Sputnik V is 91.6% effective in all age groups and 100% effective against moderate and severe disease

News of the successful trial results of the Russian Sputnik vaccine, published on Wednesday by The Lancet has shored up the prospects of quick vaccine access for dozens of countries that have pinned their hopes on Russian or Chinese vaccine alternatives – as rich countries buy up the bulk of supplies of high-tech vaccines and new coronavirus variants supercharge transmission around the globe.

But for now, at least, the Russian vaccine has pulled far ahead of the Chinese candidates – not only in terms of price – USD$ 10 per dose – but also reported efficacy and safety – in the wake of the published Phase 3 trial results for the Sputnik vaccine. 

The study, which was based on almost 22,000 participants, found that Sputnik was safe, and 91.6 % effective in preventing symptomatic COVID-19 cases, trailing behind Pfizer’s and Moderna’s vaccines by just a few percentage points. It was also effective in preventing severe COVID amongst clinical trial participants, which included a significant number of trial participants over the age of 60 and some even older than 80. The vaccine was developed by Russia’s Gamaleya National Research Institute of Epidemiology and Microbiology.

The wave of interest comes at a time when large additional vaccine contributions by pharma companies based in rich countries to the international COVAX facility have failed to materialize. That has left many countries around the world scrambling on the open market for bilateral vaccine deals – sealed at uneven prices. 

Not incidentally, neither China nor Russia have so far offered any vaccines to the COVAX facility. 

Meanwhile, delivery timelines for AstraZeneca and Pfizer vaccines across high-income Europe have been delayed. Johnson and Johnson’s one-shot vaccine delivered lackluster results. And one of the world’s most storied vaccine-makers, Merck, recently reported that neither of its coronavirus vaccine candidates stimulates the immune system.

Not only are countries seeking quick access and affordability, they are also seeking alternatives that can be distributed to energy-strapped health facilities without the need for ultra-cold freezers, which is a requirement for Moderna’s and Pfizer’s expensive mRNA vaccines.

Russia’s Sputnik vaccine now seems to be checking all the right boxes. That makes it a significant alternative to the pricier and more temperature-sensitive mRNA vaccines by Moderna and Pfizer. 

If the clinical trial results published in The Lancet hold up to scrutiny, Sputnik’s results appear to be more robust, so far, than AstraZeneca’s already approved vaccine, not to mention the next Johnson & Johnson and Novavax vaccine candidates which are due to submit requests soon for US Food and Drug Administration (FDA) regulatory approval, and which are similarly affordable and easy to store – but with poorer efficacy results.  

President Putin announced Sputnik’s approval to Government members in August 2020

Many Factors Need to be Considered in Choosing a Vaccine 

“Many decisions need to be factored into selecting a vaccine as well as efficacy and safety,” Sheena Cruickshank, an immunologist at University of Manchester, told Health Policy Watch in an interview. “It’s important to think of the cost, storage, transport and feasibility of a vaccine too [so that] it can be readily administered in remote communities, without the need for refrigeration.”

Jens Spahn, Germany’s health minister has said that he saw no fundamental obstacle to the use of Russian or Chinese vaccines, if the vaccines were to be approved by the European Medicines Agency (EMA). Sputnik has reportedly considered that – but not yet submitted a dossier. Spahn’s comment came against reports of worldwide distrust of Russian and Chinese vaccines, according to a recent poll by YouGov. 

As noted by Judy Twigg, global health expert with the Center for Strategic and International Studies, in a recent Op-Ed in the Moscow Times: “Sputnik V appears to be a sound vaccine, but Russia damaged its scientific credibility with premature and exaggerated claims of success.”

“Regardless of the country in which a vaccine is manufactured, if they are safe and effective, they can help cope with the pandemic,” Spahn told the Frankfurter Allgemeine Zeitung newspaper Sunday, adding that any vaccine would have to be approved by the EMA before being rolled out in the bloc.

Russia Squarely in the Competitive Ring – While China Muddying Waters With Propaganda Campaign  

Researcher prepares Sputnik V vaccine

While Russia’s often boastful marketing campaign, with the RDIF CEO referring to it as “the best vaccine in the world,” raised bristles – the decision to take the route of a peer reviewed publication means that the Sputnik vaccine has now placed itself squarely in the competitive ring of western countries. 

In contrast, results of the Chinese Sinopharm vaccine’s multi-country trials, reportedly yielding results of 79.3% – 86% efficacy, remain unpublished. 

A second Chinese vaccine, by Sinovac, also has failed to publish peer reviewed results.  Company announcements of Phase 3 results in four different countries have also yielded wildly varied efficacy scores ranging from 50.3% – 91.3%.  

The poor showing of Sinovac’s vaccine in Brazil was particularly disappointing; researchers at Brazil’s independent Butantan biomedical centre said the vaccine displayed a mediocre 50% efficacy result in the second interim analysis of a late-stage clinical trial in Brazil.  

China also has muddied the waters by launching its own propaganda campaign attacking the products of its western competitors. It has claimed that the shots by Pfizer and Moderna are ineffective, risky or even deadly. While the campaign by so-called “wolf warrior” diplomats was intended to reinforce the image of the Chinese home-brews, it may also undermine  confidence in the Chinese vaccines – even if they do ultimately show robust results. 

However, even if Chinese vaccines perform less well than others, if they can at least meet the WHO and US FDA baseline of 50% efficacy, they might still be a “really great thing to have” in regions that are “absolutely desperate,” says Hilda Bastian, a public health researcher at Australia’s Bond University.  

“When you’ve got communities that are absolutely desperate, and have no other choice, then this is a really great thing to have,” she told Nature, referring to China’s Sinovac candidate.

News on the Chinese vaccines is not all bad either. 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.

In comparison, a similar study by Moderna of blood samples tested against the same variant reported a sixfold reduction – although Moderna scientists have said that the vaccine is still effective: “Despite this reduction, neutralizing titer levels with B.1.351 remain above levels that are expected to be protective,”  Moderna’s Chief Scientist Tal Zaks told a recent investors’ session. 

  

First shipment of Sinopharm vaccine reached Peru for clinical trials in September last year

More Than 50 Nations Have Eyed Russian Vaccine & 24 Have Requested Two Chinese Vaccines 

According to the Russian Direct Investment Fund (RDIF), which is marketing the Sputnik vaccine abroad, some fifty countries have already requested over 1.2 billion doses of the Sputnik vaccine.

Meanwhile, at least 24 countries have sealed deals with Sinovac and Sinopharm’s leading vaccine candidate, BBIBP-CorV, co-developed with the Beijing Institute of Biological Products. Like Sputnik, both can be stored in a conventional refrigerator. 

Together, Sinopharm and Sinovac aim to produce two billion doses this year, which is on par with the total number of doses that the international COVAX facility hopes to supply to countries in need this year – although neither company has offered COVAX any vaccine supplies.    

Summary of features of Sputnik, Sinovac and Sinopharm vaccine. (HPW/Svet Lustig)

Sputnik’s Technology Delivers A Double Whammy   

Sinovac’s vaccine reaches Brazil’s Sao Paolo airport

Sputnik’s vaccine technology relies on a chemically crippled common cold virus to deliver double-stranded DNA that codes for the SARS-CoV2 spike protein, sparking an immune reaction.

According to RDIF’s CEO, this platform represents a safe bet compared to novel delivery strategies that have never been tested in humans, like AstraZeneca’s use of a monkey adenovirus or even Pfizer’s and Moderna’s mRNA technologies.

Another feature that sets Sputnik apart from other adenoviral vaccines is its delivery strategy. Instead of delivering the same virus in both shots, Sputnik consists of two distinct adenoviruses to prime and then boost the immune response. 

“Its clever design bases its two doses on different viral vectors, in principle producing a strong, long-term immune response,” noted Twigg in her recent op-ed.

Its’ advocates claim this might help it achieve longer-lasting protection against the coronavirus – but this has yet to be demonstrated, particularly for older people and those with chronic diseases – “seems promising, however, we await to see what happens in people over 60 with underlying conditions,” observed Tracy Hussell, a University of Manchester immunologist.

At the same time, AstraZeneca hopes to take advantage of this method to bolster its own vaccine with a “booster” shot of Sputnik.

Important Data Still Missing For Sputnik 

Russian military personnel receives Sputnik V vaccine

Despite the recent fanfare around the Lancet publication of Sputnik results, important data is still missing from the Sputnik file. Preclinical data, including from animal trials, remains unpublished and some of those trials may be methodologically flawed, Cruickshank from the University of Manchester has said.

In these studies, Sputnik reportedly conferred a protection of “100%” after hamsters and marmosets were injected with a large quantity of SARS-CoV-2 virus. 

And although other Phase I/II trial data was also published in The Lancet, it was met with rebuke for its open-label methodology, failure to randomize patients, and exclusion of women and older people – all of which may have overestimated Sputnik’s performance, noted Cruickshank. 

While the chief author of The Lancet piece, Gamaleya’s Denis Logunov, has acknowledged these shortcomings, in an interview with Health Policy Watch, he stressed that ongoing Phase III trials that are larger and more robust should help answer these questions. 

Apart from the late-stage trial in Russia, others are underway in over 40,000 participants in the UAE, Egypt, Venezuela, Belarus and India.

Prices Also Make Sputnik and AstraZeneca Most Accessible For Now 

Vaccine prices per dose based on developer, compiled from various sources. (HPW/Svet Lustig)

What is clear for now is that AstraZeneca and Sputnik vaccines seem to be the most accessible to low- and middle-income countries. At USD$3 per dose, AstraZeneca’s vaccine produced by India’s Serum Institute, is still three times cheaper than Sputnik, which is priced at USD$10 per dose. Nonetheless, Sputnik’s has become more competitive after Uganda agreed to pay USD$7 per dose – USD$14 for two doses of the AstraZeneca vaccine, plus another USD$3 for shipping. 

In comparison, prices of Chinese vaccines are extremely high – at least officially. Sinovac’s vaccine is officially priced at USD$30 per dose and Sinopharm’s vaccine at USD$70 per dose.  

That makes Sinopharm’s vaccine more than twice as expensive as those from Pfizer and Moderna, eight times more than Sputnik – and twenty times more than AstraZeneca. Thus, unless Chinese vaccine-makers reduce their prices for low- and middle-income countries, they may fail to make a dent into existing vaccine vacuums.

Sputnik: Distribution Plans See Expansion Beyond Russia   

Kirill Dmitriev, head of the RDIF

So far, Russia has used its supply of Sputnik to vaccinate over a million Russians, less than 1% of its population of 144 million. Meanwhile, Argentina has already vaccinated 300,000 people. 

As a next stage, the RDIF plans to begin exporting the vaccine, Dmitriev told Health Policy Watch in a November interview. Local production of the vaccine has already begun in India, South Korea, Brazil, China, and is set to begin in Kazakhstan and Belarus – although Turkey and Iran are also expected to produce the vaccine, said Dmitriev on Tuesday.

“Our strategy right now is that most of the vaccines produced in Russia will be used for the Russian market…hopefully within a year, we could start exporting our vaccine also to the rest of the world…to satisfy the demand across the globe,” he said last year. 

So far, the vaccine has been approved by 18 regulatory agencies across the world, including: Turkmenistan, Belarus, Serbia, Hungary, Nicaragua, Mexico, Venezuela, Bolivia, Argentina, Paraguay, Palestine, UAE, Iran, Republic of Guinea, Tunisia, Algeria and Armenia. In the wake of The Lancet publication, up to 26 countries are expected to approve the vaccine, said Dmietriev at the press conference on Tuesday.

Countries that have struck firm deals with RDIF include:

Country Deal Source
Argentina Has bought 10 million doses. Reuters
Bolivia Has bought 5.2 million doses. RDIF
Brazil Plans to produce 150 million doses in 2021. RDIF
Guinea Has bought 2 million doses Africa News
India Plans to manufacture 100 million doses a year. Reuters
Kazakhstan Plans for domestic production of 2 million doses in 2021 RDIF
Mexico Has bought 24 million doses. Reuters

Israel, a high-income country that has already vaccinated a fifth of its population and almost three quarters of people over 70, has also eyed Sputnik. Zeev Rotstein, the head of Israel’s Hadassah Medical Center, has asked the Ministry of Health to purchase one million vaccine doses. 

“The diversification of vaccine sources is the kind of policy that we feel is important,” Rotstein said in an interview with Health Policy Watch in mid-November. Although Israel has since rolled out its campaign almost exclusively around the Pfizer vaccine – Rotstein has continued to tell the media that the Sputnik vaccine can remain a useful alternative – either domestically or for use in the hospital’s Russian medical center affiliate.

Right next door, the Palestinian Authority has approved the Sputnik vaccine and is expecting delivery of the first 50,000 doses this month, followed by AstraZeneca vaccines in mid-March. It has also received 5,000 Pfizer vaccines from Israel immediately for front-line health workers. There had, however, been some hesitancy around the use of the Sputnik vaccine – which the peer reviewed results may now help to dissipate.   

Sinovac –  Struck Deals for over 380 Million Doses  – Even Though Most Recent Trials Had Poor Showings

Healthcare worker in Chile opens up Sinovac vaccine

Among all of the vaccines under development, including Sputnik, the technology being used in the Chinese vaccines is also the oldest. It is based on a century-old practice in which an “inactivated” strain of the SARS-CoV-2 that cannot replicate in human cells is injected into the body, says the WHO. 

Even so, the research institutions backing the vaccines are not unknown to the west.  One of the two Chinese vaccines is being developed by Sinovac, a firm that has successfully marketed a WHO-approved hepatitis vaccine.  

In late December, Sinovac proudly announced an efficacy of 91.3% in a Turkish trial, but since then, the vaccine’s performance has consistently gone downhill. Subsequent trials yielded 78% in Brazil, 65.3% in Indonesia – and most disappointingly – 50.3% in a second Brazilian trial. 

If Sinovac’s vaccine efficacy dips below 50%, it would fail to hold up to the WHO’s and FDA’s minimum efficacy threshold. And it could become even less useful against novel coronavirus variants that are already undermining the best vaccines that currently available – as per indicative results from studies and trials by Moderna, Pfizer and Novavax. 

Some experts, however, have floated the idea that Brazil’s second interim analysis included more people with milder infections than in the first, thus reducing its efficacy. They also noted that Brazil’s trial of 12,000 people – the largest so far – exclusively recruited healthcare workers that are more likely to report mild infections, in comparison to other trials that recruited members of the general public, like those in Turkey or Indonesia. 

In her interview with Health Policy Watch, Cruickshank observed that background infection rates in the country is another factor: 

“It’s important to consider how common the disease is in the area where trials are carried out…If there is little virus in an area then fewer people may contract disease to assess how well a vaccine works.”

The Sinovac analyses also varied in terms of the time interval between the administration of the first and second vaccine doses – which may have also affected efficacy, said a spokesman from Sinovac. And a small sub-group of the last Brazilian trial, which received their vaccine doses 3 weeks apart, showed a higher efficacy (70%) than the larger group in which the vaccine was 50% efficacious – after receiving shots 2 weeks apart.  

In total, about 30,000 participants are still taking part in late-stage trials in Chile, Brazil, Turkey, Indonesia and China. If results from those trials are analysed transparently – then some of the outstanding questions will be answered. 

Despite the mixed results, the Sinovac vaccine has been approved for emergency use in China, which has vaccinated 7 million citizens, as well as Turkey, where 1.3 million people have been vaccinated, Indonesia, where 15,000 people have been vaccinated, and Chile. 

And Sinovac has already struck deals for over 380 million doses with a dozen countries, including Indonesia, Brazil and Turkey, among other countries. 

The number of Sinovac doses ordered across the top 10 countries, compiled from various sources. (HPW/Svet Lustig)

Sinopharm Sealed Deals With At Least Six Countries in Latin America, Middle East & Europe 

In June last year, Governor of São Paulo João Doria announced a partnership between Sinovac and it’s Butantan Institute

Despite its price, Sinopharm has already sealed deals with Argentina, Jordan, Morocco, Hungary, Serbia and Pakistan – which first bought 1.2 million doses outright and later received half a million additional doses as a “gift” from China.

In terms of approval, China already approved Sinopharm’s vaccine for the general public late last year, and plans to extend it to minors by March. Outside China, countries that have already approved it include Argentina, Peru, Bahrain, Egypt, Hungary, Iraq, Jordan, Pakistan, Peru Republic of Serbia, Seychelles, and the United Arab Emirates, according to McGill’s COVID-19 Vaccine Tracker. And recently, the UAE extended the vaccine’s use to people aged 60 and above.

With respect to vaccinations, one million Chinese citizens have already been inoculated with Sinopharm’s vaccine; outside China, inoculations have begun in the UAE, and further vaccination campaigns are set to begin in Egypt as well as Serbia, which became the first European country to receive doses of a Chinese vaccine last week.

Sinopharm  – Efficacy, Safety & Clinical Trials 

In a similar vein, Sinopharm’s vaccine has also puzzled scientists, with an efficacy of 79.3% in China and 86% in the UAE. 

Like Sinovac, Sinopharm has tried to reassure the world that both efficacy results are “real” and “valid,” explaining that countries have distinct case definitions for COVID-19, thus affecting national estimates of efficacy. 

“Because the standards of diagnosis of infection cases and the review process of Phase III clinical trial vary in different countries, the 86% efficacy rate announced by UAE and 79.34% by China are both real and valid,” the firm said in a press release. 

In total, some 66,000 volunteers from 125 nations are taking part in the company’s late stage clinical trials, including Argentina, Peru, Bahrain, Egypt, Jordan and the United Arab Emirates, according to McGill’s vaccine tracker.

WHO Prequalification For Chinese & Russian Vaccines Another Route Of Approval   

In light of the results reported in The Lancet, the next question is whether the Sputnik vaccine might be submitted to the European Medicines Agency (EMA) for regulatory approval.

Meanwhile, however, Gamaleya has submitted a dossier to WHO for “prequalification” of the Sputnik vaccine on WHO’s “Emergency Use Listing” – an avenue that offers another acceptable route to approval by a global health authority.  

Sinopharm and Sinovac also have submitted files to WHO, and these are currently under review as well, WHO officials said in late January.   

“We have full dossiers from three other drug companies right now, Sinopharm, Sinovac, and the Serum Institute of India and they are under assessment,” said WHO’s Dr Mariangela Simao, Assistant Director-General for Access to Medicines, who said the real time status of WHO review and approval for all vaccines can be tracked on the WHO’s website. 

“We have a mission in China right now, to do the inspections in Sinopharm, in Sinovac,” she added.

Still, for now, “nothing” can be said about the potential of these vaccines before vaccine makers reveal the datasets, warned Jarbas Barbosa in January, who is the assistant director of the WHO’s Regional Office of the Americas/Pan American Health Organization (PAHO), noting that neither the Russian nor the Chinese vaccine-makers have publicly released late stage clinical trial results – although they recently submitted their vaccine dossiers to WHO for review. 

“We only can say something about these vaccines when we reveal this data, before that we cannot say nothing based on press releases from the producers,” PAHO’s Jarbas Barbosa told Health Policy Watch at a press conference in January.

If WHO Pre-Approves Sputnik, Sinopharm & Sinovac – Will they Really Donate To COVAX? 

WHO Director-General, Dr Tedros Adhanom Ghebreyesus

WHO’s director-general Dr Tedros Adhanom Ghrebreyesus also recently warned member states against the purchase of vaccines that have not been approved by a strict regulatory authority.  

“We call on all countries introducing vaccines to only use vaccines that meet rigorous international standards for safety, efficacy and quality, and to accelerate readiness for deployment,” said Tedros, where he also called out rich countries for hoarding doses and vaccine producers for failing to provide WHO with timely data on vaccine efficacy. 

The WHO’s “prequalification” of a vaccine would also clear the way for the global COVAX facility, co-sponsored by WHO, to buy the vaccines in bulk. The COVAX initiative, also co-sponsored by UNICEF and Gavi, The Vaccine Alliance, aims to distribute 2.3 billion vaccines following a new contribution from Pfizer. 

“What’s important to understand is that pre-qualification is done, so that the international organizations such as UNICEF and others are comfortable with vaccines and able to purchase them,” David Heymann, former WHO assistant director for Health Security and professor at the London School of Hygiene & Tropical Medicine, told Health Policy Watch. “So if a vaccine doesn’t have a pre-qualification from WHO, it won’t be bought by organizations like GAVI or UNICEF.”

The initiative, designed to bolster equitable access to vaccines, is one that both Russia and China profess to support. In a global market where vaccine nationalism is running rampant – it remains to be seen if, in the event that Russia’s Sputnik, and China’s Sinopharm and Sinovac are greenlit by COVAX – whether they will follow the example of AstraZeneca and Pfizer – and offer their vaccines to the global market in bulk and at cost.  

–Vijay Shankar contributed significant reporting on Sputnik.  

Image Credits: RDIF, Kremlin, Peruvian Ministry of External Affairs, São Paulo State Government, Ministry of Defence of the Russian Federation, World Economic Forum, Pontificia Universidad Católica de Chile, State of Sao Paolo, WHO / Christopher Black .


Warning: Attempt to read property "post_title" on null in /home/clients/58f2a29976672af522a8f4d82ffa28b6/web/wp-content/plugins/better-image-credits/better-image-credits.php on line 227
Switzerland was unable to approve the Oxford AstraZeneca COVID-19 vaccine, requiring additional efficacy data.

Switzerland has become the first European country to reject an application by AstraZeneca for regulatory approval. Meanwhile, half a dozen other European countries have now said that data on the AstraZeneca/Oxford vaccine so far is insufficient to permit its use among people over the age of 65 – with Belgium being the latest. 

“The data currently available do not point to a positive decision regarding benefits and risks,” said the Swissmedic press release, issued Wednesday explaining the thumbs down given to the AstraZeneca vaccine – regardless of age. 

“To obtain a conclusive assessment, the applicant will among other things have to submit additional efficacy data from a Phase III trial under way in North and South America, and these will have to be analysed,” said Swissmedic.

Swiss Health Minister Alain Berset said that the regulatory decision would not crimp vaccine rollouts: “I think it does not affect the vaccination strategy” he said. 

Switzerland recently signed a contract with Moderna for an additional six million vaccine doses on top of the 4.5 million already purchased. Those, along with 3 million Pfizer vaccines would be  enough to vaccinate almost every adult in the country. Switzerland also has pre-orders for another six million doses of vaccines by Novavax and five million doses from CureVac, whose vaccine is in late stage development, and the Swedish government.

Nora Kronig of the Federal Office of Public Health said recent purchases would thus offset the decision on AstraZeneca. Still she was reluctant to commit to a timetable for the next phases of vaccine rollout, saying only: “We are reluctant to make predictions because that depends on various factors. What can be said is we are on track, with the new contracts we can achieve our goal by the end of summer.”

Contracts notwithstanding, Switzerland’s vaccine rollout so far has been lackluster – with only about 3.7% of the population inoculated, according to Bloomberg’s global vaccine tracker. That’s marginally more than the average for the 27-member EU, though a fraction of the UK’s 15%, and less than frontrunner Serbia, which is not an EU member. Switzerland got off to a relatively late January start to vaccines, while Pfizer and supply chain constraints have also been a factor, like elsewhere in Europe.  

Clement Beaune, French European Affairs Minister, defended the slower vaccine rollout rate across much of Europe compared to the United Kingdom, claiming that the UK took fewer precautions in using AstraZeneca’s vaccine in older individuals without sufficient data. 

World map of COVID-19 vaccinations. More than 108 million doses have been administered in 67 countries.
Six EU Countries Now Nix the AstraZeneca Vaccine For Older People – Running Against EMA Advice That It Was OK 

In the EU, meanwhile, Belgium has joined France, Poland, Sweden, Germany and Italy in advising against the use of the Oxford/AstraZeneca’s COVID-19 vaccine in people over the age of 65, due to the lack of data on its efficacy among people in this age group.

The decisions mark a departure from the European Medicines Agency (EMA) recommendations which on 29 January granted the Oxford/AstraZeneca vaccine a conditional authorization – including for older participants, stating:   

“Protection is expected, given that an immune response is seen in this age group and based on experience with other vaccines…EMA’s scientific experts considered that the vaccine can be used in older adults.” 

But one after another national health authorities have cited the need for additional clinical trial data on older individuals –  which is expected to come out of an ongoing Phase 3 trial in the United States.

French President Calls Vaccine “Quasi-Ineffective” for People Over 65 

Speaking to reporters last Friday, French President Emmanuel Macron said, “Today we think that [the AstraZeneca vaccine] is quasi-ineffective for people over 65.”

“What I can tell you officially today is that the early results we have are not encouraging for 60 to 65-year-old people concerning AstraZeneca,” he added.

“Currently available data for people aged 65 and over are limited by a small sample size and don’t allow for a conclusion on the safety and efficacy of the [AstraZeneca] vaccine for this population,” said the French health authority (Haute Autorité de Santé (HAS)). “The HAS recommends using the AstraZeneca vaccine in people under 65, starting with professionals in the health sector…and people aged 50 to 64 with co-morbidities.”

Poland set an even lower threshold of 60 years of age for the AstraZeneca vaccine, while Italy and Belgium advised against its administration to those older than 55 years old. 

“The superior health council says very clearly that the AstraZeneca vaccine is a very good vaccine for people between 18 and 55 years old,” said Frank Vandenbroucke, Belgium’s health minister. “But it also said we don’t have enough data today to say with certainty that it works so well in older people.”

“Maybe we will have the necessary data in a few weeks. For the time being we are taking it safe,” he added. 

Germany was the first to recommend an age restriction for the Oxford/AstraZeneca vaccine – a move that prompted discussions about reordering vaccine priorities – which placed older people high up on the list.

“On the one hand, we have to immediately procure alternative vaccines for people over 65 and on the other hand, we have to re-coordinate the vaccination sequence for the AstraZeneca vaccine that will arrive shortly,” said Saskia Esken, co-leader of the Social Democratic Party of Germany (SPD). 

But for now, people over the age of 65 as well as residents in nursing homes will not be able to be vaccinated with the AstraZeneca vaccine. This will potentially delay the goal to vaccinate all nursing home residents by mid-February and all people over 80 years old by the end of March. 

United Kingdom Meanwhile Rolling Out For Older People – AstraZeneca Says Strong Antibody Protection Demonstrated
An NHS worker in North London receives her first dose of the Oxford/AstraZeneca vaccine on Monday 4 January.

The UK, which authorized the AstraZeneca vaccine for emergency use already at the end of December, has already begun rolling it out for older individuals.  

AstraZeneca acknowledges that less than 10% of the participants in clinical trials were over the age of 65, reportedly because Oxford University researchers were waiting for sufficient safety data in the 18 to 55 age group before vaccinating older people.

“We don’t have a huge number of older people who have been vaccinated,” said Pascal Soriot, CEO of AstraZeneca, in an interview with la Repubblica, an Italian newspaper. “But we have strong data showing very strong antibody production against the virus in the elderly, similar to what we see in younger people.”

The AstraZeneca vaccine has also been approved for all age groups by India, Mexico and Argentina. 

Image Credits: Bloomberg.

Oxford University is commencing the first trial investigating alternating the Pfizer/BioNTech and Oxford/AstraZeneca vaccines.

The world’s first mix-and-match COVID-19 vaccine trial, sponsored by Oxford University, is currently recruiting volunteers to investigate the efficacy of alternating between Pfizer/BioNTech and Oxford/AstraZeneca vaccines.

Meanwhile, the British GlaxoSmithKline and CureVac, a German pharmaceutical company, announced their new €150 million agreement to jointly develop a COVID-19 mRNA vaccine, attempting to address multiple emerging variants in one vaccine. 

The Oxford University is funded by the United Kingdom government’s Vaccines Taskforce, which is providing £7 million to the study. Participants will receive one dose of either the Oxford/AstraZeneca or the Pfizer/BioNTech vaccine, and then either a second dose of the same vaccine or a booster of the alternate vaccine within 12 weeks.

The trial follows upon a series of UK government decisions allowing for the second Pfizer dose to be delayed as a result of vaccine shortages, as well as the mixing and matching of vaccines on “extremely rare occasions.”

Trials Will Investigate If Combining Vaccines Could Potentially Enhance Immune Response

However, there is some emerging evidence suggesting that the mixing and matching of vaccines – which rely upon different technologies – could also prove beneficial in terms of generating a stronger immune response, said Britain’s Deputy Chief Medical Officer, Jonathan Van-Tam, who will be the senior responsible officer for the study. 

“It is also even possible that by combining vaccines the immune response could be enhanced, giving even higher antibody levels that last longer. Unless this is evaluated in a clinical trial, we just won’t know,” said Van-Tam.

Data gathered in the trial is expected to help policy-makers make decisions to increase the flexibility of vaccination programs, which continues to be of high importance to the UK, where COVID-19 infections remain high, worsened by the spread of the highly transmissible variant, B.1.1.7.

“If we do show that these vaccines can be used interchangeably in the same schedule this will greatly increase the flexibility of vaccine delivery, and could provide clues as to how to increase the breadth of protection against new virus strains,” said Matthew Snape, who will be the principal investigator in the trial. 

The trial will include over 800 participants aged 50 and above and will last 13 months. The four vaccine combinations will be evaluated on two dosing schedules, at a four week interval and a 12 week interval. 

“As we roll out vaccinations in the UK, we have the opportunity to look at how to get the most out of the vaccines available to us,” said Maheshi Ramasamy, senior clinical researcher and investigator of the trial. “This innovative study looks at whether using different combinations of two currently approved vaccines is a good alternative to the standard schedule. We will also be looking at the impact of the interval between doses on immune responses.”

“This study will give us greater insight into how we can use vaccines to stay on top of this nasty disease,” said Van-Tam.

GSK and CureVac To Develop Multi-Variant COVID-19 Vaccine

As for the GSK and CureVac research into a robust vaccine against variants, the development project aims to have vaccines available in 2022, if the safety and efficacy data is strong. 

Such a product potentially could serve as an initial vaccination or as a booster if immunity from previous jabs reduces over time, said Emma Walmsley, CEO of GSK, in a press release. 

“We believe that next generation vaccines will be crucial in the continued fight against COVID-19. This new collaboration builds on our existing relationship with CureVac and means that together, we will combine our scientific expertise in mRNA and vaccine development to advance and accelerate the development of new COVID-19 vaccine candidates,” said Walmsley. 

The company will explore a COVID-19 vaccine targeting several SARS-CoV2 variants; but the collaboration will also look into developing a novel mRNA vaccine to protect against multiple respiratory viruses, she said. 

“They’re trying to develop ‘universal vaccines,’ i.e. vaccines targeting multiple respiratory viruses/coronaviruses. That would be a big contribution to the world, but it’s a big ask. The world has tried for many years to get universal flu vaccines, but they’re technically hard to develop. So this is a high-risk, high-reward strategy,” said Adam Barker, healthcare analyst at Shore Capital, in an interview with the Guardian. 

The collaboration will also include GSK assisting in manufacturing up to 100 million doses of CureVac’s COVID-19 vaccine candidate in 2021. The mRNA candidate is currently in Phase 2b/3 clinical trial; Like Moderna’s mRNA vaccine, it is designed to be stored at standard 2-8°C vaccine storage conditions.

Image Credits: BioNTech, University of Oxford.

Healthworkers examine a patient in a Kampala hospital during COVID – lack of adequate isolation wards and PPE has left front-line workers at high risk of illness.

KAMPALA, UGANDA – Responding to a swell of global criticism, a senior Ugandan health official told Health Policy Watch that Uganda’s government is not paying unreasonably higher prices for it’s AstraZeneca vaccines, in comparison to other African countries – or Europe. 

“You cannot compare prices directly between countries because there are many factors to consider. Prices have to vary anyway,” said Alfred Driwale the manager of the Uganda National Expanded Programme on Immunization (UNEPI) at the Ministry of Health, in an exclusive interview.  

News that Uganda will be paying USD $7 per dose for its 18 million dose order of the Astra Zeneca vaccine – a price that is 20% more than South Africa and roughly triple that being paid by the European Union – sparked anger and outrage around global medicines access advocates – and on social media channels. 

“This is unjust & unfair. Bilateral deals between wealthier countries & companies means low income countries like Uganda get a raw deal with price hikes.” protested one Ugandan human rights advocate on social media.   

The two-dose vaccine, together with shipping and handling costs, would bring the total cost of each immunization regime to USD $17, government officials said.

But Driwale told Health Policy Watch that the prices countries may quote, per vaccine, vary because there are many factors to consider including overhead costs, the timing of orders; transport costs; the amounts of cash down payments or deposits, as well as economies of scale etc. 

“You can not expect a country with a big population to pay the same price, the  big country will definitely have a higher bargaining power,” says Driwale while comparing the prices a country like Uganda and Nigeria may pay for the vaccine. 

Uganda has some 48 million people while South Africa has nearly 60 million.

Driwale who did not want to comment on whether this sets a precedent for what  Uganda might pay in the event  it procures other types of vaccines saying ‘ it is still too early to have that conversation now.”  

Ugandan Ministry Of Health Placing Order For 18 Million Doses  

Following a cabinet meeting on Monday, The Ministry of Health and the National Medicines Stores (NMS) announced that they had placed an order of 18 million doses of the Astra Zeneca from the Serum Institute of India, which will be used to vaccinate people above  50 years of age, as well as people with underlying health conditions, health workers, security personnel, teachers and other essential social service providers.

But on Wednesday, a spokesman for the Serum Institute of India told Reuters that the institute has not yet signed any deal with Uganda. “While discussions are ongoing, there has been no finalization of price or volumes,” the spokesman said.

The Serum Institute is supplying doses of the vaccine to Brazil, Saudi Arabia and South Africa at $5.25 per dose.

Ugandan government officials did not seem ruffled by the Serum Institute Statement, saying that the country’s order placed will only be confirmed upon remission of US$ 5 million as a down payment for the vaccine.

Uganda is also expecting to receive soon a supply of some  3.552 million AstraZeneca vaccines  from the WHO-co-sponsored COVAX global facility – enough to immunize about another 1.77 million people, according to the first interim plan.

Good News on AstraZeneca Potential For Greater Dose Spacing & Containing Disease Transmission

Meanwhile, for countries that have secured AstraZeneca doses, there was good news in a pre-print study published by researchers at the University of Oxford suggesting that the AstraZeneca vaccine was not only effective in preventing disease – but also in reducing transmission to others.

Efficacy of COVID vaccines to prevent transmisison has been a hotly debated topic – with huge policy implications.  The new paper, which examined weekly swab tests that had been administered to a group of 17,177 AstraZeneca clinical trial participants in Brazil, the United Kingdom and South Africa, found a 67% reduction in positive coronavirus swab tests, among those vaccinated as compared to those who were not.

Just as important, the analysis found that vaccine efficacy, averaging 76% at three months, was higher if the second dose was administered after three months, rather than earlier – a finding which could support country decisions to space initial and booster vaccine doses further apart in order to ration precious doses.

British Health Secretary, Matt Hancock,  welcomed the results on Wednesday as “absolutely superb.”

“We now know that the Oxford vaccine also reduces transmission and that will help us all get out of this pandemic,” Hancock said in an interview morning with the BBC.

COVAX Dose Distribution Plan Unveiled 

Seth Berkley, CEO of GAVI, The Vaccine Alliance, announces COVAX distribution plan

The good news about the AstraZeneca vaccine came just before the COVAX global vaccine facility, co-sponsored by WHO and GAVI, The Vaccine Alliance, published their list indicating how many vaccines each participating country expect to receive in the first half of 2021, with deliveries beginning in late February or early March. 

The total worldwide distribution would include about 336 million doses of the AstraZeneca vaccine and another 1.2 million doses of a promised 40 million vaccine doses from Pfizer – reflecting what COVAX will be able to roll out immediately, said GAVI CEO Seth Berkley, speaking at a press briefing today in Geneva.  

At the briefing, Berkley and other officials said that they still expected COVAX to deliver as many as 2.3 million doses in 2021 including “as many as ~1.8 billion doses” to the 92 countries that receive donor-supported vaccine aid – providing them with about 27% coverage with COVID vaccines. 

“Today is a positive day as we think about this equity agenda we have been talking about for a long time now..” declared Berkley. “At this point soon we will be able to start delivering life saving vaccines globally, an outcome that we know is essential if we are to have any chance of being able to beat this pandemic as well as being able to deal with the new scientific challenges such as the new variants.”

But Uganda, whose economy has suffered heavily from the impacts of COVID-related lockdowns – despite comparatively low infection rates – clearly wants to ensure a higher level of coverage as quickly as possible. 

Health workers demonstrate handwashing to villagers in eastern Uganda – to prevent COVID infection. The economy has suffered heavily from lockdowns.

COVAX Doses Through Advance Market Commitments – Donor Supported 

Ann Lindstrand, WHO

For the 92 countries primarily dependent on donor aid to access vaccines, doses are being allocated proportionate to their population size, at-risk groups as well as other criteria, in line with a “fair allocation mechanism” developed by WHO. 

“It is a strategy to rapidly contain the pandemic, save  lives, protect health care systems,and restore the global economies, based on human rights principles of equity and epidemiological evidence from the pandemic,” said WHO’s Ann Lindstrand of the fair allocation mechanism.

“All countries should receive doses in proportion to their population size, to immunize the highest priority groups, especially those most likely to die, who have severe disease.”

In the first phase of the COVAX distribution, Kenya would receive some 4.176 million doses,  although self-financed South Africa – which is signing other large purchase arrangements – would only receive 3.1 million doses. Nigeria, with a population of 200 million that makes it by far the largest country in Africa, would receive some 16 million COVAX doses. 

In the first round of allocations, AstraZeneca vaccines will make up most of the doses being supplied by COVAX. However, Pfizer also has signed a commitment to supply up to 40 million doses of its  Pfizer-BioNTech vaccine candidate, which has already received WHO emergency use listing, on an at-cost basis.  According to the WHO distribution list, countries that will receive the Pfizer vaccine are primarily in Latin America, eastern Europe and Asia or South-East Asia – presumably where the vaccinés ultra-freeze cold chain requirements can be managed.  

While most of the 135 countries signed up to receive the first COVAX vaccine shipments are low-income or middle-income countries, while most G-20 countries were noticeably absent, a few high income participants stood out on the list.  

For instance, the Republic of Korea is set to receive some 2.6 million doses of AstraZeneca vaccines and 117,000 doses of the Pfizer vaccine through the global facility on a for-pay basis. Upper middle income countries like Chile and Argentina are also set to receive some initial doses through the facility.  

Vaccines for countries that had access to other vaccine sources were limited in these first rounds, said Lindstrand, as part of the “fair allocation mechanism.”.  In addition to population, and other vaccine access, the mechanism considers other criteria such as country readiness to receive the vaccines and risks to health workers.

Said Lindstrand, “Review and assessment was done on the basis of first-participant readiness, whether participants had already initiated vaccines – we thought it was important for those that had not started, to be able to access doses to be able to protect their high priority populations.”

Another criteria considered was the risk of health care worker exposures, in terms of health care worker mortality over the past 28 days, she said.  That was seen as a wider indicator of “the highest possible public health impact.”

GAVI, which published the list, also noted that the final allocations will be subject to approval by WHO of the AstraZeneca vaccine for an Emergency Use Listing (EUL), as well as manufacturing and supply chain constraints. WHO has already approved the Pfizer vaccine, which was registered earlier with national regulatory authorities.

According to the COVAX arrangements, about 35-40% of the promised doses would be supplied by end March 2021, with another 60-65% made available by the end of June. 

Image Credits: Sasmson Wamani .

Members of the South African National Defence Force patrol Bree Street taxi rank in central Johannesburg during the recent lockdown, whose restrictions were eased on Tuesday.

CAPE TOWN – Despite battling against a more infectious variant, South Africa seems to have ridden out its second and deadliest wave of COVID-19 infections.  And with new case counts declining, the government relaxed its most recent set of lockdown restrictions on Tuesday – reopening beaches, and easing night-time curfews and a ban on alcohol sales. . 

In another positive development,  the country’s first batch of vaccines – one million doses of the Oxford/ AstraZeneca vaccines produced by the Serum Institute of India (SII) – arrived on Monday  – but at a higher price than the European Union paid.  

South Africa has bought 1.5 million doses in total, paying more than double the price per dose, than the EU is paying for the same vaccine – despite the fact that clinical trials of this vaccine were run in South Africa.

The South African Department of Health has confirmed that it is paying $5.25 per dose -about double what the European Union is paying, whereas the price in India is about US$ 3 a dose for the vaccine, which is first to be administered to essential health workers. 

That fact has drawn the ire of medicines access advocates – who point to the higher price as evidence of the penalty being paid by lower income countries to access vital COVID-19 vaccines and treatments.

South African protest, Tuesday 2 February, calling on the US and EU to support a World Trade Organization ” TRIPS” waiver on patents and other IP related to all COVID-19 drugs, vaccines, diagnostics.

  

“South Africa is being vastly overcharged for the AstraZeneca/ Oxford vaccine,” charged Candice Sehoma and Claire Waterhouse of Médecins Sans Frontières in an oped published in News.24 on 30 January.   

According to that and other reports, including a Belgian minister who mistakenly tweeted a secret list of EU vaccine prices in mid-December –  the EU is paying as little as $US 2.16 per dose, ostensibly because the region also invested in the vaccine’s R&D .

Some 41 Million Vaccine Doses Secured 

Addressing the country on Monday night, President Cyril Ramaphosa announced that the country, which has a population of 60 million people, had secured:

  • 12 million vaccine doses from the WHO co-sponsored global COVAX vaccine facility (with 2 million doses to be delivered in March)
  • 9 million vaccine doses from Johnson & Johnson, with delivery in the second quarter. (The Johnson & Johnson vaccine will be manufactured in South Africa by Aspen.)
  • 20 million doses from Pfizer with deliveries in the second quarter

That would work out to enough vaccines for about 25 million people – considering that the Pfizer vaccine as well as most of the vaccines being supplied through COVAX require two doses.  

South Africa will also get vaccines through the African Union, which Ramaphosa has chaired for the past year, and hands over later this month to the Democratic Republic of the Congo.

“Through the African Vaccine Acquisition Task Team of the African Union, we have to date secured 1 billion vaccines for the entire continent,” said Ramaphosa. “Seven hundred million of these will come from the global COVAX facility and 300 million have been facilitated by the African Vaccine Acquisition Task Team.”

The South African-based mobile phone company, MTN, has donated $25 million to procure 7 million vaccines for African countries and other private companies are expected to follow, added Ramaphosa. 

Health Workers Top List Of Priority Vaccine Recipients 

All health workers in the public and private sectors will be vaccinated first – some 1.25 million people. This will be followed by “essential workers, people over 60 years, people with co-morbidities as well as those living in places such as nursing homes and hostels,” said Ramaphosa. Phase 3 will involve all adults, with the aim of vacinating 40 million people to achieve herd immunity.

The stabilizing of infection rates in the country is particularly welcome news since South Africa has led the continent in terms of infection rates. And with new variants also emerging it has been seen as a global bell-weather in the battle to contain virus mutations. . 

At the peak of South Africa’s second wave in early January, new daily infections peaked at over 21,000 cases. But cases have been reducing steadily over the past three weeks and by Monday, 2,548 new cases daily were recorded. Daily hospital admissions have dropped from 2,300 patients to 295 by the end of January. 

Officially, over 44,000 people have died of COVID-19, but the SA Medical Research Council reports at least 125,000 excess deaths between 3 May 2020 and 23 January 2021 when compared to the same time last year.

Heavy Cost of Lockdowns

Lockdown in Alexandra Township, Johannesburg, South Africa.

“I want to thank the millions of South Africans who had to endure restrictions on their movement and activities so that infections could be contained, and lives could be saved,” said Ramaphosa, in his remarks to the nation. 

“We are acutely aware that these restrictions have negatively affected businesses and threatened jobs in the hospitality, tourism and related industries. That is why we are determined that such restrictions should not continue any longer than is absolutely necessary to contain the pandemic and minimise the loss of life.”

From Tuesday, the nightly curfew has been shortened, parks and beaches were re-opened and a prohibition on the sale of alcohol has been eased. Bars are able to open with restricted hours and limited church services are also allowedd.

Over 2.2 million people lost their jobs between April and June 2020, according to StatsSA’s Quarterly Labour Force Survey and 52% of adults are currently unemployed.

Before the country’s first lockdown at the end of March 2020, over 18 million people were being supported by government grants, but by July last year almost 16 million more people had joined them, with most new grantees receiving a COVID-19 relief grants after losing their jobs, according to Media Hack.

Meanwhile, lockdowns cost South African school children around 40% of school time last, and less than 10% of households had internet access to enable online learning, according to Statistics SA. The Department of Basic Education estimates that over 320,000 school children may have dropped out of school last year. 

South African government schools are due to open on 15 February, about three weeks later than usual, although some private schools opened this week.

Image Credits: Peoples Health Movement, Flickr: IMF Photo/James Oatway, Flickr: IMF Photo/James Oatway.

Children and adolescents also have suffered from lack of access to cancer tretment services as a result of the COVID pandemic.

Some 50% of countries surveyed by WHO have had cancer services partially or completely disruptive because of the pandemic, according to new WHO data released just ahead of World Cancer Day on Thursday. There have also been significant reductions in cancer-related research and clinical trials, said Andre Ilbawi, speaking at a press briefing in Geneva on Tuesday. 

“To state it simply, the consequences of the pandemic on cancer control efforts have been profound,” said WHO’s Dr Ilbawi at the Tuesday briefing in Geneva. 

Meanwhile, in an open letter to national heads of state, WHO, UNICEF, Norway’s Minister of International Development and the NCD Alliance, called for massive investments in prevention and treatment of non-communicable disease and mental health – in order to “build back better” post pandemic. 

The letter, Building Back Better: Investing in healthy populations and resilient health systems for NCDs  and Mental Health published in Foresight Global Health, was co-signed by WHO’s Director General Dr Tedros Adhanom Ghebreyesus, Director-General; UNICEF’s Executive Director Henrietta Fore, Dag-Inge Ulstein, Minister of International Development, Norway and Todd Harper, President, NCD Alliance. 

The letter cites data that shows people living with these NCDs are at a higher risk of severe complications from COVID-19, are more likely to be hospitalized, and are at a higher risk of death.

Seven of the top ten causes of premature deaths are NCD related.
Seven of the top ten causes of premature deaths are NCD related.
WHO – Cancer Cases Rising Globally Unabated

In terms of cancer, one of the big NCD killers, recent trends demonstrate how quickly the burden is rising, WHO said in its briefing. In 2000, there were an estimated 10.1 mil compared to nearly 20 million in 2020. Based on demographic projections alone, by 2040, we anticipate there will be 30 million cases per year.

Cancer is now the second leading cause of death globally, now responsible for more than one in six total deaths. Breast cancer is now the most commonly occurring cancer worldwide (12% of new cases), followed by lung and colorectal cancers. Currently, one in five people develop cancer during their lifetime. 

The burden of cancer can be lessened with global efforts. The theme of this year’s World Cancer Day – “I can and I will” – serves as a reminder that each of us can and must play a role in reducing the impact of cancer, said Ilbawi. 

While the COVID-19 pandemic has disrupted cancer services around the world, governments have begun to return to the fundamentals of cancer care – promoting early diagnosis, focusing on essential services, developing innovative models to increase care through telemedicine, and providing care as close to home as possible.

The WHO is prioritizing several initiatives calling for collective action and collaboration in combating the rise of cancer for World Cancer Day:

  1. Focusing on breast cancer – The WHO is hosting the first global consultation of breast cancer with the anticipation of launching on International Women’s Day 2021. 
  2. Eliminating cancer as a life threatening disease – WHO Europe is calling for a pan-European movement, United Action Against Cancer, that will build on a set of signature solutions. 
  3. Highlighting risk factors to cancer – One environmental risk factor, radon, an odorless gas found in residential buildings, is estimated to have caused 84000 deaths by lung cancers. In some countries, it is among the leading causes of lung cancers. 
  4. Emphasizing current WHO initiatives on cancers – In November 2020, governments endorsed the global strategy to accelerate the elimination of cervical cancer as a public health problem. This would be the first opportunity to eliminate cancer and save 4.5 million lives. Additionally, the WHO is releasing a technical package for the Global Initiative for Childhood Cancer, on International Childhood Cancer Day, 15 February. This initiative is active in more than 30 countries, working to improve survival and quality of life for children with cancer. 
 Foresight Report – COVID & NCDs  
Cancer treatment services such as chemotherapy have been disrupted in many countries due to COVID.

In terms of the specific links of COVID with the broader array of NCDs, the Foresight letter also notes that health services disruptions will result in a longer-term upsurge in deaths from NCDs which overstretched health systems will struggle to manage.  

In addition, data has shown that people living with NCDs are at a higher risk of severe complications from COVID-19, are more likely to be hospitalized, and are at a higher risk of death. Emerging studies of critically ill COVID-19 patients tell the same story around the world –  

  • Of those dying of COVID-19 in Italian hospitals, 67% were people living with hypertension and 31% with diabetes. 
  • In Spain, 43% of people who developed COVID-19 disease were living with cardiovascular diseases.
  • In Indonesia, 16% of reported COVID-19 deaths were people living with diabetes.  In Mexico, of deaths from COVID-19 in the Indigenous population, diabetes was the most frequent co-morbidity (30%).
  • Mortality has been high in long-term care facilities for people with dementia and other mental health conditions. Those who are lucky enough to recover from COVID-19 may well face additional long-term health challenges.
  • In the Netherlands, the number of people newly diagnosed with cancer dropped by 25%. In India, 30% fewer cardiac emergencies reached health facilities.  

“NCDs are the largest, and yet most underfunded, public health issue globally, where the most lives could be saved. For too long they have been overlooked by leaders and policymakers,” said the co-signers of the letter. 

The result of underfunding is that more than one in five people now live with one or more NCDs. But the pandemic has exposed even more uncomfortable truths – for these people living with NCDs, people living in poverty, people in institutions, and minority groups who are paying the price for government underspending on health around the world. 

People are facing the virus at uneven starting points. Exposure to COVID-19 and its level of severity is strongly linked to the growth and development of children, where you live and the social, political, economic and environmental inequalities that have been allowed to fester in our societies, says the authors. 

Strategies & Solutions – Invest In Prevention – Early In Life 

The Foresight letter calls on leaders and policymakers to not “shy away from the hard lessons of COVID-19”, and to include NCDs in national COVID-19 response plans:.

“It is clear that the world cannot return to the way it was pre-COVID-19. The pandemic must be a wake-up call for governments and leaders to step up in their investments and ensure that there is prevention, screening, early diagnosis, and appropriate treatment of NCDs, especially for those disproportionately affected.

“It’s high time governments invest in health and prevention, starting from early in life. COVID-19 has exposed the damage done by neglecting NCDs and reducing public spending over the years on health, prevention, and essential public health services in many countries.

“We need to invest in resilience – for health services and healthy societies – and to dismantle long-standing disparities in our societies. And we need strong social protection systems and policies in place to protect vulnerable communities and reduce inequalities.”

Cycling in Fortaleza, Brazil – Cities that promote healthy physical activity through cycling and walking networks also help prevent NCDs.

Investing in prevention early in life can also reduce the NCD burden, the authors state. Child and adolescent exposure to air pollutants, tobacco, alcohol, drugs, and poor diets that leaves them predisposed to NCDs.

Strategies include laws and economic measures to reduce salt, sugar, and trans fats in foods that growing children consume; promoting physical activity; urban planning that allows for safe physical activity; enabling clean public transportation and other policies to reduce air pollution; and price and marketing measures on tobacco and alcohol. 

Finally, there must also be investments in mental health and well-being. The COVID-19 pandemic has resulted in increases in unemployment, missed education, social isolation, and risk of family violence. “The associated distress coupled with the uncertainty as to when normal life can be resumed, has greatly impacted people’s short-term and long-term mental health. This is an opportunity to build mental health services for all people in need,” the letter states, concluding that –

“Investing in NCDs and mental health is an investment in a better future – the future of people, health security and economic stability.” 

Investment in mitigation of NCDs boosts productivity by cutting the number of wasted lives.
Investment in mitigation of NCDs boosts productivity by cutting the number of wasted lives.

 

Image Credits: Rhoda Baer/National Cancer Institute, WHO – C de Bode, World Health Organization, Global Health Estimates , WHO, City of Fortaleza, World Health Organization .

Sputnik V is 91.6% effective against symptomatic COVID-19 and 100% effective against moderate and severe disease

Fulfilling the legacy of its pioneering name, the Russian Sputnik V vaccine, was over 91% effective in preventing symptomatic COVID-19 cases and 100% effective in preventing severe COVID, according to results published Tuesday in The Lancet. 

Globally, that means that the Sputnik vaccine joins the club with just two other coronavirus vaccines that have demonstrated an efficacy of 90% or more – the others being Moderna’s and Pfizer’s high-tech mRNA vaccines.  

The Lancet publication also marks the first time that Phase 3 trial results of one of the “elusive trio” of Russian and Chinese vaccines have been published in a peer-reviewed journal.  That marks a big step forward in the transparent review of vaccines generally – setting a bar that Chinese vaccines will have to pass over as well to gain WHO approval and widespread public acceptance.  

Good News for Low and Middle Income Countries 

Most importantly, the results are very good news for the nearly fifty countries across the globe that have pre-ordered over 1.2 billion doses of the Sputnik vaccine, developed by Russia’s Gamaleya National Research Institute of Epidemiology and Microbiology, and marketed abroad by the Russian Direct Investment Fund (RDIF). 

Even before Sputnik’s Phase 3 results were formally published, the vaccine had been administered to about 2 million people worldwide thanks to an aggressive  Russian marketing campaign. 

Its low price of $US 10 per dose, and easy storage in conventional refrigerators at temperatures of 2°C to °8 C, has indeed made Sputnik a strong market competitor with the vaccines being produced by pharma companies in western Europe and the United States. Although at US$ 3 a dose, the AstraZeneca/Oxford vaccine produced by the Swedish-British collaboration is even more affordable – thanks to AstraZeneca’s no-profit pledge.

Kirill Dmitriev, head of the RDIF

The landmark publication of results in a prestigious peer-reviewed journal now means that Sputnik skeptics have “run out of arguments,” boasted Kirill Dmitriev, the head of the RDIF in a press briefing that coincided with the  announcement of the results: 

“When we take safety, efficacy, logistics, price, and long lasting immunity into account, certainly Sputnik is a leading vaccine in the world, and the publication The Lancet journal confirms that.”  

“Our interim analysis of the randomised, controlled, phase 3 trial of Gam-COVID-Vac [Sputnik] in Russia has shown high efficacy, immunogenicity, and a good tolerability profile in participants aged 18 years or older,” added Gamaleya’s Inna V Dolzhikova, a co-author of The Lancet’s Study, in a press release.

Trial Reports on 22,000 Participants 

The publication reported interim results from Russia’s randomised, double-blind, placebo-controlled, phase 3 trial in almost 22,000 participants, of which 75% received the vaccine and 25% received a placebo. 

The interim analysis found that only 16 out of 14,964 (0.1%) participants that received the vaccine developed symptomatic COVID-19, compared to 62 out of 4902 (1.3%) in the placebo group, demonstrating an overall efficacy of 91.6%. 

Importantly, secondary analyses found that the vaccine was 100% effective against moderate or severe COVID-19, and equally efficacious across all age groups, including older adults.

Apart from stimulating robust antibody responses in virtually all participants, Sputnik V also induced vigorous T-cell responses, an important component of immunity. In fact, only six of 342 participants in the vaccine group failed to develop antibodies, probably because they were older or due to possible immune disorders.

The findings also hint that a single dose of Sputnik could confer a partial protective effect of 75% within two weeks.

Although this would require further trials to confirm, the findings have already stimulated a joint trial that aims to employ Sputnik to boost AstraZeneca’s vaccine, as well as another Chinese vaccine.

“We are ready to partner with the developers of vaccines having efficacy less than 90% to help them boost efficacy,” said Dmitriev on Tuesday. “We are about to launch clinical trials together with AstraZeneca in order to analyze how adding Sputnik components can increase the efficacy of the AstraZeneca vaccine, and we’re about to announce cooperation with another Chinese developer.”

Lack of Variant Analysis & Self-Reports Of COVID Cases Remain Key Limitations 

However, the study was not without limitations.  

Because COVID-19 cases were detected through participant self-reports, asymptomatic cases were excluded from the efficacy analysis, even though these account for at least one in five infections worldwide.

And unlike the Novavax vaccine candidate, which had almost the same levels of efficacy, the Sputnik trial results do not consider the new virus variants that have emerged recently, although these studies are ongoing, said Dmitriev.

“We’ve been doing analysis of variants that we’re seeing at the moment…But of course, is very important to continue analysis,” he said, noting that Sputnik may be better at outwitting variants than other vaccines.

In the case of the Novavax Phase 3 trials, released on Monday, the vaccine showed an overall efficacy of 95.6% against older virus variants, but dipped to 85.6% and 60% for British and South African variants respectively.  

If a similar analysis had been performed on Sputnik, it would be likely that the results of the vaccine’s potency against the variants would be lower – insofar as all of the vaccines currently in R&D were designed to fight a SARS-COV-2 variant that was prevalent up until the end of 2020. 

Based on a pre-existing Ebola vaccine developed about six years ago, Sputnik’s vaccine technology relies on two genetically modified human cold viruses, Adenovirus 26 and Adenovirus 5. AstraZeneca’s technology is also based on a deactivated adenovirus – but one that circulates exclusively in monkeys. 

Lancet Commentary Welcomes Results

Despite the shortcomings, the tone of a Lancet commentary, linked to the report of the trial results themselves, was congratulatory. 

“The development of the Sputnik V vaccine has been criticised for unseemly haste, corner cutting, and an absence of transparency,” said the commentary  by Polly Roy and Ian Jones from the London School of Hygiene & Tropical Medicine and and the University of Reading.  “But the outcome reported here is clear and the scientific principle of vaccination is demonstrated, which means another vaccine can now join the fight to reduce the incidence of COVID-19.”

On the other hand, the commentators noted that the vaccines from Pfizer and Moderna vaccines will retain an advantage in terms of the smaller volumes of the vaccine required per dose – even if their cold chain requirements are more rigid and their price is twice that of Sputnik, at about $20 per dose .

Vaccines based on adenoviruses – including not only Sputnik but also AstraZeneca – demand larger volumes of product – making their manufacture and transport bulkier across the supply chain. 

Sputnik’s Vaccine Production & Distribution Already Widespread 

Healthcare worker prepares Sputnik V vials

Sputnik’s vaccine has received considerable worldwide attention in recent months, with 16 countries across Latin America, Asia, Africa, including the United Arab Emirates and the Palestinian Authority in the Eastern Mediterranean Region, already having given the vaccine regulatory approval.  

Local production has begun in India, South Korea, Brazil, China, is set to begin in Kazakhstan and Belarus, probably also in Turkey, and maybe even in Iran, said Dmitriev.

In particular, India will be a “key partner” of Sputnik because of its massive manufacturing capacity, with potential to produce as much of the vaccine as Russia is producing now. 

“We’re even ready to call Sputnik V a Russian/Indian vaccine because we have five production partners in India, and from the very beginning we’ve been in very close collaboration, because India has outstanding production capacities for the vaccine,” said Dmitriev, whose comments also reflect the geopolitical alliances around vaccine collaborations.  

Vaccine Well Tolerated Across Ages – But Gender and Ethnic Diversity Was Lacking  

The vaccine was well tolerated in all age groups, including older adults, as well as people with underlying conditions, who made up a quarter of total participants in the trial. These included people with diabetes, hypertension, ischaemic heart disease and obesity.

Like most clinical trials, however, it lacked diversity – as two thirds of participants were male and almost all were white. So further research will also be needed in adolescents, children, pregnant and lactating women as well as other diverse populations, 

Fortunately, 94% of adverse effects were categorized as mild, and the severe adverse effects that occurred were considered to be unrelated with vaccination by the study authors as well as an independent data monitoring committee. In total, 45 participants in the vaccine group and 23 in the placebo group reported serious adverse events.

Although four deaths were recorded in the trial, of which three were in the vaccine group and one in the placebo group, none were related to the vaccine, said the study authors. 

In the vaccine group, one death was associated with a fracture and the remaining two were in people with pre-existing conditions that likely had developed COVID-19 symptoms before the trial began, said the study. Furthermore, both participants self-administered non-steroidal anti-inflammatory drugs without informing clinicians, which interfered with diagnosis and prompt medical help. In the placebo group, the death was associated with a stroke. 

Unclear How Long Immunity Will Last 

Like other vaccines, it’s unclear how long immunity against SARS-CoV-2 will last, but Sputnik’s vaccine-makers have “high hopes” that it could last for “at least two years”, said Alexander Ginstsburg, who leads the Gamaleya Institute.

“We have very high hopes that the immunity lasting after this vaccine would be lost for more than several months, even more than a year, but at least two years and probably even longer.”

Even if antibody levels decrease within several months, the immune response can easily be boosted with an additional shot, noted Gamaleya’s Denis Logunov, who co-authored the article.

“Stopping the COVID-19 pandemic requires the introduction of different vaccines based on different mechanisms of action to cover diverse global health demands. Our vaccine, along with other SARS-CoV-2 vaccines, helps to diversify the world SARS-CoV-2 vaccine pipeline,” he said.  

Image Credits: RDIF.

Ursula von der Leyen, President of the European Commission, speaking at the World Economic Forum last week as Europe grappled with COVID vaccine supply shortages.

AstraZeneca has agreed to increase its COVID-19 vaccine deliveries to the European Union by 30% after a week of feuding over a shortfall in vaccine deliveries, announced by the pharma company after its manufacturing plants hit a number of snags. 

By April or June, a series of manufacturing foul-ups reported by Pfizer as well as AstraZeneca, should be resolved, enabling the EU to reach its goal of vaccinating 70% of adults in across 27 member states by the end of the summer, officials are now saying.  

The British-Swedish AstraZeneca is reportedly two months behind schedule in vaccine deliveries to Europe due to an issue with manufacturing the vaccine’s active ingredient at plants in Belgium and the Netherlands, which is producing the vaccines destined for delivery to EU member states. 

Now, however, the Oxford/AstraZeneca vaccine, which was authorized for use in the EU on Friday, will begin deliveries in the second week of February – and the company will expand its manufacturing capacity in Europe to meet high demand, according to Ursula von der Leyen, President of the European Commission. 

Some 9 million additional doses will be delivered in February and March, for a total of 40 million doses to be delivered over the next two months. February will also see more deliveries than the 17 million doses that were originally promised by Pascal Soriot, CEO of AstraZeneca. 

Although the coming two months will still be characterized by a shortage of vaccine supplies for the European region, the resolution seems to have quieted the tensions between AstraZeneca and EU officials after a series of recent meetings.. 

It represents a “step forward on vaccines,” wrote Von der Leyen on Twitter. 

Pfizer/BioNTech and J&J Also Plan To Step Up Deliveries In Second Quarter 2021 

In other good news for Europe, Von der Leyen said that Pfizer/BioNTech will deliver 75 million more doses than it had promised Europe in the second quarter of 2021 – for a total of up to 600 million doses total by the end of the year. This is likely due in part to the added commitment from Sanofi to assist BioNTech manufacture and supply over 125 million doses of the vaccine to the EU beginning in the summer of 2021. 

This represent “a pivotal step towards our industry’s collective goal of putting all the effort in to curb this pandemic,” said Paul Hudson, CEO of Sanofi, in a press release. “Although vaccination campaigns have started around the world, the ability to get shots into arms is being limited by lower than expected supplies and delayed approval timelines owing to production shortages. We have made the decision to support BioNTech and Pfizer in manufacturing their COVID-19 vaccine in order to help address global needs, given that we have the technology and facilities to do so.”

 

It is also expected that Johnson & Johnson’s single-dose vaccine will be on the European market by the second quarter of 2021 – although it has only demonstrated a 66% efficacy in preventing moderate to severe infection. And its results have been less impressive than other competitors, like Novavax, in meeting the challenge of virus variants.  

In a video conference on Sunday between Von der Leyen and the CEOs of six pharmaceutical companies – BioNTech/Pfizer, Moderna, AstraZeneca, J&J, Curevac and Sanofi – von der Leyen also launched the EU Health Emergency Preparedness and Response Authority (HERA) to improve European bio-defense preparedness. 

HERA will work with the pharmaceutical industry to fund the design and development of vaccines targeting COVID-19 variants and to scale up manufacturing in the short and medium term. 

“The pandemic highlighted that manufacturing capacities are a limiting factor. It is essential to address these challenges,” said a European Commission press release published on Sunday. 

Experts Warn United States to Prepare for Spread of COVID-19 Variant 

Meanwhile, experts are warning the US to prioritize administering single doses of COVID-19 vaccines to as many people as possible before the highly transmissible B.1.1.7 variant, first detected in the UK, becomes the dominant strain in the US.

In mid-January, the US Centers for Disease Control and Prevention (CDC) predicted that the B.1.1.7 variant would become the predominant variant in the US by March. Between 13 and 31 January, the variant spread from 12 states to 32.

Increased SARS-CoV-2 infection, caused by the more contagion variant, “might threaten strained health care resources, require extended and more rigorous implementation of public health strategies, and increase the percentage of population immunity required for pandemic control,” stated the CDC report. 

“The surge that is likely to occur with this new variant from England is going to happen in the next six to 14 weeks,” said Michael Osterholm, top US epidemiology and advisor on COVID-19 to President Joe Biden’s transition team, in an interview with NBC on Sunday. “If we see that happen…we are going to see something like we have not seen yet in this country.” 

Two weeks ago, the CDC quietly updated its guidance for immunizations to extend the interval between the first and second doses up to six weeks in “exceptional situations.” This would potentially allow for the kind of change in vaccinations recommended by some experts.

“We still want to get two doses in everyone, but I think right now in advance of this surge, we need to get as many one doses in as many people over 65 as we possibly can to reduce the serious illnesses and deaths that are going to occur over the weeks ahead,” said Osterholm.

Image Credits: Twitter.

The WHO and FIFA have been working together to address the pandemic.

The 2020 FIFA Club World Cup, which kicks off in Qatar on Thursday, will also launch a major COVID-19 media campaign focusing on fair global access to vaccines as well as preventive measures such as mask-wearing – thanks to a new partnership between the World Health Organization and football’s global body, FIFA, which was announced on Monday.

“Football is calling on the international community to act together to ensure that a level playing field exists in relation to access to vaccines, treatments and diagnostic tests all over the globe,” said FIFA president, Gianni Infantino, at a media briefing from the WHO’s Geneva headquarters, announcing the initiative.

Meanwhile Dr Tedros’s special advisor, Dr Bruce Aylward, confirmed that COVAX, the WHO co-sponsored vaccine facility, had sent letters to all 190 member countries yesterday notifying them of the “indicative allocations” of vaccines that they could expect. COVAX aims to distribute at least 2.3 million vaccines this year to countries around the world – but critics have said this falls far short of the needs in low- and middle-income countries that cannot compete with rich countries in the purchase and distribution of often pricey COVID-19 vaccines.

At the World Cup club event, television and in-stadium announcements by star footballers, will promote COVAX and other projects of the WHO co-sponsored ACT Accelerator initiative, which aims to get equitable access to vaccines, tests and treatments the world over. The public service announcements will also urge people to wear masks, practice physical distancing and hand hygiene.

Joining Monday’s WHO briefing, legendary footballer Michael Owen said he was delighted that FIFA has returned to competitive football and could use the Club World Cup “to remind a global TV audience of the importance of adhering to vital public health measures.”

“Over and above that, it is important that Dr Tedros and Gianni remind the powers-that-be that there needs to be equity and fairness in access to vaccines. This has been a global pandemic and we need global to get access to vaccination,” said Owen. 

Fairness is the Foundation of Football – It Must Be The Same For Health

“Fairness is the foundation of football and all other sports, and this also must be the same when it comes to health,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the briefing.  

“The rules of the COVID-19 challenge are simple: all people at risk from the coronavirus in all countries must have equitable access to life-saving vaccines, treatments and diagnostics. In just nine months, the world has established these three powerful lines of defense against COVID-19. But our goal now is to ensure equitable access and continued refinement of these tools,” Dr Tedros said. 

Infantino added that the World Cup, planned for 21 November 2022, is planned as an in-person event  “and we will have full stadiums, we must have this pandemic defeated by then.”

FIFA President Gianni Infantino at the WHO press briefing on Monday.

WHO’s Technical Lead on COVID-19, Dr Maria Van Kerkhove, who described herself as “the least sporty person” on the WHO team, thanked FIFA: “One of the things we’re learning is the importance of good role models. It’s very, very hard to keep up all of the hand hygiene and the mask-wearing. But if we have sports players and leaders all over the world to show us that it’s cool to do, it helps, and we can use all the help we can get.”

COVAX Has Sent Vaccine ‘Indicative Allocation’ Letters to Member Countries 

COVAX, the best known arm of the Act Accelerator, aims to distribute over 2.3 million vaccines in 2021. But it and other arms of the ACT-Accelerator initiative remain about US$26 billion short of funds, officials say.

However, with sufficient vaccine commitments under its belt for now, COVAX, co-sponsored by Gavi, The Vaccine Alliance, and UNICEF, aims to start distributing vaccines within the next few weeks – beginning with a 40 million-dose supply procured at-cost from Pfizer, as well as doses of a more affordable and temperature stable vaccine developed by AstraZeneca and Oxford University and being manufactured by India’s Serum Institute. WHO has already approved the rollout of the Pfizer vaccine, and it is in the final stages of reviewing AstraZeneca’s product – which has already been approved by regulatory authorities in the United Kingdom, the EU, India and elsewhere. 

Aylward confirmed that the global vaccine access platform, COVAX, had sent letters to all 190 member countries yesterday notifying them of the “indicative allocations” of vaccines that they could expect. He said that these allocations would be published on the COVAX Supply Forecast in the next few days. 

DG Tedros has said that the Organization wants to get initial vaccine doses to every country in the world – for administration to health workers and others most at risk – within the first 120 days of this year – e.g. end of April.  

WHO’s Mariângela Simão, Assistant Director-General for Drug Access, added that factors influencing the actual timing of the allocations included whether vaccines had been approved for emergency use and “the actual projection of how many doses will be available in February and March from the manufacturers because there have been some glitches in the manufacturing of the different vaccines and there may be less volume to be located.”

AstraZeneca has experienced significant manufacturing problems, which has particularly slowed its supply of vaccines to Europe, much to the fury of the European Union. 

WHO Launches Health Information Systems Scorecard 

In another development, WHO also launched a global scorecard today, a technical package of essential interventions, recommended actions, tools and resources to support countries in addressing challenges and meeting health information system needs. 

The initiative is supported by Bloomberg Philanthropies. 

“Strengthening health information systems is an important part of WHO’s work for detecting and responding rapidly to alerts and outbreaks, as well as many other health threats,” said Dr Tedros.

Dr Tedros Adhanom Ghebreyesus, Director General of WHO.

“Today, WHO launched the score global report on health data systems on capacity, which provides a snapshot of the state of health information systems around the world. This is the first report of its kind, covering 163 country health information systems and about 87% of the world’s population,” he added.

According to the scorecard, 4 in 10 deaths globally remain unregistered, which Dr Tedros said highlights the “urgent need for investments to strengthen health information systems in all countries to support the COVID-19 response and recovery and progress towards universal health coverage and the Sustainable Development Goals.”

Image Credits: WHO/C.Black, WHO.

The WHO visiting Wuhan’s Huanan seafood market on January 31, 2021, as part of their investigations into the origins of COVID-19.

As the World Health Organization (WHO) led expert team on the origins of the SARS-CoV-2 virus began to conduct fieldwork at hospitals, research centers and markets in Wuhan, China, the WHO attempted to curb expectations, insisting that the mission will likely raise more questions. 

“The plans and the visits that they have, provide detailed information…The more detail you have on the ground, the more questions you have,” said Dr Maria Van Kerkhove, WHO COVID-19 Technical Lead, at the body’s press conference on Monday. 

While the origin study may lead to a greater understanding about which hypotheses hold more weight, several experts have highlighted that previous investigations into the origins of outbreaks have taken years before being able to make any pronouncements. As a result, it is highly unlikely that the team will discover the exact origins after one mission. 

Additionally, after well over a year since the detection of SARS-CoV-2, a significant proportion of physical evidence will be gone, adding to the challenge of finding firm answers or conclusions. 

“We’re keeping completely open minded on all possible hypotheses,” said Dr Peter Daszak, a British zoologist and member of the team. “Where does the evidence seem to be pointing? Was the Huanan seafood market truly the origin of COVID? What was the first case ever at that market? Or is there evidence that it was circulating for longer? Is there evidence that animals were involved?

“These sorts of things we will be able to answer – as well as hopefully, more on the lab hypothesis too, depending on where the evidence takes us. So basically, I think that’s where we should expect to get to.”

International Team Commence Fieldwork on Origin Investigation

The 13-person team spent two weeks communicating and coordinating with their Chinese counterparts virtually while in quarantine in the country before commencing the fieldwork component of their fact-finding mission into the origins of the virus that caused the COVID-19 pandemic. 

Yesterday, the WHO-led team visited Huanan market, the seafood market linked to the initial clusters of SARS-CoV2 cases. The market was shut down at the beginning of last year and access has been restricted to the site ever since its closure. 

Wuhan’s Huanan seafood market that has been closed since early 2020 after a cluster of COVID-19 cases were detected.

Heavy security presence surrounded the market during the hour-long site visit and journalists were kept at a distance from the team. 

“Very important site visits today – a wholesale market first & Huanan Seafood Market just now. Very informative & critical for our joint teams to understand the epidemiology of COVID as it started to spread at the end of 2019,” wrote Dr Daszak on Twitter. 

The full itinerary for the team’s fieldwork has not yet been released, but they will reportedly conclude their visit in mid-February. The Chinese authorities have been responsible for organizing access to sites and conversations with experts, as well as restricting contact with the broader community. 

“The team will go out but they will be bussed to wherever, so they won’t have any contact with the community. They will only have contact with various individuals that are being organized as part of the study,” said Margaret Harris, WHO spokesperson, at a press briefing on Friday. 

However, according to Dr Daszak’s interview with the Telegraph, the team has gained “access to all the places we want to visit” and discussions have not been censored or “vetted.”

“It is important to remember that the success of this mission and origin-tracing is 100% depending on access to the relevant sources. No matter how competent we are, how hard we work and how many stones we try to turn, this can only be possible with the support from China,” said Professor Thea Fischer, a virologist and Danish team member, in an interview with Reuters on Thursday. 

On Friday, the team visited the Hubei Provincial Hospital of Integrated Chinese and Western Medicine, where some of the first COVID-19 patients were treated over a year ago, and spoke with healthcare professionals who were involved in the initial response in Wuhan. 

The director of the hospital’s department of respiratory and critical care, Dr Zhang Jixian, is considered by state media to be the first doctor to detect and alert the health system to the novel SARS-CoV-2.

Dr Dasnak described the visit on Twitter as: “Extremely important 1st site visit. We are in the hospital that treated some of the first known cases of COVID-19, meeting with the actual clinicians & staff who did this work, having open discussion about the details of their work.” 

The following day, the team toured an exhibition on Wuhan’s battle with COVID-19 and its 76-day lockdown, celebrating China’s response to the outbreak. 

Later, they visited the Jinyintan Hospital where samples had been collected from patients infected with a mysterious pneumonia in late 2019. Discussions with the researchers and staff revealed “stories quite similar to what I have heard from our ICU doctors,” said Dr Marion Koopmans, a Dutch virologist and team member, on Twitter. 

Most recently, the team spent four and a half hours, the longest site visit so far, at the provincial Centre for Disease Control and Prevention (CDC) located in Hubei, where the COVID-19 outbreak was detected in December 2019. 

WHO Calls for International Community to Allow Origin Mission to Continue Unhindered

The Chinese Foreign Ministry Spokesperson, Zhao Lijian, conveyed on multiple occasions in press briefings last week that the WHO mission must be science-based and attempts to politicize their activities or the data gathered should be avoided. 

“Origin-tracing is an ongoing process that may involve many countries and places where the epidemic broke out. Origin-tracing is a complex scientific matter that requires international research and cooperation by scientists across the globe,” said Zhao Lijian. 

Zhao Lijian, China’s Foreign Ministry Spokesperson, at a press conference on January 29.

“The WHO experts’ fieldwork itinerary and plan for exchanges are crucial to serious, prudent scientific studies…I’d like to stress that the exchanges and cooperation on origin-tracing between WHO experts and Chinese professionals are part of a global study, not an investigation,” he added. 

Despite China’s message of collaboration with WHO in an “open, transparent and responsible spirit,” US officials have continued to call the nation out for a lack of transparency.

“Even today, China is falling far short of the mark [in being open about COVID-19],” said new US Secretary of State Antony Blinken in an interview with NBC on Monday. 

“We hope the US side will work with China, take on a responsible attitude and respect facts, science and the diligent work of WHO experts, so that they can conduct research on origin-tracing free from any political disturbance,” said Zhao Lijian, in response to the comments from the US. 

Amid the politicized debate between the US and China, WHO officials have called out countries and individuals for claiming that they won’t accept the report resulting from the WHO mission in Wuhan before it has even been written. 

“I think we need to recognize that at the moment, the international community, not WHO, but the international community, under the World Health Assembly of 194 countries, has a team in the field…It deserves the support of the international community and it deserves to be able to finish its work,” said Ryan. 

Image Credits: South China Morning Post, Deutsche Welle, Ministry of Foreign Affairs of the People's Republic of China.