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/.

US President Joe Biden speaking at the Munich Security Conference after the closing of the private G7 meeting on Friday.

The United States is donating an additional US$2 billion to the COVAX facility over the next two years to facilitate the equitable distribution of COVID-19 vaccines to low- and middle-income countries, while the pharma company Novavax will provide a total of 1.1 billion doses of its vaccine to COVAX – a gesture that could increase the available vaccine supplies for the global facility by one-third for 2021.

The commitment by the US was met by an EU announcement that it would be doubling its COVAX funding, adding an additional €500 million and bringing its total contribution to €1 billion. Germany pledged an additional US$1.8 billion to the Access to COVID-19 Tools (ACT) Accelerator, the majority of which will go towards COVAX, the vaccine platform. Japan committed US$79 million to COVAX as well as Unitaid, and Canada  pledged US$59 million. 

The commitments bring the total funding for the ACT Accelerator to US$10.3 billion, leaving a funding gap of US$22.9 billion for 2021 to fully fund the Accelerator’s work.

In addition, the UK and France commited to share some of their surplus doses with low-and middle-income countries after a report that rich countries have stockpiled at least 1 billion vaccine doses more than they need to immunize all of their citizens.

Rush of Pledges Coincides With G-7 Meeting

The rush of new pledges coincided with Friday’s meeting of the Group of 7 (G-7) most industrialised countries, currently led by the United Kingdom, and including the US, Canada, France, Germany, Italy and Japan. 

After its meeting on Friday, the G7 leaders released a statement resolving to cooperate to: “accelerate global vaccine development and deployment; work with industry to increase manufacturing capacity, including through voluntary licensing; improve information sharing, such as on sequencing new variants; and, promote transparent and responsible practices, and vaccine confidence.”

These commitments come amid criticisms that wealthy nations are hoarding vaccines through bilateral deals and purchasing more doses than is needed to inoculate their populations.

In an address to the UN Security Council on Wednesday, UN Secretary-General António Guterres revealed that 10 countries have administered 75% of all COVID-19 vaccines, while over 130 countries have not received a single dose, and less than 1% of doses have been administered in the 32 countries facing severe humanitarian crises.

Guterres called the current global vaccine rollout “wildly uneven and unfair” and urged the G7 to create momentum to mobilise the necessary financial resources.

Team Europe Pledges European Efforts Will Have Global Impacts 

“With this new financial boost we want to make sure vaccines are soon delivered to low and middle-income countries,” said Ursula von der Leyen, President of the European Commission, in a press release Friday. “Because we will only be safe if the whole world is safe.”

“Vaccines produced in Europe are now going all over the world and we, as Team Europe, are working to share doses secured under our advanced purchase agreements preferably through COVAX with the Western Balkans, Neighborhood and Africa – benefiting above all health workers and humanitarian needs,” said Stella Kyriakides, Commissioner for Health and Food Safety. 

The WHO welcomed the new financial commitments from the US, France, Germany, UK and EU to COVAX, which it described as the mechanism “best positioned to deliver vaccines to the world and end the COVID-19 pandemic.” 

“There is a growing movement behind vaccine equity and I welcome that world leaders are stepping up to the challenge by making new commitments to effectively end this pandemic by sharing doses and increasing funds to COVAX,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, in a press release. 

“There is an urgent need for countries to share doses and technology, scale up manufacturing and ensure that there is a sustainable supply of vaccines so that everyone, everywhere can receive a vaccine,” Tedros added. 

Novavax Commitment to COVAX

Meanwhile, Novavax also announced that the company had it signed a Memorandum of Understanding (MoU) with Gavi, The Vaccine Alliance, to provide COVAX with 1.1 billion cumulative doses of its vaccine candidate. 

The agreement includes the Serum Institute of India, which has a partnership with Novavax to manufacture the vaccine and ensure the broad and equitable distribution of the vaccine in low- and middle-income countries. 

Gavi had earlier signed an agreement with the Serum Institute to supply COVAX with 100 million doses of the Novavax vaccine, forecasted for delivery in the second quarter of 2021. Gavi and Novavax now currently working to finalise an advance purchase agreement on the new commitment of 1.1 billion doses for COVAX. 

COVAX’s preliminary forecast of COVID-19 vaccines for 2021 and 2022, as of 20 January – and prior to the recent agreement with Novavax.

“We are proud to partner with all the COVAX collaborators and Serum Institute of India to provide global public health leadership and ensure that all countries have broad access to NVX-CoV2373,” said Stanley C. Erck, CEO of Novavax, in a press release. “Novavax will play a critical role in the worldwide effort to provide access to safe and effective vaccines to end the pandemic.”

The vaccine candidate is “poised to play a significant role in combating COVID-19 around the world,” said Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations (CEPI). 

“This agreement brings the COVAX Facility one step closer to its goal of supplying vaccines globally and ending the acute phase of the pandemic,” said Seth Berkley, CEO of the global vaccine alliance, Gavi, in a press release. “It helps us close in on our goal of delivering two billion doses in 2021 and increases the range of vaccines available to us as we build a portfolio suitable for all settings and contexts.” 

While the Novavax vaccine has not yet received regulatory or WHO approval, the vaccine demonstrated an efficacy rate of 89.3% two pivotal Phase 3 trials, including a trial in the United Kingdom where the B.117 variant has become dominant, and efficacy of 95.6 % against the original virus strain. A Phase 2b trial in South Africa demonstrated up to 60 percent efficacy against newly emerging escape variants there.    

The company’s NVX-CoV2373 vaccine is based upon a recombinant nanoparticle technology that generates antigens derived from the coronavirus spike (S) protein and is adjuvanted with Novavax’ patented saponin-based Matrix-M™ to enhance the immune response and stimulate high levels of neutralizing antibodies.i  The antigen can neither replicate, nor can it cause COVID-19. In preclinical studies, NVX-CoV2373 induced antibodies that block binding of spike protein to cellular receptors and provided protection from infection and disease. It was generally well-tolerated and elicited robust antibody response numerically superior to that seen in human convalescent sera in Phase 1 trials.

UK and France Also Make Pledges to Share Extra Doses

The UK and France also announced significant new plans to share vaccines to ensure a more equitable distribution of COVID-19 vaccines worldwide. 

Their pledges came in the wake of a report published on Friday by ONE, an organisation campaigning to end poverty, that rich countries have stockpiled one billion more doses than they need to vaccinate their own populations. 

According to ONE, Australia, Canada, Japan, the UK, and the US, along with the 27 EU member states could donate one billion doses of vaccines and still have enough doses to inoculate their entire populations. 

While some countries have expanded on their previous financial commitments to COVAX, the UK announced that it will send the majority of its future surplus vaccines to COVAX and encouraged other member states to follow suit. 

“As leaders of the G7 we must say today: never again” to the COVID-19 pandemic, said UK Prime Minister Boris Johnson in a statement released on Friday. 

“By harnessing our collective ingenuity, we can ensure we have the vaccines, treatments and tests to be battle-ready for future health threats, as we beat COVID-19 and build back better together,” he added.

In addition to a commitment to share vaccines, Johnson revealed an ambitious plan to reduce the time to develop vaccines for new diseases by two-thirds, aiming to achieve new vaccines in 100 days instead of the unprecedented 300 days it took to develop COVID-19 vaccines.

Vaccine-sharing was supported by Emmanuel Macron, France’s President, who urged Europe and the US to allocate up to 5% of their vaccine supplies to low- and middle-income countries, particularly to countries in Africa, in order to play a greater role in the diplomatic vaccine battle. 

“We are allowing the idea to take hold that hundreds of millions of vaccines are being given in rich countries and that we are not starting in poor countries,” said Macron in an interview with the Financial Times on Thursday. “That idea is unsustainable.”

“It’s an unprecedented acceleration of global inequality and it’s politically unsustainable too because it’s paving the way for a war of influence over vaccines,” Macron said. “You can see the Chinese strategy, and the Russian strategy too,” referring to moves from China and Russia to use their vaccines to buy influence in low- and middle-income countries. 

Emmanuel Macron, President of France, at the Munich Security Conference on Friday.

Doses of China’s Sinopharm and Sinovac vaccines have been donated to Zimbabwe, Brunei, Laos, the Philippines, and Cambodia, among others, while Russia has offered the African Union (AU) 300 million doses of the Sputnik V vaccine, along with a financing package for the 55 members of the AU. 

According to Macron, transferring “3-5 percent of the vaccines we have in stock to Africa” wouldn’t delay domestic inoculation programmes “by a single day.” 

Macron’s comments were praised by WHO officials on Thursday, with Bruce Aylward, senior advisor to WHO’s Director-General, calling this a “fantastic development.” 

Aylward appealed to member states to avoid making special vaccine-sharing arrangements outside of COVAX, which is “the best mechanism and the only global mechanism set up” to ensure the equitable allocation of vaccines. 

“We are encouraging that in the interest of equity and the most equitable distribution possible, those doses go through the COVAX facility, because that way we can coordinate across a massive number of countries and ensure everyone is getting served,” said Aylward at a press briefing on Thursday.

US Staged Rollout Of Donations 

“Today, I’m announcing the United States is making a $2 billion pledge to COVAX with the promise of an additional $2 billion to urge others to step up as well,” said President Biden at the Munich Security Conference on Friday, which was held hours after the G7 meeting ended.

The first US$500 million will be made available when the initial COVAX doses begin to be delivered to 92 low- and middle-income countries eligible for donor-supported vaccine distribution through Gavi, The Vaccine Alliance’s Advance Market Commitment (AMC) platform. 

Another US$1.5 billion will be donated in 2021 and the remaining US$2 billion by the end of 2022. In total, the US will provide COVAX with US$4 billion in funding. 

The majority of the funds will support direct vaccine procurement, while some funds will be invested in improving country readiness and vaccine service delivery. 

“The goal is clear: vaccinate vulnerable populations, and reach those without other options,” said a White House statement released ahead of the meeting, which marks new US President Joe Biden’s first major multilateral engagement. 

Following the announcement, both Seth Berkley and Dr Tedros expressed their thanks to President Biden, with Tedros explaining at the Munich Security Conference that the importance is “not the funding. The US is the major funder of WHO…[but] it’s not the money. It’s the global leadership of the US, its global role is key.”

This pledge was also intended to encourage other G7 members to increase their contributions.

“We want to turn this into a way to translate $2 billion into several billion dollars, up to at least $15 billion,” a White House official told Reuters. 

“We also call on our G7 and other partners to work alongside Gavi, to bring in billions more in resources to support global COVID-19 vaccinations, and to target urgent vaccine manufacturing, supply, and delivery needs,” said the statement released on Thursday. 

“This funding from the Administration will enable Gavi to address urgent needs, while also supporting efforts to diversify and increase contributions from other donors in 2021,” the statement concluded.

Image Credits: Munich Security Conference, Gavi.

Rwanda started vaccinating health workers against COVID-19 on Monday, but there is confusion about which vaccine it is using or where it has got it from.

A local media report said that the Moderna vaccine was being used while the BBC reported that the Pfizer/ BioNtech vaccine was being used. Meanwhile, a source told Health Policy Watch it was the AstraZeneca/ Oxford vaccine. The Rwanda health ministry did not respond to Health Policy Watch queries. 

The official announcement from the health ministry on Twitter simply said that “international partnerships” had made the vaccination drive possible.

According to the Rwandan government, the past week was simply a trial run before a more extensive vaccination rollout in two weeks time with the AstraZeneca/Oxford vaccine from the COVAX facility.

Although the source of the initial vaccines has not been confirmed by their government, the World Health Organization (WHO) Africa office said that Rwanda would have acquired these through bilateral arrangements as the COVAX vaccines will only arrive later in the month. 

Dr. Phionah Atuhebwe, a vaccinologist and the new vaccines introduction medical officer at WHO Africa office, told Health Policy Watch on Tuesday that COVAX had to wait for the WHO decision on an emergency use listing of AstraZeneca before it could dispatch the vaccines. This was granted on Monday.

AstraZeneca Due to Arrive Very Soon

Atuhebwe said most African countries participating in the COVAX initiative would receive their AstraZeneca doses in the next two weeks.

According to the COVAX Interim Distribution Forecast published early February, Rwanda will receive 996,000 AstraZeneca and 102,960 Pfizer/ BioNtech vaccine doses.

The WHO Africa office said national regulatory authorities are not compelled to inform WHO of the products they received, but given the unprecedented nature of COVID-19 the office was offering technical support and guidance to ensure the quality, safety and efficacy of products used.

In an interview on CNN this week, Rwandan president Paul Kagame said “We will take any vaccines that come that we are told work.”

Rwandan President Paul Kagame interviewed on CNN

In media reports, Rwanda said it will spend $124million to ensure vaccination coverage of at least 60% of its population. 

Aside from bilateral agreements and COVAX, African countries will also get vaccines from the African Union platform, the African Vaccine Acquisition Task Team (AVATT). AVATT has secured a provisional 270 million COVID-19 vaccine doses from Pfizer, Johnson & Johnson and AstraZeneca.

COVAX also anticipates that, via an existing agreement with AstraZeneca, at least 50 million further doses of the AstraZeneca/Oxford vaccine will be available for delivery to COVAX participants in the first quarter.

A few countries in Africa have started COVID-19 limited vaccination drives, mainly for health workers including Mauritius, Guinea, South Africa, Seychelles, Morocco, Algeria and now Rwanda.

Pfizer-BioNTech Vaccine Due Soon But Has Stringent Requirements

Rwanda is one of only four African countries, together with Cabo Verde, South Africa and Tunisia , to have been approved by COVAX to receive the Pfizer/ BioNTech vaccine, which needs to be stored at minus 70C.

According to sources, Pfizer has made access requirements stringent which has made it difficult for some African countries to apply for this vaccine. Aside from the ultra-cold storage, Pfizer has a list of legal requirements including indemnification, liability and compensation for countries that receive its vaccine.

Rwanda is scheduled to get 102,960 doses while South Africa will get 117,000, Tunisia 93,600 and Cabo Verde, 5,850, according to the COVAX Interim Distribution Forecast.

WHO’s Atuhebwe said this vaccine was expected to arrive within the next week. Meanwhile, Hassan Sibomana, the director of the vaccination unit at Rwanda Biomedical Centre (RBC), said the initial challenge of lack of capacity to store vaccines at minus 70 Celsius (minus 158 Fahrenheit) has been addressed.

Five new ultra-cold freezers worth around USD$50,000 have been purchased and the ministry has a capacity to store about 300,000 vaccine doses, Sibomana told the local media, underlining that vaccine safety is their priority to avoid any side effects on people.

Rwanda’s new cold storage facility

However, Pfizer submitted evidence to the US Food and Drug Authority this week showing that its vaccine could be stored at around minus 25 Celcius to minus 15 C, according to a company media release.

“It has been possible to procure some of the Pfizer-BioNTech vaccine for a number of African countries not very extensively, however, it will give us the experience of using this vaccine,” said Matshidiso Moeti, the Regional Director of the WHO Africa Office.

Moeti said WHO is working very hard with African countries to finalise their plans for the distribution and delivery of the vaccine and about 34 of the countries on the continent already have their plans ready. A significant roll out of the vaccines in Africa is expected by March this year.  

“I would like to encourage everyone who has the opportunity when your turn comes in your countries, to be willing to be vaccinated because it’s not only in your own interest in the interest of your immediate family, but also in the interest of the country and in the interest of the continent,” said Moeti.

At the WHO Africa press conference last week, Peter Piot, the director of the London School of Hygiene and Tropical Medicine, told reporters that having access to vaccines in Africa, is not only a moral issue but a matter of solidarity.

“This is going to become one of the big geopolitical issues of our time – access to vaccination. There, there are contracts through COVAX, the African Union and others. However, manufacturing is lagging behind. And scarcity is a big enemy of equity. So we need to really invest more in manufacturing, including in manufacturing that can happen in Africa.”

 

Air pollution has been linked to the deaths of 160,000 people in the world’s five biggest cities in 2020, according a global report by Greenpeace Southeast Asia and IQAir, the world’s largest free air quality information platform.

Of the five biggest cities, Delhi had the most deaths (54,000) due to PM2.5 air pollution in 2020 – one death per 500 people. It was followed by Tokyo (40,000) and Shanghai (39,000). Sao Paulo and Mexico City had an estimated 15,000 each. 

Greenpeace and IQAir collaborated on the ‘cost of air pollution estimator’ for 26 cities, drawing on data from over 80,000 air sensors in IQAir’s air quality database. 

The Cost Estimator is based on a methodology developed by the Centre for Research on Energy and Clean Air. The IQAir platform measures ground-level particulate matter (PM2.5) in real time and this data is then combined with a city’s population, health data, and scientific risk models to determine mortality and cost estimates.

The report estimates that Tokyo (USD$43 billion lost), Los Angeles (USD$43 billion) and  New York (USD$25 million) have paid the highest economic cost for air pollution in the past year.

“When governments choose coal, oil and gas over clean energy, it’s our health that pays the price. Air pollution from burning fossil fuels increases our likelihood of dying from cancer or stroke, suffering asthma attacks and of experiencing severe COVID-19. We can’t afford to keep breathing dirty air when the solutions to air pollution are widely available and affordable,” said Avinash Chanchal, climate campaigner at Greenpeace India.  

“Breathing should not be deadly,” said Frank Hammes, CEO of IQAir. “Governments, corporations and individuals must do more to eliminate the sources of air pollution and make our cities better places to live.”

Developing Countries Worst Affected

Air pollution kills an estimated seven million every year, according to the World Health Organization (WHO). Those in the developing world are disproportionately affected with 9 out of 10 people breathing air whose quality exceeds WHO guideline limits. 

Air pollution also leads to increased morbidity and healthcare costs due to disability, asthma and chronic respiratory diseases. These translate into lost income for family members and their caregivers, as well as lower economic productivity.

This was also reflected in the report which found that two cities in India lost over one-tenth of their GDP due to air pollution in 2020. Lucknow lost 14% of its GDP, followed by Delhi at 13%.

The Indo-Gangetic plain in northern India is one of the world’s worst affected regions due to air pollution. Recent evidence has linked air pollution to miscarriages and stillbirths in the region as well. 

“In most parts of the world it is now cheaper to build clean energy infrastructure than to continue investing in polluting fossil fuels, even before taking the cost of air pollution and climate change into account,” said Bondan Andriyanu, campaigner at Greenpeace Indonesia. 

“As governments look to recover from the economic impact of COVID, they must create green jobs, build accessible, clean-energy powered public transport systems and invest in renewable energy sources like wind and solar.”

 

Image Credits: Rashed Shumon.

New Ebola vaccines hold promise to curb various virus strains (Credit: WHO)

The World Health Organization is set to deploy over 100 experts to Guinea – to respond to a widening circle of Ebola virus cases in a country that was also at the epicenter of the historic 2013-2016 West African Ebola outbreak, officials said at twin press events in Brazzaville and Geneva on Thursday.     

As critical new vaccines are being rushed to the region, there is a growing concern about transmission abroad, said Health Emergencies Executive Director Mike Ryan at a WHO press conference in Geneva.  He noted that Guinea’s initial cluster of cases has occurred in proximity to Nzérékoré, the country’s second-largest city, at the crossroads of routes to Liberia, Côte d’Ivoire, and elsewhere. 

“Remember that these governments are currently responding to COVID-19 outbreaks in their own countries, while having to either respond to Ebola, or prepare for the potential arrival of Ebola,” said Ryan. 

WHO African Region Sounding Alarm 

Speaking at another press briefing in Brazzaville, WHO’s African Regional Director sounded an even greater note of alarm.  

“It’s a huge concern to see the resurgence of Ebola in Guinea, a country which has already suffered so much from the disease,” said Dr Matshidiso Moeti, WHO Regional Director for Africa at the briefing.

However, banking on the expertise and experience built during the previous outbreak, health teams in Guinea are on the move to quickly trace the path of the virus and curb further infections,” she added, saying that “WHO is supporting the authorities to set up testing, contact-tracing and treatment structures and to bring the overall response to full speed.”

WHO staff are already on the ground at Guinea, providing surveillance as well as ramping up infection, prevention, and control of health facilities. A humanitarian flight arrived on 15 February in N’Zerekore with 700 kg of medical equipment donated by WHO and partners. 

The country is also grappling with a surge of COVID-19 cases. On Feb 14 when the new Ebola outbreak in Guinea was announced, the country had also reported 72 new cases of COVID-19.  As of Thursdsay, the cumulative number of confirmed COVID-19 cases in Guinea had risen to 15,088 with a total of 85 deaths.

Using the glass half full or empty analogy, Moeti noted that Guinean response to COVID-19 and Ebola at the same time could be mutually reinforcing – building on already established guidelines and good practices, particularly around coordination, engaging with communities and leadership. 

“That also comes from preventive measures like physical distancing for COVID-19 and ‘don’t touch’ messages for Ebola, as well as the importance of hand hygiene for both,” she said. 

Rapid Ebola Vaccines Rollout – The Keys To Fast Containment 

House in Equateur Province gets disinfected following discovery of confirmed Ebola case there in August, 2020. Along with the outbreak in Guinea, another new DRC cluster has now emerged in Butembo.

But like with COVID-19, vaccination will provide an even more durable response. A consignment of more than 11,000 doses of Ebola vaccine was expected to arrive in Guinea this weekend. In addition, more than 8,500 doses are being shipped from the United States for a total of 20,000 doses. Vaccination is set to kick off soon after they arrive. 

Some 4,000 kilometers away, another Ebola accination drive was just launched in the city of Butembo, Democratic Republic of Congo, on 15 February – shortly after another Ebola virus outbreak was detected in there on 7 February involving four cases and two deaths so far, according to WHO’s African Regional Office. 

But unlike Guinea, DR Congo did not have to wait for Ebola vaccines from Geneva or the US as it had 8,000 doses remaining from an Ebola outbreak last year, and thus was immediately able to commence immunizations.  

“So far nearly 70 people have been vaccinated against Ebola.  The quick roll-out of vaccines is a testament to the enormous local capacity built in the previous outbreaks by the government, WHO and partners,” Moeti said.

As a new and powerful Ebola control tool in both the Guinea and DR Congo response, WHO is simultaneously trying to step up procurement and rollout of a recently-approved Ebola vaccine through a new global vaccine stockpile. The vaccine was instrumental in finally stamping out a much larger 2018-2019 Ebola outbreak in the eastern part of the Democratic Republic of Congo. 

The single-dose Ebola vaccine (rVSV∆G-ZEBOV-GP, live), manufactured by Merck, Sharp & Dohme (MSD), received emergency regulatory approval from the US Food and Drug Administration in 2019. In addition, Johnson & Johnson also received European Medicines Agency approval last year for its Ebola vaccine, a two-dose regimen of Zabdeno® (Ad26.ZEBOV) and Mvabea® (MVA-BN-Filo).

“The ultimate endpoint for this is a multi-valent vaccine capable of protecting against multiple Ebola strains,” said Ryan at the briefing.  The precise Ebola virus strain responsible for the Guinea outbreak has not yet been determined.   

The WHO, UNICEF, International Federation of Red Cross and Red Crescent Societies (IFRC) and Médecins Sans Frontières (MSF) announced in January the establishment of a global Ebola vaccine stockpile to ensure rapid response to future outbreaks. 

In his remarks in Geneva, Ryan lauded both Merck and Johnson & Johnson for pushing ahead with the R&D on the vaccines – as well as seeing to their production at cost. 

“These measures have been implemented to protect vulnerable populations,” said Ryan, adding that people at risk include “not just healthcare workers, but “occupational workers, charcoal workers, and people who work in the rainforest” – groups that might also have contact with animals carrying the Ebola virus.  

“This is really the holy grail of Ebola is to have those countermeasures in place, and not just be responding to outbreaks, but preventing the recurrence by the pre-emptive practical use of vaccination, which is always the best way to use vaccines.”

Rapid Response in Guinea – Result of Hard Experience in 2013-16 West African Outbreak

WHO has released some US$ 1.25 million to support the response in Guinea and to shore-up readiness in six neighbouring countries.

“Within the epicentre of the outbreak in a border area, the sub-region is on high alert and authorities are reinforcing public health measures, including surveillance, to quickly respond to possible cross-border infections,” Moeti said.

In other aspects of the response, Guinea’s Ministry of Health has activated national district and emergency management committees, and have advised the public to take measures to avert the spread of the disease, and to report any persons with symptoms to seek care. 

The ongoing, rapid response in Guinea and preparedness in neighboring countries is a result of the experience gained during the 2013-2016 outbreak in West Africa. 

The Ministry of Health of Guinea first reported to WHO about a cluster of Ebola Virus Disease (EVD) cases on 14 February, in the sub-prefecture of Gouécké, Nzérékoré Region, Guinea. 

Patient Zero was a nurse who originally presented at a health center in the region on 18 January 2021 with symptoms of headache, physical weakness, nausea, vomiting, loss of appetite, abdominal pain, and fever.

She was diagnosed with malaria.  On 24 January, she consulted with a traditional practitioner in Nzérékoré, and died four days later on 28 January. She was buried unsafely on 1 February in Gouécké, a town in the Nzérékoré Prefecture of Guinea. 

The other six known cases are her five family members and a traditional practitioner that she first visited for treatment. Of these seven reported cases, five people have already  died. The other two confirmed cases are currently in isolation in dedicated health facilities in the Conakry and Gouécké, Nzérékoré region.

As of 15 February, some 192 contacts of the nurse had been identified, including in N’Zérékoré Health District and 28 in Ratoma Health District, Conakry. To date, none of these contacts have reported traveling to neighboring countries. 

The Ebola virus strain responsible for the Guinea outbreak has not yet been determined. 

 

Image Credits: Trocaire/Flickr, Twitter: @WHO, WHO.