Mariângela Simão WHO Assistant Director-General on access to medicines

WHO Director General Dr Tedros Adhanom Gheyebresus on Friday issued his strongest call to date for a waiver on intellectual property related to COVID vaccines, medicines and other health products – which is due to be considered next week by the World Trade Organization’s General Council.

While welcoming a new UN Security Council resolution also approved on Friday, which calls for broader access to COVID vaccines in conflict zones and poor countries, Dr Tedros stressed that the UN resolution needed to be accompanied by concrete global actions of the kind that the WTO was positioned to take – by relaxing rules that restrict the generic manufacture and trade in patented COVID vaccines and health products. 

“I’m glad the UN Security Council has voted in favour of vaccine equity. And at the same time, if we’re going to take practical solutions, then the waiver of intellectual property should be taken seriously,” Tedros told the media at the body’s bi-weekly COVID-19 briefing.

“Voting for vaccine equity is important and we appreciate that. But concrete steps should be taken to waive intellectual property to increase production, increase coverage of immunisation and get rid of this virus as soon as possible.”

Referring to joint South African/India proposed TRIPS [Trade-Related aspects of Intellectual Property Rights] waiver to be discussed at the WTO, Tedros said that the pandemic was a “once-in-100-years occurrence”, so if the waiver “can’t be used now, when will it be used?”

The UN Security Council resolution, which was passed unanimously, calls for “the strengthening of national and multilateral approaches and international cooperation.. to facilitate equitable and affordable access to Covid-19 vaccines in armed conflict situations, post-conflict situations and complex humanitarian emergencies.”

It also calls on developed economies to donate vaccines to low- and middle-income countries and other countries in need.

Voluntary Licenses Could Also Be Tool For Increasing Manufacturing Capacity & Tech Transfer

WHO special adviser Bruce Aylward stressed that pharma should also issue more ‘voluntary licenses’ to firms in other countries for the generic manufacture of life-saving vaccines as a means of increasing vaccine manufacturing capacity and ease supplies. .

Mariângela Simão, WHO’s Assistant Director-General for Access to Medicines & Health Products, added that the WHO-managed COVID Technology Access Pool (C-TAP) offers a way to “share technology and issue voluntary licenses”.  However, so far there have been few, if any, industry takers in the COVID patent pooling plan. 

As a result, the WHO is “very interested in the outcomes ” of the upcoming WTO discussions, said Simão, saying: “Intellectual property is always a very sensitive topic in anything that’s related to access to medicines… Countries are looking for alternatives to increase production capacity and of course, this includes how to manage the intellectual property rights.

“We welcome any movement from countries to decrease and address current barriers to access as well as barriers to access that could be seen mid- and long-term. So this is quite an important discussion.”

Nigeria expects COVAX Vaccines Next Week

Also addressing the press conference were Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control (NCDC) and Walter Kazadi Mulombo, WHO Representative in Nigeria

Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control

Nigeria, which has a population of over 200 million, has secured close to 14 million doses of AstraZeneca vaccine through COVAX, and expects 4 million of these doses to be delivered next week, according to Mulombo.

Ihekweazu said that Nigeria had chosen not to do any bilateral deals with pharma suppliers, but rather to work only in a multilateral fashion through COVAX and the African Union.

“We will prioritise our health care workers, absolutely first,” said Ihekweazu. “We’re making some very hard decisions. I think at the end of the day, the key thing is we all recognise that we can only impact on transmission and reduce the burden in our hospitals if we target the right people, initially at the right pace, and at the right distribution.”

“Everything will come into play, not only the priority population groups but geography as well.  We have a very uneven outbreak in Nigeria. Lagos State, for instance, has 40% of all the cases in Nigeria, so it wouldn’t be a surprise if they are prioritised to a certain extent. But at the same time, we need to get some vaccines to every state in Nigeria. It’s a big country and a complex country, a lot of detailed planning is going into ensuring that the vaccines get to the right people as quickly as possible, so that we can get the outbreak under control.”

 

Italy launched its COVID-19 vaccine drive on Sunday, 27 December, 2020.  Two months later vaccines are only just being delivered to Africa.  Access groups say patent restrictions will constrain supplies and hamper rollouts in low- and middle-income countries throughout 2021.

Over 400 US organisations and 115 Members of the European Parliament declared their support this week for a waiver on intellectual property rights for COVID-19 products, due to be discussed by the World Trade Organisation (WTO) General Council.

Even so, WTO insiders said that consensus was more likely to build around a “third way” approach for voluntarily relaxing patent rights advocated by new WTO Director General Ngozi Okonjo-Iweala – in light of stiff opposition from other countries in Europe and Asia to the formal waiver plan. 

Informed observers also predicted that as a first step, the WTO was more likely to approve a much softer proposal by the “Ottawa Group” of 13 developed and emerging economies calling upon countries to voluntarily relax export restrictions and tariffs on key COVID-19 health products. 

At a high profile media briefing on Friday in Washington DC, US consumer, faith, health, development, labour, human rights, and other civil society groups urged the White House to reverse the Trump administration’s opposition to an emergency COVID-19 waiver of World Trade Organization (WTO) intellectual property rules so that more generic supplies of vaccines, treatments, and diagnostic tests can be produced in as many places as possible as quickly as possible. 

“The pandemic cannot be stopped anywhere unless vaccines, tests, and treatments are available everywhere so variants that evade current vaccines do not develop,” said the group in its appeal. 

Congresswoman Jan Schakowsky said she and 29 other congress members had signed a letter alongside 400 faith-based, labour and human rights urging US President Joe Biden to support the waiver.

“We have vaccine apartheid. Pharmaceutical companies and some rich countries are standing in the way of poorer countries getting access to vaccines,” said Schakowsky, a Democrat from Illinois and chair of the Consumer Protection and Commerce Subcommittee.

Sara Nelson, head of the US Association of Flight Attendants

Sara Nelson, head of the Association of Flight Attendants, told the media briefing that her members support the waiver because they “know first hand the impact of the pandemic on our health and our livelihoods”.

“I get choked up to think that some people might only get access to vaccines in 2024,” said a tearful Nelson. “I can’t imagine this going on until 2024, and the threat this poses to our livelihoods, lives and jobs. People must always be before profit.” 

Meanwhile,  a cross-party group of 115 Members of the European Parliament (MEPs)  also issued a declaration urging the European Commission and European Council to drop their opposition to the TRIPS waiver.

‘Third Way’ Approach More Likely To Gain Acceptance Than TRIPS Waiver  
Ngozi Okonjo-Iweala, new WTO Director General, at a press conference after her election, speaks about a “Third Way” to expand access to vaccines..

The waiver on certain Trade-Related aspects of Intellectual Property Rights (TRIPS) being championed by South Africa and India, would remove IP barriers on COVID-related medicines, vaccines and other health products. The TRIPS Council has been unable to reach consensus on the waiver and is expected to submit an oral report to the General Council.

Access groups have championed the waiver proposal, saying that would enable greater access to affordable COVID-19 health technologies, including vaccines, in particular for developing and middle-income countries. It is supported by the African Union and most of Latin America.

Geneva trade and diplomatic sources have said, however, that it is extremely doubtful that the WTO General Council would actually act, at least in this session, to approve such an initiative. 

There has been staunch opposition from the United States, United Kingdom, and other G-7 countries to the waiver measure, which opponents say would harm intellectual property rights, and thereby dampen pharma R&D investments. 

New WTO Director General Dr Ngozi Okonjo-Iweala, elected just last week, has talked about a “third way” to break the deadlock between rich countries and poorer ones over the issue – focusing on the issuance of more voluntary licenses by pharma companies to low- and middle-income countries for generic manufacture of their patented products. 

Ottawa Group’s Trade & Health Draft Initiative Could Get Support  

As a more likely initial WTO gesture on the pandemic, the General Council could next week approve a draft decision on Trade and Health around which more consensus may be building. This could pre-empt the waiver negotiations due to resume in the TRIPS Council on 10 and 11 March.

The draft decision, based on a Trade and Health initiative launched last year by the “Ottawa Group” of 13 countries, urges countries to review and “promptly eliminate unnecessary restrictions” on export of essential COVID health products,  temporarily remove or reduce tariffs; streamline customs processes; strengthen supply chains, display transparency in trade-related monitoring, and step up cooperation with the WTO and other international agencies in trade-related aspects of pandemic response. 

The measure, based on a joint statement from June 2020, has been backed by the Ottawa Group’s mix of high-income countries, which includes Norway, Switzerland, the EU and Canada, as well as emerging economies such as Kenya, Mexico and Chile, could at least send a signal of greater multi-lateral cooperation in pandemic related trade issues, sources say. 

Latin American countries are, meanwhile, expected to make a statement calling for relaxation of export restrictions, in the wake of recent European Union moves to restrict the export of vaccines manufactured in the EU region after supply shortages emerged. 

EU Parliamentarians Charge: EU Bloc’s “Open Opposition to TRIPS Waiver” Exacerbates North-South Divide  

In their declaration on the TRIPS waiver, European members of parliament (MEPs) stressed that “the EU’s open opposition to the TRIPS waiver risks exacerbating a dangerous North-South divide when it comes to affordable access to COVID-19 diagnostics, personal protective equipment, treatments and vaccines. 

“The WTO decision on a potential waiver offers a crucial and much-needed act of effective solidarity, as it is an important step towards increasing local production in partner countries and, ultimately, suppressing this pandemic on a global scale. As the Commission President has repeatedly stated, no one is safe until everyone is safe.”

Earlier in the week, Archbishop Ivan Jurkovic, Holy See representative to the United Nations, said that “the principles of justice, solidarity and inclusiveness, must be the basis of any specific and concrete intervention in response to the pandemic”, and the TRIPS waiver “would be a strong signal demonstrating real commitment and engagement and thus moving from declaration to action in favor of the entire human family”. 

WHO’s Director General Dr Tedros Adhanom Ghebreyesus also reaffirmed his support for the WTO IP waiver initiative on Friday. Speaking at a WHO press conference, he and other senior WHO officials said that the IP waiver offers a “practical solutions” for scaling up access, as compared to Friday’s Security Council Resolution on the issue, which remains largely symbolic.

“I’m glad the UN Security Council has voted in favour of vaccine equity. And at the same time, if we’re going to take practical solutions, then the waiver of intellectual property should be taken seriously,” Tedros told the media at the body’s bi-weekly COVID-19 briefing.

“We are very interested in the outcome of this discussion at the TRIPS Council,” said Mariangela Simao, head of the WHO’s Access to Medicines and Health Products. “We welcome any movement from countries to decrease and to address current barriers to access.”,

https://twitter.com/abinader/status/1365386652961619970

Image Credits: Tadeau Andre/MSF , Euoropean Commission , WTO.

A Pakistani healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis; Pakistan ranks fifth worldwide in TB burden.

ISLAMABAD, PAKISTAN –  EXCLUSIVE – The Global Fund to fight HIV/AIDS, Tuberculosis and Malaria and Pakistan’s Health Ministry are investigating a private sector hospital in Karachi for alleged mismanagement of some  US$ 4.2 million in Global Fund funds allocated to the country for tuberculosis elimination (TB) activities. 

The Indus Hospital (TIH), the principal recipient of the Global Fund’s TB grant to Pakistan, is alleged to have mis-spent US$ 4,196,938 of the country’s TB programme grant of  US$ 39.7 million for the years 2016-2018 in “fraudulent” awards to a service provider.

The funds provided to TIH were intended to be used  to provide TB outreach services in Karachi and the surrounding rural areas of Sindh province – both of which are high-TB burden areas in Pakistan.

The Indus Hospital, Karachi, Pakistan

The hospital was accused of embezzling the money in the December 2020 draft of a report by the Global Fund’s Geneva Office of Inspector General (OIG), obtained by this team from a Pakistani source in the Ministry of National Health Services – Regulations & Coordination  (NHSR&C).  The same allegations were repeated in an official NHSR&C committee report – subsequently obtained by these reporters. 

According to the World Health Organization (WHO), Pakistan is ranked fifth amongst high-burden countries of TB worldwide and it accounts 61 percent of the communicable disease in WHO’s Eastern Mediterranean Region (EMRO).

The GF’s OIG report covers the period of two years i.e January 01,2016 to December 31, 2018.  It found that some 4,196,938 USD in non-compliant expenses – related to “irregular payments” to suppliers or related conflicts of interests. 

Out of the total amount of mis-spent funds, some US$ 1,172689 USD is ‘potentially’ recoverable, the OIG report states.

TIH Failed To Conduct Competitive Tender For Services – And Was Overcharged

The report says that the TIH pre-selected a firm called Interactive Research and Development (IRD) as a long-term technical assistance supplier in connection to the GF grant, instead of conducting a competitive tender.  Then, IRD significantly overcharged for its services. 

“The Indus Hospital fraudulently awarded four projects to IRD. IRD then overcharged the Global Fund for these projects through non-delivery, fabricating and inflating programmatic achievements, and through unsupported expenses,” said the early investigation draft of the OIG.

An IT provider on the project, also misrepresented and overcharged for its services to the Indus Hospital, the OIG report states. The Indus Hospital engaged Interactive Health Solutions Private Limited (IHS) to provide IT services, but paid out double what IHS actually spent to  delivering the services.

Unmitigated conflicts of interest between the hospital and its providers were enablers for the alleged fraud, the OIG report states. 

But the Global Fund Pakistan Country Team also failed to provide adequate oversight, the OIG report concludes. The country team breached budget procedures in the process of approving The Indus Hospital’s selection of IRD and IHS.

“Conflicts of interest and irregular procurements contributed to US$4,196,9381 of non-compliant expenses, of which US$1,172,6892 is potentially recoverable,” states the OIG  report.  The report also contains a detailed diagram illustrating the complex conflict of interest patterns that emerged between TIH and its suppliers – as well as the failed oversight channels between the country’s Global Fund programme management team and the hospital.

That diagram, published in the original online version of the Health Policy Watch story, was later removed at the request of Global Fund’s OIG, pending the Global Fund’s publication of it’s full and final report on the investigation, scheduled for mid-March.

Global Fund Responses 

The Global Fund’s OIG Office in Geneva confirmed, however, to us the authenticity of the report, saying that an  “early draft version” had been leaked. GF Communications Specialist Dougal Thomson  said that a detailed report will be released around 16 March.  

The Global Fund Pakistan Country Team, approached by us for comment, through the Global Fund local funding agent, Amir Chaudry, declined to respond. 

The Global Fund has invested US$697 million in Pakistan since 2003; the GF is the country’s biggest donor for programmes related to HIV/AIDS and TB.

Pakistan’s Health Ministry Formed Inquiry Committee

Following their receipt of the draft  GF report on 1 December 2020, Pakistan’s Ministry of NHSR&C formed an inquiry committee to probe the charges against TIH. A committee report issued on 14 December 2020, validated the financial allegations leveled by the GF’s OIG against the Karachi hospital. 

The four-member inquiry committee concluded that the wrongdoing occurred because individuals violated health ministry and GF Standard Operating Procedures (SOPs), causing ‘triple damage’ to the cause of ending TB efforts in the country.

The committee also reported that the wrongdoing resulted had damaged donor trust – as well as causing national dishonor.  As a result of the episode, the Global Fund has now applied an  Additional Safeguard Policy (ASP) to Pakistan, to monitor future GF investments more closely.

The Health Ministry committee also concluded that it agrees with the OIG findings that the GF  portfolio manager in charge of the monies, had failed to provide adequate oversight, and when conflicts of interest became apparent, had not adequately flagged the issues to the Senior Recoveries Officer which is the GF standard procedure.

The Health Ministry committee report further added that “TIH responses are too generic and not responding satisfactorily to the documented facts and figures of OIG report.”The

The Indus Hospital (TIH) Responds To Charges 

TIH Chief Executive Officer (CEO),  Dr. Abdul Bari Khan, when asked by our team about the GF’s allegations on TIH,  said that “we have submitted our reply and are waiting for the final version of the report.”

A subsequent TIH media statement, signed by Khan, stated,  “the OIG carries out audits to ensure compliance in relation to good practices. At times there are certain procedures and related expenses which may require necessary explanation based on ground realities.”

The statement added that these observations about procedures or expenses are ‘not to be interpreted as fraud’.

Pakistan Committed To Battling TB – A Major Public Health Challenge  
WHO Global Tubercullosis Report, 2020

According to the National Program Manager of TB Control Program Pakistan, Dr. Naseem Akhtar, TB is one of the major public health problems in Pakistan, with the country ranking fifth among 30 TB high-burden countries worldwide.

She said that the estimated burden is 570,000 TB cases and 25,000 DRTB cases annually while 42000 people die of TB every year.

“In 2020, 330,000 TB cases were put on treatment and 93% of those were successfully treated while 3004 cases of DR TB [drug resistant TB] were also enrolled,” said Dr. Naseem.

In a response to queries by our team, Dr. Faisal Sultan, special assistant to the Prime Minister on National Health Services (NHS) stressed that TIH was contracted directly by the Global Fund – and not through Pakistan’s national ministry.  He said that the inquiry, as well, was conducted by GF inspectors. 

Irregardless of the issues that have emerged in relation to the GF, he pledged that the TB elimination remains a high national priority: “Our own [government] TB programme will continue, and we plan to fund it much better this coming year.”

___________________________________________________

  • Rahul Basharat Rajput is a Pakistan based journalist and a US Education Foundation – International Center for Journalist fellow. Muhammad Nadeem Chaudhry is a Pakistan based journalist reporting on health, social and poltical issues. 
  • Updated on 3 March 2021

Image Credits: Rahul Basharat Rajput , Stop TB Partnership, WHO .

The Medical Association of Tanzania (MAT) has started a massive awareness campaign on the prevention of COVID-19 following last Sunday’s admission by President John Magufuli and the Ministry of Health that the disease exists in the country.  

“We have started an advocacy strategy through the media and communities on prevention of COVID-19,” Dr. Elisha Osati, the immediate past president of the Medical Association of Tanzania told Health Policy Watch in an exclusive interview.  

“We have a lot of patients in our wards so we are also dealing with their treatment and management,” Dr. Osati said. “We of course have been taking precaution on our side, for our patients and their relations.” 

The medical profession has been stressing wearing masks, washing hands, using hand sanitizers, social distancing and generally seeking medical help for those that may feel unwell.  

For months, the Tanzania president, who has a doctorate in chemistry, cast doubt over the existence of coronavirus and said it was the work of the devil. Since April, Tanzania has not reported a single case of the virus to the WHO and no public measures have been implemented to contain the virus. 

High-Profile Deaths, WHO prompting

A source within the Tanzania government said that the  president’s recent change of heart could be due to the deaths of two prominent politicians, the vice-president Zanzibar Seif Sharif Hamad, died on Wednesday of COVID-19, and the head of civil service, John Kijazi who died on the same day although the reason for his death has not been given.   

However, another source said it was due to the WHO Director-General’s statement on Tanzania and COVID-19 issued on 20 February, in which he urged the government to scale public health measures against COVID-19 and to prepare for vaccination – a highly usual step for the global body that does not usually involve itself in the internal affairs of member states.

“This situation remains very concerning. I renew my call for Tanzania to start reporting COVID-19 cases and share data. I also call on Tanzania to implement the public health measures that we know work in breaking the chains of transmission, and to prepare for vaccination,” said Dr. Tedros Adhanom Ghebreyesus. 

Use Knowledge and Science, Says Moeti

Dr Matshidiso Moeti, the WHO Regional Director for Africa, said the WHO encourages countries to use knowledge, science and evidence for implementations they ask them to undertake.

The change to a medical approach from a faith-based approach comes amidst a pandemic that the Tanzania government may slowly be admitting to. 

However, a number of religious leaders have challenged Magufuli’s stance as being ‘not completely right’ and have been trying to encourage COVID-19 preventive measures within their communities. 

Catholic Bishop Siverine Niwemugizi of Rulenge-Ngara Diocese, which borders Rwanda and Burundi, suspended the celebration of public mass and community prayers. Instead, he resorted to using Radio Kwizera, established by the Jesuit Refugee Service (JRS) in partnership with the United Nations High Commission for Refugees (UNHCR) to broadcast Mass. 

Last Sunday, Magufuli acknowledged that there was a problem and called on people to wear face masks. On Wednesday, the Ministry of Health issued a statement urging the public to guard against contagious and non contagious diseases in the country, avoid crowds and wear safe masks approved by the ministry.

The Partnership of Evidence Based Response to COVID-19 (PERC) Weekly Update: COVID-19 Epidemiology and Policy in Africa observed that in February alone, there were 293 social media posts mentioning pneumonia in Tanzania. One Twitter user commented, “My timeline and groups are inundated with obituaries, deaths caused by ‘severe pneumonia”.

The Tanzania Ministry of Health stopped releasing Covid-19 updates last April, blaming “fake” COVID-19 test kits and fear mongering. The last update indicating 509 confirmed cases and 21 deaths.

Tanzania stopped sending COVID-19 to the WHO in April.

Osati also told Health Policy Watch that the medical fraternity will also start advocating for the use of  vaccines in once they have been approved by the national drug regulatory bodies. 

“As scientists, we know that vaccines are game changers. But we are still waiting for the relevant bodies to test and approve them,” he said. “ We want a vaccine that is safe, effective and cost-effective. 

The Tanzanian government officials had dismissed COVID-19 vaccines and were instead promoting herbal remedies. The Health Minister Dorothy Gwajima said they were not satisfied that the vaccines were clinically proven.

Osati said scientists in his country would continue to dialogue with the authorities in government until the management of COVID-19 pandemic is medically managed.  

“We are pleased about the Tanzanian government actions. A gap that has been created since last year. We await an appropriate strategy to engage with Tanzania,” said Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, during a weekly press briefing.

 

Ghana’s President, Nana Akufo-Addo, will be publicly vaccinated with the Oxford/AstraZeneca SARS-CoV2 vaccine on 2 March, signifying the start of the West African country’s vaccine rollout.

On Wednesday, Ghana became the first country in the world to receive vaccines via the global vaccine access platform, COVAX, according to Health Policy Watch. The Ivory Coast is expected to receive its COVAX vaccine delivery on Friday.

According to the COVAX Interim Distribution Forecast, Ghana – with a population of 31 million – will get a total of 2,412,000 doses of the Oxford/AstraZeneca vaccine. 

Ghana is the10th most affected country in Africa with over 81,000 confirmed cases and 584 deaths as at Thursday, a case fatality ratio of about 0.7% – far lower than the continent’s average of 2.7%.

Ghana has been prepared since early December 

On Thursday, Dr Franklin Asiedu-Bekoe, Ghana’s Director of Public Health, suggested that his country’s level of preparedness could be a major reason why it was able to get the vaccine ahead of several other countries.

Ghana submitted its COVAX application on 4 December, 13 days ahead of the deadline, with support from the World Bank and the World Health Organization (WHO), said Bekoe. 

The Ghana Health Service and partners also worked with the justice ministry to sort out the controversial indemnity request by the pharmaceutical companies as a pre-qualifying condition for countries to access the vaccines.

Dr Franklin Asiedu-Bekoe, Director of Public Health, Ghana Health Service

Every country receiving the COVAX vaccines is required to indemnify manufacturers and those that would administer the vaccine against liabilities arising out from the vaccine, as it has been  approved for emergency use and its safety profile is not yet fully known.

This is a global requirement and the United Kingdom passed a similar law recently.

Ghana’s plan for COVID-19 and the vaccine doses

Bekoe added that multi sectoral representation on Ghana’s COVID-19 working group had helped to develop its national plan on the pandemic.

Ghana aims to vaccinate 20 million Ghanaians. To achieve this, health officials will be deploying segmentation by population and by geography approaches.

“We looked at where are hotspots and which people are at most risk of contracting COVID in Ghana,” Bekoe said. 

For the first 600,000 doses received this week, the focus is on high-burden regions of Greater Accra, and Ashanti region. Bekoe said these are the key areas that will receive the vaccine. 

Regarding population segmentation, the government will be prioritising individuals above 60 years of age, and those that are needed to keep the government running.

“The executive, judiciary, and the parliament are also able to receive a portion of the 600,000 doses of the AstraZeneca vaccine. Then we are looking at the front line of security. So these are the persons that will form the first line—the first group of persons to receive doses of the vaccines,” he added.

Beyond allocating doses of the vaccine, he said the country admits that it has some challenges regarding vaccine hesitancy and as such, it has included communication plans in its COVID-19 agenda.

“Ghana also has a logistics and waste management committee, we have data, safety and a number of other committees that are embedded in the national development plan for COVID-19,” he added.

Emerging as the first country to get the COVID-19 vaccine through COVAX suggests that Ghana is very much reliant on the dose. Bekoe added that the country expects to receive subsequent doses but is also looking elsewhere to get sufficient doses that will enable it to reach the national goal. 

“We are very much reliant on the COVID facility and we’re also looking at other bilateral and multilateral facilities, to ensure that 20 million Ghanaians get vaccinated,” he said.

Johnson and Johnson vaccine in the mix

As Ghana was receiving the Oxford/AstraZeneca COVID-19 vaccines delivered by the Serum Institute in India, the US Food and Drug Administration (FDA) affirmed the efficacy of Johnson & Johnson’s single dose COVID-19 vaccine. 

According to the FDA, the vaccine is also efficacious against the dominant variant in South Africa. The vaccine which is already listed on the Africa CDC-supported platform for African countries to procure doses of various vaccines for their citizens.

Earlier in the day, Africa CDC director Dr John Nkengasong welcomed the Johnson & Johnson decision, but told a media briefing that the vaccine alone would not mark the end of the COVID-19 pandemic.

 

Africa CDC Director Dr John Nkengasong

“By using a combination of vaccines early on, we can begin to achieve our goals,” Nkengasong told Health Policy Watch “The vaccine landscape will continue to improve. We now have a menu of vaccines coming months as clinical trials are completed. The menu of vaccines will improve and countries will have a choice or choices of which vaccines to use for their vaccination programme.” 

Médecins Sans Frontières/Doctors Without Borders (MSF) has called on Johnson & Johnson to send its first shipments to COVAX for low- and middle-income countries, rather than high-income countries, should it get FDA approval at its meeting on Friday.

MSF said the vaccine could be an important tool in low-resource settings as, unlike the other COVID-19 vaccines being used today, it requires only one dose and can be stored at normal refrigerator temperatures. 

Preliminary data from a phase 3 trial testing the vaccine also suggests that the vaccine is effective against the 501Y.V2 COVID-19 variant, first identified in South Africa.

“J&J should supply low- and middle-income countries and immediately fulfil its pledge to the COVAX Facility,” said Dana Gill, US Policy Advisor, MSF Access Campaign.

“It is simply unfair that most of J&J’s vaccine doses are pledged to wealthy countries with already significant stockpiles of the other approved vaccines, where immunisations have been underway for nearly three months, while low- and middle-income countries where barely any vaccination has taken place are left at the back of the queue.” 

 

Israel has seen sharp declines serious COVID cases among people 60+ (yellow line) since the vaccine campaign began – but a parallel rise in cases among younger people (black line).

The largest peer reviewed study to date of some 1.193 million Israelis – half of whom received the Pfizer COVID-19 vaccine – confirms the vaccine’s efficacy in preventing symptomatic COVID-19 as well as serious cases and deaths – even after the first dose is administered.

The study, published in the New England Journal of Medicine, used data from Israel’s largest healthcare organization, Clalit Health Services (CHS), to evaluate the effectiveness of Pfizer’s BNT162b2 mRNA vaccine in a nationwide mass vaccination setting. 

Estimated vaccine effectiveness during the follow-up period, beginning 7 days after the second dose, was 92% for a documented infection, 94% in preventing a symptomatic COVID-19 case, 87% effective in preventing hospitalization and 92% in preventing severe disease. 

Even after the first dose, the vaccine was 72% effective in preventing serious illness or death, the study found.  

The study, led by researchers from Ben Gurion University of the Negev, matched, on a 1:1 basis Israeli’s diverse subpopulations of Israeli Jewish and Arab citizens, including people from a wide range of ethnic and religious backgrounds, in order to compare outcomes among those who had received the vaccines – and those who had not. 

“This is immensely reassuring … better than I would have guessed,” the Mayo Clinic’s Gregory Poland was quoted as saying in one local press report.

Just One Dose Highly Effective  
Drop-in testing clinic outside a health clinic in the ultra-orthodox city of Bnei Brak – one of Israel’s virus hotspots

The research may, however, provide an unintended incentive to countries struggling with vaccine supply shortages to delay the second Pfizer dose – despite the fact that the two vaccine jabs are recommended to be administered just 3 weeks apart.

“Even after one dose we can see very high effectiveness in prevention of death,” said Dr Buddy Creech of Vanderbilt University.  “I would rather see 100 million people have one dose than to see 50 million people have two doses,” Creech said.

With just 9 million people, half of them already vaccinated with at least one dose of the Pfizer vaccine, Israel has become a living laboratory for the efficacy of the brand new mRNA vaccine preparations being rolled out by Pfizer as well as Moderna.

The successful campaign has led to a sharp drop in serious cases and hospitalizations among people over the age over the age of 60 since a peak in the current COVID wave of mid-January. 

But Vaccines Alone Aren’t Enough 
Arrivals at “closed” Ben Gurion Airport – reported use of forged COVID tests by some ultra-Orthodox passengers to board “rescue” flights has provoked outrage among other Israelis, as thousands of people remain stranded abroad .

However, cases among under-50 Israelis have sharply risen – as the so-called British variant of the virus, B.117 takes over among younger age groups –  so that overall declines in new infections and hospitalizations has been much slower. In addition, the highly successful vaccine campaign has now met with resistance among some pockets of younger Israelis, ultra Orthodox Israelis and Arab Israeli citizens who tend to be more vaccine hesitant and suspicious of the government. 

In addition, despite closing its airport to all but 200 incoming passengers a day, Israel has been struggling with a wave of people returning on “rescue” flights with forged COVID-test documents- some even bragging about it.

Thousands of Israelis meanwhile remain stranded abroad – due to the inability of the government to both effectively prevent sick passengers from getting onto planes and enforce quarantines on arrivals – who routinely ignore mandatory quarantine requirements. 

“A jarring story this week of people forging documents to return to Israel, despite the closure, raises alarm bells…. Israel bills itself as the Start-Up Nation – but the country can’t even affirm if a document is forged prior to boarding people on a plane?” opined the English-language  Jerusalem Post. “The country that supposedly has the best security against terrorism in the world can’t spot a forged document? How can it be sure then that other people arriving are not forging their documents? Meanwhile, real Israelis with real-life problems are still stuck abroad without the option of getting home.”

Israeli health officials also are issuing sharp warnings that new infections could rise again if Israelis gather for traditionally raucous parties and celebrations during this weekend’s Jewish holiday of Purim.  

In addition, Israel’s campaign has come in for sharp criticism by local and international human rights groups for the lack of vacccine-sharing with some 5 million neighboring Palestinians in the occupied West Bank and Hamas-controlled Gaza, which has been under a longstanding Israeli security barricade. 

Vaccine-Sharing Plan To Latin America & Europe Halted Over Sharp Criticism at Home & Abroad 
Israeli Prime Minister Benjamin Netanyahu kicked off the mssave vaccine campaign in December.

Prime Minister Benjamin Netanyahu meanwhile had announced plans to share “symbolic” doses with countries with which Israel maintains close ties. 

On Thursday, Israel’s Attorney General halted the plan, which had not been fully disclosed – but was said to include the sharing of about 80,000 Pfizer vaccine doses with about 20 friendly nations in Europe, Latin America and Africa, including ones that have recognized Jerusalem as Israel’s capital – while Palestinians only received about 5,000 doses.  The plan was halted, but not before some countries, such as Honduras, had already received a shipment.  

In a statement, published on Twitter Thursday,the centrist Defense Minister Benny Gant decried Netanyahu’s moves as “undemocratic”, saying it was an arbitrary decision by the prime minister – who is also seeking re-election next month.   

”While the supply of vaccines to medical staff in the Palestinian Authority was transferred in an orderly fashion, paired with the need for the vaccines here in Israel, supplying vaccines to other countries around the world has never been brought up for discussion in the relevant forums,” Gantz said in a letter to Netanyahu and the Attorney General.   

Netanyahu’s moves, coming after a month in which Israel shared only a few thousand doses, at most, with the Palestinian Authority, was also decried abroad.

“It’s understandable to vaccinate one’s own citizens – but only to a point. After that, failure to share is ethically grotesque. Vaccines have become more scarce & valuable than the dollar. It is the new currency of influence & diplomacy. Wield it ethically,” said Lawrence Gostin, a global health professor at Georgetown University and head of a WHO collaborating centre on health and human rights,” in a series of tweets criticizing Netanyahu and Israel’s policies.

“It’s one thing for the Israeli gov to argue that it must prioritize vaccinating Israeli citizens over Palestinians living under Israeli occupation. But it’s morally indefensible to give surplus vaccines to Guatemalans, Hondurans, Hungarians and Czechs over Palestinians,” tweeted Dov Waxman, UCLA’s chair of Israel studies, in a post on Thursday. 

“Not only does Israel have a legal responsibility to help vaccinate Palestinians living under Israeli military rule (according to the Geneva Conventions, and notwithstanding the Oslo Accords), but Israel also has a moral responsibility to them.

“And, as if that’s not sufficient, Israel also has a pragmatic self-interest in preventing widespread transmission of COVID among Palestinians in the West Bank and Gaza.”

Sharing Epidemiological Space &  ‘Symbolic’ Quantities of Vaccines 
Palestinian health worker administers COVID test to young child – as the SARS CoV2 virus infects more young people on both sides of the poltiical divide

In a brief comment, the Prime Minister’s office stated that at the moment only “symbolic”: vaccine quantities were being offered to anyone for the moment: “no ability to render significant assistance is anticipated at least until the vaccines campaign in Israel will have ended. 

“Nevertheless, over the past month, a limited quantity of unused vaccines was accumulated; therefore, it has been decided to assist Palestinian Authority medical teams and several of the countries that contacted Israel with a symbolic quantity of vaccines.” 

With less fanfare, Israel has set up mobile posts along the borders of east Jerusalem and the West Bank – in an effort to vaccinate more Palestinian residents of the city and its environs  – which Israelis and Arabs share de-facto – regardless of political claims. 

On the other side of the political divide more nationalistic Israelis have sharply opposed delivering vaccines to Gaza, until two Israelis, one mentally ill, who are being held hostage are released, along with the remains of two deceased soldiers. 

However, Israel did finally permit the PA, headquartered in the West Bank, to transfer some 2,000 Russian supplied vaccine doses to Gaza – followed by another 20,000 Sputnik doses donated by the United Arab Emirates, which entered from Egypt.   

Along with purchasing supplies of Russia’s Sputnik vaccine, the Palestinian Authority is also expecting some 300,000 COVID vaccine doses from the WHO co-sponsored COVAX facility in coming weeks.

But those will only begin to cover some of the highest-risk groups among the estimated 5 million people living in the West Bank and Gaza. 

Per capita, Palestinian COVID cases and deaths have in fact been somewhat lower than those in Israel – but Palestinians are now reporting a recent surge  – possibly  driven by the same variants to have infected Israel, and where over 5,685 people have now died.  According to Palestinian authorities, some 2,261 Palestinians have died from COVID-19 –  but those deaths also include several hundred Palestinians living in East Jerusalem – which Israel also claims and counts as its own COVID cases too. 

 

Image Credits: HPW , Israel Ministry of Health, Uri Misgav/Twitter , Youtube – Israeli PM, Alia Ameen/Twitter .

Essential COVID-19 supplies like oxygen remain in short supply in many others,

A new COVID-19 Oxygen Emergency Taskforce has been created in response to the dearth of sustainable oxygen supplies in low- and middle-income countries (LMICs) – and its critical importance for treatment of COVID-19. 

Co-created by Unitaid and Wellcome Trust in partnership with the WHO and a range of other global public health agencies, the taskforce, launched Thursday, is taking a new role to coordinate and advocate for increased supply of oxygen in LMICs. 

The oxygen supply in most LMIC’s was already constrained prior to COVID-19, and needs have only been exacerbated by the pandemic. 

According to an oxygen tracker tool created by the Geneva-based PATH, LMIC countries need about 7.8 million cubic meters of oxygen per day to treat the more than half a million hospitalized patients. That translates into a supply of about 1.46 million cylinders of oxygen per day, with 25 countries currently reporting surges in demand, especially in Africa. 

PATH COVID oxygen tracker tool

Paul Schreier, Chief Operating Officer at Wellcome, said: “We have made critical advances in providing lifesaving clinical care and treatments to COVID-19 patients over the last year. The impact of the combination of oxygen and dexamethasone to treat severely ill patients has, in particular, been incredible.”

“But global access to advances remains unequal. We need to urgently increase access to medical oxygen to ensure patients are benefiting regardless of where they live and ability to pay. International solidarity is the quickest – and only – way out of this pandemic. It is a public health, scientific, economic and moral imperative that all tools are made available globally.”

PATH COVID oxygen tracker shows needs for oxygen by country,
US 1.6 billion Needed – US$90 Million Immediately  

The Taskforce says that some US$ 90 million in immediate funding is needed to address key challenges in oxygen access in delivery in up to 20 countries, including Malawi, Nigeria, and Afghanistan.  Unitaid and Wellcome will make an immediate contribution of up to US $20 million in total for emergency response. Urgent, short-term requirements of additional countries will be measured in the coming weeks, with the overall estimated funding needed to be US $1.6 billion. 

Philippe Duneton, Executive Director of Unitaid, said: “This is a global emergency that needs a truly global response, both from international organisations and donors. Many of the countries seeing this demand struggled before the pandemic to meet their daily oxygen needs. 

“Now it’s more vital than ever that we come together to build on the work that has already been done, with a firm commitment to helping the worst-affected countries as quickly as possible.”

The COVID-19 Oxygen Emergency Taskforce also brings together a long list of other organizations that have been working to improve access to oxygen since the start of the pandemic – WHO, UNICEF, the Global Fund, World Bank, Save the Children, the Clinton Health Access Initiative (CHAI), PATH, and the Every Breath Counts coalition to end pneumonia.

‘Double-Burden’ of Pneumonia and COVID-19 Places Strain on Global Health Systems 

Even before COVID-19, pneumonia was the world’s biggest infectious killer of adults and children, claiming the lives of 2.5 million people in 2019. 

COVID-19 has put increased strain on health systems, especially in ‘double-burden’ countries with both high levels of pneumonia and COVID-19. Many hospitals in LMICs are running out of oxygen, resulting in preventable deaths and families of hospitalized patients paying a premium for scarce oxygen supplies. 

Oxygen has long been regarded as an essential medicine, and despite being vital for the effective treatment of hospitalized COVID-19 patients, LMICs cannot access crucial oxygen supply due to costs, infrastructure constraints, and logistical barriers.  

The Taskforce recognizes the central importance of oxygen in treatment, and partners will focus on four key objectives as part of an emergency response plan: measuring acute and longer-term oxygen needs in LMICs; connecting countries to financing partners for their assessed oxygen requirements; and supporting the procurement and supply of oxygen, along with related products and services.

They will also address the need  for innovation market-shaping interventions and reinforce advocacy efforts to highlight the importance of oxygen access in the COVID-19 response. As well as meeting immediate needs of the pandemic, the taskforce will also look to aid in long-term pneumonia control.  

 

Image Credits: Independent Panel for Pandemic Preparedness – Second Progress Report. , PATH .

Global health is all but global, says Fifa Rahman, Permanent Representative for NGOs for the WHO-backed ACT-Accelerator

The appointment of Ngozi Okonjo-Iweala, the former Nigerian Finance Minister, World Bank development economist and its former Vice President, and black African woman, as head of the WTO, has been heralded as ‘a big deal’, an inspiration, and ‘a sign of the many strides (Africa) has made in gender parity’. While all this is true, and while representation is important, it is but one step towards tackling pervasive racism in global health. 

On 25th February 2021, twenty black and brown leaders in global health, including implementers, academics, civil society, and communities living with the diseases, will convene in a virtual roundtable to discuss how racism and white supremacy affects global health governance, hiring, and programming. This roundtable, convened by Matahari Global Solutions, a global research and policy group, and the AIDS and Rights Alliance of Southern Africa (ARASA), will define the parameters for an in-depth study to take place this year – and advocacy meetings with global health agencies. A meeting report will be published and sent directly to heads of key global health agencies. 

COVID-19 Impact of Race on Health

The COVID-19 pandemic has brought to the fore clear disparities in infection rates, death rates, and access to diagnostics, vaccines, therapeutics, and care for black and brown communities. It’s a bleak reminder of the enduring inequity in global public health.  As early as April 2020, one Brookings Institute article pointed out that the COVID-19 response does not take into account the fact that black individuals in predominantly white geographies are more likely to live in areas with ‘lack of healthy food options, green spaces, recreational facilities, lighting, and safety’, and that black people are more likely to live in densely populated areas. 

In addition, COVID-19 tools are not well adapted to dark skin, with pulse oximeters showing misleading readings 12% of the time in persons with non-white skin. And contrary to what was expected, Global North responses to COVID-19 have not necessarily been the most efficacious nor the most effective. For example, the United Kingdom, the United States, and Sweden failed to adequately protect their populations, while global south countries such as Rwanda and Taiwan effectively instituted systems and deployed technologies to respond effectively to the pandemic. Yet in the Global Health Security Index, the United States and the United Kingdom were ranked first and second in the world in terms of pandemic preparedness. This underscores the need for us to decolonise and redefine global health and address existing power imbalances within global health structures and debates. 

Racism as a Systemic Issue Through Organisations

The white Global North perspective is inherent in global health. Yet only recently has the impact of race and whiteness on global health governance, hiring, and programming come into focus. Anu Kumar, CEO of IPAS, a non-profit working across Africa, Asia, and the Americas on reproductive rights, asked in a June 2020 op-ed, “Why do we in the global health sector, which is dominated by white people, especially white women, believe that we know how to solve the health problems of people in other countries?” 

Stephanie Kimou, who has worked extensively on sexual and reproductive health in francophone Africa, commented in a separate op-ed: “[A]t work, nobody looked like me. The person who started the nonprofit, the finance manager, the operations person — all white. All the major money and programmatic decisions — all made by white people being driven around in fancy cars and living in gated communities. It was so clearly neocolonialist.”

At its very basis it may seem to the untrained eye that this is solely an issue of hiring more Black, Indigenous and people of colour.  We need to recognize that there is intersectionality of oppression and inclusion. However, as mentioned above, tokenistic diversity hires will not address the philosophy behind why black and brown people, in particular women, don’t get hired in the first place. These are entrenched within culture and everyday practice. In the words of Anu Kumar, “What we don’t talk about is how the structures and operations of our organizations are part of white supremacist culture.”

What defines global health deliverables and decision-making is membership. Covert racism means that while the parameters of membership go largely unsaid, it is white people that are seen to be reliable and responsible for important documents that guide implementation of programs, setting guidelines on how many diagnostic tests should be deployed to countries that need them, etcetera. White people are considered most suitable to respond to emails promptly, to feedback more eloquently in project design, are promoted into leadership positions and thus get to represent the views of black and brown implementers. This is the de facto modus operandi, even if it would never be uttered in such plain language.

Real Examples – Race and Whiteness in Global Health

2020 presented several examples of institutional white supremacy culture – notably, how structures and institutions are structured to uphold white dominance. In June last year, a Médecins Sans Frontières internal statement highlighted that while 90% of its staff were hired locally in countries where MSF works, most of its operations were run by European senior managers. So based on absolute numbers alone diverse hiring doesn’t appear to be the issue here. But of course it is an issue when, much like colonial times, positions of power are overwhelmingly filled by white people. 

MSF insider Arnab Majumdar wrote last year about MSF senior managers assuming national staff were ‘intellectually lazy’, explicitly referring to them as being ‘vulnerable to corruption’. Complaints of racism were met by the accusation of ‘reverse racism’, a recognized signifier of white supremacy. And while the MSF core executive committee responded by saying they would address the difference in compensation in their teams, and that they would continue to address broad issues of harassment, abuse, and discrimination within the organisation, nothing public has emerged since that time on the effects of this work. 

Also in June 2020, the Women Deliver CEO, Katja Iversen, took a leave of absence after allegations of a toxic work environment, including racist comments about hair of black women, black people being refused for hire multiple times, and that the organisation suffered from a ‘white saviour’ complex. Four months later, reports emerged of the conclusion of investigations into racism at Women Deliver – that no single person was responsible. The verdict was slammed as a ‘slap in the face’, and was accompanied with critique that Women Deliver ‘doesn’t really know what accountability is’. 

A similar situation transpired at the International Women’s Health Coalition – with a letter being published on racist and toxic culture within the organisation, the President resigning as a result of the allegations, but with investigations clearing the President and senior managers of racism – finding instead that there was a ‘pervading culture of fear and intimidation’.

These white-centred power structures result in widespread race-based oppression within organisations and within health systems. Priorities are distorted, sociocultural reasons for disparity in healthcare are ignored and/or misunderstood, and new health technologies end up not being culturally appropriate nor equitably efficacious. Dolutegravir, a major HIV drug on the WHO Essential Medicines List, was predominantly trialled on white populations, missing out key genetically diverse populations. In November 2019, the ADVANCE trial found the risk of major weight gain among black women.  Has the system learned from such mistakes? No. Moderna proudly advertised that in its Phase 3 COVE trials for the new COVID-19 vaccine 28% of study participants were from “diverse communities” – i.e. 72% were white. Conversations within the WHO Access to COVID-19 Tools Accelerator (the ACT-Accelerator), specifically designed to bring necessary vaccines, diagnostics, therapeutics, PPE, and oxygen supplies to countries most in need – have been dominated by white individuals from the Global North, leaving a knowledge deficit among countries that would receive these technologies. 

The Way Forward

COVID-19 is showing the world with renewed urgency that representation and participation is essential in formulating public health responses. It is for this precise reason that Matahari Global Solutions and AIDS and Rights Alliance for Southern Africa (ARASA) have embarked on an ambitious project to document the various effects of a lack of diversity and white supremacy, on global health programming, hiring, and governance. 

With a small amount of funding from Open Society Foundations, we’ll start with a roundtable with black and brown leaders in global health, then conduct an in-depth qualitative study to ascertain how whiteness is experienced in global health. Results will be publicised widely – and discussed directly with key global health agencies. We still have to secure funding for a larger quantitative study of over 300 individuals, and advocacy missions by organisations in the Global South on distorted priorities and colonialist global health, to Geneva and New York-based decision-making bodies. But this work is a start. 

Racism, white supremacy, and colonialism echo through our global health. The system is unglobal and misses out on equitable representation. Colonialist, (un)global health doesn’t work and it needs to change. 

Fifa A Rahman is principal consultant at Matahari Global Solutions

– Dr Fifa A Rahman is the Permanent Representative for NGOs on the Diagnostics Pillar and the Facilitation Council of the ACT-Accelerator, and principal consultant at Matahari Global Solutions; Felicita Hikuam is Director at the AIDS and Rights Alliance of Southern Africa; Nyasha Chingore-Munazvo is Programmes Lead at the AIDS and Rights Alliance for Southern Africa; and Gisa Dang is Associate Consultant at Matahari Global Solutions. 

Image Credits: Fifa Rahman.

Thumbs up: WHO representative in Ghana, Francis Kasolo, on left, with UNICEF’s representative, Anne-Claire Dufay as first COVAX vaccine doses arrive on 24 February in Accra, Ghana.

Under cloudy skies, Ghana’s first precious doses of Covid-19 vaccines arrived Wednesday morning at Accra’s Kotoka International Airport. They are also the first supplies to be distributed by the WHO co-sponsored COVAX facility on the African continent.

The arrival of some 600,000 vaccines marks a milestone in months of effort by WHO, UNICEF, GAVI and other partners to mount the largest global vaccine campaign in history – and ensure that scarce and often pricey COVID-19 vaccine doses are distributed more equitably to countries around the world. 

“This day is the culmination of many months of planning, research, negotiation & coordination,” tweeted WHO Director General Dr Tedros Adhanom Ghebreyesus, who co-launched the COVAX initiative nearly a year ago. “But it’s just the beginning. We still have a lot of work to do to realize our shared vision for VaccinEquity by starting vaccination in all countries within the first 100 days of the year.”  

COVAX hopes to deliver 2.3 billion doses by the year’s end — mostly to 92 low- and middle-income countries that are part of a GAVI-backed Advanced Marketing Commitment scheme. The equity scheme aims to overcome price and supply barriers thrown up by high-income nations, which have already snapped up one billion more vaccines than they need for their populations.

Ghana was selected as the first African recipient of vaccines after sending a rollout plan to COVAX, demonstrating that its health-care teams and cold chain equipment could support a quick distribution. The WHO Ghana office, known for its efficiency and close collaborations with Ghana Health Services, can be relied upon as a flagbearer for the initiative, insiders say.  

“This is a momentous occasion,”  declared WHO’s representative in Ghana Francis Kasolo, in a joint statement with UNICEF’s representative, Anne-Claire Dufay, just as the first palettes of AstraZeneca/Oxford vaccines, produced by India’s Serum Institute, were unloaded on the airport runway. 

“After a year of disruptions due to the COVID-19 pandemic, with more than 80,700 Ghanaians getting infected with the virus and over 580 lost lives, the path to recovery for the people of Ghana can finally begin,” said Kasolo. 

The initial COVAX shipments will be used to vaccinate frontline healthcare workers, adults over the age of 60, and people with underlying health conditions in the weeks to come, said the Ghanaian authorities on Wednesday.

Ghana’s program manager for immunization, Kwame Amponsa-Akyianu, told reporters earlier this month that the country aims to vaccinate two-thirds of its population of over 31 million people.

The historic shipment comes a week after Africa’s coronavirus death toll surpassed the 100,000 mark. That is a fraction of the death toll on other continents, but it is now rising fast as a second wave of infections overwhelms hospitals – most of which lack the oxygen supplies and intensive care units that are standard in more affluent regions.

Coronavirus Disease 2019 (COVID-19)

Africa CDC Also Welcomes Deliveries

John Nkengasong, Director of the Addis-based Africa Centres for Disease Control and Prevention, sounded a similar note, saying: “These first deliveries of COVID-19 vaccines through COVAX are a critical moment in Africa’s fight against the virus.” 

Nkengasong described the first deliveries as “an important step towards our continental goal of immunising at least 60% of Africa’s population with safe and efficacious vaccines against COVID-19″ over three years. 

So far, the African Union (AU) has secured some 670 million doses of the AstraZeneca, Pfizer and Johnson & Johnson vaccines – in addition to the COVAX supplies of some 90 million doses that will flow to the continent.  Russia has also offered to supply 300 million doses of its Sputnik V vaccine to the AU scheme along with a financing package.

Desperate to begin vaccinations soon, South Africa, Uganda and Rwanda, among others, have also made smaller bilateral deals. And China has donated small batches of its Sinopharm vaccine to to countries like Zimbabwe and Equatorial Guinea. 

Still, the rollouts underway in Europe, the Americas, India and even the Middle East remain the exception rather than the norm.  Of the 210 million doses of vaccine that have been administered globally so far, half have been doled out in just two countries, Tedros warned on Tuesday. 

Ghana’s Minister of Health Kwaku Agyeman-Manu at Accra’s Kotoka International Airport

Nigeria Watching Ghana – And Wondering When Their Turn Will Come  

But just north of Accra, in the continent’s most populous country and the largest economy, Nigerians were eying the local vaccine landscape with concerns about how and when a campaign would commence on home turf. Such plans have yet to be announced by the government.

Emeka Nsofor, CEO of EpicAFRIC,a philanthropic impact agency, told Health Policy Watch that while the country’s epidemiological response to the pandemic has been impressive so far, the paucity of information and the non-availability of a timeline for the delivery of COVID-19 vaccines is becoming a source of major concern not only to professionals, but to the public.

“It is not good for Nigerians to be watching clips of the vaccines being delivered to South Africa, Zimbabwe and other African countries when no one knows when Nigerians will start receiving the vaccine,” he told Health Policy Watch.

Nsofor said the government ought to have made its plans for procuring and administering doses public – whether they are secured through COVAX, the AU or other means.

“By now we should have known who will get the vaccines first, where will they be administered, who are the officials that will be involved,” he added.

In several countries where vaccines are already being administered, frontline health workers and aged individuals are eager to be the first to receive the jabs in their arms. But in Nigeria, health workers are less optimistic about their prospects.

At the Casualty and Emergency unit of Nigeria’s first teaching hospital, the University College Hospital, a physician who was among the first in his unit to test positive for COVID-19 told Health Policy Watch that he dreads getting reinfected. Not knowing when he will be able to receive a jab compounds those fears and is “very discouraging”, he said.

“Getting the virus was a very scary experience for me, especially at a time when we knew so little about it. Every now and then, I still dread contracting it again. I believe receiving the vaccine would protect me and allay my fears but realising that no one, probably including the government, knows when we will get it, is very discouraging,” he told Health Policy Watch on condition of anonymity.

For its part, the Nigeria Center for Disease Control (NCDC) continues to coordinate testing, messaging and other aspects of the country’s response to the pandemic. It recently released findings of household seroprevalence surveys conducted in four Nigerian states — Lagos, Enugu, Nasarawa and Gombe States.

The survey findings revealed that the prevalence of SARS-CoV-2 antibodies was 23% in Lagos and Enugu States, 19% in Nasarawa State, and 9% in Gombe State.

“This means that as many as 1 in 5 individuals in Lagos, Enugu and Nasarawa State would have ever been infected with SARS-CoV-2. In Gombe, the proportion is about 1 in 10,” NCDC said in a statement.

South African Variant – A Risk In Ghana

The fact that the B-1351 variant, first discovered in South Africa, has now spread to eight African countries including Ghana, has further implications for the vaccine campaign in the West African region. 

In a small South African trial, experts found that the AstraZeneca vaccine had virtually no efficacy in reducing mild or moderate COVID cases among people infected with the B-1351 virus strain – leading authorities in Pretoria to cancel the vaccine rollout and switch to a Johnson & Johnson jab – which has recently demonstrated efficacy against the variant in Phase 3 trials. 

The WHO nonetheless has said it recommends AstraZeneca’s use across Arica – even in countries infected with the variant. Speaking at a recent press conference, WHO experst maintained that the vaccine is still likely to reduce incidence of severe COVID cases, even among people stricken with the B-1351 strain. 

However, the African Union has issued a slightly different recommendation – that countries where the strain is “dominant” shift gears to another vaccine. 

So experts will be closely eyeing Ghana’s AstraZeneca rollout to see how the vaccine performs against the variant in the real world laboratory there.

Map of African Union Member States by hotspot level on PERC (Partnership For Evidence-Based Response) dashboard.

Expect More African Pressures On COVAX to Roll Out Johnson & Johnson – Following Expected FDA approval Friday

COVAX’s preliminary candidate-specific supply of COVID-19 vaccines for 2021 and 2022, as of 20 January. Since then Novavax also committed 1 million more vaccines.

The arrival of the AstraZeneca vaccine batches in Ghana also coincides with big news of a likely US Food and Drug Administration emergency approval of the J&J vaccine as early as Friday – following today’s positive FDA expert panel review of the vaccine. 

The J&J results, reported by the FDA review, showed a 66% average efficacy for the vaccine in preventing moderate and severe disease in Phase 3 trials The trials involved over 44,000 recruits in the US, Latin America, and South Africa. 

The J&J vaccine was also 64% efficacious in preventing moderate and severe disease in the South African trial arm – a significant finding from the first large-scale trial of a vaccine meeting up with the B.1351 variant. And more important, the vaccine was 85% effective in preventing severe disease – 82% in South Africa. While that is not as good a showing as the 90% or better efficacy results for the mRNA vaccines by Pfizer and Moderna, J&J trial was the first to directly pit a vaccine against the B.1351 variant, which has been the one most resistant to vaccines generally among the recent SARS-CoV2 mutations to emerge. 

The J&J vaccine also has the advantage of being a one-shot vaccine which can be stored in a normal refrigerator rather than ultra-cold storage conditions – factors that could significantly help rollout in low-income countries where access to cold storage as well as to health services is more challenging. 

The FDA approval of the  J&J vaccine will almost certainly pave the way for a WHO greenlight, leading to a COVAX rollout of the vaccine as soon as commercial supplies are available. 

But that, in turn, could also give rise to new dilemmas for COVAX distribution plans.  In African countries like Ghana, faced with creeping vases of the B.1351 variant – there may also be future pressures to swap out AstraZeneca vaccines for J&J doses.

Although J&J has in fact committed to provide 500 million vaccine doses through COVAX facility – AstraZeneca dose still comprise the lions share of the COVAX portfolio, with some 720 million doses already procured. 

The bottom line is that while the jury is still out on AstraZeneca’s performance against the B-1351 variant, the J&J trial data shows clear efficacy for the vaccine in preventing serious disease in the African setting – where other vaccines have not [yet] been widely tested and tried.

And that means that the COVAX rollout – even as it begins, is set to face a new series of challenges in a constantly evolving landscape of science, big pharma deals and geopolitics.

Image Credits: WHO Ghana, PERC, Gavi.

Europe Lockdown
Frankfurt, Germany

The United Kingdom, Switzerland, Israel and Turkey are cautiously reopening businesses and relaxing limits on gatherings and travel as COVID-19 cases declined both globally and within these countries.  

However, parts of France, the Czech Republic, and Sweden are preparing for harder lockdown measures as their cases surge in contrast to worldwide trends.

As of 23 February, there were 2,530,101 new cases in the past week. The COVID-19 Epidemiological Update reported a 16% global decline in cases, with over 500,000 fewer cases than the beginning of the month. 

Five out of six WHO regions were showing double-digit percentage declines in new cases, with only the Eastern Mediterranean Region showing a 7% rise. Europe and the Americas continue to see the greatest drops in absolute numbers of cases while the number of new deaths has also declined in all regions.

UK & Switzerland Outline Roadmaps to Relax Restrictions 
Europe lockdown
Lockdown “Green” border roads between Switzerland and Germany

Switzerland will relax some restrictions from 1 March, allowing museums, shops, and zoos to open at limited capacity. Private outdoor events with up to 15 people will also be permitted. A second phase of reopening should commence on 1 April. 

On Monday, UK Prime Minister Boris Johnson announced the government’s roadmap to ease restrictions in England, which will be guided at all stages by data as opposed to set dates. 

Step 1 of the roadmap will begin in March with a return to in-person education in schools and colleges. Most outdoor attractions and settings, as well as non-essential retail, which includes zoos, pubs, restaurants, gyms, and retail stores, will stay closed for at least another month. Step 4, which will see a wider opening of a number of businesses, is expected no later than 21 June. 

The United Kingdom had implemented a national lockdown in response to the rising cases that resulted from the B.1.1.7 variant, and has even extended the lockdown in Northern Ireland, to 1 April. 

London, UK: Camden High Street in lockdown

Together with an ongoing vaccine campaign, these measures appear to be working, with case rates declining across all age groups and regions, in the most recent weekly surveillance report published. 

“Our efforts are working as case rates, hospitalisation rates and deaths are slowly falling,” said Dr Yvonne Doyle, Medical Director at Public Health England. Doyle still expressed concern about the new infection numbers, which were still higher than the cases at the end of September. “This could increase very quickly if we do not follow the current measures. Although it is difficult, we must continue to stay home and protect lives.”

The UK roadmap for reopening outlines four steps: continued successful vaccine deployment, evidence that demonstrates vaccines are sufficient in reducing hospitalizations and deaths in those vaccinated, reduction in infection rates that prevent a surge in hospitalizations, and assessment of the risks not to be fundamentally changed by the new emerging variants of concern. 

There will be a minimum of five weeks between each step: four weeks for the data to reflect changes in restrictions; followed by seven days’ notice of the restrictions to be eased. 

lockdown
Istanbul, Turkey

Turkey also plans to start a gradual normalization process in March, with measures to be lifted “on a provincial basis”. The country’s 81 provinces will be categorized based on risk levels – from very high to low – and progress in vaccinations to determine whether they are ready for normalization. 

This new process for normalization comes after the Turkish Health Ministry started announcing an average of weekly cases for provinces last week. This data will be used to determine whether restrictions are lifted. 

Israel Re-opens For Business – Except During Holiday & At Airport

Meanwhile, the Israeli government began to reopen hotels, shopping centers, and even cultural events on 21 February after its government approved the second and third phases of the exit plan from lockdown as new COVID cases continued to decline, particularly among people over 60,  most of whom have been immunized.

Infections rates and serious cases in Israel have declined sharply after more than 80% of people over the age of 60 either were vaccinated or recovered from COVID-19. The campaign has since opened to everyone over the age of 16.

However, airports and land borders will be closed for 14 more days, and the country’s borders closed until 6 March.  Only 200 people a day are allowed to board “rescue flights”, and this has left thousands of Israeli citizens stranded around the world.  

Restrictions on mass gatherings have also been relaxed to 20 people outdoors and 10 people indoors, instead of 10 and 5 respectively.  At the same time, it was likely that the government would declare a curfew over the upcoming Purim weekend, a holiday traditionally observed by raucous celebrations commemorating the biblical story of the rescue of Persian Jews by the Queen Esther.   

Coinciding with the relaxation measures, a Green Pass system was put into place to grant Israelis who have had two vaccine doses automatic access to gyms, studios, cultural and sports events, fairs and hotels. Those without the pass have to show proof of a recent COVID test. Children under 16, who can’t be immunized, may still be admitted to some venues, like hotels, along with their immunized parents.    

Palestine Vaccination Campaign to Begin, Calls on Israel to Reserve More Vaccines for Palestinians
Nabi Moussa, Occupied West Bank

Palestinians in Gaza were also reportedly due to get their first jabs as another 20,000 vaccines donated by the United Arab Emirates arrived Sunday in the barricaded strip from Egypt via the Rafah crossing.  Israel allowed the transfer of 2,000 vaccine doses into the Strip last week. 

In the Occupied West Bank, vaccine campaigns by the Palestinian Authority with Russia’s Sputnik V vaccine were only just beginning – although West Bank Palestinian infection rates have been comparatively lower than those in Israel, even after the latter had immunized over 50% of its 9.3 million citizens with at least a first dose.

A World Bank report on Monday called on Israel to share more of its vaccines with the PA, saying: “While Israel has been leading the world in terms of per capita vaccinations, no one has been vaccinated in the Palestinian territories yet, and the Israeli MoH has not formulated an allocation strategy to support the territories, beyond providing 5,000 vaccines for Palestinian doctors. Humanitarian organizations in both Israel and West Bank and Gaza have called for Israel to reserve a higher amount of vaccines for the Palestinian territories. Given the challenges for the Palestinian Authority to procure vaccines, the statement calls for operational and financial support from Israel to PA.”  

The Economic Monitoring report further stated: “In order to ensure there is an effective vaccination campaign, Palestinian and Israeli authorities should coordinate in the financing, purchase and distribution of safe and effective COVID-19 vaccines,” noting that the Palestinian Authority faces a US$ 30 million shortfall in vaccine funding, even after support from the WHO co-sponsored COVAX facility.

Germany Considers Reopening Even if Cases are Rising
Angela Merkel, Chancellor of Germany.

Germany’s Chancellor Angela Merkel has also proposed a plan to ease that country’s lockdown which has been in place since November. Merkel reportedly told her Christian Democrat (CDU) party that lockdown measures could be eased in several stages, combined with increased coronavirus testing. 

The stages would focus on personal contacts (how many people a person meets); schools, sports, restaurants, cafes, and cultural events. 

However, talk of easing restrictions in Germany belies the upward trend of infections in the country. The Robert Koch Institute reported 4,369 new COVID-19 cases as well as 62 associated deaths. There are major concerns of the COVID-19 variants pushing up numbers. 

Europe lockdown
Frankfurt, Germany: Masks required on cycle path
France, Sweden, and the Czech Republic – Tougher Lockdowns 
Europe lockdown
Paris, France: A woman serves a hot dog in front of a restaurant in the Latin Quarter. French bars and restaurants can no longer accommodate consumers because of the measures taken to combat the COVID-19 pandemic. Some restaurants remain open and serve drinks and take-out meals.

While other countries will soon enjoy relaxed restrictions, there have been increases in Nice in France, the Czech Republic, and Sweden. 

Nice reported 740 new cases per week per 100,000 residents, triple the national average. France has applied a localized lockdown over the next two weekends from Théoule-sur-Mer to Menton, and Nice. 

French Health Minister Olivier Veran said that measures could include a stricter form of the curfew imposed nationwide in France or a weekend lockdown in the city. 

“Consultations will be conducted over the weekend to take additional measures to stem the epidemic, ranging from a reinforced curfew to local lockdown at weekends,” Véran said.

The Czech Republic is also experiencing a rise, with 11, 233 cases reported on Tuesday, an increase of 7,100 in a single day. Test positivity rate also increased to 40.6%, the highest since 9 January. 

The Czech Ministry of Health has mandated that masks must be worn in places with larger concentrations of people, especially shops, public transportation, and hospitals, effective Thursday. 

The Ministry has also submitted to the government a law on emergency measures in an effort to curb the resurgence of COVID-19 in the country, including restrictions on services, a ban on mass events, and the restriction of public transport. 

“The purpose of the proposed law is to legally enshrine the measures that we issue as a crisis in accordance with the crisis law as part of the COVID-19 epidemic. Thanks to this, it is possible to issue measures for which we have so far needed an emergency, ” explained the Minister of Health Jan Blatný.

Europe lockdown
Uppsala, Sweden: People social distancing

Meanwhile, Sweden is preparing the strictest restrictions yet, in an effort to curb a resurgence in COVID-19 cases as the variant first detected in the UK spreads rapidly. 

“The British variant is increasing very fast. This variant will with fairly high probability be the dominant one within a few weeks or a month… We have a package [of national measures] being readied that will be presented tomorrow,” said Chief Epidemiologist Anders Tegnell at a news conference. 

Concerns about a possible third wave of the pandemic have been growing since the number of new infections have risen and the new variants have spread. The Swedish government has laid the ground for potential lockdown measures to be tougher than previously measures enacted earlier in the pandemic. 

The list of businesses that will face mandatory closure in Sweden include shops, hair salons, gyms, and restaurants. The country has also closed its borders to Denmark and Norway. Negative COVID-19 tests are now required for entry into Sweden. 

Declines Also Seen in United States and India
New York City, United States: Outdoor dining during pandemic

While declines in serious cases in Israel and the UK may be attributed to vaccines, it remains unclear why numbers are declining globally as some countries battle their second, third, and fourth waves of COVID-19. 

For the United States, the scale-up of vaccination and the shift in seasons are driving down cases, according to the Institute for Health Metrics and Evaluation (IHME) during a briefing last week. 

However, variants including the more infectious B.1.1.7 which first emerged in the UK in November 2019, have been detected in the US which could drive transmission. 

Epidemiologists in India have also questioned the declining cases, pointing to low rates of testing and habitual underreporting of causes of death, particularly in rural India. 

However, Prime Minister Narendra Modi is hoping that the vaccination drive that began in January will spur wider recovery. Though vaccine uptake remains slower than officials hoped, as of 18 February, more than 98 million vaccine doses have been administered in India. 

“I don’t think anyone really thinks that without vaccines and a vaccination program being widely available that we can go back to whatever is full normalcy,” said Sireesha Yadlapalli, a Hyderabad-based senior director at the United States Pharmacopeia, a scientific nonprofit organization. “Hopefully this is the slowdown and there’s no second wave.”

lockdowns
Bangalore, India: Empty streets during lockdown in early 2020.

Despite a nationwide declide, there has been a rise in cases seen in the Indian state of Maharashtra, which has ordered new restrictions on people’s movement and imposed night time curfews. Mumbai, Maharashtra’s capital and India’s financial hub, also banned religious, social, and political gatherings. 

The state has reported nearly 7,000 new cases on Sunday, a steep rise from 2,000 daily cases earlier this month. The Indian Ministry of Health and Family Welfare has stated that the surge in COVID cases in the state cannot be attributed to strains N440K and E484Q, which have been detected in other countries. 

WHO Warns Against Complacency 
Dr Michael Ryan, Health Emergencies Executive Director

While some of the declines, such as those in England, Scotland and Israel, may be attributed to massive vaccine campaigns – in other regions, where vaccination is only just getting under way, global health officials have had few explanations for the dip in cases.  

“We’re certainly not out of the woods yet,” said Health Emergencies Executive Director Dr Mike Ryan at a WHO press conference in Geneva last Thursday.

“The virus still has a lot of energy. You’re also dealing with urban settings, many people still living in areas that are overcrowded, multi-generation, multi-family homes. It is very difficult to break chains of transmission in a complex society. Some countries are coming down that hill more quickly than others.”

WHO technical lead on COVID-19 Dr Maria van Kerkhove stressed: “We cannot let ourselves get into a situation where the virus can resurge again. Remember what we need to continue to do to drive it down and get cases down into single digits.

“We just need to stay the course, hold on to what is working consistently deliberately as we roll out vaccines and make sure that vaccinations start in all countries,” said Van Kerkhove. 

Ryan also cautioned that, although the global COVID-19 cases are now at their lowest since last October, this could be the result of the natural patterns of the virus.

“I do think a good portion of that has been done to the huge efforts made by communities. There have been very stringent lockdowns and stay-at-home orders and other things, but also serum prevalence is rising,” said Ryan.

“We need to understand what is driving those transmission dynamics. Is it natural seasonality and wave-like pattern of the disease? Are we building up a level of immunity in the population that’s preventing the disease from finding the next case? Are our control measures having an impact on that?’ asked Ryan.

“I think as we move into [northern hemisphere] springtime, we need to drive towards higher levels of vaccinations, getting an equitable distribution of that vaccine, getting rid of the deaths and the hospitalizations and the suffering, but [also] continuing to drive the case numbers down.” 

 

Image Credits: Twitter, 7C0/Flickr, Falk Lademann/Flickr, Marc Barrot/Flickr, Sergey Yeliseev/Flickr, Health Policy Watch , David King/Flickr, Ben Hartschuh, 7C0/Flickr, Flickr: IMF Photo/Cyril Marcilhacy.