Animal parts (including from endangered species) go into the Chinese medicines sold at this market stall in Dali, Yunnan, China.

A new appeal about the course of the SARS-CoV2 virus hunt, penned by an international group of scientists, urges WHO member states to seize the moment of the upcoming World Health Assembly to adopt a much tougher mandate, with more rigorous scientific measures, to get to the truth of whether the SARS-CoV2 virus first infected humans from a natural source, a wild animal market, or in a laboratory.  

The letter praises WHO’s Director General Dr Tedros Adhanom Ghebreyesus’ recent admissions of the shortcomings of the investigation conducted by a panel of WHO-convened scientists in January and February, 2021 as a  “courageous defense of the scientific method and of the WHO’s integrity.” 

But the letter calls upon the WHO Executive Board and WHO member states to take up the gauntlet more squarely in pursuit of the real cause of the pandemic – leaving “all possible origins of the COVID-10 pandemic” on the table – including the possibility the virus first infected humans in the wild, as a result of contact with farmed wildlife, or due to a lab escape. 

In their third appeal in as many months, published Friday, the scientists also called upon China to grant unfettered access to the remote Mojiang mine in Yunnan Province, including release of confiscated samples and censored data – so that researchers can unlock the mysteries it may hold. 

The mine was the site of where a group of six miners became infected with a mysterious pneumonia-like illness in 2012. 

“To this day all the coronaviruses most closely related to SARS-CoV-2 come from that Mojiang mine,” the letter notes, asking: “Were any SARS-like coronaviruses isolated from the patient samples? What samples were taken from these six patients and sent to the WIV [Wuhan Institute of Virology] and other labs? Are any of these samples available for independent analysis?”

‘Treasure Map’ for way forward

Novel Coronavirus (2019-nCoV) Global Cases as of 28 January 2020 – just before WHO declared a global health emergency,

“It should be clear to everyone that any pandemic origins process that does not fully investigate the possibility that this crisis stems from an accidental lab leak and cover up can not be considered credible,” Jamie Metzl, a senior fellow of the US Atlantic Council, and co-organizer of the appeal, told Health Policy Watch. 

“It should deeply concern everyone that a year and a half after the outbreak, with over three million people dead and conditions worsening dramatically in many parts of the world, there is still no international process for fully investigating the origins of this pandemic. Not understanding how this crisis began leaves us at much greater risk of the same thing happening again.   

“We’re entering the era of synthetic biology where it’s easy to imagine future pandemics far more dangerous than this one. If we can’t get to the bottom of how this crisis began and address our many shortcomings, how can we possibly imagine we’ll be ready for the next one?”

“Our open letter is essentially a treasure map to help guide any credible COVID-19 origins investigation process going forward. We’ve listed some essential questions to ask and resources where critical data can be found,” said Metzl adding that the choice of directions, nonetheless, remains up to WHO member states: 

“Tedros has shown great leadership and courage by rejecting pressure to limit the scope of examination into pandemic origins and essentially risked his career by calling for a full investigation into all origin hypotheses, including a possible lab incident. The very least world leaders can do is support him and the WHO in this effort.”

https://twitter.com/JamieMetzl/status/1388099197254131717

Wild animal, farmed animal, or lab escape? All avenues need more research 

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team in early February, 2021. Critics say WIV officials did not cough up the laboratory’s secrets

Next steps into the origins issue should dig much more aggressively into all three possibilities on the table: “exclusively ‘natural’ zoonosis in the wild, human contamination in an animal farm, and a research-related accident,” the group of 26 scientists also say. 

They discounted out of hand a fourth theory propagated by Chinese authorities that the virus contamination somehow came from imported frozen foods. 

Along with further critique of what has gone wrong, the letter charts a political and technical way forward for what should happen next, including key provisions such as: 

  • More explicit language in a draft WHA resolution that acknowledges all theories – and supersedes the “reductive language” of the resolution adopted last year, which referred solely to the ‘zoonotic’ origins of the virus.  
  • Broader mandate and revised terms of reference for a team of independent experts mandating it “to conduct a full scientific and forensic investigation into all possible origins of COVID-19, be it zoonotic or not,” – as compared to the softer role assigned to it now to “recommend, help design and review scientific studies.”
  • Removal of China’s veto power of team members and revised criteria for team selection – ensuring WHO Executive Board oversight of the selection process, and inclusion of experts in biosafety and biosecurity, biodata and forensic investors in the team “as the WHO previously very successfully did following the SARS lab-leaks in Singapore and Taiwan in 2003/4.” 

Said Metzel upon the release of the letter: “The people who’ve died, are now dying & will die from #COVID19 deserve the fullest possible investigation into how this terrible pandemic began & our other failures. Our leaders, the @UN & @WHO have a sacred obligation to make that happen. #China has no legitimate right to refuse.”

Upcoming World Health Assembly debate – a key moment  

Chinese experts present their ‘frozen food’ theory for the emergence of SARS-CoV2 in Wuhan at a 9 February, 2021 press conference wrapping up the WHO -International expert mission.

In terms of the upcoming World Health Assembly debate, a 20 April copy of the draft WHA resolution that refers to the origins issue, obtained by Health Policy Watch, reflects the continuing, deep disagreements among member states over how the virus quest should be pursued. 

Proposals for a “strengthened” WHO mandate on that issue (and many others) remain up for grabs – with extensive sections still marked up as additions or deletion – rival geopolitical blocs.   

Notably, China and its allies want to water down references to WHO’s mandate to collect animal and ecosystem health data for the rapid “investigation” of public health risks and events, proposing that the reference merely be to “assessment”. (P4.2). 

China also wants to limit the obligation of countries to share pathogens and genetic sequences with the global agency – adding a caveat that this be done “in accordance with” national laws and regulations.(OP 4.3).  

Richard H. Ebright, a molecular biologist at Rutgers University said the next steps at WHO  remains a key turning point in the future of the origins research.  

“The draft resolution on strengthening WHO preparedness and response is too limited (and could be limited further by an amendment proposed by China and Russia that deletes the word ‘investigation’, and by an amendment proposed by China that nullifies the requirement for sharing samples and sequences by subjecting it to ‘national…laws and regulations’),” Ebright said. 

More rigorous methods and protocols 

Wuhan’s Huanan seafood market that has been closed since early 2020 after one of the first clusters of COVID-19 cases were detected there.

The letter’s authors, which include scientists from the US, Australia, New Zealand, Japan and India, as well as Austria, Belgium, France, Germanny and Spain, also call for a major overhaul of methods and protocols used in moving forward in the virus origins research, including far greater access to data and a much wider range of freedom for scientist-investigators, including the right to conduct confidential interviews. Specifics include:  

  • Clearly listing the possible paths for virus evolution and human infection and allocating enough time to examine all paths, without a priori assumptions;
  • Ensuring factual data supports all assumptions and steps in the analysis;
  • Guaranteeing access to required raw data (relevant records, samples, project applications, project reports, personnel information, field trip information, relevant emails, laboratory notebooks, etc.) and not solely semi-aggregated data or summaries;
  • Sharing of all relevant medical records, anonymized according to local laws for confidentiality protection, with the joint study team; 
  • Ensuring that the team of scientists and specialists is able to undertake their studies at key meetings and visits with no unnecessary presence of host government non-scientific personnel; 
  • Ensuring mission members can conduct interviews, as needed, confidentially and/or anonymously, and with assistance of translators appointed by the WHO if necessary. 

Access to Essential Financial and Technical Resources 

The appeal also notes that the joint study so far has suffered from limited access to more granular data, records and samples, including the lack of adequate access to: 

  • Anonymized data and biological samples from early COVID-19 patients, close contacts and possibly infected persons. 
  • Records of laboratories and institutions involved in coronavirus research in Wuhan. 
  • Key databases of pathogens, samples and isolates.  As for the latter, the experts also note specific password protected databases, to which WHO-mandated researchers still don’t have access, including: 62MB MySQL database  batvirus.whiov.ac.cn www.virus.org.cn portal and underlying databases:  “These databases are essential as they contain data about viruses not yet published, and some of these viruses may be closely related to SARS-CoV-2.” 
  • The full sequence of the 8 coronaviruses sampled in the Mojiang mine several years [ago, which are some of the closest relatives of SARS-CoV-2, and were mentioned in an Addendum to a Nature paper published in November 2020.  

Unfettered Access to Yunnan’s Mojiang Mine  – And Footprints of the ‘RaTG13’ Virus

Horseeshoe bats found in Yunnan province carry the viruses most similar to SARS-CoV2 found to date,

The Mojiang site in Yunnan Province is one where a group of six Chinese miners are believed to have become infected with a pneumonia-like illness in 2012, as a result of contact with a bat-borne virus, leaving three people dead.

“To this day all the coronaviruses most closely related to SARS-CoV-2 come from that Mojiang mine. Some scientists who went sampling at the mine had their samples confiscated while investigative journalists have been systematically turned away,” the scientists state.

Even so,  “unspecified samples from these patients were sent to the Wuhan Institute of Virology and other labs in 2012. Dr. Shi Zhengli [WIV chief bat virus researcher] recently announced that the WIV tested the serum samples again.” However, independent researchers never have had access to the raw data.

Independent interviews with the surviving miners were never permitted, and the miners’ unusual pneumonia cases were never reported by China CDC or to the WHO. 

One bat coronavirus, in particular that was found at the Mojiang mine site, ‘RaTG13’, holds special interest, the researchers say. They call it the virus sample closely-related to SARS-CoV-2 today.

Yet, despite the fact that it was sampled and described by researchers, the full genome sequence seems to have disappeared. Shi Zhengli and Yanyi Wang, director of the WIV, have said in interviews that there is:  ‘no more sample’ of RaTG13, so that no further sequencing is possible, and the virus was no longer ‘in our lab.’

“Based on the raw data provided, it has unfortunately not been possible to assemble the RaTG13 genome sequence,” the researchers lamented.

Even so, however, tantalizing biological footprints of the RaTG13 virus, and its components, remain – which could help unravel the mysteries of SARS-CoV2’s emergence, the scientists say. Not to mention the gene sequences of other SARS-related coronaviruses – and yet those footprints remain locked in Chinese research archives, databases, or censored publications.  

Databases Missing in Action  

One published analysis of hospital traffic in Wuhan China in autumn 2019 indicates shows high number of visitors, compared to the same time, in the year before – and before the typical flu season began.

Related to that, data bases from the WIV and sister insitutions have gone missing in action – beginning in September 2019 – which is around the same time when many experts now believe the virus was spreading silently in Wuhan. 

“Dr. Shi Zhengli has stated that Wuhan Institute of Virology virus databases were taken offline during the pandemic. However the key bat virus database was taken offline in September 2019, three months before the official start of the outbreak,” the researchers state. 

“Can Chinese officials explain this contradiction? Can Chinese officials explain why the scientific paper describing the key database…was taken offline from the corresponding Chinese journal website “China Science Data” in mid-2020?  Can Chinese officials also explain why the full website of “China Science Data”, where the database was described, became inaccessible in March-April 2021?”

The scientists also suggest that the claims by the Wuhan Virology Institute officials in March, 2020 that they had found no SARS-CoV2 cases at the institute, even in the height of the Wuhan outbreak – are disingenuous given the widespread community transmission of the disease at the time.  

“Dr. Shi Zhengli and Dr. Yuan Zhiming have both stated that ‘all staff tested negative for SARS-CoV-2 antibodies’ at the WIV in March 2020. Yet, this is statistically unlikely (roughly less than one chance in a billion) given that there are more than 590 staff and students at the WIV and about 4.4% of the Wuhan urban population tested positive at around that time. Even if only 85 people were tested, the chance of no positive test would still be less than 4%. How can this contradiction be explained?”

Tweeted Gilles Demaneuf, co-organizer of the open letter and a data scientist: “[WHO’s Peter Ben] Embarek back in March mentioned 1,000+ cases in December 19, 13 variations in the virus, all pointing to likely November cases. Today China keeps pretending that the first case was on the 8th Dec 2019. How is it possible? Who is shaping the narrative?”

All Eyes On the United States 

Ultimately, a way forward now depends on WHO member states, other co-authors of the letter said. Said one informed expert, most eyes are looking first to the US administration of new President Joe Biden, to see how Washington might lead on the issue; if it does so, it can likely depend upon support from the UK, western Pacific countries such as Australia and Japan, as well as India – all nervous about China’s outsized influence – and in the case of India, the huge toll the pandemic has exacted in human lives.   

Recently, the stance taken by the WHO DG over the incomplete nature of the inquiry so far has been welcome, said another commentator, who asked not to be named: 

 “I feel we should take Tedros at his word. My personal sense is that he believes what he’s saying but he’ll only be able to take meaningful steps forward with political backing from key states.”

 

Image Credits: Johnson&Johnson, David Stanley/Flickr, John's Hopkins CSSE, CNN, WHO, Deutsche Welle, European Medicines Agency, Nsoesie, Elaine Okanyene et al. Harvard University Pre-print Repository, .

A doctor providing essential health services to children in a refugee camp in northwest Syria during the COVID-19 pandemic.

Even as foreign aid from multiple countries arrives in India in response to its COVID-19 surge, a new epicenter of the SARS-CoV2 virus is emerging in Syria. The situation in Syria is “deteriorating extremely rapidly,” according to UN agencies and aid relief organizations. 

Although the official number of confirmed cases and deaths in Syria is extremely low as compared to its neighbouring countries, the spread of the virus in Syria is “rapid and accelerating,” warned UN officials in a briefing to the Security Council on Wednesday. That’s in comparison to data showing recent declines in new cases in countries nearby such as Turkey, Lebanon, as well as Jordan and the Israeli-occupied West Bank and Gaza – where vaccine campaigns of various degrees are now underway – albeit at a much slower pace than Israel. 

Credible data collection is a serious challenge in the conflict-ravaged country, which, combined with low testing rates, makes knowledge about the scale of the pandemic uncertain. 

But the available data suggests that cases are surging nationwide. The number of new cases recorded by the Ministry of Health in March was double the number from February and reports indicate that hospitals in Damascus are at capacity, according to UN officials.

After 10 years of war, Syria’s health system is weak and lacks the infrastructure to trace and diagnose cases and contain the spread of the virus. Approximately 90% of the population live in poverty. 

In northeast Syria, controlled by Kurdish-led forces, over 5,300 new COVID-19 cases have been confirmed in April alone, accounting for more than half of the total recorded in 2020. Some 47% of tests are coming back positive in the past week. 

In addition, two refugee camps in northern Syria, Al-Hol and Roj, have recorded cases recently, but neither have the resources to treat COVID-19 patients. 

The only COVID-19 lab in northeast Syria is at risk of suspending testing services in less than seven days because of a shortage of testing kits.

“Testing capacity in the northeast has never been sufficient, and now it may be lost altogether,” said Misty Buswell, Policy and Advocacy Director for the International Rescue Committee in the Middle East and North Africa, in a press release. 

“Currently, 83% of patients who receive invasive ventilation in the region are not surviving and we fear that things will only get worse. Treatment facilities are being forced to close due to a lack of funding, oxygen is beginning to run out, and COVID cases are reaching the highest levels seen to date,” said Buswell. 

Seven UN and NGO-funded treatment facilities have been forced to close due to a lack of funding. In March, the UK cut aid to Syria by a third in a move that aid agencies criticized as causing lives to be lost in the future.

Some 24 million people in Syria rely on aid to survive, a figure that has increased during the pandemic.

The International Rescue Committee has issued an urgent call for the UN Security Council to reauthorize the Al Yarubiyah border crossing on the Syrian-Iraqi border so UN agencies can deliver relief and support the region’s COVID-19 response. 

Cross border aid deliveries into northwest Syria are currently only authorized through a single crossing, Bab al-Hawa, on the Syrian-Turkish border. China and Russia vetoed resolutions to re-open the two other border crossings, Al Yarubiyah and Bab al-Salam, on the Syrian-Turkish border.

“The vaccine doses that reached north-west Syria were delivered, like all UN humanitarian assistance there, through the Bab al-Hawa border crossing. It is really not clear how future such deliveries could reach north-west Syria unless you confirm the reauthorization of UN cross-border access,” said Mark Lowcock, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, in a briefing to the Security Council. 

COVAX Vaccines Arrived in Syria

Syria received its first batch of AstraZeneca vaccines from COVAX on 22 April.

Syria received its first bulk of vaccines from the COVAX facility last week, with 203,000 doses of the AstraZeneca vaccine arriving in Damascus and 53,800 doses delivered to the northwest of the country. 

The distribution and administration of the jabs will begin in early May. 

“This is a milestone in our collective fight against the pandemic,” said Akjemal Magtymova, WHO Representative in Syria, in a press release. “Delivery of the COVID-19 vaccines by COVAX and partners brings us closer to vaccine equity and gives hope for the people in Syria, whose lives have been shattered by a decade of conflict and the devastating impact of the pandemic.” 

The COVAX delivery was followed by the arrival of 150,000 doses of the Sinopharm vaccine, donated by China. COVAX plans to allocate a total of 912,000 doses to Syria in the coming months, with an additional 336,000 doses intended for northwest Syria. 

In addition, a donation of 150,000 doses of China’s Sinopharm vaccine arrived in Damascus on 24 April. Healthcare workers and vulnerable populations will be prioritized in the vaccination campaign. 

Currently, it is not known when doses will reach the northeast of Syria, where supplies of oxygen are limited and testing resources are running out.

“Although they will not be a silver bullet, they cannot get there soon enough,” said Buswell. 

COVID Crisis Continues to Worsen in India

As India hit a new record high of daily COVID-19 cases on Thursday and hospitals and crematoriums are increasingly overwhelmed, emergency medical supplies arrived in Delhi from the United States on Friday. 

Amid a deadly second wave and soaring infections, India reported 386,555 new cases on Thursday – another global record – and 3,498 deaths within 24 hours. The country has surpassed 18.7 million cases recorded since the beginning of the pandemic, six million of which took place in April. 

The catastrophic rise in cases has devastated the country’s health system, with hospital beds and oxygen in dangerously low supply. Crematoriums have had to build makeshift funeral pyres to cope with the rising death toll. 

“If we get more bodies then we will cremate on the road. There is no more space here,” Jitender Singh Shanty, a crematorium coordinator in Delhi, told the Guardian. “We had to request authorities to allow us to extend the facility to the parking lot.” 

Several crematoriums in Delhi are performing over 100 funerals per day and say that the official death toll doesn’t reflect the overwhelming increase in demand for their service.

Currently families are forced to wait up to 20 hours for a funeral pyre, while the crematoriums are attempting to rapidly expand to increase capacity to complete several hundred cremations a day in the worst hit areas. 

Crematoriums have become overwhelmed by the surge in COVID-19 deaths, forcing them to quickly build makeshift funeral pyres to cope with the rising death toll.

The second wave, which has hit major cities – Delhi, Mumbai, Lucknow, and Pune – hardest, is now spreading to smaller cities and more remote villages across the country. 

In Kota, a city of 1.3 million, located in Rajasthan state, 35% of the cases recorded were from April. Over the past 24 hours, Rajasthan reported 6,147 new cases and 158 deaths. Only two of the district’s 329 intensive care units were available as of Tuesday.

Kabirdham district, in Chhattisgarh state, went from recording zero active cases on 1 March to recording nearly 3,000 in the past week. The district currently has a shortage of nurses and lab technicians.

“We are in this situation because the government didn’t plan to augment facilities in remote areas,” a doctor in Nainital, a Himalayan city in Uttarakhand state, told BBC. “I am worried that many people in remote Himalayan areas will die and we will never hear about them. They will never show up in statistics.”

Emergency Foreign Aid Arrives

A US military plane carrying over 400 oxygen cylinders, nearly one million rapid COVID-19 tests, 100,000 N95 masks, and other medical equipment landed at the Indira Gandhi International Airport in Delhi on Friday.

“Today we are proud to deliver our first shipment of critical oxygen equipment, therapeutics and raw materials for vaccine production,” Antony Blinken, US Secretary of State, wrote on Twitter. 

This is the first of several planned COVID-19 emergency relief shipments from the US. According to a State Department spokesperson, the US will deliver supplies worth over US$100 million in the coming days, including a total of 15 million N95 masks and 20,000 courses of treatment of remdesivir.

AstraZeneca manufacturing supplies have also been redirected from the US to India, which will allow the country to manufacture 20 million doses.

Over 40 countries have committed to send supplies to assist India’s hospitals, including nearly 550 oxygen-generating plants, over 4,000 oxygen concentrators, 10,000 oxygen cylinders, and 17 cryogenic tankers. 

However, experts worry that the aid will be insufficient to make a dent in India’s national COVID-19 crisis that continues to spiral out of control.

Blame for Rise in Cases Largely Placed on Modi

Criticism and blame is increasingly being directed at India’s Prime Minister, Narendra Modi, who continued to hold large election rallies throughout the pandemic and refused to cancel Kumbh Mela, a Hindu religious festival where pilgrims dip in the Ganges river, widely considered the largest religious gathering globally.

Millions of people gathered on the banks of river Ganges to celebrate Kumbh this year, which runs from February to late April. The festival is believed to be a factor that contributed to the massive surge in COVID-19 cases, along with a lack of compliance to public health measures, low vaccination rates, and the emergence of a new contagious variant. 

Tens of millions gathered to celebrate the Kumbh Mela festival in India amid surging COVID-19 cases.

Modi’s approval rating, while still high, is at its lowest point at 67% and a disapproval rating that rose eight points since early April to 28%.

Modi has been widely criticized for the government’s lack of preparedness for the second wave and the shortages of oxygen and hospital beds that accompanied it. Only a few of the 160 new oxygen plants had been installed by April, when cases began to surge. 

The government claimed to have successfully contained the virus after its first wave, going so far as to stating that India was in the “end game of the COVID-19 pandemic” in early March. 

“That illusion came to settle in the minds of most people and clouded their judgement,” Srinath Reddy, President of the Public Health Foundation of India, told the Washington Post. 

Government officials focused largely on the vaccination campaign, however, the rollout was too slow and the percentage of the population vaccinated was too low to hinder the second wave.

Only 9% of the population of 1.3 billion has received at least one dose of a COVID-19 vaccine. 

Despite the government’s plan to open up vaccinations to all adults on 1 May, several states have run out of vaccines ahead of the expansion of the inoculation drive. Vaccination centers will be closed in some cities, including Mumbai, until they receive more doses. 

With shortages in vaccine supplies being seen across India, hospitals and crematoriums will continue to bear the burden of the second wave.

Image Credits: Sky News, International Rescue Committee, UNICEF/Khaled Akasha, Sky News.

moderna

Moderna has announced new investments from Europe and the US to increase global vaccine supply, expecting to increase 2022 capacity to up to 3 billion doses of its COVID-19 vaccine. The announcement was followed by the World Health Organization’s (WHO) decision to list the Moderna vaccine for emergency use, making it the fifth vaccine to receive emergency validation from WHO. 

“As we follow the rapid spread of SARS-CoV-2 variants of concern, we believe that there will continue to be significant need for our mRNA COVID-19 vaccine and our variant booster candidates into 2022 and  2023,” said Stéphane Bancel, Chief  Executive Officer of Moderna.

The vaccine manufacturer highlighted studies that predicted waning immunity will impact vaccine efficacy within 12 months, compounding the need for variant boosters in the coming years. 

Though many agreed that variant boosters will be necessary in the future, governments were concerned about the ability to scale up production. “We are hearing from governments that there is no technology that provides the high efficacy of mRNA vaccines and the speed necessary to adapt to variants while allowing reliable scalability of manufacturing.”

But with these investments, Moderna now has the capability to scale up drug manufacturing at the company’s Switzerland and Spain-based facilities. There will also be a 50% increase of drug substances at Moderna’s facilities in the US. 

Increased Shelf-Life for Vaccines

Moderna also announced that ongoing development data related to its current COVID-19 vaccine formula could support a three-month refrigerated (2-8 degrees Celsius) shelf life in alternate formats that make it easier to distribute, such as the doctor’s office or other small settings. 

Current vaccine supply is approved for storage up to one month at refrigerated temperatures (2-8 degrees Celsius) and up to seven months in a standard freezer (-20 degrees Celsius). Moderna’s vaccine is the only authorized mRNA vaccine that does not require on-site dilution. 

The company is also working on new formulas of its COVID mRNA-1273 vaccine and a next generation of the vaccine that will extend refrigerated shelf life longer. 

Variant and Vaccine Booster Tests Underway

Stéphane Bancel, Chief Executive Officer, Moderna.

The company is raising its 2021 supply forecast to between 800 million to 1 billion doses, with production from investments expected to ramp up in later this year early 2022. 

Earlier this year it announced that it is already testing the SARS-CoV-2 variant vaccine and multivalent vaccine boosters in humans. 

Results from its ongoing variant clinical trials and develops its booster shot strategy will place Moderna in a position to better estimate the supply ranges for 2022, which will be based on product mix across single-dose boosters, primary (two-dose) vaccinations for adults, and primary (two-doses) shots for children, which may be at lower dose levels. 

The scaled-up production and manufacturing capabilities come after last week’s forum sponsored by the International Pharmaceutical Manufacturers and Associations (IFPMA).  

Bancel, at the press briefing, had said that the company is “in the final stretch to get an agreement with COVAX” for its vaccine. 

Pfizer CEO Announces COVID-19 Oral Drug Could Be Available at the End of 2021

Pfizer CEO Albert Bourla

Pfizer’s experimental oral drug for treating COVID-19 could be available at the end of 2021,  CEO Albert Bourla told CNBC on Tuesday.  

“If clinical trials go well and the Food and Drug Administration approves it, the drug could be distributed across the U.S. by the end of the year,” Bourla told CNBC. 

Pfizer, which developed the first authorized COVID-19 vaccine in the US with German drugmaker BioNTech, began an early-stage clinical trial in March testing new antiviral therapy for coronavirus. In addition to the drug, Pfizer is testing its vaccine in 6-month to 11-year-old children. 

Earlier this month, the company asked the Food and Drug Administration (FDA) to expand its vaccine authorization to adolescents ages 12 to 15 after the shot was found to be 100% in a study, with no serious side effects. 

Bourla also told CNBC that the company is ‘comfortable’ in producing at least 2.5 billion vaccine doses for 2021, noting how Pfizer had overcome the original ‘forecasted losses’. 

“We made tremendous progress in improving processes, in building the infrastructure at the speed of light and in resolving issues with third-party supplies,” he added.

Bourla noted that the ‘horrible situation’ in India and the rest of the world, where the rate of vaccinations and availability of vaccines is lower, needed to be addressed, and saw this as an ‘ethically unacceptable issue’.

“If we are not able to provide services for India or Africa, they will become a pool where the virus will replicate and generate variants.” 

India is currently facing a catastrophic second wave that accounts for 38% of global cases reported in the past week, according to the WHO. 

 

Image Credits: Jernej Furman/Flickr, WEF, CNBC.

GHC Webinar – ‘What Lessons from COVID-19 For Advancing Antibiotic R&D?
Clockwise, moderator Suerie Moon, Manica Balasegaram (GARDP), Michelle Childs (DNDi)

In the midst of the COVID-19 pandemic, a “silent pandemic” of drug resistance to mutated bacteria, viruses and parasites is gaining ground and requires major government investments in antibiotic research and development (R&D), a group of experts has warned.

“People are dying across the world from drug-resistant infections. This is a problem of today, and it’s a problem that’s getting worse,” said Manica Balasegaram, Executive Director of the Global Antibiotic Research Development and Partnership (GARDP), during a webinar on antimicrobial resistance (AMR) hosted by the Geneva Graduate Institute Global Health Centre. 

The Geneva symposium, held on Thursday, highlighted key lessons learned from COVID-19 when looking towards the future of AMR and preparing for the next public health emergency. 

Increased Investment In AMR as a Global Health Priority 

amr pandemic
An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganism they act primarily against.

Advancing antibiotic R&D requires global health to invest in AMR as a public health issue in its own right, as antibiotics are going to be a critical tool in pandemic preparedness.

One of the benefits of AMR is that, due to its extensive R&D, researchers know the pathogens behind it, which makes it a global issue that can be prepared for, Balasegaram added. 

“We have to ensure access, particularly diagnostics, treatments, vaccines, and other tools – for infection, prevention, and control. We need to see this not just in terms of AMR but as a cornerstone for pandemic preparedness,” he added.

Although there has been a lot of progress in relation to vaccines, Michelle Childs, Director of Policy Advocacy at Drugs for Neglected Diseases Initiative (DNDi), spoke of the “acute need” to invest in COVID-19 effective treatments.

Childs addressed the need to have “well-powered, adaptive, clinical trials” to see if these treatments can be successful in repurposed and novel technologies, as well as a need to hone in on specific COVID-19 treatments, especially for those with mild to moderate symptoms of the virus.

“Potentially, those treatments could not just stop progression but could offer some hope for post-COVID symptoms,” she said. “We need to invest in virus-agnostic types of treatment in the early stages and discovery, not just for COVID but also for future pandemics.” 

Innovation in Global Health Needed, Shift Away from Traditional Sources 

The World Bank only releases funds to products qualified by the FDA

Global health actors also need to set their priorities towards innovation, as they reframe the way AMR is viewed, said Childs. She added that the level of innovation demonstrated during the COVID-19 pandemic should be applied to the future. 

“We need to ensure that when we’re looking for innovations, we don’t just look in the traditional sources in high-income countries.”

Childs also addressed the need to shift away from a “dependence on stringent regulatory agencies”, citing the negative effects on funding and access with the World Bank, for example, which only releases funds to buy products qualified by the FDA. 

“We need to strengthen further and respect the growing regulatory capacity worldwide. We have to move away from just a reliance solely on the EMA and the FDA,” said Childs, raising the African Vaccine Regulatory Forum as an example.  

Inequitable Global Response Prolongs the Pandemic

A health worker wearing personal protective equipment (PPE) carries a patient suffering from COVID-19 outside the casualty ward at Guru Teg Bahadur Hospital, in New Delhi, India.

Many of the lessons of COVID-19 are still ongoing, the most prominent being lessons on inequitable global response. The US was experiencing a drop in coronavirus cases with increasing vaccinations, while countries such as India are facing their worst outbreaks of COVID-19.

“We can’t really lift ourselves out of this situation unless we have a global response and that means global access. Inequitable access to medical countermeasures will have devastating consequences, and will prolong the pandemic,” said Balasegaram.

“If we don’t fix this now, then we’re going to face this again in AMR, and every other health issue that follows.” 

Intellectual Property Restrictions – Inequitable Access

IP

 

“We can’t really talk about lessons for COVID for the innovation system without addressing the real issues that we’re facing with COVID now,” said Childs. 

One of these issues concerns intellectual property, which comes days after nearly 400 members of the European Parliament (MEPs) and national parliaments across the European Union issued a joint appeal calling for the European Commission to drop its opposition to a proposed WTO waiver on IP related to COVID-19 health technologies for the duration of the pandemic. 

“[Lifting the restrictions allows] the vaccine recipe to be shared for countries [so they are able] to support themselves, [sharing] the know-how of technologies using some of the processes that are already available. We can’t rely on business as usual, or just rely on private licensing deals, which are inadequate.”

Image Credits: Staicon Life/Flickr, GHC, Felton Davis/Flickr, Adnan Abidi/Flickr, Open Source/Flickr.

Sanitizing public areas in Itapevi, Brazil

While India’s COVID-19 pandemic continues to burn through that country’s health system, concerns are mounting that Latin America may become the next global pandemic flashpoint — issues that the World Health Organization (WHO) is rightly trying to highlight to its broad global constituency of policymakers, influencers, and the general public.

All the more reason why it was surprising that the WHO chose to underscore the dimensions of Latin America’s plight by featuring Brazil’s new, and controversial, health minister Marcelo Querioga at its biweekly media briefing. 

The move set off a storm of social media commentary over what appeared to effectively showcase an alliance with the government of President Jair Bolsonaro – who has personally denied the dangers of COVID-19 and chalked up one of the worst global records for managing the pandemic. 

Not only is the track record abysmal, but  Bolsonaro has consistently ignored or undermined basic WHO advice on measures such as mask-wearing in public.  He has advocated the use of drugs discredited by WHO, such as hydroxychloroquine, as well as the importance of vaccines – which Brazil only belatedly began to aggressively seek out and acquire – despite its scientific and economic means. 

The catastrophe has been such that it has given rise not only to a huge death toll – but also the rise of a new, and dangerous variant.  That, in turn, has cast a shadow over the rest of Latin America, as observed in a New York Times article: “living side-by-side with Brazil, a country of more than 200 million whose president has consistently dismissed the threat of the virus and denounced measures to control it, helping fuel a dangerous variant that is now stalking the continent.”

Querioga On Centre Stage

Brazilian health minister Marcelo Queiroga

Granted the WHO stage, Queiroga, the fourth health minister to have been appointed in the past year, was at pains to say that he is now trying to bolster his country’s vaccination drive since taking office on 23 April.

“First, I have committed myself to ensuring there is an acceleration in vaccination across the country and this has been done by increasing the access to doses of vaccines and ensuring that there is better efficacy in the distribution of the vaccines,” Queiroga told the WHO briefing.

He added that the country had procured 500 million vaccine doses and by Monday will have administered more than 60 million vaccine doses – although that amounts to only about 18 doses per 100 people – a record that  pales in comparison to that of Chile, which has administered 73 doses for every 100 people.

Indeed, Brazil’s Fiocruz Institute is providing fill-and-finish services for AstraZeneca vaccines, while its Butantan Institute is doing the same for the Chinese vaccine, Sinovac, said Queiroga. But outside experts say that that can be credited more to the long scientific record of Fiocruz and other Brazilian instiutes, than any recent government moves. 

Queiroga did, however, provide new support for “clear and objective” guidance on “non-pharmacological measures that need to be followed in the fight against COVID-19, such as using masks, hand hygiene, and respecting social distancing.” 

That was in stark contrast to Bolsonaro’s statements railing at mask-wearing as recently as late February during the height of the country’s second wave. And so it remains to be seen if the president also will heed the advice of his new health minister. 

MOH Still Plans to use discredited drug treatments  

Queiroga also did not mention at the briefing that his ministry is preparing a protocol for the use of Ivermectin and hydroxychloroquine against COVID-19, treatments that are favoured by Bolsonaro – even though WHO has explicitly discouraged their use after large-scale studies found them ineffective.

Along with a social media storm, the appearance also sent ripples through WHO’s ranks – which has a significant constituency of Brazilian and Latin American technical staff posted not only in the region, but across the worldwide organization.  

As one senior WHO scientist told Health Policy Watch: “I am nauseated. What has been done right in this pandemic in Brazil has been done despite the national government.”

He added that there was a parliamentary inquiry into the role of the president in the pandemic, but “it looks like WHO is backing the government. Why? It only makes our work more difficult”. 

Meanwhile, Queiroga failed to answer most of the questions from the media and left the press briefing early.

Offers ‘Olive Branch’ on Vaccine Access 

WHO Director-General Tedros Adhanom Ghebreyesus reported that “Brazil is scaling up the domestic production of COVID-19 vaccines and has joined the World Trade Organisation (WTO) initiative to increase vaccine production through technology transfer.”

In terms of access to vaccines, still sorely lacking in most of lower-income Latin America, Queiroga appeared to offer an olive branch to critics, saying:

“We are looking at the discussions that are currently underway in the WTO on protecting intellectual property.  We defend that there should be access to vaccines and that they should be made available immediately because they should be considered a public good.” 

That statement was striking, insofar as Brazil has been one of the only developing countries to oppose the India-South Africa proposal for a WTO waiver on intellectual property for the duration of the pandemic. Brazil’s opposition to the waiver has also triggered widespread internal criticism. Brazilian parliamentarians  penned an open letter recently saying that the position flails in the face of Brazil long tradition of supporting public access to essential medicines.  

Quieroga did not reverse the country’s stance on that matter at his briefing, but rather appeared to be seeking a middle ground on the polarizing issue. He stressed that Brazil was in favour of “reaching a consensus” on the way forward, adding that existing flexibilities in IP and trade rules need to be used more effectively:

 “Brazil understands that the TRIPS agreement does have a number of flexibilities regarding innovation, which are included in the Doha Declaration on TRIPS and public health, and this includes the principle of what is in the public interest to fight health crises.”

He also called on pharmaceutical manufacturers to “ensure that agreements for licensing and technology transfer are facilitated as well as facilitation of expertise and know-how”. 

“We need to identify any commercial barrier to producing and distributing these products, including anything linked to intellectual property,” he added.

Cases In Many Latin American Countries Continue To Rise With Few Vaccines in Sight

Brazil has reported over 14,5 million cases of COVID-19 and over 420,000 deaths since the pandemic started. Its cases increased by 2% in the past week, and most ICU beds have been full during April. 

The P.1 variant first identified in Brazil is 2.5 times more contagious than the original wild type virus and became the dominant strain in the country in just seven weeks, sweeping through the 200 million strong population from early November. 

Brazil’s reluctance to impose restrictions on its citizens has exacerbated the spread of the variant, which is now believed to be driving case increases in the region.

Ciro Ugarte, director of health emergencies in the WHO region of the Americas and the Pan American Health Organisation (PAHO), told the briefing that most countries in South America were starting to experience case increases. 

These range from a 54% increase in Ecuador, to 19% in Honduras, 13% in Bolivia and single-digit increases in Uruguay, Peru and  Colombia, according to Worldometer.

But even a modest weekly increase of 3% in Colombia has meant that “ICU beds are running out in major metropolitan cities like Bogota and Medellin”, said Ugarte.

“Several countries in our region are reporting increases in COVID-19 cases in their younger populations. These are linked to increased exposure and no vaccination in these groups, as most countries have few vaccines and are applying them to vulnerable older groups and health care workers.” 

COVAX has only been able to deliver 7.3 million doses of vaccines in Latin America and the Caribbean so far. 

“Many countries cannot afford large bilateral deals with producers and are relying on COVAX for vaccines, but the outlook is not optimistic for increased supplies soon,” added Urgarte.

Image Credits: Pedro Godoy/ExLibris/PMI.

The UK government has been slammed for cutting millions in aid for family planning which will also lead to several job losses

The UK government has been accused of “using tactics reminiscent of the Trump era” after cutting millions in aid for family planning.

Boris Johnson’s government is set to slash its commitment to the United Nations Population Fund (UNFPA) by 85% – from an expected contribution of £154m to just £23m – in an enormous blow for women and girls in the poorest countries where health services have already been decimated by COVID-19.

News of the cuts, which were announced earlier this week, has left aid leaders seething. “By breaking its manifesto commitments with tactics reminiscent of the Trump era, the UK government will undo years of progress and investment,” Dr Alvaro Bermejo, the director general of the International Planned Parenthood Federation (IPPF), said. 

The IPPF said the loss of funding represents “one of the most significant funding losses for IPPF since 2017 when former US President Donald Trump reinstated and expanded the Mexico City Policy, also known as the Global Gag Rule”, a policy that blocked US federal funding for non-governmental organisations providing abortion advice, counselling or referrals. 

The IPPF, the UNPFA’s lead partner in providing family planning services, is set to lose out on £72m ($100m) as a result of the UK’s actions. Bermejo added this was “just another example of the UK government stepping back when it is needed most”.

Without additional funding, IPPF says it will be forced to close services in Afghanistan, Bangladesh, Zambia, Mozambique, Zimbabwe, Côte D’Ivoire, Cameroon, Uganda, Mozambique, Nepal and Lebanon, while services in an additional nine countries are under threat.

An internal memorandum sent to UNFPA, says that no staff cuts are expected yet – but insiders say this will be hard to avoid. However, agency partners contracted to deliver services will be less fortunate. IPPF will have to cut at least 480 staff over the next 90 days.

Manuelle Hurwitz, IPPF’s director of programme delivery and capacity, warned that “millions of the world’s most vulnerable women and girls in some of the poorest and most marginalized communities will pay the price” for the UK government’s decision.

“The fallout will force many girls out of school before they are even 16 and further contribute to an increase in unintended pregnancies, a rise in maternal deaths and an increase in unsafe abortions,” said Hurwitz.

The UK’s contribution would have prevented “around 250,000 maternal and child deaths, 14.6 million unintended pregnancies and 4.3 million unsafe abortions,” according to UNFPA director Natalia Kanem.

Kanem described the UK’s “retreat from agreed commitments” as “devastating for women and girls and their families across the world”.

Unnecessary Deaths

Rose Caldwell, CEO of Plan International UK, the global children’s charity described the decision as “shameful”, and would “result in the unnecessary deaths of tens of thousands more women and girls during pregnancy and childbirth”. 

“For decades, the UK has fought for the fundamental rights of women and girls to have control over their own bodies, and now is not the time to renege on our commitments,” said Caldwell.

“COVID-19 is fuelling a hidden pandemic of gender-based violence and we are likely to see a steep rise in early and unwanted pregnancies. This is already a leading cause of death for adolescent girls around the world, as well as one of the main reasons why girls drop out of school early.”

Urging the UK government to “come to its senses and reinstate funding for these vital services”, Caldwell added that “this is not the ‘Global Britain’ we want the world to see”.

Another programme set to lose out is WISH (Women’s Integrated Sexual Health), which delivers life-saving contraception and sexual and reproductive health services for women and girls in some of the world’s poorest and most marginalized communities.

Since its launch in October 2018, WISH has prevented an estimated 11.7 million unintended pregnancies, 4.3 million unsafe abortions and 34,000 maternal deaths, according to IPPF.

Luka Nkhoma, WISH programme project director in Zambia, said she is “scared for the futures” of the girls and women in the country who will no longer have access to contraception. By the age of 19, almost 60% of Zambian girls have fallen pregnant – mostly because of lack of health services in rural communities.

“When WISH came along, we helped expand much-needed contraception and sexual health services in [rural] areas, including services for youth with integrated HIV support, treatment for sexually transmitted infections and cervical cancer screening,” said Nkhoma. 

“For many women, it was their first time using contraception and the first time they’ve ever had complete control over their bodies and fertility. WISH also helps girls stay in school to finish their education, giving them control over their futures.”

When WISH closes, the community outreach in rural areas will end and the only way women will get contraception is by making long, costly trips to clinics.

“I don’t know what these women and girls will do. Just because there is a global pandemic, women’s needs don’t suddenly stop, and if they can’t access safe services, an unsafe abortion might be the only option,” said Nkhoma.

The UK is also cutting its contribution to UNAIDS, the UN’s HIV/AIDS programme by 80%, from  £15m to £2.5m this year.

“These cuts couldn’t have come at a worse time for the HIV pandemic. AIDS remains the number one killer of women of reproductive age and 1.7 million people acquired HIV in 2019,” said STOPAIDS, a UK network of agencies working to end HIV globally.

The cuts come days after the news that the UK had slashed aid to the Global Polio Eradication Initiative by 95%.

A Foreign, Commonwealth & Development Office spokesperson said: “The seismic impact of the pandemic on the UK economy has forced us to take tough but necessary decisions, including temporarily reducing the overall amount we spend on aid. 

“We will still spend more than £10bn this year to fight poverty, tackle climate change and improve global health. We are working with suppliers and partners on what this means for individual programmes.”

* Co-published with openDemocracy

Image Credits: United Nations Population Fund.

Several African countries struggling with vaccine rollout programs are forced to donate COVID-19 vaccine doses to other countries before the lifesaving drugs expire, the Africa CDC revealed on Thursday.

Details of the “donations” are sketchy, but Africa CDC director John Nkengasong, during a media briefing, disclosed how one African country, the Democratic Republic of Congo (DRC), was forced to return 1.3 million doses of vaccines received via the COVAX Facility for redistribution to other countries, including to Caribbean countries, that can expedite its rollout before expiry dates.

“DR Congo returned 1.3 million doses of vaccines to the COVAX mechanism and they are working with UNICEF to get them redistributed within 5 weeks,” said Nkengasong.

There is high vaccine hesitancy in DRC. Africa CDC revealed that in a study it carried out, only 59% of the people there are willing to get vaccinated. So far, the country has recorded nearly 30,000 confirmed cases and 763 deaths.

Africa CDC could not provide a list of other countries who had to redistribute their vaccines, but together with the World Health Organization on Thursday further admitted African countries are struggling with rolling out the vaccines at scale and at speed.

The developments however casts doubts on the true state of preparedness for COVID-19 vaccine roll out in many African countries that once accused the Global North of hoarding doses.

Inability to quickly administer the vaccine doses were however not the sole reason for the return of the life saving drugs – delays in initial deliveries of the shipments to the continent also contributed to the short period left before the vaccines expired.

Some of the doses redistributed were the AstraZeneca doses initially procured by South Africa, but were not rolled out again after the country decided to pause the vaccination exercise and switch to J&J’s vaccine.

Then, delays in sorting out new indemnification arrangements prevented the Africa CDC from quickly distributing the doses that were made available by telecommunications giants MTN, to interested African countries early enough to give sufficient time for vaccination.

According to the WHO, the short life span of vaccines (six months after production) further shortened by the pause of the vaccine rollout in countries like DRC, also contributed to the redistribution. The Serum Institute of India has said that vaccines can be used for up to nine months from its manufacture date, rather than the prescribed six months. But, some African countries, including Malawi and South Sudan, are refusing to administer the expired vaccine doses even though they are being encouraged to still administer them.

The WHO however said that a number of countries, including Togo and The Gambia, were able to administer the doses before their expiry date.

Africa Runs Successful Vaccination Programs, but Need Help With COVID-19 Vaccines

Dr John Nkengasong

While admitting the shortcomings in COVID-19 vaccine rollout programs, Nkengasong said the latest developments in no way suggest that Africa has a poor vaccination system. “Africa knows how to vaccinate and has been vaccinating its citizens for a long time. Ethiopia alone, within the COVID-19 pandemic, has vaccinated over 12 million children with the measles vaccine. That suggests that if the vaccines are available, the countries will administer them,” he said.

For COVID-19 vaccination in general, Nkengasong acknowledged that African countries needed more support to speed up vaccination rollouts. “We need support to scale up vaccinations and commodities including Personal Protective Equipment and others. That is what we need as a continent. The know-how is there. But for COVID-19, we are not just vaccinating the children, we are vaccinating the entire population. This is where the challenge is,” he said.

But with little or no vaccine shipments coming from India, which is dealing with an alarming surge in the number of COVID-19 cases, the WHO has urged African countries to use shipment delays to improve their logistics.

India has decided to use all doses of vaccines produced in the country as the country experiences a devastating second wave. Over 18.8 million cases of COVID-19 have been confirmed with over 208,000 deaths. On April 29, the country recorded its highest number of confirmed cases in a single day (386,555). Nearly 124 million people have received at least one dose of vaccine in the country, representing just 9.1% of the country’s population. And nearly 2% of the population (about 25.5 million people) have been fully vaccinated.

“We are advising African countries to use this pause to tighten their planning so that whatever doses they can get will be rolled out most efficiently,” said Nkengasong.

Africa‘s Vaccine Rollout Programs

Despite the flaws or lack of efficient rollout programs, the continent has successfully administered more than half of all COVID-19 vaccine doses it has received, said Dr Phionah Atuhebwe, WHO Vaccines Introduction Medical Officer for Africa.

“Many countries have not been able to prepare adequately before the vaccines arrived in the country and that is one of the reasons we have seen a slow pace overall,” she said.

In addition to the slow pace of rollouts, vaccine hesitancy due to myths and rumours and insufficient operational funding were also contributing factors.

Atuhebwe believes more doses than reported may have been administered in Africa as limited data could mask the true state of vaccine rollouts.

“It is easier to get this information links at the national level because most of these systems are now internet-based. So we are having issues with getting that data. We know for sure more vaccines are given than we receive on a daily update on the live dashboard,” she said.

Learning from India

Tens of millions gathered to celebrate the Kumbh Mela festival in India amid surging COVID-19 cases.

Health experts are concerned about the surge in India spilling over to Africa as the major drivers of the pandemic in India are still present in several African countries where public health measures are no longer being enforced and large gatherings are being held.

Matshidiso Moeti, WHO’s regional director for Africa, said that while the situation in India is “sad”, it is also a wakeup call for African countries to take the COVID-19 response more seriously. “We should look at the situation in India and see what we can learn about it and how we can better prepare for any upsurge of cases in Africa,” she said.

According to her, religious ceremonies, gatherings and mass gatherings at electoral activities were super spreader events.

“There is also a circulating variant [of the virus] that is causing difficulty in terms of its transmissibility. The lesson there for Africa is to anticipate that such a wave is possible in different countries and to look at the driving factors. So, African countries that will have elections where mass gatherings will occur should be on the lookout,” she urged.

She pleaded with religious leaders in Africa to sustain the COVID-19 measures they adopted at the outset of the pandemic. “We are seeing in African countries the drop of wearing of masks particularly. In some countries, the proportion of people not wearing masks has gone up nearly 80% against 17% in the early days of the pandemic,” Moeti said.

Maximising Available Vaccine Doses and Securing More

India’s continued suspension of COVID-19 vaccine exports other countries  have resulted in them defaulting in meeting global agreements and putting delivery of second doses for many Africans in doubt. The WHO on Thursday urged African countries to maximise the available doses to cover as many people as possible instead of keeping doses to provide second doses for those that have received the first doses.

“We have advised our countries to cover as many people as possible as far as the first doses are concerned. We will have to see what will happen as far as getting other supplies so that countries can provide the second dose,” Moeti said.

Regarding expired vaccine doses, Atuhebwe said the global health body is working with the manufacturers to develop a guidance on how they should handle them considering the manufacturer’s recommendation that the doses can still be used until July if they are properly stored.

WHO was evaluating all the evidence and data from the Serum Institute of India to ensure the potency and stability of the vaccine.

“An extension of shelf life is about the stability and potency of the vaccine during the stated time frame, and does not affect the safety of the vaccine.. Then we will get to each individual country and see how they have stored their doses. We are working with the countries to help them to see how to destroy this vaccine. We have a waste management protocol for all vaccines. But let’s wait for the guidance that should be out as early as Monday,” Atuhebwe said.

For countries like Malawi that have removed some doses from their cold chain, WHO said those doses cannot be used and will therefore be destroyed.

Image Credits: WHO AFRICA, Paul Adepoju, Sky News.

A new study of stroke patients  hospitalized during the COVID-19 pandemic, has found a higher rate of young and healthy stroke victims, as compared to averages before the pandemic began.

The researchers in 136 hospitals across 32 nations found that some 25% of stroke patients who had also been sick with COVID-19, were under the age of 55,  as compared to onlky 10-15% percent of stroke patients in that age group prior to the pandemic.

The study released in the peer reviewed journal “Stroke” also found that aside from being COVID-positive some 25% of the stroke patients studied had no other obvious risk factors such as high blood pressure, diabetes or smoking. And many of the stroke victims had asymptomatic COVID cases.

The study results correlate with a growing body of anecdotal observations that COVID appears to be an added risk factor for stroke due to the tendency of the virus to stimulate blood clotting, among other pathological responses to the disease.

The study analyzed data from patients who tested positive for the coronavirus after they had been hospitalized for stroke and other serious brain events. Of the 136 different medical centres participating, at least 71 reported a patient who had a stroke during their hospitalization for coronavirus or shortly thereafter.

Of the 432 COVID-positive patients studied, 323 (74.8%) had acute ischaemic stroke, which is the most common kind, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis.  Most troubling was the high occurrence of ischaemic strokes in younger patients with no known existence of the types of ‘classical’ risk factors that contribute to the onset of stroke, the study’s co-authors stated.

The research should help doctors to better understand “the connection between the coronavirus and strokes in younger patients, as a result of blockages in larger blood vessels,” said one of the study co-authors, Professor Ronen Leker, of the Hebrew University of Jerusalem, in a Hebrew University press release.

Equally worrisome, 144 of the COVID-positive stroke victims had had no recognizable symptoms from the virus, such as cough, fever; so the COVID diagnosis came only after they were admitted to the hospital for stroke.

Leker added that: “Going forward, we recommend performing COVID testing on all younger patients with strokes, particularly those with no known pre-existing conditions.  I am hopeful and confident that this study will be instrumental in providing a better understanding of the link between COVID-19 and stroke, and provide direct therapeutic benefits to patients.”

 

Image Credits: GJBrainResearch/Twitter, STROKE .

PAHO Regional Director Carissa Etienne welcomed recent announcements of vaccine donations from the US as well as Spain, but urged other countries to donate surplus vaccine doses to Latin America and not hoard the life-saving vaccines in “warehouses” .

While aid is rushed to India, WHO’s Pan American Health Organization (PAHO) has called out rich countries to donate more “desperately needed” coronavirus vaccines to Latin America and the Caribbean – in the face of persistently high levels of COVID-19 infections in that region, which has consistently been one of the hardest hit by the pandemic.

The call from PAHO came as the WHO European Region (EURO) on Thursday reported a significant decline in new cases, hospitalisation and deaths for the first time in a month – a bright spot that may be due to the growing impact of expanding vaccination campaigns.

At a briefing on Wednesday, PAHO Regional Director Carissa Etienne welcomed recent announcements of vaccine donations from the US as well as Spain – the latter directing surplus doses to Latin America. But she also urged other rich countries to stop hoarding life-saving vaccines in “warehouses” and follow suit.

“No vaccines should be sitting in warehouses where they can be promptly used to save lives,” she said, adding that: ““This pandemic is not only not over, it is accelerating,” she warned. “Our region is still under the grip … in several countries of South America the pandemic in the first four months of this year was worse than what we faced in 2020.”

Vaccine supplies to the region continue to “languish behind our urgent need for more doses… That’s why we urge countries with extra doses to consider donating a significant portion of these to the Americas, where these life-saving doses are desperately needed and will be promptly used,” she said.

“Significant portions” of donated vaccines also are needed for vulnerable populations, including migrants,” she stressed, adding, “expanded vaccination will also ensure that all people and economies can begin to reopen, rebuild and recover.”

Vaccine Donations So Far

The Spanish government last week announced that it would donate 5-10% of its vaccine doses to Latin American and Caribbean countries – once Spain a reaches 50% immunisation rate.

“The announcement from Spain is a show of solidarity, and your contributions to the well being of all,” said Etienne, adding, “WHO also congratulates the United States government for their announcement earlier this week that they will share up to 60 million doses of the AstraZeneca vaccine.

“We urge other countries to pick similar components,” she said.

The US government has said its excess vaccine doses will go to WHO co-sponsored COVAX global vaccine facility. A large portion of those vaccines, observers say, are likely to go to crisis-ridden India – although some may find their way to Latin America.

In addition, France has announced that it will donate 500,000 vaccine doses to the COVAX initiative by mid-June – although those appear mostly earmarked for west African neighbours with which France has close ties. Indeed the first batch of 105,000 donated AstraZeneca vaccines began arriving in Mauritania in April.

New Zealand also will redirect 1.6 million doses of AstraZeneca vaccines pre-purchased through COVAX to low- and middle-income countries, after deciding in March that it will vaccinate its population with only the Pfizer vaccine, due to its higher efficacy. At least some of New Zealand’s surplus is expected to go to neighbouring Western Pacific island states.

Latin America Remains Hard-Hit Region In Acute Need

New Coronavirus cases by WHO region, as of 28 April 2021

That leaves Latin America, one of the world’s regions hardest hit by the pandemic in need of still more big vaccine infusions.

In PAHO, where a 1.1 % increase in new cases was recorded on Wednesday, many health systems are “struggling to cope” with an influx of COVID-19 patients, especially the younger population who are less frequently vaccinated and more often exposed, said Etienne at the briefing.

Increased exposure, a shortage of vaccines has led to an increase in hospitalisation she added, and have also resulted in increased consumption of critical inputs, including oxygen, intubation drugs, personal protective equipment and infusion pumps.

“Nearly every country in Central America is reporting a rise in infections. Hospitalisations are at an all time high in Costa Rica, and we expect more patients will require care as the country reported a 50% jump in cases,” she said.

Infections also remain high across other parts of South America, she added. In Colombia ICU beds are running out in major metropolitan cities, such as Bogota. Similar situations exist in hard-hit Peru, Bolivia and Argentina.

“It’s no surprise then that many countries in our region have tightened public health measures by extending curfews, limiting re-openings, and imposing new stay-at-home orders,” she said. “These decisions are never easy, but based on how infections are surging, this is exactly what needs to happen. We know these measures work, and I commend leaders across our region for putting health first.”

Vaccine Alone Won’t End Pandemic

WHO PAHO regional director Dr Carissa Etienne said significant portions of donated vaccines are needed for vulnerable populations in the region, including migrants.

More than 317 million doses of COVID-19 vaccines have been administered in the Americas, but more than 70% of these have been distributed in the United States.

Along with bilateral vaccine deals, Latin America and Caribbean nations, have received seven million doses in the first allotment procured through COVAX, the global partnership to ensure equitable distribution of vaccines. A second shipment of vaccines through the COVAX facility is due between May and June.

However, so far vaccine rates range from highs of 73 doses per 100 people in upper-income Chile and 46 doses/100 in Uruguay; to 17 doses or less/100 in about 18 other Latin American countries, including Brazil, Argentina, Colombia, Peru, Ecuador, Mexico and El Salvador.

In the Caribbean, access varies widely from a high of 30 doses/100 people in Antigua to lows of 1/100 in Trinidad. In Paraguay, Nicaragua, Guatemala, Venezuela and Honduras, authorities have administered just one dose or less. Central America 1 dose or less in the Caribbean and Central America.

Etienne said, adding that PAHO is able to “quickly” deploy vaccines to countries in the Latin American region that are heavily impacted by the pandemic – citing its 100% implementation rate so far, with available supplies. .

In order to disburse available vaccines efficiently, countries have organised drive-thru vaccination and door-to-door campaigns to reduce the chance of transmission.

“Thanks to these efforts, our region has administered nearly every COVAX dose it has received thus far,” Etienne said. “Our region has demonstrated that it can successfully distribute COVID-19 vaccines quickly and effectively.”

Etienne however cautioned that particularly in light of the limited supplies, vaccines alone would not put an end to the pandemic. She encouraged social distancing, wearing of masks and washing of hands to help reduce the spread of the virus:

“We will only overcome this pandemic with a combination of rapid and equitable vaccine access and effective preventive measures.”

In Europe, COVID-19 Numbers Drop Significantly for First Time

WHO EURO regional director Dr Hans Kluge said COVID-19 vaccines are saving lives and will change the course of the pandemic and eventually help end it.

Meanwhile in Europe, infection numbers seem to be finally dropping sharply – even though only 12.5 % of Europe’s population has been fully vaccinated or recovered from COVID-19, said WHO’s European Office on Thursday.

“Based on numbers of confirmed cases, 5.5% of the entire European population have now had Covid-19, while 7% have completed a full vaccination series,” WHO EURO Dr Hans Kluge said at a briefing, adding that new cases “fell significantly” last week for the first time since 1 April, when new cases peaked at over 300,000 in 24 hours. “Yet, infection rates across the region remain extremely high,” he pointed out. On April 28, there were 180,000 new confirmed cases across the region.

To date, some 215 million doses of vaccine have been administered in the WHO European region’s 53 member states, which include Turkey, Israel and central Asian states of the former Soviet Union.

Approximately 16% of the region’s population has had a first vaccine dose, and 81% of health workers in 28 countries have had a first dose.
“Where vaccination rates in high-risk groups are highest, admissions to hospitals are decreasing and death rates are falling,” said Kluge, citing that as evidence that the vaccines are already having an impact. “Vaccines are saving lives, and they will change the course of this pandemic and eventually help end it,” he said.
However, vaccinations alone will not “end the pandemic”, he, too, warned, also emphasising the need for continued testing, quarantine, contact tracing and social distancing measures.

“Without informing and engaging communities, they remain exposed to the virus. Without surveillance, we can’t identify new variants. And without contact tracing, governments may need to reimpose restrictive measures.”

Image Credits: WHO PAHO, WHO , PAHO.

The implementation of COVID-19 restrictions and social distancing measures in South Korea in early March 2020.

A handful of five countries that forcefully acted to eliminate COVID-19 transmission fared better over the duration of the pandemic than others – experiencing far fewer deaths, faster economic recovery, and the preservation of a greater range of personal liberties, according to a sweeping review, published in The Lancet on Thursday. 

The review of policies adopted by the 37 member states of the Organisation for Economic Co-operation and Development (OECD) compared COVID-19 deaths, gross domestic product (GDP) growth/contraction, and severity of lockdown measures during the first year of the pandemic – which was declared in March 2020. 

Countries that took the maximum action to curb community transmission and contain SARS-CoV2 – including Australia, Iceland, Japan, South Korea, and New Zealand – had an average death rate that was 25 times lower than those countries that implemented restrictions in a more stepwise, targeted manner, according to the group of French, British and Spanish  researchers. 

COVID-19 deaths, GDP growth, and strictness of lockdown measures for OECD countries choosing SARS-CoV-2 elimination versus mitigation.
Economic Growth Rebounded in Early 2021

Just as importantly, GDP growth returned to pre-pandemic levels in the five “elimination” countries in early 2021, while economic growth for the other 32 OECD countries that pursued a mitigation approach remained negative until the end of the study period in early March 2021, according to the review, co-authored by a number of senior UN and national government policy advisors, including Ilona Kickbusch, founder of the Geneva Graduate Institute’s Global Health Centre, and Devi Sridhar of the University of Edinburgh.

Civil liberties also were most strictly constrained in countries that chose mitigation. By contrast, swift measures taken in the early weeks of the pandemic were categorized as less strict on a ‘stringency scale’ applied by the researchers, lasting for a shorter duration. 

Life in New Zealand is back to normal after strict travel limits and one lockdown eliminated the virus on the island nation.

Countries that chose SARS-CoV2 mitigation included Germany, France, Israel, Poland, the United Kingdom, and the US. Most of these countries were forced to impose new national lockdowns in the first quarter of 2021 following renewed surges in cases. 

“Countries opting for elimination are likely to return to near normal: they can restart their economies, allow travel between green zones, and support other countries in their vaccination campaigns and beyond,” the authors state. 

Assessment Ends Before Vaccination Campaigns Kick In

The assessment, however, ended just before the impacts of mass vaccination campaigns began to kick in over the course of March and April in Israel, followed by the United Kingdom and the United States. 

In Israel, for instance, which had recorded one of the  world’s highest infection rates, per capita, in January, with over 7,000 new cases daily, new infections dropped to about 120 daily in late April, when 60% of the population had either vaccine- or infection-related immunity. A rapid economic recovery, meanwhile, has seen it leap ahead of Canada to become one of the top 20 richest OECD nations, based on per-capita GDP – following economic contraction in 2020.  

It remains to be seen, however, how rapidly disease burden will decline and economies reignite in other OECD countries as vaccine rates tick upwards – and what will become of low- and middle-income countries where vaccines have yet to even reach large proportions of the population.  

Maintaining Other Public Health Measures Will Remain Essential, Even With COVID Vaccines

According to the authors, a swift path to elimination is easier now than ever over the past year due to the existance of COVID-19 vaccines and better testing.

But while COVID-19 vaccines are critical to ending the pandemic, they cannot be the sole tool to contain the virus due to their uneven and inequitable rollout, the time-limited immunity, and the emergence of new variants, which could threaten the efficacy of the vaccines, the authors stated:

“History shows that vaccination alone can neither single-handedly nor rapidly control a virus and that a combination of public health measures are needed for containment.” 

And so other public health measures will remain critical to preventing new waves of infections, a rise in mortality, and the proliferation of new SARS-CoV2 variants. 

“With the emergence of variants of concern, the more likely (if not the only) path to elimination is to combine several potent tools,” Bary Pradelski, co-author of the article and Professor of Economics at the French National Centre of Scientific Research, told Health Policy Watch.

The elimination of the SARS-CoV2 virus also will require a more coordinated international strategy, as opposed to separate government COVID-19 responses that have led to varying outcomes, since the pandemic is only going to end anywhere once it is under control everywhere. The authors concluded by stating: 

“National action alone is insufficient and a clear global plan to exit the pandemic is necessary.”

Image Credits: Wikimedia, The Lancet, Mona Masoumi.