A health worker receives her first dose of Sinovac Biotech’s Coronavac vaccine at the Ospital ng Malabon (Hospital of Malabon).

New York City – While the Philippines ranks 50 out of the 155 countries that have administered the most COVID-19 vaccines, opposition leaders and health officials fear the collapse of the country’s healthcare system amid a surge in new infections. 

Globally, more than 704 million doses – about 4.6% of the global population – of vaccines have been administered so far, according to the Bloomberg Vaccine Tracker.

As of 5 April, the Philippines has administered 854,063 doses, placing it as the 50th highest of 155 countries, said vaccine “czar” Secretary Carlito Galvez Jr, who is also the chief implementer of the National Task Force against COVID-19 in the country.

Those vaccinated include 789,415 health workers, around 11,000 elderly, and some 7,100 people with comorbidities, he added.

But while the national government touts its successes in vaccination, what is occurring on the ground reflects a different story.

“Inconsistent” Data Underreports Full Capacity Hospitals 
ABS-CBN Data Analytics head Edson Guido

A senior data analyst flagged the “inconsistent” data reporting from the Department of Health (DOH) regarding hospital bed occupancy in the country.

ABS-CBN Data Analytics head Edson Guido said there was conflicting reporting on the occupancy rate of hospitals, particularly in Metro Manila. 

The DOH had initially reported 78% of intensive care unit beds in the region were filled, 78% of isolation beds were utilized, and 60% of ward beds were occupied. Around 60% of ventilators were also in use. 

“The reports on the ground say [bed occupancy] in Metro Manila is full and [patients] were brought to other provinces. So, there seems to be a disconnect in terms of deaths and bed occupancy that the DOH is reporting from what’s happening on the ground,” Guido said. 

A patient is seen in a hospital bed outside the San Juan Medical Center in San Juan City on Thursday.

Philippine hospitals across the country had declared full capacity and many were no longer taking patients. Some private hospitals had switched to offering home care.

The Medical City, an 800-bed hospital in Metro Manila, has three-to-10 day programs that can cost as much as 65,000 pesos (USD $1,340), which includes infection control, virtual monitoring, swabbing and blood extraction services. 

Vice President Leni Robredo, who leads the political opposition, questioned, in a Facebook post last week, these expensive “Home Care Medical Packages,” which only the richest Filipinos can afford. 

“Are there guidelines from the DOH that the Home Care Specialists have to follow to ensure the safety of the people who get sick?” she said. 

The surge is taking its toll on the healthcare workforce as well, as 117 of 180 staff tested positive at the Philippine Orthopedic Center in Manila, forcing the facility to close its outpatient department, which can serve as many as 450 patients a day. 

“When our medical front-liners are getting sick, the threat of collapse of our healthcare system is big. We must control the spread of the disease,” Opposition Senator Francis Pangilinan, in a 3 April statement, said. 

Former president Joseph Estrada spent the night in an emergency room after being rushed to a Manila hospital with COVID-19 complications on 28 March, since regular beds were occupied. Estrada was later admitted to the intensive care unit and is now on a ventilator as his pneumonia worsened, his son said in a Facebook post on Monday. 

Philippine hospitals are at overcapacity, forcing patients to receive treatments in their cars.

Others do not even have the chance to enter a hospital at all. 

“Many have already died inside tents outside hospitals, waiting to be admitted to the ERs, in an ambulance while in transit, at home without receiving any medical help,” Robredo said.

The government is currently planning to allocate more living quarters for healthcare workers in the National Capital Region Plus (NCR Plus), making arrangements with hotels and other lodging service providers. 

Pangilinan warns of a “humanitarian crisis that will overwhelm the country and wipe out families” if the government does not step up its efforts. “Step on the gas. Testing, tracing, isolation, and treatment are the four wheels of the anti-COVID ambulance. Government efforts must be toward accelerating the ambulance to outpace the infection and save all of us,” he said. 

Government Recalibrating Strategy – Vaccinations and Self-Isolation Measures
Vaccine “czar” Secretary Carlito Galvez Jr, (left) who is also the chief implementer of the National Task Force against COVID-19

In response to the continued rise of COVID-19 cases in NCR Plus, the government is recalibrating its immunization efforts towards areas with high infection rates. 

Building herd immunity in high-risks areas such as Metro Manila could address the spike in local transmissions, said vaccine czar Galvez. 

He added that inoculation of at least five million individuals in Metro Manila will jumpstart the process of achieving herd immunity and will enable the government to offset the delays in vaccine deliveries. 

Senator Pangilinan also advised free mass testing, citing Vice President Robredo’s mobile free mass testing initiative called Swab Cab. 

The Swab Cab initiative brings COVID-19 testing to communities through use of buses that were converted into mobile testing sites. The program, started with Robredo’s private sector partners, is meant to augment the government’s testing capacity. 

Both Robredo and Pangilinan highlighted the need for the government, on top of recalibrating its vaccination strategy, to ensure that the people of the Philippines were provided for during self-isolation.

“Those who go on self-isolation and their family must be assured of food,” said Pangilinan. 

Said Robredo: “Have we built a system where people who are self isolating at home would still have access to medical help when necessary? Did [the government] even fix the infrastructure?” 

Strictest Lockdown Measure Implemented In Philippines Capital Region
philippines
A delivery driver wears a mask and unloads essential items amid the COVID-19 lockdown

The Philippines’s dramatic surge in cases has forced the government to implement the toughest of 4 lockdown levels until 11 April in Metro Manila and the surrounding provinces of Bulacan, Cavite, Laguna, and Rizal. 

Health officials attribute the rising cases to the unexpected spread of more infectious coronavirus variants.

“No one could have probably foreseen how infectious these new variants are and as a result of which we have these ballooning numbers,” presidential spokesman Harry Roque told ABS CBN News.

The Philippines nationwide cases data, with recent weeks averages not computed, owing to delays in reporting

As of 8 April, there are 828,366 COVID-19 cases in the Philippines, with 9,216 new cases and 14,119 deaths, the highest totals in Southeast Asia after Indonesia. 

The national government had initially placed Metro Manila and its provinces under a General Community Quarantine (GCQ) bubble on 22 March.

A bubble setup is applied to a cluster of people restricted from going in and out of a covered area unless authorized to do so. Going in and out of NCR Plus is limited to essential workers and essential travel. 

Public transportation remains operational, with proper social distancing measures in place. 

However, the GCQ was upgraded to an Enhanced Community Quarantine (ECQ) on 29 March, and was extended to 11 April as daily infections breached 10,000. 

The ECQ limits further movement to accessing essential goods or services, or performing essential work. Religious services, including the past week’s Holy Week and Easter events for Roman Catholics, were shifted online after public gatherings were temporarily banned. 

PH Lags Behind Southeast Asia Neighbours; Temporarily Suspends Use of AstraZeneca Vaccine
Doses administered per 100 people

According to NY Times data, the country in fact lags behind the rest of its Southeast Asian neighbours, having administered 0.9 doses per 100 people as of today, compared to Indonesia’s 2.4 doses and Malaysia’s 1.1 doses. 

The country expects to vaccinate up to 70 million people this year, and has so far received 2 million COVID-19 doses from China-based Sinovac Biotech, and 525,600 vaccine doses from British-Swedish pharma company AstraZeneca. Vaccines from Russia-based Sputnik V are also expected to arrive this month. 

Vaccine deliveries will gradually increase in May and June, with a total of 10.5 million doses from Sinovac, Sputnik V, Novavax, and AstraZeneca. 

However, the announcement by the European Medicines Agency during a 7 April press conference that there appears to be a link between AstraZeneca’s vaccine and very rare cases of blood clots mainly younger women,  has resulted in the Philippines government temporarily suspended use of the vaccine in people under 60. 

“I want to emphasize that this temporary suspension DOES NOT MEAN that the vaccine is unsafe or ineffective. It just means that we are taking precautionary measures to ensure the safety of every Filipino. We continue to underscore that the benefits of vaccination continue to outweigh the risks and we urge everyone to get vaccinated when it’s their turn,” Philippines Food and Drug Administration Director General Rolando Enrique Domingo said in a statement.

Image Credits: ILO/Minette Rimando, IMF Photo/Lisa Marie David, ABS-CBN, Philippine Star/Twitter , HDetalla/Twitter, ABS-CBN, Philippines DOH, NYTimes.

In a powerful ruling that could increase transparency and thus, industry compliance, India’s National Green Tribunal has directed state and central pollution control boards to chart and openly share with the public detailed data from online continuous emissions/effluents monitoring systems (OCEMS) operating in the country’s highly-polluting industrial sector. 

These powerful industrial interests – ranging from cement to mining – account for one-third and one half of the country’s urban air pollution – and a large part of pollution of the country’s  lakes and streams, including the iconic Ganges.  

In issuing the directive on data collection and sharing, the Green Tribunal – established 11 years ago for the expeditious legal review of appeals on environmental pollution issues –  was following up on a 2017 Supreme Court order directing all states to ensure that polluting industries instal OCEMS and make industrial emissions data publicly available.

In an assessment of state inaction and industry non-compliance,  the Indian non-profit Legal Initiative for Forest and Environment (LIFE) last year reported that of the 32 state-managed pollution control boards, one-half had not even bothered to create online continuous emission monitoring portals – as per the Supreme Court directive. 

And of the 16 Indian states that had complied with the original Supreme Court judgement, only 38% allow public users to access and assess the data generated, LIFE noted. 

The rest is hidden away behind passwords, something the petitioners want to unlock to force transparency. 

In the recent case, the southern regional bench of the Green Tribunal, directed the states of Tamil Nadu, Karnataka, Andhra Pradesh, Kerala and the union territory of Bunchberry to comply with the Supreme Court  directive by April 9. 

The  petitioners now plan to approach the western, eastern and principal [national] benches of the Green Tribunal, to ensure nationwide compliance with the Supreme Court directives, environmental lawyer and LIFE founder Ritwick Dutta told Health Policy Watch this week. 

The industrial emissions monitored under the OCEMS systems and regulations include both effluents dumped into lakes and rivers, often untreated, as well as airborne emissions of particulate matter, carbon monoxide, nitrous oxides, sulphur oxides, and hydrogen fluorides – released as smokestack emissions from plants lacking effective filtering equipment. 

 

Air pollution leads to almost 1.7 million premature deaths a year in India, as a result of cardiovascular and respiratory diseases, lung and other cancers, strokes, pre-term birth, type-2 diabetes, and several other neurological and cognitive illnesses. 

Clean Air Advocates Welcome Ruling Covering Tens of Thousands of Industrial Polluters 

The ruling was welcomed by citizen scientists and clean air advocates, who said that making data on emission and effluents more transparent and accessible will help empower the public and drive change. 

“Brilliant directive,” tweeted Ronak Sutaria, data scientist and urban policy researcher who has been following this data – or lack of it – since the Indian government started monitoring industrial emissions and effluents that flow into rivers and lakes across the country in 2014.  

“Industrial pollution from notified high-polluting industries typically accounts for 30% to 50% of the total pollution experienced in most urban cities and towns,” said Sutaria, who runs urbansciences.in, a low-cost real-time air quality monitoring network. “The OCEMS systems are the last checkpoints before these pollutants escape into our environment.” 

Another issue is the overall lack of OCEMS device and thus monitoring at many industrial sites. In the heavily industrialised western state of Maharashtra, for instance, in just one region,  there are nearly 23,500 high pollution potential industries. In contrast,  the total number of OCEMS installed in the entire country is only about 4,000. This is a problem of industry compliance.

Most data generated by even these is largely inaccessible to the public, added clean air expert, Chetan Bhattacharji, a board member of the advocacy group Care for Air.  “The data the OCEMS collects—inarguably vital for public health—remains opaque. It is either faulty, insufficient, complicated or difficult to access,” says Bhattacharji. 

North India is equally non-compliant. A news story in March reported that the Central Pollution Control Board (CPCB) itself cracked the whip on the 1,631 “grossly polluting industries in the Yamuna basin,”  80% of which are non-compliant, asking them to share their pollution data and connect to the CPCB server within 3 months.

How the OCEMS Work

Seventeen categories of industries designated as highly polluting are legally mandated to instal and maintain online continuous emissions monitoring systems. These “red” categories of polluting industries include aluminium, zinc, copper plants, power and cement plants, distilleries, fertilisers, iron and steel plants, oil refineries, petrochemical and tanneries, all of which have powerful lobbies at work.

These industries are supposed to share the data they generate with the pollution control boards in the states where they are located –  uploading it in 15-minute intervals.  Those boards, in turn, are supposed to create a repository under the supervision of  the CPCB – but they don’t always do so. 

So while the monitoring equipment is owned by industry, the data it generates is intended to be shared with the government, at state level and nationally. 

The petitioners are trying to ensure that this, by default, is also shared with the public. This, they say, should also include public access to historic data, location coordinates of air quality monitoring stations, and more. Made public, such data would flow into a central repository of OCEMS data, paid for by industry, but owned by the public via the CPCB, which oversees and reports on air pollution nationally. 

Industry Conflicts of Interest Remain At Heart Of Transparency & Compliance Issues 

 

While the recent Green Tribunal ruling, issued in March, focuses on industry compliance and public accessibility of data,  what it doesn’t address is an inherent and clear conflict of interest: The commissioning and operations of the monitoring systems are left to the same industries which are themselves being monitored for their emissions. This means polluting units themselves self-monitor and upload pollution data to the pollution control boards directly.  This is akin to asking students to grade their own exam papers. 

Thus, the recent ruling only goes part-way in making most effective use of the considerable data-generation potential inherent to the OCEMS systems. But even if the ruling ends up solving the problems of compliance and accessibility, that would be a good first step. 

In fact, Sutaria and Bhattacharji have argued that these thousands of monitors be immediately brought under a transparent regime where the data can be analysed, verified and reported. The two sought greater air pollution data transparency in a report published by an Indian research foundation. 

“Understanding of city-level air quality could be strengthened if residents who live in spaces where industries are present, are able to access information about industrial emissions in their areas,” the report by Sutaria and Bhattacharji stated.

Developed countries such as the United States and countries in the European Union make similar data freely available to the public enabling citizens to track industrial air pollution across the country. In India, this is not the case, they observe. 

“The Environment Protection Agency (EPA) makes industrial emissions data from all Continuous Emission Monitoring System (CEMS) -regulated monitoring locations freely available to the public… the European Environmental Agency maintains the European Pollutant Release and Transfer Register (E-PRTR) which contains industrial pollution data from more than 34,000 facilities across 33 EU countries,” Sutaria and Bhattacharji note in their report.

“Environmental groups have used such data to identify the air polluters in a region and have held them accountable, such as the Tata Steel plant in Netherlands. Overall, in the European countries, industrial pollution emissions have steadily gone down since 2007, when the datasets were first made available across the Union.”

“This data enables citizens to track industrial air pollution data across Europe, including who the top polluters are and the spatial and temporal trends of the emissions for each of those industrial locations. If 33 countries can collaborate to do this, one country, India, should easily be able do this across all its states,” adds Sutaria.

If all the OCEMS data was publicly and transparently available, it could give enough raw data to create a robust environmental monitoring ecosystem, a first step towards transparency, accountability and control. Such a system would not just empower the populations most vulnerable to health harm from industrial pollution, but also strengthen the government’s own monitoring, helping it to geolocate where industrial pollution is coming from.

Until now, however, the government’s pollution boards in fact fail to have any impact on pollution mitigation, says one researcher, Dharmesh Shah. 

“Empirically speaking, the Central and state pollution control board across India have effectively, and for all practical reasons, abandoned the notion of “controlling” pollution,” he tweeted.

Properly Collected Industry Data Could Fill Gaps in Ambient Air Pollution Monitoring Systems

If industry shared its data cleanly and ethically, that data would also fill existing gaps in ambient air pollution monitoring systems, says Bhattacharji. The breadth of health harm triggered by air pollution makes this real-time data from these OCEMS of critical importance.

Until October 2020, the government owned just 234 continuous air pollution monitors (called Continuous Ambient Air Quality Monitoring Systems (CAAQMS)), the data that  serves as the basis for urban air quality monitoring and reporting, based on a national Air Quality Index. 

In comparing sheer numbers of monitoring devices, industrial monitoring is about ten times as dense as government-controlled ambient air quality monitoring systems, he notes, saying, “By this yardstick, it is apparent that the scale of monitoring of pollutants is bigger in the country’s industrial sector.” 

CAAQMS and OCEMS differ only insofar  as the first tracks ambient air quality levels, while the OCEMS track industrial  emissions at source. 

Health advisories are made based on CAAQMS. Industry in most places contributes anywhere from 30%  to 50% to ambient pollution, explain experts. However, at the same time, OCEMS systems are critical to identifying the actual sources of air pollution – and then acting to limit them. 

“The OCEMS network is regulated by the same regulatory body, the CPCB, and monitors similar parameters as those covered by the CAAQMS,” says Bhattacharji – arguing that the two need to be linked directly under the control of the national pollution control board.

With data as key, if such linkage was ever made, the nemesis for industry’s rampant pollution may yet be around the corner.

–

Jyoti Pande Lavakare is a journalist and author whose non-fiction memoir about the human cost of air pollution, Breathing Here is Injurious to Your Health, was published by Hachette in November 2020.

Image Credits: Flickr, Uncommonthought.com, Jyoti Pande Lavakare.

A new report has found that HIV and TB patients faced significant new barriers to access care in the COVID pandemic era.

In the past year, across all non-COVID conditions, routine health care has changed. GPs feel that acute care has been compromised due to their own changed focus, and because patients consult less frequently for non-COVID conditions. 

For HIV and TB communities, both diseases exacerbated by poverty and marginalisation, these impacts are particularly acute. The World Health Organization has estimated that 1.4 million fewer people received care for TB in 2020 than in 2019, and a recent Lancet study found that 11 out of 19 countries in Central and Eastern Europe had physicians sharing HIV and COVID-19 care duties, impacting the quality and frequency of services to HIV key affected populations. 

A new report by the Alliance for Public Health finds that in Eastern Europe, Central Asia, and the Balkans, HIV and TB patients faced significant new barriers to access care in the COVID pandemic era.  These findings are particularly significant since two of the six countries studied, Bosnia and Herzegovina and Moldova, are also among the ten top countries worldwide in terms of COVID deaths per capita. 

Findings of the study were also presented in an online discussion on 7th April 2021, on the occasion of World Health Day, attended by over 150 individuals working in the HIV and TB space across the region. The issues, likely to be seen in other high-burden HIV and TB countries as well, include:  

  • Less ability of patients to consult clinicians; 
  • Reduced access to testing and treatment, including threats of sanctions for breaches of lockdown;
  • Technological barriers to access new mobile- and e-health methods to access care. 
  • Insufficient social safety nets and direct financial support for HIV and TB communities – especially given their work in the informal economy

The study, co-authored by APH along with Matahari Global Solutions, drew upon interviews with patients, clinicians, government officials, and key informants in Bosnia and Herzegovina, Georgia, Kyrgyzstan, Moldova, Russia, and Ukraine, and sought to provide an illustrative picture of access to care for HIV and TB communities in those countries. 

25-50% Reductions of HIV Testing & TB Detection

All countries examined found reductions of HIV testing and TB detection of at least 25-50%. 

Similarly in the case of HIV treatment, comprehensive treatment in the framework of “People Living with HIV” (PLHIV) in the Eastern Europe and Central Asia (EECA) region only stood at 44% pre-COVID pandemic. In comparison, HIV testing services were reduced by 33% in Moldova, 12% in Kyrgyzstan, and by 21% in Ukraine in 2020 as compared to 2019. Similarly, antiretroviral treatment (ART) uptake in Moldova decreased by 25% over the past year, in Kyrgyzstan by 14%, and by 11% in Ukraine. 

In Georgia, the National Centre for TB and Lung Diseases sought to tackle the 25% reduction in TB detection by increasing screening via mobile X-rays equipped with artificial intelligence technology and screening each COVID-19 patient for TB, given similar symptoms. 

In Kyrgyzstan, a country already struggling with inadequate medical infrastructure, organisations working on TB in Osh, the country’s second largest city, said that X-ray machines were of low quality, and that COVID-19 rules saw long queues for access to X-rays and other necessary services for TB screening. Patients also didn’t have the financial resources to pay out of pocket for additional diagnostics. There were additional barriers caused by security guards to health facilities, whose main duties were to ensure adherence to social distancing, and did not comprehend the necessity of patients attending in person. 

An NGO leader based in Osh told us: “Doctors sent (the patient) for a CT scan, which costs about $30, and the clients do not have the financial resources for this… The security guard at the entrance asked visitors in great detail why they came to the doctor, and it took a lot of time and effort to explain everything to these guards, who, in principle, did not understand the issues and did not care about (them).” Compounding these access issues, according to one medical specialist from Bishkek, was the use of anti-TB antibiotics to treat COVID patients at the early stage of the pandemic, and concerns about rising antimicrobial resistance (AMR) and drug-resistant forms of TB. And while there are ongoing projects to tackle serious AMR issues in Kyrgyzstan via promoting the rational use of antibiotics, COVID-19 set back progress and will need urgent scale-up of AMR stewardship activities. 

A medical professional works in the temporary Covid-19 care centre Palace of Sport in Bishkek, Kyrgyz Republic in July 2020.

All countries saw the scale-up of mobile- and e-health tools to access services during the COVID-19 pandemic. In Ukraine, people living with HIV used an app to track their recent viral load counts, HIV medicine supplies, and allowed for management for appointments with clinicians. In Kyrgyzstan, ad hoc Whatsapp groups allowed patients in remote rural areas to connect with specialists from Bishkek, an opportunity not normally afforded to them. In Moldova, Georgia, Ukraine, and Kyrgyzstan, the use of video support to increase adherence to TB medication regimens increased. 

Loss of Incomes During COVID-19 Exacerbate HIV & TB Outcomes

But emerging from all countries was the sense that without income support, especially for vulnerable groups that had lost their jobs during COVID-19, treatment adherence measures would all fall by the wayside. An activist from TBPeople Ukraine told us: “We have not once spoken of the fact that people were left without support. What happened to tuberculosis? People who were on treatment for a long time but were unable to find jobs – they felt like burdens on their families. Most were just left to go home without any material or social assistance. What DOT and treatment adherence can we talk about if the person had nothing to eat?” In Moldova, ex-prisoners predominantly work as construction workers and had lost all income during the COVID-19 pandemic, and was cited as a factor for TB treatment dropout. All countries examined lacked sufficiently broad social safety nets to support individuals and families through COVID-19 income losses. 

And in Bosnia and Herzegovina, a poor transition out of Global Fund funding meant that services for key HIV populations, including men who have sex with men and people who use drugs, had serious sustainability issues, and these were amplified during COVID. In a country where stigma tow-ards gay men is high, and where clinical care for gay men is outdated, drop-in centres proved to be an important safe space where gay men could get services. After the Global Fund transition, these drop-in centres were de-funded, and COVID-19 saw a massive reduction in access to HIV and other sexual health services for this group. 

The region will need comprehensive COVID-19/HIV/TB recovery strategies, including widening of mobile HIV and TB screening services, a scale-up in HIV self-testing, scale-up of funding of programs to serve HIV and TB communities (including safe spaces for gay men in Bosnia and Herzegovina), broader social safety programmes, integration of TB and COVID-19 testing, and digital support initiatives to help bridge e-health gaps. 

Insights from the Panel Discussions 

Dr Nino Lomtadze, Head of Surveillance from the Georgian National Centre for TB and Lung Diseases.

Additionally, a number of important insights emerged from Wednesday’s discussion:  

  • Dr Andrei Dadu of the WHO European Regional Office, emphasised that people living with HIV and TB communities should be prioritised to receive COVID-19 vaccinations under second phases of vaccination programmes. 
  • Anton Basenko, of the Alliance for Public Health in Ukraine, said that the financial support for HIV and TB communities shouldn’t solely be focused on masks and sanitisers, but also on direct financial support and provision of psychosocial support. 
  • Maka Gogia, of the Georgian Harm Reduction Network, described how the pandemic-era  scale-up of sterile needle-and-syringe vending machines in Tbilisi, five-day take home doses for opioid substitution therapies, and online medical consultations with people who use drugs, had all become important adaptations to the pandemic. But there is a need for increased financial support to deliver services to remote regions of the country. 

Pavel Aksenov, summarising findings for Russia, and said that there is a need for the better  integration of community-based TB programmes and facilities with psychosocial support for patients. 

In addition, he called for a revival of high profile HIV and TB testing campaigns to recover declines in testing seen during the COVID-19 pandemic. 

Finally, there is a need to develop and integrate new remote and contactless ways for key affected populations to access necessary services, including the optimisation of online counselling. Aksenov also noted that NGOs receiving external funding may be categorised as ‘foreign agents’, so need flexibility from donors in COVID-19/HIV/TB fund reprogramming, to ensure that NGOs can cope with additional administrative and financial burdens of reporting on donor funding. 

All in all, COVID-19/HIV/TB recovery plans need to take into account best practices and findings from this report, including the urgent need to broaden social safety nets to HIV and TB communities, including direct financial support, and to facilitate access to online and mobile access to HIV and TB services. 

In the words of Dr Stela Bivol from PAS Center in Moldova, quoted in the report, “What’s not covered now is that all these vulnerable populations need more material support. They need more welfare support that is beyond the financial incentives to be on TB treatment, they need livelihood support.”

Dr Fifa Rahman

* Dr Fifa Rahman is Principal Consultant for Matahari Global Solutions, and Permanent NGO Representative on the Facilitation Council of the WHO Access to COVID-19 Tools Accelerator; Pavel Aksenov is Associate Consultant for Matahari Global Solutions; Tetiana Deshko is Director of the International Programs for the Alliance for Public Health, and Oleksandr Zeziulin is MD, MPH, Senior Researcher, Ukraine Institute on Public Health Policy

Image Credits: World Health Organization, Shutterstock.

Brazil on Tuesday recorded 4,195 COVID-19 deaths – bringing the total number of deaths in the country to 366, 000- second only to the United States.

The World Health Organization on Wednesday urged governments in the Americas Region to take decisive action to slow a surge of COVID-19 cases after recording more than 1.3 million new cases and 37 000 deaths in just the past week.

Describing the new rate of infections as “worrisome”, Carissa Etienne, director of the WHO’s regional office, the Pan American Health Organization, said health care facilities in the region were being stretched to the limit as the rate of infections continued to climb, ICU beds were nearing capacity.

Brazil alone recorded more than 4,000 deaths in its deadliest 24 hours of the pandemic so far.

“Over the last week, the United States, Brazil and Argentina were among the 10 countries in the world, registering the highest number of new infections worldwide” said Etienne, adding that “more than half of all global deaths reported last week were in the Americas.

“The United States, Brazil and Argentina were among the 10 countries in the world registering the highest number of new infections worldwide,” she noted, with many other countries in the region not far behind. 

Despite the skyrocketing numbers, people are steadily increasing their movement and travelling within and between countries. “If these trends continue, our health systems will be in deeper trouble,” warned Etienne, urging people to stay home to drive down infections.  

Infection rates Slowing in United States & Mexico 

“Cases are mounting in nearly every country. In areas of Bolivia and Colombia cases have doubled in the last week. All four countries in the southern code have been experiencing acceleration in COVID-19 cases with one interrupted community transmission in recent weeks,” she said.

Rising rates of new infections were also still being recorded in countries including Costa Rica, Honduras,  Ecuador, Guatemala, as well as in smaller islands like Martinique Bermuda and the US Virgin Islands.

The exceptions were the United States, Mexico, Salvador and Panama, where the rate of new cases was now finally slowing down. 

In the United States, US government officials said that the slowdown in the US in new cases may be attributable to the huge US vaccine drive which has seen some 60 million vaccine doses distributed so far – the most in absolute terms anywhere in the world. 

Brazil’s Grim COVID-19 Numbers – ‘A Biological Fukushima’

The Brazilian Health Ministry on Tuesday said 4,195 people had died ín the past 24 hours due to the virus – bringing the total number of deaths in the country to 366,000- second only to the United States.

Sylvian Aldighieri, PAHO incident manager for COVID, said: “Our concern at the moment is also for the Brazilian citizens themselves in this context of services that are overwhelmed by the number of severe cases to be managed”.  He added that PAHO was working with Brazil to acquire more vaccines.

Brazilian hospitals across the country are being stretched to their limits as the rate of infections continues to climb. More young people are falling ill, and needing medical care, he noted, as the current wave of the pandemic is marked by more easily transmissible strains of the virus.

“It’s a nuclear reactor that has set off a chain reaction and is out of control. It’s a biological Fukushima,” Dr Miguel Nicolelis, a Brazilian medic and professor at Duke University, was quoted as saying.  Over the course of April 2021, Brazil appears set to hit an all-time record of 200,000 deaths per month, with 50% of those due to COVID19.  It would be the first time deaths surpass births in the country, Nicolelis remarked in a tweet. 

“Never in Brazilian history have we seen a single event kill so many people in 30 days,”, added the Duke professor, who also coordinates COVID response in Brazil’s northeastern region, speaking to AFP, adding that with winter now approaching, Brazil is facing “a perfect storm.”

Speaking on local Brazilian TV, Nicolelis held President Jair Bolsonaro largely responsible – due to his pushback against mask-wearing, social distancing, and lockdown measures. 

“We’re in a dreadful situation, and we’re not seeing effective measures by either state or federal governments” to respond, epidemiologist Ethel Maciel of Espirito Santo Federal University also told the AFP.

Despite the recent surge, Brazilian officials have tried to retain an upbeat note, insisting that the country can soon return to something resembling business as usual. 

“We think that probably two, three months from now Brazil could be back to business,” Economy Minister Paulo Guedes said during an online event on Tuesday. “Of course, probably economic activity will take a drop but it will be much, much less than the drop we suffered last year … and much, much shorter.”

Economic Impact of the Pandemic

Overall for the region, however, the financial strain of this pandemic has been devastating and effectively fighting COVID-19 is impossible without addressing some of the inequalities and supporting the most vulnerable as they struggle to protect themselves, said Etienne.

“While many of us have been lucky enough to continue working during the pandemic from the comfort and safety of home, half of our workforce relies on the informal economy. Staying at home would have meant forgoing their livelihoods, “she said, adding that 22 million people fell into poverty this year in the region. 

Despite the gloom and doom, there is some good news, according to Etienne.

To date more than 210 million doses of COVID-19 vaccines have been administered across 49 countries and territories in the Americans. While the United States is leading the region and the world in its vaccine campaign, other countries, such as Chile, are also vaccinating at high rates. 

PAHO has also developed an interactive platform where countries can visualize the public health measures that were implemented. This will help countries, among others, identify peaks and mobility during specific periods such as Christmas New Year and inform pandemic responses.

“As we continue to fight this virus, we must do more than just stop COVID-19.  We must commit to working together to build a fairer healthier world, we must also take this opportunity to build a healthier region that’s better prepared to tackle the next challenge, and realises our promise of health for all,” said Etienne.

 

One in three COVID-19 survivors received a neurological or psychiatric diagnosis within 6 months of infection with the virus.

A new study published by the journal Lancet Psychiatry estimates that one in three COVID-19 survivors received a neurological or psychiatric diagnosis within six months of infection with the SARS-CoV-2 virus. 

The study, conducted with researchers from both the United States and United Kingdom, analyzed the electronic health records of 236,379 COVID-19 patients primarily from the US, also comparing them to 105,579 patients diagnosed with the flu and 236,038 patients diagnosed with any respiratory tract infection (including flu). 

Overall, it was estimated that 34% of patients were diagnosed with a neurological or psychiatric disorder in the first six months after after a COVID diagnosis – with some 13% having a first-time ever diagnosis. Results also showed that the risks were greatest in, but not limited to, those with severe COVID-19.

Professor Paul Harrison, University of Oxford, lead author of study

Professor Paul Harrison, lead author of the study, from the University of Oxford, said: “These are real-world data from a large number of patients. They confirm the high rates of psychiatric diagnoses after COVID-19, and show that serious disorders affecting the nervous system (such as stroke and dementia) occur too. While the latter are much rarer, they are significant, especially in those who had severe COVID-19.”

And while countries around the world are now focused on vaccine rollouts, in hopes of achieving herd immunity, the study underlines how effects of COVID-19 will be felt for much longer, said Dr Jonathan Rogers, who was not involved in the study, from University College London (UCL), UK, in a separate comment on the study.

“Sadly, many of the disorders identified in this study tend to be chronic or recurrent, so we can anticipate that the impact of COVID-19 could be with us for many years.”

Neurological and Mental Health Risk Increase Following COVID-19, When Compared to Flu or Respiratory Tract Infections, Says Study 

Additionally, neurological and psychiatrist outcomes were more frequent in COVID-19 patients than those patients who had suffered from the flu or respiratory tract infections –  suggesting the specific impact of COVID-19, the researchers found. 

After taking into account underlying health characteristics, such as age, sex, ethnicity, and existing health conditions, there was overall a 44% greater risk of neurological and mental health diagnoses after COVID-19 than after flu, and a 16% greater risk after COVID-19 than with other respiratory tract infections.

Ischaemic Stroke and Hemorrhage Risks Also Elevated
Associations between COVID-19 and ischemic stroke and intracranial hemorrhage is “concerning”

The risk of ischemic stroke and intracranial hemorrhage was elevated after COVID-19, with incidence of stroke increasing almost one in ten in patients with delirium (encephalopathy). Substance use disorders and insomnia were also more common. 

The study authors called the associations between COVID-19 and brain diseases and psychiatric disorders “concerning”, with additional research needed on disease severity and development. 

“We now need to see what happens beyond six months. The study cannot reveal the mechanisms involved, but does point to the need for urgent research to identify these, with a view to preventing or treating them,” Dr Max Taquet, a co-author of the study, from the University of Oxford, said.

The results also point to a substantial impact on health systems and social care networks, given the potentially chronic nature of many of these conditions, added Harrison.

“Health care systems need to be resourced to deal with the anticipated need, both within primary and secondary care services,”  he advised. 

Will Mental Health Or Neurological Conditions Predominate Over Time?  
COVID-19
Patients who received a psychiatric or neurological diagnoses 6 months after COVID-19

In the wake of these findings, health experts also questioned if the severe, chronic, and less common mental health conditions linked to these findings will manifest more as neurological disorders or common mental disorders over time. 

While this study found that anxiety (17%) and mood disorders (14%) were the most common diagnoses, diagnosis of stroke and dementia were more common in patients who required hospitalization (83%), and even more so in those who required intensive treatment (46%) and in those with delirium (encephalopathy) during COVID-19 infection (62%). 

Writing in a linked comment to the study, Rogers, found the link with encephalopathy [delirium caused by a brain disease typically caused by infection, tumor or stroke] “important, even if the underlying mechanism turns out to be indirect.” 

But Rogers issued a note of caution about the apparent connections between encephalopathy and COVID-19, citing difficulties in distinguishing between psychotic disorders and delirium. 

On the one hand, the average age of patients with first-onset mental health disorders (53 years old) was on average much greater than those in the general population, where onset usually occurs in early adulthood. But, in some cases, however, that psychosis may have been exacerbated by pre-existing conditions unknown to the health-care provider, he argued. 

However, Rogers added that the study has important implications pointing “us towards the future, in both its methods and implications. 

“Researchers need to be able to observe and anticipate the neurological and psychiatric outcomes of future emerging health threats by use of massive, international, real-world clinical data,” Rogers added, calling on countries with public health-care systems to “enable truly comprehensive national data to be available for research.” 

Image Credits: AMSA/Flickr, Flickr: Florey Institute of Neuroscience & Mental Health.

Azerbaijan’s President Ilham Aliyev

Some of the world’s smallest countries joined the World Health Organization (WHO) to appeal for equitable access to COVID-19 vaccines on the eve of World Health Day – as the pipeline of global vaccine supplies to low- and middle-income countries risk drying up for the coming few months. 

Barbados Prime Minister Mia Amor Mottley told the WHO press briefing on Tuesday that her country was simply too small to negotiate with large pharmaceutical companies, while Namibian President Hage Geingob said that his country had only received small donations of vaccines from China and Russia.

“The bald reality is that our market size is simply too small to command the attention of global pharmaceutical companies, or indeed other suppliers of goods,” said Mottley, who added that her country had received its first delivery of COVAX vaccines just today – but only enough to cover 3% of its population.

“We’ve not had access, even when we are prepared to pay,” said Mottley, who also expressed concern for the health of Tom Rowley, Prime Minister of Trinidad and Tobago who had been diagnosed with COVID-19 earlier in the day, a mere hours before he had been due to be vaccinated.

WHO Director-General Dr Tedros Adhanom Ghebreyesus made a five-point global call to action ahead of World Health Day on Wednesday, calling for:

  • Accelerated equitable access to COVID-19 technologies between and within countries;
  • Investment in primary health care;
  • Prioritizing health and social protection;
  • Building safe, healthy and inclusive neighbourhoods;
  • Strengthening data and health information systems.

“At the start of the year, I made a call for every country to start vaccinating health workers and older people in the first 100 days of 2021. This week [10 April] will mark the 100th day, and 190 countries and economies have now started vaccinations.”

Even so, he added that although COVAX has delivered 36 million vaccine doses to 286 countries and economies, “equitable distribution remains the major barrier to ending the acute stage of this pandemic” – with supplies running dry after initial deliveries are completed.

“It is a travesty that health workers and most at-risk groups remain completely unvaccinated” in some countries, the WHO DG said. “We need to invest in equitable production and access to COVID-19 rapid tests, oxygen treatments and vaccines, between and within countries.”  

Azerbaijan’s President Ilham Aliyev, speaking via a recorded video, said that his country had co-sponsored the resolution adopted in the March session of the UN Human Rights Council calling for “equitable, affordable, timely, and universal access for all countries” to COVID-19 vaccines. 

Access to ‘Concessionary Capital’ to Address Pandemic Impact

Appealing for more investment in primary healthcare, Tedros said that the pandemic has “exposed the fragility of our health systems”.

“At least half of the world’s population still lacks access to essential services, and out-of-pocket expenses on health drive almost 100 million people into poverty each year,” he said.

In the past year, the pandemic is estimated to have driven between 119 and 124 million more people into extreme poverty, according to the WHO.

Mottley, who chairs the development committee of the World Bank and the International Monetary Fund, said she would propose to the committee at its meeting this week that it needed to use “different criteria” to determine how countries get access to “serious concessional capital” to stave off the pandemic and its long-lasting consequences.

President Carlos Andrés Alvarado Quesada of Costa Rica also appealed for “multilateral organisations” to provide financing for poorer countries to address the medium and long-term effects of the pandemic. 

“Today, developed economies have managed to achieve special packages to help their countries to overcome the effects of COVID-19 but that’s not something that poorer countries can do,” said Quesada, appealing for “debt forgiveness” and long-term financing at zero or low rates.

“There is no magic bullet. and there is no magic recipe,” concluded Mottley. “The answer is simply for us to work together to get that fairer world and for there to be a level of global moral leadership, recognising that the singular pursuit of individual countries will not rid the world of the major problems because human beings cannot be contained behind boundaries easily in this globally interdependent world.”

Risk-benefit for AstraZeneca Still ‘Positive’ But More Data Expected in Next Day

Rogerio Pinto de Sa Gaspar, the WHO’s Director of Regulation and Prequalification

On a related matter, WHO’s Director of medicines Regulation and Prequalification, told the media briefing that it expected to have more data about possible linkages between the AstraZeneca vaccine and rare “thrombolytic events” in the next few days.

However, Rogerio Pinto de Sa Gaspar, stressed that “at the present moment, and under the assessment that we have from the data submitted up to yesterday, we are confident that the benefit-risk assessment for the vaccine is largely still positive.”

The European Medicines Agency (EMA) was meeting again Tuesday and Wednesday over  the issue, as was the United Kingdom’s Health Products Regulatory Authority following a decision by Germany last week to suspend the vaccine’s use among people under the age of 60 – after further rare blood clot events occurred.

 WHO’s own Global Advisory Committee on vaccine safety was due to meet on Wednesday, said De Sa Gaspar amind the ongoing controversy about the vaccine.

European Medicines Agency Meeting is Viewing All Data

The WHO also has observers at the EMA meeting, which is assessing “the core clinical data that was submitted by AstraZeneca”.

Describing the events as “rare”, De Sa Gaspar said there was “no evidence that the benefit-risk assessment for the vaccine needs to be changed, and we know from the data coming from countries like the UK and others, that the benefits are really important in terms of reduction of the mortality of populations that are being vaccinated”. 

He added that the WHO expected to have “a fresh conclusive assessment from our experts” by Wednesday or Thursday.

 “There’s no link for the moment between the vaccine and thrombolytic events with thrombocytopenia, but of course it’s under evaluation, and we wait for some feedback from those communities in the coming days and coming hours just to give a full assessment,”  asserted De Sa Gaspar.

“WHO is relying heavily on the national pharmacovigilance systems, but also on the assessment committees from national regulatory authorities, and also from regional regulatory authorities like the EMA,” he said.

Mariangela Simão, WHO’s Assistant Director-General, added that data was being assessed from all regions of the world: “Millions and millions of AstraZeneca doses have been distributed and used in Latin America, Africa, India and other countries in Asia so we are very actively proactively collecting data from different national regulatory authorities,” said Simão. “We are also in touch with AstraZeneca, as AstraZeneca has an obligation to monitor the safety data and report to the WHO.”

‘Let’s Not Speculate’ About Serum Institute of India Vaccine Supplies to COVAX 

Dr Bruce Aylward

Related to the vaccine shortage issue, Bruce Aylward, Tedros’ special advisor and the WHO’s lead on COVAX, dismissed a reporter’s question about the possibility that the Serum Institute of India (SII) might delay vaccine deliveries to COVAX until as late as June – well beyond the April suspension date announced by Gavi, The Vaccine Alliance late last month.  SII suspended its exports abroad after being asked by the Indian government to redirect its production to the domestic Indian market – which is seeing a surge in coronavirus cases. 

“Let’s not speculate on what’s going to happen in terms of future deliveries from any of the companies that we’re working with,” said Aylward.

“Right now, every country we talk to, every company, is trying to make sure that they prioritise COVAX and that we get the vaccines that we need. Obviously, if we have an interruption with any one of our suppliers for a short time, a month or so, we can find ways to manage as best we can, but if it prolongs for longer, that would be a challenge.”

Aylward added that some additional supplies from SII had come through in the past few days to enable “which are important to all countries being able to start vaccination by the end of the 100-day period”.

Aylward also stressed that the vaccine supply situation was “fluid” and COVAX also had deals with other pharma manufacturers, most notably Johnson and Johnson and Novavax, which are due to come online in the coming weeks and months.

 

Ugandan private health providers have been given the green light to import and distribute their own COVID-19 vaccines.

In what may be a first for the African continent, the Ugandan government has decided to allow private sector health providers to import and distribute their own COVID-19 vaccines amidst strict regulations – in an effort to expedite the country’s vaccination drive, which is caught in the crosswinds of vaccine supply shortages plaguing the entire region and low-income countries more generally.

The Ugandan decision comes just after the Kenyan government decided last week not to allow the private importation of vaccines –  due largely to fears of fake vaccines swamping markets.

The immediate future of vaccine roll-outs in African countries remains uncertain in the wake of India’s recent decision to suspend for the immediate future, its bulk supplies of AstraZeneca vaccines, produced by the Serum Institute of India (SII), to low-income countries in Africa, Asia and the Americas.  Those countries are largely  dependent on vaccine deliveries arranged through the WHO co-sponsored COVAX facility.   Meanwhile, South Africa and Nigeria have also made strategic decisions to shift away from further bilateral purchases of the AstraZeneca vaccine in favour of the Johnson and Johnson jab – which will nonetheless take longer to deliver.

In an effort to expedite the vaccination drive, the Ugandan Ministry of Health last week outlined the rules whereby the private sector will be able to participate in the  COVID-19 vaccine supply chain, including an accreditation process which will require them to source the vaccine, detail the quantities to be imported and the cold chain capacity of the provider.

Providers will  be required to import only those vaccines that have received an “Emergency Use Listing” from the World Health Organization as well as being cleared by the national drug regulator, the Uganda National Drug Authority.

Uganda has thus far vaccinated 80,836 people since vaccinations commenced on 10 March.  The country received a first tranche of 864,000 doses of the AstraZeneca COVID-19 vaccine on 5 March from the COVAX facility – out of a total expected COVAX supply of about 3.5 million doses that was supposed to be delivered over the course of 2021.  But as with many African countries, COVAX vaccine deliveries for April, May and possibly even beyond, are now in jeopardy due to the suspension of Indian exports – as SII redirects its vaccine production to domestic use in India, which is seeing a surge of COVID cases.  

“A list of facilities will be provided and a Memorandum of Understanding will be  signed spelling out the modalities of the collaboration,” said Jane Ruth Aceng, the Minister of Health, regarding the private procurement arrangements. She added that the vaccines authorized for import to private sector health service providers, would have to be administered by that same health care provider – and could not be resold again. The ultimate goal, said Aceng, was to protect the consumer.

Ugandan Health Minister Jane Ruth Aceng

Safety of Citizens is Paramount

Alfred Driwale, the programme manager of Uganda National Expanded Programme on Immunisation echoed Aceng’s sentiments: “One of the roles of the government is to protect the public so we want to know most importantly the source of the vaccine. The safety of the people is paramount”.

The private sector represents half of all health services delivered in Uganda.  But up until the pandemic, private health care providers have not been deeply involved in mass immunisation programmes. In Uganda, over 90% of immunisations are administered free of charge by the public health system, which receives support from GAVI, The Vaccine Alliance.   

The Private sector will also be required to import the vaccines through the National Medical Stores which is the national agency for the storage, importation and distribution of all drugs in Uganda. This will ensure that the maintenance of the cold chain and viability of the vaccines, officials said.

“If the private sector will help us to acquire COVID-19 vaccines it is good and we have created rules to have order ” said Driwale. He said a few private players have approached the Ministry of Health, but none have qualified yet.

High Demand, Low Supply Opens Market for Fake Vaccines

However, allowing the private sector to participate in the COVID-19 supply chain at a time when demand outweighs supply, opens the market to fake vaccines and exploitation and abuse, Gideon Badagawa, the Executive Director of the Private Sector Foundation-Uganda told Health Policy Watch. Badagawa said he is against complete liberalisation of the COVID-19 vaccines for the private sector in Uganda  and said the government should remain in control to maintain standards and enable the private sector to follow specifications. 

In cases where private sector health services are authorized, participation should be in a ‘phased manner’ – allowing only those who meet the government specifications to participate. In the case of COVID vaccines, he said, only about 10 health sector entities would have the capacity.  “They can allow just a few players initially because the COVID-19 vaccines are delicate and not everybody can participate in the market,” said Badagawa, adding that: “If we import in partnership with the government it will enable us to follow the specifications that are required”.

Grace Kiwanuka, Executive Director of the Uganda HealthCare Federation had mixed reactions to the decision. “It is a right step to mobilise domestic resources and it helps us to achieve herd immunity which would be difficult if only left for the government,” she said. But on the other hand, she warned that Uganda is an open economy – and privatizing the vaccine market opens the way for profiteers to substitute saline and glucose solutions for genuine vaccines.

For just those reasons, Uganda’s neighbory, Kenya, on Friday said that it would ban the “ importation, distribution and administration of vaccines, until such time there is greater transparency and accountability in the entire process”.  The Kenyan government’s ban comes amid fears that counterfeit inoculations may otherwise infiltrate the market.  

WHO Risk communication and Infection Prevention and Control teams provide massive community sensitization on COVID-19 vaccinations

South Africa’s Medical Aid Giant Ready To Help With Vaccinations

Meanwhile, frustration over the slow pace of vaccination in South Africa also saw the health services giant, Discovery Health, announce plans last week to vaccinate up to 550, 000 of its high risk members within weeks of vaccines becoming available, through a partnership with the South Africa government.  In the case of South Africa, however, the supplies would still be procured by the government, and then distributed by Discovery Health. 

The private medical aid company said it plans to vaccinate up to 50, 000 of its members a day. 

Discovery Health CEO Adrian Gore said the company would be establishing  20 large-scale vaccination sites and plans to vaccinate three million adult beneficiaries, beginning on May 1.

Gore  said Discovery would not be importing any vaccines, but that it was ready to vaccinate its members in high volumes when the supply of vaccines became available from the South African government’s health department.

“Our segmentation approach is aligned with the national prioritisation framework, as guided by the ministerial advisory committee. Simply, this means that we know exactly who should receive the vaccine first, and we will communicate quickly with our scheme members to confirm their place in the roll-out, contingent on vaccine supply,” Gore explained.

“This would help realise meaningful health and economic outcomes, and avoid many preventable Covid-related deaths,” he said, adding that those who qualify to receive the vaccine, will be contacted by the medical aid.

Abacus pharma Limited , one of the companies hoping to participate in the COVID-19 vaccine supply chain in East Africa, said collaborating with the government would help expedite the COVID-19 vaccination drive.

“Opening up the vaccines to the private sector will help accelerate the process of providing protection as long as it is done in a thoughtful manner and in line with regulatory requirements,” said Rajaram Sankaran, Group Chief Executive Officer & Director on Board at Abacus Pharma (Africa) 

“We would be glad to collaborate with the government such that we complement their efforts and not duplicate. Such public-private partnerships would be more sustainable in the long run,” Sankaran told Health Policy Watch. 

Image Credits: ABC7 News.

A new survey shows that the use of family planning services in Kenya increased from 56% in 2019 to 61% despite curfews and lockdowns.

Kenya’s family planning services experienced a 5% increase in the uptake of modern contraceptives at the height of the COVID-19 pandemic last year, possibly contributing to a decline in unwanted pregnancies in the country, a new survey has shown.

The survey, conducted by Performance Monitoring for Action (PMA), shows that the use of family planning services increased from 56% in 2019 to 61% in 2020 in married women and from 40% to 46% in all women, despite curfews and lockdowns.

The PMA generates surveys of key health indicators in nine countries in Africa and Asia, whose open-resource data is available for research, programme planning and policymaking. 

The increased use of contraceptives is likely to have contributed to the decline of unintended pregnancies over the same period from 42% to 37%. 

The survey – done between November and December last year in 11 counties (Nairobi, Kilifi, Nandi, Nyamira, Kiambu, Bungoma, Siaya, Kericho, Kitui, Kakamega and West Pokot) – also found that unmarried women prefer short-acting methods, while their married counterparts chose longer-acting methods.

The most popular method for unmarried women were male condoms (29%), injectables and implants (both at 26%). The married women, on the other hand, preferred injectables (39%) and implants (37%).

Family Planning is an Essential Service 

Albert Ndwiga, the National Family Planning Program manager in the Ministry of Health, said family planning was an essential service and that the country “had to come up with guidelines quickly to ensure continued care in public health facilities during the pandemic”.

Family planning services are offered free of charge in public health facilities in Kenya. The guidelines were formulated in April last year, giving directives to facilities on how to protect the client and the service provider.

The government is now collaborating with the private sector, which supplies over a quarter of Kenyans (28%) with their family planning methods and commodities. 

“Some may choose to get services from the private sector because of the convenience it offers to them, therefore reducing the burden on government-owned facilities,” Ndwiga said, adding that the health ministry has formulated a “total market approach” as a result. 

The ministry has also actively engaged with communities “because issues around culture and religious beliefs have for a long time affected the uptake of family planning,” observes Josephine Kinyua, the director of Delivering Equitable and Sustainable Increases in Family Planning (DESIP) in Kenya, a program funded by the UK.

The DESIP program is implemented in 19 counties where the modern method contraceptive prevalence rate is less than 45%.

Commodity Financing and Economic Empowerment

Ndwiga said family planning was going to be included as one of the government’s four key agendas, of which universal health coverage is a key component. The agendas include food security, affordable housing, manufacturing and affordable healthcare for all.

Kenya’s government has committed to financing 100% of family planning commodities by 2023, and Ndwiga said they were now able to use health insurance to fund family planning.

Linking family planning with economic empowerment has contributed to increased uptake, according to Kinyua, who said some counties were now introducing bills geared towards funding maternal and child health alongside family planning.

“This will ensure that later, even if the programme is no longer there, some funding will be available to support maternal and child health,” she said.

However, cutting back on family planning commodities wastage would also go a long way towards saving money. This could be achieved by improving the quality of family planning services.

Ndwiga said an example of preventing wastage would be if a mother is counseled properly so that if she chooses to have a long-term contraceptive method, she will not change her mind after two months to have it removed.

“Because if that implant is meant to last for five years, but is removed after only two months, you lose four years and 10 months that it could have been used,” he says.

Data is Important to Inform Policies and Programs

Contraceptive use is known to be one of the determinants that influence fertility, according to Dr Anne Akonyo, senior lecturer and director of population studies at the University of Nairobi.

“It is one of the greatest inhibitors of fertility when used properly,” she explains.

Professor Peter Gichangi, the lead investigator of the PMA, says that the data collected should not just be used to inform programmes, policies and scientific publications, but as data sets that can be used for different purposes.

The data presented also posed some questions that need further investigating such as stock-outs for Intrauterine Devices (IUDs), which increased from 7% in 2019 to 11% in 2020.

Image Credits: iStock.

A “human error” at a Johnson & Johnson production facility caused millions of doses of its COVID-19 vaccine to be spoiled and unusable.

A mix-up with vaccine ingredients at a production site in Baltimore, Maryland, which is manufacturing both the Johnson & Johnson and AstraZeneca COVID-19 vaccines, has led to the contamination of 15 million J&J doses, which risks delaying national and global deliveries of the recently-approved vaccine. 

The pharma company, which is producing the world’s first single dose COVID-19 vaccine, announced Wednesday that a batch of doses failed its “rigorous quality control” standards. The doses were manufactured at a facility run by Emergent BioSolutions, which has production deals with both J&J and AstraZeneca.

Federal officials have described the issue as human error, as workers at the plant reportedly confused components for the two vaccines in late February. It took several days for the mistake to be recognised, ruining a batch of millions of doses.

The Emergent Bayview Facility in Baltimore has not yet, in fact, been authorised by the US Food and Drug Administration (FDA) to manufacture the J&J drug substance, but is currently under review for Emergency Use Authorization. 

The authorization has been held up by the FDA’s investigation into the site’s lapse in quality control.  

J&J will send experts in manufacturing, technical operations, and quality monitoring to supervise and support activity at the facility and gain more control over the manufacturing processes to avoid another public hiccup in production.

The production of Johnson & Johnson’s one-shot COVID-19 vaccine, delivered through an inactivated adenovirus.
Potential Delays in Vaccine Shipments

J&J stressed, however, that the error won’t impact its upcoming delivery to the US of 11 million doses, forecasted to arrive this week from a manufacturing site in the Netherlands. However, the company had been expected to deliver 24 million more doses to US destinations from the Baltimore site in April.

Although J&J officials said that they intend to remain on schedule with deliveries, US health officials said that they anticipate fluctuations in the vaccine delivery timetable, saying it could still take weeks to get the facility up to regulatory standards.

The US has ordered a total of 100 million doses from J&J, which are to be shipped by the end of June.

As of Thursday, approximately 7.8 million J&J doses were delivered and 3.4 million doses administered, according to the US Centers for Disease Control and Prevention.

The J&J vaccine has widely been regarded as essential to speed up vaccination campaigns globally due to the fact it is a one-jab vaccine as well as its logistical advantages: it can be stored for at least three months at temperatures of 2-8°C and can be transported using existing cold chain technologies and standard vaccine distribution channels.

“Changing the trajectory of the pandemic will require mass vaccination to create herd immunity, and a single-dose regimen with fast onset of protection and ease of delivery and storage provides a potential solution to reaching as many people as possible,” said Mathai Mammen, Global Head of Research and Development at Janssen Pharmaceuticals – a Belgian pharma company owned by J&J and responsible for developing the vaccine – in a press release published in late February.

J&J expects to deliver one billion doses globally by the end of 2021, including some 400 million doses to African Union member states beginning in the third quarter of 2021. An agreement is also underway between J&J and Gavi, the Vaccine Alliance to provide 500 million doses to the WHO co-sponsored global COVAX Facility through 2022. The facility is trying to ensure more equitable distribution vaccines to low- and middle-income coutnries.  

However, insofar as J&J has already faced previous manufacturing delays in January, it remains to be seen if J&J will succeed in scaling up production to meet its commitments. 

CDC Warns – US Facing Fourth Wave of COVID-19 In ‘Critical Moment’ for Pandemic

Meanwhile, the US could be facing an imminent fourth wave in the pandemic, with COVID-19 cases increasing in 25 states, and an average of 64,000 new cases reported daily over the past week, officials from the US Centers for Disease Control warned. The rise in cases coincides with multiple states loosening COVID restrictions on social distancing and other measures.

Cases have increased by 12% from last week, accompanied by higher hospitalisation and death rates, with a seven day average of deaths at 940 per day. 

“This is a critical moment in our fight against the pandemic. As we see increases in cases, we can’t afford to let our guard down,” said Dr Rochelle Walensky, Director of the CDC, at a White House press briefing of the COVID-19 Response Team.  

“We need to keep taking the mitigation measures, like wearing a mask and social distancing, as we continue to get more and more Americans vaccinated every single day,” Walensky added, speaking at a White House press briefing on Wednesday. 

The B.1.1.7 variant, first identified in the United Kingdom, is responsible for 26% of the SARS-CoV2 variants circulating across the US, and it is the predominant strain in at least five regions of the country. 

“We do know it’s more transmissible – somewhere between 50 and 70 percent more transmissible than the wild-type strain,” said Walensky. “So to the extent that people are not practising those standard mitigation strategies, we do think that more infections will result because of B.1.1.7.”

At the same time, however, several states have begun abandoning mask mandates and allowing for more social gatherings, which may provide an opportunity for the virus to spread as well as to mutatey, developing new deadly variants. 

“The failure to take this virus seriously [is] precisely what got us in this mess in the first place [and] risks more cases and more deaths,” said President Joe Biden at a press conference on Monday.

Joe Biden, US President, delivering his presidential remarks on COVID-19 response and vaccinations on Monday.

BIden pledged that the US will continue scaling up its vaccination campaign, setting the goal of having a vaccination site within five miles of every American by 19 April.

“We are in a ‘life-and-death race’ against the virus. We are facing an accelerating threat,” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services, at the White House press briefing on Wednesday.

This will simultaneously require continued adherence to public health measuring and the improvement of vaccine access nationally.

Image Credits: Johnson & Johnson, Johnson & Johnson, C-Span.

Community health worker distributes ivermectin – the mainstay treatment against onchocercisasis (river blindness) – for the past several decades.

A recent trial of ivermectin, a mainstay treatment for the parasitic disease onchocerciasis for the past three decades, has failed to show significant impacts against COVID-19, a new study,  published in JAMA, reports. The study by a group of researchers in Cali, Colombia found that the use of the antiparitic drug, typically used to treat onchocersiasis  (river blindness) endemic to West Africa, did not not significantly shorten the durationof COVID symptoms in patients with mild disease.

The study of some 400 people found that those trated with the drug had a resolution of symptoms in 10 days, on average, as compared to 12 days – but the two day difference was not deemed statistically significant. “Further trials of ivermectin as a treatment against COVID-19 are, however, still underway. The ANTICOV Consortium, for example, is considering adding ivermectin – in combination with another drug – as an additional arm of its ANTICOV series of clinical trials underway in Africa.  The clinical trials, coordinated by DNDi, are testing the efficacy of different drugs as a potential treatment against mild to moderate cases of COVID-19.”

In light of the inconclusive evidence, WHO, meanwhile, has issued a recommendation that use of ivermectin be limited to clinical trials, until more data is available. This recommendation, which applies to patients with COVID-19 of any disease severity, is now part of WHO’s guidelines on COVID-19 treatments.

Ivermectin is a broad spectrum anti-parasitic agent, included in WHO essential medicines list, and a mainstay of treatment against river blindness for the past four decades or more. Following the breakthrough discovery of efficacy in trials conducted by WHO in the 1970s, it was put into widespread use in West Africa, where river blindness is endemic, under programmes of preventative, mass community administration of the drug once a year.  Only in the past several years has a new treatment for river blindness, moxidectin emerged, which shows promise of even greater efficacy against onchocerciasis. Ivermectin is also used for the tratment of scabies, strongyloidiasis and other diseases caused by soil transmitted helminthiasis.

Ivermectin is traditionally used against onchocerciasis and scabies

The current WHO guidance on ivermectin was issued following a review of the evidence by an international panel of experts. The group reviewed pooled data from 16 randomized controlled trials (total enrolled 2407), including both inpatients and outpatients with COVID-19. They determined that the evidence on whether ivermectin reduces mortality, need for mechanical ventilation, need for hospital admission and time to clinical improvement in COVID-19 patients is of “very low certainty,” due to the small sizes and methodological limitations of available trial data, including small number of events. The panel did not look at the use of ivermectin to prevent COVID-19, which is outside of scope of the current guidelines.  Other WHO recommendations on COVID-19 treatments include:

  • Strong recommendation for the use systemic corticosteroids (e.g. dexemethesone) for severe or critically ill COVID-19 patients; with a conditional recommendation against their use in patients with mild/moderate COVID-19;
  • Conditional recommendation for the use of low dose anticoagulants in hospitalized patients (this recommendation is part of the clinical management guidelines). We suggest the use of low dose anticoagulants rather than higher doses, unless otherwise indicated;
  • Conditional recommendation against administering remdesivir in addition to usual care;
  • Strong recommendation against the use of hydroxychloroquine or chloroquine for treatment of COVID-19 of any severity;
  • Strong recommendation against administering lopinavir/ritonavir for treatment of COVID-19 of any severity.

Updated on 6 April 2020. 

Image Credits: Mectizan Donation Programme, Sarang.