In the US this week, the CDC said fully vaccinated people don’t need to mask or physical distance in most cases, a situation that seems to offer a tantalizing glimpse of “normal,” whatever that means almost 18 months into the pandemic. Yet that normal is open only to a small percentage of the world population in a handful of rich countries. Only 3.42 percent of the global population has been fully vaccinated. Vaccine apartheid continues to be a major, unchanging storyline for COVID.
 
AP (US) reports, “The World Health Organization says nearly a dozen countries—many of them in Africa—are still waiting to get vaccines. Those last in line on the continent along with Chad are Burkina Faso, Burundi, Eritrea and Tanzania. ‘Delays and shortages of vaccine supplies are driving African countries to slip further behind the rest of the world in the COVID-19 vaccine rollout and the continent now accounts for only 1 percent of the vaccines administered worldwide,’ WHO warned.”
 

If You Are in a Hurry

 

• Read a long piece in Nature that argues “The pandemic stress-tested the way the world produces evidence—and revealed all the flaws.”
• Read STAT on why the pandemic and the global response to it should be a ‘Chernobyl moment.’
• Read a commentary in NPR’s Goats and Soda blog on who should be working to end vaccine apartheid.
• In the US, racial inequities seen in COVID cases are also being seen in long COVID. Read about it on STAT.
• Read VICE on just how difficult it is for some to put aside masks and fears from the last year.
• Read Axios on how vaccines are driving infection rates down in the US.

 

Vaccines and Variants

 
STAT (US) reports, “People who’ve received one of the highly powerful vaccines don’t need to be too worried about the variants for now, experts say.” But, a fuller answer is “more complicated.” STAT reports experts say in the short-term vaccinated people shouldn’t worry about existing variants. “The question is, what might we expect a year from now? Some scientists think that people eventually will need vaccine boosters, and that the vaccines might need to be tweaked to better match the evolving virus. Among the questions that will influence when and how that might occur: How long does vaccine-generated protection last, and will the waning process accelerate in the presence of certain variants? If immunity starts to wane, will people still generally be protected from the worst outcomes, even if they’re more vulnerable to infection?”
 
MIT Technology Review (US) reports, “Vaccines may become less effective over time, but there’s no evidence that we’re on the brink of catastrophe…. Some variants do seem to be better at dodging our immune system, at least in lab experiments. For example, a small study posted on May 10 shows that the newest variant of global concern—B.1.617—is more resistant to antibodies from people who have been vaccinated or have previously been infected. Despite that, all 25 people who had received shots from Moderna or Pfizer produced enough antibodies to neutralize the variant.”
 

It Didn’t Have to Be This Bad    

 
BBC (UK) reports an independent review panel concluded the COVID-19 pandemic was preventable. “The panel, set up by the World Health Organization, said the combined response of the WHO and global governments was a ‘toxic cocktail’. The WHO should have declared a global emergency earlier than it did, its report said, adding that without urgent change the world was vulnerable to another major disease outbreak.”
 
Nature (UK) reports, “The lengthy investigation identifies February 2020 as the month when—in a parallel universe—the devastating toll of the pandemic might have been lessened, had countries acted fast to limit the spread of the virus.” Read the report here.
 
STAT (US) reports, “The COVID-19 crisis should serve as a ‘Chernobyl moment’ for global pandemic preparedness, triggering a series of actions to speed the end of this pandemic and to ensure it’s the last of its kind the world ever faces, according to a report from an international panel of experts…. [The report]… calls on wealthy countries with COVID vaccine to share their supplies in large volumes and quickly, with 1 billion doses donated by September and another 1 billion by the end of the year. The report calls for swift negotiations to lift intellectual property protections for COVID vaccines—and an automatic waiver if the negotiations fail to deliver within three months…. One of the report’s boldest recommendations is that the WHO should be given the authority to send teams to investigate outbreaks that appear to pose a pandemic threat without having to wait for approval from the country where the disease is spreading. The WHO does not currently have that power and it is not at all clear countries would be willing to give it to the agency…. ‘Sensitivities about sovereignty should surely not delay alerting the world to the threat of a new pathogen of pandemic potential,’ panel co-chair Helen Clark, a former prime minister of New Zealand, said during a press conference about the report.”
 

India’s Crisis

 
CNBC (US) reports, “India’s daily COVID-19 death toll hit another record high on Wednesday, as the World Health Organization said the country accounted for half the total reported cases in the world last week. Health ministry data showed that at least 4,205 people died over a 24-hour period—the largest single-day increase in fatalities reported by the South Asian country since the pandemic began. However, reports have suggested that the death toll in India is being undercounted.
 
A commentary in Nature India warns “the country is likely to become a hotspot of future mutations unless the contagion is rapidly controlled.” The authors argue there is a need for “sequencing, sequencing and more sequencing” to identify variants of concern that may be fueling the pandemic. “The population of many Indian states is more than those of several European nations combined and infections have been rising at a furious pace. India is, therefore, likely to become a hotspot for rise of future variants of concern, unless things are rapidly brought under control. Even then, careful surveillance for an extended period must continue. Simple things like masking, COVID appropriate behaviour, and rapid vaccination roll out still remain key in the public health fight.”
 
Nature (UK) reports “Evidence is growing that one variant first detected in India might be more transmissible and slightly better at evading immunity than existing variants. Animal models also hint that it might be able to cause more severe disease. Researchers want to know if this variant and others might be driving the second wave and what kind of danger they pose globally. In just a few weeks, the B.1.617 variant has become the dominant strain across India and has spread to about 40 nations, including the United Kingdom, Fiji and Singapore.”
 

COVID’s Impact on Scientific Evidence

 
Nature (UK) reports “With the pandemic now deep into its second year, it’s clear the crisis has exposed major weaknesses in the production and use of research-based evidence—failures that have inevitably cost lives. Researchers have registered more than 2,900 clinical trials related to COVID-19, but the majority are too small or poorly designed to be of much use. Organizations worldwide have scrambled to synthesize the available evidence on drugs, masks and other key issues, but can’t keep up with the outpouring of new research, and often repeat others’ work. There’s been ‘research waste at an unprecedented scale’, says Huseyin Naci, who studies health policy at the London School of Economics. At the same time, shining examples of good practice have emerged: medical advances based on rigorous evidence have helped to chart a route out of the pandemic. The rapid trials of vaccines were spectacular successes, and well-run trials of possible treatments have shown, for instance, that some steroids help to fight COVID-19, but the drug hydroxychloroquine doesn’t. Many physicians point to the United Kingdom’s RECOVERY trial as exemplary in showing how quick action and simple protocols make it possible to conduct a large clinical trial in a crisis. And researchers have launched ‘living’ systematic reviews that are constantly updated as research emerges—essential in a fast-moving disease outbreak.”
 
In an accompanying editorial, Nature’s (UK) editors say, “It’s important that researchers, doctors and global leaders assess what worked, what didn’t and why, and make recommendations for change. They must fix the evidence pipeline so that it is stronger and better able to supply timely, high-quality evidence—not just for the next pandemic, but for everyday health emergencies, from malaria to heart disease…. There is a danger that everyone will be so keen to move on and forget the trauma of the pandemic that we won’t take time to reflect and improve. But Archie Cochrane’s 50-year-old plea that decisions be based on rigorous evidence is more important than ever, and, tired though everyone is, we need to put in the work now so that we can deliver better, quicker evidence next time around.”
 

Cases Rise in Latin America and Asia

 
Reuters (UK) reports “Nearly 40 percent of all global deaths from COVID-19 reported last week happened in the Americas, and nearly 80 percent of the region's intensive care units are filled with COVID-19 patients, the Pan American Health Organization (PAHO) said….”
 
AP (US) reports, “Coronavirus cases are exploding in Asia and the Pacific with over 5.9 million new confirmed infections in the past two weeks, more than in all other regions combined, the International Federation of the Red Cross said…. Seven out of 10 countries globally that are doubling their infection numbers the fastest are in Asia and the Pacific, it said. Laos took just 12 days to see its cases double, and the number of confirmed infections in India has doubled in under two months to more than 23 million….”
 

Vaccination Drives US Rates Down

 
Axios (US) reports reported COVID cases and deaths are down across the US. “The US is finally winning its battle against COVID-19 thanks almost exclusively to one weapon: the vaccines…. 99.7 percent of hospitalized coronavirus patients are unvaccinated, the Cleveland Clinic said this week—more real-world evidence that the vaccines prevent the type of serious infections that were killing over 3,000 Americans per day just a few months ago.”
 

Calls to End Vaccine Apartheid

 
An opinion piece on NPR’s Goats and Soda blog (US) outlines a chain of donations through the pandemic— $2 million from the Irish people to the hard hit Navaho and Hopi nations in the US last year, a thank you for a long ago $170 gift from the tribes to Ireland during the potato famine. The Navaho in turn this year have gathered PPE to send to India. The authors argue this is a “feel good story,” and more: “The burden of helping marginalized people in need in our global community belongs to those with wealth and power—in this case, wealthy nations like the United States—and not to those who have borne the brunt of systemic oppression and economic disenfranchisement. But up to now in this pandemic, well-off nations have chosen a state of vaccine apartheid. Rich countries as a rule have enough vaccines. Poorer countries do not.” They argue the Biden administration’s move on the TRIPS waver is a move in the right direction. “When the US took a stand this week to change course, it took a critical first step to bringing an urgency to our response that has been lacking to date. A first step to finding our way back from vaccine apartheid to vaccine equity.”
 
An open letter to the US Congress and Pres. Biden signed by a number of US researchers and public health experts calls on the US government “to please donate vaccines in surplus in the US to India and South Asia now given the massive humanitarian crisis there now” according to a tweet by Dr Monica Gandhi.
 
The New York Times (US) reports, “Dr. Patrick Soon-Shiong, the billionaire biotechnology entrepreneur who owns the Los Angeles Times, announced on Wednesday that his corporation and his philanthropic foundation would commit an initial 3 billion South African rand (about $210 million) to transfer the latest technology for producing vaccines and biological therapies to South Africa, where he was born….  Dr. Soon-Shiong said he hoped that the technology, including therapies and vaccines built on viral vectors, messenger RNA and adjuvants, would be used not only to meet the immediate coronavirus crisis, but also to address neglected diseases including schistosomiasis, a parasitic infection common in sub-Saharan Africa.”
 

Racial Inequities in Long COVID

 
STAT (US) reports, “Researchers and health care clinics fear that the same reasons that caused certain racial and ethnic groups to experience higher infection rates and illness severity may be responsible for driving disparities in the treatment of long COVID. Many vulnerable communities lack access to quality care, or face heightened burdens to convince providers that their conditions are real.”
 

Getting “Back to Normal” Not So Easy  

 
VICE (US) looks at the difficulties some face as the US moves back toward normal and eases COVID restrictions. “There's a glaring omission from this discussion about why people ‘can’t quit’ pandemic behaviors: the mental and emotional toll of the last year. After what many have been through—death, grief, isolation, stress, anxiety, unemployment, trauma—people are going to have some feelings around transitioning back to a less cautious way of life…. There are other reasons why people may be hanging onto COVID precautions. Some people have unvaccinated children who, though at low risk, don't have zero risk. Others may be immunocompromised or worried about the uncertainty around variants. Individual risk tolerance varies, and since the pandemic is certainly not over, it's understandable if people's tolerances still rest at different levels.”
 

Booster Shots?

 
Reuters (UK) reports, “In interviews with Reuters, more than a dozen influential infectious disease and vaccine development experts said there is growing evidence that a first round of global vaccinations may offer enduring protection against the coronavirus and its most worrisome variants discovered to date. Some of these scientists expressed concern that public expectations around COVID-19 boosters are being set by pharmaceutical executives rather than health specialists, although many agreed that preparing for such a need as a precaution was prudent.”