Globally only 1.71 percent of the population is fully vaccinated. New waves of COVID are sweeping across multiple countries and regions with new lockdowns coming in some places, while others continue to open up.
 
More than a year into the pandemic it is clear that there is a sizeable impact on health and development overall from lockdowns, reluctance or inability to seek healthcare, economic impacts and other issues. The latest evidence comes from a Lancet Global Health (UK)  “systematic review and meta-analysis of studies on the effects of the pandemic on maternal, fetal, and neonatal outcomes.” The New York Times (US) reports “Reviewing data on more than six million pregnancies, the investigators found evidence that disruptions to health care systems and patients’ fear of becoming infected at clinics may have led to avoidable deaths of mothers and babies, especially in low- and middle-income countries. Data from a dozen studies showed that the chances of a stillbirth increased by 28 percent. And the risk of women dying while pregnant or during childbirth increased by more than a third in two countries: Mexico and India. A subset of studies that assessed mental health showed that postpartum depression and anxiety were also heightened during the pandemic.”
 

If You Are in a Hurry       

• Read a NEJM perspective from several HIV researchers about lessons from the HIV pandemic for COVID vaccine scale-up.
• Read Nature on what it will take to vaccinate the world.
• Read about the dire situation in Brazil and how it could fuel more variants in Scientific American.
• Read about pandemic-induced scientist burnout in Science.
• Listen to a NEJM audio discussion that touches on results by press release, ongoing trials and issues with COVID vaccine uptake.

 

Vaccine Hesitancy

 
A NEJM (US) commentary addresses some of the issues around vaccine hesitancy and lack of access to COVID vaccines among BIPOC in the US: Although BIPOC communities have important reasons to be hesitant, increasing reports of disparities in vaccine access throughout the country point to broader systemic challenges, such as inequitable distribution of doses, failure to place clinics in sites accessible to BIPOC communities, and underinvestment in health care providers and services in BIPOC communities…. It is essential to remember that hesitancy doesn’t mean refusal, and in fact, skepticism can be protective for BIPOC communities. However, we believe it’s time to shift the focus from a sole emphasis on changing hearts and minds among members of BIPOC communities to ensuring that institutions are trustworthy, transparent, and engaged with communities during the vaccine rollout.”
 
The Star (Kenya) reports “Nairobi residents have been urged not to be misled by negative propaganda about the COVID-19 vaccination and to get the jab as soon as possible. Negative reports cite terrible side effects…[some] say the vaccine genetically alters those who receive it—…not true…. The Ministry of Health has said most side effects, if any, are mild to moderate and short-lasting. The benefits of the vaccine far outweigh any side efforts or contracting COVID-19.”
 
The Atlantic (US) reports Hong Kong “is having trouble getting the public to take part in its vaccination drive, an effort hampered in large part by deep suspicion of the government and a historically unpopular leader who has struggled mightily to convince the public of the benefits of getting inoculated. An abundance of vaccines, officials are discovering, means very little when trust is in such short supply.”
 

Learning from HIV to Scale Up COVID Vaccines in Africa

 
A NEJM perspective from several HIV researchers argues “concerns regarding access to COVID-19 vaccines in Africa are reminiscent of concerns raised about responding to the HIV pandemic in the mid-1990s and early 2000s” when ART was not readily available in African countries. “As we have learned from the HIV pandemic, biomedical advances alone are insufficient to sustainably control a pandemic. Considerations related to health infrastructure, local epidemiology, and responsiveness to local concerns and beliefs are critical for ending the COVID-19 pandemic—not only in Africa, but also globally. Each country will have its own unique challenges in vaccine distribution, which should be addressed with careful planning, including leveraging computational models of prioritization and rollout strategies, and applying methods from implementation science to maximize local impact. Addressing these differences is essential if we are to control current and future pandemics.”
 

Vaccine Passports

 
As more people in a few countries are vaccinated the idea of “vaccine passports” continues to be a topic of conversation and debate. A commentary in NEJM (US) notes several western countries are discussing or have already implemented some form of vaccine passports. The authors point out “while vaccine supply remains limited, privileging people who are fortunate enough to have gained early access is morally questionable. Second, even after supply constraints ease, rates of vaccination among racial minorities and low-income populations seem likely to remain disproportionately low; relatedly, if history is a guide, programs that confer social privilege on the basis of ‘fitness’ can lead to invidious discrimination. Third, the extent of protection conferred by vaccination, particularly against new variants, is not yet well understood, nor is the potential for viral transmission by people who have been vaccinated. Fourth, privileging the vaccinated will penalize people with religious or philosophical objections to vaccination. Finally, we lack a consensus approach to accurately certifying vaccination…. Rational and ethical vaccine certification policy is likely to shift regularly as vaccine availability increases, herd immunity nears, and scientific evidence of effectiveness or limitations grows. Determining how long vaccines work and how well they protect against new variants will be critical. But knowing that change is inevitable is not grounds for holding back guidance until circumstances become clear. Current circumstances demand immediate policies that offer reasonable leeway for balancing protection of public health with a return to prepandemic life.”
 
PBS Newshour (US) reports that vaccine passports are likely “inevitable” despite concerns about privacy and inequity. Dr Leena Wen is quoted: “Vaccine passports could be a valuable tool to help people feel safe about once again boarding cruise ships and airplanes or packing into restaurants and theaters, she said. Activities that were once commonplace are now shrouded with dread about airborne illness, outbreaks and a pandemic without end. With a vaccine passport system in place, Wen said, ‘many people will feel more comfortable in engaging in activities where they’re assured that people around them are fully vaccinated, too.’” In the US, as with much of the response to COVID, there is a political divide around passports, with many on the right seeing it as a potential for government control.
 

Vaccine Fraud

 
The Star (Kenya) reports “The World Health Organization has warned criminals are increasingly attempting to exploit ongoing vaccination to peddle bogus COVID-19 vaccines. It said countries must now increase vigilance within their supply systems to prevent falsified products. ‘Increased vigilance should include hospitals, clinics, health centres, wholesalers, distributors, pharmacies, and any other suppliers of medical products,’ WHO said in a statement…. The WHO warning comes after bogus liquid being sold as Sputnik V and Pfizer COVID-19 vaccines was intercepted in South America and South Africa.”
 

Vaccinating the World: What Will It Take?         

 
Nature looks at what it will take to “vaccinate the world,” reporting “Some 413 million COVID-19 vaccine doses had been produced by the beginning of March, according to Airfinity data. The company projects that this will rise to 9.5 billion doses by the end of 2021. A larger figure was published last week in an analysis from the Global Health Innovation Center at Duke University in Durham, North Carolina. The Center’s researchers aggregated publicly announced forecasts from vaccine makers, which add up to around 12 billion doses by the end of the year.” Nature looks at several issues that may be slowing vaccine capacity, including intellectual property: “Proponents argue that the waiver will enable governments and manufacturers to jointly organize a ramping up of vaccine supply. Without such a waiver, they say, poorer countries will remain dependent on the charity of richer countries and their pharmaceutical industries….’ We cannot repeat the painful lessons from the early years of the AIDS response, when people in wealthier countries got back to health, while millions of people in developing countries were left behind,’ Winnie Byanyima, executive director of UNAIDS, said earlier this month.” But “Jerome Kim, director-general of the International Vaccine Institute in Seoul, says: ‘The thing about vaccines is that, unlike a drug, you can’t just [follow instructions] and assume that you’ve got a vaccine. This is a complex biological process that has multiple quality-control steps.’ For RNA technology, he says, ‘it’s really not that robust yet’.”
 

Variants

 
A key question is how well the various vaccines will protect against existing and future variants. Some encouraging data is emerging. MedPage Today (US) reports “Pfizer-BioNTech's COVID-19 vaccine appeared to be 100 percent effective at preventing cases of the South African variant, B.1.351…. Topline results from a phase III clinical trial of 800 people in South Africa, where the variant is predominant, showed nine cases in the placebo group versus none among vaccine recipients, for a vaccine efficacy of 100 percent, albeit with a wide 95 percent confidence interval (lower bound 53.1 percent).”
 
Scientific American reports that the hard-hit city of Manaus and “Brazil as a whole have become an exemplar of what happens when a country pursues a strategy of denying the pandemic and embracing herd immunity by letting the virus spread unchecked. Brazil’s president Jair Bolsonaro has promoted the idea of letting the pathogen move throughout the population until most people have been infected. He described proposals for a lockdown in before a crushing second wave of infections hit as ‘absurd.’ And he has downplayed the severity of the crisis, saying that the nation of 211 million has to recognize that death is an inevitability and so Brazilians should stop being ‘sissies.’ The country is currently recording around a quarter of all weekly COVID-19 deaths despite being home to less than 3 percent of the world’s population. The legacy of the nation’s approach to countering COVID has meant that the spiraling case numbers and deaths registered in Manaus and the rest of Brazil are now spreading through the world in the form of a new variant of the virus. Studies suggest this variant could spread more than twice as fast.”

CNN reports, “COVID-19 cases are on the rise among Brazil's younger population, a Brazilian research institute has found…’The country is in a situation of collapse of the health system. At the same time, the pandemic has been gaining new characteristics affecting younger age groups: 30 to 39 years, 40 to 49 years and 50 to 59 years,’ reads the report published Friday by Brazil's Oswaldo Cruz Foundation (Fiocruz).”
 
The Guardian (UK) reports, “The planet could have a year or less before first-generation COVID-19 vaccines are ineffective and modified formulations are needed, according to a survey of epidemiologists, virologists and infectious disease specialists…. Persistent low vaccine coverage in many countries would make it more likely for vaccine-resistant mutations to appear, said 88 percent of the respondents...” Gregg Gonsalves is quoted: “Unless we vaccinate the world, we leave the playing field open to more and more mutations, which could churn out variants that could evade our current vaccines and require booster shots to deal with them.”
 

Pandemic Toll on Scientists

 
Science has given us many answers and solutions for fighting this virus in an amazingly compressed timeline. But not without cost to the researchers working on understanding the virus and finding solutions. Science (US) reports, “From academic research centers to intensive care units (ICUs) to scientific journals to government agencies, scientists fighting the pandemic say they are hitting a wall, 15 months after the first report of a cluster of cases of pneumonia in Wuhan, China, introduced the virus that would upend their lives.” Researcher David O’Connor says, ““A year into this, we need to assess: What does the future look like? Does it look like the same workforce being asked to do twice as much as they were doing before? I don't know what the right answer is, but the number of times recently I've heard ‘I'm just done with this’ uttered in frustration from friends and colleagues is really concerning.”
 
As scientists have learned more about the virus and the best ways to fight it over the past 15 or so months, they have often revised their opinions about key issues or even learned early suppositions were wrong. A Yale researcher writes in Wired (US), “Over the last year I’ve been frustrated with the scientific community’s general reluctance to openly discuss when and why we’re wrong, and specifically, in our study and prognostications of the pandemic. Our unwillingness to highlight what we were wrong about was a missed opportunity to teach the public about the scientific process, to put its necessary ups and downs on fuller display…. As we reflect on ways to prevent the next pandemic, most conversations have appropriately focused on improving the sciences of prediction—data science, genomics, virus ecology, computational modeling, and others. But the science of communicating with the public is just as essential. We must build effective ways to explain more than the facts, but also the process through which ideas are born, live, and die. Walking the public through this process will involve a willingness to take the world inside the capricious, sometimes chaotic world of science, where even the best of us are often wrong. And wrongness is not the sign of a flaw, but is a feature of a healthy, strong scientific instrument that may one day take us to the stars, prevent a climate crisis, and conquer the plagues of today and tomorrow.”
 

The Pandemic Is an Evolution

 
In a NEJM audio discussion researchers Carlos Del Rio, Chidi Akusobi and NEJM editors discuss the ongoing research for COVID vaccines that continues to provide data. As NEJM Deputy Editor Lindsey Baden says, “This pandemic is an evolution.” It’s a somewhat technical discussion, but it lays out how evidence and understanding of data is evolving as more information is gathered. They note that “Science by press release is very challenging,” but needed in these times. They also discuss the issues that drive the COVID pandemic in minority communities in the US and compare it to the impact of HIV in minority communities.
 

COVID and Politics

 
The New York Times (US) reports on a CNN interview in which several of the doctors who worked on the COVID response in the Trump administration talked about that response and the politics that often drove it: “The administration’s pandemic response was riddled with dysfunction, and the discord, untruths and infighting most likely cost many lives…. Dr. Deborah L. Birx, Mr. Trump’s coronavirus response coordinator, suggested that hundreds of thousands of Americans may have died needlessly, and Adm. Brett P. Giroir, the testing czar, said the administration had lied to the public about the availability of testing.”
 

Hunger Rising

 
The Nation (Kenya) reports, “The government has warned that millions of Kenyans are likely to face hunger due to the effects of the COVID-19 pandemic and the drought currently being experienced in parts of the country. Government Spokesman Cyrus Oguna on Thursday said that an estimated 1.4 million Kenyans are currently facing hunger, a figure that is likely to rise in the coming days if a solution is not found.”
 

Broader Access to J&J Vaccine

 
FiercePharma reports, “Johnson & Johnson locked up a deal to provide the African Union with up to 400 million doses of its one-and-done COVID-19 vaccine through 2022, to be rolled out as it’s approved by the bloc’s 55-member states.” This follows a previous deal for 500 million vaccines to Africa. “J&J will sell the African Vaccine Acquisition Trust (AVAT) up to 220 million doses to start, with the option to sell another 180 million shots in the future. Deliveries from the initial tranche should kick off in the third quarter of 2021, while the remaining doses will be supplied through next year.” Bloomberg reports “Johnson & Johnson’s coronavirus vaccine has been approved by South African regulators for general use days after President Cyril Ramaphosa said the country will get more than 30 million doses.”
 

Studying Long COVID

 
JD Davids writes in The Body (US) that lessons from HIV research must help guide long COVID research at the US NIH: “it is vital from the start that NIH and federal partners establish and implement an integrated long-COVID strategic research plan in and across the post-viral conditions seen in long COVID/post-acute COVID-19 syndrome (PACS)—explicitly including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)—and including long-term COVID sequelae such as heart damage. In addition, we’ve learned in the global HIV effort the importance of integrating implementation science to determine the best and most accessible ways to disseminate findings for those in need.”
 

Where Did SARS-CoV-2 Come From?     

 
The WHO released a report this week on the origins of the virus. Nature (UK) reports “Researchers say that a World Health Organization (WHO) report on the pandemic’s origins offers an in-depth summary of available data, including unseen granular details. But much remains to be done to establish the provenance of the virus—knowledge that will help to prevent future pandemics.” US News and World Report (US) says the US, Canada and several other countries “raised concerns over the World Health Organization's study on the origin of the coronavirus. 'The mission of the WHO is critical to advancing global health and health security, and we fully support its experts and staff and recognize their tireless work to bring an end to the COVID-19 pandemic, including understanding how the pandemic started and spread,’ the joint statement said. "With such an important mandate, it is equally essential that we voice our shared concerns that the international expert study on the source of the SARS-CoV-2 virus was significantly delayed and lacked access to complete, original data and samples."