canada, alongside high, middle and low income countries of Latin America and the Caribbean. 

Routine childhood vaccinations for a third dose of diphtheria, tetanus, pertussis (DTP) vaccine has declined by 10% in the region, as a result of setbacks from the COVID-19 pandemic, leaving the region at very “high-risk” for new and re-emergent vaccine-preventable diseases because of lower immunization coverage, she said: 

“Despite the tremendous achievements of immunization programs in past decades, that progress has stalled in some countries, and has even reversed in this region.”  

Carissa Etienne, Director of the Pan American Health Organization/WHO Region of the Americas

While the goal was to fully cover at least 95% of eligible children in 2020 with the DTP vaccine, 26 countries and territories of the Americas did not reach that goal. And some 14 countries in the region had particularly low coverage with the third dose – of 10% or less. 

As in Europe, she attributed the setbacks to the reassignment of healthcare professionals from primary care centers to hospitals and intensive care units – alongside public hesitations about getting vaccinated during the pandemic.  

PAHO is currently working with Ministries of Health across the Americas to revitalize family immunization programs as one of their “highest priorities”.

“We are at a juncture where it is urgent to look at routine immunization programs,” said Etienne. 

As countries reopen – uneven vaccination coverage exacerbates future variant risks 

Both Europe and the Americas also are facing major inconsistencies in vaccine coverage rates within countries of the region, the officials also noted. 

And that poses additional risks as countries relax restrictions, Kluge stressed. 

“We in the European region have a unique situation,” Kluge said. “Once the Omicron wave has subsided, there will be a large capital of [SARS-CoV2]  immunity, due to the infection in general, and quite high vaccination rates generally.”

That offers opportunities to restore normalcy and “respond to new variants that will inevitably emerge without reinstalling the kind of disruptive measures that we needed before,” he said. 

Can the pandemic ceasefire bring enduring peace?

“This period of higher protection should be seen as a ‘ceasefire’ that could bring us enduring peace,” he said.  But he insisted that his message does not contradict those coming from Geneva, either, where WHO’s Director General Tedros Adhanom Ghebreyesus urged caution in reopening economies at a briefing earlier in the week.

“The pandemic is not over, as Dr Tedros is rightly saying.”    

In particular, vaccination rates need to be pushed higher in undercovered parts of the Europe – as well as worldwide – to expand protection against the emergence of still newer, and potentially more dangerous variants, Kluge stressed. 

“It is because we see the opportunity that the top priority is to bring all countries to a level of protection which allows them to grasp this opportunity and look ahead towards more stable days

“And that means that we need a drastic and uncompromising increase in vaccine-sharing.” 

For instance, while 66% of people across WHO’s vast European region have received a second vaccine dose, the numbers go as high as 70% in high income countries – where 40% of the population also has boosters, said Oleg Benes, another WHO European region official. 

But in the region’s lower middle income countries, rates remain much lower. “Booster courses are just starting to roll out.” Vaccine rates are as low as 30% in some countries, with only one in 3 older adults, on average protected.” That, he admitted, is also due in part to higher rates of vaccine hesitation among older people in some countries. 

Inconsistent vaccination coverage in the Americas ‘worrisome’ 

Similar inconsistencies in vaccination coverage prevail in the Americas – where average vaccination rates are also 60% or more. And that remains a “worrisome sign”, said Etienne. 

That is particularly true as the Americas region overall is still seeing rising rates of the Omicron variant – even while Europe seems to have turned the corner.

While 14 countries and territories have immunized 70% of their populations, the same number of countries have yet to protect 40% of their people. 

More than 25% of people across the region have yet to receive a single dose of protection – rising to 54% in low- and middle-income countries, PAHO officials said. 

As in other parts of the world, countries that have experienced civil conflict, unrest and natural disasters lag even further behind. 

Haiti, notably, has less than 1% of its population fully vaccinated against COVID-19. The country  began its vaccine drive late last year, having only received donations from donors such as the WHO-co sponsored COVAX initiative in July. 

Jamaica also is behind in its vaccinations – with only 21% of people fully vaccinated. 

Meanwhile, COVID-related deaths have increased for the fourth consecutive week in all subregions of north and south America and the Caribbean, with an increase of 33% last week over the week previous.  That, officials added, further underscores the impacts of uneven vaccination rates – which continue to leave unvaccinated older and more vulnerable groups more prone to serious disease.

Image Credits: Daily Caller/Twitter , Radio Metropolitana Cuba/Twitter .

Geneva’s central train station where masks, a universal apparel for public transport users and shoppers, may soon be discarded along with most COVID restrictions.

Switzerland could be the next European country to lift virtually all COVID restrictions, federal officials said Wednesday – despite warnings from the World Health Organization, headquartered in Geneva, that a total relaxation of the pandemic rules could be premature.

In a press briefing on Wednesday, Swiss federal government officials lifted all work-from-home and some quarantine requirements as of Thusday, and said they were considering a complete lifting of mask mandates, vacccine certificate requirements and other measures by 17 February.

The other option would be to take a two-phase approach to the relaxation, government officials said. This would lift requirements for vaccine certificates to enter restaurants and other leisure and cultural venues, but maintain a “2-G” (two vaccine dose) requirement for entry to indoor pools, discotheques, and other similar venues.

The government said that it would undertake a series of consultations with Cantonal authorities in the coming two weeks to decide whether to remove the domestic restrictions all in one go – or in two stages.

Additionally, the government said it would propose the lifting of all restrictions on entry into Switzerland, including requirements for vaccine passports, testing, and the collection of contact data.

Swiss Federal Council President Ignaio Cassis at a press conference in Berne, on Wednesday

“Today is a beautiful day – and not only because of the weather. Today is a great day. It marks the beginning of a new phase in this long and difficult crisis,” declared Ignazio Cassis, president of the Swiss Federal Council, in a press conference, speaking in Italian, French and German.  “The pandemic is not entirely behind us, but the Federal Council is very pleased to see light on the horizon.”

He spoke even as Swiss reports of confirmed new COVID cases remain among the highest in Europe, although there are signs of a plateau in just the past couple of days.

Premature to declare victory or surrender’

Two hours away in Geneva, at a WHO press briefing on Tuesday, WHO Director General Tedros Adhanom Ghebreysus appealed to countries to move gradually in relaxing restrictions. He noted that the Omicron variant of SARS-CoV2 had caused 90 million infections in just the past 10 weeks – more than all of the cases recorded in 2021.

“It is premature for any country either to surrender or to declare victory,” Tedros said. “This virus is dangerous and it continues to evolve,” he warned, noting the evolution of yet new Omicron sub-variants in Europe as well as India.

With deaths in four of the WHO’s six regions increasing over the past week “now is not the time to lift everything all at once,” cautioned Dr Maria van Kerkhove, WHO’s lead on COVID-19, cautioned Tuesday.

In Europe at least, more and more countries seem to be disregarding those WHO warnings. 

Last week, Denmark lifted most COVID-19 restrictions despite registering over 40,000 new cases daily, with France, Norway, Finland and Sweden among the other European countries following suit or poised to do so.  

Swiss moves could be among the most far-reaching

However, Switzerland’s moves, if made all at once in just two weeks, could be among the most far-reaching yet on the European continent.

In his briefing, Cassis credited the relaxation to a successful vaccination campaign – although in fact, Swiss vaccine rates also remain somewhat below the average of other comparably high-income European countries.

“We can enter this new phase thanks to the vaccination,” Cassis said. “This has contributed to a much more favorable epidemiological evolution [of the virus].”

While the Omicron variant has infected a very large numbers of people “its repercussions had been much lighter” with a significant reduction in hospitalization rates, as in other countries, Cassis added.

Thanks to that, as well, “we can envisage the future with optimism. A new phase is beginning and we will soon be able to recover all of our liberties – while also living with one more virus.”

Asked for a comment on the planned Swiss measures, WHO not had not responded at the time of publication.

See related Health Policy Watch story:

https://healthpolicy-watch.news/as-denmark-scraps-covid-restrictions-who-urges-caution/

Image Credits: HP-Watch/Svet Lustig Vijay.

Child COVID vaccinations – now the FDA has invited Pfizer to submit for approval of vaccines for under-5s.

What does the FDA know that we don’t? Hopefully a lot.

Without offering much detail, the FDA yesterday afternoon asked Pfizer to send over a rolling submission to amend its Covid-19 vaccine Emergency Use Authorization to include children 6 months to under 5 years of age.

The tricky part in making such a request is that last month, Pfizer announced that its vaccine (a 3 µg dose for the youngest population) had performed better in the 6- to 24-month-old population, than in children ages 2-4 – that is as compared to the results of the vaccine among 16- to 25-year-olds, in which high efficacy was demonstrated.

But the company wants to test a third jab for all of the under-5s to see if it will even out the results somehow for older tots. And it doesn’t seem to be changing its tune, even with this latest FDA request.

“Ultimately, we believe that three doses of the vaccine will be needed for children 6 months through 4 years of age to achieve high levels of protection against current and potential future variants. If two doses are authorized, parents will have the opportunity to begin a COVID-19 vaccination series for their children while awaiting potential authorization of a third dose,” Pfizer CEO Albert Bourla said in a statement.

No safety concerns were identified in that prior analysis of the 3 µg dose data among children 6 months to under 5 years of age, Pfizer said.

While the FDA often requests that companies provide additional safety or efficacy data (usually before a new drug or vaccine is approved or authorized), the agency rarely requests a specific submission, but acting FDA commissioner Janet Woodcock said this is a priority right now for the agency.

But others are not so sure:

“I don’t think authorizing two doses in children ages 2 to 4 years of age where effectiveness in this age group hasn’t been confirmed is going to convince the majority of parents to vaccinate their children,” Norman Baylor, president and CEO of Biologics Consulting and a former head of the FDA’s vaccine office, told STAT News. “If the vaccine in this age cohort is a three-dose vaccine, FDA should review the data from the three-dose series before authorizing the vaccine.”

See ENDPOINTS News: FDA takes a rare step and asks Pfizer to submit a COVID-19 vaccine EUA for the youngest children.

Image Credits: Quinn Dombrowski.

Moderna and the nonprofit science research organization IAVI have administered the first doses in a Phase I clinical trial of an experimental HIV vaccine, delivered by messenger RNA (mRNA) – the technology that revolutionized vaccines against COVID-19.

The trial kicked off last week at George Washington University School of Medicine and Health Sciences in Washington, D.C. It is partially funded by the Bill & Melinda Gates Foundation.

The Phase I trial, IAVI G002, is testing the hypothesis that sequential administration of priming and boosting HIV immunogens delivered by messenger RNA (mRNA) can induce specific classes of B-cell responses and guide their maturation to generate broadly neutralizing antibodies (bnAb) that would protect against disease, a joint statement by Moderna and IAVI explained.

The immunogens being tested were developed by scientific teams at IAVI and the Scripps Research Institute, and will be delivered via Moderna’s mRNA technology.

“The search for an HIV vaccine has been long and challenging, and having new tools in terms of immunogens and platforms could be the key to making rapid progress toward an urgently needed, effective HIV vaccine,” said Mark Feinberg, CEO of IAVI – whose board includes prominent names from industry, research, The Global Fund, and the Africa Centers for Disease Control.

More than 36 million people have died of AIDS-related illnesses

As of June 2021, 28.2 million people were using antiretroviral therapy for the treatment of HIV, according to UNAIDS, and 37.7 million people were living with the disease in 2020.

Some 680,000 people died of AIDS-related illnesses in 2020. A total of 36.3 million people have died of AIDS since the virus exploded into a pandemic in the late 1980s.

Photo: UNAIDS/Sydelle Willow Smith

The mRNA vaccine strategy centers on stimulating the immune system to produce bnAbs against HIV, a process known as “germline-targeting.” Antibodies are produced by B cells, which start out in a “germline” state.

BnAbs are believed to be capable of neutralizing different HIV strains by binding to hard-to-reach but consistent regions of the virus surface. If it works, the germline targeting strategy could offer protection against millions of different HIV strains circulating in various parts of the world.

Last year, Dr William Schief, a professor at Scripps Research Institute and executive director of vaccine design at IAVI’s Neutralizing Antibody Center – who developed the HIV vaccine antigens  being evaluated in mRNA formats in this study – announced results from the IAVI G001 clinical trial, showing that an adjuvanted protein-based version of the priming immunogen induced the desired B-cell response in 97% of recipients.

Until now, no HIV vaccine candidate has been able to induce a protective bnAb response in humans.

The release said that “given the speed with which mRNA vaccines can be produced,” using the platform could shave off years from typical vaccine development timelines – like it did for the development of an emergency coronavirus vaccine.

“We believe advancing this HIV vaccine program in partnership with IAVI and Scripps Research is an important step in our mission to deliver on the potential for mRNA to improve human health,” said Moderna’s president Dr Stephen Hoge.

Image Credits: Moderna, Sydelle Willow Smith/ UNAIDS.

Denmark’s capital, Copenhagen, is expected to return to pre-pandemic life as the country scraps most COVID-19 restrictions.

The world is “sick and tired” of COVID-19, World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus acknowledged but warned that Omicron posed a substantial threat to global health, having caused 90 million infections in the past 10 weeks – more than all the cases recorded in 2021.

Tedros’s appeal came as Denmark lifted most COVID-19 restrictions including wearing masks this week despite registering over 40,000 new cases daily, with Norway and Sweden poised to follow suit. 

The UK eased many restrictions last month but kept masking, while South Africa’s Cabinet announced on Monday that people with asymptomatic COVID-19 no longer had to isolate and reduced quarantine days from 10 to seven.

Denmark’s rationale is that over 80% of its population is vaccinated, and that Omicron is substantially less infectious than previous variants.

But deaths in four of the WHO’s six regions have increased in the past week and Tedros urged countries to “protect their people using every tool in the toolkit” at a media briefing on Tuesday.

‘Premature to declare victory or surrender’

“It is premature for any country either to surrender or to declare victory. This virus is dangerous and it continues to evolve,” warned Tedros, adding that  the WHO is currently tracking for sub-variants of Omicron.

Dr Maria van Kerkhove, the WHO’s lead on COVID-19, cautioned that “now is not the time to lift everything all at once”.

“We have always urged caution in applying interventions as well as lifting those interventions in a steady and slow way,” said Van Kerkhove, although she acknowledged that countries are in very different situations around the world, and there was no “one solution”. 

Responding to South Africa’s changes to its isolation policies, Van Kerkhove said while the WHO recommended isolation is to prevent onward transmission some countries had so many cases they had to shorten isolation period and quarantine period “because they need to keep operating”.

“Most people still transmit the [Omicron] virus right around the time they develop symptoms from about two days before symptom onset up through the first five to nine days if you’re mild. It can be longer if you have severe disease,” added Van Kerkhove.

Dr Maria Van Kerkhove

Celebrate a new phase of disease control

Dr Michael Ryan, WHO Executive Director of Health Emergencies, said that the Scandinavian countries had a very high vaccination rates and strong health systems.

Every country in the world was trying to calculate “how do we have maximum protection of our population while minimising the impact on our society and our economy”, added Ryan.

He urged them not to “follow blindly” the decisions of other countries but to make decisions “based on your current epidemiology, your demographics, the population of risk, your vaccination levels, your population immunity, your access to tools, the strength of your health service”.

He also said that countries also needed to allow individual choice: “There are many, many people in my own personal view, who will be well advised to continue wearing masks in crowded situations and public transport even if it’s not mandated by government”.

In addition, “communities need to understand that measures may have to be reintroduced in order to moderate transmission if there is an unexpected rise in transmission or a new variant emerges”

Ryan urged “flexibility, agility, the ability to adjust, making good decisions based on your situation, and being ready to change that if needed”.

“We should be in some ways, celebrating when countries get to another stage of disease control, but at the same time being cautious and know that not all paths are straight,” he added.

Omicron sub-variants

Dr Tedros said that the WHO was researching four sub-variants of Omicron, including BA.2 which is more infectious that the original variant (BA.1).

Van Kerkhove said that there was some evidence that the prevalence of BA.2 was increasing in countries including Denmark and in India but that “there’s not a lot of information that we have on this particular sub-variant yet”.

“There is a suggestion from some of the initial data on BA.2 that there’s a slight increase in growth rate above BA.1. But what beyond that the data is really quite limited.”

New SARS-CoV2 origins group report weeks away

Van Kerkhove confirmed that the new Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) had already had six meetings since it was constituted in late November.

Made up of 27 people, the WHO Secretariat expected guidance from SAGO “in the next few weeks” on the way forward in trying to ascertain the origins of SARS-CO-V2.

They were working on three issues: developing a framework for the study of any emerging pathogen; looking at the origins of this particular pandemic, building upon previous missions that have gone to China, and thirdly, looking at all of the literature and evidence that exists to look at studies that have been conducted since the original team had returned form China last March. 

“This group is currently working on their first set of recommendations to WHO on what is needed next, focusing on the urgent needs in terms of the studies that are necessary,” said Van Kerkhove.

 

Image Credits: Febiyan/ Unsplash.

Gaudenz Silberschmidt, WHO Director of Health and Multilateral Partnerships.

The World Health Organization (WHO) is considering changing how it relates to non-state actors (NSAs), but some of these organisations are concerned that the changes envisaged by the global body may weaken their voices.

In 2016, the WHO’s World Health Assembly (WHA) adopted a Framework for Engagement with NSAs – known as FENSA –  to enable closer collaboration with a wide range of organisations to respond to national and global health challenges. An initial evaluation of its implementation was conducted in 2019, and a two-year timeframe was set to fully operationalise the framework.

Over the past weekend, the WHO Executive Board considered a report on progress to implement FENSA , as well as inputs from various NSAs on how their relationships with the global body could be improved.

According to the report, the WHO said it seeks to improve NSAs’ role, voice and contribution in its governance system including by introducing a global constituency for NSAs and grouping NSA statements accordingly. While welcoming the WHO’s intentions, a number of NSAs noted that the proposal could weaken and soften the NSAs’ contributions to WHO’s agenda. 

International humanitarian medical non-governmental organization Médecins Sans Frontières (MSF) expressed concern with the proposal, saying that it fails to acknowledge the value of diversity and expertise inherent in NSA. 

MSF’s Dr Maria Guevara

“The creation of a global constituency and the grouping of NSA statements risk diluting these voices and limiting their meaningful participation in the dialogue and in finding solutions to current health challenges,” MSF’s Dr Maria Guevara argued. 

The International Council of Nurses said that while it supports informal meetings before WHO meeting, it called for more notice and added that the selection of the agenda items must be agreed on between NSAsand WHO member states. 

“After testing [introducing] constituency statements at the 75th WHA, we strongly encourage consultation with NSAs before making a final decision on their implementation,” said the ICN, adding that constituency statements should not prevent individual statements.

In its submission, the European Society for Medical Oncology (ESMO) also called for the WHO to allow non-state actors to still be able to make individual statements on issues that are in line with their core areas of expertise. To accommodate the contribution of more non-state actors, the society called for the WHO to publish each non-state actor’s statement on its website and for these to be included in meetings’ official minutes.

“Non-state actors can submit individual statements on the WHO website and in a way that they are translated and reported in the official minutes of WHO meetings, allowing non-state actors for each agenda item,” ESMO’s Gracemarie Bricalli recommended.

Meanwhile, the Save the Children Fund called on WHO Member States to also prioritize interactions with NSAs, especially the civil society, by actively participating in informal sessions and systematically sharing draft documents and resolutions for civil society organizations to engage in policy making.

It also slammed the WHO Secretariat over lack of time and support provided to NSAs regarding new processes, including constituency statements. It said the process lacked transparency and open dialogue among the different actors.

“We welcome all opportunities to engage with member states and the Secretariat to ensure the meaningful engagement of NSAs including when it comes to the development of a civil society engagement strategy.”

IPPF’s Estelle Wagner

The International Planned Parenthood Federation (IPPF) urged Member States to compel the Secretariat to constitute a diverse working group of member states and civil society organizations to review and develop proposals and report back at the 152nd executive board meeting next year on more robust recommendations to involve NSAs at the WHO beyond making general statements on agenda items.

“More than ever, the pandemic has shown the essential role of NSAs in the work of the WHO and we look forward to a constructive and transparent process to define mechanisms for truly meaningful engagement with WHO governing bodies beyond generalized statements at the end of agenda items,” the federation’s Estelle Wagner stated. 

Canada, USA and UK side with NSAs

Canada’s Elizabeth King

The government of Canada noted that the positions of NSAs on topical issues need to be taken more seriously, adding member states need to hear from NSAs before positions are finalized. It pledged its continuous support for meeting with NSAs prior to the WHA in May, adding that sufficient notice should be provided.

Canada also supported that NSAs should continue to have the option to deliver individual statements on all agenda items to ensure that member states benefit from the diversity of NSAs’ views. 

“This could be combined with a reasonable limit to the number of individual statements an NSA can deliver,” Canada stated.

Canada and the United Kingdom also agreed that the WHO Secretariat should work with NSAs to identify the agenda items where constituency statements would be more valuable, rather than identifying them independently.

“We’d like to reaffirm that hearing and understanding the voices of non state actors in all of our efforts to more meaningfully engage will increase our chances of success,” Canada’s Elizabeth King concluded. 

The US said the priority should be on ensuring WHO’s engagements and involvement of NSAs in its agenda are more meaningful and routine.

It noted that NSAs were critical to the development of vaccines, therapeutics and other medical medical countermeasures, as well as their distribution and delivery to individuals across the globe. By working together with NSAs, the United States said the WHO and the global health community can become more effective, efficient and avoid duplication or miscommunications that could undermine joint aims and efforts. 

A concluding remark from Gaudenz Silberschmidt, Director of Health and Multilateral Partnerships at the WHO said the global health body is committed to making the engagements and interactions between NSAs, member states and the WHO Secretariat to be more meaningful.

The challenge, according to him, is that the increased number of agenda items and interest have put pressure on the time for interventions for NSAs and delegates. He announced plans to organize a meeting with NSAs in February 2022 to consult both on the planning of the informal pre-meeting and on the constituency statements.

“We propose to include a session on those engagement modalities in the informal pre-meeting of the World Health Assembly,” he added.

Billions of masks and gloves have been discarded during the pandemic.

Almost four times the usual medical waste was generated in New Delhi during the height of India’s COVID-19 pandemic in May 2021 when all COVID-19 waste was mistakenly classified as infectious, according to a new report issued by the World Health Organization (WHO) on Tuesday. 

Most of the approximately 87,000 tonnes of personal protective equipment (PPE) procured between March 2020- November 2021 through a joint UN emergency initiative is expected to have ended up as waste.

Over 140 million test kits, with a potential to generate 2,600 tonnes of waste and 731,000 litres of chemical waste have also been shipped, according to data from the United Nations (UN) COVID-19 supply portal.

But the report authors warn that the portal’s data represents “a small fraction of global procurement”.

“It does not take into account any of the COVID-19 commodities procured outside of the [UN] initiative, nor waste generated by the public like disposable medical masks,” they point out.

One estimate suggests that up to 3.4 billion single use-masks were discarded every day in 2020.

Over the past two years, over 296-million people have been confirmed with COVID-19.

“Each of these cases, as well as hundreds of millions more people – because of exposure to COVID-19, travel, work or leisure obligations – will undergo COVID-19  testing.  

“Finally,  over nine billion doses of COVID-19 vaccines have been administered, covering 35% of the global population. Billions more are planned. These activities all produce an enormous amount of COVID-19-related waste, a proportion of which is potentially infectious,” the report notes.

About a third of all healthcare facilities (and 60% in the least developed countries) are not equipped to handle existing waste loads, let alone the additional COVID-19 load. Much of this will end up in landfills.

Mistaken classification of all COVID waste as hazardous

“Many facilities and countries mistakenly classified 100% of COVID-19 healthcare waste as hazardous, rather than the 10–15% level typically generated from routine health service provision,” according to the report.

“ A  number of major cities and countries that have experienced a large number of cases issued guidance that all waste generated by COVID-19 patients should be classified and treated as infectious. 

“This is despite the fact that SARS-CoV-2 is an enveloped virus, which means that it is inactivated relatively quickly by environmental factors such as sunlight or heat.  Most  evidence  indicates  that  the  main  route  of  transmission  of  the  virus  is  directly  from  person to person through exhaled respiratory particles, not fomites.”

It points to gloves as one of the most commonly overused or misused items of PPE. In many cases, gloves are not necessary and proper hand-washing would suffice – such as vaccinations,  measuring temperature and blood pressure – don’t need gloves.  

“Overuse of gloves was a longstanding problem even before COVID-19, resulting in unnecessary financial costs and adverse environmental impacts,” according to the report.

“It is absolutely vital to provide health workers with the right PPE, “said Dr Michael Ryan, Executive Director, WHO Health Emergencies Programme. “But it is also vital to ensure that it can be used safely without impacting on the surrounding environment.” 

Dr Maria Neira, Director of WHO Environment, Climate Change and Health

Reuse, recycle, don’t burn

The report lays out a set of recommendations for integrating better, safer, and more environmentally sustainable waste practices into the current COVID-19 response and future pandemic preparedness.

These include safe and reusable gloves, aprons and masks; using recyclable or biodegradable materials, and using non-burn waste treatment technologies, such as autoclaves (steam-cleaning machines).

“Significant change at all levels, from the global to the hospital floor, in how we manage the health care waste stream is a basic requirement of climate-smart health care systems, which many countries committed to at the recent UN Climate Change Conference,” said said Dr Maria Neira, WHO Director of Environment, Climate Change and Health. 

Meanwhile, Dr Anne Woolridge, Chair of the Health Care Waste Working Group at the  International Solid Waste Association (ISWA), says that the “safe and rational use of PPE will not only reduce environmental harm from waste, it will also save money, reduce potential supply shortages and further support infection prevention by changing behaviours”.

The tens of thousands of tonnes of extra medical waste from the response to the COVID-19 pandemic has put tremendous strain on health care waste management systems around the world, threatening human and environmental health and exposing a dire need to improve waste management practices, according to the report. 

 

Image Credits: Brian Yurasits/ Unsplash, Hermes Rivera/ Unsplash, Planetary Health Eastern Africa Hub.