** COVID-19 Vaccine Doses Administered by Country Income Group
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September 17, 2021


** Table of Contents
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* Africa Vaccine Shortfall (#shortfall)
* Booster Data and Debate (#booster)
* Global Decline in Cases, But Not Nearly Enough (#decline)
* Long COVID Study Planned (#long)
* Keeping Access to PrEP During the Pandemic (#PrEP)
* Vaccine Mandates (#mandates)
* One in 500 American Killed by COVID (#americans)
* Sex Workers Call for Equitable Vaccine Access (#workers)

* Broadening Vaccine Access in Kenya (#Kenya)
* Fighting Disinformation (#disinformation)
* Making COVID Vaccines in Poor Countries (#making)
* UK and Hong Kong Plan Single Dose of Vaccine for Teens (#teens)
* Millions of Children Still out of School (#school)
* Resource of the Week (#resource)

The debate about booster shots heated up this week with conflicting data and a US FDA hearing on boosters planned for Friday. Outside of rich countries with the luxury to discuss boosters, the projections for vaccine availability were dismal. Ahead of next week’s UN General Assembly where vaccines are expected to be a major topic of discussions, public health advocates and officials are calling for action from rich countries. The New York Times ([link removed]) (US) quotes Dr. Ayoade Olatunbosun-Alakija, chairwoman of the African Vaccine Delivery Alliance: “Ask the rich countries: Where are Africa’s vaccines? Where are the vaccines for the low- and middle-income countries of the world?”

**
If You Are in a Hurry
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Read Science ([link removed]) on a planned long COVID study to enroll 40,000 people.

Read Nature ([link removed]) on the push to manufacture COVID vaccines in low-income countries.

Read STAT ([link removed]) and KHN ([link removed]) on the booster debate.

Read SABC ([link removed]) on Africa CDC’s call for vaccine production transparency.

Read the latest Protecting Global Gains ([link removed]) story highlighting a differentiated service approach to PrEP delivery the pandemic.

Read about a sex worker call for vaccine equity in The Botswana Gazette ([link removed]).

Read about a powerful call for vaccine equity from Dr. Ayoade Olatunbosun-Alakija in Devex ([link removed]).


**
Africa Vaccine Shortfall
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A WHO Africa press release ([link removed]) notes, “the continent faces almost 500 million doses short of the global year-end target of fully vaccinating 40% of its population. This shortfall comes as Africa tops 8 million COVID-19 cases this week.” WHO Africa director Dr Matshidiso Moeti, World Health Organization (WHO) is quoted: “Export bans and vaccine hoarding have a chokehold on vaccine supplies to Africa. As long as rich countries lock COVAX out of the market, Africa will miss its vaccination goals. The huge gap in vaccine equity is not closing anywhere near fast enough. It is time for vaccine manufacturing countries to open the gates and help protect those facing the greatest risk.”

SABC ([link removed]) (South Africa) reports the Africa CDC “has called for vaccine production transparency – saying poor and developing countries are not receiving enough COVID-19 vaccinations… CDC Director John Nkengasong… says despite the continent welcoming vaccine donations, countries need to purchase enough vaccines to help fight the pandemic. ‘We need transparency in who is producing vaccines and where are the vaccines going to? We heard that some vaccines are not available. Developed countries are vaccinating and achieving higher percentage coverage there. So we don’t know where these are coming from. We, on the continent, don’t always have access to vaccines so it is not a money issue. Tell us where the vaccines are and we will go buy vaccines for our people on the continent. We welcome all donations but it does not provide us with a long-term solution to solving our problem.’”

Devex ([link removed]) (US) reports on remarks by Dr. Ayoade Olatunbosun-Alakija, co-chair of the African Union’s African Vaccine Delivery Alliance. She said, “’As we hold the global north, and their leaders accountable, we must also hold our own African leadership accountable for their failures.’…She called upon African leadership to take advantage of the meetings next week at the United Nations General Assembly to put vaccine equity at the top of the agenda. ‘We elect leaders for moments of crisis. Every side meeting they have, needs to begin with: Our people are dying or getting long COVID. The first line of every talking point needs to be Mr. President of whichever country, Mr. Foreign Minister: Where are the vaccines?’”

Reuters ([link removed]) (UK) reports, “India is considering resuming exports of COVID-19 vaccines soon, mainly to Africa, as it has partly immunised a majority of its adults and supplies have surged…The African Union on Tuesday accused manufacturers of denying them a fair chance to buy vaccines, and urged manufacturing countries - in particular India - to lift export restrictions.”


** Booster Data and Debate
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There is no clear consensus on the need for and timing for booster shots and the debate in the US and other rich countries is raging as US regulatory agencies plan to review data on mRNA boosters on Friday.

Washington Post ([link removed]) (US) reports, “Pfizer and government officials have relied heavily on data from Israel in making the case to the public that boosters are necessary six months after full vaccination. One of the studies from Israel, published Wednesday in the New England Journal of Medicine ([link removed]) , showed that people 60 and older who were given a booster shot had an 11-fold lower risk of contracting an infection than people who did not receive the additional shot. But FDA reviewers cautioned that a raft of studies with clear limitations have emerged in the last few months, pointing out that ‘biases can affect their reliability.’ The reviewers stated that ‘US-based studies… may most accurately represent vaccine effectiveness.’…’Overall, data indicate that currently US-licensed or authorized COVID-19 vaccines still afford protection against severe COVID-19 disease and death
in the United States,’ they wrote. ‘There are many potentially relevant studies, but FDA has not independently reviewed or verified the underlying data or their conclusions.’”

In a commentary in The Lancet ([link removed](21)02046-8/fulltext) (UK) a group of experts including officials from WHO and the US FDA argue, “The vaccines that are currently available are safe, effective, and save lives. The limited supply of these vaccines will save the most lives if made available to people who are at appreciable risk of serious disease and have not yet received any vaccine. Even if some gain can ultimately be obtained from boosting, it will not outweigh the benefits of providing initial protection to the unvaccinated. If vaccines are deployed where they would do the most good, they could hasten the end of the pandemic by inhibiting further evolution of variants.”

Nature ([link removed]) (UK) reports, “Older Israelis who have received a third dose of a COVID-19 vaccine are much less likely to test positive for SARS-CoV-2 or to develop severe COVID-19 than are those who have had only two jabs, according to a highly anticipated study published on 15 September. The standard regimen for messenger RNA-based COVID-19 vaccines is two doses, but some governments, including Israel’s, have started administering third ‘booster’ shots. The latest study evaluated 1.1 million Israelis over the age of 60 who had received their first two doses at least five months earlier. Twelve or more days after receiving a third jab, participants were about 19.5 times less likely to have severe COVID-19 than were people in the same age group who had received only two jabs and were studied during a similar time period.”

NPR ([link removed]) (US) reports the US FDA “released an analysis by Pfizer on the need for a booster shot of the Pfizer-BioNTech COVID-19 vaccine. Pfizer's analysis ([link removed]) says data from Israel and the United States in the context of the delta variant suggests ‘that vaccine protection against COVID-19 infection wanes approximately 6 to 8 months following the second dose.’ The company said the available data supports its request for FDA approval of a third dose of the COVID-19 vaccine to be given about six months after the second dose in people 16 years and older.”

Reuters ([link removed]) (UK) reports, “New data from Moderna Inc's large COVID-19 vaccine trial shows that the protection it offers wanes over time, supporting the case for booster doses, the company said in a news release on Wednesday… Wednesday's analysis…showed higher rates of infection among people vaccinated roughly 13 months ago compared with those vaccinated roughly eight months ago. The study period was from July-August, when Delta was the predominant strain. It has yet to undergo peer review.”

STAT ([link removed]) (US) reports US FDA “scientists have expressed skepticism about the need for additional doses of Pfizer’s Covid-19 vaccine for all people who have received it. The assessment by the agency’s staff, included in documents released Wednesday ([link removed]) , sets up a high-stakes debate over who will need an additional booster dose — and when they will need it — at the meeting of experts being convened by the Food and Drug Administration on Friday. In the documents, the FDA’s own scientists seemed to strike a cautious position about the need for widespread booster shots. Overall, they said, ‘data indicate that currently US-licensed or authorized COVID-19 vaccines still afford protection against
severe COVID-19 disease and death in the United States.’… On one side are drug companies and some researchers, who point to data showing the efficacy of the vaccines to protect all infections is waning and that a third shot will provide additional protection. On the other are those who point out that these vaccines are still keeping people out of the hospital and preventing them from dying, indicating that a booster is not needed yet.”

KHN ([link removed]) (US) reports, “Fauci, whose team has closely tracked research from Israel, the United Kingdom and elsewhere, said in an exclusive interview with KHN on Wednesday that “there’s very little doubt that the boosters will be beneficial.” But, he emphasized, the official process, which includes reviews by scientists at the Food and Drug Administration and the Centers for Disease Control and Prevention, needs to take place first. ‘If they say, “We don’t think there’s enough data to do a booster,” then so be it,’ Fauci said. ‘I think that would be a mistake, to be honest with you.’ The support for an extra dose of covid vaccine clearly emerged, at least in part, from an NIH research dynamo, built by Fauci, that for months has been getting intricate real-time data about covid variants and how they respond to vaccine-produced immunity. The FDA and CDC were seeing much of the same data, but
as regulatory agencies, they were more cautious. The FDA, in particular, won’t rule on a product until the company making it submits extensive data. And its officials are gimlet-eyed reviewers of such studies.”


**
Global Decline in Cases, But Not Nearly Enough
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CIDRAP ([link removed]) (US) reports “For the first time in more than 2 months, weekly global COVID-19 cases dropped substantially, as cases decline in recent hot spots, including India and Japan, the World Health Organization (WHO) said yesterday in its latest update. All of the world's regions saw declines, but nearly 4 million new cases and more than 62,000 deaths were reported. Maria Van Kerkhove, PhD, the WHO's technical lead for COVID-19, said on Twitter ([link removed]) yesterday that the levels are still far too high, especially when the world has the tools to prevent infections and deaths.


** Long COVID Study Planned
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Science ([link removed]) (US) reports, The US NIH “announced ([link removed]) a nearly $470 million grant to enroll up to 40,000 adults and children newly and previously infected with SARS-CoV-2 in a study that will probe the causes of these postinfection effects, dubbed Long Covid, and look for clues to treatments and prevention…. Long Covid, or what NIH calls postacute sequelae of SARS-CoV-2 infection (PASC), can include pain, fatigue, “brain fog,” trouble sleeping, headaches, shortness of breath, fever, chronic cough, depression, and anxiety that linger or appear more than 4 weeks after an initial infection ([link removed]) . Sometimes the symptoms are so severe that a person can’t work and struggles
through daily tasks.”


**
Keeping Access to PrEP During the Pandemic
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The latest Protecting Global Gains ([link removed]) story highlights a differentiated service approach to deliver PrEP to more of those who need it in Thailand during the pandemic. “In Thailand… lay providers — health workers without formal medical certifications — offer PrEP at community clinics nationwide, thanks to training from the Bangkok-based Institute for HIV Research and Innovation (IHRI)… IHRI is now applying the differentiated service delivery approach and other lessons learned from the fight against HIV to tackle COVID-19. Working directly with leaders in communities most affected by the pandemic, they are teaching lay providers how to screen for COVID-19 and link those who test positive to community-based care that addresses stigma, discrimination, mental health, and other health issues affecting people with COVID-19 and their families.”


**
Vaccine Mandates
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The Guardian ([link removed]) (UK) looks at what countries are instituting vaccine mandates. “Following the decision by the US president, Joe Biden, to introduce a vaccine mandate for millions of workers ([link removed]) , and the UK government’s decision to row back on its push to require vaccine passports for nightclubs and other crowded events, where does the issue of insisting on vaccination stand globally?... A number of countries including Australia, France and England and Wales have moved to make vaccination mandatory for care workers ([link removed]) including those working in nursing homes... On Monday Greece ([link removed]) also introduced mandatory weekly testing for public and private sector
employees who will have to pay for weekly tests or carry a vaccination certificate to gain access to their place of work... Indonesia announced [nationwide] mandatory vaccination in February, with potential hefty fines for those who do not comply.”

The Guardian ([link removed]) (UK) reports, “France has suspended 3,000 health workers without pay for refusing the Covid vaccine. The health minister, Olivier Véran, said the staff had been notified in writing before the government-imposed deadline to have at least one dose.

Reuters ([link removed]) (UK) reports, “The Italian government approved on Thursday some of the strictest anti-COVID measures in the world, making it obligatory for all workers either to show proof of vaccination, a negative test or recent recovery from infection.”


**
One in 500 Americans Killed by COVID
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“America has passed another grim Covid-19 milestone, as data shows that one in 500 people living in the US have died from the virus since the pandemic began. Almost 664,000 people had died of the virus in the US by Tuesday evening… About one in four US hospitals have intensive care units that are at least 95% full…”

Physician-scientist Eric Topol tweeted ([link removed]) a chart of US COVID deaths, with the comment: “There's only one country in the world that has already lost the lives of 1 of every 500 residents and is now averaging 2,000 covid deaths a day.”

AP ([link removed]) (US) reports, “COVID-19 deaths and cases in the US have climbed back to levels not seen since last winter, erasing months of progress and potentially bolstering President Joe Biden’s argument for his sweeping new vaccination requirements. The cases — driven by the delta variant combined with resistance among some Americans to getting the vaccine — are concentrated mostly in the South.”

AFP ([link removed]) (France) reports, “Idaho, the US state with the lowest Covid vaccination rate in the country, announced Thursday it was rationing medical care and would turn patients away from ventilators if they aren't likely to recover. The northwestern state's health department said it had enacted the measure because of ‘the massive increase of COVID-19 patients requiring hospitalization’ which had ‘exhausted’ existing resources. ‘The situation is dire,’ said health department director Dave Jeppesen in a statement.”


**
Sex Workers Call for Equitable Vaccine Access
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The Botswana Gazette ([link removed]) reports, “Ten migrant sex workers were sent away from vaccination centres in Gaborone and Mogoditshane unvaccinated because of their migrant status… This is in spite of the government stated policy of vaccinating all eligible people in Botswana, including documented and undocumented migrants. ‘We believe that there should be equitable access to COVID-19 vaccines, including sex workers,’ [Mandla Pule, Programme Officer at Sisonke, a sex workers’ rights group, said.]”


**
Broadening Vaccine Access in Kenya
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The Star (Kenya) reports “The Ministry of Health is set to offer Covid-19 vaccination in the 14 new hospitals launched by the Nairobi Metropolitan Service, which is a relief to informal settlements. Health CS Mutahi Kagwe said that they are targeting the vulnerable and the aged within Nairobi.”


**
Fighting Disinformation
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The Guardian ([link removed]) reports, “Trinidad and Tobago’s health minister has dismissed claims by the rapper Nicki Minaj that a cousin’s friend had become impotent after receiving the Covid-19 vaccine, saying that health officials in the Caribbean country had found no evidence that any patient had reported such side-effects… Deyalsingh lamented the time health officials spent investigating the claim, saying that they ‘take all these claims seriously’.” Minaj, who has more than 22.7 million followers on twitter, “prompted a global backlash ([link removed]) on Monday with a tweet ([link removed]) in which she claimed that a cousin’s friend had become impotent after receiving the Covid-19 vaccine.”


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Making COVID Vaccines in Poor Countries
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Nature ([link removed]) (UK) reports “Many researchers say the best way to ensure equitable access to COVID-19 vaccines is to enable countries in the global south to make their own. “Charity is good, but we can’t rely on charity alone,” says Peter Singer, an adviser to the director-general of the [WHO]… Calls to manufacture more vaccines in the global south have grown louder in advance of high-level pandemic discussions at the United Nations General Assembly, which began this week, and a US-led, Global COVID-19 Summit on 22 September… In a letter signed by several Indian civil society groups ([link removed]) — shared with Nature — advocates are urging US President Joe Biden to compel J&J to partner with drug companies in the global south, arguing that those making Sputnik V could easily pivot to the J&J vaccine because they rely on similar technologies. They estimate that the transition would take less than six
months.”


**
UK and Hong Kong Plan Single Dose of Vaccine for Teens
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The Guardian ([link removed]) (UK) reports, “After months of uncertainty, the UK’s four chief medical officers have said that Covid-19 vaccinations can be offered to all 12-to-15-year-olds… A single shot of the Pfizer/BioNTech Covid vaccine is about 55% protective against Covid infection, and more so against hospitalisation and death, though severe Covid disease is rare in healthy children. So the vaccination programme will not stop Covid in schools, but should help to keep cases down and so reduce disruption from the disease.”

Reuters ([link removed]) (UK) reports, “A panel of health experts advising the Hong Kong government has recommended children aged 12-17 should get only one dose of BioNTech’s COVID-19 vaccine after reports of heart inflammation as a side effect… [The chair of the advisory committee] said experts decided it was better for teenagers to get only one dose to ‘greatly reduce the chance of heart inflammation’. Hong Kong’s low COVID-19 risk also means that one dose should offer sufficient protection, he said.”


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Millions of Children Still out of School
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A Press release from UNICEF ([link removed]) says, “Eighteen months into the COVID-19 pandemic, schools for nearly 77 million students in six countries continue to be almost completely closed, according to an updated data analysis ([link removed]) released today by UNICEF. According to the analysis, Bangladesh, the Philippines and Panama are among the countries that kept schools closed the longest. In total, an estimated 131 million students in 11 countries have missed more than three-quarters of their in-person learning. Around 27 per cent of countries worldwide continue to have schools fully or partially closed.”


**
Resource of the Week
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The COVID Behaviors Dashboard ([link removed]) is an “interactive tool [that] presents data from a global survey of knowledge, attitudes, and behaviours around COVID-19. Data from this ongoing survey (launched May 20 2021) are collected daily, and the dashboard is updated every two weeks. The website is intended to be used by policymakers, health officials, and communication practitioners at national and subnational levels to better understand the behavioural drivers behind vaccine uptake, masking, testing, and physical distancing - among other practices that affect the spread of COVID-19.”
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