-- Editorial in The Lancet

 

The COVID story this week remains largely about rising cases and rising vaccine hopes. In both of those threads the common theme is inequity. In the US, infection rates among Black and Brown communities remain much higher than among Whites. And globally the good vaccine news is `blunted by concerns that vaccine nationalism will limit access to many countries for possibly years.
 

If You Are in a Hurry

• Click here to see a cartoon in South Africa’s Daily Maverick that sums up many of the issues around vaccine access.
• Read a Love Letter to Black America from Black doctors and nurses.
• See a graphic from Gzero that outlines which countries have reserved vastly more COVID vaccine doses than they have citizens.
• Read about WHO’s new mask guidelines on CBC.
• Read Reuters for Africa CDC’s John Nkengasong's vaccine plan for Africa.
• Listen to the Undark podcast about COVID-induced collective trauma.
• Check out “COVID-19 Diagnostics In Context” a resource from Harvard.
• Read an Internews blog about how experiences reporting on HIV and Ebola prepared journalists to report on COVID.

 

Addressing Inequities in the US

 
AP reports that Dr. Marcella Nunez-Smith, associate dean for health equity research at Yale’s medical school and co-chair of President-elect Biden’s COVID task force is focused on addressing racial inequities in the pandemic response. AP notes, “For Blacks, Hispanics and Native Americans in the US, the rates of hospitalization and death from COVID-19 are two to four times higher than for whites, according to the Centers for Disease Control and Prevention.” Nunez-Smith says, “The pandemic, very sadly and unfortunately, laid bare what were preexisting structural and social realities that really predisposed particular communities to be hardest hit by this pandemic. Hardest hit from a health perspective and hardest hit from an economic perspective.”
 
A report from the Urban Institute found “that Black, Native American, and Hispanic/Latinx workers are more likely than white workers to have jobs that place them at greater risk of exposure to and transmission of the coronavirus. More than half of all Black, Native American, and Hispanic/Latinx workers have essential or nonessential jobs that must be done in person and close to others, compared with 41 percent of white workers.” The authors write, “Importantly, with safe, effective vaccines emerging for COVID-19, it is essential that distribution of free or very low–cost vaccines be prioritized for essential workers whose jobs place them in frequent contact with others. Efforts to vaccinate workers should encourage voluntary receipt while accounting for workers’ potential concerns about vaccine safety and cost. At the same time, the roll out of the vaccine will need to be accompanied by outreach campaigns developed and implemented with community input, using trusted messengers and health care providers.”
 

Vaccine Acceptance

 
Essence reports “While trust in the vaccine process is not only a Black issue, Black healthcare professionals are making it their mission to help inform Black people about the vaccine process and safety. In late November, eight Black health professionals put out a “Love Letter to Black America” affirming their commitment to Black communities and encouraging people to trust in the safety of vaccinations.” The letter in part reads, “Respect for our Black bodies and our Black lives must be a core value for those who are working to find the vaccine for this virus that has already taken so many of our loved ones. Our colleagues across healthcare know that we are urging our community to take safe and effective vaccines once available. However, for this to be successful, they must do more to earn your trust—now and in the future.”
 
In an NPR interview, Dr. Robert Atmar, a member of the Advisory Committee on Immunization Practices that recommended “the first vaccines should go to health care workers and residents and staff of long-term care facilities” says “We're hearing a lot of hesitation among health care personnel, and I think a lot of it has to do with the politicized nature of the vaccine development and the whole response to the pandemic." 
 

Vaccine Approvals

 
The UK became the first Western country to approve a vaccine. (Russia and China have already approved and rolled out vaccines to some of their populations.) BBC reports that the UK medical regulatory agency approved the Pfizer/BioNTech vaccine. “Elderly people in care homes and care home staff have been placed top of the priority list, followed by over-80s and health and care staff. But because hospitals already have the facilities to store the vaccine at -70C, as required, the very first vaccinations are likely to take place there—for care home staff, NHS staff and patients—so none of the vaccine is wasted.” The Wire reports that the EU was critical of the UK approval. “The decision was made under an ultra-fast, emergency approval process, which allowed the British drugs regulator to temporarily authorise the vaccine only 10 days after it began examining data from large-scale trials. In an unusually blunt statement, the European Medicines Agency (EMA), which is in charge of approving COVID-19 vaccines for the EU, said its longer approval procedure was more appropriate as it was based on more evidence and required more checks than the emergency procedure chosen by Britain.”
 
The EU plans to review the Pfizer vaccine on December 29. The US FDA will review the Pfizer vaccine in an open meeting on December 10 and the Moderna vaccine on December 17.
 

Vaccine Access

 
Reuters reports “Africa aims to have 60 percent of its population vaccinated against COVID-19 within the next two to three years, the African Union’s disease control group said on Thursday.” Africa CDC’s John Nkengasong is quoted: “We hope that for that for this to be meaningful, our 60 percent must be reached in the next two to three years. We should be deliberate in this. If the delay takes us to four to five years then the virus will be endemic in our communities.”
 
A Lancet editorial calling for a vaccine plan for Africa concludes “as the governments of wealthy countries push their way to the front of the vaccine queue, their leaders would do well to remember that without a vaccine plan for African countries and other nations with resource constraints, the protection of their citizens from COVID-19 will be an illusory victory.”
 
Gzero has published a graphic showing the number of vaccine doses per citizen key countries have reserved. Canada leads the pack with 11 doses per citizen, the US has reserved just under 8 doses per citizen and the EU just over 4. The accompanying text notes, “many governments in emerging market economies, where healthcare infrastructure is generally weaker, are worried they'll be kicked to the back of the line in the global distribution process. Indeed, history bears out their concerns: while a lifesaving HIV treatment hit shelves in the West in the mid-1990s, for example, it took years to become widely in Africa….”
 
An open letter in Medium to US President-elect Biden from  “a cross-section of leaders from public health, business, faith-based, racial justice and labor organizations, public service, entertainment and economics” calls on Biden “to commit to a People’s Vaccine, which provides protection as a global public good, freely and fairly available to all, prioritizing those most in need worldwide.”
 
CNN reports, “In the coming months, China will be sending hundreds of millions of doses of coronavirus vaccines to countries that have conducted last-stage trials for its leading candidates. Chinese leaders have also promised a growing list of developing countries priority access to its successful vaccines…. Having largely eliminated the coronavirus inside its borders, Chinese drugmakers had to look abroad for places to test the efficacy of their vaccines. Together, they have rolled out phase 3 trials in at least 16 countries. In exchange, many of the host countries have been promised early access to the successful vaccines—and in some cases, the technology know-how to manufacture them locally.” Importantly, none of the Chinese vaccine candidates have announced any preliminary efficacy results, though company executives have repeatedly stressed their safety, insisting no serious adverse effect has been observed in vaccinated volunteers.”
 
US News reports that Russia plans to begin mass vaccinations with its vaccine Sputnik, beginning with doctors and teachers. “Russia claimed last month that preliminary data shows its vaccine is more than 95 percent effective, though scientists have been wary of the country's claims and the country has been criticized for its premature announcement in August that it had the world's first coronavirus vaccine before phase three trials of Sputnik V had even been completed.”
 
News24 (South Africa) reports, “South Africa should use lessons from the pandemic to focus on ensuring that it can manufacture vaccines in future, rather than just advocating that these should be made freely available to all, International Relations and Cooperation Minister Naledi Pandor has said…. ‘There's no better lesson than the pandemic towards the importance of research development and innovation and I believe, if there is anything South Africa should give attention to, it is that. If we don't, we remain vulnerable.’”
 
Bloomberg reports, “South Africa is hosting three trials, including for Johnson & Johnson and a partnership between AstraZeneca Plc and the University of Oxford, yet hasn’t announced a firm strategy to immunize a population that’s bracing for a potential resurgence of the pandemic…. South Africa did confirm last week that it plans to sign up to COVAX, a global initiative that strives to ensure that poorer countries have access to shots. The National Treasury has allocated 500 million rand ($33 million) toward the program and will need to find a further 4.5 billion rand to move to “the front of the queue,” Finance Minister Tito Mboweni said in an interview.” Researcher Francois Venter is quoted: “What worries me about government is the clear lack of communication. We’re all sitting here terrified, not knowing if we get the vaccine.”
 
A cartoon in Daily Maverick (South Africa) graphically illustrates the inequities in global vaccine access and pleads “This World AIDs Day, lets learn from past mistakes.”
 

Vaccine Research/Results

 
Jon Cohen reports in Science on data from the Moderna vaccine. Reporting on data from a company press release: “Only 11 people who received two doses of the vaccine developed COVID-19 symptoms after being infected with the pandemic coronavirus, versus 185 symptomatic cases in a placebo group. That is an efficacy of 94.1 percent, the company says, far above what many vaccine scientists were expecting just a few weeks ago. More impressive still, Moderna’s candidate had 100 percent efficacy against severe disease. There were zero such COVID-19 cases among those vaccinated, but 30 in the placebo group.”
 
Last week’s news of efficacy for the AstraZeneca/Oxford vaccine was tempered with new information. New York Times reports, “since unveiling the preliminary results, AstraZeneca has acknowledged a key mistake in the vaccine dosage received by some study participants, adding to questions about whether the vaccine’s apparently spectacular efficacy will hold up under additional testing. Scientists and industry experts said the error and a series of other irregularities and omissions in the way AstraZeneca initially disclosed the data have eroded their confidence in the reliability of the results.”
 
The Hill reports, “Moderna said Wednesday it will begin testing its COVID-19 vaccine on children, starting with kids aged 12 through 17…. The study will include 3,000 participants, with half receiving the vaccine and half being injected with a saline placebo. Both will be administered in two doses, scheduled 28 days apart.”
 

Vaccine Black Market

 
The Wall Street Journal reports, “Criminal gangs will likely attempt to get their hands on the new COVID-19 vaccines, international police organization Interpol warned, potentially disrupting supplies of the crucial shots as they become available. The agency issued a global orange notice—which it describes as a serious and imminent threat to public safety—to its 194 members, calling the vaccines “liquid gold.” It warned that counterfeit vaccines or fake coronavirus tests could become a growing problem as international travel gradually resumes in the months to come.”
 
STAT reports “Athletes, politicians, and other wealthy or well-connected people have managed to get special treatment throughout the pandemic, including preferential access to testing and unapproved therapies. Early access to coronavirus vaccines is likely to be no different, medical experts and ethicists told STAT. It could happen in any number of ways, they said: fudging the definition of ‘essential workers’ or ‘high-risk’ conditions, lobbying by influential industries, physicians caving to pressure to keep their patients happy, and even through outright bribery or theft.
 

Covidization of Research

 
Nature reports on concerns from researchers not working on COVID-related projects: “covidization describes the distorting impact of the pandemic on the way science is funded, produced, published and reported on. Pai was worried that the pandemic would force countries, funders, health agencies and researchers to focus too much on infectious threats of pandemic significance. Research into other factors vital for public health, from non-infectious diseases to climate change, could lose out.”
 

Why a COVID Vaccine Before an HIV One?

 
Aisha Abdool Karim writes in Bhekesisa about why there are COVID vaccines before HIV ones. “The biggest challenge with HIV is that our bodies haven’t yet figured out how to produce antibodies that can completely kill the virus. In the case of SARS-CoV-2, the virus that causes COVID-19, millions of people have recovered from the virus, so researchers can use the antibodies we produce naturally to guide them as to the type of antibodies and killer cells the vaccines they develop should generate.”
 

New WHO Guidance on Masks

 
WHO released new guidance on mask use. CBC reports the “tightened guidelines” recommend that “where COVID-19 is spreading, they be worn by everyone in health-care facilities and for all interactions in poorly ventilated indoor spaces…. Masks should also be worn outdoors and in well ventilated indoor spaces where physical distancing of at least one metre can't be maintained….”
 

Inequities

 
All Africa reports on a study commissioned by the Gates Foundation that “analyzed indicators of gender equality in reporting in terms of women as protagonists and as sources of news expertise and the coverage of gender equality issues in general in COVID-19 reporting. The report raised concerns about how women's voices have been blocked out during the COVID-19 pandemic, largely because of society's patriarchal values. Each woman's voice in news coverage of the crisis is ‘drowned out’ by at least three, four, or five men, the report said.” The study looked at media coverage in six countries: South Africa, Kenya, Nigeria, India, United States, and the United Kingdom.
 

Healthcare Worker Burnout

 
A commentary in STAT addresses “burnover” among US healthcare workers—moving past burnout to something more serious. “Clinicians again face work that is risky, heart-rending, physically exhausting, and demoralizing, all the elements of burnout. They have seen this before and are intensely frustrated it is happening again…. The disconnect between what health care workers know and how the public is behaving, driven by relentless disinformation, is unbearable.” The authors argue, “It is time for leaders of hospitals and health care systems to add another, deeper layer of support for their staff by speaking out publicly and collectively in defense of science, safety, and public health, even if it risks estranging patients and politicians.”
 

Human Rights Abuses

 
SciDevNet reports an investigation has found “people living with HIV have been arrested, tortured and denied medication as COVID-19 restrictions across the globe become tools of discrimination…. Across the world, authorities have been using coronavirus control measures as justification to attack and arbitrarily arrest people living with HIV, particularly those in the lesbian, gay, bisexual, and transgender communities (LGBTQ+).” Sharifah Sekalala, a global health law expert is quoted: “one of the things that concerns me is that we’ve already seen with the HIV crisis that if you discriminate against people in this way within a crisis, then people go underground. It’s not just for AIDS, it’s also going to be for COVID-19 because you destroy trust in public health systems. When you use law in this way you really harm public health as a whole.”
 
Buzzfeed reports, “Uganda is using social distancing rules as a reason to detain 19 people for a month without access to lawyers, following a raid on an LGBTQ shelter…. They’ve been charged with violating social distancing orders and were formally accused of committing a ‘negligent act likely to spread an infectious disease’ because they had so many people under one roof.”
 

Pot Calling Kettle…

 
Mt Kenya Times reports the US CDC “has categorized four East Africa Countries at COVID-19 level 4 meaning there is a very high level of coronavirus infection.” The countries include Burundi, Kenya, Tanzania and Uganda. “The institution has warned American citizens against travelling to the countries over increased COVID-19 infections. Some says it is perfect case of pot calling kettle black as the United States reported more than 200,000 new infections yesterday.
 

Infodemic

 
UN News reports WHO announced a new network in Africa that “aims to combat the ‘infodemic’ of misinformation online surrounding COVID-19 and other health emergencies on the continent…” The Africa Infodemic Response Alliance (AIRA) “is the first initiative of its kind, working to detect, disrupt and counter damaging misinformation on public health issues in Africa.”
 

Pandemic Trauma

 
South Africa’s Undark podcast interviews “researchers and therapists examining the psychological impacts of COVID-19 through the lens of collective trauma.” Lydia Chain, host of the podcast notes, “Sometimes a community goes through something so traumatic that the event leaves a societal scar. It’s not just the sum of each individual person’s struggle with their own private trauma—it’s bigger than that. Psychologists call this collective, or communal trauma, and it can impact the psyche and culture of the group itself, sometimes spanning generations. As the Covid-19 pandemic is unfolding, so are the psychological effects. Some of these effects, like anxiety over a job, or grief over a lost loved one, impact individuals. But collective trauma researchers say this is the kind of event that will have widespread and long-lasting impacts on society. They are trying to study and ease this trauma as it unfolds, all while suffering through the pandemic themselves.”
 

Language Matters

 
Axios reports, “A new study finds certain vocabulary is more effective at getting the public to take the COVID-19 pandemic seriously.” Polling in the US suggests, “Republicans tend to take the coronavirus less seriously, in part because the vocabulary used to describe safety measures feels invasive of their constitutional rights. It also finds that the language used to talk about the virus is often too impersonal to be effective…. The data shows that Americans have a more positive reaction when rules and regulations to address COVID-19 are called ‘protocols’ as opposed to ‘mandates,’ ‘directives,’ ‘controls,’ or ‘orders.’”
 

Resource of the Week

 
A resource from Harvard “COVID-19 Diagnostics In Context” provides a handy overview of COVID tests.
 

Fauci Is Staying

 
We knew he wouldn’t leave, but according to Reuters “President-elect Joe Biden has asked top US infectious disease expert Anthony Fauci to continue in his job and serve as Biden’s chief medical adviser and on the COVID-19 team after Biden takes office on Jan. 20, Biden said on Thursday…. Biden also said he would get the COVID-19 vaccine when Fauci says it is safe and would be happy to take it publicly.
 

Pandemic Preparedness for Journalists

 
An Internews blog looks at how experiences reporting on HIV and Ebola prepared journalists in Africa to report on COVID. The blog notes many reporters “had already mastered the semantics of public health (when is a rapidly spreading disease an ‘outbreak’, an ‘epidemic’ or a ‘pandemic’, for example?) as well as much of the science underpinning public and clinical-health measures. They knew ‘the right questions to ask,’ says Anna Miti, in terms of learning about a new public health threat.”