For much of 2021 the problem for many countries in Africa was a lack of vaccine doses, but in 2022 the problem is more complex. According to POLITICO (US), “John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said the primary challenge for vaccinating the continent is no longer supply shortages but logistics challenges and vaccine hesitancy — leading the agency and the African Vaccine Acquisition Trust to seek [a delay until the third or fourth quarter of 2022 in vaccine donations]… ‘The greatest barrier you have now is: how do you provide enough logistics to vaccinate at scale?’…There are scenarios where a government will deliver vaccines to a remote area, but when you go there, you realize that you just lack a needle to get the vaccines into arms,’ Nkengasong said.”
 

If You Are in a Hurry

• Read Al Jazeera on what the next generation of COVID vaccines need to do.
• Read a Comment in Nature that argues governments need to be doing more to ensure vaccine uptake.
• Read The Atlantic on what’s needed for a new phase of controlling the virus.
• Read The New York Times on the US CDC withholding data from the public.
• Read The Atlantic on what the “return to normal” means for immunocompromised people.
• Read CIDRAP on a new study that shows maternal vaccination protects babies.
• Read Nature on a surge of reinfections during Omicron waves.
• Read MedPage Today on new data that shows ivermecrtin “flops” in a recent trial.
• Read a demand to the global community to invest in African health care systems in Common Dreams.

 

What Governments Need to do to Increase Vaccine Uptake

 
A Comment in Nature (UK) argues we must “focus more on what governments must do to build people’s trust and ensure easy access to vaccines for all…. For the past decade—but especially during the COVID-19 pandemic—politicians and medical professionals, the media, even some scientists, have often attributed people’s resistance to vaccination to a vulnerability to misinformation, a lack of education or simply selfishness. The implied solution is more education and persuasion, for instance through messaging campaigns, and if these strategies fail—mandates. But a closer look at why some people are not getting vaccinated indicates that the problems are more complicated and, invariably, they start further up the chain. Also, issues around access feed into issues around acceptance. If governments fail to reach people promptly with easy-to-get vaccines and clear encouragement, other messages fill the void and people are likely to grow more worried about getting vaccinated.”
 
Reuters (UK) reports, “South Africa has changed its COVID-19 vaccination rules in an effort to encourage more people to get jabs, health authorities said on Monday. Inoculations have slowed and the country—which has recorded more than 98,000 deaths and more than 3.6 million positive COVID-19 in total in the pandemic—has ample vaccine stocks. The government is shortening the interval between the first and second doses of the Pfizer vaccine from 42 to 21 days and will allow people who have received two doses of Pfizer to get a booster dose three months after their second shot as opposed to six months previously.”
 

Global Vaccine Access

 
An editorial in East Asia Forum (Australia) argues, “The world—not for the first time—has a coordination problem. Pharmaceutical companies had the incentive to create vaccines. Governments have an incentive and responsibility to vaccinate their own people. The incentive to vaccinate others is lacking. This comes at a terrible cost—in terms of lives lost, jobs destroyed, and in the rise of vaccine hesitancy due to growing distrust of governments…. Dealing with global challenges that spill across borders is made exponentially more difficult when major powers, like China and the United States, are more focused on their rivalry than on providing global public goods. On vaccines, just as on climate change and the international economic action required for a strong global recovery, middle powers in Asia like Indonesia and elsewhere will need to step up and provide the leadership that neither superpower, through national conceit or self-regard, seems willing to offer.”
 
An opinion piece in Cape Times (South Africa) argues, “Rich countries protecting their own citizens will not prevent new mutants from emerging. In fact, furtherance of any model that promotes vaccine inequity will not only worsen the existing crisis but also stand in the way to ending this pandemic and recovering from COVID-19 sooner. Economically, epidemiologically and morally, it is in all countries’ best interest to use the latest available data to make life-saving vaccines available to all and within periods commensurate with individual country roll-out programmes to avoid battling with expiry dates which lead to wastage of vaccines. There is no viable alternative to this approach, and if wealthy countries continue to hoard vaccines or send nearly expired doses to Africa, the cycle of deadly waves and variants will continue for a long time.”
 
Business Daily (Kenya) looks at what is needed to capitalize on recent initiatives to increase vaccine manufacturing in Africa, including the WHO’s mRNA technology transfer program and BioNTech’s announcement of mobile vaccine production units. The author argues, “Whereas these advances are a beneficial shot in the arm for African countries, a lot of careful planning needs to occur in order to actualize this idea. Previously, such noble initiatives have ended in oblivion due to a lack of accompanying skills training. Fortunately, Kenya has just launched a National Institute of Public Health in response to the risk of future epidemics. It would be prudent to consider allocating the responsibility of sustaining the mRNA technology to the institute as part of its core mandates.”
 
The Washington Post (US) reports, “The Biden administration will ‘surge’ more than $250 million in coronavirus vaccine assistance to 11 countries in sub-Saharan Africa….” The countries will “‘receive intensive support’ for their vaccination campaigns through in-person staffing, technical assistance and more diplomatic engagement…. Under the Global VAX initiative, the US plans to spend more than half of the $510 million staked for the program to boost vaccination efforts in the 11 countries, which could include investments in mobile centers to administer shots, freezers for safe vaccine storage and other supplies…”
 
Bloomberg (US) reports, “Egypt is readying to export locally made Covid vaccines to African nations, looking to position itself as a hub for inoculations on the continent grappling with the virus…. The Arab world’s most populous nation is positioning itself as a hub for COVID-19 vaccine exports, with Vacsera producing Sinovac using materials from China. The World Health Organization said Feb. 18 that Egypt was one of six African countries that will be given technology to produce mRNA vaccines.”
 
A Common Dreams (US) opinion piece written by three people who worked on the 2014 Ebola outbreak argues, “Having observed the devastations of disease spread and the valiant efforts of locals to respond to them, we demand that the international community invest in African health care systems in reversing the spread of COVID-19 on the continent. Such an investment would not be just an act of morality and fairness. As this pandemic and Ebola have vividly shown, improving African health care is in the self-interest of the entire world. Africans have mobilized all their resources to beat back the spread of the coronavirus—it's time the rest of the world does its part.”
 

Vaccine Patents

 
Science Business (Belgium) reports, “The dispute over COVID-19 vaccine patents continues to overshadow the EU’s efforts to broker closer research links with Africa, with campaigners for health equity arguing Brussels is stymying Africa’s attempt to build its own independent manufacturing capacity. At the EU-Africa summit in Brussels last week, South African president Cyril Ramaphosa demanded that the EU stop blocking a proposed waiver on vaccine patents, so that African researchers will have the legal certainty to develop home-grown versions of COVID-19 vaccines…. The pandemic has starkly shown that Africa cannot afford rely on the outside world for vaccines, with moves by the Coalition for Epidemic Preparedness Innovations, the GAVI vaccines alliance, WHO and others in the COVAX initiative, falling well short of delivering sufficient supplies.”
 

A Call for Transparency in Pharma Contracts

 
Business Insider (South Africa) reports, “A South African organisation has started legal proceedings to demand the commercial details around COVID-19 vaccine supply in this country—the kind of information that coronavirus manufacturers have sought to keep secret across the world. The non-profit Health Justice Initiative (HJI) said on Tuesday it had filed papers in Gauteng in an action that seeks to compel the minister of health to hand over a range of documents. It wants to see not only all contracts and agreements, but also wants copies "of all COVID-19 vaccine negotiation meeting outcomes and/or minutes, and correspondence" involved.”
 

Looking for a “New Normal”

 
Many countries as Omicron waves—or at least deaths and hospitalizations—subside are looking to move beyond the pandemic phase and look for endemicity or a “return to normal.”
 
Bloomberg (US) reports, “Europe looks to be gradually leaving the pandemic behind, with Germany becoming the latest in the region to unwind restrictions that have disrupted life for two years…. Once the global epicenter of the crisis, Europe is looking to return to something close to normal. The shift is being helped by relatively high vaccination rates and milder symptoms caused by the omicron variant, even if infection rates remain near peak levels in some countries.”
 
The Atlantic (US) reports on a push to relax mask mandates and proof of vaccine protocols across the US. “We can debate ad nauseam whether these rollbacks are premature. What’s far clearer is this: We’ve been at similar junctures before—at the end of the very first surge, again in the pre-Delta downslope. Each time, the virus has come roaring back. It is not done with us. Which means that we cannot be done with it. What’s up ahead is not COVID’s end, but the start of our control phase, in which we invest in measures to shrink the virus’s burden to a more manageable size…. Taking this challenge seriously—trying to properly contain a deadly, fast-moving, shape-shifting virus that has spent the past two years walloping us—could require a revamp of the standard American approach to quelling disease, on a scale the nation’s never managed before. We’ll have to write a brand-new public-health playbook, and figure out a way to execute it.”
 
CIDRAP (US) reports on a new UK “plan for living with COVID” which includes, “phasing out free testing for most people and removing requirements to self-isolate after testing positive…. In an open letter to the country's chief medical advisor and its chief scientific adviser, who appeared with Johnson at today's briefing, a group of doctors and scientists aired concerns about the government's plans to end testing, surveillance surveys, and the legal requirement for isolation. ‘We do not believe there is a solid scientific basis for the policy. It is almost certain to increase the circulation of the virus and remove the visibility of emerging variants of concern,’ they wrote.”
 
Dr. Céline Gounder writes in STAT (US) that in the US “public health attention deficit disorder has been the pattern with public health crises in the past. Americans focus, rally, and surge funding for public health for a short time and then, when many have lost interest or feel safe enough, the nation moves on. It’s the story of tuberculosis, HIV, flesh eating and other antibiotic resistant bacteria, and Ebola. But we’re moving on, yet again, without having taken long-term steps to prepare for the next surge, which is sure to come…. The US will have to choose to deal with COVID-19 on the front end or the back end. There’s a lot more that can be done to prevent transmission and mitigate disease without shutting down society or the economy. But I fear that we will default to business as usual, leaving it for the American health care system to treat what could have been prevented. And, as usual, this system will do what it does best: provide care expensively, inequitably, and with underwhelming results.”
 

Omicron’s Impact

 
The New York Times (US) reports that in the US, “The Omicron wave is breaking, but deaths, which lag cases by as much as several weeks, have surpassed the numbers from the Delta wave and are still increasing in much of the country…. The official case count about [was] 176 percent higher during the Omicron wave than in the equivalent-length Delta period…. The death toll during the Omicron wave is about 17 percent higher so far than the death toll in the Delta wave.”
 
Bloomberg (US) reports, “A study from Denmark, one of the countries where omicron has spread the fastest, suggests that in rare cases people can be infected by the virus variant twice. Samples from 1.8 million positive tests showed that 47 people had both the BA.1., and the BA.2. sub-variant of omicron with a 20 to 60 day interval… Those who had both variants were predominately young and unvaccinated and they only suffered mild symptoms, according to the data, which hasn’t yet been peer reviewed. Another 20 people have likely been infected with the same omicron variant twice.”
 
Nature (UK) reports, “Since the Omicron variant of SARS-CoV-2 was first detected, the number of people reinfected with the coronavirus has been rising sharply—a trend that was not observed with previous variants. Researchers say that the new variant is probably driving the surge because it is able to evade the body’s immune defences.”
 
Reuters (UK) reports, “Hong Kong will roll out compulsory testing for COVID-19 starting in mid-March for its 7.4 million residents, leader Carrie Lam said on Tuesday, as university researchers predicted new infections could peak at a staggering 180,000 a day next month…. Hong Kong is home to some of the most densely populated districts on Earth, with the majority of people living in high-rise apartment blocks cheek by jowl with family members and often sharing cramped lifts.”
 

The Next Generation of Vaccines

 
Al Jazeera (Qatar) reports, “Second-generation COVID-19 vaccines will need to build upon the success of the current ones. Whereas the widely used mRNA vaccines stimulate an immune response to the SARS-CoV-2 spike protein, we have recently seen that mutations and new variants can change the structure of this part of the virus, making the vaccines less effective. The next generation of vaccines should be made with the aim of protecting us against current and future variants, no matter how infectious or virulent they may be…. The Swedish biotech Ziccum…has developed a technology to air-dry existing vaccines, converting them into powder forms that do not need to be stored or transported at cold temperatures. Ziccum has partnered with the Janssen pharmaceutical company in a bid to develop dry powder versions of their vaccines, including Janssen’s COVID-19 vaccines.”
 

The Next Pandemic

 
Science (US) reports on “the pandemic risks of the exotic game trade…. Wild animals sometimes found on the menu in China harbor a bewildering panoply of viruses, a new study has found—including many that can infect humans. Although none is closely related to the coronavirus that touched off the COVID-19 pandemic, the study sends a clear warning that other viral threats are lurking in the animal kingdom, scientists say.”
 

Research in Kenya

 
The Standard (Kenya) reports on what may be holding Kenya back in research, quoting several experts. “Matilu Mwau, the deputy director at KEMRI, argues that, unlike Kenya, and other countries, South Africa has invested heavily in artificial intelligence, bioinformatics and machine learning which enable quicker detection of COVID-19 variants…. ‘In Kenya, because we have not invested much in bioinformatics, we go to some labs and find there are sequences, and start looking at them one by one to find out which variant they might be related to,’ explained Mwau. “
 

What Went Right with Vaccine Rollout

 
Vox (US) reports on a new report from the Center for Global Development (CGD) which “found that the COVID-19 vaccination campaign ‘has been the most rapid in history,’ outpacing landmark achievements in vaccination for diseases like smallpox, measles, and polio. The feat is even more impressive because while most global vaccination campaigns to date have targeted children specifically, COVID-19 vaccination efforts are aimed at the entire global population. Charles Kenny, a senior fellow at CGD and one of the co-authors of the report, told Vox that it was unprecedented for a global vaccine campaign to focus on ‘every adult in a single year for the great majority of countries.’”
 

Long COVID

 
SABC (South Africa) reports, “Long COVID is less likely to affect vaccinated people than unvaccinated people, a new review of 15 studies by the UK Health Security Agency released on Tuesday has concluded. UKHSA said the people who received two doses of Pfizer-BioNTech, AstraZeneca or Moderna vaccine, or one dose of the single-shot J&J vaccine, were around half as likely to develop symptoms of long COVID compared to the unvaccinated.”
 

Vaccine Mandates

 
Reuters (UK) reports, “Uganda plans to impose fines on people who refuse to be vaccinated against COVID-19 and those who fail to pay could be sent to prison under a new public health law which lawmakers are scrutinising, parliament said on Tuesday. Although the East African country started administering COVID-19 jabs nearly a year ago, only about 16 million jabs have been administered in a population of 45 million, with officials blaming widespread reluctance for the low coverage.”
 

US CDC Not Publishing Data

 
The New York Times (US) reports the US CDC is coming under fire for not releasing massive amounts of data they have collected. “Two full years into the pandemic, the agency leading the country’s response to the public health emergency has published only a tiny fraction of the data it has collected, several people familiar with the data said. Much of the withheld information could help state and local health officials better target their efforts to bring the virus under control. Detailed, timely data on hospitalizations by age and race would help health officials identify and help the populations at highest risk. Information on hospitalizations and death by age and vaccination status would have helped inform whether healthy adults needed booster shots. And wastewater surveillance across the nation would spot outbreaks and emerging variants early…. 'Tell the truth, present the data,’ said Dr. Paul Offit, a vaccine expert and adviser to the Food and Drug Administration. ‘I have to believe that there is a way to explain these things so people can understand it.’”
 

COVID and the Immunocompromised

 
The Atlantic (US) reports, “Much of the United States dropped COVID restrictions long ago; many more cities and states are now following. That means policies that protected…immunocompromised people, including mask mandates and vaccination requirements, are disappearing, while accommodations that benefited them, such as flexible working options, are being rolled back…. In the past, immunocompromised people lived with their higher risk of infection, but COVID represents a new threat that, for many, has further jeopardized their ability to be part of the world…”
 

Supporting Vaccination in High Risk Individuals

 
A press release from MSF outlines a successful program to vaccinate people at higher risk of COVID in a South African township. “A vaccination support program developed by Doctors Without Borders/Médecins Sans Frontières (MSF) in Khayelitsha in partnership with the Western Cape Department of Health (WCDoH), South Africa has shown that it is possible to target individuals with comorbidities that increase the risk of severe disease and death from COVID-19…. MSF deployed 15 health promoters to speak with patients who were waiting in line to receive clinical services. If these patients were willing to receive a vaccine, they were then registered on the Electronic Vaccination Data System (EVDS)—the government COVID-19 vaccination program registration portal—while waiting in line for clinical services. Once their routine consultation was over, patients were escorted by the health promoter to the vaccine site.”
 

Maternal Vaccination Protects Babies

 
CIDRAP (US) reports, “COVID-19 vaccination during pregnancy—already known to protect women from hospitalization and severe complications—can also protect babies younger than 6 months…. The study authors found that babies born to pregnant women who had received two doses of an mRNA vaccine were 61 percent less likely than those born to unvaccinated moms to be hospitalized with a COVID-19 infection.”
 

Vaccine Hesitancy

 
Healio (US) reports, “CDC Director Rochelle P. Walensky, MD, MPH, had some advice for combating vaccine hesitancy in the United States. ‘People always ask me, “How do you convince somebody to get vaccinated?” And the truth is, I think you listen before you talk…. The problem is that takes a long time. You have to listen one by one. It’s not a monolith as to why people have not gotten vaccinated yet. That’s a lot of hard work, and that’s the work we have ahead.’”
 
An opinion piece in STAT (US) written by a doctor whose patient told him: “‘I trust my drug dealer more than I trust this vaccine.’ Here’s the gist of what she told me: When she speaks to her dealer, they listen to her concerns without judgment and accept her for who she is. When she feels bad, they are attentive to her. They will not sell her drugs if they know she is in a bad place because they have known each other for a long time. They are highly accessible, often by text or phone at all hours. They deliver a tangible, immediate response to the needs she expresses. They have time for her and treat her like they would any other human…. Perhaps providers and public health experts can learn from my patient’s drug dealer. Be attentive and available to people who use drugs, who distrust the health care system. Create systems of care that are accessible to them and offer them long-lasting provider relationships. Listen to their concerns without judgment and meet them where they are. Deliver an actionable, tangible response to their needs.”
 

Boosters

 
The New York Times (US) reports, “As people across the world grapple with the prospect of living with the coronavirus for the foreseeable future, one question looms large: How soon before they need yet another shot? Not for many months, and perhaps not for years, according to a flurry of new studies. Three doses of a COVID vaccine—or even just two—are enough to protect most people from serious illness and death for a long time, the studies suggest.”
 

New Data on Ivermectin

 
MedPage Today (US) reports, “Ivermectin failed to prevent older adults with COVID-19 from progressing to severe disease compared with standard of care alone, an open-label randomized trial in Malaysia found…. The authors were unequivocal in their conclusions: ‘The study findings do not support the use of ivermectin for patients with COVID-19,’ they wrote.”