“The world has made tremendous progress against HIV. If we allow COVID-19 to set us back, we could lose more than a decade of these gains…The good news is we know how to preserve the progress made: we have to urgently expand models for differentiated service delivery, and we have to do it right now.” — AVAC 

 

Vaccine Storyline

STAT reports that Trump administration officials indicated that a vaccine would be “free to ‘vulnerable’ Americans unable to afford it…. Officials also said the federal government would employ a ‘tiered approach’ for distributing a future vaccine to high-risk individuals like elderly Americans, those with pre-existing health conditions, and frontline health care workers. People in those categories would be prioritized such that they received a vaccine before the general public, officials said.”

Reuters reports that “AstraZeneca Plc has signed a contract with European governments to supply the region with its potential vaccine against the coronavirus…. The contract is for up to 400 million doses of the vaccine, developed by the University of Oxford, the company said on Saturday, adding that it was looking to expand manufacturing of the vaccine, which it said it would provide for no profit during the pandemic.” A separate Reuters story reports, “AstraZeneca’s potential coronavirus vaccine is likely to provide protection against contracting COVID-19 for about a year, the company’s chief executive told a Belgian radio station….”

Bloomberg reports, “Desperation for a way to keep economies from collapsing under the weight of COVID-19 could mean settling for a vaccine that prevents people from getting really sick or dying but doesn’t stop them from catching the coronavirus.” Researcher Robin Shattock says, “It’s quite possible a vaccine that only protects against severe disease would be very useful.” Some worry about disinhibition with such a vaccine, including one drug development expert who warned: “My guess would be that the day after someone gets immunized, they’re going to think, ‘I can go back to normal. Everything will be fine. They’re not going to necessarily realize that they might still be susceptible to infection.”

Politico says, “public health experts are growing increasingly worried that the White House will pressure regulators to approve the first vaccine candidate to show promise—without proof that it provides effective, reliable protection against the virus.” Experts are concerned that the FDA “could grant emergency-use authorization to one or more vaccines before clinical trials have definitively determined whether they can prevent infection. Taking that step also could make millions of doses available outside of clinical trials, making it hard to enroll enough people in the trials to get the data ultimately needed to show the vaccine works. It could also squeeze other—potentially better—candidates out of the market.”

“As Latin America becomes the new epicentre of COVID-19, concerns are flaring about the prospect of relying on a vaccine developed and manufactured elsewhere, especially given that rich countries have had better access to vaccines in the past,” reports Nature. Researchers in Brazil and other countries are working to find their own vaccine. Brazilian researcher Gustavo Cabral de Miranda “thinks Brazil would be able to produce a safe and effective vaccine on a large scale and distribute it throughout the nation and to neighbouring countries. The country is one of the largest vaccine producers in Latin America. Over the past several decades, it has introduced improved technologies, trained pioneering scientists and developed the most diverse vaccine portfolio in the region—even exporting to other nations.”

Devex reports that CEPI’s CEO believes “Global politics and vaccine scarcity are the biggest challenges to ensuring that a future COVID-19 vaccine will be available in the world’s poorest countries…. Wealthy countries will come under significant pressure to either purchase large quantities or prohibit exports of a locally developed vaccine in order to meet domestic needs, which could mean that poorer countries are left without access. This ‘vaccine nationalism’ is a great challenge, and one seen in 2009 when 15-20 of the world’s wealthy countries bought up all the influenza vaccines in response to the H1N1 pandemic, Hatchett said.”

Medscape reports on concerns with the fast pace of vaccine research: “The speed is a double-edged sword: It could end the pandemic sooner if there is equitable global distribution, but it could also trigger vaccine hesitancy if people believe that safety is being overlooked. Many people, according to multiple polls, are already expressing doubts about whether they would accept a COVID-19 vaccine.”

Bhekesisa reports that advocates from South Africa and other African countries called for a vaccine trial testing the BCG TB vaccine to be stopped “citing concerns about the study’s lack of transparency and community engagement. The groups also demand that the trial’s investigators provide volunteer participants—health workers and other types of hospital employees such as security guards and administrative clerks—are given protective gear.” The full civil society statement is online here.

The potential of challenge studies keeps appearing in the media. A Washington Post article begins, “Lehua Gray, a 32-year-old product manager in Austin, wants to risk her life for a coronavirus vaccine. A cloud of potentially deadly microbes would be spritzed up her nose—if she’s allowed to participate in what’s called a human challenge trial.” The Post article does lay out both the ethical challenges and addresses some of the scientific difficulties of developing a challenge. See AVAC and TAG’s statement on challenge trials here.

STAT reports that Sinovac Biotech, a Chinese company, “announced preliminary study results on Saturday showing its experimental COVID-19 vaccine generated immune responses in patients and was safe—early data that suggest it might protect people against infections with the novel coronavirus.” The data came from a 600-person phase 2 trial and has not been peer reviewed and published. Fierce Pharma reports, “Last week, Sinovac penned a deal with Brazilian immunobiologic producer Instituto Butantan to run the vaccine’s phase 3 in Brazil. In return, Instituto Butantan gains license to the investigational shot in its home country.”

Mis-/dis-information Wars

Wired reports on a new initiative called Stronger that “aims to take the fight to anti-vaccine organizers where they’ve long had the upper hand: on social media. To do so, PGP plans to conscript the vast but largely silent majority of Americans who support vaccines into any army of keyboard warriors trained to block, hide, and report vaccine misinformation…. Their idea is to create an army of debunkers who can quickly be mobilized into action. Having enough people is paramount; there’s safety in numbers when posting on a topic that’s likely to spawn a vigorous online battle.”
 

Pushing Trial Timelines

The overarching narrative of COVID-19 research continues to be speed. STAT reports on “TrialSpark, a startup that is aimed at lowering the cost—and increasing the speed—of clinical trials…. TrialSpark’s model is based on finding patients digitally, often through social media, and using telemedicine, remote data collection, and even at-home testing and specimen collection to test drugs at home.” 

The Second Wave in the US: Coming or not?

The Wall Street Journal had dueling storylines on Tuesday with an op-ed by VP Pence headlined, There Isn’t a Coronavirus ‘Second Wave’, arguing that “the media has taken to sounding the alarm bells over a ‘second wave’ of coronavirus infections. Such panic is overblown.” He argues we are winning against “the invisible enemy.” Over on the news page, Tony Fauci says, “When I look at the TV and I see pictures of people congregating at bars when the location they are indicates they shouldn’t be doing that, that’s very risky. People keep talking about a second wave. We’re still in a first wave.”
 

Disease Clusters and Growing Numbers

CNBC reports, “The World Health Organization said Monday that more scientists globally should investigate disease clusters to analyze what is driving infection and causing further spread, in light of China’s recent outbreak of novel coronavirus cases. ‘The answers lie in careful, systematic, exhaustive investigation of disease clusters to really look at what is happening in these situations and what is causing the amplification of the disease in the human context,’ said Dr. Mike Ryan, executive director of the WHO’s emergencies program.” The call came as China reported a cluster of cases in Beijing and other countries reported a resurgence of cases.

Daily Sabah reports, “India, the fourth-worst-hit country in the world by cases, has now recorded 354,065 cases, according to official figures.”

Nigeria’s Daily Trust reports that “Medical experts have warned that Nigeria could experience dire consequences in the rate of COVID-19 cases and deaths if people continued to violate protective measures against the disease…. Findings by Daily Trust revealed that doubts about the existence of COVID-19 was still widespread among Nigerians in spite of the increasing number of cases. This is happening three months after the country recorded its first case of the disease.”

Mail & Guardian reports, “South Africa is likely to see about 40,000 deaths from COVID-19 by November, according to mathematical modelling released late on Tuesday. And the country will quickly run out of hospital beds to treat patients…. Even in an optimistic course of events, the country faces tens of thousands of deaths in the coming months as the epidemic peaks in July or August, scientists revealed. Pessimistic projections, meanwhile, place the death toll closer to 50,000.”

Drowning in COVID-19 Pubs, but Few by Women 

Every day sees a raft of new COVID preprints and journal articles based on the unprecedented rate of research happening around the disease.

A BMJ article notes that “Women account for about a third of all authors who published papers related to COVID-19 since the beginning of the outbreak in January 2020. Women’s representation is lower still for first and last authorship positions…. With lockdowns enforced across the globe due to the COVID-19 pandemic, many researchers are now working from home and face competing demands from parenting, homeschooling and other caring duties. These roles are predominantly assumed by women, especially in countries with high gender inequality. Women’s representation in research generally, and specifically in the study of COVID-19, may be disproportionately affected by lockdown measures. Under-representation of female researchers tends to create under-representation of issues that are relevant to women in research—in our current situation this may create important gaps in our understanding of COVID-19.”

A STAT opinion piece argues the need for open access for COVID-19 research to help speed research and collaborations. The authors argue that “The COVID-19 crisis merely highlights an acute form of a more chronic and systemic problem. Scientific research has a fundamental role in finding solutions to many of the pressing problems facing the world today, from cancer to climate change, and progress on all these fronts is slowed when access to the latest research, as well as archives, is unnecessarily restricted.” More than 100 researchers “urge the scientific publishing industry to open its store of scientific knowledge—which the research community has entrusted to it—and make this knowledge available to the world. If not, the governments that funded this work should declare eminent domain over these materials and demand immediate, unimpeded access. It would be the ethical thing to do.”

COVID-19 and Children

Nature reports, “research suggests that the answer might lie in children’s healthy blood vessels.” Noting that “a growing number of researchers think that the difference between adults and children might be the condition of their blood vessels.” The article describes one very small study that “found that SARS-CoV-2 can infect endothelial cells, which are found throughout the body. In a study of three people with COVID-19, two of whom died, Ruschitzka’s team found that SARS-CoV-2 had infected the patient’s endothelium and caused inflammation and signs of clotting.” Researchers “think that children’s blood vessels are able to withstand a viral attack than adults.” Studies are underway now to provide more information on this theory.

AP fact checked comments by Trump on children and COVID-19. He said, “They’ve come out of this at a level that’s really inconceivable. By the way, the regular flu, other flus, other things, SARS or H1N1, any of them, if you look at the young people they were affected like everybody else, but for whatever reason with respect to COVID, the numbers are very, very low.” AP says, “Trump’s statements overlook severe COVID-19 illnesses and some deaths of children in the US, even though kids in general tend to get less sick from it than adults do. He also glosses over the fact that kids can spread disease without showing symptoms themselves.”

Who Is at Risk and How Should Risk Be Addressed?

New York Times reports on a Lancet Global Health modelling study that estimates “Roughly 1.7 billion people have at least one of the underlying health conditions that can worsen cases of the coronavirus.” A commentary in Lancet that accompanies the study argues that “Tailoring policies on the basis of emerging evidence about conditions associated with COVID-19 severity is key to informing the actions of both policy makers and individuals. This means moving from generalised population-based mitigation strategies to focusing on those most at risk of severe outcomes from COVID-19.” The authors note that “based on lessons learned from HIV and Ebola on the importance of working together with communities, it is time for policy makers to shift to a less patriarchal approach and engage with, rather than shield, communities so that communities have agency and voice in developing the response. A two-way dialogue with formal and informal leaders is an evidence-based approach to addressing fear, misinformation, and contextualising the response for those at risk of severe outcomes.” 

MMWR reports on US COVID Cases: “As of May 30, 2020, among COVID-19 cases, the most common underlying health conditions were cardiovascular disease (32 percent), diabetes (30 percent), and chronic lung disease (18 percent). Hospitalizations were six times higher and deaths 12 times higher among those with reported underlying conditions compared with those with none reported.”

STAT reports that researchers at “eight Centers for AIDS Research” in the US are “examining the records of people living with HIV who have also had COVID-19. They plan to add coronavirus antibody testing to upcoming patient appointments so they can include in their study people who had asymptomatic or mild cases of the disease without knowing they were sick. [They] are hoping to answer several questions: Are people living with HIV at higher risk of complications if they contract COVID-19? What factors might predict which patients are most at risk? Are people with HIV who contract COVID-19 more likely to be symptomatic? And are people with HIV more likely to die if they do contract the new coronavirus?”
 

Protests and COVID

There continues to be disagreements about the risk of protesting during this time. Right wing US politicians, pundits and others have called those who support protesting for Black Lives Matter but not opening up hypocritical. Epidemiologists Gregg Gonsalves and Julia Marcus write, “Supporting one kind of protest but not another may seem confusing at first, but the decision reflects what public-health experts have always tried to do: maximize the health of the population across all aspects of life. And health is about more than simply remaining free of coronavirus infection…. The people who are marching in the streets right now are well aware of the risk of coronavirus transmission. Many of the protesters are from communities of color, which have been hit hardest by the pandemic, and some have lost loved ones to the coronavirus.”

The Washington Post writes that “More than 1,000 public health specialists signed a letter supporting the massive outpouring of grief and anger…. Ranu S. Dhillon, an infectious-disease expert at Harvard Medical School, said he views the protests as risky but necessary—just like working in a nursing home or grocery store. ‘Protesting against systemic injustice that is contributing directly to this pandemic is essential. The right to live, the right to breathe, the right to walk down the street without police coming at you for no reason... that’s different than me wanting to go to my place of worship on the weekend, me wanting to take my kid on a roller coaster, me wanting to go to brunch with my friends.’”

Kaiser Health News reports on “street medics” who have “plunged into street protests over the past weeks to help the injured—sometimes rushing to the front lines as soon as their hospital shifts ended…. Many are medical professionals who see parallels between the front lines of COVID-19, where they confront stark racial imbalances among those stricken by the coronavirus, and what they see as racialized police brutality.”
 

Antibody Hope in Animal Study

A peer reviewed study in Science “showed that passive transfer of a nAb provides protection against disease in high-dose SARS-CoV-2 challenge in Syrian hamsters, as revealed by maintained weight and low lung viral titers in treated animals. The study suggests a role for nAbs in prophylaxis, and potentially therapy, of COVID-19. The nAbs define protective epitopes to guide vaccine design.” A press release says the finding “offers a paradigm of swift reaction to an emergent and deadly viral pandemic, and sets the stage for clinical trials and additional tests of the antibodies, which are now being produced as potential treatments and preventives for COVID-19.”  The research may also help guide vaccine research.
 

The End of Hydroxychloroquine for COVID-19?

CNN and other outlets report that the FDA “has revoked its emergency use authorization for the drugs hydroxychloroquine and chloroquine for the treatment of COVID-19. Hydroxychloroquine was frequently touted by President Donald Trump, and he has claimed to have used it himself. After reviewing the current research available on the drugs, the FDA determined that the drugs do not meet ‘the statutory criteria’ for emergency use authorization as they are unlikely to be effective in treating COVID-19 based on the latest scientific evidence, the agency noted on its website on Monday.”

STAT reports, “Interest in the drug could also grow again as more clinical trials readout. There are still over 100 active or recruiting clinical trials testing hydroxychloroquine as a COVID-19 treatment, according to clinicaltrials.gov. FDA’s decision has no impact on those clinical trials, and if one or more have positive results, that could reignite interest over the drug.”
 

Masks Work

Washington Post reports, “Population-wide face mask use could push COVID-19 transmission down to controllable levels for national epidemics, and could prevent further waves of the pandemic disease when combined with lockdowns, according to a British study last week.”
 

COVID’s Knock-on Effects

The Guardian reports that “COVID-19 has exposed just how much work remains to be done to wipe out female genital mutilation (FGM) around the world. Two million girls who would otherwise be safe from the practice are believed to be at risk over the next decade as a direct result of the virus.”

Washington Post reports, “Global shutdowns have pushed about 1.5 billion students out of school since March, according to a United Nations Children’s Fund report citing data from UNESCO, including 111 million girls in the world’s least developed countries. The disruptions are projected to end or seriously delay the education of 10 million secondary-school-age girls, according to an April report from the Malala Fund, which analyzed data from Sierra Leone’s Ebola crisis.”

NPR’s Goats and Soda blog reports, “The case and death rates from COVID-19 in Thailand are among the world's lowest, with about 3,100 confirmed cases and 58 deaths, as of Thursday. Thai epidemiologists say their health care system—one of the finest in the world—had a major role to play. So did a strict lockdown. But like many other countries, the measures to contain the virus have also caused mass disruptions as the economy came to a sudden stop.” A public health official “says that now the threat of COVID-19 is under control, the government is faced with a different public health challenge: ‘The next wave of the problem will be mental health.’”

Politico reports that as brothels reopen in many European countries, “Sex workers are faced with a dilemma: open for business and risk getting coronavirus, or face having no income. The pandemic has laid bare the legal limbo in which most sex workers operate in Europe, with many unable to access state support. During the lockdown, that meant either no money or breaking the rules and carrying on working — adding an extra layer of risk to what for many is already a dangerous job.”
 

Inequities

The Commonwealth Fund reports that “The COVID-19 data reported by the US Centers for Disease Control and Prevention (CDC) are solely for the national and state level, and for total population only. The first data sets to document the count of confirmed cases and deaths by US county, released on March 27, were produced not by a government agency, but by the New York Times and Washington Post…a growing number of health professionals, politicians, and advocates have begun to call for COVID-19 data to be reported in relation to race and ethnicity, as journalists have begun to reveal starkly higher burdens of COVID-19 mortality among African American, Latinx, and American Indian communities.”

Medscape reports “of the 2042 COVID-19 clinical trials listed on clinicaltrials.gov on June 10, just three are looking at therapeutics in pregnant women; most therapeutic trials exclude pregnant women.” Some researchers are advocating for including pregnant women in trials and it appears to be working. “The international SOLIDARITY trial, sponsored by the World Health Organization (WHO), changed its inclusion criteria to allow pregnant women to participate. And a large trial in the United Kingdom—RECOVERY—allows pregnant and lactating women to participate with informed consent.”

Politico reports that “Federal and state health agencies are refusing to give Native American tribes and organizations representing them access to data showing how the coronavirus is spreading around their lands, potentially widening health disparities and frustrating tribal leaders already ill-equipped to contain the pandemic.”
 

Fact Checks and Press Suppression

BBC factchecks a Harvard study that posited that COVID-19 may have emerged in August 2019 “based on satellite imagery of traffic movements around hospitals in Wuhan and the tracking of online searches for specific medical symptoms.” BBC concludes, “The study findings—that coronavirus may have been present in Wuhan as far back as last August—are for the reasons we've highlighted, highly problematic. There is, however, still much we don't know about the early onset of the virus in China - both when and how the first cases emerged.”

The Committee to Protect Journalists issued a statement “in response to a newly published internal email showing that the US Centers for Disease Control and Prevention (CDC) prohibited its employees from accepting interviews with the US Congress-funded broadcaster Voice of America.” CPJ said, “The Trump administration has created an environment of fear for officials speaking to the press, which interferes with the media’s work as a watchdog.” The VOA director issued a condemnation of the CDC move and resigned her position.
 

Need a Hug

WebMD reports on a family who built a human size “plastic glove” to allow them to hug an older relative. The story notes, “Understanding the reason why we can’t hug and touch those we love during this pandemic is one thing. Dealing with the effects of that are still proving very difficult for many. Some say we’re having ‘skin hunger.’ Others refer to it as hug deprivation or touch starvation…. For many—including those who are older, considered high-risk for COVID-19, or who love people who are especially vulnerable to the virus—it’s especially hard because the prospect of hugging loved ones again feels very far off.”
 

Resource of the Week

Accountability International’s scorecard is “an independent, civil society driven analysis of the COVID - 19 data for Africa…which connects the various issues of health, human rights, socio-economics and accountability to Africa community leaders and human rights activists.”