Vaccination can effectively prevent mother-to-child transmission of hepatitis B

In a landmark achievement, incidence of chronic hepatitis B has successfully dropped below 1% in children under five, reaching the 2020 goal set at the 2016 World Health Assembly, said World Health Organization Director-General Dr. Tedros Adhanon Ghebreyesus on Monday.

The target reduction in hepatitis B virus (HBV) incidence in children was met in 2019, a rare case where global health goals were achieved within the intended timeline. The achievement, announced just ahead of World Hepatitis Day, provides a much-needed boost of morale for the embattled global health community in the wake of this year’s pandemic and its knock-on effects on other disease areas. 

“HBV has been a scourge in many countries for so many decades”, said WHO’s Head of Health Emergencies Mike Ryan. “To see incidence [of hepatitis B] less than 1% in children is just incredible”

“I know it doesn’t sound like it, but we should take these successes because they’re true victories for global health.”

The reductions in HBV incidence in children were largely thanks to the wide deployment of a childhood vaccine against the virus. 

Still, Dr Tedros warned that countries must stay on guard.

Disruption of essential services, like vaccination against Hepatitis B, could result in five million additional chronic hepatitis B (HBV) infections in children born between 2020 and 2030, as well as one million additional HBV-related deaths among those children later on, according to a study by Imperial College London and WHO which has not been published yet. 

Additionally, the hepatitis death toll could skyrocket because of coronavirus-related disruptions, warned Dr. Tedros. Hepatitis infections can cause liver damage and liver cancer, and currently claim 1.3 million lives a year. 

Globally, about 325 million people live with hepatitis B and C, the most deadly of the five types of hepatitis disease.

Hepatitis B Vaccine Coverage Threatened During Coronavirus Pandemic
A healthcare worker in Lao PDR provides the first dose of the hepatitis B vaccine, given within 24 hours of birth.

As a result of the pandemic, disruption of essential hepatitis services, like HBV vaccination of infants, threatens to claim thousands of additional lives, added panelists at the WHO briefing.

“Even in the midst of the COVID-19 pandemic, we must ensure that mothers and their babies have access to life-saving services including hepatitis B vaccinations. Preventing transmission of hepatitis B from mother-to-child and in early childhood is the most important strategy for controlling the disease and saving lives”, said Dr. Tedros.

Mother-to-child transmission is responsible for the brunt of new HBV infections, and the virus claims nearly 900,000 lives each year. Boosting vaccine coverage is particularly important in WHO’s African Region, where HBV vaccine coverage at birth is ten times lower than the global average of 42%.

“For regions such as sub-Saharan Africa with low access to the vaccine, increasing coverage of a timely birth dose is the priority,” emphasized Doherty.

Some countries have successfully maintained essential services for other infectious diseases like measles despite the pandemic, suggesting the same could be done for HBV. Ethiopia, for instance, has successfully vaccinated almost 15 million children against measles during the pandemic, according to a report from WHO’s African region on Monday.

The HBV vaccine can protect against the virus in more than 95% of cases, and has been proven to be safe after nearly four decades of use.

WHO Issues New Hepatitis Guidelines To Prevent Mother-to-Newborn Transmission

On Monday, Dr. Tedros also called on countries to implement two new recommendations to prevent onward transmission of HBV from pregnant women to their newborns.

As part of the new guidance, pregnant women that are HBV-positive and present a high viral load can protect their newborns through preventive antiviral therapy from the 28th week of pregnancy until birth.

The antiviral of choice, tenofovir, only costs $3 per month in many regions of the world.

However, in settings where viral load testing is unavailable, women are encouraged to use the low-cost “HBeAg” antigen test to assess their infection status, recommends the WHO.

Battle Against Hepatitis C Continues Amidst High Medicines Costs and Barriers To Diagnosis
Meg Doherty, WHO’s Director of Global HIV, Hepatitis and STI Programmes

In recent years, so-called “direct acting antivirals” have also prevented thousands of deaths from hepatitis C (HCV) for as little as $60 in some regions, Meg Doherty, WHO’s Director of Global HIV, Hepatitis and STI Programmes, said on Monday. A typical treatment course on these drugs is twelve weeks.

However, these lifesaving drugs are still out of reach for many patients in high- and middle-income countries, where a twelve-week treatment course can even climb to $3000 given the absence of special licenses with generic companies to produce the drugs at a cheaper price, Doherty told Health Policy Watch.

“Not all countries will have access to the [cheaper] generics, though more and more countries have access now [over 105 countries] to some of the direct acting antivirals.”

She also added that without access to testing, “the medicines will remain out of reach”, as she referred to the fact that only 19% of HCV patients (13.1 million) are diagnosed with HCV, and only 7% of people with HCV (5 million) are treated for the disease, according to WHO data from 2017.

People waiting to receive free hepatitis C
testing during World Hepatitis Day 2016, Rwanda

Image Credits: WHO, Flickr: CDC Global, WHO, WHO.

Moderna, a frontrunner in the COVID-19 vaccine development race, today entered the final phase of testing required before pursuing regulatory approval, beginning the Phase III trial for their vaccine candidate mRNA-1273.

The trial, titled COVE (Coronavirus Efficacy), will measure how well a 100 microgram dose of the vaccine can protect people against developing symptomatic COVID-19 disease. It will enroll over 30,000 volunteers in the United States, and also measure how well the vaccine can prevent severe disease, and infection with SARS-CoV-2, the virus that causes COVID-19.

Moderna’s Phase III trial launch comes days after the biotech firm lost a key patent dispute last Thursday against Arbutus, a small Canadian company that holds rights to technology that delivers medical treatments via mRNA. The US Patent and Trademark Office ruled against Moderna’s claims that Arbutus’ patents were invalid. Moderna’s vaccine uses an mRNA vector to deliver the vaccine component.

So far, the dispute settlement seemed to have no effect in slowing down Moderna’s vaccine development. However, Arbutus could file for an injunction, which could block Moderna from selling the vaccine, or force the company to negotiate a license agreement that would require a portion of profits to go to Arbutus, according to STAT News.

But some patent experts think that governments are unlikely to let patent disputes hold up the vaccine’s market debut if trials are successful – particularly given the urgency of the coronavirus pandemic.

“If patent thickets present real delays in manufacturing, governments should, and I expect will, issue compulsory licenses and/or refuse injunctions,” James Love, director of patent watchdog Knowledge Ecology International, told Health Policy Watch. Compulsory licenses allow companies to override patent protections in select cases to scale up production of a medical product, or reduce competition to encourage lower prices.

Moderna claimed in a statement that the company “is not aware of any significant intellectual property impediments for any products we intend to commercialize, including mRNA-1273.”

Developed in collaboration by the United States National Institute of Allergies and Infectious Diseases (NIAID) and now supported in clinical trials by the United States Biomedical Advanced Research and Development Authority (BARDA), an arm of the US Department of Health and Human Services, Moderna’s vaccine candidate seems to have the solid backing of the US government.

Moderna Gets US $472 Million from BARDA For Late Stage Clinical Trials

Vaccine candidates use different mechanisms, shown above, to prompt the body to produce an immune response against SARS-CoV-2.

Moderna on Sunday announced a US $472 million infusion in funding from US BARDA for the mRNA1273 Phase III trial, bringing the total amount of funding Moderna has received from the US agency to US $955 million.

The biotech firm’s vaccine candidate is one of five to enter into final phase clinical trials, after being the first to publish early phase trial results in a peer-reviewed journal just two weeks ago. It is one of 25 vaccine candidates currently being tested in humans.

The COVID-19 vaccine rat race has been moving at record speed. Anthony Fauci, director of the US NIAID and America’s foremost trusted COVID-19 expert, described the rapid pace of vaccine development as “unprecedented” in a webinar hosted by the TB Alliance last week.

“We started a Phase I 62 days following the beginning of vaccine development. And many candidates, at least a handful more, will be going into phase three trials in the next several months, one of which will start at the end of this month,”  Fauci said at the webinar, referring to the Moderna trial. “That is unprecedented.”

Massive final Phase III trials will be critical in determining whether the vaccine candidate can actually protect against developing COVID-19 symptoms or infection by the novel coronavirus. While Phase I and Phase II results from many vaccine candidates have shown that the vaccines can induce an immune response in healthy volunteers and is safe to use, they are not large or robust enough to prove whether the vaccine can actually prevent infection.

Image Credits: Flickr: Marco Verch, US Government Accountability Office.

Elyne Kaingu, a 33-year old mother and her 2 -year old son Abdul. Elyne benefitted from IPTp treatment during her second pregnancy.

Kilifi County, Kenya – Elyne Kaingu, a 33-year old mother from the beautiful Mnarani area of Kilifi County, overlooking the Indian Ocean, was extremely wary during her first pregnancy about the silent killer in her midst – malaria.  She knew some other first time mothers had fallen ill with the disease, and had even lost their babies or had premature births.

“I had to be very careful, given the pain caused by the disease to first time mothers, which I had witnessed,” recounts the homemaker, who was born and raised in Kilifi.  

For example, she was aware of the complications that might arise from maternal aneamia attributable to malaria.

Kaingu therefore took extra precautions by seeking medical advice from the village antenatal care (ANC) clinic, “where I was given iron and folic acid tablets, that prevented anemia while helping the development of the baby,” she says.

She was one of the lucky first-time mothers who had a successful and safe birth.

When she became pregnant for a second time in 2018, she discovered something that allowed her to feel even more reassured.  

During a prenatal check at the Mafumbini Dispensary she heard about the fact that Intermittent preventive treatment of malaria in pregnancy (IPTp) could help protect mothers and their babies from malaria, and she decided to take the treatment. 

“For every [ANC] clinic visit, I was given the malaria medicine which had to be taken at the dispensary before leaving for home,” Kaingu said, recalling the trips she made from the second trimester onward. 

There are good reasons for requiring the treatment be done at the clinic, she says, explaining that since the medicine sometimes causes nausea, some women might not take it within the confines of their homes.  

Even so, she made sure to arrive at the clinic with a good meal in her stomach. “It was not advisable to take the medicine on an empty stomach, according to the advice of the clinicians,” she says, explaining this helped ward off possible nausea.

Intermittent preventive treatment in Pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is effective in preventing maternal death and reducing maternal malaria episodes.

A minimum of three doses of sulfadoxine-pyrimethamine (SP) from the second trimester onwards has been shown to help prevent maternal malaria episodes, maternal and foetal anaemia, and related adverse outcomes like low birth weight and premature birth, according to the Geneva-based Medicines for Malaria Venture.  MMV is working with the World Health Organization, Roll Back Malaria and other partners to help ramp up IPTp treatment worldwide in the malaria-endemic zones at highest risk.  

About 31% of pregnant women that need IPTp treatment in Sub-Saharan Africa get at least two doses of the preventive medicine, according to WHO’s 2019 World Malaria Report. That is a big leap since 2010 when only about 2% of women received treatment, but still a long way to go in terms of ensuring full coverage.    

IPTp Offered in an Integrated Package of Services 

Integrating IPTp treatment with other services important to pregnant women has been one of the scale-up strategies stressed by MMV and others. 

In Kaingu’s case, the integrated approach was evident from the start – giving her extra motivation to return for more ANC care – and IPTp treatments. 

During her visits, for instance, she was provided with an insecticide-treated mosquito net: “Up until that time, I was using an ordinary, untreated mosquito net in my home.” 

Other benefits included being tested for breast cancer; advice on breastfeeding and on saving money specifically to meet the needs of the newborn baby.  Finally, there was the assurance that she could remain safe from malaria. 

“The treatment and the clinic visits have been beneficial to me and my baby, because I have never been attacked by malaria,” says Kaingu.

IPTp reduced malaria in pregnancy – even while Kilifi saw an overall rise in malaria cases
Malaria is still a concern in seaside Kilifi County, nestled by the Indian Ocean in southeast Kenya.

IPTp is one of the most widely used preventive interventions in this coastal region of Kenya as well as in Kenya’s Lake Victoria area – where malaria is endemic and incidence has even risen in recent years.

Expanding access to IPTp is the first objective of the six-phase Kenya Malaria Strategy adopted in 2019, which aims to help everyone in at-risk areas adopt appropriate measures to prevent malaria from the outset – as compared to only taking a curative approach.

Whereas some parts of Kenya have seen gradual declines in malaria incidence, heavy rains seen in the coastal area have led to a rising disease rate in some counties, such as Kilifi, where Kaingu lives. 

In 2018, there were an estimated 20-50 confirmed malaria cases, per 1,000 people, in Kilifi County, according to county malaria records. By 2019, that rate had doubled.  

Even so, malaria incidence among pregnant women in the rural area where Kaingu lives, actually declined over that same period, according to the records of the Kadzinuni Kendrick Dispensary, which serves her area. And the IPTp rollout has had a lot to do with that, in the opinion of Daniel Karisa, the clinical officer in charge of the Dispensary, which covers the northern rural part of Kilifi County. 

Daniel Karisa, a clinician at Kendrick Dispensary Kadzinuni in Kilifi, attending to a patient and his parent.

“There is a significant reduction of malaria cases among pregnant women even though there is an upsurge of malaria cases in the general population, during the rainy season,” Karisa said in an interview with Health Policy Watch. 

Some 200 pregnant women visited the dispensary for ANC treatment last year Karisa said in the interview, in which he constantly referred to the carefully kept dispensary records. Of those, only nine developed malaria in their second trimester and thereafter  – or 4.5% of pregnant women. The rate was 9% per cent on average before IPTp treatment was started.

Karisa believes that the integrated approach taken by the clinic to providing the treatment, in combination with bednets, advice about breastfeeding and breast cancer prevention, has   yielded other benefits. Out of their exposure to such issues, many women have developed better health-seeking behaviors. 

“IPTp is a big part of this change,” Karisa says.

Less Maternal Anaemia, Low-Weight Babies and Involuntary Abortions
Kendrick Dispensary Kadzinuni in Kilifi County on the Kenyan coast, where mothers receive IPTp treatment and other pregnancy-related care.

Karisa cites a long list of other benefits that he has observed, in terms of pregnancy outcomes: 

“There was reduced hospitalization resulting from severe maternal anaemia,” he asserts, referring again to the records. He notes that out of 100 mothers receiving IPTp, and reviewed during their ANC visits, only one was found to be severe anaemic. IPTp treatment helps prevent maternal anaemia by killing malaria parasites in the placenta. 

None of the babies born at the dispensary over the past year were low-birth weight (less than 1.5 kilograms).  Says Karisa: “Following the introduction of IPTp in the community, it is now rare to have low birth weight deliveries.”  

Finally, there has also been a reduced incidence of premature labour as well as a decline in involuntary abortions, he says, noting that the facility used to record an average of 4 cases of involuntary abortion per month for expectant mothers, before IPTp treatment was introduced. 

This year, between January and June, there was only a single case of miscarriage. This occurred among a total of 10 pregnant women who were found to be infected with malaria in their first trimester – when current forms of IPTp cannot be safely administered.  

“This is caused by the malaria parasites lodging inside the womb,” Karisa explains.

COVID-19 Slowed but Didn’t Stop IPTp Services  

In Kenya’s priority areas, IPTp coverage appears to already be slightly higher than it is Africa-wide. According to the Kenya Malaria Indicator Survey (KMIS) some 38 percent of pregnant women in the priority areas of Kilifi and Lake Victoria received IPTp treatment in 2015, the last year for which national data is available.

Based on observations at clinics such as Kadzinuni, the proportion of women being reached also seems to have increased further over the past five years. However, it will be some time before new national data is forthcoming, since the updated malaria survey that had been due to take place in 2020 has been pushed back to 2021, in light of the  COVID-19 pandemic. 

Indeed, coronavirus has been another new challenge that local health facilities have had to address – along with the unusually heavy rains, Karisa says. 

“The fear was that the new disease could severely handicap our ability to dispense malaria treatment to patients,” he explains.  “Fortunately this has not come to pass.”

Initially, in April and May, the number of mothers seeking ANC services dropped by about half, as COVID-19 cases started to spike nationwide.

While the clinic used to receive 100 individuals on average per day, the number dropped to between 50 and 60 in that period. As there was no lockdown in Kilifi, this was largely due to women’s fears of getting infected with the new disease.

“This however, is not to say that the services were interrupted per se; they were delayed,” Karisa says, noting that in June, numbers of women visiting the clinic rebounded  – even though COVID-19 cases began to climb sharply around the country.

Fortunately so far, COVID-19 case counts in Kilifi have also remained relatively low. On 19 July, for instance, six new COVID cases were recorded in the county, out of 603 cases nationally. 

Healthcare workers, like Daniel Karisa, are providing essential malaria care against the background of the COVID-19 pandemic and unusually heavy rains.

Against the uncertain landscape of the pandemic, the determination of health workers like Karisa to maintain routine health services, such as treatment for malaria in pregnancy, is good news to David Reddy, CEO of MMV.  

“As responding to COVID-19 will be a marathon, not a sprint, it is critical that prevention and treatment of leading killers such as malaria not be left behind,” Reddy told Health Policy Watch. “This is particularly the case in sub-Saharan Africa where the malaria disease burden remains so very high particularly among children and pregnant women. In that context, preservation and scale up of essential services such as those that prevent malaria in pregnancy remains critical.”

Malaria Remains a Major Burden to Communities
Elyne Kaingu, a 33-year old mother in Kilifi and her 2 -year old son Abdul.

And despite the progress seen recently on reducing malaria in pregnancy, the parasitic disease  remains a big burden, socially and economically, to communities in Kilifi County, Karisa underlines. 

As many as 40% of people visiting health facilities may receive a malaria diagnosis – at least in the rainy season.  And some people are discouraged from seeking treatment, because they have to travel such long distances to get to a clinic. 

Just like many mothers in her community, Kaingu also has been more wary of visiting the clinic for routine care for fear of COVID-19. “Honestly, I stopped going to the clinic, unless my child fell ill,” she says. 

However, she remains keenly aware of how important IPTp treatment is to pregnant women, even in the coronavirus period, and is actively encouraging other women to seek it. 

She now volunteers to mobilize women in her community whenever there is a health-related drive in her village.

She notes that malaria remains a huge concern, “especially at this time, when we are experiencing a lot of rains.” Mothers like her are particularly vigilant as spikes in early childhood mortality from malaria have been observed.  

In speaking out about the issues, Kaingu is also a model to other women – some of whom may still be fearful about getting treatment, but also fearful about speaking out about the risks.  Indeed, malaria in pregnancy remains a traumatic issue to talk about among women in Kilifi – as there are more than a few women who have suffered the tragic consequences. 

Kaingu says more action is still needed:

“Even though a lot of effort has been made in encouraging expectant women to visit health facilities and seek ANC services, I think more still need to be done to sensitize this population group in the community, on the importance of guarding against malaria in pregnancy.”

A view of the Indian Ocean in Kilifi County, Kenya.

Image Credits: HP-Watch/G Kamadi, Karel Prinsloo/Jhpiego.

COVID-19 responders receive training on how to don and doff protective equipment

Ibadan, Nigeria – As the number of health care worker infections continues to rise in Africa, Health Ministers are calling attention to increasing pressure on Africa’s health system – and the people running it.

Lack of personal protective equipment, adequate infection prevention protocols, and burnout have led to widespread dissatisfaction among doctors in recent weeks, culminating in health worker strikes in some countries.

Over 10,000 health workers across 40 countries in Africa have tested positive for COVID-19, representing about 2% of the continent’s total number of coronavirus cases, according to African Health Ministers and experts present at a World Health Organization press briefing on Thursday.

While globally, some 10% of all cases are among health workers, the large shortage of healthcare workers in Africa predating the pandemic has many experts and Health Ministers concerned. On average, most African countries have less than 1 physician per 1000 people, and less than 2 nurses or midwives per 1000 people, according to World Bank data.

And in four Sub-Saharan countries, health workers make up more than 10% of all infections.

In Gambia, 22% of individuals that tested positive for COVID-19 are health workers, according to the WHO African region’s 21st COVID-19 situation report published July 22. This is followed by Niger Republic, where health workers account for 16.6% of COVID-19 cases in the country. 

In Africa, WHO noted that there is limited information on health worker infections, but health workers make up more than 5% of cases in 14 countries in sub-Saharan Africa.

WHO described the increasing number of health workers infected with COVID-19 as a sign of the challenges that medical staff on the frontlines of the outbreak face. It added that some countries are approaching a critical number of infections that can place stress on health systems as the pandemic continues to wax stronger across the continent further exposing health workers to the virus.

“The growth we are seeing in COVID-19 cases in Africa is placing an ever-greater strain on health services across the continent,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “This has very real consequences for the individuals who work in them, and there is no more sobering example of this than the rising number of health worker infections.”

Regional Director for WHO Africa Matshidiso Moeti

Aside from personal exposure to COVID-19, Moeti added that health workers are also afraid of taking the virus home, potentially exposing their family members to the pandemic. 

And the availability of personal protective equipment, and infection prevention and control measures were often inadequate and weak in many countries in Africa.

The agency added that health workers can also be exposed to patients who do not show signs of the disease and are in the health facilities for a range of other services. 

“Risks may also arise when health personnel are repurposed for COVID-19 response without adequate briefing, or because of heavy workloads which result in fatigue, burnout and possibly not fully applying the standard operating procedures,” WHO stated.

It is therefore not surprising that health workers in several African countries have expressed their dissatisfaction with a number of industrial actions, including strikes.

African Governments’ Limited Options – Sierra Leone’s Case

In Sierra Leone, three doctors, two community health workers and one nurse have died of COVID-19.

In all, about 10% of the country’s COVID-19 cases are among health workers. Moreover, a row between doctors and the country’s government over what doctors described as misuse of funds for the coronavirus response in the country and a lack of protection and compensation for health workers escalated into strike action early July. Even doctors treating patients with COVID-19 refused to continue working.

The country’s Medical and Dental Association said the government bought about 30 4×4 vehicles for managers from money intended for the fight against the virus rather than drugs and equipment.

But the country’s Minister of Health and Population, Dr Alpha Wurie acknowledged that healthcare workers in Sierra Leone were the first to be affected by COVID-19 while participating in a WHO press conference on Thursday.

Sierra Leone’s Minister of Health and Population Alpha Wurie

“It so happens that while COVID-19 treatment centers were in readiness and had enough PPEs, this was not so in the other hospitals,” Wurie said.

He also described how a doctor and several nurses at one of the country’s designated COVID-19 treatment centres, tested positive, resulting in the closure of the facility.

While admitting that the country has not become fully confident in the ways it is striving to prevent the spread of COVID-19, he countered that the case fatality management for COVID-19 has been satisfactory – compared with the outcomes of the country’s cycles of Ebola outbreak.

“The recovery rate for COVID-19 has been very good and the case fatality rate has been very low at 3.8%,” Wurie said.

Nurses Can’t Social Distance in Ghana

Dr. Jemima Dennis-Antwi, an Accra-based international maternal health and midwifery specialist, decried the paucity of published information on the true magnitude of health professionals’ infectivity which she described as an information that is highly guarded by countries.

Ghana has reported 2,035 cases of health workers infected with COVID-19. Some 91% fully recovered and there have been nine deaths which included four doctors, one nurse and three laboratory workers.

In addition to the use of PPEs, maintaining social distancing is another major COVID-19 prevention measure. But for several health workers, especially nurses, this is unrealistic.

“Nurses and midwives have the majority of infectivity – over 410 nurses and midwives have been affected in Ghana in the line of duty. This is because we are designated to serve our patients 24/7,” Antwi said.

Jemima Dennis-Antwi, an Accra-based international maternal health and midwifery specialist

Increasing exposure of health workers to COVID-19 without adequate provision of PPEs has led to health workers refusing to attend to patients, causing psychological stress to self and families, and constant threat of legal action. She noted that the implication of the development has impacts on a wide array of health issues other COVID-19 and other infectious diseases.

“This has serious implications for quality care, especially reproductive, maternal, newborn, child and adolescent care,” she said.

While calling for urgent action to keep Africa’s health professionals alive to provide the care they are trained to give, Antwi added that health workers on their part also needs to be more proactive and take actions that would boost their immune systems and will also clear respiratory pathways which is the major route of entry for COVID-19.

Tracking & Adjusting to Realities in Burkina Faso

Moeti also admitted that more needs to be done to reveal the true status of the pandemic among the continent’s health workers and to guide the enactment of appropriate policies.

“We are looking at improving the collection of data on health workers so that we can determine the extent of infection at work, and to inform the health workers on how to limit transmission at home,” she said.

In Burkina Faso for example, 8.5% of confirmed cases of COVID-19 are from health workers. While admitting that health professionals in the country are exposed to the pandemic, Dr Léonie Claudine Lougue, Minister of Health of Burkina Faso said the country has introduced a surveillance measure to screen its health workforce for COVID-19.

Léonie Claudine Lougue, Minister of Health of Burkina Faso

But a bigger problem still exists, persisting even as African countries continue to deal with COVID-19 – it is the limited capacity of the continent’s health institutions. 

WHO stated that in many African countries, infection prevention and control measures aimed at preventing infections in health facilities are still not fully implemented. 

“When WHO assessed clinics and hospitals across the continent for these measures, only 16% of the nearly 30 000 facilities surveyed had assessment scores above 75%. Many health centres were found to lack the infrastructure necessary to implement key infection prevention measures, or to prevent overcrowding. Only 7.8% (2213) had isolation capacities and just a third had the capacity to triage patients,” WHO stated.

Wurie however expressed optimism noting that in spite of the weak health systems across the continent, health workers will still be able to handle the pressure and threats from COVID-19 considering the case fatality ratio is rapidly reducing as the number of confirmed cases continues to rise.

“For people that may be infected, most of them are asymptomatic. The confidence of each country in being to manage the pandemic is getting better and the more we provide psychosocial support services for our health workers, the more their confidence also develops,” Wurie said.

 

Image Credits: WHO AFRO, HP-Watch/P Adepoju.


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Mangroves under threat in India

Three of India’s leading environmental websites, including Fridays For Future – India, part of the climate youth movement founded by Sweden’s Greta Thunberg, were blocked this week by Delhi police – after they protested a pending revision in the country’s environmental rules that would pave the way for polluting industries to mount projects without public hearings or appeals.

Late Thursday evening, the Indian police withdrew some of their initial allegations that the Fridays for Future group violated anti-terror laws, eventually allowing it and a second site, LetIndiaBreathe, to resume operations.  But a third Indian environmental site, There Is No Earth B, remained in a blackout Friday evening, even though it had never received any police warning. Meanwhile, environmental advocates expressed worries about the wider implications of the media censorship.

“Government muzzles young environmental voices in India,” said Greta Thunberg Thursday in a retweeted post by India’s Fridays For Future (FFF), protesting the crackdown. “Youth environmental movement @FFFIndia slapped with bizarre allegations by authorities &silenced by digital censorship for facilitating ‘too many emails’ to the MOEFCC.”

The saga began in early July, when Fridays For Future’s internet service provider was sent notices by New Delhi’s Cyber Crime division after the environmental activist group had posted stories and launched email campaigns protesting the hotly debated revisions in the country’s Environmental Impact Assessment (EIA), which would limit or even cancel opportunities for the public to review and object to new industrial projects potentially harmful to health and the environment.  On the other hand, There Is No Earth B, never received a notice in the first place, organizers told Health Policy Watch.

India’s Revisions In EIA Follow Plans For Massive Coal Mining Expansion

The proposed loosening of EIA rules comes as India faces mounting criticism for fueling its post-pandemic recovery with dirty energy by auctioning off 41 Indian coal mines to private investors for the first time ever, in moves announced last month.

Observers called it a significant repression of media freedoms in one of the world’s largest democracies. They said it has been orchestrated by the powerful Minister of Industry, Prakash Javadekar, who is also Minister of Environment as well as the Minister of Public Information and Broadcasting.

They said the new rules would open the way for mining and industrial projects to pour even more pollution into India’s chronically dirty skies and rivers in a country where air pollution killed some 1.2 million people a year in 2017, according to a study in The Lancet, and reduces life expectancy by an average 2.6 years, according to India’s Center for Science and Environment.  

“The draft of the new EIA dilutes several environmental norms which allow for faster environmental clearances bypassing existing safeguards”, Jyoti Pande Lavakare, an environmental journalist and founder of the Delhi-based NGO Care for Air, told Health Policy Watch. She also added that it eases environmental clearance and expands the list of projects exempted from publications or clearances altogether.

Jyoti Pande Lavakare, New Delhi based independent journalist and co-founder of Indian non-profit Care for Air

Industry, Environment and Media Portfolios Concentrated in Hands of One Minister

She attributed the media crackdown to the concentration of industry, environment and media portfolio into the hands of just one minister. 

“The Environment minister is the same as the heavy industries minister, who is the same as the information and broadcasting minister – one man – Prakash Javadekar,” said Pande Lavakare. “So there is a direct conflict here. As industry minister, he wants faster approvals for projects especially now when India is staring at a recession. As information and broadcasting minister, media is afraid to call him out on the environmental front.”

“Unlawful Activities” & “Terrorist Acts” 

In early July, New Delhi’s Deputy Commissioner of Police Anyesh Roy urged FFF’s internet service provider – Endurance Domains Technology LLP – to block the website for its “unlawful activities’:

“The above website [FFF] depicts objectionable contents and unlawful activities or terrorist acts, which are dangerous for the peace, tranquility and sovereignty of India.”

“It is requested that you may take necessary action [block FFF’s website] in this regard and send us a report immediately.”

Said India’s FFF branch in response to the crackdown: “Our movement is based on peaceful protests…It’s a shock to know that our dissent has been reduced to ‘being illegal’ with our site being censored.”

Others added that civil society is “simply carrying out its duty” to compensate for the government’s failure to protect its citizens.

“The Indian Constitution’s Article 51-A (g), says that ‘It shall be duty of every citizen of India to protect and improve the natural environment’ including forests, lakes, rivers & wild life & to have compassion for living creatures.”

“The authorities have repeatedly failed and it’s imperative now that we hold them accountable and demand action”, said There Is No Earth B.

This story was modified on July 24 as two of the websites were partiallly restored, though it is stll unclear whether the website of ThereIsNoEarthB is back online, according to Indian reporting agency Newslaundry.

Image Credits: There Is No Earth B / Sanjay Vann, Twitter: @FFFIndia, Jyoti Pande Lavakare, Fridays For Future.

Dr Tedros responds to US Secretary of State allegations that WHO made a deal with China.

In the strongest and most direct rebuttal yet to United States’ allegations of misconduct by the World Health Organization, WHO Director-General Dr Tedros Adhanom Ghebreyesus emphatically told reporters on Thursday that claims that he was ‘bought off’ by China are “untrue, without any foundation, and unacceptable.”

Dr Tedros called the allegations a “distraction,” saying politicization of the pandemic would hinder the response.

“Our sole focus is on saving lives. WHO will not be distracted by these comments, and we don’t want the entire international community to also be distracted,” Dr Tedros emphasized. “One of the greatest threats we face continues to be the politicization of the pandemic. COVID-19 does not respect borders, ideologies, or political parties.

“I have said it many times – COVID politics should be quarantined. Politics and partisanship have made things worse.”

Other members of WHO’s core COVID-19 response team, including COVID-19 Technical Lead Maria Van Kerkhove, who is an American citizen, echoed Dr Tedros’ response.

“I feel the need to say something as an American and as a proud WHO employee,”  said Van Kerkhove. “I see firsthand, every day, the work that Dr Tedros, Mike and our teams do all over the world. We are firmly focused on saving lives, we will not be distracted.”

WHO Health Emergencies Executive Director Mike Ryan said that it was important to maintain morale of “front-line workers” at the WHO and around the world. He added that while the the agency had room for growth, Dr Tedros’ leadership had been essential in catalyzing a “transformation in the organization.”

“Many of us have worked 20 hours a day, seven days a week for the past seven months,” said Ryan. “We have for years, sent our people in harm’s way every day. Many of us have spent months and years on the front line, risking our lives, worrying our families.

“None of us are perfect. But we all serve to save lives… We have benefited from [Dr Tedros’] leadership and from a transformation in the organization [that I thought would never come], and I can say this as someone who has spent a quarter of a century associated with this organization.”

WHO Team Growing Weary Of Repeated US Attacks

The WHO team was responding to reports of US Secretary of State Mike Pompeo’s claim that China had ‘bought-off’ Dr Tedros, helping him secure the 2017 election as WHO’s Director-General. The alleged deal led to WHO missteps in handling the pandemic, contributing to “dead Britons,” Pompeo was quoted as saying in The Telegraph while in London on Tuesday. The US Secretary of State reportedly made his remarks in a closed door meeting with British Members of Parliament on Tuesday, according to unnamed sources.

The strong response from the WHO reflected the agency’s growing weariness with US claims attacking WHO’s handling of the coronavirus crisis.

In March, the Trump administration threatened to withhold funding from the WHO, claiming that the Organization had yielded to pressure from China to downplay the virus’ seriousness. The ensuing back and forth led to Trump notifying the United Nations and Congress in early July that he was beginning the process to officially withdraw the US from the agency by July 2021.

Dr Tedros’ comments calling the US’ allegations “distracting” echoed comments from critics who have accused the Trump administration of using WHO as a scapegoat for the US’ own botched coronavirus response.

With nearly 4 million cumulative cases and more than 140,000 deaths, the United States has the highest coronavirus burden in the world, and the number of new cases reported daily is rapidly rising. Still, the administration has been pushing for states to reopen, resisted passing a national masking mandate, and encouraged schools to resume in-person learning in the fall, countering advice from their own public health experts.

Cumulative cases of COVID-19 around the world and COVID-19 deaths in the United States (top left) as of 8:00PM CET 23 July 2020, Numbers change rapidly.

 

Image Credits: Johns Hopkins CSSE.

COVID-19 is on it’s way to becoming the deadliest infectious disease in the world this year, and could cause more deaths worldwide than the current deadliest infectious disease killer tuberculosis.

Currently tuberculosis, one of humankind’s oldest known infectious diseases, takes the lives of some 1.8 million people per year.

Global Deaths Due to Various Causes & COVID-19 – by Tony Nickonchuk. Tuberculosis deaths are not included.

However, Wednesday marked a gain in the fight against TB. Pretomanid, only the third antibiotic to be approved for treating the disease in nearly half a century, was on Wednesday approved for use in India, which has the highest TB burden in the world. The oral drug has a 90% cure rate when used correctly to treat multi-drug resistant TB, according to peer-reviewed studies published by the TB Alliance, who developed pretomanid.

Meanwhile, COVID-19 has killed over 600,000 people since the beginning of the pandemic, already surpassing the number of deaths caused by HIV/AIDS, suicide, and malaria. But experts at a virtual event hosted by the TB Alliance on Wednesday warned that steadily growing outbreaks in hotspots like the United States, Latin America, South Asia, and Africa could lead to a death count higher than that of tuberculosis.

“Tragically COVID-19, which didn’t exist a year ago, may be in a position to match or surpass tuberculosis as the infectious killer this year,” warned Ariel Pablos-Mendez, a founding board member of the TB Alliance. 

“I don’t mean to be melodramatic about it, but it is really, as an infectious diseases person, a public health person, almost your worst nightmare. It’s almost the perfect storm,”  said Anthony Fauci, director of the US National Institute of Allergies and Infectious Diseases. Fauci has become a household name in recent months, emerging as the preeminent expert voice on COVID-19 in the United States, many times countering messages put out by the Trump administration downplaying the seriousness of the virus.

COVID-19 is the “Perfect Storm” – And It’s Not Going Away Anytime Soon
Subway workers in New York City hand out masks to commuters. Even those who don’t show symptoms of COVID-19 can spread the disease if they were infected.

The novel coronavirus has a number of characteristics that make it “particularly formidable,” said Fauci. It causes a wide range of disease severity, and is easily spread between humans.

SARS-CoV-2, the virus that causes COVID-19, has the ability to jump from animals to humans, and is easily spread from one person to the next as a respiratory-borne virus.

Some 20-45% of infected people may never show symptoms. But people without symptoms are still able to pass the disease onwards, although it’s unclear how much of COVID-19’s spread can be contributed to asymptomatic transmission.

“It is spectacularly efficient in spreading from human to human,”  said Fauci. “I don’t see this disappearing the way that SARS1, [the virus that sickened over 8000 in a 2002-2003 epidemic], did. I don’t really see us eradicating it.”

Additionally, the virus causes anywhere from non-existent to critical disease, hitting large swathes of the population like older people and those with common preexisting conditions particularly hard.

“I have never seen an infection in which you have such a broad range of [disease severity],”  said Fauci. “[You have] literally nothing – no symptoms at all – in a substantial proportion of the [infected] population, to some who get ill with minor symptoms, to some who get ill enough to be in bed for week and have post-viral syndromes, to others who get hospitalized, require oxygen intensive care, ventilation, and face death.”

Still, Fauci remained cautiously hopeful.

“I think with the combination of good public health measures, a degree of global herd immunity, and a good vaccine, which I do feel cautiously optimistic we will get, we will get very good control of this,” he said. “Whether it’s this year, or next year I’m not certain. But I think ultimately… we will bring it down to such a low level that we will not be in the position that we’re in right now for an extended period of time.”

Image Credits: Marc A. Hermann / MTA New York City Transit.

More droplet particles may remain airborne and travel further in poorly ventilated spaces

A new study by researchers at the University of Hong Kong (HKU) has documented how poor building ventilation plays a role in indoor transmission of Covid-19. The study looked at the air flow and infection dynamics from three important Covid-19 outbreaks in China and Japan, concluding that spread of the virus was “definitely favored by poor air ventilation”.

“It can be understood that a normally non-long-range-airborne infection turns to long-range airborne in poorly ventilated spaces. Opportunistic airborne transmission can lead to super-spreading events”, said Professor Yuguo Li, Chair Professor of Building Environment at HKU.

“The findings provide evidence that short-range airborne is also a major transmission channel, which in turn suggests that other precautionary measures have to be taken in order to better contain the pandemic.

Why The Hong Kong Study Is Important 

Recently 239 international experts signed a an open letter to WHO asking it to recognize that the SARS-CoV-2 virus transmission is occuring not only via large virus droplets at very close ranges of 1 meter, but via smaller viral particles that become “airborne” and travel a few meters away, particularly indoors. While experts debate ‘droplets’ versus ‘airborne’ particles, the HKU study points to ventilation as the “elephant in the room” that no one is examining closely.

Even WHO admits that some droplets may evaporate into tiny “droplet nuclei” that can become airborne. The HKU study says that in poorly ventilated rooms, viral droplets or particles will remain suspended in the air for longer – and travel further with a greater potential to infect. The HKU study calls this “opportunistic airborne transmission”:

“In short-range airborne transmission of diseases, droplet concentrations in the exhaled jet of air from an infected person continually decrease away from the mouth and the exhaled jet becomes sufficiently weakened to be indistinguishable from the background room air at a distance of approximately 1.5 m. However, if air ventilation is insufficient, the short-range airborne transmission route can be extended to result in a long-range airborne route to infect more people beyond the proximity.”

A Study Of Three Major Outbreaks 

In collaboration with the Guangdong and Hunan Centers for Disease Control and Prevention, Sun Yat-Sen University and Southeast University, Professor Li and his team at the Department of Mechanical Engineering of the University of Hong Kong (HKU) studied three major outbreaks that occurred between January and March 2020: These included outbreaks on Hunan’s bus system (January 22, 2020), where 10 bus passengers sitting as far as 9.5 meters from the infected passenger came down with Covid-19; at the Guangzhou Restaurant (January 24, 2020) where 9 people sitting as far away as five meters were infected by one person; and on the Diamond Princess Cruise ship where some 696 people became ill (January to March 2020).

Guangzhou Restaurant 1.jpgSARS-CoV-2 transmission dynamics in the Guangzhou restaurant

While the team didn’t find evidence of long distance viral transmission via the cruise ship’s air conditioning system, it found clear evidence of transmission beyond the range of 1.5 meters within the Hunan buses and the Guangzhou restaurant. At the restaurant, the ventilation flow rate was only 1 L/s per person. The two Hunan buses studied had a time-averaged ventilation rate of 1.7 L/s. Professor Li:

“In both the Guangzhou Restaurant case and the Hunan buses case, there is evidence that airborne is the probable way of transmission of the virus, given that those infected were sitting at a distance, and quite a number of them more than 2m apart from the index patients, and no other transmission route can explain the spatial pattern of the infection. We found that a poor ventilation rate is a major contributing factor to the virus’ spreading in the environment.”

Air Flow & Ventilation Rate

They concluded that transmission of the SARS-CoV-2 virus in the indoor environment is more likely when the ventilation rate is less than 3 litres/second per person, with a sufficient exposure period. The international standard ASHRAE 62.1 – requires at least 5 liters of air per second per person (or per cubic meter of space). In fact, a 2008 WHO guideline refers to a desired 10 l/s per person for office spaces, for effective infection prevention. That works out to about 36 air exchanges per hour for 1 cubic meter of space. Professor Li:

“Airborne transmission of Covid-19 outbreak in the indoor environment is likely when the ventilation rate is less than 3 L/s per person, with a sufficient exposure period.”

airborne transmissions.jpgPoor ventilation increases the infective range of SARS-CoV-2 virus particles

Mechanistic Airflow Models 

During the SARS epidemic of 2003, Professor Li and a group of mechanical engineering experts at HKU developed an advanced mechanistic airflow model with computational fluid dynamics simulations and detailed thermo-fluid analyses to track and explain the main infection patterns and characteristics of the SARS outbreak at Amoy Gardens and at Ward 8A of Princess of Wales Hospital, where poor ventilation was widely attributed to broader airborne transmission of the virus. Based on these models, they studied the actual data and air flow dynamics from the ventilation sytems in the more recent Covid-19 cases, to reach their conclusions.

Solutions To Airborne Infections

As the major culprit is opportunistic airborne that occur in poorly ventilated areas, the most effective interventions prevent the opportunistic transmission of the virus through effective ventilation and filtration control, the authors conclude:

  • Enhance air ventilation in indoor environments, particularly in restaurants, public transport, bars, gyms, etc.
  • Ensure even higher ventilation rates for more strenuous indoor activities. Avoid social gatherings in an indoor environment where sufficient ventilation is not provided.
  • Install Carbon Dioxide (CO2) sensors as a “proxy” measure of ventilation quality. While not a perfect indicator, a concentration of over 1,000 parts per million (ppm) may indicate that the room is not sufficiently ventilated.
  • Hand hygiene and social distancing remain critical, with the use of masks in indoor spaces as essential barrier measures (handled with clean hands when putting it on and taking it off).

Improved Filtering of Recirculated Air

To ensure effective ventilation, air conditioning systems must include high quality HEPA filters or equivalent portable filtering technologies to capture and prevent the recirculation of viral particles indoors, added Harvard University Professor Joseph Allen, at a university webinar on the ventilation issue on Tuesday.

“Air conditioning in itself is not the [only] problem”, said Allen, founder of the Healthy Buildings Program at the Harvard Chan School of Public Health. “You [also] want to…filter out any recirculated air.”

Another oft-ignored factor in virus travel behaviour is humidity, Allen observed. He noted that viral respiratory droplets are more likely to evaporate into smaller aerosol particles that travel further in the air when the humidity is below 40%. At humidity levels above above 40%, virus particles are more likely to drop to the ground because the air is already saturated with water.

“Less evaporation of droplets [means they will] settle out of the air quicker. It’ll be a heavier, bigger aerosol”, he added. “If it’s drier, you get a higher likelihood of droplet nuclei which can stay airborne for longer periods of time.”

WHO Response

In 2008, WHO published formal guidelines on “Natural ventilation in health care settings” which discussed the fundamental relationship between ventilation and infection transmission in indoor spaces. Annex C, based on a WHO systematic review, talks about the potential of respiratory droplets to become suspended in the air as “respiratory nuclei” in poorly ventilated spaces. Annex D of these guidelines refers to a desired ventilation standard for office buildings, stating:

“In an office, we need a 10 l/s per person ventilation rate.”

Current WHO guidance about Covid-19 management in community settings does not, however, relate to ventilation issues. A WHO spokesperson said WHO had no comment about the Hong Kong study, but conceded that the ways in which poor ventilation may exacerbate virus transmission needs more systematic review:

“Outside of healthcare settings, some outbreak reports suggest the possibility of airborne transmission in indoor crowded spaces with poor ventilation. WHO calls for more systematic research of these kind of settings/outbreaks so we can have more definitive answers, and is activating the R&D Blueprint to accelerate research in this area.”

Svĕt Lustig Vijay contributed to this story.

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Republished from Geneva Solutions. Health Policy Watch is partnering with Geneva Solutions, a new non-profit journalistic platform dedicated to covering Genève internationale. In the midst of the Coronavirus pandemic, a special news stream is published at heidi.news/geneva-solutions, providing insights into how the institutions and people in Geneva are responding to this crisis. The full Geneva Solutions platform and its daily newsletter will launch in August 2020. Follow @genevasolutions on Twitter for the latest news updates.

Image Credits: Hong Kong University.

Schools could spawn COVID-19 outbreaks as children can also transmit the coronavirus.

In past decades, Europe has achieved one of the world’s highest water and sanitation coverages, but it is often forgotten that one in ten schools in the 53 countries of WHO’s European region still lack basic hand washing facilities, leaving some 5 million pupils without access to soap and clean water.

All in all, some 31 million Europeans lack access to basic sanitation, even in the form of a latrine, and 16 million lack access to basic drinking-water services that also enable hygiene – mostly in Eastern Europe, Central Asia and the Caucasus.

As students begin filling up schools in attempts to return to the ‘new normal’, these worrying gaps in Europe have potential to spur more Covid-19 outbreaks and to fuel existing inequalities, warned Marta Vargha from Hungary’s National Institute for Environmental Health, at a recent webinar hosted by Geneva Environment Dialogues.

Last Friday, Vargha’s warnings became even more relevant as a South Korean study of 65,000 people showed children between the ages of 10 and 19 can also spread the coronavirus, strengthening the case for improved water and sanitation coverage in all settings – including schools.

“[The] South Korea study means we can’t assume older kids won’t transmit”, said Director of Harvard’s Global Health Institute Ashish Jha, referring to the study by the South Korea’s Centers for Disease Control and Prevention. “Opening schools will need us to focus on suppressing virus transmission”.

As a result of inadequate water, sanitation, hygiene and health (WASH) services, 14 people die every day from diarrhoeal diseases in the WHO European Region.

And within European countries, services are unevenly distributed. In some cases, there is a four-fold difference between urban and rural settings in access to drinking-water and sanitation services, said a WHO spokesperson to Health Policy Watch.

But the burden of water-related disease is most significant outside of Europe, as about 90% of diarrhoeal deaths occur in south Asia and sub-Saharan Africa, acccording to the Global Burden of Disease 2016 Study.

Access to Safe Water – First Line of Defense Against COVID-19

Access to safe water is the first line of defense against the new coronavirus, and is the “primary tool” to prevent infection from any disease-causing organism, emphasized Vargha at a webinar hosted by Geneva Environment Dialogues last month:

“Under the current pandemic, to be really efficient in prevention, safe [water] should be accessible not only at home, but also wherever we go, including schools, healthcare facilities, in workplaces and public settings” like public transport facilities.

A Thirst For Data

The European region lacks basic data on water and hygiene services.

Europe’s nations cannot expand access to safe water to protect against the new coronavirus without reliable data.

Currently, basic data on water, sanitation, hygiene and health (WASH) services remains “limited” in some European countries, especially in healthcare settings and households, said Vargha.

Large regional disparities are also hidden behind national averages in “almost every country”, owing to the fact that basic WASH indicators have not been embedded into national monitoring.

The Protocol on Water and Health – A Unique International Legal Agreement In Europe 

While the problem of water, sanitation and hygiene in schools and other public buildings remains serious, Europe is still better placed than most regions of the world to address it, as 27 countries in the region are signatories to the 2005 Protocol on Water and Health.

Co-administered by the United Nations Economic Commission for Europe (UNECE) and the WHO Regional Office for Europe, the Protocol is the “only” international legal agreement of its kind that links oft-siloed sectors together – sustainable water management and prevention to control and reduction of water-related diseases, said Natalyia Nikiforova, Environmental Affairs Officer for the United Nations Economic Commission for Europe (UNECE), who also spoke at last month’s panel.

The Protocol helps countries set national targets on water sanitation, hygiene and health (WASH) based on their needs – and ensures “long-standing commitments” because they must report progress at national and international levels every three years.

In contrast to other legally binding agreements – like the WHO’s International Health Regulations (IHRs) or its Framework Convention on Tobacco Control (FCTC) –  the protocol’s compliance committee is a ‘very interesting’ alternative because it does not force Parties to comply, said Co-Secretary for the Protocol on Water and Health Oliver Schmoll. Instead, it achieves effective implementation through a “non-confrontational” and “facilitative” framework:

“The consultation mechanism is not a very hard instrument”, explained Nikiforova. “But it’s a very smart instrument to work with countries in order to facilitate implementation in a non-confrontational way through a consultative process, and thereby ensuring implementation.“

In total, twelve countries have already undertaken a self-assessment to address disparities in their populations, especially in rural settings, said Vargha.

In the Republic of Moldova, the self-assessment brought safe drinking water to some 67,000 villagers in rural areas through new infrastructure initiatives. Meanwhile, other countries like France, Portugal, Hungary, Ukraine and Armenia, have amended national legislation to fill gaps in WASH services, each in different ways.

Hungary has improved minimum standards for water safety, while Portugal and France have cheapened the cost of drinking water. And Armenia has incorporated a definition of marginalized groups in their Water Code, ensuring that legislation caters to the most vulnerable. 

Expanding The Protocol To Other Regions 

At the moment, protocol membership is exclusive to the 53 Member States in the pan-European region. However, it is Africa, Asia and slabs of Central and Latin America where WASH services are most needed.

Sanitation facilities are mostly needed outside Europe.

Around the world, some 2 billion people lack access to basic sanitation facilities, and one billion people in 149 countries suffer from neglected tropical diseases, which thrive in areas that lack basic sanitation. Most of these are outside Europe.

In light of unmet needs around the world, it “would make sense” for the Protocol to “open up” to other regions, said Nikiforova, although there is currently no road map for doing so.

Before the Protocol can expand, 26 additional European member states would need to ratify the Protocol first, and “considerable political will” is going to be necessary, added Nikiforova, as she referred to the fact that only 27 out of the 53 Member States in the Region have ratified the Protocol.

27 out of 53 Member States have officially ratified the Protocol on Water and Health

Image Credits: Source: Allison Shelley/The Verbatim Agency for American Education, Martha Vargha, Deep Knowledge Group.

Credit: Jernej Furman

In the largest and perhaps most robust peer-reviewed study to date, A COVID-19 vaccine candidate developed by pharma giant AstraZeneca and Oxford University has been shown to induce strong antibody and T cell responses in healthy volunteers, according to Phase 1/2 trial results published in The Lancet on Monday.

Most studies so far have focused on measuring the level of neutralizing antibodies, or antibodies that can bind to the virus in the blood to prevent it from attacking human cells. However, the Oxford/AstraZeneca vaccine was also able to to induce another type of immune response in a subset of 43 healthy volunteers within 14 days of vaccine – a T-cell response, which is another specialized immune response that can attack cells infected with the virus.

“The immune system has two ways of finding and attacking pathogens – antibody and T cell responses. This vaccine is intended to induce both, so it can attack the virus when it’s circulating in the body, as well as attacking infected cells,” said study lead author and Oxford professor Andrew Pollard in a press release. “We hope this means the immune system will remember the virus, so that our vaccine will protect people for an extended period.”

However, “there is still much work to be done before we can confirm if our vaccine will help manage the COVID-19 pandemic, but these early results hold promise,” added co-author on the study and Oxford professor, Sarah Gilbert.

WHO Health Emergencies Executive Director Mike Ryan shared the same sentiment.

“This is a positive result but again there’s a long way to go. These are Phase I studies; we now need to move into larger scale real world trials, but it is good to see more data,” Ryan told reporters on Monday.

The Oxford/AstraZeneca group tested their vaccine in 1,077 healthy volunteers, making the trial many times larger that of Moderna, which tested their vaccine candidates in only 45 healthy volunteers in Phase I trials. Moderna’s vaccine candidate, developed in collaboration with the US National Institute of Allergies and Infectious Diseases, was the first to have Phase I results released in a peer reviewed journal.

A third COVID-19 vaccine candidate, developed by Chinese biopharma company CanSino Biologics Inc. and the Chinese Academy of Military Sciences, was also able to induce an immune response in a Phase 2 trial that enrolled over 500 healthy volunteers, according to results published in The Lancet on Monday.

However, researchers have previously expressed concerns about the Ad5 vector, the technology used to carry the vaccine, in the CanSino candidate. HIV vaccine candidates using the Ad5 vector had inadvertently increased the risk of HIV infection in previous trials, and it is unknown whether the CanSino COVID-19 vaccine may have similar effects.

While early Phase clinical trail results have shown to be able to induce an immune response in healthy volunteers, it’s still too early to tell whether that immune response will protect against coronavirus infection or disease.

All three vaccine candidates are preparing to enter the final and largest phase of the vaccine testing process, Phase III clinical trials. These massive trials will enroll tens of thousands of volunteers in all age groups in order to test whether the vaccines can protect against infection by the virus and symptomatic COVID-19 disease.

AstraZeneca/Oxford Vaccine Candidate Set to Move Into Multi-Country Phase III Trials

Colorized electron microscope image of SARS-CoV-2, the virus that causes COVID-19

While the Phase 1/2 trial is ongoing, the AstraZeneca/Oxford vaccine, ChAdOx1, will move into further Phase 2 and Phase 3 trials. AstraZeneca has already ordered 100 million doses to be produced by the Serum Institute of India, a major developing world biopharma company and generics producer, for Phase 3 trials.

Volunteers are currently being enrolled in the UK, Brazil, and South Africa, making this the first vaccine candidate to be tested on the African continent.

The authors further noted that the Phase III trial will focus on observing the vaccine in a wider demographic, including those at higher risk of COVID-19 infection or death such as older people, ethnic minorities or marginalized people, people with preexisting health conditions, and healthcare workers. Participants in the earlier Phase 1/2 trial were mostly likely to be young and Caucasian – some 91% of study subjects were white and the average age of participants was 35 years.

None of the participants reported serious adverse reactions to the vaccine. Around 70% of the participants who received ChAdOx1 reported mild adverse side effects such as fatigue and headache, compared to 48% in those who received the placebo meningitis vaccine.

Participants who took paracetamol, a pain common pain medication, at the time of injection had a reduced likelihood of experiencing adverse side effects. Paracetamol had no effect on the immune response generated by the vaccine.

WHO Experts Urge Countries To Step Up Contact Tracing Rather Than Waiting For Vaccine

WHO Assistant Director-General of Emergency Response, Ibrahima Socé Fall

Still, WHO experts on Monday warned against waiting for an effective vaccine to stem the tide of the pandemic, urging countries to step up contact tracing efforts.

“We do not have to wait for a vaccine. We have to save lives now,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Contact tracing has long been the bedrock of outbreak response from smallpox to polio to Ebola, and now COVID-19.”

“If we look at viruses that are much more fatal than COVID-19, we were able manage and master these epidemics by regularly following [contacts] with high level efficiency,” said WHO Assistant Director-General of Emergency Response, Ibrahima Socé Fall. The 2014-2016 Ebola outbreak in West Africa for example, was largely managed and quashed through contact tracing, before a vaccine was available.

Investing in contact tracing now is even more important, considering “many countries were not very well prepared for contact tracing” at the beginning of the pandemic, according to Fall.

“Developed countries have surveillance systems centered on hospitals, but by the time the patients arrive it’s too late. They’ve already contaminated others in the community,” said Fall.

“Nothing replaces boots on the ground,”  said Dr Tedros. “[Countries must] train workers to go door to door to find cases and contacts, and break the chains of transmission.”

Image Credits: Flickr: Jernej Furman, National Institute of Allergy and Infectious Diseases, NIH.