The unprecedented rapid development of COVID vaccines and treatments has led to widespread access in high income countries, but that access is definitely not even trickling down to most low- and middle-income countries. A New York Times (US) article about this lack of access to COVID treatments is headlined “As Poor Nations Seek COVID Pills, Officials Fear Repeat of AIDS Crisis” and reports, “The antiviral pills, plentiful in the United States, are scarce overseas. Health groups and the White House want to expand access but face obstacles that evoke the HIV epidemic.” The One Campaign’s Gayle Smith is quoted: “Here we are with another virus that’s creating havoc all over the world. Maybe it’s not as lethal as HIV, but it’s still pretty bad. And we’ve got therapeutics. How are we going to think about this? Are we going to take the lessons learned and have a plan?” “We have a world divided between treatment for the rich and treatment for the poor, still today,” said MSF’s Felipe Carvalho. He then added “We are still struggling 20 years, 30 years after the HIV-AIDS crisis to convince companies to do the right thing.”
 

If You Are in a Hurry

• Read Muhammad Ali Pate and Michelle A. Williams in a STAT opinion piece calling for rethinking the paradigm for global scientific cooperation.
• Read Nature on the possibility that COVID surges are becoming more predictable.
• Read a NEJM editorial on what kinds of new COVID vaccines are needed.
• Read The New York Times on a new WHO report on that looks at the true toll of the pandemic through excess deaths. Then read The Hindu on India’s objections to the estimates for that country .
• Read Medscape on a new PCR test that can help quickly identify variants.
• Read Reuters on the status of a potential WTO waiver for vaccines and treatment. The read an interview in In These Times with South African activist Tian Johnson who calls for justice from pharmaceutical companies.

 

WTO and Vaccine and Drug Access

 
Reuters (UK) reports, “The first World Trade Organization meeting to discuss a draft agreement to temporarily waive intellectual property rights for COVID-19 vaccines went ‘very well’, its chair said on Friday, although some members voiced reservations…. The waiver idea, proposed by India and South Africa in October 2020, is supported by the majority of members of the global trade body. But some wealthy countries including Britain and Switzerland have in the past raised objections on grounds that it could harm pharmaceutical research.”
 
The Guardian (UK) reports, “Last week, the World Trade Organization (WTO) announced that the 180-member trade forum had taken a step towards a patent waiver that would allow developing countries to make the drugs they need—including vaccines, tests, and treatments—for as long as five years, without payments to pharma giants such as Pfizer…. Health and anti-poverty campaigners say WTO boss Ngozi Okonjo-Iweala, elected last year amid a fanfare of hope and expectation, appears to have provided cover for big pharma rather than pushing for wider access, as she promised. Ngozi’s supporters say she is playing a long game, though COVID-19 may be a distant memory—and Pfizer shareholders even richer than they are today—by the time this long game plays out. She is understood to be in favour of a full waiver, but progress towards a breakthrough remains elusive, despite official claims to the contrary.”
 
Bloomberg (US) reports, “China objected to a key provision of a World Trade Organization proposal to waive intellectual-property rights for COVID-19 vaccines that Beijing said would discourage shipments of doses to poorer nations. The development may complicate the WTO’s multi-year effort to reach an agreement to help speed production of vaccines in the developing world by permitting certain countries to authorize the use of COVID-19 jabs without the consent of the holders of the patent rights.”
 
In an interview with In These Times (US) South African activist Tian Johnson says, “We’ve known this: These are the same pharmaceutical companies that took the government of Nelson Mandela to court when we were struggling for access to antiretrovirals in this country. So, we are not holding our breath. We’re not waiting for pharma to have an ​‘Aha!’ moment. We’re not waiting for the secret number — X billion dollars — of profits to be reached before Moderna says, ​“Okay guys, we’ve reached the peak of our profits. Let’s now help everyone else stay alive.” We’re under no illusions that they will have a moment of reckoning, or that they will develop a conscience. This is what they do. They’ve shown us this with HIV, and now they’re showing us this with Covid. And if we don’t act drastically to destabilize the current status quo, this pattern will be repeated in the next pandemic.”
 

Does the World Still Need New COVID Vaccines?

 
Two members of the WHO Strategic Advisory Group of Experts (SAGE) Working Group for COVID-19 vaccines ask in a NEJM (US) editorial if we still need new COVID vaccines, following publication of two studies that found two new effective vaccines. They answer a qualified yes. “The first COVID-19 vaccines used during the pandemic may not be the best long-term solution. The next generation of COVID-19 vaccines will need to have broader epitope coverage to provide cross-immunity against SARS-CoV-2 variants, confer a longer duration of protection, and be easy to update in a timely manner for protection against any new variants. We should remain agile in fine-tuning the best use of COVID-19 vaccines for the greatest effect on global public health by acknowledging trade-offs…. Finally, currently available vaccines have only modest effectiveness against mild infection and transmission, which is further reduced in the context of the newly emerging omicron subvariants. Hence, to slow down the circulation of the virus and to limit the speed at which further variants emerge, new vaccines that have a substantial effect on reducing mild infection and transmission are needed, even as the world attempts to learn how to live with SARS-CoV-2.”
 
The Guardian (UK) reports, “It is questionable how much longer current COVID-19 vaccines will be used as they have largely done their job in preventing mass deaths, and scientists should focus on developing a vaccine that stops transmission of the virus, according to leading scientist Sir John Bell. The huge success of COVID vaccines in countries able to get them has led to sharp declines in deaths and severe disease from the virus, even though the latest COVID variant, Omicron, has spread rapidly. ‘We need a new vaccine to stop transmissions and there are lots of interesting ideas,’”
 

Strengthen Gavi for Vaccine Equity

 
A STAT (US) opinion piece argues that the COVAX “model has proved woefully inadequate for the challenges at hand. [But] instead of pointing fingers, the world has the opportunity to learn from the successes in childhood vaccination and the failures of COVID-19 to design a new way forward for vaccine procurement and delivery…. First and foremost, it is time for a new global contract with the pharmaceutical companies that make vaccines. Instead of just agreeing to buy large quantities of vaccines to be distributed in low-income countries, Gavi and others should also insist that equity provisions be written into procurement contracts with product innovators. These would include commitments to sharing intellectual property, technology, and vaccine manufacturing knowledge, and support for training manufacturers in nascent vaccine-producing regions in areas that include vaccine production, quality assurance, and regulatory affairs.”
 

Biden Comes to New COVID Summit Without New Funds

 
POLITICO (US) reports, “The White House is hosting a global COVID response summit this week — but the US isn’t currently prepared to bring significant new money to fight the virus worldwide, according to two people familiar with the preparations. Some senior administration officials and health advocates said they fear the world will see the lack of renewed financial assistance by the US as a retreat from the global efforts, and that could affect the Biden administration’s ability to drum up support from other countries…. Concerns about the summit come after US lawmakers failed to approve $5 billion in additional funding for the global pandemic response.”
 

Predictable COVID Surges?

 
Nature (UK) looks at the possibility that COVID surges may be becoming more predictable based on data from South Africa. “Several studies released in the past week show that the variants—known as BA.4 and BA.5—are slightly more transmissible than earlier forms of Omicron, and can dodge some of the immune protection conferred by previous infection and vaccination. ‘We’re definitely entering a resurgence in South Africa, and it seems to be driven entirely by BA.4 and BA.5,’ says Penny Moore, a virologist at the University of the Witwatersrand in Johannesburg, South Africa, whose team is studying the variants. “We’re seeing crazy numbers of infections.’… However, scientists say it is not yet clear whether BA.4 and BA.5 will cause much of a spike in hospitalizations in South Africa or elsewhere. High levels of population immunity—provided by previous waves of Omicron infection and by vaccination—might blunt much of the damage previously associated with new SARS-CoV-2 variants…. Moreover, the rise of BA.4 and BA.5—as well as that of another Omicron offshoot in North America—could mean that SARS-CoV-2 waves are beginning to settle into predictable patterns, with new waves periodically emerging from circulating strain…”
 

Vaccine Uptake Falters in Ghana

 
The Telegraph (UK) reports, “Ghana was dubbed a major success story of COVAX, the vaccine scheme aimed at distributing jabs across lower- and middle-income countries. In February 2021, the west African nation received the first COVAX shipment in the world—600,000 AstraZeneca doses. Its rollout is now the longest running in Africa. But today, only 30 per cent of Ghanaians have received one coronavirus jab, and 19 per cent two. Officials want these numbers to be higher, so why has demand started to flag?... Indifference about COVID jabs is also linked to the scale of other urgent and competing healthcare needs. While the country has reported 161,000 COVID cases in total, nearly six million people were diagnosed with malaria in 2020 alone.”
 

Estimating the True COVID Death Rate

 
The New York Times (US) reports, “Nearly 15 million more people died during the pandemic than would have in normal times, the World Health Organization said on Thursday, a staggering measure of COVID’s true toll that laid bare how vastly country after country has undercounted victims…. Most of the excess deaths were victims of COVID itself, the experts said, but some died because the pandemic made it more difficult to get medical care for ailments such as heart attacks. The previous toll, based solely on death counts reported by countries, was six million…. Nearly a third of the excess deaths globally—4.7 million—took place in India, according to the WHO estimates. The Indian government’s own figure through the end of 2021 is 481,080 deaths. But India was far from the only country where deaths were substantially underreported. Where excess deaths far outstripped the number of reported COVID fatalities, experts said the gap could reflect countries’ struggles to collect mortality data or their efforts to intentionally obscure the toll of the pandemic.”
 
The Hindu (India) reports, “India has objected to the sourcing of data, methodology for collecting data, mathematical model used for arriving at the final figures that have been released, the outcome of the data analyses and the fact that it has been listed in tier-2 countries despite being open to share all data with the WHO…. India has also said that the WHO should appreciate the fact that mortality is a sensitive topic and any speculative report on this can have multiple and needless adverse effects.”
 

Preparing for the Next Pandemic

 
A STAT (US) opinion piece by two Harvard faculty calls for “rethinking the paradigm for global scientific cooperation.” Muhammad Ali Pate and Michelle A. Williams argue, “The scientific and political elite have long assumed that the Global North is the best place to develop solutions for challenges in Africa, South Asia, and Latin America. Top-down biases have generally blinded high-income countries to the enormous reserves of talent and ideas in low- and middle-income nations. Time and again, pioneers in the Global South have made crucial scientific discoveries, ranging from breakthrough research on Burkitt lymphoma to groundbreaking work on HIV treatment and prevention to the first sequencing of the Omicron variant, yet their contributions are often discounted…. The worlds of science and public health can no longer afford this arrogance. People in the Global North must stop ignoring, marginalizing, and patronizing the Global South. In an era of global challenges, respectful, balanced global collaborations matter. It is essential that high-income nations accelerate building scientific infrastructure and capacity in low- and middle-income nations while also embracing the big thinking and bold innovation that exists within them.”
 
The Economist (UK) looks at a new book by Bill Gates, How to Prevent the Next Pandemic, reporting: “Early detection is vital, and is the first item on Mr. Gates’s list of things to accomplish. Others include helping people protect themselves; finding new treatments; and developing vaccines. And practice drills: he is big on the idea that, just as military forces drill and earthquake-response teams drill, so should those tasked with combating pandemics…. He suggests creating a global ‘fire brigade’ of 3,000 experts scattered around the world, recruited for skills ranging from epidemiology and genetics, through drug and vaccine development and computer modelling, to diplomacy. This outfit, which would probably work under the auspices of the World Health Organisation, would remain on permanent standby, ready to respond to any detected outbreak.”
 

Unvaccinated Elderly Barrier to Lifting China’s Lockdowns

 
The Washington Post (US) reports that across China “it is the elderly who are the main [vaccination] holdouts. Unlike most of China’s coronavirus prevention measures, vaccination is not mandatory, and low uptake among the country’s most vulnerable groups is a major reason Communist Party leaders feel compelled to persist with a grueling ‘zero COVID’ approach…. Shanghai has suffered staggeringly over the past month, with residents trapped by a strict lockdown unable to reach hospitals and suffering psychological breakdowns after weeks-long home confinement with an unknown end date. Supply chains worldwide have been upended.”
 

Kenya Vaccine Plant Plans Tied to Demand

 
Business Daily (Kenya) reports, “American biotechnology firm Moderna now says its plans to start filling doses of its COVID-19 vaccine locally to serve Africa from next year will be based on demand. The firm announced the development in regulatory filings last week. It revealed in the update its other key plan to build a manufacturing facility in Kenya, its first in Africa, to produce messenger RNA (mRNA) vaccines, including COVID-19 shots is firmly on course.”
 
Meanwhile, Reuters (UK) reports, “Aspen Pharmacare will switch about half of its COVID-19 vaccine production capacity onto other products if demand doesn't pick up within six weeks, its CEO warned, as South Africa's president and health officials urged more Africans to take up the shots. Aspen completed a deal in March to package, sell and distribute Johnson & Johnson's COVID-19 vaccine in what was considered a game-changing moment for an under-vaccinated continent frustrated by sluggish Western handouts…. Aspen said on Saturday it had not received a single order for its Aspenovax vaccine.”
 
A separate Reuters (UK) article notes, “The World Health Organization (WHO) and its COVID-19 vaccine partner Gavi have no immediate plans to buy shots made by Aspen Pharmacare the two bodies said, dealing a blow to Africa's efforts to develop its own vaccine production capacity…. The Africa Centres for Disease Control and Prevention (CDC), Africa's top public health body, has called upon organisations procuring shots for the continent to prioritise sourcing from African producers.”
 

Learning Why Some People Haven’t Had COVID

 
The Washington Post (US) reports, “Scientists around the world are investigating how a dwindling number of people such as Green have managed to dodge the coronavirus for more than two years, even after the highly transmissible omicron variant drove a record-shattering surge in cases this winter…. Experts hope that studying people who have avoided infection may offer clues—perhaps hidden in their genes—that could prevent others from being infected or more effectively treat those who contract the virus.”
 

Reaching Population Immunity

 
ENCA (South Africa) reports, “The only way to fight the COVID-19 pandemic is through population immunity according to Professor Tulio de Oliveira, of the KZN Research Innovation and Sequencing Platform. He says vaccination against COVID-19 remains important. ‘A lot of people have assumed, especially with the very big wave that happened in South Africa that immunity from just previous infections-the great majority of people in SA have been infected, either symptomatic or asymptomatic would protected from all the waves of infections, unfortunately that’s not true, and that was some very advanced scientific results that came last week from a colleague of ours that shows that previous infection after three months will have lower levels antibodies which allow one to be re-infected…. So, we really want people to protect themselves. What we found, even in people that have previously been infected, is that follow that with vaccination will create very high-level antibodies and that’s is the kind of ways that we really are going to get out of the pandemic.’”
 

New Test to Identify Variants

 
Medscape (US) reports,  group of US scientists have developed a lab test that can quickly identify which variant of the coronavirus has infected someone who tests positive for COVID-19, according to a recent report published in The Journal of Molecular Diagnostics. The test, which can identify all current variants of concern and potentially future ones, could help health officials track the pandemic more easily and help doctors treat patients more effectively…. The new test uses “molecular beacon” technology, which deploys microscopic probes to seek out molecules that carry genetic information to make proteins. The probes are so precise that they can distinguish between different gene-sequence targets that may only differ by a single chemical base. Once the probes latch onto the target, they become fluorescent and serve as a ‘beacon.’ That information allows scientists to determine the coronavirus strain.”