WTO Director-General Ngozi Okonjo-Iweala addresses the meeting alongside General Council Chair Ambassador Dacio Castillo

The European Union (EU) has described India’s call for an urgent meeting of the World Trade Organization (WTO) Ministerial Conference to discuss the body’s response to the COVID-19 pandemic, including a proposed waiver of relevant intellectual property protections, as “premature”.

Addressing the WTO General Council informal meeting on Monday, EU Ambassador João Aguiar Machado said that while the pandemic response was important, it “must not lead to a loss of momentum on the other key components” – including “the fisheries subsidies negotiations, agreeing on a way forward on agriculture, and finalising the Ministerial Declaration with a strong commitment on WTO reform”.

General Council Chair Ambassador Dacio Castillo (Honduras) had convened the 10 January virtual meeting in response to India’s recent proposal – sent in a letter to the WTO last month. 

India and South Africa tabled a proposal well over a year ago to waive certain provisions of the TRIPS Agreement for COVID-19-related vaccines, therapeutics, and diagnostics.

At Monday’s meeting, WTO Director-General Ngozi Okonjo-Iweala urged member states to urgently step up their efforts, suggesting that “with the requisite political will, members can in the space of the coming weeks reach multilateral compromises on intellectual property and other issues so that the WTO fully contributes to the global response to COVID-19 and future pandemics”, according to a WTO statement.

“More than two years have passed since the onset of the pandemic. The emergence of the Omicron variant, which forced us to postpone our Twelfth Ministerial Conference, reminded us of the risks of allowing large sections of the world to remain unvaccinated,” said Okonjo-Iweala.

“We at the WTO now have to step up urgently to do our part to reach a multilateral outcome on intellectual property and other issues so as to fully contribute to the global efforts in the fight against COVID-19,” she added.

‘No better time than now’

The Director-General also updated members on her efforts, together with Deputy Director-General Anabel González, “to support an informal group of members to converge around a meaningful acceptable outcome that can be built upon by the wider membership to bring a successful conclusion to the intellectual property issue.” 

“It is slow but steady progress, and we are hopeful that this approach can help us together find the direction we need,” she said. “There is no better time to build convergence than now.” 

She noted that while pandemic response remained the most urgent endeavour facing WTO members, many members had reached out to her to emphasise the importance of other items on the WTO agenda, including fisheries subsidies, agriculture and WTO reform. She stressed that these areas remained priorities for outcomes, and expressed hope “that we can all agree on getting results as soon as possible.”

Describing the meeting as “useful,” General Council Chair Ambassador Castillo said he would continue to hold consultations with members on the Indian proposal, underlining “the urgency and importance of reaching a meaningful outcome.” A common WTO response to COVID-19 “remains an urgent priority for the membership,” he said.

However, the EU Ambassador Machado said that “before any decision to call a virtual Ministerial meeting and topics to be decided, we believe the WTO Director-General and the Chair of the General Council should hold consultations with Members, to assess the way forward on all four issues that I referred to”.

“Any virtual Ministerial should take place only once there is a consensus both on intellectual property rights and on the Declaration and Action Plan on the wider pandemic response,” he added.

“Only a comprehensive trade response to the pandemic can make a difference and address the identified bottlenecks as regards the production and distribution of COVID-19 vaccines such as restricted access to raw materials and other inputs as well as complex supply chains.”

 

“Including the experiences and skills of people living with disabilities in the design and delivery of health systems is fundamental to achieving #HealthForAll,” wrote World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus on Twitter last week.

His tweet was a reminder of the upcoming Thematic Pre-Summit on Disability Inclusion in the Health Sector, which takes place virtually on Wednesday (12 January). 

The pre-summit will formalize a new engagement among participants of the second Global Disability Summit, scheduled for 16-17 February, around the importance of inclusion within the health sector. Discussions around the health theme that will also feed into the larger summit taking place next month, hosted by the governments of Norway and Ghana, and the International Disability Alliance.

The pre-summit focusing on the health sector is a first, insofar as the topic of disability and health services was not part of the first Global Disability Summit held in 2018. 

Wednesday’s two-hour pre-summit will include several panels covering topics such as the need for the health sector to listen to the voices of people who live with disabilities, to how inclusion of people with disabilities could help achieve national health objectives and opportunities for international collaboration. 

The high-level line-up of speakers include WHO DG Tedros; Yannis Vardakastanis, president of the International Disability Alliance; Norwegian Prime Minister Jonas Gahr Støre; and Dr Natalia Kanem, Executive Director of the United Nations Population Fund.

Mental health to be addressed

Atmiyata’s community and volunteer-based support network for people in distress in Gujarat, India.

One other focus of the health pre-summit event will be the need to improve services for persons with mental health conditions and psychosocial disabilities. A panel on that issue will include Olga Runciman, co-founder of the Danish Hearing Voices Network.  A psychiatric nurse, she will discuss her own lived experience with schizophrenia, as well as her experience in the health sector to articulate her views about how mental health treatment needs to change to recognize and empower individuals.

“I hear voices, and I don’t want my voices to be removed or go away,” Runciman told Health Policy Watch. “But when you are given the devastating label of schizophrenia, you lose your voice, you most likely experience abuses within the psychiatric system – forced seclusion, forced medication, being tied to beds. It is really difficult to get people to hear and listen to what you are saying.”

Western psychiatry has harmed people with mental health conditions and psychosocial disabilities, she asserts. Hearing Voices and other rights-based organizations offer models for how treatment can be handled differently. Other alternative models, described in a recent report by the World Health Organization, include the “open-dialogue” approach being practiced in Western Lapland, the Atmiyata community and volunteer-based service in India, and the BET Unit, an open-door psychiatric ward in Norway, which operates around principles of voluntary choice of treatment and minimal drug use.

“The goal is that people will sign on to some of these best practices, quality-of-life programs and help people change their attitudes and to work in different ways,” Runciman said. 

Health systems often neglect people with disabilities 

The idea of bringing the topic of inclusion in the health sector into the summit came following the adoption of a landmark World Health Assembly resolution on achieving the highest attainable standard on health for persons with disabilities in January 2021. The resolution called on countries and health sector partners to move away from an exclusively medical approach to disability towards adopting a comprehensive people-centred and human rights-based approach.

Very often, health systems neglect to consider the needs of people with disabilities, organizers say.  And with around a billion individuals around the world with disabilities, inclusion is essential for countries to reach universal health coverage – something further highlighted by the COVID-19 pandemic. 

Although WHO has been working on disability and health for many years, Wednesday’s pre-summit event represents the building momentum on the issue across a range of WHO programmes, as well as the growing partnership between WHO and the international disability community. 

While the pre-summit will stay focused on disability inclusion in the health sector, the larger summit in February will tackle a broader set of themes covering: Inclusive education, health, employment and livelihood, and inclusion in situations of crises and conflict, including a focus on climate change.

Februrary’s summit will also push for countries to adopt concrete commitments contributing to successful inclusion around themes such as: access to communication and information, enabling independent living; ensuring people with disabilities can access land and property rights. 

To sign up for the pre-summit event, click here. To maximize inclusion in the pre-summit, International Sign Language and American Sign Language, closed captioning in English, as well as language interpretation in English, Spanish, French, Chinese, Russian and Arabic will be available.  

To learn more about the larger summit, visit https://www.globaldisabilitysummit.org/. 

Image Credits: Rasmus Gerdin/ Unsplash, Amiyata, Gujarat, India.

Bexlovid, the world’s first generic of the successful Pfizer antiviral, is already on sale in Bangladesh.

The first generic version of Paxlovid, the Pfizer pill that has proven highly effective in treating COVID-19, is already available in Bangladesh.

However, Indian generic company Dr Reddy’s, which has started to produce the Merck antiviral, molnupiravir, might be in trouble after the country’s National Task Force for COVID-19 resolved on Monday that there were too many safety risks associated with the drug for it to be included in national treatment protocols, according to the Times of India.

Molunpiravir, which has been shown to reduce hospitalisations by 30% in clinical trials, has also been associated with birth defects and other issues.

However, Bangladesh’s generic company Beximco started distributing its version of Paxlovid – called Bexlovid – last week after Bangladesh’s Directorate General of Drug Administration issued an Emergency Use Authorisation (EUA) for its production on 30 December.

A week earlier, the US Food and Drug Administration (FDA) had issued an EUA for Paxlovid, allowing doctors to prescribe a five-day course for adults and children 12 years of age upwards within five days of symptoms for people who “are at high risk for progression to severe COVID-19, including hospitalization or death”. This includes people with obesity, diabetes and those over the age of 60.

The antiviral is a combination of two drugs – nirmatrelvir and ritonavir – and has been found 89% effective in preventing at-risk people with mild to moderate COVID-19 infections from severe disease and death.

“Having previously introduced the world’s first generic COVID-19 treatments of remdesivir and molnupiravir, we are pleased to add this breakthrough therapy to our portfolio,” said Beximco managing director Nazmul Hassan.

“It is further testament to our commitment to making affordable treatments accessible as soon as possible. As data continues to emerge demonstrating the effectiveness of nirmatrelvir and ritonavir against the the fast-emerging Omicron variant, we believe that Bexovid has the potential to be a powerful tool in combating the ongoing pandemic.”

Nirmatrelvir inhibits a SARS-CoV-2 enzyme to stop the virus from replicating, while ritonavir slows nirmatrelvir’s breakdown to help it remain in the body longer. 

Voluntary licenses for Pfizer pill

Last November, Pfizer signed a voluntary license agreement with the Medicines Patent Pool (MPP), enabling the MPP to grant sub-licenses to qualified generic medicine manufacturers, to produce and supply Paxlovid to 95 countries, covering up to approximately 53% of the world’s population. 

According to the agreement, Pfizer will not receive royalties on sales in low-income countries and will waive royalties on sales in all countries covered by the agreement while COVID-19 is classified as a Public Health Emergency of International Concern by the World Health Organization (WHO).

Unlucky Dr Reddy’s?

After entering into a voluntary licensing agreement with Merck late last year, Indian generic company Dr Reddy’s announced this month that it will sell its generic version of Merck’s COVID antiviral, molnupiravir, for about $0.50 per capsule, or $20 for a five-day treatment course of 40 capsules – in comparison to Merck’s US price of around $700 per course.

But although India last week gave EUA to molnupiravir, the head of India’s Council of Medical Research, Dr Balram Bhargava, said that the drug had “major safety concerns” and would not be included in the country’s treatment protocols.

Meanwhile, wealthy nations have ordered around 30 million doses of Paxlovid, according to Luis Gil Abinader,, a researcher with Knowledge Ecology International (KEI), who has been tracking the orders. 

 

 

A Palestinian health worker administers a COVID-19 test to young child

Some researchers and governments are questioning the accuracy of rapid antigen tests to identify Omicron – and it has been suggested that rapid tests based on throat- instead of nasal swabs might be more accurate in detecting the highly infectious COVID-19 variant.

Last week, a small pre-print study reported that 29 fully vaccinated and boosted individuals who became infected with Omicron during December were diagnosed by PCR tests three days sooner on average than testing positive with antigen tests (also called lateral flow tests). 

The study, which tracked COVID-19 in five workplaces in New York and California through daily employee testing, used saliva-based PCR tests and antigen tests using nasal swabs.

Lead author Dr Blythe Adamson told Health Policy Watch that the median time from the first positive PCR to the first detectable antigen-positive test was three days and that the viral load appeared to peak in an individual’s saliva as much as one to two days before in their nasal cavities. 

“We did epidemiological investigations and contact tracing and had four confirmed transmissions in the time period between phase zero and one, when the antigen test was negative and the PCR was positive,” added Adamson.

All individuals developed symptoms within two days of the first positive PCR test results, but the antigen tests only revealed a positive result after they developed symptoms. 

UK sticks to rapid tests

The US Food and Drug Administration (FDA) recently warned: “Early data suggests that antigen tests do detect the Omicron variant but may have reduced sensitivity.” 

However, the FDA acknowledged that antigen tests “are generally less sensitive and less likely to pick up very early infections compared to molecular tests”, adding that “if a person tests negative with an antigen test but is suspected of having COVID-19, such as experiencing symptoms or have a high likelihood of infection due to exposure, follow-up molecular [PCR] testing is important for determining a COVID-19 infection”. 

Meanwhile, the UK Health Security Agency reported last month that the antigen tests it was using “indicate a comparable sensitivity [to Omicron]  to that observed for previous strains of SARS-CoV-2 including Delta, which has been the predominant strain in the UK from May to December 2021”.

Rapid tests are accurate once symptoms start

A Cochrane review of 64 studies measuring the accuracy of antigen tests published in March last year, before Omicron emerged, found that the rapid tests detected almost three-quarters of COVID-19 cases once people showed symptoms but only 58% of cases in people without symptoms.

“Tests were most accurate when used in the first week after symptoms first developed (an average of 78% of confirmed cases had positive antigen tests). This is likely to be because people have the most virus in their system in the first days after they are infected,” according to the review.

“In people who did not have COVID-19, antigen tests correctly ruled out infection in 99.5% of people with symptoms and 98.9% of people without symptoms.”

Meanwhile, in the face of its growing COVID-19 caseload, Israel recently switched to home testing, opting to reserve PCR tests for older people. However, this week it urged those who have come into contact with someone with the virus to take an antigen test 72 hours after exposure rather than 12 to 24 hours and asked people to put the swab in the throat and not just the nose.

Scientists believe that one of the reasons the antigen tests may be less effective is that Omicron infects the throat more than the lungs so throat swabs or saliva tests would be more effective.

“The method of testing only from the nose probably misses Omicron,” said Dr. Gili Regev-Yochay, director of the Infectious Disease Epidemiology Unit at Sheba Medical Center in an interview with Israeli media. “The swab should be inserted into the pharynx and from there into the nose, and only then will the sensitivity increase.”

However, most health professionals have been slow to give such advice for fear that users would swab their throats too deeply or in a way that could cause them harm. 

“You have to use the right test at the right time,” Adamson continued. “Omicron will not be the last variant. We need to make sure we are ready and able to better identify variants as they come.”

 

Image Credits: Alia Ameen/Twitter .

WHA special session in Geneva in November 2021 meets in a hybrid form to approve negotiations on a new global Pandemic Accord.

China wants to delete language supporting rapid World Health Organization (WHO) access to outbreak sites in future pandemics from a critical document that maps out a way forward in future pandemics, a diplomatic source has told Health Policy Watch.

This emerged at Monday’s start of a three-day meeting in Geneva of the global body’s Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR).

The WHO working group is negotiating over an  interim draft report summing up 131 proposals from member states, four panels and various committees on how to improve global pandemic preparedness and response.

The draft report, which also zeroes in on vaccine and medicines equity, pathogen sharing, stronger “One-Health” approaches, and “adequate and sustainable financing” for WHO, is to go before the WHO Executive Board’s 150th session, 24-59 January, for “guidance”.  Further rounds of talks are then planned for February, March and April before a final version is submitted to the 75th World Health Assembly (WHA), set for 22-28 May. 

The final report, presuming it is approved by the WHA, would then form the backbone for future intergovernmental negotiations on a new global pandemic accord. A special November session of the World Health Assembly agreed to move ahead on intergovernmental negotiations over a new legal instrument to govern preparedness and response to future pandemic threats.  

Along with China veto, other parts of draft riddled with additions and deletions 

Colin McIff, USA co-chair, along with Indonesia, of the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR)

However, in the first day of discussions, China took exception to the suggestion that the WHO should have rapid access to “relevant sites during an outbreak to facilitate public health investigations”, particularly ”explicit power to investigate”, according to diplomatic sources.

China requested Paragraph 11 (d) be deleted altogether from the report, so as to wipe out any reference at all to the issue, the diplomatic source told Health Policy Watch. It was backed by Syria, sources said.

The paragraph states in full: “The four panels and committees came to the same conclusions regarding the need for WHO access to relevant sites during an outbreak to facilitate public health investigations.  However, there was divergence over the means by which this should be implemented: some advocated that WHO should be given explicit power to investigate, while others suggested that WHO be limited to offering immediate technical support to the concerned Member State(s).

“On this topic, there has been some discussion within WGPR on this as a critical gap that needs to be addressed, while several Member States have also cautioned the need to move forward in a way that fully respects national sovereignty.”

The draft text published Monday appeared sure to undergo further significant revisions – as member states entered dozens of other proposed additions and deletions in bracketed texts, color-coded in green, sources said. 

Since WHA decisions are customarily approved by consensus, opposition by just one or two countries to a concrete measure – like onsite inspections of outbreaks – can thwart approval altogether.  

Other key recommendations in the draft report include stronger action to ensure: 

  • Timely sharing of pathogens and genomic sequencing data;
  • Sustainable financing for pandemic preparedness; 
  • A “One Health” approach to preparedness that recognizes how environmental degradation, animal health and zoonotic diseases can feed outbreaks; 
  • “Equitable and timely access to countermeasures, including personal protective equipment, diagnostics, therapeutics and vaccines;”
  • More investments in R&D along with “effective and scalable supply chains”;
  • “Timely technology transfer”, including knowledge sharing. 

The recommendations were drawn from a series of external reviews of pandemic responses conducted over the last year. These include reports by: the Independent Panel for Pandemic Preparedness and Response, the Review Committee on the International Health Regulations (IHR) during the COVID-19 Response, and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme.

China also standing fast on its refusal to allow further investigation of SARS-CoV2

Zeng Yixin, Vice Minister of the National Health Commission, at a press conference on 23 July 2021, slamming proposals for another WHO mission to China to investigate the origins of SARS-CoV2.

China has long been at odds with the WHO and member states, and particularly the United States, over its refusal to allow a second phase of on-site investigation into the origins of the SARS-CoV2 – in Wuhan and elsewhere. 

It also has refused a panel of scientists convened by the WHO access to Chinese medical and other records related to the outbreak in Wuhan.

In July, Zeng Yixin, China’s Vice Minister of the National Health Commission, described the WHO’s proposal for a more rigorous Phase II investigation of the origins of the SARS-CoV2 virus, including renewed consideration that the virus may have escaped from a laboratory, as “impossible” at a press conference.   

“We will not accept such an origin-tracing plan as it, in some aspects, disregards common sense and defies science,” said Zeng at the press conference organized by the Chinese State Council Information Office. 

Pandemic ‘instrument’ agreement

The working group of WHO member states, co-chaired by Indonesia’s Ambassador Grata Endah Werdaningtyas and the USA’s Colin McIff, deputy director of Global Affairs in the US Department of Health and Human Services, was widely credited with brokering last year’s historic agreement on the need for a global instrument to improve the world’s response to future pandemics.

Virtually all 194 member states committed to negotiating a new global accord to guide the response to future global pandemics at the WHO’s World Health Assembly Special Session (WHASS).

Equity recommendations also a lightning rod

The reference to on-site investigations was not the only clause in dispute in the report today. 

Most other paragraphs in the draft report were also being red-marked extensively, with proposed additions and deletions by various member states. 

Section 12 (d) addresses equity, for instance, and the draft Working Group report states that “Member States agree that equity is critically important for global health both as a principle and as an outcome”.

“Member States emphasized that equity is essential in particular in prevention, preparedness and response to health emergencies, including with respect to capacity-building, equitable and timely access to and distribution of medical countermeasures and addressing barriers to timely access to and distribution of medical countermeasures,” the report notes.

It also noted that “related issues such as research and development, intellectual property, technology transfer and empowering/scaling up local and regional manufacturing capacity during emergencies to discover, develop and deliver effective medical countermeasures and other tools and technologies,” were important.

A civil society representative monitoring the session indicated that the United States wanted to add the word “voluntary” sharing of licenses “on mutually agreed terms” to that text. Low-income countries such as Ghana, meanwhile, stressed that “equity is a priority” as member states ploughed word by word through the language. 

The equity language is additionally charged in light of the ongoing push by over 100 countries, led by India and South Africa, to approve a waiver of intellectual property rules in the World Trade Organization that would also facilitate more compulsory forms of tech transfer during the pandemic.  

In addition, Argentina pointed out that there needs to be stronger equity rules around the sharing of pathogens, from which new vaccines and medicines are typically developed. 

It proposed that the text on equity include reference to “the fair, and just participation in the derived benefits of the use of the exchange of pathogens”. 

Image Credits: China Daily.

president duterte
Philippine President Rodrigo Duterte addresses the nation

Philippine President Rodrigo Duterte has threatened to order the arrest of Filipinos who refuse to receive COVID-19 vaccinations – in one of the most extreme vaccine mandate edicts to be made by any government worldwide.  

“Because it is a national emergency, it is my position that we can restrain [unvaccinated people],” said Duterte in a televised Thursday address last week to the nation, in reference to a recent surge in infections.  

“I’m now giving orders to barangay captains (village leaders) to look for those persons who are not vaccinated and request them to stay put [in their house].”

If these individuals refuse to vaccinate, or continue to leave their home, the barangay captain, being a person of authority, is empowered now to arrest the recalcitrant persons, he added. 

The Philippines has administered at least 111,908,830 doses of COVID vaccines as of 10 January, with about 51.8% of the country’s population vaccinated with at least one dose. However, according to the World Bank Vaccine Deployment Tracker, only 34% of the population is fully vaccinated. 

The Philippines lags behind in vaccines in comparison to its neighbors in the WHO Western Pacific region, which have high vaccine coverage even in lower- and middle income countries like China, Malaysia and Thailand, along with high income Singapore, Taiwan and Australia, which Duterte has lamented. 

“Those who are not vaccinated, they will put everybody in jeopardy,” he said.

While other Wester Pacific region countries such as Australia, New Zealand, and Japan have become famous for their crackdowns on COVID-19 – with Australia most recently barring men’s tennis star Novak Djokovic from entering the country despite his vaccination exemption, the Philippines has gotten less attention globally, despite Duterte’s stringent policies.

Duterte brushes away legal concerns  

While Duterte acknowledged that some lawyers “are saying that we cannot restrain” unvaccinated people, he argued against this.

“I said that the ministrant function of the government is to come up with measures to protect public health, public interest, public order, and public safety.” 

“In the absence of a law, a President is called upon to act,” Duterte said, adding that those who disagree with this order “can file cases.”

“I already have a case at the International Criminal Court (ICC). File it on top of that, so I’ll just answer them simultaneously when the time comes,” Duterte said in Tagalog.  

The ICC had called for a formal investigation into Duterte’s so-called “war on drugs”, in which thousands of people have been killed. However, the Philippines has filed a deferral request in November, with the prosecution temporarily suspending its investigation for the time being.

Duterte has previously threatened people who refused to get vaccinated with jail time or an injection of Ivermectin, an anti-parasite drug widely used to treat animals. 

Arresting unvaccinated people violates Constitution 

The Commission of Human Rights (CHR) has also said that the President’s directive “violates” the Philippine 1987 constitution and human rights. 

“Presently, there is no law that makes being unvaccinated a crime, nor is there any law that would satisfy the Constitutional provision on curtailing freedom of movement. Any arrest made on these grounds may be illegal; thus, violative of the Constitution and our guaranteed human rights,” said CHR spokesperson Jacqueline Ann de Guia. 

While the 1987 Constitution does state that liberty of movement can be restricted in the interest of national security, public safety, or public health, there needs to be a law to make such restrictions legal. 

Vice President suggests incentives to encourage vaccinations

vice president robredo
Philippine Vice President Leni Robredo

Countering the president’s punitive measures, Vice President Leni Robredo took a different route, considering “positive reinforcement” as a method to address the low vaccination rates. 

“I hope the encouragement for vaccination can be more of positive reinforcement, not the fear of getting arrested for not getting vaccinated,” Robredo said in Tagalog during her weekly radio program BISErbisyong Leni over dzXL, on Monday. 

She added that refusing to get vaccinated is not a crime, and that there is no law criminalizing being unvaccinated, but COVID-19 vaccinations save lives, protect people, and prevent the spread of the virus. 

“There’s no such law, because I’ve heard there’s an order to arrest. But I will go back to my previous belief that we should be giving incentives to encourage a person to get vaccinated.”

“It should be thought of, and not be easily punitive – if you’re not vaccinated, you will be arrested or this or that. It’s more positive if it’s like this: if you get vaccinated, here are the privileges you will enjoy,” she said.

Omicron strain may soon overtake Delta as dominant strain 

The Delta strain remains the dominant variant in the Philippines, although Omicron may take over in the next three to four weeks, Philippine Department of Health (DOH) Undersecretary and country’s treatment czar Leopoldo Vega said in an interview with ABS-CBN News Channel last week.

“I think we still have the Delta around, but since we reported our first Omicron case way back 5 December, and there has been a continuously increase in the sequencing of this Omicron virus, it looks like we will presume that the Omicron is here, but it’s still not dominant.” 

As of 9 January, 28,707 new cases of COVID have been reported, nine times the number of cases reported on 1 January (3,617). 

Restrictive measures ramped up once more to stop COVID spread 

The Philippines has increased its restrictive measures once more following the rise in cases.

While the government had relaxed lockdown conditions last October in an effort to revive the battered economy, the increase in cases has forced the government to tighten its restrictions once more.

Restaurants, parks, churches and beauty salons will operate at lower capacity, while in-person classes and contact sports have been suspended.

Unvaccinated residents have to stay at home unless buying essentials or exercising, and are  barred from using public transportation. These rules have also been applied to individuals who have only a single dose of COVID-19 vaccine.

Some bus stations have imposed a “no vaccine card, no ride policy” and have also barred individuals with only their first dose from entering. These measures can encourage people to get vaccinated, but they do not address the lack of accessibility to vaccines, said James Patrick Cruz, speaking with Health Policy Watch. 

“It’s a nice safety measure and a great way to encourage people to be vaccinated but the inaccessibility of vaccines is something the government should also think about.”

Slowdown in vaccinations

While the surge of COVID-19 cases has impacted the Philippine government’s vaccination drive, many have attributed the slowdown in vaccinations to other reasons, including lack of access, anti-poor proposals, and an overwhelmed healthcare system.

The government’s attempts to ramp up vaccinations have been previously criticised as being anti-poor. In November, the Duterte administration proposed to exclude the unvaccinated poor from the cash assistance program, essentially “disincentivisizing” them for being unvaccinated.

“Easy access” to vaccination sites have also been primarily found in urban regions such as Metro Manila, as opposed to other parts of the country.

In addition, healthcare workers administering the jabs have been recalled to hospitals to handle the influx of COVID admissions.

Regi Pamugas, representative of the group Health Action for Human Rights, said that Duterte’s threats will not convince people to get vaccinated.

“We’re almost two years into the COVID-19 crisis and he did not yet learn,” he told INQUIRER.net, saying Duterte should do more to convince people to take the vaccine.

Image Credits: GMA News/Youtube, Leni Robredo/Twitter, ILO/Minette Rimando.

Tourists enjoy Cape Town’s beaches as COVID-19 restrictions are lifted

CAPE TOWN – Shortly before New Year’s eve, the South African government lifted the country’s curfew and allowed indoor gatherings of up to 1000 people – despite the prevalence of the highly infectious Omicron variant.

The Cabinet-level decision was taken after considering “the trajectory of the pandemic, the levels of vaccination in the country and the available capacity within the health sector”, according to a government statement.

On 23 December, the health department had declared that those who were asymptomatic did not have to quarantine and it dumped contact tracing. However, after a public outcry, the department backtracked a week later, saying that it had “decided to put the implementation of the revised policy changes on hold, while taking all additional comments and inputs received into consideration”.

Nonetheless, the health department explained that its initial decision was based on the fact that  “most people have vaccinated with at least one vaccine dose and developed some level of immunity”, “many people do not show any symptoms, and only a small percentage of them are diagnosed” – and “a number of people including children who are in contact with COVID-19 positive people, lose their income and valuable school time while staying at home without symptoms”.

As South Africa opens up, Europe goes for lockdowns

In contrast, European nations including France, Austria, the Netherlands and Germany introduced tough restrictions on gatherings and all but cancelled Christmas as they faced Omicron.

However, South Africa’s mild disease trajectory – coupled with its dire economic situation – enabled a different response.

A couple of weeks after Omicron was identified, scientists reported that its effects were substantially milder than previous COVID-19 outbreaks.

A study published in the International Journal of Infectious Diseases on 28 December based on statistics from hospitals in Tshwane, the city at the centre of the initial Omicron outbreak, reported Omicron deaths were 4.5% of hospital cases versus 21.3% from the previous three COVID-19 outbreaks, ICU admissions were 1% vs 4.3% and Omicron patients’ length of stay in hospital was 4.0 days – less than half the 8.8 days of the previous outbreaks. 

Meanwhile, the country’s most populous state, Gauteng, passed the peak of COVID-19 Omicron infections about a week ago, recording 15% of the deaths of Delta, and half the number of hospitalisations.

While case numbers are still relatively high in states such as the Western Cape, the disease is substantially milder throughout the country, and even though the variant is more infectious than previous ones, it has not overwhelmed the country’s hospitals.

On 6 January, the country reported 9860 new cases and 151,800 active cases in its population of over 55,4 million people.

One of the key reasons for how quickly Omicron has passed in the country is the substantial community exposure to COVID-19, which has built immunity. 

A sero-survey of over 7000 people in Gauteng between October and December 2021 found that almost three-quarters (72%) had experienced previous COVID-19 infection. Sero-positivity was 79% in unvaccinated people and 93% in vaccinated people over the age of 50, which is the group most at risk.

Over half of all adults are also vaccinated against COVID-19, mostly with Pfizer followed by the Johnson & Johnson vaccine. Furthermore, the average South African is much younger than the average European.

Economic desperation

However, the country is also desperately trying to salvage its economy. The GDP contracted by 1,5% in the third quarter of last year, and South Africa is in the midst of the worst unemployment since it started compiling statistics. Over two million people have lost their jobs during the pandemic and the discovery of Omicron shortly before the Christmas tourism season has cost the hospitality industry millions of dollars.

Shops were noticeably quieter this Christmas as job losses and a weakened currency translated into higher prices for fuel and other imported goods. 

Professor Shabir Madhi, head of  Vaccinology at the University of Witwatersrand, has called for new generation vaccines that target a number of different sites of the virus – much like highly active HIV antiretroviral therapy, which targets three different sites of cell entry to combat the fast mutations of HIV.

“The South African government appears to have come to appreciate that the past practices have had limited success in preventing infections, and fully appreciates the detrimental effects that restrictions have had on the economy and society,” wrote Madhi and others in an article in The Conversation on 7 January.

“In addition, it has run out of road to continue with what has unfortunately not yielded much benefit. Despite all the severe lockdowns South Africa still ranks high with a Covid death rate of 481 per 100,000.”

Madhi and colleagues argue that “the major risk is the unpredictability of new variants that evade all aspects of past infection and vaccine-induced immunity”, but also declare that “with Omicron the epidemic phase of COVID-19 is coming to an end”.

Image Credits: Unsplash/ Ethan Smith.

Women who have been vaccinated against COVID-19 had a slight but not clinically significant change in the length of their menstrual cycles compared to unvaccinated women, according to a new study published by researchers from Oregon Health & Science University in Portland in Obstetrics & Gynecology.

Specifically, vaccinated women experienced a less than one-day (0.71-day) unadjusted increase in the length of their menstrual cycle after their first shot and a less than one-day (0.91-day) after their second shot, the study found. 

The increase in cycle length, however, seemed to be driven by several hundred women in the study who received both shots during a single cycle. This subgroup experienced a two-day unadjusted mean cycle length increase. 

“Statistically significant differences existed between vaccination status groups, but the change in cycle length was less than one day, which is below the reportable difference in the menstrual cycle tracking application and is not clinically significant,” the authors stressed.

Reverted to normal

In all cases, the cycles reverted to their original length after two post-vaccine cycles. 

This is the first peer-reviewed research published on the matter through the US National Institute of Child Health and Human Development (NICH), which awarded five grants totaling $1.67 million in October to agencies to explore the link between COVID-19 vaccination and menstruation changes after tens of thousands of women worldwide reported changes in menstruation after receiving the jab. 

“Concerns about a possible association between coronavirus disease 2019 vaccination and abnormal menstrual cycles may lead to vaccine hesitancy,” the study’s authors wrote in their report. “Unfortunately, clinical trials of the current COVID-19 vaccines did not collect menstrual cycle outcomes post vaccine.”

Other NICH-funded research is still underway by teams from Boston University, Harvard Medical School, Johns Hopkins University and Michigan State University.

The study was a retrospective cohort analysis, leveraging data from the Natural Cycles digital fertility-awareness application between October 2020 and September 2021. Nearly 4,000 women – 2,403 vaccinated and 1,556 unvaccinated – between the ages of 18 and 45 who had regular cycles, were not pregnant or taking hormonal contraception were evaluated as part of the study. 

Participants were inoculated with Pfizer (55%), Moderna (35%) or Johnson and Johnson (7%). 

Six cycles were analysed for each participant – for those who were vaccinated, three cycles before the first shot and three cycles during and after.

Study limitations

Dr Itamar Netzer, a gynaecologist and a sub-district director for Clalit Healthcare Services in Israel, there were some challenges with the study, which were also noted by the research team. These included that it relied completely on Natural Cycles data and application users tend to be mostly white, college-educated and have lower BMIs than the average American woman. 

In addition, he said that because the study relies on self-reported data by women, it is possible that these women did not accurately record their number of bleeding days. 

“Women with underlying gynaecological disorders may experience greater differences,” according to Netzer, who noted that only healthy women were included in the study.

Menstrual cycle timing is regulated by the hypothalamic-pituitary-ovarian axis, the researchers explained, which can be affected by life, environment and health stressors. They hypothesised that because mRNA vaccines create a robust immune response or stressor this could temporarily affect this axis, which could be the cause of the slight shift in cycle length. 

Netzer said that the research shows that the vaccine is “probably safe for everyone” and especially menstruating women. He noted that separate studies have shown that the vaccine is safe for pregnant women and does not impact the rate of stillbirths or premature delivery.

“In contrast, we have seen the hazards of COVID-19 on pregnancy,” Netzer stressed. “A pregnant woman who catches COVID is two to five times more likely to be hooked up to a lung-heart machine than a non-pregnant woman.

“We are quite sure the vaccine is safe in pregnancy,” Netzer continued, “and we know the [COVID-19] disease is dangerous for pregnancy.”

WHO press briefing – first of the new year sounds gloomy notes.

Mass Omicron infection could lead to the formation of new and potentially even more dangerous coronavirus variants, officials from the World Health Organization warned on Thursday.

That is despite the fact that the Omicron variant is proving less lethal than its SARS-CoV2 predecessors, such as Alpha, Beta and Delta – which swept through India and then the world beginning in the spring of 2021. 

“We are giving this virus plenty of opportunities to circulate and the more the virus circulates the more opportunity it has to change,” said Dr. Maria Van Kerkhove, WHO’s COVID-19 technical lead, speaking at the first global press briefing of 2022. 

“I think, unfortunately, this will not be the last variant you hear us address. It will not be the last variant of concern.”

Her comments followed on remarks by a WHO European Region Emergencies official, Catherine Smallwood, earlier in the day, who sounded an even more ominous note:  

”The more Omicron spreads, the more it transmits and the more it replicates, the more likely it is to throw out a new variant,” Smallwood told AFP, “Now Omicron is lethal, it can cause death, maybe a little bit less than Delta, but who’s to say what the next variant might throw out.”

At the WHO global briefing later in the day, Mike Ryan, executive director of WHO’s Health Emergencies Program, also recalled having discussions during the previous Delta wave with top scientists who said that the Delta variant was so adept at infecting and replicating, that they could not imagine it mutating much more.  

“Yet it did,” Ryan stressed, “and we have seen a further variant emerge that is even more transmissible than Delta, which was even more transmissible than its predecessors… We are not doing well enough globally to say with any degree of certainty that we can avoid the emergence of new variants.”

Spreading at an unprecedented rate 

Dr Tedros Adhanom Ghebreyesus, WHO Director General.

Omicron is spreading at an unprecedented pace worldwide. In the United States, it now makes up 95% of cases, the Centers for Disease Control and Prevention said. The United Kingdom has said that one in 15 people are infected with the virus, and Indian health officials said Thursday that the country logged more than 90,000 new COVID cases in a 24-hour period, with a positivity rate of more than 4%. 

Last week also saw record highs in the number of new COVID-19 cases to be reported since the beginning of the pandemic  – “and we know for sure this is an underestimate number of cases,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus.  He stressed that increased vaccine roll-out in underserved countries 

While Omicron does appear to be less severe compared to Delta, especially in those who are vaccinated, it should not be classified as mild, he warned. 

“Omicron is hospitalizing people and killing people,” Tedros said. “It is overwhelming health systems around the world.”

Moreover, the Delta variant is still dominant in some countries and is mutating too, Van Kerkhove added. 

“Omicron is very efficient, but Delta is evolving as well,” Van Kerkhove said. “There are about 30 sub-lineages of Delta that we are tracking.”

WHO Advice includes more of same: masking, social distancing, vaccination  

While the WHO officials sounded a gloomy prognosis on the massive infection wave underway – and what that could mean for future virus mutations  – there were few new measures that they could suggest. 

And certain thorny questions that countries are struggling with now, such as  whether rapid antigen tests could be a reliable go-to protocol for people that suspect they are infected, or want to be released from quarantine, were not addressed. 

Ryan stressed, however, the need to continue with quarantine policies –  even while in some countries as many as one in 15 people are infected with Omicron. He said that quarantines should remain in place for at least five days, while people are most infectious.   That is generally in line with the revised advice that has been issued by the United States Centers for Disease Control, to respond to the infection surge. 

Ryan added that one of the ways to temper longer periods of isolation is through regular testing.  But he didn’t enter the debate raging now in many countries about reliance on rapid antigen tests, as compared to PCRs, to determine COVID infection status, officially report on COVID cases, and send people to quarantine – or allowing them to exit.  

While positive results of rapid antigen tests, using lateral flow devices, are generally regarded as reliable, negative results are considered far less accurate.

One recent pre-print study found that rapid tests are particularly unreliable at detecting the early stages of infection – leaving many people to walk around infectious for an average of three days after a positive PCR test – before showing a positive antigen test result. See related story:

COVID-19 Could Become Endemic in Africa if 70% Vaccination Coverage is not Achieved by 2022 – Africa CDC

WHO officials reiterated well-worn advice on the value of masking, social distancing and vaccination. Tedros also stressed, once more, the importance of expanding vaccine drives in under-resourced developing countries, where even more variants could otherwise fester. 

“This is about making personal decisions,” Van Kerkhove said, “this is about distancing – keeping your distance from others – wearing a well-fitted, appropriately made mask… Make sure you spend more time in places where there is better ventilation… and stay home if you are unwell.”

Air pollution in Mashhad, Iran

Almost nine out of ten (86%) people living in urban areas across the globe, or 2.5 billion people, are exposed to unhealthy particulate matter levels, leading to the 1.8 million excess deaths in cities globally in 2019, in a study that examined urban air pollution and related mortality trends in over 13,000 cities globally. 

The first of two studies, both published today in The Lancet Planetary Health journal, found that 86% of urban inhabitants lived in areas that exceeded the 2005 World Health Organization (WHO) guidelines for annual PM2.5 exposure of 10 micrograms per cubic meter (μg/m3); in 2021 that safe air quality guideline was tightened even further to 5 μg/m3 of PM2.5.  

“The majority of the world’s urban population still live in areas with unhealthy levels of PM2.5,” said lead author of the study Veronica Southerland, of US-based George Washington University. 

Figure 3Change in population-weighted PM2·5 concentrations and PM2·5-attributable mortality rates between 2000 and 2019 for the top 250 most populated urban areas based on 2019 WorldPop estimates

Exposure to PM2.5 (fine particulate matter with a diameter of 2.5 micrometers or less) is a leading environmental risk factor for disease. 

Inhalation is known to increase the risk of premature death from health conditions such as cardiovascular disease, respiratory disease, lung cancer, and lower respiratory infection. 

Additionally, the second study, focusing on transport-related NO2 (nitrogen dioxide gas) pollution and paediatric asthma incidence, found that nearly two in three urban childhood asthma cases in 2019 were attributable to NO2 pollution, with nearly 2 million asthma cases found among children worldwide.  

Both studies highlight the urgent need to improve air quality in cities and reduce exposure to pollution, particularly among children and the elderly. 

PM2.5 concentration seven times WHO 2021 guidelines in first study 

The first study focused on PM2.5 concentrations and associated mortality trends in over 13,000 cities globally between 2000 – 2019. 

Average population-weighted PM2.5 concentration in 2019 across all urban areas globally was 35 micrograms per cubic meter – equivalent to seven times the new 2021 WHO guideline for annual average PM2.5 of five micrograms per cubic meter. 

Study authors estimate that 61 deaths per 100,000 inhabitants in urban areas were attributable to PM2.5 in 2019. 

A 2021 report by Greenpeace Southeast Asia and IQAir had also found the link between urban air pollution and attributed mortality, with exposure to PM2.5 responsible for the deaths of 160,000 in the world’s five biggest cities.  

Southeast Asia sees largest increase in PM2.5 concentration and attributable deaths 

urban
Pollution in Delhi peaks in late autumn when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources

While global average PM2.5 concentrations remained consistent over the 19-year period, there were large variations by regions.

Urban areas in Southeast Asia (including India) saw the largest regional increases, with a 27% increase in average population-weighted PM2.5 concentration between 2000 – 2019. Southeast Asian cities also saw the largest increase in PM2.5-attributable mortality during this period – 33% – from 63 to 84 deaths annually per 100,000 people. 

Trends in global urban mortality rates and PM2·5 concentrations, 2000 to 2019

However, higher or lower PM2.5 concentrations in some urban areas of Asia, Africa and elsewhere did not always yield correspondingly lower PM2.5-attributable death rates. That is because demographic factors, such as the age of the population, as well as baseline health conditions, also have a strong impact on pollution-related deaths. 

For instance, Guangzhou, China, had a decrease in population-weighted PM2·5 of 14% during the 19 year period, from 37 μg/m3 to 32 μg/m3. Howver, PM2·5-attributable mortality rates increased by 10%. In contrast, Luanda, Angola, saw a 38%  increase in PM2·5 population-weighted concentrations from 13 μg/m3 to 18 μg/m3. But attributable mortality decreased by 16%.

At the same time, decreases in PM2.5 concentrations had a comparatively larger impact on reducing PM2.5 attributable mortality in urban areas where pollution levels were already low, such as the Americas and Europe, the researchers found.

For instance, in European cities, a 20% reduction in contractions, from an average of 20 μg/m3 to 16 μg/m3 over the course of the 19 year period, resulted in a 23% decrease in PM2.5 attributable deaths despite an ageing population, the study found. That is because proportionally speaking, decreases in air pollution at relatively lower levels yield comparatively greater reductions in mortality.   

“Avoiding the large public health burden caused by air pollution will require strategies that not only reduce emissions but also improve overall public health to reduce vulnerability,” stated Sutherland. 

Second study finds two out of three new pediatric asthma cases in cities due to NO2 

The second study analyzed global concentrations of NO2 with population and baseline asthma rates in order to estimate the paediatric asthma incidence attributable to NO2 between 2000 – 2019 in 13,129 cities.

NO2 is an air pollutant mainly emitted by vehicles, power plants, industrial manufacturing, and agriculture.

Previous research has shown transport-related air pollution is associated with both asthma exacerbation and new onset of asthma in children. 

The study revealed that 1.85 million, or 8.5% of all new paediatric asthma cases reported in 2019 were attributed to NO2.  Two out of  three of these new cases occurred in the 13,129 urban areas covered in the study.  

In urban areas, NO2 was responsible for 16% of all new child asthma cases in 2019. 

“Our results demonstrate the important influence of combustion-related air pollution on children’s health in cities globally,” says Susan Anenberg of US-based George Washington University, who is co-first author on the NO2 study and corresponding author of both studies.

Anenberg pointed out that despite the downward trend of NO2 concentrations over several decades – the result of effective air quality management programs, NO2 continues to contribute to child asthma. 

“Current NO2 levels contribute substantially to pediatric asthma incidence, highlighting that mitigating air pollution should be a critical element of children’s public health strategies.”

Image Credits: Mohammad Hossein Taaghi, The Lancet, Planetary Health , Flickr, The Lancet, Planetary Health .