African vaccine producers supply just 1% of the continent’s needs at present – but the plan is to increase this to 60% by 2040, according to John Nkengasong, Director of the Africa Centers for Disease Control (CDC). 

“The vision is to ensure Africa has timely access to vaccines to protect public health security, by establishing a sustainable vaccine development and manufacturing ecosystem in Africa,” Nkengasong said at the opening of the two-day African Vaccine Manufacturing Virtual Conference on Monday.

There are currently 10 pharmaceutical manufacturing companies on the continent.

By deploying a coordinated regional strategy, Nkengasong said Africa can establish vaccine manufacturing hubs in each of the continent’s five regions — western, central, northern, eastern and southern.

If Africa is able to effectively leverage its capabilities, Nkengasong said the continent can vaccinate 60% of its people against COVID-19 by 2022. 

By 2040, he said Africa can be fully responsible for the manufacture of vaccines of three emerging diseases including Ebola,Lassa fever and Rift Valley disease; have capacity to manufacture vaccines for unknown global pandemic for up to 60% of its population, and should be able to meet 60% of its routine immunisation.

Dr Stavros Nicolaou, Aspen’s Senior Executive for Strategic Trade Development

In March 2021, South Africa’s largest pharmaceuticals maker, Aspen Pharmacare, announced it was involved in a technology transfer that will enable it to commence the supply of 200 million Johnson & Johnson COVID-19 vaccine doses before the end of June.

Dr Stavros Nicolaou, the company’s Senior Executive for Strategic Trade Development, told the conference that African governments need to ensure the availability of economies of scale, and to ensure the economies are sustainable.

“We cannot any longer sustain this continuous dependence on imports, particularly in the midst of a pandemic that we’re witnessing today, and for that matter any future pandemic,” Nicolaou  said. 

He said that the governments of Italy and France had approached Aspen for anesthetic and other supplies during the pandemic last year. 

He added that African governments and the continent’s major donor agencies have active roles to play in supporting local manufacturing through long-term contracts and guarantees of tax.

“Right now, with importing reigning supreme, there is no real support for localization and local efforts. It becomes very difficult to attract and retain investors. Without guarantees, we will not succeed,” he added.

To start with, he said Africa needs to look beyond vaccines and expand its target to medical equipment and local companies that are involved in their production across the continent.

“We need to identify more of these facilities, leverage the volumes, regionally, and the entirety of the continent, and look to see how we leverage those volumes, into our domestic manufacturing plants across the country. So we start establishing these economies of scale, and we grow from there,” he concluded.

Setting Priorities

Abderrahmane Maaroufi, Director of Morocco’s National Public Health Institute, noted that Africa’s stakeholders need to identify top priorities for medicine production, and set goals for the local vaccine production on the continent.

He said that Africa can prioritise vaccines like the human papillomavirus (HPV) vaccine that are complex and expensive globally, as well as vaccines against meningitis.

Maaroufi added that Africa should also prioritise vaccines to respond to the epidemiological threats of emerging diseases such as Ebola and rabies.

“And the reason I say this is because these kinds of products are very expensive, on a global level. It’s very hard to buy them because the demand is low and are limited to a few countries,” Maaroufi said.

Notably, Maaroufi added that Africa can also focus on improving the local production of anti-snake venom and similar treatments that are specific and peculiar to Africa.

“We need to prioritize this kind of production which is very specific to the scorpions and other serpents that exist in our continent,” he added. 

Dr Amadou Alpha Sall, Director of the Institut Pasteur de Dakar in Senegal

Africa needs to be able to produce up to 200 million doses of COVID-19 vaccine, according to Dr Amadou Alpha Sall, Director of the Institut Pasteur de Dakar in Senegal.

He noted that new technology could accelerate the pace towards closing the wide gap that exists in Africa’s vaccine manufacturing landscape.

“This action-oriented approach is something that we learn not only from the vaccine perspective but also we’ve learned from the diagnosis process,” he said.

Sall was referring to the $1 COVID-19 test kits that were developed by the Institut Pasteur de Dakar in collaboration with the British biotechnology company Mologic and the IRD, the French National Research Institute for Sustainable Development.

He added that Africa also needs to figure out long-term funding and identify partners that will commit to the venture for a long-term.

“It’s not just about putting money on a regular basis but also about building business models that are very relevant to Africa,” he added.

He opined that attention should be focused on Africa’s peculiarities—putting into consideration the continent’s specificity in order to identify the unique business model that would be financially sustainable and at the same time make high quality products with affordable access. 

“These would be something that is critically important and that’s where the value of partnership is important. We need to put together a great foundation that will support these initiatives while at the same time, mobilizing some domestic funds,” he added.

Despite the enormous tasks ahead, Sall said the coordination of the African Union through the Africa CDC could and should enable the continent to achieve the set goals. 

“With the coordination through platforms and hubs, we can build in different regions, capacity to be involved. To provide vaccines to everybody seems to be critical to coordination is really key,” he added.

WTO to Prevent ‘Vaccine Hoarding’

Ngozi Okonjo-Iweala, Director-general of the World Trade Organization (WTO), told the conference that the organisation intends to create a framework to prevent “vaccine hoarding” in future pandemics.

She also revealed that the WTO will hold a meeting this week with vaccine manufacturers to discuss trade barriers and how to increase the production of COVID-19 vaccines.

This initiative comes as the effort by India and South Africa to get pharmaceutical manufacturers to waive their intellectual property rights to COVID-related medicines and products, appears to have stalled. 

In the weeks leading to the conference, Health Policy Watch reported stakeholders in public health on the continent warned against vaccine wars and expressed worry regarding the fate of Africa which they said is a victim of an unfair distribution of the already approved COVID-19 vaccines. 

While countries in the Western world have more than enough doses for their citizens, African countries that got some doses of vaccines through COVAX Facility are already running out of supplies and developments elsewhere, including in India, suggested they may not get additional doses anytime soon.

“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,” said William Kwabena Ampofo, Chairperson of African Vaccine Manufacturing Initiative.

Naoko Yamamoto, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations

Although taxing tobacco products is one of the most effective ways to discourage smokers – and it provides governments with revenue – it is “the least implemented” tobacco control policy globally, according to the World Health Organization (WHO).

“It takes vision and courage for political leaders to stand up against the powerful vested interests that profit from tobacco,” said WHO Director General Dr Tedros Adhanom Ghebreyesus at Monday’s launch of a manual on tobacco tax administration aimed at helping governments to levy taxes.

Tobacco use accounts for an estimated eight million deaths a year, but only 38 countries covering 14% of the global population had sufficiently high tobacco taxes in 2018, according to the WHO. 

“Raising tobacco taxes so that they account for at least 70 percent of retail prices would lead to significant price increases, induce many current users to quit, and deter numerous youth from taking up tobacco use, leading to large reductions in the death and disease caused by tobacco use,” according to the WHO.

Highest Taxes in Sri Lanka

Sri Lankan Health Minister Pavithra Devi Wanniarachchi

Sri Lanka and Oman are amongst the handful of countries with high taxes – accounting for 70% and 64% of the price of cigarette packs respectively.

Sri Lankan Health Minister Pavithra Devi Wanniarachchi told the launch that her country  “proudly meets the highest level of achievement with regards to tobacco taxation on cigarettes”.

“We have increased this tax at regular intervals in order to effectively decrease the affordability, and therefore the consumption, of these deadly products,” said Wanniarachchi, but added that bidis and chewing tobacco also needed to be taxed at the same level as cigarettes as they were “just as deadly”.

Oman’s health minister, Ahmed Mohammed Obaid Al Saidi, told the launch that his country had raised taxes from 25% to 64% between 2018 and 2020 and expected this to have an impact on consumption although “smoking is very low” in Oman. 

Jeremias Paul, the WHO’s Coordinator of the Tobacco Control Economics Unit, said that the tobacco industry used scare tactics to dissuade governments from taxation, including claiming taxes were anti-poor, would cause job losses and result in court action.

He urged governments to prepare adequately to combat industry arguments, and that the manual would assist with this.

Young People Are Price- Sensitive

Young people are two to three times more responsive to taxes and price than older persons, thus “higher taxes and prices are particularly effective in keeping young people from moving beyond experimentation with tobacco use, preventing them from becoming regular and, eventually, addicted users”, according to the manual.

It guides readers through the steps necessary to create strong tobacco taxation policies, including practical pointers on how to navigate through the political process and win support for taxes.

In the “best practice” chapter, the WHO urges governments to use the tax revenue to address the health problems caused by tobacco, implement a simple excise tax, tax all tobacco products in a similar way to avoid consumers moving from one product to another and eliminating duty-free sales.

Where the tobacco industry has threatened job losses, “using a portion of new tobacco tax revenues to move tobacco farmers into other crops or to retrain those employed in tobacco product manufacturing for work in other sectors would significantly reduce these concerns”.

Naoko Yamamoto, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations, said raising taxes “is particularly timely in the context of a COVID-19 recovery where countries face large budgetary pressure”. 

“Improved tobacco tax policy can be a crucial component of building for better,” said Yamamoto.

Dr. Maria Van Kerkhove, WHO Technical Lead on COVID-19, at the press conference on Monday.

The World Health Organization (WHO) has called for a global “reality check” as COVID-19 infections increased by 4.4 million in the past week, with countries and individuals abandoning proven methods to protect themselves.

“This is not the situation we want to be in 16 months into a pandemic, where we have proven control measures. It is time right now where everyone has to have a reality check about what we need to be doing,” Maria van Kerkhove, WHO’s COVID-19 Technical Lead, told the global body’s bi-weekly media briefing.

Van Kerkhove warned that the world was in a “critical point of the pandemic,” which is “growing exponentially.”

WHO Director General Dr Tedros Adhanom Ghebreyesus blamed “confusion, complacency and inconsistency in public health measures” for the increases, pointing to “several countries in Asia and the Middle East that have seen large increases in cases.”

India, Turkey, Iran, the Philippines and Iraq are driving these regional increases.  

“Make no mistake, vaccines are a vital and powerful tool, but they are not the only tool,” stressed Tedros. “We say this day after day, week after week, and we will keep saying it: physical distancing works, masks work, and hygiene works. Ventilation works, surveillance testing, contact tracing, isolation, supportive quarantine and compassionate care all work to stop infections and save lives.”

Tedros pointed to the fact  that in some countries with high transmission rates “restaurants and nightclubs are full, markets are open and crowded with few people taking precautions.”

He also warned young people not to assume that they could not get seriously ill, pointing to the deaths of young, healthy people and the effects of ‘long COVID.’

“Many people who have suffered even mild disease report long term symptoms, including fatigue, weakness, brain fog, dizziness, tremors, insomnia, depression, anxiety, joint pain, chest tightness and more, which are symptoms of long COVID,” warned Tedros.

Dr Tedros Adhanom Ghebreyesus, WHO Director General.

“This is exactly the time where we need to double down on the non-pharmaceutical interventions, on masking and reducing transmission, because we give the vaccines their best chance of providing protection,” said Kate O’Brien, WHO’s Director of Vaccines. “When, in addition to scaling up immunity through vaccination, we reduce transmission, this reduces the likelihood of having [the] emergence of variants.”

Van Kerkhove urged people to “check their social media feeds” to see “what people are doing and how you are mixing” to keep safe.

Vaccine Supply is ‘Precarious’

Bruce Aylward, WHO’s lead at COVAX, admitted that the “whole vaccine supply situation remains precarious,” and the challenge of managing community was “very difficult one to manage.”

India continued to make “tremendous demand” on the supply of AstraZeneca vaccines being produced by the Serum Institute of India.

This vaccine is the backbone of COVAX and requires two doses but the interval between doses could be extended to 12 weeks, said Aylward. 

“Obviously we’d like to make sure that that interval doesn’t go longer than that so we’re doing everything possible to ensure the supply of AstraZeneca’s product in particular because that’s what’s gone out,” said Aylward. 

Vaccine Manufacturing Task Force

The WHO’s Chief Scientist, Soumya Swaminathan, clarified that the Vaccine Manufacturing Task Force being set up under COVAX was focused on the “immediate removal of any obstacles” to vaccine rollout.

At present, it was focused on “raw materials and ingredients and the tubings and the plastic, which is getting into short supply,” she said.

Dr. Soumya Swaminathan, WHO Chief Scientist.

“There are also export restrictions that have been put in place by some countries on some of these products, which is creating a problem for some manufacturers,” added Swaminathan. 

“The first step is really to identify what those critical needs are, where there is a global supply shortage and try to address them, but also work with governments to make sure that there are no export restrictions. That’s where the World Trade Organization (WTO) and the trade rules would come in.”

Earlier in the day, the WTO’s new Director General Dr Ngozi Okonjo-Iweala, told an African manufacturing conference that the trade body planned to introduce rules to prevent hoarding during pandemics.

Image Credits: Mohsen Atayi, WHO.

Previous SARS-CoV2 infection conferss a high degree of protection, according to a new study.

Previous infection with SARS-CoV2 induces effective immunity against future infections by 84% – but reinfection rate is still 16%, found a study published in The Lancet on Friday. This suggests that infection-induced immunity is similar to, or greater than, vaccine-associated immunity, said the authors. 

The SARS-CoV2 Immunity and Reinfection Evaluation (SIREN) study involved 25,661 health workers in the UK and took place between June 2020 and January 2021. 

It was conducted by researchers at Public Health England, and the Universities of Oxford, Bristol and Cambridge.

Participants were separated into a positive cohort – based on antibody positive or previous positive PCR tests – and a negative cohort – antibody negative or no previous positive PCR test.

Questionnaires on symptoms were sent to participants and diagnostic testing was conducted every two weeks, and antibody testing took place every four weeks. Reinfection was defined by the researchers as a participant with two positive PCR tests 90 or more days apart or an antibody-positive participant with a positive PCR test. 

Some 155 reinfections were detected in the positive cohort of 8,278 participants and 1,704 new infections were identified in the negative cohort of 17,383 participants. The interim results from the study showed that previous infection reduced reinfection by at least 84%.

 

Weekly frequency of study participants with a positive PCR test result by cohort assignment, from March 2020, to January 2021.

 

Approximately 50.3% of the reinfections were symptomatic, with 32.3% of those having typical COVID-19 symptoms, which include cough, fever, and loss of taste or smell. The average interval between primary infection and reinfection among participants was 201 days.

The lowest level of protection against reinfection was provided to asymptomatic infection, with 76 of the 155 participants with reinfection having asymptomatic reinfection.

Vaccines and Variants

During the study period, 52.2% of the participants were vaccinated, however, the authors said that the findings on the durability of protection following their previous infection were independent of the vaccine effect. 

The researcher recommended that future studies examine the protective effect of both previous infections and vaccine efficacy. 

In addition, the B.1.1.7 variant had spread rapidly during the study period causing over 50% of the infections among participants. Despite the circulation of the more transmissible variant, the study found no evidence that the spread of the variant adversely impacted reinfection rates. 

This shows that immunity from a previous infection from a different SARS-CoV2 strain is still protective against the variant. 

Comparable Protection from Infection and Vaccines, Say the Authors

“Our findings…show equal or higher protection from natural infection, both for symptomatic and asymptomatic infection [compared to vaccines],” said the authors. 

The protection against asymptomatic reinfection is particularly important to reduce the risk of onward transmission.

Although the Pfizer/BioNTech and Moderna COVID-19 vaccines were 90% effective against PCR-confirmed infection, according to a study conducted by the US Centers for Disease Control and Prevention (CDC) in early April, natural infection induces a wider range of immune responses. 

Antibodies induced by infection are often lower in concentration compared to antibody responses induced from vaccinations, but can include responses beyond the spike protein, which is the target of current vaccines, said Florian Krammer, Professor of Microbiology at the Icahn School of Medicine at Mount Sinai in New York, in a comment to the study. 

This study is “valuable to understand the nature and duration of protective immunity,” said Soumya Swaminathan, WHO Chief Scientist, on Twitter. 

Further studies on the longevity of antibody responses, reinfection with the new SARS-CoV2 variants, and the impact of the existing vaccines on reinfection are reportedly underway.

Image Credits: Flickr – International Monetary Fund, The Lancet.

The Johnson & Johnson COVID-19 vaccine.

The European Medicines Agency is reviewing the cases of four people who developed blood clots after receiving Johnson & Johnson’s (J&J) COVID-19 vaccine, the regulator announced on Friday. 

“Four serious cases of unusual blood clots with low blood platelets have been reported post-vaccination with COVID-19 Vaccine Janssen. One case occurred in a clinical trial and three cases occurred during the vaccine rollout in the USA. One of them was fatal,” the regulator said in a statement after a meeting of its Pharmacovigilance Risk Assessment Committee (PRAC) ended on Friday.

The vaccine is currently being used in the USA under an emergency use authorisation, and in South Africa as an implementation trial to vaccinate health workers.

It was authorised in the EU on 11 March and member states were expected to start rolling it out in the next few weeks. 

“These reports point to a ‘safety signal’, but it is currently not clear whether there is a causal association between vaccination with COVID-19 Vaccine Janssen and these conditions,” said the EMA. “PRAC is investigating these cases and will decide whether regulatory action may be necessary, which usually consists of an update to the product information.”

PRAC is also investigating a bleeding disorder linked to AstraZeneca. 

“Five cases of this very rare disorder, characterised by leakage of fluid from blood vessels causing tissue swelling and a drop in blood pressure, were reported in the EudraVigilance database,” according to the EMA, although it said no causal relationship had been established between the condition and the vaccine.

PRAC has also concluded that unusual blood clots with low blood platelets should be listed as very rare side effects of AstraZeneca.

Both AstraZeneca and Johnson & Johnson vaccines use the same viral vector technology. 

Image Credits: Johnson & Johnson.

South Africa’s Health Minister Zweli Mkhize

CAPE TOWN – South Africa has secured enough COVID-19 vaccine doses for 41 million people from Johnson and Johnson and Pfizer, but only 6 million of these will be delivered by June because of “supply constraints”, the country’s health ministry announced on Friday.

Health Minister Zweli Mkhize told a civil society briefing that the vaccination of the country’s 1.25 million health workers should be completed by mid-May – although it has only vaccinated about 300,000 health workers so far because of shortages.

From 17 May, the country will start vaccinating people over the age of 60, workers over 40 and people working in “congregant settings” such as nursing homes. By July, it hopes to move to all people over the age of 40. After October, vaccinations will be opened to everyone and South Africa hopes to vaccinate 41 million of its almost 60 million citizens by February 2022 – the most ambitious rollout by an African country so far.

Secret Pfizer Negotiations ‘Took a While’

Mkhize said that the negotiations with Pfizer “took a while” and this had also prevented the country from getting the 117,000 Pfizer doses it had been allocated by the global vaccine platform, COVAX. The terms of the deal are secret, and the ministry has been unwilling to share the price it is paying or what the sticking points were in the negotiations.

However, Pfizer will start to deliver South Africa’s 20-million-dose order in tranches within 14 days after it received payment on Friday, said the Minister. These will mainly be dispensed in urban areas given that people needed two doses and they needed to be kept in very cold conditions.

Meanwhile, Johnson and Johnson (J&J) has agreed to supply the country with 31 million of its vaccine, which would be prioritised for rural and migrant populations given that they can be kept in ordinary fridges and people only need a single dose.

The J&J vaccines will be assembled in South Africa by the country’s generic producer, Aspen, which means it can be distributed fast because the regulatory safety checks would have been done at the factory, said the minister.

“Our vaccine rollout plan couldn’t be finalised until we knew the flow of the vaccines,” said Mkhize, adding that J&J had provided a schedule until the end of June while Pfizer would be “week to week deliveries”.

Pressure After June

In an earlier interview, Mkhize said he expected one million J&J doses by the end of April and a further 900,000 each in May and June, and some 6.75 million Pfizer doses by June – but this seems to have been over-optimistic.

Health department official Dr Lesley Bamford said that the “largest number of doses are expected in the second half of the year. Supply in the first half is relatively constrained and will cover about six million people”.

This means that the country will have to vaccinate almost 130,000 people a day between June and February 2022 in order to meet its vaccination target. 

To do this, the country has resolved to use a wide range of public and private vaccine sites, including health facilities, schools, churches and workplaces. 

While private doctors and private health facilities will be used, they will be provided with the vaccines by the government and all vaccines will be free.

Trade unions, civil society and faith-based organisations have been invited to join the government’s vaccine oversight committee and the five sub-committees that will assist with the process.

Africa ‘Barely Moved Beyond Starting Line’

Meanwhile, Africa’s Centres for Disease Control (CDC) reported this week that 45 of Africa’s 55 countries had received COVID-19 vaccines and 43 had started vaccinations.

“The pace of vaccine rollout is, however, not uniform, with 93% of the doses given in 10 countries,” said the Africa CDC.

“Many African countries have barely moved beyond the starting line. Limited stocks and supply bottlenecks are putting COVID-19 vaccines out of reach of many people in this region,” warned Dr Matshidiso Moeti, the World Health Organization (WHO) Regional Director for Africa. “Fair access to vaccines must be a reality if we are to collectively make a dent on this pandemic.”

Vaccine rollouts in some countries were being delayed by “operational and financial hurdles or logistical difficulties such as reaching remote locations”.

“Africa is already playing COVID-19 vaccination catch-up, and the gap is widening. While we acknowledge the immense burden placed by the global demand for vaccines, inequity can only worsen scarcity,” said Dr Moeti. “More than a billion Africans remain on the margins of this historic march to overcome the pandemic.”

Through the COVAX, 16.6 million vaccine doses – mainly AstraZeneca – have been delivered to African countries.

 

Image Credits: GCIS.

The COVAX facility aims to deliver 2.3 billion COVID-19 vaccine doses by the end of 2021.

The global vaccine delivery platform, COVAX, might only deliver 20% of its vaccine target by mid-year because of “supply constraints” but it aims to make up the backlog in the second half of the year, according to Dr Seth Berkley, CEO of the global vaccine alliance, Gavi.

“Our goal is still to try to get to 2.3 billion doses by the end of 2021 assuming that there are not any major supply disruptions with any of the manufacturers,” Berkeley told the World Health Organization’s (WHO) biweekly COVID-19 briefing on Friday.

The Serum Institute of India (SII) recently stopped its vaccine supply to COVAX in order to meet the growing domestic demand as COVID-19 cases in India surge.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said on Friday that there “remains a shocking imbalance in the global distribution of vaccines”.

“More than 700 million doses have been administered globally, but over 87% have gone to high-income or upper-middle-income countries while low-income countries have received just 0.2%. On average, in high-income countries, almost one in four people has received a vaccine. In low-income countries, it’s one in more than 500,” said Dr Tedros.

But only 14 countries were not yet ready to vaccinate their health workers and elderly, said Tedros, who had set Saturday 10 April – the 100th day of 2021 – as the global deadline for this to begin. 

Bilateral Deals and Donations Mean Less for COVAX

Seth Berkley, CEO, Gavi, the Vaccine Alliance.

Berkley called for the “continued support from governments and manufacturers because every time a bilateral deal gets done around the COVAX facility it means less doses for COVAX and for equitable distribution”.

“What we’re now beginning to see is supply constraints, not just of vaccines, but also of the goods that go into making vaccines: the filters, the bags that are necessary, the mediums,” said Berkley, whose organisation manages COVAX, along with the Coalition for Epidemic Preparedness Innovations (CEPI).

However, Berkley added that he expected donations of surplus doses from high-income countries to be “an important source of vaccines for COVAX in 2021”.

COVAX has also been working with multilateral development banks to develop mechanisms to enable low-income countries to buy additional vaccines from COVAX “through cost-sharing mechanisms”. 

So far, COVAX has delivered about 38 million vaccine doses to 105 countries.

“The problem is not getting vaccines out of COVAX. The problem is getting them in,” said Tedros. 

Tedros also condemned “vaccine diplomacy” whereby “some countries and companies plan to do their own bilateral vaccine donations by passing COVAX for their own political or commercial reasons”. 

“This is a time for partnership, not patronage. Scarcity of supply is driving vaccine nationalism and vaccine diplomacy,” he stressed.

China and Russia are the biggest culprits of “vaccine diplomacy”, and both countries have donated millions of doses of vaccines developed in their countries to strategically placed low and middle-income countries, particularly in Africa and Latin America. 

Decision on Chinese Vaccine

Meanwhile, the Chinese vaccines, Sinopharm and Sinovac, which applied for WHO emergency use listing in January, “are in the final stages of evaluation”, according to WHO’s Director of medicines Regulation and Prequalification, Rogerio Pinto de Sá Gaspar.

WHO’s technical advisory group on vaccines would discuss the application on 26 April, and possibly also at a second meeting in the first week of May when the final decision would be reached, said De Sá Gaspar.

Berkley said that there were currently seven vaccine products available, and COVAX hoped that this would be expanded to 10 to 15, but the crucial question was how to expand production.

“There is a COVAX manufacturing task force that is looking at technology transfer and how to expand production, but right now one of the worries is limitations in supplies,” said Berkley, as the global vaccine production was usually 5 billion doses but now needed to expand to 10-14 billion. 

“We don’t yet know exactly what 2022 is going to bring. Will we need new vaccines which are going to replace the existing vaccines? Will we need booster doses because of immunity waning or will we need vaccines that are specifically targeted at some of the variants?”

To finance the demand, Gavi is looking for at least $2 billion in additional funding this year and will be appealing for this at next week’s virtual investment opportunity event being hosted by the US, said Berkley.

Meanwhile, Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), described COVAX reaching over 100 countries as an innovation and manufacturing success story “with the scaling up from zero to one billion doses being produced by April 2021”.

“The COVAX public-private partnership and political leadership to equitably share surplus vaccines are the best guarantees we have that people who need the vaccines will get it whenever they live, fast enough to outpace the virus’ mutations,” added Cueni.

Image Credits: WHO, Gavi/Tony Noel.

The WHO and its member states must take swift action to enable a transparent, independent and rigorous investigation into the origins of the SARS-CoV-2 virus, said two dozen international scientists in their second open letter. 

The letter – released on Wednesday by 24 scientists and researchers across Europe, the United States, and Japan – comes on the heels of the controversial WHO-China investigation, which has been criticised for its methodological weaknesses, and for allegedly kowtowing to Chinese interests. 

“In our previous open letter, we outlined our fears that the joint international committee/Chinese government team ‘did not have the mandate, the independence, or the necessary access to carry out a full and unrestricted investigation into all the relevant SARS-CoV-2 origin hypotheses,’ said the letter on Wednesday, which was drafted by former US National Security Council official Jamie Metzl, who is a member of the WHO expert advisory committee on human genome editing.

“Having read the report entitled ‘WHO-convened Global Study of Origins of SARS-CoV-2: China part’…we have regrettably concluded that our concerns were fully justified.”

A group of scientists has called on the WHO and member states to conduct a more thorough investigation into the origins of SARS-CoV-2

WHO-Convened Study Methodologically Weak

Echoing earlier criticisms of the WHO-convened report, the letter expressed concerns that it arbitrarily discounted a key theory on the emergence of SARS-CoV-2, namely that it leaked from the Wuhan Virology Institute, a lab that is well-known for its research on bat coronaviruses that are closely related to SARS-CoV-2.

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team on Wednesday.

Instead, the WHO’s report concluded it was “possible to very likely” that the virus emerged from bats and other wildlife via an animal. It also suggested that the virus could have spread through frozen foods – even though the evidence to support either of those theories remains lackluster, warned the letter.

“No solid justification is provided for why a ‘lab-related accident’(whether a lab-leak or sampling accident) should be considered ‘extremely unlikely’, or why a natural spillover via an unknown animal host should be considered ‘likely to very likely’. At this stage there is still no direct evidence for either pathway nor any verified data or evidence sufficient to rule any one out, while historical evidence amply supports both,” said the letter.

The letter also denounced the report for containing over a dozen incorrect, imprecise, and contradictory assessments in its appendix. One of those – in the report’s Annex D7 – claims that the deaths of a handful of miners in the Yunnan province in 2012 were ‘more likely explained by fungal infections”.

That view, however, contradicts positive antibody results for a bat SARS coronavirus in 4 out 6 of the miners that fell ill, the letter said. It also seems to go against the diagnosis of Zhong Nanshan, a leading coronavirus expert who believed that the primary cause of death of the miners was a SARS-like coronavirus infection rather than a secondary fungal infection.

“The fungal infection diagnosis is however in contradiction with the diagnostic of Prof. Zhong Nanshan, the foremost Chinese SARS expert at the time, who diagnosed a most likely primary infection from a SARS-like coronavirus, with a possible secondary fungal infection in some cases (pulmonary aspergillosis),” said the letter.

“Further, the diagnosis of the ‘WIV [Wuhan Institute of Virology] experts’ also contradicts the positive bat SARS coronavirus antibody tests (IgM and/or IgG) obtained for 4 of the 6 miners (these four tests were carried out at the WIV itself and described in this PhD thesis”.

Chinese Foreign Ministry Said Open Letter Lacks Scientific Credibility  

Responding to the open letter, Chinese Foreign Ministry spokesperson Zhao Lijian questioned its scientific credibility, calling it an attempt to politicise the ‘origins’ investigation and to discredit China – claims that Metzl later rebutted on Twitter.

“These [open letter] signatories can deceive no one as to whether their letters are meant to make a true proposal for scientific and professional origin-tracing or target a specific country with presumption of guilt,” Jijian told a press conference on Thursday.

“The origin-tracing study was indeed affected by political factors, but that did not come from China, but from the United States and some other countries, who are bent on politicizing the origin-tracing issue in an attempt to disrupt China’s cooperation with WHO and discredit China, ” he added.

He also said the lab hypothesis is “extremely unlikely”, noting that the findings of the SARS-CoV-2 origins report were based on “frank” and “science-based exchanges” between WHO experts and “relevant” Chinese institutions.

“As for the lab hypothesis, experts on the mission all agreed that lab leaking is extremely unlikely, after visiting disease control centers in Hubei and Wuhan, the Wuhan Institute of Virology and various biosafety labs, and after having in-depth, frank and science-based exchanges with their Chinese peers from relevant research institutions.”

Open Letter Echoes Earlier Calls For More Robust Investigation

However, even the WHO’s director-general, Dr Tedros Adhanom Ghebreyesus, who has tried to steer a careful balance between US and Chinese geopolitical rivalries on the origins investigation, has admitted that the report’s findings are limited – and he has also told member states that the lab hypothesis should not be discarded out of hand. 

“Although the team has concluded that a laboratory leak is the least likely hypothesis, this requires further investigation, potentially with additional missions involving specialist experts, which I am ready to deploy,” he said at a closed-door briefing with member states last month.

“I do not believe that this assessment was extensive enough. Further data and studies will be needed to reach more robust conclusions.”

The letter also echoes earlier calls from a bloc of 14 countries – including the United States, Australia, Canada, Denmark, Japan, Norway, Korea and the United Kingdom – for more comprehensive studies into the origins of the virus in the future.

“It is critical for independent experts to have full access to all pertinent human, animal, and environmental data, research, and personnel involved in the early stages of the outbreak relevant to determining how this pandemic emerged,” said the joint statement from member states. 

Renewed Commitment Needed To Enable Robust Investigation 

Going forward, the WHO and member states can take three possible steps to enable a more comprehensive, independent, and transparent study into the origins of SARS-CoV-2.

The “most logical” step would involve revising the terms of reference between the WHO and China, to ensure that:

  • The composition of the expert group is determined in a transparent way by the WHO’s Executive board;
  • The selection procedure prevents conflicts of interests;
  • The group includes experts on biosafety, biosecurity and biodata;
  • The group gains greater access to sites, records and data, without requiring supervision from government authorities;

In anticipation that the revisions “cannot be agreed upon and implemented in the very near term”, the letter proposes a second option – a new resolution that could be passed at the upcoming World Health Assembly (WHA) to give the WHO the legal mandate for an “independent” and “unrestricted investigation”.

However, should a resolution fail to be ratified at the WHA, the letter suggests a third option.

Governments could come together to develop a “new and independent process”, with China’s cooperation if possible, but without it if not.

“If it should prove impossible for the Terms of Reference to be quickly revised or for a new and sufficient World Health Assembly resolution to be passed in the coming session, the best remaining alternative would be for governments…to come together to develop a new and independent process, with China’s cooperation if possible but without it if not.”

-This story was updated on Friday to reflect the Chinese Foreign Ministry’s reaction to the open letter and Jamie Metzl’s subsequent response to it.

Image Credits: CNN, New York Times.

Delays in COVID-19 vaccine deliveries to Africa will hamper public health agencies’ vaccination schedules.

The latest wave of the COVID-19 pandemic in India has delayed vaccine delivery to African countries and is expected to adversely affect vaccine roll-out programs and the continent’s response efforts until the third quarter of the year.

The Indian government’s decision to suspend exports of the vaccines from the Serum Institute of India (SII) to countries in Africa will further prevent public health agencies from maintaining specific vaccination schedules in a predictable manner, especially from mid-April to July, according to  Dr John Nkengasong, Director of the Africa CDC.

Speaking during a press briefing on Thursday Nkengasong said: “If the shipment of vaccines was not interrupted because of the situation in India, we would have had a nice coverage between now to June, and then from June or July onwards, our own deliveries will kick in and even more COVAX deliveries will come in”.

“In a good vaccination program, predictability of availability of vaccines is very, very important so that you know when and how to use your first doses and how to counsel people that have received their first doses to come in for a second dose. The situation with the Serum Institute and the government of India makes it very complicated for our vaccination program across the continent,” Nkengasong added.

India is battling a new wave of COVID-19 infections. On April 7, the pandemic reached a new peak with nearly 127,000 confirmed cases — the highest number of daily confirmed cases in the country since the pandemic began. To control the spread of the pandemic, several major cities including Mumbai and New Delhi have imposed curfews and the government aims to vaccinate as many people with doses of vaccines produced in the country within a short period of time. 

To achieve this, it directed the country’s leading vaccine producer to prioritise the country’s vaccine needs over its international commitments. Already, India has vaccinated over 90 million people against COVID-19 with more than 11.4 million people fully vaccinated. However, it has only been able to fully vaccinate 0.8% of its total population.

Dr Matshidiso Moeti, World Health Organization’s (WHO) regional head for Africa however said that despite the delay in the India shipments, more vaccine  deliveries were expected in the coming weeks from the COVAX facility to several African countries including Guinea, Guinea-Bissau, Mauritania, Niger, Cameroon and the Comoros.

Moeti said several African countries that had initially received vaccine shipments have already exhausted more than two-third of their supplies. With no information on the next shipment dates, WHO said it is guiding countries on how to optimise the national deployment of the available doses while also working with key partners to scale up Africa’s vaccine production capacities.

“But we recognize that this cannot be achieved overnight, short term solutions are needed, that prioritize vaccine equity [as] Africa is already playing COVID-19 vaccination catch up,” Moeti said.

COVAX Reaches Over 100 Economies

The COVAX facility led by Gavi announced in a statement today that it has reached 100 economies just 42 days after the first international delivery of vaccine – it expects to deliver doses to all participating economies that have requested vaccines in the first half of the year.

Gavi said over 38 million doses of vaccines from manufacturers AstraZeneca, Pfizer-BioNTech and SII have been delivered.

Dr Seth Berkley, Gavi  CEO,  said there were still several challenges with vaccine delivery as  the world seeks to end the acute stage of the pandemic. 

“We will only be safe when everybody is safe and our efforts to rapidly accelerate the volume of doses depend on the continued support of governments and vaccine manufacturers. As we continue with the largest and most rapid global vaccine rollout in history, this is no time for complacency,” Berkley said.

AstraZeneca Vaccines Benefits Outweigh the Risks

Dr Matshidiso Moeti, WHO Regional Director for Africa

The Africa CDC and the WHO said despite the latest report from the European Medicines Agency (EMA) regarding the Oxford/AstraZeneca COVID-19 vaccine, African countries can still continue to roll out the vaccine noting that the occurrence of the blood clot findings is very low and does not warrant a suspension of ongoing vaccination efforts.

“I just like to emphasize how very few people this is compared to those that have received the vaccine. So about 200 million people have received the (AstraZeneca) vaccine and about 100 to 200 cases of this manifestation have been found, so it is an extremely rare event,” Moeti said.

While WHO and its partners are analysing the date, the global health body said it will continue to recommend the vaccine because the benefits outweigh the risks.

“If you look at the millions of people that have died of COVID-19, compared to those that have been vaccinated, and a very tiny number that have manifested this side effect. We will continue to recommend its use,” Moeti said.

Nkengasong said there has  been no reported case of the side effects of AstraZeneca in Africa.

“We and others including the WHO, have also put in place a system to continue to monitor the side effects and rare occurrences of any other events across Africa,” Nkengasong said.

Vaccine Passports Will Exacerbate Huge Inequalities

The Africa CDC and WHO further expressed concerns regarding the growing calls for vaccine passports which they said could be discriminating against Africans who would have received the vaccines if enough doses were available in their countries.

Vaccine passports for COVID-19 continue to be a polarising debate across the world. Similar to a country’s national passport, holders of vaccine passports could gain entry into venues for crowded concerts, it could also be required by foreign countries as proof of vaccination against COVID-19 as another requirement for entry other than valid national passport. Even though it is considered to be likely legal, vaccine passports are on track to become the latest divide in the global fight against the COVID-19 pandemic.

Nkengasong told Health Policy Watch any imposition of a vaccination passport will create and exacerbate huge inequalities. “We already are in a situation where we don’t have vaccines, and it will be extremely unfortunate that countries impose travel requirements of vaccine immunisation certificates, whereas the rest of the world has not had the chance to have access to vaccines — not because the continent doesn’t want to be vaccinated, they just don’t have the vaccine.”

John Nkengasong, Director of the Africa Centres for Disease Control, believes vaccination passports will create and exacerbate huge inequalities.

According to him, there are African countries that have the money to get vaccines, but there are no vaccines to be acquired. “So our position is clear that we cannot at this point impose it. It will be inappropriate to impose vaccination passport requirements, given where we are in the rollout of vaccination across the continent,” he said.

Moeti is of the view that vaccine passports can only be used for vaccines that are widely and equitably available across countries. “This is not yet the situation with the COVID-19 vaccination,” she said. “We would like to encourage the imposition of vaccine passports, as a condition for people to gain entry into countries not be applied, while we work together at the global level.”

Image Credits: Felix Dlangamandla, Our World in Data, Paul Adepoju.

A health worker receives her first dose of Sinovac Biotech’s Coronavac vaccine at the Ospital ng Malabon (Hospital of Malabon).

New York City – While the Philippines ranks 50 out of the 155 countries that have administered the most COVID-19 vaccines, opposition leaders and health officials fear the collapse of the country’s healthcare system amid a surge in new infections. 

Globally, more than 704 million doses – about 4.6% of the global population – of vaccines have been administered so far, according to the Bloomberg Vaccine Tracker.

As of 5 April, the Philippines has administered 854,063 doses, placing it as the 50th highest of 155 countries, said vaccine “czar” Secretary Carlito Galvez Jr, who is also the chief implementer of the National Task Force against COVID-19 in the country.

Those vaccinated include 789,415 health workers, around 11,000 elderly, and some 7,100 people with comorbidities, he added.

But while the national government touts its successes in vaccination, what is occurring on the ground reflects a different story.

“Inconsistent” Data Underreports Full Capacity Hospitals 
ABS-CBN Data Analytics head Edson Guido

A senior data analyst flagged the “inconsistent” data reporting from the Department of Health (DOH) regarding hospital bed occupancy in the country.

ABS-CBN Data Analytics head Edson Guido said there was conflicting reporting on the occupancy rate of hospitals, particularly in Metro Manila. 

The DOH had initially reported 78% of intensive care unit beds in the region were filled, 78% of isolation beds were utilized, and 60% of ward beds were occupied. Around 60% of ventilators were also in use. 

“The reports on the ground say [bed occupancy] in Metro Manila is full and [patients] were brought to other provinces. So, there seems to be a disconnect in terms of deaths and bed occupancy that the DOH is reporting from what’s happening on the ground,” Guido said. 

A patient is seen in a hospital bed outside the San Juan Medical Center in San Juan City on Thursday.

Philippine hospitals across the country had declared full capacity and many were no longer taking patients. Some private hospitals had switched to offering home care.

The Medical City, an 800-bed hospital in Metro Manila, has three-to-10 day programs that can cost as much as 65,000 pesos (USD $1,340), which includes infection control, virtual monitoring, swabbing and blood extraction services. 

Vice President Leni Robredo, who leads the political opposition, questioned, in a Facebook post last week, these expensive “Home Care Medical Packages,” which only the richest Filipinos can afford. 

“Are there guidelines from the DOH that the Home Care Specialists have to follow to ensure the safety of the people who get sick?” she said. 

The surge is taking its toll on the healthcare workforce as well, as 117 of 180 staff tested positive at the Philippine Orthopedic Center in Manila, forcing the facility to close its outpatient department, which can serve as many as 450 patients a day. 

“When our medical front-liners are getting sick, the threat of collapse of our healthcare system is big. We must control the spread of the disease,” Opposition Senator Francis Pangilinan, in a 3 April statement, said. 

Former president Joseph Estrada spent the night in an emergency room after being rushed to a Manila hospital with COVID-19 complications on 28 March, since regular beds were occupied. Estrada was later admitted to the intensive care unit and is now on a ventilator as his pneumonia worsened, his son said in a Facebook post on Monday. 

Philippine hospitals are at overcapacity, forcing patients to receive treatments in their cars.

Others do not even have the chance to enter a hospital at all. 

“Many have already died inside tents outside hospitals, waiting to be admitted to the ERs, in an ambulance while in transit, at home without receiving any medical help,” Robredo said.

The government is currently planning to allocate more living quarters for healthcare workers in the National Capital Region Plus (NCR Plus), making arrangements with hotels and other lodging service providers. 

Pangilinan warns of a “humanitarian crisis that will overwhelm the country and wipe out families” if the government does not step up its efforts. “Step on the gas. Testing, tracing, isolation, and treatment are the four wheels of the anti-COVID ambulance. Government efforts must be toward accelerating the ambulance to outpace the infection and save all of us,” he said. 

Government Recalibrating Strategy – Vaccinations and Self-Isolation Measures
Vaccine “czar” Secretary Carlito Galvez Jr, (left) who is also the chief implementer of the National Task Force against COVID-19

In response to the continued rise of COVID-19 cases in NCR Plus, the government is recalibrating its immunization efforts towards areas with high infection rates. 

Building herd immunity in high-risks areas such as Metro Manila could address the spike in local transmissions, said vaccine czar Galvez. 

He added that inoculation of at least five million individuals in Metro Manila will jumpstart the process of achieving herd immunity and will enable the government to offset the delays in vaccine deliveries. 

Senator Pangilinan also advised free mass testing, citing Vice President Robredo’s mobile free mass testing initiative called Swab Cab. 

The Swab Cab initiative brings COVID-19 testing to communities through use of buses that were converted into mobile testing sites. The program, started with Robredo’s private sector partners, is meant to augment the government’s testing capacity. 

Both Robredo and Pangilinan highlighted the need for the government, on top of recalibrating its vaccination strategy, to ensure that the people of the Philippines were provided for during self-isolation.

“Those who go on self-isolation and their family must be assured of food,” said Pangilinan. 

Said Robredo: “Have we built a system where people who are self isolating at home would still have access to medical help when necessary? Did [the government] even fix the infrastructure?” 

Strictest Lockdown Measure Implemented In Philippines Capital Region
philippines
A delivery driver wears a mask and unloads essential items amid the COVID-19 lockdown

The Philippines’s dramatic surge in cases has forced the government to implement the toughest of 4 lockdown levels until 11 April in Metro Manila and the surrounding provinces of Bulacan, Cavite, Laguna, and Rizal. 

Health officials attribute the rising cases to the unexpected spread of more infectious coronavirus variants.

“No one could have probably foreseen how infectious these new variants are and as a result of which we have these ballooning numbers,” presidential spokesman Harry Roque told ABS CBN News.

The Philippines nationwide cases data, with recent weeks averages not computed, owing to delays in reporting

As of 8 April, there are 828,366 COVID-19 cases in the Philippines, with 9,216 new cases and 14,119 deaths, the highest totals in Southeast Asia after Indonesia. 

The national government had initially placed Metro Manila and its provinces under a General Community Quarantine (GCQ) bubble on 22 March.

A bubble setup is applied to a cluster of people restricted from going in and out of a covered area unless authorized to do so. Going in and out of NCR Plus is limited to essential workers and essential travel. 

Public transportation remains operational, with proper social distancing measures in place. 

However, the GCQ was upgraded to an Enhanced Community Quarantine (ECQ) on 29 March, and was extended to 11 April as daily infections breached 10,000. 

The ECQ limits further movement to accessing essential goods or services, or performing essential work. Religious services, including the past week’s Holy Week and Easter events for Roman Catholics, were shifted online after public gatherings were temporarily banned. 

PH Lags Behind Southeast Asia Neighbours; Temporarily Suspends Use of AstraZeneca Vaccine
Doses administered per 100 people

According to NY Times data, the country in fact lags behind the rest of its Southeast Asian neighbours, having administered 0.9 doses per 100 people as of today, compared to Indonesia’s 2.4 doses and Malaysia’s 1.1 doses. 

The country expects to vaccinate up to 70 million people this year, and has so far received 2 million COVID-19 doses from China-based Sinovac Biotech, and 525,600 vaccine doses from British-Swedish pharma company AstraZeneca. Vaccines from Russia-based Sputnik V are also expected to arrive this month. 

Vaccine deliveries will gradually increase in May and June, with a total of 10.5 million doses from Sinovac, Sputnik V, Novavax, and AstraZeneca. 

However, the announcement by the European Medicines Agency during a 7 April press conference that there appears to be a link between AstraZeneca’s vaccine and very rare cases of blood clots mainly younger women,  has resulted in the Philippines government temporarily suspended use of the vaccine in people under 60. 

“I want to emphasize that this temporary suspension DOES NOT MEAN that the vaccine is unsafe or ineffective. It just means that we are taking precautionary measures to ensure the safety of every Filipino. We continue to underscore that the benefits of vaccination continue to outweigh the risks and we urge everyone to get vaccinated when it’s their turn,” Philippines Food and Drug Administration Director General Rolando Enrique Domingo said in a statement.

Image Credits: ILO/Minette Rimando, IMF Photo/Lisa Marie David, ABS-CBN, Philippine Star/Twitter , HDetalla/Twitter, ABS-CBN, Philippines DOH, NYTimes.