Drive-through COVID-19 testing in Papua New Guinea. Only approximately 50,000 tests have been carried out in a country of almost nine million.

Papua New Guinea (PNG), a country that has largely avoided the SARS-CoV2 virus, is now facing an outbreak that could cause the country’s health system to collapse, while Australia is being chided by a Médecins Sans Frontières (MSF) official for its opposition to a World Trade Organization (WTO) patent waiver that MSF says would have opened up generic vaccine production faster. The disproportionate access of Papua New Guineans, as compared to Australians, to newly-developed COVID vaccines, is evidence of larger worldwide disparities between vaccine haves and have-nots, MSF says. 

Nearly half of the cases recorded in Papua New Guinea since the beginning of the pandemic, 2,351 total cases as of Monday, have been reported in the last two weeks. 

“PNG was relatively quiet last year with its low number of cases being reported, but today it has bypassed countries like Australia by reporting the highest number of confirmed cases in the last 24 hours,” David Manning, Controller of the PNG COVID-19 National Pandemic Response, said in a statement on Monday. 

James Marape, the PNG’s Prime Minister, warned on Monday that the country was approaching an infection rate of one person in three or four, calling the situation “critical.”

“The number is quite staggering, if we don’t do [a] corrective response to this, our health system will be clogged and we won’t be able to sustain it,” Marape told reporters on Monday, announcing the implementation of nationwide restrictions. 

Prime Minister James Marape at a media conference in Port Moresby on Monday, announcing the implementation of nationwide restrictions.

The low rates of testing, in combination with the large gatherings held last month to commemorate the death of the former Prime Minister, Michael Somare, indicates that the number of infections and deaths is likely to rise rapidly in the coming weeks. 

Australia Blocked a World Trade Organization Proposal for an IP Waiver on COVID Tools – Would Open Markets For More Generic Vaccine Production, Charges MSF

The PNG was set to receive 200,000 doses of the AstraZeneca vaccine from Australia and 70,000 from India through the COVAX facility, but was not expected to receive shipments of either until April at the earliest.

Responding to the crisis, Australian Prime Minister Scott Morrison on Wednesday announced that Australia would send 8,000 emergency doses of the COVID-19 vaccine to Papua New Guinea, which has seen cases of the virus increase dramatically in the last month.

However, Médecins Sans Frontières (MSF) Australia said Morrison’s gesture is far from being enough – charging that Australia should reverse its opposition to an intellectual property waiver on COVID-19 vaccines, being debated by the WTO, so poorer Pacific Island countries could get doses faster. 

“There’s no doubt [if] the intellectual property waiver had been hastened and scaled at an earlier time there was a higher probability that Papua New Guinea would have been able to get vaccines [by now],” Jennifer Tierney, Executive Director of Médecins Sans Frontières (MSF) Australia, told The Guardian.

“The intellectual property waiver proposal was first made to the WTO by India and South Africa in October last year. Australia was one of the countries opposing this from the start,” said Tierney.

“Add to that the fact that wealthy countries, including Australia, representing only 13% of the global population, had already locked up at least half of the world’s leading potential COVID-19 vaccines, through pre-purchase deals with pharmaceutical companies,” she added.

Australia’s objections to the patent waiver under debate in the WTO – which would temporarily waive intellectual property rights on COVID-19 medicines and vaccines came alongside those of Brazil, Canada, the EU, Japan, Norway, Switzerland, the United Kingdom and the United States. 

Australia to Send Vaccines and PPE to Assist with “Uncontrolled” Outbreak in PNG 

Marape has reportedly asked Australian officials for assistance expediting vaccines for healthcare workers. This call has been echoed by aid groups, urging Australia to act immediately. 

“I put to [Australia] if possibly a smaller supply of vaccines could come in at the very earliest so that the health workers are given the defence in the first instance,” said Marape. 

In response Morrison said that 8,000 doses of the AstraZeneca vaccine would be sent immediately, along with personal protective equipment (PPE) and a team of health specialists to provide technical advice and help with emergency management of the outbreak. 

“We’ve known that [the] challenge was always going to be too great for Papua New Guinea, as time went on, and that indeed is proving to be the case now,” said Morrison at a  Wednesday press conference. 

Scott Morrison, Australia’s Prime Minister, at a press conference on Wednesday.

He also announced that Australia had requested the European Union to permit the immediate export to Australia of one million doses, for which the country had already contracted. Australia has purchased 53.8 million doses from AstraZeneca, 3.8 million of which are to be imported from overseas. 

“We’ve contracted them. We’ve paid for them. And we want to see those vaccines come here so we can support our nearest neighbour, PNG, to deal with their urgent needs in our region,” Morrison said. 

This call comes shortly after Italy blocked a shipment of 250,000 vaccines to Australia in early March due to its own domestic vaccine shortages; the Italian move was the only export order that a European Union member state has refused to implement – out of over 300 requests. 

An answer is expected from the EU within days.

Brazil’s Health System in Crisis as New Record in Deaths is Hit

Meanwhile, Brazil recorded 2,841 deaths on Tuesday, a record high for the country since the beginning of the pandemic, surpassing the US in the 7 day average of COVID-19 deaths, as the health service is experiencing a historic collapse. 

The COVID-19 units in 25 of Brazil’s 27 states are at or above 80% capacity. The health system is being overwhelmed by cases and the situation is “extremely critical across the country,” the Fundação Oswaldo Cruz (Fiocruz), a biomedical centre manufacturing the AstraZeneca vaccine in Brazil, said in a statement.

“The situation in Brazil is a cautionary tale that keeping this virus under control requires continuous attention by public health authorities and leaders to protect people and health systems alike from the devastating impact of this virus,” said Carissa F. Etienne, Director of the Pan American Health Organization, at a press briefing on Wednesday.

Brazil has the second highest number of infections and deaths in the world, with over 11.6 million cases and 282,127 deaths, and only 4.6% of the population have received at least one dose of a COVID-19 vaccine. 

The health authorities are rolling out the Oxford/AstraZeneca and Sinovac vaccines and have purchased doses of the Pfizer/BioNTech, Johnson & Johnson, and Sputnik V vaccines. The vaccination campaign, however, is slow and only a fifth of the expected doses produced in Brazil will be delivered by the end of March. 

Fiocruz researchers urged the government to adopt strict prevention and control measures, including restricting non-essential activities, expanding physical distancing measures, enforcing the use of masks on a large scale, and accelerating the rollout of vaccines. 

New Health Minister Continues With Bolsonaro’s Controversial COVID Policies

Brazil’s fourth health minister since the start of the pandemic was officially appointed on Wednesday. It is doubtful, however, that he will represent a change in the policies of President Jair Bolsonaro, who has consistently downplayed the severity of the virus and has received widespread criticism for his handling of the pandemic. 

Marcelo Queiroga, the new health minister, stopped short of endorsing social distancing measures or a lockdown to curb the spread of the virus at a press conference on Tuesday. Instead he asked the population to wear masks and wash their hands.

Marcelo Queiroga, Brazil’s new health minister, speaking to reporters on Tuesday.

“These are simple measures but they are important, because people can with these measures avoid having to shut down the country’s economy,” Queiroga said. 

He stressed that the country’s health policy is set by the president and the minister is responsible for implementing it.

Disapproval of President Bolsonaro’s handling of the pandemic has reached a record high, with 54% of respondents to a new Datafolha poll considering his actions bad or very bad. This has risen since late January, when 48% of respondents were disapproving.

Image Credits: ABC News Australia, Facebook – Papua New Guinea National Department of Health, ABC News Australia, Reuters.

tb
In just one year COVID-19 has undone 12 years or progess in the fight against tuberculosis.

In just one year, COVID-19 has undone more than a decade’s progress in the fight against tuberculosis (TB), health experts said on Thursday.

While COVID-19 fatality numbers are decreasing worldwide, TB-related deaths remain steady at 4000 cases a day – an occurrence experts partly attribute to limited access to TB treatment services during COVID lockdown periods and TB funds being diverted to fight the virus.

“Twelve years of impressive gains in the fight against TB, including in reducing the number of people who were missing from TB care, have been tragically reversed by another virulent respiratory infection,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership. 

The STOP TB Partnership shared new data on Thursday showing that nine of the countries with the most TB cases – representing 60% of the global TB burden – saw a drastic decline in in diagnosis and treatment of TB infections in 2020, ranging from 16 – 41% (with an average of 23%). The drop brought the overall number of people diagnosed and treated for TB in those countries to 2008 levels. 

Annual percentage change in TB diagnosis and enrollment for nine high-TB burden countries

There are many similarities between TB and COVID-19. Both are airborne infections transmitted through breathing, affecting primarily the respiratory tract, and causing similar symptoms such as cough, fever, and breathlessness. 

Responses to COVID-19 and TB are also similar, including testing, tracing, masking, isolation, and airborne infection control in health care and other settings. 

When the COVID-19 pandemic started in high burden countries, TB program expertise and resources were used to respond to virus.But, as a result of lockdowns, TB diagnostic and treatment services became inaccessible, greatly impacting the amount of people reached and treated. 

As the number of people vaccinated against COVID-19 grows, the number of COVID-19 deaths decrease while TB will continue to kill roughly 4000 people every day, the new data shows.

“In the process, we put the lives and livelihoods of millions of people in jeopardy. I hope that in 2021 we buckle up and we smartly address, at the same time, TB and COVID-19 as two airborne diseases with similar symptoms,”  Said Ditiu.

Dr Lucica Ditiu, Executive Director of the Stop TB Partnership
Investment in TB ‘Drastically Different’ From COVID-19 

In addition to the worldwide drop in TB diagnosis and treatment, data emerging from India and South Africa shows that people coinfected with TB and COVID-19 have three times higher mortality than those infected with TB alone. This makes contact tracing, case finding, and bi-direction TB and COVID-19 testing essential.

“Why is it that TB, which was not too long ago, a global pandemic killing people all over the world in very large numbers?” asked Peter Sands, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria, during a press briefing.

Peter Sands, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria

COVID-19 claimed 1.8 million lives in 2020 and said Sands pointed out that the numbers of people who died from TB in 2020 may have been around 1.7 million, 90% of the number of COVID deaths.. 

But the investment in TB is not as substantial as the investment in COVID-19 – 2% of what is spent on COVID-19 is the amount invested in TB, which Sands called “drastically different in terms of resource commitment.” 

“Why is it that we have left people behind? We haven’t finished the fight against TB, as an older pandemic. Should we not use the forced rethinking of our approaches to global health that COVID has catalyzed?” 

“Let’s really step up our fight against TB, and get rid of it. If we don’t, we are again creating another future risk for humanity in the form of multidrug resistant (MDR) TB.” 

India’s Integrated TB and COVID-19 Response 
The TB programs of several high TB burden countries have made efforts to recover. Some have been more successful than others, such as India.

India was one one of the first countries with a high TB burden that have made vast efforts to recover, developing a rapid response plan by August 2020, after the national government’s TB notification system, “Nikshay,” reported a 70% drop between the 10th and 15th weeks of 2020.

“TB didn’t go anywhere when the COVID-19 pandemic hit,” said Dr. Harsh Vardhan, Minister of Health and Family Welfare, India. “People just got distracted, health workers were redirected, and health systems became overwhelmed. Recovery efforts succeed with political leadership and substantial resources, along with an insistence that COVID-19 outreach and prevention efforts include TB work, instead of replacing it.”

progress
Honorable Harsh Vardhan, Minister of Science and Technology, Minister of Health and Family Welfare, India

The primary goal of the response plan was to integrate TB into all COVID-19 programming, taking advantage of how both infections attack people’s respiratory systems. 

Boosted by public commitment from India’s Prime Minister, efforts to locate TB and COVID-19 cases in all health care facilities intensified, and rapid molecular testing for TB expanded. 

Bi-direction screening of TB and COVID-19 took place for people displaying influenza-like illnesses and severe acute respiratory infections. Contact tracing systems and testing for TB linked to COVID-19 contact tracing were set up, and private care TB facilities were opened. 

India’s response to the simultaneous burden of both TB and COVID-19 has shown that it is possible to integrate approaches to tackle airborne pandemics. “If a nation like India can dream of this, the rest of the world has to think beyond this. We have to admit that the current pandemic has demonstrated the vulnerability of humankind to exigencies, recognizing that we have to strive to add speed and predictability,” said Vardhan.

Investing in TB Creates a ‘Defense System’ Against Respiratory Diseases 

The shift of TB resources to COVID-19 has disproportionately impacted people in low and middle-income countries, which means that more resources and investment towards TB can greatly reduce the double burden of both diseases. 

“We can rein in COVID, and we can protect against new airborne risks in the TB response service platforms to fight current and future airborne diseases, but to succeed, we will need to put equity and human rights at the center of the approach,” said Dr Joanna Carter, Vice-Chair of the Stop TB Partnership Board and Executive Director, RESULTS.

The theme for World TB Day, observed on 24 March, is ‘The Clock is Ticking’, which conveys the sense that the world is running out of time to act on the commitments to end TB made by global leaders.  

The theme for World TB Day 2021 is ‘The Clock is Ticking’

Carter Concluded: “This kind of level of annual investment could have a transformative impact on TB efforts globally, and help build the infrastructure that protectings communities in the world against all kinds of airborne diseases. We can’t force a false choice between fighting COVID or fighting TB. Communities, individuals, and health systems are facing both of these challenges, and they have to have the financial and human resources to respond.” 

“If we act ambitiously now, we can make huge progress against TB and COVID, [creating] a defense system against future infectious respiratory disease threats, [protecting] everyone.” 

Image Credits: STOP TB partnership , STOP TB partnership , WHO.

disaster
Nearly 1 million Somalians were affected during the 2020 flooding. The World Disaster Report found that COVID-19 has presented new risks to the African continents already limited in their financial resources.

COVID-19 has presented new risks to the African continent, with already limited financial resources needed to respond to climate hazards and natural disasters now being diverted to fight the pandemic.

The pandemic has made it all the more challenging to ensure there is adequate disaster financing on the continent, and this now needs urgent attention, said Kai Gatkuoth, the technical coordinator for disaster risk reduction at the Directorate of Rural Economy and Agriculture of the African Union Commission, following the launch of the International Federaton of the Red Cross and Red Crescent Societies (IFRC) 2020 World Disaster Report in the Africa Region.

Released under the theme The World Disaster Report 2020: Come Heat or High Water: Tackling the Humanitarian Impacts of Climate Change Crisis, the global report is based on inputs from a number of Red Cross Red Crescent National Societies around the world.  But there is a special focus on the African continent, one of the most vulnerable regions, particularly in terms of climate change-related disasters, which also have knock-on effects in terms food security, conflict – and of course disease.

“Now the confluence between the Covid-19 and climate hazards makes vulnerability even worse for different communities,” observed Gatkuoth.

He cited recent flooding in parts of east, central and west Africa that led to mass movement of people as an example of a natural disaster worsening the Covid-19 situation. “What we need to do now is address the disaster risk within the context of Covid-19,” he urged.

A Covid-19 disaster recovery framework is now under development that will help AU member states respond to the pandemic in the context of disaster reduction. “We are also developing multi-hazard warning systems that will ensure that there is a clear linkage between natural hazards and pandemics as well as pests, diseases and conflicts,” Gatkuoth said.

One of the major challenges for tackling natural disasters on the continent is the disconnect between disaster risk reduction and climate change adaptation approaches. At the moment about 30 national disaster risk reduction strategies exist in Africa and are growing.

“The report highlights the importance of having linkages between the two,” said Amjad Abbashar of the United Nations Office for Disaster Risk Reduction. One of the reasons why this is the case is that a lot of governments do not have climate change and disaster risk reduction actors working together, he added, calling for increased dialogue between the sectors. 

More Financing Needed for Disaster Risk Reduction

But with climate related droughts, flooding, locust waves and other events becoming more intense and frequent, preparedness has never been more urgent. But higher levels of preparedness can only be achieved if disaster risk reduction financing is available and adequate, to help African countries better cope with natural calamities, the report stresses. 

This is particularly the case, given that weather-related disasters have risen in intensity, per decade, by nearly 35% since the 1990s. Therefore, increasing disaster risk reduction financing remains a big priority to building resilience across the continent.

The report comes at a time when the “entire humanity is facing complex risks”, noted Ambassador Josefa Sacko, the high commissioner for Agriculture Rural Development Blue Economy and Sustainable Environment at the African Union. She added that the report provided important lessons for narrowing the divide between climate change and disaster risk reduction.

However, Abbashar  said “there needs to be disaster risk financing attached …because you are not going to implement the strategies if they are not budgeted. 

“So, more financial commitment is needed by governments, to ensure that disaster risk reductions strategies are not only coherent, integrated [and] complement climate change adaptation strategies – but that they are also adequately funded,” he observed.

When Abbashar took over as the Africa Region director at the IFRC in September 2020, 11 African countries were appealing for support to cope with floods.

“Is the level preparedness and readiness enough? The clear answer is no,” said the IFRC’s Mohammed Mukier, IFRC’s African Regional Director, referencing the technical capacity and financial resources needed to deal with emergencies.

However, Mukier was also quick to point out that with improved climate modeling, the ability to project and predict trends has improved significantly For example projections of impending drought, floods and even population movements for 2022 is now possible. “With all this predictability why are not investing in terms of building local preparedness and readiness?” Mukier said. 

Despite all the challenges, the mindset across African governments is also changing, Abbashar added, saying that in the wake of the devestation seen by COVID as well as from climate related events, “There is political buy-in as illustrated by such strategies as the African Union Strategy for Disaster Risk Reduction, that is critical at the regional level.” 

 

Tanzanian president John Magufuli died on Wednesday following a three week absence from public view.

JOHANNESBURG –The death of Tanzanian President and COVID-19 skeptic John Magufuli has drawn decidedly mixed emotions  – as tributes poured in from both average Tanzanians, as well as other African heads of state and world leaders. But Tanzanian opposition forces said that the president’s mysterious death was a chance for a reboot on both Tanzania’s pandemic response as well as  other vital reform issues.

The responses followed Wednesday’s announcement of Magufuli’s death by the country’s Vice President Samia Suluhu Hassan, set to take over as Tanzania’s first female president, while saying that Magufuli’s death was due to heart failure.

Magufuli, a prominent skeptic of the coronavirus,  died at Mzena Hospital in Dar es Salaam where he was receiving treatment for heart complications he had been suffering from for a decade, according to Hassan.

But his fiercest critic and opposition and main opposition leader Tundu Lissu on Thursday claimed that Magufuli, 61,  had in fact died of the coronavirus, calling his death “poetic justice” following Magufuli downplaying the severity of the COVID-19.  Since last May, Tanzania had steadily suppressed reports of any COVID cases to the World Health Organization – pressuring medical doctors to cite causes other than COVID in hospital records and on death certificates. 

Lissu charged that the Tanzanian government was not being honest about the cause of Maguguli’s death, saying they were “lying even now that he is dead”.

“Magufuli died of corona,” said Lissu, speaking from Belgium in an interview broadcast on Kenyan network KTN News, citing personal sources.  “My message to Tanzania is that this is an opportunity to open a new chapter….This is a rare opportunity for us to step back from disaster and go back to sanity,” the opposition leader added.

 

Magufuli Downplayed COVID-19

Magufuli had scoffed at the coronavirus, championing alternative medicines and calling for prayer instead of face masks. Then three weeks ago, shortly after two senior officials in his government died of COVID-19, Magufuli disappeared from public view.  His disappearance immediately fuelled rumours that he had contracted COVID-19, but his illness remained unconfirmed, and its precise nature, was not disclosed. 

 “President Magufuli did not wear a face mask. He actually denigrated anyone who wore face masks. He did not believe in vaccines, he did not believe in science,” said Lissu.

“He placed his faith in faith healers and herbal concoctions of dubious medical value. And what has happened, happened. He went down with corona.” 

Magaguli downplayed the pandemic and denounced vaccines as a Western conspiracy against Africans.  Magufuli claimed prayer had beaten the virus.

Tanzania has not updated its COVID-19 cases or deaths since May, 2020 when the country had recorded a total of 509 cases and 16 deaths, but a doctor in Dar es Salaam told the BBC that there has been a significant increase in the last two months in admissions of patients exhibiting respiratory symptoms consistent with COVID-19. 

Hassan said Magufuli was admitted on 6 March to Jakaya Kikwete Cardiac Institute for heart problems and discharged the next day. A week later he felt bad and was rushed to Mzena Hospital where he was getting treatment under the supervision of doctors from the cardiac institute. Hassan said burial arrangements were underway and announced 14 days of mourning and the flying of flags at half-staff.  

Vice President Hassan Set To Become Tanzania’s First Female President
Tanzania’s Vice President Samia Suluhu Hassan should assume the Presidency following the death of President John Magufuli.

Despite his reputation as a COVID-skeptic, fellow African leaders heaped praise on Magufuli’s leadership, with Kenyan President Uhuru Kenyatta announcing that flags in Kenya and all Kenyan diplomatic missions abroad will be flown at half-mast from Thursday 18, until Magufuli’s burial.

“In testimony of the high esteem in which the People of Kenya hold President John Pombe Magufuli, the Republic of Kenya will observe a period of seven days of national mourning,” Uhuru Kenyatta said. “As a symbol of Kenya’s enduring respect for Magufuli, as well as Kenya’s solemn solidarity with the Nation and People of the United Republic of Tanzania,” flags in Kenya and its diplomatic missions will be flown at half-mast, he added. Kenyatta termed Magufuli as a champion of pan-African ideals.

South African president Cyril Ramaphosa said: “South Africa is united in grief with the government and people of Tanzania as they go through this difficult moment.”

According to Tanzania’s Constitution, Vice President Samia Hassan will assume the presidency for the remainder of the five-year term that Magufuli began serving last year after winning a second term. She is the East African nation’s first female president. 

 

 

 

 

 

 

 

EMA Executive Director Emer Cooke

The European Medicines Agency’s safety committee (PRAC) on Thursday gave a resounding endorsement of the Oxford/AstraZeneca vaccine against COVID-19, concluding that the vaccine’s benefits vaccine “far outweigh” any risks  –  despite a possible link between some vaccinations and rare cases of blood clotting associated with low levels of blood platelets. The EMA statement followed two weeks of mounting concerns over reports of such rare events – leading to 17 countries to suspend the vaccine rollout, at least temporarily. 

In a press briefing Thursday evening, an EMA panel stressed that the AstraZeneca vaccine “is not associated” with an increase in the overall risk of blood clots. Nor is there evidence of problems related to specific batches of the vaccine or to particular manufacturing sites. 

However, the EMA safety review did find that the vaccine may be associated with very rare cases of blood clots associated with thrombocytopenia, i.e. low levels of blood platelets (clotting elements in the blood), and also including rare cases of clots in the vessels draining blood from the brain (CVST).

“The EMA Committee has come to a clear scientific conclusion. This is a safe and effective vaccine. Its benefits in protecting people from COVID-19, with the associated risks of death and hospitalisation, outweigh possible risks,” said EMA Executive Director Emer Cooke at the press briefing, adding that overall, “The committee also concluded that the vaccine is not associated with an increase in overall risk of thromboembolic events or blood clots.” 

At the same time, she said, in the Agency’s Pharmacovigilence Risk Assessment Committee (PRAC) investigation and review, a “small number of cases of rare and unusual, but very serious disorders” were detected, that triggered a more focused review.  “And we still cannot rule out definitively a link between these cases and the vaccine,” said Cooke. 

As a result, she said that the agency would be adding a warning about rare events to the vaccine label and patient information – as well as launching more follow up studies. 

“If it were me, I would want to be vaccinated tomorrow,” Cooke stated, when asked by reporters if she would take the AstraZeneca vaccine herself – or wait for another product. ”But I would want to know if anything happens to me after vaccination, what I should do about it, and that’s what we’re saying today.  

“I want to reiterate that our scientific position is that this vaccine is a safe and effective option to protect citizens against COVID-19. It demonstrated that at least 60% efficacy in clinical trials and preventing coronavirus disease, and in fact the real world evidence suggests that the effectiveness could be even higher than that.”

Blood Clots – Still Very Rare Events 
Sabine Straus, chair EMA pharmacovigilence Risk Assessment Committee (PRAC)

Cooke stressed that the instances of thrombocytopenia-associated blood clotting remained very rare events. And rare adverse events are common with almost any vaccine or medication:

“About seven million people have now been vaccinated in the EU with the AstraZeneca vaccine, and 11 million have been vaccines in the UK…When you vaccinate millions of people it’s inevitable that you have rare or serious incidents,” she said.

“But I want to reiterate that our scientific position is that this vaccine is a safe and effective option to protect citizens against COVID-19.” 

According to the latest EMA data, of an estimated 20 million people in the United Kingdom and Europe that have so far received the vaccine as of March 16, the EMA had reviewed only 7 cases of blood clots in multiple blood vessels (disseminated intravascular coagulation, DIC) and 18 cases of CVST (cerebral events).

”A causal link with the vaccine is not proven, but is possible and deserves further analysis,” stated an EMA news release issued simultaneously with the press briefing. 

Greater Proportion of Very Rare Cases Observed in Young Women 
astrazeneca
EMA Panel announces results of its review of the safety of the Oxford/AstraZeneca COVID-19 vaccine.

A greater proportion of these very rare cases, however, have been observed in young women, the committee members acknowledged. This may also explain why more are being seen on the European continent than in the United Kingdom, where the AstraZeneca rollout focused first on older groups. 

The EMA experts did not rule out, either, a possible link between such rare events and contraceptive pill use, which can increase the overall risk of blood clots for young women: 

“Yes, it is always a distinct possibility,’’ said Sabine Straus, EMA Safety Committee head, in referring to those risk factors that might contribute to such a rare event among those being vaccinated. “One of the risk factors that is highlighted for the [thrombosis] disease or the syndrome, as such, is also oral contraceptives. The committee also is investigating if the risk of such events might be higher among recovered COVID patients who are vaccinated.” 

A past COVID infection might also add to the risks of such, she said. “COVID is an important risk factor for thrombosis and also a post-COVID syndrome. So that might have played a role.” 

She added that smoking was also a general risk factor for thrombosis anyway, but cautioned, “I am not sure it’s a risk factor for these specific cases, but it’s something that we are also looking into.” 

United Kingdom versus Europe Differences 

There have also been proportionately fewer reports of the rare events in the United Kingdom – just three cases – as compared to elsewhere on the European continent, including seven cases in Germany, three in Italy, one in Spain and two in India, the panel stated. 

Said Peter Arlett, head of EMA analytics, “we know that the AZ vaccine in the UK, was given predominantly to older patients, compared to the totality of European member states. And therefore, if blood clot cases are more common in younger women, for example, then it would suggest that you get more cases in Europe than you would in the UK.”

In some European countries, health workers, including young women, have been a first priority in vaccine campaigns.

The panel also said that they would be investigating other reports of other rare adverse events seen in any of the vaccines that have so far been EMA approved. Those have also included reports in the United States of sudden decreases in blood platelet clotting elements, called “immune thrombocytopenia” (ITP), shortly after vaccination with the Pfizer and Moderna vaccines.  The syndrome can cause excessive bruising and bleeding. 

Said Straus, “A separate investigation has been started for ITP, and that is a signal that is ongoing for the moment.” 

Image Credits: HPW .

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Smog over Delhi, India

The unexpected – and unexplained – dissolution of India’s brand-new Commission on Air Quality Management (CAQM), established by Prime Minister Narendra Modi at the peak of North India’s air pollution crisis five months ago has taken air pollution scientists and clean air advocates by surprise. Members of the commission were also taken aback, learning of the news through weekend media reports, sources familiar with the issue said.

The Commission, disbanded after the Modi government failed to see through a parliamentary law to back up the executive decree issued in October, prompted immediate protests  by opposition politicians, with Atishi Marlena from Delhi’s ruling Aam Aadmi Party charging the national government with yet another failure in pollution policies.   

“Who will take action on Haryana, Punjab, UP (Uttar Pradesh), Rajasthan due to burning of stubble?,” Marlena asked, referring to the rural regions around Delhi which flood the city with air pollution during the late fall and early winter. “With the CAQM gone, who will now take action against errant polluters,” she asked, speaking to a Hindi language media outlet. 

Government – Rattled by Farm Protests, Doesn’t Want to Penalise Stubble Burning
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Farmers in India protesting new agricultural laws passed by the Modi government.  While the new laws focus on crop price policies – the government may be fearful of any step that could alienate farmers further, some observers believe.

While Modi and his ministers offered no comment, sources told Health Policy Watch that his government was nervous about the powers that had been granted to the new commission – which had been empowered to prosecute polluters, including farmers burning crop stubble, and impose stringent penalties. 

“Farmers protests have become a very sensitive topic,” the source said, noting that the government is rattled by the media attention the protests have gained both domestically and internationally. “It wants no more trouble in this sector in the current scenario.”  

For over 100 days, tens of thousands of farmers have been camped around Delhi’s periphery to protest against a series of agricultural laws passed by the Modi government in September 2020.  Billed as modernization measures, the laws would leave farmers to negotiate produce prices on the open market – something farmers say  will put at the mercy of large agro-businesses, and threaten their livelihoods. Even after multiple rounds of talks between the government and farmers, the protests show no sign of ending. 

Lack of any official communication on the Commission’s sudden dissolution has, however, led to confusion and conjecture. That, after Commision members had reportedly been appointed for a period of three years. 

The confusion continued this week, as some government sources said they still expected the CAQM to be “up and running in a few weeks,” but without saying how that could happen since there is no legal framework for the body to operate – after the time frame for transforming an executive decree into a parliamentary act elapsed. 

One news report even quoted Environment Secretary R.P Gupta saying cryptically “ It’s not that the commission will not come back, but not now. The commission will be coming back slightly late.” 

Commission set up during October Crisis – Initially Offered Hopes Of Change 

The Commission had been hurriedly set up on October 28, 2020 when north India’s air quality was at its worst. The appointed chairman, a retired head of the country’s petroleum and natural gas, took charge on a day in November when official monitors reported PM2.5 levels at almost 100 times more  than WHO’s guidelines for 24-hour average levels of fine particulate matter. 

air
Air Quality Index of India – real time air quality data as of 17 March, based on a scale of 0 to 500 (Good to Hazardous). Every city in India observed air quality improvements compared to 2018 and earlier,  However, India continues to feature prominently at the top of the most polluted cities ranking with 22 of the top 30 most polluted cities globally.

It is estimated that 1.7 million people die every year in India from air pollution – with Delhi consistently ranking as one of the most polluted cities in the world. The city was estimated to have seen 54,000 deaths due to PM2.5 air pollution in 2020 – or one death per 500 people, according to the most recent Greenpeace-IQAir study, reported by Health Policy Watch.

When it was established last fall, the Commission was billed as a replacement for a bureaucratically awkward, and largely ineffective, Environment Pollution (Prevention and Control) Authority (EPCA), which had set up 22 years ago by India’s Supreme Court. The Commission, reporting directly to the Modi’s government, was presented as a body that could act more effectively on the thorny air quality issue. 

Although air quality experts and advocates at the time had questioned its mode of creation – by executive decree at a time when India’s parliament was in recess – they also expressed hopes that the Commission could be a step forward – consolidating the functions of the EPCA and multiple other task forces into a single body with more significant powers, and membership including representatives from the central and state governments.  

Defunct Commission Had Innovative Features – Welcomed By Air Quality Campaigners  

The executive decree, or “ordinance”, that established the now-defunct Commission also included some other innovations that were welcomed at the time by air quality campaigners. These included treating the Delhi national capital region as an airshed; involving some well-respected clean air non-profits; and working from the ground up with a fully-funded secretariat. 

And in some ways, the Commission’s creation also represented the most explicit action yet by Prime Minister Modi to address the threat of India’s air pollution to public health – even though the Prime Minister continues to consistently avoid the issue in his public statements.

“While the process of creating the CAQM was problematic, the agency itself represented a significant milestone. The CAQM had an airshed-level mandate, dedicated funds and staff, and would have assumed accountability for air quality outcomes in the region. The lapsing of the ordinance definitely leaves an institutional vacuum, and is a deeply worrying development,” says Santosh Harish, Fellow at the Centre of Policy Research who specialises in energy and environment policy and air quality governance. 

‘Set Up To Fail’ – Clean Air Community Angry and Aghast  
Real time air pollution indicators globally, as of 17 March, from World Air Quality Index – with pollution indicatrors ranging from Good (0 to 50) to Hazardous (301 to 500).

Now, the commission’s dissolution just five months after its formation has left the clean air community wondering if the body was, in fact, created to fail. 

Throughout its five-month tenure, the commission was publicly invisible – with no official or even social media channels of communication, although sources unofficially spoke about data collection that was underway to better identify local emission sources, exposure levels and pollution levels.

“This one was set up to fail – and it did so gloriously. Without periodic reporting on what the CAQM did, it is unclear what they delivered, so what are we lamenting about?,’ says Karthik Ganesan, a fellow with the non-profit Council on Energy, Environment and Water. 

“In theory, these centrally constituted bodies are effectively replicating the Central Pollution Control Board in its coordination role. Strengthening institutions that actually are vested with the task of addressing AQ at various levels – starting with the CPCB and giving it the autonomy to constitute committees to coordinate action in regional air sheds, would make this a more productive effort,” he added. 

In a scathing piece, environmental lawyer Ritwick Dutta echoed the message saying: “It was clear from the beginning that the CAQM was designed to fail. In the five months of its existence, its single major failing was that almost nobody even knew it existed. It had no office, email address, website or even a phone number through which people could contact its offices.” 

Dutta added: “The government gave the CAQM the power to hear grievances of the people affected by air pollution, but the main grievance of the people was finding the commission itself.”

Added Bhavreen Kandhari, a member of activist group WarriorMoms called it a shocking lapse:  “The lapse of the CAQM Ordinance has been very disappointing and shocking. This clearly shows how serious the government is about the critical issue of air pollution.”

Campaigners Call For Intervention of Courts Once More 

Now that the Commission has effectively dissolved, air quality advocates are calling for the courts to intervene once more. Traditionally, India’s Supreme Court has been the leading arbitrator of air quality issues – in the absence of strong government policies. 

In fact, shortly before the CAQM was created, the Supreme Court ordered the creation of a new single-judge committee to lead the charge on the air pollution issue, headed by a retired Supreme Court  judge, Madan Lokur.  

Then, just after that appointment was announced, Modi’s government announced that it was forming the new Commission – making judicial intervention irrelevant at the time. 

Some critics now suspect that the Commission’s creation was merely a ploy to head off intervention by the courts at the peak of India’s annual air quality crisis – a crisis that builds up every winter in the dry season, which coincides with autumn crop burning and household heating, and then ebbs again with springtime weather and monsoon rains.  

“Clearly it wasn’t the honest and genuine political will of the government to set up this commission,” said Vimlendu Jha, founder of environment and sustainability non-profit Swechha.

“The dissolution of the commission is just one more flag up in the air displaying arrogance and ignorance of our political class. This episode is a joke on all of us who felt we had arrived at the regional and airshed approach to clean air,” he added. 

Kandhari said that clean air advocates would now file a new legal appeal to the Supreme Court to reinstate it’s committee.  She  said that  the application will be made on behalf of a 17-year old student Aditya Dubey – who suffers the respiratory effects of air pollution – borrowing on a successful legal strategy used last year in the United Kingdom to get the courts there recognize the health effects of air pollution on children. 

“We need immediate intervention by the honourable court to protect our right to breathe,” she said. 

Aam Aadmi Party criticises the dissolution of CAQM, federal govt

Speaking in the  Hindi language  media outlet, opposition legislator Marlena  urged the city’s government to protest the Commission’s dissolution.  In addition to crop burning, she added, other deliberate development policies are contributing to Delhi’s longtime pollution stew, she stressed.

Those, she added, include the federal government’s allowance of “5,000 polluting  brick kilns, 13 thermal power plants and several polluting industries” to flourish within a 300 km radius of Delhi; some 60%  of Delhi’s pollution comes from outside the city. 

CPR’s Harish sounded a more upbeat note saying: “I hope that a new bill to replace the ordinance may yet get tabled, discussed, and passed in the Parliament, and that the CAQM is only temporarily suspended.” 

Depending on the outrage the dissolution generates, that may yet happen. 

Jyoti Pande Lavakare is a journalist and author whose non-fiction memoir about the human cost of air pollution, ‘Breathing Here is Injurious to Your Health’, was published by Hachette in November 2020.

Image Credits: toiplus/India, Jean-Etienne Minh-Duy Poirrier/Flickr, World Air Quality Index.

Ursula von der Leyen, President of the European Commission, announcing the Digital Green Certificate proposal at a press conference on Wednesday.

The European Commission has released a proposal establishing a framework for a “Digital Green Certificate”, clearing the way for a vaccine certificate system to be set up by the summer. 

The proposal comes as many European countries are witnessing a third wave of infections and as the region’s vaccination campaign is lagging from vaccine shortages and the suspension of the AstraZeneca vaccine, a key vaccine in the inoculation effort – with only 10% of EU residents vaccinated. 

European Commission and WHO Encourage Trust in AstraZeneca Vaccine

President of the European Commission, von der Leyen, announced the moves  in a press conference – whrere she also stressed her confidence in the safety of the AstraZeneca vaccine, echoing the same message sent by the European Medicines Agency and the World Health Organization. 

“I trust AstraZeneca, I trust the vaccines,” said Von der Leyen. 

WHO’s expert safety team called the investigation into the thromboembolic events “good practice,” but stressed that there is currently no causal link to the vaccine. 

“At this time, WHO considers that the benefits of the AstraZeneca vaccine outweigh its risks and recommends that vaccinations continue,” said WHO in a statement released on Wednesday.   

The EMA is expected to publish its assessment of the vaccine on Thursday in a statement that Von der Leyen said would “clarify the situation.” 

Certificate System to Support Free Movement and Revitalize Economy

The Digital Green Certificate is designed to facilitate the safe and free movement of citizens in the EU during the COVID-19 pandemic. It will provide proof that an individual has been vaccinated against COVID-19, has received a negative test, or has recovered from COVID-19. 

Mock-ups of a paper and digital vaccination certificate, proposed by the European Commission on Tuesday.

“The Digital Green Certificate offers an EU-wide solution to ensure that EU citizens benefit from a harmonised digital tool to support free movement in the EU,” said Vera Jourová, Vice President for Values and Transparency at the European Commission, in a press release. 

“Our key objectives are to offer an easy to use, non-discriminatory and secure tool that fully respects data protection,” Jourová added. 

Several EU member states that rely heavily on tourism, including Greece, Spain, and Italy, were strong proponents of a common approach to such a system to revitalize air travel and ease the pressure on economies. Airlines and the travel industry also put pressure on EU politicians to implement a standardised travel solution. 

“We aim to help member states reinstate the freedom of movement in a safe, responsible and trusted manner,” said Ursula von der Leyen, President of the European Commission, at a press conference on Wednesday. 

Certificate System Won’t Be Discriminatory, Say Commission Officials

The proposed system will benefit everyone travelling within the EU and won’t discriminate against those who have not been vaccinated, emphasised the Commission in a statement. This comes after several countries and experts raised concerns about the ethics of such a system. 

National authorities in EU member states will be responsible for issuing the certificate, meaning it could be issued by hospitals, test centres, or health authorities. The certificate will include the individuals’ name, date of birth, date of issuance, information about the vaccine, test or recovery status, and a unique identifier. 

A QR code will be used to authenticate the certificate, ensure the security of data, and protect against falsification. According to the Commission, no personal data will be retained by the visited countries. 

The stages of the Digital Green Certificate System in practice.

The rights of individuals falling within the three categories on the Digital Green Certificate will be equal and member states will be required to waive the same public health restrictions, such as testing or quarantine, for all travellers with a certificate. 

“The Digital Green Certificate will not be a pre-condition to free movement and it will not discriminate in any way,” said Didier Reynders, Commissioner for Justice. “A common EU-approach will not only help us gradually restore free movement within the EU and avoid fragmentation. It is also a chance to influence global standards and lead by example based on our European values like data protection.”

Free movement is a fundamental right for EU citizens and the certificate system will “make it easier to exercise that right,” said the Commission. Those without a certificate will be able to travel, but may be subject to testing or quarantine. 

Commission officials have made a point to avoid the term “passport,” instead describing the Digital Green Certificate as a common system to help EU member states coordinate travel measures.

The certificate will be available to EU citizens and their family members, non-EU nationals who reside in the EU, and visitors who have the right to travel to other member states. It will be valid in all EU member states and Iceland, Liechtenstein, Norway, and Switzerland will be able to decide whether or not to introduce it. 

There will be no difference in the treatment of citizens and eligible non-EU citizens, said the Commission. 

The European Commission will develop a gateway for all certificates to be verified across the EU, assist member states in the technical implementation of the certificates, and support member states to develop software to scan and check the QR codes.

Vaccines Included Under Certificate System

The COVID-19 vaccines that have received EU marketing authorization will automatically be recognised on the certificate, but member states will be able to accept vaccine certificates issued for other vaccines, specifically ones that have been granted authorization by a member state’s regulatory agency or ones that have received WHO Emergency Use Listing. 

This is particularly an issue for the countries – Hungary, Slovakia, and Czech Republic – that have rolled out the Russian Sputnik V and Chinese Sinovac and Sinopharm vaccines before they have been approved by the European Medicines Agency (EMA). 

It is unclear if the proposed system will automatically be updated with the vaccines currently under rolling review by the EMA, including the Sputnik V vaccine, once they receive authorization.

The proposed system leaves the door open for updates based on new scientific evidence on the efficacy of vaccines in halting the transmission of SARS-CoV2 and the duration of protective immunity from prior infection. 

Currently the framework sets the maximum validity period of the certificate of recovery from a previous COVID-19 infection at 180 days. 

Next Step for Approval of Proposal

The Commission’s proposal is subject to approval by the majority of member states and the European Parliament before it can be implemented across the region. The proposal will be discussed at the next European summit, which is set to take place in late March. 

Member states will have to implement the trust framework, which defines the rules, protocols, and standards to ensure that the certificates are interoperable, verifiable, and trusted, in order to take a common approach to the certificates. 

The system could be implemented within three months EU officials said in February during the virtual summit of the European Council.

The Digital Green Certificate system will be temporary, “it will be suspended once the World Health Organization (WHO) declares the end of the COVID-19 international health emergency,” said the Commission. 

EU Threatens to Halt Vaccine Exports to UK, If Vaccine Exports to the Continent Aren’t Reciprocated

Meanwhile, in vaccine rollout news, the EC President threatened to curb the export of COVID-19 vaccines produced in the EU to countries that have higher vaccination rates, referring to the United Kingdom and the United States, both of which have been restrictive in their export of vaccines manufactured locally. 

“We want reliable deliveries of vaccines, we want to see increases in the contracts, we want to see reciprocity and proportionality in exports,” said Von der Leyen at a press conference. “We are ready to use whatever tool we need to deliver on that.”

“This is about making sure that Europe gets its fair share,” she added. 

The EU has exported 41 million doses of vaccines manufactured in the region to some 33 countries over the past six weeks – including 9.1 million Pfizer/BioNTech vaccines to Britain and one million to the US – and is the largest funder of the WHO co-sponsored COVAX global vacccine facility, which aims to share vaccines more equitably with low- and middle-income countries too.

But the bloc of 27 member states has not received its “fair share” of vaccines in return, particularly from the UK, Von der Leyen stressed, referring to the AstraZenec/Oxford vaccine produced there. 

“It is hard to explain to our citizens why vaccines produced in the EU are going to other countries that are also producing vaccines, but hardly anything is coming back,” said Von der Leyen. 

The EU is “still waiting for doses to come from the UK,” produced by AstraZeneca, said Von der Leyen. 

According to the Commission, two factories manufacturing the AstraZeneca vaccine in the UK are mentioned in the EU’s contract with the pharma company as sites for the production of vaccines designated for the EU.

The irony is that at the same time that the EU is clamouring for the UK to permit more AstraZeneca exports, some 17 countries have suspended its use due to about 30 reports of blood clots and abnormal bleeding in recipients of the jab. 

EU is “Not Ruling Out Anything” to Secure Vaccines

“We need to ensure that there is ‘reciprocity’ and ‘proportionality,’” said Von der Leyen. “If the situation does not change, we will have to reflect on how to make export to vaccine-producing countries dependent on their level of openness.”

When asked about potentially seizing production or waiving intellectual property rights to secure vaccine supplies for member states, von der Leyen said that “all options are on the table.”

“We are in the crisis of the century and I’m not ruling out anything for now because we have to make sure that Europeans are vaccinated as soon as possible,” Von der Leyen said.

Her comments contrasted sharply with the EU’s longstanding opposition to an IP waiver on COVID-19 tools and technologies at the World Trade Organization (WTO). The EU has joined several high income countries in blocking the proposal, arguing that WTO rules are flexible enough to address the vaccine access issues faced by low- and middle-income countries.

The export restrictions could also extend to countries “who have higher vaccination rates” than the EU, which could apply to Israel, Chile, the United Arab Emirates, Bahrain, Serbia, Qatar, Turkey, and Morocco.

UK Defends its Use of the “UK-Funded” Vaccine

In a rebuke to Von der Leyen’s comments, Matt Hancock, the British Health Minister, said that the UK had the legal right to prioritize doses of the AstraZeneca vaccine, developed with government support, to its citizens. The government has repeatedly prioritised UK citizens but continues to say it has not imposed an export ban on doses. 

“We legally signed a contract for delivery of the first 100 million doses here for people in the UK, as you would expect, both to ensure that people in the UK can get their jab and also because this is a UK-funded, UK-delivered vaccine,” Hancock said at a press conference on Wednesday. 

Matt Hancock, the UK’s Health Minister, at a news briefing on Wednesday.

“It remains the case that we expect the EU to stand by its commitment,” said a spokesperson for the UK government. “Putting in place restrictions endangers global efforts to fight the virus.”

“We’ve, all of us, including with our European friends, been saying throughout the pandemic that you’d be wrong to curtail or interfere with lawfully-contracted supply,” Dominic Raab, the UK’s Foreign Secretary, said on Wednesday. “I’m surprised we’re having this conversation. It is normally what the UK and EU team up with to reject when other countries with less democratic regimes than our own engage in that kind of brinkmanship.”

The decision to fulfill the UK’s vaccine needs before exporting to the EU coincides with an announcement on Wednesday that there will be a significant reduction in the amount of vaccines available in the UK from 29 March. 

This is due to “reductions in national inbound vaccines supply,” said a letter from the National Health Service, conveying information it received from the government’s vaccines task force. 

The EU has faced vaccine supply issues for several months now. AstraZeneca has underproduced and underdelivered doses to the EU, which has slowed the speed of the regional vaccination campaign. Initially the pharma company was expecting to deliver 90 million doses in the first quarter, but this has dropped to 30 million doses.

Despite the struggles the EU has faced with their rollout of vaccines, Von der Leyen said that she remains optimistic that the target of having 70% of the adult population fully vaccinated by the end of the summer could still be reached. 

Image Credits: Twitter – Ursula von der Leyen, European Commission, European Commission, Sky News.

 

Dr John Nkenkasong, Director of the Africa CDC says negotiations to secure COVID-19 vaccines are out of their hands.

Africa’s goal of achieving herd immunity against COVID-19 hangs in the balance as 270 million doses of vaccines are yet to arrive in the continent despite being secured three months ago by the African Union (AU) and African Centres for Diseae Control (ACDC).

Mid-January 2021, Health Policy Watch reported that the Africa CDC had pre-ordered millions of much-needed vaccines from various suppliers. But to date not even the centre’s leadership knows when the first set of shipment is due to arrive – or which country will be the first to receive the doses.

With two weeks to the anticipated April roll-out of the vaccine, Dr John Nkenkasong, Director of the Africa CDC, told Health Policy Watch that the finalisation of the process, by which Member States of the African Union (AU) can confirm and obtain their doses, is yet to occur. This includes the negotiations with the Afreximbank which is providing African countries with credit facilities, with which they can procure doses of the vaccines from the manufacturers.

“Most of the processes and negotiations are work in progress,”  said Dr Nkenkasong.

In the statement in January announcing the acquisition of the 270 million doses, the African Vaccine Acquisition Task Team (AVATT) established by African Union Chair President Cyril Ramaphosa, said the doses will be supplied by Pfizer, Johnson & Johnson and AstraZeneca (through an independent licensee, Serum Institute of India).

“From the onset of this pandemic, our focus as a continent has been on collaboration and collective effort. We have held steadfastly to the principle that no country should be left behind,” Ramaphosa said at the time.

AVATT officials said at the time that all 270 million vaccine doses will be made available this year with at least 50 million being available for the crucial period of April to June 2021.

Africa CDC then asked African countries to order doses through the African Medical Supplies Platform and when the deadline for the expression of interest expired in mid-February, Nkenkasong revealed that only about 26 countries (less than half of the countries in Africa) had expressed interest in securing doses through the platform.

But less than two weeks to April, there is no clear indication of whether the doses will be available by April or not.  And any delays would threaten the goal of achieving herd immunity for COVID-19 in Africa within one year, as AU and Africa CDC officials aim to do.  

 

Africa’s Long Road to Herd Immunity
Vaccinations in Kenya: about a dozen African countries have now launched vaccine drives in priority groups like health workers, older people and teachers, with the support of the WHO co-sponsored COVAX global facility. But supplies available through COVAX fall far short of demand. 

Last week, the president of the African Development Bank, Dr. Akinwumi Adesina called for vaccine justice for Africa. Speaking at the launch of the Bank’s African Economic Outlook 2021 report on Friday, Adesina decried the lack of Covid-19 vaccines reaching Africa.

“So far, 14.6 million vaccines have been delivered in Africa, but many people still cannot get shots in their arms. That is only 1% of what we need. We are way off the mark in terms of getting to 60% of herd immunity, and sadly, I do not see that happening for another year or two at this rate— not unless things change,” Adesina said.

According to him, there is a need to improve Africa’s access to vaccines. But so far, the COVAX Facility has been the major source of vaccine doses available to African countries, beginning with Ghana in late February.   However, the COVAX supplies would cover only about 20% of the population, at most, by the end of 2021. 

“COVAX is doing a great job but still, we need more. We need them in adequate quantity. We need them quickly and we need them at an affordable price,” Adesina said.

Negotiations to Secure Vaccine Doses “are really out of our hands”

Nkenkasong is a major proponent of African countries accessing vaccine doses through multiple means considering COVAX will only provide doses for one in five of those needing jabs. But he told Health Policy Watch that several aspects of the processes involved in securing the doses of the various COVID-19 vaccines are beyond the control of the public health agency.

“Our own role is to say to the continent — this is the kind of vaccines we should get, this is exactly why we should get this vaccine and these are the targets that we are trying to achieve. The rest of the back end negotiations are really out of our hands. So be patient with us,” Nkenkasong told Health Policy Watch.

But the non-arrival of the doses of COVID-19 vaccines, which have been expected through AVATT,  has not stopped Africa CDC from getting involved in the roll-out of COVID-19 vaccines in the tens of African countries where COVAX-supplied doses are available. 

“What we are doing is to collect all those vaccines that are coming in, in a dashboard, project them and show where each country is with respect to getting to 60%. That is our role and we will use that to catalyse the process and advocate for more partners,” Nkenkasong said.

 

Image Credits: Wish FM Radio.

Vaccinated: Sister Amanda Swartz believes the vaccinations will give South Africa a fighting chance against COVID.

South Africa’s vaccination programme for health workers is inching forward, fuelled by small deliveries of the Johnson & Johnson vaccine every two weeks.  However, overall supplies remain far short of the needs – even for the health sector. 

The country has an estimated 1.25 million health workers in public and private health to serve its population of 60 million – but by 15 March, slightly fewer than 148,000 had been vaccinated due to a dearth of vaccines.

A looming third wave of COVID infections, predicted in June when the country’s winter forces people indoors, and the more infectious B.1.351 variant now dominant in the country, are two big anxieties facing health workers.  There is also hesitancy with some health workers believing that there is insufficient safety and efficacy data for most vaccines so far approved.

But Sister Amanda Swartz did not hesitate when offered a vaccine in late February. At the very front of the ‘frontline’ against the pandemic, Swartz works at Brackengate Intermediate Care Facility,  a 300-bed facility set up specifically for COVID-19 patients in Cape Town. A nurse for 30 years who has worked with HIV and tuberculosis patients, Swartz says she has never experienced anything like the second wave of the pandemic, which hit the country in December and January. 

At its zenith, South Africa was recording 22,000 new cases per day, and Swartz says the Brackengate facility was overwhelmed with patients: “We lost 20 patients in one day. Young people with no comorbidities were coming in scared because they have never been sick in their lives but they couldn’t breathe,” says Swartz. 

Swartz felt sickly on Christmas eve and spent the next 10 days in isolation. Sick with COVID-19, she had to self-isolate from her three children.

Covid is a Lonely Disease
Health workers in the Western Cape province of South Africa getting their Covid vaccination.

Describing COVID-19 as a “lonely disease”, Swartz said the nights she spent alone and struggling to breathe were the worst – but hearing her family in the house kept her going.

“It made me think about my patients differently. How they were all alone in the hospital and scared, and we are the only people that can motivate them and keep them in touch with their families.”

Returning to work was “scary”, admitted Swartz. She was still tired, suffered shortness of breath and feared being reinfected. 

When she was offered the vaccine, she grabbed the opportunity and was one of the first to be vaccinated at her facility on 24 February.

“I couldn’t actually wait for us to start with vaccinations in the country because this gives us a fighting chance against the disease,” said Swartz. “I didn’t only do it for myself. As I’m working with COVID patients, I also put the people that I love at risk. So by protecting myself, I’m also protecting my family.”

While there is still “negativity” about the vaccine on Facebook and other social media platforms, most of Swartz’s colleagues who were afraid to be vaccinated have come around:

“They see that those who have taken the vaccine didn’t have side-effects or, if we did, they were very mild like a headache or fatigue – just like if you have Hepatitis B vaccine. So most of them say they are prepared to take the vaccine now.”

Swartz believes that a third wave is inevitable in the country as people have become lax about wearing masks and physically distancing.

The Western Cape government on Thursday said that to date 27 570 healthcare workers in the province had been vaccinated,  urging others to register and get the jab to “shield each other”.

“The vaccine is currently being rolled out to healthcare workers, but not enough of us have been vaccinated at this stage to stop the spread of the virus,” the province said in a statement.

Relaxed Lockdown Regulation Could See Spike in New Cases 
On 1 March, most pandemic-related restrictions were relaxed in South Africa in the face of falling caseloads and the devastating economic impact of lock-downs. 

But with the curfew eased, alcohol on sale again over weekends, bars and restaurants open and people allowed to mingle, health experts warn that new cases are soon going to rise again –  although, for now, new infections remain under the bar of 700 a day in a country of 60 million people.

In the face of another wave of infections, Swartz said: “What I would really like to see is that each and everyone in our country takes the vaccine if the world will give it to us. We had too many losses in the second wave. If we can prevent that by taking the vaccine, I think that will help a lot.”

South Africa’s vaccine procurement, like that of other African countries, is slow and uncertain. 

Shortly after securing 1.5 million doses of the AstraZeneca/ Oxford vaccine in a bilateral deal with the Serum Institute of India for health workers in early February, a small study, just now published in the New England Journal of Medicine, showed that the AstraZeneca vaccine was not effective in preventing mild and moderate infection against the B.1.351 variant prevalent in the country.

The government decided instead to offer the Johnson & Johnson vaccine to health workers. Although the vaccine is not yet registered for use in the country, a clinical trial on efficacy had just been completed – so scientists expanded the terms of the trial to encompass an implementation study for health workers.  Since then, the J&J vaccine has been approved both by the US Food and Drug Administration and the European Medicines Agency. 

South Africa Sells AstraZeneca Vaccine Doses Despite Calls for Roll-Out


The government, however, generated a controversy when it resolved to sell its 1.5 million AstraZeneca doses to the African Union. A number of leading scientists condemned this decision, particularly Professor Schabir Madhi, dean of the Faculty of Health Sciences at the University of the Witwatersrand and Director of the SA Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit.

Madhi was the principal investigator on an AstraZeneca efficacy trial being run in South Africa.

Writing in Business Day earlier this month, Madhi argued that “there remains a strong biologically plausible reason to expect the AstraZeneca vaccine will protect against severe disease due to the B.1351 variant, likely to a similar magnitude as the J&J vaccine”.

The World Health Organization also recommended in mid-February that the AstraZeneca vaccine should still be rolled out, even in countries where the B.1.351 variant was circulating, said Madhi.

He and other health professionals, including infectious diseases expert Professor Francois Venter, believe that the AstraZeneca vaccine should have been rolled out to high-risk South Africans who have no other protection against severe illness and death.

“Every additional day of procrastination lends itself to much of the R75m [75 million Rand/$US 4.87 million] used to procure the vaccine going to waste, while the elderly and other high-risk individuals would certainly remain unprotected as opposed to being offered a fighting chance of being protected against Covid-19 severe disease and death,” wrote Madhi.

The AstraZeneca vaccine is the backbone of the global COVAX vaccine platform’s vaccination programme and it also makes up a large portion of the African Union’s vaccine procurement.

Unlike many other African countries, South Africa has yet to receive a COVAX vaccine delivery. According to the COVAX allocation plans published on 2 March,  South Africa is still due to get over 2.4 million doses of the AstraZeneca vaccine and 117 000 Pfizer doses.

However, given the government’s decision to return its own AstraZeneca purchases and a global shortage of vaccines, it is going to take a while before the country’s citizens get the jab.

Image Credits: Western Cape government, Kerry Cullinan , Western Cape Provincial Government, South Africa .

AstraZeneca vaccine

Major European nations remain divided over the use of Oxford/AstraZeneca’s COVID-19 vaccine, while the pharma company said there was no evidence of increased risk of blood clotting and abnormal bleeding among people who get the vaccine.    

AstraZeneca’s review of all the safety data of more than 17 million people vaccinated in the European Union (EU) and the United Kingdom (UK) has shown no increased risk of pulmonary embolism, deep vein thrombosis (DVT) or thrombocytopenia in any particular age group, gender, or country, the company said on Sunday. 

Across the EU and the UK, there have been 15 cases of DVT and 22 cases of pulmonary embolism reported among those given the AstraZeneca vaccine. Five deaths have also been reported – two dying from brain hemorrhages.

The reports have prompted more than a dozen countries to either partially or fully suspend the vaccine’s use while cases are being investigated. Some 17 countries, including Spain and Sweden have joined France, Germany, and Italy in suspending use of the vaccine. 

“The nature of the pandemic has led to increased attention in individual cases and we are going beyond the standard practices for safety monitoring of licensed medicines in reporting vaccine events, to ensure public safety,”  AstraZeneca said in its statement on Sunday. Ann Taylor, Chief Medical Officer, added:

 “number of cases of blood clots reported in this group is lower than the hundreds of cases that would be expected among the general population,” but she said that the company will continue to closely monitor the vaccine rollout.   

UK’s Boris Johnson Issues Strong Defense – Australia, and Thailand Also Remain Confident in AstraZeneca 

Outside of Europe, however, the AstraZeneca vaccine rollout through the WHO co-sponsored COVAX initiative was continuing in most countries – although the Democratic Republic of Congo said they had postponed an immunization launch that had been planned for this week. 

And Australia, India and Thailand were moving ahead with the vaccine as well as the UK. 

UK Prime Minister Boris Johnson issued a series of strong statements in defense of the vaccine – whose R&D the UK also supported. “The vaccine is safe and works extremely well,” Johnson wrote in an article published on Tuesday in The Times.

Prime Minister Boris Johnson says UK ‘very confident’ about AstraZeneca vaccine

“People should still go and get their COVID-19 vaccines when asked to do so,” said Dr Phil Bryan, UK Medicines and Healthcare products Regulatory Agency (MHRA) Vaccines Safety Lead, in a statement. 

Bryan added: “We are working closely with international counterparts in understanding the global safety experience of COVID-19 vaccines and on the rapid sharing of safety data and reports.” 

On Monday, Johnson told reporters that Britain’s MHRA is “one of the toughests and most experienced regulators in the world,” saying it’s approval signalled that the vaccine was safe. He went on to praise the UK’s vaccine rollout, one of the largest so far, which is helping to bring down COVID-19 rates. . 

More than 24 million people in the UK have received at least one dose of a coronavirus vaccine, with the UK government aiming to offer a first vaccine dose to about 32 million people in nine priority groups by 15 April.  

But Johnson reiterated, “Successful as the UK vaccination programme may be, there is little point in achieving some isolated national immunity. We need the whole world to be protected.” 

Australia will also not pause their AstraZeneca COVID-19 vaccine rollout with Chief Medical Officer Paul Kelly remaining “confident that [the vaccine] is safe.”  

“The Therapeutic Goods Administration is aware of the issue and also does not’ see any link between the AstraZeneca vaccine and blood clots,” Kelly said in a press conference on Tuesday.  

Australia’s CMO (right) Paul Kelly addresses blood clot concerns over AstraZeneca vaccine

Kelly also stated that there have been no increased incidence of blood clots among Australians who have already received the AstraZeneca vaccine. 

Thailand’s prime minister, Prayuth Chan-ocha, who received a dose of the AstraZeneca vaccine on Tuesday, urged people to “believe doctors” as other countries suspended the vaccine’s use. 

“There are people who have concerns,” Chan-ocha said after receiving the vaccine. “But we must believe doctors, believe in our medical professionals.”

Most Asian countries have continued to administer the AstraZeneca vaccine, with India the largest user. 

Thailand has ordered enough doses from AstraZeneca and China to cover around half of its population. The country has so far vaccinated around 50,000 people in high-risk groups. 

Suspensions of Vaccine is ‘Political’, Says Italy 

As many national vaccination strategies remain reliant on the vaccine made by AstraZeneca, the decision to suspend its use may slow down rollout even more, as efforts are marred by political infighting, mixed messaging, and supply shortages. 

Despite delays of the vaccine in several countries, Spain remains confident that the Spanish government’s two-week suspension will not alter the country’s vaccination calendar, government spokeswoman Maria Jesus Montero said on Tuesday. 

Spain aims to vaccinate 70% of its 47 million population by the end of the summer. 

Italy’s medicines authority director-general called the decision to delay the vaccines largely “political”.

“We got to the point of a suspension because several European countries, including Germany and France, preferred to interrupt vaccinations… to put them on hold in order to carry out checks. The choice is a political one,” Nicola Magrini told the la Repubblica daily in an interview, Reuters reported. Prior to taking on his new role,  Magrini was a former top WHO official specializing in medicines approvals and access.   

Italy has recently blocked a shipment of AstraZeneca vaccines from leaving the country, arguing that it had failed to meet its contractual obligations to provide the vaccine to the European Union. 

EMA and WHO Urge Continued Use  – WHO Data Review to be Completed on Thursday 

The European Medicines Agency and the World Health Organization have been quick to defend the Oxford/AstraZeneca vaccine – and urge its continued use. 

“I’m not here to give you the outcome of any scientific review”, said EMA director Emer Cooke at the start of a press conference on AstraZeneca vaccine safety on Tuesday. 

“I’m here to explain the steps in the process, what we’re doing, and when you can expect us to come to a conclusion.”

Experts will meet on Thursday “to come to a conclusion on the full information that has been gathered and to advise us as to whether there are further actions that need to be taken,” said Cooke. “We will inform the public of the outcome immediately after this meeting.” 

The EMA currently concludes that while the investigation is still ongoing, “We are firmly convinced that the benefits of the AstraZeneca vaccine in preventing COVID-19 with its associated risk of hospitalization and death outweigh the risk of the side effects.” 

The WHO has also issued similar messages, with the WHO’s Global Advisory Committee on Vaccine Safety saying that at the moment, “benefits of the vaccine outweigh the risks”.  The  EMA is to issue reports about the safety of the vaccine on Thursday, after examining all data. 

WHO Director General Dr Tedros Adhanom Ghebreyesus

WHO Director General Dr Tedros Adhanom Ghebreyesus said the events are not necessarily linked to vaccination, “but it’s routine practice to investigate them, and it shows that the surveillance system works and that effective controls are in place.”

–Updated 18 March, 2021

Image Credits: Flickr, gencat cat/Flickr, The Guardian, Sophie Scott/ABC.