More than one billion vaccine doses have been administered worldwide, but still less than 4 percent of the world population is fully vaccinated. In the few countries where larger percentages of the population have been vaccinated cases are starting to decline. But in most of the world, there are enough vaccines to make a difference. The
 
India has become the epicenter of the epidemic. As the New York Times (US) New Delhi bureau chief writes, “I’m sitting in my apartment waiting to catch the disease. That’s what it feels like right now in New Delhi with the world’s worst coronavirus crisis advancing around us…. The infections have spread so fast that hospitals have been completely swamped. People are turned away by the thousands. Medicine is running out. So is lifesaving oxygen. The sick have been left stranded in interminable lines at hospital gates or at home, literally gasping for air.”
 
Yasmeen Serhan writes in The Atlantic: “Though mass vaccination has provided an off-ramp from the pandemic for some countries, India is a stark reminder that, for many others, a long road lies ahead. The world is on track to record more COVID-19 deaths this year than it did in 2020. The risks of allowing current outbreaks to ravage places such as India aren’t limited to those countries alone. Emerging variants and further delays to more equitable vaccine distribution stand to affect everyone, including vaccinated populations. India’s problem is the world’s problem.”
 

If You Are in a Hurry

• Read Jeffrey Sachs in the Daily Maverick on why IP waivers are a practical and urgent need, as well as being a moral imperative.
• Read a devastating account of India’s COVID “apocalypse” by Indian health journalist Vikas Dandekar in STAT.
• Read about a new treatment trial beginning in 13 African countries in Devex.
• Peak behind the curtain and see how the Pfizer mRNA vaccine is made in a multimedia article in the New York Times.
• Read Science on an experiment to let crowds gather for Eurovision and other large public events in the Netherlands.
• Read a long piece in Nature examining whether systemic heath inequities exposed (again) by COVID will finally be addressed. 
• Read Vox on Senegal’s “chain of solidarity” that helped contain COVID and respond to a surge.

 

India’s Surge

 
Bloomberg (US) via Japan Times reports, “When India launched its COVID-19 vaccination drive in mid-January, the chances of success looked high: It could produce more shots than any country in the world and had decades of experience inoculating pregnant women and babies in rural areas…. Just over three months later, that initial promise has evaporated and the government’s plans are in disarray. India has fully vaccinated less than 2 percent of its 1.3 billion-strong population, inoculation centers across the country say they’re running short of doses and exports have all but stopped. Rather than building protection, the South Asian nation is setting daily records for new infections as a second wave overwhelms hospitals and crematoriums.”
 
In an opinion piece in STAT (US) Indian health journalist Vikas Dandekar writes, “Hospitals don’t have enough beds for those seeking help, and even if they do, the shortage of oxygen is an agonizing death sentence for patients who can’t get access to it. Video clips are making the rounds showing people dying even as they are hurriedly wheeled on stretchers into hospitals. Ambulances are being crammed with the dead—as many as 20 bodies at a time—on their way to crematoria and burial grounds. Funeral pyres glowing 24/7 are a constant reminder of the staggering death toll. If there is an apocalypse, this has to be one.”
 

US to Share Some Vaccines

 
BBC (UK) reports, “The US will share up to 60 million doses of its AstraZeneca vaccine with other countries as they become available, the White House has said. The doses will be able to be exported in the coming months after a federal safety review. The US has a stockpile of the vaccine even though its regulators have not yet authorised it for public use. Critics have accused the government of hoarding the vaccine, while other countries are in desperate need. Reuters (UK) reports, “India expects to secure the biggest chunk of the 60 million AstraZeneca COVID-19 vaccine doses that the United States will share globally, two Indian government sources told Reuters, as New Delhi battles a devastating surge in infections.”
 

A Moral Imperative

 
Jeffrey Sachs writes in the Daily Maverick (South Africa) “Given the surge of COVID-19 in several regions, most recently in India, the continuing emergence of new and deadly variants of the virus, and the inability of the current vaccine producers to keep pace with global needs, an IP waiver or its equivalent has become a practical, urgent need as well as a moral imperative. As a general principle, IP should not stand in the way of scaling up production to fight COVID-19 or any other public health emergency. We need more countries to be producing vaccines, test kits and other needed commodities…. We have the capabilities to scale worldwide immunisation in order to save lives, prevent the emergence of new variants and end the pandemic. IP must serve the global good, rather than humanity serving the interests of a few private companies.”
 

Brazil’s Anti-science Government

 
Nature (UK) reports “More than a year after Brazil detected its first case of COVID-19, the country is facing its darkest phase of the pandemic yet. Researchers are devastated by the recent surge in cases and say that the government’s failure to follow science-based guidance in responding to the pandemic has made the crisis much worse…. Mauricio Nogueira, a virologist at the FAMERP medical school in São José do Rio Preto, Brazil, says researchers in Brazil studying SARS-CoV-2 variants are unable to study them properly because Bolsonaro has cut funding for science so severely. ‘We don’t have funds to do basic research, such as to understand how the variants are more or less virulent,’ he says. ‘We don’t have the lab equipment or reagents for that.’"
 

Indian Surge Seen as Warning in Africa

 
Clare Keeton reports in Sunday Times (South Africa) “Africa needs to learn from the devastation COVID-19 is causing in India to avoid a similar scenario, warned director of the Africa CDC Dr John Nkengasong on Thursday at his weekly update…. ‘We are watching with total disbelief what is happening in India. This speaks to the fact that we as a continent must be very, very prepared. We must continue to raise our guard,’ he said. All African ministers of health will be called to a meeting on May 8 convened by the AU ‘to put everybody on alert’, Africa’s health chief announced.” Daily Maverick (South Africa) reports “Nkengasong noted that India and Africa were similar in many ways. They had about the same populations (1,3 billion) and both had fragile health systems. India was actually better off, with a better health system than Africa’s (on average) and was also manufacturing COVID-19 vaccines at scale. So, it would be ‘catastrophic’ for Africa’s health systems to try to bear the impact of a huge surge like India was experiencing. ‘We don’t have enough oxygen, beds, vaccines or health workers to deal with such a massive attack,’ he said.”
 

New Treatment Trial Begins Across Africa

 
Sara Jerving reports in Devex (US), “Researchers are recruiting participants for Africa’s largest clinical trial for treatments for early-stage COVID-19. The trial will examine a drug combination aimed at treating patients with mild-to-moderate cases, hoping to prevent their progression into critical cases…. The ANTICOV study includes a consortium of 26 African and global research and development organizations and will take place in 13 African countries. The trial will examine the combination of antiparasitic nitazoxanide and inhaled corticosteroid ciclesonide. These drugs—which are commercially available and affordable—could potentially interfere with the replication of the virus in the body and decrease inflammation in the upper respiratory tract.”
 

Impact of COVID on Clinical Research

 
A paper in Lancet Global Health (UK) argues, “COVID-19 has had negative repercussions on the entire global population. Despite there being a common goal that should have unified resources and efforts, there have been an overwhelmingly large number of clinical trials that have been registered that are of questionable methodological quality.” The authors conclude, “We hope that the COVID-19 pandemic will become a historical turning point that leads to better coordination and collaboration within the medical research community, but this outcome will first require buy-in from funders and global health researchers (particularly those in HICs) who currently control the design of trials.” NPR’s Goats and Soda blog (US) reports the authors of this and three other Lancet papers, “are pushing for broader reliance on experiments known as adaptive clinical trials. These trials are more complex than the typical randomized, controlled clinical trials where people are neatly divided into a treatment group and placebo group and watched for a pre-set period of time. Adaptive trials are designed so the rules can be altered before the trial is finished. For example, if midway through a trial it looks like a treatment might be effective but there are not enough people in the trial to verify it, more people can be added. Or if a treatment does appear to be working well, more people can be added to the treatment arm so the results will be more statistically significant. And new treatments can be added in, and ineffective treatments removed.”
 

US Baby Bust

 
AP (US) reports, “When most of the US went into lockdown over a year ago, some speculated that confining couples to their homes—with little to entertain them beyond Netflix—would lead to a lot of baby-making. But the statistics suggest the opposite happened. Births have fallen dramatically in many states during the coronavirus outbreak, according to an Associated Press analysis of preliminary data from half the country…births in December 2020 and in January and February 2021—nine months or more after the spring 2020 lockdowns—were down 6.5 percent, 9.3 percent and 10 percent respectively, compared with the same months a year earlier.”
 

Babies in Vaccine Trials

ABC News (US) reports that with many US adults vaccinated, “Pfizer and Moderna have moved on to the next phase of the fight against the virus: studying to see if the vaccine will be safe and effective for children…. Today, kids as young as 6 months old are taking part in trials for both companies’vaccines with their parent’s consent.” The current studies are “dosing studies.” After researchers find an appropriate dose with the younger children, they’ll move onto the second part of the trial, which includes splitting children into a placebo and a treatment group.”
 

How the Pfizer Vaccine is Made

 
The New York Times (US) reports in a multimedia piece on how the Pfizer mRNA vaccine is made. The article looks at every step of the process and notes, “Pfizer and BioNTech are developing and testing new versions of their vaccine against recent variants, and might eventually alter their genetic recipe to mass-produce COVID-19 vaccines that target specific variants.”
 

Fewer Real-world Side Effects

 
CIDRAP (US) reports, “A new real-world study finds fewer side effects after vaccination with the Pfizer/BioNTech and the AstraZeneca/Oxford COVID-19 vaccines than reported in phase 3 clinical trials…” The study was published in Lancet Infectious Disease. CIDRAP quotes a press release on the study: “senior study author Tim Spector, MD, said the findings show that most side effects are non-severe and self-limiting. ‘The data should reassure many people that in the real world, after effects of the vaccine are usually mild and short-lived, especially in the over 50's who are most at risk of the infection,’ he said.”
 

Unmasked at Eurovision – for Science

 
Science (US) reports, “The Eurovision Song Contest, known best for its over-the-top performances and outrageous costumes, has a new feature this year: It will be the site of a massive field experiment to see whether concerts and other events can be held safely in the middle of the COVID-19 pandemic. Nine rehearsals and televised shows, staged 18–22 May in Rotterdam, Netherlands, will each be attended by 3500 visitors who will have to show a recent negative SARS-CoV-2 test to get in. Those admitted can choose to drop social distancing and go without face masks—precautions currently mandatory in indoor public spaces in the Netherlands, where most people remain unvaccinated.” The Eurovision events are part of a larger research program of large events called ‘FieldLab.’ And last week, more than 350 researchers criticized the studies in a letter that complained of a lack of peer review, an intransparent setup, and ethical failings.”

Bloomberg (US) reports on a separate undertaking in the UK: “Thousands of people at a mass nightclub rave in the UK this week will be a key test of whether live events halted during the pandemic can reopen at full capacity as planned from the end of June…. There are also no early signs that live events are spreading the disease, according to government scientist Paul Monks, and the program is expected to move to its second phase next month -- with live events held at a ‘full range’ of indoor and outdoor venues with ‘different scales’ of capacity.”
 

Addressing Inequity in Health

 
A long piece in Nature (UK) looks at the disparate levels of illness and death among agricultural workers in the US from COVID. “The reasons for such disparities, say public-health researchers, include discrimination, low wages, limited labour protections and inadequate access to health care, affordable housing and education. These are some of the ‘social determinants of health’, a concept that has been around for at least 150 years, but which has gained recognition during the pandemic.” The author notes, “Public-health specialists are correct in saying that they don’t have control of workplaces, but when they can’t successfully push back against policies that favour corporate interests, historians say the field can’t accomplish one of its core functions—protecting the most vulnerable from disease.”
 

DRC Unable to Administer Vaccine Doses           

 
The Nation (Kenya) reports, “The Democratic Republic of Congo says it will return to the United Nations Children's Fund (UNICEF) a total of 1.3 million doses of the 1.7 million it received, for redistribution to other African countries…. the decision was made to ensure usage of the vaccines before the expiry date on June 24…. The DRC has not issued a vaccination plan to support a campaign of this scale and has an insufficient number of vaccination sites, which will hinder ‘access to this vaccine,’ [an] official said.”
 

Florida School to Not Employ Vaccinated Teachers        

 
Science (US) reports, “one private pre-K to eighth grade school in Florida…last week told its teachers and other staff they should avoid the ‘COVID-19 injection’ because of the purported dangers that vaccinated people posed to students.” In a letter to parents the school’s co-founder wrote: “It is our policy, to the extent possible, not to employ anyone who has taken the experimental COVID-19 injection until further information is known.… It is in the best interests of the children to protect them from the unknown implications of being in close proximity for the entire day with a teacher who has very recently taken the COVID-19 injection.” Science notes that this is contrary to all evidence about the vaccines.
 

Senegal’s COVID Response

 
Vox (US) reports, “The West African country [of Senegal] used aggressive interventions like this isolation policy to slow transmission. At the same time, community and local health actors bolstered the public health response from the bottom up, relying on longstanding relationships and trust to convince people to wear masks, seek out testing, and get treatment…. ‘We have what we call a ‘chain of solidarity’: The nation joined hands together,’ Moussa Seydi, chief of infectious disease service at Dakar’s University of Fann Hospital Center, said. ‘Religious leaders came to join the political decision-makers, and also, the community involved themselves in giving this response to COVID-19.’”