— Commentary in Scientific American

 

Slightly more than two percent of the world population has been fully vaccinated. Even as the US and some other wealthy countries push ahead with ambitious vaccination plans, for the majority of the world’s population there is no vaccine in sight. And cases and deaths are rising again around the world.
 
Vaccine access and equity remain one of the major unsolved issues of the pandemic response.
 
India now has the most cases of COVID in the world, passing Brazil and the US. The Economist (UK) reports, “Cases in India have been rising shockingly fast. They leapt from 15,000 a day to 100,000 a day in just a month…. On its current trajectory, South Asia, home to a quarter of humanity, will soon eclipse the European Union as the centre of the pandemic. Having suffered almost 200,000 known deaths from the disease already, the region is on the verge of further tragedy…Bangladesh, India and Pakistan are all vaccinating as fast as they can, but given the scale of the task their efforts are too little and too late.”
 

If You Are in a Hurry  

 

• Read about a community member who is helping link people to COVID testing and information in Medscape.
• Read Vanity Fair on what’s stopping the US from sharing vaccine doses with the world.
• Read a comment in Scientific American about decolonizing global health in the COVID era.
• Read how older people in Zimbabwe are fighting vaccine hesitancy in New Zimbabwe.
• Read how the RECOVERY trial “rewrote the textbook on how clinical trials can be done” in Lancet Digital Health.
• Follow an illustrated guide to how to prevent the next pandemic in POLITICO.
• Read about what COVID vaccines and Serena Williams have in common in Business Insider.

 

Variants and More Variants

 
Bloomberg (US) reports on efforts by researchers to understand how the virus is mutating and what those mutations mean for vaccines and for spread of disease. One of the problems: “new mutations are popping up in increasingly complicated patterns, spurring a drive by top biologists to devise new ways to track a fire hose of incoming genomic data. The goal: Quickly detect variants that can lessen the effectiveness of vaccines for a pathogen that’s unlikely to be eradicated any time soon. The SARS-CoV-2 virus could settle down and become a mere nuisance like the common cold. Or much like influenza, it could retain its ability to cause severe disease in some segments of the population, a scenario that could require regular booster shots.”
 
Writing in The Conversation (Global) members of the Lancet COVID-19 Commission Taskforce on Public Health called “for urgent action in response to the new variants. These new variants mean we cannot rely on the vaccines alone to provide protection but must maintain strong public health measures to reduce the risk from these variants. At the same time, we need to accelerate the vaccine program in all countries in an equitable way.” They say, “The danger is that variants will arise that can overcome the immunity conferred by vaccinations or prior infection. What’s more, many countries lack the capacity to track emerging variants via genomic surveillance. This means the situation may be even more serious than it appears.”
 
POLITICO (US) reports, “The global scramble to produce enough COVID-19 vaccine for 7 billion people is about to get even tougher, as drugmakers and countries ready a second round of shots to combat the growing threat of virus variants. Finding vaccines that can ward off more contagious or virulent strains is only half the battle. The United States has virtually no capacity to manufacture revised vaccines or booster shots alongside the original versions, according to a half-dozen vaccine experts and Biden administration health officials. Setting up additional facilities could take months or even years.”
 
Business Insider (US) reports on one researcher’s sports analogy to explain how highly effective vaccines may still work against new variants. "If Serena Williams all of a sudden was 10 percent less effective than usual, or 50 percent less effective than usual, she would still kick everyone's ass." He argues the vaccines “like elite athletes, can still perform very well against” emerging variants.  
 

The Impact of Structural Inequities and Racism       

 
A report in JAMA (US) found that in a study of more than one million Americans, “African American individuals with low income, Hispanic individuals, and women of all racial/ethnic groups had higher risks of experiencing unemployment, class cancellations, food insufficiency, and mental health problems during the first wave of the COVID-19 pandemic…. These findings suggest that public health policies that ignore existing distributions of risks to well-being may be intrinsically regressive if they fail to target necessary relief measures to individuals who have historically experienced the most marginalization.”
 
Jimmie Briggs writes in Vanity Fair (US), “We are in a phase of the pandemic that could not be more celebratory. By April 19, 90 percent of American adults will be eligible to receive a COVID shot. And yet people of color, like me, are facing the harshest realities of a health care system entrenched in bias, systemic inequity, and suspicion. As the vaccination effort continues to roll out with increased speed under President Biden, only 8 percent of those who have received at least one shot of the vaccine, according to the Centers for Disease Control and Prevention (CDC), are Black Americans (who make up 13.4 percent of the US population). Some 9 percent of the doses have gone to Latino Americans.” He concludes, “The success of the vaccination effort will succeed or fail on our ability to reach the least visible, the least served, the most historically marginalized.”
 
Heather Boerner reports in Medscape (US) on Brenda Hampton, a community member in rural Lawrence County, Alabama who has added COVID testing and information to her arsenal of community help and interventions for a community hard hit by polluted water and other structural and health issues. One state health official says, “"It takes individuals who know people and who people trust. It takes individuals being able to speak from the heart and who people know are sincere, and who have been there already. That's Brenda. She didn't just show up. She's been there and she's been caring about people's health. And now she says, 'Hey, this is what's going on.’"
 
CIDRAP (US) reports, “Four new studies highlight the dangers of COVID-19 in cramped prisons with inmates transferred among facilities, scarce testing resources and personal protective equipment (PPE), and high vaccine hesitancy at US prisons and jails.”
 

Investing in Community Health Workers            

 
A comment in The Hill (US) argues, “it is important to embrace the opportunity afforded by this crisis to ‘build back better,’ as President Biden says, — not only for global health security but also for accelerating health improvements and socio-economic development for the poorest of the poor around the world. Now is the time for the United States to provide financial and technical leadership in reducing the ‘evidence-practice’ gap in expanding the coverage of the broad range of low-cost basic and essential preventive and curative interventions that communities and community health workers (CHWs) in low-income countries can provide.” To find out more about how community health workers are helping to build more reliant and sustainable health systems visit Protecting Global Gains.
 

Vaccinating the World

 
Vanity Fair (US) reports on an unexpected hurdle to the US sharing surplus vaccine dosies with the world: “The contracts the Trump administration signed with the vaccine manufacturers prohibit the US from sharing its surplus doses with the rest of the world. According to contract language Vanity Fair has obtained, the agreements with Pfizer, Moderna, AstraZeneca, and Janssen state: “The Government may not use, or authorize the use of, any products or materials provided under this Project Agreement, unless such use occurs in the United States” or US territories. The clauses in question are designed to ensure that the manufacturers retain liability protection, but they have had the effect of projecting the Trump administration’s America First agenda into the Biden era.”
 
A commentary in Scientific American (US) argues that the continued impact of COVID is “in no small part…due to failures of governance and intentional health policy choices. Despite the swift and unprecedented development of multiple COVID-19 vaccines, more than 66 percent of the countries around the world—predominantly in the Global South—have yet to receive a single vaccine dose. In comparison, 10 countries have received 75 percent of the global vaccine supply. These appalling statistics represent the outcomes of contemporary neocolonial approaches—policies, programs and global governance structures that continue to sustain the same power dynamics and outcomes as during colonization—towards the non-Western world.” The authors conclude, “This is a once-in-a-lifetime opportunity for the United States to start fresh with humility, engage in healthy competition with other nations, earn back its credibility and tackle the increasingly complicated global public health landscape while leaving behind its colonial practices. As the effects of climate change continue to unfold, global health and national security will become increasingly intertwined. Therefore, we must act now to reimagine, develop and implement decolonial global health diplomacy.”
 
A NEJM (US) perspective argues, “Vaccinating the world is not only a moral obligation to protect our neighbors, it also serves our self-interest by protecting our security, health, and economy. These goals will not be accomplished by making the world wait for wealthy countries to be vaccinated first. By investing in multilateral partnerships with a sense of shared commitment and employing a global allocation strategy that increases supply and manufacturing, we can meet the urgent challenge of COVID-19, while creating sustainable infrastructures and health systems for the future. Getting the world vaccinated may well be the critical test of our time.”
 

Brazil Suspends Drug Patent Extensions       

 
Reuters reports, “A Brazilian Supreme Court judge on Wednesday suspended extensions of drug patents in the country, a preliminary decision that could lower costs for drugs critical to treating COVID-19 patients at the expense of pharmaceutical firms. Justice Dias Toffoli cited the ‘public health emergency arising from COVID-19’ in his ruling. The ruling, which takes effect immediately, must still go before the full Supreme Court for consideration and could be reversed. The Affordable Medicines Movement…said scrapping the extensions would lower costs for a drug used when intubating patients and a type of blood thinner used for treating COVID-19.”
 

Combatting Vaccine Hesitancy

 
New Zimbabwe reports in Zimbabwe, “Amid widespread scepticism among the younger population, it is elderly people who are coming out to lead by example. One 85-year-old says, 'I had already dismissed prospects of getting this vaccine. I feared it would trigger some health issues, as I am not young. But after seeing that my neighbour, who is my age, was still OK a week after getting it, that gave me the courage.'”
 

AstraZeneca and Blood Clots

 
The European Medicines Agency (EMA) found a possible link between AstraZeneca’s vaccine and very rare cases of unusual blood clots. CNN (US) reports, “EMA said that these severe blood clotting events were being reported at a rate of about 1 in 100,000. Without age and sex data, it's not known if the risk is higher or lower for particular groups, it said. The overall rate could also change upwards or downwards, as more people are vaccinated and a clearer picture emerges.” More than 100 countries are using the AstraZeneca vaccine. Several countries have now restricted the vaccine to older people or are reviewing when and how to use the vaccine.
 
The problems with this vaccine have added to Europe’s vaccine rollout woes. The Guardian (UK) reports, “Germany’s health minister has said he wants to hold talks with Moscow about obtaining supplies of the Russian vaccine Sputnik V, in an effort to boost the country’s inoculation campaign.”
 

COVID and the Brain

 
STAT (US) reports on a study in The Lancet Psychiatry, which found “six months after being diagnosed with COVID-19, 1 in 3 patients also had experienced a psychiatric or neurological illness, mostly mood disorders but also strokes or dementia…. About 1 in 8 of the patients (12.8 percent) were diagnosed for the first time with such an illness, most commonly anxiety or depression. Compared to control groups of people who had the flu or other non-COVID respiratory infections, first-ever neuropsychiatric diagnoses were almost twice as high.”
 

More Data Needed on Reinfection         

 
STAT (US) reports “Reinfections from COVID-19 continue to seem rare, and are not responsible for the current, stubbornly high case counts in the United States, according to scientists and the latest findings. At least, that’s what researchers are left to conclude. Experts say the country and individual states don’t have strong systems to determine how frequently people are getting reinfected—another consequence of the nation’s limited surveillance network. They’re calling for better data collection and analysis around second cases of COVID-19.”
 

Rethinking How Trials Work

 
Lancet Digital Health (UK) reports “Faced with a soaring death toll from a previously unknown disease, researchers combined the magic of randomisation (a means of reducing bias in treatment trials) with the scale of routine data collection to find effective therapies, all at an astonishing speed. In so doing, the UK's flagship RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial rewrote the textbook on how clinical trials can be done…. If necessity is the mother of invention, then the needs of treating COVID-19 have propelled clinical trial design towards innovation and greater efficiency.” Martin Landray who helped run the trial is quoted “The way routine data has been used in RECOVERY needs to go beyond pandemics and tackle the enormous burden of common disease on patients, their families, and health systems worldwide.”
 

Stopping the Next Pandemic

 
POLITICO (US) looks at what is needed to prevent the next pandemic. In a beautifully illustrated piece, they note scientists say “If we want to really prevent another pandemic… we should prevent it at the source: animals…. Resolving this will take buy-in from policymakers around the globe. But there are solutions. We reviewed the two broad strategies scientists say could make a difference.” The two strategies are reducing deforestation and regulating the wildlife trade. “These solutions aren’t cheap, but neither are the alternatives. Estimates show the cost of preventative measures is at least 10 times cheaper than the damages from COVID-19, not to mention saving thousands of human lives.”
 

Tanzania Shifts Its Response to COVID  

 
Devex (US) reports Tanzania’s new president said she plans to form a committee of experts to evaluate the nation’s COVID-19 response, suggesting a shift from the government’s adamant denial of the disease’s presence in the country. ‘We cannot isolate ourself as an island,’ President Samia Suluhu Hassan said, adding that the country ‘cannot accept everything from abroad, but we also cannot reject everything.’’
 

COVID and Children

 
The New York Times (US) reports, “Many children and teenagers who developed the mysterious inflammatory syndrome that can emerge several weeks after contracting the coronavirus never had classic COVID-19 symptoms at the time of their infection, according to the largest study so far of cases in the United States.” The findings based on an evaluation of 1,733 cases “show that although the syndrome is rare, it can be serious. The CDC’s data only included patients who were hospitalized. Over 90 percent of those young people experienced symptoms involving at least four organ systems and 58 percent needed treatment in intensive care units.”
 

Reimagining Mental Health

 
A comment in The Lancet Planetary Health (UK) argues, “Immediate and short-term attention has been directed to the negative mental health effects of COVID-19 in many countries. However, such attention needs to be put to more ambitious use. Now is the opportunity to make securing the emotional and mental wellbeing of humanity a common expectation of global governance…. The negative mental health effects of COVID-19 are and will remain massive, far reaching, and long term. These effects include the cumulative toll of diagnosable illness fueled by wide exposure to loss, stress, and trauma, but also reflect much more. Planetary-sized ecological ruptures like this pandemic amplify structural disadvantage and a cascade of compounding risks and multiple vulnerabilities that all result in deep social and emotional damage. These effects therefore not only add to clinical burdens, but also take apart social cohesion, collective efficacy, and overall health and longevity. They are a collective trauma. They reflect a degree of loss, grief, polarisation, and damaged ways of life and suffering that require far more access to services to help individuals. But they also sap the collective will, civic morale, and prosocial soul of whole communities. Such a fragile and depleted social climate disables the civic muscle needed to navigate the urgent and relentless realities of the ongoing global ecological crisis, of which COVID-19 is an opening act.”