COVID News Brief: The news you need to know

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AVAC's weekly COVID News Brief provides a curated perspective on what COVID news is worth your time.
"COVID-19 revealed that equitable vaccine distribution won’t come about naturally through the free market or through charity and good will in the heat of a crisis. That’s why now is the time to make structural changes to ensure equity before the next emergency hits."
-- Amy Maxmen, New York Times ([link removed]) essay”


** Share of People Who Completed the Initial COVID-19 Vaccination Protocol
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December 8, 2022
Source: Our World in Data ([link removed])


** Table of Contents
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* If You Are in a Hurry (#If You Are in a Hurry)
* China’s Zero COVID-19 Policy Relaxed (#China’s Zero COVID-19 Policy Relaxed)
* Why Isn’t the US Supporting Vaccine Plan for Pandemics? (#Why Isn’t the US Supporting Vaccine Plan for Pandemics?)
* Pandemic Effects on HIV testing and Services (#Pandemic Effects on HIV testing and Services)
* Fauci on Prospects for Better COVID-19 Vaccines (#Fauci on Prospects for Better COVID-19 Vaccines)
* Moving from Vaccine Supporters to Vaccine Advocates (#Moving from Vaccine Supporters to Vaccine Advocates)
* US Won’t Support COVID-19 Patent Waivers (#US Won’t Support COVID-19 Patent Waivers)
* COVID-19 and Increased Deaths in South Africa (#COVID-19 and Increased Deaths in South Africa)


* Severe COVID-19 Impacts Brain (#Severe COVID-19 Impacts Brain)
* Tanzania’s Success with Vaccination (#Tanzania’s Success with Vaccination)
* Overcoming Misinformation (#Overcoming Misinformation)
* Suboptimal HIV Treatment and COVID (#Suboptimal HIV Treatment and COVID)
* Sex, Race and Ethnicity in COVID-19 Trials (#Sex, Race and Ethnicity in COVID-19 Trials)
* Mpox Emergency to End in US (#Mpox Emergency to End in US)
* First Mpox Vaccines for Africa (#First Mpox Vaccines for Africa)
* Lower Ebola Rates in Uganda Bring Vaccine Testing Challenges (#Lower Ebola Rates in Uganda Bring Vaccine Testing Challenges)
* Global Shortage of Cholera Vaccines (#Global Shortage of Cholera Vaccines)

COVAX’s days appear to be numbered. The New York Times ([link removed]) (US) reports, “The organization that has led the global effort to bring COVID-19 vaccines to poor and middle-income countries will decide this week whether to shut down that project, ending a historic attempt to achieve global health equity with a tacit acknowledgment that the effort fell far short of its goal. The deliberations reflect the reality that demand for COVID-19 vaccines is waning quickly throughout the world and is near nonexistent in countries that have some of the lowest rates of coverage.” The board of GAVI is expected to vote soon on “sunsetting” the initiative sometime in 2023. GAVI’s Seth Berkley is quoted: “The plan in 2023 is to continue to work on getting primary coverage up as high as countries want it but also to really focus in on helping countries get those high-risk populations covered. The current proposal is that we integrate the COVAX
work into the core work of GAVI — not closing it down but integrating it. Because the belief is that, by the end of 2023, it shouldn’t be seen as an emergency program anymore.”


**
If You Are in a Hurry
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* Read The Atlantic ([link removed]) on what might be next as China relaxes its zero COVID-19 policy.
* Read Bloomberg ([link removed]) on news the US won’t support patent waivers for COVID-19 treatments and diagnostics.
* Read The East African ([link removed]) on COVID-19 vaccine success in Tanzania.
* Read aidsmap ([link removed]) on a large preprint study that shows people with suboptimal HIV treatment are more likely to die from COVID-19.
* Read a JAMA ([link removed]) (US) review that shows underrepresentation of some populations in COVID-19 trials.
* Read a MedPage Today ([link removed]) interview with Dr. Demetre Daskalakis on the future of mpox in the US.
* Read Al Jazeera ([link removed]) on prospects for the first mpox vaccines to come to Africa.



** China’s Zero COVID-19 Policy Relaxed
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China’s zero COVID-19 policy is falling apart, but what does that mean for China and the world? In a new Global Health Insights video ([link removed]) , IHME says when the policy becomes unstainable, “there will be widespread transmission of Omicron, and that will actually have a considerable death toll in the over-80 population.” Many of the over-80 population in China remains unvaccinated. On Wednesday, AP ([link removed]) (US) reported, “China rolled back rules on isolating people with COVID-19 and dropped virus test requirements for some public places Wednesday in a dramatic change to a strategy that confined millions of people to their homes and sparked protests and demands for President Xi Jinping to resign…. Experts warn, however, that restrictions can’t be lifted completely until at least mid-2023 because millions of elderly people still must be
vaccinated and the health care system strengthened.”

It is unclear how the lifting of restrictions will play out, but some experts are worried about what could happen now. The Atlantic ([link removed]) (US) warns the rollbacks are “swiftly tilting the nation toward a future that’s felt inevitable for nearly three years: a flood of infections—accompanied, perhaps, by an uncharted morass of disease and death. A rise in new cases has already begun to manifest in urban centers such as Chongqing, Beijing, and Guangzhou. Now experts are waiting to see just how serious China’s outbreak will be, and whether the country can cleanly extricate itself from the epidemic ahead.” The Atlantic quotes Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations: “There is still the possibility that they may muddle through it without a mass die-off. But even the most smooth and orderly transition will not prevent a surge of cases.”

But what about the fear of new variants arising from the expected onslaught of new infections? The Atlantic notes, “The risk of new variants spinning out of a Chinese outbreak may be a bit less than it seems, Abdool Karim and other experts told me. China has stuck with zero COVID-19 so long that its population has, by and large, never encountered Omicron subvariants; people’s immune systems remain trained almost exclusively on the original version of the coronavirus, raising only defenses that currently circulating strains can easily get around…. and any new versions of the virus that do emerge might not fare particularly well outside of China."


** Why Isn’t the US Supporting Vaccine Plan for Pandemics?
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Science journalist Amy Maxmen writes in a New York Times ([link removed]) oped, “To prevent history [of delayed COVID vaccine access for many countries] from repeating, governments across Africa, Latin America and Southeast Asia are trying to strengthen regional abilities to produce vaccines against COVID-19 and other diseases. Their goal is to build this capacity now and stay afloat so that the companies are ready when the next pandemic hits.” Several initiatives exist in low- and middle-income countries, but the US has largely not been supportive of these efforts. Dr. Maxmen argues, “COVID-19 revealed that equitable vaccine distribution won’t come about naturally through the free market or through charity and good will in the heat of a crisis. That’s why now is the time to make structural changes to ensure equity before the next emergency hits.”


** Pandemic Effects on HIV testing and Services
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Healio ([link removed]) (US) There is more evidence – this time from the US – of the pandemic’s dampening effect on HIV testing and services. Data reported by the US CDC shows, “that HIV testing declined by around 32 percent between the first and second quarter in 2020, from approximately 2.47 million tests to 1.68 million tests, but began to rebound in the third quarter, when around 2.3 million people were tested. Following a similar pattern, the number of people prescribed PrEP decreased by 6 percent from around 190,000 to 179,000 between the first two quarters, then rebounded to around 184,000 prescriptions in the third quarter.”


** Fauci on Prospects for Better COVID-19 Vaccines
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In a Bloomberg ([link removed]) (US) interview Dr. Anthony Fauci is asked whether we’ve run out of time to develop better COVID-19 vaccines. His answer: “I don’t think we’ve run out of time. When you’re doing research and public health, you’ve got to keep pushing the envelope and pushing the envelope. That’s one of the important tenets of doing research and discovery and implementation: You can’t get discouraged by failures.”


** Moving from Vaccine Supporters to Vaccine Advocates
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A new study in the journal Vaccines ([link removed]) (Switzerland) looks at what it takes for people to move from supporting vaccines to advocating for them. A press release bout the study from Ohio State University notes, “People who said they were more confident in their beliefs that vaccines and medicines were safe and effective were more likely to want to actively support these views..... Findings showed that those who expressed more pro-medicine views on the questionnaire were more likely to say they would share pro-vaccine messages when they were more certain about their beliefs. And willingness to advocate in favor of vaccination can predict actual behavior. In a pilot study of 66 college students, the researchers found that those who said they were more likely to advocate for vaccines were more likely to sign a petition to support the development of vaccines.”


** US Won’t Support COVID-19 Patent Waivers
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Bloomberg ([link removed]) (US) reports, “The US won't agree to waive intellectual-property protections for COVID-19 treatments and tests this year — aligning with developed-nation peers and delaying prospects for a World Trade Organization accord aimed at boosting global access to life-saving medicines. On Tuesday, US Trade Representative Katherine Tai said the agency needs more information about the market dynamics for COVID-19 diagnostics and therapeutics, and plans to ask the US International Trade Commission to launch an investigation into the matter.”


** COVID-19 and Increased Deaths in South Africa
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Bloomberg ([link removed]) (US) reports, “Africa’s biggest health insurer said the number of heart-related deaths rose more than sixfold during the COVID-19 pandemic among the clients of one of its units.... Discovery attributed the surge in deaths to a confluence of pandemic problems. This includes long COVID, an array of physical ailments that can follow an infection with the respiratory disease, a 50 percent reduction in medical checkups during that time and people exercising less.”


** Severe COVID-19 Impacts Brain
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Nature ([link removed]) (UK) reports, “Severe COVID-19 is linked to changes in the brain that mirror those seen in old age, according to an analysis of dozens of post-mortem brain samples. The analysis revealed brain changes in gene activity that were more extensive in people who had severe SARS-CoV-2 infections than in uninfected people who had been in an intensive care unit (ICU) or had been put on ventilators to assist their breathing — treatments used in many people with serious COVID-19.”


** Tanzania’s Success with Vaccination
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The East African ([link removed]) (Kenya) reports, “Over 94 percent of Tanzanians targeted by the government for COVID-19 vaccination have been vaccinated against the global pandemic, the Health Ministry has revealed. The ministry revealed that by December 2, 2022, out of the targeted 30.7 million people, about 29.1 million had received the COVID-19 jabs. And out of the entire population of 61.7 million people, 29.1 million have been vaccinated, representing 47.2 percent.”


** Overcoming Misinformation
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An article in EMJ Reviews (And%20out%20of%20the%20entire%20population%20of%2061.7%20million%20people,%2029.1%20million%20have%20been%20vaccinated,%20representing%2047.2%20percent.) (UK) looks at lessons learned in overcoming misinformation in New York City, “an early epicenter” of the pandemic in the US. The three lessons from the authors are leveraging already built trust and partnerships, talking to people and listening with compassion. The authors conclude: A core principle in all three of these lessons learned is that they are rooted in trust. Trust is not something that is fostered overnight. Nor is it something that can be gained immediately during a health crisis. Rather, it takes time to build trust between and among people, providers, public health professionals, healthcare systems, and public health agencies. We cannot tell someone to just trust this agency or person. Instead, we must acknowledge this imperative core principle in outbreak response and begin to work actively to
foster it.”


** Suboptimal HIV Treatment and COVID
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Aidsmap ([link removed]) (UK) reports on a preprint study from South Africa: “People with HIV who have low CD4 counts, or unsuppressed viral load, no history of HIV treatment, or active tuberculosis, were more likely to die of COVID-19 than other people with HIV, a large study of COVID-19 deaths in South Africa’s Western Cape province has reported…. The authors say that ensuring people are on suppressive antiretroviral treatment and being treated for comorbidities, especially TB, should be priorities for limiting COVID-19 deaths in a context where vaccination access and uptake may be suboptimal. The study authors also highlight the need for access to antiviral treatments for COVID-19 for people with HIV with severe illness.”


** Sex, Race and Ethnicity in COVID-19 Trials
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A JAMA ([link removed]) (US) review looks at sex, racial, and ethnic representation in COVID-19 clinical trials, finding: “In this systematic review and meta-analysis of 122 US-based COVID-19 clinical trials with 176 654 participants, female participants were underrepresented in treatment trials, Asian and Black participants were underrepresented in prevention trials, and Hispanic or Latino participants were overrepresented in treatment trials…. Strategies to better ensure diverse representation in COVID-19 studies are needed, especially for prevention trials.”


** Mpox Emergency to End in US
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CNBC ([link removed]) (US) reports, “The Biden administration will end the public health emergency declared in response to the monkeypox outbreak, as new infections have declined dramatically and vaccination rates have increased. The Health and Human Services Department does not expect it will renew the emergency declaration after it expires on Jan. 31 “given the low number of cases today,” HHS Secretary Xavier Becerra said in a statement…” USA Today ([link removed]) (US) reports, “So how did an infectious disease that seemed to be raging out of control this summer become almost irrelevant three months later? It's a combination of luck, good behavior and effective vaccines, experts say…. Griffin credits behavior changes within the gay community for stopping the virus' spread. ‘We were fortunate with the mpox
spread that the most impacted population does not suffer from widespread embracing of the anti-science misinformation and were quick to embrace vaccines, proactive about getting treated, really did reduce risky behaviors.’”

In a MedPage Today ([link removed]) (US) interview Dr. Demetre Daskalakis, deputy coordinator of the White House Monkeypox Response Team, says when asked about the possibility of eradicating mpox in the US: “I think a long tail is what we can expect. This outbreak went straight up, and it's going down. Do I think we're going to get to zero next week? No. Will we have weeks when we get to zero? I think yeah. Not quite yet. This is where we have to ante up and move faster with the vaccine, because it's working. We've seen some softening in vaccine demand, and so we just need to sort of get the word out and keep magnifying it. This is not the time to back off. The more protection we can get during this peaceful lull, the better we are in long-term infections.”


** First Mpox Vaccines for Africa
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Al Jazeera ([link removed]) (Qatar) reports, “The African continent is set to receive its first batch of mpox vaccines, 50,000 doses in all, as a donation from South Korea, according to the Africa Centre for Disease Control and Prevention (CDC). The doses will be given to health workers and people living in the hardest-hit areas. But no timing was given for the doses’ arrival. There have been 202 deaths recorded from mpox in the continent with a death rate of 19.3 percent across 13 countries.”


** Lower Ebola Rates in Uganda Bring Vaccine Testing Challenges
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Science (US) reports, “Last week, Uganda announced uplifting news about the Ebola outbreak that surfaced there in mid-September: The last known patient had recovered and been discharged from a hospital. Health officials hope that signals the spread of the virus has slowed dramatically, if not stopped altogether. Yet the aggressive containment efforts that led to the waning of the outbreak also means a quickly arranged trial of experimental ebolavirus vaccines faces formidable hurdles.” While the vaccine trial may be cancelled or redesigned in some way, the experience has led to calls from experts to “stockpile experimental vaccines on the continent—for Ebola and other emerging diseases—and agree on trial protocols ahead of time.” GAVI’s Seth Berkley is quoted: “It would have been awfully nice to have had 100,000 doses ready to go at the start of this outbreak. That’s where I think we have to go next.”


** Global Shortage of Cholera Vaccines
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Science ([link removed]) (US) reports on a number of cholera outbreaks across the globe. “The outbreaks are part of what the World Health Organization (WHO) calls an ‘unprecedented’ surge in cholera cases, driven in part by climate change and fallout from the COVID-19 pandemic…. A global cholera vaccine stockpile is falling short, forcing health organizations to ration doses—and rethink their control strategy.”
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