A Canadian pharmaceutical company, Biolyse, has agreed to provide Bolivia with 15 million doses of the Johnson & Johnson COVID-19 vaccine – as long as the Canadian government gives it a compulsory license to manufacture the vaccine.

In March, Johnson & Johnson rejected an application by Biolyse for a voluntary license to make a generic version of its vaccine. 

Biolyse is now seeking a compulsory license in terms of Canada’s Access to Medicines Regime (CAMR) in order to supply vaccines to Bolivia, which has only managed to vaccinate around 5% of its population.

But for this to succeed, the COVID-19 vaccine will have to be listed in Schedule 1 of the Canadian Patent Act as only medical products listed there are eligible for compulsory licenses in terms of CAMR.

“Although Schedule 1 can be amended to include additional products, Canadian authorities have refused to tell KEI and Biolyse whether COVID-19 vaccines will be added to the list or what the estimated time frame is for that amendment to take place,” said non-profit organisation Knowledge Ecology International (KEI), which has been advising the company on its compulsory license application.

Canada ‘Stonewalls’ Legitimate Attempt

According to KEI, Canada has claimed at the World Trade Organization (WTO) that existing TRIPS flexibilities are working “as intended,” and asked those in favour of a TRIPS waiver for “concrete” evidence of patent-related challenges in procuring COVID-19 goods.

“If Canada fails to expeditiously allow Bolivia to import vaccines manufactured by Biolyse under a compulsory license, they would be directly contradicting their own statements at the WTO,” said KEI.

“Canada cannot continue to claim that article 31bis of the TRIPS agreement and the CAMR function ‘as intended’ while it stonewalls a legitimate attempt to use this mechanism,” it added.

Biolyse has agreed to sell vaccines to Bolivia at an estimated manufacturing cost of $3 to $4 a dose.

Meanwhile, COVID-19 cases are rising in Bolivia, which has a population of almost 12 million people and around 43,000 official cases of COVID-19 and 13,228 deaths.

Bolivia’s daily COVID-19 cases

 

Image Credits: Johnson & Johnson.

 

Geneva Global Health Hub panel debates a proposal for a global pandemic treaty – to be put before WHO member states next week.

The draft of a landmark resolution to establish a global “Pandemic Treaty” will be put to World Health Organization (WHO) member states this week in preparation for the World Health Assembly beginning 24 May,  Jaouad Mahjour, WHO Assistant Director-General Emergency Preparedness, told a panel in Geneva Monday.

The proposal for the Pandemic Treaty – which aims to tighten global rules around disease outbreak response so that countries react rapidly and more transparently, was first tabled by WHO Director General Dr Tedros Adhanom Ghebreyesus in January.  It has garnered the support of some 25 global leaders ranging from President of the European Council Charles Michel, to Germany’s Angela Merkel, Prime Minister JV Bainimarama of Fiji; UK Prime Minister Boris Johnson and South African President Cyril Ramaphosa.

The concept has met with resistance in some quarters, as well – notably the United States has not yet signed onto the idea. And some civil society voices have said that absent of political will, a treaty would not necessarily have more clout than existing International Health Regulations governing emergencies.

However, the countries now pushing for the treaty represent every region of the WHO, and range from superpowers to small island states, Mahjour told a panel convened by the Geneva Global Health Hub (G2H2), saying that the time for a treaty is ripe

The countries pushing for a “legally binding international framework” see this as the only way to deal with the magnitude and impact of the pandemic, he underlined. And there are some fundamental principles that have garnered wide agreement already:

“The first issue [is] that everybody agrees on is national preparedness. The world cannot be safe if only one country is not prepared,” said Mahjour. 

The second issue [is] mechanisms to ensure global preparedness, including supply chains that can provide all countries with goods and control measures; an early pandemic warning and alert system lead by WHO and including those involved in animal health; and accelerating research, innovation and development.

Not Everyone is Convinced

However, other panelists appearing at the session were less convinced that a treaty would add value to existing IHR rules, which are already binding on member states. 

Panel moderator Nicolette Dentico, director of global health at the Society for International Development as well as G2H2 co-president, asked why a new treaty would be effective when the COVID-19 pandemic had shown that member states “are not capable of actually abiding by those binding norms that have been already negotiated, established and agreed upon” in 2005, namely the International Health Regulations. 

“So why should we create another tool? Shouldn’t we work on the legally binding instrument that exists already instead of creating a new one?” she asked.

Treaty Needs to be Based on Human Rights

Meanwhile, an influential group of activists and academics writing in the BMJ on Monday, said that a pandemic treaty, if adopted, needs to be “based on human rights”.

“Those in charge of drafting the treaty must begin with a clear look at the grave abuses that have characterised the COVID-19 pandemic: authoritarian power grabs; continuing monopolies in diagnostics, therapeutics, and vaccines; failure to resource health systems; staggering setbacks for women; and an upsurge in violence, including covid-related hate crimes,” wrote Meg Davis, senior researcher at the Geneva Global Health Centre and 21 others.

“States have all-too-easily sidelined the international human rights framework under cover of emergency responses,” they added, calling for such a treaty to address a range of key issues including the right to health, the decriminalisation of infections, workers’ rights, and gender inequalities.

One panelist at Monday’s event, echoed those sentiments.  Ana María Suárez Franco, director of the food security network, FIAN International, based in Honduras, said that any pandemic treaty needs to be aligned with UN Human Rights Council principles, and make transnational companies legally accountable for their actions.

“A pandemic treaty has to be built from the bottom up. It needs to prevent corporate abuse,” said Franco.

To be effective, a treaty just be able to curb abuses that have occured in the current pandemic – for instance cases in which COVID-19 vaccine manufacturers had tried to force countries to sign exclusionary clauses that protected pharma companies from claims of adverse vaccine effects, and provided sovereign resources as payment guarantees – including natural resources and even embassy buildings – ahead of vaccine orders.

Concerns about the timing of the pandemic treaty negotiations and capacity of WHO to implement a vast new treaty project, are other issues that have come up, panelists said. 

Some critics have worried the “timing of these negotiations,” could divert attention, resources and personnel from addressing the current pandemic, said Priti Patnaik, editor of the Geneva Health Files newsletter.

“Some even raised the question of whether there is enough capacity within the WHO Secretariat to service the needs of treaty negotiations among member states,” she added, noting that according to European Union internal timelines, ‘the treaty has to be imposed next year”. 

Dr Tedros Adhanom Ghebreyesus, WHO Director General.

The World Health Organization (WHO) has decided to classify the B1.617 variant first identified in India as a “variant of concern”, according to Maria Van Kerkhove, WHO lead on COVID-19.

“There is some available information to suggest increased transmissibility of B1.617,” Van Kerkhove explained to the WHO’s biweekly media briefing on Monday.

In addition, a preprint (a paper that has not undergone peer review) involving a limited number of patients suggested that there is also “some reduced neutralisation” [of antibodies] and as such we are classifying it as a variant of concern”, said Van Kerkhove.

However, she stressed: “We don’t have anything to suggest that our diagnostics or therapeutics and our vaccines don’t work. This is important as we will continue to see variants of concern around the world.”

Over the weekend, India reported over 4,000 deaths in 24 hours and it is recording over 400,000 new cases every day.

WHO Chief Scientist Soumya Swaminathan added that genomic surveillance was ongoing in India and scientists were looking at transmissibility, clinical security, and the response of the B1.617 variant to antibodies generated in people who have been vaccinated with the three main vaccines being used in India – Covaxin (developed by Bharat Biotech), Covishield (AstraZeneca) and Sputnik. 

“Over the coming weeks, there’ll be much more data forthcoming,” she added.

WHO Chief Scientist Soumya Swaminathan

Cases Plateau – But at Very High Rate

WHO Director General Dr Tedros Adhanom Ghebreyesus told the briefing that global COVID-19 cases have started to “plateau” – but at an “unacceptably high” rate with more than 5.4 million new cases and almost 90,000 deaths in the past week.

“Cases and deaths are still increasing rapidly in WHO’s South East Asia region and there are countries in every region with increasing trends,” added Tedros. 

“The spread of variants, increased social mixing, the relaxation of public health and social measures and inequitable vaccination, are all driving transmission,” he added.

Condemning vaccine diplomacy as “geopolitical maneuvering”, Tedros said that only global cooperation and solidarity can end the COVID-19 pandemic.

“High and upper-middle income countries represent 53% of the world’s population, but have received 83% of the world’s vaccines,” said Tedros. “In contrast, low and lower middle income countries account for 47% of the world’s population but have received just 17% of the world’s vaccines. Redressing this global imbalance is an essential part of the solution, but not the only part and not an immediate solution.”

Seychelles Surge in Cases Seem to Have Occurred After First Jab

Addressing reports that cases in Seychelles were surging despite the high vaccination rate of citizens, Dr Kate O’Brien, the WHO’s Director of Immunisation and Vaccines, said that some of the infections occurred after the first dose of the Sinopharm vaccine.

“The Sinopharm vaccine really requires two doses, and some of the cases that are being reported are occurring either soon after a single dose or soon after a second dose or between the first and second doses,” said O’Brien.

Approximately 60% of vaccinations on the island are of Sinopharm vaccines donated by the United Arab Emirates, while the remainder of doses are of the AstraZeneca vaccine, according to the Washington Post.

“When we see cases continuing to occur in the setting of vaccines, it really does require a very detailed assessment of what the situation is,” she stressed.

“First of all, what are the strains that are circulating in the country? Secondly, when do the cases occur relative to when somebody received doses? Third, what is the severity of the cases? Only by doing that kind of evaluation can we make an assessment of whether or not these are vaccine failures or whether it is more about the kinds of cases that are occurring, the milder end of cases, and then the timing of the cases relative to when individuals received doses.”

She stressed that this evaluation is “ongoing”, and the WHO was supporting and engaging with Seychelles to understand what was happening.

Image Credits: Adnan Abidi/Flickr, WHO.

A doctor administering the Johnson & Johnson COVID-19 vaccine candidate during the phase 3 clinical trials.

In a far-reaching statement, WHO and the International Coalition of Medicines Regulatory Authorities (ICMRA) called on the pharma industry to provide much wider access to clinical data for all new medicines and vaccines approved, or under review, and even those that had been rejected. 

“Clinical trial reports should be published without redaction of confidential information for reasons of overriding public health interest,” WHO said in the joint statement on Friday.

“The COVID-19 pandemic has brought into sharp focus the need for information and data to support academics, researchers and industry in developing vaccines and therapeutics; to support regulators and health authorities in their decision-making; to support healthcare professionals in their treatment decisions; and to support public confidence in the vaccines and therapeutics being deployed.”

WHO noted that while some initiatives to share data with regulators, and store it transparently have met with stakeholder support, such as the WHO International Clinical Trials Registry Platform, the US ClinicalTrials.gov database, and the EMA Clinical Trials Register, “not all past efforts have been successful,” WHO said, adding, “often this was because they were unsustainable due to reliance on goodwill or lack of appropriate resourcing.

“Regulators continue to spend considerable resources negotiating transparency with sponsors. Both positive and negative clinically relevant data should be made available, while only personal data and individual patient data should be redacted,” said WHO, adding that, “Lack of public access to negative trials has been identified as a source of bias, which weakens the conclusions of systematic reviews and provides a false sense of reassurance on the safety or efficacy of the medicine.”

“Providing systematic public access to data supporting approvals and rejections of medicines reviewed by regulators, is long overdue despite existing initiatives, such as those from the European Medicines Agency and Health Canada. The COVID-19 pandemic has revealed how essential to public trust access to data is.

“ICMRA and WHO call on the pharmaceutical industry to commit, within short timelines, and without waiting for legal changes, to provide voluntary unrestricted access to trial results data for the benefit of public health.”

Image Credits: University of Oxford, Johnson & Johnson.

Healthcare workers vaccinating at risk patients with the Pfizer-BioNTech COVID-19 vaccine in Lima, Peru.

Pfizer on Friday became the first pharma company to apply for full approval of its COVID-19 vaccine from the US Food and Drug Administration (FDA. The announcement also followed the publication of two studies which found that the Pfizer/BioNTech vaccine is highly effective against two major SARS-CoV2 variants of concern. Moderna plans to follow suit and apply for full approval from the FDA later this month, the company announced on Thursday.

Two peer reviewed studies published on Wednesday found that the Pfizer/BioNTech COVID-19 vaccine protects against severe disease caused by the B.1.1.7 variant, first identified in Britain, and the B.1.351 variant, first identified in South Africa. The studies were based on the real-world use of the vaccine in Qatar and Israel.

The Qatar-based study, published in the New England Journal of Medicine, used data on vaccinations, PCR tests, and hospitalization from the national COVID-19 databases between February and March.

Some 385,853 people received one dose since the launch of the immunization campaign and 265,410 people received both doses of the vaccine, as of the end of March. 

Efficacy of the vaccine in preventing infection was estimated to be 87% against the B.1.1.7 variant and 72.1% against the B.1.351 variant two weeks past the second dose. Protection was even higher against severe or fatal disease, with a total efficacy of 97.4%.

A second study based on Israeli data, and published in the Lancet, found that two doses of the Pfizer vaccine was highly effective against a range of SARS-CoV2 outcomes, including symptomatic (97%) and asymptomatic infection (91.5%), hospitalization (97.2%), and death (96.7%), in those aged 16 and older.

The B.1.1.7 variant was the dominant strain of SARS-CoV2 in the study period, from January to April. The variant accounted for 94.5% of the infections recorded by national surveillance data. 

As vaccine coverage increased in the study participants, the incidents of SARS-CoV2 outcomes declined. Other countries could “similarly achieve marked and sustained declines in SARS-CoV2 incidence if they can achieve high vaccine uptake” said the co-authors, from Pfizer and the Israeli Public Health Services.  

Israel has vaccinated a larger proportion of its population than any other country, with 61% of the population having received at least one jab as of early April. 

Positive Early Findings from Moderna Booster Shot Study

A doctor preparing the Moderna COVID-19 vaccine at the Naval Hospital in Bremerton, Washington, US.

In other vaccine news, Moderna announced on Thursday that initial data on its COVID-19 booster shots demonstrated that the boosters increased the neutralizing antibody responses of vaccinated individuals against two variants of concern.

The data is from an ongoing phase 2 study in which three strategies for boosting immune responses are being tested: a booster dose of Moderna’s existing vaccine, a booster candidate based on the B.1.351 variant, and a booster candidate that combines the two previous boosters.

After six to eight months following the administration of the second jab, the level of antibodies against the wild-type SARS-CoV2 remained high in the study participants, but antibodies against the B.1.351 and P.1 variants, first identified in Brazil, were much lower. 

“We are encouraged by these new data, which reinforce our confidence that our booster strategy should be protective against these newly detected variants,” said Stéphane Bancel, CEO of Moderna, in a press release.

While the findings are encouraging, the data has not yet been peer reviewed. According to the pharma company, the preliminary results have been submitted as a preprint and will later be submitted for peer-reviewed publication upon the completion of another arm of the study. 

Pfizer License Application 

The Biologics License Application (BLA) was initiated for the approval of the vaccine in individuals 16 years of age and above. Data will be submitted to the regulatory agency on a rolling basis and the review process will likely take several months.

“Following the successful delivery of more than 170 million doses to the US population in just a few months, the BLA submission is an important cornerstone of achieving long-term herd immunity and containing COVID-19 in the future,” said Ugur Sahin, CEO of BioNTech, Pfizer’s German manufacturer,  in a press release. 

Some 134 million doses of the Pfizer/BioNTech vaccine have been administered in the US, as of Thursday, according to the US Centers for Disease Control and Prevention (CDC).

The FDA is expected to issue emergency use authorization for the Pfizer vaccine in adolescents aged 12 to 15 early next week. 

Image Credits: BioNTech, International Monetary Fund/Ernesto Benavides, Flickr – Official US Navy.

Almost seven million people are estimated to have died of COVID-19 globally based on  “excess mortality” statistics, according to the Institute for Health Metrics and Evaluation (IHME), which announced on Friday that it would now be using these statistics rather than official death rates.

This “major change in how we think about the number of deaths” had occured after the institute had completed an analysis of all-cause mortality for 59 countries and 198 states and provinces within countries, said IHME Director Dr Christopher Murray from the University of Washington.

Using the new estimates, the US has the highest deaths in the world – over 900,000 – followed by India with over 650,000. Egypt’s death toll of around 170,000 is the highest in Africa – and way higher than official statistics.

New global death estimates, based on excess mortality.

Murray said that using excess mortality as a metric allowed IHME “to get closer to the true number of COVID deaths”, and the institute noted that “most excess mortality is likely misclassified COVID-19 deaths”.

Murray acknowledged that factors inflating excess mortality included deaths of people who had avoided healthcare during the pandemic, and deaths related to increased depression and drug use.

But “injuries are down perhaps about 5% globally due to reductions in mobility”, and so were flu deaths because of lockdowns. 

“When you put all that together, we conclude that the closest estimate for the true COVID-19 death is still excess mortality because some of those things are on the positive side, some of those other factors are on the negative side,” said Murray.

“Once we have completed this analysis, our understanding of the magnitude of COVID up to date, is that it’s been much worse than we have been thinking so far, and we have estimated that today 6.9 million people have died from COVID already,” he added.

Rival Spanish Flu

“Given our expectation of continued deaths, COVID is going to rival Spanish flu at the global level in terms of the count before we see the end of this epidemic.”

An analysis by the Netherlands statistical agency suggested that all excess deaths in the Netherlands were directly due to COVID-19, according to IHME.

“Their analysis actually suggested that direct COVID-19 deaths may be higher than estimated excess deaths because deaths due to some other causes have declined during the pandemic,” it added.

“Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality,” said the IHME.

“For the reasons presented in this section, we believe that this is likely an underestimate. As the evidence is strengthened in the coming months and years, it is likely that we will revise our estimates of the total COVID-19 death rate upward in future iterations of this work, once we can properly take into account the drivers described in this section.”

 

 

Production of Sinopharm’s inactivated COVID-19 vaccine candidate.

The Chinese-made Sinopharm vaccine became the latest COVID-19 vaccine to receive an Emergency Use Listing from the World Health Organization (WHO) on Friday; experts said the vaccine showed an overall efficacy rate of 79% in preventing symptomatic and serious disease. 

The WHO approval positions Sinopharm to become a major player in the COVAX global facility. The facility, co-sponsored by WHO and Gavi, the Vaccine Alliance, is struggling to provide desperately needed vaccine supplies to low- and middle-income countries in the wake of India’s COVID surge – which forced Indian vaccine manufacturers to divert production to domestic needs.  

It remains to be seen, what kind of deal the Beijing-based pharma company might negotiate with COVAX. The vaccine’s state-controlled developers, Beijing Bio-Institute of Biological Products, have so far pursued only bilateral vaccine donations or deals – with an official sales price exceeding that of the pricey Pfizer and Moderna vaccines – whose efficacy is much higher. 

At a press briefing on Friday, it was clear that WHO officials are keen to call on Sinopharm’s participation.

“This expands the list of vaccines that COVAX can buy, and gives countries confidence to expedite their own regulatory approval, and to import and administer the vaccine,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at a Friday press briefing announcing the move.  

Dr Tedros Adhanom Ghebreyesus, WHO Director General.

“We urge the manufacturer to participate in the COVAX Facility and contribute to the goal of more equitable vaccine distribution,” said Dr Mariângela Simão, WHO Assistant-Director General for Access to Health Products, said in a press release.

“From the very beginning, in all of our conversations with this company, it has been very interested in looking at playing a role to help with the global response, which is encouraging,” said Bruce Aylward, WHO Senior Advisor to the Director-General and lead on the ACT-Accelerator. 

He noted that the pharma company has also made significant efforts to expand its manufacturing capacity from the low double digit numbers to high three digit numbers to be positioned to export large numbers of doses. 

Appeal to G-7 to Close Grave, Immediate Vaccine Shortfall in LMICs

Meanwhile, WHO officials issued their second plea this week to the G-7 group of industrialized nations, meeting 11-13 June, to share excess vaccine doses with COVAX that they are holding in reserves – so the highest risk groups in low-income countries can be vaccinated. 

“Nearly 1.25 billion doses of COVID-19 vaccines have been administered globally, however, only 5 million of those have been in the lowest income countries” said Aylward. “Over 80% of the vaccines distributed have gone to high income countries and only 0.3% have been delivered to low income countries.”

Dr Bruce Aylward, WHO Senior Advisor to the Director General, at the press conference on Friday.

“We need the help of the G7 to change that equation and raise the proportion of the populations that are vaccinated,” Aylward said.  

A bigger G-7 financial commitment is also required to combat the current “unacceptable” divide in vaccine distribution, stressed WHO officials at the biweekly press conference. 

“For G-7 now, the most important and the immediate support we need is vaccines [and] vaccine equity,” said Dr Tedros.

“The industrial and financial weight of the G-7 in supporting that is going to be absolutely crucial,” said Alyward. He warned that “we could be in a different position much faster globally than we will [otherwise] be, if we get that support through the financing, the sharing, and the scaling up of these products.”

The ACT-Accelerator, a global collaboration to accelerate the development, production, and equitable access to COVID-19 vaccines and technologies, currently is facing a financing gap of US$19 billion, which is slowing the procurement and delivery of vaccines to countries in dire need, the WHO officials said. 

Along with vaccines, funding is also needed to  scale-up of up production of other countermeasures, including diagnostics, oxygen, and PPE. 

“Without that financing or without those donations, there simply aren’t the doses that are needed to assure that countries that are really [relying on] the COVAX facility can achieve the impact” of immunity, said Dr Kate O’Brien, WHO Director of the Department of Immunization, Vaccines and Biologicals.

The comments came as WHO also reported on the first meeting of  a new “Health for All” collaboration of 11 top economists and health experts – tasked with articulating new strategies for injecting health goals into the heart of global finance, not only for medicines and vaccines access but also in terms of economic recovery. 

Professor Mariana Mazzucato, Chair of the Council on the Economics of Health for All, at the press conference on Friday.

Sinopharm Approved For Older People – Although Clinical Trials Included Few People 60+ 

The Sinopharm vaccine had an efficacy rate of  79% in clinical trials, with respect to prevention of symptomatic disease and hospitalizations, the WHO review by the Strategic Advisory Group of Experts on Immunization (SAGE) found. Their review also included on-site inspections of the production facility.

The sixth vaccine to receive WHO’s approval, it is based on a traditional vaccine technology that delivers an inactivated form of the virus to provoke immunity. It’s cold chain storage requirements make it suitable for distribution in low-income countries. 

“The addition of this vaccine has the potential to rapidly accelerate COVID-19 vaccine access for countries seeking to protect health workers and populations at risk,” Simão said. 

WHO’s approval included a recommendation for use in adults of any age over the age of 18 – despite the admittedly scarce data from clinical trials on adults over the age of 60. 

“There is no reason to think that the vaccine would behave differently in this older age group, and in fact, in many countries in the world where the vaccine is already being used, this group has already been vaccinated,” said Dr Alejandro Cravioto, Chair of WHO’s Strategic Advisory Group of Experts on Immunization (SAGE).

Dr Alejandro Cravioto, Chair of WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), the body that recommends vaccines for WHO approval.

However, WHO officials said that they would encourage those in charge of country vaccination programs to implement strong followup programs to monitor the safety and efficacy of the vaccine in those over 60 years old, as well as in people with comorbidities, and pregnant women. 

“Once we have this information then, as with any other vaccine that SAGE has reviewed, we will look at the new evidence and make changes in our interim recommendations for this vaccine,” said Cravioto. “But for now, after getting an EUL approval we see no reason why this vaccine should not be recommended fully for use in people 18 years and above, in a dosage of two doses, from two to three weeks apart.”

The Sinovac vaccine, another Chinese developed COVID-19 vaccine, was also expected to receive WHO Emergency Use Listing this week, according to a statement made by Simao at the press conference on Monday. But on Friday, officials said it remains under review.

The Sinovac vaccine has in the past reported varying efficacy results in its clinical trials, ranging from 50% to 84%. SAGE had requested additional information from the manufacturer and was awaiting a response, WHO said.

Image Credits: Sinopharm, WHO.

In the eye of the storm: How can media hold government accountable? Global Health Centre/ Health Policy Watch Panel

The COVID-19 pandemic has highlighted how crucial journalism is to counter the rapid spread of inaccurate information and to hold governments accountable, a diverse panel of leading journalists noted on Thursday, a few days after World Press Freedom Day.

Sometimes that story-telling saves lives, but it can also come at a high personal cost to those telling the stories. In India, over 200 Indian journalists have died of COVID-19, and worldwide, others have been imprisoned and censored for criticising their government’s pandemic effort.

“It’s in crisis that we really come to appreciate the essential role that journalists and media play in keeping societies well-informed, providing us with accurate information, and the essential role it plays in holding governments accountable,” stressed Suerie Moon, the Co-Director of the Geneva Graduate Institute’s Global Health Centre, which hosted the panel with Health Policy Watch.

The event featured leading journalists from India’s Pune, Pakistan’s Islamabad, and South Africa’s Cape Town, who reflected on how the media shapes public discourse and the challenges they face – often in contexts that are under-resourced and even life-threatening. 

Keep Questioning Authorities

“Our job is to ask and keep questioning authorities, and it’s our role to tell people what the government is not telling them,“ stressed Rahul Basharat Rajput, Health Policy Watch Pakistan correspondent, and Fellow at the International Center for Journalists.

“Indian journalists have tried their best to play the role of a watchdog and hold the government accountable, especially because Prime Minister Narendra Modi’s government has been responsible for several superspreader events,” added science journalist Disha Shetty, who also reports for Health Policy Watch – noting that journalists had warned long-ago that a complacent government could trigger a potentially devastating pandemic.

Shetty and Rajput spoke from their homes in India and Pakistan, which are among the most dangerous countries for journalists in the world. 

“Reporting is coming at huge personal costs to journalists telling the stories,” Shetty said. “India is one of the world’s most dangerous places to be a journalist at the moment, according to Reporters Without Borders.”

Over 200 Indian journalists have already died from COVID-19, according to a list that is being compiled by the Network of Women in Media in the country.

Fighting The Spread of Inaccurate Information

In India, the media has played a key role in countering inaccurate information, whose spread has mainly been driven by governmental authorities, Shetty said.

“A lot of the source of misinformation is coming from the government machinery, [for example] during government press conferences, which have been used to downplay the extent of the pandemic and to promote herbal cures that lack scientific backing,” she said. 

“Media in India, the US and other countries have a crucial role in calling out misinformation that comes from government sources because you can’t just report on a press conference when this misinformation is being spewed out.”

Some reporters with massive social media followings have also contributed to the dissemination of inaccurate information, she added, calling on her colleagues to hold each other accountable to protect an increasingly vulnerable public.

Vaccine hesitancy, uncommon in India prior to COVID-19, has been fueled by inaccurate information, as well as the government’s lack of transparency around the indigenous Bharat Biotech vaccine. This has visibly affected vaccine uptake in India since the pandemic struck, Shetty warned. 

The African continent has not been immune to these issues either, even though its official COVID-19 burden has been low in comparison to the rest of the world, added Kerry Cullinan, the Africa Editor of Health Policy Watch.

In South Africa, only a fifth of eligible South Africans over the age of 60 have registered for a jab, she warned. Meanwhile, in Kenya, where around a quarter of citizens are Catholic, the Kenyan Catholic Doctors’ Association has dismissed COVID-19 vaccines as “unnecessary”, instead promoting unproven treatments from antiparasitic drug ivermectin to other herbal medicines.

African Journalism is “Massively Under-Resourced”

In Africa, the fight against increasingly inaccurate information and growing vaccine hesitancy has been exacerbated by the fact that journalism is now “massively under-resourced“, Cullinan added, referring to a wave of job losses in the sector since the pandemic emerged. 

At the South African Broadcasting Corporation (SABC), the country’s public broadcaster, 620 people were retrenched at the end of March while most magazines had closed, she said.

In some African countries, journalists accept money from governments to write about various initiatives, and this “obviously affects the quality of articles produced”, she said.

“If you can’t earn a living from this profession [journalism] you’re not going to be doing it very well,” noted Elaine Ruth Fletch, the editor-in-chief of Health Policy Watch, who moderated the discussion.

Still, recent funding from the Wellcome Trust has helped several Africa-based journalists stay afloat during the pandemic, panelists said on an encouraging note.

 Striking Success Story – How Two Pakistani Reporters Shifted National Policy

Pakistan health workers getting vaccinated with Sinopharm.

Meanwhile, a series of articles by Rajput and co-writer Mohammed Nadeem Chaudhry published by Health Policy Watch made a “huge difference” to Pakistani society and national health policy, the writers reported. 

“After one of our stories was published by Health Policy Watch, it made a huge difference,“ said Rajput, referring to a story he co-authored with Chaudry in mid-April amid an intense third wave in Pakistan. 

In that story, he shed light on the country’s quiet suspension of its vaccination campaign for healthcare workers – although 40% had not received a single vaccine jab. 

But after Rajput and Chaudhry sent queries about the campaign to Pakistan’s Special Assistant to the Prime Minister (SAPM), Faisal Sultan, the country’s vaccine campaign suddenly resumed.

“The government’s move to halt the vaccination of healthcare workers was made transparent after our story was published in the media,“ said Rajput, adding. “This is a very important story that shows how public stories influence the decisions that governments make.“

He cited another hard-hitting story he co-authored with Chaudry for Health Policy Watch which exposed a $ 4.2 million misallocation of Global Fund donations for tuberculosis elimination, which was instead funneled to a private hospital in Karachi. Only about $1 million of those funds are “potentially” recoverable, found Rajput.

Local media outlets did not want to publish some of these stories and even the World Health Organization’s Pakistan office refused to comment on either story.

“The story about the Global Fund, our first story in Health Policy Watch, local news networks refused to publish it, but we felt that it was a very important story to report to tell the people, so we looked elsewhere,” he said. “In Pakistan, you cannot report on a lot of things.“

Pakistan is the fifth most dangerous country for journalists worldwide, said Rahul. Between May and April 2020, The Freedom Network reported 148 violations against journalists. This includes 60 murders.

Image Credits: Photo by Markus Winkler on Unsplash.

Humanitarian organisation Médecins Sans Frontières (MSF) has called on US diagnostics corporation Cepheid, which produces the GeneXpert testing machines that run COVID-19 tests, to immediately reduce the prices for the tests to allow for more people to be diagnosed as the pandemic continues to ravage parts of the world.

MSF’s plea comes after Cepheid on Thursday announced that it will reduce the price of its new 10-color IV-4 GeneXpert machines from US$19,000 to $15,800, and additionally offer countries buying those machines ‘100 COVID-19 tests for free’.  Similar bundled price reductions for the larger XVI GeneXpert machines and COVID-19 and TB tests have also been announced. 

Stijn Deborggraeve, Diagnostic Advisor, MSF Access Campaign however slammed the company’s announcement, saying it was “another sign that the corporation is not actually willing to make a real commitment to increasing access to affordable tests in low- and middle-income countries, and is prioritising its profits over people’s lives”.

Deborggraeve said the price “reduction” was not meaningful, but rather a way to “promote their newer testing devices”.

“The COVID-19 pandemic should not be used by Cepheid to profiteer by charging low- and middle-income countries over four times the price it costs to produce the COVID-19 tests. It’s high time for Cepheid to do what’s right and immediately provide countries with real price reductions for the COVID-19 test, so more tests can be run and more people diagnosed as the pandemic continues to rage across many parts of the globe.” 

MSF together with the Treatment Action Group (TAG) and more than 140 other civil society organisations sent open letters on 24 February and 1 April to express concerns about the impact of Cepheid overcharging low- and middle-income countries for COVID-19 tests, and to ask for a significant and immediate price reduction of the tests. 

Cepheid has set the price for each COVID-19 test at $19.80, which is at least 400% more than it costs the corporation to produce the test, based on MSF’s analysis of the cost of manufacturing Cepheid’s similar TB and HIV tests. The analysis shows that the corporation could still make a profit by selling each test for $5 or less.  

MSF repeated its call for Cepheid to reduce the price of the COVID-19 test and all other GeneXpert tests to no more than $5 each. 

“It is unacceptable that Cepheid sells the COVID-19 tests to low- and middle-income countries at a price over four times higher than it costs to produce the test, while Cepheid’s annual revenue has doubled during the pandemic, reaching over $2 billion, largely from the sale of COVID-19 tests,” said MSF in its statement.

Image Credits: UCT.

 

The Seychelles, known for its beaches and giant tortoises, has recorded a spike in COVID-19 cases.

A significant surge in COVID-19 cases in the tropical island of Seychelles, despite almost 70% of the population having been vaccinated, is baffling health officials while residents are calling for stricter law enforcement, especially for tourists.

The World Health Organization (WHO) is currently working with health officials on the island to analyse the latest data, including patterns and characteristics of people testing positive, and will soon have a clearer understanding of the development.

To date over 68,000 people, almost 70% of the population, have been vaccinated in the Seychelles, reaching the target for herd immunity — indirect protection from an infectious disease when a population is immune either through vaccination or immunity developed through previous infection, according to the WHO.  

However, on 3 May the island recorded 500 new infections which has resulted in strict new lockdown measures being implemented a day after the spike in numbers. These include the closure of schools until 24 May and a ban on social gatherings including weddings, conferences, group sport events, graduations.

The case surge has raised questions regarding the efficacy of vaccination against the deadly virus and has shown the catastrophic consequences of relaxing public health measures. With less than 100,000 inhabitants, Seychelles is the smallest of any sovereign African country.  

Richard Mihigo, Immunisation and Vaccines Development Programme Coordinator at WHO, said the surge provided justification for the vaccination of more people in the country. “Until everybody’s protected, there is no reason why the disease will not continue in the country. So I think that is a very big illustration on how important it is to continue to vaccinate people,” Mihigo said.

There’s no official statement yet regarding the origin of the surge in new cases, but the global health organisation and local health authorities are carefully monitoring the development.

The island’s first COVID-19 cases were recorded on 11 March 2020 when a couple in their sixties travelled from Italy to the island. By 5 May this year, the smallest African country had recorded 6,273 cases and 28 deaths.

Analyses of Data to get to Root of Spike

The WHO said it is working with health officials in Seychelles to analyse the data and will soon have a clearer understanding of the development.

“Officials are already looking at the patterns and the characteristics of the people that are testing, whether they’ve been vaccinated or not, and then try to come up with a true picture of the situation that is going on in Seychelles,” Mihigo said.

Mihigo encouraged the Seychelles and other African countries to continue their vaccinations programmes,  taking into consideration the developments in Israel and the United States where the number of cases are dropping significantly due to the large number of people being vaccinated.

Dr John Nkengasong, Director of the Africa Centres for Disease Control (CDC),  also expressed his organisation’s willingness to help the government of Seychelles to understand the situation and to respond accordingly. 

While the scientists are researching the resurgence, citizens are also taking to social media to voice their opinions. Tessy Anne, who lives in Victoria in the Seychelles, said on Facebook that the surge in new cases may be as a result of poor enforcement of COVID-19 rules and regulations, especially for tourists visiting the country.

The Seychelles announced on January 14, 2021, that visitors from all over the world who are fully vaccinated against COVID-19 will be able to visit without going through quarantine. The rules for opening up the East African island country known for its beaches and giant tortoises, could point the way forward for tourism after vaccines become more widely available.

“It’s time for the Ministry of Health to strictly emphasise that all visitors wear their masks in public. Too often they are seen walking about without a mask. Sometimes police officers also see them but do nothing, yet they fine Seychellois who they see not wearing a mask,” she said. 

Seychelles Urgently Needs to Regain Socio-economic Loss

According to the United Nations Development Program (UNDP) 62-page assessment of the socio-economic impact of COVID-19 in Seychelles, the country’s GDP shrunk by 11.5% and unemployment rate rose from 2.7% in 2019 to 4.8% in the first half of 2020. Between March and September, 1,300 employees were retrenched and  4,000 applications by migrant workers were cancelled. There has been a 70% loss in tourism revenue.

Naadir Hassan, Minister of Finance, Economic Planning and Trade, noted in the report on the socio-economic report, that his and other tourism-dependent Small Island Development States, have been most affected by the pandemic, and face slow recovery as long-haul travel will take longer to return to normal. 

Experts are aiming to reawaken the discourse on diversification of the economy since the pandemic has clearly demonstrated the vulnerabilities that come with over-reliance on the tourism sector. 

But in the immediate term, all efforts are geared towards preventing the spread of the virus, investing in measures to stimulate local economic activity, support social cohesion, and address rising unemployment, in addition to ensuring the mechanisms for innovative and sustainable financing in the face of the growing debt burden remain at the core of the government’s response.

Seychelles kickstarted COVID-19 vaccination in Africa with the  country’s president, Wavel Ramkalawan being one of the first to receive the Sinopharm COVID-19 jab which he publicly received, an action that was geared towards getting more citizens to trust and receive the vaccines. 

Seychelles has been getting vaccines from different sources including a donation of 50,000 doses of China’s Sinopharm vaccine from the government of the United Arab Emirates and  100,000 doses of the Oxford-AstraZeneca vaccine from the Government of India.

Back to Masks

Seychelles President Wavel Ramkalawan was one of the first to receive a COVID-19 vaccine.

Oyewale Tomori, Nigerian professor of virology and chairman of Nigeria’s Ministerial Expert Advisory committee on COVID-19, told Health Policy Watch that poor communication regarding COVID-19 vaccines could create confusion. 

He noted that while the vaccines may not be able to stop infection, they can ensure the infections do not result in severe life-threatening diseases.

He added that efforts need to be made towards encouraging Africans not to get tired of observing the recommended measures including proper masking.

Thabani Maphosa, Gavi Managing Director for Country Programmes, added that health measures such as wearing face masks will go a long way in keeping the pandemic under control in the light of the paucity of vaccine doses.

“If anyone is still walking out there without a mask, it is like working out of your house naked and it is horrifying. We need to stand up to the virus,” Maphosa said.

Image Credits: Roadgoat, Seychelles government.