African health experts reflect on lessons learnt from the pandemic.

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

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

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

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

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

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

Building the health workforce

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

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

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

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

 Changing the care model

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

Director-General Dr Tedros Adhanom Ghebreyesus

UK lifts travel ban amid community transmission

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

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

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

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

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

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

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

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

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

Real-world evidence of impact on vaccines

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

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

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

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

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

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

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

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

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

 

Image Credits: Govind Krishnan/ Unsplash.

WHO’s Martin Friede

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

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

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

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

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

New hub on viral vectors?

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

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

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

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

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

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

WHO and Medicines Patent Pool provide governance

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

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

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

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

 

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

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

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

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

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

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

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

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

Six-year platform to reach 120,000 children 

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

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

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

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

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

High prices of medicines complicate availability

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

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

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

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

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

Twelve countries to participate in pilot phase 

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

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

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

Image Credits: WHO.

 

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

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

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

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

COVID-19 and alcohol

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

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

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

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

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

Young and poor people are particularly affected

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

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

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

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

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

Adam Karpati
Princess Dina Mired

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

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

 

Image Credits: Drug Helpline .

plastic

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

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

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

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

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

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

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

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

Growing demand

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

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

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

Plastics in surface soil reduce crop yields

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

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

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

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

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

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

Absence of international policies on agro-plastics use

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

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

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

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

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

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

Report Details Health Crisis Hidden In Plastics Lifecycle

 

 

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

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

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

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

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

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

Less severe so far – but early days

South African health minister, Dr Joe Phaahla

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

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

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

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

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

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

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

Hospital at epicentre

Tshwane Omicron cases

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits: Gauteng Department of Health.

Violence against health workers has increased despite the adoption of a UN resolution in 2017.

Despite death threats from rebel Chechens and Russian forces, Dr Khassan Baiev saved and treated countless lives from both sides of the Chechen wars. He did not waver from what he considered was his ethical duty as a doctor, and yet he was targeted and punished for his actions. 

His story, and the stories of many other heroic healthcare workers, who continued to provide care despite the dangers they faced during conflicts, are brought to life in Leonard Rubenstein’s new book, Perilous Medicine: The Struggle to Protect Care from the Violence of War. 

While there has been increasing discussion regarding the problem of violence against healthcare workers, such conversations often do not include the voices of healthcare workers themselves. 

Rubenstein and other global health experts reflected on the need to humanize these experiences of health workers during a Global Health Centre’s (GHC) launch of Perilous Medicine, and also considered long-term solutions to an increasing trend of attacks against the health sector. 

Leonard Rubenstein, Professor of Practice, Johns Hopkins Bloomberg School of Public Health

“Right now we’re in a situation where the violence continues. There’s been international paralysis, and we need to find ways to assess what is an extremely serious problem,” said Rubenstein, a professor at Johns Hopkins University.

In addition to extensive research, first-hand experience, and compelling personal stories, Perilous Medicine also offers lessons from the international community on how to move forward to protect both people suffering in war and those on the front lines of health care in conflict-ridden places around the world. 

Five reasons why combatants justify attacks 

Rubenstein has created a framework of five reasons why combatants justified attacks on healthcare, namely: to prevent enemies from being treated and returning to fight; to undermine support for rebelling forces; for tactical advantage of taking over a hospital or health centre; refusing to distinguish between military and civilians; and to exploit distrust in government. 

The sources of restraint that can ameliorate or prevent harm to health workers include leadership, domestic or international pressure and accountability, Rubenstein added. 

However, while UN Security Council Resolution 2286, passed in 2016, was one such source of restraint, condemning violence and threats against the wounded and sick, against medical and humanitarian personnel exclusively engaged in medical duties, and against healthcare resources. But the attacks have only increased since.    

More than 700 healthcare workers and patients have died, and more than 2,000 have been injured in attacks on health facilities across 17 emergency-affected countries and fragile settings since December 2017, according to a WHO report released in August. 

Rubenstein called on the global health community to draw its attention towards this pressing issue that seeps into other sectors of health. 

“We need to go beyond the humanitarian, human rights community to address the problem. We talk about the need to develop health systems and universal healthcare – both of those are threatened when health systems are destroyed.” 

More than accountability needed 

Maciej Polkowski, Head of Health Care in Danger Initiative at the International Committee of the Red Cross

Beyond holding the right people accountable for these attacks, there is a need to create lasting change and diminish the violence by engaging with both government and civil society. 

“We often see [violence against healthcare] as merely a problem of accountability, as a collection of outrageous incidents that have to be met with international condemnation and criminal prosecution, if possible,” said Macief Polkowski, International Committee of the Red Cross (ICRC). 

But Polkowski notes that “the arsenal of responses we have at our disposal is far greater.”

“A lot can be done in terms of technical responses, advocacy – these can have practical and concrete effects in terms of diminishing some of these attacks.” 

These “untapped avenues” include engaging with Ministries of Health at the national level to working with professional medical associations. But these efforts require global solidarity and support from both parties.

“[Ministries of Health and medical associations] can take the next step of urging policy changes at the domestic level,” said Rubenstein.

This includes changing counterterrorism laws, demanding militaries adjust their rules of operating in the field, and making sure the voices of those in healthcare in conflict settings are heard. 

Local healthcare workers bear brunt of attacks

Aula Abbara, Honorary Senior Clinical Lecturer in Infectious Diseases at Imperial College and Chair of Syria Public Health Network

Shifting the focus away from the humanitarian workers of high-income countries, whose actions and stories often take center stage, Perilous Medicine instead highlights the individual stories of local healthcare workers.

“Healthcare workers that come from abroad, who come into these conflict settings, are often glorified, or treated as heroic. Whereas actually, the local healthcare workers are the ones who bear the brunt of such attacks on health care in their local communities, on their healthcare facilities, day in and day out,” said Aula Abbara of Imperial College and Chair of Syria Public Health Network. 

Abbara notes how tremendously important it is to talk to the healthcare workers directly involved in the line of conflict, as Rubenstein had done in his book.

“We can all state that more than 900 healthcare workers have been killed directly during the conflict, but every single one of those [who died] has a story.” 

Moderator Tammam Aloudat echoed Abbara’s sentiments about Perilous Medicine: “The genuine way of delivering stories in this work, the ability for us to actually see people rather than statistics, to talk about something that hurts rather than something that gets conceptualized as an academic exercise is one of great significance.” 

Image Credits: International Committee of the Red Cross, GHC.

Dr Richard Mihigo, WHO Africa Coordinator of Immunization and Vaccine Development,

There has been a substantial increase in COVID-19 vaccine deliveries to Africa in the past four weeks, with around 20 million doses arriving every week at present – but only six countries out of 54 African countries will reach the global target of vaccinating 40% of their population by the end of this year.

This is according to Dr Richard Mihigo, WHO Africa Coordinator of Immunization and Vaccine Development, who said that “millions of people are without protection against COVID-19 and this is simply dangerous and untenable”. 

Most countries had used 60-80% of their allocations, and only two were lagging behind with only 10% of supply used, Mihingo told the regional body’s media briefing on Thursday

However, Mihingo said the WHO, UNICEF and COVAX had appealed to all countries that were donating vaccines to ensure that they were not expiring soon.

“We have seen the issues that have been created by the vaccines that are coming with a very short shelf life, as these pose additional challenges when it comes to the rollout of these vaccines,” he said.

Nigeria faced media criticism this week for destroying one million doses donated from Germany, but it transpired that they had been due to expire within a month of delivery.

Serum Institute of India ‘let Africa down’

In response to the claim from the Serum Institute of India (SII) that it was halving the production of its Astra Zeneca vaccines because of low demand including from Africa, Mihingo pointed out that it was SII that had stopped supplying Africa.

Mihingo said that the SII’s decision to suspend all the export of vaccines to COVAX in April had “created a lot of issues in this region”. 

“Some countries were left without provision of a second dose,” added Mihingo. “In the meantime, countries moved on and looked for alternatives. And if we look at the current pipeline in the COVAX forecasts, this is quite very promising. We are expecting to receive between 800 million to almost one billion doses through COVAX [this year] and this number is going probably to double next year. 

“I think we have now enough vaccines that are going to come through the COVAX mechanisms, and the challenge is now in deploying them,” he added.

Earlier in the day, Dr John Nkengasong, Executive Director of Africa Centres for Disease Control (CDC) said bluntly that the SII had “acted unprofessionally”, let Africa down and created mistrust when it had suspended its vaccine exports despite having committing to supplying African countries via COVAX.

Omicron in 11 African countries

WHO Africa virologist Dr Nicksy Gumede-Moeletsi

While 57 countries worldwide have identified the COVID-19 Omicron variant, only 11 of these are in Africa – and only six in southern Africa, which is on the receiving end of travel bans from around 70 countries.

Of the 14 countries in southern African, Botswana, South Africa, Namibia and Zambia have officially notified the World Health Organization (WHO) Africa of the presence of Omicron, and Zimbabwe is also expected to confirm the variant’s presence, said WHO virologist Dr Nicksy Gumede-Moeletsi. 

Mozambique has also reported cases, according to the Africa Centre for Disease Control and Prevention (CDC).

Gumede-Moeletsi added that around 50 of the 55 African member states had the ability to do genome sequencing of viruses themselves.

A regional genomic sequencing laboratory based in South Africa is currently supporting the 14 southern African countries and has increased its samples sequenced to 5000 every month.

However, the continent has experienced a 88% increase in COVID-19 cases in the past week, with 79% of these new cases coming from southern Africa followed by 14% in the northern region, according to the Africa Centre for Disease Control and Prevention (CDC).

“We are watching the situation in South Africa very carefully and over the past seven days,  we have seen a major increase in the number of cases, almost 255% increase in the number of cases.. And an almost 12% increase in hospitalisations,” said Mihingo.

“Encouragingly emerging data from South Africa suggests that Omicron may cause less severe disease,” he added, with only 6.3% of ICU cases being related to COVID-19 cases.

Africa collaborates on genome sequencing

WHO head of operational partnerships Dr Thierno Balde

Nigeria, Ghana, Uganda, Senegal and Tunisia have also confirmed the presence of Omicron.

Professor Christian Happi, Director of the African Center of Excellence for Genomics of Infectious Diseases (ACEGID) at Redeemer’s University in Nigeria, said that a “handful” of Omicron cases had been detected in Nigeria but the country was not experiencing a surge.

Happi’s centre is providing laboratory training in genomic sequencing to 16 other African countries.

Describing Africa’s genome sequencing ability as “very robust although not consistent in all countries”, Happi said there were also centres of excellence in Ghana and Senegal.

“What is beautiful about what is happening during this pandemic is that there is strong cooperation among African countries. We are collaborating, and we’re supporting all African countries,” said Happi.

Condemning the travel bans against African countries that had detected Omicron, WHO head of operational partnerships, Dr Thierno Balde, appealed to countries to “apply the International National Health regulations, especially by implementing the scientific evidence-based interventions at the point of entries” rather than travel bans.

He said some countries appeared to be reconsidering their “hasty and emotional” decisions, and the WHO hoped to see the reversal of the travel bans that were having a serious economic impact on countries.

Happi described Canada’s refusal to accept PCR tests from South Africa for its citizens travelling back from that country, as “ridiculous”.

“If Canada is accepting the existence of Omicron that was detected in South Africa, then it’s ridiculous for them not to accept testing from that country. It is not only discriminated but very ridiculous,” said Happi.

 

Teachers in Kenya getting vaccinated. Will everyone now need a booster shot?

Shortly after the release of research showing reduced efficacy of the two-jab Pfizer-BioNTech COVID-19 vaccine against Omicron infection, but better protection with boosters, the World Health Organization (WHO) cautioned that more research is still needed to draw definite conclusions about vaccine strategies in the face of the new variant wave. 

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

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

“Sera obtained from vaccinees one month after receiving the booster vaccination neutralized the Omicron variant to levels that are comparable to those observed for the wild-type SARS-CoV-2 spike protein after two doses,” according to a statement from Pfizer.

While double-vaccinated people had a “more than a 25-fold reduction in neutralization titers” against Omicron, they would likely still still be protected against severe disease thanks to their T cells which are not affected by the Omicron mutations, according to Pfizer.

“Although two doses of the vaccine may still offer protection against severe disease caused by the Omicron strain, it’s clear from these preliminary data that protection is improved with a third dose of our vaccine,” added Pfizer CEO Albert Bourla.

Late Wednesday, South Africa’s medicine regulatory authority approved boosters for all adults over 18 who had been vaccinated at least six months ago, and for all immunocompromised people over the age of 12 vaccinated at least 28 days ago. No other southern African countries have authorised boosters yet, although the region was the first to detect Omicron.

WHO says Pfizer results are preliminary & top priority remains jabs for the unvaccinated

Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals,

In a press briefing later Wednesday afternoon, Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals, said that the WHO was “very much interested” in the Pfizer findings, but these were preliminary and only concerned one vaccine. 

“We are still very much in a Delta pandemic and so vaccinating all people, especially those at highest risk of disease, with our existing vaccines, continues to be the top priority,” O’Brien told the global body’s COVID-19 briefing on Wednesday.

WHO has spoken out repeatedly against mass administration of booster shots – saying that available vaccine supplies should instead be focused on getting jabs to less-developed countries, mostly in Africa, where less than 40% of  people have yet to get jabs.

Meanwhile, WHO Director-General Dr Tedros Adhanom Ghebreyesus called on all countries to share information about Omicron speedily, as what was happening in South Africa might not be the same as the rest of the world.

“Cases in South Africa are increasing quickly,” Dr Tedros told the media briefing. “However Omicron was detected when transmission of Delta was very low so it had little competition. It will therefore be important to monitor carefully what happens around the world to understand whether Omicron can outcompete Delta.”

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

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

New South African findings also show reduced efficacy from two-shot vaccines against Omicron

On Tuesday night, Alex Sigal of the Africa Health Research Institute in South Africa released research on 12 double-vaccinated people, which found a 41-fold reduction in neutralising Omicron. Six of the 12 subjects had also previously been infected by SARS-COV2 and five of these showed a high level of protection against Omicron.

However, the research showed that the variant still used the ACE receptor to bind to the spike protein.

But Swaminathan stressed that “[these studies] are only looking at one element, just the neutralising antibodies”.

“It’s premature to conclude that this reduction in neutralising activity would result in a significant reduction in vaccine effectiveness. The immune system is much more complex, with the T cells and the memory B cells. What we really need now is a coordinated research effort and not jumping to conclusions, study by study,” she added.

The WHO expects information about how infectious Omicron is on Friday, and said that a number of high-level scientific committees were examining Omicron.

WHO Chief Scientist Dr Soumya Swaninathan

WHO expert bodies are examining Omicron

“The technical advisory group for virus evolution is assessing Omicron’s effect on transmission, disease severity, vaccines, therapeutics and diagnostics and the effectiveness of public health and social measures,” said Dr Tedros.

The joint advisory group on COVID-19 therapeutics is analysing the possible effects of Omicron on treatment of hospitalised patients. 

The Research and Development Blueprint for Epidemics is convening researchers to identify knowledge gaps, and the studies needed urgently to answer the most pressing questions. And the technical advisory group for COVID-19 vaccine composition is assessing impacts of Omicron on current vaccines, said Dr Tedros.

Describing the idea that viruses became less virulent as they evolved as “something of an urban myth”, the WHO’s Assistant Director-General for Health Emergencies, Dr Mike Ryan, said that even if this was the case with Omicron, if it generated more cases this would put pressure on health systems and more people die. 

“That’s what we can avoid. We cannot do anything about maybe the inherent qualities of a virus but we can prevent our systems coming under pressure,” stressed Ryan – through vaccination, masks and reducing social contact. 

Lift the travel bans – end ‘travel apartheid’

Dr Tedros thanked Switzerland and France for lifting their travel bans on southern Africa and called on other countries to do the same.

However, on Monday the UK added Nigeria to its red list, while many countries are only likely to reassess the bans after a month – way too late to salvage the Christmas tourist season in southern Africa.

The moves by developed countries to shut out travelers from southern Africa, or all of Africa in some cases, were last week denounced as “travel apartheid” by UN Secretary General Antonio Guterres.

Guterres said it was “unacceptable to have one of the most vulnerable parts of the world’s economy condemned to a lockout when they were the ones who  revealed the existence of a new variant.”

His comments were echoed this week by Nigeria’s Ambassador to the UK, Sarafa Tunji Isola, who told the BBC that “the reaction in Nigeria is that of travel apartheid.”

“Because Nigeria is actually aligned with the position of the UN secretary general that the travel ban is apartheid, in the sense that we’re not dealing with an endemic situation, we are dealing with a pandemic situation, and what is expected is a global approach, not selective,” Isola said.

Image Credits: Wish FM Radio.