Charles Michel, President of the European Council

After the COVID-19 pandemic exposed fundamental flaws in the global health architecture, a proposal for a new pandemic treaty that could strengthen the world’s capacity to contain the current pandemic and prepare for future ones, is gaining momentum.  

That was a key message at a World Health Organization (WHO) launch of an open letter by 25 global leaders calling for the world to negotiate such a treaty, featuring Charles Michel, President of the European Council, and two dozen other global leaders that are now backing the treaty initiative. 

Other signatories now include the United Kingdom’s Boris Johnson, Germany’s Angela Merkel, France’s Emmanuel Macron, along with the leaders of Indonesia, Kenya, Rwanda and South Africa’s Cyril Ramaphosa. But China, the United States and Russia have yet to sign the call. 

“Today, we are calling for an international treaty on pandemics [to] foster a comprehensive approach to better predict, prevent and respond to pandemics,” said Michel, who has championed the treaty since late last year saying that the treaty would support the principle of “health for all”.

If ratified, the treaty will give the WHO the political clout to better carry out part of its mandate in terms of improved pandemic alert systems, better investments in coronavirus research, and sharing of crucial data on infectious pathogens, vaccine supply chains and vaccine formulas.

WHO’s director-general Dr. Tedros Adhanom Ghebreyesus echoed Michel’s sentiments, saying: “The time to act is now”.

“The world cannot afford to wait until the pandemic is over to start planning for the next one. We cannot do things the way we have done them before and expect a different result. Without an internationally coordinated response…we remain vulnerable,” said Dr Tedros.

Pandemic Treaty Rooted In WHO Constitution 

The treaty “would be rooted in the constitution of the World Health Organisation, drawing in other relevant organizations key to this endeavour,” said the letter, also signed by the heads of: Albania, Chile, Costa Rica, Greece, Korea, Trinidad and Tobago, the Netherlands, Senegal, Spain, Norway, Serbia, Indonesia, and Ukraine.

“Existing global health instruments, especially the International Health Regulations, would underpin such a treaty, ensuring a firm and tested foundation on which we can build and improve.”

The Pandemic Treaty Will Strengthen WHO’s Mandate 

According to Michel, “Such a treaty [could] play an interesting role in order to make sure that we have more transparency on the supply chains [and] on the level of productions of vaccines and of tests; it will mean more rust and better cooperation.” 

Michel suggested that the treaty could also be used to expand vaccine production by facilitating  technology transfer in low- and middle-income countries, referring to the “third way” initially proposed by the World Trade Organisation’s (WTO) new chief Ngozi Okonjo-Iweala. 

“Certainly there is a debate in the international community about how to improve our vaccine production capacities to improve vaccine coverage, particularly in the African continent,” said Michel, adding that “we are closely following the debate at the WTO for the ‘third way’ voiced by Ngozi”.

 US and China Didn’t Sign Call – But Sent Positive ‘Comments’   

WHO’s director-general Dr. Tedros Adhanom Ghebreyesus

Although China and the US did not sign Tuesday’s op-ed, Dr Tedros said that that both countries had voiced “positive” comments during informal discussions with Member States – and that it was not necessarily an issue that the op-ed had only been signed by two dozen countries.

“It doesn’t need to be all 194 countries [to write an op-ed],” said Dr. Tedros. “I don’t want it to be seen as a problem, it wasn’t even a problem. When the discussion on the global pandemic treaty starts, all Member States will be represented.”

The Pandemic Treaty Will  Synergize With The International Health Regulations

Meanwhile, Mike Ryan, WHO’s Director of Emergency Programmes, emphasised that the treaty would “by no means” undermine the existing global framework that governs WHO countries’ behaviour during health emergencies – the legally binding International Health Regulations (IHRs). These regulations set out the mandates under which countries are obliged to report on disease outbreak risks, and share epidemic information, with WHO and other member states.

Rather, the pandemic treaty would generate the necessary political commitment to ensure that the IHRs are implemented; and bolster global pandemic preparedness and response by covering a broader set of issues than those covered by the IHRs, such as the sharing of crucial data.  

“The IHRs…is a really really good instrument,” said Ryan. “But in itself [it] is a piece of legislation that is without meaning unless countries are fully committed to its implementation.”

“IHR only works if we have trust, if we have transparency, if we have accountability. Such a treaty would provide that political framework in which we in public health can do our work much more effectively.”

“The proposed treaty will definitely bring strong political commitment and support for the IHR implementation,” added Jaouad Mahjour, WHO Regional Director for the Eastern Mediterranean region, who also spoke at Tuesday’s press conference.

In an initial response to the initiative, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that pharma partners should play a role in shaping such a treaty. The statement reflected IFPMA concerns over preserving what it described as the patent “incentive system” for developing new vaccines and medicines.

“The discussions around a possible International Pandemic Treaty need to take into account the important role played by the innovative biopharmaceutical industry and its supply chain in fighting the virus,” said the IFPMA statement.  

“It will be important to acknowledge the critical role played by the incentive system in developing tests, therapeutics, and vaccines to contain and defeat the coronavirus. We hope that the discussions on an International Pandemic Treaty will address enablers for future pandemic preparedness – the importance of incentives for future innovation, the immediate and unrestricted access to pathogens, and the importance of the free flow of goods and workforce during the pandemic – in addition to continuing the multi stakeholder approach undertaken in ACT-A and COVAX.”

WHO’s Peter Ben Embarek, head of the origins task team, at the release of the report on Tuesday.

The international team assembled by the World Health Organization (WHO) to investigate the origins of SARS-CoV-2 has identified animal transmission – through an elusive ‘Animal X’ – as the most likely route of infection.

The long-awaited report was released on Tuesday after the 17-person expert team, together with a 17-person team of Chinese scientists, visited Wuhan and its surroundings during January and February to examine evidence about the virus, which was first identified in 174 people in Wuhan in December 2019, and has since infected over 128 million people and caused 2.7 million deaths.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the report advances the world’s understanding in important ways, but it also raises questions that will need to be addressed by further studies. 

“As far as WHO is concerned, all hypotheses remain on the table,” said Dr Tedros. “This report is a very important beginning, but it is not the end. We have not yet found the source of the virus, and we must continue to follow the science and leave no stone unturned as we do.” 

Tedros added that no single research trip could provide all the answers, as “finding the origin of a virus takes time and we owe it to the world to find the source so we can collectively take steps to reduce the risk of this happening again”. 

What follows is a summary of the report’s key points, which the team described as a “work in progress”.

The team examined four main scenarios for introduction: 

  1. Direct zoonotic transmission from a host animal to humans
  2. Indirect zoonotic transmission, involving the virus first infecting a host animal, then adapting through an intermediate host animal, before infecting humans
  3. Introduction through the cold/ food chain, particularly frozen wild animals sold at Wuhan markets
  4. Introduction through a laboratory incident.
Horsehoe bats carry viruses most similar to SARS-CoV-2

1. Direct zoonotic introduction:

Finding: possible to likely. 

Hypothesis: Transmission of SARS-CoV-2 (or very closely-related progenitor virus) moves from an animal reservoir host to human, and is followed by direct person-to-person transmission.

Arguments in favour 

  • The majority of emerging diseases originate from animal reservoirs and most of the current human coronaviruses have originated from animals. 
  • Surveys of the bat viromes conducted after the SARS epidemic in 2003 found SARSr-CoV in various bats, particularly Rhinolophus (horseshoe) bats. 
  • Viruses with a high genetic similarity to SARS-CoV-2 have been found in these bats in China, Japan, Thailand, and Cambodia. 
  • Two distinct types of SARSr-CoV were recently detected in Malayan pangolins. 
  • Minks have shown to be highly susceptible to SARS-CoV-2 and cannot be ruled out as the primary source of SARS-CoV-2. 
  • Antibodies to bat coronavirus proteins have also been found in humans with close contact with bats. 

Arguments against 

  • Although the closest genetic relationship to SARS-CoV-2 was a bat virus, more detailed analysis found “several decades” of evolutionary space between the viruses. 
  • Few of the identified bat virus genomes showed the ability to bind to human cells. 
  • Contact between humans and bats or pangolins is not as common as contact between humans and livestock or farmed wildlife. 
  • Despite the consumption of bats and other wild animal meat in some countries, there is no evidence for transmission of coronaviruses from such encounters. 

Information still needed: Detailed trace-back studies of the animal supply chain of Wuhan markets have provided some credible leads to survey potential reservoir hosts. 

2. Introduction through intermediate host followed by zoonotic transmission 

Finding: possible to likely 

Hypothesis: SARS-CoV-2 is transmitted from an animal reservoir to an animal host, followed by spread within that intermediate host (“spillover host”), and then transmitted to humans. 

Arguments in favour

  • Although the closest related coronaviruses have been found in bats, SARS-CoV-2 has evolved by an estimated “several decades”, which suggests a missing link. 
  • Similar viruses have also been found in pangolins, suggesting cross-species transmission from bats, but again with considerable genetic distance. 
  • Bats and pangolins have infrequent contact with humans, and an intermediary step involving an “amplifying host” has happened in a number of viruses, including influenza and MERS. 
  • SARS-CoV-2 adapts relatively rapidly in susceptible animals (such as mink). 
  • The increasing number of animals shown to be susceptible to SARS-CoV-2 includes animals that are farmed in sufficient densities to allow the potential for viral circulation. 
  • There was a large network of domesticated wild animal farms, supplying farmed wildlife to Wuhan. In high-density farms, there often are connections between farms, leading to complex transmission pathways that may be difficult to unravel. 

Arguments against 

  • SARS-CoV-2 has been identified in an increasing number of animal species, but genetic and epidemiological studies have suggested that these were infections from humans, rather than other animals. 
  • There is no evidence of repeated early SARS-CoV-2 strains of animal origin in humans in China. 
  • There was no genetic or serological evidence for SARS-CoV-2 in tests of a wide range of domestic animals (where large-scale screenings took place) and wild animals, where screening was more limited. 

Information still needed: Further surveys, including a wider geographic range. Studies of the supply chain of Wuhan markets have not found any evidence of infected animals but provided information for follow-up studies, including targeting supply chains from wild-life farms in provinces where the higher prevalence of SARSr-CoVs have been detected in bats. 

Animal products from outside Southeast Asia, where more distantly related SARSr-CoVs circulate, should not be disregarded.

A market in Wuhan, Hubei, China

3. Introduction through the cold/ food chain 

Finding: Possible

Hypothesis: SARS-CoV-2 is introduced or amplified through the cold/ food chain. This could involve direct zoonotic transmission, or spillover through an intermediate host. 

Arguments in favour 

  • The arguments are similar to those listed for zoonotic introduction, but with an emphasis on the potential for initial introduction through food animals or cold/ food chain products or the contamination of food and food containers (for instance by animal waste). 
  • Since the near-elimination of SARS-CoV-2 in China, the country has experienced some outbreaks related to imported frozen products in 2020. 
  • Screening programmes have found limited evidence for the presence of SARS-CoV-2 by nucleotide acid tests in different batches of unopened packages and containers in different cities. For example in an outbreak in Qingdao, the live virus was isolated from the outer package of imported frozen products. 
  • Foodborne outbreaks with enteric viruses are common, but contamination of food with human viruses usually comes from sewage or contaminated water for irrigation. 
  • Sewage treatment typically does not remove all infectious viruses prior to the release of wastewater in the environment. These processes have been investigated widely for non-enveloped viruses but far less for enveloped viruses in the food chain, but there is widespread evidence of  SARS-CoV-2 nucleic acid in sewage. 
  • There is some evidence that the oral route could lead to infection for SARS-CoV-2 from hamster infection experiments, and the virus replicates in gut organoids. 
  • Food animal handlers had an increased prevalence of SARS-CoV-specific antibodies. 
  • Humans infected with SARS-CoV-2 shed virus through faeces and can have gastrointestinal symptoms, suggesting the involvement of the gastrointestinal tract. 
  • Humans can also be exposed to contaminated objects. 

Arguments against 

  • There is no conclusive evidence for foodborne transmission of SARS-CoV-2 and the probability of cold-chain contamination with the virus from a reservoir is very low. 
  • While there is some evidence of the possible reintroduction of SARS-CoV-2 through handling imported contaminated frozen products in China since the initial pandemic wave, this would have been extraordinary in 2019 where the virus was not widely circulating. 
  • Industrial food production has high levels of hygiene criteria and is regularly audited. 
  • Most viruses have been found in 2020 in low concentrations and are not amplified on cold-chain products. It is not clear what the infection route would be (possibly oral, touch, or aerosol). 
  • There was no evidence of infection in animals tested following the Wuhan outbreak. 
  • The risk of foodborne transmission of SARS-CoV-2 through pathways such as objects is very low in comparison with respiratory transmission. 

Information still needed: Case-control studies of outbreaks, in which the cold chain product and food supply are positive, would be useful to provide support for cold chain products and food as a transmission route.

There are some preliminary reports of SARS-CoV-2 positive testing in other parts of the world before the end of 2019. 

There is also evidence of more distantly related SARSr-CoV in bats outside Asia. Some producers in these countries were supplying products to the markets. 

If there are credible links to products from other countries or regions with evidence for circulation of SARS-CoV-2 before the end of 2019, such pathways should be followed up. 

If there are leftover frozen products from the Huanan market from December 2019, particularly frozen animal products from farmed wildlife or linked to areas with the early circulation of SARS-CoV-2, these should be tested. 

4. Introduction through a laboratory incident 

Finding: Extremely unlikely.

Hypothesis: SARS-CoV-2 is introduced through a laboratory incident, reflecting an accidental infection of staff from laboratory activities involving the relevant viruses. We did not consider the hypothesis of deliberate release. The deliberate bioengineering of SARS-CoV-2 for release has been ruled out by other scientists following analyses of the genome. 

Arguments in favour 

  • Although rare, laboratory accidents do happen, and different laboratories around the world are working with bat CoVs. 
  • Humans could become infected in laboratories with limited biosafety, poor laboratory management practice, or through negligence. 
  • The closest known animal coronavirus strain (96.2%) to SARS-CoV-2 detected in bat anal swabs have been sequenced at the Wuhan Institute of Virology. 
  • The Wuhan CDC laboratory moved on 2 December 2019 to a new location near the Huanan market. Such moves can be disruptive for the operations of any laboratory. 

Arguments against 

  • SARS-CoV-2 from bats and pangolin are evolutionarily distant from SARS-CoV-2 in humans. 
  • There is no record of viruses closely related to SARS-CoV-2 in any laboratory before December 2019, or genomes that in combination could provide a SARS-CoV-2 genome. 
  • Prior to December 2019, there is no evidence of circulation of SARS-CoV-2 among people globally and therefore the risk of accidental culturing SARS-CoV-2 in the laboratory is extremely low. 
  • The three laboratories in Wuhan working with coronavirus diagnostics, isolation and vaccine development all had high-quality biosafety level (BSL3 or 4) facilities that were well-managed. 
  • A staff health monitoring programme showed no reports of COVID-19 compatible respiratory illness before or during December 2019, and no serological evidence of infection in workers through SARS-CoV-2-specific serology-screening. 
  • The Wuhan CDC lab which moved on 2 December 2019 reported no disruptions or incidents caused by the move. They also reported no storage nor laboratory activities on CoVs or other bat viruses preceding the outbreak. 

Information still needed: Regular administrative and internal review of high-level biosafety laboratories worldwide. Follow-up of new evidence supplied around possible laboratory leaks. 

At the end of the report, the team called for “a continued scientific and collaborative approach to be taken towards tracing the origins of COVID-19”, something that has been echoed by WHO.

 

Image Credits: CGTN, Arend Kuester/Flickr.

CAPE TOWN – Johnson & Johnson (J&J) will deliver its COVID-19 vaccine to Africa from October after reaching an agreement with the African Union to supply the continent with up to 400 million doses over the next two years. 

However, Africa may still be struggling to obtain vaccine supplies for some months following last week’s decision by the Serum Institute of India (SII) to scale back its delivery of the AstraZeneca vaccine to the WHO co-sponsored COVAX global vaccine facility – in order to address domestic demand as COVID-19 cases soar in India. 

To date, the AstraZeneca vaccine has been the backbone of the COVAX facility’s ambitious roll-out of vaccines to dozens of low- and middle-income countries. But the SII suspension would interrupt the planned March and April delivery of some 90 more vaccine doses at a time when some countries have already used up their allotted supplies, and another 10 countries in Africa and 20 worldwide have yet to receive any vaccines at all.    

J&J CEO Alex Gorsky

 J&J CEO Alex Gorsky announced the deal with the AU’s “African Vaccine Acquisition Trust (AVAT)” on Monday saying that his company has been “committed to equitable, global access to new COVID-19 vaccines” from the start of the pandemic.

“Our support for the COVAX Facility, combined with supplementary agreements with countries and regions, will help accelerate global progress toward ending the COVID-19 pandemic,” he added.

AVAT can order up to 220-million doses this year and an additional 180 million doses in 2022, according to the company.

Single Dose and Efficacious Against Variant

The J&J vaccine only requires one dose, it can be stored in a normal fridge for up to three months.  It has been tested in diverse populations and it has shown be able prevent death and severe illness – even in the case of the more infectious B.1351 (501Y.V2) variant first identified in South Africa. 

J&J has also committed to providing its vaccine on a not-for-profit basis for emergency use during the pandemic.

The vaccine was granted Emergency Use Listing from the World Health Organization (WHO) on 12 March, Conditional Marketing Authorization from the European Commission on 11 March and Emergency Use Authorization by the US Food and Drug Administration on 27 February. The single-shot COVID-19 vaccine has also been granted Interim Order authorization in Canada on 5 March.

It is also being used to vaccinate South African health workers as part of an implementation study. The country abandoned its original plan to roll out the AstraZeneca vaccine after a small trial showed that vaccine was ineffective in preventing mild and moderate infection by the B.1351 variant.

South Africa announced on Sunday that it expected 2.8 million J&J doses at the end of April to expand its vaccination programme. It also announced that it had secured an order of 30 million doses from the company but did not divulge the expected delivery date of the bulk of its order.

J&J Tested on Diverse Populations

So far, the J&J vaccine is in fact the only vaccine to have been rigorously clinically trialled on the B.1.1351 variant that first emerged in South Africa and has now reportedly spread to some 16 other countries. 

Those states reporting on the presence of the B.1.351 variant, namely Angola, Botswana, Cameroon, Comoros, DR Congo, Eswatini, Gambia, Ghana, Kenya, Malawi, Mauritius, Mozambique, Namibia, Rwanda, South Africa, Zambia and Zimbabwe, according to the Africa Centers for Disease Control (CDC).

“The availability of the vaccine candidate is subject to its successful approval or authorization by the national regulatory authorities of AU member states,” according to the company’s press statement.

The J&J vaccine has been tested on almost 44 000 people from four continents, including 7,000 South Africans, most of whom were exposed to the B.1351 variant. The vaccine showed 57% protection against moderate disease, 85% protection against severe disease and 100% protection against death.

Globally, the J&J vaccine demonstrated a 67 percent reduction in symptomatic COVID-19 disease in participants who received the vaccine in comparison to participants given the placebo. 

In addition, South Africa’s Aspen Pharmacare will assist to manufacture the vaccine and support shipments to the AU member states, according to the company.

Gavi in Talks With Indian Government Over SII supplies

Meanwhile, lat last week the global vaccine alliance, Gavi, announced that COVID-19 vaccines produced by the Serum Institute of India to lower-income economies that as part of COVAX “will face delays during March and April as the government of India battles a new wave of COVID-19 infections”.

“COVAX and the Government of India remain in discussions to ensure some supplies are completed during March and April,” added Gavi

According to the agreement between Gavi and SII, the company is contracted to provide COVAX with the SII-licensed and manufactured AstraZeneca vaccine to 64 lower-income economies participating in the Gavi COVAX AMC, alongside its commitments to the Government of India.

 

Image Credits: NBC News.

Pakistani health workers getting vaccinated with donated Chinese Sinopharm vaccines.

ISLAMABAD – (EXCLUSIVE) A controversial plan to sell Russia’s Sputnik V COVID-19 vaccine to wealthy citizens in Pakistan has been put on hold following a dispute between the government and the private pharmaceutical company involved over the vaccines’ sale price, Health Policy Watch has learned.

Meanwhile, Transparency International – Pakistan appealed to Prime Minister Imran Khan to “cancel” the private importation of COVID-19 vaccines altogether, citing concerns with price and the potential for corruption.

“Pakistan is one of the first countries to allow the private sector to import and sell COVID-19 vaccines and [this] will provide a window of corruption, as there are possibilities some of the government vaccines may be sold to …private hospital[s],” Transparency International stated in a letter to the Prime Minister’s office, also obtained by Health Policy Watch.

Public health experts have also expressed disquiet about how a two-tier system would deepen inequality, allowing wealthy citizens who can pay to move to the front of the vaccination queue. 

The arrangement would also enable private buyers to obtain a vaccine [Sputnik V] whose clinical trial results have significantly outperformed the donated Chinese Sinopharm vaccines that are currently being rolled out by Pakistan’s public health authorities to health workers and other priority groups.

And the vaccine deals set a precedent for other low- and middle-income countries. Along with Pakistan, Brazil, Indonesia, and the Philippines, as well as Thailand and the United Arab Emirates are also reportedly weighing, or in the process of creating, a private market vaccine channel.

Government Initially Gave Sputnik Sales Go-ahead

In early February, Pakistan health authorities granted emergency use authorization for Russia’s Gam-COVID-Vac (Sputnik V) vaccine and gave permission to Ali Gohar Pharmaceutical (AGP), a private pharmaceutical company, to import and sell the vaccine.

Last week, AGP brought the first shipment of 50,000 Sputnik V doses into Karachi – but disagreement over price has put the private vaccination rollout on hold.

Initially, the government had approved private importation without fixing a price. But it later classified COVID-19 vaccines in the “hardship” category of medicines, which enables the Drug Regulatory Authority of Pakistan (DRAP) to set a maximum price.

The government then fixed the sale price at around $55 for two doses. But AGP says this is too cheap, while Transparency International believes is too high.

According to Transparency’s letter to Prime Minister Khan, “the federal cabinet has fixed the maximum retail price of Sputnik-V Russian vaccine at PKR8449 (US$54.46) for two doses and China’s Conividecia at PKR4225 ($27.30) per injection”.

However, said Transparency, the global price set for the Sputnik-V is $10 per dose.

“This means that, internationally, the two doses of Sputnik V are available at $20. However, the approved price for its commercial sale in Pakistan is 160% higher than the international price,” said the letter.

The price cap came from the Ministry of National Health Services Regulations and Coordination (NHSRC). Confirming this, NHSRC secretary Aamir Ashraf Khawaja also defended the government’s decision of allowing the private sector to import COVID-19 vaccine.

Russian military personnel receive Sputnik V vaccine

In a letter written to Transparency, Khawaja said that Pakistan remains committed to fighting COVID-19 with “everything available” at its disposal, including private vaccinations.

“This is expected in a large country like Pakistan, with a population over 220 million. The government, therefore, as a deliberate policy tool, allowed private sector to import vaccines to cater to those segments of the society which were not on the immediate priority list of the government,” said Khawaja in his letter.

“Government is fixing the maximum retail price, leaving room for competition and free market dynamics. It may also be added that COVID-19 vaccine market dynamics entail the sale in large quantities, typically in millions, and it is not easy for small players to access small number of doses,” said the letter.

Company Has Reservations About Price Cap

When asked for its response to DRAP’s decision to cape the price on privately imported vaccines, the AGP official said that “obviously company has reserved some appropriate steps about it”. 

Sources close to the company said that it had been planning to sell the double-dose vaccine for at least $70 and it may not sell its current stock at all now.

Meanwhile, DRAP spokesperson Akhtar Abbas said that medicine prices are fixed by the federal government and DRAP can only recommend prices on technical grounds.

He said that the reconsideration of the Sputnik-V vaccine set price was possible only on the advice of the federal Cabinet and, as far as he knew, Cabinet had not passed any directions to the regulatory authority.

Abbas added that if the company had any reservations about the pricing of the vaccine, it must submit these to the pricing committee of the DRAP.

Ellen ‘t Hoen, from South Centre, said that although the World Health Organization (WHO) had not finished assessing Sputnik’s efficacy and safety, the vaccine has been approved for emergency use by certain countries.

She added that it was “only a matter of time” before COVID-19 vaccines became “big business”. She also said that now India is planning to impose export controls on vaccines, more countries will start to look at China and Russia for supply.

Pakistan has given Emergency Use Approvals to a number of vaccines, including the Pfizer, AstraZenca, SinoPharm and Conividecia vaccines, as well as Sputnik-V.  However, so far only the Chinese-donated SinoPharm is being administered to healthcare workers and people above age 60.

Meanwhile, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said its members were not focusing on selling vaccines to private companies.

 “The major international vaccine makers, who are members of our federation, fully appreciate the public health emergency and therefore are focusing all their efforts on meeting the requests of governments or their appointed health authorities; as well a COVAX,” said IFPMA Director General Thomas Cueni.

The manufacturer of Sputnik V has submitted dossiers to the World Health Organization (WHO) and the European Medicines Agency for approval.  In February, a peer reviewed study of Sputnik’s clinical trial reults in The Lancet  found it to be safe and effective.

Asked to comment on the reports of the private market vaccine arrangements being laid in Pakistan and other countries, neither WHO’s Pakistan country office, nor WHO’s global headquarters in Geneva, had replied as of press time.

Image Credits: Ministry of Defence of the Russian Federation.

WHO Director-General Dr Tedros Adhanom Ghebreyesus

COVAX has run out of COVID-19 vaccines to supply the last 20 countries in the world that have not yet started vaccinations, and it urgently needs a donation of 10 million doses from either manufacturers or countries that have piiled up surplus doses, according to World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus.

While 36 countries have not yet started vaccinations, 16 of these are due to receive COVAX deliveries within the next two weeks, Tedros told the WHO bi-weekly pandemic briefing on Friday.

“That leaves 20 countries who are ready to go and waiting for vaccines. COVAX is ready to deliver, but we can’t deliver vaccines we don’t have,” said Tedros, who set a global target of vaccination drives in all countries within the first 100 days of 2021.

He blamed “bilateral deals, export bans, vaccine nationalism and vaccine diplomacy” for causing delays in “tens of millions of doses” for COVAX. 

“COVAX needs 10 million doses immediately as an urgent stop-gap measure so these 20 countries can start vaccinating their health workers, and older people within the next two weeks.”

Although the WHO director refrained from mentioning any countries by name, India’s Serum Institute, the world’s largest vaccine manufacture, has interrupted planned deliveries to COVAX in March and April of tens of millions of AstraZeneca doses, diverting the vaccines to domestic use following a new spike in cases in the country. The suspension of deliveries was confirmed by Gavi, The Vaccine Aliance on Thursday.  (see related story).

‘Plenty’ of Countries That Can Afford to Donate

Appealing for donations of vaccines that have WHO emergency use listing (EUL) from manufacturers and countries, Tedros said that “there are plenty of countries who can afford to donate those with little disruption to their own vaccination plans”.

Only Pfizer, Moderna and AstraZeneca have WHO EUL. Four vaccines at different stages in the process of being assessed for EUL, and “at least one” was expected to be approved by the end of April, according to Tedros.

So far, 177 countries have started vaccinations, and COVAX has distributed more than 32 million vaccines to 61 countries in a single month. 

WHO’s COVAX representative, Bruce Aylward, acknowledged that political leaders were under incredible pressure from their citizens to deliver vaccines but stressed that “it’s the right thing to do to make sure everyone has access to vaccines”.

“We also have an economic reason to get to the world’s economy going, and we also have a health security reason because of variants,” stressed Aylward.

Criminals, Corruption and Fake Vaccines

The Director-General also warned of the danger of criminals exploiting the “huge global unmet demand for vaccines” and urged people not to buy vaccines outside government-run vaccination programmes as these could be “sub-standard or falsified”.

“A number of ministries of health, national regulatory authorities, and public procurement organisations have received suspicious offers to supply COVID-19 vaccines,” warned Tedros.

“We’re also aware of vaccines being diverted and reintroduced into the supply chain, with no guarantee that cold chain has been maintained. Some falsified products are also being sold as vaccines on the internet, especially on the dark web,” he warned.

WHO’s technical lead on COVID-19 Maria Van Kerkhove

Maria van Kerkhove, WHO’s Technical Lead on COVID-19, said that there had been a 15% increase in COVID-19 cases in the past week, with all six WHO regions showing increases.

She stressed that while “we might be tired of the pandemic, it is not finished with us”, and that masks, hand-washing and our “mixing patterns” were the only measures that could keep us safe in the face of the global shortage of vaccines.

“Fifteen months in, people want this to be over, but we still have to put in the work. All of us have a role to play here in reducing transmission and this includes during holidays,” stressed Van Kerkhove, referring to the looming Passover and Easter holidays.

“All of us want to spend time with our families and travel around and, and there are safe ways to be able to start to do this, but we need to think about what each of us are doing every day. We will get to a point where this pandemic will be over. I promise we will get there, but we need to put in the work now to drive transmission down,” she stressed.

 

Kenya’s capital, Nairobi and four other counties go into lockdown as COVID-19 cases surge

NAIROBI – Kenya has suspended parliament and banned church gatherings in its capital, Nairobi, and four other counties as the country records its highest number of COVID-19 deaths since the pandemic started last year and amid a surge of positive cases.

President Uhuru Kenyatta on Friday announced partial lockdown and instituted new curfew measures to start from 8pm to 4.00am, the suspension of county assemblies and the closure of bars in Nairobi as the country experiences a third wave of the deadly virus.

The four counties affected by the lockdown are Kiambu, Nakuru, Machakos and Kajiado.

He said the number of confirmed COVID-19 cases had increased to 15,916 on 21 March, up from 4,380 in January. The  positivity rate has jumped from 2.6% to 22% in the same period. The lockdown was necessary to avert a health crisis.

“This tells us that our rate of infection has gone up 10 times between January and March 2021. Indeed, it is a clear indication of a new trend, that now Kenya is squarely in the grip of a third wave of the Pandemic,” said Kenyatta, adding that the peak is likely to flatten by mid-May.

Data shared by the Ministry of Health on Friday showed that 1,463 people tested positive for COVID-19, from a sample size of 8,976 tested in the last 24 hours – 26 deaths had been reported in the last 24 hours.

A total of 1,080 patients are currently admitted in various health facilities countrywide, while 3,825 patients are on Home Based Isolation and Care.

Some 121 patients are in intensive care units, 35 of whom are on ventilatory support and 77 on supplemental oxygen, nine patients are on observation, 81 patients are on supplementary oxygen with 68 of them in the general wards and 13 in the High Dependency. Kenya has one of the highest cumulative incidence rates among the African Union member states in the Eastern region.

Strict Lockdown Regulations

Kenyatta said the spike in new cases called for urgent and drastic measures and that lockdown was crucial to avert a national health crisis. Some of the lockdown rules include:

  • Suspension of gatherings at places of worship in the five counties;
  • Banning of the sale of alcohol and suspending the sale of alcohol at bars and restaurants;
  • Meetings or events including social gatherings are limited to 15;
  • Funeral, cremations and other interment ceremonies, must be conducted within 72 hours of confirmation of death; and limited to 50 mourners and
  • People travelling to Kenya must be in possession of a negative COVID-19 PCR Certificate, acquired no more than 96 hours prior to arrival; with the PCR Certificate also having been validated under the Trusted Travel platform for those travelling by air.

Spike in New Cases Likely Drive by Two Variants

Kenya’s increasing COVID-19 cases are likely driven by the highly transmissible variants of concern B.1.1.7 and B.1.351 detected in January, according to a report released by the Africa Centres for Disease Control on 23 March.Scientists say although there are increased cases of variants the lack of adherence to COVID-19 protocols is also leading to increased infections.

Professor Joachim Osur, technical advisor for programmes at AMREF Africa, says Kenya was experiencing high infection rates among communities. He said hospitals are getting overwhelmed, Intensive Care Units (ICU) in hospitals are full, not everyone needing ICU care is getting it and the number of deaths is steadily increasing.
“I think the reason is that we stopped taking precautions,” said Osur, adding that people started behaving irresponsibly when schools, churches and markets re-opened.

“I am worried that schools are running and children who are super spreaders are infecting the older populations,” said Osur.

More Surveillance Needed To Curb Further Infections

“It has to be a systematic analysis to see that the variant has evolved over time,” says  John Nkenkasong, head of Africa CDC.

“Unfortunately Kenya is not technologically competent enough to be monitoring the strains of the virus we have and the mutations that are happening. So, we are unable to know at this point if it is the variants but it could be a reason,” said Osur. “Mutations happen everyday but it is possible that we have more than one variant and it is possible that they are more aggressive.”

Earlier this week Nkenkasong said additional resources and efforts are required to track the virus through surveillance. He said vaccinations should continue. “We do not think the situation in Kenya has evolved to a threshold past where the vaccine should not be used,” he said.

The vaccine uptake in Kenya has been slow with only 640, 000 people vaccinated so far. On 3 March Kenya received 1 million Oxford/AstraZeneca vaccines from the COVAX facility.

“These simple public health measures are what will save us but people are not taking them seriously. The responsibility relies on individuals- more community education is needed on what this virus is and what it should be done to the community,” said Osur.

Image Credits: US news.

Last Ebola patients leave a treatment centre in the Democratic Republic of Congo this week, marking the countdown to declaring the end of the pandemic.

(Geneva Solutions) – As Guinea and the Democratic Republic of Congo discharge their last Ebola patients, following the most recent outbreak, new research points to the virus’ long lasting ability to lurk within the body. So while the 42 day countdown begins to the day when both countries can declare that the current outbreak is over, preparedness remains key to heading off future infections everywhere in the region, warns the International Federation of Red Cross and Red Crescent Societies (IFRC).

With no more confirmed cases and the discharge of the last Ebola patient from a health centre in DRC’s Katwa city on Monday, followed by the discharge of the last Ebola patient in Guinea, on Tuesday night, the latest outbreak of Ebola virus in central and west Africa ma now have ended.

However, global health officials warn that vigilance needs to remain high.  That is particularly true, in light of the recent evidence that the Guinea outbreak was apparently triggered by an Ebola survivor who carried the virus unknowingly for five years before transmitting it to someone else.

The Republic of Guinea was one of the countries at the center of West Africa’s Ebola virus epidemic that raged from 2014-2016 claiming 11,000 lives.  The DRC faced a major outbreak in 2018, that concluded a year later, but has been followed by others. During the most recent DRC outbreak in February, 12 cases were confirmed leading to six deaths – while 1,737 people were vaccinated against the virus, according to the WHO – with IFRC teams on the ground providing key support.

“The main objective of the Red Cross’ intervention on the ground, over the past two years or so, is to ensure Ebola is contained, and does not spread to other areas and across borders into countries such as South Sudan and Rwanda,” Dr Balla Conde, who is managing the IFRC response on the ground with a team of 100 health workers, told Geneva Solutions.

In the case of Guinea, the outbreak declared on 14 February 2021 in the N’Zerekore region led to 14 confirmed cases, leaving five people dead.   However, the even more worrisome aspect of the current Guinea outbreak was its apparent source – a survivor of Guinea’s previous 2014-2016 outbreak who appears to have harbored the virus for as long as five years, before infecting someone else.

“”Patient O” in 2021 Guinea Outbreak Harbored the Virus for Five Years.

The new research findings about “Patient O” of the 2021 outbreak in Guinea hold serious implications for the longevity of one of the world’s most deadly pathogens.

The discovery was made in the course of contact tracing and genetic sequencing of virus strains in Guinea’s present-day patients, which linked those cases back to strains prevalent in 2014 and a recovered patient from that time, according to three independent studies released. Given the lengthy interval between the two events this comes as a “shock” to virologists.  It had been previously believed that the outbreak was transmitted by an animal such as a bat.

“This is absolutely stunning,” Dr Angela Rasmussen, a virologist at Georgetown University in Washington DC, wrote on Twitter, adding. “This is bad for a whole host of reasons, including the further stigmatization of Ebola virus disease survivors.”

Previously, the longest reported duration of virus persistence in an EVD survivor was 531 days, reported on in 2016. That case involved  a 56-year-old survivor whose seminal fluid contained the virus 17 months after the onset of the disease.  According to the reports, he sexually transmitted the virus to someone else in early 2016, triggering further infections in Guinea, one of which was carried back to Liberia.

While it is rare for survivors to harbour and transmit the virus after such a long period, scientists now understand that the virus can remain in the body for a sustained period of time in places such as the eyes, spinal cord and testes – which are not easily reached by immune defences.

Naomi Nolte, IFRC emergency communication coordinator, called the new research findings “worrying” – although she emphasised that the findings remain preliminary.

The overriding message, she said, is that people must “remain vigilant, keep physical distancing, disinfect spaces and ensure that people have all the right information.”

Teaching community workers about Ebola surveillance

 

Potential for EVD Sexual Transmission Could Stigmatise Ebola Survivors.

Reports linking some of the episodes of virus resurgence to sexual transmission could wind up stigmatising  Ebola survivors, warned Gwen Eamer, public health expert in emergencies at the IFRC.

“Although the findings of the virus sticking around for a long time may be true, it is important that we do not jump to conclusions that it is due to sexual transmission as this has very real impacts on survivors,” said Eamer.

Surveilance Key to Containment

Meanwhile, IFRC officials said that they are supporting local health systems by building capacity for community-based disease surveillance. In these cases, trained community volunteers seek out and report cases of people whose symptoms appear to meet EVD definitions, and take blood samples to confirm suspected cases.

Such training is vital as many common illnesses, including influenza, malaria, typhoid and cholera have similar symptoms of vomiting, and fever to Ebola.

Another pillar of preparedness is ensuring safe and dignified burials – since the Ebola virus is also very easily transmitted after the person has died of the disease.

“We know from the previous outbreak in Guinea and neighbouring countries that burials and funerals were key drivers of transmission, because of traditional burial practices that involve touching the body,” said Eamer.

To ensure “safe and dignified burials, we provide the team with personal protective equipment,” said Eamer, adding that the teams actively support the family, while “adapting funeral rituals ensuring that the dignity of the deceased remains intact, taking into account the mental health, social, cultural and religious perspectives.”

There is a higher level of trust today between communities and Red Cross field workers – something that represents a very positive shift from the 2013-2016 Ebola epidemic – and makes it easier for the organization to do it’s work, adds Nolte.

She adds that Covid-19 also has highlighted to policymakers the importance of preparedness for other highly contagious viruses, e.g. Ebola, which pose “perpetual” threats to countries’ economies and societies.

However, the new research findings have also renewed calls for more widespread EVD immunisation campaigns across larger parts in West and Central Africa.

That would require more funding, including some 8.5 million Swiss francs that the Red Cross says it needs for the Ebola response – which has only garnered less than a one million so far.

“We really don’t want to wait for another humanitarian shock like we had during the last outbreak in Guinea in 2013-2016 or are in DRC between 2018 and 2020,” said Nolte.

  • Updated on 25 March, 2021
Originally published in Geneva Solutions. Health Policy Watch Watch is collaborating with Geneva Solutions, a non-profit platform for constructive journalism covering International Geneva

Image Credits: WHO African Region, Geneva Solutions .

european commission
Katalin Cseh a Hungarian MEP associated with the  Renew Europe Group.
EP Plenary session – Preparation of the European Council meeting of 25 and 26 March 2021 and Digital Green Certificate

European Parliament members (MEPs) expressed overwhelming support for a coronavirus-related “Digital Green Certificate” to ease travel within the European Union, voting by a more than two-thirds majority to accelerate approval by the summer.  

But parliamentarians also warned that all efforts to recover from COVID-19 will be void unless Europeans are vaccinated more quickly. 

“We need to speed up vaccination – that is the only light at the end of the tunnel,” said Katalin Cseh a Hungarian MEP associated with the  Renew Europe Group, on the opening day of a two-day debate at the European Union Summit  happening today and tomorrow on the “Digital Green Certificate”.

“We need to increase production capacities to set up more ambitious targets for deliveries to work together with manufacturers, and also to ramp up production,” said Cseh. 

“Only vaccines can offer us a way out of the crisis; we need to do our utmost to help boost vaccine production and ensure more transparency, predictability, and supply of the vaccines, so that we can speed up the vaccination campaigns across the EU,” said Ana Paula Zacarias of Portugal. 

The majority of the MEPs who took the floor said the Digital Green Certificate proposed by the European Commission on 17 March, would support the much-needed recovery of the travel and tourism sector. 

With 468 votes in favor, 203 against, and 16 abstentions, MEPs took advantage of an urgency procedure (Rule 163), which allows for faster parliamentary scrutiny of the Commission’s proposals. The MEPs will next mandate negotiations over the proposal, to be considered during the parliament’s next plenary session (26 – 29 April). 

Certificate To Offer Proof of COVID Vaccination, Recovery Or Negative Test Result
digital green certificate
The stages of the Digital Green Certificate System in practice.

The certificate would be free of charge, in digital or paper format, with a QR code to help ensure security and authenticity.  It would offer proof that a person has either been vaccinated, received a negative test result, or recovered from COVID-19, and has antibodies. 

Other key provisions are that the certificate will be recognized in every EU member state, and it will pave the way for the establishment, or re-establishment, of  full freedom of movement inside the EU during the COVID-19 pandemic. 

“The Commission will build a gateway to ensure all certificates can be verified across the European Union, and will support member states in the technical implementation of certificates,” said Commission Vice-President Maroš Šefčovič. Šefčovič said the Commission aims to have the system in place by June. 

MEPs Call For Legal Action Over AstraZeneca Vaccine Delays & Unreported  Doses 
AstraZeneca vaccine

In terms of speeding up Europe’s vaccine rollout, the MEPs focused most of their fire on the recent AstraZeneca delays in vaccine deliveries. 

Concerns over the failure of the company to meet its EU commitments have been compounded by the  recent discovery of almost 30 million undelivered AstraZeneca doses stashed  in an Italian factory. 

During the debate,  several MEPs speakers called for legal action against the manufacturer.  

Iratxe Garcia Perez, Group of the Progressive Alliance of Socialists and Democrats in the European Parliament, Spain, called the reports about AstraZeneca’s undelivered doses “the straw that broke the camel’s back.” 

“We’re not talking about the fact that they are not complying with their commitments and the contracts. Basically, they’re laughing at us in our faces,” she said. 

The AstraZeneca vaccines were discovered by Italian police in a raid of a factory in Anagni, a town near Rome.  Italian government officials were reportedly unaware of the vaccine stash until the EU’s internal market commissioner, Thierry Breton, launched an investigation, and then tipped off Italian police, according to the Italian newspaper La Stampa. 

Some EU sources said that the jabs had initially been bound for the UK – before being  blocked by Italy after the country introduced new rules on vaccine exports, EU sources told the paper. 

However, in a statement on Wednesday, AstraZeneca said that 16 million of the vaccine doses were simply awaiting quality control to be disbursed to EU countries.  

Another 13 million doses were manufactured outside of the EU, and then brought to the plant for the “fill and finish” process of putting the vaccine into vials, the company said. These doses are awaiting shipment to low and middle-income countries, in the framework of the WHO co-sponsored COVAX global vaccine rollout initiative, which is supported by the EU. 

“It is incorrect to describe this as a stockpile. The process of manufacturing vaccines is very complex and time consuming. In particular, vaccine doses must wait for quality control clearance after the filling of vials is completed,”  the company said.  

Garcia Perez and other MEPs, however, blamed  AstraZeneca for still moving too slowly on the EU vaccine deliveries. 

“[We] have to act firmly and take actions against a pharmaceutical company because they are undermining the prestige of other companies that are meeting their obligations. So I would urge the Commission to get down to work and do something about this flagrant attack against the commitments that the company undertook, “ said Garcia Perez. 

Independence From Pharma, Though Not Through Export Ban 
Martin Schirdewan, of The Left Group in the European Parliament, Germany.

Although several MEPs called for legal action against AstraZeneca to restrain it from exporting vaccines to the UK and elsewhere in the world, others warned that an export ban could result in further delays in Europe’s vaccine rollout. 

“Export bans can lead to retaliatory measures and that could lead to lower production of vaccines in the EU. We could end up in the worst possible situation where nobody benefits,” said Martin Schirdewan, of The Left Group in the European Parliament, Germany.

Schirdewan, however, called on the European Commission to “give up all contracts with the pharmaceutical companies and release the patents to produce the vaccines.” 

“We have made ourselves dependent on the pharmaceutical companies. We have made ourselves dependent on a market that regulates nothing, shown clearly by AstraZeneca stockpiling 29 million doses in Italy that have just been accidentally discovered.” 

“Let’s create a joint European strategy that we can use to combat the virus. Let’s coordinate healthcare, let’s deal with the social and economic consequences of this pandemic for our populations.” 

 

Image Credits: Jan Van De Vel, European Commission, gencat cat/Flickr, Alexis Haulot.

rapid antigen test
A new study suggests that administration to travelers of a rapid antigen test upon arrival at their destination, may be just as effective as quarantine requirements, to stop imports of COVID-19 cases.

A new study published by a consortium of UK-based airline industry interests suggested that administration to travelers of a rapid antigen test upon arrival at their destination, may be just as effective as quarantine requirements, to stop imports of COVID-19 cases.

The study, which reviewed case studies of airport testing procedures elsewhere, claims that a single on-arrival antigen test is as effective as a ten-day-self isolation period in reducing imported cases of COVID-19, while testing after five-seven days of quarantine may catch as many as 90% of cases. Specifically, it found that: 

  • Air passenger testing after five days of quarantine in Iceland is between 83% and 90% effective. 
  • Testing after seven days in Toronto and Paris is between 84% and 90% effective. ​
  • Single tests on arrival in Canada (Toronto-Pearson Airport), France (Paris-Charles de Gaulle Airport), Jersey and Iceland detected between 54% and 76% of infected travellers.

“Real world evidence supports a significant reduction in current UK 14-day quarantine policy,” claimed the studies authors who also disputed a previously published Public Health England (PHE) paper that  had concluded  airport testing would identify only ‘7%’ of virus cases.

The study was prepared for a consortium of British airlines interests, including Virgin Atlantic, Heathrow Airport, and the International Airlines Transportation Association. 

“We believe that international travel can safely restart at scale, using a risk-based, phased easing of testing requirements and border restrictions, that follows the scientific evidence,” Virgin Atlantic’s chief executive Shai Weiss said, upon publication of the review.

Britain has currently banned all foreign travel, except for essential work, education, or health reasons. The ban, along with the current quarantine requirement, was supported by the PHE paper. The new study finds that this significantly underestimates the effectiveness of passenger testing.  

The study has been submitted to Britain’s Global Taskforce, which is set to review how and when travel should restart on 12 April. 

Image Credits: Wikimedia Commons: Nemo.

 

African health officials appeal for more COVID vaccines after current supplies run out in some countries

About 10 African countries have yet to receive any doses of a COVID vaccine, while at least one country, Rwanda, has already run out of the doses that it received through the WHO co-sponsored COVAX facility, said WHO’s African Regional Office on Thursday, citing this as evidence of the vaccine inequalities that continue to mark the battle against the pandemic.  

“It is unfair. I believe that some high income countries are looking to vaccinate their entire populations while others, including most countries in our region, are struggling to reach a significant proportion of at-risk populations,” said Dr Richard Mihigo, Immunization and Vaccines Development Program Coordinator at WHO’s African Regional Office, speaking at a WHO/AFRO press briefing on Thursday.

Under the COVAX initiative, countries are supposed to receive some 20% of their COVID-19 vaccine needs, with the shipment of the doses officially beginning in Accra, Ghana, just weeks ago.  So far, some 7.7 million doses have been administered in 32 African countries through COVAX or national initiatives, the WHO African region officials said.  And some 44 countries have received vaccines through COVAX or other channels.  

At the same time, however, some 10 countries have not received any vaccines at all, and have no idea when the next shipments will be, while other countries are already running out of the doses that they received. 

Rwanda Already Used Its COVAX Vaccine Supplies

Rwanda, for instance,  received about 240,000 doses of the Oxford/AstraZeneca COVID-19 vaccine through the WHO co-sponsored COVAX Facility on March 3. It received a further 103,000 doses of the Pfizer vaccine, as the first African country to administer the vaccine that requires ultracold storage. 

But only 20 days after it commenced vaccination, Rwanda has already administered all of its doses. Rwandan government officials said they did not know when the next shipment will be received, especially since the new guidelines that prioritise India and Europe over the rest of the world, delay vaccine deliveries to Africa. Rwanda has a population of about 13 million and needs to vaccinate 7.8 million people to achieve herd immunity.

“When the COVID vaccine was made available, we already had a programme that was built from the community to national level, so we just plugged into the existing system, and that made it easier and faster to make it happen,” said Dr Sabin NSanzimana, director of the Rwanda Biomedical Centre, at the WHO briefing, describing the country’s experience. “And the thing is that, deploying a vaccine rapidly, without waiting is the best way you can actually stop the progression of this virus.”

However, that success has now been tinged with anxiety as Rwanda awaits more vaccine doses to arrive.

And while countries like Rwanda are rapidly and impressively vaccinating their people against COVID-19 with the very limited doses available, they are largely helpless regarding getting additional doses, said Dr John Nkenkasong, Director of the Africa Centres for Disease Control and Prevention. 

Speaking at a back-to-back Africa CDC briefing, Nkenkasong urged global leaders to pursue equitable access to vaccines, saying:  “There is absolutely no need, absolutely no need for us as a world, as humanity, to go into a vaccine war to fight this pandemic. We’ll all be losers. 

John Nkenkasong, Director of the Africa Centres for Disease Control has appealed for equitable distribution of COVID-19 vaccines, saying there was no need for a vaccine war.

“I remain hopeful that the power of humanity will prevail,”  Nkenkasong added, “I strongly believe that we should continue to be our neighbour’s keeper and the only way we do that is to exercise that strong sense of solidarity and coordination and with common wisdom. I remain hopeful that wisdom will prevail over time.”

Worries That Serum Institute Doses Will Be Kept In India or Diverted To  European Union   

Officials also are worried about the news that AstraZeneca vaccine doses produced by the Serum Institute of India, Africa’s main vaccine supplier either directly and through COVAX, may be kept in India or diverted to the European Union. 

The Oxford/AstraZeneca vaccine is the main vaccine that African countries are receiving through the COVAX  initiative – as well as through bilateral deals. And most of those doses are produced by the Serum Institute. 

In February, however, Adar Poonawalla, CEO of vaccine producer, Serum Institute of India (SII), announced his company had been directed to prioritise the needs of India, currently undergoing a surge in COVID cases. 

“SII has been directed to prioritise the huge needs of India and along with that balance the needs of the rest of the world. We are trying our best,” Poonawalla said on Twitter.   

That was confirmed by a GAVI announcement Thursday, which stated that some 90 million doses due to be supplied to COVAX in March and April may not be delivered – as a result of the Indian government’s decision to divert doses domestically.  

In addition, Africa CDC officials fear that Africa COVID-19 vaccines produced in Europe could also be threatened by new guidelines issued by the European Commission that limit the export of coronavirus vaccines to countries outside the bloc. The guidelines stipulate that the EU countries may curb the exportation of vaccines for six weeks to destinations with fewer COVID cases or higher vaccination rates – although the restrictions explicitly exclude exports to low-income countries that are participating in COVAX. 

Ursula von der Leyen, president of the European Commission, justified the guidelines and said the world is in the crisis of the century and the commission is not ruling anything out. 

“I’m not ruling out anything for now, because we have to make sure that Europeans are vaccinated as soon as possible. Human lives, civil liberties and also the prosperity of our economy are dependent on that, on the speed of vaccination, on moving forward,” Leyen said.

Threats to Africa’s vaccine plans

Also speaking at today’s briefing, Anthony Costello, Professor of Global Health and Sustainable Development, University College London, supported the call for speedier delivery of vaccines to Africa and said the continent’s plan to vaccinate 60% of its citizens by mid-2022 can only be achieved if there is quick access to doses of the vaccines. 

While expecting access to improve before the end of 2021, Costello said the continent needs to vaccinate about 35% of its citizens before the end of the year and this would require about 800 million doses of COVID-19 vaccines.

“If you’re going to reach a 60% target of vaccinating the continent by the middle of next year, which I think is the aim, then, in this year, if you want to reach 35% of the African population, you’re going to need 800 million doses. Let’s say the population of Africa is 1.2 billion, you’re probably going to need to vaccinate 727.5 million people by the middle of next year, that’s going to mean you’ll need almost 1.5 billion doses (of Oxford/AstraZeneca COVID-19 vaccine), so that’s a huge challenge,” Costello said.

Costello expressed confidence that Africa’s health infrastructure  was adequate to ensure a speedy roll-out if the doses became available. “I’m pretty confident that Africa can get there because I think the immunisation infrastructure in Africa is generally not bad. The figures have come up dramatically over the past 10 or 15 years. I think Africa’s public health structure is often better than Europe, to be honest,” he said.

Earlier this month, Africa CDC also announced plans to hold a major conference in April to discuss the local production of vaccines, as one avenue to address the continent’s vaccine shortages. 

Speaking at the time, William Kwabena Ampofo, Chairperson of African Vaccine Manufacturing Initiative, called for a “roadmap” to increase vaccine production that will facilitate immunization of childhood diseases and enable Africa to control outbreaks of highly infectious pathogens

 

Image Credits: Johnson & Johnson, WHO African Region .