The co-chair of the African Union's African Vaccine Delivery Alliance, Dr. Ayoade Alakija is adamant that the pandemic is not over in Africa and the continent has not been relatively untouched by the virus. In an interview with NPR (US) she said, “People absolutely are dying silently. The very measure of the impact of this pandemic around the world has been: How far are health systems being affected? Have hospitals been overwhelmed? We saw in the early days those awful images from New York hospitals, and from hospitals in Brazil. And that was the measure of the impact. But what do you do in countries where you do not have health systems to be overwhelmed? So we have said in parts of Africa that, ‘Oh, well, they hadn't had COVID’ and ‘COVID has not affected them,’ but that is not true. It is just we haven't had the cameras in hospital wards, because those wards do not exist. So people have died silently, people have died at home and they haven't even been able to be celebrated or memorialized So many of these deaths have gone unrecorded. And therefore, there has been a silent pandemic, a silent toll on parts of this world where the inequity in measuring the impact of the pandemic itself is pushing the inequity of access to the countermeasures and to the tools needed to prevent further infection.”
 

If You Are in a Hurry

• Read The Atlantic on the power imbalance “baked into global health” that led to an uneven TRIPS agreement around COVID vaccines.
• Read Reuters on the news that 25 million children missed childhood vaccines in 2021, even more than in 2020.
• Read Global Health Now on the impact of COVID on basic science research.
• Read STAT on fears that monkeypox may not be able to be contained.
• Read POLITICO for an interview with Tony Fauci and what’s next in his career.
• Read NPR’s Goats and Soda blog on LMICs working to develop their own vaccines.
• Read a review in Global Health Research and Policy that looks at reasons for vaccine hesitancy.
• Read WIRED on the why vaccines aren’t yet matched with the latest variants.

 

Pandemic Knock-on Effects

 
We’ve known since early in the pandemic that that illness and death from COVID are not the only consequences of this virus. More than two years in there is more evidence of the widespread impact of the pandemic. Reuters (UK) reports, “Around 25 million children around the world missed out on routine vaccinations last year that protect against life-threatening diseases, as the knock-on effects of the pandemic continue to disrupt health care globally…. UNICEF described the drop in vaccination coverage as the largest sustained backslide in childhood vaccination in a generation, taking coverage rates back to levels not seen since the early 2000s.”
 
The Daily Maverick (South Africa) reports, “Scientists say the world is facing a ‘tsunami’ of health risks caused by COVID infections, as increased knowledge of the virus shows that it is not just a respiratory disease. New data from patients who contracted COVID shows that an infection, even if asymptomatic, increases their risk for heart disease (with one study indicating a 50 percent increase) within a year. Another large study involving 181,000 patients also showed an increased risk for diabetes. Prof. Salim Abdool Karim is quoted: “’We cannot go into the future of this pandemic and just say ‘let the virus spread’. We need public health awareness. Vaccines must become an essential requirement,’ he said. While it is estimated, based on seroprevalence surveys, that about 80 to 85 percent of South Africans have been infected at some time since the start of the pandemic, Abdool Karim said the new data on the after effects of COVID makes it essential that those who have not been infected are protected.”
 

Latest in the Patent Wars

 
NPR’s Goats and Soda blog (US) reports on “an unprecedented collaboration between scientists from middle-income countries to help each other break the lock that wealthy countries have on not just COVID vaccines but on the invention of new vaccines in general.” Conceived by Sotiris Missailidis of Brazil’s Bio-Manguinhos Fiocruz Foundation after Moderna and Pfizer refused to share mRNA know-how, “If the vision comes to fruition, in future pandemics, it would save hundreds of millions of lives in low- and middle-income countries. It would also amount to a tectonic shift in the way science is done.” The team in Brazil along with colleagues in Argentina are one of the WHO sponsored “hubs that will not just figure out how to make mRNA vaccines against COVID but, with WHO's support, teach that knowledge to manufacturers from low- and middle-income countries around the world.”
 
Vidya Krishnan writes in The Atlantic (US) that the recent TRIPS agreement around COVID vaccines “is not a success story…If anything, it illustrates the injustice baked into the global health structure. The deal comes too late in the pandemic, falls short on a number of counts, and will have a limited impact on bringing about an end to the world’s coronavirus nightmare. What has been passed has little resemblance to what was proposed…. If there is a positive to be taken from this experience, it is that this power imbalance has finally been exposed for what it is. Poorer countries may have had to settle for a watered-down deal nearly two years after it was first put forward, but in that time, they have managed to mobilize together to challenge the racism baked into intellectual-property laws. Admittedly, this is the thinnest of silver linings, yet a silver lining it is nevertheless. The West won this round, but the power of the rest is growing.”
 
Reuters (UK) reports, “An alliance of companies has pledged to ensure equitable access to vaccines and treatments for pandemics, as the friction around intellectual property rights for COVID-19 interventions between the pharmaceutical industry and developing nations endures…. The Berlin Declaration also asserts that the industry's intellectual property (IP) rights should be preserved.” Advocates are skeptical: “Anna Marriott, policy lead for the People's Vaccine Alliance and health policy manager at Oxfam, said it was hard to take advice from the pharmaceutical industry given many companies have repeatedly demonstrated over the pandemic that they will pursue profit over equitable supply. ’I just don't think we can believe a word that they propose,’ she said.”
 

Fauci Signals Plan to Move On

 
POLITICO (US) reports, “After more than five decades of federal service under seven presidents, Anthony Fauci says he’s leaving by the end of President Joe Biden’s term…” In an interview with Politico the 81-year-old Fauci made it clear that COVID is not going away anytime soon: “We’re in a pattern now. If somebody says, ‘You’ll leave when we don’t have COVID anymore,’ then I will be 105. I think we’re going to be living with this…”
 

Cases Rising: UK passes 200,000 COVID deaths

 
The Guardian (UK) reports, “Doctors and people bereaved by COVID have described the 200,000th death from the virus in the UK as a ‘tragic milestone’ and called for the return of infection control measures, including mask wearing and better sick pay amid concern about rising cases and new variants.” Several advocates used the milestone to call for a return to COVID controls, with one saying, “Four hundred and fifty-four people died within 28 days of a positive test from COVID just last week, and yet the government refuses to take even basic steps to protect people from the virus. By making people pay for tests, not enforcing adequate sick pay or taking measures to prevent the spread of COVID-19 in hospitals, the government is effectively throwing the most vulnerable in our society to the wolves.”
 
EuroNews (France) reports, “Coronavirus cases have tripled across Europe in the past six weeks, accounting for nearly half of all infections globally, while hospitalisation rates have also doubled, according to the World Health Organization…. Kamran Abbasi of the BMJ and Alastair McLellan of the Health Service Journal wrote in a joint editorial that the UK government is failing to address persistent problems worsened by COVID, including ambulances lining up outside hospitals that are too overloaded to accept new patients. They attacked the government's insistence that vaccines have broken the link between infections and hospitalisations. Although vaccines dramatically reduce the chances of severe disease and death, they have not made a significant dent on transmission.”
 
DW (Germany) reports, “Over the last two years, COVID-19 infections [in Germany] have dropped during the summer, when people spend more time outside. This has meant a reprieve for health workers during the warmer months. But this year is different. Case numbers are rising even in summer and the health system is already approaching its limits, according to the Marburger Bund doctors' association. While in early June the 7-day incidence rate was the lowest it had been all year, numbers have since spiked rapidly. The spread has been facilitated, as authorities have relaxed prevention measures. People in Germany are no longer subject to contact restrictions or mask requirements in most public spaces. Many are also traveling and attending events once again.”
 
In a WHO Euro statement, WHO Regional Director for Europe Dr. Hans Henri P. Kluge released a new Autumn/Winter strategy for the region: “The strategy calls on countries to relaunch mitigation efforts and be ready to respond to an increased burden on their health-care systems…. Our health systems and society at large must continue to adapt our collective response to this virus – and any future variants of concern. We must continue to do all we can to protect those most at risk. This means we must continue to monitor and track the evolution of SARS-CoV-2, which remains a highly unpredictable virus. Yet most countries in the European Region have stopped or greatly reduced COVID-19 surveillance, creating a dangerous blind spot in our knowledge of how the virus is evolving. “
 

Understanding Vaccine Hesitancy

 
A review of 71 studies of vaccine hesitancy in Africa published in the journal Global Health Research and Policy (Germany) found, “The major reasons for vaccine hesitancy were concerns with vaccine safety and side effects, lack of trust for pharmaceutical industries and misinformation or conflicting information from the media. Factors associated with positive attitudes towards the vaccine included being male, having a higher level of education, and fear of contracting the virus.”
 

Understanding and Forecasting Outbreaks and Pandemics

 
A WHO statement reports on a significant increase in diseases spread from animals to people in Africa. “Africa is facing a growing risk of outbreaks caused by zoonotic pathogens, such as the monkeypox virus which originated in animals and then switched species and infected humans. There has been a 63 percent increase in the number of zoonotic outbreaks in the region in the decade from 2012-2022 compared to 2001-2011, according to World Health Organization (WHO) analysis…. The increase in zoonotic cases may be due to several reasons. Africa has the world’s fastest-growing population and there is a growing demand for food derived from animals including meat, poultry, eggs, and milk. The population growth is also leading to rising urbanization and encroachment on the habitats of wildlife. Road, rail, boat and air links are also improving across Africa increasing the risk of zoonotic disease outbreaks spreading from remote areas where there are few inhabitants to large urban areas. As we have seen with the West African Ebola outbreaks, there can be a devastating number of deaths and cases, when zoonotic diseases arrive in cities.”
 
The East African (Kenya) reports, “Tanzania has confirmed 20 cases of leptospirosis, a bacterial infection that has claimed three lives, in the southern region of Lindi. Health minister Ummy Mwalimu said test results from samples of patients in Ruangwa were positive for the disease. Last week, samples of people presenting with fever, nosebleeds, headache and body fatigue tested negative for COVID-19, Ebola and Marburg, the ministry said, calling for calm as it worked to detect it…. The [leptospirosis] bacteria are transmitted from animals to humans through cuts or abrasions in the skin, nose, or eyes that come in contact with water or soil contaminated with the urine of infected animals. But, the disease cannot be transmitted from one human to another.”
 

Vaccines and Variants

 
WIRED (US) reports, “The promise of mRNA technology was its adaptability. Vaccine makers touted its plug-and-play nature. If the virus mutated to evade current vaccines, scientists could simply swap in a new piece of mRNA to match the new version of the virus. But today, despite waves of variants including Delta, Omicron, and the latest threats—Omicron subvariants BA.4 and BA.5—the COVID-19 vaccines and booster shots still target the original virus that was identified in late 2019…. Jacqueline Miller, senior vice president of infectious diseases at Moderna…says it takes Moderna about four to six weeks from the time of generating a new variant’s genome sequence to producing enough vaccine doses to begin human testing. Pfizer’s process is similarly fast.” But that’s only the beginning of the process. “While the process of updating an mRNA booster goes rather quickly, testing and manufacturing it at scale takes longer. Variant-specific vaccines still need to go through animal and human testing to make sure they’re safe and generate an immune response.”
 

Long COVID

 
Gizmodo (US) reports trying to understand how frequently long COVID occurs is difficult. “Part of the struggle in studying this issue is that the definition of long COVID remains imprecise. Patient advocates were the first to document lingering issues following the initial illness by mid-2020, but it took public health agencies much longer to formally recognize the condition. The World Health Organization, for instance, only released its clinical case criteria for ‘post-COVID-19’ in October 2021…. Even today, there is no simple test or biomarker for identifying someone with long COVID, meaning that diagnosis is a process of elimination. There are commonly agreed-upon symptoms, such as fatigue, respiratory problems, and cognitive dysfunction or ‘brain fog.’ But there remains much debate about the extent of health problems that can conclusively be linked to long COVID.”
 

How COVID Slowed Basic Science

 
Global Health Now (US) reports, “The pandemic has fundamentally changed the lives and work of basic scientists. Many found themselves locked out of labs for weeks or months. When they were finally allowed back, they were unable to get critical supplies like reagents. Or they were at home taking care of their children, sick with COVID-19 themselves, or refocusing their work to study various aspects of SARS-CoV-2. The end result was a slowing of science—and the training of scientists—that is being widely discussed among research leaders but is likely to take years to quantify.”
 

COVID Disinformation and Bogus Treatments

 
NPR (US) reports on “a network of fringe medical doctors, natural healers and internet personalities ready to push unproven cures for COVID.” Trust in these entities can be deadly. One of the most common bogus treatment hawked by these online groups is ivermectin. “Mackey says there's a whole range of entities trying to make a buck off the underground demand for ivermectin. It's difficult to track how many people are seeking it out on the black market, but Mackey believes many Americans are affected. ‘There's probably thousands of people, tens of thousands of people that have looked for drugs, tried to buy something...maybe been defrauded and at worst maybe even harmed from these products,’ he says.”
 

Concerns About Chinese Monitoring Bracelets

 
Reuters (UK) reports, “Some Beijing residents returning from domestic travel were asked by local authorities to wear COVID-19 monitoring bracelets, prompting widespread criticism on Chinese social media by users concerned about excessive government surveillance…. ‘This bracelet can connect to the Internet, it can definitely record my whereabouts, it is basically the same as electronic fetters and handcuffs, I won't wear this,’ [social media site] Weibo user Dahongmao wrote on Wednesday evening…”
 

Monkeypox Updates

 
There is growing concern that the multi-country outbreak of monkeypox cannot be contained as cases rise and mitigation strategies are inadequate.
 
Helen Branswell writes in STAT (US): “It has been a mere nine weeks since the United Kingdom announced it had detected four cases of monkeypox, a virus endemic only in West and Central Africa. In that time, the number of cases has mushroomed to nearly 13,000 in over 60 countries throughout Europe, North and South America, the Middle East, new parts of Africa, South Asia, and Australia. The growth in cases and the geographic spread has been rapid and relentless. Now, even as global health officials race to curb spread of the virus, most experts polled by STAT said they don’t believe it will be possible to contain it.” Agoritsa Bakaof the European Centre for Disease Prevention and Control is quoted: “We are piling up one difficult outbreak on top of a pandemic and I think it is too much for the public health services and authorities all over. I think this is the trickiest part.”
 
Ben Ryan writes in an op-ed in The Washington Post (US), “Here is what we can discern from data collected about monkeypox so far: This viral outbreak isn’t just mostly occurring among men who have sex with men. The confirmed cases, at least to date, have consistently almost entirely occurred among this demographic, which accounts for 96 percent or more of diagnoses where data are available…. Tragically, the monkeypox outbreak is occurring just as a shocking resurgence of anti-LGBTQ sentiment grips the United States. But public health officials cannot be expected to police the public’s reactions to epidemiological facts. Gay men deserve to hear the unvarnished truth about monkeypox so we can take action accordingly. We’re adults. Please be honest with us.”
 
Reuters (UK) reports, “Sexual health clinics on the frontline of the monkeypox response are already financially stretched, leaving the United States and UK ill-equipped to tackle the first major global health test since the COVID-19 pandemic. Infectious disease experts say sexual health clinics…are best placed to identify and treat cases of monkeypox…. Yet such programs are doing so largely without additional funding despite years of financial neglect.”
 
Medical Brief (South Africa) reports as a third monkeypox case is confirmed in South Africa and cases rise globally, “African researchers are lobbying for the continent’s experience and expertise in this and other diseases to receive the attention they deserve.” Doctors Without Borders Aula Abbara, “said specialists in African countries have ‘decades of experience managing such outbreaks, often with little support, and have repeatedly warned of the potential for monkeypox’s globalisation and the need for affordable tools and improved surveillance’. Despite vast expertise, the voices of specialists in Africa are ‘notably absent from the current discourse’ and ‘many have struggled for years to raise awareness, publish their findings, or attract funding to study this disease’.”