As rich countries contemplate booster shots, just over 16 percent of the global population is fully vaccinated and in many countries that number is less than 1 percent. Vaccine equity remains the major issue of the pandemic. The COVAX facility that was meant to provide vaccines to poor countries has failed to meet its goals and other plans to increase vaccine access are slow at best. Even as vaccines are being destroyed in US states where many refuse vaccination, people in other countries have no hope of a vaccine for the foreseeable future. Africa CDC’s John Nkengasong tweeted earlier this week: “Vaccine hesitancy is not Africa’s #1 challenge. Rather vaccine famine is the real issue. Long lines, like the one in this video, of Africans across many @_AfricanUnion member states waiting to be vaccinated.”
 
The Washington Post (US) reports, “More than 175 public health experts, scientists and activists on Tuesday demanded that President Biden take urgent steps to confront the global spread of the coronavirus, warning that without immediate action to inoculate the rest of the world, newer variants are likely to emerge—including ones that may evade vaccines’ protection. ‘We urge you to act now,’ the experts wrote in a joint letter to senior White House officials Tuesday and shared with the Washington Post. ‘Announcing within the next 30 days an ambitious global vaccine manufacturing program is the only way to control this pandemic, protect the precious gains made to date, and build vaccine infrastructure for the future.’”

You can read the letter here.
 

If You Are in a Hurry

• Read Bhekisisa’s “COVID crash course” on the virus, variants and vaccines.
• Read Al Jazeera on the diminishing possibility of reaching herd immunity.
• Read how critical care doctors are impacted by the ongoing pandemic in Scientific American.
• Read Ed Yong in The Atlantic on how the pandemic ends.
• Read Scientific American on the legality and efficacy of vaccine mandates.
• Read Al Jazeera on herd immunity: is it still possible?
• Read how COVID survivors and families are becoming activists in the New York Times.

 

All Things Delta

 
The Washington Post (US) reports, “The speed with which [the Delta variant] dominated the pandemic has left scientists nervous about what the virus will do next. The variant battles of 2021 are part of a longer war, one that is far from over. Delta is sending thousands of people into hospitals every day and has knocked the Biden administration back on its heels. In a few short weeks, the delta variant changed the calculations for what it will take to end the pandemic. Epidemiologists had hoped getting 70 or 80 percent of the population vaccinated, in combination with immunity from natural infections, would bring the virus under control. But a more contagious virus means the vaccination target has to be much higher, perhaps in the range of 90 percent.”
 
Information Nigeria reports, “This variant of the virus is spreading faster than other variations. The World Health Organisation established that the Delta variant has certain mutations that allow the virus to adhere to human cells more easily and that experts are also seeing a higher viral load in individuals infected. The Organisation goes a step further by tagging this new variant as “dangerous and the most transmissible SARS-CoV-2 virus to date.” 
 
The New York Times (US) reports, “Breakthrough infections seemed to be vanishingly rare when previous versions of the coronavirus dominated in the United States. But recent outbreaks suggest that the numbers may be higher with the arrival of the Delta variant…. Still, most vaccinated people with a breakthrough infection are likely to have mild symptoms. And they may even benefit, in the long run: Every exposure to the virus is an opportunity for the immune system to strengthen its defenses against variants that may emerge in the future. Booster shots and mild natural infections can both increase the immunity initially gained from the vaccines, said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health. ‘This is why young adults and adults don’t get sick—it’s because as a kid you get an opportunity to see these pathogens over and over and over,’ he said…. Some experts believe breakthrough infections are likelier after exposure to the Delta variant than to prior forms of the virus. Even when more recent data becomes available, however, it still is likely to show that a vast majority of hospitalizations and deaths from COVID-19 occur in unvaccinated people.”
 
A multimedia story in the Washington Post looks at “How the world is grappling with yet
another major coronavirus surge” fueled by the Delta variant.
 

COVID and Children

 
Medscape (US) reports, “With recent increases in COVID-19 cases and hospitalizations in children, some experts are concerned that the Delta variant may cause more severe illness in kids than previous variants. Though the data remain in short supply, some have suggested it would be reasonable to extrapolate mounting evidence of increased severity with Delta in adults to children…. With recent increases in COVID-19 cases and hospitalizations in children, some experts are concerned that the Delta variant may cause more severe illness in kids than previous variants…. David Kimberlin, MD, a pediatric infectious disease expert at the University of Alabama…[says], ‘Across the South, where we have low vaccination rates, children's hospitals are experiencing many more cases than they did at the worst of the peak at the end of 2020 and the beginning of 2021, suggesting it's possible that Delta causes more severe disease in children.’”
 
Reuters (UK) reports, “Moderna Inc is planning to double the size of an ongoing trial testing its COVID-19 vaccines in children aged six months to less than 12 years. According to updated details on clinical trial record site clinicaltrials.gov, the study will now enroll an estimated 13,275 participants, nearly double the earlier target of 6,975 participants. In July, Moderna said it was in discussions with the US Food & Drug Administration to expand the study with an objective to enroll a larger safety database, which increases the likelihood of detecting rarer events.”
 

Disinformation Thriving

 
In the highly politicized environment in the US and other countries, disinformation continues to drive vaccine and mask refusal and sow confusion among people looking for information about the virus. Media Matters (US) reports, “In a little more than three days, a viral video pushing misleading claims about coronavirus vaccines and masks has earned more than 90 million Facebook engagements from uploads to streaming platforms, receiving millions of views…. The new video features a man named Dan Stock…[who] falsely suggested that coronavirus vaccines were not effective…. And rather than vaccines, Stock suggested people use the drug ivermectin to treat COVID-19—which the FDA has specifically advised against…. That a new coronavirus misinformation video was not just able to go viral but apparently surpass the wide spread of previous COVID conspiracy theory videos suggests that Facebook and YouTube continue to struggle with containing misinformation about vaccines and COVID-19.”
 
The Los Angeles Times (US) reports, “Ivermectin, the latest supposed treatment for COVID-19 being touted by anti-vaccination groups, had “no effect whatsoever” on the disease, according to a large patient study. That’s the conclusion of the Together Trial, which has subjected several purported nonvaccine treatments for COVID-19 to carefully designed clinical testing…. The study’s results on Ivermectin haven’t been formally published or peer-reviewed. Earlier peer-reviewed results from the Together Trial related to the antimalarial drug hydroxychloroquine, which had been touted as a miracle treatment for COVID by then-President Trump, were published in April; they showed no significant therapeutic effect on the virus.”
 
The Institute for War and Peace Reporting (UK) is working to counteract the disinformation using “open source intelligence and investigative techniques to probe some of the most prevalent fake news stories.”
 
Business Insider (US) profiles Dr. Sherri Tenpenny “named as one of the 12 most prolific sources of anti-vax misinformation…. Tenpenny's social media presence is warm, world-weary, and comforting. In her cozy Instagram chats, she seems completely sincere in her beliefs. But for [Imran Ahmed, CEO of the Center for Countering Digital Hate], the Disinformation Dozen have one prime motivation: Money. ‘There is no true self’ with them, he said. ‘There's no bottom line beyond the bottom line.’" Facebook and Instagram have done little to curb Tenpenny and the others.
 
The Nation (Nigeria) reports, “The Federal Government says a media report raising doubt on the propriety of using the four million doses of Moderna COVID-19 vaccines donated by the US is “fake, baseless and irresponsible…. The minister, a member of the Presidential Steering Committee (PSC) on COVID-19 said contrary to the speculations in the report, the Moderna vaccine was safe, approved by the World Health Organisation and being administered globally…. Mohammed urged Nigerians not to be dissuaded by the rumours, disinformation and fake news on COVID-19 and the vaccines.”
 

Africa Third Wave Waning, but New Viral Threat Rises

 
Sunday Times (South Africa) reports, “Guinea has been hit by the Marburg virus just as the third wave of coronavirus on the continent has started levelling out and vaccines have begun steadily flowing in. Africa CDC director Dr John Nkengasong reported at his weekly COVID-19 briefing on Thursday that there had been an overall 1 percent average decrease in new cases reported over the past four weeks…. On Monday, the World Health Organisation confirmed the first case of the highly infectious and deadly Marburg virus in Guinea—which also entered its third wave of COVID-19 infections in the past week.”
 
SABC News (South Africa) reports, “Four countries in Africa have entered their fourth wave of surging COVID-19 infections. According to the Africa Centre for Disease Control (Africa CDC), Algeria, Kenya, Somalia, and Tunisia are seeing infections rise again for the fourth time since the pandemic. Less than 2 percent of the continent’s population is fully vaccinated as countries continue to struggle in securing COVID-19 vaccine doses. CDC Director, John Nkengasong says he is also worried about the high positivity rates for the majority of member states especially after 30 reported the Delta variant.”
 

What’s New in Vax Research and Regulation?

 
Reuters (UK) reports, “Antibody levels are a good predictor for how effective Moderna Inc's COVID-19 vaccine is, according to a new study released on Tuesday, a finding which could help speed up future clinical trials for vaccines against the disease…. Regulators currently rely on large placebo-controlled studies to determine if a vaccine works, but the study…showed that measuring the antibody levels in vaccine recipients could also determine effectiveness. The study, which has not yet been peer-reviewed, found that the Moderna vaccine was more effective in vaccine recipients with high levels of antibodies. These recipients also reported a lower rate of breakthrough infections after being vaccinated.”
 
HealthWorld (India) reports, “A WHO official has said the agency’s assessment of made-in-India Covaxin is at an advanced stage and a decision on emergency authorisation for Bharat Biotech’s vaccine is likely by mid-September. Covaxin is still to be authorised by Western authorities…. Simao says WHO is also considering other versions of vaccines already licensed by the agency, including one made by Sinopharm. She expects they’ll begin evaluating vaccines made by Sanofi Pasteur and Novavax in September. ‘There are many, many vaccines in the final stages of the pipeline,’ Simao says.”
 
Reuters (UK) reports, “Three new conditions reported by a small number of people after vaccination with COVID-19 shots from Pfizer and Moderna are being studied to assess if they may be possible side-effects, Europe's drugs regulator said on Wednesday.” The conditions include a skin rash and two kidney disorders.
 
Fast Company (US) reports, “As the super-contagious delta variant began to spread widely, scientists at BioNTech…went into the lab to quickly create a new version of the vaccine that specifically targeted the variant…. Editing the vaccine involves a relatively simple change in the code. ‘The vaccine we are using now has the original spike protein, and the only thing we basically need to do is cut out this part and take the spike protein of the delta variant,’ says Özlem Türeci, co-founder and chief medical officer of BioNTech.”
 
African Pharma Review (South Africa) reports, “According to Professor Glenda Gray, who is the co-principal investigator of the Sisonke implementation study, booster shots are not required for those who have received Johnson & Johnson’s single-shot vaccine. ‘These results show there is no need for a booster yet,’ said Gray during an address on Friday. According to Gray, in addition to demonstrating durability for eight months, the vaccine showed 71 percent efficacy against hospitalization and up to 96 percent efficacy against death. The latter was the trial’s primary endpoint, and as a result, enabled the researchers to conclude that the ‘vaccine protected health workers against death.’"
 
The New York Times (US) reports, “Federal health officials on Wednesday bolstered their recommendation that pregnant people be vaccinated against COVID-19, pointing to new safety data that found no increased risk of miscarriage among those who were immunized during the first 20 weeks of gestation. Earlier research found similarly reassuring data for those vaccinated later in pregnancy.”
 

Vaccine Mandates

 
Several US cities, companies, universities and other organizations have enacted or plan to enact vaccine mandates—usually with some exceptions allowed. Vaccine mandates are also in place or being considered in other countries.
 
Scientific American (US) reports, “Reflecting deep concern over lagging vaccinations, the Biden administration recently mandated vaccinations for all federal workers and contractors (with masking and regular testing as an alternative option), while the Department of Veterans Affairs issued mandates for all frontline health workers at its facilities. President Joe Biden also ordered the military to move toward compulsory vaccinations…. Are these mandates lawful and ethical? The short answer is emphatically yes. And there is strong behavioral science evidence that mandates will be highly effective….There is considerable behavioral scientific data that vaccine mandates are effective. That includes both “hard” mandates (required vaccinations for school or workplace attendance) and “soft” mandates (the choice to vaccinate or undergo regular testing and indoor masking). Hospitals that have required influenza vaccinations have achieved and maintained far higher coverage than those that make it voluntary. At the same time, K–12 school and IHE mandates have given the US high vaccination rates.”
 
AFP (France) reports, “Kenyan civil servants have until late August to get vaccinated against COVID-19 or risk disciplinary action, according to a government document made public this week. The order comes as parliament is due to consider a motion to bar unvaccinated people or those without negative COVID certificates from certain public and private spaces. Kenya is witnessing a surge in coronavirus cases but the vaccine rollout remains slow, with less than three percent of the 47 million population having had shots.”
 

Is Herd Immunity for COVID Possible?

 
Al Jazeera (Qatar) asks, “As new COVID variants emerge, is herd immunity impossible?” noting “the biggest challenge is the uneven distribution of vaccines across the world. As the most affluent countries rolling out effective vaccination programmes for their own populations, this leaves many poorer nations without vaccines and open to huge waves of infections; perfect breeding grounds for new variants to arise that could be resistant to the effects of the original vaccines…. It may be that, like the flu virus, we do not aim for herd immunity but rather maximum population protection through vaccines. To be frank, protecting people from serious illness and preventing healthcare systems from being overwhelmed may have to be enough.”
 
NDTV (India) reports, “The highly transmissible Delta variant of coronavirus has rendered the prospect of herd immunity, where the majority of a country's population becomes immune to a virus, difficult, the head of the UK's Oxford Vaccine Group has warned. Professor Andrew Pollard…told the All-Party Parliamentary Group (APPG) on Coronavirus Tuesday that the fear of another even more transmissible variant remains a possibility and, therefore, there is nothing that can completely stop the deadly virus from spreading…. ‘The Delta variant will still infect people who have been vaccinated. And that does mean that anyone who's still unvaccinated at some point will meet the virus. We don't have anything that will stop transmission, so I think we are in a situation where herd immunity is not a possibility and I suspect the virus will throw up a new variant that is even better at infecting vaccinated individuals,’ he said.”
 

How Does It End?

 
Ed Yong writes in The Atlantic (US), “In simple terms, many people who caught the original virus didn’t pass it to anyone, but most people who catch Delta create clusters of infection. That partly explains why cases have risen so explosively. It also means that the virus will almost certainly be a permanent part of our lives, even as vaccines blunt its ability to cause death and severe disease…. the ‘zero COVID’ dream of fully stamping out the virus is a fantasy. Instead, the pandemic ends when almost everyone has immunity, preferably because they were vaccinated or alternatively because they were infected and survived. When that happens, the cycle of surges will stop and the pandemic will peter out. The new coronavirus will become endemic—a recurring part of our lives like its four cousins that cause common colds. It will be less of a problem, not because it has changed but because it is no longer novel and people are no longer immunologically vulnerable.”
 

COVID Survivors and Families Become Activists

 
The New York Times (US) reports, “New grass-roots groups are learning how to lobby for things like mental health and disability benefits, research on ‘long haulers,’ an investigation of the pandemic and a day to honor the dead…. not since the early days of the HIV/AIDS epidemic has an illness been so colored by politics, and the new COVID activists are navigating challenging terrain.”
 

COVID’s Toll on Healthcare Workers

 
Scientific American (US) looks at the impact of the almost 18-month pandemic on US critical care doctors. “For nearly 18 months, critical care workers have been on the front lines of one of the worst medical crises in American history. The intensive care unit (ICU) death toll for COVID-19 patients is almost unimaginable: a mortality rate of approximately 35 percent, according to one meta-analysis. Nurses in the ICU have served, suffered devastating loss and ultimately left the profession in droves. We have read their stories of grief and pain. Only now, in the long tail of COVID’s run, are we beginning to understand the depth of the toll the pandemic has taken on the physicians on the front lines. Although hardly surprising, the news is not good. In a recent national survey of roughly 12,000 doctors, more than half of critical care physicians reported burnout. Staffing and personal protective equipment (PPE) shortages, the death toll, personal safety concerns, a feeling of inadequacy in providing emotional support to patients and their families—all contribute to a wave of difficulty that, deep into the summer of 2021, continues to build. “
 
Chavi Karkowsky a medical doctor writes in The Atlantic (US), “After the horrors that health-care workers have endured during the pandemic, many are struggling to sympathize with people who won’t protect themselves.” She chronicles the darkest days of the pandemic in New York City in 2020 and writes after vaccines became available, she and other doctors believed “Science had brought us a solution, and we could finally see the end of all those months of fear, exhaustion, and sacrifice. But that’s not what happened. COVID-19 hasn’t ended. Instead, infection rates are going up. The Delta variant has taken hold, and hospitals are filling up again. But this time the suffering seems different, because it is avoidable. Optional. A choice…. A year ago, we worried about dwindling N95-mask supplies and a limited ventilator inventory. Now we are burning through our most irreplaceable health-care resource: hope.”
 
A new report from The Physicians Foundation (US) “sought to understand the breadth of COVID-19’s impact on physicians, and their patients, colleagues and practices.” The report found, “More than half of physicians (57 percent) have felt inappropriate feelings of anger, tearfulness or anxiety because of COVID-19, 46 percent of physicians have withdrawn or isolated themselves from others and 34 percent felt hopeless or without a purpose…. Twenty percent know of a physician who has either considered, attempted or died by suicide during the COVID-19 pandemic.”
 

Booster Shots in the US

 
AP (US) reports, “US regulators say transplant recipients and others with severely weakened immune systems can get an extra dose of the Pfizer or Moderna COVID-19 vaccines to better protect them as the delta variant continues to surge. The late-night announcement Thursday by the Food and Drug Administration applies to several million Americans who are especially vulnerable because of organ transplants, certain cancers or other disorders. Several other countries, including France and Israel, have similar recommendations…. Importantly, the FDA's decision only applies to this high-risk group, estimated to be no more than 3 percent of US adults. It's not an opening for booster doses for the general population.
 
Medscape (US) reports, “More than 1 million people have already received a third shot of the Moderna or Pfizer COVID-19 vaccine, which isn't yet authorized by the FDA, according to ABC News. The estimate of 1.1 million third shots is likely an undercount, according to an internal CDC document obtained by ABC News. The number includes people who received the two-shot Moderna and Pfizer vaccines and then received another dose, but it doesn't count people who may have received the one-shot Johnson & Johnson vaccine and then received a second dose of either Moderna or Pfizer vaccines.”
 

Resource of the Week

 
Bhekisisa has published a “COVID crash course” breaking down how the virus works; what variants are and what vaccines can do. “Viruses succeed by making mistakes. Their existence (although there is debate about whether viruses are actually ‘alive’) requires constant mistakes in order to gain the advantage over their hosts (in the case of SARS-CoV-2 the host is our bodies). Errors made during replication sometimes make the new virus particles more efficient at spreading, defending themselves or replicating. Viruses with such beneficial errors thrive, while less efficient mistakes die out…. But nothing in nature is static, and human immune cells also evolve to fight their viral foes. Antibody responses “mature”, becoming more efficient. “Both virus and antibodies are dynamically evolving systems through mutation…and selection.”