Despite repeated calls to make more vaccine available to poor countries more quickly only 2.5 percent of people in poor countries are fully vaccinated. Activists Tian Johnson, Tom Moultrie, Gregg Gonsalves and Fatima Hassan write for Bhekisisa (South Africa), “Albert Bourla, the CEO of the US-based pharma giant Pfizer, recently claimed the slow uptake of COVID jabs in Africa is because of vaccine hesitancy…. Bourla’s statements about vaccine hesitancy perpetuates a far too common narrative, grounded in racism and which paints people in Africa as being science shy and resistant towards vaccines and other medical advances. Quite to the contrary, a team of leading researchers reported in Nature Medicine in July this year that COVID vaccine acceptance is higher in several low- and middle-income countries, including a number in Africa, than in richer countries such as the United States (US) and Russia…. The current situation of vaccine inequity and racist tropes being flung about to justify knowledge hoarding and a dire lack of vaccine supplies is sadly shameful. It is also a moral crime.”
 

If You Are in a Hurry

• Read a chilling Nature piece on harassment and abuse of scientists who speak publicly about COVID.
• Read Human Rights Watch on the impact of the pandemic on poverty in many African countries.
• Read a Science study on how the Delta variant drove increases in cases in Delhi, India.
• Read a long investigative piece by The Bureau of investigative Journalism on what went wrong with COVAX.
• Read Pharmaceutical Technology on the important question of whether Merck’s new pill will be available in poor countries.
• Read Tom Frieden’s call in the Washington Post to break up the Pfizer-Moderna duopoly.
• Read The Atlantic on the nine pandemic words no one gets right.
• Read The Conversation on recorded acts of pandemic kindness in South Africa.

 

A Ring Strategy for COVID Vaccinations in Africa

 
Health Policy Watch (Switzerland) reports, “Africa is estimated to have seven times more COVID-19 cases and three times as many deaths as officially reported, according to the World Health Organization (WHO) Africa region. This means that the continent could have around 59 million cases and 634,500 deaths…. The WHO has thus decided to invest $1.8 million to roll out COVID-19 rapid tests in hot spots, starting with pilots in eight countries…”
 
Africa Times reports, “Just one in every seven cases of COVID-19 infection on the African continent is diagnosed correctly, a trend that the World Health Organization hopes to reverse by applying a “ring strategy” approach to the outbreak in affected communities. The new approach is based on models used successfully to curb the transmission of Ebola and smallpox in the past, said WHO…. The ring approach means that each time a confirmed COVID-19 case is detected, health officials will target people living inside a radius of 100 meters from the location where COVID infection was found. Each household within the circle will receive kits with face masks and hand sanitizers, while anyone who tests positive will be treated at home or transferred to a designated COVID-19 treatment center.”
 

Moderna (and Biden Administration and Pfizer) Called Out by Activists

 
Axios (US) reports, “Moderna is under fire for not doing enough to vaccinate the world, particularly low-income countries—and the Biden administration is being criticized for not doing enough to force Moderna's hand…. A top Biden official publicly threatened Moderna with more aggressive government action if it doesn't voluntarily provide enough vaccines to the global initiative COVAX at not-for-profit prices, which the administration has asked it to do…. Activists speaking on the panel said that it's time for the federal government to give up on Moderna voluntarily taking action, and to take much more aggressive steps to increase global vaccine capacity.” Watch the webinar here.
 
The New York Times reports, “Moderna, whose coronavirus vaccine appears to be the world’s best defense against COVID-19, has been supplying its shots almost exclusively to wealthy nations, keeping poorer countries waiting and earning billions in profit. After developing a breakthrough vaccine with the financial and scientific support of the US government, Moderna has shipped a greater share of its doses to wealthy countries than any other vaccine manufacturer…. There is limited public information about the deals that Moderna has struck with individual governments. Of the 22 countries, plus the European Union, to which Moderna and its distributors have reported selling the shots, none are low income, and only the Philippines is classified as lower middle income. (Six are upper middle income.)”
 
Tom Frieden calls in the Washington Post for breaking up the Pfizer-Moderna “duopoly.” He writes, “Drug companies claim they are on track to produce a glut of coronavirus vaccines globally by 2022. Don’t believe them. Failure to ramp up production now could cost lives and prolong the pandemic. The best way to avoid that is to break up the duopoly that Moderna and Pfizer maintain over mRNA vaccines…. The only responsible way forward is for them to transfer their vaccine technology to other companies that can rapidly increase production.”
 

Boosters

 
CIDRAP (US) reports WHO advisors “said people in the immunocompromised groups should be offered an additional dose in the vaccine series, since they are less likely to respond adequately to vaccination with the standard series and are at high risk for severe disease.”
 
The New York Times (US) reports, “A panel of independent medical experts on Thursday unanimously recommended Moderna booster shots for many of those who had received the company’s coronavirus vaccine, paving the way to sharply expand the number of people eligible for an additional shot in the United States.” The panel recommended the Moderna booster for the same groups the Pfizer third dose is approved for. “The panel made clear it did not favor expanding eligibility for booster shots beyond the higher-risk groups that qualify for Pfizer boosters. No vote was taken on that question, but the committee expressed concern that booster eligibility decisions could become a slippery slope. Several experts said they were worried about recommending additional shots based on clinical trial results from just a few hundred participants.”
 
The New York Times reports, “People who received a Johnson & Johnson coronavirus vaccine may be better off with a booster shot from Moderna or Pfizer-BioNTech, according to preliminary data from a federal clinical trial published on Wednesday. That finding, along with a mixed review by the Food and Drug Administration of the case made by Johnson & Johnson for an authorization of its booster, could lead to a heated debate about how and when to offer additional shots to the 15 million Americans who have received the single-dose vaccine.”
 
Helen Branswell reports in STAT (US) on the first US data on mixing vaccines. “The goal of the trial was to see whether using a different vaccine as a booster shot improves protection…. Is it possible that any combination of vaccine types or brands will work as well—or better—than if the shots were all of a single brand? That’s not yet clear, but it’s possible—even likely—that the combinations and the order in which the vaccines are given will matter.” Several experts weigh in on the possible benefits of mixing and matching.”
 
aidsmap (UK) reports, “People with HIV with well-controlled viral load on antiretroviral treatment have similar levels of antibodies to HIV-negative people after two doses of a SARS-CoV-2 vaccine and in most cases will not need a third dose, Canadian researchers report. However, they found that people who received two doses of the Oxford/Astra Zeneca vaccine had lower antibody levels after two doses compared to people who received other vaccines. Antibody levels were also lower in older people and those with multiple underlying health conditions.”
 

COVAX’s Failures

 
An investigation by The Bureau of investigative Journalism (UK) and STAT looked at the failures of COVAX. “As richer countries roll out booster shots, 98 percent of people in low-income countries remain unvaccinated. COVAX, described as “naively ambitious” by one expert, has contributed just 5 percent of all vaccines administered globally and recently announced it would miss its 2 billion target for 2021…. COVAX has delivered some 330 million vaccines so far, yet now intends to distribute a massive 1.1 billion vaccines in just the next three months. Some officials in poorer countries fear that the abrupt surge could overwhelm their health systems and lead to much-needed vaccines going to waste…. The scheme’s concept was good, but it ‘failed miserably’ in practice, Libya’s UN ambassador Baiou said. ‘I can’t understand and don’t understand why COVAX would enter into these agreements when it did not address how to control the supply of vaccines.’”
 

Changes Needed for ACT-A

 
Devex (US) reports, “A new review has recommended that the Access to COVID-19 Tools Accelerator, or ACT-A, continue its work in 2022 as long as there’s a critical need for coordinated support to drive access to COVID-19 tools in low- and middle-income countries…. Fifa Rahman, a civil society representative at ACT-A, told Devex that the mechanism’s key drawback is ‘the failure to integrate LMIC expertise in equal intellectual partnership.’ It also needs to engage more meaningfully with civil society, which she said isn’t just about civil society participation in meetings.”
 

Attacks on Scientists

 
Nature (UK) reports, “A survey by Nature of more than 300 scientists who have given media interviews about COVID-19—many of whom had also commented about the pandemic on social media—has found wide experience of harassment or abuse; 15 percent said they had received death threats…more than two-thirds of researchers reported negative experiences as a result of their media appearances or their social media comments, and 22 percent had received threats of physical or sexual violence. Some scientists said that their employer had received complaints about them, or that their home address had been revealed online. Six scientists said they were physically attacked…. Some aspects of COVID-19 science have become so politicized that it is hard to mention them without attracting a storm of abuse. Epidemiologist Gideon Meyerowitz-Katz at the University of Wollongong in Australia, who has gained a following on Twitter for his detailed dissection of research papers, says that two major triggers are vaccines and the anti-parasite drug ivermectin…”
 

Expanded Social Protections Needed

 
Human Rights Watch (US) reports, “The COVID-19 pandemic has highlighted the need for African governments to strengthen social protection systems and fulfill people’s rights to social security and an adequate standard of living. Many African governments introduced measures like cash transfers and food assistance in response to the rising poverty and hunger occasioned by the pandemic, but most households received no support. The World Bank forecasts that the COVID-19 crisis will have pushed an additional 29 million Africans into extreme poverty by the end of 2021.”
 

UK Public Health Failure

 
The Guardian (UK) reports on a scathing new report on the UK’s handling of the pandemic. “Britain’s early handling of the coronavirus pandemic was one of the worst public health failures in UK history, with ministers and scientists taking a ‘fatalistic’ approach that exacerbated the death toll…. ‘Groupthink’, evidence of British exceptionalism and a deliberately ‘slow and gradualist’ approach meant the UK fared ‘significantly worse’ than other countries….”
 

Vaccine Acceptance

 
A JAMA (US) study on vaccine acceptance among Black and Latinx communities, “identified 3 themes to understanding factors associated with facilitating or obstructing COVID-19 vaccination: pervasive mistreatment of Black and Latinx communities and associated distrust; informing trust via trusted messengers and messages, choice, social support, and diversity; and addressing structural barriers to vaccination access.”
 

Vaccine Mandates

 
Premium Times (Nigeria) reports, “The Nigerian government has directed all its employees to get vaccinated against the COVID-19 virus as this will soon become a prerequisite for gaining access into their various offices…. Mr. Mustapha said beginning December 1, 2021 all federal government employees will be required to show proof of COVID-19 vaccination or present a negative PCR result to gain access to their offices.”
 

COVID’s Impact on Public Health Services

 
PLOS ONE (US/UK) study “assess[ed] the extent to which staffing for essential public health services has been redirected to the COVID-19 response.” The study found “The provision of many essential public health functions and tasks have been limited or eliminated while the US public health workforce responds to the COVID-19 pandemic.” A statement about the study published on Medical Xpress (US) notes, “Of special concern is the fact that many public health workers have been redeployed to COVID-related duties during the pandemic response, leaving other critical public health issues with reduced or suspended services. That means investigation of other communicable diseases, food-related illness, public-health surveillance, chronic diseases and other critical services have suffered.”
 

TB Deaths Rise During COVID

 
France24 (France) reports, “Tuberculosis is on the rise again globally for the first time in a decade, linked to disruptions in access to healthcare because of the COVID pandemic…. The setback has erased years of progress toward tackling the curable disease, which affects millions of people worldwide. WHO says around 4.1 million people have tuberculosis but have not been diagnosed or officially declared, up sharply from 2.9 million in 2019.”
 

Doctors Sue Brazilian Health System

 
Medscape (US) reports a group of doctors recently fired by a Brazilian private healthcare system is suing the company for allegedly coercing them into prescribing hydroxychloroquine along with other unproven drugs for COVID-19. Prevent Senior turned out to be one of the most enthusiastic advocates of unproven medications for COVID and issued what has become known in Brazil as the ‘COVID kit’ including different combinations of hydroxychloroquine, azithromycin, ivermectin, nitazoxanide, zinc, vitamin D, and flutamide, among others. The lawsuit accuses Prevent Senior’s directors of pressuring them to recommend specific drugs and of setting goals as incentives to write more prescriptions.”
 

More Data on Delta

 
A Science (US) study looks at the outbreak of the Delta variant in Delhi, India, reporting, “Seropositivity of an employee and family cohort increased from 42 percent to 87.5 percent between March and July 2021, with 27 percent reinfections, as judged by increased antibody concentration after a previous decline. The likely high transmissibility and partial evasion of immunity by the Delta variant contributed to an overwhelming surge in Delhi.” The authors “conclude that the Delta variant is capable of initiating fast-rising outbreaks in populations with immune responses to prior variants, resulting in reinfections and vaccination breakthroughs. Public health strategies may need to be revised to account for variants with heightened transmissibility and immune escape.”
 
Reuters (UK) reports, “The Delta variant of the coronavirus does not appear to cause more severe disease in children than earlier forms of the virus, a UK study suggests…. [A study reported] ahead of peer review [found] children infected with Delta had slightly more symptoms. But in both groups, very few children needed to be hospitalized and long periods of illness were uncommon.”
 

US FDA Plans to Review Merck’s Pill

 
In a statement the US FDA announced, “an upcoming meeting of its Antimicrobial Drugs Advisory Committee (AMDAC) to discuss Merck and Ridgeback’s request for an emergency use authorization (EUA) for molnupiravir, an investigational antiviral drug to treat COVID-19. On Nov. 30, the advisory committee will meet to discuss the available data supporting the use of molnupiravir to treat mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who have tested positive for COVID-19, and who are at high risk for progression to severe COVID-19, including hospitalization or death…. ‘We believe that, in this instance, a public discussion of these data with the agency’s advisory committee will help ensure clear understanding of the scientific data and information that the FDA is evaluating to make a decision about whether to authorize this treatment for emergency use,’ said Patrizia Cavazzoni, MD, director of the FDA’s Center for Drug Evaluation and Research.”
 
Pharmaceutical Technology (UK) reports “Approval of Merck’s highly effective COVID-19 pill would be an important step towards tackling the pandemic—but will those in low- and middle-income countries, who need the treatment most desperately of all, be able to access it?... In April, Merck entered into non-exclusive, voluntary licensing agreements for molnupiravir with five Indian generics manufacturers. The purpose of the deals, the company said, is to boost availability of the antiviral drug in more than 100 LMICs, including India…. Despite Merck’s efforts to boost molnupiravir production and availability in LMICs, there are fears that poor countries could be left behind once again as wealthier nations scramble to buy up supplies of the drug.”
 

Long COVID

 
Medscape (US) reports more than half of long COVID patients, “reported experiencing effects longer than 6 months after recovery, according to a systematic review of 57 studies that included more than 250,000 patients. The results indicate that long COVID is common and persistent and will necessitate reevaluating future demands on the healthcare system, experts say.”
 

Still Looking for Virus’s Origins

 
An editorial by Tedros and other WHO leaders in Science (US) argues, “COVID-19 will not be the last Disease X. We need scientific collaboration, data sharing, and implementation of a robust ‘one health’ approach that brings together the human, animal, and environmental spheres to boost risk identification, reduction, and surveillance in animals and at the human-animal-environment interface. This must be linked to early action to investigate, characterize, and contain threats. In parallel, the world needs systematic processes to study the emergence of these pathogens and their routes of transmission from natural reservoirs to humans. Laboratory protocols around the world must be monitored and strengthened. Globally, at least 4.8 million people have died from COVID-19. They and their families are owed answers as to where and how the virus originated.”
 
Science (US) reports on a new WHO appointed team to investigate the origins of the virus. “The Scientific Advisory Group on the Origins of Novel Pathogens (SAGO) will also be tasked with studying the origins of future outbreaks and epidemics and guiding studies of emerging pathogens more generally…. WHO hopes that establishing a permanent panel will take some of the heat out of the current COVID-19 origin debate and make future investigations of new pathogens feel more standard.”
 

Acts of Pandemic Kindness

 
The Conversation (US) reports on “recorded acts of kindness” in South Africa following lockdowns in the country. “Remarkably, the country mobilised. Individuals offered whatever support they could, in money, in food and in services. In every corner of the nation, communities sprang into action to take care of their most vulnerable citizens. In many ways, across the country, South Africans were stepping up to support one another in ways rarely seen…. The collection included almost 2,000 submissions of remarkable acts of kindness and care between everyday people resident in South Africa during the national lockdown. Much of it—particularly during the early phases of the lockdown—demonstrated the best of who we can be as a country.”
 

Resource of the Week

 
The Atlantic provides a helpful explainer for Nine Pandemic Words Almost No One Gets Right, reporting “We’ve had to assimilate a whole slew of terms from public health, immunology, and medicine, some of them totally foreign (cytokines, positive predictive value, R-naught), others more familiar but with colloquial and academic meanings that at least partially conflict (bubbles, breakthroughs, boosters). The transition doesn’t always go smoothly, and confusion and misunderstandings, much like contagion, are very hard to rein in once they’ve started to spread.”