The ‘Patent Bargain’, Public Good & COVID19 26/04/2021 Priti Patniak/Geneva Health Files Civil society groups demonstrate in February 2021 outside embassies of the United States, United Kingdom, Australia, Canada, Brazil, and other countries, which oppose a temporary WTO patent waiver on COVID-19 health products. As the hotly contested proposal for an IP waiver on COVID-related health products comes up again for debate on Friday, 30 April at the World Trade Organization’s TRIPS Council, legal expert Hyo Yoon Kang looks at the foundations of IP law to challenge “TRIPS waiver” naysayers. Geneva Health Files [GHF]: You have argued that IP law must serve the global public, not national interests, saying, ‘There is no logical reason why patent law’s grant of monopoly power cannot be curtailed, if its public purpose is not fulfilled.’ Can you elaborate? Hyo Yoon Kang [HYK]: With my statement, I was transferring the commonly held justification for patent law at the level of national jurisdictions to the global level. Much of modern patent law’s legitimacy rests on the belief that the public will be better served by granting a limited monopoly right in an invention than allowing market competition. This is commonly known as the ‘patent bargain’: private risk is rewarded and incentivised in return for a limited private monopoly right, which in turn is supposed to benefit the public at large in a trickle-down or trickle-across effect. Yet the scale of such a bargain has arguably not been in an equilibrium for some time, as pharmaceutical companies’ price hikes and ever-greening practices [nb. referring to efforts to extend the life of some patents] have shown. Also, not all inventions have the same importance for the public. It is not sensible that medicines are treated in the same way as hair dryers in patent law. Patent Bargain is Skewed In the current COVID-19 pandemic, the scale of the ‘patent bargain’ has become even more skewed against the public interest because monopoly rights are being claimed for inventions that have been effectively de-risked and funded with public taxpayers’ money, not to mention the decade long public support for basic research that has led to these products, such as the United States National Institutes of Health (NIH) funding of mRNA vaccine technologies. These arguments have been published in the research literature, including The Lancet.. While there is no need to repeat what has already been said, it bears pointing out that – a year into the pandemic – governments have created a de-facto oligopolistic market dominated by a handful of companies that have been subsidised by the public sector, providing fora range of intellectual property protections, ranging from patents to trade secrets. How does such a skewed patent bargain play out on the global scale? At least since the 1995 World Trade Organization agreement on Trade-related Aspects of Intellectual Property Rights (TRIPS), what counts as ‘public’ and ‘private’ in the context of IP can no longer be national categories. Yet the understandings of what is ‘public’ and ‘private’ in much of IP law discourse have remained rooted at the national level. The result is a dissonance of legitimacy between a transnationally enforceable IP legal structure and its justification based on 19th century concepts of sovereignty, colonisation and industrialisation. Existing WTO IP flexibilities enshrined in “31bis” of the TRIPS agreement still make it difficult to export health products manufactured under a compulsory license to other countries in need. Impracticability of Article 31bis The history of TRIPS, including the de-facto impracticability of Art. 31 bis is one example. The unwieldy restrictions around, and consequent limited use of this provision – which is supposed to facilitate a country’s export of medicines produced under a compulsory license WTO members that cannot produce the needed medicine in sufficient quantities – illustrates how institutional design has not been a level playing field, and favoured certain multinational corporations over others from the start. We can currently observe the unequal effects of such a legal institutional design in the pharmaceutical industry’s resistance to any compulsory licensing, to the WHO proposed C-TAP patent pool, and the TRIPS IP waiver proposal. They clearly illustrate that particular, private interests hosted by a minority of nation-states are pitted against the global majority public health interest. Serving the Global Public Interest This is why we ought to go back to the initial motivation that legitimised patent monopolies in the first place and conceive of the notion of a public clearly as a global public, and not a national one. If TRIPS is the legal architecture that underpins the ability to extract monopoly rent on a global scale, then by the same token, transnational patent law needs to serve a global public’s interest. Lastly, the public interest in rewarding ‘inventions’ is often erroneously conflated with ‘innovation’ as a desirable good in itself. For example, the term “technological innovation” has been included as TRIPS’ objective in Article 7 of the TRIPS Agreement, albeit with a caveat that it should be of mutual benefit to producers and users of “technological knowledge”. Additionally, while much of the PR generated by intellectual property offices, the pharmaceutical industry and the media assume that they are interchangeable notions, in fact “inventions’’, “‘patents” and “innovations” are not the same. The belief that ‘patents equal inventions equal innovation’ is rather a myth. Economic historical research has been inconclusive as to the benefits of patents to innovation until to date. [GHF] You have also spoken about how “the entanglement of governments with university science-entrepreneurs, venture capitalists and preferred industrial champions, further complicates the notion of what is ‘public’.” Can you elaborate? [HYK] The notion of ‘public’ is used by a variety of actors with different interests without asking: who does the ‘public’ include, who does it exclude? Are governments acting in the best interest of their citizens? Sciences are implicated in the erosion of the notion of ‘public’ since at least the Bayh-Dole Act 1980. (It allows for the commercialization of US federally funded research.) But the relationship between scientific research & development and industrial implementation/production stretches back to the 19th century and before. Publicly-funded universities and public research organisations are avid users of the intellectual property system, as recent European Patent Office analysis of pharmaceutical patent applications has shown. As much of their interests are monetary in nature now, university science departments, both fundamental and applied, cannot be necessarily understood as ‘public’ without qualifications; for instance, the high profile CRISPR patent dispute involved scientists in universities or public research institutions, and their spin-offs. Problem of Profit Motives Pervading Underfunded Universities is Complex In my Critical Legal Thinking piece, I explained the patent interests of Oxford University and their scientists. These existed prior to Gates’ push for an exclusive contract with AstraZeneca, and it is not entirely accurate to portray the university scientists as the innocent victims of commercial influence. There are, of course, some exceptions to the (now unfortunately normalised) figure of the ‘scientist-entrepreneur,’. I am thinking about Katalin Karikó who was instrumental in inventing the mRNA technology, [but holds no patents on it]. The pressure exerted on scientists by the university administration to apply for patents is not negligible, and the problem of private profit motives pervading underfunded public universities is a complex one. In relation to a government’s public duties, the pandemic has laid bare how particular, private and corporate interests have permeated what ought to be essentially public processes and decision-making power beyond an advisory capacity. ‘Venture Capitalist’ Thinking In Government For example, in the UK, the Boris Johnson government has favoured certain private actors under the guise of having no time for public procurement processes during a pandemic. Some journalists have argued that it was such ‘Venture Capitalist (VC) thinking’ that led to the UK’s vaccine success. The UK ‘vaccine tsar’, Kate Bingham, is a venture capitalist who has expressed that her vaccine procurement responsibility was ‘outside’ of politics (“Politics is separate”). In a recent FT interview, she claimed such VC thinking entailed that the government could not afford to be “penny pinching,” even if it was public money that she was spending. What is interesting is that the government, or the civil service, is regarded to have no capacity to direct and shape the process of vaccine manufacturing and distribution, whilst being expected to give a carte blanche. In other words, it is asked to pay and shush. Some US patent academics had, moreover, argued on social media that more financial incentives should be given to pharmaceuticals by the government in order to scale-up vaccine production. Yet the COO of BioNTech stated on German TV that it was not the lack of financial incentive that made the scaling up of vaccine production difficult at the moment. Need to Strengthen Public Sector Capacity – After Years of Austerity What this pandemic has demonstrated very clearly, is that we need to strengthen public sector capacity after years of austerity rather than diminishing it. This will reduce the present dependency on corporate actors. Also governments and their officials need to negotiate harder on the public’s behalf instead of accepting without question financial sector mentality in which maximising profit margin is the rational thing to do. Such a mentality forgets that it is the taxpayers’ money, not their own, that they play with. The public underwrites all risk whilst the financial gain is all private and distributed among a small number of shareholders or corporate owners. Without wishing to diminish the exceptional advances in vaccine development that we have seen in the past year, it is equally important to remember the extraordinary mobilisation of public funding into medical research and supplies which has been unprecedented in our lifetime. Should the Government Act like a Venture Capitalist? It seems therefore odd and disproportionate to me that there doesn’t seem to be a single contract in the UK or US, in which a government has taken co-ownership of a vaccine patent or receives future royalty, precisely because the vaccine development efforts were headed by a venture capitalist or a former pharmaceutical executive who would normally demand such returns on their investments. Beyond this incongruence, there is the fundamental political question – should the government act like a venture capitalist, at all? For example, the UK government runs the biggest venture capital fund in Europe which has received little scrutiny and is also reported to have taken a stake in Vaccitech, the Oxford University spin-off behind the Oxford/AstraZeneca vaccine. Alternative ways to balance public and private interests could be through IP restrictions on certain subject matters, national compulsory license legislation, and the enforcement of price ceilings on publicly funded inventions, but it will also be interesting to think about higher taxation on IP rent income. [GHF] Some believe that IP is not a barrier for medicines during the pandemic. Particularly with respect to vaccines. It has been suggested that the WTO TRIPS IP waiver will not sufficiently address access barriers to vaccines or wider medical products – particularly since the waiver itself would not force technology transfer. [HYK] The TRIPS waiver proposal does not only comprise patents, but also copyright, industrial design and importantly, undisclosed information, such as trade secrets, in relation to the fight against Covid-19. Trade secrets are also part of IP. They are especially relevant in relation to Pfizer because it has decided to keep its vaccine manufacturing know-how secret. Some argue that waiving patents is not sufficient because the knowledge-transfer and sharing of know-how are needed. This is certainly true, and also because of the low standard of the disclosure requirements in different national patent laws: the disclosed inventive information in patent documents is often woefully insufficient to be used as a “recipe” or for reverse engineering. That is also why analogising patents with recipes and copies is not accurate. I find the arguments advanced against the TRIPS waiver proposal claiming that as “patents are not the problem” disingenuous because, even if know-how was shared, tech was transferred, and a vaccine was developed, it would be illegal to produce it without a license – if the substance, its parts, or its process of manufacture, remains under patent protection. The patent holder would continue to hold the power to block vaccine production, regardless of existing or shared expertise and capacity. This is not a good way of clearing all barriers for scaling-up vaccine production in a global pandemic. The IP waiver is therefore necessary as an integral part of a concerted effort to share know-how and scale up production. We need the waiver in order to end the pandemic instead of prolonging it through artificial scarcity. Both IP waiver and tech transfer need to go hand in hand. Turning the argument on its head, we may ask why is the pharma lobby and Gates Foundation defending IP so much if it does not matter? If they are not the problem right now, then why not waive the IP rights temporarily? It seems to me that they are fighting so vehemently against the IP waiver because patents do enable monopoly power, and a future profit pipeline of a huge global market desperate for the vaccine. From a Purely Financial Perspective – It’s not In the Vaccine Makers’ Interest to End the Pandemic As Soon As Possible From a purely financial perspective, it is not in the vaccine makers’ and their shareholders’ interest to end the pandemic as soon as possible. Even though policy makers and governments are reluctant to push the pharmaceutical players too hard, the pharmaceutical industry, universities and their technology transfer offices will not self-regulate and voluntarily open license their patents through C-TAP or share their know-how in the latest announced WHO Technology Transfer pool, precisely because it is contrary to their rational commercial self-interest to do so. In my view, there must be both a carrot and stick approach towards the vaccine makers to change their present course. This could include the introduction and implementation of national compulsory license measures. [GHF] How do you see these IP issues, and the consequent “capitalisation of knowledge” play out in the future with respect to biological resources and digital health? [HYK] I don’t think I can answer the question about biological resources and digital health accurately without looking more into detail into the main issues and players in these fields, but in relation to the latter we will see an increasing overlap of copyright and patent law issues because the key value driving digital health will be access to datasets for pattern recognition and correlation tracing. The current debates about privacy, social media and regulation of AI are instructive for digital health. Similar to internet companies, the valuation of digital health companies will be data and computing-capacity driven. The role of IP law in the capitalisation of knowledge is that it creates a link between knowledge and speculative value through a legal monopoly right. In a way, this is nothing new. Intellectual property rights have always acted as currencies of international trade (chemical patents in the 19th century, for example), and have been hence nationalistic instruments of trade policy. It is also nothing new that academic or university science departments have been implicated in industrial policy since the 19th century, which in turn shaped the foundations of modern patent law. Historians of science, science studies scholars, and myself from the patent law side, have studied the different phases and modalities of co-option of science into industry. What has been novel since roughly the mid-1990s, is the pursuit of IP as not only monopoly for extracting monopoly rent in a commodity market, so via monetisation, (this is the case presently in the Covid-19 vaccine oligopoly), but using IP as a financial tool: either to raise more equity or as technique of financial arbitrage. I have analysed the financialisation of patents as assets. The financial forward-looking, speculative function of IP is reflected in the total reversal in the proportion between physical and intangible assets value in the S&P 500 index between 1975 and 2017. The last forty years have been characterised by increasing financialisation of knowledge-making and uses via IP, both through copyright and patent laws. As already noted, inventions, innovation and IP are routinely and misleadingly conflated today, partly as a result of patent office rhetoric that equates more IP with more innovation. Patents are seen as a key asset in the so-called “knowledge economy” of disruptive innovations. In turn, knowledge enclosures create new forms of colonial dependencies, as we observe now in this current pandemic. As much of the current financialised economy rests upon monopolies that are enabled through intellectual property law, unless health data and knowledge about them are safeguarded through privacy or other rights-based measures, they will become as monetised and financialised as any other data. If they concern matters of global public health, IP rights will again stand in the way of health equity. I can only hope that we will learn the lessons of this pandemic. Intellectual property law expert, Hyo Yoon Kang, is a Reader in Law at Kent Law School, University of Kent, United Kingdom. Kang works at the intersection of law, history of sciences, and science and technology studies. Hyo Yoon Kang, IP specialist at University of Kent, United Kingdom Adapted from the article first published in Geneva Health Files by Priti Patniak, GHF founder and publisher. Image Credits: Tadeau Andre/MSF , AstraZeneca, Image credit: Shariq Siddiqui). India Faces Urgent Shortage Of Oxygen As Cases Soar – Japan Enters Third State of Emergency 24/04/2021 Madeleine Hoecklin India’s first ‘Oxygen Express’ train is transporting liquid medical oxygen from steel plants that produce oxygen to different parts of the country in desperate need of supplies to support treatment of seriously ill COVID patients. India recorded the world’s highest daily toll of new infections for the second consecutive day on Friday, while Japan plans to impose its third state of emergency, just three months before the Tokyo Olympics are set to begin. India is currently facing its worst outbreak of SARS-CoV2 since the pandemic began, with over 330,000 new cases recorded on Friday – more than triple India’s previous peak in late September, and surpassing the US record of 300,669 new cases on 8 January 2021. Over the past week, nearly 1.6 million new COVID-19 cases have been recorded across India. Daily deaths are also on the rise, 2,263 deaths were recorded on Thursday, bringing the total COVID-19 deaths up to 186,920, according to health ministry data. “The second wave is a consequence of complacency and mixing and mass gatherings,” Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy in New Delhi, told Reuters. Hospitals Call for Help as Oxygen Supplies Dwindle Health officials in northern and western India are raising the alarm that hospitals in major cities are becoming overwhelmed, pleading for government assistance. Oxygen supplies are running low. The low pressure of oxygen could be the cause of 25 deaths recorded over the last 24 hours at the Sir Ganga Ram hospital in Delhi. “Oxygen will last another two hours. Ventilators and Bipap not working effectively. Resorting to manual ventilation in ICUs and Emergency. Major crisis likely. Lives of another 60 sickest patients at risk, need urgent intervention,” the Sir Ganga Ram hospital in Delhi said in a statement to the government early Friday morning. “Need oxygen to be airlifted urgently. Governments please help,” the statement said. Max Healthcare, a healthcare provider operating 16 facilities across North and West India, also sent out a warning about a shortage of oxygen, asking for “immediate assistance” on Twitter. SOS – Less than an hour's Oxygen supplies at Max Smart Hospital & Max Hospital Saket. Awaiting promised fresh supplies from INOX since 1 am. @drharshvardhan @msisodia @PMOIndia @ArvindKejriwal @PiyushGoyal @SatyendarJain over 700 patients admitted, need immediate assistance 🙏🏼 — Max Healthcare (@MaxHealthcare) April 23, 2021 The Max Smart Hospital and Max Hospital Saket received emergency supplies of oxygen shortly after the SOS call, however, it was only sufficient to last two hours and the facilities are still awaiting more supplies. Admissions to Max Healthcare hospitals in Delhi were suspended until the oxygen supply stabilised. A Fortis Healthcare hospital in Haryana announced that it had “only 45 minutes of oxygen left” on Thursday evening, calling on Prime Minister Narendra Modi to dispatch an oxygen tanker to the hospital urgently. Fortis Hospital in #Haryana has only 45 minutes of oxygen left. Requesting @ashokgehlot51, @rajnathsingh, @PiyushGoyalOffc, @mlkhattar and @AmitShah to act immediately and help us to save patients’ lives. (1/2) — Fortis Healthcare (@fortis_hospital) April 22, 2021 According to the city government of New Delhi, six hospitals in the city have run out of oxygen and neighbouring states have been accused of holding back supplies to service their own hospitals and blocking oxygen tankers at border crossings. Sites producing oxygen are ramping up manufacturing to meet demand and a train, dubbed the ‘Oxygen Express,’ made its first trip carrying seven tankers, each filled with 15 tonnes of liquid medical oxygen on Thursday evening. The first ‘Oxygen Express’ train loaded with liquid medical oxygen tankers has left for Maharashtra from Vizag. Railways continues to serve the nation in difficult times by transporting essential commodities and driving innovation to ensure the wellbeing of all citizens. pic.twitter.com/4t7ZKbjeIT — Piyush Goyal (मोदी का परिवार) (@PiyushGoyal) April 22, 2021 Government hotlines are reportedly mostly down in the worst affected states, leading individuals to seek information on available hospital beds and oxygen supply on social media, sharing experiences and photos of patients waiting outside of emergency rooms that are over capacity. Urgent Imports of Oxygen Arranged The Indian government has arranged to import 23 mobile oxygen generation plants from Germany, which will arrive within a week. The Armed Forces Medical Services will also airlift oxygen cylinders, essential medicines, and medical personnel from other regions to Delhi. Plans to import 50,000 metric tonnes of medical oxygen to meet the demand are underway, with Russia offering to supply both oxygen and Remdesivir. Imports are expected to begin within 15 days. China has also extended support to India to assist in getting the current outbreak under control. “China takes note of the recent grave situation in India with a temporary shortage of anti-epidemic medical supplies. We stand ready to provide India with necessary support and assistance to get the epidemic under control,” said Wang Wenbin, Spokesperson for the Ministry of Foreign Affairs of the People’s Republic of China, at a press conference on Thursday. At the same time, a growing number of countries are severely restricting or barring travelers from India, putting the country on the travel ‘red list.’ These include countries in Europe, as well as Canada, Britain, Hong Kong, Singapore, and New Zealand – amid mounting concern about the surge of cases in India. The US Centers for Disease Control and Prevention issued a level 4 warning for India, advising travelers to avoid all travel to India. As India’s catastrophic second wave of COVID-19 rages on, only 8.1% of the population has received at least one dose of a COVID-19 vaccine. The national vaccination program will open to all individuals over 18 on 1 May, however, experts warn that the vaccine supply is not sufficient to cover the hundreds of millions of people who will become eligible. Japan Issues Targeted State of Emergency Meanwhile, Japan has also declared a new state of pandemic emergency in Tokyo, Osaka, and two other regions. New restrictions will go into effect on Sunday until 11 May, the government announced. “We absolutely have to limit the movement of people, and we have to do it decisively,” said Yasutoshi Nishimura, the minister in charge of the country’s COVID-19 response, at the announcement of the new restrictions on Friday. The state of emergency coincides with the Golden Week, a public holiday when domestic travel is expected to be widespread. Restaurants and grocery stores will close early and the public will be asked to work from home, but school will remain open. Japan recorded over 4,300 new cases on Friday, 1,162 were reported in Osaka and 759 in Tokyo. The rise in cases is taking place just three months before the Olympics games are set to begin on 23 July. The emergency measures are expected to be lifted by 11 May, ahead of a visit by the International Olympic Committee (IOC) President Thomas Bach. Despite opposition from the Japanese public and worries expressed by health experts, the Japanese government, supported by the International Olympic Committe (IOC) has remained determined to have the games go ahead. SHORT THREAD on JAPAN / OLYMPICS: Japan is going through a major new Covid wave and this potentially puts the Olympics later this summer at real risk… (and of course Japan's large population!) 1/4 pic.twitter.com/6PTGJRnBsH — Prof. Christina Pagel (@chrischirp) April 23, 2021 “We’re not thinking about cancellation. We’re thinking about how we can prepare in a way that prioritises safety and makes people feel it can be held safely, and makes them want it to be held,” said Seiko Hashimoto, President of the Tokyo 2020 Olympics Organising Committee, on Friday. According to Prime Minister Yoshihide Suga, Japan has no say in whether or not the Olympic games take place. “The IOC has the authority to decide and the IOC has already decided to hold the Tokyo Olympics,” said Suga. “We aim to hold the games while taking strong measures to protect people’s lives from the further spread of infections.” Image Credits: Prasar Bharati News Services. In Fighting COVID-19, We Can’t Neglect Malaria 24/04/2021 Peter Sands Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria World Malaria Day is a reminder that, as the world battles with COVID-19, we still haven’t beaten a much older pandemic. Malaria is a mosquito-borne disease that has plagued humanity for millennia and still kills over 400,000 people per year – mainly children under five. In fact, that grim number will almost certainly have increased in 2020 and will do so again in 2021, as COVID-19 has severely disrupted malaria testing and treatment services in many of the most affected countries. New data from Global Fund spot-checks of 504 health care facilities across 32 countries in Africa and Asia in 2020 revealed a 31% drop in malaria diagnoses over a six-month period compared to the previous year, and a 13% drop in malaria treatment. Since swift diagnosis and treatment are key to preventing death, and there’s no reason to believe that the number of cases has fallen, such a sharp reduction in diagnoses and treatment will inevitably translate into increased mortality. It could have been even worse. The first line of defence against malaria are insecticide-treated mosquito nets that protect people from mosquitoes. When the pandemic first hit we were extremely concerned that supply chain disruptions and the challenges of distributing millions of mosquito nets during lockdowns would leave hundreds of millions of people unprotected. A massive effort, led by countries’ national malaria campaigns, supported by the Global Fund and the U.S. President’s Malaria Initiative (PMI) and with huge engagement of community organizations, prevented what could have been a catastrophe. While some mosquito net distribution campaigns were delayed in 2020, almost all were successfully implemented. Sustaining Community Health Workers’ Test-and-Treat Ability Community health workers are crucial to the testing and treating of malaria in rural parts of Africa. This year, the challenge will be to sustain community health workers’ ability to test and treat malaria. In much of rural Africa, community health workers are the lynchpin of the health system, and in the highest burden regions of central and western Africa, most of their time is spent treating malaria cases. I recall talking to a community health worker in Mali, who told me the malaria situation was much better than it was years earlier when she first started. But when I looked at her register of patient visits, I was surprised to see that every single entry was a malaria case. When I asked her to explain, she said the big difference was in the number of deaths; rapid testing and effective treatment had dramatically reduced mortality. Since 2000, the worldwide malaria death rate has dropped by 60% thanks to the tireless efforts of community health workers like her. But given the number of people they interact with, community health workers are extremely vulnerable to being infected with COVID-19 and often have limited access to basic personal protective equipment (PPE) like gloves and masks. In the same round of Global Fund spot-checks of health facilities last year, a shocking 55% of facilities in Africa didn’t have enough basic PPE available for their workers. If a community health worker falls ill, there’s often no back-up. Community health workers will also be called on to play a vital role in COVID-19 vaccination campaign as these get going. It is crucial to protect people from the new virus, but we also need to ensure that the diversion of focus doesn’t lead to an escalation in malaria deaths. Increasing Malaria Grants An infant and mother under an insecticide-treated mosquito net in Ghana – such nets remain a key prevention technique. In the poorest countries in Africa it seems quite likely that unless we take decisive action, the knock-on impact of the pandemic in terms of incremental malaria deaths may well exceed the direct impact of COVID-19. As the largest funder of malaria programmes worldwide, the Global Fund is working urgently with partners to prevent such a disastrous outcome and get us back on track towards ending malaria. From January 2021, we have increased malaria grants by 23% on average, and are committed to deploying about US$4 billion over the next three years. In addition, our COVID-19 Response Mechanism is providing US$3.7 billion in funding to help countries respond to COVID-19, mitigate the impact on HIV, TB and malaria services, and make urgent fixes to health systems. For malaria, the priorities in 2021 are to continue to ensure we maintain campaigns for mosquito net distribution, spraying of insecticide in homes, and the provision of seasonal malaria chemoprevention for children, and to step up support to community health worker networks. We need more community health workers and we need to support them better – financially, with technology, with training and with personal protective equipment. Looking beyond 2021, we should take COVID-19 as a catalyst to rethink our approach to malaria. Global policy-makers are already discussing how to better protect the world from future pandemics. Let’s not forget the imperative to finish the fight against older pandemics like malaria, which may not threaten those in Washington DC, London or Paris, but still kill hundreds of thousands of people every year. Building Pandemic Preparedness An infant receiving the RTS,S malaria vaccine in Ghana in 2019. New malaria vaccines hold promise of significantly reducing childhood infections and severe malaria cases. In fact, the best way to build pandemic preparedness in many of the poorest parts of the world would be to mount a significant step-up in the fight against malaria. The capabilities needed to prepare and respond to any new pathogenic threat are largely the same as those needed to defeat malaria – primary health care that reaches everyone, however remote; rapid diagnostics; genomic sequencing to detect variants; disease surveillance including the ability to trace individual infections; supply chains that ensure essential medicines are available everywhere. New potential malaria vaccines could be used to pilot accelerated models for clinical trials, regulatory approval and deployment. Rather than predicate pandemic preparedness on hypothetical threats, pathogens that might cost lives, let’s build such protection by beating malaria and by doing so save millions of lives – the vast majority of them young children. For too long we have accepted people dying of a treatable disease we know how to eliminate – and that we have eliminated in dozens of countries. Now we should make this happen everywhere, and in doing so reinforce our defences against other pandemic threats. Peter Sands is the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria Image Credits: What is Malaria, WHO. Pharma Execs: Unlock Export & Supply Chain Barriers & Ramp Up Sharing Of Excess Vaccine Doses To Beat Back COVID Pandemic 23/04/2021 Elaine Ruth Fletcher Stephane Bancel, CEO of Moderna, says company is close to agreement on supply of its mRNA vaccines to COVAX. A group of leading pharmaceutical industry executives called upon global health leaders to work together to unlock export barriers, open up supply chain bottlenecks, and encourage high-income countries that are hoarding vaccines to redirect their excess doses to the WHO co-sponsored COVAX global vaccine facility – as ways to rapidly scale up equitable vaccine access and beat back the pandemic. The executives, including the CEO of Moderna and India’s Bharat Biotech, as well as GSK’s head of global vaccines, and the heads of the Developing Countries Vaccine Manufacturers Network (DCVMN) and the Biotechnology Innovation Organization (BIO), were speaking at an event Friday marking a year since the establishment of the WHO co-sponsored Act Accelerator COVAX initiative. Patents and other IP constraints are not the main obstacle to expanding access to vaccines, they asserted. And increasing vaccine manufacturing capacity in lower-income countries, while important, will take time to develop – given the complexities of vaccine production, they said, speaking at a forum sponsored by the International Pharmaceutical Manufacturers and Associations (IFPMA). Rather, the best way out of pandemic lockdowns and losses of life is to make better use of available resources, they stressed, including smoother supply chains and vaccine sharing schemes with COVAX. “We are on track to make a billion doses this year, and potentially to have up to 1.4 billion doses for 2022,” said Moderna CEO, Stephane Bancel, at the press briefing, adding that the company is also “in the final stretch to get an agreement with COVAX,” for distribution of the mRNA vaccine through the global vaccine equity pool. But he stressed that expanding manufacturing capacity further, and in more locations, would sap efforts to produce doses this year – and could ultimately even cost lives. “We need to focus on delivering as many vaccines as we can this year,” he said, while trying to add more manufacturing capacity risks “being a distraction limiting what we can do in 2021… and by next year there is going to be way too many vaccines for people on the planet.” United States Raw Inputs Are Key To Global Vaccine Manufacturing Supply Chains Michelle McMurry-Heath, CEO BIO Added Michelle McMurry-Heath, a former US Food and Drug Administration expert, unlocking supplies of key raw products and vaccine dose sharing are important low-hanging fruit in the battle against the virus: “We need to recognise that there are only a handful of manufacturers across the globe who have that expertise on hand, and we need to focus on getting them the materials that they need to produce as many doses, as quickly as possible, and to release backlogs,” said Heath, who is now CEO of BIO, a global trade association organisation that represents biotech researchers in government, the private sector, and academic institutions. This this includes items as basic as single-use plastics and filters for the vaccine manufacturing process, some of which can only be supplied from in the United States. Currently the US Defense Production Act (DPA) restrictions are holding up release of many of those raw inputs, she stressed, adding that: “the US has to take a hard look at itself…. This Defense Protection Act, which was really designed to withhold capacity, expertise, doses and raw materials to the US, customer was well intentioned – but somewhat misguided at this stage – we need to get those raw materials, out to the limited manufacturing capacity that exists around the globe.” In addition, she added, high income countries need to be encouraged to start dose-sharing with the COVAX initiative – following on the example of France’s announcement only today that it will share 500,000 vaccine doses. “The US is projected to have as many as 200 million excess doses on hand by the spring, we need to focus on getting those doses to COVAX,” said Heath. Vaccine Companies Can be Counted In ‘Double Digits’ Vaccine quality, which require adherence to strict biosafety requirements as well as to sterile conditions, is also a critical issue, she underlined. And quality control failures in manufacturing plants, such as ones seen recently in the case of a Johnson & Johnson vaccine plan, can undermine already shaky public confidence in the quality of brand-new COVID-19 vaccines. Added Sai Prasad, CEO of Bharat Biotech, which has developed the first indigenous Indian COVID-19 vaccine, “Vaccine companies you can probably count in double digits so we need to be careful about whom we are transferring technology to, and whether they can receive it as well. Technology transfer cannot be done with an entity that has no experience.” Sai Prasad, CEO Bharat Biotech “I think that as industry, we need to increase the partnerships between innovators and vaccine manufacturers…. We need to be agnostic as to whether these companies are US, Europe, India, China or Brazil, for example. And I think there is [already] a good track record of that,” he added, noting that over 200 partnerships between big pharma innovators and developing country manufacturers have been formed already. At the same time, he said, supply chain bottlenecks and export barriers are a big threat to scale up: “Some of the vaccines take 150 to 200 little components that come from different parts of the world. “So interruptions in just one component, can slow production significantly, he pointed out, referring to the Serum Institute of India’s recent problems securing certain inputs from the United States. “We’ve had reports from the Serum Institute having problems with certain single use materials that are supposed to come from the United States… plastic bags for example which we think is a mundane consumable, because maybe a decade ago industry, as such, we were all thinking about going into single use systems, which involved a lot of single use consumables – but now this unfortunately has become an impediment, and a bottleneck.” Rajinder Suri, CEO DCVMN Rajinder Suri, CEO of the Developing Countries Vaccine Manufacturing Network (DCVMN), echoed that saying: “We are on the verge of expanding and ramping up the capacities, which are really required to meet the global demand…..and we are certainty facing some of the bottlenecks, from cell culture mediums and serum adjuvant filters, and single use plastic bags, to bio reactors. “Most of these materials are coming from the US – so if the DPA is not handled properly, then the supply chain will get impacted, and building the global capacity will adversely get impacted.” COVAX Distributions Should Accelerate – With Stronger US Support On the brighter side, meanwhile, Heath said she was confident that with stronger support for COVAX from the new US administration of President Joe Biden, the global vaccine facility can make up for its comparatively slow start in the second quarter of the year. “COVAX didn’t have full support of all the developed countries. Now that this is up to speed…. we need to focus on great efforts like COVAX which are just beginning to fully ramp up, and can deliver very affordable vaccines around the globe. I is the fastest way to get high quality doses to developing countries, and that speed is so critical,” she said. Added Bancel, “we are focused on working with COVAX to provide vaccine, right now. COVAX is the way for us to get maximum access on the planet.” See entire press briefing: ACT-Accelerator Celebrates 1st Anniversary Amid COVID-19 Surge in India 23/04/2021 Kerry Cullinan Health worker Evelyn Narkie Dowuona holds up her vaccination card after receiving a dose of the COVAX-delivered AstraZeneca COVID-19 vaccine at Accra’s Ridge Hospital in Ghana. One of the few silver linings of the COVID-19 pandemic is the unprecedented collaboration of every sector of society to overcome it – best demonstrated by the Access to COVID-19 Tools Accelerator (ACT-Accelerator), which celebrated its first anniversary on Friday. The ACT-Accelerator’s most famous pillar is the vaccine facility, COVAX, which has distributed almost 40 million vaccine doses to 119 countries so far. “Vaccinating at this scale and in this time frame constitutes the largest and most complex vaccine rollout in history,” according to the WHO, but added that there are also “severe supply constraints characterising the market at present”. Other key achievements in the past year include: procuring 65 million COVID-19 tests for LMICs and supporting the development and Emergency Use Listing (EUL) of reliable rapid antigen diagnostic tests by its diagnostics pillar supporting the identification of dexamethasone as the first life-saving therapy against COVID-19 and, within 20 days of its identification, making 2.9m doses available to LMICs vis its therapeutics pillar Assisting to providing oxygen to half-a-million COVID-19 patients every day in LMICs. Procuring $50 million of PPE for LMICs via the Health Systems Connector pillar. While the ACT Accelerator has attracted $14.1 billion in funding, it needs another $19-billion this year to meet its aim of vaccinating 20% of the world’s population by the end of the year. Equitable Access Still a Long Way Off “The ACT Accelerator was conceived with two aims: the rapid development of vaccines diagnostics and therapeutics, and equitable access to those tools,” Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General, told the virtual anniversary featuring all partners. While the first objective “has been achieved”, said Tedros, “we have a long way to go on the second objective”. Of the more than 950 million vaccinations that have been given, 0.3% have been administered in low-income countries and testing rates in high-income countries are about 70 times higher than those in low-income countries, according to the WHO. “Around the world, people are dying because they are not vaccinated. They are not tested and they are not treated. We’re deeply concerned about the increasing number of cases in India right now,” said Tedros. India recorded 332,730 new cases and 2,263 deaths on Friday amid reports that many hospitals had run out of oxygen. South African President Cyril Ramaphosa South African President Cyril Ramaphosa told the event that “a COVID-19 vaccine is a public good and must be recognised as such”. South Africa and Norway co-chair the accelerator’s facilitation council, which provides political leadership for the body. TRIPS Waiver and Technology Transfer “South Africa and India are calling for a temporary TRIPS waiver to respond to COVID-19,” Ramaphosa added. “This, in our view, will facilitate the transfer of technology and intellectual property to more countries for the production of COVID-19 vaccines, as well as diagnostics and treatments.” He also welcomed the WHO initiative to establish a COVID-19 mRNA vaccine technology transfer hub and called on the pharmaceutical industry to “directly transfer this technology free of intellectual property barriers to low and middle-income countries”. Norway’s Minister of International Development, Dag Ulstein, said that his country and South Africa had sent out letters to 89 countries appealing to them to contribute to the ACT-Accelerator. “At this one-year anniversary, our choice is simple: invest in saving lives by treating the course of the pandemic everywhere now, or continue to spend trillions on the consequences of the pandemic with no end in sight,” said Ulstein, whose country has donated a number of its vaccine doses to COVAX. Describing the accelerators’ achievements as “a miracle”, Ursula von der Leyen, President of the European Commission, said that the EU had recently doubled its contribution. Meanwhile, French President Emmanuel Macron said that “now was the time to share”, and announced that his country would donate 500,000 vaccine doses to COVAX by mid-June. He appealed to other countries to donate vaccines to COVAX, saying that he hoped that the goal of EU members donating 5% of their vaccine stocks he set in February would be “exceeded” by the end of the year. However, Macron said the lack of technology transfer, not intellectual property rights, was hampering vaccine rollout. France is one of a handful of wealthy countries opposing the TRIPS waiver. Thomas Cueni, Director General of International Federation of Pharmaceutical Manufacturers (IFPMA), said that a year into the AC-Accelerator “we can say science wins”. “Not one but several highly effective vaccines are being developed at record speed, and now being produced in historic quantities,” said Cueni, committing his industry to accelerating “global access to safe, effective and affordable COVID-19 treatments and vaccines”. French President Emmanuel Macron Jeremy Farrar, Director of Wellcome, said in a press release about the anniversary that “huge strides have been made in the last year” but “science only works if it reaches society”. “The world remains in the grip of a devastating pandemic – and it is not slowing, only escalating. There must be no further delays to getting COVID-19 vaccines, tests and treatments to the most vulnerable groups everywhere,” added Farrar, whose organisation is a partner and significant contributor to the accelerator. “We are in desperate need of strong global leadership. Wealthy countries with access to surplus vaccine doses must start sharing these with the rest of the world now through COVAX, alongside national rollouts. And they should urgently set out a timetable for how these donations will be increased as they vaccinate more of their populations.” Surge of COVID-19 in India is ‘Really, Really Difficult’ Mike Ryan, WHO’s Executive Director of Health Emergencies Programme, said the global body was assisting India to secure oxygen, as well as with technical assistance and clinical management and triaging of patients. “There’s a lot of fear in India right now. We support the Government of India, like we support all governments, in facing this really, really difficult situation. This is not time for recommendations. It is the time for solidarity, the time to move quickly together to reduce deaths and reduce transmission by decreasing mobility and mixing, supporting communities with mask-wearing, maintaining social distance and reducing social gatherings,” said Ryan. Seth Berkley, CEO of the vaccine alliance, Gavi, added that because of India’s domestic need, “the first 10 million vaccine doses from COVAX went to India”. However, Berkeley acknowledged that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. Image Credits: WHO. Global Health Is In Disarray – But Is A Pandemic Treaty The Way Out ? 23/04/2021 Svĕt Lustig Vijay Lines of people wait their turn to receive the AstraZeneca COVID-19 vaccine in Rwanda in early March, after WHO-supported COVAX facility supplies are delivered. Should countries build a new pandemic treaty – or bolster existing mechanisms? Despite rising calls for a pandemic treaty, including from 25 world leaders in an open letter last month, some global health experts doubt that a treaty would be the most efficient way to quickly strengthen the world’s capacity to beat COVID – and prevent future pandemics. “I don’t think we have time to negotiate another treaty on vaccines. I mean, we really are in this emergency,” said Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia, Canada. Lee was one of four panelists featured at a session on “Global Health in Disarray-What Next,” hosted by the Geneva-based Graduate Institute’s Global Health Centre to mark the launch of its newly appointed International Advisory Board (IAB). The wide-ranging session covered a range of issues, from the feasibility of a pandemic treaty, to the challenges of achieving vaccine equity and the lack of progress made in strengthening health systems in low-income countries, despite years of international funding. A Pandemic Treaty Is Not Essential Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia. “Do we need a treaty to move forward? The answer is no,” said Esperanza Martinez, the Head of COVID-19 Crisis Management at the International Committee of the Red Cross (ICRC). “I don’t think that we are short of frameworks and short of treaties… there are already enough mechanisms to act.” According to Lee, legal frameworks such as the World Trade Organization’s TRIPS agreement, and accompanying TRIPS flexibilities create frameworks under which countries can gain access to lifesaving products during health emergencies. And the legally binding International Health Regulations (IHRs), which mandate countries to report on disease outbreaks, and share information with WHO and other member states, is another “useful” framework that should not be forgotten, added Finland’s Director for International Affairs Outi Kuivasniem, another panel member. Rather, the global health community needs to find ways to reform existing frameworks so that they serve us better, panelists suggested. Esperanza Martinez, Head of COVID-19 Crisis Management at the International Committee of the Red Cross In particular, there is a need to reform the IHRs, Kuivasniem said, because countries have not always complied – including by enacting export bans on vital health products or inputs, which have destabilized crucial supply chains, including those relating to vaccines and other essential medicines. Treaty Would Need Strong Member State Alignment At the same time, panelists acknowledged that a pandemic treaty could have some use if it was closely linked to existing legal frameworks like the IHRs and international humanitarian law, and generated greater adherence from countries, as well as support from civil society. “If we have a treaty, we need to have a conversation about what makes sense to have in the treaty so that it has an impact, and that countries are willing to adhere to those promises that are [made] through a treaty,” warned Kuivasniem. Allan Maleche, Executive Director, Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN) Conversely, a “lack of political alignment” between governments and between government and civil society, could frustrate efforts to develop a new pandemic treaty, cautioned Allan Maleche, Executive Director of Kenya’s Legal & Ethical Issues Network on HIV & AIDS (KELIN). And other “political solutions” are also on the table, she and other panelists pointed out, to accelerate pandemic response. Few would actually require a treaty. Those initiatives range from the WHO co-sponsored COVAX global vaccine facility to proposals for an IP waiver under the TRIPS rules of World Trade Organization the COVID-19 Technology Access Pool (C-TAP), and tech transfer initiatives. Despite controversies over some initiatives, such as the IP waiver, none really require a pandemic treaty to be implemented. Should a pandemic treaty be negotiated, civil society should really drive its development, Maleche underlined. “If we are serious about getting our pandemic treaty in place, it’s important for scholars, academics, human rights lawyers, civil society groups, and affected communities to push their governments and [define] what should be that framework,” he said. “A treaty would be important but the more important is respect and implementation of that treaty so that it can have an effect on the lives of people,” he said. Stronger Business Case Needed For Investing In Health Systems in LMICs Healthcare workers treat a patient with drug-resistant TB in Myanmar, using drugs procured by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Beyond the immediate pandemic, however, a stronger business case is needed to convince governments that global health is a long-term investment that makes economic sense, stressed Martinez – particularly in LMICs. “We need to have a business case, an economic case for investment in global health,” she said, pointing out that while the case has recently been made for investment in vaccine access, “there’s a need for making a stronger case for global health in general… as a way of also bridging the conversation gap between government and the private sector.” Meanwhile, Maleche expressed dismay that decades of international funding meant to strengthen healthcare delivery in developing countries such as Kenya had failed to create more sustainable health systems. “Has this money actually been fixing the health systems?” he asked. “Because the time we needed the health system to be fully functional, COVID came and exposed the things that are not working. “COVID also exposed the underbelly of things that many countries don’t normally give priority,” he added. “You’re telling people: wash your hands, put on a mask, social distance, but in certain countries including Kenya and in other low- and middle-income countries, some of those things are luxuries as people have never seen clean running water in taps.” In addition, Maleche added, COVID-19 has highlighted the fact funds are also misspent by governments lacking public transparency and accountability: “Even within a pandemic we still are able to see that resources are not accountably used, we see that governments are not transparent. So again, this comes to show that some of the bad habits that we had when we had a normal sort of situation in the globe are played out in quite an extreme picture, in the context of a pandemic. ” In the humanitarian sector, in particular, financial support for fragile healthcare systems has been particularly scarce, added Martinez. “Very little has been done to strengthen health care systems in LMICs,” she asserted. “We have been speaking for years about the need to strengthen healthcare systems in developing countries and in humanitarian crises, but really when we look, very little has been done. In terms of vaccine access as well, “fundamentally there is a lack of production, science and research and development in the global south, and unless we address that issue, we will not have a sustainable solution to these [vaccine production] needs that we have globally,” she added. “There is a need for investment, but the investment at the level that is required is not coming through.” Regional Initiatives and Grassroots Action As Way Forward Ilona Kickbusch, Founder and Chair of the International Advisory Board, Global Health Centre “There is a feeling in the air [that] we need to reform,” said Ilona Kickbusch, founder of the Global Health Center, and chair of the new International Advisory Board, and moderator of the panel discussion. “Now there’s a number of suggestions on the table, for how global health, both in terms the way we do research and the way the global health regime and organizations are set up, could be changed. “And it’s interesting that right now we’re facing a pressure to some extent from above, top-down, from heads of state and government who are saying, ‘we need a new treaty in global health,’ and as many of you know we only have one so far… “On the other hand, there’s this movement from below that says we need to decolonize global health, we need totally different ideas, approaches, and we need to be much clearer about equity and access, and the social justice agenda.” Among the new ideas, Kickbusch pointed to regional initiatives that are underway, particularly in Africa, to chart a more strategic direction for the continent’s pandemic response. While many countries turned inward during the pandemic, Africa started working together more closely at the regional level, she pointed out. A new African region multi-hazard warning system will seek to link early warning, and responses to natural hazards, pandemics and pests and diseases as well as conflict. That collaboration has stimulated initiatives ranging from AU-based vaccine procurement to the new AU/Africa CDC partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), announced just last week to ramp up vaccine research, development and manufacturing in the region – with funding from Afreximbank and the Africa Finance Corporation. In addition, the African Union and Africa CDC are developing a new COVID-19 Disaster Recovery Framework and multi-hazard warning system for the continent to better link responses to climate, health, and environmental emergencies. “It is one of the encouraging things in global health..that there are these regional initiatives,” Kickbusch said. “Particularly in the African Union, we’ve seen the activities of the African CDC during the pandemic, and seend that a true consensus is building up.” Said Martinez, “This pandemic is precisely an example of how critical it is for us to have this broader view of health… “So we have the pandemic crisis and we also have the climate change crisis. And if we look at the issue we need to think beyond climate change [and] understand that polar bears are drowning in the Arctic, to think about the millions of people that today are facing diseases that were confined to the tropics. “We [need to] link all of those elements to the broader components of human health and health systems. I think that’s when we truly talk about human global Health.” Image Credits: WHO, The Global Fund / John Rae. UK Study Shows Similar, Significant Reductions In COVID-19 Infections With Single Dose Of Oxford-AstraZeneca Or Pfizer-BioNTech Vaccine 23/04/2021 Raisa Santos One dose of either vaccine resulted in 65% reduction of infections. There was greater impact against symptomatic infections (72%) than infections without reported symptoms (57%). 2 doses were even more effective against symptomatic infections (90%, and gave similar level of protection as prior infection. COVID-19 infections fell significantly – by 65% percent – after a first dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccine in a study of more than 373,000 British residents who received one of the two jabs. The first in a series of two new studies, published by the University of Oxford, found that the reduction in new COVID-19 infections was similarly dramatic following either the first dose of the Oxford/AstraZeneca or Pfizer-BioNTech vaccine. “We found very similar, significant reductions in infections [rates] after the first rounds of either [Oxford/AstraZeneca] and [PfizerBioNTech] vaccines,” said Dr Koen Pouwels, senior researcher in Oxford University’s Nuffield Department of Population Health, during the press briefing. The studies, which used data from the COVID-19 Infection Survey, a partnership between the University of Oxford, the UK’s Office of National Statistics (ONS), and the Department for Health and Social Care (DHSC), analyzed 1,610,562 test results from nose and throat swabs taken from 373,402 study participants between 1 December 2020 and 3 April 2021. First Study Focused on Infection Reduction Rates Clockwise, left to right: Dr David Eyre, Dr Sarah Walker, moderator Fiona Lethbridge, Dr Koen Pouwels The first study focused on infection reduction rates following a single shot of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines. Twenty-one days after a single dose of either vaccine, with no second dose, the rates of all new COVID-19 infections had dropped by 65%, symptomatic infections by 74%, and infections without reported symptoms by 57%. One dose of either of the two vaccines also were similarly effective against the B.1.1.7 variant, which was first identified in the UK. Vaccination was just as effective in individuals aged 75 or older with underlying health conditions as it was in those under 75 or without health conditions. Two doses of the Pfizer-BioNTech vaccine, meanwhile, reduced asymptomatic infections by 70% and symptomatic infections by 90%. During the press briefing, Dr Sarah Walker, Professor of Medical Statistics and Epidemiology at the University of Oxford and Chief Investigator and academic lead for the COVID-19 Infection Survey, stated that she was ‘pleasantly surprised’ by these results. “The benefits are greater for people with high viral load and for people with symptoms, both of who have probably got the greatest chance of transmission, was really not necessarily something I was expecting.” However, too few people had yet received two doses of Oxford-AstraZeneca to assess the final degree of protection obtained from that vaccine, the researchers concluded. In the press release, Dr Koen Pouwels said: ‘The protection from new infections gained from a single dose supports the decision to extend the time between first and second doses to 12 weeks to maximise initial vaccination coverage and reduce hospitalisations and deaths.” “However, the fact that we saw smaller reductions in asymptomatic infections than infections with symptoms highlights the potential for vaccinated individuals to get COVID-19 again, and for limited ongoing transmission from vaccinated individuals, even if this is at a lower rate. This emphasises the need for everyone to continue to follow guidelines to reduce transmission risk, for example through social distancing and masks.” Antibody Responses High After Second Pfizer Vaccination Antibody responses after receiving either AstraZeneca or Pfizer COVID-19 vaccines The second study compared how antibody levels changed after a single dose of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines, as compared with two doses of the Pfizer-BioNTech vaccine, generally given 21-42 days apart. Antibody levels were comparatively lower with a single dose of either vaccine, particularly at older ages. But while the size of the immune response differed, there was no group of individuals who didn’t respond at all to either vaccine. There was, however, a small percentage of people – 5% – who had low responses to both vaccines, which makes it essential to monitor responses to a second vaccination. Antibody responses to a single dose of either vaccine also were generally lower in older individuals, especially over 60 years – unless they had had a prior COVID infection. Antibody responses to two doses of the Pfizer-BioNTech vaccine were high across all ages, and particularly increased in older people – reaching levels similar to those who had received a single vaccine dose after a prior infection. David Eyre, Associate Professor at the Big Data Institute at the University of Oxford, said that while the findings still highlighted the importance of people getting a second vaccine dose degrees of protection different by age: “In older individuals, two vaccine doses are as effective as prior natural infection at generating antibodies to the SARS-CoV-2 virus that causes COVID-19. In younger individuals a single dose achieves the same level of response.” Walker also emphasized the importance of vaccinations to control the spread of COVID. “Vaccines are clearly going to be the only way that we are going to have a chance to control this long term. WIthout vaccines, I don’t think getting close to zero [infections] is really feasible,” she said, during the press briefing. The findings come on the heels of recent announcements by Pfizer CEO Albert Bourla that in fact a third booster jab of the vaccine may be necessary “somewhere between six and 12 months.” Risk of Blood Clot from AstraZeneca Vaccine Doubles, UK Still Says ‘Benefits Outweigh Risks’ A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine. Meanwhile, new UK government data suggested that the risk of serious blood clots from AstraZeneca jabs was greater than had previously been reported at national level. The most recent survey found 168 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA). The estimated number of first doses of AstraZeneca COVID-19 vaccines administered in the UK was 21.2 million by 14 April, giving an overall case incidence of 7.9 such events per million doses – or one person in every 125,000. Out of these cases, which occurred in 93 women and 75 men, 32 deaths occurred (19%). Previously, there had been 79 cases and 19 deaths reported in the UK. The UK government’s regulatory agency, however, continues to emphasize that the benefits still outweigh the risks. “On the basis of this ongoing review, the advice remains that the benefits of the vaccine outweigh the risks in the majority of people,” the MHRA said. Image Credits: University of Oxford, Flickr. Africa’s New COVID-19 Disaster Recovery Framework – Aims To Improve Response To Future Pandemics 22/04/2021 Geoffrey Kamadi A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19. The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks. The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch. Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective. Multi-hazard Warning System Will Predict Potential Outbreaks In a related development, the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance, as a result of unusually heavy desert rainfall – creating significant disruptions in food production. The multi-hazard warning system will be instrumental in predicting such potential outbreaks of environment and climate related and health events, critical in mobilizing resources for effective response efforts. A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict. “Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview. The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present. New Initiatives To Complement Existing African Risk Capacity The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters. So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth. He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. One Health Approach – Urgent Action Needed Now The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. “If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch. Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done. The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative. Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. “IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre. Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent. “That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals. WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination 22/04/2021 Madeleine Hoecklin Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria. Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. The forum Reaching Zero: Virtual Forum on Malaria Elimination saw the launch of a new new initiative – E2025 – to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. https://twitter.com/endmalaria/status/1384871850338131972 The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria. Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020. The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event. “These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. Zero Malaria Initiative In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria. Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. “Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. Dr Pedro Alonso, Director of the WHO Global Malaria Programme. The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. Challenges to Reaching Zero Malaria Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality. Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers. E-2025 Initiative The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. “At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. “Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.” Impact of COVID-19 on Malaria Programmes Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued. During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision. “Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. In addition, more children than ever before received seasonal malaria chemoprevention last year. The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. “We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw. “[But] of course we’re not out of the woods yet,” she added. Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey. Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. “Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. The current biggest challenge is keeping the political focus on malaria, said the speakers. “We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. RTS,S Malaria Vaccine is a “Promising Additional Tool” Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti. Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday. The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%. “This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria. “We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.” “And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months. While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said. “For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually. Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti. As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight. “Every year that we let malaria continue to spread, health and development suffer,” Moeti said. Image Credits: WHO, WHO. Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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India Faces Urgent Shortage Of Oxygen As Cases Soar – Japan Enters Third State of Emergency 24/04/2021 Madeleine Hoecklin India’s first ‘Oxygen Express’ train is transporting liquid medical oxygen from steel plants that produce oxygen to different parts of the country in desperate need of supplies to support treatment of seriously ill COVID patients. India recorded the world’s highest daily toll of new infections for the second consecutive day on Friday, while Japan plans to impose its third state of emergency, just three months before the Tokyo Olympics are set to begin. India is currently facing its worst outbreak of SARS-CoV2 since the pandemic began, with over 330,000 new cases recorded on Friday – more than triple India’s previous peak in late September, and surpassing the US record of 300,669 new cases on 8 January 2021. Over the past week, nearly 1.6 million new COVID-19 cases have been recorded across India. Daily deaths are also on the rise, 2,263 deaths were recorded on Thursday, bringing the total COVID-19 deaths up to 186,920, according to health ministry data. “The second wave is a consequence of complacency and mixing and mass gatherings,” Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy in New Delhi, told Reuters. Hospitals Call for Help as Oxygen Supplies Dwindle Health officials in northern and western India are raising the alarm that hospitals in major cities are becoming overwhelmed, pleading for government assistance. Oxygen supplies are running low. The low pressure of oxygen could be the cause of 25 deaths recorded over the last 24 hours at the Sir Ganga Ram hospital in Delhi. “Oxygen will last another two hours. Ventilators and Bipap not working effectively. Resorting to manual ventilation in ICUs and Emergency. Major crisis likely. Lives of another 60 sickest patients at risk, need urgent intervention,” the Sir Ganga Ram hospital in Delhi said in a statement to the government early Friday morning. “Need oxygen to be airlifted urgently. Governments please help,” the statement said. Max Healthcare, a healthcare provider operating 16 facilities across North and West India, also sent out a warning about a shortage of oxygen, asking for “immediate assistance” on Twitter. SOS – Less than an hour's Oxygen supplies at Max Smart Hospital & Max Hospital Saket. Awaiting promised fresh supplies from INOX since 1 am. @drharshvardhan @msisodia @PMOIndia @ArvindKejriwal @PiyushGoyal @SatyendarJain over 700 patients admitted, need immediate assistance 🙏🏼 — Max Healthcare (@MaxHealthcare) April 23, 2021 The Max Smart Hospital and Max Hospital Saket received emergency supplies of oxygen shortly after the SOS call, however, it was only sufficient to last two hours and the facilities are still awaiting more supplies. Admissions to Max Healthcare hospitals in Delhi were suspended until the oxygen supply stabilised. A Fortis Healthcare hospital in Haryana announced that it had “only 45 minutes of oxygen left” on Thursday evening, calling on Prime Minister Narendra Modi to dispatch an oxygen tanker to the hospital urgently. Fortis Hospital in #Haryana has only 45 minutes of oxygen left. Requesting @ashokgehlot51, @rajnathsingh, @PiyushGoyalOffc, @mlkhattar and @AmitShah to act immediately and help us to save patients’ lives. (1/2) — Fortis Healthcare (@fortis_hospital) April 22, 2021 According to the city government of New Delhi, six hospitals in the city have run out of oxygen and neighbouring states have been accused of holding back supplies to service their own hospitals and blocking oxygen tankers at border crossings. Sites producing oxygen are ramping up manufacturing to meet demand and a train, dubbed the ‘Oxygen Express,’ made its first trip carrying seven tankers, each filled with 15 tonnes of liquid medical oxygen on Thursday evening. The first ‘Oxygen Express’ train loaded with liquid medical oxygen tankers has left for Maharashtra from Vizag. Railways continues to serve the nation in difficult times by transporting essential commodities and driving innovation to ensure the wellbeing of all citizens. pic.twitter.com/4t7ZKbjeIT — Piyush Goyal (मोदी का परिवार) (@PiyushGoyal) April 22, 2021 Government hotlines are reportedly mostly down in the worst affected states, leading individuals to seek information on available hospital beds and oxygen supply on social media, sharing experiences and photos of patients waiting outside of emergency rooms that are over capacity. Urgent Imports of Oxygen Arranged The Indian government has arranged to import 23 mobile oxygen generation plants from Germany, which will arrive within a week. The Armed Forces Medical Services will also airlift oxygen cylinders, essential medicines, and medical personnel from other regions to Delhi. Plans to import 50,000 metric tonnes of medical oxygen to meet the demand are underway, with Russia offering to supply both oxygen and Remdesivir. Imports are expected to begin within 15 days. China has also extended support to India to assist in getting the current outbreak under control. “China takes note of the recent grave situation in India with a temporary shortage of anti-epidemic medical supplies. We stand ready to provide India with necessary support and assistance to get the epidemic under control,” said Wang Wenbin, Spokesperson for the Ministry of Foreign Affairs of the People’s Republic of China, at a press conference on Thursday. At the same time, a growing number of countries are severely restricting or barring travelers from India, putting the country on the travel ‘red list.’ These include countries in Europe, as well as Canada, Britain, Hong Kong, Singapore, and New Zealand – amid mounting concern about the surge of cases in India. The US Centers for Disease Control and Prevention issued a level 4 warning for India, advising travelers to avoid all travel to India. As India’s catastrophic second wave of COVID-19 rages on, only 8.1% of the population has received at least one dose of a COVID-19 vaccine. The national vaccination program will open to all individuals over 18 on 1 May, however, experts warn that the vaccine supply is not sufficient to cover the hundreds of millions of people who will become eligible. Japan Issues Targeted State of Emergency Meanwhile, Japan has also declared a new state of pandemic emergency in Tokyo, Osaka, and two other regions. New restrictions will go into effect on Sunday until 11 May, the government announced. “We absolutely have to limit the movement of people, and we have to do it decisively,” said Yasutoshi Nishimura, the minister in charge of the country’s COVID-19 response, at the announcement of the new restrictions on Friday. The state of emergency coincides with the Golden Week, a public holiday when domestic travel is expected to be widespread. Restaurants and grocery stores will close early and the public will be asked to work from home, but school will remain open. Japan recorded over 4,300 new cases on Friday, 1,162 were reported in Osaka and 759 in Tokyo. The rise in cases is taking place just three months before the Olympics games are set to begin on 23 July. The emergency measures are expected to be lifted by 11 May, ahead of a visit by the International Olympic Committee (IOC) President Thomas Bach. Despite opposition from the Japanese public and worries expressed by health experts, the Japanese government, supported by the International Olympic Committe (IOC) has remained determined to have the games go ahead. SHORT THREAD on JAPAN / OLYMPICS: Japan is going through a major new Covid wave and this potentially puts the Olympics later this summer at real risk… (and of course Japan's large population!) 1/4 pic.twitter.com/6PTGJRnBsH — Prof. Christina Pagel (@chrischirp) April 23, 2021 “We’re not thinking about cancellation. We’re thinking about how we can prepare in a way that prioritises safety and makes people feel it can be held safely, and makes them want it to be held,” said Seiko Hashimoto, President of the Tokyo 2020 Olympics Organising Committee, on Friday. According to Prime Minister Yoshihide Suga, Japan has no say in whether or not the Olympic games take place. “The IOC has the authority to decide and the IOC has already decided to hold the Tokyo Olympics,” said Suga. “We aim to hold the games while taking strong measures to protect people’s lives from the further spread of infections.” Image Credits: Prasar Bharati News Services. In Fighting COVID-19, We Can’t Neglect Malaria 24/04/2021 Peter Sands Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria World Malaria Day is a reminder that, as the world battles with COVID-19, we still haven’t beaten a much older pandemic. Malaria is a mosquito-borne disease that has plagued humanity for millennia and still kills over 400,000 people per year – mainly children under five. In fact, that grim number will almost certainly have increased in 2020 and will do so again in 2021, as COVID-19 has severely disrupted malaria testing and treatment services in many of the most affected countries. New data from Global Fund spot-checks of 504 health care facilities across 32 countries in Africa and Asia in 2020 revealed a 31% drop in malaria diagnoses over a six-month period compared to the previous year, and a 13% drop in malaria treatment. Since swift diagnosis and treatment are key to preventing death, and there’s no reason to believe that the number of cases has fallen, such a sharp reduction in diagnoses and treatment will inevitably translate into increased mortality. It could have been even worse. The first line of defence against malaria are insecticide-treated mosquito nets that protect people from mosquitoes. When the pandemic first hit we were extremely concerned that supply chain disruptions and the challenges of distributing millions of mosquito nets during lockdowns would leave hundreds of millions of people unprotected. A massive effort, led by countries’ national malaria campaigns, supported by the Global Fund and the U.S. President’s Malaria Initiative (PMI) and with huge engagement of community organizations, prevented what could have been a catastrophe. While some mosquito net distribution campaigns were delayed in 2020, almost all were successfully implemented. Sustaining Community Health Workers’ Test-and-Treat Ability Community health workers are crucial to the testing and treating of malaria in rural parts of Africa. This year, the challenge will be to sustain community health workers’ ability to test and treat malaria. In much of rural Africa, community health workers are the lynchpin of the health system, and in the highest burden regions of central and western Africa, most of their time is spent treating malaria cases. I recall talking to a community health worker in Mali, who told me the malaria situation was much better than it was years earlier when she first started. But when I looked at her register of patient visits, I was surprised to see that every single entry was a malaria case. When I asked her to explain, she said the big difference was in the number of deaths; rapid testing and effective treatment had dramatically reduced mortality. Since 2000, the worldwide malaria death rate has dropped by 60% thanks to the tireless efforts of community health workers like her. But given the number of people they interact with, community health workers are extremely vulnerable to being infected with COVID-19 and often have limited access to basic personal protective equipment (PPE) like gloves and masks. In the same round of Global Fund spot-checks of health facilities last year, a shocking 55% of facilities in Africa didn’t have enough basic PPE available for their workers. If a community health worker falls ill, there’s often no back-up. Community health workers will also be called on to play a vital role in COVID-19 vaccination campaign as these get going. It is crucial to protect people from the new virus, but we also need to ensure that the diversion of focus doesn’t lead to an escalation in malaria deaths. Increasing Malaria Grants An infant and mother under an insecticide-treated mosquito net in Ghana – such nets remain a key prevention technique. In the poorest countries in Africa it seems quite likely that unless we take decisive action, the knock-on impact of the pandemic in terms of incremental malaria deaths may well exceed the direct impact of COVID-19. As the largest funder of malaria programmes worldwide, the Global Fund is working urgently with partners to prevent such a disastrous outcome and get us back on track towards ending malaria. From January 2021, we have increased malaria grants by 23% on average, and are committed to deploying about US$4 billion over the next three years. In addition, our COVID-19 Response Mechanism is providing US$3.7 billion in funding to help countries respond to COVID-19, mitigate the impact on HIV, TB and malaria services, and make urgent fixes to health systems. For malaria, the priorities in 2021 are to continue to ensure we maintain campaigns for mosquito net distribution, spraying of insecticide in homes, and the provision of seasonal malaria chemoprevention for children, and to step up support to community health worker networks. We need more community health workers and we need to support them better – financially, with technology, with training and with personal protective equipment. Looking beyond 2021, we should take COVID-19 as a catalyst to rethink our approach to malaria. Global policy-makers are already discussing how to better protect the world from future pandemics. Let’s not forget the imperative to finish the fight against older pandemics like malaria, which may not threaten those in Washington DC, London or Paris, but still kill hundreds of thousands of people every year. Building Pandemic Preparedness An infant receiving the RTS,S malaria vaccine in Ghana in 2019. New malaria vaccines hold promise of significantly reducing childhood infections and severe malaria cases. In fact, the best way to build pandemic preparedness in many of the poorest parts of the world would be to mount a significant step-up in the fight against malaria. The capabilities needed to prepare and respond to any new pathogenic threat are largely the same as those needed to defeat malaria – primary health care that reaches everyone, however remote; rapid diagnostics; genomic sequencing to detect variants; disease surveillance including the ability to trace individual infections; supply chains that ensure essential medicines are available everywhere. New potential malaria vaccines could be used to pilot accelerated models for clinical trials, regulatory approval and deployment. Rather than predicate pandemic preparedness on hypothetical threats, pathogens that might cost lives, let’s build such protection by beating malaria and by doing so save millions of lives – the vast majority of them young children. For too long we have accepted people dying of a treatable disease we know how to eliminate – and that we have eliminated in dozens of countries. Now we should make this happen everywhere, and in doing so reinforce our defences against other pandemic threats. Peter Sands is the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria Image Credits: What is Malaria, WHO. Pharma Execs: Unlock Export & Supply Chain Barriers & Ramp Up Sharing Of Excess Vaccine Doses To Beat Back COVID Pandemic 23/04/2021 Elaine Ruth Fletcher Stephane Bancel, CEO of Moderna, says company is close to agreement on supply of its mRNA vaccines to COVAX. A group of leading pharmaceutical industry executives called upon global health leaders to work together to unlock export barriers, open up supply chain bottlenecks, and encourage high-income countries that are hoarding vaccines to redirect their excess doses to the WHO co-sponsored COVAX global vaccine facility – as ways to rapidly scale up equitable vaccine access and beat back the pandemic. The executives, including the CEO of Moderna and India’s Bharat Biotech, as well as GSK’s head of global vaccines, and the heads of the Developing Countries Vaccine Manufacturers Network (DCVMN) and the Biotechnology Innovation Organization (BIO), were speaking at an event Friday marking a year since the establishment of the WHO co-sponsored Act Accelerator COVAX initiative. Patents and other IP constraints are not the main obstacle to expanding access to vaccines, they asserted. And increasing vaccine manufacturing capacity in lower-income countries, while important, will take time to develop – given the complexities of vaccine production, they said, speaking at a forum sponsored by the International Pharmaceutical Manufacturers and Associations (IFPMA). Rather, the best way out of pandemic lockdowns and losses of life is to make better use of available resources, they stressed, including smoother supply chains and vaccine sharing schemes with COVAX. “We are on track to make a billion doses this year, and potentially to have up to 1.4 billion doses for 2022,” said Moderna CEO, Stephane Bancel, at the press briefing, adding that the company is also “in the final stretch to get an agreement with COVAX,” for distribution of the mRNA vaccine through the global vaccine equity pool. But he stressed that expanding manufacturing capacity further, and in more locations, would sap efforts to produce doses this year – and could ultimately even cost lives. “We need to focus on delivering as many vaccines as we can this year,” he said, while trying to add more manufacturing capacity risks “being a distraction limiting what we can do in 2021… and by next year there is going to be way too many vaccines for people on the planet.” United States Raw Inputs Are Key To Global Vaccine Manufacturing Supply Chains Michelle McMurry-Heath, CEO BIO Added Michelle McMurry-Heath, a former US Food and Drug Administration expert, unlocking supplies of key raw products and vaccine dose sharing are important low-hanging fruit in the battle against the virus: “We need to recognise that there are only a handful of manufacturers across the globe who have that expertise on hand, and we need to focus on getting them the materials that they need to produce as many doses, as quickly as possible, and to release backlogs,” said Heath, who is now CEO of BIO, a global trade association organisation that represents biotech researchers in government, the private sector, and academic institutions. This this includes items as basic as single-use plastics and filters for the vaccine manufacturing process, some of which can only be supplied from in the United States. Currently the US Defense Production Act (DPA) restrictions are holding up release of many of those raw inputs, she stressed, adding that: “the US has to take a hard look at itself…. This Defense Protection Act, which was really designed to withhold capacity, expertise, doses and raw materials to the US, customer was well intentioned – but somewhat misguided at this stage – we need to get those raw materials, out to the limited manufacturing capacity that exists around the globe.” In addition, she added, high income countries need to be encouraged to start dose-sharing with the COVAX initiative – following on the example of France’s announcement only today that it will share 500,000 vaccine doses. “The US is projected to have as many as 200 million excess doses on hand by the spring, we need to focus on getting those doses to COVAX,” said Heath. Vaccine Companies Can be Counted In ‘Double Digits’ Vaccine quality, which require adherence to strict biosafety requirements as well as to sterile conditions, is also a critical issue, she underlined. And quality control failures in manufacturing plants, such as ones seen recently in the case of a Johnson & Johnson vaccine plan, can undermine already shaky public confidence in the quality of brand-new COVID-19 vaccines. Added Sai Prasad, CEO of Bharat Biotech, which has developed the first indigenous Indian COVID-19 vaccine, “Vaccine companies you can probably count in double digits so we need to be careful about whom we are transferring technology to, and whether they can receive it as well. Technology transfer cannot be done with an entity that has no experience.” Sai Prasad, CEO Bharat Biotech “I think that as industry, we need to increase the partnerships between innovators and vaccine manufacturers…. We need to be agnostic as to whether these companies are US, Europe, India, China or Brazil, for example. And I think there is [already] a good track record of that,” he added, noting that over 200 partnerships between big pharma innovators and developing country manufacturers have been formed already. At the same time, he said, supply chain bottlenecks and export barriers are a big threat to scale up: “Some of the vaccines take 150 to 200 little components that come from different parts of the world. “So interruptions in just one component, can slow production significantly, he pointed out, referring to the Serum Institute of India’s recent problems securing certain inputs from the United States. “We’ve had reports from the Serum Institute having problems with certain single use materials that are supposed to come from the United States… plastic bags for example which we think is a mundane consumable, because maybe a decade ago industry, as such, we were all thinking about going into single use systems, which involved a lot of single use consumables – but now this unfortunately has become an impediment, and a bottleneck.” Rajinder Suri, CEO DCVMN Rajinder Suri, CEO of the Developing Countries Vaccine Manufacturing Network (DCVMN), echoed that saying: “We are on the verge of expanding and ramping up the capacities, which are really required to meet the global demand…..and we are certainty facing some of the bottlenecks, from cell culture mediums and serum adjuvant filters, and single use plastic bags, to bio reactors. “Most of these materials are coming from the US – so if the DPA is not handled properly, then the supply chain will get impacted, and building the global capacity will adversely get impacted.” COVAX Distributions Should Accelerate – With Stronger US Support On the brighter side, meanwhile, Heath said she was confident that with stronger support for COVAX from the new US administration of President Joe Biden, the global vaccine facility can make up for its comparatively slow start in the second quarter of the year. “COVAX didn’t have full support of all the developed countries. Now that this is up to speed…. we need to focus on great efforts like COVAX which are just beginning to fully ramp up, and can deliver very affordable vaccines around the globe. I is the fastest way to get high quality doses to developing countries, and that speed is so critical,” she said. Added Bancel, “we are focused on working with COVAX to provide vaccine, right now. COVAX is the way for us to get maximum access on the planet.” See entire press briefing: ACT-Accelerator Celebrates 1st Anniversary Amid COVID-19 Surge in India 23/04/2021 Kerry Cullinan Health worker Evelyn Narkie Dowuona holds up her vaccination card after receiving a dose of the COVAX-delivered AstraZeneca COVID-19 vaccine at Accra’s Ridge Hospital in Ghana. One of the few silver linings of the COVID-19 pandemic is the unprecedented collaboration of every sector of society to overcome it – best demonstrated by the Access to COVID-19 Tools Accelerator (ACT-Accelerator), which celebrated its first anniversary on Friday. The ACT-Accelerator’s most famous pillar is the vaccine facility, COVAX, which has distributed almost 40 million vaccine doses to 119 countries so far. “Vaccinating at this scale and in this time frame constitutes the largest and most complex vaccine rollout in history,” according to the WHO, but added that there are also “severe supply constraints characterising the market at present”. Other key achievements in the past year include: procuring 65 million COVID-19 tests for LMICs and supporting the development and Emergency Use Listing (EUL) of reliable rapid antigen diagnostic tests by its diagnostics pillar supporting the identification of dexamethasone as the first life-saving therapy against COVID-19 and, within 20 days of its identification, making 2.9m doses available to LMICs vis its therapeutics pillar Assisting to providing oxygen to half-a-million COVID-19 patients every day in LMICs. Procuring $50 million of PPE for LMICs via the Health Systems Connector pillar. While the ACT Accelerator has attracted $14.1 billion in funding, it needs another $19-billion this year to meet its aim of vaccinating 20% of the world’s population by the end of the year. Equitable Access Still a Long Way Off “The ACT Accelerator was conceived with two aims: the rapid development of vaccines diagnostics and therapeutics, and equitable access to those tools,” Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General, told the virtual anniversary featuring all partners. While the first objective “has been achieved”, said Tedros, “we have a long way to go on the second objective”. Of the more than 950 million vaccinations that have been given, 0.3% have been administered in low-income countries and testing rates in high-income countries are about 70 times higher than those in low-income countries, according to the WHO. “Around the world, people are dying because they are not vaccinated. They are not tested and they are not treated. We’re deeply concerned about the increasing number of cases in India right now,” said Tedros. India recorded 332,730 new cases and 2,263 deaths on Friday amid reports that many hospitals had run out of oxygen. South African President Cyril Ramaphosa South African President Cyril Ramaphosa told the event that “a COVID-19 vaccine is a public good and must be recognised as such”. South Africa and Norway co-chair the accelerator’s facilitation council, which provides political leadership for the body. TRIPS Waiver and Technology Transfer “South Africa and India are calling for a temporary TRIPS waiver to respond to COVID-19,” Ramaphosa added. “This, in our view, will facilitate the transfer of technology and intellectual property to more countries for the production of COVID-19 vaccines, as well as diagnostics and treatments.” He also welcomed the WHO initiative to establish a COVID-19 mRNA vaccine technology transfer hub and called on the pharmaceutical industry to “directly transfer this technology free of intellectual property barriers to low and middle-income countries”. Norway’s Minister of International Development, Dag Ulstein, said that his country and South Africa had sent out letters to 89 countries appealing to them to contribute to the ACT-Accelerator. “At this one-year anniversary, our choice is simple: invest in saving lives by treating the course of the pandemic everywhere now, or continue to spend trillions on the consequences of the pandemic with no end in sight,” said Ulstein, whose country has donated a number of its vaccine doses to COVAX. Describing the accelerators’ achievements as “a miracle”, Ursula von der Leyen, President of the European Commission, said that the EU had recently doubled its contribution. Meanwhile, French President Emmanuel Macron said that “now was the time to share”, and announced that his country would donate 500,000 vaccine doses to COVAX by mid-June. He appealed to other countries to donate vaccines to COVAX, saying that he hoped that the goal of EU members donating 5% of their vaccine stocks he set in February would be “exceeded” by the end of the year. However, Macron said the lack of technology transfer, not intellectual property rights, was hampering vaccine rollout. France is one of a handful of wealthy countries opposing the TRIPS waiver. Thomas Cueni, Director General of International Federation of Pharmaceutical Manufacturers (IFPMA), said that a year into the AC-Accelerator “we can say science wins”. “Not one but several highly effective vaccines are being developed at record speed, and now being produced in historic quantities,” said Cueni, committing his industry to accelerating “global access to safe, effective and affordable COVID-19 treatments and vaccines”. French President Emmanuel Macron Jeremy Farrar, Director of Wellcome, said in a press release about the anniversary that “huge strides have been made in the last year” but “science only works if it reaches society”. “The world remains in the grip of a devastating pandemic – and it is not slowing, only escalating. There must be no further delays to getting COVID-19 vaccines, tests and treatments to the most vulnerable groups everywhere,” added Farrar, whose organisation is a partner and significant contributor to the accelerator. “We are in desperate need of strong global leadership. Wealthy countries with access to surplus vaccine doses must start sharing these with the rest of the world now through COVAX, alongside national rollouts. And they should urgently set out a timetable for how these donations will be increased as they vaccinate more of their populations.” Surge of COVID-19 in India is ‘Really, Really Difficult’ Mike Ryan, WHO’s Executive Director of Health Emergencies Programme, said the global body was assisting India to secure oxygen, as well as with technical assistance and clinical management and triaging of patients. “There’s a lot of fear in India right now. We support the Government of India, like we support all governments, in facing this really, really difficult situation. This is not time for recommendations. It is the time for solidarity, the time to move quickly together to reduce deaths and reduce transmission by decreasing mobility and mixing, supporting communities with mask-wearing, maintaining social distance and reducing social gatherings,” said Ryan. Seth Berkley, CEO of the vaccine alliance, Gavi, added that because of India’s domestic need, “the first 10 million vaccine doses from COVAX went to India”. However, Berkeley acknowledged that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. Image Credits: WHO. Global Health Is In Disarray – But Is A Pandemic Treaty The Way Out ? 23/04/2021 Svĕt Lustig Vijay Lines of people wait their turn to receive the AstraZeneca COVID-19 vaccine in Rwanda in early March, after WHO-supported COVAX facility supplies are delivered. Should countries build a new pandemic treaty – or bolster existing mechanisms? Despite rising calls for a pandemic treaty, including from 25 world leaders in an open letter last month, some global health experts doubt that a treaty would be the most efficient way to quickly strengthen the world’s capacity to beat COVID – and prevent future pandemics. “I don’t think we have time to negotiate another treaty on vaccines. I mean, we really are in this emergency,” said Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia, Canada. Lee was one of four panelists featured at a session on “Global Health in Disarray-What Next,” hosted by the Geneva-based Graduate Institute’s Global Health Centre to mark the launch of its newly appointed International Advisory Board (IAB). The wide-ranging session covered a range of issues, from the feasibility of a pandemic treaty, to the challenges of achieving vaccine equity and the lack of progress made in strengthening health systems in low-income countries, despite years of international funding. A Pandemic Treaty Is Not Essential Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia. “Do we need a treaty to move forward? The answer is no,” said Esperanza Martinez, the Head of COVID-19 Crisis Management at the International Committee of the Red Cross (ICRC). “I don’t think that we are short of frameworks and short of treaties… there are already enough mechanisms to act.” According to Lee, legal frameworks such as the World Trade Organization’s TRIPS agreement, and accompanying TRIPS flexibilities create frameworks under which countries can gain access to lifesaving products during health emergencies. And the legally binding International Health Regulations (IHRs), which mandate countries to report on disease outbreaks, and share information with WHO and other member states, is another “useful” framework that should not be forgotten, added Finland’s Director for International Affairs Outi Kuivasniem, another panel member. Rather, the global health community needs to find ways to reform existing frameworks so that they serve us better, panelists suggested. Esperanza Martinez, Head of COVID-19 Crisis Management at the International Committee of the Red Cross In particular, there is a need to reform the IHRs, Kuivasniem said, because countries have not always complied – including by enacting export bans on vital health products or inputs, which have destabilized crucial supply chains, including those relating to vaccines and other essential medicines. Treaty Would Need Strong Member State Alignment At the same time, panelists acknowledged that a pandemic treaty could have some use if it was closely linked to existing legal frameworks like the IHRs and international humanitarian law, and generated greater adherence from countries, as well as support from civil society. “If we have a treaty, we need to have a conversation about what makes sense to have in the treaty so that it has an impact, and that countries are willing to adhere to those promises that are [made] through a treaty,” warned Kuivasniem. Allan Maleche, Executive Director, Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN) Conversely, a “lack of political alignment” between governments and between government and civil society, could frustrate efforts to develop a new pandemic treaty, cautioned Allan Maleche, Executive Director of Kenya’s Legal & Ethical Issues Network on HIV & AIDS (KELIN). And other “political solutions” are also on the table, she and other panelists pointed out, to accelerate pandemic response. Few would actually require a treaty. Those initiatives range from the WHO co-sponsored COVAX global vaccine facility to proposals for an IP waiver under the TRIPS rules of World Trade Organization the COVID-19 Technology Access Pool (C-TAP), and tech transfer initiatives. Despite controversies over some initiatives, such as the IP waiver, none really require a pandemic treaty to be implemented. Should a pandemic treaty be negotiated, civil society should really drive its development, Maleche underlined. “If we are serious about getting our pandemic treaty in place, it’s important for scholars, academics, human rights lawyers, civil society groups, and affected communities to push their governments and [define] what should be that framework,” he said. “A treaty would be important but the more important is respect and implementation of that treaty so that it can have an effect on the lives of people,” he said. Stronger Business Case Needed For Investing In Health Systems in LMICs Healthcare workers treat a patient with drug-resistant TB in Myanmar, using drugs procured by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Beyond the immediate pandemic, however, a stronger business case is needed to convince governments that global health is a long-term investment that makes economic sense, stressed Martinez – particularly in LMICs. “We need to have a business case, an economic case for investment in global health,” she said, pointing out that while the case has recently been made for investment in vaccine access, “there’s a need for making a stronger case for global health in general… as a way of also bridging the conversation gap between government and the private sector.” Meanwhile, Maleche expressed dismay that decades of international funding meant to strengthen healthcare delivery in developing countries such as Kenya had failed to create more sustainable health systems. “Has this money actually been fixing the health systems?” he asked. “Because the time we needed the health system to be fully functional, COVID came and exposed the things that are not working. “COVID also exposed the underbelly of things that many countries don’t normally give priority,” he added. “You’re telling people: wash your hands, put on a mask, social distance, but in certain countries including Kenya and in other low- and middle-income countries, some of those things are luxuries as people have never seen clean running water in taps.” In addition, Maleche added, COVID-19 has highlighted the fact funds are also misspent by governments lacking public transparency and accountability: “Even within a pandemic we still are able to see that resources are not accountably used, we see that governments are not transparent. So again, this comes to show that some of the bad habits that we had when we had a normal sort of situation in the globe are played out in quite an extreme picture, in the context of a pandemic. ” In the humanitarian sector, in particular, financial support for fragile healthcare systems has been particularly scarce, added Martinez. “Very little has been done to strengthen health care systems in LMICs,” she asserted. “We have been speaking for years about the need to strengthen healthcare systems in developing countries and in humanitarian crises, but really when we look, very little has been done. In terms of vaccine access as well, “fundamentally there is a lack of production, science and research and development in the global south, and unless we address that issue, we will not have a sustainable solution to these [vaccine production] needs that we have globally,” she added. “There is a need for investment, but the investment at the level that is required is not coming through.” Regional Initiatives and Grassroots Action As Way Forward Ilona Kickbusch, Founder and Chair of the International Advisory Board, Global Health Centre “There is a feeling in the air [that] we need to reform,” said Ilona Kickbusch, founder of the Global Health Center, and chair of the new International Advisory Board, and moderator of the panel discussion. “Now there’s a number of suggestions on the table, for how global health, both in terms the way we do research and the way the global health regime and organizations are set up, could be changed. “And it’s interesting that right now we’re facing a pressure to some extent from above, top-down, from heads of state and government who are saying, ‘we need a new treaty in global health,’ and as many of you know we only have one so far… “On the other hand, there’s this movement from below that says we need to decolonize global health, we need totally different ideas, approaches, and we need to be much clearer about equity and access, and the social justice agenda.” Among the new ideas, Kickbusch pointed to regional initiatives that are underway, particularly in Africa, to chart a more strategic direction for the continent’s pandemic response. While many countries turned inward during the pandemic, Africa started working together more closely at the regional level, she pointed out. A new African region multi-hazard warning system will seek to link early warning, and responses to natural hazards, pandemics and pests and diseases as well as conflict. That collaboration has stimulated initiatives ranging from AU-based vaccine procurement to the new AU/Africa CDC partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), announced just last week to ramp up vaccine research, development and manufacturing in the region – with funding from Afreximbank and the Africa Finance Corporation. In addition, the African Union and Africa CDC are developing a new COVID-19 Disaster Recovery Framework and multi-hazard warning system for the continent to better link responses to climate, health, and environmental emergencies. “It is one of the encouraging things in global health..that there are these regional initiatives,” Kickbusch said. “Particularly in the African Union, we’ve seen the activities of the African CDC during the pandemic, and seend that a true consensus is building up.” Said Martinez, “This pandemic is precisely an example of how critical it is for us to have this broader view of health… “So we have the pandemic crisis and we also have the climate change crisis. And if we look at the issue we need to think beyond climate change [and] understand that polar bears are drowning in the Arctic, to think about the millions of people that today are facing diseases that were confined to the tropics. “We [need to] link all of those elements to the broader components of human health and health systems. I think that’s when we truly talk about human global Health.” Image Credits: WHO, The Global Fund / John Rae. UK Study Shows Similar, Significant Reductions In COVID-19 Infections With Single Dose Of Oxford-AstraZeneca Or Pfizer-BioNTech Vaccine 23/04/2021 Raisa Santos One dose of either vaccine resulted in 65% reduction of infections. There was greater impact against symptomatic infections (72%) than infections without reported symptoms (57%). 2 doses were even more effective against symptomatic infections (90%, and gave similar level of protection as prior infection. COVID-19 infections fell significantly – by 65% percent – after a first dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccine in a study of more than 373,000 British residents who received one of the two jabs. The first in a series of two new studies, published by the University of Oxford, found that the reduction in new COVID-19 infections was similarly dramatic following either the first dose of the Oxford/AstraZeneca or Pfizer-BioNTech vaccine. “We found very similar, significant reductions in infections [rates] after the first rounds of either [Oxford/AstraZeneca] and [PfizerBioNTech] vaccines,” said Dr Koen Pouwels, senior researcher in Oxford University’s Nuffield Department of Population Health, during the press briefing. The studies, which used data from the COVID-19 Infection Survey, a partnership between the University of Oxford, the UK’s Office of National Statistics (ONS), and the Department for Health and Social Care (DHSC), analyzed 1,610,562 test results from nose and throat swabs taken from 373,402 study participants between 1 December 2020 and 3 April 2021. First Study Focused on Infection Reduction Rates Clockwise, left to right: Dr David Eyre, Dr Sarah Walker, moderator Fiona Lethbridge, Dr Koen Pouwels The first study focused on infection reduction rates following a single shot of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines. Twenty-one days after a single dose of either vaccine, with no second dose, the rates of all new COVID-19 infections had dropped by 65%, symptomatic infections by 74%, and infections without reported symptoms by 57%. One dose of either of the two vaccines also were similarly effective against the B.1.1.7 variant, which was first identified in the UK. Vaccination was just as effective in individuals aged 75 or older with underlying health conditions as it was in those under 75 or without health conditions. Two doses of the Pfizer-BioNTech vaccine, meanwhile, reduced asymptomatic infections by 70% and symptomatic infections by 90%. During the press briefing, Dr Sarah Walker, Professor of Medical Statistics and Epidemiology at the University of Oxford and Chief Investigator and academic lead for the COVID-19 Infection Survey, stated that she was ‘pleasantly surprised’ by these results. “The benefits are greater for people with high viral load and for people with symptoms, both of who have probably got the greatest chance of transmission, was really not necessarily something I was expecting.” However, too few people had yet received two doses of Oxford-AstraZeneca to assess the final degree of protection obtained from that vaccine, the researchers concluded. In the press release, Dr Koen Pouwels said: ‘The protection from new infections gained from a single dose supports the decision to extend the time between first and second doses to 12 weeks to maximise initial vaccination coverage and reduce hospitalisations and deaths.” “However, the fact that we saw smaller reductions in asymptomatic infections than infections with symptoms highlights the potential for vaccinated individuals to get COVID-19 again, and for limited ongoing transmission from vaccinated individuals, even if this is at a lower rate. This emphasises the need for everyone to continue to follow guidelines to reduce transmission risk, for example through social distancing and masks.” Antibody Responses High After Second Pfizer Vaccination Antibody responses after receiving either AstraZeneca or Pfizer COVID-19 vaccines The second study compared how antibody levels changed after a single dose of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines, as compared with two doses of the Pfizer-BioNTech vaccine, generally given 21-42 days apart. Antibody levels were comparatively lower with a single dose of either vaccine, particularly at older ages. But while the size of the immune response differed, there was no group of individuals who didn’t respond at all to either vaccine. There was, however, a small percentage of people – 5% – who had low responses to both vaccines, which makes it essential to monitor responses to a second vaccination. Antibody responses to a single dose of either vaccine also were generally lower in older individuals, especially over 60 years – unless they had had a prior COVID infection. Antibody responses to two doses of the Pfizer-BioNTech vaccine were high across all ages, and particularly increased in older people – reaching levels similar to those who had received a single vaccine dose after a prior infection. David Eyre, Associate Professor at the Big Data Institute at the University of Oxford, said that while the findings still highlighted the importance of people getting a second vaccine dose degrees of protection different by age: “In older individuals, two vaccine doses are as effective as prior natural infection at generating antibodies to the SARS-CoV-2 virus that causes COVID-19. In younger individuals a single dose achieves the same level of response.” Walker also emphasized the importance of vaccinations to control the spread of COVID. “Vaccines are clearly going to be the only way that we are going to have a chance to control this long term. WIthout vaccines, I don’t think getting close to zero [infections] is really feasible,” she said, during the press briefing. The findings come on the heels of recent announcements by Pfizer CEO Albert Bourla that in fact a third booster jab of the vaccine may be necessary “somewhere between six and 12 months.” Risk of Blood Clot from AstraZeneca Vaccine Doubles, UK Still Says ‘Benefits Outweigh Risks’ A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine. Meanwhile, new UK government data suggested that the risk of serious blood clots from AstraZeneca jabs was greater than had previously been reported at national level. The most recent survey found 168 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA). The estimated number of first doses of AstraZeneca COVID-19 vaccines administered in the UK was 21.2 million by 14 April, giving an overall case incidence of 7.9 such events per million doses – or one person in every 125,000. Out of these cases, which occurred in 93 women and 75 men, 32 deaths occurred (19%). Previously, there had been 79 cases and 19 deaths reported in the UK. The UK government’s regulatory agency, however, continues to emphasize that the benefits still outweigh the risks. “On the basis of this ongoing review, the advice remains that the benefits of the vaccine outweigh the risks in the majority of people,” the MHRA said. Image Credits: University of Oxford, Flickr. Africa’s New COVID-19 Disaster Recovery Framework – Aims To Improve Response To Future Pandemics 22/04/2021 Geoffrey Kamadi A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19. The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks. The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch. Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective. Multi-hazard Warning System Will Predict Potential Outbreaks In a related development, the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance, as a result of unusually heavy desert rainfall – creating significant disruptions in food production. The multi-hazard warning system will be instrumental in predicting such potential outbreaks of environment and climate related and health events, critical in mobilizing resources for effective response efforts. A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict. “Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview. The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present. New Initiatives To Complement Existing African Risk Capacity The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters. So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth. He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. One Health Approach – Urgent Action Needed Now The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. “If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch. Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done. The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative. Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. “IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre. Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent. “That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals. WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination 22/04/2021 Madeleine Hoecklin Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria. Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. The forum Reaching Zero: Virtual Forum on Malaria Elimination saw the launch of a new new initiative – E2025 – to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. https://twitter.com/endmalaria/status/1384871850338131972 The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria. Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020. The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event. “These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. Zero Malaria Initiative In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria. Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. “Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. Dr Pedro Alonso, Director of the WHO Global Malaria Programme. The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. Challenges to Reaching Zero Malaria Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality. Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers. E-2025 Initiative The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. “At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. “Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.” Impact of COVID-19 on Malaria Programmes Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued. During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision. “Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. In addition, more children than ever before received seasonal malaria chemoprevention last year. The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. “We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw. “[But] of course we’re not out of the woods yet,” she added. Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey. Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. “Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. The current biggest challenge is keeping the political focus on malaria, said the speakers. “We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. RTS,S Malaria Vaccine is a “Promising Additional Tool” Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti. Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday. The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%. “This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria. “We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.” “And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months. While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said. “For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually. Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti. As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight. “Every year that we let malaria continue to spread, health and development suffer,” Moeti said. Image Credits: WHO, WHO. Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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In Fighting COVID-19, We Can’t Neglect Malaria 24/04/2021 Peter Sands Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria World Malaria Day is a reminder that, as the world battles with COVID-19, we still haven’t beaten a much older pandemic. Malaria is a mosquito-borne disease that has plagued humanity for millennia and still kills over 400,000 people per year – mainly children under five. In fact, that grim number will almost certainly have increased in 2020 and will do so again in 2021, as COVID-19 has severely disrupted malaria testing and treatment services in many of the most affected countries. New data from Global Fund spot-checks of 504 health care facilities across 32 countries in Africa and Asia in 2020 revealed a 31% drop in malaria diagnoses over a six-month period compared to the previous year, and a 13% drop in malaria treatment. Since swift diagnosis and treatment are key to preventing death, and there’s no reason to believe that the number of cases has fallen, such a sharp reduction in diagnoses and treatment will inevitably translate into increased mortality. It could have been even worse. The first line of defence against malaria are insecticide-treated mosquito nets that protect people from mosquitoes. When the pandemic first hit we were extremely concerned that supply chain disruptions and the challenges of distributing millions of mosquito nets during lockdowns would leave hundreds of millions of people unprotected. A massive effort, led by countries’ national malaria campaigns, supported by the Global Fund and the U.S. President’s Malaria Initiative (PMI) and with huge engagement of community organizations, prevented what could have been a catastrophe. While some mosquito net distribution campaigns were delayed in 2020, almost all were successfully implemented. Sustaining Community Health Workers’ Test-and-Treat Ability Community health workers are crucial to the testing and treating of malaria in rural parts of Africa. This year, the challenge will be to sustain community health workers’ ability to test and treat malaria. In much of rural Africa, community health workers are the lynchpin of the health system, and in the highest burden regions of central and western Africa, most of their time is spent treating malaria cases. I recall talking to a community health worker in Mali, who told me the malaria situation was much better than it was years earlier when she first started. But when I looked at her register of patient visits, I was surprised to see that every single entry was a malaria case. When I asked her to explain, she said the big difference was in the number of deaths; rapid testing and effective treatment had dramatically reduced mortality. Since 2000, the worldwide malaria death rate has dropped by 60% thanks to the tireless efforts of community health workers like her. But given the number of people they interact with, community health workers are extremely vulnerable to being infected with COVID-19 and often have limited access to basic personal protective equipment (PPE) like gloves and masks. In the same round of Global Fund spot-checks of health facilities last year, a shocking 55% of facilities in Africa didn’t have enough basic PPE available for their workers. If a community health worker falls ill, there’s often no back-up. Community health workers will also be called on to play a vital role in COVID-19 vaccination campaign as these get going. It is crucial to protect people from the new virus, but we also need to ensure that the diversion of focus doesn’t lead to an escalation in malaria deaths. Increasing Malaria Grants An infant and mother under an insecticide-treated mosquito net in Ghana – such nets remain a key prevention technique. In the poorest countries in Africa it seems quite likely that unless we take decisive action, the knock-on impact of the pandemic in terms of incremental malaria deaths may well exceed the direct impact of COVID-19. As the largest funder of malaria programmes worldwide, the Global Fund is working urgently with partners to prevent such a disastrous outcome and get us back on track towards ending malaria. From January 2021, we have increased malaria grants by 23% on average, and are committed to deploying about US$4 billion over the next three years. In addition, our COVID-19 Response Mechanism is providing US$3.7 billion in funding to help countries respond to COVID-19, mitigate the impact on HIV, TB and malaria services, and make urgent fixes to health systems. For malaria, the priorities in 2021 are to continue to ensure we maintain campaigns for mosquito net distribution, spraying of insecticide in homes, and the provision of seasonal malaria chemoprevention for children, and to step up support to community health worker networks. We need more community health workers and we need to support them better – financially, with technology, with training and with personal protective equipment. Looking beyond 2021, we should take COVID-19 as a catalyst to rethink our approach to malaria. Global policy-makers are already discussing how to better protect the world from future pandemics. Let’s not forget the imperative to finish the fight against older pandemics like malaria, which may not threaten those in Washington DC, London or Paris, but still kill hundreds of thousands of people every year. Building Pandemic Preparedness An infant receiving the RTS,S malaria vaccine in Ghana in 2019. New malaria vaccines hold promise of significantly reducing childhood infections and severe malaria cases. In fact, the best way to build pandemic preparedness in many of the poorest parts of the world would be to mount a significant step-up in the fight against malaria. The capabilities needed to prepare and respond to any new pathogenic threat are largely the same as those needed to defeat malaria – primary health care that reaches everyone, however remote; rapid diagnostics; genomic sequencing to detect variants; disease surveillance including the ability to trace individual infections; supply chains that ensure essential medicines are available everywhere. New potential malaria vaccines could be used to pilot accelerated models for clinical trials, regulatory approval and deployment. Rather than predicate pandemic preparedness on hypothetical threats, pathogens that might cost lives, let’s build such protection by beating malaria and by doing so save millions of lives – the vast majority of them young children. For too long we have accepted people dying of a treatable disease we know how to eliminate – and that we have eliminated in dozens of countries. Now we should make this happen everywhere, and in doing so reinforce our defences against other pandemic threats. Peter Sands is the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria Image Credits: What is Malaria, WHO. Pharma Execs: Unlock Export & Supply Chain Barriers & Ramp Up Sharing Of Excess Vaccine Doses To Beat Back COVID Pandemic 23/04/2021 Elaine Ruth Fletcher Stephane Bancel, CEO of Moderna, says company is close to agreement on supply of its mRNA vaccines to COVAX. A group of leading pharmaceutical industry executives called upon global health leaders to work together to unlock export barriers, open up supply chain bottlenecks, and encourage high-income countries that are hoarding vaccines to redirect their excess doses to the WHO co-sponsored COVAX global vaccine facility – as ways to rapidly scale up equitable vaccine access and beat back the pandemic. The executives, including the CEO of Moderna and India’s Bharat Biotech, as well as GSK’s head of global vaccines, and the heads of the Developing Countries Vaccine Manufacturers Network (DCVMN) and the Biotechnology Innovation Organization (BIO), were speaking at an event Friday marking a year since the establishment of the WHO co-sponsored Act Accelerator COVAX initiative. Patents and other IP constraints are not the main obstacle to expanding access to vaccines, they asserted. And increasing vaccine manufacturing capacity in lower-income countries, while important, will take time to develop – given the complexities of vaccine production, they said, speaking at a forum sponsored by the International Pharmaceutical Manufacturers and Associations (IFPMA). Rather, the best way out of pandemic lockdowns and losses of life is to make better use of available resources, they stressed, including smoother supply chains and vaccine sharing schemes with COVAX. “We are on track to make a billion doses this year, and potentially to have up to 1.4 billion doses for 2022,” said Moderna CEO, Stephane Bancel, at the press briefing, adding that the company is also “in the final stretch to get an agreement with COVAX,” for distribution of the mRNA vaccine through the global vaccine equity pool. But he stressed that expanding manufacturing capacity further, and in more locations, would sap efforts to produce doses this year – and could ultimately even cost lives. “We need to focus on delivering as many vaccines as we can this year,” he said, while trying to add more manufacturing capacity risks “being a distraction limiting what we can do in 2021… and by next year there is going to be way too many vaccines for people on the planet.” United States Raw Inputs Are Key To Global Vaccine Manufacturing Supply Chains Michelle McMurry-Heath, CEO BIO Added Michelle McMurry-Heath, a former US Food and Drug Administration expert, unlocking supplies of key raw products and vaccine dose sharing are important low-hanging fruit in the battle against the virus: “We need to recognise that there are only a handful of manufacturers across the globe who have that expertise on hand, and we need to focus on getting them the materials that they need to produce as many doses, as quickly as possible, and to release backlogs,” said Heath, who is now CEO of BIO, a global trade association organisation that represents biotech researchers in government, the private sector, and academic institutions. This this includes items as basic as single-use plastics and filters for the vaccine manufacturing process, some of which can only be supplied from in the United States. Currently the US Defense Production Act (DPA) restrictions are holding up release of many of those raw inputs, she stressed, adding that: “the US has to take a hard look at itself…. This Defense Protection Act, which was really designed to withhold capacity, expertise, doses and raw materials to the US, customer was well intentioned – but somewhat misguided at this stage – we need to get those raw materials, out to the limited manufacturing capacity that exists around the globe.” In addition, she added, high income countries need to be encouraged to start dose-sharing with the COVAX initiative – following on the example of France’s announcement only today that it will share 500,000 vaccine doses. “The US is projected to have as many as 200 million excess doses on hand by the spring, we need to focus on getting those doses to COVAX,” said Heath. Vaccine Companies Can be Counted In ‘Double Digits’ Vaccine quality, which require adherence to strict biosafety requirements as well as to sterile conditions, is also a critical issue, she underlined. And quality control failures in manufacturing plants, such as ones seen recently in the case of a Johnson & Johnson vaccine plan, can undermine already shaky public confidence in the quality of brand-new COVID-19 vaccines. Added Sai Prasad, CEO of Bharat Biotech, which has developed the first indigenous Indian COVID-19 vaccine, “Vaccine companies you can probably count in double digits so we need to be careful about whom we are transferring technology to, and whether they can receive it as well. Technology transfer cannot be done with an entity that has no experience.” Sai Prasad, CEO Bharat Biotech “I think that as industry, we need to increase the partnerships between innovators and vaccine manufacturers…. We need to be agnostic as to whether these companies are US, Europe, India, China or Brazil, for example. And I think there is [already] a good track record of that,” he added, noting that over 200 partnerships between big pharma innovators and developing country manufacturers have been formed already. At the same time, he said, supply chain bottlenecks and export barriers are a big threat to scale up: “Some of the vaccines take 150 to 200 little components that come from different parts of the world. “So interruptions in just one component, can slow production significantly, he pointed out, referring to the Serum Institute of India’s recent problems securing certain inputs from the United States. “We’ve had reports from the Serum Institute having problems with certain single use materials that are supposed to come from the United States… plastic bags for example which we think is a mundane consumable, because maybe a decade ago industry, as such, we were all thinking about going into single use systems, which involved a lot of single use consumables – but now this unfortunately has become an impediment, and a bottleneck.” Rajinder Suri, CEO DCVMN Rajinder Suri, CEO of the Developing Countries Vaccine Manufacturing Network (DCVMN), echoed that saying: “We are on the verge of expanding and ramping up the capacities, which are really required to meet the global demand…..and we are certainty facing some of the bottlenecks, from cell culture mediums and serum adjuvant filters, and single use plastic bags, to bio reactors. “Most of these materials are coming from the US – so if the DPA is not handled properly, then the supply chain will get impacted, and building the global capacity will adversely get impacted.” COVAX Distributions Should Accelerate – With Stronger US Support On the brighter side, meanwhile, Heath said she was confident that with stronger support for COVAX from the new US administration of President Joe Biden, the global vaccine facility can make up for its comparatively slow start in the second quarter of the year. “COVAX didn’t have full support of all the developed countries. Now that this is up to speed…. we need to focus on great efforts like COVAX which are just beginning to fully ramp up, and can deliver very affordable vaccines around the globe. I is the fastest way to get high quality doses to developing countries, and that speed is so critical,” she said. Added Bancel, “we are focused on working with COVAX to provide vaccine, right now. COVAX is the way for us to get maximum access on the planet.” See entire press briefing: ACT-Accelerator Celebrates 1st Anniversary Amid COVID-19 Surge in India 23/04/2021 Kerry Cullinan Health worker Evelyn Narkie Dowuona holds up her vaccination card after receiving a dose of the COVAX-delivered AstraZeneca COVID-19 vaccine at Accra’s Ridge Hospital in Ghana. One of the few silver linings of the COVID-19 pandemic is the unprecedented collaboration of every sector of society to overcome it – best demonstrated by the Access to COVID-19 Tools Accelerator (ACT-Accelerator), which celebrated its first anniversary on Friday. The ACT-Accelerator’s most famous pillar is the vaccine facility, COVAX, which has distributed almost 40 million vaccine doses to 119 countries so far. “Vaccinating at this scale and in this time frame constitutes the largest and most complex vaccine rollout in history,” according to the WHO, but added that there are also “severe supply constraints characterising the market at present”. Other key achievements in the past year include: procuring 65 million COVID-19 tests for LMICs and supporting the development and Emergency Use Listing (EUL) of reliable rapid antigen diagnostic tests by its diagnostics pillar supporting the identification of dexamethasone as the first life-saving therapy against COVID-19 and, within 20 days of its identification, making 2.9m doses available to LMICs vis its therapeutics pillar Assisting to providing oxygen to half-a-million COVID-19 patients every day in LMICs. Procuring $50 million of PPE for LMICs via the Health Systems Connector pillar. While the ACT Accelerator has attracted $14.1 billion in funding, it needs another $19-billion this year to meet its aim of vaccinating 20% of the world’s population by the end of the year. Equitable Access Still a Long Way Off “The ACT Accelerator was conceived with two aims: the rapid development of vaccines diagnostics and therapeutics, and equitable access to those tools,” Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General, told the virtual anniversary featuring all partners. While the first objective “has been achieved”, said Tedros, “we have a long way to go on the second objective”. Of the more than 950 million vaccinations that have been given, 0.3% have been administered in low-income countries and testing rates in high-income countries are about 70 times higher than those in low-income countries, according to the WHO. “Around the world, people are dying because they are not vaccinated. They are not tested and they are not treated. We’re deeply concerned about the increasing number of cases in India right now,” said Tedros. India recorded 332,730 new cases and 2,263 deaths on Friday amid reports that many hospitals had run out of oxygen. South African President Cyril Ramaphosa South African President Cyril Ramaphosa told the event that “a COVID-19 vaccine is a public good and must be recognised as such”. South Africa and Norway co-chair the accelerator’s facilitation council, which provides political leadership for the body. TRIPS Waiver and Technology Transfer “South Africa and India are calling for a temporary TRIPS waiver to respond to COVID-19,” Ramaphosa added. “This, in our view, will facilitate the transfer of technology and intellectual property to more countries for the production of COVID-19 vaccines, as well as diagnostics and treatments.” He also welcomed the WHO initiative to establish a COVID-19 mRNA vaccine technology transfer hub and called on the pharmaceutical industry to “directly transfer this technology free of intellectual property barriers to low and middle-income countries”. Norway’s Minister of International Development, Dag Ulstein, said that his country and South Africa had sent out letters to 89 countries appealing to them to contribute to the ACT-Accelerator. “At this one-year anniversary, our choice is simple: invest in saving lives by treating the course of the pandemic everywhere now, or continue to spend trillions on the consequences of the pandemic with no end in sight,” said Ulstein, whose country has donated a number of its vaccine doses to COVAX. Describing the accelerators’ achievements as “a miracle”, Ursula von der Leyen, President of the European Commission, said that the EU had recently doubled its contribution. Meanwhile, French President Emmanuel Macron said that “now was the time to share”, and announced that his country would donate 500,000 vaccine doses to COVAX by mid-June. He appealed to other countries to donate vaccines to COVAX, saying that he hoped that the goal of EU members donating 5% of their vaccine stocks he set in February would be “exceeded” by the end of the year. However, Macron said the lack of technology transfer, not intellectual property rights, was hampering vaccine rollout. France is one of a handful of wealthy countries opposing the TRIPS waiver. Thomas Cueni, Director General of International Federation of Pharmaceutical Manufacturers (IFPMA), said that a year into the AC-Accelerator “we can say science wins”. “Not one but several highly effective vaccines are being developed at record speed, and now being produced in historic quantities,” said Cueni, committing his industry to accelerating “global access to safe, effective and affordable COVID-19 treatments and vaccines”. French President Emmanuel Macron Jeremy Farrar, Director of Wellcome, said in a press release about the anniversary that “huge strides have been made in the last year” but “science only works if it reaches society”. “The world remains in the grip of a devastating pandemic – and it is not slowing, only escalating. There must be no further delays to getting COVID-19 vaccines, tests and treatments to the most vulnerable groups everywhere,” added Farrar, whose organisation is a partner and significant contributor to the accelerator. “We are in desperate need of strong global leadership. Wealthy countries with access to surplus vaccine doses must start sharing these with the rest of the world now through COVAX, alongside national rollouts. And they should urgently set out a timetable for how these donations will be increased as they vaccinate more of their populations.” Surge of COVID-19 in India is ‘Really, Really Difficult’ Mike Ryan, WHO’s Executive Director of Health Emergencies Programme, said the global body was assisting India to secure oxygen, as well as with technical assistance and clinical management and triaging of patients. “There’s a lot of fear in India right now. We support the Government of India, like we support all governments, in facing this really, really difficult situation. This is not time for recommendations. It is the time for solidarity, the time to move quickly together to reduce deaths and reduce transmission by decreasing mobility and mixing, supporting communities with mask-wearing, maintaining social distance and reducing social gatherings,” said Ryan. Seth Berkley, CEO of the vaccine alliance, Gavi, added that because of India’s domestic need, “the first 10 million vaccine doses from COVAX went to India”. However, Berkeley acknowledged that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. Image Credits: WHO. Global Health Is In Disarray – But Is A Pandemic Treaty The Way Out ? 23/04/2021 Svĕt Lustig Vijay Lines of people wait their turn to receive the AstraZeneca COVID-19 vaccine in Rwanda in early March, after WHO-supported COVAX facility supplies are delivered. Should countries build a new pandemic treaty – or bolster existing mechanisms? Despite rising calls for a pandemic treaty, including from 25 world leaders in an open letter last month, some global health experts doubt that a treaty would be the most efficient way to quickly strengthen the world’s capacity to beat COVID – and prevent future pandemics. “I don’t think we have time to negotiate another treaty on vaccines. I mean, we really are in this emergency,” said Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia, Canada. Lee was one of four panelists featured at a session on “Global Health in Disarray-What Next,” hosted by the Geneva-based Graduate Institute’s Global Health Centre to mark the launch of its newly appointed International Advisory Board (IAB). The wide-ranging session covered a range of issues, from the feasibility of a pandemic treaty, to the challenges of achieving vaccine equity and the lack of progress made in strengthening health systems in low-income countries, despite years of international funding. A Pandemic Treaty Is Not Essential Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia. “Do we need a treaty to move forward? The answer is no,” said Esperanza Martinez, the Head of COVID-19 Crisis Management at the International Committee of the Red Cross (ICRC). “I don’t think that we are short of frameworks and short of treaties… there are already enough mechanisms to act.” According to Lee, legal frameworks such as the World Trade Organization’s TRIPS agreement, and accompanying TRIPS flexibilities create frameworks under which countries can gain access to lifesaving products during health emergencies. And the legally binding International Health Regulations (IHRs), which mandate countries to report on disease outbreaks, and share information with WHO and other member states, is another “useful” framework that should not be forgotten, added Finland’s Director for International Affairs Outi Kuivasniem, another panel member. Rather, the global health community needs to find ways to reform existing frameworks so that they serve us better, panelists suggested. Esperanza Martinez, Head of COVID-19 Crisis Management at the International Committee of the Red Cross In particular, there is a need to reform the IHRs, Kuivasniem said, because countries have not always complied – including by enacting export bans on vital health products or inputs, which have destabilized crucial supply chains, including those relating to vaccines and other essential medicines. Treaty Would Need Strong Member State Alignment At the same time, panelists acknowledged that a pandemic treaty could have some use if it was closely linked to existing legal frameworks like the IHRs and international humanitarian law, and generated greater adherence from countries, as well as support from civil society. “If we have a treaty, we need to have a conversation about what makes sense to have in the treaty so that it has an impact, and that countries are willing to adhere to those promises that are [made] through a treaty,” warned Kuivasniem. Allan Maleche, Executive Director, Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN) Conversely, a “lack of political alignment” between governments and between government and civil society, could frustrate efforts to develop a new pandemic treaty, cautioned Allan Maleche, Executive Director of Kenya’s Legal & Ethical Issues Network on HIV & AIDS (KELIN). And other “political solutions” are also on the table, she and other panelists pointed out, to accelerate pandemic response. Few would actually require a treaty. Those initiatives range from the WHO co-sponsored COVAX global vaccine facility to proposals for an IP waiver under the TRIPS rules of World Trade Organization the COVID-19 Technology Access Pool (C-TAP), and tech transfer initiatives. Despite controversies over some initiatives, such as the IP waiver, none really require a pandemic treaty to be implemented. Should a pandemic treaty be negotiated, civil society should really drive its development, Maleche underlined. “If we are serious about getting our pandemic treaty in place, it’s important for scholars, academics, human rights lawyers, civil society groups, and affected communities to push their governments and [define] what should be that framework,” he said. “A treaty would be important but the more important is respect and implementation of that treaty so that it can have an effect on the lives of people,” he said. Stronger Business Case Needed For Investing In Health Systems in LMICs Healthcare workers treat a patient with drug-resistant TB in Myanmar, using drugs procured by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Beyond the immediate pandemic, however, a stronger business case is needed to convince governments that global health is a long-term investment that makes economic sense, stressed Martinez – particularly in LMICs. “We need to have a business case, an economic case for investment in global health,” she said, pointing out that while the case has recently been made for investment in vaccine access, “there’s a need for making a stronger case for global health in general… as a way of also bridging the conversation gap between government and the private sector.” Meanwhile, Maleche expressed dismay that decades of international funding meant to strengthen healthcare delivery in developing countries such as Kenya had failed to create more sustainable health systems. “Has this money actually been fixing the health systems?” he asked. “Because the time we needed the health system to be fully functional, COVID came and exposed the things that are not working. “COVID also exposed the underbelly of things that many countries don’t normally give priority,” he added. “You’re telling people: wash your hands, put on a mask, social distance, but in certain countries including Kenya and in other low- and middle-income countries, some of those things are luxuries as people have never seen clean running water in taps.” In addition, Maleche added, COVID-19 has highlighted the fact funds are also misspent by governments lacking public transparency and accountability: “Even within a pandemic we still are able to see that resources are not accountably used, we see that governments are not transparent. So again, this comes to show that some of the bad habits that we had when we had a normal sort of situation in the globe are played out in quite an extreme picture, in the context of a pandemic. ” In the humanitarian sector, in particular, financial support for fragile healthcare systems has been particularly scarce, added Martinez. “Very little has been done to strengthen health care systems in LMICs,” she asserted. “We have been speaking for years about the need to strengthen healthcare systems in developing countries and in humanitarian crises, but really when we look, very little has been done. In terms of vaccine access as well, “fundamentally there is a lack of production, science and research and development in the global south, and unless we address that issue, we will not have a sustainable solution to these [vaccine production] needs that we have globally,” she added. “There is a need for investment, but the investment at the level that is required is not coming through.” Regional Initiatives and Grassroots Action As Way Forward Ilona Kickbusch, Founder and Chair of the International Advisory Board, Global Health Centre “There is a feeling in the air [that] we need to reform,” said Ilona Kickbusch, founder of the Global Health Center, and chair of the new International Advisory Board, and moderator of the panel discussion. “Now there’s a number of suggestions on the table, for how global health, both in terms the way we do research and the way the global health regime and organizations are set up, could be changed. “And it’s interesting that right now we’re facing a pressure to some extent from above, top-down, from heads of state and government who are saying, ‘we need a new treaty in global health,’ and as many of you know we only have one so far… “On the other hand, there’s this movement from below that says we need to decolonize global health, we need totally different ideas, approaches, and we need to be much clearer about equity and access, and the social justice agenda.” Among the new ideas, Kickbusch pointed to regional initiatives that are underway, particularly in Africa, to chart a more strategic direction for the continent’s pandemic response. While many countries turned inward during the pandemic, Africa started working together more closely at the regional level, she pointed out. A new African region multi-hazard warning system will seek to link early warning, and responses to natural hazards, pandemics and pests and diseases as well as conflict. That collaboration has stimulated initiatives ranging from AU-based vaccine procurement to the new AU/Africa CDC partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), announced just last week to ramp up vaccine research, development and manufacturing in the region – with funding from Afreximbank and the Africa Finance Corporation. In addition, the African Union and Africa CDC are developing a new COVID-19 Disaster Recovery Framework and multi-hazard warning system for the continent to better link responses to climate, health, and environmental emergencies. “It is one of the encouraging things in global health..that there are these regional initiatives,” Kickbusch said. “Particularly in the African Union, we’ve seen the activities of the African CDC during the pandemic, and seend that a true consensus is building up.” Said Martinez, “This pandemic is precisely an example of how critical it is for us to have this broader view of health… “So we have the pandemic crisis and we also have the climate change crisis. And if we look at the issue we need to think beyond climate change [and] understand that polar bears are drowning in the Arctic, to think about the millions of people that today are facing diseases that were confined to the tropics. “We [need to] link all of those elements to the broader components of human health and health systems. I think that’s when we truly talk about human global Health.” Image Credits: WHO, The Global Fund / John Rae. UK Study Shows Similar, Significant Reductions In COVID-19 Infections With Single Dose Of Oxford-AstraZeneca Or Pfizer-BioNTech Vaccine 23/04/2021 Raisa Santos One dose of either vaccine resulted in 65% reduction of infections. There was greater impact against symptomatic infections (72%) than infections without reported symptoms (57%). 2 doses were even more effective against symptomatic infections (90%, and gave similar level of protection as prior infection. COVID-19 infections fell significantly – by 65% percent – after a first dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccine in a study of more than 373,000 British residents who received one of the two jabs. The first in a series of two new studies, published by the University of Oxford, found that the reduction in new COVID-19 infections was similarly dramatic following either the first dose of the Oxford/AstraZeneca or Pfizer-BioNTech vaccine. “We found very similar, significant reductions in infections [rates] after the first rounds of either [Oxford/AstraZeneca] and [PfizerBioNTech] vaccines,” said Dr Koen Pouwels, senior researcher in Oxford University’s Nuffield Department of Population Health, during the press briefing. The studies, which used data from the COVID-19 Infection Survey, a partnership between the University of Oxford, the UK’s Office of National Statistics (ONS), and the Department for Health and Social Care (DHSC), analyzed 1,610,562 test results from nose and throat swabs taken from 373,402 study participants between 1 December 2020 and 3 April 2021. First Study Focused on Infection Reduction Rates Clockwise, left to right: Dr David Eyre, Dr Sarah Walker, moderator Fiona Lethbridge, Dr Koen Pouwels The first study focused on infection reduction rates following a single shot of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines. Twenty-one days after a single dose of either vaccine, with no second dose, the rates of all new COVID-19 infections had dropped by 65%, symptomatic infections by 74%, and infections without reported symptoms by 57%. One dose of either of the two vaccines also were similarly effective against the B.1.1.7 variant, which was first identified in the UK. Vaccination was just as effective in individuals aged 75 or older with underlying health conditions as it was in those under 75 or without health conditions. Two doses of the Pfizer-BioNTech vaccine, meanwhile, reduced asymptomatic infections by 70% and symptomatic infections by 90%. During the press briefing, Dr Sarah Walker, Professor of Medical Statistics and Epidemiology at the University of Oxford and Chief Investigator and academic lead for the COVID-19 Infection Survey, stated that she was ‘pleasantly surprised’ by these results. “The benefits are greater for people with high viral load and for people with symptoms, both of who have probably got the greatest chance of transmission, was really not necessarily something I was expecting.” However, too few people had yet received two doses of Oxford-AstraZeneca to assess the final degree of protection obtained from that vaccine, the researchers concluded. In the press release, Dr Koen Pouwels said: ‘The protection from new infections gained from a single dose supports the decision to extend the time between first and second doses to 12 weeks to maximise initial vaccination coverage and reduce hospitalisations and deaths.” “However, the fact that we saw smaller reductions in asymptomatic infections than infections with symptoms highlights the potential for vaccinated individuals to get COVID-19 again, and for limited ongoing transmission from vaccinated individuals, even if this is at a lower rate. This emphasises the need for everyone to continue to follow guidelines to reduce transmission risk, for example through social distancing and masks.” Antibody Responses High After Second Pfizer Vaccination Antibody responses after receiving either AstraZeneca or Pfizer COVID-19 vaccines The second study compared how antibody levels changed after a single dose of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines, as compared with two doses of the Pfizer-BioNTech vaccine, generally given 21-42 days apart. Antibody levels were comparatively lower with a single dose of either vaccine, particularly at older ages. But while the size of the immune response differed, there was no group of individuals who didn’t respond at all to either vaccine. There was, however, a small percentage of people – 5% – who had low responses to both vaccines, which makes it essential to monitor responses to a second vaccination. Antibody responses to a single dose of either vaccine also were generally lower in older individuals, especially over 60 years – unless they had had a prior COVID infection. Antibody responses to two doses of the Pfizer-BioNTech vaccine were high across all ages, and particularly increased in older people – reaching levels similar to those who had received a single vaccine dose after a prior infection. David Eyre, Associate Professor at the Big Data Institute at the University of Oxford, said that while the findings still highlighted the importance of people getting a second vaccine dose degrees of protection different by age: “In older individuals, two vaccine doses are as effective as prior natural infection at generating antibodies to the SARS-CoV-2 virus that causes COVID-19. In younger individuals a single dose achieves the same level of response.” Walker also emphasized the importance of vaccinations to control the spread of COVID. “Vaccines are clearly going to be the only way that we are going to have a chance to control this long term. WIthout vaccines, I don’t think getting close to zero [infections] is really feasible,” she said, during the press briefing. The findings come on the heels of recent announcements by Pfizer CEO Albert Bourla that in fact a third booster jab of the vaccine may be necessary “somewhere between six and 12 months.” Risk of Blood Clot from AstraZeneca Vaccine Doubles, UK Still Says ‘Benefits Outweigh Risks’ A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine. Meanwhile, new UK government data suggested that the risk of serious blood clots from AstraZeneca jabs was greater than had previously been reported at national level. The most recent survey found 168 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA). The estimated number of first doses of AstraZeneca COVID-19 vaccines administered in the UK was 21.2 million by 14 April, giving an overall case incidence of 7.9 such events per million doses – or one person in every 125,000. Out of these cases, which occurred in 93 women and 75 men, 32 deaths occurred (19%). Previously, there had been 79 cases and 19 deaths reported in the UK. The UK government’s regulatory agency, however, continues to emphasize that the benefits still outweigh the risks. “On the basis of this ongoing review, the advice remains that the benefits of the vaccine outweigh the risks in the majority of people,” the MHRA said. Image Credits: University of Oxford, Flickr. Africa’s New COVID-19 Disaster Recovery Framework – Aims To Improve Response To Future Pandemics 22/04/2021 Geoffrey Kamadi A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19. The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks. The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch. Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective. Multi-hazard Warning System Will Predict Potential Outbreaks In a related development, the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance, as a result of unusually heavy desert rainfall – creating significant disruptions in food production. The multi-hazard warning system will be instrumental in predicting such potential outbreaks of environment and climate related and health events, critical in mobilizing resources for effective response efforts. A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict. “Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview. The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present. New Initiatives To Complement Existing African Risk Capacity The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters. So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth. He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. One Health Approach – Urgent Action Needed Now The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. “If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch. Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done. The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative. Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. “IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre. Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent. “That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals. WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination 22/04/2021 Madeleine Hoecklin Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria. Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. The forum Reaching Zero: Virtual Forum on Malaria Elimination saw the launch of a new new initiative – E2025 – to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. https://twitter.com/endmalaria/status/1384871850338131972 The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria. Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020. The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event. “These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. Zero Malaria Initiative In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria. Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. “Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. Dr Pedro Alonso, Director of the WHO Global Malaria Programme. The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. Challenges to Reaching Zero Malaria Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality. Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers. E-2025 Initiative The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. “At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. “Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.” Impact of COVID-19 on Malaria Programmes Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued. During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision. “Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. In addition, more children than ever before received seasonal malaria chemoprevention last year. The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. “We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw. “[But] of course we’re not out of the woods yet,” she added. Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey. Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. “Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. The current biggest challenge is keeping the political focus on malaria, said the speakers. “We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. RTS,S Malaria Vaccine is a “Promising Additional Tool” Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti. Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday. The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%. “This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria. “We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.” “And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months. While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said. “For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually. Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti. As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight. “Every year that we let malaria continue to spread, health and development suffer,” Moeti said. Image Credits: WHO, WHO. Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Pharma Execs: Unlock Export & Supply Chain Barriers & Ramp Up Sharing Of Excess Vaccine Doses To Beat Back COVID Pandemic 23/04/2021 Elaine Ruth Fletcher Stephane Bancel, CEO of Moderna, says company is close to agreement on supply of its mRNA vaccines to COVAX. A group of leading pharmaceutical industry executives called upon global health leaders to work together to unlock export barriers, open up supply chain bottlenecks, and encourage high-income countries that are hoarding vaccines to redirect their excess doses to the WHO co-sponsored COVAX global vaccine facility – as ways to rapidly scale up equitable vaccine access and beat back the pandemic. The executives, including the CEO of Moderna and India’s Bharat Biotech, as well as GSK’s head of global vaccines, and the heads of the Developing Countries Vaccine Manufacturers Network (DCVMN) and the Biotechnology Innovation Organization (BIO), were speaking at an event Friday marking a year since the establishment of the WHO co-sponsored Act Accelerator COVAX initiative. Patents and other IP constraints are not the main obstacle to expanding access to vaccines, they asserted. And increasing vaccine manufacturing capacity in lower-income countries, while important, will take time to develop – given the complexities of vaccine production, they said, speaking at a forum sponsored by the International Pharmaceutical Manufacturers and Associations (IFPMA). Rather, the best way out of pandemic lockdowns and losses of life is to make better use of available resources, they stressed, including smoother supply chains and vaccine sharing schemes with COVAX. “We are on track to make a billion doses this year, and potentially to have up to 1.4 billion doses for 2022,” said Moderna CEO, Stephane Bancel, at the press briefing, adding that the company is also “in the final stretch to get an agreement with COVAX,” for distribution of the mRNA vaccine through the global vaccine equity pool. But he stressed that expanding manufacturing capacity further, and in more locations, would sap efforts to produce doses this year – and could ultimately even cost lives. “We need to focus on delivering as many vaccines as we can this year,” he said, while trying to add more manufacturing capacity risks “being a distraction limiting what we can do in 2021… and by next year there is going to be way too many vaccines for people on the planet.” United States Raw Inputs Are Key To Global Vaccine Manufacturing Supply Chains Michelle McMurry-Heath, CEO BIO Added Michelle McMurry-Heath, a former US Food and Drug Administration expert, unlocking supplies of key raw products and vaccine dose sharing are important low-hanging fruit in the battle against the virus: “We need to recognise that there are only a handful of manufacturers across the globe who have that expertise on hand, and we need to focus on getting them the materials that they need to produce as many doses, as quickly as possible, and to release backlogs,” said Heath, who is now CEO of BIO, a global trade association organisation that represents biotech researchers in government, the private sector, and academic institutions. This this includes items as basic as single-use plastics and filters for the vaccine manufacturing process, some of which can only be supplied from in the United States. Currently the US Defense Production Act (DPA) restrictions are holding up release of many of those raw inputs, she stressed, adding that: “the US has to take a hard look at itself…. This Defense Protection Act, which was really designed to withhold capacity, expertise, doses and raw materials to the US, customer was well intentioned – but somewhat misguided at this stage – we need to get those raw materials, out to the limited manufacturing capacity that exists around the globe.” In addition, she added, high income countries need to be encouraged to start dose-sharing with the COVAX initiative – following on the example of France’s announcement only today that it will share 500,000 vaccine doses. “The US is projected to have as many as 200 million excess doses on hand by the spring, we need to focus on getting those doses to COVAX,” said Heath. Vaccine Companies Can be Counted In ‘Double Digits’ Vaccine quality, which require adherence to strict biosafety requirements as well as to sterile conditions, is also a critical issue, she underlined. And quality control failures in manufacturing plants, such as ones seen recently in the case of a Johnson & Johnson vaccine plan, can undermine already shaky public confidence in the quality of brand-new COVID-19 vaccines. Added Sai Prasad, CEO of Bharat Biotech, which has developed the first indigenous Indian COVID-19 vaccine, “Vaccine companies you can probably count in double digits so we need to be careful about whom we are transferring technology to, and whether they can receive it as well. Technology transfer cannot be done with an entity that has no experience.” Sai Prasad, CEO Bharat Biotech “I think that as industry, we need to increase the partnerships between innovators and vaccine manufacturers…. We need to be agnostic as to whether these companies are US, Europe, India, China or Brazil, for example. And I think there is [already] a good track record of that,” he added, noting that over 200 partnerships between big pharma innovators and developing country manufacturers have been formed already. At the same time, he said, supply chain bottlenecks and export barriers are a big threat to scale up: “Some of the vaccines take 150 to 200 little components that come from different parts of the world. “So interruptions in just one component, can slow production significantly, he pointed out, referring to the Serum Institute of India’s recent problems securing certain inputs from the United States. “We’ve had reports from the Serum Institute having problems with certain single use materials that are supposed to come from the United States… plastic bags for example which we think is a mundane consumable, because maybe a decade ago industry, as such, we were all thinking about going into single use systems, which involved a lot of single use consumables – but now this unfortunately has become an impediment, and a bottleneck.” Rajinder Suri, CEO DCVMN Rajinder Suri, CEO of the Developing Countries Vaccine Manufacturing Network (DCVMN), echoed that saying: “We are on the verge of expanding and ramping up the capacities, which are really required to meet the global demand…..and we are certainty facing some of the bottlenecks, from cell culture mediums and serum adjuvant filters, and single use plastic bags, to bio reactors. “Most of these materials are coming from the US – so if the DPA is not handled properly, then the supply chain will get impacted, and building the global capacity will adversely get impacted.” COVAX Distributions Should Accelerate – With Stronger US Support On the brighter side, meanwhile, Heath said she was confident that with stronger support for COVAX from the new US administration of President Joe Biden, the global vaccine facility can make up for its comparatively slow start in the second quarter of the year. “COVAX didn’t have full support of all the developed countries. Now that this is up to speed…. we need to focus on great efforts like COVAX which are just beginning to fully ramp up, and can deliver very affordable vaccines around the globe. I is the fastest way to get high quality doses to developing countries, and that speed is so critical,” she said. Added Bancel, “we are focused on working with COVAX to provide vaccine, right now. COVAX is the way for us to get maximum access on the planet.” See entire press briefing: ACT-Accelerator Celebrates 1st Anniversary Amid COVID-19 Surge in India 23/04/2021 Kerry Cullinan Health worker Evelyn Narkie Dowuona holds up her vaccination card after receiving a dose of the COVAX-delivered AstraZeneca COVID-19 vaccine at Accra’s Ridge Hospital in Ghana. One of the few silver linings of the COVID-19 pandemic is the unprecedented collaboration of every sector of society to overcome it – best demonstrated by the Access to COVID-19 Tools Accelerator (ACT-Accelerator), which celebrated its first anniversary on Friday. The ACT-Accelerator’s most famous pillar is the vaccine facility, COVAX, which has distributed almost 40 million vaccine doses to 119 countries so far. “Vaccinating at this scale and in this time frame constitutes the largest and most complex vaccine rollout in history,” according to the WHO, but added that there are also “severe supply constraints characterising the market at present”. Other key achievements in the past year include: procuring 65 million COVID-19 tests for LMICs and supporting the development and Emergency Use Listing (EUL) of reliable rapid antigen diagnostic tests by its diagnostics pillar supporting the identification of dexamethasone as the first life-saving therapy against COVID-19 and, within 20 days of its identification, making 2.9m doses available to LMICs vis its therapeutics pillar Assisting to providing oxygen to half-a-million COVID-19 patients every day in LMICs. Procuring $50 million of PPE for LMICs via the Health Systems Connector pillar. While the ACT Accelerator has attracted $14.1 billion in funding, it needs another $19-billion this year to meet its aim of vaccinating 20% of the world’s population by the end of the year. Equitable Access Still a Long Way Off “The ACT Accelerator was conceived with two aims: the rapid development of vaccines diagnostics and therapeutics, and equitable access to those tools,” Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General, told the virtual anniversary featuring all partners. While the first objective “has been achieved”, said Tedros, “we have a long way to go on the second objective”. Of the more than 950 million vaccinations that have been given, 0.3% have been administered in low-income countries and testing rates in high-income countries are about 70 times higher than those in low-income countries, according to the WHO. “Around the world, people are dying because they are not vaccinated. They are not tested and they are not treated. We’re deeply concerned about the increasing number of cases in India right now,” said Tedros. India recorded 332,730 new cases and 2,263 deaths on Friday amid reports that many hospitals had run out of oxygen. South African President Cyril Ramaphosa South African President Cyril Ramaphosa told the event that “a COVID-19 vaccine is a public good and must be recognised as such”. South Africa and Norway co-chair the accelerator’s facilitation council, which provides political leadership for the body. TRIPS Waiver and Technology Transfer “South Africa and India are calling for a temporary TRIPS waiver to respond to COVID-19,” Ramaphosa added. “This, in our view, will facilitate the transfer of technology and intellectual property to more countries for the production of COVID-19 vaccines, as well as diagnostics and treatments.” He also welcomed the WHO initiative to establish a COVID-19 mRNA vaccine technology transfer hub and called on the pharmaceutical industry to “directly transfer this technology free of intellectual property barriers to low and middle-income countries”. Norway’s Minister of International Development, Dag Ulstein, said that his country and South Africa had sent out letters to 89 countries appealing to them to contribute to the ACT-Accelerator. “At this one-year anniversary, our choice is simple: invest in saving lives by treating the course of the pandemic everywhere now, or continue to spend trillions on the consequences of the pandemic with no end in sight,” said Ulstein, whose country has donated a number of its vaccine doses to COVAX. Describing the accelerators’ achievements as “a miracle”, Ursula von der Leyen, President of the European Commission, said that the EU had recently doubled its contribution. Meanwhile, French President Emmanuel Macron said that “now was the time to share”, and announced that his country would donate 500,000 vaccine doses to COVAX by mid-June. He appealed to other countries to donate vaccines to COVAX, saying that he hoped that the goal of EU members donating 5% of their vaccine stocks he set in February would be “exceeded” by the end of the year. However, Macron said the lack of technology transfer, not intellectual property rights, was hampering vaccine rollout. France is one of a handful of wealthy countries opposing the TRIPS waiver. Thomas Cueni, Director General of International Federation of Pharmaceutical Manufacturers (IFPMA), said that a year into the AC-Accelerator “we can say science wins”. “Not one but several highly effective vaccines are being developed at record speed, and now being produced in historic quantities,” said Cueni, committing his industry to accelerating “global access to safe, effective and affordable COVID-19 treatments and vaccines”. French President Emmanuel Macron Jeremy Farrar, Director of Wellcome, said in a press release about the anniversary that “huge strides have been made in the last year” but “science only works if it reaches society”. “The world remains in the grip of a devastating pandemic – and it is not slowing, only escalating. There must be no further delays to getting COVID-19 vaccines, tests and treatments to the most vulnerable groups everywhere,” added Farrar, whose organisation is a partner and significant contributor to the accelerator. “We are in desperate need of strong global leadership. Wealthy countries with access to surplus vaccine doses must start sharing these with the rest of the world now through COVAX, alongside national rollouts. And they should urgently set out a timetable for how these donations will be increased as they vaccinate more of their populations.” Surge of COVID-19 in India is ‘Really, Really Difficult’ Mike Ryan, WHO’s Executive Director of Health Emergencies Programme, said the global body was assisting India to secure oxygen, as well as with technical assistance and clinical management and triaging of patients. “There’s a lot of fear in India right now. We support the Government of India, like we support all governments, in facing this really, really difficult situation. This is not time for recommendations. It is the time for solidarity, the time to move quickly together to reduce deaths and reduce transmission by decreasing mobility and mixing, supporting communities with mask-wearing, maintaining social distance and reducing social gatherings,” said Ryan. Seth Berkley, CEO of the vaccine alliance, Gavi, added that because of India’s domestic need, “the first 10 million vaccine doses from COVAX went to India”. However, Berkeley acknowledged that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. Image Credits: WHO. Global Health Is In Disarray – But Is A Pandemic Treaty The Way Out ? 23/04/2021 Svĕt Lustig Vijay Lines of people wait their turn to receive the AstraZeneca COVID-19 vaccine in Rwanda in early March, after WHO-supported COVAX facility supplies are delivered. Should countries build a new pandemic treaty – or bolster existing mechanisms? Despite rising calls for a pandemic treaty, including from 25 world leaders in an open letter last month, some global health experts doubt that a treaty would be the most efficient way to quickly strengthen the world’s capacity to beat COVID – and prevent future pandemics. “I don’t think we have time to negotiate another treaty on vaccines. I mean, we really are in this emergency,” said Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia, Canada. Lee was one of four panelists featured at a session on “Global Health in Disarray-What Next,” hosted by the Geneva-based Graduate Institute’s Global Health Centre to mark the launch of its newly appointed International Advisory Board (IAB). The wide-ranging session covered a range of issues, from the feasibility of a pandemic treaty, to the challenges of achieving vaccine equity and the lack of progress made in strengthening health systems in low-income countries, despite years of international funding. A Pandemic Treaty Is Not Essential Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia. “Do we need a treaty to move forward? The answer is no,” said Esperanza Martinez, the Head of COVID-19 Crisis Management at the International Committee of the Red Cross (ICRC). “I don’t think that we are short of frameworks and short of treaties… there are already enough mechanisms to act.” According to Lee, legal frameworks such as the World Trade Organization’s TRIPS agreement, and accompanying TRIPS flexibilities create frameworks under which countries can gain access to lifesaving products during health emergencies. And the legally binding International Health Regulations (IHRs), which mandate countries to report on disease outbreaks, and share information with WHO and other member states, is another “useful” framework that should not be forgotten, added Finland’s Director for International Affairs Outi Kuivasniem, another panel member. Rather, the global health community needs to find ways to reform existing frameworks so that they serve us better, panelists suggested. Esperanza Martinez, Head of COVID-19 Crisis Management at the International Committee of the Red Cross In particular, there is a need to reform the IHRs, Kuivasniem said, because countries have not always complied – including by enacting export bans on vital health products or inputs, which have destabilized crucial supply chains, including those relating to vaccines and other essential medicines. Treaty Would Need Strong Member State Alignment At the same time, panelists acknowledged that a pandemic treaty could have some use if it was closely linked to existing legal frameworks like the IHRs and international humanitarian law, and generated greater adherence from countries, as well as support from civil society. “If we have a treaty, we need to have a conversation about what makes sense to have in the treaty so that it has an impact, and that countries are willing to adhere to those promises that are [made] through a treaty,” warned Kuivasniem. Allan Maleche, Executive Director, Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN) Conversely, a “lack of political alignment” between governments and between government and civil society, could frustrate efforts to develop a new pandemic treaty, cautioned Allan Maleche, Executive Director of Kenya’s Legal & Ethical Issues Network on HIV & AIDS (KELIN). And other “political solutions” are also on the table, she and other panelists pointed out, to accelerate pandemic response. Few would actually require a treaty. Those initiatives range from the WHO co-sponsored COVAX global vaccine facility to proposals for an IP waiver under the TRIPS rules of World Trade Organization the COVID-19 Technology Access Pool (C-TAP), and tech transfer initiatives. Despite controversies over some initiatives, such as the IP waiver, none really require a pandemic treaty to be implemented. Should a pandemic treaty be negotiated, civil society should really drive its development, Maleche underlined. “If we are serious about getting our pandemic treaty in place, it’s important for scholars, academics, human rights lawyers, civil society groups, and affected communities to push their governments and [define] what should be that framework,” he said. “A treaty would be important but the more important is respect and implementation of that treaty so that it can have an effect on the lives of people,” he said. Stronger Business Case Needed For Investing In Health Systems in LMICs Healthcare workers treat a patient with drug-resistant TB in Myanmar, using drugs procured by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Beyond the immediate pandemic, however, a stronger business case is needed to convince governments that global health is a long-term investment that makes economic sense, stressed Martinez – particularly in LMICs. “We need to have a business case, an economic case for investment in global health,” she said, pointing out that while the case has recently been made for investment in vaccine access, “there’s a need for making a stronger case for global health in general… as a way of also bridging the conversation gap between government and the private sector.” Meanwhile, Maleche expressed dismay that decades of international funding meant to strengthen healthcare delivery in developing countries such as Kenya had failed to create more sustainable health systems. “Has this money actually been fixing the health systems?” he asked. “Because the time we needed the health system to be fully functional, COVID came and exposed the things that are not working. “COVID also exposed the underbelly of things that many countries don’t normally give priority,” he added. “You’re telling people: wash your hands, put on a mask, social distance, but in certain countries including Kenya and in other low- and middle-income countries, some of those things are luxuries as people have never seen clean running water in taps.” In addition, Maleche added, COVID-19 has highlighted the fact funds are also misspent by governments lacking public transparency and accountability: “Even within a pandemic we still are able to see that resources are not accountably used, we see that governments are not transparent. So again, this comes to show that some of the bad habits that we had when we had a normal sort of situation in the globe are played out in quite an extreme picture, in the context of a pandemic. ” In the humanitarian sector, in particular, financial support for fragile healthcare systems has been particularly scarce, added Martinez. “Very little has been done to strengthen health care systems in LMICs,” she asserted. “We have been speaking for years about the need to strengthen healthcare systems in developing countries and in humanitarian crises, but really when we look, very little has been done. In terms of vaccine access as well, “fundamentally there is a lack of production, science and research and development in the global south, and unless we address that issue, we will not have a sustainable solution to these [vaccine production] needs that we have globally,” she added. “There is a need for investment, but the investment at the level that is required is not coming through.” Regional Initiatives and Grassroots Action As Way Forward Ilona Kickbusch, Founder and Chair of the International Advisory Board, Global Health Centre “There is a feeling in the air [that] we need to reform,” said Ilona Kickbusch, founder of the Global Health Center, and chair of the new International Advisory Board, and moderator of the panel discussion. “Now there’s a number of suggestions on the table, for how global health, both in terms the way we do research and the way the global health regime and organizations are set up, could be changed. “And it’s interesting that right now we’re facing a pressure to some extent from above, top-down, from heads of state and government who are saying, ‘we need a new treaty in global health,’ and as many of you know we only have one so far… “On the other hand, there’s this movement from below that says we need to decolonize global health, we need totally different ideas, approaches, and we need to be much clearer about equity and access, and the social justice agenda.” Among the new ideas, Kickbusch pointed to regional initiatives that are underway, particularly in Africa, to chart a more strategic direction for the continent’s pandemic response. While many countries turned inward during the pandemic, Africa started working together more closely at the regional level, she pointed out. A new African region multi-hazard warning system will seek to link early warning, and responses to natural hazards, pandemics and pests and diseases as well as conflict. That collaboration has stimulated initiatives ranging from AU-based vaccine procurement to the new AU/Africa CDC partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), announced just last week to ramp up vaccine research, development and manufacturing in the region – with funding from Afreximbank and the Africa Finance Corporation. In addition, the African Union and Africa CDC are developing a new COVID-19 Disaster Recovery Framework and multi-hazard warning system for the continent to better link responses to climate, health, and environmental emergencies. “It is one of the encouraging things in global health..that there are these regional initiatives,” Kickbusch said. “Particularly in the African Union, we’ve seen the activities of the African CDC during the pandemic, and seend that a true consensus is building up.” Said Martinez, “This pandemic is precisely an example of how critical it is for us to have this broader view of health… “So we have the pandemic crisis and we also have the climate change crisis. And if we look at the issue we need to think beyond climate change [and] understand that polar bears are drowning in the Arctic, to think about the millions of people that today are facing diseases that were confined to the tropics. “We [need to] link all of those elements to the broader components of human health and health systems. I think that’s when we truly talk about human global Health.” Image Credits: WHO, The Global Fund / John Rae. UK Study Shows Similar, Significant Reductions In COVID-19 Infections With Single Dose Of Oxford-AstraZeneca Or Pfizer-BioNTech Vaccine 23/04/2021 Raisa Santos One dose of either vaccine resulted in 65% reduction of infections. There was greater impact against symptomatic infections (72%) than infections without reported symptoms (57%). 2 doses were even more effective against symptomatic infections (90%, and gave similar level of protection as prior infection. COVID-19 infections fell significantly – by 65% percent – after a first dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccine in a study of more than 373,000 British residents who received one of the two jabs. The first in a series of two new studies, published by the University of Oxford, found that the reduction in new COVID-19 infections was similarly dramatic following either the first dose of the Oxford/AstraZeneca or Pfizer-BioNTech vaccine. “We found very similar, significant reductions in infections [rates] after the first rounds of either [Oxford/AstraZeneca] and [PfizerBioNTech] vaccines,” said Dr Koen Pouwels, senior researcher in Oxford University’s Nuffield Department of Population Health, during the press briefing. The studies, which used data from the COVID-19 Infection Survey, a partnership between the University of Oxford, the UK’s Office of National Statistics (ONS), and the Department for Health and Social Care (DHSC), analyzed 1,610,562 test results from nose and throat swabs taken from 373,402 study participants between 1 December 2020 and 3 April 2021. First Study Focused on Infection Reduction Rates Clockwise, left to right: Dr David Eyre, Dr Sarah Walker, moderator Fiona Lethbridge, Dr Koen Pouwels The first study focused on infection reduction rates following a single shot of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines. Twenty-one days after a single dose of either vaccine, with no second dose, the rates of all new COVID-19 infections had dropped by 65%, symptomatic infections by 74%, and infections without reported symptoms by 57%. One dose of either of the two vaccines also were similarly effective against the B.1.1.7 variant, which was first identified in the UK. Vaccination was just as effective in individuals aged 75 or older with underlying health conditions as it was in those under 75 or without health conditions. Two doses of the Pfizer-BioNTech vaccine, meanwhile, reduced asymptomatic infections by 70% and symptomatic infections by 90%. During the press briefing, Dr Sarah Walker, Professor of Medical Statistics and Epidemiology at the University of Oxford and Chief Investigator and academic lead for the COVID-19 Infection Survey, stated that she was ‘pleasantly surprised’ by these results. “The benefits are greater for people with high viral load and for people with symptoms, both of who have probably got the greatest chance of transmission, was really not necessarily something I was expecting.” However, too few people had yet received two doses of Oxford-AstraZeneca to assess the final degree of protection obtained from that vaccine, the researchers concluded. In the press release, Dr Koen Pouwels said: ‘The protection from new infections gained from a single dose supports the decision to extend the time between first and second doses to 12 weeks to maximise initial vaccination coverage and reduce hospitalisations and deaths.” “However, the fact that we saw smaller reductions in asymptomatic infections than infections with symptoms highlights the potential for vaccinated individuals to get COVID-19 again, and for limited ongoing transmission from vaccinated individuals, even if this is at a lower rate. This emphasises the need for everyone to continue to follow guidelines to reduce transmission risk, for example through social distancing and masks.” Antibody Responses High After Second Pfizer Vaccination Antibody responses after receiving either AstraZeneca or Pfizer COVID-19 vaccines The second study compared how antibody levels changed after a single dose of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines, as compared with two doses of the Pfizer-BioNTech vaccine, generally given 21-42 days apart. Antibody levels were comparatively lower with a single dose of either vaccine, particularly at older ages. But while the size of the immune response differed, there was no group of individuals who didn’t respond at all to either vaccine. There was, however, a small percentage of people – 5% – who had low responses to both vaccines, which makes it essential to monitor responses to a second vaccination. Antibody responses to a single dose of either vaccine also were generally lower in older individuals, especially over 60 years – unless they had had a prior COVID infection. Antibody responses to two doses of the Pfizer-BioNTech vaccine were high across all ages, and particularly increased in older people – reaching levels similar to those who had received a single vaccine dose after a prior infection. David Eyre, Associate Professor at the Big Data Institute at the University of Oxford, said that while the findings still highlighted the importance of people getting a second vaccine dose degrees of protection different by age: “In older individuals, two vaccine doses are as effective as prior natural infection at generating antibodies to the SARS-CoV-2 virus that causes COVID-19. In younger individuals a single dose achieves the same level of response.” Walker also emphasized the importance of vaccinations to control the spread of COVID. “Vaccines are clearly going to be the only way that we are going to have a chance to control this long term. WIthout vaccines, I don’t think getting close to zero [infections] is really feasible,” she said, during the press briefing. The findings come on the heels of recent announcements by Pfizer CEO Albert Bourla that in fact a third booster jab of the vaccine may be necessary “somewhere between six and 12 months.” Risk of Blood Clot from AstraZeneca Vaccine Doubles, UK Still Says ‘Benefits Outweigh Risks’ A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine. Meanwhile, new UK government data suggested that the risk of serious blood clots from AstraZeneca jabs was greater than had previously been reported at national level. The most recent survey found 168 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA). The estimated number of first doses of AstraZeneca COVID-19 vaccines administered in the UK was 21.2 million by 14 April, giving an overall case incidence of 7.9 such events per million doses – or one person in every 125,000. Out of these cases, which occurred in 93 women and 75 men, 32 deaths occurred (19%). Previously, there had been 79 cases and 19 deaths reported in the UK. The UK government’s regulatory agency, however, continues to emphasize that the benefits still outweigh the risks. “On the basis of this ongoing review, the advice remains that the benefits of the vaccine outweigh the risks in the majority of people,” the MHRA said. Image Credits: University of Oxford, Flickr. Africa’s New COVID-19 Disaster Recovery Framework – Aims To Improve Response To Future Pandemics 22/04/2021 Geoffrey Kamadi A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19. The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks. The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch. Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective. Multi-hazard Warning System Will Predict Potential Outbreaks In a related development, the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance, as a result of unusually heavy desert rainfall – creating significant disruptions in food production. The multi-hazard warning system will be instrumental in predicting such potential outbreaks of environment and climate related and health events, critical in mobilizing resources for effective response efforts. A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict. “Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview. The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present. New Initiatives To Complement Existing African Risk Capacity The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters. So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth. He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. One Health Approach – Urgent Action Needed Now The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. “If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch. Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done. The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative. Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. “IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre. Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent. “That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals. WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination 22/04/2021 Madeleine Hoecklin Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria. Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. The forum Reaching Zero: Virtual Forum on Malaria Elimination saw the launch of a new new initiative – E2025 – to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. https://twitter.com/endmalaria/status/1384871850338131972 The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria. Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020. The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event. “These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. Zero Malaria Initiative In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria. Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. “Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. Dr Pedro Alonso, Director of the WHO Global Malaria Programme. The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. Challenges to Reaching Zero Malaria Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality. Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers. E-2025 Initiative The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. “At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. “Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.” Impact of COVID-19 on Malaria Programmes Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued. During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision. “Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. In addition, more children than ever before received seasonal malaria chemoprevention last year. The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. “We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw. “[But] of course we’re not out of the woods yet,” she added. Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey. Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. “Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. The current biggest challenge is keeping the political focus on malaria, said the speakers. “We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. RTS,S Malaria Vaccine is a “Promising Additional Tool” Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti. Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday. The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%. “This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria. “We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.” “And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months. While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said. “For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually. Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti. As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight. “Every year that we let malaria continue to spread, health and development suffer,” Moeti said. Image Credits: WHO, WHO. Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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ACT-Accelerator Celebrates 1st Anniversary Amid COVID-19 Surge in India 23/04/2021 Kerry Cullinan Health worker Evelyn Narkie Dowuona holds up her vaccination card after receiving a dose of the COVAX-delivered AstraZeneca COVID-19 vaccine at Accra’s Ridge Hospital in Ghana. One of the few silver linings of the COVID-19 pandemic is the unprecedented collaboration of every sector of society to overcome it – best demonstrated by the Access to COVID-19 Tools Accelerator (ACT-Accelerator), which celebrated its first anniversary on Friday. The ACT-Accelerator’s most famous pillar is the vaccine facility, COVAX, which has distributed almost 40 million vaccine doses to 119 countries so far. “Vaccinating at this scale and in this time frame constitutes the largest and most complex vaccine rollout in history,” according to the WHO, but added that there are also “severe supply constraints characterising the market at present”. Other key achievements in the past year include: procuring 65 million COVID-19 tests for LMICs and supporting the development and Emergency Use Listing (EUL) of reliable rapid antigen diagnostic tests by its diagnostics pillar supporting the identification of dexamethasone as the first life-saving therapy against COVID-19 and, within 20 days of its identification, making 2.9m doses available to LMICs vis its therapeutics pillar Assisting to providing oxygen to half-a-million COVID-19 patients every day in LMICs. Procuring $50 million of PPE for LMICs via the Health Systems Connector pillar. While the ACT Accelerator has attracted $14.1 billion in funding, it needs another $19-billion this year to meet its aim of vaccinating 20% of the world’s population by the end of the year. Equitable Access Still a Long Way Off “The ACT Accelerator was conceived with two aims: the rapid development of vaccines diagnostics and therapeutics, and equitable access to those tools,” Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General, told the virtual anniversary featuring all partners. While the first objective “has been achieved”, said Tedros, “we have a long way to go on the second objective”. Of the more than 950 million vaccinations that have been given, 0.3% have been administered in low-income countries and testing rates in high-income countries are about 70 times higher than those in low-income countries, according to the WHO. “Around the world, people are dying because they are not vaccinated. They are not tested and they are not treated. We’re deeply concerned about the increasing number of cases in India right now,” said Tedros. India recorded 332,730 new cases and 2,263 deaths on Friday amid reports that many hospitals had run out of oxygen. South African President Cyril Ramaphosa South African President Cyril Ramaphosa told the event that “a COVID-19 vaccine is a public good and must be recognised as such”. South Africa and Norway co-chair the accelerator’s facilitation council, which provides political leadership for the body. TRIPS Waiver and Technology Transfer “South Africa and India are calling for a temporary TRIPS waiver to respond to COVID-19,” Ramaphosa added. “This, in our view, will facilitate the transfer of technology and intellectual property to more countries for the production of COVID-19 vaccines, as well as diagnostics and treatments.” He also welcomed the WHO initiative to establish a COVID-19 mRNA vaccine technology transfer hub and called on the pharmaceutical industry to “directly transfer this technology free of intellectual property barriers to low and middle-income countries”. Norway’s Minister of International Development, Dag Ulstein, said that his country and South Africa had sent out letters to 89 countries appealing to them to contribute to the ACT-Accelerator. “At this one-year anniversary, our choice is simple: invest in saving lives by treating the course of the pandemic everywhere now, or continue to spend trillions on the consequences of the pandemic with no end in sight,” said Ulstein, whose country has donated a number of its vaccine doses to COVAX. Describing the accelerators’ achievements as “a miracle”, Ursula von der Leyen, President of the European Commission, said that the EU had recently doubled its contribution. Meanwhile, French President Emmanuel Macron said that “now was the time to share”, and announced that his country would donate 500,000 vaccine doses to COVAX by mid-June. He appealed to other countries to donate vaccines to COVAX, saying that he hoped that the goal of EU members donating 5% of their vaccine stocks he set in February would be “exceeded” by the end of the year. However, Macron said the lack of technology transfer, not intellectual property rights, was hampering vaccine rollout. France is one of a handful of wealthy countries opposing the TRIPS waiver. Thomas Cueni, Director General of International Federation of Pharmaceutical Manufacturers (IFPMA), said that a year into the AC-Accelerator “we can say science wins”. “Not one but several highly effective vaccines are being developed at record speed, and now being produced in historic quantities,” said Cueni, committing his industry to accelerating “global access to safe, effective and affordable COVID-19 treatments and vaccines”. French President Emmanuel Macron Jeremy Farrar, Director of Wellcome, said in a press release about the anniversary that “huge strides have been made in the last year” but “science only works if it reaches society”. “The world remains in the grip of a devastating pandemic – and it is not slowing, only escalating. There must be no further delays to getting COVID-19 vaccines, tests and treatments to the most vulnerable groups everywhere,” added Farrar, whose organisation is a partner and significant contributor to the accelerator. “We are in desperate need of strong global leadership. Wealthy countries with access to surplus vaccine doses must start sharing these with the rest of the world now through COVAX, alongside national rollouts. And they should urgently set out a timetable for how these donations will be increased as they vaccinate more of their populations.” Surge of COVID-19 in India is ‘Really, Really Difficult’ Mike Ryan, WHO’s Executive Director of Health Emergencies Programme, said the global body was assisting India to secure oxygen, as well as with technical assistance and clinical management and triaging of patients. “There’s a lot of fear in India right now. We support the Government of India, like we support all governments, in facing this really, really difficult situation. This is not time for recommendations. It is the time for solidarity, the time to move quickly together to reduce deaths and reduce transmission by decreasing mobility and mixing, supporting communities with mask-wearing, maintaining social distance and reducing social gatherings,” said Ryan. Seth Berkley, CEO of the vaccine alliance, Gavi, added that because of India’s domestic need, “the first 10 million vaccine doses from COVAX went to India”. However, Berkeley acknowledged that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. Image Credits: WHO. Global Health Is In Disarray – But Is A Pandemic Treaty The Way Out ? 23/04/2021 Svĕt Lustig Vijay Lines of people wait their turn to receive the AstraZeneca COVID-19 vaccine in Rwanda in early March, after WHO-supported COVAX facility supplies are delivered. Should countries build a new pandemic treaty – or bolster existing mechanisms? Despite rising calls for a pandemic treaty, including from 25 world leaders in an open letter last month, some global health experts doubt that a treaty would be the most efficient way to quickly strengthen the world’s capacity to beat COVID – and prevent future pandemics. “I don’t think we have time to negotiate another treaty on vaccines. I mean, we really are in this emergency,” said Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia, Canada. Lee was one of four panelists featured at a session on “Global Health in Disarray-What Next,” hosted by the Geneva-based Graduate Institute’s Global Health Centre to mark the launch of its newly appointed International Advisory Board (IAB). The wide-ranging session covered a range of issues, from the feasibility of a pandemic treaty, to the challenges of achieving vaccine equity and the lack of progress made in strengthening health systems in low-income countries, despite years of international funding. A Pandemic Treaty Is Not Essential Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia. “Do we need a treaty to move forward? The answer is no,” said Esperanza Martinez, the Head of COVID-19 Crisis Management at the International Committee of the Red Cross (ICRC). “I don’t think that we are short of frameworks and short of treaties… there are already enough mechanisms to act.” According to Lee, legal frameworks such as the World Trade Organization’s TRIPS agreement, and accompanying TRIPS flexibilities create frameworks under which countries can gain access to lifesaving products during health emergencies. And the legally binding International Health Regulations (IHRs), which mandate countries to report on disease outbreaks, and share information with WHO and other member states, is another “useful” framework that should not be forgotten, added Finland’s Director for International Affairs Outi Kuivasniem, another panel member. Rather, the global health community needs to find ways to reform existing frameworks so that they serve us better, panelists suggested. Esperanza Martinez, Head of COVID-19 Crisis Management at the International Committee of the Red Cross In particular, there is a need to reform the IHRs, Kuivasniem said, because countries have not always complied – including by enacting export bans on vital health products or inputs, which have destabilized crucial supply chains, including those relating to vaccines and other essential medicines. Treaty Would Need Strong Member State Alignment At the same time, panelists acknowledged that a pandemic treaty could have some use if it was closely linked to existing legal frameworks like the IHRs and international humanitarian law, and generated greater adherence from countries, as well as support from civil society. “If we have a treaty, we need to have a conversation about what makes sense to have in the treaty so that it has an impact, and that countries are willing to adhere to those promises that are [made] through a treaty,” warned Kuivasniem. Allan Maleche, Executive Director, Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN) Conversely, a “lack of political alignment” between governments and between government and civil society, could frustrate efforts to develop a new pandemic treaty, cautioned Allan Maleche, Executive Director of Kenya’s Legal & Ethical Issues Network on HIV & AIDS (KELIN). And other “political solutions” are also on the table, she and other panelists pointed out, to accelerate pandemic response. Few would actually require a treaty. Those initiatives range from the WHO co-sponsored COVAX global vaccine facility to proposals for an IP waiver under the TRIPS rules of World Trade Organization the COVID-19 Technology Access Pool (C-TAP), and tech transfer initiatives. Despite controversies over some initiatives, such as the IP waiver, none really require a pandemic treaty to be implemented. Should a pandemic treaty be negotiated, civil society should really drive its development, Maleche underlined. “If we are serious about getting our pandemic treaty in place, it’s important for scholars, academics, human rights lawyers, civil society groups, and affected communities to push their governments and [define] what should be that framework,” he said. “A treaty would be important but the more important is respect and implementation of that treaty so that it can have an effect on the lives of people,” he said. Stronger Business Case Needed For Investing In Health Systems in LMICs Healthcare workers treat a patient with drug-resistant TB in Myanmar, using drugs procured by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Beyond the immediate pandemic, however, a stronger business case is needed to convince governments that global health is a long-term investment that makes economic sense, stressed Martinez – particularly in LMICs. “We need to have a business case, an economic case for investment in global health,” she said, pointing out that while the case has recently been made for investment in vaccine access, “there’s a need for making a stronger case for global health in general… as a way of also bridging the conversation gap between government and the private sector.” Meanwhile, Maleche expressed dismay that decades of international funding meant to strengthen healthcare delivery in developing countries such as Kenya had failed to create more sustainable health systems. “Has this money actually been fixing the health systems?” he asked. “Because the time we needed the health system to be fully functional, COVID came and exposed the things that are not working. “COVID also exposed the underbelly of things that many countries don’t normally give priority,” he added. “You’re telling people: wash your hands, put on a mask, social distance, but in certain countries including Kenya and in other low- and middle-income countries, some of those things are luxuries as people have never seen clean running water in taps.” In addition, Maleche added, COVID-19 has highlighted the fact funds are also misspent by governments lacking public transparency and accountability: “Even within a pandemic we still are able to see that resources are not accountably used, we see that governments are not transparent. So again, this comes to show that some of the bad habits that we had when we had a normal sort of situation in the globe are played out in quite an extreme picture, in the context of a pandemic. ” In the humanitarian sector, in particular, financial support for fragile healthcare systems has been particularly scarce, added Martinez. “Very little has been done to strengthen health care systems in LMICs,” she asserted. “We have been speaking for years about the need to strengthen healthcare systems in developing countries and in humanitarian crises, but really when we look, very little has been done. In terms of vaccine access as well, “fundamentally there is a lack of production, science and research and development in the global south, and unless we address that issue, we will not have a sustainable solution to these [vaccine production] needs that we have globally,” she added. “There is a need for investment, but the investment at the level that is required is not coming through.” Regional Initiatives and Grassroots Action As Way Forward Ilona Kickbusch, Founder and Chair of the International Advisory Board, Global Health Centre “There is a feeling in the air [that] we need to reform,” said Ilona Kickbusch, founder of the Global Health Center, and chair of the new International Advisory Board, and moderator of the panel discussion. “Now there’s a number of suggestions on the table, for how global health, both in terms the way we do research and the way the global health regime and organizations are set up, could be changed. “And it’s interesting that right now we’re facing a pressure to some extent from above, top-down, from heads of state and government who are saying, ‘we need a new treaty in global health,’ and as many of you know we only have one so far… “On the other hand, there’s this movement from below that says we need to decolonize global health, we need totally different ideas, approaches, and we need to be much clearer about equity and access, and the social justice agenda.” Among the new ideas, Kickbusch pointed to regional initiatives that are underway, particularly in Africa, to chart a more strategic direction for the continent’s pandemic response. While many countries turned inward during the pandemic, Africa started working together more closely at the regional level, she pointed out. A new African region multi-hazard warning system will seek to link early warning, and responses to natural hazards, pandemics and pests and diseases as well as conflict. That collaboration has stimulated initiatives ranging from AU-based vaccine procurement to the new AU/Africa CDC partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), announced just last week to ramp up vaccine research, development and manufacturing in the region – with funding from Afreximbank and the Africa Finance Corporation. In addition, the African Union and Africa CDC are developing a new COVID-19 Disaster Recovery Framework and multi-hazard warning system for the continent to better link responses to climate, health, and environmental emergencies. “It is one of the encouraging things in global health..that there are these regional initiatives,” Kickbusch said. “Particularly in the African Union, we’ve seen the activities of the African CDC during the pandemic, and seend that a true consensus is building up.” Said Martinez, “This pandemic is precisely an example of how critical it is for us to have this broader view of health… “So we have the pandemic crisis and we also have the climate change crisis. And if we look at the issue we need to think beyond climate change [and] understand that polar bears are drowning in the Arctic, to think about the millions of people that today are facing diseases that were confined to the tropics. “We [need to] link all of those elements to the broader components of human health and health systems. I think that’s when we truly talk about human global Health.” Image Credits: WHO, The Global Fund / John Rae. UK Study Shows Similar, Significant Reductions In COVID-19 Infections With Single Dose Of Oxford-AstraZeneca Or Pfizer-BioNTech Vaccine 23/04/2021 Raisa Santos One dose of either vaccine resulted in 65% reduction of infections. There was greater impact against symptomatic infections (72%) than infections without reported symptoms (57%). 2 doses were even more effective against symptomatic infections (90%, and gave similar level of protection as prior infection. COVID-19 infections fell significantly – by 65% percent – after a first dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccine in a study of more than 373,000 British residents who received one of the two jabs. The first in a series of two new studies, published by the University of Oxford, found that the reduction in new COVID-19 infections was similarly dramatic following either the first dose of the Oxford/AstraZeneca or Pfizer-BioNTech vaccine. “We found very similar, significant reductions in infections [rates] after the first rounds of either [Oxford/AstraZeneca] and [PfizerBioNTech] vaccines,” said Dr Koen Pouwels, senior researcher in Oxford University’s Nuffield Department of Population Health, during the press briefing. The studies, which used data from the COVID-19 Infection Survey, a partnership between the University of Oxford, the UK’s Office of National Statistics (ONS), and the Department for Health and Social Care (DHSC), analyzed 1,610,562 test results from nose and throat swabs taken from 373,402 study participants between 1 December 2020 and 3 April 2021. First Study Focused on Infection Reduction Rates Clockwise, left to right: Dr David Eyre, Dr Sarah Walker, moderator Fiona Lethbridge, Dr Koen Pouwels The first study focused on infection reduction rates following a single shot of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines. Twenty-one days after a single dose of either vaccine, with no second dose, the rates of all new COVID-19 infections had dropped by 65%, symptomatic infections by 74%, and infections without reported symptoms by 57%. One dose of either of the two vaccines also were similarly effective against the B.1.1.7 variant, which was first identified in the UK. Vaccination was just as effective in individuals aged 75 or older with underlying health conditions as it was in those under 75 or without health conditions. Two doses of the Pfizer-BioNTech vaccine, meanwhile, reduced asymptomatic infections by 70% and symptomatic infections by 90%. During the press briefing, Dr Sarah Walker, Professor of Medical Statistics and Epidemiology at the University of Oxford and Chief Investigator and academic lead for the COVID-19 Infection Survey, stated that she was ‘pleasantly surprised’ by these results. “The benefits are greater for people with high viral load and for people with symptoms, both of who have probably got the greatest chance of transmission, was really not necessarily something I was expecting.” However, too few people had yet received two doses of Oxford-AstraZeneca to assess the final degree of protection obtained from that vaccine, the researchers concluded. In the press release, Dr Koen Pouwels said: ‘The protection from new infections gained from a single dose supports the decision to extend the time between first and second doses to 12 weeks to maximise initial vaccination coverage and reduce hospitalisations and deaths.” “However, the fact that we saw smaller reductions in asymptomatic infections than infections with symptoms highlights the potential for vaccinated individuals to get COVID-19 again, and for limited ongoing transmission from vaccinated individuals, even if this is at a lower rate. This emphasises the need for everyone to continue to follow guidelines to reduce transmission risk, for example through social distancing and masks.” Antibody Responses High After Second Pfizer Vaccination Antibody responses after receiving either AstraZeneca or Pfizer COVID-19 vaccines The second study compared how antibody levels changed after a single dose of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines, as compared with two doses of the Pfizer-BioNTech vaccine, generally given 21-42 days apart. Antibody levels were comparatively lower with a single dose of either vaccine, particularly at older ages. But while the size of the immune response differed, there was no group of individuals who didn’t respond at all to either vaccine. There was, however, a small percentage of people – 5% – who had low responses to both vaccines, which makes it essential to monitor responses to a second vaccination. Antibody responses to a single dose of either vaccine also were generally lower in older individuals, especially over 60 years – unless they had had a prior COVID infection. Antibody responses to two doses of the Pfizer-BioNTech vaccine were high across all ages, and particularly increased in older people – reaching levels similar to those who had received a single vaccine dose after a prior infection. David Eyre, Associate Professor at the Big Data Institute at the University of Oxford, said that while the findings still highlighted the importance of people getting a second vaccine dose degrees of protection different by age: “In older individuals, two vaccine doses are as effective as prior natural infection at generating antibodies to the SARS-CoV-2 virus that causes COVID-19. In younger individuals a single dose achieves the same level of response.” Walker also emphasized the importance of vaccinations to control the spread of COVID. “Vaccines are clearly going to be the only way that we are going to have a chance to control this long term. WIthout vaccines, I don’t think getting close to zero [infections] is really feasible,” she said, during the press briefing. The findings come on the heels of recent announcements by Pfizer CEO Albert Bourla that in fact a third booster jab of the vaccine may be necessary “somewhere between six and 12 months.” Risk of Blood Clot from AstraZeneca Vaccine Doubles, UK Still Says ‘Benefits Outweigh Risks’ A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine. Meanwhile, new UK government data suggested that the risk of serious blood clots from AstraZeneca jabs was greater than had previously been reported at national level. The most recent survey found 168 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA). The estimated number of first doses of AstraZeneca COVID-19 vaccines administered in the UK was 21.2 million by 14 April, giving an overall case incidence of 7.9 such events per million doses – or one person in every 125,000. Out of these cases, which occurred in 93 women and 75 men, 32 deaths occurred (19%). Previously, there had been 79 cases and 19 deaths reported in the UK. The UK government’s regulatory agency, however, continues to emphasize that the benefits still outweigh the risks. “On the basis of this ongoing review, the advice remains that the benefits of the vaccine outweigh the risks in the majority of people,” the MHRA said. Image Credits: University of Oxford, Flickr. Africa’s New COVID-19 Disaster Recovery Framework – Aims To Improve Response To Future Pandemics 22/04/2021 Geoffrey Kamadi A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19. The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks. The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch. Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective. Multi-hazard Warning System Will Predict Potential Outbreaks In a related development, the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance, as a result of unusually heavy desert rainfall – creating significant disruptions in food production. The multi-hazard warning system will be instrumental in predicting such potential outbreaks of environment and climate related and health events, critical in mobilizing resources for effective response efforts. A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict. “Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview. The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present. New Initiatives To Complement Existing African Risk Capacity The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters. So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth. He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. One Health Approach – Urgent Action Needed Now The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. “If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch. Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done. The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative. Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. “IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre. Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent. “That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals. WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination 22/04/2021 Madeleine Hoecklin Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria. Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. The forum Reaching Zero: Virtual Forum on Malaria Elimination saw the launch of a new new initiative – E2025 – to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. https://twitter.com/endmalaria/status/1384871850338131972 The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria. Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020. The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event. “These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. Zero Malaria Initiative In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria. Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. “Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. Dr Pedro Alonso, Director of the WHO Global Malaria Programme. The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. Challenges to Reaching Zero Malaria Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality. Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers. E-2025 Initiative The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. “At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. “Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.” Impact of COVID-19 on Malaria Programmes Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued. During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision. “Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. In addition, more children than ever before received seasonal malaria chemoprevention last year. The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. “We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw. “[But] of course we’re not out of the woods yet,” she added. Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey. Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. “Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. The current biggest challenge is keeping the political focus on malaria, said the speakers. “We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. RTS,S Malaria Vaccine is a “Promising Additional Tool” Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti. Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday. The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%. “This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria. “We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.” “And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months. While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said. “For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually. Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti. As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight. “Every year that we let malaria continue to spread, health and development suffer,” Moeti said. Image Credits: WHO, WHO. Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Global Health Is In Disarray – But Is A Pandemic Treaty The Way Out ? 23/04/2021 Svĕt Lustig Vijay Lines of people wait their turn to receive the AstraZeneca COVID-19 vaccine in Rwanda in early March, after WHO-supported COVAX facility supplies are delivered. Should countries build a new pandemic treaty – or bolster existing mechanisms? Despite rising calls for a pandemic treaty, including from 25 world leaders in an open letter last month, some global health experts doubt that a treaty would be the most efficient way to quickly strengthen the world’s capacity to beat COVID – and prevent future pandemics. “I don’t think we have time to negotiate another treaty on vaccines. I mean, we really are in this emergency,” said Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia, Canada. Lee was one of four panelists featured at a session on “Global Health in Disarray-What Next,” hosted by the Geneva-based Graduate Institute’s Global Health Centre to mark the launch of its newly appointed International Advisory Board (IAB). The wide-ranging session covered a range of issues, from the feasibility of a pandemic treaty, to the challenges of achieving vaccine equity and the lack of progress made in strengthening health systems in low-income countries, despite years of international funding. A Pandemic Treaty Is Not Essential Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia. “Do we need a treaty to move forward? The answer is no,” said Esperanza Martinez, the Head of COVID-19 Crisis Management at the International Committee of the Red Cross (ICRC). “I don’t think that we are short of frameworks and short of treaties… there are already enough mechanisms to act.” According to Lee, legal frameworks such as the World Trade Organization’s TRIPS agreement, and accompanying TRIPS flexibilities create frameworks under which countries can gain access to lifesaving products during health emergencies. And the legally binding International Health Regulations (IHRs), which mandate countries to report on disease outbreaks, and share information with WHO and other member states, is another “useful” framework that should not be forgotten, added Finland’s Director for International Affairs Outi Kuivasniem, another panel member. Rather, the global health community needs to find ways to reform existing frameworks so that they serve us better, panelists suggested. Esperanza Martinez, Head of COVID-19 Crisis Management at the International Committee of the Red Cross In particular, there is a need to reform the IHRs, Kuivasniem said, because countries have not always complied – including by enacting export bans on vital health products or inputs, which have destabilized crucial supply chains, including those relating to vaccines and other essential medicines. Treaty Would Need Strong Member State Alignment At the same time, panelists acknowledged that a pandemic treaty could have some use if it was closely linked to existing legal frameworks like the IHRs and international humanitarian law, and generated greater adherence from countries, as well as support from civil society. “If we have a treaty, we need to have a conversation about what makes sense to have in the treaty so that it has an impact, and that countries are willing to adhere to those promises that are [made] through a treaty,” warned Kuivasniem. Allan Maleche, Executive Director, Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN) Conversely, a “lack of political alignment” between governments and between government and civil society, could frustrate efforts to develop a new pandemic treaty, cautioned Allan Maleche, Executive Director of Kenya’s Legal & Ethical Issues Network on HIV & AIDS (KELIN). And other “political solutions” are also on the table, she and other panelists pointed out, to accelerate pandemic response. Few would actually require a treaty. Those initiatives range from the WHO co-sponsored COVAX global vaccine facility to proposals for an IP waiver under the TRIPS rules of World Trade Organization the COVID-19 Technology Access Pool (C-TAP), and tech transfer initiatives. Despite controversies over some initiatives, such as the IP waiver, none really require a pandemic treaty to be implemented. Should a pandemic treaty be negotiated, civil society should really drive its development, Maleche underlined. “If we are serious about getting our pandemic treaty in place, it’s important for scholars, academics, human rights lawyers, civil society groups, and affected communities to push their governments and [define] what should be that framework,” he said. “A treaty would be important but the more important is respect and implementation of that treaty so that it can have an effect on the lives of people,” he said. Stronger Business Case Needed For Investing In Health Systems in LMICs Healthcare workers treat a patient with drug-resistant TB in Myanmar, using drugs procured by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Beyond the immediate pandemic, however, a stronger business case is needed to convince governments that global health is a long-term investment that makes economic sense, stressed Martinez – particularly in LMICs. “We need to have a business case, an economic case for investment in global health,” she said, pointing out that while the case has recently been made for investment in vaccine access, “there’s a need for making a stronger case for global health in general… as a way of also bridging the conversation gap between government and the private sector.” Meanwhile, Maleche expressed dismay that decades of international funding meant to strengthen healthcare delivery in developing countries such as Kenya had failed to create more sustainable health systems. “Has this money actually been fixing the health systems?” he asked. “Because the time we needed the health system to be fully functional, COVID came and exposed the things that are not working. “COVID also exposed the underbelly of things that many countries don’t normally give priority,” he added. “You’re telling people: wash your hands, put on a mask, social distance, but in certain countries including Kenya and in other low- and middle-income countries, some of those things are luxuries as people have never seen clean running water in taps.” In addition, Maleche added, COVID-19 has highlighted the fact funds are also misspent by governments lacking public transparency and accountability: “Even within a pandemic we still are able to see that resources are not accountably used, we see that governments are not transparent. So again, this comes to show that some of the bad habits that we had when we had a normal sort of situation in the globe are played out in quite an extreme picture, in the context of a pandemic. ” In the humanitarian sector, in particular, financial support for fragile healthcare systems has been particularly scarce, added Martinez. “Very little has been done to strengthen health care systems in LMICs,” she asserted. “We have been speaking for years about the need to strengthen healthcare systems in developing countries and in humanitarian crises, but really when we look, very little has been done. In terms of vaccine access as well, “fundamentally there is a lack of production, science and research and development in the global south, and unless we address that issue, we will not have a sustainable solution to these [vaccine production] needs that we have globally,” she added. “There is a need for investment, but the investment at the level that is required is not coming through.” Regional Initiatives and Grassroots Action As Way Forward Ilona Kickbusch, Founder and Chair of the International Advisory Board, Global Health Centre “There is a feeling in the air [that] we need to reform,” said Ilona Kickbusch, founder of the Global Health Center, and chair of the new International Advisory Board, and moderator of the panel discussion. “Now there’s a number of suggestions on the table, for how global health, both in terms the way we do research and the way the global health regime and organizations are set up, could be changed. “And it’s interesting that right now we’re facing a pressure to some extent from above, top-down, from heads of state and government who are saying, ‘we need a new treaty in global health,’ and as many of you know we only have one so far… “On the other hand, there’s this movement from below that says we need to decolonize global health, we need totally different ideas, approaches, and we need to be much clearer about equity and access, and the social justice agenda.” Among the new ideas, Kickbusch pointed to regional initiatives that are underway, particularly in Africa, to chart a more strategic direction for the continent’s pandemic response. While many countries turned inward during the pandemic, Africa started working together more closely at the regional level, she pointed out. A new African region multi-hazard warning system will seek to link early warning, and responses to natural hazards, pandemics and pests and diseases as well as conflict. That collaboration has stimulated initiatives ranging from AU-based vaccine procurement to the new AU/Africa CDC partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), announced just last week to ramp up vaccine research, development and manufacturing in the region – with funding from Afreximbank and the Africa Finance Corporation. In addition, the African Union and Africa CDC are developing a new COVID-19 Disaster Recovery Framework and multi-hazard warning system for the continent to better link responses to climate, health, and environmental emergencies. “It is one of the encouraging things in global health..that there are these regional initiatives,” Kickbusch said. “Particularly in the African Union, we’ve seen the activities of the African CDC during the pandemic, and seend that a true consensus is building up.” Said Martinez, “This pandemic is precisely an example of how critical it is for us to have this broader view of health… “So we have the pandemic crisis and we also have the climate change crisis. And if we look at the issue we need to think beyond climate change [and] understand that polar bears are drowning in the Arctic, to think about the millions of people that today are facing diseases that were confined to the tropics. “We [need to] link all of those elements to the broader components of human health and health systems. I think that’s when we truly talk about human global Health.” Image Credits: WHO, The Global Fund / John Rae. UK Study Shows Similar, Significant Reductions In COVID-19 Infections With Single Dose Of Oxford-AstraZeneca Or Pfizer-BioNTech Vaccine 23/04/2021 Raisa Santos One dose of either vaccine resulted in 65% reduction of infections. There was greater impact against symptomatic infections (72%) than infections without reported symptoms (57%). 2 doses were even more effective against symptomatic infections (90%, and gave similar level of protection as prior infection. COVID-19 infections fell significantly – by 65% percent – after a first dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccine in a study of more than 373,000 British residents who received one of the two jabs. The first in a series of two new studies, published by the University of Oxford, found that the reduction in new COVID-19 infections was similarly dramatic following either the first dose of the Oxford/AstraZeneca or Pfizer-BioNTech vaccine. “We found very similar, significant reductions in infections [rates] after the first rounds of either [Oxford/AstraZeneca] and [PfizerBioNTech] vaccines,” said Dr Koen Pouwels, senior researcher in Oxford University’s Nuffield Department of Population Health, during the press briefing. The studies, which used data from the COVID-19 Infection Survey, a partnership between the University of Oxford, the UK’s Office of National Statistics (ONS), and the Department for Health and Social Care (DHSC), analyzed 1,610,562 test results from nose and throat swabs taken from 373,402 study participants between 1 December 2020 and 3 April 2021. First Study Focused on Infection Reduction Rates Clockwise, left to right: Dr David Eyre, Dr Sarah Walker, moderator Fiona Lethbridge, Dr Koen Pouwels The first study focused on infection reduction rates following a single shot of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines. Twenty-one days after a single dose of either vaccine, with no second dose, the rates of all new COVID-19 infections had dropped by 65%, symptomatic infections by 74%, and infections without reported symptoms by 57%. One dose of either of the two vaccines also were similarly effective against the B.1.1.7 variant, which was first identified in the UK. Vaccination was just as effective in individuals aged 75 or older with underlying health conditions as it was in those under 75 or without health conditions. Two doses of the Pfizer-BioNTech vaccine, meanwhile, reduced asymptomatic infections by 70% and symptomatic infections by 90%. During the press briefing, Dr Sarah Walker, Professor of Medical Statistics and Epidemiology at the University of Oxford and Chief Investigator and academic lead for the COVID-19 Infection Survey, stated that she was ‘pleasantly surprised’ by these results. “The benefits are greater for people with high viral load and for people with symptoms, both of who have probably got the greatest chance of transmission, was really not necessarily something I was expecting.” However, too few people had yet received two doses of Oxford-AstraZeneca to assess the final degree of protection obtained from that vaccine, the researchers concluded. In the press release, Dr Koen Pouwels said: ‘The protection from new infections gained from a single dose supports the decision to extend the time between first and second doses to 12 weeks to maximise initial vaccination coverage and reduce hospitalisations and deaths.” “However, the fact that we saw smaller reductions in asymptomatic infections than infections with symptoms highlights the potential for vaccinated individuals to get COVID-19 again, and for limited ongoing transmission from vaccinated individuals, even if this is at a lower rate. This emphasises the need for everyone to continue to follow guidelines to reduce transmission risk, for example through social distancing and masks.” Antibody Responses High After Second Pfizer Vaccination Antibody responses after receiving either AstraZeneca or Pfizer COVID-19 vaccines The second study compared how antibody levels changed after a single dose of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines, as compared with two doses of the Pfizer-BioNTech vaccine, generally given 21-42 days apart. Antibody levels were comparatively lower with a single dose of either vaccine, particularly at older ages. But while the size of the immune response differed, there was no group of individuals who didn’t respond at all to either vaccine. There was, however, a small percentage of people – 5% – who had low responses to both vaccines, which makes it essential to monitor responses to a second vaccination. Antibody responses to a single dose of either vaccine also were generally lower in older individuals, especially over 60 years – unless they had had a prior COVID infection. Antibody responses to two doses of the Pfizer-BioNTech vaccine were high across all ages, and particularly increased in older people – reaching levels similar to those who had received a single vaccine dose after a prior infection. David Eyre, Associate Professor at the Big Data Institute at the University of Oxford, said that while the findings still highlighted the importance of people getting a second vaccine dose degrees of protection different by age: “In older individuals, two vaccine doses are as effective as prior natural infection at generating antibodies to the SARS-CoV-2 virus that causes COVID-19. In younger individuals a single dose achieves the same level of response.” Walker also emphasized the importance of vaccinations to control the spread of COVID. “Vaccines are clearly going to be the only way that we are going to have a chance to control this long term. WIthout vaccines, I don’t think getting close to zero [infections] is really feasible,” she said, during the press briefing. The findings come on the heels of recent announcements by Pfizer CEO Albert Bourla that in fact a third booster jab of the vaccine may be necessary “somewhere between six and 12 months.” Risk of Blood Clot from AstraZeneca Vaccine Doubles, UK Still Says ‘Benefits Outweigh Risks’ A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine. Meanwhile, new UK government data suggested that the risk of serious blood clots from AstraZeneca jabs was greater than had previously been reported at national level. The most recent survey found 168 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA). The estimated number of first doses of AstraZeneca COVID-19 vaccines administered in the UK was 21.2 million by 14 April, giving an overall case incidence of 7.9 such events per million doses – or one person in every 125,000. Out of these cases, which occurred in 93 women and 75 men, 32 deaths occurred (19%). Previously, there had been 79 cases and 19 deaths reported in the UK. The UK government’s regulatory agency, however, continues to emphasize that the benefits still outweigh the risks. “On the basis of this ongoing review, the advice remains that the benefits of the vaccine outweigh the risks in the majority of people,” the MHRA said. Image Credits: University of Oxford, Flickr. Africa’s New COVID-19 Disaster Recovery Framework – Aims To Improve Response To Future Pandemics 22/04/2021 Geoffrey Kamadi A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19. The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks. The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch. Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective. Multi-hazard Warning System Will Predict Potential Outbreaks In a related development, the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance, as a result of unusually heavy desert rainfall – creating significant disruptions in food production. The multi-hazard warning system will be instrumental in predicting such potential outbreaks of environment and climate related and health events, critical in mobilizing resources for effective response efforts. A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict. “Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview. The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present. New Initiatives To Complement Existing African Risk Capacity The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters. So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth. He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. One Health Approach – Urgent Action Needed Now The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. “If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch. Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done. The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative. Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. “IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre. Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent. “That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals. WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination 22/04/2021 Madeleine Hoecklin Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria. Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. The forum Reaching Zero: Virtual Forum on Malaria Elimination saw the launch of a new new initiative – E2025 – to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. https://twitter.com/endmalaria/status/1384871850338131972 The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria. Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020. The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event. “These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. Zero Malaria Initiative In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria. Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. “Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. Dr Pedro Alonso, Director of the WHO Global Malaria Programme. The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. Challenges to Reaching Zero Malaria Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality. Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers. E-2025 Initiative The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. “At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. “Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.” Impact of COVID-19 on Malaria Programmes Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued. During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision. “Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. In addition, more children than ever before received seasonal malaria chemoprevention last year. The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. “We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw. “[But] of course we’re not out of the woods yet,” she added. Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey. Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. “Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. The current biggest challenge is keeping the political focus on malaria, said the speakers. “We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. RTS,S Malaria Vaccine is a “Promising Additional Tool” Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti. Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday. The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%. “This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria. “We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.” “And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months. While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said. “For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually. Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti. As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight. “Every year that we let malaria continue to spread, health and development suffer,” Moeti said. Image Credits: WHO, WHO. Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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UK Study Shows Similar, Significant Reductions In COVID-19 Infections With Single Dose Of Oxford-AstraZeneca Or Pfizer-BioNTech Vaccine 23/04/2021 Raisa Santos One dose of either vaccine resulted in 65% reduction of infections. There was greater impact against symptomatic infections (72%) than infections without reported symptoms (57%). 2 doses were even more effective against symptomatic infections (90%, and gave similar level of protection as prior infection. COVID-19 infections fell significantly – by 65% percent – after a first dose of either the Oxford-AstraZeneca or the Pfizer-BioNTech vaccine in a study of more than 373,000 British residents who received one of the two jabs. The first in a series of two new studies, published by the University of Oxford, found that the reduction in new COVID-19 infections was similarly dramatic following either the first dose of the Oxford/AstraZeneca or Pfizer-BioNTech vaccine. “We found very similar, significant reductions in infections [rates] after the first rounds of either [Oxford/AstraZeneca] and [PfizerBioNTech] vaccines,” said Dr Koen Pouwels, senior researcher in Oxford University’s Nuffield Department of Population Health, during the press briefing. The studies, which used data from the COVID-19 Infection Survey, a partnership between the University of Oxford, the UK’s Office of National Statistics (ONS), and the Department for Health and Social Care (DHSC), analyzed 1,610,562 test results from nose and throat swabs taken from 373,402 study participants between 1 December 2020 and 3 April 2021. First Study Focused on Infection Reduction Rates Clockwise, left to right: Dr David Eyre, Dr Sarah Walker, moderator Fiona Lethbridge, Dr Koen Pouwels The first study focused on infection reduction rates following a single shot of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines. Twenty-one days after a single dose of either vaccine, with no second dose, the rates of all new COVID-19 infections had dropped by 65%, symptomatic infections by 74%, and infections without reported symptoms by 57%. One dose of either of the two vaccines also were similarly effective against the B.1.1.7 variant, which was first identified in the UK. Vaccination was just as effective in individuals aged 75 or older with underlying health conditions as it was in those under 75 or without health conditions. Two doses of the Pfizer-BioNTech vaccine, meanwhile, reduced asymptomatic infections by 70% and symptomatic infections by 90%. During the press briefing, Dr Sarah Walker, Professor of Medical Statistics and Epidemiology at the University of Oxford and Chief Investigator and academic lead for the COVID-19 Infection Survey, stated that she was ‘pleasantly surprised’ by these results. “The benefits are greater for people with high viral load and for people with symptoms, both of who have probably got the greatest chance of transmission, was really not necessarily something I was expecting.” However, too few people had yet received two doses of Oxford-AstraZeneca to assess the final degree of protection obtained from that vaccine, the researchers concluded. In the press release, Dr Koen Pouwels said: ‘The protection from new infections gained from a single dose supports the decision to extend the time between first and second doses to 12 weeks to maximise initial vaccination coverage and reduce hospitalisations and deaths.” “However, the fact that we saw smaller reductions in asymptomatic infections than infections with symptoms highlights the potential for vaccinated individuals to get COVID-19 again, and for limited ongoing transmission from vaccinated individuals, even if this is at a lower rate. This emphasises the need for everyone to continue to follow guidelines to reduce transmission risk, for example through social distancing and masks.” Antibody Responses High After Second Pfizer Vaccination Antibody responses after receiving either AstraZeneca or Pfizer COVID-19 vaccines The second study compared how antibody levels changed after a single dose of either Oxford/AstraZeneca or Pfizer-BioNTech vaccines, as compared with two doses of the Pfizer-BioNTech vaccine, generally given 21-42 days apart. Antibody levels were comparatively lower with a single dose of either vaccine, particularly at older ages. But while the size of the immune response differed, there was no group of individuals who didn’t respond at all to either vaccine. There was, however, a small percentage of people – 5% – who had low responses to both vaccines, which makes it essential to monitor responses to a second vaccination. Antibody responses to a single dose of either vaccine also were generally lower in older individuals, especially over 60 years – unless they had had a prior COVID infection. Antibody responses to two doses of the Pfizer-BioNTech vaccine were high across all ages, and particularly increased in older people – reaching levels similar to those who had received a single vaccine dose after a prior infection. David Eyre, Associate Professor at the Big Data Institute at the University of Oxford, said that while the findings still highlighted the importance of people getting a second vaccine dose degrees of protection different by age: “In older individuals, two vaccine doses are as effective as prior natural infection at generating antibodies to the SARS-CoV-2 virus that causes COVID-19. In younger individuals a single dose achieves the same level of response.” Walker also emphasized the importance of vaccinations to control the spread of COVID. “Vaccines are clearly going to be the only way that we are going to have a chance to control this long term. WIthout vaccines, I don’t think getting close to zero [infections] is really feasible,” she said, during the press briefing. The findings come on the heels of recent announcements by Pfizer CEO Albert Bourla that in fact a third booster jab of the vaccine may be necessary “somewhere between six and 12 months.” Risk of Blood Clot from AstraZeneca Vaccine Doubles, UK Still Says ‘Benefits Outweigh Risks’ A package of 10 multidose vials of the Oxford/AstraZeneca COVID-19 vaccine. Meanwhile, new UK government data suggested that the risk of serious blood clots from AstraZeneca jabs was greater than had previously been reported at national level. The most recent survey found 168 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) were reported to the Medicines and Healthcare products Regulatory Agency (MHRA). The estimated number of first doses of AstraZeneca COVID-19 vaccines administered in the UK was 21.2 million by 14 April, giving an overall case incidence of 7.9 such events per million doses – or one person in every 125,000. Out of these cases, which occurred in 93 women and 75 men, 32 deaths occurred (19%). Previously, there had been 79 cases and 19 deaths reported in the UK. The UK government’s regulatory agency, however, continues to emphasize that the benefits still outweigh the risks. “On the basis of this ongoing review, the advice remains that the benefits of the vaccine outweigh the risks in the majority of people,” the MHRA said. Image Credits: University of Oxford, Flickr. Africa’s New COVID-19 Disaster Recovery Framework – Aims To Improve Response To Future Pandemics 22/04/2021 Geoffrey Kamadi A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19. The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks. The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch. Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective. Multi-hazard Warning System Will Predict Potential Outbreaks In a related development, the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance, as a result of unusually heavy desert rainfall – creating significant disruptions in food production. The multi-hazard warning system will be instrumental in predicting such potential outbreaks of environment and climate related and health events, critical in mobilizing resources for effective response efforts. A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict. “Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview. The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present. New Initiatives To Complement Existing African Risk Capacity The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters. So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth. He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. One Health Approach – Urgent Action Needed Now The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. “If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch. Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done. The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative. Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. “IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre. Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent. “That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals. WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination 22/04/2021 Madeleine Hoecklin Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria. Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. The forum Reaching Zero: Virtual Forum on Malaria Elimination saw the launch of a new new initiative – E2025 – to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. https://twitter.com/endmalaria/status/1384871850338131972 The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria. Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020. The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event. “These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. Zero Malaria Initiative In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria. Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. “Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. Dr Pedro Alonso, Director of the WHO Global Malaria Programme. The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. Challenges to Reaching Zero Malaria Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality. Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers. E-2025 Initiative The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. “At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. “Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.” Impact of COVID-19 on Malaria Programmes Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued. During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision. “Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. In addition, more children than ever before received seasonal malaria chemoprevention last year. The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. “We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw. “[But] of course we’re not out of the woods yet,” she added. Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey. Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. “Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. The current biggest challenge is keeping the political focus on malaria, said the speakers. “We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. RTS,S Malaria Vaccine is a “Promising Additional Tool” Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti. Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday. The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%. “This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria. “We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.” “And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months. While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said. “For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually. Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti. As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight. “Every year that we let malaria continue to spread, health and development suffer,” Moeti said. Image Credits: WHO, WHO. Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Africa’s New COVID-19 Disaster Recovery Framework – Aims To Improve Response To Future Pandemics 22/04/2021 Geoffrey Kamadi A quiet street Cape Town, in South Africa, during one of the hard lockdown periods in 2020 to help curb the spread of COVID-19. The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks. The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch. Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective. Multi-hazard Warning System Will Predict Potential Outbreaks In a related development, the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict. Large parts of eastern Africa as well as the horn of Africa were plagued over the past year by swarms of locusts, for instance, as a result of unusually heavy desert rainfall – creating significant disruptions in food production. The multi-hazard warning system will be instrumental in predicting such potential outbreaks of environment and climate related and health events, critical in mobilizing resources for effective response efforts. A new multi-hazard warning system will seek to show a clear linkage between natural hazards, pandemics and pests and diseases as well as conflict. “Operationalization of the system is expected by December this year, upon meeting a number of milestones,” Gatkuoth told Health Policy Watch in the interview. The milestones include conducting a study on existing early warning systems to assess good practices, as well as what to expect in terms of challenges and opportunities such a system may present. New Initiatives To Complement Existing African Risk Capacity The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union, set up to help African governments improve their capacities to better plan, prepare and respond to extreme weather events and natural disasters. So far, 11 countries have contributed more than $50 million to the ARC over the last nine years. However, with the anticipated multi-hazard system becoming operational soon, “countries are expected to increase domestic financing,” says Gatkuoth. He said the new programme is expected to cost more than $50 million over the next five years – and will need the support of a new financial mechanism, such as a multi-hazard disaster risk management fund, said Gatkuoth. One Health Approach – Urgent Action Needed Now The links between environmental and climate change and the spread of disease is becoming ever more important in addressing health concerns around the world, other experts emphasize, in arguing for the new systems’ urgency. “If we do not do anything now, we will see more intense and frequent extreme events that will impact on more vulnerable people,” Dr. Ben Adinoyi, the Coordinator Health Care at the International Federation of Red Cross and Red Crescent Societies (IFRC) told Health Policy Watch. Dr. Adinoyi points to The Cost of Doing Nothing – a 2019 report by the IFRC – which showed that the number of people needing humanitarian assistance every year as a result of climate-related disasters could rise from 108 million to beyond 200 million by 2050, if nothing is done. The IFRC’s Community Epidemic and Pandemic Preparedness Program (CP3), is also working closely with both the ministries of health and ministries of agriculture in Africa to incorporate a One Health approach into the CP3 initiative. Such approaches aim to improve the human-animal environment interface, so as to reduce the spread of what are fundamentally zoonotic diseases from wilderness areas and wild animal populations into human communities. Most major disease outbreaks in Africa over the past few decades, originated including Ebola and HIV, emerged from wild animal sources. Similarly, the SARS-CoV2 virus is believed to have originated in bats, which may have infected wild mammals such as pangolins, widely consumed in Asia for food. “IFRC has also formed a climate and health working group which brings together experts from various disciplines including climate scientists and health practitioners,” adds Eddie Jjemba, the Urban Resilience Advisor at the Red Cross Red Crescent Climate Centre. Adinoyi said the effects of pandemics in general, but COVID-19 in particular, cuts across all facets of human existence, therefore making the need for multisectoral collaboration and coordination even more urgent. “That is why the IFRC coordinates and collaborates closely with regional economic communities,” he says, adding that the humanitarian organization also works with the African Union, the Africa CDC and the WHO to ensure alignment of priorities to global, regional and national commitments and goals. WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination 22/04/2021 Madeleine Hoecklin Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria. Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. The forum Reaching Zero: Virtual Forum on Malaria Elimination saw the launch of a new new initiative – E2025 – to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. https://twitter.com/endmalaria/status/1384871850338131972 The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria. Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020. The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event. “These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. Zero Malaria Initiative In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria. Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. “Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. Dr Pedro Alonso, Director of the WHO Global Malaria Programme. The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. Challenges to Reaching Zero Malaria Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality. Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers. E-2025 Initiative The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. “At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. “Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.” Impact of COVID-19 on Malaria Programmes Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued. During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision. “Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. In addition, more children than ever before received seasonal malaria chemoprevention last year. The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. “We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw. “[But] of course we’re not out of the woods yet,” she added. Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey. Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. “Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. The current biggest challenge is keeping the political focus on malaria, said the speakers. “We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. RTS,S Malaria Vaccine is a “Promising Additional Tool” Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti. Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday. The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%. “This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria. “We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.” “And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months. While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said. “For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually. Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti. As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight. “Every year that we let malaria continue to spread, health and development suffer,” Moeti said. Image Credits: WHO, WHO. Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination 22/04/2021 Madeleine Hoecklin Children under the age of 5 years in sub-Saharan Africa continued to account for approximately two thirds of global deaths from malaria. Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. The forum Reaching Zero: Virtual Forum on Malaria Elimination saw the launch of a new new initiative – E2025 – to halt transmission of the disease in 25 countries by 2025 co-sponsored by the RBM Partnership to End Malaria. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one-third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. https://twitter.com/endmalaria/status/1384871850338131972 The preventable and treatable disease kills over 400,000 people every year across 87 countries. The WHO African Region accounts for 94% of all malaria cases and deaths worldwide, with deaths in children under the age of five in sub-Saharan Africa constituting the majority of global deaths from malaria. Although progress towards critical targets of the global malaria strategy has plateaued, particularly in high burden countries, 24 countries have reported zero indigenous malaria cases for three or more years between 2000 and 2020. The number of countries with less than 1,000 malaria cases has more than doubled since 2000, from 14 to 34 and more countries than ever before are within reach of zero malaria, said the panelists at the event. “These countries have shown that malaria elimination is a viable goal for all countries, no matter how far they may be from the ultimate target,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the forum. Zero Malaria Initiative In 2017, WHO launched the E-2020 initiative to support a group of countries to achieve zero indigenous cases of malaria by 2020. Some 21 countries across five regions were identified as having the potential to reach the milestone of eliminating malaria. Of the 21 countries, eight reported zero cases of malaria, as of April 2021. The countries included, Algeria, Belize, Cabo Verde, China, El Salvador, Iran, Malaysia, and Paraguay. In February 2021, El Salvador became the first Central American country to achieve the milestone of being classified as malaria-free. The number of cases fell from more than 9,000 in 1990 to less than 30 in 2010. The long term commitment to malaria elimination involved establishing a large network of vector control personnel, labs, and over 3,000 community health workers responsible for case detection. Cabo Verde previously experienced severe malaria epidemics and came close to eliminating the disease twice before successfully achieving three consecutive years of zero indigenous cases in January 2021. The government established a five year national strategic malaria plan in 2009 and invested in the expansion of diagnostic and early treatment services, which were provided for free, along with capacity building for investigating detected cases. “Success is driven by political commitment, which is translated into sustained funding, it is driven by a health system that leaves no one behind, that ensures good diagnosis and treatment…without financial hardship,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. Dr Pedro Alonso, Director of the WHO Global Malaria Programme. The key elements shared by countries that have eliminated malaria also include robust health information systems and surveillance systems to track cases and cross-border collaboration to prevent the disease from being transmitted across international borders, according to the new WHO report on the E-2020 initiative. A number of other countries also made progress towards zero malaria transmission, with Timor-Leste reporting only 1 indigenous case, and three countries recording fewer than 100 cases. In addition, six countries in Southeast Asia have advanced towards the target of elimination by 2030, with a 97% fall in the reported number of cases between 2000 and 2020. Challenges to Reaching Zero Malaria Several persistent issues challenge efforts to eliminate malaria, outlined the new WHO report on the E-2020 initiative. Drug and insecticide resistance, along with imported cases of malaria threaten to undermine the goal of becoming malaria-free. Resistance to antimalarial drugs is driven by counterfeit or substandard treatments and the unregulated administration of the drugs. Drug resistance poses a serious threat to the effective control of malaria and it increases morbidity and mortality. Insecticide-based vector control is a cornerstone of the global fight against malaria, however, insecticide resistance is widespread in all major malaria vectors in high burden countries, according to a WHO report. Resistance to at least one of the four insecticide classes was detected in 73 of the 81 malaria endemic countries, as of 2018. In addition, numerous countries have struggled with reducing imported cases of malaria, which threatens the ability of countries to prevent onward transmission and maintain zero indigenous cases. This is particularly a challenge for countries surrounded by other endemic countries with porous borders. For example, in recent years, more than 80% of cases detected in Iran have been imported, largely linked to the frequent cross-border movement of migrant workers. E-2025 Initiative The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria. “At least a further 25 countries that still have malaria transmission today could potentially interrupt transmission in the next five years. That would be a massive global public health achievement,” said Alonso. The set of countries includes all E-2020 member countries that did not yet receive malaria-free certification, along with eight new countries: Guatemala, Honduras, Dominican Republic, Panama, Sao Tome and Principe, Vanuatu, Thailand, and the Democratic People’s Republic of Korea. The new countries were selected based on four criteria: the establishment of a government-endorsed elimination plan; meeting the threshold of malaria case reductions in recent years; having the capacity of malaria surveillance and a designated governmental agency responsible for malaria elimination; and being selected by the WHO Malaria Elimination Oversight Committee. The E-2025 countries will receive technical and on-the-ground support by WHO and its partners. In return, they are expected to audit their elimination programmes annually, participate in elimination forums, conduct surveillance assessments, and share malaria case data periodically. “Malaria…is a very unforgiving disease. You’re either winning or you’re losing,” said Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. “In these countries where we have already made such progress towards elimination, if we take the foot off the accelerator now, we will go backwards. So we must continue to drive towards elimination.” Impact of COVID-19 on Malaria Programmes Despite COVID-19, many indoor insecticide spraying campaigns and campaigns to deliver insecticide-treated mosquito nets and antimalarial medicines were delayed but continued. During the COVID-19 pandemic, human and financial resources were diverted from national malaria programmes to tackle COVID-19. This, along with nationwide lockdowns, delayed the delivery of malaria preventative measures and the provision of treatment services. However, the impact of COVID-19 on malaria cases in 2020 didn’t reach the worst case scenario in WHO predictions conducted early on in the pandemic. The modelling predicted that there could be a doubling in malaria cases due to interruptions in mosquito net campaigns and treatment provision. “Most of the mosquito net campaigns took place as planned, or with some slight delay, so over 160 million mosquito nets were distributed despite COVID,” said Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. In addition, more children than ever before received seasonal malaria chemoprevention last year. The high level advocacy from WHO, strong leadership from governments, the prioritization of malaria, and support from partners ensured that the disruptions were as minimal as possible, said speakers at a press briefing following the forum. “We believe we avoided that worst catastrophe of a doubling of cases but we certainly will see…when the data are finalised, that there were increases in malaria deaths as a result of the COVID pandemic, largely due to service disruptions…in case management,” said Renshaw. “[But] of course we’re not out of the woods yet,” she added. Dr Melanie Renshaw, Co-chair of the Country and Regional Support Committee of the RBM Partnership to End Malaria. More than a year into the pandemic and interruptions in programmes persist. Approximately one third of malaria programmes reported serious disruptions in prevention, diagnosis, and treatment services in the first three months of 2021, according to a recent Global Fund survey. Increasingly, community health workers will be needed for COVID-19 vaccination programmes, potentially at the expense of timely diagnosis and treatment of malaria. This could drive up mortality. “Our community health workers are the absolute fulcrum of everything that happens with malaria, they’re the ones that diagnose, they’re the ones that treat, they’re the ones that mobilise the community, and understand what is really going on,” said Sands. The current biggest challenge is keeping the political focus on malaria, said the speakers. “We need to continue to keep very high on the agenda the importance of sustaining malaria and COVID Prevention at the same time,” said Renshaw. RTS,S Malaria Vaccine is a “Promising Additional Tool” Meanwhile, the world’s first malaria vaccine, administered to some 650,000 children in Ghana, Kenya, and Malawi, has demonstrated comparatively high efficacy rates in reducing malaria in large scale late stage clinical trials, including life-threatening malaria in young children, hospital admissions, and the need for blood transfusions, said Moeti. Dr Matshidiso Moeti, WHO Regional Director of Africa, at the “Reaching Zero: Virtual Forum on Malaria Elimination” on Wednesday. The four dose vaccine reduced malaria by 39% in children aged 5-17 months, which is equivalent to preventing 4 in 10 malaria cases and it reduced severe malaria by 31.5%. “This vaccine may be key to making malaria prevention more equitable, and to saving more lives,” said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals, in a press release published on Tuesday. Global advisory bodies are expected to convene on 6 October to review RTS,S data and evidence from the pilot programme to determine whether to recommend broader use of the vaccine. Clinical trials have shown that the malaria vaccine, RTS,S/AS01, reduces malaria significantly, including life-threatening severe malaria. “We feel very reassured by what we are seeing up to now,” said Alonso. “It is not a perfect vaccine, but it is one that can prevent a significant number of cases and a significant number of deaths.” “And if such a recommendation takes place, it would be a truly historical moment. The world has been looking for a malaria vaccine for 100 years,” Alonso added. In over 30 years, less than one billion dollars were invested to develop a malaria vaccine. In comparison, approximately US$40 billion was used to fund COVID-19 vaccines in a year, resulting in four licensed vaccines within 10 months. While a malaria vaccine is biologically “infinitely more complex than a COVID-19 vaccine,” the difference in the scale of effort and investment is huge, Alonso said. “For a large part of the world, and particularly sub-Saharan Africa, malaria – which they’ve had to live with for the last 10,000 years – is like COVID-19 to the rest of us, every year,” said Alonso. The RTS,S vaccine is the first vaccine developed to address a disease that impacts over 40% of the world’s population that live in malaria endemic countries and kills more than 400,000 people annually. Malaria is often referred to as a poverty related disease, with marginalized communities, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as migrants at a higher risk of contracting it. The prioritization of malaria on the political agenda should also be accompanied by investments in innovation to improve equity in health systems, said speakers at the press briefing on Wednesday. Malaria Vaccines “Critical” to Speed Up Progress Towards Zero Malaria Due to the recent plateau in progress towards global and regional malaria targets, “new tools are urgently needed – and malaria vaccines must be a critical component of the overall toolkit,” said Alonso. While new cases in the African region dropped by over 9% every five years between 2000 and 2015, in the last five years this progress has stalled, according to Moeti. As of 2019, one in three households in the region didn’t have an insecticide treated bed net and nearly half of children under five didn’t sleep under a net. Two thirds of pregnant women didn’t receive malaria preventive treatment, as a result, 11 million pregnant women contracted malaria and 820,000 newborns had a low birth weight. “Every year that we let malaria continue to spread, health and development suffer,” Moeti said. Image Credits: WHO, WHO. Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Pakistan Quietly Suspends Vaccination Of Healthcare Workers – Then Abruptly Resumes Following Media Queries 21/04/2021 Rahul Basharat Rajput & Muhammed Nadeem Chaudhry Vaccination of Pakistani health workers was quietly suspended for more than a month, but resumed on Wednesday after a Health Policy Watch media enquiry. Islamabad, Pakistan: Even as Pakistan faced an intense third wave of COVID-19, health authorities ‘silently’ suspended vaccination registration for its frontline Healthcare Workers (HCWs) for more than a month – ostensibly because of low registration and concerns about fake registrations. But following queries by Health Policy Watch on Monday, Ministry of Health officials suddenly did an about-face, announcing Wednesday that vaccinations of healthcare workers would resume again right away – with additional checks to ensure that those getting the jabs are bonafide health workers. Following Health Policy Watch queries to the Special Assistant to the Prime Minister (SAPM) on NHS, Dr. Faisal Sultan took to Twitter to announce that the vaccination registration of health workers had been reopened – but only until April 30. To give opportunity to all remaining healthcare workers to get vaccinated, registration portal (https://t.co/aI3eDzlNUo) has been re-opened till 30 April. Visit portal and register by following instructions. — Faisal Sultan (@fslsltn) April 21, 2021 “To give opportunity to all remaining healthcare workers to get vaccinated, the registration portal (http://Covid.gov.pk/vaccine) has been re-opened till 30 April. Visit portal and register by following instructions”, he said. A check of the portal, however, indicated only that health care workers would be contacted by SMS. Pakistani government has not provided information about the COVID-19 vaccination of healthcare workers on its website. Pakistan Medical Association Protests As news of the de-facto suspension of registration first began circulating this week, doctors rights groups were fuming, saying that healthcare workers’ lives are being put at risk, and one senior medical expert going so far as to call it a “crime” – in an interview with Health Policy Watch. The Pakistan Medical Association (PMA) wrote to the country’s National Command and Operations Center (NCOC) head, Minister Asad Umer, calling upon him to immediately resume the registration of healthcare workers’ for vaccines – along with older people and those with pre-conditions who continue to sign up for the free jabs. Pakistan has already been struggling to combat vaccine hesitancy in immunising frontline healthcare workers with the China donated COVID-19 vaccine SinoPharm. Official data obtained by Health Policy Watch shows that about 57 % of the country’s health workforce, or some 367,000 people out of a total of 640,000, have been vaccinated so far in the vaccine drive that began in early February of this year. The number of new COVID-19 cases in Pakistan has surged to the highest point ever, with some 5,499 new cases being reported in the past 24 hour and nearly 4500 people in critical condition. More than 100 deaths were being reported daily, leading to 1,527 deaths since 5 April. Prioritise the Vaccination of HCWs In a letter addressed to Umar, obtained by Health Policy Watch, the PMA Secretary General Dr Qaiser Sajjad, pleaded with the National Command Operations Center (NCOC), a body formed to handle the pandemic in the country, to prioritise the vaccination of health workers. In the letter, Sajjad said that even the page for priority registration for doctors had been removed from the government’s COVID-19 website. This suspension, he said, is “very distressing” for the medical fraternity, adding that according to the PMA’s records, 193 doctors and 30 paramedics have so far died while performing their duties during the pandemic. “It is dropping down their moral(e). They are very much disturbed and feel discouraged,” Sajjad wrote. “We (PMA) request you to immediately restore the priority registration of healthcare workers for vaccination to protect them from the deadly virus, so that they can serve the nation with courage and peace of mind,” Sajjad pleaded. According to the official records of the NCOC, 151 COVID-related deaths have been reported amongst health workers, including doctors, nurses and paramedics, since the start of the pandemic. That is among the estimated 15,611 health workers who have become ill with COVID-19, including 566 active cases. Slow Vaccination Rate Possibly Linked to Uncertainty About Efficacy & Supplies In an interview with Health Policy Watch, Sajjad said that he believes the Pakistani government’s pace of vaccination was “very slow” – partly because of uncertainty about supplies and also the efficacy of the Chinese-donated vaccine. Regardless, he said that health care workers should be prioritized. “Maybe the government does not have sufficient quantities of the vaccine available, but stopping frontline HCWs registration is a crime,” he said, adding that health workers below the age of 50 and working in pandemic wards are not being registered. Of the 367,322 health care workers vaccinated so far, 246, 495 have received both jabs but only 120,827 have received the first dose of the vaccine, according to the data obtained by Health Policy Watch. Registration of Pakistan’s frontline health workers started on 2 February, soon after Pakistan received the first 500,000 donated Sinopharm vaccines, out of a promised 1 million dose donation. Punjab, the country’s most populous province has so far vaccinated 156,158 health workers, 56%, while Sindh Province has vaccinated 118,149 (54%), and the national capital, Islamabad Capital Territory (ICT) 12,446, only 49%. That is in comparison to higher proportions elsewhere including in: Khyber Pakthunkhwa (KPK) 47,924 (70%); Azad Jammu & Kashmir (AJ&K) 11,440 (69%); Gilgit Baltistan (GB) 5,082 (68%); and Baluchistan 16,133 (63%). Parliamentary Secretary for the Ministry of National Health Services Regulations & Coordination (NHSR&C) Nausheen Hamid said that the vaccination registration of the health workers slowed after the vaccination of the people over the age of 50 in the general public began. She contended that health worker registration remained open, but turnout has been very low. “Health workers were hesitant to get the vaccine,” said Hamid, adding that the government had invited them to get vaccinated, but many had adopted a ‘wait and see policy’. However, others contested that. In an interview with Health Policy Watch, Dr. Murad Ali, of the Pakistan Institute of Medical Sciences (PIMS) said that he had tried to register himself for vaccination on the government website two weeks ago, but he was unable to do so. “The virus is getting scary in hospitals,” he said, adding that those who wanted to get vaccinated should be facilitated. The World Health Organization’s (WHO) Pakistan office was contacted for comments through its communication officer, Mariyam Yunus, however the country office didn’t respond despite repeated reminders. Posts navigation Older postsNewer posts