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

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

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

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

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

The reality has been somewhat different 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Vaccine hesitancy another barrier 

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

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

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

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

Candidates of the vaccine in clinincal phase.

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

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

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

Agenda for strengthening health systems is too narrowly limited 

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

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

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

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

About the Author:  

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

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

 

Image Credits: WHO.

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

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

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

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

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

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

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

Vaccination coverage does not match vaccination demand in Africa

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

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

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

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

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

High vaccine acceptance contradicts media reports about hesitancy 

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

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

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

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

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

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

Vaccine production fails to reach global targets 

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

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

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

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

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

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

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

Recommendations point towards global support and public health measures 

COVAX
COVAX vaccine deliveries in Africa.

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

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

Specifically, the report recommends: 

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

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

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

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

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

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

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

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

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

Environmental sustainability on WTO agenda

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

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

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

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

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

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

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

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

Statement 1: Fossil Fuel Subsidy Reform 

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

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

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

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

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

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

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

Statement 2: About the Plastics Initiative 

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

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

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

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

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

Statement 3: Environmental sustainability and wrap up 

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

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

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

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

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

 

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

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

African health experts reflect on lessons learnt from the pandemic.

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

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

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

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

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

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

Building the health workforce

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

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

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

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

 Changing the care model

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

Director-General Dr Tedros Adhanom Ghebreyesus

UK lifts travel ban amid community transmission

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

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

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

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

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

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

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

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

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

Real-world evidence of impact on vaccines

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

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

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

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

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

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

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

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

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

 

Image Credits: Govind Krishnan/ Unsplash.

WHO’s Martin Friede

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

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

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

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

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

New hub on viral vectors?

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

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

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

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

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

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

WHO and Medicines Patent Pool provide governance

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

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

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

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

 

childhood
WHO and St Jude Research’s Hospital announce the establishment of a Global Platform for Access to Childhood Cancer Medicines.

A $200 million dollar investment – the largest financial commitment to addressing childhood cancer ever – has been announced by the World Health Organization (WHO) and US-based St Jude Children’s Research Hospital.

The Global Platform for Access to Childhood Cancer Medicines will provide an uninterrupted supply of quality-assured cancer medicines to low- and middle-income countries. 

St Jude will be making a six-year, $200 million investment to launch the platform, which will provide medicines at no cost to countries participating in its pilot phase. 

Nearly nine in ten children with cancer live in low- and middle-income countries (LMIC). In addition, an estimated 400,000 children worldwide develop cancer –  a majority living in LMIC. 

These children are often unable to consistently obtain or afford cancer medicines, leaving nearly 100,000 children to die each year. 

“Survival in these countries is less than 30%, compared with 80% in high-income countries,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.  

“This new platform will help redress this unacceptable imbalance and give hope to many thousands of patients faced with the devastating reality of a child with cancer.” 

Six-year platform to reach 120,000 children 

The new platform aims to provide safe and effective cancer medicines to approximately 120,000 children between 2022 and 2027, with the expectation to scale up in the future.

In addition to providing end-to-end support for these medicines, consolidating the needs of children with cancer globally, the platform will also be: assisting countries with the selection of medicines; developing treatment standards; and building information systems that track and ensure effective care is being provided.  

“With this platform, we are building the infrastructure to ensure that children everywhere have access to safe cancer medicines,” said President and CEO of St Jude James R. Downing. 

WHO and St Jude’s collaborated back in 2018, when St Jude became the first WHO Collaborating Centre for Childhood Cancer. The research hospital committed more than $15 million for the Global Initiative for Childhood Cancer. 

The Initiative supports more than 50 governments to build and sustain local cancer programs – with the goal to increase cancer survival to 60% by 2030. This goal will be further supported by the newly announced platform.

High prices of medicines complicate availability

chilldhood cancer
Nearly 100,000 children die from cancer each year, as they are unable to obtain consistent and affordable medicine.

While addressing how medicine availability in LMICs is complicated by higher prices, the platform will also curtail the purchase of substandard and falsified medicines resulting from unauthorized purchases and the limited control of national regulatory agencies. 

Only 29% of low-income countries report that cancer medicines are readily available to their populations in comparison to 96% of high-income countries, according to a WHO Noncommunicable Disease Country Capacity survey published in 2020. 

“Unless we address the shortage and poor quality of cancer medicines in many parts of the world, there are very few options to cure these children,” said Carolos Rodriguez-Galino, executive vice president and chair of the St. Jude Department of Global Pediatric Medicine. 

“Health-care providers must have access to a reliable source of cancer medicines that constitute the current standard of care,” he added. 

Twelve countries to participate in pilot phase 

Twelve countries will be participating in the initial two-year pilot phase, where medicines will be distributed through a process involving governments, cancer centers, and NGOs that are already active in providing cancer care.

While discussions are currently underway to determine which countries will participate in this phase, it is anticipated that by the end of 2027, 50 countries will receive childhood cancer medicines through this platform. 

“Cancer should not be a death sentence, no matter where a child lives. By developing this platform, St Jude is helping families get access to lifesaving medicines for their children.”

Image Credits: WHO.

 

The numbers are staggering. Yet, amidst a blizzard of advertising and misinformation, most people don’t realize that alcohol is one of the world’s leading killers. Across the globe, approximately 3 million people each year die from alcohol-related causes.

Many people are aware of the toll of alcohol-related car crashes and are familiar with some long-term effects of heavy consumption, like liver disease. However,  alcohol use is also one of the most common risk factors for other preventable non-communicable diseases (NCDs), such as diabetes, heart disease, and stroke. 

There are also significant links between alcohol use and multiple types of cancer, including cancers of the head and neck, mouth, esophagus, liver, breast, and colon.  Globally, an estimated 741, 000 of all new cases of cancer in 2020 were attributable to alcohol consumption.  Alcohol contributes to infectious diseases such as tuberculosis and HIV/AIDS, and plays an insidious part in homicides, suicides, falls, acts of child abuse and violence against women.

Despite its harmful global footprint, alcohol often does not get attention worldwide as a public health issue. It’s time for that to change. 

COVID-19 and alcohol

Now is an especially urgent time – the COVID-19 pandemic appears to have driven increases in alcohol consumption, including the proportion of people drinking excessively to cope with isolation, anxiety, and stress.  

Furthermore, some countries have relaxed regulations on access to alcohol during the pandemic, allowing the alcohol industry to exploit the system and promoting alcohol as an essential item.  Substantial increases in deaths caused by excessive alcohol consumption during the COVID-19 pandemic in Brazil were documented by Vital Strategies in a recent study.

Although the industry markets alcohol consumption as a “lifestyle choice”, alcohol-related harm is an epidemic, driven by the industry that profits from it. A relentless focus on increasing sales includes capturing new customers that are less prone to drinking.

Though half the world’s adults do not use alcohol, the global numbers have been steadily growing due to marketing directed towards youth and women.

To make alcohol more palatable to these new potential customers, the industry markets alcohol brands to women using sweet flavors. Another form of marketing to exploit women by the alcohol industry is known as “pinkwashing,” the use of the color pink on products in an attempt to appeal to women and cynically link to breast cancer prevention programs.

Young and poor people are particularly affected

Evidence indicates that underage alcohol consumption and related harm is also a growing global problem. Youth who start using alcohol before age 15 are six times more likely to develop alcohol dependence than those who begin consuming alcohol at age 21.

The consequences of alcohol use are also magnified in countries with fewer economic resources. The less economically developed a country, the higher the attributable mortality and the burden of disease and injury per liter of alcohol consumed.  Alcohol-related health burdens are often greater in countries lacking effective regulation or with health systems with limited capacity to handle the burden of alcohol-attributable illnesses.

The good news is that there is a clear roadmap to address this issue. The most promising areas of global focus for alcohol policy include The WHO SAFER technical package, which calls on governments to use proven policies to reduce alcohol use including restrictions on where and when alcohol can be sold, restrictions on alcohol advertising, sponsorship, and promotion, and increasing the price of alcohol through taxes and other pricing policies.

WHO is also currently working on a new global alcohol action plan. Vital Strategies recently signed on to a joint statement that calls on WHO to prevent the alcohol industry from advancing its agenda within the action plan and to critically examine the industry’s efforts to tout the health benefits of alcohol consumption.

Government inactivity and industry interference in implementing the SAFER alcohol policies is causing suffering and lives lost to alcohol-related harms. Common sense, science-driven approaches can reduce alcohol-related injuries, illnesses, and deaths on a widespread scale.  The health and well-being of millions depend on governments’ willingness to act urgently.   

Adam Karpati
Princess Dina Mired

Adam Karpati, M.D., is Senior Vice President, Public Health Programs at Vital Strategies 

Her Royal Highness Princess Dina Mired of Jordan serves as Special Envoy for Noncommunicable Diseases at Vital Strategies

 

Image Credits: Drug Helpline .

plastic

Agricultural plastics pose large and growing threat to soils, food safety and human health – and need to be better managed as well as replaced with more sustainable alternatives, as well as more recycling and reuse of plastics consumed. 

These are the findings of a new report by the UN Food and Agriculture Organization, “Assessment of agricultural plastics and their sustainability: A call for action”, released this week.  

The agriculture sector used a massive 12.5 million tonnes of plastic in plant and animal production and 37.3 million tonnes in food packaging in 2019, according to the report.

But only a small fraction of those plastics are collected and recycled – with potentially toxic microplastics absorbed in soils, accumulating in food chains, and eventually consumed by animals and people.

“This report serves as a loud call to coordinated and decisive action to facilitate good management practices, and curb the disastrous use of plastics across agricultural sectors,” writes FAO Deputy Director-General Maria Helena Semedo, in the report, which is perhas the most high-profile call to action on the issue to date.

“Soils are one of the main receptors of agricultural plastics and are known to contain larger quantities of microplastics than oceans,” she also said in a Foreword to the report. “Microplastics can accumulate in food chains, threatening food security, food safety and potentially human health…..As the demand for agricutlturel plastics contiunues to grow, there is an urgent need to better monitor the quantities of plastic producs used and that leak into the enviornment from agriculture.

In terms of human health, plastics are increasingly ingested by fish, livestock and wildlife – and then consumed by people. That is leading to a gradual increase in the concentrations of microplastic particles, as well as associated toxins and pathogens, in human populations in many parts of the world – which may then increase peoples’ risks to cancers, reproductive and endocrine disorders and a wide range of other chronic diseases.

Torn single-use plastics abandoned, and buried into fields worldwide are leading to the accumulation of microplastics in soils

Growing demand

Today, however, demand for single use agro- plastics is soaring – and there is little awareness of risks or monitoring of actual impacts on soils, animals or people.

The agricultural plastics industry forecasts, for instance, that growing global demand will lead to a 50% increase in the use of plastics simply for greenhouses, mulching, and silage films by 2030 – from 6.1 million tonnes in 2018 to 9.5 million tonnes. 

Crop production and livestock sectors are the largest plastics users, accounting for 10 million tonnes per year collectively. This is followed by fisheries and aquaculture with 2.1 million tonnes, and forestry with 0.2 million tonnes. 

Plastics in surface soil reduce crop yields

Ease of manufacture, physical properties and affordability make plastics the material of choice for many agricultural products. 

And yet while their use is largely intended to increase short-term fruit and vegetable yields, e.g. by protecting plants from extreme heat or cold, over time, the opposite has been found to be true.

The accumulation in surface soils of mulching film plastics  – a major category of agricultural plastic by mass – is linked to reduced yield.  

The report proposes a number of alternatives and interventions to reduce plastic use – and prolong the life cycle of plastics that are used, including:

  • eliminating use of the most toxic plastic products altogether
  • substituting plastic products with natural or biodegradable alternatives;
  • promoting reusable plastic productss. 

These recommendations are based on the 6R model – Refuse, Redesign, Reduce, Reuse, Recycle, and Recover.

Absence of international policies on agro-plastics use

Currently, no international policy addresses all aspects of plastic use in agricultural food chains. 

At the international level, the report recommends a two-pronged approach: 

  1. Developing a comprehensive voluntary code of conduct to cover all aspects of plastics throughout agri-food value chains.
  2. Mainstreaming specific aspects of the life cycle of agricultural plastics in existing international conventions, where appropriate. 

Semedo notes that the FAO will continue to play an integral role in the issue of agricultural plastics.

“Tackling agricultural plastic pollution is paramount to achieving more efficient, inclusive, resilient, and sustainable agri-food systems for better production, better nutrition, and a better life, leaving no one behind.” 

See also the 2019 report on Plastics and Health, by the Center for International Environmental Law, in association with a coalition of non-profit groups.

Report Details Health Crisis Hidden In Plastics Lifecycle

 

 

Image Credits: @Antoine Giret/ Unsplash, FAO – Assessment of Agricultural Plastics and their Sustainability – A Call to Action , FAO – Assessment of Agricultural Plastics and their Sustainability – A Call to Action.

South Africa has increased its vaccination drive in the face of Omicron

The virus reproduction number of the Omicron variant in Gauteng province – the epicentre of South Africa’s pandemic – is 3 – meaning that one infected person will infect three others on average.  That is the highest seen so far in the country’s COVID-19 pandemic history – and testimony to the highly infectious nature of the new SARS-CoV2 variant.

South Africa’s health minister, Dr Joe Phaahla, described this reproductive number as “something we have never seen” at a Friday media briefing.

During the country’s Delta-driven third wave, the number remained below 2. However, in some other countries, Delta’s reproduction number breached five, according to a Lancet study.

South Africa Reproductive Number Dec 2021 (National Institute of Communicable Diseases, South Africa)

Less severe so far – but early days

South African health minister, Dr Joe Phaahla

On the more positive side, Phaahla said that early data from the department’s national hospital surveillance showed that hospitalised COVID-19 patients had shorter stays, and fewer had severe disease, as compared to patients admitted in a similar time frame in the second and third waves. 

Moreover, some 70% of those hospitalised for COVID-19 were not vaccinated, he added.

He defined severity as any patient who developed acute respiratory distress syndrome, received oxygen, ventilation, was treated in high care or ICU or died.

However, he cautioned that severity data “has several limitations at the early phase of the wave when numbers are small”.

“Patients with mild symptoms are more likely to be admitted as a precaution, patients are diagnosed with COVID-19 incidentally when admitted for other reasons, and because there has not been sufficient follow-up time for severity and outcomes to have accumulated, which is typically up to 3 weeks after diagnosis,” explained Phaahla. 

While there had been an initial increase in hospital admissions for children under five (21% of all admissions), this had decreased to 8%. 

Many of the children had been admitted for other reasons and tested positive “incidentally”, stayed in hospital for less than five days and did not show features of severe disease, the Minister added.

Hospital at epicentre

Tshwane Omicron cases

Dr Mathabo Mathubela, head of the biggest hospital at the epicentre of South Africa’s Omicron infection, reported that her COVID-19 patients were displaying less severe symptoms than previous waves.

Of the 42 COVID-19 patients in her hospital on 2 December, nine needed oxygen, three were in high care and two in ICU. However, for 33 of the patients, COVID-19 was “coincidental” to their admission, said Mathubela, CEO of Steve Biko Academic Hospital in the Tshwane area of Gauteng.

Only six patients were vaccinated, with 24 unvaccinated and the status of eight unknown, she added.

WHO warns it’s too early to draw conclusions on severity

South African statisticians also are beginning to observe a reduced rate of hospital admissions in comparison to the total number of new Omicron infections, suggesting that vaccines and previous infections are providing some protection.

In a briefing on Thursday, however, the World Health Organization has warned that it is still too early to draw conclusions from the South African data on the severity of the new variant.

WHO Lead on COVID-19, Dr Maria Van Kerkhove, said that the South African population was young and had a high level of exposure to COVID-19 from previous outbreaks, which might lessen Omicron’s impact.

WHO Chief Scientist Dr Soumya Swaninathan also warned that it is too early to come to any conclusions about the efficacy of vaccines against Omicron as the only available studies showed a “wide variation” and samples were small.

In addition, a small South African study released late Tuesday suggested that people double-vaccinated with the Pfizer-BioNTech COVID-19 vaccine had significantly reduced protection against the Omicron variant, now reported in 57 countries.

On Wednesday morning, however, Pfizer reported that a third booster of its vaccine would provide significant protection against Omicron, according to a laboratory study.

Meanwhile, South Africa’s health minister said on Friday that while restrictions had been effective in the past in stemming the rise in COVID cases, these “have had severe economic consequences, thus a careful assessment of risks is needed”. 

The South African government is still considering mandatory vaccination, which has the support of most business associations and large trade unions.

Image Credits: Gauteng Department of Health.