A new study has found that there is a higher risk of blood clots from COVID-19 than vaccines.

The risk of developing a rare brain blood clot is eight to ten times higher in people infected with COVID-19 than those who get a vaccine, a new study has found.

The study by Oxford University last week reported that the risk of the rare blood clotting known as cerebral venous thrombosis (CVT) following COVID-19 infection is around 100 times greater than normal, several times higher than it is post-vaccination or following influenza.

The study follows investigations into links between the AstraZeneca vaccine and rare blood clots and also looked at those who had a Pfizer or Moderna vaccine. According to the study, four people in one million people experience CVT after getting the Pfizer or Moderna vaccine, versus five in one million people for the AstraZeneca vaccine. In comparison, 39 in one million patients who get COVID-19 develop CVT.

Rollouts of AstraZeneca’s vaccine have been halted or limited in many countries, based on concerns about blood clots.

Led by Professor Paul Harrison and Dr Maxime Taquet from Oxford University’s Department of Psychiatry and the NIHR Oxford Health Biomedical Research Centre, the study examined the health records of 81 million people in the US, looking at the number of CVT cases diagnosed in the two weeks following a diagnosis of COVID-19 and the number of cases occurring in the two weeks after people had their first coronavirus vaccine.

They then compared these to calculated incidences of CVT following influenza, and the background level in the general population. The risk of a CVT from COVID-19 is about 10 times greater than the mRNA and eight times greater than the AstraZeneca vaccine. In addition, 80% of people who developed the clots survived.

Reassuring Findings

Based on US data, the Oxford research team said people being vaccinated should be reassured by the findings.
The study has not been through a final review and is still a work-in-progress, but the researchers say it must be “interpreted cautiously because it is difficult to calculate with certainty how common CVTs are in the general population, partly because of just how rare they are”.

According to Harrison: “We’ve reached two important conclusions. Firstly, COVID-19 markedly increases the risk of CVT, adding to the list of blood clotting problems this infection causes. Secondly, the COVID-19 risk is higher than we see with the current vaccines, even for those under 30; something that should be taken into account when considering the balances between risks and benefits for vaccination”.

Prof Beverley Hunt of Thrombosis UK told BBC news that the mechanisms behind people getting clots after COVID-19 and those experiencing clots after vaccines were likely to be different.

“Patients who are hospitalised with COVID-19 have very pro-thrombotic (sticky) changes in their blood, which persist after they have been discharged. This will lead to an increased rate of blood clots.
“The mechanism for the very rare blood clots and low platelet counts seen after the AstraZeneca vaccine is different. It is associated with an immune response.”

People are “likely” to need a third dose of the coronavirus vaccine within 12 months of getting the first two doses of the Pfizer-BioNTech vaccine, Pfizer CEO Albert Bourla said during a recent interview.

The third booster jab could be necessary “somewhere between six and 12 months” after the second one and possibly even annually, Pfizer CEO Albert Bourla told CNBC television during a recording broadcast on 15 April.

“A likely scenario is that there will be likely a need for a third dose, somewhere between six and 12 months and then from there, there will be an annual revaccination, but all of that needs to be confirmed. And again, the variants will play a key role,” he told a CNBC reporter.

Bourla said that the Pfizer-BioNTech vaccine has proved to provide immunity for six months.

Variants “will play a key role” in how regularly people will need to have their COVID immunity topped up as time goes on – in a similar way to how flu vaccines are updated and re-administered year on year.

“But protection goes down by time. It is extremely important to suppress the pool of people that can be susceptible to the virus,” Bourla said. 

Earlier this month, Pfizer said its COVID-19 vaccine was more than 91% effective at protecting against the coronavirus and more than 95% effective against severe disease up to six months after the second dose.

Beyond the study of 12,000 vaccinated people, exactly how long immunity lasts with two doses “remains to be seen”, Bourla said. Researchers say more data is needed to determine whether protection lasts after six months. 

In February, Pfizer and BioNTech said they were testing a third booster dose of their COVID-19 vaccine to better understand the immune response against new variants of the virus.

Nadhim Zahawi, the UK’s Minister for Business & Industry and COVID Vaccine Deployment, has said that his country’s top four priority groups could be invited for a third booster dose as soon as September.

The over-80s, clinically extremely vulnerable, health and social care staff and care home workers were the first to be vaccinated against coronavirus in December and the first weeks of this year.

They were offered the Pfizer-BioNTech or the Oxford-AstraZeneca jab, but Zahawi says he expects eight different vaccines to be available later in the year.

In the US, health officials are already preparing for booster doses to be issued between nine and 12 months after people are fully vaccinated.

This would mean a third dose for people who have received the Pfizer or Moderna jabs and a second dose for the Johnson & Johnson single-shot vaccine. 

Bourla’s comments come after Johnson & Johnson CEO Alex Gorsky told CNBC in February that people may need to get vaccinated against COVID-19 annually.

 

 

 

 

 

 

 

Image Credits: Flickr – World Economic Forum.

Polluted air in New Delhi

NEW DELHI, India – Delhi State aims to fight air pollution as a “mass movement” with public participation,  according to Environment Minister Gopal Rai – but a recent conference he called with experts on the issue concluded with no firm commitments.

Rai convened the two-day virtual conference with air pollution experts and clean air advocates to brainstorm ideas for a “long-term action plan to tackle pollution” ahead of north India’s seasonal winter peaks.

New Delhi is the most polluted city in the world and on certain days citizens are exposed to such poor air quality that it is the equivalent of smoking 40-50 cigarettes per day.

“The government will focus on changing the mindset and behaviour of people,” Rai told the meeting. “Within the constraints of the pandemic and restrictions on mass mobilisation, we need to create a mass movement. Our three-pronged approach needs to focus on policy, technology and making the environment a mass concern,” he said. 

Although the government has taken some steps, including an electric vehicle policy (aiming for a quarter of new vehicles licensed to be electric by 2024) and introducing bio-decomposers to curb stubble burning, Rai admitted these were not enough.

Delhi state Environment Minister Gopal Rai

“A plan is needed that can work through the year, and in the coming days we will come up with an action plan to further better Delhi’s air quality index. Nobody knows until when the pandemic will rage, and it’s not feasible to wait that long. We would like your suggestions to create a viable and effective plan for the city,” he said. 

“While we have identified hotspots, it is still challenging to measure the timing, the rate, source and impact of pollution. The Delhi government is working at a technological level to find appropriate tools to measure these indicators which would in turn help us devise the correct policy,” he explained.

However, no commitments were made at the meeting, and experts pointed out that a similar meeting had been called in February 2020, which yielded little in terms of actual pollution control.

Lots of Ideas, But No Follow Through

There is no dearth of ideas on how to control pollution – from banning the manufacture of firecrackers to installing filters in the chimney stacks of industrial units to reduce emissions or mandating norms for fuel and engines. But none is popular because commercial interests are harmed, and defensive lobbies are pushing back in courts.

In October last year, the Delhi government had announced a “war on pollution,” with great fanfare, led from a war room personally commanded by Chief Minister Arvind Kejariwal. 

His arsenal comprised a seven-point action plan that included:  tracking the city’s hotspots; launching a ‘green Delhi’ mobile app to address open air burning complaints; and repairing the city’s potholed roads to control dust. 

His most powerful weapon at the time was a cheap and simple rapid compost brew, Pusa Decomposer, that Kejriwal had hoped would inspire farmers in surrounding rural states to turn their crop waste into valuable fertilizer rather than burning it. 

Rai told the conference that teams from the adjoining states of Punjab and Haryana had visited a government decomposer pilot, but didn’t offer more details or any commitments made by them to adopt the decomposer.

Unexpected Revival of Air Quality Management Body

The experts suggested taking a proactive, year-round and an airshed approach to reducing air pollution, working collaboratively with neighboring states; creating walking and cycling paths, improving public transport, managing garbage better, choosing cleaner fuel, encouraging electric vehicles for transport and delivery, and enforcing existing pollution control laws. 

The meeting follows an unexpected move by the federal government to approve the re-promulgation of an ordinance to set up a statutory body to manage air quality in India’s polluted National Capital Region, which includes Delhi, and adjoining areas of the Indo-Gangetic plain, which includes Punjab, Haryana, Rajasthan and Uttar Pradesh. Significantly, the new ordinance envisages an expanded statutory body that will include the interests of the farming, industry and construction sectors.

The ordinance was first promulgated last October at the peak of north India’s annual ‘airpocalypse’, before being inexplicably allowed to lapse last month, when air quality was beginning to improve slightly. 

But a recent meeting of federal ministers and their bureaucrat counterparts approved the re-promulgation of the ordinance, and the government is expected to introduce it as a Bill in the monsoon session of Parliament, according to environment secretary RP Gupta.

There has been no official word on this development but Solicitor General Tushar Mehta, who represents the government in the courts applied to court to place the ordinance on record, which was accepted by the court. 

Once the ordinance is re-promulgated and enacted by presidential decree, the commission is expected to be reconstituted with most of the original members. Although there is no official notification as yet, the original members are expecting to be retained, according to government sources who declined to be named.

The erstwhile 18-member Commission on Air Quality Management (CAQM) had been headed by M.M. Kutty, a former bureaucrat who had once headed the ministry of petroleum and natural gas. The other members included Arvind Nautiyal, a joint secretary in the environment ministry, KJ Ramesh, former head of the India Meteorological Department and Ashish Dhawan of the Air Pollution Action Group as an NGO representative.

Key stakeholders including the health, agriculture, rural development and labour ministries, had been left out. 

Sources told Health Policy Watch that the government let the ordinance lapse because the CAQM’s ability to prosecute polluters meant it could impose stringent penalties on farmers for burning crop stubble.

“The farmers’ protests have become a very sensitive topic,” the source said.

Until March, the CAQM was functioning out of a temporary space in the office of the Indian Oil Corporation, and meeting every two to three weeks to outline and discuss its strategy. It had started working on a pilot project on estimating hyper-local pollution using curb-side laser measurements of vehicular pollution.

“The committee had made decent progress,” a source said, noting that if a brand new committee is constituted, this progress would be lost. 

“The only concern we had was around funding. It is still not clear where the funds will be allocated from,” another person close to the committee said. 

They added however that they expect the commission to retain its statutory powers, including those empowering it to impose strict penalties on polluters. These penalties include a jail term of up to five years as well as fines.

The unexpected, and unexplained, dissolution and, now, re-promulgation has taken atmospheric scientists and clean-air advocates by surprise. “#CAQM on the way back; for real or just another charade?” Bhavreen Kandhari, a clean air activist, tweeted.

“The CAQM is a major improvement over the EPCA. The devil is in the details, what is the fund allocation, how large will be the secretariat, how will it be able to carry out punishment and fines, etc. – all this need to be known,” Dr Laveesh Bhandari, economist and director of the Indicus Foundation, said. “It is these details that will decide whether this initiative will be effective.”

 

Image Credits: Neil Palmer.

infectious disease
A villager’s eyes are being examined for African eye worm by Dr Philippe Urwotho, a medical doctor and Provincial Coordinator of the DRC’s Neglected Tropical Disease National Programme.

Global funding to develop new drugs for some of the world’s leading infectious disease killers, such as HIV/AIDS, TB, and malaria, was US $3.876 billion, with the drop of US $185 million from 2018 reflecting COVID-related difficulties in data collection, according to the G-Finder Report, which tracks annual global investments.

However, once participation is accounted for, the report estimates that 2019 funding was virtually unchanged from its record high in 2018, with only a marginal decline of US $8 million. 

On the other hand, funding for neglected tropical diseases (NTDs) remains stagnant as it had for the past decade, with most NTDs seeing little change to their individual funding levels (although the majority did receive small increases), according to findings in the report, launched on Thursday by the Australia-based Policy Cures Research group. 

Mixed Signals in Global Trends; Policy Makers Need to Step Up to Address NTDs 
Nick Chapman, CEO, Policy Cures Research

The G-Finder Report is a comprehensive analysis of global investment into research and development of new products to prevent, diagnose, control or cure neglected diseases. It is widely used by national governments, industry, civil society, and the World Health Organization to identify gaps in progress and areas where investments would be needed. 

Reactions to the news remain mixed, in line with the good and bad news the report contains. 

“It’s not necessarily a good one or a great one. I don’t think that the level or the distribution of global funding for neglected disease is as we wanted or as it should be,” said Nick Chapman, CEO of Policy Cures Research, during the launch of the report. 

Ricardo Baptista Leite, member of the Parliament of Portugal, called on policy makers, who have both the legal and moral obligations to represent underserved populations, to tackle neglected diseases. 

“Policymakers are the ones who are at the interface of academia, social science, civil society, philanthropy, private sector, and media, be it social or conventional, and therefore they can truly represent the multi-sectoral approach needed to fight poverty and therefore tackle directly the root causes of these diseases.” 

Leading Infectious Diseases Account for Three-Quarters of Funding

Changes in neglected disease funding – increases in TB, HIV/AIDS, salmonella infections, and snakebite, decreases for helminth infections, malaria, hep C, and diarrhoeal diseases

The G-FINDER report tracks investments across 36 diseases including HIV/AIDS, tuberculosis, and malaria – which together represent the world’s leading infectious disease killers. The three accounted for US $2.7 billion, or three-quarters of global funding in 2019 

While global funding for HIV/AIDs and tuberculosis research and development increased from 2018 (up US $29 million for both), funding for malaria dropped slightly, falling US $32 million – the first drop since 2015. 

The latter quarter of R&D investment was split between the remaining 33 diseases, with funding remaining relatively stagnant, although the majority of diseases did receive small increases in funding.

Increased funding was the result of two United Kingdom public funders – Department for International Development (DFID) and Department for Health and Social Care (DHSC) – which supported a Global Health Research Group on African Snakebite Research, and ongoing funding from the UK NHS. 

Dengue, a WHO-categorized NTD listed as one of the top ten threats to global health, had its funding increased slightly by US $3.2 million. The only other NTD to see increased funding in 2019 was Buruli ulcer, which rose (up US $0.2 million) to US $2.8 million.

US Primary Contributor, But Report Calls for Diversity in Funding

The US NIH contributes to most of global infectious disease funding

Investment by public sector and philanthropic groups reached another year of growth and record highs, while private sector funding declined in 2019, according to the report.

The United States contributed close to three-quarters of total public funding, once again making it the largest public funder at US $1.878 billion. The UK was the second-largest contributor (US $210 million), followed by the European commission.

According to Paul Barnsley, senior analyst at Policy Cures Research, this “warrants celebration”, but also a “small amount of concern” as Policy Cures Research Group warned in the past about dependence on only a few major funders, and pushes for diversity in funding. 

“It’s fair to wonder whether decision makers are paying as much attention to G-FINDER report briefings as they ought to be.” 

Alongside the US, the next largest increases in funding came from low- and middle-income countries – Brazil and Colombia – with France and Switzerland following.

Most of the increase in public funding was directed to HIV/AIDS, TB, and malaria. 

Philanthropic funding for neglected disease R&D totaled US $782 million in 2019. Increases came mainly from the Gates Foundation (up US $35 million) and the Wellcome Trust. The Open Philanthropy Project became the third largest Philanthropic Funder, increasing their funding US $9.3 million from their modest investment of US $14 million. 

COVID-19 Funding Unprecedented 

COVID-19’s unprecedented funding may result in fiscal tightening that impacts NTD investment

In spite of  concerns surrounding lack of diversified funding, the Policy Cures Research Group still found the funding pledged in the last year for COVID-19 to be positive.

“Even if a chunk of these [pledges] turned out to be empty promises more than 9 billion pledged in the first 9 months of 2020 still represents an unprecedented response, much bigger than anything we saw for Ebola, much bigger than our annual spending across all neglected diseases combined,” said Paul Barnsley. 

Barnsley said high income economy interest rates remained “mostly low” and nations that had to “spend their way through COVID still have the means to spend the way out of recession.” 

While this initial picture is relatively welcoming, future fiscal tightening may impact neglected disease funding.

“We have anecdotal evidence that funding designed to help people in other countries fares badly during general belt tightening,” said Barnsley.  

But COVID-19 does speak to the need for collaboration across sectors in order to combat both pandemics and neglected diseases. 

“It is not just the science of product development, but it’s really the science of partnerships. The COVID experience will give us valuable lessons about how to be really good scientists in creating the best possible partnerships to address global health needs,” said Mark Feinberg, President and CEO of the International AIDS Vaccine Initiative (IAVI). 

Image Credits: DNDi, Policy Cures Research Group .

No new medicine is in the development pipeline to combat antimicrobial resistance.

Despite growing awareness of the urgent threat of antibiotic resistance, the world is still failing to develop needed antibacterial treats, according to a new report by the World Health Organization (WHO). 

Of the 43 antibiotics and 27 non-traditional antibacterial agents in the current clinical antibacterial pipeline, none is sufficient to tackle the challenge of increasing emergence and spread of antimicrobial resistance (AMR). 

The persistent failure to develop, manufacture, and distribute effective new antibiotics is further fueling the impact of antimicrobial resistance and threatens our ability to successfully treat bacterial infections,” said Dr Hanan Balkhy, WHO Assistant Director General on AMR.

WHO’s annual Antibacterial Pipeline Report reviews antibiotics that are in the clinical stages of testing as well as those in early product development. The aim is to assess and identify gaps in relation to urgent threats of drug resistance, and encourage action to fill those gaps.

The report evaluates the potential of the candidates to address the most threatening drug-resistance bacteria, as outlined in the WHO Bacterial Priority Pathogens list, which includes 13 priority drug-resistant bacteria, including Mycobacterium tuberculosis and Clostridioides.

Static Antibiotic Pipeline 

The 2020 Report reveals a near static development pipeline, with only a few antibiotics approved by regulatory agencies in recent years. 

Of the 43 antibiotics, 26 are active against WHO priority pathogens, 12 against M. tuberculosis and five against C.difficile.

Eleven new antibiotics have either been approved by the US Food and Drug Administration (FDA) or the European Medicines Agency (EMA), since 1 July 2017. However, the newly approved antibiotics have limited clinical benefit over existing treatment, as over 80% of them are from pre-existing classes where resistance is well-known 

Of the traditional antibacterials, only three new products entered the clinical pipeline while seven were discontinued or do not have any recent information.  

For the preclinical antibacterial pipeline, there are currently 292 diverse antibacterial agents in progress with commercial and non-commercial entities. 

Novel Solutions and Global Initiatives Needed 

The lack of progress on antibiotic development highlights the need to explore more innovative approaches to treat bacterial infections. 

While the COVID-19 crisis accentuated the gaps in sustainable funding to address the health and economic implications of an uncontrolled pandemic, it also revealed the opportunity that exists when there is both political will and enterprise. 

“Opportunities emerging from the COVID 19 pandemic must be seized to bring to the forefront the needs for sustainable investments in R&D o f new and effective antibiotics, said Haileyesus Getahun, Director of AMR Global Coordination at WHO.

“Antibiotics present the Achilles heel for universal health coverage and our global health security. We need a global sustained effort including mechanisms for pooled funding and new and additional investments to meet the magnitude of the AMR threat.”

Several global initiatives have been created to address gaps in funding in antibiotics development. WHO and its partner Drugs for Neglected Diseases Initiative (DNDi) have set up the Global Antibiotic R&D Partnership (GARDP). In addition, WHO is working closely with non-profits such as the United States-based Combating Antibiotic-Resistant Bacteria (CARB-X) to accelerate antibacterial research.

There is also the AMR Action Fund, a partnership set up by pharmaceutical companies, philanthropies, the European Investment Bank, with the support of the WHO, that aims to strengthen and accelerate antibiotic development through global pooled funding. 

Image Credits: Interpol, Shutterstock.

Rwanda
COVAX delivery of COVID-19 vaccines to Africa has been hampered by a shortage of vaccines.

NAIROBI – Kenya has developed an ambitious COVID-19 vaccination rollout plan – but it has only received enough doses for a million of its 50 million citizens, and dispensed slightly more than half of these – 565,000 – to health workers.

Kenya is currently in the third wave of the pandemic and estimates that 4 million people – healthworkers and elderly people – need to be vaccinated urgently during its first rollout phase.

At the core of the country’s rollout plan is an online registration platform known as Chanjo-Ke (Chanjo is Swahili for immunization). The platform became operational in early April and it is intended to reduce the crowd numbers in vaccination centers all over the country.

“The system will help us ensure that we are able to account for the vaccines as well as trace those who have been vaccinated and, in the end, certificates of vaccination will be issued based on data that will have been captured by the system,” explains Dr Willis Akhwale, chairperson of the Taskforce on Deployment of Vaccines in Kenya.

The taskforce was created to advise the government on the vaccine rollout, and oversee its coordination.

People seeking vaccination can register for the service in advance, choosing a day and a centre for the vaccination, then show up with a national and job ID at the station. The recipient will be reminded to come for the second dose via the system.

Given the sensitive nature of personal medical data, the ICT Authority had to be brought in to ensure protection of this data, in accordance with the laws of Kenya.

The Ministry of Health (MoH) and the National Treasury (Ministry of Finance) have asked the Africa Centers for Disease Control (CDC) for assistance in procuring more vaccines.

Expansion of Vaccination Centres

The government will also add another 1000 vaccination points to the current 658 and private healthcare facilities will add 2,500 facilities during the second phase of the vaccination exercise, set to begin in July. 

Ultimately, almost 8,000 facilities will be vaccinating people by phase three, according to Akhwale.

“These facilities have been inspected and certified to have the right infrastructure and monitoring capabilities so that we can continuously vouch for safe vaccination,” adds Dr Collins Tabu, the head of Immunization and Vaccine Programme in the Ministry of Health.

Certification of facilities is conducted by the Kenya Medical Practitioners and Dentists’ Council.

At the moment, the country has been averaging 15,000 daily vaccinations, “which could easily get over 50-60,000 vaccinations per day if 300 facilities were fully vaccinating,” says Akwale.

The whole deployment exercise is scheduled to run for 30 months and cover 60% of the adult population. The rest, including pregnant women and individuals under 18 years, are not targeted because as Akhwale explains, no vaccine for this population group exists at the moment.

Gavi, the Vaccine Alliance, is donating 20 billion Kenya Shillings ($ 188 million) whereas the Kenyan Government will contribute 14 billion Shillings ($132 million) towards these efforts. However,  Akhwale is quick to add that this will be contingent upon vaccine availability.

The vaccines have emergency use authorization, given the urgency of the pandemic. This means that the vaccine use has not gone through the usual, lengthy stringent vetting process. 

Even so, the vaccine is not exempt from the monitoring rigours that come with the introduction of such a new product into the population.

“The healthcare worker will key in the data into the Chanjo system in case of any adverse events following immunisation, and this data is channelled to the Pharmacovigilance Centre at the Pharmacy and Poisons Board,” says Dr Peter Mbuiru, acting Chief Principal Regulatory Officer at the Pharmacy and Poisons Board. 

The board has been active in both the control of the Covid-19 disease by developing key guidelines on the use of medical products and technologies including Covid-19 vaccines as well as the authorization of in vitro diagnosis used in testing the disease.

About 3,000 healthcare workers have been trained to administer Covid-19 vaccines, with an additional 700 trainer-of-trainers having received training.

Prioritisation of Target Groups

Kenya is already battling a third wave of the pandemic.

One of the biggest challenges in all this effort has been the prioritization of the target groups to receive the jab. 

The government’s initial target was to vaccinate 1.25 million frontline healthcare workers. However, Akhwale maintains that given older people were at higher risk of severe disease, this had to be expanded to include those aged 58 years and above. The population of this category of people is 2.7million in Kenya. 

This means that nearly 4 million people are most at-risk – but only 1million vaccine doses currently. 

So, given this difficult situation, can’t the government make its own bilateral arrangement to acquire doses outside the COVAX mechanism?

“Yes, we can, but you need to understand at this time there are no vaccines out there,” Akhwale told Health Policy Watch. “Secondly, COVAX and the Africa CDC have already placed massive [vaccine] orders.”

The only other option is to procure COVID-19 vaccines that are not WHO-approved, something which the country is not prepared to do.

And in any case, adds Tabu of the Immunisation Programme, “the first dose will still provide protection of more than 76% until you receive the second dose.”

The AstraZeneca vaccine, which Kenya is using, has raised some health safety concerns in some regions of the world, especially in Europe. 

“The question is, are these concerns directly related to the vaccine and are they significant enough to stop the benefits of vaccination over the risks that they may cause?” asked Dr Githinji Gitahi, CEO of Amref Health Africa, in a recent television interview, adding that the advice of the Africa CDC and WHO is that, “we should continue vaccinating.”

One of the reasons why Kenya settled on AstraZeneca as opposed to other vaccines, according to Tabu, is the guaranteed availability of the vaccine despite the current constraints in the global supply chain.

Image Credits: WHO.

chagas
World Chagas Day 2021

In commemoration of World Chagas Disease Day, Unitaid and the Brazilian Ministry of Health launched a $19 million initiative to expand access to affordable diagnostics and treatments for women and newborns in four Latin American countries where Chagas disease is endemic – Brazil, Bolivia, Colombia, and Paraguay. 

Transmitted by the blood-sucking triatomine bug called Trypanosoma cruzi, Chagas disease kills 10,000 people annually. In Latin America, it kills more people than any other parasitic disease including malaria. 

But only 7% of people with Chagas are diagnosed and only 1% receive appropriate care. If left untreated, Chagas can cause serious heart and digestive complications.

Given that mother-to-child transmission is one of the key transmission pathways for the disease, vector control, active screening, and appropriate treatment options for women of childbearing age and their children represent crucial strategies to reducing new infections, said PAHO’s Director Carissa F. Etienne on Wednesday. 

“Chagas disease continues to generate much suffering and death for thousands of people in Latin America, especially in the poorer countries and among the most vulnerable populations,” she said at a press conference. “Mother-to-child transmission of Chagas can be prevented. We hope that this new global initiative will significantly advance efforts to ensure that every child in Bolivia, Brazil, Colombia and Paraguay is born free of Chagas disease.”

The joint initiative will collaborate closely with regional and global partners, including the WHO and the Pan American Health Organization (PAHO).

Read the Unitaid press release here.

Image Credits: Unitaid.

In a vital step forward that will help accelerate global access to COVID-19 vaccines, Gavi, the vaccine alliance raised some $400 million in donations at a high-level event on Thursday, just a week after the global COVAX facility reached 100 countries with almost 40 million vaccine doses.

The event was hosted by US Secretary of State Antony J. Blinken, Acting Administrator of USAID Gloria Steele, and Chair of the Board of Gavi José Manuel Barroso, and saw pledges from Sweden, Netherlands, Lichtenstein and Portugal, as well as big donations from the Bill and Melinda Gates Foundation, Gates Philanthropy Partners, and Google.

“COVAX represents our best way of ending the pandemic by ensuring equitable global access to safe and effective vaccines,” said Per Olsson Fridh, Sweden’s Minister for International Development Cooperation. “Already reaching over 100 countries, COVAX also shows what we can achieve by working together – from scientists and manufacturers to governments and multilateral organizations, to health workers around the globe. This is an investment not only in global solidarity, but also in our common objective of putting an end to the pandemic. 

The bulk of the money will go towards Gavi’s Advanced Market Commitment, which UNICEF Executive Director Henrietta Fore called a beacon of hope.

“It’s [the AMC] an effective, realistic way to ensure fair and affordable access to vaccines for all,” she said at the high-level event on Thursday. “But getting vaccines off the tarmac and delivered to difficult-to-reach populations requires concerted, coordinated effort and dedicated funding,” said Fore.

On another encouraging note, France and New Zealand committed to donating 13 million and 1.6 million surplus doses to COVAX –  although Gavi expects “much larger” donations of suprlus doses in the future, added GAVI’s CEO Seth Berkley on Thursday.

So far, COVAX has supplied 113 countries with over than 39.5 million vaccine doses, according to UNICEF’s COVID-19 Vaccine Market Dashboard. The global vaccine facility has already enabled access to the following vaccines:

  • AstraZeneca/Oxford (via AstraZeneca and India’s Serum Institute) – up to 1.27 billion doses
  • Pfizer-BionTech – 40 million doses
  • Johnson & Johnson – 500 million doses
  • Novavax – 1.1 billion doses
  • Sanofi/GSK – 200 million doses

Read Gavi’s full press release here.

Image Credits: Global Fund/Vincent Becker.

WTO Headquarters in Geneva

A growing consensus seems to be emerging out of this week’s high-level WTO meeting that glaring inequities in access to vaccines can be remedied by strengthening supply chains, avoiding export bans across borders, and ensuring that big pharma voluntarily transfers its vaccine technologies to poorer countries so they can produce their own vaccines. 

“The significant inequities we are seeing in access to vaccines between developed and developing countries are completely unacceptable,” said United States Trade Representative Katherine Tai, in a statement published out of her appearance Wednesday at the WTO’s closed-door discussion with high-level representatives from industry, government and civil society on Wednesday.

“As governments and leaders of international institutions, the highest standards of courage and sacrifice are demanded of us in times of crisis”, she added. “The same needs to be demanded of industry.” 

Broader Technology Transfer in Poorer Countries is Possible, Says Iweala  

Ngozi Okonjo-Iweala, WTO’s newly elected Director-General

While Tai’s comments at the WTO forum were deemed “unfair” by the US Chamber of Commerce, the WTO’s new director-general, Ngozi Okonjo-Iweala, seemed to agree that the vaccine industry should more aggressively expand technology transfer in low- and middle-income countries – noting that in one case, technology transfer took only six months.

“One of the things that came out [of the discussions at the WTO] is that yes indeed, there is manufacturing capacity that exists now that can be turned around to produce more [vaccine],” she said.

However, she did acknowledge that scaling-up vaccine production will also require the training of more skilled personnel, recruitment of raw materials, and stable supply chains.

Going forward, “more active” matchmaking between companies with investment capacity and those with untapped production capacity could be fruitful to boost vaccine production in low-income countries, she added.

Discussions On Intellectual Property Waiver Have “Advanced Knowledge”

Okonjo-Iweala also said that the closed-door discussions had “advanced knowledge” about the issues surrounding the proposed waiver on WTO rules related to Trade Related Aspects of Intellectual Property (TRIPS).

Since it was proposed last year by South Africa and India, the intellectual property waiver has been backed by almost a half of WTO members and discussed eight times at the WTO. However, it seems to have remained in limbo, mostly due to fierce opposition by industry leaders and high-income WTO countries, including key European Union members, the United Kingdom,  United States, Switzerland, and Japan. 

Rather than a wholesale waiver, existing “flexibilities” in the TRIPS agreement could be used to fast-track solutions where needed, said the EU’s Executive Vice-President in a statement after Wednesday’s WTO meeting. 

“Should voluntary solutions fail, the TRIPS Agreement already provides a framework for sharing technology through the granting of compulsory licences,” said the EU’s Valdis Dombrovskis. “This includes fast-track compulsory licences for export to countries without manufacturing capacity.”

Civil Society Call To Revise TRIPS agreement; No Mention Of IP Waiver 

At the same time, civil society advocates joining the discussions seemed to be steering away from a focus on the IP waiver proposal, instead calling on the WTO to make a series of meaningful technical amendments in the existing TRIPS Agreement – as well as helping low- and middle-income countries to make more effective use of the exceptions contained in the rules.

Currently exceptions in the TRIPS agreement are difficult and cumbersome to implement, KEI’s James Love said. He called on WTO members to act on a seven point plan – some related to the easing of existing TRIPS legalities and others outside of its current scope, that he said would ramp up manufacturing capacity. Specifically, he called on WTO and its members for the following measures:

  1. Transparency of contracts: Encourage greater transparency of contracts made between by pharma and member states – in line with a recent International Monetary Fund proposal; also, he urged greater transparency from pharma and member states in reporting about drug and vaccine R&D costs, vaccine revenues and the number of doses distributed.
  2. Exports of products produced by compulsory licenses: Revise what he called a “flawed” Article 31f and 31bis of the TRIPS agreement, which allows generic producers to export products manufactured under a compulsory license to other low- and middle-income countries only under very restricted conditions; “during a pandemic, there should be no restrictions on the ability to export a useful product under a compulsory license,” added Love. 
  3. Model Exceptions. The WTO should collaborate with WHO on the development of model patent exceptions for emergencies, Love said, citing Germany and Canada as examples of countries that have already created such legal frameworks – which are often lacking elsewhere. 
  4. Sharing know-how. Love cited the “failure” of governments that invested heavily in vaccine R&D to include in their funding agreements “measures to require the sharing of manufacturing know-how and access to working cell lines and rights in data.” In the future, the WTO can work with the WHO to develop “initially soft norms” on how such know-how sharing provisions should be included in future R&D funding agreements.
  5. WTO Agreement on the Supply of Public Goods. “The pandemic is part of the larger challenge of supporting the global commons. The WTO has been asked to consider a new agreement, based in some ways on the GATS, to create voluntary offers of binding commitments to supply public goods.” 
  6. Buyouts of know-how. While not the best option last year when governments were funding R&D, today it should be given consideration, he said.
  7. Remove sanctions on Cuba, with respect to health related products. “There should be no sanctions on Cuba that relate to the development and distribution of its two promising vaccine candidates.”

“There has been an appalling lack of transparency, including regarding the agreements to subsidize and de-risk the research and development of vaccines, as well as procurement contracts and licensing agreements,” Love said.

“WTO agreement patent flexibilities have been used in some cases, but many countries have laws poorly equipped to deal with pandemics, vaccines or biologic products, and the provisions in the agreement on exports are flawed.”

“And while it is possible to issue a compulsory license on patented inventions, there are few national laws and no global agreements on providing access to manufacturing know-how, working cell lines and rights in test data.”

As a further step to support public acquisition of critical know-how, Love has suggested that governments create a buyout fund to allow for “full technology transfer”, including rights to inventions, data, know-how, and biologic resources – similar to the deals reached by private pharma companies such as AstraZeneca when it purchased Oxford’s vaccine technology and/or Pfizer’s acquisition of BioNtech. He has emphasized that governments may not need to buy out the know-how for all vaccines – and suggested that as little as $20 million in funding, with an aim of an initial $1 billion, could help kick off negotiations with manufacturers. 

Image Credits: @WTO/Bryan Lehmann.

africa cdc
Dr John Nkengasong warns delays in shipments could threaten achieving set vaccination goals in Africa


IBADAN – The Africa CDC has expressed concerns over the disruption of the COVID-19 vaccination drive in Africa saying it was preventing many Africans who have received the first dose of the Oxford/AstraZeneca vaccine may not be able to receive the second dose 12 weeks after the first dose as recommended in the vaccination guideline. 

Rwanda has already exhausted its doses, Ghana is administering its last 100,000 doses even as Nigeria is also racing to administer its remaining doses.

While it is not clearly known what the implications of delay in receiving the second dose will be, recipients of the first dose already have some form of immune protection against the virus,  Dr John Nkengasong, Director of the Africa CDC said  while addressing a Thursday morning press briefing.

“We don’t know that delay by a couple of months or weeks, will impair the ability to boost it (immune system) when you get a second dose. I don’t think so. It’s just that it doesn’t give you that full range of your immune system reacting and getting ready to fight the virus once you get exposed to it. But they can be assured that with the first dose, they are already getting some protection from developing disease,” Nkengasong said.

At a WHO African region press briefing, Dr Richard Mihigo, Immunization and Vaccine Development Programme Coordinator at the WHO Regional Office for Africa, noted that African countries did the right thing by using the first shipments they received to immunise as many people as possible instead of halving the recipients in order to fully immunise some recipients.

Dr Richard Mihigo

“African countries, I must say, took the right decision with the limited supply to use most of their doses as the first dose with the expectation that the second dose will come quite soon,” he added. 

While admitting that there have been some challenges regarding the arrival of the second doses, the WHO said indications from COVAX Secretariat and other ongoing discussions pertaining to the AstraZeneca vaccine for which many African countries have applied a 12-week interval between dose one and dose two, suggest the additional shipments will be available soon.

“I think everything is being put in place to make sure that they can receive the second shipment on time to deliver the second dose of the AstraZeneca vaccine,” he added. 

Wakeup Call for Africa
Prof Oyewale Tomori

Oyewale Tomori, Professor of Virology at Nigeria’s Redeemer’s University, noted that the circumstances surrounding delays in receiving shipments for second doses of the vaccine is a wakeup call for Africa as a continent to be more proactive regarding its vaccine sources.

“We’ve been at the receiving end of global omission for too long. Now is an opportunity for us to plan for the future. We shouldn’t be in this position again,” he said. 

He enjoined African leaders to be more proactive, move the continent forward and stop its dependence on the rest of the world. 

“Our leaders must be proactive in getting this. We shouldn’t repeat this issue when we are at the mercy of  the rest of the world. We’ve been in this position for too long,” Tomori said.

South Africa, DRC to Resume COVID-19 Vaccinations
Dr Boitumelo Semete

There are meanwhile indications that COVID-19 immunizations with the Johnson & Johnson vaccine will soon resume in South Africa and begin in the Democratic Republic of Congo with the AstraZeneca vaccine – despite the concerns registered in the USA and Europe over rare occurrences of blood clots from those jabs. 

On 13 April, the Minister of Health of South Africa, the only African country that is rolling out the Johnson & Johnson COVID-19 vaccine, announced that the country has decided to pause rollout of the vaccine as a precautionary measure as review of the situation is ongoing.

But while addressing the WHO press briefing, Dr Boitumelo Semete, CEO of the South African Health Products Regulatory Authority, announced the country will soon resume J&J vaccinations.

“We anticipate the pause will be lifted in a couple of days to come,” Semete said.

Semete noted that the decision to pause the vaccine rollout was to enable the country to review available data considering only a few countries have rolled the vaccine. 

For DR Congo, Africa CDC announced the country is ready to nationally roll out the Oxford/AstraZeneca COVID-19 vaccine from 19 April.

“The Democratic Republic of Congo’s Minister of Interior announced yesterday that the country will finally launch the national COVID-19 vaccination campaign on 19 April, initially suspended due to concerns about adverse events related to the AstraZeneca vaccine,” Nkengasong said.

By 12 April 2021, over 34.6 million vaccine doses have been acquired by African countries with nearly 14 million doses administered so far. 

Morocco, Nigeria and Ghana are leading with 8.6 million, over 1 million and nearly 700,000 doses administered respectively. Moreover, 32 African countries have received consignment of COVID-19 vaccines from the COVAX facility, with 12 additional countries receiving allocation through the African Vaccine Acquisition Task Team (AVATT).

Image Credits: Paul Adepoju, Paul Adepoju .