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AVAC's weekly COVID News Brief provides a curated perspective on what COVID news is worth your time.
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“The scientific process is like a hamburger. By examining the quality of each ingredient, you can see how good the end product is. You wouldn’t want mouldy bread or wilted lettuce ruining a perfectly good meal—and similarly you don’t want bad science ruining what could otherwise be a perfectly good vaccine.”
— Aisha Abdool Karim and Joan van Dyk in Bhekisisa |
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Latest Global Stats
August 27, 2021
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Global Documented Cases
214,962,872
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Global Reported Deaths
4,479,309
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People Fully Vaccinated
1,938,089,751
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COVID vaccines led the news this week, with US FDA approval of the Pfizer vaccine, more data on potentially waning immunity from mRNA vaccines and news that a second shot of the J&J vaccine increases antibody response.
More wealthy countries are moving to add 3rd shots for vaccinated people even as low- and middle-income countries struggle to find enough shots for those most at risk. Vaccination rates have ticked up in some countries, yet worldwide only 1 in every 4 people is fully vaccinated. Global Health Strategies tweeted, “At Wednesday's @WHO briefing, @DrTedros made two important points about #COVID19 vaccine boosters: 1. Benefits & safety data are not conclusive 2. Administering boosters before others have even received their first dose is wrong, morally & epidemiologically."
If You Are in a Hurry
- Dive into Aisha Abdool Karim and Joan van Dyk’s multi-part series for Bhekisisa looking at the Sputnik V vaccine and get a good lesson in vaccine development.
- Read a statement from The American Academy of Pediatricians on off-label vaccinations for children under 12.
- Read an op-ed in the Daily Maverick that looks at the impact of the COVID pandemic on children and what needs to be done for them.
- Read BBC on a new Oxford study that finds the complications of COVID “dwarf” the side effects from vaccines.
- Read Hilda Bastian’s excellent primer in The Atlantic on what full FDA approval looks like and why it needs to take time.
- Read Apoorva Mandavilli in the New York Times on how we have to learn to live with scientific uncertainty.
- Read Your Local Epidemiologist on how the vaccinated and the unvaccinated contribute to the transmission chain.
- Read the New York Times on critiques of Biden’s global COVID policy and then read PrEP4All’s report Playing Fiddle While the World Burns.
Full FDA Approval of Pfizer Vaccine
The biggest news story of the week was the full US FDA approval of the Pfizer COVID vaccine. NPR (US) reports, “The two-dose vaccine is now fully approved for people ages 16 and older. For those who are ages 12 to 15 and for those who are immunocompromised and need a booster shot, the vaccine is still available under an FDA emergency use authorization. The approval, says the FDA, means ‘the public can be very confident that this vaccine meets the high standards for safety, effectiveness, and manufacturing quality the FDA requires of an approved product.’"
There was hope that the full approval would push more people to get the vaccine, but the Washington Post (US) reports, “hopes that many of those skeptics would be swayed by vaccine approval appear to have been unrealistic, according to interviews with 16 unvaccinated Americans—including six who said earlier this year that they would be more likely to get vaccinated if the FDA approved the shots…. The sheer number of still-skeptical Americans—and their willingness to shift the goal posts on what might convince them—underscores that vaccination mandates are essential, said Robert Murphy, an infectious-disease physician and executive director of the Institute for Global Health at Northwestern University’s Feinberg School of Medicine.”
In a separate article, the Washington Post (US) reports that vaccine skeptics and critics who had been relying on the fact the vaccines were available only under emergency-use authorizations shifted their narrative after the FDA approval. “The claim: The FDA didn’t really fully authorize the Pfizer vaccine. It’s a claim many of the most prominent vaccine skeptics you might have heard of are pushing with increasing gusto. It’s just not something that, according to experts, actually lines up with the FDA’s announcement…. Robert F. Kennedy, a leading purveyor of anti-vaccine conspiracy theories, claimed with a co-author, ‘The FDA appears to be purposefully tricking American citizens into giving up their right to refuse an experimental product.’”
In a statement following the approval, MSF calls “on US-based Pfizer and German-based BioNTech to immediately share the vaccine technology and knowledge with manufacturers on the African continent that could help boost the global supply. MSF is also calling on the US government to demand these companies follow through. As COVID-19 vaccines remain scarce and people continue to die from COVID-19 at alarming rates across Africa, additional manufacturers stand ready to help boost the global supply, but cannot do so because Pfizer-BioNTech will not share the information and expertise needed for them to make more doses.”
Hilda Bastian in The Atlantic (US) looks at why the FDA took the time it did to fully approve the Pfizer vaccine, concluding, “We’ve gotten used to the emergency-use-authorization world. We can’t predict for sure what open season on marketing for the vaccines will be like. Some things may be simpler, but others may get more complicated. What is certain: We need widespread confidence on efficacy, safety, and the reliability of vaccine quality. The FDA’s job is to make sure that confidence is well placed and difficult to undermine. Even when it seems as though the agency is lumbering along, a perception that corners were cut under pressure would only make things worse.”
Vaccine Complications Much Lower Than COVID Risks
BBC (UK) reports, “A major review of vaccines suggests the AstraZeneca jab does raise the risk of blood clots and another serious condition that can cause bleeding. But the study found the risk of such problems following a coronavirus infection was still much higher. The University of Oxford-led team also found an increased risk of stroke after the Pfizer jab—but again at a much lower rate than after infection. The team said it once again showed the ‘substantial’ benefit of vaccination.”
J&J Second Dose Data
NPR (US) reports, “Johnson & Johnson says it has evidence that people who received its one-shot COVID-19 vaccine could benefit from a booster shot after six months. The pharmaceutical giant said in a news release Wednesday that when it gave participants in a study a second jab of its coronavirus vaccine after six months, their antibody levels were nine times higher than 28 days after their first dose. The data suggests that an additional shot might serve as a booster if the vaccine's effectiveness begins to wane.”
Fighting Disinformation
The Washington Post reports on “a private Facebook group called Vaccine Talk that billed itself as ‘an evidence-based discussion forum’ for pro-vaccine and anti-vaccine folks alike…. Amid the online scare stories and anti-vaccine memes, an army of local influencers and everyday users is waging a grass-roots campaign on Facebook, Reddit and other platforms to gently win over the vaccine skeptical. They’re spending hours moderating forums, responding to comments, linking to research studies, and sharing tips on how to talk to fearful family members…. Vaccine Talk now has nearly 70,000 members, each of whom must gain administrators’ approval to join and commit to a code of conduct. Strict rules prohibit users from misrepresenting themselves, offering medical advice and harassing or bullying people. Another key rule: Be ready to provide citations within 24 hours for any claim you make. Twenty-five moderators and administrators in six countries monitor the posts, and those who flout the rules are kicked out.”
The New York Times (US) reports that in the first quarter of 2021 on Facebook, “the most-viewed link was a news article with a headline suggesting that the coronavirus vaccine was at fault for the death of a Florida doctor.” A report with that information was never released to the public, but provided to The Times. BBC (UK) reports, “The widespread circulation of this story of a doctor who died two weeks after receiving a COVID-19 jab exposes just how fertile a breeding ground Facebook can be for anti-vaccination content. This can be partly explained by a committed network of activists, under a variety of different guises, who oppose coronavirus vaccines. Promoting emotive, personal stories like this one on Facebook has been one of their primary tactics in scaring others from getting jabbed—even when, as was the case with this story, it turns out the death has no link to a COVID-19 vaccine at all.”
Anti-Mask and Anti-Vax Protests Turn Violent in the US
Medscape (US) reports, “Across the country, anti-vaccine and anti-mask demonstrations are taking scary and violent turns, and educators, medical professionals and public figures have been stunned at the level at which they have been vilified for even stating their opinion. And they have been terrified over how far protesters will go in confronting leaders outside their homes and in their workplaces.”
“You Are Not a Horse”
As reports of people taking the animal drug Ivermectin to treat COVID, the US FDA took to twitter to promote a fact sheet Why You Should Not Use Ivermectin to Treat or Prevent COVID-19 with a pithy tweet: “You are not a horse. You are not a cow. Seriously, y'all. Stop it.” Countless headlines note the increasing use of the drug especially in places where vaccine skepticism is high. Sata on the use of the drug to treat COVID has been mixed and there is no conclusive evidence that it works, and doses meant for large animals are definitely not beneficial to humans. The Washington Post (US) reports, “Even if you just treat this as an unanswered question, though, the endorsements of the drug in conservative media have often gone way beyond the evidence. They’ve pitched ivermectin as a bona fide treatment, despite most scientists, the FDA, the World Health Organization and other prominent groups continuing to discourage its use.”
Living with Scientific Uncertainty
Apoorva Mandavilli writes in the New York Times (US) “Americans are living with science as it unfolds in real time. The process has always been fluid, unpredictable. But rarely has it moved at this speed, leaving citizens to confront research findings as soon as they land at the front door, a stream of deliveries that no one ordered and no one wants…. To frustrated Americans unfamiliar with the circuitous and often contentious path to scientific discovery, public health officials have seemed at times to be moving the goal posts and flip-flopping, or misleading, even lying to, the country…research into all aspects of the pandemic turns up online almost as quickly as authors can finish their manuscripts. ‘Preprint’ studies are dissected online…or in emails between experts. What researchers have not done is explain, in ways that the average person can understand, that this is how science has always worked. The public disagreements and debates played out in public, instead of at obscure conferences, give the false impression that science is arbitrary or that scientists are making things up as they go along.”
South Africa’s Vaccine Rollout
BMJ (UK) reports on the setbacks to South Africa’s vaccine program. “The government has set a target to vaccinate 67 percent of the population by February 2022. Is that feasible? Harsha Somaroo, a public health medicine specialist at Wits University, answers a tentative, “yes.” By her calculations, 270 776 people would need to be vaccinated for 30 days a month between August and February 2022. “It is theoretically achievable but will be very dependent on the contextual supply and demand factors,” she told the BMJ. Consistency is key—something that has been in short supply so far.”
Calls for COVID Screening for Hospital Patients in Kenya
The Star (Kenya) reports, “Mombasa county health officials have called on the government to initiate compulsory screening of COVID-19 for patients before admissions. This comes after more than 40 health workers tested positive in Mombasa in the last three weeks of August, according to the latest report from the county health department.” An official from Kenya National Union of Nurses says, “Patients get admissions without being screened for COVID-19 and upon doing further tests, the patients test positive for the virus and this is after interacting and infecting the health workers.”
Innate Resistance to COVID
STAT (US) reports on “a growing effort to identify factors that may make people resistant to COVID, with the goal of finding clues to treatments, as well as understanding resistance against viruses more broadly.” The article profiles research happening in Brazil with “discordant couples.”
Needle-free Vaccine Gets EUA in India
IFLScience (UK) reports, “The Drug Controller General of India has given the Emergency Use Authorization for the ZyCov-D vaccine. This is the first approved DNA needle-free vaccine against COVID-19 and the pharmaceutical company Zydus Cadila reports efficacy of 66 percent against the disease. The vaccine will be delivered in three doses each 28 days apart. It was well-tolerated and safe. It was tested in over 28,000 volunteers including 1,000 adolescents between 12 and 18. The approval will allow for this age group to be immunized in India.” Hindustan Times (India) reports, “ZyCoV-D is a needle-free vaccine administered with the help of a needle-free applicator. The applicator pushes a small quantity of the vaccine into the skin at very high pressure…. Some studies state that needle-free jet injections can improve the delivery of DNA vaccine compared to a standard needle injector. The needle-free technology also reduces needle injuries as well as waste.”
The Role of the Vaccinated in the Transmission Chain
Your Local Epidemiologist (US) writes, “Vaccines continue to help on the individual-level: they keep you out of the hospital. They also continue to help on a population-level: You play less of a role in the transmission chain than unvaccinated. If and when a vaccinated person is contagious, it’s for less amount of time compared to unvaccinated (6 days vs. 18 days). This will no doubt help end the pandemic. But, even given this, we all still need to wear our masks to stop transmission at every corner.”
Pregnant People and Vaccines
Yahoo News (US) reports on US CDC data that shows, “As of Aug. 21, about 3 in 4 pregnant women aged 18-49 were unvaccinated, or in other words, 23.9 percent overall received at least one dose, per data from the agency’s Vaccine Safety Datalink. Vaccination coverage was reported lowest among Hispanic/Latina (19.2 percent) and Black pregnant women (11.7 percent), with higher coverage reported among Asian (35.2 percent) and White pregnant women (26.6 percent).”
Biden Critiqued for Slow Global Vaccine Response
The New York Times (US) reports “President Biden, who has pledged to fight the coronavirus pandemic by making the United States the ‘arsenal of vaccines’ for the world, is under increasing criticism from public health experts, global health advocates and even Democrats in Congress who say he is nowhere near fulfilling his promise…. In an analysis to be published on Thursday, the AIDS advocacy group PrEP4All found that the administration had spent less than 1 percent of the money that Congress appropriated for ramping up COVID-19 countermeasures on expanding vaccine manufacturing. Report author James Krellenstein is quoted: ‘If they don’t change course pretty soon,’ he said, ‘the Biden administration is going to be remembered in terms that the Reagan administration is remembered today in not dealing with the AIDS crisis.’”
The Hill (US) reports, “Members of the Congressional Black Caucus (CBC) are reportedly calling on the Biden administration to deliver an additional 100 million COVID-19 vaccine doses to Africa as the continent has vaccinated slightly more than 2 percent of its population. ‘The longer it takes to vaccinate the world, the more variants we will see and the longer this pandemic will continue,’ California Reps. Barbara Lee and Karen Bass, wrote in a letter to Biden…”
In a CNN (US) oped Reshma Ramachandran and Asia Russell write, “with little effort spent to build support for this IP waiver, refusal to commit to the World Health Organization (WHO) Director-General's plea for a moratorium on booster vaccinations until at least 10 percent of every country has been vaccinated, and a global response plan with little more than platitudes, Biden's statements of support have proved to be empty words…His policies continue to put America first and have largely benefitted the ever-expanding profit margin of the pharmaceutical industry, and as such, President Biden's global COVID-19 response has so far failed.
Warning Against Off-label Vaccines for Children
The American Academy of Pediatricians (US) says in a statement that following full approval of the Pfizer vaccine, “While questions may now arise about the administration of the vaccine off-label for children aged 11 and younger, who currently have no available vaccine, the American Academy of Pediatrics strongly discourages that practice…. The dose of the adult vaccine is much higher than the doses being tested in children younger than 12.”
MedPage Today (US) reports, “FDA Acting Commissioner Janet Woodcock, MD, warned against off-label use of the Pfizer vaccine in younger children during a press briefing Monday, warning that they're ‘not just small adults.’"
Thailand Shifts to “Living with COVID” Strategy
IntellAsia (Australia) reports, “Thailand is preparing for life with COVID, with preliminary plans being drawn up to relax some restrictions and reopen its borders to vaccinated visitors even as new cases hover around 20,000 a day. The National Communicable Disease Committee on Monday approved a shift in the country’s strategy to ‘learning to live with COVID-19’, recognising the endemic nature of the virus, according to Opas Karnkawinpong, director-general of the Department of Disease Control. The focus going forward will be on containing infections to a level that doesn’t exceed capacity of the public-health system, with key measures being total vaccination coverage for vulnerable groups and faster case-tracing on the assumption that everyone can become infected and transmit the virus, he said.”
The Next Pandemic
Gizmodo (US) reports, “Researchers warn that the next major pandemic may not be too far away. In a new paper out Monday, they estimate that a pandemic as deadly as COVID-19 is expected to arrive within the next six decades, while a pandemic on the scale of the 1918 Spanish flu could be expected to recur every 400 years. They also argue that the annual probability of these extreme events may increase over time, given that emerging and re-emerging diseases have become more common in recent decades…. Researchers at Duke University and elsewhere say there hasn’t been much statistical work done to estimate the probability of these major outbreaks of disease—a knowledge gap they hoped to address in their new paper, published Monday in the journal PNAS.”
Bringing Back Contact Tracers
The Chicago Tribune (US) reports, “state and local health departments are trying to build back operations with depleted resources, as COVID-19 fatigue among their workers and the public alike complicates those efforts.” Many health departments wound down contact tracing when infections waned earlier in the year. “’Contact tracing from the start of this pandemic provided us with really kind of invaluable information,’ said Dr. Amanda Castel, a professor of epidemiology at George Washington University. Castel said it’s still ‘a fundamental part of our response.’ As is COVID-19 testing, especially for those who are vulnerable or unvaccinated, such as children under age 12. Yet numerous departments now find themselves with fewer contact tracers and less robust programs. Like testing, contact tracing seems to have fallen by the wayside.”
Collateral Damage
An op-ed in the Daily Maverick (South Africa) warns, “Young people have paid an enormous price in terms of numerous losses, on a personal level and through schooling disruptions. Many children have lost parents, grandparents or close relatives. In South Africa where many grandparents assume the role of primary caregivers, the loss of older family members to COVID-19 has been particularly devastating. The loss or separation from a primary caregiver has a profound impact on a child’s mental health in terms of loss of attachment figures, a safe base from which to explore the world, and heightened anxiety about the future.”
Healio (US) reports, “Researchers reported in the American Journal of Preventive Medicine that the pandemic led to major decreases in HCV virus testing and treatment, including a 59 percent decrease in HCV antibody testing volume in April 2020 compared with the previous 2 years. [a World Hepatitis Alliance (WHA) survey found]: From March 30 to May 4, 2020, 94 percent reported that their services were impacted by the COVID-19 crisis, and just 36 percent said people were able to access viral hepatitis testing, mostly because of closed testing facilities…”
China Back to Zero Reported Cases, but Through Draconian Methods
Bloomberg (US) reports, “China has once again squelched COVID-19, bringing its local cases down to zero. It was more difficult this time…. The arrival of the more infectious delta variant has raised the stakes, as the pathogen refines its ability to escape curbs and flout vaccination. It’s unclear how long the victory will last. The China model shows what it takes to get Covid under control, and raises questions about whether other nations would be willing—or able—to follow the same draconian steps.”
COVID Vax Doesn’t Harm Fertility or Sexual Function
Scientific American (US) reports, “Rumors and myths about COVID-19 vaccine effects on all aspects of reproduction and sexual functioning have spread like a Delta variant of viral misinformation across social media platforms, where people swap rumors of erectile dysfunction and fertility disruptions following vaccination.” Yet there has been no evidence the vaccines cause any of these issues, while COVID can cause such problems. “All of the experts had the same take-home message: the key to protecting against the reproductive and sexual effects of COVID-19 is to get vaccinated.”
COVID Vaccines Aren’t Perfect
Helen Branswell reports in STAT (US) that following news of highly effective COVID vaccines last year, “the world rejoiced—and even veteran scientists were blown away. Very few vaccines are that protective. Those made to fend off viruses like SARS-CoV-2—viruses that invade the nose and throat, like flu—typically aren’t at the high end of the efficacy scale. That was the good news. Now, however, our soaring expectations for COVID-19 vaccines are in the process of sinking back to earth…. The vaccines are wondrous weapons, but they aren’t impenetrable armor.”
A Surge That Didn’t Have to Happen
A Florida doctor writes in STAT (US), “All of us have been showing up for 18 months, caring for people with this disease, risking our health and risking exposing our families to it. We’re exhausted, physically and emotionally. We’re traumatized by the phone calls we must make telling families their loved one isn’t going to make it. For me, the most devastating part of this surge is that it didn’t have to happen. The hope that I and other health care workers felt when COVID-19 vaccines arrived was real. Vaccines have since become easy to get—at the corner pharmacy, pop-up vaccination center, on the job, and elsewhere—which makes it unfathomable that nearly all of my current COVID-19 patients haven’t been vaccinated.”
Intersecting Pandemics and the Criminal Justice-involved Individuals
A blog post for Health Affairs (US) argues, “Given the concentration of both HIV and COVID-19 among the incarcerated and those involved in the [criminal justice (CJ)] system, there is a need to focus on this intersection rather than each disease individually. Additionally, given COVID-19’s severe impact on those involved in the CJ system, it is important to rethink how HIV prevention and treatment can be restructured in a way to withstand this and future disruptions…. As the COVID-19 pandemic continues, it is increasingly pressing that public health professionals and researchers find innovative ways to focus on the health of these vulnerable communities and community members, provide linkages to HIV- and COVID-19-related care between CJ and community settings, and push for decarceration of our communities.”
Excess Infant Deaths During the Pandemic
A BMJ (UK) modeling study estimates “267,208 (95 percent CI 112,000 to 422,415) excess infant deaths in 128 countries, corresponding to a 6.8 percent (95 percent CI 2.8 percent to 10.7 percent) increase in the total number of infant deaths expected in 2020.” The authors conclude, “The findings underscore the vulnerability of infants to the negative income shocks such as those imposed by the COVID-19 pandemic. While efforts towards prevention and treatment of COVID-19 remain paramount, the global community should also strengthen social safety nets and assure continuity of essential health services.”
Resource of the Week: When Science Is Like a Hamburger
In a multi-part series in Bhekisisa (South Africa) Aisha Abdool Karim and Joan van Dyk look at the Sputnik V vaccine through the lens of what makes good science and regulation. “The scientific process is like a hamburger. By examining the quality of each ingredient, you can see how good the end product is. You wouldn’t want mouldy bread or wilted lettuce ruining a perfectly good meal—and similarly you don’t want bad science ruining what could otherwise be a perfectly good vaccine.”
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