• The Covid-19 pandemic has made previously routine vaccinations against other infectious diseases, such as measles, a challenge
• This is because many vaccination campaigns were paused for months in 2020
• These factors may result in severe measles outbreaks in 2021, and governments need to urgently address the situation

Measles, a highly contagious respiratory disease, claimed over 207 500 lives in 2019, according to the World Health Organization – a 50% increase from 2016.

While vaccination efforts may have reduced the number of deaths from 2000 to 2018, the Covid-19 pandemic is impacting efforts to control and treat other diseases, including measles.

The disease, caused by a virus in the paramyxovirus family, affects mainly unvaccinated young children and unvaccinated pregnant women. However, any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected, notes the WHO.

A recently-published article in The Lancet has therefore called for urgent international action to prevent potentially devastating measles epidemics in the years to come.

As a result of resources and attention shifting to the pandemic, many children have missed out on measles vaccination this year, making future measles outbreaks inevitable, said lead author Professor Kim Mulholland, from the Murdoch Children’s Research Institute and Chair of the WHO’s SAGE Working Group on measles and rubella vaccines.

Economic impact of lockdown, malnutrition, and measles

The year 2020 has been a quiet year for measles, thanks to travel reductions and national Covid-19 control measures implemented globally. However, the resulting economic impact could have a direct effect on the proliferation of the disease, especially against the background of childhood malnutrition.

The severity of measles can be worsened through malnutrition, the authors wrote, leading to poorer outcomes and more deaths, especially in low- and middle-income countries. (Measles is particularly common in parts of Africa and Asia, where the majority – more than 95% – of measles deaths occur in countries with low per capita incomes and weak health infrastructures.)

“Children who die from measles are often malnourished, but acute measles pushes many surviving children into malnutrition,” Mulholland said.

“Malnutrition, along with measles-associated immune suppression, leads to delayed mortality, while co-existing vitamin A deficiency can also lead to measles-associated blindness.

“The coming months are likely to see increasing numbers of unimmunised children who are susceptible to measles. Many live in poor, remote communities where health systems are less resilient, and malnutrition and vitamin A deficiency are already increasing.”

Vaccination campaigns also halted during pandemic

Mulholland also expressed concern about the negative effect the Covid-19 pandemic has had on the control of vaccine-preventable diseases, as a result of vaccination campaigns being paused during some months in 2020, and routine immunisation services disrupted in many countries.

By the end of October 2020, the WHO estimated that delayed vaccination campaigns in 26 countries led to 94 million children missing scheduled measles vaccine doses.

“All these factors create the environment for severe measles outbreaks in 2021, accompanied by increased death rates and the serious consequences of measles that were common decades ago,” Mulholland said.

“This is despite the fact that we have a highly cost-effective way to prevent this disease through measles vaccination.”

The return of measles in 2019

Before Covid-19 swept the globe, there was already a dramatic return of measles – more than at any time in the past 20 years, the researchers stated.

According to WHO data, there were 9.8 million measles cases and 207 000 deaths in 2019, a staggering 50% more than in 2016.

Where have most cases occurred?

Africa has seen the large majority of measles-related deaths, with major outbreaks happening in Madagascar and the Democratic Republic of Congo. The disease also re-emerged in South America, especially among indigenous communities.

Mulholland explained that the inadequate vaccination that led to the 2019 measles outbreaks has still not been adequately addressed, adding that the situation has been exacerbated by service disruptions during the Covid-19 pandemic where high-risk, unimmunised children were clustered together in unreached communities.

The way forward: Proposed solutions

The authors proposed three pillars for immediate action:

• Help countries reach unimmunised children through catch-up immunisation and campaigns.
• Better prepare countries for expected outbreaks – the WHO and partners have developed a Strategic Response Plan to assist with measles outbreak prevention, preparedness and response.
• Maintain measles and rubella elimination targets. WHO’s new Measles Rubella Strategic Framework 2021–2030, aligned with the Immunization Agenda 2030 provides a plan for strengthening routine immunisation and surveillance.

“Without concerted efforts now, it is likely that the coming years will see an increase in measles and its severe, frequently fatal, complications,” Mulholland said, commenting that the proposed solutions might help end the outbreaks of the past decade.

READ | How measles complications can affect every organ

READ | Measles leaves people more vulnerable to future infections

READ | Vaccinations halted in several poor countries due to coronavirus fears

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South Africa has a long tradition of using plants for medicinal purposes. Some of these, such as Aloe ferox, Sutherlandia frutescens and Kiggelaria africana, have been studied as sources of useful compounds. But most still need to be scientifically validated as treatments for particular diseases.

Medicinal plants are gradually gaining prominence in scientists’ search for potential treatment agents for Covid-19. Currently there is no specific antiviral drug to treat this new respiratory disease. Most treatment strategies focus on managing symptoms and supportive therapy such as supplementary oxygen and mechanical ventilation.

My colleagues and I from the Durban University of Technology and the University of KwaZulu-Natal in South Africa are among the researchers looking for potential Covid-19 treatments from plants. We recently completed the first phase of our project, which ultimately seeks to develop a novel SARS-CoV-2 therapeutic.

Our aim in the first phase was to identify bioactive compounds in plants that are indigenous to South Africa which could be effective against SARS-CoV-2, the virus that causes Covid-19. We looked for potential Covid-19 therapeutic agents from a list of 29 bioactive compounds.

The species chosen were based on their use for the common cold, flu, other respiratory conditions, antimalarial, antiviral and antioxidant activity.

Our initial findings show that some compounds had the potential to inhibit SARS-CoV-2. We are now in the second phase of our study, which will test the compounds rigorously in the laboratory. This is a starting point in the search for a novel SARS-CoV-2 therapeutic.

From plant extract to therapeutic

In the initial stage of this project we worked with collaborators from the University of KwaZulu-Natal, Bio-computational and drug design laboratory. The team screened potential bioactive compounds isolated from commonly used South African medicinal plants using molecular docking.

Molecular docking is the study of how two or more molecular structures (for example, a drug and an enzyme or protein) fit together. Protein-binding may affect drug activity in one of two ways: either by changing the effective concentration of the drug at its site of action or by changing the rate at which the drug is eliminated, thus affecting the length of time for which effective concentrations are maintained.

We performed molecular docking of the plant compounds against SARS-CoV-2, using biocomputational analysis.

Some of the plant compounds showed potential. These were from Acacia senegal, Sutherlandia frutescens, Hypoxis hemerocallidea, Xysmalobium undulatum and Aspalathus linearis (commonly known as rooibos).

They exhibited favourable binding orientations and were identified as potential inhibitors of the SARS-CoV-2 receptor binding domain and SARS-CoV-2 RNA-dependent polymerase.

Four compounds exhibited extremely good binding to the virus, meaning that these compounds may prevent the virus from replicating.

These compounds could serve as a starting point for the discovery of a novel SARS-CoV-2 therapeutic.

Next steps

For the next stage we will infect animal cells with the virus. Then we’ll administer the compounds (cytotoxicity screening) to see what effect they have. If this in vitro study shows promising results, further analysis will be conducted using an animal model. The effects of the compounds on infected rats will be monitored.

Our end goal is to finally have a successful treatment for this virus. Infections can still occur even when a safe and effective vaccine is available. This is why it’s important to ensure effective treatments are also part of the efforts to end Covid-19.

No traditional African medicine has been scientifically validated yet as a treatment for SARS-CoV-2.

We are now in the second phase of our study, which will test the compounds rigorously in the laboratory if funding can be found. This depends on a lot of different factors.

We will be working with collaborators from the University of KwaZulu-Natal’s Department of Virology, where the analysis will take place.

Depika Dwarka, Post doctoral Fellow, Durban University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

• High blood sugar levels in Covid-19 patients are a major red flag, even if they don’t have diabetes.
• A large Spanish study found this to be especially true when levels are high upon admission to hospital.
• Hyperglycaemia should be actively monitored and treated in Covid-19 patients to reduce mortality rates.

The deadly impact of Covid-19 on diabetic patients has been well-established during the coronavirus pandemic, but more research is showing that high blood sugar can be fatal, even if you don’t suffer from diabetes.

Earlier research in July first revealed this sinister complication in coronavirus patients, and the latest study from Spain is the largest to date, using data from more than 11 000 patients.

Published in Annals of Medicine, the study took a closer look at the blood sugar levels of Covid-19 patients at the time of their hospital admission, regardless of their diabetic status.

READ | High blood sugar in Covid-19 patients who have never had diabetes can cause death

Early warning sign

The researchers established that high blood sugar – also known as hyperglycaemia – upon non-critical admission is an early warning sign that a Covid-19 patient might need mechanical ventilation and have a higher risk of death. 

In those without diabetes, hyperglycaemia can be triggered by infection, trauma, medications and other chronic conditions.

“Although several studies and meta-analyses have shown that patients with diabetes have a significantly higher risk of severe Covid-19 and increased mortality rates,” write the researchers, “the impact of hyperglycaemia itself, rather than the presence of [diabetes], has not been sufficiently described in non-critical patients hospitalised with Covid-19”.

What is the link between blood sugar and Covid-19?

One theory suggests that the virus’s infection of endocrine pancreas cells can disrupt the body’s insulin management, while another highlights that the inflammation a body endures during an infection can increase insulin resistance.

“One question that remains to be answered is whether hyperglycaemia plays any role in the physiopathology of the disease or if it is just an inflammatory bystander,” the study speculates.

Using data from 11 312 Covid-19 patients from 109 hospitals in Spain, they looked at admission hyperglycaemia in non-critical patients and its link to the length of hospital stay, ICU admission, mechanical ventilation and death.

The study, however, didn’t include patients who developed hyperglycaemia while in the hospital due to treatments and medications.

READ MORE | More evidence shows why Covid mortality rate is higher in men

High glucose levels, higher death rate

The patients were assigned to three groups based on their blood sugar levels – less than 140mg/dL, between 140 and 180 mg/dL, and more than 180mg/dL. Only about 18.9% of the group was classified as diabetic, and those with high levels tended to be older, male and mostly had some history of diabetes, hypertension and other chronic conditions.

Just more than 20% of the patients died in the hospital and, out of the mortalities, 41.1% were in the high blood glucose group, 33% from the middle range and 15.7% below 140mg/dL.

“Indeed, there was a gradual increase in all-cause mortality as admission [blood glucose] levels increased, and there were no differences in mortality rates within each category of [blood glucose] levels between patients with or without a previous history of diabetes,” explain the researchers.

Early monitoring important 

Even compared to other factors like age, gender, hypertension, chronic obstructive pulmonary disease and anaemia, high blood sugar levels still stood out as a predictor for mortality from Covid-19.

Those with elevated levels also tended to stay in hospital for longer and were more likely to be admitted to ICU and go on a ventilator.

The results from the study highlight the importance of blood glucose monitoring in Covid-19 patients, even if they don’t have diabetes, especially in the early stages of infection and hospitalisation.

“Early correction of hyperglycaemia in the course of Covid-19 could result in a decrease in the release of inflammatory cytokines and a reduction in the virus’s ACE binding capacity, consequently resulting in better outcomes,” the researchers concluded.

READ | Covid-19: An extensive study of the outbreak in Spain found most people did not develop immunity

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When you think of swimming, you probably imagine pushing through the water — creating backwards thrust that pushes you forward. New research at the Marine Biological Laboratory (MBL) suggests instead that many marine animals actually pull themselves through the water, a phenomenon dubbed “suction thrust.”

Anthraquinones are a class of naturally occurring compounds prized for their medicinal properties, as well as for other applications, including ecologically friendly dyes. Despite wide interest, the mechanism by which plants produce them has remained shrouded in mystery until now.

A common insecticide that is a major hazard for honeybees is now effectively detected in honey thanks to a simple new method.

In the long dark tunnel that has been 2020, November stands out as the month that light appeared. Some might see it as a bright light, others as a faint light – but it is unmistakably a light.

On November 9, Pfizer announced the interim results of its candidate vaccine, showing it to be “more than 90% effective” in preventing symptomatic Covid-19 in late-stage human trials. The news was greeted with joy.

A couple of days later, the Russian Direct Investment Fund announced that the candidate vaccine they are funding – dubbed Sputnik V – showed 92% efficacy in late-stage trials. Not to be outdone, Moderna then announced that its candidate vaccine showed 94.5% efficacy.

The latest Covid-19 vaccine announcement comes from Oxford University. And, as with all of the above announcements, it came via press release. Its vaccine candidate, developed in partnership with AstraZeneca, showed an overall effectiveness of 70.4%.

In case that sounds disappointing, bear in mind that these are interim results and the figures might change. Also, the Oxford vaccine was given to one group of volunteers as two standard doses, which showed 62% effectiveness, and another group of volunteers as a smaller dose followed by a standard second dose. This raised effectiveness to 90%.

It’s not immediately clear why this is the case. Professor Andrew Pollard, one of the lead researchers on the project, described the results as “intriguing”. He also highlighted that the use of lower doses means that there would be more vaccine doses available.

There were no cases of severe Covid-19 in those who received the vaccine. And it seems to generate a protective immune response in older people. Although we’ll have to wait for the final breakdown of results to get clarification on that.

Effectiveness is not the only measure

Despite the Oxford vaccine having lower overall effectiveness than the Pfizer or Moderna vaccines – at least at this interim stage – there are other success factors to consider. Safety is one, and the Oxford vaccine is so far reported to have a good safety record with no serious side-effects.

Another crucial factor is storage. The Oxford vaccine can be stored in a domestic fridge. The need for sustained freezing across the whole vaccine journey from factory to clinic at ultra-low temperatures – as seen with the Pfizer vaccine – may be a problem for many countries, but especially poorer countries.

The Oxford vaccine, based on a viral vector, is also cheaper (around US$4) than Pfizer and Moderna’s mRNA vaccines – around US$20 and $33, respectively. AstraZeneca has made a “no profit pledge”.

Equitable distribution

As I have previously discussed, equitable distribution of new vaccines is vital, especially for low- and middle-income countries who don’t have the profile or purchasing power of wealthier countries. GAVI – a global health partnership that aims to increase access to immunisation in poor countries – has worked for years to address this very point.

It set up the COVAX initiative in 2020, which has access to 700 million doses of Covid vaccine if clinical trials are successful.

Oxford and AstraZeneca have previously made their own commitments to provide a billion doses of their vaccine for low- and middle-income countries, with a commitment to provide 400 million doses before the end of 2020.

Certainly, AstraZeneca has committed to provide more doses to countries outside of Europe and the US than any of its nearest competitors.

An excellent start

These commitments will clearly not be enough for immediate global coverage, but it is an excellent start. Around 9% of the world’s population live in extreme poverty, and the health systems around them are fragile.

With promises for equitable vaccine distribution, there is hope that the poorer populations around the world will not be forgotten. The global health community must keep its focus on this area.

What does this announcement mean for the world? Potentially a huge amount. But remember that the trials are not yet complete and, at the time of writing, the regulators have yet to approve any of the new vaccine candidates.

Even when those hurdles are cleared, we still need to vaccinate the world, which requires successfully navigating the complex obstacles of distance, terrain, politics, cold-chain logistics and human behaviour.

The global pandemic is not over and won’t be for a long time yet – but the light is getting brighter.

Michael Head, Senior Research Fellow in Global Health, University of Southampton

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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• Growth measured in height and weight recognised as a measure of health
• Imbalance between investment in improving nutrition in pre-schoolers, and in school-aged children and adolescents
• In SA, polices needed to to support an enabling environment

“Tall as trees” sounds very clichéd but it may not apply to children in many sub-Saharan African countries, according to a Lancet article reporting on children’s height and weight changes over the past thirty years. 

The Lancet article pooled data from over two thousand studies from two hundred countries with a study population of 65 million participants and reported on the projected changes of height and body-mass index (BMI) of school-aged children and adolescents from 1985 to 2019. 

The data showed that the unhealthiest changes – gaining too little height and/or too much weight for their height occurred in many countries in sub-Saharan Africa, including South Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls.

Growth measured in height and weight has long been recognised as a measure of the health of individuals, hence part of the reasoning for the promotion of routine growth monitoring for children under five years of age. In South Africa, every child is presented with a Road to Health Booklet to record and monitor their weight and height measures from birth.

Mothers and caregivers are encouraged to visit their health facility for monthly growth monitoring to track their child’s growth and development as a proxy for health. 

A major public health concern

Malnutrition identified in the failure to grow in height and weight is a major public health concern worldwide. In South Africa, 27% of children younger than five years are too short for their age and in the same age group, 15% are too fat. These indicators serve as proxies for the state of overall health.

As reflected in the Lancet article, young South African children are too short and too fat.Our adolescent nutrition profile does not paint a much better picture, with 6.1% males and 16.7% females in the age group 15-19 years overweight and their average height below the global average of 1.62m. 

The Lancet reported that 19-year-old boys in 11 countries throughout Asia, Latin America, and sub-Saharan Africa had the same mean height as that of Dutch boys aged 13 years. In many countries in sub-Saharan Africa, with emerging economies, the height of children and adolescents, especially boys, has on average stagnated or become shorter since 1985.

This points directly to the increasing levels of poverty driving the vicious cycle of malnutrition as households and communities struggle to access adequate and sufficiently nutritious food. The Lancet reported that the largest improvements in average height of children over the 35-year period were seen in emerging economies such as China, South Korea and some parts of southeast Asia.

For example, 19-year-old boys in China in 2019 were 8cm taller than in 1985, with their global rank changing from 150th tallest in 1985 to 65th in 2019. Over the same period, the average height of South African girls stagnated, while boys gained only around 2cm.

Nineteen-year-old South African girls had the same average height as 12-year-old Dutch girls, while South African boys of the same age had the average height of 14-year-old Dutch boys. 

South Africa is mentioned in the report as one of the countries where children compared fairly well with international growth references at the age of five years, but by the time they reached 19 years, they fell behind due to insufficient growth in height during school-age years.

While little or no height was gained per year of age, the girls in particular gained weight, so that the average weight of South African girls in each age group was markedly higher after 2010 than in the 1980s and was in the overweight range at age 19 years.

Falling behind

The Lancet report also highlighted that while children in some countries grow healthily to age five years, they fall behind in the school years in terms of growth in length.

This highlights that there is an imbalance between investment in improving nutrition in pre-schoolers, and in school-aged children and adolescents. This issue was especially important during the Covid-19 pandemic when schools were closed throughout the world, and many poor families are unable to provide adequate nutrition for their children.

This recognition that school feeding is an important and integral intervention to promote and sustain child nutrition, prompted civil society in South Africa to approach the courts to force government to reinstate the national school nutrition programme.

While many school-aged children do not have access to adequate nutritious food for linear growth and physical development, they seem to have high enough intakes of sweetened cold drinks and cheap snack foods to gain excessive weight. Some of these cold drinks and snacks are even available in the school environment at low cost.

This is probably an important driver of the weight gain reported in South African school-age girls.

Ensure food security

The Lancet report re-affirms the imperative to sustain adequate food and nutrition support throughout the critical stages of life including during pregnancy, early childhood, adolescent and adult years to consolidate and reap the benefits gained in food and nutrition interventions and investments in infants and children younger than five years.

This is imperative because adolescents and women of child-bearing age are the future parents of the next generation of children. 

Mothers with poor nutritional status will bear children with poor nutritional status and this is a lost and costly opportunity as malnutrition castes a long shadow into the future robbing individuals, communities and countries of health, well-being and development.

If we are to improve child health and nutrition, governments need to ensure food security.

Food security is defined as all people at all times having physical and economic access to adequate amounts of nutritious, safe, and culturally appropriate foods. This will help children grow taller without gaining excessive weight for their height. 

To achieve these goals, South Africa needs policies to support an enabling environment, with restricted access to unhealthy foods and drinks and more access to facilities in the community and in the school environment for safe play and sports.

*Dr Witten is at based the University of the Free State’s Faculty of Health Sciences, Division of Health Science Education. Kruger is a Professor at the North-West University’s Centre of Excellence for Nutrition.

*This article was produced by SPOTLIGHT – health journalism in the public interest. SIGN UP for our newsletter.

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The first drug against HIV brought dying patients back from the brink. But as excited doctors raced to get the miracle drug to new patients, the miracle melted away. In each and every patient, the drug only worked only for a while.

It turned out the drug was very good at killing the virus, but the virus was even better at evolving resistance to the drug. A spontaneous mutation in the virus’ genetic material prevented the drug from doing its work, and so the mutant viruses were able to replicate wildly despite the drug, making the patients sick again. It took another decade before scientists found evolution-proof therapies.

Could the same thing happen to a Covid-19 vaccine? Could a vaccine that is safe and effective in initial trials go on to fail because the virus evolves its way out of trouble? As evolutionary microbiologists who have studied a poultry virus that has evolved resistance to two different vaccines, we know such an outcome is possible. We also think we know what it takes to stop it. Covid-19 vaccines could fail – but if they have certain properties, they won’t.

History of vaccine resistance

For the most part, humanity has been lucky: Most human vaccines have not been undermined by microbial evolution.

For instance, the smallpox virus was eradicated because it never found a way to evolve around the smallpox vaccine, and no strain of the measles virus has ever arisen that can beat the immunity triggered by the measles vaccine.

But there is one exception. A bacterium that causes pneumonia managed to evolve resistance against a vaccine. Developing and replacing that vaccine with another was expensive and time-consuming, with seven years between the initial emergence of resistant strains and the licensing of the new vaccine.

There haven’t been other failures for human vaccines yet, but there are hints that viruses, bacteria and parasites can evolve or are evolving in response to vaccination. Escape mutants that are able to evade vaccine-induced immunity are regularly seen in the microbes that cause hepatitis B and pertussis.

For such human diseases as malaria, trypanosomiasis, influenza and AIDS, vaccines have been hard or impossible to develop because the microbes that cause those diseases evolve so fast. In agricultural settings, animal vaccines are frequently undermined by viral evolution.

What would it look like?

If SARS-CoV-2 evolves in response to a Covid vaccine, there are several directions it could take. The most obvious is what happens with the flu virus. Immunity works when antibodies or immune cells bind to molecules on the surface of the virus. If mutations in those molecules on the surface of the virus change, antibodies can’t grab on to them as tightly and the virus is able to escape.

This process explains why the seasonal flu vaccine needs updating each year. If this happens, a Covid vaccine would need frequent updating.

But evolution might head off in other directions. It would be better for human health, for example, if the virus evolves a stealth mode, perhaps by reproducing slowly or hiding in organs where immunity is less active. Many pathogens that cause barely noticeable chronic infections have taken this tack. They avoid detection because they do not cause acute disease.

A more dangerous avenue would be if the virus evolved a way to replicate more quickly than the immunity generated by the vaccine. Another strategy would be for the virus to target the immune system and dampen vaccine-induced immunity.

Many microbes can survive inside the human body because of their exquisite ability to interfere with our immune systems. If SARS-CoV-2 has ways of even partially disabling human immunity, a Covid vaccine could favor mutants that do it even better.

Evolution-proof vaccines

Before Covid came along, the two of us compared vaccines that keep working with vaccines that have been undermined by pathogen evolution.

It turns out that truly evolution-proof vaccines have three features. First, they are highly effective at suppressing viral replication. This stops further transmission. No replication, no transmission, no evolution.

Second, evolution-proof vaccines induce immune responses that attack several different parts of the microbe at the same time. It is easy for a single part of the virus to mutate and escape being targeted. But if many sites are attacked at once, immune escape requires many separate escape mutations to occur simultaneously, which is almost impossible.

This has already been shown in the laboratory for SARS-CoV-2. There the virus rapidly evolved resistance to antibodies targeting a single site, but struggled to evolve resistance to a cocktail of antibodies each targeting multiple different sites.

Third, evolution-proof vaccines protect against all circulating strains, so that no others can fill the vacuum when competitors are removed.

Will a Covid vaccine be evolution-proof?

Around 200 Covid vaccine candidates are at various stages of development. It is too soon to know how many of them have those evolution-proofing features.

Fortunately we don’t need to wait until a licensed vaccine fails to find out. A bit of extra effort during vaccine trials can go a long way to working out whether a vaccine will be evolution-proof. By swabbing people who have received the experimental vaccine, scientists can tell how far virus levels are suppressed.

By analysing the genome of any virus in vaccinated people, it might be possible to see evolutionary escape in action. And by taking blood from vaccinees, we can work out in the lab how many sites on the virus are being attacked by vaccine-induced immunity.

Clearly, the world needs Covid vaccines. We believe it is important to pursue those that will keep working. Likely, many candidates in the current portfolio will. Let’s work out which those are in clinical trials and go with them. Vaccines that provide only temporary relief leave people vulnerable and take time and money to swap out. They may also negate other vaccines should viruses evolve that are resistant to several vaccines at once.

Today, the world has insecticide-resistant mosquitoes and crop pests, herbicide-resistant weeds, and an antibiotic resistance crisis. No need for history to repeat itself.

Andrew Read, Evan Pugh University Professor of Biology and Entomology, Eberly Professor of Biotechnology, Director, Huck Institutes of the Life Sciences, Penn State and David Kennedy, Assistant Professor of Biology, Penn State

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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• Two Covid-19 vaccine trials have shown promising results during recent weeks
• Vaccines could start reaching people before the end of the year, experts say
• However, the threat of vaccine nationalism has increasingly become a concern

Two vaccine candidates from pharmaceutical and biotech companies Pfizer and Moderna have shown promising results, but African countries need to ensure they aren’t left behind when vaccine rollouts start happening.

These were the words of the Regional Director of the World Health Organization (WHO) Regional Office for Africa, Dr Matshidiso Moeti, during a virtual discussion hosted by Doha Debates on Wednesday.

“It’s true we need to wait for full efficacy and safety data to be available, but we are all gearing up to make sure there is equitable distribution in Africa,” Moeti said. “Coming from Africa, I have to say our experience in the past has been that when a new technology comes out, African countries are at the back of the queue to get it.

“We’ve seen sometimes it takes a decade for a new technology to be available in Africa, in a scaled-up fashion in our health systems.”

‘Vaccine nationalism’

In comments made earlier this year, Professor Helen Rees, executive director of the Wits Reproductive Health and HIV Unit (RHI), stressed that the opportunity to participate in trials must ensure that Africa is not left behind like it was in the past.

If trials are limited to the North, Rees cautioned that it will result in “vaccine nationalism”, which typically occurs when a country’s government manages to secure vaccine doses for its own citizens before it’s made available to other countries – something that has already been seen in the US and UK. 

According to The Telegraph, the UK has already put in an order for five million doses of the Moderna vaccine, while CNBC reported in July that the US struck an agreement with Pfizer to get 100 million doses of their vaccine, and acquire 500 million additional doses if needed.

Rees commented then on the crisis with the pandemic flu vaccine and HIV antiretrovirals in the past, where Africa got left behind and ultimately received very little vaccine and months too late. “We cannot allow that to happen again,” she said. 

COVAX Facility

Moeti also drew attention to the COVAX Facility – led by Gavi, the Vaccine Alliance, along with the WHO and the Coalition for Epidemic Preparedness Innovation – an alliance that finances vaccine development in order to guard against inequity in the distribution of the vaccine to developing countries.

By September, the Gavi COVAX Advance Market Commitment (AMC) had raised around US$ 700 million from sovereign donors as well as philanthropy and the private sector, against an initial target of US$ 2 billion in seed funding needed by the end of 2020, the WHO stated.

Funding the Gavi COVAX AMC is critical to ensuring that the ability to pay is not a barrier to accessing Covid-19 vaccines, “a situation which would leave the majority of the world unprotected, with the pandemic and its impact continuing unabated”, the organisation noted.

However, Moeti cautioned that wealthier countries, mainly the Western countries, are already entering into advanced purchase agreements with vaccine manufacturers to reserve doses. 

“From the African perspective, we are very concerned but also hoping that we hold to this principle of equity and that we don’t have deals being entered into with countries that then sweep up the supplies,” Moeti said.

Moeti said that they are hoping for at least 20% of populations to be covered in Africa, initially, starting with the most vulnerable. “We hope we do not have inequality based on geography, income level of countries and also racial inequality,” she commented.

Covid-19 vaccine for distribution in Africa: Where do we stand?

South Africa had not yet managed to secure any doses of vaccines from Pfizer, whose vaccine was shown to be over 95% efficacious this week, or any other manufacturer, Spotlight recently reported, adding that the country also missed the first deadline to commit to COVAX.

However, spokesman for the Department of Health, Popo Maja, confirmed to Spotlight that although SA had not concluded any vaccine deal, negotiations with manufacturers and COVAX were underway.

“My staff and I, with partners, are doing all our best to persuade the African countries to go for it, to go looking for the money. Let’s have a pooled approach so that we constitute a market that’s going to be competing,” said Moeti.

“We’re working with the African countries to get ready now. In fact, we are doing an assessment of their readiness and preparing to roll out the vaccine in terms of all the logistics, the technical work that needs to be done. 

“I do think one of the best experiences from the HIV era was the solidarity among people. Covid-19 has become very political, much more than HIV did,” she said.

READ | Pfizer ends Covid-19 vaccine trial with 95% efficacy, to seek emergency-use authorisation in US

READ | Covid-19: Two of the vaccine front runners have already reported promising evidence – so what now?

READ | Why vaccines need to be tried and tested in different populations across the world

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