AstraZeneca vaccine

Major European nations remain divided over the use of Oxford/AstraZeneca’s COVID-19 vaccine, while the pharma company said there was no evidence of increased risk of blood clotting and abnormal bleeding among people who get the vaccine.    

AstraZeneca’s review of all the safety data of more than 17 million people vaccinated in the European Union (EU) and the United Kingdom (UK) has shown no increased risk of pulmonary embolism, deep vein thrombosis (DVT) or thrombocytopenia in any particular age group, gender, or country, the company said on Sunday. 

Across the EU and the UK, there have been 15 cases of DVT and 22 cases of pulmonary embolism reported among those given the AstraZeneca vaccine. Five deaths have also been reported – two dying from brain hemorrhages.

The reports have prompted more than a dozen countries to either partially or fully suspend the vaccine’s use while cases are being investigated. Some 17 countries, including Spain and Sweden have joined France, Germany, and Italy in suspending use of the vaccine. 

“The nature of the pandemic has led to increased attention in individual cases and we are going beyond the standard practices for safety monitoring of licensed medicines in reporting vaccine events, to ensure public safety,”  AstraZeneca said in its statement on Sunday. Ann Taylor, Chief Medical Officer, added:

 “number of cases of blood clots reported in this group is lower than the hundreds of cases that would be expected among the general population,” but she said that the company will continue to closely monitor the vaccine rollout.   

UK’s Boris Johnson Issues Strong Defense – Australia, and Thailand Also Remain Confident in AstraZeneca 

Outside of Europe, however, the AstraZeneca vaccine rollout through the WHO co-sponsored COVAX initiative was continuing in most countries – although the Democratic Republic of Congo said they had postponed an immunization launch that had been planned for this week. 

And Australia, India and Thailand were moving ahead with the vaccine as well as the UK. 

UK Prime Minister Boris Johnson issued a series of strong statements in defense of the vaccine – whose R&D the UK also supported. “The vaccine is safe and works extremely well,” Johnson wrote in an article published on Tuesday in The Times.

Prime Minister Boris Johnson says UK ‘very confident’ about AstraZeneca vaccine

“People should still go and get their COVID-19 vaccines when asked to do so,” said Dr Phil Bryan, UK Medicines and Healthcare products Regulatory Agency (MHRA) Vaccines Safety Lead, in a statement. 

Bryan added: “We are working closely with international counterparts in understanding the global safety experience of COVID-19 vaccines and on the rapid sharing of safety data and reports.” 

On Monday, Johnson told reporters that Britain’s MHRA is “one of the toughests and most experienced regulators in the world,” saying it’s approval signalled that the vaccine was safe. He went on to praise the UK’s vaccine rollout, one of the largest so far, which is helping to bring down COVID-19 rates. . 

More than 24 million people in the UK have received at least one dose of a coronavirus vaccine, with the UK government aiming to offer a first vaccine dose to about 32 million people in nine priority groups by 15 April.  

But Johnson reiterated, “Successful as the UK vaccination programme may be, there is little point in achieving some isolated national immunity. We need the whole world to be protected.” 

Australia will also not pause their AstraZeneca COVID-19 vaccine rollout with Chief Medical Officer Paul Kelly remaining “confident that [the vaccine] is safe.”  

“The Therapeutic Goods Administration is aware of the issue and also does not’ see any link between the AstraZeneca vaccine and blood clots,” Kelly said in a press conference on Tuesday.  

Australia’s CMO (right) Paul Kelly addresses blood clot concerns over AstraZeneca vaccine

Kelly also stated that there have been no increased incidence of blood clots among Australians who have already received the AstraZeneca vaccine. 

Thailand’s prime minister, Prayuth Chan-ocha, who received a dose of the AstraZeneca vaccine on Tuesday, urged people to “believe doctors” as other countries suspended the vaccine’s use. 

“There are people who have concerns,” Chan-ocha said after receiving the vaccine. “But we must believe doctors, believe in our medical professionals.”

Most Asian countries have continued to administer the AstraZeneca vaccine, with India the largest user. 

Thailand has ordered enough doses from AstraZeneca and China to cover around half of its population. The country has so far vaccinated around 50,000 people in high-risk groups. 

Suspensions of Vaccine is ‘Political’, Says Italy 

As many national vaccination strategies remain reliant on the vaccine made by AstraZeneca, the decision to suspend its use may slow down rollout even more, as efforts are marred by political infighting, mixed messaging, and supply shortages. 

Despite delays of the vaccine in several countries, Spain remains confident that the Spanish government’s two-week suspension will not alter the country’s vaccination calendar, government spokeswoman Maria Jesus Montero said on Tuesday. 

Spain aims to vaccinate 70% of its 47 million population by the end of the summer. 

Italy’s medicines authority director-general called the decision to delay the vaccines largely “political”.

“We got to the point of a suspension because several European countries, including Germany and France, preferred to interrupt vaccinations… to put them on hold in order to carry out checks. The choice is a political one,” Nicola Magrini told the la Repubblica daily in an interview, Reuters reported. Prior to taking on his new role,  Magrini was a former top WHO official specializing in medicines approvals and access.   

Italy has recently blocked a shipment of AstraZeneca vaccines from leaving the country, arguing that it had failed to meet its contractual obligations to provide the vaccine to the European Union. 

EMA and WHO Urge Continued Use  – WHO Data Review to be Completed on Thursday 

The European Medicines Agency and the World Health Organization have been quick to defend the Oxford/AstraZeneca vaccine – and urge its continued use. 

“I’m not here to give you the outcome of any scientific review”, said EMA director Emer Cooke at the start of a press conference on AstraZeneca vaccine safety on Tuesday. 

“I’m here to explain the steps in the process, what we’re doing, and when you can expect us to come to a conclusion.”

Experts will meet on Thursday “to come to a conclusion on the full information that has been gathered and to advise us as to whether there are further actions that need to be taken,” said Cooke. “We will inform the public of the outcome immediately after this meeting.” 

The EMA currently concludes that while the investigation is still ongoing, “We are firmly convinced that the benefits of the AstraZeneca vaccine in preventing COVID-19 with its associated risk of hospitalization and death outweigh the risk of the side effects.” 

The WHO has also issued similar messages, with the WHO’s Global Advisory Committee on Vaccine Safety saying that at the moment, “benefits of the vaccine outweigh the risks”.  The  EMA is to issue reports about the safety of the vaccine on Thursday, after examining all data. 

WHO Director General Dr Tedros Adhanom Ghebreyesus

WHO Director General Dr Tedros Adhanom Ghebreyesus said the events are not necessarily linked to vaccination, “but it’s routine practice to investigate them, and it shows that the surveillance system works and that effective controls are in place.”

–Updated 18 March, 2021

Image Credits: Flickr, gencat cat/Flickr, The Guardian, Sophie Scott/ABC.

ISLAMABAD – Pakistan authorities are threatening to fire healthcare workers who refuse to be vaccinated with the Chinese-donated SinoPharm COVID-19 vaccine. 

In a harshly worded letter, , the Directorate of Health Services in Sindh warns frontline health care workers that reluctance to get the jab will result in “strict disciplinary action” including suspension or dismissal from government services.

The letter dated 24 February and signed by Dr Nazir Ahmed Rind states that: “If any frontline health care worker refuses to vaccinate, he/ she may be terminated/ suspended from the Government Services”.

Warning letter to health workers.

The objection to being vaccinated with the SinoPharm vaccine stem from concerns raised about its efficacy and safety, particularly as a division of Pakistan’s health ministry initially declared that the vaccine was unsafe for people older than 60, pregnant women and lactating mothers. 

Although the government has since reversed its position on this, it has done little to address  health workers’ concerns. 

So far, only half of the 500,000 HCWs registered to be vaccinated have received the vaccine and the country’s health authorities are not taking kindly to their unwillingness to be vaccinated.  

The Sindh health ministry confirmed that the notice was issued by the secretary’s office, but the provincial health minister’s PR officer failed to respond to requests for comment.

Similarly, in another letter dated 27 February, the management of the Pakistan Institute of Medical Sciences (PIMS) in Islamabad, one of the largest hospitals in the country, has issued a stern warning to employees that “all registered PIMS staff must get vaccinated as soon as possible. Otherwise, strict disciplinary action will be taken against the defaulter, as per rules”.

Flip-flopping decisions and ‘trials’  

Pakistan started vaccinating its frontline health care workers (HCWs) – including doctors, nurses and paramedics – in its federal capital and all of its federating units simultaneously in early February. 

Dr Rana Mohammad Safdar, Director General of the Health Ministry’s National Health Services Regulations and Coordination (NHSR&C), said that about 250,000 people have been vaccinated out of the 500,000 HCWs that had registered.

“The vaccine has side effects,” said Dr Yasmin Rashid, Health Minister of Pakistan’s most populous province, Punjab, in a press briefing after receiving the SinoPharm vaccines. She added that anyone getting the vaccination should do so at their own risk. 

At the time, the minister also said that it would be “premature to say how long [the vaccine] will be effective”.

 

https://twitter.com/Nadeemchisd/status/1368582866175721472

Initially, the Ministry of NHSR&C had recommended that people over the age 60, lactating mothers and pregnant women should not get this vaccine, but a month later, the Drug Regulatory Authority of Pakistan approved the vaccine for these groups.

The contradictory advice raised concerns among HCWs. Dr Tanvir-ullah, serving in the federal capital Islamabad’s Federal Government Services Polyclinic Hospital, said that he tested COVID-19 positive after getting the vaccine.

“I received the vaccine on 18 February and after that I felt body aches and later on, mild flu symptoms also developed,” he said.

On 4 March he tested positive for COVID-19.

Tanvir-ullah said that HCWs feared that the vaccine may be being tested on them. 

“Generally, HCWs are reluctant of the vaccine [and] believe they are being involved in the vaccine’s trial,” said Tanvir-ullah. “Safety and efficacy are indeed a concern of HCWs not going for vaccination.” 

Mixed Messages

Dr Qaiser Sajjad, secretary general of the Pakistan Medical Association (PMA) – a body working for doctors’ rights – said the vaccination of HCW was “slow” as doctors are ‘reluctant’ to get the Chinese vaccine.

Sajjad said that PMA has registered 189 doctors’ deaths in the fight against COVID-19 and the “unclear” message by the government regarding the efficacy of the vaccine was creating problems.

“Doctors [are] reaching out to the PMA platform and ask[ing] about efficacy, data availability, research standards, expiry and status of the donated SinoPharm vaccine,” said Sajjad. “Unfortunately, instead of convincing the HCWs, the government is trying to force them to vaccinate, which is unethical.” 

“Government must inform HCWs on how a vaccine that was not effective for people above the age of 60 years, suddenly became effective,” said Sajjad.

Public health expert Dr Zafar Mirza, who served as health minister for Pakistan and director of the Health System of World Health Organization (WHO), said that the government should have communicated to the HCWs about the safety of the vaccine in a well thought-out way.

“There is a need to correct the perception of safety and efficacy of the SinoPharm vaccine in HCWs and the public as well,” he said.

Mirza pointed out that, although no adverse case had been recorded after administering the SinoPharm vaccination, the vaccine’s safety had not been appropriately conveyed.

“Out of 500,000 HCWs the number of registered and vaccinated is very low and should have been completed so far,” said the doctor.

No Adverse Events Recorded

Akhtar Abbas, spokesperson for the Drug Regulatory Authority of Pakistan said the authority had approved the vaccine after analyzing the submitted data. He said no adverse case about safety of the SinoPharm vaccine had been reported from anywhere in the world.

Abbas said the vaccine had also been approved for people older than 60 after the expert committee reviewed the data that no adverse effect was recorded from any other country.  

According to the data released by Pakistan’s National Command and Operations Center (NCOC), a strategic forum established by the government to deal with the COVID-19 pandemic, 504,000 doses of the SinoPharm vaccine had been distributed in all federating units of the country for the frontline HCWs.

Punjab had received 118,000 doses, Sindh 102,100, Khyber Pakthunkhwa 28,000, Baluchistan 16,000, Islamabad 15 000, Azad Jammu & Kashmir 11,000 and in Gilgit Baltistan, 5 000 doses of the vaccine have been provided so far.

In the southern region, only 12,194 HCWs had been vaccinated and in north-western province, Khyber Pakthunkhwa, 26,697 HCWs had been vaccinated so far.

Rizwan Malik, Public Relations officer for the health minister of Khyber Pakthunkhwa, said that health authorities had observed an upward trend in vaccinations in the last two weeks of February, but this dropped off recently.

“Provincial government is encouraging HCWs to come for the vaccination,” he said.

Federal Minister Asad Umer, who heads the NCOC, said that around 50 percent of the HCWs had been vaccinated and “not a single case” regarding safety of the vaccine had been reported.

He agreed that there was a reluctance from HCWs to get vaccinated but that this was happening in other parts of the world as well. “Maybe HCWs are reluctant because it is something new for them,” he said.

Meanwhile, Dr Imran Sikandar of PIMS hospital, who received the first vaccine in the countrywide vaccination drive, said that he feels “perfect” after getting both doses of the SinoPharm vaccine.

“I received the first dose on 2 February and the second jab on 23 February and I am feeling healthy,” said Sikandar.

He said concerns about the vaccine were only misconceptions and needed to be eradicated. He added that vaccinations of HCWs should be made mandatory for the safety of the public.

 

Inactivated COVID-19 vaccine candidate produced by Beijing Institute of Biological Products and Sinopharm Group.

No Peer Review Study Yet

Neither of China’s two leading vaccine candidates, SinoPharm and Sinovac, have been approved by an external regulatory agency and discussions are still continuing with the WHO, according to WHO officials.

Chinese vaccine developers have also not published peer-reviewed studies on their vaccines. Company reports show SinoPharm’s multi-country trials yielded efficacy results of 79 percent, while Sinovac trials from four different countries showed results ranging from 91.3 percent in a Turkish trial to 50.3 percent in an independently managed Brazilian trial among health care workers.

Although China has been accused of donating its COVID-19 vaccines for political power, Chinese President Xi Jinping 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. China reports that it has also 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.

A recent preprint paper, which has not undergone peer review, suggests that SinoPharm’s vaccine held up well against a South African SARS-CoV2 variant (501Y.V2). In the analysis of blood samples from a dozen vaccinated participants, the vaccine’s neutralizing power was only reduced by a factor of 1.6 when it was exposed to the variant.   

Countries Have Autonomy to Authorise Health Products, says WHO

When asked for comment about countries using vaccines that did not yet have WHO emergency using listing, the WHO stressed that “countries have the autonomy to issue emergency use authorizations for any health product. Domestic emergency use authorizations are issued at the discretion of countries and not subject to WHO approval”.

“There are and will likely continue to be manufacturers of some vaccine candidates who may be delayed in seeking or choose not to seek emergency use listing by WHO or authorisation by a stringent regulatory authority,” the WHO told Health Policy Watch.

“The use of some of these products has proceeded in a number of countries with the agreement of national authorities. It is possible that the data required for a WHO emergency use listing assessment may not have been available at the time of national decisions to use such vaccines.”

In cases where a country’s vaccines were not requalified by the WHO but approved by a country’s national regulatory authority, it was common for the global body and UNICEF to provide technical assistance, added WHO.

“WHO’s support is provided to the immunization programme of the country, not to a specific vaccine. This support includes capacity assessments, planning, advising on delivery strategies, ensuring adequate cold chain, data monitoring, communication including raising public awareness and promoting demand for vaccination, and risk communication,” stressed the WHO.

Image Credits: Sinopharm.

WHO’s Franceso Zambon has resigned after he spoke out against the Organization’s censorship of a crucial report on Italy’s botched COVID-19 response

The WHO scientist who spoke out against the suppression of a damning report exposing key flaws in Italy’s COVID-19 response has resigned, Health Policy Watch has learned.

Franscesco Zambon, a senior figure at WHO’s Venice Office who led the preparation of the controversial report, told Health Policy Watch that he resigned over the WHO’s censorship of an “independent” report that was intended to “critically examine” both the strengths and weaknesses of Italy’s COVID-19 pandemic response. That report, said critics, contained valuable evidence that could have helped other countries in their COVID-19 response when it first hit.

But the report was removed on 14 May, just a day after it was published online on the WHO European Regional Office website – at the request of Ranieri Guerra, WHO’s assistant director-general for strategic initiatives, and former chief of preventive health at the Italian Ministry of Health from  2014 to 2017.

Strikingly, the report revealed that Italy’s national pandemic preparedness plan had not been updated for 14 years – a task that Guerra was meant to have undertaken while he was working with the Ministry between 2014 and 2017. The report also said that Italy’s initial response to the pandemic was “improvised, chaotic and creative” – which is likely to have contributed to a devastating death toll in the country in the early days of the pandemic.

The WHO’s suppression of the report adds to a growing body of evidence that has compromised the international organisation’s credibility, neutrality and transparency at a time when it is most needed, critics have said.

Read more about the report in our three-part series here.

Elizabeth Cousens, CEO of the UN Foundation

Over 662,000 people, hundreds of corporations and organisations from 190 countries have donated $242 million to the COVID-19 Solidarity Response Fund in the past year, according to Elizabeth Cousens, CEO of the UN Foundation.

Addressing the World Health Organization (WHO) biweekly media briefing on Monday, the first anniversary of the fund, Cousens said the fund had been a demonstration of global solidarity.

“In just six weeks, we raised more than $200 million, and to date the fund has dispersed more than $226 million, making it one of the top donors to WHO’s COVID-19 response,” said Cousens.

Donors included “online gamers (who) ran livestream marathons generating hundreds of thousands of dollars, celebrities, fitness gurus, musicians, artists, athletes, children, even the Minions”, said Cousens, who was assisted to set up the fund by the Swiss Philanthropy Foundation.

Fund Covers Millions of Items of PPE, COVID Tests and ICU Beds

Thanking all those who had donated, WHO Director General Dr Tedros Adhanom Ghebreyesus said that the fund had enabled the WHO to ship “more than 250 million items of personal protective equipment, provide technical support to hundreds of labs, supply more than 250 million COVID-19 tests, coordinate the deployment of more than 180 teams and missions, deliver oxygen and support over 12,000 intensive care beds to prevent health systems from being overwhelmed”.

Expressing his heartfelt thanks, Mike Ryan, WHO’s Executive Director of Health Emergencies Programme, admitted that funds for the pandemic had been extremely tight a year ago.

“This time last year was a very, very difficult time. Funding was very sparse. Everyone was reacting in different ways. The creation of the fund, and the fact that companies and institutions and individuals people out there just reached into their pockets and put money into this response, provided a vital lifeline for many organisations,” said Ryan.

However, Cousens and Tedros appealed for more donations as many countries were struggling to finance their COVID-19 vaccine programmes.

Countries Should Continue to Vaccinate With AstraZeneca 

WHO Chief Scientist Soumya Swaminathan

The WHO repeated its advice to countries to continue to vaccinate people with the AstraZeneca vaccine, despite safety concerns.

This follows the suspension of vaccinations with AstraZeneca in Denmark, Norway, Iceland and Bulgaria and Austria, Italy, Estonia, Latvia, Luxembourg and Lithuania stopping the use of vaccines from the most recent batches after reports of serious blood clots among 30 of the 5 million people vaccinated. 

During the course of this week, the WHO’s Global Advisory Committee on Vaccine Safety and the European Medicine Agency would issue reports about the safety of the AstraZeneca vaccine after examining all the data, said WHO Chief Scientist Soumya Swaminathan.

“In European and the UK, more than 17 million doses of AstraZeneca vaccines were administered so far,” said Swaminathan. “The recommendation is that the risk benefit of not vaccinating using AstraZeneca vaccines is outweighed by the risk of the COVID-19 infection.”

‘No Association’ Found Between Vaccine and Adverse Events

“If you remember, there was an initial scare about excess deaths amongst the elderly that was reported from Norway and then it was clarified that it was not really excess deaths. It was just a normal, expected rate of deaths.”

She added that “people do get thrombo-embolic events, pulmonary embolisms, and people die every day”.

“So the question really is the linkage with the vaccine and this is why we need to look at all of the data, and the experts are looking at the data. So far, we do not find an association between these events, and the vaccine, because the rates at which these events have occurred in the vaccinated group are in fact less than what you would expect in the general population at the same time,” stressed Swaminathan.

Although at least 300 million vaccine doses had been administered worldwide, not one documented death has been linked to a COVID-19 vaccine, she concluded.

Vaccine Passports Must Not ‘Create Inequity’

Mike Ryan, Executive Director of WHO Health Emergencies Programme.

While the European Union is expected to issue guidelines this week on a digital “green passport” allowing people who have been vaccinated against COVID-19 to move freely in the EU, Ryan warned of the human rights consequences of such a move.

While the concept of digital registration of health information, including vaccination records, was “a very positive thing within national health systems”, said Ryan, such a policy should not create inequity particularly given the unequal access to vaccines at present.

“We need to be very, very careful that the process of certifying vaccination does not result in personal freedoms, or human rights being impeded in any way that is not justified,” said Ryan.

There has to be a “very strong justification” for any health measure to be mandatory “and then whether or not someone has the right to do certain things after vaccination again requires deep thought on the ethical and human rights issues at the centre of this,” he added.

 

Image Credits: WHO.

EU Ambassador to the African Union, Birgitte Markussen.

Although the European Union (EU) is opposed to the proposal by South Africa and India urging the World Trade Organisation (WTO) to waive intellectual property (IP) rights on COVID-19 products for the duration of the pandemic, the EU will support the expansion of vaccine access in Africa.

This is according to the EU Ambassador to the African Union, Birgitte Markussen, who told a recent AU media briefing that the EU is putting its full weight behind the COVAX Facility to ensure that African countries are able to vaccines, rather than supporting the waiver proposal. 

“The universal and equitable access to safe and effective diagnosis, treatments and vaccines, is the crucial issue for us. The whole issue of intellectual property rights does not really stand in the way for the efforts. It’s rather part of the solution,” Markussen said.

WTO ‘Flexible Enough’ Without Waiver

“I know that there are many issues related to the transfer of technology and so on, and the WTO rules are already flexible enough to address the problems. So it’s not that we are against it, we just think that the solution is already there,” she said.

Markussen said there were provisions in the licensing of vaccine technology and know-how, including the granting of compulsory licenses without the patent owner’s consent, that can be fast-tracked in emergencies, such as the pandemic.

Together with the Africa Centers for Disease Control (CDC), the EU has been involved in multilateral responses to control the spread of COVID-19 in Africa, but acknowledged that there needed to be more fostering of solidarity and cooperation to tackle the threats that both Europe and Africa are facing.

Markussen also told Health Policy Watch that the EU supports calls by France and Germany for  European countries to donate substantial doses of their COVID-19 vaccines to African countries.

However, she said there is no date yet for when the donation exercise will begin although  measures are already in place to coordinate it.

“We have a mechanism whereby our member states can redistribute these types of vaccines and that’s an additional instrument to the COVAX Facility,” she told Health Policy Watch. 

Africa CDC Wants Continent to Produce COVID Vaccine

Meanwhile, Africa CDC Director John Nkengasong, Director of the Africa CDC, said the center  is keen on ensuring that African institutions including the Institut Pasteur de Dakar in Senegal are capable of producing COVID-19 vaccines to ensure that African countries are able to have quick access to the vaccines especially when additional doses are needed.

“It is so important for us as a continent to have that because we truly don’t know how these vaccines will perform in terms of the longevity of immunity,” said Nkengasong. “So if it happens that immunity wanes after two years or so, then it means you need regular additional vaccination or boosting, and that will require that we have a continental capacity so I’m really really hoping there will be the right partnerships, and then see how we can roll that across the continent,” he said.

Novavax’s COVID-19 candidate vaccine NVX-CoV2373 is administered to a health volunteer during the clinical trial.

Novavax’s COVID-19 vaccine candidate has an efficacy rate of 96.4% against the original strain of SARS-CoV2. However, the efficacy rate drops up to 55.4% against the new B.1351 variant first identified in South Africa, and also spreading globally. 

The pharma company, which has never brought a vaccine to market before, published the data from two late-stage trials conducted in the United Kingdom and South Africa on Thursday.

The Phase 3 clinical trial conducted in the UK had over 15,000 participants, including 27% over the age of 65. The efficacy rate against the original SARS-CoV2 strain is on par with results from the Pfizer/BioNTech and Moderna vaccines. 

The efficacy rate reduced to 86.3% against the B.1.1.7 variant, first identified in the UK, and declined even further against the B.1.351 variant, initially detected in South Africa. 

The South African trial included two cohorts, one of 2,665 HIV-negative adults and the other of 240 HIV-positive adults. An analysis of both groups found an overall efficacy of 48.6%, but among HIV-negative participants, the efficacy rose to 55.4%. The majority of SARS-CoV2 cases in the trial were linked to the B.1.351 variant.

Although the efficacy was lower against both widespread variants, the vaccine candidate still demonstrated  “100%  protection against severe disease, including all hospitalisation and death,” across all arms of the trial, the company stressed.   

“We are very encouraged by the data showing that NVX-CoV2373 not only provided complete protection against the most severe forms of disease, but also dramatically reduced mild and moderate disease across both trials,” said Stanley C. Erck, CEO of Novavax, in a press release. 

“Importantly, both studies confirmed efficacy against the variant strains,” he added.

Leading COVID-19 Vaccines Have Reduced Efficacy Against New Variants

Novavax announced in January, after the release of the interim trial results, that it started developing a new version of the vaccine to target the more contagious and potentially more deadly variants. Clinical testing on the new vaccine will begin between April and June of this year.

Novavax joins Pfizer, Moderna, and AstraZeneca with results showing lower efficacy against the COVID-19 variants, specifically the B.1.351 variant. Moderna found a six fold reduction in neutralizing antibodies against B.1.351, Pfizer reported lower neutralization of the variant, AstraZeneca’s vaccine was minimally protective against mild to moderate infection from the variant, and Johnson & Johnson’s vaccine efficacy rate fell from 72% in the US to 57% in South Africa. 

The B.1.1.7 variant has been detected in over 90 countries by early March and the B.1.351 variant has spread to at least 48 countries. With the increased ability for the variants to evade the immune response triggered by the vaccines, new or updated vaccines will likely be necessary for sustained protection.

Sputnik V Vaccine Developers Question EMA’s Neutrality
Healthcare worker prepares Sputnik V COVID-19 vials.

Meanwhile, the developers of Russia’s Sputnik V COVID-19 vaccine accused the European Medicines Agency (EMA) of politicizing the vaccine approval process after a senior EMA official urged EU member states to postpone national rollouts of the vaccine until the EMA had completed its regulatory review.

In an interview last week, Christa Wirthumer-Hoche, chair of the EMA managing board, likened the use of the Sputnik V vaccine without a sufficient evaluation of the safety data to “playing Russian roulette.”

In response, the vaccine developers wrote on the Sputnik V Twitter account, “demand[ing] a public apology from EMA’s Christa Wirthumer-Hoche for her negative comments…, (which) raise serious questions about possible political interference in the ongoing EMA review.”  The EMA had not made any other such comments about other vaccines that it had reviewed, Sputnik’s developers noted. 

The Sputnik V vaccine is currently under rolling review by the EMA.

The issue was quickly resolved by Thursday, but tensions are still present between the EMA, the Russian Direct Investment Fund (RDIF), the company responsible for marketing the Sputnik V vaccine abroad, and EU countries that are welcoming of the new vaccine.

Italy Becomes Latest EU Member State To Embrace Sputnik V

Italy, meanwhile, became the first country in the EU to sign a deal to produce the Sputnik V vaccine, with plans to produce 10 million doses of the vaccine in Italy by the end of the year. The deal was signed between Adienne, an Italian-Swiss pharma company, and Kirill Dmitriev, CEO of the RDIF, on Tuesday.

The production could start as early as July, if the vaccine is authorised by the EMA and Italy’s national medicines regulatory agency, AIFA. 

“The innovative production process will help create new jobs and allow Italy to control the entire production of the compound,” said the Italian-Russian Chamber of Commerce, which facilitated the negotiations. “This step will help solve the problem of the shortage of vaccine doses in Italy.”

Italy has significant business ties with China – and there has been longtime speculation that the heavy travel patterns back and forth between northern Italy and China may be one of the reasons why the Italy became the first European epicentre for the virus a year ago.

As for the Russian vaccine, a couple of EU countries have already moved forward with national approval and rollout, including Hungary, Slovakia, and Czech Republic. 

A RDIF spokesperson said on Tuesday that discussions also were underway with production facilities in Spain, France and Germany to manufacture the Sputnik V vaccine. A conversation on vaccine production cooperation was held between German Chancellor Angela Merkel and Russian President Vladimir Putin in January. 

Germany is reportedly “open to the idea of bilateral cooperation for the purpose of tapping European production capacities,” said Ulrike Demmer, deputy spokesperson for the German government. 

“Sputnik V is a very clever construct,” Thomas Mertens, head of Germany’s standing commission on vaccination, told Rheinische Post in an interview. “[It is a] good vaccine that will presumably also be approved in the EU at some point.” 

Proposed EU Vaccine Certificate Will Include Sputnik V and Chinese Vaccines

According to reports on the EU vaccine passport, the preliminary plans for which will be announced next week, the Sputnik V, Sinovac and Sinopharm vaccines will likely all be accepted as part of the certificate system, along with the EMA-approved vaccines. 

This system is designed to ease certain restrictions for individuals who have been inoculated, specifically for travelling between particular countries or within regions, in an effort to revitalize air travel and ease the pressure on economies.

Including the Chinese and Russian vaccines is being seen as a pragmatic move insofar as some EU countries have also authorised the Sputnik V, Sinovac, or Sinopharm vaccines for use, or are preparing to do so. 

Image Credits: Novavax, RDIF.

The daily new COVID-19 cases in Kenya, reaching over 550 on 11 March.

Kenya has officially announced a third wave of the COVID-19 outbreak this week, while the World Health Organization’s (WHO) Africa region reported a “slight uptick in cases and an upward trend in 12 countries, including in Cote d’Ivoire, Ethiopia and Cameroon.”

Dr Matshidiso Moeti, WHO Regional Director for Africa, during the weekly press conference said there was an upward trend in some countries. 

On Friday, Kenyan President Uhuru Kenyatta tightened up the country’s COVID-19 measures, extending the 9pm curfew and decreeing that bars and restaurants close by 9pm.

Kenya recorded 713 new cases and 12 deaths on Wednesday, a record number since the start of this year. The positivity rate is up to 14% since November last year and the country’s total official death toll is 1,898. The Africa CDC reported a 13% average increase in deaths for Kenya for this week’s COVID-19 epidemiology update.  

Mutahi Kagwe, Kenya’s Cabinet Secretary for Health, said there had been an increase in the number of patients on ventilators and in need of oxygen and warned that the situation could worsen. 

“We are about to start another difficult period, but we can also overcome this period. It has taken a toll on us over the past year, and it is at this time that we can’t let our guard down,“ Kagwe stressed.

Meanwhile Raila Odinga, the leader of opposition in Kenya is being treated with COVID-19 in Nairobi Hospital, according to a statement from his doctor.  

Kenya’s health ministry established a National COVID-19 Vaccine Deployment Task Force this week to guide the rollout of COVID-19 vaccines, including regulation and safety monitoring, financing, procurement and logistics.

This week the Kenyan Conference of Catholic Bishops (KCCB) condemned the statement by the Kenyan Catholic Doctors’ Association that COVID-19 vaccines were “totally unnecessary.” The KCCB said in a statement on Tuesday that the association did not speak for the Catholic Church, and encouraged all Kenyans to accept the vaccine.

Africa Centres for Disease Control (CDC) director John Nkengasong told last week’s WHO Africa briefing that “we are beginning to see the beginning of a third wave in East Africa.”

The WHO warned that Africa is poised to surpass 4 million COVID-19 infections this week since the continent’s first confirmed case in February 2020, but described the arrival of vaccines in the continent over the past two weeks via COVAX as a “crucial boost.”

More than 14.6 million vaccine doses have been delivered to 22 African countries since 24 February through COVAX, a global vaccine effort co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance and the WHO.

“While deaths reported have dropped by more than 50% over the past 28 days compared with the previous 28 days, the case fatality ratio or the proportion of deaths among confirmed cases is at 3.6% for the past 28 days. This is higher than the global average,” warned the WHO Africa.

Image Credits: Twitter: @WHOKenya, Our World in Data.

Rumours about the whereabouts of Tanzanian president John Magufuli, are intensifying as the leader who questioned the existence of the SARS-CoV2 virus was reportedly in intensive care with COVID-19 – somewhere in Nairobi or possibly now even in India.

Magufuli has not been seen for almost two weeks, sparking widespread speculation about his health. His absence is unusual as he is known for making frequent public speeches and appearing on state television several times a week.

Tanzanian opposition leader, Tundu Lissu, who lost last year’s election to Magufuli, tweeted on Thursday that the president had been transferred from a hospital in Kenya to India – although he did did not provide evidence:  “His COVID denialism in tatters, his prayers-over-science folly has turned a deadly boomerang!” Said Lissu in a tweet. 

But Tanzania’s Prime Minister, Kassim Majaliwa, urged citizens to ignore “fraudsters”, claiming that  the president was strong and at work, as usual. Majaliwa also said he had talked to him on the phone and that he was grateful to the voters.

“The president is very busy. Where do they want him to go? Have you ever found him wandering around Kariakoo or Magomeni?” he asked while at a function in Tanzania’s Njombe region. The information was sent in tweets on social media in Swahili.

Rumours and Conspiracies

However, the government is under increasing pressure to reveal Magufuli’s whereabouts – as an online publication speculated that the rumours about him also were being fed by the Tanzania Intelligence and Security Service (TISS) as part of a power struggle withn in the ruling party.

Government sources in Tanzania told Health Policy Watch that they did not know the whereabouts of the President: “

We are just following what is happening on social media and other news outlets but we do not know what is happening to him,” one source said. 

Some source salso  are reporting ‘unusual activity’ at the Tanzania High Commission in Nairobi, Kenya. 

Opposition leader Lissu told the BBC that the 61-year-old president had suffered a cardiac arrest before being flown to a hospital in Nairobi for urgent treatment.  Lissu later said that the president was in a coma and had been transferred to a hospital in India. 

Scientist and Devout Catholic – But COVID-Skeptic

Magfuli, a scientist and a devout Catholic, has frequently played down the threat of COVID-19, saying that God would protect his nation from the disease.  In late-February, following a rebuke by the WHO and the death from COVID of his own vice-president, Magfuli finally signaled that he was willing to take the disease more seriously.   

At that point, the Tanzania Medical Association unleashed a new camapign on prevention of COVIVD-19.  But some worry that the shift may have been too little too late. 

For months, Tanzania has refrained from reporting to the WHO on new COVID cases – and doctors in the country privately admitted that they were under tremendous pressure to write anything but COVID on death certificates. 

Meanwhile, officials such as the chief government chemist, Fidelice Mafumiko, promoted the use of herbal medicine to cure COVID-19. Tanzania’s Health Ministry announced in a press conference last month that it had no plans to accept COVID-19 vaccines, insisting that the country is safe. 

Now social media is awash with news of the Tanzania president allegedly being admitted in a high care hospital because of the virus. 

Many people posting on social media with the hashtag #prayforMagufuli have also criticized irresponsible the way Tanzania handled the pandemic.  

“If it’s true Covid denier Magufuli is in Nairobi Hospital with related complications, the inequity of it would be endless. He gets to fly to a Nairobi hospital, while those who listened to him stay home inhaling eucalyptus steam & hanging on to prayers. Still, wish him recovery,” said Charles Onyango- Obbo, a Ugandan author, journalist and editor. 

 

The Brazilian government needs to enforce “serious social measures” to contain the virus before it overwhelms its health facilities, World Health Organization (WHO)  Director-General Dr Tedros Adhanom Ghebreyesus told the body’s weekly COVID-19 briefing.

Brazil’s President Jair Bolsanaro continues to downplay the pandemic despite the country reaching its highest death rate in the past week and having the second-highest death rate in the world after the US.

“Starting from the government, all the stakeholders should really take it seriously,” added Tedros, warning that pandemic threatened neighbouring countries, most of which had the pandemic under control.

“There should be clear messages from the authorities on what the situation is, and what measures people should take and enforce those measures with full participation of the health system,” said Tedros.

Mike Ryan, WHO’s executive director of health emergencies, reported that ICU bed occupancy had reached over 96% in the midwest and south of the country, and there was very little “resilience” left in the health system.

Despite Deaths, Bolsanaro Tells Citizens to Stop Whining

Despite the grim situation, complicated by a fast-spreading variant named P.1,  Bolsonaro told citizens in the midwestern state of Goiás last week to “stop all this fussing and whining” about the pandemic.

In a veiled reference to the Brazilian president’s poor handling of the pandemic, Tedros said that the rapid spread of COVID-19 was “contrary to our expectations” given the country’s relatively strong health system based on primary healthcare.

Meanwhile, the P.1 variant circulating in Brazil “has a number of mutations that confer increased transmissibility” and it appeared to be more easily transmitted and possibly more severe, added WHO’s COVID-19 response lead Maria Van Kerkhove.

On Tuesday, Brazil registered a record daily number of deaths due to COVID-19 and hospitals are buckling under the strain of widespread infections from the coronavirus. The country’s Health Ministry reported 1,972 fatalities and more than 70,000 new COVID-19 cases. 

The strain on Brazil’s health system is immense. One Brazilian health care provider dies of the coronavirus every 19 hours, according to the latest Brazilian government statistics. 

Dr. Miguel Nicolelis, in São Paulo, told The World’s Marco Werman (🎧) that his colleagues are under such immense stress that many feel as though they’ve spent the past year in a war zone.

“If I can be totally frank … I got a shivering to my body,” Nicolelis said. “You know, it is probably the worst loss of health professionals in the world. It probably is the worst in the world.”

WHO Gives J&J Emergency Use Listing

The WHO gave emergency use listing (EUL) to Johnson & Johnson’s COVID-19 vaccine on Friday making it the first single-dose vaccine to qualify, Tedros told the weekly COVID-19 briefing.

EUL is a prerequisite for a vaccine to be procured by the global distribution platform, COVAX, which has already pre-ordered 500 million J&J doses in anticipation of its approval.

“We hope that this new vaccine will help to narrow vaccine inequalities and not deepen them,” said Tedros, adding that COVAX looks forward to receiving these doses “as soon possible”.

However, the WHO’s approval of J&J came a day after its approval by the European Union Medicines Agency (EMA), which also has a significant order with the company and it is unclear which orders will get precedent, according to Health Policy Watch.

 

WHO Chief Scientist Dr Soumya Swaminathan

WHO special advisor Bruce Aylward and the body’s COVAX representative said that COVAX “is trying to work with the company” to get the vaccine by July.

While COVAX has delivered almost 30 million doses to 38 low- and middle income in the past two weeks, it represents barely over 10% of the 335 million doses administered globally, three-quarters of which have taken place in only 10 countries, said Tedros.

“The inequitable distribution of vaccines remains the biggest threat to ending the pandemic and driving a global recovery,” he added.

Meanwhile, a shortage of supplies such as glass vials is limiting the production of COVID-19 vaccines and could also “put the supply of routine childhood vaccines at risk’, said Tedros

WHO Chief Scientist Soumya Swaminathan said that the WHO was ready to help J&J and any other vaccine manufacturers to expand their capacity, adding that COVAX partner the Coalition for Epidemic Preparedness Innovation (CEPI), had identified “fill and finish capacity that is immediately available to any company to expand supplies”. 

Cafes in Jerusalem reopened fully exactly a week ago, inside for vaccinated “green pass” holders and outdoors for everyone. So far, COVID infection rates continue to drop.

JERUSALEM – One year after the COVID-19 global health emergency was termed a “pandemic” by the World Health Organization – new vaccines are showing their power and efficacy through sharp declines in case rates in Israel – as well as  in the United Kingdom and the United States – the second and third countries in terms of vaccine uptake. 

All three countries have also been among the world’s highest burden COVID places – time and again throughout the pandemic. But in recent months, they have also proven to be the fastest in getting vaccines to their populations – despite the bumps along the way – particularly in the United States.  

In Israel –  where more than 5 million of the country’s six million eligible adults have now received at least one dose of the Pfizer vaccine – and a couple of million people have already gotten the recommended two doses – the profound influence of the vaccines is becoming more and more evident, with the passage of every day – and sharply declining infection rates. 

Pfizer, in a joint press release released with Israel’s Ministry of Health, on Thursday cited the “dramatically lower COVID-19 disease incidence rates observed in individuals fully vaccinated with the Pfizer-BioNTech vaccine, based on real-world data gathered by the Israel Ministry of Health. 

In addition, the company said:  

  • Data suggest Pfizer-BioNTech vaccine prevents asymptomatic SARS-CoV-2 infection
  • Latest data analysis finds unvaccinated individuals were 44 times more likely to develop symptomatic COVID-19 and 29 times more likely to die from COVID-19

Those findings represent the most comprehensive real-world evidence to date demonstrating the effectiveness of a COVID-19 vaccine,” the company stated. “Data are of global importance to other countries as vaccination campaigns continue worldwide.


Good News Comes After Anxious Two Weeks 
Celebrating in Jerusalem – Rowdy ‘Purim” holiday celebrations in Israel in late February gave rise to fears of an infection surge – but thanks to the country’s comparably high rate of vaccinations, including among young people, that didn’t happen.

The reports are all the more significant insofar as they come two weeks after raucous, carnival-style  gatherings indoors and outside marking Israel’s annual “Purim” celebrations. 

Health authorities had feared that the spontaneous and largely uncontrolled mass gatherings of young people bent on celebrating after months pent-up inside – would usher in another spike in cases.

Instead, serious COVID cases in Israel continued their trend of decline, along with new cases.   

Adding to the pressures, Israel’s schools also reopened on Sunday. Wedding halls, sports and cultural events also resumed, with most entries limited to “green pass holders” of people vaccinated.  

Bars and restaurants were throbbing once more with life inside as well as on the pavements – with friends, family and work colleagues gathering and toasting each other – on the  belated “new” and hopefully “corona-free” year – as the disease is described locally. 

“It’s been a long time since we have been together” sighed Yoram, head of a small high-tech firm in the Tel Aviv area who was gathered with 12 young colleagues over pizzas and beers for the company’s first outing in over a year, at a scenic cafe perched over a nature reserve, mid-way between Jerusalem and Tel Aviv. “But we have all been vaccinated – at least with the first shot- by now.” 

Bourla: Important for Humanity to Show Real-World Results 
Albert Bourla, Pfizer CEO, interviewed on Israel’s channel N12 news on the vaccine results.

In his Israel TV interview, Bourla confirmed that Pfizer had deliberately chosen to provide Israel with almost an unlimited supply of the Pfizer vaccine – in order to rapidly demonstrate the vaccines effectiveness in real time. 

“We knew that this deployment of the vaccine will will take time around the world, and the anxiety will build the benefits of a vaccine and so we knew that it is very appropriate for humanity, to be able to select one country that we can demonstrate what the vaccination of the people can do to the health of the people and the economic index,” he said. 

With a population of only 9 million people, a strong public health system featuring universally digitalized medical records – Israel had the “right conditions,” he added. 

“We are so happy because the way that you executed it was beyond our imagination,” said Bourla,  “and now, a year from the declaration of the pandemic by the WHO, we were able today to issue a press release together with the minister of health of your country about the results. 

Bourla said that in the meantime, “I keep receiving calls from, from heads of state or follow the counters to congratulate me because they see the hope now.” 

Vaccine Adminstration – as well as Access – Key to Success

To a somewhat lesser extent, the sharp downturn in reported cases in the United Kingdom and the United States is also likely attributable to their comparatively higher levels of vaccination, observers say.  In the UK, some 35 vaccine doses have been administered for every 100 eligible adults, while in the United States there have been some 30 doses administered for every 100 people – although proportions actually getting vaccinated are still somewhat lower insofar all vaccines being used until now, require two doses.

The data is all the more striking since cases in Europe overall, as well as in Latin America, are currently rising – contrary to trends almost everywhere else in the world.  In Latin America, the increases are largely driven by Argentina and Brazil – whose government has flagrantly ignored the pandemic, if not denying it.  In Europe, increases in new cases are still being seen in France, Italy, Poland, German, Spain and Hungary.

Against that landscape, the Israeli and UK experiences may also be seen to illustrate how the able adminsitration of vaccines is also critical to the success of a campaign.

Both countries feature strong public health systems – with a hybrid mix of centralized command and control – and more localized service networks that could be deployed for the unprecedented vaccine drive.

In contrast, some of the same European countries that are seeing spikes in COVID cases, also have been criticized domestically for being too slow and awkward about vaccine rollouts.  While the root causes are mixed, more fragmented and decentralized public health systems are a factor, along with pure bureaucratic inefficiencies.  Widely publicized manufacturing hiccups leading to supply interruptions from major providers, including Pfizer, have also pleayed a significant role, however,  issues that have stimulated an EU-wide debate over vulnerable supply chains and lack of local manufacturing capacity.

Geopolitics of Vaccine Haves & Havenots

The Israel-as-laboratory story has, of course, also illustrated the geo-politics of vaccine access. The high-profile Israeli vaccine camapign – symbolizing the vaccine “haves” – has come against that of the vaccine “have-nots” – in this case some 5 million Palestinians who aren’t even on the vaccine data maps yet.

So far, Palestinians in the Israeli-occupied West Bank and Hamas-controlled Gaza have only received about 60,000 vaccine doses, in total, mostly of Russia’s Sputnik V.  And due to the complex political rivalries between Gaza’s Hamas-controlled government and the West Bank Palestinian Authority  –  most of those vaccines have gone to Gaza.

It comes against a hotly contested Israeli elections campaign in which Prime Minister Benjamin Netanyahu is trying to retain his grip on power – and another campaign between the West Bank Palestinian Authority and rivals in the Hamas-controlled Gaza.  So far, the vaccines that have been received by the Palestinians have been mostly donations from the United Arab Emirates – to Gaza’s Hamas-controlled enclave, while the West Bank Palestinian continues to wait.

Last month, the PA was supposed to be receiving tens of thousands of doses of the Sputnik vaccine from Russia – but those haven’t yet arrived. Nor have the AstraZeneca vaccines from the WHO co-sponsored COVAX initiative. On Friday, the Palestinian Authority’s (PA) Health Ministry in the West Bank announced yet another channel of supply -saying it would get a free donation of 100,000 Sinopharm vaccines from China.

Side by Side – Palestinian See Cases Rising While Israel’s Decline
Palestinian worker gets COVID vaccine at a West Bank checkpoint this week.

Meanwhile, the dearth of Palestinian vaccine access is painfully evident in the rising rates of new COVID infections, particularly in West Bank Palestinian communities that live uneasily side by side with half a million Jewish settlers – and also work in pre-1967 Israel.

While Israel’s new COVID case rate has dropped from a peak of nearly 1000 a day (per million people) in mid-January to about 344 cases, per million on 11 March, Palestinian case rates have moved in exactly the opposite direction.  New COVID cases among Palestinians rose from about 95 cases/ million in early February to about 349 cases/ million on Thursday, 11 March – overtaking Israeli rates for the first time in months.

The infection surge comes after weeks in which Israeli government officials have resisted giving the West Bank Palestinian Authority (PA), with which it has cooperated on other aspects of the pandemic, significant vaccine doses. The fact more supplies have reached Gaza than the West Bank is also more striking insofar as Israel has a former cooperation agreement with the Palestinian Authority – while it doesn’t recognize Hamas, or vice versa.

Israeli officials have maintained that under the Oslo accords of the mid-1990s, it is up to the PA to procure its own vaccines. This is despite the warnings from public health experts that infection reservoirs in Palestinian communities will inevitably spill over to pockets of under-vaccinated Israelis, including children and youths who cannot get vaccinated at all.

In belated recognition of the threats, Israel this week did finally begin vaccinating some 120,000 Palestinian workers employed in pre-1967 Israel or within West Bank Jewish settlements and industrial areas.

The free vaccine drive, using brand-new shipments of the mRNA Moderna vaccine, appeared to be meeting a positive response as Palestinian day labourers lined up for the vaccine at military checkpoints. Media images of average workers getting the vaccine have also resonated among some members of the Palestinian public – who are already resentful that, according to media reports, the PA’s own scarce initial doses went mainly to politicians, athletes and other VIPs.

Even so, the new Israeli vaccine drive among Palestinian workers won’t close the ever-growing chasm between Israel’s vaccine haves and Palestinian have-nots – or reach the most at-risk Palestinian groups – health workers, older people, and people living with chronic diseases.

On Friday, five United States senators, including Bernie Sanders and Elizabeth Warren, sent a letter Friday to US Secretary Antony Blinken asking the Biden administration “to urge the Israeli government to do more to help the Palestinians in Israeli-occupied territories receive adequate supplies of the COVID vaccine…

“The urgency of the moment, as both Israelis and Palestinians face the threat of COVID, demands immediate action,” the senators wrote, noting that while the West Bank Palestinian Authority has some responsibility for health under the terms of the 1990s- era Oslo Accords, the responsibilities of Israel, as the occupying power, supersede that under the terms of the Fourth Geneva convention.

“There is an increase in infections and a full occupancy in Palestinian hospitals in the West Bank and Jerusalem,” said Physicians for Human Rights in a post on Thursday. “And yet Israel is neglecting its responsibilities of supplying vaccines to the oPT (occupied Palestinian territories.”

Image Credits: N12, Health Policy Watch , Israel MFA .