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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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“Just as 20 years ago, when the Global Fund partnership galvanized the world to fight the world's leading infectious diseases, it is time for another global push to save lives. We must protect the gains made against HIV, TB and malaria. We must also fight COVID-19 and build strong and resilient systems for health that can protect everyone, everywhere, from future yet-unseen pathogens. The fight against COVID-19 should be a catalyst to finish the unfinished fights against HIV, TB and malaria. If we can continue to innovate and collaborate—at global, national and local levels—we can end HIV, TB and malaria, beat COVID-19 and build a much stronger foundation for pandemic preparedness and response.”
— Global Fund director Peter Sands
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Share of the population fully vaccinated against COVID-19 Worldwide
Sep 9, 2021
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This week the Africa CDC reported that just over 3 percent of people in Africa have been fully vaccinated, with only 1.7 percent of those in sub-Saharan Africa fully vaccinated.
In a major blow to the hopes of ramping up vaccinations in Africa by the end of 2021, the COVAX facility announced a sharp decrease in expected doses to be delivered. The New York Times (US) reports COVAX “slashed its forecast for doses available in 2021 by roughly a quarter.”
The Times reports, “Shortly after the forecast was released [the WHO] asked wealthy countries to hold off on administering booster shots for healthy patients until at least the end of the year as a way of enabling every country to vaccinate at least 40 percent of their populations, quoting WHO director general, Dr. Tedros Adhanom: ‘I will not stay silent when the companies and countries that control the global supply of vaccines think the world’s poor should be satisfied with leftovers.’” Times Live (South Africa) quotes Africa CDC’s Dr. John Nkengasong: “This is a virus that is ahead of us. We are not winning the battle in Africa, let us be very clear...we need to vaccinate quickly…. We are not, as a continent, keen on vaccine diplomacy when pledges are not backed by reality. Pledges do not put vaccines into people’s arms.”
AP (US) reports WHO’S Africa director, Dr. Matshidiso Moeti told reporters the downwards forecast is “in part because of the prioritization of bilateral deals over international solidarity.” AP reports, “Moeti noted that while COVAX has delivered over 5 million vaccine doses to African countries in the past week, ‘three times as many doses have been thrown away in the United States alone’ since March.”
If You Are in a Hurry
- Read the New York Times (US) on a new report from the Global Fund that shows the devastating impact of COVID19 on the fight against HIV, TB and malaria.
- Read a letter in Nature (UK) from CEPI calling for access to existing vaccines for clinical trials.
- Then dive deeper into what’s needed and what the roadblocks are in a STAT article.
- Read some good news from NPR about the potential for “superhuman” immunity.
- Read Bloomberg on a large genomic study that traces the spread of the pandemic in Africa. And dive into the journal article in Science.
- Read AP on new vaccine mandates in the US.
- Read about a moral dilemma for a peer reviewer in Science.
- Read how the US global vaccine efforts are in disarray in Vanity Fair.
Genomic Research Shows How COVID Unfolded Across Africa
A research article in Science (US) looks at clues from genomic sequencing from 33 African countries to outline how the pandemic unrolled on the continent. The authors note, “The dominance of [variants of interest (VOIs)] and [variants of concern (VOCs)] in Africa has important implications for vaccine rollouts on the continent. For one, slow rollout of vaccines in most African countries creates an environment in which the virus can replicate and evolve: this will almost certainly produce additional VOCs, any of which could derail the global fight against COVID-19.”
Bloomberg (US) reports, “The study showed that COVID-19 was introduced to most African nations from Europe, and in turn the continent has exported the variants it spawned back to European countries. Different strains of the virus spread around the continent mainly from South Africa, Nigeria and Kenya - three of the African countries with the strongest links to the wider world. The research is the first major output by Africa’s leading scientists in an effort to increase the continent’s ability to produce and analyze genomic data. Two variants in West Africa and East Africa, known as B.1.525 and A.23.1, need to be contained, it said…. ‘If the virus keeps evolving on the African continent, this will become a global problem,’ said Tulio de Oliveira, a bioinformatics professor who helped put together the study and runs gene-sequencing institutions at two South African universities. ‘It is our moral duty to try to protect Africa and the world.’”
VOA (US) reports the WHO is supporting scale up of genomic sequencing in Africa, launching a Regional Center of Excellence for Genomic Surveillance in Cape Town. WHO Regional Director for Africa Matshidiso Moeti is quoted: “Knowing which variants are circulating and where is critical for informing effective response operations…. The continent lags far behind the rest of the world when it comes to sequencing, accounting for only 1 percent of over 3 million COVID-19 sequences conducted worldwide. So, this ground-breaking initiative aims to initially support 14 Southern African countries to scale up their genomic sequencing by 15-fold each month.”
COVID Sets Back Fight Against HIV, TB and Malaria
New York Times (US) reports on a new report from the Global Fund that shows, “The COVID-19 pandemic has severely set back the fight against other global scourges like HIV, tuberculosis and malaria…Before the pandemic, the world had been making strides against these illnesses. Overall, deaths from those diseases have dropped by about half since 2004. ‘The advent of a fourth pandemic, in COVID, puts these hard-fought gains in great jeopardy,’ said Mitchell Warren, executive director of AVAC…. Many fewer people sought diagnosis or medication, because they were afraid of becoming infected with the coronavirus at clinics. And some patients were denied care because their symptoms, such as a cough or a fever, resembled those of COVID-19.”
In a letter accompanying the report Global Fund director Peter Sands writes, “Just as 20 years ago, when the Global Fund partnership galvanized the world to fight the world's leading infectious diseases, it is time for another global push to save lives. We must protect the gains made against HIV, TB and malaria. We must also fight COVID-19 and build strong and resilient systems for health that can protect everyone, everywhere, from future yet-unseen pathogens. The fight against COVID-19 should be a catalyst to finish the unfinished fights against HIV, TB and malaria. If we can continue to innovate and collaborate - at global, national and local levels—we can end HIV, TB and malaria, beat COVID-19 and build a much stronger foundation for pandemic preparedness and response.”
Budget Implications for Low-Income Countries Procuring Vaccines
Devex (US) reports, “to vaccinate at least 70 percent of their populations, [low-income] countries will need to significantly increase their current health care spending, creating a financial crisis as they are likely to incur more debt to make that happen…According to the Vaccine Affordability Index, which is part of the Global Dashboard on COVID-19 Vaccine Equity…low-income countries will have to increase their average health care spending by almost 57 percent to cover the cost of vaccinating 70 percent of their population, based on the assumption that a two-dose vaccination costs $35.”
New Sweeping Vaccine Mandates for US
AP (US) reports, “In his most forceful pandemic actions and words, President Joe Biden on Thursday ordered sweeping new federal vaccine requirements for as many as 100 million Americans in an all-out effort to increase COVID-19 vaccinations and curb the surging delta variant…. Biden sharply criticized the tens of millions of Americans who are not yet vaccinated, despite months of availability and incentives.”
Separately AP (US) reports, “The Los Angeles Board of Education has voted to require students 12 and older to be vaccinated against the coronavirus if they attend in-person classes in the nation’s second-largest school district.” LA is the largest of a handful of districts to mandate vaccines for students.
The mandates comes as Axios (US) quotes Fauci: “The endgame is to suppress the virus. Right now, we're still in pandemic mode, because we have 160,000 new infections a day. That's not even modestly good control...which means it's a public health threat. In a country of our size, you can't be hanging around and having 100,000 infections a day. You've got to get well below 10,000 before you start feeling comfortable.”
A commentary in the journal Ethics & Human Research “describes challenges that are inherent to COVID-19 research studies, such as the difficulty of obtaining informed consent from patients ill with the highly infectious virus. The commentary recommends several steps that [research ethics committees (RECs)] can take to ensure ethical review of research studies during the COVID-19 pandemic and future infectious disease outbreaks.” The authors conclude, “RECs face a very difficult task in making sure the ethical principles of The Belmont Report are upheld, even in the face of tremendous internal, external, and even personal pressures to address the unprecedented impact of COVID-19. High-quality ethical research is the key to ending this pandemic. It is important to ensure ethical research and not to abandon the long-held principles of ethical review and protections for research participants.”
Moral Dilemma for Peer Reviewer
Science (US) reports on a dilemma faced by a European researcher, Thijs Kuiken, who was asked to review a Lancet paper in early 2020 that documented transmission between humans, including from those with no symptoms. “That Thursday evening, the evidence was in front of Kuiken’s eyes, and he felt the world needed to know. But disclosing it could cost Kuiken his scientific reputation, he says. Journal reviewers are not allowed to share unpublished manuscripts under any circumstances….” Kuiken and Lancet editors agreed to ask the researchers to make their data public immediately, but the researchers were prohibited by the Chinese government from making it public. Kuiken then provided the data to the WHO and within two days the Chinese government had made the data public. Kuiken says, “there are no clear guidelines or agreements about how reviewers of scientific manuscripts should deal with such crucial information during public health emergencies. I’ve done it outside the rules. It should be possible within.”
COVID-19 Hasn’t Revolutionized Publishing
Science (US) reports, “Critics of the tradition-bound world of scientific publishing saw a rare opportunity to tackle long-standing complaints—for example, that journals place many papers behind paywalls and take months to complete peer review. They hoped the pandemic could help birth a new publishing system. But nearly 2 years later, hopes for a wholesale revolution are fading. Preprints by medical researchers surged, but they remain a small fraction of the literature on COVID-19. Much of that literature is available for free, but access to the underlying data is spotty. COVID-19 journal articles were reviewed faster than previous papers, but not dramatically so, and some ask whether that gain in speed came at the expense of quality.”
Pandemic of the Unvaccinated in the US Overwhelms Hospitals
NPR (US) reports, “The US health care system is again buckling under the weight of a COVID-19 surge that has filled more than 100,000 hospital beds nationwide and forced some states to consider enacting ‘crisis standards of care’—a last resort plan for rationing medical care during a catastrophic event. The idea is an alarming sign of how the delta variant has ripped through large swaths of the country—primarily sickening the unvaccinated and straining an already depleted health care workforce.”
Hurdle in Testing New Vaccines
A letter from CEPI published in Nature (UK) says, “Scientists must develop the next generation of COVID-19 vaccines now, if the world is to meet the challenge of SARS-CoV-2 variants and reduce vaccine inequity by increasing global supply. This can be done only if comparator COVID-19 vaccines—those that have already been approved—are available to support clinical trials. Such comparator vaccines are almost impossible to secure; governments, developers and manufacturers must find a solution to unlock supplies.” Helen Branswell reports in STAT (US), “In an interview with STAT, CEPI’s US director, Nicole Lurie, said the organization has been trying for months to break the logjam, to no avail. ‘We’re going round and round in circles.’…The problem stems in part from the fact that at this point in the pandemic, it isn’t considered ethical to test new vaccines against placebos; instead they would have to be tested against one of the existing shots. But getting one’s hands on licensed or authorized vaccines for study purposes is nigh on impossible; all available doses have been snapped up by countries keen to vaccinate as many of their citizens as possible…. Lurie said the problem could be solved, if countries buying vaccine modify the contracts with suppliers. A number have initially indicated willingness, she said, but progress has stalled when they realize the amount of work involved.”
US Global Vaccination Efforts in Disarray
Vanity Fair (US) reports, The White House says it is donating more doses than “all other countries combined,” but critics inside and outside the US government warn of an effort that is "wildly insufficient."… "Roughly 4.6 billion people on earth have yet to get a first vaccine shot, according to Our World in Data. ‘It’s a weird place to be,’ said Matthew Rose of Health GAP. ‘The president is known for his compassion. But everyone’s sense is that we are currently stuck and struggling to get the administration’ to act with the needed level of urgency. ‘As delta crashes through the world, [America’s] current response is wildly insufficient.’”
Call To “Confront the Pandemic Head-On”
An opinion piece in IOL (South Africa) says, “Experts on the COVID-19 virus have called on humanity to confront the pandemic head-on and not be distracted by side issues. One of the South Africa’s leading voices on the pandemic, Professor Salim Abdool Karim, says understanding the genesis of the virus matters. But it’s more important to urgently find solutions to tackle the virus head-on ‘because there’s more coming.’”
“Superhuman” Immunity
NPR (US) reports, “Over the past several months, a series of studies has found that some people mount an extraordinarily powerful immune response against SARS-CoV-2, the coronavirus that causes the disease COVID-19. Their bodies produce very high levels of antibodies, but they also make antibodies with great flexibility—likely capable of fighting off the coronavirus variants circulating in the world but also likely effective against variants that may emerge in the future…. ‘Based on all these findings, it looks like the immune system is eventually going to have the edge over this virus,’ says Bieniasz, of Rockefeller University. ‘And if we're lucky, SARS-CoV-2 will eventually fall into that category of viruses that gives us only a mild cold.’"
What’s New in Vaccine Research?
Reuters (UK) reports, “A booster dose of Sinovac Biotech's COVID-19 vaccine reversed a decline in antibody activities against the Delta variant, a study showed, easing some concerns about its longer-term immune response to the highly contagious strain of the virus…. Several countries which have relied heavily on the Sinovac vaccine have begun giving booster shots developed by Western manufacturers to people fully vaccinated with the Chinese shot.”
Reuters (UK) reports, “A Chinese study looking at mixing COVID-19 vaccines showed that receiving a booster shot of CanSino Biologics' vaccine after one or two doses of Sinovac Biotech's vaccine yielded a much stronger antibody response than using the Sinovac shot as a booster. The study, among the first analyses in China combing different COVID-19 vaccines, comes as the country said it would use booster shots in specific groups amid concerns over vaccines' waning protection over time.”
Medscape (US) reports, “Receiving a COVID-19 vaccine early in pregnancy is not associated with an increased risk for spontaneous abortion, new research suggests. The study, published online in JAMA, evaluated the proportion of women who received the vaccine and had ongoing pregnancies in comparison with those who experienced a miscarriage or spontaneous abortion. Overall, a COVID-19 vaccine was received within 28 days prior to an index date among 8.0 percent of ongoing pregnancy surveillance periods vs 8.6 percent of spontaneous abortions.”
Reuters (UK) reports, “Moderna, Inc. said on Thursday it is developing a single vaccine that combines a booster dose against COVID-19 with its experimental flu shot. The company hopes to eventually add vaccines it is working on for respiratory syncytial virus (RSV) and other respiratory diseases as an annual shot.” Separately Reuters reports, “Vaccine developer Novavax Inc said on Wednesday it has initiated an early-stage study to test its combined flu and COVID-19 vaccine…. Novavax had said in May it expects seasonal influenza and COVID-19 combination vaccines to likely be critical in combating emerging COVID-19 variants. Its vaccine NanoFlu/NVX-CoV2373 had elicited robust responses to both influenza A and B and protected against the coronavirus in pre-clinical studies.”
News24 (South Africa) reports, “In a first for South Africa, Sinovac will start phase three clinical trials of a COVID-19 vaccine for children from Friday. According to Numolux, which has the approval to distribute Sinovac in South Africa, the trials will be conducted on 2,000 children aged six months to 17 years. They will be conducted at seven research sites across the country. The trials will enroll 14,000 children from South Africa, Chile, the Philippines, Malaysia and Kenya.” Reuters (UK) reports, “’The primary objective of the study is to evaluate the efficacy of two doses of CoronaVac against confirmed symptomatic COVID-19 cases in children and adolescents ... efficacy will also be evaluated against hospitalisation and severe COVID-19,’ Sinovac and Numolux said.”
Kids and COVID
Nature (UK) looks at why COVID is generally less severe in children. “Research is beginning to reveal that the reason children have fared well against COVID-19 could lie in the innate immune response—the body’s crude but swift reaction to pathogens. Kids seem to have an innate response that’s ‘revved up and ready to go’, says [Betsy] Herold. But she adds that more studies are needed to fully support that hypothesis. The emergence of the Delta variant has made finding answers more urgent. Reports suggest that in the United States and elsewhere, children are starting to make up a larger proportion of reported infections and hospitalizations. These trends might be due to Delta’s high transmission rate and the fact that many adults are now protected by vaccines.”
The New York Times (US) reports, “Just as millions of families around the United States navigate sending their children back to school at an uncertain moment in the pandemic, the number of children admitted to the hospital with COVID-19 has risen to the highest levels reported to date. Nearly 30,000 of them entered hospitals in August. Pediatric hospitalizations, driven by a record rise in coronavirus infections among children, have swelled across the country, overwhelming children’s hospitals and intensive care units in states like Louisiana and Texas…. Children remain markedly less likely than adults, especially older adults, to be hospitalized or die from COVID-19. But the growing number of children entering the hospital, however small compared with adults, should not be an afterthought, experts say, and should instead encourage communities to take on more efforts to protect their youngest residents.”
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