The most important story this week continues to be vaccine apartheid. Less than five percent of the world population has been fully vaccinated and there are no global plans in place to ensure the end of this apartheid. NDTV (India) reports, “Highlighting the gap of vaccinations between high-income countries and low and lower-middle countries, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus on Monday said that the world is at risk of ‘vaccine apartheid’. Speaking at the Paris Peace Forum Spring Meeting, Tedros Adhanom Ghebreyesus said: ‘I think I would go one step further and say not just that the world is at risk of vaccine apartheid; the world is in vaccine apartheid’…. He also noted that the basic problem of vaccine inequity was a lack of sharing, which could be resolved by sharing financial resources to fully fund the Access to COVID-19 Tools (ACT) Accelerator, sharing doses with COVAX, and sharing technology to scale up the manufacturing of vaccines.”

Protecting Global Gains (US) looks at the "need to build more resilient and sustainable systems for the delivery of essential health services like vaccines. Even the most effective COVID-19 vaccines won’t stem the tide of the pandemic: delivery through equitable and efficient immunization systems will."
 

If You Are in a Hurry

• Read Helen Branswell in STAT on how previous flu pandemics may help predict how the COVID pandemic ends.
• Read one epidemiologist’s views about all those New York Yankee infections and find out more about how PCR tests work in New York Magazine.
• Read the New York Times on the disproportionate impact of COVID on children in Brazil.
• Read Times of India on how the pandemic is affecting rural areas of India.
• Read a Nature editorial calling for a focus on universal healthcare even in the midst of the efforts to get COVID vaccines out globally.
• Read a New York Times editorial calling on the Biden administration to do the right thing about vaccinating the world.
• Read a Bhekisisa opinion piece on what HIV vaccine research can learn from the COVID response.

 

India’s Crisis Continues

 
NDTV (India) reports on the death of a 26-year-old doctor “the youngest of 244 doctors who have lost their lives to COVID this year in India's second wave. Last year, 736 doctors had lost their lives during the first wave. A total of nearly 1,000 doctors across India have lost their lives due to COVID so far.” Most of those who died had not been vaccinated. “Five months into India's vaccination drive, only 66 percent of India's healthcare workers have been fully vaccinated.”
 
Times of India reports, “After devastating India’s biggest cities, the latest COVID-19 wave is now ravaging rural areas across the world. And most villages have no way to fight the virus. In Basi, about 1.5 hours from the capital New Delhi, about three-quarters of the village’s 5,400 people are sick and more than 30 have died in the past three weeks. It has no health-care facilities, no doctors and no oxygen canisters. And unlike India’s social-media literate urban population, residents can’t appeal on Twitter to an army of strangers willing to help.”
 

Africa Death Rate High Among Severely Ill

 
South Africa News reports on a comment from Lancet (UK), which found that in 10 African coutries, “Death rates among adults in the 30 days after being admitted to critical care with suspected or confirmed COVID-19 was considerably higher (48 percent) in ten African countries, compared to the global average of 31.5 percent.... Until now, little has been known about how COVID-19 was affecting critically ill patients in Africa as there has been no reported clinical outcomes data from Africa or patient management data in low-resource settings (except for an earlier version of this study).”
 
The New York Times (US) reports, “The increased risk of death applies only to those who become severely ill, not to everyone who catches the disease. Over all, the rates of illness and death from COVID in Africa appear lower than in the rest of the world. But if the virus begins to spread more rapidly in Africa, as it has in other regions, these findings suggest that the death toll could worsen.”
 
This news comes as WHO says in a press release, “A blockage on supplies and financial challenges are delaying Africa’s rollout of COVID-19 vaccines and risk curtailing plans to significantly expand the continent’s rollout later this year. Vaccine deliveries to Africa through the COVAX facility ground to a near halt in May as the Serum Institute of India diverted doses for domestic use. Between February and May the continent received just about a quarter—18.2 million—of the 66 million expected doses through COVAX…. While limited supplies of doses are hampering the large-scale rollout of vaccines, funding for operational costs is also a critical barrier. Eight countries have used up all their vaccines, but over 20 countries have administered less than 50 percent of their doses. COVAX is providing its share of vaccines for free to lower-income countries, but there are other significant costs. It is estimated that 60 percent of every dollar spent on delivering vaccines is needed for operations. The World Bank calculates that on top of the money needed to buy enough vaccines to ensure adequate protection from COVID-19, another 3 billion is required to deliver the vaccines into the arms of people.”
 

Call for Focus on Universal Healthcare

 
The editors of Nature (UK) write, “Vaccinating the world’s population against COVID-19 remains a global health priority. But it is vital that this effort does not overshadow the need to ensure that everyone, everywhere has access to basic health care…. The pandemic has amply demonstrated how a lack of reliable health care can render communities vulnerable. Although access to health care isn’t the sole factor that determined how well countries fared, its absence clearly fuelled the flames…. Universal health care might seem a lofty goal amid a crisis, but if we do not push for change now, we will regret it. The pandemic has increased the number of people living in extreme poverty, making them more vulnerable to disease. It’s infected, killed and traumatized health-care workers everywhere, most devastatingly in places that had too few already. ‘Our failure to invest in health systems doesn’t only leave individuals, families and communities at risk, it also leaves the world vulnerable to outbreaks and other health emergencies,’ Tedros said in October 2019. ‘A pandemic could bring economies and nations to their knees.’ A few months later, it did. We must not let that happen again.”
 

US to Send Some Vaccine Abroad

 
Bloomberg News (US) reports, “President Joe Biden plans to send an additional 20 million doses of US coronavirus vaccines abroad by the end of June—including, for the first time, shots authorized for domestic use, where supply is beginning to outstrip demand…. [An official] stressed that the measures are only a first step as the US pivots its attention to quelling the pandemic abroad. Biden has previously pledged that the US would soon become an ‘arsenal’ of global vaccine supply.”
 
The New York Times (US) looks at what it will take to deliver vaccines to the world, reporting “The only way around the zero-sum competition for doses is to greatly expand the global supply of vaccines. On that point, nearly everyone agrees. But what is the fastest way to make that happen? On that question, divisions remain stark, undermining collective efforts to end the pandemic.” Some argue for patent waivers and tech transfer, while others say that will make things worse. “The world should not put poorer countries ‘in this position of essentially having to go begging, or waiting for donations of small amounts of vaccine,’ said Dr. Chris Beyrer, senior scientific liaison to the COVID-19 Prevention Network. ‘The model of charity is, I think, an unacceptable model.’”
 
An editorial in the New York Times argues “By marshaling this nation’s vast resources to produce and distribute enough vaccines to meet global demand, the United States would act in keeping with the nation’s best traditions and highest aspirations while advancing its geopolitical and economic interests. It is a moment of both obligation and opportunity. Unfortunately, instead of a bold, comprehensive strategy to vaccinate the world as quickly as possible, the Biden administration has thus far made a string of tactical decisions….”
 

COVID Isn’t Over in the US

 
With vaccination rates in the US climbing (although still low in many places), some people are predicting a return to “normal” and an end to the pandemic in the US. Leave aside the certain knowledge that we can’t end COVID anywhere until we end it everywhere, there are mounting concerns about hot spots in the US. Vox (US) reports, “experts are increasingly worried that, in the southern half of the country, the return to normalcy could be a mirage and that summer could bring another wave of the virus in parts of the country. The concern isn’t about another nationwide surge, but potential state or local spikes. That’s because southern states, including much of the Sun Belt and especially the Deep South, face three distinct disadvantages this summer that other parts of the country don’t.” These include: lower vaccination rates, higher temperatures that make it hard for people to be outside and lower adherence to mask wearing, distancing and other mitigation.
 
PBS Newshour (US) reports on results from a poll: “As fewer people die from the coronavirus, the pace of vaccinations is stalling, and four out of 10 Republicans say they do not plan to get a vaccine…. Since August 2020, the percentage of those who do not want to get immunized against COVID-19 has declined by only 9 points—not as much of a change as experts hoped. That concerns public health experts because getting vaccinated is no longer an abstract concept in the US.”
 

Get a Vaccine, Win the Lottery?

 
As American demand for COVID vaccines wanes, well before everyone who could benefit from vaccination has gotten the jab, policymakers and others are looking for ways to encourage people to get vaccinated. Ranging from sports tickets to free beers, most are small tokens, but some states are using tax money to offer lottery tickets or enter the vaccinated in a special lottery for $1 million. A column in the Washington Post (US) argues that incentives from private business are one thing, but “Government exists to protect its citizens, and it is clear that the greater public good is to vaccinate as much of the population as possible. Members of the military, public employees and students should all be required to get vaccinated, absent legitimate excuses for opting out. Yes, there might be backlash, but in some ways politicians have invited that, by using euphemisms such as ‘vaccine hesitant’ to describe people who—let’s face it—selfishly ignore experts. This contagion has killed more than 586,000 Americans and infected more than 33 million. Countless victims report long-haul symptoms. This alone should instill sufficient fear in the holdouts to roll up their sleeves for a jab. After all, the vaccine is a free return ticket to normal life. People shouldn’t need to be paid to take it.”
 

Mix and Match Vax

 
Nature (UK) reports on a study from Spain that found benefit in combining different vaccines. “Vaccinating people with both the Oxford–AstraZeneca and Pfizer–BioNTech COVID-19 vaccines produces a potent immune response against the virus SARS-CoV-2…. Researchers hope that such mix-and-match COVID-19 vaccination regimens will trigger stronger, more robust immune responses than will two doses of a single vaccine, while simplifying immunization efforts for countries facing fluctuating supplies of the various vaccines.”
 

Finding Lessons for HIV Vaccines from COVID

 
In an opinion piece published by Bhekisisa (South Africa), Mitchell Warren and Fatima Hassan write, “The way in which the world has responded to COVID-19 has fundamentally changed ideas of what’s possible in vaccine development—but, regrettably, access to that scientific knowledge remains the property of a few drug companies and research institutions in wealthy countries. COVID-19 has shown us that the urgency to end an epidemic can be so great that billions of dollars in research funding can be found within months. It’s demonstrated that public institutions, universities, pharmaceutical companies and non-profit organisations can work together in ways we’ve never seen before to create lifesaving technologies.”
 

New Coronavirus Identified in Malaysia

 
NPR (US) reports, “scientists are reporting that they have discovered what may be the latest coronavirus to jump from animals into people. And it comes from a surprising source: dogs.” Scientists developed a new test to look for any corona viruses and “found evidence of an entirely new coronavirus associated with pneumonia in hospitalized patients—mostly in kids. This virus may be the eighth coronavirus known to cause disease in people, the team reports Thursday in the journal Clinical Infectious Diseases.”
 

COVID and Children

 
Al Jazeera (Qatar) reports, “Children have been largely overlooked during the COVID-19 pandemic; thankfully the majority of them get mild or even no symptoms if they catch the virus. Much of the discussion around the role of children in the pandemic has been about how they may spread the virus. However, over time there has been a growing body of evidence that suggests that a proportion of children may develop long COVID, whether or not they had any symptoms when they actually contracted the virus.”
 
Reuters (UK) reports, “Singapore warned on Sunday that the new coronavirus variants, such as the one first detected in India, were affecting more children, as the city-state prepares to shut most schools from this week and draws up plans to vaccinate youngsters.”
 
NPR (US) reports on vaccine trials among kids five and under. “Pfizer is planning to apply to the Food and Drug Administration in September for emergency authorization of the vaccine for children aged 2 to 11. Moderna is also conducting clinical trials in small kids for its vaccine. The FDA has already approved vaccinating those 12 and older…. Pfizer is planning to apply to the Food and Drug Administration in September for emergency authorization of the vaccine for children aged 2 to 11. Moderna is also conducting clinical trials in small kids for its vaccine. The FDA has already approved vaccinating those 12 and older.”
 
The New York Times (US) reports, “COVID-19 is ravaging Brazil, and, in a disturbing new wrinkle that experts are working to understand, it appears to be killing babies and small children at an unusually high rate…[one expert] who is leading a study tallying the death toll among children based on both suspected and confirmed cases, estimates that more than 2,200 children under 5 have died since the start of the pandemic, including more than 1,600 babies less than a year old…. A study published in the Pediatric Infectious Disease Journal in January found that children in Brazil and four other countries in Latin America developed more severe forms of COVID-19 and more cases of multisystem inflammatory syndrome, a rare and extreme immune response to the virus, compared with data from China, Europe and North America.”
 

That Baseball Outbreak: What Happened?

 
There has been a great deal of media coverage of nine members of the New York Yankees team and support staff testing positive for COVID after being vaccinated. New York Magazine (US) talked to a Harvard epidemiologist who says, “The Yankees are testing themselves frequently. When that happens, especially if you’re doing PCR tests, you’re going to find exposures and infections” even in people who have been fully vaccinated. He argues PCR testing “is a technology that can catch just ten molecules of virus. But this is a virus that when it is contagious, there are billions of molecules. So, we have to be very careful about how we interpret PCR results. Just because the virus can grow a bit—and be detected on a PCR test—does not mean we are stuck in the woods as far as herd immunity goes. A vaccine that doesn’t create sterilizing immunity can still greatly limit virus growth, perhaps enough to massively limit transmission.”
 

Call to Cancel Tokyo Olympics

 
Reuters (UK) reports, “The Tokyo Medical Practitioners Association representing about 6,000 primary care doctors said hospitals in the Games host city ‘have their hands full and have almost no spare capacity’ amid a surge in infections. ‘We strongly request that the authorities convince the IOC (International Olympic Committee) that holding the Olympics is difficult and obtain its decision to cancel the Games,’ the association said in a May 14 open letter to Prime Minister Yoshihide Suga…. Overall, Japan has avoided an explosive spread of the virus experienced by other nations, but the government has come under sharp criticism for its sluggish vaccination roll-out. Only about 3.5 percent of its population of about 126 million has been vaccinated, according to a Reuters tracker…. Still, Suga says Japan can host ‘a safe and secure Olympics’ while following appropriate COVID-19 containment measures.”
 

Looking to the Past to See the End of COVID     

 
Helen Branswell reports in STAT, “The truth of the matter is that pandemics always end. And to date vaccines have never played a significant role in ending them. (That doesn’t mean vaccines aren’t playing a critical role this time. Far fewer people will die from COVID-19 because of them.)" She notes previous flu pandemics, including the 1918 pandemic weren’t ended by vaccines. "How did those pandemics end? The viruses didn’t go away; a descendent of the Spanish flu virus, the modern H1N1, circulates to this day, as does H3N2. Humans didn’t develop herd immunity to them, either…. Instead, the viruses that caused these pandemics underwent a transition. Or more to the point, we did. Our immune systems learned enough about them to fend off the deadliest manifestations of infection, at least most of the time. Humans and viruses reached an immunological détente. Instead of causing tsunamis of devastating illness, over time the viruses came to trigger small surges of milder illness. Pandemic flu became seasonal flu. The viruses became endemic. If the pattern holds, and it is expected to, SARS-2 will at some point join a handful of human coronaviruses that cause colds, mainly in the winter, when conditions favor their transmission.”
 

It's Airborne

 
Bloomberg (US) reports, “A quiet revolution has permeated global health circles. Authorities have come to accept what many researchers have argued for over a year: The coronavirus can spread through the air. That new acceptance, by the World Health Organization and the US Centers for Disease Control and Prevention, comes with concrete implications: Scientists are calling for ventilation systems to be overhauled like public water supplies were in the 1800s after fetid pipes were found to harbor cholera…. [Authors of a study in Science], comprising 39 scientists from 14 countries, are demanding universal recognition that infections can be prevented by improving indoor ventilation systems. They want the WHO to extend its indoor air quality guidelines to cover airborne pathogens, and for building ventilation standards to include higher airflow, filtration and disinfection rates, and monitors that enable the public to gauge the quality of the air they’re breathing.”