A Tanzanian mother and her baby.

Children living with HIV in six African countries will soon get access to the antiretroviral (ARV) drug, dolutegravir (DTG), which is more effective, easier to take and has fewer side effects than many other ARVs.

DTG will soon be recommended for children in Uganda, Benin, Kenya, Malawi, Nigeria and Zimbabwe, Kenyan AIDS activist Jacque Wambui told Health Policy Watch. Wambui has been advocating for DTG for a number of years following her own struggles with ARV side effects.

“The drug I was using before was giving me dizzy spells and nightmares and I could not sleep. So when I heard about dolutegravir, I told myself, this is the kind of drug that I would like to use and I also want it in my country as soon as possible,” said Wambui, who is as an alternate representative for Kenya on the African Community Advisory Board (AfroCAB), a network of African HIV treatment advocates.

“We are excited that what happened for us will now happen to the children. With dolutegravir, treatment outcomes are better and you notice you are no longer lethargic. We’re having more productive lives,” said Wambui.

Drug also suitable for toddlers

DTG also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to efavirenz and nevirapine-based regimens.

The World Health Organization (WHO) last week welcomed results of a study presented at the International Pediatric HIV Workshop on the superiority of dolutegravir (DTG)-based regimens in young children.

Last year, the ODYSSEY trial demonstrated superior treatment efficacy for DTG plus two nucleoside analogue drugs versus standard-of-care (SoC) ARVs in children over 14 kg with an average age of 12.

A follow-up study completed last month found that DTG is also superior for toddlers with a median age of 1.4 years. Only 28% had treatment failure by 96 weeks in the DTG arm in comparison to 48% in the SoC arm, and 76% of children in the DTG arm had undetectable viral loads (<50copies/ml) compared with half in SOC. 

“​​Children living with HIV continue to be left behind by the global AIDS response,” according to the WHO. “In 2020, only 54% of the 1.7 million children living with HIV received antiretroviral therapy compared to 74% among adults living with HIV.” 

WHO recommends dolutegravir back in 2018

The WHO has recommended DTG as a first-line treatment for adults and children with HIV since 2018, but this has not been rolled out properly in many African countries, according to a presentation at the International AIDS Society (IAS) HIV science conference that opened on Sunday.

Of the 20 sub-Saharan countries with the highest burden of HIV treatment guidelines, only eight – Uganda, Rwanda, Botswana, Eswatini, South Africa, Tanzania, Zimbabwe, and Zambia – recommend DTG for adults in line with the current WHO guidelines.  

Five countries – Kenya, Malawi, Namibia, Côte d’Ivoire and Ethiopia – recommend DTG except for pregnant women.

Lesotho and Nigeria only recommend it as an alternative regimen, while Angola, Mozambique, Cameroon, Democratic Republic of Congo and South Sudan do not recommend it at all, according to researchers Somya Gupta and Dr Reuben Granich.

An initial study in Botswana had highlighted a possible link between DTG and neural tube defects (birth defects of the brain and spinal cord that cause conditions such as spina bifida) in infants born to women using the drug at the time of conception.

This potential safety concern was reported in May 2018 from the Botswana study that found four cases of neural tube defects out of 426 women who became pregnant while taking DTG.

Based on these preliminary findings, many countries advised pregnant women and women of childbearing age to not take it. Activists who met in Kigali and interrupted a meeting in Amsterdam helped to press for more research on DTG.

“There is a lot of exciting science, both in treatment and in prevention, but that is not why we do this work. It’s how people like Jacque and other advocates make it happen in terms of policies and programmes and actual work on the ground,” said Mitchell Warren, the executive director of AVAC, the non-profit HIV prevention organisation. 

The researchers called for speedy processes to translate scientific research into policy and services at the IAS meeting.

“We are going to send out this information to caregivers. We’re even starting to develop materials for advocacy for DTG for children. We are also going to ask different ministers of health across countries to adopt it,” said Wambui. 

Image Credits: WHO.

The health system in Indonesia is being battered by the surge in COVID-19 cases, with hospitals reaching capacity and oxygen supplies running low.

Indonesia has overtaken Brazil and India to claim the highest number of new COVID-19 cases and deaths, becoming the new epicenter of the pandemic. The surge is part of a third wave hitting all across Southeast Asia.

Countries in Southeast Asia emerged from the first year of the pandemic relatively unscathed, but SARS-CoV2 variants, inconsistent enforcement of public health measures, and slow vaccine rollouts have led to large outbreaks in Vietnam, Malaysia, Myanmar, Thailand, and Indonesia. 

As the highly transmissible Delta variant, first identified in India and classified as a WHO variant of concern in mid-May, sweeps across the world, cases, deaths, and nationwide restrictions are increasing. 

The Delta variant has been recorded in 111 countries. The three other variants of concern (Alpha, Beta, and Gamma) have been found in Malaysia, Thailand, Philippines, Singapore, and Indonesia. 

Indonesia Facing Massive Surge and Overwhelmed Health System

Over the past month, daily new cases in Indonesia have increased five-fold and the number of new deaths has doubled since the beginning of July. On Sunday, the country of 276,5-million recorded 44,721 new cases and 1,093 deaths, bringing the total cumulative cases to 2.8 million and deaths to 73,582, according to the Indonesia Health Ministry. 

The figures, however, are likely underestimated due to the limited testing capacity. 

“We predict that the real number of those who died from COVID-19 should be three to five times higher than the official number,” Irma Hidayana, Co-founder of LaporCOVID19, a citizen coalition for data disclosure on COVID, told Al Jazeera.

“We miss many cases and we don’t identify maybe 80% of these cases in the community,” Dr Dicky Budiman, an Indonesian epidemiologist at Griffith University in Australia, told the Guardian. 

“In Indonesia, the testing is passive, it’s not active. The one who comes to the healthcare facility is the one who gets tested if they show symptoms, or if they also identify as the contact,” said Budiman. 

According to WHO, one indicator that the epidemic is under control in a country is a positive rate of less than 5%. In Indonesia, some 29.3% of tests conducted return positive results. This suggests that the level of testing in the country is inadequate relative to the size of the outbreak. 

The health system is being battered by the third wave, and hospitals on the island of Java have reached capacity, oxygen supplies are running low, and four of the five designated COVID burial grounds are nearly full. 

Some 33 patients at Dr. Sardjito General Hospital in Yogyakarta died this month after the supply of oxygen ran out. 

Hospitals have set up large tents and added thousands of beds to increase capacity and meet the demands of the surge, but there is also a shortage of healthcare workers which has been exacerbated by healthcare workers succumbing to the virus. 

Tents have been set up outside of hospitals on the island of Java to treat the surge in COVID patients.

Some 114 doctors in Indonesia have died so far this month, accounting for 20% of the 545 total health worker deaths from SARS-CoV2 since the beginning of the pandemic. 

Many expect the situation to worsen, but government officials say they have the situation under control. 

“If we talk about the worst-case scenario, 60,000 or slightly more [daily cases], we are pretty OK,” said Luhut Pandjaitan, a senior minister assigned to tackle the COVID-19 pandemic. “We are hoping that it will not reach 100,000, but even so, we are preparing now for if we ever get there.” 

The government has implemented restrictions on the islands of Java, Bali, and 15 other cities, closing places of worship, schools, shopping malls and sports facilities, reducing public transit capacity, and limiting restaurants to takeout. 

The restrictions are set to end on Tuesday, but officials are considering extending them.

Malaysia Experiences Dual Health and Economic Crisis

As of 13 July, the Southeast Asia region saw a 16% increase in new cases and a 26% increase in new deaths over the course of one week. India, Indonesia, and Bangladesh are responsible for the greatest numbers of cases and deaths from the region. 

Malaysia has recorded the worst COVID infection rate per capita, with 354 new cases per million people, compared to 182 in Indonesia, 137 in Thailand, and 97 in Myanmar. 

On Monday, Malaysia recorded 10,972 new cases and 129 deaths, bringing the total cumulative cases to 927,533 and 7,148 deaths, according to the Malaysian Ministry of Health. 

Fatalities have tripled since early May.

Malaysia is also facing an economic crisis and thousands are in need of assistance from the government after the most recent lockdown, which was introduced on 1 June. 

“Generous and comprehensive welfare protection to support nutrition, mental health and the ability to stay home for all Malaysians” is needed, Dr Khor Swee Kheng, an independent health policy consultant for WHO, told the Guardian. 

Health experts have blamed the continued rise in cases on the government’s inconsistent implementation of restrictions and failure to close loopholes.  

Frustration Mounting Over Government’s Handling of COVID-19 in Thailand

Thailand recorded 11,784 new cases and 81 deaths on Sunday, marking the third consecutive day of cases over 9,000. As the country attempts to tackle its worst outbreak to date, a protest was held to criticize the government’s handling of the pandemic. 

The country has recorded a total of 415,170 cases and 3,422 deaths since the pandemic started. Over 90% of cases and deaths have occurred since April. 

COVID restrictions were expanded on Sunday to include limits on travel, shopping mall closures, and a curfew in 13 provinces, making these the strictest social and public health measures implemented in over a year. 

On the same day, protesters, armed with N95 masks, gloves and hand sanitizer, broke the ban on gathering of more than five people, to call for the Prime Minister’s resignation. Prime Minister Prayut Chan-o-cha has been criticized for his failure to secure adequate supplies of COVID vaccines and his inability to prevent the mounting infections and deaths. 

The police used teargas, water cannons, and rubber bullets to disperse protesters.

Areas of Vietnam Experiencing ‘Very Complicated Epidemics’

Vietnam has put its southern region in a two-week lockdown starting on Sunday after three consecutive days of record cases, deemed “very complicated epidemics,” by Vietnam’s Prime Minister Pham Minh Chinh.

On Sunday, Vietnam recorded 3,218 new cases and 16 deaths, the majority of which took place in the Mekong Delta and Ho Chi Minh City. Some 84% of the COVID deaths have occurred since April, after months of no recorded cases.

“The situation is getting serious with a high rate of transmission, especially with the dangerous Delta variant,” said Vietnam’s Prime Minister Pham Minh Chinh. “We have to put the health and safety of the people as the top priority.”

“We have to keep the transmission rate at the lowest possible to ensure the health system functions effectively and is not being overloaded,” said Vu Duc Dam, Deputy Prime Minister and head of the Committee for COVID-19 Pandemic Prevention. 

The surge has come as Vietnam struggles to speed up its vaccine rollout.

Booster Shots Planned to Bolster Sinovac

Vaccination rates across Southeast Asia remain low, with 30.3% of Malaysia’s population having received one dose, 15.4% of Thailand’s, 15.2% of Indonesia’s, 4% of Vietnam’s, 3.5% of Bangladesh’s, and 3.3% of Myanmar’s. 

Even Malaysia, which has done the best out of this group of Southeast Asian countries, has only fully vaccinated 9.6% of its population, compared to 52.9% in the United Kingdom and 48.1% in the United States.

Not only have fewer people across Southeast Asia received COVID jabs, but there are growing concerns that the Chinese-made Sinovac vaccine may not be performing as well as expected – particularly against rapidly spreading variants of SARS-CoV-2.

Both Indonesia and Thailand, which have vaccinated their healthcare workers with Sinovac, have announced plans to offer a booster dose of the Moderna or Pfizer/BioNTech vaccines. 

“There’s a lot of doctors and medical workers who have been vaccinated twice but endured medium and severe symptoms, or even died,” said Slamet Budiarto, Deputy Chief of the Indonesian Medical Association, to Parliament in early July. 

“It is the time for medical workers to get a third booster to protect them from the impact of more vicious and worrying new variants,” said Melki Laka Lena, Deputy Chairman of the Indonesian Parliamentary Commission Overseeing Health.

Image Credits: Sky News, ABC News (Australia), ABC News (Australia).

Max Appenroth of Global Action for Trans Equality (GATE)

Almost one in five trans women globally are living with HIV – 49 times greater than the general population – while HIV in trans men is woefully understudied. 

Yet trans and gender-diverse (TGD) people are “frequently and often systematically left out of HIV prevention research and responses”, according to No Data No More, a global HIV prevention manifesto launched on Monday with the support of the non-profit HIV prevention organisation, AVAC.

“Forty years into the global HIV pandemic, which is endemic to most trans communities, it’s beyond time to align HIV prevention research with trans and gender-diverse realities,” Max Appenroth of Global Action for Trans Equality (GATE), told the launch.

“The best way to reduce HIV in TGD communities is to invite our communities to participate meaningfully in the response. The ‘No Data No More’ manifesto is an invitation to recognize the fundamental and critical role that empowered TGD communities can play in protecting our own wellbeing and reducing the global toll of HIV.”

Warning to Academia

Even when TGD people are included in research, they are considered as subjects rather than collaborators with agency, according to Leigh-Ann van der Merwe, from the Social, Health and Empowerment Feminist Collective of Transgender Women in South Africa.

“I want to caution academia that transgender people are no longer willing to be recruited as as data collectors only,” said Van der Merwe, adding that transgender people needed to be included in all the various stages of decision-making from research design, to implementation and dissemination.

The manifesto, which was written by TGD advocates from South Africa, Europe and the United States, argues for an HIV TGD research agenda that “considers diversity, including the full range of participants along the gender spectrum” and accurately tracks epidemiological data on HIV incidence and prevalence in TGD populations.

Immaculate Nyawira Mugo, consultant on gender, intersectional sexual and reproductive health and rights in South Africa, also called for more research into drug interactions between gender-affirming hormone therapy and antiretroviral drugs, including ARVs taken to prevent HIV as pre-exposure prophylaxis (PrEP)

“Much work remains to make the perspective and participation of trans and gender diverse communities central to HIV response, but this manifesto charts an essential path forward for researchers, advocates and implementers worldwide,” said AVAC Senior Manager for Partnerships Cindra Feuer.

The manifesto was launched in association with the International AIDS Society’s Conference on HIV Science which started on Sunday and runs until Wednesday.

 

Relief supplies that were stockpiled through the UN Humanitarian Response Depot hub in Brindisi, Italy were sent to Somalia in the wake of Cyclone Gati. The new project plans to utilise this existing infrastructure for health emergencies.

The World Food Program (WFP) and World Health Organization (WHO) launched a health emergencies project, INITIATE2, on Monday.

The joint INITIATE2 project will gather health emergency actors, research and academic institutions, and international and national partners to facilitate knowledge sharing and skills transfer to improve emergency health responses. 

The project will develop innovative solutions to health crises, including disease-specific facilities and kits. Healthcare workers and those working in logistics will be trained to implement and adjust the solutions to local contexts. 

The agencies plan to leverage existing infrastructure, such as the UN Humanitarian Response Depot (UNHRD) – a global network of hubs that procures, stores, and transports emergency supplies for the humanitarian community – to stockpile relief items. 

Currently, there are six strategically located hubs around the world in Italy, Ghana, Malaysia, Panama, Spain, and the United Arab Emirates. 

The UNHRD Lab will be used to research and develop improved logistics support equipment, cost-effective and sustainable solutions, and standardised field items for health responses. 

“Health emergencies like the West Africa Ebola response and the current COVID-19 pandemic have shown just how crucial working together as a humanitarian community is, and so we’re extremely pleased to be able to further cement our role as an enabler of humanitarian response through this collaboration with WHO,” said Alex Marianelli, WFP Director of Supply Chain, in a press release. 

COVID Health Emergency Program

During the COVID-19 pandemic, WHO and WFP developed the COVID-19 Supply Chain System to address the acute shortage of essential supplies, including personal protective equipment (PPE), biomedical equipment, and diagnostics supplies. 

WHO has worked with partner agencies to provide a channel for countries to request critical healthcare supplies. 

“The WHO-WFP-led COVID-19 Supply Chain System has already illustrated an end-to-end integration of technical and operational capacities for impact,” said Dr Ibrahima Soce-Fall, WHO Assistant Director General for Emergencies Response. 

“With INITIATE2, WFP and WHO are now extending the collaboration to build synergies among different actors and foster innovation in this critical field, to quickly respond to health emergencies and create a conducive environment for knowledge sharing and skills transfer,” said Soce-Fall.

This is an excellent example of how we can scale and harmonise emergency preparedness, readiness, and response,” he added.

Image Credits: UNHRD.

Almost half of Sudanese households are concerned about food security.

KHARTOUM – A telemedicine programme is helping Sudanese medical students to both treat community members with mild COVID-19 in their homes and educate their communities about the pandemic.

Many medical students, who have been sitting at home since medical schools were closed last year due to the pandemic, joined the community medical response teams (CMRT) established earlier this year by US-based Sudanese physician Dr Nada Fadul, an infectious disease physician at University of Nebraska, and Dr Reem Ahmed from Emory University.

Over the past five months, Fadul,  Ahmed and other Sudanese physicians outside the country, have trained more than 120 medical and healthcare students in over 50 Sudanese neighborhoods to manage patients with COVID-19 in their homes. 

“The students wanted to do something, but they didn’t know what to do or how to do it safely,” said Dr Fadul.

“In addition to the impact they’re having on patients, students benefit from pursuing their learning in a hands-on way. When they return to their classrooms, they will be better equipped to take on new challenges.” 

The CMRT training focuses on the principles of home management for mild to moderate cases; home isolation and quarantine methods; and identifying life-threatening symptoms that require immediate medical attention.

Access to up-to-date information

Last month, the CMRTs linked up with Project ECHO, a US-based initiative that connects the students to medical experts who offer case-based telementoring and collaborative problem-solving.

Asmaa Alhadi, a fifth year medical student studying at the National Ribat University in Khartoum, joined the first cohort of CMRT facilitators in January, and said that the programme has enabled her to access up-to-date information on scientific studies and data on the pandemic.

“All this has made it easier for me to speak comfortably to community members

since I am equipped with a huge amount of knowledge and skills to overcome community hesitancy and fears towards the disease and vaccines,” she said.

Alhadi explained that there is a lot of stigma surrounding the virus in Sudan, particularly in rural areas where there is greater vaccine hesitancy. 

“The real change I believe the project has had is through the number of awareness and educational campaigns held in different local neighbourhoods,” she said.

These campaigns, she maintains, have played a big role in convincing people to get the vaccine by sharing with them the benefits of being vaccinated and how it will help in saving lives.

“From my point of view, even changing only one individual’s misconceptions about COVID-19 is quite satisfying, especially in a closed country like Sudan,” she said.

The CMRT, with support from ECHO, hopes to reach 400 students in Sudan by the end of 2021.

Rising hardship caused by pandemic

A World Bank report published in May highlighted the massive economic impact of the pandemic on the country, with 67% of people reporting that they had been unable to return to work, almost half of households (47%) concerned about food security and one-fifth unable to buy basics such as bread and milk because of rising prices.

The country has vaccinated approximately 0.8% of its population against COVID-19 using vaccines provided by COVAX, according to Reuters. 

Project ECHO was founded in 2003 at the University of New Mexico in the US, and has launched about 1000 programmes in nearly 50 countries, addressing more than 70 health conditions. 

In Sudan, the University of New Mexico is collaborating with the University of Nebraska Medical Centre (UNMC) and the Sudanese Federal Ministry of Health (MoH). It is also working with the Sudanese American Medical Association (SAMA) and Sudan NextGen (SNG), both of which are coalitions of Sudanese organisations against COVID-19.

Dr Bruce Baird Struminger, senior associate director of the ECHO Institute at the University of New Mexico, said that the pandemic had challenged Sudan’s health system that was already weakened by years of civil war and unrest. 

“We hope to continue to expand the use of ECHO more broadly in future years to enable the CMRT volunteers to target other priority communicable and non-communicable diseases,” Struminger told Health Policy Watch.

One of the main challenges facing the initiative is power outages and poor internet connectivity. The programme is seeking solutions to strengthen internet connectivity and power access at local medical schools and other sites to transform these locations into local ECHO learning sites. 

Students can either join learning sessions remotely or at the Sudanese American Medical Association main office and at the Federal Ministry of Health offices.

Almost 50 community outreach activities have been conducted in Sudan by volunteers in the programme. This includes education sessions on COVID-19 prevention and vaccination in schools, local mosques and neighbourhood clubs.

Alhadi believes that attracting more players, not only medical field partners like the Federal Ministry of Health, could help improve the initiative.

“I do believe that being in touch with different partners from different fields will make it similar to a multidisciplinary team who are working side-by-side to achieve the project”s goals, starting from democratisation of medical knowledge through to reaching community members and changing their thoughts and practices towards the disease,” she said.

Since April 2020, more than 180,000 people have participated in ECHO video-conference-based virtual learning sessions across Africa, most of which have been focused on COVID-19. 

 

Image Credits: Sarah Farhat/World Bank.

Vaccine supplies have dried up in most African countries after COVAX was unable to procure supplies from India.

Burkina Faso, Djibouti, and Ethiopia will be the first African countries to benefit from the US donation of COVID-19 vaccines, with a million doses expected “in the coming days” as part of the US pledge to provide 25 million vaccines to the continent, US officials and the global vaccine alliance, Gavi, said on Friday.

This comes amid a surge in cases on the continent, which has seen COVID-related deaths increase by 43% in the past week.

The Johnson & Johnson vaccines are being delivered via the Africa Union’s African Vaccine Acquisition Trust (AVAT) and the global vaccine delivery platform, COVAX.

The World Health Organization (WHO) has urged the vaccination of 10% of the world’s population by the end of September, but Africa has only vaccinated 1.3% of the continent’s population, according to the Africa Centre for Disease Control and Prevention (CDC).

African Vaccination Figures, July 2021

Donated vaccines will go to 49 African countries in the coming weeks as part of a collaboration between the African Union and Africa CDC, AVAT, financing bank AFreximbank, COVAX and the US government.

“We appreciate the US Government for their support in helping contribute to the AU target to vaccinate 60% of the population in Africa especially at this moment when we are witnessing the third-wave in a number of African countries,” said Strive Masiyiwa, AU Special Envoy and head of AVAT.

“In partnership with the African Union and COVAX, the United States is proud to donate 25 million COVID-19 vaccines to 49 African countries,” said Gayle Smith, Coordinator for COVID-19 Recovery and Global Health, US Department of State.

“The Biden Administration is committed to leading the global response to the pandemic by providing safe and effective vaccines to the world.  Working together, we can save lives and bring the COVID-19 pandemic to an end.”

The African allocation is part of the 80-million dose donation recently announced by US President Joe Biden.

Financial institution Afreximbank has put in place a US$2 billion Advance Procurement Commitment (APC) Guarantee facility to buy 400 million J&J doses, according to Prof Benedict Oramah, President of Afreximbank.

“These combined efforts give reason to be optimistic that the African Union’s goal of at least 60% vaccination coverage will be achieved soon,” said Oramah.

COVAX  “expects to deliver 620 million doses to Africa by the end of 2021, rising to 1 billion doses by the end of the first quarter of 2022”, according to Gavi.

Meanwhile, the Partnerships for African Vaccine Manufacturing (PAVM) launched in April, recently reported that Senegal, the European Union, the US and other partners, have signed an accord to finance vaccine production at the Institut Pasteur of Dakar.

Earlier in July, Morocco and Swedish company Recipharm signed a memorandum of understanding to establish and scale up COVID-19 vaccine manufacturing capacity in the country. 

In late June, the South African government, Biovac, Afrigen Biologics & Vaccines, a network of universities, the World Health Organization (WHO), COVAX, and Africa CDC announced the establishment of the first COVID-19 mRNA vaccine technology transfer hub in Africa.

 

Image Credits: WHO African Region .

In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis.

On the 100th anniversary of the world’s only vaccine for tuberculosis, the Stop TB Partnership has urged world leaders and other stakeholders to prioritise the development of an effective, safe and affordable tuberculosis vaccine by 2025. 

But there is a financial shortfall to achieve this goal, with only around a fifth of the target funding having been raised so far. In 2019, US$117 million was invested in TB vaccine research against a target of at least US$550 million per year over the next four years to achieve the 2025 deadline. In contrast, COVID-19 vaccine research received over US$100 billion in funding over the past year.

“What the world has achieved in the past year with regards to the development of safe and effective COVID-19 vaccines is astonishing and worth celebrating,” said Dr Lucica Ditiu, executive director of the Stop TB Partnership.

Ditiu noted that the same level of energy and funding that went into new vaccines for COVID-19 should also go into vaccines for TB, another airborne, deadly infectious disease that has been around for millennia and kills 4,000 people every day, including 700 children. 

“Today, we call on the world to provide sufficient financial resources and political will by 2023 to allow for the rollout of an effective TB vaccine by 2025. Lessons learned from recent pandemics clearly show that it is possible,” Ditiu added.

Carol Nawina, a TB survivor and person living with HIV noted that prior to COVID-19, TB advocates had come to the conclusion that there may not be a new vaccine again. 

“For me, it’s really outrageous that the world, for 100 years, could not come together and develop an effective vaccine for TB. But here we are, within two years, we already have several vaccines for COVID-19,” she told a briefing on Thursday convened by Stop TB.

Nawina, who is a Zambian, also said that Zambia and other TB-high burden countries should declare TB a national priority for investment and that political will is operationalised. 

“COVID-19 has shown us that we can do with investment. We must leverage the COVID-19 investment to end TB. The global community must now invest funds and allocate domestic resources for this purpose,” she added.

BCG ‘isn’t doing what we need it to do’

David Lewinsohn, professor of medicine at Oregon Health and Science University, and chair of Stop TB Partnership’s working group on new TB vaccines

David Lewinsohn, professor of medicine at Oregon Health and Science University, and chair of Stop TB Partnership’s working group on new TB vaccines, described the BCG vaccine that was first administered in July 1921 as a good vaccine that has been effective in preventing the really severe complications of childhood TB including meningitis and disseminated TB. 

“I don’t think the BCG vaccine has failed. One of the reasons why we have been reluctant to discard the vaccine is because it works in preventing severe forms of TB in children. It hasn’t failed, but it isn’t really doing what we needed it to do,” Lewinsohn said.

But the BCG vaccine has not been able to bring about dramatic reduction in the number of TB cases among the populations like the vaccines against measles, mumps or polio as a leading infectious disease worldwide, killing thousands of people, including hundreds of children, daily.

Lewinsohn said that there were 15 TB vaccine candidates in the pipeline currently.

In September 2018, the results a Phase 2b clinical trial were announced that showed GSK’s M72/AS01E candidate vaccine significantly reduced the incidence of pulmonary TB disease in HIV-negative adults with latent TB infection with an overall vaccine efficacy of 54%.

“Now, that was 2018, and working our way backwards, the actual discovery and development of that vaccine took place in the late 1990s. And so it really took about 20 years to go from vaccine development to the first promising results in humans, and we contrast that to the enrollment of the COVID vaccines which took something less than 100 days. Admittedly that benefited greatly from defense investments in SARS and MERS. But nonetheless, that’s a pathetically short timeline, ” Lewinsohn said.

In addition to upstream investments into TB vaccine development, Lewinsohn said there is also the need for far greater capacity to evaluate and license the vaccines to ensure equitable TB vaccine distribution.

A challenging disease for vaccine development

Even with the availability of funds and political will, in comparison with COVID-19, TB has been described as a challenging disease for vaccine development. 

While SARS-CoV-2 is highly transmissible and capable of causing disease in most individuals infected, the situation is different for TB where most people who get infected do not fall sick in the short term.

“So we need to think about vaccines in different contexts and it’s very likely we’re going to need more than one vaccine,” Lewinsohn said.

He noted that the vaccine that is efficacious among children may be different from the ones for adolescents. In the same vein, the vaccine that prevents infection may be different from the one that prevents people from falling sick.

“I think there’s really good science that supports vaccines for all of those indications, but it just highlights the idea that we’re going to need to pursue different vaccines with different indications as rapidly as we can,” the professor said.

In March 2021, Health Policy Watch reported that 12 months of COVID-19 have eliminated 12 years of progress in the global fight against tuberculosis. At Thursday’s briefing, Sahu Suvanand, Stop TB Partnership’s Deputy Executive Director said COVID-19 has been a major setback in the global fight against TB. 

“We are not on track to end TB,” he said.

He noted that dealing with the limitations of the BCG vaccination will improve the realisation of global TB goals. 

“It offers mostly variable or poor protection against other forms of TB. It particularly doesn’t prevent TB transmission, and disease in adolescents,” he added.

Going forward, he said the world needs to recover from the impact of COVID-19 and come back on track towards ending TB.

“It will require the existing tools to be applied at scale and with some innovations to get over the barriers that COVID has faced. Also, the new tools that are in the pipeline need to come in and be rolled out, and then we should be able to end TB by 2030,” Suvanand added.

Image Credits: Stop TB Partnership.

Many people turned to video gaming as a way of connecting with others during COVID-19 lockdown.

The isolation of COVID-19, especially during the early stages of the pandemic, has forced many people to turn to alternative methods of communication and engagement, such as video games, speakers noted during a Thursday event, organized by video games industry associations.

At the event, panelists discussed the role of video games on health and well-being, and the potential for video games to be used as a positive force in the field of mental health. The event was hosted by the Interactive Software Federation of Europe, in collaboration with the Entertainment Software Association (ESA), and other video game associations.  

People found solace in video games during the COVID-19 pandemic, as players used the medium to share and keep in touch with peers while playing together, said panelist Andrew Przybylski, director of research at Oxford Internet Institute, who led a recent study that exampled the impacts of video game playing on well-being during the pandemic.

Other recent research has found that video games can be used to reinforced connections between parents and children, when they play together during pabdemic lockdowns. 

“Video games proved their relevance with its audience, facilitating a medium to connect and share experiences,” said Eduardo Mena, Research Director at the UK-based Ipsos Mori, another one of the panelists who appeared at the event.

But while video games have become a dominant source of entertainment for children and adults alike, the industry itself continues to be misunderstood. Media continues to rely on old research,  stereotypes, and broad generalizations to report on this hobby, resulting in the misinformed engaging with video games in a “uniform, monolithic way,” said Gene Park of The Washington Post, moderating the event.

“[Video games] remains woefully understudied as an industry,” said Park.

Pandemic Interrupted “Circadian Rhythm of Play” 

Andrew Przybylski, Director of Research, Oxford Internet Institute

The pandemic interrupted the “circadian rhythm of play”, leading people to play video games more on a daily basis, especially online multiplayer ones, when national lockdowns first began in the UK in 2020 when compared to 2019. 

A study, conducted by the Oxford Internet Institute, examined the top 500 games on Steam, a video game distribution service, and compared daily play data for 2019 and 2020, to determine whether the COVID-19 pandemic was related to an uptick or change in behavior for players worldwide. 

Typically, video games engagement is subjected to what Przybylski called the “circadian rhythm of play”, with people normally playing during weekends, or on days of rest. However, the pandemic interrupted this circadian rhythm, prompting a “weekend effect” that led to increased gameplay. 

“The pandemic erased the weekends, leading people to play more year-round,” said Przybylski.

While the heightened video game engagement led to concerns of possible addiction, the study also found that when lockdowns eased, the engagement also waned again, although some aspects of the ”weekend effect” persisted, when people continued to work from home.    

Video Games May Contribute to Well-Being, Says Ground Breaking New Study

A previous study, also conducted by the Oxford Internet Institute, examined industry data on actual play time for two popular video games, Plants vs Zombies: Battle for Neighborville and Animal Crossing: New Horizons.

This groundbreaking study suggests that experiences of competence and social connection with others through play may contribute to people’s well-being. 

The experiences during play could even be more important than the actual amount of time a player invests in games and could play a major role in the well-being of players. 

Przybylski sees these studies as an opportunity for the video game industry to go further in understanding the connection between video games and behavior and health, as opposed to jumping to “fast, cheap narratives that miss the big picture.” 

“We need to take care not to forget the basics behind human behavior and how we understand health, in light of the digital world, in light of video games.”

He emphasizes that going forward, industries and researchers alike should collect data that “acts as a rising tide for all ships.” 

“If you want to understand how human collaboration plays into specific types of narratives, feeds into the human story and into mental health….it means you have to dig a bit deeper. Players themselves need to be part of that process.” 

Supportive Role of Video Games During the Pandemic 

Around 30% of players appreciated the supportive role of video games during pandemic restrictions, the number increasing with those who played multiplayer online games.

The COVID-19 pandemic accelerated video game engagement, with players appreciating the supportive role of video games during pandemic restrictions, another new study found.

This study, conducted by Ipsos Mori, examined the impact of the pandemic on people who play video games. 

Around 30% of surveyed players said that playing video games helped their mood and allowed them to feel less isolated as they stayed in contact with friends and family, this number increasing to almost 50% with multiplayer online games. 

One in four players also improved their perception about the link between video games and mental health. 

There was also an increase in parents who played video games. Parents who played video games with their children found the experiences helpful in connecting with their children and in facilitating their learning. 

Normalizing Mental Health Discussions Through Video Games 

Cornelia Geppert, CEO of Jo-Mei Games. Jo-Mei Games is a German game developer of Sea of Solitude.

The video game Sea of Solitude allowed players to normalize mental health conversations through an active form of storytelling, leading many fans to say that the game “changed their life for the better,” said game developer Cornelia Geppert, CEO of Jo-Mei Games.

Many have written to Geppert, saying that they now “hope to have a better future for themselves, for the first time in decades. They now want to seek therapy and feel hopefully [in overcoming] their own issues.” 

The game tells an intimate story of a young woman’s emotional journey to overcome loneliness. 

Several different manifestations of loneliness are depicted throughout the game – from bullying, family, relationships and mental health issues. The main character, Kaye, turns into a monster as she suffers from strong feelings of worthlessness and hopelessness. 

Players experience what she and the other characters are going through as they help her turn back into a human, with the key message of the game not only to chase joy and happiness, “but to embrace all your angles, to bring all your emotions into balance,” said Geppert.

“[Sea of Solitude] shows that sometimes it is most important to focus on your own well-being first.” 

Image Credits: MaxPixel, ISFE, ISFE .

Ghana, Africa
Ghanian health worker Evelyn Narkie Dowuona holds up her vaccination card after being vaccinated in March, but vaccine supplies to the continent have virtually dried up.

Africa experienced a 43% week-on-week increase in COVID-19 deaths, as the Delta variant accelerated infections for the eighth week in a row, the World Health Organisation (WHO) reported at its weekly Africa press briefing.

Hospital admissions increase rapidly and countries face shortages in oxygen and intensive care beds, as the Africa hit six million cumulative COVID cases – riding the worst wave ever of the pandemic on the continent.

New infections in Africa’s third wave outsrip previous peaks, according to the latest data from Africa Centres for Diseae Control, with southern and northern Africa as the epicenters.

Infections are now moving at an unprecedented speed, health officials warned. Over the past month, the continent registered an additional one million cases whereas it took around three months for the previous million cases to be cases to recorded.

“Deaths have climbed steeply for the past five weeks. This is a clear warning sign that hospitals in the most impacted countries are reaching a breaking point,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

Moeti noted that countries are facing dire shortages of the health workers, supplies, equipment and infrastructure needed to provide care to severely ill COVID-19 patients.

Some 20% of Namibia’s Hospital Cases in ICU

Namibian physician, Dr Ismael Katjitae

 

Namibia, South Africa, Tunisia, Uganda and Zambia accounted for 83% of the new deaths recorded in the past week. The proportion of deaths among confirmed cases reported in Africa is 2.6% against the global average of 2.2%. 

Namibian physician Dr Ismael Katjitae, told the briefing that over 20% of Namibia’s hospitalised COVID-19 cases are in intensive care units (ICU), with one-half of hospitalised patients concentrated in Windhoek, the country’s capital city.

“This has resulted in a very high bed occupancy rate that is beyond the capacity of the healthcare system. There has been an associated spike in the number of deaths, with approximately 1000 deaths in the last month,” Katjitae said.

He revealed that the Delta variant is a major contributor to the high number of COVID deaths in the country.

“With a high number of new infections within a short period of time, it has resulted in a high number of severe and critically ill patients,” he added.

Other contributors to the high number of COVID-19 deaths in Namibia, Katjitae said, also include the high prevalence of comorbidities in some communities, limited capacity of the health system in some districts and regions, and misinformation.

DRC’s Cases Rise Almost 500% in Five Weeks

Dr Jean-Jacques Mbungani Mbanda, the DRC’s Minister of Public Health

The situation in DR Congo is similar to that in Namibia, according to Dr Jean-Jacques Mbungani Mbanda, the DRC’s Minister of Public Health. Mbanda, who also addressed the WHO press briefing, noted that the country had gone from 448 cases after 21 weeks to 2,660 cases during the 25th week. 

“This is an impressive increase of 481% in five weeks. We have overtaken the peaks of the previous two waves,” the minister said.

He added that about 32% of hospitalised COVID-19 patients were severely ill and required oxygen. 

“The number one priority for African countries is boosting oxygen production to give critically ill patients a fighting chance,” Dr Moeti said. “Effective treatment is the last line of defence against COVID-19 and it must not crumble.”

She noted that insufficient quantity, disrepair or poor maintenance of production plants as well as challenges in distribution, scarcity of cylinders, personnel or technical skills were barriers to adequate medical oxygen supply in Africa.

Mbanda also revealed that comorbidities are contributing to COVID-19 deaths in the country. He said DRC has recorded over 150 patients with at least one comorbidity, or co-infection such as high blood pressure, diabetes and so on. The majority of (about 110) are in Kinshasa.

“This third wave came about after confinement measures were taken. But then, once they were eliminated, we had protection measures that were revised, and then the situation became worse because of the Delta variant,” the minister said. 

While vaccine acceptance was a challenge, demand for the vaccine was rising, said Mbanda. He called on Gavi, WHO, UNICEF and other partners to support the country with more vaccine doses to enable the country to combat the COVID-19 pandemic and reduce the pressure on the country’s healthcare system.

“Vaccination is the only way to reduce the extent of the disease, and to also limit the number of deaths and morbidity,” the minister said.

Urgent Need for Vaccines

Dr Matshidiso Moeti, WHO Regional Director for Africa.

While vaccine delivery is rising in Asia, Africa still faces woefully inadequate vaccine supplies. So far only 52 million of the continent’s 1.3 billion people have been vaccinated, since rollout began in March 2021 in South Africa and with the first deliveries of vaccines to Ghana, by the WHO co-sponsored COVAX global vaccine facility initiative. 

African vaccinations account for only 1.6% of the 3.5 billion people vaccinated worldwide, although Africans constitute 17% of the world’s population. Moreover, only 18 million people on the continent have been fully vaccinated, 1.5% of the continent’s population, although some countries in the North have fully immunised more than 50% of their people.  

 “The double barrier of vaccine scarcity and treatment challenges is seriously undermining effective response to the surging pandemic,” said Dr Moeti. “However, with the expected fresh vaccine shipments and strong preventive measures, we can still turn the tide against the virus.”

The WHO said Africa needs 190 million additional COVID-19 vaccine doses to fully vaccinate 10% of the African population by the end of September, with around 750 million more doses needed to fully vaccinate 30% of the continent’s population by the end of 2021.

Health Policy Watch recently reported that Africa will pivot sharply away from Covishield, the AstraZeneca vaccine produced by the Serum Institute of India (SII), and towards the Johnson & Johnson one-shot alternative in coming months – with a new deal to procure some 400 million J&J doses produced by the South Africa-based Aspen Pharmacare, which is due to begin deliveries in August. Along with that, US-donated Pfizer vaccines are reportedly set to reach some African countries even this month, the White House has said, although uptake of those vaccines will be limited to cities and hospitals that can manage the vaccine’s ultra-cold storage requirements. 

Image Credits: WHO.

German Health Minister Jens Spahn (centre) at the Global Health Centre, Geneva Graduate Institute.  On left, Ilona Kickbusch, founder, Global Health Centre. Right, Suerie Moon, current co-director,

Germany’s Health Minister Jens Spahn pushed back hard Thursday against voices calling for a waiver on the intellectual property of COVID-19 treatments and vaccines in a high-profile visit to Geneva. His trip coincided with German Chancellor Angela Merkel’s farewell visit to the United States, including a summit with US President Joe Biden, where protestors chanted “free the vaccines” along Merkel’s route.

In Geneva, Spahn’s day of meetings included public appearances at a WHO press briefing, followed by a panel discussion at the Geneva Graduate Institute’s Global Health Centre, Spahn said that the three companies that had developed the first COVID mRNA vaccine technologies “are startups” and should not be compelled to give up their IP.  Encouraging them to voluntarily share their know-how with developing countries would also yield more vaccines, faster, he stressed – with that being the ultimate goal.  

“This is always better to be done on a voluntary basis, as long as the companies are willing to cooperate and we are building up the capacity…” said Spahn, speaking at the Graduate Institute event, co-moderated by GHC founder Ilona Kickbusch and co-director Suerie Moon. 

Two German firms, CureVac and BioNTech, have been the frontrunners, along with Moderna, in the development of COVID mRNA vaccines. But only BioNTech has brought its COVID vaccine to market – in a collaboration with Pfizer. CureVac’s vaccine, meanwhile, showed disappointing results in its latest clinical trial – which yielded only a 47% efficacy.  

COVID mRNA Vaccine Was First Product Marketed by Startups

German Health Minister Jens Spahn at WHO briefing in Geneva

“For Moderna, CureVac and BioNTech it is the first product in their inventory, and the first time that they actually make a profit,” Spahn observed, speaking at the WHO briefing.

He added that removing their IP rights at this stage would not be effective – since the main barrier is to expanding capacity is the know-how required for complex and sensitive vaccine manufacturing – rather than patents per se. 

“I am sure that next year, we will have a surplus of production,” he added. “So if we can reach this goal without interfering with intellectual property rights, let’s do it this way, it’s even quicker.”

He stressed, however, that German government support for BioNTech and CureVac vaccine R&D process came with the understanding that the firms would voluntarily collaborate in rapidy scale up –  “with the expectation that these companies would cooperate with companies in Asia and Africa, and there are talks going on….”

However, he stopped short of saying whether either company might actually join initiatives such as he recently-announced WHO mRNA vaccine technology transfer hub – which WHO said it was creating in partnership with the South African government. 

German Position Challenged By WHO and UNAIDs, Demonstrators in DC  

Over the course of Thursday, however, Germany’s approach was being sharply challenged on various fronts.

In Baltimore protestors chanted “free the vaccine” as Merkel arrived to receive an honorary degree at Johns Hopkins University, which boasts one of the most prestigious schools of public health in the world. Later, in Washington, D.C., demonstrators were set to protest outside of the White House as Merkel and Biden met. They were calling upon the German Chancellor to stop blocking the COVID IP waiver initiative, which is currently deadlocked in talks at the World Trade Organization.  

In Geneva, meanwhile, Spahn was also being challenged for his country’s continued opposition to the IP waiver – first by WHO Director-General Dr Tedros Adhanom Ghebreyesus and later by UNAIDS Director Winnie Byanyima. 

WHO Director General Dr Tedros Adhanom Ghebreyesus contends IP waiver justified due to “market failure.”

Tedros, appearing with Spahn at the WHO briefing where a new German vaccine donation of 30 million doses also was announced, said that donations were no longer enough to stem the pandemic tide in poor countries.  He declared that the continuing unequal distribution of vaccines between rich and poor countries, pointed to a “market failure” which meant that a “limited” waiver on vaccine IP was needed.  

Referring to the talks at Geneva’s WTO, currently deadlocked between countries seeking a blanket patent waiver and high-income countries, including Germany, Japan and the United Kingdom, that are opposed, Tedros said, “When we say waiver, it is not to snatch the property of the private sector….  I think there could be a balance…. if there is an agreement in IP waiver. It could be for a limited period or instance…. It could be for a year or two, and it could be for a specific product like, like the vaccine.”

The Indian and South African sponsors of the waiver initiative had hoped to have final draft proposal ready for review by WTO’s General Council meeting at the end of the month. However, prospects for that appear uncertain. 

UNAIDS’ Byanyima Lays Down Gauntlet

Winnie Byanyima, Executive Director of UNAIDs, challenges Germany’s position on COVID IP waiver at Global Health Centre session.

In the late afternoon session at the Global Health Centre, Byanyima harkened to the history of the AIDS pandemic, when millions of Africans died before life-saving anti-retroviral treatments became accessible. 

She warned that history is now being repeated with COVID – with Africa now seeing it’s biggest COVID wave so far  – accompanied by far higher mortality rates than that seen in developed nations.   

“There was an increase of 15% in the number of new cases in Africa last week, globally it is 3 %,” said Byanyima.  “Deaths have increased by 23% in the African region, while globally it’s coming down by 7%.

“So here is my challenge, my dilemma,” she told Spahn, “People are 40 years struggling with HIV/AIDs. When antiretrovirals were first found in the west, in Europe and America, people in the south continued to die.  It was only when a global movement came to demand, it took six more years before the prices came down.

“Nine million people died, who could be alive today…. Now their survivors are now at risk of severe disease and deaths from COVID. How many years will they have to fight to have a vaccine that would protect them?

“It seems to me that the approach you’re proposing, which is that the companies who own this technology choose when and whom to share with, at the time they want to, could mean that more millions of people could die,” Byanyima continued.

And while donations, such as the one million doses committed recently at a meeting of G7 nations, “are welcome” they are not enough.

“The world needs 13 billion..every corner of the world needs this… and this means  maximizing the supply,” she asserted asking, “how can this happen without sharing the technology, and how can governments wait for profit-seekers?”

Spahn Sticks to Support for Tech Transfer, not IP Waiver

German Health Minister Jens Spahn

Responded Spahn: “I agree, it’s about sharing technology.  But the question here is how it’s shared.  And it always brings me back to this one argument, which still is valid:  just having the patent, does not make you a vaccine producer the next week. It’s far too complex.

“And when we see how long it takes to build up to set up the production side, even for experienced companies, then I would say if you really want to share it needs, cooperation, sharing tech transfer, transferring expertise.

“I do absolutely agree with you, we really need to scale-up, But we are, and they are, on the way to scale-up.  It has taken some time to produce the first 50 million doses, but we will see, I don’t know how many billion doses produced already this year, and especially next year.

“And as I said, I might be wrong, but from today’s point of view, and what I see going on worldwide, I actually see that there is an overcapacity developing for mRNA technology… which as I said is OK.  But it actually shows how different it is this time, to the experience you so rightly described of the HIV experience.”

Image Credits: Health Policy Watch.