Rumours about the whereabouts of Tanzanian president John Magufuli, are intensifying as the leader who questioned the existence of the SARS-CoV2 virus was reportedly in intensive care with COVID-19 – somewhere in Nairobi or possibly now even in India.

Magufuli has not been seen for almost two weeks, sparking widespread speculation about his health. His absence is unusual as he is known for making frequent public speeches and appearing on state television several times a week.

Tanzanian opposition leader, Tundu Lissu, who lost last year’s election to Magufuli, tweeted on Thursday that the president had been transferred from a hospital in Kenya to India – although he did did not provide evidence:  “His COVID denialism in tatters, his prayers-over-science folly has turned a deadly boomerang!” Said Lissu in a tweet. 

But Tanzania’s Prime Minister, Kassim Majaliwa, urged citizens to ignore “fraudsters”, claiming that  the president was strong and at work, as usual. Majaliwa also said he had talked to him on the phone and that he was grateful to the voters.

“The president is very busy. Where do they want him to go? Have you ever found him wandering around Kariakoo or Magomeni?” he asked while at a function in Tanzania’s Njombe region. The information was sent in tweets on social media in Swahili.

Rumours and Conspiracies

However, the government is under increasing pressure to reveal Magufuli’s whereabouts – as an online publication speculated that the rumours about him also were being fed by the Tanzania Intelligence and Security Service (TISS) as part of a power struggle withn in the ruling party.

Government sources in Tanzania told Health Policy Watch that they did not know the whereabouts of the President: “

We are just following what is happening on social media and other news outlets but we do not know what is happening to him,” one source said. 

Some source salso  are reporting ‘unusual activity’ at the Tanzania High Commission in Nairobi, Kenya. 

Opposition leader Lissu told the BBC that the 61-year-old president had suffered a cardiac arrest before being flown to a hospital in Nairobi for urgent treatment.  Lissu later said that the president was in a coma and had been transferred to a hospital in India. 

Scientist and Devout Catholic – But COVID-Skeptic

Magfuli, a scientist and a devout Catholic, has frequently played down the threat of COVID-19, saying that God would protect his nation from the disease.  In late-February, following a rebuke by the WHO and the death from COVID of his own vice-president, Magfuli finally signaled that he was willing to take the disease more seriously.   

At that point, the Tanzania Medical Association unleashed a new camapign on prevention of COVIVD-19.  But some worry that the shift may have been too little too late. 

For months, Tanzania has refrained from reporting to the WHO on new COVID cases – and doctors in the country privately admitted that they were under tremendous pressure to write anything but COVID on death certificates. 

Meanwhile, officials such as the chief government chemist, Fidelice Mafumiko, promoted the use of herbal medicine to cure COVID-19. Tanzania’s Health Ministry announced in a press conference last month that it had no plans to accept COVID-19 vaccines, insisting that the country is safe. 

Now social media is awash with news of the Tanzania president allegedly being admitted in a high care hospital because of the virus. 

Many people posting on social media with the hashtag #prayforMagufuli have also criticized irresponsible the way Tanzania handled the pandemic.  

“If it’s true Covid denier Magufuli is in Nairobi Hospital with related complications, the inequity of it would be endless. He gets to fly to a Nairobi hospital, while those who listened to him stay home inhaling eucalyptus steam & hanging on to prayers. Still, wish him recovery,” said Charles Onyango- Obbo, a Ugandan author, journalist and editor. 

 

The Brazilian government needs to enforce “serious social measures” to contain the virus before it overwhelms its health facilities, World Health Organization (WHO)  Director-General Dr Tedros Adhanom Ghebreyesus told the body’s weekly COVID-19 briefing.

Brazil’s President Jair Bolsanaro continues to downplay the pandemic despite the country reaching its highest death rate in the past week and having the second-highest death rate in the world after the US.

“Starting from the government, all the stakeholders should really take it seriously,” added Tedros, warning that pandemic threatened neighbouring countries, most of which had the pandemic under control.

“There should be clear messages from the authorities on what the situation is, and what measures people should take and enforce those measures with full participation of the health system,” said Tedros.

Mike Ryan, WHO’s executive director of health emergencies, reported that ICU bed occupancy had reached over 96% in the midwest and south of the country, and there was very little “resilience” left in the health system.

Despite Deaths, Bolsanaro Tells Citizens to Stop Whining

Despite the grim situation, complicated by a fast-spreading variant named P.1,  Bolsonaro told citizens in the midwestern state of Goiás last week to “stop all this fussing and whining” about the pandemic.

In a veiled reference to the Brazilian president’s poor handling of the pandemic, Tedros said that the rapid spread of COVID-19 was “contrary to our expectations” given the country’s relatively strong health system based on primary healthcare.

Meanwhile, the P.1 variant circulating in Brazil “has a number of mutations that confer increased transmissibility” and it appeared to be more easily transmitted and possibly more severe, added WHO’s COVID-19 response lead Maria Van Kerkhove.

On Tuesday, Brazil registered a record daily number of deaths due to COVID-19 and hospitals are buckling under the strain of widespread infections from the coronavirus. The country’s Health Ministry reported 1,972 fatalities and more than 70,000 new COVID-19 cases. 

The strain on Brazil’s health system is immense. One Brazilian health care provider dies of the coronavirus every 19 hours, according to the latest Brazilian government statistics. 

Dr. Miguel Nicolelis, in São Paulo, told The World’s Marco Werman (🎧) that his colleagues are under such immense stress that many feel as though they’ve spent the past year in a war zone.

“If I can be totally frank … I got a shivering to my body,” Nicolelis said. “You know, it is probably the worst loss of health professionals in the world. It probably is the worst in the world.”

WHO Gives J&J Emergency Use Listing

The WHO gave emergency use listing (EUL) to Johnson & Johnson’s COVID-19 vaccine on Friday making it the first single-dose vaccine to qualify, Tedros told the weekly COVID-19 briefing.

EUL is a prerequisite for a vaccine to be procured by the global distribution platform, COVAX, which has already pre-ordered 500 million J&J doses in anticipation of its approval.

“We hope that this new vaccine will help to narrow vaccine inequalities and not deepen them,” said Tedros, adding that COVAX looks forward to receiving these doses “as soon possible”.

However, the WHO’s approval of J&J came a day after its approval by the European Union Medicines Agency (EMA), which also has a significant order with the company and it is unclear which orders will get precedent, according to Health Policy Watch.

 

WHO Chief Scientist Dr Soumya Swaminathan

WHO special advisor Bruce Aylward and the body’s COVAX representative said that COVAX “is trying to work with the company” to get the vaccine by July.

While COVAX has delivered almost 30 million doses to 38 low- and middle income in the past two weeks, it represents barely over 10% of the 335 million doses administered globally, three-quarters of which have taken place in only 10 countries, said Tedros.

“The inequitable distribution of vaccines remains the biggest threat to ending the pandemic and driving a global recovery,” he added.

Meanwhile, a shortage of supplies such as glass vials is limiting the production of COVID-19 vaccines and could also “put the supply of routine childhood vaccines at risk’, said Tedros

WHO Chief Scientist Soumya Swaminathan said that the WHO was ready to help J&J and any other vaccine manufacturers to expand their capacity, adding that COVAX partner the Coalition for Epidemic Preparedness Innovation (CEPI), had identified “fill and finish capacity that is immediately available to any company to expand supplies”. 

Cafes in Jerusalem reopened fully exactly a week ago, inside for vaccinated “green pass” holders and outdoors for everyone. So far, COVID infection rates continue to drop.

JERUSALEM – One year after the COVID-19 global health emergency was termed a “pandemic” by the World Health Organization – new vaccines are showing their power and efficacy through sharp declines in case rates in Israel – as well as  in the United Kingdom and the United States – the second and third countries in terms of vaccine uptake. 

All three countries have also been among the world’s highest burden COVID places – time and again throughout the pandemic. But in recent months, they have also proven to be the fastest in getting vaccines to their populations – despite the bumps along the way – particularly in the United States.  

In Israel –  where more than 5 million of the country’s six million eligible adults have now received at least one dose of the Pfizer vaccine – and a couple of million people have already gotten the recommended two doses – the profound influence of the vaccines is becoming more and more evident, with the passage of every day – and sharply declining infection rates. 

Pfizer, in a joint press release released with Israel’s Ministry of Health, on Thursday cited the “dramatically lower COVID-19 disease incidence rates observed in individuals fully vaccinated with the Pfizer-BioNTech vaccine, based on real-world data gathered by the Israel Ministry of Health. 

In addition, the company said:  

  • Data suggest Pfizer-BioNTech vaccine prevents asymptomatic SARS-CoV-2 infection
  • Latest data analysis finds unvaccinated individuals were 44 times more likely to develop symptomatic COVID-19 and 29 times more likely to die from COVID-19

Those findings represent the most comprehensive real-world evidence to date demonstrating the effectiveness of a COVID-19 vaccine,” the company stated. “Data are of global importance to other countries as vaccination campaigns continue worldwide.


Good News Comes After Anxious Two Weeks 
Celebrating in Jerusalem – Rowdy ‘Purim” holiday celebrations in Israel in late February gave rise to fears of an infection surge – but thanks to the country’s comparably high rate of vaccinations, including among young people, that didn’t happen.

The reports are all the more significant insofar as they come two weeks after raucous, carnival-style  gatherings indoors and outside marking Israel’s annual “Purim” celebrations. 

Health authorities had feared that the spontaneous and largely uncontrolled mass gatherings of young people bent on celebrating after months pent-up inside – would usher in another spike in cases.

Instead, serious COVID cases in Israel continued their trend of decline, along with new cases.   

Adding to the pressures, Israel’s schools also reopened on Sunday. Wedding halls, sports and cultural events also resumed, with most entries limited to “green pass holders” of people vaccinated.  

Bars and restaurants were throbbing once more with life inside as well as on the pavements – with friends, family and work colleagues gathering and toasting each other – on the  belated “new” and hopefully “corona-free” year – as the disease is described locally. 

“It’s been a long time since we have been together” sighed Yoram, head of a small high-tech firm in the Tel Aviv area who was gathered with 12 young colleagues over pizzas and beers for the company’s first outing in over a year, at a scenic cafe perched over a nature reserve, mid-way between Jerusalem and Tel Aviv. “But we have all been vaccinated – at least with the first shot- by now.” 

Bourla: Important for Humanity to Show Real-World Results 
Albert Bourla, Pfizer CEO, interviewed on Israel’s channel N12 news on the vaccine results.

In his Israel TV interview, Bourla confirmed that Pfizer had deliberately chosen to provide Israel with almost an unlimited supply of the Pfizer vaccine – in order to rapidly demonstrate the vaccines effectiveness in real time. 

“We knew that this deployment of the vaccine will will take time around the world, and the anxiety will build the benefits of a vaccine and so we knew that it is very appropriate for humanity, to be able to select one country that we can demonstrate what the vaccination of the people can do to the health of the people and the economic index,” he said. 

With a population of only 9 million people, a strong public health system featuring universally digitalized medical records – Israel had the “right conditions,” he added. 

“We are so happy because the way that you executed it was beyond our imagination,” said Bourla,  “and now, a year from the declaration of the pandemic by the WHO, we were able today to issue a press release together with the minister of health of your country about the results. 

Bourla said that in the meantime, “I keep receiving calls from, from heads of state or follow the counters to congratulate me because they see the hope now.” 

Vaccine Adminstration – as well as Access – Key to Success

To a somewhat lesser extent, the sharp downturn in reported cases in the United Kingdom and the United States is also likely attributable to their comparatively higher levels of vaccination, observers say.  In the UK, some 35 vaccine doses have been administered for every 100 eligible adults, while in the United States there have been some 30 doses administered for every 100 people – although proportions actually getting vaccinated are still somewhat lower insofar all vaccines being used until now, require two doses.

The data is all the more striking since cases in Europe overall, as well as in Latin America, are currently rising – contrary to trends almost everywhere else in the world.  In Latin America, the increases are largely driven by Argentina and Brazil – whose government has flagrantly ignored the pandemic, if not denying it.  In Europe, increases in new cases are still being seen in France, Italy, Poland, German, Spain and Hungary.

Against that landscape, the Israeli and UK experiences may also be seen to illustrate how the able adminsitration of vaccines is also critical to the success of a campaign.

Both countries feature strong public health systems – with a hybrid mix of centralized command and control – and more localized service networks that could be deployed for the unprecedented vaccine drive.

In contrast, some of the same European countries that are seeing spikes in COVID cases, also have been criticized domestically for being too slow and awkward about vaccine rollouts.  While the root causes are mixed, more fragmented and decentralized public health systems are a factor, along with pure bureaucratic inefficiencies.  Widely publicized manufacturing hiccups leading to supply interruptions from major providers, including Pfizer, have also pleayed a significant role, however,  issues that have stimulated an EU-wide debate over vulnerable supply chains and lack of local manufacturing capacity.

Geopolitics of Vaccine Haves & Havenots

The Israel-as-laboratory story has, of course, also illustrated the geo-politics of vaccine access. The high-profile Israeli vaccine camapign – symbolizing the vaccine “haves” – has come against that of the vaccine “have-nots” – in this case some 5 million Palestinians who aren’t even on the vaccine data maps yet.

So far, Palestinians in the Israeli-occupied West Bank and Hamas-controlled Gaza have only received about 60,000 vaccine doses, in total, mostly of Russia’s Sputnik V.  And due to the complex political rivalries between Gaza’s Hamas-controlled government and the West Bank Palestinian Authority  –  most of those vaccines have gone to Gaza.

It comes against a hotly contested Israeli elections campaign in which Prime Minister Benjamin Netanyahu is trying to retain his grip on power – and another campaign between the West Bank Palestinian Authority and rivals in the Hamas-controlled Gaza.  So far, the vaccines that have been received by the Palestinians have been mostly donations from the United Arab Emirates – to Gaza’s Hamas-controlled enclave, while the West Bank Palestinian continues to wait.

Last month, the PA was supposed to be receiving tens of thousands of doses of the Sputnik vaccine from Russia – but those haven’t yet arrived. Nor have the AstraZeneca vaccines from the WHO co-sponsored COVAX initiative. On Friday, the Palestinian Authority’s (PA) Health Ministry in the West Bank announced yet another channel of supply -saying it would get a free donation of 100,000 Sinopharm vaccines from China.

Side by Side – Palestinian See Cases Rising While Israel’s Decline
Palestinian worker gets COVID vaccine at a West Bank checkpoint this week.

Meanwhile, the dearth of Palestinian vaccine access is painfully evident in the rising rates of new COVID infections, particularly in West Bank Palestinian communities that live uneasily side by side with half a million Jewish settlers – and also work in pre-1967 Israel.

While Israel’s new COVID case rate has dropped from a peak of nearly 1000 a day (per million people) in mid-January to about 344 cases, per million on 11 March, Palestinian case rates have moved in exactly the opposite direction.  New COVID cases among Palestinians rose from about 95 cases/ million in early February to about 349 cases/ million on Thursday, 11 March – overtaking Israeli rates for the first time in months.

The infection surge comes after weeks in which Israeli government officials have resisted giving the West Bank Palestinian Authority (PA), with which it has cooperated on other aspects of the pandemic, significant vaccine doses. The fact more supplies have reached Gaza than the West Bank is also more striking insofar as Israel has a former cooperation agreement with the Palestinian Authority – while it doesn’t recognize Hamas, or vice versa.

Israeli officials have maintained that under the Oslo accords of the mid-1990s, it is up to the PA to procure its own vaccines. This is despite the warnings from public health experts that infection reservoirs in Palestinian communities will inevitably spill over to pockets of under-vaccinated Israelis, including children and youths who cannot get vaccinated at all.

In belated recognition of the threats, Israel this week did finally begin vaccinating some 120,000 Palestinian workers employed in pre-1967 Israel or within West Bank Jewish settlements and industrial areas.

The free vaccine drive, using brand-new shipments of the mRNA Moderna vaccine, appeared to be meeting a positive response as Palestinian day labourers lined up for the vaccine at military checkpoints. Media images of average workers getting the vaccine have also resonated among some members of the Palestinian public – who are already resentful that, according to media reports, the PA’s own scarce initial doses went mainly to politicians, athletes and other VIPs.

Even so, the new Israeli vaccine drive among Palestinian workers won’t close the ever-growing chasm between Israel’s vaccine haves and Palestinian have-nots – or reach the most at-risk Palestinian groups – health workers, older people, and people living with chronic diseases.

On Friday, five United States senators, including Bernie Sanders and Elizabeth Warren, sent a letter Friday to US Secretary Antony Blinken asking the Biden administration “to urge the Israeli government to do more to help the Palestinians in Israeli-occupied territories receive adequate supplies of the COVID vaccine…

“The urgency of the moment, as both Israelis and Palestinians face the threat of COVID, demands immediate action,” the senators wrote, noting that while the West Bank Palestinian Authority has some responsibility for health under the terms of the 1990s- era Oslo Accords, the responsibilities of Israel, as the occupying power, supersede that under the terms of the Fourth Geneva convention.

“There is an increase in infections and a full occupancy in Palestinian hospitals in the West Bank and Jerusalem,” said Physicians for Human Rights in a post on Thursday. “And yet Israel is neglecting its responsibilities of supplying vaccines to the oPT (occupied Palestinian territories.”

Image Credits: N12, Health Policy Watch , Israel MFA .

The AstraZeneca vaccine being administered in Catalonia, Spain in mid-February.

Both the European Medicines Agency and the World Health Organization have urged that immunizations with the Oxford/AstraZeneca COVID-19 vaccine continue – despite a decision by several European countries to suspend its use – after reports of serious blood clots among 30 of the 5 million people vaccinated – leading to at least five deaths. 

An EMA statement said that the inoculations can continue while the investigation is underway.

“There is currently no indication that vaccination has caused these conditions,” said the EMA in a press release. “The position of EMA’s safety committee PRAC is that the vaccine’s benefits continue to outweigh its risks and the vaccine can continue to be administered.”

In addition, the number of cases of blood clots doesn’t exceed the cases in the general population, the EMA said. 

This message was echoed by a WHO spokesperson, Margaret Harris, who called the pause of the vaccine a “precautionary measure,” saying that no causal relationship has been established yet. 

“It is very important we are hearing safety signals because if we were not hearing about safety signals that would suggest there is not enough review and vigilance,” said Harris at a media briefing on Friday. “Any safety signal must be investigated.”

Some 30 cases of blood clots have been reported among the 5 million people vaccinated in the European Economic Area with the AstraZeneca vaccine, as of Thursday. This includes one death in Austria, one in Denmark, one in Bulgaria, and two in Italy.

Ten EU Countries Temporarily Pause Vaccinations, While Others Push Ahead

Denmark, Norway, Iceland and Bulgaria are pausing all AstraZeneca vaccinations, while Austria, Italy, Estonia, Latvia, Luxembourg and Lithuania are blocking further use of doses from the most recent batch of vaccines.

The batch of one million doses was delivered to 17 EU countries. A full investigation conducted by the EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) is ongoing and it will evaluate the batch quality, along with all reported cases of post-vaccination blood clots with the AstraZeneca vaccine.

A WHO advisory committee on vaccine safety is also currently reviewing the reports.

“It’s very important to understand that…we should continue to be using the AstraZeneca vaccine,” said Harris, calling it an “excellent vaccine.”

Germany, France and the United Kingdom have decided to continue with their rollout of the vaccine, reaffirming the safety and efficacy of the jab. Germany and France are facing a scarcity of vaccines and a rise in infection rates. Suspending the AstraZeneca vaccine could undermine their already struggling vaccination efforts. 

“Everything we know so far suggests that the benefits of the vaccine, even after every individual case reported, are greater than the risks, and that continues to be the case,” said Jens Spahn, Germany’s health minister, at a news briefing on Friday. 

“Available evidence does not confirm that the vaccine is the cause,” said Phil Bryan, vaccine safety lead of the UK Medicines and Healthcare Products Regulatory Agency (MHRA). 

Investigation Into Blood Clots As Possible Vaccine Side Effect
A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine.

National health agencies in the EU countries that have paused the use of some or all AstraZeneca vaccines have emphasized their need to examine and clarify the possible serious side effects before resuming with vaccinations. 

“It is currently not possible to conclude whether there is a link,” said Magnus Heunicke, the Danish health minister, on Twitter. “We are acting early, it needs to be thoroughly investigated.” 

Five deaths have been reported among individuals who were inoculated from the same batch of AstraZeneca vaccine doses. A 49 year old nurse in Austria died of blood coagulation problems, a 60 year old woman in Denmark formed a fatal blood clot, a 57 year old woman in Bulgaria died of heart failure, and two police officers in Italy, aged 43 and 50, died of severe coagulation disorders. 

Following the news of the suspension of vaccination programs, Thailand announced its decision to delay the rollout of the AstraZeneca vaccine, which was set to begin on Friday. 

“We are delaying to let others prove [the side effects] of whether or not it is because of the vaccine or if it is only on that specific batch,” Yong Poovarawan, a Thai virologist, told the Guardian. “We are waiting for Denmark and Austria to make a conclusion.”

Blood clots were not listed as possible side effects from the vaccine and no pattern of serious adverse events provided a safety signal, according to clinical trial results. 

“An analysis of our safety data of more than 10 million records has shown no evidence of an increased risk of pulmonary embolism or deep vein thrombosis in any defined age group, gender, batch or in any particular country,” Gonzalo Viña, a spokesperson for AstraZeneca, told the New York Times. 

EMA To Review Bleeding and Bruising Issues Associated With Three Vaccines  

In sharp contrast, to the reports of clotting, there also have been reported side effects of bleeding and bruising from both the AstraZeneca vaccine as well as Pfizer’s and Moderna’s. 

The EMA announced on Friday that the PRAC started a review of reports of immune thrombocytopenia – a disorder of low levels of blood platelets that can lead to bruising and bleeding – for those three EMA authorized COVID-19 vaccines. 

Following reports of several cases of immune thrombocytopenia, case reports and clinical trial data from Pfizer/BioNTech, AstraZeneca, and Moderna will be gathered to determine if there is a causal relationship.

“At this stage, it is not yet clear whether there is a causal association between vaccination and the reports of immune thrombocytopenia,” said the EMA in a press release. “These reports point to a ‘safety signal’ – information on new or changed adverse events that may potentially be associated with a medicine and that warrants further investigation.” 

In a separate investigation, the EMA concluded that a link between severe allergic reactions and the AstraZeneca vaccine was “likely in at least some of [the 41 cases of anaphylaxis].” 

This finding comes after the Agency reviewed the 41 reports that emerged among five million vaccinations in the UK. The EMA is recommending an update to AstraZeneca’s vaccine product information to add to the existing warning of anaphylaxis and hypersensitivity as side effects. According to the EMA, any individual that develops a severe allergic reaction to the first dose of the vaccine shouldn’t be given a second dose.

AstraZeneca to Delay Vaccine Deliveries to EU Again, Risking Restarting Feud with EU

Meanwhile, AstraZeneca is reportedly facing difficulties with its international supply chains and expects to deliver 30 million doses to the EU by the end of March – 10 million less than it pledged in February and a third of its contractual obligation, according to a document seen by Reuters.

The pharma company risks angering EU officials once again by scaling back vaccine deliveries, adding to the EU’s problem of vaccine scarcity. AstraZeneca’s manufacturing and delivery efforts were described as “not good enough” by Thierry Breton, EU Commissioner on internal market.

AstraZeneca said it expects to ship doses produced in the US – where some 30 millions of doses are in manufacturing facilities, waiting for the US Food and Drug Administration’s (FDA) authorization – to the EU. The FDA won’t make a decision on the vaccine until the US late-stage clinical trial is complete, which may take another month.

“We understand other governments may have reached out to the US government about donation of AstraZeneca doses, and we’ve asked the US government to give thoughtful consideration to these requests,” said Viña to the New York Times.

The Biden Administration, however, has denied these requests for the near future.

“If we have a surplus, we’re going to share it with the rest of the world,” said President Joe Biden to reporters on Wednesday. “We’re going to start off making sure Americans are taken care of first.”

The US’ hesitancy to export vaccines was criticized by Charles Michel, President of the European Council, who said in a statement that the US and UK have “imposed an outright ban on the export of vaccines or vaccine components produced on their territory…[while] the EU has never stopped exporting.”

Image Credits: Flickr, Flickr, Flickr.

Wulai, a scenic town near Taipei, was still packed with crowds of local tourists on weekends – as the lunar New Year holiday ended in mid-February.

Not many places resemble the pre-pandemic world more than Taiwan. Residents do wear masks, and the ways in which people use public spaces have changed. But in a locked-down world of damaged economies, Taiwan’s institutions are functioning; its classrooms, tourist sites and restaurants carry on.

TAIPEI – One year after COVID-19 was declared to be a global pandemic, Taiwan’s policies have kept COVID cases under 1000 reported infections and just 10 deaths in a population of 23 million. In comparison, Florida has had 1.9 million cases and 30,700 deaths in 21 million residents.

Taiwan’s success is due largely to the high-tech policies of President Tsai Ing-wen’s government. Imported cases have been efficiently isolated and contacts traced to halt community transmission. This is a pandemic success story, yet the world knows little about Taiwan.

Blast into the Past

Returning to Taipei in November 2020 from northern Minnesota felt like a trip back in time – not only to a place where I had lived and worked for many years – but back to normal life as well.

Rural America was broken just after the election, with most services and organisations closed and no end in sight. I nearly hitchhiked 200 frigid miles to the Minneapolis airport because COVID had closed the jitney services. Every day my county’s rate of new cases was higher; I left as these jumped into the newly-created black zone – more than 100 cases per 100,000.

Most businesses didn’t challenge maskless Trump supporters; everyone desperately needed customers as the pandemic had kept most summer visitors away from our lake resort town. The COVID numbers were worse in counties north, west and east of Hubbard County, where the White Earth, Red Lake and Leech Lake reservations of Anishinaabe (also known as Chippewa or Ojibwe) tribal groups remain vastly underserved by medical resources.

We ordered our groceries and stayed home, but the nearby town of Nevis actually voted against the governor’s mask mandate. Because its Muskie Days music festival was officially maskless, we stayed in the car to listen safely.

Strict Quarantine with a Heart

After that dystopia, landing in Taiwan felt like relaxing into a Club Med holiday: every quarantine-related detail was well-managed and convenient. At the airport we were whisked to get quarantine SIM cards. Taiwan Centers for Disease Control workers checked our pre-filed quarantine papers and gave us phone numbers where police would call us daily. (We paid for these, but they were a bargain for the local phone service with unlimited data we would need anyway.)

Monitor at the Taipei immigration office displays information about COVID while people wait for their number to be called.

I was guided to a quarantine taxi – which was an ordinary taxi charging the usual metered fare, around US $5 in town – except that drivers were well-masked, gloved and trained to disinfect surfaces. I shudder to think how much this would cost in the USA, where every possible markup is applied to services that are even remotely health-related.

Then I settled into my apartment for the 2 weeks of isolation. I was fortunate to have tree-shaded windows overlooking a busy street and a laundry balcony to step into sunlight and fresh air. Quarantine hotels were almost entirely full when I arrived, but they do make sourcing meals less demanding; friends brought food to my apartment when Uber Eats and Food Panda couldn’t use my foreign credit cards.

That SIM card delivers daily texts from police involved in the quarantine effort; they come to the door if they don’t get a return text indicating I’m fine / not fine / need help. Most days an officer also called to politely inquire whether I needed anything. When I complained I’d used up the calling credit, a free loaner phone was delivered for the remaining days of quarantine. The officer who delivered it even made an extra trip to the convenience store downstairs; I knew I was home when she brought a fish-liver rice ball and salty tea eggs.

I looked out the windows a lot, and noted how the city had painted waiting lines at popular bus stops so people line up in a more orderly fashion – which also helps encourage distancing. My friend who let me “video shop” for quarantine groceries showed me markers keeping customers spaced in checkout lines too.

The New Normal at Work

Given the traumatic experience of the 2003-04 SARS outbreak that shut down public life for much of that year, Taiwanese readily accepted that in the case of SARS-CoV2, masking allows meeting, and that these policies are for the common good.

Perhaps the only pushback is slightly spottier mask wearing in areas that have not seen cases. An English teacher in Hsinchu noted that her elementary-age students resist the mask rule. Yet after a year with no cases in the area, the private school’s leaders still discipline maskless students.

Even with a negligible case rate (only about 3 new COVID cases in the past week), many events are distanced or outdoors. Jitters about recent cases cancelled many popular Lunar New Year’s fireworks/concert celebrations in February, including the Lantern Festival. In public areas, such as medical waiting rooms, every other seat is frequently marked off, although this is not the case in buses or trains.

An art museum had a sign-in with ID numbers and body temperatures noted; if cases are traced to a museum-goer, we can all be notified. Visitors are strongly encouraged to rub their hands with alcohol from dispensers provided at entrances and restrooms. Many stores and apartment buildings as well as transit stations use equipment to detect body temperatures.

At the university where I used to work, meetings continue with an online option. As a result, conferences may drop hefty registration fees – expanding access to elite scholarly events for students and others who lack institutional support. But the experts do confer in person here as well as onscreen; papers are delivered and scholarly life goes on in shared laboratories and libraries.

My teacher friends still lecture, but they are getting used to screens. This is easier because many institutions had already embraced open courseware, so students can access and review any class at any time. Institutions also limit potential exposures by keeping groups physically separated. In the case of my former employer, Taipei Medical University, there was a severing of campus and hospital to minimise potential virus spread. Entering either compound requires a separate temperature check and ID scan.

Once inside the university-affiliated hospital, I was overjoyed to find my old friends who staff three massage chairs in the hospital hallway. As massage has always been integral to Asian traditional medicine, the hospital provides this service so patients can buy 10-minute increments for about US$ 3.50. Outside the hospital premises, however, storefront massage studios get less traffic, and are notable losers from pandemic fears; my favourite place is having trouble paying its staff even by extending hours.

In stores, plastic wrap now adorns many fruits and vegetables we pinched and sniffed in times past; bakeries and buffets often pre-wrap as well.

Vigilant Monitoring, Flexible Response
Bopiliao historic district in downtown Taipei is a restored area of Qing dynasty-era buildings, is known for its artistic events and cultural displays. It has remained open for business – although more local patrons and fewer foreign tourists come to enjoy the quaint alleyways.

Policies keep changing; this month Taiwan has reopened to nonresident travellers with visas and will allow transit passengers after two months of suspending these arrivals. Since my flight in November, COVID testing has become mandatory for everyone boarding a flight to Taipei.

There has also been a tightening of quarantine rules; returnees with apartments may quarantine in their homes, but only if they have monthly rentals. A German expat told me she won’t be allowed to quarantine with her own domestic partner this summer when they return from a European trip together – she said adults must each have their own bathroom, although families with children are allowed to share.

Unlike other hard-hit institutions of higher education around the globe, Taiwan has managed to keep its substantial foreign student population mostly intact, with foreign students now allowed to enter with quarantine too.

The accredited quarantine hotels and hostels are often full and are not cheap (averaging over US$100 a night). Until recently, however, a government programme covered part of the cost. The government also offered domestic tourism incentives and sold restaurant vouchers for a third of their face value to strengthen demand in those areas.

Taiwan’s health system was recently ranked #1 worldwide for a third consecutive year in the online database Numbeo. This reflects the system’s effectiveness, cost-efficiency and universal coverage; South Korea, France and Japan were the runners-up. Since Taiwan’s national health insurance was launched in 1995, administrative costs have been limited to less than 1% of health spending.

I remain amazed by and grateful to this system; last month a university dental clinic took two x-rays and repaired my broken tooth for US$ 23. A government list of drugs approved for reimbursement saves Taiwanese from pharma price-gouging – in contrast to the wildly varying markups and zero transparency seen in the United States.

The system’s successes are not only due to health policies, per se. Digital minister Audrey Tang is widely credited for adopting a series of a strategies that had been crowdsourced by Taiwan’s g0v.tw “shadow government” before Tsai was elected in 2016. And this digitalization contributed to more effective COVID response.

For instance, one of the earliest pandemic responses was quick rationing and distribution of disposable masks that included live digital tracking of supplies at every local pharmacy.

Stigma Against Foreigners

Taiwan has shown that fast and smart pandemic response can deliver both optimal health and economic results. It has therefore been a delight to return to normal life here, where good sense and kindness can be felt at every level.

Masked visitor to the iconic Dihua street – Taipei’s best preserved historic shopping district.

Well, almost every level. Recent video ads show health authorities speaking out against stigmatizing foreigners and others due to public perceptions that we are COVID risks.

There is a need for this campaign, because almost every visibly foreign resident with whom I have spoken has noted the fishy looks that they may receive in elevators, and the empty seats next to them in crowded trains and buses. I’ve also been chased from a restaurant twice by a manager who wouldn’t let a foreigner sit in her place (I was allowed to order take-away if I stayed outdoors).

Usually this would be cause for much drama on my part, but compared with daily standoffs with COVID deniers and mask avoiders in my US hometown it seems rather mild. After all, the restaurant owner didn’t threaten to kill me with a macho enactment of disbelief in science and contempt for public health; she just wanted her restaurant kept safe.

Time for Taiwan

Even though my riverfront home in my native Minnesota is dirt-cheap and parklike by Taiwan standards, rural Minnesota’s social divisions and dysfunctional health system have made Taiwan a better home for me. I’m happier in a safe, functioning metropolis with optimal public transit, famously great food and reliable, affordable health care.

I first saw Taiwan when it was a dictatorship in 1978 and 1980. Its social and political development have impressed me ever since martial law ended in 1986. Since 2011, I also edited English documents for the health ministry’s international cooperation section, which gave me a catbird seat to observe Taiwan’s health diplomacy.

Under the comparatively pro-China Kuomintang government, Taiwan was allowed to join the World Health Assembly as “Chinese Taipei.” Since Tsai took office, Chinese pressure at the World Health Organization has blocked the current government from attending, even as an observer.

Yet Taiwan has had valuable knowledge and policies to share with world health leaders all along, and now it is finally recognised worldwide for its unmatched success against the pandemic. Will the world stand by as China strangles it like Hong Kong?

___________________________________________

Freelance editor Val Crawford has worked in international news and scholarly publishing, and edited for United Nations University in Tokyo and the World Health Organization. She taught scientific writing, journalism and popular culture courses at Taipei Medical University from 2010 to 2019, and served as visiting professor at the University of the Philippines and Sri Ramachandra University in Chennai, India. 

Image Credits: Val Crawford.

WHO Headquarters in Geneva, Switzerland.

One year after the World Health Organization (WHO) declared the coronavirus outbreak a pandemic on 11 March 2020, a new report by the Foundation for Geneva has traced the success and the failures of the WHO and other international Geneva organisations in their response – as well as the implications for the future of multilateralism.

“This deep-dive into 2020, seen from international Geneva, reveals in a crude way the underlying planetary crises: multilateralism at half-mast, states turning in on themselves, the race for drugs and vaccines, and vaccines disrupted by private financial issues and national sovereignty, increasingly noisy alternative truths, etc. But what COVID reveals is also the capacity of the international community to unite to defeat the same common enemy, with a cockpit located mainly in Geneva,” states the report, released this week.

At the time the epidemic was declared to be a “pandemic, the virus had already swept across 110 countries or territories, infected over 110,000 people, and claimed 4,000 lives. A year on, and 117 million confirmed cases later, health experts and researchers have been trying to dissect how the global health body could have reacted differently in the face of the unfolding crisis and how to overhaul it.

With the 70-plus NGOs and international organisations that gravitate around the WHO and make up its global health hub,  international Geneva has been at the front lines of the global efforts to fight the disease.

An Already ‘Weakened’ WHO

WHO has been heavily criticised over its handling of the pandemic. However, before the onset of the pandemic, the WHO was already facing one of the deepest crises of its 73 years of existence. An earlier edition of the Foundation for Geneva (Fondation pour Genève) study conducted before the emergence of COVID-19 revealed that alread by the end of 2019, WHO was financially and politically fragile.

Its limited budget was funded less and less by member states, whose regular, assessed contributions had dropped from 46% of the total budget in 1999 to just 17% last year. Meanwhile, voluntary donations by members and private donors like The Bill and Melinda Gates Foundation now contribute to around 80% of WHO’s overall budget. “This poses an obvious governance problem: who makes the decisions in Geneva? Civil society made up of Member States and WHO or private donors?,” ask the report’s authors, led by Heidi News health journalist Annick Chevillot.

Even before the new pandemic emerged, the organization had yet to fully restore its reputation following the Ebola epidemic in 2014, when it was widely blamed for failing to take leadership and for being too slow in declaring it an international public health emergency: “The WHO is facing a crisis of confidence and mistrust at the dawn of 2020,” explains the report. The organisation “begins 2020 with a new enemy to face: the coronavirus.”

International Geneva’s COVID-19 Response

The international community’s response, at least initially, “overwhelmingly followed the tempo set by the WHO.” More than 20 core organisations based in Geneva or with a direct link to Geneva, like the International Committee of the Red Cross (ICRC), the Global Fund or the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), have played a key role in tackling the crisis, making it “possible to appreciate the extent of the number of actors that have made Geneva an international centre of influence in the fight against the pandemic,” the report finds.

The International Committee of the Red Cross headquarters in Geneva, Switzerland.

However, the pandemic grew into more than a health crisis and organizations working across the fields of human rights, humanitarian aid, trade and the economy were soon implicated, with various calls for funding support.

Despite its clear need for reform, the pandemic also underscored the crucial role of the WHO, the authors say: “The global crisis generated by the pandemic has also shown the importance of multilateralism, of which the WHO is a tool that is as fragile as it is indispensable.”

It was only with the support of the international global health institutions, including Geneva-based “heavyweights” such as the Global Fund and Gavi, that WHO was able to respond to the emergency, and launch one of the greater successes last year: the ACT Accelerator to speed up access to vaccines, treatments and diagnostics against COVID-19.

The Global Health Campus, home to the Global Fund, Gavi, Unitaid, Roll Back Malaria and Stop TB.

Within the ACT Accelerator, its vaccine pillar, the COVAX initiative, has beeen designed to ensure that vaccines reach poor and middle income countries – with the vaccine  rollout having reached the first countries in Africa, including Ghana, Cote d’Ivoire and Ghana, just last week.

“The COVAX initiative is a good illustration of the raison d’être of International Geneva and its ability to find solutions. It offers the prospect of a world that is both interdependent and united,” says Olivier Coutau, delegate for International Geneva at the directorate of international affairs of the canton of Geneva.

Key Achievements

Among some of the other key successes of International Geneva’s health cluster, the report lists:

  • The international randomised clinical Solidarity trials, which “made it possible to evaluate the effectiveness of already existing treatments against Covid-19”, such as dexamethasone.
  • Fundraising that allowed the WHO to raise US$ 241 million (as of January 25, 2021).

“Experts believe that the WHO has risen to the challenge by providing technical and normative guidance, taking the lead in coordinating the scientific response to the pandemic and shaping logistical operations with a number of other international organisations,” says Priti Patnaik, a global health journalist, who is cited in the report.

Read also: Covid-19 vs WHO and the world: successes, failures and hopes a year on

The Road to Reform

The report concludes with a series of recommendations for the “International Geneva” health and development community, but in particular, for the World Health Organization, with respect to its need for reforms.

Observed Antoine Flahault, director of the Institute for Global Health: “The Member States of the WHO, which ensure its governance through the World Health Assembly and its Executive Board, will first have to ask themselves what prerogatives they wish to entrust to the WHO in the event of a health emergency…As long as the WHO General Secretariat has no independent investigative powers in member states, it cannot be expected to play the role of conductor that it is sometimes criticised for not playing.”

WHO’s funding also needs to be reviewed, as explained by Gian Luca Burci, former WHO legal adviser and associate professor of international law at the Graduate Institute of International and Development Studies (IHEID) in Geneva, “because it is dysfunctional. Voluntary contributions, which represent about 80% of the budget, are too volatile. The WHO must have sustainable and predictable funding in the future.”

Partly as a result of such imbalances, Patnaik observes: “the decisions that shaped the international response to the pandemic quickly and decisively shifted from WHO to some donor governments, other actors, including private philanthropists, public-private partnerships, outside the global health field.”

Republished from Geneva Solutions. Health Policy Watch Watch is collaborating with Geneva Solutions, a non-profit Geneva platform for constructive journalism covering International Geneva.

Image Credits: Flickr – Guilhem Vellut, Flickr – US Mission Geneva, Flickr – US Mission Geneva, Global Fund/Vincent Becker.

The Johnson & Johnson COVID-19 vaccine.

With the European Union Medicines Agency (EMA) approval Thursday of Johnson and Johnson’s one-shot COVID-19 vaccine, it now remains to be seen which countries and regions will be the first in line for distribution of the one-jab vaccine. Along with its comparatively low-cost, and ease of storage, the one-shot vaccine could be particularly important to Africa in light of its demonstrated its efficacy against the wily virus variant B.1351, first identified in South Africa.

“With this latest positive opinion, authorities across the European Union will have another option to combat the pandemic and protect the lives and health of their citizens,” said Emer Cooke, EMA’s Executive Director, adding, “this is the first vaccine which can be used as a single dose”.

The challenge now, for the pharma company is how to share the bounty.  Johnson and Johnson had last year reached an agreement in principle with Gavi, The Vaccine Alliance, to supply the new COVAX vaccine facility with up to 500 million doses through 2022 – which would go to low- and middle-income countries. It also has pledged to charge a ‘non-profit’ US$ 10 price during the pandemic, making it particularly attractive to lower-income countries. But it also now has major supply commitments to Europe, the United Kingdom and the United States. 

Following the EMA approval, the WHO can be expected to rapidly issue its own “emergency use listing”, clearing the way for the vaccine’s rollout by COVAX.  

Known Vaccine Manufacturing Capacity – J&J

However, the United States this week doubled its own order of the J&J vaccine to 200 million doses. The European Union has also ordered 200 million doses of the shot, with an option for 200 million more. The UK has options for 55 million doses. And, meanwhile, the J&J agreement with COVAX would only supply 100 million doses to the global facility this year. 

The bigger dilemma is that the COVAX rollout is right now almost exclusively dependent on the Astra Zeneca vaccine. And that vaccine yielded poor results in a South African trial of healthy adults, where it failed to demonstrate efficacy in preventing mild and moderate forms of COVID disease. That left South Africa to rapidly pivot to the Johnson & Joshnson vaccine several weeks ago, for the first stage of its vaccine rollout to health workers. Insofar as South Africa was participating with J&J in clinical trials, it had access to at least some initial vaccine supplies.  But other African countries don’t have that luxury.

So in more ways than one, the J&J vaccine’s distribution is likely to be watched as a bellweather of equity – or not. 

Advocacy Groups Call For More J&J Vaccines to be Shifted to Low-Middle Income Countries
johnson
COVID -19 Secured Doses 2021, aggregate and per capita, by countries’ income level

Advocacy groups have recently issued calls for the first cuts of the J&J vaccine to go to low- and middle-income countries through COVAX.

They point out that even South Africa, whose Aspen Pharmacare is set to produce some 300 million doses of the vaccine, will only keep a fraction ( 9 million doses)  for itself.

Meanwhile, the country is on the front lines of the battle with the B.1351 variant, which is slowly creeping northward across eastern Africa – as well well as appearing in Ghana on the west African coast. All of those countries remain almost exclusively dependent on the COVAX supply of AstraZeneca vaccines – complemented by some donations from China, whose vaccines have never undergone a regulatory review.

“MSF is worried that if J&J continues with business-as-usual tactics, countries most affected by this variant will once again be left waiting at the back of the queue,” stated an appeal two weeks ago, issued just ahead of the very first, US Food and Drug Administration, approval.

“For example, South Africa has the highest prevalence of this variant in the world and has been a critical partner in J&J’s clinical trials, yet the country is due to receive a mere nine million of the 300 million doses that will be filled in vials and packaged by a local manufacturer. J&J should right away ensure that South Africa receives, at minimum, enough doses to vaccinate its healthcare workers and high-risk groups, as well as prioritize shipments to other low- and middle-income countries.

While WHO has sought to reassure African nations the the AstraZeneca vaccine can still be effective against serious disease from the variant – that hasn’t yet been demonstrated in a clinical trial – in the same way that the J&J vaccine has been tested.  And as MSF stated, the vaccine’s one-jab regimen and modest refrigerator storage requirements make it particularly attractive in lower-income settings:

“The vaccine could be an important tool in the world’s response to this pandemic – particularly in low-resource settings where MSF works – since unlike the other COVID-19 vaccines being used today… it could require only one dose and could be stored at normal refrigerator temperatures.”

US and Other Rich Countries Keep Piling Up Vaccine Surpluses

On the other side of the Atlantic, meanwhile, noting that some 850 million vaccine doses have been purchased by the United States for an adult population of only 260 million – enough to vaccine all eligible adults three times over. “Prospects of a vaccine shortage giving way to a surplus seem nearer than ever this week,” noted the Washington Post, wryly.  However, with the largest J&J manufacturing base in the United States, the US also can impose export barriers on the vaccine – should it choose to do so.   

And even without an outright export ban, nearly 1.5 billion doses of J&J’s vaccine are already tied up in advance purchase agreements, most (801 million out of 1.439 billion doses) committed to high-income countries.

Dr Paul Stoffels, vice chairman and chief scientific officer at Johnson & Johnson.Pharma sources say that J&J’s Vice Chairman and Chief Scientific Officer Paul Stoffels, the Belgian-born physician who has spearheaded the vaccine’s R&D through its European affiliate, Janssen, is deeply committed to a rapid rollout of the new product in low- and middle-income countries – and possesses a track record on equity issues, with J&J’s prior development of an Ebola vaccine, as just one example.

At the same time, J&J has also received US $1.5 billion from the US government for its COVID-19 vaccine R&D, and the United Kingdom is co-funding a global clinical trial testing a two-dose regimen of the vaccine.

In light of those hefty research investments, the pre-purchase agreements, and the J&J manufacturing hubs clustered in the United States and Europe, it remains to be seen if the US, the EU or other high income countries that have snapped up more vaccines than there are people to jab, might offer to release some of those excess supplies to COVAX, the African Union or even directly in bilateral deals.

If those countries act, it might enable a more rapid rollout of the single-jab vaccine in parts of the world that not only need it the most – but where the vaccine could also have the most impact in halting the global spread of dangerous variants.

Image Credits: Johnson & Johnson, Johnson & Johnson, IFPMA, IFPMA , World Economic Forum.

Proponents to the African Medicines Agency say that it will improve access to safe, affordable medicines – and also ensure a better COVID-19 response.

NAIROBI – Kenya is one of the leading African countries yet to ratify the African Medicines Agency Treaty (AMA) – but a senior official in the Ministry of Health has said that the move  should come soon. 

According to Susan Mochache, the country’s Principal Secretary in the Ministries of Health (MoH), Kenya has already undergone the induction process, and is now waiting for details on operational modalities, which need to be worked out, before ratifying the treaty.

 “The country is now waiting for clarity on whether payments will be made directly to the suppliers and on information on the tax exemption modalities,” Mochache told Health Policy Watch in an interview.

She was referring to questions arising among some African countries about whether the AMA would take on bulk procurement functions – alongside its regulatory role. 

Proponents of the continent-wide approach to medicines regulation say that it will help streamline medicines and vaccines reviews and approvals – also ensuring a better COVID-19 response. 

A unified regulatory mechanism could also pave the way for more efficient bulk procurement of medicines and vaccines, through the African Union or regional blocs of countries – and more local production, its advocates say. 

However, the functions assigned to the AMA through the pending treaty, requiring ratification, are strictly regulatory in nature, the treaty’s architects and proponents underline. 

Dr Margaret Agama-Anyetei, of Head of the Health, Nutrition and Population Division, Africa Union – speaking at the AMA session Wednesday.

“It’s important to focus on Article 6 and what the African Medicines Agency’s specific role would be,” said Dr Margaret Agama-Anyetei, of Head of the Health, Nutrition and Population Division Africa Union, in a panel session on the AMA Wednesday at the African Health Agenda International Conference 2021. She underlined the need for caution in assuming that the AMA could do everything that is needed on the continent – in terms of procurement and production – even though it can set the stage.

Article 6 lays out the primary functions of the African Medicines Agency, which include: coordinating and strengthening initiatives to harmonize medical product regulation; providing guidance on regulation of traditional medical products, and evaluating and deciding on medical products for treatment of priority diseases and conditions, as determined by the African Union and WHO.

African Union Agreed To Create AMA Two Years Ago – But 7 More Countries Need To Ratify Treaty.  

A resolution to create the AMA was adopted at the 32nd African Union Assembly two years ago. However, among Africa’s 54 countries, only 19 countries have so far signed the treaty and only eight countries, mostly in West Africa, have ratified it. 

While that is still three more ratifications since October, the treaty needs to be signed by at least 15 countries to become operational. And meanwhile,  the continent’s biggest countries like South Africa, Nigeria,… and Kenya  remain outliers. 

 In terms of its regulatory function, the agency would function much the same way as the European Medicines Agency (EMA) operates – offering a region-wide umbrella for countries to use in review and approval of drugs and vaccines. 

It may however, also play a role in managing bulk medicines and vaccines procurement – ensuring that the process is cheaper, simpler and faster for the countries that have joined, while also guaranteeing safety in a region where fakes often proliferate.

Kenya Medical Association – AMA Ratification Will Help Expand Vaccines Access 
Teachers aged 50 years and above, are to be the among first to get COVID-19 vaccines in Kenya.

 In a separate interview, Dr. Elizabeth Gitau, CEO of the Kenya Medical Association (KMA), also expressed hopes that the national government will soon ratify the AMA Treaty, saying it would also help improve COVID-19 vaccines access. 

“So, we are waiting and actually do hope that at the end of the day the government will ratify the treaty so that we have more access to vaccines,” she said in a separate interview. 

But, she added, “The Ministry is still going through the decision making process.” 

The KMA has been a key partner in the government’s COVID response, providing technical support to the Ministry of Health, including on prioritization of people who should receive vaccines, advocacy and rollout.  

Its members are participating in the COVID-19 vaccine administration training programmes currently under way in the country – as part of the rollout of the first AstraZeneca vaccines, which were received through the WHO co-sponsored COVAX global distribution facility last week .

AMA would help Kenya Fight Fakes & ‘Grow’ Its Pharma Industry 
kenya
Kenya receiving the first suppplies of Oxford-AstraZeneca COVID-19 vaccines from the WHO co-sponosored global COVAX facility.

Whereas cross-boundary harmonization of the regulatory standards and guidelines in accordance with global standards, and specifically those mandated by the WHO, will be the core function of the AMA, Kenya also stands to benefit in other ways, should it join the agency.

Notably, AMA membership could also help link up Kenya’s pharma producers to a much larger purchasing block, should the AMA’s functions also extend to the supervision of pooled medicines procurement. 

Said Dr. Fred Siyoi, CEO of the country’s Pharmacy and Poisons Board (PPB): “It will help Kenya nurture its growing pharmaceutical industry leading to the realization of the provision in the constitution of the right to health by guaranteeing safe, quality and efficacious locally manufactured medicines.”

For instance, “pooled procurement will enable countries to receive medicines from WHO prequalified, or from AMA prequalified manufacturers,” explained Dr. Siyoi. The PBB Board regulates the pharmaceutical practices in the country in addition to the manufacture and trade of drugs and poisons.

Dr. Gitau concurs, adding:  “Negotiating as a block as opposed to going it alone as individual countries, we are bound to benefit in terms of economies of scale, but also we are more likely to get better access to vaccines with the initiative and possibly better pricing.”

Pooled AMA Procurement Also Would Help “Fight the Fakes” 
The African Medicines Agency’s framework would help combat falsified products

Even though the PPB has its own mechanisms in place for detection and prevention of substandard and falsified products (SF), pooling resources together within the AMA framework will serve to strengthen its programmes further, Siyoi said.

For instance, the national board would benefit from “information sharing from regional blocks on substandard and falsified products,” he says, something which will ensure timely response to risk alerts on medicines of substandard quality and safety.

Dealing with fake medicines has been one of the biggest challenges facing many African countries.

Up to a quarter of the continent’s medicines are substandard or falsified, according to the African Union Development Agency New Partnership for Africa’s Development (AUDA-NEPAD).

One reason why this continues to be a problem for Kenya – just like other countries on the continent – is the lack of adequate personnel.

Understaffing is a big challenge facing the PPB, according to Dr. Siyoi. The limited number of inspectors manning the border points, leaves the agency ill-equipped to cope with vast areas laced with informal border crossings between neighbouring countries through which smuggled drugs find their way.

“This is in addition to modified transport vehicles for concealment of [counterfeit] medicines,” says Dr. Siyoi.

Should the AMA come into being, the PPB hopes to benefit greatly from the technical assistance drawn from the pool of experts at the continental level.

In addition, the Agency will also enhance PPB’s capacity for dossier evaluations and the undertaking of joint Good Manufacturing Practices inspection of drugs being manufactured in Kenya itself. 

Some of these challenges, other pharma sources admit, would indeed be “better be addressed” through the AMA mechanism. 

Oksana Pyzik, Senior Teaching Fellow, Global Engagement Lead and Founder of UCL Fight the Fakes

At no time has the existence of AMA been so critical as today, observed Oksana Pyzik, Global Engagement Lead and founder of the University College London Fight the Fakes initiative, during a Wednesday panel session on ‘Why AMA’ – held under the auspices of the African Health Agenda, International Conference 2021 (AHAIC).     

“AMA is critical now more than ever and ties into the WHO’s patient safety plan directly,” she said. This, she explained further, is a concept which Dr. Tedros Adhanom, WHO’s director general, has been pushing, that without quality medicines, there is no universal health coverage for patients.

Image Credits: MOH_Kenya, AHAIC, Wish FM Radio, Inquirer, Marco Verch/Flickr.

“The future generations are not going to excuse this,” pleaded Kawaldip Sehmi, CEO of the International Alliance of Patients’ Organizations (IAPO). “They will be looking at us and will say, ‘What the hell were they doing procrastinating on their neighbors during a pandemic?”

Sehmi was one of seven speakers from across Africa who convened at an online session on Wednesday, the third and final day of the Africa Health Agenda International Conference (AHAIC), to discuss the prospects for near-term ratification of the African Union treaty to create an African Medicines Agency. a single centralizing regulatory body for pharmaceuticals in Africa.

The creation of the AMA was approved two years ago at the 32nd African Union Assembly, where it was touted as a critical tool that can enhance regulatory oversight of medicines and vaccines across the continent’s 54 countries. But the start of AMA operations have fallen victim to slow bureaucratic procedures in dozens of African countries that have foot-dragged in the required treaty ratification.  

The treaty has been signed by 19 countries but only ratified by eight out of a required 15 countries.  Meanwhile, the glaring absence of a body of this nature has only been more acutely felt during the COVID-19 pandemic, as the panelists highlighted.

Out of the continent’s 54 countries, 19 had signed the treaty ratifying for an African Medicines Agency (AMA), but only 8 out of the required 15 had ratified.

While IAPO’s Sehmi focused on the big picture vision of the AMA as the realization of a pan-African institution, epitomizing teachings of great African thinkers like Dr Kwame Nkrumah, the Ghanaian independence leader and first prime minister, other panelists detailed the nitty gritty  practical problems that AMA could help resolve  – focusing on the heart of concerns, African patients.

Take the case of sickle cell anemia.   Speaking at the AMA session, Mary Ampomah, President and CEO of the Global Alliance of Sickle Cell Disease Organisation (GASCDO) emphasized the critical role a body like AMA could play in helping sickle cell patients access more reliable and affordable drug supplies.  This has been a big problem in contempoary Ghana where, despite the existence of treatments like hydroxyurea for over three decades, patients could not access them prior to 2019 when Novartis finally intervened to create a supply channel for west African countries.

Mary Ampomah, President and CEO, Global Alliance of Sickle Cell Disease Organisations (GASCDO)

Going a step further, she asserted that the creation of a single regulatory authority would also help stimulate more local manufacturing – to supply a bigger market: “I think AMA will be helpful here because we know that when drugs are locally manufactured, they become cheaper and therefore accessible to patients,” she said.

Better regulation for Better Medicine

Oksana Pyzik, founder of the University College London Fight the Fakes,’ campaign, said that the AMA would assist in the “identification, prevention, detection and response strategies” in delivering quality medication across Africa. 

Oksana Pyzik, Senior Teaching Fellow, Global Engagement Lead and Founder of UCL Fight the Fakes

Pyzik spoke of how the COVID-19 pandemic had highlighted the need for a regulatory body such as the AMA to fill gaps and inconsistencies in the current patchwork of regulations that exist among the continents five regional regulatory authorities and dozens of national authorities. 

Citing the proliferation of false information surrounding the pandemic, which has affected people across the globe, she explained that in Africa “the lack of national regulatory and technical capacity has been one of the weak points around [the pandemic], fueled with misinformation that also then leads to people outside of traditional marketplaces, able to purchase medicines.”  This, in turn, places patients in grave danger – because they secure medications through channels where the products are not vetted and tested. 

Dr Eva Wangechi Mubia Njenga, Chair of the Non-Communicable Diseases Alliance of Kenya (NCDAK), further explained that the COVID pandemic has brought to a fore numerous “fake” products, including not only medicines, but also substandard personal protective equipment ( PPE), like masks, gloves, etc, which have entered into circulation.

Philip Tagboto – Chair of the Association of Ethical Pharmaceutical Industries – Moderates AMA Sesseion in the ”virtual space” of the Africa Health Agenda International Conference  2021

Fake vaccines, meanwhile, have already made their appearance.  In November 2020, some 400 ampoules of fake COVID-19 vaccines – equivalent to about 2,400 doses, along with a large quantity of fake 3M masks, were confiscated by police in South Africa working with the global police coordination agency, Interpol. The cross-border investigation led police in China to the manufacturing premises, where arrests of a number of Chinese nationals were made just last week – and a further 3,000 fake vaccines were seized. 

And Interpol Secretary General Juergen Stock said that this is only the tip of the iceberg when it comes to COVID-19 vaccine related crime. Efforts by bodies like the France-headquartered Interpol could be bolstered by AMA to support such cross-border successes, according to several panelists.. 

Through an Africa-wide regulatory body like AMA, processes like “market surveillance” and “supply chain security” could be implemented to better protect patients, Pyzik and other panelists stressed.

Big Pharma and Aid as ‘Gifts’ 
africa
COVID-19 vaccines arrive in Guinea – distinguishing fakes from authentic vaccines could become a serious problem as Africa’s vaccine rollout amplifies.

Dr Njenga also said that Africa’s inadequate [regulatory] barriers have left it vulnerable to the possibility of authentic, but still substandard, ineffective or defective vaccines and medicines could enter the market, by way of “gifts”. In February alone, Guinea accepted a donation of 200,000 vaccines from China, which has offered vaccines to over 50 countries around the world – even though China’s vaccine developers have yet to publish peer-reviewed studies of any of their products, or submit them for review by stringent regulatory agencies abroad. 

Exacerbating the problem, said Njenga, is the fact that vaccine know-how is difficult to share and transfer – with big pharma compnies, mostly based in high-income countries,more  eager to sell their products to the highest- bidders – leaving low- and middle-income countries out of the loop. It’s thus no surprise that vaccines entering the continent are either “unregulated, or to a lesser extent, what doesn’t meet regulatory standards in the West is often offered or passed on to the African continent,” said Dr Njenga.

African Medicine for Africa, the World

Another important aspect of the AMA’s work may be improving the supervison and regulation of African traditional medicine, said Isaac Nii Ofoli Anang, chairperson of the African Regional Office of the International Pharmaceutical Students’ Federation (IPSF), “especially in a time when we want to improve access and safety traffic and traditional medicines to help augment their production and distribution across the continent.”

Isaac Nii Ofoli Anang, Chairperson, African Regional Office, International Pharmaceutical Students’ Federation (IPSF)

Anang said that for IPSF, AMA serves two key roles, that of education and that of science. With respect to education, as in the case of African traditional medicine, the agency would serve to streamline education of a medicinal regulation framework. 

Speaking about science, he said AMA would serve to harmonize the “scientific processes to improve on our local drug production and distribution pharmacies and pharmacies.”

Civil Society and Free Trade Concerns

With countries still stalling in the ratification process, Dr Njenga placed the responsibility on civil society to demand this continental regulatory body. 

She painted a grim picture of the alternatives, pointing to the double-edged sword of Africa’s recently agreed, Free Trade Agreement (FTA) which facilitates faster and more efficient trade across Africa’s countries. As pharmaceuticals are amongst the most traded products in Africa, in the absence of an AMA, the FTA could actually open the doors wider to the proliferation of poor quality and poorly regulated pharmaceuticals being trading across several borders with little to no control or recourse, to the potential detriment to all Africans.

Moving beyond the need for ratification, per se, however, she stressed that the next step needed for the AMA will be an “operational business plan.”

Image Credits: IFPMA, A, AHAIC, srb news.

A study of people taking regular, low doses of aspirin found that the aspirin users were 29% less likely than others to test positive for COVID-19, as well as being less prone to serious disease and its “long COVID” after-effects.

The new peer-reviewed study, published in The FEBS Journal of the Federation of European Biochemical Societies, was led by an Israeli team associated with one of the country’s leading public health funds as well as a leading medical school and hospital.

Some of the same team members also were among the first to identify, last year, a link between low Vitamin D levels and higher COVID infection risks. 

In the observational study on aspirin and COVID, the team reviewed the medical records of 10,477 patients who had been tested for SARS-CoV2 infection between February and July of 2020. 

They identified a subgroup of over 2,000 patients who took 75 milligrams of aspirin regularly to prevent cardiovascular disease – and compared them with a similarly sized sample of people who didn’t regularly take aspirin doses – adjusting statistically for any differences in age and health status.  

Among people who had tested COVID-positive, the proportion of those regularly taking aspirin (or statins) was significantly lower, as compared to the group of people who tested COVID-19-negative group, the study, published in The FEBS Journal, of the Federation of European Biochemical Societies.  

People who had purchased, prior to their COVID test, at least 3 prescriptions for aspirin and statins were also less likely to be COVID-infected than those who did not.   

Among those who tested COVID positive, the aspirin users were also likely to have a shorter illness — by about two days — as determined by the length of time between their first positive COVID test and a negative test.  And they were less likely to suffer from aftereffects of the coronavirus, in terms of chronic health issues identified in follow-up. 

 The focus of the study was on aspirin users at risk of cardiovascular disease – but not chronically ill. 

“This observation of the possible beneficial effect of low doses of aspirin on COVID-19 infection is preliminary but seems very promising,” lead author, Eli Magen, of Barzilai Hospital, was quoted as saying in an Israeli news outlet.

“We were really excited to see a big reduction in the proportion of people testing positive, and this gives a promising indication that aspirin, such a well-known and inexpensive drug, may be helpful in fighting the pandemic,” added Milana Frenkel-Morgenstern of Bar-Ilan University 

“This finding with regard to ‘long COVID,’ a phenomenon that is a real concern, is very important,” she added.   While the mechanism by which aspirin might reduce disease risks and seriousness would require further study, she speculated that it was associated with the medication’s anti-inflammatory qualities. 

In addition to reducing inflammation, other observational studies on aspirin have also suggested that the century old medication, originally derived from willow bark,  can help play a role in preventing infections from other single-strand RNA viruses, similar to the coronavirus, as well as in preventing some forms of cancer. 

Frenkel-Morgenstern, the corresponding author on the aspirin study, also set a precedent in her observational study last year that found an association between low levels of Vitamin D and increased risk of COVID infection.  

Image Credits: University Health News .