WHO’s Peter Ben Embarek, head of the origins task team, at the release of the report on Tuesday.

The international team assembled by the World Health Organization (WHO) to investigate the origins of SARS-CoV-2 has identified animal transmission – through an elusive ‘Animal X’ – as the most likely route of infection.

The long-awaited report was released on Tuesday after the 17-person expert team, together with a 17-person team of Chinese scientists, visited Wuhan and its surroundings during January and February to examine evidence about the virus, which was first identified in 174 people in Wuhan in December 2019, and has since infected over 128 million people and caused 2.7 million deaths.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the report advances the world’s understanding in important ways, but it also raises questions that will need to be addressed by further studies. 

“As far as WHO is concerned, all hypotheses remain on the table,” said Dr Tedros. “This report is a very important beginning, but it is not the end. We have not yet found the source of the virus, and we must continue to follow the science and leave no stone unturned as we do.” 

Tedros added that no single research trip could provide all the answers, as “finding the origin of a virus takes time and we owe it to the world to find the source so we can collectively take steps to reduce the risk of this happening again”. 

What follows is a summary of the report’s key points, which the team described as a “work in progress”.

The team examined four main scenarios for introduction: 

  1. Direct zoonotic transmission from a host animal to humans
  2. Indirect zoonotic transmission, involving the virus first infecting a host animal, then adapting through an intermediate host animal, before infecting humans
  3. Introduction through the cold/ food chain, particularly frozen wild animals sold at Wuhan markets
  4. Introduction through a laboratory incident.
Horsehoe bats carry viruses most similar to SARS-CoV-2

1. Direct zoonotic introduction:

Finding: possible to likely. 

Hypothesis: Transmission of SARS-CoV-2 (or very closely-related progenitor virus) moves from an animal reservoir host to human, and is followed by direct person-to-person transmission.

Arguments in favour 

  • The majority of emerging diseases originate from animal reservoirs and most of the current human coronaviruses have originated from animals. 
  • Surveys of the bat viromes conducted after the SARS epidemic in 2003 found SARSr-CoV in various bats, particularly Rhinolophus (horseshoe) bats. 
  • Viruses with a high genetic similarity to SARS-CoV-2 have been found in these bats in China, Japan, Thailand, and Cambodia. 
  • Two distinct types of SARSr-CoV were recently detected in Malayan pangolins. 
  • Minks have shown to be highly susceptible to SARS-CoV-2 and cannot be ruled out as the primary source of SARS-CoV-2. 
  • Antibodies to bat coronavirus proteins have also been found in humans with close contact with bats. 

Arguments against 

  • Although the closest genetic relationship to SARS-CoV-2 was a bat virus, more detailed analysis found “several decades” of evolutionary space between the viruses. 
  • Few of the identified bat virus genomes showed the ability to bind to human cells. 
  • Contact between humans and bats or pangolins is not as common as contact between humans and livestock or farmed wildlife. 
  • Despite the consumption of bats and other wild animal meat in some countries, there is no evidence for transmission of coronaviruses from such encounters. 

Information still needed: Detailed trace-back studies of the animal supply chain of Wuhan markets have provided some credible leads to survey potential reservoir hosts. 

2. Introduction through intermediate host followed by zoonotic transmission 

Finding: possible to likely 

Hypothesis: SARS-CoV-2 is transmitted from an animal reservoir to an animal host, followed by spread within that intermediate host (“spillover host”), and then transmitted to humans. 

Arguments in favour

  • Although the closest related coronaviruses have been found in bats, SARS-CoV-2 has evolved by an estimated “several decades”, which suggests a missing link. 
  • Similar viruses have also been found in pangolins, suggesting cross-species transmission from bats, but again with considerable genetic distance. 
  • Bats and pangolins have infrequent contact with humans, and an intermediary step involving an “amplifying host” has happened in a number of viruses, including influenza and MERS. 
  • SARS-CoV-2 adapts relatively rapidly in susceptible animals (such as mink). 
  • The increasing number of animals shown to be susceptible to SARS-CoV-2 includes animals that are farmed in sufficient densities to allow the potential for viral circulation. 
  • There was a large network of domesticated wild animal farms, supplying farmed wildlife to Wuhan. In high-density farms, there often are connections between farms, leading to complex transmission pathways that may be difficult to unravel. 

Arguments against 

  • SARS-CoV-2 has been identified in an increasing number of animal species, but genetic and epidemiological studies have suggested that these were infections from humans, rather than other animals. 
  • There is no evidence of repeated early SARS-CoV-2 strains of animal origin in humans in China. 
  • There was no genetic or serological evidence for SARS-CoV-2 in tests of a wide range of domestic animals (where large-scale screenings took place) and wild animals, where screening was more limited. 

Information still needed: Further surveys, including a wider geographic range. Studies of the supply chain of Wuhan markets have not found any evidence of infected animals but provided information for follow-up studies, including targeting supply chains from wild-life farms in provinces where the higher prevalence of SARSr-CoVs have been detected in bats. 

Animal products from outside Southeast Asia, where more distantly related SARSr-CoVs circulate, should not be disregarded.

A market in Wuhan, Hubei, China

3. Introduction through the cold/ food chain 

Finding: Possible

Hypothesis: SARS-CoV-2 is introduced or amplified through the cold/ food chain. This could involve direct zoonotic transmission, or spillover through an intermediate host. 

Arguments in favour 

  • The arguments are similar to those listed for zoonotic introduction, but with an emphasis on the potential for initial introduction through food animals or cold/ food chain products or the contamination of food and food containers (for instance by animal waste). 
  • Since the near-elimination of SARS-CoV-2 in China, the country has experienced some outbreaks related to imported frozen products in 2020. 
  • Screening programmes have found limited evidence for the presence of SARS-CoV-2 by nucleotide acid tests in different batches of unopened packages and containers in different cities. For example in an outbreak in Qingdao, the live virus was isolated from the outer package of imported frozen products. 
  • Foodborne outbreaks with enteric viruses are common, but contamination of food with human viruses usually comes from sewage or contaminated water for irrigation. 
  • Sewage treatment typically does not remove all infectious viruses prior to the release of wastewater in the environment. These processes have been investigated widely for non-enveloped viruses but far less for enveloped viruses in the food chain, but there is widespread evidence of  SARS-CoV-2 nucleic acid in sewage. 
  • There is some evidence that the oral route could lead to infection for SARS-CoV-2 from hamster infection experiments, and the virus replicates in gut organoids. 
  • Food animal handlers had an increased prevalence of SARS-CoV-specific antibodies. 
  • Humans infected with SARS-CoV-2 shed virus through faeces and can have gastrointestinal symptoms, suggesting the involvement of the gastrointestinal tract. 
  • Humans can also be exposed to contaminated objects. 

Arguments against 

  • There is no conclusive evidence for foodborne transmission of SARS-CoV-2 and the probability of cold-chain contamination with the virus from a reservoir is very low. 
  • While there is some evidence of the possible reintroduction of SARS-CoV-2 through handling imported contaminated frozen products in China since the initial pandemic wave, this would have been extraordinary in 2019 where the virus was not widely circulating. 
  • Industrial food production has high levels of hygiene criteria and is regularly audited. 
  • Most viruses have been found in 2020 in low concentrations and are not amplified on cold-chain products. It is not clear what the infection route would be (possibly oral, touch, or aerosol). 
  • There was no evidence of infection in animals tested following the Wuhan outbreak. 
  • The risk of foodborne transmission of SARS-CoV-2 through pathways such as objects is very low in comparison with respiratory transmission. 

Information still needed: Case-control studies of outbreaks, in which the cold chain product and food supply are positive, would be useful to provide support for cold chain products and food as a transmission route.

There are some preliminary reports of SARS-CoV-2 positive testing in other parts of the world before the end of 2019. 

There is also evidence of more distantly related SARSr-CoV in bats outside Asia. Some producers in these countries were supplying products to the markets. 

If there are credible links to products from other countries or regions with evidence for circulation of SARS-CoV-2 before the end of 2019, such pathways should be followed up. 

If there are leftover frozen products from the Huanan market from December 2019, particularly frozen animal products from farmed wildlife or linked to areas with the early circulation of SARS-CoV-2, these should be tested. 

4. Introduction through a laboratory incident 

Finding: Extremely unlikely.

Hypothesis: SARS-CoV-2 is introduced through a laboratory incident, reflecting an accidental infection of staff from laboratory activities involving the relevant viruses. We did not consider the hypothesis of deliberate release. The deliberate bioengineering of SARS-CoV-2 for release has been ruled out by other scientists following analyses of the genome. 

Arguments in favour 

  • Although rare, laboratory accidents do happen, and different laboratories around the world are working with bat CoVs. 
  • Humans could become infected in laboratories with limited biosafety, poor laboratory management practice, or through negligence. 
  • The closest known animal coronavirus strain (96.2%) to SARS-CoV-2 detected in bat anal swabs have been sequenced at the Wuhan Institute of Virology. 
  • The Wuhan CDC laboratory moved on 2 December 2019 to a new location near the Huanan market. Such moves can be disruptive for the operations of any laboratory. 

Arguments against 

  • SARS-CoV-2 from bats and pangolin are evolutionarily distant from SARS-CoV-2 in humans. 
  • There is no record of viruses closely related to SARS-CoV-2 in any laboratory before December 2019, or genomes that in combination could provide a SARS-CoV-2 genome. 
  • Prior to December 2019, there is no evidence of circulation of SARS-CoV-2 among people globally and therefore the risk of accidental culturing SARS-CoV-2 in the laboratory is extremely low. 
  • The three laboratories in Wuhan working with coronavirus diagnostics, isolation and vaccine development all had high-quality biosafety level (BSL3 or 4) facilities that were well-managed. 
  • A staff health monitoring programme showed no reports of COVID-19 compatible respiratory illness before or during December 2019, and no serological evidence of infection in workers through SARS-CoV-2-specific serology-screening. 
  • The Wuhan CDC lab which moved on 2 December 2019 reported no disruptions or incidents caused by the move. They also reported no storage nor laboratory activities on CoVs or other bat viruses preceding the outbreak. 

Information still needed: Regular administrative and internal review of high-level biosafety laboratories worldwide. Follow-up of new evidence supplied around possible laboratory leaks. 

At the end of the report, the team called for “a continued scientific and collaborative approach to be taken towards tracing the origins of COVID-19”, something that has been echoed by WHO.

 

Image Credits: CGTN, Arend Kuester/Flickr.

A healthcare worker in France monitoring a COVID-19 patient in critical condition in April 2020.

European countries are experiencing soaring COVID-19 infection and death rates. With a third wave sweeping across Europe, hospitals are at risk of becoming overwhelmed and governments are facing increasing public opposition to continued lockdowns and social distancing restrictions.

The WHO European Region, which includes 53 member states, has recorded an upward trend in cases for four consecutive weeks, with a 13% increase in new cases since mid-March. France, Germany, and Poland are among those worst hit.

The newly reported and cumulative COVID-19 cases and deaths by WHO Region, as of 21 March 2021.

Europe has recorded 1.4 million new cases in the last seven days, as of 21 March, accounting for 44% of global new cases. Compared to countries with high rates of vaccinations, including Israel, the United Kingdom and the United States, several countries in the European region, especially in central Europe, have reported much higher infection rates. 

The current surge in cases is likely due to the more transmissible B.117 variant, first identified in Britain, making this wave “harder to curb” than previous surges in cases, according to German health officials.

In the midst of critiques over the slow rollout of COVID-19 vaccines and the rising infection rates, some leaders are encountering an increasingly restive public. Last week, German Chancellor Angela Merkel walked back a strict lockdown planned for the Easter weekend (2-4 April) following widespread public opposition. French President Emmanuel also came under fire for his refusal to take responsibility for the recent surge in cases – after failing to implement a national lockdown in late January. 

France’s Hospitals May Have to Decide Which Patients Get Limited Resources

Over a dozen regions in France, including Paris, have been put under partial lockdown, but infections continue to soar, with 37,014 new cases reported nationally on Sunday. Some 20 million people are living in ‘high-infection zones’ and are under strict travel restrictions.

A healthcare worker in France caring for a COVID-19 patient in critical condition in April 2020.

In an article published on Sunday in Le Journal du Dimanche, 41 critical care doctors in Paris warned that “the current measures will be insufficient to quickly reverse the alarming curve in infections.”

In the coming weeks, the doctors predict an unprecedented situation for the French public health system – of triaging what seriously ill patients may receive intensive care.

“We have never seen such a situation, even during the worst moments of these last years,” the Paris-based group of physicians wrote.

“In this catastrophic situation, where there is a discordance between needs and available resources, we will be obliged to triage patients, in order to save as many lives as possible. This triage will concern all patients, COVID and non-COVID, in particular adult patients in critical care,” the doctors wrote. 

The number of patients in intensive care in France is already nearing the level seen during the last big COVID wave in the autumn of 2020. On Sunday, the number of patients in ICUs was 4,872, almost reaching the 4,919 ICU cases that were recorded during the country’s worst point in the pandemic so far.

France’s ICU beds were at 90% capacity, with the majority of cases linked to the B.117 variant. According to French healthcare workers, those with severe COVID illness are also younger than patients seen in the previous waves. Currently, a large portion of hospitalized patients are between 30 and 65 years of age.

“For the past year, French people have been bombarded with data and daily death tolls. And we don’t always realize what these figures mean: 300, 400 deaths every day – that’s like a plane crashing every day…We must not get used to these numbers, because if we do, the fight is lost,” Benjamin Clouzeau, an ICU doctor at Bordeaux Hospital, told Euronews. 

Germany Risks Nearing “Breaking Point” – Cases Could Reach 100,000 Per Day

Germany recorded 16,378 new cases on Sunday, up from 8,365 on 9 March. In total, the country has reported 2.7 million confirmed cases and 75,913 deaths. 

“The forecasting shows that if the measures are as they are now, the [new case] numbers could reach 100,000 per day…if this situation is not contained,” Lothar Wieler, President of the Robert Koch Institute – the governmental agency leading Germany’s pandemic response – said at a press conference on Friday. 

“At the moment, the figures are rising too fast and the variants are making the situation especially dangerous,” said Jens Spahn, the German Health Minister, at the joint press conference with Wieler. “If this continues unabated, we run the risk of our healthcare system reaching its breaking point during the month of April.” 

Jens Spahn, the German Health Minister, at a press conference on Friday.

Angela Merkel, Germany’s Chancellor, threatened to centralize Germany’s pandemic response, enabling the government to implement a strict national lockdown. Currently, the decision to impose a lockdown is up to the 16 federal states, several of which are refusing to put in place restrictions to curb the rising infection rates. 

“We need action in the federal states,” Merkel said in a televised interview on the public broadcaster ARD’s Anne Will talkshow on Sunday. “We need to take the appropriate measures very seriously. Some states are doing it; others are not yet doing it.”

Several states have plans to reopen despite the worsening public health situation.

“If we look at the numbers, including the developments today, we need another 10-14 days, at least, of properly driving down contacts and movements, a lockdown if you want to call it that,” Spahn said.

Central Europe Hit by Third Wave

Hungary, Estonia and Poland are also experiencing record high infection rates, among the worst in the world. The rapidly rising infections are forcing governments to tighten restrictions in an effort to halt the third wave.

Hungary recorded 7,263 new cases on Monday, making the total number of cases 641,124. Last week, Hungary claimed the grim record of having the world’s highest daily deaths per capita. 

In spite of the worsening situation, the government has plans to shorten the overnight curfew and extend the hours stores are allowed to remain open. Hungary’s Prime Minister, Viktor Orban, insisted there will be a “free summer” without restrictions on national radio on Friday. Virologist Miklós Rusvai predicted that Hungary would see the peak of the third wave in the coming days, while others speculate that the wave will be much bigger than expected. 

Hungary is largely relying on its vaccination campaign to combat the current surge in cases. Some 1.9 million people – 19.9% of the population – have received at least one COVID vaccine dose. Restrictions will ease once 2.5 million people have received the first dose.

Estonia became the country with the world’s highest COVID-19 infection rate in mid-March, with 886 daily new confirmed cases per one million people. On Sunday, Estonia recorded 1,175 new cases and 8 deaths.

Despite having several restrictions in place, Estonia saw infections rise by 10% in those over the age of 65 last week. Government officials warned that the country may have to go under a comprehensive lockdown over the summer if the spread of COVID cannot be curbed. 

Poland tightened restrictions over the weekend, closing kindergartens and hair salons and limiting the number of people allowed to attend church services, but stopping short of implementing restrictions on movement and imposing a nationwide lockdown.

“We have recorded a 25% growth of new infections week on week,” said Wojciech Andrusiewicz, a spokesperson for Poland’s Ministry of Health, on Monday. “For the time being, we have to expect bad scenarios, a growth of new infections, and, unfortunately, a growing number of deaths.”

Poland will increase the number of COVID-19 beds in hospitals by 3,000 this week, followed by another 3,800 next week. Over the past two weeks, the country has increased COVID beds by 10,000, including 1,000 equipped with ventilators. 

“We are a step away from the point when health services will be unable to treat patients properly…And we have to do all we can to avoid this scenario,” said Mateusz Morawiecki, Poland’s Prime Minister, at a press briefing on Thursday.

Image Credits: Euronews, WHO, Bundesministerium für Gesundheit.

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team. WHO team members say they have discounted a lab escape theory – other critics say their conclusions are too hasty.  WHO’s Director General says all hypotheses remain on the table.

All four original chains of query remain on the table in terms of the origins of the SARS-CoV2 virus, said WHO Director General Dr Tedros Adhanom Ghebreyesus at a press briefing on Monday. 

But his comments appear to contradict the leaked conclusions of the investigation which point towards a natural cause for the virus emergence among farmed wildlife. 

This is in contrast to the hypothesis that the virus had escaped from the Wuhan Virology Institute, an international centre for the study of bat coronaviruses – which critics have asserted should remain on the table until China provides more data.  

“All hypotheses are open, from what I read from the report, so I would suggest that… we wait until the international experts… face the public tomorrow,” said Tedros, speaking after a meeting with Gerd Müller, the German Minister for Development Cooperation.  

“The report of course was sent… under embargo to member states based on their request, because we will have a mission briefing tomorrow with member states,” Dr Tedros added, noting that a media briefing will follow Tuesday’s briefing to member states. 

“We will read the report and discuss, digest its content and next steps with member states. But as I have said all hypotheses are on the table and warrant complete and further studies, from what I have seen so far,” Tedros added.

The long-awaited report, due to be released Tuesday, is the fruit of an investigation by a group of international experts into the origins of the SARS-CoV2 virus, which included a mission to China by the 17 international team members in late January and early February – working in tandem with a 17-member Chinese team, designated by the government. 

WHO Team Members Have Different View

Wholesale markets in China traditionally sell wild animals, captured or bred, for food consumption, and which provide a breeding ground for viruses and virus variants dangerous to humans.

However, a leading member of the WHO investigative team said on Monday that the report pointed to the Chinese wildlife trade as the most likely source of the virus leap to humans – discounting a lab biosafety accident as a factor that is “extremely unlikely” according to the WHO report.  

“What we found is evidence of a way the virus could have emerged from rural China into a big city like Wuhan… at the end of the report, both the China team of experts & the WHO experts all felt this was the most likely pathway that the virus took,” said Peter Daszak, president of the EcoHealth Alliance, just ahead of the report’s formal presentation Tuesday before WHO member states. 

“One key recommendation… is to go to those farms & interview the owners, their relatives & test people to look for evidence on whether they were infected with Covid-19 earlier than the first known patients in Wuhan,” Daszak added. 

Large commercial farms that breed wildlife animals for human food consumption have been developed over the past years in remote Yunnan Province, near the Myanmmar border, with Chinese government support.  These same areas are home to horseshoe bats harbouring coronaviruses that genetically most resemble the SARS-CoV2 virus. These farms also supply wild foods – in fresh and frozen – to markets like those in Wuhan city where clusters of the virus first appeared. 

Other Critics –  Its  Premature To Discount Lab Escape Theory 

But another international expert told Health Policy Watch that it is far too early to rule out the possibility that the virus might have escaped from the Wuhan Virology Institute, which has been studying bat coronaviruses for years. 

Richard H. Ebright, a professor at Rutgers University, underlined that the hypothesis of a biosafety accident – or lab escape – should still remain on the table because there is as of yet insufficient evidence to either prove or discount it as China had limited the investigative team’s access,

“Zoonotic spillover occurring at a wildlife farm is one of several plausible scenarios under the zoonotic spillover hypothesis,” said Ebright, a professor of chemical biology. “At this point in time, there is no secure basis to assign relative probabilities to the natural-accident hypothesis and the laboratory-accident hypothesis,” Ebright told Health Policy Watch, adding that:   

“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 was one of some 26 scientists who signed an open letter in early March calling for a new, and more independent, investigation into the virus origins. The letter by a group of international experts stated the WHO mandated team did not have access to sufficient original data either from the Virology Institute, the first Wuhan patient clusters, or wildlife sources to make an independent determination about the virus origins.  

Virus Likely Originated From A Horseshoe Bat – But From Where? 

Ebright said he agreed that a coronavirus originating in horseshoe bats is the most likely progenitor of the virus.  But how the virus made the leap into the human body is another question. 

“The genome sequence of the outbreak virus indicates that its progenitor was either the horseshoe-bat coronavirus RaTG13 (collected by Wuhan Institute of Virology in 2013 from a horseshoe-bat colony in a mine in Yunnan province in which miners had died from a SARS-like pneumonias in 2012; partly sequenced by Wuhan Institute of Virology in 2013-2016; fully sequenced by Wuhan Institute of Virology in 2018-2019; published by Wuhan Institute of Virology in 2020) – or a closely related bat coronavirus,” Ebright told Health Policy Watch.  

“Bat coronaviruses are present in nature in multiple parts of China. Therefore, the first human infection could have occurred as a natural accident, with a virus passing from a bat to a human, possibly through another animal. There is clear precedent for this: the first entry of the SARS virus into the human population occurred as a natural accident in a rural part of Guangdong province in 2002,” Ebright continued.

However, terms of the possibility the virus escaped from a laboratory, he also notes that: “Bat coronaviruses are collected and studied by laboratories in multiple parts of China – including the Wuhan Institute of Virology.  Therefore, the first human infection also could have occurred as a laboratory accident, with a virus accidentally infecting a field collection staffer, a field survey staffer, or a laboratory staffer, followed by transmission from the staffer to the public.  

“There also is clear precedent for this: the second, third, fourth, and fifth entries of the SARS virus into human populations occurred as a laboratory accident in Singapore in 2003, a laboratory accident in Taipei in 2003, and two separate laboratory accidents in Beijing in 2004.”

Some other WHO international team members have also complained bitterly that politics took precedence over science on key aspects of the mission, and that Chinese authorities won’t turn over critical patient data that would allow the team to ascertain the breadth of the virus circulation in December 2019, as well as exploring the circumstances around likely cases in Wuhan that occurred earlier. 

US also Expresses Concerns About Transparency Of Report 

On Sunday, US Secretary of State Anthony Blinken also said that the US has “real concerns about the methodology and process” of the report, including the fact that Chinese government experts “apparently helped write it”. Blinken was speaking on CNN’s State of the Union. 

This follows last Friday’s comments by White House Press Secretary Jen Psaki that the US was concerned about the international team’s lack of access to data needed to evaluate the various scenarios that have been considered, including direct infection by an original source, such as a bat; infection of humans by an intermediate wild animal source; infection by a semi- or frozen food source; or the escape of the virus from a laboratory. 

“We’ll have to take a look at it and make sure we have access to the underlying information, Psaki said in a White House press briefing, criticizing the “lack of transparency from the Chinese.”

Meanwhile, Anthony Fauci, the chief medical advisor to the Biden Administration, took more of a wait-and-see attitude. “What I would like to do is to first see the report,” Fauci told CBS’s Face the Nation. “You’re getting a lot of conjecture around what they did and what they were allowed to do or not.”  But he added, “If, in fact, obviously there was a lot of restrictions on the ability of the people who went there to really take a look, then I’m going to have some considerable concern about that.”

Possible China Bias an Issue Since Beginning  

WHO’s Peter Ben Embarek, third from right, at 9 February Wuhan press conference on origins of the COVID-19 virus.

The possible “China bias” of the report, drafted by 17 international expert team members together with 17 Chinese experts, has been an issue since the team concluded its work in Wuhan in early February.  

At a joint press conference on 9 February, China’s team leader attempted to promote the idea that the virus had been imported into Wuhan via frozen foods, something that the WHO team coordinator Peter Ben Embarek later dismissed as unlikely. 

However, Ben Embarek suggested that wild animals arriving in Wuhan, either alive or in semi-frozen form, may very well be the virus source, and that the WHO needed more information about possible infection chains coming from farmed wildlife sources.  

Ben Embarek also said that over a dozen SARS-CoV2 virus strains were circulating in Wuhan in December 2019.  “The virus was circulating widely in Wuhan in December, which is a new finding,” he said.

He has since admitted that the WHO-led international team was still seeking Chinese government permission to access some 200,000 samples from Wuhan’s blood donor bank, which, if tested for virus antigens, could shed far greater light on the true prevalence of the virus in that period. 

“There are about 200,000 samples available there that are now secured and could be used for a new set of studies,” Ben Embarek told CNN. “It would be fantastic if we could [work] with that.”  

However, Chinese authorities have resisted sharing that data, claiming that they are only allowed to be used for litigation purposes. Said Ben Embarek. “There is no mechanism to allow for routine studies with that kind of sample.”  

The WHO team members also did not visit or obtain samples from the wildlife farms where the virus may have emerged naturally.

Image Credits: @PeterDaszak, CNN, Peter Griffin/Public Domain Pictures, CGTN.

CAPE TOWN – Johnson & Johnson (J&J) will deliver its COVID-19 vaccine to Africa from October after reaching an agreement with the African Union to supply the continent with up to 400 million doses over the next two years. 

However, Africa may still be struggling to obtain vaccine supplies for some months following last week’s decision by the Serum Institute of India (SII) to scale back its delivery of the AstraZeneca vaccine to the WHO co-sponsored COVAX global vaccine facility – in order to address domestic demand as COVID-19 cases soar in India. 

To date, the AstraZeneca vaccine has been the backbone of the COVAX facility’s ambitious roll-out of vaccines to dozens of low- and middle-income countries. But the SII suspension would interrupt the planned March and April delivery of some 90 more vaccine doses at a time when some countries have already used up their allotted supplies, and another 10 countries in Africa and 20 worldwide have yet to receive any vaccines at all.    

J&J CEO Alex Gorsky

 J&J CEO Alex Gorsky announced the deal with the AU’s “African Vaccine Acquisition Trust (AVAT)” on Monday saying that his company has been “committed to equitable, global access to new COVID-19 vaccines” from the start of the pandemic.

“Our support for the COVAX Facility, combined with supplementary agreements with countries and regions, will help accelerate global progress toward ending the COVID-19 pandemic,” he added.

AVAT can order up to 220-million doses this year and an additional 180 million doses in 2022, according to the company.

Single Dose and Efficacious Against Variant

The J&J vaccine only requires one dose, it can be stored in a normal fridge for up to three months.  It has been tested in diverse populations and it has shown be able prevent death and severe illness – even in the case of the more infectious B.1351 (501Y.V2) variant first identified in South Africa. 

J&J has also committed to providing its vaccine on a not-for-profit basis for emergency use during the pandemic.

The vaccine was granted Emergency Use Listing from the World Health Organization (WHO) on 12 March, Conditional Marketing Authorization from the European Commission on 11 March and Emergency Use Authorization by the US Food and Drug Administration on 27 February. The single-shot COVID-19 vaccine has also been granted Interim Order authorization in Canada on 5 March.

It is also being used to vaccinate South African health workers as part of an implementation study. The country abandoned its original plan to roll out the AstraZeneca vaccine after a small trial showed that vaccine was ineffective in preventing mild and moderate infection by the B.1351 variant.

South Africa announced on Sunday that it expected 2.8 million J&J doses at the end of April to expand its vaccination programme. It also announced that it had secured an order of 30 million doses from the company but did not divulge the expected delivery date of the bulk of its order.

J&J Tested on Diverse Populations

So far, the J&J vaccine is in fact the only vaccine to have been rigorously clinically trialled on the B.1.1351 variant that first emerged in South Africa and has now reportedly spread to some 16 other countries. 

Those states reporting on the presence of the B.1.351 variant, namely Angola, Botswana, Cameroon, Comoros, DR Congo, Eswatini, Gambia, Ghana, Kenya, Malawi, Mauritius, Mozambique, Namibia, Rwanda, South Africa, Zambia and Zimbabwe, according to the Africa Centers for Disease Control (CDC).

“The availability of the vaccine candidate is subject to its successful approval or authorization by the national regulatory authorities of AU member states,” according to the company’s press statement.

The J&J vaccine has been tested on almost 44 000 people from four continents, including 7,000 South Africans, most of whom were exposed to the B.1351 variant. The vaccine showed 57% protection against moderate disease, 85% protection against severe disease and 100% protection against death.

Globally, the J&J vaccine demonstrated a 67 percent reduction in symptomatic COVID-19 disease in participants who received the vaccine in comparison to participants given the placebo. 

In addition, South Africa’s Aspen Pharmacare will assist to manufacture the vaccine and support shipments to the AU member states, according to the company.

Gavi in Talks With Indian Government Over SII supplies

Meanwhile, lat last week the global vaccine alliance, Gavi, announced that COVID-19 vaccines produced by the Serum Institute of India to lower-income economies that as part of COVAX “will face delays during March and April as the government of India battles a new wave of COVID-19 infections”.

“COVAX and the Government of India remain in discussions to ensure some supplies are completed during March and April,” added Gavi

According to the agreement between Gavi and SII, the company is contracted to provide COVAX with the SII-licensed and manufactured AstraZeneca vaccine to 64 lower-income economies participating in the Gavi COVAX AMC, alongside its commitments to the Government of India.

 

Image Credits: NBC News.

Pakistani health workers getting vaccinated with donated Chinese Sinopharm vaccines.

ISLAMABAD – (EXCLUSIVE) A controversial plan to sell Russia’s Sputnik V COVID-19 vaccine to wealthy citizens in Pakistan has been put on hold following a dispute between the government and the private pharmaceutical company involved over the vaccines’ sale price, Health Policy Watch has learned.

Meanwhile, Transparency International – Pakistan appealed to Prime Minister Imran Khan to “cancel” the private importation of COVID-19 vaccines altogether, citing concerns with price and the potential for corruption.

“Pakistan is one of the first countries to allow the private sector to import and sell COVID-19 vaccines and [this] will provide a window of corruption, as there are possibilities some of the government vaccines may be sold to …private hospital[s],” Transparency International stated in a letter to the Prime Minister’s office, also obtained by Health Policy Watch.

Public health experts have also expressed disquiet about how a two-tier system would deepen inequality, allowing wealthy citizens who can pay to move to the front of the vaccination queue. 

The arrangement would also enable private buyers to obtain a vaccine [Sputnik V] whose clinical trial results have significantly outperformed the donated Chinese Sinopharm vaccines that are currently being rolled out by Pakistan’s public health authorities to health workers and other priority groups.

And the vaccine deals set a precedent for other low- and middle-income countries. Along with Pakistan, Brazil, Indonesia, and the Philippines, as well as Thailand and the United Arab Emirates are also reportedly weighing, or in the process of creating, a private market vaccine channel.

Government Initially Gave Sputnik Sales Go-ahead

In early February, Pakistan health authorities granted emergency use authorization for Russia’s Gam-COVID-Vac (Sputnik V) vaccine and gave permission to Ali Gohar Pharmaceutical (AGP), a private pharmaceutical company, to import and sell the vaccine.

Last week, AGP brought the first shipment of 50,000 Sputnik V doses into Karachi – but disagreement over price has put the private vaccination rollout on hold.

Initially, the government had approved private importation without fixing a price. But it later classified COVID-19 vaccines in the “hardship” category of medicines, which enables the Drug Regulatory Authority of Pakistan (DRAP) to set a maximum price.

The government then fixed the sale price at around $55 for two doses. But AGP says this is too cheap, while Transparency International believes is too high.

According to Transparency’s letter to Prime Minister Khan, “the federal cabinet has fixed the maximum retail price of Sputnik-V Russian vaccine at PKR8449 (US$54.46) for two doses and China’s Conividecia at PKR4225 ($27.30) per injection”.

However, said Transparency, the global price set for the Sputnik-V is $10 per dose.

“This means that, internationally, the two doses of Sputnik V are available at $20. However, the approved price for its commercial sale in Pakistan is 160% higher than the international price,” said the letter.

The price cap came from the Ministry of National Health Services Regulations and Coordination (NHSRC). Confirming this, NHSRC secretary Aamir Ashraf Khawaja also defended the government’s decision of allowing the private sector to import COVID-19 vaccine.

Russian military personnel receive Sputnik V vaccine

In a letter written to Transparency, Khawaja said that Pakistan remains committed to fighting COVID-19 with “everything available” at its disposal, including private vaccinations.

“This is expected in a large country like Pakistan, with a population over 220 million. The government, therefore, as a deliberate policy tool, allowed private sector to import vaccines to cater to those segments of the society which were not on the immediate priority list of the government,” said Khawaja in his letter.

“Government is fixing the maximum retail price, leaving room for competition and free market dynamics. It may also be added that COVID-19 vaccine market dynamics entail the sale in large quantities, typically in millions, and it is not easy for small players to access small number of doses,” said the letter.

Company Has Reservations About Price Cap

When asked for its response to DRAP’s decision to cape the price on privately imported vaccines, the AGP official said that “obviously company has reserved some appropriate steps about it”. 

Sources close to the company said that it had been planning to sell the double-dose vaccine for at least $70 and it may not sell its current stock at all now.

Meanwhile, DRAP spokesperson Akhtar Abbas said that medicine prices are fixed by the federal government and DRAP can only recommend prices on technical grounds.

He said that the reconsideration of the Sputnik-V vaccine set price was possible only on the advice of the federal Cabinet and, as far as he knew, Cabinet had not passed any directions to the regulatory authority.

Abbas added that if the company had any reservations about the pricing of the vaccine, it must submit these to the pricing committee of the DRAP.

Ellen ‘t Hoen, from South Centre, said that although the World Health Organization (WHO) had not finished assessing Sputnik’s efficacy and safety, the vaccine has been approved for emergency use by certain countries.

She added that it was “only a matter of time” before COVID-19 vaccines became “big business”. She also said that now India is planning to impose export controls on vaccines, more countries will start to look at China and Russia for supply.

Pakistan has given Emergency Use Approvals to a number of vaccines, including the Pfizer, AstraZenca, SinoPharm and Conividecia vaccines, as well as Sputnik-V.  However, so far only the Chinese-donated SinoPharm is being administered to healthcare workers and people above age 60.

Meanwhile, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said its members were not focusing on selling vaccines to private companies.

 “The major international vaccine makers, who are members of our federation, fully appreciate the public health emergency and therefore are focusing all their efforts on meeting the requests of governments or their appointed health authorities; as well a COVAX,” said IFPMA Director General Thomas Cueni.

The manufacturer of Sputnik V has submitted dossiers to the World Health Organization (WHO) and the European Medicines Agency for approval.  In February, a peer reviewed study of Sputnik’s clinical trial reults in The Lancet  found it to be safe and effective.

Asked to comment on the reports of the private market vaccine arrangements being laid in Pakistan and other countries, neither WHO’s Pakistan country office, nor WHO’s global headquarters in Geneva, had replied as of press time.

Image Credits: Ministry of Defence of the Russian Federation.

The manufacturing of the Oxford/AstraZeneca COVID-19 vaccine.

The European Medicines Agency (EMA) has officially authorized expanded capacity in three new vaccine manufacturing facilities on the continent producing AstraZeneca, Pfizer/BioNTech and Moderna vaccines – a move that the agency says should also help pharma suppliers ramp up their deliveries of now scarce vaccines to European Union bloc countries. 

At the same time, a surge of COVID cases in India has threatened a major supply chain of AstraZeneca vaccines to lower-income countries, produced by the Serum Institute of India (SII). 

The EMA statement issued on Friday, said the approval of the Halix manufacturing plant in The Netherlands, producing the AstraZeneca vaccine’s active substance, along with approvals of another Pfizer plant and a Moderna plant expansion, should “increase manufacturing capacity and supply of COVID-19 vaccine supplies in the EU,” after weeks of vaccine shortages and disputes with manufacturers over delivery delays. 

But it was unclear whether the EMA moves would also help ease  tensions between Europe, the United Kingdom and low- and middle-income countries (LMICs) over scarce vaccines, and particularly AstraZeneca supplies.  In the case of AstraZeneca, the newly EMA authorised plant was already producing vaccines that were being  shipped abroad.  

AstraZeneca is the major vaccine supplier to LMICs – through the WHO co-sponsored COVAX initiative. Some of the AstraZeneca doses bound for COVAX are also manufactured in Europe, including at the Halix plant, one of four operated by the pharma firm in the EU. 

Gavi Announces Delays in COVAX  Supplies From India  

At the same time AstraZeneca expands in Europe, the Serum Institute of India, which is the largest single supplier to the COVAX facility, is diverting some of its promised doses to meet India’s domestic needs. This, in the face of a major COVID surge on the subcontinent. 

The delays in delivery to COVAX of some 90 million AstraZeneca doses to some 64 low-income countries was announced Thursday by Gavi, the Vaccine Alliance – which is co-sponsoring the COVAX facility alongside the World Health Organization. 

“Deliveries of COVID-19 vaccines produced by the Serum Institute of India (SII) to lower-income economies participating in the COVAX Facility will face delays during March and April as the Government of India battles a new wave of COVID-19 infections,” said the Gavi statement. 

To date, COVAX has been supplied with 28 million AstraZeneca vaccine doses produced by SII, and was expecting an additional 40 million doses in March, and up to 50 million doses in April, according to the Gavi statement. 

The announcement set no new date for the deliveries, saying only that, “COVAX and the Government of India remain in discussions to ensure some supplies are completed during March and April.”

Pfizer & Moderna Sites Approved 

Among the other sites to now have received formal EMA approval, are a Pfizer facility in Marburg, Germany, which began production in February of both active substances and finished vaccine products – joining three other Pfizer manufacturing sites in the EU. EMA storage guidelines of the Pfizer vaccine were also relaxed, allowing the transport and storage of vials between -25 to -15˚C, instead of the previous requirement of -90 to -60˚C, based on updated evidence that the vaccine’s ultra-cold requirements are less extreme than previously thought. 

Meanwhile, the EMA approval of an expansion in Moderna’s vaccine manufacturing site in Visp, Switzerland, will enable the company to fulfill a major new order for an additional 150 million doses of the mRNA vaccine to the bloc, purchased in February, and due to be delivered in the third and fourth quarters of 2021.  That is in addition to 160 million Moderna doses already purchased earlier, a Moderna spokesperson said, noting that the deliveries of a total of 310 million Moderna doses for 2021 remain on track. The EU also has the option to purchase an additional 150 million doses for delivery in 2022, Moderna has said. The vaccines are being produced in Visp by the Swiss-based company Lonza, with which Moderna forged a partnership in 2020.

Moderna’s active vaccine ingredient has been produced at the Visp site since mid-December; that is then sent to Spain or France for “fill and finish”.  Swissmedic, Switzerland’s regulatory agency, also granted approval to the expansion of the Visp site 15 March.  A total of 6 million Moderna vaccine does are to be delivered to the Swiss Confederation in the first six months of 2021, out of a total contract of some 13.5 million doses – an agreement that is separate from the EU purchase.   

India Retains Vaccines As New COVID Wave Threatens Country 

India’s decision to temporarily curtail exports by the Serum Institute, the world’s largest COVID vaccine manufacturer, comes on the heels of a new COVID infection wave. 

Some 47,474 new infections and 225 daily new confirmed deaths were recorded on Thursday, a sharp increase from two weeks ago – bringing India up to 11.8 million total cases and 160,949 total deaths. The spike in cases is likely due to the relaxation of restriction and public health measures over the past couple weeks, experts said. 

Only 3.4% of the population has received at least one dose of a COVID-19 vaccine. Over 55.5 million doses have been administered in a country of 1.3 billion, a rate which is much slower than in the United Kingdom, US, and Israel. 

India’s Pivotal Export Role Means Big Ripple Effect For Delays 

India has exported over 60 million doses of the AstraZeneca COVID-19 vaccine to 77 countries, including supplying 28 million doses to COVAX, which have been distributed to over 50 countries.

But now, the Indian government is reportedly keeping the majority of the 2.4 million doses that SII produces daily to expand its domestic immunization campaign. Vaccinations will open to those over the age of 45 in early April, with the goal of inoculating 300 million people by August, according to the government.

In a press briefing on Thursday, John Nkengasong, director of the Africa Centres for Disease Control and Prevention, noted the supply interruptions, saying that he “truly feels helpless that this situation is going to significantly impact our ability to fight this virus.”  

John Nkenkasong, Director of the Africa Centres for Disease Control, appealed for equitable distribution of COVID-19 vaccines on Thursday, saying there was no need for a vaccine war.

However the Serum Institute site is not the only one in the AstraZeneca network, and hopes are that vaccines from elsewhere can still be recruited to fill the supply chain to low-income countries in need. 

“AstraZeneca, which uses a novel supply chain network with sites across multiple continents, is working to enable initial supply to 82 countries through COVAX in the coming weeks,” noted the Gavi statement. 

At least 10 African countries have yet to receive any COVAX vaccines whatsoever – along with another 10 other low-income countries elsewhere in the world. 

Impact of Tightening Export Restrictions on Global Vaccination Campaigns

Beyond the COVAX facility, SII is critical in the broader global supply chain of AstraZeneca’s vaccine. India exported five million doses to the UK, four million to Brazil, seven million to Bangladesh and three million to Saudi Arabia in January and February through direct commercial deals.  

The delays in India’s vaccine deliveries could thus disrupt vaccination campaigns globally and may even cause some campaigns to temporarily halt, as in the case of Nepal. Nepal received a total of 2.3 million doses from India between January and March, partly through COVAX, commercial deals, and a donation from India.

Nepal suspended its vaccinations on 17 March due to an insufficient supply of doses. India’s export restrictions “will affect us and the entire world,” said Jhalak Sharma, chief of Nepal’s National Immunization Program. 

“Many countries around the world, poorer ones in particular, are counting on India,” said Olivier Wouters, assistant professor of health policy at the London School of Economics, in an interview with the New York Times.

Indian government officials have so far refuted claims that India has imposed a vaccine export ban, as such, although officials have also conceded that “everything other than India is on hold for the time being; India is the priority.”

New Rules Allow States To Block Export Requests To Countries With High Vaccination Rates – LMICs Exempted

Earlier this week, the European Commission tightened rules by which member states reject vaccine export requests, under an emergency mechanism that will be in place for the next six weeks. 

However, low- and middle-income countries that are part of the COVAX’s “Advance Market Commitment” list would be exempted from the export restrictions, as the EC affirmed its commitment to “international solidarity…[and] humanitarian aid.” 

While the decision to authorise or reject export requests will still be left up to member states, the rules specifically allow states to block shipments to countries that have a higher vaccination rate than the EU – which only has 10% of its population vaccinated. 

Countries may also weigh export requests in light of the epidemiological situation in the destination country, and whether the destination country for the doses restricts its own exports of vaccines or raw materials. 

The policy is expected to affect the UK the most, although Israel and Canada could also be impacted by the stricter export rules – Canada depends on the EU for almost its entire vaccine supply. 

Since December, a total of 77 million doses have been exported from the EU and the UK has received 21 million of these doses, Ursula von der Leyen, President of the European Commission, highlighted at the virtual Euro Summit on Thursday. 

“While our Member States are facing the third wave of the pandemic and not every company is delivering on its contract, the EU is the only major OECD producer that continues to export vaccines at large scale to dozens of countries,” said von der Leyen in a press release on Wednesday. 

“We want to make sure that Europe gets its fair share of vaccines,” and that exports don’t “risk [the] security of supply in the European Union,” said von der Leyen at a joint press conference with Charles Michel, President of the European Council, on Thursday.

“With this mechanism we have a certain leverage, so we can engage in discussion with other major vaccine producers,” said Valdis Dombrovskis, European Commissioner for Trade, at a press briefing. 

UK Issues Mild Reaction – Member States Stop Short of Backing New Regulations

A spokesperson for the British government responded to the new rules, saying: “We are all fighting the same pandemic – vaccines are an international operation…And we will continue to work with our European partners to deliver the vaccine rollout.”

At the Euro Summit on Thursday, EU leaders emphasized that they would not damage supply chains essential for the production and distribution of vaccines, despite the vaccine shortage crisis.

“Regarding the export regime we said we had absolutely no desire to disturb the global supply chain, but also that we of course have an interest in ensuring that the companies that have made contracts with us remain truly loyal to those contracts,” Angela Merkel, the German Chancellor, told reporters. 

“We are, as the EU, the part of the world that is not only supplying itself but also exporting to the wider world – unlike the US, unlike Britain,” she added.

The move to expand restrictions was criticized by pharma executives. 

“Should it really come to export restrictions, that would be a ‘lose-lose’ situation for everyone, also for the members of the European Union,” said Sabine Bruckner, the Swiss country manager for Pfizer. 

A statement by the European Council, which represents EU member states, issued a diplomatically worded statement that avoided endorsing the new European Commission policy – saying only that “accelerating the production, delivery and deployment of vaccines remains essential and urgent to overcome the crisis.”

-Updated 29.03.2021

Image Credits: AstraZeneca, AstraZeneca.

WHO Director-General Dr Tedros Adhanom Ghebreyesus

COVAX has run out of COVID-19 vaccines to supply the last 20 countries in the world that have not yet started vaccinations, and it urgently needs a donation of 10 million doses from either manufacturers or countries that have piiled up surplus doses, according to World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus.

While 36 countries have not yet started vaccinations, 16 of these are due to receive COVAX deliveries within the next two weeks, Tedros told the WHO bi-weekly pandemic briefing on Friday.

“That leaves 20 countries who are ready to go and waiting for vaccines. COVAX is ready to deliver, but we can’t deliver vaccines we don’t have,” said Tedros, who set a global target of vaccination drives in all countries within the first 100 days of 2021.

He blamed “bilateral deals, export bans, vaccine nationalism and vaccine diplomacy” for causing delays in “tens of millions of doses” for COVAX. 

“COVAX needs 10 million doses immediately as an urgent stop-gap measure so these 20 countries can start vaccinating their health workers, and older people within the next two weeks.”

Although the WHO director refrained from mentioning any countries by name, India’s Serum Institute, the world’s largest vaccine manufacture, has interrupted planned deliveries to COVAX in March and April of tens of millions of AstraZeneca doses, diverting the vaccines to domestic use following a new spike in cases in the country. The suspension of deliveries was confirmed by Gavi, The Vaccine Aliance on Thursday.  (see related story).

‘Plenty’ of Countries That Can Afford to Donate

Appealing for donations of vaccines that have WHO emergency use listing (EUL) from manufacturers and countries, Tedros said that “there are plenty of countries who can afford to donate those with little disruption to their own vaccination plans”.

Only Pfizer, Moderna and AstraZeneca have WHO EUL. Four vaccines at different stages in the process of being assessed for EUL, and “at least one” was expected to be approved by the end of April, according to Tedros.

So far, 177 countries have started vaccinations, and COVAX has distributed more than 32 million vaccines to 61 countries in a single month. 

WHO’s COVAX representative, Bruce Aylward, acknowledged that political leaders were under incredible pressure from their citizens to deliver vaccines but stressed that “it’s the right thing to do to make sure everyone has access to vaccines”.

“We also have an economic reason to get to the world’s economy going, and we also have a health security reason because of variants,” stressed Aylward.

Criminals, Corruption and Fake Vaccines

The Director-General also warned of the danger of criminals exploiting the “huge global unmet demand for vaccines” and urged people not to buy vaccines outside government-run vaccination programmes as these could be “sub-standard or falsified”.

“A number of ministries of health, national regulatory authorities, and public procurement organisations have received suspicious offers to supply COVID-19 vaccines,” warned Tedros.

“We’re also aware of vaccines being diverted and reintroduced into the supply chain, with no guarantee that cold chain has been maintained. Some falsified products are also being sold as vaccines on the internet, especially on the dark web,” he warned.

WHO’s technical lead on COVID-19 Maria Van Kerkhove

Maria van Kerkhove, WHO’s Technical Lead on COVID-19, said that there had been a 15% increase in COVID-19 cases in the past week, with all six WHO regions showing increases.

She stressed that while “we might be tired of the pandemic, it is not finished with us”, and that masks, hand-washing and our “mixing patterns” were the only measures that could keep us safe in the face of the global shortage of vaccines.

“Fifteen months in, people want this to be over, but we still have to put in the work. All of us have a role to play here in reducing transmission and this includes during holidays,” stressed Van Kerkhove, referring to the looming Passover and Easter holidays.

“All of us want to spend time with our families and travel around and, and there are safe ways to be able to start to do this, but we need to think about what each of us are doing every day. We will get to a point where this pandemic will be over. I promise we will get there, but we need to put in the work now to drive transmission down,” she stressed.

 

Kenya’s capital, Nairobi and four other counties go into lockdown as COVID-19 cases surge

NAIROBI – Kenya has suspended parliament and banned church gatherings in its capital, Nairobi, and four other counties as the country records its highest number of COVID-19 deaths since the pandemic started last year and amid a surge of positive cases.

President Uhuru Kenyatta on Friday announced partial lockdown and instituted new curfew measures to start from 8pm to 4.00am, the suspension of county assemblies and the closure of bars in Nairobi as the country experiences a third wave of the deadly virus.

The four counties affected by the lockdown are Kiambu, Nakuru, Machakos and Kajiado.

He said the number of confirmed COVID-19 cases had increased to 15,916 on 21 March, up from 4,380 in January. The  positivity rate has jumped from 2.6% to 22% in the same period. The lockdown was necessary to avert a health crisis.

“This tells us that our rate of infection has gone up 10 times between January and March 2021. Indeed, it is a clear indication of a new trend, that now Kenya is squarely in the grip of a third wave of the Pandemic,” said Kenyatta, adding that the peak is likely to flatten by mid-May.

Data shared by the Ministry of Health on Friday showed that 1,463 people tested positive for COVID-19, from a sample size of 8,976 tested in the last 24 hours – 26 deaths had been reported in the last 24 hours.

A total of 1,080 patients are currently admitted in various health facilities countrywide, while 3,825 patients are on Home Based Isolation and Care.

Some 121 patients are in intensive care units, 35 of whom are on ventilatory support and 77 on supplemental oxygen, nine patients are on observation, 81 patients are on supplementary oxygen with 68 of them in the general wards and 13 in the High Dependency. Kenya has one of the highest cumulative incidence rates among the African Union member states in the Eastern region.

Strict Lockdown Regulations

Kenyatta said the spike in new cases called for urgent and drastic measures and that lockdown was crucial to avert a national health crisis. Some of the lockdown rules include:

  • Suspension of gatherings at places of worship in the five counties;
  • Banning of the sale of alcohol and suspending the sale of alcohol at bars and restaurants;
  • Meetings or events including social gatherings are limited to 15;
  • Funeral, cremations and other interment ceremonies, must be conducted within 72 hours of confirmation of death; and limited to 50 mourners and
  • People travelling to Kenya must be in possession of a negative COVID-19 PCR Certificate, acquired no more than 96 hours prior to arrival; with the PCR Certificate also having been validated under the Trusted Travel platform for those travelling by air.

Spike in New Cases Likely Drive by Two Variants

Kenya’s increasing COVID-19 cases are likely driven by the highly transmissible variants of concern B.1.1.7 and B.1.351 detected in January, according to a report released by the Africa Centres for Disease Control on 23 March.Scientists say although there are increased cases of variants the lack of adherence to COVID-19 protocols is also leading to increased infections.

Professor Joachim Osur, technical advisor for programmes at AMREF Africa, says Kenya was experiencing high infection rates among communities. He said hospitals are getting overwhelmed, Intensive Care Units (ICU) in hospitals are full, not everyone needing ICU care is getting it and the number of deaths is steadily increasing.
“I think the reason is that we stopped taking precautions,” said Osur, adding that people started behaving irresponsibly when schools, churches and markets re-opened.

“I am worried that schools are running and children who are super spreaders are infecting the older populations,” said Osur.

More Surveillance Needed To Curb Further Infections

“It has to be a systematic analysis to see that the variant has evolved over time,” says  John Nkenkasong, head of Africa CDC.

“Unfortunately Kenya is not technologically competent enough to be monitoring the strains of the virus we have and the mutations that are happening. So, we are unable to know at this point if it is the variants but it could be a reason,” said Osur. “Mutations happen everyday but it is possible that we have more than one variant and it is possible that they are more aggressive.”

Earlier this week Nkenkasong said additional resources and efforts are required to track the virus through surveillance. He said vaccinations should continue. “We do not think the situation in Kenya has evolved to a threshold past where the vaccine should not be used,” he said.

The vaccine uptake in Kenya has been slow with only 640, 000 people vaccinated so far. On 3 March Kenya received 1 million Oxford/AstraZeneca vaccines from the COVAX facility.

“These simple public health measures are what will save us but people are not taking them seriously. The responsibility relies on individuals- more community education is needed on what this virus is and what it should be done to the community,” said Osur.

Image Credits: US news.

Last Ebola patients leave a treatment centre in the Democratic Republic of Congo this week, marking the countdown to declaring the end of the pandemic.

(Geneva Solutions) – As Guinea and the Democratic Republic of Congo discharge their last Ebola patients, following the most recent outbreak, new research points to the virus’ long lasting ability to lurk within the body. So while the 42 day countdown begins to the day when both countries can declare that the current outbreak is over, preparedness remains key to heading off future infections everywhere in the region, warns the International Federation of Red Cross and Red Crescent Societies (IFRC).

With no more confirmed cases and the discharge of the last Ebola patient from a health centre in DRC’s Katwa city on Monday, followed by the discharge of the last Ebola patient in Guinea, on Tuesday night, the latest outbreak of Ebola virus in central and west Africa ma now have ended.

However, global health officials warn that vigilance needs to remain high.  That is particularly true, in light of the recent evidence that the Guinea outbreak was apparently triggered by an Ebola survivor who carried the virus unknowingly for five years before transmitting it to someone else.

The Republic of Guinea was one of the countries at the center of West Africa’s Ebola virus epidemic that raged from 2014-2016 claiming 11,000 lives.  The DRC faced a major outbreak in 2018, that concluded a year later, but has been followed by others. During the most recent DRC outbreak in February, 12 cases were confirmed leading to six deaths – while 1,737 people were vaccinated against the virus, according to the WHO – with IFRC teams on the ground providing key support.

“The main objective of the Red Cross’ intervention on the ground, over the past two years or so, is to ensure Ebola is contained, and does not spread to other areas and across borders into countries such as South Sudan and Rwanda,” Dr Balla Conde, who is managing the IFRC response on the ground with a team of 100 health workers, told Geneva Solutions.

In the case of Guinea, the outbreak declared on 14 February 2021 in the N’Zerekore region led to 14 confirmed cases, leaving five people dead.   However, the even more worrisome aspect of the current Guinea outbreak was its apparent source – a survivor of Guinea’s previous 2014-2016 outbreak who appears to have harbored the virus for as long as five years, before infecting someone else.

“”Patient O” in 2021 Guinea Outbreak Harbored the Virus for Five Years.

The new research findings about “Patient O” of the 2021 outbreak in Guinea hold serious implications for the longevity of one of the world’s most deadly pathogens.

The discovery was made in the course of contact tracing and genetic sequencing of virus strains in Guinea’s present-day patients, which linked those cases back to strains prevalent in 2014 and a recovered patient from that time, according to three independent studies released. Given the lengthy interval between the two events this comes as a “shock” to virologists.  It had been previously believed that the outbreak was transmitted by an animal such as a bat.

“This is absolutely stunning,” Dr Angela Rasmussen, a virologist at Georgetown University in Washington DC, wrote on Twitter, adding. “This is bad for a whole host of reasons, including the further stigmatization of Ebola virus disease survivors.”

Previously, the longest reported duration of virus persistence in an EVD survivor was 531 days, reported on in 2016. That case involved  a 56-year-old survivor whose seminal fluid contained the virus 17 months after the onset of the disease.  According to the reports, he sexually transmitted the virus to someone else in early 2016, triggering further infections in Guinea, one of which was carried back to Liberia.

While it is rare for survivors to harbour and transmit the virus after such a long period, scientists now understand that the virus can remain in the body for a sustained period of time in places such as the eyes, spinal cord and testes – which are not easily reached by immune defences.

Naomi Nolte, IFRC emergency communication coordinator, called the new research findings “worrying” – although she emphasised that the findings remain preliminary.

The overriding message, she said, is that people must “remain vigilant, keep physical distancing, disinfect spaces and ensure that people have all the right information.”

Teaching community workers about Ebola surveillance

 

Potential for EVD Sexual Transmission Could Stigmatise Ebola Survivors.

Reports linking some of the episodes of virus resurgence to sexual transmission could wind up stigmatising  Ebola survivors, warned Gwen Eamer, public health expert in emergencies at the IFRC.

“Although the findings of the virus sticking around for a long time may be true, it is important that we do not jump to conclusions that it is due to sexual transmission as this has very real impacts on survivors,” said Eamer.

Surveilance Key to Containment

Meanwhile, IFRC officials said that they are supporting local health systems by building capacity for community-based disease surveillance. In these cases, trained community volunteers seek out and report cases of people whose symptoms appear to meet EVD definitions, and take blood samples to confirm suspected cases.

Such training is vital as many common illnesses, including influenza, malaria, typhoid and cholera have similar symptoms of vomiting, and fever to Ebola.

Another pillar of preparedness is ensuring safe and dignified burials – since the Ebola virus is also very easily transmitted after the person has died of the disease.

“We know from the previous outbreak in Guinea and neighbouring countries that burials and funerals were key drivers of transmission, because of traditional burial practices that involve touching the body,” said Eamer.

To ensure “safe and dignified burials, we provide the team with personal protective equipment,” said Eamer, adding that the teams actively support the family, while “adapting funeral rituals ensuring that the dignity of the deceased remains intact, taking into account the mental health, social, cultural and religious perspectives.”

There is a higher level of trust today between communities and Red Cross field workers – something that represents a very positive shift from the 2013-2016 Ebola epidemic – and makes it easier for the organization to do it’s work, adds Nolte.

She adds that Covid-19 also has highlighted to policymakers the importance of preparedness for other highly contagious viruses, e.g. Ebola, which pose “perpetual” threats to countries’ economies and societies.

However, the new research findings have also renewed calls for more widespread EVD immunisation campaigns across larger parts in West and Central Africa.

That would require more funding, including some 8.5 million Swiss francs that the Red Cross says it needs for the Ebola response – which has only garnered less than a one million so far.

“We really don’t want to wait for another humanitarian shock like we had during the last outbreak in Guinea in 2013-2016 or are in DRC between 2018 and 2020,” said Nolte.

  • Updated on 25 March, 2021
Originally published in Geneva Solutions. Health Policy Watch Watch is collaborating with Geneva Solutions, a non-profit platform for constructive journalism covering International Geneva

Image Credits: WHO African Region, Geneva Solutions .

european commission
Katalin Cseh a Hungarian MEP associated with the  Renew Europe Group.
EP Plenary session – Preparation of the European Council meeting of 25 and 26 March 2021 and Digital Green Certificate

European Parliament members (MEPs) expressed overwhelming support for a coronavirus-related “Digital Green Certificate” to ease travel within the European Union, voting by a more than two-thirds majority to accelerate approval by the summer.  

But parliamentarians also warned that all efforts to recover from COVID-19 will be void unless Europeans are vaccinated more quickly. 

“We need to speed up vaccination – that is the only light at the end of the tunnel,” said Katalin Cseh a Hungarian MEP associated with the  Renew Europe Group, on the opening day of a two-day debate at the European Union Summit  happening today and tomorrow on the “Digital Green Certificate”.

“We need to increase production capacities to set up more ambitious targets for deliveries to work together with manufacturers, and also to ramp up production,” said Cseh. 

“Only vaccines can offer us a way out of the crisis; we need to do our utmost to help boost vaccine production and ensure more transparency, predictability, and supply of the vaccines, so that we can speed up the vaccination campaigns across the EU,” said Ana Paula Zacarias of Portugal. 

The majority of the MEPs who took the floor said the Digital Green Certificate proposed by the European Commission on 17 March, would support the much-needed recovery of the travel and tourism sector. 

With 468 votes in favor, 203 against, and 16 abstentions, MEPs took advantage of an urgency procedure (Rule 163), which allows for faster parliamentary scrutiny of the Commission’s proposals. The MEPs will next mandate negotiations over the proposal, to be considered during the parliament’s next plenary session (26 – 29 April). 

Certificate To Offer Proof of COVID Vaccination, Recovery Or Negative Test Result
digital green certificate
The stages of the Digital Green Certificate System in practice.

The certificate would be free of charge, in digital or paper format, with a QR code to help ensure security and authenticity.  It would offer proof that a person has either been vaccinated, received a negative test result, or recovered from COVID-19, and has antibodies. 

Other key provisions are that the certificate will be recognized in every EU member state, and it will pave the way for the establishment, or re-establishment, of  full freedom of movement inside the EU during the COVID-19 pandemic. 

“The Commission will build a gateway to ensure all certificates can be verified across the European Union, and will support member states in the technical implementation of certificates,” said Commission Vice-President Maroš Šefčovič. Šefčovič said the Commission aims to have the system in place by June. 

MEPs Call For Legal Action Over AstraZeneca Vaccine Delays & Unreported  Doses 
AstraZeneca vaccine

In terms of speeding up Europe’s vaccine rollout, the MEPs focused most of their fire on the recent AstraZeneca delays in vaccine deliveries. 

Concerns over the failure of the company to meet its EU commitments have been compounded by the  recent discovery of almost 30 million undelivered AstraZeneca doses stashed  in an Italian factory. 

During the debate,  several MEPs speakers called for legal action against the manufacturer.  

Iratxe Garcia Perez, Group of the Progressive Alliance of Socialists and Democrats in the European Parliament, Spain, called the reports about AstraZeneca’s undelivered doses “the straw that broke the camel’s back.” 

“We’re not talking about the fact that they are not complying with their commitments and the contracts. Basically, they’re laughing at us in our faces,” she said. 

The AstraZeneca vaccines were discovered by Italian police in a raid of a factory in Anagni, a town near Rome.  Italian government officials were reportedly unaware of the vaccine stash until the EU’s internal market commissioner, Thierry Breton, launched an investigation, and then tipped off Italian police, according to the Italian newspaper La Stampa. 

Some EU sources said that the jabs had initially been bound for the UK – before being  blocked by Italy after the country introduced new rules on vaccine exports, EU sources told the paper. 

However, in a statement on Wednesday, AstraZeneca said that 16 million of the vaccine doses were simply awaiting quality control to be disbursed to EU countries.  

Another 13 million doses were manufactured outside of the EU, and then brought to the plant for the “fill and finish” process of putting the vaccine into vials, the company said. These doses are awaiting shipment to low and middle-income countries, in the framework of the WHO co-sponsored COVAX global vaccine rollout initiative, which is supported by the EU. 

“It is incorrect to describe this as a stockpile. The process of manufacturing vaccines is very complex and time consuming. In particular, vaccine doses must wait for quality control clearance after the filling of vials is completed,”  the company said.  

Garcia Perez and other MEPs, however, blamed  AstraZeneca for still moving too slowly on the EU vaccine deliveries. 

“[We] have to act firmly and take actions against a pharmaceutical company because they are undermining the prestige of other companies that are meeting their obligations. So I would urge the Commission to get down to work and do something about this flagrant attack against the commitments that the company undertook, “ said Garcia Perez. 

Independence From Pharma, Though Not Through Export Ban 
Martin Schirdewan, of The Left Group in the European Parliament, Germany.

Although several MEPs called for legal action against AstraZeneca to restrain it from exporting vaccines to the UK and elsewhere in the world, others warned that an export ban could result in further delays in Europe’s vaccine rollout. 

“Export bans can lead to retaliatory measures and that could lead to lower production of vaccines in the EU. We could end up in the worst possible situation where nobody benefits,” said Martin Schirdewan, of The Left Group in the European Parliament, Germany.

Schirdewan, however, called on the European Commission to “give up all contracts with the pharmaceutical companies and release the patents to produce the vaccines.” 

“We have made ourselves dependent on the pharmaceutical companies. We have made ourselves dependent on a market that regulates nothing, shown clearly by AstraZeneca stockpiling 29 million doses in Italy that have just been accidentally discovered.” 

“Let’s create a joint European strategy that we can use to combat the virus. Let’s coordinate healthcare, let’s deal with the social and economic consequences of this pandemic for our populations.” 

 

Image Credits: Jan Van De Vel, European Commission, gencat cat/Flickr, Alexis Haulot.