As cases and deaths rise around the world, driven in many countries by the highly transmissible Delta variant, vaccination rates continue to lag in many countries and communities. Low vaccination rates are driven largely by lack of access in most low- and middle-income countries, while in some communities in rich countries low vaccination rates are driven by politics and disinformation. The US is awash in vaccines, but has yet to reach high enough vaccination rates to curtail the spread of the Delta variant and the reasons many people give for not being vaccinated are not based at all in reality. Meanwhile, millions of people around the world who are desperate for vaccines have no way of accessing them.
 

If You Are in a Hurry

• Read a great explainer on variants at JHU’s Hub.
• Read what Gregg Gonsalves says are the 3 things President Biden needs to do now in The Nation.
• Read about what might be the true toll of COVID in India in The Guardian.
• Read Reuters on the astounding number of COVID orphans.
• And then read an op-ed in the New York Times that lays out what the scale of family loss means.
• Read Lynne Mofenson in Mail & Guardian on lessons from HIV for the COVID response.
• Read Bhekisisa’s explainer on what needs to happen for mRNA vaccines to be fully manufactured in Africa.
• Read Newsweek on a poll that exposes the misinformation driving vaccine refusal in the US.
• Read a study in Nature Medicine that found vaccine acceptance is much higher in many low- and middle-income countries than in the US or Russia.

 

Vaccines and Delta

 
WebMD News (US) reports “The Pfizer and AstraZeneca vaccines—the primary vaccine options in the United Kingdom—were less effective against Delta variant of the coronavirus compared with the Alpha variant (known as B.1.1.7), according to a study published [in NEJM]…. Still, the Pfizer vaccine was at least 88 percent effective against Delta after two doses; the AstraZeneca vaccine was 67 percent effective.”
 
The New York Times (US) reports, “The coronavirus vaccine made by Johnson & Johnson is much less effective against the Delta and Lambda variants than against the original virus, according to a new study [a preprint] posted online on Tuesday. Although troubling, the findings result from experiments conducted with blood samples in a laboratory, and may not reflect the vaccine’s performance in the real world. But the conclusions add to evidence that the 13 million people inoculated with the J&J vaccine may need to receive a second dose—ideally of one of the mRNA vaccines made by Pfizer-BioNTech or Moderna, the authors said.
 

Variants Explained

 
JHU’s Hub (US) published a great interview with virologist Andrew Pekosz that dives into why Delta is more contagious than other variants. “Say, for example, it's a one in a million chance that a mutation will be advantageous to the virus. If you let the virus replicate itself 900,000 times, odds are that the advantageous mutation will occur. But if you limit the overall replication of the virus to 1,000 times, then it's much less likely that the random advantageous mutation is going to occur. And that's where public health interventions really help us a lot during this pandemic—by reducing the total amount of virus replication and therefore reducing the chances that the virus can improve or adapt."
 
Nature (UK) reports, “Since first appearing in India in late 2020, the Delta variant of SARS-CoV-2 has become the predominant strain in much of the world. Researchers might now know why Delta has been so successful: people infected with it produce far more virus than do those infected with the original version of SARS-CoV-2, making it very easy to spread. According to current estimates, the Delta variant could be more than twice as transmissible as the original strain of SARS-CoV-2…. In a preprint posted 12 July, the researchers report that virus was first detectable in people with the Delta variant four days after exposure, compared with an average of six days among people with the original strain, suggesting that Delta replicates much faster. Individuals infected with Delta also had viral loads up to 1,260 times higher than those in people infected with the original strain.”
 

Calling Biden To Do the Right Thing

 
Activist and epidemiologist Gregg Gonsalves writes in The Nation (US), “There are three things the Biden administration can do right now to change the course of the pandemic and put the virus on the defensive.” This includes invoking the Defense Production Act to manufacture mRNA vaccines, supporting global manufacturing hubs for mRNA vaccines, making unused doses of vaccines deployed in the US available globally. Gonsalves concludes, “Biden can choose fealty to industry in the midst of a pandemic; that may indeed be the most politically expedient path. But it’s a morally reprehensible choice that will indelibly tarnish his young presidency, leaving a legacy where millions suffered and died while he refused to act.”
 
Check out AVAC’s Breaking the Bottlenecks graphic that identifies the factors contributing to the bottlenecks in the global supply of COVID-19 vaccines.
 
STAT (US) reports, “Millions of unused COVID-19 vaccines are set to go to waste as demand dwindles across the United States and doses likely expire this summer, according to public health officials. Several state health departments told STAT they have repeatedly asked the federal government to redistribute their supply to other countries, many of which are facing a third wave of the COVID-19 pandemic. Officials in Washington have rejected those requests, citing legal and logistical challenges…. States are permitted to donate vaccines that have been allocated to them but not yet distributed to the federal pool, which could potentially be sent elsewhere. The federal government also responded to state health department concerns by allowing them to request only specific quantities of vaccine rather than receiving a set amount determined by population. For now, there’s still hope something can be done. Public health experts believe doses could be returned to the federal government to then be centrally redistributed. Doing so would be a challenge and take resources, they said, but would be worthwhile given the global need.”
 

Speeding up COVID Vaccine Development

 
Reuters (UK) reports, “Scientists are working on a benchmark for COVID-19 vaccine efficacy that would allow drugmakers to conduct smaller, speedier human trials to get them to market and address a huge global vaccine shortage. Researchers are trying to determine just what level of COVID-19 antibodies a vaccine must produce to provide protection against the illness. Regulators already use such benchmarks—known as correlates of protection—to evaluate flu vaccines without requiring large, lengthy clinical trials.”
 
A NEJM (US) perspective from UK researchers argues, “Our experience thus far indicates that a SARS-CoV-2 human challenge research program can be developed as part of the pandemic response. Its establishment has relied on broad collaboration (established before the pandemic through the Human Infection Challenge Network for Vaccine Development) that provided the varied expertise, broad consensus, and funding required. This approach accelerated both challenge-virus manufacture and the ethics review process, ensuring that study design was informed by real-time scientific data. With SARS-CoV-2 continuing to cause major outbreaks globally and improved vaccination and treatment still necessary, the ethical arguments for human challenge studies remain compelling, despite the changing nature of the pandemic.”
 

The True Toll of COVID in India

 
The Guardian (UK) reports, “The number of excess deaths in India during the Covid-19 pandemic could be 10 times higher than the official death toll, according to a study that estimates that between 3 million and 4.7 million more people died than would be expected between January 2020 and June 2021…. ‘India’s official COVID death count as of end-June 2021 is 400,000,’ the report says. ‘The reality is, of course, catastrophically worse…. What is tragically clear is that too many people, in the millions rather than hundreds of thousands, may have died.’”
 
Indian Express (India) reports, “Up to two-thirds of the Indian population above the age of six have already been infected with the coronavirus, the latest nationwide serological survey conducted by the Indian Council of Medical Research (ICMR) has found…. A total of 28,975 people were tested for the presence of antibodies specific to SARS-CoV2 virus, and 67.6 percent were found to have them. For the first time, minors in the age group of 6 to 17 years were also included in the serosurvey, with antibodies interestingly discovered in nearly half of them.”
 

The Global Fund and COVID

 
Devex (US) reports on “calls for [the Global Fund to Fight AIDS, Tuberculosis and Malaria] to expand its mandate to cover financing for COVID-19 and future pandemics,” quoting Friends of the Global Fight’s Chris Collins: "This is an enormous opportunity to advance progress on AIDS, TB, and malaria, identifying synergies between pandemic preparedness...and ending longstanding epidemics.”
 

COVID Orphans

 
Reuters (UK) reports “During the first 14 months of the pandemic, an estimated 1.5 million children worldwide experienced the death of a parent, custodial grandparent, or other relative who cared for them, as a result of COVID-19, according to a study published in The Lancet…. ‘For every two COVID-19 deaths worldwide, one child is left behind to face the death of a parent or caregiver,’ Dr. Susan Hillis from the US Centers for Disease Control and Prevention COVID-19 Response Team, who led the study, said in a statement. The number of COVID-19 orphans will increase as the pandemic progresses, she added.”
 
In a New York Times (US) op-ed, Lucie Cluver, one of the report authors says, “In South Africa, one in every 200 children lost his or her primary caregiver. In Peru, it was one in every 100…. What we found was a scale of family loss that has not been seen since AIDS first rampaged through sub-Saharan Africa…. In some places, children who lost parents to Ebola or AIDS are in the care of grandparents who are falling victim to COVID-19. These are the very countries, in Africa, South Asia and Latin America, experiencing new surges in infections.”
 

Long COVID and Kids

 
Axios (US) reports, “Children's National Hospital in Washington, D.C. and the National Institutes of Allergy and Infectious Disease are launching a $40 million study to examine long COVID and multi-system inflammatory syndrome in children…. While kids have been comparatively unscathed by COVID, this is the largest study of its kind aimed at understanding the long-term impacts COVID can have on children when they do have more serious outcomes.”
 

COVID Vaccine Mandates?

 
NBC News (US) reports more vaccine mandates in the US may come as soon as the US FDA “grants full approval to one or more of the shots, public health experts predicted…. But as the pace of vaccinations lags and concerns about the highly-contagious delta variant grow, the official regulatory signoff would remove a significant legal and public relations barrier for businesses and government agencies that want to require vaccinations for their employees and customers, former health officials from the Biden and the Obama administrations said.”
 

Vaccine Access in Africa

 
Maravi Post (Malawi) reports a decline in COVID cases in Africa does not mean the 3^rd wave is coming to an end and notes a call from WHO to ramp up vaccination efforts. “’Be under no illusions, Africa’s third wave is absolutely not over. This small step forward offers hope and inspiration but must not mask the big picture for Africa,’ said Dr Matshidiso Moeti, WHO Regional Director for Africa. ‘Many countries are still at peak risk and Africa’s third wave surged up faster and higher than ever before. The Eid celebrations which we marked this week may also result in a rise in cases. We must all double down on prevention measures to build on these fragile gains.’…Some 60 million doses should be arriving on the continent in the coming weeks, including from the United States, Europe, the United Kingdom and through the COVAX global solidarity initiative. COVAX is also expected to deliver over half a billion doses alone this year. ‘A massive influx of doses means that Africa must go all out and speed up the vaccine rollout by five to six times if we are to get all these doses into arms and fully vaccinate the most vulnerable 10 per cent of all Africans by the end of September,’ said Dr. Moeti.”
 
PanAfrican Visions reports, “Some Zambians that have completed their dose of the AstraZeneca COVID-19 vaccine have recommended others to get vaccinated owing to what they described as improved immune system after they got their first and second dose of the AstraZeneca vaccine.”
 
Nigerian Tribune (Nigeria) reports, “Africa’s ability to produce its own vaccines has received a boost with the announcement that the United States will invest in South Africa and Senegal for vaccine production. In the meantime, the United States will deliver three brands of COVID-19 vaccines, Pfizer, Moderna, and Johnson & Johnson, to African nations as from August.”
 
Newsday (Zimbabwe) looks at what would be needed for Africa to manufacture its own vaccines, including time to build and equip plants; “Knowledge transfer: Building and operating a vaccine plant requires state-of-the-art knowledge—especially for new types of vaccine such as mRNA, including how to build and operate a plant, and how to control its quality.” Investment that “can be addressed by advance purchase commitments, preferably with up-front payment” from national governments and “intellectual property rights” waivers.
 
Lynne Mofenson writes in Mail & Guardian (South Africa), “Forty years ago, the world recorded the first known cases of AIDS. Today, that pandemic holds essential lessons for the latest disease outbreak—and in particular, the quest for an equitable—and effective—global COVID-19 vaccine roll-out.” She finds 4 lessons from HIV for the COVID response, including “Infectious diseases are global—that was one of HIV’s most important lessons. What happens in one country affects us all. In the HIV pandemic, delays in the global roll-out of HIV treatment led to deaths the world could have prevented. It also made it more difficult—and costly—to prevent new cases. The same could now be said about the stark inequality in global COVID-19 vaccine distribution: lives that could have been saved will be lost.”
 
Health Policy Watch (Switzerland) reports, “In a milestone deal for Africa, Pfizer/BioNTech announced Wednesday that it would partner with the Cape Town-based pharma firm Biovac to produce over 100 million doses annually of its cutting edge mRNA vaccine—for distribution within the African Union…. But the plan to produce 100 million doses, beginning in early 2022, won’t solve the here-and-now problems of vaccine supply shortages in a region where only about 1.5 percent of the population is fully vaccinated, public health advocates also stressed. That, in comparison to 40-60 percent vaccine rates in high-income countries, and even 30 percent coverage in emerging economies such as India.”  
 
Bhekisisa (South Africa) explains “Biovac…won’t produce the vaccine from scratch. The SA manufacturer will import the drug substance (the active ingredient that makes the vaccine work) from Europe and 'fill and finish' the shot in South Africa.” The story explains what needs to happen for full vaccine manufacturing to happen in South Africa.
 
In a GAVI interview with Africa CDC director Dr. John Nkengasong, he argues for “a whole of Africa approach [to vaccine manufacturing], which is why the Africa CDC, as a continental public health agency, and the African Union are central to this. We are building what we call a hub and spoke model, where everybody doesn’t need to do everything from end to end. If we recognise that it takes so many components to produce a vaccine, then we could say that Country X focuses on glassware for vaccines, Country Y focuses on lipids, and so on. The analogy we use is the Airbus production process. The final aircraft is manufactured in Toulouse, France, but the parts come from all over the place. That’s the formula that we think will work for Africa. It would mean that nobody can just say, first of all we’re going to immunise 200 million people in this country, before anyone else gets anything.”
 

Misinformation Drives COVID Rise in US

 
AP (US) reports “COVID-19 cases nearly tripled in the US over two weeks amid an onslaught of vaccine misinformation that is straining hospitals, exhausting doctors and pushing clergy into the fray. ‘Our staff, they are frustrated,’ said Chad Neilsen, director of infection prevention at UF Health Jacksonville, a Florida hospital that is canceling elective surgeries and procedures after the number of mostly unvaccinated COVID-19 inpatients at its two campuses jumped to 134, up from a low of 16 in mid-May. ‘They are tired. They are thinking this is déjà vu all over again, and there is some anger because we know that this is a largely preventable situation, and people are not taking advantage of the vaccine.’"
 
Medscape (US) reports, “As COVID-19 hospitalizations rise [in areas of the US] with low vaccination rates, patients are asking for a vaccine, but it's often ‘too late,’ one doctor said. At Grandview Medical Center in Birmingham, Alabama, for instance, doctors are treating young, otherwise healthy patients who have gotten serious coronavirus infections. ‘One of the last things they do before they're intubated is beg me for the vaccine,’ Brytney Cobia, MD, a hospitalist at Grandview, wrote in a Facebook post. ‘I hold their hand and tell them that I'm sorry, but it's too late,’ she wrote. ‘A few days later when I call time of death, I hug their family members and I tell them the best way to honor their loved one is to go get vaccinated and encourage everyone they know to do the same.’"
 
Newsweek (US) reports “A new survey from YouGov and The Economist released Thursday reveals a startling number of Americans will not get vaccinated due to concerns about side effects, "microchip" implantation and political motivations. One in five Americans believe that the US government is using the vaccine to plant microchip tracking devices into people, the survey found. A significant number of those who reject vaccines also cite the belief that inoculation in general causes autism.”
 

Antibodies Persist After Infection

 
UPI (US) reports, ”People infected with COVID-19 continue to produce antibodies against the virus for up to nine months, whether or not they experienced symptoms, a study published Monday by Nature Communications found. Just under 99 percent residents of Vo, Italy—which saw a high volume of cases in the early stages of the pandemic—who were infected in February or March of last year still had antibodies against the virus in November, the data showed.”
 

The Infodemic and Anxiety

 
A study in the journal JMIR Infodemiology (Canada) looks at “the effect of fear-inducing news articles on people’s expression of anxiety on Twitter.” The study authors concluded, “The level of anxiety in users’ tweets increased sharply in response to article anxiety early on in the COVID-19 pandemic, but as the casualty count climbed, news articles seemingly lost their ability to elicit anxiety among readers. Desensitization offers an explanation for why the increased threat is not eliciting widespread behavioral compliance with guidance from public health officials.”
 

Vaccine Acceptance

 
A study in Nature Medicine (UK) looked at “COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals…. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3 percent; median 78 percent; range 30.1 percentage points) compared with the United States (mean 64.6 percent) and Russia (mean 30.4 percent)…. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage.”
 

COVID’s Impact on Scientific Fieldwork

 
Science (US) reports on how COVID has impacted fieldwork for many scientists. “In a typical year, thousands of graduate students and faculty fan out across the world to tackle important research in climate change, fragile ecosystems, animal populations, and more. But the pandemic shut down travel, and fieldwork can’t be done via Zoom, depriving young scientists like Lele of the data and publications they need to climb the academic ladder and help advance science. Now, he and a few others are venturing out—into a very different world…. ‘Travel to countries still having trouble [is] just not going to happen,’ says Frank Burbrink, a herpetologist. ‘This is the longest I’ve ever gone without catching snakes since I was 12 years old.’”