A South African man demonstrates the use of the HIV self-test, waiting a few minutes for his results.

JOHANNESBURG – A new agreement to slash the price of HIV self-tests in half could ultimately assist eight million people estimated to be unaware of their HIV status to know they are infected – and get them on treatment. 

The agreement announced on Wednesday between the Geneva-based international health agency, Unitaid, and the US-based global healthcare company, Viatris, will see poorer countries dramatically increase their access to the blood-based HIV self-tests made available for under $2 across 135 low and middle-income countries.

Unitaid said the deal follows a request for proposals launched by Unitaid and Population Services International (PSI) in 2020 to drive forward equitable access to these tests. 

The self-tests are seen as important tools to help people more easily discover their status and move towards the treatment they need, and thus reducing the HIV burden globally.

This is particularly relevant in poorer countries, where concerns around stigma and difficulties accessing healthcare can create significant barriers, said Unitaid.

“HIV self-testing is a crucial factor in helping people learn their status – it is one of the key ways in which the global goals for HIV will be achieved. This announcement today will have a concrete impact on the ability of countries to access affordable self-testing, a foundation of people-centred healthcare in which Unitaid has led the way,” said Unitaid Director of Programmes Robert Matiru.

Access to HIV- self-tests has been recognised as a key factor in meeting the global goal of 90% of people knowing their HIV status,” said the agency.

In just the past six years, that rate has nearly doubled, from 45% to 81%, it added.

However, achieving even higher testing rates has been hampered by the fact that the market for HIV self-tests in low- and middle-income countries have been dominated by a single affordable oral HIV test, the OraSure.

That test is sold in a limited number of poorer countries for $2, but elsewhere the price is higher, and other options have cost significantly more.

HIV Self-tests Deal Announced at the Right Time

The World Health Organization (WHO) welcomed the availability of the HIV self-testing kits to increase access to testing.

“This announcement is particularly timely now, as HIV self-testing has become an important choice during COVID-19, allowing people to test when other options are difficult to access or restricted,” Dr Meg Doherty, WHO Director of Global HIV, Hepatitis and STI said.

The self-test will be a vital tool in the fight against HIV/Aids in South Africa which has one of the largest burdens of HIV in the world with 7.9 million people living with HIV.

With over two years of implementing HIV self screening in SA, the country has seen the positive impacts of the intervention.

Said Dr Thato Chidarikire, Director of HIV Prevention Strategies at the National Department of Health of South Africa:  “We have managed to reach men, women between 19 and 24 years old, as well as [other] key populations.

Following on that, he said that the news of the price reduction “is very well-received by South Africa, as we are currently procuring the tests using domestic funding. Lower prices translate to more quantities and expansion of the programme to reach more untested and test-averse populations, contributing to the country reaching the 95-95-95 targets.”

Unitaid said another recently developed blood-based HIV self-test from US-based health care company Abbott Laboratories, which is currently undergoing regulatory review; it is also set to become part of the expanded Unitaid programme, which would see around one million self tests distributed “to stimulate in-country demand”.

How the HIV Self-test Works

Husband and wife demonstrate use the HIV self-test kit in the privacy of their own home.

HIV self-testing (HIVST) is a process whereby a person collects his or her own specimen using a simple rapid HIV test and then performs the test and interprets the results themselves.

An innovative WhatsApp interactive digital solution is used to support consumers by offering a platform to guide them through the HIVST experience with clear, concise and individualized instructions on how to properly administer the HIVST and accurately interpret the results. Based on the results, the WhatsApp platform informs the consumer of the appropriate next steps to link them to care and prevention services according to the outcome of their test.

Linkage to confirmative testing and care and treatment after an HIV positive self-test is crucial.

Over 3 million people in South Africa have used HIV self-test kits so far, either as oral fluid or blood-based kits.  SA’s Department of Health in collaboration with Unitaid and PSI’s  HIV Self-Testing Africa (STAR) Initiative project will further scale up HIVST to make it available wherever people want to access it, including through vending machines and online ordering or through peer-to-peer distribution.

To date, Unitaid investment has resulted in 5 million kits being distributed, with 21 million kits set to be procured by countries between 2020 and 2023. Additionally, self-testing protocols have been embedded in the health policies of more than 85 national governments.

Image Credits: ©PSI-Dogsontherunphotography, Dogsontherunphotography:.

Tens of millions of Hindu worshippers gathered in April to celebrate the Kumbh Mela festival in India – a factor believed to have contributed to a massive surge COVID-19 cases.

ISLAMABAD, PAKISTAN – Pakistan and its three estranged neighbouring countries – India, Iran and Afghanistan – are all struggling to restrain their large populations from attending deeply rooted and centuries-old cultural, religious festivals – so as to curb the spread of COVID-19 in the region. 

The cultural, political, and religious gatherings in all four developing countries have emerged as a major challenge for governments as people continue celebrating festivals with cultural and religious zeal and zest. 

The four countries share common borders with porous passages through rural and mountain areas where the virus can easily pass, regardless of official restrictions or closures in place. 

With a cumulative population of 1.69 billion, the four countries have recorded a total of 21.2 million COVID-19 cases and 291,847 deaths since the beginning of the pandemic. 

India is currently facing a catastrophic second wave, accounting for 38% of global cases reported in the past week, according to the World Health Organization (WHO). However, important, although lesser noticed surges of varying degrees also are occurring in neighbouring Iran, Pakistan and Afghanistan – with new cases daily in Iran per million population approaching Indian levels. 

And those, too, appear heavily linked to the season’s ritual mass gatherings, health experts and authorities told Health Policy Watch in an exclusive set of interviews. The events include the recent “Nowruz” New Year celebrated in Iran and parts of Afghanistan, the ongoing Islamic month of Ramadan, and the February-April Hindu celebrations of Kumbh Mela, where pilgrims dip in the Ganges in what has been described as the largest religious gathering in the world. 

Whatever their national affiliations, health experts from Pakistan, India and Iran believe that the situation in the region will deteriorate further if human interaction is not more controlled. 

WHO has noted the lack of compliance to public health measures, low vaccination rates, and mass gatherings have combined to cause a “perfect storm” in the case of India’s surge. 

However so far WHO’s public messages have fallen short of specifically calling out the mass gatherings, related to sensitive cultural and religious moments, as a key cause of the rising case loads – even though health officials privately say that this may be one of the biggest drivers both in India as well as throughout the region. 

“The extent to which these virus changes are responsible for the rapid increase in cases in the country remains unclear, as there are other factors such as recent large gatherings that may have contributed to the rise,” said Tarik Jašarević, WHO spokesperson at a press briefing Tuesday. 

Hindu & Muslim Holidays Have Seen Surge of Mass Gatherings 
Hindu celebrations of Kumbh Mela, where pilgrims dip in the Ganges, drew millions together.

As around 25 million people gathered on the banks of river Ganges in India to celebrate the Hindu festival of Kumbh, which runs from February to late April, people in Iran and northern areas of Afghanistan were preparing for, and celebrating ‘Nowruz’ festival (New Year) over the latter two weeks of March. 

Meanwhile, the holy month of Ramadan, which began on 12 April, is in full swing for Muslims across the region, which is marked by daytime fasting but evening break-fast and social gatherings. Pakistani health authorities are trying to toe a strict line, but they fear that over the even more intensive gatherings that mark the end of Ramadan and Eid-al-Fitr holiday, the country could see a further rise in cases, especially if the public doesn’t comply with the national Standard Operating Procedures (SOPs) for COVID-19.  

Pakistan, India and Iran imposed partial lockdowns over the past two weeks in an attempt to curb transmission in the worst affected cities. However adherence to the restrictions has been mixed – and government leadership in some instances has also been wanting – for instance in India where State election campaigns have also seen big mass gatherings organised by the government’s leading political parties. 

According to Dr Zafar Mirza, a former high-ranking official in the WHO Office for the Eastern Mediterranean Region, which covers Pakistan, Iran and Afghanistan, human interaction at religious, cultural and political gatherings in Pakistan, India and Iran have indeed contributed to the regional rise in cases.

The only real solution to the virus is immunity – either acquired from natural infection or vaccines, stressed Mirza.

Accessing COVID-19 vaccines, however, has been a challenge for low- and middle-income countries, as high-income countries “over-booked” the available vaccines through bilateral deals with pharma companies. This has left low- and middle-income countries with two equally difficult choices: 

“Either develop their own vaccine and end their 100% vaccine import dependency or strictly follow COVID-19 SOPs, minimizing the human interaction to save maximum lives,” said Mirza. 

Mirza feared that if human proximity is not controlled throughout the region, there is a high chance that the dire situation being seen in India could further deteriorate. 

Pakistan Takes Steps to Enforce Domestic Restrictions

Eying with worry developments among neighbours, Pakistan’s government has recently further tightened COVID-19 restrictions, and even deployed army troops to help the civil administration with their implementation during the latter half of Ramdan. 

The country’s Interior Minister, Sheikh Rashid Ahmed, announced that the ministry issued a notification enabling provincial governments and federal territories to seek the help of the army to enforce standard operating procedures for curbing the spread of the coronavirus. 

The government’s moves have received strong backing from the Chairman of the Council of Islamic Ideology (CII) in Pakistan, Qibla Ayaz, said in a press briefing that the third wave of COVID-19 was more dangerous than the previous two and the religious segments of society had a serious responsibility to follow the precautionary SOPs and spread the message among the citizens.

He said in the press briefing that prayers can be performed at home and the public needs to  adapt some of its traditional practices, as recommended by health experts to prevent the deadly virus from spreading.

Ayaz also stressed that there is nothing in Islamic tradition requiring observant Muslims to  shake hands or embrace when they do meet or assemble, saying that embraces should be avoided for the time being and replaced with verbal greetings, such as the traditional “Assalamalaikum” – meaning “peace be with you”. 

According to the National Command and Operations Center (NCOC) – a forum established to lead the national effort to tackle COVID-19 – the confirmed cases in Pakistan have reached 804,939, some 17,329 deaths have been reported, and 5,075 COVID-19 patients are in critical condition. 

Nearly two million people have been vaccinated in Pakistan, mainly using China’s Sinopharm vaccine.

People waiting to register for COVID-19 vaccines in the Pakistan Institute of Medical Science.

Pakistan Proffers Aid to Beleaguered India 

In response to the rising cases in India, the government of Pakistan banned the entry of travelers from India from arriving at land crossings, which operate in the disputed Kashmir region and elsewhere. 

At the same time Prime Minister Imran Khan extended an olive branch to the Indian people, writing on Twitter: “Our prayers are for all those suffering from the pandemic in our neighbourhood.”

And Pakistan’s Foreign Minister Shah Mehmmod Quershi also offered ventilators, personal protective equipment, and other supplies as a gesture of solidarity with India.  

India – Virtual Religious and Political Events Could Have Helped Avoid Crisis 

India has meanwhile seen an outpouring of aid offers from countries ranging from the United States and the United Kingdom to Saudi Arabia and Bhutan – but the question remains whether supplies can arrive in time and whether they can make a sufficient dent, quickly enough, in the ongoing crisis in the country, which now recorded the largest numbers of new cases daily, yet to be seen in any country during the pandemic. 

Medical supplies from the UK landed in Delhi on Tuesday morning, which included 100 ventilators and 95 oxygen concentrators. Later on Tuesday, Thailand airlifted four cryogenic oxygen tanks to India, Singapore sent 256 oxygen cylinders, Mauritius donated 200 oxygen concentrators.

Resources from European countries are expected to arrive in the coming days, with Germany providing an oxygen production plant, France shipping oxygen concentrators and respirators, and several others pledging support.

In terms of the factors leading up to the crisis, Anant Bhan, Professor in the Department of Community Medicine at Yenepoya University in Mangaluru, said that at least some of the surge in cases could have likely been avoided if stricter measures had been taken earlier on, to control or restrict mass gatherings.  

“Any large congregations are a major risk factor as we know for COVID-19. Given this, it would have been ideal to conduct any religious or political events only symbolically or use online virtual platforms for these. Failure to do so could have led to events which helped in the spread of the disease,” Anant told Health Policy Watch. 

Instead, mass gatherings have not only continued unhindered, but they have been marked by a lack of adherence to COVID-19 precautions, especially mask wearing. In addition, the period has seen an increasing number of social gatherings such as marriages and cultural events, which were a factor in the spread. 

Although India is making a major effort to vaccinate its population, the challenge remains the sheer size of the country and the population – and meanwhile social distancing, mask wearing and other preventive measures remain critical, he said.  

“The current spread has reinforced the need for a rapid increase in coverage with the vaccines, but supply might be a constraint,” Anant added.  

While the surge is national, Anant pointed out that some states in India are experiencing a comparatively higher burden of cases, including Maharashtra, Karnataka, Chhattisgarh, Chandigarh, Madhya Pradesh, Delhi, Haryana, Uttar Pradesh. And those, indeed are among the same states that have seen particularly large social and religious gatherings recently. 

According to the Indian Health Ministry, the number of active cases has risen to 2.9 million, with over 300,000 new cases being reported for the seventh day in a row, and a total of 201,187 deaths. 

Iran Also Sees Infection Surges  

Meanwhile, per capita, Iran was seeing almost as large a surge in new cases as India – although it has received far less attention. 

A medical doctor in Mashad, Dr Ali Zaday, who spoke to Health Policy Watch under a pseudonym due to government restrictions on speaking to foreign media, said that the COVID-19 cases began to spike after the New Year’s festival of Nowruz, which was celebrated for two weeks beginning on 20 March. 

Last year, festival restrictions were highly restricted, he noted, as Iran became one of the biggest epicenters for the virus during the first wave. This year, however, restrictions were much more was celebrated in a restricted way last year but this year the celebrations were in violation of the COVID-19 SOPs by the public. 

“Now there are partial lockdowns and daily above four hundred people are dying,” said Dr Zaday. 

However, a doctor in Tehran, Mustafa Zareef (also speaking under a pseudonym) said that from what he saw, Nowruz celebrations were comparatively modest, and government officials are trying to preserve adherence to COVID-19 restrictions.

Mosques were closed in Tehran during “Nowruz,” the Iranian New Year, and public celebrations were cancelled. 

Even so, the country has still seen a sharp increase in cases since the end of March. 

He also viewed that comparatively low gatherings were held during the last two years for the Nowruz festival, which is usually celebrated on a large scale. 

“To a large extent SOPs [COVID standard operating procedures] were also followed during Nowruz,” he said, noting, as one example, that important shrines remain closed – although prayer goers and pilgrims can visit outside. 

The Iranian Health Ministry reported that over 2.4 million people in the country have now been infected with the virus, with 21,713 new cases recorded on Thursday and 5,287 patients in critical condition – in the country of some 82.9 million people. 

According to the health ministry statistics more than 700,000 people have been vaccinated with a first dose of vaccines, using the AstraZeneca, Russia’s Sputnik V, and China’s Sinopharm vaccine.

Afghanistan Witnesses Slight Rise in Cases

Afghanistan has so far largely avoided the negative effects of COVID-19 faced by its neighbouring countries, however, health officials warn that if the current rise in cases is accompanied by a continued disregard of public health measures, the country could suffer the same fate as India.

Afghanistan’s acting Minister of Public Health Waheed Majrooh announced at a press conference this week that Afghanistan had already entered the third wave of the pandemic, which is more threatening than the first or second.

According to Majrooh, if people don’t follow health recommendations, don’t pay attention to social distancing and don’t wear masks, there is a fear that Afghanistan will experience a catastrophic situation similar to India’s. 

Kabul-based physician, Dr. Obaid Ullah, told Health Policy Watch that people were reluctant to follow most COVID restrictions until recently. Weddings, religious gatherings and other routine activities have been continuing in full swing. 

But the deadly surge of COVID-19 cases in India have left more people worried, leading to better compliance with public health measures and greater vaccine acceptance as well. 

“You would be surprised to know that many were reluctant to get vaccinated and the donated doses of vaccines were reaching expiry date, but that too has begun to change with more and more people going to get the jabs,” said Ullah, whose country is mainly using AstraZeneca vaccines donated by the WHO-supported COVAX initiative. 

Some 169 new COVID-19 cases were reported on Tuesday across 20 provinces, bringing the cumulative total number of cases to 59,370. Over the past 24 hours, 13 deaths were recorded. Kabul, the capital city, has been the hardest hit. 

Afghanistan Launches Campaign With Support of Religious Scholars 

Just this week, Afghanistan launched a nationwide campaign with the support of religious scholars to convince people to adhere more closely to preventive public health measures – warning the public that if they failed to do so, they could suffer the same fate as India. 

On Tuesday, the country’s Minister of Hajj and Religious Affairs, Mohammad Qasim Halimi, called on religious scholars to educate the people about the threat of coronavirus and encourage them to follow the guidelines of the Ministry of Public Health.

Ayaz, Chairman of the CII, told Health Policy Watch that a ‘Fatwa’ declaration – an interpretation on an aspect of Islamic law – had been given by religious scholars on religious practices during the pandemic, which stated that gatherings should be avoided and religious services should be held at home.

Image Credits: Sky News, Rahul Basharat Rajput, Press TV.

Pakistan health workers getting vaccinated with Sinopharm.

As India restricts COVID-19 vaccine exports to address its domestic surge, the World Health Organization (WHO) is poised to give the Chinese vaccine, Sinopharm, emergency use listing (EUL) this week – potentially catapulting China into becoming the biggest global supplier of COVID-19 vaccines for low- and middle-income countries (LMIC).

However, Sinopharm is reported to be one of the most expensive vaccines on the market, with the most recently reported price $36 a dose paid by Hungary – in comparison to $2.15 for AstraZeneca.

Global vaccine alliance Gavi, on behalf of the COVAX Facility, confirmed to Health Policy Watch on Thursday that it is “in dialogue with several manufacturers, including Sinopharm, to expand and diversify the portfolio further and secure access to additional doses for Facility participants. We will provide updates on any new deals in due course.”

After delivering over 49 million vaccines to 120 countries, the vast majority of which were AstraZeneca vaccines manufactured by the Serum Institute of India (SII), COVAX deliveries have ground to a halt because of domestic demand in India – causing panic in LMICs reliant on COVAX.

China joined COVAX late last year and announced in February that it would be donating 10 million vaccine doses to the facility – but this cannot happen until the WHO grants the vaccines EUL.

WHO Decision on Sinopharm This Week

A decision on Sinopharm is expected by the end of the week, but late last month Alejandro Cravioto, the chairperson of WHO’s Strategic Advisory Group of Experts (SAGE), told a media briefing that both Chinese vaccines, Sinopharm and Sinovac, have presented efficacy data that meets WHO requirements. 

“The information that the companies shared publicly at the [SAGE] meeting last week clearly indicates that they have levels of efficacy that would be compatible with the requirements that WHO has asked for this vaccine,” Cravioto told the briefing.

The WHO has set 50% efficacy against the virus as the lowest bar for EUL, and its decision is based on a risk-benefit analysis. 

The decision on the other Chinese vaccine, Sinovac, is expected next week, but reports indicate that it has lower efficacy than Sinopharm. 

A decision on the Moderna vaccine is expected on Friday, but the WHO has already issued interim recommendations on the use of Moderna and no impediments are expected for it.

“We are on track to make a billion doses this year, and potentially to have up to 1.4 billion doses for 2022,” said Moderna CEO, Stephane Bancel told a press briefing last week, adding that the company is also “in the final stretch to get an agreement with COVAX,” for distribution of the mRNA vaccine.

However, Moderna, like the Pfizer vaccine, needs ultra-cold storage which precludes its use in many low income countries.

COVAX Searching for New Vaccine Suppliers

COVAX confirmed last week that 90 million AstraZeneca vaccine doses it had expected the Serum Institute to deliver in March and April have been kept for use in India, which is facing a massive surge in cases.

Seth Berkley, CEO, Gavi, the Vaccine Alliance.

Seth Berkley, CEO of vaccine alliance Gavi, acknowledged last week that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. Gavi co-leads COVAX with the WHO and CEPI.

He confirmed that COVAX was “waiting for when supplies will resume [from India], and we’re looking at other options at the same time”.

Berkley also said that COVAX was “in early days on discussions on dose sharing”.

“We had an announcement last Friday from French President Macron that he would be sharing up to a half a million doses and we’ve also had an announcement from New Zealand, that they would be sharing 1.6 million doses and we’ve heard from the Spanish Prime Minister that they would be sharing doses, so we’re beginning to see engagement from many on dose sharing,” explained Berkley.

A Gavi spokesperson explained to Health Policy Watch that dose-sharing can happen “through the transfer of vaccine doses purchased by self-financing participants to the COVAX AMC economies, as pioneered by Norway and followed by New Zealand, or by donating own doses purchased for domestic consumption to COVAX AMC economies, in line with the recent French announcement”. 

“We welcome commitments of intention to share doses from other countries, including Spain, and continue to be in close dialogue with these countries who have expressed interest. We expect further announcements on this to take place over the coming weeks and months,” added the spokesperson.

Sinopharm To Produce One Billion Doses This Year

In contrast to the vaccine shortage in India, Sinopharm’s manufacturers claim that they have already sent 50 million vaccines to other countries, according to a report published last week.

By the end of February, China said that it had supplied 69 countries with vaccines – some as donations as some as sales. Recipients include Zimbabwe, Guinea, Egypt, Pakistan, Serbia, the Maldives, and the United Arab Emirates.

Meanwhile, Botswana announced this week that it had bought 200,000 Sinopharm doses to supplement a donation of the same amount.

Bangladesh also turned to China this week after being forced to suspend its vaccination programme when India told the country that it could not deliver its second batch of AstraZeneca vaccines to it any time soon. Six million Bangladeshis have already received one dose of the AstraZeneca vaccine.

China has offered to give Bangladesh 600,000 doses as a donation and the country will buy the rest. However, the cost of Chinese vaccines could cripple LMICs. 

On Tuesday, China’s foreign minister, Wang Yi, hosted a virtual meeting of the foreign ministers of Afghanistan, Pakistan, Nepal, Sri Lanka and Bangladesh at which the ministers “agreed to deepen cooperation as South Asian countries are facing a new wave of the COVID-19 pandemic”, according to the Chinese media agency.

According to Wang, China is willing to “promote vaccine cooperation” in South Asia through “flexible methods such as free aid, commercial procurement, and filling and production of vaccines”, to ensure “more diversified and stable vaccine supplies”.

India was invited but did not attend the meeting, but Wang said that “China is ready to provide support and assistance to the Indian people at any time according to the needs of India”.

Yu Qingming, chairman of Sinopharm Group, indicated last month that the state-owned pharmaceutical group expected to produce over one billion doses of its vaccine, according to Chinese state media.

Yu added that the annual output of the vaccines could reach three billion doses “in the future”.

The UAE and Serbia have also signed contracts with China to produce Sinopharm while Egypt has signed an agreement with China to produce Sinovac.

Yin Weidong, CEO of Sinovac’s producer, Biotech, said last week that his company was producing six millions doses a day, had sent at least 156 million doses to other countries, and could produce two billion doses this year.

In China itself, by Tuesday over 230 million doses of COVID-19 vaccines had been administered across China, according to Chinese health authorities. But the most populous country in the world estimates that it will be able to cover all 1,4 billion citizens by early next year.

Little Data About Chinese Vaccines

However, both Chinese vaccines are viewed with skepticism in many parts of the world because virtually no independent scientific information is available – only company information.

Sinopharm has claimed efficacy of 79.3% – 86% in multi-country trials, but these results are unpublished. 

Sinovac has also failed to publish peer reviewed results, but company announcements of Phase 3 results in four different countries have also yielded wildly varied efficacy scores ranging from 50.3% – 91.3%, according to Health Policy Watch research.

Researchers at Brazil’s independent Butantan biomedical centre said that Sinovac  displayed 50% efficacy in its clinical trial in Brazil.  

Interestingly, Serbia recently reported results in which it compared the antibodies of 10,000 citizens vaccinated with Pfizer, Sputnik and Sinopharm – all the vaccines currently in use in the country. 

With Pfizer and Sputnik, good antibody responses were noted after the first jab. But people vaccinated with Sinopharm only developed antibodies around two weeks after getting their second dose, and men over the age of 65 did not generate a strong antibodies response. The Sinopharm-vaccinated also showed a faster decline in antibodies than those vaccinated with the Pfizer and Sputnik vaccines.

US AstraZeneca Vaccine 

On Monday, the US announced that it would pass 60 million doses of AstraZeneca vaccines on to countries in need “as they become available”, according to Andy Slavitt, White House Senior Advisor on COVID-19.

However, it is unclear when these vaccines will become available as they are supposed to be manufactured by Emergent BioSolutions, the company that recently had to destroy millions of contaminated AstraZeneca and Johnson & Johnson vaccines.

It is also unclear who will receive the doses or how they will be delivered. Gavi would not comment on whether COVAX would receive any of the 60 million US AstraZeneca vaccine doses. A Gavi spokesperson simply said: “We welcome the US Government decision to share surplus doses as a positive step towards addressing the pandemic on a global scale. We will not be safe anywhere until we are safe everywhere.”

Image Credits: 中国新闻网, Gavi/Tony Noel.

A South African protest, Tuesday 2 February 2021, calling on the US and EU to support a World Trade Organization ” TRIPS” waiver on patents and other IP related to all COVID-19 drugs, vaccines, diagnostics.

Nearly 400 members of the European Parliament (MEPs) and of national parliaments from across the European Union issued a joint appeal Tuesday 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, being co-sponsored by India and South Africa.

The proposed IP waiver is due to be debated once again Friday, 30 April, by the WTO’s TRIPS Council, which oversees the Trade Related Agreement on Aspects of Intellectual Property Rights that govern global IP rules.

Proponents are pushing for the Council to move to “text based” negotiations on the draft waiver proposal, as a means ot advancing the initiative through TRIPS Council approval, so that it could go before the entire WTO General Council later this year.

But those moves continue to be opposed by the Europe, the United Kingdom, the United States and other industrialized countries – along with pharma industry voices that have stressed that manufacturing capacity – and not IP – are the key barriers to faster vaccine scale up.

“We stand with the Director-General of the World Health Organization, over 100 national governments, hundreds of civil society organizations, and trade unions, and join them in urging the European Commission and EU member states to discuss at the highest levels and support the temporary waiver of certain obligations under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

“The waiver proposed by South Africa and India would facilitate the sharing of all intellectual property and know-how. It will lift IP monopolies, remove legal uncertainty, and provide the freedom to operate to enable collaboration to increase
and speed up the availability, accessibility and affordability of COVID-19 vaccines, tests, and treatments globally,” stated the letter by MEPs.

“Variants show how no one is safe until everybody is safe. We need more vaccines quickly. Lifting patents and transferring technology are absolutely key to ramping up vaccine production. Private profit should never stand in the way of public health,” said MEP Marc Botenga, of the European Parliament’s “Left group.”

MEP Call Among Spate of Recent Initiatives

The call by MEPs was just one among a number of recent initiatives, including one by a group of Brazilian parliamentarians, addressed to WTO’s new director general Ngozi Okonjo Iweala, and another by US civil society groups targeting US President Joe Biden.

In a closed-door WTO meeting involving pharma and global health leaders, convened by Iweala in mid April, the focus was also on tech transfer and supply chain strengthening as “third way” options out of the crisis.  However, in the meantime, India has all but halted its export of COVID vaccines to countries in Africa and elsewhere, in the face of a huge increase in COVID cases. And that has amplified civil society calls upon global leaders to act more assertively – calls that could also reverberate in the next round of TRIPS Council discussions.

In related moves, the United States appeal, issued by some by some 66 US health and development groups, called upon President Biden to jump start an “urgent manufacturing program to help provide billlions of additional COVID-19 vaccine doses to the world” including open sharing of mRNA vaccine technology that has been the basis for the most effective vaccines produced so far – currently by Pfizer and Moderna.

The letter to Ngozi by Brazilian parliamentarians, meanwhile, was written to protest the opposition of the rightist government of Brazilian President Jair Bolsanaro to the IP waiver – a policy stance that the parliamentarians said goes against Brazil long tradition of public health advocacy.

Image Credits: Peoples Health Movement.

NAIROBI – A new drug combination therapy to fight COVID-19, unveiled on Tuesday, will be tested in a multi-country clinical trial that is already ongoing in Africa. The drugs nitazoxanide and ciclesonide will be used in the ANTICOV clinical trials testing treatments for mild to moderate COVID cases across groups in 13 African countries.

A consortium of 26 organizations of African research institutions and international health organizations is conducting the trials, which is coordinated by the Geneva-based Drugs for Neglected Diseases initiative (DNDi) – a non-profit research and development organization.

The ANTICOV clinical trials, launched in November 2020,  are the largest such trials in Africa testing remedies for people with mild COVID-19 disease. This new effort is particularly important, especially considering that access to vaccines across the continent remains very low, while the spread of new variants remains a big concern.

Dr John Nkengasong, the director of the Africa Centres for Disease Control and Prevention (CDC), said in a press statement released by DNDi: “We need urgently to identify affordable and easy-to-administer treatments that can prevent the evolution to a severe form of the disease and slow the rate of infection.

“In many African countries our worst fears are being realised, as already-strained intensive care units are beginning to fill up with COVID-19 patients. Yet the number of vaccine doses that are reaching the African continent is too limited. The rapid spread of new variants also threatens to reduce the efficacy of existing vaccines, which is another cause for concern.”

The New Combination Therapy

The drugs to be used now in the trials are a known parasite drug (nitazoxanide) and a form of inhaled steroid (ciclesonide). Used in combination, these drugs can work synergistically and at different sages of infection, researchers believe.

Trials of the anti-parasitic and steroid combination will replace other antiretroverial and anti-malaria drugs that ANTICOV had originally tested or planned to test, but have since been discarded because of the lack of evidence of efficacy – in the open-ended trial design.  

The study will explore whether the antiparasitic drug can reduce the initial viral replication of SARS-COV-2 infection, while the steroid reduces inflammation that can begin a few days later. No treatment currently exists for early stage COVID-19, and identifying effective therapies could also help prevent advance of the disease to a more severe condition. 

“It has been more than a year since COVID-19 was declared a pandemic, and while we have vaccines registered for use, there are still very few treatment options – especially for the early stage when we could prevent severe progression, potentially reduce transmission, and maybe prevent the risk of developing post-COVID condition,” Dr Nathalie Strub-Wourgraft, director of the COVID-19 Response for DNDi was quoted as saying. 

In addition to new treatments, there remains a need for simple, reliable, and more affordable SARS-CoV2 tests, according to Dr Monique Wasunna, director of DNDi’s Africa Regional Office.

These tests, maintains Dr Wasunna, could serve as the backbone of test-and-treat programmes led by African governments. The ANTICOV trials employs a flexible design platform, which allows for treatments to be added or removed as new evidence emerges. 

First participants in the clinical trial will be enrolled in the Democratic Republic of Congo (DRC) and the Republic of Guinea. This will be followed with others from Burkina Faso, Cameroon, Cote d’Ivoire, and Equatorial Guinea. Participants from Ethiopia, Ghana, Kenya, Mali as well as Mozambique, Sudan and Uganda will also take part.

Image Credits: UCT.

The European Union is suing coronavirus vaccine manufacturer AstraZeneca for delayed vaccine deliveries.

The European Union (EU) is suing coronavirus vaccine manufacturer AstraZeneca over an alleged breach of its vaccine supply contract and for not having a “reliable” plan to ensure timely deliveries. 

The European Commission – the EU’s executive branch – said the legal action emanates from a longstanding dispute over shortfall in vaccine deliveries.

The 27 nations of the EU had ordered 300 million doses of the Covid-19 vaccine from the British-Swedish drug maker to be delivered by the end of June, with an option to purchase an additional 100 million. However, AstraZeneca has said that it will be able to deliver only a third of those doses – sparking the fight over the terms of the contract.

“This action is due to the continuous breach of the terms of the contract and to the lack of a reliable strategy by the company to ensure the timely supply of vaccines in the current circumstances,” Stefan De Keersmaecker, a spokesman for the European Commission, said during a televised appearance on Monday. 

Earlier this year, AstraZeneca said its supplies would be reduced because of production problems. Of the 80 million doses planned for delivery in the first quarter of 2021, only about 30 million were sent. However, Pascal Soriot, the company’s chief executive, has said that the contract with the EU is not absolute – requiring the pharma company make its “best efforts” to deliver the promised doses.

According to the European Commission, AstraZeneca has said it will provide the bloc with only 70 million doses in the second quarter of 2021 instead of the 180 million that were initially arranged.  Despite the AstraZeneca delays, the European Commission on Tuesday tweeted that there will be enough vaccine doses to immunise 70% of all EU adults by July. 

 

The EU originally planned to use AstraZeneca as the main vaccine in its roll-out, but following the supply issues, the bloc now relies mostly on the Pfizer-BioNTech jab. 

Health Commissioner Stella Kyriakides on Monday tweeted that the commission’s priority was to “ensure Covid-19 vaccine deliveries take place to protect the health of the European Union”. “Every vaccine dose counts. Every vaccine dose saves lives,” she wrote.

AstraZeneca Will Contest Lawsuit 

AstraZeneca said the lawsuit was “without merit” and that it would “strongly defend itself in court”. In a statement responding to the announcement, AstraZeneca said it had “fully complied” with its agreement with the EU, and hoped to resolve the dispute as soon as possible.

“Following an unprecedented year of scientific discovery, very complex negotiations, and manufacturing challenges, our company is about to deliver almost 50m doses to European countries by the end of April, in line with our forecast,” the company said. “We are making progress addressing the technical challenges and our output is improving, but the production cycle of a vaccine is very long which means these improvements take time to result in increased finished vaccine doses,” the statement read.

“AstraZeneca has fully complied with the Advance Purchase Agreement with the European Commission and will strongly defend itself in court. We believe any litigation is without merit and we welcome this opportunity to resolve this dispute as soon as possible,” the statement read.

AstraZeneca had previously said that the contract obliged the company to make its “best effort” to meet EU demand, without compelling it to stick to a specific timetable.

Under the contract, any legal action would be heard by Belgian courts.

AstraZeneca’s Continuing Vaccine Headaches

The EU legal action is only the latest in a long series of mishaps that have plagued the roll-out of the vaccine that has been billed as the cheapest and most temperature stable option among those vaccines currently available. 

Shortly after the vaccine was registered in the United Kingdom and in the EU, AstraZeneca came under scrutiny in the United States over the way it had presented its clinical trial data with respect to efficacy in older adults. 

Some European countries also initially also advised against using the jabs among older adults, because of a lack of trial data in those age groups. of the continent.

While those questions were later resolved, reports of a rare but sometimes fatal blood clotting condition put a spotlight on the vaccine again. Those questions revolve mainly among use in younger adults, mostly women. Despite a European Medicines Agency review and assurances that the vaccine is safe for all age groups, some European countries, such as Germany, decided to recommend the vaccine only among older people. Other countries, such as Denmark, scrapped use of the vaccine altogether. 

Shortly after that, AstraZeneca’s Indian manufacturer, the Serum Institute of India, which was supposed to be the main pillar of vaccine deliveries to the WHO co-sponsored COVAX global vaccine initiative, halted shipments to COVAX – in order to redirect vaccines to the surging needs in India.  That has left many African countries, in particular, worried about receipt of their next vaccine supplies.  

Schoolchildren gather in the playground as they return to classes at Lepeltier Primary School in La Trinite, near Nice, amid the coronavirus disease (COVID-19) outbreak in France.

Some European Countries Ease COVID Restrictions

On a more positive note, the European Commission’s announcement of legal action on Monday came even as some EU countries began to ease COVID restrictions as new cases European vaccination campaigns began making small inroads into recent surges in COVID cases.  Around the continent about 20% of the total population have received at least one vaccine dose, rising to about 28% in Serbia.  

Millions of French children returned to the classroom, as primary schools and nurseries reopened following a three-week shutdown. In Italy, restaurants and bars in much of the country were allowed to serve customers outside, while hairdressers in Belgium reopened their doors. Even so, the mayor of the Spanish city of Pamplona announced that the annual Sanfermín fiesta in July – with its famous running of the bulls – would be cancelled for a second year.

Outside of the EU, Turkey announced a coronavirus lockdown until 17 May in a bid to curb a surge in coronavirus cases and deaths.

Kenya
Selena Ruto, a community health volunteer, visits the Kibet family in Narok County in Kenya to discuss the risk of anthrax.

Africa’s brutal experiences battling Ebola and a range of other deadly diseases helped prepare health systems to deal with COVID-19.  And by the time the SARS-CoV2 virus landed on the continent, its Centre for Disease Control (CDC) had already “established regional coordinating centres, increased lab capacity and unified surveillance networks”. 

The lessons in emergency response had been honed by countries facing dire threats not only from Ebola, but other little-known pathogens such as anthrax and monkeypox, according to Epidemics That Didn’t Happen, a report launched on Tuesday by Resolve to Save Lives, an initiative of Vital Strategies.

In 2014, Nigeria was able to contain Ebola through a “herculean public health effort” that involved “effective communication, coordinated response activities and dedicated leadership”, according to the report.

Meanwhile, in 2019 only one Ugandan family was infected with Ebola before the country contained the disease, which has a fatality rate of 66%.

Within days of an Ebola outbreak being declared in the Democratic Republic of Congo (DRC) in August 2018, Uganda had opened multiple Ebola treatment centres and rapid testing laboratories near its border with the DRC, screening all people entering the country. By that November, Uganda had vaccinated almost 5,000 health workers and response staff.

In June 2019, a family returning to Uganda from the DRC were diagnosed with Ebola at a routine border screening point. They were immediately placed in an Ebola treatment centre and almost 300 of their contacts were vaccinated. There were no further Ebola cases in the country.

Meanwhile, a sharp-witted Red Cross volunteer in the Kenyan town of Narok along the Great Rift Valley triggered a community-based surveillance system after encountering three people who became sick after eating meat from a dead cow. This helped to contain a potentially deadly anthrax outbreak in 2019.

‘Now or Never Moment to Invest in Public Health’

The report shows “how the trajectory of an outbreak can be altered when a country invests in and prioritises preparedness combined with swift strategic action”.

“This is our now or never moment to invest in public health, to prevent the next pandemic, and ensure that as a world, we are never again so underprepared,” said Resolve’s President, Dr Tom Frieden. 

“This report highlights great work of public health professions from around the world and shows that epidemics don’t have to spread uncontrollably and cause devastating loss of life. If we work together, we can make the world a much safer and healthier place,” he added.

According to Resolve, the COVID-19 pandemic could have been contained if there had been adequate global pandemic preparedness.

Interestingly, Africa fares well – precisely because the continent has faced a number of serious disease outbreaks and developed a wide range of responses.

In contrast, a complacent US defunded its pandemic preparedness efforts shortly before the COVID-19 pandemic. This is best illustrated by the Trump administration’s decision to disband the Global Health Security and Biodefense unit and Predict, a $200-million pandemic early-warning programme designed to work with scientists across the world including in China, to identify viruses that had the potential to cause epidemics. Predict was ditched three months before the COVID-19 pandemic was declared.

Unlike the US, Africa’s CDC, which coordinates the continent’s response to COVID-19, has been honing its response to disease outbreaks over the past decade. 

“To date, the entirety of Africa has seen just over 100,000 COVID-19 deaths, a fifth of the death toll of the United States, despite having more than three times the population,” the report notes. 

“While emerging variants in South Africa and elsewhere remain a threat, and Africa CDC warns against declaring victory too early, it is clear that the coordinated response spurred by Africa CDC has saved lives while better preparing the continent to address future outbreaks,” the report concludes.

 

Image Credits: International Federation of Red Cross and Red Crescent Societies / The Kenya Red Cross Society.

India’s Armed Forces Medical Services (AFMS) deploys doctors and paramedics at Sardar Vallabhbhai Patel (SVP) COVID hospital in Delhi to respond to the surge in COVID-19 cases.

PUNE – Indian twitter for days has been a desperate space. There are appeals for oxygen cylinders, cries for funding to meet healthcare costs, and panic-stricken relatives scouting for hospital beds for their loved ones. Hospitals are now approaching the courts for help as they run out of oxygen. And even prominent lawyers and influencers are scouting for help online. 

In the Indian state of Karnataka, deaths are so high that the government has allowed the dead to be buried in land owned by family members, or on farm property, as the crematoriums are flooded with dead bodies. Not only are hospitals discouraging COVID patients from even coming for treatment, but COVID tests have now run out in many parts of the country. While the international community is now proffering offers of assistance – observers fear it will be too little too late.  

Government Held To Blame 

The government has been blamed for the mismanagement of the crisis – most recently for allowing the super spreader religious event called the Kumbh Mela, involving  mass gatherings of prayer goers in the Ganges River and on land. 

Indian Prime Minister Narendra Modi’s own election rallies in the election-bound state of West Bengal have also contributed to the rising cases in that state. Modi’s BJP government even offered voters free vaccines if it came to power in the state, whose eight-phase election will continue until 29 April.

The Prime Minister, meanwhile, has not only downplayed the crisis – but even gone so far as to argue before the country’s Delhi High Court that there has been no shortage of oxygen – despite the public pleas from patients and hospitals around the country on social media. 

india
India’s Health Minister Harsh Vardhan visits the Sardar Patel Covid Center, near Chhatarpur Temple, in New Delhi on April 24, 2021 – an emergency facility set up to cope with the current crisis.

Opposition leaders have highlighted instances where tweets criticizing the government’s handling of Covid-19 also have been deleted from social media platforms.

They also note that government public health officials utterly failed to restrict the mass Hindu religious gatherings, while Modi has personally boasted about his own the mass election gatherings – despite the clear risks both poised to public health.  

Amidst all this the country has been reporting close to 350,000 new cases daily, outpacing the highest daily case rates of the worst-affected country in the world, the United States (US) at the peak of its third pandemic wave. In terms of cumulative cases, as well, India now ranks second after the US. 

Opening Up Domestic Vaccine Market 

On May 1 the government will open up vaccines to those above the age of 18 – but it’s clear that in light of the severe vaccine shortages, many people will still not be able to access vaccines for several months. 

And at the same time, the country is opening up its vaccine market to private players as Health Policy Watch reported earlier.  

Some 50% of the total available vaccine supplies will be offered by the vaccine manufacturers directly to the States and private hospitals. But this means that they will now have to negotiate directly with the manufacturers, as well as competing with each other to procure limited supplies at significantly higher prices than the national government is paying. 

Meanwhile, only those people over age 45 eligible for free national government supplied jabs – with individual states having to decide on whether or not to subsidize the costs of vaccinating other population groups. 

Most states so far have said they would provide the vaccines free of cost – at a huge financial toll. 

Critics said that the privatization move, effectively, means that the national government has  shifted its vaccine costs to the state budgets. 

India’s former health secretary took to Twitter to criticize the move and called it an abdication of fundamental duty by the government and one that will lead to chaos and confusion from May 1 onwards as state governments and private hospitals jostle to procure vaccines. 

Leena Menghaney, a public health lawyer specializing in vaccine pricing in India, said the new policy would create inequities in access to the vaccine within the country. “In no other country you would see the price one for the central government and one for the state.” 

Vaccine prices shoot up amidst case surge

While vaccines sold to the central government will continue to be priced at Rs 150-400 ($2-$5), the new prices set by India’s two vaccine manufacturers, Bharat Biotech and the Serum Institute will range from Rs 400 – 1200 ($5-20). 

SII’s CEO Adar Poonawalla recently declared that the company lacks capital for investing in vaccine manufacturing scale-up,  particularly in light of the fact that it has to pay AstraZeneca some 50% in royalties to locally-manufacture the AstraZeneca vaccine. 

Earlier he also told an Indian news channel that the price of $2 was profitable but meant that SII was forgoing “super-profits” that would allow them to invest  in vaccine research and development.

COVAX Also Affected – While International Community Proffers Help

India’s crisis also affects the 91 low-income countries depending on vaccine supply through the Covax agreement. Currently the exports of vaccines are frozen given the magnitude of the humanitarian crisis in the country. “It (India’s crisis) comes at a great cost where other most vulnerable populations in developing countries are still waiting for vaccines,” said Menghaney.

Poonawalla has said that he expects the export situation to ease in two to three months. 

Following the global outcry over India’s situation the United States, the United Kingdom, European Union, as well as other countries from around the world have stepped in to offer help – including emergency oxygen supplies and PPE. 

And Pakistan’s Prime Minister Imran Khan expressed concern for India’s explosive infection situation – putting aside decades of geopolitical friction over Kashmir and other disputed areas to do so. 

Significantly, the United States also has agreed to lift an export ban on the raw materials required by the Serum Institute of India to manufacture the local version of the AstraZeneca vaccine (Covishield) after initially refusing to do so. The country has also offered to help India with rapid diagnostic test kits, ventilators, and Personal Protective Equipment (PPE). Ashish K Jha, dean of the Brown Institute of Public Health has called these excellent steps.

Also on Monday, the United States was reported to be poised to donate excess vaccine doses to the WHO co-sponsored COVAX initiative – and if so, Indian observers were hopeful, some of those could be directed to the subcontinent. 

https://twitter.com/JonLemire/status/1386723272721588229

The World Health Organization (WHO) also announced additional help to India, with WHO Director General Dr Tedros Adhanom Ghebreyesus calling the situation “beyond heartbreaking” in a press briefing on Monday. 

Around 2,600 WHO staff members will be deployed to India he said to support the response effort along with dispatches of PPE and other equipment.  

 

-Disha Shetty is an independent journalist based in Pune, India who writes on public health, environment and gender. 

 

 

Image Credits: Press Information Bureau (PIB), Credit: Press Information Bureau (PIB).

Red and white capsules in pharmaceutical production line.

Amid a huge global push for the World Trade Organization (WTO) to waive intellectual property (IP) rights on products related to COVID-19 for the duration of the pandemic, the pharmaceutical industry launched a document on Monday – World IP Day – asserting that a “strong IP system advances public health” .

According to the 10-point IP Principles for Advancing Cures and Therapies (IP PACT), IP is the “cornerstone” for the creation of new diagnostics, treatments and vaccines.

The industry declares that “society benefits from the disclosure and dissemination of the information contained in patents and patent applications” and commits itself to “support voluntary and meaningful initiatives that make information about patented medicines more easily available and accessible, and improve the public understanding of the global patent status of approved medicines”.

“We believe that intellectual property is a key facilitator of medical progress and we are committed to patient and societal benefit as guiding principles in our IP practices,” states the document’s first principle.

Meanwhile, it’s 10th and final principle declares that “all countries, including Least Developed Countries (LDCs), stand to benefit from the implementation of the TRIPS Agreement and effective IP regimes”. 

But in recognition of socio-economic challenges faced by these countries, the industry proposes “a time-based transition period for LDCs to meet the TRIPS standards while they focus on overcoming these structural challenges and work towards implementing the necessary framework to protect and enforce IP”. 

Industry Commits to Engaging with Least-Developed Countries

In the meantime, the industry commits to engaging with LDCs in a way that “takes into account their unique challenges”, and this could include “voluntary licensing, non-assert policies or selective approaches to filing, in addition to supporting capacity-building initiatives”. 

“IP has been the oil in the machine of collaboration during this pandemic that has seen unprecedented cooperation and sharing of know-how,” explains Andrew Jenner, Director-General of Interpat, the pharmaceutical industry organisation that focuses on patents and IP.

Jenner says that the IP PACT explains how the industry uses IP in practice for the benefit of patients and society.

Corey Salsberg, Novartis Vice-President and Global Head IP Affairs, told the launch that the IP PACT had been developed to ensure that patients and broader society “have a better understanding of how we approach IP, which is as a means to drive life-changing medical innovations, and as a tool to advance our efforts to contribute solutions to the world’s healthcare challenges”.  

“Several of the principles pertain specifically to themes that are on full display in the COVID context, such as the important role that IP plays in enabling collaborations and partnerships, driving innovation, and bringing together the expertise and capacity needed to achieve things like manufacturing breakthrough technologies on a global scale,” added Salsberg.

An investigation by Intercept published last week revealed that over 100 lobbyists have been paid to approach US politicians to urge them to oppose the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Waiver proposed by South Africa and India at the WTO.

It also comes a few days after the claim by the People’s Vaccine Alliance that Pfizer, Johnson & Johnson and AstraZeneca have paid $26bn in dividends and stock buyouts to shareholders in the past year – enough to cover Africa’s entire COVID-19 vaccination programme.

Babies and children in 50 countries are missing out on routine immunisations.

Fifty countries have not yet resumed routine immunisations disrupted by the COVID-19 pandemic, affecting 228 million people – mainly children – and there have already been serious measles outbreaks in Yemen, Pakistan and the Democratic Republic of the Congo, according to World Health Organization (WHO) director general Dr Tedros Adhanom Ghebreyusus. 

To address this, the WHO, UNICEF, and the global vaccine alliance, Gavi, launched the Immunization Agenda 2030 (IA2030) to strengthen global immunization systems at the WHO biweekly press conference on Monday. 

UNICEF Executive Director Henrietta Fore

The main targets to be achieved by 2030 are: 

* 90% coverage for essential vaccines given in childhood and adolescence

*Halving the number of children completely missing out on vaccines  

* Completing 500 national or subnational introductions of new or under-utilized vaccines, such as those for COVID-19, rotavirus, and human papillomavirus (HPV) .

Dr Kate O’Brien, the WHO’s head of immunisations, said that if these goals are achieved, “the latest estimates show that the strategy would avert over 50 million deaths of children and adolescents”.

Over half of the 50 affected countries are in Africa, highlighting “protracted inequities in people’s access to critical immunisation services”, according to WHO.

“The pandemic has made a bad situation worse, causing millions more children to go unimmunized. Now that vaccines are at the forefront of everyone’s minds, we must sustain this energy to help every child catch up on their measles, polio and other vaccines. We have no time to waste. Lost ground means lost lives,” said Henrietta Fore, UNICEF Executive Director. 

Fore added that, due to pandemic-related disruptions, UNICEF delivered 2.01 billion vaccine doses in 2020, compared to 2.29 billion in 2019.

“We are embarking on an unprecedented global [COVID-19] immunisation campaign. But this campaign cannot come at the cost of childhood vaccinations,” said Fore.

”We cannot trade one global health crisis for another. In a year when vaccines are at the forefront of everyone’s minds, we must sustain this energy to accelerate efforts on all three fronts: providing equitable access to COVID-19 vaccines, catching up on missed vaccinations due to the pandemic lockdowns and, critically, extending immunisation efforts to all children currently missing out on vaccines entirely.”

Gavi CEO Dr Seth Berkley said that “to support the recovery from COVID-19 and to fight future pandemics, we will need to ensure routine immunization is prioritized as we also focus on reaching children who do not receive any routine vaccines, or zero-dose children”. 

COVAX Depending on Dose Donations

COVAX had expected another 90 million vaccine doses from the Serum Institute of India in March and April for low income countries but these had been kept for domestic use given the COVID-19 “crisis” in India, according to Berkley, whose organisation co-leads COVAX.

“We are in early days on discussions on dose sharing,” added Berkley. “We had an announcement last Friday from French President Macron that he would be sharing up to a half a million doses and we’ve also had an announcement from New Zealand, that they would be sharing 1.6 million doses and we’ve heard from the Spanish Prime Minister that they would be sharing doses, so we’re beginning to see engagement from many on dose sharing.”

He confirmed that COVAX was “waiting for when supplies will resume [from India], and we’re looking at other options at the same time”.

Meanwhile, on Monday the US announced that it would be releasing 60 million doses of AstraZeneca vaccines that it had ordered “as they become available”, according to Andy Slavitt, White House Senior Advisor on COVID-19.

Maria Van Kerkhove, WHO Lead on COVID-19

 

Tedros described the situation in India as “beyond heartbreaking”.

“WHO is doing everything we can, providing critical equipment and supplies, including thousands of oxygen concentrators, prefabricated mobile and field hospitals and laboratory supplies,” said Tedros, adding that it had redeployed 2,600 staff “to support the response on the ground, providing support or surveillance, technical advice and vaccination efforts”.

Dr Maria Van Kerkhove, the WHO Lead on COVID-19, described the exponential growth in COVID-19 cases in India as “really, truly astonishing”, but warned that “this can happen in a number of countries if we let our guard down”. 

“We’re in a fragile situation, with nine weeks of case increasing, with more than 5.7 million new cases reported last week, and that is certainly an underestimate,” said Van Kerkhove.

“The situation can grow if we allow it to, and this is why it’s important that every single person on the planet knows that they have a role to play,” she added. “We need governments to continue to apply comprehensive approaches and enabling populations so that they know what they need to do to keep themselves and their loved ones safe.”

 

Image Credits: © UNICEF/Claudio Fauvrelle, Jaya Banerji/MMV, UNICEF.