Israeli Prime Minister Benjamin Netanyahu kicked off Israel’s vaccine campaign 21 December – in which more than half of the country’s population have now received at least one jab.

JERUSALEM – A three-way collaboration between Israel, Austria and Denmark to expand COVID vaccine manufacturing capacity may be taking shape – just as Moderna gears up for a major global manufacturing expansion and the Israeli-based firm, Teva Pharmaceuticals, negotiates with vaccine manufacturers about ways to support more vaccine production and distribution.  

Austria’s Chancellor Sebastian Kurz and Denmark’s Prime Minister Mette Frederiksen were reported to be planning a visit to Israel at the invitation of Prime Minister Benjamin Netanyahu – to talk about setting up “an international corporation for manufacturing vaccines” – in the words of the Israeli prime minister on Monday.  

The high-profile visits, if they come off, coincide with a quest by Moderna Therapeutics to set up some 20 new manufacturing plants around the world where “fill and finish” vaccine manufacture could start immediately, Israeli sources told Health Policy Watch. 

But rather than siting their plants in Israel, Moderna may also be eyeing Teva facilities in Europe or elsewhere, some sources suggest. Teva, while based in Israel, has a worldwide network of over 61 manufacturing plants, including Austria and Denmark as well as elsewhere in Europe. 

Riding on the jet-stream of fast-moving vaccine geopolitics, Pfizer’s CEO Albert Bourla was also reportedly set to make a visit to Israel on Sunday, 8 March. The visit could coincide with an announcement by Pfizer that it will locate a vaccine R&D facility in Israel – to come up with next-generation jabs against the ever-mutating coronavirus.

Bourla last week described Israel as “the world’s lab” for the Pfizer vaccine “ because they are using only our vaccine at this state and they have vaccinated a very big part of their population, so we can study both economy and health indices.”  

Moves Come Against Backdrop of Israeli Election Campaign 
Albert Bourla, CEO Pfizer, announces vaccine procurement deal with the WHO co-sponsored COVAX, Friday 22 January 2021

However, some leading Israeli scientists and diplomats have urged the Pfizer CEO to postpone his high profile visit –  which would come just two weeks ahead of a hotly-contested Israeli national election campaign. 

Netanyahu is trying to retain his 12-year-long grip as prime minister – despite corruption cases in the courts and political challenges from former allies on the political right. Showcasing Israel’s success in its vaccination campaign, which has seen over half of Israelis get first jabs and led to a dramatic decline in COVID cases among people over the age of 60, has been a key part of Netanyahu’s re-election strategy. 

While Netanyahu has been widely acknowledged by Israelis for his aggressive moves to acquire and roll out vaccines rapidly and efficiently – he has also been criticized for politicizing an already charged vaccine landscape at home and abroad  – including recent offers of vaccines to alliles in far-flung capitals even before Palestinians next door get access to significant COVID vaccine supplies.

“It is understandable why the chairman and CEO of Pfizer, Dr. Albert Bourla wants to visit Israel. The country – both the government and the scientific and medical communities – will enthusiastically welcome him. Many are looking forward to exploring the possibility of R&D projects and a Pfizer production line in Israel,” wrote Alon Pinkas, former Israeli Consul General in New York, in an op-ed in the Ha’aretz national daily. 

But, Pinkas added, “It defies logic why Bourla, the CEO of a world-leading biopharmaceutical company worth nearly $190 billion, would visit Israel on March 8, 15 days before the Knesset [parliamentary] election. To put it bluntly, Pfizer will become a political prop, and the visit will be politicized with high-octane intensity. Prime Minister Benjamin Netanyahu no longer has Donald Trump as some brother-in-arms campaign asset, so why not use Pfizer?”

Netanyahu Says Israel May Host Moderna Plant –  Others Say Country Lacks Immediate Manufacturing Capacity
Tal Ohana, mayor of the Negev desert town of Yeruham, Israel is actively searching for a COVID vaccine manufacturer to locate in an available facility.

In a February 15 interview with Israel’s Channel 12 news channel, Netanyahu said that he was negotiating with both Moderna and Pfizer  “to build two factories in Israel – making us a global center in the fight against COVID-19.” 

“The Moderna complex will be a center for filling vaccine vials, while Pfizer’s will work as a research and development site for the fight against future viruses,” Netanyahu said.

However, Tal Ohana, the mayor of the Israeli Negev desert town of Yeruham, which had been considered one of the leading sites in the country for a vaccine manufacturing plant, said in an interview with Health Policy Watch that she doubts that Israel can host a plant of the capacity and dimensions that Moderna is seeking at this stage. 

“We are in touch with Moderna,” said Ohana, who had been trying to attract a vaccine manufacturer to the town of 10,000 people even before the pandemic began. “They have decided to create 20 new manufacturing sites around  the world.  But they need something immediate for ‘fill and finish’, with sterile rooms.  To produce at export scale, the company is also looking for large-scale facilities – e.g. of 5,000 square meters in size and employing about 200 workers to produce 100 million vaccines a year, she said. 

While Yeruham is “the most advanced in the process among all of the options in the country… we aren’t at that stage…. we don’t have that capacity here. It takes time,” Ohana said of the facilities already available. “So Moderna is looking at establishing sites elsewhere in the region and to come back to us later.”  

Ohana said it was her understanding that Pfizer would, however, be setting up an R&D facility somewhere else in the country soon. She noted that the company has been eyeing an R&D facility in Israel for some time – “but there were disputes over the IP… then with the interventions of the prime minister, I’m pretty optimistic it will happen,” she added.    

The 36 year-old Ohana, who holds a master’s degree in government and diplomacy and has won recognition for driving COVID cases in the town down to single digits, said that she is focused on attracting a vaccine manufacturer – which would provide a larger employment base. To that end, the municipality is still in negotiations with a third pharma company – which she preferred not to name.

Teva Keen to Fill Manufacturing Niche in International Vaccine Market 
Israeli Prime Minister Benjamin Netanyahu and Health Minister Yuli Edelstein visit a Teva Pharmaceuticals ultra-cold logistics center in November 2020, just before the first deliveries of Pfizer mRNA COVID vaccines – for which Teva is managing distribution.

Meanwhile, as another piece in the jigsaw, Teva appears likely to step in soon as a manufacturing solution for capacity-strapped vaccine producers – which are struggling to fill orders now that vaccines have been approved. A spokesperson for Teva, the world’s largest generic drug manufacturing company, confirmed to Health Policy Watch on Wednesday that “there are discussions between Teva and vaccine originators about production – but we have no information to add about their identity.”

In a series of mid-February media interviews Teva CEO Kare Schultz said Teva was one of the companies best positioned to fill the current holes in the COVID-19 vaccine manufacture market: 

“We have a large, worldwide network of manufacturing capabilities,” from creating underlying drug substances to putting solutions into sterile vials, known as the fill-finish process, Schultz told Fortune Magazine. “There are a limited number of facilities that can do this kind of manufacturing, and it takes time to build them.”

While declining to comment on which vaccines Teva might produce, the company is equipped to make the messenger RNA active ingredients used in the Moderna and Pfizer-BioNTech vaccines.

Teva has already played a huge roll in Israel’s massive vaccine rollout, – the largest in the world, handling the distribution process from airport delivery to ultra cold-chain storage and transportation to hundreds of vaccination sites around the country.

“We also have distribution capability in the U.S. and would be more than happy to help there,” Schultz also said.

But significant to any upcoming talks between Israel, Austria and Denmark, Teva also has plants in Europe, including in Seborg, Denmark and  Teva Ratiopharm Austria, an Austrian firm acquired by Teva in 2010, 

Flurry of Activities Come Against Persistent European & Global Vaccine Shortages 

The flurry of activities by both countries and pharma manufacturers to rev up vaccine manufacturing production come against the stark reports of vaccine supply shortages in Europe – not to mention globally. 

Speaking at her first session of the World Trade Organization’s General Council on Monday, incoming WTO Director General Ngozi Onkonjo-Iweala noted that the world’s vaccine manufacturing capacity currently stands at only about 3.5 billion doses annually – while the needs in the COVID era are for the manufacture of some 10 billion doses a year. 

Iweala has also said she would advocate for a “third way” approach with pharma companies to expand global manufacturing, particularly in low- and middle-income settings where production could also expand access to vaccines among less developed countries.  

It remains to be seen if the vaccine scale-up envisioned by Moderna, and the moves being made by Teva, as well as Israel and its European allies will support that wider objective – or merely expand supplies to high-income countries in Europe and elsewhere.    

 

Image Credits: Youtube – Israeli PM, wikipedia , Kobi Gideon, GPO.

As a deaf child in India, Sneha Das Gupta struggled to make friends and to learn during classes at school. Fortunately, in her earliest years, she was able to do well because she had access to a hearing aid, as well as speech therapy and support from her teachers at school.  Today, she is a PhD student at the prestigious TATA Institute of Social Sciences.

Most people who are at risk of hearing loss, however, are less lucky than Sneha, struggling to communicate, study, and to earn a living, revealed the WHO’s first World Report on Hearing, published on Tuesday, ahead of World Hearing Day on 3 March. 

“Our ability to hear is precious,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Untreated hearing loss can have a devastating impact on people’s ability to communicate, to study and to earn a living. It can also impact on people’s mental health and their ability to sustain relationships.”

Over 1.5 billion People Affected – Another 1 Billion At Risk 

The number of people affected is massive, found the report, with over 1.5 billion people, from all walks of life, with some degree of hearing loss. And unless hearing care is prioritized and integrated into national health systems, that number will grow to 2.5 billion people by 2050, generating losses of over US$ 1 trillion a year to economies worldwide –  especially in low- and middle-income countries which harbor 80% of the total number of people with hearing loss. 

The report, published in collaboration with the US-based Institute of Health Metrics and Evaluation, found that most countries have failed to integrate hearing care into their national health systems, and that the bulk of people who need EHC services cannot access them – largely as a result of stigma associated with hearing loss, as well as insufficient human resources and services to deliver, fit, maintain and support use of the hearing aids.

“About 1 billion people around the world are at risk of avoidable hearing loss,” said Malala Yousafzai, Nobel laureate and UN messenger of peace. “WHO estimates that over 400 million, including 34 million children, live with disabling hearing loss, affecting their health and quality of life”, added Yousafzai, who has suffered from hearing loss herself. 

Because hearing loss severely impairs the cognitive and linguistic development of children, it can have lifelong impacts on their education and employability. People with moderate to severe hearing loss were half as likely to achieve higher education and twice as likely to be unemployed as people without hearing loss, the report notes.

The causes of hearing loss are often preventable, at least in children and young adults. In children, 60% of hearing loss can be prevented through vaccinations against preventable illnesses and treatment of common ear diseases. And 50% of young people aged 12–35 years – or one billion people – are at risk of losing their hearing due to exposure to unsafe sound levels in recreational settings. 

Number of people with hearing loss, by severity

Workplaces & Public Venues Key To Reducing Risks  

The report also illustrates how practical solutions for workplaces and stricter legislation for public venues can reduce hearing loss risks. 

European countries such as France, Italy, the United Kingdom, and Czechia – have reported dwindling levels of noise-induced hearing loss (NIHL) in past years, largely as a result of hearing conservation programmes. In the US, for instance, a military hearing conservation programme found that workers were almost 30% less likely to develop hearing loss.

Meanwhile, strict legislation in Switzerland has ensured that audiences at public venues are offered free ear plugs. Together with other measures, this may explain why an impressive 40% of attendees in recreational venues in Switzerland wear hearing protection – a much higher percentage than in other countries. Such measures include: 

  1. A limit on the average hourly sound levels to 100 A-weighted decibels.
  2. Measurement and recording of sound levels.
  3. Visible information and posters on safe listening.
  4. Provision of “quiet areas” for events whose duration exceeds three hours. 

The report also calls on Member States to implement “HEARING”, a package of cost-effective interventions that include: screening and intervention; ear disease prevention and management; access to technologies; rehabilitation services; improved communication; noise reduction; greater community engagement.

Through HEARING, the WHO aims to boost the relative coverage of ear and healthcare services by 20%, building on the World Health Assembly’s resolution in 2017 to prevent deafness and hearing loss, and contributing to the Sustainable Development Goals – including SDG3 (good health and well-being), SDG4 (quality education), SDG8 (decent work and economic growth), and SDG10 (equality). 

Shortage Of Trained Specialists To Address Ear Health

The WHO’s report also found glaring disparities in the numbers of trained professionals equipped to help people with hearing issues. It found that 80% of LMICs have only 1 ear, nose and throat specialists (EAT) specialist per 1 million people – in contrast to 95% of high-income countries, which have ten times as many ENT specialists.

Similarly, the report found that 35% of countries in Africa had less than 1 teacher of the deaf per million people, in comparison to 15 teachers per million people in 50% of American and 42% of European countries, respectively. 

Using various case studies, the report also illustrates strategies to overcome the shortage of highly specialized professionals at a low-cost in a range of settings. 

On Kiribati’s island of South Tarawa, for instance, 25% of patients who presented at the island’s hospital suffered from ear problems – prompting authorities to train nurses to deliver ear health care to children in three primary schools. The strategy, which also included the set up of a specialized ear clinic on the island, contributed to a “dramatic decrease” in chronic ear problems faced by students.

Use of earplugs in noisy places can reduce the risk of hearing loss significantly

Stigma As Key Barrier To Uptake Of Hearing Services 

The report also emphasizes that stigma is a key issue that has hampered progress in EHC care. In some communities, deaf babies are regarded as a “bad omen” that could bring misfortune. As a result, families are less likely to screen their children for hearing disabilities.

“Hearing loss has often been referred to as an “invisible disability”, not just because of the lack of visible symptoms, but because it has long been stigmatized in communities and ignored by policy-makers,” said Dr. Tedros in the report. 

Stigma could also explain why adults usually stall for ten years before seeking any hearing care, and why in high-income countries, three-quarters of the people that need hearing aids do not use them, even when they are available. 

Marketing strategies that promote hearing devices do not help either, notes the report, because they emphasize discreteness of their devices, thus reinforcing the belief that hearing devices should be hidden, and contributing to public reluctance to wear these devices – even when they are accessible. 

According to the WHO, usage of a hearing aid can reduce the years lived with disability (YLDs) due to unaddressed hearing loss by almost 60% – but only 68 million out of a total 400 million people in need actually use one.

Hearing Aids Are Expensive ; Six Manufacturers Produce 98% of Hearing Aids Worldwide

Apart from stigma, hearing devices can be expensive, and earmolds, batteries, and maintenance services are not always covered by health insurance. In countries like the US, the price of hearing aids ranges between US$ 500 and US$ 3000, although low-cost devices in India can be bought for as little as US$50.

Another issue that is likely to maintain high prices is the fact that a mere 6 manufacturers produce up to 98% of the hearing devices worldwide. And they mostly tailor their products to high-income markets, further complicating access in low-resource settings. 

Initiatives like pooled procurement, usage of solar-powered batteries and locally-sourced materials, or even innovative reimbursement schemes, can bolster access to hearing aids across a range of settings, suggests the report, noting that the UK’s pooled procurement scheme has fitted 750,000 hearing aids across all age groups in recent years.

Universal Screening Is Crucial 

A child in South Africa receives screening using automated audiometry and noise cancelling headphones

Given that hearing lies at the heart of cognitive and linguistic development in children, health systems should attempt to screen children as early as possible, emphasizes the report. 

Perhaps surprisingly, many parents may be unaware of their children’s hearing difficulties, according to a Polish study of 71, 000 first-graders who were examined in over 4,000 schools. In the study, about half of parents who had children with hearing issues were unaware of their child’s condition. In total, almost 15% of all children who were screened were diagnosed with hearing loss, and referred for further care and treatment. 

Screening, however, should not be limited to children, given that 1.1 billion young people are at risk of permanent hearing loss due to exposure to unsafe sound levels in recreational settings.

Older people should also take part in screening programmes, as two thirds of people over the age of 60 experience some degree of hearing loss. 

Timely diagnosis of hearing loss in older people could also have another benefit – it could prevent up to 8% of cases of dementia in older adults, which is one of the major causes of disability in adults worldwide.

Image Credits: WHO/Otto Mejía, Eddie Linssen / WHO, Hear The World Foundation.

COVAX press conference: (from left): President of Ghana, Nana Akufo-Addo, UNICEF’s Henrietta Fore, Africa CDC Director John Nkengasong, GAVI’s Olly Cann; CEPI CEO Richard Hatchett; German Parliamentary State Secretary, Maria Flaschbarth; Gavi CEO Seth Berkley; UNICEF’s Gian Gandh; Soumya Swaminathan, WHO Chief Scientist; Kate O’Brien, WHO Vaccines & Biologicals; WHO Director General, Tedros Adhanom Ghebreyesus.

The global vaccine platform, COVAX, aims to distribute 237 million doses of the Oxford/ AstraZeneca vaccine to 142 countries by the end of May 2021, its managing partners told the media on Tuesday.

Eleven million doses will be delivered this week alone, with Angola, Cambodia, Democratic Republic of Congo and Nigeria getting their vaccines on Tuesday, according to World Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus.

Tedros described COVAX as “an unprecedented partnership that will not only change the course of the pandemic but will change the way the world responds to future health emergencies,” at a media briefing hosted by the WHO, the Global Vaccine Alliance (GAVI), the Coalition for Epidemic Preparedness Innovations (CEPI) and the United Nations Children’s Fund (UNICEF). 

“We very much appreciate the support of Germany and other G7 countries who have supported COVAX with the resources it needs,” said Tedros. 

“The distribution of vaccines has not been as equitable as we would have liked, but it has been certainly more equitable than it could have been and we still have many challenges to overcome, including the local production barriers and delays to intellectual property,” he added.

COVAX, led by the WHO, GAVI and CEPI with UNICEF as the implementing partner, hopes to deliver 2 billion doses to people in 190 countries in less than a year. 

Some 1.2 million doses of the Pfizer-BioNTech COVID shot will also be delivered in the first quarter of 2021, according to the COVAX allocations.

Seth Berkley, CEO of GAVI, The Vaccine Alliance.

GAVI CEO  Seth Berkley said that it might be possible to purchase “1,8 billion doses of vaccine in 2021 for the low and lower middle income AMC countries in 2021” – 500 million more doses than anticipated last year. 

“We are also excited by the progress made by the Johnson and Johnson single-dose vaccine which just received US FDA emergency use authorisation and has agreed to provide us with a half a million doses,” said Berkely. 

Meanwhile, COVAX aimed to turn a recent memorandum of understanding with as-yet-unlicensed Novavax into a “firm advance-purchase agreement for 1.1 billion doses in the current weeks,” Berkley told the media briefing.

He also applauded the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States) for doubling COVAX’s funding recently.

UNICEF – COVAX Making Good on Promises

UNICEF executive director Henrietta Fore said COVAX was beginning to make good on its promise to ensure that there was equitable access to vaccines. 

“Vaccine doses have arrived in West Africa and Asia, with many more countries to follow in the coming days and weeks,” said Fore, whose organization is overseeing the logistics.

“We’ve now seen Africa’s first vaccinations with COVAX doses in Ghana and Ivory Coast, in truly moving ceremonies in both countries yesterday. 

“But what took place on Monday is more than a feel-good story that speaks to our collective best natures. It is a necessary first step that speaks to our collective interests. 

“The only way out of this pandemic is to ensure that vaccination is available across the globe and that people from less wealthy countries are not left behind in the race to be protected,” said Fore.

She revealed that at least 20 countries could expect to receive hundreds of thousands of doses this week.

“Only today, we have five shipments including to Democratic Republic of Congo, Angola, Nigeria where we are delivering COVID-19 vaccines with consolidated syringes and routine vaccinations, ensuring that children are also protected among many other countries,” Fore said.

Nigeria alone received nearly four million doses. 

Fore said that the arrival of the vaccines represented hope particularly for children as “their access to education, health and protection services has been severely disrupted by the pandemic”.

Multilateralism key to fighting Covid-19
Ghaanian President Nana Akufo-Addo gets vaccinated against COVID-19 on Monday, 1 March, with the first COVAX vaccine to be distributed in the world.

Also addressing the briefing, Ghanaian president Nana Akufo-Addo, who was vaccinated on Monday, said that Africa needed to develop the capacity to produce vaccines “to facilitate easy and affordable access”.

 Maria Flaschbarth, Parliamentary State Secretary to the German Minister for Economic Cooperation and Development, described COVAX as an indication of the strength of multilateralism and working together to achieve a common goal.

“What we are witnessing here is the strength of multilateralism. We have seen what can be achieved when all actors work together. The public sector, scientific community, economic actors as well as civil society. We will defeat COVID-19 everywhere or nowhere. No one is safe until everyone is safe. The current mutations show this simple fact very clearly,” Flaschbarth said.

Flaschbarth further indicated that the current financing gap of the Access to COVID-19 Tools (ACT) Accelerator which includes COVAX, was over US$22 billion for 2021 alone. 

“To close this gap, it will be necessary to widen the donor base by further sustainable contribution of other public donors as well as the private sector,” she said. “Therefore, Germany very much welcomes the leadership of the current G7 and G20 presidencies putting equitable access to Covid-19 vaccines, therapeutics and diagnostics on the international agenda. This will be very helpful to mobilise more funding for the global medical answer to the Covid-19 pandemic.” 

Africa Centre for Disease Control (CDC) director John Nkengasong also said COVAX was beginning to show the power of global cooperation and the victory of “multilateralism versus protectionism”.

Nkengasong added that the African Union Commission will host a meeting on 12 April “to develop a roadmap and a framework that will enable Africa to begin to address with specifics, the key milestones to begin to manufacture vaccines on the continent”.

“All of this speaks to the need for our own ability to stand up and say that we as a people of 1,2 billion people will continue to invest in our health security and economic security that increasingly is being threatened by COVID-19,” Nkengasong said.

Vaccines to Address Virus Variants

CEPI chief executive officer Richard Hatchett said while the world was making progress in curbing COVID-19 through COVAX, there was a need for the more sophisticated vaccines to deal with emerging variants.

“In parallel to the global rollout of vaccines, we must now double our R&D efforts so that we have the tools we need for the emerging type of variant of Covid-19 as rapidly as possible,” Hatchett said.

“CEPI will continue to invest in R&D for vaccines that can be made available to COVAX to support the adaptation of existing vaccines and to initiate the development of new vaccines specifically targeted at the new variants” Hatchett said. 

 

Angela Merkel, Chancellor of Germany, at the European Council’s virtual meeting on Thursday.

Leaders of the 27 European Union member states are moving closer to a consensus on an EU-wide system of vaccine certificates for travel between countries in the bloc. Within three months a system will be introduced, EU officials announced on Thursday, the first day of the two-day virtual summit of the European Council.

Several EU member states that rely heavily on tourism believe that a system of digital vaccine passports or certificates could revitalize air travel and ease the pressure on economies. Many, including Greece, Spain and Italy, are urging other countries to support a common European approach.

“Of course more work needs to be done on digitalization and on cooperation with the World Health Organization, but we felt tonight more and more convergence among us about this important topic,” said Charles Michel, President of the European Council, at a press conference on Thursday. “The European Council will resolve this matter.”

WHO has been reluctant to move forward on creating an international framework for vaccine passports so far, until it becomes clear that vaccination inhibits COVID-19 transmission and vaccines become more available globally – beyond the high-income countries that currently dominate in the number of doses administered. 

WHO officials have made clear, however, that requiring proof of vaccination could be a good idea in the future – and based on an existing clause allowing for countries to demand proof of yellow fever vaccination – embedded in the WHO International Health Regulations. 

Hesitancy From Some EU Leaders Won’t Stop Plans To Establish An EU-Wide System

The leaders of France, Germany, and Belgium have, however, expressed concerns that more evidence on vaccines inhibiting SARS-CoV2 transmission needs to be amassed before such a system is put in place. 

“First, it must actually be clearly resolved that vaccinated people are no longer infectious,” Angela Merkel, Chancellor of Germany, told the Frankfurter Allgemeine Zeitung. 

However, “we all agree that we need [a digital vaccination certificate],” Merkel said at a press conference Thursday following the virtual meeting. 

Angela Merkel, Chancellor of Germany, at a press conference following the meeting of the European Coucil on Thursday.

Despite concerns about the current low level of vaccinations, particularly in Germany where people have been hesitat about accepting the Oxford/AstraZeneca jab, Merkel announced that the EU member states will have developed digital vaccine certificates and the technical framework required for their introduction within three months.

“That will make travel within the European Union possible by having more information,” and could open up the opportunity for third-country nationals to enter the EU, said Merkel. 

COVID-19 tests could also be part of the new system, she added.

Both political and scientific questions remain to be answered, said Ursula von der Leyen, President of the European Commission, at a press conference on Thursday. The issue of what the certificates will be used for will ultimately be decided upon at the national level.

“But at the EU level, I believe we should use them to ensure the functioning of the single market,” Von der Leyen said. 

The content of the certificates will be uniform and will contain minimal medical information. Beyond providing proof of vaccination and specifying which vaccine was administered, the  system would also allow for the certification of immunity from a previous COVID-19 infection, or a negative PCR test.

The certificates will provide individuals with a unique identifier – similar to an IBAN code. 

Each country will need to integrate this into their health systems and the European Commission will provide a “gateway for interoperability” between nations, said Von der Leyen. 

“Member states will need to move fast with the implementation if we want such a green certificate to be in place by summer,” said Von der Leyen. “Beyond bringing on the principles and the technology, they will have to ensure a quick and complete rollout in their national health systems and in their border systems.”

Ursula von der Leyen, President of the European Commission, at a press conference on Thursday.
Some European Countries and Others Already Moving Ahead with Systems 

Some EU countries already have created systems or have advanced plans for digital systems that document individuals’ vaccination status, both for the purposes of travel as well as to facilitate entrance to crowded venues or attendance of large in-person events. Many others are likely to move forward even without an EU-wide system – such as Denmark, Greece, Iceland, Hungary, and Poland.

The African Union, in partnership with the African Centers for Disease Control and Prevention (CDC), is developing a “My COVID Pass” tool to verify vaccine certificates, COVID test records and other documents, to facilitate travel across Africa. 

Thailand plans to ease restrictions for vaccinated individuals and shorten the mandatory quarantine from two weeks to three days. Lebanon is reportedly allowing those who have received the COVID-19 vaccine to be exempt from quarantine if they also take a PCR test upon arrival. 

Bahrain incorporated vaccine certificates into its “BeAware” contact tracing app, allowing authorities to scan a QR code linking to the national vaccine register.

Israel’s  “green pass” programme was launched last week –  and is intended to provide access to gyms, theatres, hotels, concerts and synagogues. Israel has also created bilateral agreements with Greece and Cyprus – and is in talks with Seychelles and Romania to establish a similar agreement – to permit the free flow of vaccinated travellers back and forth. 

However, at the country’s Ben Gurion Airport, current reality is almost the diametric opposite of any “green passport” vision. International flights have all but halted with thousands of Israelis left stranded overseas – and those wishing to return forced to submit requests to a “Exceptions” Committee – which critics say is politically stacked. The travel bottleneck has led to widespread allegations of corruption and bias in the issuing of the precious “exceptions” permits largely for ultra-Orthodox travelers and politically well-connected individvuals. And this is happening just week’s before a national election.  More fundamentally, COVID test forgeries and inconsistent quarantine enforcement also plague the system – with bureaucrats so far unable to come up with solutions for either.

Israel’s vaccination “Green Pass” that can be used to access in-person events and gatherings.
Experts Raise Scientific & Technical Questions About Vaccine Passport Plans

The experiences illustrate just a few of the technical, scientific, and ethical dilemmas yet to be faced from a region-wide or international system of vaccine certifications. 

Others include questions such as: Will two doses of the vaccine be needed? For how long will immunity – and thus the passport – be recognized?   And which vaccines would qualify? For instance, would individuals who have been vaccinated by China’s Sinopharm and Sinovac vaccines or Russia’s Sputnik V vaccine –  that have not been approved by an internationally recognized regulatory agency or the WHO have problems travelling? 

Along with those issues, experts wonder about the ability of vaccines to actually halt the transmissibility of SARS-CoV2, and the effectiveness of vaccines against the virus variants that continue to evolve and mutate, are yet to be faced.  

“If we can still get infected but remain asymptomatic, a vaccine passport may make the situation worse if it is not supported by testing and social distancing, so it may not be a real way out,” Gian Luca Burci, Professor of International Law at the Graduate Institute of International and Development Studies, told Health Policy Watch. 

“The science doesn’t support COVID Passports b/c vaccines can’t guarantee immunity,” wrote Lawrence Gostin, Professor of Global Health Law at Georgetown University, on Twitter. “Vaccines are really good, but passports are premature.”

Validation of Vaccine Status – Requires Cooperation Across Complex Systems

Beyond the scientific considerations, there are also worries about validating the certificates, preventing forgery and hacking, protecting medical privacy and assuring digital data security.

“The ability to identify an individual and validate vaccination status requires international cooperation, orchestration across complex systems and widespread adoption of open interoperability standards to support secure data access or exchange,” said a WHO statement released in early February. 

While a WHO standard does exist for providing proof of vaccination for international travellers, with the requirement of vaccination against yellow fever for entry into countries where yellow fever is endemic, implementing such a system for SARS-CoV2 would bring countless more considerations. 

International Certificate of Vaccination or Prophylaxis (ICVP) booklet. Yellow fever is the only disease in the International Health Regulations (2005) for which proof of vaccination may be required for entry to a country.

“Disease passports have rarely been tried. The only parallel is @WHO’s Yellow Fever certificates. That program is small & doesn’t face near[ly] the same logistical, scientific, legal & ethical hurdles of #COVIDVaccine Passports,” Gostin tweeted. “COVID Passports are tempting, but too many hard problems.”

Others say that the bigger challenge may very well be how to use vaccine passports domestically – outside of the travel industry.

“Being certified for being vaccinated is not a new or recent issue. If you want to travel internationally, it is expected that you have been vaccinated against some of the major diseases,” Dr. Sridhar Venkatapuram, Senior Lecturer in Global Health and Philosophy at King’s College London, told Health Policy Watch. “This seems to be like that for international travel during this pandemic.” 

“The difficult and new thing is that vaccination is not just for travel, but to carry on with daily activities like work, socializing, sports et cetera,” said Venkatapuram. “You can’t create benefits to being vaccinated if you can’t assure everyone who wants a vaccine has access.” 

Human Rights and Ethical Questions

In line with those challenges, the prospects that a system of vaccine certificates could create new forms of discrimination, exacerbate existing inequality, and even amplifying vaccine hesitancy are another source of expert concern. 

The use of vaccine passports could “create a two-speed society with potential for marginalization and demonization of the non-vaccinated,” said Burci. 

“Another criticism is that it would make vaccination practically compulsory, which is an extremely sensitive point given the widespread vaccine hesitancy and [may] even generate pushback against vaccination programmes,” Burci added. 

COVID vaccine hesitancy is widespread in many European countries, with Italy (53.7%), Poland (56.3%), and France (58.9%) having among the lowest rates of vaccine acceptance, found a study reviewing the results from 31 peer-reviewed studies on COVID-19 vaccine acceptance. Ecuador, Malaysia, Indonesia and China had the highest rates of vaccine acceptance, among members of the public, the study found – while the lowest was in Kuwait, at only 23.6%. Meanwhile, in the Democratic Republic of Congo, another study found that less than 30% of health care workers would readily take up a COVID vaccine. 

Such low rates of vaccine acceptance also could pose a challenge for the widespread implementation of vaccine certificate programmes. 

“There is distrust of vaccines and pharma companies. So certifications will make people choose between their beliefs and distrust vs the benefits of getting vaccines,” said Venkatapuram.

In addition, vaccine certificates could lead to the gathering of “data that places marginalized and stigmatized people at risk, and could create a two-tier system that jeopardizes all our human right to work and to freedom of movement,” Dr. Sara Meg Davis, Senior Researcher at the Global Health Center at the Graduate Institute of International and Development Studies, told Health Policy Watch. 

National and Global Vaccine Equity

But one of the biggest barriers to the international rollout of a vaccine passport may be the small and disproportionate numbers of people to be vaccinated so far. Only about 8% of the adult population in Europe have received jabs: 

“Do we want to confer even more privilege on people who have so much privilege? Do we want to deny people a normal life if they can’t access vaccines?” Gostin tweeted. 

Beyond national equity, global equity is another concern, with vaccination campaigns in low- and middle-income countries only beginning recently and the first COVAX delivery of vaccines taking place on Wednesday. 

“Would we prevent travel & other joys of life primarily to rich country residents, when poorer nations can’t afford vaccines – especially when rich states hoard scarce vaccines,” Gostin tweeted. 

“One can also imagine that given extremely limited quantities of vaccines, if you add further benefits to getting vaccines, then they become even more valuable and people may start to distribute them even more unfairly or unjustly,” Venkatapuram said. 

“Despite the problems, there are policy makers and others who are interested in the big picture…The suffering of disadvantages of the few will be seen as acceptable, or will be ironed out as time goes on,” said Venkatapuram. 

Under Pressure from Travel Industry 

Whatever the the issues may be, EU politicians are also under pressure to act from the airline and travel industry. Ahead of the European Council meeting, the International Air Transport Association (IATA), a trade association representing 290 airlines globally, had urged EU leaders to implement a standardised travel solution. 

The IATA has already issued its own proposal for  a digital travel pass to verify and store details of travellers’ vaccination status and COVID-19 tests, sharing the results with government authorities before entry into the country. 

An overview of the IATA Travel Pass system presented at a media briefing this week.

According to Venkatapuram, it would be technically feasible for the EU to establish a vaccine certificate system within three months, as announced by EU officials on Thursday. 

“Policies can be made quite quickly…Different countries, or groups of countries may implement them. Like the EU,” said Venkatapuram. “The airline and travel industry is likely putting a lot of pressure on governments and summer is when people will want to travel. So yes, a policy could be put in place.” 

“The policy is easy to draft and enact. [Setting up] the actual infrastructure is a different story,” he added.

Image Credits: Twitter – EU Council Press, Press Office of the Federal Government, Deutsche Welle, Twitter, WHO, IATA.

COVID-19 vaccine administered in mid January at the Jacob K. Javits Center in New York City, which has been converted into a vaccination site.

A new COVID-19 virus variant recently detected in New York is “surging alarmingly,” according to the authors of two new pre-print studies by two teams of US researchers, from Columbia University and the California Institute of Technology. 

Even worse, the new variant, dubbed B.1.526, shares some key mutations in its “spike” protein structure with several other major variants of concern – which may enhance the SARS-CoV2 virus’ ability to evade the immune system and reduce vaccine efficacy.

The studies also predict that the variant is already on its way to becoming the predominant viral variant in New York and in the broader Northeast region of the United States. 

The most recent study – published by the Columbia University team on Thursday – which tested 1,142 samples from patients at the University’s Irving Medical Center, found that those infected with the new variant were on average six years older – and more frequently hospitalized than those infected with the original strain of SARS-CoV2. 

The B.1.526 variant first emerged in November 2020 and a steady increase in the detection rate was noted in the study – with an “alarming rise” of 12.3% in the past two weeks.

Mutations Can Give Variants ‘Evolutionary Fitness Advantage’

“As mutations develop, one of those variants may have an evolutionary fitness advantage allowing it to predominate over its ancestral virus and outcompete other variants,” Stephen Morse, Professor of Epidemiology at the Mailman School of Public Health at Columbia University, told Health Policy Watch.

Notably, the new variant identified in New York contains a key mutation in its spike protein, called the E484K mutation, which is also present in the B.1.1.7 and B1.351 variants, first detected in the United Kingdom and South Africa respectively. 

This mutation has been linked to reduced activity of neutralizing antibodies; studies have thus reported lower protective efficacy of vaccines against the variants with the E484K mutation. 

E484K has emerged in at least 59 lineages of SARS-CoV2, which is evident of convergent evolution – meaning it appeared in variants that evolved independently from each other. This may signal that the mutation is advantageous for the virus. 

According to the Columbia researchers, the B.1.526 variant “could threaten the efficacy of current antibody therapies and vaccines.”

“We find the rate of detection of this new variant is going up over the past few weeks. A concern is that it might be beginning to overtake other strains, just like the UK and South African variant,” David Ho, head of the Columbia University study, told CNN. 

“However, we don’t have enough data to firm up this point now,” he added.

Another Worrying Mutation Detected By Researchers

A separate pre-print study, led by researchers at the California Institute of Technology and published on Tuesday, used a variant database to detect the same emerging B.1.526 virus variant. The study found that as of February, the variant accounted for 25% of the COVID-19 genomes sequences in the state of New York. 

Among the other mutations identified in this B.1.526 variant, the CIT researchers detected another, the S477N mutation, which occurs near the binding site of multiple antibodies and has been associated with increased viral infectivity in previous virus lineages. 

“Given the involvement of E484K or S477N, combined with the fact that the New York region has a lot of standing immunity from the spring wave, this is definitely one to watch,” Kristian Andersen, a virologist at the Scripps Research Institute in San Diego, told the New York Times. 

Basic Public Health Measures Critical To Curb Variant Evolution 

“As long as the virus continues to circulate, variants will continue to emerge, and we don’t know what future variants may do,” said Morse. “We can reduce this risk by preventing viral transmission.”

This can be done by maintaining compliance with public health measures – masks, distancing, ventilation and hand hygiene – “at very least until everyone in the world is effectively vaccinated,” Morse said. 

Several experts, including the researchers involved with the Columbia University study, agree that systematic national and global genomic surveillance is needed to detect the variants in a more coordinated and consistent manner.

The UK, where the B.1.1.7 variant is widespread, has a program to sequence 10% of its positive SARS-CoV2 samples, which has assisted with the tracking of the variant. The United States, by contrast, is sequencing less than 1% of samples.

“There are probably far more variants already out there than we know about,” said Morse. “Luckily for us, they haven’t taken over the world yet, but we really do need systematic and meaningful global genomic surveillance.” 

Image Credits: Flickr – New York National Guard, Flickr – Metropolitan Transport Authority.

Mariângela Simão WHO Assistant Director-General on access to medicines

WHO Director General Dr Tedros Adhanom Gheyebresus on Friday issued his strongest call to date for a waiver on intellectual property related to COVID vaccines, medicines and other health products – which is due to be considered next week by the World Trade Organization’s General Council.

While welcoming a new UN Security Council resolution also approved on Friday, which calls for broader access to COVID vaccines in conflict zones and poor countries, Dr Tedros stressed that the UN resolution needed to be accompanied by concrete global actions of the kind that the WTO was positioned to take – by relaxing rules that restrict the generic manufacture and trade in patented COVID vaccines and health products. 

“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.

“Voting for vaccine equity is important and we appreciate that. But concrete steps should be taken to waive intellectual property to increase production, increase coverage of immunisation and get rid of this virus as soon as possible.”

Referring to joint South African/India proposed TRIPS [Trade-Related aspects of Intellectual Property Rights] waiver to be discussed at the WTO, Tedros said that the pandemic was a “once-in-100-years occurrence”, so if the waiver “can’t be used now, when will it be used?”

The UN Security Council resolution, which was passed unanimously, calls for “the strengthening of national and multilateral approaches and international cooperation.. to facilitate equitable and affordable access to Covid-19 vaccines in armed conflict situations, post-conflict situations and complex humanitarian emergencies.”

It also calls on developed economies to donate vaccines to low- and middle-income countries and other countries in need.

Voluntary Licenses Could Also Be Tool For Increasing Manufacturing Capacity & Tech Transfer

WHO special adviser Bruce Aylward stressed that pharma should also issue more ‘voluntary licenses’ to firms in other countries for the generic manufacture of life-saving vaccines as a means of increasing vaccine manufacturing capacity and ease supplies. .

Mariângela Simão, WHO’s Assistant Director-General for Access to Medicines & Health Products, added that the WHO-managed COVID Technology Access Pool (C-TAP) offers a way to “share technology and issue voluntary licenses”.  However, so far there have been few, if any, industry takers in the COVID patent pooling plan. 

As a result, the WHO is “very interested in the outcomes ” of the upcoming WTO discussions, said Simão, saying: “Intellectual property is always a very sensitive topic in anything that’s related to access to medicines… Countries are looking for alternatives to increase production capacity and of course, this includes how to manage the intellectual property rights.

“We welcome any movement from countries to decrease and address current barriers to access as well as barriers to access that could be seen mid- and long-term. So this is quite an important discussion.”

Nigeria expects COVAX Vaccines Next Week

Also addressing the press conference were Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control (NCDC) and Walter Kazadi Mulombo, WHO Representative in Nigeria

Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control

Nigeria, which has a population of over 200 million, has secured close to 14 million doses of AstraZeneca vaccine through COVAX, and expects 4 million of these doses to be delivered next week, according to Mulombo.

Ihekweazu said that Nigeria had chosen not to do any bilateral deals with pharma suppliers, but rather to work only in a multilateral fashion through COVAX and the African Union.

“We will prioritise our health care workers, absolutely first,” said Ihekweazu. “We’re making some very hard decisions. I think at the end of the day, the key thing is we all recognise that we can only impact on transmission and reduce the burden in our hospitals if we target the right people, initially at the right pace, and at the right distribution.”

“Everything will come into play, not only the priority population groups but geography as well.  We have a very uneven outbreak in Nigeria. Lagos State, for instance, has 40% of all the cases in Nigeria, so it wouldn’t be a surprise if they are prioritised to a certain extent. But at the same time, we need to get some vaccines to every state in Nigeria. It’s a big country and a complex country, a lot of detailed planning is going into ensuring that the vaccines get to the right people as quickly as possible, so that we can get the outbreak under control.”

 

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.