“Contrary to a commonly held perception, Africa is not unfamiliar with effectively responding to large disease outbreaks. … But having to rely only on the continent’s own capacity and resources will not be enough to save African lives. Nor should it be. African lives matter, just as much as lives in Berlin, Washington, Tel Aviv, Geneva, London, Toronto or Brussels. COVID-19 is a global crisis that requires global action, in which all countries should be able to share equally.”

—Tian Johnson, Tom Moultrie, Gregg Gonsalves & Fatima Hassan in Bhekisisa

According to Our World in Data, “48.5 percent of the world population has received at least one dose of a COVID-19 vaccine. 6.84 billion doses have been administered globally, and 25.52 million are now administered each day. Only 3 percent of people in low-income countries have received at least one dose.”
 

If You Are in a Hurry

• Read Goats and Soda Blog on the African country WHO is paying to crack the Moderna vaccine recipe.
• Read a call from Dr. Tlaleng Mofokeng, UN Special Rapporteur on the Right to Health to restore SRHR for millions of women around the globe.
• Listen to the latest episode of the podcast On The Media for a discussion of the accuracy in language about the virus and the pandemic and the way the narrative of the pandemic has played out in media.
• Read a Bhekisisa commentary looking at how COVID testing rates and reported cases in Africa drive misconceptions about the extent of the pandemic.
• Read Epicenter-NYC on what is driving low vaccination rates in some communities of color in New York City.
• Read an opinion in the Daily Maverick calling for a nationwide vaccine mandate in South Africa.
• Read The Star on plans for a new laboratory in Kenya to sequence SARS-CoV-2 and other pathogens.
• Read The Citizen on the ways religious and traditional leaders in South Africa are encouraging vaccinations.
• Read NPR and The Guardian on calls to address the mental health effects of the COVID pandemic.

 

Call To Restore SRHR Lost During Pandemic

 
UN News (US) reports, “’Millions of women globally had limited or no access to maternal and new-born healthcare, some 14 million women lost access to contraception, and specialized services for victims of gender-based violence became inaccessible, when they were needed most’, said Dr. Tlaleng Mofokeng. The Special Rapporteur pointed out that lockdowns, movement restrictions and diversion of funds due to COVID-19 have ‘jeopardized access to essential sexual and reproductive health services.’ In presenting her report on the effect of the pandemic on physical and mental health services, she also spoke of ‘new measures and laws in place across regions, further restricting access to safe abortion, a component of sexual and reproductive services encompassed in the right to health.’”
 

Access

 
The Hill (US) reports, “The Bill and Melinda Gates Foundation announced Tuesday that it will send $120 million worth of Merck’s new COVID-19 treatment pill to developing countries if it is authorized by the Food and Drug Administration (FDA). The foundation said in a statement that the new multimillion-dollar commitment will ‘accelerate access to the investigational antiviral drug molnupiravir for lower-income countries as part of its COVID-19 response effort.’”
 
Bloomberg (US) reports “Moves by several countries to buy supplies of Merck & Co.’s promising COVID pill before it’s even approved are raising concerns that some poorer nations could be left behind, in a repeat of the slow and inequitable rollout of vaccines. Merck has taken steps to ensure countries around the world can get its drug, including licensing its experimental medication to generic-drug firms and planning production increases. Yet in a worrisome echo of the global vaccine situation, some wealthy and middle-income nations like Australia, Singapore, Malaysia and Thailand have followed the US and already secured molnupiravir or started talks to obtain it.”
 

Language Matters

 
The podcast On The Media (US) looked at the need for precision in the language we use to describe the COVID-19 pandemic and interventions. “Nowadays, we casually refer to COVID-19 tests, asymptomatic COVID cases, and the fully vaccinated. But the fact is, we aren't deploying those words with precision, and so they confuse, rather than clarify.” The segment includes an interview with The Atlantic’s Katherine Wu, whose story on language we shared in the last issue. The episode also includes an interview with Dr. Paul Offit and a look at “the shape” of the COVID-19 narrative.
 

Missing Data Drives Misconceptions of African Pandemic

 
In part two of their look at vaccine equity for Bhekisisa (South Africa) Tian Johnson, Tom Moultrie, Gregg Gonsalves and Fatima Hassan look at COVID testing and reported cases in Africa. “Each country on the continent has its own particular social, political and economic endowments and histories. And barring a few exceptions, we know almost nothing really of the extent to which COVID is ravaging its way through the continent. Public healthcare in Africa is complex, with the legacy of neo-colonial social and economic policies having left most countries’ systems fragile. As a result, few are able to confidently detect and report COVID-19 cases and deaths. The (misinformed) interpretation of already sketchy statistics from COVID data aggregators perpetuates the ignorant myth that somehow Africa is ‘immune’ to the disease…. Officially reported statistics show that by mid-October 2021, approximately 75-million tests had been performed across Africa—roughly one for every 20 people on the continent. Compare that with the situation in the United States, where data shows that more tests have been performed than there are people—approximately two for every one person in the country. That is 40 times more than in Africa.”
 

Sputnik V and HIV Concerns

 
Africa News reports, “South Africa's health products regulator on Monday said it would not approve Russia's Sputnik V COVID-19 vaccine due to concerns it could increase the risk of HIV infection among men. The decision was based on earlier studies testing the safety of a modified form of adenovirus—a type of virus that causes respiratory infections—known as the Ad5 and contained in the Russian jab. ‘Use of the Sputnik V vaccine in South Africa, a setting of a high HIV prevalence and incidence, may increase the risk of vaccinated males acquiring HIV,’ the South African Health Product Regulatory Authority said in a statement. It added that the company behind the application for the use of Sputnik V in South Africa had no proof the formula would be safe ‘in settings of high HIV prevalence.’”
 
Reuters (UK) reports, “Namibia will suspend its rollout of Russia's Sputnik V COVID-19 vaccine, its health ministry said on Saturday, days after the drugs regulator in neighbouring South Africa flagged concerns about its safety for people at risk of HIV…. Namibia's health ministry said in a statement that the decision to discontinue use of the Russian vaccine was ‘out of (an) abundance of caution that men (who) received Sputnik V may be at higher risk of contracting HIV,’ adding that it had taken SAHPRA's decision into account.”
 
Bloomberg (US) reports, “More than a decade ago an experimental AIDS vaccine from Merck & Co. that relied on the cold virus was tied to increased infections with HIV, and research was halted. Part of the problem in figuring out which vaccines get approval and which don’t is that research into the effects of a new shot on immune-compromised people is often not prioritized, according to Shabir Madhi, a vaccinologist from the University of the Witwatersrand who led trials of both AstraZeneca’s and Novavax’s shots in South Africa. That’s especially critical for a disease like HIV, where the bulk of cases are in poor countries. ‘It’s the legacy of many vaccines that doing research that is specific to low-income countries is often delayed,’ he says. Also, because South Africa already has vaccines recommended for use, including for people with HIV, it’s unethical to do large scale tests where some HIV-positive people are inoculated and other are not, he said.”
 

Breakthrough Cases

 
The death of former US Secretary of State Colin Powell from a “breakthrough infection” garnered significant media attention and social media discussion, with many who are opposed to or skeptical of vaccines using his death as evidence that vaccines are not as effective as believed. Bloomberg (US) reports his death “shines a high-profile spotlight on what has been a rare phenomenon…. Powell, who previously underwent surgery for prostate cancer in 2003, had been diagnosed with multiple myeloma prior to falling ill with COVID-19. The available data show that such deaths are exceptionally rare. Out of the more than 187 million people who had been fully vaccinated in the US as of Oct. 12, 7,178, or 0.004 percent, had died from a breakthrough infection, according to the US Centers for Disease Control and Prevention. Of that group, 85 percent were over the age of 65.”
 

Boosters

 
Healio (US) reports, “American Association for Cancer Research urged the CDC to expand availability of COVID-19 booster vaccinations to caregivers and other individuals who share a home with patients with cancer…. Extending booster access to caregivers and household members could increase protection against COVID-19 for patients with cancer, who often have weakened immune systems that increase their risk for severe disease and death due to the virus, the letter stated.”
 
Eyewitness News (South Africa) reports, “The South African Medical Association (SAMA) is calling for COVID-19 booster shots for healthcare workers. With South Africa in good supply of vaccines, the association says that booster shots for frontline healthcare workers should be made available immediately. SAMA chairperson Dr Angelique Coetzee said the booster shots would ensure the continued health of healthcare workers and reduce transmissions in facilities.”
 

Vaccine Hesitancy

 
All Africa (South Africa) reports, “A new analysis of online content in six African nations referring to COVID-19 vaccines has revealed that posts reflecting distrust of, or hesitancy over, vaccinations are dominating social media…. [Researchers] concluded that ‘the vaccine conversation is a polarised and combative space. Misinformation and disinformation are rife, driven mainly by minority clusters that have an overt distrust of institutions, government, elites and experts.’” Read the report here.
 
Devex (US) looks at the role of “conflicting information” in vaccine hesitancy in Nairobi, Kenya. “Rumors discourage many people from getting the jab. An August survey found 36 percent of Kenyans are unsure about the shot…. Only about 5 percent of Kenya’s population is fully vaccinated. The country has received 7.5 million vaccine doses, and has administered 4.7 million. The vaccines have trickled into the country at a glacial pace—in sporadic and small batches. This unpredictability means health centers don’t always know when they might have supplies of vaccines, meaning people might show up to be vaccinated on a day when there are none… Because of the miniscule number of doses circulating in Kenya, vaccine hesitancy is not necessarily harming vaccination efforts at this point, according to health workers, who said people are showing up in large numbers for vaccination. The supply of vaccines remains the primary issue.”
 
Epicenter-NYC (US) reports, “The ‘anti-vaxxers’ of NYC aren’t the stereotypical white, Republican, conspiracy theorists we often see on television and social media pushing dangerous falsehoods. In fact, the Black population of NYC has the lowest vaccination rate across the five boroughs with only 48 percent of Black residents having received at least one dose of the vaccine. These people aren’t widely spreading misinformation on social media, nor are they going to anti-vax protests, boycotting restaurants or even watching Fox News. However, the numbers speak for themselves…. Fears of the Covid-19 vaccine among the Black population are real and should be taken seriously, rather than mocked or derided…. Another reason why many in these communities haven’t gotten their vaccine is because of a lack of accessibility…. There were many reasons why people couldn’t get vaccinated. They didn’t have time to wait in lines, make appointments or simply because they didn’t know where to go….”
 
Standard News (Kenya) reports, “Journalists in the country have recorded low uptake of the coronavirus vaccines, even as Delta variant continues to cause more hospitalization and deaths. Only 1,600 journalists out of 6,000 accredited by the Media Council of Kenya (MCK) have been vaccinated… According to [Victor Bwire, MCK Deputy Chief Executive Officer and Programmes Manager], journalists are expected to seek and report factual information about the disease, vaccines and variants to minimize harm since ‘It is through media that the community will be able to demystify myths from facts, information that will boost the fight against the virus.’”
 
The Citizen (South Africa) reports, “Religious and traditional leaders across the country are coming together to help the government achieve its desired 70 percent population immunity by December. While the vaccination pace is picking up, it is still far below the required 70 percent mark for life to somewhat resume to normal next year.
 

Politics and COVID

 
Bloomberg (US) reports, “Brazil senators said Jair Bolsonaro should be charged for nine crimes, including charlatanism, malfeasance and crimes against humanity in their conclusion of a probe into the government’s handling of the pandemic that’s unlikely to have any short-term impact on the president’s political fate. A Senate commission presented a final report on Wednesday after six months of heated hearings and discussions, which included testimony from the four men who served as health ministers since the start of the pandemic, Bolsonaro allies and foes, companies that pushed for unproven early treatments and Covid patients.”
 
The Guardian (UK) reports, “Eighteen months of global lockdowns have led to growing engagement in a toxic online cocktail of extremist material ranging from terrorist content to conspiracy theories and disinformation, experts warn. Jacob Davey from the Institute of Strategic Dialogue (ISD) said studies had already shown ‘there has been a proliferation of harmful and troubling activity online’ during the pandemic, with an impact that is impossible to predict.”
 
STAT (US) reports, “Among scientists, there’s little debate: People who get sick with COVID-19 develop at least some protection against being infected in the future. But exactly how much protection they have, and how long it lasts, are the subjects of the country’s latest COVID-19 controversy. For the past month, university employees, professional athletes, and conservative lawmakers across the country have argued they should be exempted from increasingly strict vaccine mandates because, scientifically speaking, they don’t need them: They’re already protected by their body’s own immune response…. Unlike the conspiracy-riddled arguments about hydroxychloroquine or ivermectin, the concept of natural immunity has a rational basis and data to support it. Like the other debates, though, it has devolved into partisan bickering, highlighting how the state of American politics has ruined the country’s scientific process and made nuanced debates all but impossible.
 
An opinion piece in the Daily Maverick (South Africa) argues, “South African society is lit up by discussion and debate about the place of vaccine mandates in the fight against COVID-19. Conspicuous by their absence in this crucial issue are those elected and appointed to provide leadership at local, provincial and national level…. While there are aspects of the South African response to COVID-19 to date that are commendable, the deafening silence on vaccine mandates that have proven effective elsewhere around the globe is hard to understand.” The authors, “propose that national leadership should seriously consider nationwide vaccine mandates now that we have good vaccine access with lower-than-expected demand. National leadership should call on leaders at all levels and from all sectors to rally society towards a common purpose, allaying anxieties and asking individuals and institutions to sacrifice for the greater good—and call on all of us to give practical meaning to the concept of ubuntu so that ‘you are more likely to remain alive because we are all vaccinated.’”
 

Eritrea and North Korea Last Remaining Countries with No Vaccines as Burundi Gives Shots

 
AP (US) reports, “One of the world’s last three countries to administer COVID-19 vaccines started giving out doses on Monday as the East African nation of Burundi launched its national campaign. The vaccinations started in the commercial capital, Bujumbura, though health workers told The Associated Press that barely more than a dozen people had received doses by mid-afternoon. Recipients included the ministers of health and security. Only North Korea and the Horn of Africa nation of Eritrea have not administered any COVID-19 vaccines, according to the World Health Organization.”
 

Vaccine Makers Prepare for New Variants

 
Nature (UK) looks at what it will “take to be nimble enough to design and test an updated vaccine against an unknown viral strain, in record time,” speaking to Pfizer, Moderna and AstraZeneca. “Over the past few months, all three companies have been running dress rehearsals by practising on known SARS-CoV-2 variants. This involves updating their vaccines to match variants such as Beta and Delta, testing them in clinical studies, tuning their internal workflows and coordinating with regulators. Their goal is to learn from these warm-up trials and smooth out kinks in their processes, so that they can move fast if, or when, a true escape variant emerges.”
 

Regulatory Decisions on Vaccines

 
Economic Times (India) reports, “The WHO said on Monday it was ‘aware that many people are waiting for WHO’s recommendation for Covaxin to be included in the COVID-19 emergency use listing (EUL)’ but that it ‘cannot cut corners’. It added that ‘before recommending a product for emergency use, we must evaluate it thoroughly to make sure it is safe and effective.’”
 
The US FDA and CDC made several decisions and recommendations about vaccines in the last week. The Washington Post (US) reports, “Tens of millions of Americans can sign up to get Moderna and Johnson & Johnson boosters…. The green light from Rochelle Walensky, director of the Centers for Disease Control and Prevention, means that eligible Americans at risk of severe disease can choose any of the three boosters now authorized in the United States regardless of their original shot.
 
The Washington Post (US) reports, “The Pfizer-BioNTech coronavirus vaccine appears poised to become available to children 5 to 11 years old within weeks, after a Food and Drug Administration review found the benefits of the shot outweigh the risks in most scenarios, with the possible exception of when there are very low levels of viral transmission…. The review represents the first independent evaluation of company data and arrives ahead of a pivotal meeting next week at which outside experts are scheduled to debate and vote on whether the vaccine should be authorized. Extending vaccine eligibility to children younger than 12 has been a major goal of public health officials and eagerly awaited by many pediatricians and families.”
 

Cracking the Moderna Recipe for Africa

 
NPR’s Goats and Soda Blog (US) reports, “The World Health Organization has hired the company, called Afrigen Biologics and Vaccines, as part of a $100 million plan to figure out how to make an mRNA vaccine against COVID that is as close as possible to the version produced by Moderna…. Once Afrigen has sorted out all the complicated steps to make Moderna's shot on an industrial scale, WHO and other partners plan to pay Afrigen to become a teaching center…. Moderna is facing growing pressure to share this type of know-how. Last week several US Democratic senators and congress members released a letter pointing out that Moderna got a massive infusion of US taxpayer funds to help develop its vaccine. At least $1 billion was for the research component alone. These officials contend that the Biden Administration can and should use language in the government's contracts with Moderna to force the company to divulge its process.”
 

More Real-World Evidence of Vaccine Efficacy

 
Reuters (UK) reports, “People vaccinated against COVID-19 are highly unlikely to die of the disease unless very old and already badly ill before getting it, a study in Italy showed on Wednesday. The study by the national Health Institute (ISS), contained in a regular ISS report on COVID-19 deaths, shows the average age of people who died despite being vaccinated was 85. On average they had five underlying illnesses…. The average age of death among those not vaccinated was 78, with four pre-existing conditions.”
 
CNN (US) reports, “People who got COVID-19 vaccines were not only less likely to die from the virus, but they were less likely to die from any cause over the following months, researchers reported Friday. The research team was trying to demonstrate that the three authorized COVID-19 vaccines are safe and they say their findings clearly demonstrate that…. ‘This finding reinforces the safety profile of currently approved COVID-19 vaccines in the United States. All persons aged 12 years and older should receive a COVID-19 vaccine,’ they concluded.”
 

Mental Health Crisis

NPR (US) reports, “A coalition of the nation's leading experts in pediatric health has issued an urgent warning declaring the mental health crisis among children so dire that it has become a national emergency…. In a letter…the groups say that rates of childhood mental health concerns were already steadily rising over the past decade. But the coronavirus pandemic, as well as the issue of racial inequality, they write, has exacerbated the challenges. ‘This worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by COVID-19 and the ongoing struggle for racial justice and represents an acceleration of trends observed prior to 2020,’ the declaration from the pediatric groups says.”
 
The Guardian (UK) reports, “Cases of psychosis have risen over the past two years in England as an increasing number of people experience hallucinations and delusional thinking amid the stresses of the COVID-19 pandemic. There was a 29 percent increase in the number of people referred to mental health services for their first suspected episode of psychosis between April 2019 and April 2021, NHS data shows. One advocate, urging the government to invest more in mental health services said, “The pandemic has had a game changing effect on our mental health and it requires a revolutionary response. Dedicated additional funding for mental health and social care must go to frontline services to help meet the new demand, otherwise thousands of people could bear a catastrophic cost.”
 

Kenya Lab to Sequence Variants

 
The Star (Kenya) reports, “Kenya has received Sh300 million to set up a facility to identify variants such as COVID-19's Delta strain. It will also identify other COVID variants and those for HIV, TB, malaria, influenza and other neglected tropical diseases…. Sequencing of COVID-19 variants has previously been done on behalf of the Health Ministry by partners such as the International Livestock Research Institute, KEMRI-Welcome Trust, the US Centres for Disease Control and Prevention and the US Walter Reed Hospital.”
 

Vaccine Mandates

 
The Economist (UK) reports, “Because jabs for COVID-19 are new, the impact of mandating them will probably differ from that of requiring children to get well-established vaccines. However, history still offers relevant data on hardline refuseniks’ susceptibility to legal fiat…. The best evidence that mandates matter comes from America…. After adjusting for demographic and political characteristics that also affect jab rates, uptake in states with the fewest exceptions is 1.1 percentage points higher than in those with the most. These effects sound small. But since jab rates cannot exceed 100 percent, mandates can only do so much if uptake is already high. Moreover, for diseases like measles, 95 percent of people need protection to reach herd immunity. A few percentage points can determine if outbreaks take off or fizzle out.”
 
NPR (US) reports, “Across the country, employers are firing workers for refusing to comply with vaccine mandates. Some people are opting to quit their jobs rather than take the shot. These workers represent only a tiny fraction of overall employees, not even 1 percent in some workplaces. But it can add up to thousands of people in many states.”