The city of Chicago in the United States used innovative ways to help fight the COVID-19 pandemic.

A real-time COVID-19 data dashboard, celebrities and athletes sharing information about COVID-19 and vaccine hesitancy, rapid response task teams and public communications campaigns have formed part of response strategies to help two major cities fight the pandemic.

The Partnership for Healthy Cities – supported by Bloomberg Philanthropies, the World Health Organization and Vital Strategies— on Thursday hosted a VitalTalks webinar on how Chicago in the US and Montevideo in Uruguay developed and implemented various systems to prioritise equity in their COVID-19 recovery plans.

In his opening remarks, WHO Director General Dr Tedros Adhanom Ghebreyesus said the virus has exploited and exacerbated underlying inequalities and that cities have borne the brunt of the pandemic.

“But many cities have also shown how the virus can be brought under control,” said Dr Tedros, adding that with “tailored and consistent use of proven public health measures” some cities were able to mitigate the devastating impact of COVID-19 and the inequalities it brought to the fore.

Tedros called on mayors across the world to implement policies to ensure equitable access to vaccines, with priority given to health workers, the elderly and those with health conditions that put them at higher risk. Health was not a luxury,  said Tedros, but a “fundamental human right and the foundation of social, economic, and political stability”.

“As you rebuild, we need to address the underlying inequalities that have left so many communities vulnerable,” he said.

Protecting The Most Vulnerable

Chicago mayor Lori Lightfoot and Intendant Carolina Cosse of Montevideo shared information about how they mounted response campaigns to support high risk populations, protect the lives of those most vulnerable to COVID-19 and the innovative campaigns they launched to communicate and educate residents about new programmes.

 

A year ago, Chicago picked up that its Black residents were dying at seven times the rate of any other population group, forcing authorities to prioritise providing these  residents with tools to protect themselves.

“The progress that we’re now benefiting from is a result of that hard work that started over a year ago. I see this as an opportunity for us to build a really permanent foundational infrastructure to work on community health issues in disparities that we’ve all known about. But now we have an opportunity because of COVID, to really make significant progress and reverse the trends,” said Lightfoot.

Chicago relied heavily on data to ensure that the city prioritised the vaccination of healthcare workers and citizens with comorbidities. Its vaccination drive focused on neighbourhoods that were hardest hit by the pandemic, many predominantly Black and Latinx, and the city is now seeing COVID-19  numbers steadily decreasing in these areas for the first time since the pandemic.

Key to the city’s interventions was “listening to our residents” and forming authentic relationships including forming a racial equity rapid response team, said Lightfoot.

Chicago’s residents are divided equally between white, Black and Latinx people, but in some instances, the life expectancy gap between Black and white was 12 years or more, said Lightfoot.

COVID-19’s deadly toll has hit Black and Latinx Chicagoans hardest, accounting for 71% of all deaths, while those groups make up 66% of the city’s population, according to city data.

No ‘Band Aid’ Solutions

Chicago mayor Lori Lightfoot

One of the challenges that the city faced, Lightfoot said, was that many people of colour did not have adequate access to healthcare and COVID-19 infections were disproportionately affecting Black residents. 

“I said to my team at that time, we need to dig into this. We can’t look away, but we also can’t do temporary Band Aid solutions,” said Lightfoot.

The formation of the racial equity rapid response team saw the city partner with a community health care organisation that had already been working on this issue.

Chicago also relies heavily on a data dashboard which is updated daily to follow and understand the pandemic in real time. The dashboard tracks daily COVID-19 positive rates, deaths, hospitalisations, ICU admissions and the number of people on ventilators across the city. All this information is shared with the public.

Another intervention called “the doctor is in” involves a medical doctor fielding  COVID-19 questions from residents on Facebook Live. At first offered only in English, the service is now available in Spanish.

“We know that the only way that we’re going to calm people’s fears and educate them about the things that they can do to protect themselves is by being 100%, transparent, but meeting them where they are in the moment, using trusted community partners, and that has served us well here in Chicago.”

More still needs to be done, but Lightfoot believes the city has laid a foundation  for addressing “larger systemic health care inequities going forward”.

Montevideo’s Used Existing Health Partnerships

Montevideo drew on its history of working with partners to prevent non-communicable diseases to address the pandemic. 

Cosse said they reinforced existing policies and legislation to help with the fight the pandemic and developed an ABC emergency plan. The ABC plan, among other things, promotes gender equality, and helps with food distribution and housing.

The city had extensive public communications campaigns, including dedicated telephone lines to assist its residents with any COVID-19 related queries or counselling. Many people, especially the elderly who did not have access to the Internet, used the telephone lines to ask about preventative measures, vaccines and testing centres.

Cosse said while they were not responsible for vaccine distribution, they assisted 23  polyclinics in Montevideo with staff and mobile gear.

Lightfoot said there was no “playbook” on how to manage cities during a pandemic.

Partnerships and collaborations with various stakeholders was vital to fighting the pandemic on various levels, she said.

“I think the mayors have to be the center of gravity for what’s happening, but bringing other people to the table that are necessary to address vaccine hesitancy, For example, we’ve done everything from celebrities talking about vaccines, you know, athletes, entertainers.”

Proper Systems

Lightfoot said her city was able to provide a robust response because as the  Department of Public Health had proper systems in place.

“You remember the early days of this pandemic, where people were flying around with suitcases of money to find personal protective equipment and mass ventilators? We didn’t have that struggle in Chicago, because we have a robust public health structure, ” said Lightfoot.

But more importantly, she said, following the data and transparency about decision making was “critical”.

“People have been carrying a lot of burdens over this last year. We treated people like adults, and we’ve done it with data, and science. Without rebelling in the way that we’ve seen in other parts of the world, is because we told them the truth.”

For Cosse, it was about cities having holistic responses to healthcare provision and finding a working solution between science, education and the economy.

“The solution is complex, but the solution is not in the main office. Go out and talk to people.”

infectious disease
A villager’s eyes are being examined for African eye worm by Dr Philippe Urwotho, a medical doctor and Provincial Coordinator of the DRC’s Neglected Tropical Disease National Programme.

Global funding to develop new drugs for some of the world’s leading infectious disease killers, such as HIV/AIDS, TB, and malaria, was US $3.876 billion, with the drop of US $185 million from 2018 reflecting COVID-related difficulties in data collection, according to the G-Finder Report, which tracks annual global investments.

However, once participation is accounted for, the report estimates that 2019 funding was virtually unchanged from its record high in 2018, with only a marginal decline of US $8 million. 

On the other hand, funding for neglected tropical diseases (NTDs) remains stagnant as it had for the past decade, with most NTDs seeing little change to their individual funding levels (although the majority did receive small increases), according to findings in the report, launched on Thursday by the Australia-based Policy Cures Research group. 

Mixed Signals in Global Trends; Policy Makers Need to Step Up to Address NTDs 
Nick Chapman, CEO, Policy Cures Research

The G-Finder Report is a comprehensive analysis of global investment into research and development of new products to prevent, diagnose, control or cure neglected diseases. It is widely used by national governments, industry, civil society, and the World Health Organization to identify gaps in progress and areas where investments would be needed. 

Reactions to the news remain mixed, in line with the good and bad news the report contains. 

“It’s not necessarily a good one or a great one. I don’t think that the level or the distribution of global funding for neglected disease is as we wanted or as it should be,” said Nick Chapman, CEO of Policy Cures Research, during the launch of the report. 

Ricardo Baptista Leite, member of the Parliament of Portugal, called on policy makers, who have both the legal and moral obligations to represent underserved populations, to tackle neglected diseases. 

“Policymakers are the ones who are at the interface of academia, social science, civil society, philanthropy, private sector, and media, be it social or conventional, and therefore they can truly represent the multi-sectoral approach needed to fight poverty and therefore tackle directly the root causes of these diseases.” 

Leading Infectious Diseases Account for Three-Quarters of Funding

Changes in neglected disease funding – increases in TB, HIV/AIDS, salmonella infections, and snakebite, decreases for helminth infections, malaria, hep C, and diarrhoeal diseases

The G-FINDER report tracks investments across 36 diseases including HIV/AIDS, tuberculosis, and malaria – which together represent the world’s leading infectious disease killers. The three accounted for US $2.7 billion, or three-quarters of global funding in 2019 

While global funding for HIV/AIDs and tuberculosis research and development increased from 2018 (up US $29 million for both), funding for malaria dropped slightly, falling US $32 million – the first drop since 2015. 

The latter quarter of R&D investment was split between the remaining 33 diseases, with funding remaining relatively stagnant, although the majority of diseases did receive small increases in funding.

Increased funding was the result of two United Kingdom public funders – Department for International Development (DFID) and Department for Health and Social Care (DHSC) – which supported a Global Health Research Group on African Snakebite Research, and ongoing funding from the UK NHS. 

Dengue, a WHO-categorized NTD listed as one of the top ten threats to global health, had its funding increased slightly by US $3.2 million. The only other NTD to see increased funding in 2019 was Buruli ulcer, which rose (up US $0.2 million) to US $2.8 million.

US Primary Contributor, But Report Calls for Diversity in Funding

The US NIH contributes to most of global infectious disease funding

Investment by public sector and philanthropic groups reached another year of growth and record highs, while private sector funding declined in 2019, according to the report.

The United States contributed close to three-quarters of total public funding, once again making it the largest public funder at US $1.878 billion. The UK was the second-largest contributor (US $210 million), followed by the European commission.

According to Paul Barnsley, senior analyst at Policy Cures Research, this “warrants celebration”, but also a “small amount of concern” as Policy Cures Research Group warned in the past about dependence on only a few major funders, and pushes for diversity in funding. 

“It’s fair to wonder whether decision makers are paying as much attention to G-FINDER report briefings as they ought to be.” 

Alongside the US, the next largest increases in funding came from low- and middle-income countries – Brazil and Colombia – with France and Switzerland following.

Most of the increase in public funding was directed to HIV/AIDS, TB, and malaria. 

Philanthropic funding for neglected disease R&D totaled US $782 million in 2019. Increases came mainly from the Gates Foundation (up US $35 million) and the Wellcome Trust. The Open Philanthropy Project became the third largest Philanthropic Funder, increasing their funding US $9.3 million from their modest investment of US $14 million. 

COVID-19 Funding Unprecedented 

COVID-19’s unprecedented funding may result in fiscal tightening that impacts NTD investment

In spite of  concerns surrounding lack of diversified funding, the Policy Cures Research Group still found the funding pledged in the last year for COVID-19 to be positive.

“Even if a chunk of these [pledges] turned out to be empty promises more than 9 billion pledged in the first 9 months of 2020 still represents an unprecedented response, much bigger than anything we saw for Ebola, much bigger than our annual spending across all neglected diseases combined,” said Paul Barnsley. 

Barnsley said high income economy interest rates remained “mostly low” and nations that had to “spend their way through COVID still have the means to spend the way out of recession.” 

While this initial picture is relatively welcoming, future fiscal tightening may impact neglected disease funding.

“We have anecdotal evidence that funding designed to help people in other countries fares badly during general belt tightening,” said Barnsley.  

But COVID-19 does speak to the need for collaboration across sectors in order to combat both pandemics and neglected diseases. 

“It is not just the science of product development, but it’s really the science of partnerships. The COVID experience will give us valuable lessons about how to be really good scientists in creating the best possible partnerships to address global health needs,” said Mark Feinberg, President and CEO of the International AIDS Vaccine Initiative (IAVI). 

Image Credits: DNDi, Policy Cures Research Group .

The hospitals and health workforce in Papua New Guinea are under pressure amid surging COVID-19 cases.

As the world quickly approaches the highest weekly rate of infection recorded since the start of the pandemic over a year ago, several countries that have largely held COVID-19 at bay so far are seeing surges in infections. 

Papua New Guinea (PNG), a small Pacific island state that successfully shielded itself from the SARS-CoV2 virus until recently, has reported a total of 9,343 cases and 82 deaths, half of which were reported in the last month. This sharp rise in cases holds the potential for a large epidemic, according to WHO officials. 

PNG and the broader Western Pacific region was the focus of the WHO biweekly press conference on Friday.

The global number of new cases per week has nearly doubled over the past two months and continues to increase, along with the number of deaths, at “worrying” rates, said Dr Tedros Adhanom Ghebreyesus, WHO Director General.

The Western Pacific region has been “relatively fortunate” in the pandemic, Dr Takeshi Kasai, WHO Regional Director for the Western Pacific Region, told the press conference. Home to one quarter of the world’s population, the region has only recorded 1.6% of the global cases and 1.2% of the deaths. 

However, several countries in the region, including PNG, are now witnessing surges in cases.

“In remote Pacific countries, even a few cases could have a devastating impact,” said Kasai. “The pandemic means that every corner of every country in every part of the world must be prepared and protected against COVID-19.

“We must continue to pay special attention to small countries who have so far been able to stop the virus [from] coming in,” he added.

The WHO has deployed 13 experts to assist with case management, epidemiology, infection prevention and control, lab support, and information management. Emergency medical teams from Australia, Germany, and the US have also arrived to aid in PNG’s response. 

The Australian medical team leaving for Papua New Guinea last week, taking with them critical medical equipment to assist local authorities.

In addition, several countries have donated much needed PPE, oxygen concentrators, and biomedical equipment, which are critical to strengthen the local capacity across the country.

PNG Began Vaccine Rollout, But Best Defense is Public Health Measures

Australia provided PNG with an emergency supply of 8,000 doses of the AstraZeneca vaccine in late March, enabling the country to vaccinate healthcare and frontline workers. However, out of a population of 8.7 million, only 1,600 people have received at least one dose of the vaccine. 

But the first batch of 132,000 AstraZeneca vaccines was received earlier this week from the COVAX facility. The government expects to administer these jabs nationwide by May, said Jelta Wong, PNG’s Minister of Health. 

“With rising infections, understandable fatigue with social restrictions, low levels of immunity among the population and the fragile health system, it is vital that [PNG] receives more vaccines as soon as possible,” said Tedros. 

In the broader Western Pacific region, several countries are yet to receive any vaccines or have only received very few doses. In this context, “it is important to emphasize that vaccines alone will not end the Papua New Guinea outbreak or the pandemic,” said Kasai.

Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at the press conference on Friday.

The supplies that the PNG expects to receive in the coming months will only be enough to protect the most high-risk and vulnerable groups in the country. 

Instead, the country’s best defense is the strong enforcement of, and compliance with, proven public health measures, Kasai stressed. 

Improving Information Sharing Will be Central Topic at World Health Assembly 

Meanwhile, at the upcoming 74th World Health Assembly in May, it is expected that the ongoing evaluations of the WHO’s response to the COVID-19 pandemic will be the subject of numerous discussions, specifically on information sharing. 

Several reports on the COVID-19 response, WHO’s work in health emergencies, and strengthening WHO’s global emergency preparedness and response will be reviewed, according to the provisional agenda. 

In addition, several reports on WHO reform will be discussed. 

“I think we do have to look at how information moves in the system,” said Dr Mike Ryan, Executive Director of the WHO Health Emergencies Programme. “We have so much data, our problem is [establishing the platforms]…so that each user in the system, from the frontline primary health care worker, all the way through to global epidemiologists and modelers, have access to data in real time, at the right time, before, during, and after epidemics.”

Dr Mike Ryan, Executive Director of the WHO Health Emergencies Programme.

“We have not invested enough in accessing, managing, and using data to prevent, to respond to, and to recover from pandemics. This is a major focus for WHO going forward,” Ryan added. 

According to WHO officials, member states are “pushing very hard” for increased investments in the gathering and sharing of local, national, and global surveillance data and the sharing of biological tools and technology to strengthen global preparedness in the face of threats. 

“We will continue to make the system really robust because information is the basis and that’s how we can beat the current [pandemic] and also prepare for the future,” said Tedros. “It’s a learning organization and we will continue to learn and improve our system.”

Vaccine Passports Raise Several Issues if Made Mandatory

Meanwhile, WHO officials advise all individuals and governments to keep a record of vaccinations, but say that there are scientific, ethical, and equity implications of requiring a COVID-19 vaccine for activities and travel. 

“Having a record…of your vaccination status is good for you, that’s good for your health. And it’s good for the authorities to know who’s been vaccinated in any given country,” said Ryan. “That’s very different to what that document is then used for.”

Research is still underway on the efficacy of the vaccines against asymptomatic infection or infection with mild symptoms, as well as protection after national infection. This means that the scientific rationale behind vaccine passports – that those with a vaccine certificate are unlikely to infect other people – is currently unsupported. 

“We cannot take it for granted that, just because somebody is vaccinated, they are absolutely not going to be infected and therefore not be a risk to others,” said Dr Soumya Swaminathan, WHO Chief Scientist.

Dr Soumya Swaminathan, WHO Chief Scientist, at the press conference on Friday.

While a vaccine certificate would likely represent the immunity of the individual, it may not reflect that the person won’t transmit the virus. 

In addition, ethical and equity issues are raised once vaccine certificates are required to access a person’s school, workplace, or international travel, “especially in a world where vaccines are distributed in such a grossly inequitable way,” said Ryan. 

“While some countries have vaccinated over 30 or 40% of their adult populations, others have barely reached 1% or even less,” Swaminathan said. “So this is not something that can be applied globally right now because not enough people have had the vaccine.”

The International Health Regulations Emergency Committee, the committee advising WHO on travel regulations, held its seventh meeting on Thursday. Updated guidance on using vaccination certificates as a prerequisite for travel is expected to be received by Dr Tedros by Monday. 

Image Credits: ABC News Australia, ABC News Australia, WHO.

No new medicine is in the development pipeline to combat antimicrobial resistance.

Despite growing awareness of the urgent threat of antibiotic resistance, the world is still failing to develop needed antibacterial treats, according to a new report by the World Health Organization (WHO). 

Of the 43 antibiotics and 27 non-traditional antibacterial agents in the current clinical antibacterial pipeline, none is sufficient to tackle the challenge of increasing emergence and spread of antimicrobial resistance (AMR). 

The persistent failure to develop, manufacture, and distribute effective new antibiotics is further fueling the impact of antimicrobial resistance and threatens our ability to successfully treat bacterial infections,” said Dr Hanan Balkhy, WHO Assistant Director General on AMR.

WHO’s annual Antibacterial Pipeline Report reviews antibiotics that are in the clinical stages of testing as well as those in early product development. The aim is to assess and identify gaps in relation to urgent threats of drug resistance, and encourage action to fill those gaps.

The report evaluates the potential of the candidates to address the most threatening drug-resistance bacteria, as outlined in the WHO Bacterial Priority Pathogens list, which includes 13 priority drug-resistant bacteria, including Mycobacterium tuberculosis and Clostridioides.

Static Antibiotic Pipeline 

The 2020 Report reveals a near static development pipeline, with only a few antibiotics approved by regulatory agencies in recent years. 

Of the 43 antibiotics, 26 are active against WHO priority pathogens, 12 against M. tuberculosis and five against C.difficile.

Eleven new antibiotics have either been approved by the US Food and Drug Administration (FDA) or the European Medicines Agency (EMA), since 1 July 2017. However, the newly approved antibiotics have limited clinical benefit over existing treatment, as over 80% of them are from pre-existing classes where resistance is well-known 

Of the traditional antibacterials, only three new products entered the clinical pipeline while seven were discontinued or do not have any recent information.  

For the preclinical antibacterial pipeline, there are currently 292 diverse antibacterial agents in progress with commercial and non-commercial entities. 

Novel Solutions and Global Initiatives Needed 

The lack of progress on antibiotic development highlights the need to explore more innovative approaches to treat bacterial infections. 

While the COVID-19 crisis accentuated the gaps in sustainable funding to address the health and economic implications of an uncontrolled pandemic, it also revealed the opportunity that exists when there is both political will and enterprise. 

“Opportunities emerging from the COVID 19 pandemic must be seized to bring to the forefront the needs for sustainable investments in R&D o f new and effective antibiotics, said Haileyesus Getahun, Director of AMR Global Coordination at WHO.

“Antibiotics present the Achilles heel for universal health coverage and our global health security. We need a global sustained effort including mechanisms for pooled funding and new and additional investments to meet the magnitude of the AMR threat.”

Several global initiatives have been created to address gaps in funding in antibiotics development. WHO and its partner Drugs for Neglected Diseases Initiative (DNDi) have set up the Global Antibiotic R&D Partnership (GARDP). In addition, WHO is working closely with non-profits such as the United States-based Combating Antibiotic-Resistant Bacteria (CARB-X) to accelerate antibacterial research.

There is also the AMR Action Fund, a partnership set up by pharmaceutical companies, philanthropies, the European Investment Bank, with the support of the WHO, that aims to strengthen and accelerate antibiotic development through global pooled funding. 

Image Credits: Interpol, Shutterstock.

Rwanda
COVAX delivery of COVID-19 vaccines to Africa has been hampered by a shortage of vaccines.

NAIROBI – Kenya has developed an ambitious COVID-19 vaccination rollout plan – but it has only received enough doses for a million of its 50 million citizens, and dispensed slightly more than half of these – 565,000 – to health workers.

Kenya is currently in the third wave of the pandemic and estimates that 4 million people – healthworkers and elderly people – need to be vaccinated urgently during its first rollout phase.

At the core of the country’s rollout plan is an online registration platform known as Chanjo-Ke (Chanjo is Swahili for immunization). The platform became operational in early April and it is intended to reduce the crowd numbers in vaccination centers all over the country.

“The system will help us ensure that we are able to account for the vaccines as well as trace those who have been vaccinated and, in the end, certificates of vaccination will be issued based on data that will have been captured by the system,” explains Dr Willis Akhwale, chairperson of the Taskforce on Deployment of Vaccines in Kenya.

The taskforce was created to advise the government on the vaccine rollout, and oversee its coordination.

People seeking vaccination can register for the service in advance, choosing a day and a centre for the vaccination, then show up with a national and job ID at the station. The recipient will be reminded to come for the second dose via the system.

Given the sensitive nature of personal medical data, the ICT Authority had to be brought in to ensure protection of this data, in accordance with the laws of Kenya.

The Ministry of Health (MoH) and the National Treasury (Ministry of Finance) have asked the Africa Centers for Disease Control (CDC) for assistance in procuring more vaccines.

Expansion of Vaccination Centres

The government will also add another 1000 vaccination points to the current 658 and private healthcare facilities will add 2,500 facilities during the second phase of the vaccination exercise, set to begin in July. 

Ultimately, almost 8,000 facilities will be vaccinating people by phase three, according to Akhwale.

“These facilities have been inspected and certified to have the right infrastructure and monitoring capabilities so that we can continuously vouch for safe vaccination,” adds Dr Collins Tabu, the head of Immunization and Vaccine Programme in the Ministry of Health.

Certification of facilities is conducted by the Kenya Medical Practitioners and Dentists’ Council.

At the moment, the country has been averaging 15,000 daily vaccinations, “which could easily get over 50-60,000 vaccinations per day if 300 facilities were fully vaccinating,” says Akwale.

The whole deployment exercise is scheduled to run for 30 months and cover 60% of the adult population. The rest, including pregnant women and individuals under 18 years, are not targeted because as Akhwale explains, no vaccine for this population group exists at the moment.

Gavi, the Vaccine Alliance, is donating 20 billion Kenya Shillings ($ 188 million) whereas the Kenyan Government will contribute 14 billion Shillings ($132 million) towards these efforts. However,  Akhwale is quick to add that this will be contingent upon vaccine availability.

The vaccines have emergency use authorization, given the urgency of the pandemic. This means that the vaccine use has not gone through the usual, lengthy stringent vetting process. 

Even so, the vaccine is not exempt from the monitoring rigours that come with the introduction of such a new product into the population.

“The healthcare worker will key in the data into the Chanjo system in case of any adverse events following immunisation, and this data is channelled to the Pharmacovigilance Centre at the Pharmacy and Poisons Board,” says Dr Peter Mbuiru, acting Chief Principal Regulatory Officer at the Pharmacy and Poisons Board. 

The board has been active in both the control of the Covid-19 disease by developing key guidelines on the use of medical products and technologies including Covid-19 vaccines as well as the authorization of in vitro diagnosis used in testing the disease.

About 3,000 healthcare workers have been trained to administer Covid-19 vaccines, with an additional 700 trainer-of-trainers having received training.

Prioritisation of Target Groups

Kenya is already battling a third wave of the pandemic.

One of the biggest challenges in all this effort has been the prioritization of the target groups to receive the jab. 

The government’s initial target was to vaccinate 1.25 million frontline healthcare workers. However, Akhwale maintains that given older people were at higher risk of severe disease, this had to be expanded to include those aged 58 years and above. The population of this category of people is 2.7million in Kenya. 

This means that nearly 4 million people are most at-risk – but only 1million vaccine doses currently. 

So, given this difficult situation, can’t the government make its own bilateral arrangement to acquire doses outside the COVAX mechanism?

“Yes, we can, but you need to understand at this time there are no vaccines out there,” Akhwale told Health Policy Watch. “Secondly, COVAX and the Africa CDC have already placed massive [vaccine] orders.”

The only other option is to procure COVID-19 vaccines that are not WHO-approved, something which the country is not prepared to do.

And in any case, adds Tabu of the Immunisation Programme, “the first dose will still provide protection of more than 76% until you receive the second dose.”

The AstraZeneca vaccine, which Kenya is using, has raised some health safety concerns in some regions of the world, especially in Europe. 

“The question is, are these concerns directly related to the vaccine and are they significant enough to stop the benefits of vaccination over the risks that they may cause?” asked Dr Githinji Gitahi, CEO of Amref Health Africa, in a recent television interview, adding that the advice of the Africa CDC and WHO is that, “we should continue vaccinating.”

One of the reasons why Kenya settled on AstraZeneca as opposed to other vaccines, according to Tabu, is the guaranteed availability of the vaccine despite the current constraints in the global supply chain.

Image Credits: WHO.

chagas
World Chagas Day 2021

In commemoration of World Chagas Disease Day, Unitaid and the Brazilian Ministry of Health launched a $19 million initiative to expand access to affordable diagnostics and treatments for women and newborns in four Latin American countries where Chagas disease is endemic – Brazil, Bolivia, Colombia, and Paraguay. 

Transmitted by the blood-sucking triatomine bug called Trypanosoma cruzi, Chagas disease kills 10,000 people annually. In Latin America, it kills more people than any other parasitic disease including malaria. 

But only 7% of people with Chagas are diagnosed and only 1% receive appropriate care. If left untreated, Chagas can cause serious heart and digestive complications.

Given that mother-to-child transmission is one of the key transmission pathways for the disease, vector control, active screening, and appropriate treatment options for women of childbearing age and their children represent crucial strategies to reducing new infections, said PAHO’s Director Carissa F. Etienne on Wednesday. 

“Chagas disease continues to generate much suffering and death for thousands of people in Latin America, especially in the poorer countries and among the most vulnerable populations,” she said at a press conference. “Mother-to-child transmission of Chagas can be prevented. We hope that this new global initiative will significantly advance efforts to ensure that every child in Bolivia, Brazil, Colombia and Paraguay is born free of Chagas disease.”

The joint initiative will collaborate closely with regional and global partners, including the WHO and the Pan American Health Organization (PAHO).

Read the Unitaid press release here.

Image Credits: Unitaid.

In a vital step forward that will help accelerate global access to COVID-19 vaccines, Gavi, the vaccine alliance raised some $400 million in donations at a high-level event on Thursday, just a week after the global COVAX facility reached 100 countries with almost 40 million vaccine doses.

The event was hosted by US Secretary of State Antony J. Blinken, Acting Administrator of USAID Gloria Steele, and Chair of the Board of Gavi José Manuel Barroso, and saw pledges from Sweden, Netherlands, Lichtenstein and Portugal, as well as big donations from the Bill and Melinda Gates Foundation, Gates Philanthropy Partners, and Google.

“COVAX represents our best way of ending the pandemic by ensuring equitable global access to safe and effective vaccines,” said Per Olsson Fridh, Sweden’s Minister for International Development Cooperation. “Already reaching over 100 countries, COVAX also shows what we can achieve by working together – from scientists and manufacturers to governments and multilateral organizations, to health workers around the globe. This is an investment not only in global solidarity, but also in our common objective of putting an end to the pandemic. 

The bulk of the money will go towards Gavi’s Advanced Market Commitment, which UNICEF Executive Director Henrietta Fore called a beacon of hope.

“It’s [the AMC] an effective, realistic way to ensure fair and affordable access to vaccines for all,” she said at the high-level event on Thursday. “But getting vaccines off the tarmac and delivered to difficult-to-reach populations requires concerted, coordinated effort and dedicated funding,” said Fore.

On another encouraging note, France and New Zealand committed to donating 13 million and 1.6 million surplus doses to COVAX –  although Gavi expects “much larger” donations of suprlus doses in the future, added GAVI’s CEO Seth Berkley on Thursday.

So far, COVAX has supplied 113 countries with over than 39.5 million vaccine doses, according to UNICEF’s COVID-19 Vaccine Market Dashboard. The global vaccine facility has already enabled access to the following vaccines:

  • AstraZeneca/Oxford (via AstraZeneca and India’s Serum Institute) – up to 1.27 billion doses
  • Pfizer-BionTech – 40 million doses
  • Johnson & Johnson – 500 million doses
  • Novavax – 1.1 billion doses
  • Sanofi/GSK – 200 million doses

Read Gavi’s full press release here.

Image Credits: Global Fund/Vincent Becker.

WTO Headquarters in Geneva

A growing consensus seems to be emerging out of this week’s high-level WTO meeting that glaring inequities in access to vaccines can be remedied by strengthening supply chains, avoiding export bans across borders, and ensuring that big pharma voluntarily transfers its vaccine technologies to poorer countries so they can produce their own vaccines. 

“The significant inequities we are seeing in access to vaccines between developed and developing countries are completely unacceptable,” said United States Trade Representative Katherine Tai, in a statement published out of her appearance Wednesday at the WTO’s closed-door discussion with high-level representatives from industry, government and civil society on Wednesday.

“As governments and leaders of international institutions, the highest standards of courage and sacrifice are demanded of us in times of crisis”, she added. “The same needs to be demanded of industry.” 

Broader Technology Transfer in Poorer Countries is Possible, Says Iweala  

Ngozi Okonjo-Iweala, WTO’s newly elected Director-General

While Tai’s comments at the WTO forum were deemed “unfair” by the US Chamber of Commerce, the WTO’s new director-general, Ngozi Okonjo-Iweala, seemed to agree that the vaccine industry should more aggressively expand technology transfer in low- and middle-income countries – noting that in one case, technology transfer took only six months.

“One of the things that came out [of the discussions at the WTO] is that yes indeed, there is manufacturing capacity that exists now that can be turned around to produce more [vaccine],” she said.

However, she did acknowledge that scaling-up vaccine production will also require the training of more skilled personnel, recruitment of raw materials, and stable supply chains.

Going forward, “more active” matchmaking between companies with investment capacity and those with untapped production capacity could be fruitful to boost vaccine production in low-income countries, she added.

Discussions On Intellectual Property Waiver Have “Advanced Knowledge”

Okonjo-Iweala also said that the closed-door discussions had “advanced knowledge” about the issues surrounding the proposed waiver on WTO rules related to Trade Related Aspects of Intellectual Property (TRIPS).

Since it was proposed last year by South Africa and India, the intellectual property waiver has been backed by almost a half of WTO members and discussed eight times at the WTO. However, it seems to have remained in limbo, mostly due to fierce opposition by industry leaders and high-income WTO countries, including key European Union members, the United Kingdom,  United States, Switzerland, and Japan. 

Rather than a wholesale waiver, existing “flexibilities” in the TRIPS agreement could be used to fast-track solutions where needed, said the EU’s Executive Vice-President in a statement after Wednesday’s WTO meeting. 

“Should voluntary solutions fail, the TRIPS Agreement already provides a framework for sharing technology through the granting of compulsory licences,” said the EU’s Valdis Dombrovskis. “This includes fast-track compulsory licences for export to countries without manufacturing capacity.”

Civil Society Call To Revise TRIPS agreement; No Mention Of IP Waiver 

At the same time, civil society advocates joining the discussions seemed to be steering away from a focus on the IP waiver proposal, instead calling on the WTO to make a series of meaningful technical amendments in the existing TRIPS Agreement – as well as helping low- and middle-income countries to make more effective use of the exceptions contained in the rules.

Currently exceptions in the TRIPS agreement are difficult and cumbersome to implement, KEI’s James Love said. He called on WTO members to act on a seven point plan – some related to the easing of existing TRIPS legalities and others outside of its current scope, that he said would ramp up manufacturing capacity. Specifically, he called on WTO and its members for the following measures:

  1. Transparency of contracts: Encourage greater transparency of contracts made between by pharma and member states – in line with a recent International Monetary Fund proposal; also, he urged greater transparency from pharma and member states in reporting about drug and vaccine R&D costs, vaccine revenues and the number of doses distributed.
  2. Exports of products produced by compulsory licenses: Revise what he called a “flawed” Article 31f and 31bis of the TRIPS agreement, which allows generic producers to export products manufactured under a compulsory license to other low- and middle-income countries only under very restricted conditions; “during a pandemic, there should be no restrictions on the ability to export a useful product under a compulsory license,” added Love. 
  3. Model Exceptions. The WTO should collaborate with WHO on the development of model patent exceptions for emergencies, Love said, citing Germany and Canada as examples of countries that have already created such legal frameworks – which are often lacking elsewhere. 
  4. Sharing know-how. Love cited the “failure” of governments that invested heavily in vaccine R&D to include in their funding agreements “measures to require the sharing of manufacturing know-how and access to working cell lines and rights in data.” In the future, the WTO can work with the WHO to develop “initially soft norms” on how such know-how sharing provisions should be included in future R&D funding agreements.
  5. WTO Agreement on the Supply of Public Goods. “The pandemic is part of the larger challenge of supporting the global commons. The WTO has been asked to consider a new agreement, based in some ways on the GATS, to create voluntary offers of binding commitments to supply public goods.” 
  6. Buyouts of know-how. While not the best option last year when governments were funding R&D, today it should be given consideration, he said.
  7. Remove sanctions on Cuba, with respect to health related products. “There should be no sanctions on Cuba that relate to the development and distribution of its two promising vaccine candidates.”

“There has been an appalling lack of transparency, including regarding the agreements to subsidize and de-risk the research and development of vaccines, as well as procurement contracts and licensing agreements,” Love said.

“WTO agreement patent flexibilities have been used in some cases, but many countries have laws poorly equipped to deal with pandemics, vaccines or biologic products, and the provisions in the agreement on exports are flawed.”

“And while it is possible to issue a compulsory license on patented inventions, there are few national laws and no global agreements on providing access to manufacturing know-how, working cell lines and rights in test data.”

As a further step to support public acquisition of critical know-how, Love has suggested that governments create a buyout fund to allow for “full technology transfer”, including rights to inventions, data, know-how, and biologic resources – similar to the deals reached by private pharma companies such as AstraZeneca when it purchased Oxford’s vaccine technology and/or Pfizer’s acquisition of BioNtech. He has emphasized that governments may not need to buy out the know-how for all vaccines – and suggested that as little as $20 million in funding, with an aim of an initial $1 billion, could help kick off negotiations with manufacturers. 

Image Credits: @WTO/Bryan Lehmann.

africa cdc
Dr John Nkengasong warns delays in shipments could threaten achieving set vaccination goals in Africa


IBADAN – The Africa CDC has expressed concerns over the disruption of the COVID-19 vaccination drive in Africa saying it was preventing many Africans who have received the first dose of the Oxford/AstraZeneca vaccine may not be able to receive the second dose 12 weeks after the first dose as recommended in the vaccination guideline. 

Rwanda has already exhausted its doses, Ghana is administering its last 100,000 doses even as Nigeria is also racing to administer its remaining doses.

While it is not clearly known what the implications of delay in receiving the second dose will be, recipients of the first dose already have some form of immune protection against the virus,  Dr John Nkengasong, Director of the Africa CDC said  while addressing a Thursday morning press briefing.

“We don’t know that delay by a couple of months or weeks, will impair the ability to boost it (immune system) when you get a second dose. I don’t think so. It’s just that it doesn’t give you that full range of your immune system reacting and getting ready to fight the virus once you get exposed to it. But they can be assured that with the first dose, they are already getting some protection from developing disease,” Nkengasong said.

At a WHO African region press briefing, Dr Richard Mihigo, Immunization and Vaccine Development Programme Coordinator at the WHO Regional Office for Africa, noted that African countries did the right thing by using the first shipments they received to immunise as many people as possible instead of halving the recipients in order to fully immunise some recipients.

Dr Richard Mihigo

“African countries, I must say, took the right decision with the limited supply to use most of their doses as the first dose with the expectation that the second dose will come quite soon,” he added. 

While admitting that there have been some challenges regarding the arrival of the second doses, the WHO said indications from COVAX Secretariat and other ongoing discussions pertaining to the AstraZeneca vaccine for which many African countries have applied a 12-week interval between dose one and dose two, suggest the additional shipments will be available soon.

“I think everything is being put in place to make sure that they can receive the second shipment on time to deliver the second dose of the AstraZeneca vaccine,” he added. 

Wakeup Call for Africa
Prof Oyewale Tomori

Oyewale Tomori, Professor of Virology at Nigeria’s Redeemer’s University, noted that the circumstances surrounding delays in receiving shipments for second doses of the vaccine is a wakeup call for Africa as a continent to be more proactive regarding its vaccine sources.

“We’ve been at the receiving end of global omission for too long. Now is an opportunity for us to plan for the future. We shouldn’t be in this position again,” he said. 

He enjoined African leaders to be more proactive, move the continent forward and stop its dependence on the rest of the world. 

“Our leaders must be proactive in getting this. We shouldn’t repeat this issue when we are at the mercy of  the rest of the world. We’ve been in this position for too long,” Tomori said.

South Africa, DRC to Resume COVID-19 Vaccinations
Dr Boitumelo Semete

There are meanwhile indications that COVID-19 immunizations with the Johnson & Johnson vaccine will soon resume in South Africa and begin in the Democratic Republic of Congo with the AstraZeneca vaccine – despite the concerns registered in the USA and Europe over rare occurrences of blood clots from those jabs. 

On 13 April, the Minister of Health of South Africa, the only African country that is rolling out the Johnson & Johnson COVID-19 vaccine, announced that the country has decided to pause rollout of the vaccine as a precautionary measure as review of the situation is ongoing.

But while addressing the WHO press briefing, Dr Boitumelo Semete, CEO of the South African Health Products Regulatory Authority, announced the country will soon resume J&J vaccinations.

“We anticipate the pause will be lifted in a couple of days to come,” Semete said.

Semete noted that the decision to pause the vaccine rollout was to enable the country to review available data considering only a few countries have rolled the vaccine. 

For DR Congo, Africa CDC announced the country is ready to nationally roll out the Oxford/AstraZeneca COVID-19 vaccine from 19 April.

“The Democratic Republic of Congo’s Minister of Interior announced yesterday that the country will finally launch the national COVID-19 vaccination campaign on 19 April, initially suspended due to concerns about adverse events related to the AstraZeneca vaccine,” Nkengasong said.

By 12 April 2021, over 34.6 million vaccine doses have been acquired by African countries with nearly 14 million doses administered so far. 

Morocco, Nigeria and Ghana are leading with 8.6 million, over 1 million and nearly 700,000 doses administered respectively. Moreover, 32 African countries have received consignment of COVID-19 vaccines from the COVAX facility, with 12 additional countries receiving allocation through the African Vaccine Acquisition Task Team (AVATT).

Image Credits: Paul Adepoju, Paul Adepoju .

Denmark will no longer use the AstraZeneca COVID-19 vaccine, making it the first European country to abandon the jab over suspected rare but serious side effects.

The World Health Organization (WHO) Europe region sidestepped criticism of Denmark’s decision to permanently stop administering the AstraZeneca vaccine, saying the country’s low population numbers and low COVID-19 positivity rate of under 1% allowed for a lot of room to manoeuvre.

Denmark’s low rate of infections gives the country manoeuvring room in terms of their vaccine choices, WHO European regional COVID-19 incident manager Dr Catherine Smallwood said during a press briefing on Thursday.   

“Denmark has had an ability to bring down cases to really controlled levels, has  widespread testing, and has a testing positivity rate of significantly under 1%, which means that they are quite confident in their current ability to control COVID-19 in the country. So I think that’s something that really has to be made very specifically in the context of any discussions around Denmark and its decisions around vaccination,” said Smallwood, adding that the country had managed to bring down COVID-19 levels since the beginning of the year. 

At the same time Smallwood and WHO Regional Director Hans Kluge reaffirmed WHO’s confidence in the overall safety of the AstraZeneca vaccine, saying there is far more risk of blood clots from COVID-19 infections, than from the vaccine. 

But in light of the decision, Kluge urged the Danish government to share its surplus AstraZeneca vaccines with other countries in need. 

Denmark Is First Country To Permanently Halt AstraZeneca Use  

Denmark on Wednesday became the first country to permanently stop administering the AstraZeneca vaccine, a month after suspending its use following reports that a small number of recipients had developed a rare but serious blood-clotting disorder.

Announcing the decision, Danish health director general Dr Soeren Brostroem, said Denmark was able to halt use of the vaccine because it had the pandemic under control and could rely on two other vaccines, from Pfizer and Moderna.

Their decision, said Brostroem, was “based on the scientific findings, our overall assessment is there is a real risk of severe side effects associated with using the Covid-19 vaccine from AstraZeneca”.

“If Denmark were in a completely different situation and in the midst of a violent third outbreak, for example, and a health care system under pressure,” he added, “then I would not hesitate to use the vaccine, even if there were rare but severe complications associated with using it.”

A man receives his Covid-19 vaccine in Jutland, Denmark.

The country initially suspended the use of the vaccine on March 11, along with Iceland and Norway. Several other European countries, including France, Germany and Italy, followed suit last month.

Siddharta Datta, WHO-Europe vaccination expert, said they were keen to learn from Denmark’s monitoring and reporting systems of safety events that led to this decision. 

“Countries, not only Denmark, or any of all our 53 Member States would have a system in place so that they can monitor any of the safety events, and then make a decision. The countries are suffering  to look into their own data and then make a decision. We are keen to learn from Denmark into this whole process on the investigated results, and thereafter,” said Datta.

With a population of 5.8 million, Denmark has managed to contain the pandemic. As of Wednesday, Denmark had recorded 2,447 Covid-related deaths.

Almost one million people in the country have received at least a first dose of a vaccine, 77% of them received the Pfizer vaccine according to Denmark’s Serum Institute. Around 15 % received a first dose of the AstraZeneca vaccine before the authorities suspended its use last month, and the remaining 8 % received the Moderna vaccine.

Denmark Urged to Share Leftover AstraZeneca Vaccines

WHO Regional Director Hans Kluge

Asked to comment on what European countries, including Denmark, should do with the excess vaccines that are not being used,  Kluge said he had discussed the issue of donating or reselling Denmark’s excess vaccines with Dr. Susan Brewster, the Director General of the Danish Board of Health. Kluge said he is of the understanding that Denmark was “already looking into options of sharing”.

Kluge however stressed that “safety is paramount” for WHO, and said among the 200 million people who had been vaccinated with AstraZeneca, only a “very small number” of blood clotting had been reported. He urged member states to report any adverse events that may occur following vaccination, as early as possible.

“For now, the risk of suffering, blood clots, is much higher for someone with COVID-19 than for someone who has taken the AstraZeneca vaccine. There’ll be no doubt about this. AstraZeneca vaccine is effective in reducing COVID-19 hospitalisation. WHO recommends it to all eligible adults to gain protection from COVID-19  quickly as possible.”

WHO was also monitoring reports of thrombo-embolic events in a small number of people who were administered with the Johnson and Johnson vaccine and will in due course communicate motoring reports on it.

Last week, the WHO Europe region surpassed 1 million confirmed COVID-19 deaths. “The situation in our region is serious,  1.6 million new cases are reported every week. That’s 9500 every hour, 160 people, every minute,’ said Kluge, adding that COVID-19 preventive measures need to remain in place while vaccination campaigns proceed. 

To date, 171 million doses of seven COVID-19 vaccines and products have been administered in WHO’s European region, which also includes Turkey, Israel and republics of the former Soviet Union. Some  13% of the European population have received at least one vaccine dose, while close to 6% have completed a two-dose vaccine series. Among European Union countries, WHO singled out Greece for already vaccinating 1.6 million people – or 16% of the population – with at least one dose, while 7% are fully covered.

Green Passports Could Lead to Prioritisation of Vaccines for Travellers

Kluge also reiterated WHO position opposing Europe’s creation of “green passports” for travel – repeating statements made just after the European Commission outlined proposals for the EU’s “digital green pass” – which would allow travellers who have been vaccinated, or recovered from COVID-19, to move freely without being subject to quarantine.

Kluge said that WHO is concerned such a rule could lead to the prioritisation of vaccines for international travellers, rather than health workers, older people or other priority groups. 

“We do not encourage at this stage that getting a vaccination determines whether you can travel internationally or not,” said Kluge at the time.

Kluge however said it “extremely important that we have documentation of the people who are vaccinated…or the vaccination effectiveness”, but that it should not be called a passport.

WHO was currently examining the political, ethical and legal aspects of the digital green card to minimise inequalities, said Kluge.  Greece has already signed a bilateral agreement with Israel to allow vaccinated or recovered travellers to move freely between the two countries. The country’s tourism sector re-opens mid-May.

Greek Minister for Health, Dr Vassilis Kikilias, Minister of Health of Greece, also attended the press briefing, to announce the creation of a new WHO quality of care centre  in Athens.  

He said the centre will serve the needs of countries of the south eastern part of the  region, and the Mediterranean basin, focusing on technical assistance, support and leadership on quality of care and patient safety.