americas
COVID vaccination in Brazil

Though more than 114 million people have been vaccinated against COVID-19 in the Americas, the WHO Pan American Health Organization (PAHO) has warned that the pandemic is far from over. 

Last week, the region reported more than 1.2 million new COVID-19 cases and nearly 34,000 COVID related deaths – nearly 40% of all global deaths reported.

“This is a clear sign that transmission is far from being controlled here in the Americas,” said PAHO Regional Director Carissa Etienne at a briefing on Wednesday. 

She noted that while countries such as the United States and Brazil were reporting a reduction in cases, other countries such as Canada, Cuba, and Trinidad and Tobago, are seeing higher rates of infections.  

The WHO’s approval of Chinese Sinopharm vaccine offers ‘fresh confidence’ to countries in the Americas who currently use the vaccine, and ‘brings hope for expanding access to vaccines’ in the region. But Etienne stressed the dire toll the pandemic has taken on health systems – rising hospitalization rates have impacted both oxygen supplies and the health workforce. 

“Until we have enough vaccines to protect everyone, our health systems and the patients that rely on them remain in danger.” 

Countries that have begun their vaccination programmes may also have a ‘false sense of security and safety that things are improving, when in reality this is not the case at all right now’, added PAHO Director of Health Emergencies Ciro Ugarte, citing the lack of oxygen supply and increased transmission of the virus in the region. 

Vaccine Donations Urgently Needed to Supplement COVAX 

Assistant Director of PAHO Jarbas Barbosa

In light of the growing spread of COVID in the region, prompting Latin America and the  Caribbean to be labeled an epicenter of the current pandemic wave, PAHO continues seek out donations from countries that ‘already have vaccines for their own needs’, said Assistant Director of PAHO Jarbas Barbosa.

Such donations, he added, will be used to supplement vaccines offered through COVAX, in addition to the Sinopharm vaccines, which will take time to arrive in the region.  

Barbosa emphasized that in the meantime, vulnerable groups must continue to be prioritized. 

“We need to continue using vaccines in a rational fashion for the most vulnerable groups.” 

Spain has already announced that they will make donations to Latin America and the Caribbean through the WHO co-sponsored global COVAX facility, and negotiations are ongoing with the United States. 

Healthcare Capacity Needs to Expand 

PAHO Regional Director Carissa Etienne

The pandemic also has underlined the need to expand healthcare capacity, scale up oxygen production, and make needed investments in equipment, maintenance, and human resources. 

“Countries are being forced to act quickly to make up for years of underinvestment,” said Etienne. 

Across the Americas, nearly 80% of intensive care units (ICU) are filled with COVID-19 patients, with the numbers ‘even more dire’ in countries such as Chile – with 95% of ICU beds occupied by COVID patients – and Brazil, which has waiting lists for ICU beds. 

Etienne estimates that based on the increasing spread of COVID-19, 20,000 doctors and more than 30,000 nurses will be needed to manage the ICU needs of ‘just half’ of the countries in Latin America and the Caribbean. 

In response, PAHO has deployed 26 emergency medical teams across 23 countries in the Americas to provide specialized care. More than 400 emergency medical teams and alternative medical care sites have been set up to expand hospital capacity.  

Oxygen Supply Challenge in the Americas

Rising hospitalizations rates leads to lack of oxygen for COVID patients

The rise in hospitalizations has triggered an ‘unprecedented oxygen supply challenge throughout the Americas, forcing countries and governments to find urgent solutions to the supply problem. 

While hospitalized COVID patients typically require up to 300,000 liters of oxygen during a 20-day hospital stay, patients in critical care often require double that.

In response, PAHO has donated more than several thousand pulse oximeters and nearly 2000 oxygen concentrators to aid health workers in identifying when a patient needs oxygen, and to ensure that workers are equipped with the supplies to help recovery. PAHO is also working alongside Ministries of Health to ensure the availability of oxygen now and for future emergencies. 

Protecting Health Workers Through Vaccinations 

Healthcare worker in Peru preparing COVID-19 vaccines. Healthcare workers in the Americas have been hard hit by COVID.

Since the start of the pandemic, at the least 1.8 million health workers have become infected with COVID in the Americas – 12% of the estimated regional health workforce – and over 9000 have died, the majority of them women and nurses.  

Etienne urged countries to protect the 8.4 million nurses in the Americas, honoring their work, sacrifice, and contribution in commemoration of International Nurses Day, celebrated 12 May.

“Let’s invest in the nurses and ensure that they have the tools and resources that they need to do their job.” 

Quarterly reports from 18 countries in Latin America and the Caribbean show that 1.5 million health workers are vaccinated, but countries are urged to make the most of limited doses and prioritize health workers first.

Image Credits: Flickr: IMF/ Raphael Alves, PAHO, Flickr: UNICEF Ethiopia/2015/Mersha, Andres Montesinos Malpartida/Flickr.

St Peter’s Basilica in Vatican City, Italy.

Italy is pushing for the Vatican – a steadfast opponent of sexual and reproductive health rights – to have an enhanced role and greater privileges at the WHO member state meetings of the World Health Assembly and its governing Executive Board, according to a copy of a draft resolution, seen by openDemocracy.

A handful of other European countries, including conservative Hungary and Poland, are understood to be co-sponsors of Italy’s draft decision that would go before the 74th session of the World Health Assembly (WHA), the governing body of the World Health Organization (WHO), meeting from 24 May-1 June. 

The measure would give the Vatican added rights to participate directly in WHA and Executive Board debates with member states, as well as the right to “co-sponsor draft WHA resolutions and decisions that make reference to the Holy See”.

The Vatican’s right to intervention would be immediately “after the last Member State inscribed on the list”, according to the draft, and “seating for the Holy See shall be arranged immediately after Member States.”

Effectively, the proposal also formalises a decades-long ad hoc arrangement in which it has been invited to the WHA every year at the discretion of WHO’s Director-General, under the rules governing “observers of non-Member states and territories” giving the Holy See a permanent seat at the table.

The Vatican also would have speaking priority over the other entities that currently attend the WHA as observers, upon DG invitation, including:  Palestine (Palestinian Authority, the Sovereign Military Order of Malta, the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies, the South Centre, and the Inter-Parliamentary Union.  In the past, Taiwan has also been an observer; its exculsion from an invite over the past several years has prompted heated debates and sharp criticism from the United States and other allies.

Worries About Hidden Agendas On Sexual and Reproductive Health Rights

Since February, Italy has been led by a coalition that includes both the right-wing Lega party and the centre-left Democratic Party. The government’s key, stated goal is to tackle health, economic and social crises related to the COVID-19 pandemic.

But Italy’s move to advance a decision formalizing the status of the Holy See at the WHA to participate shoulder to shoulder with member states in debates and meetings, including those of policy and budget committees, has alarmed advocates of reproductive and sexual health rights. 

Jessica Stern, executive director of the LGBTIQ rights group OutRight Action International, contrasted the WHO’s mission to support the health of all people with the Vatican’s “exclusionary” position towards sexual minorities. 

“The WHO is no place for religiously-based exclusion, especially in the midst of a pandemic which has disproportionately harmed those who are most vulnerable, including LGBTIQ people and women,” she said. 

Jamie Manson, president of Catholics for Choice, said the Vatican has tried to thwart progress on women’s and LGBT rights at the UN for decades. Church doctrine on sexual and reproductive health issues, Manson added, “has life or death consequences, particularly in the poorest parts of the global south. It’s very serious.”

When Italy’s initial draft of the proposal was first shared with government delegations earlier this month, it proposed giving the Holy See the right to co-sponsor decisions on any topic whatsoever – potentially including measures referring to the right to abortion, contraception and LGBT rights.

Holy See to ‘Co-Sponsor’ Resolutions?

Italy later backtracked on that initial draft – with the current, more limited text, referring only to the Vatican’s right to co-sponsor those “[WHA] resolutions and decisions that make reference to the Holy See”. 

Effectively, the proposal also formalises a decades-long ad hoc arrangement in which it has been invited to the WHA each year at the discretion of its director-general, under the rules governing “observers of non-Member states and territories” giving the Holy See a permanent seat at the table.

The Vatican already holds a similar role at the UN General Assembly. However, rights advocates are still concerned – because of how the Vatican has used other UN bodies to “obstruct” resolutions and decisions on sexual and reproductive rights. 

Neil Datta, secretary of the European Parliamentary Forum on Sexual and Reproductive Rights (EPF), argued: “Pope Francis gives the Vatican a softer image, but its international diplomacy and the content behind it hasn’t changed.”

“With such an institutionalised status at the WHA, as opposed to courtesy invitations, the Holy See could start acting here as it does elsewhere in the UN and that could cause trouble for sexual and reproductive rights,” Datta warned. 

Italian journalist and activist Nicoletta Dentico, who heads the Global Health Programme at Society for International Development, said that while “faith-based entities should be allowed to express their points of view at UN agencies, they should “in no way play an enhanced role” as it remains unclear to whom they are accountable. 

“The Holy See should not have the same status as member states on health issues,” she added, both because of its “viewpoint on sexual and reproductive health and women’s health rights,” as well as the fact that the Vatican also serves as a private healthcare provider, with a vast network of hospitals and clinics around the world. 

Anti-rights Track Record

The Vatican has long opposed access to abortion, contraception, surrogacy and in-vitro fertilisation (IVF) – as well as marriage and adoption for same-sex couples. 

Stern at OutRight Action International cited as examples previous Vatican guidance “denying the existence and rights of transgender and intersex people”, and advocacy at the UN “against numerous gender and LGBTIQ equality initiatives”.

Gualberto Garcia Jones, the Holy See’s legal officer at the Organization of American States (OAS), is also on the board of CitizenGO – which launched a 2020 petition to defund the WHO over “promoting Communist China’s false COVID-19 information”.

Several Vatican officials were also listed as speakers in the programme of the 2019 summit of the World Congress of Families. This is a network of anti-abortion and anti-LGBT rights movements, founded by US and Russian ultra-conservatives. 

Negotiations over Italy’s resolution are ongoing behind closed doors and positions appear to be changing rapidly – both within the European Union and internationally. An informal meeting over the text was held on Thursday morning. 

None of the states believed to be co-sponsors of the resolution, including Italy, responded to requests for comment. The Holy See also did not reply. 

Additional reporting by Nandini Archer, Lou Ferreira and Elaine Ruth Fletcher

 

Image Credits: DAVID ILIFF. License: CC BY-SA 3.0, Pixabay.

The sixth meeting of the ACT-Accelerator Facilitation Council on Wesnesday.

In a rush to jumpstart more global vaccine manufacturing capacity, the global COVAX vaccine facility is now stepping into the fray. 

A new COVAX Supply Chain and Manufacturing Task Force has laid out a three-stage plan to enhance existing vaccine production capacity, as well setting up a new “vaccine manufacturing group” – to further expand production long-term.   

The plan aims to address immediate manufacturing bottlenecks, expanding existing capacity and workforce capacity limitations as fast as possible, through: 

  • Identifying and matching “fill and finish” manufacturers with  producers of active ingredient; 
  • Accelerating approvals of export permits/customs clearances;
  • Facilitating partnerships for the supply of vital vaccine inputs. 

“From the COVAX facility, the critical issue that we’re focused on as of today, is how do we get doses today to try to make a difference, and that means stopping these export bans, it means making sure that if there are surplus doses that those get shared, it means trying to accelerate the production of vaccines that are being made and to make sure that every facility that has capability can be used,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance, speaking at the session. 

According to Berkley’s vision, over the next few months, COVAX will be focused on ensuring there aren’t shortages in products or delays at existing manufacturing facilities. Over the medium-term, through end- 2022, a manufacturing workforce will be developed to maximize even more production using existing systems. 

The long-term goals of COVAX, meanwhile, include expanding production capacity in low- and middle-income countries, and particularly in Africa, through efforts such as a new mRNA vaccine technology hub, led by WHO.

The Task Force’s three-part preliminary plan to enhance and expand vaccine production capacity.

As an opening shot, a US-based foundation said it would donate some US$213 million to catalyze the expansion of manufacturing capacity in South Africa, announced Dr Patrick Soon Shiong, CEO of ImmunityBio and NantHealth, and chairman of the US-based Chan Soon-Shiong Family Foundation. 

The Foundation will provide seed funding to South African biotech partners “so that the capacity, and most importantly second generation vaccinology, second generation cell therapy, and signature delivery systems could be enabled,” said Shiong, a South African native, now living in the United States. 

“I’ve been interacting directly with my fellow South Africans for the last year and I am more and more convinced that not only do we have the science, we have the human capital, and the capacity and the desire. So South Africa could catalyze capacity building, and self-sufficiency, and most importantly the innovation for Africa and for vaccines,” said Shiong, of the partnership. 

Dr Patrick Soon Shiong, CEO of ImmunityBio and NantHealth, and chairman of the US-based Chan Soon-Shiong Family Foundation.

He was speaking at a meeting of the ACT-Accelerator’s Facilitation Council, which provides WHO member state oversight to the global COVAX vaccine facility, and its umbrella  ACT-A  initiative, dedicated to expanding equitable access to tests and medicines, as well as vaccines. 

Addressing ‘Shocking Global Disparity’

While the COVAX facility has delivered 60 million doses to 122 countries, “the shocking global disparity in access to vaccines and other COVID-19 tools remains one of the biggest risks to ending the pandemic,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the beginning of the meeting.  

Cumulative cases and deaths are double what that at the beginning of 2021, he stressed – and part of that is due to uneven rollout of vaccines. 

High- and upper-middle-income countries represent 53% of the world’s population, but have received 83% of the world’s vaccines. In contrast, over the first five months of 2021, the African continent has vaccinated under 1% of its population, Dr Tedros said. 

The same inequalities extend to diagnostics, therapeutics, personal protective equipment (PPE), and oxygen – with one million people in low- and middle-income countries (LMICs) needing over four million cylinders of oxygen per day.  The ACT- Accelerator, led by Gavi, the Vaccine Alliance, WHO and CEPI (the Coalition for Epidemics Preparedness) – are struggling to address all of these needs simultaneously.

Long-term: mRNA Vaccine Technology Transfer – Training Hub 

As a longer-term thrust, a new WHO vaccine mRNA manufacturing training facility aims to train and develop more vaccine manufacturing professionals – who could help kickstart new vaccine facilities in LMICs. 

WHO has already received some 42 expressions of interest from countries, institutions and biotech partners to create the hub – which would train professionals in vaccine manufacturing- who would then help to jump start manufacturing facilities in partner LMICs.  

The 42 expressions of interest from countries, institutions and biotech partners to create the mRNA vaccine technology transfer hub.

The approach has been used successfully in the past to stimulate the creation of capacity in LMICs to manufacture flu vaccines – beginning with the H5N1 pandemic (so-called bird flu)  scare of 2005.  While some vaccine facilities folded after a few years, once  pandemic fears declined, others manufacturers have become sustainable producers of vaccines for seasonal flu and childhood diseases – both for domestic and export consumption, WHO insiders say. 

“Manufacturing of vaccine needs capacity building, not just in the manufacturing, but also in the regulatory environment, in the clinical research environment, in ethics, in quality assurance, and a number of areas, so that will have to happen side by side,” said Soumya Swaminathan, WHO Chief Scientist.  

The hub and training center are expected to launch by 2022,  according to WHO, Gavi and CEPI officials – urging realism against the calls from LMICs to expand manufacturing capacity even more rapidly.

Timeline and vision for the WHO COVID-19 mRNA vaccine technology transfer hub.

COVAX Sets Up Manufacturing Task Force Coordination Office  

In yet another thrust, a COVAX Task Force Coordination Office will also be created to map the vaccine manufacturing ecosystem, including shortages in key vaccine raw ingredients, identifying supply gaps for the Task Force address.  

For instance, nearly 300 vaccine components and inputs, coming from different parts of the world, are required to manufacture one vaccine dose of a Pfizer mRNA vaccine – and so shortages in just one input can create a bottleneck that halts production. 

“There is this concept of having a Coordination Office where the data is collected, where the supply baseline is being done, and that really is to make sure that we’re all operating from the same point, and share that information as we work with all of those groups including new groups that will come in that have a role to play here,” said Berkley.

“The multiple work streams create a very complex set of interactions and tasks and as we have within COVAX where we coordinate across the work stream, we are also going to create a coordinating office that we’re in the process of setting up,” said Dr Richard Hatchett, CEO of CEPI.

Gavi and CEPI officials announced that they expect to have the coordination office “fully up and running very shortly,” said Hatchett.

WTO Set To Join Manufacturing Task Force 

Dr Ngozi Okonjo-Iweala, Director General of the World Trade Organization (WTO), announced that WTO would join the COVAX Supply Chain and Manufacturing Task Force at the Facilitation Council meeting on Wednesday.

“I’ve decided that WTO should join the effort that is being made on vaccine manufacturing,” said Okonjo-Iweala. “Through the pandemic, trade and supply chains have helped countries meet skyrocketing demand for medical products, like personal protective equipment.”

Dr Ngozi Okonjo-Iweala, Director General of the World Trade Organization.

“We must continue this by facilitating the cross border flow of vaccines and vaccine components,” Okonjo-Iweala added.

Expanding manufacturing capacity and addressing vaccine inequity is related to the TRIPS waiver proposed to the WTO by South Africa and India. The acceptance of this waiver would “allow for increased and diversified access to technology know-how [for the] manufacturing of vaccines, diagnostics and therapeutics,” said Okonjo-Iweala. 

“An agreement that allows access to vaccines and to manufacturing capability with some automaticity married with trying to still incentivize research and development is very important,” said Okonjo-Iweala.

“I’m convinced that if we work hard…we will be able to come to a conclusion that will be practical and beneficial for low income countries,” she added.

COVID-19 Vaccine Manufacturing Working Group – Long Term Horizon

Meanwhile, as part of a longer-term initiative – a “COVID-19 Vaccine Manufacturing Working Group”, was announced Wednesday by the ACT Accelerator Initiative. 

That high-level effort, co-chaired by Germany and South Africa, aims to address more fundamental shortages in raw materials, and opportunities for technology transfer by vaccine manufacturers – to increase the long-term stability of doses to the global vaccine facility, COVAX, and ensure the equitable distribution of vaccines by 

“It has become clear that worldwide demand exceeds existing vaccine supply by far. We therefore very much welcome the establishment of the new COVAX manufacturing and supply chain task force and the respective high level working group,” said Germany’s delegate. 

“Germany stands ready to take on responsibility and is glad to announce strong commitment to this new working group by taking on the role as co-chair alongside South Africa,” she added.

Increased Funding Required for ACT-Accelerator

In order to deliver on the promises of the ACT-Accelerator, US$18.5 billion is needed to fill the financing gap. Some US$6 billion was mobilized in 2020 and an additional US$8.5 billion was mobilized so far in 2021, however, more is needed urgently. 

“More financing is needed. That’s the only way to really deliver on what we have been talking about today, both [to address] the needs, the hardship and the difficult situations in many countries, and to deliver on full implementation in equitable manners of the technologies,” said John-Arne Røttingen, Chair of the ACT-Accelerator Resource Mobilization Working Group.

Numerous member states and WHO officials called for increased financial commitments to the ACT-Accelerator at the meeting on Wednesday. 

“We have to fully finance the ACT accelerator, as [it is] the only global solution to bring about the fastest possible end to the pandemic,” said Okonjo-Iweala. 

 

Image Credits: WHO.

Dr Ellen Johnson Sirleaf speaking at the launch of the report on Wednesday

A sweeping report on the global pandemic response has found that the World Health Organization should have taken a more “precautionary’ approach to the emerging SARS-COV2 virus in the early days of the pandemic, advising countries earlier on that it could be transmitted person-to-person — rather than only warning of such a “possibility”.

The report also says that the WHO Emergencies Committee dallied in declaring a global public health emergency – delaying a decision from its meeting on 22 January until 30 January 2020 – and losing another critical week in the first month of the pandemic battle. 

”The Panel’s view is that the outbreak in Wuhan is likely to have met the criteria to be declared a PHEIC by the time of the first meeting of the Emergency Committee on 22 January 2020,” said the final report of the Independent Panel, published Wednesday. 

“While WHO advised of the possibility of human-to-human transmission in the period until it was confirmed, and recommended measures that health workers should take to prevent infection, the Panel’s view is that it could also have told countries that they should take the precaution of assuming that human-to-human transmission was occurring. 

Air travel has exploded in past decades, increasing risks of rapid international pathogen transmission, the report notes.

“Given what is known about respiratory infections, there is a case for applying the precautionary principle and assuming that in any outbreak caused by a new pathogen of this type, sustained human-to-human transmission will occur unless the evidence specifically indicates otherwise,” states the panel report. 

The Independent Panel report, co-chaired by the former President of Liberia, Ellen Johnson Sirleaf, and Helen Clark, the former Prime Minister of New Zealand, sets out a wide-ranging set of recommendations for ending the current pandemic and preparing for the next one.  

“This must be the last pandemic to cause destruction on the scale we are seeing today,” said Sirleaf at the report’s launch. “A new deadly virus could arise tomorrow. The world was not prepared for this one. We must prepare for the next one.”

Said Clark, “almost 100,000 people died from COVID-19 last week around our world. It is a disaster which our panel believes coudl have been averted.”

In terms of ending the current pandemic, the Panel calls for a shake up in the vaccine manufacturing landscape; a World Trade Organization patent waiver; global support for establishment of new vaccine manufacturing hubs; over US$ 10 billion in new G-20 finance for medicines, tests and vaccines, and a commitment by high-income countries to provide the world’s 92 lowest-income countries with more than two billion doses by mid-2022.  

Helen Clark, former Prime Minister of New Zealand at the report launch.

Added Clark. “COVID-19 must not evolve into a neglected pandemic” where it is over in wealthy countries while poorer nations face border closures and years of wait to access vaccines,” adding that. “Covid-19 must not evolve into a neglected pandemic” where it is over in wealthy countries while poorer nations face border closures and years of wait to access vaccines.

But the long-awaited report is likely to be more scrutinized for it’s treatment of the pandemic narrative and its recommendations on preparedness for the next pandemic, when it is reviewed by the World Health Assembly, meeting 24 May- 2 June. 

Stronger & More Independent WHO

In that narrative, The Independent Panel in fact places most of the blame for a faulty, delayed, and ineffective pandemic response on WHO member states – rather than the organization or its current senior management.  

The report lays out a set of recommendations for a “stronger” and “more independent”  WHO – including extension of the Director General’s term from five to seven years  – ostensibly to protect the position from undue political influences. 

“The Independent Panel has found weak links at every point in the chain of preparedness and response. Preparation was inconsistent and underfunded. The alert system was too slow—and too meek. The World Health Organization was under-powered. The response has exacerbated inequalities. Global political leadership was absent,” the report concludes. 

COVID-19 cases as of 30 January 2020 – WHO’s global health emergency declaration came too late. .

 

COVID-19 cases as of 11 March 2020 – the date WHO declared a global pandemic.

Emergency Alert System ‘Two Worlds at Different Speeds’ 

The Independent Panel Team

Chief among the structural weaknesses exposed is infrastructure of the present emergency alert system. 

WHO responses were guided largely by the legally-binding international emergency system, the International Health Regulations (IHR), which “are a conservative instrument as currently constructed and serve to constrain rather than facilitate rapid action.’’ As a result, the “precautionary principle was not applied to the early alert evidence when it should have been,” the Panel concluded. 

To address that, the Panel calls for an overhaul of the IHR emergency alert rules – as well as a new Pandemic Framework Convention –  to make them more responsive to fast – moving pathogens and the rapid flow of modern information systems. 

“The Panel’s view is that the definition of a new suspected outbreak with pandemic potential needs to be refined, as different classes of pathogen have very different implications for the speed with which they are likely to spread and their implications for the type of response needed,” the report states. 

“The chronology of the early events in raising the alarm about COVID-19 show two worlds operating at very different speeds. One is the world of fast-paced information and data-sharing.

…. Digital tools are now core elements in disease surveillance and alert, sifting through vast quantities of instantly available information,” it notes. 

“The other world is that of the slow and deliberate pace with which information is treated under the IHR (2005), with their step-by-step confidentiality and verification requirements and threshold criteria for the declaration of a PHEIC, with greater emphasis on action that should not be taken, rather than on action that should.”

Redesign Surveillance and Alert Systems to Function at Near-Instantaneous Speed

Among a wide-ranging menu of solutions, The Independent Panel says that global, regional and national surveillance and alert systems need to be designed to ensure that “detection functions” and “relay functions – ensuring that signals are verified and acted upon” actions are synchronized. 

“Both must be able to function at near instantaneous speed,” The Independent Panel report states. 

China and Asian Pacific Countries Applauded for Early Action  

pandemic
Shoppers in Wuhan, China, post-COVID-19 lockdown

“The question we must ask ourselves is why the PHEIC declaration did not spur more action, when the impending threat should have been clearly evident? After a stuttering start to the global response in January 2020 by the end of that month it was clear that a full-scale response would be needed. It is glaringly obvious to the Panel that February 2020 was a lost month, when steps could and should have been taken to curtail the epidemic and forestall the pandemic,” the report finds. 

However, the report avoids assigning any specific blame for the failures to any single country – including China which has been widely criticized for failing to report early on the depth and breadth of the spreading virus. 

“The Panel’s analysis suggests that the failure of most countries to respond during February was a combination of two things. One was that they did not sufficiently appreciate the threat and know how to respond. The second was that, in the absence of certainty about how serious the consequences of this new pathogen would be, “wait and see” seemed a less costly and less consequential choice than concerted public health action.”

At the same time, it applauds China and a handful of other countries, mostly in the Asian Pacific region, such as New Zealand, Korea, Singapore, Thailand and Viet Nam, which recognized the threat early on and undertook an “aggressive containment strategy.”  

Seven Point Plan For Strengthening Preparedness 

Pandemic Preparedness Regional Response – The Panel’s Seven Point Plan includes a pre-negotiated platform for essential supplies.

Beyond a more agile, digitally-based alert and response system, much more also needs to be done, in terms of strengthening other aspects of pandemic preparedness – the Panel concludes, etching out seven key recommendations, including: 

Free WHO from national government controls. The report calls on the World Health Assembly to give WHO explicit authority to publish information about outbreaks with pandemic potential immediately – without requiring the prior approval of national governments, and the power to investigate pathogens with pandemic potential with short-notice access to relevant sites, provision of samples, and standing multi-entry visas for international epidemic experts to outbreak locations.

High-level political leadership. Adoption of a Pandemic Framework Convention within the next six months, as well as a United Nations General Assembly political declaration at the September 2021 meeting. 

Stronger, more independent WHO. Extend the Director General’s term to seven years, but with no option for re-election – with the same rule to apply to WHO’s six Regional Directors. “Depoliticize recruitment especially at senior levels”, prioritizing merit-based evaluation of performance. Increase WHO member state fees to two-thirds of the WHO base programme budget and abolish the “earmarking’ of donor funds so that they can be used more flexibly.  

Invest in pandemic preparedness.  Along with calls to national government to update their pandemic preparedness plans, WHO should formalize periodic peer reviews of country’s preparedness, and the International Monetary Fund should routinely undertake pandemic preparedness assessment 

Pre-negotiated Platform for supplies.  Institutionalize and transform the current Act Accelerator and COVAX platforms into a “truly global end-to-end platform to deliver the global public goods of vaccines, therapeutics, diagnostics, and essential supplies.” This would be accompanied by new donor and member state agreements to:  

  • “Secure technology transfer and commitment to voluntary licensing in all agreements where public funding has been invested in research and development.
  • “Establish stronger regional capacities for manufacturing, regulation, and procurement of needed tools for equitable and effective access to vaccines, therapeutics, diagnostics, and essential supplies, as well as for clinical trials.”

Financing pandemic preparedness and response. Create an International Pandemic Financing Facility to raise additional reliable funding for pandemic preparedness and for rapid surge financing for response in the event of a pandemic with the capacity to mobilize long term (10-15 year) contributions of approximately US$5-10 billion per annum to finance preparedness, with the ability to disburse up to US$50-100 billion at short notice in the event of a crisis

Appoint “National Pandemic” coordinators with direct line to heads of state. Heads of State and Government to appoint national pandemic coordinators who are accountable to them, and who have a mandate to drive whole-of- government coordination for pandemic preparedness and response.  

Access Advocates Laud Report’s Proposals On Vaccines & Medicines Access  

UNAIDS welcomed the report’s recommendations, particularly the “urgent need to establish at Global Health Threats Council at the highest political level in order to coordinate global action against pandemics and secure agreement between governments on aligning efforts to tackle the health, social and economic challenges of major pandemics.

“The IPPR recommendations are a wake-up call for transforming health systems across the world,” said Winnie Byanyima, Executive Director of UNAIDS, in a statement. “Health is a universal public good in this interconnected society—no one is safe until everyone is safe, so we must reimagine health to provide the same quality of care regardless of geography, income or social status.” 

Meanwhile, the advocacy group Medicines, Law and Policy, lauded the report’s “bold recommendations” including its support for the proposed waiver of intellectual property rights on Covid-19 vaccines.  

It cited Clark’s comments that the US support for the waiver, is “a game changer” and “a vital step in the right direction”noting that she also called for WHO to convene vaccine producing countries and companies to agree to voluntary licences and technology transfer for COVID vaccines immediately. 

 

Image Credits: IPPR, The Independent Panel , José Mauquer .

East African truck drivers will get access to one common COVID-19 testing system by mid-May.

Limitations in COVID-19 testing capacity and surveillance—as well as uneven demand for testing—are likely masking the true severity of COVID-19 on the African continent, fueling the dangerous myth that much of Africa has been unscathed by COVID-19.

Test positivity rates were above 10% across many African Union (AU) member states during the second wave—substantially higher than the 5% maximum warning level suggested by the WHO and suggesting that many cases have gone undetected – says new research from the Partnership for Evidence-Based Response to COVID-19 (PERC).

A survey of 24,000 people across 19 AU member states also found that 81% of survey respondents reported challenges in accessing food, 77% reported experiencing income loss and 42% reported missing medical visits since the start of the pandemic.

The report calls for targeted public health measures for high-risk populations, increased surveillance in light of new variants, and scaled-up vaccine supply from the global community to control the pandemic in Africa.

“As case counts surge across the world, new variants emerge and vaccine rollout remains slow, it will be crucial for African Union Member States to use evidence-based strategies to manage COVID-19,” said Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention. “The PERC report provides valuable insights to countries to strategically tailor their ongoing responses.”

High Vaccine Acceptance, But Global Community Needs to Deliver Them to Africa

Though vaccine acceptance was high among survey respondents, with 67% of people saying they would get the vaccine when it’s available, there are several important caveats to consider.

At the time of the survey, access to vaccines and information about them was still being rolled out across the African Union, with lack of information the driving factor to vaccine hesitancy. Recent news about vaccine side-effects also is likely to have diminished vaccine confidence. 

“Vaccine hesitancy is driven by high levels of disinformation, misinformation, and lack of information, which erodes trust in the safety and efficacy of vaccines,” said Dr Richard Mihigo, Program Coordinator, Immunization and Vaccine Development,  WHO’s Regional Office for Africa. 

“Going forward, we must prioritize sustained and targeted campaigns which address the growing infodemic around vaccines while providing evidence-based information to dispel myths and build confidence in vaccines. Communication and engagement is key to building trust and creating a positive discourse around vaccines from the ground up.” 

The delayed rollout of vaccines and the rapidly growing threat posed by new variants does present the opportunity for African Union Member States to ramp up vaccine acceptance campaigns and logistics for efficient vaccine rollout – and continually monitor and address vaccine confidence – before vaccines arrive in the region. 

In addition, the report calls on the global community to deliver vaccines to member states as soon as possible. 

The Africa CDC recently called the United States’ reversal on the World Trade Organization Trade-Related Aspects of Intellectual Property (TRIPS) waiver a ‘positive development’, though also cautioned that the announcement did not guarantee global patent rules for COVID-19 vaccines would be lifted immediately. 

Scale-Up in Public Health Strategies to Prevent Potential COVID-19 Surge

africa
South Africa continues to drive reported COVID-19 cases in Africa; however, reported cases increased significantly in all African Union Member States during the second COVID-19 wave compared to the first

The African Union must also scale up effective testing strategies for detecting potential surges and sustaining the use of public health measures to prevent subsequent waves. 

Nearly nine in 10 respondents reported using masks near others in February 2021, but in some populous and hard hit countries, such as South Africa and Ethiopia, self-reported mask wearing trended downward, suggesting the need to redouble efforts to promote this low-cost and effective intervention in some countries. 

Overall, self-reported adherence to social distancing measures declined between August 2020 and February 2021. 

“Countries are most effective controlling the pandemic when they consider what measures people will actually follow at this stage in the pandemic and take steps to inform, partner with, and support communities,” said Dr Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies.

“Analysis of PERC data can help governments predict adherence to preventive measures, craft effective communications and mount a stronger response to COVID-19.”

Image Credits: EAC, WHO AFRICA, Partnership for Evidence-Based Response to COVID-19.

Overcrowding in refugee camps, mistrust of authorities including vaccination registration processes, and lack of access to vaccines are some of the most pressing problems preventing migrants, refugees and other “uprooted people” from getting COVID-19 vaccines.

A diverse, but also common set of issues are faced in refugee camps, informal settlements that house an estimated 79.5 million people living around, or fleeing the world’s conflict zones in Asia, the Middle East, Europe, and Latin America, panelists said at a Geneva Global Health Hub (G2H2) panel on Tuesday.  Among those, only about 26 million are officially registered as refugees according to UNHCR, The UN Refugee Agency.

Local and regional conflicts, such as the recent flareup of violence in Israeli-occupied East Jerusalem, further impede an already halting supplies of vaccines to Palestinians in the Israeli-occupied West Bank and Hamas-controlled Gaza, the latter now locked in a bloody battle with Israel, said Firas Jaber of the Palestinian social and economic policies monitor, Al-Marsad. 

“Today in the uprising against the settlers in Jerusalem, and the rest of the West Bank and Gaza, the situation is now a triple crisis: the occupation, COVID-19, and also the inability of providing the vaccination to our people,” said Jaber.  Power outages in health facilities, damaged or depleted hospitals, and an overall lack of health personnel also are contributing to low Palestinian vaccination rates, Jaber contended. 

Misinformation in Lebanon

In neighboring Lebanon, there is a high level of misinformation about vaccines among refugee communities, says Safaa Fawaz Tahhan, a Syrian refugee who works as an health outreach officer. It is difficult for people to register for vaccines on the Lebanese online platform, and vaccination centres are far away from refugee centres. 

Meanwhile, in Latin America, political instability in neighbouring Nicaragua had led to tensions and added health challenges for Costa Rica, which saw the exodus of Nicaraguans seeking to avoid both violence and the pandemic as a threat, observed Ana Quiroz,  director of the Center For Information and Advisory Services In Health (CISAS) in Costa Rica.

“Costa Rica has quite a centralised health system. They work a great deal on [COVID-19] prevention information, border control, promoting social distancing, etc,” said Quiroz.

“On the other hand in Nicaragua, the government preferred to deny the existence of the pandemic and instead, to call for political rallies with no preventive measures to prevent spread of the virus.”

This has caused conflict between Costa Rica and Nicaragua, with around 15,000 Nicaraguan refugees being denied access to Costa Rica, as a result of tighter border restrictions, designed to keep the virus at bay.

“This situation has led to an increase in xenophobia towards Nicaraguan people in particular, and poor people,” she added.

Greek Refugee Camps – Three Times More Exposed to COVID 

In Europe’s refugee camps, COVID prevention measures are impossible to maintain, asserted Apostolos Veizis from Intersos in Greece, where many refugees from Africa and the Middle East, attempting to enter the European Union, have been stranded in camps since 2016.

“The refugee camps in Greece are synonymous with overcrowding,” said Veizis. “During the COVID pandemic, we talk about keeping distance. This is a joke because there are 30 people in a tent. In less than two square metres, you find five to six people. When you are asking people to keep distance, that is not possible.

“You ask people to wash their hands, it is again not possible. So in reality, we are talking about measures that cannot be implemented, and people on the move are the ones to be punished.”

To make matters worse, since 17 March 2020, the camps have been under curfew from 7pm to 7am, making refugees even more vulnerable to COVID-19, he said.

“Our data shows that people living in the camps are three times more exposed to COVID-19 than the local population. When it comes to vaccinations, Greece is happy to present saying that one in four Greeks have had the first dose – about four million people – but that’s not the case and situation for asylum seekers and refugees,” said Veizis.

Vaccine registration has started, but there is a high level of mistrust of authorities, he added.

For Veizis, addressing the needs of refugees is largely a matter of “political will”; presently there are only 100,000 refugees arriving in the European Union each year, which is not a large number.

However, the pandemic is being used to put people in detention facilities when it would be better, health-wise and socially, for refugees to be integrated into the societies where they are now living, he said.

“When it comes to vaccinations, we have to include everybody from the beginning. If we want to control the pandemic, then the prevention and vaccination needs to take place for everybody in Europe, for everybody in Asia, for everybody in Africa, for everybody around the world.”

Image Credits: Mercy Corps.

A Canadian pharmaceutical company, Biolyse, has agreed to provide Bolivia with 15 million doses of the Johnson & Johnson COVID-19 vaccine – as long as the Canadian government gives it a compulsory license to manufacture the vaccine.

In March, Johnson & Johnson rejected an application by Biolyse for a voluntary license to make a generic version of its vaccine. 

Biolyse is now seeking a compulsory license in terms of Canada’s Access to Medicines Regime (CAMR) in order to supply vaccines to Bolivia, which has only managed to vaccinate around 5% of its population.

But for this to succeed, the COVID-19 vaccine will have to be listed in Schedule 1 of the Canadian Patent Act as only medical products listed there are eligible for compulsory licenses in terms of CAMR.

“Although Schedule 1 can be amended to include additional products, Canadian authorities have refused to tell KEI and Biolyse whether COVID-19 vaccines will be added to the list or what the estimated time frame is for that amendment to take place,” said non-profit organisation Knowledge Ecology International (KEI), which has been advising the company on its compulsory license application.

Canada ‘Stonewalls’ Legitimate Attempt

According to KEI, Canada has claimed at the World Trade Organization (WTO) that existing TRIPS flexibilities are working “as intended,” and asked those in favour of a TRIPS waiver for “concrete” evidence of patent-related challenges in procuring COVID-19 goods.

“If Canada fails to expeditiously allow Bolivia to import vaccines manufactured by Biolyse under a compulsory license, they would be directly contradicting their own statements at the WTO,” said KEI.

“Canada cannot continue to claim that article 31bis of the TRIPS agreement and the CAMR function ‘as intended’ while it stonewalls a legitimate attempt to use this mechanism,” it added.

Biolyse has agreed to sell vaccines to Bolivia at an estimated manufacturing cost of $3 to $4 a dose.

Meanwhile, COVID-19 cases are rising in Bolivia, which has a population of almost 12 million people and around 43,000 official cases of COVID-19 and 13,228 deaths.

Bolivia’s daily COVID-19 cases

 

Image Credits: Johnson & Johnson.

 

Geneva Global Health Hub panel debates a proposal for a global pandemic treaty – to be put before WHO member states next week.

The draft of a landmark resolution to establish a global “Pandemic Treaty” will be put to World Health Organization (WHO) member states this week in preparation for the World Health Assembly beginning 24 May,  Jaouad Mahjour, WHO Assistant Director-General Emergency Preparedness, told a panel in Geneva Monday.

The proposal for the Pandemic Treaty – which aims to tighten global rules around disease outbreak response so that countries react rapidly and more transparently, was first tabled by WHO Director General Dr Tedros Adhanom Ghebreyesus in January.  It has garnered the support of some 25 global leaders ranging from President of the European Council Charles Michel, to Germany’s Angela Merkel, Prime Minister JV Bainimarama of Fiji; UK Prime Minister Boris Johnson and South African President Cyril Ramaphosa.

The concept has met with resistance in some quarters, as well – notably the United States has not yet signed onto the idea. And some civil society voices have said that absent of political will, a treaty would not necessarily have more clout than existing International Health Regulations governing emergencies.

However, the countries now pushing for the treaty represent every region of the WHO, and range from superpowers to small island states, Mahjour told a panel convened by the Geneva Global Health Hub (G2H2), saying that the time for a treaty is ripe

The countries pushing for a “legally binding international framework” see this as the only way to deal with the magnitude and impact of the pandemic, he underlined. And there are some fundamental principles that have garnered wide agreement already:

“The first issue [is] that everybody agrees on is national preparedness. The world cannot be safe if only one country is not prepared,” said Mahjour. 

The second issue [is] mechanisms to ensure global preparedness, including supply chains that can provide all countries with goods and control measures; an early pandemic warning and alert system lead by WHO and including those involved in animal health; and accelerating research, innovation and development.

Not Everyone is Convinced

However, other panelists appearing at the session were less convinced that a treaty would add value to existing IHR rules, which are already binding on member states. 

Panel moderator Nicolette Dentico, director of global health at the Society for International Development as well as G2H2 co-president, asked why a new treaty would be effective when the COVID-19 pandemic had shown that member states “are not capable of actually abiding by those binding norms that have been already negotiated, established and agreed upon” in 2005, namely the International Health Regulations. 

“So why should we create another tool? Shouldn’t we work on the legally binding instrument that exists already instead of creating a new one?” she asked.

Treaty Needs to be Based on Human Rights

Meanwhile, an influential group of activists and academics writing in the BMJ on Monday, said that a pandemic treaty, if adopted, needs to be “based on human rights”.

“Those in charge of drafting the treaty must begin with a clear look at the grave abuses that have characterised the COVID-19 pandemic: authoritarian power grabs; continuing monopolies in diagnostics, therapeutics, and vaccines; failure to resource health systems; staggering setbacks for women; and an upsurge in violence, including covid-related hate crimes,” wrote Meg Davis, senior researcher at the Geneva Global Health Centre and 21 others.

“States have all-too-easily sidelined the international human rights framework under cover of emergency responses,” they added, calling for such a treaty to address a range of key issues including the right to health, the decriminalisation of infections, workers’ rights, and gender inequalities.

One panelist at Monday’s event, echoed those sentiments.  Ana María Suárez Franco, director of the food security network, FIAN International, based in Honduras, said that any pandemic treaty needs to be aligned with UN Human Rights Council principles, and make transnational companies legally accountable for their actions.

“A pandemic treaty has to be built from the bottom up. It needs to prevent corporate abuse,” said Franco.

To be effective, a treaty just be able to curb abuses that have occured in the current pandemic – for instance cases in which COVID-19 vaccine manufacturers had tried to force countries to sign exclusionary clauses that protected pharma companies from claims of adverse vaccine effects, and provided sovereign resources as payment guarantees – including natural resources and even embassy buildings – ahead of vaccine orders.

Concerns about the timing of the pandemic treaty negotiations and capacity of WHO to implement a vast new treaty project, are other issues that have come up, panelists said. 

Some critics have worried the “timing of these negotiations,” could divert attention, resources and personnel from addressing the current pandemic, said Priti Patnaik, editor of the Geneva Health Files newsletter.

“Some even raised the question of whether there is enough capacity within the WHO Secretariat to service the needs of treaty negotiations among member states,” she added, noting that according to European Union internal timelines, ‘the treaty has to be imposed next year”. 

Dr Tedros Adhanom Ghebreyesus, WHO Director General.

The World Health Organization (WHO) has decided to classify the B1.617 variant first identified in India as a “variant of concern”, according to Maria Van Kerkhove, WHO lead on COVID-19.

“There is some available information to suggest increased transmissibility of B1.617,” Van Kerkhove explained to the WHO’s biweekly media briefing on Monday.

In addition, a preprint (a paper that has not undergone peer review) involving a limited number of patients suggested that there is also “some reduced neutralisation” [of antibodies] and as such we are classifying it as a variant of concern”, said Van Kerkhove.

However, she stressed: “We don’t have anything to suggest that our diagnostics or therapeutics and our vaccines don’t work. This is important as we will continue to see variants of concern around the world.”

Over the weekend, India reported over 4,000 deaths in 24 hours and it is recording over 400,000 new cases every day.

WHO Chief Scientist Soumya Swaminathan added that genomic surveillance was ongoing in India and scientists were looking at transmissibility, clinical security, and the response of the B1.617 variant to antibodies generated in people who have been vaccinated with the three main vaccines being used in India – Covaxin (developed by Bharat Biotech), Covishield (AstraZeneca) and Sputnik. 

“Over the coming weeks, there’ll be much more data forthcoming,” she added.

WHO Chief Scientist Soumya Swaminathan

Cases Plateau – But at Very High Rate

WHO Director General Dr Tedros Adhanom Ghebreyesus told the briefing that global COVID-19 cases have started to “plateau” – but at an “unacceptably high” rate with more than 5.4 million new cases and almost 90,000 deaths in the past week.

“Cases and deaths are still increasing rapidly in WHO’s South East Asia region and there are countries in every region with increasing trends,” added Tedros. 

“The spread of variants, increased social mixing, the relaxation of public health and social measures and inequitable vaccination, are all driving transmission,” he added.

Condemning vaccine diplomacy as “geopolitical maneuvering”, Tedros said that only global cooperation and solidarity can end the COVID-19 pandemic.

“High and upper-middle income countries represent 53% of the world’s population, but have received 83% of the world’s vaccines,” said Tedros. “In contrast, low and lower middle income countries account for 47% of the world’s population but have received just 17% of the world’s vaccines. Redressing this global imbalance is an essential part of the solution, but not the only part and not an immediate solution.”

Seychelles Surge in Cases Seem to Have Occurred After First Jab

Addressing reports that cases in Seychelles were surging despite the high vaccination rate of citizens, Dr Kate O’Brien, the WHO’s Director of Immunisation and Vaccines, said that some of the infections occurred after the first dose of the Sinopharm vaccine.

“The Sinopharm vaccine really requires two doses, and some of the cases that are being reported are occurring either soon after a single dose or soon after a second dose or between the first and second doses,” said O’Brien.

Approximately 60% of vaccinations on the island are of Sinopharm vaccines donated by the United Arab Emirates, while the remainder of doses are of the AstraZeneca vaccine, according to the Washington Post.

“When we see cases continuing to occur in the setting of vaccines, it really does require a very detailed assessment of what the situation is,” she stressed.

“First of all, what are the strains that are circulating in the country? Secondly, when do the cases occur relative to when somebody received doses? Third, what is the severity of the cases? Only by doing that kind of evaluation can we make an assessment of whether or not these are vaccine failures or whether it is more about the kinds of cases that are occurring, the milder end of cases, and then the timing of the cases relative to when individuals received doses.”

She stressed that this evaluation is “ongoing”, and the WHO was supporting and engaging with Seychelles to understand what was happening.

Image Credits: Adnan Abidi/Flickr, WHO.

A doctor administering the Johnson & Johnson COVID-19 vaccine candidate during the phase 3 clinical trials.

In a far-reaching statement, WHO and the International Coalition of Medicines Regulatory Authorities (ICMRA) called on the pharma industry to provide much wider access to clinical data for all new medicines and vaccines approved, or under review, and even those that had been rejected. 

“Clinical trial reports should be published without redaction of confidential information for reasons of overriding public health interest,” WHO said in the joint statement on Friday.

“The COVID-19 pandemic has brought into sharp focus the need for information and data to support academics, researchers and industry in developing vaccines and therapeutics; to support regulators and health authorities in their decision-making; to support healthcare professionals in their treatment decisions; and to support public confidence in the vaccines and therapeutics being deployed.”

WHO noted that while some initiatives to share data with regulators, and store it transparently have met with stakeholder support, such as the WHO International Clinical Trials Registry Platform, the US ClinicalTrials.gov database, and the EMA Clinical Trials Register, “not all past efforts have been successful,” WHO said, adding, “often this was because they were unsustainable due to reliance on goodwill or lack of appropriate resourcing.

“Regulators continue to spend considerable resources negotiating transparency with sponsors. Both positive and negative clinically relevant data should be made available, while only personal data and individual patient data should be redacted,” said WHO, adding that, “Lack of public access to negative trials has been identified as a source of bias, which weakens the conclusions of systematic reviews and provides a false sense of reassurance on the safety or efficacy of the medicine.”

“Providing systematic public access to data supporting approvals and rejections of medicines reviewed by regulators, is long overdue despite existing initiatives, such as those from the European Medicines Agency and Health Canada. The COVID-19 pandemic has revealed how essential to public trust access to data is.

“ICMRA and WHO call on the pharmaceutical industry to commit, within short timelines, and without waiting for legal changes, to provide voluntary unrestricted access to trial results data for the benefit of public health.”

Image Credits: University of Oxford, Johnson & Johnson.