Increasingly Brutal Attacks on Civilians by Islamist Rebels Take Toll on Mental Health in DR Congo 22/02/2023 Claude Muhindo Sengenya via The New Humanitarian The town of Beni in the DRC has been the scene of a number of ADF massacres. “We have never experienced such killings,” says an aid work as local health centres struggle to help survivors deal with mental health problems in the aftermath of increasingly brutal attacks by the Islamic rebel group, Allied Democratic Forces. Of the more than 100 armed groups active in DRC’s eastern provinces, one of the oldest and most violent is the Allied Democratic Forces (ADF), a militant movement of Ugandan origins that has pledged allegiance to the so-called Islamic State (IS). With the spotlight on the M23 – which is backed by Rwanda and has seized large chunks of territory in the east – The New Humanitarian spent time speaking with survivors of ADF atrocities and health workers addressing the conflict’s fallout. “I have been supporting displaced people of different wars for 20 years… [but] the ADF massacres have become serious and we have never experienced such killings,” said Marie-Jeanne Masika, who works for a local NGO helping conflict victims. Interviewees said recent measures taken to combat the ADF – from a joint Uganda-DRC military intervention to the introduction of martial law – have failed to improve security for civilians. Instead, the militants have expanded geographically, carrying out massacres, abductions, and bombings in urban areas that have struck targets including a government building, a cinema, and a church in recent months. Those affected by the long-running violence – which centres on North Kivu and Ituri provinces – raised warnings of a rising mental health toll. Yet local health workers said there is an absence of support for those needing psychosocial services. “Today, we must no longer reduce humanitarian assistance to the sole distribution of provisions… to victims,” said Masika. “A big problem also remains psychosocial care to avoid having mental illnesses in the future.” ‘We are in so much pain’ The ADF was formed in 1995 after members fled to DRC amid military pressure in Uganda. It has its roots in the repression of Ugandan Muslims, though its complex history and modus operandi is obscured by narratives that focus solely on its Islamist orientation. Military operations, including by UN peacekeepers, are frequently launched against the group. Yet they often result in ADF reprisal attacks designed to punish civilians who support the army and pressure the government to end offensives. Recent ADF raids have sought to undermine support for Uganda’s operations. That mission – which may be guided by economic interests rather than security concerns – was launched after IS claimed a triple suicide bombing in Kampala in late 2021. A meeting of displaced people who had fled recent ADF massacres healed at a cathedral in Butembo, a town in North Kivu, earlier this month, highlighted the suffering caused by the conflict. Kavugho Sikiliza, 42, said she had lost four of her relatives, including her son and daughter-in-law, in an ADF attack in Bashu chiefdom – in the North Kivu territory of Beni – last September. “We suffer so much. We have abandoned our fields and we no longer find anything to eat,” Kavugho said. “Today, we are spending the night in the bush; we have orphans who are struggling to [eat].” Next to Kavugho sat Yoha Nyasavo Bibiche. Six months ago, she saw her son killed by ADF rebels in Mungamba, in Ituri province. She is now living in Butembo but was recently forced out of her house there because she couldn’t afford rent. “As we were about to harvest, the ADF attacked the village and stabbed my son, who is dead,” said Bibiche. “We no longer have a home. Eating, dressing – it has become a headache.” Mental health toll The cumulative impact of attacks – which have killed thousands over the past decade – has led to serious mental health challenges, according to survivors and medical staff from three psychiatric centres in Beni and Butembo. Esdras Pika, a psychologist at a health centre in Butembo, said his clinic treats survivors of ADF killings, kidnap victims, and farmers and traders struggling to cope with the loss of their livelihoods. “Before 2015, the reasons that led patients to be admitted to mental healthcare here were often drug abuse [and] cases of romantic disappointment,” Pika said. “But today, most of the patients who come to us are victims of insecurity.” Kakule Kisonia, from Beni territory, said his brother went to the local Muyisa psychiatric centre after witnessing a recent ADF attack that cost the lives of his wife, sister, and two of his children. Kisonia said his brother’s behaviour changed after the attack. “Every night he shouted: Ba Nalu! Ba Nalu! [a reference to the ADF in Swahili],” Kisonia said. “Each time a neighbour came, he shouted that it was the ADF, and did not hesitate to take either a wooden stick or a machete to attack the visitors.” More support is needed Medical staff from the health centres said they receive around 30 patients per month who are victims of ADF attacks. Yet the staff said their clinics receive no support from the state or from aid organisations, and that patients must self-finance their treatment. “Most of the victims are in a state of serious vulnerability, but we too are private, unsubsidised structures,” said Pika from the Butembo clinic. “We have to buy the drugs, pay the state taxes, and pay our nursing staff. We have no choice.” Marie-Jeanne Masika, the local NGO worker, said some displaced families have come to her organisation presenting bills of more than $300 issued by health centres for psychiatric support. “It is too much for the victims, who have lost everything in the attacks, and these kinds of bills trouble them rather than relieve them,” said Masika, whose organisation is called Social Integration for the Promotion of the Needy (ISPRON). Mumbere Nyerere, an ADF victim who is receiving therapy, said paying for care represents a “big difficulty”. “I am the father of the family. Those who finance my care are my parents, older than me. It is I who should assist them,” Nyerere said. As attacks continue, Masika called for the government to subsidise clinics providing mental health support and said occupational therapy should be rolled out in villages to “tackle the problem at the base”. Georges Machokuona, a psychosocial worker in Butembo, said livelihood support is needed too: “Once they have returned home, most of those cured are faced with challenges… linked to survival, which led some to fall ill again.” This story was originally published by The New Humanitarian, which puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world. Image Credits: Robert Flummerfelt/ TNH, The New Humanitarian. Ukraine Gets New Emergency Funds for HIV and TB Programmes 21/02/2023 Kerry Cullinan Alliance Global’s Andrii C shelters in the NGO’s basement in Lviv and waits for air raid sirens to finish. The organisation is helping to get treatment to people living with HIV. On the eve of the first anniversary of Russia’s invasion of Ukraine, the Global Fund to Fight AIDS, Tuberculosis and Malaria has approved an additional $10.32 million in emergency funding to maintain essential HIV and tuberculosis (TB) services in Ukraine. The funds are earmarked for HIV and TB treatment, prevention and care, including for internally displaced persons and hard-to-reach communities. Since the start of the war, more than 13.5 million people have been internally displaced or forced to flee to neighbouring countries as refugees. “If displaced people don’t get the medicines they need, there is a high risk that they will actually die because of the lack of therapy,” said Dmytro Sherembei, head of 100% LIFE, a Global Fund-supported nongovernmental organization delivering HIV medications in war-affected Ukraine. In the past year, the Global Fund has allocated $25.32 million in emergency funds in addition to $119.48 million allocated to Ukraine to support the fight against HIV and TB in the country over the 2021-2023 period. Ukraine has the second-largest HIV epidemic in Eastern Europe and Central Asia, and a high burden of TB, including drug-resistant TB, according to the Global Fund in a statement on Tuesday. “Both HIV and TB require long-term treatment to reduce the risk of transmission and both diseases have the best outcome with early diagnosis. As people escape the fighting, they often lose access to health care and their medications. HIV and TB prevention and diagnosis services have also been significantly disrupted.” Needs more desperate “As the war rages on, the needs in the country are getting more severe and urgent,” said Peter Sands, the Global Fund’s Executive Director. “Damage and destruction to water, electricity and sanitation facilities, health facilities, as well as road and residential infrastructure continue to be reported across multiple areas throughout the country. The additional emergency funding that we are unlocking today is intended to support the government in filling the significant financing gaps across critical HIV and TB interventions. We will continue to monitor the situation closely.” The World Health Organization (WHO) reports that over 1,200 health facilities in the country have been attacked, and 170 of these facilities have been destroyed, leaving healthcare workers and patients displaced, injured or dead. “It’s been a year since the Russian Federation’s invasion of Ukraine, and today, the fighting and deadly missile strikes continue, bringing more destruction and devastating impact in several oblasts of the country,” said Minister of Health of Ukraine Viktor Liashko. “Despite the crisis and challenges, Ukraine’s HIV and TB programs sustained operations. The Global Fund’s investments through the emergency funding, on top of the ongoing grant, have proven invaluable, especially as health facilities have been damaged or destroyed and people continue to be displaced, causing them to lose access to health care, including treatment for HIV and TB.” Over the last 20 years, Ukraine has been a champion in maintaining long-term and innovative HIV and TB programs, according to the Global Fund. More than 100 community-based and community-led organizations have been delivering HIV and TB services to vulnerable people. Image Credits: Global Fund. Scientists Launch R&D Plan to Develop Broad Vaccine for Coronaviruses 21/02/2023 Kerry Cullinan SARS-Co-V2. Fifty influential scientists have developed a coronavirus vaccines research and development (R&D) roadmap aimed at developing broadly protective vaccines to combat fast-evolving coronaviruses threatening humans. “The COVID-19 pandemic marks the third time in just 20 years that a coronavirus has emerged to cause a public health crisis,” said Professor Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP). “Rather than waiting for a fourth coronavirus to emerge — or for the arrival of an especially dangerous SARS-CoV-2 variant — we must act now to develop better, longer-lasting and more broadly protective vaccines,” added Osterholm, whose centre spearheaded the development of the roadmap that was unveiled on Tuesday. CIDRAP unveils roadmap for advancing better coronavirus vaccines The roadmap provides a detailed a strategy to develop broadly protective vaccines—suitable for wide use—to tackle future #COVID19 variants and other worrisome coronaviruseshttps://t.co/yfv7nb5Jnq pic.twitter.com/mQBonJneZc — CIDRAP (@CIDRAP) February 21, 2023 The roadmap sets out steps to accelerate the development of broadly effective coronavirus vaccines capable of preventing severe disease and death that are suitable for all regions worldwide. New SARS-CoV-2 variants pose the most immediate threat and could evolve until they evade the protection of current vaccines. But the bigger fear is the emergence of a super-coronavirus that has the transmissibility of SARSCoV-2 combined with the deadliness of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS-CoV spilled over from camels to humans in 2012 and kills about a third of the people it infects. To head off such a threat, the roadmap proposes a number of approaches. One could involve a stepwise process, starting with vaccines to protect against SARS-CoV-2 variants. As knowledge about coronaviruses expands, it may be possible to develop vaccines that are capable of protecting against multiple types of coronaviruses, including those likely to spill over from animals to humans in the future. “It is critical that we start now to develop vaccines that are future-ready for coronaviruses circulating in animals now, that might infect humans and cause pandemics in the future as SARS-CoV-3 and beyond,” said Professor Linfa Wang, executive director of Singapore’s Programme for Research in Epidemic Preparedness and Response (PREPARE). Wang, who was part of the team that developed the roadmap, also said that the work was daunting: “The coronavirus diversity in bats is so great that we even don’t know how much we really know about them.” Five work areas The roadmap proposes five areas of work: Virology: learning more about the global distribution of coronaviruses circulating in animal reservoirs that have the potential to spill over to humans. Immunology: learning more about human immunology to expand the breadth and durability of immune protection from vaccines and natural infection. This includes a better understanding of mucosal immunity, which may unlock new strategies to block infection such as nasal sprays. Vaccinology: identifying key preferred product characteristics for vaccines, including new technologies and identifying the best methods to assess vaccine efficacy. Animal and human infection models for vaccine research: expanding the range of suitable animal models, which is a key barrier to developing broadly protective coronavirus vaccines. Policy and financing: reinvigorating and sustaining a high level of political commitment and long-term investment in vaccine R&D and manufacturing to ensure the successful development and global distribution of broadly protective coronavirus vaccines. While praising the current COVID-19 vaccines, Wellcome Trust’s Dr Charlie Weller, said the roadmap would research “new ways to deliver vaccines, such as skin patches or intranasal vaccines – and maybe even vaccines that could block transmission”. Constant mutation “Coronaviruses such as SARS-CoV-2 are constantly mutating. With every infection, there is an interplay among host characteristics, past infection, and vaccination – each exerting further pressures on the virus to evolve and acquire further reproductive and fitness advantages,” wrote Dr Margaret Hamburg, former Food and Drug Administration (FDA) commissioner, and Dr Gregory Poland, from the Mayo Clinic’s Vaccine Research Group in the US in a commentary published in the journal, Vaccine. “As a consequence, we are chasing continually evolving viral opponents, leaving the global community in a reactive rather than proactive position in regard to vaccines, therapeutics, and public health policies.” They warn that the global community cannot afford “to play reactive catch up continuously, chasing the latest variant”, or expect people to get vaccinated several times a year. However, Hamburg and Poland added that the roadmap also needs “a governance or administrative structure” to better coordinate vaccine R&D and track progress –and accountability – on the goals and milestones that will further facilitate and accelerate this process. They point to the “siloed” activities by governments, industry and researchers, and how the roadmap can “build bridges between these various sectors” to reduce barriers and duplication, and improve efficiencies. Image Credits: Johnson&Johnson. Natural Immunity Against COVID-19 ‘At Least’ On Par With Vaccination in Preventing Death 21/02/2023 Stefan Anderson Natural immunity provides strong protection against severe illness from COVID-19, but obtaining it carries its own set of risks. New research published in The Lancet suggests that individuals who have previously been infected with COVID-19 have an 88% lower risk of hospitalization or death than those who have not. The study is the most comprehensive review of data on natural immunity to date, covering data from 65 studies across 19 countries published since January 2021. The analysis found that the strength and 10-month duration of protection conferred by natural immunity against severe illness is “at least” on par with that provided by two doses of Moderna and Pfizer-BioNtech’s mRNA vaccines. The study’s authors said the data suggests natural immunity in people recently infected with COVID-19 should be recognised by policymakers but warned against using their findings to undermine the importance of vaccination due to the risks associated with the first infection. “Vaccination is the safest way to acquire immunity, whereas acquiring natural immunity must be weighed against the risks of severe illness and death associated with the initial infection,” lead author Dr Stephen Lim of the University of Washington’s School of Medicine. Researchers also cautioned that differences between the infectious properties of COVID-19 variants mean protection levels can vary. Infection by pre-Omicron variants, for example, yielded substantially lower natural immunity protection against reinfection by the now dominant Omicron BA.1 variant, with just 36% protection remaining after the 10-month window. Nevertheless, protection against hospitalization and death remained high at 88%. “The weaker cross-variant immunity with the Omicron variant and its sub-lineages reflects the mutations they have that make them escape built-up immunity more easily than other variants,” report co-author Dr Hasan Nassereldine of the University of Washington’s School of Medicine said. “The limited data we have on natural immunity protection from the Omicron variant and its sub-lineages underscores the importance of continued assessment, particularly since they are estimated to have infected 46% of the global population between November 2021 and June 2022.” The analysis excluded studies examining “hybrid immunity” (the combination of immune responses from vaccination and natural infection) as well as data relating to Omicron XBB and its sub-lineages. The authors encouraged further research to fill the gaps in the study. Europeans Don’t Exercise Enough – And Policy-Makers Should Do More to Encourage Them 17/02/2023 Kerry Cullinan A third of Europeans don’t meet the World Health Organization’s (WHO) guidelines for physical activity – but if they did, this would avert over 10 000 premature deaths, almost four million cases of cardiovascular disease, three and a half million cases of depression and nearly a million cases of type two diabetes by 2050. This is according to a report launched on Friday by the WHO Europe and the Organisation for Economic Co-operation and Development (OECD), which urges policy-makers to adopt strategies to increase people’s physical activity. The findings are based on a recent Eurobarometer survey conducted for the European Commission which found that 45% of the respondents report that they never exercise or play sport, an increase of 6% since 2009. People in Finland (71%), Luxembourg (63%), the Netherlands (60%), and Denmark and Sweden (both 59%) were the most likely to exercise, while people in Portugal, Greece and Poland were least likely to exercise. “We find that it’s worse among women, with some countries having almost half of all adult women not meeting the WHO recommended guidelines on physical activity,” OECD health policy analyst Sabine Vuik told the launch on Friday. Meanwhile, less than a quarter of people who consider themselves to be working class exercise at least once a week, and over half of all adults surveyed said that they exercised less frequently since the COVID-19 pandemic. Recommended activity The WHO recommends that everyone does at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity every week. “This could be a half-hour run twice a week, running about 10 kilometres per hour, but it doesn’t need to be formal exercise. It can also be walking the dog every day for half an hour,” added Vuik. OECD health analyst Sabine Vuik “Our analysis shows that larger countries such as Germany, France and Italy can save more than €1 billion every year if everyone were to meet the physical activity guidelines. And across the EU, we could save €8 billion every year in healthcare expenditure if everyone meets the minimum recommended guidelines.” WHO Europe regional director Dr Hans Kluge, said that the report “provides evidence that investing in policies that promote physical activity not only improves individual well-being and population health, but also pays economic dividends”. “Every €1 invested in physical activity generates an almost two-fold return of €1.7 in economic benefits. We need to communicate the benefits of being active, not just the physical benefits, but the benefits to mental health, the environment and society in the WHO European Region, and we need to make sure that our systems can and will sustain these changes – as real, long-term transformation,” added Kluge, who is an avid cyclist and cycles to work and back daily. The report calls on policymakers to step up the policy response to increase physical activity in schools, in urban and transport design and in healthcare settings and workplaces. Since 2015, some EU countries have adopted policies to improve access to physical activity. For example, Finland adopted a resolution to promote active modes of transportation, Austria builds up co-operation between sports clubs and primary schools and Bulgaria develops a programme to help people whose jobs involve sitting for long periods. Investing in #PhysicalActivity improves individual and population health, while returning 1.7 EUR in economic benefits for every 1 EUR invested. New WHO/@OECD report funded by the #EU shares great ideas for policy makers to consider.👇https://t.co/Ri3xynx9bv@EU_Commission pic.twitter.com/A28qBknwiQ — WHO/Europe (@WHO_Europe) February 17, 2023 Lack of Test Kits for Marburg Virus Hamper Africa’s Response to Outbreak 16/02/2023 Paul Adepoju Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control. The Africa Centres for Disease Control and Prevention (Africa CDC) is closely monitoring Equatorial Guinea’s first-ever Marburg virus disease outbreak, Africa CDC acting director Dr Ahmed Ogwell Ouma told a media briefing on Thursday “One big challenge we have are test kits and we are working around the clock to try and get test kits to Equatorial Guinea and also to Cameroon and Gabon, to ensure that we have a very short turnaround time for samples being tested in the laboratory,” Ouma added. So far, one case has been confirmed and nine deaths have been reported, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. Ouma added that a key priority is to limit the spread of the virus, as well as monitor neighbouring countries such as Cameroon and Gabon for potential cross-border spillover. As reported by Health Policy Watch, on Tuesday, the WHO received updates from five vaccine developers who have been working on candidate vaccines. The WHO plans to convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. Diphtheria, cholera, mpox, Lassa fever, and measles are some of the other health emergencies that African countries are also grappling with, alongside COVID-19, and Ouma, a Kenyan epidemiologist, said that his center is currently monitoring up to nine different public health events. Nigeria reported over 600 new cases of diphtheria and several African countries reported cases of cholera, including Malawi, where three-quarters of the continent’s cases have been reported. The continent has documented over 12 million cases of COVID-19 and 256,705 deaths, a case fatality rate of 2.1%, which is double the global average, Ouma told the media. While the number of new cases and deaths have decreased over the past several weeks, he emphasized the importance of continuing to encourage vaccination efforts and targeted campaigns to reach more people. “The general trend on the continent now is quite flat with the indications that we may be seeing further decreases in numbers and also in deaths,” Ouma told journalists. Ouma noted that Africa CDC is working with governments and health organizations to provide technical assistance and medical countermeasures as needed for these and other health emergencies. He added that the organization is also continuing to promote vaccination efforts and targeted campaigns to help prevent the spread of infectious diseases. Draft Pandemic Accord Neglects Prevention, Particularly ‘Zoonotic Spillover’ 15/02/2023 Kerry Cullinan INB co-chair Roland Driece The draft pandemic accord needs more emphasis on preventing pandemics at their source – where animal pathogens “spill over” to people – according to a number of organisations participating in a consultation on the document’s “zero draft” on Wednesday. Negotiations between World Health Organization (WHO) member states on the draft are due to begin at the fourth meeting of the Intergovernmental Negotiating Body (INB), scheduled to take place from 27 February to 3 March. However, Wednesday’s meeting gave WHO’s civil society stakeholders an opportunity to comment on the draft ahead of that meeting. Only member states will take part in the actual treaty negotiations, which are likely to start behind closed doors on the second day of the month-end meeting (called INB 4), INB co-chair Roland Driece told the meeting. INB 4 and the following INB5 meeting from 3 to 6 April would be approached as “one big meeting”, he added. While the start of the meeting would be open to all stakeholders, “as soon as member states tell us that they accept the zero draft as the zero draft, we will move into negotiation mode, and that means that only member states can be present,” said Driece. “So that’s why it’s so important that you tell us and member states now what you feel and think about this zero draft.” He added that he thought that the INB Bureau had done “a pretty decent job [of synthesizing stakeholders’ inputs]” but “this is an important moment for you all to share whether or not you share my optimism about that and tell us what you think is important”. Prevent ‘zoonotic spillover’ – environmental and animal health groups Across large swathes of Asia and Africa, wholesale markets often sell wild animals captured or bred for food consumption, and which may harbor dangerous viruses. Many scientists believe that SARS-CoV2 was transmitted to humans via live, wild animals, caged for slaughter in Wuhan’s wet market. An unprecedented number of organisations spoke about how the draft needs to pay more attention to pandemic prevention at the source; this means addressing the social, environmental and food safety factors that lead to the spillover of pathogens from wild animal populations into human communities. These drivers range from deforestation which has prompted animal populations like bats, which harbor a range of deadly pathogens from SARS-COV to Marburg, to move closer to human habitats; to wild animal trafficking and trade, both legal and illicit; as well as industrial production, sale and slaugher of wild animal species. The Wildlife Conservation Society recommended that the accord commit governments to “identifying and prioritising actions to prevent pathogen spillover in the first place” by prioritising tougher regulations on “markets and trade chains and wildlife domestic and international trade”. “We have extensive experience and expertise with habitat degredation, deforestation, forest degradation, wildlife trade and wildlife markets,” said the WCS representative. “And this isn’t about illegal trade, its about any live trade, particularly for food but also for other purposes, birds and mammals. We look forward to working with member states and the INB to ensure that first and foremost there are commitments by governments to avoid the spillover in the first place. And we do know how to do that, from a biodiversity perspective and in terms of markets.” The World Wildlife Fund (WWF) appealed for the “list of drivers of pathogen emergence risks to be expanded to include not just deforestation, but ecosystem loss, fragmentation and degradation”. “Deforestation alone omits many of the potentially important pandemic frontiers and ignores the role of fragmentation and degradation in increasing proximity between humans and wildlife,” said the WWF. Meanwhile, the World Organisation of Animal Health (WOAH) called for the inclusion of the full definition of “One Health” in the treaty. Its delegate also questioned why preparedness and response were stressed whereas “preventive actions targeting activities and places that increase the risk of zoonotic spillover” were not. Pointing to a lack of expertise to address zoonotic spillover, the Action for Animal Health Coalition said that member states needed to invest in increasing the animal health workforce. Equity obligations Oxfam’s Piotr Kolczynski, who also represented the People’s Vaccine Alliance. Meanwhile, Oxfam, also representing the People’s Vaccine Alliance, said that “the accord’s language must oblige governments to take specific actions to ensure equity; otherwise it would be very difficult to implement this”. The current zero draft also assumes that “critical public health interventions are based on the willingness of pharmaceutical companies to engage in voluntary mechanisms” but “these have proved to be largely insufficient during the current and previous pandemics,” said Piotr Kolczynski, of Oxfam and PVA. For this reason, it added, “the accord must require governments to invest in research and development and manufacturing capacities and to condition public funding on the sharing of technologies, knowledge and intellectual property with developers and manufacturers in the South”. In reference to the accord’s proposal that 20% of pandemic-related goods be allocated to the WHO for distribution, Oxfam stated that “equitable allocation of medical countermeasures cannot be achieved by reserving a 20% of production for 80% of the world’s population”. Medecins sans Frontieres (MSF), meanwhile, asked for a legal definition of “pandemic”, and “explicit reference to governments complying with international humanitarian law obligations in the context of pandemic preparedness, prevention and response”. It also demanded stronger language in relation to commitments to protect “humanitarian populations of concerns” and healthcare workers during pandemics. Private sector is a ‘critical partner’ IFPMA’s Grega Kumer, Deputy Director of Government Relations. “The private sector should be seen as a critical partner in preparedness, response and recovery, and should have a seat at the table,” stated Grega Kumer, Deputy Director of Government Relations at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). However, it warned that some of the accord’s proposals “would jeopardise our capacity to efficiently prepare for the next pandemic.” Key concerns it cited included proposals for a waiver on intellectual property rights (IP) for health products during a pandemic, as well as proposals that would “be “transactionally linking access to pathogens and sharing of benefits”. It also urged the INB to “avoid unnecessary overlaps and duplications including other multilateral organisations mandate and expertise such as WTO and WIPO”. While there were over 200 participants online, a handful of member states were also on hand to listen in person at WHO’s Geneva Headquarters to the inputs as they prepare for INB4, when the real negotiations begin for the accord that is due to be presented by May 2024 to the World Health Assembly. Image Credits: Peter Griffin/Public Domain Pictures. Mpox To Remain A Public Health Emergency of International Concern Says WHO 15/02/2023 Megha Kaveri Dr Tedros Adhanom Ghebreyesus speaking at the media briefing on Wednesday. The World Health Organization (WHO) declared on Wednesday that Mpox will continue to remain a Public Health Emergency of International Concern (PHEIC). The decision to continue with the status quo on Mpox was based on the recommendations made by an Mpox Emergency Committee, whose findings were published on the same day. “The emergency committee for the global outbreak of Mpox met to assess whether, in its view, the outbreak remains a public health emergency of international concern. The committee has advised me that, in its view, Mpox remains a global health emergency, and I have accepted that advice,” Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a press briefing on Wednesday. In its report, the Mpox committee, which met on 9 February, acknowledged the progress made in reducing the virus transmission and the sharp decline of reported cases. However, it also expressed concerns that “a few countries continued to see a sustained incidence of illness” while in other countries it’s likely that more cases are occuring under the radar. “More than 30 countries continue to report cases, and the possible underdetection and under-reporting of confirmed cases in some regions is concerning. Particularly in countries where animal-human transmission of Mpox has been reported before,” Tedros pointed out. In its report, the expert committee also expressed concerns about the possible resurgence of cases due to the expected resumption of LGBTQ social events and other mass gathering events; lack of access to vaccines and testing capacities in many lower-income countries; and the recurring zoonotic transmission in Africa. It added that “not all countries are receiving the support they need or have structures or systems to respond to mpox, including inadequate support for marginalized groups; and general fatigue among supporting agencies.” Returning from Syrian scenes of devastation Tedros spoke at the briefing shortly after returning to Geneva from a visit to earthquake affected areas in Syria. The 7.8 magnitude earthquake that hit Syria and Türkiye last week is now estimated to have killed over 41,000 people. I've never in my life seen the level of destruction as I did on the road from Aleppo to Damascus. Skeletons of houses. Almost no people in sight. Over a decade of war has taken an unimaginable toll. Syrians need our support now and in years to come to rebuild their lives. pic.twitter.com/Ym2zmDixdw — Tedros Adhanom Ghebreyesus (@DrTedros) February 14, 2023 Describing the damage caused to Aleppo and Damascus first due to the war, and now by the earthquake, Tedros said “I saw the destruction of entire communities, the unspeakable suffering of people, and the courage and determination of survivors and responders. As we drove from Aleppo to Damascus, I saw the legacy of conflict, with town after town destroyed and abandoned. Survivors are now facing freezing conditions without adequate shelter, heating, food, clean water, or medical care.” While two more cross-border points between Türkiye and Syria have been opened, Tedros said he had had asked Syrian president Bashar al-Assad to open still more crossings so that relief could reach people in need more rapidly. Humanitarian aid groups charge that the Syrian president has “weaponized aid” channeling available supplies to government controlled areas – while most of western Syria where the earthquake hit, is controlled by Kurdish and other Syrian anti-government militias. “WHO remains committed to supporting all people in the Syrian Arab Republic now and in the days, weeks, months, and years ahead,” Tedros added. The WHO has launched an appeal for $43 million to support its response in Syria and Türkiye and expects the amount to double by this weekend. Meanwhile, UN Secretary General Antonio Guterres called upon countries to fully fund a $397 million earthquake fund for Syria, in particular, which lacks resources to mount its own response. Marburg disease – ramping up diagnostics and clinical trial possibilities Touching back on the Marburg Virus Disease (MVD) outbreak in Equatorial Guinea, which has claimed nine lives, Tedros said that the WHO is working with the country’s health authorities to ramp up their diagnostic capacity. “So far, no confirmed cases have been reported in Cameroon and or Gabon,” he added, referring to the two countries that, along with Liberia, border Equatorial Guinea. “We’re also supporting the governments of Cameroon and Gabon to prepare to rapidly detect, isolate, and provide care for any suspected cases.” Following up on the Marburg Virus Vaccine Consortium (MARVAC)’s meeting on Tuesday, Tedros said that WHO is trying to accelerate talks on possibile clinical trials for Marburg virus diseaes vaccine candidates. But he reiterated that any decision on the trials of vaccines and therapeutics for Marburg needs to be taken by researchers and the national authorities of Equatorial Guinea. “In the meantime, WHO is convening the vaccine prioritization committee to identify which vaccine candidates should be evaluated first and prepare for potential trials. WHO is also discussing with the ministry of health, the possibility of providing access to experimental therapeutics as part of a clinical trial,” he said. WHO Denies it Abandoned Investigation of COVID-19 Origins – But Way Forward Unclear 15/02/2023 Megha Kaveri Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing. A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic. The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021, But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country. In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.” Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating: “I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.” However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question: “In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.” China has evaded WHO’s requests for cooperation China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted. “Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. “Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones. “Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated. But apparently so far, there has been no return mail. Image Credits: Megha Kaveri. WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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The town of Beni in the DRC has been the scene of a number of ADF massacres. “We have never experienced such killings,” says an aid work as local health centres struggle to help survivors deal with mental health problems in the aftermath of increasingly brutal attacks by the Islamic rebel group, Allied Democratic Forces. Of the more than 100 armed groups active in DRC’s eastern provinces, one of the oldest and most violent is the Allied Democratic Forces (ADF), a militant movement of Ugandan origins that has pledged allegiance to the so-called Islamic State (IS). With the spotlight on the M23 – which is backed by Rwanda and has seized large chunks of territory in the east – The New Humanitarian spent time speaking with survivors of ADF atrocities and health workers addressing the conflict’s fallout. “I have been supporting displaced people of different wars for 20 years… [but] the ADF massacres have become serious and we have never experienced such killings,” said Marie-Jeanne Masika, who works for a local NGO helping conflict victims. Interviewees said recent measures taken to combat the ADF – from a joint Uganda-DRC military intervention to the introduction of martial law – have failed to improve security for civilians. Instead, the militants have expanded geographically, carrying out massacres, abductions, and bombings in urban areas that have struck targets including a government building, a cinema, and a church in recent months. Those affected by the long-running violence – which centres on North Kivu and Ituri provinces – raised warnings of a rising mental health toll. Yet local health workers said there is an absence of support for those needing psychosocial services. “Today, we must no longer reduce humanitarian assistance to the sole distribution of provisions… to victims,” said Masika. “A big problem also remains psychosocial care to avoid having mental illnesses in the future.” ‘We are in so much pain’ The ADF was formed in 1995 after members fled to DRC amid military pressure in Uganda. It has its roots in the repression of Ugandan Muslims, though its complex history and modus operandi is obscured by narratives that focus solely on its Islamist orientation. Military operations, including by UN peacekeepers, are frequently launched against the group. Yet they often result in ADF reprisal attacks designed to punish civilians who support the army and pressure the government to end offensives. Recent ADF raids have sought to undermine support for Uganda’s operations. That mission – which may be guided by economic interests rather than security concerns – was launched after IS claimed a triple suicide bombing in Kampala in late 2021. A meeting of displaced people who had fled recent ADF massacres healed at a cathedral in Butembo, a town in North Kivu, earlier this month, highlighted the suffering caused by the conflict. Kavugho Sikiliza, 42, said she had lost four of her relatives, including her son and daughter-in-law, in an ADF attack in Bashu chiefdom – in the North Kivu territory of Beni – last September. “We suffer so much. We have abandoned our fields and we no longer find anything to eat,” Kavugho said. “Today, we are spending the night in the bush; we have orphans who are struggling to [eat].” Next to Kavugho sat Yoha Nyasavo Bibiche. Six months ago, she saw her son killed by ADF rebels in Mungamba, in Ituri province. She is now living in Butembo but was recently forced out of her house there because she couldn’t afford rent. “As we were about to harvest, the ADF attacked the village and stabbed my son, who is dead,” said Bibiche. “We no longer have a home. Eating, dressing – it has become a headache.” Mental health toll The cumulative impact of attacks – which have killed thousands over the past decade – has led to serious mental health challenges, according to survivors and medical staff from three psychiatric centres in Beni and Butembo. Esdras Pika, a psychologist at a health centre in Butembo, said his clinic treats survivors of ADF killings, kidnap victims, and farmers and traders struggling to cope with the loss of their livelihoods. “Before 2015, the reasons that led patients to be admitted to mental healthcare here were often drug abuse [and] cases of romantic disappointment,” Pika said. “But today, most of the patients who come to us are victims of insecurity.” Kakule Kisonia, from Beni territory, said his brother went to the local Muyisa psychiatric centre after witnessing a recent ADF attack that cost the lives of his wife, sister, and two of his children. Kisonia said his brother’s behaviour changed after the attack. “Every night he shouted: Ba Nalu! Ba Nalu! [a reference to the ADF in Swahili],” Kisonia said. “Each time a neighbour came, he shouted that it was the ADF, and did not hesitate to take either a wooden stick or a machete to attack the visitors.” More support is needed Medical staff from the health centres said they receive around 30 patients per month who are victims of ADF attacks. Yet the staff said their clinics receive no support from the state or from aid organisations, and that patients must self-finance their treatment. “Most of the victims are in a state of serious vulnerability, but we too are private, unsubsidised structures,” said Pika from the Butembo clinic. “We have to buy the drugs, pay the state taxes, and pay our nursing staff. We have no choice.” Marie-Jeanne Masika, the local NGO worker, said some displaced families have come to her organisation presenting bills of more than $300 issued by health centres for psychiatric support. “It is too much for the victims, who have lost everything in the attacks, and these kinds of bills trouble them rather than relieve them,” said Masika, whose organisation is called Social Integration for the Promotion of the Needy (ISPRON). Mumbere Nyerere, an ADF victim who is receiving therapy, said paying for care represents a “big difficulty”. “I am the father of the family. Those who finance my care are my parents, older than me. It is I who should assist them,” Nyerere said. As attacks continue, Masika called for the government to subsidise clinics providing mental health support and said occupational therapy should be rolled out in villages to “tackle the problem at the base”. Georges Machokuona, a psychosocial worker in Butembo, said livelihood support is needed too: “Once they have returned home, most of those cured are faced with challenges… linked to survival, which led some to fall ill again.” This story was originally published by The New Humanitarian, which puts quality, independent journalism at the service of the millions of people affected by humanitarian crises around the world.
Ukraine Gets New Emergency Funds for HIV and TB Programmes 21/02/2023 Kerry Cullinan Alliance Global’s Andrii C shelters in the NGO’s basement in Lviv and waits for air raid sirens to finish. The organisation is helping to get treatment to people living with HIV. On the eve of the first anniversary of Russia’s invasion of Ukraine, the Global Fund to Fight AIDS, Tuberculosis and Malaria has approved an additional $10.32 million in emergency funding to maintain essential HIV and tuberculosis (TB) services in Ukraine. The funds are earmarked for HIV and TB treatment, prevention and care, including for internally displaced persons and hard-to-reach communities. Since the start of the war, more than 13.5 million people have been internally displaced or forced to flee to neighbouring countries as refugees. “If displaced people don’t get the medicines they need, there is a high risk that they will actually die because of the lack of therapy,” said Dmytro Sherembei, head of 100% LIFE, a Global Fund-supported nongovernmental organization delivering HIV medications in war-affected Ukraine. In the past year, the Global Fund has allocated $25.32 million in emergency funds in addition to $119.48 million allocated to Ukraine to support the fight against HIV and TB in the country over the 2021-2023 period. Ukraine has the second-largest HIV epidemic in Eastern Europe and Central Asia, and a high burden of TB, including drug-resistant TB, according to the Global Fund in a statement on Tuesday. “Both HIV and TB require long-term treatment to reduce the risk of transmission and both diseases have the best outcome with early diagnosis. As people escape the fighting, they often lose access to health care and their medications. HIV and TB prevention and diagnosis services have also been significantly disrupted.” Needs more desperate “As the war rages on, the needs in the country are getting more severe and urgent,” said Peter Sands, the Global Fund’s Executive Director. “Damage and destruction to water, electricity and sanitation facilities, health facilities, as well as road and residential infrastructure continue to be reported across multiple areas throughout the country. The additional emergency funding that we are unlocking today is intended to support the government in filling the significant financing gaps across critical HIV and TB interventions. We will continue to monitor the situation closely.” The World Health Organization (WHO) reports that over 1,200 health facilities in the country have been attacked, and 170 of these facilities have been destroyed, leaving healthcare workers and patients displaced, injured or dead. “It’s been a year since the Russian Federation’s invasion of Ukraine, and today, the fighting and deadly missile strikes continue, bringing more destruction and devastating impact in several oblasts of the country,” said Minister of Health of Ukraine Viktor Liashko. “Despite the crisis and challenges, Ukraine’s HIV and TB programs sustained operations. The Global Fund’s investments through the emergency funding, on top of the ongoing grant, have proven invaluable, especially as health facilities have been damaged or destroyed and people continue to be displaced, causing them to lose access to health care, including treatment for HIV and TB.” Over the last 20 years, Ukraine has been a champion in maintaining long-term and innovative HIV and TB programs, according to the Global Fund. More than 100 community-based and community-led organizations have been delivering HIV and TB services to vulnerable people. Image Credits: Global Fund. Scientists Launch R&D Plan to Develop Broad Vaccine for Coronaviruses 21/02/2023 Kerry Cullinan SARS-Co-V2. Fifty influential scientists have developed a coronavirus vaccines research and development (R&D) roadmap aimed at developing broadly protective vaccines to combat fast-evolving coronaviruses threatening humans. “The COVID-19 pandemic marks the third time in just 20 years that a coronavirus has emerged to cause a public health crisis,” said Professor Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP). “Rather than waiting for a fourth coronavirus to emerge — or for the arrival of an especially dangerous SARS-CoV-2 variant — we must act now to develop better, longer-lasting and more broadly protective vaccines,” added Osterholm, whose centre spearheaded the development of the roadmap that was unveiled on Tuesday. CIDRAP unveils roadmap for advancing better coronavirus vaccines The roadmap provides a detailed a strategy to develop broadly protective vaccines—suitable for wide use—to tackle future #COVID19 variants and other worrisome coronaviruseshttps://t.co/yfv7nb5Jnq pic.twitter.com/mQBonJneZc — CIDRAP (@CIDRAP) February 21, 2023 The roadmap sets out steps to accelerate the development of broadly effective coronavirus vaccines capable of preventing severe disease and death that are suitable for all regions worldwide. New SARS-CoV-2 variants pose the most immediate threat and could evolve until they evade the protection of current vaccines. But the bigger fear is the emergence of a super-coronavirus that has the transmissibility of SARSCoV-2 combined with the deadliness of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS-CoV spilled over from camels to humans in 2012 and kills about a third of the people it infects. To head off such a threat, the roadmap proposes a number of approaches. One could involve a stepwise process, starting with vaccines to protect against SARS-CoV-2 variants. As knowledge about coronaviruses expands, it may be possible to develop vaccines that are capable of protecting against multiple types of coronaviruses, including those likely to spill over from animals to humans in the future. “It is critical that we start now to develop vaccines that are future-ready for coronaviruses circulating in animals now, that might infect humans and cause pandemics in the future as SARS-CoV-3 and beyond,” said Professor Linfa Wang, executive director of Singapore’s Programme for Research in Epidemic Preparedness and Response (PREPARE). Wang, who was part of the team that developed the roadmap, also said that the work was daunting: “The coronavirus diversity in bats is so great that we even don’t know how much we really know about them.” Five work areas The roadmap proposes five areas of work: Virology: learning more about the global distribution of coronaviruses circulating in animal reservoirs that have the potential to spill over to humans. Immunology: learning more about human immunology to expand the breadth and durability of immune protection from vaccines and natural infection. This includes a better understanding of mucosal immunity, which may unlock new strategies to block infection such as nasal sprays. Vaccinology: identifying key preferred product characteristics for vaccines, including new technologies and identifying the best methods to assess vaccine efficacy. Animal and human infection models for vaccine research: expanding the range of suitable animal models, which is a key barrier to developing broadly protective coronavirus vaccines. Policy and financing: reinvigorating and sustaining a high level of political commitment and long-term investment in vaccine R&D and manufacturing to ensure the successful development and global distribution of broadly protective coronavirus vaccines. While praising the current COVID-19 vaccines, Wellcome Trust’s Dr Charlie Weller, said the roadmap would research “new ways to deliver vaccines, such as skin patches or intranasal vaccines – and maybe even vaccines that could block transmission”. Constant mutation “Coronaviruses such as SARS-CoV-2 are constantly mutating. With every infection, there is an interplay among host characteristics, past infection, and vaccination – each exerting further pressures on the virus to evolve and acquire further reproductive and fitness advantages,” wrote Dr Margaret Hamburg, former Food and Drug Administration (FDA) commissioner, and Dr Gregory Poland, from the Mayo Clinic’s Vaccine Research Group in the US in a commentary published in the journal, Vaccine. “As a consequence, we are chasing continually evolving viral opponents, leaving the global community in a reactive rather than proactive position in regard to vaccines, therapeutics, and public health policies.” They warn that the global community cannot afford “to play reactive catch up continuously, chasing the latest variant”, or expect people to get vaccinated several times a year. However, Hamburg and Poland added that the roadmap also needs “a governance or administrative structure” to better coordinate vaccine R&D and track progress –and accountability – on the goals and milestones that will further facilitate and accelerate this process. They point to the “siloed” activities by governments, industry and researchers, and how the roadmap can “build bridges between these various sectors” to reduce barriers and duplication, and improve efficiencies. Image Credits: Johnson&Johnson. Natural Immunity Against COVID-19 ‘At Least’ On Par With Vaccination in Preventing Death 21/02/2023 Stefan Anderson Natural immunity provides strong protection against severe illness from COVID-19, but obtaining it carries its own set of risks. New research published in The Lancet suggests that individuals who have previously been infected with COVID-19 have an 88% lower risk of hospitalization or death than those who have not. The study is the most comprehensive review of data on natural immunity to date, covering data from 65 studies across 19 countries published since January 2021. The analysis found that the strength and 10-month duration of protection conferred by natural immunity against severe illness is “at least” on par with that provided by two doses of Moderna and Pfizer-BioNtech’s mRNA vaccines. The study’s authors said the data suggests natural immunity in people recently infected with COVID-19 should be recognised by policymakers but warned against using their findings to undermine the importance of vaccination due to the risks associated with the first infection. “Vaccination is the safest way to acquire immunity, whereas acquiring natural immunity must be weighed against the risks of severe illness and death associated with the initial infection,” lead author Dr Stephen Lim of the University of Washington’s School of Medicine. Researchers also cautioned that differences between the infectious properties of COVID-19 variants mean protection levels can vary. Infection by pre-Omicron variants, for example, yielded substantially lower natural immunity protection against reinfection by the now dominant Omicron BA.1 variant, with just 36% protection remaining after the 10-month window. Nevertheless, protection against hospitalization and death remained high at 88%. “The weaker cross-variant immunity with the Omicron variant and its sub-lineages reflects the mutations they have that make them escape built-up immunity more easily than other variants,” report co-author Dr Hasan Nassereldine of the University of Washington’s School of Medicine said. “The limited data we have on natural immunity protection from the Omicron variant and its sub-lineages underscores the importance of continued assessment, particularly since they are estimated to have infected 46% of the global population between November 2021 and June 2022.” The analysis excluded studies examining “hybrid immunity” (the combination of immune responses from vaccination and natural infection) as well as data relating to Omicron XBB and its sub-lineages. The authors encouraged further research to fill the gaps in the study. Europeans Don’t Exercise Enough – And Policy-Makers Should Do More to Encourage Them 17/02/2023 Kerry Cullinan A third of Europeans don’t meet the World Health Organization’s (WHO) guidelines for physical activity – but if they did, this would avert over 10 000 premature deaths, almost four million cases of cardiovascular disease, three and a half million cases of depression and nearly a million cases of type two diabetes by 2050. This is according to a report launched on Friday by the WHO Europe and the Organisation for Economic Co-operation and Development (OECD), which urges policy-makers to adopt strategies to increase people’s physical activity. The findings are based on a recent Eurobarometer survey conducted for the European Commission which found that 45% of the respondents report that they never exercise or play sport, an increase of 6% since 2009. People in Finland (71%), Luxembourg (63%), the Netherlands (60%), and Denmark and Sweden (both 59%) were the most likely to exercise, while people in Portugal, Greece and Poland were least likely to exercise. “We find that it’s worse among women, with some countries having almost half of all adult women not meeting the WHO recommended guidelines on physical activity,” OECD health policy analyst Sabine Vuik told the launch on Friday. Meanwhile, less than a quarter of people who consider themselves to be working class exercise at least once a week, and over half of all adults surveyed said that they exercised less frequently since the COVID-19 pandemic. Recommended activity The WHO recommends that everyone does at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity every week. “This could be a half-hour run twice a week, running about 10 kilometres per hour, but it doesn’t need to be formal exercise. It can also be walking the dog every day for half an hour,” added Vuik. OECD health analyst Sabine Vuik “Our analysis shows that larger countries such as Germany, France and Italy can save more than €1 billion every year if everyone were to meet the physical activity guidelines. And across the EU, we could save €8 billion every year in healthcare expenditure if everyone meets the minimum recommended guidelines.” WHO Europe regional director Dr Hans Kluge, said that the report “provides evidence that investing in policies that promote physical activity not only improves individual well-being and population health, but also pays economic dividends”. “Every €1 invested in physical activity generates an almost two-fold return of €1.7 in economic benefits. We need to communicate the benefits of being active, not just the physical benefits, but the benefits to mental health, the environment and society in the WHO European Region, and we need to make sure that our systems can and will sustain these changes – as real, long-term transformation,” added Kluge, who is an avid cyclist and cycles to work and back daily. The report calls on policymakers to step up the policy response to increase physical activity in schools, in urban and transport design and in healthcare settings and workplaces. Since 2015, some EU countries have adopted policies to improve access to physical activity. For example, Finland adopted a resolution to promote active modes of transportation, Austria builds up co-operation between sports clubs and primary schools and Bulgaria develops a programme to help people whose jobs involve sitting for long periods. Investing in #PhysicalActivity improves individual and population health, while returning 1.7 EUR in economic benefits for every 1 EUR invested. New WHO/@OECD report funded by the #EU shares great ideas for policy makers to consider.👇https://t.co/Ri3xynx9bv@EU_Commission pic.twitter.com/A28qBknwiQ — WHO/Europe (@WHO_Europe) February 17, 2023 Lack of Test Kits for Marburg Virus Hamper Africa’s Response to Outbreak 16/02/2023 Paul Adepoju Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control. The Africa Centres for Disease Control and Prevention (Africa CDC) is closely monitoring Equatorial Guinea’s first-ever Marburg virus disease outbreak, Africa CDC acting director Dr Ahmed Ogwell Ouma told a media briefing on Thursday “One big challenge we have are test kits and we are working around the clock to try and get test kits to Equatorial Guinea and also to Cameroon and Gabon, to ensure that we have a very short turnaround time for samples being tested in the laboratory,” Ouma added. So far, one case has been confirmed and nine deaths have been reported, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. Ouma added that a key priority is to limit the spread of the virus, as well as monitor neighbouring countries such as Cameroon and Gabon for potential cross-border spillover. As reported by Health Policy Watch, on Tuesday, the WHO received updates from five vaccine developers who have been working on candidate vaccines. The WHO plans to convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. Diphtheria, cholera, mpox, Lassa fever, and measles are some of the other health emergencies that African countries are also grappling with, alongside COVID-19, and Ouma, a Kenyan epidemiologist, said that his center is currently monitoring up to nine different public health events. Nigeria reported over 600 new cases of diphtheria and several African countries reported cases of cholera, including Malawi, where three-quarters of the continent’s cases have been reported. The continent has documented over 12 million cases of COVID-19 and 256,705 deaths, a case fatality rate of 2.1%, which is double the global average, Ouma told the media. While the number of new cases and deaths have decreased over the past several weeks, he emphasized the importance of continuing to encourage vaccination efforts and targeted campaigns to reach more people. “The general trend on the continent now is quite flat with the indications that we may be seeing further decreases in numbers and also in deaths,” Ouma told journalists. Ouma noted that Africa CDC is working with governments and health organizations to provide technical assistance and medical countermeasures as needed for these and other health emergencies. He added that the organization is also continuing to promote vaccination efforts and targeted campaigns to help prevent the spread of infectious diseases. Draft Pandemic Accord Neglects Prevention, Particularly ‘Zoonotic Spillover’ 15/02/2023 Kerry Cullinan INB co-chair Roland Driece The draft pandemic accord needs more emphasis on preventing pandemics at their source – where animal pathogens “spill over” to people – according to a number of organisations participating in a consultation on the document’s “zero draft” on Wednesday. Negotiations between World Health Organization (WHO) member states on the draft are due to begin at the fourth meeting of the Intergovernmental Negotiating Body (INB), scheduled to take place from 27 February to 3 March. However, Wednesday’s meeting gave WHO’s civil society stakeholders an opportunity to comment on the draft ahead of that meeting. Only member states will take part in the actual treaty negotiations, which are likely to start behind closed doors on the second day of the month-end meeting (called INB 4), INB co-chair Roland Driece told the meeting. INB 4 and the following INB5 meeting from 3 to 6 April would be approached as “one big meeting”, he added. While the start of the meeting would be open to all stakeholders, “as soon as member states tell us that they accept the zero draft as the zero draft, we will move into negotiation mode, and that means that only member states can be present,” said Driece. “So that’s why it’s so important that you tell us and member states now what you feel and think about this zero draft.” He added that he thought that the INB Bureau had done “a pretty decent job [of synthesizing stakeholders’ inputs]” but “this is an important moment for you all to share whether or not you share my optimism about that and tell us what you think is important”. Prevent ‘zoonotic spillover’ – environmental and animal health groups Across large swathes of Asia and Africa, wholesale markets often sell wild animals captured or bred for food consumption, and which may harbor dangerous viruses. Many scientists believe that SARS-CoV2 was transmitted to humans via live, wild animals, caged for slaughter in Wuhan’s wet market. An unprecedented number of organisations spoke about how the draft needs to pay more attention to pandemic prevention at the source; this means addressing the social, environmental and food safety factors that lead to the spillover of pathogens from wild animal populations into human communities. These drivers range from deforestation which has prompted animal populations like bats, which harbor a range of deadly pathogens from SARS-COV to Marburg, to move closer to human habitats; to wild animal trafficking and trade, both legal and illicit; as well as industrial production, sale and slaugher of wild animal species. The Wildlife Conservation Society recommended that the accord commit governments to “identifying and prioritising actions to prevent pathogen spillover in the first place” by prioritising tougher regulations on “markets and trade chains and wildlife domestic and international trade”. “We have extensive experience and expertise with habitat degredation, deforestation, forest degradation, wildlife trade and wildlife markets,” said the WCS representative. “And this isn’t about illegal trade, its about any live trade, particularly for food but also for other purposes, birds and mammals. We look forward to working with member states and the INB to ensure that first and foremost there are commitments by governments to avoid the spillover in the first place. And we do know how to do that, from a biodiversity perspective and in terms of markets.” The World Wildlife Fund (WWF) appealed for the “list of drivers of pathogen emergence risks to be expanded to include not just deforestation, but ecosystem loss, fragmentation and degradation”. “Deforestation alone omits many of the potentially important pandemic frontiers and ignores the role of fragmentation and degradation in increasing proximity between humans and wildlife,” said the WWF. Meanwhile, the World Organisation of Animal Health (WOAH) called for the inclusion of the full definition of “One Health” in the treaty. Its delegate also questioned why preparedness and response were stressed whereas “preventive actions targeting activities and places that increase the risk of zoonotic spillover” were not. Pointing to a lack of expertise to address zoonotic spillover, the Action for Animal Health Coalition said that member states needed to invest in increasing the animal health workforce. Equity obligations Oxfam’s Piotr Kolczynski, who also represented the People’s Vaccine Alliance. Meanwhile, Oxfam, also representing the People’s Vaccine Alliance, said that “the accord’s language must oblige governments to take specific actions to ensure equity; otherwise it would be very difficult to implement this”. The current zero draft also assumes that “critical public health interventions are based on the willingness of pharmaceutical companies to engage in voluntary mechanisms” but “these have proved to be largely insufficient during the current and previous pandemics,” said Piotr Kolczynski, of Oxfam and PVA. For this reason, it added, “the accord must require governments to invest in research and development and manufacturing capacities and to condition public funding on the sharing of technologies, knowledge and intellectual property with developers and manufacturers in the South”. In reference to the accord’s proposal that 20% of pandemic-related goods be allocated to the WHO for distribution, Oxfam stated that “equitable allocation of medical countermeasures cannot be achieved by reserving a 20% of production for 80% of the world’s population”. Medecins sans Frontieres (MSF), meanwhile, asked for a legal definition of “pandemic”, and “explicit reference to governments complying with international humanitarian law obligations in the context of pandemic preparedness, prevention and response”. It also demanded stronger language in relation to commitments to protect “humanitarian populations of concerns” and healthcare workers during pandemics. Private sector is a ‘critical partner’ IFPMA’s Grega Kumer, Deputy Director of Government Relations. “The private sector should be seen as a critical partner in preparedness, response and recovery, and should have a seat at the table,” stated Grega Kumer, Deputy Director of Government Relations at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). However, it warned that some of the accord’s proposals “would jeopardise our capacity to efficiently prepare for the next pandemic.” Key concerns it cited included proposals for a waiver on intellectual property rights (IP) for health products during a pandemic, as well as proposals that would “be “transactionally linking access to pathogens and sharing of benefits”. It also urged the INB to “avoid unnecessary overlaps and duplications including other multilateral organisations mandate and expertise such as WTO and WIPO”. While there were over 200 participants online, a handful of member states were also on hand to listen in person at WHO’s Geneva Headquarters to the inputs as they prepare for INB4, when the real negotiations begin for the accord that is due to be presented by May 2024 to the World Health Assembly. Image Credits: Peter Griffin/Public Domain Pictures. Mpox To Remain A Public Health Emergency of International Concern Says WHO 15/02/2023 Megha Kaveri Dr Tedros Adhanom Ghebreyesus speaking at the media briefing on Wednesday. The World Health Organization (WHO) declared on Wednesday that Mpox will continue to remain a Public Health Emergency of International Concern (PHEIC). The decision to continue with the status quo on Mpox was based on the recommendations made by an Mpox Emergency Committee, whose findings were published on the same day. “The emergency committee for the global outbreak of Mpox met to assess whether, in its view, the outbreak remains a public health emergency of international concern. The committee has advised me that, in its view, Mpox remains a global health emergency, and I have accepted that advice,” Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a press briefing on Wednesday. In its report, the Mpox committee, which met on 9 February, acknowledged the progress made in reducing the virus transmission and the sharp decline of reported cases. However, it also expressed concerns that “a few countries continued to see a sustained incidence of illness” while in other countries it’s likely that more cases are occuring under the radar. “More than 30 countries continue to report cases, and the possible underdetection and under-reporting of confirmed cases in some regions is concerning. Particularly in countries where animal-human transmission of Mpox has been reported before,” Tedros pointed out. In its report, the expert committee also expressed concerns about the possible resurgence of cases due to the expected resumption of LGBTQ social events and other mass gathering events; lack of access to vaccines and testing capacities in many lower-income countries; and the recurring zoonotic transmission in Africa. It added that “not all countries are receiving the support they need or have structures or systems to respond to mpox, including inadequate support for marginalized groups; and general fatigue among supporting agencies.” Returning from Syrian scenes of devastation Tedros spoke at the briefing shortly after returning to Geneva from a visit to earthquake affected areas in Syria. The 7.8 magnitude earthquake that hit Syria and Türkiye last week is now estimated to have killed over 41,000 people. I've never in my life seen the level of destruction as I did on the road from Aleppo to Damascus. Skeletons of houses. Almost no people in sight. Over a decade of war has taken an unimaginable toll. Syrians need our support now and in years to come to rebuild their lives. pic.twitter.com/Ym2zmDixdw — Tedros Adhanom Ghebreyesus (@DrTedros) February 14, 2023 Describing the damage caused to Aleppo and Damascus first due to the war, and now by the earthquake, Tedros said “I saw the destruction of entire communities, the unspeakable suffering of people, and the courage and determination of survivors and responders. As we drove from Aleppo to Damascus, I saw the legacy of conflict, with town after town destroyed and abandoned. Survivors are now facing freezing conditions without adequate shelter, heating, food, clean water, or medical care.” While two more cross-border points between Türkiye and Syria have been opened, Tedros said he had had asked Syrian president Bashar al-Assad to open still more crossings so that relief could reach people in need more rapidly. Humanitarian aid groups charge that the Syrian president has “weaponized aid” channeling available supplies to government controlled areas – while most of western Syria where the earthquake hit, is controlled by Kurdish and other Syrian anti-government militias. “WHO remains committed to supporting all people in the Syrian Arab Republic now and in the days, weeks, months, and years ahead,” Tedros added. The WHO has launched an appeal for $43 million to support its response in Syria and Türkiye and expects the amount to double by this weekend. Meanwhile, UN Secretary General Antonio Guterres called upon countries to fully fund a $397 million earthquake fund for Syria, in particular, which lacks resources to mount its own response. Marburg disease – ramping up diagnostics and clinical trial possibilities Touching back on the Marburg Virus Disease (MVD) outbreak in Equatorial Guinea, which has claimed nine lives, Tedros said that the WHO is working with the country’s health authorities to ramp up their diagnostic capacity. “So far, no confirmed cases have been reported in Cameroon and or Gabon,” he added, referring to the two countries that, along with Liberia, border Equatorial Guinea. “We’re also supporting the governments of Cameroon and Gabon to prepare to rapidly detect, isolate, and provide care for any suspected cases.” Following up on the Marburg Virus Vaccine Consortium (MARVAC)’s meeting on Tuesday, Tedros said that WHO is trying to accelerate talks on possibile clinical trials for Marburg virus diseaes vaccine candidates. But he reiterated that any decision on the trials of vaccines and therapeutics for Marburg needs to be taken by researchers and the national authorities of Equatorial Guinea. “In the meantime, WHO is convening the vaccine prioritization committee to identify which vaccine candidates should be evaluated first and prepare for potential trials. WHO is also discussing with the ministry of health, the possibility of providing access to experimental therapeutics as part of a clinical trial,” he said. WHO Denies it Abandoned Investigation of COVID-19 Origins – But Way Forward Unclear 15/02/2023 Megha Kaveri Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing. A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic. The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021, But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country. In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.” Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating: “I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.” However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question: “In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.” China has evaded WHO’s requests for cooperation China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted. “Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. “Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones. “Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated. But apparently so far, there has been no return mail. Image Credits: Megha Kaveri. WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Scientists Launch R&D Plan to Develop Broad Vaccine for Coronaviruses 21/02/2023 Kerry Cullinan SARS-Co-V2. Fifty influential scientists have developed a coronavirus vaccines research and development (R&D) roadmap aimed at developing broadly protective vaccines to combat fast-evolving coronaviruses threatening humans. “The COVID-19 pandemic marks the third time in just 20 years that a coronavirus has emerged to cause a public health crisis,” said Professor Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP). “Rather than waiting for a fourth coronavirus to emerge — or for the arrival of an especially dangerous SARS-CoV-2 variant — we must act now to develop better, longer-lasting and more broadly protective vaccines,” added Osterholm, whose centre spearheaded the development of the roadmap that was unveiled on Tuesday. CIDRAP unveils roadmap for advancing better coronavirus vaccines The roadmap provides a detailed a strategy to develop broadly protective vaccines—suitable for wide use—to tackle future #COVID19 variants and other worrisome coronaviruseshttps://t.co/yfv7nb5Jnq pic.twitter.com/mQBonJneZc — CIDRAP (@CIDRAP) February 21, 2023 The roadmap sets out steps to accelerate the development of broadly effective coronavirus vaccines capable of preventing severe disease and death that are suitable for all regions worldwide. New SARS-CoV-2 variants pose the most immediate threat and could evolve until they evade the protection of current vaccines. But the bigger fear is the emergence of a super-coronavirus that has the transmissibility of SARSCoV-2 combined with the deadliness of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS-CoV spilled over from camels to humans in 2012 and kills about a third of the people it infects. To head off such a threat, the roadmap proposes a number of approaches. One could involve a stepwise process, starting with vaccines to protect against SARS-CoV-2 variants. As knowledge about coronaviruses expands, it may be possible to develop vaccines that are capable of protecting against multiple types of coronaviruses, including those likely to spill over from animals to humans in the future. “It is critical that we start now to develop vaccines that are future-ready for coronaviruses circulating in animals now, that might infect humans and cause pandemics in the future as SARS-CoV-3 and beyond,” said Professor Linfa Wang, executive director of Singapore’s Programme for Research in Epidemic Preparedness and Response (PREPARE). Wang, who was part of the team that developed the roadmap, also said that the work was daunting: “The coronavirus diversity in bats is so great that we even don’t know how much we really know about them.” Five work areas The roadmap proposes five areas of work: Virology: learning more about the global distribution of coronaviruses circulating in animal reservoirs that have the potential to spill over to humans. Immunology: learning more about human immunology to expand the breadth and durability of immune protection from vaccines and natural infection. This includes a better understanding of mucosal immunity, which may unlock new strategies to block infection such as nasal sprays. Vaccinology: identifying key preferred product characteristics for vaccines, including new technologies and identifying the best methods to assess vaccine efficacy. Animal and human infection models for vaccine research: expanding the range of suitable animal models, which is a key barrier to developing broadly protective coronavirus vaccines. Policy and financing: reinvigorating and sustaining a high level of political commitment and long-term investment in vaccine R&D and manufacturing to ensure the successful development and global distribution of broadly protective coronavirus vaccines. While praising the current COVID-19 vaccines, Wellcome Trust’s Dr Charlie Weller, said the roadmap would research “new ways to deliver vaccines, such as skin patches or intranasal vaccines – and maybe even vaccines that could block transmission”. Constant mutation “Coronaviruses such as SARS-CoV-2 are constantly mutating. With every infection, there is an interplay among host characteristics, past infection, and vaccination – each exerting further pressures on the virus to evolve and acquire further reproductive and fitness advantages,” wrote Dr Margaret Hamburg, former Food and Drug Administration (FDA) commissioner, and Dr Gregory Poland, from the Mayo Clinic’s Vaccine Research Group in the US in a commentary published in the journal, Vaccine. “As a consequence, we are chasing continually evolving viral opponents, leaving the global community in a reactive rather than proactive position in regard to vaccines, therapeutics, and public health policies.” They warn that the global community cannot afford “to play reactive catch up continuously, chasing the latest variant”, or expect people to get vaccinated several times a year. However, Hamburg and Poland added that the roadmap also needs “a governance or administrative structure” to better coordinate vaccine R&D and track progress –and accountability – on the goals and milestones that will further facilitate and accelerate this process. They point to the “siloed” activities by governments, industry and researchers, and how the roadmap can “build bridges between these various sectors” to reduce barriers and duplication, and improve efficiencies. Image Credits: Johnson&Johnson. Natural Immunity Against COVID-19 ‘At Least’ On Par With Vaccination in Preventing Death 21/02/2023 Stefan Anderson Natural immunity provides strong protection against severe illness from COVID-19, but obtaining it carries its own set of risks. New research published in The Lancet suggests that individuals who have previously been infected with COVID-19 have an 88% lower risk of hospitalization or death than those who have not. The study is the most comprehensive review of data on natural immunity to date, covering data from 65 studies across 19 countries published since January 2021. The analysis found that the strength and 10-month duration of protection conferred by natural immunity against severe illness is “at least” on par with that provided by two doses of Moderna and Pfizer-BioNtech’s mRNA vaccines. The study’s authors said the data suggests natural immunity in people recently infected with COVID-19 should be recognised by policymakers but warned against using their findings to undermine the importance of vaccination due to the risks associated with the first infection. “Vaccination is the safest way to acquire immunity, whereas acquiring natural immunity must be weighed against the risks of severe illness and death associated with the initial infection,” lead author Dr Stephen Lim of the University of Washington’s School of Medicine. Researchers also cautioned that differences between the infectious properties of COVID-19 variants mean protection levels can vary. Infection by pre-Omicron variants, for example, yielded substantially lower natural immunity protection against reinfection by the now dominant Omicron BA.1 variant, with just 36% protection remaining after the 10-month window. Nevertheless, protection against hospitalization and death remained high at 88%. “The weaker cross-variant immunity with the Omicron variant and its sub-lineages reflects the mutations they have that make them escape built-up immunity more easily than other variants,” report co-author Dr Hasan Nassereldine of the University of Washington’s School of Medicine said. “The limited data we have on natural immunity protection from the Omicron variant and its sub-lineages underscores the importance of continued assessment, particularly since they are estimated to have infected 46% of the global population between November 2021 and June 2022.” The analysis excluded studies examining “hybrid immunity” (the combination of immune responses from vaccination and natural infection) as well as data relating to Omicron XBB and its sub-lineages. The authors encouraged further research to fill the gaps in the study. Europeans Don’t Exercise Enough – And Policy-Makers Should Do More to Encourage Them 17/02/2023 Kerry Cullinan A third of Europeans don’t meet the World Health Organization’s (WHO) guidelines for physical activity – but if they did, this would avert over 10 000 premature deaths, almost four million cases of cardiovascular disease, three and a half million cases of depression and nearly a million cases of type two diabetes by 2050. This is according to a report launched on Friday by the WHO Europe and the Organisation for Economic Co-operation and Development (OECD), which urges policy-makers to adopt strategies to increase people’s physical activity. The findings are based on a recent Eurobarometer survey conducted for the European Commission which found that 45% of the respondents report that they never exercise or play sport, an increase of 6% since 2009. People in Finland (71%), Luxembourg (63%), the Netherlands (60%), and Denmark and Sweden (both 59%) were the most likely to exercise, while people in Portugal, Greece and Poland were least likely to exercise. “We find that it’s worse among women, with some countries having almost half of all adult women not meeting the WHO recommended guidelines on physical activity,” OECD health policy analyst Sabine Vuik told the launch on Friday. Meanwhile, less than a quarter of people who consider themselves to be working class exercise at least once a week, and over half of all adults surveyed said that they exercised less frequently since the COVID-19 pandemic. Recommended activity The WHO recommends that everyone does at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity every week. “This could be a half-hour run twice a week, running about 10 kilometres per hour, but it doesn’t need to be formal exercise. It can also be walking the dog every day for half an hour,” added Vuik. OECD health analyst Sabine Vuik “Our analysis shows that larger countries such as Germany, France and Italy can save more than €1 billion every year if everyone were to meet the physical activity guidelines. And across the EU, we could save €8 billion every year in healthcare expenditure if everyone meets the minimum recommended guidelines.” WHO Europe regional director Dr Hans Kluge, said that the report “provides evidence that investing in policies that promote physical activity not only improves individual well-being and population health, but also pays economic dividends”. “Every €1 invested in physical activity generates an almost two-fold return of €1.7 in economic benefits. We need to communicate the benefits of being active, not just the physical benefits, but the benefits to mental health, the environment and society in the WHO European Region, and we need to make sure that our systems can and will sustain these changes – as real, long-term transformation,” added Kluge, who is an avid cyclist and cycles to work and back daily. The report calls on policymakers to step up the policy response to increase physical activity in schools, in urban and transport design and in healthcare settings and workplaces. Since 2015, some EU countries have adopted policies to improve access to physical activity. For example, Finland adopted a resolution to promote active modes of transportation, Austria builds up co-operation between sports clubs and primary schools and Bulgaria develops a programme to help people whose jobs involve sitting for long periods. Investing in #PhysicalActivity improves individual and population health, while returning 1.7 EUR in economic benefits for every 1 EUR invested. New WHO/@OECD report funded by the #EU shares great ideas for policy makers to consider.👇https://t.co/Ri3xynx9bv@EU_Commission pic.twitter.com/A28qBknwiQ — WHO/Europe (@WHO_Europe) February 17, 2023 Lack of Test Kits for Marburg Virus Hamper Africa’s Response to Outbreak 16/02/2023 Paul Adepoju Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control. The Africa Centres for Disease Control and Prevention (Africa CDC) is closely monitoring Equatorial Guinea’s first-ever Marburg virus disease outbreak, Africa CDC acting director Dr Ahmed Ogwell Ouma told a media briefing on Thursday “One big challenge we have are test kits and we are working around the clock to try and get test kits to Equatorial Guinea and also to Cameroon and Gabon, to ensure that we have a very short turnaround time for samples being tested in the laboratory,” Ouma added. So far, one case has been confirmed and nine deaths have been reported, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. Ouma added that a key priority is to limit the spread of the virus, as well as monitor neighbouring countries such as Cameroon and Gabon for potential cross-border spillover. As reported by Health Policy Watch, on Tuesday, the WHO received updates from five vaccine developers who have been working on candidate vaccines. The WHO plans to convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. Diphtheria, cholera, mpox, Lassa fever, and measles are some of the other health emergencies that African countries are also grappling with, alongside COVID-19, and Ouma, a Kenyan epidemiologist, said that his center is currently monitoring up to nine different public health events. Nigeria reported over 600 new cases of diphtheria and several African countries reported cases of cholera, including Malawi, where three-quarters of the continent’s cases have been reported. The continent has documented over 12 million cases of COVID-19 and 256,705 deaths, a case fatality rate of 2.1%, which is double the global average, Ouma told the media. While the number of new cases and deaths have decreased over the past several weeks, he emphasized the importance of continuing to encourage vaccination efforts and targeted campaigns to reach more people. “The general trend on the continent now is quite flat with the indications that we may be seeing further decreases in numbers and also in deaths,” Ouma told journalists. Ouma noted that Africa CDC is working with governments and health organizations to provide technical assistance and medical countermeasures as needed for these and other health emergencies. He added that the organization is also continuing to promote vaccination efforts and targeted campaigns to help prevent the spread of infectious diseases. Draft Pandemic Accord Neglects Prevention, Particularly ‘Zoonotic Spillover’ 15/02/2023 Kerry Cullinan INB co-chair Roland Driece The draft pandemic accord needs more emphasis on preventing pandemics at their source – where animal pathogens “spill over” to people – according to a number of organisations participating in a consultation on the document’s “zero draft” on Wednesday. Negotiations between World Health Organization (WHO) member states on the draft are due to begin at the fourth meeting of the Intergovernmental Negotiating Body (INB), scheduled to take place from 27 February to 3 March. However, Wednesday’s meeting gave WHO’s civil society stakeholders an opportunity to comment on the draft ahead of that meeting. Only member states will take part in the actual treaty negotiations, which are likely to start behind closed doors on the second day of the month-end meeting (called INB 4), INB co-chair Roland Driece told the meeting. INB 4 and the following INB5 meeting from 3 to 6 April would be approached as “one big meeting”, he added. While the start of the meeting would be open to all stakeholders, “as soon as member states tell us that they accept the zero draft as the zero draft, we will move into negotiation mode, and that means that only member states can be present,” said Driece. “So that’s why it’s so important that you tell us and member states now what you feel and think about this zero draft.” He added that he thought that the INB Bureau had done “a pretty decent job [of synthesizing stakeholders’ inputs]” but “this is an important moment for you all to share whether or not you share my optimism about that and tell us what you think is important”. Prevent ‘zoonotic spillover’ – environmental and animal health groups Across large swathes of Asia and Africa, wholesale markets often sell wild animals captured or bred for food consumption, and which may harbor dangerous viruses. Many scientists believe that SARS-CoV2 was transmitted to humans via live, wild animals, caged for slaughter in Wuhan’s wet market. An unprecedented number of organisations spoke about how the draft needs to pay more attention to pandemic prevention at the source; this means addressing the social, environmental and food safety factors that lead to the spillover of pathogens from wild animal populations into human communities. These drivers range from deforestation which has prompted animal populations like bats, which harbor a range of deadly pathogens from SARS-COV to Marburg, to move closer to human habitats; to wild animal trafficking and trade, both legal and illicit; as well as industrial production, sale and slaugher of wild animal species. The Wildlife Conservation Society recommended that the accord commit governments to “identifying and prioritising actions to prevent pathogen spillover in the first place” by prioritising tougher regulations on “markets and trade chains and wildlife domestic and international trade”. “We have extensive experience and expertise with habitat degredation, deforestation, forest degradation, wildlife trade and wildlife markets,” said the WCS representative. “And this isn’t about illegal trade, its about any live trade, particularly for food but also for other purposes, birds and mammals. We look forward to working with member states and the INB to ensure that first and foremost there are commitments by governments to avoid the spillover in the first place. And we do know how to do that, from a biodiversity perspective and in terms of markets.” The World Wildlife Fund (WWF) appealed for the “list of drivers of pathogen emergence risks to be expanded to include not just deforestation, but ecosystem loss, fragmentation and degradation”. “Deforestation alone omits many of the potentially important pandemic frontiers and ignores the role of fragmentation and degradation in increasing proximity between humans and wildlife,” said the WWF. Meanwhile, the World Organisation of Animal Health (WOAH) called for the inclusion of the full definition of “One Health” in the treaty. Its delegate also questioned why preparedness and response were stressed whereas “preventive actions targeting activities and places that increase the risk of zoonotic spillover” were not. Pointing to a lack of expertise to address zoonotic spillover, the Action for Animal Health Coalition said that member states needed to invest in increasing the animal health workforce. Equity obligations Oxfam’s Piotr Kolczynski, who also represented the People’s Vaccine Alliance. Meanwhile, Oxfam, also representing the People’s Vaccine Alliance, said that “the accord’s language must oblige governments to take specific actions to ensure equity; otherwise it would be very difficult to implement this”. The current zero draft also assumes that “critical public health interventions are based on the willingness of pharmaceutical companies to engage in voluntary mechanisms” but “these have proved to be largely insufficient during the current and previous pandemics,” said Piotr Kolczynski, of Oxfam and PVA. For this reason, it added, “the accord must require governments to invest in research and development and manufacturing capacities and to condition public funding on the sharing of technologies, knowledge and intellectual property with developers and manufacturers in the South”. In reference to the accord’s proposal that 20% of pandemic-related goods be allocated to the WHO for distribution, Oxfam stated that “equitable allocation of medical countermeasures cannot be achieved by reserving a 20% of production for 80% of the world’s population”. Medecins sans Frontieres (MSF), meanwhile, asked for a legal definition of “pandemic”, and “explicit reference to governments complying with international humanitarian law obligations in the context of pandemic preparedness, prevention and response”. It also demanded stronger language in relation to commitments to protect “humanitarian populations of concerns” and healthcare workers during pandemics. Private sector is a ‘critical partner’ IFPMA’s Grega Kumer, Deputy Director of Government Relations. “The private sector should be seen as a critical partner in preparedness, response and recovery, and should have a seat at the table,” stated Grega Kumer, Deputy Director of Government Relations at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). However, it warned that some of the accord’s proposals “would jeopardise our capacity to efficiently prepare for the next pandemic.” Key concerns it cited included proposals for a waiver on intellectual property rights (IP) for health products during a pandemic, as well as proposals that would “be “transactionally linking access to pathogens and sharing of benefits”. It also urged the INB to “avoid unnecessary overlaps and duplications including other multilateral organisations mandate and expertise such as WTO and WIPO”. While there were over 200 participants online, a handful of member states were also on hand to listen in person at WHO’s Geneva Headquarters to the inputs as they prepare for INB4, when the real negotiations begin for the accord that is due to be presented by May 2024 to the World Health Assembly. Image Credits: Peter Griffin/Public Domain Pictures. Mpox To Remain A Public Health Emergency of International Concern Says WHO 15/02/2023 Megha Kaveri Dr Tedros Adhanom Ghebreyesus speaking at the media briefing on Wednesday. The World Health Organization (WHO) declared on Wednesday that Mpox will continue to remain a Public Health Emergency of International Concern (PHEIC). The decision to continue with the status quo on Mpox was based on the recommendations made by an Mpox Emergency Committee, whose findings were published on the same day. “The emergency committee for the global outbreak of Mpox met to assess whether, in its view, the outbreak remains a public health emergency of international concern. The committee has advised me that, in its view, Mpox remains a global health emergency, and I have accepted that advice,” Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a press briefing on Wednesday. In its report, the Mpox committee, which met on 9 February, acknowledged the progress made in reducing the virus transmission and the sharp decline of reported cases. However, it also expressed concerns that “a few countries continued to see a sustained incidence of illness” while in other countries it’s likely that more cases are occuring under the radar. “More than 30 countries continue to report cases, and the possible underdetection and under-reporting of confirmed cases in some regions is concerning. Particularly in countries where animal-human transmission of Mpox has been reported before,” Tedros pointed out. In its report, the expert committee also expressed concerns about the possible resurgence of cases due to the expected resumption of LGBTQ social events and other mass gathering events; lack of access to vaccines and testing capacities in many lower-income countries; and the recurring zoonotic transmission in Africa. It added that “not all countries are receiving the support they need or have structures or systems to respond to mpox, including inadequate support for marginalized groups; and general fatigue among supporting agencies.” Returning from Syrian scenes of devastation Tedros spoke at the briefing shortly after returning to Geneva from a visit to earthquake affected areas in Syria. The 7.8 magnitude earthquake that hit Syria and Türkiye last week is now estimated to have killed over 41,000 people. I've never in my life seen the level of destruction as I did on the road from Aleppo to Damascus. Skeletons of houses. Almost no people in sight. Over a decade of war has taken an unimaginable toll. Syrians need our support now and in years to come to rebuild their lives. pic.twitter.com/Ym2zmDixdw — Tedros Adhanom Ghebreyesus (@DrTedros) February 14, 2023 Describing the damage caused to Aleppo and Damascus first due to the war, and now by the earthquake, Tedros said “I saw the destruction of entire communities, the unspeakable suffering of people, and the courage and determination of survivors and responders. As we drove from Aleppo to Damascus, I saw the legacy of conflict, with town after town destroyed and abandoned. Survivors are now facing freezing conditions without adequate shelter, heating, food, clean water, or medical care.” While two more cross-border points between Türkiye and Syria have been opened, Tedros said he had had asked Syrian president Bashar al-Assad to open still more crossings so that relief could reach people in need more rapidly. Humanitarian aid groups charge that the Syrian president has “weaponized aid” channeling available supplies to government controlled areas – while most of western Syria where the earthquake hit, is controlled by Kurdish and other Syrian anti-government militias. “WHO remains committed to supporting all people in the Syrian Arab Republic now and in the days, weeks, months, and years ahead,” Tedros added. The WHO has launched an appeal for $43 million to support its response in Syria and Türkiye and expects the amount to double by this weekend. Meanwhile, UN Secretary General Antonio Guterres called upon countries to fully fund a $397 million earthquake fund for Syria, in particular, which lacks resources to mount its own response. Marburg disease – ramping up diagnostics and clinical trial possibilities Touching back on the Marburg Virus Disease (MVD) outbreak in Equatorial Guinea, which has claimed nine lives, Tedros said that the WHO is working with the country’s health authorities to ramp up their diagnostic capacity. “So far, no confirmed cases have been reported in Cameroon and or Gabon,” he added, referring to the two countries that, along with Liberia, border Equatorial Guinea. “We’re also supporting the governments of Cameroon and Gabon to prepare to rapidly detect, isolate, and provide care for any suspected cases.” Following up on the Marburg Virus Vaccine Consortium (MARVAC)’s meeting on Tuesday, Tedros said that WHO is trying to accelerate talks on possibile clinical trials for Marburg virus diseaes vaccine candidates. But he reiterated that any decision on the trials of vaccines and therapeutics for Marburg needs to be taken by researchers and the national authorities of Equatorial Guinea. “In the meantime, WHO is convening the vaccine prioritization committee to identify which vaccine candidates should be evaluated first and prepare for potential trials. WHO is also discussing with the ministry of health, the possibility of providing access to experimental therapeutics as part of a clinical trial,” he said. WHO Denies it Abandoned Investigation of COVID-19 Origins – But Way Forward Unclear 15/02/2023 Megha Kaveri Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing. A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic. The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021, But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country. In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.” Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating: “I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.” However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question: “In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.” China has evaded WHO’s requests for cooperation China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted. “Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. “Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones. “Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated. But apparently so far, there has been no return mail. Image Credits: Megha Kaveri. WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Natural Immunity Against COVID-19 ‘At Least’ On Par With Vaccination in Preventing Death 21/02/2023 Stefan Anderson Natural immunity provides strong protection against severe illness from COVID-19, but obtaining it carries its own set of risks. New research published in The Lancet suggests that individuals who have previously been infected with COVID-19 have an 88% lower risk of hospitalization or death than those who have not. The study is the most comprehensive review of data on natural immunity to date, covering data from 65 studies across 19 countries published since January 2021. The analysis found that the strength and 10-month duration of protection conferred by natural immunity against severe illness is “at least” on par with that provided by two doses of Moderna and Pfizer-BioNtech’s mRNA vaccines. The study’s authors said the data suggests natural immunity in people recently infected with COVID-19 should be recognised by policymakers but warned against using their findings to undermine the importance of vaccination due to the risks associated with the first infection. “Vaccination is the safest way to acquire immunity, whereas acquiring natural immunity must be weighed against the risks of severe illness and death associated with the initial infection,” lead author Dr Stephen Lim of the University of Washington’s School of Medicine. Researchers also cautioned that differences between the infectious properties of COVID-19 variants mean protection levels can vary. Infection by pre-Omicron variants, for example, yielded substantially lower natural immunity protection against reinfection by the now dominant Omicron BA.1 variant, with just 36% protection remaining after the 10-month window. Nevertheless, protection against hospitalization and death remained high at 88%. “The weaker cross-variant immunity with the Omicron variant and its sub-lineages reflects the mutations they have that make them escape built-up immunity more easily than other variants,” report co-author Dr Hasan Nassereldine of the University of Washington’s School of Medicine said. “The limited data we have on natural immunity protection from the Omicron variant and its sub-lineages underscores the importance of continued assessment, particularly since they are estimated to have infected 46% of the global population between November 2021 and June 2022.” The analysis excluded studies examining “hybrid immunity” (the combination of immune responses from vaccination and natural infection) as well as data relating to Omicron XBB and its sub-lineages. The authors encouraged further research to fill the gaps in the study. Europeans Don’t Exercise Enough – And Policy-Makers Should Do More to Encourage Them 17/02/2023 Kerry Cullinan A third of Europeans don’t meet the World Health Organization’s (WHO) guidelines for physical activity – but if they did, this would avert over 10 000 premature deaths, almost four million cases of cardiovascular disease, three and a half million cases of depression and nearly a million cases of type two diabetes by 2050. This is according to a report launched on Friday by the WHO Europe and the Organisation for Economic Co-operation and Development (OECD), which urges policy-makers to adopt strategies to increase people’s physical activity. The findings are based on a recent Eurobarometer survey conducted for the European Commission which found that 45% of the respondents report that they never exercise or play sport, an increase of 6% since 2009. People in Finland (71%), Luxembourg (63%), the Netherlands (60%), and Denmark and Sweden (both 59%) were the most likely to exercise, while people in Portugal, Greece and Poland were least likely to exercise. “We find that it’s worse among women, with some countries having almost half of all adult women not meeting the WHO recommended guidelines on physical activity,” OECD health policy analyst Sabine Vuik told the launch on Friday. Meanwhile, less than a quarter of people who consider themselves to be working class exercise at least once a week, and over half of all adults surveyed said that they exercised less frequently since the COVID-19 pandemic. Recommended activity The WHO recommends that everyone does at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity every week. “This could be a half-hour run twice a week, running about 10 kilometres per hour, but it doesn’t need to be formal exercise. It can also be walking the dog every day for half an hour,” added Vuik. OECD health analyst Sabine Vuik “Our analysis shows that larger countries such as Germany, France and Italy can save more than €1 billion every year if everyone were to meet the physical activity guidelines. And across the EU, we could save €8 billion every year in healthcare expenditure if everyone meets the minimum recommended guidelines.” WHO Europe regional director Dr Hans Kluge, said that the report “provides evidence that investing in policies that promote physical activity not only improves individual well-being and population health, but also pays economic dividends”. “Every €1 invested in physical activity generates an almost two-fold return of €1.7 in economic benefits. We need to communicate the benefits of being active, not just the physical benefits, but the benefits to mental health, the environment and society in the WHO European Region, and we need to make sure that our systems can and will sustain these changes – as real, long-term transformation,” added Kluge, who is an avid cyclist and cycles to work and back daily. The report calls on policymakers to step up the policy response to increase physical activity in schools, in urban and transport design and in healthcare settings and workplaces. Since 2015, some EU countries have adopted policies to improve access to physical activity. For example, Finland adopted a resolution to promote active modes of transportation, Austria builds up co-operation between sports clubs and primary schools and Bulgaria develops a programme to help people whose jobs involve sitting for long periods. Investing in #PhysicalActivity improves individual and population health, while returning 1.7 EUR in economic benefits for every 1 EUR invested. New WHO/@OECD report funded by the #EU shares great ideas for policy makers to consider.👇https://t.co/Ri3xynx9bv@EU_Commission pic.twitter.com/A28qBknwiQ — WHO/Europe (@WHO_Europe) February 17, 2023 Lack of Test Kits for Marburg Virus Hamper Africa’s Response to Outbreak 16/02/2023 Paul Adepoju Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control. The Africa Centres for Disease Control and Prevention (Africa CDC) is closely monitoring Equatorial Guinea’s first-ever Marburg virus disease outbreak, Africa CDC acting director Dr Ahmed Ogwell Ouma told a media briefing on Thursday “One big challenge we have are test kits and we are working around the clock to try and get test kits to Equatorial Guinea and also to Cameroon and Gabon, to ensure that we have a very short turnaround time for samples being tested in the laboratory,” Ouma added. So far, one case has been confirmed and nine deaths have been reported, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. Ouma added that a key priority is to limit the spread of the virus, as well as monitor neighbouring countries such as Cameroon and Gabon for potential cross-border spillover. As reported by Health Policy Watch, on Tuesday, the WHO received updates from five vaccine developers who have been working on candidate vaccines. The WHO plans to convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. Diphtheria, cholera, mpox, Lassa fever, and measles are some of the other health emergencies that African countries are also grappling with, alongside COVID-19, and Ouma, a Kenyan epidemiologist, said that his center is currently monitoring up to nine different public health events. Nigeria reported over 600 new cases of diphtheria and several African countries reported cases of cholera, including Malawi, where three-quarters of the continent’s cases have been reported. The continent has documented over 12 million cases of COVID-19 and 256,705 deaths, a case fatality rate of 2.1%, which is double the global average, Ouma told the media. While the number of new cases and deaths have decreased over the past several weeks, he emphasized the importance of continuing to encourage vaccination efforts and targeted campaigns to reach more people. “The general trend on the continent now is quite flat with the indications that we may be seeing further decreases in numbers and also in deaths,” Ouma told journalists. Ouma noted that Africa CDC is working with governments and health organizations to provide technical assistance and medical countermeasures as needed for these and other health emergencies. He added that the organization is also continuing to promote vaccination efforts and targeted campaigns to help prevent the spread of infectious diseases. Draft Pandemic Accord Neglects Prevention, Particularly ‘Zoonotic Spillover’ 15/02/2023 Kerry Cullinan INB co-chair Roland Driece The draft pandemic accord needs more emphasis on preventing pandemics at their source – where animal pathogens “spill over” to people – according to a number of organisations participating in a consultation on the document’s “zero draft” on Wednesday. Negotiations between World Health Organization (WHO) member states on the draft are due to begin at the fourth meeting of the Intergovernmental Negotiating Body (INB), scheduled to take place from 27 February to 3 March. However, Wednesday’s meeting gave WHO’s civil society stakeholders an opportunity to comment on the draft ahead of that meeting. Only member states will take part in the actual treaty negotiations, which are likely to start behind closed doors on the second day of the month-end meeting (called INB 4), INB co-chair Roland Driece told the meeting. INB 4 and the following INB5 meeting from 3 to 6 April would be approached as “one big meeting”, he added. While the start of the meeting would be open to all stakeholders, “as soon as member states tell us that they accept the zero draft as the zero draft, we will move into negotiation mode, and that means that only member states can be present,” said Driece. “So that’s why it’s so important that you tell us and member states now what you feel and think about this zero draft.” He added that he thought that the INB Bureau had done “a pretty decent job [of synthesizing stakeholders’ inputs]” but “this is an important moment for you all to share whether or not you share my optimism about that and tell us what you think is important”. Prevent ‘zoonotic spillover’ – environmental and animal health groups Across large swathes of Asia and Africa, wholesale markets often sell wild animals captured or bred for food consumption, and which may harbor dangerous viruses. Many scientists believe that SARS-CoV2 was transmitted to humans via live, wild animals, caged for slaughter in Wuhan’s wet market. An unprecedented number of organisations spoke about how the draft needs to pay more attention to pandemic prevention at the source; this means addressing the social, environmental and food safety factors that lead to the spillover of pathogens from wild animal populations into human communities. These drivers range from deforestation which has prompted animal populations like bats, which harbor a range of deadly pathogens from SARS-COV to Marburg, to move closer to human habitats; to wild animal trafficking and trade, both legal and illicit; as well as industrial production, sale and slaugher of wild animal species. The Wildlife Conservation Society recommended that the accord commit governments to “identifying and prioritising actions to prevent pathogen spillover in the first place” by prioritising tougher regulations on “markets and trade chains and wildlife domestic and international trade”. “We have extensive experience and expertise with habitat degredation, deforestation, forest degradation, wildlife trade and wildlife markets,” said the WCS representative. “And this isn’t about illegal trade, its about any live trade, particularly for food but also for other purposes, birds and mammals. We look forward to working with member states and the INB to ensure that first and foremost there are commitments by governments to avoid the spillover in the first place. And we do know how to do that, from a biodiversity perspective and in terms of markets.” The World Wildlife Fund (WWF) appealed for the “list of drivers of pathogen emergence risks to be expanded to include not just deforestation, but ecosystem loss, fragmentation and degradation”. “Deforestation alone omits many of the potentially important pandemic frontiers and ignores the role of fragmentation and degradation in increasing proximity between humans and wildlife,” said the WWF. Meanwhile, the World Organisation of Animal Health (WOAH) called for the inclusion of the full definition of “One Health” in the treaty. Its delegate also questioned why preparedness and response were stressed whereas “preventive actions targeting activities and places that increase the risk of zoonotic spillover” were not. Pointing to a lack of expertise to address zoonotic spillover, the Action for Animal Health Coalition said that member states needed to invest in increasing the animal health workforce. Equity obligations Oxfam’s Piotr Kolczynski, who also represented the People’s Vaccine Alliance. Meanwhile, Oxfam, also representing the People’s Vaccine Alliance, said that “the accord’s language must oblige governments to take specific actions to ensure equity; otherwise it would be very difficult to implement this”. The current zero draft also assumes that “critical public health interventions are based on the willingness of pharmaceutical companies to engage in voluntary mechanisms” but “these have proved to be largely insufficient during the current and previous pandemics,” said Piotr Kolczynski, of Oxfam and PVA. For this reason, it added, “the accord must require governments to invest in research and development and manufacturing capacities and to condition public funding on the sharing of technologies, knowledge and intellectual property with developers and manufacturers in the South”. In reference to the accord’s proposal that 20% of pandemic-related goods be allocated to the WHO for distribution, Oxfam stated that “equitable allocation of medical countermeasures cannot be achieved by reserving a 20% of production for 80% of the world’s population”. Medecins sans Frontieres (MSF), meanwhile, asked for a legal definition of “pandemic”, and “explicit reference to governments complying with international humanitarian law obligations in the context of pandemic preparedness, prevention and response”. It also demanded stronger language in relation to commitments to protect “humanitarian populations of concerns” and healthcare workers during pandemics. Private sector is a ‘critical partner’ IFPMA’s Grega Kumer, Deputy Director of Government Relations. “The private sector should be seen as a critical partner in preparedness, response and recovery, and should have a seat at the table,” stated Grega Kumer, Deputy Director of Government Relations at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). However, it warned that some of the accord’s proposals “would jeopardise our capacity to efficiently prepare for the next pandemic.” Key concerns it cited included proposals for a waiver on intellectual property rights (IP) for health products during a pandemic, as well as proposals that would “be “transactionally linking access to pathogens and sharing of benefits”. It also urged the INB to “avoid unnecessary overlaps and duplications including other multilateral organisations mandate and expertise such as WTO and WIPO”. While there were over 200 participants online, a handful of member states were also on hand to listen in person at WHO’s Geneva Headquarters to the inputs as they prepare for INB4, when the real negotiations begin for the accord that is due to be presented by May 2024 to the World Health Assembly. Image Credits: Peter Griffin/Public Domain Pictures. Mpox To Remain A Public Health Emergency of International Concern Says WHO 15/02/2023 Megha Kaveri Dr Tedros Adhanom Ghebreyesus speaking at the media briefing on Wednesday. The World Health Organization (WHO) declared on Wednesday that Mpox will continue to remain a Public Health Emergency of International Concern (PHEIC). The decision to continue with the status quo on Mpox was based on the recommendations made by an Mpox Emergency Committee, whose findings were published on the same day. “The emergency committee for the global outbreak of Mpox met to assess whether, in its view, the outbreak remains a public health emergency of international concern. The committee has advised me that, in its view, Mpox remains a global health emergency, and I have accepted that advice,” Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a press briefing on Wednesday. In its report, the Mpox committee, which met on 9 February, acknowledged the progress made in reducing the virus transmission and the sharp decline of reported cases. However, it also expressed concerns that “a few countries continued to see a sustained incidence of illness” while in other countries it’s likely that more cases are occuring under the radar. “More than 30 countries continue to report cases, and the possible underdetection and under-reporting of confirmed cases in some regions is concerning. Particularly in countries where animal-human transmission of Mpox has been reported before,” Tedros pointed out. In its report, the expert committee also expressed concerns about the possible resurgence of cases due to the expected resumption of LGBTQ social events and other mass gathering events; lack of access to vaccines and testing capacities in many lower-income countries; and the recurring zoonotic transmission in Africa. It added that “not all countries are receiving the support they need or have structures or systems to respond to mpox, including inadequate support for marginalized groups; and general fatigue among supporting agencies.” Returning from Syrian scenes of devastation Tedros spoke at the briefing shortly after returning to Geneva from a visit to earthquake affected areas in Syria. The 7.8 magnitude earthquake that hit Syria and Türkiye last week is now estimated to have killed over 41,000 people. I've never in my life seen the level of destruction as I did on the road from Aleppo to Damascus. Skeletons of houses. Almost no people in sight. Over a decade of war has taken an unimaginable toll. Syrians need our support now and in years to come to rebuild their lives. pic.twitter.com/Ym2zmDixdw — Tedros Adhanom Ghebreyesus (@DrTedros) February 14, 2023 Describing the damage caused to Aleppo and Damascus first due to the war, and now by the earthquake, Tedros said “I saw the destruction of entire communities, the unspeakable suffering of people, and the courage and determination of survivors and responders. As we drove from Aleppo to Damascus, I saw the legacy of conflict, with town after town destroyed and abandoned. Survivors are now facing freezing conditions without adequate shelter, heating, food, clean water, or medical care.” While two more cross-border points between Türkiye and Syria have been opened, Tedros said he had had asked Syrian president Bashar al-Assad to open still more crossings so that relief could reach people in need more rapidly. Humanitarian aid groups charge that the Syrian president has “weaponized aid” channeling available supplies to government controlled areas – while most of western Syria where the earthquake hit, is controlled by Kurdish and other Syrian anti-government militias. “WHO remains committed to supporting all people in the Syrian Arab Republic now and in the days, weeks, months, and years ahead,” Tedros added. The WHO has launched an appeal for $43 million to support its response in Syria and Türkiye and expects the amount to double by this weekend. Meanwhile, UN Secretary General Antonio Guterres called upon countries to fully fund a $397 million earthquake fund for Syria, in particular, which lacks resources to mount its own response. Marburg disease – ramping up diagnostics and clinical trial possibilities Touching back on the Marburg Virus Disease (MVD) outbreak in Equatorial Guinea, which has claimed nine lives, Tedros said that the WHO is working with the country’s health authorities to ramp up their diagnostic capacity. “So far, no confirmed cases have been reported in Cameroon and or Gabon,” he added, referring to the two countries that, along with Liberia, border Equatorial Guinea. “We’re also supporting the governments of Cameroon and Gabon to prepare to rapidly detect, isolate, and provide care for any suspected cases.” Following up on the Marburg Virus Vaccine Consortium (MARVAC)’s meeting on Tuesday, Tedros said that WHO is trying to accelerate talks on possibile clinical trials for Marburg virus diseaes vaccine candidates. But he reiterated that any decision on the trials of vaccines and therapeutics for Marburg needs to be taken by researchers and the national authorities of Equatorial Guinea. “In the meantime, WHO is convening the vaccine prioritization committee to identify which vaccine candidates should be evaluated first and prepare for potential trials. WHO is also discussing with the ministry of health, the possibility of providing access to experimental therapeutics as part of a clinical trial,” he said. WHO Denies it Abandoned Investigation of COVID-19 Origins – But Way Forward Unclear 15/02/2023 Megha Kaveri Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing. A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic. The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021, But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country. In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.” Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating: “I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.” However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question: “In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.” China has evaded WHO’s requests for cooperation China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted. “Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. “Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones. “Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated. But apparently so far, there has been no return mail. Image Credits: Megha Kaveri. WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Europeans Don’t Exercise Enough – And Policy-Makers Should Do More to Encourage Them 17/02/2023 Kerry Cullinan A third of Europeans don’t meet the World Health Organization’s (WHO) guidelines for physical activity – but if they did, this would avert over 10 000 premature deaths, almost four million cases of cardiovascular disease, three and a half million cases of depression and nearly a million cases of type two diabetes by 2050. This is according to a report launched on Friday by the WHO Europe and the Organisation for Economic Co-operation and Development (OECD), which urges policy-makers to adopt strategies to increase people’s physical activity. The findings are based on a recent Eurobarometer survey conducted for the European Commission which found that 45% of the respondents report that they never exercise or play sport, an increase of 6% since 2009. People in Finland (71%), Luxembourg (63%), the Netherlands (60%), and Denmark and Sweden (both 59%) were the most likely to exercise, while people in Portugal, Greece and Poland were least likely to exercise. “We find that it’s worse among women, with some countries having almost half of all adult women not meeting the WHO recommended guidelines on physical activity,” OECD health policy analyst Sabine Vuik told the launch on Friday. Meanwhile, less than a quarter of people who consider themselves to be working class exercise at least once a week, and over half of all adults surveyed said that they exercised less frequently since the COVID-19 pandemic. Recommended activity The WHO recommends that everyone does at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity every week. “This could be a half-hour run twice a week, running about 10 kilometres per hour, but it doesn’t need to be formal exercise. It can also be walking the dog every day for half an hour,” added Vuik. OECD health analyst Sabine Vuik “Our analysis shows that larger countries such as Germany, France and Italy can save more than €1 billion every year if everyone were to meet the physical activity guidelines. And across the EU, we could save €8 billion every year in healthcare expenditure if everyone meets the minimum recommended guidelines.” WHO Europe regional director Dr Hans Kluge, said that the report “provides evidence that investing in policies that promote physical activity not only improves individual well-being and population health, but also pays economic dividends”. “Every €1 invested in physical activity generates an almost two-fold return of €1.7 in economic benefits. We need to communicate the benefits of being active, not just the physical benefits, but the benefits to mental health, the environment and society in the WHO European Region, and we need to make sure that our systems can and will sustain these changes – as real, long-term transformation,” added Kluge, who is an avid cyclist and cycles to work and back daily. The report calls on policymakers to step up the policy response to increase physical activity in schools, in urban and transport design and in healthcare settings and workplaces. Since 2015, some EU countries have adopted policies to improve access to physical activity. For example, Finland adopted a resolution to promote active modes of transportation, Austria builds up co-operation between sports clubs and primary schools and Bulgaria develops a programme to help people whose jobs involve sitting for long periods. Investing in #PhysicalActivity improves individual and population health, while returning 1.7 EUR in economic benefits for every 1 EUR invested. New WHO/@OECD report funded by the #EU shares great ideas for policy makers to consider.👇https://t.co/Ri3xynx9bv@EU_Commission pic.twitter.com/A28qBknwiQ — WHO/Europe (@WHO_Europe) February 17, 2023 Lack of Test Kits for Marburg Virus Hamper Africa’s Response to Outbreak 16/02/2023 Paul Adepoju Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control. The Africa Centres for Disease Control and Prevention (Africa CDC) is closely monitoring Equatorial Guinea’s first-ever Marburg virus disease outbreak, Africa CDC acting director Dr Ahmed Ogwell Ouma told a media briefing on Thursday “One big challenge we have are test kits and we are working around the clock to try and get test kits to Equatorial Guinea and also to Cameroon and Gabon, to ensure that we have a very short turnaround time for samples being tested in the laboratory,” Ouma added. So far, one case has been confirmed and nine deaths have been reported, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. Ouma added that a key priority is to limit the spread of the virus, as well as monitor neighbouring countries such as Cameroon and Gabon for potential cross-border spillover. As reported by Health Policy Watch, on Tuesday, the WHO received updates from five vaccine developers who have been working on candidate vaccines. The WHO plans to convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. Diphtheria, cholera, mpox, Lassa fever, and measles are some of the other health emergencies that African countries are also grappling with, alongside COVID-19, and Ouma, a Kenyan epidemiologist, said that his center is currently monitoring up to nine different public health events. Nigeria reported over 600 new cases of diphtheria and several African countries reported cases of cholera, including Malawi, where three-quarters of the continent’s cases have been reported. The continent has documented over 12 million cases of COVID-19 and 256,705 deaths, a case fatality rate of 2.1%, which is double the global average, Ouma told the media. While the number of new cases and deaths have decreased over the past several weeks, he emphasized the importance of continuing to encourage vaccination efforts and targeted campaigns to reach more people. “The general trend on the continent now is quite flat with the indications that we may be seeing further decreases in numbers and also in deaths,” Ouma told journalists. Ouma noted that Africa CDC is working with governments and health organizations to provide technical assistance and medical countermeasures as needed for these and other health emergencies. He added that the organization is also continuing to promote vaccination efforts and targeted campaigns to help prevent the spread of infectious diseases. Draft Pandemic Accord Neglects Prevention, Particularly ‘Zoonotic Spillover’ 15/02/2023 Kerry Cullinan INB co-chair Roland Driece The draft pandemic accord needs more emphasis on preventing pandemics at their source – where animal pathogens “spill over” to people – according to a number of organisations participating in a consultation on the document’s “zero draft” on Wednesday. Negotiations between World Health Organization (WHO) member states on the draft are due to begin at the fourth meeting of the Intergovernmental Negotiating Body (INB), scheduled to take place from 27 February to 3 March. However, Wednesday’s meeting gave WHO’s civil society stakeholders an opportunity to comment on the draft ahead of that meeting. Only member states will take part in the actual treaty negotiations, which are likely to start behind closed doors on the second day of the month-end meeting (called INB 4), INB co-chair Roland Driece told the meeting. INB 4 and the following INB5 meeting from 3 to 6 April would be approached as “one big meeting”, he added. While the start of the meeting would be open to all stakeholders, “as soon as member states tell us that they accept the zero draft as the zero draft, we will move into negotiation mode, and that means that only member states can be present,” said Driece. “So that’s why it’s so important that you tell us and member states now what you feel and think about this zero draft.” He added that he thought that the INB Bureau had done “a pretty decent job [of synthesizing stakeholders’ inputs]” but “this is an important moment for you all to share whether or not you share my optimism about that and tell us what you think is important”. Prevent ‘zoonotic spillover’ – environmental and animal health groups Across large swathes of Asia and Africa, wholesale markets often sell wild animals captured or bred for food consumption, and which may harbor dangerous viruses. Many scientists believe that SARS-CoV2 was transmitted to humans via live, wild animals, caged for slaughter in Wuhan’s wet market. An unprecedented number of organisations spoke about how the draft needs to pay more attention to pandemic prevention at the source; this means addressing the social, environmental and food safety factors that lead to the spillover of pathogens from wild animal populations into human communities. These drivers range from deforestation which has prompted animal populations like bats, which harbor a range of deadly pathogens from SARS-COV to Marburg, to move closer to human habitats; to wild animal trafficking and trade, both legal and illicit; as well as industrial production, sale and slaugher of wild animal species. The Wildlife Conservation Society recommended that the accord commit governments to “identifying and prioritising actions to prevent pathogen spillover in the first place” by prioritising tougher regulations on “markets and trade chains and wildlife domestic and international trade”. “We have extensive experience and expertise with habitat degredation, deforestation, forest degradation, wildlife trade and wildlife markets,” said the WCS representative. “And this isn’t about illegal trade, its about any live trade, particularly for food but also for other purposes, birds and mammals. We look forward to working with member states and the INB to ensure that first and foremost there are commitments by governments to avoid the spillover in the first place. And we do know how to do that, from a biodiversity perspective and in terms of markets.” The World Wildlife Fund (WWF) appealed for the “list of drivers of pathogen emergence risks to be expanded to include not just deforestation, but ecosystem loss, fragmentation and degradation”. “Deforestation alone omits many of the potentially important pandemic frontiers and ignores the role of fragmentation and degradation in increasing proximity between humans and wildlife,” said the WWF. Meanwhile, the World Organisation of Animal Health (WOAH) called for the inclusion of the full definition of “One Health” in the treaty. Its delegate also questioned why preparedness and response were stressed whereas “preventive actions targeting activities and places that increase the risk of zoonotic spillover” were not. Pointing to a lack of expertise to address zoonotic spillover, the Action for Animal Health Coalition said that member states needed to invest in increasing the animal health workforce. Equity obligations Oxfam’s Piotr Kolczynski, who also represented the People’s Vaccine Alliance. Meanwhile, Oxfam, also representing the People’s Vaccine Alliance, said that “the accord’s language must oblige governments to take specific actions to ensure equity; otherwise it would be very difficult to implement this”. The current zero draft also assumes that “critical public health interventions are based on the willingness of pharmaceutical companies to engage in voluntary mechanisms” but “these have proved to be largely insufficient during the current and previous pandemics,” said Piotr Kolczynski, of Oxfam and PVA. For this reason, it added, “the accord must require governments to invest in research and development and manufacturing capacities and to condition public funding on the sharing of technologies, knowledge and intellectual property with developers and manufacturers in the South”. In reference to the accord’s proposal that 20% of pandemic-related goods be allocated to the WHO for distribution, Oxfam stated that “equitable allocation of medical countermeasures cannot be achieved by reserving a 20% of production for 80% of the world’s population”. Medecins sans Frontieres (MSF), meanwhile, asked for a legal definition of “pandemic”, and “explicit reference to governments complying with international humanitarian law obligations in the context of pandemic preparedness, prevention and response”. It also demanded stronger language in relation to commitments to protect “humanitarian populations of concerns” and healthcare workers during pandemics. Private sector is a ‘critical partner’ IFPMA’s Grega Kumer, Deputy Director of Government Relations. “The private sector should be seen as a critical partner in preparedness, response and recovery, and should have a seat at the table,” stated Grega Kumer, Deputy Director of Government Relations at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). However, it warned that some of the accord’s proposals “would jeopardise our capacity to efficiently prepare for the next pandemic.” Key concerns it cited included proposals for a waiver on intellectual property rights (IP) for health products during a pandemic, as well as proposals that would “be “transactionally linking access to pathogens and sharing of benefits”. It also urged the INB to “avoid unnecessary overlaps and duplications including other multilateral organisations mandate and expertise such as WTO and WIPO”. While there were over 200 participants online, a handful of member states were also on hand to listen in person at WHO’s Geneva Headquarters to the inputs as they prepare for INB4, when the real negotiations begin for the accord that is due to be presented by May 2024 to the World Health Assembly. Image Credits: Peter Griffin/Public Domain Pictures. Mpox To Remain A Public Health Emergency of International Concern Says WHO 15/02/2023 Megha Kaveri Dr Tedros Adhanom Ghebreyesus speaking at the media briefing on Wednesday. The World Health Organization (WHO) declared on Wednesday that Mpox will continue to remain a Public Health Emergency of International Concern (PHEIC). The decision to continue with the status quo on Mpox was based on the recommendations made by an Mpox Emergency Committee, whose findings were published on the same day. “The emergency committee for the global outbreak of Mpox met to assess whether, in its view, the outbreak remains a public health emergency of international concern. The committee has advised me that, in its view, Mpox remains a global health emergency, and I have accepted that advice,” Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a press briefing on Wednesday. In its report, the Mpox committee, which met on 9 February, acknowledged the progress made in reducing the virus transmission and the sharp decline of reported cases. However, it also expressed concerns that “a few countries continued to see a sustained incidence of illness” while in other countries it’s likely that more cases are occuring under the radar. “More than 30 countries continue to report cases, and the possible underdetection and under-reporting of confirmed cases in some regions is concerning. Particularly in countries where animal-human transmission of Mpox has been reported before,” Tedros pointed out. In its report, the expert committee also expressed concerns about the possible resurgence of cases due to the expected resumption of LGBTQ social events and other mass gathering events; lack of access to vaccines and testing capacities in many lower-income countries; and the recurring zoonotic transmission in Africa. It added that “not all countries are receiving the support they need or have structures or systems to respond to mpox, including inadequate support for marginalized groups; and general fatigue among supporting agencies.” Returning from Syrian scenes of devastation Tedros spoke at the briefing shortly after returning to Geneva from a visit to earthquake affected areas in Syria. The 7.8 magnitude earthquake that hit Syria and Türkiye last week is now estimated to have killed over 41,000 people. I've never in my life seen the level of destruction as I did on the road from Aleppo to Damascus. Skeletons of houses. Almost no people in sight. Over a decade of war has taken an unimaginable toll. Syrians need our support now and in years to come to rebuild their lives. pic.twitter.com/Ym2zmDixdw — Tedros Adhanom Ghebreyesus (@DrTedros) February 14, 2023 Describing the damage caused to Aleppo and Damascus first due to the war, and now by the earthquake, Tedros said “I saw the destruction of entire communities, the unspeakable suffering of people, and the courage and determination of survivors and responders. As we drove from Aleppo to Damascus, I saw the legacy of conflict, with town after town destroyed and abandoned. Survivors are now facing freezing conditions without adequate shelter, heating, food, clean water, or medical care.” While two more cross-border points between Türkiye and Syria have been opened, Tedros said he had had asked Syrian president Bashar al-Assad to open still more crossings so that relief could reach people in need more rapidly. Humanitarian aid groups charge that the Syrian president has “weaponized aid” channeling available supplies to government controlled areas – while most of western Syria where the earthquake hit, is controlled by Kurdish and other Syrian anti-government militias. “WHO remains committed to supporting all people in the Syrian Arab Republic now and in the days, weeks, months, and years ahead,” Tedros added. The WHO has launched an appeal for $43 million to support its response in Syria and Türkiye and expects the amount to double by this weekend. Meanwhile, UN Secretary General Antonio Guterres called upon countries to fully fund a $397 million earthquake fund for Syria, in particular, which lacks resources to mount its own response. Marburg disease – ramping up diagnostics and clinical trial possibilities Touching back on the Marburg Virus Disease (MVD) outbreak in Equatorial Guinea, which has claimed nine lives, Tedros said that the WHO is working with the country’s health authorities to ramp up their diagnostic capacity. “So far, no confirmed cases have been reported in Cameroon and or Gabon,” he added, referring to the two countries that, along with Liberia, border Equatorial Guinea. “We’re also supporting the governments of Cameroon and Gabon to prepare to rapidly detect, isolate, and provide care for any suspected cases.” Following up on the Marburg Virus Vaccine Consortium (MARVAC)’s meeting on Tuesday, Tedros said that WHO is trying to accelerate talks on possibile clinical trials for Marburg virus diseaes vaccine candidates. But he reiterated that any decision on the trials of vaccines and therapeutics for Marburg needs to be taken by researchers and the national authorities of Equatorial Guinea. “In the meantime, WHO is convening the vaccine prioritization committee to identify which vaccine candidates should be evaluated first and prepare for potential trials. WHO is also discussing with the ministry of health, the possibility of providing access to experimental therapeutics as part of a clinical trial,” he said. WHO Denies it Abandoned Investigation of COVID-19 Origins – But Way Forward Unclear 15/02/2023 Megha Kaveri Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing. A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic. The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021, But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country. In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.” Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating: “I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.” However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question: “In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.” China has evaded WHO’s requests for cooperation China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted. “Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. “Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones. “Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated. But apparently so far, there has been no return mail. Image Credits: Megha Kaveri. WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Lack of Test Kits for Marburg Virus Hamper Africa’s Response to Outbreak 16/02/2023 Paul Adepoju Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control. The Africa Centres for Disease Control and Prevention (Africa CDC) is closely monitoring Equatorial Guinea’s first-ever Marburg virus disease outbreak, Africa CDC acting director Dr Ahmed Ogwell Ouma told a media briefing on Thursday “One big challenge we have are test kits and we are working around the clock to try and get test kits to Equatorial Guinea and also to Cameroon and Gabon, to ensure that we have a very short turnaround time for samples being tested in the laboratory,” Ouma added. So far, one case has been confirmed and nine deaths have been reported, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. Ouma added that a key priority is to limit the spread of the virus, as well as monitor neighbouring countries such as Cameroon and Gabon for potential cross-border spillover. As reported by Health Policy Watch, on Tuesday, the WHO received updates from five vaccine developers who have been working on candidate vaccines. The WHO plans to convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. Diphtheria, cholera, mpox, Lassa fever, and measles are some of the other health emergencies that African countries are also grappling with, alongside COVID-19, and Ouma, a Kenyan epidemiologist, said that his center is currently monitoring up to nine different public health events. Nigeria reported over 600 new cases of diphtheria and several African countries reported cases of cholera, including Malawi, where three-quarters of the continent’s cases have been reported. The continent has documented over 12 million cases of COVID-19 and 256,705 deaths, a case fatality rate of 2.1%, which is double the global average, Ouma told the media. While the number of new cases and deaths have decreased over the past several weeks, he emphasized the importance of continuing to encourage vaccination efforts and targeted campaigns to reach more people. “The general trend on the continent now is quite flat with the indications that we may be seeing further decreases in numbers and also in deaths,” Ouma told journalists. Ouma noted that Africa CDC is working with governments and health organizations to provide technical assistance and medical countermeasures as needed for these and other health emergencies. He added that the organization is also continuing to promote vaccination efforts and targeted campaigns to help prevent the spread of infectious diseases. Draft Pandemic Accord Neglects Prevention, Particularly ‘Zoonotic Spillover’ 15/02/2023 Kerry Cullinan INB co-chair Roland Driece The draft pandemic accord needs more emphasis on preventing pandemics at their source – where animal pathogens “spill over” to people – according to a number of organisations participating in a consultation on the document’s “zero draft” on Wednesday. Negotiations between World Health Organization (WHO) member states on the draft are due to begin at the fourth meeting of the Intergovernmental Negotiating Body (INB), scheduled to take place from 27 February to 3 March. However, Wednesday’s meeting gave WHO’s civil society stakeholders an opportunity to comment on the draft ahead of that meeting. Only member states will take part in the actual treaty negotiations, which are likely to start behind closed doors on the second day of the month-end meeting (called INB 4), INB co-chair Roland Driece told the meeting. INB 4 and the following INB5 meeting from 3 to 6 April would be approached as “one big meeting”, he added. While the start of the meeting would be open to all stakeholders, “as soon as member states tell us that they accept the zero draft as the zero draft, we will move into negotiation mode, and that means that only member states can be present,” said Driece. “So that’s why it’s so important that you tell us and member states now what you feel and think about this zero draft.” He added that he thought that the INB Bureau had done “a pretty decent job [of synthesizing stakeholders’ inputs]” but “this is an important moment for you all to share whether or not you share my optimism about that and tell us what you think is important”. Prevent ‘zoonotic spillover’ – environmental and animal health groups Across large swathes of Asia and Africa, wholesale markets often sell wild animals captured or bred for food consumption, and which may harbor dangerous viruses. Many scientists believe that SARS-CoV2 was transmitted to humans via live, wild animals, caged for slaughter in Wuhan’s wet market. An unprecedented number of organisations spoke about how the draft needs to pay more attention to pandemic prevention at the source; this means addressing the social, environmental and food safety factors that lead to the spillover of pathogens from wild animal populations into human communities. These drivers range from deforestation which has prompted animal populations like bats, which harbor a range of deadly pathogens from SARS-COV to Marburg, to move closer to human habitats; to wild animal trafficking and trade, both legal and illicit; as well as industrial production, sale and slaugher of wild animal species. The Wildlife Conservation Society recommended that the accord commit governments to “identifying and prioritising actions to prevent pathogen spillover in the first place” by prioritising tougher regulations on “markets and trade chains and wildlife domestic and international trade”. “We have extensive experience and expertise with habitat degredation, deforestation, forest degradation, wildlife trade and wildlife markets,” said the WCS representative. “And this isn’t about illegal trade, its about any live trade, particularly for food but also for other purposes, birds and mammals. We look forward to working with member states and the INB to ensure that first and foremost there are commitments by governments to avoid the spillover in the first place. And we do know how to do that, from a biodiversity perspective and in terms of markets.” The World Wildlife Fund (WWF) appealed for the “list of drivers of pathogen emergence risks to be expanded to include not just deforestation, but ecosystem loss, fragmentation and degradation”. “Deforestation alone omits many of the potentially important pandemic frontiers and ignores the role of fragmentation and degradation in increasing proximity between humans and wildlife,” said the WWF. Meanwhile, the World Organisation of Animal Health (WOAH) called for the inclusion of the full definition of “One Health” in the treaty. Its delegate also questioned why preparedness and response were stressed whereas “preventive actions targeting activities and places that increase the risk of zoonotic spillover” were not. Pointing to a lack of expertise to address zoonotic spillover, the Action for Animal Health Coalition said that member states needed to invest in increasing the animal health workforce. Equity obligations Oxfam’s Piotr Kolczynski, who also represented the People’s Vaccine Alliance. Meanwhile, Oxfam, also representing the People’s Vaccine Alliance, said that “the accord’s language must oblige governments to take specific actions to ensure equity; otherwise it would be very difficult to implement this”. The current zero draft also assumes that “critical public health interventions are based on the willingness of pharmaceutical companies to engage in voluntary mechanisms” but “these have proved to be largely insufficient during the current and previous pandemics,” said Piotr Kolczynski, of Oxfam and PVA. For this reason, it added, “the accord must require governments to invest in research and development and manufacturing capacities and to condition public funding on the sharing of technologies, knowledge and intellectual property with developers and manufacturers in the South”. In reference to the accord’s proposal that 20% of pandemic-related goods be allocated to the WHO for distribution, Oxfam stated that “equitable allocation of medical countermeasures cannot be achieved by reserving a 20% of production for 80% of the world’s population”. Medecins sans Frontieres (MSF), meanwhile, asked for a legal definition of “pandemic”, and “explicit reference to governments complying with international humanitarian law obligations in the context of pandemic preparedness, prevention and response”. It also demanded stronger language in relation to commitments to protect “humanitarian populations of concerns” and healthcare workers during pandemics. Private sector is a ‘critical partner’ IFPMA’s Grega Kumer, Deputy Director of Government Relations. “The private sector should be seen as a critical partner in preparedness, response and recovery, and should have a seat at the table,” stated Grega Kumer, Deputy Director of Government Relations at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). However, it warned that some of the accord’s proposals “would jeopardise our capacity to efficiently prepare for the next pandemic.” Key concerns it cited included proposals for a waiver on intellectual property rights (IP) for health products during a pandemic, as well as proposals that would “be “transactionally linking access to pathogens and sharing of benefits”. It also urged the INB to “avoid unnecessary overlaps and duplications including other multilateral organisations mandate and expertise such as WTO and WIPO”. While there were over 200 participants online, a handful of member states were also on hand to listen in person at WHO’s Geneva Headquarters to the inputs as they prepare for INB4, when the real negotiations begin for the accord that is due to be presented by May 2024 to the World Health Assembly. Image Credits: Peter Griffin/Public Domain Pictures. Mpox To Remain A Public Health Emergency of International Concern Says WHO 15/02/2023 Megha Kaveri Dr Tedros Adhanom Ghebreyesus speaking at the media briefing on Wednesday. The World Health Organization (WHO) declared on Wednesday that Mpox will continue to remain a Public Health Emergency of International Concern (PHEIC). The decision to continue with the status quo on Mpox was based on the recommendations made by an Mpox Emergency Committee, whose findings were published on the same day. “The emergency committee for the global outbreak of Mpox met to assess whether, in its view, the outbreak remains a public health emergency of international concern. The committee has advised me that, in its view, Mpox remains a global health emergency, and I have accepted that advice,” Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a press briefing on Wednesday. In its report, the Mpox committee, which met on 9 February, acknowledged the progress made in reducing the virus transmission and the sharp decline of reported cases. However, it also expressed concerns that “a few countries continued to see a sustained incidence of illness” while in other countries it’s likely that more cases are occuring under the radar. “More than 30 countries continue to report cases, and the possible underdetection and under-reporting of confirmed cases in some regions is concerning. Particularly in countries where animal-human transmission of Mpox has been reported before,” Tedros pointed out. In its report, the expert committee also expressed concerns about the possible resurgence of cases due to the expected resumption of LGBTQ social events and other mass gathering events; lack of access to vaccines and testing capacities in many lower-income countries; and the recurring zoonotic transmission in Africa. It added that “not all countries are receiving the support they need or have structures or systems to respond to mpox, including inadequate support for marginalized groups; and general fatigue among supporting agencies.” Returning from Syrian scenes of devastation Tedros spoke at the briefing shortly after returning to Geneva from a visit to earthquake affected areas in Syria. The 7.8 magnitude earthquake that hit Syria and Türkiye last week is now estimated to have killed over 41,000 people. I've never in my life seen the level of destruction as I did on the road from Aleppo to Damascus. Skeletons of houses. Almost no people in sight. Over a decade of war has taken an unimaginable toll. Syrians need our support now and in years to come to rebuild their lives. pic.twitter.com/Ym2zmDixdw — Tedros Adhanom Ghebreyesus (@DrTedros) February 14, 2023 Describing the damage caused to Aleppo and Damascus first due to the war, and now by the earthquake, Tedros said “I saw the destruction of entire communities, the unspeakable suffering of people, and the courage and determination of survivors and responders. As we drove from Aleppo to Damascus, I saw the legacy of conflict, with town after town destroyed and abandoned. Survivors are now facing freezing conditions without adequate shelter, heating, food, clean water, or medical care.” While two more cross-border points between Türkiye and Syria have been opened, Tedros said he had had asked Syrian president Bashar al-Assad to open still more crossings so that relief could reach people in need more rapidly. Humanitarian aid groups charge that the Syrian president has “weaponized aid” channeling available supplies to government controlled areas – while most of western Syria where the earthquake hit, is controlled by Kurdish and other Syrian anti-government militias. “WHO remains committed to supporting all people in the Syrian Arab Republic now and in the days, weeks, months, and years ahead,” Tedros added. The WHO has launched an appeal for $43 million to support its response in Syria and Türkiye and expects the amount to double by this weekend. Meanwhile, UN Secretary General Antonio Guterres called upon countries to fully fund a $397 million earthquake fund for Syria, in particular, which lacks resources to mount its own response. Marburg disease – ramping up diagnostics and clinical trial possibilities Touching back on the Marburg Virus Disease (MVD) outbreak in Equatorial Guinea, which has claimed nine lives, Tedros said that the WHO is working with the country’s health authorities to ramp up their diagnostic capacity. “So far, no confirmed cases have been reported in Cameroon and or Gabon,” he added, referring to the two countries that, along with Liberia, border Equatorial Guinea. “We’re also supporting the governments of Cameroon and Gabon to prepare to rapidly detect, isolate, and provide care for any suspected cases.” Following up on the Marburg Virus Vaccine Consortium (MARVAC)’s meeting on Tuesday, Tedros said that WHO is trying to accelerate talks on possibile clinical trials for Marburg virus diseaes vaccine candidates. But he reiterated that any decision on the trials of vaccines and therapeutics for Marburg needs to be taken by researchers and the national authorities of Equatorial Guinea. “In the meantime, WHO is convening the vaccine prioritization committee to identify which vaccine candidates should be evaluated first and prepare for potential trials. WHO is also discussing with the ministry of health, the possibility of providing access to experimental therapeutics as part of a clinical trial,” he said. WHO Denies it Abandoned Investigation of COVID-19 Origins – But Way Forward Unclear 15/02/2023 Megha Kaveri Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing. A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic. The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021, But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country. In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.” Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating: “I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.” However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question: “In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.” China has evaded WHO’s requests for cooperation China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted. “Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. “Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones. “Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated. But apparently so far, there has been no return mail. Image Credits: Megha Kaveri. WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Draft Pandemic Accord Neglects Prevention, Particularly ‘Zoonotic Spillover’ 15/02/2023 Kerry Cullinan INB co-chair Roland Driece The draft pandemic accord needs more emphasis on preventing pandemics at their source – where animal pathogens “spill over” to people – according to a number of organisations participating in a consultation on the document’s “zero draft” on Wednesday. Negotiations between World Health Organization (WHO) member states on the draft are due to begin at the fourth meeting of the Intergovernmental Negotiating Body (INB), scheduled to take place from 27 February to 3 March. However, Wednesday’s meeting gave WHO’s civil society stakeholders an opportunity to comment on the draft ahead of that meeting. Only member states will take part in the actual treaty negotiations, which are likely to start behind closed doors on the second day of the month-end meeting (called INB 4), INB co-chair Roland Driece told the meeting. INB 4 and the following INB5 meeting from 3 to 6 April would be approached as “one big meeting”, he added. While the start of the meeting would be open to all stakeholders, “as soon as member states tell us that they accept the zero draft as the zero draft, we will move into negotiation mode, and that means that only member states can be present,” said Driece. “So that’s why it’s so important that you tell us and member states now what you feel and think about this zero draft.” He added that he thought that the INB Bureau had done “a pretty decent job [of synthesizing stakeholders’ inputs]” but “this is an important moment for you all to share whether or not you share my optimism about that and tell us what you think is important”. Prevent ‘zoonotic spillover’ – environmental and animal health groups Across large swathes of Asia and Africa, wholesale markets often sell wild animals captured or bred for food consumption, and which may harbor dangerous viruses. Many scientists believe that SARS-CoV2 was transmitted to humans via live, wild animals, caged for slaughter in Wuhan’s wet market. An unprecedented number of organisations spoke about how the draft needs to pay more attention to pandemic prevention at the source; this means addressing the social, environmental and food safety factors that lead to the spillover of pathogens from wild animal populations into human communities. These drivers range from deforestation which has prompted animal populations like bats, which harbor a range of deadly pathogens from SARS-COV to Marburg, to move closer to human habitats; to wild animal trafficking and trade, both legal and illicit; as well as industrial production, sale and slaugher of wild animal species. The Wildlife Conservation Society recommended that the accord commit governments to “identifying and prioritising actions to prevent pathogen spillover in the first place” by prioritising tougher regulations on “markets and trade chains and wildlife domestic and international trade”. “We have extensive experience and expertise with habitat degredation, deforestation, forest degradation, wildlife trade and wildlife markets,” said the WCS representative. “And this isn’t about illegal trade, its about any live trade, particularly for food but also for other purposes, birds and mammals. We look forward to working with member states and the INB to ensure that first and foremost there are commitments by governments to avoid the spillover in the first place. And we do know how to do that, from a biodiversity perspective and in terms of markets.” The World Wildlife Fund (WWF) appealed for the “list of drivers of pathogen emergence risks to be expanded to include not just deforestation, but ecosystem loss, fragmentation and degradation”. “Deforestation alone omits many of the potentially important pandemic frontiers and ignores the role of fragmentation and degradation in increasing proximity between humans and wildlife,” said the WWF. Meanwhile, the World Organisation of Animal Health (WOAH) called for the inclusion of the full definition of “One Health” in the treaty. Its delegate also questioned why preparedness and response were stressed whereas “preventive actions targeting activities and places that increase the risk of zoonotic spillover” were not. Pointing to a lack of expertise to address zoonotic spillover, the Action for Animal Health Coalition said that member states needed to invest in increasing the animal health workforce. Equity obligations Oxfam’s Piotr Kolczynski, who also represented the People’s Vaccine Alliance. Meanwhile, Oxfam, also representing the People’s Vaccine Alliance, said that “the accord’s language must oblige governments to take specific actions to ensure equity; otherwise it would be very difficult to implement this”. The current zero draft also assumes that “critical public health interventions are based on the willingness of pharmaceutical companies to engage in voluntary mechanisms” but “these have proved to be largely insufficient during the current and previous pandemics,” said Piotr Kolczynski, of Oxfam and PVA. For this reason, it added, “the accord must require governments to invest in research and development and manufacturing capacities and to condition public funding on the sharing of technologies, knowledge and intellectual property with developers and manufacturers in the South”. In reference to the accord’s proposal that 20% of pandemic-related goods be allocated to the WHO for distribution, Oxfam stated that “equitable allocation of medical countermeasures cannot be achieved by reserving a 20% of production for 80% of the world’s population”. Medecins sans Frontieres (MSF), meanwhile, asked for a legal definition of “pandemic”, and “explicit reference to governments complying with international humanitarian law obligations in the context of pandemic preparedness, prevention and response”. It also demanded stronger language in relation to commitments to protect “humanitarian populations of concerns” and healthcare workers during pandemics. Private sector is a ‘critical partner’ IFPMA’s Grega Kumer, Deputy Director of Government Relations. “The private sector should be seen as a critical partner in preparedness, response and recovery, and should have a seat at the table,” stated Grega Kumer, Deputy Director of Government Relations at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). However, it warned that some of the accord’s proposals “would jeopardise our capacity to efficiently prepare for the next pandemic.” Key concerns it cited included proposals for a waiver on intellectual property rights (IP) for health products during a pandemic, as well as proposals that would “be “transactionally linking access to pathogens and sharing of benefits”. It also urged the INB to “avoid unnecessary overlaps and duplications including other multilateral organisations mandate and expertise such as WTO and WIPO”. While there were over 200 participants online, a handful of member states were also on hand to listen in person at WHO’s Geneva Headquarters to the inputs as they prepare for INB4, when the real negotiations begin for the accord that is due to be presented by May 2024 to the World Health Assembly. Image Credits: Peter Griffin/Public Domain Pictures. Mpox To Remain A Public Health Emergency of International Concern Says WHO 15/02/2023 Megha Kaveri Dr Tedros Adhanom Ghebreyesus speaking at the media briefing on Wednesday. The World Health Organization (WHO) declared on Wednesday that Mpox will continue to remain a Public Health Emergency of International Concern (PHEIC). The decision to continue with the status quo on Mpox was based on the recommendations made by an Mpox Emergency Committee, whose findings were published on the same day. “The emergency committee for the global outbreak of Mpox met to assess whether, in its view, the outbreak remains a public health emergency of international concern. The committee has advised me that, in its view, Mpox remains a global health emergency, and I have accepted that advice,” Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a press briefing on Wednesday. In its report, the Mpox committee, which met on 9 February, acknowledged the progress made in reducing the virus transmission and the sharp decline of reported cases. However, it also expressed concerns that “a few countries continued to see a sustained incidence of illness” while in other countries it’s likely that more cases are occuring under the radar. “More than 30 countries continue to report cases, and the possible underdetection and under-reporting of confirmed cases in some regions is concerning. Particularly in countries where animal-human transmission of Mpox has been reported before,” Tedros pointed out. In its report, the expert committee also expressed concerns about the possible resurgence of cases due to the expected resumption of LGBTQ social events and other mass gathering events; lack of access to vaccines and testing capacities in many lower-income countries; and the recurring zoonotic transmission in Africa. It added that “not all countries are receiving the support they need or have structures or systems to respond to mpox, including inadequate support for marginalized groups; and general fatigue among supporting agencies.” Returning from Syrian scenes of devastation Tedros spoke at the briefing shortly after returning to Geneva from a visit to earthquake affected areas in Syria. The 7.8 magnitude earthquake that hit Syria and Türkiye last week is now estimated to have killed over 41,000 people. I've never in my life seen the level of destruction as I did on the road from Aleppo to Damascus. Skeletons of houses. Almost no people in sight. Over a decade of war has taken an unimaginable toll. Syrians need our support now and in years to come to rebuild their lives. pic.twitter.com/Ym2zmDixdw — Tedros Adhanom Ghebreyesus (@DrTedros) February 14, 2023 Describing the damage caused to Aleppo and Damascus first due to the war, and now by the earthquake, Tedros said “I saw the destruction of entire communities, the unspeakable suffering of people, and the courage and determination of survivors and responders. As we drove from Aleppo to Damascus, I saw the legacy of conflict, with town after town destroyed and abandoned. Survivors are now facing freezing conditions without adequate shelter, heating, food, clean water, or medical care.” While two more cross-border points between Türkiye and Syria have been opened, Tedros said he had had asked Syrian president Bashar al-Assad to open still more crossings so that relief could reach people in need more rapidly. Humanitarian aid groups charge that the Syrian president has “weaponized aid” channeling available supplies to government controlled areas – while most of western Syria where the earthquake hit, is controlled by Kurdish and other Syrian anti-government militias. “WHO remains committed to supporting all people in the Syrian Arab Republic now and in the days, weeks, months, and years ahead,” Tedros added. The WHO has launched an appeal for $43 million to support its response in Syria and Türkiye and expects the amount to double by this weekend. Meanwhile, UN Secretary General Antonio Guterres called upon countries to fully fund a $397 million earthquake fund for Syria, in particular, which lacks resources to mount its own response. Marburg disease – ramping up diagnostics and clinical trial possibilities Touching back on the Marburg Virus Disease (MVD) outbreak in Equatorial Guinea, which has claimed nine lives, Tedros said that the WHO is working with the country’s health authorities to ramp up their diagnostic capacity. “So far, no confirmed cases have been reported in Cameroon and or Gabon,” he added, referring to the two countries that, along with Liberia, border Equatorial Guinea. “We’re also supporting the governments of Cameroon and Gabon to prepare to rapidly detect, isolate, and provide care for any suspected cases.” Following up on the Marburg Virus Vaccine Consortium (MARVAC)’s meeting on Tuesday, Tedros said that WHO is trying to accelerate talks on possibile clinical trials for Marburg virus diseaes vaccine candidates. But he reiterated that any decision on the trials of vaccines and therapeutics for Marburg needs to be taken by researchers and the national authorities of Equatorial Guinea. “In the meantime, WHO is convening the vaccine prioritization committee to identify which vaccine candidates should be evaluated first and prepare for potential trials. WHO is also discussing with the ministry of health, the possibility of providing access to experimental therapeutics as part of a clinical trial,” he said. WHO Denies it Abandoned Investigation of COVID-19 Origins – But Way Forward Unclear 15/02/2023 Megha Kaveri Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing. A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic. The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021, But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country. In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.” Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating: “I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.” However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question: “In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.” China has evaded WHO’s requests for cooperation China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted. “Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. “Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones. “Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated. But apparently so far, there has been no return mail. Image Credits: Megha Kaveri. WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Mpox To Remain A Public Health Emergency of International Concern Says WHO 15/02/2023 Megha Kaveri Dr Tedros Adhanom Ghebreyesus speaking at the media briefing on Wednesday. The World Health Organization (WHO) declared on Wednesday that Mpox will continue to remain a Public Health Emergency of International Concern (PHEIC). The decision to continue with the status quo on Mpox was based on the recommendations made by an Mpox Emergency Committee, whose findings were published on the same day. “The emergency committee for the global outbreak of Mpox met to assess whether, in its view, the outbreak remains a public health emergency of international concern. The committee has advised me that, in its view, Mpox remains a global health emergency, and I have accepted that advice,” Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a press briefing on Wednesday. In its report, the Mpox committee, which met on 9 February, acknowledged the progress made in reducing the virus transmission and the sharp decline of reported cases. However, it also expressed concerns that “a few countries continued to see a sustained incidence of illness” while in other countries it’s likely that more cases are occuring under the radar. “More than 30 countries continue to report cases, and the possible underdetection and under-reporting of confirmed cases in some regions is concerning. Particularly in countries where animal-human transmission of Mpox has been reported before,” Tedros pointed out. In its report, the expert committee also expressed concerns about the possible resurgence of cases due to the expected resumption of LGBTQ social events and other mass gathering events; lack of access to vaccines and testing capacities in many lower-income countries; and the recurring zoonotic transmission in Africa. It added that “not all countries are receiving the support they need or have structures or systems to respond to mpox, including inadequate support for marginalized groups; and general fatigue among supporting agencies.” Returning from Syrian scenes of devastation Tedros spoke at the briefing shortly after returning to Geneva from a visit to earthquake affected areas in Syria. The 7.8 magnitude earthquake that hit Syria and Türkiye last week is now estimated to have killed over 41,000 people. I've never in my life seen the level of destruction as I did on the road from Aleppo to Damascus. Skeletons of houses. Almost no people in sight. Over a decade of war has taken an unimaginable toll. Syrians need our support now and in years to come to rebuild their lives. pic.twitter.com/Ym2zmDixdw — Tedros Adhanom Ghebreyesus (@DrTedros) February 14, 2023 Describing the damage caused to Aleppo and Damascus first due to the war, and now by the earthquake, Tedros said “I saw the destruction of entire communities, the unspeakable suffering of people, and the courage and determination of survivors and responders. As we drove from Aleppo to Damascus, I saw the legacy of conflict, with town after town destroyed and abandoned. Survivors are now facing freezing conditions without adequate shelter, heating, food, clean water, or medical care.” While two more cross-border points between Türkiye and Syria have been opened, Tedros said he had had asked Syrian president Bashar al-Assad to open still more crossings so that relief could reach people in need more rapidly. Humanitarian aid groups charge that the Syrian president has “weaponized aid” channeling available supplies to government controlled areas – while most of western Syria where the earthquake hit, is controlled by Kurdish and other Syrian anti-government militias. “WHO remains committed to supporting all people in the Syrian Arab Republic now and in the days, weeks, months, and years ahead,” Tedros added. The WHO has launched an appeal for $43 million to support its response in Syria and Türkiye and expects the amount to double by this weekend. Meanwhile, UN Secretary General Antonio Guterres called upon countries to fully fund a $397 million earthquake fund for Syria, in particular, which lacks resources to mount its own response. Marburg disease – ramping up diagnostics and clinical trial possibilities Touching back on the Marburg Virus Disease (MVD) outbreak in Equatorial Guinea, which has claimed nine lives, Tedros said that the WHO is working with the country’s health authorities to ramp up their diagnostic capacity. “So far, no confirmed cases have been reported in Cameroon and or Gabon,” he added, referring to the two countries that, along with Liberia, border Equatorial Guinea. “We’re also supporting the governments of Cameroon and Gabon to prepare to rapidly detect, isolate, and provide care for any suspected cases.” Following up on the Marburg Virus Vaccine Consortium (MARVAC)’s meeting on Tuesday, Tedros said that WHO is trying to accelerate talks on possibile clinical trials for Marburg virus diseaes vaccine candidates. But he reiterated that any decision on the trials of vaccines and therapeutics for Marburg needs to be taken by researchers and the national authorities of Equatorial Guinea. “In the meantime, WHO is convening the vaccine prioritization committee to identify which vaccine candidates should be evaluated first and prepare for potential trials. WHO is also discussing with the ministry of health, the possibility of providing access to experimental therapeutics as part of a clinical trial,” he said. WHO Denies it Abandoned Investigation of COVID-19 Origins – But Way Forward Unclear 15/02/2023 Megha Kaveri Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing. A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic. The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021, But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country. In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.” Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating: “I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.” However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question: “In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.” China has evaded WHO’s requests for cooperation China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted. “Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. “Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones. “Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated. But apparently so far, there has been no return mail. Image Credits: Megha Kaveri. WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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WHO Denies it Abandoned Investigation of COVID-19 Origins – But Way Forward Unclear 15/02/2023 Megha Kaveri Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing. A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic. The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021, But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country. In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.” Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating: “I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.” However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question: “In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.” China has evaded WHO’s requests for cooperation China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted. “Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. “Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones. “Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated. But apparently so far, there has been no return mail. Image Credits: Megha Kaveri. WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
WHO Aims to Accelerate Trials of Vaccine Candidates for Marburg Disease as Equatorial Guinea Reports Nine Deaths 14/02/2023 Megha Kaveri Health workers in protective gear during the Marburg outbreak in Guinea in 2021. Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate. At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines. WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands. So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation. All cases have occurred in the province of Kie Ntem in the country’s western region. “The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting. In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. “Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these should be included in in such a study,” Krause said. Phil Krause at the WHO-led MARVAC meeting on Tuesday. The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province. Vaccines in the pipeline At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development. The five active vaccine candidates that are in development for Marburg disease. Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable. Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.” The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added. Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year. In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said. Index case on 7 January The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February. “In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. Equatorial Guinea is located in west central Africa. Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities. “Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti. Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials. In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea. Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO. “Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday. “WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.” Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons. Posts navigation Older postsNewer posts