Midwives around the world adapted their practices to help pregnant women affected by COVID-19 restrictions, showing how important flexible, community-based care is in crises.

More than a year after the start of the global coronavirus pandemic, and the release of openDemocracy’s investigation into childbirth during COVID-19, we know that there have been too many violations of women’s pregnancy and childbirth rights during this crisis, including outright suspensions of services. 

Too often, the response of governments and health facilities to the spreading pandemic quickly abandoned evidence-based, respectful care practices, without adequately considering alternatives – including via midwives and community-based care models – that could enhance infection prevention while also protecting such practices. 

But there is also good news. Around the world, women, healthcare providers and (some) decision makers have imagined and implemented solutions in response to these problems. These innovations, crafted in a time of crisis, hold very valuable lessons.

At the level of healthcare providers and facilities, damaging top-down changes that suspended rights and services were mitigated in some contexts by rapid adaptations to uphold respectful care in the face of COVID-19 challenges. 

Ban on birth partners

In Croatia, for example, staff at the small Čakovec General Hospital – which serves a population north of the capital Zagreb with a high proportion of Roma women – resisted banning birth companions at a time when 90% of the country’s hospitals did so. Instead, they decided to procure COVID-19 rapid antigen tests for both the expectant mother and her companion, to ensure that women could have birth companions and remain with their babies at all times – a correct and best practice for optimal health outcomes. 

In the Netherlands and in Mexico, midwives used hotels and newly-established ‘maternity homes’, respectively, for birth and postpartum care for healthy women with low-risk pregnancies. This minimised their exposure to COVID-19 and also ensured their autonomy during birth. 

Digital and telehealth alternatives enabled women to talk to doctors and other healthcare professionals via virtual consultations (UK), and facilitated self-care through YouTube videos (Japan) and online group birth preparation classes (mostly in high-income countries). However, this shift to online methods also exacerbated inequalities. One doctor in India noted that “the use of the phone, SMS and WhatsApp is a success for telemedicine, but only 30% of the people have a smartphone.”

For women facing intersecting barriers to accessing healthcare, it was community-based health workers, especially midwives, who stepped in and stepped up. 

In Mexico, groups of midwives in the states of Chiapas, San Luis Potosí and Oaxaca coordinated ‘care brigades’ to visit women in remote, predominantly Indigenous communities. In Alaska, Indigenous women have approved the return to traditional practices of being supported by a midwife to give birth at home, where they can speak their native language and have family nearby. Before the pandemic,they were often encouraged – or even required – to travel hundreds of miles south to give birth. 

In Croatia, Slavojka Aresnović, a midwife working on the island of Korčula, accompanied pregnant and birthing women on their precarious 100 kilometre ambulance journey over bumpy roads to the hospital in Dubrovnik on the mainland. 

Austerity measures threaten community-based care 

With COVID-19 far from over and growing disparities and inequities in health outcomes around the world, what can we learn from the solutions crafted during the pandemic about restructuring and improving the ways that maternity care is delivered? 

Countries around the world have long abandoned community midwifery services in favour of centralised care, but the pandemic has shown how dangerous it is to rely on a single form of care delivery during emergencies. It is past time to reinstate community-based models of care, including community midwifery services. Flexibility in healthcare delivery allows for adaptation during crises.

Midwives are often part of the community and therefore can be the last health professionals left standing to provide care during crises. Throughout the pandemic, midwives continued to provide culturally sensitive care, while also supporting autonomy and choice for women even as COVID-19 stoked fear and uncertainty. 

But midwives and community health workers need support to provide this critical care. 

As a first step, midwifery must be financed as an integrated part of a country’s health system and pandemic readiness. Ensuring that midwives are involved when essential public health policy and funding decisions are being made is also critical to building – and sustaining – equitable and women-centered models of care.

Right now, forthcoming post-crisis austerity measures threaten further cuts to maternal and reproductive health, and especially to community services, despite evidence that expanding midwifery services is a cost-effective model. In Mexico, pandemic-related austerity measures are already depriving existing traditional midwives and dedicated Indigenous women’s centres of essential federal funding. . 

As we manage the ongoing evolution of the pandemic amid inequitable vaccine rollouts, as well as the inevitable future conflict and climate disasters, we must not be complacent about violations of women’s and newborn rights – but we must also do more than simply fix what has failed over the past year. What women want are birth experiences and sexual and reproductive healthcare services that are centered on respect and dignity, where health professionals are supported to deliver that care. 

In the most precarious situations, it is community-based healthcare models, especially midwifery services, that uphold human rights and respectful, accessible and, ultimately, safe care for women and their families. As countries around the world ebb and flow toward reopening and rebuilding, it is time to reimagine and reinvest in models of care that we know and have seen work during COVID-19 and beyond. 

*The writers are from the White Ribbon Alliance for Safe Motherhood. This article is co-published with openDemocracy.

 

Image Credits: Elizabeth Poll/MMV.

Temperature, extreme heat and frost, and environmental disasters will increase in frequency, duration, and magnitude as the world warms, predicted a major new scientific report.

Climate change is now an existential health problem overshadowing all others, say scientists in a major report by the Intergovernmental Panel on Climate Change (IPCC) – the world’s largest and most comprehensive assessment of the state of the planet. 

Unprecedented changes in the Earth’s climate have been recorded in every region and the world is currently 1.09°C warmer than in the second half of the 19th century. The past five years have been the hottest on record since 1850.

The report links climate change with changing weather patterns, intensifying water cycles, rising sea levels, ocean acidification, thawing of permafrost, and increasing exposure to extreme heat. 

“The alarm bells are deafening, and the evidence is irrefutable: greenhouse gas emissions from fossil fuel burning and deforestation are choking our planet and putting billions of people at immediate risk,” said UN Secretary-General António Guterres in a statement in response to the report. “Global heating is affecting every region on Earth, with many of the changes becoming irreversible.”

The report, ‘Climate Change 2021: The Physical Science Basis’, was written by 234 scientists who are members of the IPCC Working Group I, and it was approved on Friday by 195 member governments of the IPCC. 

The landmark report is the first major review of the science of climate change since 2013, and the first instalment of the IPCC’s sixth assessment report, due to be released in 2022. 

“It has been clear for decades that the Earth’s climate is changing, and the role of human influence on the climate system is undisputed,” said Valérie Masson-Delmotte, IPCC Working Group I co-chairperson, in a press release. 

Temperature change projections from the IPCC report, which was published on Monday.

Extreme heat exposure threatens livelihoods and health 

Since 1970, global surface temperatures have risen faster than in any other 50-year period over the past 2,000 years, said the report. 

Changes in mean temperature and extreme heat and frost have already begun to occur and are expected to increase in frequency, duration, and magnitude as the world warms. 

It is “virtually certain” that hot extremes, including heatwaves, have become more frequent and intense across most regions since the 1950s, while cold extremes have decreased in frequency and severity, according to the authors.

Human-induced climate change is the main driver of these changes. 

“Heatwaves, floods, and droughts are taking thousands of lives, forcing displacement, and exacerbating food insecurity, hunger, and malnutrition,” said WHO on Twitter. “Climate change is the single biggest health threat facing humanity.”

Heatwaves can exacerbate respiratory and cardiovascular diseases, result in excess mortality, and cause power-shortages, leading to loss of health service delivery.

The health impacts from heatwaves can include dehydration, kidney diseases, respiratory disease, and heat stroke. 

Between 1998 and 2017, more than 166,000 people died due to heatwaves. The number of people exposed to extreme heat is rising – increasing by 125 million from 2000 to 2016.

If the world’s temperature warms by 1.5°C by the end of the century, populations will have a 1.6 times higher risk of experiencing extreme heat. This risk rises to 2.3 times higher risk at 2°C warming. If the world warms by over 3°C, the report projects that 80% of the world’s land area will be exposed to dangerous heat. 

Outdoor and manual workers are particularly at risk of the negative health impacts of extreme heat exposure.

“At increasing warming levels, extreme heat will exceed critical thresholds for health, agriculture and other sectors more frequently, and it is likely that cold spells will become less frequent towards the end of the century,” said the report. 

Extreme weather affects infrastructure, displaces people 

Changes in global monsoon precipitation have increasingly been observed since the 1950s, rising in some regions and falling in others as a result of greenhouse gas and aerosol emissions, said the report. 

Tropical cyclones have increased in frequency over the last four decades. The location in the western North Pacific where cyclones previously reached their peak intensity has now shifted northward.

“Human influence has likely increased the chance of compound extreme events since the 1950s,” said the report. “This includes increases in the frequency of concurrent heatwaves and droughts on the global scale; fire weather in some regions of all inhabited continents; and compound flooding in some locations.”

The annual occurrence of disasters has increased three-fold since the 1970s and 1980s, found a report by the Food and Agriculture Organization (FAO). Low- and middle-income countries (LMICs) bear the brunt of the disasters. 

Every year, environmental disasters result in 60,000 deaths, mainly in LMICs. There will likely be an increase in the number of people displaced by and suffering from injuries from extreme weather events.

Weather-related natural disasters destroy homes, infrastructure, medical facilities, and other essential services, disrupting health care delivery. 

Variable rainfall patterns and floods can affect the supply of fresh water, increasing the risk of diarrhoeal disease, respiratory infections, and affecting the transmission of vector-borne diseases. For example, residual water may serve as breeding grounds for disease-carrying mosquitoes. 

Climate change jeopardizes nutrition and food security

Today’s food systems are fragile and unequal, requiring widespread reforms in policies, farming practices, and financing.

Human activities have contributed to changing weather and precipitation patterns, along with agricultural and ecological droughts, impacting crop yields, nutrition, and food security.

“Several regions in Africa, South America and Europe are projected to experience an increase in frequency and/or severity of agricultural and ecological droughts, [while] heavy precipitation and associated flooding events are projected to become more intense and frequent in the Pacific Islands and across many regions of North America and Europe,” said the study. 

Climate change affects food production, availability, access, quality, utilization, and the stability of food systems.

As temperatures rise, crop yields are expected to decline, particularly in tropical and semi-tropical regions. Food security is already being affected in arid areas in Africa and high mountainous regions of Asia and South America. 

Rising temperatures and variable precipitation are likely to decrease the production of staple foods, particularly in LMICs. This will increase the prevalence of malnutrition and undernutrition, which currently cause 3.1 million deaths every year.

The loss of crop and livestock production from natural disasters can result in a total of 6.9 trillion lost kilocalories per year – the equivalent of the annual calorie intake of seven million adults.  

Increased carbon dioxide emissions lower the nutritional value of crops as temperatures rise. Previous studies by IPCC show that wheat grown at 546-586 ppm CO2 has 5.9% to 12.7% less protein, along with less zinc and iron. 

Almost 690 million people went hungry in 2019 and 45% of deaths among children under the age of 5 years are linked to undernutrition. These numbers could increase as climate change worsens food insecurity. 

“In a number of regions (Southern Africa, the Mediterranean, North Central America, Western North America, the Amazon regions, South America, and Australia), increases in one or more of drought, aridity and fire weather will affect a wide range of sectors, including agriculture, forestry, health and ecosystems,” said the report. 

Calls for urgent and large-scale actions to reduce emissions 

The report finds that unless there are immediate, rapid, and large-scale reductions in greenhouse gas emissions, the world will not be able to limit global warming to 1.5°C or 2°C above pre-industrial levels. 

Over the next 20 years, the global temperature is expected to reach or exceed 1.5°C of warming. 

“This report is a reality check,” said Masson-Delmotte. “We now have a much clearer picture of the past, present and future climate, which is essential for understanding where we are headed, what can be done, and how we can prepare.” 

The findings of the report “imply that reaching net zero anthropogenic CO2 emissions is a requirement to stabilize human-induced global temperature increase at any level,” said the authors. 

Emitting an extra 500 billion tonnes of carbon dioxide would leave only a 50-50 chance of staying under 1.5°C. The authors believe that 1.5°C of warming will be reached by 2040, but drastic measures to cut global emissions and reach net zero could slow or even halt the rise in temperatures.

“Stabilizing the climate will require strong, rapid, and sustained reductions in greenhouse gas emissions, and reaching net zero CO2 emissions. Limiting other greenhouse gases and air pollutants, especially methane, could have benefits both for health and the climate,” said IPCC Working Group I Co-Chair Panmao Zhai. 

“The message could not be clearer, as long as we continue to emit CO2 the climate will continue to warm and the weather extremes – which we now see with our own eyes – will continue to intensify,” said Corinne Le Quéré, Professor of Climate Change Science at the University of East Anglia in the UK and contributing author to the report. “Thankfully we know what to do: stop emitting CO2.”

It is too late for some of the effects of climate change, which are already irreversible for hundreds to thousands of years.

“If global net negative CO2 emissions were to be achieved and be sustained, the global CO2-induced surface temperature increase would be gradually reversed but other climate changes would continue in their current direction for decades to millennia,” said the report. 

“For instance, it would take several centuries to millennia for global mean sea level to reverse course, even under large net negative CO2 emissions,” the report said.

Messages to COP26 participants

The release of the report comes three months before a key climate summit, the 26th UN Climate Change Conference of the Parties (COP26), is set to be held in Glasgow. 

“The innovations in this report, and advances in climate science that it reflects, provide an invaluable input into climate negotiations and decision-making,” said Hoesung Lee, Chair of the IPCC.

“In my view, there are two key messages from the report for attendees at COP26. First, the report emphasises to climate negotiators – again – the need to reduce emissions further than currently looks likely in order to hit Paris targets,” said Nigel Arnell, Professor of Climate System Science at the University of Reading in the UK and a contributing author to the report. 

“Second, the report highlights – more urgently than the last report from 2013 – the importance of ramping up our collective efforts to adapt to our changing climate and increase resilience to more frequent and more extreme weather disasters in the future,” he said.

“Recent events have shown we are all exposed to climate risks,” Arnell added.

Extreme events are currently being felt across the globe, with wildfires in North America to floods in China, Europe, India, and parts of Africa, and heatwaves in Siberia.

Image Credits: Issy Bailey/ Unsplash, FAO.

Pakistani soldiers closing markets during the COVID-19 pandemic.

#COVIDReporting: For the past 18 months, Health Policy Watch’s team of global reporters has covered the COVID-19 pandemic. But the virus has also wreaked havoc with their personal lives. Over the next few weeks, we will bring you their stories.

ISLAMABAD – One evening in mid-March, I was at my office filing a report on developments on COVID-19 in Pakistan, when my mother called me.

“Your father is not well and asking you to reach home soon,” she said. Although she sounded calm, I felt uneasy and I dialed my father.

He told me that he was having difficulty breathing: “The situation is not good, come back home,” he said.

 It was an unusual instruction and alarm bells started ringing in my mind as I realised that he had probably contracted COVID-19 although he thought he was simply facing normal flu with fever and body aches.

The second COVID-19 wave had hit the country hard. Over 150 deaths were being reported every day and the health authorities had confirmed the presence of the Alpha variant, which is faster in transmission.

I asked my younger brother, Vyas Ali, to take our father to a clinic and made another call to my sister Nain, who is a doctor. 

Within an hour, all of us were in the clinic for his examination. As my father had a chronic problem of gout, the doctor conducted a detailed examination including a COVID-19 test and a CT scan.

Within 15 minutes, the doctor confirmed that he contracted COVID-19 and his oxygen saturation had fallen to 82% (normal is 90-100%). He recommended moving my father to the hospital if his oxygen dropped by two points.

We were aware that over a dozen family members have been exposed to the virus. We live in a traditional joint family system. Aside from my parents, my four siblings, and one-year-old niece live in our large household. 

It was a nerve-wracking night as we watched my father’s oxygen saturation levels dropping. All the hospitals were full and we were not able to find a single nurse who could install an intravenous drip to start his medication.

The next morning, Vyas and I searched for oxygen and also found a male nurse to assist him in an isolated room.

During the peaks of the first and second COVID-19 waves in Pakistan, the hospitals faced shortages of oxygen. After much searching, my brother and I found a small shop that rented oxygen cylinders and we were able to buy these to meet our needs.

Each oxygen cylinder lasted for eight hours and we managed to keep stocks for the uninterrupted supply. Along with the oxygen and medicines, my father also needed physiotherapy every 15 minutes to raise his oxygen saturation. 

All my siblings and mother tested positive

After the slight stabilisation in my father’s health, all the members of our household took their PCR tests for COVID-19. Shockingly, I, my four siblings, and my mother (a cardiac patient) all tested positive with COVID-19.

One by one, my mother, brothers and sisters started showing symptoms of COVID-19. Despite having close contact with all my COVID-19 positive family members, I did not develop any symptoms.

For 12 days, the entire house became an isolation center where my doctor sister and I nursed the entire family. My father and mother were oxygen-dependent and were also treated with Remdesivir injections. The rest of the family were on other medicine and fighting COVID-19 in different ways.

My siblings experienced COVID differently. One lost sense of taste and smell, while some coughed and had high fever. 

But the post COVID-19 effects on my parents were also tough as they experienced side-effects from the steroids they were taking and both remained bed ridden. and we sought a next phase of treatment after their recovery from COVID-19. To this day, my parents still feel weak and say the virus has made them “hollow from inside”.

The family ordeal did not end here. As our home was recovering from the virus, other family members including my aunt and uncle, other family members and friends all became infected with the virus.

As we had successfully managed to take our large family out from the critical point, they all sought our opinion and help to deal with the COVID-19. 

There was only one talk and topic on my mobile and that was COVID-19. 

However, in these difficult times, my friends and close aides also played a very supportive role from arranging medicines to providing moral support. 

After recovering from the virus, my siblings got vaccinated with the available Chinese vaccines – some with SinoPharm, a few with Sinovac and some with CanSino. My parents received Moderna jabs.

Aside from the health effects of COVID-19, there have been very severe economic effects from the lockdowns in my hometown of Hasanabdal ,which is around 45 km west of the capital, Islamabad.

Many people have lost their jobs. Schoolteachers’ salaries have not been not paid and a number of businesses closed. 

During the lockdowns, my family ran charities to support the people who are struggling for their bread and butter. But the tough time we experienced as a family made us more enlightened in our vision of helping others in difficult times. 

It reaffirmed our commitment to helping people around us by arranging medicines, giving people medical advice and trying to find space for those who needed to be hospitalised. 

For more in our #COVIDReporting series, read:

COVID in NYC: Spending My Twenties in Isolation, Fearing Racial Attack

COVID in Delhi: ‘I was More Afraid of Suffocating Than of Dying’

 

Rahul Basharat is a journalist based in Pakistan, who covers health, climate, human rights and education.

Follow him on Twitter @TheRahulRajput

 

 

 

 

Image Credits: Mohammed Nadeem Chaudhry.

Gulshana Bano and women from her community have no say over child-bearing.

Gulshana Bano does not remember her exact age when she got married – probably aged 16 or 17, she recalls.

Now 27 years old and 10 years into her marriage, a frail and petite Bano has four children aged between the ages of four and nine with gaps of less than two years between each of them.

She is part of a tribal group known as the Gujjar-Bakerwals in the Indian-administered Kashmiri Ganderbal district who migrate by foot to warmer places twice a year.

She is also one of the hundreds of women who have no say over her reproductive rights, including family planning and are made to feel like  “child-making machines”.

Bano’s husband believes contraceptives are taboo as children come from God, while her elders believe that family planning interferes with nature.

For Bano and the women in her village, getting timely family planning is an uphill battle due to the stigma attached to the service. Most of them give birth to four to seven children, sometimes even more.

“In our community, it’s the men who take all the decisions including the right to give birth,” Bano says.

Married to a labourer who is against the use of contraceptives, she is likely to have even more children although the family is already struggling to survive on her husband’s meagre daily wage.

“I had to go to a main tertiary care hospital in Srinagar 60km away for my last delivery. The hospital nearby doesn’t have the necessary facilities and in many cases, they refer us to the city hospital,” says Bano.

“My last delivery was through a caesarean and I know that having more kids will affect my health, but I can’t do anything,” she says, adding that the women in her community do not even think about family planning.

Birth control is taboo and ‘God decides when children are conceived’

Birth control is taboo in Gujjar and Bakerwa communities and men believe God decides when children are conceived.

Talking about birth control is taboo. Women have little knowledge about contraception and no access to reproductive rights. As a result, they are forced to have a series of unplanned pregnancies.

“My husband says that the provider of children is God and we cannot stop it, so I don’t even discuss it further,” she says.

India’s National Health Policy 2017  made it mandatory for states to provide contraceptives at various levels of the health system. But these schemes are hardly accessed by the Gujjar-Bakerwal women, the third-largest ethnic group in the state of Jammu and Kashmir, and constitute more than 20%of the region’s population.

A survey conducted by Tribal Research and Cultural Foundation, a non-governmental organisation that works to promote the rights of tribal communities, revealed that more than 71% of the nomads were unaware of the schemes of the state and central government.

The foundation’s research found that tribal women are not exposed to education, don’t have access to modern facilities, and bear the “burden from unsafe sex which includes both infections and the complications of unwanted pregnancy,” according to the research. 

In Bano’s case, her husband has made it clear that he wants more children “so that they can take care of the cattle”. 

“We are told to have babies as long as we can,” she says.

The family lives in  a small two-roomed house built of stone and mud and it’s often a struggle to feed the six mouths in the household as her husband often struggles to find work.

“My husband earns a meagre amount as he is a day labourer. The lockdown months have been very tough as there were days and weeks where he couldn’t go to work. The amount he earns is not enough to feed the family,’ Bano says.

‘My husband will never agree to family planning’ 

Nagina Begum’s husband will never agree to birth control. She had three daughters in five years.

In the same village, Bano’s neighbour, Nagina Begum, 26, was married at the age of 16. She gave birth to three daughters in five years and says that her husband wants boys as well.

“Here in this village, we have no one to educate us of any methods of birth control. Even if I want it, my husband will never agree. I have three girls and he wants boys as well. We do not have the right to choose to give birth. Even our elders tell us not to come in the way of nature,” Begum says.

Begum and Bano face the same predicament when it comes to discussing contraceptives.

“First, I cannot talk to my husband about family planning or using any methods of birth control. Even if I tell him, he won’t agree. There is an amount of shame associated if we even mention using contraceptives. He wants more children and I cannot oppose him,” Begum says. “In our community, women are hardly educated and we only feel like child-making machines.”

The women do all the household work and even work in the fields.

In 2005,  under the National Rural Health Mission, the Indian government launched the Accredited Social Health Activist (ASHA) mission which empowered women’s health activists from the local communities  to promote awareness on health and its social determinants and to mobilise communities to support local health planning.

ASHA counsels women on “birth preparedness, the importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception and prevention of common infections including reproductive tract infections and sexually transmitted infections and care of the young child.”

Responsibilities include educating couples about safe spacing (waiting for at least two years before planning another child) and family planning. 

“We have an ASHA worker in the village, but we were never counselled about any schemes by the government. The only time she comes is when a woman is pregnant. When I was pregnant and during different pregnancies, there was no one to counsel me about spacing between the children or family planning,” Nagina says. “These schemes don’t reach the poor.”

‘Keeping more children is a way to keep a human resource’

Javaid Rahi, the General Secretary of Tribal Research and Cultural Foundation, says that there are many factors responsible for women’s  lack of access of their reproductive rights.

“In tribal societies, having more children is a way to have human resources because they have animals like cows and buffaloes and they can’t afford a caretaker. So they use the human resource at their home. They want more children as they serve as human resources for them. For them, having more children is not a stigma. It is a strength for them, Rahi says.

The women of the tribal communities rarely have any say in household matters.

“A husband wants more than three or four children and if a woman can give birth to only two children, her husband marries again to produce more kids. They prefer to have more and more children as they also serve later to do different kinds of tasks at home and outside,” Rahi says.

“The marriage ceremony is very simple with little money needed. Even divorce is very easy,” Rahi adds.

The tribal community also marry off their children at a young age. Years back,  marriages used to take place when the girl was eight or nine years old, but now it has gone to 15 or 16, Rahi says.

Family planning among the tribal communities  is out of the question.

“The government brought in some schemes regarding family planning, but it is not looked at in a good way in the tribal people and it is even out of question. They feel it’s anti-faith and against God’s wishes,” says Rahi.

Image Credits: Raihana Maqbool.

Innovation in COVID-19 treatments needs to be shared equitably.

Much more global attention needs to be paid to developing early therapeutics to protect patients with COVID-19 from “hospitalisation, intensive care, or worse”, according to a report from Drugs for Neglected Diseases initiative (DNDi) released on Thursday.

In addition, the few innovative treatments that exist are mostly available in high-income countries, and DNDi warns that the world risks “replicating the vaccine inequality that has become a defining characteristic of this global pandemic” if these are not shared with low and middle-income countries (LMIC).

To arrest the progress of COVID-19, there is a “clear rationale emerging” that strong antivirals combined with host-directed therapies (anti-inflammatories and immunomodulators) need to be given to patients during the first few days of infection, according to the report.

“Efforts are today rightly focused on identifying novel antivirals, additional repurposed therapeutics, and more affordable and adapted new approaches, such as second-generation monoclonal antibodies and other biologics,” it adds. 

But, says Rachel Cohen, DNDi’s North America Executive Director, “with more interest now in second-generation monoclonal antibodies and antivirals, the investment going into these areas needs to be directed to the right area, and it must ensure access.”

Change the governance of ACT-Accelerator

Describing the development vaccines as a success for science, but their rollout as a failure for access, the report proposes three main solutions to ensure that the COVID-19 “vaccine apartheid” is not replicated with therapeutics. 

The first is support for open drug discovery and development of “novel antivirals, host-targeted interventions, and repurposed compounds, as well as for robust testing of these options in comparable adaptive platform trials”.

Second, DNDi recommends that the governance structure of the Access to COVID-19 Tools Accelerator (ACT-A) be changed to provide for equal representation from LMICs. 

ACT-A houses the global vaccine platform, COVAX, which has recently faced criticism from African leaders for having a “charity” mindset rather than seeing LMIC as partners. ACT-A was set up by the World Health Organization (WHO) and others to ensure global access to vaccines, but it has been undermined by pharmaceutical companies selling their vaccines to wealthy countries first.

The report also urges ACT-A to address all intellectual property (IP) barriers and “improve transparency with respect to development, production, and supply of COVID-19 medicines, diagnostics, and vaccines”.

The third solution proposed by the DNDi report rests on securing “specific contractual commitments and enabling policies, such as a temporary waiver on IP”, to ensure equitable access to new and existing COVID-19 therapeutics. 

COVID could become endemic to Africa

“Great strides have been made in the development of new tools for COVID-19, especially vaccines, but the past year has made it painfully clear that access is the unfinished business of global health,” said Dr Bernard Pécoul, Executive Director of DNDi, the International non-profit organisation dedicated to developing safe, effective, and affordable treatments for the most neglected patients.

“We now have the opportunity to course correct with treatments and make the response to COVID-19 a model for equity, collaboration, and knowledge- sharing.”

Dr John Nkengasong, Executive Director of Africa Centre for Disease Control (CDC), recently warned that COVID-19 may become endemic to Africa unless the continent’s lack of vaccines was addressed.

“If we have a predictable supply of vaccines, we can break the backbone of this pandemic by the end of next year,” Nkengasong told a recent media briefing. “But if vaccines are not available to enable us to vaccinate at speed and at scale then, past next year we’ll be moving towards the endemicity of this virus on our continent and the consequences will be catastrophic.

“Our economy will continue to be damaged, the death rate will continue to increase. We will see the fourth, fifth, sixth waves, and it will be extremely difficult for us to survive as a people.”

Image Credits: DNDi.

Eleven African countries will this weekend start receiving their portion of the first batch of 400 million COVID-19 vaccines from Johnson and Johnson (J&J), the Africa CDC announced on Thursday.

Recipients include Togo, Lesotho, Ghana, Tunisia, Angola, Cameroon, Egypt, Botswana, Nigeria, Ethiopia and Mauritius, and they are part of pool purchasing facilitated by the African Union (AU) and African Vaccine Acquisition Trust (AVAT) to AU member states. Six Carribean communities including Jamaica, Barbados, Guyana, St Kitts & Nevis, Trinidad &Tobago and the Bahamas will also have doses delivered next week.

The delivery of the lifesaving drug comes as 32 of the continent’s 55 countries are battling a third wave of COVID-19 infections, 25 of which are experiencing a “severe third wave”.

However, the target of vaccinating 60% of Africa’s population by the end of 2022 might not be enough to protect the continent, Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC), said during the centre’s weekly COVID-19 briefing.

Africa will now need to vaccinate 75% to 80% of people, taking into consideration several factors, including the different virus variants and the continent’s population structure, according to Nkengasong. The initial target of 60% was partly based on the assumption that 40% of the population was 18 and under and that they would not need to be vaccinated as they will “immediately come down with a disease.”

“We now know that anybody is vulnerable now… those young people are falling sick and they are dying and that needs to be factored into a new projection,” said Nkengasong. However, he said that the continent will in the meantime aim for the 60% target after which a possible adjustment will be made based on “the biology and the pathogenesis of the variants”.

Major vaccine announcement expected in the coming days

Strive Masiyiwa, the African Union’s (AU) Special Envoy on COVID-19 and the co-ordinator of the AU Vaccine Acquisition Task Team (AVATT)

Giving a breakdown of the vaccine deliveries, Strive Masiyiwa, the African Union’s (AU) Special Envoy on COVID-19 and the co-ordinator of the AU Vaccine Acquisition Task Team (AVATT), said that the J&J vaccine had been chosen because it is a single-dose vaccine, partly manufactured in South Africa, has a long shelf-life and it was the only vaccine available in large volumes.

This month, more than six million doses will be shipped to countries that have fulfilled all the AVAT requirements, including loan agreements with the World Bank and other global lenders. The deliveries will increase exponentially over the following months, with 10 million doses to be delivered from September until December. From January 2022, J&J has undertaken to deliver 25 million doses per month until the order is completed in September 2022.

A $2 billion loan facility provided by African Export-Import Bank (Afreximbank), which is the guarantor of the deal, has enabled African countries to purchase the J&J vaccines.

Said Nkengasong in a statement released on the rollout of the vaccines: “During the last months, we have seen the vaccination gap between Africa and other parts of the world widen, and a devastating third wave hit our continent. The deliveries starting now will help us get to the vaccination levels necessary to protect African lives and livelihoods.”

Masiyiwa said other vaccines will come from global vaccine facility COVAX, and bilateral donations from countries including the United States. He let slip that other donor governments have stepped up and that a “very good announcement” from a “major government” will be made in the next few days.

COVAX needs to improve its operation and be held accountable for its failures

COVAX
COVAX vaccine deliveries in Africa.

In the past week, Africa has recorded 273,000 new COVID-19 infections – a 14% average increase of new cases. Recorded deaths stood at 6,454, a slight decrease of 4%. As of 2 August, a total of 103 million vaccine doses have been procured in 53 member states of which 70.6 million have already been administered.

However, Nkengasong said only 1.58% of Africa’s population have been fully vaccinated with two doses.
Masiyiwa said that the continent would have had greater vaccination numbers if COVAX had honored its promises. “They (COVAX) told us in December they would have delivered 700 million doses, being 27% of our population [by August],” said Masiyiwa.

According to Masiyiwa, Africa was then going to pick up vaccine deliveries from August 2021 to September 2022.
This did however not happen, and around 79 million doses have been delivered to Africa so far by COVAX.
“And this is where the crisis is for us. This has not happened. We can all debate about how, where, who did what, how many committees, how many task forces, how many accelerators, you can create all those things, but this is where the rubber hits the road,” said Masiyiwa.

Asked whether the AU would call for the disbandment of the COVAX facility, Masiyiwa said they are seeking an improvement of “the way things are done” and for accountability from the facility.

Africa CDC agrees with WHO’s call for a moratorium on booster shots

Africa CDC director Dr John Nkengasong

Nkengasong, who got vaccinated in April and who is currently recovering from a COVID infection, said the organization supported the WHO’s call for a moratorium on a third booster vaccine shot until at least the end of September to ensure that vaccines reach those who need them most.

His stance is “vaccinate as many people as possible with the available vaccines”, before looking into booster shots. “We run the risk of creating more variants, maybe because we continue to accept sub-optimal pressure on the virus and it will mutate and then even continue to infect those who have received their vaccinations,” said Nkengasong.

“I’m a good example. I received a full dose of the vaccine in April, and look, I have a breakthrough infection. So again, the only way to stop this pandemic is to vaccinate many people…,” said Nkengasong.

Image Credits: WHO AFRICA, UNICEF/Khaled Akasha, UNICEF.

Raisa’s mother, Maria Isabelle Santos, (second from the right) at a nurses appreciation week in 2020.

#COVIDReporting: For the past 18 months, Health Policy Watch global reporters have covered the COVID-19 pandemic. But they have not been immune from its impacts on their personal lives – and the virus has wreaked havoc with their lives. Over the next few weeks, we will bring you their stories.

NEW YORK – I turned 24 a few weeks before New York City was shut down. 

I turned 25 a few weeks after the first vaccines were being rolled out. 

They say that your twenties are the most important, the most fun part of your life. When New York was hit by the first wave of the pandemic and was forced to lockdown, a year of my life was put on pause. 

Acceptance dinners for grad school, traveling with my friends, all on hold. 

I cannot say that it’s resumed in the exact way since then. There’s a hyper-awareness in all of us that things cannot be ‘back to normal’, despite what everyone likes to believe.

My parents, both nurses, were directly on the front lines of the pandemic. They were exposed to the constant suffering and death in their respective hospitals and departments, without any reprieve.  

My grandma was the most social person pre-COVID-19, with birthday parties and events numbering almost a hundred per gathering. Now my family and I fret over her constantly, worrying if it’s even okay for her to be in crowded spaces or go back to hosting parties.

And I’ve become hyper-aware that it has become increasingly unsafe to walk through the city that has been my home since I was born. 

I don’t just carry my mask with me when I walk through the boroughs. I have to carry pepper spray, and a perpetual apprehension that sets throughout my body, that I may be attacked because of my race.

Asian American attacks have increased by nearly 150% over the course of the pandemic. It’s disconcerting to cover news globally, and yet be exposed to a flood of articles on attacks and shootings, one right after another, that take place in my own city.

And some articles don’t even match the face to the name, reporting our deaths and our hurt without any empathy. 

How can America go back to normal after all of this, patting itself on the back and assuring the public that it’s safe now for everyone?

It wasn’t that our ‘normal’ was stalled when the pandemic hit. COVID-19 changed our sense of normalcy. We’re not given time to process the past year. We’re just cogs in a machine, working constantly from home or in the hospital, expected to push ourselves right up on our feet the moment the tiniest resemblance of the old life, pre-COVID, slips in. 

I’ve reported a lot on hidden pandemics, because COVID-19 uncovered many. But the hidden pandemic of mental health is a neglected one that shouldn’t be swept under the rug any longer. 

If only America realized that we need our time to grieve, especially when the truth is, the pandemic is far from ending.

It’s worsened by the fact that American exceptionalism knows no bounds. Reporting on COVID-19 from the global perspective for the past year has made me all-too aware that this exceptionalism extends to vaccinations and social distancing and what even is happening in other countries. 

Do anti-vaxxers who refused COVID vaccines know that the rest of the world is suffering? That my relatives in the Philippines have to travel here to get vaccinated, that thousands of people come here to get their shots when their own countries don’t have as many vaccines? Americans believe in their right to refuse something they label a preposterous conspiracy. The rest of the world doesn’t have that luxury. 

Most privileged Americans live in a bubble of selfishness, rushing to get back to their version of normal. But it isn’t that easy. 

Raisa Santos, who reports from New York City.

Raisa is pursuing her Masters in Public Health at the Columbia Mailman School of Public Health. As a daughter of Filipino immigrants, she has a special interest in immigrant health and international policy. In her free time, she reads and blogs about books, and enjoys writing fiction. 

 

This is part of our #COVIDReporting series:

See also: COVID in Delhi: ‘I was More Afraid of Suffocating Than of Dying’

An unprecedented surge in climate-related disasters, including wildfires and flooding, has been recorded since 2019. 

A new study, conducted by an international group of scientists, found that key indicators of the state of the climate crisis were reaching critical tipping points. 

The study, published in the journal BioScience, measured some 31 planetary vital signs, ranging from coal, oil, and gas consumption to carbon dioxide emissions to ocean acidity to fossil fuel subsidies. 

The researchers compiled a set of global time series related to human actions that affect the environment and climatic responses, which include sea level change and surface temperature change. 

Out of the 31 planetary vital signs tracked, 18 were at new all-time record lows or highs. 

“There is growing evidence we are getting close to or have already gone beyond tipping points associated with important parts of the Earth system,” said Dr William Ripple, Professor of Ecology at Oregon State University and co-author of the study, in a statement.

In the past two years, there has been an unprecedented surge in climate-related disasters, with extreme flooding in South America, Southeast Asia, and Europe, record-breaking heatwaves and wildfires in Australia and western US, and devastating cyclones in Africa, South Asia, and the Western Pacific.

According to the study’s authors, governments have consistently failed to address the “overexploitation of the Earth,” which is the root cause of the current crisis.

Trends in potential drivers of climate change

Carbon dioxide, methane, and nitrous oxide all set new year-to-date records for atmospheric concentrations in 2020 and 2021. In April 2021, carbon dioxide concentrations reached 416 parts per million, the highest monthly global average concentration ever recorded. 

In addition, the year 2020 was the second hottest year on record. The top five warmest years have all occurred since 2015. 

The study also found that glacier thickness set a new all-time low in 2020 and minimum Arctic sea ice was at its second smallest extent on record. Glaciers are currently losing 31% more snow and ice per year compared to 15 years ago. 

Time series of climate-related responses, which include sea level change and surface temperature change.

Ocean pH reached its second-lowest yearly average value on record, threatening marine life with increased acidification. The ocean absorbs approximately 30% of the carbon dioxide that is released in the atmosphere, which has far-reaching impacts on aquatic ecosystems, human health, and food systems. Billions of people worldwide rely on food from the ocean as their primary source of protein.

Another concerning pattern noted was that the annual forest loss rate for the Brazilian Amazon reached a 12-year high of 1.11 million hectares destroyed in 2021.

Among the numerous worrying trends, there were a few bright spots in the study’s findings.

Fossil fuel energy consumption has decreased since 2019, along with carbon dioxide emissions, and air transport, likely due to the COVID-19 pandemic. Although projections for 2021 estimate that these measures will rise again.

Solar and wind power consumption increased by 57% between 2018 and 2021.

Fossil fuel divestment increased by US$6.5 trillion between 2018 and 2020, while fossil fuel subsidies dropped to a record low of US$181 billion in 2020.

Time series of climate-related global human activities, which include fertility rate and fossil fuel subsidies.

Calls for ‘transformational system changes’

“The updated planetary vital signs we present largely reflect the consequences of unrelenting business as usual,” said Ripple. “A major lesson from COVID-19 is that even colossally decreased transportation and consumption are not nearly enough and that, instead, transformational system changes are required.”

Priorities at the national and international level must focus on enacting immediate and drastic reductions in greenhouse gas emissions, particularly methane. Methane is emitted during the production and transport of coal, natural gas, and oil and it results from livestock and agricultural practices. 

The authors call for changes in six areas:

  • eliminating fossil fuels and shifting to renewable energy sources;
  • cutting black carbon, methane, and hydrofluorocarbons;
  • restoring and protecting the Earth’s ecosystems to restore biodiversity;
  • switching to mostly plant-based diets, reducing food waste, and improving cropping practices;
  • moving from overconsumption to ecological economics and a circular economy; and
  • stabilising population growth by providing voluntary family planning and supporting education and rights for women and girls

“By halting the unsustainable exploitation of natural habitats, we can simultaneously reduce zoonotic disease transmission risks, conserve biodiversity, and protect carbon stocks,” said the study. “So long as humanity’s pressure on the Earth system continues, attempted remedies can only redistribute this pressure.”

“Given the impacts we are seeing at roughly 1.25°C warming, combined with the many reinforcing feedback loops and potential tipping points, massive-scale climate action is urgently needed,” said the study. 

The world may have already lost the opportunity to limit warming to 1.5°C, a goal set out in the Paris Agreement, said the authors.

In the context of the major upcoming climate conference – the 26th UN Climate Change Conference of the Parties (COP26) – the authors recommend a three-pronged approach at the international level.

First, the world needs the global implementation of a significant carbon price, secondly, there needs to be a global phase-out and eventual permanent ban of fossil fuels, and the third intervention is the development of climate reserves to protect and restore natural carbon sinks and biodiversity, said the authors. 

“Implementing these three policies soon will help ensure the long-term sustainability of human civilization and give future generations the opportunity to thrive,” said the study. The study was a follow-up to one published in 2020, which nearly 14,000 scientists have signed across 153 countries, calling for urgent action to tackle the climate emergency.

Image Credits: UNDP, BioScience.

Director-General Dr Tedros Adhanom Gheybreysus

The World Health Organization (WHO) has called for a moratorium on COVID-19 vaccine boosters until at least the end of September to enable a minimum of 10% of the population of every country to be vaccinated.

Making the appeal at the WHO’s COVID-19 media briefing on Wednesday, Director-General Dr Tedros Adhanom Gheybreysus said support for the moratorium from the G20 countries was vital as they are “the biggest producers, the biggest consumers and the biggest donors of COVID-19 vaccines”.

Israel started to offer third booster shots to people over the age of 60 this week, while Germany and the UK intend to do so soon. Bahrain, the United Arab Emirates and Thailand already offer boosters to fully vaccinated people.

“It’s no understatement to say that the course of the pandemic depends on the leadership of the G20 countries,” said Tedros, as he called on these countries to “make concrete commitments to support WHO’s global vaccination targets”.

Tedros called on “everyone with influence – Olympic athletes, investors, business leaders, faith leaders, and every individual in their own family and community – to support our call for a moratorium on booster shots until at least the end of September”.

https://twitter.com/NCEMAUAE/status/1422588310388723718

Not enough evidence for boosters

WHO special adviser Dr Bruce Aylward described the moratorium as a call for “global solidarity around the goal of catching up with the rest of the world” with immunisation.

“The entire world is in the middle of this pandemic and, as we have seen from the emergence of variant after variant, we cannot get out of it unless the whole world gets out of it together,” added Aylward. “With the huge disparity in vaccination coverage, we’re simply not going to be able to achieve that. By now going into third, fourth doses or whatever in areas that already have high coverage, we just will not be able to catch up.”

However, Aylward said organ transplant recipients were an “exceptional case” and boosters could be considered to be part of their “primary series’ vaccinations as their level of immunity was still low after two doses.

Meanwhile, Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals, said that while a few countries had started to administer boosters, a number of others were contemplating this – despite the lack of evidence to support boosters.

“We don’t have a full set of evidence around whether this is needed or not,” said O’Brien.

“We need instead to focus on those people who are most vulnerable, most at risk of severe disease and death to get their first and second doses, and then we can move on to how to advance programmes as the evidence gets stronger, and as supply is assured and we have much higher coverage for those first doses in much greater percentages of populations in every country around the world.”

A number of trials are underway at present to test boosters, including Pfizer vaccines that have been tweaked to address the Delta variant.

Health Policy Watch has produced a three-part series on vaccine boosters looking at the global country positions on boosters, boosters in immuno-compromised people and the need for field-based evidence to balance laboratory evidence.

Dr Mariangelo Simao, WHO Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals

Pfizer, Moderna price increases are in response to ‘demand not costs’

Commenting on the news that both Pfizer and Moderna had increased their COVID-19 vaccine prices, Dr Mariangelo Simao, WHO’s Assistant Director-General for Access to Medicines and Vaccines, said this appeared to be demand-driven rather than related to production costs.

“Both manufacturers, Pfizer and Moderna have increased their manufacturing capacities. They have diversified manufacturing plants, and we understand that they have also increased efficiency in the production lines,” said Simao.

“This would, in a normal market situation, lead to a decrease in price not an increase in price. So what we have is clearly a market where the demand is very high in comparison with the production,” added Simao.

“The WHO urges companies to keep prices down. There are many countries around the world that cannot afford any higher price. It’s urgent that we think about this in terms of affordable pricing in times where there is increased manufacturing from those two mRNA, producers, and more efficient production lines as well.”

Over the weekend, the Financial Times reported that Pfizer had increased its price per shot from around $18.50 to $23, while Moderna doses had increased from around $22.60 to $25.50.

 

Dr Faisal Shuaib, NPHCDA’s Executive Director, inspects the US donation of four million COVID-19 vaccines.

IBADAN – On Sunday 1 August, two planes carrying four million doses of the Moderna vaccine from the US touched down in Abuja, Nigeria’s capital city. 

With the arrival of the new doses, Nigeria will be able to resume its COVID-19 vaccination programme which was suspended on 22 July when the Nigeria Primary Healthcare Development Agency (NPHCDA) announced it had exhausted the four million doses of Covishield (Oxford/AstraZeneca COVID vaccine) the country got via the COVAX facility. 

Even though Nigeria’s delivery was the largest shipment by COVAX at the time, it was a drop in the ocean that did not do much in closing the vaccination gap in Nigeria, which has a population of over 211 million people.

At present, only 1.4 million people are fully vaccinated, which represents 0.68% of the population. 

“We are excited that this [delivery] presents another opportunity for us to advance the protection of Nigerians against the COVID-19 virus, especially against the Delta variant,” said Dr Faisal Shuaib, NPHCDA’s Executive Director.

The rollout plan is re-started

According to Shuaib, the Moderna vaccines will first be tested by country’s regulatory agency to ascertain they are up to the country’s standard as established by the regulator.

“Random samples of the vaccines have been taken and are being tested. Within 48 hours they will give us feedback on whether we are good to go,” Shuaib told journalists in Abuja.

When the vaccines become certified, NPHCDA said it will then activate its comprehensive logistic deployment plan at sub-national level in partnership with the Coalition Against COVID-19 (CACOVID), a private sector-led organization.

“This is particularly important because we are already experiencing a third wave and there is no need for the vaccine to be at the national level while they are needed by our citizens,” Shuaib said.

Through the CACOVID partnership, vaccines will be distributed and transported to the respective states via the distribution channels that were utilised for the first set of doses received. When these get to their destinations, local health authorities will then redistribute them to centers where the doses will be administered, while still maintaining a cold chain.

Nigerians who want to be vaccinated need to complete an online registration on a dedicated platform operated by the NPHCDA. From the platform, an appointment date for the vaccination exercise is obtained when the individual is expected to visit the health center.

But the reality of the first phase of the vaccination showed appointment dates and locations were not enforced as vaccination officers only required proof of online registration to give vaccine doses to recipients.

After receiving a vaccination, an individual is given a vaccination card that contains the date and details of the administered vaccine. It also contains the expected date for the second dose if the person receives a two-dose vaccine.

Even though there is growing evidence to support mixing vaccine types, the Nigerian government is still reluctant to direct citizens that received Covishield (AstraZeneca) as first dose to get  Moderna as second dose as it argues that additional Covishield vaccine doses will soon be available in the country.

“For those who have taken the first dose of the AstraZeneca vaccine, within the next week or so, an additional consignment of AstraZeneca vaccine will be delivered. We expect that by mid-August, we will get up to 3.9 million doses of AstraZeneca vaccine,” Shuaib said.

In spite of Nigeria’s extensive COVID-19 vaccination rollout plans, there are still concerns about how the country will track the side effects of the vaccines which appear to hinge on patients presenting to government hospitals with symptoms. Experts described this as inadequate but admitted that the unprecedented pressure on the health authorities to quickly roll out vaccines may have limited the available options.

“Don’t forget that nothing as huge as this one has never been done. It’s not too much to ask that when there are scenarios, such are taken to government hospitals where they can be escalated and tracked,” Bimbo Ibukunoluwa, a primary healthcare worker in Ibadan southwest Nigeria, told Health Policy Watch.

A slowly rising third wave?

 

Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control

When Dr Chikwe Ihekweazu, Director-General of the Nigeria Centre for Disease Control (NCDC), spoke to Health Policy Watch in late June 2021, the country’s COVID-19 epicurve suggested the pandemic was under control. 

However, the latest epicurve suggested that a third wave is gradually emerging in the country, although this varies from one state to another.

In Lagos, Nigeria’s commercial epicenter, there are indications that a third wave is already underway with recent cases already reaching reported figures for the peak of the first wave. But in Abuja, the number of daily cases remains very low in comparison with the first and second waves.

But the true case load is hard to ascertain as testing remains inadequate. Over a year after the first case was confirmed, Nigeria has only conducted about 2.5 million tests so far.

“At the moment, about 20% to 30% of all the tests we do a week are rapid diagnostic tests. So we do about 40 000 to 50 000 COVID-19 tests every week,” Ihekweazu told Health Policy Watch.

There is also an unequal distribution of testing among Nigeria’s 36 states. According to NCDC’s COVID-19 situation report, while states like Lagos have tested over 626,000 people since the pandemic began, Kogi state which is inhabited by about five million people has only conducted about 6,000 COVID tests as at 25 July.

 But this is not peculiar to Nigeria. Dr John Nkengasong, Director of the Africa CDC, told Health Policy Watch that Africa is still not conducting enough tests. 

“The continent is not testing enough. We would like to see a steady increase over time because the foundation for fighting any infectious disease is good testing. And we have to test at scale all the time and maintain that level of testing,” he said. 

Furthermore, only eight African countries have a system to measure excess mortality and Nigeria is not one of them – so it is hard to see whether the pandemic causing abnormally high deaths.

https://www.worldometers.info/coronavirus/country/nigeria/

Unready for vaccination exercise?

Ihekweazu and Shuaib expressed confidence in Nigeria’s response to COVID and preparedness for the massive rollout of millions of doses of different vaccines requiring different conditions, respectively.

But the country’s health minister Dr Osagie Ehanire said Nigeria’s relatively weak health system is also threatening the country’s COVID response – in addition to vaccine inequity.

“I do not believe that all African countries are prepared, there are countries that require some support,” the minister said.

“We are very worried because of our population, and the similarity with India – with high population density and the fervor for politics and religion, which lead people very often to ignore the public health advisories that we have put in place.” 

He added that Nigeria’s COVID response, including vaccine rollout, will benefit from risk communication and community engagement.

“I don’t think that this can be done in a very short time but there’s absolutely a lot of emphasis and pressure put on governments across Africa, to wake up to the risks,” he said.

Compounding difficulties with the rollout, doctors in Nigerian state hospitals have begun a strike over pay, benefits and poor working conditions. The strike is organised by the National Association of Resident Doctors, which represents about 40% of doctors in the country.

A health worker gets vaccinated with the first donation via COVAX.

Nigeria’s vaccine pipeline 

Nigeria is expecting doses of vaccines from COVAX, the African Union’s COVID-19 Vaccine Acquisition Task Team (AVATT), and donations from various sources including this week’s US donation.

From August, Enahire said Nigeria is expecting over 29 million doses of J&J vaccine through AVATT.

In addition, the country is also expecting over three million doses of Oxford/AstraZeneca vaccine and 3.5 million doses of Pfizer COVID vaccine.

“From the end of July through August, and beyond, we are going to have more doses, and more varieties,” the minister said.

Furthermore, Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC) has also issued authorisation for the AstraZeneca, Johnson & Johnson, Pfizer and Moderna vaccines while Enahire expressed confidence in the country’s ability to meet the storage requirements of the various vaccines, including those that require ultracold chain, and those that require direct refrigeration.

Even though he said there are ongoing collaborations to ensure the doses are quickly distributed and administered, he noted that emphases are being placed on states that are considered as the hotspots of the pandemic in the country.

“We are looking to scale up the vaccination capacity right across the whole country, with a little bit of emphasis on those areas that are already the hotspots,” Enahire said. 

With expanded vaccine access the main goal of Nigeria’s endgame for COVID, Ihekweazu said attention should be on sustaining the gains and securing more doses.

“So the key thing now is to hold on to the fragile successes that we’ve had, [and] continue pushing for more vaccines so that we can get more shots into the arms of our people as quickly as possible,” Ihekweazu told Health Policy Watch.

The Delta variant conundrum

Nigeria is one of the 21 African countries where the Delta variant of the SARS-CoV-2 virus has been reported. Ihekweazu told Health Policy Watch that the variant is becoming worrisome for the country’s public health officials. 

He described quick access to vaccines as a major way through which Nigeria can limit the impact of the pandemic on its people. 

“The good thing is that the variant is still very susceptible to the vaccines. So as we increase our vaccine coverage rates, we will continue to protect ourselves even against the Delta variant,” Ihekweazu said.

With reports of health systems in several African countries becoming overwhelmed and overrun by the Delta variant, Nigerians who were initially reluctant to get vaccinated are now more interested, including a nurse on a psychiatry ward at Nigeria’s first teaching hospital, the University College Hospital in Ibadan.

Initially, Nurse Shade (name changed to protect her identity) refused to be vaccinated because her church pastor, inspired by US-based right wing anti-vaccine messages, preached against the vaccine to his Nigerian congregation.

But with daily reports of deaths due to the Delta variant among the unvaccinated, Shade became afraid and was anxious to quickly receive the jab. However, registration had closed and she would now wait until vaccination resumes.

“Since I heard that one is more likely to die of COVID if one is not vaccinated, I’ve felt very stupid for failing to receive the vaccine when I could easily get it. Now I daily listen to news for updates on when the next round will begin,” she told Health Policy Watch.

Nkengasong also revealed the success of vaccine rollout in many African countries has also shore up confidence for the exercise among the people considering healthcare workers were the first to receive the doses.

“People are seeing that nothing happened to those who received the vaccines against what the misinformation made them to believe. It has been shown that if the vaccines are available, Africans will receive the vaccine,” Nkengasong said.

Image Credits: USAID.