The US has reported 2 million new COVID-19 cases in the past 2 weeks, over the Thanksgiving holiday and in the month leading to Christmas.

WHO officials have expressed concern about yet another spike in COVID-19 infections and deaths across the Americas, following the Thanksgiving holiday on Thursday, and in the run-up to Christmas – echoing concerns already being expressed by United States health authorities.

The US has reported 2 million new COVID-19 cases in the past 2 weeks: a striking new record, considering the country had not recorded more than 500,000 cases a week before November. As a result, US health officials have urged those traveling nationwide to take measures to stem a further increase.

“If you’re young and you gathered, you need to be tested about five to 10 days later,” said Deborah Birx, the White House COVID-19 response coordinator, in an interview with CBS News. “You need to assume that you’re infected and not go near your grandparents and aunts and others without a mask.”

With new infections from the Thanksgiving holiday, “we might see a surge superimposed upon that surge that we’re already in”, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in an interview with NBC.

The delay between the time of infection, first symptoms and actual testing will also delay nationally reported rates of infection, hospitalization and deaths, experts warned. 

“Probably what this means is three or four weeks after Thanksgiving, we will see more people die than otherwise would have,” said Michael Mina, epidemiology at Harvard’s T.H. Chan School of Public Health. “We’ll see more people get infected over Thanksgiving. And unfortunately, it will probably be a lot of older people who are gathering together with their families.”

The number of cumulative cases in the Americas as of 30 November 2020. (Johns Hopkins)
WHO: Do You Really Need To Travel?

At a WHO media briefing on Monday, Director General Dr Tedros Adhanom Ghebreyesus asked  the general public to carefully consider their choices over the coming holidays, saying: “The first question to ask yourself is, do you really need to travel?

“The COVID-19 pandemic will change the way we celebrate, but it doesn’t mean we can’t celebrate. The changes you make will depend on where you live.”

Dr Tedros also urged holiday shoppers to “avoid crowded shopping centres, and shop at less crowded times”. The United Kingdom recently announced that shops can stay open up to 24 hours to aid economic recovery in the Christmas build-up, following a 4-week national lockdown. If people travel, mix households or shop in person, social distancing measures should be adopted and masks should be worn, Dr Tedros added. 

In his NBC interview, Fauci gave similar advice: “If we can hang together as a country and do these kinds of things [mask wearing and physical distancing] to blunt these surges until we get a substantial proportion of the population vaccinated, we can get through this.”

Dr Tedros Adhanom Ghebreyesus, WHO Dicrector General.

 

WHO Urges Brazil’s President to ‘Take It Seriously’

In a rare calling out of a head of state, Dr Tedros also said Brazilian President Jair Bolsonaro should take the pandemic “seriously,” citing the steep rise in active cases in Brazil, which threatens to surpass the country’s July peak if adequate action is not taken.

“I just would like to add one thing, because I want the president to take it seriously,” Dr Tedros said. The number of cases in Brazil climaxed in July, with 319,000 cases per week recorded, which then dropped to around 114,000. “It is back again to 218,000 cases per week.”

More than 200,000 cases were reported in Brazil last week, and since the first week of November, the death rate has risen from 2,500 to nearly 3,900.

Dr Tedros described the situation as “very, very worrisome”, especially when local transmissions are considered in aggregate.

“In the case of Brazil, the disease numbers are going down in a number of states but rising in others,” said Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme. “As they begin to see a rising number of cases, countries need to look at a national and sub-national level.”

He added that Brazil, and countries facing similar regional challenges, need to be “very, very clear and directed [in locating] where cases are jumping back up and what’s driving this rise in cases”.

Tailored and targeted interventions are vital in stemming local transmissions, but just as important is a country’s ability to maintain a low case rate after a successful intervention.

“Bring it down, keep it down,” said Dr Maria van Kerkhove, WHO’s COVID-19 Technical Lead. “We have seen so many countries that have brought transmission under control, but they haven’t been able to keep it low.” She added that countries should jump on regional outbreaks urgently “so that they don’t have the opportunity to seed into something further”.

Ryan added: “We are not just trying to get the COVID numbers down for the sake of getting COVID numbers down. We are trying to get the core with numbers down so the health system can get back to what it’s supposed to be doing.”

WHO Calls Out Mexican President’s Refusal To Wear A Mask

When asked about Mexican President Andrés Manuel López Obrador’s refusal to wear a mask at public events, WHO officials reiterated the need for political leaders to set a model for citizens, especially as cases continue to rise in many countries.

The president has been notorious in his refusal to wear a mask to prevent transmitting COVID-19, even telling reporters in July that he will put on a mask “when there is no corruption. Then I’ll put on a mask and I’ll stop talking”.

“As we would say to leaders all over the world: it is very important that behavior is modeled,” Ryan said on Monday. “If we’re advising people to do things then it is really important that political leaders and society influencers are in fact modeling those behaviors [themselves].”

As of the end of November, Mexico has seen more than 1 million cases and reported more than 100,000 deaths with COVID-19.

If politicians do not adhere to COVID prevention measures and restrictions, Ryan said, the basic prevention etiquette “becomes politicized [and] that helps nobody”.

The WHO stance, he added, is that when measures are implemented they require the support of everyone in government: “Everyone in a position of authority and influence [should be] is trying their best to model those behaviors in the best way they can.”

 

Image Credits: Nathan Rupert, Johns Hopkins University & Medicine, WHO.

Moderna’s mRNA research and innovation centre.

Moderna on Monday announced that it would immediately request emergency authorization today for its mRNA COVID-19 vaccine candidate from both the U.S. Food and Drug Administration (US FDA)  and the European Medicines Agency – as well as asking the World Health Organization for an emergency use listing. 

The announcement came in a week that will see movement towards the first approval of COVID vaccines anywhere in the world outside of Russia and China. The United Kingdom’s independent regulatory agency was set to review the Pfizer mRNA candidate this week and possibly approve it as  early as next Monday or Tuesday (7 or 8 December). 

US FDA approval for the Pfizer vaccine could come as early as 10 December, the day after the Moderna review is scheduled, followed by a 17 December FDA review – and likely approval – of the Pfizer candidate. 

The UK government also asked its Medicines and Healthcare Products Regulatory Agency, to evaluate AstraZeneca’s potential COVID-19 vaccine for an accelerated release of a temporary supply.  A letter from top officials at Britain’s National Health Service to NHS hospitals, already outlined plans for a staged rollout of vaccines to high-risk groups, saying that “latest advice indicates that the very earliest we will have the first vaccine approved is early December.”  

The AstraZeneca adenovirus vaccine candidate, developed in partnership with researchers at Oxford University, is the least expensive and easiest to manage of the three front-running options. The UK has also signed a supply agreement with AstraZeneca for 100 million doses of the vaccine, 4 million doses of which are anticipated to be delivered by the end of 2020 and 40 million by the end of March 2021. 

“We are working tirelessly to be in the best possible position to deploy a vaccine as soon as one is approved by the independent regulator, the MHRA,” said Matt Hancock, UK Health and Social Care Secretary. 

Stéphane Bancel, CEO of Moderna

Moderna Vaccine 100% Efficacious Against Severe COVID

In a press release by Moderna, the company announced that its vaccine had a 94.1% efficacy rate, in a just completed, primary efficacy analysis of results from 30,000 study participants in the USA. Significantly,  efficacy against severe COVID was 100%, the company said, and efficacy was consistent across age, race, ethnicity and gender demographics.

Release of today’s results, which updated an interim analysis reported earlier, found a total of 196 COVID-19 cases among Moderna’s 30,000 trial participants, of which 185 cases were in the placebo group, versus 11 in the group that received the vaccine.   All 30 severe cases, including one COVID-19 related death, occurred in the placebo group, the company reported. 

“This positive primary analysis confirms the ability of our vaccine to prevent COVID-19 disease with 94.1% efficacy and importantly, the ability to prevent severe COVID-19 disease. We believe that our vaccine will provide a new and powerful tool that may change the course of this pandemic and help prevent severe disease, hospitalizations and death,” said Stéphane Bancel, Moderna Chief Executive Officer.

As a result, the company said in its press release that it is taking the following immediate steps: 

  • Moderna plans today to request Emergency Use Authorisation (EUA) from the U.S. FDA. The next step will be a Vaccines and Related Biological Products Advisory Committee (VRBPAC) meeting to review the safety and efficacy data package for mRNA-1273, which the FDA has told Moderna to expect on December 17, 2020
  • Moderna plans today to apply for a conditional marketing authorization with the European Medicines Agency (EMA)
  • Moderna intends to seek Prequalification (PQ) and/or Emergency Use Listing (EUL) with the World Health Organization (WHO)

The company also said that it would be submitting its results to a peer reviewed journal for publication. 

WHO Emergency Use Listing Or Prequalification? 

While Moderna so far has made no commitment to license its vaccine to other manufacturers, its move to apply for recognition of its vaccine with WHO could position the company to open the doors to generic vaccine production, in collaboration with global health agencies – if it chose. 

Currently, the Moderna vaccine carries an estimate US$ 25 per dose, for the two-dose regime, as compared to the AstraZeneca vaccine, which will cost only about US$ 3 per dose – for a two dose regime – placing it beyond the budgets of many countries in the world. 

Access to affordable vaccines has loomed as the dominant global health issue of 2021 as the world’s rich nations, along with a few low- and middle-income countries such as India, Mexico and Brazil have already bought up – or placed options on – a dominant proportion of available supplies from the first vaccines becoming available – outside of Russian and Chinese vaccines which have not yet released full details of their data. 

The Brazil-based Oswaldo Cruz Foundation (Fiocruz) signed an agreement with AstraZeneca to acquire and distribute its COVID-19 vaccine.

Globally and Nationally – Countries Watch To See Who Will Be First In Line  

As the pace of vaccine reviews and approvals picked up, so was the anticipation about timelines and logistics around vaccines rollout.   

In the United States, active preparations were already underway to facilitate distribution of the Pfizer/BioNTech vaccine, including test flights on American Airlines and United to check shipment processes for the vaccine, which needs to be stored at -70°C. 

Pfizer has two main facilities producing its COVID-19 vaccine, one in Michigan and the other in Puurs, Belgium to support European distribution. But late last week, US officials acknowledged that some Pfizer vaccines were in fact being moved from Europe to the United States – in anticipation of the earlier rollout in the latter.

“Operation Warp Speed leaders are aware of and facilitating vaccine shipments coming to the US from Belgium. In an effort to minimize the potential risk to delivery and distribution, we are unable to provide specific details regarding where vaccines are produced and stored,” said a statement from the US Department of Health and Human Services. 

An Advisory Committee on Immunization Practices (ACIP) of the US Centers for Disease Control and Prevention (CDC), was to be convened Tuesday to decide which individuals will be prioritized to receive the vaccine once it is approved. “We foresee imminent authorization if this vaccine is shown to be effective and safe in the near future and we want to be at the point where we are providing appropriate guidance to the states and jurisdictions for the use of these vaccines,” said Jose Romero, ACIP chair. 

Canada and Switzerland May Wait Much Longer

But in neighboring Canada there was also disappointment over news that Canadians might not get access to the vaccine until later in 2021.  

In Switzerland, meanwhile, Moderna said it was ready to swing into action with vaccine production at the manufacturing facility of its partner Lonza in the country’s Valais region.  But that depends on the vaccine’s approval by the independent Swiss medicines Agency, Swiss Medic – which might only happen in early 2021, a Moderna spokesperson told Health Policy Watch.  

“There is no fixed timeline for the rolling review process,” said a Moderna spokesperson.  “Our best estimate is that the SwissMedic approval will be granted at the start of 2021… As you may also know, Switzerland was one of the first to  conclude an agreement for the procurement of 4.5 million vaccine doses. Therefore, vaccine delivery to Switzerland is dependent on the approval of the vaccine candidate by SwissMedic.”

He added that Switzerland is manufacturing Moderna’s vaccines “for all markets outside of the USA,” while for the US, there is another dedicated manufacturing and supply chain. 

While Moderna so far has made no commitment to license its vaccine to other manufacturers, the move to apply for recognition of its vaccine with WHO could also position the company to open the doors to more production in collaboration with global health agencies – if it chose.  However, for now, the Moderna vaccine carries a price tag of US$ 25 per dose, for the two-dose regime, as compared to the AstraZeneca vaccine, which will cost only about US$ 3 per dose – pricing the Moderna option out of the budgets of many countries. 

WHO – Vaccine Logistics Huge Challenge   

While access to COVID-19 vaccines looms as the defining global health issue of 2021 – it’s not only an issue of price, WHO experts pointed out at Monday’s press briefing.  While the world’s rich nations have bought up huge stocks of vaccines, a few low- and middle-income countries such as India, Mexico and Brazil, also are positioned to get earlier access to supplies – by virtue of their domestic manufacturing base.  

WHO’s Mariangela Simão blamed it on excessive global concentration of manufacturing. 

“We have seen the world not so much divided, not so much between high, low and middle income countries… but between countries that have manufacturing capacity – and there are low and middle-income countries that do have manufacturing capacity – and countries that do not have manufacturing capacity,” said Simão, who is Assistant Director General for Drug Access, Vaccines and Pharmaceuticals. There’s a need for government to reflect about the concentration that we have nowadays on the global supply chain of medicine and vaccines, and health products in general.

“I think it’s the time that when also when we think of the future, to really establish policies where we can have a more diversified supply chain that don’t risk shortages, not only for vaccines.  We are seeing for example some shortages of ICU medicines that we didn’t expect like injectable opioids.  The need for countries to think of development policies or infrastructure policies that actually enhance local production of health products is extremely important – and I think is one of the lessons learned from this pandemic. 

In the near-term, meanwhile,concerns being expressed even by rich countries like Canada about vaccine access, highlight the importance of making the WHO COVAX vaccine procurement facility work well – so that the highest risk groups around the world can get access to the first available vaccine supplies,regardless of their local manufacturing base, said WHO’s Katherine O’Brien, head of the department of vaccines, biological and immunologicals. 

Pan American Health Organization (PAHO) administering vaccines in Venezuela.

The COVAX facility, which is to serve 187 countries has so far raised US$ 2 billion this year.  But it remains US$ 5 billion short for 2021 to raise the funds sufficient to produce and distribute 2 billion vaccine doses, O’Brien noted, saying: “The ability to procure vaccines, on behalf of the facility is dependent on the funding that is available for procuring those vaccines.

“So I think we really do have to take….  the expectations and turn that on the global lens – that really, the scientifically and epidemiologically impactful thing to do is to have adequate supply in equal time, in equal measure around the world for every country to …be immunizing those populations that highest priority, and to move as quickly as possible through those priority groups onto those who have a lower risk of serious disease.”

Along with that, she said, the delivery infrastructure of vaccines is going to be the equivalent of “building base camp at Everest”, she added. “The competence in communities, the acceptance of vaccines, and assuring that people are in fact immunized with the right number of doses, with the products that are available, is what it’s going to take to scale to the peak of  the mountain. 

“And so as we anticipate that the year ahead for every country, it’s not only about assuring that there is supply, it’s also about a massive unprecedented scale of readiness and implementation of delivery and all that that will take in every community in every country around the world.”

News Hailed By Experts – WHO’s Dr Tedros Talks About Hope 

Dr Tedros Adhanom Ghebreyesus, WHO Dicrector General.

Despite the obstacles, news of the Moderna submission was greeted as a kind of watershed, with gleeful expressions of hope and delight even among normally sober scientists. 

“Moderna Covid vaccine has 94% efficacy, final results confirm. Looking forward to seeing the results published in scientific journals,” tweeted Didier Pittet, an infectious disease expert and director of the infectious control programme at the University Hospital of Geneva. 

“It’s a Monday in November which means a #COVID19 vaccine press release. Today’s is from @moderna_tx reporting data from its primary analysis and showing a 94.1% efficacy in the prevention of COVID-19 disease and 100% efficacy in preventing severe disease.  A game changer!” said Carlos del Rio, executive associate dean of Emory School of Medicine, in Atlanta Georgia. 

Said Director General, Dr Tedros Adhanom Ghebreyesus at the WHO press conference: “There is a lot of hope, especially with the advent of the vaccines that have been announced. In the last few weeks. And from the WHO side. We are sure that we can defeat this pandemic using the existing tools, and also the vaccines that are in the pipeline. The most important thing is we need to have hope. And not only hope. But solidarity, to work together to fight a common enemy, using the existing tools, and also the new announcements of vaccines, in the pipeline.”

–Madeleine Hoecklin contributed to this story.

Image Credits: Moderna, Ministério da Saúde , WHO/PAHO, WHO.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

In a politically charged series of exchanges at a Friday press briefing, World Health Organization officials pushed back against queries by a representative of China’s state-controlled CCTV, asking about whether the SARS-CoV2 virus discovered in Wuhan, China in December of 2019 could have been circulating in humans “outside of China before the outbreak in Wuhan, but without being noticed.” 

“One thing that has to be clear is the study will start from China, Wuhan, where the first report came,” said WHO Director General Dr Tedros Adhanom Ghebreyesus at the press briefing. “And then from there, based on the findings, we can go anywhere. So I think it’s better to really underline that.”

Mike Ryan, WHO Health Emergencies Executive Director, did not directly rule out the possibility that the virus could have been circulating somewhere else in the world among animal populations –  he said that the evidence of its first presence in humans led to China: 

“It is clear from a public health perspective that you start your investigation from the place where the cases first emerge,” said Ryan, recalling that Chinese clinicians had first picked up the cluster of acute pneumonia cases in the city of 10 million people. “There was a link to the market market and it triggered in their minds a suspicion, and they reported it to the authorities. 

Dr. Michael Ryan, WHO Executive Director of Health Emergencies

“So I think it’s highly speculative for us to say that the disease did not emerge in China. What we do know is the first clusters of human cases that were detected, were in Wuhan and China, there was a massive response to containing that disease there. And we look forward to working with our Chinese scientific colleagues to understand better the origins of the virus within China or beyond China, wherever that leads,” said Ryan. 

While an international WHO committee of experts mandated to investigate the big questions over the virus’s murky origins has now been named, and even held initial virtual meetings with colleagues in China – no date for any visit by the group to Wuhan, China has yet been set.  WHO insiders have said that securing Chinese cooperation for a genuine fact-finding mission has been an uphill battle, despite the pledges of cooperation that have been publicly made, and repeated. 

Speaking at Friday’s press conference, WHO officials deferred yet again from setting a date, affirming only that  the group will indeed visit Wuhan at some time in the future. 

“Yes, it’s correct, it will go to Wuhan, it will travel to Wuhan, thank you,” said Dr Tedros, briefly in response to another query by the Japan-based media outlet, NHK.

Wuhan, China

Patient ”Zero” and Geopolitics

The origins of the virus in China, while linked to a Wuhan market where wild animals were slaughtered and sold for traditional foods,has never been pinned down completely through the identification of a “patient zero” who was the first to become infected from an animal source. The virus is thought to have emerged among bats; coronaviruses circulate in bat populations in rural regions of the country.  Although there could have been other intermediary animals involved as well, including ones transported to the Wuhan market by traders. However, no clear animal to human transmission chain has so far been identified, and the heavy official Chinese government controls over research, travel and media have left many avenues closed to international sleuths.

And after months in which outgoing US President Donald Trump repeatedly blamed China for the pandemic’s emergence, constantly referring to SARS-COV2 as the “China virus”, the issue of the virus’s origins has become even more politically charged, with Chinese government officials and media hitting back with the circulation of theories suggesting that maybe the virus lept the animal-human barrier somewhere else, outside of China.

At the Friday briefing, WHO officials acknowledge that there is, in fact, evidence from Italian sewage and blood samples that human carriers of the virus may have been moving around the region, which has heavy business exchanges with China, as early as autumn, 2019.

Maria Van Kerkhove, WHO technical lead for the WHO Health Emergencies team, referred to a recent studies at Milan’s National Cancer Institute (INT), which found traces of the SARS-CoV2 virus RNA in some peoples’ blood samples as early as September. Another study found traces in sewage in  Milan and Turin. But insofar as the SARS-COV-2 family of viruses have never been reported to circulate in European animal populations prior to the pandemic, experts still conclude that any silent human carriers in Italy either brought the virus back with them from China – or were exposed to someone else who had traveled back and forth.

Bats are are reservoir for cornaviruses that circulate in nature

“There is one study that was published very recently, looking at serological samples from Italy, at a cancer screening institute in the fall, and they found serum positive samples in September,” Van Kerkhove said.  “We reached out to these reserachers and they have generously offered to work with us and to colaborate with us on some further studies looking at those samples.

“But as Mike has pointed out, the studies need to begin where the first cases were detected in Wuhan, where those first casese were detected in December,” she concluded.

At a World Health Assembly (WHA) meeting in May, WHO member states unanimously agreed to mandate a team of international experts to identify “the zoonotic source of the virus and the route of introduction to the human population”.  Following that, WHO sent an advance team to China in July to pave the way for a visit by the expert group, but progress on an actual visit stalled after that. 

Asked why at a media briefing on Monday, Kerkhove would say only that “the international team will travel to China”, and that it “is being discussed amongst the international team and the Chinese counterparts. And that will be arranged in due time”. 

An initial virtual meeting between the international and Chinese teams took place in October. Following that, WHO published outlines of  a Phase 1 and Phase 2 study for the virus origins investigation.  Just this week, WHO finally released the names of the experts who have been assigned to the delicate task of the virus hunt.

Peter Daszak, President of EcoHealth Alliance

They include prominent public health, animal health and virology experts from Australia, Denmark, Great Britain, Germany, Japan, Netherlands, Russia, Japan, Qatar, Viet Nam and the USA, including Marion Koopmans, who is leading research into the Dutch outbreak on mink farms and John Watson, former UK deputy chief medical officer. The team also includes Peter Daszak, a prominent British zoologist and researcher into bat coronaviruses in southeastern China, who is also president of the US Ecohealth Alliance. He holds the double hat as head of an independent Lancet’s COVID-19 Commission Task Force, which is also looking into the virus origins.    

At a November session of the WHA, Garrett Grigsby, deputy director of the US Department of Health and Human Services, charged that the investigation team’s terms of reference were “not negotiated in a transparent way with all WHO member states” and were inconsistent with the original WHA mandate, adding, “Understanding the origins of COVID-19 through a transparent and inclusive investigation is what must be done to meet the mandate.”

WHO officials have said that they are regularly consulting with the missions of other governments in Geneva, and that the study process and findings will be transmitted transparently.  Behind the scenes there is pressure on WHO to also push harder on the Chinese government – but whether this is out of deference to Beijing or a realistic assessment that it will not achieve anything, Dr Tedros and have team have resisted doing that. 

High Tech Freezer Solutions Could Make Even Pfizer Vaccine Feasible In Africa

Katherine O’Brien, Director WHO Vaccines, Immunizations and Biologicals

At the briefing, WHO officials also said that high-tech freezer solutions could make it feasible to even distribute COVID-19 vaccines like Pfizer’s mRNA candidate, which requires ultra-cold storage – at least in the central health facilities of developing countries. 

That could help ease the rollout of much-needed vaccines to vulnerable groups like health care workers, as soon as regulatory approval is obtained, said WHO’s Katherine O’Brien, speaking at the WHO press briefing. 

However, the experts also acknowledged that another up and coming vaccine, produced by AstraZeneca, and which can be preserved in normal refrigerator conditions, will be more practical for widespread rollout – if it wins approval soon. Their remarks echoed comments made earlier this week by WHO African regional officials. 

“We do have experience in a number of countries, specifically in Africa, being able to deploy a vaccine with that ultra cold chain requirement,” said O’Brien, referring to past experiences managing Ebola vaccines. 

“So as we anticipate the use of the Pfizer vaccine, the intention is certainly to be able to use it, along with other vaccines because no one vaccine is going to have adequate supply, nor will any one vaccine necessarily have suitable operational characteristics to meet all of the needs. 

O’Brien noted that Pfizer has already developed a special shipping container for its vaccine, that can maintain its stability for 101-15 days, and despite the overall ultra-cold requirement of -70 C, the vaccine can in fact be kept in a normal vaccine refrigerator for up to 5 days prior to its final use. 

Pfizer’s request for emergency use approval by the United States Food and Drug Administration will be reviewed on 10 December, and there is widespread expectation among US experts that the vaccine could even be approved the next day – making it the first to actually hit the market for distribution even before the end of the year.

However, along with that, WHO’s Dr Tedros stressed once more that urgent funds are still needed to finance the massive procurement of billions of vaccine doses for low- and middle-income countries that cannot afford to purchase the vaccines themselves – and particularly not at the high-end prices of US$ 25-US$ 30 per dose (for a two dose shot) that is likely to be the benchmark in Europe and the United States for the cutting edge mRNA vaccines developed by Pfizer and Moderna.   

In comparison, AstraZeneca’s vaccine, which relies upon a less expensive adenovirus delivery platform, long been used in vaccine development and manufacture, is to be sold at the no-profit levels of just US$ 3 dollars a dose – or about US$ 6 in total.   

-James Hacker contributed to this story. 

 

Image Credits: Arend Kuester/Flickr, R Santos/HP Watch, Wikipedia , Shutterstock .

The 2020 G20 Riyadh summit, November 2020.

We are kicking off our expanded new series of opinion pieces, with Ilona Kickbusch’s reflections on last week’s G-20 and the mission of COVID vaccine distribution – what she describes as the most “defining global challenge” of 2021.  We invite contributions from health policy leaders, influencers and practitioners who wish to speak out on issues of concern – from wherever you may be in the world.   

In his global “wake up call” UN Secretary General, Antonio Guterres called on the global community to move from international chaos to the construction of an international global community that is capable of meeting and solving tomorrow’s challenges.

It was clear early on in 2020 that the Group of 20 most industrialized nations (G20) could not contribute much to resolve the present pandemic challenge – let alone the future – given the decision of the US president to disregard the pandemic, fight the World Health Organization (WHO) and to obstruct multilateral solutions.  It was even clearer last weekend that the G20 has not helped move this agenda forward.

COVID-19 is global, but the response to this collective global threat is still largely national. Its global dimension is still dependent on contributions in the form of development aid (ODA) and fundraising efforts of various types. This is also insufficient. Global health financing needs a full reset.

Instead, the rhetoric of global health in the speeches by global leaders has included regular mention of global goods and abounded with reference to equitable access to vaccines. “We will spare no efforts” said the G20 declaration at the conclusion of last weekend’s leaders summit, “we recognize the role of extensive vaccination as a global public good.” But the G20 has not stepped up to the plate to enable the ambitious goal to distribute 2 billion doses of COVID-19 vaccines before the end of 2021.

COVID-19 Vaccines is Test Case – But No Signal In Right Direction

The paradigmatic test case of common goods for health will be the equitable and fair access to a COVID-19 vaccine; this may be the defining global challenge of 2021. The G20 did not face up to a serious discussion on how to define and finance common goods. For example, recent estimates call for about US$ 26 billion a year of investment in common goods for health over the next five years, a manageable amount at just 0.32 % of total global spending on health.

Ilona Kickbusch, Founding Director of the Graduate Institute’s Global Health Programme in Geneva.

The G20 is not a pledging forum but a signal in the right direction might have helped. The European Commission called for US$ 4.5 billion at the G20 meeting to be invested by the end of 2020 in the WHO co-sponsored ACT Accelerator – a new global collaboration for procurement and delivery of COVID-19 tests, treatments, and vaccines everywhere. Germany – which holds the EU Council Presidency – had already contributed more than €500 million (US$ 592.65 million) to this effort.

So if each G20 member had committed to paying only US$250 million (in cash or kind), the approximately $US5 billion would be available. They have not. Instead a small group of rich countries representing 13% of the world’s population has bought up more than half of the future supply of leading COVID-19 vaccines.  In response, India and South Africa (members of G20) have sent a proposal to the WTO asking “that it allow countries to suspend the protection of certain kinds of intellectual property related to the prevention, containment and treatment of COVID-19.”

But much more serious than the lack of easily affordable action on the present crisis is the lack of foresight in relation to the future.

During the global financial crisis in 2008, the structural problems that contributed to the crisis were addressed, leading to changes in the financial regulatory architecture at national and regional level.

In the same way the G20 should have used the pandemic to address the major structural financing deficits of the global order – especially in relation to financing global common goods for health. Economic losses from the pandemic are currently estimated to exceed 4.9%–7.6% of global GDP (US$4–US$ 6 trillion), an amount that is 20 to 30 times greater than the estimated cost of investing in epidemic preparedness. COVID-19 has resulted in the deepest recession in decades as the International Monetary Fund and the OECD have calculated – it will probably have 4-fold the impact of the 2008 financial crisis.

No Global Revenue Raising Mechanism For Global Goods – Leaves Health Leaders Fundraising With Music Industry 

The G20 finance ministers should have addressed the fact that after 75 years there is still no reliable mechanism at a global level to raise revenues for global functions produced by the United Nations system. Yet even in the face of the largest pandemic in 100 years there is no political will to address the financing of global common goods for health – except to embark on yet another round of fundraising, one fancier than the next.

This political neglect has left key institutions like the WHO severely underfinanced. As millions die of COVID-19, it must create a new foundation and reach out to the global music industry to engage in fundraising for vaccine development and distribution as well as for the pandemic response in low- and middle-income countries.

This does not bode well for a future where the world will not only have to deal with pandemics, but also with antimicrobial resistance and the impacts of carbon emissions on air pollution and climate change.  Even generous countries – like the United Kingdom (who will preside over the G7 next year) are pulling back on their ODA commitments and have announced a cut to the UK’s foreign aid budget, which will be reduced from 2021 from 0.7% of gross national income to 0.5%, “saving” approximately £4 billion.

At the G20 it was obvious that the US would stall any move in the direction of a proposal that has even a whiff of WHO involvement linked to it –  outgoing President Donald Trump preferred to play golf rather than attend much of the conference proceedings.

In contrast the European Union has been particularly active in pushing funding for the COVAX facility, the global risk-sharing mechanism for pooled procurement and equitable distribution of possible COVID-19 vaccines. This must be recognized. But it too has not yet pushed for a longer-term blueprint for new financing mechanisms for global health.

Whether it’s a Digital Tax or Financial Transactions Tax Or Other Means – Paradigm Shift Still Needed 

A collective global problem typically requires a common response.  As outlined in a recent paper, this requires a paradigm change that would transform global health funding.

Rather than engage in declarations full of nice words, the joint meetings of the Health and Finance Ministers of the G20 should devise a financing framework that ensures a sustained source of revenue for global common goods for health. Possibly through a global or multinational taxation system or mix of national, global and regional taxation. A digital tax is frequently mentioned in this regard as well as taxing financial transactions. In the meantime, coordinated institutional mechanisms like COVAX should be supported to pool resources for common goods – such as vaccines – that are desperately needed.

Raising some US$ 25 billion a year for pandemic preparedness in a world whose GDP exceeds US$ 75 trillion would require a very minimal, and thus almost painless, level of taxation, making this a particularly feasible option.

But without political will it cannot be done. Not only must the heads of government come together and address this issue – in 2020 in both the G7 (chaired by UK) and G20 (chaired by Italy) – but also the many interest groups in global health covering a wide span of agendas and diseases must come together to address this larger issue of a new financing regime for common goods for health. The system that is build on ODA and philanthropy is broken and the sooner we address this issue the better. Because with a new financing paradigm the world will be more equitable and we will all be safer.

________________________

Professor Ilona Kickbusch is the Founding Director of the Global Health Programme at the Graduate Institute of International and Development Studies in Geneva. She is a member of the Global Preparedness Monitoring Board and the WHO High-Level Independent Commission on NCDs and co-chair of Universal Health Coverage 2030. She has been involved in German G7 and G20 health-related activities, and the development of the German global health strategy.

Image Credits: G20, European Health Forum Gastein.

As coronavirus policies initially forced many of us to turn into couch potatoes glued to our screens, the World Health Organization emphasizes that we can remain active and healthy even in COVID times. 

Regular physical activity of any type, and any duration, including dance, running, or even everyday household tasks like gardening or cleaning, can boost health and wellbeing, although more is always better, emphasized the WHO’s director of health promotion Ruediger Krech on Wednesday, at the launch of the Organization’s new guidelines on physical activity and sedentary behaviour.

The guidelines come on the heels of surprising statistics that a whopping four out of five adolescents, and one in five adults, are failing to get their minimum dose of physical activity, especially girls, women and lower-income groups. If they were widely adopted, the guidelines could help save five million lives a year that are lost to physical inactivity, as well as US$54 billion in direct health care, and another US$14 billion in productivity. 

“Being physically active is critical for health and well-being – it can help to add years to life and life to years,” added WHO Director-General Dr Tedros Adhanom Ghebreyesus at a press conference on Friday. “Every move counts, especially now as we manage the constraints of the COVID-19 pandemic. We must all move every day – safely and creatively.” 

There are few health promotion strategies that can hit so many diseases in one go as physical activity. In fact, regular exercise can help prevent and manage heart disease, type-2 diabetes, and cancer, which together account for almost three quarters of deaths worldwide, according to the WHO. Physical activity can also reduce symptoms of depression and anxiety, curb cognitive decline in older people, while also enhancing memory and bolstering brain health. 

The new guidelines call for moderate to vigorous aerobic activity for one hour a day in children and adolescents, 2.5 hours a week for pregnant women, and 2.5 to 5 hours a week for adults and older people, including those with chronic conditions or disabilities.

“The new guidelines recommend between 150 and 300 minutes of moderate to vigorous activity per week for for all adults, and an average of 60 minutes per day for children and adolescents,” said Dr. Tedros at the press briefing.

Older people should also engage in activities that promote functional balance, coordination and muscle strengthening to help prevent falls, which are the second leading cause of accidental deaths from injury worldwide.

The new, and more detailed guidelines replace the earlier guidelines on diet, exercise and physical activity issued a decade ago. In contrast to the guidelines from 2010, the latest guidelines are more inclusive because they offer specific advice on physical activity for pregnant women, postpartum women, as well those living disabilities and chronic conditions. 

The new guidelines are based on a comprehensive 500-page review of the most recent evidence on physical activity and its benefits, and are are part of the broader global action plan on physical activity, whose aim is to reduce physical inactivity by 15% in the next decade. 

WHO reccommends 2.5 hours a week of physical excercise for pregnant women

Image Credits: @WHO/Yoshi Shimizu, WHO.

Immunization programs ssuspended by COVID lockdowns have resulted in an increase in vaccine-derived polio cases in Africa.

Africa’s COVID-19 rollout is anticipated for Spring 2021, despite the continent’s low vaccine preparedness, multiple health leaders in Africa have said, as policy advisory groups flag the importance that other successful immunization campaigns will have on COVID recovery.

At a press briefing on Thursday, Dr. John Nkengasong, Director of Africa CDC, said: “Africa may have to wait until the second quarter of 2021 to roll-out COVID-19 vaccines. I have seen how Africa is neglected when drugs are available in the past.” The sentiment was echoed by WHO Regional Director for Africa Matshidiso Moeti, who specified an anticipated March roll-out.

The statements follow calls made by the African Regional Immunization Technical Advisory Group (RITAG) for countries to urgently resume routine and catch-up immunization services, while adhering to strict COVID-19 prevention protocols.

When African countries began to lockdown at the beginning of the pandemic, critical vaccination programs for diseases like polio were suspended for several months. Since the countries began reopening, governments have taken steps to undo the impact the pandemic has had on these campaigns, but the months-long interlude to routine immunizations has left its mark. While Africa was declared wild polio-free in August 2020, vaccine-derived polio cases have increased.

“Collective action to strengthen immunization is needed, now more than ever, as we approach the end of the Decade of Vaccines and COVID-19 limits access to essential health services across Africa,” said Professor Helen Rees, Chair of the RITAG, which is the principal advisory group to the WHO on regional immunization policies and programmes

Resuming routine vaccination could help countries prepare their systems for immunizing adult populations with up-and-coming COVID-19 vaccines.

Currently, African vaccine preparedness appears to be low, warned a WHO group on Thursday – which evaluated self-assessment of vaccine readiness levels in 40 of the region’s 47 countries, only to find that average readiness was only about 33% – in comparison to the WHO benchmark of 80%.

Through COVAX – a program aiming to accelerate the development of COVID-19 vaccines – Africa will be able to access vaccines for up to 20% of its population but at the outset, early dose will only reach about 3% of the population : namely, health workers and the elderly.

Nkengasong added that the continent needs to provide vaccine access to up to 60% of its population before it can achieve herd immunity indicating that additional funding needs to be arranged to extend COVID-19 vaccine coverage in Africa beyond what the continent would get through COVAX. He put the cost at up to US$12 billion.

How COVID-19 has impacted immunisation in Africa

Africa has a regional immunization target of 90% but in 2019, immunization coverage in the region stagnated at 74% for the third dose of the diphtheria-tetanus-pertussis containing-vaccine (DTP3), and at 69% for the first dose of the measles vaccine. WHO and its partners had hoped there would be improvement in 2020.

Moeti stressed that pre-existing gaps in immunisation coverage have been exacerbated in 2020 by the COVID-19 pandemic, putting millions of children at risk for deadly diseases.

An additional 1.37 million children across the African region missed the Bacille Calmette-Guerin (BCG) vaccine which protects against tuberculosis, and an extra 1.32 million children below the age of one missed their first dose of measles vaccine between January and August 2020, when compared with the same period in 2019, WHO said in a statement.

Moreover, immunization campaigns covering measles, yellow fever, polio and other diseases have been postponed in at least 15 African countries in 2020.

“Current outbreaks of vaccine-preventable diseases are an apt reminder of the work that remains to be done,” said Dr. Richard Mihigo, Programme Manager for Vaccine-Preventable Diseases at the WHO Regional Office for Africa. “How we respond to these outbreaks amid the COVID-19 pandemic will be critical to protecting children and communities, and to preventing further disease outbreaks.”

Image Credits: WHO, United Nations Photo.

Young school girls organize themselves before the March to End Gender-Based Violence in Dar es Salaam, Tanzania.  One sign reads: “Refrain from using abusive language for Women and Children”.

Violence against women and girls has been neglected during and worsened by the COVID-19 pandemic, and urgent efforts are needed to protect women, UNAIDS has said.

One in three women likely to experience violence at least once in their lifetime. Evidence indicates that the COVID-19 pandemic has resulted in significant increases in gender-based violence in nearly all countries.

Speaking on International Day for the Elimination of Violence Against Women, 25 November, UNAIDS called for urgent efforts for nations to improve or follow-through on neglected health services and outreach programmes to support victimes of violence or abuse.

“The growing evidence confirms that the impacts of the COVID-19 pandemic are not gender-neutral,” said Winnie Byanyima, UNAIDS Executive Director. “The impacts of lockdowns and travel restrictions imposed in many countries to curb the spread of the COVID-19 pandemic, the failure to designate sexual and reproductive health services and services for survivors of violence as essential services, and the undermining of women’s economic security have compounded the barriers for women and girls experiencing abuse, especially those who are trapped at home with their abusers.”

Ending violence against women is everyone’s business, and it is possible to make a difference during the 16 days of Activism against Gender-Based Violence

The pandemic has both amplified violence against women, as well as currently existing gender inequalities, a panel of representatives from various ministries of health said. Service providers, representing Spain, Argentina, India and Iraq, discussed how their countries have implemented strategies to combat violence against women, including actively searching for cases of violence in COVID-19 patients, improving connectivity between victims and authorities, and creating outreach services.

Argentina – Actively Assisting Victims of Violence Who Do Not Come Forward

Argentina has implemented a program that actively searches out COVID-19 patients in their homes and social circles for cases of gender-based violence, as lockdown measures designed to curb the COVID-19 pandemic have made made it harder to connect with victims.

The country has focused its approach on implementing preventative measures to protect potential victims from future abuse, and has expanded its response to protect LGBTQ+ people. It has also made its sexual and reproductive health services more accessible, with non-discriminatory policies established. There has still been an increase in femicides between January and November, however, with 265 women murdered this year.

“We have learned during this long pandemic that we have to adjust our current mechanisms in place to defend women and combat gender-based violence,” said Argentina Minister of Health Dr. Gines Gonzalez Garcia. Garcia addressed the significant changes that have come with the pandemic – in people’s behaviors and emotional states. Economic changes especially can increase violence against women, and has stated that “there is still more to be done.”

Young Syrian refugees performed a silent play on the importance of education in preventing early marriage in the UN Women-led ‘Women and Girls Oasis’ in District 4 of the Za’atari refugee camp (Jordan) on the occasion of the 16 Days of Activism Against Gender Violence campaign 2015.
Iraq – Addressing the Connection Between Health Emergencies and Gender-Based Violence

Iraq’s Ministry of Health has drafted human rights strategies and action plans to provide protective maternal, newborn, and child and adolescent health policies related to the pandemic. It has also developed education and communication materials and is assessing care provided for gender-based violence during the pandemic.

“COVID-19 showed us the link between health emergencies and gender-based violence,” said Dr. Riyadh Adbul Ameer Alhifi, of the Iraq Ministry of Health, noting that the role of the health system is to address both issues, with many survivors during the pandemic seeking mental health and psychosocial support.

Iraq saw high levels of domestic violence even before the pandemic, and the number has only risen since. At least 46% of married women are exposed to at least one form of spousal abuse, and 57% of them to domestic violence. Gender-based violence is also rooted in child marriages, with 20% of girls aged 15-19, and 5.5% of girls under the age of 15.

“It is important that gender-based violence services are included in the list of essential health services, and health facilities are equipped to properly answer survivors’ emotional, physical, and practical needs.”

Riyadh discussed the need to strengthen the referral system for gender-based violence survivors within the health system, and the need to address the social traditions and beliefs that perpetuate this violence. If these issues are not addressed, this will remain confined to the Ministry of Health – services will not improve and the number of victims will increase.

“Violence against women connot be reduced unless those beliefs and traditions change. This needs a great force in which all sectors in the country must contribute.”

Orange the World 2018 – Uganda
Ugandan police joined with UN Women Uganda, UN in Uganda & SafeBoda for a safe ride to mark the 16 Days Of Activism under the theme ‘Safe ride to end violence against women and girls’. Over 300 boda riders and other participants took part in the activity.
Spain – Facilitating Communication Through Technology and Pharmacies

Spain’s gender-based violance helpline has observed nearly 30,000 requests for assistance during the pandemic: an increase of nearly 60% from 2019. Emotional and psychological assistance against gender-based violence, which was devliered via WhatsApp during the strictest period of lockdown, received 2,500 requests. This service ended in June, when in-person services could be provided again.

As a result, Spain has established a contingency plan against gender-based violence with the Ministry of Equality, following the declaration of a state of emergency. These were strategic measures designed to help, prevent, control, and minimize the negative consequences for many victims of gender violence. While health laws in Spain allow for diagnosis and care for people suffering from violence in both primary and specialized health services, it is a common problem that seriously impacts health, said Dr. Pilar Apracio, Director of the National School of Public Health in Spain.

The government of Spain has taken measures to prevent femicide, facilitating connections through telephone and internet. A network in pharmacies has also been created that allows women who go into pharmacies to contact the pharmacist, connecting the pharmacy to the helpline and authorities.

Added Apracio: “If you facilitate the communication, this contributes to solving problems women have to face in gender violence situations.”

The second wave of COVID-19 indicates the possibility that there will once more be an increase of physical violence in the new phase of the pandemic, and people have been urged to not let their guard down against gender-based violence.

Activism against Gender-Based Violence at the National University of Lao, Dong Dok campus
India – Health Experts Ensuring Safety for Victims of Gender-Based Violence

India has seen a decrease in incidence of domestic and sexual violence reported, due to a lack of transportation during lockdown and fear of contracting COVID-19. The severity of the cases of those victims who have come forward, however, has increased.

The Government Medical College and Hospital Aurangabad has created a section of the hospital for victims of sexual violence, where experts such as gynecologists, pediactricians, surgeons, forensic specialists, and psychiatrists are on staff to console and treat victims. A shelter has also been created in the medical college admission ward to ensure the safety of its patients.

Dr. Shrinivas Gadappa of the Government Medical College brought up the importance of training practitioners to recognize the signs of gender-based violence, especially in the primary healthcare system, citing difficulty in screening for both domestic violence and COVID-19, and called it a “loophole in this pandemic”.

Workshops to train practitioners is very important in increasing sensitivity towards and awareness of gender-based violence, Gadappa added. Primary health care centers should be strengthened to deal with such cases during the pandemic which will, in turn, increase the amount of women reporting instances of violence, he said.

WHO Director General Dr Tedros Adhanom Ghebreyesus, in a final statement, said that countries need to increase accessibility to healthcare that aids women affected by violence, implementing it as an essential service, as well as offering more resources towards training health professionals on how to identify women experiencing abuse, and how to provide first line support.

“All women have the right to live free of violence and coercion, working together, we can build gender responsive, health and social protection systems to keep all women safer and healthier.”

Image Credits: UN Women Tanzania/Deepika Nath, UN Women, UN Women, UN Women/ Martin Ninsiima, DANHO/Daniel Hodgso.

Nairobi.  Africa’s limited cold-chain capacity will constrain the continent’s ability to take up the more cutting-edge Pfizer and Moderna vaccines that are likely to win approval first from regulatory authorities, said WHO’s African Regional Director Dr Matshidiso Moeti on Thursday.

Those same constraints make the AstraZeneca (AZD1222) vaccine the most attractive option, despite its lower efficacy results, so far, which has averaged about 70 %, Moeti observed in a press briefing on Africa’s vaccine preparedness. 

WHO’s African Regional Director Dr Matshidiso Moeti

“The latter vaccine is much better and easier to handle with storage required…  unlike the Pfizer vaccine that would pose a big challenge with distribution,” Moeti said, referring to the ultra-freeze conditions at  -70° C that the mRNA-based vaccine candidate, Pfizer requires. Moderna’s vaccines can be stored at more moderate freezer temperatures of 2-4° C. In contrast, the AstraZeneca vaccine, which relies up an older, adenovirus delivery technology, only requires refrigerator temperatures of 2-8° C.   

“In any case at an efficacy rate of 70% the AstraZeneca vaccine is still good enough,” she added. Most regulatory authorities have said even a bar of 60% efficacy would be acceptable to clear the way for new COVID vaccines. 

Shortly after she spoke, AstraZeneca’s CEO Pascal Soriot told Bloomberg News that the company would run a fresh global trial to test a dosing option that seems to attain much higher, 90% efficacy levels. The higher results were in one arm of the trial already under way in the United Kingdom, the USA, and Brazil, after a serendipitous under-dosing of one group of volunteers under the age of 55 was found to yield better interim results than the 70% average.  

“Now that we’ve found what looks like a better efficacy, we have to validate this, so we need to do an additional study,” Soriot was quoted as saying. Based on its existing results, however, Soriot said that he is also optimistic that AstraZeneca, which co-developed its vaccine with Oxford University, will remain on track to obtain regulatory approval for the vaccine in the United Kingdom and Europe by the end of the year. 

Due to its low cost and modest cold chain requirements, AstraZeneca is expected to be one of the main vaccines to be supplied to many low and middle income countries, including through the COVAX facility global vaccine procurement and distribution facility, co-led by WHO and the Global Vaccines Alliance (GAVI). COVAX aims to support the vaccination of up to 20% of Africa’s population against the SARS-CoV virus by the end of 2021, Moeti said. But doing so is highly dependent on the rollout of cheap and accessible vaccines. 

Under the plans of the COVAX facility, an initial 3% of Africa’s population – mainly health workers and the elderly will be immunized, with hoped for coverage of  20% of the population by the end of 2021, said Moeti.  Following that, Africa Centres for Disease Control (CDC) has said that it will lead another effort that will aim to vaccinate up to 60 % of the population, revealed Dr Moeti.

She added: “the COVAX vaccine will be highly subsidized thanks to donor contributions and will ensure Africa gets vaccines at the same time as everybody else”.

COVAX aims to support the vaccination of up to 20% of Africa’s population against the SARS-CoV virus by the end of 2021
African Vaccine Preparedness – Rates 33% 

Beyond cold chain limitations, Africa’s overall preparedness for COVID-19 immunisation campaigns is low, Moeti said.  She referred to a recent WHO assessment that ranked the countries’ average readiness at only about 33%, significantly lower than the WHO benchmark of 80%, Moeti said at the briefing, where a WHO assessment of the continents “vaccine readiness” was presented.

The low level of readiness is worrying, given that the continent hopes to commence administering vaccines for the disease toward March, 2021, she said. 

The WHO evaluation was based on national vaccine preparedness surveys performed by 40 out of the 47 countries in the WHO Africa Region. The national self-assessments evaluate vaccine country readiness based upon  10 key sets of indicators, including:  planning and coordination, resources and funding, vaccine regulations, service delivery, training and supervision, monitoring and evaluation, vaccine logistics, vaccine safety and surveillance, communications and community engagement.

After seeing the results of the surveys,  WHO held a meeting with ministers of health from across the continent two days ago, to brief them on the urgent need to up their preparedness levels, to ensure Africa was not left out of the global vaccination drive.

“At WHO, we are supporting countries to increase their preparedness levels and we will do everything possible to ensure Africa is not left out of COVID-19 vaccination initiative,” Dr Moeti told a press briefing on Thursday.

“We can say that we are far from getting there, each pillar has a different average that is supposed to be achieved before we can safely deploy vaccines and reach a maximum number of people,” said Dr Richard Mihigo, a WHO Immunization and Vaccine Development officer, at the briefing. 

While cold storage capacity remains a big concern, countries can still rely upon pre-existing infrastructure – built over decades of vaccine campaigns – for vaccine cold storage. WHO is working with governments to support countries fill “cold chain gaps” before the exercise started, he said without providing details.

Information Campaign Also Needed 

Along with that, a systematic media campaign needs to accompany the vaccine drive, to counter misinformation already appearing in social media, said Professor Helen Rees, Executive Director, Wits Reproductive Health and HIV Institute at the University of the Witwatersrand, South Africa.

Recent studies in South Africa have indicated that different socio-economic groups have different perceptions towards vaccines, with men generally less willing to be immunized, and educated members of the society being more willing, she offered. On the other hand, young people feel less vulnerable to the disease like their counterparts around the world, she added.

“For these reasons we need to develop different messages for different groups and be transparent with what we know about the vaccines. For example we need to explain why a vaccine prioritizes group ‘A’ and not group ‘B’, added Rees, who is also the Chairperson of  WHO’s African Regional Immunization Technical Advisory Group (RITAG).

“Vaccines are one of the biggest global health goods we have, and we must ensure they reach as many people as possible,” the professor added.

Ensuring the vaccine reaches as many people as possible can be done through effective media campaigns.
Ongoing Studies Needed To Determine Which Vaccines Are Best For Africa

It was important to have ongoing studies on available vaccines even as vaccinations begin, to see how they respond to the “African situation” said  Professor Pontiano Kaleebu, director Uganda Virus Research Institute (UVRI).

Currently some of the COVID vaccines in various stages of clinical trial appear to be more effective in preventing development of severe disease, while others seem to offer better protection against infection in the first place. 

The latter would be more desirable, over time,  especially in Africa, where more of the cases are mild, he said. He echoed the sentiments of Moeti, that overall, the Pfizer vaccine is untuiable for African conditions, noting that even laboratories have trouble handling samples that need storage at -70 C.

So far Africa is the continent with the fewest infections — around 2.1 million cases and 50,000 deaths. More than 84 % of the infections have been mild or asymptomatic. It has also participated in the fewest number of trials for both drugs and vaccines. Although one major multi-country African trial of COVID-19 drug treatments, supported by the Drugs for Neglected Diseases Initiative (DNDi), just got underway this week. 

Image Credits: Twitter: @WHO, WHO, Jernej Furman/Flickr, CDC Global/Flickr.

Shelters in Central America overcrowded by hurricane evacuees have increased risk of COVID-19 transmission

New York City. The pandemic has been exacerbated by recent hurricanes in Central America, as a result of outbreaks in overcrowded emergency shelters, as well as travel during the American Thanksgiving season, health leaders said at a Pan American Health Organization (PAHO) press conference.

Last week, saw an increase of 1.5 million cases reported in the WHO “Americas” region, mostly in the USA where new cases are now averaging close to 180,000 a day, but also with climbing numbers in vulnerable populations and among indigenous communities in Central America, who are especially vulnerable due to their remote location and the challenge of access to the health infrastructure.

“Since the start of the pandemic, there have been more than 25 million cases and more than 700,000 deaths due to COVID-19 in the Americas,” said Dr. Jarbas Barbosa, Assistant Director at PAHO.

Back-to-Back Hurricanes Impact Pandemic Response in Central America

Central America’s pandemic surveillance system has been greatly impacted by recent hurricanes Eta and Iota. The number of cases reported has dropped dramatically in Honduras and Nicaragua, which have seen approximately 640 testing centres and other facilities hit by the hurricanes, which have affected more than 8 million people, also leading to widespread evacuations to hurricane shelters. 653,000 people have been evacuated in the region. The Caribbean, Guatemala, and El Salvador have also been similarly impacted.

“Shelters organized to host thousands of people in these countries do not necessarily have the conditions to prevent transmission from COVID-19,” said Dr Ciro Ugarte, Director of Health Emergencies. “This creates a very challenging situation.”

Decreased reporting of cases following Hurricanes Iota and Eta.

In Central America, hospitals and shelters have reported a lack of care personnel and capacity – increasing the risk of transmission of disease – as already vulnerable populations, like the elderly, have been left with limited or no access to healthcare. The region has also seen decreased water and sanitation services, making it difficult to maintain infection, prevention, and control efforts: all important in preventing the spread of waterborne and other communicable diseases like COVID-19. Collapsed roads have also prevented timely humanitarian response.

Ugarte noted at the PAHO conference that the health sector, supported by PAHO and other international NGOS, have been assisting assessment as well as emergency response.

Holiday Season Brings Good News of Promising COVID Vaccines but also Increased Transmission Risk

While Central America is facing increased transmission from a damaged healthcare infrastructure, there is another source also driving increased disease transmission and that is traveling and family gatherings during the holiday season, which began with Thanksgiving celebrations in Canada and this weekend in the United States.

“During an epidemic there is no such thing as a risk free holiday season. Every gathering, every shopping trip, every travel plan, you increase the chance of spreading the virus,” Dr Barbosa warned, advising against large social gatherings, especially indoors. He recommended that any gatherings be held in well-ventilated areas, with masks, or outdoors, and if that is not feasible postponed entirely.

The US CDC also has issued stiff warnings against travel and mixing between households. But on Thursday the United States Supreme Court also issued a stiff blow to authorities’ attempts to curb religious mass gatherings that can be superspreader events. The Court on Thursday ruled that limits which had been imposed by the City of New York on the number of people gathering in churches, mosques and synagogues – were unconstitutional because they impinged on people’s freedom of worship.

Travel Not Risk-Free Even With a COVID Test

Speakers also flagged that many people falsely assume that being tested means safe travels, free of infection. Testing often leads travelers into a false sense of security, as it does not guarantee risk of infection is eliminated. Countries must continually use data on the spread of the virus to reassess their travel guidance to make travel safer, they said.

Although November saw announcements of the very positive interim efficacy results of several potential vaccine candidates announced, with vaccine candidates produced by Pfizer and possibly Moderna, in line for emergency use approval by the US FDA by mid- or end of December, PAHO officials warned that vaccines are still some months off, in terms of reaching the general public.

“Unfortunately, we will not have enough vaccines to vaccinate everyone and stop the transmission,” Barbosa said. Once the vaccine is released, however, its use is still recommended in order to save lives. Achieving herd immunity, in theory, would only be possible if a population reached a threshold of 60-70% immunity, either through natural infection or vaccination.

The total number of confirmed vaccine doses procured, displayed by income level.

Even in the US, which has amassed the largest stock in the world of pre-purchased vaccine supplies from Pfizer, Moderna and others, it is yet to be determined who will be vaccinated first. In addition, officials are concerned about public resistance to vaccines. The most recent US poll showed 51% of people were inclined to be vaccinated, and while that is an increase from previously, it is still far lower than the 90% levels that would need to be achieved.

A much stronger public information effort needs to be undertaken to inform people about the personal and community-level benefits of vaccination against COVID-19, PAHO officials said. And more awareness raising needs to be done to inform the public of how the virus can be transmitted, particularly during the holidays.

Barbosa noted: “The individual decisions we make this holiday season affect the people closest to us. They will also impact our communities. Solidarity has been our region’s response to COVID-19. [Solidarity] is more important than ever, during the holidays.”

Image Credits: PAHO, Duke Global Health Innovation Center.

Winnie Byanyima, Executive Director of UNAIDS.

Far greater investment in global pandemic response is required to ensure that core public health initiatives, like AIDS prevention and treatment aren’t thrown off course by future pandemics, while roll-out of a cheap and accessible “People’s Vaccine” would help get other core public health programmes quickly back on track, UNAIDS has said.

In a message at the launch of the annual World AIDS Day report, Prevailing against pandemics by putting people at the centre, UNAIDS Executive Director Winnie Byanyima also called on the global pharma industry to unlock the secrets to their COVID-19 vaccine technologies to produce a cheap and accessible “People’s Vaccine”.

“Even today, more than 12 million people are still waiting to get on HIV treatment and 1.7 million people became infected with HIV in 2019 because they could not access essential services, said the UNAIDS head in her message. “That is why UNAIDS has been a leading advocate for a People’s Vaccine against the coronavirus. Global problems need global solidarity.

“As the first COVID-19 vaccine candidates have proven effective and safe, there is hope that more will follow, but there are serious threats to ensuring equitable access,” she said. “We are calling on companies to openly share their technology and know-how and to wave their intellectual property rights so that the world can produce the successful vaccines at the huge scale and speed required to protect everyone and so that we can get the global economy back on track.”

Byanyima’s comments followed upon her open letter to the The Financial Times, and published Thursday, which said that media coverage of fast-moving vaccine research has too often ignored “the fundamental problem of the failure of pharmaceutical firms to openly share their technologyand knowhow, and waive their intellectual property rights.

“The Pfizer/BioNtech and Moderna vaccines have received millions in public money, from the US and EU to develop these vaccines,” Byanyima added in her letter, referring to the two companies most likely to win regulatory approval in the next few weeks for the first vaccines against COVID to show efficacy, but which rely upon expensive mRNA technologies that are out of the price range of low- and middle-income countries.

“These vaccines are not private property to be sold for a profit, but public property to be mass produced for the global common good. We would urge all corporations to join the World Health Organization’s Covid technology access pool (C-TAP) and for their rich country backers to insist that they do so, given the huge public subsidy they have received. Only this will enable every vaccine producer in the world to manufacture on the huge scale required to protect everyone, and get our global economy back on track. We cannot let this be a profit vaccine; it must be a peoples’ vaccine,” Byanyima wrote in the FT letter.

Weak Health Systems Left World Unprepared For COVID

The UNAIDS report notes how insufficient investment and action on HIV and other pandemics left the world exposed to COVID-19. State UNAIDS: “Had health systems and social safety nets been even stronger, the world would have been better positioned to slow the spread of COVID-19 and withstand its impact. COVID-19 has shown that investments in health save lives but also provide a foundation for strong economies. Health and HIV programmes must be fully funded, both in times of plenty and in times of economic crisis.”

“The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price,” Byanyima also said. “Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.”

There are bright spots nonetheless, the UNAIDS report notes: “The leadership, infrastructure and lessons of the HIV response are being leveraged to fight COVID-19. The HIV response has helped to ensure the continuity of services in the face of extraordinary challenges. The response by communities against COVID-19 has shown what can be achieved by working together.

But the Organization warned that countries risk repeating the “mistakes” of the early days of HIV response – when millions of people in Africa died as a result of being unable to access expensive new antiretroviral drug treatments that were being rolled out in developed countries:

“The world must learn from the mistakes of the HIV response, when millions in developing countries died waiting for treatment. Even today, more than 12 million people still do not have access to HIV treatment and 1.7 million people became infected with HIV in 2019 because they did not have access to essential HIV services,” said the statement.

“Everyone has a right to health, which is why UNAIDS has been a leading advocate for a People’s Vaccine against COVID-19. Promising COVID-19 vaccines are emerging, but we must ensure that they are not the privilege of the rich. Therefore, UNAIDS and partners are calling on pharmaceutical companies to openly share their technology and know-how and to wave their intellectual property rights so that the world can produce successful vaccines at the huge scale and speed required to protect everyone.”

When asked at a press conference on Thursday about how young people will be considered in this startegy, she flagged that the risks posing young people today are different to those experienced by young people at the start of the AIDS crisis.

“The HIV pandemic is in its second – even third – generation, and the attitudes toward the disease each geneeration keep changing,” she said, citing that Uganda’s younger generation as viewing the disease as “just a chronic illness, like diabetes or hypertension”.

“They have no sense that it kills. They think you just live with it because they never saw the deaths,” she added. “I saw the deaths.” Young people today, in countries with a high number of cases are made more vulnerable by this lack of education, she said.

Countries Falling Way Behind – New 2025 Targets for Getting Back on Track

Modelling of the pandemic’s long-term impact on the HIV response shows that there could be up to 293,000 additional new HIV infections and up to 148,000 additional AIDS-related deaths between by 2022, the new UNAIDS report finds.In its latest report UNAIDS outlined a series of new targets for reducing HIV infections by 2025  – aimed at  getting progress that was admittedly already “off track before the COVID-19 pandemic hit” – back on the rails.

New HIV/AIDS treatment targets set out in the report aim at achieving a 95% coverage for each sub-group of people living with and at increased risk of HIV. By taking a person-centred approach and focusing on the hotspots, countries will be better placed to control their epidemics.

The targets  also focus on a high coverage of HIV and reproductive and sexual health services together with the removal of punitive laws and policies and on reducing stigma and discrimination. They focus on people most at risk and marginalized— including young women and girls, adolescents, sex workers, transgender people, people who inject drugs and gay men and other men who have sex with men.

And the 2025 targets also include the promotion of more ambitious anti-discrimination laws and policies – so that less than 10% of countries have punitive laws and policies vis a vis people living with HIV; less than 10% of people living with and affected by HIV experience stigma and discrimination; and less than 10% experience gender inequality and violence.

Although some countries in sub-Saharan Africa, such as Botswana and Eswatini, have achieved or even exceeded the targets set for 2020, many more countries are falling way behind, the Organization also noted, stating that nonetheless. “The high-performing countries have created a path for others to follow.”

 

Image Credits: UNAIDS.