World Trade Organization Director General Ngozi Onkonjo-Iweala presides over a meeting of the General Council discussing a proposal to suspend IP rules on COVID health products for the duration of the pandemic

The United States has swung its weight behind a hotly-debated proposal by India and South Africa to suspend intellectual property rights on COVID-19 vaccines for the duration of the pandemic.

The dramatic turnabout in the US position, announced Wednesday evening by US Trade Representative Katherine Tai, signals a sea change in the balance of powers around the debate over the IP waiver  – which until now had been supported primarily by low- and middle-income countries.

The announcement came on the heels of a World Trade Organization (WTO) General Council meeting where members seemed to be inching towards more granular, text-based, negotiations over the proposal by South Africa and India to temporarily suspend intellectual property rights COVID-19 treatments, tests and vaccines.

It also came just afrer the two co-sponsors had said that they would revise their original blanket waiver proposal  – in a bid to reconcile positions between the LMIC bloc of supporters and the primarily high-income opponents.

Now, with the US administration of President Joe Biden behind the waiver concept – albeit only for vaccines – the revisions required to eventually reach consensus may become less daunting.

“This is a global health crisis, and the extraordinary circumstances of the COVID-19 pandemic call for extraordinary meausres,” said Tai in her statement, published by the Office of the US Trade Representative. “The Administration believes strongly in intellectual property protections, but in service of ending this pandemic, supports the wiaver of those prpotections for COVID-19 vaccines,” she said in the statement.

“We will actively participate in text-based negotiations at the World Trade Organization (WTO) needed to make that happen.”

The US shift brought a swift reaction from all sides in the polarized debate – which has seen the pharma industry and civil society go head-to-head over the highly-technical IP issue.

A statement by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)  warned that waiving IP is the wrong answer to a complex problem.

“Waiving patents of COVID-19 vaccines will not increase production nor provide practical solutions needed to battle this global health crisis,” the statement said. “On the contrary, it is likely to lead to disruption, while distracting from addressing the real challenges in scaling up production and distribution of COVID-19 vaccines globally.”

Move Hailed by Waiver Advocates – But Some Protest Limitations To ‘Vaccines’

On the other side of the divide, the heads of WHO and most other global health agencies hailed the move, as did medicines access advocates, who have waged a hard camapign for the measure. But some voices also criticized the fact that the US statement referred only to “COVID-19 vaccines” and not treatments or tests – signalling the long road that still remains to reach consensus.

Among the first to express support was WHO Director General Dr Tedros Adhanom Ghebreyesus – who has not concealed his position on the controversial initiative.   The WHO DG called it a reflection of the “wisdom and moral leadership” of the United States.

Jeremy Farrar, director of the Wellcome Trust, an insitution that has invested heavily in key aspects of pharma’s COVID vaccine R&D, called it a “hugely important decision from Ambassador Tai and the USA.”

At the same time, Jamie Love, head of the advocacy group, Knowledge Ecology International, said that by only tagging “vaccines” and not COVID tests or treatments, the initiative still doesn’t go far enough.

“One reason why Biden will back a waiver on vaccines but not therapeutics or diagnostics, is that vaccines in foreign markets protect us. Therapeutics, diagnostics in foreign markets, don’t,” tweeted Love which has lobbied hard in the US and globally for the waiver.

“Yeah – I think this is the next step of the battle. Tons of money going into treatments now, no reason to leave them out,” tweeted back, Nick Dearden, director of the UK-based non-profit Global Justice Now.

At Wednesday’s WTO General Council meeting, meanwhile, WTO Director General Ngozi Okonjo-Iweala welcomed news of South Africa’s and India’s plans to revise the original IP Waiver proposal, submitted in October 2020.

She urged all WTO members to advance to more nuanced talks over ways to ensure trade enables the scale up of needed COVID health products, as well as ensuring their freer and more equitable flow between countries.

“I am firmly convinced that once we can sit down with an actual text in front of us, we shall find a pragmatic way forward, acceptable to all sides that allow the kinds of answers that our developing country members are looking at with respect to vaccines, whilst at the same time looking at research and innovation and how to protect them,” DG Okonko-Iweala said.

TRIPS IP Waiver – Proposal Seen Polarizing Debate

African health officials have appealed for more COVID vaccines after current supplies run out in some countries.

The TRIPS waiver, initially championed by South Africa and India. has since been co-sponsored by a total of 60 WTO members, including Kenya, Eswatini, Mozambique, Pakistan, Bolivia, Venezuela, Mongolia, Zimbabwe, Egypt, the African Group, and the Least Developed Countries (LDC) Group.

The proposal would suspend trade rules on COVID vaccines and medicines IP, governed by the WTO “TRIPS” Agreement on Trade Related Agreement on Aspects of Intellectual Property.  While current rules do allow for countries to produce their own versions of patented products during health emergencies, many lower and middle-income countries (LMICs) have said that the IP “flexibilities” are in fact too rigid, and don’t really allow for the rapid scale-up of vaccines and medicines required by the COVID-19 pandemic.

At the same time, G-7 countries, including the US, UK, European Union, Switzerland, Japan and Australia, as well as pharma industry stakeholders, have been lined up against the waiver proposal since its inception.  Opponents say that what is really missing is technical capacity in LMICs to produce their own health products.  In addition, broken supply chains for just one input into a vaccine, can create a bottleneck for manufacturing scale up.

With the new US position, It can be expected that a revised proposal, might seek to expand existing TRIPS flexibilities on vaccines, per se, while still stopping short of the blanket waiver that was proposed in October on all COVID tests, treatments and equipments.

A revised proposal might also address some of the deeper structural problems that exist in current trade rules – particularly the barriers that countries face when producing vital COVID health products under a “compulsory license”  – to exporting those products to third country partners. And at least rhetorically, a revised proposal may try to tackle some of the broader supply chain, tech transfer and capacity building issues that everyone agrees are obstacles.

In her statement Wednesday, Tai warned that negotiations on the waiver proposal “will take time, given the consensus nature of the institution [WTO] and the complexity of the issues involved.”

However, the debate is likely to resume soon. South Africa and India have already proposed that the TRIPS Council hold a special meeting open to all WTO members in the second half of May. That would be followed by a formal TRIPS Council meeting in early June.

WTO Needs “Sense of Urgency”

Keith Rockwell, WTO spokesperson at Wednesday briefing.

Iweala has constantly called for WTO members to etch a “third way” in the debate over the waiver issue. In her comments Wednesday, she urged WTO members to act quickly to ensure that the Agency can do its part to expand access to COVID treatments and vaccines more equitably.

“The way the WTO handles this matter is critical,” DG Okonjo-Iweala told members. “We need to have a sense of urgency on how we approach this issue of response to COVID-19 because the world is watching.”

“Vaccine policy is economic policy because the global economic recovery cannot be sustained unless we find a way to get equitable access to vaccines, therapeutics, and diagnostics,” she added.

WTO spokesperson Keith Rockwell said that Wednesday’s WTO discussion was “far more constructive, pragmatic” and less “emotive” and contentious than previous debates – with some 42 delegations taking the floor.

“We’ve learned in the last few weeks, that there is unutilized capacity in the developing world that can be tapped into in order to help to meet the demand,” said Rockwell.  But what’s also clear is that there are “many other things” driving shortages – even if the “TRIPS waiver …were to be approved in its in its revised form.

“There are many, many other factors that need to come into play. Among them, and perhaps the foremost among them is the importance of transferring know how to new production sites. It’s not enough to have the recipe for making these vaccines, you need to have the know how, as well that means, trained, skilled workers. It means having the right equipment. It also means having a regulatory infrastructure that is both strict and transparent.”

In line with that, he said that member states were now also focusing on these and other key barriers to scale-up: “Many members have also said he calls for much greater transparency in terms of dealings between, between innovators and producers and governments, so that the terms of the of the transfers of technology for example, are more clear to everyone involved. Those are important elements to this.

“In addition to that, we’ve seen a quite a lot of discussion about how it would be that we could tap into the unused capacity that’s been identified in recent weeks in the developing world,” he said, referring to Iweala’s estimates that the world may need to go from 5 billion doses [of all vaccines] produced last year to 10.8 billion – or even 15 billion doses – if there is a need to produce COVID booster doses.

Moving Ahead  – Iweala’s Four Points

Ngozi Okonjo-Iweala, Director-General of the WTO, at a press conference held shortly after taking office. She pledged to bring countries together over access to COVID vaccines.

In her closed-door comments at the WTO, Iweala stressed to members that countries need to step up the sharing of vaccines immediately – while negotiations over the waiver proceed.

“Those who have ordered more than they need, need to share them with others, either through the COVAX  facility or other mechanisms,” she was quoted as saying, by WTO spokesperson Keith Rockwell.

“Secondly, it’s important that we look closely at export restrictions and prohibitions, and bureaucratic procedures customs procedures, red tape that has slowed the trade in vaccines diagnostics and therapeutics,” Rockwell said.

Referring back to a high-level meeting with pharma companies last month, he noted that they had stressed that one of the biggest obstacles to ramping up production was access to raw inputs and materials:  “We heard from one company… they said that because of a lack of filters, they had to shut down the entire production process.

“So, even relatively simple or even mundane things like that vitals tubes, filters, if they’re not available, this can have an impact. Trading these products as well as in the ingredients for vaccines must continue.

Thirdly, Iweala stressed the importance of WTO member countries to work with manufacturers to enable them to mobilize the existing capacity that’s idle: “She mentioned countries that we’ve heard from – Pakistan, Bangladesh, India, South Africa, Indonesia and Senegal. All said, there is more capacity that has gone underutilized….because of the need for technology and the need for the raw materials.

Meanwhile, Iweala also urged Russia, China, Cuba and Brazil, which have vaccines under development, to “be in touch with the, with the World Health Organization to get emergency use authorization to enable universal access to these vaccines.”

So far, China and Russia have focused on bilateral deals for vaccine distribution to LMICs – rather than working through WHO and the global COVAX vaccine facility. While China’s vaccines are currently in late stages of WHO quality and efficacy review – although the Russian Sputnik V vaccine remains further behind.

Stocks In Vaccine Producers Plummet

Along with any statements, the industry reaction was also evident in the stock market.  Shares of Moderna, Pfizer and BioNTech dropped upon the US news – including a decline of 9.7% in Moderna stocks, which Bloomberg reported as the biggest intraday drop in two months. Pfizer dropped as much as 2.6% and American depositary receipts of Germany’s BioNTech retreated as much as 8.9%. Novavax Inc., which is also developing a Covid-19 vaccine, declined as much as 11%, Bloomberg reported.  By Thursday morning, however, some of the same stocks had rebounded.

This story was updated on 6 May.

Image Credits: @WTO, WHO African Region , BBC.

A new report recommends that governments prioritise funding and support for midwifery amid a global shortfall of 900,000 midwives.

Two in every three deaths in childbirth could be prevented by 2035 if the world starts recruiting and training more midwives, a new report on the “State of World’s Midwifery 2021” has found.

The report, launched by the UN Population Fund (UNFPA) on Wednesday found a  global shortfall of 900,000 midwives – and said that the global midwifery workforce needs to be expanded by some 30% to close that gap.

Compiled by the UNFPA, the UN’s sexual and reproductive health agency (UNFPA), WHO (World Health Organization), the International Confederation of Midwives (ICM) and other partners, the report evaluates the midwifery workforce and related health resources in 194 countries.

It states that for “midwives to achieve their life-saving and life-changing potential, greater investment is needed in their education and training, midwife-led service delivery, and midwifery leadership”.

Governments must prioritise funding and support for midwifery and take concrete steps to include midwives in determining health policies.

“Midwives play a vital role in reducing the risks of childbirth for women all over the world,” said WHO director general Dr Tedros Adhanom Ghebreyesus.

Increasing their numbers will “deliver a triple dividend in contributing to better health, gender equality and inclusive economic growth,” he said.

The last State of the World’s Midwifery report, published in 2014, also raised the alarm over shortages and provided a roadmap on how to remedy this deficit. But progress over the past eight years has been too slow, the report found. The analysis in this year’s report shows that, at current rates of progress, the situation will have improved only slightly by 2030.

ICM president Franka Cadee said “midwives are continually overlooked and ignored” and called on “governments to acknowledge the evidence surrounding the life-promoting, life-saving impact of midwife-led care, and take action on the report’s recommendations”.

Almost one in five women give birth without a skilled health provider, exposing both mothers and babies to risk,  the report  further found.

It gives the latest stillbirths estimates at about two million a year, along with an estimated 2.4 million new-born deaths and some 295,000 maternal deaths, either during or soon after pregnancy.

Describing the report’s findings as “alarming”, UNFPA executive director Dr Natalia Kanem  said 1.1million more essential health workers are needed  to deliver sexual, reproductive, maternal, newborn and adolescent health care, and 80 per cent of these missing essential health workers are midwives.

“A capable, well-trained midwife can have an enormous impact on childbearing women and their families – an impact often passed on from one generation to the next,” Kanem said.

The lack of midwives, the report states,  is driven by gender inequality, with countries overlooking sexual and reproductive health and under-estimating the value of a female-dominated workforce.

Fixing the gaps in provision could save an estimated 4.3 million mothers and babies a year, cutting two in three needless deaths by 2035, said analysis conducted for the report published in The Lancet medical journal last December.

The report urged governments to put money into boosting midwife numbers, improving training and offering midwives a greater role in health policy and maternal healthcare.

Image Credits: WHO, WHO SEARO.

German Chancellor Angela Merkel

The World Health Organization and the German government on Wednesday announced the launch of a new Global Hub for Pandemic and Epidemic Intelligence that aims to harness the world of big data, media and epidemiological reports to more rapidly identify and respond to emerging disease risks.  

The hub, to be launched in Berlin later this year, would bring together scientists, data experts and other know-how from governments, international organizations and the private sector, in new, and more flexible forms of collaboration, WHO’s Director of Health Emergencies, Mike Ryan, said at a press briefing on Wednesday. 

Launch of the hub is being supported by €30 million in seed funds from the German government, said officials at the briefing, addressed by German Chancellor Angela Merkel and Health Minister Jens Spahn.

“The WHO Hub for Pandemic and Epidemic Intelligence can make a difference for a safer future…(we should focus on) the development of a global data ecosystem to produce timely insights and tools for policymakers, before and after an epidemic and pandemic events,” Spahn said.

The hub would help gather data more efficiently to predict, prevent and respond to future pandemics and epidemic risks worldwide, said WHO Director General Dr Tedros Adhanom Ghebreyesus.

“One of the lessons of the Covid-19 pandemic is that the world needs a significant leap forward in data analysis to help leaders make informed public health decisions,” Tedros said. 

“This requires harnessing the potential of advanced technologies such as artificial intelligence, combining diverse data sources, and collaborating across multiple disciplines. Better data and better analytics will lead to better decisions,” he said.

Faster Identification of Threats and Responses

Some of the first SARS-COV-2 cases emerged around Wuhan’s “wet markets” selling wild animals for slaughter and meat consumption; such markets can be a flashpoint for pathogen transmission to humans.

The initiative responds to a key issue raised by WHO member states and independent reviewers regarding the initial stages of  COVID-19 pandemic response – and the belated recognition of the SARS-CoV2 outbreak that was now obviously simmering in Wuhan throughout the fall of 2019 – and possibly even spreading then to other countries, such as Italy, where COVID-positive serum samples from the period were later identified.

Even so, the first Chinese government and media reports of the mysterious pneumonia-like outbreak in Wuhan were only picked up on 31 December, 2019 – by WHO’s China country office as well as by the WHO EIOS (Epidemic Intelligence Open Sources) platform – which noted a report from ProMED, the International Society for Infectious Diseases.  

Following that, criticism has also been leveraged against the quality of data collection by WHO, China and other member states reflecting the early days of the pandemic spread  – which may have contributed to WHO’s delays in declaring an international public health emergency over the virus – which so far has killed over 3.2 million people worldwide. 

Although not “new”, the idea of a hub, according to Tedros, coalesced during discussions with Merkel in October 2020 about the creation of a centre that would serve as a global nerve centre to enhance global capacity for pandemic and epidemic intelligence.

Merkel, in a video message, said that the COVID-19 pandemic “has taught us that we can only fight pandemics and epidemics together”.

“The new WHO Hub will be a global platform for pandemic prevention, bringing together various governmental, academic and private sector institutions,” Merkel said, further welcoming WHO’s decision to base the hub in Berlin.

The hub will bring together governmental, academic and private sector institutions to harness global data, surveillance and analytics and will involve a global collaboration of countries and partners to look for pre-signals that go beyond current systems that monitor publicly available information for signs of emerging outbreaks.

Build Upon EIOS – CERN-like Model For Cooperation 

WHO’s Director of Health Emergencies, Mike Ryan

Ryan said that the hub would not be about creating another “big bureaucratic WHO institution” but rather a transformed and engaging centre.

He said that WHO envisages the platform as functioning similar to CERN, the European Organization for Nuclear Research – an iconic Geneva-area institution that brings together research fellows, visiting scholars and other experts for brief stints,  where they can share and apply their knowledge and skills. 

“It’s about creating a platform with Germany, where everyone can come and contribute. And this becomes a facilitating environment. We bring the best minds, we bring the best ideas and we facilitate that with the infrastructure and the tools and all of the things that we need…(to) allow others to take the real innovative steps to move us forward in this regard,” Ryan added. 

He said that the hub would build upon the networks created by EIOS – in a more sophisticated model – to become operational from September. 

Germany has offered a seed fund of €30 million annually as a startup for the hub, with WHO still working on further details of the budget, he added. .

Appeals for further funding are being discussed with various potential donors at the G7 level, said Ryan.

Berlin “Ideal Location” for Global Hub

German Health Minister Jens Spahn

Merkel said Berlin was an ideal location for the hub as it already had leading players in the digital and health fields, such as the Robert Koch Institute, the German federal government’s scientific research institution.

“If that expertise is now supplemented by the WHO Hub, we will create a unique environment for pandemic and health research here in Berlin — an environment from which important action-oriented insights will emerge for governments and leaders around the world,” she said.

Emphasising that the new hub would still fall under WHO’s governance, Spahn said Germany was offering an “enabling environment for the inter linkages between public health and digital players”.

“We are very confident that this local environment will provide numerous opportunities for synergies with a new double edge  for the hub,” Spahn said, echoing Tedros’ sentiments that there was a clear need for stronger early local warning alerts and emergency response system  to help improve public health intelligence and risk analysis.

Transparent Data is Imperative

WHO affirmed that data from the new global hub will be held openly and transparently.

While affirming that data, in principle, should be held openly and transparently, Ryan acknowledged that it will still be up to the member states and the rules of the International Health Regulations to decide how, and with whom, to share verified information. 

“The aim is to bring together partners from around the world to develop better access to data and to develop tools we need to generate the insights we need before, during and after pandemics. But, also to build  trust between partners in sharing that data in sharing those insights. We aim to bring that whole process together,” Ryan said.

He acknowledged, however, that access to data as well as tools for generating insight from such data is not evenly distributed across the member states.  And the hub would try to address those inequalities, as well. 

“I can assure you that that’s the point of the centre… to democratize that process, bring more parameters and create facilities, translate trends and transformative technologies on the capabilities to our member states.”

However, issues around transparency and accountability will not be solved by new technologies, but by building trust between partners in sharing data and insights, Ryan added.

Three independent panels are due to report at the upcoming World Health Assembly (WHA)on how the WHO and member states reacted to the pandemic, and propose reforms in rules and procedures.

Effectively the creation of the hub leapfrogs over what is likely to be highly politicized deliberations on those reforms at the WHA – to create at least one fait accompli that would support earlier warnings.   

Image Credits: Breaking Asia, UCT.

High-level panel on TRIPS waiver

CAPE TOWN – The “circular discussion” at the World Trade Organization (WTO) on the TRIPS waiver needs to move to “text-based” negotiations, Ambassador Xolelwa Mlumbi-Peter, South Africa’s Permanent Representative to the WTO said on Tuesday.

Her Indian counterpart, Brajendra Navnit, added that opponents of the waiver had been using “delaying tactics” since the beginning of the year, “changing goalposts” to raise new problems once their earlier concerns had been addressed.

Mlumbi-Peter and Navnit were addressing a high-level panel on Tuesday organised by a range of civil society organisations, on the eve of yet another meeting of the TRIPS Council on the waiver issue, set for Wednesday and Thursday. 

A waiver in the enforcement of patents, copyright, industrial designs, and trade secrets, under WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), was proposed in October 2020 by India and South Africa, for all COVID-related health products for the duration of the pandemic. 

This proposal has been supported by over 60 member states, but opposed by mostly high-income nations. During the ensuing six months of negotiations, a further two million people have died from the SARS-CoV2 virus, participants at Tuesday’s panel pointed out. 

A revised version of the TRIPS waiver proposal is to be presented at Wednesday’s TRIPS General Council “in a bid to reconcile positions”, according to the WTO.

‘Hopeful Signs” on US Position 

Ambassador Xolelwa Mlumbi-Peter, South Africa’s Permanent Representative to the WTO

Until recently, Mlumbi-Peters had chaired the WTO TRIPS Council, on behalf of South Africa, and had thus been unable to speak publicly in support of the waiver proposal. 

Another panelist, United States Congresswoman Jan Schakowsky, who has been championing the waiver in her country, said that it was still unclear if the US administration would support the waiver – but there were some hopeful signs of “dramatic change”.

“The United States position is evolving. There are divisions even within the administration – and [within] the Members of Congress, a majority of the Democrats have weighed in, in favour of a TRIPS waiver,” said Schakowsky.

“When Big Pharma talks about its priorities and that intellectual property rights rule everything, they are forgetting that the American people, the taxpayers, have spent billions and billions of dollars in research and development and distribution, have a huge stake in this,” she added.

No ‘Good Examples’ of Voluntary Licensing 

Schakowsky supported text-based negotiations on the waiver “to make the changes that are necessary that are going to allow all countries to have access”.

“We really don’t have the time to argue with the pharmaceutical industry,” said added.

Kathleen Van Brempt, Belgian Member of the European Parliament and the trade coordinator for the Parliament’s Progressive Alliance of Socialists and Democrats Group, proposed “a coalition of the willing” involving European and US politicians in particular.

Van Brempt said that opponents of the waiver claimed that it was an “ideological” proposal that would not facilitate the technology transfer needed to speed up vaccine production, and that this could be achieved with voluntary licensing of COVID-19 treatments and medicines.

“The facts and figures prove them wrong,” said Van Brempt. “I don’t know any good examples of voluntary licensing, or even of compulsory licensing, that would ramp up production. That is not the case today, and that’s why we have to move on.” 

Kathleen Van Brempt, Belgian Member of the European Parliament

Van Brempt added: “I’m very happy to see my colleague of the US Congress [Schakowsky]. I think we should work much more closely together  because I hear that the Biden Administration might move.”

She also suggested engaging with the pharmaceutical industry as a first step to inform them about “how unacceptable it is that they decide on the price, and they decide who can produce”, when these decisions “should be steered by governments”. 

She also suggested opening up the discussion on the TRIPS waiver with the aim of “ramping up [vaccine] production”. 

More Pragmatic Than Ideological

Ruth Dreifuss, former President of Switzerland, said that “unilateral, bilateral tools, like voluntary licenses, compulsory licenses, parallel imports have not adapted to the current situation”. 

“We urgently need a more global approach as proposed by India and South Africa,” added Dreifuss, who chairs WHO’s Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH) and was co-chair of the UN Secretary General’s High-Level Panel on Access to Medicines.

Neither voluntary licenses (issued by pharma companies) nor compulsory licenses (which may be issued by countries in health emergencies) are tools “that would allow us to go as swiftly as we should”, as they have always involved bilateral arrangements or decisions by individual states, which do not address the broader global situation.

“With more than $100 billion of public money invested in R&D and supply of vaccines and therapeutics, the risk taken by the pharmaceutical industry has been largely overtaken by the taxpayers,” Dreifuss added. “It is, therefore, an obligation for the states to guarantee fair access, and therefore the means to control the pandemic worldwide.” 

Dreifuss added that Switzerland “doesn’t share this idea, but I think it is a victim of a vision that is more ideological – not really pragmatic and adapted to the challenge we are facing now.” 

“Making the rights of intellectual property something very sacred is not a political position I can share,” she added.

 Van Brempt, meanwhile, said she had been encouraged that the ambassadors of India and South Africa are “not locked into their own truth” but open to negotiations.

“I might be wrong but I think I can establish a majority of the European Parliamentarians, but it will involve compromises, and maybe it will not say that we fully support the waiver, as requested by India and South Africa. Maybe it will need another wording, but what I want is a shift in how the Commission looks at it.” 

 

Image Credits: Tadeau Andre/MSF .

Taiwan Health Minister Shih-Chung Chen

“If we could participate in the WHO and World Health Assembly (WHA), the warning messages we would give to the organisation would receive more weight, and this would probably result in better responsive actions.”  – Taiwan Health Minister Shih-Chung Chen

Arguably, Taiwan has been repeating this statement  for decades. Yet when Chen’s mild words are matched with the COVID-19 pandemic experience, the familiar message is knife-sharp: WHO lagged for ten weeks after Taiwan started sending WHO warnings of a Chinese illness through its limited and informal channels on 31 December 2019. 

Weeks before WHO declared a pandemic on 11 March 2020, Taiwan had already implemented 124 pandemic policies other nations would have done well to emulate. 

Widely applauded for its management of the pandemic, Taiwan has one of the lowest per capita COVID-19 rates in the world and life on the island has largely returned to normal.

Taiwan’s plea to be included as an observer in the WHA and participate more actively in WHO expert consultations has become a broader topic of discussion this year  – perhaps due in part to the fact that with a population of almost 24 million, Taiwan suffered just 12 COVID-related deaths, with total reported cases only reaching 1,153 as of Tuesday. 

Even so, since 2016, after the Democratic Progressive Party won elections, Taiwan has been locked out of WHA participation, even as an observer – due to fierce objections from Beijing.  

The issue is sure to come up yet again at the upcoming World Health Assembly (24 May- 2 June), as one signal tweet by the US State Department spokesman last week, seemed to indicate. 

But the effectiveness goes beyond policy design and implementation. It reflects trusted leadership. When I returned to Taiwan in early February 2020, Minister Chen’s face was everywhere. 

From Dentistry to Pandemic  

Taiwan’s Health Minister didn’t start out as a rock star. Trained as a dentist at Taipei Medical University, Shih-Chung Chen (Chén Shízhōng) rose through the ranks of  Taiwan’s health leadership, becoming minister in 2017. He doesn’t mince words about China, but is known as the “iron minister” more for his sleep-in-the-office work ethic. Delivering hot meals to health care workers and other appearances also endeared him to the public.  

In our exclusive interview at Taiwan’s Central Epidemic Command Center, the minister who guided Taiwan through the pandemic explains how the 2003 experience with Severe Acute Respiratory Syndrome (SARS) led Taiwan to be prepared for the next threat.  

Health Policy Watch: Can you tell us the bare-bones story of Taiwan’s successful early interventions?  

Shih-Chung Chen: At the onset of the epidemic … no one really knew what was going on in China. But since we always have lots of interactions with China, we were quite attuned to relevant information, and were very alarmed when we received news [of a virus] from various sources. [Editor’s note: More than 800,000 Taiwanese live in mainland China, which is Taiwan’s primary business and export-import partner; cheap mainland labour also fills many low-end retail jobs in Taiwan.] 

We kept pursuing this topic and decided to act early on it. On 31 December 2019 we started with flight boarding inspections in the hope of stopping the virus from spreading, in case it did pose an epidemic threat. 

As a direct result from our SARS experience, the Infectious Disease Prevention and Control Act was already in place. This provided for horizontal communication between agencies during pandemics, as we knew very well that inter-agency cooperation is essential. [Based on the act], the Central Epidemic Command Center (CECC) was established on 20 January 2020. 

Three days later, when Wuhan locked down, the situation quickly escalated to alert level 2 – this mandated the multi-agency communication. On  25 February the COVID-19 Special Act was passed, and on 27 February  the CECC was established for the highest level of alert, under which all departments were required to send representatives to CECC for cooperative action. 

We collaborated closely with the Interior Ministry, since immigration, police and civil affairs are all under its jurisdiction. Because of this, we appointed the Interior Ministry’s Deputy Minister as our CECC ’s second in command.  

HP-Watch:  Can you comment on public adherence to pandemic guidelines?

S-C Chen: Every compliance requirement is hard to implement, although the actual rules themselves are not difficult. It’s easy to wear a mask and get new habits that discourage virus transmission – but to make all civilians willing to comply with these changes is hard.

Since in the longer term we want to be a trusted organisation, we decided to be transparent and start this conversation with the public using press releases and interactions through Internet platforms.  

Because the public perceives that we are transparent with policy, they have placed their trust in us and have complied well. It is because the public carried out these simple prevention practices that our first-line prevention efforts have been successful.

HP-Watch: Which Taiwan health policies do you consider most innovative? 

S-C Chen: First and foremost is our National Health Insurance (NHI), because this single-payer system is running well and has been effective in administering quality medical services with total coverage at low costs.  

The other experience we could share is how we succeeded in [pandemic] prevention while placing minimal restrictions on civilian life as a democratic country. These two aspects are what we could share most with the world, especially prevention.

Certain countries with more centralized authority were able to contain the pandemic with human rights tradeoffs. This is a contrast to Taiwan’s success as a democracy, and could be a good subject for study in the future.

Solid Privacy in Real-Time Cloud  

HP-Watch:Your high-tech, cloud-based information systems are widely praised, but outsiders often claim: they face commercial, privacy and legal issues in litigious private health systems. Have there been data breaches or other privacy nightmares with your system? 

S-C Chen: I don’t think there are data privacy controversies relating to the NHI system. . When the government centralized information on citizens, it is natural to worry that data will be used inappropriately. We should not avoid using cloud-based systems because of such concerns; instead we need laws that regulate how data can be used. 

It is two sides of the same coin  – you can only act fast when you have good information – and only have good information when data is timely. Whether the data is used for health administration or contributes to research advances and safer drug prescriptions … if you don’t get organised in those areas, then you won’t be enabled when you need them. 

Leaking of any data belongs to the realm of the law. So the law should be amended to regulate this area instead of [providing opt-out alternatives and] impairing the information system due to concerns over privacy. 

HP-Watch: What challenges do you see coming next, both in terms of COVID-19 and after Taiwan is immunised?

S-C Chen: Containment of the virus is going well currently. The next phase is vaccination. We have seen this offer encouraging results in countries like the US, Israel and UK. But we are also seeing failed attempts like Turkey and Chile, where after vaccination the pandemic got even more difficult to contain.Similar situations faced advanced countries such as Italy, Germany and Spain, with huge costs and losses. 

In relation to vaccination-related policies, civilians’ knowledge about the vaccines will be critical in determining vaccination’s ultimate ability to contain the pandemic. We will watch closely as other nations employ different vaccines and policies. There are new virus strains evolving and corresponding public worries whether vaccines will be effective; these doubts have influenced some people’s willingness to be vaccinated. 

I think we should be humble when we face the virus, but not be fearful without any limit. We should face the problem proactively, solving these issues one by one and collaborating with the world. 
Equal Isn’t Fair in Health Budget Cuts 

Another issue we are facing is the reform of NHI policy. We have a strong centralized power and fiscal policy: we have a total budget to execute and this budget dictates what we can spend. 

Our national insurance policy is run by the government based on a single-payer system. This means that adequate planning is critical… Too much centralized control created many issues, so alternatives in setting budget priorities should be discussed.  

It is not working to cut spending solely based on total budget changes. In other words, improving the health care system rather than solely suppressing medical expenses for better-looking numbers is one issue that we have to face.

 As far as the budget goes, the public wants to see how their health can benefit if more money is allocated to NHI, so we have to see how the budget can best serve people’s well-being. Since we have total coverage, everyone will share in these changes. 

Message to the World 

HP-Watch: Is there anything you wish the world understood about Taiwan’s health system and its anti-pandemic policies? Clearly both are unusually effective, yet Taiwan is often misrepresented through China’s claims when it receives global coverage at all. 

S-C Chen: For a very long time, China has used its political power and UN memberships as a roadblock to Taiwan in terms of public relations. But I think now, due to COVID-19, more countries are recognising China’s closed system and errors as well as the subsequent [health] effects from those errors.  

When global powers around the world see China’s actions and errors, this shifts the political atmosphere. Taiwan is eager to play a positive role, and especially now we should be proactive in service and exchanges. We want to be recognised globally for our policies, but also recognised for our engagement with global health and our long record of service. 

Internationally, Taiwan continues to seek ways to participate in the global health system. We also participate by providing our experience and supplying physical aid, and we will continue to help countries with health-related needs. 

However, due to our diplomatic situation and certain countries that don’t want Taiwan to serve in international organizations … we do experience setbacks. In the future, we hope like-minded countries will come to our side. This diplomatic help will allow Taiwan to help in more health-related contexts.

In the grander scale of things, future pandemics certainly can be even worse..Human disrespect for nature can bring disaster, destroy habitats and so on. 

It all comes down to what we understand: there are people who tend to think human beings are more powerful than nature. With this pandemic experience we will be more humble — knowing our limits and realising we can’t fight nature, but must co-exist with it. 

  • Val Crawford has worked in international news and scholarly publishing, and edited for United Nations University in Tokyo and the World Health Organization. She taught scientific writing, journalism and popular culture courses at Taipei Medical University from 2010 to 2019, and served as visiting professor at the University of the Philippines and Sri Ramachandra University in Chennai, India. 

 

Image Credits: Wikipedia.

India has received emergency COVID-19 supplies from several countries.

PUNE – For two weeks now Sijo Raju, along with a group of 20 young men and women, have been fielding calls from family members looking for oxygen cylinders, ventilator beds and ambulances. Finding a match can take a few hours as India’s overwhelmed health system and front-line healthcare workers try desperately to provide a semblance of care to the massive number of COVID patients.  

In the absence of a centrally coordinated response, citizens like Raju have stepped up. They verify messages posted online, guide family members to facilities with resources, and do their best to step in place of a government machinery that has effectively abandoned its citizens. 

“There is just too much information on the internet,” Raju told Health Policy Watch. While the group members, most of them in their 20s and 30s, are based in the Mumbai metropolitan area, they are now trying to help verify requests coming from across India and are among many such citizen groups that have banded together in the past few weeks.   

On 1 May, India reported over 400,000 cases – a record-high figure in the history of the COVID-19 pandemic so far. It was also the day the country officially lowered the age for those eligible for vaccines from 45 and above to 18 and above.

The government had placed orders for the additional vaccines that would be needed just two days before vaccination was to be expanded, and not surprisingly most young people aren’t able to find slots as they try to register for vaccines.  But Adar Poonawalla, whose company Serum Institute of India (SII) is responsible for supplying the bulk of the vaccines, said given that the orders were recently received, ramping up production would take still time.

Cases continue to rise in India overwhelming the country’s already fragile health infrastructure

Promoting Alternative Medicines
Meanwhile, India’s government is promoting a poly herbal drug named Ayush-64, calling it a “ray of hope”. The drug is being promoted by the Ministry of  Ayurvedic Medicines, Yoga, Unani, Siddha and Homeopathy (AYUSH). Alternative therapies are widely popular albeit not without controversy as mainstream treatments in the pandemic. 

The government said the drug has been found to be useful in mild to moderate cases. It is also promoting yoga as a way to “strengthen natural immunity”. Most COVID-19 cases are mild to moderate that require little to no treatment under normal circumstances.

“The claims made about certain AYUSH interventions in the absence of quality clinical studies and data being presented is unfortunate,” said Anant Bhan, a bioethicist and global health policy expert based in India.

“It could lead to reliance on interventions which could not be working, and take the focus away from interventions which do. As is the requirement with allopathic medicines, any claims about AYUSH interventions and utility in COVID-19 needs to be backed by data.”

Indian government’s push for alternative medicines comes at a time when Indians are in need of a planned COVID-19 response and urgent ramping up of health facilities. 

The country’s cases have been on an upward trajectory since March when Prime Minister Narendra Modi held massive election rallies in the state of West Bengal and allowed the Hindu religious event Kumbh Mela to go on that saw gathering of thousands of devotees to perform rituals by the holy river Ganges. Both these events ended up being super spreader ones and worsened the pandemic.

Restrictions continue in many high burden states in India and the popular cricket tournament Indian Premier League has also been postponed. The tournament had come under heavy criticism for continuing despite rising COVID-19 deaths. The secretary of the Board of Cricket Administration is Jay Shah, the son of India’s home minister Amit Shah, a key figure in the Modi Administration.

Aid Distribution and Vaccine Rollout

After India’s pandemic made headlines around the world, the country started receiving aid. Ireland became the most recent country to send aid and US aid has also arrived. Despite this, ordinary citizens continue to struggle for basics based on messages on social media. 

The government issued a statement saying that the aid will be distributed based on the number of cases and the need in the states – after questions were raised in the Indian media about the plans for distribution. 

This while the public waits for the Serum Institute to ramp up its production further.

India’s Supreme Court has also pulled up the Modi administration for failing to regulate the prices of the vaccines. Currently vaccine manufacturers are offering different prices to the centre and state governments, as well as private players, as Health Policy Watch reported in an earlier story.

Health experts have said this would set a dangerous precedent while policy experts have criticized the government for its handling of the vaccine distribution.  

Disha Shetty is an independent journalist based in Pune, India

Image Credits: @MEAIndia -Ministry of External Affairs, Spokesman's office , Our World In Data .

East African truck drivers will get access to one common COVID-19 testing system by mid-May.

KAMPALA – Uganda, Kenya and Rwanda have suspended passenger flights from India amid that country’s surge in COVID-19 cases and  fears that a number of African countries are on the brink of their own surges.

“All flights from India and all passengers originating from India are suspended from 1 May,” the Uganda Ministry of Health said in a statement. “All passenger flights are suspended until further notice. No travellers from India shall be allowed into Uganda regardless of the route of travel.”

Meanwhile, Kenya has suspended flights from India for 14 days, according to the Kenya Ministry of Health. Kenya Airways and Rwandair have also suspended flights from and to India.  

However, East African residents will be allowed to return home. India is a top medical tourism destination for residents in East Africa. 

The three countries are demanding that travellers who have been to India or travelled through India in the last 14 days, be in possession of a negative PCR COVID-19 test certificate that is digitally verifiable and has been conducted within 120 hours of travel. They will also undergo a PCR test upon arrival.

Uganda will allow cargo flights from India where the crew do not disembark and technical stops where travelers do not disembark. It is also allowing aircraft in a state of emergency, operations related to humanitarian aid, medical evacuation, diplomatic flights approved by the appropriate Authority.

Uganda has also advised travellers from the USA, United Kingdom, United Arab Emirates, Turkey, South Africa, and Tanzania to consider postponing non-essential travel to Uganda.

Travellers from these countries, including Ugandans, will be subjected to a PCR test upon arrival at the points of entry into the country said Dr Jane Ruth Aceng, Uganda’s Minister of Health, during a weekly briefing.  

“We should make a difference between people and the virus. The virus is the enemy, not the people. If someone has an authentic negative PCR test, they do not cause a problem,” said Dr John Nkengasong, director for Africa Centres for Disease Control and Prevention (CDC).  

Truck Drivers’ Testing is Tightened

The East African Community (EAC) is tightening up on the COVID-19 testing requirements  of interstate truck drivers, identified as vectors of the virus, amid numerous problems including forged tests 

At a recent EAC meeting, Uganda, Kenya, Tanzania, Burundi and South Sudan agreed to submit the names of accredited national laboratories for COVID-19 testing so that these could be linked to the upgraded Regional Electronic Cargo and Driver Tracking System (RECDTS), which recognises digital COVID-19 certificates for truck drivers.

The deadline for uploading all accredited COVID-19 testing laboratories in the RECDTS is 15 May. This will ensure that interstate truck drivers and other travellers test for COVID-19 in only through accredited laboratories and that all partner states take up and implement the RECDTS system.

Digital certificates are uploaded on the drivers’ smartphones through an app and are valid for 14 days. The App, which was launched in September 2020, was developed with donor funding. It provides a surveillance system to monitor long-distance truckers’ health and enables contact tracing. It also allows partner states to electronically share truck drivers’ COVID-19 test results.

The new system is aimed at resolving some of the challenges that were being experienced in the execution of health protocols including multiple testing of truck drivers at the border crossing as there lacked a framework of mutual recognition, document fraud and conflicting test results.

The interstate truck drivers also are the single largest group of people who have been identified to be carrying the variants of concern – the  B.1.351 variant from South Africa and the B.1.1.7 from the UK. From 399 samples sequenced by the Uganda Virus Research Institute (UVRI) these two variants were detected in 30 truck drivers.The Indian variant has been identified in one patient who was admitted to Mulago Hospital.

By Wednesday, the EAC Secretariat expects to have shared a detailed concept note on the development of a common regional health pass to be linked to the upgraded surveillance.

Uganda and Kenya Cases Increase

By Monday, the Ministry of Health in Kenya had reported that 369 people had tested positive for the disease, from a sample of 4,469 tested in the last 24 hours – a positivity rate of 8.3% compared to the world average of 2.2%. 

A total of 1,298 patients are in various health facilities countrywide, while 6,652 patients are in isolation at their homes and 19 had died in the 24 hours before Monday. Total confirmed positive cases are now 160,422 and cumulative tests so far conducted are 1,679,779.

Some 190 patients are in the ICU, 29 of whom are on ventilatory support and 118 on supplemental oxygen – 43 patients are on observation. 

Aceng said that Uganda was “experiencing a gradual increase in the COVID-19 cases and it is the beginning of a resurgence”. 

“This surge is already showing in districts that have remained on high alert and have been carrying out active surveillance,” said Aceng, adding that “this second wave will be worse than the first one”.

Uganda has already organised a resurgence plan which is projected to cost over $290 million and is organised around three thresholds: control, alert, and action. The alert threshold is reached when there is a 10% increase in cases while the action threshold begins when there is a 20% increase in the cases observed from the baseline in any geographical location.

“The main objective of the resurgence plan is to mitigate transmission and minimise the public health and social economic impact,” said Aceng. The resurgence plan will include enhanced surveillance, active case search, contact tracing, procurement of test kits, Personal Protective Equipment, critical care support, strengthening community engagement and risk communications, and supporting the vaccination teams but it does not include procurement of vaccines.

By 30 April, Uganda’s cumulative COVID-19 cases stood at 41,866 with 342 deaths. There are currently 444 active cases.

WHO Warns of African Resurgence

Dr Matshidiso Moeti, WHO Regional Director for Africa.

The World Health Organisation (WHO) predicts a high risk of COVID-19 resurgence in several African countries due to poor adherence to public health measures, mass gatherings, low testing and vaccination rates.

“We cannot be lulled into a false sense of security. The devastating surge of cases and deaths in India, and increases in other regions of the world, are clear signs that the pandemic is not yet over in African countries,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. 

“ A new upsurge of COVID-19 infections is a real risk in many countries even if the region’s case count in recent weeks appears to be stable,” she added. “Combatting COVID-19 fatigue appears to be the key battle in our collective response to the pandemic.”

According to the WHO analysis of 46 African countries, Kenya, Egypt, Ethiopia face a very high risk of resurgence, while a further 20 countries face a high risk and 22, moderate risk, and only one country faces low risk. 

The risk was calculated using seven indicators with data from the past four weeks, including COVID-19 cases per million people; the percentage of change in new cases; the percentage of change in new deaths; the reproductive number (the rate at which an infection spreads); the pandemic trend; the average weekly number of tests per 10 000 people; and the percentage of the population that has received at least one vaccine dose.

With more than 4.5 million confirmed cases and over 120 000 deaths to date, the continent has not experienced a surge in cases since January and the epidemic curve has plateaued for six weeks. 

But the relatively low number of cases has encouraged complacency and reduced adherence to behavioural measures to prevent the spread of the virus.

In addition, recent political rallies in Benin, Cote d’Ivoire, Guinea and Kenya caused a spike in new cases. Upcoming elections in Cape Verde, Ethiopia, Gambia, Sao Tome and Principe and Zambia could also trigger cases due to mass gatherings, said Moeti.

Of the 46 countries analysed, 31 performed fewer than 10 tests per 10,000 people per week in the past four weeks.

“Most new cases are still not being detected among known contacts. Investigation of clusters of cases and contact tracing are worryingly low in most countries in the region,” Moeti said. “We must scale up testing including through rapid diagnostic tests to enhance response to the pandemic.”

 

 

Image Credits: EAC.

A shipment of the Chinese Sinopharm vaccine reaches Peru

The World Health Organization (WHO) appears to be inching towards the approval of the Chinese Sinopharm and Sinovac vaccines as it struggles to fill a looming vaccine vacuum left by India’s Serum Institute – which has halted exports as the country continues to reel from a tragic coronavirus outbreak. 

Meanwhile, the WHO declared the latest Ebola outbreak in the Democratic Republic of Congo to be over, just three months after the first case was reported in North Kivu.

Chinese Sinopharm & Sinovac May be Approved By End of Week

Mariângela Simão, WHO Assistant-Director General for Access to Medicines

The Chinese vaccines from Sinopharm and Sinovac could be approved by the end of this week, noted the WHO Assistant Director-General for Drug Access, Vaccines and Pharmaceuticals Mariangela Simao, speaking at a WHO press conference on Monday.

“We are finalizing the assessment of Sinopharm [but] there’s still some documentation that needs to be added,” she said. “We will start the final assessment for the listing of Sinovac on the fifth [of May], so we expect both the Chinese vaccines [to] be finalized by the end of this week.”

If both vaccines receive the WHO’s green light, China could could become the world’s largest vaccine supplier, assuming that Sinovac and Sinopharm will honor their commitment to produce two billion vaccine doses this year.

Despite the lack of published data for the two vaccines, as well as their hefty price, both seem to have met the WHO’s minimum efficacy requirement of 50%, the WHO’s chairperson of Strategic Advisory Group of Experts (SAGE) said late last month.

With regards to the WHO’s approval of another vaccine frontrunner that seems to be significantly more potent and cheaper than its Chinese counterparts, Russia’s Sputnik V, the WHO expects a final decision by June or even July, said Simao. 

“WHO still does not have the entire dossier [for Sputnik], it’s not complete yet,” she said, noting that the WHO is in the process of assessing good clinical practices for Sputnik V and is set to begin evaluating manufacturing practices next Monday until early June. 

“We expect that as soon as we have the entire dossier, plus the compliance to both good manufacturing practices and the good clinical practice, the vaccine can be assessed then by the technical expert group [SAGE] and we expect that this is likely to happen [by the] end of June or probably in July.”

Ebola Outbreak in DRC Declared Over by WHO

Meanwhile, the WHO’s Director General, Dr Tedros Adhanom Ghebreyesus, hailed the DRC’s milestone in bringing an end to the twelfth Ebola outbreak in the country – a deadly disease that kills about half of the people it infects. 

“Earlier today, the government of the Democratic Republic of the Congo, announced the end of the most recent Ebola outbreak three months after the first case was reported in North Kivu,” said Dr. Tedros on Monday, emphasizing that a comprehensive public health approach was crucial in ending the latest outbreak of Ebola.

“Huge credit must be given to the local health workers and the national authorities for their prompt response, tenacity, experience and hard work that brought this outbreak under control,” added Dr Matshidiso Moeti, WHO Regional Director for Africa. She was referring to the country’s swift move to vaccinate almost 2,000 people at high-risk of contracting the virus and providing treatment as soon as the outbreak was declared in February.

However, she stressed that going forward, strong surveillance systems will be crucial to swiftly detect potential flare-ups and to fight parallel epidemics of measles, cholera and COVID-19.

“Although the outbreak has ended, we must stay alert for possible resurgence and at the same time use the growing expertise on emergency response to address other health threats the country faces.”

Image Credits: Sinopharm, Peruvian Ministry of External Affairs.

JOHANNESBURG – South Africa received its first batch of 325,260 Pfizer vaccine doses late on Sunday night, Health Minister Zweli Mkhize announced.

This follows lengthy negotiations between the South African government and Pfizer, during which the company made “difficult and sometimes unreasonable” terms including at one stage that the country put up sovereign assets as potential collateral, according to a report by the Bureau of Investigative Journalism.

South Africa’s Health Minister Zweli Mkhize

Mkhize sent a briefing letter to parliamentarians last month, saying that the government had been “relieved” when Pfizer eventually removed the “problematic term” which had put the government in the “precarious position of having to choose between saving our citizens’ lives and risking putting the country’s assets into private companies’ hands”, according to the bureau.

Samples of the Pfizer vaccines are currently undergoing quality checks by the National Control Laboratory, and will then be sent to urban vaccination centres where they will be administered to healthcare workers.

The country expects approximately the same number of doses – 325 260 – to arrive each week during May and 636 480 doses per week in June, with close to 4,5 million doses having been delivered by the end of next month.

Each person needs two doses of the vaccine, which also needs ultra-cold storage which makes it unsuitable for rural distribution.

Johnson & Johnson Vaccines Also Being Checked

South Africa has only vaccinated slightly more than 320,000 of its estimated 1.2 million health workers so far. The country opted not to use the AstraZeneca vaccine following research that showed that it had limited efficacy against the B.1.351 variant dominant in the country.

Until now, it has been vaccinating health workers with a very limited supply of the Johnson & Johnson (J&J) vaccines. However, 1.1 million more J&J vaccines are in the country undergoing safety checks that are likely to be completed in mid-May. 

“This is due to a protracted safety verification process with international regulatory agencies,” said Mkhize in a statement on Sunday. 

“This is a precautionary measure following the adverse findings during inspection of Emergent BioSolutions Bayview facility in the United States, one of the manufacturing partners of Johnson and Johnson, which prompted the authorities to extend their assessments of all Johnson and Johnson stock worldwide.”

Once through the safety checks, the J&J vaccines will be used in rural settings as they don’t require ultra-cold storage and people only need one dose.

The country plans to start vaccinating all citizens over the age of 60 from 17 May.

Meanwhile, South Africa’s National Institute for Communicable Diseases (NICD) has released modeling data last week which predicts that the country can expect a “third wave” of the pandemic in two to three months – but that this is not likely to be as severe as the second wave as long as there are no new variants.

“The most likely drivers of a third wave are behaviour change after the end of the last wave;  ongoing viral mutation; seasonal factors; and reinfection due to the waning of immunity conveyed by previous infection,” according to the NICD.

Image Credits: US Centers for Disease Control, GCIS.

Gavi will receive 500 million doses of the Moderna vaccine to help expand vaccine coverage around the world

Gavi, The Vaccine Alliance, has secured half a billion doses of Moderna’s mRNA vaccine for the COVAX global vaccine facility in a landmark agreement that will deepen vaccination coverage in poor countries around the world, Gavi said on Monday.

Meanwhile, Sweden announced that it will donate one million doses of the AstraZeneca vaccine to the global COVAX facility to help fill an urgent shortfall of 20 million doses as the world’s vaccine powerhouse, the Serum Institute of India, has diverted most of its vaccine supply to fend off a devastating outbreak in the country. The announcement came as WHO’s Director General Dr Tedros Adhanom Ghebreyesus said in a press conference that COVAX and related medicines access initiatives face an immediate funding gap of US$19 billion, along with “further needs” of US $35-$US40 billion over the coming year. 

“We will only solve the vaccine crisis with the leadership of G7 countries,” Tedros said, speaking at a WHO press conference that featured an appeal by former British Prime Minister Gordon Brown to rich countries to immediately donate more excess vaccines.

Brown, now the UN Envoy for Global Eradication, also joined WHO in an appeal to G7 nations to dedicate some US$ 20 billion a year from their combined resources to a more robust pipeline of COVID vaccines and medicines – at an upcoming G7 meeting 11 June.

“Mass vaccination is not just an epidemiological and ethical imperative. It’s an economic imperative,” stressed Brown. “But if the cost of vaccines is in billions the overall savings is in trillions of additional economic output, made possible when trade resumes in a COVID free world.”

“In the next few months we do not expect the Serum Institute of India to be able to supply the kind of [vaccine] volumes that were originally predicted. And so it would be really helpful to get [additional] doses from other countries,” said WHO Chief Scientist Soumya Swaminathan, speaking at the briefing.

Senior WHO advisor Bruce Aylward, meanwhile, said that the immediate donation of 20 million doses is needed to ensure that vulnerable populations who have already received their first dose would get a second jab as soon as possible.

Moderna Will Supply COVAX With 34 Million Doses In 2021 and 466 Million In 2022

Moderna’s latest agreement will allow COVAX to receive 34 million doses in the fourth quarter of 2021 and 466 million doses in 2022, with an option to access a vaccine jab that is adapted to emerging variants, said Gavi in its press release. 

The announcement comes a week after Moderna pledged to expand its production capacity to three billion doses by 2022 and received the WHO’s stamp of approval – making it the fifth vaccine to be approved by the global health body to date. 

“This is an important milestone as we work to ensure that people around the world have access to our COVID-19 vaccine,” said Moderna’s CEO Stéphane Bancel in a press release.

“We recognize that many countries have limited resources to access COVID-19 vaccines. We support COVAX’s mission to ensure broad, affordable and equitable access to COVID-19 vaccines and we remain committed to doing everything that we can to ending this ongoing pandemic with our mRNA COVID-19 vaccine.”

“Expanding and having a diverse portfolio has always been a core goal for COVAX, and to remain adaptable in the face of this continually evolving pandemic – including the rising threat posed by new variants,” added Gavi CEO Seth Berkley in a press release. “This agreement is a further step in that direction.”

Moderna’s latest agreement represents the largest commitment of mRNA vaccines to COVAX yet, given that Pfizer/BioNTech, another mRNA vaccine frontrunner, has committed a mere 40 million doses to the global vaccine facility. 

Unlike the vaccine from Pfizer/BioNTech which needs to be stored at temperatures as cold as -60ºC, Moderna’s vaccine can be stored in a standard fridge at 2-8 °C for one month, and potentially for up to three months, said Moderna’s CEO last week; those looser storage requirements for Moderna’s vaccine are likely to ease its distribution to low- and middle-income countries that lack the cold-chain infrastructure to store vaccines at sub-zero temperatures. 

Sweden’s Vaccine Donation Hailed as ‘Superb’ Gesture by Tedros 
WHO director-general Dr. Tedros Adhanom Ghebreyesus and Per Olsson Fridh, Sweden’s Minister for Development Cooperation, met at WHO’s headquarters on Monday.

Meanwhile, WHO’s Director-General Dr Tedros Adhanom Ghebreyesus hailed Sweden’s donation of one million vaccine doses to COVAX as a “superb gesture” and urged the rest of the world to follow suit. So far, only a handful of countries have donated doses to COVAX, including New Zealand and France, which donated 13 million and 1.6 million doses to the global vaccine facility, respectively.

“Sweden’s announcement that it will share 1 million doses of COVID-19 vaccines with COVAX is a superb gesture that must be replicated urgently, and repeatedly, by governments around the world to accelerate the equitable rollout of vaccines globally,” said Dr Tedros in a press release Monday, shortly after his meeting with Per Olsson Fridh, Sweden’s Minister for Development Cooperation.

“Such support will ensure that people in vulnerable countries, especially, in Africa, will be able to receive their second doses through the COVAX initiative,” he added.

Gordon Brown Makes US$30 Billion Year Pitch To G7 For COVID Medicines & Vaccine Finance
Gordon Brown UN Envoy for Eradication at WHO press briefing 3 May 2021

Meanwhile, in the leadup to the next G-7 meeting on 11 June, Brown said that he was joining WHO in an appeal to the Group of 7 most industrialized nations to finance some US$ 30 billion in mass vaccination, affordable tests and treatments for lower- and middle-income countries.

“The bill for mass vaccinating the world and ensuring access also to tests and treatments is affordable: a total of around US$30billions a year,” he asserted. “If spread across the richest countries – its just 25 cents a week per citizen – and it is money we cannot afford not to spend. ”

“In total over 2 years we need to raise an estimated US$60 billion, which is not only to cover vaccines, research, production and distribution to 92 lower income countries, but help pay for vital medical supplies including diagnostics and medical oxygen currently and shamefully in short supply in India and elsewhere.

“Based on ability to pay – a formula that takes into account national income, current wealth and benefits from the resumption of trade, America would pay 27% of the costs Europe 23%, the UK 5%, Japan 6%, Korea Canada and Australia 2% (each), he said,” noting that those G7 contributions alone would cover about 67% of the US$ 30 billion needed – or about US$ 20 billion.

” I say to the G7, the forum that on June 11, six weeks from now, brings together the world’s seven richest countries: you have the power and the ability to pay for nearly two thirds (of the total costs)  and secure a historic breakthrough by agreeing an equitable burden sharing formula for global health provision.”

He said the proposed measures would also include expansion of international finance for grants for low income countries, and creation of a guarantee-based finance facility for middle income countries.

“I say to the G20: with your leadership, we can cover over 80% of the costs, and you have the means to urgently donate vaccine doses to cover the gap in supply.

“I say to the richest 30 countries in the world: you can cover almost 90% of the costs. And the same burden-sharing formula can also be applied – so that instead of the familiar pandemic cycle of ‘panic now’ and neglect later, the world invests now now, when there is a shortfall, and for the future in pandemic preparedness…to ensure that even if future outbreaks happen pandemics become preventable.”

Image Credits: Gavi , WHO .