MOMBASA, KENYA – Africa’s ports are vulnerable to crime and corruption. Now they’re set to be the main thoroughfare for COVID vaccines entering the continent. Here’s why we need a better strategy to curb potential counterfeits coming through.

Black-green tears of moss streak the facades of once-white buildings. The city is a maze of narrow streets, some cobbled with sea-stones, calcified by the centuries that have passed since they were laid. 

The air, always humid, is aromatic with sweet spices and fish, salt-washed from the nearby sea; the cacophony of the many markets and the muezzins’ call to prayer add to an atmosphere already heavy on the senses.   

There is rhythm here, in the cauldron of the Old Town, but it is offbeat – chaotic even.

port
Mombasa, Kenya

This is Mombasa — Africa’s fifth-busiest harbour, according to a report by financial advisory firm Okan and the Africa CEO Forum. Kenya’s chief port, it handles cargo for the whole of East Africa and parts of Central Africa. 

Because of its strategic position, Mombasa has been a place of conflict since at least the 1300s: Arabs, Persians, Portuguese and Turks have all fought wars over it. 

It’s also long been a haven for assorted miscreants. 

In the 1960s it was a favourite haunt of infamous soldier of fortune “Mad” Mike Hoare and his “Wild Geese” mercenaries. More recently, Mombasa sheltered one of the world’s most wanted terrorism suspects, Samantha Lewthwaite. The “White Widow” and alleged Al-Shabaab member, is wanted on charges related to several terror attacks in East Africa and has been implicated in the deaths of hundreds of people.

The city today retains its reputation as an integral part of Africa’s criminal underbelly, being a major entry point for narcotics from the Middle East and illicit pharmaceuticals from Asia. Over the past 12 months, there’s been increasing talk in East African intelligence and law enforcement circles about the role Mombasa could play in facilitating shipments of falsified and substandard COVID-19 vaccines. 

Mombasa’ many organised crime groups have never been shy to miss out on new opportunities – and there are a lot of them. A September report by EU-funded anti-crime initiative, Enact, says Kenyan law enforcement puts the number of organised crime groups operating there at 132. Most are involved in trafficking cocaine and heroin from Asia and Latin America.

Now, the port is set to become the primary conduit for vaccine supplies from India and China to landlocked East African countries such as Uganda, Rwanda and Burundi, plus South Sudan, Somalia and the Democratic Republic of Congo.

More Goods Mean Fewer Inspections — Making It Easier for Criminals to Operate  

Interpol East Africa crime intelligence analyst John-Patrick Broome identifies Mombasa as a “key facility” for trade in falsified and substandard medicines. 

Already, he says, there’s been a noticeable reduction in inspections at Mombasa port and other ports in the region. It’s an unavoidable by-product of the pandemic: the port needs to receive medication and support from around the world if the region is to cope with COVID-19. 

“Inspection regimes have been reduced in order to facilitate the swift and hassle-free movement of items through the border, to be distributed across the region,” says Broome. 

This, however, also allows organised crime groups “to facilitate the movement of illicit medications” – most of them from Asia. An inspector at the port who spoke to Bhekisisa on condition of anonymity says as much. “At the moment we are only inspecting a small fraction of goods that come in. This is because our systems are overloaded with products. There’s so much cargo coming in that we have introduced trains that can transport double-stacked containers.”

port
Containers at a port in Mombasa

In the next few months, large consignments of vaccines will begin flowing into Africa, including jabs bought through international procurement mechanism COVAX. With cargo planes unlikely to handle the required volumes, they’ll be shipped to some of the continent’s many free-trade zones (FTZs), including Mombasa. 

It is at these FTZs that the vaccine supply chain will be most at risk of criminals inserting fake and substandard jabs, according to crime analysts, international anti-crime agencies and law enforcement officers.

What is a Free Trade Zone?

US think-tank Global Financial Integrity (GFI), which analyses financial crime around the world, has called FTZs “a Pandora’s box for illicit money” and a “haven for free crime”. 

It defines FTZs, otherwise known as free ports, as “special economic areas that benefit from tax and duties exemptions. While located geographically within a country, they essentially exist outside its borders for tax purposes.” 

By 2019, Africa was home to 189 of these FTZs, in 47 of 54 countries, according to the Africa Free Zones Association. Ten of them are in SA. And while FTZs are often found at ports, they can also be strategic inland hubs, as is the Musina-Makhado special economic zone in Limpopo, near South Africa’s border with Zimbabwe. 

Developing countries especially encourage the existence of FTZs, as they offer attract export businesses and foreign investment, and create jobs. 

But the GFI report warns: “Criminals see them as perfect places to manufacture and transport illicit goods, as controls and checks by authorities are often irregular or absent. Customs authorities have little or no oversight of what actually goes on in an FTZ, goods are rarely ever inspected and companies operating in FTZs tend to benefit from low disclosure and transparency requirements.”

Criminals are Exploiting the Socio-Economic Impact of COVID by Offering Border Officials Bribes 

In the midst of the pandemic, the AU launched the African Continental Free Trade Area (AfCFTA) on January 1. With 54 signatories, it’s the largest trade bloc by number of members. 

According to the African Centre for Economic Transformation, the AfCFTA could create an economic bloc with a combined GDP of $3.4-trillion and grow intra-African trade by 33%. 

It’s not just a free-trade agreement. “It’s a vehicle for Africa’s  economic transformation,” the centre notes. “Through its various protocols, it would facilitate the movement of persons and labour, competition, investment and intellectual property.”

But a former trafficker in illicit medicines, who now co-operates with law enforcement investigating the crime in West Africa, warns: “I’m sure the AU means well by making Africa one big party of a free trade area, but that could not be more perfect for the gangs who are already bringing fake medicine into Africa … It’s like a ‘welcome to Africa’ sign is being held up for them.”

Not that there weren’t risks prior to the launch of the AfCFTA. As intellectual property lawyers Marius Schneider and Nora Ho Tu Nam argue, Africa’s plethora of FTZs already unite organised crime groups specialising in the trade in illicit medicines.  

Schneider and Ho Tu Nam, advisers to some of the world’s largest pharmaceutical companies, authored a report in May that warned of the probability of falsified COVID-19 vaccines being distributed on the continent.

“At ports like Mombasa, and other FTZs, pharmaceutical products are packaged and repacked in ways that disguise their origins,” explains Schneider. “There’s no doubt that the use of FTZs is facilitating and boosting trade in counterfeit pharmaceuticals … Could they have a role to play in crime around COVID vaccines? Definitely. Because in our experience they aren’t policed properly and they are also very open to corruption.”

Broome says organised crime groups have been attempting to “corrupt” officials at East African ports to receive fake personal protection equipment consignments since the pandemic began. 

“The unfortunate context of COVID-19 in terms of its socioeconomic impact has led to a situation where individuals fear for their job security. And we’ve seen organised crime groups approach individuals with offers of payment in order to gain access to the reduced inspection capabilities that are present in the ports at the moment.”

Djibouti – The end of the Silk Road … and the Possible Beginning of a Dark Journey with Fake Vaccines

Schneider says Djibouti, which serves as Ethiopia’s port, is also a possible concern.  

“It’s at the end of the Chinese Silk Road; a major entry point of Chinese products into Africa,” he explains. “Djibouti is therefore in a very strategic position. It’s on one of the world’s busiest maritime commerce routes and links Asia, Africa and the Middle East.”

In 2018, the small Horn of Africa state opened what will eventually be Africa’s largest single FTZ. Its various stages of development, funded by China, have cost about $US 3.5 billion.  

Several crime intelligence sources in East Africa are anxious about Djibouti, saying it’s ideal for organised crime groups to exploit when it comes to vaccine shipments because it doesn’t have a formal customs recorder (an electronic record of brands/trademarks and products that enter a country). 

 “The Djibouti authorities don’t record brands; that means they don’t take any action in terms of alerting a company when there’s a suspicious shipment,” says a crime intelligence source, who asked not to be named. “The criminals are, of course, well aware of entry points like this, which have weaknesses that they can take advantage of.”

Djibouti, Ethiopia

Bhekisisa’s attempts to speak with Djibouti customs authorities were not successful, but Schneider confirms that it’s not their policy to notify companies in the event of suspected counterfeit goods.   

He says he recently made inquiries of the Djibouuti authorities. “There is a possibility of signing a kind of memorandum of understanding with their customs [service] and then they may look after your products,” he explains. “But it’s not something that’s provided for and that’s de facto done; in countries such as SA and Mauritius, on the other hand, co-operation with customs to seize illicit goods works quite well.”

North & West Africa Entry Points – Libya, Lomé and Cotonou

Last July, a research brief by the UN Office on Drugs & Crime (UNODC) also identified the ports of Lomé (Togo) and Cotonou (Benin) as key entry points for falsified and substandard pharmaceutical products related to the COVID-19 pandemic.  

According to Mark Micallef of the Global Initiative against Transnational Organised Crime, Libya is currently the “epicentre” of trafficking in falsified, substandard and stolen pharmaceuticals in North Africa and the Sahel region.

“Drug trafficking in general grew exponentially in Libya after 2011 [when the regime of Muammar Gaddafi was overthrown], with new players, new markets developing and prescription medication and counterfeit pharmaceuticals being a very big growth market, and rapid growth also of an internal market which, prior to the revolution, was pretty much controlled very strictly by the regime.” 

Micallef says there are “key nodes in ports and strategic border areas that are completely operational for criminal business” and that could easily function as conduits for falsified COVID-19 vaccines.

Servicing Landlocked Countries puts South Africa’s Points of Entry under Immense Pressure

Like other customs officials Bhekisisa spoke with in several African regions, a Mombasa inspection officer says he’s “under a strict order” to “concentrate on shipments coming in from Asia” when trying to detect possible falsified vaccines. 

But the instruction has left him frustrated and disenchanted. 

“These days everything comes from China,” he says. “We don’t have the capacity to inspect everything that is entering from Asia; no way! We can only look at a few, so lots of illegal stuff is getting past us here, but there is nothing we can do about it.” 

Ho Tu Nam says if there are “bottlenecks” of vaccines at Africa’s points of entry, organised crime groups will try to exploit the chaos. 

“About a third of Africa is landlocked, so you have a few ports [like Mombasa and Durban] serving many countries,” she points out.

Six landlocked countries will depend on South Africa’s points of entry to process and distribute large consignments of vaccines, especially from China and India. These include: Botswana, Lesotho, Malawi, Swaziland, Zambia and Zimbabwe. On South Africa’s eastern coast, the KwaZulu-Natal’s provincial Department of Transport describes Durban as the largest and busiest shipping terminal in sub-Saharan Africa and the fourth-largest container terminal in the southern hemisphere – one that links “the Far East, Middle East, Australasia, South America, North America and Europe. It also serves as a trans-shipment hub for East Africa and Indian Ocean islands.”

Durban, Kwa-Zulu Natal Province, South Africa

Ho Tu Nam says organised crime groups could take advantage of busy points of entry by mislabelling consignments of falsified and substandard medicines as “in-transit” goods. 

“We’ve noticed a lot of counterfeiters are labelling their products, going for example through the port of Mombasa, as destined for South Sudan, destined for Rwanda. The customs officers are so busy, and so focused on products marked for distribution in their own country, that they don’t check those labelled ‘in-transit’. Once those mislabelled products hit the road, they’re diverted into local markets.” 

The “Little Chemist” Threat

In East Africa, several police officers tell Bhekisisa they’re concerned that falsified, substandard and stolen COVID vaccines could be distributed by some of the region’s many thousand informal “chemists”. 

It’s a valid concern, says Interpol.  

“The number of unlicensed pharmacies has increased across the region during COVID-19,” says Broome. “We see an example of this during this period where 56 arrests were made in Uganda and there was the closure of 1,526 facilities. These enable, for example, the sales of fake antivirals imported from Asia.”

Broom says members of organised crime groups are trying to “franchise” some illegal pharmacies all over East Africa, “which would give them an even greater air of legitimacy”.

But according to Micallef, it’s the legal and as well as the illegal pharmacies that are important channels for the flow of illicit medicines throughout North Africa, and specifically the Maghreb countries of Algeria, Libya, Mauritania, Morocco and Tunisia.

Across the continent, one-person, one-family operations, often doing business from informal settlements or mobile units such as the back of pickup trucks, offer an important source of cheaper genuine medicine to populations that could otherwise not afford treatment. Law enforcement agencies say criminals frequently use such pharmacies as “fronts” and “channels” for illicit pharmaceuticals. 

Crime analyst Maurice Ogbonnaya, a former security official in Nigeria’s National Assembly, explains: “They’re notoriously difficult to control, because they’re mobile; and if the police start inspecting them they just shut for a while before opening again, or they relocate.” 

Lack of Punishment Means Criminals aren’t Afraid to Produce Fake Medicines

There’s been progress in developing frameworks around substandard and falsified medical products over the past decade, says the UNODC. But “few countries have an adequate legal and regulatory system in place to address substandard and falsified medical product-related crimes associated with COVID-19”. 

And, says Schneider, if the past is anything to go by, punishment for people in Africa caught distributing falsified vaccines won’t be harsh. 

“Fake medicine is usually regarded as a violation of intellectual property rights and not a crime in many parts of the world, including Africa,” he explains. 

Cyntia Genolet, associate director of Africa engagement at the International Federation of Pharmaceutical Manufacturers and Associations, says that’s precisely why organised crime groups could be inspired to invest in falsified and substandard inoculations.   

“If you don’t have any [real] punishment, you just take the risk, then maybe you have three days of jail, you pay your small fine, and then you’re good to continue,” she says.  

In 2018, an OECD report identified Egypt as a continental hub for trade in, and production of, illicit products. However, in that year, the country made just one arrest for the manufacturing of counterfeit medicines. 

Disturbingly, that single arrest was enough to put Egypt among the top 10 countries for the number of arrests for such a crime. 

“That says it all about how seriously not just Africa, but the world, has taken this issue so far,” says Schneider. “If you’re caught in the Comoros, for example, selling counterfeit pharmaceuticals, they will let you get away with a fine and you will be able to walk away with your fake products.” 

Bust with fake pharmaceuticals worth R95-million – but the criminals walked free

Andy Gray, a senior pharmacist at the University of KwaZulu-Natal, recalls what is arguably SA’s most infamous case of trade in falsified medicines, for which the perpetrators also got off extremely lightly. 

In 2000, police raided a factory in Potchefstroom and confiscated pharmaceuticals, many smuggled from India, with a market value later estimated at 95-million Rand (about US$ 15 million). 

Two years later, a magistrate concluded that three pharmacists from the North West city – Derrick Adlam, Deon de Beer and Johan du Toit – had operated a syndicate that repackaged and distributed falsified, stolen and expired medicines.

The three pled guilty – but only to contravening the trademarks act. Each received a suspended five-year jail term and was set free immediately after paying a fine. 

Poor Quality, Fake Vaccines will have a “Chilling Effect”

Ogbonnaya says some government agencies, especially in West Africa, are trying to confront the trade in illegal pharmaceuticals, but most action is taken by individual governments focusing only on local crimes. 

Organised crime groups, he points out, operate regionally, continentally and globally, so what’s needed is corresponding cross-border co-operation. 

“What you have in some African countries right now is every few months or even years you’ll have raids and arrests, and shutting down of illegal pharmacies, for example, and then a few months after that, the criminals are up and running again,” says Ogbonnaya. 

“This is a well-entrenched system and it’s not one that will end with a few arrests here and there. It will be prevented in a big way by co-ordination between law enforcement, governments, pharmaceutical manufacturers and many other actors. And that’s what’s missing at the moment, co-ordination. Africa, and the world, needs a single system focused on the illicit medicine trade, and we don’t have that.” 

In 2010 the Council of Europe drafted and adopted the Medicrime Convention – the only international legal instrument providing the means to criminalise the falsification of medical products as a public health threat. But only 18 countries have ratified it so far. Of those, three are African: Benin, Burkina Faso and Guinea.

“So, they are the only three [countries] in Africa that actually make falsification of medicines a crime,” says Genolet – though it’s hoped that more will ratify the agreement soon. 

Ruona Meyer, the producer of Sweet, Sweet Codeine, an Emmy-nominated documentary on the illegal trafficking of medicine in Nigeria, says she’d like to see an example being made of the first person or group caught distributing falsified, substandard or stolen COVID-19 vaccines in Africa, no matter where that may happen.

“It would be a big help if the law enforcement authorities stamp out the fires of fake vaccines as soon as the flames start,” she says. “Get these dealers into court and into jail as fast as possible to deter organised crime. The fake vaccine cases must be expedited and must be very, very public,” she says. 

[WATCH] Sweet Sweet Codeine: What Happened Next?

 

But, Salim Abdool Karim, co-chair of South Africa’s scientific ministerial advisory committee on COVID-19, warns that falsification in itself could do “tremendous harm” to people’s faith in the safety of the jabs.

Gray similarly believes any wave of falsified vaccines in SA could have a “really chilling effect on people’s confidence and trust, both in government and in the regulatory authority”. 

“We already have vaccine-hesitant parents and members of the public in this country. If we want to eventually vaccinate 70%of the population, we can’t have a third or half of them refusing that vaccination. And anything which breaks down trust – be it mismanagement of adverse effects after genuine vaccination, or experience of a falsified vaccine or suddenly it’s arriving in strange places and people are being [vaccinated] on the pavements – that’ll hit the press very quickly and I think it could be really damaging.” 

This article is the second in a series, produced by the Bhekisisa Centre for Health Journalism.  The first story, LIttle Vials, Big Crime: Criminals Primed For Onslaught On Africa’s Vaccines was pubilshed on 11 February 2021. The work is supported by a grant from the Global Initiative Against Transnational Organised Crime (GI-TOC). Sign up to Bhekisisa’s newsletter.

Image Credits: Kyle Steckler, U.S. Navy/Flickr, Flickr, Bhekisisa, Sinny Pak/Flickr, Michael Jansen/Flickr, Bhekisisa.

The European Comission has announced a new plan to respond to coronavirus variants

The European Commission will establish an emergency biodefense plan to prevent, mitigate and respond to new variants of the coronavirus that are supercharging transmission and threatening the performance of available vaccines. Creation of a voluntary licensing mechanism involving local manufacturers is one of the strategies proposed in the plan to hasten the production of updated vaccines.

“This very real threat of variants requires determined, collective and immediate action,” said the European Commission on Wednesday. “The Commission will establish and operate a new bio-defence preparedness plan called HERA Incubator, to access and mobilise all means and resources necessary to prevent, mitigate and respond to the potential impact of variants.”

With at least €75 million ($90.2 million) in initial funding, the EU’s five-pronged plan aims to rapidly detect variants and to adapt vaccines accordingly, while ensuring their approval is fast-tracked and that production is upscaled.

“The Commission will foster the creation, if need be, of a voluntary dedicated licensing mechanism, which would allow technology owners to retain a continued control over their rights whilst guaranteeing that technology, know-how and data are effectively shared with a wider group of manufacturers.”

Specifically, the Commission aims to urgently work towards:

  1. Rapid detection of variants;
  2. Swift adaptation of vaccines;
  3. Setting up a European Clinical Trials Network;
  4. Fast-tracking regulatory approval of updated vaccines and new or repurposed manufacturing infrastructures;
  5. Enable upscaling of production of existing, adapted or novel COVID-19
    vaccines.

Until now, only one major European vaccine-developer, AstraZeneca, has licensed its vaccine voluntarily with a number of manufacturers around the world – thus sharing the vaccine know-how with producers in India, the Republic of Korea and Brazil, among other countries.

The EC initiative comes on the heels of a call by the new Director General of the World Trade Organization, Ngozi Okonjo-Iweala, to encourage vaccine pharma companies to issue more voluntary licenses to manufacturers in low- and middle-income countries so as to open up the global bottleneck in access to vaccines.  She also called upon countries to support the ramping up of such local production capacity in low- and middle-income countries, noting that on the African continent, for instance, 90% of medical products are imported, Iweala said shortly after her election by the WTO General Council on Monday.

Medicines Access Advocates Say European Commission Plan Is To Euro-Centric

While seeming to echo Iweala’s approach, health advocacy groups voiced concerns that the EC initiative was too Eurocentric.

Notably, the Commission’s plan did not explictly mention any push to expand voluntary licensing internationally – through efforts such as the WHO-backed initiative to created a COVID-19 Technology Access Pool (C-TAP) for the voluntarily licensing of COVID-19 vaccines and other COVID health products. Nor did the EC explicitly mention the WHO co-sponsored global vaccine facility COVAX – which is struggling to recruit more funds and vaccines to distribute to low- and middle-income countries

“The EU proposal today, and the comments by the incoming WTO DG Ngozi Okonjo-Iweala, as well as earlier comments on CTAP by [WHO Director General] DrTedros seem at odds. EU proposal on licensing seems focuses on EU needs, not global,” said Knowledge Ecology International’s Jamie Love in a tweet.

In a followup remark to Health Policy Watch, Love added, “we have some details but there is a lot we don’t know yet [about the EC plan].” I am guessing that the EU sees any new capacity as serving the whole world, but it seems to focus on ramping up EU based manufactureing and addressing EU vaccine security needs, as its priority, very similar to what other governments, including the US, have done.

“If the EU wants to work on a more global technology transfer initiative, it would want to engage in C-TAP, and maybe even help C-TAP get its programme off the ground in a meaningful way.”

On the other hand, the EC plan stresses that the benefits of the European initiative will extend “far beyond” the EU’s borders through cooperation with low- and middle-income countries, particularly in Africa and global health bodies like the World Health Organization, GAVI, The Vaccine Alliance and the Coalition for Epidemic Preparedness Initiatives (CEPI). “In the medium and long-term, the EU should cooperate with lower and middleincome countries, in particular in Africa to help scale up local manufacturing and production capacities,” said the Commission’s plan.

The European Commission plan also “emphasizes that the sharing of know-how will be restricted and controlled,” Love added. “Such conditionality diverges from the open-access vision of the WHO co-sponsored C-TAP, but that  “may be what is feasible” for vaccines already being marketed now as products with patent restrictions.

However, for new products, Love said the EU model would be more effective if it were based around “open sharing of the tech, and even some existing technology can be put into the public domain through tech buyouts. There is too much embracing the model of proprietary manufacturing know-how, when that is the opposite of what is needed for scaling up and making access more fair.”

The European Union’s Vaccine Strategy has so far secured access to more than 2 billion doses of coronavirus vaccines, which is roughly double the amount needed to vaccine the EU’s 450 million citizens. And just this Wednesday, the European Commission sealed a deal with Moderna for 150 million additional doses of its vaccine, bringing its order to a total of 310 million doses for this year, and an option to purchase 150 million extra doses in 2022.

Image Credits: almathias.

MSF relief worker administers a pneumonia vaccine to a child in Greece as part of a 2016 campaign targeting refugees arriving in Europe – Photo: MSF/ Sophia Apostolia

The United Kingdom, Norway and UNICEF on Wednesday appealed to world leaders to give stronger backing to UN Secretary General Antonio Guterres’ call in March 2020 for a “global cease-fire” in order to beat the COVID-19 pandemic and get vaccines to tens of millions of undocumented migrants and refugees, as well as people living in conflict zones. The latter includes some 60 million people living in areas controlled by non-stated armed groups, according to estimates by the International Committee of the Red Cross (ICRC).

They spoke during an open debate on getting COVID-19 vaccines to conflict zones, underway in the UN Security Council on Wednesday.   

The debate brings together foreign ministers from nearly a dozen other countries, including the United Kingdom, United States, China, India, Kenya, Mexico, Tunisia and Ireland – to address barriers to ensuring that the vaccine rollout can reach the most vulnerable – including nbot only people living in conflict zones, but also migrants and unregistered immigrants. Conversely, the role of the pandemic in exacerbating ongoing local and regional conflicts is also on the agenda.  

UK Foreign Secretary Dominic Raab, who was chairing the virtual debate, on the implementation of UN Security Council Resolution 2532, on the cessation of hostilities in the context of the COVID-19 pandemic, which was adopted in July, 2020, noted that some 160 million people in countries such as Yemen could miss out on vaccines due to war. 

United Nations Security Council debate on vaccine access in conflict zones

British Prime Minister Boris Johnson is expected to set out more details on vaccinating refugees and people in conflict zones at a virtual meeting of G7 leaders on Friday.

“The COVID-19 pandemic has been a stress test of national and global health systems and our systems of governance,” said Norway’s Foreign Minister Ine Marie Eriksen Søreide. “Now we, as an international community, and as this Security Council, must forge a united way forward.” 

The Norwegian minister said that the Scandanavian country was advocating three key principles in terms of the pandemic battle: ensuring equitable global access to COVID-19 vaccines; humanitarian access for vaccines to reach the most vulnerable; and the global cease-fire.

“Hostilities must cease in order to allow vaccination to take place in conflict areas,” said Søreide. “In many conflict areas, civilians and combatants are living in territories controlled or contested by non-state armed groups. Reaching these populations may involve engaging with actors whose behaviour we condemn. The successful dialogues with armed groups in Afghanistan, Syria and elsewhere to allow humanitarian access for polio and other health campaigns offer lessons for the rollout of COVID-19 vaccines.”

She added: “From Idlib to Gaza, from Menaka to Tigray: It is our duty as the Security Council to keep a close eye on these shifting dynamics, to coordinate efforts, and to facilitate full and unimpeded humanitarian access, as well as peaceful resolution of conflicts. We must call for concerted action across all the pillars and institutions of the UN to secure the widest and most equitable distribution of COVID-19 vaccines.” 

Her remarks came shortly after Israel agreed to allow the transfer of some 2000 vaccines donated by Russia to the barricaded Gaza Strip, despite demands by some Israeli parliamentarians that Gaza’s Hamas rulers first return two Israelis being held hostage in the Strip, Avera Megistu and Hisham al-Sayed, as well as the bodies of two Israeli soldiers killed in border skirmishes. 

India Calls On Countries to ‘Stop Vaccine Nationalism & Hoarding’ – Offers 200,000 Sergum Institute Vaccine Doses To UN Peacekeepers as a Gift
Indian External Affairs Minister S Jaishankar

Meanwhile, India’s External Affairs Minister S Jaishankar announced that India will provide 200,000 doses of COVID-19 vaccines to UN Peacekeepers – India’s vaccines are being locally produced by the Serum Institute of India under a license from AstraZeneca.

“Keeping in mind UN Peacekeepers, we would like to announce today a gift of 200,000 vaccine doses for them,” he said.

Jaishankar protested what he described as the “glaring disparity” in vaccines access, calling for stronger member state “cooperation within the framework of COVAX, which is trying to secure adequate vaccine doses for the world’s poorest nations,” and outlined a nine-point plan to: “Stop ‘vaccine nationalism’; ….actively encourage internationalism” and combat pandemic and vaccine disinformation.

He called out rich countries that have purchased multiple doses for every citizen stating that: “hoarding superfluous doses will defeat our efforts towards attaining collective health security.”

Henrietta Fore – Countries Also Must Restart Vaccine Campaigns Against Other Diseases
A refugee filling an application at the UNHCR registration center in Tripoli, Lebanon.

Meanwhile, UNICEF’s Henrietta Fore said that her agency was working hard to support a plan to distribute some two billion vaccines in low- and middle-income areas over the course of 2021 through the COVAX global vaccine facility, co-sponsored by WHO, GAVI-The Vaccine Alliance, and CEPI, the Oslo-based Coalition for Epidemic Preparedness Initiative.  

However, UN member states  must “include the millions of people living through, or fleeing, conflict and instability” in their national vaccine planning, “regardless of their legal status or if they live in areas controlled by non-state entities.”

Fore described it “not only as a matter of justice. But as the only pathway to ending this pandemic for all.” 

Restarting stalled immunization campaigns for other diseases remains equally critical, she said, adding: “We cannot allow the fight against one deadly disease to cause us to lose ground in the fight against others.”

UNICEF Lays Out Huge Logistics Challenges Of Vaccine Campaigns
Physical distancing measures have been set up by the UN in a refugee camp in South Sudan, where rations have been increased to reduce the number of times large groups need to gather to receive humanitarian aid.

In her remarks, Fore also laid out the huge logistics challenges that the agency is facing, together with its partners – as well as the challenge of reaching a vaccine target audience of older people that is not typically a UNICEF focus.

“Using existing immunization infrastructure, we’re also working to reach people not normally targeted in our immunization programmes — including health workers, the elderly and other high-risk groups,” Fore said.

“We’re helping governments establish pre-registration systems and prioritizing which people, such as health-care workers, need to receive vaccines first.

“We’re engaging communities and building trust to defeat misinformation.

“We’re training health workers to deliver the vaccine, and helping governments recruit and deploy more health workers where they’re needed most.

“We’re advocating with local and national governments to use other proven health measures like masks and physical distancing.

“And now, through the COVAX Facility, we’re working with Gavi, WHO and CEPI to procure and deliver the COVID vaccines in close collaboration with vaccine manufacturers, and freight, logistics and storage providers.

The daunting challenges also mean ensuring that enough syringes are available for the available doses in each country, procuring syringes and safety boxes, and inventories of cold chain systems.

“It means finding ways to ensure distribution and delivery in logistically difficult contexts like South Sudan or DRC — or high-threat environments like Yemen or Afghanistan,” she said. “It means negotiating access to populations across multiple lines of control by non-state armed groups — areas that the ICRC estimates represent some 60 million people.”

Image Credits: UNHCR/Elizabeth Marie Stuart, MSF/ Sophia Apostolia, Mohamed Azakir / World Bank.

Secretary of State Antony J. Blinken

The United States will pay over $200 million it owes to the WHO by the end of February, marking a positive step to restabilize the global health body’s fragile finances at a time when they are most needed.

“This is a key step forward in fulfilling our financial obligations as a WHO member and it reflects our renewed commitment to ensuring the WHO has the support it needs to lead the global response to the pandemic,” said U.S. Secretary of State Antony Blinken at the U.N. Security Council on Wednesday.

“The United States will work as a partner to address global challenges. This pandemic is one of those challenges and gives us an opportunity not only to get through the current crisis, but also to become more prepared and more resilient for the future.”

The move comes less than a month after the Biden administration rejoined the WHO as part of its seven-point pandemic plan, reversing former president Donald J Trump’s plan to withdraw from the Organization and suspend its contributions.

In 2019, the US was the global health body’s largest donor, with a US$400 million contribution that represented 15% of the WHO’s annual budget. In total, the Organization’s budget equates to that of two sub-regional hospitals.

The US will also provide “significant” financial support to the international COVAX facility to equitably distribute vaccines around the world, added Blinken. Co-led by WHO and Gavi, the Vaccine Alliance, COVAX is still facing a US $27 billion shortfall in funding.

Image Credits: U.S. Department of State / Ronny Przysucha.

The pandemic has revealed that health must be woven into all aspects of society – from our workplaces to schools, businesses as well as the government.

The COVID-19 pandemic has revealed the profound dangers of having social, economic and health care systems that marginalize public health. To go forward, we must start by looking back. We must build a stronger foundation with better systems that can prevent future pandemics and also weave health into all aspects of society, from our workplaces to our schools to our businesses to every action of government. We can work for a world where people have equitable access to health care, and where they are protected from the leading drivers of death and disease no matter their race, gender, or sex or where they live.

Here are five critical priorities:

Invest in Epidemic Preparedness
We know that the next pandemic is only a plane flight away. Every level of government must do better to be prepared. We must seize and build on the public interest and political will that has been created by the experience of living through and witnessing the impact of COVID-19 This means investing in global surveillance systems like the WHO’s Joint External Evaluation (JEE) tool so that new outbreaks can be identified and contained. Spurred by the 2014 Ebola crisis, the JEE provides a way for countries to assess their ability to find, stop and prevent epidemics, and target improvements. We need to accelerate this process so that every country completes a JEE. We need to provide funding for improvements—an estimated investment of just US $1 per person per year could significantly blunt the health and economic costs of future epidemics. Consider the alternative—The International Monetary Fund estimates the impact of COVID-19 is at least US $28 trillion in lost output. And then, technical assessments and competency are not enough—the countries that did the best to address COVID-19 also had strong and coordinated leadership across agencies and levels of government, depended on science to guide their actions rather than political considerations, and carried out effective public communication.

Invest in Prevention of Noncommunicable Diseases

Governments need to prioritize prevention to slow the staggering increase in conditions like cancer, diabetes and high blood pressure—noncommunicable diseases that cause up to 80% of premature deaths throughout the world. Investing in prevention will save trillions in treatment. This means properly resourcing national and state ministries of health and urban health departments that are too often poorly funded. In the United States, a paltry 3% of all health spending goes to public health. Public health protections may seem invisible—a tax on sugary drinks to discourage consumption, strong surveillance data that improves resource allocation, the absence of tobacco advertising—but COVID-19 has brought new visibility and public and political support for greater investment in health. Public health entities are essential and must be properly funded. We have a rare opportunity to implement a comprehensive approach to health. Let’s not lose the moment.

Build Economies Around Health
There’s growing momentum behind the idea that successful economies prioritize investments in the wellness of people. We can better harness the power of economic policy and partnerships. Even before COVID-19, more than 100 CEOS of leading Fortune 500 companies came together to declare that company performance must be measured in more than shareholder returns. Among its ideals: investing in their employees and protecting the environment. Let’s empower large employers to invest in the health of employees—including mental health—and promote business practices that promote healthier environments including fewer health-harming emissions. Governments can tilt economies away from ill health by ending subsidies for products with negative impacts on health—tobacco, alcohol and fossil fuels—and taxing unhealthy commodities. This will reduce health care costs and generate revenue for social good. Policies can make healthy choices the easy choice for people, by making fruits and vegetables more affordable, junk food less accessible, informing consumers with clear warning labels on packaged food, and promoting smart city designs that create safer spaces for walking, biking and playing.

Put Equity at the Center

COVID-19 has laid bare the tragic scope of health inequities across many dimensions. In the United States, Black, Indigenous, and Latinx Americans are dying from COVID-19 at triple the rate of white Americans. As the vaccine rollout continues, it is critical that the shots are distributed to the Black, Indigenous, and Latinx Americans communities to avoid exacerbating existing health disparities. Globally, a Duke University study warns that billions of people in low- and middle-income countries will not have access to the COVID-19 vaccine until 2023, and in some cases, 2024. Until all people are protected equally, we must concentrate investments—not only for COVID-19 but also on the myriad health problems exacerbated by inequity—in communities that are disproportionately affected and work to address root causes. This means speaking out, partnering with all levels of government and other sectors such as education and housing where good health is rooted, and empowering the most-affected groups to shape the health and social policies that have placed disproportionate health burdens on them.

Increase Global Cooperation

The weakness of our global health coordination systems was one reason a preventable epidemic mushroomed into a global pandemic. Formal mechanisms of global cooperation from the Paris Climate Change Treaty to the Framework Convention on Tobacco Control, bring country accountability. Alternatively, we can strengthen health-related components of existing frameworks, such as demonstrating that the Conventions on the Rights of the Child includes committing to access to healthy nutrition and protecting children from the unhealthiest commodities. We must also bolster our coordination bodies and mechanisms across multilateral organizations and governments, focusing first on the World Health Organization.

In revealing systemic weaknesses, COVID-19 also has painted a way forward for greater progress. Together, we can reimagine a world where everyone is protected by a strong public health system so they can lead longer, healthier lives, where science is the core of public health decisions and measures, and where we can effectively prepare for and even prevent future pandemics. This will not be our last.

José Luis Castro, president and CEO of global health organization Vital Strategies

Image Credits: Vital Strategies, Tewodros Emiru, Vital Strategies.

Sinopharm vaccines prepared to be flown to Zimbabwe on Sunday.

As low- and middle-income countries begin receiving their first batches of vaccines and commence their vaccination campaigns, at least 40 countries across Africa are seeing a second wave and record case numbers are being reported in the southern African region, where the B.1.351 variant is spreading.

Rwanda has become the first country in East Africa to start vaccinating its frontline health workers, according to the health ministry via an announcement on Twitter.  

The ministry simply referred to “WHO-approved COVID-19 vaccines acquired through international partnerships in limited quantities.” However, a government source told AFP that the country, which has over 12 million citizens, had acquired 1,000 doses of the Moderna vaccine for its frontline health workers.

The Moderna vaccine needs cold storage – but not at the ultra-cold temperatures required for the Pfizer/BioNTech vaccine. A month ago, the country purchased five ultra-cold storage freezers with the capacity to store vaccines up to -80°C in preparation for the arrival of the two mRNA vaccines. 

Rwanda is one of only four African countries – together with Cabo Verde, South Africa and Tunisia – that have been approved by COVAX to receive the Pfizer/BioNTech vaccine, which needs to be stored at -70°C.

After the initial vaccination phase, additional jabs will be provided both by COVAX and the African Union (AU), which secured over 600 million doses of vaccines for its member states. 

Kigali, the capital city, has been under lockdown since mid-January after a second wave of the pandemic hit. Rwanda has recorded over 17,000 cases and 239 deaths.

On Monday, Zimbabwe also received its first batch of COVID-19 vaccines, developed by Sinopharm and donated by the Chinese government. The 200,000 donated doses were delivered to the Robert Gabriel International Airport in the capital city of Harare and vaccinations will begin this week. 

 

Zimbabwe also purchased 600,000 doses of the Sinopharm vaccines, which will be delivered in early March. Frontline workers, including healthcare workers and immigration agents working at the borders, will be prioritized in the first part of the rollout plan. 

But the country will need millions more doses to reach herd immunity in its population of 14.6 million. As a result, the government submitted an expression of interest to be part of the initiative to receive vaccines from the AU. 

Lebanon Begins Campaign in Eastern Mediterranean Region

Lebanon began its vaccination campaign on Sunday after receiving 28,500 doses of the Pfizer/BioNTech vaccine, which arrived from Belgium on Saturday at the Rafic Hariri International Airport in Beirut.

This week, the government plans to vaccinate between 300 and 400 people per day in 17 approved medical centers and hospitals across the country, beginning with healthcare professionals working in COVID departments and individuals in senior care homes. 

Lebanon, a country of 6.8 million, has recorded over 330,000 COVID cases and 3,961 deaths. 

The hospitals have reportedly rehearsed their vaccination procedures to learn from “the mistakes of the Americans and French, and…[try] to avoid the same issues,” said Abdul Rahman Bizri, head of the National Committee for the Administration of COVID-19 Vaccines. 

The Oxford/AstraZeneca vaccine is also expected to arrive in Lebanon in two weeks. The government has ordered 2.1 million doses of the Pfizer/BioNTech vaccine and is set to receive 2.7 million doses from the COVAX facility. Talks are also underway to order 1.5 million doses of the Oxford/AstraZeneca vaccine. 

Lebanon’s Health Minister, Hamad Hassan, promised that all residents, including Syrian and Palestinian refugees, of which there are approximately 1.7 million, would be vaccinated. 

The COVID-19 pandemic has coincided with a political and financial crisis in Lebanon, which has caused the cost of importing medicines and food to skyrocket. In addition, the explosion in the port of Beirut in August, 2020 heavily damaged four hospitals in the capital. 

Nearby in the Israeli-occupied West Bank, the Palestinian Authority last week began to vaccinate health workers with several thousand doses of the Pfizer vaccine acquired from Israel along with a shipment of Sputnik V vaccines, acquired from Russia.  But  Israeli authorities were currently barring the PA’s delivery of some 2,000 vaccines to the Gaza Strip.  Israel has been demanding that Hamas, which controls the Strip, first return the bodies of two deceased soldiers as well as two Israeli citizens reportedly being held hostage there.

Under Reporting of Cases and Deaths in LMICS – Could Make Vaccines Appear Less Urgent

Meanwhile, some experts were expressing concerns that the underreporting of COVID cases in many low-income countries, due to the lack of capacity to conduct mass testing and collect reliable data on COVID cases and deaths, could also reduce the sense of urgency around vaccination for global policymakers.

“Some might argue the need for vaccines is much less urgent…so the vaccines will go to countries with stronger reporting systems and so further entrench inequity,” Oliver Watson, an infectious disease expert at Imperial College London, told the Guardian.

Several studies have suggested that only a fraction of the cases in developing countries of Africa have actually been reported, with one study estimating that only 2% of deaths due to COVID-19 were officially reported between April and September in Sudan.

“CV19 cases were under reported because testing was rarely done, not because CV19 was rare,” said a study conducted by the Boston University School of Public Health in Lusaka, Zambia. “If our data are generalizable, the impact of CV19 in Africa has been vastly underestimated.”

“The increasing deaths from COVID-19 we see seeing are tragic, but are also disturbing warning signs that health workers and health systems in Africa are dangerously overstretched,” said Matshidiso Moeti, WHO’s Regional Director for Africa, during a press conference last week.

Without accurate reporting, low-income countries could be left even lower on the priority ladder than they already are, delaying the protection of hundreds of millions of people.

Image Credits: Twitter – Chinese Ambassador to Zimbabwe.

Countries and health authorities debate the implementation of vaccine passport programs domestically and internationally to boost economy and prevent further spread of virus variants.

A World Health Organization (WHO) Special Envoy for COVID-19 has suggested that ‘vaccine passports’ could prove to be an important part of future international travel regulations to stop the spread of COVID-19 and its variants.

A growing number of countries around the world are in fact already racing ahead to create vaccine passport systems – accompanied by some bilateral travel deals.  Officially, however, WHO has been reluctant to move quickly on the issue – until it becomes clear that vaccination really inhibits COVID transmission and vaccines become more available to the billions of people around the world who can’t access them at all right now.  

“I am absolutely certain in the next few months we will get a lot of movement and what are the conditions around which people are easily able to move from place to place, so some sort of vaccine certificate no doubt will be important,” said David Nabarro, who is a WHO Special Envoy for COVID-19, in an interview with Sky News on Monday. 

Such passport programmes would create a “bubble” to help restart international travel, Nabarro said – particularly in light of the new risks posed by evolving SARS-CoV2 variants and the fact that the virus is “going to be with us” for the foreseeable future. 

“We’ve got to be quite vigilant from now looking forward, both inside our countries, because variants can appear inside our own borders, but also [outside] because sometimes variants can be brought by people from other places,” said Nabarro. 

Speaking Tuesday with ITV’s Good Morning Britain, Nabarro added that “I shan’t be surprised if some system for COVID will emerge – but it will require a lot of hard work.  First of all, governments have to agree on what they are going to do, and we also have to bear in mind that similar certification should be there for people who have had the disease and can show that they have antibodies against the virus.” 

While the extreme shortage of vaccines remains a challenge to the immediate implementation of an international vaccine passport system, Nabarro said he expects the global vaccine supply to expand dramatically over the coming year: 

“Yes, I think that is a reality, those of us who have not yet been in the position to be vaccinated will perhaps not be able to travel as widely as those who have, for a bit. But I want to stress that the current situation of extreme shortages of vaccines, will, I believe remedy itself in the coming months, as more vaccines come on stream and as more manufacturing sites are opened up to make vaccines.”

COVID Vaccine Passports Already Happening – Iceland Was the First 

An expanding array of countries across Europe, as well as a few nations in Asia, Africa and the Middle East – are already racing ahead with plans for digital vaccine passports, and mandatory vaccines for entering travelers.  Leaders include Iceland, Poland, Sweden, Denmark, and Israel –  while the United Kingdom and the United States are also considering systems. 

In late January, Iceland became the first European country to provide citizens with vaccination certificates and to update its guidance on entry restrictions accordingly. People with a certificate of vaccination against COVID-19 with a vaccine authorized by the European Medicines Agency (EMA) or WHO are exempt from the testing and quarantine requirements upon arrival. 

Poland launched a digital vaccine passport last month, which “will confirm that the person has been vaccinated and can use the rights to which vaccinated people are entitled,” said Anna Golawska, Poland’s Deputy Minister of Health, to reporters. 

And Israel is about to initiate a vaccine passport system next week exempting vaccinated arrivals from mandatory quarantine.  In an effort to restart mass events and incentivize more people to get the jabs, the Israeli system will admit people only who can show proof of vaccination or COVID-recovery to local cultural and sports events, and even  restaurants and gyms. 

Denmark and Sweden have also announced that they have digital passport systems in the works, which will be used not only for traveling, but also for large in-person events and dining out. Sweden plans to establish the program by June, while Denmark set an ambitious goal to rollout the project by the end of February. 

“This is fundamental because if we want to start to export again and trading again, see business people meet again, things like the corona passport are fundamental to making that happen,” Jeppe Kofod, the Danish Foreign Minister, told CNN. 

“If you start when COVID-19 has left society, it will be too late. With this project we’re very positive we will have a summer of joy, football, of music. So better to get started sooner, now, to plan,” said Lars Ramme Nielsen, Head of Tourism in Denmark’s Chamber of Commerce, in an interview with CNN.

In The Philippines, a bill creating a vaccine passport system is before the Senate. And in Africa, Mauritius may become the first country to require proof of COVID vaccination for tourists to enter. 

EU Countries Call for International Agreement – Based on Yellow Fever Vaccination Requirements in WHO International Health Rules

The WHO’s International Health Regulations have a precedent for COVID-vaccine passports.  Existing IHR requirements allow countries where yellow fever is endemic to require proof of yellow fever vaccination by entering travelers – and almost all countries strictly adhere to that principle.

According to the national pandemic strategy plan released by President Biden on his first day in office, the United States is investigating the feasibility of including COVID-19 vaccination into the International Certificates of Vaccination or Prophylaxis (ICVP) documentation, the IHR system set up to document yellow fever vaccination status. 

Spain, Greece, and Cyprus have also recently expressed support for an internationally recognized immunity passport, particularly to ensure EU member states have a unified approach and a common understanding of vaccination certificates. 

“Spain will support any tool that facilitates the recovery of safe travel and mobility,” Reyes Maroto, Spain’s Industry, Commerce and Tourism Minister, told journalists on Thursday. 

In a letter to Ursula von der Leyen, President of the European Commission, Greece’s Prime Minister, Kyriakos Mitsotakis, proposed a coordinated system and a common European certificate to “facilitate transport and therefore a gradual return to normality.”

Von der Leyen seems to have welcomed the concept of a mutually recognized EU certificate for those who have received the full vaccine course, calling it a “medical requirement” to have a certificate. 

Ursula von der Leyen, President of the European Commission, at a visit to Portugal in January.

“Whatever is decided – whether it gives priority or access to certain goods – is a political and legal decision that should be discussed at a European level,” she said to the press during a European Commission visit to Portugal in January. 

While Awaiting International Agreement – Some Countries Make Bilateral Travel Deals

Meanwhile, some countries are not waiting for international action; a travel agreement between Cyprus and Israel was signed on Sunday, allowing vaccinated citizens to travel freely between the two countries. It was considered a “huge achievement” by Savvas Perdios, Cyprus’ Deputy Tourism Minister.

“Israel is effectively one of the most important markets for us in terms of tourism and this agreement will certainly boost our economy,” Perdios told a state radio agency on Monday. 

The implementation of a vaccine passport scheme is currently under consideration in the UK, however, various officials have given differing accounts of the potential scope and details of the programme. 

“Inevitably there will be great interest in ideas like, can you show you’ve had a vaccination against COVID – just like you have to show you’ve had a vaccination against yellow fever or other diseases – in order to travel somewhere,” said Boris Johnson, Britain’s Prime Minister, at a press conference in South London on Monday. “I think that is going to be very much in the mix down the road.”

Boris Johnson, Britain’s Prime Minister, at a press conference on Monday.

While Johnson ruled out using vaccine passports domestically, Dominic Raab, Britain’s Foreign Secretary suggested that using the passports locally could also be considered as part of discussions about the mechanisms for reopening the country. 

“Whether it’s at an international, domestic or local level, you’ve got to know that the document being presented is something that you can rely on and that it’s an accurate reflection of the status of the individual,” said Raab in an interview with LBC.

“I’m not sure there’s a foolproof answer in the way that it’s sometimes presented, but of course we’ll look at all the options,” he added. 

By contrast, last week, Nadhim Zahawi, Britain’s Minister for COVID Vaccine Deployment, insisted that there was no plan to introduce a vaccine passport.

“Vaccines are not mandated in this country…that’s not how we do things in the UK,” said Zahawi in an interview with the BBC. “We yet don’t know what the impact of vaccines on transmission is and it would be discriminatory.”

Concerns About Discrimination and Lack of Evidence on Transmission 

Leading voices in France and Germany, however, have voiced concerns about vaccine passport systems. They point to the fact that there is still insufficient evidence that vaccines hinder disease transmission.  It may also be too soon, in light of the likelihood that new vaccines may have to be developed, or existing ones updated to address the SARS-CoV2 variants – which are highly transmissible and potentially linked to higher hospitalizations and deaths. 

But more fundamentally, the issue pits values of individual freedom – against values that stress the importance of vaccination in normalizing travel and economies as part of a braoder whole-of-society approach.

Germany’s Ethics Council advised against giving vaccinated individuals special freedoms as it would be “unacceptable” to lift restrictions on an individual basis and it may encourage others to not comply with public health measures. 

“Lifting civil liberty restrictions prior to [the reduction in case numbers] exclusively for vaccinated people, could at most be justified if it were sufficiently certain that they could no longer spread the virus,” the council said, however that evidence does not yet exist. 

In addition, in France, which has fairly high rates of vaccine hesitancy, the population may perceive a vaccine passport program as an effort to make vaccination mandatory. Officials have also noted that so far only a limited portion of the population have had access to a vaccine.

“We are very reluctant,” said Clément Beaune, France’s European Affairs Minister. “It would be shocking, while the campaign is still just starting across Europe, for there to be more important rights for some than for others.”

“Until we have entered a phase of vaccination for the general public, telling people their activity is limited while access to vaccines is not generalised doesn’t work,” Beaune told Franceinfo in January. 

WHO Hesitant About Pushing Ahead Rapidly On Vaccine Passports – But Leaves Door Open For Future

As of mid-January, WHO’s International Health Regulations Emergency Committee also was advising countries against introducing requirements of proof of vaccination as a condition for international travel and entry into countries. 

“At the moment, we are lacking critical evidence regarding whether or not persons who are vaccinated could continue to be infected, or continue to transmit disease, and…nobody in the world beyond health workers and very vulnerable people have access to the vaccine,” said Mike Ryan, Executive Director of WHO’s Health Emergencies Programme. 

“The scientific evidence is not complete and there aren’t enough vaccines and therefore, we shouldn’t create an unnecessary restriction to travel until such time as we have the evidence and the vaccine is available,” Ryan added. 

Speaking at a press briefing on Monday, Ryan re-iterated that WHO official stance, saying, “the vaccine is not widely available would actually tend to restrict travel more than permit travel” and there is still not enough data to understand “to what extent vaccination will interrupt transmission”.

However, Ryan left the door open for the future saying that once COVID-19 vaccinations are widely available, and there is clarity about transmission dynamics, “disease vaccination passports can form part of a long term strategy for disease control and for the prevention of the disease potentially moving from one place to another, as we’ve seen with yellow fever vaccination requirements, which have been in place for a large number of decades now.”

 

Image Credits: Flickr – Marco Verch, European Commission, ITV News.

Cape Town – The first South African health workers will be vaccinated against SARS-CoV2 on Wednesday with the Johnson & Johnson vaccine, instead of the AstraZeneca vaccine, which was recently shown to be unable to stop mild or moderate infection against the B.1351 (501Y.V2) variant dominant in South Africa.

In a hastily assembled Plan B, President Cyril Ramaphosa announced last week that 500,000 J&J vaccines would be arriving in batches over the next month, starting with 80 000 doses this week. J&J has made these available as a research donation.

The health workers’ vaccination programme is being run as a phase 3.b, open-label implementation trial to get around the fact that the J&J vaccine is not (yet) licensed by the South African Health Products Regulatory Authority (SAHPRA).

South Africa will meanwhile make the 1 million doses of the AstraZeneca vaccine, which it has already, received available to the African Union.  At a press briefing last week, the head of the African Centers For Disease Control said that countries where the B.1351 variant is not dominant should still roll out the AstraZeneca vaccine.  

“It did shock everyone that the AstraZeneca did not have the desired effect in South Africa,” said South African Health Minister Zweli Mkhize, explaining the country’s decision to fast-track  its switch to the J&J vaccine at a media briefing last week.

The country was initially considering running a trial to test whether the AstraZeneca vaccine could prevent severe infection in the face of the B1.351 variant but it has since decided to focus on the J&J vaccine, which has proven to work against the variant.

Global Trial Found J&J Vaccine 57% Efficacious In Preventing SA Infection – 85% In Preventing Severe Disease

Professor Linda-Gail Bekker, one of the national protocol chairs of the J&J healthworkers vaccination study, which is being called Sisonke (meaning “together” in isiZulu), told a media briefing last week that the J&J vaccine had been proven to be safe and efficacious in a large global study involving over 44,000 people in the USA, Latin America and South Africa. 

It is a follow-on to the Ensemble study which found the vaccine to be 72% efficacious in preventing infection in the US; 57% efficacious in South Africa, and 85% effective overall in preventing severe infection. A  third of the study was made up of people of the age of 60, and it included those with co-morbidities including diabetes and HIV. Fifteen percent of participants came from South Africa.

“This high vaccine efficacy was consistent across countries and regions, including South Africa where almost all cases were due to the new variant of SARS-CoV-2, B.1.351,” said Bekker.

Professor Glenda Gray, president of the SA Medical Research Council (SAMRC) and the principal investigator of the Ensemble study in South Africa, said that J&J had a “rolling” application with SAHPRA but that the regulatory agency was only likely to decide on an emergency use license for the vaccine in late March or April. 

The SAMRC and the Department of Health will co-host the Sisonke study, which starts on Wednesday at 16 hospitals countrywide, including those that have been hardest-hit by the pandemic. It aims to reach the country’s 1.25 million health workers. By mid-Tuesday, 28% of healthworkers had registered to receive theJ&J vaccine, which only requires a single dose.

Sisonke is described on the SAMRC website as an “open label, single-arm Phase 3b vaccine implementation study of the investigational single-dose Janssen COVID-19 vaccine candidate [that] aims to monitor the effectiveness of the investigational single-dose Janssen vaccine candidate at preventing severe COVID-19, hospitalizations and deaths among healthcare workers as compared to the general unvaccinated population in South Africa.”

South Africa Also Waiting For Pfizer Vaccine Doses To Arrive Next Month

South Africa has also bought 20 million Pfizer doses directly from the pharma manufacturer – but these are only expected to arrive in the latter part of the year. In the meantime, it has been allocated 117 000 Pfizer doses from COVAX according to its interim distribution forecast. These are expected within the next month or so and, as the WHO has granted an emergency use license for this vaccine, that will enable a fast-tracked approval process by SAHPRA.

South Africa has been the hardest hit country on the continent, accounting for over 55% of cases and an accumulated caseload of almost 1.5 million. 

In a race to vaccinate health workers before a third wave of COIVID-19 infections – predicted to hit the country in late May – the South African government bought 1.5 million doses of the AstraZeneca vaccine directly from the Serum Institute of India.

One million AstraZeneca doses arrived in the country on 1  February to much fanfare. However, within a matter of days, the country’s optimism was shattered by the results of a small study of the AstraZeneca vaccine, which showed that it did not protect against mild or moderate infection of the B.1351 variant.

“South Africa could not delay the receipt of the vaccine batches to await the results of the efficacy studies by our scientists. If we had done this, it would have relegated our country to the back of the line, due to the global shortage of supplies,” added Mkhize at last week’s briefing. 

Image Credits: Janssen.

Ngozi Okonjo-Iweala speaking at her first press conference after being appointed as the new WTO Director General on Monday.

IBADAN, NIGERIA – She is happy to be breaking World Health Organization (WTO) ceilings for women and Africans – but has always been a disrupter and technocrat who is used to making changes that stand the test of time and put those in need at the center — even when it is unpopular. 

Beginning on 1 March 2021, Ngozi Okonjo-Iweala will become the first woman and African to take the helm as Director General of the WTO. While this feat is resonating across the world, it is not the first time the Nigeria-born and US-educated development economist has broken global records. She also did so whilst holding senior positions as Finance and later Economics Minister in the Nigerian government. Iweala was widely regarded and even revered as one of the country’s most able technocrats – sustaining major achievements like the renegotiation of Nigeria’s crippling foreign debt – while suffering personal tragedies of her own.

Young Iweala with her now husband while in college.

Iweala was just six years old when her country gained independence from its British colonial masters. Just 60 years later, she has become one of Nigeria’s—and indeed one of Africa’s—frontline technocrats working with national governments and politicians while remaining relevant on the global scene. 

Princess in Nigeria’s Southern Delta Region   

Born in Ogwashi Ukwu in southern Nigeria’s Delta region, Iweala is an indigene of a town that has  produced several notable Africans, including Olympics medalists and the phenomenal football legend, JJ Okocha. But Iweala is not just an indigene of the town, she is also known to Nigerians as a princess of the city considering that her father, Professor Chukwuka Okonjo, was the Obi (King) from the Obahai Royal Family of Ogwashi-Ukwu.

Her early years were spent modestly; she lived with her grandmother in her hometown while her parents studied abroad. But education was always a family priority; she attended a series of top-notch schools that flourished in this period, including Queen’s School, in Enugu State, followed by St. Anne’s School, Molete, in the city of Ibadan, and then the International School of Ibadan. 

In 1973, she moved to the United States to study economics at Harvard University, graduating in 1976. She loved the education she had at Harvard – later ensuring that all four of her children would also have a Harvard education.  

5 Harvard graduates in one family. Iweala with her husband Dr.Ikemba Iweala, a neurosurgeon, and their four children.

Five years after leaving Harvard, Iweala finished her PhD in regional economics and development from the Massachusetts Institute of Technology (MIT) in 1981 – her thesis focusing on credit policy, rural financial markets, and Nigeria’s agricultural development.

Twenty-five Year World Bank Career

Throughout her travails in the face of opposition from President Donald Trump-led US government, supporters of Iweala spoke glowingly of her credentials, both in her national government roles and her World Bank career that spanned 25-years – and where she rose to the position of Managing Director, overseeing the financial institution’s $US 81 billion operational portfolio in Africa, South Asia, Europe and Central Asia.

During her term as Nigeria’s finance minister, from 2003-2006 Iweala led discussions and negotiations that resulted in the Paris Club wiping out US$30 billion of Nigeria’s debt. She was also instrumental in the creation of the Nigerian government’s excess crude oil account — in which revenues accruing above a reference benchmark oil price are saved in the special account for use to stabilize the country’s economy and smooth out the impact of price volatility in oil exports. 

Ngozi Okonjo-Iweala at the 2004 Spring Meetings of the International Monetary Fund and the World Bank Group when she was the Finance Minister of Nigeria.

Over 18 years later, the policy is still being implemented, and it has helped Nigeria in protecting itself from today’s volatile oil market. In February 2014, the account had a balance of about US $3.6 billion – although over the past few years of global oil price decreases, the account has been drawn down dramatically by the current government to its current balance of just  $72.4 million in January 2021.

In a later term, as Minister of Economics, she tackled corruption frontally – instituting a practice whereby the national government began to publish the monthly financial allocation that each state received from the federal government in the national dailies with the aim of improving transparency in governance. This is still being done to date.

Her policies met a challenge of the most personal nature. 

On 9 December 2012, Iweala’s mother, Prof Kamene Okonjo, was kidnapped from the family home in Ogwashi-Uku, with the kidnappers demanding Iweala’s resignation. After three days her mother was freed, and Iweala went public. 

“My mother, a retired professor, was held without food or water. The kidnappers spent much of the time harassing her. They told her that I must get on the radio and television and announce my resignation,” Iweala later said.

The kidnappers, she said, were most likely driven by her intervention to address a US$ 6.8 billion oil subsidy scam.

Within Nigeria, Iweala has been a rallying force driving public attention to previously ignored ministries, agencies and issues – including issues where health, well-being and economics converge. 

This same drive has already been evident in her rise to the leadership of the WTO—an organisation that many Nigerians did not know much about – before the US opposition to her candidacy drew vast attention from different quarters to the election process.

In another term at the World Bank, between her stints in the Nigerian national government, she led the organization’s initiatives to assist low-income countries during the 2008-09 food crisis that coincided with the US stock market crash and global recession – rising to the position of managing director. 

Ngozi Okonjo-Iweala as Managing Director of the World Bank at a World Bank/IMF Spring Meetings Water and Sanitation Event in Washington, DC in 2010.
Iweala’s Critics and Targeted Attacks

Inasmuch as Iweala’s rise to the top of the WTO is being celebrated, it has also not been void of controversies.  Iweala’s years of experience at the World Bank means that she is also closely associated with an institution that many progressive critics say can use economic policies to reinforce global inequalities.

In its publication on the criticisms of the World Bank, the Bretton Woods Project noted that power imbalance in the World Bank meant there is structural under-representation of the Global South.

From a policy point of view, some critics will no doubt say that Iweala’s long sojourn at the World Bank means she is well aligned with its more regressive side – including policies that can favor government reductions in social services, protections and subsides; support labour “flexibilities” and lowering of public sector wages; or increase value added taxes and other regressive tax measures- as a means of containing inflation and keeping corporate tax rates low. 

Leading on a Broader Path – Including Health, Gender & Climate

Still in terms of the WTO, which has become deeply mired in the more legalistic and tactical aspects of trade policies and disputes over the past few years, Iweala now sees herself leading the trade organization on a potentially broader path, which looks more deeply at the bigger picture issues.

She also wants the Organization to regain its stature, telling WTO members shortly after her election that: “A strong WTO is vital if we are to recover fully and rapidly from the devastation wrought by the COVID-19 pandemic.”

In June 2020, a few weeks after the first case of COVID-19 was confirmed in Nigeria, Iweala was on a World Economic Forum podcast where, among other things, she revealed that while globalisation is good, COVID-19 has shown that individual countries would need to reassess their supply chain, and ensure that a certain basic minimum of the supply chain is either locally available or accessible when the needs arise – to avoid the rush for gloves and surgical masks seen then.  

“If we are rebuilding and creating jobs through infrastructure, do we build them back in the old way or do we look for low carbon emission more climate friendly ways to do it?” she asked.

And the gender agenda can also be integrated into that, by putting women and youth more at the center of decision making.

“Very often they [women] are not consulted in the way they should and this pandemic has affected them differently. Take women, for example, they’re the bulk of frontline workers in terms of nurses, community, health workers, and so on. But are they really consulted in the way decisions are made? The answer is no,” Iweala has said.

The Critical Moment for WTO – in the Post Trump Era 

WTO may have been sigficantly weakened by the bigger geopolitical and economic battles at play – between the United States and China as well as global haves and have nots. But those also were sharply exacerbated over the past four years by the administration of former US President Donald Trump. 

The Trump administration not only blocked Iweala’s election as WTO DG, it also effectively blocked one of WTO’s most important functions, that of of resolving trade disputes between countries – by blocking the appointment of new judges to the trade dispute mechanism – thus paralyzing the global organisation.

Along with unlocking Iweala’s stalled appointment, it is now hoped that new US administration of President Joe Biden will also help facilitate the appointment of judges to the WTO appellate body, so that the organisation can resume its adjudication responsibilities in trade disputes between countries. 

In a press conference Monday, just after her election, Iweala recalled the moment at which she learned of the Biden administration’s decision to support her candidacy as “absolutely wonderful…. when the Biden-Harris administration came in and broke that logjam joined the consensus and and gave me such a strong endorsement.

But she said that she hasn’t taken much time to celebrate, adding that as the first African and woman to assume the helm of the WTO “I absolutely do feel an additional burden” as well.

“Being the first woman and the first African means that one really has to perform,” she said. “It’s groundbreaking, and all credit members for electing me and making that history. But the bottom line is that if I want to really make Africa, and women proud I have to produce results, and that’s where my mind is at. Now, how do we work together with members to get results.”

Image Credits: WTO, Facebook, Wikimedia Commons, Flickr – World Bank Photo Collection.

The AstraZeneca/Oxford COVID-19 vaccines being produced by the Serum Institute of India and SK Bio in South Korea were listed for emergency use by the World Health Organization (WHO) on Monday.

Emergency use listing (EUL), which involves experts assessing their safety, efficacy and quality, is a prerequisite for vaccines before they can be distributed by the global vaccine facility, COVAX. 

“Although the companies are producing the same vaccine, because there are many different production plants they require separate reviews and approvals,” WHO Director General, Dr Tedros Adhanom Ghebreyesus told the body’s biweekly pandemic media briefing.

“This listing was completed in just under four weeks from the time WHO received the full dossier from the manufacturers,” said Dr Tedros, adding that it was the second vaccine to get the WHO’s EUL after the Pfizer-BioNTech vaccine.

Dr Mariângela Simão, WHO Assistant-Director General for Access to Medicines

Dr Mariângela Simão, WHO Assistant-Director General for Access to Medicines, said there was now no need for countries to do bilateral deals with vaccine manufacturers as COVAX had already secured two billion vaccine doses and worked out their distribution, and the listing would “trigger a lot of purchase orders”.

“Countries with no access to vaccines to date will finally be able to start vaccinating their health workers and populations at risk, contributing to the COVAX Facility’s goal of equitable vaccine distribution,” added Simão, who described the vaccine as easy to use as it can be kept in a normal fridge.

The Pfizer/BioNTech vaccine, which was giving EUL in December, needs to be kept in very cold storage of minus 70C.

China Team Summary Report Will be Based on Consensus

In response to news reports that indicated differences of opinion among the WHO expert group on the origin of the virus, which returned from China recently, WHO technical lead on COVID-19, Dr Maria van Kerkhove stressed that the team had not yet issued its report.

“The mission team from have recently returned from China and they are working on two reports. The first is a summary report just highlighting the work that has been done and some initial findings and recommendations, and then there will be a longer report. The idea would be that they would issue the summary report and then have a full press briefing themselves,” said Van Kerkhove.

Dr Peter Ben Embarek

Team leader Dr Peter Ben Embarek said that the summary report, expected in a matter of days, would be a “consensus report” reflecting  joint activities.

“The international teams and its Chinese counterparts have already agreed on the summary report when we were in Wuhan on the last day of mission, in particular, in terms of key conclusions, key findings, and key recommendations,” said Ben Embarek, adding that they were currently finalising the technical, background and methodological parts.

“The report will make recommendations for future long-term studies to explore some of the hypotheses and advance our understanding of the origin of the virus,” he added.

“Of course, the fact that we have different scientists with different backgrounds and different fields of experience, means that everybody has their specific views, specific recommendations, specific interest in moving some studies forward,” he said.

His comments came after Dominic Dwyer, an Australian infectious disease expert who was part of the international expert team, said the team had requested raw patient data from the Chinese but were only given a summary.

Dwyer told Reuters on Saturday that sharing anonymised raw data is “standard practice” for an outbreak investigation. He said raw data was particularly important in efforts to understand Covid-19 as only half of 174 initial cases had exposure to the now-shuttered market where the virus was initially detected. “That’s why we’ve persisted to ask for that,” Dwyer said. “Why that doesn’t happen, I couldn’t comment. Whether it’s political or time or it’s difficult.”

Dwyer also told the New York Times that the lack of access to detailed patient records from early confirmed cases, and possible ones before that, had prevented the team from nailing down when the first clusters of cases really emerged from Wuhan.

“We asked for that on a number of occasions and they gave us some of that, but not necessarily enough to do the sorts of analyses you would do,” said Dwyer.  The black spots are all the more troublesome because Chinese scientists have acknowledged that nearly 100 people were hospitalized in Wuhan as early as October 2019 with symptoms such as fever and coughing. Other international reports have also provided evidence of an uptake in hospitalizations overall in the autumn months – before the usual start of the flu season. Although the Chinese experts claims that these patients were not COVID cases – without detailed records that would be impossible to confirm.

The battle over the early cases is critical because it would be evidence that the virus originated in China. China has tried to promote a theory that the virus first infected people in Wuhan via imported frozen foods – something the WHO team agreed to investigate – even though key members are skeptical: “I think it started in China,” Dr. Dwyer said. “There is some evidence of circulation outside China, but it’s actually pretty light.”

A Danish epidemiologist on the team was also highly critical of the lack of Chinese transparency regarding the data, saying that the trip was. “If you are data focused, and if you are a professional,” said Thea Kølsen Fischer told the New York Times, then obtaining data is “like for a clinical doctor looking at the patient and seeing them by your own eyes.”  She added, “It was my take on the entire mission that it was highly geopolitical….Everybody knows how much pressure there is on China to be open to an investigation and also how much blame there might be associated with this.”

WHO Does Not Support Vaccine Passports at Present

Dr Michael Ryan, WHO executive director of emergencies, said that the emergency committee “does not advise the use of immunity certification as a prerequisite of travel” at this stage.

This was because “the vaccine is not widely available would actually tend to restrict travel more than permit travel” and there was not enough data to understand “to what extent vaccination will interrupt transmission”, particularly whether a vaccinated person can continue transmitting disease, said Ryan.

Once the vaccine is widely available and there is clarity about transmission dynamics, “disease vaccination passports can form part of a long term strategy for disease control and for the prevention of the disease potentially moving from one place to another, as we’ve seen with yellow fever vaccination requirements, which have been in place for a large number of decades now”, said Ryan. 

Ryan also cautioned that, although the global COVID-19 cases had decreased for the fifth consecutive week and were now at their lowest since last October, this could be the result of the natural patterns of the virus.

“I do think a good portion of that has been done to the huge efforts made by communities. There have been very stringent lockdowns and stay-at-home orders and other things, but also serum prevalence is rising. We need to understand what is driving those transmission dynamics. Is it natural seasonality and wave-like pattern of the disease? Are we building up a level of immunity in the population that’s preventing the disease from finding the next case? Are our control measures having an impact on that?’ asked Ryan.

He said that while all these factors were likely to hold some truth, the virus also had “a high force of infection” and it could “re-ignite and re-accelerate”. 

“It’s the accelerations in these in this disease that have been the most worrying,” said Ryan. “The disease can move along at fairly low levels and then you see this really fast acceleration and spread.

“We need to avoid that the next time, and we do believe that vaccines offer an opportunity to reduce the hospitalizations and deaths. ”

  • Updated 16 February, 2021

Image Credits: AstraZeneca.