Mock album cover for ‘We Are Family’ campaign, featuring WHO DG Tedros Adhanom Ghebreyesus, Mike Ryan and Maria Van Kerkhove of the Health Emergencies campaign.

WHO is launching a collaboration with R&B Vocalist Kim Sledge of “We Are Family” fame to reproduce her signature album in a campaign aimed to promote global solidarity for COVID-19, and raise funds to battle COVID-19.  

The campaign, which will be coordinated by The World We Want Foundation, is to feature a special edition cover of the classic song “We Are Family” in a worldwide viral video that would include versions of the song by people ranging from  celebrities to frontline health heroes, political leaders and members of the public  – singing together to support global public health needs, including COVID-19. 

American singer Kim Sledge

“Together we are unity strong, and we can do this as a family because we are one big global family,” Sledge, of the legendary music group Sister Sledge, said, speaking at a WHO press conference on Monday. Sledge said that she embarked on this initiative after being motivated by those around her who are looking for ways to end the crisis, including her husband and daughter, who both work as doctors on the COVID-19 frontlines. 

The video campaign invites people to star in the music video by recording themselves with their close family and friends singing the song and sharing on their social media channels. In order to submit sing-along videos to the special edition of the We Are Family song, members of the public can:

  • Record yourself singing We Are Family either alone, or with friends and family, whilst observing physical distancing guidelines.
  • Share the video on your favourite social media channel, with the hashtag #WeAreFamily #COVID19 #HealthforAll and tag @WHO, @The_WorldWeWant and @thewhof.
  • Upload your video to www.unitystrong.com.
  • If you want your video to be considered for inclusion in the global We Are Family video, you will need to share your video by Monday, 30 November 2020.
  • Video clips will be selected based on age, geographical diversity, and appropriate physical distancing if the video includes groups of people beyond immediate family members and correct handwashing if singing along to the song while washing hands.
  • More details including Terms & Conditions can be found here www.unitystrong.com. 

Part of the proceeds from the new song, to be released on November 9, are to be donated to the WHO Foundation to support the response to COVID-19, as well as to other health promotion initiatives worldwide. 

Video Release To Coincide With World Health Assembly Autumn Session  

The release will coincide with the resumption of the 73rd session of the World Health Assembly, November 9-14. The WHA began in a two-day special virtual session in May to discuss the COVID-19 crisis, and then was adjourned until the autumn. 

Sledge is also scheduled to perform for the WHA alongside singers from New York to Tonga. 

Sledge is collaborating with Natasha Mudhar, founder of The World We Want Foundation, and another driving force behind the #WeAreFamily campaign. 

Natasha Mudhar, Founder of The World We Want

Said Mudhar: “We Are Family is one of the most instantly recognizable anthems in the world. The song carries such an inspiring message of unity and solidarity.

“What is so powerful about music and what we feel will be so powerful about this particular campaign, the song, and the video is that it will not only just entertain, but inspire action. And that’s just really bringing everybody together.”  

Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization, emphasizes in his closing remarks, “This campaign is more than a song. It’s a call to action for collaboration and kindness, and the reminder of the strength of family and the importance of coming together to help others in times of need. 

“It represents that to heal the world from this pandemic, we must come together like never before in national unity and global solidarity with a family, and as humankind. We have more in common with one another, than we would ever dare to believe.” This comes after his announcement that 184 countries have now joined the COVAX initiative, Ecuador and Paraguay having joined this weekend. Tedros reiterated the importance of sharing vaccines equitably around the world by safeguarding high risk populations and working together to share life-saving health supplies globally. 

“Let us use this anthem as a family, to help unite us, unite the world, and together, we wouldn’t just beat this pandemic. We will take on, and successfully tackle other global challenges like air pollution and the climate crisis. So join us in the We Are One Family campaign. Because together we can do anything we put our minds to: national unity and global solidarity. We are one family.”

Image Credits: R Santos/HP Watch.

Doctors and hospital staff in Florida put on personal protective equipment in the COVID-19 unit.

Along with recording the most deaths from COVID-19 of any country in the world, the US has ranked highest among leading OECD countries in deaths per capita from the infectious disease, according to a recent study published in the Journal of the American Medical Association (JAMA) by researchers from Harvard University and the University of Pennsylvania. 

The United States also has experienced consistently high COVID-19 mortality rates since the country saw its first surge of cases in May, more so than other countries with high mortality rates. 

The JAMA study last week suggests that the comparatively higher death rates may be linked to the US’ weak public health infrastructure and a decentralized and inconsistent pandemic response. 

An additional factor may be the high level of pre-existing conditions among Americans who have comparatively high rates of obesity, hypertension and diabetes as compared to other developed countries.  

The authors compared US COVID-19 related deaths and excess all-cause mortality across 18 countries in the Organization for Economic Co-operation and Development, from the start of the pandemic until September 2020. 

The best performing countries in the study were South Korea, Japan and Australia, with fewer than 5 deaths per 100,000 people. Countries with moderate death rates included Norway, Finland, and Austria, with 5-25 deaths per 100,000 people. The worst performing countries with the highest mortality rates were the United States, Belgium, and Spain – with over 25 deaths per 100,000. 

The study also examined excess all-cause mortality, per capita, during the pandemic period to capture indirect pandemic effects. 

COVID-19 mortality comparison between countries with low, moderate, and high mortality.
US Rates Were Initially Low – But Consistently High Since May

The US’ mortality rate in the early spring was lower than other high mortality countries, with 60.3 deaths per 100,000 compared to 86.8/100,000 in Belgium and 65.0/100,000 in Spain. 

However, by mid-May, the US had exceeded all countries in deaths per 100,000, with 36.9 compared to 12.4 in Belgium and 8.6 in Spain. In September, the US’ death rates (60.3/100,000) were more comparable with other high morality countries, including Italy (59.1/100,000) and Belgium (86.8/100,000). 

In May and June, the US had death rates more than double most other high mortality countries, despite the implementation of prevention measures. The patterns observed in the study were also found for excess all-cause mortality, with the US leading in excess all-cause mortality since May. 

Since September, death rates have increased in several countries, with Peru now leading in COVID-19 deaths per 100,000 (105.35), compared to Spain (72.29), and the US (67.14). 

Number of deaths per 100,000 population in the 20 most affected countries as of October 19.

Image Credits: Flickr – National Guard, Journal of American Medical Association, Johns Hopkins.

Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization

As the northern hemisphere enters winter, “COVID-19 cases are accelerating, particularly in Europe and North America,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus, speaking at a Monday press briefing. 

Active cases of COVID-19 around the world and COVID-19 deaths globally (top right) as of 2:11PM EST 19 October 2020.

In words that echoed warnings from European officials last week, Dr Tedros and WHO’s health emergencies team stressed that governments need to double down on testing, contact-tracing and quarantine measures – before surges overwhelm health systems – potentially leading to death rates like those seen in the first wave of the spring. 

“It’s important that all governments focus on the fundamentals that helped to break the chains of transmission and save both lives and livelihoods,” Tedros said at the press briefing.  

“This means active case finding, cluster investigations, isolating all cases, quarantining contacts, ensuring good clinical care, supporting and protecting health workers and protecting the vulnerable. We are in this for the long haul. But there is hope, that if we make smart choices together, we can keep cases down. Ensure essential services continue and children can still go to school. We all have a part to play. 

Dr Tedros said he was “encouraged” by the measures that some governments are taking – most of northern Europe has responded by clamping on night-time curfews, limited lockdowns, closures of restaurants and businesses, and the imposition of stricter limits on public and private gatherings.  

But the WHO Director General also he warned that public “fatigue” was also a worry – without widespread adherence to rules about masks, social distancing and hand sanitation – trends could continue to escalate out of control. 

“The virus has shown that when we lead our guard down, it can surge back at breakneck speed,” Dr Tedros said. 

‘Europe and Others Will Experience ‘High Numbers of Cases; Many Countries Not Doing Enough For Contact Tracing and Quarantine 

Worldwide trends remain volatile, said Health Emergencies Executive Director Mike Ryan. But particularlyin regions where infections are now surging, many countries are not following through enough on contact tracing and quarantine  measures – even after they set out restrictions, he observed.  He warned of  “high numbers of cases” ahead. 

“People are tired, as we move into the next few weeks, Europe and others will experience high numbers of cases,” he said.  “We must protect the vulnerable, we must protect the health system, we must try to keep our kids in school, but potentially be willing to give up some of the things we love to do. And we must test, test test, and reinforcing quarantine and isolation.” 

He said the follow-through on testing and tracing and quarantining has been one thing setting apart countries that succeeded in containing outbreaks from those that have not. 

“Many Asian countries, not only just China, but others in east Asia and also Australia, have managed to crush transmission and keep it down,” he noted, drawing a contrast between trends in Asia and Europe or North America.  

“The things they had in common were tracking cases and quarantining contacts. The success that countries had in Asia was in their ability to find those [infected] people and continue doing that. Serious follow through, they ran through the finish line and beyond because they knew the race wasn’t over. Too many countries put an imaginary finish line – and then stopped.”. 

Countries successful in controlling their outbreaks, also zeroed in on hotspots, said Maria Van Kerkhove, technical lead of the health emergencies team.   

At the same time, health systems have become better at coping with seriously ill cases, she said. And that is reassuring: . 

“Everyone, everywhere, is better prepared at dealing with severe patients. Health systems check oxygen levels right away; that saves lives.  There is dexamethasone, which is widely available all over the world. We are not in the same position, we know a lot more. Now is the time to be really strategic and smart about these interventions.””  

Despite Clinical Trial Setbacks – Some Vaccine Candidates Showing Good Results Impacts on Older People 

Soumya Swaminathan, WHO Chief Scientist

Meanwhile, WHO’s Chief Scientist Soumya Swaminathan said that she was not “unduly alarmed” over the delays in some vaccine and medicines trials being seen recently. 

She was speaking in the wake of an announcement last week by Johnson & Johnson that it was temporarily suspending its one-dose vaccine trial after an unexpected illness in one participant.  The pharma firm Eli Lilly also suspended its trial of an antibody cocktail after an adverse event – the potential treatment had received a great deal of hype after US President Donald Trump received a similar preparation.  

“We should stay hopeful and optimistic,” said Swaminathan, about the trials. “These are things that happen in clinical trials but they are getting more attention now now that they are under the spotlight.  

“Overall we have  45 candidates now in Phase 3 trials,” said Swaminathan, adding that the good news is that some of the vaccines seem to be provoking immune response in older people who are among the most vulnerable.  

“Some of the vaccines now are showing very good immunogencity for older people – and that is important because older people are a high risk group and we hope it would be possible to protect them with a vaccine,” she said. 

184 Countries Committed to WHO Co-Sponsored COVAX Vaccine Facility 

On another positive note, Dr Tedros said that some 184 countries have now committed to the WHO co-sponsored COVAX vaccine facility, including Ecuador and Uruguay as among the latest to join.  

With buy in from high income countries – as well as low-income donor dependent nations, the facility aims to foster a more systematic and equitable system to get the first available vaccine doses to the most needy parts of the world’s population, including health workers, older people and people with pre-existing conditions.  

The facility has, however, also been criticized by medicine advocates who say that the procurement pool hasn’t stopped rich countries from making huge pre-purchase orders for more than one-half of anticipated vaccine stocks that are likely to become available in 2021 – after the first vaccines in final Phase 3 clinical trials are approved as safe and effective. 

Critics, who grouped around a proposal for a patent “waiver” on all COVID related therapie, that was debated at the World Trade Organization last Friday, have also noted that the COVAX facility fails to address the other equipment and medicines needs of low and middle-income countries. A parallel WHO effort to create an “intellectual property pool” for needed COVID therapies – C-TAP – aimed at easing access to products that are still under patent, has not really gotten off the ground. 

Tedros made no reference to the criticism of COVAX or the slow progress on the parallel WHO C-TAP initiative, saying only: “equitably sharing vaccines is the fastest way to safeguard high risk communities. Stabilize health systems and drive a truly global economic recovery. 

“As winter comes we know that the next few months will be tough, but by working together today and sharing life saving health supplies globally including personal protective equipment, supplies of oxygen dexamethasone and vaccines, when they are proven to be safe and effective. 

Referring to the new WHO partnership with Kim Sledge and The World We Want,  to produce a global version of her hit cover “We Are Family,” which was announced by WHO on Monday, Tedros added, “ ‘We are Family’ is more than a song. It’s a call for collaboration and kindness. To heal the world form this pandemic, we must come together like never before in national unity and global solidarity. We are family as humankind – we have more in common with one another than we would ever dare to believe.” 

Image Credits: Flickr: Prachatai, Johns Hopkins.

Genetically modified mosquitoes could be an innovative tool to combat vector-borne diseases and eliminate malaria.

Genetically modified mosquitoes could be an innovative tool to combat vector-borne diseases and eliminate malaria, says a new WHO position statement. Genetically modified mosquitoes are designed to suppress mosquito populations and reduce their susceptibility to infection and their ability to transmit disease-carrying pathogens.

WHO announced their support for the continued investigation into genetically modified mosquitoes as an alternative to existing interventions to reduce or prevent vector-borne diseases.

“These diseases are not going away,” said John Reeder, Director of TDR, the Special Program for Research and Training in Tropical Diseases. “We really do need to think about new tools that could make an impact.”

Each year 700,000 people die from vector-borne diseases and over 80 percent of the global population live in areas with higher risks of contracting a vector-borne disease, including malaria, dengue, yellow fever, and others. Major vector-borne diseases account for 17 percent of the global burden of communicable diseases.

Genetically modified mosquito approaches use recombinant DNA technology to introduce heritable traits to reduce the transmission of mosquito-borne diseases. WHO raised concerns about the ethics, safety, and governance of this new potential vector-borne disease control strategy.

The statement advised for the implementation of oversight mechanisms, risk assessment, and community engagement for further research and field trials of genetically modified mosquitoes. Guidance on vector-borne disease prevention and control was released by the WHO to respond to key ethical issues involved.

Image Credits: Flickr: Tom.

GBD research has also shown that ambient air pollution (from particulate matter) was one of the fastest growing ‘health risks’, along with drug use, high blood sugar  levels, and high body mass index (BMI).

The COVID-19 pandemic, along with the continued global rise in chronic illness and related disease risk factors, such as obesity, high blood sugar, and outdoor air pollution exposures, seen over the past 30 years has created a ‘perfect storm’, fueling COVID-19 deaths, says a new study published Thursday in The Lancet .

The global disease estimates provide insights into how rising chronic disease, along with public health failures, is fueling excess deaths from SARS-CoV-2 among people with pre-existing conditions.

Led by the Institute of Health Metrics and Evaluation, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is a comprehensive global study, analyzing and ranking 286 causes of death, 369 disease and injuries, and 87 risk factors in 204 countries and territories.

The GBD study, covering 204 countries, also tracks a population’s social and economic status on the basis of socio-demographic index (SDI). SDI combines information on average income per capita, educational attainment, and total fertility rates. 

Increased COVID-19 Illness and Death Associated With NCDs & NCD Risk Factors

The study found that increased illness and death from COVID-19 is associated with several risk factors and non-communicable diseases, including obesity, diabetes, and cardiovascular disease, as well as outdoor air pollution exposures. 

But these diseases don’t just interact biologically, they also interact with socioeconomic factors, the study highlights. Underlying social inequities that perpetuate chronic diseases need to be addressed through policy and research in order to prevent the burden of disease from worsening and leaving populations vulnerable to increased risk of COVID-19, the study concludes.

Said Dr Richard Horton, Editor-in-Chief of The Lancet: “The syndemic nature of the threat we face demands that we not only treat each affliction, but also urgently address the underlying social inequalities that shape them—poverty, housing, education, and race, which are all powerful determinants of health.”

He continues, “COVID-19 is an acute-on-chronic health emergency. And the chronicity of the present crisis is being ignored at our future peril. Non-communicable diseases have played a critical role in driving the more than 1 million deaths caused by COVID-19 to date, and will continue to shape health in every country after the pandemic subsides. As we address how to regenerate our health systems in the wake of COVID-19, this Global Burden of Disease Study offers a means of targeting where the need is greatest, and how it differs between countries” .

An accompanying Lancet editorial “Global Health: time for radical change” also states: “The message of GBD is that unless deeply embedded structural inequities in society are tackled and unless a more liberal approach to immigration policies is adopted, communities will not be protected from future infectious outbreaks and population health will not achieve the gains that global health advocates seek. It’s time for the global health community to change direction.”

The study also reveals that the rise in exposure to key risk factors (including high blood pressure, high blood sugar, high body-mass index [BMI], and elevated cholesterol), combined with rising deaths from cardiovascular disease in some countries (e.g., the USA and the Caribbean), suggests that the world might be approaching a turning point in life expectancy gains.

The authors stress that the promise of disease prevention through government actions or incentives that enable healthier behaviours and access to health-care resources is not being realised around the world.

“Most of these risk factors are preventable and treatable, and tackling them will bring huge social and economic benefits. We are failing to change unhealthy behaviours, particularly those related to diet quality, caloric intake, and physical activity, in part due to inadequate policy attention and funding for public health and behavioural research”, says Professor Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, USA, who led the research.

“Double Down” on Development Promotes Health – Address NCDs in Low & Middle Income Countries 
Since the 1990s, the health burden has shifted towards NCDs and away from communicable, maternal, neonatal, and nutritional (CMNN) disease

The report also contains some good news. Over the past two decades, since the adoption of the UN Millennium Development Goals, low and low-middle income countries have chalked up faster progress in their socio-demographic index (SDI), in comparison to rich countries, the report finds. Such progress is “highly correlated” with better health outcomes as well.  

“Given the overwhelming impact of SDI on health progress, doubling down on policies and strategies that stimulate economic growth, expand access to primary and secondary schooling, and improve the status of women should be our collective priority,” adds Murray.

However, LMICs are not prepared to handle the growing transition in the disease burden from communicable diseases to non-communicable diseases (NDCs), the report also finds. 

Indeed, most global health policy discussion, including that of WHO, still focuses on communicable diseases, “even though there is an inevitable shift of disease burden to non-communicable disease.” 

‘Functional Disorders’ – A Growing Problem

Another challenge low- and middle-income countries may face, in particular, is the loss of so-called “functional health” capacities, which may not be well represented in classic health metrics characterizations of so-called “premature disability (DALY’s)”, the report notes. 

This can include issues such as: musculoskeletal disorders, mental disorders, substance misuse, vision loss, and hearing loss – issues which also become more acute as people live to older ages. Instead, current policy discussion is primarily focused on cardiovascular diseases and cancers, with low investment in research towards understanding underlying causes and therapeutic solutions for functional health loss.

Health of Children Has Seen Steady Improvement; Not So for Older Age Groups 
Since 2000, lower SDI countries have improved in the index faster when compared to higher SDI countries

While global health has still steadily improved over the past 30 years, especially for children under 10 years old, thanks to improvements in prenatal care and efforts to tackle infectious diseases, the same cannot be said for older age groups. 

Worldwide health loss, measured in disability-adjusted life-years (DALYs), is increasing. Six of the causes primarily affect older adults (ischaemic heart disease, diabetes, stroke, chronic kidney disease, lung cancer, and age-related hearing loss) and the other four are common from teenage years into old age (HIV/AIDS, other musculoskeletal disorders, low back pain, and depressive disorders). 

Though the number of DALYs hasn’t increased, there are a greater number occurring at old age. There has been a global shift towards non-communicable diseases and injuries, with them being half of the disease burden for 11 countries in 2019. However, global public health has focused more on primary causes of death rather than the systemic disparities of health, such as inequalities in access to preventative and curative services for lower socioeconomic groups.

As said in the GBD: “Policy makers should remain aware that the number of DALYs represents the burden of disease that the world’s health systems must manage.” Health relies on more than just health systems. 

Air Pollution among the Fastest Increasing Health Risks 
Risk factors that have had the largest increases in exposure are high BMI, ambient particulate matter pollution, and high fasting plasma glucose

GBD research has also shown that ambient air pollution (from particulate matter) was one of the fastest growing ‘health risks’, along with  drug use, high fasting plasma glucose, and high body mass index (BMI) by more than 0.5% per year. Many health risks are considered preventable and can be slowed down and reversed through public health action and policy. 

Risks that are strongly linked to social and economic development were the largest declines in risk exposure from 2010 to 2019. These included household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. This correlates to increasing global SDI. Global declines were also reported for tobacco smoking and lead exposure. 

The decrease in tobacco smoking, down 1-2% per year since 2010, is a partial success due partly to the governmental interventions and policy on tobacco control. In comparison, there has been inadequate policy and attention dedicated to BMI, one of the leading causes to contributable DALYs. 

Speaking about the findings, Murray says, “Governments should invest more funding in research and action to tackle these stagnating or worsening risk exposures. A core obstacle to accelerating progress on behavioural risks is the notion of individual agency and the need for governments to let individuals make their own choices. 

“This concept is naïve, given that individual choices are influenced by context, education, and availability of alternatives. Governments can and should take action to facilitate healthier choices by rich and poor individuals alike. When there is a major risk to population health, concerted government action through regulation, taxation, and subsidies, drawing lessons from decades of tobacco control, might be required to protect the public’s health.” 

Image Credits: Igbarrio, The Lancet/IHME.

Albert Bourla, CEO of Pfizer, at a World Economic Forum meeting in 2018.

Pfizer CEO, Albert Bourla, announced Friday in an open letter that the pharmaceutical company developing a COVID-19 vaccine will not request an emergency authorization before mid-November – meaning that the file of the vaccine candidate that is regarded as the front-runner in the global race to get a vaccine to market would only be reviewed after the US presidential elections. 

Pfizer said that it would continue running the trial through final analyses before seeking an emergency authorization from the US Food and Drug Administration (FDA). Moderna is also expected to submit the file for its vaccine around the same time. 

“Assuming positive data, Pfizer will apply for Emergency Authorization Use in the US soon after the safety milestone is achieved in the third week of November,” said Bourla. 

Bourla emphasized the three key areas Pfizer prioritized for public use of the vaccine: vaccine efficacy, safety, and high quality and consistent manufacturing. These were also highlighted by Mike Ryan, Executive Director of WHO Health Emergencies Program, at a WHO press briefing on Friday. 

“It’s not just about the safety and efficacy of vaccines. It’s the quality of the vaccine as well,” and good manufacturing practices contribute to developing a high quality vaccine, said Ryan. 

These practices and steps, along with transparency, are necessary to provide reassurance to populations and improve public trust. Bourla noted Pfizer’s commitment to transparency and the importance of clarity in the context of “critical public health considerations.” 

“To ensure public trust and clear up a great deal of confusion, I believe it is essential for the public to understand our estimated timelines for each of these three areas,” Bourla said. 

The timeline of COVID-19 vaccines has been highly politicized, particularly by US President Donald Trump in his campaigning for re-election. Bourla previously lambasted the President for his politicization of the independent, scientific process of vaccine development and approval. 

Earlier in October, Bourla published an open letter saying that the company “would never succumb to political pressure” and is “moving at the speed of science.” 

Pfizer previously had an accelerated timeline compared to the other leading vaccine candidates in the US, due to the shorter interval between the two-doses of the vaccine. Moderna announced in early October that it would not seek Emergency Authorization until after November 25 and Johnson & Johnson’s Phase 3 vaccine trial was “paused” earlier this week for a participant illness. 

NIH Begins Clinical Trial on Immune Modulator Treatments for COVID-19
Doctor checking on a COVID-19 patient connected to a ventilator in the ICU in Louisiana.

Meanwhile, a new Phase 3 clinical trial was launched by the US National Institutes of Health (NIH) to evaluate the efficacy of three immune-modulating therapies in reducing the need for ventilators and the duration of hospital stays. 

Immune-modulating therapies are drugs that alter the way the immune system works. The therapies will be examined for their ability to suppress an immune response that sometimes occurs in COVID-19 patients, where the immune system releases excessive amounts of proteins that lead to inflammation and life-threatening complications. 

The trial will be part of the NIH’s Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) initiative, a public-private partnership established in April to coordinate research strategies to speed up development of treatments and vaccines. 

“This is the fifth master protocol to be launched under the ACTIV partnership in an unprecedented timeframe, and focuses efforts on therapies that hold the greatest promise for treating COVID-19,” said Francis S. Collins, Director of NIH. “Immune modulators provide another treatment modality in the ACTIV therapeutic toolkit to help manage the complex, multi-system conditions that can be caused by this very serious disease.” 

The clinical trial will evaluate Remicade, developed by Johnson & Johnson’s Janssen Research unit, Bristol Myers Squibb’s Orencia, and AbbVie’s Cenicriviroc. Approximately 2,100 hospitalized adults with moderate to severe COVID-19 symptoms will be enrolled in the study that will last six months. 

All trial participants will receive Remdesivir, due to the current standard of care treatment of hospitalized COVID-19 patients. It is unclear if the interim results of the WHO’s Solidarity Trial on Remdesivir will impact the guidelines on standard of care treatment.

 

Image Credits: Flickr – World Economic Forum, Flickr – US Navy.

Remdesivir received emergency use approval for COVID-19, only to fall by wayside in WHO Solidarity trial.

Two more experimental COVID-19 drugs, including the much-touted Remdesivir, appear to have fallen by the wayside, failing to show significant reductions in mortality among seriously ill patients. Interim results on Remdesivir and three other drug treatments being studied as part of the WHO Solidarity Therapeutics Trial, the world’s largest randomized controlled trial of COVID-19 drugs, were published Friday on the pre-print journal, medRxiv.org. 

The WHO-coordinated study, covering some 11,266 participants across 30 countries, found that the antiviral Remdesivir, as well as Interferon, had no effect on 28-day mortality among hospitalized COVID-19 patients and little or no effect in reducing the initiation of ventilation or the duration of hospital stay. While the news on Remdesivir was fresh, the study also reported results of treatments with two other drugs, the anti-malarial Hydroxychloroquine, and the HIV/AID drug combination Lopinavir/Ritonavir, which have already been largely disqualified as good treatment options, in light of findings from studies published over the spring and early summer.  

“These Remdesivir, Hydroxychloroquine, Lopinavir and Interferon regimens appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay,” states the study. “The mortality findings contain most of the randomized evidence on Remdesivir and Interferon, and are consistent with meta-analyses of mortality in all major trials.”

Dr Tedros Adhanom Ghebreyesus, WHO Director-General announcing negative Remdesivir results

The study includes findings from drug trials covering some 11,266 participants across 30 countries, with 2750 participants administered Remdesivir, 954 Hydroxychloroquine, 1411 Lopinavir, 651 Interferon plus Lopinavir, 1412 Interferon, and 4088 receiving no treatment drug. 

In a sober announcement of the results at Friday’s WHO press conference, Director General Dr Tedros Adhanom Ghebreyesu made it even more plainly clear:

“Interim results from the trial now show that the other two drugs in the trial, Remdesivir and Interferon, have little or no effect in preventing death from COVID-19 or reducing time in hospital. 

“For the moment, the corticosteroid steroid dexamethasone is still the only therapeutic shown to be effective against COVID-19 for patients with severe disease,” Dr Tedros added. 

WHO Will Push On To Test Monoclonal Antibodies and Other Antivirals

Despite the dead-end reached with the drugs that only a few months ago had seemed to offer potential for improving COVID treatment, Dr Tedros also said that WHO Solidarity Trial would push ahead  in coordinating new research to “assess other treatments, including monoclonal antibodies and new antivirals.”

The potential of drugs containing controlled portions of anti-SARS-CoV2 monoclonal antibodies have catapulted into the spotlight recently, after US President Donald Trump claimed that such a cocktail by the pharma company Regeneron had virtually “cured’ him of COVID-19.  

Even so,  clinical trials on a similar treatment, under development by Eli Lilly, were halted just this week after an adverse reaction occurred in one trial participant. Despite the lack of evidence about either drug, both Eli Lilly and Regeneron have already filed requests with the United States Food and Drug Administration for Emergency Use Authorizations of their products.  Remdesivir had also been approved by the FDA as well as by the European Medicines Agency, under the same EUA process.

The WHO Director General said that the global Solidarity Trial also is considering for evaluation other, newer antiviral drugs and immunomodulators – the latter are being studied because of the role they may play in tempering over-reactions by the immune system.  

Mass Gatherings, Protests, Masks & Travel – WHO Offers Views But Says Decisions Up To Member States 

With no drugs, or a vaccine, yet in sight, WHO officials are also stressing the importance of using what they call “non-pharma” measures that have been demonstrated to be effective in controlling the virus spread.  

Key among those strategies are the management of mass gatherings, use of masks, and safety in travel, said WHO Health Emergencies Executive Director Mike Ryan.  But he hedged on providing firm advice to countries to mandate masks or ban mass gatherings – saying it is ultimately up to the governments themselves to set out policies based on the local context.  Some excerpts: 

Mike Ryan, Executive Director of WHO Health Emergencies Programme

Mass gatherings – Not only the United States, but leading countries around Africa and the Eastern Mediterranean are also entering election season. Ryan repeated comments made earlier this week, saying that the pandemic shouldn’t be used as an excuse to discourage people from coming out to vote – saying rather that mass gatherings can be “managed” to ensure that elections can proceed.  

Ryan: “In terms of people coming together and gathering, many countries, groups and communities have shown that it is possible for communities to come together to express their views, to vote and to do other things, and that can be done in a safe manner. And therefore we continue to offer advice to countries and to organizations who are planning gatherings, especially important gatherings and elections. They must be associated with good risk management measures.”

Protests – Civil disobedience and protests are common occurrences, particularly during the COVID-19 pandemic, which has exacerbated existing inequalities and has strained the relationship between individuals and public authorities and institutions, Ryan acknowledged, adding:

“We do call for calm. People are suffering and when people are tired and suffering, there can be a gap in trust that emerges between communities and the people that govern them. But governments don’t govern people, governments are there to serve the people first and foremost…Governments should always encourage the right to protest and express dissatisfaction and we will continue to provide support to countries to ensure that they support their communities in that way.”

“Many people in many countries have many issues they want to raise with governments, everything from climate, to social justice, to employment, to COVID-19. It’s an important part of our global approach to democracy to ensure that people always have the right to protest and express their views. But obviously, we hope that can be done safely and in a properly risk managed way and can be done peacefully.”

Masks – WHO only belatedly began supporting masks as a public health measure – after considerable evidence showed efficacy. Now that it has become enthusiastic about their use, some countries, such as Sweden, still refrain from mandating masks, even in confined and crowded spaces, like public transport. 

Ryan: “Each country has had to take a different approach in this response, and each country has had to determine what its social contract is, and what is possible within the context of the relationship that the government has with people.”

“We, as WHO, would say that masks are an important part of the strategic, comprehensive approach to stopping the spread of this disease, especially where you have widespread community transmission and where you do not understand fully the chains of transmission…We will continue to work in our European regional office with all countries in the region to optimize their strategies.” 

Maria Van Kerkhove, WHO Health Emergencies Technical Lead

Maria Van Kerkhove, Health Emergencies technical lead adds: “Masks must be used as part of a comprehensive package. It must not be masks alone, because you still need hand hygiene and to use alcohol based rub…When you enter the workplace, avoid crowded settings, enclosed spaces, especially with poor ventilation, open the windows, physical distancing. All of this needs to happen.”

Travel precautions  – WHO’s Tedros and Mike were adamantly opposed to any travel restrictions in the early months of the COVID-19 epidemic, even as international travel was clearly the vector carrying the infection across the world. After most countries ignored WHO’s advice and unilaterally slapped on their own travel restrictions, sometimes closing their air space altogether and at other times, applying more selective measures, WHO fell silent on the matter and has largely remained so, despite pleas by some member states, such as Austria at last week’s Executive Board meeting, for more targeted and nuanced advice.  

Says Ryan: “Great strides have been made in ensuring that international travel is safer…De-risking travel is one thing in the sense of ensuring people aren’t exposed to the virus while traveling. 

“It’s a very different issue when it comes to deciding who can travel from one country to the other. If we’re going to see international travel resume in a meaningful way, we can commend the travel industry for doing all they can to reduce the risk of exposure during travel, but there’s still a way to go to create the confidence and trust between countries, so that travel can be opened between countries.”

COVID-19 Soaring, but Restrictions May also Help Reduce Flu in Northern Hemisphere

Although COVID cases are rising sharply in 8 out of 10 countries of WHO’s European region after a reprieve over the summer, the spread remains uneven and posing various levels of threat, WHO officials also noted at the briefing.

Active cases of COVID-19 around the world and COVID-19 deaths globally (top right) as of 8:00PM CET 16 October 2020.

“Within Europe there are about 37 areas in 13 countries that have an increasing incidence and increasing hospitalizations that we’re looking at,” said Van Kerkhove.

Meanwhile, Dr Tedros expressed hopes this year’s flu season in the northern hemisphere might at least be lighter as a result of the wave of restrictions and preventive measures that are now being adopted by European countries to combat COVID-19.  

“Many of the same measures that are effective in preventing COVID-19 are also effective for preventing influenza, including physical distancing, hand hygiene, covering coughs, ventilation, and masks,” said Dr Tedros. “But we cannot assume the same will be true in the Northern Hemisphere flu season,” warned Tedros. 

Every year there are approximately 3.5 million cases of severe seasonal influenza worldwide, however, during this year’s influenza season in the Southern hemisphere, there were far fewer cases than usual, said Dr Tedros. 

Influenza coupled with COVID-19 has the potential to overwhelm health systems and facilities. Although vaccines exist for influenza, high demands would stretch supplies, particularly in low-income countries.  

However, it is hoped that the northern hemisphere countries can replicate the experience in the southern hemisphere, where the flu season was light, presumably because of precautionary COVID-19 measures taken there. 

Influenza Vaccination May Also Help Protect Against COVID-19 – New Study Finds

Meanwhile, several recent epidemiological studies also have suggested that there may be cross-protection between influenza vaccination and COVID-19 during the pandemic. Another preprint  study published Friday by a group of Dutch researchers on medriXiv.org even suggested the possibility of using an influenza vaccine against both influenza and COVID-19 for the 2020-2021 influenza season. 

The study found that the quadrivalent inactivated influenza vaccine used in the 2019-2020 influenza season in the Netherlands induced a trained immune response against SARS-CoV2, in laboratory blood samples, suggesting a possible relative protection against COVID-19. In addition, observational study of 10,000 Dutch health workers found somewhat lower levels of COVID-19 infection among people who had received their flu vaccine for the 2019-20 flu season. In the study group, 1.3% of vaccinated workers came down with test-positive cases of COVID-19, as compared to  2% of those who did not get the vaccine.

Image Credits: European Medicines Agency, WHO, Johns Hopkins.

John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC) at Thursday’s press briefing.

IBADAN, Nigeria – Nearly two years after the Assembly of the African Union, adopted a milestone  treaty establishing an African Medicines Agency (AMA) that could provide a more unified approach to regulatory approval of new medicines and vaccines, the AMA treaty is yet to enter into force – because it has not been ratified by 15 countries.  

So far only 18 of Africa’s 55 countries have even signed the framework agreement establishing the agency, including the Republic of Congo, which signed in Addis Ababa just yesterday.  But only 5 countries have actually ratified the agreement – including Rwanda, Mali, Burkina Faso, Ghana and Seychelles. Major holdouts include almost all of the largest countries in southern and eastern Africa, along with Nigeria, the Democratic Republic of Congo, and Egypt.

18 of Africa’s 55 countries have signed the AMA agreement, while only 5 have ratified it

Paradoxically, a functional AMA could also be a valuable tool in the fight against the COVID-19 pandemic that has already claimed thousands of lives across the continent – speeding new drugs and a hoped-for vaccine more quickly to markets, said .  

Fielding questions Thursday from Health Policy Watch, Director of the Africa Centres for Disease Control and Prevention (African CDC), John Nkengasong,  a Cameroonian virologist, attributed the delay in treaty ratification to the political processes that the agreement must move through in individual AU member countries – which have stalled due to the pandemic.

“There is a lot of work to be done to bring other countries on board. It has to go through the parliament of each country. There is a process,” Nkengasong told Health Policy Watch.  He said that he regretted that the approvals have not moved faster. 

“I don’t think it is because countries do not want to sign on. I think it is because of the process that is required to make them sign that treaty, and the countries are currently focusing more on COVID-19,” Nkengasong said, adding: “I think it’s a much needed institution. If we had the AMA, it would be working very closely with the WHO and other bodies to facilitate regulatory issues on drugs to help control the COVID-19 pandemic.”

Shabir Madhi, Principal Investigator of the first Covid-19 vaccine trial in South Africa

AMA Approved in February 2019 

Establishment of the AMA was approved in principal at the thirty-second ordinary session of the Assembly of the African Union (AU) in February 2019. 

Drafted before the onset of SARS-CoV-2, proponents of the agency perceived a need for a more unified approach to drug reviews and approvals, based on experience with recent disease outbreaks, such as the devastating Ebola epidemics in western Africa and the Democratic Republic of Congo, which led to shortfalls in many needed health products. Although the emergencies triggered new R&D into vaccines and other medical products – getting new products into clinical trial, through approvals, and to market remains a complex process with different regulatory and oversight mechanisms operating in every country affected.  

Most of the countries that have signed onto the agreement so far are located in north and west Africa. They include Algeria, Benin, Burkina-Faso, Chad, Gabon, Mali, Senegal and Tunisia, among others. Even so, Cameroon, Nigeria and the Democratic Republic of Congo, in western and central regions, as well as leading southern and eastern Africa nations, such as South Africa, Kenya, Uganda and Tanzania, are yet to even approve the agreement. Likewise, Egypt remains a holdout.   

When it becomes operational, AMA is expected to link up existing national regulatory systems with the continent-wide approval mechanism, to speed up review and approval processes, improving access to essential medicines.  

With the race for COVID-19 vaccines heating up, and with palpable nationalist tendencies already emerging, Nkengasong said the AMA would now be well placed to champion the cause of COVID-19 vaccines and drugs for African countries – and ensure a more rapid, but also well-managed, introduction to markets. 

“If we had the AMA, it would be working very closely with the WHO and other bodies to facilitate regulatory issues on drugs to help control the COVID-19 pandemic. I think it’s a much needed institution.”

WHO Also Waiting in Wings for AMA Ratification 

Following the AU’;s lead, The World Health Organisation (WHO) signed a memorandum of understanding with the AU in November 2019 to collaborate on improving access to medicines, strengthening epidemic preparedness, and expanding universal health coverage across the African continent.

Under the agreement, WHO will provide technical expertise to the AMA, bolstering it to support regulatory approvals and local production of essential medicines, while hopefully increasing access to quality-assured drugs.

“One of the biggest obstacles to improving access to medical products in Africa is the lack of strong national regulatory systems. To address that, all of the African Union countries signed a treaty at the AU Summit last year to create an African Medicines Agency,” said Dr Tedros in January 2020, at moment when excitement for the idea was high, before the COVID-19 swept across the world. Speaking at Thursday’s press briefing, WHO Regional Director in Africa, Dr Matshidiso Moeti, reiterated that in spite of the delays seen since, the global health body is still fully supporting AMA and would like to see it come to reality.

Matshidiso Moeti, Regional Director of WHO Regional Office for Africa

“AMA is a very important platform for medicines to be available and affordable equitably, and to be of good quality so that we have both good outcomes for the money that people and countries are spending, and that we prevent problems,” Moeti told Health Policy Watch.

Intra-African Nationalist Tendencies – Another Factor?

Healthcare workers don protective equipment during Ebola outbreak which wracked DRC in 2018-19

Delays in ratifying intra-African treaties is not unique to the AMA. In fact, it has become a familiar dynamic, with the most recent issues arising around the African Continental Free Trade Area (AfCFTA) which is aimed at accelerating intra-African trade and boosting Africa’s trading position in the global market by strengthening Africa’s common voice and policy space in global trade negotiations.

Despite its purported benefits, Nigeria which is the continent’s most populous country and the largest economy, held out for some time.  It was among the last countries to sign to be part of the AfCFTA agreement in July 2019. Nigerian President Muhammadu Buhari explained this saying that the country wanted to avoid undermining local manufacturers and entrepreneurs.

With the ratification of the AMA treaty dragging behind despite its exigent need in the middle of a pandemic, concerns are emerging that Nigeria and other African countries with large pharmaceutical markets may be holding out in a similar fashion to safeguard and protect their local markets over continent priorities.

While fighting fake drugs and improving the quality of pharmaceutical products are shared goals of most countries in Africa, there are also fears that a more centralized approach to regulatory approvals may not sufficiently different countries’ distinctive national features and needs, some experts say. For instance, while some countries already have well-controlled drug sectors, others are still struggling. This and other issues could tend to push ratification of a continent-wide treaty lower on the agenda in some countries, as local health authorities are focused on very immediate vaccine and medicines supply chain needs, as well as lowering the impacts of COVID-19. 

Even so, there are still hopes that the treaty will be ratify during the next general assembly meeting of the African Union in February 2021, as per the comments of  Dr. Margaret Agama-Anyetei, head of health, nutrition, and population at the African Union Commission, in a July 2020 interview with Devex.  

In terms of Africa CDC, Nkengasong said the AMA, once it is ratified, will become a critical component towards achieving the AU’s Agenda 2063 — a call for action to all segments of African society to work together to build a prosperous and united Africa based on shared values and a common destiny.

“We have a serious issue of drugs that are counterfeit on the continent and that creates a huge economic loss for the population; it has a huge effect on the ability to create antimicrobial resistance (resistance to antibiotics). With the creation and ratification of such an agency, those issues we believe will begin to be addressed,” Nkengasong told Health Policy Watch. 

Image Credits: Africa CDC, Health Policy Watch – based on data from nepad.org, University of the Witwatersrand, WHO, Twitter: @WHOAFRO.

Inactivated COVID-19 vaccine candidate produced by Beijing Institute of Biological Products and Sinopharm Group.

A new study published in The Lancet on Thursday found that an inactivated vaccine candidate, called BBIBP-CorV, was safe and provoked an immune response in healthy individuals. This is the first study of an inactivated COVID-19 vaccine to include participants over 60 years of age.

The BBIBP-CorV vaccine is being developed by the Beijing Institute of Biological Products and Sinopharm in China. The vaccine candidate was based on a sample of the virus isolated from an infected patient, then chemically inactivated and mixed with aluminium hydroxide to boost immune responses.

Inactivated virus vaccines use technology and mechanisms that many existing vaccines use, including measles and polio vaccines. The virus is modified and rendered uninfectious. Inactivated vaccines cannot replicate, so they typically require multiple doses and large quantities of infectious virus are needed to develop inactivated vaccines. 

Types of vaccines, some of which are being used for COVID-19 vaccine development.

A previous clinical trial for an inactivated SARS-CoV2 vaccine – designed by the Wuhan Institute of Biological Products Co Ltd – published its Phase 1 and 2 results in August in JAMA, but the trial did not include participants over the age of 60. The study reported results similar to those of Sinopharm’s BBIBP-CorV vaccine, with low rates of adverse reactions and high levels of detectable neutralizing antibody responses in the majority of participants. However, the study was limited by its lack of inclusion and analysis of participants who are 60 years or older, the group at higher risk of serious illness. 

Phases 1 and 2 of the Sinopharm clinical trial included participants from 18 to 80 years of age with no underlying conditions. The vaccine was given in two-doses. A small proportion of participants reported side effects of pain at the injection site and fever, however all adverse events were either mild or moderate in severity, according to the study results. 

Neutralizing antibody responses – which in principle would also be protective against the actual SARS-CoV-2 virus – were induced in all trial participants who received the vaccine.  Antibodies were detected at 28 days in participants aged 18-59, and over 75 percent of participants in the 18-59 age group had detectable antibodies after the first dose. But it took two doses and a total of 42 days for all of the participants aged 60-80 to show detectable levels of neutralizing antibodies. Not only did the immune response take longer to develop in participants over 60 years of age, but antibody levels were comparatively lower than in the younger age group.

“Protecting older people is a key aim of a successful COVID-19 vaccine as this age group is at greater risk of severe illness from the disease,” said Xiaoming Yang, one of the authors of the study. “It is therefore encouraging to see that BBIBP-CorV induces antibody responses in people aged 60 and older, and we believe this justifies further investigation.” 

The results also suggested that a booster shot would generate the greatest antibody response against SARS-CoV2. Phase 3 of the clinical trial will examine the safety and immunization dose and schedule of the vaccine, as well as extending the follow-up period after the two vaccinations. 

With 42 candidate vaccines in clinical trials and 151 in preclinical evaluation, the landscape of potential COVID-19 candidate vaccines is crowded and diverse in vaccine type. Some experts have raised concerns about the ability of inactivated SARS-CoV2 vaccines to induce and maintain protective immunity for infection. 

“Because the correlates of protection afforded by inactivated SARS-CoV2 vaccines are yet to be identified, the results of a phase 3 trial of BBIBP-CorV vaccine…will provide information on whether this vaccine is safe and efficacious against SARS-CoV2 infection, and for how long the protective effect is maintained,” said Irina Isakova-Sivak and Larisa Rudenko in a review of the study. 

Image Credits: Sinopharm, WHO.

COVID-19 testing program in Jangamakote Village in Karnataka, India.

A significant surge in COVID-19 cases is currently taking place across Europe, something that Hans Kluge, WHO Regional Director for Europe, described as the “fall/winter surge” in a press briefing Thursday. Europe has reported its highest weekly number of COVID-19 cases since the beginning of the pandemic, with nearly 700,000 cases. 

Even though mortality rates remain lower, in comparison to those seen in the first wave in April, the unprecedented number of new infections mean that the death toll is mounting daily as well. With 1,000 deaths per day, COVID-19 has now become the fifth leading cause of death in WHO’s European Region, which in fact cuts a broad swathe, including the former Soviet Union republics, Turkey and Israel. 

“Projections from reliable epidemiological models are not optimistic,” Kluge said. “These models indicate that prolonged relaxing policies [of restrictions] could propel – by January 2021 – daily mortality at levels 4 to 5 times higher than what we recorded in April.”

Stronger national and local restrictions on large gatherings and social distancing measures are needed to stave off the worst consequences, he said. Measures need to anticipate the worsening situation and flatten the course of the virus – although they don’t necessarily need to include lockdowns, he added.

“Today, lockdown means a very different thing. It means a stepwise escalation of proportionate, targeted and time-limited measures. Measures in which all of us are engaged both as individuals and as a society together in order to minimize collateral damage to our health, our economy and our society,” said Kluge. 

Indeed, most European countries have sought to take a more incremental approach. Spain,  Germany and the United Kingdom have drastically increased their restrictions on commercial and leisure activities, and public gatherings, as well as imposing curfews or partial closures on “red” cities or regions. Israel, however, imposed a total, nation-wide lockdown three weeks ago, after racking up some of the highest daily rates of new infections in the world; it is now exploring ways to relax restrictions gradually and selectively. 

Against the patchwork of policies being adopted, Ursula von der Leyen, president of the European Commission, said on Thursday that the European Union needs to establish common rules on quarantining and testing, for suspected cases as well as travel. 

Speaking at the start of a two-day meeting of EU leaders, “I think it is also necessary that there will be an agreement on the time of quarantine or the necessity of testing. Here I call on the stakeholders that we also find an agreement. This is important.” 

United States & India Both Facing COVID Surges In Rural Areas 

Active cases of COVID-19 around the world and COVID-19 deaths globally (top right) as of 8:00PM CET 15 October 2020.

Meanwhile, in the United States, the country was seeing a ‘third wave’ in cases, with predominantly rural states now reporting some of the country’s highest daily number of new cases, per capita. The surges have been particularly striking in midwestern and western states such as North Dakota, Montana, Wyoming, Idaho, and Alaska. 

“We, as North Dakotans, find ourselves in the middle of a regional Covid storm,” said Governor Doug Burgum. 

“We are starting from a much higher plateau than we were before the summer wave,” said Caitlin Rivers, an epidemiologist at Johns Hopkins University. “It concerns me that we might see even more cases during the next peak than we did during the summer.”

North Dakota National Guard Soldiers administer voluntary COVID-19 testing at a drive-through site.

A similar trend of rising infection rates in less populous areas has also been reported in India. The proportion of cases occurring in India’s rural areas increased from 15 percent to 24 percent between July to August, Indian media reported.  In Mahara­shtra state, five districts recorded a rise of 400 percent in August, as compared to 28 percent in Mumbai, India’s largest city.

The common thread linking these trends on opposite sides of the earth may be that COVID-19 mask and social distancing rules are being ignored, experts said. That may be deliberate defiance, particularly in parts of the US where such measures have become highly politicized. Or it may simply be a result of the economic costs of quarantining and lack of awareness, particularly in the case of India. 

In India, most public awareness campaigns have taken place in urban areas, with few strategies targeting rural areas, as a result. Many people in rural Indian towns also may believe the government is exaggerating the severity of the pandemic. An additional issue is the limited capacity of health systems in rural areas, experts say.

“Covid is spreading to smaller towns and villages and this is truly worrying,” K. Srinath Reddy, president of the Public Health Foundation of India, was quoted as saying in India Today. “A rural pandemic will be very different and far more challenging than an urban one,” rural India has just 3.2 hospital beds per 10,000 people. Although it represents 65 percent of the nation’s population, only 37 percent of doctors work in rural areas.

COVID-19 outreach program in Jangamakote Village, Karnataka, India.

India also is catching up with the US in terms of the total number of COVID-19 cases, with 7.3 million cases and 7.9 million cases respectively. The US, however, remains the worldwide leader in numbers of cases as well as in deaths from COVID-19.

Open Letter in The Lancet Warns of “Dangerous Fallacy” of Herd Immunity 

Countering the COVID-skeptics, an open letter published in The Lancet on Thursday, signed by over 80 experts and specialists, called out the herd immunity approach of allowing large, uncontrolled outbreaks in low-risk populations in an attempt to develop infection acquired population immunity as a “dangerous fallacy.” 

“Uncontrolled transmission in younger people risks significant morbidity and mortality across the whole population,” say the authors, outlining measures to mitigate the transmission of SARS-CoV2 and the need for multi-pronged population-level strategies.

With increasing cases across many countries worldwide, effective measures to find, test, trace, and isolate COVID-19 cases are critical and have been successful in several countries, including New Zealand, Japan, and Vietnam. 

“Controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months,” said the authors. 

Image Credits: Flickr – Trinity Care Foundation, Flickr – Trinity Care Foundation, Johns Hopkins, Flickr – The National Guard, Flickr – Trinity Care Foundation.