Vials of the Pfizer-BioNTech COVID-19 vaccine.

COVID-19 vaccine manufacturers are expected to produce 12 billion doses by the end of the year – almost half made by China – and there could be a vaccine surplus by mid-next year.

In addition, by the end of this month, around 500 million doses should be ready for “redistribution” from wealthy to low-and middle-income countries.

This emerged at a media briefing organised by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) on Tuesday.

“By January 2022, there will be sufficient vaccines produced for every adult on every continent,” according to IFPMA.

“Modelling by Airfinity indicates that even if vaccine advisory committees and governments in G7 countries vaccinate teenagers and adults and decide to give boosters to at-risk populations, there would still be over 1.2 billion doses available for redistribution in 2021 alone. This means that each month for the foreseeable year, over 200 million doses would be, with effective planning, available for low- and lower-middle-income countries,” it added.

 

Describing the vaccine production increase as “absolutely extraordinary”, Rasmus Bech Hansen, CEO of research forecast group Airfinity, said that it had been “a surprise to pretty much everyone how fast China has scaled up vaccine production”.

Hansen added that, even when third booster shots for citizens in high-income countries were factored in, Infinity estimated that, “by the end of September, there will be around 500 million doses available in the US, UK, European Union and Canada that could be redistributed” through donations, swaps or reselling.

“In the last G7 summit, one billion doses were pledged [to LMIC] and it actually seems that these stocks will be available by the end of the year so G7 countries could meet those pledges,” he added.

IFPMA Director General Thomas Cueni told the briefing that ‘by June 2022, we expect that we will have more than 24 billion doses of COVID-19 vaccines available”.

IFPMA Director General Thomas Cueni

“At this point, vaccine supplies may actually outstrip global demand,” added Cueni. “Vaccine manufacturers are now producing 1.5 billion doses per month, and are expected to continue manufacturing at that scale on the basis of the most conservative protection projections.”

Hansen noted that 73% of the production increases were the result of pharmaceutical companies enhancing their in-house capacity, supported by an array of collaboration agreements within the industry – Affinity had counted 231.

Pfizer doses mostly allocated for next year 

Pfizer CEO Dr Albert Bourla said that his company had doubled its production capacity in the past six months and was on track to produce three billion doses by the end of the year, thanks to “sleepless nights, and a lot of effort from thousands of people”.

While it was testing a version of its vaccine that had been tweaked to combat the Delta variant, Bourla said this didn’t seem necessary as the current vaccine is highly efficacious.

One of the key challenges Pfizer faced in scaling up was access to raw material to make it’s mRNA vaccine.

“We literally created new suppliers” by giving companies financial, scientific and technical support, said Bourla.

However, in response to a Health Policy Watch question, Bourla dismissed joining the mRNA technology transfer hub established recently in South Africa by the World Health Organization (WHO) to assist Africa to develop its own mRNA vaccines.

Pfizer CEO Dr Albert Bourla

“I’m not sure what is the point of transferring technology that it is going to take years to transfer. And, by the way, this is what we do. I’m not sure I understand what they want, to give it someone else to do?” asked Bourla.

Pfizer expects to make four billion doses in 2022, but Bourla but urged all countries to place their vaccine orders as soon as possible.

“We have allocated doses already for this year and frankly, we have allocated a very big part of the doses that we are going to be producing next year also to countries that they have placed orders for these doses,” said Bourla, adding that 41% of this year’s production had been allocated to LMICs.

Bourla said most orders for 2022 were from high-income countries, with boosters fueling demand. While Pfizer would like to allocate at least one billion doses to LMIC for 2022, it had  yet to receive orders for this amount.

“When it comes to the ability to pay, we implemented tiered pricing. High-income countries were receiving one tier of pricing, mainly the cost of a meal in their country. Middle-income countries received half of this price, and the low-income countries received doses at cost,” said Bourla, who is also IFPMA’s vice-president.

Johnson & Johnson has policy of technology transfer

Dr Paul Stoffels, Chief Scientific Officer for Johnson & Johnson

Dr Paul Stoffels, Chief Scientific Officer for Johnson & Johnson, said that his company had established a global vaccine manufacturing network across four continents with 11 manufacturing  sites

“We made a commitment to equitable access and committed by putting a billion doses forward for low and middle-income countries in the next 12 to 18 months,” said Stoffels, adding that over half the company’s vaccines would go to LMICs in the coming year.

“Our strategy of focusing on technology transfer brought us to partnering with Aspen Pharmacare in South Africa. Aspen is now fully in production and we anticipate that all supplies produced by Aspen from now on will go to COVAX countries and African Union. And we are also transferring our technology as we speak to BioE in India,” said Stoffels.

This follows a recent report by The New York Times that Aspen, which has a ‘fill and finish’ contract with J&J, had been exporting millions of vaccines to Europe while lagging behind in its African deliveries. The EU recently agreed to send these vaccines back to South Africa.

However, Stoffels warned that technology transfers are “highly technical by nature and highly complex”. 

“We need to work with many partners. Multiple steps are needed, including biological manufacturing, quality testing and release, regulatory inspections and controls. Most critical is the training of workforce and new technologies,” he added. 

Progress in therapeutics

Cueni reported that “a handful of authorised COVID-19 treatments are becoming standard of care for COVID-19 patients that have been hospitalised and are saving lives”. 

“Monoclonal antibody treatments are beginning to offer promise as are novel antivirals,” said Cueni.

Some of the key treatments that have been authorised for emergency use include the anti-viral, Remdesivir (Gilead Sciences), Monoclonal IL-6 blocker, Tocilizumab (Roche), Monoclonal Casirivimab and  Imdevimab (REGEN-COV Roche Regeneron) and Monoclonal Sotrovimab (GlaxoSmithKline).

“Getting the therapeutic rollout right will be important for all countries to be able to benefit from future innovation, such as the anticipated oral outpatient COVID-19 therapeutic candidates,” he added.

Roche has been involved in 10 experimental treatments for COVID-19 “focused on preventing progression to mechanical ventilation and preventing death”– but testing these was complex and difficult, said its CEO, Bill Anderson.

Roche CEO Bill Anderson

One of these, tocilizumab (Actemra), is a monoclonal antibody that reduces inflammation by blocking the interleukin-6 receptor.

“As it suppresses the immune system, we thought, ‘you don’t want to give it to patients that are newly diagnosed’. It’s really for patients who’ve progressed to a severe illness where their immune system may actually be more doing more damage than good. So we had to run multiple studies. I think we’ve run ultimately, we’ve run seven pivotal studies,” said Anderson, adding that the first pivotal study had failed to show any results.

“Many people thought, well, that’s the answer. But we had seen enough to think, hmm, you know, I don’t think that’s a complete story. And ultimately, we’ve shown that Actemra does decrease need for mechanical ventilation and death quite significantly in hospitalised patients,” he added. 

But there are only so many facilities in the world capable of producing monoclonal antibodies, said Anderson, and the treatments needed large quantities.

“We ultimately did a partnership with Regeneron, which is a company that we compete with in many other fields, but we felt like they were farthest along,” added Anderson.

“We made an exceptional decision that we would not assert patent rights if companies could make a product of a biosimilar to Actemra and deliver it to LMICs, and that, in fact, it looks to be happening,” he added.

However, Anderson added that Roche was only prepared to support technology transfer to companies with the capacity to produce large amounts of monoclonal antibodies.

“Tech transfer is very laborious, and we can’t afford to take our people that are producing Actemra and that are also doing tech transfer with the existing external contracts, unless we have somebody who can produce large quantities.”

 

Image Credits: Twitter: @WHOAFRO, US Centers for Disease Control.

air quality

Over a third of the world’s countries – 37% – have either not created or are not enforcing legally mandated ambient air quality standards (AAQS), according to a new report released by the United Nation Environment Programme (UNEP).

The report, “First Global Assessment of Air Pollution Legislation” assesses national air quality legislation in 194 states and the European Union, and found  persistent policy, capacity, and implementation gaps to prevent more effective action against air pollution.

Approximately 60% of countries, accounting for 1.3 billion people, have no annual ground-based monitoring for fine particulate matter (PM 2.5), while at least 31% of countries with the ability to introduce sub-standards for ambient air quality standards (AAQS) have not done so. 

Unregulated air pollution continues to pose the greatest environmental threat to health. There are over seven million premature deaths every year due to the combined effects of outdoor and household air pollution – with millions more people falling ill from breathing polluted air, according to the WHO. More than half of these deaths are recorded in low- and middle-income countries.

UNEP calls for multi-sectoral action, in light of the report’s launch coinciding with International Day of Clean Air for Blue Skies, that can enable cleaner air for all. 

“Investments in air quality will [not only] enhance our health, but also job creation, energy efficiency, clean transport, sustainable agriculture, and green and resilient cities,” said UNEP Executive Director Inger Andersen, during a Tuesday launch event of the report. 

“We can’t clean the air overnight, and we can’t clean the air without the full engagement of every sector of society. But if we put the work in today, we can one day soon breathe easier.”

‘Lack of ambition’ in heterogeneous approach to air quality control

Eloise Scotford, one of the co-authors of the UNEP report

While the majority of countries (64%) embed AAQS in legislation, the global picture of national air quality is one of heterogeneity, with some cases of implementation masking a “lack of ambition”, said Eloise Scotford, Professor of Environmental Law at the University College London and one of the co-authors of the study.

Poor enforcement of air quality laws has led to 43% of countries lacking a legal definition of air pollution and only 51% of national air quality laws globally with explicit public health, or public and ecosystem health as their main objective.

“We found that processes for setting AAQS are often not transparent, or accountable, or accessible,” said Scotford, noting that standards could often be made more ambitious.

Although the heterogeneous approach to embedding air quality standards reflects specific air quality challenges and diverse legal cultures, in addition to acknowledging that there is no one-size fits-all approach to air quality control, this also risks masking weak ambition and legalizing unclean air.

In addition, only 33% of countries impose requirements on governments to achieve AAQS, indicating that the institutional responsibility on air pollution is quite weak and are the bare legal standards, added Scotford. 

The lack of level playing field for AAQS may keep the world at odds with the demanding requisites on global policies on climate change expressed in the 2015 Paris Agreement.

Legal standards need to be established

Figure 1 is a conceptual map explaining how legislative incorporation of AQS may sit within, and provide the foundation for a domestic “system of air quality governance”.

Regulating and controlling the different sources of air pollution remains a “coordination challenge”, according to Scotford, with the first step establishing legal standards for air quality. 

“Once you have legal standards for air quality, that’s really important. Ambition is important. But that is not enough. More needs to be done to have a full system of quality governance that is robust, to ensure the achievement of clean air.” 

The UNEP report notes that a robust system of air quality governance is one which: 

  • requires governments to develop and regularly review applicable air quality standards in light of public health objectives;
  • determines institutional responsibility for those standards;
  • monitors compliance with air quality standards;
  • defines consequences for failure to meet them;
  • supports the implementation of air quality standards with appropriate and coordinated air quality plans, regulatory measures and administrative capacity;
  • is transparent and participatory.

WHO air quality guidelines launching end of the month

Maria Neira, WHO Director of Environment, Climate Change and Health

In light of the launch of the UNEP report, WHO has announced that they will be launching their 2021 Air Quality Guidelines on 22 September.

These guidelines will serve as a global target for national, regional, and city governments to work towards reducing air pollution. 

WHO Director of Public Health, Environmental and Social Determinants of Health Maria Neira echoed UNEP’s calls for urgent and collective action in reducing air pollution.   

“It is time to stop with those fossil fuels. It is time to accelerate towards a very ambitious and quick transition to clean sources of energy. We need to do it for the economy, we need to do it for our society, but we also need to do it for our health. The more we postpone this transition, the more we will have death and disease on our shoulders.”

Image Credits: Flickr, UNEP, UNEP.

 

Climate change: A firefighter fighting a battle against a fire in South Africa

“The greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1·5°C, and to restore nature. Urgent, society-wide changes must be made and will lead to a fairer and healthier world,” according to an editorial published simultaneously in 200 journals world-wide.

The aim of the editorial is to help develop momentum for “urgent action to keep average global temperature increases below 1·5°C, halt the destruction of nature, and protect health” in the run-up to the UN General Assembly which starts on 14 September,  the biodiversity summit in Kunming, China, and the UN Climate Change Conference of the Parties (COP26) in Glasgow, UK. 

“The science is unequivocal; a global increase of 1·5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse. Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions,” states the editorial, published in journals that are usually in competition with one another.

The editorial warns that temperature rises of above 1·5°C ”increase the chance of reaching tipping points in natural systems that could lock the world into an acutely unstable state” and “critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change”.

It says that targets set by many governments, financial institutions, and businesses “are not enough”. 

“They are yet to be matched with credible short-term and longer-term plans to accelerate cleaner technologies and transform societies. Emissions reduction plans do not adequately incorporate health considerations.

“Concern is growing that temperature rises above 1·5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community,” states the editorial.

“Relatedly, current strategies for reducing emissions to net-zero by the middle of the 21st century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.

“This insufficient action means that temperature increases are likely to be well in excess of 2°C, a catastrophic outcome for health and environmental stability. Crucially, the destruction of nature does not have parity of esteem with the climate element of the crisis, and every single global target to restore biodiversity loss by 2020 was missed. This is an overall environmental crisis.

“Health professionals are united with environmental scientists, businesses, and many others in rejecting that this outcome is inevitable.”

 

Image Credits: Commons Wikimedia.

European Commission head Ursula von der Leyen has agreed to return to Africa millions of Johnson & Johnson  (J&J) COVID-19 vaccines that were imported from a South African manufacturer following a meeting with South Africa’s President Cyril Ramaphosa last week.

This was revealed by African Union envoy Strive Masiyiwa said at an Africa Centres for Disease Control (CDC) press conference on Thursday.

News that J&J had fallen behind in vaccine deliveries to African countries while the Aspen Pharmacare manufacturing facility in South Africa was busy exporting millions of the J&J/ Janssen vaccines to Europe was exposed by the New York Times in mid-August.

The report was met with outrage from civil society activists, African governments and the World Health Organization (WHO) – particularly as Aspen has been lagging behind in its J&J vaccines deliveries to African countries.

However, after Ramaphosa raised the issue with Von der Leyen at the G20 Compact with Africa event on 27 August, she agreed to reverse the imports, said Masiyiwa, who heads the African Vaccine Acquisition Trust (AVAT).

“All the vaccines produced at Aspen will stay in Africa and will be distributed to Africa,” said Masiyiwa on Thursday.

He added that J&J’s “finish and fill” contract with Aspen would be converted to a license agreement in which J&J would no longer control where the vaccines went. 

But Fatima Hassan, head of the South African Health Justice Initiative (HJI), said that the AU and South African government should not take credit for the EU’s U-turn.

“Civil Society shone a lone light with two New York Times investigative journalists. Mostly, governments were caught napping and unaware,” said Hassan, adding that she was reserving her celebrations until the J&J vaccines were actually returned to the continent.

Meanwhile, AVAT also facilitated the delivery of 12,000 J&J vaccines to the African Union Commission staff, AU embassy staff and their dependents in Addis Ababa this week.

Only a quarter of this group is vaccinated, according to AU Commission Deputy Chairperson Dr Monique Nsanzabaganwa.

“This figure is far below where we need to be, in order to be near normalcy and return to work.  It is therefore pertinent that all staff and supervisors should encourage colleagues to get vaccinated as this is the only way for us to return to our previous working environment”, she said.

The doses, which had been paid for by donors, were delivered by AVAT on Wednesday alongside the first batch of a large J&J order for Ethiopia.

Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply.

As some 32 countries worldwide, including seven African nations, face “code red” oxygen shortages, WHO and its partners are in the midst of a major effort to recruit sufficient supplies to meet countries’ urgent needs for life-saving oxygen.  

But while over US$500 million is now available in funds and finance for oxygen through the Access to COVID-19 Tools (ACT) Accelerator initiative, many African countries at risk of oxygen shortages have yet to apply for available funding to bolster their oxygen supplies – including Algeria, South Africa and the Democratic Republic of Congo.  

Delays in asking for funding, or asking for the wrong mix of supplies, can make response to oxygen demand surges an even bigger challenge, warned experts at an event Thursday co-organised by Unitaid, Waci Health, and the Every Breath Counts partnership, a coalition of UN agencies, businesses, donors and NGO.

They urged countries to fine-tune requests and accelerate their applications to meet the next deadline for financing requests – as well as to fine-tune demands to ensure a faster and more flexible response to shortages – including a “very dire” situation in some African nations.

‘Very dire’ situation in Africa

Globally 70 countries are at risk of oxygen shortages. Surges in COVID cases – due in large part to the Delta variant (B.1.617.2) – and hospitalizations are overwhelming health systems and driving up deaths.  

Among the African countries facing dangerous levels of oxygen shortages are: Ethiopia, Nigeria, Ghana, Benin, Togo, Cote d’Ivoire, and Somalia. Meanwhile, Somalia and nine other African at-risk countries have yet to even apply for funding for oxygen supplies. They include: Algeria, Libya, Mauritania, Guinea, the Democratic Republic of Congo, South Africa, eSwatini, Mozambique, and Botswana. 

As a result of health systems lacking oxygen and other supplies needed to manage serious COVID cases, the African region is also witnessing “worrying mortality trends,” according to WHO. Last week eight African countries reported increases of over 50% in weekly deaths.

“[There are] large and critical surges in the need for oxygen and too many unacceptable deaths [have been] associated with the lack of access to it,” said Robert Matiru, Director of Programmes at Unitaid, at the event.

Robert Matiru, Director of Programmes at Unitaid, at an event on Thursday co-organized by Unitaid, Every Breath Counts, and Waci Health.

“Medical grade oxygen is one of the most critical medicines for people with severe and critical COVID-19…but unfortunately it is not something that is readily available,” said Dr Raji Tajudeen, Head of the Division of Public Health Institutes and Research at Africa Center for Disease Control and Prevention (CDC). “When oxygen is available, the cost is prohibitive.”

Financing requests exceed available oxygen supplies 

The ACT-Accelerator’s COVID-19 Oxygen Emergency Taskforce, which was launched in February, has mobilised over US$340 million for oxygen-related products in low- and middle-income countries (LMICs) through the Global Fund’s COVID-19 Response Mechanism (C19RM). 

In addition, some US$182 million has been donated to the therapeutics pillar of UNICEF’s Access to COVID-19 Tools Accelerator Supplies Financing Facility (ACT-A SFF). The finance mechanism is dedicated to the procurement and delivery of therapeutics for LMICs, including oxygen. 

But while this represents significant progress toward ACT-A’s goal of raising US$1.2 billion for COVID oxygen needs – bottlenecks in the manufacture of oxygen cylinders and long lead times required for the construction of large-scale pressure swing absorption (PSA) oxygen generating plants are delaying the acute deployment of crisis support, officials said. 

Challenges faced by the Access to COVID-19 Tools (ACT) Accelerator’s COVID-19 Oxygen Emergency Taskforce to address the immediate demand surges in oxygen.

“Even though it’s really encouraging news that we have almost US$340 million awarded, we don’t have enough supply to meet that once procurement and delivery actually begin,” said Robert Matiru, Director of Programmes at Unitaid, at the event on Thursday.

“That is why it’s really critical to already be putting in place interventions to accelerate procurement and delivery and also medium-term measures to ensure that these lead times are cut dramatically for subsequent suppliers and awards,” he added.

Countries urged to fine-tune demands & prioritise oxygen sourcing options that could accelerate access

A breakdown of the approved funding requests from the Global Fund’s COVID-19 Response Mechanism (C19RM).

He urged countries to fine-tune their oxygen supply plans and finance requests accordingly – by considering a wider range of oxygen supply options.

Rather than prioritizing the construction of new PSA facilities, which take a long time to build, countries should consider alternatives like the repair of existing PSA systems, and procurement of bulk liquid oxygen supplies, Matiru said.

“Once you have massive surges, you really need a larger generation capacity and a larger supply capacity than PSA can provide,” said Matiru. 

Procurement of liquid oxygen, which can be stored in bulk at facilities or converted to oxygen cylinders for delivery, may be the fastest way to increase oxygen supply in countries that have existing supply lines for deliveries, he said.

Repairing existing PSA plants may also be more cost-effective and faster than constructing new facilities, as new plants can cost up to US$250,000 and take three to 12 months to complete. 

Algeria, DRC, South Africa and other countries yet to apply for oxygen support finance

In addition, more LMICs should be encouraged to apply for funding for oxygen supplies through the Global Fund’s COVID-19 Response Mechanism, said Matiru.

The deadline to submit the financing request is fast approaching on 17 September, he warned, urging countries to meet it.

Officials from organisations on the ACT-A taskforce also said that there was room for improvement among partners in their coordination of efficient procurement and delivery services. 

“We know as a taskforce we need to be more effective as partners to more effectively attract demand, financing, technical cooperation, and supply, so that we can ensure tight coordination, avoid duplication and be efficient with these resources that are being channelled at unprecedented rates in countries,” said Matiru.

Building local technical and manufacturing capacity – avoiding ‘white elephants’

Along with increasing the supply of oxygen products, building technical capacity and human capital is essential for the sustainable continuation of oxygen infrastructure, said the experts. 

Investing in the health workforce, and expanding biomedical human capital in member states, is important for the service and maintenance of oxygen services and facilities. 

“This unprecedented amount of equipment and supplies has to be maintained and sustained,” said Matiru. “We can’t afford to have white elephants and not sustain the benefit of these investments through this pandemic and even beyond this pandemic for the critical needs we know are out there and predated this pandemic: childhood pneumonia, trauma, complications in childbirth, sepsis and so on.”

One of the key steps moving forward is investing in local manufacturing capacity and developing a “new public health order” in Africa, said Tajudeen.

Dr Raji Tajudeen, Head of the Division of Public Health Institutes and Research at Africa Center for Disease Control and Prevention (CDC).

“To guarantee continental health security, we cannot continue to rely on importation of [oxygen products] from the outside,” Tajudeen said. 

“We know that with new COVID-19 waves there will definitely be new variants,” he added. “And with the low level of vaccine coverage on the continent, we need to continue to make the case for the investment in medical grade oxygen.” 

Some 2.8% of the African population are fully vaccinated, compared to 47.7% in Europe and 42.3% in North America. 

“Going forward [we] really need to begin to look at investing in an oxygen infrastructure so that people with severe COVID and those who…cannot afford oxygen will be able to have access to this oxygen,” said Tajudeen.

Image Credits: WHO/Blink Media – Nada Harib, UNICEF/Ralaivita, Unitaid.

Only a quarter of countries worldwide have a national plan to support people with dementia and their families, according to the World Health Organization’s (WHO)  ‘Global status report on the public health response to dementia’ released on Thursday. 

More than 55 million people globally are living with dementia and the number is estimated to increase by almost 40% to 139 million by 2050,  according to WHO.

While most countries have made progress in implementing public awareness campaigns to improve public understanding of dementia, only a quarter of countries have a national policy, strategy or plan for supporting people with dementia and their families, prompting WHO to call for renewed commitment from governments. 

Half the countries with national policies, strategies or plans are in WHO’s European Region, yet even in Europe, many plans are expiring or have already expired.

The COVID-19 pandemic has also resulted in “profound” disruption for people living with dementia, including hampering dementia risk reduction programmes.

“The world is failing people with dementia, and that hurts all of us,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “ Four years ago, governments agreed on a clear set of targets to improve dementia care. But targets alone are not enough. We need concerted action to ensure that all people with dementia are able to live with the support and dignity they deserve.”

WHO’s Western Pacific Region has the highest number of people with dementia (20.1m), followed by the European Region (14.1m), the Region of the Americas (10.3m), the South-East Asia Region (6.5m), the Eastern Mediterranean Region (2.3 m) and the African Region (1.9m). 

If left unaddressed, the increase would significantly undermine social and economic development globally, warned Tedros.

Dementia is caused by a variety of diseases and injuries that affect the brain, including Alzheimer’s disease or stroke. It affects memory and other cognitive functions, as well as the ability to perform everyday tasks.

In 2019, 1.6 million dementia-related deaths were recorded, making it the seventh leading cause of death. Nearly half of these deaths occurred in high-income countries with women representing roughly 65% of the total number of dementia-related deaths.

The global cost of dementia was estimated to be $1.3 trillion in 2019,  projected to increase to $1.7 trillion by 2030, or $2.8 trillion if corrected for increases in care costs. 

“A challenge of this size cannot be tackled by working in silos. We must combine forces, improve the capacity of health systems to prevent and treat dementia, share quality data, reach beyond our traditional ways of conducting research, and address dementia as a global community,” said Dévora Kestel, WHO Director Department Mental Health and Substance Use.

“Dementia robs millions of people of their memories, independence and dignity, but it also robs the rest of us of the people we know and love,” said Dr Tedros.

COVID-19 and dementia

In addition to the high number of COVID-19 deaths in long-term care facilities, some countries reported unexplained increased numbers of deaths among people with dementia. England and Wales recorded 83% more deaths in people with dementia in April 2020.

“These increased deaths reported in 2020 may be due to factors such as interruptions in routine care, breaks in medication supply chains and resultant medication stock-outs, decreased access to emergency services, and the psychosocial impacts of public health measures designed to control the pandemic,” states the report.

It highlights numerous barriers that impede the progress of dementia reduction including stigma and the lack of public awareness of its importance, lack of financial resources available for dementia risk reduction programmes, inequitable distribution of services, human resource limitations, and lack of coordination between sectors both nationally and locally. 

In terms of COVID-19’s impact on dementia carers, the report found that lockdowns limited the services offered to people living with dementia resulting in delayed access to diagnostic and post-diagnostic care and a significant impact on cognitive health.

Urgent need for more support 

A stand-out finding of the report is the urgent need to strengthen support, of care for people with dementia, and in support for the people who provide that care, in both formal and informal settings.

Some 75% of primarily high-income countries reported that they offer some level of support for carers – carers spent on average five hours a day caring for those suffering from dementia, with 70% of care being provided by women.

Dementia sufferers require various degrees of care including primary health care, specialist care, community-based services, rehabilitation, long-term care, and palliative care.

Most countries (89%) reporting to WHO’s Global Dementia Observatory say they provide some community-based services for dementia, but provision is higher in high-income countries than in low- and middle-income countries. In low- and middle-income countries, two-thirds of dementia care costs are attributable to informal care as opposed to 40% in richer countries. 

Dementia research 

High costs of research and development coupled with several unsuccessful clinical trials have led to a decline in new efforts, the report found.

However, countries like Canada and the US have recently allocated funds towards more dementia research. The US increased its annual investment in Alzheimer’s disease research from US$ 631 million in 2015 to an estimated $ 2.8 billion in 2020. 

“To have a better chance of success, dementia research efforts need to have a clear direction and be better coordinated,” said Dr Tarun Dua, Head of the Brain Health Unit at WHO. “This is why WHO is developing the Dementia Research Blueprint, a global coordination mechanism to provide structure to research efforts and stimulate new initiatives.” 

Future research efforts, states the report, should focus on the people living with dementia and their carers and family.

 

Image Credits: WHO/I. Montilla, WHO/Cathy Greenblat.

Dr Chikwe Ihekweazu, head of the new WHO Hub for Pandemic and Epidemic Intelligence, speaking at the hub’s launch in Berlin.

Monkey Pox, Lassa Fever, Yellow Fever, Cerebrospinal Meningitis, and COVID-19 are some of the epidemics that Dr Chikwe Ihekweazu has addressed as head of the Nigeria Centre for Disease Control (NCDC).

Now, however, Ihekweazu’s repertoire of disease experience is about to expand exponentially, following his appointment as the head of the World Health Organization’s (WHO) new Hub for Pandemic and Epidemic Intelligence.

The hub was formally launched in Berlin on Wednesday in event co-hosted by WHO Director General Dr Tedros Adhanom Ghebreyesus and outgoing German Chancellor Angela Merkel.

The aim of the hub is to create the tools and data needed to enable countries to better “prepare, detect and respond to pandemic and epidemic risks,” according to WHO.

Ihekweazu, an infectious disease epidemiologist, is widely credited with modernising and transforming the Nigerian CDC to address the multitude of epidemics that Africa’s most populous country faces every year.

Believing in themselves

Speaking at the hub’s launch, Ihekweazu said that his biggest lesson from working at the NCDC was empowering its staff to believe in themselves.

“I met a group of people that really didn’t believe that they could do what was expected of them,” he said.  “By believing that they could stretch a little bit beyond what they would normally do, they started trying. And once they started trying and succeeding in small steps, they started believing that they could do more.”

He frankly admitted that the new WHO hub faces “a lot of uncertainty, and sometimes a lack of definition in terms of where exactly we want to go.”

Said Ihekweazu: “We have to be comfortable with that uncertainty, but really look for people that would believe the vision and once they believe the vision and … the threats that we face, that we can work together, despite some of the political challenges, despite some of the economic differences between countries.” 

Ihekweazu, who will now be based in Berlin, has a German mother and Nigerian father. He has a Master’s in Public Health degree from the Heinrich-Heine University in Dusseldorf and worked for the Robert Koch Institute in Berlin, Germany’s national global health research and surveillance hub.

Ihekweazu was appointed as CEO of the NCDC in August 2016, just as the devastating, two-year West African Ebola epidemic was finally coming to an end.  Although the epidemic struck hardest in Guinea, Liberia and Sierra Leone, bruising Nigeria with only about 20 cases, it underscored the immense risks faced by the country of more than 210 million people, where many of the 32 200 health facilities were ill-equipped to address basic health needs.

Ihekweazu spent his first months in office assessing the country’s readiness for other future epidemics – including a range of threats that could potentially be as deadly as Ebola, or even less so, but more infectious, as COVID has proven to be.

“I met Disease Surveillance and Notification Officers without laptops and laboratory technicians with no laboratories,” Ihekweazu wrote in a blog a few months after his appointment.

“Motivated and properly equipped health workers at the frontline of our surveillance work are critical to our disease control efforts. An effective public health laboratory is critical. Proper supply chain management for our medical supplies will ensure that we are always ready for any outbreak.”

Sleepless nights about Ebola

He admitted to having sleepless nights, asking himself: “If we were to have another case of Ebola in Nigeria, would we have the laboratory infrastructure to make a timely diagnosis to recognise it and prevent a large outbreak?”

In June 2017, a WHO team conducted a Joint External Evaluation (JEE) to test Nigeria’s capacity to implement the International Health Regulations (IHR), a set of mandatory laws aimed at ensuring that member states are able to prevent the spread of diseases.

Nigeria’s JEE scorecard was littered with red warnings, and the country’s overall score was 39 percent. But the JEE highlighted the positive role of the NCDC, describing it as “among the most noteworthy best practices observed in Nigeria”.

It described the NCDC’s outbreak investigations as “robust and timely”, and praised the Emergency Operations Centre (EOC) activated to respond to outbreaks, and its call centre, which the public uses extensively during public health emergencies.

By 2018, Ihekweazu had doubled the staff of the NCDC and set up laboratories across the country.

In November 2020, the NCDC and external evaluators conducted a midterm JEE and the country’s score had increased to 46%, bringing them from the “not ready” category into the “work to do” category, according to Prevent Epidemics.

New fire

“The NCDC has given the nation a sense of pride,” said Dr Ifeanyi Nsofor, Director of Policy and Advocacy for Nigeria Health Watch, a civil society organisation that advocates for improved health for Nigerians.

In an interview with me a few years ago, Nsofor described Ihekweazu as being “really instrumental in the changes” made to Nigeria’s approach to fighting epidemics.

“He is the new fire in the agency. It is no longer business as usual. He has brought in the right way of doing things. He has the knowledge, the personality and the networks.”

After Ebola, one of Ihekweazu’s next challenges was to deal with Lassa Fever, a viral hemorrhagic fever from the same family as Ebola spread by rats that is endemic in West Africa.

During an outbreak in 2018, the NCDC proved that it was able to act fast to save lives, which Nsofor attributes to the center’s ability to “conduct research while an outbreak was happening”.

“There was real-time gene sequencing of the virus and the NCDC was able to establish that there was not just one strain of the virus but different strains. This meant a different diagnostic process,” said Nsofor.

His new appointment has been praised across Twitter by health experts and ordinary Nigerians.

Speaking at the launch of the new pandemics hub, WHO’s Tedros said of Ihekweazu: “he brings a wealth of experience, and will serve a dual role as head of the hub here in Berlin and as Assistant Director-General for health emergency intelligence in Geneva.”

 

WHO Director-General Dr Tedros Adhanom Ghebreyesus addresses the launch of the WHO Pandemic Intelligence Hub.

The only thing that moves faster than viruses is data, experts noted at Wednesday’s launch of the World Health Organization (WHO) Hub for Pandemic and Epidemic Intelligence in Berlin.

The aim of the hub is to work with partners to “create the tools and data needed to enable countries to prepare, detect and respond to pandemic and epidemic risks”, according to the WHO.

It named Dr Chikwe Ihekweazu, Director-General of Nigeria’s Centre for Disease Control, as new head of the hub, and WHO Assistant Director-General for health emergency intelligence in Geneva.

READ about Dr Chikwe Ihekweazu here

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the hub was about ”leveraging innovation in data science, harnessing the power of artificial intelligence, quantum computing and other cutting edge technologies and fostering greater sharing of data and information between communities and countries”. 

“No single institution, or nation can do this alone. That’s why we have coined the term collaborative intelligence to sum up our collective mission,” Dr Tedros told a media briefing after the launch.

“This hub will bring together scientists, innovators, policymakers, and civil society representatives from around the world to work across borders and disciplines, of course, the ultimate goal is not just to develop new toys, it’s to save lives.”

According to the WHO, the hub will work to:
* Enhance methods for access to multiple data sources vital to generating signals and insights on disease emergence, evolution and impact;
* Develop state of the art tools to process, analyse and model data for detection, assessment and response;
* Provide WHO, Member States, and partners with these tools to underpin better, faster decisions on how to address outbreak signals and events; and
* Connect and catalyze institutions and networks developing disease outbreak solutions for the present and future.

Dr Tedros, who cut a ribbon with German Chancellor Angela Merkel to inaugurate the hub, credited Merkel with the vision to set up the institution, and later in the event awarded her with the WHO Global Leadership Award in recognition of her “outstanding contribution to global health”.

WHO Director-General Dr Tedros Adhanom Ghebreyesus giving German Chancellor Angela Merkel the WHO Global Leadership Award

The catalyst for the hub, said Tedros, was Merkel’s question: “How can we react faster and avoid the needless suffering and death of the COVID-19 pandemic in future?”

The hub will be supported by the German government, already the biggest contributor to the ACT Accelerator, and international donors.

“To effectively prevent future pandemics, we need more transparency, more real-time data sharing and experiences at all levels from different sectors,” said German health minister Jens Spahn.

“Once again, I call on China to finally become fully cooperative and to make the examination of the origin of the SARS-CoV2 virus transparent to the international community. That’s important to learn for future pandemics,” added Spahn. 

Ready, fast and agile

Dr Michael J Ryan, Executive Director WHO Health Emergencies Programme, saidd that he had spent most of his professional life trying to protect people from epidemics and other health emergencies.

“In my experience, we need three really important, critical things to be effective in response. We must be ready, we must be fast and we must be agile,” said Ryan.

“We need to be able to predict, prepare and plan for what may happen. We must be able to detect, assess and react to what is happening around us the earliest possible signal of an event, and then we must be able to adapt quickly to the realities of an evolving event, which is never exactly what you plan for or expect,” he added.

Describing as prescient the remark that the only thing that could move faster than viruses was data, Ryan said a more effective response to pandemics could be honed through “better data analytics and insights to improve the speed and adaptability of our response”.

Ursula von der Leyen, President of the European Commission.

As the European Union (EU) announced on Tuesday that 70% of its adults had been fully vaccinated against COVID-19, it recommended reimposing restrictions on travellers from the US, Israel, Kosovo, Lebanon, Montenegro, and North Macedonia.

On 8 June, the six were included on an EU Council list of “safe countries” identified for the relaxing of non-essential travel restrictions. But rising COVID-19 cases in these countries – alongside the US failure to lift its travel restrictions on EU citizens – were behind their removal, which was announced in a press release on Monday.

The EU Council recommendation is not binding on member states, who can determine what restrictions to impose.

The EU also recommended the gradual lifting of restrictions on a number of new countries including Canada, Japan, South Korea and the Ukraine  – as well as China, “subject to confirmation of reciprocity”.

In early August, EU Commission president Ursula von den Leyen appealed to the US to lift its ban on travellers from Schengen states – virtually the entire EU – who have to quarantine in a third country for 14 days before being allowed into the US.

In the US, 63% of adults are fully vaccinated and COVID-19 cases continue to rise amid a politicised battle over vaccines and masks, with Republican Party supporters markedly less likely to be vaccinated than Democrats. 

Welcoming the fact that 70% of adults were vaccinated, Von den Leyen said that more needed to be done to assist other countries to vaccinate citizens.

“The EU is already doing a lot. We are exporting, donating vaccines to our partners and we are the lead contributor to COVAX but more needs to be done. We will only end this pandemic if we defeat it in every corner of the globe,” said Von der Leyen.

However, there are substantial differences between member states. Only 20% of Bulgarian and 32% of Romanian adults are fully vaccinated. In contrast, Malta has vaccinated 90% of its population and Portugal, 83,5%, according to the European Centre for Disease Prevention and Control (ECDPC).

Image Credits: Twitter – Ursula von der Leyen.

The World Health Organization (WHO) has not listed the SARS-CoV2 C.1.2 variant discovered in South Africa as either a variant of interest or of concern, and it does not appear to be increasing in circulation.

This follows an alert about the variant that was issued on Monday by the South African National Institute for Communicable Disease (NICD), and a recent pre-print article that reported “the identification of a potential variant of interest assigned to the PANGO lineage C.1.2”.

Maria Van Kerkhove, WHO’s lead on COVID-19, tweeted on Monday that the variant “did not seem to be increasing in circulation but we need more sequencing to be conducted and shared globally. Delta appears dominant from available sequences”.

According to the NICD, the variant has been “detected in all provinces in South Africa at relatively low frequency (up to ~2% of genomes)” between May, when it was first detected, and August. By far the majority of COVID-19 cases in the country are due to the Delta variant.

“While the C.1.2 lineage shares a few common mutations with the Beta and Delta variants, the new lineage has a number of additional mutations,” according to the NICD.

“While some of the mutations in the C.1.2 lineage have arisen in other SARS-CoV-2 variants of concern or variants of interest, we are being cautious about the implications, while we gather more data to understand virus of this lineage.”

The preprint article notes that C.1.2 has “concerning constellations of mutations”. These include “multiple substitutions (R190S, D215G, E484K, N501Y, H655Y and T859N) and deletions (Y144del, L242-A243del) within the spike protein, which have been observed in other VOCs and are associated with increased transmissibility and reduced neutralization sensitivity”.

However, the article notes: “Of greater concern is the accumulation of additional mutations (C136F, Y449H and N679K) which are also likely to impact neutralization sensitivity or furin cleavage and therefore replicative fitness.”

 

Professor Tulio de Oliveria of the KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), one of the authors, said that the scientists had decided to publish the pre-print as they observed “the C.1.2 persistence in South Africa and is now in another 10 countries”. 

Acknowledging that “it is early days as only 95 genomes have been published”,  we have found that “in this pandemic is share info quicker than later”, said De Oliveria.

De Oliveria said that C.1.2 has 14 mutations in the spike protein “including three mutations at the receptor-binding motif, the Y449H, E484K, and N501Y” and that two of the mutations have been found in variants of concern Alpha, Beta, and Gamma.

It has since been found in Africa, Europe, Asia and Oceania.

“Based on our understanding of the mutations in this lineage, partial immune escape may be possible, but despite this, vaccines will still offer high levels of protection against hospitalization and death,” according to the NICD.

“We expect new variants to continue to emerge wherever the virus is spreading. Vaccination remains critical to protect those in our communities at high risk of hospitalization and death, to reduce strain on the health system, and to help slow transmission.”

The WHO defines a “variant of concern” as one that enables “an increase in transmissibility or detrimental change in COVID-19 epidemiology, or an increase in virulence or change in clinical disease presentation; or a decrease in effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics”. 

Meanwhile, a WHO “variant of interest” is characterised by “genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape; and identified to cause significant community transmission or multiple COVID-19 clusters, in multiple countries with increasing relative prevalence, alongside increasing number of cases over time, or other apparent epidemiological impacts to suggest an emerging risk to global public health”.