Covid Chronicles XXIII

By lockdown_exit - 8th Jan 2021, 1:51 pm - Covid Chronicles

Despite the end of the "Year That Wasn't" with its huge baggage of pandemic death and disruption and the growing promise of more and more vaccines capable of containing Covid-19, 2021 seems off to a shaky start. In the race to beat the virus, the virus is still way out in front. There are shortages of needles in Italy, Greece and other countries. Spain has not trained enough nurses. France has only managed to vaccinate around 7,000 people. Poland's programme was rocked by scandal after it was revealed that celebrities were given preferential treatment. There are calls in Germany to take control over vaccine purchases from European Union authorities. Nearly every country in Europe has complained about burdensome paperwork. 

As cases surge, many countries are considering or have embraced delaying the second dose to ensure as many people as possible receive at least partial protection - seen as a controversial move by some. Even with countries that have the vaccine being administered, there doesn't seem to be enough to go around leading to a controversial "rethink" of delaying the second dose. The vaccines require two doses for each recipient spaced out within 21-28 days of the first. Despite experts' concerns, more countries are mulling over details, following the UK strategy of delaying Covid vaccine doses to increase availability. Delaying the second dose after four weeks has been deemed risky by some experts and manufacturers, though there is debate on the issue. This controversy notwithstanding, Germany is reportedly considering following the UK, and Denmark has approved a similar plan for up to six weeks' delay. Earlier research has shown the Pfizer vaccine to be 52% effective after the first dose and 95% after the second.

Some countries are spacing out the doses longer than three to four weeks so that the vaccine vial supply stretches further. This is despite there being no available scientific evidence that the protection offered by the first shot is sustained beyond a 21-28 day period, according to Pfizer and BioNTech. The World Health Organization has weighed in. It says both doses should be received within 21-28 days. However, countries can have the latitude to space out shots for up to six weeks, so that the more vulnerable can be inoculated. 

The U.S. Food and Drug Administration made a statement that there is no adequate scientific evidence that supports changing the authorised Covid-19 vaccine schedule or dosing. "Without appropriate data supporting such changes in vaccine administration, we run a significant risk of placing public health at risk, undermining the historic vaccination efforts to protect the population from Covid-19," the FDA said. But with jabs in limited supply as production ramps up, the WHO has been examining how they can be used most effectively

Meanwhile, adding to the growing numbers of countries with a vaccine, one of the world's largest vaccine producers, India commenced a national trial of its Covid immunisation programme last Saturday in the wake of regulatory bodies reportedly approving the Oxford/AstraZeneca vaccine for emergency use. The mammoth task of vaccinating 1.3 billion people will include a first phase seeking to inoculate 300 million Indians, prioritising those over 50 and/or with comorbidities, frontline workers, and police and military personnel. However, even here desperation rules with experts raising concerns over India's emergency approval of a second locally produced coronavirus vaccine before the completion of trials. Last Sunday, Delhi approved the vaccine - known as Covaxin - as well as the global AstraZeneca Oxford jab, which is also being manufactured in India. Prime Minister Narendra Modi touted the approval as a "game changer". The head of Bharat Biotech, which makes Covaxin, defended the approval process, but health experts warn it was rushed. It said that there were "intense concerns arising from the absence of the efficacy data" as well as a lack of transparency that would "raise more questions than answers and likely will not reinforce faith in our scientific decision-making bodies". The statement came after India's Drugs Controller General, VG Somani, insisted Covaxin was "safe and provides a robust immune response". He added the vaccines had been approved for restricted use in "public interest as an abundant precaution, in clinical trial mode, to have more options for vaccinations, especially in case of infection by mutant strains".

Moderna's Covid-19 vaccine has been approved for use by the EU's drug regulator. The decision by the European Medicines Agency came on the same day as the Netherlands began administering its first doses. EMA executive director Emer Cooke said: "This (Moderna) vaccine provides us with another tool to overcome the current emergency". The decision, which must be rubber stamped by the EU's executive commission, came hours after nurse Sanna Elkadiri, 39, became the first person in the Netherlands to receive the Pfizer-BioNTech vaccine.

Faced with so much confusion, fortunately there are some voices seeking to overturn last year's nationalistic race to beat all others in a bid to secure enough vaccines for themselves. German Chancellor Angela Merkel has told Russian President Vladimir Putin that she is "open to the idea" of using European manufacturing capacities to increase the production of Russia's Sputnik V vaccine, a German government spokesperson said on Wednesday. News of a Merkel-Putin call on Tuesday to discuss cooperation on vaccine production was first made public by the Kremlin that same day. Speaking at a German government press briefing Wednesday, deputy spokesperson Ulrike Demmer said that Merkel had told Putin "that she is open to the idea of bilateral cooperation for the purpose of tapping European production capacities [for the Russian vaccine]". Demmer added that this would only happen if the European Medicines Agency gives its approval to the Sputnik V vaccine.

With some probable shortcomings in existing vaccines there are efforts to combine more than one to examine prospects of improvement in both. Russia is ready to conduct clinical trials in Ukraine of a Covid-19 vaccine combining its Sputnik V with a vaccine developed by AstraZeneca together with Oxford University, the head of the Russian Direct Investment Fund (RDIF) said on Saturday. Russia's sovereign RDIF, which is marketing the Sputnik V vaccine abroad, announced in December that there would be trials to test a combination of the AstraZeneca vaccine with the Sputnik V shot to see if this can boost the efficacy of the British drugmaker's vaccine.

A welcome change to the vaccine nationalism of 2020. However, this still leaves many countries without the vaccine out in the cold despite the cooperation that seems to be emerging. John Nkengasong, head of the Africa Center for Disease and Control Prevention, has warned that the world faces a "moral catastrophe" if access to vaccines against Covid-19 is delayed in the region. "The second wave of the coronavirus pandemic is already here with a vengeance," he said. Cases rose by 19% in the last week. "We cannot delay, we need those vaccines, and we need them now," he added.

The issue that arises is not one that merely takes account of how many vaccines are available, but also about how best to use them as quickly and efficiently as possible, and how best to reach them worldwide. The UK, for example, has seen the vaccine drive gaining momentum within the country only to realise that a mutant strain from South Africa is invading its borders stealthily. There is virtually no vaccine drive going on in South Africa. Israel hitherto regarded as "a model" in its vaccination process has witnessed a sudden surge in new cases. The neighbouring Palestinians have been left out of the vaccination drive. Given the dislocation in the distribution and use of vaccines that are available both within a country and without, there are always "non-state players" waiting in the wings, ready, willing and able to get involved to serve their own nefarious purpose. The mafia will be trying to get their hands on Covid-19 vaccines, Italian police have warned. Giving vaccines to millions of people is proving problematic for most governments and now law enforcement authorities are bracing for an additional challenge - criminals targeting vaccine distribution. "Their interest in vaccines is due to the high demand and the low initial supply," the Italian police body monitoring mafia infiltration of the economy said in an internal report, extracts of which were released last Wednesday. 

Despite all its initial teething troubles, here's wishing the world at large a Happy, Healthy and Safe 2021!

Lalita Panicker is Consulting Editor, Views, Hindustan Times, New Delhi