Healthcare workers vaccinating at risk patients with the Pfizer-BioNTech COVID-19 vaccine in Lima, Peru.

Pfizer on Friday became the first pharma company to apply for full approval of its COVID-19 vaccine from the US Food and Drug Administration (FDA. The announcement also followed the publication of two studies which found that the Pfizer/BioNTech vaccine is highly effective against two major SARS-CoV2 variants of concern. Moderna plans to follow suit and apply for full approval from the FDA later this month, the company announced on Thursday.

Two peer reviewed studies published on Wednesday found that the Pfizer/BioNTech COVID-19 vaccine protects against severe disease caused by the B.1.1.7 variant, first identified in Britain, and the B.1.351 variant, first identified in South Africa. The studies were based on the real-world use of the vaccine in Qatar and Israel.

The Qatar-based study, published in the New England Journal of Medicine, used data on vaccinations, PCR tests, and hospitalization from the national COVID-19 databases between February and March.

Some 385,853 people received one dose since the launch of the immunization campaign and 265,410 people received both doses of the vaccine, as of the end of March. 

Efficacy of the vaccine in preventing infection was estimated to be 87% against the B.1.1.7 variant and 72.1% against the B.1.351 variant two weeks past the second dose. Protection was even higher against severe or fatal disease, with a total efficacy of 97.4%.

A second study based on Israeli data, and published in the Lancet, found that two doses of the Pfizer vaccine was highly effective against a range of SARS-CoV2 outcomes, including symptomatic (97%) and asymptomatic infection (91.5%), hospitalization (97.2%), and death (96.7%), in those aged 16 and older.

The B.1.1.7 variant was the dominant strain of SARS-CoV2 in the study period, from January to April. The variant accounted for 94.5% of the infections recorded by national surveillance data. 

As vaccine coverage increased in the study participants, the incidents of SARS-CoV2 outcomes declined. Other countries could “similarly achieve marked and sustained declines in SARS-CoV2 incidence if they can achieve high vaccine uptake” said the co-authors, from Pfizer and the Israeli Public Health Services.  

Israel has vaccinated a larger proportion of its population than any other country, with 61% of the population having received at least one jab as of early April. 

Positive Early Findings from Moderna Booster Shot Study

A doctor preparing the Moderna COVID-19 vaccine at the Naval Hospital in Bremerton, Washington, US.

In other vaccine news, Moderna announced on Thursday that initial data on its COVID-19 booster shots demonstrated that the boosters increased the neutralizing antibody responses of vaccinated individuals against two variants of concern.

The data is from an ongoing phase 2 study in which three strategies for boosting immune responses are being tested: a booster dose of Moderna’s existing vaccine, a booster candidate based on the B.1.351 variant, and a booster candidate that combines the two previous boosters.

After six to eight months following the administration of the second jab, the level of antibodies against the wild-type SARS-CoV2 remained high in the study participants, but antibodies against the B.1.351 and P.1 variants, first identified in Brazil, were much lower. 

“We are encouraged by these new data, which reinforce our confidence that our booster strategy should be protective against these newly detected variants,” said Stéphane Bancel, CEO of Moderna, in a press release.

While the findings are encouraging, the data has not yet been peer reviewed. According to the pharma company, the preliminary results have been submitted as a preprint and will later be submitted for peer-reviewed publication upon the completion of another arm of the study. 

Pfizer License Application 

The Biologics License Application (BLA) was initiated for the approval of the vaccine in individuals 16 years of age and above. Data will be submitted to the regulatory agency on a rolling basis and the review process will likely take several months.

“Following the successful delivery of more than 170 million doses to the US population in just a few months, the BLA submission is an important cornerstone of achieving long-term herd immunity and containing COVID-19 in the future,” said Ugur Sahin, CEO of BioNTech, Pfizer’s German manufacturer,  in a press release. 

Some 134 million doses of the Pfizer/BioNTech vaccine have been administered in the US, as of Thursday, according to the US Centers for Disease Control and Prevention (CDC).

The FDA is expected to issue emergency use authorization for the Pfizer vaccine in adolescents aged 12 to 15 early next week. 

Image Credits: BioNTech, International Monetary Fund/Ernesto Benavides, Flickr – Official US Navy.

Almost seven million people are estimated to have died of COVID-19 globally based on  “excess mortality” statistics, according to the Institute for Health Metrics and Evaluation (IHME), which announced on Friday that it would now be using these statistics rather than official death rates.

This “major change in how we think about the number of deaths” had occured after the institute had completed an analysis of all-cause mortality for 59 countries and 198 states and provinces within countries, said IHME Director Dr Christopher Murray from the University of Washington.

Using the new estimates, the US has the highest deaths in the world – over 900,000 – followed by India with over 650,000. Egypt’s death toll of around 170,000 is the highest in Africa – and way higher than official statistics.

New global death estimates, based on excess mortality.

Murray said that using excess mortality as a metric allowed IHME “to get closer to the true number of COVID deaths”, and the institute noted that “most excess mortality is likely misclassified COVID-19 deaths”.

Murray acknowledged that factors inflating excess mortality included deaths of people who had avoided healthcare during the pandemic, and deaths related to increased depression and drug use.

But “injuries are down perhaps about 5% globally due to reductions in mobility”, and so were flu deaths because of lockdowns. 

“When you put all that together, we conclude that the closest estimate for the true COVID-19 death is still excess mortality because some of those things are on the positive side, some of those other factors are on the negative side,” said Murray.

“Once we have completed this analysis, our understanding of the magnitude of COVID up to date, is that it’s been much worse than we have been thinking so far, and we have estimated that today 6.9 million people have died from COVID already,” he added.

Rival Spanish Flu

“Given our expectation of continued deaths, COVID is going to rival Spanish flu at the global level in terms of the count before we see the end of this epidemic.”

An analysis by the Netherlands statistical agency suggested that all excess deaths in the Netherlands were directly due to COVID-19, according to IHME.

“Their analysis actually suggested that direct COVID-19 deaths may be higher than estimated excess deaths because deaths due to some other causes have declined during the pandemic,” it added.

“Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality,” said the IHME.

“For the reasons presented in this section, we believe that this is likely an underestimate. As the evidence is strengthened in the coming months and years, it is likely that we will revise our estimates of the total COVID-19 death rate upward in future iterations of this work, once we can properly take into account the drivers described in this section.”

 

 

Production of Sinopharm’s inactivated COVID-19 vaccine candidate.

The Chinese-made Sinopharm vaccine became the latest COVID-19 vaccine to receive an Emergency Use Listing from the World Health Organization (WHO) on Friday; experts said the vaccine showed an overall efficacy rate of 79% in preventing symptomatic and serious disease. 

The WHO approval positions Sinopharm to become a major player in the COVAX global facility. The facility, co-sponsored by WHO and Gavi, the Vaccine Alliance, is struggling to provide desperately needed vaccine supplies to low- and middle-income countries in the wake of India’s COVID surge – which forced Indian vaccine manufacturers to divert production to domestic needs.  

It remains to be seen, what kind of deal the Beijing-based pharma company might negotiate with COVAX. The vaccine’s state-controlled developers, Beijing Bio-Institute of Biological Products, have so far pursued only bilateral vaccine donations or deals – with an official sales price exceeding that of the pricey Pfizer and Moderna vaccines – whose efficacy is much higher. 

At a press briefing on Friday, it was clear that WHO officials are keen to call on Sinopharm’s participation.

“This expands the list of vaccines that COVAX can buy, and gives countries confidence to expedite their own regulatory approval, and to import and administer the vaccine,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at a Friday press briefing announcing the move.  

Dr Tedros Adhanom Ghebreyesus, WHO Director General.

“We urge the manufacturer to participate in the COVAX Facility and contribute to the goal of more equitable vaccine distribution,” said Dr Mariângela Simão, WHO Assistant-Director General for Access to Health Products, said in a press release.

“From the very beginning, in all of our conversations with this company, it has been very interested in looking at playing a role to help with the global response, which is encouraging,” said Bruce Aylward, WHO Senior Advisor to the Director-General and lead on the ACT-Accelerator. 

He noted that the pharma company has also made significant efforts to expand its manufacturing capacity from the low double digit numbers to high three digit numbers to be positioned to export large numbers of doses. 

Appeal to G-7 to Close Grave, Immediate Vaccine Shortfall in LMICs

Meanwhile, WHO officials issued their second plea this week to the G-7 group of industrialized nations, meeting 11-13 June, to share excess vaccine doses with COVAX that they are holding in reserves – so the highest risk groups in low-income countries can be vaccinated. 

“Nearly 1.25 billion doses of COVID-19 vaccines have been administered globally, however, only 5 million of those have been in the lowest income countries” said Aylward. “Over 80% of the vaccines distributed have gone to high income countries and only 0.3% have been delivered to low income countries.”

Dr Bruce Aylward, WHO Senior Advisor to the Director General, at the press conference on Friday.

“We need the help of the G7 to change that equation and raise the proportion of the populations that are vaccinated,” Aylward said.  

A bigger G-7 financial commitment is also required to combat the current “unacceptable” divide in vaccine distribution, stressed WHO officials at the biweekly press conference. 

“For G-7 now, the most important and the immediate support we need is vaccines [and] vaccine equity,” said Dr Tedros.

“The industrial and financial weight of the G-7 in supporting that is going to be absolutely crucial,” said Alyward. He warned that “we could be in a different position much faster globally than we will [otherwise] be, if we get that support through the financing, the sharing, and the scaling up of these products.”

The ACT-Accelerator, a global collaboration to accelerate the development, production, and equitable access to COVID-19 vaccines and technologies, currently is facing a financing gap of US$19 billion, which is slowing the procurement and delivery of vaccines to countries in dire need, the WHO officials said. 

Along with vaccines, funding is also needed to  scale-up of up production of other countermeasures, including diagnostics, oxygen, and PPE. 

“Without that financing or without those donations, there simply aren’t the doses that are needed to assure that countries that are really [relying on] the COVAX facility can achieve the impact” of immunity, said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals.

The comments came as WHO also reported on the first meeting of  a new “Health for All” collaboration of 11 top economists and health experts – tasked with articulating new strategies for injecting health goals into the heart of global finance, not only for medicines and vaccines access but also in terms of economic recovery. 

Professor Mariana Mazzucato, Chair of the Council on the Economics of Health for All, at the press conference on Friday.

Sinopharm Approved For Older People – Although Clinical Trials Included Few People 60+ 

The Sinopharm vaccine had an efficacy rate of  79% in clinical trials, with respect to prevention of symptomatic disease and hospitalizations, the WHO review by the Strategic Advisory Group of Experts on Immunization (SAGE) found. Their review also included on-site inspections of the production facility.

The sixth vaccine to receive WHO’s approval, it is based on a traditional vaccine technology that delivers an inactivated form of the virus to provoke immunity. It’s cold chain storage requirements make it suitable for distribution in low-income countries. 

“The addition of this vaccine has the potential to rapidly accelerate COVID-19 vaccine access for countries seeking to protect health workers and populations at risk,” Simão said. 

WHO’s approval included a recommendation for use in adults of any age over the age of 18 – despite the admittedly scarce data from clinical trials on adults over the age of 60. 

“There is no reason to think that the vaccine would behave differently in this older age group, and in fact, in many countries in the world where the vaccine is already being used, this group has already been vaccinated,” said Dr Alejandro Cravioto, Chair of WHO’s Strategic Advisory Group of Experts on Immunization (SAGE).

Dr Alejandro Cravioto, Chair of WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), the body that recommends vaccines for WHO approval.

However, WHO officials said that they would encourage those in charge of country vaccination programs to implement strong followup programs to monitor the safety and efficacy of the vaccine in those over 60 years old, as well as in people with comorbidities, and pregnant women. 

“Once we have this information then, as with any other vaccine that SAGE has reviewed, we will look at the new evidence and make changes in our interim recommendations for this vaccine,” said Cravioto. “But for now, after getting an EUL approval we see no reason why this vaccine should not be recommended fully for use in people 18 years and above, in a dosage of two doses, from two to three weeks apart.”

The Sinovac vaccine, another Chinese developed COVID-19 vaccine, was also expected to receive WHO Emergency Use Listing this week, according to a statement made by Simao at the press conference on Monday. But on Friday, officials said it remains under review.

The Sinovac vaccine has in the past reported varying efficacy results in its clinical trials, ranging from 50% to 84%. SAGE had requested additional information from the manufacturer and was awaiting a response, WHO said.

Image Credits: Sinopharm, WHO.

In the eye of the storm: How can media hold government accountable? Global Health Centre/ Health Policy Watch Panel

The COVID-19 pandemic has highlighted how crucial journalism is to counter the rapid spread of inaccurate information and to hold governments accountable, a diverse panel of leading journalists noted on Thursday, a few days after World Press Freedom Day.

Sometimes that story-telling saves lives, but it can also come at a high personal cost to those telling the stories. In India, over 200 Indian journalists have died of COVID-19, and worldwide, others have been imprisoned and censored for criticising their government’s pandemic effort.

“It’s in crisis that we really come to appreciate the essential role that journalists and media play in keeping societies well-informed, providing us with accurate information, and the essential role it plays in holding governments accountable,” stressed Suerie Moon, the Co-Director of the Geneva Graduate Institute’s Global Health Centre, which hosted the panel with Health Policy Watch.

The event featured leading journalists from India’s Pune, Pakistan’s Islamabad, and South Africa’s Cape Town, who reflected on how the media shapes public discourse and the challenges they face – often in contexts that are under-resourced and even life-threatening. 

Keep Questioning Authorities

“Our job is to ask and keep questioning authorities, and it’s our role to tell people what the government is not telling them,“ stressed Rahul Basharat Rajput, Health Policy Watch Pakistan correspondent, and Fellow at the International Center for Journalists.

“Indian journalists have tried their best to play the role of a watchdog and hold the government accountable, especially because Prime Minister Narendra Modi’s government has been responsible for several superspreader events,” added science journalist Disha Shetty, who also reports for Health Policy Watch – noting that journalists had warned long-ago that a complacent government could trigger a potentially devastating pandemic.

Shetty and Rajput spoke from their homes in India and Pakistan, which are among the most dangerous countries for journalists in the world. 

“Reporting is coming at huge personal costs to journalists telling the stories,” Shetty said. “India is one of the world’s most dangerous places to be a journalist at the moment, according to Reporters Without Borders.”

Over 200 Indian journalists have already died from COVID-19, according to a list that is being compiled by the Network of Women in Media in the country.

Fighting The Spread of Inaccurate Information

In India, the media has played a key role in countering inaccurate information, whose spread has mainly been driven by governmental authorities, Shetty said.

“A lot of the source of misinformation is coming from the government machinery, [for example] during government press conferences, which have been used to downplay the extent of the pandemic and to promote herbal cures that lack scientific backing,” she said. 

“Media in India, the US and other countries have a crucial role in calling out misinformation that comes from government sources because you can’t just report on a press conference when this misinformation is being spewed out.”

Some reporters with massive social media followings have also contributed to the dissemination of inaccurate information, she added, calling on her colleagues to hold each other accountable to protect an increasingly vulnerable public.

Vaccine hesitancy, uncommon in India prior to COVID-19, has been fueled by inaccurate information, as well as the government’s lack of transparency around the indigenous Bharat Biotech vaccine. This has visibly affected vaccine uptake in India since the pandemic struck, Shetty warned. 

The African continent has not been immune to these issues either, even though its official COVID-19 burden has been low in comparison to the rest of the world, added Kerry Cullinan, the Africa Editor of Health Policy Watch.

In South Africa, only a fifth of eligible South Africans over the age of 60 have registered for a jab, she warned. Meanwhile, in Kenya, where around a quarter of citizens are Catholic, the Kenyan Catholic Doctors’ Association has dismissed COVID-19 vaccines as “unnecessary”, instead promoting unproven treatments from antiparasitic drug ivermectin to other herbal medicines.

African Journalism is “Massively Under-Resourced”

In Africa, the fight against increasingly inaccurate information and growing vaccine hesitancy has been exacerbated by the fact that journalism is now “massively under-resourced“, Cullinan added, referring to a wave of job losses in the sector since the pandemic emerged. 

At the South African Broadcasting Corporation (SABC), the country’s public broadcaster, 620 people were retrenched at the end of March while most magazines had closed, she said.

In some African countries, journalists accept money from governments to write about various initiatives, and this “obviously affects the quality of articles produced”, she said.

“If you can’t earn a living from this profession [journalism] you’re not going to be doing it very well,” noted Elaine Ruth Fletch, the editor-in-chief of Health Policy Watch, who moderated the discussion.

Still, recent funding from the Wellcome Trust has helped several Africa-based journalists stay afloat during the pandemic, panelists said on an encouraging note.

 Striking Success Story – How Two Pakistani Reporters Shifted National Policy

Pakistan health workers getting vaccinated with Sinopharm.

Meanwhile, a series of articles by Rajput and co-writer Mohammed Nadeem Chaudhry published by Health Policy Watch made a “huge difference” to Pakistani society and national health policy, the writers reported. 

“After one of our stories was published by Health Policy Watch, it made a huge difference,“ said Rajput, referring to a story he co-authored with Chaudry in mid-April amid an intense third wave in Pakistan. 

In that story, he shed light on the country’s quiet suspension of its vaccination campaign for healthcare workers – although 40% had not received a single vaccine jab. 

But after Rajput and Chaudhry sent queries about the campaign to Pakistan’s Special Assistant to the Prime Minister (SAPM), Faisal Sultan, the country’s vaccine campaign suddenly resumed.

“The government’s move to halt the vaccination of healthcare workers was made transparent after our story was published in the media,“ said Rajput, adding. “This is a very important story that shows how public stories influence the decisions that governments make.“

He cited another hard-hitting story he co-authored with Chaudry for Health Policy Watch which exposed a $ 4.2 million misallocation of Global Fund donations for tuberculosis elimination, which was instead funneled to a private hospital in Karachi. Only about $1 million of those funds are “potentially” recoverable, found Rajput.

Local media outlets did not want to publish some of these stories and even the World Health Organization’s Pakistan office refused to comment on either story.

“The story about the Global Fund, our first story in Health Policy Watch, local news networks refused to publish it, but we felt that it was a very important story to report to tell the people, so we looked elsewhere,” he said. “In Pakistan, you cannot report on a lot of things.“

Pakistan is the fifth most dangerous country for journalists worldwide, said Rahul. Between May and April 2020, The Freedom Network reported 148 violations against journalists. This includes 60 murders.

Image Credits: Photo by Markus Winkler on Unsplash.

Humanitarian organisation Médecins Sans Frontières (MSF) has called on US diagnostics corporation Cepheid, which produces the GeneXpert testing machines that run COVID-19 tests, to immediately reduce the prices for the tests to allow for more people to be diagnosed as the pandemic continues to ravage parts of the world.

MSF’s plea comes after Cepheid on Thursday announced that it will reduce the price of its new 10-color IV-4 GeneXpert machines from US$19,000 to $15,800, and additionally offer countries buying those machines ‘100 COVID-19 tests for free’.  Similar bundled price reductions for the larger XVI GeneXpert machines and COVID-19 and TB tests have also been announced. 

Stijn Deborggraeve, Diagnostic Advisor, MSF Access Campaign however slammed the company’s announcement, saying it was “another sign that the corporation is not actually willing to make a real commitment to increasing access to affordable tests in low- and middle-income countries, and is prioritising its profits over people’s lives”.

Deborggraeve said the price “reduction” was not meaningful, but rather a way to “promote their newer testing devices”.

“The COVID-19 pandemic should not be used by Cepheid to profiteer by charging low- and middle-income countries over four times the price it costs to produce the COVID-19 tests. It’s high time for Cepheid to do what’s right and immediately provide countries with real price reductions for the COVID-19 test, so more tests can be run and more people diagnosed as the pandemic continues to rage across many parts of the globe.” 

MSF together with the Treatment Action Group (TAG) and more than 140 other civil society organisations sent open letters on 24 February and 1 April to express concerns about the impact of Cepheid overcharging low- and middle-income countries for COVID-19 tests, and to ask for a significant and immediate price reduction of the tests. 

Cepheid has set the price for each COVID-19 test at $19.80, which is at least 400% more than it costs the corporation to produce the test, based on MSF’s analysis of the cost of manufacturing Cepheid’s similar TB and HIV tests. The analysis shows that the corporation could still make a profit by selling each test for $5 or less.  

MSF repeated its call for Cepheid to reduce the price of the COVID-19 test and all other GeneXpert tests to no more than $5 each. 

“It is unacceptable that Cepheid sells the COVID-19 tests to low- and middle-income countries at a price over four times higher than it costs to produce the test, while Cepheid’s annual revenue has doubled during the pandemic, reaching over $2 billion, largely from the sale of COVID-19 tests,” said MSF in its statement.

Image Credits: UCT.

 

The Seychelles, known for its beaches and giant tortoises, has recorded a spike in COVID-19 cases.

A significant surge in COVID-19 cases in the tropical island of Seychelles, despite almost 70% of the population having been vaccinated, is baffling health officials while residents are calling for stricter law enforcement, especially for tourists.

The World Health Organization (WHO) is currently working with health officials on the island to analyse the latest data, including patterns and characteristics of people testing positive, and will soon have a clearer understanding of the development.

To date over 68,000 people, almost 70% of the population, have been vaccinated in the Seychelles, reaching the target for herd immunity — indirect protection from an infectious disease when a population is immune either through vaccination or immunity developed through previous infection, according to the WHO.  

However, on 3 May the island recorded 500 new infections which has resulted in strict new lockdown measures being implemented a day after the spike in numbers. These include the closure of schools until 24 May and a ban on social gatherings including weddings, conferences, group sport events, graduations.

The case surge has raised questions regarding the efficacy of vaccination against the deadly virus and has shown the catastrophic consequences of relaxing public health measures. With less than 100,000 inhabitants, Seychelles is the smallest of any sovereign African country.  

Richard Mihigo, Immunisation and Vaccines Development Programme Coordinator at WHO, said the surge provided justification for the vaccination of more people in the country. “Until everybody’s protected, there is no reason why the disease will not continue in the country. So I think that is a very big illustration on how important it is to continue to vaccinate people,” Mihigo said.

There’s no official statement yet regarding the origin of the surge in new cases, but the global health organisation and local health authorities are carefully monitoring the development.

The island’s first COVID-19 cases were recorded on 11 March 2020 when a couple in their sixties travelled from Italy to the island. By 5 May this year, the smallest African country had recorded 6,273 cases and 28 deaths.

Analyses of Data to get to Root of Spike

The WHO said it is working with health officials in Seychelles to analyse the data and will soon have a clearer understanding of the development.

“Officials are already looking at the patterns and the characteristics of the people that are testing, whether they’ve been vaccinated or not, and then try to come up with a true picture of the situation that is going on in Seychelles,” Mihigo said.

Mihigo encouraged the Seychelles and other African countries to continue their vaccinations programmes,  taking into consideration the developments in Israel and the United States where the number of cases are dropping significantly due to the large number of people being vaccinated.

Dr John Nkengasong, Director of the Africa Centres for Disease Control (CDC),  also expressed his organisation’s willingness to help the government of Seychelles to understand the situation and to respond accordingly. 

While the scientists are researching the resurgence, citizens are also taking to social media to voice their opinions. Tessy Anne, who lives in Victoria in the Seychelles, said on Facebook that the surge in new cases may be as a result of poor enforcement of COVID-19 rules and regulations, especially for tourists visiting the country.

The Seychelles announced on January 14, 2021, that visitors from all over the world who are fully vaccinated against COVID-19 will be able to visit without going through quarantine. The rules for opening up the East African island country known for its beaches and giant tortoises, could point the way forward for tourism after vaccines become more widely available.

“It’s time for the Ministry of Health to strictly emphasise that all visitors wear their masks in public. Too often they are seen walking about without a mask. Sometimes police officers also see them but do nothing, yet they fine Seychellois who they see not wearing a mask,” she said. 

Seychelles Urgently Needs to Regain Socio-economic Loss

According to the United Nations Development Program (UNDP) 62-page assessment of the socio-economic impact of COVID-19 in Seychelles, the country’s GDP shrunk by 11.5% and unemployment rate rose from 2.7% in 2019 to 4.8% in the first half of 2020. Between March and September, 1,300 employees were retrenched and  4,000 applications by migrant workers were cancelled. There has been a 70% loss in tourism revenue.

Naadir Hassan, Minister of Finance, Economic Planning and Trade, noted in the report on the socio-economic report, that his and other tourism-dependent Small Island Development States, have been most affected by the pandemic, and face slow recovery as long-haul travel will take longer to return to normal. 

Experts are aiming to reawaken the discourse on diversification of the economy since the pandemic has clearly demonstrated the vulnerabilities that come with over-reliance on the tourism sector. 

But in the immediate term, all efforts are geared towards preventing the spread of the virus, investing in measures to stimulate local economic activity, support social cohesion, and address rising unemployment, in addition to ensuring the mechanisms for innovative and sustainable financing in the face of the growing debt burden remain at the core of the government’s response.

Seychelles kickstarted COVID-19 vaccination in Africa with the  country’s president, Wavel Ramkalawan being one of the first to receive the Sinopharm COVID-19 jab which he publicly received, an action that was geared towards getting more citizens to trust and receive the vaccines. 

Seychelles has been getting vaccines from different sources including a donation of 50,000 doses of China’s Sinopharm vaccine from the government of the United Arab Emirates and  100,000 doses of the Oxford-AstraZeneca vaccine from the Government of India.

Back to Masks

Seychelles President Wavel Ramkalawan was one of the first to receive a COVID-19 vaccine.

Oyewale Tomori, Nigerian professor of virology and chairman of Nigeria’s Ministerial Expert Advisory committee on COVID-19, told Health Policy Watch that poor communication regarding COVID-19 vaccines could create confusion. 

He noted that while the vaccines may not be able to stop infection, they can ensure the infections do not result in severe life-threatening diseases.

He added that efforts need to be made towards encouraging Africans not to get tired of observing the recommended measures including proper masking.

Thabani Maphosa, Gavi Managing Director for Country Programmes, added that health measures such as wearing face masks will go a long way in keeping the pandemic under control in the light of the paucity of vaccine doses.

“If anyone is still walking out there without a mask, it is like working out of your house naked and it is horrifying. We need to stand up to the virus,” Maphosa said.

Image Credits: Roadgoat, Seychelles government.

Bloomberg Philanthropies is supporting cities’ COVID-19 prevention effort

CAPE TOWN – The city is planning a vaccine outreach campaign aimed at encouraging an estimated 530,000 homeless people and migrants to get vaccinated.

Cape Town is one of 18 cities that has been chosen by Bloomberg Philanthropies’ ‘Healthy Cities’ initiative for a grant of up to $50,000 to support vaccine distribution to reach high-risk populations.

The city plans to use the grant for advertising on minibus taxis, mobile billboards and sky banners, and to fight misinformation via radio ads. In addition, vaccine registration units “will partner with trusted community leaders and hold socially distanced face-to-face consultations with people in hard-to-reach areas”, according to a news release. 

“It is important that, while our communities have access to health care, they also have access to reliable health information,” said Cape Town mayor Dan Plato. “We’ve seen the power of working with trusted local voices to share COVID-19 safety messages with vulnerable people earlier in the pandemic, and we plan to build on those efforts to encourage vaccination for all.” 

South Africa is currently only vaccinating health workers due to vaccine shortages but will start vaccinating those over the age of 60 on 17 May.

Buenos Aires in Argentina, will tackle a vaccine hesitancy problem among older homeless or isolated adults, using targeted messaging and by training formerly homeless “peer companions” for local outreach. 

Ending The Pandemic Everywhere

Phnom Penh in Cambodia will improve vaccine logistics and delivery, including acquiring new cold storage equipment to protect the vaccines as the onset of the local rainy season slows road travel.  

Brazil’s Rio de Janeiro will use the new funds to reach transgender people who are unhoused or in otherwise high-risk or isolated situations. 

Bloomberg Philanthropies founder Michael Bloomberg said that “local leaders have helped spearhead the world’s response to the pandemic from the beginning, and that now includes pushing to ensure vaccinations happen as quickly as possible, especially in high-risk communities”. 

Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus, described the equitable distribution of vaccines as “not only a moral imperative, it is also an epidemiological and economic imperative”.

“As long as this virus is transmitting anywhere, the higher the chances that a variant will emerge that evades vaccines, and the longer the global economic recovery will take,” said Dr Tedros.

“We simply will not end the pandemic anywhere until we end it everywhere. These grants will support city leaders to reach some of the most vulnerable groups with vaccines.” 

Founded in 2017, the Partnership for Healthy Cities has grown into a network of 70 cities around the world committed to saving lives by preventing non-communicable diseases, such as heart disease, diabetes, chronic lung disease and cancer, and injuries. 

In March 2020, Bloomberg Philanthropies expanded support to help member cities by providing tools and information for COVID-19 prevention and mitigation measures as part of a $40 million Bloomberg Philanthropies COVID-19 Global Response Initiative. 

“Cities are drivers of public health and over the past year have mounted a remarkable COVID-19 response. The path to widespread vaccination is complex and requires detailed planning, coordination, data management, and logistics support by urban leaders and their staff,” said José Luis Castro, CEO of Vital Strategies, which is a partner in the initiative.

“We look forward to using our expertise to help cities improve their ability to reach high-risk communities as they develop and implement equitable policies and practices to safeguard health and rebuild stronger health, social, and economic systems.” 

Image Credits: Bloomberg Philanthropies.

WTO Director-General Ngozi Okonjo-Iweala

World Trade Organization’s (WTO) director general Ngozi Onkonjo-Iweala on Thursday hailed the United States government’s decision to support the suspension of intellectual property rules on COVID-19 vaccines – while also emphasising the urgency of even more immediate actions to increase vaccine supplies to lower-income countries.  

In a statement after a two-day closed-door WTO General Council meeting, Onkonjo-Iweala said she “warmly welcomed” the US’s willingness to “engage with proponents of a temporary waiver of the TRIPS agreement to help in combating the Covid-19 pandemic”.

“We need to respond urgently to COVID-19 because the world is watching and people are dying,” Onkonjo-Iwela said, in a carefully measured statement. That statement also underlined the fact the lead sponsors of the blanket waiver, South Africa and India, were revising their proposal to reconcile the deep differences among high- and low-income WTO member states. 

“I am pleased that the proponents are preparing a revision to their proposal and I urge them to put this on the table as soon as possible so that text-based negotiations can commence,” Onkonjo-Iweala said. 

“It is only by sitting down together, that we will find a pragmatic way forward, acceptable to all members, which enhances developing countries, access to vaccines, while protecting and sustaining the research and innovation, so vital to the production of these life saving vaccines.”

The global trade body has for months been facing calls by a group of 60 low-income countries, led by India and South Africa to temporarily remove the intellectual property protections on COVID-19 vaccines, medicines and tests, which are governed by the WTO’s Trade Related Aspects of Intellectual Property (TRIPS).

Proponents say this would help boost medicines and vaccine production in developing countries that so far have received far fewer jabs – as well as oiling the wheels of international trade – in which developing countries that produce generic or biosimilar versions of drugs and vaccines, can face IP barriers in producing and exporting those products to other countries in need. 

Until now, however, most leading developed countries, as well as the pharma industry, have opposed the blanket waiver, saying that it would not really serve to ramp up technologically complex medicines or vaccine production. The US change in position vis a vis vaccines, at least, under the new administration of President Joe Biden, is a significant shift that could pull other countries along too – particularly the European Union.

Already on Thursday, New Zealand’s trade minister, Damien O’Connor, said that the country would align with the initiative for an  IP waiver on vaccines. “We welcome the US announcement and look forward to taking this forward with urgency.”  

And European Commission President Ursula von der Leyen signalled that the EU might also reconsider its previously staunch opposition to the TRIPS waiver, saying “we are open to discuss any other effective and pragmatic solution.”

Speaking at the European University Institute in Florence, Italy, Von der Leyen said that the EU was ready to discuss the US-backed proposal.

But she also called upon all vaccine-producing countries to immediately remove export limits on their products and avoid other measures that disrupt supply chains – a thinly-veiled criticism of the United States and the United Kingdom’s moves that have, at times, limited exports of vaccines or their inputs. 

Mood At WTO General Council More Constructive

WTO spokesman Keith Rockwell

At a press briefing on Thursday, WTO Spokesperson Keith Rockwell noted that the “‘mood was very different” and “discussions were constructive” at the General Council meeting following the announcement by US Trade Representative, Ambassador Katherine Tai, Wednesday evening, in a statement that declared:

“This is a global health crisis, and the extraordinary circumstances of the Covid-19 pandemic call for extraordinary measures.”.

Said Rockwell: “Clearly, there is a change in the atmosphere,” adding that while the US support does not guarantee an agreement, it signals a ‘very different dynamic’ from the United States, which is a key WTO player – that will move the negotiations to a concrete text formulation.

“Without this kind of change, an agreement could not be possible. And we don’t tend to come up with agreements by magic. These agreements tend to arise when we have when we have a text from which to negotiate,” Rockwell said.

Global Health Experts Applaud the United States’ Leadership 

The US move has been widely applauded by many leading global health experts – although opposed by industry voices as something that won’t really achieve the aim of ramping up needed.

“This is a game changer. US is stepping up. Doing the right thing. Doing the smart thing,” said Lawrence Gostin, Director of a WHO Collaborating Center on Global Health Law, on Twitter.

“I never thought I would live to see the day the US used its political muscle to waive IP rights against the implacable opposition of the pharma industry,” added Gostin. He described the pandemic as a ‘long game’ that could rage globally for many years until everyone is vaccinated. 

“The answer isn’t only sharing a scarce supply of vaccine doses, even if that is still important. It’s also vital to build capacity globally so that there’s enough doses for everyone. A win-win.” 

Conversely, a statement by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) warned that: “Waiving patents of COVID-19 vaccines will not increase production nor provide practical solutions needed to battle this global health crisis.

“On the contrary, it is likely to lead to disruption, while distracting from addressing the real challenges in scaling up production and distribution of COVID-19 vaccines globally.”

In a BBC interview, IFPMA Director-General Thomas Cueni said he was “even more concerned” about bolstering pandemic preparedness in the wake of the US change in position.

“Here you had 300 plus vaccine developers engaged in trying to be the first to the finishing line on COVID-19, trusting that the legal framework would be honoured. Now, with this precedent, if it is carried through, the message for future pandemic preparedness to investors, to companies is ‘don’t count that this legal framework will be honoured” – if there is a crisis, the patent will be ignored, which is not really the incentive you need.”

The so-called “Ottawa Group-plus”, led by Canada and including a mix of high- and lower-income WTO countries, have meanwhile tried to advance a more general declaration on Trade and Health, which would aspire to eliminate export restrictions on vital COVID-19 health products and curb vaccine nationalism.  But many other WTO members, including not only the sponsors but other Latin America countries, have said that the initiative falls short of achieving real impacts.

“What they said was that these things do not go far enough,” said Rockwell, reporting on the results of Thursday’s WTO General Council session. “And reference was made on a number of occasions to the need to have a waiver of TRIPS that this is really a critical tool for combating this. Many countries have spoken up in favour of the statement made by Katherine Tai yesterday.”

Image Credits: Africa Centre for International Trade&Development, WTO.

Low-and-middle-income countries have made significantly less progress than high-income countries in implementing hand hygiene and infection prevention programmes that can stop deadly diseases, from diarrhoea to COVID-19, according to a recent A World Health Organization survey of 88 countries. 

And one in four health care facilities in poorer countries do not have basic water services and one in three lacks hand hygiene supplies, said WHO, marking World Hygiene Day on Wednesday.  

Meanwhile, universal access to safe drinking waters, sanitation and hygiene, are unlikely to be met unless affordability is addressed and monitored – according to a new report by UNICEF and WHO, released on World Hygiene Day.  Improved monitoring of “affordability” indicators will ultimately allow governments and the water, sanitation and hygiene (WASH) sector to more effectively target support and to make WASH services affordable to all.  

Good Hygiene Critical to Stopping COVID-10 – as well as Other Deadly Diseases

Good hygiene practices remain  a “serious challenge” at any time, but more so when the world is fighting the deadly COVID-19 pandemic, WHO said in a statement.     

“COVID-19 has dramatically demonstrated just how important good hand hygiene practices are in reducing the risk of transmission, when used as part of a comprehensive package of preventative measures.

“For example, in some low-and-middle-income countries, only one in 10 have workers who practice proper hand hygiene while caring for patients at high-risk of health care susceptibility infection in intensive care units.  While, also in high-income countries, hand hygiene compliance rarely exceeds 60% to 70%.”

Moreover, few low-income countries have the capacity to monitor Infection, Prevention and Control (IPC) effectively.  A new WHO online monitoring portal will help countries identify and address gaps. The first ever IPC monitoring portal is a protected online platform for countries to collect data in a standardised and user-friendly manner and download their situation analysis following data entry along with advice on areas and approaches for improvement. 

Infections acquired in health care settings like hospitals and clinics affect millions of patients and health workers globally. Europe alone records nearly nine million infections yearly, said the U.N. agency. 

But  highly effective and low-cost hand hygiene strategies are available that could reduce these infections by half.

“Half these infections can be avoided by implementing effective IPC practices and programmes, including hand hygiene improvement strategies. Such strategies can also prevent 3 out of 4 the AMR-related deaths that occur in health care facilities.”

The organisation has also declared 2021 the “Year of the Health and Care Worker”, and in relation to that, evidence has shown that appropriate hand hygiene practices reduce infections during health care delivery:

“So, engaging different health professionals, as well as patients and everyone in the society in World Hand Hygiene Day 2021 is critical also to supporting the “Year of Health and Care Workers”.

Image Credits: Pixabay.

A new report recommends that governments prioritise funding and support for midwifery amid a global shortfall of 900,000 midwives.

Two in every three deaths in childbirth could be prevented by 2035 if the world starts recruiting and training more midwives, a new report on the “State of World’s Midwifery 2021” has found.

The report, launched by the UN Population Fund (UNFPA) on Wednesday found a  global shortfall of 900,000 midwives – and said that the global midwifery workforce needs to be expanded by some 30% to close that gap.

Compiled by the UNFPA, the UN’s sexual and reproductive health agency (UNFPA), WHO (World Health Organization), the International Confederation of Midwives (ICM) and other partners, the report evaluates the midwifery workforce and related health resources in 194 countries.

It states that for “midwives to achieve their life-saving and life-changing potential, greater investment is needed in their education and training, midwife-led service delivery, and midwifery leadership”.

Governments must prioritise funding and support for midwifery and take concrete steps to include midwives in determining health policies.

“Midwives play a vital role in reducing the risks of childbirth for women all over the world,” said WHO director general Dr Tedros Adhanom Ghebreyesus.

Increasing their numbers will “deliver a triple dividend in contributing to better health, gender equality and inclusive economic growth,” he said.

The last State of the World’s Midwifery report, published in 2014, also raised the alarm over shortages and provided a roadmap on how to remedy this deficit. But progress over the past eight years has been too slow, the report found. The analysis in this year’s report shows that, at current rates of progress, the situation will have improved only slightly by 2030.

ICM president Franka Cadee said “midwives are continually overlooked and ignored” and called on “governments to acknowledge the evidence surrounding the life-promoting, life-saving impact of midwife-led care, and take action on the report’s recommendations”.

Almost one in five women give birth without a skilled health provider, exposing both mothers and babies to risk,  the report  further found.

It gives the latest stillbirths estimates at about two million a year, along with an estimated 2.4 million new-born deaths and some 295,000 maternal deaths, either during or soon after pregnancy.

Describing the report’s findings as “alarming”, UNFPA executive director Dr Natalia Kanem  said 1.1million more essential health workers are needed  to deliver sexual, reproductive, maternal, newborn and adolescent health care, and 80 per cent of these missing essential health workers are midwives.

“A capable, well-trained midwife can have an enormous impact on childbearing women and their families – an impact often passed on from one generation to the next,” Kanem said.

The lack of midwives, the report states,  is driven by gender inequality, with countries overlooking sexual and reproductive health and under-estimating the value of a female-dominated workforce.

Fixing the gaps in provision could save an estimated 4.3 million mothers and babies a year, cutting two in three needless deaths by 2035, said analysis conducted for the report published in The Lancet medical journal last December.

The report urged governments to put money into boosting midwife numbers, improving training and offering midwives a greater role in health policy and maternal healthcare.

Image Credits: WHO, WHO SEARO.