The COVID-19 summit held on the sidelines of the UN General Assembly meeting brought more attention to the need for more vaccines and other support for low-income countries to fight COVID. It also brought new commitments from world leaders. But they fall far short of what is needed.
 
AP (US) reports, “President Joe Biden announced Wednesday that the United States is doubling its purchase of Pfizer’s COVID-19 shots to share with the world to 1 billion doses as he embraces the goal of vaccinating 70 percent of the global population within the next year. The latest purchase reflects only a fraction of what will be necessary to meet a goal of vaccinating 70 percent of the global population—and 70 percent of the citizens of each nation—by next September’s UN meeting.”
 
Brook Baker writes in STAT, “Biden has asked for endorsement of a set of targets and commitment to directly address one or more of them. These targets fall terribly short of the ambition that’s needed to stop this global pandemic. The targets also downplay the obligations of rich countries to reverse the horrific consequences of vaccine, testing, and therapeutics apartheid that they—and the biopharmaceutical industry—have engendered…. The Biden administration should jettison its summit targets and instead engage proactively with leaders, especially from the Global South, to identify a bolder set of actionable targets that would simultaneously reverse private sector control over COVID-19 health technologies and massively increase coordinately public investments in defeating the pandemic in all corners of the world. The time for real leadership is now.”
 

If You Are in a Hurry

• Watch United Nations Secretary-General Antonio Guterres’s speech excoriating rich countries’ unethical actions at Reuters.
• Read profiles of US healthcare workers who are being crushed by the continued wave of COVID cases in the Washington Post.
• Read STAT on how Delta is devastating the Southern United States.
• Read a twitter thread from Dr. Tom Frieden that lays out what’s needed for global equity and to bring the pandemic under control.
• Read Gregg Gonsalves in The Nation on the way politics is driving COVID cases and death in the American South.
• Read a STAT investigation of the new “in vogue” health equity research that is often not really equitable.
• Read Monica Gandhi in the Washington Post on what it will take to “degfang” COVID in the US.
• Read the Washington Post on how Denmark may have beaten COVID.

 

New Commitments Fall Short of What is Needed

 
Reuters (UK) reports, “United Nations Secretary-General Antonio Guterres reprimanded the world on Tuesday for the inequitable distribution of COVID-19 vaccines…. Addressing the annual UN gathering of world leaders in New York, Guterres said images from some parts of the world of expired and unused vaccines in the garbage told ‘the tale of our times’—with the majority of the wealthier world immunised while more than 90 percent of Africa has not even received one dose. ‘This is a moral indictment of the state of our world. It is an obscenity. We passed the science test. But we are getting an F in Ethics,’ Guterres told the UN General Assembly.”
 
A WHO Africa statement notes, “COVID-19 vaccine shipments to Africa must rise by over seven times from around 20 million per month to 150 million each month on average if the continent is to fully vaccinate 70 percent of its people by September 2022. The 70 percent target was agreed at the global COVID-19 summit…. ‘The global COVID-19 summit was a dose of hope for Africa and we commend pledges to share more vaccines, save lives and build back better. It is the kind of international solidarity that will help to end the pandemic. This is about life and death for potentially millions of Africans so there is no time to waste in getting these shipments moving…. Actions speak far louder than words and African countries need clear delivery dates so they can plan properly. We also need strong structures set up to ensure that all promises made are promises kept,’ said Dr Matshidiso Moeti” of WHO Africa.
 
Reuters (UK) reports, “Leaders from developing nations warned the UN General Assembly this week that COVID-19 vaccine hoarding by wealthy countries left the door open for the emergence of new coronavirus variants even as infections already increase in many places. The Philippines warned of a "man-made drought" of vaccines in poor countries, Peru said international solidarity had failed and Ghana lamented vaccine nationalism.”
 
The New York Times (US) quotes several experts who say Biden’s targets are not enough, quoting Public Citizen’s Peter Maybarduk: “’Purchasing doses for donation sometime next year is helpful, but it does not meaningfully expand the global supply, and it is not justice.’ Some experts pleaded for more aggressive action by Mr. Biden to pressure American vaccine makers to share their formulas with nations that desperately need more shots. ‘Where is the monthly calendar of what each wealthy country is going to deliver?’ said Kate Elder, senior vaccines policy adviser for Doctors Without Borders’ Access Campaign. She added, ‘Where are the announcements about meeting the calls of regions and middle-income countries that are begging to be self-sufficient?’”
 
Africa is not the only region facing vaccine shortages, Reuters (UK) reports, “The Pan American Health Organization (PAHO) warned on Wednesday that countries in the region could continue to face localized COVID-19 outbreaks ‘well into 2022’ even while deaths have fallen from their peak in January. While vaccinations are progressing, the region faces a ‘severe vaccine inequality problem’ that will prolong the pandemic, particularly in the poorer Latin American nations….”
 
In a twitter thread former US CDC director Dr. Tom Frieden writes, “We MUST increase global vaccine supply through tech transfer—especially mRNA vaccines. Donations are not enough. So far, the US has failed to increase manufacturing. Neither Pfizer nor Moderna have behaved as good corporate citizens. (That’s the polite way of saying their behavior in focusing on selling boosters to rich countries and not expanding production for the rest of the world, and, in the case of Pfizer, claiming Africa can’t handle the vaccines, is egregious beyond words.)…Failure to increase vaccine production is a moral failing and epidemiologically short-sighted. The US taxpayers paid for Moderna’s invention, and Moderna now has $12 billion in the bank. It’s way past time for the US to ensure Moderna shares this technology much more widely.”
 

American Health Systems in Crisis

 
Buzzfeed (US) reports, “A COVID nightmare is unfolding in Idaho, where overwhelmed hospitals are starting to ration care and medical workers feel like the public has turned on them. In response to the crush of patients, which is not expected to slow anytime soon, the Idaho Department of Health and Welfare (DHW) last week activated crisis standards of care. When implemented by hospitals, these plans, first formulated in April 2020 with the hope they would rarely need to be used, help guide overwhelmed medical workers on how to ration scarce resources. The crisis standards apply to all patients—not just those with COVID-19…. Last Thursday, the day the crisis standards were first activated, one older adult came into a hospital after she suffered a stroke. In normal times, she would be held overnight for monitoring, but instead she was discharged that same day.”
 
Reuters (UK) reports, “Alaska, which led most US states in coronavirus vaccinations months ago, took the drastic step on Wednesday of imposing crisis-care standards for its entire hospital system, declaring that a crushing surge in COVID-19 patients has forced rationing of strained medical resources…. The Delta variant is ‘crippling our healthcare system. It’s impacting everything from heart attacks to strokes to our children if they get in a bike accident,’ Dr. Anne Zink, Alaska’s chief medical officer, said at a news conference….”
 
The Washington Post (US) reports, “Health-care workers say in some ways, this phase [of the pandemic in the US] has been the hardest yet. Earlier this summer, it looked like the widespread availability of vaccines might mean the coronavirus pandemic was behind them. Now, those on health-care’s front lines share a hardening view toward the delta variant’s biggest target: the willingly unprotected. The workers are baffled over how, after so much pain and death, there is still even a debate over whether to get vaccinated or wear a mask in public. Their patience is wearing thin, they say. And as they toil in stifling plastic protective gear, or glance down the growing lists of new patients to contact, exhaustion has settled in. Many have quit…or are thinking about it.
 

Delta Devastating the Rural Southern US

 
STAT (US) reports, “Health inequities in rural communities across the South are continuing to determine who is most vulnerable to COVID-19 now that the Delta variant is bringing a new surge in deaths….The same factors that contributed to racial disparities during earlier waves of Covid, such as comorbidities and access to health care and transportation, have been relevant during the Delta surge, said Bentley-Edwards. The loosening of social distancing rules restrictions also likely hurt Black and Latino people, who are more likely to work in service industries, she said.”
 
Gregg Gonsalves writes in The Nation (US) about the way politics is driving COVID cases and deaths in many Southern states. “What is happening in the American South is no accident. It is not born of ignorance or folly. It is a choice…. [Florida] Governor DeSantis and his colleagues in the South genuinely think they are doing the right thing. Their persistent, horrific quest for herd immunity confirms preexisting biases about the role of the state in our lives—the less the better. In the People’s Temple of the Sunshine State, this faith has led the people’s leader to hand out the Kool-Aid to his own citizens, leading them to their own deaths…. The pandemic has enabled these leaders to pursue policies they have wanted to push way before SARS-COV-2 had entered the scene…. The GOP is looking for ways to undermine access to health care, public health regulations and programs—the whole already-frayed safety net….”
 

Breakthrough Infections

 
Business Insider (US) reports “More than two-thirds of fully vaccinated people in a Texas prison caught COVID-19 during an outbreak of the Delta variant in July, but vaccines protected against severe illness, a study from the [CDC] found…. Another CDC study from this month found that unvaccinated Americans were 11 times as likely to die of COVID-19 as vaccinated people. About 45 percent of people in the US are unvaccinated, according to the CDC.”
 
Roll Call (US) reports, “Mild cases of COVID-19 among vaccinated individuals are becoming increasingly common as the highly contagious delta variant barrels through communities, but physicians and public health experts say that shouldn’t be a cause for significant concern…. ‘It’s likely that everybody will probably get infected with COVID-19 [at some point] because it’s an endemic respiratory virus. The goal is to make sure that at that time, that infection occurs after you’ve been vaccinated so it’s mild,’ said Amesh Adalja, a doctor and infectious disease specialist at Johns Hopkins Center for Health Security.”
 

Boosters

The New York Times (US) reports, “The director of the Centers for Disease Control and Prevention on Friday overruled a recommendation by an agency advisory panel that had refused to endorse booster shots of the Pfizer-BioNTech COVID vaccine for frontline workers. It was a highly unusual move for the director, Dr. Rochelle Walensky, but aligned CDC policy with the Food and Drug Administration’s endorsements over her own agency’s advisers. The CDC’s Advisory Committee on Immunization Practices on Thursday recommended the boosters for a wide range of Americans, including tens of millions of older adults, and younger people at high risk for the disease. But they excluded health care workers, teachers and others whose jobs put them at risk. That put their recommendations at odds with the FDA’s authorization of booster shots for all adults with a high occupational risk…. Dr. Walensky said providing booster shots to health care workers and others who risk contracting the disease on the job would ‘best serve the nation’s public health needs.’… Dr. Walensky’s decision revealed the continuing divisions and confusion among federal regulators and outside advisers about how to contain the virus nearly two years into the pandemic.”
 
The Boston Globe (US) reports, “With a majority of the worldwide population, especially in low-income countries, still waiting to get a first vaccine dose, WHO officials have criticized rich countries’ plans to set aside shots for boosters for their own citizens…. During a virtual appearance Wednesday at the inaugural Globe Summit, [Anthony Fauci] defended the United States’ plan, casting boosters as a central part of the COVID-19 vaccine regimen. ‘There’s no doubt that, in the United States, those who’ve been vaccinated several months ago are having a diminution in protection against infection and the beginning of the hint of a diminution of protection against severe disease,’ Fauci told Boston Globe. ’I think…that three shots will be the actual correct regimen, as opposed to two shots is the correct regimen, it fails, so you got to give a third,’ he said. ‘It should be that the proper one from the get-go is three shots.’”
 

The Unvaccinated, but Willing

 
The Washington Post (US) reports, “Barriers to getting the shot and information about the vaccines have hindered the “unvaccinated but willing,” who account for approximately 10 percent of the American population, according to a report last month by the Department of Health and Human Services. Unlike those who have declined vaccines, some vocally, because of their politics or ideology, a quieter share—about 44 percent of unvaccinated people—were willing to get a shot in late June and early July, including those who said they would definitely or probably get a shot and those who are unsure, HHS estimated. Those who remain on the fence for certain reasons…lack transportation or other means, while others wish to wait and see or don’t know coronavirus vaccines are free.”
 

New Data on Remdesivir

 
Bloomberg (US) reports, “Early treatment with Gilead Sciences Inc.’s remdesivir kept high-risk COVID-19 patients out of the hospital in a late-stage international trial that supports administering the medicine to individuals recovering at home. A three-day course of the injectable antiviral, also known as Veklury, was associated with an 87 percent reduction in hospitalizations in a randomized, placebo-controlled trial involving 562 patients, Gilead said in a statement Wednesday.”
 

New Vaccine Initiative for South Africa

 
Times Live (South Africa) reports, South African-American business tycoon Patrick Soon-Shiong has announced the launch of an SA COVID-19 and cancer vaccine initiative. Soon-Shiong and President Cyril Ramaphosa revealed the ambitious initiative during a virtual press briefing on Thursday…. The collaboration agreement will initiate the ‘transfer of biologic manufacturing technology for COVID-19 and cancer vaccines and next-generation cell-based immunotherapies. This will enable the rapid clinical development of next-generation vaccines for infectious diseases and cancer at centres of excellence across the country.’”
 

COVID and Kids

 
Undark (US) reports, “Eighteen months into the COVID-19 pandemic, with the delta variant fueling a massive resurgence of disease, many hospitals are hitting a heartbreaking new low. They’re now losing babies to the coronavirus. The first reported COVID-related death of a newborn occurred in Orange County, Florida, and an infant has died in Mississippi. Merced County in California lost a child under a year old in late August…. Although there’s no evidence the delta variant causes more severe disease, the virus is so infectious that children are being hospitalized in large numbers—mostly in states with low vaccination rates. Nearly 30 percent of COVID infections reported for the week that ended Sept. 9 were in children, according to the American Academy of Pediatrics.”
 
Reuters (UK) reports, “England's Chief Medical Officer Chris Whitty said on Wednesday that COVID-19 transmission was currently highest in 12- to 15-year-olds, and that almost all unvaccinated children would get infected at some point. All those in the 12-15 age bracket in England are to be offered a COVID-19 vaccine after Whitty and his colleagues said last week that children would benefit from reduced disruption to their education.”
 

We Won’t Eradicate COVID

 
Infectious-diseases specialist Monica Gandhi writes in the Washington Post (US) that COVID will eventually become endemic, but we won’t be able to eliminate it. “If we can tamp down viral circulation globally and largely strip the virus of its ability to cause severe disease through vaccination, the world can resume a version of the normalcy we so desperately crave. Outbreaks of severe disease will occur among populations unwilling to be vaccinated, as we see with measles, but vaccine mandates can help increase vaccination uptake. Because of this and naturally acquired immunity, COVID-19 will go the way of other respiratory viruses over which we have control…. Defanging the coronavirus and stripping it of its ability to cause severe disease through immunity will relegate it to the fate of other circulating cold-causing coronaviruses, an inconvenience but not a world stopper. The key to hastening this normalcy is vaccination, like the other countries that are now reopening with few restrictions We can get there, too.”
 

Post-COVID in Denmark?

 
The Washington Post (US) reports, “On Sept. 10, Danish authorities lifted all pandemic restrictions and pronounced that COVID-19 is no longer a “critical threat” in the country. Vaccination rates are high — 86 percent of all eligible citizens 12 and older have received at least one shot, and 95 percent of people 50 and older are fully vaccinated…. [Research suggests Danish] citizens’ high and stable trust in their health authorities has been a crucial factor in Denmark’s success. This trust, shown in the figure below, encouraged high vaccination rates and the successful implementation of key policies such as mass testing and coronavirus passports.”
 

England’s Vaccine Travel Rules Spark Outrage

 
The Guardian (UK) reports, “England’s COVID travel rules and refusal to recognise vaccines administered across huge swaths of the world have sparked outrage and bewilderment across Latin America, Africa and south Asia, with critics denouncing what they called an illogical and discriminatory policy…. Under the new rules, travellers fully vaccinated with Oxford/AstraZeneca, Pfizer/BioNTech, Moderna or Janssen shots in the US, Australia, New Zealand, South Korea or an EU country will be considered ‘fully vaccinated’ and exempt from quarantine when they arrive in England from an amber list country. But people who have been fully vaccinated with the same vaccines in Africa or Latin America, as well as other countries including India, will be considered ‘not fully vaccinated’ and forced to quarantine for 10 days on arrival from an amber list country.”
 

Combatting Disinformation

 
Eye Witness News (South Africa) reports, “Scientists have again stressed that COVID-19 vaccines are subjected to rigorous testing and are safe and effective. These experts participated in a Department of Science and Innovation online discussion on Wednesday, aiming to debunk myths around coronavirus vaccines. Health Products Regulatory Authority Chairperson, Professor Helen Rees, stressed that vaccines have been thoroughly tested. ‘What we've subsequently seen, if you look at things like miscarriage, we're not seeing higher rates of miscarriage and countries like the UK have been following up vaccines for a long time. Remember they started earlier than us, and in the US,’ she said.”
 
MedPage Today (US) reports, “An Oregon physician has lost his license because he refused to wear a mask while treating patients and because he spread misinformation about masking, according to an Oregon Medical Board order…. The revocation of LaTulippe's license follows a Federation of State Medical Boards advisory that medical boards should consider spreading COVID-19 misinformation as disciplinary offense, and that doctors who spread unproven theories should have their licenses subject to public disciplinary proceedings.”
 

Inequity in Health Equity Research

 
STAT looks at issues of equity in health equity research. “Fueled by the massive health disparities exposed by the coronavirus pandemic and the racial reckoning that followed the murder of George Floyd, health equity research is now in vogue. Journals are clamoring for it, the media is covering it, and the National Institutes of Health, after publicly apologizing for giving the field short shrift, recently announced it would unleash nearly $100 million for research on the topic…. A STAT investigation shows a disturbing trend: a gold rush mentality where researchers with little or no background or training in health equity research, often white and already well-funded, are rushing in to scoop up grants and publish papers…. A glaring example occurred in August when [JAMA] published a special themed issue on racial and ethnic health disparities in medicine. Meant to highlight JAMA’s new commitment to health equity, it served up an illustration of the structural racism embedded in academic publishing: Not one of the five research papers published in the issue included a Black lead or corresponding author, and just one lead author was Hispanic.”
 

A New PSA on How mRNA Vaccines Work

 
If you have never watched the American animated series Family Guy, the new PSA from its creators may seem strange. But even if you don’t know the characters, the PSA provides a nice (humorous and irreverent) overview of how mRNA vaccines work and a message to get vaccinated. Read about it in Men’s Health (US) or just watch it here.