Escalating violence in Aleppo, northwest Syria, has claimed innocent lives and further devastated homes and one critical health facility.

Syria needs $US 78-million to vaccinate 20% of its population against COVID-19 by the end of this year, and its pandemic response is being challenged by a worsening humanitarian crises in the country, including continued attacks on health care facilities.

This is according to Akjemal Magtymova, the World Health Organisation (WHO) Representative in Syria, who told a media briefing on Tuesday that the country had only received half of the funding it had requested for this year and that additional assistance was needed to combat the virus and save lives.  

The briefing comes two days after the Al-Atareb Hospital in the Aleppo area was hit by artillery shelling from Syrian government forces, killing six people and injuring 17, including patients and medical personnel. 

The underground hospital, in an area controlled by forces opposed to the Syrian regime, sustained structural damages, resulting in the evacuation of all patients and staff, and the suspension of health services.  Hospitals and clinics in opposition-held areas have been repeatedly targeted, and destroyed in attacks by government forces – backed by Russia and Iran, according to a recent report by the International Rescue Committee. The attacks have continued despite a Russian-Turkish ceasefire covering rebel-held areas of northwest Syria, in effect since March 2020. Only 58 percent of hospitals remain fully functional, according to UN data.

“Thousands of people who depend on this hospital for basic and lifesaving health care are now deprived of this basic human right. Our thoughts and prayers are with the families of the victims,” said Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean Region. 

Magtymova said funding is needed for creating mobile clinics, services, training, administration of vaccines, surveillance and dealing with side effects in the country whose health system and financial resources have been severely strained by war.

The country is expected to get its first delivery of AstraZeneca vaccines from COVAX within the next two to three weeks, allowing it to kick off a national COVID-19 vaccination programme starting with healthcare and frontline workers. Its immediate need is $7-million to vaccinate 2% of the population before the end of June.

Magtymova said WHO was working with dozens of different international and regional partners to address some of the country’s challenges, including funding, security issues and the fight against COVID-19. 

“We have worked hand in hand with our partners for coordinated efforts for COVID-19 preparedness and response against enhancing laboratory surveillance capacity, infection prevention and control points of the case management,” said Magtymova. “Most importantly is to maintain essential health services…and health care professionals are severely depleted.”  According to the IRC report, following a mass exodus of medical personnel, there remains just one Syrian doctor for every 10 000 civilians. 

COVID Adds To Multiple Healthcare Challenges in a Complex Environment

Describing the situation as “one of the most complex environments”, Magtymova said some of the challenges included “expanding public trust measures and achieving behaviour change, protecting health workers, security and access in ensuring continued use of essential health services, as well as establishing reliable supply chains”.

Some of the challenges at health care facilities include patients being treated in overcrowded rooms with no masks or social distancing and patients with abdominal wounds due to artillery strikes being treated in the same rooms as mothers with children. Some patients had to take detours of about six hours to get medical help due to hostilities and violence in their areas.

Magtymova added that while the pandemic was WHO’s priority, non-communicable diseases remain one of the major causes of mortality and morbidity with COVID-19 making people even more vulnerable. 

“Access to essential medicines have been severely compromised due to economic constraints. WHO sustains provision of life saving medicines to patients with diabetes, kidney diseases and failure, cancer, alongside with COVID-19 patients,” she said.

Giving an update on the situation in the northwest part of Syria, held by opposition forces, Mahmoud Daher, head of the WHO’s Gaza sub-office, said increased attacks on healthcare facilities were impeding the provision of critical health services.

“In Syria in general, and in northwest Syria, we have witnessed the attack on a hospital that was providing 5700 outpatient consultations, 375 hospital admissions and 160 major surgeries per month,” said Daher.

“This situation continues, and shows the fragility of that system that is prevailing in the northwest Syria. We are working with the international community and with the UN system in order to continue to provide health care services to the entire population. We are working under the United Nations Security Council Resolution to ensure that humanitarian assistance can continue despite the current volatile situation,” said Daher.

Syria’s COVID-19 real COVID-19 Numbers Are Much Higher than Official Data

On 26 March 2020, children in the town of Binnish, Syria, watch a member of the Syrian Civil Defence disinfect a former school building, now inhabited by displaced families, as part of measures to prevent the spread of COVID-19.

Syria has nine dedicated COVID-19 hospitals, 70 community care treatment centres for moderate to mild cases of the virus. Three laboratories have been established to detect and confirm COVID-19 cases. The country has registered 21, 260 COVID-19 cases, with 411 deaths.

Daher believes that investment from the international community, led by WHO, has contributed to the low numbers. He however warned that: “The situation is in need of all our efforts in order to contribute to humanitarian assistance, including radical services”.

As of 19 March, Syria had 21,000 COVID-19 cases reported in northwest Syria, more than 9,000 in the northeast and more than 17,000 in government-controlled Syria – the highest case fatality ratio is under government control territory. 

However, Magtymova believes that the numbers are not a true reflection of the COVID-19 situation, partly due to the country’s testing and record-keeping capabilities.

I do believe that the real numbers are much, much higher. The virus is not behaving differently in Syria. In fact, we are not aware of what kind of variants of the virus we are dealing with, because of the level of the capacities, but as WHO we have sent samples for sequencing to understand,” said Magtymova, adding that they were seeing a 100% bed occupancy level.

“Our epidemiological curve shows an increase in the new cases…which means that we are working in a very steep curve. And I have no reason to believe that, you know the situation of recorded cases is real. I’ve seen much more people with COVID-19, said Magtymova.

Magtymova concluded that the current infection patterns emerging in Syria and the looming third wave of the pandemic necessitates a more vigorous and urgent response.

 

Image Credits: Unicef.

WHO Director General Dr Tedros Adhanom Ghebreyesus

For the fifth week in a row, global COVID-19 cases have increased, with substantial increases in South-East Asia (49%) and the Western Pacific (29%), according to the World Health Organization (WHO).

India is driving up numbers in South-East Asia, while the Philippines and Papua New Guinea are responsible for the Western Pacific increases, according to Maria Van Kerkhove, WHO’s technical lead on COVID-19 speaking at the global body’s bi-weekly pandemic briefing.

Europe’s 12% increase was largely being driven by the spread of the B.117 variant “that was first identified in the UK, that is now starting to circulate in many countries in the eastern part of Europe,” said Van Kerkhove.

“The Americas and Africa have seen a slight decline in the last seven days, but overall, we’re seeing increasing cases and these are worrying trends in Europe and across a number of countries,” she added.

Brazilian Deaths Have Doubled in a Month

Despite a decline in the Americas, COVID-19 cases in Brazil have exploded with around 70,000 new cases a day and 2,000 deaths.

Describing Brazil’s cases as “accelerating really, really fast”, WHO Director General Dr Tedros Adhanom Ghebreyesus said that the global body was “especially worried about the death rate, which doubled in just one month from 7,000 to 15,000 a week”. 

However, Tedros was non-committal about giving Brazil’s new health minister – the fourth since the pandemic started – much advice other than that only “concerted effort of all actors that will reverse this upward trend”.

Van Kerhove reported that the ICU capacity has been running at over 80% in 25 of Brazil’s 27 federal units in the past week, and said that the P.1 variant prevalent in the country had increased the transmissibility of the virus.

“The country is under a heavy burden, but as you have heard us say many times before, Brazil has a lot of experience of dealing with not only COVID-19 but many infectious diseases,” she said.

WHO’s country staff are “working with the different federal levels in the state levels to support the country and to make sure that those who are needing care received the oxygen that they need”, and “vaccination is well underway”, added Van Kerkhove. 

Driving the increases

Van Kerkhove attributed the global increase to four main factors: pressure for countries to open up, difficulties in people and communities complying with “proven control measures”, uneven distribution of vaccines and the spread of variants, particularly B.117, B.1351 and P.1.

“If you have a combination of factors: of virus variants that transmit more easily, individuals who are fatigued and frustrated because we want this to be over, and are perhaps not being supported in carrying out the individual behavioral measures … to reduce our contact with others, and vaccination that is not yet reaching those who are most at risk – that is a very dangerous combination,” said Van Kerkhove.

Suppliers Can’t Keep Up With COVAX Orders

WHO special adviser and COVAX representative, Dr Bruce Aylward, said that “the facility can deliver that over 300 million doses” and “we’ve seen in the last couple of weeks some incredible work by t

“The procurement coordinators that are part of COVAX and UNICEF have been able to very rapidly put in place the purchase orders and very rapidly put the shipping pieces in place as well. 

“The problem that we have, quite frankly, is we simply cannot get enough vaccine to be able to keep up and the manufacturers are unable to keep up with our orders. We have two main suppliers to COVAX in this period, the Serum Institute of India, which got off to a great start but has had trouble now with its deliveries in March and April. And then AstraZeneca itself, the facility in Korea has also gotten off to a good start, but is having challenges keeping up with the rate of orders.,” said Aylward.

“We are hoping that both companies will be able to scale up and keep up with the rate of deliveries that we’re aiming for. But we’re still having some teething problems on the part of the suppliers that are trying to keep up with the demands that we’re making.”

Globally, 785 million people lack a basic drinking-water service and over half of the world’s population could be water-stressed by 2025.

COVID has highlighted deep-seated weaknesses in urban water and sanitation systems that are vital to health – but the pandemic has also underlined how improvements can hit back at the SARS-CoV2 virus – as well as reducing other traditional waterborne diseases. 

That was a key message at a seminar Monday on “Water and Sanitation in the City” – sponsored by the Geneva Cities Hub, UN Habitat, and Geneva Water Hub, on the occasion of World Water Day. It was the first in a series of ‘Geneva Urban Debates.’ 

“COVID in some ways has given us a huge opportunity in the water sector, because it has acted as an x-ray,” said Graham Alabaster, Chief of the Geneva Office of UN Habitat. 

He pointed to evidence that showed in cities where hygiene standards were improved so as to combat the spread of the SARS-CoV2 virus, the incidence of waterborne diseases has dropped significantly. “So we know that the ideas around hygiene and providing people with water and sanitation work,” Alabaster added.

On the right, Graham Alabaster, Chief of the Geneva Office of UN Habitat, and on the left, Kamelia Kemileva, Executive Manager of Geneva Cities Hub.

Water also is a a critical “engine for economic growth” and a precondition for development, said Sami Kanaan, Mayor of Geneva and the President of the Geneva Cities Hub. It is an issue that converges with health, poverty, climate change, education, and livelihoods. 

“Increasing access to safe drinking water and basic sanitation is a crucial step in eradicating growing poverty and reducing inequality in cities,” said Kanaan. 

The importance of accessing water and sanitation has been highlighted by the COVID pandemic, whereby one of the key infection prevention measures promoted from the beginning by WHO was effective handwashing and other good hygiene measures.

And yet, in many low- and middle-income cities, low-income households and neighbourhoods are often left without reliable access to clean water and must buy it from private vendors, paying up to five times as much as that paid by middle class residents. That makes uptake of hygiene messages for disease prevention all the more challenging.  

Over Half of World’s Population May Be Water-Stressed by 2025

By 2025, over half of the world’s population will be living in water-stressed areas. And some 68% of the global population is projected to be living in cities by 2050, making urban challenges around the universal provision of safe water and sanitation all the more daunting. 

At the same time, some cities have found innovative ways to meet growing demands, and sharing urban experiences across continents can help improve cities’ performance, the panelists underlined.  

The panelists highlighted the need to move beyond an approach to water and sanitation focused merely on service provision; instead attention also needs to be paid to broader assessments of water resources, the effective distribution of water, and sustainable financing for infrastructure. 

“We need an effective multi stakeholder framework, it must be an institutional will and institutional intention at the city level, with the support of the upper institutional levels,” said Kanaan. “Water management needs cooperation of all levels.”

Sami Kanaan, Mayor of Geneva and President of the Geneva Cities Hub, at the ‘Water & Sanitation in Cities’ event on Monday.

“Sustainable management of fresh water is a vital issue of this century at the center of health security, food security, energy security, and in short human security,” said François Münger, General Director of the Geneva Water Hub. 

Conference Featured Stories from Kenya, Tanzania, Nepal & Mauritania 

The conference featured good practices from cities in in Mauritania, Tanzania, Nepal and Kenya highlighting how public and public-private partnerships involved in managing urban water and sanitation had brought about change, in some of the following ways: 

Informal settlements in Dar-es-Salam, Tanzania.

Dar-es-Salaam in Tanzania – Only 10% of the city’s 7 million people have sewer connections or safe onsite septic tanks.  New approaches have revolved around “simplified sewerage” hookups, that involve laying small diameter pipes at a fairly flat gradient/slope to sewer ponds. The municipal water and sewerage utility provide technical support and finance, while households in the community provide space and labour to lay the pipes. A more recent pilot has connected households to a community-based waste water treatment plant (DEWAT) that produces biogas from the methane extracted from the sewage. The biogas then provides a clean and climate friendly fuel source for household cooking.

Nairobi, Kenya – Chronic water shortages affecting some 60% of the population have been traced to the conversion of wetlands and forests that form the watershed for the Tana River – into agriculture land. The unsustainable agricultural development has increased volumes of sedimentation that enter the river with rainfall, reducing the flow of the river and its watershed which supply 95% of the water for Nairobi’s population and causing blockages in water treatment facilities.

Several public and private partners joined to provide training and tools to over 25,000 farmers upstream on river and soil conservation and to restore forest land. These efforts have benefited farmers, by increasing agricultural yields by over US$3 million per year, and city residents, with 27 million more litres of water available every day for the city’s water needs.

The steps involved in the Upper Tana Nairobi Water Fund project in Kenya.

Dhulikhe, Nepal –  A national sanitation and hygiene campaign was launched in 2010, leading to the prioritisation of investment in sanitation facilities and increasing access to sanitation for the majority of households. In the country’s Dhulikhel municipality, the local government passed a ‘’one house, one tap’’ policy with the goal of providing safe drinking water to every household in the city. The plan arranged for every resident to get 65 liters of water per day. 

Dhulikhel also joined Banepa and Panauti, all in the Kavre district, to collaborate and manage drinking water in an integrated manner. The project identified and mapped existing drinking water sources and established Water Supply User Committees to represent and engage local communities in governmental water supply schemes and improve investment in the needs of communities.

Health Impacts of Poor Access to Clean Water and Sanitation 

Long before COVID, diarrhoea was estimated to kill some 829,000 people a year, as a result of unsafe drinking water and poor sanitation, according to the World Health Organization. Contaminated drinking water – which may be due to the encroachment of sewage or industrial pollutants into drinking water resources – is estimated to cause 485, 000 diarrhoeal deaths each year.

Many neglected tropical diseases (NTDs), which infect millions of people worldwide, are water or hygiene-related and are most often found in places with unsafe drinking water, poor sanitation, and insufficient hygiene practices.

Some of the biggest challenges occur in fast-growing cities, where sprawling informal settlements often develop on the periphery, without adequate water and sanitation infrastructure planning – leaving only ad hoc approaches. 

Poor sanitation in informal settlements disproportionately impacts women and girls, with an estimated 335 million girls attending schools without access to safe latrines, not to mention water and soap for hygiene. Deprived of adequate sanitation and hygiene facilities, adolescent girls may just avoid school on days when they are menstruating.  

Improved water, sanitation and hygiene has the potential to prevent at least 9.1% of the global disease burden and 6.3% of all deaths, according to the US Centers for Disease Control and Prevention.

Image Credits: UNHCR, Geneva Cities Hub, Geneva Cities Hub.

The Oxford/AstraZeneca COVID-19 vaccine during the vaccine development process.

In news that should be reassuring for skeptics, the Oxford/AstraZeneca COVID-19 vaccine was found to be 79% effective in preventing symptomatic COVID-19 and 100% effective against severe disease and hospitalization in results of a late-stage clinical trial, published today by the pharma company.

What’s more, analysis of safety results by an independent board found no increased risk of blood-clotting (thrombosis) among the trial participants, the company said in it’s statement – reinforcing findings of the European Medicines Agency (EMA) last week that the vaccine is safe – despite some rare blood clotting events seen in Europe, particularly among young women, that warrant further investigation.

Among trial participants over the age of 65, the vaccine efficacy rate reached 80%. This news is also reassuring, given the limited data on the vaccine efficacy in older individuals that had been seen to date, and which had led many EU countries to set age restrictions on the AstraZeneca vaccine in the first phases of rollout. 

The results of the large-scale trial, with many participants in the United States, also are expected to pave the way for approval of the vaccine by the United States Food and Drug Administration (FDA).

EMA Executive Director Emer Cooke reports the results of the body’s safety committee report  on the AstraZeneca vaccine last week.
New AZ Trial Results – United States, Peru & Chile

The new trial was conducted in the US, Peru and Chile, with 32,449 participants. Efficacy was consistent across age and ethnicity, although 79% of the participants were white, 22% were hispanic, and only 8% were black, 4% asian, and 4% native American. 

In the initial set of Phase 3 trials, which had taken place largely in the United Kingdom and Brazil, only 12% of participants were older than 55. In contrast, the newly reported US trial arm had one fifth of the participants over 65 and approximately 60% had co-morbidities – which would normally increase their risk of developing severe illness, including diabetes, severe obesity, and cardiac disease.

“These findings reconfirm previous results observed in AZD1222 trials across all adult populations, but it’s exciting to see similar efficacy results in people over 65 for the first time,” said Ann Falsey, co-lead Principal Investigator for the US trial, in a press release issued by the pharma company. 

“This analysis validates the AstraZeneca COVID-19 vaccine as a much-needed additional vaccination option, offering confidence that adults of all ages can benefit from protection against the virus,” she added. 

AstraZeneca said that it now plans to submit these findings to the FDA in the coming weeks to receive emergency use authorization. The primary analysis of the data, once it is completed, will also be submitted for peer-reviewed publication.

Planned Delivery of Doses

Meanwhile, AstraZeneca announced on Monday in a press conference that it would deliver 30 million doses of the vaccine to the United States in the first half of April after receiving approval and another 20 million later on in the same month. Subsequently, 15 to 20 million doses will be delivered. 

US health officials have predicted that the country will have enough doses to vaccinate every adult by May using the three vaccines currently approved – Pfizer/BioNTech, Moderna, and Johnson & Johnson.

It is unclear how big of a role the AstraZeneca vaccine will play in the US’ vaccination campaign and whether the government will donate excess doses to countries lacking in vaccines.

At a press conference on Monday, Ruud Dobber, President of AstraZeneca’s Biopharmaceuticals Business Unit, said he would be “very surprised” if the doses were not used to vaccinate Americans. 

Blood Clots and Vaccine Hesitancy
From Europe, concerns have spread worldwide. (on right) Paul Kelly, Australia’s Chief Medical Officer addresses blood clot concerns over AstraZeneca vaccine.

In addition to the trial results, an independent data safety monitoring board (DSMB) conducted a specific review of thrombotic events, including cerebral venous sinus thrombosis (CVST) – a rare disorder of clots in vessels draining from the brain – seen in association with the vaccine’s administration in a number of cases in Europe.

The board found no increased risk of thrombosis among the trial participants, echoing the message from the EMA last week, which stated that the vaccine is safe and effective. 

“We hope this will lead to even more widespread use of the vaccine in the global attempts to bring the pandemic to an end,” said Sarah Gilbert, Professor of vaccinology at Oxford University and co-designer of the vaccine.

According to the latest EMA data, of an estimated 20 million people in the United Kingdom and Europe that had received the vaccine as of March 16, the EMA had identified 18 cases of CVST (cerebral events), occurring shortly after vaccine administration, as well as seven other cases of disseminated intravascular coagulation, DIC.

Although no causal connection has been found between the vaccine and the blood clotting, and several countries have now resumed the rollout of the vaccine, trust in AstraZeneca’s vaccine has taken a hit, particularly in Spain, Germany, France and Italy. 

In a poll conducted by YouGov in March, which included 8,000 participants in seven European countries, respondents were more likely to view the AstraZeneca vaccine as unsafe than safe. 

Some 61% of French, 55% of Germans, 52% of Spaniards, and 43% of Italians said it was unsafe. Confidence in the vaccine has fallen since a poll conducted in February.

“After concerns about its protection and potency were raised by leaders across Europe, the Oxford/AstraZeneca vaccine has undoubtedly suffered damage to its reputation for safety on the Continent,” said Matt Smith, lead data journalist at YouGov, in a statement.

“Not only have we seen considerable rises in those who consider it unsafe in the last two weeks in Europe, the AstraZeneca vaccine continues to be seen as substantially less safe than its Pfizer and Moderna counterparts,” Smith added.

The same decline in public confidence was not seen in the UK, where 77% of participants considered the jab safe. 

According to William Schaffner, Professor of Medicine in Infectious Diseases at the Vanderbilt University School of Medicine, “there will be spillover to the United States, where…there is a substantial group of vaccine hesitant and skeptical people whom we have yet to win over. And all of this discussion, I’m sure, gives them further pause,” he said in an interview with CNBC.

The vaccine has been granted authorization in over 70 countries and received Emergency Use Listing from WHO, leading the way for its use in the COVAX facility to supply low- and middle-income countries with vaccines. 

Serum Institute of India Announces Delays in Supply of AZ Vaccine to several countries.

In other AstraZeneca vaccine news, the Serum Institute of India, a pharma company producing the Oxford/AstraZeneca vaccine for many low-  and middle-income countries, informed Brazil, Morocco and Saudi Arabia that there will be a delay in delivering vaccines they ordered due to a fire in one of the production buildings.

This has “caused obstacles to the expansion of our monthly manufacturing output,” said the Serum Institute in a statement delivered to the Fiocruz Institute in Brazil. 

The statement contradicted one that was provided immediately after the fire took place in which SII said that it would have no effect on vaccine production.

On a brighter side, the company said a production factory in the Netherlands could soon be approved by the EMA. This would expand the doses available to the EU, which has been plagued by vaccine shortages and a slow rollout across the 27-member bloc. 

The announcement came after several months of dispute between AstraZeneca and the European Union over manufacturing hiccups and vaccine supply constraints.   

At the same time, AstraZeneca is the major vaccine supplier of the WHO co-supported COVAX initiative  – and even as production in Europe and the United States moves into higher gear, it may be expected that countries in those regions will come under increased scrutiny for holding onto precious vaccine doses – while LMICs continue to wait.    

“AstraZeneca continues to engage with governments, multilateral organizations and collaborators around the world to ensure broad and equitable access to the vaccine at no profit for the duration of the pandemic,” said AstraZeneca’s statement. 

Image Credits: gencat cat/Flickr, University of Oxford, Sophie Scott/ABC.

Dr Tereza Kasaeva, Director of WHO’s Global TB Programme.

An estimated 1.4 million fewer people received care for tuberculosis (TB) in 2020 than in 2019 – a drop of 21% – according to preliminary data compiled by the World Health Organization (WHO) from over 80 countries.

Countries worst affected are Indonesia (42%), South Africa (41%), Philippines (37%) and India (25%), and the WHO fears that over half a million more people may have died from TB ilast year simply because they were unable to obtain a diagnosis.

“The effects of COVID-19 go far beyond the death and disease caused by the virus itself. The disruption to essential services for people with TB is just one tragic example of the ways the pandemic is disproportionately affecting some of the world’s poorest people, who were already at higher risk for TB,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“These sobering data point to the need for countries to make universal health coverage a key priority as they respond to and recover from the pandemic, to ensure access to essential services for TB and all diseases.”

The WHO report follows a report released last week by the Stop TB Partnership which showed that the drop in people diagnosed and treated for TB in nine high-burden countries had dropped to 2008 levels – a setback of 12 years.

New TB Screening Guidelines

“Twelve years of impressive gains in the fight against TB, including in reducing the number of people who were missing from TB care, have been tragically reversed by another virulent respiratory infection,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership.

“In the process, we put the lives and livelihoods of millions of people in jeopardy. I hope that in 2021 we buckle up and we smartly address, at the same time, TB and COVID-19 as two airborne diseases with similar symptoms.”

To mitigate the impact of COVID-19 on service delivery, the WHO has developed new screening guidance, including the use of rapid diagnostic tests, computer-aided detection to interpret chest radiography and the use of a wider range of approaches for screening people living with HIV for TB. 

The WHO recommends that the contacts of TB patients, people living with HIV, people exposed to silica, prisoners and other key populations should be prioritized for TB screening. 

People With TB Most Marginalised

“For centuries, people with TB have been among the most marginalized and vulnerable. COVID-19 has intensified the disparities in living conditions and ability to access services both within and between countries,” says Dr Tereza Kasaeva, Director of WHO’s Global TB Programme.

“We must now make a renewed effort to work together to ensure that TB programmes are strong enough to deliver during any future emergency – and look for innovative ways to do this.”

The new guidance also recommends different tools for screening, namely symptom screening, chest radiography, computer-aided detection software, molecular WHO-approved rapid diagnostic tests, and C-reactive protein. 

As the popularity of tobacco products wanes, tobacco companies are developing new products to expand their markets.

NAIROBI – The Kenyan government issued a directive in mid-February this year requiring the tobacco industry to register all nicotine products as tobacco products – but the industry has yet to comply. 

This follows the decision by the Cabinet Secretary in the Ministry of Health, Mutahi Kagwe, to declare “nicotine pouches” illegal, thus overturning a decision last year by the Pharmacy and Poisons Board (PPB) to license the manufacture and sale of nicotine products in the country.

 The criteria used to issue the license was not clearly defined, according to the Ministry of Health, hence the unprecedented move by the Cabinet Secretary.

The government’s directive comes in the wake of a nicotine production plant by the British American Tobacco (BAT) company being planned in Kenya. The plant will not only serve the east African region with nicotine products but will cater for the entire African market, making Kenya the gateway for nicotine products into the continent.

 Marketing Hub for Harmful Product

“Kenya is a manufacturing hub of this harmful tobacco product. It is unfortunate that they [BAT Kenya] are putting up another plant specifically to produce Lyft,” said Samuel Ochieng, CEO of the Consumer Information Network at a press briefing called by the Kenya Tobacco Control Alliance towards the end of February.

Lyft is the brand name for the “nicotine pouches” being manufactured by BAT. These pouches are small bags of powder containing either tobacco-derived nicotine or synthetic nicotine, but no tobacco leaf, dust, or stem. People place them under the lip to get nicotine. 

All this comes a year after the Cabinet Secretary in the Ministry of Health, Mutahi Kagwe overturned an earlier decision by the Pharmacy and Poisons Board (PPB) to license the manufacture and sale of nicotine products in the country.

The criteria used to issue the license was not clearly defined, according to the Ministry of Health, hence the unprecedented move by the Cabinet Secretary.

When asked about the government’s position on why Kenya was singled out by the tobacco multinational company, Kepha Ombacho, the Chief Public Health Officer in the Ministry of Health, told Health Policy Watch: “We cannot say for sure that they are targeting Kenya.”

Trying to Diversity Product Line

The tobacco industry is trying to diversify its product line after years of well-documented health risks associated with smoking has had an impact on consumers and industry profits. 

In the past week, the WHO published a new report calling for the strengthening of the tobacco control measures to protect the health of children.

The study, Tobacco Control To Improve Child Health and Development  found that of the 1.2 million deaths every year caused by second-hand tobacco smoke exhaled by smokers, 65,000 occur among children under 15 years.

However, the third edition of the WHO global report on the trends in prevalence of tobacco use 2000-2025 published in 2019 shows a decline in tobacco use among people of both sexes in the world.

According to the report, about a third of the global population aged 15 years and above used of some form of tobacco in 2000. This rate declined by nearly 10% to about a quarter by 2015.

If current tobacco control efforts are maintained, the rate is projected to decline to around a fifth of the (20.9%) by the year 2025, says the report.

Use of Social Media Influencers

The furore generated by the Lyft nicotine pouches in Kenya was well captured by The Guardian in February, which detailed how the brand was using social media influencers to promote Lyft. 

The influencer in the article is a young beauty blogger with an Instagram following of more than 250,000 and a Youtube channel following of well over 55,000 subscribers. She appears to have deactivated her account and removed the Lyft tweets since the expose.

Meanwhile, a PR agent working for BAT even offered a Kenyan journalist a bribe to leak details about an investigation by Bureau for Investigative Journalism into how tobacco companies were targeting young people. BAT has since suspended the agency.

It is clear from these reports that tobacco companies have been using influencers that are popular among the youth to push their nicotine products.

This is made more serious because Kenya is a signatory to the WHO’s Framework Convention of Tobacco Control (FCTC). Article 13 of the Convention clearly talks about banning all forms of tobacco advertising, promotion and sponsorship.

 The Ministry of Head’s Ombacho says that Lyft and any products that contain nicotine are not alternative products to tobacco and should be accompanied by clear labeling stating as much.

 Significant Health Risks

According to the Tobacco Act of 2007, tobacco companies are required to set aside 2% of their revenue to go into the Tobacco Fund to assist people suffering from the health effects associated with smoking.

Only BAT has started to make contributions to the fund although there are at least three active tobacco companies in Kenya, and Ombacho said that “they will just have to comply”.

Nicotine pouches appear to have been developed in Scandinavia. They have significant health risks. Issuing a health warning about them last November, Health Canada warned that they had not been authorised in the country and should not be used “by anyone”

“Nicotine is a highly toxic and addictive substance. Excessive amounts of nicotine can cause acute poisoning, resulting in respiratory failure and death,” according to Health Canada.

Image Credits: By Bystroushaak/ CC BY-SA 4.0, Chris Vaughan.

The Stelis Biopharma manufacturing site in Bangalore, India, where the Sputnik V vaccine will be produced.

Developers of Russia’s Sputnik V vaccine have entered into a partnership with Stelis Biopharma, an India-based drugmaker, to produce 200 million doses of the COVID-19 vaccine. Stelis is now the latest addition to the global production network for Sputnik V. 

The Russian Direct Investment Fund (RDIF), the company responsible for marketing the Sputnik vaccine abroad, announced the partnership on Friday, making Stelis – the biopharmaceutical division of Strides, an Indian pharma company – the most recent in a series of manufacturers RDIF signed agreements with.

“We are delighted to announce our agreement with Stelis Biopharma for a significant capacity of Sputnik V,” said Kirill Dmitriev, CEO of RDIF, in a press release. “The significant vaccine volumes, which will be produced jointly with Stelis, will help widen access to the vaccine on a global scale.”

The vaccine has shown high efficacy results in a peer-reviewed study, with 91.6% efficacy in preventing symptomatic COVID-19 cases and full protection against severe infection. Sputnik V has been authorized for use in over 50 countries, with rollouts underway in several of those countries.

Global Production Contracts for Sputnik V

The Gamaleya National Research Institute of Epidemiology and Microbiology, the developer of Sputnik V, and RDIF have signed contracts with over 15 manufacturers in ten countries to produce 1.4 billion jabs and expand the manufacturing capacity for the vaccine.

Certain factories, including ones in Brazil and Serbia, will be producing vaccines for the domestic population and others – in China, South Korea, India, and Iran – will be exporting vaccines to meet global demand.

“We have some players who are really big, and they will be producing for the whole world. And we have some who are smaller and they will be producing more for local demand,” Dmitriev told the Financial Times in February. “This is our approach: to solve the bigger production issue while also…providing local availability.”

Kirill Dmitriev, CEO of the Russian Direct Investment Fund (RDIF).

India was described as a “key partner” for the production of the vaccine. On Tuesday, an agreement with Gland Pharma, an India-based pharmaceutical company, was announced for 252 million doses, joining India’s Hetero pharma firm, which is set to produce over 100 million doses.

“We are delighted to partner with RDIF to make a substantial contribution towards providing global supply of the Sputnik V vaccine which is one of the most efficacious approved vaccines commercially available,” said Arun Kumar, the founder of the Strides Group.

Supplies from the partnership are expected to be ready for distribution from the third quarter, between July and September. 

Efforts to Expand Production in Europe

Talks are reportedly underway with companies in Spain, France, Germany and Sweden to arrange vaccine production, pending Sputnik V’s authorization for emergency use by the European Medicines Agency (EMA). 

Italy became the first country in the EU to sign a deal to produce the Sputnik V vaccine last week, with plans for Adienne, an Italian-Swiss pharma company, to produce 10 million doses of the vaccine in Italy by the end of the year. 

Support for the Sputnik V vaccine’s approval in Europe seems to be growing, with Norwegian, Austrian and German politicians calling for its procurement. The vaccine could prove to be useful in speeding up the EU’s slow vaccination campaign across the bloc’s 27 member states.

“Concerning Sputnik V and other vaccines, I strongly insist that the relevant EU bodies issue an authorization for all safe vaccines as soon as possible,” said Sebastian Kurz, the Austrian Chancellor, in an interview on OE24 TV on Wednesday. “The more vaccines we have, the better the situation is.”

Sebastian Kurz, Austria’s Chancellor, in an interview on Wednesday.

A couple of EU countries have already moved forward with the national approval and rollout processes ahead of the EMA’s decision, including Hungary, Slovakia, and Czech Republic.

Germany is also interested in signing a national supply deal for Sputnik V, according to Jens Spahn, Germany’s Health Minister, adding that the country is in close contact with Russia about the vaccine.

“I am actually very much in favor of us doing it nationally if the European Union does not do something,” said Spahn at a press conference on Friday. A requirement for the deal, however, would be specifics on the number of doses that could be delivered.

Although RDIF has established a global, decentralized network of manufacturers – attempting to avoid the production shortfalls and delays faced by AstraZeneca, mass production in several of the sites has not yet begun and scaling up production may be an issue. 

According to Dmitriev, RDIF plans to announce the details of overseas production in March. 

EU to Send a Letter to AstraZeneca in Effort to Resolve Dispute

In other vaccine news, the European Commission plans to send a letter to AstraZeneca in an attempt to resolve the dispute over vaccine supply and delays in deliveries.

According to Ursula von der Leyen, President of the European Commission, the pharma company has “under-produced and under-delivered” vaccines to the region, with a reduction in projected deliveries for the first quarter from 90 million to 30 million doses. 

Ursula von der Leyen, President of the European Commission, at a press conference on Wednesday.

AstraZeneca also will only manage to deliver 70 million doses for the second quarter instead of the 180 million stated in its contract with the EU. EU officials say the company is contractually obligated to deliver 300 million doses by the end of June, but is projecting having only 100 million doses available due to production issues. 

“We plan to send a letter to AstraZeneca that will allow us to begin a dialogue with the company as part of a process to resolve the dispute,” said a spokesperson for the European Commission at a press conference on Thursday. 

The letter will be discussed with EU governments before it is sent. 

In the EU’s Advance Purchase Agreement with AstraZeneca, the two parties are required to resolve any issues that arise through informal discussions, initiated by sending a written notice. If the dispute cannot be settled through negotiations, legal action can be pursued. 

“Today we are taking a specific step. We will see where that leads us,” said a Commission spokesperson, not ruling out the potential of the EU filing a legal case against AstraZeneca in the future.

UK Vaccine Supply to be Hit in the Coming Weeks

Meanwhile, a reduction in the United Kingdom’s vaccine supply is expected from 29 March, in part due to a delayed delivery from India of five million doses of the Oxford/AstraZeneca vaccine. India’s recent surge in cases has led the government to use the available vaccine supply to meet domestic needs.

A large increase in cases has been recorded over the past week in India, where just 2.4% of the population have received one dose of a COVID-19 vaccine. The seven day average of new COVID-19 cases is 29,355. 

According to Adar Poonawalla, CEO of the Serum Institute, the pharma company was directed in February to prioritize the needs of India in its distribution of vaccines.

The UK – a country where 37.9% of the population have received at least one jab – made a deal in early March with the Serum Institute of India, the world’s largest vaccine manufacturer and a key source of doses for COVAX to supply low- and middle-income countries, for 10 million doses.

“Five million doses had been delivered a few weeks ago to the UK and we will try to supply more later, based on the current situation and the requirement for the government immunization programme in India,” said a spokesperson for the Serum Institute. 

The shipment of the next five million doses will be delayed by at least four weeks, slowing the vaccination campaign in the UK and making it somewhat dependent on the worsening situation in India.

US Plans to Send Millions of Doses to Mexico and Canada
A healthcare professional preparing to administer the Oxford/AstraZeneca COVID-19 vaccine.

In contrast, the US has millions of doses of the Oxford/AstraZeneca vaccine that cannot be administered nationally because the vaccine has not yet received emergency use authorization from the US Food and Drug Administration (FDA). Some four million of these doses will be delivered to Mexico and Canada, the White House press secretary said on Thursday. 

Approximately 30 million doses have been sitting in a manufacturing site in Ohio, ready to be administered, awaiting data from the US clinical trial for the approval process to move forward. 

“Our first priority remains vaccinating the US population,” said Jen Psaki, the White House press secretary during a press briefing. “[But] ensuring our neighbors can contain the virus is…[a] mission critical to ending the pandemic.”

In the US’ first export of COVID-19 vaccines, 2.5 million doses will be distributed to Mexico and 1.5 million to Canada as a loan. 

Some 3.3% of the Mexican population have received at least one dose of a COVID-19 vaccine, 7.8% of the Canadian population, and 22.6% of the US population. 

The share of the total population that has received at least one dose of the COVID-19 vaccine in Mexico, Canada, and the US, as of 18 March.

Mexico has received 8.1 million doses of COVID-19 vaccines as of Thursday and has begun the rollout of the Pfizer/BioNTech, AstraZeneca, Sinovac and Sputnik V vaccines. Canada’s regulators have approved the Pfizer, Moderna, AstraZeneca and Johnson & Johnson vaccines and the country has received 4.7 million doses so far. 

Canada has struggled to acquire vaccines, turning to Europe, Asia and COVAX to increase its supply. 

“We believe they’re coming very shortly, that’s been the content of our discussions thus far, but I have to stress that we are still finalizing the details,” Anita Anand, Canada’s Vaccine Procurement Minister, said in an interview on CTV News. “We are working to expedite this process as quickly as possible, knowing that Canadians want vaccines.” 

The doses could be delivered as soon as the end of March.

Image Credits: RDIF, Stelis BioSource, CNBC, OE24.TV, Twitter – Ursula von der Leyen, Flickr, Our World in Data.

Vaccination rollout in Accra, Ghana

Mayors from three capital cities in the global south have appealed for speedy “technology transfer” to enable them to produce their own COVID-19 vaccines at Friday’s World Health Organization (WHO) bi-weekly COVID-19 media briefing.

The mayors’ appeal comes on the eve of a meeting next week between WHO Director General Dr Tedros Adhanom Ghebreyesus and World Trade Organization (WTO) Director General Dr Ngozi Okonjo-Iweala to discuss “how to overcome the barriers to boost production vaccine equity”, said Tedros.

Adjei Sowah, mayor of Accra in Ghana, said that his city had almost used up all 300,000 vaccine doses it had received recently via COVAX – yet it has a population of five million including a two-million strong transient population which could be spreading the virus to rural areas.

To achieve vaccine equity, Sowah proposed that rich countries “share their surplus doses” and the “acceleration of technology transfer” to enable manufacturing in Ghana and other countries in order to “reach herd immunity as quickly as possible”. 

‘Finish and Fit’ Possible in Bogota

Mayor Claudia Lopez from Bogota in Colombia, with a population of 11 million, said that her city would need to vaccinate six million people to achieve herd immunity – but it lacked the doses to do so.

Bogota had been able to produce vaccines until 2001 but “because we did not have the sufficient investment in research and biotechnology, we lost that capacity”, said Lopez.

She appealed to the WHO to assist her city to get investment to enable vaccine production – starting with “finish and fit”, the assembly of vaccine products once the biological component had been made elsewhere.

“We do face the real risk of a third wave and it is vital that, before May we have vaccinated, everybody over the age of 60 and all healthcare professionals. So that means that we need 2.6 million doses in the next couple of months,” said Lopez.

Mayor Yvonne Aki-Sawyerr of Freetown Sierra Leone

Mayor Yvonne Aki-Sawyerr, representing Freetown in Sierra Leone and one of the poorest countries in the world, said her city’s vaccine rollout had started with week with 296,000 doses of AstraZeneca (two doses needed per person).

At a meeting over the past week with mayors from the C40, a network of 97 of the world’s biggest capital cities’, Aki-Sawyerr said it was “really fascinating” to hear from cities such as Los Angeles “who are able to talk about a mass vaccination rollout, in contrast to some of us”.

While Freetown had only recorded 2,222 COVID-19 cases and 80 deaths ”you’d almost think that COVID had passed us by, but it hasn’t because the economic impact has been significant”, said Aki-Sawyerr of her city of slightly over a million people.

“What we face, and what other countries and cities in emerging economies that don’t have the access to the vaccine in the same way as countries who are ordering five times what they require and holding on to these, is economic exclusion and greater inequality,” said Aki-Sawyerr.

“We face a risk of being in a situation where vaccine passes are needed for travel, and that could certainly have an impact on tourism,” she said. “We are very concerned about how this will move from a disparity in a vaccine rollout to reinforcing inequalities, reinforcing economic exclusion and thereby putting everyone at risk.”

 

Independent Panel Still Seeking Views Ahead of Submission Date

 

If the world’s pandemic preparedness, alert and response system had been working properly, the COVID-19 pandemic would not have had such “catastrophic consequences”, according to Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response.

So far,  the pandemic has cost 2.6 million lives, had a substantial impact on the education of  millions of children and is projected to have cost economies $22 trillion by 2025, according to a media release from the panel on Friday following a two-day meeting.

“If the existing system, from the global to the national levels was good enough, the worst would not have happened,” said Helen Clark, former Prime Minister of New Zealand, co-chair of the panel, at the opening of the meeting. “The status quo isn’t just not good enough; it has actually had catastrophic consequences,” she said. 

The panel is considering a range of recommendations aimed at “resetting the international pandemic preparedness and alert system” as it prepares its final report to be presented to the World Health Organization (WHO) in May.

These include solving the problems of speed and transparency in alert and response; country preparedness; the authority of and support for the WHO and equitable access to diagnostics, therapeutics, and vaccines. It is also still taking submissions to its website.

Eleven Million Girls Have Dropped Out of School

The 13-person panel reflected on the International Monetary Fund’s projection that COVID-19 will cost $22 trillion in projected cumulative output loss over 2020-2025 relative to pre-pandemic projections.  

It also noted the World Bank report that, as a result of the pandemic and school closures, 72 million more primary school-aged children may not be able to read or understand a simple text by the age of 10. Some 11 million girls are estimated to have dropped out of school.

Co-Chair Ellen Johnson Sirleaf, former president of Liberia, stressed that behind those enormous numbers are millions of people who have suffered incalculable setbacks, from which recovery will be difficult.  

“People who are poor, people who are marginalized, and those who have faced structural injustices have been at a great disadvantage during the pandemic. This must not continue through the recovery. We must keep their lives and their voices at the heart of our conclusions and recommendations.” 

The Independent Panel was established by the WHO’s Director-General to review experience gained and lessons learned from the WHO-coordinated international response to COVID-19.    

 

 

Image Credits: Gavi/2021/Jeffrey Atsuson.

Dentists are confronting the fallout from a year of disrupted dental care and treatment.

One of the unquantified side effects (or health impacts) of the pandemic has been in a place few people cared to look very deeply – that is our mouths.

For significant parts of the past year, dentists’ chairs in many offices around the world sat empty – as COVID-19 disrupted routine dental treatments. During the early days of the first lockdowns a year ago, we were able to accept patients for emergency dental treatments only.

Patients’ fear of leaving their homes resulted in delays and cancellations of regular check–ups, while others simply delayed pending treatment. And most of the patients we saw during this period were suffering from severe tooth pain resulting from unfinished or delayed treatment, ultimately culminating in either an extraction or a permanent restoration of the tooth.

On top of that, the dental profession had been called out (falsely) as being one of the most unsafe in terms of pandemic risks.

COVID-19 and Dental Safety

Most dental practices have now been able to re-open (both in and out of lockdowns), by reinforcing our already stringent infection prevention and control protocols as necessary and according to regulations.

We also have updated data showing that the profession has experienced significantly lower infection rates of SARS-CoV-2 than other healthcare professions in the USA, in Europe and beyond.

Preliminary data on the COVID-19 infection rate among dentists and other healthcare workers, suggest that COVID-19 infection in dental practice may be less likely than in other healthcare settings.

Dental practices are proven to be safe. Despite this, an underlying fear in the general public of contracting COVID-19 persists and has resulted in many of our patients delaying regular check-ups and only booking an appointment once they are already in pain or with infections that require complicated treatment. We encourage our higher-risk patients to have a dental check-up every three to six months – many have quite clearly put off a visit for nearly a year, which has led to extractions that could have been avoided.

This is serious cause for alarm, as these initial oral health issues can transform into broader health concerns. High-risk patients – tobacco users, pregnant women, people with diabetes – who are more susceptible to gum disease and tooth decay can also be more vulnerable to other diseases. Poor oral health has been linked to a host of other health conditions including heart disease and stroke, cancers, and respiratory disorders.

If the call for investing in health systems as part of universal health coverage has largely fallen on deaf ears until now, COVID-19 has certainly forced the issue. This pandemic has severely exacerbated health inequities across the spectrum.

Increasing Burden of Oral Disease

It has never been more apparent that overall health and oral health are absolutely intertwined and cannot exist independently. This World Oral Health Day we need to acknowledge the reality that precedes COVID-19: a picture of an increasing burden of oral disease across the board, matched by inadequate population-level prevention strategies and ineffective care for those in need. We must advocate for oral health professionals (and our profession more broadly) to be actively involved in all efforts to improve health for all and leave no one behind.

Optimal oral health for all is certainly an aspirational goal, but what does it actually stand for? How can we make this goal truly meaningful to oral health professionals, patients and people alike?

Universal Coverage for Oral Health

Any genuine move towards oral health for all first needs to embrace the idea of universal coverage for oral health. This starts with driving better oral health awareness campaigns for public benefit, guaranteeing that by 2030 essential oral health services are integrated into primary healthcare in every country. This shift requires focusing on prevention and early detection of diseases, making oral healthcare available and accessible in both urban and rural areas, and ensuring the affordability of appropriate oral healthcare for all.

It will also be essential to integrate oral health into the general health and development agenda by 2030. This means addressing the shared social, moral, and commercial determinants of health and recognising that untreated oral disease is the most common health condition globally—accounting for a considerable fraction of the overall noncommunicable disease burden.

A Resilient Oral Health Workforce

Finally, by 2030, we need to build a resilient oral health workforce by tackling both the plethora and scarcity of oral health professionals and auxiliaries. This model of an oral health workforce would focus on the prevention of oral diseases; screen for and monitor systemic health conditions; integrate environmentally friendly, innovative, and appropriate technologies to benefit patients; and implement oral health resource and workforce planning in cooperation with governments, educators, and oral health professionals.

Let’s not overlook the obvious: as dentists, we are highly skilled health professionals allied with our medical colleagues. Just look to the role many dentists are playing in delivering the COVID-19 vaccine around the world today. This pandemic has also confirmed that we are veterans in adopting those measures considered to protect against the novel coronavirus: protective gear like masks, gloves, and goggles as well as well as established sterilization and disinfection procedures. Our value should not be underestimated, today and in the future.

Dentists have played an important role in testing for COVID-19 and delivering vaccines around the world.

Oral Health for All

Oral health for all will not happen overnight – it will require ongoing education and awareness around the broader health issues linked with noncommunicable diseases that help to change the narrative and reinforce oral health as an essential health priority. We must focus on evidence-based dentistry and critical thinking, educate and train oral healthcare professionals to advocate for oral health, empower our patients to take responsibility for their own health and well-being, and engage with industry partners around emerging technologies.

The goal of oral heath for all will also require the collective vision and engagement of many stakeholders across the spectrum: industry partners, academics, educators, and researchers.

And let’s not forget policy makers. Governments at all levels must commit to leading the conversation around oral health in their countries and allocate sufficient resources to tackle the oral disease burden.

Perhaps most critically, we need the buy-in of the population at large, who are potentially the most powerful advocates of all to lead the world to optimal oral health.

Dr Gerhard Konrad Seeberger, president of FDI World Dental Federation.

Dr Gerhard Konrad Seeberger is president of FDI World Dental Federation and a private practitioner based in Cagliari, Italy. He is a member of numerous scientific societies (implant dentistry, periodontology). and a regular contributor to Italian and international journals. He was awarded a doctor honoris causa in medicine from Yerevan State University in Armenia and is an honorary member of several national dental associations (Bulgarian Dental Association, Chicago Dental Society, Mexican Dental Association, Romanian Association of Private Practitioners).

Image Credits: FDI World Dental Federation, FDI World Dental Federation, Flickr – Navy Medicine, FDI World Dental Federation.

African countries will be hosting a conference in April to discuss the local production of vaccines.

IBADAN – African countries are hosting a large conference in April to discuss the local production of vaccines, as key players in Africa’s public health sector try to address the continent’s vaccine shortages.

Circumstances surrounding the COVID-19 vaccine production and distribution had necessitated this conversation, William Kwabena Ampofo, Chairperson of African Vaccine Manufacturing Initiative, said during a press conference on Thursday. The conference will take place on 12 and 13 April.

Currently, many African countries are getting most of their COVID-19 vaccines through the global distribution platform, COVAX.

“The current COVID-19 pandemic presents a great opportunity to harness the various conversations and proposals into an action-oriented roadmap led by the African Union and the World Health Organization (WHO) in Africa. And this will lead to increased vaccine production that will facilitate immunization of childhood diseases and enable us to control outbreaks of highly infectious pathogens,” he said. 

William Kwabena Ampofo, Chairperson of African Vaccine Manufacturing Initiative.

However, he admitted that Africa only has about 10 vaccine manufacturers based in 5 countries – South Africa, Morocco, Tunisia, Egypt and Senegal – and most were only doing packaging, labelling and filling, rather than the actual production of the vaccine. But Africa has about 80 companies with pharmaceutical production capacity and the manufacturing of sterile injectables, which provided a great opportunity, added Ampofo.

“In Africa, we usually use a primary dosage form, so there is the opportunity to really consider vaccine manufacturing as a major activity that will provide substantial financial returns to the various countries in the different economic blocs if the vaccine supply and chain is well structured,” Ampofo said.

African Health Leaders and Scientist Advocating for Local Production of COVID Vaccines

Even though the COVAX Facility has promised African countries and other beneficiaries 20% of their respective COVID-19 vaccine needs, many more doses are required to achieve herd immunity. 

In addition, Africa CDC Director John Nkengasong said citizens may need booster shots if the protection offered by the vaccine wears off. These are among the reasons why Africa’s public health leaders and scientists are advocating for the continent to be able to produce the COVID-19 vaccines. Beyond COVID-19, Africa heavily relies on UNICEF and the global alliance, Gavi, for its yellow fever and other vaccines. But there are problems ahead. The biggest, Ampofo said, is the way the market is structured. Addressing this will require active involvement of organisational blocs such as the AU.

“We need the regional economic blocs to take care of a very strategic view of how the countries are interdependent. So that production would be geared towards supplying not just a country but meeting regional needs and establishing a system which sustains vaccine production on the continent,” he said.

Covering Ground

Matshidiso Moeti, WHO Regional Director for Africa.

While the local vaccination plans and discussions are continuing, Dr Matshidiso Moeti, the WHO Regional Director for Africa said the continent is rapidly gaining back lost grounds due to the late arrival of doses of the vaccines. 

“Compared with countries in other regions that accessed vaccines much earlier, the initial rollout phase in some African countries has reached a far higher number of people,” Moeti said.

She attributed the development to Africa’s vast experience in mass vaccination campaigns and the determination of its leaders and people to effectively curb COVID-19.

According to the WHO, two weeks after receiving COVAX-funded AstraZeneca vaccines, Ghana has administered more than 420,000 doses and covered over 60% of the targeted population in the first phase in the Greater Accra region – the hardest hit by the pandemic. In the first nine days, it is estimated the country delivered doses to around 90% of health workers. 

In Morocco, WHO said more than 5.6 million vaccinations have taken place in the past seven weeks, while in Angola, vaccines have reached over 49 000 people, including more than 28 000 health workers in the past week. 

“While the rollout is going well, there is an urgent need for more doses as Ghana, Rwanda and other countries are on the brink of running dry,” Moeti said.

Image Credits: Johnson & Johnson, African Vaccine Manufacturing Initiative, Paul Adepoju.