Inequities have been a constant throughout the COVID pandemic, with richer countries hoarding vaccines and racial inequities within countries exposed through higher rates if illness and death and lower rates of vaccination.
 
In a new statement the UN Committee on the Elimination of Racial Discrimination (CERD) says the body is “Deeply concerned that the vast majority of COVID-19 vaccines have been administered in high- and upper-middle-income countries and that, as of April 2022, only 15.21 percent of the population of low-income countries has received even one vaccine dose, creating a pattern of unequal distribution within and between countries that replicates slavery and colonial-era racial hierarchies; and which further deepens structural inequalities affecting vulnerable groups protected under the Convention.” The Guardian (UK) reports, “The Committee said a failure to redress injustices has denied basic human rights to health and worsened discrimination and exclusion…. The CERD statement singled out the UK, Germany and Switzerland for continuing to block a waiver on lifting intellectual property rules that would enable the redistribution and scaling-up of the COVID response.”
 

If You Are in a Hurry

• Read an opinion piece in STAT on the need to rethink the way medical innovation is financed to overcome barriers to vaccine and access.
• Read The New York Times on South Africa’s Tulio de Oliveira and how the virus is mutating now.
• Read Bloomberg on the kinds of data needed to make better decisions about COVID.
• Read Undark on what is fueling vaccine hesitancy in rural India.
• Read The New Yorker on how China’s lockdown policies became the playbook for other authoritarian governments.
• Read Devex on CEPI’s goal of a 100 day pandemic vaccine.
• Read Ed Yong in The Atlantic on how climate change is creating new opportunities fir crossover viruses.
• Read Slate on the pros and cons of challenge trials.

 

Testing, Reporting and the Next Wave

 
More than two years into the COVID pandemic it is becoming more difficult to know what the true case rates are as many individuals, communities and nations seek to move beyond the pandemic. COVID testing rates have fallen drastically across the globe. As Devex (US) reports, “testing for COVID-19 has fallen by 70 percent to 90 percent across the world, making it more difficult for the global health community to monitor the evolution of the pandemic, treat patients, and track variants…. Reported cases and deaths are declining globally, said Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization. Last week, just over 15,000 deaths were reported, which is the lowest weekly total since March 2020. But these trends must be received with some degree of caution, Tedros said.”
 
At the same time, News24 (South Africa) reports that a fifth wave of COVID may be underway in South Africa. The “3,838 new COVID-19 cases in the country...represents a 22.0 percent positivity rate…. However, the authorities remain uncertain if the spike in COVID-19 numbers is the start of the fifth wave or simply a resurgence caused by increased travel during the Easter long weekend and other religious holidays.” In a twitter thread South African researcher Ridhwaan Suliman notes, “With 1 in every 5 tests returning a positive result, it also indicates many more cases going undetected…”
 
CNN (US) reports, “In the next few weeks, the US is likely to record its 1 millionth reported COVID-19 death, a number that is so staggering it seems unbelievable. There is an uptick in cases in the US and hospitalizations are up 10 percent since last week…. Many states are dialing back their COVID-19 data tracking efforts from daily to weekly reports…which could affect how public health officials are able to gauge and predict outbreaks…. ‘Things are not stable right now,’ said William Hanage, an epidemiologist and associate professor at the Harvard T.H. Chan School of Public Health. ‘Even if I don't reckon we are going to see [another] large surge, weekly reporting means that if I am wrong, we would learn about it later and so be able to do less about it.’"
 
The New York Times (US) quotes Tulio de Oliveira, director of South Africa’s KwaZulu-Natal Research and Innovation Sequencing Platform: “’What we are seeing now, or at least maybe the first signs, is not completely new variants emerging, but current variants are starting to create lineages of themselves,’ Dr. de Oliveira said. Since its initial identification in South Africa and Botswana last November, Omicron has produced several subvariants…. In South Africa, researchers estimate about 90 percent of the population has some immunity, in part from inoculation but largely because of previous infection. Yet immunity from infection typically begins to wane at around three months.”
 

Making COVID Decisions with Faulty Data

 
Bloomberg (US) reports, “Even after billions of dollars in spending and a million dead, the way we measure the risk of the virus hasn’t improved much in the past two years. The question of how many people are hospitalized is crucial—new thresholds for public health rules from the Centers for Disease Control and Prevention depend on it. If the virus does return in another wave, it will be essential to know how much vulnerability exists in communities—but US data systems make that impossible. And how will we spot that wave when more people either stop testing or shift to at-home tests that don’t get reported?... Our response to COVID is evolving—or being pushed—from a public-health problem to an individual one, from a shared risk to a personal one. For many people, a combination of vaccination, more widely available therapies and prior infection means their risk has fallen substantially from where it was a year ago. But not for everyone. The country is still recording more than 300 deaths a day. Many of the most vulnerable are the same people who were at risk at the start of the pandemic: the old, the frail, those with underlying medical conditions. ‘This question of “we’re all in this together” versus “everybody is on their own” is the debate we’re going through right now,’ says Varma.”
 

Africa Needs More Self-testing

 
Activist Tian Johnson writes in Business A.M. (South Africa) “millions of Africans…are still unable to access rapid antigen detection testing two years into a global pandemic. Meanwhile, Americans can order up to four free home test kits, children in Germany get a free test-kit each morning and, if positive, go home to self-isolate…. HIV has shown us the importance of empowering individuals with their health status knowledge; when it came to COVID-19, but for too long, the WHO placed undue weight on concerns that self-testing will lead to more false negatives, unreported results, and inferior disease surveillance, which delayed the issuing of this new guidance. As rapid tests become more accurate, this proved to be an exaggerated caution. This must not happen again…. The long delay in the WHO recommending self-testing also delayed access to treatment, care and support for millions. With the current timeline, global health agencies and procurers may only deploy self-tests in 2023. This is unacceptable. The power lies with our own governments who must have the courage that they continue to lack in ensuring that Africans can fully realise their right to life, health and dignity.”
 

Indian Regulatory Agency Under Fire

 
Science (US) reports, “Critics say [India’s] regulatory agency lacks key capabilities and is under political pressure to greenlight vaccines produced in India…. The agency has used ‘suboptimal’ standards on several occasions, says Vineeta Bal, an immunologist at India’s National Institute of Immunology. That has led some scientists to ask whether the agency has the capabilities—and is independent enough—to oversee the quality of medicines for India’s 1.4 billion people. The implications go beyond India, because the country is a major global medicine supplier. The World Health Organization has “prequalified” 54 vaccines produced in India for use elsewhere, and WHO relies on CDSCO to oversee the manufacturers.”
 

Vaccine Hesitancy

 
Undark (US) reports on extremely low COVID vaccination rates in 16 Indian villages. A health worker interviewed “estimates that 82 percent of the population hasn’t had a single shot. This is in stark contrast to India as a whole, where 73 percent have received at least one dose…. In more than two dozen interviews with villagers, health workers, and local leaders in the tribal villages of Talasari, a subdivision of the Palghar district where Shivpada lies, Undark identified the four most common barriers to vaccination in the region: the fear of side effects, misinformation, distrust in the public health system, and a lack of guidance from community leaders. Other deterrents include the influence of local religious leaders and waiting for others to take the vaccine first.”
 

COVID and Authoritarianism

 
The New Yorker (US) reports, “China provided a playbook for information repression that spread around the world alongside the virus. Citing COVID, authoritarian governments in Russia, Iran, Nicaragua, and eighty other nations, according to Human Rights Watch, enacted new restrictions on free speech and political expression that were falsely described as public-health measures. In at least ten countries, protests against the government were also banned or interrupted. Information on the virus that did not come from the government was criminalized as ‘fake news’ or propaganda. Authoritarian regimes called the censorship necessary and much of it temporary, but, in reality, the pandemic amplified or accelerated a shift toward authoritarianism that, according to the US-based pro-democracy organization Freedom House, had been under way for fourteen years. At least ninety-one countries that the group monitored restricted news media in response to the virus outbreak in the first months of 2020, including sixty-seven per cent of the states that the nonprofit classifies as ‘not free.’”
 

The Virus’s Evolution

 
STAT (US) reports, “SARS-CoV-2 remains a long way from being ordinary. It has not yet found seasonal cadence—take the recent surge in Europe and the UK, which comes just weeks after the initial Omicron wave subsided—and it’s still capable of inflicting mass death and disability (see Hong Kong’s lethal last few months). But there are signs that the virus—and our relationship to it—is shifting in subtle ways that make it more like seasonal flu than it was at the start of the pandemic.
 

India’s Supreme Court Rules Against Mandatory Vaccination

 
NDTV (India) reports, “No one can be forced to take the vaccine, the Supreme Court said today in a landmark decision on India's COVID vaccine policy, also directing the central government to publish reports on the adverse effects of vaccination. ‘Bodily integrity is protected under the law and nobody can be forced to be vaccinated,’ the Supreme Court said. The court asserted, however, that "certain limitations on individual rights" could be imposed in the interest of community health. ‘Barring COVID-appropriate behaviour, we suggest no curbs on unvaccinated individuals in access to public places, services and resources if cases are low,’ the Supreme Court said.”
 

Pfizer Pill Fails to Prevent COVID

 
Reuters (UK) reports, Pfizer Inc on Friday said a large trial found that its COVID-19 oral antiviral treatment Paxlovid was not effective at preventing coronavirus infection in people living with someone infected with the virus…. Those who took the five-day course were found to be 32 percent less likely to become infected than the placebo group. That rose to 37 percent with 10 days of Paxlovid. However, the results were not statistically significant and thus possibly due to chance.
 

COVID Relapses After Pfizer Pill

 
Bloomberg (US) reports, “US government researchers are planning studies of how often and why coronavirus levels rebound in some COVID patients who have completed a five-day course of treatment with Pfizer Inc.’s Paxlovid. ‘It is a priority,’ said Clifford Lane, deputy director for clinical research at the National Institute of Allergy and Infectious Diseases, calling the issue ‘a pretty urgent thing for us to get a handle on.’ The agency is discussing a variety of possible epidemiological and clinical studies to examine post-Paxlovid rebound with scientists at the [CDC]…. Little is known about the rebound cases, including how frequently they occur and whether the highly transmissible omicron variant plays a role. While there’s no proof it’s caused by the drug, doctors say they need more information about what action to take when the virus surges in someone who’s just been treated.”
 

COVID Vaccines for the Youngest

 
Reuters (UK) reports, “Canada is reviewing a request by Moderna to approve its COVID-19 vaccine for pediatric use in children aged 6 months to 5 years, the government and the company said on Friday. The New York Times (US) reports, “The Food and Drug Administration laid out a tentative timetable on Friday for deciding whether to authorize a coronavirus vaccine for America’s youngest children, announcing that June 8 is the earliest date that it will present data to its outside advisers for a recommendation. The nation’s 18 million children under 5 are the only group not yet eligible for vaccination against the coronavirus. The agency said that it understood the urgency of protecting that group and that it would act quickly ‘if the data support a clear path forward following our evaluation.’”
 

Challenge Trials

 
Slate (US) looks at the pros and cons of challenge trials for COVID. “Intentionally infecting people with the virus that has disrupted life across the planet for the past two years and killed more than 6 million people worldwide might seem difficult, even impossible, to justify. But newly developed treatments mean that such studies are now more feasible than they have ever been, and, as the pandemic continues to trudge on, they could answer essential questions that might otherwise prove insoluble…. There’s one more tantalizing piece of knowledge that challenge studies are particularly well positioned to discover: correlates of protection. When someone mounts a successful immune response to a pathogen and prevents it from taking hold in their body, their immune system typically shows a characteristic response such as the presence of certain antibodies or types of white blood cell. If scientists identify these so-called correlates of protection for COVID, they can test new vaccines without ever exposing subjects to the coronavirus, naturally or otherwise. They will be able to infer successful protection just by studying a person’s immune response in the days following inoculation.”
 

South African Vaccine Plant in Peril

 
Eyewitness News (South Africa) reports, “South African pharma giant Aspen said on Tuesday it has not received any orders for its new anti-COVID vaccine despite relatively low vaccination rates and a looming new wave. The Durban-headquartered company clinched a deal last November with US-based Johnson & Johnson to manufacture a ‘made in Africa for Africa’ Aspen-branded COVID vaccine Aspenovax…. ‘If we do not get any COVID vaccine orders then clearly there will be no rationale for retaining the lines to make this production,’ senior executive for strategic trade development Stavros Nicolau said in an email response to AFP. The company ‘had counted and were assured that the regional manufacturing platform was critical and would be supported.’”
 

Pharma Investors and Global Health

 
An opinion piece in STAT (US) looks at how pharma companies are perpetuating the vaccine inequity. “Tedros Adhanom Ghebreyesus…took the unprecedented step of supporting a shareholder resolution put forward by Oxfam to compel companies to share the know-how and technology underlying COVID-19 vaccines and allow manufacturers in low- and middle-income countries to supply their communities with vaccines, which would help reverse ongoing vaccine inequities. Speaking to Moderna shareholders in a pre-recorded statement, Tedros pleaded for urgent action to ‘save lives, decrease the risk of variants, and reduce the pandemic’s economic toll.’…The companies’ shareholders decided they knew better than one of the world’s top public health officials about how to tackle the continuing pandemic, which has claimed more than 6 million lives so far, and the toll continues to mount. Pharma executives and shareholders argued that their companies are now producing enough doses to vaccinate the world, and that what I and others call “vaccine inequity” is instead a problem of so-called last-mile logistics…. It is time to reclaim the purpose of the pharmaceutical enterprise to focus on improving people’s health globally. This will require a radical rethinking of the way medical innovation is financed and governed and taking back the public responsibility to ensure that medicines and vaccines developed to address people’s health needs are available as common goods.”
 

Measles Rebounds

 
Bloomberg (US) reports, “There is an ‘epidemic’ of measles, global health leaders have warned, as cases of the potentially deadly disease appear to be on the rise. The World Health Organisation (WHO) urged parents to get their children vaccinated against the highly infectious disease. It raised concerns that a dip in vaccination uptake during the COVID-19 pandemic could be behind a rise in cases compared to what would usually be expected in the first two months of the year.” The Citizen (South Africa) reports, “According to the [WHO], 20 African countries reported measles outbreaks in the first quarter of this year, eight more than in the first three months of 2021. In a statement, the WHO and Humanitarian aid organization UNICEF said measles cases increased by 79 percent worldwide this year, warning that the rise of the ‘canary in a coal mine’ illness indicates that outbreaks of other diseases are likely on the way.”
 

Preparing for the Next Pandemic

 
Devex (US) reports, “The timeline for the development of the COVID-19 vaccine was unprecedented: just 326 days from the sequencing of the coronavirus until the first jabs received emergency use authorization. Now experts at the Coalition for Epidemic Preparedness Innovations believe they can slash that window by more than two-thirds. CEPI is spearheading an effort that would facilitate the development of a vaccine against an emerging disease in 100 days…. Dedicated surveillance systems would detect the emergence of a disease, triggering standard containment measures. At the same time, the disease could be quickly sequenced to identify whether it is something previously unseen and, if so, trigger vaccine development…. That development would rely on a vaccine library, a collection of vaccine candidates drawn from the roughly 25 viral families.”
 
Ed Yong reports in The Atlantic (US), “Earth’s changing climate is forcing animals to relocate to new habitats, in a bid to track their preferred environmental conditions. Species that have never coexisted will become neighbors, creating thousands of infectious meet-cutes in which viruses can spill over into unfamiliar hosts—and, eventually, into us. Many scientists have argued that climate change will make pandemics more likely, but a groundbreaking new analysis shows that this worrying future is already here, and will be difficult to address.”
 

Finding the COVID Plot

 
In a New York Times op-ed, journalist and narratologist Frederick Kaufman asks, “How will we think of this episode in human history? What will we glean from it? In order to come to terms with what has happened—the losses, the fears, the conspiratorial craziness, the isolation, the political conflict and all the rest—COVID will need its own story. What will the COVID plot be? ... It’s possible that we’re so eager to forget the trauma of the past two years that the cultural works of our time will redact it from our collective memory…. Could we be on the verge of such a moment of difficult enlightenment—not a new plot, perhaps, but a new understanding? If so, let it be one that eschews the hero’s journey, replacing it with a mosaic of collective valor, a human community assembled to withstand the ferocity of nature when it assumes its next epically violent form. That may be our best shot at a happy ending.”