Professor Sarah Gilbert, University of Oxford, co-founder of Vaccitech and the developer of the Oxford/AstraZeneca vaccine against COVID-19

The structural barriers to a faster and more equitable COVID-19 vaccine roll-out go far beyond the issue of patents, declared two of the world’s leading vaccine researchers and pharma execs at a WHO event on Monday evening. 

Sarah Gilbert, developer of the Oxford/AstraZeneca vaccine and Özlem Türeci, chief medical officer of BioNTech, the developer of the cutting-edge Pfizer-BioNTech mRNA vaccine, were speaking at a WHO media event honouring women in global health on the occasion of International Women’s Day. 

But their statements about the challenges of vaccine distribution – made at the tail end of a WHO press conference – illustrate a certain disconnect between WHO Director General Dr Tedros Adhanom Ghebreyesus’ recent offer to act as a “matchmaker” between pharma innovators and manufacturers to ensure faster production and more equitable distribution of new COVID jabs – and the hard-nailed infrastructure and logistical challenges actually faced – which are not a traditional area of WHO expertise.

“Delighted to be joined by 2 women who created 2 of the #COVID19 vaccines now being rolled out” – @DrTedros tweets at press briefing on International Women’s Day. .
Free IP Won’t ‘Go Anywhere Close’ To Solving Problem 

Asked by a reporter about WHO’s COVID-19 Technology Access Pool (C-TAP) initiative, which has sought to involve pharma manufacturers into a patent pool – to share IP on COVID vaccines and other health technologies, Gilbert replied, “I have to confess I’m not familiar with that initiative, I’m sorry.”   

Gilbert added:  “I don’t think that just making IP freely available goes anywhere close to solving this problem, because it’s not just to the right to use the technology that’s needed, it’s the feedstocks, the  cell banks, the protocols, the assays, the standards, the reagents to do everything. 

“This requires a great deal of support from the first company that licensed the vaccine, and this can be done, but it can’t be done in a completely unlimited way. 

“So we have to recognize that it’s important we have many vaccines to use across the world: those that are licensed Now, those that are still in clinical trials and will be approaching licensure. We want to see a good range of vaccines, ideally using different technologies,  because that will increase the chance of having the largest number of doses available. 

“And then what we need is that once those vaccines are manufactured, licensed and distributed, the ones that are sitting in vaccine centers actually get used to protect people and we don’t let them sit there going past their expiry date.”

Gilbert also stressed that Oxford’s R&D philosophy has always been that:  “we wanted to have a vaccine for the world, and we wanted it to be manufactured and distributed widely. And we’re very pleased to see that that is being done with many sub-licenses to different manufacturers in different parts of the world – increasing the number of doses of the vaccine that we initiated development of, have now been made available across the world.” 

Novel mRNA Vaccine Technologies Require New Manufacturing Setup – Repurposed Facilities Not Good Enough 
Professor Sarah Gilbert, University of Oxford, co-founder of Vaccitech and the developer of the Oxford/AstraZeneca vaccine against COVID-19

Dr Özlem Türeci, co-founder and Chief Medical Officer of BioNTech, and the developer of the Pfizer-BioNTech COVID-19 vaccine, echoed Gilbert’s remarks saying:  “Yes, I can only echo what Sarah has pointed out, so it is a comprehensive solution and approach we need. 

“Also, in particular if it is about novel platforms and novel technologies for which even the setup of production facilities need to be expanded, and you cannot just repurpose existing facilities. So patents are one thing but there are so many other things we have to ensure.”

The Oxford/AstraZeneca’s developers have pledged to sell the vaccine on a not-for-profit basis for the duration of the pandemic.

Despite that, the company’s executives  have so far not explained why one of their key licensees, the Serum Institute of India, has been selling the Oxford/AstraZeneca vaccine to South Africa and Uganda at 2-3 times the price of the vaccine in Europe – where the European Union procured it for around US$ 3 a dose.

The Oxford/AstraZeneca vaccine is also the leading product being used in the initial rollout of vaccines by the WHO co-sponsored COVAX initiative – with the first doses of the COVAX rollout having reached the first three countries in Africa, Ghana, Cote d’Ivoire and Ghana, just last week. 

Pfizer/BioNTech, meanwhile, is marketing its  vaccine at for upwards of US$25 a dose, although Pfizer recently offered some 40 million doses of the cutting edge mRNA vaccine to the WHO co-sponsored COVAX initiative at cost. Uptake of the Pfizer vaccine in low and middle income countries is, however, limited by the vaccine’s cold-chain requirements storage at -70 C.  

The remarks coincided with a two-day Global C19 Vaccine Supply Chain & Manufacturing Summit, a closed door forum sponsored by the UK-based Chatham House, in which pharma leaders and global health experts and research institutes are meeting to discuss ways to unlock existing vaccine supply bottlenecks.

Image Credits: @WHO.

Innovation has, until recently been a male-dominated preserve, but a group of women pioneers speaking at the Africa Health Agenda International Conference on Monday told of how the right mindset and a desire to improve lives has helped change the landscape.

Speaking during a virtual panel discussion on Women in Innovation: Providing leadership, creating solutions and driving change, panellists shared their stories of how they overcame adversity and gender disparity as women inventors and entrepreneurs to make a difference.

Dr Matshidiso Moeti, the World Health Organization’s Africa Director, who grew up in a South African township during apartheid,  encouraged participants to push for positive change even when facing challenges. She emphasised the importance of bringing men on board when dealing with gender imbalances.

“Help men to understand that it is to their benefit. Men can be powerful enablers of gender empowerment. Women are power…let’s get men to support us,” Moeti said.

The first day of the conference coincided with International Women’s Day and the discussions were aimed at demystifying the notion that women have a limited role in innovation.

“Through this event, we wish to mobilize and provoke change, and help advance women in the field of technology and science topics that we aim to further explore in a series of discussions through the year,” said the conference organisers, adding that “innovation is crucial to identifying solutions to achieve the UN sustainable development goals (SDGs)”.

For Edna Adan Ismail, Somaliland’s first midwife and renowned healthcare activist, the journey to success was all about considerable and equal participation of women in business, education and innovation. 

Driven by the urge to address the inadequate healthcare in her country and increase women participation in an almost male-dominated environment, Ismail said her focus had been to do something that would advance women. 

On Tuesday, Ismail will celebrate the 20th anniversary of a hospital she built in Somaliland, the Edna Adan Maternity Hospital, which was established primarily to provide better health care to people whose lives have been traumatized by war, and to train nurses, midwives, and other health workers. 

The hospital also has diagnostic laboratory facilities and an emergency blood bank and offers diagnosis and treatment for sexually transmitted diseases.

Ismail also built a medical university 10 years ago which currently has 1500 students enrolled in various disciplines of the medical field,  70% of whom are women. 

At 84, Ismail said one is never too old to contribute to meaningful change and encouraged participants to “never give up as giving up is never an option”.

“What we do, how we collaborate, the contributions we make to save human lives is what will continue to drive us,” she said adding that women bring positive change when provided with opportunities and training.

Several panellists shared personal stories of how they used entrepreneurial skills to overcome adversity, how they were empowered and the challenges they faced.

Sheila Alumo, Managing Director, Eastern Agricultural Development Co. Ltd, was forced to care for her two younger siblings when she was just 11-years-old after her mother died. There were days when her family went without food and she had lost all hope.

Her story is one of hope, perseverance and succeeding against all odds. Alumo recalled how, at one stage, she would walk several kilometers to buy and resell sugar cane to help feed her family.

Today Alumo’s Uganda-based company employs 22 people and, through its agricultural business, pursues improved socio-economic and human development of rural smallholder farmers. The company has a network of 3,117 farmers, 40% of whom are women. Alumo said she works with rural populations to contribute to their livelihood improvement.

“I know what it is to be hungry, not to have food…no hope. As a young girl knew that I had to make a difference.”

It was Alumo’s parting words that resonated with most of the panelists and participants: “Our backgrounds define our future, but our resilience will carry us through”.

The conference runs until Wednesday, and covers a range of topics including the state of health security in Africa and the need for an African Medicines Agency.

Image Credits: Photo credit: NSTOP Team.

Vials of the Sputnik V vaccine that is under rolling review by the EMA.

A senior official at the European Medicines Agency (EMA) has cautioned EU member states to wait until the agency has reviewed the safety and efficacy data of Russia’s Sputnik V vaccine  before granting the vaccine emergency use authorization at national level, and beginning mass rollouts.

Last week, the EMA formally began a rolling review of the Sputnik V vaccine, developed by Russia’s Gamaleya National Centre of Epidemiology and Microbiology. If approved, the vaccine would be the first jab to be used in the 27 member states that was developed outside of the EU or the United States.

The EMA announcement comes after Hungary and Slovakia already approved the Sputnik vaccine for national use and the Czech Republic is currently assessing the vaccine. All three countries are moving ahead without EMA approval.

Austria has also expressed an interest in procuring doses of Sputnik V, but officials have indicated that the country won’t bypass the EMA.

“I would urgently advise against giving a national emergency authorization,” Christa Wirthumer-Hoche, chair of the EMA managing board, told ORF, an Austrian news broadcast. “We need documents that we can review. We also don’t at the moment have data…about vaccinated people. It is unknown.”

The rolling review will continue until enough evidence is gathered for a formal marketing authorization application, said the EMA in a press release.

“Data packages are coming from Russian manufacturers and of course they will be reviewed according to European standards for quality, safety and efficacy. When everything is proven then it will also be authorised in the European Union,” Wirthumer-Hoche said.

“We can have Sputnik V on the market here in the future when the appropriate data have been reviewed,” she added.

Moscow has pointed to the high efficacy results – 91.6% in preventing symptomatic COVID-19 cases and full protection against severe infection – and the 42 countries that have already authorised the use of Sputnik V, pushing the EU to follow their lead.

According to Kirill Dmitriev, CEO of the Russian Direct Investment Fund (RDIF), the company responsible for marketing the Sputnik vaccine abroad, enough vaccines to inoculate 50 million Europeans will be available to deliver to the EU starting in June 2021.

EU Concerned That Russia Is Using The Sputnik V Vaccine As A Geopolitical Tool
Doses of the Sputnik V vaccine arriving in North Macedonia on Sunday.

While some EU member states have been quick to accept the Sputnik V vaccine, in light of the delays seen in the manufacture and delivery of promised doses from Pfizer and AstraZeneca, with which the EU has created bulk purchase contracts, EU officials remain very wary of Russia’s potential use of the vaccine as a soft-power tool.

“Overall I must say we still wonder why Russia is offering theoretically millions and millions of doses while not sufficiently progressing in vaccinating their own people,” said Ursula von der Leyen, President of the European Commission, in mid-February. “This is…a question that I think should be answered.”

The Gamaleya Center responded to Von der Leyen’s comments in a Twitter statement, saying that: “Sputnik V considers EU a partner and would like to work together with EU to protect EU citizens and to produce Sputnik V vaccine in EU.”

“Sputnik V suggests that vaccines should be above and beyond politics. We hope that EU and EMA will evaluate the vaccine on [a] scientific and not political basis,” the company added.

This message was echoed by RDIF CEO Dmitriev: “Vaccine partnerships should be above politics and cooperation with EMA is a perfect example demonstrating that pooling efforts is the only way to end the pandemic,” he said in a press release last week.

The slow rollout of vaccines in Europe has pushed several countries to pivot to the Sputnik V vaccine, hoping that it will fill the gap left by the delays in deliveries of the Western vaccines, namely Pfizer/BioNTech, Moderna and AstraZeneca.

Some of the region’s most powerful states, such as Germany, have indicated that if the Sputnik V vaccine receives approval from the EMA, it would be keen to procure and even produce the Russian vaccine.

“We are open to the idea of bilateral cooperation for the purpose of tapping European production capacities” for the vaccine, said Ulrike Demmer, deputy spokesperson for the German government, at a press conference in early January.

The statement was made after German Chancellor Angela Merkel had a phone call with Vladimir Putin, Russia’s President, to discuss cooperation on vaccine production.

RDIF Already Received ‘Numerous Requests’

“We have received numerous requests from EU states to provide Sputnik V directly to them based on the reviews of their national agencies. We will continue to do so as well as work with EMA based on the rolling review procedure,” said Dmitriev in a press release.

The decision of some countries to unilaterally approve of the Sputnik V vaccine goes against the EU’s unified approach to the pandemic and could cause a rift in the European Commission.

Already in November officials from the European Commission warned Hungary against procuring the vaccine ahead of the rest of the bloc.

“This is where the authorization process and vaccine confidence meet. If our citizens start questioning the safety of a vaccine, should it not have gone through rigorous scientific assessment to prove its safety and efficacy, it will be much harder to vaccinate a sufficient proportion of the population,” a spokesperson for the Commission told Reuters.

Even within Slovakia the decision to purchase two million doses of the Sputnik V vaccine ahead of approval by the EMA has caused some friction among government officials, with the foreign minister opposing the prime minister’s decision.

“It is clear that Sputnik V is not just a vaccine, but a tool in hybrid warfare,” said Ivan Korcok, Slovakia’s Foreign Minister. “It divides us at home, it divides us abroad, it aims to create doubt about processes in the European Union.”

The EMA, which has been criticised for its slow approval process for COVID-19 vaccines, is already set to make a decision on Johnson & Johnson’s single-dose vaccine on 11 March. Along with Sputnik, jabs by Novavax and CureVac, a German biotech firm, are also currently under a so-called “rolling review” with no timeline yet announced for a decision.

Image Credits: Twitter – Sputnik V, RDIF.

Less than half of Africa’s citizens (52%) – some 615 million people – have access to the healthcare they need, the continent’s quality of health services is generally poor and the family planning needs of half the continent’s women and girls are unmet.

This is according to a report on Africa’s progress toward achieving universal health coverage (UHC) released on Monday at the Africa Health Agenda International Conference (AHAIC).

Each year, approximately 97 million Africans, representing 8.2% of the continent’s population, incur “catastrophic healthcare costs” – particularly in Sierra Leone, Egypt and Morocco. Annually, 15 million people will be pushed into poverty as a result of these out-of-pocket costs, according to the report, which was compiled by a multi-national AHAIC commission.

 

Some 15-million Africans are forced into poverty every year because of massive medical bills.

World Health Organization Director General Dr Tedros Adhamon Ghebreyesus said that the COVID-19 pandemic had highlighted the importance of all people having access to adequate health services.

“Achieving UHC require investments in resilient health systems, especially in strong primary health care with an emphasis on promoting health and preventing disease,” said Tedros. 

“ An important part of that journey is ensuring a reliable supply of safe, effective and high-quality medicines across the continent. To that end, WHO is working with the African Union and the Africa Centres for Disease Control (CDC) to establish the African Medicines Agency (AMA). And I call on all AU countries to ratify the treaty so that African Medicines Agency can enter into force.”

The AMA is envisaged as a central regulatory agency expected to improve access to medicines on a continent where some countries simply don’t have the capacity to regulate medicines.

Life Expectancy Has Increased Thanks to Malaria and Reproductive Health Management

Also opening the conference was Kenya’s President Uhuru Kenyatta who pointed out that Africa’s life expectancy had increased from around 40 in the 1960s to 64 currently, mainly as a result of better management of malaria, and reproductive health services.

“If we are to achieve universal health coverage by 2030, we need to give greater priority to primary health care, water, sanitation and hygiene,” said Kenyatta. “Indeed, during this COVID period, all of us have been amazed by how simple hygiene practices such as hand washing, introduced during this response to this pandemic, have reduced diarrhea and other diseases.” 

Tedros praised Kenya and Rwanda for making the most progress on the continent in achieving UHC.

Kenyatta explained that user charges had been removed in Kenyan dispensaries and health centres, and free maternity services had been introduced. 

“Currently, we are embarking on a national programme to ensure universal access to health hospital insurance fund through mandatory enrollment, and a full government subsidy for the poor and most vulnerable,” said Kenyatta.

Both he and Kenya’s Health Secretary, Mutahi Kagwe, stressed the importance of local production of health products.

Welcoming the fact that the International Federation of Pharmaceutical Manufacturers Associations (IFPMA) was one of the conference sponsors, Kagwe said he wanted to send a message to them to improve production capacity on the continent.

“It is possible for you to have money and not to have supplies,” said Kagwe. “One of the most frustrating and panicky things for African health ministers at the start of the pandemic was when we did not have PPEs yet we were getting cases in our hospitals. We didn’t have reagents but we wanted to test. Why didn’t we have reagents? Because they are not made on the continent. Regions have closed systems and there was no way of getting reagents from anywhere,” said Kagwe. 

COVID-19 Has ‘Made Us Aware of Our Potential’

“We have learned from COVID-19 experiences. They have made us more aware of our vulnerability and made us more aware also of our potential. We are no longer importing PPEs. We are making them locally.”

Rwanda’s health minister, Dr Daniel Ngamije, said his country has introduced community-based health insurance for those who could not pay for health services. 

“The premium for their membership of this scheme is paid by the government and it allows them to be treated from the primary health care application level of care,” said Ngamije.

Rwanda had also recognised that women’s and girls’ access to family planning was hampered by religious health service providers not providing this service and by the legal requirement for girls to be 18 before they could get contraceptives.

The Rwandan government was trying to ensure it had family planning clinics in areas dominated by faith-based service providers and it was engaging with parliament to address the legal barrier of age which was driving unwanted pregnancies among teenagers.

Ethiopia’s health minister, Lia Tadesse, said that her government had initially subsidized services for the poor while the rest pay out-of-pocket. 

“But this was not sustainable for government and also caused high out-of-pocket expenses. So in the past few years, Ethiopia started a community-based insurance system and we are on our way to starting social health insurance. We still have exempted services for things like family planning, immunization, HIV, maternal and neonatal services but universal insurance is what we are trying to head towards.”

Some of the solutions proposed by the report to speed up UHC include using the “vast network of African traditional healthcare providers” to improve primary healthcare services, “especially preventive and promotive care”, strengthening governance including anti-corruption strategies and progressively increasing financing of the health sector.

 

Image Credits: Xavier Vahed/DNDi, AHAIC Commission Report on UHC in Africa.

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team in February.

The WHO-convened international investigation into the origin of the SARS-CoV2 virus is too politically limited by China and lacks the mandate to yield fully independent conclusions about how the novel coronavirus emerged and infected humans, according to a group of prominent international scientists – who have called for a new, independent and “unrestricted” probe into the source of the virus that triggered a pandemic.

“The joint team did not have the mandate, the independence, or the necessary accesses to carry out a full and unrestricted investigation into all the relevant SARS-CoV-2 origin hypotheses – whether natural spillover or laboratory/research related incident,” stated an open letter published on Thursday.

The open letter signed by 26 scientists from France, the US, Australia, German, Austria and India, with expertise in virology, zoology, microbiology and global health policy, argued that it was “all but impossible” for the WHO-convened mission to fully examine all SARS-CoV2 origin hypotheses.

While the Chinese government on Friday disputed claims that it withheld information and delayed international responses to the pandemic, the scientists said that critical data had indeed been withheld. Moreover, statements made at a press conference after WHO´s mission concluded in Wuhan in mid-February, revealed the the limitations inherent to the current inquiry, in which 17 Chinese scientists must agree with the conclusions and findings of the international team of 17 experts in any final report.   

One expert, Richard H. Ebright, a professor of chemical biology at Rutgers University, went as far as to call the mission a “charade” with “no credibility, its members were willing–and, in at least one case, eager–participants in disinformation.¨

The WHO investigative team concluded its month-long expert mission in China in mid February, announcing in a press conference on 9 February that the most likely hypothesis is that the SARS-CoV2 virus originated from an animal intermediary that transmitted the virus from bats to humans.

But Peter Ben Embarek, convenor of the group, also said that the joint Chinese-international group had ruled out the hypotheses that the virus might have escaped from the Wuhan Virology Institute, an internationally known research center into coronaviruses. 

However, the signatories to Thursday’s letter said that those conclusions were made hastily, and based on inadequate information.  They said that the “zoonosis hypothesis…is only one of a number of possible SARS-CoV2 origins, alongside the research-related accident hypothesis” – and both require further investigation.

“The aim of the Open Letter was to highlight that the Joint WHO-China ‘global study’ was not an ‘investigation’. The joint WHO-China team did not have the mandate, the independence, or access to carry out a full and unrestricted investigation,” Dr. Filippa Lentzos, Senior Lecturer in Science & International Security at King’s College London, and a signatory of the letter, told Health Policy Watch. 

“An independent investigation is simply not feasible within WHO’s restricted mandate,” Lentzos added.

The criticism by the group of scientists came as WHO said that it would delay release of an interim summary statement on the mission to China. Instead, the joint WHO-China team will publish a full report in the week of March 15, said Dr. Tedros Adhanom Ghebreyesus, WHO Director General, in statements Friday to WHO member states and the media. 

Limitations of the Joint Investigation
The joint WHO-Chinese team of experts presenting the most likely hypotheses for the origins of SARS-CoV2 in Wuhan at the 9 February press conference wrapping up the international WHO expert mission.

According to the authors and signatories of the letter, the structural limitations of the mission compromise the scientific validity of the investigation. Those issues include a lack of transparency around the development of the team’s original Terms of Reference; the lack of access to raw case data and individuals who were early victims or responders in the initial outbreaks of coronavirus; an alleged biased selection of international experts; and the fact that a final report needs to have the consensus agreement of both the international and Chinese teams. Specifically:

  • The Terms of Reference of the joint study, which were decided upon in July, allowed for the Chinese experts to conduct the majority of the fieldwork. This resulted in the use of a format for the study that was chosen by the Chinese counterparts and limited the data that was available to the international members of the team.
  • The raw data, which includes lab records and early COVID-19 cases, was withheld from the international experts. They were instead provided with summaries of patient data and limited access to personnel for interviews. 

“They showed us a couple of examples, but that’s not the same as doing all of them, which is standard epidemiological investigation,” Dominic Dwyer, a medical virologist at New South Wales Health Pathology in Sydney, Australia and a member of the WHO team, told the Wall Street Journal in mid February. “So then, you know, the interpretation of that data becomes more limited from our point of view, although the other side might see it as being quite good.”

According to the letter, the gatekeeping of the raw data by the Chinese members of the joint team impacted the ability of the team to confidently evaluate all of the origin hypotheses – which include four possibilities: a) that an animal such as a bat, which was harbouring the virus directly infected the first individual(s); b) that the animal infected other intermediate hosts, which then infected people when those animals were slaughtered or sold in a Wuhan food market; c) that the infection was somehow imported on frozen or semi-frozen wildfoods arriving from elsewhere, or d) that the infection emerged as a result of biosafety incident at the virology lab – which is a centre for the research into coronaviruses.

Laboratory Origin Hypothesis Inadequately Studied – Experts Charge

The possible laboratory-related hypotheses – including infection at a sampling site of a lab employee, infection during transport of collected animals or samples, lab acquired infection, and lab-escape virus – were not adequately explored, said the scientists in the open letter. 

The scientists concluded that due to political pressures and the structure of the investigation saying, “the joint team did not have the mandate, the independence, or the necessary accesses to carry out a full and unrestricted investigation into all the relevant SARS-CoV-2 origin hypotheses – whether natural spillover or laboratory/research- related incident.”

While none of the findings from the mid-February China mission pointed to a lab accident, the WHO-led international team lacked the skills and capacity to examine the possibility of a lab incident since the focus of the experts was largely on public health and zoonosis, the experts stated. The WHO-led mission may have also avoided deeper investigation of the lab-based theories to avoid political upset with their Chinese hosts, they pointed out.

In addition, at least one of the WHO team members’ expressed doubts about the lab-related hypotheses even before the mission to China, and others suggested that the issue was outside of their realm of expertise.  

“The group wasn’t designed to go and do a forensic examination of lab practice,” one member of the WHO team, Dwyer, admitted in an interview with Nature in February. 

The WHO team arriving at the Wuhan Institute of Virology in February, one of the world’s largest sites for the research of coronaviruses.

Whatever the reasons, the possibility that the coronavirus infected humans as a result of a laboratory accident needs to be examined, alongside the theory that the chain of infection emerged from direct human contact with an infected animal, or with an intermediate host animal somewhere along the food chain.

“I believe both the natural spillover and lab leak origin theories need to be thoroughly examined. I am not saying it was a lab leak, but that it could have been, and that it is a serious possibility that needs to be investigated,” Dr. Lentzos said.

“At this point in time, all scientific data related to the genome sequence of SARS-CoV-2 and the epidemiology of COVID-19 are equally consistent with a natural-accident origin or a laboratory-accident origin,” Ebright told Health Policy Watch.

However, according to Ebright, some circumstantial evidence could point to a laboratory-related accident as the origin of the virus outbreak.

Based on the genome sequencing of the outbreak virus, the closest relative was likely a horseshoe-bat coronavirus, he pointed out.

“Wuhan, China is tens of kilometers from the nearest known horseshoe-bat colony and the outbreak occurred during hibernation, meaning the bats would not have left their colonies. In addition, Wuhan is the site of the world’s largest research project on horseshoe-bat coronaviruses. The first human infection could have occurred as a laboratory accident, followed by transmission to the public.”

Guidelines for a Credible Investigation

A thorough and credible investigation will require a truly independent team of multidisciplinary experts with no national or partisan interests, the expert letter adds. The experts will need full access to all relevant sites, records, samples, personnel of interest, and raw data.

Access to incident reports, databases of pathogens and samples, lab experiment logs, and the Chinese Centers for Disease Control and Protection (CDC) case records are essential. 

In addition, confidential interviews with early patients and past and present personnel working at the related markets, hospitals, and labs will need to be conducted, the signatories state.

At least one senior member of the WHO-convened team said that the pursuit of such avenues could still take place in the context of the ongoing joint investigation.

“[This] is exactly the sort of follow up source-tracking that will be listed in the recommendations of the Joint WHO-China Mission report,” Dr. Peter Daszak told the Telegraph in response to the letter. 

“I urge the global community to wait until that report is published, read the recommendations, and assess next steps from a scientific viewpoint, not a geopolitical one,” he added.

However, in another interview, with the New York Times. Daszak charged that the demands to further investigate a lab origin for the SARS-CoV2 virus is a position “supported by political agendas.” 

Unfounded theories that the virus either escaped from, or was created in, the Wuhan Institute of Virology circulated widely earlier on in the pandemic. Former US President Donald Trump was among those pushing these theories, claiming that he had seen evidence that gave him a “high degree of confidence that the Wuhan Institute of Virology was the origin of this virus.”

Calls for New International Inquiry

The 26 experts that authored and signed the open letter concluded by referring to the WHO joint investigation as “opaque and restrictive” and calling for a new independent investigation into the origins of the virus.

“Because we believe the joint team process and efforts to date do not constitute a thorough, credible, and transparent investigation, we call on the international community to put in place a structure and process that does,” said the open letter.

“From my perspective, one possibility for a credible investigation is a UN General Assembly mandate to the UN Secretary General to carry out an investigation,” said Dr. Lentzos. 

However, the call for a new inquiry is unlikely to result in a future probe, given the number of hurdles WHO faced in organising the origin mission, including a last minute foul-up over visas. Cooperation from Beijing would be required to arrange a new inquiry. 

Chinese and US Officials Disagree Over Investigation

At a press conference in Beijing on Friday, Wang Wenbin, China’s Foreign Ministry spokesperson, said its government was cooperating fully with WHO on the joint origin-tracing research.

“The Chinese government has done a lot of administrative, technical, logistic and supporting work. In support of this joint research, the Chinese side, at the request of the WHO and the international team, arranged top Chinese experts in relevant fields to take part, and assembled a large number of technical personnel to support the joint mission in collecting data and documents,” said Wang Wenbin.

Wang Wenbin, China’s Foreign Ministry Spokesperson, at a press conference on Friday.

“The experts on the mission made their own decisions independently as to where they would like to visit, who they would like to talk to and what they would like to talk about as the field work proceeded. The report is also drafted by the mission independently,” he added. 

Despite the change of administration in Washington, US officials have maintained their dissatisfaction with China’s response to the COVID-19 pandemic and continue to express worries about the independence of the WHO joint mission. 

“We have deep concerns about the way in which the early findings of the COVID-19 investigation were communicated, and questions about the underlying process used to reach them,” said Ned Price, spokesperson for the US State Department, at a press briefing on Thursday. 

“It’s imperative that this report be independent, with expert findings free from intervention or alteration by Chinese Government authorities…We’ve continued to call upon China to make available its data from the earliest days of the outbreak,” Price said.

Summary Report and Full Report To Be Released Simultaneously 

The findings of the joint mission will be released in two weeks, announced WHO officials at the biweekly press briefing on Friday. The summary report, which was expected to be released first, will be delayed for publication until the final report is ready.

“The team is working on its full report as well as an accompanying summary report, which we understand will be issued simultaneously in a couple of weeks,” Tarik Jasarevic, WHO spokesperson, told Health Policy Watch. 

“By definition a summary report does not have all the details,” Dr. Peter Ben Embarek, a food safety expert at WHO and lead of the investigative team, told the Wall Street Journal. “So since there [is] so much interest in this report, a summary only would not satisfy the curiosity of the readers.”

WHO officials at the press conference on Friday made assurances that the report would prioritize transparency and demonstrate progress in the process of discovering the origins of the SARS-CoV2 virus and collaborating with countries. 

“We are waiting for the report. I am waiting for the report like you. Everything that happened during the trip will be presented transparently,” said Dr. Tedros. “I assure you that there will be transparency and we [will] see exactly what happened. What were the gains, what were the challenges, and then, where do we take it from here.”

Dr. Tedros Adhanom Ghebreyesus, WHO Director General.

“If others want to call for anything else they’re perfectly within their rights to do so,” said Dr. Mike Ryan, WHO Executive Director of the Health Emergencies Programme, addressing the open letter. “I would suggest that people, maybe just take a few days to wait and examine what the outcomes are…There will certainly need to be more work…[It is] going to take time and potentially multiple missions to fully understand this.”

“This is a process of discovery. And it is a process of working in new ways, with all countries,” Ryan added.

Image Credits: CNN, WHO, Ministry of Foreign Affairs of the People's Republic of China.

On 1 March, Ghana started its COVID-19 vaccine campaign. Samira Bawumira, the vice-president’s wife, was one of the first to be vaccinated.

The World Health Organization (WHO) and its COVAX partners are hosting a summit next week with governments and pharmaceutical companies to address the bottlenecks in COVID-19 vaccine production and delivery.

This follows a spectacular start in the past week for COVAX, the global vaccine delivery platform, which delivered more than 20 million doses of COVID-19 vaccines to 20 countries, according to WHO Director General Dr Tedros Adhanom Ghebreyesus.

“We currently face several barriers to increasing the speed and volume of production of vaccines, from export bans to shortage of raw materials, including glass, plastic, and stoppers,” Tedros told the body’s bi-weekly media briefing on Friday. 

“Next week, WHO and our COVAX partners will meet with partners from governments and the industry to identify bottlenecks in production and discuss how to solve them.”

The WHO runs COVAX together with GAVI, the global vaccine alliance and the Coalition for Epidemic Preparedness Innovations (CEPI).

COVAX Distribution Remains Small – Relative to Needs

Describing the COVAX launch as a landmark, Tedros added that “the volume of those being distributed through COVAX is still relatively small”, as they covered “between 2-3% of the population of countries receiving vaccines, even as other countries make rapid progress towards vaccinating their entire population within the next few months”.

To help all countries to end the pandemic, the WHO was looking at four approaches, said Tedros.

The first and most short-term was to link vaccine producers with companies that have excess capacity to “fill and finish”, such as the deal reached this week between Johnson & Johnson and Merck, where Merck will provide “fill and finish” services – filling vials with vaccines and packaging them – for the J&J vaccine.

“We need more partnerships like this,” stressed Tedros. “And we need them in all regions. WHO can support this process by identifying gaps and providing a matchmaking service between vaccine producers and companies with capacity.”

The second approach, said Tedros, was “bilateral technology transfer through voluntary licensing from a company that owns the patents on a vaccine to another company who can produce them”. 

“A good example of this approach is AstraZeneca, which has transferred the technology for its vaccine to SK Bio in the Republic of Korea, and the Serum Institute of India, which is producing AstraZeneca vaccines for COVAX,” said Tedros, although he decried the “the lack of transparency” in this approach.

´Coordinated’Technology Transfer

The third approach is a “coordinated technology transfer” that would see universities and manufacturers licensing their vaccines to other companies through a global mechanism, coordinated by WHO.

With this approach, there would be more transparency, global coherence and it would also “facilitate the training of staff at the recipient companies and coordinate investments in infrastructure”, said Tedros.

The final solution, said Tedros, was for countries “to start producing their own vaccines by waiving intellectual property rights as provided for in the TRIPS agreement”.

“Those provisions are there for use in emergencies. The WHO believes that this is a time to trigger that provision and waive patent rights. We thank South Africa and India for their proposal to the World Trade Organisation to waive patents on medical products, or COVID-19, until the end of this unprecedented pandemic.”

Next week’s summit will involve the International Federation of Pharmaceutical Manufacturers Associations (IFPMA), which represents most major pharma companies. However, Marie-Paul Kieny, chair of the Medicines Patent Pools Foundation and a guest at the briefing, said that many other generic manufacturers needed to be brought into the discussion.

Kieny said her foundation was in the process of “leveraging our close relationships with generic manufacturers across the globe to help identify suitable partners to ‘fit and finish’ vaccine needs, and as potential recipients of technology transfer”.

COVAX Roll-out Continues Next Week
WHO special advisor Dr Bruce Aylward

This week’s first COVAX deliveries were to Ghana, and Cote d’Ivoire. Shortly afterwards, deliveries were made to Angola, Cambodia, Colombia, the Democratic Republic of the Congo, Gambia, India, Kenya, Lesotho, Malawi, Mali, Moldova, Nigeria, the Philippines. the Republic of Korea, Rwanda, Senegal, Sudan, and Uganda.

By the end of next week, COVAX will deliver 14.4million more doses to 31 additional countries, which will mean it have reached 51 countries out of the 190 COVAX members, said WHO adviser and COVAX representative Dr Bruce Aylward.

Aylward described the process of getting the vaccines to countries as complex.

At a global level, the WHO had to examine the vaccines and grant them emergency use listing, while at country level, “some of the biggest challenges that we’ve seen is the regulatory authorisation for these products as well as the indemnification and liability provisions for the use of these products”, said Aylward.

“The national vaccine plans have to be in place. And then once all that’s in place, we’ve got to be able to link it up with the shipments, the logistics, the purchase orders etc.”

Despite the complexities, Aylward said only 24 countries had not jumped through all the hoops – but were expected to have done so within the next two weeks.

 

Image Credits: Flickr: Francis Kokoroko/UNICEF.

Women in Africa account for a slightly smaller proportion of Covid-19 infections and deaths than men although a health expert cautions that access to testing and reluctance to being treated in hospitals could mean that women’s cases are undercounted.

Unveiling findings of a preliminary analysis of COVID-19 gender-specific epidemiological data in 28 African countries, the World Health Organization (WHO) on Thursday revealed that women account for about 41% of African COVID-19 cases. However, there was a large range from 31% for cases in Niger to over 57% in South Africa.

“In most countries, women are somewhat less likely to die from COVID-19 than men,” WHO stated. 

In Côte d’Ivoire, the case fatality ratio stands at 0.4% for women compared with 0.5% in men, while in the Democratic Republic of the Congo it is 2.2% versus 2.7%. In Seychelles, it is 0.1% for women against 0.5% in men, although the country has only had 13 COVID-related deaths.

This is despite the fact that women account for a large part of the health workforce and are thus at higher risk of infection. 

“In Africa, more than 95,000 health workers have been infected with COVID-19. In Seychelles, women account for 71% of health worker infections, 64% in Eswatini, 55% in Cote d’Ivoire and 54% in Senegal,” the WHO reported.

“Other studies report that men are significantly more likely to suffer severe effects of COVID-19 and more likely to have pre-existing conditions, explaining the slightly lower fatality rate seen in women,” the report stated.

Noting the need for further analyses to determine the factors behind the gender disparity, the report suggested that biological, behavioural or social factors could be responsible. 

However, Nigerian public health expert Bayo Ajala noted that the trend could be as a result of fewer women getting tested and unable to abandon their family duties to be at isolation centres.

“Many people are getting over COVID-19 even without any intervention. For women, in many African countries, they are the pillars of families and the household cannot survive without them. Maybe they are not getting tested for their details to be captured in the official data,” he told Health Policy Watch in Ibadan, Nigeria.

Women at higher risk of gender-based violence

But while fewer women appear to have been infected than men, the WHO noted that school closures during the COVID-19 crisis led to “an increase in teenage pregnancy and unintended pregnancies in many countries”. “Additionally, staying out of school for an extended period usually led to greater likelihood of engagement in risky sexual behaviour and increased sexual violence and exploitation. Also, women and girls are increasingly becoming victims in the spike of domestic violence fuelled by economic hardship as millions of people are pushed into extreme poverty.”

According to Matshidiso Moeti, the WHO Regional Director for Africa. “the aftershocks of the COVID-19 pandemic on women and girls have been profound, leaving many grappling with heightened risks to their health and safety”. 

“Our response must go beyond the clinical aspects of the pandemic and address the hidden crises that risk causing long-term effects to lives and livelihoods.”

According to WHO preliminary analysis of 22 countries, 10 reported a rise in maternal deaths between February and July 2020 compared with the same period in 2019, with the highest increases reported in Comoros, Mali, Senegal and South Africa. 

“Nine of the 22 countries reported a decline in births in health facilities and an increase in complications due to abortions,” WHO stated.

Oulimata Sarr, UN Women Regional Director for Central and West Africa, called for efforts to promote “positive masculinity”, involving men in addressing issues affecting women. 

“At UN Women, we are convinced that to be able to bring about change, people want to leapfrog into the future. We need to enroll the men, and those men, we call them our HeforShe. Those are really our champions who might be on decision-making tables where we are not and who will take full responsibility for a fair and just world that gives equal opportunity to men and boys and girls and women,” Sarr said.

As Africa joins the rest of the world to celebrate International Women’s Day on 8 March, Moeti said efforts should be geared towards closing the gender gaps by designing services in a people-centered way. 

“And taking into account inequity, and gender-driven inequity as well in the design of policies from financing health for designing our systems for health insurance for making sure that the approaches to improving access to services take into account all people,” Moeti concluded.

 

 

 

 

Minister of State for Masvingo Provincial Affairs and Devolution Ezra Chadzamira has today received his first dose of SinoPharm Covid-19 vaccine.

CAPE TOWN & KAMPALA – From Asia to the Americas, vaccines are fast becoming the new currency by which nations and geopolitical blocs wield influence and buy political favours – with more value than oil or bitcoin. 

But nowhere is this more apparent, perhaps, than in Africa, Latin America and south Asia, where both Russia and China are using bilateral SARS-CoV2 vaccine donations and deals to cement alliances with low- and middle income countries stung by the vaccine gold rush – in which high income countries have charged far ahead buying up limited supplies. 

Vast Trade in Vaccines 
The first consignment of AstraZeneca’s vaccine arrived in South Africa on 1 February

While global COVID-19 vaccine procurement and donations developments are very fluid, Health Policy Watch has tracked a vast trade in vaccines across Africa and other continents.  And it is clear that Chinese and Russian vaccines are deeply penetrating markets in many low- and middle-income countries (LMICs) – declarations of global solidarity by G-20 countries notwithstanding.

China reports that it has offered vaccine assistance to 53 developing countries, and that it has exported or is exporting vaccines to 22 nations, according to Foreign Minister Wang Yi. Meanwhile, by 25 February, Sputnik V had been registered in 37 countries.

In contrast, Western companies such as Pfizer/ BioNtech, Moderna, AstraZeneca/Oxford, and Johnson & Johnson, whose vaccine was the latest to be approved by the US Food and Drug Administration, are focused on a select group of high income countries in North America, Europe, the Middle East – peppered by only a few middle- or upper-middle income African or Latin American nations that teamed up with big pharma in clinical trials or swung heavily leveraged deals.  

Although the AstraZeneca vaccine is also being marketed to LMICs through the WHO co-sponsored COVAX global vaccine initiative, those sales are taking place through a separate license with the Serum Institute of India (SII). And there, too, SII has made a series of parallel, bilateral  deals, charging South Africa and Uganda 2-3 times the fee per dose, paid by Europe for the same vaccine.  

“As some high-income nations have already immunized more than 20% of their population with at least one dose, only a few African countries have reached even 1 in 1,000 people. It is frankly impossible to defeat the virus if these disparities persist,” says Solomon Zewdu, the Bill & Melinda Gates Foundation’s deputy director told Health Policy Watch, in explaning the desperate rush of others.

China’s Vaccine Outreach To Africa Began Months Ago

It is on the African continent where the Chinese vaccines are being marketed the most intensively – and perhaps embraced the most extensively. 

Beijing has confirmed that it is assisting 21 African countries to get vaccines, according to Foreign Ministry spokesperson Wang Wenbin. Significantly, Egypt, Africa’s fourth largest country, has signed an agreement with China’s Sinovac to produce its COVID vaccine, as well as distribute it to other African countries. 

That represents the fruits of a Chinese vaccine outreach initiative that began months ago.

 

Sinopharm hosted an in-person delegation of some 50 ambassadors and diplomats on its factory premises.

Already in October of 2020, Sinopharm hosted an in-person delegation of some 50 African ambassadors and diplomats on its factory premises – in a period when Beijing was stonewalling over WHO requests to permit entry of just 14 scientists into Wuhan to investigate the origins of the SARS-CoV2 virus.  

“Sinopharm stands ready to work with the African people to deepen cooperation in the fight against and pandemic, consolidate China-Africa friendship and make an important contribution to the joint development of the China-Africa health community,” Company chairperson Liu Jingzhen told the visiting delegation at the time.  

“President Xi Jinping pointed out that after the COVID-19 vaccine is developed and put into use, it will take the lead in benefiting African countries.” 

Using a ‘Common Interest’ Approach to Cement Superpower Status

China had become an expert in public diplomacy on the continent using a “common interest approach” in its quest to cement its superpower status,  Dr Yazini April, co-ordinator of the BRICS (Brazil, Russia, India, China and South Africa) Research Centre at the Human Sciences Research Council in Pretoria, told Health Policy Watch in an interview. 

Its “vaccine diplomacy” involved three things, according to April: the country’s desire to be viewed as a “trusted friend, business and political control”.

While much of Africa is not yet part of China’s massive global transport “Belt and Road” infrastructure plan, often referred to as the Silk Road, “each country has something they can trade with, such as water in Lesotho etcetera”, she added, referring to the country’s abundant resources that provide water to parched South Africa and hydroelectricity domestically. 

On New Year’s Eve, Gabonese President Ali Bongo Ondimba promised his people that they would be among the first on the continent to get the COVID-19 vaccine. But by mid-February, when there were no signs of COVAX deliveries, Gabon turned to China and will soon get 100,000 doses of the Sinopharm vaccine. 

Many other African countries are receiving China’s Sinopharm vaccine. Equatorial Guinea has received a donation of 100,000 doses, Zimbabwe received 200,000 doses as did Sierra Leone. Algeria is set to receive 200,000 doses and Senegal has purchased 200,000 China’s Sinopharm doses, with rollout anticipated soon. 

Uganda has also been offered a donation of 300,000 Sinopharm doses. However, the modalities of receipt of vaccine have not been concluded, said Ugandan Health Minister Jane Ruth Acheng during a press briefing in Kampala last week.

China’s Foreign Ministry spokesperson Wang Wenbin said that the vaccine aid “is a clear manifestation of the China-Africa traditional friendship”,  adding that China will continue to provide support and assistance within its capacity and in accordance with the needs of Africa.

Russia – Also Present in Africa

While less active, Russia is also present too. South Africa’s regulatory authority confirmed to Health Policy Watch that it had received an application for licensing from Sputnik V’s manufacturer on 24 February and was in the process of considering the “safety, quality and efficacy of the vaccine”. The South African government has also confirmed that it is in talks with Sinopharm but has a non-disclosure agreement with the company.

In late December, Guinea, one of the world’s poorest countries – but also a Russian source of the mineral bauxite – started to vaccinate people “on an experimental basis” with Sputnik V. Most vaccinations so far have been of government officials. 

On 1 March, Ghana started its COVID-19 vaccine campaign with vaccines received from the WHO co-sponsored COVAX initiative – but still more are needed.

Ghana’s government also has said that it is considering securing some doses of Sputnik V under bilateral arrangements. Franklin Asiedu-Bekoe, Ghana’s Director of Public Health, confirmed that the country has “opened our doors outside the COVAX facility to ensure that more than 20 million Ghanaians are vaccinated. We have registered the Russian Sputnik V vaccine which will provide a backup of doses”.

Africa Centres for Diseases Control and Prevention (CDC) also is in contact with the producers of Chinese and Russia vaccines – which have no special requirements for transportation and can be stored at normal refrigeration temperatures.  John Nkengasong, the director of Africa CDC, said Russia has already submitted its dossier for the Sputnik V vaccine directly to Africa CDC – and an expert committee was reviewing their data and would come up with guidance. 

Whether or not Africa CDC will act on its own or wait for WHO remains to be seen. WHO officials have urged countries to procure only those vaccines that have received an “Emergency Use Listing” from WHO, or are approved by another strict national regulatory agency, usually understood to mean the US, UK or European Medicines Agency. In the case of both Sputnik as well as the Sinopharm and Sinovac vaccines, those WHO reviews are still pending, said Matshidiso Moeti, WHO’s  Regional Director for Africa. 

The WHO also has repeatedly urged both pharma manufacturers and countries to refrain from bilateral deals and procure their COVID-19 vaccines through the COVAX facility – although those pleas have largely been to no avail. 

“To maximimize the chance of getting fair price for COVID-19 vaccines, we are advising countries to use as much as they can the pooled procurement platforms that are in existence for the moment: COVAX or AVATT,” said Dr. Richard Muhigo the head of immunisation and vaccine development at the WHO Africa office. 

“If the countries decide to go for bilateral deals with vaccine manufacturing, our recommendation is to procure as much as they can vaccines that have been listed by WHO for emergency use,” said Muhigo. 

China and Asia
Thailand’s first shipment of vaccines arrives from China.

Between October and January, Chinese Foreign Minister Wang Yi visited every country in Southeast Asia except Vietnam, according to the Center for Strategic and International Studies. 

“At each of his stops, Wang coupled promises of Chinese vaccine access with other foreign policy priorities, including advancing major projects under China’s Belt and Road Initiative (BRI), which have been stalled amid the pandemic,” according to the CSIS.

In the Philippines, Wang promised half a million doses of Covid-19 vaccines along with $1.3 billion in loans and $77 million in grants for infrastructure projects. In Indonesia, the delivery of 3 million Sinovac vaccines has come with China’s commitment to “help Indonesia become a manufacturing hub for Chinese vaccines” and speed up a high-speed railway link, according to the center. 

In Myanmar, a promise of 300,000 vaccine doses was accompanied by talks to develop a  China-Myanmar Economic Corridor, which would also ensure that China’s Yunnan Province just over the border would gain better access to the Indian Ocean.

All in all, China says that it is providing vaccines to 14  Asian countries including Pakistan, Brunei, Nepal, the Philippines, Myanmar, Cambodia, Laos, Sri Lanka, Mongolia and the Palestinian Authority: “China has decided to donate COVID-19 vaccines to Palestine,” China’s UN Ambassador Geng Shuang told the Security Council in late February, during its monthly meeting on the Israeli-Palestinian conflict.  

The Palestinian Authority (PA), however, has so far spoken publicly only about its procurement of Russia’s Sputnik vaccine – after a high-level PA official visited Moscow last month and signed a contract. The PA is also receiving a dispatch of vaccines from the Global COVAX facility. On 22 February, Hamas-controlled Gaza, received a shipment of some 20,000 Sputnik vaccines, donated by the United Arab Emirates.  Israel, criticized for failing to share more of its supply of Pfizer vaccines, has given the PA a few thousand doses directly, and is now beginning to vaccinate some 140,000 Palestinian workers – along with Arab residents of East Jerusalem which both Israel and the PA claim.  

China has also been active elsewhere in the Middle East region, supplying the UAE, Iran, Bahrain, Jordan, Iran, Egypt and Morocco. However, the UAE, Bahrain, Kuwait, Oman, Qatar and Saudi Arabia have also bought the Pfizer vaccine.

Russia Makes Inroads in Europe & Latin America 

Meanwhile, Russia has mostly sewn up vaccine markets in Euroasia and is also making inroads in the European Union, according to official news agency Tass. 

“Hungary became the first EU country to receive samples of the Sputnik V vaccine for research. Austria, Germany, Greece, Italy, Slovenia, the Czech Republic and Finland have already expressed interest in the possible use of the Russian preparation or its local production in case of its approval,” reported Tass on 19 February.

Sputnik Favoured in Latin America

At least 10 Latin American countries have received Sputnik V, beginning with starting with Argentina on 30 December. Since then Belize, Brazil, Bolivia, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay and Venezuala have all received doses – some as small donations and others as paid orders. 

In Bolivia, vaccine talks were accompanied by discussions of Russian assistance to develop gas reserves, restart a nuclear plant project and co-operate on lithium mining, according to Reuters.

Russia has also licensed manufacturing companies to produce its vaccine in India, Brazil, China, South Korea, and Argentina.

Argentina, Brazil, Bolivia and Mexico are getting both the Sputnik and Sinopharm vaccines, while Colombia, the Dominican Republic, Ecuador, Peru, Chile and Uruguay have only secured the Sinopharm vaccine so far.

Political Power or Donations to the Global Public Good ? 
China’s Xi Jinping in 18 May 2020 address before the World Health Assembly

Although China has been accused of donating its Coronavirus vaccines for political power, Chinese President Xi Jinping has stressed at recent meetings of the World Health Assembly that it viewed its COVID vaccines as a global “public good’. 

China has also joined the global vaccine access platform, COVAX, and promised it 10 million doses.  However neither of the two leading vaccine candidates, by Sinpharm and Sinovac, have been approved by an external regulatory agency – and discussions are still continuing, according to WHO officials.

Nor have the Chinese vaccine developers published peer-reviewed studies on their vaccines. Company reports show Sinopharm’s multi-country trials yielding efficacy results  of 79%, while Sinovac trials from four different countries showed results ranging from 91.3% in a Turkish trial to 50.3% in an independently managed  Brazilian trial among health care workers. 

In the case of Russia’s Sputnik V vaccine, the Gamaleya Institute developers together with the Russian Direct Investment Fund (RDIF) say they have submitted the vaccine portfolio to the  European Medicines Agency for review.  And a Lancet report on Phase 3 trial results, found the vaccine to be 90% efficacious against the SARS-CoV2 virus.  But the CEO of the  RDIF has also stated that it prefers to deal directly with countries rather than via the global COVAX facility.

Meanwhile, in the absence of other approvals, individual countries ranging from upper middle income Chile to impoverished Zimbabwe have taken matters into their own hands – registering Chinese or Russian vaccines for emergency use – regardless of the capacity of their regulatory authorities. 

And regardless of regulatory status, China and Russia have taken advantage of the three-month interval between the start of vaccine drives in wealthy countries and the launch of the COVAX facility’s global vaccine distribution effort in lower and middle-income countries, beginning just this past week in Ghana, Cote D’Ivoire and Nigeria.

COVAX Enters The Picture 

Now that COVAX has finally started the first allocations, with the aim to deliver some 2 bllion vaccines in 2021, it may soon eclipse the individual bilateral efforts of China and Russia. Or will it? 

In fact,  COVAX is only likely to reach about 20% of the populations of countries that have joined the facility by the end of the year.  So given the global vaccine thirst, Russian and Chinese vaccines will likely continue to find willing markets, at least in the near-term.

If the Russian Sputnik is finally approved by the EMA – the doors to much wider distribution in Europe and elsewhere will open much wider – particularly in light of the vaccine’s affordable US$ 10 price tag per dose. 

However, China appears unlikely to submit its Sinopharm and Sinovac vaccines to the EMA – or to any other strict western regulatory agency for review and approval.  

So what remains to be seen, against the landscape of unmet demands as well as enormous political pressures, is how WHO will handle the delicate balance of science and politics that could surround the review of the Chinese vaccines’ efficacy for a WHO Emergency Use Listing.

Image Credits: TellZimbabwe/Twitter, GovernmentZA/Flickr, CGTN, Flickr: Francis Kokoroko/UNICEF, the foreign photographer/Flickr.

Police in South Africa seized hundreds of fake COVID-19 vaccines and make several arrests in November, 2020, following a global alert by INTERPOL – leading to the recent arrest in China of the global trafficking ring.

LYON, France – Chinese police have successfully identified a network selling counterfeit COVID-19 vaccines as far away as Africa, raiding the manufacturing premises, arresting some 80 suspects, and seizing more than 3,000 fake vaccines on the scene, according to  the global INTERPOL agency [International Criminal Police Organization]. The investigation was supported and facilitated by INTERPOL’s Illicit Goods and Global Health (IGGH) Programme.

The China-South Africa trafficking ring, the first confirmed instance of fake vaccine smuggling across continents, was first identified in a February 2021 Health Policy Watch report of the exclusive investigation by the South African journal, Bhekisisa, “Little Vials, Big Crime, Criminals Primed For Onslaught on Africa’s Vaccines.

The story warned of the risks of organized crime flooding Africa and other markets with fake COVID-19 vaccines – and cited the case of 2,400 fake vaccine doses imported from China, and discovered in a warehouse outside of Johannesburg’s OR Tambo airport, by South African authorities in November 2020.

As Interpol told Bhekisisa, the “vaccines” had been advertised for sale on a Chinese social media app, WeChat, and had been imported from Singapore as “cosmetic injections”.  South African authorities arrested three Chinese and a Zambian national in connection with the counterfeit goods seizure.

Fake vaccine vials seized by South African police in November 2020, as a result of INTERPOL warnings, leading to the recent arrests in China of the trafficking ring.

“This is only the tip of the iceberg when it comes to COVID-19 vaccine related crime,” Jürgen Stock, the agency’s secretary general, noted in the agency’s most recent statement on Wednesday, March 3, on the arrests in China of the traffickers.

In addition to the arrests in South Africa and China, INTERPOL is also receiving additional reports of fake vaccine distribution and scam attempts targeting health bodies, such as nursing homes, the agency said in its statement.

Read the Interpol statement on the arrests and follow-up investigation here:

Image Credits: Interpol , INTERPOL.

The Brazilian state of Acre declared a state of emergency, facing rising COVID cases, a dengue epidemic, and flooding.

NEW YORK CITY – Although North America is experiencing an overall decline in new COVID-19 cases and deaths, Brazil and other localized hotspots in South America are experiencing a dramatic spike in infection and hospitalization rates, said WHO officials in the region’s Washington DC-based Americas office. 

In a Wednesday briefing, Pan American Health Organization (PAHO) director Dr. Carissa F. Etienne expressed particular concern regarding countries and areas in the Amazon Basin. “The Brazilian state of Acre has just declared a state of emergency due to a deadly combination of COVID-19 infections, a dengue epidemic, and flooding in several cities,” she said. 

“Nearly 94% of [Acre’s] ICU is occupied and the health system is collapsing as more and more patients require hospitalization.” 

Her comments followed an outspoken interview in the Guardian by Duke University neuroscientist Miguel Nicolelis, who called Brazil a “breeding ground for this virus” due to its lack of effective control of the pandemic. 

“If you allow the virus to proliferate at the levels it is currently proliferating here, you open the door to the occurrence of new mutations and the appearance of even more lethal variants,” said Nicolelis, complaining of the government’s lack of direction in controlling cases. 

As of 3 March, Brazil reports 10, 587, 001 confirmed cases of COVID-19 with 255,720 deaths. 

With Second Wave of Pandemic in Brazil, People Cannot Remain Complacent

Nicolelis, who has been self-confined to an apartment in São Paulo for most of the pandemic, called Brazil’s response a “domestic tragedy”. The failures of the far-right  president Jair Bolsonaro to implement effective prevention measures, such as masking and social distancing,  and more recently, a vaccination campaign, will impact the country until late 2020, Nicolelis said. 


Speaking at the PAHO briefing, incident manager Sylvain Aldighieri said:  “Brazil at this point in time is confronting a second wave of the pandemic, which is nationwide. This is impacting their health services, including ICU use – the rate of occupancy of beds in ICUs,” said 

Algieri also stressed the impact the virus has on the health supply chain, given the oxygen and access to special medicines needed to those who are in the ICU. 

The ongoing situation in Brazil only serves to remind us that remaining complacent during the COVID-19 pandemic can result in immeasurable loss of life. 

Etienne called on several lessons to guide the world moving forward in coming months. “As we prepare for the next crisis, first, our COVID-19 response has been strongest when it has been guided by data and science. When we use policies in data and science, we save lives.” 

“Second, public health is a global concern. COVID-19 showed us that a deadly virus that emerges halfway around the world can be a threat to anyone, anywhere. Third, access to quality health care should be universal. Where we live or how much money you have should not determine whether you live or die from COVID-19, or any disease. ”

Image Credits: IMF/ Raphael Alves.