South African President Cyril Ramaphosa and Deputy President David Mabuza visit an Aspen Pharmacare facility in March 2021, a key partner in the country’s J&J vaccine drive.

A new South African study shows that a second Johnson & Johnson dose, administered 6-9 months after the initial single-dose vaccine provided 84% protection against hospitalization from the Omicron SARS-CoV2 variant – results that even outperformed those of an earlier South African study looking at effectiveness of the two-dose Pfizer regime in the face of Omicron.

The study, published in the medrxiv.org preprint server on Thursday,  measured the vaccine’s effectiveness in a group of some 227,000 health care workers, including 69,000 people who received the vaccine booster, between 8 November and 17 December – just as the Omicron variant was taking hold in the country.

The study found that vaccine efficiency against hospitalizations increased over time since the booster dose was administered from 63% in the first to weeks, to 85% post-boost.

“This data is important given the increased reliance on the Ad26.COV.2 [J&J] vaccine in Africa,” said the team of researchers, led by scientists at the South African Medical Research Council, the Desmond Tutu HIV Centre, and other prominent research centers.

Previous large-scale South African study on two Pfizer jabs yielded weaker results

A University of Michigan researcher administers the Johnson & Johnson COVID-19 vaccine candidate during phase 3 clinical trials in the US and seven other countries. The vaccine was authorized in February 2021 by the US FDA.

The study contrasts with a 14 December report on Pfizer vaccine efficacy in the face of Omicron by one of South Africa’s largest insurance providers.

The study by Discovery Health,  found that a two-dose Pfizer-BioNTech vaccine provided 70% protection against severe COVID cases, requiring hospitalizations, but only 33% protection against COVID infection during the current Omicron wave. The study examined some 211,000 COVID-19 test results obtained between 15 November and 7 December, 41% of which were from adult members who had received two-doses of the Pfizer vaccine.

Although the U.S. Food and Drug Administration was one of the first regulatory agencies to authorize the Johnson & Johnson/Janssen COVID-19 vaccine in February 2021, and following that, a booster shot, the vaccine had fallen from favour more recently in the United States. And that was following warnings from the US Centers for Disease Control and Prevention about rare but life-threatening blood clots that could be linked to the vaccine.

The South African Medical Association in November also had protested the exclusive arrangements between Johnson & Johnson and the government which led to health workers having only one booster option – a second J&J jab – while the company ran research on the results.

Latest South African results – turn earlier assumptions on head

Johnson & Johnson can ship vaccines standard cold chain technologies, because the temperature requirements are not as strict as for Pfizer’s and Moderna’s vaccines.

At the time, the South African Medical Association complained that the Pfizer jabs appeared to generate a more robust response – and should thus also be made available to highly exposed health workers.

Now, those assumptions may be turned on the head.

The J&J vaccine has been an anchor of the South African vaccine response from the beginning of vaccine rollouts – where the jab is also being produced in a collaboration with Aspen Pharmaceuticals for domestic use – as well as for the wider African market.

Along with stimulating a high degree of response with the first shot, the J&J vaccine can remain stable for up to three months at  2°C to 8°C, while the Pfizer and Moderna mRNA vaccines require cold chain storage at -28°C to 70°C.

The J&J vaccine uses a inactivated adenovirus  (cold virus) to deliver a genetic fragment of the SARS-CoV2 spike protein into the body, which in turn stimulates immune response.

In contrast, the Pfizer and Moderna vaccines deliver messenger RNA (mRNA) – a single strand genetic instruction making part of a SARS-CoV2 spike protein – into the body.  And that mRNA triggers and immune response.

Unexpectedly potent T Cell responses to Omicron Variant

In another a pre-print laboratory study published on 26 December, South African researchers also found that T-cells taken from people who received Johnson & Johnson vaccines recognized Omicron-infected cells almost as well as they recognized cells infected with other variants. That study is also significant as it suggests that even if antibody response to Omicron is not as robust in vaccinated individuals, the other critical factor in the body’s immune response remains more resilient.

“We found that 70-80% of the CD4 and CD8 T cell response to spike was maintained across study groups. Moreover, the magnitude of Omicron cross-reactive T cells was similar to that of the Beta and Delta variants, despite Omicron harbouring considerably more mutations,” wrote the authors, led by scientists at the University of Cape Town.

See here a video about how the four main categories of SARS-CoV2 actually work:

https://youtu.be/lFjIVIIcCvc

Image Credits: Johnson & Johnson, NBC News.

A major new British study has provided encouraging data that people infected with the Omicron variant are 20% less like to visit a hospital and 40% less likely to be admitted overnight than those with the Delta variant.

The Imperial College study, published Thursday, looked at everyone with a confirmed infection of either variant in the UK between 1-14 December – for a total of more than 324,000 cases.   

At the beginning of the tracking the 164 Omicron cases detected comprised only .6% of total daily cases recorded  By day 14, however, there were 15,804 Omicron cases –  more than 50% of the nearly 30,000 cases a day being reported – reflecting the steep rise in infections from the new variant.  

“Overall, we find evidence of a reduction in the risk of hospitalisation for Omicron relative to Delta infections, averaging over all cases in the study period,” concludes the study, undertaken by researchers at Imperial College. 

“The extent of reduction is sensitive to the inclusion criteria used for cases and hospitalisation, being in the range 20-25% when using any attendance at hospital as the endpoint, and 40-45% when using hospitalisation lasting 1 day or longer or hospitalisations with the ECDS discharge field recorded as “admitted” as the endpoint.

However, the proportionately smaller rate of hospitalizations must be balanced against the “the larger risk of infection with Omicron, due to the reduction in protection provided by both vaccination and natural infection,” the researchers warned.  

Imperial College, UK, study reveals 40% lower hospital admissions for Omicron cases as compared to Delta, even as Omicron rapidly becomes the dominant SARSCoV-2 variant.

Hospitalization risks for people vaccinated and previously infected

The study also found that previous COVID infection reduced the risk of any hospitalisation by approximately 50% and the risk of a hospital stay of 1+ days by 61%.

Cases vaccinated with Pfizer or Moderna for doses 1 and 2 have a similar or higher risk of hospitalisation with Omicron compared with Delta, while cases vaccinated with AstraZeneca for their primary series tended to have a lower risk of hospitalisation relative to Delta. 

The studies authors noted that the small overall numbers of people hospitalized with Omicron so far limits their ability to interpret the data – in light of vaccination status. 

“As more data accumulate, with longer periods of follow-up, assessment of more severe outcomes will become feasible,” report the study’s authors, who are part of the Imperial College COVID response team, and also a WHO Collaborating Center. 

“Currently, vaccination-status stratified hazard ratio estimates … remain very sensitive to small numbers of hospitalisation, particularly in the unvaccinated Omicron group. 

“It is quite possible that larger reductions in hospitalisation risk for Omicron vs Delta may be estimated [among  those vaccinated] for the endpoints of ICU admission and death, given that remaining immune protection against more severe outcomes of infection are expected to be much higher than those against milder endpoints.”

Image Credits: PAHO.org, Imperial College, UK.

Exclusive end year WHO media briefing in Geneva behind closed doors on Monday

Driven by Omicron, Africa is facing a steep wave of new COVID infections – last week reporting the fourth highest number of cases ever recorded in a single week, said WHO Director General Dr Tedros Adhanom Ghebreyesus on Monday. 

He was speaking at an exclusive media briefing in Geneva behind closed doors to a handful of international media outlets with UN-accredited Geneva bureaus.

The rambling two-hour long briefing, released a day later on YouTube, excluded Geneva-based health media as well as most African, Asian, and Latin American media across the world – which the UN press office in Geneva does not recognise or credential. 

While some reporters linked up online, the in-person gathering with reporters hosted by the UN Office at Geneva occurred at a time when Switzerland is facing one of the highest infection rates in the world – and other mass gatherings in Switzerland, such as the World Economic Forum’s 2022 meeting in Davos, have recently been cancelled. 

“Africa is now facing a steep wave of infections, driven largely by the Omicron variant,” said the Director General in the briefing, shared only a day later with Geneva health media, as well as other national and regional media worldwide.  

“Just a month ago, Africa was reporting its lowest number of cases in 18 months. Last week, it reported the fourth-highest number of cases in a single week so far,” he said. In fact, while Africa’s rates remain low overall, due to what experts attribute to a complex range of factors include a younger population and widespread underreporting, new infection rates in southern countries like Botswana, Eswatini and South Africa have now soared to worrisome highs. Per capita reported new infections in those states, where Omicron was first discovered, are comparable to those in the most infection-wracked countries of Europe, including Switzerland and Germany. 

“There is now consistent evidence that Omicron is spreading significantly faster than the Delta variant,” said the DG, in a wide-ranging briefing with senior staff, which looked at the pace of Omicron spread, booster campaigns, and new vaccines under review or approval – as well as reviewing WHO’s record for the year 2021.

Given the fast pace of Omicron’s spread, the WHO Director General urged people preparing for the upcoming Christmas and New Years’ holidays to cancel or delay mass events and social gatherings, in order to slow the variant’s advance. 

“All of us are sick of this pandemic. All of us want to spend time with friends and family. All of us want to get back to normal,” the Director-General declared.  

Dr Tedros Adhanom Ghebreyesus, WHO Director General

But given Omicron’s unique ability to avoid previously acquired immunity, “it is more likely that people who have been vaccinated or have recovered from COVID-19 could be infected or reinfected,” he added. 

And faced with that reality, “there can be no doubt that increased social mixing over the holiday period in many countries will lead to increased cases, overwhelmed health systems and more deaths.  

“The fastest way to do that is for all of us – leaders and individuals – to make the difficult decisions that must be made to protect ourselves and others. 

“In some cases, that will mean canceling or delaying events – just as we have had to cancel the reception we planned to have with you today,” he said, referring to a social event that had been planned for the journalists who had gathered physically at WHO headquarters, following Monday’s briefing.  

“But an event canceled is better than a life canceled. It’s better to cancel now and celebrate later, than to celebrate now and grieve later,” he added.  

Walking back on opposition to boosters 

Senior WHO Advisor, Dr Bruce Aylward

The Director General, as well as senior members of his team, also walked back some of their previous messaging opposing booster vaccines- admitting that there is growing evidence about their potential medical value – particularly for older people.  

“Clearly there is increasing evidence that those most vulnerable will benefit from an additional dose.  Yes, there is a role, but we want to ensure the right programme and vaccinate in the right order,” said Dr Bruce Aylward, WHO senior advisor. 

Aylward and other senior staff stressed that WHO remained opposed to mass booster campaigns on equity grounds – due to fears this will divert potential doses needed by  the more than 90 low-income countries which will miss the 40% vaccination coverage target set by WHO for the end of this year.  

“Remember what we are seeing in some places is not just a booster for those at highest risk but a booster for everyone in the population,” said Aylward. 

“And again, that would make a real demand on vaccines in an environment where they simply are not available to everyone who needs them at this time.”

However, Aylward later contradicted himself somewhat saying that in the first quarter of 2022:  “there will be enough vaccines to vaccinate 40% of the population of every country in the world, plus give a third dose to everybody over 50 years old. So we are very quickly getting into a situation where the production capacity is sufficient.

“The challenge is making sure the right products get  to the right places,.. optimising the allocations to get to where its needed .. to these countries that have been starved of vaccines for so long. everyone in high-income countries over the age of 50 as well as to distribute sufficient doses in low-income countries to meet the WHO 40% goals.”

Added Tedros, “There is new evidence emerging now of the benefits for elderly, over 65, so if it [booster] is going to be used, it’s better focusing on those groups. 

“But some countries are doing boosters very aggressively while their hospitals are filled with people who are not vaccinated. 

So the best would be for countries to convince those who are not vaccinated, convince them to be vaccinated and make sure that they are safe.  Their energy should be spent on finding the unprotected and protecting them.” 

He added: “Instead of boostering a child in high income countries, it’s better to vaccinate the elderly in counties who have not been vaccinated even with the primary vaccines. So the equity issue will also come into play.”  

Data on boosters’ impacts on global supplies lacks transparency

So far, WHO has not come up with detailed data around the likely impact of booster campaigns on global supplies for low- and middle-income countries – despite repeated requests by Health Policy Watch for more clarification of the data and its statements.  

An interview with one senior WHO official, published last week in the Financial Times, claimed that mass boosters in higher income countries could leave global supply chains 3 billion doses short of what is needed for developing regions in the first quarter of 2022.   

But those estimates are based on a presumption that 90% of people in high income countries would accept boosters – when in fact not even 70% have received their first and second jabs. 

Financial Times mapping of WHO claims of 3 billion vaccine dose shortfall in “aggressive scenario” – assumes 90% vaccine coverage in high- and upper-middle income countries.

Conversely, in a pharma-sponsored briefing last week, the data forecasting firm Airfinity claimed that boostering 70% of the population in G-7 countries would not significantly dent supplies needed by LMICs – since the world is now producing over 1.5 billion vaccines a month.  

That assessment, however, was based only on projected estimates of booster needs for seven of the world’s richest economies – and not the three dozen or so high- and upper-middle income countries that have already initiated booster campaigns. 

In response to yet another query by Health Policy Watch, Airfinity said it was trying to update its projections to include all G-20 countries – but had not yet completed the analysis as of the time of this publication.  

What is really needed, said Aylward in Monday’s briefing is more “transparency” that ensures manufacturers prioritize their deliveries of doses to the COVAX global vaccine facility – ahead of more deliveries to rich countries.

Aylward also warned about relying too much on vaccine dose donations, saying that while some 1 billion vaccine doses have been donated so far, only about 15% of those have actually been delivered.

“There is a danger that we create a perverse incentive if we keep encouraging donations,” he added, noting that donations come with many strings attached – including deliveries too close to their expiration date and a lack of choices for low-income countries about which vaccine to receive and when.  

How frequent boosters?

WHO Chief Scientist, Dr Soumya Swaminathan

In terms of how frequently boosters might be needed in the future, and for what vaccines, “the fact is that we don’t know,” added  Dr Soumya Swaminathan, WHO Chief Scientist. 

She said that key driving factors include: “The biology of the individual, the age, how strong the immune system is. 

“There is some data now to show that there is a slippage due to the protection in different vaccines at six months or so. But with Omicron, the initial data is showing that it is very successfully able to evade immune responses and therefore needs higher levels of antibodies.  

“For now, we believe boosters may be needed for people who have weaker immune systems, the older individuals who are more vulnerable. 

“And whether there will be a need for additional vaccines every year, like influenza, it’s too early to say and we really need to follow the science on that.”  

Good news on new vaccines being rolled out  

Meanwhile,  the list of WHO-approved vaccines expanded once more on Tuesday with the Agency’s Emergency Use Listing of the European-made version of Novavax’s new Nuvaxovid™ vaccine. The WHO moved followed just after approval by the European Medicines Agency (EMA) earlier Tuesday. 

The new vaccine was developed by Novavax along with the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI), and is the originator product for the Covovax™ vaccine, produced by the Serum Institute of India, that had received WHO emergency use listing last week.

Both two-dose vaccines are made using the same technologies –  using an engineered baculovirus that delivers the gene of a modified SARS-CoV-2 spike protein into the body to provoke an immune response.  The technology, while novel, is more comparable to the traditional vaccines that deliver dead or inactivated viruses rather than to the mRNA models that deliver “instructions” to the body to produce an antibody response – without delivering any part of the virus itself.   

Significantly, the Novavax vaccines remain stable at 2 to 8 °C refrigerated temperatures – making them particularly relevant for vaccine campaigns in countries with poor cold chains.

The global COVAX vaccine facility has pre-purchased hundreds of millions of doses of the new two-dose vaccine, which is based upon has scored high marks in clinical trials. 

“This new vaccine is part of the COVAX portfolio, and we hope that it will play an important role in achieving our global vaccination targets,” said Tedros. 

Sputnik V – another review in early 2022

WHO officials at the briefing also said that the Agency’s long-delayed review of Russia’s Sputnik V vaccine would hopefully move ahead early next year, providing that the Russian-based Gamaleya Institute submits updated clinical trial data, by the end of this month.   

“Providing all information is available by the end of December, we will be able to perform GMP (Good Manufacturing Practice) inspections locally on Sputnik in February,” said Dr Rogerio Pinto de Sa Gaspar, who heads WHO’s “prequalification” activity.

Reported problems in some of the Sputnik vaccine facilities earlier this year stalled the approval processes for the vaccine, which has lagged well behind Chinese, Indian, European or American counterparts. 

In November, Sputnik’s developers have reported comparative results of its vaccine efficacy in Europe – but the studies have yet to be transformed into peer-reviewed papers. 

 

Image Credits: The Financial Times .

The World Health Organization on Friday issued an emergency use listing for a novel COVID vaccine produced – in a move that should help ramp up new rounds of COVID vaccine distributions to low- and middle-income countries in coming months. 

Approval of the novel vaccine, developed by the US-based firm Novavax, and to be produced by the Serum Institute of India under licence, is long awaited because of it’s particularly high marks in clinical trials and modest cold chain requirements – the vaccine remains stable at only 2 to 8 °C. 

Some 350 million doses of the vaccine, dubbed Covovax™, have been promised to Gavi, The Vaccine Alliance, for the COVAX vaccine facility portfolio, which supplies COVID vaccines to some 93 low and middle-income countries.  

Prior to the WHO authorization, the SII-produced vaccine had so far only received authorisation for use in Indonesia, and is in the process of being approved in Japan. 

Another version of the same vaccine is also under review by the U.S. Food and Drug Administration and European Medicines Agency. 

The WHO move opens the way for the jump-starting of Covovax vaccine distribution under the COVAX framework – even ahead of the FDA or EMA approvals. WHO approval also allows low-and middle-income countries to expedite their own regulatory approval to import and administer COVID-19 vaccines. 

SII expects to manufacture 1 billion doses of Covovax in 2022 

According to reports, the Pune-based Serum Institute of India is expected to manufacture one-billion doses of Covovax for supply to low- and middle-income countries by the end of 2022.

COVAX is co-led by the Coalition for Epidemic Preparedness Innovations, Gavi and the WHO to accelerate the development and manufacture of COVID-19 vaccines, along with fair and equitable access for every country in the world. CEPI also invested financially in the R&D of the new Covovax vaccine. 

According to reports on the phase-3 trial of the vaccine in North America, Covovax was 90.4% effective against infection and was 100% effective against moderate to severe illnesses. The shot has proven effective against COVID-19 infection in the United Kingdom and South Africa, according to the New England Journal of Medicine. 

“This listing aims to increase access particularly in lower-income countries, 41 of which have still not been able to vaccinate 10% of their populations, while 98 countries have not reached 40%,” said Dr Mariângela Simão, WHO Assistant-Director General for Access to Medicines and Health Products in a press release. 

First Of A Kind Vaccine

The vaccine is the first of a different class of COVID-19 vaccine – a protein-based vaccine and one would need two doses of it for protection against the virus.

The vaccine is produced using an engineered baculovirus that contains a gene for a modified SARS-CoV-2 spike protein. 

“With robust data on safety and efficacy against several variants, strong potential in mix and match and booster regimens, a nine-month shelf life, and standard storage temperatures, this vaccine can be used in a variety of contexts and will provide countries with another critical option in the quest to protect their populations,” said Dr Seth Berkley, CEO, Gavi, the Vaccine Alliance. 

According to the press release, the originator product produced by Novavax, named NuvaxovidTM, is currently under assessment by the European Medicines Agency (EMA). WHO will complete its own assessment of this vaccine once the EMA has issued its recommendation.

The Technical Advisory Group for Emergency Use Listing that is convened by the WHO determined that the vaccine meets WHO standards for protection against COVID-19 and that the benefit of the vaccine far outweighs any risks, and that the vaccine can be used globally, according to the press release. 

The vaccine was assessed under the WHO’s EUL procedure based on the review of data on efficacy, quality, safety, a risk management plan, programmatic suitability, and manufacturing site inspections carried out by the Drugs Controller General of India.

Thanks to a high vaccination coverage, rich countries have curbed down COVID’s death tolls and hospitalizations, and now some of them can afford to keep most services up running with limited restrictions even amid a COVID wave. 

As more vaccine supplies finally become available to the world’s low-and middle-income countries (LMICs), the latent challenges that should have been addressed long before have emerged. Those include vaccine hesitancy and the ability of weak health systems to mount mass vaccination campaigns amidst other pressing health needs. Global policymakers need to shift their attention from focusing only on the sheer numbers of vaccine deliveries – to developing vaccines fit for purpose in LMICs, and building health systems capable of absorbing these life-saving health products.     

Thanks to a high vaccination coverage, rich countries have curbed down COVID’s death tolls and hospitalizations, and now some of them can afford to keep most services up running with limited restrictions even amid a COVID wave. 

COVID19 vaccination was so impactful that some experts suggest that the virus will soon become endemic – rather than the epidemic-cum pandemic that it has been for the past 20 months. 

Nevertheless, the low vaccine coverage in resource-constrained countries may lead to the creation of still more variants, slowing  the endemization process.  In that sense, the discovery of the Omicron variant was a timely reminder to the world that “no one is safe until everyone is safe” and that, in a better world, vaccines should be available for everyone at the same time.

The reality has been somewhat different 

Highly populated Asian countries have only fully vaccinated around 1 in 3 people. Coverage is 27% in Bangladesh, 27% in Pakistan, 35% in India, 39% in Philippines, and 38% in Indonesia,  leaving hundreds of millions with no jabs. 

Proportionally,  the situation is much worse in Africa (from only about 0.2% vaccination coverage in the Democratic Republic of Congo to about 2% in Tanzania, Burkina Faso, Niger and Madagascar. 

This  is far from all being safe at the same time.  And even as more doses finally become widely available in many African countries, the issues are  far from being resolved. Access to vaccines is quite complex and it encompasses technological, social, financial, and systemic dynamics. So in some countries, only a portion of available supplies actually end up being administered. 

Some countries hold off on more deliveries that they can’t absorb

Countries like South Africa, Namibia, and Mozambique have reportedly asked vaccine manufacturers and donors to hold off on sending more shots because they “can’t use the supplies they have”, according to a recent New York Times report. 

In manycountries less well-resourced, any vaccine campaign is likely to be  a real ordeal – even if health authorities have plenty of doses. 

Even the least demanding  COVID vaccines [e.g. AstraZeneca] require a refrigeration cold chain, while  the most effective mRNA jabs  require much lower temperatures  for long-term storage. 

Cold chain challenges will remain a barrier  – new types of vaccines are needed  

Just impossible for many countries with poor electricity coverage and basic logistics. Not to mention the number of health workers necessary to deploy mass immunization campaigns in countries with historical shortages of medical staff. 

That means that essentially, the existing available  COVID19 vaccines are effective and safe – but they are best fit for high-income countries’ contexts.

Massive investments should urgently go into transversal health system strengthening.  But in view of the time that will take, there is also a need to focus research on the development of a new generation of vaccines suitable for low-income countries. 

Much as resource constraints drove the development of rapid tests for HIV/AIDs and malaria, the same constraints should drive research into vaccines that are fit for purpose in health clinics with little access to electricity and few trained staff. . 

An ideal vaccine should be an oral or nasal spray one with a 12-month shelf life which requires no refrigeration nor the assistance of health workers. 

Out of the 137 vaccines in clinical development reported by WHO, less than 1 in 10 belong to a new generation. As their efficacy and safety still have to be proved, it is not clear how much public investment they receive compared to proven products already in the market. 

Out of the 137 vaccines in clinical development reported by WHO, less than 1 in 10 belong to a new generation.

It will take years to strengthen poor countries’ health systems and years to develop new vaccines. COVID-19 pandemic made clear that these investments should not be punted down the field to another time. .

Vaccine hesitancy another barrier 

Additionally, vaccine campaigns suffer from hesitancy among people, and poor countries are not spared. The fact that vaccine hesitancy may be a potential threat to the achievements of traditional vaccination programmes in Africa has been well reported, even before the pandemic hit. 

Although one new survey suggests that in many African countries the willingness to get COVID vaccines is certainly far greater than availability, the picture is not uniform. South Africa has only reached a 26% vaccination coverage – despite comparatively wide vaccine access.  In places like the DR Congo, vivid memories also persist of vaccine coercion episodes or doubtful drug testing. Public awareness campaigns can counteract the distrust but, again, almost no investment has gone into low-income countries for vaccine promotion: education on vaccines is left to the social media. Certainly, this trust cannot be built by shipping close-to-expiration doses or second-class vaccines, as it has been repetitively reported in the media.

Government buy-in – at the price of other health priorities ? 

Finally, COVID19 vaccine campaigns are only partially endorsed by countries facing other pressuring health priorities. For example in Niger, half of the population is below the age of 15 and only 2% of the population is aged above 65, the life expectancy is around 62 years and almost 1 child in 10 dies before the age of 5 from preventable diseases. Burkina Faso, Mali, and many countries in Africa share a similar profile. What is the incentive for those countries to divert their scarce resources to a virus that is predominantly perceived to hit the elder?

Candidates of the vaccine in clinincal phase.

International agenda has been too focused on supply numbers and not quality of delivery

Despite the complexity in deploying COVID vaccine campaigns, starting from the G20 in Rome and their reaffirmed commitment to the Access to COVID-19 Tools (ACT) Accelerator, the focus of the international agenda has been mainly about shipping as many doses as possible. In early November, a Task Force meeting on Scaling COVID-19 Tools was held among International Organizations including World Health Organization and COVID-19 vaccine manufacturers. 

The discussions were disappointingly limited on how to supply more vaccines, how to tackle trade-related bottlenecks, how to diversify manufacturing, etc. 

Agenda for strengthening health systems is too narrowly limited 

Although the latest Strategic Plan of the Act Accelerator  – the umbrella initiative for COVID  vaccination, treatment and testing, does include investment for health systems in the fight against the pandemic, it is narrowly limited to the “the technical, operational and financial resources to translate new COVID-19 tools into effective health interventions” (e.g.to set up ultra- cold chain infrastructure).

Even members of the civil society have recurrently called for more doses or a patent lift, as if it were a magic formula, while it is just a piece of a complex puzzle. 

In a recent opinion piece, Medicins Sans Frontieres’ director of operations Isabelle Defourny, rightly suggested avoiding simplistic views and pointed out the need for more holistic and localized responses to the pandemic. Similarly, the European Federation of Academies of Sciences and Humanities (ALLEA) in a December statement raised similar concerns that the current focus on a patent waiver may distract attention from other measures that are of fundamental importance in striving towards global vaccination. 

If the multiple barriers to vaccination are not surmounted in the first place, we will not reach vaccination for all at once, and no one will be safe. A genuine roadmap to end COVID19 should be inclusive of all countries and not driven by a few. It should consider all stakeholders involved and give voice to them. Failing to do so, the pandemic will likely last for longer.

About the Author:  

Riccardo Lampariello, head of Health Programme, at Terre des Homes, the leading Swiss relief agency for children’s aid, holds an MSc in Applied Statistics and an MBA. He has over 20 years of experience in Health: from Pharma – where he worked for 10 years in various positions in Clinical Development and Business Development – to International Organizations and International NGOs. He worked for GAVI Alliance, the Union of International Cancer Control and in May 2017 Riccardo joined Terre des hommes (the Swiss leading child protection agency improving millions of children’s lives worldwide) where he is Head of the Health division. With a focus on innovation, he drives the development and deployment of innovative projects (both disruptive and incremental), including one of the largest digital health solutions in Sub Saharan Africa. Twitter: @RLampa75 LinkedIn : www.linkedin.com/in/lampariellor

The opinions expressed in this article are the author’s own and do not reflect necessarily the view of Terre des Hommes.

 

Image Credits: WHO.

Global support is needed to ensure equitable distribution of vaccines in Africa. Rollout in Madagascar in early March, just before vaccine supplies to Africa dried up.

An overwhelming majority of people in Africa – 78% of people surveyed across 19 countries in the African Union – are willing to get vaccinated, according to new research from the Partnership for Evidence-Based Response to COVID-19 (PERC).

PERC – a public-private partnership consisting of organizations and institutions such as the African Union, Africa Centres for Disease Control and Prevention (CDC), Vital Strategies, the World Health Organization, and others – polled approximately 23,000 people across 19 African Union Member States. 

The 19 countries surveyed included South Africa, Kenya, the Democratic Republic of Congo, and Morocco – representing countries with wider access to vaccines and almost none at all.  

That is despite the fact that as of November 2021  less than 7% of the African continent has been vaccinated. 

The report, released on Thursday, highlights that vaccine hesitancy is not the top challenge in Africa. 

Despite efforts of the African Vaccine Acquisition Trust (AVAT) and the COVAX facility to expand vaccine access, only three African countries – Egypt, Morocco, and Zimbabwe – have reached the end-of-year WHO vaccination coverage target of 40%, according to the report. 

Vaccination coverage does not match vaccination demand in Africa

This demonstrates a substantial unmet need between acceptance and coverage, and underscores even further the importance of consistent vaccine supply and support for vaccination programmes in Africa. 

“We must work urgently towards equitable access to safe and effective vaccines on the African continent,” said Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention. 

“The PERC data show that demand for vaccines is substantially higher than supply.”

The PERC report considers the inequity surrounding global vaccination efforts and the logistical challenges to vaccinating the African continent. It also further outlines several preventative measures critical to mitigating COVID-19 transmission in the wake of new, more transmissible variants, such as Omicron. 

While respondents’ intention to vaccinate remains high, coverage remains low

High vaccine acceptance contradicts media reports about hesitancy 

Top reasons for vaccine hesitancy in Africa include: low risk perception, lacking information about vaccines, and lack of trust in government

The high vaccine acceptance rates of the African continent, higher now at 78% when compared to a previous PERC survey conducted earlier in the year (67%), contradicts media reports that low vaccination rates across Africa are due to hesitancy.

Five surveyed countries – Guinea, Morocco, Mozambique, Tunisia, and Zimbabwe, even had acceptance at 90% or higher. Acceptance rates were influenced by trust in governments and their handling of the pandemic; perceived risk of COVID-19; availability of information; as well as trust in the vaccines.

Among the 20% of respondents who did express vaccine hesitancy, top reasons included low risk perception, not having enough information about vaccines, and lack of trust in government. 

Misinformation has also been shown to influence decision-making regarding vaccines.

The global reaction to adverse events associated with AstraZeneca’s vaccine at the beginning of Africa’s rollout campaign likely had a lasting impact on vaccine acceptance and product choice in many member states. 

Vaccine production fails to reach global targets 

An insufficient number of vaccine doses have been promised to low- and middle-income countries, with the supply delivered even lower than expected.

Global production targets totaled 20.8 billion doses, but manufacturers’ project that only about 12 billion will be produced by the end of the year. 

In addition, less than 15% of donated doses were actually delivered to LMICs. 

Unpredictable and inconsistent supply act as logistical bottlenecks that threaten countries’ ability to meet demand. 

In its report, PERC called on numerous stakeholders – manufacturers, donor countries, AVAT and COVAX to work collaboratively with recipient governments to ensure advance vaccination campaign planning and rollout.

“As vaccine supply increases in many countries, efforts to identify and address barriers to getting shots into arms are critical,” the report read.

“WIthout immediate, coordinated support to address these bottlenecks, the pace of vaccination will remain slow, in spite of the great demand for COVID-19 vaccination.” 

Recommendations point towards global support and public health measures 

COVAX
COVAX vaccine deliveries in Africa.

The report makes several calls to action, noting that in addition to scaling-up public health infrastructure and implementing preventative measures, the global community would need to support and supply AU Member States with vaccines for more effective and equitable distribution.

Notably, while individual public health measures – handwashing, mask-wearing, and social distancing – all garnered support from at least 90% of survey respondents, preventative measures that restricted gathering received less support. Unemployment and food security made it difficult to adhere to restrictive community measures.

Specifically, the report recommends: 

  • Governments should prioritize strengthening surveillance structures and health data systems.
  • Though reliable supply of safe and effective COVID-19 vaccines is necessary, it is not sufficient. The global community should support vaccine delivery with resources and expertise to ensure coverage.
  • Public health and social measures are critical tools for mitigating COVID-19 transmission, especially as more transmissible variants emerge in under-vaccinated populations. 
  • To the fullest extent possible, the global community and national governments should invest in public health infrastructure and social protection programs. 

“The PERC data enable policymakers to both save lives and minimize impacts on livelihoods,” said Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies. 

“The global community has an opportunity to invest in health care workers and public health infrastructure to support vaccine delivery and COVID-19 care and prevention in the near term, and also repair and restore health service delivery disrupted by COVID-19 for the long term.”

Image Credits: World Bank/Flickr, PERC , PERC, UNICEF.

In a historic first, World Trade Organization (WTO) members launched three high-level ministerial statements calling for the global trade body to support fossil fuel subsidy reforms and measures to reduce plastics pollution of land and seas.

The pivotal new statements call for a “phase out of inefficient fossil fuel subsidies”, a key driver of climate change – as well as the cause of an estimated $8.1 trillion global cost of health damages associated with exposure to air pollution. Individuals from low- and middle-income countries are usually at the receiving end of climate change effects, panelists and speakers at the launch echoed. 

The fossil fuels subsidy reform statement was only signed by 44 countries, including the European Union. However, the reference to “phase out of inefficient fossil fuel subsidies” is stronger that the agreement reached at the COP26 to “phase down” fossil fuel use after a last-minute intervention by India. 

A second statement calls for launching “informal dialogue” on ways to reduce trade in polluting single use plastics -was launched along with a third statement calling for a more structured WTO dialogue on trade and environmental sustainability. 

The growing risks of microplastics pollution to the human food chain, and human health via both fisheries as well as agriculture, has been highlighted recently in a new UN Food and Agriculture Organization study. According to Australian Ambassador and Permanent Representative to WTO Geroge Mina, the global trade in plastics measures US$1 trillion annually. “If we don’t act now, the weight of plastics in our ocean will be greater than the weight of the fish.” 

Environmental sustainability on WTO agenda

Together, the three statements – co-signed by 81 countries – aim to put environmental sustainability issues on WTO agendas, at least informally, as challenges that need to be tackled by the global trade body. “More than half of the 81 co-sponsors across the three statements are from developing countries,” the Director General of the WTO Ngozi Okonjo-Iweala said at the virtual launch of the statements. 

“Treaties are about people but the fact is that people are the most vulnerable and are increasingly paying the price of environmental degradation,” she added. This is the first time in the WTO’s 26-year history that there has been a separate ministerial statement on environment issues beyond fisheries subsidies reform. “There is too much at stake for us to wait decades more for results. The ministerial statements must lead to action,” she added. 

WTO Director-General Dr. Ngozi Okonjo-Iweala speaks at the launch of the statements.

“The launch of the three ministerial statements today represents a landmark in the history of the WTO,” said Carolyn Deere Birkbeck, head of the new Geneva-based forum on Trade, Environment and the SDGs (TESS), at the launch event. 

“Environment issues have been a challenging topic for members for much of the organization’s first 25 years. This event today is remarkable because it is a set of environmental issues, pressing crises, which is bringing members together.” 

The statements were due to be launched at the WTO’s 12th Ministerial Conference, which was to have taken place in Geneva over the week of 29 November – but cancelled due to travel restrictions associated with the new Omicron wave, imposed by the Swiss authorities. 

Although they contain no concrete or binding measures, they are an important signal of a new direction that the WTO is taking to bring trade policies better into alignment with global climate and sustainability goals. The launch of the statements are also essential since they also work towards addressing the environmental impacts of WTO’s rules and subsidies. 

“The three statements today strike at very important drivers of the triple planetary crisis- the climate crisis, the nature and biodiversity loss crisis, and the pollution and waste crisis,” said Inger Andersen, Executive Director, UN Environmental Programme. 

Statement 1: Fossil Fuel Subsidy Reform 

The statement on fossil fuel subsidies was co-sponsored by 45 WTO members. 

This statement aims to rationalise and “phase out of” inefficient fossil fuel subsidies that encourage wasteful consumption. The co-signatories remain optimistic about more member countries joining the initiative as they aim to elaborate concrete options to advance this issue at the WTO in advance of MC13.

Incidentally, the world’s four largest fossil fuel consumers–China, U.S, India and Russia– have not yet signed on to the statement. But current signatories remain optimistic that more members will sign the initiative. 

“It is vital that we shift from business as usual as soon as possible” said Damien O’Connor, Minister for Trade and Export Growth, New Zealand at the launch of the statement. He added that fossil fuel subsidies must be reformed if we are to stay on the 1.5C pathway and called the current subsidies “environmentally damaging to the planet.” 

Damien O’Connor, Minister for Trade and Export Growth (New Zealand).

“This statement targets one of the biggest barriers to renewable energies. These [current] subsidies encourage greenhouse gas emissions and wasteful consumption and drive down the price of primary plastics adding to the plastic pollution crisis.” Inger Andersen said. 

But building consensus on how we can make trade a part of the solution remains a significant challenge, said Rebeca Grynspan, Secretary General, United Nations Conference on Trade and Development (UNCTAD). “A fair, transparent and inclusive dialogue will be essential for success and that hopes to bring to this discussion the developing countries’ perspective on how we can support them toward sustainable trade and development.”

Statement 2: About the Plastics Initiative 

The ministerial statement on plastic pollution and environmentally sustainable plastic trade recognizes that rising environmental, biodiversity, health and economic costs of plastic pollution are concerns that have been amplified by the COVID-19 pandemic.

UNCTAD had estimated that trade in plastics accounts for nearly 5 % of global trade which is worth more than US$ 1 trillion in 2019. This was almost 40% higher than previously estimated, with more trade in plastics still not accounted for. The statement thus aims toward building more sustainable channels, sharing experiences on approaches toward sustainable plastics trade, and to help the least developed members toward more sustainable technologies and collaborations. 

The US is the world’s second-largest producer of plastic waste but is currently not a signatory to the Ministerial statement on plastic pollution and environmentally sustainable plastics trade. It has only co-signed the ministerial statement on trade and environmental sustainability. China, on the other hand, is one of the first co-signatories. 

This statement especially builds on the existence of micro plastics in the oceans, our food and in spaces we never imagined it to be in. It highlights the need to reduce plastic usage and waste, and cutting down micro plastics that are now found in fish and even vegetables.

The statement identifies concrete opportunities and areas for cooperation on trade and trade policy that would help reduce plastic pollution while emphasizing the importance for members that the work complements and supports the work in the WTO’s committee on trade and environment. 

Statement 3: Environmental sustainability and wrap up 

The ministerial statement on trade and environmental sustainability highlights the importance of international trade and trade policy in supporting environmental and climate goals and promote more sustainable production and consumption with the SDGs in mind. This has been co-signed by over 60 signatories including the European Union. 

The statement highlights the need of identifying the best approaches and opportunities in enhancing supply chains as well as identifying challenges and opportunities for sustainable trade for all members. 

The statement also points towards finding a common ground and aim in furthering the goals of a sustainable trade approach. This would also mean training, knowledge sharing and finding alternative sustainable solutions to current challenges. 

“Finding common ground would require investment, transparency and knowledge sharing along with support to have all countries to have more countries improve resilience and ensure a fair transition,” said Mathias Cormann, Secretary-General of the Organization for Economic Co-operation and Development. 

Andres Valenciano, Minister of Foreign Trade (Costa Rica) at the launch of the statements

 

Disclaimer: Carolyn Deere Birkbeck is also chairman of the board of Global Policy Reporting, the non-profit association that oversees Health Policy Watch. 

Image Credits: WHO/European Pressphoto Agency (EPA), @Antoine Giret/ Unsplash, WTO , WTO.

African health experts reflect on lessons learnt from the pandemic.

The COVID-19 pandemic has been a “wake-up call” to African countries to build resilient health systems, boost local manufacturing of medicines, and improve the skills of health workers, according to Rwanda’s President Paul Kagame.

Opening the continent’s first-ever Conference on Public Health in Africa this week, Kagame – chairperson of the African Union Commission – said that the continent could not depend on “external funding” to build resilient health systems.

He outlined a new public health order based on four components:

  • Building the capabilities and professionalism of continental health bodies including the  Africa Centres for Disease Control (CDC) and the African Medicines Agency (AMA),
  • Increasing domestic funding for public health,
  • Investing in national health systems that have the ability to implement critical health programmes, including regular mass vaccination campaigns, and
  • Implementing the Partnership for African Vaccine Manufacturing “to ensure that Africa does not remain at the back of the queue for life-saving medicines and vaccines”.

Meanwhile, Dr John Nkengasong, director of the Africa Centre for Disease Control (CDC), said that the conference marked the beginning of “self-determination” in public health for the continent.

“The Ebola outbreak in West Africa was a signal to all of us that something big was going to come. Hardly have the memories of that devastating outbreak died down, then COVID showed up. And perhaps COVID could be telling us that we have to prepare aggressively for something even worse to come,” warned Nkengasong at a media briefing on Wednesday.

Building the health workforce

Dr Githinji Gitahi, CEO Amref Health Africa, called for investment in the public health workforce was a priority given huge shortages in skilled staff – for example, the continent only had 1,900 epidemiologists but needed at least 6000.

Gitahi added that each country needed to build “strong national public health institutes that are not working independently but are coordinated by the Africa CDC.

Working conditions for health workers are notoriously bad in many countries, and there have been a number of strikes by health workers during the pandemic.

In Uganda, for example, doctors went on strike on Wednesday in support of medical interns who were fired last week after a five-week strike after the government failed to pay them. Other grievances include lack of equipment and poor working conditions.

 Changing the care model

South Africa’s Professor Helen Rees said that COVID-19 had enabled Africa “to break the old world order” where research questions on the continent were dominated by researchers from high-income countries.

Rees called for a “diagnostic on what actually happened to stop the flow of vaccines to the African region”, including asking questions of high-income countries that hoarded vaccines and profit-driven pharmaceutical companies.

“Next time around and as we go on, there needs to be tiered pricing from the outset and commitment to access,” said Rees.

However, Rees said that the continent had to make health systems patient-friendly to reach the poorest people who always fared worst in diseases.

People were expected to travel long distances and queue for hours at clinics to get healthcare, but with some creativity, they could be served better.

One way to do this was to offer integrated services for all members of families instead of  separate “vertical programmes” for different diseases, usually based on funding.

The conference, which attracted over 15,000 online delegates, came as less than 20 African countries had met the global goal of vaccinating at least 10% of the adult population by 30 September, while nearly 90% of high income-countries met this target. 

As of 3 December 2021, only 7% of the African population has been fully vaccinated, as many countries face a surge in new infections and the emergence of the SARS-CoV-2 variant of concern Omicron.

 

Omicron-related travel bans have emptied airports but ‘give a false sense of security’.

Omicron is now in 77 countries, spreading at a rate not seen by other COVID-19 variants and countries should not assume that it is mild, warned World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus on Tuesday.

Even if people get milder symptoms from Omicron, the sheer number of cases could overcome health systems that have already been weakened by previous COVID-19 waves, WHO officials stressed at the global body’s COVID-19 media briefing on Tuesday.

Tedros acknowledged that COVID-19 booster vaccines may have an important role to play against Omicron, especially for those vulnerable to severe disease – but stressed that “WHO is not against boosters, we are against inequity”.

“The emergence of Omicron has prompted some countries to roll out booster programmes for their entire adult populations even while we lack evidence for the effectiveness of boosters against this variant,” said Tedros. “WHO is concerned that such programmes will repeat the vaccine hoarding we saw this year and exacerbate inequity.”

On Tuesday, data released from South Africa’s largest insurance provider showed a 70% protection rate against serious Omicron infection for people vaccinated with two Pfizer doses, as compared to 93% or more in previous waves. Other, smaller studies, however, have shown that while the current 2-dose regimes vaccines are significantly weaker against Omicron, boosters can restore protection. Research from Pfizer also has made the case for boosters.

WHO officials stressed that countries had to use all the means at their disposal – vaccinations, particularly prioritising those most at risk; masks and social distancing – to prepare for Omicron.

Director-General Dr Tedros Adhanom Ghebreyesus

UK lifts travel ban amid community transmission

Meanwhile, the UK has decided to lift its travel ban on all African countries from Wednesday morning, acknowledging that it was not working.

“Now that there is community transmission of Omicron in the UK and Omicron has spread so widely across the world, the travel red list is now less effective in slowing the incursion of Omicron from abroad,” UK Health Secretary Sajid Javid told the UK parliament on Tuesday.

Dr Tedros expressed his appreciation to the UK for lifting its ban, while Dr Matshidiso Moeti, WHO Africa director, made an appeal earlier in the day for all countries to “urgently reconsider the recently introduced travel bans” that were destroying African livelihoods, and  “instead show solidarity with your neighbours and act in the interests of the global good”.

Dr Mike Ryan, WHO Assistant Director of health emergencies, said that the global bodies wanted to see “layered control measures” to reduce the risk of viral transmission during travel.

“When a variant like this emerges, it probably has spread in advance of it being detected, and blanket travel bans give a false sense of security,” said Ryan.

“They destroy economies. They have a negative impact on transparency, and we would advise governments to use a more nuanced, more risk-managed and targeted approach,” said Ryan.

“Countries have a right to defend and protect themselves. They have a right to control their borders. They do it for all kinds of other reasons. But it must be done in a way that maintains to the maximum extent possible movement of people, individual human rights and with due regard for the economic impacts that such measures have on countries,” he added.

By Tuesday morning, Omicron accounted for 10% of global COVID-19 infections and this was growing fast, according to Professor Penny Moore, South African Research Chair of Virus-Host Dynamics.

So far, the UK, Norway, Denmark have the highest number of cases outside of South Africa.

Real-world evidence of impact on vaccines

While all the research so far shows reduced vaccine efficacy against Omicron, quantifying this is hard given the different contexts and different methods.

However, data released on Tuesday by South Africa’s biggest health insurance company, Discovery Health, showed that two doses of the Pfizer vaccine provided around 70% protection against hospital admissions but only around 25% protection against infection.

This was according to an analysis of the vaccine and clinical records, and pathology test results of around 78,000 Discovery members who had been infected by Omicron between 15 November and 7 December, according to the group.

However, the group cautioned that the data was taken from the early part of the outbreak.

The WHO’s COVID incident manager, Dr Abdi Mahmud, said that South Africa had shared the data of 400,000 patients and the body was in the process of comparing the profiles of those infected with Delta with those infected by Omicron.

“What’s really important is that these are early reports and there are considerations about exactly who was vaccinated, and what the disease severity is,” said Dr Kate O’Brien, WHO Director of Immunisation and Vaccines.

“So [this data] is certainly of significant interest and we will continue working with partners on additional reports that we know are coming because what is really important is an aggregate of evidence from around the world,” said O’Brien.

“I think the important thing though, is that transmission of Omicron is not going to be solved by vaccines. Protecting against that severe end of the disease spectrum. is really critical. But we have to be doing all of the interventions in order to assure that we have the lowest transmission possible as Omicron is moving its way through different populations,” she stressed.

Ryan added that the WHO was in contact with hundreds of researchers around the world but that it was too early to answer a number of questions related to Omicron, including whether it was milder than Delta and whether vaccines could prevent severe infection.

 

Image Credits: Govind Krishnan/ Unsplash.

WHO’s Martin Friede

CAPE TOWN – The mRNA vaccine ‘hub’ being set up in South Africa aims to have a COVID-19 vaccine candidate ready for clinical trials by 2023.

Meanwhile, the World Health Organization (WHO) – which initiated the South Africa hub to address regional inequity – is setting up a “biomanufacturing workforce training centre” to address the skills shortages in low and middle-income countries that make technology transfer difficult.

This is according to the WHO’s head of technology transfer, Martin Friede, who addressed the first public engagement on the South African tech transfer hub last Friday.

“We have recognised that the lack of a skilled workforce in biomanufacturing is one of the biggest challenges to doing technology transfer into low and middle-income countries, so we will be announcing a biomanufacturing workforce training centre,” said Friede.

This centre will be linked to the WHO Academy, which is in the process of being set up in Lyon in France.

New hub on viral vectors?

In addition, the WHO aims to set up another technology transfer hub early next year, potentially focusing on viral vectors, he said.

The South African mRNA ‘hub’ will teach African manufacturers how to make mRNA vaccines, like the Pfizer and Moderna COVID-19 vaccines.

Foreign manufacturers will share techniques with local institutions and WHO and partners will bring in production know-how, quality control and will assist with getting necessary licenses.

However, South Africa’s deputy science minister, Buti Manamela, stressed that the vaccine candidate is “being modelled on open source technology, and the Medicines Patent Pool, which is responsible for the intellectual property and licencing elements of the project, will ensure that patents are not infringed upon”.

South Africa has allocated approximately 100-million euros for vaccine development and manufacturing over the next five years, added Manamela.

“The mRNA vaccine technology is also promising for use against other diseases such as TB, malaria, and possibly HIV/ AIDS and the facility will also strive to build its innovation capacity and develop a pipeline of homegrown products, including an mRNA-based vaccine for malaria,” he added.

WHO and Medicines Patent Pool provide governance

The  South African hub will be based at a company called Afrigen, which will house the equipment and technology, which will be passed on to “spokes” – local and African manufacturers. 

The vaccine tech transfer hubs, which are also being set up in other regions, are being governed by the WHO’s Secretariat and the Director-General, assisted by an advisory committee called Product Development for Vaccines Advisory Committee (PDVAC). Each hub has a steering committee.

Key decisions involve which mRNA technologies to choose, intellectual property issues, ensuring the recipients of the technology transfer are applying it correctly and ensuring that the facilities can make other mRNA vaccines when COVID is over.

The South African hub is chaired by Dr Marie-Paule Kieny, the chairperson of the Medicines Patent Pool, and its governance includes the African Centre for Disease Control and Prevention (CDC), and the South African Department of Science and Innovation.