AVAC's weekly COVID News Brief provides a curated perspective on what COVID news is worth your time.

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“...while the COVID-19 pandemic has already taken a devastating global toll on global health and well-being, it has also provided a strong example of the importance of health research capacity as an essential element of pandemic preparedness. The world faces a wide range of health challenges, from chronic diseases and risk factors to emerging global threats. Building research capacity, especially in countries with lower levels, while learning the lessons of COVID-19, must become a higher priority to achieve our current shared global health goals while increasing resilience to address future health threats.”

— Peter Kilmarx and Roger Glass in Medicine


** Table of Contents
------------------------------------------------------------
* Vaccine Effectiveness Against Severe Disease Remains High
* Large Study Shows Masks Work
* Booster Conversations and Controversy Continue
* Turmoil at US FDA
* Helping Young Women Get Through COVID-19
* EU to Return Vaccines to Africa
* Delta May Double Risk of Hospitalizations
* COVID Vaccines for Children in LMICs
* Vaccine Hesitancy
* US Wastes Millions of Vaccines
* Building Global Health Research Capacity Post-COVID
* Ivermectin Use Continues Politicization of Health
* New Variants
* COVID Origins Report
* Resource of the Week

Rich countries continue to move forward with third doses of mRNA vaccines even as the number of people vaccinated in low- and middle-income countries – particularly in Africa remains – low. Fewer than 5 percent of Africans have received a vaccine, fewer than 2 percent of Africans are fully vaccinated and programs to get vaccines to poor countries are not moving forward with any speed.

Aljazeera ([link removed]), reporting on the vaccine apartheid, quotes a 58-year-old Kenyan man, James Nderitu, who was just getting access to a first dose of the AstraZeneca vaccine: “I would therefore like to urge the European countries that have the vaccine to assist us. Instead of vaccinating children, they should stop being selfish and help the African countries so that we can get vaccinated.”

WHO Africa ([link removed]) says in a statement, “Africa is set to miss the urgent global goal of vaccinating the most vulnerable 10 percent of every country’s population against COVID-19 by the end of September. Forty-two of Africa’s 54 nations—nearly 80 percent—are set to miss the target if the current pace of vaccine deliveries and vaccinations hold... ’With less than a month to go, this looming goal must concentrate minds in Africa and globally. Vaccine hoarding has held Africa back and we urgently need more vaccines, but as more doses arrive, African countries must zero in and drive forward precise plans to rapidly vaccinate the millions of people that still face a grave threat from COVID-19,’ said Dr Matshidiso Moeti, WHO Regional Director for Africa.”


** If You Are in a Hurry
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* Check out a blog post on Nature Microbiology ([link removed]) that tells the story of vaccine apartheid in 10 images.

* Read about a large study from Bangladesh that shows mask work and that medical masks are better than cloth ones on NBC News ([link removed]) and Fast Company ([link removed]).

* Read the New York Times ([link removed]) on turmoil at the US FDA and read an important New York Times ([link removed]) opinion piece about trust issues with the FDA and the drug industry.

* Read Protecting Global Gains ([link removed]) on how PEPFAR’s DREAMS program is helping young women in Rwanda get through the pandemic safely.

* Read MSF’s Candice Sehoma in Bhekisisa ([link removed]) on the controversy around J&J sending vaccines out of South Africa to the EU.

* Axios ([link removed]) says vaccine hesitancy is down in the US and NBC News ([link removed]) reports on Black doctors in the US who are taking on vaccine hesitancy.

* Read Peter Kilmarx and Roger’s PLoS Medicine ([link removed]) perspective on COVID and building global research capacity.


** Vaccine Effectiveness Against Severe Disease Remains High
------------------------------------------------------------
CNN ([link removed]) (US) reports, “Overall effectiveness of coronavirus vaccines has not dropped much yet for most vaccinated Americans, US Centers for Disease Control and Prevention vaccine advisers were told” in a meeting. Dr. Sara Oliver told the advisors, “Regardless of the vaccine evaluated, all vaccines remain effective in preventing hospitalization and severe disease. But they may be less effective in preventing infection and mild illness recently. These reasons for lower effectiveness likely include both waning over time and the Delta variant."

** Large Study Shows Masks Work
------------------------------------------------------------
NBC News ([link removed]) (US) reports, “A study involving more than 340,000 people in Bangladesh offers some of the strongest real-world evidence yet that mask use can help communities slow the spread of Covid-19. The research, conducted across 600 villages in rural Bangladesh, is the largest randomized trial to demonstrate the effectiveness of surgical masks ([link removed]) , in particular, to curb transmission of the coronavirus... The preprint study was posted online Wednesday ([link removed]) by the nonprofit organization Innovations for Poverty Action and is currently undergoing peer review.

Fast Company ([link removed]) (US) reports, “As COVID-19 continues to surge, accelerated by the delta variant, several European governments and companies are banning cloth masks, arguing that they are not as effective as medical masks in the midst of the current outbreak. Instead, they are mandating medical-grade masks... The effectiveness of surgical masks was confirmed in a new study ([link removed]) conducted by Yale and Stanford researchers that tracked more than 340,000 adults in Bangladesh. Among the subset of people who wore masks, there was a 9.3 percent reduction in symptomatic COVID; those who did get sick experienced a 11.9 percent reduction in COVID symptoms. The study’s authors believe symptomatic infections would have decreased even more dramatically if everybody in the sample group wore a mask.”

A NEJM ([link removed]) (US) letter to the editor from researchers in California notes that among healthcare workers at UC San Diego Health, “coincident with the end of California’s mask mandate on June 15 and the rapid dominance of the B.1.617.2 (delta) variant that first emerged in mid-April and accounted for over 95 percent of UCSDH isolates by the end of July, infections increased rapidly, including cases among fully vaccinated persons... The dramatic change in vaccine effectiveness from June to July is likely to be due to both the emergence of the delta variant and waning immunity over time, compounded by the end of masking requirements in California and the resulting greater risk of exposure in the community. Our findings underline the importance of rapidly reinstating nonpharmaceutical interventions, such as indoor masking and intensive testing strategies, in addition to continued efforts to increase vaccinations, as strategies to prevent avoidable
illness and deaths and to avoid mass disruptions to society during the spread of this formidable variant.”

** Booster Conversations and Controversy Continue
------------------------------------------------------------
CNBC ([link removed]) (US) reports, “The World Health Organization asked world leaders again ([link removed]) to hold off on administering Covid-19 boosters for at least another month to give poorer nations the chance to inoculate more of their populations with first doses. More than 5 billion Covid vaccine shots have been administered globally, with 75 percent of them administered in just 10 countries, according to the WHO. ‘That’s why I have called for a moratorium on boosters, at least until the end of this month to allow those countries that are furthest behind to catch up,’ WHO Director-General Tedros Adhanom Ghebreyesus said...”

CNN ([link removed]) (US) reports the US FDA “has called a meeting of its vaccine advisers for September 17 to discuss booster doses of coronavirus vaccine. That's three days before the September 20 target date to start offering booster doses announced by the White House last month... Dr. Peter Marks, head of FDA’s vaccine division is quoted “The process for authorizing or approving the use of a booster dose of a COVID-19 vaccine involves each vaccine manufacturer submitting data pertaining to safety and effectiveness to the agency to support this use. The FDA is evaluating data submitted by Pfizer-BioNTech in a supplemental Biologics License Application for its COVID-19 vaccine and will discuss it with the agency's advisory committee to inform our decision-making. Should the data received from other manufacturers raise unique questions that would benefit from the committee's input, the agency intends to consider additional public discussions." Moderna has submitted an application for a booster that would be half the original dose of the vaccine.

Science ([link removed]) (US) reports, “Israel’s nationwide campaign to provide its population with COVID-19 vaccine boosters appears to benefit recipients. A third dose of the Pfizer-BioNTech vaccine significantly lowers the risk of infection, according to two new studies. A report for the country’s Ministry of Health ([link removed]) , posted Friday, showed a third dose reduced recipients’ risk of testing positive for SARS-CoV-2 by more than 10-fold 2 weeks later. And in a preprint posted yesterday ([link removed]) , researchers used data from a health maintenance organization (HMO) to calculate that a third dose roughly halves a person’s chances of testing positive for the virus starting 1 week after the shot and further reduces it after the second week.” David Dowdy, an epidemiologist at Johns Hopkins University warns, “The question is not, ‘Does a booster shot ramp up your immune system in the short term?’ But rather ‘Does a booster shot provide a meaningful increase in longer term immunity over months? And if so, what is the right interval for providing booster shots?’ The answers to those crucial questions, he says, are still ‘completely unknown.’”



** Turmoil at US FDA
------------------------------------------------------------
New York Times ([link removed]) (US) reports two top US FDA vaccine regulators are leaving the agency, “a development that could disrupt its work on deciding whether to recommend coronavirus vaccines for children under 12 and booster shots for the general population... One reason is that Dr. Gruber and Dr. Krause were upset about the Biden administration’s recent announcement that adults should get a coronavirus booster vaccination eight months after they received their second shot, according to people familiar with their thinking. Neither believed there was enough data to justify offering booster shots yet, the people said, and both viewed the announcement, amplified by President Biden, as pressure on the FDA to quickly authorize them.”

Referencing Gruber and Krause’s departures and other recent issues, New York Times ([link removed]) (US) opinion columnist Farhad Manjoo writes that the FDA is mired in controversy in part because it “has grown alarmingly cozy with the industry it is supposed to oversee[.]... I realize this is a tricky moment to criticize the FDA We live in a conspiratorial age of meme medicine — an era when lots of people would rather take untested snake oil hawked by politicians, pundits and B-list celebrities than vaccines whose effectiveness and safety have been proved in clinical studies and that have been approved by the FDA Calling attention to the agency’s failures might only deepen distrust in the agency when it is more vital than ever — at the very least to remind Americans that they are not horses and should consequently refrain from taking horse medicine... Still, if the drug industry and its regulators are mistrusted, one plausible reason
is that they have not been doing a lot to inspire trust lately.”


** Helping Young Women Get Through COVID-19
------------------------------------------------------------
The latest story on innovative programs responding to COVID from Protecting Global Gains ([link removed]) focuses on a PEPFAR DREAMS project in Rwanda. "Twenty-three-year-old Violette is a skilled tailor, having received vocational training through [DREAMS]. DREAMS also provided equipment and start-up materials so that Violette and her colleagues could set up their tailoring business. When the time came to pivot to face masks, DREAMS helped connect the young women to schools and other local businesses who needed a steady supply of masks... 'I am glad that I have helped prevent the spread of COVID-19 in my community and also made some income!' Violette says."


** EU to Return Vaccines to Africa
------------------------------------------------------------
FiercePharma ([link removed]) (US) reports, "Johnson & Johnson drew sharp criticism two weeks ago amid reports that doses of its single-shot COVID-19 vaccine produced in South Africa were being exported to Europe. Now, it appears that the arrangement is coming to an end. J&J doses manufactured at Aspen Pharmacare’s facility in South Africa will now be shipped to African countries, the Wall Street Journal reports ([link removed]), citing comments from African Union’s Strive Masiyiwa. In addition, millions of doses that had been shipped to Europe and stored in warehouses will be returned to the continent."

In an opinion piece for Bhekisisa ([link removed]) (South Africa) MSF’s Candice Sehoma notes the delays in making doses available in South Africa and elsewhere on Africa and says, "All of this is happening against the background of South Africa having contributed hugely to J&J’s research — one of the legs of the vaccine’s efficacy trial, the Ensemble study, was conducted in South Africa ([link removed]) and the country also ran an implementation trial, Sisonke ([link removed]), which looked at the real life efficacy ([link removed]) of J&J’s jab among healthcare workers... South Africa should also take this opportunity to reevaluate its policies on clinical trial involvement to ensure improved access to any future medical tools developed based on the contributions of South Africans. The millions of people in South Africa and countries in the Global South who have yet to receive COVID-19 vaccines, should not have to wait any longer. Everyone deserves an opportunity to be protected against COVID-19 as soon as possible. We need dramatically improved access to COVID-19 vaccines to help make that happen."


** Delta May Double Risk of Hospitalization
------------------------------------------------------------
CBS News ([link removed]) (US) reports, "The Delta variant — which is more contagious than the original 'Alpha variant' that spread globally — more than doubles the risk of hospitalization for the unvaccinated, according to a U.K. study published in The Lancet Infectious Diseases...' The results suggest that patients with the Delta variant had more than two times the risk of hospital admission compared with patients with the Alpha variant,' according to the UK study ([link removed](21)00475-8/fulltext) . 'Emergency care attendance combined with hospital admission was also higher for patients with the Delta variant, showing increased use of emergency care services as well as inpatient hospitalization.'"


** COVID Vaccines for Children in LMICs
------------------------------------------------------------
Beate Kampmann and Uduak Okomo write in a comment in The Lancet ([link removed](21)01748-7/fulltext?) (UK), that Low and middle income countries have yet to introduce COVID-19 vaccines for children and young people, arguing, "During deliberations on the potential benefits of COVID-19 vaccines for CYP, it is important to recognise that this pandemic has already deprived more than 8 million children, primarily in LMICs, from life-saving, routine childhood vaccines. Immunisation services are preoccupied with the implementation of COVID-19 vaccine programmes for adults. At present, greater benefit for children's health globally will be derived by delivering the health interventions we already know will save their lives, such as vaccines against measles and other vaccine-preventable diseases, than by focusing on delivering COVID-19 vaccines to part of a population that does not currently represent a strategic priority in the response to this pandemic."



** Vaccine Hesitancy
------------------------------------------------------------
Axios ([link removed]) (US) reports on a new poll in the US which shows, "Fewer adults than ever now say they won't take the shot, and in the past two weeks there has been a sharp increase in the share of parents who plan to get their younger kids vaccinated as soon as it's allowed... Many factors are playing a role — including the Delta variant's strength, kids' return to school and FDA approval of the first COVID-19 vaccine — but the biggest drivers appear to be the rise of mandates."

NBC News ([link removed]) (US) reports on Black doctors in the US who are taking on vaccine hesitancy, including through an initiative in the US called myCovidMD, "which offers free coronavirus testing through mobile sites, [and] has a network of ‘culturally competent health care volunteers’ to respond to Covid-related needs in Black communities and other communities of color... Dr. Jayne Morgan, clinical director of the Covid Task Force at Piedmont Healthcare in Atlanta, combats the myths and misunderstandings around the coronavirus by posting YouTube videos that answer pandemic-related questions, using “plain and easily digestible language.” Some of her videos get thousands of views, some fewer than 500. She said she has heard from many viewers who thank her for the information. And yet, she said, she continues to hear an array of theories about the vaccines’ effectiveness and the origins of the vaccines themselves that make Black patients uneasy."


** US Wastes Millions of Vaccines
------------------------------------------------------------
NBC News ([link removed]) reports, "Pharmacies and state governments in the United States have thrown away at least 15.1 million doses of Covid-19 vaccines since March 1, according to government data obtained by NBC News — a far larger number than previously known and still probably an undercount." Sharifah Sekalala, a global health law professor is quoted: "A lot of the global south is unvaccinated. The African continent is still below 10 percent, and that's just a huge inequality and it's really problematic." The story notes the 15 million is a small fraction of the vaccines that have been delivered in the US.



** Building Global Health Research Capacity Post-COVID
------------------------------------------------------------
In a PLoS Medicine ([link removed]) perspective Peter Kilmarx and Roger Glass write, "...while the COVID-19 pandemic has already taken a devastating global toll on global health and well-being, it has also provided a strong example of the importance of health research capacity as an essential element of pandemic preparedness. The world faces a wide range of health challenges, from chronic diseases and risk factors to emerging global threats. Building research capacity, especially in countries with lower levels, while learning the lessons of COVID-19, must become a higher priority to achieve our current shared global health goals while increasing resilience to address future health threats."



** Ivermectin Use Continues Politicization of Health
------------------------------------------------------------
The use of the unproven drug ivermectin to treat or prevent COVID in the US is the latest reflection of the politicization of the pandemic response. Several prominent right-wing personalities have promoted the drug’s use, some have taken it as treatment and some of those have died of COVID. Ivermectin is increasingly being touted as an alternative to proven, effective COVID vaccines.

Medscape ([link removed]) (US) reports, "Another case, another state, another judge ordering a hospital to give a patient a controversial horse de-worming drug to treat a severe case of COVID-19. This time, a judge in Ohio has ordered West Chester Hospital, part of the University of Cincinnati network, to provide Jeffrey Smith, 51, with Ivermectin ([link removed])... Judge Gregory Howard’s ruling comes after Smith’s wife sued to force the hospital to provide the controversial drug to her husband, who has been hospitalized since July 15."

The US CDC Health Alert Network ([link removed]) released a health advisory on the “rapid increase” in use of ivermectin. "Adverse effects associated with ivermectin misuse and overdose are increasing, as shown by a rise in calls to poison control centers reporting overdoses and more people experiencing adverse effects... In July 2021, ivermectin calls have continued to sharply increase, to a five-fold increase from baseline. These reports are also associated with increased frequency of adverse effects and emergency department/hospital visits."


** New Variants
------------------------------------------------------------
Axios ([link removed]) (US) reports WHO “added a coronavirus strain called Mu, which was first detected in Colombia in January, to its ‘Variants of Interest’ ([link removed]) list on Monday... The WHO warned that data suggests protection from prior infection or vaccination may not be as strong against the Mu variant, adding that further research is needed to confirm that... The Mu variant, formally known as B.1.621, has a cluster of mutations that "that indicate potential properties of immune escape...”

Aljazeera ([link removed]) (Qatar) reports, "South African scientists have detected a new coronavirus variant with multiple mutations but are yet to establish whether it is more contagious or able to overcome the immunity provided by vaccines or prior infection, the National Institute for Communicable Diseases (NICD) has said. The variant, known as C.1.2, was flagged last week by the KwaZulu-Natal Research and Innovation and Sequencing Platform in a preprint study that has yet to be peer-reviewed. NICD scientists said on Monday C.1.2 was only ‘present at very low levels’ and that it was too early to predict how it might evolve."


** COVID Origins Report
------------------------------------------------------------
Nature ([link removed]) (UK) reports on the release of some information about the US intelligence services’ investigation of the origins of the virus. "The topline result is that the investigation was inconclusive. Intelligence agencies were divided on whether the pandemic most likely began because of a laboratory accident, or because of human contact with an infected animal. The only strong conclusion is that the coronavirus was not developed as a biological weapon; most agencies thought, with low confidence, that it was unlikely to have been genetically engineered. In a press statement, the intelligence community writes that it aims to issue more details on its investigation in the near future."


** Resource of the Week
------------------------------------------------------------
A blog post on Nature Microbiology ([link removed]) (UK) shares a "series of 10 images [that] tell the story behind the great vaccine apartheid — the single biggest moral and scientific failure during this global crisis... Just over 5 billion Covid-19 vaccine doses have been administered globally. But only 1.6 percent of people in low-income countries have received at least one dose. This shameful inequity is getting worse by the day. Rich nations are offering third (booster) doses to their citizens, even as 3.5 billion people are waiting for their first dose."


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