Italy launched its COVID-19 vaccine drive on Sunday, 27 December, 2020.  Two months later vaccines are only just being delivered to Africa.  Access groups say patent restrictions will constrain supplies and hamper rollouts in low- and middle-income countries throughout 2021.

Over 400 US organisations and 115 Members of the European Parliament declared their support this week for a waiver on intellectual property rights for COVID-19 products, due to be discussed by the World Trade Organisation (WTO) General Council.

Even so, WTO insiders said that consensus was more likely to build around a “third way” approach for voluntarily relaxing patent rights advocated by new WTO Director General Ngozi Okonjo-Iweala – in light of stiff opposition from other countries in Europe and Asia to the formal waiver plan. 

Informed observers also predicted that as a first step, the WTO was more likely to approve a much softer proposal by the “Ottawa Group” of 13 developed and emerging economies calling upon countries to voluntarily relax export restrictions and tariffs on key COVID-19 health products. 

At a high profile media briefing on Friday in Washington DC, US consumer, faith, health, development, labour, human rights, and other civil society groups urged the White House to reverse the Trump administration’s opposition to an emergency COVID-19 waiver of World Trade Organization (WTO) intellectual property rules so that more generic supplies of vaccines, treatments, and diagnostic tests can be produced in as many places as possible as quickly as possible. 

“The pandemic cannot be stopped anywhere unless vaccines, tests, and treatments are available everywhere so variants that evade current vaccines do not develop,” said the group in its appeal. 

Congresswoman Jan Schakowsky said she and 29 other congress members had signed a letter alongside 400 faith-based, labour and human rights urging US President Joe Biden to support the waiver.

“We have vaccine apartheid. Pharmaceutical companies and some rich countries are standing in the way of poorer countries getting access to vaccines,” said Schakowsky, a Democrat from Illinois and chair of the Consumer Protection and Commerce Subcommittee.

Sara Nelson, head of the US Association of Flight Attendants

Sara Nelson, head of the Association of Flight Attendants, told the media briefing that her members support the waiver because they “know first hand the impact of the pandemic on our health and our livelihoods”.

“I get choked up to think that some people might only get access to vaccines in 2024,” said a tearful Nelson. “I can’t imagine this going on until 2024, and the threat this poses to our livelihoods, lives and jobs. People must always be before profit.” 

Meanwhile,  a cross-party group of 115 Members of the European Parliament (MEPs)  also issued a declaration urging the European Commission and European Council to drop their opposition to the TRIPS waiver.

‘Third Way’ Approach More Likely To Gain Acceptance Than TRIPS Waiver  
Ngozi Okonjo-Iweala, new WTO Director General, at a press conference after her election, speaks about a “Third Way” to expand access to vaccines..

The waiver on certain Trade-Related aspects of Intellectual Property Rights (TRIPS) being championed by South Africa and India, would remove IP barriers on COVID-related medicines, vaccines and other health products. The TRIPS Council has been unable to reach consensus on the waiver and is expected to submit an oral report to the General Council.

Access groups have championed the waiver proposal, saying that would enable greater access to affordable COVID-19 health technologies, including vaccines, in particular for developing and middle-income countries. It is supported by the African Union and most of Latin America.

Geneva trade and diplomatic sources have said, however, that it is extremely doubtful that the WTO General Council would actually act, at least in this session, to approve such an initiative. 

There has been staunch opposition from the United States, United Kingdom, and other G-7 countries to the waiver measure, which opponents say would harm intellectual property rights, and thereby dampen pharma R&D investments. 

New WTO Director General Dr Ngozi Okonjo-Iweala, elected just last week, has talked about a “third way” to break the deadlock between rich countries and poorer ones over the issue – focusing on the issuance of more voluntary licenses by pharma companies to low- and middle-income countries for generic manufacture of their patented products. 

Ottawa Group’s Trade & Health Draft Initiative Could Get Support  

As a more likely initial WTO gesture on the pandemic, the General Council could next week approve a draft decision on Trade and Health around which more consensus may be building. This could pre-empt the waiver negotiations due to resume in the TRIPS Council on 10 and 11 March.

The draft decision, based on a Trade and Health initiative launched last year by the “Ottawa Group” of 13 countries, urges countries to review and “promptly eliminate unnecessary restrictions” on export of essential COVID health products,  temporarily remove or reduce tariffs; streamline customs processes; strengthen supply chains, display transparency in trade-related monitoring, and step up cooperation with the WTO and other international agencies in trade-related aspects of pandemic response. 

The measure, based on a joint statement from June 2020, has been backed by the Ottawa Group’s mix of high-income countries, which includes Norway, Switzerland, the EU and Canada, as well as emerging economies such as Kenya, Mexico and Chile, could at least send a signal of greater multi-lateral cooperation in pandemic related trade issues, sources say. 

Latin American countries are, meanwhile, expected to make a statement calling for relaxation of export restrictions, in the wake of recent European Union moves to restrict the export of vaccines manufactured in the EU region after supply shortages emerged. 

EU Parliamentarians Charge: EU Bloc’s “Open Opposition to TRIPS Waiver” Exacerbates North-South Divide  

In their declaration on the TRIPS waiver, European members of parliament (MEPs) stressed that “the EU’s open opposition to the TRIPS waiver risks exacerbating a dangerous North-South divide when it comes to affordable access to COVID-19 diagnostics, personal protective equipment, treatments and vaccines. 

“The WTO decision on a potential waiver offers a crucial and much-needed act of effective solidarity, as it is an important step towards increasing local production in partner countries and, ultimately, suppressing this pandemic on a global scale. As the Commission President has repeatedly stated, no one is safe until everyone is safe.”

Earlier in the week, Archbishop Ivan Jurkovic, Holy See representative to the United Nations, said that “the principles of justice, solidarity and inclusiveness, must be the basis of any specific and concrete intervention in response to the pandemic”, and the TRIPS waiver “would be a strong signal demonstrating real commitment and engagement and thus moving from declaration to action in favor of the entire human family”. 

WHO’s Director General Dr Tedros Adhanom Ghebreyesus also reaffirmed his support for the WTO IP waiver initiative on Friday. Speaking at a WHO press conference, he and other senior WHO officials said that the IP waiver offers a “practical solutions” for scaling up access, as compared to Friday’s Security Council Resolution on the issue, which remains largely symbolic.

“I’m glad the UN Security Council has voted in favour of vaccine equity. And at the same time, if we’re going to take practical solutions, then the waiver of intellectual property should be taken seriously,” Tedros told the media at the body’s bi-weekly COVID-19 briefing.

“We are very interested in the outcome of this discussion at the TRIPS Council,” said Mariangela Simao, head of the WHO’s Access to Medicines and Health Products. “We welcome any movement from countries to decrease and to address current barriers to access.”,

https://twitter.com/abinader/status/1365386652961619970

Image Credits: Tadeau Andre/MSF , Euoropean Commission , WTO.

The Medical Association of Tanzania (MAT) has started a massive awareness campaign on the prevention of COVID-19 following last Sunday’s admission by President John Magufuli and the Ministry of Health that the disease exists in the country.  

“We have started an advocacy strategy through the media and communities on prevention of COVID-19,” Dr. Elisha Osati, the immediate past president of the Medical Association of Tanzania told Health Policy Watch in an exclusive interview.  

“We have a lot of patients in our wards so we are also dealing with their treatment and management,” Dr. Osati said. “We of course have been taking precaution on our side, for our patients and their relations.” 

The medical profession has been stressing wearing masks, washing hands, using hand sanitizers, social distancing and generally seeking medical help for those that may feel unwell.  

For months, the Tanzania president, who has a doctorate in chemistry, cast doubt over the existence of coronavirus and said it was the work of the devil. Since April, Tanzania has not reported a single case of the virus to the WHO and no public measures have been implemented to contain the virus. 

High-Profile Deaths, WHO prompting

A source within the Tanzania government said that the  president’s recent change of heart could be due to the deaths of two prominent politicians, the vice-president Zanzibar Seif Sharif Hamad, died on Wednesday of COVID-19, and the head of civil service, John Kijazi who died on the same day although the reason for his death has not been given.   

However, another source said it was due to the WHO Director-General’s statement on Tanzania and COVID-19 issued on 20 February, in which he urged the government to scale public health measures against COVID-19 and to prepare for vaccination – a highly usual step for the global body that does not usually involve itself in the internal affairs of member states.

“This situation remains very concerning. I renew my call for Tanzania to start reporting COVID-19 cases and share data. I also call on Tanzania to implement the public health measures that we know work in breaking the chains of transmission, and to prepare for vaccination,” said Dr. Tedros Adhanom Ghebreyesus. 

Use Knowledge and Science, Says Moeti

Dr Matshidiso Moeti, the WHO Regional Director for Africa, said the WHO encourages countries to use knowledge, science and evidence for implementations they ask them to undertake.

The change to a medical approach from a faith-based approach comes amidst a pandemic that the Tanzania government may slowly be admitting to. 

However, a number of religious leaders have challenged Magufuli’s stance as being ‘not completely right’ and have been trying to encourage COVID-19 preventive measures within their communities. 

Catholic Bishop Siverine Niwemugizi of Rulenge-Ngara Diocese, which borders Rwanda and Burundi, suspended the celebration of public mass and community prayers. Instead, he resorted to using Radio Kwizera, established by the Jesuit Refugee Service (JRS) in partnership with the United Nations High Commission for Refugees (UNHCR) to broadcast Mass. 

Last Sunday, Magufuli acknowledged that there was a problem and called on people to wear face masks. On Wednesday, the Ministry of Health issued a statement urging the public to guard against contagious and non contagious diseases in the country, avoid crowds and wear safe masks approved by the ministry.

The Partnership of Evidence Based Response to COVID-19 (PERC) Weekly Update: COVID-19 Epidemiology and Policy in Africa observed that in February alone, there were 293 social media posts mentioning pneumonia in Tanzania. One Twitter user commented, “My timeline and groups are inundated with obituaries, deaths caused by ‘severe pneumonia”.

The Tanzania Ministry of Health stopped releasing Covid-19 updates last April, blaming “fake” COVID-19 test kits and fear mongering. The last update indicating 509 confirmed cases and 21 deaths.

Tanzania stopped sending COVID-19 to the WHO in April.

Osati also told Health Policy Watch that the medical fraternity will also start advocating for the use of  vaccines in once they have been approved by the national drug regulatory bodies. 

“As scientists, we know that vaccines are game changers. But we are still waiting for the relevant bodies to test and approve them,” he said. “ We want a vaccine that is safe, effective and cost-effective. 

The Tanzanian government officials had dismissed COVID-19 vaccines and were instead promoting herbal remedies. The Health Minister Dorothy Gwajima said they were not satisfied that the vaccines were clinically proven.

Osati said scientists in his country would continue to dialogue with the authorities in government until the management of COVID-19 pandemic is medically managed.  

“We are pleased about the Tanzanian government actions. A gap that has been created since last year. We await an appropriate strategy to engage with Tanzania,” said Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, during a weekly press briefing.

 

Essential COVID-19 supplies like oxygen remain in short supply in many others,

A new COVID-19 Oxygen Emergency Taskforce has been created in response to the dearth of sustainable oxygen supplies in low- and middle-income countries (LMICs) – and its critical importance for treatment of COVID-19. 

Co-created by Unitaid and Wellcome Trust in partnership with the WHO and a range of other global public health agencies, the taskforce, launched Thursday, is taking a new role to coordinate and advocate for increased supply of oxygen in LMICs. 

The oxygen supply in most LMIC’s was already constrained prior to COVID-19, and needs have only been exacerbated by the pandemic. 

According to an oxygen tracker tool created by the Geneva-based PATH, LMIC countries need about 7.8 million cubic meters of oxygen per day to treat the more than half a million hospitalized patients. That translates into a supply of about 1.46 million cylinders of oxygen per day, with 25 countries currently reporting surges in demand, especially in Africa. 

PATH COVID oxygen tracker tool

Paul Schreier, Chief Operating Officer at Wellcome, said: “We have made critical advances in providing lifesaving clinical care and treatments to COVID-19 patients over the last year. The impact of the combination of oxygen and dexamethasone to treat severely ill patients has, in particular, been incredible.”

“But global access to advances remains unequal. We need to urgently increase access to medical oxygen to ensure patients are benefiting regardless of where they live and ability to pay. International solidarity is the quickest – and only – way out of this pandemic. It is a public health, scientific, economic and moral imperative that all tools are made available globally.”

PATH COVID oxygen tracker shows needs for oxygen by country,
US 1.6 billion Needed – US$90 Million Immediately  

The Taskforce says that some US$ 90 million in immediate funding is needed to address key challenges in oxygen access in delivery in up to 20 countries, including Malawi, Nigeria, and Afghanistan.  Unitaid and Wellcome will make an immediate contribution of up to US $20 million in total for emergency response. Urgent, short-term requirements of additional countries will be measured in the coming weeks, with the overall estimated funding needed to be US $1.6 billion. 

Philippe Duneton, Executive Director of Unitaid, said: “This is a global emergency that needs a truly global response, both from international organisations and donors. Many of the countries seeing this demand struggled before the pandemic to meet their daily oxygen needs. 

“Now it’s more vital than ever that we come together to build on the work that has already been done, with a firm commitment to helping the worst-affected countries as quickly as possible.”

The COVID-19 Oxygen Emergency Taskforce also brings together a long list of other organizations that have been working to improve access to oxygen since the start of the pandemic – WHO, UNICEF, the Global Fund, World Bank, Save the Children, the Clinton Health Access Initiative (CHAI), PATH, and the Every Breath Counts coalition to end pneumonia.

‘Double-Burden’ of Pneumonia and COVID-19 Places Strain on Global Health Systems 

Even before COVID-19, pneumonia was the world’s biggest infectious killer of adults and children, claiming the lives of 2.5 million people in 2019. 

COVID-19 has put increased strain on health systems, especially in ‘double-burden’ countries with both high levels of pneumonia and COVID-19. Many hospitals in LMICs are running out of oxygen, resulting in preventable deaths and families of hospitalized patients paying a premium for scarce oxygen supplies. 

Oxygen has long been regarded as an essential medicine, and despite being vital for the effective treatment of hospitalized COVID-19 patients, LMICs cannot access crucial oxygen supply due to costs, infrastructure constraints, and logistical barriers.  

The Taskforce recognizes the central importance of oxygen in treatment, and partners will focus on four key objectives as part of an emergency response plan: measuring acute and longer-term oxygen needs in LMICs; connecting countries to financing partners for their assessed oxygen requirements; and supporting the procurement and supply of oxygen, along with related products and services.

They will also address the need  for innovation market-shaping interventions and reinforce advocacy efforts to highlight the importance of oxygen access in the COVID-19 response. As well as meeting immediate needs of the pandemic, the taskforce will also look to aid in long-term pneumonia control.  

 

Image Credits: Independent Panel for Pandemic Preparedness – Second Progress Report. , PATH .

Global health is all but global, says Fifa Rahman, Permanent Representative for NGOs for the WHO-backed ACT-Accelerator

The appointment of Ngozi Okonjo-Iweala, the former Nigerian Finance Minister, World Bank development economist and its former Vice President, and black African woman, as head of the WTO, has been heralded as ‘a big deal’, an inspiration, and ‘a sign of the many strides (Africa) has made in gender parity’. While all this is true, and while representation is important, it is but one step towards tackling pervasive racism in global health. 

On 25th February 2021, twenty black and brown leaders in global health, including implementers, academics, civil society, and communities living with the diseases, will convene in a virtual roundtable to discuss how racism and white supremacy affects global health governance, hiring, and programming. This roundtable, convened by Matahari Global Solutions, a global research and policy group, and the AIDS and Rights Alliance of Southern Africa (ARASA), will define the parameters for an in-depth study to take place this year – and advocacy meetings with global health agencies. A meeting report will be published and sent directly to heads of key global health agencies. 

COVID-19 Impact of Race on Health

The COVID-19 pandemic has brought to the fore clear disparities in infection rates, death rates, and access to diagnostics, vaccines, therapeutics, and care for black and brown communities. It’s a bleak reminder of the enduring inequity in global public health.  As early as April 2020, one Brookings Institute article pointed out that the COVID-19 response does not take into account the fact that black individuals in predominantly white geographies are more likely to live in areas with ‘lack of healthy food options, green spaces, recreational facilities, lighting, and safety’, and that black people are more likely to live in densely populated areas. 

In addition, COVID-19 tools are not well adapted to dark skin, with pulse oximeters showing misleading readings 12% of the time in persons with non-white skin. And contrary to what was expected, Global North responses to COVID-19 have not necessarily been the most efficacious nor the most effective. For example, the United Kingdom, the United States, and Sweden failed to adequately protect their populations, while global south countries such as Rwanda and Taiwan effectively instituted systems and deployed technologies to respond effectively to the pandemic. Yet in the Global Health Security Index, the United States and the United Kingdom were ranked first and second in the world in terms of pandemic preparedness. This underscores the need for us to decolonise and redefine global health and address existing power imbalances within global health structures and debates. 

Racism as a Systemic Issue Through Organisations

The white Global North perspective is inherent in global health. Yet only recently has the impact of race and whiteness on global health governance, hiring, and programming come into focus. Anu Kumar, CEO of IPAS, a non-profit working across Africa, Asia, and the Americas on reproductive rights, asked in a June 2020 op-ed, “Why do we in the global health sector, which is dominated by white people, especially white women, believe that we know how to solve the health problems of people in other countries?” 

Stephanie Kimou, who has worked extensively on sexual and reproductive health in francophone Africa, commented in a separate op-ed: “[A]t work, nobody looked like me. The person who started the nonprofit, the finance manager, the operations person — all white. All the major money and programmatic decisions — all made by white people being driven around in fancy cars and living in gated communities. It was so clearly neocolonialist.”

At its very basis it may seem to the untrained eye that this is solely an issue of hiring more Black, Indigenous and people of colour.  We need to recognize that there is intersectionality of oppression and inclusion. However, as mentioned above, tokenistic diversity hires will not address the philosophy behind why black and brown people, in particular women, don’t get hired in the first place. These are entrenched within culture and everyday practice. In the words of Anu Kumar, “What we don’t talk about is how the structures and operations of our organizations are part of white supremacist culture.”

What defines global health deliverables and decision-making is membership. Covert racism means that while the parameters of membership go largely unsaid, it is white people that are seen to be reliable and responsible for important documents that guide implementation of programs, setting guidelines on how many diagnostic tests should be deployed to countries that need them, etcetera. White people are considered most suitable to respond to emails promptly, to feedback more eloquently in project design, are promoted into leadership positions and thus get to represent the views of black and brown implementers. This is the de facto modus operandi, even if it would never be uttered in such plain language.

Real Examples – Race and Whiteness in Global Health

2020 presented several examples of institutional white supremacy culture – notably, how structures and institutions are structured to uphold white dominance. In June last year, a Médecins Sans Frontières internal statement highlighted that while 90% of its staff were hired locally in countries where MSF works, most of its operations were run by European senior managers. So based on absolute numbers alone diverse hiring doesn’t appear to be the issue here. But of course it is an issue when, much like colonial times, positions of power are overwhelmingly filled by white people. 

MSF insider Arnab Majumdar wrote last year about MSF senior managers assuming national staff were ‘intellectually lazy’, explicitly referring to them as being ‘vulnerable to corruption’. Complaints of racism were met by the accusation of ‘reverse racism’, a recognized signifier of white supremacy. And while the MSF core executive committee responded by saying they would address the difference in compensation in their teams, and that they would continue to address broad issues of harassment, abuse, and discrimination within the organisation, nothing public has emerged since that time on the effects of this work. 

Also in June 2020, the Women Deliver CEO, Katja Iversen, took a leave of absence after allegations of a toxic work environment, including racist comments about hair of black women, black people being refused for hire multiple times, and that the organisation suffered from a ‘white saviour’ complex. Four months later, reports emerged of the conclusion of investigations into racism at Women Deliver – that no single person was responsible. The verdict was slammed as a ‘slap in the face’, and was accompanied with critique that Women Deliver ‘doesn’t really know what accountability is’. 

A similar situation transpired at the International Women’s Health Coalition – with a letter being published on racist and toxic culture within the organisation, the President resigning as a result of the allegations, but with investigations clearing the President and senior managers of racism – finding instead that there was a ‘pervading culture of fear and intimidation’.

These white-centred power structures result in widespread race-based oppression within organisations and within health systems. Priorities are distorted, sociocultural reasons for disparity in healthcare are ignored and/or misunderstood, and new health technologies end up not being culturally appropriate nor equitably efficacious. Dolutegravir, a major HIV drug on the WHO Essential Medicines List, was predominantly trialled on white populations, missing out key genetically diverse populations. In November 2019, the ADVANCE trial found the risk of major weight gain among black women.  Has the system learned from such mistakes? No. Moderna proudly advertised that in its Phase 3 COVE trials for the new COVID-19 vaccine 28% of study participants were from “diverse communities” – i.e. 72% were white. Conversations within the WHO Access to COVID-19 Tools Accelerator (the ACT-Accelerator), specifically designed to bring necessary vaccines, diagnostics, therapeutics, PPE, and oxygen supplies to countries most in need – have been dominated by white individuals from the Global North, leaving a knowledge deficit among countries that would receive these technologies. 

The Way Forward

COVID-19 is showing the world with renewed urgency that representation and participation is essential in formulating public health responses. It is for this precise reason that Matahari Global Solutions and AIDS and Rights Alliance for Southern Africa (ARASA) have embarked on an ambitious project to document the various effects of a lack of diversity and white supremacy, on global health programming, hiring, and governance. 

With a small amount of funding from Open Society Foundations, we’ll start with a roundtable with black and brown leaders in global health, then conduct an in-depth qualitative study to ascertain how whiteness is experienced in global health. Results will be publicised widely – and discussed directly with key global health agencies. We still have to secure funding for a larger quantitative study of over 300 individuals, and advocacy missions by organisations in the Global South on distorted priorities and colonialist global health, to Geneva and New York-based decision-making bodies. But this work is a start. 

Racism, white supremacy, and colonialism echo through our global health. The system is unglobal and misses out on equitable representation. Colonialist, (un)global health doesn’t work and it needs to change. 

Fifa A Rahman is principal consultant at Matahari Global Solutions

– Dr Fifa A Rahman is the Permanent Representative for NGOs on the Diagnostics Pillar and the Facilitation Council of the ACT-Accelerator, and principal consultant at Matahari Global Solutions; Felicita Hikuam is Director at the AIDS and Rights Alliance of Southern Africa; Nyasha Chingore-Munazvo is Programmes Lead at the AIDS and Rights Alliance for Southern Africa; and Gisa Dang is Associate Consultant at Matahari Global Solutions. 

Image Credits: Fifa Rahman.

Thumbs up: WHO representative in Ghana, Francis Kasolo, on left, with UNICEF’s representative, Anne-Claire Dufay as first COVAX vaccine doses arrive on 24 February in Accra, Ghana.

Under cloudy skies, Ghana’s first precious doses of Covid-19 vaccines arrived Wednesday morning at Accra’s Kotoka International Airport. They are also the first supplies to be distributed by the WHO co-sponsored COVAX facility on the African continent.

The arrival of some 600,000 vaccines marks a milestone in months of effort by WHO, UNICEF, GAVI and other partners to mount the largest global vaccine campaign in history – and ensure that scarce and often pricey COVID-19 vaccine doses are distributed more equitably to countries around the world. 

“This day is the culmination of many months of planning, research, negotiation & coordination,” tweeted WHO Director General Dr Tedros Adhanom Ghebreyesus, who co-launched the COVAX initiative nearly a year ago. “But it’s just the beginning. We still have a lot of work to do to realize our shared vision for VaccinEquity by starting vaccination in all countries within the first 100 days of the year.”  

COVAX hopes to deliver 2.3 billion doses by the year’s end — mostly to 92 low- and middle-income countries that are part of a GAVI-backed Advanced Marketing Commitment scheme. The equity scheme aims to overcome price and supply barriers thrown up by high-income nations, which have already snapped up one billion more vaccines than they need for their populations.

Ghana was selected as the first African recipient of vaccines after sending a rollout plan to COVAX, demonstrating that its health-care teams and cold chain equipment could support a quick distribution. The WHO Ghana office, known for its efficiency and close collaborations with Ghana Health Services, can be relied upon as a flagbearer for the initiative, insiders say.  

“This is a momentous occasion,”  declared WHO’s representative in Ghana Francis Kasolo, in a joint statement with UNICEF’s representative, Anne-Claire Dufay, just as the first palettes of AstraZeneca/Oxford vaccines, produced by India’s Serum Institute, were unloaded on the airport runway. 

“After a year of disruptions due to the COVID-19 pandemic, with more than 80,700 Ghanaians getting infected with the virus and over 580 lost lives, the path to recovery for the people of Ghana can finally begin,” said Kasolo. 

The initial COVAX shipments will be used to vaccinate frontline healthcare workers, adults over the age of 60, and people with underlying health conditions in the weeks to come, said the Ghanaian authorities on Wednesday.

Ghana’s program manager for immunization, Kwame Amponsa-Akyianu, told reporters earlier this month that the country aims to vaccinate two-thirds of its population of over 31 million people.

The historic shipment comes a week after Africa’s coronavirus death toll surpassed the 100,000 mark. That is a fraction of the death toll on other continents, but it is now rising fast as a second wave of infections overwhelms hospitals – most of which lack the oxygen supplies and intensive care units that are standard in more affluent regions.

Coronavirus Disease 2019 (COVID-19)

Africa CDC Also Welcomes Deliveries

John Nkengasong, Director of the Addis-based Africa Centres for Disease Control and Prevention, sounded a similar note, saying: “These first deliveries of COVID-19 vaccines through COVAX are a critical moment in Africa’s fight against the virus.” 

Nkengasong described the first deliveries as “an important step towards our continental goal of immunising at least 60% of Africa’s population with safe and efficacious vaccines against COVID-19″ over three years. 

So far, the African Union (AU) has secured some 670 million doses of the AstraZeneca, Pfizer and Johnson & Johnson vaccines – in addition to the COVAX supplies of some 90 million doses that will flow to the continent.  Russia has also offered to supply 300 million doses of its Sputnik V vaccine to the AU scheme along with a financing package.

Desperate to begin vaccinations soon, South Africa, Uganda and Rwanda, among others, have also made smaller bilateral deals. And China has donated small batches of its Sinopharm vaccine to to countries like Zimbabwe and Equatorial Guinea. 

Still, the rollouts underway in Europe, the Americas, India and even the Middle East remain the exception rather than the norm.  Of the 210 million doses of vaccine that have been administered globally so far, half have been doled out in just two countries, Tedros warned on Tuesday. 

Ghana’s Minister of Health Kwaku Agyeman-Manu at Accra’s Kotoka International Airport

Nigeria Watching Ghana – And Wondering When Their Turn Will Come  

But just north of Accra, in the continent’s most populous country and the largest economy, Nigerians were eying the local vaccine landscape with concerns about how and when a campaign would commence on home turf. Such plans have yet to be announced by the government.

Emeka Nsofor, CEO of EpicAFRIC,a philanthropic impact agency, told Health Policy Watch that while the country’s epidemiological response to the pandemic has been impressive so far, the paucity of information and the non-availability of a timeline for the delivery of COVID-19 vaccines is becoming a source of major concern not only to professionals, but to the public.

“It is not good for Nigerians to be watching clips of the vaccines being delivered to South Africa, Zimbabwe and other African countries when no one knows when Nigerians will start receiving the vaccine,” he told Health Policy Watch.

Nsofor said the government ought to have made its plans for procuring and administering doses public – whether they are secured through COVAX, the AU or other means.

“By now we should have known who will get the vaccines first, where will they be administered, who are the officials that will be involved,” he added.

In several countries where vaccines are already being administered, frontline health workers and aged individuals are eager to be the first to receive the jabs in their arms. But in Nigeria, health workers are less optimistic about their prospects.

At the Casualty and Emergency unit of Nigeria’s first teaching hospital, the University College Hospital, a physician who was among the first in his unit to test positive for COVID-19 told Health Policy Watch that he dreads getting reinfected. Not knowing when he will be able to receive a jab compounds those fears and is “very discouraging”, he said.

“Getting the virus was a very scary experience for me, especially at a time when we knew so little about it. Every now and then, I still dread contracting it again. I believe receiving the vaccine would protect me and allay my fears but realising that no one, probably including the government, knows when we will get it, is very discouraging,” he told Health Policy Watch on condition of anonymity.

For its part, the Nigeria Center for Disease Control (NCDC) continues to coordinate testing, messaging and other aspects of the country’s response to the pandemic. It recently released findings of household seroprevalence surveys conducted in four Nigerian states — Lagos, Enugu, Nasarawa and Gombe States.

The survey findings revealed that the prevalence of SARS-CoV-2 antibodies was 23% in Lagos and Enugu States, 19% in Nasarawa State, and 9% in Gombe State.

“This means that as many as 1 in 5 individuals in Lagos, Enugu and Nasarawa State would have ever been infected with SARS-CoV-2. In Gombe, the proportion is about 1 in 10,” NCDC said in a statement.

South African Variant – A Risk In Ghana

The fact that the B-1351 variant, first discovered in South Africa, has now spread to eight African countries including Ghana, has further implications for the vaccine campaign in the West African region. 

In a small South African trial, experts found that the AstraZeneca vaccine had virtually no efficacy in reducing mild or moderate COVID cases among people infected with the B-1351 virus strain – leading authorities in Pretoria to cancel the vaccine rollout and switch to a Johnson & Johnson jab – which has recently demonstrated efficacy against the variant in Phase 3 trials. 

The WHO nonetheless has said it recommends AstraZeneca’s use across Arica – even in countries infected with the variant. Speaking at a recent press conference, WHO experst maintained that the vaccine is still likely to reduce incidence of severe COVID cases, even among people stricken with the B-1351 strain. 

However, the African Union has issued a slightly different recommendation – that countries where the strain is “dominant” shift gears to another vaccine. 

So experts will be closely eyeing Ghana’s AstraZeneca rollout to see how the vaccine performs against the variant in the real world laboratory there.

Map of African Union Member States by hotspot level on PERC (Partnership For Evidence-Based Response) dashboard.

Expect More African Pressures On COVAX to Roll Out Johnson & Johnson – Following Expected FDA approval Friday

COVAX’s preliminary candidate-specific supply of COVID-19 vaccines for 2021 and 2022, as of 20 January. Since then Novavax also committed 1 million more vaccines.

The arrival of the AstraZeneca vaccine batches in Ghana also coincides with big news of a likely US Food and Drug Administration emergency approval of the J&J vaccine as early as Friday – following today’s positive FDA expert panel review of the vaccine. 

The J&J results, reported by the FDA review, showed a 66% average efficacy for the vaccine in preventing moderate and severe disease in Phase 3 trials The trials involved over 44,000 recruits in the US, Latin America, and South Africa. 

The J&J vaccine was also 64% efficacious in preventing moderate and severe disease in the South African trial arm – a significant finding from the first large-scale trial of a vaccine meeting up with the B.1351 variant. And more important, the vaccine was 85% effective in preventing severe disease – 82% in South Africa. While that is not as good a showing as the 90% or better efficacy results for the mRNA vaccines by Pfizer and Moderna, J&J trial was the first to directly pit a vaccine against the B.1351 variant, which has been the one most resistant to vaccines generally among the recent SARS-CoV2 mutations to emerge. 

The J&J vaccine also has the advantage of being a one-shot vaccine which can be stored in a normal refrigerator rather than ultra-cold storage conditions – factors that could significantly help rollout in low-income countries where access to cold storage as well as to health services is more challenging. 

The FDA approval of the  J&J vaccine will almost certainly pave the way for a WHO greenlight, leading to a COVAX rollout of the vaccine as soon as commercial supplies are available. 

But that, in turn, could also give rise to new dilemmas for COVAX distribution plans.  In African countries like Ghana, faced with creeping vases of the B.1351 variant – there may also be future pressures to swap out AstraZeneca vaccines for J&J doses.

Although J&J has in fact committed to provide 500 million vaccine doses through COVAX facility – AstraZeneca dose still comprise the lions share of the COVAX portfolio, with some 720 million doses already procured. 

The bottom line is that while the jury is still out on AstraZeneca’s performance against the B-1351 variant, the J&J trial data shows clear efficacy for the vaccine in preventing serious disease in the African setting – where other vaccines have not [yet] been widely tested and tried.

And that means that the COVAX rollout – even as it begins, is set to face a new series of challenges in a constantly evolving landscape of science, big pharma deals and geopolitics.

Image Credits: WHO Ghana, PERC, Gavi.

Europe Lockdown
Frankfurt, Germany

The United Kingdom, Switzerland, Israel and Turkey are cautiously reopening businesses and relaxing limits on gatherings and travel as COVID-19 cases declined both globally and within these countries.  

However, parts of France, the Czech Republic, and Sweden are preparing for harder lockdown measures as their cases surge in contrast to worldwide trends.

As of 23 February, there were 2,530,101 new cases in the past week. The COVID-19 Epidemiological Update reported a 16% global decline in cases, with over 500,000 fewer cases than the beginning of the month. 

Five out of six WHO regions were showing double-digit percentage declines in new cases, with only the Eastern Mediterranean Region showing a 7% rise. Europe and the Americas continue to see the greatest drops in absolute numbers of cases while the number of new deaths has also declined in all regions.

UK & Switzerland Outline Roadmaps to Relax Restrictions 
Europe lockdown
Lockdown “Green” border roads between Switzerland and Germany

Switzerland will relax some restrictions from 1 March, allowing museums, shops, and zoos to open at limited capacity. Private outdoor events with up to 15 people will also be permitted. A second phase of reopening should commence on 1 April. 

On Monday, UK Prime Minister Boris Johnson announced the government’s roadmap to ease restrictions in England, which will be guided at all stages by data as opposed to set dates. 

Step 1 of the roadmap will begin in March with a return to in-person education in schools and colleges. Most outdoor attractions and settings, as well as non-essential retail, which includes zoos, pubs, restaurants, gyms, and retail stores, will stay closed for at least another month. Step 4, which will see a wider opening of a number of businesses, is expected no later than 21 June. 

The United Kingdom had implemented a national lockdown in response to the rising cases that resulted from the B.1.1.7 variant, and has even extended the lockdown in Northern Ireland, to 1 April. 

London, UK: Camden High Street in lockdown

Together with an ongoing vaccine campaign, these measures appear to be working, with case rates declining across all age groups and regions, in the most recent weekly surveillance report published. 

“Our efforts are working as case rates, hospitalisation rates and deaths are slowly falling,” said Dr Yvonne Doyle, Medical Director at Public Health England. Doyle still expressed concern about the new infection numbers, which were still higher than the cases at the end of September. “This could increase very quickly if we do not follow the current measures. Although it is difficult, we must continue to stay home and protect lives.”

The UK roadmap for reopening outlines four steps: continued successful vaccine deployment, evidence that demonstrates vaccines are sufficient in reducing hospitalizations and deaths in those vaccinated, reduction in infection rates that prevent a surge in hospitalizations, and assessment of the risks not to be fundamentally changed by the new emerging variants of concern. 

There will be a minimum of five weeks between each step: four weeks for the data to reflect changes in restrictions; followed by seven days’ notice of the restrictions to be eased. 

lockdown
Istanbul, Turkey

Turkey also plans to start a gradual normalization process in March, with measures to be lifted “on a provincial basis”. The country’s 81 provinces will be categorized based on risk levels – from very high to low – and progress in vaccinations to determine whether they are ready for normalization. 

This new process for normalization comes after the Turkish Health Ministry started announcing an average of weekly cases for provinces last week. This data will be used to determine whether restrictions are lifted. 

Israel Re-opens For Business – Except During Holiday & At Airport

Meanwhile, the Israeli government began to reopen hotels, shopping centers, and even cultural events on 21 February after its government approved the second and third phases of the exit plan from lockdown as new COVID cases continued to decline, particularly among people over 60,  most of whom have been immunized.

Infections rates and serious cases in Israel have declined sharply after more than 80% of people over the age of 60 either were vaccinated or recovered from COVID-19. The campaign has since opened to everyone over the age of 16.

However, airports and land borders will be closed for 14 more days, and the country’s borders closed until 6 March.  Only 200 people a day are allowed to board “rescue flights”, and this has left thousands of Israeli citizens stranded around the world.  

Restrictions on mass gatherings have also been relaxed to 20 people outdoors and 10 people indoors, instead of 10 and 5 respectively.  At the same time, it was likely that the government would declare a curfew over the upcoming Purim weekend, a holiday traditionally observed by raucous celebrations commemorating the biblical story of the rescue of Persian Jews by the Queen Esther.   

Coinciding with the relaxation measures, a Green Pass system was put into place to grant Israelis who have had two vaccine doses automatic access to gyms, studios, cultural and sports events, fairs and hotels. Those without the pass have to show proof of a recent COVID test. Children under 16, who can’t be immunized, may still be admitted to some venues, like hotels, along with their immunized parents.    

Palestine Vaccination Campaign to Begin, Calls on Israel to Reserve More Vaccines for Palestinians
Nabi Moussa, Occupied West Bank

Palestinians in Gaza were also reportedly due to get their first jabs as another 20,000 vaccines donated by the United Arab Emirates arrived Sunday in the barricaded strip from Egypt via the Rafah crossing.  Israel allowed the transfer of 2,000 vaccine doses into the Strip last week. 

In the Occupied West Bank, vaccine campaigns by the Palestinian Authority with Russia’s Sputnik V vaccine were only just beginning – although West Bank Palestinian infection rates have been comparatively lower than those in Israel, even after the latter had immunized over 50% of its 9.3 million citizens with at least a first dose.

A World Bank report on Monday called on Israel to share more of its vaccines with the PA, saying: “While Israel has been leading the world in terms of per capita vaccinations, no one has been vaccinated in the Palestinian territories yet, and the Israeli MoH has not formulated an allocation strategy to support the territories, beyond providing 5,000 vaccines for Palestinian doctors. Humanitarian organizations in both Israel and West Bank and Gaza have called for Israel to reserve a higher amount of vaccines for the Palestinian territories. Given the challenges for the Palestinian Authority to procure vaccines, the statement calls for operational and financial support from Israel to PA.”  

The Economic Monitoring report further stated: “In order to ensure there is an effective vaccination campaign, Palestinian and Israeli authorities should coordinate in the financing, purchase and distribution of safe and effective COVID-19 vaccines,” noting that the Palestinian Authority faces a US$ 30 million shortfall in vaccine funding, even after support from the WHO co-sponsored COVAX facility.

Germany Considers Reopening Even if Cases are Rising
Angela Merkel, Chancellor of Germany.

Germany’s Chancellor Angela Merkel has also proposed a plan to ease that country’s lockdown which has been in place since November. Merkel reportedly told her Christian Democrat (CDU) party that lockdown measures could be eased in several stages, combined with increased coronavirus testing. 

The stages would focus on personal contacts (how many people a person meets); schools, sports, restaurants, cafes, and cultural events. 

However, talk of easing restrictions in Germany belies the upward trend of infections in the country. The Robert Koch Institute reported 4,369 new COVID-19 cases as well as 62 associated deaths. There are major concerns of the COVID-19 variants pushing up numbers. 

Europe lockdown
Frankfurt, Germany: Masks required on cycle path
France, Sweden, and the Czech Republic – Tougher Lockdowns 
Europe lockdown
Paris, France: A woman serves a hot dog in front of a restaurant in the Latin Quarter. French bars and restaurants can no longer accommodate consumers because of the measures taken to combat the COVID-19 pandemic. Some restaurants remain open and serve drinks and take-out meals.

While other countries will soon enjoy relaxed restrictions, there have been increases in Nice in France, the Czech Republic, and Sweden. 

Nice reported 740 new cases per week per 100,000 residents, triple the national average. France has applied a localized lockdown over the next two weekends from Théoule-sur-Mer to Menton, and Nice. 

French Health Minister Olivier Veran said that measures could include a stricter form of the curfew imposed nationwide in France or a weekend lockdown in the city. 

“Consultations will be conducted over the weekend to take additional measures to stem the epidemic, ranging from a reinforced curfew to local lockdown at weekends,” Véran said.

The Czech Republic is also experiencing a rise, with 11, 233 cases reported on Tuesday, an increase of 7,100 in a single day. Test positivity rate also increased to 40.6%, the highest since 9 January. 

The Czech Ministry of Health has mandated that masks must be worn in places with larger concentrations of people, especially shops, public transportation, and hospitals, effective Thursday. 

The Ministry has also submitted to the government a law on emergency measures in an effort to curb the resurgence of COVID-19 in the country, including restrictions on services, a ban on mass events, and the restriction of public transport. 

“The purpose of the proposed law is to legally enshrine the measures that we issue as a crisis in accordance with the crisis law as part of the COVID-19 epidemic. Thanks to this, it is possible to issue measures for which we have so far needed an emergency, ” explained the Minister of Health Jan Blatný.

Europe lockdown
Uppsala, Sweden: People social distancing

Meanwhile, Sweden is preparing the strictest restrictions yet, in an effort to curb a resurgence in COVID-19 cases as the variant first detected in the UK spreads rapidly. 

“The British variant is increasing very fast. This variant will with fairly high probability be the dominant one within a few weeks or a month… We have a package [of national measures] being readied that will be presented tomorrow,” said Chief Epidemiologist Anders Tegnell at a news conference. 

Concerns about a possible third wave of the pandemic have been growing since the number of new infections have risen and the new variants have spread. The Swedish government has laid the ground for potential lockdown measures to be tougher than previously measures enacted earlier in the pandemic. 

The list of businesses that will face mandatory closure in Sweden include shops, hair salons, gyms, and restaurants. The country has also closed its borders to Denmark and Norway. Negative COVID-19 tests are now required for entry into Sweden. 

Declines Also Seen in United States and India
New York City, United States: Outdoor dining during pandemic

While declines in serious cases in Israel and the UK may be attributed to vaccines, it remains unclear why numbers are declining globally as some countries battle their second, third, and fourth waves of COVID-19. 

For the United States, the scale-up of vaccination and the shift in seasons are driving down cases, according to the Institute for Health Metrics and Evaluation (IHME) during a briefing last week. 

However, variants including the more infectious B.1.1.7 which first emerged in the UK in November 2019, have been detected in the US which could drive transmission. 

Epidemiologists in India have also questioned the declining cases, pointing to low rates of testing and habitual underreporting of causes of death, particularly in rural India. 

However, Prime Minister Narendra Modi is hoping that the vaccination drive that began in January will spur wider recovery. Though vaccine uptake remains slower than officials hoped, as of 18 February, more than 98 million vaccine doses have been administered in India. 

“I don’t think anyone really thinks that without vaccines and a vaccination program being widely available that we can go back to whatever is full normalcy,” said Sireesha Yadlapalli, a Hyderabad-based senior director at the United States Pharmacopeia, a scientific nonprofit organization. “Hopefully this is the slowdown and there’s no second wave.”

lockdowns
Bangalore, India: Empty streets during lockdown in early 2020.

Despite a nationwide declide, there has been a rise in cases seen in the Indian state of Maharashtra, which has ordered new restrictions on people’s movement and imposed night time curfews. Mumbai, Maharashtra’s capital and India’s financial hub, also banned religious, social, and political gatherings. 

The state has reported nearly 7,000 new cases on Sunday, a steep rise from 2,000 daily cases earlier this month. The Indian Ministry of Health and Family Welfare has stated that the surge in COVID cases in the state cannot be attributed to strains N440K and E484Q, which have been detected in other countries. 

WHO Warns Against Complacency 
Dr Michael Ryan, Health Emergencies Executive Director

While some of the declines, such as those in England, Scotland and Israel, may be attributed to massive vaccine campaigns – in other regions, where vaccination is only just getting under way, global health officials have had few explanations for the dip in cases.  

“We’re certainly not out of the woods yet,” said Health Emergencies Executive Director Dr Mike Ryan at a WHO press conference in Geneva last Thursday.

“The virus still has a lot of energy. You’re also dealing with urban settings, many people still living in areas that are overcrowded, multi-generation, multi-family homes. It is very difficult to break chains of transmission in a complex society. Some countries are coming down that hill more quickly than others.”

WHO technical lead on COVID-19 Dr Maria van Kerkhove stressed: “We cannot let ourselves get into a situation where the virus can resurge again. Remember what we need to continue to do to drive it down and get cases down into single digits.

“We just need to stay the course, hold on to what is working consistently deliberately as we roll out vaccines and make sure that vaccinations start in all countries,” said Van Kerkhove. 

Ryan also cautioned that, although the global COVID-19 cases are now at their lowest since last October, this could be the result of the natural patterns of the virus.

“I do think a good portion of that has been done to the huge efforts made by communities. There have been very stringent lockdowns and stay-at-home orders and other things, but also serum prevalence is rising,” said Ryan.

“We need to understand what is driving those transmission dynamics. Is it natural seasonality and wave-like pattern of the disease? Are we building up a level of immunity in the population that’s preventing the disease from finding the next case? Are our control measures having an impact on that?’ asked Ryan.

“I think as we move into [northern hemisphere] springtime, we need to drive towards higher levels of vaccinations, getting an equitable distribution of that vaccine, getting rid of the deaths and the hospitalizations and the suffering, but [also] continuing to drive the case numbers down.” 

 

Image Credits: Twitter, 7C0/Flickr, Falk Lademann/Flickr, Marc Barrot/Flickr, Sergey Yeliseev/Flickr, Health Policy Watch , David King/Flickr, Ben Hartschuh, 7C0/Flickr, Flickr: IMF Photo/Cyril Marcilhacy.

Global Citizen CEO Hugh Evans launches 5-point global recovery campaign

Vaccinating all of Africa’s health workers would need half a percent of all the doses that the G-7 countries have purchased, according to Global Citizen CEO Hugh Evans.

On Tuesday, Global Citizen launched a five-point ‘Recover Better Together’ plan for the world, aimed at getting millions of citizens behind ending COVID-19 for all, ending the hunger crisis, resuming learning for children, fully protecting the planet, and advancing equity for all.

“First we must focus on achieving sufficient worldwide vaccine coverage to break the chain of transmission, including, for the poorest nations,” Evans told a media briefing convened jointly with the World Health Organization, and addressed by world leaders including European Commission president Ursula von der Leyen, US Special Envoy in Climate John Kerry and South African president Cyril Ramaphosa.

In his address, Ramaphosa applauded French president Macron who has called on rich countries to donate 5% of their vaccines to needy countries.

“Another important step is to enable the transfer of medical technology for the duration of the pandemic. This will allow us to increase the production of COVID-19 vaccines and other medical products, lower prices, and improve distribution so that these vaccines and medical supplies reach all corners of the world,” said Ramaphosa.

Guinea Starts Ebola Vaccination Drive – Nigerian and Zambian Studies Show High Levels of SARS-CoV2 Infection

Healthworkers during the 2017 Ebola outbreak in the DRC.

Guinea started Ebola vaccinations on Tuesday of people at high risk in Gouecke, a rural community in N’Zerekore prefecture where the first cases were detected on 14 February – the first cases since 2016.

“All people who have come into contact with a confirmed Ebola patient are given the vaccine, as well as frontline and health workers. The launch started with the vaccination of health workers,” according to a media release from WHO’s Africa region.

“The last time Guinea faced an Ebola outbreak, vaccines were still being developed,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “With the experience and expertise it has built up, combined with safe and effective vaccines, Guinea has the tools and the know-how to respond to this outbreak. WHO is proud to support the government to engage and empower communities, to protect health and other frontline workers, to save lives and provide high-quality care.”

The WHO sent 11 000 doses of the rVSV-ZEBOV Ebola vaccine from its headquarters in Geneva, while a further 8500 doses are being procured from Merck, the vaccine’s producer in the US,

“The speed with which Guinea has managed to start up vaccination efforts is remarkable and is largely thanks to the enormous contribution its experts have made to the recent Ebola outbreaks in the DRC,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Africans supporting fellow Africans to respond to one of the most dangerous diseases on the planet is a testament to the emergency response capacity we have built over the years on the continent.”

Implementing an Ebola vaccination strategy is a complex procedure as the vaccines need to be maintained at a temperature of minus 80 degrees centigrade. Guinea has developed ultra-cold chain capacity with vaccine carriers, which can keep the vaccine doses in sub-zero temperatures for up to a week.

There are eight cases (four confirmed and four probable) and five people have died so far. Guinea’s neighbours are on high alert, particularly Liberia and Cote d’Ivoire which are close to the border with N’Zerekore, Guinea’s second-largest city.

Meanwhile, a second person died of Ebola last week in the Democratic Republic of the Congo’s North Kivu province.

Ebola, a haemorrhagic fever, is transmitted from wild animals and spreads in the humans through direct contact with the blood, and bodily fluids of infected people, and contaminated surfaces and materials.

Nigeria’s First SARS-CoV-2 Seroprevalence Study Finds Almost 25% of Lagos Residents Had Antibodies

Lagos

Almost a quarter of Nigerians living in Lagos may have been infected with SARS-CoV2, according to the results of a seroprevalence study released on Monday by the Nigeria Centre for Disease Control (NCDC) and Nigeria Institute for Medical Research (NIMR)

The household seroprevalence survey was conducted in Lagos, Enugu, Nasarawa and Gombe States in September and October last year and involved blood samples from over 10,000 people.

SARS-CoV-2 antibodies were found in 23% of people sampled in Lagos and Enugu States, 19% in Nasarawa State, and 9% in Gombe State. 

“These rates of infection are higher than those reported through the national surveillance system and reveal that the spread of infection in the states surveyed is wider than is obvious from surveillance activities,” according to a statement by the NCDC and NIMR.

The survey also showed that men had higher infection rates than women (21% of men and 17% of women in Nasarawa), and urban areas had higher infection rates than rural areas (28% of urban residents and 18% of rural residents in Enugu).

The survey is currently being expanded to more states in the North-West and South geopolitical zones which were not included in the initial round of surveys.

Zambia Post-Mortems Find High Level of SARS-CoV2, Minimal Testing

Post-mortem surveillance of 364 Zambians who died between June and September last year  detected SARS-CoV2 in 70 (19%), according to a study published in the BMJ last week.

PCR tests were administered on people at the University Teaching Hospital morgue in the capital of Lusaka within 48 hours of death.

Fifty of the 70 with COVID-19 had died in their communities without ever having been tested for the virus. Only five of the 19 who died in hospital had been tested. Seven children were part of the study and only one had been tested before death. The most common co-morbidities among those who died of the virus were tuberculosis (31%), hypertension (27%), HIV/AIDS (23%), alcoholism (17%), and diabetes (13%).

 

Image Credits: WHO, Wikipedia.

More than a year into the world’s largest global health emergency, health diplomats have fought hard to ensure that every country across the globe secures access to lifesaving coronavirus health products, including vaccines, treatments, and diagnostics.  

That has not happened yet, given that 80% of countries that are now rolling out vaccines are either high-income or upper middle-income countries. 

Export bans on essential health products in 80 countries, ranging from personal protective equipment to ventilators, have not helped either. And in the absence of clear global guidance, up to 130 countries have imposed an uneven patchwork of travel restrictions in an attempt to keep more contagious variants at bay – mostly to no avail. 

A panel of some two dozen leading diplomats and health policy experts from WHO, government, academia and media pondered the current state of affairs, at the Global Health Centre’s (GHC) launch of a new Guide to Global Health Diplomacy, authored by GHC founder Ilona Kickbusch along with a former Hungerian Health Minister, Haik Nikogosian, former head of the Framework Convention on Tobacco Control, Mihály Kökény; and a preface from WHO’s Director General Dr Tedros Adhanom Ghebreyesus.  

The guide, co-sponsored by the Swiss Confederation, offers a compass to navigate the complexity of global health diplomacy through “practical insights” and “sound wisdom”, said Norway’s leader of the labor party Jonas Gahr Stør at the launch event on Thursday. 

Norway’s Labour Party leader, Jonas Gahr Støre

The event featured some of the bright stars in the world’s global health constellation, including former WHO DG Margaret Chan; Trudi Makhaya, economic advisor to South Africa’s President Cyril Ramaphonsa, Suhasini Haidar, editor of India’s The Hindu Newspaper, Juan Jorge Gómez Camacho, Mexico’s Ambassador to Canada, and Swiss Federal Councillor Alain Berset. The event, moderated by Kickbusch, was co- sponsored by the World Health Organization and the Swiss Federal Council. 

Said Kickbush: “As you can see from the subtitle of this book [better health – improved global solidarity – more equity], the three words, health, so that health moves to the centre of negotiations, solidarity, and equity – those truly are the goals of global health diplomacy.”Better health – improved global solidarity – more equity

Ilona Kickbusch, Founding Director of the Graduate Institute’s Global Health Centre in Geneva.
Crisis Has Shown The Failures of The Current International Health Regulations System For Pandemic Preparedness & Response 
Michel Kazathchkine, former Executive Director of the Global Fund and a member of the Independent Panel for Pandemic Preparedness and Response

The pandemic has uncovered “many flaws” in global preparedness and response, said Michel Kazathckine, former executive director of the Global Fund to fight AIDS, Tuberculosis and Malaria, and currently serving as a member of the Independent Panel for Pandemic Preparedness and Response, mandated by the World Health Assembly in May, to explore how and why the SARS-CoV2 pandemic caught the world so badly off guard.

“The international system we have established for health security did not really work as a system,” he said. “There were clear gaps in preparedness management of the response coordination.”

If there is anything that diplomacy has “certainly” not achieved in the midst of the pandemic, it is “firm and binding commitments” at the international level, added the Global Health Centre’s co-director Suerie Moon. 

Suerie Moon, Co-Director of Global Health Centre at Geneva Graduate Institute
Same Challenges Were Apparent in H5N1 Avian Flu Epidemic 

The challenges are not new. Some 15 years ago after the eruption of the H5N1 Avian Influenza epidemic, Indonesia protested the fact that after low- and middle-income Asian countries had shared samples of the emergent pathogen with research networks around the world,  rich countries then bought up most of the vaccines thus produced  – leaving other countries vulnerable.  

In 2021, the continued lack of clear and binding agreements to ensure equitable access to health products during health emergencies remains largely unresolved, Moon said. 

“We’ve known this for quite some time, but actually we have very weak, frankly, quite non-existent rules and agreements at the international level to make sure that countries get access to vaccines, so this is not a surprise,” she said. “This is not something that is new to the global health community, but it’s something that we have not yet managed to address.”

While some global frameworks do exist to allow LMICs to gain emergency access to lifesaving health products – such as the pre-existing donor-financed vaccine pool for 92 LMICs managed by Gavi, The Vaccine Alliance, or tools like the WTO’s TRIPS agreement (Trade-Related Aspects of Intellectual Property Rights) – the global south still struggles to take advantage of available IP flexibilities, partially due to fear of retaliation from stronger nations and big pharma. And recent negotiations over a South African and Indian proposal for a more far-reaching TRIPS waiver have “not been easy” either, noted Trudi Makhaya, who is economic advisor to South Africa’s President Cyril Ramaphonsa. 

Trudi Makhaya, Economic Advisor to South Africa’s President Cyril Ramaphonsa.

Another alternative, the WHO-backed voluntary licensing pool, has also failed to garner pharma support for now. Still, there is a growing appreciation that technology transfer and the development of more local health product manufacturing capacity is crucial for low- and middle-income countries going forward, said Makhaya. Notably, new World Trade Organization Director General Dr Ngozi Okonjo-Iweala has talked about a “third way” that would encourage big pharma to sign more voluntary deals with countries for local production – without impinging on intellectual property rights.  

However, Makhaya remains wary:  “There is an appreciation that there’s got to be technology transfer [to LMICs], there’s got to be local manufacturing and that current other alternative arrangements to do that, in the absence of the TRIPS [waiver], are going to be very difficult,” she said. 

Economy Among the Myriad Of Global Health Challenges 

But access to vaccines is only one of a myriad challenges facing low- and middle-income countries in the pandemic response. Makhaya also talked about the economic response to COVID : while some “important” ideas have been floated by the international community to bolster fragile economies – such as special IMF drawing rights for low-income countries – fiscal measures have remained stunted in poorer nations, in comparison to advanced countries that have pumped up to 20% of their GDP into local economies for temporary relief to businesses and the unemployed, she said.

“There have been significant calls that there should be resources at the global level that should be injected [into emerging economies],” said Makhaya. “ A key example was special drawing rights at the IMF…[but] it hasn’t found much expression.”

“We have a situation where amongst advanced countries’ central banks there’s cooperation, but none has been extended to many other developing countries.”

Added Juan Jorge Gómez Camacho, Mexico’s Ambassador to Canada: “Health is not just about health itself,” he said.“Health means prosperity, or the lack of. Health means economic growth, or the lack of. “Health means wealth or poverty. Health is everything. In other words, health criss-crosses all the spectrum of human activity – socially, politically, economically.”

Some Successes: COVAX is Unprecedented 
Dr Tedros Adhanom Ghebreyesus speaking at Thursday Global Health Centre event

Even so, some successes have been apparent since the pandemic struck. If the global health community has achieved anything, it is the WHO co-sponsored COVAX global vaccine facility, which has successfully brought together 190 countries “out of thin air” in the aim to provide more equitable distribution of coronavirus vaccines around the world, said Moon. 

“The access to COVID-19 tools accelerator is health diplomacy in action,” added Dr. Tedros. “It is an unprecedented collaboration between countries, international agencies, the private sector, and other partners to ensure vaccines, diagnostics and therapeutics are shared equitably as global public goods. Vaccine equity is a litmus test for solidarity and global health diplomacy.”

Just last Friday, G7 leaders committed an additional $4.3 billion to the ACT Accelerator initiative, which includes COVAX, as well as parallel efforts for tests and treatments and health systems strengthening. That brings the total commitment to ACT for 2021 to $10.3 billion – although global health leaders say that another $22.9 billion is still needed for all arms of the initiative. 

Local Manufacturing Of New Vaccines 
Scaling up generic manufacture of COVID-19 vaccines could help expand supply and stimulate local economies

Meanwhile, some vaccine-makers have made strides in advancing more local production of their vaccines around the world. Russia’s Sputnik V vaccine, for instance, which showed impressive results in the publication of recent Phase 3 results in The Lancet, is already being produced in India, South Korea, Brazil, China. And production is set to begin in Kazakhstan and Belarus, among other countries like Turkey and Iran – although Sputnik has yet to receive formal regulatory approval from a western regulatory agency or the World Health Organization.  

India’s Serum Institute is manufacturing a local version of the Oxford/AstraZeneca, recently approved by the European Medicines Agency. The vaccine, locally branded as Covishield, is set to play a big part in advancing the access agenda through the COVAX facility as well as through bilateral deals. Over the past two weeks, India has exported 23 million doses of the locally-produced “Covishield” vaccine to low- and middle-income countries, said National Editor for The Hindu media outlet Suhasini Haidar, who also spoke at the panel event.

Still, despite the big ambition for COVAX to distribute more than 2 billion vaccines by the end of 2021, it is a rather sobering fact that COVAX-supplied countries will only be able to vaccinate 3% of their population over the first half of this year, said Moon, adding, “frankly, we need to aim far, far, higher than that.”

Meanwhile, countries like Canada have already ordered five times more vaccines than they need, and the EU has ordered twice as many vaccine doses than it needs. That has opened a debate about vaccine sharing of surplus stocks by rich countries to poorer ones – an exchange which WHO would like to encourage through the COVAX facility instead of through uneven bilateral deals and donations.  

Global Solutions Are Important – But Regional Solutions Also Required 
Modi
India’s prime minister Narendra Modi as he recently announced a South East Asia regional initiative.

Finally, while global frameworks are crucial in the pandemic response, countries shouldn’t wait for Geneva to take action, added other panelists. 

Notably, the African continent has come together in unprecedented ways through initiatives like the African Response Fund, the African Medical Supplies Platform, or the African Vaccine Acquisition Task Force, among others, said Makhaya.

“Instead of looking at the world as one large area of cooperation, perhaps [we need smaller] building blocks, much more about the regions and then come to some kind of success,” added Haidar. 

“If we only look at the solutions as an all-or-nothing huge global system, I think we’re going to close off,” added Moon. “It’s a very complex multipolar ecosystem with lots of different solutions being figured out by different actors who are not waiting for the answers to come from Geneva.” 

Indeed, as this event was happening, other new regional initiatives were also taking shape – including Europe’s announcement of an emergency biodefense plan and a SouthEast Asia regional initiative for pandemic preparedness and medical emergencies mooted by Indian Prime Minister Narendra Modi. 

This, however, does not mean “we don’t need Geneva”, said Moon. “We absolutely need global frameworks and global agreements, but when we think about how have countries figured out how to solve their problems, it has not always been through massive global agreements and so I think we have to think creatively about how does the entire ecosystem work, including what needs to truly be global versus [regional].” 

One of the newer global frameworks that is now gaining steam is a “Pandemic Treaty”proposed by DG Tedros at the World Health Assembly. The treaty aims to garner stronger political commitment towards pandemic preparedness and response, noted the WHOs regional director for the EMRO region Jaouad Mahjour, also appearing at the panel debate. But until such initiatives are put into force, it “isn’t difficult” to guess who will emerge as a winner in the pandemic response, warned Kazathckine.

 “Health is a political choice that can and must transcend politics,” Dr Tedros said at the Thursday event. “That’s why this book is so important to build the health diplomacy capacity of both diplomats and health experts around the world.”

But as Moon reminded the panel: “At the end of the day, the big challenge will not be what needs to be done, but actually how to do it. 

“And this is the work of diplomats – just how to implement, and how to navigate the politics… reminds us that the work of diplomats is really just beginning and that there’s a huge agenda ahead of us.”

Other Key Points By Panelists 

Juan Jorge Gómez Camacho, Ambassador of Mexico to Canada.“The only way we can address this pandemic is by moving all together. We cannot address [the pandemic] country by country. It is self-defeating not only collectively [but also] individually as a country, if we focus on us instead of focusing on working together. For a diplomat, to understand in this case it is not my own interest versus everybody else’s interests. In fact, everybody else’s interest is in my best interest. 

Joseph Borrell Fontelles, High Representative of the EU for Foreign Affairs and Security Policy Vice-President of the European Commission -“Sharing expertise and information should be at the heard of global health diplomay.”

Dr Tedros, WHO Director General “If we have learned anything, this past year, it’s that none of us can go it alone. We can only thrive when we work together across institutions across borders,” he said. “That’s why it’s truly a pleasure to join you for the launch of the guide to global health diplomacy.”

Margaret Chan, former WHO Director General “Without diplomacy, we cannot begin to negotiate,” she said.“And we cannot begin to [advance] the important policy decisions that impact the health and well being of the world’s population.”

Alain Berset, Federal Councillor of Switzerland “The value of global health diplomacy has probably never been more apparent as it is today,” he said. “In this crisis, we need skilled diplomacy to find good solutions.”

Michel Kazathchkine, member of the Independent Panel for Pandemic Preparedness and Response “The question for us today…is not whether 2020 has been the year of global health diplomacy, but what has global health diplomacy achieved during the crisis, and where has it failed, and looking forward, which are the challenges.”

Global Health Diplomacy Book – Co Published with the WHO and the Swiss Federal Council 

The new book, published in collaboration with the WHO and the Swiss Federal Council, will be translated into Chinese and Portuguese, among other languages, said Kickbush.

Given that health is negotiated across all sectors, the new guide is relevant to a range of stakeholders, including the media, civil society, academia, as well as ministries across various sectors, emphasized the Global Health Centre’s co-director Suerie Moon.

“The book makes it quite clear that you don’t need to be a health specialist and you don’t need to be a former diplomat, and in fact some of the most important global diplomats are economic advisors or are coming from media or coming from civil society and academia and foundations and not necessarily from the traditional ranks of diplomacy. 

“If there’s one lesson we’ve really seen over the past year from COVID it’s that diplomacy is not only the responsibility of ministries of health, but trade, science, technology, intellectual property,  travel, tourism, finance…Every single one of these ministries in government needs to be mobilized to negotiate solutions.”

Read the Global Health Centre’s new guide here https://www.graduateinstitute.ch/GHD-Guide

 

Image Credits: NBC, European Health Forum Gastein, IHEID, Twitter: @WHOAFRO.

Threats from the European Commission to sue AstraZeneca over the delay in deliveries of COVID-19 vaccines hold no weight, according to the EU’s contract with the pharma company in which the right to sue was waived. 

Following the drugmaker’s announcement in late January of a 60% shortfall in vaccine deliveries for the first quarter after its manufacturing plants in Europe hit a number of snags, furious EU officials examined possible legal avenues to resolve the issue.

The release of the full contract by RAI, an Italian broadcaster, makes public several key elements that were redacted from a version previously published by the European Commission. In particular it reveals that the Commission is unable to sue for issues with the storage, transport, and administration of vaccines, including delays in the delivery of vaccines.

The exception to the restrictions on the right to legal action is AstraZeneca’s “wilful misconduct or failure to comply with EU regulatory requirements…including manufacture.”

While the EU’s hands are tied in terms of filing a lawsuit, there are other pathways open, including suspending payments to AstraZeneca. 

The initial funding for the doses promised to the EU totals €336 million, of which the Commission already paid two-thirds. The remaining €112 million is supposed to be paid within 20 days of receiving the first installment of doses, however, with the lack of evidence of progress towards manufacturing the doses, “the Commission will have no obligation to pay the second installment and may seek to recover the first installment or a portion of it,” states the contract.

It appears that AstraZeneca overestimated its manufacturing capacity and supply to the EU, setting a goal of delivering 300 million doses by the end of 2021, with 30 million doses by the end of 2020, 40 million in January, 30 million in February, 20 million in March, 80 million in April, 40 million in May, and 60 million in June. 

The company agreed to use its “best reasonable effort” to manufacture the initial doses ordered by the EU and to build its manufacturing capacity. AstraZeneca recently announced that it can deliver 41 million doses by the end of March with its “best reasonable effort.” 

That estimate is 20 million fewer doses than initially predicted, meaning the drugmaker is over two months behind schedule. 

Germany Commits to Sharing Vaccine Doses

 

WHO’s Tedros and Germany’s President Frank-Walter Steinmeier address the media.

German President Frank-Walter Steinmeier committed his country to sharing some of the vaccines it has ordered with low-income countries at a joint press conference with World Health Organization Director General Dr Tedros Adhanom Ghebreyesus, on Monday.

However, Steinmeier said how this would be done and how many vaccines would be shared was still under discussion.

Last Friday, Germany announced that it would be contributing an additional €1.5 billion in funding for the multilateral response to the pandemic, including the ACT Accelerator, at the G7 leaders’ meeting last week.

Steinmeier also used the briefing to restate Germany’s opposition to the proposal of a waiver on patent protection for COVID-19 related products, as mandated by the Agreement on Trade-Related Aspects of Intellectual Property Rights, known as the TRIPS waiver.

“The interest of public institutions and private companies have to be kept alive to invest in research and the development of drugs medicines and vaccines,” said Steinmeier. “So I don’t think the proposal some have made that we have waiver for patents or licensing would be the right approach.”

 

The TRIPS waiver, currently being discussed by the World Trade Organization, has wide support including from the WHO, but it is floundering because of opposition from wealthy countries with powerful pharmaceutical industries, like Germany, the US and the UK.

While Tedros welcomed Germany’s financial contribution, he pointed out that while many wealthy countries claimed to support the global vaccine access facility, COVAX, they were still trying to do bilateral deals with manufacturers for more vaccine doses “without stopping to ask whether this was undermining COVAX”.

“This pandemic is really unprecedented, and we have to do everything to defeat this common enemy including waivers on intellectual property to increase production,” said Tedros. 

He added that the WHO was engaging directly with manufacturers and encouraging pharmaceutical companies to “turn over their facilities to produce other companies’ vaccines as Sanofi has done for the BioNTech vaccine”, and issue non-exclusive licences to enable other manufacturers to produce their vaccines.

 

After donating over 6 million Covid vaccines to more than 13 countries, the Indian government suggested the creation of a regional pandemic platform for preparedness and medical emergencies with its 10 neighbouring countries.

At a meeting with health officials, Indian Prime Minister Narendra Modi proposed creating “a special visa scheme” for doctors and nurses to enable swift travel during health emergencies,coordinated air ambulances, a regional platform for “collating, compiling and studying data about the effectiveness of Covid-19 vaccines” and a network for “promoting technology-assisted epidemiology for preventing future pandemics.”

India has reported more 11 million COVID-19 cases and over 156,000 deaths. Although cases have been declining since September last year and had considerably reduced by January, there has been an increase of about 31% in the past week, mostly in the Western state of Maharashtra.

“Through our openness and determination, we have managed to achieve one of the lowest fatality rates in the world,” said Modi. “This deserves to be applauded. Today, the hopes of our region and the world are focused on rapid deployment of vaccines. In this too, we must maintain the same cooperative and collaborative spirit.”

Modi was referring to the Indian government’s “Vaccine Maitri” (meaning vaccine friendship) initiative, through which the Indian government has donated more than 6.27 million doses of COVID-19 vaccines to  more than 13 countries, including neighbours Bangladesh, Afghanistan, Bhutan, Myanmar and countries such as Oman, Barbados and El Salvador. It also commercially exported 10.5 million doses of vaccines to 8 countries. 

 

Modi was addressing a workshop on COVID-19 management attended by health leaders, experts and officials of Afghanistan, Bangladesh, Bhutan, Maldives, Mauritius, Nepal, Pakistan, Seychelles, Sri Lanka and India.

Evoking the “spirit of collaboration” among these countries, Modi said that India and these countries have a lot in common and should share their successful health policies and schemes.

“We share so many common challenges – climate change, natural disasters, poverty, illiteracy, and social and gender imbalances. But we also share the power of centuries old cultural and people-to-people linkages. If we focus on all that unites us, our region can overcome not only the present pandemic, but our other challenges too,” he said. 

Variants May be Associated With Surge in COVID Cases 

In the last few days, the Maharashtra state government reported a sudden burst of cases in the Vidarbha region, closer to Central India. The genome sequencing of a few cases in Amravati district showed “unique mutations” including E484Q, which is similar to a mutation (E484K) found in South African and Brazilian variants, according to a Times of India report.

Maharashtra and Kerala account for more than 74% of the cases in the country while  Chhattisgarh and Madhya Pradesh are also seeing a rise. 

This is in contrast to the steady downward trend of the pandemic in India since last September last year. The country is reporting an average of 12,000 cases a day, as compared to more 90,000 cases in a day in September. 

Experts have attributed the overall fall in COVID-19 positive cases over the past few months to herd immunity caused by widespread infection, especially in cities such as Mumbai, Pune, and Delhi which saw the largest outbreaks in the country.

A recent round of sero-surveillance in Delhi between January 15 to January 23 among 28,000 people found that 56% of those surveyed had antibodies against COVID-19. 


“Those infected with Covid will only protect themselves but also protect others. Half the population will not transmit to others. Besides, the susceptible population is reduced by 50%,” explained Dr Sanjay Rai, from Delhi’s All India Institute of Medical Sciences. 

Citing a recently published study in the New England Journal of Medicine, Rai said that those who are infected are protected from disease for at least six months. The study which was conducted with more than 12,000 health workers in the UK, showed that presence of antibodies was associated with a substantially reduced risk of reinfection in six months.

More than 9 million people have been at least given one dose of the vaccine.

“India has a young population. About 50% of the population is under 25 years, and 65% of the population under 35 years. There could be a very large fraction of the population then which had asymptomatic infections and were not tested. They would also offer some protection to the population,” said Dr Shahid Jameel, a virologist with Ashoka University, Delhi. 

However, a nation-wide survey showed only one out of 5 people have been exposed to the virus.  

“The message is that a large proportion of the population remains vulnerable,” said Dr. Balram Bhargava, who heads Indian Council of Medical Research, that helmed the national-wide sero-survey. 

Meanwhile, there is some evidence that people who have already had COVID-19 can become reinfected with variants.

 

 

Image Credits: https://dashboard.cowin.gov.in/.