Press briefing after Chatham House discussion on COVID-19 vaccine supply chain bottlenecks and solutions

A two-day summit of the world’s top pharma and public health sector players to address COVID-19 vaccine supply chain and manufacturing bottlenecks ended on Tuesday with agreement that large vaccine manufacturing scale up potential exists – even in 2021 – but the route is complex and there are no easy fixes. 

And most immediately, there are  “increasing signs of strain within supply chains” as vaccine manufacturers scramble to procure some of the same raw material inputs and equipment, said. Richard Hatchett, CEO of the Coalition for Epidemic Preparedness (CEPI), which has seeded key  COVID-19 vaccine R&D investments, which are now driving the global vaccine distribution platform, COVAX.  

“Companies are beginning to report shortages of critical raw materials, critical consumables, even equipment, that is necessary for vaccine manufacturing,” said Hatchett, at the close of the summit, hosted by the UK-based Chatham House.

He pointed out that the usual global production of vaccines was between 3.5 – 5.5 billion doses whereas the aim for this year was to produce 14 billion COVID-19 vaccines.  A background paper produced out of the summit discussions  “Towards Vaccinating the World” provides one of the most detailed papers to date on the landscape of current vaccine supply chain bottlenecks, manufacturing challenges and possible solutions.  

The paper warns that already “it has become apparent that many COVID-19 vaccine input supplies of raw and packaging materials, consumables and equipment are in short supply which may result in several COVID-19 vaccine manufactures not being able to meet their current vaccine manufacturing commitments.

“Such shortages will also impact the ability to manufacture other lifesaving vaccines and biologics. Mechanisms to ensure input supplies for current and increased manufacturing capacity intent need to be put in place with short, medium and longterm solutions.”

Vaccine Producers by Continent

Largest Ramp-up of Vaccine Manufacturing World Has Ever Seen

Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers (IFPMA) added that few people fully understand the scale of the task at hand. 

“This is the largest ramping up of manufacturing the world has ever seen,” said Cueni. “I have to admit to myself, if you would have asked me three months ago, I would have said there is no idle capacity. Everybody is already doing the maximum of that they can.

“But just over the last few weeks, we have seen new players, experienced players in pharmaceutical manufacturing coming in. We have also seen an amazing amount of collaboration and togetherness, for example, between innovative manufacturers and developing country manufacturers.”

Cueni said the meeting delved into granular detail about the kinds of technology transfers would be needed to fast-track vaccine manufacturing – pointing to the importance of being able to move skilled workforce around, political will and regulatory harmonisation. 

“I think we all extremely grateful for the incredible work regulators do. It is amazing how fast we saw safe and effective vaccines approved,” said Cueni.

COVID -19 Secured Doses 2021 – by high income (HIC), upper middline income (UMIC) and low income (AMC) countries 

Technology Transfer For Vaccines More Complex Than for Chemical Compounds

While access groups have focused in great detail on the issues of patents and IP as a barrier to rapid manufacturing scale-up, the summit participants stressed the ways in which knowledge transfer and the presence of a skilled workforce are preliminary requirements for any expansion of capacity – along with sensitive and sophisticated infrastructure needs.

“Unlike pharmaceuticals which are chemistry-based products, the complexities of biological vaccine operations are still of higher challenge,” said Rajinder Suri, CEO of the Developing Countries Vaccine Manufacturer’s Network (DCVMN).

“You have a drug substance, … you have a drug product. And then you have the final fill and finish. So at the drug substance level itself, there are several complexities which are involved, whether it is in terms of platform technology; whether it is in the form of capacity,… so there are so many issues which one has to really understand, before getting into the tech transfer. And then, matching the scaling up of the facility, whether in terms of fill and finish, or final product.

“Again, this has to be fully understood before getting into this kind of a tech transfer agreement with other companies or other countries. So, the ability of an individual company to absorb technology and have trained manpower to really understand what are complexities and how to take it forward, are also going to be the key challenges.”

Developing Vaccine Manufacturing Capcity in LMICs – Long Term Goal

And while developing vaccine manufacturing capacity in low and middle-income countries was important, said Cueni, this was a long-term goal.

The most immediate challenge is to simply find ways for the world to produce more COVID-19 vaccines – and that meant looking at every corner of the planet “where you have the know-how, expertise and equipment.

Sai Prasad, President of the DCVMN, agreed, saying: “With COVID-19, we need to ensure vaccines as soon as possible so for 2021 and 2022, we need to go where there is existing capacity, human resources and know-how”.

Prasad also added that technology transfer was “less about intellectual property and more about knowledge transfer”.  He was referring to the South African/Indian joint proposal for an intellectual proper waiver on COVID-19 related health technologies, not before the World Trade Organization – which advocacy groups say would unlock supply bottlenecks.

Rasmus Hansen from research company AirFinity added that manufacturers also were concerned about “a mismatch between supply and demand” – in which ramping up too fast might even create excess capacity.

“Will we get to a point of over-supply?” asked Hansen. He said that manufacturers that were considering expensive and technologically complex investments in vaccine production, were also asking what their level of long-term investment should be.

Meanwhile, Hatchett said he was concerned about the potential for the United States to use its Defense Production Act to reserve scarce vaccine ingredients for its own use, saying this, too, would “disrupt vaccine manufacturing” at a more global level.

Solutions for ramping up vaccine manufacture – and technology transfer 

Summit Was Not About ‘Matchmaking’ and there were ‘No Blind Dates’  

Cueni said that while “everybody who was at the summit, is keen to follow up, this summit was not a dating meeting.”

His comments were a direct rebuttal to a WHO statement last week by Director General Dr Tedros Adhanom Ghebreyesus that the global health agency stood ready to play “matchmaker” between pharma innovators and manufacturers in order to increase vaccine production more  rapidly.

“There were no blind dates or things like that,” he said noting that the virtual nature of such a summit and the legal constraints companies already operate under would discourage “matchmaking” in particular.

At the same time, he said he is optimistic about the potential of seeing more partnerships evolve that can address the global bottlenecks seen now.  ” I do expect  we will see more partnerships, we will see more surprising announcements about new capacities found,” declared Cueni.

“But also we will see we will see the longer term dialogue about how to improve on tech transfer,” he added. “I think there’s a commonality of views I’ve already had discussions with several manufacturers from our side afterwards, and there’s a willingness to to engage in that.

“In terms of the tech transfer, it’s already happening though, and the expansion of capacity has taken place because you have partnerships, for example between innovative manufacturers and developing country manufacturers, both bringing their respective competencies competencies to the fore. But we also had of course, a number of high level government representatives there. I think also understood that they can help to address inefficiencies.”

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Image Credits: IFPMA .

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The pandemic is a call for a comprehensive, multi-sectoral approach to ensure that Africa is prepared for future outbreaks.

African governments, the private sector, and development partners need to invest more in health and health systems to intensify the fight against the COVID-19 pandemic and any future disease outbreaks, according to health experts speaking at the African Health Agenda International Conference (AHAIC) on Tuesday.

The experts agreed that a comprehensive, multi-sectoral approach is needed to not only ensure that Africa does not face crippling effects of another pandemic, but that well-planned and integrated responses to improving health securities and building health societies are adopted.

Dr Matshidiso Moeti, the World Health Organization’s Africa Director, said the pandemic was a massive wake up call for Africa’s health systems, both revealing glaring gaps in health security and health systems and highlighting the lack of funding in the advancement of the health eco-chain.

“A big issue is investment in health and financing of health. We have noticed a stagnation per capita in most African countries in the past few years,” said Moeti, adding that the WHO had recommended that countries increase the funding per capita from $60 to $90 in lower income countries and $170 in higher income countries.

African governments, the private sector and development partners need to invest more in health and health systems to intensify the fight against the COVID-19 pandemic and any future disease outbreaks, according to health experts speaking at the African Health Agenda International Conference (AHAIC) on Tuesday.

Speaking under the theme Build Back Better: Health Security Beyond COVID-19, the plenary on the second day of the conference focussed on how governments, private sector entities, civil society organizations and development partners need to put in place long term, country-led strategies to prevent another widespread disease outbreak and ultimately build back better post-COVID-19. 

The experts made a case for urgent, concrete action for governments and health leaders to take in order to strengthen health systems, prepare and protect populations; highlight existing response and preparedness strategies to mitigate the risks of future disease outbreaks and build resilient health systems. 

They also called upon health leaders, policy makers, pan-African organizations, academic and research institutions, and global organizations to commit to disease outbreak preparedness and recovery measures.

Provide Environments Conducive for Investment

Greg Perry, assistant director general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), called for greater investment in health, universal health coverage, health insurance, health systems and manufacturing.

“Investment in health is fundamental for economic sustainability…and all economic actors should be on board,” he said.

The need for investment was paramount to the fight against pandemics, but Perry said the continent should be cognisant of some of the challenges faced in attracting investments and should work on addressing such.

These include fragmented markets, regulatory challenges, skilled workforce and proper environments to enable investment, said Perry.

He pointed to how, even if African countries produce local vaccines, they might be dependent on open borders to import components of what will be produced locally.

“A lot of these challenges are pre-existing, but a lot of work has been done to address them,” he said, adding that a mind shift was taking place everywhere on how best to move forward.

Perry further emphasised the need for an improved culture of pandemic preparedness and solidarity between countries.

Moeti echoed this sentiment and said a comprehensive, multi-sectoral approach needed to be adopted to “protect health, the economy and the most vulnerable people”. “We need to put safety nets in place.”

Where Did We Go Wrong With The COVID-19 Response?
African Health Agenda International Conference (AHAIC) – Plenary 2: Build Back Better – Rebuilding Africa’s Health Systems Beyond COVID-19
Clockwise: Dr Solomon Zewdu, Patricia Vermuelen, Dr Ngcobo, WHO Africa Director Dr Matshidiso Moeti, Director of the Africa Centres for Disease Control and Prevention Dr John Nkengasong

John Nkengasong, Director of the Africa Centres for Disease Control and Prevention, said that in addition to investing in health, countries need to interrogate improvements that could be considered to fight the pandemic. 

This would include investigating “what went wrong, what went right and what we can do better”.

One year, two months into the pandemic, Nkengasong is of the view that there needs to be a holistic approach to better understand pathogens, population, policy and politics. More importantly, he said that if policy and politics are not aligned then whatever work is done in pathogens and population would be of little use.

“The fight is still ahead…now we have political leadership that is quite adamant about being aligned to hold downstream accountable,” said Nkengasong.

Lessons learnt from previous outbreaks, including Ebola, should have been adapted to fight the pandemic which to date has globally claimed the lives of more than 2.6-million people.

“We need to invest in endemic diseases…if we get those systems right then we can fight any pandemic. This pandemic has shaken us to the core …still a lot of work needs to be done.”

Rapid Vaccine Delivery Should be Celebrated

While the pandemic had devastating consequences, Dr Martin Fitchet, Global Head of Research & Development for Johnson & Johnson Medical Devices, said it was not “all bad news in terms of response” as there was “remarkable co-ordination” between governments and the private sector to deliver vaccines to the markets in reasonable time.

“Very rapid decisions were made for obvious reasons…we need to continue to invest to ensure that we have the appropriate response,” he said, quipping that: “Let’s just do it and not say we are going to do it.”

Image Credits: African Development Bank , Amref Health Africa.

Healthcare worker in Chile opens up the Chinese-developed “CoronaVac” COVID-19 vaccine.

The Chinese-developed “CoronaVac” vaccine against COVID-19 vaccine triggers a sixfold reduction in neutralizing antibody response against the P.1 variant first identified in Brazil, according to a pre-print study published last week, while the Oxford/AstraZeneca vaccine is likely effective against the variant of concern. 

These findings come as hospitals in northern Brazil are increasingly overwhelmed and overcrowded; the country is reporting record high death rates; and the P.1 variant is becoming dominant in most of the country. 

The CoronaVac vaccine, produced by the Chinese pharma firm, Sinovac Biotech, is Brazil’s principal vaccine, with 120 million doses purchased by the government. CoronaVac accounts for over 70% of COVID-19 vaccines now being administered in Brazil. 

Some 10.83 million doses of COVID-19 vaccines have been administered in Brazil, but the virus continues to rage out of control, nearing record highs in daily cases, with 80,508 new cases reported on Sunday. With 2.68 million people fully vaccinated – 1.28% of the population – it could be too soon to draw conclusions about the efficacy of the vaccines in preventing transmission and infection in Brazil.

The new COVID-19 cases reported in Brazil. The country is reaching record high daily cases, with a seven day average of 66,869 new cases in March.

The P.1 variant was discovered in Manaus City in Brazil in early January and has several mutations – E484K, K417T, and N510Y – that are also present in the B.1.325 variant, which is circulating around the United Kingdom and South Africa and has been linked to higher transmissibility. 

The small-scale study of the CoronaVac vaccine, produced by the Chinese firm Sinovac Biotech, was conducted by researchers in Brazil, the United Kingdom, and the United States, found that the plasma from eight individuals vaccinated with Sinovac’s vaccine “failed to efficiently neutralize” the P.1 SARS-CoV2 variant. 

“Our data suggests that the SARS-CoV2 lineage P.1 can escape from neutralization antibodies elicited during infection or immunisation with previous circulating viral variants,” said the authors of the study. 

The neutralizing capacity in the blood plasma was six times lower against the P.1 variant compared to earlier lineages. According to the authors, the partial immunity against new variants could suggest that reinfection of previously infected or vaccinated individuals could occur. 

AstraZeneca’s Vaccine is Effective Against P.1 Variant, Says Preliminary Data

In contrast to Sinovac’s CoronaVac vaccine, early results from a study conducted at the University of Oxford indicate that the Oxford/AstraZeneca COVID-19 vaccine is effective against the P.1 variant. The results of the AstraZeneca study, which have not yet been made public, were shared with Reuters. The data indicates that the vaccine would not need to be modified to target the variant. 

This encouraging news follows the earlier release of data from a South Africa study, suggesting that the AstraZeneca vaccine was unable to protect people against mild and moderate cases of the B.1.351 variant of the SARS-CoV2, first detected in South Africa and bearing similarities to the P.1 variant. The full study will likely be released in March.

Sinovac Vaccine To Be Rolled Out Across Several Countries in Latin America and Asia
A second batch of 6.5 million doses of the Sinovac vaccine arriving in Turkey in late January.

Along with Brazil, mass vaccination drives of CoronaVac have begun in China, Indonesia, and Turkey and the vaccine has also been approved for emergency use in Colombia and Mexico. 

The efficacy rate of the vaccine against SARS-CoV2 was only 50.3%, based on late stage clinical trial results from Brazil. However, its developers claim that the vaccine is still 83.7% effective for more serious cases requiring medical treatment, and 100% effective in preventing hospitalisation. 

Sinovac previously said that the firm is looking into developing a vaccine for the variants or offering booster shots to extend protection. Both of these options could be developed fairly quickly, the company says.

“It’s like there’s this thief whom we’ve already caught,” said Yin Weidong, Sinovac’s CEO, in an interview with the Chinese government-controlled TV channel, CGTN, last week. “Even if it’s mutating, we can totally use the current research and production capacity to effectively develop a vaccine for the new variant.”

Risk Posed By P.1 Variant Extends To Other COVID Vaccines

Meanwhile, the P.1 variant, which has spread to more than 20 countries, poses potential risks to several other COVID-19 vaccines as well as possibly being more fatal. 

According to a pre-print study conducted by researchers at the University of São Paulo, Imperial College London, and the University of Oxford, the P.1 variant is between 1.4 and 2.2 times more transmissible than previous SARS-CoV2 lineages. 

The researchers estimate that P.1 evades 25% to 61% of protective immunity provided by infection from a different strain of the virus. 

“There was also evidence of an increase in mortality risk but whether this is due to P.1 or the extensive healthcare collapse Manaus has experienced remains uncertain,” said Thomas Mellan, a research associate at Imperial College London and co-author of the study, in a press release. 

“Uncertainty in the ways SARS-CoV2 is changing and implications for vaccine design calls for much more sequencing and analysis of virus genomes globally,” said Ester Sabino, professor of infectious diseases at the University of São Paulo and co-author of the study.

Image Credits: Twitter – Chinese Embassy Manila, Pontificia Universidad Católica de Chile, New York Times, Twitter – TRT World Now.

Professor Sarah Gilbert, University of Oxford, co-founder of Vaccitech and the developer of the Oxford/AstraZeneca vaccine against COVID-19

The structural barriers to a faster and more equitable COVID-19 vaccine roll-out go far beyond the issue of patents, declared two of the world’s leading vaccine researchers and pharma execs at a WHO event on Monday evening. 

Sarah Gilbert, developer of the Oxford/AstraZeneca vaccine and Özlem Türeci, chief medical officer of BioNTech, the developer of the cutting-edge Pfizer-BioNTech mRNA vaccine, were speaking at a WHO media event honouring women in global health on the occasion of International Women’s Day. 

But their statements about the challenges of vaccine distribution – made at the tail end of a WHO press conference – illustrate a certain disconnect between WHO Director General Dr Tedros Adhanom Ghebreyesus’ recent offer to act as a “matchmaker” between pharma innovators and manufacturers to ensure faster production and more equitable distribution of new COVID jabs – and the hard-nailed infrastructure and logistical challenges actually faced – which are not a traditional area of WHO expertise.

“Delighted to be joined by 2 women who created 2 of the #COVID19 vaccines now being rolled out” – @DrTedros tweets at press briefing on International Women’s Day. .
Free IP Won’t ‘Go Anywhere Close’ To Solving Problem 

Asked by a reporter about WHO’s COVID-19 Technology Access Pool (C-TAP) initiative, which has sought to involve pharma manufacturers into a patent pool – to share IP on COVID vaccines and other health technologies, Gilbert replied, “I have to confess I’m not familiar with that initiative, I’m sorry.”   

Gilbert added:  “I don’t think that just making IP freely available goes anywhere close to solving this problem, because it’s not just to the right to use the technology that’s needed, it’s the feedstocks, the  cell banks, the protocols, the assays, the standards, the reagents to do everything. 

“This requires a great deal of support from the first company that licensed the vaccine, and this can be done, but it can’t be done in a completely unlimited way. 

“So we have to recognize that it’s important we have many vaccines to use across the world: those that are licensed Now, those that are still in clinical trials and will be approaching licensure. We want to see a good range of vaccines, ideally using different technologies,  because that will increase the chance of having the largest number of doses available. 

“And then what we need is that once those vaccines are manufactured, licensed and distributed, the ones that are sitting in vaccine centers actually get used to protect people and we don’t let them sit there going past their expiry date.”

Gilbert also stressed that Oxford’s R&D philosophy has always been that:  “we wanted to have a vaccine for the world, and we wanted it to be manufactured and distributed widely. And we’re very pleased to see that that is being done with many sub-licenses to different manufacturers in different parts of the world – increasing the number of doses of the vaccine that we initiated development of, have now been made available across the world.” 

Novel mRNA Vaccine Technologies Require New Manufacturing Setup – Repurposed Facilities Not Good Enough 
Professor Sarah Gilbert, University of Oxford, co-founder of Vaccitech and the developer of the Oxford/AstraZeneca vaccine against COVID-19

Dr Özlem Türeci, co-founder and Chief Medical Officer of BioNTech, and the developer of the Pfizer-BioNTech COVID-19 vaccine, echoed Gilbert’s remarks saying:  “Yes, I can only echo what Sarah has pointed out, so it is a comprehensive solution and approach we need. 

“Also, in particular if it is about novel platforms and novel technologies for which even the setup of production facilities need to be expanded, and you cannot just repurpose existing facilities. So patents are one thing but there are so many other things we have to ensure.”

The Oxford/AstraZeneca’s developers have pledged to sell the vaccine on a not-for-profit basis for the duration of the pandemic.

Despite that, the company’s executives  have so far not explained why one of their key licensees, the Serum Institute of India, has been selling the Oxford/AstraZeneca vaccine to South Africa and Uganda at 2-3 times the price of the vaccine in Europe – where the European Union procured it for around US$ 3 a dose.

The Oxford/AstraZeneca vaccine is also the leading product being used in the initial rollout of vaccines by the WHO co-sponsored COVAX initiative – with the first doses of the COVAX rollout having reached the first three countries in Africa, Ghana, Cote d’Ivoire and Ghana, just last week. 

Pfizer/BioNTech, meanwhile, is marketing its  vaccine at for upwards of US$25 a dose, although Pfizer recently offered some 40 million doses of the cutting edge mRNA vaccine to the WHO co-sponsored COVAX initiative at cost. Uptake of the Pfizer vaccine in low and middle income countries is, however, limited by the vaccine’s cold-chain requirements storage at -70 C.  

The remarks coincided with a two-day Global C19 Vaccine Supply Chain & Manufacturing Summit, a closed door forum sponsored by the UK-based Chatham House, in which pharma leaders and global health experts and research institutes are meeting to discuss ways to unlock existing vaccine supply bottlenecks.

Image Credits: @WHO.

Innovation has, until recently been a male-dominated preserve, but a group of women pioneers speaking at the Africa Health Agenda International Conference on Monday told of how the right mindset and a desire to improve lives has helped change the landscape.

Speaking during a virtual panel discussion on Women in Innovation: Providing leadership, creating solutions and driving change, panellists shared their stories of how they overcame adversity and gender disparity as women inventors and entrepreneurs to make a difference.

Dr Matshidiso Moeti, the World Health Organization’s Africa Director, who grew up in a South African township during apartheid,  encouraged participants to push for positive change even when facing challenges. She emphasised the importance of bringing men on board when dealing with gender imbalances.

“Help men to understand that it is to their benefit. Men can be powerful enablers of gender empowerment. Women are power…let’s get men to support us,” Moeti said.

The first day of the conference coincided with International Women’s Day and the discussions were aimed at demystifying the notion that women have a limited role in innovation.

“Through this event, we wish to mobilize and provoke change, and help advance women in the field of technology and science topics that we aim to further explore in a series of discussions through the year,” said the conference organisers, adding that “innovation is crucial to identifying solutions to achieve the UN sustainable development goals (SDGs)”.

For Edna Adan Ismail, Somaliland’s first midwife and renowned healthcare activist, the journey to success was all about considerable and equal participation of women in business, education and innovation. 

Driven by the urge to address the inadequate healthcare in her country and increase women participation in an almost male-dominated environment, Ismail said her focus had been to do something that would advance women. 

On Tuesday, Ismail will celebrate the 20th anniversary of a hospital she built in Somaliland, the Edna Adan Maternity Hospital, which was established primarily to provide better health care to people whose lives have been traumatized by war, and to train nurses, midwives, and other health workers. 

The hospital also has diagnostic laboratory facilities and an emergency blood bank and offers diagnosis and treatment for sexually transmitted diseases.

Ismail also built a medical university 10 years ago which currently has 1500 students enrolled in various disciplines of the medical field,  70% of whom are women. 

At 84, Ismail said one is never too old to contribute to meaningful change and encouraged participants to “never give up as giving up is never an option”.

“What we do, how we collaborate, the contributions we make to save human lives is what will continue to drive us,” she said adding that women bring positive change when provided with opportunities and training.

Several panellists shared personal stories of how they used entrepreneurial skills to overcome adversity, how they were empowered and the challenges they faced.

Sheila Alumo, Managing Director, Eastern Agricultural Development Co. Ltd, was forced to care for her two younger siblings when she was just 11-years-old after her mother died. There were days when her family went without food and she had lost all hope.

Her story is one of hope, perseverance and succeeding against all odds. Alumo recalled how, at one stage, she would walk several kilometers to buy and resell sugar cane to help feed her family.

Today Alumo’s Uganda-based company employs 22 people and, through its agricultural business, pursues improved socio-economic and human development of rural smallholder farmers. The company has a network of 3,117 farmers, 40% of whom are women. Alumo said she works with rural populations to contribute to their livelihood improvement.

“I know what it is to be hungry, not to have food…no hope. As a young girl knew that I had to make a difference.”

It was Alumo’s parting words that resonated with most of the panelists and participants: “Our backgrounds define our future, but our resilience will carry us through”.

The conference runs until Wednesday, and covers a range of topics including the state of health security in Africa and the need for an African Medicines Agency.

Image Credits: Photo credit: NSTOP Team.

Vials of the Sputnik V vaccine that is under rolling review by the EMA.

A senior official at the European Medicines Agency (EMA) has cautioned EU member states to wait until the agency has reviewed the safety and efficacy data of Russia’s Sputnik V vaccine  before granting the vaccine emergency use authorization at national level, and beginning mass rollouts.

Last week, the EMA formally began a rolling review of the Sputnik V vaccine, developed by Russia’s Gamaleya National Centre of Epidemiology and Microbiology. If approved, the vaccine would be the first jab to be used in the 27 member states that was developed outside of the EU or the United States.

The EMA announcement comes after Hungary and Slovakia already approved the Sputnik vaccine for national use and the Czech Republic is currently assessing the vaccine. All three countries are moving ahead without EMA approval.

Austria has also expressed an interest in procuring doses of Sputnik V, but officials have indicated that the country won’t bypass the EMA.

“I would urgently advise against giving a national emergency authorization,” Christa Wirthumer-Hoche, chair of the EMA managing board, told ORF, an Austrian news broadcast. “We need documents that we can review. We also don’t at the moment have data…about vaccinated people. It is unknown.”

The rolling review will continue until enough evidence is gathered for a formal marketing authorization application, said the EMA in a press release.

“Data packages are coming from Russian manufacturers and of course they will be reviewed according to European standards for quality, safety and efficacy. When everything is proven then it will also be authorised in the European Union,” Wirthumer-Hoche said.

“We can have Sputnik V on the market here in the future when the appropriate data have been reviewed,” she added.

Moscow has pointed to the high efficacy results – 91.6% in preventing symptomatic COVID-19 cases and full protection against severe infection – and the 42 countries that have already authorised the use of Sputnik V, pushing the EU to follow their lead.

According to Kirill Dmitriev, CEO of the Russian Direct Investment Fund (RDIF), the company responsible for marketing the Sputnik vaccine abroad, enough vaccines to inoculate 50 million Europeans will be available to deliver to the EU starting in June 2021.

EU Concerned That Russia Is Using The Sputnik V Vaccine As A Geopolitical Tool
Doses of the Sputnik V vaccine arriving in North Macedonia on Sunday.

While some EU member states have been quick to accept the Sputnik V vaccine, in light of the delays seen in the manufacture and delivery of promised doses from Pfizer and AstraZeneca, with which the EU has created bulk purchase contracts, EU officials remain very wary of Russia’s potential use of the vaccine as a soft-power tool.

“Overall I must say we still wonder why Russia is offering theoretically millions and millions of doses while not sufficiently progressing in vaccinating their own people,” said Ursula von der Leyen, President of the European Commission, in mid-February. “This is…a question that I think should be answered.”

The Gamaleya Center responded to Von der Leyen’s comments in a Twitter statement, saying that: “Sputnik V considers EU a partner and would like to work together with EU to protect EU citizens and to produce Sputnik V vaccine in EU.”

“Sputnik V suggests that vaccines should be above and beyond politics. We hope that EU and EMA will evaluate the vaccine on [a] scientific and not political basis,” the company added.

This message was echoed by RDIF CEO Dmitriev: “Vaccine partnerships should be above politics and cooperation with EMA is a perfect example demonstrating that pooling efforts is the only way to end the pandemic,” he said in a press release last week.

The slow rollout of vaccines in Europe has pushed several countries to pivot to the Sputnik V vaccine, hoping that it will fill the gap left by the delays in deliveries of the Western vaccines, namely Pfizer/BioNTech, Moderna and AstraZeneca.

Some of the region’s most powerful states, such as Germany, have indicated that if the Sputnik V vaccine receives approval from the EMA, it would be keen to procure and even produce the Russian vaccine.

“We are open to the idea of bilateral cooperation for the purpose of tapping European production capacities” for the vaccine, said Ulrike Demmer, deputy spokesperson for the German government, at a press conference in early January.

The statement was made after German Chancellor Angela Merkel had a phone call with Vladimir Putin, Russia’s President, to discuss cooperation on vaccine production.

RDIF Already Received ‘Numerous Requests’

“We have received numerous requests from EU states to provide Sputnik V directly to them based on the reviews of their national agencies. We will continue to do so as well as work with EMA based on the rolling review procedure,” said Dmitriev in a press release.

The decision of some countries to unilaterally approve of the Sputnik V vaccine goes against the EU’s unified approach to the pandemic and could cause a rift in the European Commission.

Already in November officials from the European Commission warned Hungary against procuring the vaccine ahead of the rest of the bloc.

“This is where the authorization process and vaccine confidence meet. If our citizens start questioning the safety of a vaccine, should it not have gone through rigorous scientific assessment to prove its safety and efficacy, it will be much harder to vaccinate a sufficient proportion of the population,” a spokesperson for the Commission told Reuters.

Even within Slovakia the decision to purchase two million doses of the Sputnik V vaccine ahead of approval by the EMA has caused some friction among government officials, with the foreign minister opposing the prime minister’s decision.

“It is clear that Sputnik V is not just a vaccine, but a tool in hybrid warfare,” said Ivan Korcok, Slovakia’s Foreign Minister. “It divides us at home, it divides us abroad, it aims to create doubt about processes in the European Union.”

The EMA, which has been criticised for its slow approval process for COVID-19 vaccines, is already set to make a decision on Johnson & Johnson’s single-dose vaccine on 11 March. Along with Sputnik, jabs by Novavax and CureVac, a German biotech firm, are also currently under a so-called “rolling review” with no timeline yet announced for a decision.

Image Credits: Twitter – Sputnik V, RDIF.

Less than half of Africa’s citizens (52%) – some 615 million people – have access to the healthcare they need, the continent’s quality of health services is generally poor and the family planning needs of half the continent’s women and girls are unmet.

This is according to a report on Africa’s progress toward achieving universal health coverage (UHC) released on Monday at the Africa Health Agenda International Conference (AHAIC).

Each year, approximately 97 million Africans, representing 8.2% of the continent’s population, incur “catastrophic healthcare costs” – particularly in Sierra Leone, Egypt and Morocco. Annually, 15 million people will be pushed into poverty as a result of these out-of-pocket costs, according to the report, which was compiled by a multi-national AHAIC commission.

 

Some 15-million Africans are forced into poverty every year because of massive medical bills.

World Health Organization Director General Dr Tedros Adhamon Ghebreyesus said that the COVID-19 pandemic had highlighted the importance of all people having access to adequate health services.

“Achieving UHC require investments in resilient health systems, especially in strong primary health care with an emphasis on promoting health and preventing disease,” said Tedros. 

“ An important part of that journey is ensuring a reliable supply of safe, effective and high-quality medicines across the continent. To that end, WHO is working with the African Union and the Africa Centres for Disease Control (CDC) to establish the African Medicines Agency (AMA). And I call on all AU countries to ratify the treaty so that African Medicines Agency can enter into force.”

The AMA is envisaged as a central regulatory agency expected to improve access to medicines on a continent where some countries simply don’t have the capacity to regulate medicines.

Life Expectancy Has Increased Thanks to Malaria and Reproductive Health Management

Also opening the conference was Kenya’s President Uhuru Kenyatta who pointed out that Africa’s life expectancy had increased from around 40 in the 1960s to 64 currently, mainly as a result of better management of malaria, and reproductive health services.

“If we are to achieve universal health coverage by 2030, we need to give greater priority to primary health care, water, sanitation and hygiene,” said Kenyatta. “Indeed, during this COVID period, all of us have been amazed by how simple hygiene practices such as hand washing, introduced during this response to this pandemic, have reduced diarrhea and other diseases.” 

Tedros praised Kenya and Rwanda for making the most progress on the continent in achieving UHC.

Kenyatta explained that user charges had been removed in Kenyan dispensaries and health centres, and free maternity services had been introduced. 

“Currently, we are embarking on a national programme to ensure universal access to health hospital insurance fund through mandatory enrollment, and a full government subsidy for the poor and most vulnerable,” said Kenyatta.

Both he and Kenya’s Health Secretary, Mutahi Kagwe, stressed the importance of local production of health products.

Welcoming the fact that the International Federation of Pharmaceutical Manufacturers Associations (IFPMA) was one of the conference sponsors, Kagwe said he wanted to send a message to them to improve production capacity on the continent.

“It is possible for you to have money and not to have supplies,” said Kagwe. “One of the most frustrating and panicky things for African health ministers at the start of the pandemic was when we did not have PPEs yet we were getting cases in our hospitals. We didn’t have reagents but we wanted to test. Why didn’t we have reagents? Because they are not made on the continent. Regions have closed systems and there was no way of getting reagents from anywhere,” said Kagwe. 

COVID-19 Has ‘Made Us Aware of Our Potential’

“We have learned from COVID-19 experiences. They have made us more aware of our vulnerability and made us more aware also of our potential. We are no longer importing PPEs. We are making them locally.”

Rwanda’s health minister, Dr Daniel Ngamije, said his country has introduced community-based health insurance for those who could not pay for health services. 

“The premium for their membership of this scheme is paid by the government and it allows them to be treated from the primary health care application level of care,” said Ngamije.

Rwanda had also recognised that women’s and girls’ access to family planning was hampered by religious health service providers not providing this service and by the legal requirement for girls to be 18 before they could get contraceptives.

The Rwandan government was trying to ensure it had family planning clinics in areas dominated by faith-based service providers and it was engaging with parliament to address the legal barrier of age which was driving unwanted pregnancies among teenagers.

Ethiopia’s health minister, Lia Tadesse, said that her government had initially subsidized services for the poor while the rest pay out-of-pocket. 

“But this was not sustainable for government and also caused high out-of-pocket expenses. So in the past few years, Ethiopia started a community-based insurance system and we are on our way to starting social health insurance. We still have exempted services for things like family planning, immunization, HIV, maternal and neonatal services but universal insurance is what we are trying to head towards.”

Some of the solutions proposed by the report to speed up UHC include using the “vast network of African traditional healthcare providers” to improve primary healthcare services, “especially preventive and promotive care”, strengthening governance including anti-corruption strategies and progressively increasing financing of the health sector.

 

Image Credits: Xavier Vahed/DNDi, AHAIC Commission Report on UHC in Africa.

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team in February.

The WHO-convened international investigation into the origin of the SARS-CoV2 virus is too politically limited by China and lacks the mandate to yield fully independent conclusions about how the novel coronavirus emerged and infected humans, according to a group of prominent international scientists – who have called for a new, independent and “unrestricted” probe into the source of the virus that triggered a pandemic.

“The joint team did not have the mandate, the independence, or the necessary accesses to carry out a full and unrestricted investigation into all the relevant SARS-CoV-2 origin hypotheses – whether natural spillover or laboratory/research related incident,” stated an open letter published on Thursday.

The open letter signed by 26 scientists from France, the US, Australia, German, Austria and India, with expertise in virology, zoology, microbiology and global health policy, argued that it was “all but impossible” for the WHO-convened mission to fully examine all SARS-CoV2 origin hypotheses.

While the Chinese government on Friday disputed claims that it withheld information and delayed international responses to the pandemic, the scientists said that critical data had indeed been withheld. Moreover, statements made at a press conference after WHO´s mission concluded in Wuhan in mid-February, revealed the the limitations inherent to the current inquiry, in which 17 Chinese scientists must agree with the conclusions and findings of the international team of 17 experts in any final report.   

One expert, Richard H. Ebright, a professor of chemical biology at Rutgers University, went as far as to call the mission a “charade” with “no credibility, its members were willing–and, in at least one case, eager–participants in disinformation.¨

The WHO investigative team concluded its month-long expert mission in China in mid February, announcing in a press conference on 9 February that the most likely hypothesis is that the SARS-CoV2 virus originated from an animal intermediary that transmitted the virus from bats to humans.

But Peter Ben Embarek, convenor of the group, also said that the joint Chinese-international group had ruled out the hypotheses that the virus might have escaped from the Wuhan Virology Institute, an internationally known research center into coronaviruses. 

However, the signatories to Thursday’s letter said that those conclusions were made hastily, and based on inadequate information.  They said that the “zoonosis hypothesis…is only one of a number of possible SARS-CoV2 origins, alongside the research-related accident hypothesis” – and both require further investigation.

“The aim of the Open Letter was to highlight that the Joint WHO-China ‘global study’ was not an ‘investigation’. The joint WHO-China team did not have the mandate, the independence, or access to carry out a full and unrestricted investigation,” Dr. Filippa Lentzos, Senior Lecturer in Science & International Security at King’s College London, and a signatory of the letter, told Health Policy Watch. 

“An independent investigation is simply not feasible within WHO’s restricted mandate,” Lentzos added.

The criticism by the group of scientists came as WHO said that it would delay release of an interim summary statement on the mission to China. Instead, the joint WHO-China team will publish a full report in the week of March 15, said Dr. Tedros Adhanom Ghebreyesus, WHO Director General, in statements Friday to WHO member states and the media. 

Limitations of the Joint Investigation
The joint WHO-Chinese team of experts presenting the most likely hypotheses for the origins of SARS-CoV2 in Wuhan at the 9 February press conference wrapping up the international WHO expert mission.

According to the authors and signatories of the letter, the structural limitations of the mission compromise the scientific validity of the investigation. Those issues include a lack of transparency around the development of the team’s original Terms of Reference; the lack of access to raw case data and individuals who were early victims or responders in the initial outbreaks of coronavirus; an alleged biased selection of international experts; and the fact that a final report needs to have the consensus agreement of both the international and Chinese teams. Specifically:

  • The Terms of Reference of the joint study, which were decided upon in July, allowed for the Chinese experts to conduct the majority of the fieldwork. This resulted in the use of a format for the study that was chosen by the Chinese counterparts and limited the data that was available to the international members of the team.
  • The raw data, which includes lab records and early COVID-19 cases, was withheld from the international experts. They were instead provided with summaries of patient data and limited access to personnel for interviews. 

“They showed us a couple of examples, but that’s not the same as doing all of them, which is standard epidemiological investigation,” Dominic Dwyer, a medical virologist at New South Wales Health Pathology in Sydney, Australia and a member of the WHO team, told the Wall Street Journal in mid February. “So then, you know, the interpretation of that data becomes more limited from our point of view, although the other side might see it as being quite good.”

According to the letter, the gatekeeping of the raw data by the Chinese members of the joint team impacted the ability of the team to confidently evaluate all of the origin hypotheses – which include four possibilities: a) that an animal such as a bat, which was harbouring the virus directly infected the first individual(s); b) that the animal infected other intermediate hosts, which then infected people when those animals were slaughtered or sold in a Wuhan food market; c) that the infection was somehow imported on frozen or semi-frozen wildfoods arriving from elsewhere, or d) that the infection emerged as a result of biosafety incident at the virology lab – which is a centre for the research into coronaviruses.

Laboratory Origin Hypothesis Inadequately Studied – Experts Charge

The possible laboratory-related hypotheses – including infection at a sampling site of a lab employee, infection during transport of collected animals or samples, lab acquired infection, and lab-escape virus – were not adequately explored, said the scientists in the open letter. 

The scientists concluded that due to political pressures and the structure of the investigation saying, “the joint team did not have the mandate, the independence, or the necessary accesses to carry out a full and unrestricted investigation into all the relevant SARS-CoV-2 origin hypotheses – whether natural spillover or laboratory/research- related incident.”

While none of the findings from the mid-February China mission pointed to a lab accident, the WHO-led international team lacked the skills and capacity to examine the possibility of a lab incident since the focus of the experts was largely on public health and zoonosis, the experts stated. The WHO-led mission may have also avoided deeper investigation of the lab-based theories to avoid political upset with their Chinese hosts, they pointed out.

In addition, at least one of the WHO team members’ expressed doubts about the lab-related hypotheses even before the mission to China, and others suggested that the issue was outside of their realm of expertise.  

“The group wasn’t designed to go and do a forensic examination of lab practice,” one member of the WHO team, Dwyer, admitted in an interview with Nature in February. 

The WHO team arriving at the Wuhan Institute of Virology in February, one of the world’s largest sites for the research of coronaviruses.

Whatever the reasons, the possibility that the coronavirus infected humans as a result of a laboratory accident needs to be examined, alongside the theory that the chain of infection emerged from direct human contact with an infected animal, or with an intermediate host animal somewhere along the food chain.

“I believe both the natural spillover and lab leak origin theories need to be thoroughly examined. I am not saying it was a lab leak, but that it could have been, and that it is a serious possibility that needs to be investigated,” Dr. Lentzos said.

“At this point in time, all scientific data related to the genome sequence of SARS-CoV-2 and the epidemiology of COVID-19 are equally consistent with a natural-accident origin or a laboratory-accident origin,” Ebright told Health Policy Watch.

However, according to Ebright, some circumstantial evidence could point to a laboratory-related accident as the origin of the virus outbreak.

Based on the genome sequencing of the outbreak virus, the closest relative was likely a horseshoe-bat coronavirus, he pointed out.

“Wuhan, China is tens of kilometers from the nearest known horseshoe-bat colony and the outbreak occurred during hibernation, meaning the bats would not have left their colonies. In addition, Wuhan is the site of the world’s largest research project on horseshoe-bat coronaviruses. The first human infection could have occurred as a laboratory accident, followed by transmission to the public.”

Guidelines for a Credible Investigation

A thorough and credible investigation will require a truly independent team of multidisciplinary experts with no national or partisan interests, the expert letter adds. The experts will need full access to all relevant sites, records, samples, personnel of interest, and raw data.

Access to incident reports, databases of pathogens and samples, lab experiment logs, and the Chinese Centers for Disease Control and Protection (CDC) case records are essential. 

In addition, confidential interviews with early patients and past and present personnel working at the related markets, hospitals, and labs will need to be conducted, the signatories state.

At least one senior member of the WHO-convened team said that the pursuit of such avenues could still take place in the context of the ongoing joint investigation.

“[This] is exactly the sort of follow up source-tracking that will be listed in the recommendations of the Joint WHO-China Mission report,” Dr. Peter Daszak told the Telegraph in response to the letter. 

“I urge the global community to wait until that report is published, read the recommendations, and assess next steps from a scientific viewpoint, not a geopolitical one,” he added.

However, in another interview, with the New York Times. Daszak charged that the demands to further investigate a lab origin for the SARS-CoV2 virus is a position “supported by political agendas.” 

Unfounded theories that the virus either escaped from, or was created in, the Wuhan Institute of Virology circulated widely earlier on in the pandemic. Former US President Donald Trump was among those pushing these theories, claiming that he had seen evidence that gave him a “high degree of confidence that the Wuhan Institute of Virology was the origin of this virus.”

Calls for New International Inquiry

The 26 experts that authored and signed the open letter concluded by referring to the WHO joint investigation as “opaque and restrictive” and calling for a new independent investigation into the origins of the virus.

“Because we believe the joint team process and efforts to date do not constitute a thorough, credible, and transparent investigation, we call on the international community to put in place a structure and process that does,” said the open letter.

“From my perspective, one possibility for a credible investigation is a UN General Assembly mandate to the UN Secretary General to carry out an investigation,” said Dr. Lentzos. 

However, the call for a new inquiry is unlikely to result in a future probe, given the number of hurdles WHO faced in organising the origin mission, including a last minute foul-up over visas. Cooperation from Beijing would be required to arrange a new inquiry. 

Chinese and US Officials Disagree Over Investigation

At a press conference in Beijing on Friday, Wang Wenbin, China’s Foreign Ministry spokesperson, said its government was cooperating fully with WHO on the joint origin-tracing research.

“The Chinese government has done a lot of administrative, technical, logistic and supporting work. In support of this joint research, the Chinese side, at the request of the WHO and the international team, arranged top Chinese experts in relevant fields to take part, and assembled a large number of technical personnel to support the joint mission in collecting data and documents,” said Wang Wenbin.

Wang Wenbin, China’s Foreign Ministry Spokesperson, at a press conference on Friday.

“The experts on the mission made their own decisions independently as to where they would like to visit, who they would like to talk to and what they would like to talk about as the field work proceeded. The report is also drafted by the mission independently,” he added. 

Despite the change of administration in Washington, US officials have maintained their dissatisfaction with China’s response to the COVID-19 pandemic and continue to express worries about the independence of the WHO joint mission. 

“We have deep concerns about the way in which the early findings of the COVID-19 investigation were communicated, and questions about the underlying process used to reach them,” said Ned Price, spokesperson for the US State Department, at a press briefing on Thursday. 

“It’s imperative that this report be independent, with expert findings free from intervention or alteration by Chinese Government authorities…We’ve continued to call upon China to make available its data from the earliest days of the outbreak,” Price said.

Summary Report and Full Report To Be Released Simultaneously 

The findings of the joint mission will be released in two weeks, announced WHO officials at the biweekly press briefing on Friday. The summary report, which was expected to be released first, will be delayed for publication until the final report is ready.

“The team is working on its full report as well as an accompanying summary report, which we understand will be issued simultaneously in a couple of weeks,” Tarik Jasarevic, WHO spokesperson, told Health Policy Watch. 

“By definition a summary report does not have all the details,” Dr. Peter Ben Embarek, a food safety expert at WHO and lead of the investigative team, told the Wall Street Journal. “So since there [is] so much interest in this report, a summary only would not satisfy the curiosity of the readers.”

WHO officials at the press conference on Friday made assurances that the report would prioritize transparency and demonstrate progress in the process of discovering the origins of the SARS-CoV2 virus and collaborating with countries. 

“We are waiting for the report. I am waiting for the report like you. Everything that happened during the trip will be presented transparently,” said Dr. Tedros. “I assure you that there will be transparency and we [will] see exactly what happened. What were the gains, what were the challenges, and then, where do we take it from here.”

Dr. Tedros Adhanom Ghebreyesus, WHO Director General.

“If others want to call for anything else they’re perfectly within their rights to do so,” said Dr. Mike Ryan, WHO Executive Director of the Health Emergencies Programme, addressing the open letter. “I would suggest that people, maybe just take a few days to wait and examine what the outcomes are…There will certainly need to be more work…[It is] going to take time and potentially multiple missions to fully understand this.”

“This is a process of discovery. And it is a process of working in new ways, with all countries,” Ryan added.

Image Credits: CNN, WHO, Ministry of Foreign Affairs of the People's Republic of China.

On 1 March, Ghana started its COVID-19 vaccine campaign. Samira Bawumira, the vice-president’s wife, was one of the first to be vaccinated.

The World Health Organization (WHO) and its COVAX partners are hosting a summit next week with governments and pharmaceutical companies to address the bottlenecks in COVID-19 vaccine production and delivery.

This follows a spectacular start in the past week for COVAX, the global vaccine delivery platform, which delivered more than 20 million doses of COVID-19 vaccines to 20 countries, according to WHO Director General Dr Tedros Adhanom Ghebreyesus.

“We currently face several barriers to increasing the speed and volume of production of vaccines, from export bans to shortage of raw materials, including glass, plastic, and stoppers,” Tedros told the body’s bi-weekly media briefing on Friday. 

“Next week, WHO and our COVAX partners will meet with partners from governments and the industry to identify bottlenecks in production and discuss how to solve them.”

The WHO runs COVAX together with GAVI, the global vaccine alliance and the Coalition for Epidemic Preparedness Innovations (CEPI).

COVAX Distribution Remains Small – Relative to Needs

Describing the COVAX launch as a landmark, Tedros added that “the volume of those being distributed through COVAX is still relatively small”, as they covered “between 2-3% of the population of countries receiving vaccines, even as other countries make rapid progress towards vaccinating their entire population within the next few months”.

To help all countries to end the pandemic, the WHO was looking at four approaches, said Tedros.

The first and most short-term was to link vaccine producers with companies that have excess capacity to “fill and finish”, such as the deal reached this week between Johnson & Johnson and Merck, where Merck will provide “fill and finish” services – filling vials with vaccines and packaging them – for the J&J vaccine.

“We need more partnerships like this,” stressed Tedros. “And we need them in all regions. WHO can support this process by identifying gaps and providing a matchmaking service between vaccine producers and companies with capacity.”

The second approach, said Tedros, was “bilateral technology transfer through voluntary licensing from a company that owns the patents on a vaccine to another company who can produce them”. 

“A good example of this approach is AstraZeneca, which has transferred the technology for its vaccine to SK Bio in the Republic of Korea, and the Serum Institute of India, which is producing AstraZeneca vaccines for COVAX,” said Tedros, although he decried the “the lack of transparency” in this approach.

´Coordinated’Technology Transfer

The third approach is a “coordinated technology transfer” that would see universities and manufacturers licensing their vaccines to other companies through a global mechanism, coordinated by WHO.

With this approach, there would be more transparency, global coherence and it would also “facilitate the training of staff at the recipient companies and coordinate investments in infrastructure”, said Tedros.

The final solution, said Tedros, was for countries “to start producing their own vaccines by waiving intellectual property rights as provided for in the TRIPS agreement”.

“Those provisions are there for use in emergencies. The WHO believes that this is a time to trigger that provision and waive patent rights. We thank South Africa and India for their proposal to the World Trade Organisation to waive patents on medical products, or COVID-19, until the end of this unprecedented pandemic.”

Next week’s summit will involve the International Federation of Pharmaceutical Manufacturers Associations (IFPMA), which represents most major pharma companies. However, Marie-Paul Kieny, chair of the Medicines Patent Pools Foundation and a guest at the briefing, said that many other generic manufacturers needed to be brought into the discussion.

Kieny said her foundation was in the process of “leveraging our close relationships with generic manufacturers across the globe to help identify suitable partners to ‘fit and finish’ vaccine needs, and as potential recipients of technology transfer”.

COVAX Roll-out Continues Next Week
WHO special advisor Dr Bruce Aylward

This week’s first COVAX deliveries were to Ghana, and Cote d’Ivoire. Shortly afterwards, deliveries were made to Angola, Cambodia, Colombia, the Democratic Republic of the Congo, Gambia, India, Kenya, Lesotho, Malawi, Mali, Moldova, Nigeria, the Philippines. the Republic of Korea, Rwanda, Senegal, Sudan, and Uganda.

By the end of next week, COVAX will deliver 14.4million more doses to 31 additional countries, which will mean it have reached 51 countries out of the 190 COVAX members, said WHO adviser and COVAX representative Dr Bruce Aylward.

Aylward described the process of getting the vaccines to countries as complex.

At a global level, the WHO had to examine the vaccines and grant them emergency use listing, while at country level, “some of the biggest challenges that we’ve seen is the regulatory authorisation for these products as well as the indemnification and liability provisions for the use of these products”, said Aylward.

“The national vaccine plans have to be in place. And then once all that’s in place, we’ve got to be able to link it up with the shipments, the logistics, the purchase orders etc.”

Despite the complexities, Aylward said only 24 countries had not jumped through all the hoops – but were expected to have done so within the next two weeks.

 

Image Credits: Flickr: Francis Kokoroko/UNICEF.

Women in Africa account for a slightly smaller proportion of Covid-19 infections and deaths than men although a health expert cautions that access to testing and reluctance to being treated in hospitals could mean that women’s cases are undercounted.

Unveiling findings of a preliminary analysis of COVID-19 gender-specific epidemiological data in 28 African countries, the World Health Organization (WHO) on Thursday revealed that women account for about 41% of African COVID-19 cases. However, there was a large range from 31% for cases in Niger to over 57% in South Africa.

“In most countries, women are somewhat less likely to die from COVID-19 than men,” WHO stated. 

In Côte d’Ivoire, the case fatality ratio stands at 0.4% for women compared with 0.5% in men, while in the Democratic Republic of the Congo it is 2.2% versus 2.7%. In Seychelles, it is 0.1% for women against 0.5% in men, although the country has only had 13 COVID-related deaths.

This is despite the fact that women account for a large part of the health workforce and are thus at higher risk of infection. 

“In Africa, more than 95,000 health workers have been infected with COVID-19. In Seychelles, women account for 71% of health worker infections, 64% in Eswatini, 55% in Cote d’Ivoire and 54% in Senegal,” the WHO reported.

“Other studies report that men are significantly more likely to suffer severe effects of COVID-19 and more likely to have pre-existing conditions, explaining the slightly lower fatality rate seen in women,” the report stated.

Noting the need for further analyses to determine the factors behind the gender disparity, the report suggested that biological, behavioural or social factors could be responsible. 

However, Nigerian public health expert Bayo Ajala noted that the trend could be as a result of fewer women getting tested and unable to abandon their family duties to be at isolation centres.

“Many people are getting over COVID-19 even without any intervention. For women, in many African countries, they are the pillars of families and the household cannot survive without them. Maybe they are not getting tested for their details to be captured in the official data,” he told Health Policy Watch in Ibadan, Nigeria.

Women at higher risk of gender-based violence

But while fewer women appear to have been infected than men, the WHO noted that school closures during the COVID-19 crisis led to “an increase in teenage pregnancy and unintended pregnancies in many countries”. “Additionally, staying out of school for an extended period usually led to greater likelihood of engagement in risky sexual behaviour and increased sexual violence and exploitation. Also, women and girls are increasingly becoming victims in the spike of domestic violence fuelled by economic hardship as millions of people are pushed into extreme poverty.”

According to Matshidiso Moeti, the WHO Regional Director for Africa. “the aftershocks of the COVID-19 pandemic on women and girls have been profound, leaving many grappling with heightened risks to their health and safety”. 

“Our response must go beyond the clinical aspects of the pandemic and address the hidden crises that risk causing long-term effects to lives and livelihoods.”

According to WHO preliminary analysis of 22 countries, 10 reported a rise in maternal deaths between February and July 2020 compared with the same period in 2019, with the highest increases reported in Comoros, Mali, Senegal and South Africa. 

“Nine of the 22 countries reported a decline in births in health facilities and an increase in complications due to abortions,” WHO stated.

Oulimata Sarr, UN Women Regional Director for Central and West Africa, called for efforts to promote “positive masculinity”, involving men in addressing issues affecting women. 

“At UN Women, we are convinced that to be able to bring about change, people want to leapfrog into the future. We need to enroll the men, and those men, we call them our HeforShe. Those are really our champions who might be on decision-making tables where we are not and who will take full responsibility for a fair and just world that gives equal opportunity to men and boys and girls and women,” Sarr said.

As Africa joins the rest of the world to celebrate International Women’s Day on 8 March, Moeti said efforts should be geared towards closing the gender gaps by designing services in a people-centered way. 

“And taking into account inequity, and gender-driven inequity as well in the design of policies from financing health for designing our systems for health insurance for making sure that the approaches to improving access to services take into account all people,” Moeti concluded.