The Oxford/AstraZeneca COVID-19 vaccine during the vaccine development process.

In news that should be reassuring for skeptics, the Oxford/AstraZeneca COVID-19 vaccine was found to be 79% effective in preventing symptomatic COVID-19 and 100% effective against severe disease and hospitalization in results of a late-stage clinical trial, published today by the pharma company.

What’s more, analysis of safety results by an independent board found no increased risk of blood-clotting (thrombosis) among the trial participants, the company said in it’s statement – reinforcing findings of the European Medicines Agency (EMA) last week that the vaccine is safe – despite some rare blood clotting events seen in Europe, particularly among young women, that warrant further investigation.

Among trial participants over the age of 65, the vaccine efficacy rate reached 80%. This news is also reassuring, given the limited data on the vaccine efficacy in older individuals that had been seen to date, and which had led many EU countries to set age restrictions on the AstraZeneca vaccine in the first phases of rollout. 

The results of the large-scale trial, with many participants in the United States, also are expected to pave the way for approval of the vaccine by the United States Food and Drug Administration (FDA).

EMA Executive Director Emer Cooke reports the results of the body’s safety committee report  on the AstraZeneca vaccine last week.
New AZ Trial Results – United States, Peru & Chile

The new trial was conducted in the US, Peru and Chile, with 32,449 participants. Efficacy was consistent across age and ethnicity, although 79% of the participants were white, 22% were hispanic, and only 8% were black, 4% asian, and 4% native American. 

In the initial set of Phase 3 trials, which had taken place largely in the United Kingdom and Brazil, only 12% of participants were older than 55. In contrast, the newly reported US trial arm had one fifth of the participants over 65 and approximately 60% had co-morbidities – which would normally increase their risk of developing severe illness, including diabetes, severe obesity, and cardiac disease.

“These findings reconfirm previous results observed in AZD1222 trials across all adult populations, but it’s exciting to see similar efficacy results in people over 65 for the first time,” said Ann Falsey, co-lead Principal Investigator for the US trial, in a press release issued by the pharma company. 

“This analysis validates the AstraZeneca COVID-19 vaccine as a much-needed additional vaccination option, offering confidence that adults of all ages can benefit from protection against the virus,” she added. 

AstraZeneca said that it now plans to submit these findings to the FDA in the coming weeks to receive emergency use authorization. The primary analysis of the data, once it is completed, will also be submitted for peer-reviewed publication.

Planned Delivery of Doses

Meanwhile, AstraZeneca announced on Monday in a press conference that it would deliver 30 million doses of the vaccine to the United States in the first half of April after receiving approval and another 20 million later on in the same month. Subsequently, 15 to 20 million doses will be delivered. 

US health officials have predicted that the country will have enough doses to vaccinate every adult by May using the three vaccines currently approved – Pfizer/BioNTech, Moderna, and Johnson & Johnson.

It is unclear how big of a role the AstraZeneca vaccine will play in the US’ vaccination campaign and whether the government will donate excess doses to countries lacking in vaccines.

At a press conference on Monday, Ruud Dobber, President of AstraZeneca’s Biopharmaceuticals Business Unit, said he would be “very surprised” if the doses were not used to vaccinate Americans. 

Blood Clots and Vaccine Hesitancy
From Europe, concerns have spread worldwide. (on right) Paul Kelly, Australia’s Chief Medical Officer addresses blood clot concerns over AstraZeneca vaccine.

In addition to the trial results, an independent data safety monitoring board (DSMB) conducted a specific review of thrombotic events, including cerebral venous sinus thrombosis (CVST) – a rare disorder of clots in vessels draining from the brain – seen in association with the vaccine’s administration in a number of cases in Europe.

The board found no increased risk of thrombosis among the trial participants, echoing the message from the EMA last week, which stated that the vaccine is safe and effective. 

“We hope this will lead to even more widespread use of the vaccine in the global attempts to bring the pandemic to an end,” said Sarah Gilbert, Professor of vaccinology at Oxford University and co-designer of the vaccine.

According to the latest EMA data, of an estimated 20 million people in the United Kingdom and Europe that had received the vaccine as of March 16, the EMA had identified 18 cases of CVST (cerebral events), occurring shortly after vaccine administration, as well as seven other cases of disseminated intravascular coagulation, DIC.

Although no causal connection has been found between the vaccine and the blood clotting, and several countries have now resumed the rollout of the vaccine, trust in AstraZeneca’s vaccine has taken a hit, particularly in Spain, Germany, France and Italy. 

In a poll conducted by YouGov in March, which included 8,000 participants in seven European countries, respondents were more likely to view the AstraZeneca vaccine as unsafe than safe. 

Some 61% of French, 55% of Germans, 52% of Spaniards, and 43% of Italians said it was unsafe. Confidence in the vaccine has fallen since a poll conducted in February.

“After concerns about its protection and potency were raised by leaders across Europe, the Oxford/AstraZeneca vaccine has undoubtedly suffered damage to its reputation for safety on the Continent,” said Matt Smith, lead data journalist at YouGov, in a statement.

“Not only have we seen considerable rises in those who consider it unsafe in the last two weeks in Europe, the AstraZeneca vaccine continues to be seen as substantially less safe than its Pfizer and Moderna counterparts,” Smith added.

The same decline in public confidence was not seen in the UK, where 77% of participants considered the jab safe. 

According to William Schaffner, Professor of Medicine in Infectious Diseases at the Vanderbilt University School of Medicine, “there will be spillover to the United States, where…there is a substantial group of vaccine hesitant and skeptical people whom we have yet to win over. And all of this discussion, I’m sure, gives them further pause,” he said in an interview with CNBC.

The vaccine has been granted authorization in over 70 countries and received Emergency Use Listing from WHO, leading the way for its use in the COVAX facility to supply low- and middle-income countries with vaccines. 

Serum Institute of India Announces Delays in Supply of AZ Vaccine to several countries.

In other AstraZeneca vaccine news, the Serum Institute of India, a pharma company producing the Oxford/AstraZeneca vaccine for many low-  and middle-income countries, informed Brazil, Morocco and Saudi Arabia that there will be a delay in delivering vaccines they ordered due to a fire in one of the production buildings.

This has “caused obstacles to the expansion of our monthly manufacturing output,” said the Serum Institute in a statement delivered to the Fiocruz Institute in Brazil. 

The statement contradicted one that was provided immediately after the fire took place in which SII said that it would have no effect on vaccine production.

On a brighter side, the company said a production factory in the Netherlands could soon be approved by the EMA. This would expand the doses available to the EU, which has been plagued by vaccine shortages and a slow rollout across the 27-member bloc. 

The announcement came after several months of dispute between AstraZeneca and the European Union over manufacturing hiccups and vaccine supply constraints.   

At the same time, AstraZeneca is the major vaccine supplier of the WHO co-supported COVAX initiative  – and even as production in Europe and the United States moves into higher gear, it may be expected that countries in those regions will come under increased scrutiny for holding onto precious vaccine doses – while LMICs continue to wait.    

“AstraZeneca continues to engage with governments, multilateral organizations and collaborators around the world to ensure broad and equitable access to the vaccine at no profit for the duration of the pandemic,” said AstraZeneca’s statement. 

Image Credits: gencat cat/Flickr, University of Oxford, Sophie Scott/ABC.

Dr Tereza Kasaeva, Director of WHO’s Global TB Programme.

An estimated 1.4 million fewer people received care for tuberculosis (TB) in 2020 than in 2019 – a drop of 21% – according to preliminary data compiled by the World Health Organization (WHO) from over 80 countries.

Countries worst affected are Indonesia (42%), South Africa (41%), Philippines (37%) and India (25%), and the WHO fears that over half a million more people may have died from TB ilast year simply because they were unable to obtain a diagnosis.

“The effects of COVID-19 go far beyond the death and disease caused by the virus itself. The disruption to essential services for people with TB is just one tragic example of the ways the pandemic is disproportionately affecting some of the world’s poorest people, who were already at higher risk for TB,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“These sobering data point to the need for countries to make universal health coverage a key priority as they respond to and recover from the pandemic, to ensure access to essential services for TB and all diseases.”

The WHO report follows a report released last week by the Stop TB Partnership which showed that the drop in people diagnosed and treated for TB in nine high-burden countries had dropped to 2008 levels – a setback of 12 years.

New TB Screening Guidelines

“Twelve years of impressive gains in the fight against TB, including in reducing the number of people who were missing from TB care, have been tragically reversed by another virulent respiratory infection,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership.

“In the process, we put the lives and livelihoods of millions of people in jeopardy. I hope that in 2021 we buckle up and we smartly address, at the same time, TB and COVID-19 as two airborne diseases with similar symptoms.”

To mitigate the impact of COVID-19 on service delivery, the WHO has developed new screening guidance, including the use of rapid diagnostic tests, computer-aided detection to interpret chest radiography and the use of a wider range of approaches for screening people living with HIV for TB. 

The WHO recommends that the contacts of TB patients, people living with HIV, people exposed to silica, prisoners and other key populations should be prioritized for TB screening. 

People With TB Most Marginalised

“For centuries, people with TB have been among the most marginalized and vulnerable. COVID-19 has intensified the disparities in living conditions and ability to access services both within and between countries,” says Dr Tereza Kasaeva, Director of WHO’s Global TB Programme.

“We must now make a renewed effort to work together to ensure that TB programmes are strong enough to deliver during any future emergency – and look for innovative ways to do this.”

The new guidance also recommends different tools for screening, namely symptom screening, chest radiography, computer-aided detection software, molecular WHO-approved rapid diagnostic tests, and C-reactive protein. 

As the popularity of tobacco products wanes, tobacco companies are developing new products to expand their markets.

NAIROBI – The Kenyan government issued a directive in mid-February this year requiring the tobacco industry to register all nicotine products as tobacco products – but the industry has yet to comply. 

This follows the decision by the Cabinet Secretary in the Ministry of Health, Mutahi Kagwe, to declare “nicotine pouches” illegal, thus overturning a decision last year by the Pharmacy and Poisons Board (PPB) to license the manufacture and sale of nicotine products in the country.

 The criteria used to issue the license was not clearly defined, according to the Ministry of Health, hence the unprecedented move by the Cabinet Secretary.

The government’s directive comes in the wake of a nicotine production plant by the British American Tobacco (BAT) company being planned in Kenya. The plant will not only serve the east African region with nicotine products but will cater for the entire African market, making Kenya the gateway for nicotine products into the continent.

 Marketing Hub for Harmful Product

“Kenya is a manufacturing hub of this harmful tobacco product. It is unfortunate that they [BAT Kenya] are putting up another plant specifically to produce Lyft,” said Samuel Ochieng, CEO of the Consumer Information Network at a press briefing called by the Kenya Tobacco Control Alliance towards the end of February.

Lyft is the brand name for the “nicotine pouches” being manufactured by BAT. These pouches are small bags of powder containing either tobacco-derived nicotine or synthetic nicotine, but no tobacco leaf, dust, or stem. People place them under the lip to get nicotine. 

All this comes a year after the Cabinet Secretary in the Ministry of Health, Mutahi Kagwe overturned an earlier decision by the Pharmacy and Poisons Board (PPB) to license the manufacture and sale of nicotine products in the country.

The criteria used to issue the license was not clearly defined, according to the Ministry of Health, hence the unprecedented move by the Cabinet Secretary.

When asked about the government’s position on why Kenya was singled out by the tobacco multinational company, Kepha Ombacho, the Chief Public Health Officer in the Ministry of Health, told Health Policy Watch: “We cannot say for sure that they are targeting Kenya.”

Trying to Diversity Product Line

The tobacco industry is trying to diversify its product line after years of well-documented health risks associated with smoking has had an impact on consumers and industry profits. 

In the past week, the WHO published a new report calling for the strengthening of the tobacco control measures to protect the health of children.

The study, Tobacco Control To Improve Child Health and Development  found that of the 1.2 million deaths every year caused by second-hand tobacco smoke exhaled by smokers, 65,000 occur among children under 15 years.

However, the third edition of the WHO global report on the trends in prevalence of tobacco use 2000-2025 published in 2019 shows a decline in tobacco use among people of both sexes in the world.

According to the report, about a third of the global population aged 15 years and above used of some form of tobacco in 2000. This rate declined by nearly 10% to about a quarter by 2015.

If current tobacco control efforts are maintained, the rate is projected to decline to around a fifth of the (20.9%) by the year 2025, says the report.

Use of Social Media Influencers

The furore generated by the Lyft nicotine pouches in Kenya was well captured by The Guardian in February, which detailed how the brand was using social media influencers to promote Lyft. 

The influencer in the article is a young beauty blogger with an Instagram following of more than 250,000 and a Youtube channel following of well over 55,000 subscribers. She appears to have deactivated her account and removed the Lyft tweets since the expose.

Meanwhile, a PR agent working for BAT even offered a Kenyan journalist a bribe to leak details about an investigation by Bureau for Investigative Journalism into how tobacco companies were targeting young people. BAT has since suspended the agency.

It is clear from these reports that tobacco companies have been using influencers that are popular among the youth to push their nicotine products.

This is made more serious because Kenya is a signatory to the WHO’s Framework Convention of Tobacco Control (FCTC). Article 13 of the Convention clearly talks about banning all forms of tobacco advertising, promotion and sponsorship.

 The Ministry of Head’s Ombacho says that Lyft and any products that contain nicotine are not alternative products to tobacco and should be accompanied by clear labeling stating as much.

 Significant Health Risks

According to the Tobacco Act of 2007, tobacco companies are required to set aside 2% of their revenue to go into the Tobacco Fund to assist people suffering from the health effects associated with smoking.

Only BAT has started to make contributions to the fund although there are at least three active tobacco companies in Kenya, and Ombacho said that “they will just have to comply”.

Nicotine pouches appear to have been developed in Scandinavia. They have significant health risks. Issuing a health warning about them last November, Health Canada warned that they had not been authorised in the country and should not be used “by anyone”

“Nicotine is a highly toxic and addictive substance. Excessive amounts of nicotine can cause acute poisoning, resulting in respiratory failure and death,” according to Health Canada.

Image Credits: By Bystroushaak/ CC BY-SA 4.0, Chris Vaughan.

The Stelis Biopharma manufacturing site in Bangalore, India, where the Sputnik V vaccine will be produced.

Developers of Russia’s Sputnik V vaccine have entered into a partnership with Stelis Biopharma, an India-based drugmaker, to produce 200 million doses of the COVID-19 vaccine. Stelis is now the latest addition to the global production network for Sputnik V. 

The Russian Direct Investment Fund (RDIF), the company responsible for marketing the Sputnik vaccine abroad, announced the partnership on Friday, making Stelis – the biopharmaceutical division of Strides, an Indian pharma company – the most recent in a series of manufacturers RDIF signed agreements with.

“We are delighted to announce our agreement with Stelis Biopharma for a significant capacity of Sputnik V,” said Kirill Dmitriev, CEO of RDIF, in a press release. “The significant vaccine volumes, which will be produced jointly with Stelis, will help widen access to the vaccine on a global scale.”

The vaccine has shown high efficacy results in a peer-reviewed study, with 91.6% efficacy in preventing symptomatic COVID-19 cases and full protection against severe infection. Sputnik V has been authorized for use in over 50 countries, with rollouts underway in several of those countries.

Global Production Contracts for Sputnik V

The Gamaleya National Research Institute of Epidemiology and Microbiology, the developer of Sputnik V, and RDIF have signed contracts with over 15 manufacturers in ten countries to produce 1.4 billion jabs and expand the manufacturing capacity for the vaccine.

Certain factories, including ones in Brazil and Serbia, will be producing vaccines for the domestic population and others – in China, South Korea, India, and Iran – will be exporting vaccines to meet global demand.

“We have some players who are really big, and they will be producing for the whole world. And we have some who are smaller and they will be producing more for local demand,” Dmitriev told the Financial Times in February. “This is our approach: to solve the bigger production issue while also…providing local availability.”

Kirill Dmitriev, CEO of the Russian Direct Investment Fund (RDIF).

India was described as a “key partner” for the production of the vaccine. On Tuesday, an agreement with Gland Pharma, an India-based pharmaceutical company, was announced for 252 million doses, joining India’s Hetero pharma firm, which is set to produce over 100 million doses.

“We are delighted to partner with RDIF to make a substantial contribution towards providing global supply of the Sputnik V vaccine which is one of the most efficacious approved vaccines commercially available,” said Arun Kumar, the founder of the Strides Group.

Supplies from the partnership are expected to be ready for distribution from the third quarter, between July and September. 

Efforts to Expand Production in Europe

Talks are reportedly underway with companies in Spain, France, Germany and Sweden to arrange vaccine production, pending Sputnik V’s authorization for emergency use by the European Medicines Agency (EMA). 

Italy became the first country in the EU to sign a deal to produce the Sputnik V vaccine last week, with plans for Adienne, an Italian-Swiss pharma company, to produce 10 million doses of the vaccine in Italy by the end of the year. 

Support for the Sputnik V vaccine’s approval in Europe seems to be growing, with Norwegian, Austrian and German politicians calling for its procurement. The vaccine could prove to be useful in speeding up the EU’s slow vaccination campaign across the bloc’s 27 member states.

“Concerning Sputnik V and other vaccines, I strongly insist that the relevant EU bodies issue an authorization for all safe vaccines as soon as possible,” said Sebastian Kurz, the Austrian Chancellor, in an interview on OE24 TV on Wednesday. “The more vaccines we have, the better the situation is.”

Sebastian Kurz, Austria’s Chancellor, in an interview on Wednesday.

A couple of EU countries have already moved forward with the national approval and rollout processes ahead of the EMA’s decision, including Hungary, Slovakia, and Czech Republic.

Germany is also interested in signing a national supply deal for Sputnik V, according to Jens Spahn, Germany’s Health Minister, adding that the country is in close contact with Russia about the vaccine.

“I am actually very much in favor of us doing it nationally if the European Union does not do something,” said Spahn at a press conference on Friday. A requirement for the deal, however, would be specifics on the number of doses that could be delivered.

Although RDIF has established a global, decentralized network of manufacturers – attempting to avoid the production shortfalls and delays faced by AstraZeneca, mass production in several of the sites has not yet begun and scaling up production may be an issue. 

According to Dmitriev, RDIF plans to announce the details of overseas production in March. 

EU to Send a Letter to AstraZeneca in Effort to Resolve Dispute

In other vaccine news, the European Commission plans to send a letter to AstraZeneca in an attempt to resolve the dispute over vaccine supply and delays in deliveries.

According to Ursula von der Leyen, President of the European Commission, the pharma company has “under-produced and under-delivered” vaccines to the region, with a reduction in projected deliveries for the first quarter from 90 million to 30 million doses. 

Ursula von der Leyen, President of the European Commission, at a press conference on Wednesday.

AstraZeneca also will only manage to deliver 70 million doses for the second quarter instead of the 180 million stated in its contract with the EU. EU officials say the company is contractually obligated to deliver 300 million doses by the end of June, but is projecting having only 100 million doses available due to production issues. 

“We plan to send a letter to AstraZeneca that will allow us to begin a dialogue with the company as part of a process to resolve the dispute,” said a spokesperson for the European Commission at a press conference on Thursday. 

The letter will be discussed with EU governments before it is sent. 

In the EU’s Advance Purchase Agreement with AstraZeneca, the two parties are required to resolve any issues that arise through informal discussions, initiated by sending a written notice. If the dispute cannot be settled through negotiations, legal action can be pursued. 

“Today we are taking a specific step. We will see where that leads us,” said a Commission spokesperson, not ruling out the potential of the EU filing a legal case against AstraZeneca in the future.

UK Vaccine Supply to be Hit in the Coming Weeks

Meanwhile, a reduction in the United Kingdom’s vaccine supply is expected from 29 March, in part due to a delayed delivery from India of five million doses of the Oxford/AstraZeneca vaccine. India’s recent surge in cases has led the government to use the available vaccine supply to meet domestic needs.

A large increase in cases has been recorded over the past week in India, where just 2.4% of the population have received one dose of a COVID-19 vaccine. The seven day average of new COVID-19 cases is 29,355. 

According to Adar Poonawalla, CEO of the Serum Institute, the pharma company was directed in February to prioritize the needs of India in its distribution of vaccines.

The UK – a country where 37.9% of the population have received at least one jab – made a deal in early March with the Serum Institute of India, the world’s largest vaccine manufacturer and a key source of doses for COVAX to supply low- and middle-income countries, for 10 million doses.

“Five million doses had been delivered a few weeks ago to the UK and we will try to supply more later, based on the current situation and the requirement for the government immunization programme in India,” said a spokesperson for the Serum Institute. 

The shipment of the next five million doses will be delayed by at least four weeks, slowing the vaccination campaign in the UK and making it somewhat dependent on the worsening situation in India.

US Plans to Send Millions of Doses to Mexico and Canada
A healthcare professional preparing to administer the Oxford/AstraZeneca COVID-19 vaccine.

In contrast, the US has millions of doses of the Oxford/AstraZeneca vaccine that cannot be administered nationally because the vaccine has not yet received emergency use authorization from the US Food and Drug Administration (FDA). Some four million of these doses will be delivered to Mexico and Canada, the White House press secretary said on Thursday. 

Approximately 30 million doses have been sitting in a manufacturing site in Ohio, ready to be administered, awaiting data from the US clinical trial for the approval process to move forward. 

“Our first priority remains vaccinating the US population,” said Jen Psaki, the White House press secretary during a press briefing. “[But] ensuring our neighbors can contain the virus is…[a] mission critical to ending the pandemic.”

In the US’ first export of COVID-19 vaccines, 2.5 million doses will be distributed to Mexico and 1.5 million to Canada as a loan. 

Some 3.3% of the Mexican population have received at least one dose of a COVID-19 vaccine, 7.8% of the Canadian population, and 22.6% of the US population. 

The share of the total population that has received at least one dose of the COVID-19 vaccine in Mexico, Canada, and the US, as of 18 March.

Mexico has received 8.1 million doses of COVID-19 vaccines as of Thursday and has begun the rollout of the Pfizer/BioNTech, AstraZeneca, Sinovac and Sputnik V vaccines. Canada’s regulators have approved the Pfizer, Moderna, AstraZeneca and Johnson & Johnson vaccines and the country has received 4.7 million doses so far. 

Canada has struggled to acquire vaccines, turning to Europe, Asia and COVAX to increase its supply. 

“We believe they’re coming very shortly, that’s been the content of our discussions thus far, but I have to stress that we are still finalizing the details,” Anita Anand, Canada’s Vaccine Procurement Minister, said in an interview on CTV News. “We are working to expedite this process as quickly as possible, knowing that Canadians want vaccines.” 

The doses could be delivered as soon as the end of March.

Image Credits: RDIF, Stelis BioSource, CNBC, OE24.TV, Twitter – Ursula von der Leyen, Flickr, Our World in Data.

Vaccination rollout in Accra, Ghana

Mayors from three capital cities in the global south have appealed for speedy “technology transfer” to enable them to produce their own COVID-19 vaccines at Friday’s World Health Organization (WHO) bi-weekly COVID-19 media briefing.

The mayors’ appeal comes on the eve of a meeting next week between WHO Director General Dr Tedros Adhanom Ghebreyesus and World Trade Organization (WTO) Director General Dr Ngozi Okonjo-Iweala to discuss “how to overcome the barriers to boost production vaccine equity”, said Tedros.

Adjei Sowah, mayor of Accra in Ghana, said that his city had almost used up all 300,000 vaccine doses it had received recently via COVAX – yet it has a population of five million including a two-million strong transient population which could be spreading the virus to rural areas.

To achieve vaccine equity, Sowah proposed that rich countries “share their surplus doses” and the “acceleration of technology transfer” to enable manufacturing in Ghana and other countries in order to “reach herd immunity as quickly as possible”. 

‘Finish and Fit’ Possible in Bogota

Mayor Claudia Lopez from Bogota in Colombia, with a population of 11 million, said that her city would need to vaccinate six million people to achieve herd immunity – but it lacked the doses to do so.

Bogota had been able to produce vaccines until 2001 but “because we did not have the sufficient investment in research and biotechnology, we lost that capacity”, said Lopez.

She appealed to the WHO to assist her city to get investment to enable vaccine production – starting with “finish and fit”, the assembly of vaccine products once the biological component had been made elsewhere.

“We do face the real risk of a third wave and it is vital that, before May we have vaccinated, everybody over the age of 60 and all healthcare professionals. So that means that we need 2.6 million doses in the next couple of months,” said Lopez.

Mayor Yvonne Aki-Sawyerr of Freetown Sierra Leone

Mayor Yvonne Aki-Sawyerr, representing Freetown in Sierra Leone and one of the poorest countries in the world, said her city’s vaccine rollout had started with week with 296,000 doses of AstraZeneca (two doses needed per person).

At a meeting over the past week with mayors from the C40, a network of 97 of the world’s biggest capital cities’, Aki-Sawyerr said it was “really fascinating” to hear from cities such as Los Angeles “who are able to talk about a mass vaccination rollout, in contrast to some of us”.

While Freetown had only recorded 2,222 COVID-19 cases and 80 deaths ”you’d almost think that COVID had passed us by, but it hasn’t because the economic impact has been significant”, said Aki-Sawyerr of her city of slightly over a million people.

“What we face, and what other countries and cities in emerging economies that don’t have the access to the vaccine in the same way as countries who are ordering five times what they require and holding on to these, is economic exclusion and greater inequality,” said Aki-Sawyerr.

“We face a risk of being in a situation where vaccine passes are needed for travel, and that could certainly have an impact on tourism,” she said. “We are very concerned about how this will move from a disparity in a vaccine rollout to reinforcing inequalities, reinforcing economic exclusion and thereby putting everyone at risk.”

 

Independent Panel Still Seeking Views Ahead of Submission Date

 

If the world’s pandemic preparedness, alert and response system had been working properly, the COVID-19 pandemic would not have had such “catastrophic consequences”, according to Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response.

So far,  the pandemic has cost 2.6 million lives, had a substantial impact on the education of  millions of children and is projected to have cost economies $22 trillion by 2025, according to a media release from the panel on Friday following a two-day meeting.

“If the existing system, from the global to the national levels was good enough, the worst would not have happened,” said Helen Clark, former Prime Minister of New Zealand, co-chair of the panel, at the opening of the meeting. “The status quo isn’t just not good enough; it has actually had catastrophic consequences,” she said. 

The panel is considering a range of recommendations aimed at “resetting the international pandemic preparedness and alert system” as it prepares its final report to be presented to the World Health Organization (WHO) in May.

These include solving the problems of speed and transparency in alert and response; country preparedness; the authority of and support for the WHO and equitable access to diagnostics, therapeutics, and vaccines. It is also still taking submissions to its website.

Eleven Million Girls Have Dropped Out of School

The 13-person panel reflected on the International Monetary Fund’s projection that COVID-19 will cost $22 trillion in projected cumulative output loss over 2020-2025 relative to pre-pandemic projections.  

It also noted the World Bank report that, as a result of the pandemic and school closures, 72 million more primary school-aged children may not be able to read or understand a simple text by the age of 10. Some 11 million girls are estimated to have dropped out of school.

Co-Chair Ellen Johnson Sirleaf, former president of Liberia, stressed that behind those enormous numbers are millions of people who have suffered incalculable setbacks, from which recovery will be difficult.  

“People who are poor, people who are marginalized, and those who have faced structural injustices have been at a great disadvantage during the pandemic. This must not continue through the recovery. We must keep their lives and their voices at the heart of our conclusions and recommendations.” 

The Independent Panel was established by the WHO’s Director-General to review experience gained and lessons learned from the WHO-coordinated international response to COVID-19.    

 

 

Image Credits: Gavi/2021/Jeffrey Atsuson.

Dentists are confronting the fallout from a year of disrupted dental care and treatment.

One of the unquantified side effects (or health impacts) of the pandemic has been in a place few people cared to look very deeply – that is our mouths.

For significant parts of the past year, dentists’ chairs in many offices around the world sat empty – as COVID-19 disrupted routine dental treatments. During the early days of the first lockdowns a year ago, we were able to accept patients for emergency dental treatments only.

Patients’ fear of leaving their homes resulted in delays and cancellations of regular check–ups, while others simply delayed pending treatment. And most of the patients we saw during this period were suffering from severe tooth pain resulting from unfinished or delayed treatment, ultimately culminating in either an extraction or a permanent restoration of the tooth.

On top of that, the dental profession had been called out (falsely) as being one of the most unsafe in terms of pandemic risks.

COVID-19 and Dental Safety

Most dental practices have now been able to re-open (both in and out of lockdowns), by reinforcing our already stringent infection prevention and control protocols as necessary and according to regulations.

We also have updated data showing that the profession has experienced significantly lower infection rates of SARS-CoV-2 than other healthcare professions in the USA, in Europe and beyond.

Preliminary data on the COVID-19 infection rate among dentists and other healthcare workers, suggest that COVID-19 infection in dental practice may be less likely than in other healthcare settings.

Dental practices are proven to be safe. Despite this, an underlying fear in the general public of contracting COVID-19 persists and has resulted in many of our patients delaying regular check-ups and only booking an appointment once they are already in pain or with infections that require complicated treatment. We encourage our higher-risk patients to have a dental check-up every three to six months – many have quite clearly put off a visit for nearly a year, which has led to extractions that could have been avoided.

This is serious cause for alarm, as these initial oral health issues can transform into broader health concerns. High-risk patients – tobacco users, pregnant women, people with diabetes – who are more susceptible to gum disease and tooth decay can also be more vulnerable to other diseases. Poor oral health has been linked to a host of other health conditions including heart disease and stroke, cancers, and respiratory disorders.

If the call for investing in health systems as part of universal health coverage has largely fallen on deaf ears until now, COVID-19 has certainly forced the issue. This pandemic has severely exacerbated health inequities across the spectrum.

Increasing Burden of Oral Disease

It has never been more apparent that overall health and oral health are absolutely intertwined and cannot exist independently. This World Oral Health Day we need to acknowledge the reality that precedes COVID-19: a picture of an increasing burden of oral disease across the board, matched by inadequate population-level prevention strategies and ineffective care for those in need. We must advocate for oral health professionals (and our profession more broadly) to be actively involved in all efforts to improve health for all and leave no one behind.

Optimal oral health for all is certainly an aspirational goal, but what does it actually stand for? How can we make this goal truly meaningful to oral health professionals, patients and people alike?

Universal Coverage for Oral Health

Any genuine move towards oral health for all first needs to embrace the idea of universal coverage for oral health. This starts with driving better oral health awareness campaigns for public benefit, guaranteeing that by 2030 essential oral health services are integrated into primary healthcare in every country. This shift requires focusing on prevention and early detection of diseases, making oral healthcare available and accessible in both urban and rural areas, and ensuring the affordability of appropriate oral healthcare for all.

It will also be essential to integrate oral health into the general health and development agenda by 2030. This means addressing the shared social, moral, and commercial determinants of health and recognising that untreated oral disease is the most common health condition globally—accounting for a considerable fraction of the overall noncommunicable disease burden.

A Resilient Oral Health Workforce

Finally, by 2030, we need to build a resilient oral health workforce by tackling both the plethora and scarcity of oral health professionals and auxiliaries. This model of an oral health workforce would focus on the prevention of oral diseases; screen for and monitor systemic health conditions; integrate environmentally friendly, innovative, and appropriate technologies to benefit patients; and implement oral health resource and workforce planning in cooperation with governments, educators, and oral health professionals.

Let’s not overlook the obvious: as dentists, we are highly skilled health professionals allied with our medical colleagues. Just look to the role many dentists are playing in delivering the COVID-19 vaccine around the world today. This pandemic has also confirmed that we are veterans in adopting those measures considered to protect against the novel coronavirus: protective gear like masks, gloves, and goggles as well as well as established sterilization and disinfection procedures. Our value should not be underestimated, today and in the future.

Dentists have played an important role in testing for COVID-19 and delivering vaccines around the world.

Oral Health for All

Oral health for all will not happen overnight – it will require ongoing education and awareness around the broader health issues linked with noncommunicable diseases that help to change the narrative and reinforce oral health as an essential health priority. We must focus on evidence-based dentistry and critical thinking, educate and train oral healthcare professionals to advocate for oral health, empower our patients to take responsibility for their own health and well-being, and engage with industry partners around emerging technologies.

The goal of oral heath for all will also require the collective vision and engagement of many stakeholders across the spectrum: industry partners, academics, educators, and researchers.

And let’s not forget policy makers. Governments at all levels must commit to leading the conversation around oral health in their countries and allocate sufficient resources to tackle the oral disease burden.

Perhaps most critically, we need the buy-in of the population at large, who are potentially the most powerful advocates of all to lead the world to optimal oral health.

Dr Gerhard Konrad Seeberger, president of FDI World Dental Federation.

Dr Gerhard Konrad Seeberger is president of FDI World Dental Federation and a private practitioner based in Cagliari, Italy. He is a member of numerous scientific societies (implant dentistry, periodontology). and a regular contributor to Italian and international journals. He was awarded a doctor honoris causa in medicine from Yerevan State University in Armenia and is an honorary member of several national dental associations (Bulgarian Dental Association, Chicago Dental Society, Mexican Dental Association, Romanian Association of Private Practitioners).

Image Credits: FDI World Dental Federation, FDI World Dental Federation, Flickr – Navy Medicine, FDI World Dental Federation.

African countries will be hosting a conference in April to discuss the local production of vaccines.

IBADAN – African countries are hosting a large conference in April to discuss the local production of vaccines, as key players in Africa’s public health sector try to address the continent’s vaccine shortages.

Circumstances surrounding the COVID-19 vaccine production and distribution had necessitated this conversation, William Kwabena Ampofo, Chairperson of African Vaccine Manufacturing Initiative, said during a press conference on Thursday. The conference will take place on 12 and 13 April.

Currently, many African countries are getting most of their COVID-19 vaccines through the global distribution platform, COVAX.

“The current COVID-19 pandemic presents a great opportunity to harness the various conversations and proposals into an action-oriented roadmap led by the African Union and the World Health Organization (WHO) in Africa. And this will lead to increased vaccine production that will facilitate immunization of childhood diseases and enable us to control outbreaks of highly infectious pathogens,” he said. 

William Kwabena Ampofo, Chairperson of African Vaccine Manufacturing Initiative.

However, he admitted that Africa only has about 10 vaccine manufacturers based in 5 countries – South Africa, Morocco, Tunisia, Egypt and Senegal – and most were only doing packaging, labelling and filling, rather than the actual production of the vaccine. But Africa has about 80 companies with pharmaceutical production capacity and the manufacturing of sterile injectables, which provided a great opportunity, added Ampofo.

“In Africa, we usually use a primary dosage form, so there is the opportunity to really consider vaccine manufacturing as a major activity that will provide substantial financial returns to the various countries in the different economic blocs if the vaccine supply and chain is well structured,” Ampofo said.

African Health Leaders and Scientist Advocating for Local Production of COVID Vaccines

Even though the COVAX Facility has promised African countries and other beneficiaries 20% of their respective COVID-19 vaccine needs, many more doses are required to achieve herd immunity. 

In addition, Africa CDC Director John Nkengasong said citizens may need booster shots if the protection offered by the vaccine wears off. These are among the reasons why Africa’s public health leaders and scientists are advocating for the continent to be able to produce the COVID-19 vaccines. Beyond COVID-19, Africa heavily relies on UNICEF and the global alliance, Gavi, for its yellow fever and other vaccines. But there are problems ahead. The biggest, Ampofo said, is the way the market is structured. Addressing this will require active involvement of organisational blocs such as the AU.

“We need the regional economic blocs to take care of a very strategic view of how the countries are interdependent. So that production would be geared towards supplying not just a country but meeting regional needs and establishing a system which sustains vaccine production on the continent,” he said.

Covering Ground

Matshidiso Moeti, WHO Regional Director for Africa.

While the local vaccination plans and discussions are continuing, Dr Matshidiso Moeti, the WHO Regional Director for Africa said the continent is rapidly gaining back lost grounds due to the late arrival of doses of the vaccines. 

“Compared with countries in other regions that accessed vaccines much earlier, the initial rollout phase in some African countries has reached a far higher number of people,” Moeti said.

She attributed the development to Africa’s vast experience in mass vaccination campaigns and the determination of its leaders and people to effectively curb COVID-19.

According to the WHO, two weeks after receiving COVAX-funded AstraZeneca vaccines, Ghana has administered more than 420,000 doses and covered over 60% of the targeted population in the first phase in the Greater Accra region – the hardest hit by the pandemic. In the first nine days, it is estimated the country delivered doses to around 90% of health workers. 

In Morocco, WHO said more than 5.6 million vaccinations have taken place in the past seven weeks, while in Angola, vaccines have reached over 49 000 people, including more than 28 000 health workers in the past week. 

“While the rollout is going well, there is an urgent need for more doses as Ghana, Rwanda and other countries are on the brink of running dry,” Moeti said.

Image Credits: Johnson & Johnson, African Vaccine Manufacturing Initiative, Paul Adepoju.

Ugandan doctor Samson Wamani getting his COVID-19 vaccine.

KAMPALA – On 12 March, Samson Wamani, a doctor at Mukono General Hospital, received his COVID-19 vaccine under a tent placed outside the hospital as Uganda implements its plan to vaccinate half the population in the next year.

As the government already had a database of its health workers registered, all Wamani had to do was present his National Identification Number (NIN) to confirm and tally with the government register. “The vaccine arrived before we were registered. They already had our details, so we just needed to confirm with the NIN,” says Wamani. “The process was not hard at all.”

The Ugandan Ministry of Health received 864,000 doses of the AstraZeneca COVID-19 vaccine, shipped via the COVAX facility – the world’s facility for universal access to COVID-19 vaccines. The first consignment arrived in the country on 5 March and vaccination started five days later.

Uganda targets to vaccinate half its population, almost 22 million, in a phased manner within the next year. Each phase is planned to cover 20 percent of the population – approximately 4.38 million people. 

Other health workers who are not employed by the government, namely those working in the non-profit and private health facilities, had to register to get the vaccine distributed free to all. 

COVID-19 has heavily jolted the health workforce in the African region. Since the beginning of the pandemic, 267 health worker infections have been recorded on average every day, translating to 11 new health worker infections per hour. 

To date, more than 100 000 health workers have contracted COVID-19 in the African region. Health worker infections account for 3.5% of the total number of cases in the region according to WHO.

Meanwhile, 30 out of 55 African countries have started immunisations for health workers, and Uganda has been doing well with its COVAX vaccine allocation.

“The pandemic has nearly knocked loose the lynchpin of the health systems in many countries,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We must further protect and equip our health workers to effectively contribute to the efforts to contain COVID-19. Everyone’s wellbeing is at stake without an adequately supported health workforce.

“Doses will remain limited and it’s critical that frontline health workers and other priority groups are at the front of the queue. Health workers deserve protection because without their pivotal role, efforts against the pandemic can go only so far, ” said Moeti. 

Health care workers need to be protected

“Health care providers have been pivotal in managing the COVID-19 pandemic in Uganda. With their crucial role, dealing with patients comes the high risk of being infected with the disease. We shall immunise them first to protect them,” said the WHO Representative to Uganda, Yonas Tegegn Woldemariam.

“Unless we protect health care providers, health systems will remain overwhelmed, and the most vulnerable children will continue to lose access to life-saving services, risking years of progress and resulting in the poorest children falling further behind,” said UNICEF Uganda Representative Munir Safieldin.  

“We are taking care of the caretakers – health workers are normally forgotten – we are starting with frontline health workers so that they are able to also protect you,” said Phiona Atuhebwe, a vaccinologist at the WHO Africa office. 

“I got my first shot but I still fit and I am here facilitating this workshop. I am not feeling anything and can get into my car and drive to Arua (district in Northern Uganda),” said Alfred Driwale, the programme manager of Uganda National Expanded Programme on Immunization (UNEPI).

Health Minister Dr Jane Ruth Aceng, was the first Ugandan to take the jab. She said health workers and all their support personnel, numbering to 150,000, will be vaccinated first. 

Thereafter, up to 250,000 security personnel will be vaccinated. Following this, teachers and staff in all education institutions will be next – an estimated 550,000 persons. 

Essential service workers who interact with many people in their work and people aged 50 years and above will be next. In total about 3.3 million will get the vaccine. COVAX allocated 3,552,000 doses to Uganda. The remaining doses are expected in the country by June 2021. 

 

Covid19 vaccination of Ugandan health workers are on track.

Wamani’s vaccination took about 10 minutes. The nurse spent about 5 minutes explaining the procedure and then he had to sign a consent form before taking the jab.  “I fear injections as a person. There was a bit of muscular pain and the injection was painful,” he says. After that, he had to spend 30 minutes under observation. 

There has been a lot of debate about vaccines being tied to NINs. The Initiative for Social Economic Rights and Unwanted Witnesses challenged the decision in court, saying it would leave out many Ugandans who have never received IDs or have lost them. The government eventually agreed to relax its decision but at the vaccination sites it is still a requirement.

“I got my vaccine today. After the shot, I was advised to rest for 30 minutes. I felt a bit thirsty but I was given some water. At the moment I feel normal. You have to present your NIN. It is a requirement,”  said Joyce Matovu, a hospital liaison coordinator.

‘Consent Form Needs to be Simpler’

“I hope the consent form will be modified. For instance, the headline with side effects should be in bold and include some images so that it is easy to peruse through. People like me do not read long text,” says Wamani. “It is an implied consent”. 

He says the consent should also be summarised to make it simpler, letters should be bigger, have imagery and important points should be bolded to enable easy reading. The consent forms are also only in one language – English. 

“The consent forms will eventually be in every language so that people agree to what they understand and the government is not held accountable, so no one is going to be forced to be vaccinated,” said Monica Musenero, the presidential advisor on epidemics. 

“They will be translated. Right now we are dealing with a category of people who are 100 percent literate,” says Driwale, who added that the vaccination exercise is going well. 

However, some media reports have pointed to a refusal by some health workers to take the jab because the President has not been seen to take it.

During his televised address on 14 March, President Yoweri Museveni said that he was yet to decide on which COVID-19 vaccine to use although so far only the AstraZeneca vaccine manufactured by the Serum Institute of India (SII) is available. 

“WHO gave us assurance and our national drug authority (National Drug Authority -NDA) also gave us assurance. We shall use AstraZeneca – there is no business of delaying – the challenge we are having is that of inadequate stock and we will do whatever it takes to address this issue,” said Driwale. “When the WHO says it is okay and our National Drug Authority says so we go ahead with it.”

Pharmacovigilance and Security

WHO says pharmacovigilance for any country requires a rigorous process both from the government and the manufacturer. Countries also need to be able to identify, detect and monitor any adverse event that has come from the vaccine and to show that they can manage it.  

“The structures needed to be in place before any manufacturer accepted to ship the vaccine. There had to be signatures between the government and the manufacturers and the government being able to prove that any person who gets a side effect can be followed up to the last level,” said Atuhebwe. 

“We establish the causality of a side effect – and investigate up to the manufacturer. We have a model laboratory in Uganda the Uganda Virus Institute (UVRI) in case of any problem,” says Atuhebwe.  “Countries have invested so much and we know that if anything happens the population is protected.”

Driwale explained that the security of the vaccines is tight. They are being guarded at the National Medical Stores (NMS) and distributed under armed escort. When they arrive in a district, they are received by the district security officer and district health officer and are locked in fridges at the health facilities.

“They are accounted for on a daily basis, and any person who fails to account for a vaccine will face tough consequences,” said Driwale. 

  

 

   

 

Image Credits: Supplied, supplied.

Nurses preparing a diagnostic test for COVID-19 at a drive-through testing center at the University of Washington Northwest Hospital & Medical Center in March 2020.

Previous infection with COVID-19 protects most people against reinfection for over six months, but those over the age of 65 are more likely to get infected again, found a peer reviewed study published in The Lancet. 

In the world’s first large-scale study of COVID-19 reinfections, researchers from Denmark, Sweden and the United Kingdom discovered that protection provided by prior SARS-CoV2 infection dropped from 80% for those under 65 years of age to 47% in those over 65. 

“Our study confirms what a number of others appeared to suggest: reinfection with COVID-19 is rare in younger, healthy people, but the elderly are at greater risk of catching it again,” said Steen Ethelberg, co-author of the study and senior researcher in the epidemiology of zoonotic infections at the Statens Serum Institut in Denmark, in a press release. 

The study used national PCR test data from 2020 in Denmark to compare the infection rates between individuals who tested positive and negative during the first and second surge of the pandemic. 

Between February and December, Denmark’s testing capacity increased rapidly and managed to test approximately 10% of the population each week by the end of 2020. The population-level observational study was conducted in Denmark due to the country’s investment in high intensity testing and its free-of-charge testing strategy. 

Some four million individuals took a PCR test in 2020. During the first surge, from March to May, of the 533,381 people tested, 2.11% tested positive. Among the PCR-positive people from the first wave, 0.65% tested positive again during the second surge, from September to December, compared to 3.27% of those who tested negative during the first surge. 

There were 5.35 positive tests per 100,000 people among those who had previously tested positive, compared to 27.06 positive tests per 100,000 people among those who tested negative. 

Approximately 0.88% of those over 65 years of age who tested positive during the first wave were infected again in the second surge. Among those in this age group who tested negative, 2% tested positive during the second wave. 

The researchers estimated that protection against repeat SARS-CoV2 infection was 80.5%, but the protection among those aged 65 years and older was reduced to 47.1%.

The increased likelihood of testing positive again among older individuals could be due to age-related changes in the immune system, which affect the coordination of immune responses and adaptive immune system, said the authors. This makes individuals over 65 more susceptible to emerging infectious diseases. 

These findings could inform decisions on which groups should be vaccinated and the implementation of public health measures, including physical distancing and mask wearing. 

People wearing face masks to prevent the spread of SARS-CoV2 as they commute inside a metro station amid the COVID-19 pandemic in Colombia.

“Given what is at stake, the results emphasise how important it is that people adhere to measures implemented to keep themselves and others safe, even if they have already had COVID-19,” Ethelberg said. 

“Our insights could also inform policies focused on wider vaccination strategies and the easing of lockdown restrictions,” he added.

These findings, however, could be limited. The number of infected older people included in the study was small. In addition, the researchers only examined diagnostic test results, so it is possible that those who became reinfected were asymptomatic or had mild symptoms and were not tested.

Duration of Protective Immunity

The longevity of the protection against repeat infection is still unknown, but the researchers found no evidence that the protection waned in six months after infection. 

A separate longitudinal study found that 95% of participants retained immunity for up to eight months after infection, but concentrations of antibodies decreased moderately. 

“The closely related coronaviruses SARS and MERS have both been shown to confer immune protection against reinfection lasting up to three years, but ongoing analysis of COVID-19 is needed to understand its long-term effects on patients’ chances of becoming infected again,” said Daniela Michlmayr, co-author and researcher on bacteria and parasites at the Staten Serum Institut. 

The authors of the study concluded that natural protection cannot be relied upon to achieve long term herd immunity.

“These data are all confirmation, if it were needed, that for SARS-CoV2 the hope of protective immunity through natural infections might not be within our reach and a global vaccination programme with high efficacy vaccines is the enduring solution,” said Rosemary J. Boyton and Daniel M. Altmann, professors at Imperial College London, in a comment linked to the study. 

Healthcare professional administering a COVID-19 vaccine in the United States in February.
Protection Against Reinfection with COVID Variants

The study analyzed infection with the original COVID-19 strain, as variants were not yet present in Denmark during the study period. 

More longitudinal studies and molecular surveillance are needed to assess if the protection against repeated infection differs with the COVID-19 variants that have emerged over the past several months, according to the authors. 

Some of the variants of concern are known to be more transmissible and could escape from natural and vaccine-induced immunity. This could complicate protective immunity, potentially pushing immunity below a protective margin.

Image Credits: Flickr – Trinity Care Foundation, University of Washington Northwest Hospital & Medical Center, Flickr: IMF Photo/Joaquin Sarmiento, ABC7 News.

Drive-through COVID-19 testing in Papua New Guinea. Only approximately 50,000 tests have been carried out in a country of almost nine million.

Papua New Guinea (PNG), a country that has largely avoided the SARS-CoV2 virus, is now facing an outbreak that could cause the country’s health system to collapse, while Australia is being chided by a Médecins Sans Frontières (MSF) official for its opposition to a World Trade Organization (WTO) patent waiver that MSF says would have opened up generic vaccine production faster. The disproportionate access of Papua New Guineans, as compared to Australians, to newly-developed COVID vaccines, is evidence of larger worldwide disparities between vaccine haves and have-nots, MSF says. 

Nearly half of the cases recorded in Papua New Guinea since the beginning of the pandemic, 2,351 total cases as of Monday, have been reported in the last two weeks. 

“PNG was relatively quiet last year with its low number of cases being reported, but today it has bypassed countries like Australia by reporting the highest number of confirmed cases in the last 24 hours,” David Manning, Controller of the PNG COVID-19 National Pandemic Response, said in a statement on Monday. 

James Marape, the PNG’s Prime Minister, warned on Monday that the country was approaching an infection rate of one person in three or four, calling the situation “critical.”

“The number is quite staggering, if we don’t do [a] corrective response to this, our health system will be clogged and we won’t be able to sustain it,” Marape told reporters on Monday, announcing the implementation of nationwide restrictions. 

Prime Minister James Marape at a media conference in Port Moresby on Monday, announcing the implementation of nationwide restrictions.

The low rates of testing, in combination with the large gatherings held last month to commemorate the death of the former Prime Minister, Michael Somare, indicates that the number of infections and deaths is likely to rise rapidly in the coming weeks. 

Australia Blocked a World Trade Organization Proposal for an IP Waiver on COVID Tools – Would Open Markets For More Generic Vaccine Production, Charges MSF

The PNG was set to receive 200,000 doses of the AstraZeneca vaccine from Australia and 70,000 from India through the COVAX facility, but was not expected to receive shipments of either until April at the earliest.

Responding to the crisis, Australian Prime Minister Scott Morrison on Wednesday announced that Australia would send 8,000 emergency doses of the COVID-19 vaccine to Papua New Guinea, which has seen cases of the virus increase dramatically in the last month.

However, Médecins Sans Frontières (MSF) Australia said Morrison’s gesture is far from being enough – charging that Australia should reverse its opposition to an intellectual property waiver on COVID-19 vaccines, being debated by the WTO, so poorer Pacific Island countries could get doses faster. 

“There’s no doubt [if] the intellectual property waiver had been hastened and scaled at an earlier time there was a higher probability that Papua New Guinea would have been able to get vaccines [by now],” Jennifer Tierney, Executive Director of Médecins Sans Frontières (MSF) Australia, told The Guardian.

“The intellectual property waiver proposal was first made to the WTO by India and South Africa in October last year. Australia was one of the countries opposing this from the start,” said Tierney.

“Add to that the fact that wealthy countries, including Australia, representing only 13% of the global population, had already locked up at least half of the world’s leading potential COVID-19 vaccines, through pre-purchase deals with pharmaceutical companies,” she added.

Australia’s objections to the patent waiver under debate in the WTO – which would temporarily waive intellectual property rights on COVID-19 medicines and vaccines came alongside those of Brazil, Canada, the EU, Japan, Norway, Switzerland, the United Kingdom and the United States. 

Australia to Send Vaccines and PPE to Assist with “Uncontrolled” Outbreak in PNG 

Marape has reportedly asked Australian officials for assistance expediting vaccines for healthcare workers. This call has been echoed by aid groups, urging Australia to act immediately. 

“I put to [Australia] if possibly a smaller supply of vaccines could come in at the very earliest so that the health workers are given the defence in the first instance,” said Marape. 

In response Morrison said that 8,000 doses of the AstraZeneca vaccine would be sent immediately, along with personal protective equipment (PPE) and a team of health specialists to provide technical advice and help with emergency management of the outbreak. 

“We’ve known that [the] challenge was always going to be too great for Papua New Guinea, as time went on, and that indeed is proving to be the case now,” said Morrison at a  Wednesday press conference. 

Scott Morrison, Australia’s Prime Minister, at a press conference on Wednesday.

He also announced that Australia had requested the European Union to permit the immediate export to Australia of one million doses, for which the country had already contracted. Australia has purchased 53.8 million doses from AstraZeneca, 3.8 million of which are to be imported from overseas. 

“We’ve contracted them. We’ve paid for them. And we want to see those vaccines come here so we can support our nearest neighbour, PNG, to deal with their urgent needs in our region,” Morrison said. 

This call comes shortly after Italy blocked a shipment of 250,000 vaccines to Australia in early March due to its own domestic vaccine shortages; the Italian move was the only export order that a European Union member state has refused to implement – out of over 300 requests. 

An answer is expected from the EU within days.

Brazil’s Health System in Crisis as New Record in Deaths is Hit

Meanwhile, Brazil recorded 2,841 deaths on Tuesday, a record high for the country since the beginning of the pandemic, surpassing the US in the 7 day average of COVID-19 deaths, as the health service is experiencing a historic collapse. 

The COVID-19 units in 25 of Brazil’s 27 states are at or above 80% capacity. The health system is being overwhelmed by cases and the situation is “extremely critical across the country,” the Fundação Oswaldo Cruz (Fiocruz), a biomedical centre manufacturing the AstraZeneca vaccine in Brazil, said in a statement.

“The situation in Brazil is a cautionary tale that keeping this virus under control requires continuous attention by public health authorities and leaders to protect people and health systems alike from the devastating impact of this virus,” said Carissa F. Etienne, Director of the Pan American Health Organization, at a press briefing on Wednesday.

Brazil has the second highest number of infections and deaths in the world, with over 11.6 million cases and 282,127 deaths, and only 4.6% of the population have received at least one dose of a COVID-19 vaccine. 

The health authorities are rolling out the Oxford/AstraZeneca and Sinovac vaccines and have purchased doses of the Pfizer/BioNTech, Johnson & Johnson, and Sputnik V vaccines. The vaccination campaign, however, is slow and only a fifth of the expected doses produced in Brazil will be delivered by the end of March. 

Fiocruz researchers urged the government to adopt strict prevention and control measures, including restricting non-essential activities, expanding physical distancing measures, enforcing the use of masks on a large scale, and accelerating the rollout of vaccines. 

New Health Minister Continues With Bolsonaro’s Controversial COVID Policies

Brazil’s fourth health minister since the start of the pandemic was officially appointed on Wednesday. It is doubtful, however, that he will represent a change in the policies of President Jair Bolsonaro, who has consistently downplayed the severity of the virus and has received widespread criticism for his handling of the pandemic. 

Marcelo Queiroga, the new health minister, stopped short of endorsing social distancing measures or a lockdown to curb the spread of the virus at a press conference on Tuesday. Instead he asked the population to wear masks and wash their hands.

Marcelo Queiroga, Brazil’s new health minister, speaking to reporters on Tuesday.

“These are simple measures but they are important, because people can with these measures avoid having to shut down the country’s economy,” Queiroga said. 

He stressed that the country’s health policy is set by the president and the minister is responsible for implementing it.

Disapproval of President Bolsonaro’s handling of the pandemic has reached a record high, with 54% of respondents to a new Datafolha poll considering his actions bad or very bad. This has risen since late January, when 48% of respondents were disapproving.

Image Credits: ABC News Australia, Facebook – Papua New Guinea National Department of Health, ABC News Australia, Reuters.