Minister of State for Masvingo Provincial Affairs and Devolution Ezra Chadzamira has today received his first dose of SinoPharm Covid-19 vaccine.

CAPE TOWN & KAMPALA – From Asia to the Americas, vaccines are fast becoming the new currency by which nations and geopolitical blocs wield influence and buy political favours – with more value than oil or bitcoin. 

But nowhere is this more apparent, perhaps, than in Africa, Latin America and south Asia, where both Russia and China are using bilateral SARS-CoV2 vaccine donations and deals to cement alliances with low- and middle income countries stung by the vaccine gold rush – in which high income countries have charged far ahead buying up limited supplies. 

Vast Trade in Vaccines 
The first consignment of AstraZeneca’s vaccine arrived in South Africa on 1 February

While global COVID-19 vaccine procurement and donations developments are very fluid, Health Policy Watch has tracked a vast trade in vaccines across Africa and other continents.  And it is clear that Chinese and Russian vaccines are deeply penetrating markets in many low- and middle-income countries (LMICs) – declarations of global solidarity by G-20 countries notwithstanding.

China reports that it has offered vaccine assistance to 53 developing countries, and that it has exported or is exporting vaccines to 22 nations, according to Foreign Minister Wang Yi. Meanwhile, by 25 February, Sputnik V had been registered in 37 countries.

In contrast, Western companies such as Pfizer/ BioNtech, Moderna, AstraZeneca/Oxford, and Johnson & Johnson, whose vaccine was the latest to be approved by the US Food and Drug Administration, are focused on a select group of high income countries in North America, Europe, the Middle East – peppered by only a few middle- or upper-middle income African or Latin American nations that teamed up with big pharma in clinical trials or swung heavily leveraged deals.  

Although the AstraZeneca vaccine is also being marketed to LMICs through the WHO co-sponsored COVAX global vaccine initiative, those sales are taking place through a separate license with the Serum Institute of India (SII). And there, too, SII has made a series of parallel, bilateral  deals, charging South Africa and Uganda 2-3 times the fee per dose, paid by Europe for the same vaccine.  

“As some high-income nations have already immunized more than 20% of their population with at least one dose, only a few African countries have reached even 1 in 1,000 people. It is frankly impossible to defeat the virus if these disparities persist,” says Solomon Zewdu, the Bill & Melinda Gates Foundation’s deputy director told Health Policy Watch, in explaning the desperate rush of others.

China’s Vaccine Outreach To Africa Began Months Ago

It is on the African continent where the Chinese vaccines are being marketed the most intensively – and perhaps embraced the most extensively. 

Beijing has confirmed that it is assisting 21 African countries to get vaccines, according to Foreign Ministry spokesperson Wang Wenbin. Significantly, Egypt, Africa’s fourth largest country, has signed an agreement with China’s Sinovac to produce its COVID vaccine, as well as distribute it to other African countries. 

That represents the fruits of a Chinese vaccine outreach initiative that began months ago.

 

Sinopharm hosted an in-person delegation of some 50 ambassadors and diplomats on its factory premises.

Already in October of 2020, Sinopharm hosted an in-person delegation of some 50 African ambassadors and diplomats on its factory premises – in a period when Beijing was stonewalling over WHO requests to permit entry of just 14 scientists into Wuhan to investigate the origins of the SARS-CoV2 virus.  

“Sinopharm stands ready to work with the African people to deepen cooperation in the fight against and pandemic, consolidate China-Africa friendship and make an important contribution to the joint development of the China-Africa health community,” Company chairperson Liu Jingzhen told the visiting delegation at the time.  

“President Xi Jinping pointed out that after the COVID-19 vaccine is developed and put into use, it will take the lead in benefiting African countries.” 

Using a ‘Common Interest’ Approach to Cement Superpower Status

China had become an expert in public diplomacy on the continent using a “common interest approach” in its quest to cement its superpower status,  Dr Yazini April, co-ordinator of the BRICS (Brazil, Russia, India, China and South Africa) Research Centre at the Human Sciences Research Council in Pretoria, told Health Policy Watch in an interview. 

Its “vaccine diplomacy” involved three things, according to April: the country’s desire to be viewed as a “trusted friend, business and political control”.

While much of Africa is not yet part of China’s massive global transport “Belt and Road” infrastructure plan, often referred to as the Silk Road, “each country has something they can trade with, such as water in Lesotho etcetera”, she added, referring to the country’s abundant resources that provide water to parched South Africa and hydroelectricity domestically. 

On New Year’s Eve, Gabonese President Ali Bongo Ondimba promised his people that they would be among the first on the continent to get the COVID-19 vaccine. But by mid-February, when there were no signs of COVAX deliveries, Gabon turned to China and will soon get 100,000 doses of the Sinopharm vaccine. 

Many other African countries are receiving China’s Sinopharm vaccine. Equatorial Guinea has received a donation of 100,000 doses, Zimbabwe received 200,000 doses as did Sierra Leone. Algeria is set to receive 200,000 doses and Senegal has purchased 200,000 China’s Sinopharm doses, with rollout anticipated soon. 

Uganda has also been offered a donation of 300,000 Sinopharm doses. However, the modalities of receipt of vaccine have not been concluded, said Ugandan Health Minister Jane Ruth Acheng during a press briefing in Kampala last week.

China’s Foreign Ministry spokesperson Wang Wenbin said that the vaccine aid “is a clear manifestation of the China-Africa traditional friendship”,  adding that China will continue to provide support and assistance within its capacity and in accordance with the needs of Africa.

Russia – Also Present in Africa

While less active, Russia is also present too. South Africa’s regulatory authority confirmed to Health Policy Watch that it had received an application for licensing from Sputnik V’s manufacturer on 24 February and was in the process of considering the “safety, quality and efficacy of the vaccine”. The South African government has also confirmed that it is in talks with Sinopharm but has a non-disclosure agreement with the company.

In late December, Guinea, one of the world’s poorest countries – but also a Russian source of the mineral bauxite – started to vaccinate people “on an experimental basis” with Sputnik V. Most vaccinations so far have been of government officials. 

On 1 March, Ghana started its COVID-19 vaccine campaign with vaccines received from the WHO co-sponsored COVAX initiative – but still more are needed.

Ghana’s government also has said that it is considering securing some doses of Sputnik V under bilateral arrangements. Franklin Asiedu-Bekoe, Ghana’s Director of Public Health, confirmed that the country has “opened our doors outside the COVAX facility to ensure that more than 20 million Ghanaians are vaccinated. We have registered the Russian Sputnik V vaccine which will provide a backup of doses”.

Africa Centres for Diseases Control and Prevention (CDC) also is in contact with the producers of Chinese and Russia vaccines – which have no special requirements for transportation and can be stored at normal refrigeration temperatures.  John Nkengasong, the director of Africa CDC, said Russia has already submitted its dossier for the Sputnik V vaccine directly to Africa CDC – and an expert committee was reviewing their data and would come up with guidance. 

Whether or not Africa CDC will act on its own or wait for WHO remains to be seen. WHO officials have urged countries to procure only those vaccines that have received an “Emergency Use Listing” from WHO, or are approved by another strict national regulatory agency, usually understood to mean the US, UK or European Medicines Agency. In the case of both Sputnik as well as the Sinopharm and Sinovac vaccines, those WHO reviews are still pending, said Matshidiso Moeti, WHO’s  Regional Director for Africa. 

The WHO also has repeatedly urged both pharma manufacturers and countries to refrain from bilateral deals and procure their COVID-19 vaccines through the COVAX facility – although those pleas have largely been to no avail. 

“To maximimize the chance of getting fair price for COVID-19 vaccines, we are advising countries to use as much as they can the pooled procurement platforms that are in existence for the moment: COVAX or AVATT,” said Dr. Richard Muhigo the head of immunisation and vaccine development at the WHO Africa office. 

“If the countries decide to go for bilateral deals with vaccine manufacturing, our recommendation is to procure as much as they can vaccines that have been listed by WHO for emergency use,” said Muhigo. 

China and Asia
Thailand’s first shipment of vaccines arrives from China.

Between October and January, Chinese Foreign Minister Wang Yi visited every country in Southeast Asia except Vietnam, according to the Center for Strategic and International Studies. 

“At each of his stops, Wang coupled promises of Chinese vaccine access with other foreign policy priorities, including advancing major projects under China’s Belt and Road Initiative (BRI), which have been stalled amid the pandemic,” according to the CSIS.

In the Philippines, Wang promised half a million doses of Covid-19 vaccines along with $1.3 billion in loans and $77 million in grants for infrastructure projects. In Indonesia, the delivery of 3 million Sinovac vaccines has come with China’s commitment to “help Indonesia become a manufacturing hub for Chinese vaccines” and speed up a high-speed railway link, according to the center. 

In Myanmar, a promise of 300,000 vaccine doses was accompanied by talks to develop a  China-Myanmar Economic Corridor, which would also ensure that China’s Yunnan Province just over the border would gain better access to the Indian Ocean.

All in all, China says that it is providing vaccines to 14  Asian countries including Pakistan, Brunei, Nepal, the Philippines, Myanmar, Cambodia, Laos, Sri Lanka, Mongolia and the Palestinian Authority: “China has decided to donate COVID-19 vaccines to Palestine,” China’s UN Ambassador Geng Shuang told the Security Council in late February, during its monthly meeting on the Israeli-Palestinian conflict.  

The Palestinian Authority (PA), however, has so far spoken publicly only about its procurement of Russia’s Sputnik vaccine – after a high-level PA official visited Moscow last month and signed a contract. The PA is also receiving a dispatch of vaccines from the Global COVAX facility. On 22 February, Hamas-controlled Gaza, received a shipment of some 20,000 Sputnik vaccines, donated by the United Arab Emirates.  Israel, criticized for failing to share more of its supply of Pfizer vaccines, has given the PA a few thousand doses directly, and is now beginning to vaccinate some 140,000 Palestinian workers – along with Arab residents of East Jerusalem which both Israel and the PA claim.  

China has also been active elsewhere in the Middle East region, supplying the UAE, Iran, Bahrain, Jordan, Iran, Egypt and Morocco. However, the UAE, Bahrain, Kuwait, Oman, Qatar and Saudi Arabia have also bought the Pfizer vaccine.

Russia Makes Inroads in Europe & Latin America 

Meanwhile, Russia has mostly sewn up vaccine markets in Euroasia and is also making inroads in the European Union, according to official news agency Tass. 

“Hungary became the first EU country to receive samples of the Sputnik V vaccine for research. Austria, Germany, Greece, Italy, Slovenia, the Czech Republic and Finland have already expressed interest in the possible use of the Russian preparation or its local production in case of its approval,” reported Tass on 19 February.

Sputnik Favoured in Latin America

At least 10 Latin American countries have received Sputnik V, beginning with starting with Argentina on 30 December. Since then Belize, Brazil, Bolivia, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay and Venezuala have all received doses – some as small donations and others as paid orders. 

In Bolivia, vaccine talks were accompanied by discussions of Russian assistance to develop gas reserves, restart a nuclear plant project and co-operate on lithium mining, according to Reuters.

Russia has also licensed manufacturing companies to produce its vaccine in India, Brazil, China, South Korea, and Argentina.

Argentina, Brazil, Bolivia and Mexico are getting both the Sputnik and Sinopharm vaccines, while Colombia, the Dominican Republic, Ecuador, Peru, Chile and Uruguay have only secured the Sinopharm vaccine so far.

Political Power or Donations to the Global Public Good ? 
China’s Xi Jinping in 18 May 2020 address before the World Health Assembly

Although China has been accused of donating its Coronavirus vaccines for political power, Chinese President Xi Jinping has stressed at recent meetings of the World Health Assembly that it viewed its COVID vaccines as a global “public good’. 

China has also joined the global vaccine access platform, COVAX, and promised it 10 million doses.  However neither of the two leading vaccine candidates, by Sinpharm and Sinovac, have been approved by an external regulatory agency – and discussions are still continuing, according to WHO officials.

Nor have the Chinese vaccine developers published peer-reviewed studies on their vaccines. Company reports show Sinopharm’s multi-country trials yielding efficacy results  of 79%, while Sinovac trials from four different countries showed results ranging from 91.3% in a Turkish trial to 50.3% in an independently managed  Brazilian trial among health care workers. 

In the case of Russia’s Sputnik V vaccine, the Gamaleya Institute developers together with the Russian Direct Investment Fund (RDIF) say they have submitted the vaccine portfolio to the  European Medicines Agency for review.  And a Lancet report on Phase 3 trial results, found the vaccine to be 90% efficacious against the SARS-CoV2 virus.  But the CEO of the  RDIF has also stated that it prefers to deal directly with countries rather than via the global COVAX facility.

Meanwhile, in the absence of other approvals, individual countries ranging from upper middle income Chile to impoverished Zimbabwe have taken matters into their own hands – registering Chinese or Russian vaccines for emergency use – regardless of the capacity of their regulatory authorities. 

And regardless of regulatory status, China and Russia have taken advantage of the three-month interval between the start of vaccine drives in wealthy countries and the launch of the COVAX facility’s global vaccine distribution effort in lower and middle-income countries, beginning just this past week in Ghana, Cote D’Ivoire and Nigeria.

COVAX Enters The Picture 

Now that COVAX has finally started the first allocations, with the aim to deliver some 2 bllion vaccines in 2021, it may soon eclipse the individual bilateral efforts of China and Russia. Or will it? 

In fact,  COVAX is only likely to reach about 20% of the populations of countries that have joined the facility by the end of the year.  So given the global vaccine thirst, Russian and Chinese vaccines will likely continue to find willing markets, at least in the near-term.

If the Russian Sputnik is finally approved by the EMA – the doors to much wider distribution in Europe and elsewhere will open much wider – particularly in light of the vaccine’s affordable US$ 10 price tag per dose. 

However, China appears unlikely to submit its Sinopharm and Sinovac vaccines to the EMA – or to any other strict western regulatory agency for review and approval.  

So what remains to be seen, against the landscape of unmet demands as well as enormous political pressures, is how WHO will handle the delicate balance of science and politics that could surround the review of the Chinese vaccines’ efficacy for a WHO Emergency Use Listing.

Image Credits: TellZimbabwe/Twitter, GovernmentZA/Flickr, CGTN, Flickr: Francis Kokoroko/UNICEF, the foreign photographer/Flickr.

Police in South Africa seized hundreds of fake COVID-19 vaccines and make several arrests in November, 2020, following a global alert by INTERPOL – leading to the recent arrest in China of the global trafficking ring.

LYON, France – Chinese police have successfully identified a network selling counterfeit COVID-19 vaccines as far away as Africa, raiding the manufacturing premises, arresting some 80 suspects, and seizing more than 3,000 fake vaccines on the scene, according to  the global INTERPOL agency [International Criminal Police Organization]. The investigation was supported and facilitated by INTERPOL’s Illicit Goods and Global Health (IGGH) Programme.

The China-South Africa trafficking ring, the first confirmed instance of fake vaccine smuggling across continents, was first identified in a February 2021 Health Policy Watch report of the exclusive investigation by the South African journal, Bhekisisa, “Little Vials, Big Crime, Criminals Primed For Onslaught on Africa’s Vaccines.

The story warned of the risks of organized crime flooding Africa and other markets with fake COVID-19 vaccines – and cited the case of 2,400 fake vaccine doses imported from China, and discovered in a warehouse outside of Johannesburg’s OR Tambo airport, by South African authorities in November 2020.

As Interpol told Bhekisisa, the “vaccines” had been advertised for sale on a Chinese social media app, WeChat, and had been imported from Singapore as “cosmetic injections”.  South African authorities arrested three Chinese and a Zambian national in connection with the counterfeit goods seizure.

Fake vaccine vials seized by South African police in November 2020, as a result of INTERPOL warnings, leading to the recent arrests in China of the trafficking ring.

“This is only the tip of the iceberg when it comes to COVID-19 vaccine related crime,” Jürgen Stock, the agency’s secretary general, noted in the agency’s most recent statement on Wednesday, March 3, on the arrests in China of the traffickers.

In addition to the arrests in South Africa and China, INTERPOL is also receiving additional reports of fake vaccine distribution and scam attempts targeting health bodies, such as nursing homes, the agency said in its statement.

Read the Interpol statement on the arrests and follow-up investigation here:

Image Credits: Interpol , INTERPOL.

The Brazilian state of Acre declared a state of emergency, facing rising COVID cases, a dengue epidemic, and flooding.

NEW YORK CITY – Although North America is experiencing an overall decline in new COVID-19 cases and deaths, Brazil and other localized hotspots in South America are experiencing a dramatic spike in infection and hospitalization rates, said WHO officials in the region’s Washington DC-based Americas office. 

In a Wednesday briefing, Pan American Health Organization (PAHO) director Dr. Carissa F. Etienne expressed particular concern regarding countries and areas in the Amazon Basin. “The Brazilian state of Acre has just declared a state of emergency due to a deadly combination of COVID-19 infections, a dengue epidemic, and flooding in several cities,” she said. 

“Nearly 94% of [Acre’s] ICU is occupied and the health system is collapsing as more and more patients require hospitalization.” 

Her comments followed an outspoken interview in the Guardian by Duke University neuroscientist Miguel Nicolelis, who called Brazil a “breeding ground for this virus” due to its lack of effective control of the pandemic. 

“If you allow the virus to proliferate at the levels it is currently proliferating here, you open the door to the occurrence of new mutations and the appearance of even more lethal variants,” said Nicolelis, complaining of the government’s lack of direction in controlling cases. 

As of 3 March, Brazil reports 10, 587, 001 confirmed cases of COVID-19 with 255,720 deaths. 

With Second Wave of Pandemic in Brazil, People Cannot Remain Complacent

Nicolelis, who has been self-confined to an apartment in São Paulo for most of the pandemic, called Brazil’s response a “domestic tragedy”. The failures of the far-right  president Jair Bolsonaro to implement effective prevention measures, such as masking and social distancing,  and more recently, a vaccination campaign, will impact the country until late 2020, Nicolelis said. 


Speaking at the PAHO briefing, incident manager Sylvain Aldighieri said:  “Brazil at this point in time is confronting a second wave of the pandemic, which is nationwide. This is impacting their health services, including ICU use – the rate of occupancy of beds in ICUs,” said 

Algieri also stressed the impact the virus has on the health supply chain, given the oxygen and access to special medicines needed to those who are in the ICU. 

The ongoing situation in Brazil only serves to remind us that remaining complacent during the COVID-19 pandemic can result in immeasurable loss of life. 

Etienne called on several lessons to guide the world moving forward in coming months. “As we prepare for the next crisis, first, our COVID-19 response has been strongest when it has been guided by data and science. When we use policies in data and science, we save lives.” 

“Second, public health is a global concern. COVID-19 showed us that a deadly virus that emerges halfway around the world can be a threat to anyone, anywhere. Third, access to quality health care should be universal. Where we live or how much money you have should not determine whether you live or die from COVID-19, or any disease. ”

Image Credits: IMF/ Raphael Alves.

Government officials in Nigeria receive 3.92 million doses of the Oxford/AstraZeneca vaccine at the international airport in Abuja on Tuesday

IBADAN – Nigeria has received the largest single shipment of COVID-19 vaccines from the WHO global COVAX initiative to date – with initial delivery of some 3.92 million doses of the Oxford/AstraZeneca vaccines out of a total of 16 million doses that have been allocated to the country through the platform for the first phase of distribution. 

But the fact that Nigeria, a country of 201 million people – will only receive some 16 million vaccine doses through the global platform – enough to vaccinate roughly 4% of the population in the first stages – highlights the huge discrepancy between the aims of the global initiative and reality.

Even so, the delivery of the first packages on Tuesday allowed Nigerian government officials to breathe a sigh of relief – after mounting pressure from media and the Nigerian public – to produce a timeline for the vaccine rollout.

In January, the country experienced its biggest surge to date of COVID-19 cases to date, peaking at the end of the month. Cases have dropped sharply since then, however, with a total of 1,923 deaths to date, and eight new deaths on Tuesday.

Dr Walter Kazadi Mulombo, WHO Representative in Nigeria, witnessed the arrival of the vaccines.

Said Dr Walter Kazadi Mulombo, WHO Representative in Nigeria: “Vaccines are a critical new tool in the battle against COVID-19; therefore, this is a step in the right direction. These vaccines have undergone rigorous regulatory processes at global and country level and have been deemed safe and effective.” 

According to data released by COVAX, only India and Pakistan are receiving more COVID-19 vaccine doses from COVAX than Nigeria – and it was not surprising that Nigeria received the largest doses from the platform shipped yet. 

About 15 minutes before noon, an Emirates Air Boeing 777-300ER, landed at  the Nnamdi Azikiwe International Airport, in Nigeria’s capital city of Abuja with doses of the vaccine produced by the Serum Institute in India. The first consignment package was officially received by the Chair of the Presidential Taskforce on COVID-19, Boss Mustapha. Mustapha then handed over the package to the country’s Health minister, Dr. Osagie Ehanire, who presented it to the National Agency for Food and Drug Administration and Control (NAFDAC). 

On Friday, a vaccination event will be held at the National Hospital Abuja’s COVID-19 treatment centre—the first site for the commencement of vaccination of frontline health workers and support staff.

Nigeria Relying on African Union Platform For More Vaccines
A banner at the airport welcomed guests to the reception ceremony.

While the COVAX deliveries to Nigeria remain woefully short of needs, the country is relying on the African Union’s African Vaccination Acquisition Task Team (AVATT) platform to secure more doses for the country. The AU has pre-ordered over 700 million doses of vaccine for the continent’s member states in collaboration with Africa Centres for Disease Control.

Earlier in February 2021, Ehanire projected that Nigeria will be able to secure vaccine doses for about 45% of its citizens in 2021 – through acquisition of some 42 million more doses of the AstraZeneca COVID-19 vaccine through the AVATT platform.  

“Nigeria subscribes to this whole-of-Africa approach, that strives to ensure that we are safe and our neighbours are safe,” Ehanire told a press briefing. “We shall be offered over 42 million doses by AVATT. If all the projected vaccines are supplied, we estimate we should have covered over 45 per cent of the population.” 

In addition to COVAX and AVATT, however, the health minister also revealed Nigeria is holding bilateral negotiations aimed at securing doses of Sputnik V vaccine produced by Russia’s Gamaleya, as well as doses of COVAXIN, India’s first indigenous COVID-19 vaccine, which has just released interim Phase 3 results.

In a statement, the World Health Organization (WHO) described the arrival of doses of vaccine in Nigeria as “a historic step towards the goal to ensure equitable distribution of COVID-19 vaccines globally, in what will be the largest vaccine procurement and supply operation in history”.

Through the COVAX Facility, about 90 million doses of COVID-19 vaccines are expected to be delivered to Sub-Saharan Africa in the first quarter of 2021. The facility is expected to provide up to 600 million doses to the region by the end of 2021 thus vaccination of 20% of its population. The COVAX Facility, a joint initiative of the WHO, Gavi the Vaccine Alliance, and other global health groups, aims to deliver at least 2 billion doses of COVID-19 vaccines globally by the end of 2021.

Confusion on Eligibility for Vaccine 

At the same time that the first doses were being received, however, there was confusion on who really qualifies to get the vaccine first of all. 

On Monday evening, Tolu Ogunlesi, Special Assistant to President Buhari on Digital and New Media, affirmed in a  Tweet that the phases for vaccine rollout in Nigeria are: frontline health workers and strategic leadership, older people, with priority for those with comorbidities; individuals aged 18 to 49 with comorbidities and the rest of eligible population (i.e. 18-49 without comorbidities).

But just a few hours before the arrival of the vaccines in Abuja, the National Primary Health Care Development Agency (NPHCDA), which is responsible for vaccine campaigns, released a link to a COVID-19 vaccination e-registration website which suggested that any Nigerian can register and book COVID-19 vaccination appointments right away – irrespective of their age or medical background.  

The launch of the platform has resulted in confusion including a rebuke from the Nigerian Medical Association (NMA) the umbrella body of medical doctors in Nigeria.

NMA President, Professor Innocent Uja, said the move would amount to a violation of the agreement the government previously made to vaccinate frontline workers before others.

“It means it will violate the issue of frontliners first,” he said adding, “maybe they want to see the depth of acceptability of the vaccine.” 

Later, Dr. Faisal Shuaib, CEO of the NPHCDA, expressed confidence in the ability of his agency to deliver the vaccines to targeted groups first – as well as ensure cold chain storage of the vaccines. 

“We have a robust cold chain system that can store all types of COVID-19 vaccine in accordance with the required temperature. We are therefore confident that we will have a very effective roll-out of the vaccine, starting with our critical healthcare workers, who are in the frontline in providing the care we all need,” Shuaib said.

Ray of Hope

In spite of the confusion regarding registration for vaccination, Peter Hawkins, UNICEF Nigeria Country Representative, said that with the arrival of vaccines, the path to recovery for Nigerians can finally begin. 

“The only way out of this crisis is to ensure that vaccinations are available to all,” Hawkins said.

Thabani Maphosa, Managing Director for Country Programmes at Gavi, the Vaccine Alliance, said the focus now should be on ensuring the vaccines are made available to the people most at risk, as soon as possible, and to ensuring that routine immunization services for other life-threatening infections are also delivered to avoid other disease outbreaks.

Even though experts are pessimistic about Nigeria being able to reach the 70% levels of vaccine coverage that experts say would be required to reach herd immunity, Mustapha was optimistic.  He said the country could achieve herd immunity within a little more than a year:

“I therefore urge all Nigerians to continue to comply with the non-pharmaceutical measures, even as we roll out the vaccines administration plan, which is expected to reach 70 percent of our population between 2021 and 2022.” 

Image Credits: Twitter , WHO AFRO.

older
AstraZeneca vaccine found effective in reducing COVID-19 in older adults

The AstraZeneca/Oxford vaccine can reduce severe COVID-19 in older adults by up to 70%, says a new Public Health England (PHE) study – which offers the first real-world evidence of the effectiveness of the vaccine in preventing serious disease among older adults, following its approval by UK and European regulatory agencies. 

Findings about the efficacy of the AstraZeneca/Oxford vaccine in among older people are critically important for countries not only in Europe but also in Asia and Africa – where the vaccine’s efficacy has been a matter of debate – even as it starts to be rolled out massively through the WHO co-sponsored COVAX global vaccine initiative.  

Meanwhile, an indigenous Indian COVID vaccine showed an “efficacy trend of 81%”  in a Phase 3 trial involving some 25,800 people, according to a statement Wednesday by the Indian Council of Medical Research.  The “interim analysis” involved some 6,000 participants, including mostly older people and people who had chronic diseases.

Among the 46 participants who contracted COVID, 36 had been given a placebo, said Bharat Biotech, the company that co-developed the vaccine.  

“The interim efficacy trend of 81%, analyzed as per the protocol approved by the DCGI, puts it at par with other global front-runner vaccines,” stated the ICMR press release.  It quoted ICMR’s director general as saying: “The bench-to-bedside journey of [a] completely indigenous COVID-19 vaccine in less than 8 months’ time … is a testament to India’s emergence as a global vaccine superpower.” 

UK Findings Relevant For Europe, Asia and Africa – Where AstraZeneca’s Efficacy had been Questioned 
AstraZeneca’s COVID vaccine will be the bulk of the COVAX products shipped to Africa

With regards to the AstraZeneca vaccine, preliminary findings from the Public Health England study, pre-released Monday in draft form, should provide welcome reassurance to other national health authorities rolling out the vaccine. 

“The effect of a single dose of the ChAdOx1 [AstraZeneca/Oxford] vaccine against symptomatic disease was approximately 60-75% and there was again an additional protective effect against hospitalisation, though it is too early to assess the effect and mortality,” state the study’s authors. 

Among older people aged 70 and above, who received the first dose of the AstraZeneca/Oxford vaccine, effectiveness against symptomatic disease was approximately 60-75% – although the paper did not assess the effectiveness of the full two-dose vaccine regimen. 

The study also looked at impacts from the Pfizer vaccine, finding that one vaccine dose prevented up to 70% of symptomatic disease. For two Pfizer doses, effectiveness was up to 90% among older adults. 

PHE Study Should Build AstraZeneca Vaccine Confidence – In Europe as well as Asia & Africa 
COVID-19 vaccination of elderly in India

While the Pfizer vaccine has already demonstrated its effectiveness in reducing serious illness and mortality among older adults in a number of large Israeli studies, the UK data represents the first real-world findings on the efficacy of the AstraZeneca/Oxford vaccine since the vaccine was approved by regulators in the UK as well as the European Medicines Agency. 

A number of European governments had last month recommended against using the AstraZeneca/Oxford vaccine among older age people – due to what authorities then described as a lack of evidence following approval by the European Medicines Agency. 

French President Emmanuel Macron even went so far to describe the vaccine as “quasi-ineffective for people over 65”. The Swiss regulatory agency, Swissmedic refused to approve the vaccine altogether, saying that the data so far was “not yet sufficient to permit authorization.’’ 

On 10 February, however, the World Health Organization recommended the vaccine’s use across all age groups. The WHO expert group expressed  “high confidence” efficacy among the +65 age group. The experts noted that even though the numbers of older people involved in AstraZeneca’s Phase 3 studies had been small – their immune response had been almost as good as that of younger people. 

In Africa, the Oxford/Astra Zeneca vaccine is set to be a cornerstone of the first phase rollout of COVID vaccine deliveries by the WHO co-sponsored COVAX vaccine facility initiative. The first shipments of AstraZeneca vaccines  reached Ghana and the Ivory Coast on Monday, followed by Nigeria later this week.   

In India, the AstraZeneca vaccine is a cornerstone of the national campaign – along with the Covaxin indigenous vaccine.

Study Shows Vaccines Are Effective Against so-Called British SARS-CoV2 Variants 

The PHE results also are reassuring insofar as they reflect the efficacy of both Pfizer and AstraZeneca/Oxford vaccines against the so-called British (B.117) variant that has now become dominant in the country – also spreading widely across Europe and beyond.  

The study results do not, however, provide evidence about the vaccine’s efficacy against another variant that has become a major concern due to its apparently greater ability to elude the body’s immune response – and that is the B.1351 variant first identified in South Africa. 

Earlier findings from a small South African study found that the AstraZeneca/Oxford vaccine was ineffective in preventing mild and moderate disease among younger age groups – prompting the country to rapidly shift its vaccine campaign from AstraZeneca/Oxford to Johnson & Johnson – which just received US FDA regulatory approval. 

The UK was the first country to implement a COVID-19 vaccination campaign following the approval of the Pfizer-BioNtech messenger RNA (mRNA) vaccine, BNT162b2. The UK was also the first high-income country to approve and begin rolling out the AstraZeneca adenovirus-vector vaccine, ChAdOx1 nCOV-19.  

“This adds to growing evidence showing that the vaccines are working to reduce infections and save lives. “While there remains much more data to follow, this is encouraging and we are increasingly confident that vaccines are making a real difference,” said Mary Ramsay, PHE Head of Immunisation, in a comment on the study. 

Pfizer Vaccine Also Offers High Levels of Protection Against Asymptomatic COVID  
Vaccination of the UK’s healthcare workers and elderly began in December 2020

In another UK study among healthcare workers, the Pfizer vaccine was shown to provide high levels of protection against any form of infection – preventing up to 85% of those immunized  from developing asymptomatic forms of COVID-19  as well.  

The study is important because it shows that the vaccines can also help stop the wider cycle of COVID transmission, as well as preventing symptomatic and serious disease. 

Healthcare workers in the study are regularly tested for coronavirus every 2 weeks, whether or not they have symptoms. Early data from the PHE SIREN study showed a single dose of the Pfizer vaccine had efficacy of up to 70% in preventing asymptomatic disease, rising up to 85% following the second dose. 

Even so, Ramsay cautioned: “It is important to remember that protection is not complete and we don’t yet know how much these vaccines will reduce the risk of you passing COVID-19 onto others. Even if you have been vaccinated, it is really important that you continue to act like you have the virus, practise good hand hygiene and stay at home.”

Image Credits: Gilbert Mercier/Flickr, Tim Reckman/Flickr, BNarayanpatna/Twitter, Eric Fiegl-Ding/Twitter.

Israeli Prime Minister Benjamin Netanyahu kicked off Israel’s vaccine campaign 21 December – in which more than half of the country’s population have now received at least one jab.

JERUSALEM – A three-way collaboration between Israel, Austria and Denmark to expand COVID vaccine manufacturing capacity may be taking shape – just as Moderna gears up for a major global manufacturing expansion and the Israeli-based firm, Teva Pharmaceuticals, negotiates with vaccine manufacturers about ways to support more vaccine production and distribution.  

Austria’s Chancellor Sebastian Kurz and Denmark’s Prime Minister Mette Frederiksen were reported to be planning a visit to Israel at the invitation of Prime Minister Benjamin Netanyahu – to talk about setting up “an international corporation for manufacturing vaccines” – in the words of the Israeli prime minister on Monday.  

The high-profile visits, if they come off, coincide with a quest by Moderna Therapeutics to set up some 20 new manufacturing plants around the world where “fill and finish” vaccine manufacture could start immediately, Israeli sources told Health Policy Watch. 

But rather than siting their plants in Israel, Moderna may also be eyeing Teva facilities in Europe or elsewhere, some sources suggest. Teva, while based in Israel, has a worldwide network of over 61 manufacturing plants, including Austria and Denmark as well as elsewhere in Europe. 

Riding on the jet-stream of fast-moving vaccine geopolitics, Pfizer’s CEO Albert Bourla was also reportedly set to make a visit to Israel on Sunday, 8 March. The visit could coincide with an announcement by Pfizer that it will locate a vaccine R&D facility in Israel – to come up with next-generation jabs against the ever-mutating coronavirus.

Bourla last week described Israel as “the world’s lab” for the Pfizer vaccine “ because they are using only our vaccine at this state and they have vaccinated a very big part of their population, so we can study both economy and health indices.”  

Moves Come Against Backdrop of Israeli Election Campaign 
Albert Bourla, CEO Pfizer, announces vaccine procurement deal with the WHO co-sponsored COVAX, Friday 22 January 2021

However, some leading Israeli scientists and diplomats have urged the Pfizer CEO to postpone his high profile visit –  which would come just two weeks ahead of a hotly-contested Israeli national election campaign. 

Netanyahu is trying to retain his 12-year-long grip as prime minister – despite corruption cases in the courts and political challenges from former allies on the political right. Showcasing Israel’s success in its vaccination campaign, which has seen over half of Israelis get first jabs and led to a dramatic decline in COVID cases among people over the age of 60, has been a key part of Netanyahu’s re-election strategy. 

While Netanyahu has been widely acknowledged by Israelis for his aggressive moves to acquire and roll out vaccines rapidly and efficiently – he has also been criticized for politicizing an already charged vaccine landscape at home and abroad  – including recent offers of vaccines to alliles in far-flung capitals even before Palestinians next door get access to significant COVID vaccine supplies.

“It is understandable why the chairman and CEO of Pfizer, Dr. Albert Bourla wants to visit Israel. The country – both the government and the scientific and medical communities – will enthusiastically welcome him. Many are looking forward to exploring the possibility of R&D projects and a Pfizer production line in Israel,” wrote Alon Pinkas, former Israeli Consul General in New York, in an op-ed in the Ha’aretz national daily. 

But, Pinkas added, “It defies logic why Bourla, the CEO of a world-leading biopharmaceutical company worth nearly $190 billion, would visit Israel on March 8, 15 days before the Knesset [parliamentary] election. To put it bluntly, Pfizer will become a political prop, and the visit will be politicized with high-octane intensity. Prime Minister Benjamin Netanyahu no longer has Donald Trump as some brother-in-arms campaign asset, so why not use Pfizer?”

Netanyahu Says Israel May Host Moderna Plant –  Others Say Country Lacks Immediate Manufacturing Capacity
Tal Ohana, mayor of the Negev desert town of Yeruham, Israel is actively searching for a COVID vaccine manufacturer to locate in an available facility.

In a February 15 interview with Israel’s Channel 12 news channel, Netanyahu said that he was negotiating with both Moderna and Pfizer  “to build two factories in Israel – making us a global center in the fight against COVID-19.” 

“The Moderna complex will be a center for filling vaccine vials, while Pfizer’s will work as a research and development site for the fight against future viruses,” Netanyahu said.

However, Tal Ohana, the mayor of the Israeli Negev desert town of Yeruham, which had been considered one of the leading sites in the country for a vaccine manufacturing plant, said in an interview with Health Policy Watch that she doubts that Israel can host a plant of the capacity and dimensions that Moderna is seeking at this stage. 

“We are in touch with Moderna,” said Ohana, who had been trying to attract a vaccine manufacturer to the town of 10,000 people even before the pandemic began. “They have decided to create 20 new manufacturing sites around  the world.  But they need something immediate for ‘fill and finish’, with sterile rooms.  To produce at export scale, the company is also looking for large-scale facilities – e.g. of 5,000 square meters in size and employing about 200 workers to produce 100 million vaccines a year, she said. 

While Yeruham is “the most advanced in the process among all of the options in the country… we aren’t at that stage…. we don’t have that capacity here. It takes time,” Ohana said of the facilities already available. “So Moderna is looking at establishing sites elsewhere in the region and to come back to us later.”  

Ohana said it was her understanding that Pfizer would, however, be setting up an R&D facility somewhere else in the country soon. She noted that the company has been eyeing an R&D facility in Israel for some time – “but there were disputes over the IP… then with the interventions of the prime minister, I’m pretty optimistic it will happen,” she added.    

The 36 year-old Ohana, who holds a master’s degree in government and diplomacy and has won recognition for driving COVID cases in the town down to single digits, said that she is focused on attracting a vaccine manufacturer – which would provide a larger employment base. To that end, the municipality is still in negotiations with a third pharma company – which she preferred not to name.

Teva Keen to Fill Manufacturing Niche in International Vaccine Market 
Israeli Prime Minister Benjamin Netanyahu and Health Minister Yuli Edelstein visit a Teva Pharmaceuticals ultra-cold logistics center in November 2020, just before the first deliveries of Pfizer mRNA COVID vaccines – for which Teva is managing distribution.

Meanwhile, as another piece in the jigsaw, Teva appears likely to step in soon as a manufacturing solution for capacity-strapped vaccine producers – which are struggling to fill orders now that vaccines have been approved. A spokesperson for Teva, the world’s largest generic drug manufacturing company, confirmed to Health Policy Watch on Wednesday that “there are discussions between Teva and vaccine originators about production – but we have no information to add about their identity.”

In a series of mid-February media interviews Teva CEO Kare Schultz said Teva was one of the companies best positioned to fill the current holes in the COVID-19 vaccine manufacture market: 

“We have a large, worldwide network of manufacturing capabilities,” from creating underlying drug substances to putting solutions into sterile vials, known as the fill-finish process, Schultz told Fortune Magazine. “There are a limited number of facilities that can do this kind of manufacturing, and it takes time to build them.”

While declining to comment on which vaccines Teva might produce, the company is equipped to make the messenger RNA active ingredients used in the Moderna and Pfizer-BioNTech vaccines.

Teva has already played a huge roll in Israel’s massive vaccine rollout, – the largest in the world, handling the distribution process from airport delivery to ultra cold-chain storage and transportation to hundreds of vaccination sites around the country.

“We also have distribution capability in the U.S. and would be more than happy to help there,” Schultz also said.

But significant to any upcoming talks between Israel, Austria and Denmark, Teva also has plants in Europe, including in Seborg, Denmark and  Teva Ratiopharm Austria, an Austrian firm acquired by Teva in 2010, 

Flurry of Activities Come Against Persistent European & Global Vaccine Shortages 

The flurry of activities by both countries and pharma manufacturers to rev up vaccine manufacturing production come against the stark reports of vaccine supply shortages in Europe – not to mention globally. 

Speaking at her first session of the World Trade Organization’s General Council on Monday, incoming WTO Director General Ngozi Onkonjo-Iweala noted that the world’s vaccine manufacturing capacity currently stands at only about 3.5 billion doses annually – while the needs in the COVID era are for the manufacture of some 10 billion doses a year. 

Iweala has also said she would advocate for a “third way” approach with pharma companies to expand global manufacturing, particularly in low- and middle-income settings where production could also expand access to vaccines among less developed countries.  

It remains to be seen if the vaccine scale-up envisioned by Moderna, and the moves being made by Teva, as well as Israel and its European allies will support that wider objective – or merely expand supplies to high-income countries in Europe and elsewhere.    

 

Image Credits: Youtube – Israeli PM, wikipedia , Kobi Gideon, GPO.

As a deaf child in India, Sneha Das Gupta struggled to make friends and to learn during classes at school. Fortunately, in her earliest years, she was able to do well because she had access to a hearing aid, as well as speech therapy and support from her teachers at school.  Today, she is a PhD student at the prestigious TATA Institute of Social Sciences.

Most people who are at risk of hearing loss, however, are less lucky than Sneha, struggling to communicate, study, and to earn a living, revealed the WHO’s first World Report on Hearing, published on Tuesday, ahead of World Hearing Day on 3 March. 

“Our ability to hear is precious,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Untreated hearing loss can have a devastating impact on people’s ability to communicate, to study and to earn a living. It can also impact on people’s mental health and their ability to sustain relationships.”

Over 1.5 billion People Affected – Another 1 Billion At Risk 

The number of people affected is massive, found the report, with over 1.5 billion people, from all walks of life, with some degree of hearing loss. And unless hearing care is prioritized and integrated into national health systems, that number will grow to 2.5 billion people by 2050, generating losses of over US$ 1 trillion a year to economies worldwide –  especially in low- and middle-income countries which harbor 80% of the total number of people with hearing loss. 

The report, published in collaboration with the US-based Institute of Health Metrics and Evaluation, found that most countries have failed to integrate hearing care into their national health systems, and that the bulk of people who need EHC services cannot access them – largely as a result of stigma associated with hearing loss, as well as insufficient human resources and services to deliver, fit, maintain and support use of the hearing aids.

“About 1 billion people around the world are at risk of avoidable hearing loss,” said Malala Yousafzai, Nobel laureate and UN messenger of peace. “WHO estimates that over 400 million, including 34 million children, live with disabling hearing loss, affecting their health and quality of life”, added Yousafzai, who has suffered from hearing loss herself. 

Because hearing loss severely impairs the cognitive and linguistic development of children, it can have lifelong impacts on their education and employability. People with moderate to severe hearing loss were half as likely to achieve higher education and twice as likely to be unemployed as people without hearing loss, the report notes.

The causes of hearing loss are often preventable, at least in children and young adults. In children, 60% of hearing loss can be prevented through vaccinations against preventable illnesses and treatment of common ear diseases. And 50% of young people aged 12–35 years – or one billion people – are at risk of losing their hearing due to exposure to unsafe sound levels in recreational settings. 

Number of people with hearing loss, by severity

Workplaces & Public Venues Key To Reducing Risks  

The report also illustrates how practical solutions for workplaces and stricter legislation for public venues can reduce hearing loss risks. 

European countries such as France, Italy, the United Kingdom, and Czechia – have reported dwindling levels of noise-induced hearing loss (NIHL) in past years, largely as a result of hearing conservation programmes. In the US, for instance, a military hearing conservation programme found that workers were almost 30% less likely to develop hearing loss.

Meanwhile, strict legislation in Switzerland has ensured that audiences at public venues are offered free ear plugs. Together with other measures, this may explain why an impressive 40% of attendees in recreational venues in Switzerland wear hearing protection – a much higher percentage than in other countries. Such measures include: 

  1. A limit on the average hourly sound levels to 100 A-weighted decibels.
  2. Measurement and recording of sound levels.
  3. Visible information and posters on safe listening.
  4. Provision of “quiet areas” for events whose duration exceeds three hours. 

The report also calls on Member States to implement “HEARING”, a package of cost-effective interventions that include: screening and intervention; ear disease prevention and management; access to technologies; rehabilitation services; improved communication; noise reduction; greater community engagement.

Through HEARING, the WHO aims to boost the relative coverage of ear and healthcare services by 20%, building on the World Health Assembly’s resolution in 2017 to prevent deafness and hearing loss, and contributing to the Sustainable Development Goals – including SDG3 (good health and well-being), SDG4 (quality education), SDG8 (decent work and economic growth), and SDG10 (equality). 

Shortage Of Trained Specialists To Address Ear Health

The WHO’s report also found glaring disparities in the numbers of trained professionals equipped to help people with hearing issues. It found that 80% of LMICs have only 1 ear, nose and throat specialists (EAT) specialist per 1 million people – in contrast to 95% of high-income countries, which have ten times as many ENT specialists.

Similarly, the report found that 35% of countries in Africa had less than 1 teacher of the deaf per million people, in comparison to 15 teachers per million people in 50% of American and 42% of European countries, respectively. 

Using various case studies, the report also illustrates strategies to overcome the shortage of highly specialized professionals at a low-cost in a range of settings. 

On Kiribati’s island of South Tarawa, for instance, 25% of patients who presented at the island’s hospital suffered from ear problems – prompting authorities to train nurses to deliver ear health care to children in three primary schools. The strategy, which also included the set up of a specialized ear clinic on the island, contributed to a “dramatic decrease” in chronic ear problems faced by students.

Use of earplugs in noisy places can reduce the risk of hearing loss significantly

Stigma As Key Barrier To Uptake Of Hearing Services 

The report also emphasizes that stigma is a key issue that has hampered progress in EHC care. In some communities, deaf babies are regarded as a “bad omen” that could bring misfortune. As a result, families are less likely to screen their children for hearing disabilities.

“Hearing loss has often been referred to as an “invisible disability”, not just because of the lack of visible symptoms, but because it has long been stigmatized in communities and ignored by policy-makers,” said Dr. Tedros in the report. 

Stigma could also explain why adults usually stall for ten years before seeking any hearing care, and why in high-income countries, three-quarters of the people that need hearing aids do not use them, even when they are available. 

Marketing strategies that promote hearing devices do not help either, notes the report, because they emphasize discreteness of their devices, thus reinforcing the belief that hearing devices should be hidden, and contributing to public reluctance to wear these devices – even when they are accessible. 

According to the WHO, usage of a hearing aid can reduce the years lived with disability (YLDs) due to unaddressed hearing loss by almost 60% – but only 68 million out of a total 400 million people in need actually use one.

Hearing Aids Are Expensive ; Six Manufacturers Produce 98% of Hearing Aids Worldwide

Apart from stigma, hearing devices can be expensive, and earmolds, batteries, and maintenance services are not always covered by health insurance. In countries like the US, the price of hearing aids ranges between US$ 500 and US$ 3000, although low-cost devices in India can be bought for as little as US$50.

Another issue that is likely to maintain high prices is the fact that a mere 6 manufacturers produce up to 98% of the hearing devices worldwide. And they mostly tailor their products to high-income markets, further complicating access in low-resource settings. 

Initiatives like pooled procurement, usage of solar-powered batteries and locally-sourced materials, or even innovative reimbursement schemes, can bolster access to hearing aids across a range of settings, suggests the report, noting that the UK’s pooled procurement scheme has fitted 750,000 hearing aids across all age groups in recent years.

Universal Screening Is Crucial 

A child in South Africa receives screening using automated audiometry and noise cancelling headphones

Given that hearing lies at the heart of cognitive and linguistic development in children, health systems should attempt to screen children as early as possible, emphasizes the report. 

Perhaps surprisingly, many parents may be unaware of their children’s hearing difficulties, according to a Polish study of 71, 000 first-graders who were examined in over 4,000 schools. In the study, about half of parents who had children with hearing issues were unaware of their child’s condition. In total, almost 15% of all children who were screened were diagnosed with hearing loss, and referred for further care and treatment. 

Screening, however, should not be limited to children, given that 1.1 billion young people are at risk of permanent hearing loss due to exposure to unsafe sound levels in recreational settings.

Older people should also take part in screening programmes, as two thirds of people over the age of 60 experience some degree of hearing loss. 

Timely diagnosis of hearing loss in older people could also have another benefit – it could prevent up to 8% of cases of dementia in older adults, which is one of the major causes of disability in adults worldwide.

Image Credits: WHO/Otto Mejía, Eddie Linssen / WHO, Hear The World Foundation.

COVAX press conference: (from left): President of Ghana, Nana Akufo-Addo, UNICEF’s Henrietta Fore, Africa CDC Director John Nkengasong, GAVI’s Olly Cann; CEPI CEO Richard Hatchett; German Parliamentary State Secretary, Maria Flaschbarth; Gavi CEO Seth Berkley; UNICEF’s Gian Gandh; Soumya Swaminathan, WHO Chief Scientist; Kate O’Brien, WHO Vaccines & Biologicals; WHO Director General, Tedros Adhanom Ghebreyesus.

The global vaccine platform, COVAX, aims to distribute 237 million doses of the Oxford/ AstraZeneca vaccine to 142 countries by the end of May 2021, its managing partners told the media on Tuesday.

Eleven million doses will be delivered this week alone, with Angola, Cambodia, Democratic Republic of Congo and Nigeria getting their vaccines on Tuesday, according to World Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus.

Tedros described COVAX as “an unprecedented partnership that will not only change the course of the pandemic but will change the way the world responds to future health emergencies,” at a media briefing hosted by the WHO, the Global Vaccine Alliance (GAVI), the Coalition for Epidemic Preparedness Innovations (CEPI) and the United Nations Children’s Fund (UNICEF). 

“We very much appreciate the support of Germany and other G7 countries who have supported COVAX with the resources it needs,” said Tedros. 

“The distribution of vaccines has not been as equitable as we would have liked, but it has been certainly more equitable than it could have been and we still have many challenges to overcome, including the local production barriers and delays to intellectual property,” he added.

COVAX, led by the WHO, GAVI and CEPI with UNICEF as the implementing partner, hopes to deliver 2 billion doses to people in 190 countries in less than a year. 

Some 1.2 million doses of the Pfizer-BioNTech COVID shot will also be delivered in the first quarter of 2021, according to the COVAX allocations.

Seth Berkley, CEO of GAVI, The Vaccine Alliance.

GAVI CEO  Seth Berkley said that it might be possible to purchase “1,8 billion doses of vaccine in 2021 for the low and lower middle income AMC countries in 2021” – 500 million more doses than anticipated last year. 

“We are also excited by the progress made by the Johnson and Johnson single-dose vaccine which just received US FDA emergency use authorisation and has agreed to provide us with a half a million doses,” said Berkely. 

Meanwhile, COVAX aimed to turn a recent memorandum of understanding with as-yet-unlicensed Novavax into a “firm advance-purchase agreement for 1.1 billion doses in the current weeks,” Berkley told the media briefing.

He also applauded the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States) for doubling COVAX’s funding recently.

UNICEF – COVAX Making Good on Promises

UNICEF executive director Henrietta Fore said COVAX was beginning to make good on its promise to ensure that there was equitable access to vaccines. 

“Vaccine doses have arrived in West Africa and Asia, with many more countries to follow in the coming days and weeks,” said Fore, whose organization is overseeing the logistics.

“We’ve now seen Africa’s first vaccinations with COVAX doses in Ghana and Ivory Coast, in truly moving ceremonies in both countries yesterday. 

“But what took place on Monday is more than a feel-good story that speaks to our collective best natures. It is a necessary first step that speaks to our collective interests. 

“The only way out of this pandemic is to ensure that vaccination is available across the globe and that people from less wealthy countries are not left behind in the race to be protected,” said Fore.

She revealed that at least 20 countries could expect to receive hundreds of thousands of doses this week.

“Only today, we have five shipments including to Democratic Republic of Congo, Angola, Nigeria where we are delivering COVID-19 vaccines with consolidated syringes and routine vaccinations, ensuring that children are also protected among many other countries,” Fore said.

Nigeria alone received nearly four million doses. 

Fore said that the arrival of the vaccines represented hope particularly for children as “their access to education, health and protection services has been severely disrupted by the pandemic”.

Multilateralism key to fighting Covid-19
Ghaanian President Nana Akufo-Addo gets vaccinated against COVID-19 on Monday, 1 March, with the first COVAX vaccine to be distributed in the world.

Also addressing the briefing, Ghanaian president Nana Akufo-Addo, who was vaccinated on Monday, said that Africa needed to develop the capacity to produce vaccines “to facilitate easy and affordable access”.

 Maria Flaschbarth, Parliamentary State Secretary to the German Minister for Economic Cooperation and Development, described COVAX as an indication of the strength of multilateralism and working together to achieve a common goal.

“What we are witnessing here is the strength of multilateralism. We have seen what can be achieved when all actors work together. The public sector, scientific community, economic actors as well as civil society. We will defeat COVID-19 everywhere or nowhere. No one is safe until everyone is safe. The current mutations show this simple fact very clearly,” Flaschbarth said.

Flaschbarth further indicated that the current financing gap of the Access to COVID-19 Tools (ACT) Accelerator which includes COVAX, was over US$22 billion for 2021 alone. 

“To close this gap, it will be necessary to widen the donor base by further sustainable contribution of other public donors as well as the private sector,” she said. “Therefore, Germany very much welcomes the leadership of the current G7 and G20 presidencies putting equitable access to Covid-19 vaccines, therapeutics and diagnostics on the international agenda. This will be very helpful to mobilise more funding for the global medical answer to the Covid-19 pandemic.” 

Africa Centre for Disease Control (CDC) director John Nkengasong also said COVAX was beginning to show the power of global cooperation and the victory of “multilateralism versus protectionism”.

Nkengasong added that the African Union Commission will host a meeting on 12 April “to develop a roadmap and a framework that will enable Africa to begin to address with specifics, the key milestones to begin to manufacture vaccines on the continent”.

“All of this speaks to the need for our own ability to stand up and say that we as a people of 1,2 billion people will continue to invest in our health security and economic security that increasingly is being threatened by COVID-19,” Nkengasong said.

Vaccines to Address Virus Variants

CEPI chief executive officer Richard Hatchett said while the world was making progress in curbing COVID-19 through COVAX, there was a need for the more sophisticated vaccines to deal with emerging variants.

“In parallel to the global rollout of vaccines, we must now double our R&D efforts so that we have the tools we need for the emerging type of variant of Covid-19 as rapidly as possible,” Hatchett said.

“CEPI will continue to invest in R&D for vaccines that can be made available to COVAX to support the adaptation of existing vaccines and to initiate the development of new vaccines specifically targeted at the new variants” Hatchett said. 

 

Ngozi Okonjo-Iweala enters the WTO on 1 March 2021 to take over as WTO Director General.

Despite a groundswell of growing support, a South African and Indian proposal to the World Trade Organization to suspend patents and other intellectual property on vital COVID-19 vaccines and other health products was put on hold by WTO’s General Council in its session on Monday – with the next debate likely to occur in May. 

But there is growing pressure among supporters to move discussions to a draft text – to be hammered out in the interim by WTO members of the TRIPS Council, (which oversees the Trade Related Agreement on Aspects of Intellectual Property Rights).   

The proposed TRIPS Waiver, first submitted by South Africa and India on 2 October, now has the support of Kenya, eSwatini, Mozambique, Pakistan, Bolivia, Venezuela, Mongolia, Zimbabwe and Egypt – as well as WTO’s least developed group of 35 mostly African and SouthEast Asian countries.   

“I think there is a general agreement among members to continue these discussions with the aim of trying to find some sort of compromise that would help and address this urgent matter regarding the global crisis,” said a Geneva WTO official, commenting on the TRIPS waiver deliberations, just after they concluded Monday evening.  

The official said that some 31 delegations had taken the floor to comment at today’s WTO General Council meeting, the first since the election of new WTO Director General Ngozi Okonjo-Iweala. 

New WTO Director General, Ngozi Okonjo-Iweala presides over virtual meeting of WTO General Council, 1 March 2021

“The discussion was overall positive and constructive,” the official said. “Proponents underlined the urgency of addressing the matter.  Nearly all the delegations agreed on the need to ensure widespread and affordable access to vaccinations as soon as possible. 

“It was very constructive, with no animosity between the delegations, no name-calling, but a sense of urgency among many of the proponents, to ramp up manufacturing the vaccines – ensuring their widespread and affordable distribution.  And I think nearly all members agree to that goal. The difference is how that is to be achieved. Some pointed to initiatives outside of the WTO that are being undertaken on the matter.” 

According to other sources, while the majority of the 31 WTO  members who took the floor spoke on behalf of the waiver, about 10 countries remained in the middle while about six countries cautioned against relying on the waiver as the approach for this issue, [saying that] the argument is more complex and we have to look more at the exact role of IP as a problem in accessing vaccines.  

Among those more cautioning voices, Switzerland, Japan and New Zealand also stressed that pharma and industry representatives need to be drawn more deeply into the waiver discussions – in which they have so far not been involved.  

Significantly, neither the United States nor the European Union took the floor Monday on the waiver matter, sources said. 

Interventions by OECD members were “rather short” a Geneva trade official told Health Policy Watch.  Some focused on the existing TRIPS “flexibilities”, which allow countries to manufacture or export generics in health emergencies, but said they were keen to hear practical and effective ways to address bottlenecks. Others stressed existing international cooperation around the WHO co-sponsored COVAX vaccine facility as the preferred way forward to expand vaccine access.

But overall, obsevers say, countries that are supporting the waiver still haven’t yet managed to make a convincing case to high-income countries that IP is the major roadblock to expanded COVID vaccine manufacturing.

Significantly, South Africa’s  Xolelwa Mlumbi-Peter, currently chairs the TRIPS Council where waiver discussions are currently being held. But that roll will soon rotate to another country – there has been some speculation that the next candidate could be Norway, which could potentially play a bridging role between countries pro and con on the issue. 

Ngozi Says: WTO Delegates Need to ‘Walk & Chew Gum’ SImultaneously
Virtual meeting of WTO General Council, which began Monday, is likely to continue until Wednesday, 3 March.

Incoming WTO DG Iweala, meanwhile, said that WTO delegates and countries should “walk and chew gum” simultaneously – stepping up informal contacts with industry voices over the vaccines manufacturing bottleneck – while debates over the formal WTO waiver proposal continue at the WTO TRIPS Council. 

“We have a demand for a TRIPS waiver by a growing number of developing countries and the dialogue is intensifying,” declared Iweala. 

“Whilst this is happening, I propose that we “walk and chew gum” by also focusing on the immediate needs of dozens of poor countries that have yet to vaccinate a single person. 

“People are dying in poor countries. We just had our first COVAX shipment to Ghana last week and others will follow but it will not be enough. There is serious supply scarcity and some countries are out bidding COVAX and diverting supplies. 

‘Third Way’ Now Framed As ‘Interim’ Approach  

At the same time, Iweala’s comments represented a slight shift from remarks that she had made only two weeks ago, when she was elected to head the WTO. At the time, she said she would advocate for a “third way” approach based on voluntary licensing of patented vaccines to generic manufacturers in the global south.  

However, in her remarks to the WTO General Council this Monday, shared after the closed meeting, Iweala said that would only serve as an “interim solution” – until a more formal agreement were reached. 

“The world has a normal capacity of production of 3.5 billion doses of vaccines and we now seek to manufacture 10 billion doses. 

“This is just very difficult, so we must focus on working with companies to open up and license more viable manufacturing sites now in emerging markets and developing countries. We must get them to work with us on know-how and technology transfer now. 

“There will soon be a world manufacturing convention where we can seek to build this partnership. I also hope we can initiate a dialogue and information exchange between us and representatives of manufacturers associations from developing and developed countries. Excellencies, this should happen soon so we can save lives. 

“As I said at the beginning, this will be an interim solution whilst we continue the dialogue on the TRIPS waiver,” said Iweala. 

In her remarks, Iweala also called on members to “do things differently” to achieve reforms necessary to keep the WTO relevant, starting with swift action to curb harmful fisheries subsidies, as well as scaling COVID-19 vaccine production and distribution. The new head of the WTO noted that high expectations for her tenure can only be met if members are willing to compromise and reach agreements – instead of “talking past each other” as has become the norm.

Without such compromises, she warned that the WTO risks becoming irrelevant and bypassed increasingly in global trade discussions and debates. 

 

Image Credits: ©WTO/Bryan Lehmann, ©WTO/Bryan Lehmann.

Ghanaian President Nana Akufo-Addo gets vaccinated against COVID-19 with the first vaccine in the world to be distributed by the WHO co-sponsored global COVAX facility.

Ghana and Cote d’Ivoire have become the first countries in the world to start vaccinating their health workers against COVID-19 with a supply of doses from the WHO co-sponsored global COVAX facility. But it is “regrettable” that this milestone has come almost three months after vaccine campaigns already began in rich countries, World Health Organisation’s (WHO) Director General Dr Tedros Adhanom Ghebreyesus said on Monday.

“And it is regrettable that some countries continue to prioritise vaccinating younger, healthier adults at lower risk of disease in their own populations, ahead of health workers and older people elsewhere,” Tedros told the WHO bi-weekly media briefing.

However, Tedros told the briefing that, by the end of May, 237 million doses of COVID-19 vaccines will be allocated to 142 countries participating in the global COVAX facility.

Samira Bawumia, wife of the Ghanaian vice president, Mohammed Bawumia, enters her biodata into the Ghana vaccine data base just before she and her husband are vaccinated against COVID 19 in the kickoff to the Ghanaian campaign on Monday, 1 March.

Eleven million more doses will be dispatched to 15 countries this week, 14 in Africa, according to the WHO. Nigeria reported last week that it is expecting to get 4 million COVAX vaccines this week.

The WHO has been at pains to stress that, if the virus is to be eliminated, there needs to be a uniform global vaccination campaign that prioritises health workers and the elderly throughout the world.

But COVAX, the facility set up to acquire and distribute vaccines equitably, has been undermined by bilateral deals between pharmaceutical companies and wealthier countries intent on vaccinating all their citizens first. This has resulted in a worldwide shortage of doses and a situation whether 130 countries have not yet started to vaccinate citizens.

“The goal of COVAX was to bring an end to the acute phase of the pandemic by the end of 2021,” said WHO Chief Scientist Soumya Swaminathan. 

WHO Chief Scientist Soumya Swaminathan

“We cannot completely eradicate the virus by the end of the year but we can reduce hospitalizations, deaths and severe illness. But we can only do that if people at risk around the world get the vaccine. And at this point in time, they’re not. 

COVAX aims to vaccinate 20% of the world’s population by the end of the year – those who are most at risk of severe illness and death. 

“Then we can scale up as production increases and expand the vaccination campaigns to cover healthier younger adults and really start bringing down transmission,” explained Swaminathan. “But our goal really should be to protect people’s lives and do it as quickly as possible by sharing the vaccines that we have today.”

Swaminathan, who described the COVAX launch as “the start of the largest vaccine campaign the world has ever seen”, added that early data from countries who had started vaccinations showed a “very encouraging” impact on hospitalisation and deaths.

“The safety profile is also encouraging, as about 250 million doses have been given worldwide and so far there have been no major safety signals,” she added.

Mariângela Simão, WHO Assistant Director-General for Drug Access, said the order in which countries were getting COVAX doses was based on “preparedness”, as each country had to accept the vaccine liability indemnification and their medicine regulatory authorities had to authorise the vaccine for use.

Bruce Alyward, who represents the WHO at COVAX, added that “just getting so much vaccine labelled, packaged, booking shipping space and getting them shipped” was a “massive logistical operation that UNICEF and the Pan American Health Organisation are managing right now”. 

Cases Increase, Raising Threat of New Variants

Tedros reported that, for the first time in seven weeks, COVID-19 cases had increased in four WHO regions, the Americas, Europe, Southeast Asia, and the eastern the Mediterranean, apparently because of a “relaxation of public health measures”.

“This virus will rebound if we let it,” said Maria van Kerkhoven, WHO’s Technical Lead on COVID-19. “We’ve all been in a position previously, where we’ve gotten transmission down to very low numbers. We cannot allow it to take off again, especially as we have vaccines rolling out, and especially as more vaccines are coming online and as COVAX is starting to distribute the vaccine around the world.”

Van Kerkhove stressed that people must continue to “limit your contacts with others”, reduce social mixing with other families as schools open up, continue to keep a distance from others and wear masks.

Kate O’Brien, WHO’s director of immunisations, said that “anywhere where the virus is transmitting, and transmits in ever-increasing numbers, is going to increase the chance that there are changes to the virus that would also put the vaccines at threat. 

“So this is really really important that, as vaccines are rolling out, people continue to pay attention and be as vigilant as possible to ensure that transmission is as low to give the vaccines their best opportunity for impact.”

 

Image Credits: Samuel Neequaye , Samuel Neequaye .