A study of people taking regular, low doses of aspirin found that the aspirin users were 29% less likely than others to test positive for COVID-19, as well as being less prone to serious disease and its “long COVID” after-effects.

The new peer-reviewed study, published in The FEBS Journal of the Federation of European Biochemical Societies, was led by an Israeli team associated with one of the country’s leading public health funds as well as a leading medical school and hospital.

Some of the same team members also were among the first to identify, last year, a link between low Vitamin D levels and higher COVID infection risks. 

In the observational study on aspirin and COVID, the team reviewed the medical records of 10,477 patients who had been tested for SARS-CoV2 infection between February and July of 2020. 

They identified a subgroup of over 2,000 patients who took 75 milligrams of aspirin regularly to prevent cardiovascular disease – and compared them with a similarly sized sample of people who didn’t regularly take aspirin doses – adjusting statistically for any differences in age and health status.  

Among people who had tested COVID-positive, the proportion of those regularly taking aspirin (or statins) was significantly lower, as compared to the group of people who tested COVID-19-negative group, the study, published in The FEBS Journal, of the Federation of European Biochemical Societies.  

People who had purchased, prior to their COVID test, at least 3 prescriptions for aspirin and statins were also less likely to be COVID-infected than those who did not.   

Among those who tested COVID positive, the aspirin users were also likely to have a shorter illness — by about two days — as determined by the length of time between their first positive COVID test and a negative test.  And they were less likely to suffer from aftereffects of the coronavirus, in terms of chronic health issues identified in follow-up. 

 The focus of the study was on aspirin users at risk of cardiovascular disease – but not chronically ill. 

“This observation of the possible beneficial effect of low doses of aspirin on COVID-19 infection is preliminary but seems very promising,” lead author, Eli Magen, of Barzilai Hospital, was quoted as saying in an Israeli news outlet.

“We were really excited to see a big reduction in the proportion of people testing positive, and this gives a promising indication that aspirin, such a well-known and inexpensive drug, may be helpful in fighting the pandemic,” added Milana Frenkel-Morgenstern of Bar-Ilan University 

“This finding with regard to ‘long COVID,’ a phenomenon that is a real concern, is very important,” she added.   While the mechanism by which aspirin might reduce disease risks and seriousness would require further study, she speculated that it was associated with the medication’s anti-inflammatory qualities. 

In addition to reducing inflammation, other observational studies on aspirin have also suggested that the century old medication, originally derived from willow bark,  can help play a role in preventing infections from other single-strand RNA viruses, similar to the coronavirus, as well as in preventing some forms of cancer. 

Frenkel-Morgenstern, the corresponding author on the aspirin study, also set a precedent in her observational study last year that found an association between low levels of Vitamin D and increased risk of COVID infection.  

Image Credits: University Health News .

Almost one in three women experience physical and/or sexual violence across the course of their lifetimes. And over the past 12 months, more than one in ten women suffered from physical and/or sexual intimate partner violence, according to a new WHO-led report on gender-based violence, published just a day after International Women’s Day.

Gender-based violence is “unequivocally pervasive” across all regions of the world, putting the health and well-being of billions of women and girls at risk, reveals the most comprehensive WHO report yet on violence against women and girls. 

The results, said the WHO’s director-general Dr Tedros, paint a “horrifying picture” of out-of-control levels of violence against women by their intimate partners, as well as sexual violence against women by family, friends or strangers,  in many parts of the world. 

Young girls are unfortunately not immune; one in four adolescents aged 16-19 that have been in a relationship were subject to ether physical or sexual violence, found the report. In addition, 16% of women aged 15-24 reported physical or sexual violence over the past year.

 Given that the report was compiled from data preceding the pandemic, its estimates do not reflect the ways in which lockdowns, disruptions to essential services, and economic turmoil have exacerbated violence against women. But available data from the pandemic year suggest that many forms of violence against women have indeed risen.

Said UN Women Executive Director Phumzile Mlambo-Ngcuka: “It’s deeply disturbing that this pervasive violence by men against women not only persists unchanged, but is at its worst for young women aged 15-24 who may also be young mothers. And that was the situation before the pandemic stay-at home orders.”

“We know that the multiple impacts of COVID-19 have triggered a ‘shadow pandemic’ of increased reported violence of all kinds against women and girls. Every government should be taking strong, proactive steps to address this, and involving women in doing so”, she added.

The report was produced by WHO on behalf of a the United Nations Inter-Agency Working Group on Violence Against Women Estimation and Data (VAW-IAWGED), which includes representatives from UN Women, UNICEF, UNFPA, UNODC, and UNSD. 

Phumzile Mlambo-Ngcuka, UN Women executive director

Pandemic Has Exacerbated Violence – And Can’t Be Stopped Just With A Vaccine 

“Violence against women is endemic in every country and culture, causing harm to millions of women and their families, and has been exacerbated by the COVID-19 pandemic,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, also appearing at the briefing.

“But unlike COVID-19, violence against women cannot be stopped with a vaccine. We can only fight it with deep-rooted and sustained efforts – by governments, communities and individuals – to change harmful attitudes, improve access to opportunities and services for women and girls, and foster healthy and mutually respectful relationships.”

Stark Differences In Violence Between Rich & Poor Countries

These global figures, however, hide “very stark” differences between rich and poor countries, emphasised WHO’s Claudia Garcia Moreno, who led the preparation of the report, speaking at a press conference on Tuesday.

In the poorest countries of the world, intimate partner violence affected almost 40 % of women across their lifetime, almost twice that of high-income countries. The highest levels of violence were localized to regions of Oceania, Southern Asia and Sub-Saharan Africa – ranging from 33% to 51%. But the trends were unacceptably high everywhere”, said Moreno. According to the report, lifetime prevalence of intimate partner violence reached 31% in the Eastern Mediterranean, 25% in the Americas, 22% in Europe, and 20% in the Western Pacific.

 “The rates are really unacceptably high everywhere, but we see the highest prevalence in the least developed countries,” said Moreno in a separate interview  that accompanied the report. 

“In particular, the regions of Oceania, Sub-saharan Africa and South Asia, and also when we look at countries we see that it’s the poorer countries, and countries which have been affected by conflict recently tend to have among the higher rates.”

Most Robust & Largest Dataset To Date 

The report, which draws on data from 161 countries for intimate partner violence and 137 countries for non-partner sexual violence, was collected across nearly two decades, between 2000 and 2018. As such, it is comprises the largest and most robust dataset on violence against women yet. 

At the same time, many of its findings echo those of an earlier WHO report on violence against women, published in 2013, which was based on data from 1983-2010. 

However, strictly speaking, the estimates of violence levels reported on in 2013 are not comparable with the latest figures – because they were calculated using different methods, said Moreno at Tuesday’s press conference; but she did note that the figures seem to have stayed relatively constant since they were last measured.

“We do not want to compare the estimates from 2013 with these findings [from 2021] because the methodology has changed, and the availability of data is substantially changed, and the quality of the data substantially changed,” said Moreno.

Claudia Garcia Moreno leads the World Health Organization’s work on violence against women

Cross-Country Comparisons Key Advantage 

Even so, one key feature of the new report is the fact that data has been assessed in a way that allows for key cross-country comparisons of violence levels and characteristics  – adjusting for differences in national survey methodologies.  

In addition, the report presents the first-ever global and regional estimates of levels of sexual violence against women by men other than their intimate partners.

The findings suggest that at least 6% of women above the age of 15 suffered from sexual violence by someone other than a husband or intimate partner at least once in their lifetime. Like all surveys that attempt to measure sexual violence against women and girls, this reportedly slim figure is likely to represent a “substantial” underestimate of the true extent of non-partner sexual violence, emphasized the study authors.

The report warns that unless urgent action is taken, the world will fail to reach one of the key targets of Sustainable Development Goal (SDG) 5 on gender equality which calls on countries “to eliminate all forms of violence against women and girls in the public and private spheres (SDG 5.2).” by 2030. 

Impacts of Violence Are Physical & Psychological 

Violence against women has severe impacts on the health of their children

Violence against women deals a severe blow to mental, sexual and reproductive health, and contributes to other chronic health conditions, unplanned pregnancies, as well as poorer health in the children of affected women – which are more likely to perpetuate or experience violence in their lifetime than children of women that are unexposed to violence.

However, the report doesn’t go so far as to quantify the total number of deaths and disabilities that arise from the number of women who are raped, beaten or sexually assaulted every year. 

That data is compiled by the United Nations Office on Drugs and Crime, which in 2017 found that some 87,000 women were intentionally killed in 2017, amounting to some 137 deaths of women every day, of which more than half were killed by intimate partners or family members.

Some Progress In Measurement of Violence Apparent

While the WHO led report presents a “very bleak” picture, the report does highlight some good news, noted Moreno. Since 2010, the number of nations with nationally representative surveys on violence against women has doubled – to 161 countries from 82, which is a key step forward, she said in an encouraging note.

Still, quite a few regions and countries lack any data whatsoever on violence against women, while others have “one or two data points” that are more than a decade-old. These patterns are most apparent in regions of South-East Asian and Eastern Mediterranean Regions for intimate partner violence; and also in the Eastern Mediterranean Region for non-partner sexual violence.

Data on violence is especially scarce in humanitarian settings and conflict zones, and lacking for some sub-groups of women – including older women, women with disabilities, migrants, Indigenous and ethnic minorities, and transgender women, noted the report. 

Even when countries adopt population-based surveys, it is challenging to assess their quality, as important contextual details relating to the interview process are rarely explicitly stated in survey results – whether interviewers were trained to collect data in a private space in a non-judgmental way, in the absence of male counterparts, and whether they provided referral services, is typically unclear, muddling our understanding of the quality of data gathered. 

Another issue with existing surveys is their failure to adequately capture the full spectrum of sexual violence, typically skewing results towards forms of violence that are easier to measure than others, such as rape. As a result, other forms of violence, like psychological violence, often slip under the radar. 

Surveys also lack the granularity to distinguish between different perpetrators of violence (e.g. former spouse, existing intimate partner, family member, friend, stranger), the type of sexual violence commited (e.g. rape, attempted rape, other sexual contact, non-contact sexual abuse), and fail to disaggregate data by age group in a consistent way. Meanwhile, some forms of violence – like cyberviolence or sexual harassment – are rarely measured at all in surveys, which is why they were not included in the report. 

Strategies For Reducing Violence Against Women And Girls

Men in Burkina Faso practice domestic work to ease the burden on their wives

Despite these issues, recent research has uncovered an extensive palette of evidence-based interventions that can help prevent violence in just a few years, emphasized Wendy Morton from the British Parliament, who also spoke at the WHO briefing Tuesday. 

She was referring to promising results from the UK-funded What Works to Prevent Violence Against Women and Girls evaluation programme – which found that interventions in homes, schools and communities can reduce violence against women by 50% in a few years.

 “We will not be deterred by the scale of the problem,” said Morton. “We now have the evidence that violence is preventable, and we know what approaches are effective. Together, we have the opportunity and the responsibility to translate this evidence into long-term prevention.”

Legal responses can also help curb violence against women and girls, added Phumzile Mlambo-Ngcuka, UN Women’s executive director, noting that, worldwide, 155 countries have already passed laws related to domestic violence, and 140 have put in place legislation to prevent sexual harassment in the workplace.

But policies need to go beyond broad generalities about reducing violence against women and instead empower them in matters related to inheritance, property rights, divorce, child custody, and more, Moreno stressed. 

Laws against domestic violence, “need to be also coupled with laws and policies that do not perpetuate discrimination and not just laws on violence against women, but laws around inheritance or property rights laws around divorce or child custody…as well as interventions around economic opportunities and economic empowerment,” she said.

Hospital in Pakistan offers counselling for women experiencing gender-based violence.

Scarce Resources Bad Excuse To Not Fight Violence Against Women 

One barrier to change is, of course, the costs of providing better services in low- and middle-income countries that both lack strong public and mental health systems – and where violence against women may be most prevalent.  Those challenges have redoubled during the pandemic.  

But communities, families and parents can still do “a lot” to fight violence against women, WHO’s Assistant Director for Family, Women, and Children, Princess Nothemba (Nono) Simelela said:  

“There’s a lot that communities can do on their own without looking at big resources,” she said. “I just want to highlight that it’s not only about money and reports, it’s about us as a people, and how we treat ourselves, others and those we see and love.”

“Governments can help you, but you as a partner can take responsibility for your well-being with your family.”

Princess Nothemba Simelela, WHO’s Assistant Director for Family, Women, and Children

Image Credits: UNICEF/Noorani, UNFPA Moldova/Anastasia Pirvu, UNFPA/Ollivier Girard, WHO / Blink .

Press briefing after Chatham House discussion on COVID-19 vaccine supply chain bottlenecks and solutions

A two-day summit of the world’s top pharma and public health sector players to address COVID-19 vaccine supply chain and manufacturing bottlenecks ended on Tuesday with agreement that large vaccine manufacturing scale up potential exists – even in 2021 – but the route is complex and there are no easy fixes. 

And most immediately, there are  “increasing signs of strain within supply chains” as vaccine manufacturers scramble to procure some of the same raw material inputs and equipment, said. Richard Hatchett, CEO of the Coalition for Epidemic Preparedness (CEPI), which has seeded key  COVID-19 vaccine R&D investments, which are now driving the global vaccine distribution platform, COVAX.  

“Companies are beginning to report shortages of critical raw materials, critical consumables, even equipment, that is necessary for vaccine manufacturing,” said Hatchett, at the close of the summit, hosted by the UK-based Chatham House.

He pointed out that the usual global production of vaccines was between 3.5 – 5.5 billion doses whereas the aim for this year was to produce 14 billion COVID-19 vaccines.  A background paper produced out of the summit discussions  “Towards Vaccinating the World” provides one of the most detailed papers to date on the landscape of current vaccine supply chain bottlenecks, manufacturing challenges and possible solutions.  

The paper warns that already “it has become apparent that many COVID-19 vaccine input supplies of raw and packaging materials, consumables and equipment are in short supply which may result in several COVID-19 vaccine manufactures not being able to meet their current vaccine manufacturing commitments.

“Such shortages will also impact the ability to manufacture other lifesaving vaccines and biologics. Mechanisms to ensure input supplies for current and increased manufacturing capacity intent need to be put in place with short, medium and longterm solutions.”

Vaccine Producers by Continent

Largest Ramp-up of Vaccine Manufacturing World Has Ever Seen

Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers (IFPMA) added that few people fully understand the scale of the task at hand. 

“This is the largest ramping up of manufacturing the world has ever seen,” said Cueni. “I have to admit to myself, if you would have asked me three months ago, I would have said there is no idle capacity. Everybody is already doing the maximum of that they can.

“But just over the last few weeks, we have seen new players, experienced players in pharmaceutical manufacturing coming in. We have also seen an amazing amount of collaboration and togetherness, for example, between innovative manufacturers and developing country manufacturers.”

Cueni said the meeting delved into granular detail about the kinds of technology transfers would be needed to fast-track vaccine manufacturing – pointing to the importance of being able to move skilled workforce around, political will and regulatory harmonisation. 

“I think we all extremely grateful for the incredible work regulators do. It is amazing how fast we saw safe and effective vaccines approved,” said Cueni.

COVID -19 Secured Doses 2021 – by high income (HIC), upper middline income (UMIC) and low income (AMC) countries 

Technology Transfer For Vaccines More Complex Than for Chemical Compounds

While access groups have focused in great detail on the issues of patents and IP as a barrier to rapid manufacturing scale-up, the summit participants stressed the ways in which knowledge transfer and the presence of a skilled workforce are preliminary requirements for any expansion of capacity – along with sensitive and sophisticated infrastructure needs.

“Unlike pharmaceuticals which are chemistry-based products, the complexities of biological vaccine operations are still of higher challenge,” said Rajinder Suri, CEO of the Developing Countries Vaccine Manufacturer’s Network (DCVMN).

“You have a drug substance, … you have a drug product. And then you have the final fill and finish. So at the drug substance level itself, there are several complexities which are involved, whether it is in terms of platform technology; whether it is in the form of capacity,… so there are so many issues which one has to really understand, before getting into the tech transfer. And then, matching the scaling up of the facility, whether in terms of fill and finish, or final product.

“Again, this has to be fully understood before getting into this kind of a tech transfer agreement with other companies or other countries. So, the ability of an individual company to absorb technology and have trained manpower to really understand what are complexities and how to take it forward, are also going to be the key challenges.”

Developing Vaccine Manufacturing Capcity in LMICs – Long Term Goal

And while developing vaccine manufacturing capacity in low and middle-income countries was important, said Cueni, this was a long-term goal.

The most immediate challenge is to simply find ways for the world to produce more COVID-19 vaccines – and that meant looking at every corner of the planet “where you have the know-how, expertise and equipment.

Sai Prasad, President of the DCVMN, agreed, saying: “With COVID-19, we need to ensure vaccines as soon as possible so for 2021 and 2022, we need to go where there is existing capacity, human resources and know-how”.

Prasad also added that technology transfer was “less about intellectual property and more about knowledge transfer”.  He was referring to the South African/Indian joint proposal for an intellectual proper waiver on COVID-19 related health technologies, not before the World Trade Organization – which advocacy groups say would unlock supply bottlenecks.

Rasmus Hansen from research company AirFinity added that manufacturers also were concerned about “a mismatch between supply and demand” – in which ramping up too fast might even create excess capacity.

“Will we get to a point of over-supply?” asked Hansen. He said that manufacturers that were considering expensive and technologically complex investments in vaccine production, were also asking what their level of long-term investment should be.

Meanwhile, Hatchett said he was concerned about the potential for the United States to use its Defense Production Act to reserve scarce vaccine ingredients for its own use, saying this, too, would “disrupt vaccine manufacturing” at a more global level.

Solutions for ramping up vaccine manufacture – and technology transfer 

Summit Was Not About ‘Matchmaking’ and there were ‘No Blind Dates’  

Cueni said that while “everybody who was at the summit, is keen to follow up, this summit was not a dating meeting.”

His comments were a direct rebuttal to a WHO statement last week by Director General Dr Tedros Adhanom Ghebreyesus that the global health agency stood ready to play “matchmaker” between pharma innovators and manufacturers in order to increase vaccine production more  rapidly.

“There were no blind dates or things like that,” he said noting that the virtual nature of such a summit and the legal constraints companies already operate under would discourage “matchmaking” in particular.

At the same time, he said he is optimistic about the potential of seeing more partnerships evolve that can address the global bottlenecks seen now.  ” I do expect  we will see more partnerships, we will see more surprising announcements about new capacities found,” declared Cueni.

“But also we will see we will see the longer term dialogue about how to improve on tech transfer,” he added. “I think there’s a commonality of views I’ve already had discussions with several manufacturers from our side afterwards, and there’s a willingness to to engage in that.

“In terms of the tech transfer, it’s already happening though, and the expansion of capacity has taken place because you have partnerships, for example between innovative manufacturers and developing country manufacturers, both bringing their respective competencies competencies to the fore. But we also had of course, a number of high level government representatives there. I think also understood that they can help to address inefficiencies.”

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Image Credits: IFPMA .

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The pandemic is a call for a comprehensive, multi-sectoral approach to ensure that Africa is prepared for future outbreaks.

African governments, the private sector, and development partners need to invest more in health and health systems to intensify the fight against the COVID-19 pandemic and any future disease outbreaks, according to health experts speaking at the African Health Agenda International Conference (AHAIC) on Tuesday.

The experts agreed that a comprehensive, multi-sectoral approach is needed to not only ensure that Africa does not face crippling effects of another pandemic, but that well-planned and integrated responses to improving health securities and building health societies are adopted.

Dr Matshidiso Moeti, the World Health Organization’s Africa Director, said the pandemic was a massive wake up call for Africa’s health systems, both revealing glaring gaps in health security and health systems and highlighting the lack of funding in the advancement of the health eco-chain.

“A big issue is investment in health and financing of health. We have noticed a stagnation per capita in most African countries in the past few years,” said Moeti, adding that the WHO had recommended that countries increase the funding per capita from $60 to $90 in lower income countries and $170 in higher income countries.

African governments, the private sector and development partners need to invest more in health and health systems to intensify the fight against the COVID-19 pandemic and any future disease outbreaks, according to health experts speaking at the African Health Agenda International Conference (AHAIC) on Tuesday.

Speaking under the theme Build Back Better: Health Security Beyond COVID-19, the plenary on the second day of the conference focussed on how governments, private sector entities, civil society organizations and development partners need to put in place long term, country-led strategies to prevent another widespread disease outbreak and ultimately build back better post-COVID-19. 

The experts made a case for urgent, concrete action for governments and health leaders to take in order to strengthen health systems, prepare and protect populations; highlight existing response and preparedness strategies to mitigate the risks of future disease outbreaks and build resilient health systems. 

They also called upon health leaders, policy makers, pan-African organizations, academic and research institutions, and global organizations to commit to disease outbreak preparedness and recovery measures.

Provide Environments Conducive for Investment

Greg Perry, assistant director general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), called for greater investment in health, universal health coverage, health insurance, health systems and manufacturing.

“Investment in health is fundamental for economic sustainability…and all economic actors should be on board,” he said.

The need for investment was paramount to the fight against pandemics, but Perry said the continent should be cognisant of some of the challenges faced in attracting investments and should work on addressing such.

These include fragmented markets, regulatory challenges, skilled workforce and proper environments to enable investment, said Perry.

He pointed to how, even if African countries produce local vaccines, they might be dependent on open borders to import components of what will be produced locally.

“A lot of these challenges are pre-existing, but a lot of work has been done to address them,” he said, adding that a mind shift was taking place everywhere on how best to move forward.

Perry further emphasised the need for an improved culture of pandemic preparedness and solidarity between countries.

Moeti echoed this sentiment and said a comprehensive, multi-sectoral approach needed to be adopted to “protect health, the economy and the most vulnerable people”. “We need to put safety nets in place.”

Where Did We Go Wrong With The COVID-19 Response?
African Health Agenda International Conference (AHAIC) – Plenary 2: Build Back Better – Rebuilding Africa’s Health Systems Beyond COVID-19
Clockwise: Dr Solomon Zewdu, Patricia Vermuelen, Dr Ngcobo, WHO Africa Director Dr Matshidiso Moeti, Director of the Africa Centres for Disease Control and Prevention Dr John Nkengasong

John Nkengasong, Director of the Africa Centres for Disease Control and Prevention, said that in addition to investing in health, countries need to interrogate improvements that could be considered to fight the pandemic. 

This would include investigating “what went wrong, what went right and what we can do better”.

One year, two months into the pandemic, Nkengasong is of the view that there needs to be a holistic approach to better understand pathogens, population, policy and politics. More importantly, he said that if policy and politics are not aligned then whatever work is done in pathogens and population would be of little use.

“The fight is still ahead…now we have political leadership that is quite adamant about being aligned to hold downstream accountable,” said Nkengasong.

Lessons learnt from previous outbreaks, including Ebola, should have been adapted to fight the pandemic which to date has globally claimed the lives of more than 2.6-million people.

“We need to invest in endemic diseases…if we get those systems right then we can fight any pandemic. This pandemic has shaken us to the core …still a lot of work needs to be done.”

Rapid Vaccine Delivery Should be Celebrated

While the pandemic had devastating consequences, Dr Martin Fitchet, Global Head of Research & Development for Johnson & Johnson Medical Devices, said it was not “all bad news in terms of response” as there was “remarkable co-ordination” between governments and the private sector to deliver vaccines to the markets in reasonable time.

“Very rapid decisions were made for obvious reasons…we need to continue to invest to ensure that we have the appropriate response,” he said, quipping that: “Let’s just do it and not say we are going to do it.”

Image Credits: African Development Bank , Amref Health Africa.

Healthcare worker in Chile opens up the Chinese-developed “CoronaVac” COVID-19 vaccine.

The Chinese-developed “CoronaVac” vaccine against COVID-19 vaccine triggers a sixfold reduction in neutralizing antibody response against the P.1 variant first identified in Brazil, according to a pre-print study published last week, while the Oxford/AstraZeneca vaccine is likely effective against the variant of concern. 

These findings come as hospitals in northern Brazil are increasingly overwhelmed and overcrowded; the country is reporting record high death rates; and the P.1 variant is becoming dominant in most of the country. 

The CoronaVac vaccine, produced by the Chinese pharma firm, Sinovac Biotech, is Brazil’s principal vaccine, with 120 million doses purchased by the government. CoronaVac accounts for over 70% of COVID-19 vaccines now being administered in Brazil. 

Some 10.83 million doses of COVID-19 vaccines have been administered in Brazil, but the virus continues to rage out of control, nearing record highs in daily cases, with 80,508 new cases reported on Sunday. With 2.68 million people fully vaccinated – 1.28% of the population – it could be too soon to draw conclusions about the efficacy of the vaccines in preventing transmission and infection in Brazil.

The new COVID-19 cases reported in Brazil. The country is reaching record high daily cases, with a seven day average of 66,869 new cases in March.

The P.1 variant was discovered in Manaus City in Brazil in early January and has several mutations – E484K, K417T, and N510Y – that are also present in the B.1.325 variant, which is circulating around the United Kingdom and South Africa and has been linked to higher transmissibility. 

The small-scale study of the CoronaVac vaccine, produced by the Chinese firm Sinovac Biotech, was conducted by researchers in Brazil, the United Kingdom, and the United States, found that the plasma from eight individuals vaccinated with Sinovac’s vaccine “failed to efficiently neutralize” the P.1 SARS-CoV2 variant. 

“Our data suggests that the SARS-CoV2 lineage P.1 can escape from neutralization antibodies elicited during infection or immunisation with previous circulating viral variants,” said the authors of the study. 

The neutralizing capacity in the blood plasma was six times lower against the P.1 variant compared to earlier lineages. According to the authors, the partial immunity against new variants could suggest that reinfection of previously infected or vaccinated individuals could occur. 

AstraZeneca’s Vaccine is Effective Against P.1 Variant, Says Preliminary Data

In contrast to Sinovac’s CoronaVac vaccine, early results from a study conducted at the University of Oxford indicate that the Oxford/AstraZeneca COVID-19 vaccine is effective against the P.1 variant. The results of the AstraZeneca study, which have not yet been made public, were shared with Reuters. The data indicates that the vaccine would not need to be modified to target the variant. 

This encouraging news follows the earlier release of data from a South Africa study, suggesting that the AstraZeneca vaccine was unable to protect people against mild and moderate cases of the B.1.351 variant of the SARS-CoV2, first detected in South Africa and bearing similarities to the P.1 variant. The full study will likely be released in March.

Sinovac Vaccine To Be Rolled Out Across Several Countries in Latin America and Asia
A second batch of 6.5 million doses of the Sinovac vaccine arriving in Turkey in late January.

Along with Brazil, mass vaccination drives of CoronaVac have begun in China, Indonesia, and Turkey and the vaccine has also been approved for emergency use in Colombia and Mexico. 

The efficacy rate of the vaccine against SARS-CoV2 was only 50.3%, based on late stage clinical trial results from Brazil. However, its developers claim that the vaccine is still 83.7% effective for more serious cases requiring medical treatment, and 100% effective in preventing hospitalisation. 

Sinovac previously said that the firm is looking into developing a vaccine for the variants or offering booster shots to extend protection. Both of these options could be developed fairly quickly, the company says.

“It’s like there’s this thief whom we’ve already caught,” said Yin Weidong, Sinovac’s CEO, in an interview with the Chinese government-controlled TV channel, CGTN, last week. “Even if it’s mutating, we can totally use the current research and production capacity to effectively develop a vaccine for the new variant.”

Risk Posed By P.1 Variant Extends To Other COVID Vaccines

Meanwhile, the P.1 variant, which has spread to more than 20 countries, poses potential risks to several other COVID-19 vaccines as well as possibly being more fatal. 

According to a pre-print study conducted by researchers at the University of São Paulo, Imperial College London, and the University of Oxford, the P.1 variant is between 1.4 and 2.2 times more transmissible than previous SARS-CoV2 lineages. 

The researchers estimate that P.1 evades 25% to 61% of protective immunity provided by infection from a different strain of the virus. 

“There was also evidence of an increase in mortality risk but whether this is due to P.1 or the extensive healthcare collapse Manaus has experienced remains uncertain,” said Thomas Mellan, a research associate at Imperial College London and co-author of the study, in a press release. 

“Uncertainty in the ways SARS-CoV2 is changing and implications for vaccine design calls for much more sequencing and analysis of virus genomes globally,” said Ester Sabino, professor of infectious diseases at the University of São Paulo and co-author of the study.

Image Credits: Twitter – Chinese Embassy Manila, Pontificia Universidad Católica de Chile, New York Times, Twitter – TRT World Now.

Innovation has, until recently been a male-dominated preserve, but a group of women pioneers speaking at the Africa Health Agenda International Conference on Monday told of how the right mindset and a desire to improve lives has helped change the landscape.

Speaking during a virtual panel discussion on Women in Innovation: Providing leadership, creating solutions and driving change, panellists shared their stories of how they overcame adversity and gender disparity as women inventors and entrepreneurs to make a difference.

Dr Matshidiso Moeti, the World Health Organization’s Africa Director, who grew up in a South African township during apartheid,  encouraged participants to push for positive change even when facing challenges. She emphasised the importance of bringing men on board when dealing with gender imbalances.

“Help men to understand that it is to their benefit. Men can be powerful enablers of gender empowerment. Women are power…let’s get men to support us,” Moeti said.

The first day of the conference coincided with International Women’s Day and the discussions were aimed at demystifying the notion that women have a limited role in innovation.

“Through this event, we wish to mobilize and provoke change, and help advance women in the field of technology and science topics that we aim to further explore in a series of discussions through the year,” said the conference organisers, adding that “innovation is crucial to identifying solutions to achieve the UN sustainable development goals (SDGs)”.

For Edna Adan Ismail, Somaliland’s first midwife and renowned healthcare activist, the journey to success was all about considerable and equal participation of women in business, education and innovation. 

Driven by the urge to address the inadequate healthcare in her country and increase women participation in an almost male-dominated environment, Ismail said her focus had been to do something that would advance women. 

On Tuesday, Ismail will celebrate the 20th anniversary of a hospital she built in Somaliland, the Edna Adan Maternity Hospital, which was established primarily to provide better health care to people whose lives have been traumatized by war, and to train nurses, midwives, and other health workers. 

The hospital also has diagnostic laboratory facilities and an emergency blood bank and offers diagnosis and treatment for sexually transmitted diseases.

Ismail also built a medical university 10 years ago which currently has 1500 students enrolled in various disciplines of the medical field,  70% of whom are women. 

At 84, Ismail said one is never too old to contribute to meaningful change and encouraged participants to “never give up as giving up is never an option”.

“What we do, how we collaborate, the contributions we make to save human lives is what will continue to drive us,” she said adding that women bring positive change when provided with opportunities and training.

Several panellists shared personal stories of how they used entrepreneurial skills to overcome adversity, how they were empowered and the challenges they faced.

Sheila Alumo, Managing Director, Eastern Agricultural Development Co. Ltd, was forced to care for her two younger siblings when she was just 11-years-old after her mother died. There were days when her family went without food and she had lost all hope.

Her story is one of hope, perseverance and succeeding against all odds. Alumo recalled how, at one stage, she would walk several kilometers to buy and resell sugar cane to help feed her family.

Today Alumo’s Uganda-based company employs 22 people and, through its agricultural business, pursues improved socio-economic and human development of rural smallholder farmers. The company has a network of 3,117 farmers, 40% of whom are women. Alumo said she works with rural populations to contribute to their livelihood improvement.

“I know what it is to be hungry, not to have food…no hope. As a young girl knew that I had to make a difference.”

It was Alumo’s parting words that resonated with most of the panelists and participants: “Our backgrounds define our future, but our resilience will carry us through”.

The conference runs until Wednesday, and covers a range of topics including the state of health security in Africa and the need for an African Medicines Agency.

Image Credits: Photo credit: NSTOP Team.

Less than half of Africa’s citizens (52%) – some 615 million people – have access to the healthcare they need, the continent’s quality of health services is generally poor and the family planning needs of half the continent’s women and girls are unmet.

This is according to a report on Africa’s progress toward achieving universal health coverage (UHC) released on Monday at the Africa Health Agenda International Conference (AHAIC).

Each year, approximately 97 million Africans, representing 8.2% of the continent’s population, incur “catastrophic healthcare costs” – particularly in Sierra Leone, Egypt and Morocco. Annually, 15 million people will be pushed into poverty as a result of these out-of-pocket costs, according to the report, which was compiled by a multi-national AHAIC commission.

 

Some 15-million Africans are forced into poverty every year because of massive medical bills.

World Health Organization Director General Dr Tedros Adhamon Ghebreyesus said that the COVID-19 pandemic had highlighted the importance of all people having access to adequate health services.

“Achieving UHC require investments in resilient health systems, especially in strong primary health care with an emphasis on promoting health and preventing disease,” said Tedros. 

“ An important part of that journey is ensuring a reliable supply of safe, effective and high-quality medicines across the continent. To that end, WHO is working with the African Union and the Africa Centres for Disease Control (CDC) to establish the African Medicines Agency (AMA). And I call on all AU countries to ratify the treaty so that African Medicines Agency can enter into force.”

The AMA is envisaged as a central regulatory agency expected to improve access to medicines on a continent where some countries simply don’t have the capacity to regulate medicines.

Life Expectancy Has Increased Thanks to Malaria and Reproductive Health Management

Also opening the conference was Kenya’s President Uhuru Kenyatta who pointed out that Africa’s life expectancy had increased from around 40 in the 1960s to 64 currently, mainly as a result of better management of malaria, and reproductive health services.

“If we are to achieve universal health coverage by 2030, we need to give greater priority to primary health care, water, sanitation and hygiene,” said Kenyatta. “Indeed, during this COVID period, all of us have been amazed by how simple hygiene practices such as hand washing, introduced during this response to this pandemic, have reduced diarrhea and other diseases.” 

Tedros praised Kenya and Rwanda for making the most progress on the continent in achieving UHC.

Kenyatta explained that user charges had been removed in Kenyan dispensaries and health centres, and free maternity services had been introduced. 

“Currently, we are embarking on a national programme to ensure universal access to health hospital insurance fund through mandatory enrollment, and a full government subsidy for the poor and most vulnerable,” said Kenyatta.

Both he and Kenya’s Health Secretary, Mutahi Kagwe, stressed the importance of local production of health products.

Welcoming the fact that the International Federation of Pharmaceutical Manufacturers Associations (IFPMA) was one of the conference sponsors, Kagwe said he wanted to send a message to them to improve production capacity on the continent.

“It is possible for you to have money and not to have supplies,” said Kagwe. “One of the most frustrating and panicky things for African health ministers at the start of the pandemic was when we did not have PPEs yet we were getting cases in our hospitals. We didn’t have reagents but we wanted to test. Why didn’t we have reagents? Because they are not made on the continent. Regions have closed systems and there was no way of getting reagents from anywhere,” said Kagwe. 

COVID-19 Has ‘Made Us Aware of Our Potential’

“We have learned from COVID-19 experiences. They have made us more aware of our vulnerability and made us more aware also of our potential. We are no longer importing PPEs. We are making them locally.”

Rwanda’s health minister, Dr Daniel Ngamije, said his country has introduced community-based health insurance for those who could not pay for health services. 

“The premium for their membership of this scheme is paid by the government and it allows them to be treated from the primary health care application level of care,” said Ngamije.

Rwanda had also recognised that women’s and girls’ access to family planning was hampered by religious health service providers not providing this service and by the legal requirement for girls to be 18 before they could get contraceptives.

The Rwandan government was trying to ensure it had family planning clinics in areas dominated by faith-based service providers and it was engaging with parliament to address the legal barrier of age which was driving unwanted pregnancies among teenagers.

Ethiopia’s health minister, Lia Tadesse, said that her government had initially subsidized services for the poor while the rest pay out-of-pocket. 

“But this was not sustainable for government and also caused high out-of-pocket expenses. So in the past few years, Ethiopia started a community-based insurance system and we are on our way to starting social health insurance. We still have exempted services for things like family planning, immunization, HIV, maternal and neonatal services but universal insurance is what we are trying to head towards.”

Some of the solutions proposed by the report to speed up UHC include using the “vast network of African traditional healthcare providers” to improve primary healthcare services, “especially preventive and promotive care”, strengthening governance including anti-corruption strategies and progressively increasing financing of the health sector.

 

Image Credits: Xavier Vahed/DNDi, AHAIC Commission Report on UHC in Africa.

On 1 March, Ghana started its COVID-19 vaccine campaign. Samira Bawumira, the vice-president’s wife, was one of the first to be vaccinated.

The World Health Organization (WHO) and its COVAX partners are hosting a summit next week with governments and pharmaceutical companies to address the bottlenecks in COVID-19 vaccine production and delivery.

This follows a spectacular start in the past week for COVAX, the global vaccine delivery platform, which delivered more than 20 million doses of COVID-19 vaccines to 20 countries, according to WHO Director General Dr Tedros Adhanom Ghebreyesus.

“We currently face several barriers to increasing the speed and volume of production of vaccines, from export bans to shortage of raw materials, including glass, plastic, and stoppers,” Tedros told the body’s bi-weekly media briefing on Friday. 

“Next week, WHO and our COVAX partners will meet with partners from governments and the industry to identify bottlenecks in production and discuss how to solve them.”

The WHO runs COVAX together with GAVI, the global vaccine alliance and the Coalition for Epidemic Preparedness Innovations (CEPI).

COVAX Distribution Remains Small – Relative to Needs

Describing the COVAX launch as a landmark, Tedros added that “the volume of those being distributed through COVAX is still relatively small”, as they covered “between 2-3% of the population of countries receiving vaccines, even as other countries make rapid progress towards vaccinating their entire population within the next few months”.

To help all countries to end the pandemic, the WHO was looking at four approaches, said Tedros.

The first and most short-term was to link vaccine producers with companies that have excess capacity to “fill and finish”, such as the deal reached this week between Johnson & Johnson and Merck, where Merck will provide “fill and finish” services – filling vials with vaccines and packaging them – for the J&J vaccine.

“We need more partnerships like this,” stressed Tedros. “And we need them in all regions. WHO can support this process by identifying gaps and providing a matchmaking service between vaccine producers and companies with capacity.”

The second approach, said Tedros, was “bilateral technology transfer through voluntary licensing from a company that owns the patents on a vaccine to another company who can produce them”. 

“A good example of this approach is AstraZeneca, which has transferred the technology for its vaccine to SK Bio in the Republic of Korea, and the Serum Institute of India, which is producing AstraZeneca vaccines for COVAX,” said Tedros, although he decried the “the lack of transparency” in this approach.

´Coordinated’Technology Transfer

The third approach is a “coordinated technology transfer” that would see universities and manufacturers licensing their vaccines to other companies through a global mechanism, coordinated by WHO.

With this approach, there would be more transparency, global coherence and it would also “facilitate the training of staff at the recipient companies and coordinate investments in infrastructure”, said Tedros.

The final solution, said Tedros, was for countries “to start producing their own vaccines by waiving intellectual property rights as provided for in the TRIPS agreement”.

“Those provisions are there for use in emergencies. The WHO believes that this is a time to trigger that provision and waive patent rights. We thank South Africa and India for their proposal to the World Trade Organisation to waive patents on medical products, or COVID-19, until the end of this unprecedented pandemic.”

Next week’s summit will involve the International Federation of Pharmaceutical Manufacturers Associations (IFPMA), which represents most major pharma companies. However, Marie-Paul Kieny, chair of the Medicines Patent Pools Foundation and a guest at the briefing, said that many other generic manufacturers needed to be brought into the discussion.

Kieny said her foundation was in the process of “leveraging our close relationships with generic manufacturers across the globe to help identify suitable partners to ‘fit and finish’ vaccine needs, and as potential recipients of technology transfer”.

COVAX Roll-out Continues Next Week
WHO special advisor Dr Bruce Aylward

This week’s first COVAX deliveries were to Ghana, and Cote d’Ivoire. Shortly afterwards, deliveries were made to Angola, Cambodia, Colombia, the Democratic Republic of the Congo, Gambia, India, Kenya, Lesotho, Malawi, Mali, Moldova, Nigeria, the Philippines. the Republic of Korea, Rwanda, Senegal, Sudan, and Uganda.

By the end of next week, COVAX will deliver 14.4million more doses to 31 additional countries, which will mean it have reached 51 countries out of the 190 COVAX members, said WHO adviser and COVAX representative Dr Bruce Aylward.

Aylward described the process of getting the vaccines to countries as complex.

At a global level, the WHO had to examine the vaccines and grant them emergency use listing, while at country level, “some of the biggest challenges that we’ve seen is the regulatory authorisation for these products as well as the indemnification and liability provisions for the use of these products”, said Aylward.

“The national vaccine plans have to be in place. And then once all that’s in place, we’ve got to be able to link it up with the shipments, the logistics, the purchase orders etc.”

Despite the complexities, Aylward said only 24 countries had not jumped through all the hoops – but were expected to have done so within the next two weeks.

 

Image Credits: Flickr: Francis Kokoroko/UNICEF.

Women in Africa account for a slightly smaller proportion of Covid-19 infections and deaths than men although a health expert cautions that access to testing and reluctance to being treated in hospitals could mean that women’s cases are undercounted.

Unveiling findings of a preliminary analysis of COVID-19 gender-specific epidemiological data in 28 African countries, the World Health Organization (WHO) on Thursday revealed that women account for about 41% of African COVID-19 cases. However, there was a large range from 31% for cases in Niger to over 57% in South Africa.

“In most countries, women are somewhat less likely to die from COVID-19 than men,” WHO stated. 

In Côte d’Ivoire, the case fatality ratio stands at 0.4% for women compared with 0.5% in men, while in the Democratic Republic of the Congo it is 2.2% versus 2.7%. In Seychelles, it is 0.1% for women against 0.5% in men, although the country has only had 13 COVID-related deaths.

This is despite the fact that women account for a large part of the health workforce and are thus at higher risk of infection. 

“In Africa, more than 95,000 health workers have been infected with COVID-19. In Seychelles, women account for 71% of health worker infections, 64% in Eswatini, 55% in Cote d’Ivoire and 54% in Senegal,” the WHO reported.

“Other studies report that men are significantly more likely to suffer severe effects of COVID-19 and more likely to have pre-existing conditions, explaining the slightly lower fatality rate seen in women,” the report stated.

Noting the need for further analyses to determine the factors behind the gender disparity, the report suggested that biological, behavioural or social factors could be responsible. 

However, Nigerian public health expert Bayo Ajala noted that the trend could be as a result of fewer women getting tested and unable to abandon their family duties to be at isolation centres.

“Many people are getting over COVID-19 even without any intervention. For women, in many African countries, they are the pillars of families and the household cannot survive without them. Maybe they are not getting tested for their details to be captured in the official data,” he told Health Policy Watch in Ibadan, Nigeria.

Women at higher risk of gender-based violence

But while fewer women appear to have been infected than men, the WHO noted that school closures during the COVID-19 crisis led to “an increase in teenage pregnancy and unintended pregnancies in many countries”. “Additionally, staying out of school for an extended period usually led to greater likelihood of engagement in risky sexual behaviour and increased sexual violence and exploitation. Also, women and girls are increasingly becoming victims in the spike of domestic violence fuelled by economic hardship as millions of people are pushed into extreme poverty.”

According to Matshidiso Moeti, the WHO Regional Director for Africa. “the aftershocks of the COVID-19 pandemic on women and girls have been profound, leaving many grappling with heightened risks to their health and safety”. 

“Our response must go beyond the clinical aspects of the pandemic and address the hidden crises that risk causing long-term effects to lives and livelihoods.”

According to WHO preliminary analysis of 22 countries, 10 reported a rise in maternal deaths between February and July 2020 compared with the same period in 2019, with the highest increases reported in Comoros, Mali, Senegal and South Africa. 

“Nine of the 22 countries reported a decline in births in health facilities and an increase in complications due to abortions,” WHO stated.

Oulimata Sarr, UN Women Regional Director for Central and West Africa, called for efforts to promote “positive masculinity”, involving men in addressing issues affecting women. 

“At UN Women, we are convinced that to be able to bring about change, people want to leapfrog into the future. We need to enroll the men, and those men, we call them our HeforShe. Those are really our champions who might be on decision-making tables where we are not and who will take full responsibility for a fair and just world that gives equal opportunity to men and boys and girls and women,” Sarr said.

As Africa joins the rest of the world to celebrate International Women’s Day on 8 March, Moeti said efforts should be geared towards closing the gender gaps by designing services in a people-centered way. 

“And taking into account inequity, and gender-driven inequity as well in the design of policies from financing health for designing our systems for health insurance for making sure that the approaches to improving access to services take into account all people,” Moeti concluded.

 

 

 

 

Minister of State for Masvingo Provincial Affairs and Devolution Ezra Chadzamira has today received his first dose of SinoPharm Covid-19 vaccine.

CAPE TOWN & KAMPALA – From Asia to the Americas, vaccines are fast becoming the new currency by which nations and geopolitical blocs wield influence and buy political favours – with more value than oil or bitcoin. 

But nowhere is this more apparent, perhaps, than in Africa, Latin America and south Asia, where both Russia and China are using bilateral SARS-CoV2 vaccine donations and deals to cement alliances with low- and middle income countries stung by the vaccine gold rush – in which high income countries have charged far ahead buying up limited supplies. 

Vast Trade in Vaccines 
The first consignment of AstraZeneca’s vaccine arrived in South Africa on 1 February

While global COVID-19 vaccine procurement and donations developments are very fluid, Health Policy Watch has tracked a vast trade in vaccines across Africa and other continents.  And it is clear that Chinese and Russian vaccines are deeply penetrating markets in many low- and middle-income countries (LMICs) – declarations of global solidarity by G-20 countries notwithstanding.

China reports that it has offered vaccine assistance to 53 developing countries, and that it has exported or is exporting vaccines to 22 nations, according to Foreign Minister Wang Yi. Meanwhile, by 25 February, Sputnik V had been registered in 37 countries.

In contrast, Western companies such as Pfizer/ BioNtech, Moderna, AstraZeneca/Oxford, and Johnson & Johnson, whose vaccine was the latest to be approved by the US Food and Drug Administration, are focused on a select group of high income countries in North America, Europe, the Middle East – peppered by only a few middle- or upper-middle income African or Latin American nations that teamed up with big pharma in clinical trials or swung heavily leveraged deals.  

Although the AstraZeneca vaccine is also being marketed to LMICs through the WHO co-sponsored COVAX global vaccine initiative, those sales are taking place through a separate license with the Serum Institute of India (SII). And there, too, SII has made a series of parallel, bilateral  deals, charging South Africa and Uganda 2-3 times the fee per dose, paid by Europe for the same vaccine.  

“As some high-income nations have already immunized more than 20% of their population with at least one dose, only a few African countries have reached even 1 in 1,000 people. It is frankly impossible to defeat the virus if these disparities persist,” says Solomon Zewdu, the Bill & Melinda Gates Foundation’s deputy director told Health Policy Watch, in explaning the desperate rush of others.

China’s Vaccine Outreach To Africa Began Months Ago

It is on the African continent where the Chinese vaccines are being marketed the most intensively – and perhaps embraced the most extensively. 

Beijing has confirmed that it is assisting 21 African countries to get vaccines, according to Foreign Ministry spokesperson Wang Wenbin. Significantly, Egypt, Africa’s fourth largest country, has signed an agreement with China’s Sinovac to produce its COVID vaccine, as well as distribute it to other African countries. 

That represents the fruits of a Chinese vaccine outreach initiative that began months ago.

 

Sinopharm hosted an in-person delegation of some 50 ambassadors and diplomats on its factory premises.

Already in October of 2020, Sinopharm hosted an in-person delegation of some 50 African ambassadors and diplomats on its factory premises – in a period when Beijing was stonewalling over WHO requests to permit entry of just 14 scientists into Wuhan to investigate the origins of the SARS-CoV2 virus.  

“Sinopharm stands ready to work with the African people to deepen cooperation in the fight against and pandemic, consolidate China-Africa friendship and make an important contribution to the joint development of the China-Africa health community,” Company chairperson Liu Jingzhen told the visiting delegation at the time.  

“President Xi Jinping pointed out that after the COVID-19 vaccine is developed and put into use, it will take the lead in benefiting African countries.” 

Using a ‘Common Interest’ Approach to Cement Superpower Status

China had become an expert in public diplomacy on the continent using a “common interest approach” in its quest to cement its superpower status,  Dr Yazini April, co-ordinator of the BRICS (Brazil, Russia, India, China and South Africa) Research Centre at the Human Sciences Research Council in Pretoria, told Health Policy Watch in an interview. 

Its “vaccine diplomacy” involved three things, according to April: the country’s desire to be viewed as a “trusted friend, business and political control”.

While much of Africa is not yet part of China’s massive global transport “Belt and Road” infrastructure plan, often referred to as the Silk Road, “each country has something they can trade with, such as water in Lesotho etcetera”, she added, referring to the country’s abundant resources that provide water to parched South Africa and hydroelectricity domestically. 

On New Year’s Eve, Gabonese President Ali Bongo Ondimba promised his people that they would be among the first on the continent to get the COVID-19 vaccine. But by mid-February, when there were no signs of COVAX deliveries, Gabon turned to China and will soon get 100,000 doses of the Sinopharm vaccine. 

Many other African countries are receiving China’s Sinopharm vaccine. Equatorial Guinea has received a donation of 100,000 doses, Zimbabwe received 200,000 doses as did Sierra Leone. Algeria is set to receive 200,000 doses and Senegal has purchased 200,000 China’s Sinopharm doses, with rollout anticipated soon. 

Uganda has also been offered a donation of 300,000 Sinopharm doses. However, the modalities of receipt of vaccine have not been concluded, said Ugandan Health Minister Jane Ruth Acheng during a press briefing in Kampala last week.

China’s Foreign Ministry spokesperson Wang Wenbin said that the vaccine aid “is a clear manifestation of the China-Africa traditional friendship”,  adding that China will continue to provide support and assistance within its capacity and in accordance with the needs of Africa.

Russia – Also Present in Africa

While less active, Russia is also present too. South Africa’s regulatory authority confirmed to Health Policy Watch that it had received an application for licensing from Sputnik V’s manufacturer on 24 February and was in the process of considering the “safety, quality and efficacy of the vaccine”. The South African government has also confirmed that it is in talks with Sinopharm but has a non-disclosure agreement with the company.

In late December, Guinea, one of the world’s poorest countries – but also a Russian source of the mineral bauxite – started to vaccinate people “on an experimental basis” with Sputnik V. Most vaccinations so far have been of government officials. 

On 1 March, Ghana started its COVID-19 vaccine campaign with vaccines received from the WHO co-sponsored COVAX initiative – but still more are needed.

Ghana’s government also has said that it is considering securing some doses of Sputnik V under bilateral arrangements. Franklin Asiedu-Bekoe, Ghana’s Director of Public Health, confirmed that the country has “opened our doors outside the COVAX facility to ensure that more than 20 million Ghanaians are vaccinated. We have registered the Russian Sputnik V vaccine which will provide a backup of doses”.

Africa Centres for Diseases Control and Prevention (CDC) also is in contact with the producers of Chinese and Russia vaccines – which have no special requirements for transportation and can be stored at normal refrigeration temperatures.  John Nkengasong, the director of Africa CDC, said Russia has already submitted its dossier for the Sputnik V vaccine directly to Africa CDC – and an expert committee was reviewing their data and would come up with guidance. 

Whether or not Africa CDC will act on its own or wait for WHO remains to be seen. WHO officials have urged countries to procure only those vaccines that have received an “Emergency Use Listing” from WHO, or are approved by another strict national regulatory agency, usually understood to mean the US, UK or European Medicines Agency. In the case of both Sputnik as well as the Sinopharm and Sinovac vaccines, those WHO reviews are still pending, said Matshidiso Moeti, WHO’s  Regional Director for Africa. 

The WHO also has repeatedly urged both pharma manufacturers and countries to refrain from bilateral deals and procure their COVID-19 vaccines through the COVAX facility – although those pleas have largely been to no avail. 

“To maximimize the chance of getting fair price for COVID-19 vaccines, we are advising countries to use as much as they can the pooled procurement platforms that are in existence for the moment: COVAX or AVATT,” said Dr. Richard Muhigo the head of immunisation and vaccine development at the WHO Africa office. 

“If the countries decide to go for bilateral deals with vaccine manufacturing, our recommendation is to procure as much as they can vaccines that have been listed by WHO for emergency use,” said Muhigo. 

China and Asia
Thailand’s first shipment of vaccines arrives from China.

Between October and January, Chinese Foreign Minister Wang Yi visited every country in Southeast Asia except Vietnam, according to the Center for Strategic and International Studies. 

“At each of his stops, Wang coupled promises of Chinese vaccine access with other foreign policy priorities, including advancing major projects under China’s Belt and Road Initiative (BRI), which have been stalled amid the pandemic,” according to the CSIS.

In the Philippines, Wang promised half a million doses of Covid-19 vaccines along with $1.3 billion in loans and $77 million in grants for infrastructure projects. In Indonesia, the delivery of 3 million Sinovac vaccines has come with China’s commitment to “help Indonesia become a manufacturing hub for Chinese vaccines” and speed up a high-speed railway link, according to the center. 

In Myanmar, a promise of 300,000 vaccine doses was accompanied by talks to develop a  China-Myanmar Economic Corridor, which would also ensure that China’s Yunnan Province just over the border would gain better access to the Indian Ocean.

All in all, China says that it is providing vaccines to 14  Asian countries including Pakistan, Brunei, Nepal, the Philippines, Myanmar, Cambodia, Laos, Sri Lanka, Mongolia and the Palestinian Authority: “China has decided to donate COVID-19 vaccines to Palestine,” China’s UN Ambassador Geng Shuang told the Security Council in late February, during its monthly meeting on the Israeli-Palestinian conflict.  

The Palestinian Authority (PA), however, has so far spoken publicly only about its procurement of Russia’s Sputnik vaccine – after a high-level PA official visited Moscow last month and signed a contract. The PA is also receiving a dispatch of vaccines from the Global COVAX facility. On 22 February, Hamas-controlled Gaza, received a shipment of some 20,000 Sputnik vaccines, donated by the United Arab Emirates.  Israel, criticized for failing to share more of its supply of Pfizer vaccines, has given the PA a few thousand doses directly, and is now beginning to vaccinate some 140,000 Palestinian workers – along with Arab residents of East Jerusalem which both Israel and the PA claim.  

China has also been active elsewhere in the Middle East region, supplying the UAE, Iran, Bahrain, Jordan, Iran, Egypt and Morocco. However, the UAE, Bahrain, Kuwait, Oman, Qatar and Saudi Arabia have also bought the Pfizer vaccine.

Russia Makes Inroads in Europe & Latin America 

Meanwhile, Russia has mostly sewn up vaccine markets in Euroasia and is also making inroads in the European Union, according to official news agency Tass. 

“Hungary became the first EU country to receive samples of the Sputnik V vaccine for research. Austria, Germany, Greece, Italy, Slovenia, the Czech Republic and Finland have already expressed interest in the possible use of the Russian preparation or its local production in case of its approval,” reported Tass on 19 February.

Sputnik Favoured in Latin America

At least 10 Latin American countries have received Sputnik V, beginning with starting with Argentina on 30 December. Since then Belize, Brazil, Bolivia, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay and Venezuala have all received doses – some as small donations and others as paid orders. 

In Bolivia, vaccine talks were accompanied by discussions of Russian assistance to develop gas reserves, restart a nuclear plant project and co-operate on lithium mining, according to Reuters.

Russia has also licensed manufacturing companies to produce its vaccine in India, Brazil, China, South Korea, and Argentina.

Argentina, Brazil, Bolivia and Mexico are getting both the Sputnik and Sinopharm vaccines, while Colombia, the Dominican Republic, Ecuador, Peru, Chile and Uruguay have only secured the Sinopharm vaccine so far.

Political Power or Donations to the Global Public Good ? 
China’s Xi Jinping in 18 May 2020 address before the World Health Assembly

Although China has been accused of donating its Coronavirus vaccines for political power, Chinese President Xi Jinping has stressed at recent meetings of the World Health Assembly that it viewed its COVID vaccines as a global “public good’. 

China has also joined the global vaccine access platform, COVAX, and promised it 10 million doses.  However neither of the two leading vaccine candidates, by Sinpharm and Sinovac, have been approved by an external regulatory agency – and discussions are still continuing, according to WHO officials.

Nor have the Chinese vaccine developers published peer-reviewed studies on their vaccines. Company reports show Sinopharm’s multi-country trials yielding efficacy results  of 79%, while Sinovac trials from four different countries showed results ranging from 91.3% in a Turkish trial to 50.3% in an independently managed  Brazilian trial among health care workers. 

In the case of Russia’s Sputnik V vaccine, the Gamaleya Institute developers together with the Russian Direct Investment Fund (RDIF) say they have submitted the vaccine portfolio to the  European Medicines Agency for review.  And a Lancet report on Phase 3 trial results, found the vaccine to be 90% efficacious against the SARS-CoV2 virus.  But the CEO of the  RDIF has also stated that it prefers to deal directly with countries rather than via the global COVAX facility.

Meanwhile, in the absence of other approvals, individual countries ranging from upper middle income Chile to impoverished Zimbabwe have taken matters into their own hands – registering Chinese or Russian vaccines for emergency use – regardless of the capacity of their regulatory authorities. 

And regardless of regulatory status, China and Russia have taken advantage of the three-month interval between the start of vaccine drives in wealthy countries and the launch of the COVAX facility’s global vaccine distribution effort in lower and middle-income countries, beginning just this past week in Ghana, Cote D’Ivoire and Nigeria.

COVAX Enters The Picture 

Now that COVAX has finally started the first allocations, with the aim to deliver some 2 bllion vaccines in 2021, it may soon eclipse the individual bilateral efforts of China and Russia. Or will it? 

In fact,  COVAX is only likely to reach about 20% of the populations of countries that have joined the facility by the end of the year.  So given the global vaccine thirst, Russian and Chinese vaccines will likely continue to find willing markets, at least in the near-term.

If the Russian Sputnik is finally approved by the EMA – the doors to much wider distribution in Europe and elsewhere will open much wider – particularly in light of the vaccine’s affordable US$ 10 price tag per dose. 

However, China appears unlikely to submit its Sinopharm and Sinovac vaccines to the EMA – or to any other strict western regulatory agency for review and approval.  

So what remains to be seen, against the landscape of unmet demands as well as enormous political pressures, is how WHO will handle the delicate balance of science and politics that could surround the review of the Chinese vaccines’ efficacy for a WHO Emergency Use Listing.

Image Credits: TellZimbabwe/Twitter, GovernmentZA/Flickr, CGTN, Flickr: Francis Kokoroko/UNICEF, the foreign photographer/Flickr.