African vaccine producers supply just 1% of the continent’s needs at present – but the plan is to increase this to 60% by 2040, according to John Nkengasong, Director of the Africa Centers for Disease Control (CDC). 

“The vision is to ensure Africa has timely access to vaccines to protect public health security, by establishing a sustainable vaccine development and manufacturing ecosystem in Africa,” Nkengasong said at the opening of the two-day African Vaccine Manufacturing Virtual Conference on Monday.

There are currently 10 pharmaceutical manufacturing companies on the continent.

By deploying a coordinated regional strategy, Nkengasong said Africa can establish vaccine manufacturing hubs in each of the continent’s five regions — western, central, northern, eastern and southern.

If Africa is able to effectively leverage its capabilities, Nkengasong said the continent can vaccinate 60% of its people against COVID-19 by 2022. 

By 2040, he said Africa can be fully responsible for the manufacture of vaccines of three emerging diseases including Ebola,Lassa fever and Rift Valley disease; have capacity to manufacture vaccines for unknown global pandemic for up to 60% of its population, and should be able to meet 60% of its routine immunisation.

Dr Stavros Nicolaou, Aspen’s Senior Executive for Strategic Trade Development

In March 2021, South Africa’s largest pharmaceuticals maker, Aspen Pharmacare, announced it was involved in a technology transfer that will enable it to commence the supply of 200 million Johnson & Johnson COVID-19 vaccine doses before the end of June.

Dr Stavros Nicolaou, the company’s Senior Executive for Strategic Trade Development, told the conference that African governments need to ensure the availability of economies of scale, and to ensure the economies are sustainable.

“We cannot any longer sustain this continuous dependence on imports, particularly in the midst of a pandemic that we’re witnessing today, and for that matter any future pandemic,” Nicolaou  said. 

He said that the governments of Italy and France had approached Aspen for anesthetic and other supplies during the pandemic last year. 

He added that African governments and the continent’s major donor agencies have active roles to play in supporting local manufacturing through long-term contracts and guarantees of tax.

“Right now, with importing reigning supreme, there is no real support for localization and local efforts. It becomes very difficult to attract and retain investors. Without guarantees, we will not succeed,” he added.

To start with, he said Africa needs to look beyond vaccines and expand its target to medical equipment and local companies that are involved in their production across the continent.

“We need to identify more of these facilities, leverage the volumes, regionally, and the entirety of the continent, and look to see how we leverage those volumes, into our domestic manufacturing plants across the country. So we start establishing these economies of scale, and we grow from there,” he concluded.

Setting Priorities

Abderrahmane Maaroufi, Director of Morocco’s National Public Health Institute, noted that Africa’s stakeholders need to identify top priorities for medicine production, and set goals for the local vaccine production on the continent.

He said that Africa can prioritise vaccines like the human papillomavirus (HPV) vaccine that are complex and expensive globally, as well as vaccines against meningitis.

Maaroufi added that Africa should also prioritise vaccines to respond to the epidemiological threats of emerging diseases such as Ebola and rabies.

“And the reason I say this is because these kinds of products are very expensive, on a global level. It’s very hard to buy them because the demand is low and are limited to a few countries,” Maaroufi said.

Notably, Maaroufi added that Africa can also focus on improving the local production of anti-snake venom and similar treatments that are specific and peculiar to Africa.

“We need to prioritize this kind of production which is very specific to the scorpions and other serpents that exist in our continent,” he added. 

Dr Amadou Alpha Sall, Director of the Institut Pasteur de Dakar in Senegal

Africa needs to be able to produce up to 200 million doses of COVID-19 vaccine, according to Dr Amadou Alpha Sall, Director of the Institut Pasteur de Dakar in Senegal.

He noted that new technology could accelerate the pace towards closing the wide gap that exists in Africa’s vaccine manufacturing landscape.

“This action-oriented approach is something that we learn not only from the vaccine perspective but also we’ve learned from the diagnosis process,” he said.

Sall was referring to the $1 COVID-19 test kits that were developed by the Institut Pasteur de Dakar in collaboration with the British biotechnology company Mologic and the IRD, the French National Research Institute for Sustainable Development.

He added that Africa also needs to figure out long-term funding and identify partners that will commit to the venture for a long-term.

“It’s not just about putting money on a regular basis but also about building business models that are very relevant to Africa,” he added.

He opined that attention should be focused on Africa’s peculiarities—putting into consideration the continent’s specificity in order to identify the unique business model that would be financially sustainable and at the same time make high quality products with affordable access. 

“These would be something that is critically important and that’s where the value of partnership is important. We need to put together a great foundation that will support these initiatives while at the same time, mobilizing some domestic funds,” he added.

Despite the enormous tasks ahead, Sall said the coordination of the African Union through the Africa CDC could and should enable the continent to achieve the set goals. 

“With the coordination through platforms and hubs, we can build in different regions, capacity to be involved. To provide vaccines to everybody seems to be critical to coordination is really key,” he added.

WTO to Prevent ‘Vaccine Hoarding’

Ngozi Okonjo-Iweala, Director-general of the World Trade Organization (WTO), told the conference that the organisation intends to create a framework to prevent “vaccine hoarding” in future pandemics.

She also revealed that the WTO will hold a meeting this week with vaccine manufacturers to discuss trade barriers and how to increase the production of COVID-19 vaccines.

This initiative comes as the effort by India and South Africa to get pharmaceutical manufacturers to waive their intellectual property rights to COVID-related medicines and products, appears to have stalled. 

In the weeks leading to the conference, Health Policy Watch reported stakeholders in public health on the continent warned against vaccine wars and expressed worry regarding the fate of Africa which they said is a victim of an unfair distribution of the already approved COVID-19 vaccines. 

While countries in the Western world have more than enough doses for their citizens, African countries that got some doses of vaccines through COVAX Facility are already running out of supplies and developments elsewhere, including in India, suggested they may not get additional doses anytime soon.

“The current COVID-19 pandemic presents a great opportunity to harness the various conversations and proposals into an action-oriented roadmap led by the African Union and the World Health Organization (WHO) in Africa. And this will lead to increased vaccine production that will facilitate immunization of childhood diseases and enable us to control outbreaks of highly infectious pathogens,” said William Kwabena Ampofo, Chairperson of African Vaccine Manufacturing Initiative.

Naoko Yamamoto, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations

Although taxing tobacco products is one of the most effective ways to discourage smokers – and it provides governments with revenue – it is “the least implemented” tobacco control policy globally, according to the World Health Organization (WHO).

“It takes vision and courage for political leaders to stand up against the powerful vested interests that profit from tobacco,” said WHO Director General Dr Tedros Adhanom Ghebreyesus at Monday’s launch of a manual on tobacco tax administration aimed at helping governments to levy taxes.

Tobacco use accounts for an estimated eight million deaths a year, but only 38 countries covering 14% of the global population had sufficiently high tobacco taxes in 2018, according to the WHO. 

“Raising tobacco taxes so that they account for at least 70 percent of retail prices would lead to significant price increases, induce many current users to quit, and deter numerous youth from taking up tobacco use, leading to large reductions in the death and disease caused by tobacco use,” according to the WHO.

Highest Taxes in Sri Lanka

Sri Lankan Health Minister Pavithra Devi Wanniarachchi

Sri Lanka and Oman are amongst the handful of countries with high taxes – accounting for 70% and 64% of the price of cigarette packs respectively.

Sri Lankan Health Minister Pavithra Devi Wanniarachchi told the launch that her country  “proudly meets the highest level of achievement with regards to tobacco taxation on cigarettes”.

“We have increased this tax at regular intervals in order to effectively decrease the affordability, and therefore the consumption, of these deadly products,” said Wanniarachchi, but added that bidis and chewing tobacco also needed to be taxed at the same level as cigarettes as they were “just as deadly”.

Oman’s health minister, Ahmed Mohammed Obaid Al Saidi, told the launch that his country had raised taxes from 25% to 64% between 2018 and 2020 and expected this to have an impact on consumption although “smoking is very low” in Oman. 

Jeremias Paul, the WHO’s Coordinator of the Tobacco Control Economics Unit, said that the tobacco industry used scare tactics to dissuade governments from taxation, including claiming taxes were anti-poor, would cause job losses and result in court action.

He urged governments to prepare adequately to combat industry arguments, and that the manual would assist with this.

Young People Are Price- Sensitive

Young people are two to three times more responsive to taxes and price than older persons, thus “higher taxes and prices are particularly effective in keeping young people from moving beyond experimentation with tobacco use, preventing them from becoming regular and, eventually, addicted users”, according to the manual.

It guides readers through the steps necessary to create strong tobacco taxation policies, including practical pointers on how to navigate through the political process and win support for taxes.

In the “best practice” chapter, the WHO urges governments to use the tax revenue to address the health problems caused by tobacco, implement a simple excise tax, tax all tobacco products in a similar way to avoid consumers moving from one product to another and eliminating duty-free sales.

Where the tobacco industry has threatened job losses, “using a portion of new tobacco tax revenues to move tobacco farmers into other crops or to retrain those employed in tobacco product manufacturing for work in other sectors would significantly reduce these concerns”.

Naoko Yamamoto, WHO’s Assistant Director-General for Universal Health Coverage and Healthier Populations, said raising taxes “is particularly timely in the context of a COVID-19 recovery where countries face large budgetary pressure”. 

“Improved tobacco tax policy can be a crucial component of building for better,” said Yamamoto.

Dr. Maria Van Kerkhove, WHO Technical Lead on COVID-19, at the press conference on Monday.

The World Health Organization (WHO) has called for a global “reality check” as COVID-19 infections increased by 4.4 million in the past week, with countries and individuals abandoning proven methods to protect themselves.

“This is not the situation we want to be in 16 months into a pandemic, where we have proven control measures. It is time right now where everyone has to have a reality check about what we need to be doing,” Maria van Kerkhove, WHO’s COVID-19 Technical Lead, told the global body’s bi-weekly media briefing.

Van Kerkhove warned that the world was in a “critical point of the pandemic,” which is “growing exponentially.”

WHO Director General Dr Tedros Adhanom Ghebreyesus blamed “confusion, complacency and inconsistency in public health measures” for the increases, pointing to “several countries in Asia and the Middle East that have seen large increases in cases.”

India, Turkey, Iran, the Philippines and Iraq are driving these regional increases.  

“Make no mistake, vaccines are a vital and powerful tool, but they are not the only tool,” stressed Tedros. “We say this day after day, week after week, and we will keep saying it: physical distancing works, masks work, and hygiene works. Ventilation works, surveillance testing, contact tracing, isolation, supportive quarantine and compassionate care all work to stop infections and save lives.”

Tedros pointed to the fact  that in some countries with high transmission rates “restaurants and nightclubs are full, markets are open and crowded with few people taking precautions.”

He also warned young people not to assume that they could not get seriously ill, pointing to the deaths of young, healthy people and the effects of ‘long COVID.’

“Many people who have suffered even mild disease report long term symptoms, including fatigue, weakness, brain fog, dizziness, tremors, insomnia, depression, anxiety, joint pain, chest tightness and more, which are symptoms of long COVID,” warned Tedros.

Dr Tedros Adhanom Ghebreyesus, WHO Director General.

“This is exactly the time where we need to double down on the non-pharmaceutical interventions, on masking and reducing transmission, because we give the vaccines their best chance of providing protection,” said Kate O’Brien, WHO’s Director of Vaccines. “When, in addition to scaling up immunity through vaccination, we reduce transmission, this reduces the likelihood of having [the] emergence of variants.”

Van Kerkhove urged people to “check their social media feeds” to see “what people are doing and how you are mixing” to keep safe.

Vaccine Supply is ‘Precarious’

Bruce Aylward, WHO’s lead at COVAX, admitted that the “whole vaccine supply situation remains precarious,” and the challenge of managing community was “very difficult one to manage.”

India continued to make “tremendous demand” on the supply of AstraZeneca vaccines being produced by the Serum Institute of India.

This vaccine is the backbone of COVAX and requires two doses but the interval between doses could be extended to 12 weeks, said Aylward. 

“Obviously we’d like to make sure that that interval doesn’t go longer than that so we’re doing everything possible to ensure the supply of AstraZeneca’s product in particular because that’s what’s gone out,” said Aylward. 

Vaccine Manufacturing Task Force

The WHO’s Chief Scientist, Soumya Swaminathan, clarified that the Vaccine Manufacturing Task Force being set up under COVAX was focused on the “immediate removal of any obstacles” to vaccine rollout.

At present, it was focused on “raw materials and ingredients and the tubings and the plastic, which is getting into short supply,” she said.

Dr. Soumya Swaminathan, WHO Chief Scientist.

“There are also export restrictions that have been put in place by some countries on some of these products, which is creating a problem for some manufacturers,” added Swaminathan. 

“The first step is really to identify what those critical needs are, where there is a global supply shortage and try to address them, but also work with governments to make sure that there are no export restrictions. That’s where the World Trade Organization (WTO) and the trade rules would come in.”

Earlier in the day, the WTO’s new Director General Dr Ngozi Okonjo-Iweala, told an African manufacturing conference that the trade body planned to introduce rules to prevent hoarding during pandemics.

Image Credits: Mohsen Atayi, WHO.

Previous SARS-CoV2 infection conferss a high degree of protection, according to a new study.

Previous infection with SARS-CoV2 induces effective immunity against future infections by 84% – but reinfection rate is still 16%, found a study published in The Lancet on Friday. This suggests that infection-induced immunity is similar to, or greater than, vaccine-associated immunity, said the authors. 

The SARS-CoV2 Immunity and Reinfection Evaluation (SIREN) study involved 25,661 health workers in the UK and took place between June 2020 and January 2021. 

It was conducted by researchers at Public Health England, and the Universities of Oxford, Bristol and Cambridge.

Participants were separated into a positive cohort – based on antibody positive or previous positive PCR tests – and a negative cohort – antibody negative or no previous positive PCR test.

Questionnaires on symptoms were sent to participants and diagnostic testing was conducted every two weeks, and antibody testing took place every four weeks. Reinfection was defined by the researchers as a participant with two positive PCR tests 90 or more days apart or an antibody-positive participant with a positive PCR test. 

Some 155 reinfections were detected in the positive cohort of 8,278 participants and 1,704 new infections were identified in the negative cohort of 17,383 participants. The interim results from the study showed that previous infection reduced reinfection by at least 84%.

 

Weekly frequency of study participants with a positive PCR test result by cohort assignment, from March 2020, to January 2021.

 

Approximately 50.3% of the reinfections were symptomatic, with 32.3% of those having typical COVID-19 symptoms, which include cough, fever, and loss of taste or smell. The average interval between primary infection and reinfection among participants was 201 days.

The lowest level of protection against reinfection was provided to asymptomatic infection, with 76 of the 155 participants with reinfection having asymptomatic reinfection.

Vaccines and Variants

During the study period, 52.2% of the participants were vaccinated, however, the authors said that the findings on the durability of protection following their previous infection were independent of the vaccine effect. 

The researcher recommended that future studies examine the protective effect of both previous infections and vaccine efficacy. 

In addition, the B.1.1.7 variant had spread rapidly during the study period causing over 50% of the infections among participants. Despite the circulation of the more transmissible variant, the study found no evidence that the spread of the variant adversely impacted reinfection rates. 

This shows that immunity from a previous infection from a different SARS-CoV2 strain is still protective against the variant. 

Comparable Protection from Infection and Vaccines, Say the Authors

“Our findings…show equal or higher protection from natural infection, both for symptomatic and asymptomatic infection [compared to vaccines],” said the authors. 

The protection against asymptomatic reinfection is particularly important to reduce the risk of onward transmission.

Although the Pfizer/BioNTech and Moderna COVID-19 vaccines were 90% effective against PCR-confirmed infection, according to a study conducted by the US Centers for Disease Control and Prevention (CDC) in early April, natural infection induces a wider range of immune responses. 

Antibodies induced by infection are often lower in concentration compared to antibody responses induced from vaccinations, but can include responses beyond the spike protein, which is the target of current vaccines, said Florian Krammer, Professor of Microbiology at the Icahn School of Medicine at Mount Sinai in New York, in a comment to the study. 

This study is “valuable to understand the nature and duration of protective immunity,” said Soumya Swaminathan, WHO Chief Scientist, on Twitter. 

Further studies on the longevity of antibody responses, reinfection with the new SARS-CoV2 variants, and the impact of the existing vaccines on reinfection are reportedly underway.

Image Credits: Flickr – International Monetary Fund, The Lancet.

The Johnson & Johnson COVID-19 vaccine.

The European Medicines Agency is reviewing the cases of four people who developed blood clots after receiving Johnson & Johnson’s (J&J) COVID-19 vaccine, the regulator announced on Friday. 

“Four serious cases of unusual blood clots with low blood platelets have been reported post-vaccination with COVID-19 Vaccine Janssen. One case occurred in a clinical trial and three cases occurred during the vaccine rollout in the USA. One of them was fatal,” the regulator said in a statement after a meeting of its Pharmacovigilance Risk Assessment Committee (PRAC) ended on Friday.

The vaccine is currently being used in the USA under an emergency use authorisation, and in South Africa as an implementation trial to vaccinate health workers.

It was authorised in the EU on 11 March and member states were expected to start rolling it out in the next few weeks. 

“These reports point to a ‘safety signal’, but it is currently not clear whether there is a causal association between vaccination with COVID-19 Vaccine Janssen and these conditions,” said the EMA. “PRAC is investigating these cases and will decide whether regulatory action may be necessary, which usually consists of an update to the product information.”

PRAC is also investigating a bleeding disorder linked to AstraZeneca. 

“Five cases of this very rare disorder, characterised by leakage of fluid from blood vessels causing tissue swelling and a drop in blood pressure, were reported in the EudraVigilance database,” according to the EMA, although it said no causal relationship had been established between the condition and the vaccine.

PRAC has also concluded that unusual blood clots with low blood platelets should be listed as very rare side effects of AstraZeneca.

Both AstraZeneca and Johnson & Johnson vaccines use the same viral vector technology. 

Image Credits: Johnson & Johnson.

South Africa’s Health Minister Zweli Mkhize

CAPE TOWN – South Africa has secured enough COVID-19 vaccine doses for 41 million people from Johnson and Johnson and Pfizer, but only 6 million of these will be delivered by June because of “supply constraints”, the country’s health ministry announced on Friday.

Health Minister Zweli Mkhize told a civil society briefing that the vaccination of the country’s 1.25 million health workers should be completed by mid-May – although it has only vaccinated about 300,000 health workers so far because of shortages.

From 17 May, the country will start vaccinating people over the age of 60, workers over 40 and people working in “congregant settings” such as nursing homes. By July, it hopes to move to all people over the age of 40. After October, vaccinations will be opened to everyone and South Africa hopes to vaccinate 41 million of its almost 60 million citizens by February 2022 – the most ambitious rollout by an African country so far.

Secret Pfizer Negotiations ‘Took a While’

Mkhize said that the negotiations with Pfizer “took a while” and this had also prevented the country from getting the 117,000 Pfizer doses it had been allocated by the global vaccine platform, COVAX. The terms of the deal are secret, and the ministry has been unwilling to share the price it is paying or what the sticking points were in the negotiations.

However, Pfizer will start to deliver South Africa’s 20-million-dose order in tranches within 14 days after it received payment on Friday, said the Minister. These will mainly be dispensed in urban areas given that people needed two doses and they needed to be kept in very cold conditions.

Meanwhile, Johnson and Johnson (J&J) has agreed to supply the country with 31 million of its vaccine, which would be prioritised for rural and migrant populations given that they can be kept in ordinary fridges and people only need a single dose.

The J&J vaccines will be assembled in South Africa by the country’s generic producer, Aspen, which means it can be distributed fast because the regulatory safety checks would have been done at the factory, said the minister.

“Our vaccine rollout plan couldn’t be finalised until we knew the flow of the vaccines,” said Mkhize, adding that J&J had provided a schedule until the end of June while Pfizer would be “week to week deliveries”.

Pressure After June

In an earlier interview, Mkhize said he expected one million J&J doses by the end of April and a further 900,000 each in May and June, and some 6.75 million Pfizer doses by June – but this seems to have been over-optimistic.

Health department official Dr Lesley Bamford said that the “largest number of doses are expected in the second half of the year. Supply in the first half is relatively constrained and will cover about six million people”.

This means that the country will have to vaccinate almost 130,000 people a day between June and February 2022 in order to meet its vaccination target. 

To do this, the country has resolved to use a wide range of public and private vaccine sites, including health facilities, schools, churches and workplaces. 

While private doctors and private health facilities will be used, they will be provided with the vaccines by the government and all vaccines will be free.

Trade unions, civil society and faith-based organisations have been invited to join the government’s vaccine oversight committee and the five sub-committees that will assist with the process.

Africa ‘Barely Moved Beyond Starting Line’

Meanwhile, Africa’s Centres for Disease Control (CDC) reported this week that 45 of Africa’s 55 countries had received COVID-19 vaccines and 43 had started vaccinations.

“The pace of vaccine rollout is, however, not uniform, with 93% of the doses given in 10 countries,” said the Africa CDC.

“Many African countries have barely moved beyond the starting line. Limited stocks and supply bottlenecks are putting COVID-19 vaccines out of reach of many people in this region,” warned Dr Matshidiso Moeti, the World Health Organization (WHO) Regional Director for Africa. “Fair access to vaccines must be a reality if we are to collectively make a dent on this pandemic.”

Vaccine rollouts in some countries were being delayed by “operational and financial hurdles or logistical difficulties such as reaching remote locations”.

“Africa is already playing COVID-19 vaccination catch-up, and the gap is widening. While we acknowledge the immense burden placed by the global demand for vaccines, inequity can only worsen scarcity,” said Dr Moeti. “More than a billion Africans remain on the margins of this historic march to overcome the pandemic.”

Through the COVAX, 16.6 million vaccine doses – mainly AstraZeneca – have been delivered to African countries.

 

Image Credits: GCIS.

The WHO and its member states must take swift action to enable a transparent, independent and rigorous investigation into the origins of the SARS-CoV-2 virus, said two dozen international scientists in their second open letter. 

The letter – released on Wednesday by 24 scientists and researchers across Europe, the United States, and Japan – comes on the heels of the controversial WHO-China investigation, which has been criticised for its methodological weaknesses, and for allegedly kowtowing to Chinese interests. 

“In our previous open letter, we outlined our fears that the joint international committee/Chinese government team ‘did not have the mandate, the independence, or the necessary access to carry out a full and unrestricted investigation into all the relevant SARS-CoV-2 origin hypotheses,’ said the letter on Wednesday, which was drafted by former US National Security Council official Jamie Metzl, who is a member of the WHO expert advisory committee on human genome editing.

“Having read the report entitled ‘WHO-convened Global Study of Origins of SARS-CoV-2: China part’…we have regrettably concluded that our concerns were fully justified.”

A group of scientists has called on the WHO and member states to conduct a more thorough investigation into the origins of SARS-CoV-2

WHO-Convened Study Methodologically Weak

Echoing earlier criticisms of the WHO-convened report, the letter expressed concerns that it arbitrarily discounted a key theory on the emergence of SARS-CoV-2, namely that it leaked from the Wuhan Virology Institute, a lab that is well-known for its research on bat coronaviruses that are closely related to SARS-CoV-2.

The Wuhan Institute of Virology, guarded by police officers during the visit of the WHO team on Wednesday.

Instead, the WHO’s report concluded it was “possible to very likely” that the virus emerged from bats and other wildlife via an animal. It also suggested that the virus could have spread through frozen foods – even though the evidence to support either of those theories remains lackluster, warned the letter.

“No solid justification is provided for why a ‘lab-related accident’(whether a lab-leak or sampling accident) should be considered ‘extremely unlikely’, or why a natural spillover via an unknown animal host should be considered ‘likely to very likely’. At this stage there is still no direct evidence for either pathway nor any verified data or evidence sufficient to rule any one out, while historical evidence amply supports both,” said the letter.

The letter also denounced the report for containing over a dozen incorrect, imprecise, and contradictory assessments in its appendix. One of those – in the report’s Annex D7 – claims that the deaths of a handful of miners in the Yunnan province in 2012 were ‘more likely explained by fungal infections”.

That view, however, contradicts positive antibody results for a bat SARS coronavirus in 4 out 6 of the miners that fell ill, the letter said. It also seems to go against the diagnosis of Zhong Nanshan, a leading coronavirus expert who believed that the primary cause of death of the miners was a SARS-like coronavirus infection rather than a secondary fungal infection.

“The fungal infection diagnosis is however in contradiction with the diagnostic of Prof. Zhong Nanshan, the foremost Chinese SARS expert at the time, who diagnosed a most likely primary infection from a SARS-like coronavirus, with a possible secondary fungal infection in some cases (pulmonary aspergillosis),” said the letter.

“Further, the diagnosis of the ‘WIV [Wuhan Institute of Virology] experts’ also contradicts the positive bat SARS coronavirus antibody tests (IgM and/or IgG) obtained for 4 of the 6 miners (these four tests were carried out at the WIV itself and described in this PhD thesis”.

Chinese Foreign Ministry Said Open Letter Lacks Scientific Credibility  

Responding to the open letter, Chinese Foreign Ministry spokesperson Zhao Lijian questioned its scientific credibility, calling it an attempt to politicise the ‘origins’ investigation and to discredit China – claims that Metzl later rebutted on Twitter.

“These [open letter] signatories can deceive no one as to whether their letters are meant to make a true proposal for scientific and professional origin-tracing or target a specific country with presumption of guilt,” Jijian told a press conference on Thursday.

“The origin-tracing study was indeed affected by political factors, but that did not come from China, but from the United States and some other countries, who are bent on politicizing the origin-tracing issue in an attempt to disrupt China’s cooperation with WHO and discredit China, ” he added.

He also said the lab hypothesis is “extremely unlikely”, noting that the findings of the SARS-CoV-2 origins report were based on “frank” and “science-based exchanges” between WHO experts and “relevant” Chinese institutions.

“As for the lab hypothesis, experts on the mission all agreed that lab leaking is extremely unlikely, after visiting disease control centers in Hubei and Wuhan, the Wuhan Institute of Virology and various biosafety labs, and after having in-depth, frank and science-based exchanges with their Chinese peers from relevant research institutions.”

Open Letter Echoes Earlier Calls For More Robust Investigation

However, even the WHO’s director-general, Dr Tedros Adhanom Ghebreyesus, who has tried to steer a careful balance between US and Chinese geopolitical rivalries on the origins investigation, has admitted that the report’s findings are limited – and he has also told member states that the lab hypothesis should not be discarded out of hand. 

“Although the team has concluded that a laboratory leak is the least likely hypothesis, this requires further investigation, potentially with additional missions involving specialist experts, which I am ready to deploy,” he said at a closed-door briefing with member states last month.

“I do not believe that this assessment was extensive enough. Further data and studies will be needed to reach more robust conclusions.”

The letter also echoes earlier calls from a bloc of 14 countries – including the United States, Australia, Canada, Denmark, Japan, Norway, Korea and the United Kingdom – for more comprehensive studies into the origins of the virus in the future.

“It is critical for independent experts to have full access to all pertinent human, animal, and environmental data, research, and personnel involved in the early stages of the outbreak relevant to determining how this pandemic emerged,” said the joint statement from member states. 

Renewed Commitment Needed To Enable Robust Investigation 

Going forward, the WHO and member states can take three possible steps to enable a more comprehensive, independent, and transparent study into the origins of SARS-CoV-2.

The “most logical” step would involve revising the terms of reference between the WHO and China, to ensure that:

  • The composition of the expert group is determined in a transparent way by the WHO’s Executive board;
  • The selection procedure prevents conflicts of interests;
  • The group includes experts on biosafety, biosecurity and biodata;
  • The group gains greater access to sites, records and data, without requiring supervision from government authorities;

In anticipation that the revisions “cannot be agreed upon and implemented in the very near term”, the letter proposes a second option – a new resolution that could be passed at the upcoming World Health Assembly (WHA) to give the WHO the legal mandate for an “independent” and “unrestricted investigation”.

However, should a resolution fail to be ratified at the WHA, the letter suggests a third option.

Governments could come together to develop a “new and independent process”, with China’s cooperation if possible, but without it if not.

“If it should prove impossible for the Terms of Reference to be quickly revised or for a new and sufficient World Health Assembly resolution to be passed in the coming session, the best remaining alternative would be for governments…to come together to develop a new and independent process, with China’s cooperation if possible but without it if not.”

-This story was updated on Friday to reflect the Chinese Foreign Ministry’s reaction to the open letter and Jamie Metzl’s subsequent response to it.

Image Credits: CNN, New York Times.

A health worker receives her first dose of Sinovac Biotech’s Coronavac vaccine at the Ospital ng Malabon (Hospital of Malabon).

New York City – While the Philippines ranks 50 out of the 155 countries that have administered the most COVID-19 vaccines, opposition leaders and health officials fear the collapse of the country’s healthcare system amid a surge in new infections. 

Globally, more than 704 million doses – about 4.6% of the global population – of vaccines have been administered so far, according to the Bloomberg Vaccine Tracker.

As of 5 April, the Philippines has administered 854,063 doses, placing it as the 50th highest of 155 countries, said vaccine “czar” Secretary Carlito Galvez Jr, who is also the chief implementer of the National Task Force against COVID-19 in the country.

Those vaccinated include 789,415 health workers, around 11,000 elderly, and some 7,100 people with comorbidities, he added.

But while the national government touts its successes in vaccination, what is occurring on the ground reflects a different story.

“Inconsistent” Data Underreports Full Capacity Hospitals 
ABS-CBN Data Analytics head Edson Guido

A senior data analyst flagged the “inconsistent” data reporting from the Department of Health (DOH) regarding hospital bed occupancy in the country.

ABS-CBN Data Analytics head Edson Guido said there was conflicting reporting on the occupancy rate of hospitals, particularly in Metro Manila. 

The DOH had initially reported 78% of intensive care unit beds in the region were filled, 78% of isolation beds were utilized, and 60% of ward beds were occupied. Around 60% of ventilators were also in use. 

“The reports on the ground say [bed occupancy] in Metro Manila is full and [patients] were brought to other provinces. So, there seems to be a disconnect in terms of deaths and bed occupancy that the DOH is reporting from what’s happening on the ground,” Guido said. 

A patient is seen in a hospital bed outside the San Juan Medical Center in San Juan City on Thursday.

Philippine hospitals across the country had declared full capacity and many were no longer taking patients. Some private hospitals had switched to offering home care.

The Medical City, an 800-bed hospital in Metro Manila, has three-to-10 day programs that can cost as much as 65,000 pesos (USD $1,340), which includes infection control, virtual monitoring, swabbing and blood extraction services. 

Vice President Leni Robredo, who leads the political opposition, questioned, in a Facebook post last week, these expensive “Home Care Medical Packages,” which only the richest Filipinos can afford. 

“Are there guidelines from the DOH that the Home Care Specialists have to follow to ensure the safety of the people who get sick?” she said. 

The surge is taking its toll on the healthcare workforce as well, as 117 of 180 staff tested positive at the Philippine Orthopedic Center in Manila, forcing the facility to close its outpatient department, which can serve as many as 450 patients a day. 

“When our medical front-liners are getting sick, the threat of collapse of our healthcare system is big. We must control the spread of the disease,” Opposition Senator Francis Pangilinan, in a 3 April statement, said. 

Former president Joseph Estrada spent the night in an emergency room after being rushed to a Manila hospital with COVID-19 complications on 28 March, since regular beds were occupied. Estrada was later admitted to the intensive care unit and is now on a ventilator as his pneumonia worsened, his son said in a Facebook post on Monday. 

Philippine hospitals are at overcapacity, forcing patients to receive treatments in their cars.

Others do not even have the chance to enter a hospital at all. 

“Many have already died inside tents outside hospitals, waiting to be admitted to the ERs, in an ambulance while in transit, at home without receiving any medical help,” Robredo said.

The government is currently planning to allocate more living quarters for healthcare workers in the National Capital Region Plus (NCR Plus), making arrangements with hotels and other lodging service providers. 

Pangilinan warns of a “humanitarian crisis that will overwhelm the country and wipe out families” if the government does not step up its efforts. “Step on the gas. Testing, tracing, isolation, and treatment are the four wheels of the anti-COVID ambulance. Government efforts must be toward accelerating the ambulance to outpace the infection and save all of us,” he said. 

Government Recalibrating Strategy – Vaccinations and Self-Isolation Measures
Vaccine “czar” Secretary Carlito Galvez Jr, (left) who is also the chief implementer of the National Task Force against COVID-19

In response to the continued rise of COVID-19 cases in NCR Plus, the government is recalibrating its immunization efforts towards areas with high infection rates. 

Building herd immunity in high-risks areas such as Metro Manila could address the spike in local transmissions, said vaccine czar Galvez. 

He added that inoculation of at least five million individuals in Metro Manila will jumpstart the process of achieving herd immunity and will enable the government to offset the delays in vaccine deliveries. 

Senator Pangilinan also advised free mass testing, citing Vice President Robredo’s mobile free mass testing initiative called Swab Cab. 

The Swab Cab initiative brings COVID-19 testing to communities through use of buses that were converted into mobile testing sites. The program, started with Robredo’s private sector partners, is meant to augment the government’s testing capacity. 

Both Robredo and Pangilinan highlighted the need for the government, on top of recalibrating its vaccination strategy, to ensure that the people of the Philippines were provided for during self-isolation.

“Those who go on self-isolation and their family must be assured of food,” said Pangilinan. 

Said Robredo: “Have we built a system where people who are self isolating at home would still have access to medical help when necessary? Did [the government] even fix the infrastructure?” 

Strictest Lockdown Measure Implemented In Philippines Capital Region
philippines
A delivery driver wears a mask and unloads essential items amid the COVID-19 lockdown

The Philippines’s dramatic surge in cases has forced the government to implement the toughest of 4 lockdown levels until 11 April in Metro Manila and the surrounding provinces of Bulacan, Cavite, Laguna, and Rizal. 

Health officials attribute the rising cases to the unexpected spread of more infectious coronavirus variants.

“No one could have probably foreseen how infectious these new variants are and as a result of which we have these ballooning numbers,” presidential spokesman Harry Roque told ABS CBN News.

The Philippines nationwide cases data, with recent weeks averages not computed, owing to delays in reporting

As of 8 April, there are 828,366 COVID-19 cases in the Philippines, with 9,216 new cases and 14,119 deaths, the highest totals in Southeast Asia after Indonesia. 

The national government had initially placed Metro Manila and its provinces under a General Community Quarantine (GCQ) bubble on 22 March.

A bubble setup is applied to a cluster of people restricted from going in and out of a covered area unless authorized to do so. Going in and out of NCR Plus is limited to essential workers and essential travel. 

Public transportation remains operational, with proper social distancing measures in place. 

However, the GCQ was upgraded to an Enhanced Community Quarantine (ECQ) on 29 March, and was extended to 11 April as daily infections breached 10,000. 

The ECQ limits further movement to accessing essential goods or services, or performing essential work. Religious services, including the past week’s Holy Week and Easter events for Roman Catholics, were shifted online after public gatherings were temporarily banned. 

PH Lags Behind Southeast Asia Neighbours; Temporarily Suspends Use of AstraZeneca Vaccine
Doses administered per 100 people

According to NY Times data, the country in fact lags behind the rest of its Southeast Asian neighbours, having administered 0.9 doses per 100 people as of today, compared to Indonesia’s 2.4 doses and Malaysia’s 1.1 doses. 

The country expects to vaccinate up to 70 million people this year, and has so far received 2 million COVID-19 doses from China-based Sinovac Biotech, and 525,600 vaccine doses from British-Swedish pharma company AstraZeneca. Vaccines from Russia-based Sputnik V are also expected to arrive this month. 

Vaccine deliveries will gradually increase in May and June, with a total of 10.5 million doses from Sinovac, Sputnik V, Novavax, and AstraZeneca. 

However, the announcement by the European Medicines Agency during a 7 April press conference that there appears to be a link between AstraZeneca’s vaccine and very rare cases of blood clots mainly younger women,  has resulted in the Philippines government temporarily suspended use of the vaccine in people under 60. 

“I want to emphasize that this temporary suspension DOES NOT MEAN that the vaccine is unsafe or ineffective. It just means that we are taking precautionary measures to ensure the safety of every Filipino. We continue to underscore that the benefits of vaccination continue to outweigh the risks and we urge everyone to get vaccinated when it’s their turn,” Philippines Food and Drug Administration Director General Rolando Enrique Domingo said in a statement.

Image Credits: ILO/Minette Rimando, IMF Photo/Lisa Marie David, ABS-CBN, Philippine Star/Twitter , HDetalla/Twitter, ABS-CBN, Philippines DOH, NYTimes.

In a powerful ruling that could increase transparency and thus, industry compliance, India’s National Green Tribunal has directed state and central pollution control boards to chart and openly share with the public detailed data from online continuous emissions/effluents monitoring systems (OCEMS) operating in the country’s highly-polluting industrial sector. 

These powerful industrial interests – ranging from cement to mining – account for one-third and one half of the country’s urban air pollution – and a large part of pollution of the country’s  lakes and streams, including the iconic Ganges.  

In issuing the directive on data collection and sharing, the Green Tribunal – established 11 years ago for the expeditious legal review of appeals on environmental pollution issues –  was following up on a 2017 Supreme Court order directing all states to ensure that polluting industries instal OCEMS and make industrial emissions data publicly available.

In an assessment of state inaction and industry non-compliance,  the Indian non-profit Legal Initiative for Forest and Environment (LIFE) last year reported that of the 32 state-managed pollution control boards, one-half had not even bothered to create online continuous emission monitoring portals – as per the Supreme Court directive. 

And of the 16 Indian states that had complied with the original Supreme Court judgement, only 38% allow public users to access and assess the data generated, LIFE noted. 

The rest is hidden away behind passwords, something the petitioners want to unlock to force transparency. 

In the recent case, the southern regional bench of the Green Tribunal, directed the states of Tamil Nadu, Karnataka, Andhra Pradesh, Kerala and the union territory of Bunchberry to comply with the Supreme Court  directive by April 9. 

The  petitioners now plan to approach the western, eastern and principal [national] benches of the Green Tribunal, to ensure nationwide compliance with the Supreme Court directives, environmental lawyer and LIFE founder Ritwick Dutta told Health Policy Watch this week. 

The industrial emissions monitored under the OCEMS systems and regulations include both effluents dumped into lakes and rivers, often untreated, as well as airborne emissions of particulate matter, carbon monoxide, nitrous oxides, sulphur oxides, and hydrogen fluorides – released as smokestack emissions from plants lacking effective filtering equipment. 

 

Air pollution leads to almost 1.7 million premature deaths a year in India, as a result of cardiovascular and respiratory diseases, lung and other cancers, strokes, pre-term birth, type-2 diabetes, and several other neurological and cognitive illnesses. 

Clean Air Advocates Welcome Ruling Covering Tens of Thousands of Industrial Polluters 

The ruling was welcomed by citizen scientists and clean air advocates, who said that making data on emission and effluents more transparent and accessible will help empower the public and drive change. 

“Brilliant directive,” tweeted Ronak Sutaria, data scientist and urban policy researcher who has been following this data – or lack of it – since the Indian government started monitoring industrial emissions and effluents that flow into rivers and lakes across the country in 2014.  

“Industrial pollution from notified high-polluting industries typically accounts for 30% to 50% of the total pollution experienced in most urban cities and towns,” said Sutaria, who runs urbansciences.in, a low-cost real-time air quality monitoring network. “The OCEMS systems are the last checkpoints before these pollutants escape into our environment.” 

Another issue is the overall lack of OCEMS device and thus monitoring at many industrial sites. In the heavily industrialised western state of Maharashtra, for instance, in just one region,  there are nearly 23,500 high pollution potential industries. In contrast,  the total number of OCEMS installed in the entire country is only about 4,000. This is a problem of industry compliance.

Most data generated by even these is largely inaccessible to the public, added clean air expert, Chetan Bhattacharji, a board member of the advocacy group Care for Air.  “The data the OCEMS collects—inarguably vital for public health—remains opaque. It is either faulty, insufficient, complicated or difficult to access,” says Bhattacharji. 

North India is equally non-compliant. A news story in March reported that the Central Pollution Control Board (CPCB) itself cracked the whip on the 1,631 “grossly polluting industries in the Yamuna basin,”  80% of which are non-compliant, asking them to share their pollution data and connect to the CPCB server within 3 months.

How the OCEMS Work

Seventeen categories of industries designated as highly polluting are legally mandated to instal and maintain online continuous emissions monitoring systems. These “red” categories of polluting industries include aluminium, zinc, copper plants, power and cement plants, distilleries, fertilisers, iron and steel plants, oil refineries, petrochemical and tanneries, all of which have powerful lobbies at work.

These industries are supposed to share the data they generate with the pollution control boards in the states where they are located –  uploading it in 15-minute intervals.  Those boards, in turn, are supposed to create a repository under the supervision of  the CPCB – but they don’t always do so. 

So while the monitoring equipment is owned by industry, the data it generates is intended to be shared with the government, at state level and nationally. 

The petitioners are trying to ensure that this, by default, is also shared with the public. This, they say, should also include public access to historic data, location coordinates of air quality monitoring stations, and more. Made public, such data would flow into a central repository of OCEMS data, paid for by industry, but owned by the public via the CPCB, which oversees and reports on air pollution nationally. 

Industry Conflicts of Interest Remain At Heart Of Transparency & Compliance Issues 

 

While the recent Green Tribunal ruling, issued in March, focuses on industry compliance and public accessibility of data,  what it doesn’t address is an inherent and clear conflict of interest: The commissioning and operations of the monitoring systems are left to the same industries which are themselves being monitored for their emissions. This means polluting units themselves self-monitor and upload pollution data to the pollution control boards directly.  This is akin to asking students to grade their own exam papers. 

Thus, the recent ruling only goes part-way in making most effective use of the considerable data-generation potential inherent to the OCEMS systems. But even if the ruling ends up solving the problems of compliance and accessibility, that would be a good first step. 

In fact, Sutaria and Bhattacharji have argued that these thousands of monitors be immediately brought under a transparent regime where the data can be analysed, verified and reported. The two sought greater air pollution data transparency in a report published by an Indian research foundation. 

“Understanding of city-level air quality could be strengthened if residents who live in spaces where industries are present, are able to access information about industrial emissions in their areas,” the report by Sutaria and Bhattacharji stated.

Developed countries such as the United States and countries in the European Union make similar data freely available to the public enabling citizens to track industrial air pollution across the country. In India, this is not the case, they observe. 

“The Environment Protection Agency (EPA) makes industrial emissions data from all Continuous Emission Monitoring System (CEMS) -regulated monitoring locations freely available to the public… the European Environmental Agency maintains the European Pollutant Release and Transfer Register (E-PRTR) which contains industrial pollution data from more than 34,000 facilities across 33 EU countries,” Sutaria and Bhattacharji note in their report.

“Environmental groups have used such data to identify the air polluters in a region and have held them accountable, such as the Tata Steel plant in Netherlands. Overall, in the European countries, industrial pollution emissions have steadily gone down since 2007, when the datasets were first made available across the Union.”

“This data enables citizens to track industrial air pollution data across Europe, including who the top polluters are and the spatial and temporal trends of the emissions for each of those industrial locations. If 33 countries can collaborate to do this, one country, India, should easily be able do this across all its states,” adds Sutaria.

If all the OCEMS data was publicly and transparently available, it could give enough raw data to create a robust environmental monitoring ecosystem, a first step towards transparency, accountability and control. Such a system would not just empower the populations most vulnerable to health harm from industrial pollution, but also strengthen the government’s own monitoring, helping it to geolocate where industrial pollution is coming from.

Until now, however, the government’s pollution boards in fact fail to have any impact on pollution mitigation, says one researcher, Dharmesh Shah. 

“Empirically speaking, the Central and state pollution control board across India have effectively, and for all practical reasons, abandoned the notion of “controlling” pollution,” he tweeted.

Properly Collected Industry Data Could Fill Gaps in Ambient Air Pollution Monitoring Systems

If industry shared its data cleanly and ethically, that data would also fill existing gaps in ambient air pollution monitoring systems, says Bhattacharji. The breadth of health harm triggered by air pollution makes this real-time data from these OCEMS of critical importance.

Until October 2020, the government owned just 234 continuous air pollution monitors (called Continuous Ambient Air Quality Monitoring Systems (CAAQMS)), the data that  serves as the basis for urban air quality monitoring and reporting, based on a national Air Quality Index. 

In comparing sheer numbers of monitoring devices, industrial monitoring is about ten times as dense as government-controlled ambient air quality monitoring systems, he notes, saying, “By this yardstick, it is apparent that the scale of monitoring of pollutants is bigger in the country’s industrial sector.” 

CAAQMS and OCEMS differ only insofar  as the first tracks ambient air quality levels, while the OCEMS track industrial  emissions at source. 

Health advisories are made based on CAAQMS. Industry in most places contributes anywhere from 30%  to 50% to ambient pollution, explain experts. However, at the same time, OCEMS systems are critical to identifying the actual sources of air pollution – and then acting to limit them. 

“The OCEMS network is regulated by the same regulatory body, the CPCB, and monitors similar parameters as those covered by the CAAQMS,” says Bhattacharji – arguing that the two need to be linked directly under the control of the national pollution control board.

With data as key, if such linkage was ever made, the nemesis for industry’s rampant pollution may yet be around the corner.

–

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: Flickr, Uncommonthought.com, Jyoti Pande Lavakare.

A new report has found that HIV and TB patients faced significant new barriers to access care in the COVID pandemic era.

In the past year, across all non-COVID conditions, routine health care has changed. GPs feel that acute care has been compromised due to their own changed focus, and because patients consult less frequently for non-COVID conditions. 

For HIV and TB communities, both diseases exacerbated by poverty and marginalisation, these impacts are particularly acute. The World Health Organization has estimated that 1.4 million fewer people received care for TB in 2020 than in 2019, and a recent Lancet study found that 11 out of 19 countries in Central and Eastern Europe had physicians sharing HIV and COVID-19 care duties, impacting the quality and frequency of services to HIV key affected populations. 

A new report by the Alliance for Public Health finds that in Eastern Europe, Central Asia, and the Balkans, HIV and TB patients faced significant new barriers to access care in the COVID pandemic era.  These findings are particularly significant since two of the six countries studied, Bosnia and Herzegovina and Moldova, are also among the ten top countries worldwide in terms of COVID deaths per capita. 

Findings of the study were also presented in an online discussion on 7th April 2021, on the occasion of World Health Day, attended by over 150 individuals working in the HIV and TB space across the region. The issues, likely to be seen in other high-burden HIV and TB countries as well, include:  

  • Less ability of patients to consult clinicians; 
  • Reduced access to testing and treatment, including threats of sanctions for breaches of lockdown;
  • Technological barriers to access new mobile- and e-health methods to access care. 
  • Insufficient social safety nets and direct financial support for HIV and TB communities – especially given their work in the informal economy

The study, co-authored by APH along with Matahari Global Solutions, drew upon interviews with patients, clinicians, government officials, and key informants in Bosnia and Herzegovina, Georgia, Kyrgyzstan, Moldova, Russia, and Ukraine, and sought to provide an illustrative picture of access to care for HIV and TB communities in those countries. 

25-50% Reductions of HIV Testing & TB Detection

All countries examined found reductions of HIV testing and TB detection of at least 25-50%. 

Similarly in the case of HIV treatment, comprehensive treatment in the framework of “People Living with HIV” (PLHIV) in the Eastern Europe and Central Asia (EECA) region only stood at 44% pre-COVID pandemic. In comparison, HIV testing services were reduced by 33% in Moldova, 12% in Kyrgyzstan, and by 21% in Ukraine in 2020 as compared to 2019. Similarly, antiretroviral treatment (ART) uptake in Moldova decreased by 25% over the past year, in Kyrgyzstan by 14%, and by 11% in Ukraine. 

In Georgia, the National Centre for TB and Lung Diseases sought to tackle the 25% reduction in TB detection by increasing screening via mobile X-rays equipped with artificial intelligence technology and screening each COVID-19 patient for TB, given similar symptoms. 

In Kyrgyzstan, a country already struggling with inadequate medical infrastructure, organisations working on TB in Osh, the country’s second largest city, said that X-ray machines were of low quality, and that COVID-19 rules saw long queues for access to X-rays and other necessary services for TB screening. Patients also didn’t have the financial resources to pay out of pocket for additional diagnostics. There were additional barriers caused by security guards to health facilities, whose main duties were to ensure adherence to social distancing, and did not comprehend the necessity of patients attending in person. 

An NGO leader based in Osh told us: “Doctors sent (the patient) for a CT scan, which costs about $30, and the clients do not have the financial resources for this… The security guard at the entrance asked visitors in great detail why they came to the doctor, and it took a lot of time and effort to explain everything to these guards, who, in principle, did not understand the issues and did not care about (them).” Compounding these access issues, according to one medical specialist from Bishkek, was the use of anti-TB antibiotics to treat COVID patients at the early stage of the pandemic, and concerns about rising antimicrobial resistance (AMR) and drug-resistant forms of TB. And while there are ongoing projects to tackle serious AMR issues in Kyrgyzstan via promoting the rational use of antibiotics, COVID-19 set back progress and will need urgent scale-up of AMR stewardship activities. 

A medical professional works in the temporary Covid-19 care centre Palace of Sport in Bishkek, Kyrgyz Republic in July 2020.

All countries saw the scale-up of mobile- and e-health tools to access services during the COVID-19 pandemic. In Ukraine, people living with HIV used an app to track their recent viral load counts, HIV medicine supplies, and allowed for management for appointments with clinicians. In Kyrgyzstan, ad hoc Whatsapp groups allowed patients in remote rural areas to connect with specialists from Bishkek, an opportunity not normally afforded to them. In Moldova, Georgia, Ukraine, and Kyrgyzstan, the use of video support to increase adherence to TB medication regimens increased. 

Loss of Incomes During COVID-19 Exacerbate HIV & TB Outcomes

But emerging from all countries was the sense that without income support, especially for vulnerable groups that had lost their jobs during COVID-19, treatment adherence measures would all fall by the wayside. An activist from TBPeople Ukraine told us: “We have not once spoken of the fact that people were left without support. What happened to tuberculosis? People who were on treatment for a long time but were unable to find jobs – they felt like burdens on their families. Most were just left to go home without any material or social assistance. What DOT and treatment adherence can we talk about if the person had nothing to eat?” In Moldova, ex-prisoners predominantly work as construction workers and had lost all income during the COVID-19 pandemic, and was cited as a factor for TB treatment dropout. All countries examined lacked sufficiently broad social safety nets to support individuals and families through COVID-19 income losses. 

And in Bosnia and Herzegovina, a poor transition out of Global Fund funding meant that services for key HIV populations, including men who have sex with men and people who use drugs, had serious sustainability issues, and these were amplified during COVID. In a country where stigma tow-ards gay men is high, and where clinical care for gay men is outdated, drop-in centres proved to be an important safe space where gay men could get services. After the Global Fund transition, these drop-in centres were de-funded, and COVID-19 saw a massive reduction in access to HIV and other sexual health services for this group. 

The region will need comprehensive COVID-19/HIV/TB recovery strategies, including widening of mobile HIV and TB screening services, a scale-up in HIV self-testing, scale-up of funding of programs to serve HIV and TB communities (including safe spaces for gay men in Bosnia and Herzegovina), broader social safety programmes, integration of TB and COVID-19 testing, and digital support initiatives to help bridge e-health gaps. 

Insights from the Panel Discussions 

Dr Nino Lomtadze, Head of Surveillance from the Georgian National Centre for TB and Lung Diseases.

Additionally, a number of important insights emerged from Wednesday’s discussion:  

  • Dr Andrei Dadu of the WHO European Regional Office, emphasised that people living with HIV and TB communities should be prioritised to receive COVID-19 vaccinations under second phases of vaccination programmes. 
  • Anton Basenko, of the Alliance for Public Health in Ukraine, said that the financial support for HIV and TB communities shouldn’t solely be focused on masks and sanitisers, but also on direct financial support and provision of psychosocial support. 
  • Maka Gogia, of the Georgian Harm Reduction Network, described how the pandemic-era  scale-up of sterile needle-and-syringe vending machines in Tbilisi, five-day take home doses for opioid substitution therapies, and online medical consultations with people who use drugs, had all become important adaptations to the pandemic. But there is a need for increased financial support to deliver services to remote regions of the country. 

Pavel Aksenov, summarising findings for Russia, and said that there is a need for the better  integration of community-based TB programmes and facilities with psychosocial support for patients. 

In addition, he called for a revival of high profile HIV and TB testing campaigns to recover declines in testing seen during the COVID-19 pandemic. 

Finally, there is a need to develop and integrate new remote and contactless ways for key affected populations to access necessary services, including the optimisation of online counselling. Aksenov also noted that NGOs receiving external funding may be categorised as ‘foreign agents’, so need flexibility from donors in COVID-19/HIV/TB fund reprogramming, to ensure that NGOs can cope with additional administrative and financial burdens of reporting on donor funding. 

All in all, COVID-19/HIV/TB recovery plans need to take into account best practices and findings from this report, including the urgent need to broaden social safety nets to HIV and TB communities, including direct financial support, and to facilitate access to online and mobile access to HIV and TB services. 

In the words of Dr Stela Bivol from PAS Center in Moldova, quoted in the report, “What’s not covered now is that all these vulnerable populations need more material support. They need more welfare support that is beyond the financial incentives to be on TB treatment, they need livelihood support.”

Dr Fifa Rahman

* Dr Fifa Rahman is Principal Consultant for Matahari Global Solutions, and Permanent NGO Representative on the Facilitation Council of the WHO Access to COVID-19 Tools Accelerator; Pavel Aksenov is Associate Consultant for Matahari Global Solutions; Tetiana Deshko is Director of the International Programs for the Alliance for Public Health, and Oleksandr Zeziulin is MD, MPH, Senior Researcher, Ukraine Institute on Public Health Policy

Image Credits: World Health Organization, Shutterstock.