The development of Johnson & Johnson’s adenovirus COVID-19 vaccine candidate.

Johnson & Johnson is set to release its Phase 3 COVID-19 clinical trial results in two weeks and immediately file for emergency authorization from the US Food and Drug Administration (FDA) – an announcement that is likely a harbinger of positive results. 

This news on the development of the first one-shot COVID-19 vaccine, accompanied by the interim results of the Phase 1/2 trial, comes as countries globally face increasing infection rates and troubled vaccination programmes. 

In comparison with the existing two dose vaccines, the one-shot option could offer significant advantages for the speed of full immunisation, logistics and storage – as the Johnson & Johnson vaccine can be stored in a refrigerator for months instead of requiring cold chain storage – if the data shows a high level of effectiveness.

The interim Phase 1/2 data, published in the New England Journal of Medicine on Wednesday, revealed that a single dose of the vaccine elicited a strong immune response, with neutralizing antibodies detected in over 90% of trial participants, regardless of their age group. The elicited immune responses were stable, lasting at least two and a half months in participants aged 18 to 55 years. 

Despite the positive reports of the potential upcoming release of a single dose vaccine – described as a “game changer” by Moncef Slaoui, Operation Warp Speed Chief Scientific Adviser – the company is experiencing delays in manufacturing and is estimated to be two months behind schedule. 

Slaoui announced at a press conference on Tuesday that analysis of trial data and the emergency use authorization submission to the FDA will take place before the end of the month. 

Moncef Slaoui, head of Operation Warp Speed, at a press conference on Tuesday.

“We project to have a single digit million number of doses available in the second half of February. We’re trying to make that number get as close to a double digit number as possible. Then a larger number in March and a much larger number in April,” he added.

If the vaccine is authorised for emergency use by the US FDA, approximately three million doses could be delivered by the end of February, instead of the planned 12 million. The 100 million doses pledged to the US through Operation Warp Speed could be pushed back several months into Spring.

US to Release COVID Vaccines Set Aside for Second Doses

Meanwhile, the Trump Administration has decided to release all available doses of COVID-19 vaccines, instead of reserving half to ensure access to second doses. The move took place on the same day that a new record for the most COVID-19 deaths in one day was hit.

Map of incidence rate of COVID-19 globally, at 9pm EST, 13 January 2021.

On Tuesday evening, the US recorded 4,327 deaths. Hours earlier at a press conference, Alex M. Azar II, the Department of Health and Human Services Secretary, announced the expansion of vaccine eligibility to all individuals over 65 years of age, along with the broadening of locations to administer vaccines. 

The release of the second doses does not imply that the schedule of vaccination will change or that the second dose will be delayed, as in the UK. 

“Our approach continues to ensure that there will be a second dose available for someone who gets a first dose of vaccine,” said Azar. “Based on the science and evidence we have, it is imperative that people receive their second doses on time – that’s what the science says, and ignoring that would be reckless.” 

According to the federal government, the US has averaged around 700,000 vaccinations daily in the past week and has reached a total of 9 million administered vaccinations. 95% of long-term care facilities will have access to COVID-19 vaccines by the end of next week.

The policy shift has been made “as supply expands to meet demand,” said Azar. The guidelines for states have now changed from recommending adherence to the phases put forth by the US Centers for Disease Control (CDC) to advising states to open inoculations to individuals age 65 and over and all people under 65 with a co-morbidity. 

Alex Azar, Secretary of Health and Human Services, at a press conference on Tuesday.

“This next phase reflects the urgency of the situation we face. Every vaccine dose that is sitting in a warehouse rather than going into an arm could mean one more life lost or one more hospital bed occupied,” said Azar. 

The new guidance was criticised by some experts for its potential to disrupt existing timelines, undermine the prioritisation of essential workers, healthcare professionals, and vulnerable populations, and create more confusion in the vaccination program. 

“A lot of our members are feeling like this is just beginning to move too fast,” said Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials. “What we’re going to get to is a first-come, first-serve approach to vaccine distribution, and that’s just not going to be equitable.” 

Over 50 million people are now cleared to receive a vaccine, which has intensified pressure on states to register and schedule appointments for inoculation.

“This is creating a lot of confusion and chaos and anxiety days before a new administration comes in,” said Claire Hannan, executive director of the Association of Immunization Managers, in an interview with NPR. 

It is currently unclear if this new vaccination policy will continue under Joseph Biden Jr.’s new administration, which will begin on 20 January. Biden’s transition team announced last week their plan to release the available supply of vaccines, however, further details on his vaccination plan are expected this week. 

Fauci Expresses Support for the US to Join WHO’s C-TAP

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) and a leading immunologist in the US, conveyed his strong support for the US to join the WHO’s COVID-19 Technology Access Pool (C-TAP).

C-TAP is the WHO co-sponsored pool for sharing COVID vaccine patents and technologies – but so far it has barely gotten off the ground since few countries and no pharma companies have joined.  

“That’s an easy answer: yes, yes, yes,” said Fauci when asked about his support for the program at an event organised by Partners in Health. “I fully believe that whether it’s HIV/AIDS or whether it’s COVID, we are part of the global community, we are a rich country, we have to participate in [this] kind of solidarity…and join forces with the rest of the nations to make sure that billions and billions of doses are manufactured so that the poorest countries can get the same sort of access to vaccines as we do in Washington and in New York City.”

Sharing the data, knowledge, know-how, and biologic materials that are instrumental for manufacturing COVID-19 vaccines and therapeutics would enable manufacturers in low- and middle-income countries to produce COVID-19 technologies and assist with issues of vaccine shortages and the inequitable distribution of vaccines.  

Image Credits: Johnson & Johnson, Johnson & Johnson, C-Span, John Hopkins.

Waiting after the jab at Tel Aviv’s mobile vaccine station operating in a large city partk to ensure no adverse reactions. Strict criteria but no coddling.

JERUSALEM – Racing ahead in a relentless vaccine campaign that has made it a global leader, Israel has now administered an initial COVID-19 jab to nearly 2 million people – about 20% of its population, including 70% of people over the age of 60.

And it is set to have some 5.2 million people completely vaccinated by mid- or late-March – after obtaining a commitment from Pfizer to rush millions more doses of its vaccine to the country this month – in exchange for fresh data on vaccine safety and efficacy from a country that is becoming the world’s largest live vaccine laboratory. 

Israel sets out a timeline to immunize 5.2 million people – more than 60% of its population, by late March – with intensive media coverage.

While smaller in size than Los Angeles County, Israel’s population is ethnically highly diverse and has long been a popular place for medical research. Its largest communities of Middle Eastern Jews and Palestinian Arabs hail from the immediate region. But there are also huge populations of recent or distant immigrants from Europe and the Americas, as well as Asia and Africa. So researchers and policymakers elsewhere are also watching to see if the vaccines can really work their magic – in a place that also has been haunted by one of the highest rates of new SARS-CoV2 infections in the world.

Initial results coming out have good news and bad – suggesting that vaccine efficacy is high just two weeks after the first dose. But the data also suggests that a very high rate of overall immunization may be required to halt and reverse infection trends. Until that can happen, the reopening of schools and cultural activities will be cautious and staged, authorities warn. Continued adherence to social distancing guidance along with other restrictions on social gatherings, travel and economies may still remain sad facts of life for some time to come. 

And along with that, equity issues are in stark display here. Most of Israel’s 5 million Palestinian neighbors have had almost no access to the COVID vaccines. The exceptions have been the Palestinian residents of Israeli-controlled East Jerusalem who hold official Israeli residency and thus also belong to Israeli health funds. 

As a first-world country mixing daily with lower-income Palestinians, who live in a patchwork of West Bank areas controlled to varying degrees by the Israel military and the Palestinian Authority, as well as in Hamas-controlled Gaza, Israel may also have to learn the hard way that as per the maxim of WHO Director General Dr Tedros Adhanom Ghebreyesus: “no one is safe until everyone is safe.”

60% Reduction in Infections 13 Days After First Pfizer Dose – As Real World Results Begin To Emerge  

Looking forward, Israel appears set to maintain very high pace of vaccinations – administering between 100,000 and 200,000 doses daily – after clinching a deal with Pfizer for the expedited delivery of millions more doses from now through March.  While that deal was ostensibly secured in exchange for an agreement on data-sharing, in fact, Israeli researchers are already beginning to crunch the numbers on the vaccine campaign independently. And initial findings reflect both hope and challenges that lay ahead. 

On the hopeful side – a review of disease incidence among the first 460,000 Israelis over the age of 60 to receive the first dose of the Pfizer vaccine showed that infection rates among those getting the jab had dropped by 60% 13 days after receipt of the first dose. 

That research, conducted by the Maccabee Health Fund’s KSM Research Center, suggests that there is a strong protective quality even to the first vaccine – among older, and higher-risk groups. Another broader Israeli Ministry of Health analysis of data from all four national health funds that are managing the large-scale vaccine campaign yielded similar results – a decline of some 50% in SARS-CoV2 infections, two weeks after the first dose was received.  

One initial study of over 460,000 Israelis by researchers at Maccabee Health Fund showed a 60% decline in reported COVID infections, 13 days after receiving a first vaccine dose.

At the same time, Israel is still seeing record rates of new infections daily – with over 9,600 newly reported cases on Wednesday. And among the most serious 1,000 COVID cases in intensive care, some 180 are people who had already received one vaccine dose, according to Israel’s Health Ministry. This reflects the fact that one dose on it’s own cannot guarantee protection from serious COVID disease – particularly if you were exposed to the SARS-CoV2 virus before you were immunized or shortly thereafter. 

“In the competition between the vaccines and the disease, the disease is still winning,” observed former Israeli Director General Moshe Bar Siman-Tov, speaking on Israeli television Tuesday evening. He said he had been ‘optimistic’ about the vigour of the vaccine drive, but was more cautious now. 

“On the one hand, the Health Funds, which have been around for about 100 years, are performing extremely well – you reserve an appointment, you come and get the vaccine. On the other hand, we have the rising rate of infections among young people and children, who were not supposed to be vaccinated at all.”  

Israel’s ‘Secret’ Formula  – Universal Health Coverage Simply  
Media hype has accompanied the vaccines of politicians and celebrities – in this case a well-known TV reporter, Moshe Nussbaum who had a blood analysis on camera to examine levels of SARS-CoV2 antibodies between the first and second dose – in his case still low.

If anything, Israel’s success in the vaccine rollout is based on key principles of Universal Health Coverage (UHC), anchored in community-based, primary health care systems, which the World Health Organization has been preaching about for years and aspires to extend to most countries by 2030. A sophisticated management of medical records and data has also been key – along with a ready available pharma capacity to support cold chain management. More specifically: 

  • Public health funds are leading the drive. Every Israeli resident must belong to one of four public health funds. While these funds are heavily subsidized – people also get to choose which fund to join – and a small monthly membership fee is deducted from the paychecks of people who are employed. 
  • While highly centralized – the four health funds are also deeply rooted in communities with primary health care branches. Every community has at least one clinic. Large towns and cities having multiple branches of all of the funds. The community-based system has enabled the creation of multiple vaccine distribution points – which are local enough to be accessible. 
  • Central management has enabled huge efficiencies of scale. In larger cities, health funds and some hospitals have also set up vaccine stations in gyms, arenas, hospitals and public parks – ensuring ample space to receive and vaccinate large numbers of people everyday.  
  • Digitalization of all Israeli medical records means that people can sign up to be vaccinated online, and their ID will immediately show if they are eligible (in terms of age), allowing them to book a slot. There is no need for a consultation – although people can of course turn to their health care providers first before they are vaccinated – most make a decision on their own to roll up their sleeves. 
  • Quick-turn around is prioritized over personalized services – at vaccine delivery points, people simply read and sign an information form about potential allergic conditions before the jab – and then wait in a large room for 30 minutes after the vaccine to ensure there are no adverse reaction afterwards. 
  • Supply chain and distribution logistics support from a large and experienced pharma firm – in this case Teva Pharmaceuticals – Israel’s generics pharma manufacturer. The support has helped ensure the superfreeze conditions required by the Pfizer vaccine to point of delivery. The involvement underlines a broader point on the importance of fostering domestic pharma industries to maintain healthy product supply chains. This is an issue that is gaining more recognition as a global health issue, and which WHO member states plan to discuss in more detail at next week’s bi-annual meeting of the WHO Executive Board, the organization’s key governing body. 
Vaccine Eligbility – Strict Criteria with Some Flexibility 
Just-vaccinated – Client walks out of a Maccabee Health Fund’s night station in Jerusalem after getting her first dose. Stations are operating 12 hours a day.

In terms of the thorny question of vaccine eligibility – strict criteria have been established – beginning with vaccinations for people aged 60+ and health care workers. But flexibility is proving to be an advantage – both in terms of efficiencies and vaccine acceptance.

For instance, Israelis who don’t meet the age limit have still been able to get vaccinated simply by hanging out at the vaccine stations at the end of the 12-hour day. The spontaneous vaccination of drop-ins when there are lulls or cancellations have helped boost vaccine acceptance in Israeli ultra-orthodox and Israeli Arab communities, where vaccine turnout was initially low – but a stream of younger vaccine wannabes have helped inspire turnout among older people in the same community. 

Along with older people, health workers and chronically ill people, Israeli teachers are now being prioritized in an effort to get children back to school as quickly as possible. As the immunization drive for teachers began, however, the vaccine age limit for others eligible was also dropped to 50.

“This makes good use of the vaccines available,” said the head of one Israeli health fund, Meuchedet (United). “Teachers are a limited group and they will come in spurts, so we don’t want to be wasting time or doses meanwhile.”  

Other countries are now looking at the Israeli model. In the United States, decisions by some states to begin expanding the eligibility criteria for vaccination were taken after informal consultations with Israel’s Minister of Health Yuli Edelstein about what that might mean. Edelstein has been sharing insights and advice with his European counterparts, where vaccine campaigns got off to a much slower start. 

Israelis are also watching Europe and pondering why the pace there has been slower – in health systems that are widely admired as a kind of global gold standard.

Explained Gabi Barbash, a former Ministry of Health director general as well as hospital director, and now a popular TV commentator on the virus and vaccine rollout: “More of Europe’s systems are based around private doctors’ offices – these aren’t as well equipped to receive and handle the vaccines,” explaining that such fragmentation also makes rollout more challenging. 

In addition, each Israeli health fund maintains a centralized medical data registry on every patient that is enrolled. That makes it comparatively easier to register people for vaccines, harder for people that don’t qualify to cut the line – and it also facilitates rapid assessment of vaccine results and trends in real-time.  

Some factors are clearly beyond the control of any government, however – including geography and weather. Israel is tiny and its population is small – particularly in comparison to the vast spaces and populations of Europe and the Americas where campaigns are advancing much more slowly. Most of the northern hemisphere (where most of the vaccine rollouts are taking place in the world’s richest countries) is also wrapped in winter. That has included snowstorms seen in places like Spain. In comparison, weather in the eastern Mediterranean region has been particularly dry and mild; some of Israel’s vaccine stations have even been set up outdoors in under huge tents.   

Success is Not Guaranteed  – Virus Variants & Geopolitics 
New Covid cases per million people; the United States still leads the way, but United Kingdom, much of Europe and Israel are not far behind.

But even this massive vaccine drive, and gratifying public response, is still no guarantor of success. And this, experts say, illustrates how vaccines alone are not going to be a panacea for the COVID-19 pandemic.  

Nearly a week after declaring a strict lockdown, Israel was still seeing rising levels of new COVID-19 cases – reaching record highs.    

With new virus variants that were first identified in Great Britain and South Africa now surfacing here, as they have in Europe, Africa, Asia and the Americas, the country is also set to become a test case of whether the vaccine can hold against a wide range of new SARS-CoV2 mutations. Of particular concern are the mutations from the virus that may change the protein structures of the characteristic coronavirus ‘spike’ that could allow the virus to elude the vaccine. Those variants are now being closely monitored to see how widespread they become in the general population – and the extent to which they do or do not infect people who have been vaccinated.   

But one thing is becoming clear, and that is vaccinating older people may no longer be enough – thanks to the emergence of new and more infectious variants – that also infect younger people more widely. 

With the new mutations in play, vaccine rates would need to approach 80% or 90% to reach herd immunity, rather than the 70% of previous estimates, some researchers in Israel as well as in the United States are saying. 

“I was more optimistic, now I am a little more concerned,” said Bar Siman-Tov in his TV interview, who says that he is seeing “more symptomatic infections among younger people and children.”  

To halt the spread of those mutations, Israel may need to vaccinate almost everyone right down to the age of 16, the minimum allowed for the vaccine, said Eran Nir-Paz, a professor of infectious diseases at Jerusalem’s Hadassah Medical Center, in an interview on Tuesday with Israel public radio.   

“We will want to immunize 80% of the population to stop mutations and illness in younger groups – and if we don’t immunize the younger groups, the virus will eventually rebound on older people again,” he warned.  

Palestinians  – No Vaccine Access Yet 
Palestinian Authority Health Minister Mai al-Kaila (WAFA)

In addition, even if 80% of Israelis are immunized, their next door neighbors, Palestinians in the occupied West Bank and Hamas-controlled Gaza, have not yet even begun to vaccinate – with questions still circling around how and when the Palestinian Authority (PA) will access vaccine supplies.   

On Monday, PA Health Minister Mai al-Kaila announced that the PA had authorized use of the Russian Sputnik vaccine produced by the Gamalaya Institute, along with that of the UK-approved Oxford University/AstraZeneca vaccine. All in all, she said that deals with three pharma firms to cover some 70% of Palestinians with vaccines had been signed.  

But she also threw cold water on reports that vaccines being procured by the PA from AstraZeneca – which is among the three COVID vaccines recently approved by the British regulatory authority – could arrive as early as 15 February. 

“There is not yet a definite deadline for the arrival of the coronavirus vaccine, although it is probable that they will arrive in the first quarter of this year,” al-Kaila said in a press relesase, 

Israeli and Palestinian human rights groups have meanwhile asserted that Israel has a legal obligation to ensure Palestinian vaccine access – under the Geneva Conventions that call for an occupying power to ensure the health and well-being of people living in occupied territories. 

However, Israel has claimed that the 1995 Oslo II Accord delegates the Palestinian Authority with responsibility for health care – even if Israel’s military controls large swathes of the West Bank.

The PA, keen to project its image as a national authority, has also not formally requested Israeli support. In fact, up until the pandemic, the PA had always imported its own vaccines for routine childhood immunizations – often via large procurement deals with UNICEF and other global health bodies.  

However, the Oslo treaty also obligates the two sides to “cooperate” in fighting epidemics – and that’s what many people say is now needed in the vaccine drive.

Israel says it has indeed cooperated in providing PPE and training to the PA. But mass vaccinations would require a whole new level of coordination – which also opens up thorny issues of Palestinian access to health services more generally.

Palestinian Access to Health Services a Longstanding Issue 

Current Israeli limitations on Palestinian movement around the West Bank – as well as into East Jerusalem, where more specialized Palestinian health services are located – have long been a barrier. Even more problematic is access in and out of the Hamas-controlled Gaza, under a longstanding Israeli military blockade, which Israel in turn says is needed to reduce the frequency of Hamas missile and military attacks.

“Israel might also be afraid that offering Palestinians vaccines might imply that it is taking a responsibility that would extend to other health services later on,” speculated one leading human rights advocate.  

According to one report, about 100 vaccines have indeed been shipped to the PA for their highest-risk health workers – although that has been denied by both sides. 

In addition to the wider issue, there is also an appeal to Israel’s Supreme Court to get the government to vaccinate some 4,000 Palestinian prisoners who are being held in Israeli jails. Those vaccinations have been mandated by Israel’s attorney general – but the hardline Minister of Internal Security, Amir Ohana, has refused to implement the order.  

Another Supreme Court appeal, by the family of a missing Israeli soldier whose body is reportedly being held by Hamas authorities in Gaza, aims to bar Israel from facilitating Gazans’ access to vaccines at all until the soldier’s body is returned.   

Particularly with regards to Gaza, the appeal illustrates how deeply entangled vaccine access may become in geopolitical issues. 

“A big problem is the optics,” one source told Health Policy Watch, underlining how quickly the issue can become politicized by both sides. “Israel has been so successful with its vaccine programme and the Palestinians are left behind.” 

No One is Safe Until Everyone Is Safe – WHO Attempting to Mediate 
Vaccines per 100,000 people – leading countries

At the same time, some leading Israeli physicians and even some senior Ministry of Health officials have said that medical ethics and equity factors mean that Israel should help ensure and facilitate broad Palestinian vaccine access. 

Boaz Lev, a Ministry of Health official in charge of setting criteria for Israelis to access vaccines, told Health Policy Watch that, “while I don’t represent the government’s position in that respect, if you ask me as a physician, then I think that people should be vaccinated. It’s very important for Israel and for the Palestinians to be vaccinated. Period.” 

“Equitable access to vaccines is an issue everywhere – but here it is something very immediate,” said Gerald Rockenschaub, who heads up the WHO Office in Jerusalem for Occupied Palestinian territory – West Bank and Gaza, in an interview with Health Policy Watch. 

“What we are trying to do is to advocate for Israel to consider to closely collaborate with the Palestinians to facilitate vaccine availability on the Palestinian side, both for pubilc health and equity reasons. We obviously are in close consultations with both regional offices and with headquarters.”

He said that WHO had spoken recently with Israeli official sources about shifting some of the vaccines that Israel is receiving to Palestinian hospitals where front-line health workers are also facing high levels of COVID-19 infections and risks. 

“The initial feedback was that they are looking into it, but it requires some further discussion, also on their side,” Rockenshaub said. 

However, he added that “the discussions were before these new [Pfizer vaccine] supplies became available – we will also need to engage other levels of the Organization to facilitate the dialogue with the Israelis.” 

Image Credits: Israel Television N12 .

Establishing a global Ebola vaccine stockpile will prevent future outbreaks
Establishing a global Ebola vaccine stockpile will prevent future outbreaks

NEW YORK/ GENEVA. The World Health Organization, UNICEF and two leading international health and humanitarian civil society organizations announced on Tuesday the establishment of a global Ebola vaccine stockpile to ensure rapid response to future outbreaks.

Establishment of the stockpile was led by the International Coordinating Group (ICG) on Vaccine Provision, which also includes the International Federation of Red Cross and Red Crescent Societies (IFRC), and Médecins Sans Frontières (MSF).  It has received financial support from Gavi, the Vaccine Alliance. The stockpile will allow countries, with the support of humanitarian organizations, to contain future Ebola epidemics by ensuring timely access to vaccines for populations at risk during outbreaks.

The injectable single-dose Ebola vaccine (rVSV∆G-ZEBOV-GP, live) is manufactured by Merck, Sharp & Dohme (MSD) Corp. and developed with financial support from the US government. The European Medicines Agency licensed the Ebola vaccine in November 2019, and the vaccine is now prequalified by WHO, and licensed by the US Food and Drug Administration as well as in eight African countries.

Before receiving regulatory approval, the vaccine was administered to more than 350,000 people, beginning in Guinea at the end of the 2013-2016 Ebola outbreak in West Africa and then later in the 2018-2020 Ebola outbreak in the Democratic Republic of the Congo under a protocol for “compassionate use”. 

The vaccine, which is recommended by WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization for use in Ebola outbreaks as part of a broader set of outbreak response tools, protects against the Zaire ebolavirus species which is the strain of the virus that has been most commonly implicated in large outbreaks.

Example of Solidarity 
Infectious diseases such as malaria have been made preventable with vaccines
Infectious diseases such as malaria have been made preventable with vaccines

“The COVID-19 pandemic is reminding us of the incredible power of vaccines to save lives from deadly viruses,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a statement that accompanied the announcement of the vaccine stockpile.

“Ebola vaccines have made one of the most feared diseases on earth preventable. This new stockpile is an excellent example of solidarity, science and cooperation between international organizations and the private sector to save lives.”

UNICEF is managing the stockpile on behalf of the ICG which, as with stockpiles of cholera, meningitis and yellow fever vaccines, will be the decision-making body for its allocation and release.

The stockpile is stored in Switzerland and ready to be shipped to countries for emergency response. The decision to allocate the vaccine will be made within 48 hours of receiving a request from a country; vaccines will be made available together with ultra-cold chain packaging by the manufacturer for shipment to countries within 48 hours of the decision. The targeted overall delivery time from the stockpile to countries is seven days.

“We are proud to be part of this unprecedented effort to help bring potential Ebola outbreaks quickly under control,” said Henrietta Fore, UNICEF Executive Director. “We know that when it comes to disease outbreaks, preparedness is key. This Ebola vaccine stockpile is a remarkable achievement – one that will allow us to deliver vaccines to those who need them the most as quickly as possible.”

As Ebola outbreaks are relatively rare and unpredictable, there is no natural market for the vaccine. Vaccines are only secured through the establishment of the stockpile and are available in limited quantities. The Ebola vaccine is reserved for outbreak response to protect people at the highest risk of contracting Ebola – including healthcare and frontline workers.

“This is an important milestone. Over the past decade alone we have seen Ebola devastate communities in West and Central Africa, always hitting the poorest and most vulnerable the hardest,” said IFRC Secretary General, Jagan Chapagain. “Through each outbreak, our volunteers have risked their lives to save lives. With this stockpile, it is my hope that the impact of this terrible disease will be dramatically reduced.”

“The creation of an Ebola vaccine stockpile under the ICG is a positive step”, said Dr Natalie Roberts, Programme Manager, MSF Foundation. “Vaccination is one of the most effective measures to respond to outbreaks of vaccine preventable diseases, and Ebola is no exception. An Ebola vaccine stockpile can increase transparency in the management of existing global stocks and the timely deployment of the vaccine where it’s most needed, something MSF has called for during recent outbreaks in the Democratic Republic of Congo.”

An initial 6,890 doses are now available for outbreak response with further quantities to be delivered into the stockpile this month and throughout 2021 and beyond. Depending on the rate of vaccine deployment, it could take 2 to 3 years to reach the SAGE-recommended level of 500,000 doses for the emergency stockpile of Ebola vaccines. WHO, UNICEF, Gavi and vaccine manufacturers are continuously assessing options to increase vaccine supply should global demand increase.

Image Credits: Trocaire/Flickr, Asian Development Bank/Flickr.

WHO has “outsourced” its role in vaccine access and sidelined member states by leaving the running of the COVAX vaccine procurement facility to GAVI and CEPI.

The World Health Organization (WHO) has “outsourced” its role in vaccine access and sidelined member states by leaving the running of the COVAX vaccine procurement facility to GAVI, The Vaccine Alliance and CEPI (Coalition for Epidemic Preparedness Initiative), Third World Network’s Sangeeta Shashikant told a civil society forum on Tuesday.

“Disparity in access is the ugly reality of COVID-19 right now. This is getting a lot of attention because you can see some countries are getting vaccines but most of the countries are not,” Shashikant told a meeting of the G2H2 Geneva Global Health Hub, a network of civil society organizations that is convening virtually this week to discuss how to influence discussions at the upcoming WHO’s Executive Board meeting, WHO’s 33-member governing body, next week.

Shashikant proposed that WHO be lobbied to adopt four interventions to ensure that vaccines are developed as a public good, namely:

  • Securing legal commitments from manufacturers that they will reserve a proportion of their supplies for developing countries,
  • Promote vaccine manufacturing in developing countries.
  • Showing strong support for a World Trade Organization “TRIPS waiver” proposal, aimed at suspending aspects of intellectual property rights related to COVID health products during the pandemic,
  • Promoting more transparency, particularly in reporting about the details of COVAX deals with vaccine manufacturers as well as voluntary license agreements between vaccine manufacturers and production companies,

“AstraZeneca has reportedly signed licensing agreements with several manufacturers around the world, including the Serum Institute of India for one billion doses to supply low and middle-income countries. But one billion doses is never sufficient to address the need of developing countries,” Shashikant said.

Researcher and activist Els Torreele

“So why have they only licensed Serum Institute? This is what we refer to as limited and restrictive licensing. In the case of Pfizer and Moderna, there is no licensing.

“For the big pharmaceutical industry, it’s really business as usual, as they limit competition artificially, limiting supply because they are not offering global licences.”

Shashikant added that WHO “has also played a peripheral role in this whole setup of the COVAX facility”, where “decisions have primarily been taken by GAVI and its board and WHO member states are not involved in any kind of decision making”.

“The reality is that the developed countries are all relying on bilateral deals for supply. They say they’re part of COVAX, but they have all pre-booked vaccine supply for themselves outside of COVAX. There have been a lot of different issues of transparency, accountability and even scepticism about whether this facility will deliver.

Researcher and activist Els Torreele asked why, “when the US National Institutes of Health and Oxford University were the actual innovators using public money, we have agreements that transfer all of that work to Moderna and AstraZeneca?”

“How can we create a more participative, inclusive governance scheme where the ownership and the control of the vaccine is distributed among the different actors?”

WHO should Consider Human Rights Factors

On Monday, civil society organisations called for WHO to ensure that human rights considerations are part of any pandemic preparedness and response in the wake of widespread state abuse of citizens during the pandemic.

Cristina Palabay of the Karapatan Alliance in the Philippines reported that over 100,000 people had been imprisoned for “quarantine violations”.

“Many experienced physical violence including torture such as being placed in dog cages, being tied and left in the heat of the sun, hit with police batons, or placed in coffins to supposedly teach them a lesson,” said Palabay.

People in compulsory quarantine in Nepal, Bangladesh, India and Malaysia were kept in poor conditions, with reports of rapes and suicide and food shortages, particularly in Nepal, according to Richa Chinton of Jan Swasthya Abhiyan (People’s Health Movement India).

Workers who violated curfews by a few minutes in India were dealt with harshly, and wages were cut or not paid as trading hours were curtailed, she added.

School closures meant many children didn’t get food and exposed children to abuse, while there has been an increase in gender-based violence.

In Kenya, Christine Ajulu of the Health Rights Advocacy Forum said that mandatory quarantine “appeared to be a punishment”.

“If you’re found roaming out during the curfew hours, you are forced on quarantine. If you are found without a mask, you’re forced to quarantine. .The facilities were not up to standard and we have cases where lack of water was reported inadequate food was reported.”

During lockdowns, Israel has closed its borders with the Palestinian Authority, further restricting travel between the two regions, and around 80% of the workforce was affected, according to Ubai Al-Aboudi from the Bitan Centre for Research and Development in Palestine.

Israel has also refused Palestinians access to the COVID-19 vaccine, including around 4000 Palestinian prisoners being held in Israeli jails.

A group of Israeli and Palestinian human rights organizations have appealed to Israel’s Supreme Court demanding that the Palestinian prisoners, who are living in crowded conditions that put them at high risk of infection, be provided with access to the vaccines now being distributed en masse in Israel – in line with a decision by Israel’s Attorney General.  That is a decision that Israel’s hardline Minister of Public Security, Amir Ohana, has so far refused to carry out.

“With the review of the International Health Regulations (IHR) in the context of COVID-19, WHO has the opportunity to strengthen human rights considerations in pandemic preparedness and response, but we have not seen this matter addressed,” according to the G2H2 hub.

“The Covid-19 response requires more immediate action from WHO. The precedent of ignoring human rights abuses in the name of public health is a dangerous one, that should not be allowed to go unchallenged.”

Image Credits: Flickr – Mecklenburg County, United Nations Photo.

Shoppers gathered in malls in Geneva, Switzerland after restaurants and stores reopened on 6 June. WHO officials said that changing mixing patterns over the summer, into the fall and over the holidays has directly impacted the current spikes around the world.

The “almost vertical” spike in SARS-CoV-2 infections seen in many countries over the last few weeks is largely due to increased social contact and not virus mutations, WHO has said.

Speaking at a media briefing on Monday, Dr Maria Van Kerkhove, WHO’s COVID-19 Technical Lead, stated that sharp increases in transmission had occurred in a number of countries “before these variants were circulating”, adding that this “was due to increased mixing of people”.

Countries currently being overwhelmed with COVID cases include the United Kingdom, the United States, Israel and Ireland.

Yesterday, the latter recorded 1,288 cases per million people, while the UK and US recorded 854 and 751 respectively.

“We changed our mixing patterns over the summer, into the fall and especially around the Christmas and holiday period,” Dr Van Kerkhove added.

“The number of contacts that individuals and their families had increased significantly over the Christmas and New Year holiday. That’s had a direct impact on the exponential growth in many countries.”

She highlighted that, when plotted on a line graph (as below), the rising case rates appear vertical for some countries. “[It’s] not at a slant, it’s almost vertical,” she repeated.

Daily new confirmed COVID-19 cases per million people, as of 12 January 2020. Dr Maria Van Kerkhove highlighted the “almost vertical” increase.
Variants Are Not The Drivers Of Transmission

Mike Ryan, Executive Director of WHO’s Health Emergencies Programme, pointed to Ireland to illustrate exactly how case rates have been impacted by poor adherence to social distancing measures.

On 10 December, Ireland had recorded just 282 new daily cases; that was in comparison  to more than 6,500 new cases on 10 January.

“[Ireland] has suffered one of the most acute disease incidents of any country in the world over the last couple of months, and not due to the variant let me add,” he said,” but mainly due to increased social mixing and reduction of physical distancing.”

Over the past few weeks, authorities in the UK, as well as elsewhere in Europe and  the world have suggested   that the emergence of new mutations, such as those identified in the UK and South Africa in December and in Japan last week, have been the cause of the current spikes being seen in infections.

British  Prime Minister Boris Johnson insisted that its regional-lockdown tier system “[was] working with the old variant but alas this mutation, spreading with frightening speed and ease, has led to more cases than we’ve seen ever before”.

Johnson made this claim on 6 January, as he announced England would be returning to a full lockdown – its third national tightening – until at least March.

Ryan’s warning appears, then, to serve as a reminder that these restrictions are now vital in countries which “lost control” of the virus in the second half of 2020.

“The national reference laboratory [in Ireland is] doing superb surveillance for the new variant strains which they are tracking,” Dr Ryan added. “They have not been the driver of new transmission, but new variants will emerge.”

“Those countries that have managed to bring transmission down: keep it down. Do everything you can to keep it down,” Van kerkhove added.

“If any clusters are identified, really quick, rapid, aggressive investigation of those cases [are needed], so that those small numbers of cases do not become community transmission. We have been shown over and over again that countries can do this.”

Image Credits: S. Lustig Vijay/HP-Watch, Our World in Data.

Center of Excellence for Long-acting Therapeutics launched at the University of Liverpool
Center of Excellence for Long-acting Therapeutics launched at the University of Liverpool

A US$40 million research consortium has been created to repurpose existing medicines for hepatitis, tuberculosis and malaria into long-acting treatments that can benefit low- and middle-income countries (LMICs) where people often have trouble accessing medicine over and over again, Unitaid experts told Health Policy Watch.

The consortium on Tuesday launched the new Centre of Excellence for Long-acting Therapeutics (CELT) at the University of Liverpool, as a first of its kind research center in the world.

Unitaid, a global WHO-hosted partnership of private and public sector actors, is engaged in finding innovative solutions to prevent, diagnose, and treat infectious diseases more quickly, cheaply, and efficiently in LMICs, was the major funder of the cutting-edge Centre and research consortium.

Initially research will focus on developing three long-acting products as part of the Unitaid-funded LONGEVITY project – a single-injection cure for hepatitis C over a treatment period of 12-weeks, and tuberculosis and malaria preventative treatment through one-dose injectables.

“If you can replace [multiple doses] with one single shot injectable that can last for the whole malaria season, you are logistically gaining a lot. [Medicine] will be less costly to distribute, and it is more certain that people will receive treatment because they no longer need to come back [for additional treatment],” said Carmen Perez Casas, Senior Technical Manager at Unitaid, adding that the aim is to cover an individual for an entire malaria season with one injection – making medication cheaper to deliver and easier to use.  

Unitaid-funded CELT is currently working on a malaria injectable that could last a whole malaria season.
Unitaid-funded CELT is currently working on a malaria injectable that could last a whole malaria season.

“We are working to shape the market to ensure that any of the emerging long-acting technologies – whether for HIV, malaria, tuberculosis, are affordable and manufactured in sufficient volumes.” 

Long-acting technology allows the release of medication to be manipulated, with sufficient concentration of the drug to last long periods of time – for months to a year, or even longer. There are various types of long-acting technologies, including implants, oral medicines that dissolve over a period of time, and injectables.

Diverse health fields, from reproductive and mental health have already benefited and continue to benefit from long-acting technology. Patients with schizophrenia and other psychoses who have difficulty accessing therapy and treatment can use long-acting injectables to replace the daily pill. 

“One-fifth of [schizophrenia] patients will have relapses and be admitted into hospitals for emergencies. They can now be stable because of continuous intake,” said Perez Casas. 

Long-Acting Technology: Ease of Access Leads to Increased Uptake of Medicines in LMICs
Long-acting technology eases the complication of difficult and strict dose regimens for oral medication
Long-acting technology eases the complication of difficult and strict dose regimens for oral medication

Perez Casas addressed the complications that exist with traditional oral medications. These medications do not properly tackle chronic diseases or treatments that adhere to a strict dosage regimens. There is also the stigma associated with taking a pill every day, she said. 

Such complications make prevention campaigns difficult to organize in LMICs, given the multiple doses required of certain medicines and the necessary accessibility to healthcare facilities. 

Long-acting technology eases the stigma and increases the uptake and efficacy of the drug, giving it the potential to be applied to other diseases, especially those common in LMICs, by reaching more people with long-acting medications as opposed to oral daily treatments. 

For instance, HIV prevention through pre-exposure prophylaxis (PrEP) typically can only be done through an oral pill, but the efficiency of long-acting PrEP can aid in preventing HIV through increased uptake over a longer period of time. 

Though the research will be conducted primarily at laboratories at the University of Liverpool, there is continual multi-partner collaboration between scientists and global stakeholders, all working with affected communities in mind.

Long-Acting Treatments Are Particularly Suitable To Pandemic Context 

The COVID-19 pandemic has heavily impacted malaria, HIV, and tuberculosis in terms of continuity of treatment through the dependence of health systems and supplies. With CELT, Unitaid is working to urgently address affected treatment and chain of supply issues for those in LMICs impacted by COVID-19. 

Cherise Scott, Technical Manager of Strategy at Unitaid, said: “CELT aims to bring together various parties on the science and global health side. Learnings across various entities are shared, and that’s one way we can get our products to people who need them quickly.” 

Given the current vaccine hesitancy in regards to COVID-19, Unitaid is working with representatives of communities and governments for each stage of project development, as well as community advisory boards to ensure that long acting medicines will be accepted by community members, and will not impose a cost-burden compared to standard treatments.  

Co-director of CELT, Professor Andrew Owen, said: “Long-acting drug delivery promises to transform patient management, with huge potential impact for treatment and prevention of infectious diseases. Benefits for efficacy flow from overcoming issues associated with patients sometimes not taking their medication, which may also help reduce emergence of antimicrobial resistance. CELT harnesses the power of local, national and international collaboration to accelerate understanding of the medicines of the future.”  

Image Credits: Vita Student/Flickr, World Bank/Flickr, AL.Eyad/Flickr.

The Swiss Federal Government has secured 7.5 million doses of the Moderna vaccine with deliveries expected to begin next week.

Switzerland’s drug regulatory agency, Swissmedic, has authorized Moderna’s mRNA COVID-19 vaccine for use – in a move that should helop accelerate its rollout of vaccines against the pandemic,

The Swiss Federal Government has secured 7.5 million doses of the Moderna vaccine, with deliveries expected to begin next week from the Visp-based plant where most of Moderna’s international vaccine stock is being manufactured.

Switzerland’s vaccine drive has so far been slow to get off the ground, hampered by limited access to doses of the Pfizer mRNA vaccine, which was approved by Swissmedic in December,

Critics had bemoaned Switzerland’s slow pace in authorizing Moderna’s comparable product, which was approved by the United States Food and Drug Administration nearly a month ago, and by the European Union last week.

Israel was the first country outside of North America to authorize the Moderna vaccine on 5 January, with the United Kingdom and the granting approval for emergency use separately last week.

Switzerland’s Vaccine Campaign Got Off To A Slow Start – Now It May Speed Up

While Switzerland was in fact the first country in continental Europe to administer a COVID vaccine on 23 December, the motion was largely symbolic. During the Christmas and New Year’s period, only a few more vaccines were administered, with more serious efforts planned for mid-January.

Trailing far behind Israel, the UK, and the United States, Switzerland’s vaccine rollout has also lagged between that of other European Union member states which also began at the end of December, following the European Medical Agency’s approval of the Pfizer vaccine.

Deliveries of the Moderna vaccine to EU countries already began on Monday 11 January, with 160 million doses pre-purchased so far.

“Switzerland has played a critical role in Moderna’s history since our early days,” Stéphane Bancel, Chief Executive Officer of Moderna, said in a statement. “It means a lot to us that we can now provide a highly effective vaccine to help protect the citizens of Switzerland.”

Swiss bankers were among the first to invest in Moderna’s novel mRNA vaccine technology nearly a decade ago, and Bancel hails from the nearby French city of Lyon.

At a J.P. Morgan Healthcare Conference on Monday, company representatives said research so far leads them to estimate that the immunity generated by the vaccine would last for at least a year, and that it felt confident in its ability to develop a vaccine based on the new variants that have emerged in the UK and South Africa. It also confirmed it would examine the vaccine’s response to new strains.

Moderna expects to deliver between 600 million and 1 billion doses of its vaccine globally in 2021, with forecasted sales of $US 11.7 billion, based on advanced purchase agreements.

Speaking  at the JP Morgan conference, Bancel said: “The team feels very comfortable … that we are on track to deliver at least 600 million doses.”

Image Credits: KEYSTONE/Gaetan Bally.

Doctor administering a COVID-19 vaccine in North Carolina, USA.

Governments have spent at least €93 billion on COVID-19 vaccines and therapeutics globally since the beginning of the pandemic, a new study has found.

Research published on Monday by the kENUP Foundation, a European non-profit supporting research-based innovation in health industries, found that in 11 months, the public sector invested heavily in the development of vaccines, with a commitment of 95% – €86.5 billion – of the total spending, while only 5% of the funds were spent on therapeutics. 

Somewhat surprisingly, the majority of the investments made by governments for vaccines was made in Small and Medium Enterprises (SMEs) and corporations with a market value between $2 billion and $10 billion. Only 18% of public COVID-19 funds went to large pharmaceutical manufacturers. 

“Public investments have been instrumental in supporting innovation in the fight against the coronavirus,” said Holm Keller, Chairman of kENUP Foundation. This is particularly the case for SMEs, which have played a large role in driving innovation. 

The new Advance Market Commitment (AMC) mechanism – a legally binding agreement for an amount of funds to subsidize the purchase of vaccine doses prior to availability – was widely utilised by states and supported by the COVAX Facility to speed up the availability of vaccines, especially for low- and middle-income countries. 

93% of funding – €86.5 billion – was committed through AMCs and was carried out through various national, multilateral, and global efforts to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, such as through Operation Warp Speed in the US, the European Commission, and the COVAX Facility. 

The majority of the public funds directed towards vaccine developers originated from high-income countries, with 32% invested by the US, 24% by the EU, and 13% from Japan and South Korea. 

While the investment in COVID-19 vaccines has resulted in unprecedented progress, with over 40 countries vaccinating their populations using five different vaccines a year after the first recorded case of SARS-CoV2, the rollout of vaccines in low- and middle-income countries has not yet begun and the global achievement of herd immunity is still a fairly distant goal. 

The total number of COVID-19 vaccination doses administered per 100 people as of 11 January.

“To bridge the time until broad rollout of vaccines, further investment in therapeutics is especially important,” said Keller. “In parallel, a dedicated public pandemic preparedness scheme that would make vaccines and therapeutics readily available at lower development costs for any kind of pandemic pathogen is needed.”

The conclusion raised by Keller and the kENUP Foundation is supported by several experts. “So important to keep the pipeline of new potential therapeutics against COVID19 flowing,” said Connor Bamford, researcher at the Centre for Experimental Medicine at the Queen’s University Belfast. “With medicines, vaccines and public health measures, we will be able to conquer COVID and prevent the major impacts of ‘the next big one.'”

Additionally, in the context of the emergence of new SARS-CoV2 variants, high rates of infection, and limited supplies of vaccines, COVID-19 treatments could prove to be an important part of tackling the pandemic. With vaccines currently overshadowing therapeutics and drawing away investment, efforts to develop novel, better treatments are struggling.

“The SARS-CoV2 virus has taken advantage of human susceptibility and simultaneously has evolved to evade protective immunity,” said Sir Stephen Holgate, professor of immunopharmacology at the University of Southampton, in an op-ed in the Independent. “It is absolutely essential that…we prioritise research into helping sick people get better, as well as preventing them from getting ill in the first place.”

Image Credits: Flickr – Mecklenburg County, Our World in Data.

WHO has said that its investigation into the origins of the SARS-CoV-2 pandemic – although starting in Wuhan – is not about assigning blame, but rather is about improving global health.

The World Health Organization (WHO) research investigation in China to study the origin of the SARS-CoV2 virus that triggered a worldwide pandemic of COVID-19 is not intended to apportion blame, Executive Director of WHO’s Health Emergencies Programme Michael Ryan stressed in a press briefing on Monday.

The statement was made hours after WHO Executive Director Dr Tedros Adhanom Ghebreyesus confirmed that the international team of 10 would finally be traveling to China on 14 January.

The build-up to this moment has been defined by months of roadblocks, delaying the team’s formation and then it’s dispatch. Most recently, on 5 January, WHO confirmed that two members of its 10-person mission were turned away at China’s doorstep, after official visa approvals that WHO understood to be finalized were held up at the last minute.

China’s state-controlled news channels have meanwhile also been spinning claims that human infections from SARS-CoV2 may not have first originated in the China at all – reflecting the official jitters in Beijing over any research that might clearly pin the virus origins onto China’s map.

But the planned investigation is not a matter of assigning blame, Ryan asserted during Monday’s media briefing. “It is about finding the scientific answers about the very important interface between the animal kingdom and the human kingdom.”

He also stressed that species-jumps to humans from the animal kingdom – like the jump believed to have caused the current pandemic – are “not a new thing,” noting that all influenza pandemics have occurred in similar circumstances.

Dr Michael Ryan, Executive Director of WHO’s Health Emergencies Programme.

“There are a number of aspects that all of us across the world are looking at to really better understand [in] this pandemic,” he said.

“The investigations in China may lead to hypotheses, and may lead to the need to make further inquiries or investigations in other countries. We will go anywhere and everywhere to gather more information around the origins and impact of disease,” added Ryan.

Maria Van Kerkhove, WHO COVID-19 Technical Lead, also confirmed that studies into the virus origins also would take place in Wuhan, something which had previously not been confirmed.

She noted that: “The studies that are commencing in Wuhan – especially looking at those initial patients that were first identified in December – are really, really critical to help us better understand the beginning of this pandemic.”

Meanwhile, Dr Tedros said the global body was “pleased that an international team” of scientists and experts from 10 institutions and countries were travelling to China to engage in and review scientific research on the origins of the virus.

“Studies will begin in Wuhan to identify the potential source of infection of the early cases,” said Dr Tedros. “Scientific evidence will drive hypotheses, which will then be the basis for further long term studies. This is important not just for COVID-19, but for the future of global health security and to manage emerging disease threats with pandemic potential.”

Japan Reports New Variant, as WHO Urges Countries to Genome Sequence

Meanwhile, as yet another new COVID-19 variant was identified in Japan over the weekend, WHO called on all member countries to step up their monitoring of virus mutations. The Organization was also at pains to emphasize that the exponential spread of the virus in many countries was related to the relaxation of social distancing over the holiday period, moreso than than to variants.

“What is most critical is that we sequence the virus effectively, so we know how it’s changing, and how to respond,” said Dr Tedros. “While diagnostics and vaccines still seem to be effective against the current virus, we may need to tweak them in the future.” 

WHO released a comprehensive implementation guide and risk monitoring framework last week to help countries set up high impact sequencing programmes.

“We call on all countries to increase the sequencing of the virus to supplement ongoing surveillance monitoring and testing efforts, and to share that data internationally,” Dr Tedros stressed.

He warned that “the transmissibility” of the virus “appears to be increasing” through its variants, which can “drive a surge of cases and hospitalizations, which is highly problematic for health workers and hospitals already close to breaking point”.

However, Ryan stressed that there “is no evidence that variants are driving any element of severity” but “there is some evidence that variants may be increasing, or adding to transmission, and in some sense, giving them some extra transmissibility to the virus.”

“There were increases in transmission in a number of countries before these variants were circulating, and that was due to increases in the mixing of people. There’s no way around that,” added Dr Maria Van Kerkhove, the WHO’s technical lead on COVID-19. “Variants don’t help in situations where they are now circulating, and now are being identified in other countries, that’s going to make it that much harder, but we have tools in our toolbox that help us be able to break chains of transmission.”

Image Credits: Wikipedia/user: 钉钉.

On 5 January, WHO confirmed that 2 members of its 10 person mission were turned away at China’s doorstep, after official approvals that WHO understood to be finalized were held up at the last minute.

After months of delay, China has confirmed that a WHO research team investigating the origins of the SARS-CoV-2 virus will finally be allowed to enter the country on Thursday, 14 January –  a week after Beijing blocked their entry, leaving two international experts stuck in transit.

Members of the task force will now be able to enter China’s national health authority said on Monday, with Dr Tedros Adhanom Ghebreyesus, WHO Director-General, later confirming this in a tweet.

This is a landmark moment in the ongoing investigation into the origins of the current coronavirus pandemic – setting in motion a mission that was first mandated by the World Health Assembly (WHA) in May 2020.

Since then, however, there have been multiple delays in getting the investigation off of the ground; the ten team members were only named and terms of reference created in the autumn.

In December, when WHO confirmed the organization would be deploying the investigative team to China in January, Wuhan was not specifically mentioned as a place that the team would visit.

Then on 5 January, WHO confirmed that two members of its 10-person mission were turned away at China’s doorstep, after official visa approvals that WHO understood to be finalized were held up at the last minute. China claimed this was a “misunderstanding”.

China Strictly Controlling SARS-CoV-2 Research & Suggesting Alternative Origins Narrative

In the year since the pandemic began, China has strictly controlled domestic research on the sensitive topic of the virus origins, effectively closing off most channels of query or visits by foreign researchers and media. Most recently, that included blocking a BBC crew last month from visiting caves in China’s Yunnan Province, which harbour the species of horshoe bats that carry genetically-similar coronaviruses, where a number of miners also died in 2012 from a mysterious pneumonia-like illness.

China’s state-controlled news channels have meanwhile begun to construct an alternative narrative, claiming that the human infections with SARS-CoV-2 may not have first originated in China at all – even though China is the place where the most genetically comparable strains of coronaviruses have been reported to be circulating in the wild, in bat populations.

Even now, it remains unclear if the investigative team will be able to visit “ground zero” – Wuhan, where the first clusters of human infection emerged in December 2019. WHO has repeatedly insisted that any epidemiological investigation must begin with the first cluster of human cases: and those were found in Wuhan. Those first clusters included employees and shoppers at a Wuhan market where wild animals were sold for slaughter and human consumption.

However, some of the first COVID-19 cases seen in Wuhan or among visitors to the city also could not be traced back the market. This has stirred speculation that the virus could even have escaped from a local bioresearch facility that was doing research into coronaviruses. Other experts have also suggested that people from the rural parts of China where similar strains of the virus circulate the wild could have first become infected – and then carried the infection, or a mutation, to Wuhan, a city of 10 million people that is also a major trade and manufacturing center.

Along with China’s inherent resistance to any independent scrutiny of the virus origins, the US administration of outgoing President Donald Trump has also exacerbated the geopolitical tensions around the investigation, accusing WHO of bias and blaming China for the spread of SARS-CoV-2.

At a November session of the World Health Assembly, the deputy director of the US Department of Health and Human Services, Garrett Grigsby, charged that the just-published terms of reference for the investigative team were “not negotiated in a transparent way with all WHO member states”.

“Understanding the origins of COVID-19 through a transparent and inclusive investigation is what must be done” in order to meet that mandate, he said.

Image Credits: pxfuel.com.