Stephane Bancel, CEO of Moderna, says company is close to agreement on supply of its mRNA vaccines to COVAX.

A group of leading pharmaceutical industry executives called upon global health leaders to work together to unlock export barriers, open up supply chain bottlenecks, and encourage high-income countries that are hoarding vaccines to redirect their excess doses to the WHO co-sponsored COVAX global vaccine facility – as ways to rapidly scale up equitable vaccine access and beat back the pandemic.

The executives, including the CEO of Moderna and India’s Bharat Biotech, as well as GSK’s head of global vaccines, and the heads of the Developing Countries Vaccine Manufacturers Network (DCVMN) and the Biotechnology Innovation Organization (BIO), were speaking at an event Friday marking a year since the establishment of the WHO co-sponsored Act Accelerator COVAX initiative.

Patents and other IP constraints are not the main obstacle to expanding access to vaccines, they asserted.  And increasing vaccine manufacturing capacity in lower-income countries, while important, will take time to develop – given the complexities of vaccine production, they said, speaking at a forum sponsored by the International Pharmaceutical Manufacturers and Associations (IFPMA).

Rather, the best way out of pandemic lockdowns and losses of life is to make better use of available resources, they stressed, including smoother supply chains and vaccine sharing schemes with COVAX.

“We are on track to make a billion doses this year, and potentially to have up to 1.4 billion doses for 2022,” said Moderna CEO, Stephane Bancel, at the press briefing, adding that the company is also “in the final stretch to get an agreement with COVAX,” for distribution of the mRNA vaccine through the global vaccine equity pool.  But he stressed that expanding manufacturing capacity further, and in more locations, would sap efforts to produce doses this year – and could ultimately even cost lives.

“We need to focus on delivering as many vaccines as we can this year,” he said, while trying to add more manufacturing capacity risks “being a distraction limiting what we can do in 2021… and by next year there is going to be way too many vaccines for people on the planet.” 

United States Raw Inputs Are Key To Global Vaccine Manufacturing Supply Chains

Michelle McMurry-Heath, CEO BIO

Added Michelle McMurry-Heath, a former US Food and Drug Administration expert, unlocking supplies of key raw products and vaccine dose sharing are important low-hanging fruit in the battle against the virus:

“We need to recognise that there are only a handful of manufacturers across the globe who have that expertise on hand, and we need to focus on getting them the materials that they need to produce as many doses, as quickly as possible, and to release backlogs,” said Heath, who is now CEO of BIO, a global trade association organisation that represents biotech researchers in government, the private sector, and academic institutions.

This this includes items as basic as single-use plastics and filters for the vaccine manufacturing process, some of which can only be supplied from in the United States. Currently the US Defense Production Act (DPA) restrictions are holding up release of many of those raw inputs, she stressed, adding that: “the US has to take a hard look at itself…. This Defense Protection Act, which was really designed to withhold capacity, expertise, doses and raw materials to the US, customer was well intentioned – but somewhat misguided at this stage –  we need to get those raw materials, out to the limited manufacturing capacity that exists around the globe.”

In addition, she added, high income countries need to be encouraged to start dose-sharing with the COVAX initiative – following on the example of France’s announcement only today that it will share 500,000 vaccine doses.

“The US is projected to have as many as 200 million excess doses on hand by the spring, we need to focus on getting those doses to COVAX,” said Heath. 

Vaccine Companies Can be Counted In ‘Double Digits’

Vaccine quality, which require adherence to strict biosafety requirements as well as to sterile conditions, is also a critical issue, she underlined. And quality control failures in manufacturing plants, such as ones seen recently in the case of a Johnson & Johnson vaccine plan, can undermine already shaky public confidence in the quality of brand-new COVID-19 vaccines.

Added Sai Prasad, CEO of Bharat Biotech, which has developed the first indigenous Indian COVID-19 vaccine, “Vaccine companies you can probably count in double digits so we need to be careful about whom we are transferring technology to, and whether they can receive it as well.  Technology transfer cannot be done with an entity that has no experience.”

Sai Prasad, CEO Bharat Biotech

“I think that as industry, we need to increase the partnerships between innovators and vaccine manufacturers…. We need to be agnostic as to whether these companies are US, Europe, India, China or Brazil, for example. And I think there is [already] a good track record of that,” he added, noting that over 200 partnerships between big pharma innovators and developing country manufacturers have been formed already.

At the same time, he said, supply chain bottlenecks and export barriers are a big threat to scale up: “Some of the vaccines take 150 to 200 little components that come from different parts of the world. “So interruptions in just one component, can slow production significantly, he pointed out, referring to the Serum Institute of India’s recent problems securing certain inputs from the United States.

“We’ve had reports from the Serum Institute having problems with certain single use materials that are supposed to come from the United States… plastic bags for example which we think is a mundane consumable, because maybe a decade ago industry, as such, we were all thinking about going into single use systems, which involved a lot of single use consumables – but now this unfortunately has become an impediment, and a bottleneck.”

Rajinder Suri, CEO DCVMN

Rajinder Suri, CEO of the Developing Countries Vaccine Manufacturing Network (DCVMN), echoed that saying:  “We are on the verge of expanding and ramping up the capacities, which are really required to meet the global demand…..and we are certainty facing some of the bottlenecks, from cell culture mediums and serum adjuvant filters, and single use plastic bags, to bio reactors.

“Most of these materials are coming from the US – so if the DPA is not handled properly, then the supply chain will get impacted, and building the global capacity will adversely get impacted.” 

COVAX Distributions Should Accelerate – With Stronger US Support

On the brighter side, meanwhile, Heath said she was confident that with stronger support for COVAX from the new US administration of President Joe Biden, the global vaccine facility can make up for its comparatively slow start in the second quarter of the year.

“COVAX didn’t have full support of all the developed countries. Now that this is up to speed…. we need to focus on great efforts like COVAX which are just beginning to fully ramp up, and can deliver very affordable vaccines around the globe. I is the fastest way to get high quality doses to developing countries, and that speed is so critical,” she said. 

Added Bancel, “we are focused on working with COVAX to provide vaccine, right now.  COVAX is the way for us to get maximum access on the planet.” 

See entire press briefing:

 

 

Ghana, Africa
Health worker Evelyn Narkie Dowuona holds up her vaccination card after receiving a dose of the COVAX-delivered AstraZeneca COVID-19 vaccine at Accra’s Ridge Hospital in Ghana.

One of the few silver linings of the COVID-19 pandemic is the unprecedented collaboration of every sector of society to overcome it – best demonstrated by the Access to COVID-19 Tools Accelerator (ACT-Accelerator), which celebrated its first anniversary on Friday.

The ACT-Accelerator’s most famous pillar is the vaccine facility, COVAX, which has distributed almost 40 million vaccine doses to 119 countries so far.

“Vaccinating at this scale and in this time frame constitutes the largest and most complex vaccine rollout in history,” according to the WHO, but added that there are also “severe supply constraints characterising the market at present”. 

Other key achievements in the past year include:

  • procuring 65 million COVID-19 tests for LMICs and supporting the development and Emergency Use Listing (EUL) of reliable rapid antigen diagnostic tests by its diagnostics pillar 
  • supporting the identification of dexamethasone as the first life-saving therapy against COVID-19 and, within 20 days of its identification, making 2.9m doses available to LMICs vis its therapeutics pillar
  •  Assisting to providing oxygen to half-a-million COVID-19 patients every day in LMICs.
  • Procuring $50 million of PPE for LMICs via the Health Systems Connector pillar. 

While the ACT Accelerator has attracted $14.1 billion in funding, it needs another $19-billion this year to meet its aim of vaccinating 20% of the world’s population by the end of the year. 

Equitable Access Still a Long Way Off

“The ACT Accelerator was conceived with two aims: the rapid development of vaccines diagnostics and therapeutics, and equitable access to those tools,” Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General, told the virtual anniversary featuring all partners.

While the first objective “has been achieved”, said Tedros, “we have a long way to go on the second objective”. 

Of the more than 950 million vaccinations that have been given,  0.3% have been administered in low-income countries and testing rates in high-income countries are about 70 times higher than those in low-income countries, according to the WHO.  

“Around the world, people are dying because they are not vaccinated. They are not tested and they are not treated. We’re deeply concerned about the increasing number of cases in India right now,” said Tedros.

India recorded 332,730 new cases and 2,263 deaths on Friday amid reports that many hospitals had run out of oxygen.

South African President Cyril Ramaphosa

South African President Cyril Ramaphosa told the event that “a COVID-19 vaccine is a public good and must be recognised as such”.

South Africa and Norway co-chair the accelerator’s facilitation council, which provides political leadership for the body.

TRIPS Waiver and Technology Transfer

“South Africa and India are calling for a temporary TRIPS waiver to respond to COVID-19,” Ramaphosa added. “This, in our view, will facilitate the transfer of technology and intellectual property to more countries for the production of COVID-19 vaccines, as well as diagnostics and treatments.” 

He also welcomed the WHO initiative to establish a COVID-19 mRNA vaccine technology transfer hub and called on the pharmaceutical industry to “directly transfer this technology free of intellectual property barriers to low and middle-income countries”.

Norway’s Minister of International Development, Dag Ulstein, said that his country and South Africa had sent out letters to 89 countries appealing to them to contribute to the ACT-Accelerator.

“At this one-year anniversary, our choice is simple: invest in saving lives by treating the course of the pandemic everywhere now, or continue to spend trillions on the consequences of the pandemic with no end in sight,” said Ulstein, whose country has donated a number of its vaccine doses to COVAX.

Describing the accelerators’ achievements as “a miracle”, Ursula von der Leyen, President of the European Commission, said that the EU had recently doubled its contribution. 

Meanwhile, French President Emmanuel Macron said that “now was the time to share”, and announced that his country would donate 500,000 vaccine doses to COVAX by mid-June. He appealed to other countries to donate vaccines to COVAX, saying that he hoped that the goal of EU members donating 5% of their vaccine stocks he set in February would be “exceeded” by the end of the year.

However, Macron said the lack of technology transfer, not intellectual property rights, was hampering vaccine rollout. France is one of a handful of wealthy countries opposing the TRIPS waiver.

Thomas Cueni, Director General of International Federation of Pharmaceutical Manufacturers (IFPMA), said that a year into the AC-Accelerator “we can say science wins”. 

“Not one but several highly effective vaccines are being developed at record speed, and now being produced in historic quantities,” said Cueni, committing his industry to accelerating  “global access to safe, effective and affordable COVID-19 treatments and vaccines”.

French President Emmanuel Macron

Jeremy Farrar, Director of Wellcome, said in a press release about the anniversary that “huge strides have been made in the last year” but “science only works if it reaches society”.

“The world remains in the grip of a devastating pandemic – and it is not slowing, only escalating. There must be no further delays to getting COVID-19 vaccines, tests and treatments to the most vulnerable groups everywhere,” added Farrar, whose organisation is a partner and significant contributor to the accelerator.

“We are in desperate need of strong global leadership. Wealthy countries with access to surplus vaccine doses must start sharing these with the rest of the world now through COVAX, alongside national rollouts. And they should urgently set out a timetable for how these donations will be increased as they vaccinate more of their populations.”

Surge of COVID-19 in India is ‘Really, Really Difficult’

Mike Ryan, WHO’s Executive Director of Health Emergencies Programme, said the global body was assisting India to secure oxygen, as well as with technical assistance and clinical management and triaging of patients. 

“There’s a lot of fear in India right now. We support the Government of India, like we support all governments, in facing this really, really difficult situation. This is not time for recommendations. It  is the time for solidarity, the time to move quickly together to reduce deaths and reduce transmission by decreasing mobility and mixing, supporting communities with mask-wearing, maintaining social distance and reducing social gatherings,” said Ryan.

Seth Berkley, CEO of the vaccine alliance, Gavi, added that because of India’s domestic need, “the first 10 million vaccine doses from COVAX went to India”.

However, Berkeley acknowledged that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. 

 

Image Credits: WHO.

Rwanda
Lines of people wait their turn to receive the AstraZeneca COVID-19 vaccine in Rwanda in early March, after WHO-supported COVAX facility supplies are delivered. Should countries build a new pandemic treaty – or bolster existing mechanisms? 

Despite rising calls for a pandemic treaty, including from 25 world leaders in an open letter last month, some global health experts doubt that a treaty would be the most efficient way to quickly strengthen the world’s capacity to beat COVID – and prevent future pandemics. 

“I don’t think we have time to negotiate another treaty on vaccines. I mean, we really are in this emergency,” said Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia, Canada. 

Lee was one of four panelists featured at a session on “Global Health in Disarray-What Next,” hosted by the Geneva-based Graduate Institute’s Global Health Centre to mark the launch of its newly appointed International Advisory Board (IAB).

The wide-ranging session covered a range of issues, from the feasibility of a pandemic treaty, to the challenges of achieving vaccine equity and the lack of progress made in strengthening health systems in low-income countries, despite years of international funding. 

A Pandemic Treaty Is Not Essential 

Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia. 

“Do we need a treaty to move forward? The answer is no,” said Esperanza Martinez, the Head of COVID-19 Crisis Management at the International Committee of the Red Cross (ICRC). “I don’t think that we are short of frameworks and short of treaties… there are already enough mechanisms to act.”

According to Lee, legal frameworks such as the World Trade Organization’s TRIPS agreement, and accompanying TRIPS flexibilities create frameworks under which countries can gain access to lifesaving products during health emergencies. 

And the legally binding International Health Regulations (IHRs), which mandate countries to report on disease outbreaks, and share information with WHO and other member states, is another “useful” framework that should not be forgotten, added Finland’s Director for International Affairs Outi Kuivasniem, another panel member. 

Rather, the global health community needs to find ways to reform existing frameworks so that they serve us better, panelists suggested. 

Esperanza Martinez, Head of COVID-19 Crisis Management at the International Committee of the Red Cross

In particular, there is a need to reform the IHRs, Kuivasniem said, because countries have not always complied – including by enacting export bans on vital health products or inputs, which have destabilized crucial supply chains, including those relating to vaccines and other essential medicines. 

Treaty Would Need Strong Member State Alignment 

At the same time, panelists acknowledged that a pandemic treaty could have some use if it was closely linked to existing legal frameworks like the IHRs and international humanitarian law, and generated greater adherence from countries, as well as support from civil society.  

“If we have a treaty, we need to have a conversation about what makes sense to have in the treaty so that it has an impact, and that countries are willing to adhere to those promises that are [made] through a treaty,” warned Kuivasniem. 

Allan Maleche, Executive Director, Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN)

Conversely, a “lack of political alignment” between governments and between government and civil society, could frustrate efforts to develop a new pandemic treaty, cautioned Allan Maleche, Executive Director of Kenya’s Legal & Ethical Issues Network on HIV & AIDS (KELIN). 

And other “political solutions” are also on the table, she and other panelists pointed out, to accelerate pandemic response. Few would actually require a treaty.

Those initiatives range from the WHO co-sponsored COVAX global vaccine facility to proposals for an IP waiver under the TRIPS rules of World Trade Organization the COVID-19 Technology Access Pool (C-TAP), and tech transfer initiatives. Despite controversies over some initiatives, such as the IP waiver, none really require a pandemic treaty to be implemented. 

Should a pandemic treaty be negotiated, civil society should really drive its development, Maleche underlined.

“If we are serious about getting our pandemic treaty in place, it’s important for scholars, academics, human rights lawyers, civil society groups, and affected communities to push their governments and [define] what should be that framework,” he said. 

“A treaty would be important but the more important is respect and implementation of that treaty so that it can have an effect on the lives of people,” he said.

Stronger Business Case Needed For Investing In Health Systems in LMICs 

Healthcare workers treat a patient with drug-resistant TB in Myanmar, using drugs procured by the  Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

Beyond the immediate pandemic, however, a stronger business case is needed to convince governments that global health is a long-term investment that makes economic sense, stressed Martinez – particularly in LMICs. 

“We need to have a business case, an economic case for investment in global health,” she said, pointing out that while the case has recently been made for investment in vaccine access, “there’s a need for making a stronger case for global health in general… as a way of also bridging the conversation gap between government and the private sector.”

Meanwhile, Maleche expressed dismay that decades of international funding meant to strengthen healthcare delivery in developing countries such as Kenya had failed to create more sustainable health systems.   

“Has this money actually been fixing the health systems?” he asked. “Because the time we needed the health system to be fully functional, COVID came and exposed the things that are not working.

“COVID also exposed the underbelly of things that many countries don’t normally give priority,” he added. “You’re telling people: wash your hands, put on a mask, social distance, but in certain countries including Kenya and in other low- and middle-income countries, some of those things are luxuries as people have never seen clean running water in taps.”

In addition, Maleche added, COVID-19 has highlighted the fact funds are also misspent by governments  lacking public transparency and accountability: 

“Even within a pandemic we still are able to see that resources are not accountably used, we see that governments are not transparent. So again, this comes to show that some of the bad habits that we had when we had a normal sort of situation in the globe are played out in quite an extreme picture, in the context of a pandemic. ”

In the humanitarian sector, in particular, financial support for fragile healthcare systems has been particularly scarce, added Martinez.

“Very little has been done to strengthen health care systems in LMICs,” she asserted. “We have been speaking for years about the need to strengthen healthcare systems in developing countries and in humanitarian crises, but really when we look, very little has been done. 

In terms of vaccine access as well, “fundamentally there is a lack of production, science and research and development in the global south, and unless we address that issue, we will not have a sustainable solution to these [vaccine production] needs that we have globally,” she added. 

“There is a need for investment, but the investment at the level that is required is not coming through.”

Regional Initiatives and Grassroots Action As Way Forward 

Ilona Kickbusch, Founder and Chair of the International Advisory Board, Global Health Centre

“There is a feeling in the air [that] we need to reform,” said Ilona Kickbusch, founder of the Global Health Center, and chair of the new International Advisory Board, and moderator of the panel discussion. 

“Now there’s a number of suggestions on the table, for how global health, both in terms the way we do research and the way the global health regime and organizations are set up, could be changed. 

“And it’s interesting that right now we’re facing a pressure to some extent from above, top-down, from heads of state and government who are saying, ‘we need a new treaty in global health,’ and as many of you know we only have one so far…

“On the other hand, there’s this movement from below that says we need to decolonize global health, we need totally different ideas, approaches, and we need to be much clearer about equity and access, and the social justice agenda.”

Among the new ideas, Kickbusch pointed to regional initiatives that are underway, particularly in Africa, to chart a more strategic direction for the continent’s pandemic response.  

While many countries turned inward during the pandemic, Africa started working together more closely at the regional level, she pointed out. 

A new African region multi-hazard warning system will seek to link early warning, and responses to natural hazards, pandemics and pests and diseases as well as conflict.

That collaboration has stimulated initiatives ranging from AU-based vaccine procurement to the new AU/Africa CDC partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), announced just last week to ramp up vaccine research, development and manufacturing in the region – with funding from Afreximbank and the Africa Finance Corporation.  In addition, the African Union and Africa CDC are developing a new COVID-19 Disaster Recovery Framework and multi-hazard warning system for the continent to better link responses to climate, health, and environmental emergencies. 

“It is one of the encouraging things in global health..that there are these regional initiatives,” Kickbusch said. “Particularly in the African Union, we’ve seen the activities of the African CDC during the pandemic, and seend that a true consensus is building up.” 

Said Martinez, “This pandemic is precisely an example of how critical it is for us to have this broader view of health…

“So we have the pandemic crisis and we also have the climate change crisis. And if we look at the issue we need to think beyond climate change [and] understand that polar bears are drowning in the Arctic, to think about the millions of people that today are facing diseases that were confined to the tropics. 

“We [need to] link all of those elements to the broader components of human health and health systems. I think that’s when we truly talk about human global Health.”

Image Credits: WHO, The Global Fund / John Rae.

One dose of either vaccine resulted in 65% reduction of infections. There was greater impact against symptomatic infections (72%) than infections without reported symptoms (57%). 2 doses were even more effective against symptomatic infections (90%, and gave similar level of protection as prior infection.

COVID-19 infections fell significantly – by 65% percent – after a first dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccine in a study of more than 373,000 British residents who received one of the two jabs. 

The first in a series of two new studies, published by the University of Oxford, found that the reduction in new COVID-19 infections was similarly dramatic following either the first dose of the Oxford/AstraZeneca or Pfizer-BioNTech vaccine.

“We found very similar, significant reductions in infections [rates] after the first rounds of either [Oxford/AstraZeneca] and [PfizerBioNTech] vaccines,” said Dr Koen Pouwels, senior researcher in Oxford University’s Nuffield Department of Population Health, during the press briefing.

The studies, which used data from the COVID-19 Infection Survey, a partnership between the University of Oxford, the UK’s Office of National Statistics (ONS), and the Department for Health and Social Care (DHSC), analyzed 1,610,562 test results from nose and throat swabs taken from 373,402 study participants between 1 December 2020 and 3 April 2021. 

First Study Focused on Infection Reduction Rates
Clockwise, left to right: Dr David Eyre, Dr Sarah Walker, moderator Fiona Lethbridge, Dr Koen Pouwels

The first study focused on infection reduction rates following a single shot of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines. Twenty-one days after a single dose of either vaccine, with no second dose, the rates of all new COVID-19 infections had dropped by 65%, symptomatic infections by 74%, and infections without reported symptoms by 57%. 

One dose of either of the two vaccines also were similarly effective against the B.1.1.7 variant, which was first identified in the UK. Vaccination was just as effective in individuals aged 75 or older with underlying health conditions as it was in those under 75 or without health conditions. 

Two doses of the Pfizer-BioNTech vaccine, meanwhile, reduced asymptomatic infections by 70% and symptomatic infections by 90%.

During the press briefing, Dr Sarah Walker, Professor of Medical Statistics and Epidemiology at the University of Oxford and Chief Investigator and academic lead for the COVID-19 Infection Survey, stated that she was ‘pleasantly surprised’ by these results. 

“The benefits are greater for people with high viral load and for people with symptoms, both of who have probably got the greatest chance of transmission, was really not necessarily something I was expecting.” 

However, too few people had yet received two doses of Oxford-AstraZeneca to assess the final degree of protection obtained from that vaccine, the researchers concluded.

In the press release, Dr Koen Pouwels said: ‘The protection from new infections gained from a single dose supports the decision to extend the time between first and second doses to 12 weeks to maximise initial vaccination coverage and reduce hospitalisations and deaths.”

“However, the fact that we saw smaller reductions in asymptomatic infections than infections with symptoms highlights the potential for vaccinated individuals to get COVID-19 again, and for limited ongoing transmission from vaccinated individuals, even if this is at a lower rate. This emphasises the need for everyone to continue to follow guidelines to reduce transmission risk, for example through social distancing and masks.”

Antibody Responses High After Second Pfizer Vaccination 
pfizer
Antibody responses after receiving either AstraZeneca or Pfizer COVID-19 vaccines

The second study compared how antibody levels changed after a single dose of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines, as compared with two doses of the Pfizer-BioNTech vaccine, generally given 21-42 days apart. 

Antibody levels were comparatively lower with a single dose of either vaccine, particularly at older ages. But while the size of the immune response differed, there was no group of individuals who didn’t respond at all to either vaccine. 

There was, however, a small percentage of people – 5% – who had low responses to both vaccines, which makes it essential to monitor responses to a second vaccination. 

Antibody responses to a single dose of either vaccine also were generally lower in older individuals, especially over 60 years – unless they had had a prior COVID infection.

Antibody responses to two doses of the Pfizer-BioNTech vaccine were high across all ages, and particularly increased in older people – reaching levels similar to those who had received a single vaccine dose after a prior infection. 

David Eyre, Associate Professor at the Big Data Institute at the University of Oxford, said that while the findings still highlighted the importance of people getting a second vaccine dose degrees of protection different by age:  

“In older individuals, two vaccine doses are as effective as prior natural infection at generating antibodies to the SARS-CoV-2 virus that causes COVID-19. In younger individuals a single dose achieves the same level of response.”

Walker also emphasized the importance of vaccinations to control the spread of COVID. “Vaccines are clearly going to be the only way that we are going to have a chance to control this long term. WIthout vaccines, I don’t think getting close to zero [infections] is really feasible,” she said, during the press briefing. 

The findings come on the heels of recent  announcements by Pfizer CEO Albert Bourla that in fact a third booster jab of the vaccine may be necessary “somewhere between six and 12 months.” 

Risk of Blood Clot from AstraZeneca Vaccine Doubles, UK Still Says ‘Benefits Outweigh Risks’ 
A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine.

Meanwhile, new UK government data suggested that the risk of serious blood clots from AstraZeneca jabs was greater than had previously been reported at national level. 

The most recent survey found 168 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA). The estimated number of first doses of AstraZeneca COVID-19 vaccines administered in the UK was 21.2 million by 14 April, giving an overall case incidence of 7.9 such events per million doses – or one person in every 125,000.  

Out of these cases, which occurred in 93 women and 75 men, 32 deaths occurred (19%). Previously, there had been 79 cases and 19 deaths reported in the UK.  

The UK government’s regulatory agency, however, continues to emphasize that the benefits still outweigh the risks. 

“On the basis of this ongoing review, the advice remains that the benefits of the vaccine outweigh the risks in the majority of people,” the MHRA said. 

Image Credits: University of Oxford, Flickr.

A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19.

The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks.

The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch.

Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective.

Multi-hazard Warning System Will Predict Potential Outbreaks

In a related development,  the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. 

Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance,  as a result of unusually heavy desert rainfall – creating significant disruptions in food production.  

The multi-hazard warning system will be instrumental in predicting such potential outbreaks of  environment and climate related and health events, critical in mobilizing resources for effective response efforts. 

A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict.

“Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview.

The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present.

New Initiatives To Complement Existing African Risk Capacity  

The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters.

So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth.

He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. 

One Health Approach – Urgent Action Needed Now

The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. 

“If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch.

Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done.

The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative.

Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. 

“IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre.

Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent.

“That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals.

Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria.

Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. 

The forum Reaching Zero: Virtual Forum on Malaria Elimination  saw the launch of a new new initiative – E2025 –  to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria.

Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. 

https://twitter.com/endmalaria/status/1384871850338131972

The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria.

Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020.

The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event.

“These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. 

Zero Malaria Initiative

In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria.

Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. 

In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. 

The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. 

Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. 

The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. 

“Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. 

Dr Pedro Alonso, Director of the WHO Global Malaria Programme.

The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. 

A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. 

In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. 

Challenges to Reaching Zero Malaria

Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. 

Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality.

Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. 

In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers.

E-2025 Initiative

The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. 

“At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. 

The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. 

The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. 

The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. 

“Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.”

Impact of COVID-19 on Malaria Programmes
Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued.

During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. 

However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision.

“Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. 

In addition, more children than ever before received seasonal malaria chemoprevention last year. 

The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. 

“We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw.

“[But] of course we’re not out of the woods yet,” she added. 

Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria.

More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey.

Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. 

“Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. 

The current biggest challenge is keeping the political focus on malaria, said the speakers. 

“We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. 

RTS,S Malaria Vaccine is a “Promising Additional Tool” 

Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti.

Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday.

The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%.

“This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. 

Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. 

Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria.

“We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.”

“And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. 

In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months.

While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said.

“For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. 

The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually.

Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. 

The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. 

Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria

Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. 

While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti.

As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight.

“Every year that we let malaria continue to spread, health and development suffer,” Moeti said.

Image Credits: WHO, WHO.

Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry.

Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19,  health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. 

But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away –  with additional checks to ensure that those getting the jabs are bonafide health workers.   

Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30.

“To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. 

Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website.

Pakistan Medical Association Protests

As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch.

The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs.  

Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. 

Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the  vaccine drive that began in early February of this year. 

The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. 

Prioritise the Vaccination of HCWs

In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers.

In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said,  is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic.

“It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. 

“We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded.

According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic.  That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. 

Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies

In an interview with Health Policy Watch, Sajjad said that he  believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. 

“Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered.

Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch.

Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received  the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. 

Punjab, the country’s most populous province has so far vaccinated 156,158  health workers, 56%, while  Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. 

That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). 

Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began.  

She contended that health worker registration remained open, but turnout has been very low.

“Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. 

However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. 

“The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. 

The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. 

Boys play on a beach in Kiribati, one of the Pacific island states most threatened by rising sea levels due to climate change.

Climate activists have high hopes that at this week’s Leaders Summit on Climate, hosted by US President Joe Biden with forty other heads of state, climate change will be framed as a health issue that is exacerbating the risk of future pandemics, as well as causing seven million deaths a year right now as a result of air pollution and reducing already fragile crop yields critical to nutrition and food security.  

Climate activists are pinning these hopes on the Biden administration’s recent appointment of two well-known advocates of the health card in climate change negotiations – John Kerry, the U.S. Special Presidential Envoy for Climate, and Gina MacCarthy, the White House climate advisor. 

“At the Leaders’ Climate Summit, I think we’ll see the US framing their climate commitments at least in part in terms of health,” said the head of Global Climate and Health Alliance Jenny Miller, in an interview with Health Policy Watch. “The US Climate Advisor Gina McCarthy is very knowledgeable about the health impacts of climate change and the health benefits of climate solutions.” 

Even during the Trump years, Kerry was pounding the pavement of climate meetings and interacting with health advocates. Pictured here with WHO’s former Assistant Director General Flavia Bustreo at the 2019 Madrid climate conference of parties (COP 25) – the last in-person meeting before the COVID pandemic.

Indeed, Gina McCarthy has been a regular on the podium of numerous health and climate events, dating back at least to the 2014 UN Climate Summit, when she headed the work of the US Environmental Protection Agency, under the Obama Administration. Kerry, US Secretary of State in the Obama Administration who led the US team negotiating the 2015 Paris Climate Accord, remained active on the climate issue in the dark days of Trump’s climate denial policies, including meetings with climate and health advocates. Last week, just ahead of the climate summit, Kerry shuttled to Shanghai for the first meeting by a senior Biden Administration figure with Chinese officials, and President Xi Jinping later confirmed he would attend the virtual summit meeting. 

Health, however, is not formally on next week’s agenda, and there is concern that a more traditional positioning of climate action as a solution that benefits economies and businesses could detract from a strong health case, Miller warned.

“While I do think that health may come up during the Summit, it’s not actually on the official agenda,” she said, adding. “If you’re talking about climate change and you’re not talking about the impact on people, you’re missing the boat.”

“At the Summit, I’m concerned that with a more narrow focus on economies, businesses, and on new technologies, rather than on making sure the solutions we pursue really deliver benefits for people, we won’t actually get those health benefits we could see,” she said. She added that a stronger representation of health ministers in future climate conferences, such as the UN COP 26, due to be hosted by the United Kingdom in Glasgow at the end of 2021, could help position climate change as an opportunity to improve health.

Climate change has increased droughts and water scarcity, reducing crop productivity and pastureland; increased food insecurity; and driven local conflicts and migration in Africa’s Sahel and beyond.

Still, a handful of countries have begun to draw more explicit links between climate change and health in their policies, such as Canada, which recently put health front and centre in its climate adaptation plan. In the United Kingdom, meanwhile, the National Health Service recently committed to carbon neutrality by 2040. And in Latin America, countries such as Argentina are moving to integrate health into their national climate commitments, made under the 2015 Paris Agreement.

But “most” countries still have a long way to go, Miller notes, emphasizing the urgent need for bolder commitments across the board. In even the more health-and-climate conscious countries, carbon emissions have continued to increase in past years, she noted.

Concretely, the White House Summit aims to firm up a stronger consensus among the world’s largest greenhouse gas emitters, including the US and China, to limit the earth’s warming to no more than 1.5 C. In one hopeful sign, other leading state actors on the climate front, including India, the United Kingdom and Russia, have also confirmed their attendance. And while the final list of attendees hasn’t been published, it is expected that most other countries among the 40 invitees from Europe, Latin America, Africa, The Middle East, and Asia will follow suit.

Ahead of the summit, the United States and China released a historic joint statement, calling on countries to raise their level of ambition in fighting climate change, and cooperate on reaching carbon neutrality.

At the Summit, the White House has already said that the Biden administration will unveil an “ambitious 2030 emissions target” for the US, as well, to move towards the 1.5 °C goal, reversing four years of inaction under the former administration of Donald Trump, who backed out of the Paris climate agreement, bolstered the fossil fuel industry and relaxed regulations on climate and environmental pollution. Not coincidentally, Thursday’s opening session, 22 April, also coincides with the annual celebration of Earth Day.

Climate Change Is A Health Issue 
Maria Neira, WHO WHO Director of Environment, Climate Change and Health

Given that seven million people a year die from air pollution every year – mainly from the burning of fossil fuels – it makes sense to position climate change as a health issue, emphasized Maria Neira, WHO’s director of environment, climate change and health, who has previously said that “fossil fuels are literally killing us”. That framing, she argues, can help accelerate action on the climate front.

“If you care about your lungs, you better care about climate change,” she said. “If we want to speed up action on the climate front, the most powerful argument is about health.” 

Tackling the causes of climate change, she stressed, has “enormous” health benefits, because the same dirty fuels that cause pollution in households, cities and rural areas also contribute one way or another to climate change. So curbing air pollution can both rapidly reduce some of the key climate change drivers, as well as reducing risks of cardiovascular, respiratory diseases and cancers, she pointed out.

In the wake of the COVID-19 pandemic, too, it is becoming increasingly clear that cllimate change has seeded the “ideal” conditions for more frequent and more devastating pandemics – increasing human encroachment on wilderness areas, leading to the release of new pathogens that previously circulated only among animal species in the wild. 

 “Today, up to 75% of all emerging diseases come from animals,” warned teenage climate activist Greta Thunberg earlier this week at a WHO press conference. “And as we are cutting down forests and destroying habitats. We are creating the ideal conditions for diseases to spill over from one animal to another, and then to us,” she said, adding: “We can no longer separate the health crisis from the ecological crisis, and we cannot separate, separate the ecological crisis from the climate crisis. It’s all interlinked, in many ways.”

Polluting Industries Must Pay The Real Price For Carbon Emissions 

Looking ahead to the COP26 climate conference in Glasgow, planned to take place 1-12 November, climate advocates must ensure that polluting industries pay a “serious” price for the carbon they are releasing into the atmosphere, added former spokesperson for the Paris Agreement of 2015, Nick Nuttall, who is co-hosting the Exponential Climate Action Summit-Financing the Race to Zero on Thursday as well. The event brings together thought leaders from the private sector, labour unions and civil society to talk about ways in which climate action can be accelerated, while creating more jobs and global development payoffs. 

“We need a proper price on pollution to make sure that people who continue to pollute like oil companies, and like heavy industries, actually have to pay a serious price for the carbon that they’re putting out into the atmosphere – as a way of generating finance for those that are doing the right thing,” said Nuttall, in an interview with Health Policy Watch. 

The income generated from pricing carbon, he added, would both encourage dirty industries to quickly reduce their emissions and help generate the working capital to support national and regional governments and cities that are working towards reducing their emissions.

There also needs to be a “clear message from people that have pensions and have investments in pension funds that we will no longer tolerate investment in those pensions in the shares and the stocks of companies that are causing harm to our planet,” he said, noting that some of the public motivation for that kind of divestment will come from growing public awareness about the health impacts of climate change. 

He said that the last three years have finally seen the finance sector tipping into “real action” on investments into more low-carbon and greener development. “Now it needs to achieve the required velocity to first halve emissions by 2030 and then net zero by 2050.”

Ultimately, the financial arguments are also linked to the health card as well: “We need to address climate change to protect human health, and this won’t happen if we don’t finance the transition, and fast… to protect our ecosystems [needed for health], and breathable, productive cities.” 

Image Credits: UNDP, WHO, Flavia Bustreo , Flickr – EU Civil Protection and Humanitarian Aid, Maria Neira.

There is a “possible link” between the Johnson & Johnson COVID-19 vaccine and very rare cases of blood clots, but the benefits of the single-dose vaccine outweigh the risks, the European Medicines Agency (EMA) has announced.

In a statement released on Tuesday, the EMA safety committee said that the rare, but serious blood clot disorders, should be listed as “very rare side effects” of the vaccine. The EMA statement followed a similar decision with respect to the AstraZeneca vaccine, just two weeks ago. 

The European regulator had reviewed eight reports of “serious cases of unusual blood clots associated with low levels of blood platelets”, one of which was fatal – among seven million who received the jab in the United States. 

No cases of deaths associated with the J&J vaccine have so far been reported in the European Union, said EMA executive director Emer Cooke – but vaccine administration on the continent is also far less advanced.

Along with Europe, South Africa and the US had also announced a pause in J&J vaccinations over the blood clot reports in response to reports of a rare cerebral blood clot disorder that combines clots with low blood platelets (CVST).  Since then, vaccines in South Africa have resumed, but in the US, they remain on hold.  

Announcing its decision, the EMA said the risks associated with the virus itself are still higher than the vaccine.

“Covid-19 is associated with a risk of hospitalisation and death,” it said. “The reported combination of blood clots and low blood platelets is very rare, and the overall benefits of [the Johnson & Johnson] Covid-19 vaccine in preventing Covid-19 outweigh the risks of side effects.”

European Commission President Ursula von der Leyen welcomed “the announcement on the safety of the Johnson & Johnson vaccine”.

“This is good news for the roll-out of vaccination campaigns across the EU,” she tweeted.

Johnson & Johnson Rare Blood Clotting Cases

The cases of clotting in the US “occurred in people under 60 years of age within three weeks after vaccination, the majority in women”, the EMA regulator said in its statement. 

“One plausible explanation for the combination of blood clots and low blood platelets is an immune response, leading to a condition similar to one seen sometimes in patients treated with heparin called heparin induced thrombocytopenia, HIT,” it said. Heparin is a blood thinner given to people with clotting disorders.

The EMA said healthcare workers and those who have received the vaccine should be aware of potential symptoms of these rare blood clots. They include shortness of breath, chest pain, leg swelling, abdominal pain, headache, blurred vision or tiny blood spots under the skin.

The early intervention of a specialist can change the outcome for the patient, Cooke said.

‘Similarities’ with AstraZeneca

Emer Cooke, EMA Executive Director.

The cases reported with  J&J’s vaccine were similar to the rare blood clot cases linked to the AstraZeneca vaccine, EMA also noted.

Earlier this month, the EMA made the same recommendation for the Covid-19 vaccine produced by Oxford-AstraZeneca.

That recommendation, made on 7 April, came after 86 people, out of 25 million Europeans who had received the jab, developed the unusual blood clots. Germany has since halted administration of the vaccine to people under the age of 60, the UK has ceased giving the vaccine to people under age 30, and Denmark has halted it altogether. 

Both vaccines use a disabled, or inactive adenovirus vector [viruses that typically cause colds or flu-like symptoms] to deliver a double stranded DNA containing the genetic instructions for part of the SARS-CoV2 characteristic spike protein. That stimulates the body’s immune system to develop antibodies to the virus.

However, Sabine Straus, chairperson of EMA’s evaluation committee of risks and pharmacovigilance (PRAC) noted there were differences between both vaccines since Johnson & Johnson’s vaccine uses an inactivated human adenovirus as the “vector” to deliver the spike protein DNA, while AstraZeneca’s is chimpanzee-based. Both vaccines also target a different part of the SARS-CoV2’s spike proteins, she said.

Considering that the Russian-made Sputnik-V vaccine also uses adenovirus vectors to deliver its jab (in this case different ones for first and second jabs), the EU regulator will “pay close attention” to the issue of rare blood clots as it reviews the vaccine, she added.

According to the latest available data, a total of 287 cases of unusual blood clots have been  reported following the administration of the AstraZeneca vaccine; 25 in the case of the Pfizer-BioNTech vaccine and 5 for the Moderna vaccine, the EMA officials told reporters.

The first-ever informal meeting between civil society groups, WHO officials and WHO member states was held on Tuesday ahead of the formal 74th   World Health Assembly, 24 May-1 June. 

The World Health Organization (WHO) and member states have an obligation to listen to stakeholders in a “sympathetic and respectful manner” as non-state actors (NSAs) play critical roles in supporting global health work generally – and more immediately addressing COVID-19 and its impacts on communities.

That call was made by Mara Burr, director of multilateral relations at the United States Department of Health and Human Services/Global Affairs, during a first-ever informal meeting between civil society groups, WHO officials and WHO member states ahead of the formal 74th   World Health Assembly, 24 May-1 June. 

While civil society groups have expressed fears that novel format of a separate forum for more detailed discussions between NGOs and member states could also undermine their standing at the formal WHA – the presence of some leading WHO donors and member states, such as the United States, Germany and France – in at least some of the sessions  – seemed to indicate that countries are taking the new model seriously.   

“WHO needs to ensure it has the ability to engage directly with non state actors, including civil society and the private sector… who can make strong contributions that is vital to any type of success against the pandemic,” said Burr on Tuesday, the first day of the 3-day virtual meeting, adding that it is “critically” important to ensure the participation of so-called “non-state actors” (NSAs) in WHO governing bodies and that such participation be in a “transparent and accountable manner, with an open door” to allow input from all stakeholders, including the private sector.

She underlined how the COVID-19 pandemic has demonstrated the critical role NSA’s and the private sector play, in everything ranging from addressing pandemic fallout at the community level to the development of vaccines and supply chains. 

Mara Burr, director of multilateral relations at the United States Department of Health and Human Services/Global Affairs.

“We all know that the COVID 19 pandemic has worsened inequalities and threatens decades of hard won gains in childhood vaccination coverage, fighting HIV, tuberculosis, malaria, malnutrition, maternal and child mortality sexual and reproductive health and rights, property, and much more.NSAs have played critical roles, not just in addressing the direct effects of COVID-19, but also in focusing on the secondary impacts in communities across the globe.”

Other actors, however, said that they would have liked to have seen greater member state presence – and in all of the sessions – rather than only in two half day sessions – out of the three full days. Although most of the sessions during the three day event are being broadcast publicly, WHO also said it had no list of what civil society and private sector groups, as well as member states, actually had attended the informal sessions.  

WHO Reforms, Finance And Other Key Issues Raised

However, in the session on public health emergencies, preparedness and response, in which Member States also were invited on Tuesday, the opening day, leading countries such as US took the opportunity to air preliminary views on the more controversial issues that will come before the full World Health Assembly (WHA) when it meets in just a month’s time. 

Those include a proposed “Pandemic treaty” that could strengthen the legal mandates around emergency response; a more sustainable system for WHO finance; vaccine production, distribution and equity; and series of independent reviews both into the functioning of WHO’s own health emergency system, the broader global pandemic response of member states and the functionality of the international health emergency system during the crisis – with recommendations for reform.  

“It is very important that member states have the ability to review those reports, in a way that allows us to really digest the information and discuss with member states the way forward,” Burr said.  

“I think we are a bit concerned that there are proposals that are presupposing a path forward without allowing the member states to actually have a discussion and determine what path makes the most sense.”

With respect to new resolutions and political instruments such as a treaty, however, her remarks seemed to express some hesitations.  

“There are there just not enough hours in the day to negotiate several different instruments at the same time,” she said. “And so we want to make sure the path we choose is the best way forward, based on the overwhelming consensus of the member states. We are analyzing everything. We appreciate all of the inputs, but I think it’s time for us to carefully consider these recommendations before we decide on a way forward.”

NGOs Play Key Role in WHO’s Work

During opening remarks earlier in the day, WHO director general Dr Tedros Adhanom Ghebreyesus said the organisation valued the “longstanding and fruitful collaboration” it shared with NSAs in official relations.

“Nongovernmental organizations have been working with WHO since its creation, and continue to play a key role, especially on technical collaboration. Philanthropic foundations have long been strong supporters of WHO’s work, said Tedros, highlighting the support given for the COVID-19 Solidarity Response Fund. In a conciliatory remarks clearly aimed at pharma industry leaders, whom he has repeatedly slammed over past months, Tedros added that “international business associations also provide a vital link between the private sector and WHO in finding common ground in public health goals”. 

Future Emergency Response: Needs Stronger Political Commitment From All 

Jaouad Mahjour, WHO acting Regional Director for the Eastern Mediterranean

Jaouad Mahjour, WHO acting Regional Director for the Eastern Mediterranean, said engagement with all NSAs is integral to moving forward on a new global framework for pandemic preparedness and response at the WHA and beyond. 

That includes a proposed treaty on pandemic preparedness and response, which gained the support of some 25 global leaders in an open letter launching the WHO initiative just last month.

“The aim would be to garner higher local political commitment to ensure and interconnect the global system to prevent predictable response to epidemic and pandemics,” Mahjour said.

There is currently a group of countries, including the United Kingdom, Germany, France, Indonesia, Kenya, Rwanda, and South Africa, co-sponsoring a draft decision on the treaty at the WHA. The decision would mandate WHO to create an intergovernmental working group to start working through the treaty specifics. 

Mahjour stated that civil society’s role in supporting such a treaty would be “most important”: 

“We know that community readiness and resilience are essential for effective all hazard approach.”

“But we’re hoping that we go out from this pandemic with strong political commitment, that will protect the world in the future and also the best legacy to our new and future generation.”

Added Gaudenz Silberschmidt, WHO director for health and multilateral partnerships, who moderated portions of the meeting:  “It’s also a call for all of you. It won’t happen on its own. It’s also your intervention and your support which will make a difference.”

The Importance of Maintaining Essential Health Services 

At the Tuesday session, WHO referred to the importance of maintaining essential health services – pointing to the role that civil society can plan in supporting that. 

The WHO has produced operational guidance to maintain essential health services, determining which services are the ones that “absolutely need to be maintained,” said Sylvie Briand, Director of the Global Infectious Hazard Preparedness Department.

Sylvie Briand, Director of the Global Infectious Hazard Preparedness Department.

The document recommends practical actions that countries can take at national, subregional, and local levels to reorganize and safely maintain access to high-quality, essential services in the pandemic context. 

Essential services include support for chronic diseases such as diabetes, HIV, and reproductive health, and also services that reduce suffering are “extremely important,” Briand added. 

Many countries find their health system capacities have been reduced by 50%, leaving their hospitals unable to provide support, noted Altaf Musani, director of health emergency interventions.  The global health workforce currently is suffering from brain drain in many countries, and a displacement of the essential health workforce does not enable refresher training for essential care; lack of accessibility of services in fragile, conflict, and vulnerable settings.

“Access is something that has to be negotiated. Access is something that often gets reduced,” said Musani.

Supporting Youth During Emergencies 

Civil society groups also  emphasized the importance of supporting youth during COVID-19, and also during future health emergencies. 

“You cannot do proper community engagement without the youth. It is really important in public health emergencies to include all segments of the population,” said Dr Ibrahima Soce Fall, Assistant Director General, Emergency Response.

Claire Beck, Director Humanitarian health nutrition and WASH, pointed out that health services, especially during humanitarian crises and pandemics, focus on certain life-saving issues for mothers and childrens, but there are more health needs that also need to be addressed as well. “Services are not youth-friendly, she said, “[They] are not open to meet the needs of youth during an emergency – reproductive health needs and listening to concerns they have.”

“It is important that the WHO not only look at the training of health workers in dealing with disease but training them to have a sympathetic and youth-friendly way of working with youth.”

But traditional health practitioners also have an important role to play during this pandemic, said Briand.

“First, they have the trust of the population, [making them] good communication channels]. If they are properly informed and they have the right message, they can help the community to protect themselves. They have a role to play in health as well.” 

Upcoming Sessions 

While Tuesday’s sessions were focused on COVID-19 response and health emergencies more generally, Wednesday and Thursday sessions will trace the steps of the wider range of issues that will also be addressed in May’s formal World Health Assembly.

Those will include sessions on the other two “pillars” of the WHO’s current strategic plan, including: one billion more people getting access to universal health coverage and one billion more people enjoying better health and well being.  

As part of that, civil society, WHO officials and (in some sessions) member state representatives will look at initiatives to address interpersonal violence; expand access to medicines, vaccines and treatment for rare diseases, and increase transparency around medicines markets; address health workforce issues; and create a framework for more sustainable finance for WHO.

Image Credits: WHO.