The Supreme Court of Appeal has dismissed an application for leave to appeal by Solidarity and Afriforum over a 2021 court case where they challenged a condition by South African Health Products Regulatory Authority (SAHPRA) that the Johnson & Johnson vaccine be restricted to the government. SAHPRA said that this was not a condition that they had imposed.
On 26 July 2023, the Supreme Court of Appeal (SCA) dismissed an application for leave to appeal filed by Solidarity and Afriforum (the Applicants) on the grounds that there is no reasonable prospect of success.
The Pretoria High Court struck Solidarity and AfriForum’s application from the court roll on the grounds of an alleged lack of urgency, and the court also ordered them to pay SAHPRA’s legal costs which was filed in June 2021 by the Applicants, wherein they alleged that when SAHPRA approved and registered the J&J vaccine, SAHPRA imposed a condition that the sale of the J&J vaccine is restricted to the National Government. The applicants argued that SAHPRA was not mandated to stipulate the condition that only the government may purchase the J&J vaccine and questioned the legality of such a condition.
SAHPRA refuted this claim because this is not a condition that SAHPRA had imposed. Subsequently, the applicants proceeded to lodge an application for leave to appeal with the SCA . SAHPRA CEO, Dr Boitumelo Semete-Makokotlela said, “This court ruling indicates that SAHPRA is judicious in adhering to its mandate responsibly. We welcome the outcome of this judgement.”
Vaccination protects against severe COVID but not against infection. Researchers in Sweden now show that protection against infection with the new omicron variants is linked to mucosal IgA antibodies, which are not induced by vaccination. These are the findings of two studies recently published in The Lancet Infectious Diseases, and The Lancet Microbe, and could explain the limited protection by currently available vaccines against infection.
Researchers from Karolinska Institut and Danderyd Hospital conducted the COMMUNITY study, which enrolled 2149 healthcare workers in the spring of 2020. Study participants and their immune responses against SARS-CoV-2 have continuously been monitored through regular blood and airway samplings complemented with PCR screenings.
A subset of 447 participants were enrolled in a weekly PCR screening study detecting SARS-CoV-2 infections in the autumn of 2022. Mucosal IgA in nasal samples and serum IgG were determined at enrolment. The results, published in The Lancet Infectious Diseases, revealed a 50% risk reduction for infection with the newer Omicron variants if detectable mucosal IgA at baseline.
Stronger protection with higher antibody levels
Protection against infection increased with increasing mucosal IgA levels, with a 25% risk reduction for every 2-fold increase. Moreover, mucosal IgA had a higher cross-binding capacity to other SARS-CoV-2 variants as compared to serum IgG, and there was no association between high serum IgG levels and protection against infection.
“While there was a clear link between serum IgG and protection against infection with previous SARS-CoV-2 variants, our findings now question the use of serum IgG levels as a correlate to protection against infection with recent Omicron variants” says Ulrika Marking, PhD student at the Department of Clinical Sciences at Karolinska Institutet and Danderyd Hospital, and first author.
Limited vaccine protection
Another sub study, initiated in fall of 2023 and recently published in The Lancet Microbe, investigated mucosal antibody responses to a fourth mRNA booster dose. Mucosal IgA in nasal samples and serum IgG in blood were analysed from 24 participants before and at repeated time points after the booster dose.
While serum IgG levels increased as expected, the fourth vaccine dose did not affect mucosal IgA levels.
“Currently available intramuscular vaccines continue to protect against severe disease and death, but their ability to protect against infection with the new omicron variants is limited” says Oscar Bladh, PhD student and first author.
“The findings from these two studies underscore the need for the development of novel vaccine platforms capable of inducing robust mucosal immune responses protecting against respiratory viral infections”, says Charlotte Thålin, associate professor at the Department of Clinical Sciences at Karolinska Institutet and Danderyd Hospital, and principal investigator of the COMMUNITY study.
“Although the primary aim of vaccination is to protect against severe disease and death, it is also crucial to prevent infection and viral transmission of respiratory viral families with high epidemic or pandemic potential”.
The COMMUNITY study continues with regular samplings from blood and mucosa, monitoring immune responses after repeated SARS-CoV-2 infections and vaccinations.
Researchers from King’s College London have found that people with longer-term COVID symptoms including brain fog showed reduced performance in tasks testing different mental processes – up to two years after infection with the virus, according to results published in the journal eClinicalMedicine.
Researchers examined whether COVID infection affected performance in two rounds of online cognitive testing that took place in 2021 and 2022. Data was collected for over 3000 participants of the COVID Symptom Study Biobank study, across 12 tasks that tested memory, attention, reasoning, processing speed and motor control.
The participants whose test scores were most affected by COVID were those who had experienced symptoms related to the virus for 12 weeks or more. In these people, the effect of COVID on test accuracy was comparable in size to the effect of a 10-year increase in age.
There was no significant improvement in these test scores between the two rounds of testing, which took place nine months apart. By the second round of testing, the average time since participants’ initial COVID infection was almost two years.
The researchers then separated participants by whether they felt fully recovered following COVID infection. People who felt fully recovered after COVID infection performed similarly to those who had not had the virus at all. In contrast, participants who did not feel fully recovered after infection had lower task accuracy scores on average.
Lead author Dr Nathan Cheetham, a Senior Postdoctoral Data Scientist at King’s College London said:
“Our findings suggest that, for people who were living with long-term symptoms after having COVID, the effects of the coronavirus on mental processes such as the ability to recall words and shapes are still detectable at an average of almost two years since their initial infection.
“However, the result that COVID had no effect on performance in our tests for people who felt fully recovered, even if they’d had symptoms for several months and could be considered as experiencing ‘long COVID’, was good news. This study shows the need to monitor those people whose brain function is most affected by COVID-19, to see how their cognitive symptoms continue to develop and provide support towards recovery.”
Professor Claire Steves, a Professor of Ageing and Health at King’s College London, added:
“We used sensitive tests to measure speed and accuracy across a range of brain challenges. This study shows that some individuals have measurable changes in these tests after COVID-19 going on for nearly two years. The fact remains that two years on from their first infection, some people don’t feel fully recovered and their lives continue to be impacted by the long-term effects of the coronavirus. We need more work to understand why this is the case and what can be done to help.”
Research led by the University of Bristol has found that long COVID is not caused by an immune inflammatory reaction to COVID. Emerging data shows that immune activation may persist for months after contracting COVID. In this new study, published in eLife, researchers wanted to find out whether persistent immune activation and ongoing inflammation response could be the underlying cause of long COVID.
To investigate this, the Bristol team collected and analysed immune responses in blood samples from 63 patients hospitalised with mild, moderate or severe COVID at the start of the pandemic and before vaccines were available. The team then tested patients’ immune responses at three months and again at eight and 12 months post hospital admission. Of these patients, 79% (82%, 75%, and 86% of mild, moderate, and severe patients, respectively) reported at least one ongoing symptom with breathlessness and excessive fatigue being the most common.
Dr Laura Rivino, the study’s lead author, explained: “Long Covid occurs in one out of ten COVID cases, but we still don’t understand what causes it. Several theories proposed include whether it might be triggered by an inflammatory immune response towards the virus that is still persisting in our body, sending our immune system into overdrive or the reactivation of latent viruses such as human cytomegalovirus (CMV) and Epstein Barr virus (EBV).”
The team found patients’ immune responses at three months with severe symptoms displayed significant dysfunction in their T-cell profiles indicating that inflammation may persist for months even after they have recovered from the virus. Reassuringly, results showed that even in severe cases inflammation in these patients resolved in time. At 12 months, both the immune profiles and inflammatory levels of patients with severe disease were similar to those of mild and moderate patients.
Patients with severe COVID were found to display a higher number of long Covid symptoms compared to mild and moderate patients. However, further analysis by the team revealed no direct association between long COVID symptoms and immune inflammatory responses, for the markers that were measured, in any of the patients after adjusting for age, sex and disease severity.
Importantly, there was no rapid increase in immune cells targeting SARS-CoV-2 at three months, but T-cells targeting the persistent and dormant Cytomegalovirus (CMV) – a common virus that is usually harmless but can stay in your body for life once infected with it – did show an increase at low levels. This indicates that the prolonged T-cell activation observed at three months in severe patients may not be driven by SARS-CoV-2 but instead may be “bystander driven” ie driven by cytokines.
Dr Rivino added: “Our findings suggest that prolonged immune activation and Long COVID may correlate independently with severe COVID. Larger studies should be conducted looking at both a larger number of patients, including if possible vaccinated and non-vaccinated COVID patients, and measuring a larger range of markers and cytokines.
“Understanding whether inflammation and immune activation associate with Long COVID would allow us to understand whether targeting these factors may be a useful therapy for this debilitating condition.”
Patients who had heart attacks during the first COVID lockdown in the UK and Spain are predicted to live 1.5 and 2 years less, respectively, than their pre-COVID counterparts. That’s the finding of a study just published in European Heart Journal – Quality of Care and Clinical Outcomes.
“Restrictions to treatment of life-threatening conditions have immediate and long-term negative consequences for individuals and society as a whole,” said study author Professor William Wijns of the Lambe Institute for Translational Medicine, University of Galway, Ireland. “Back-up plans must be in place so that emergency services can be retained even during natural or health catastrophes.”
Research has shown that during the first wave of the pandemic, about 40% fewer heart attack patients went to hospital as governments told people to stay at home, fear of catching the virus, and the stopping of some routine emergency care. Compared to receiving timely treatment, heart attack patients who stayed at home were more than twice as likely to die, while those who delayed going to the hospital were nearly twice as likely to have serious complications that could have been avoided.
Heart attacks require urgent treatment with stents (called percutaneous coronary intervention or PCI) to open the blocked artery and restore blood flow. Delays, and the resulting lack of oxygen, lead to irreversible damage of the heart muscle and can cause heart failure or other complications. When a large amount of heart tissue is damaged, potentially fatal cardiac arrest results.
This study estimated the long-term clinical and economic implications of reduced heart attack treatment during the pandemic in the UK and Spain. The researchers compared the predicted life expectancy of patients who had a heart attack during the first lockdown with those who had a heart attack at the same time in the previous year. The study focused on ST-elevation myocardial infarction (STEMI), where a coronary artery is completely blocked. The researchers also compared the cost of STEMIs during lockdown with the equivalent period the year before.
A model was developed to estimate long-term survival, quality of life and costs related to STEMI. The UK analysis compared the period 23 March (when lockdown began) to 22 April 2020 with the equivalent time in 2019. The Spanish analysis compared March 2019 with March 2020 (lockdown began on 14 March 2020). Survival projections considered age, hospitalisation status and time to treatment using published data for each country. For example, using published data, it was estimated that 77% of STEMI patients in the UK were hospitalised prior to the pandemic compared with 44% during lockdown. The equivalent rates for Spain were 74% and 57%. The researchers also compared how many years in perfect health were lost for patients with a STEMI before versus during the pandemic.
The analysis predicted that patients who had a STEMI during the first UK lockdown would lose an average of 1.55 years of life compared to patients presenting with a STEMI before the pandemic. In addition, while alive, those with a STEMI during lockdown were predicted to lose approximately one year and two months of life in perfect health. The equivalent figures for Spain were 2.03 years of life lost and around one year and seven months of life in perfect health lost.
The cost analysis focused on initial hospitalisation and treatment, follow-up treatment, management of heart failure and productivity loss in patients unable to return to work. For example, the cost applied to a STEMI admission with PCI was £2837 in the UK and €8780 in Spain. Heart failure costs were estimated at £6086 in year one and £3882 in all subsequent years for the UK. The equivalent figures for Spain were €3815 (year one) and €2930 (each subsequent year).
Professor Wijns said: “The findings illustrate the repercussions of delayed or missed care. Patients and societies will pay the price of reduced heart attack treatment during just one month of lockdown for years to come. Health services need a list of lifesaving therapies that should always be delivered, and resilient healthcare systems must be established that can switch to emergency plans without delay. Public awareness campaigns should emphasise the benefits of timely care, even during a pandemic or other crisis.”
In a concerning trend, a study of 17 000 people has revealed that public confidence in vaccines has plunged across sub-Saharan Africa since the COVID pandemic. The study, published in Human Vaccines & Immunotherapeutics, covered eight countries including South Africa – which saw one of the biggest falls in trust.
The findings come as the World Health Organization and UNICEF have reported the largest sustained fall in uptake of routine childhood immunisations in three decades. Six million fewer children in Africa received routine shots for diseases including tetanus, polio, diphtheria and measles over the past two years, and rising outbreaks threaten to reverse decades of progress against preventable diseases.
Previously, this was attributed to pdisruption of vaccination programs by the pandemic – however these new findings, which followed a study carried out by a team from London School of Hygiene & Tropical Medicine (LSHTM) and the Africa Centres for Disease Control and Prevention, suggest there could be other possible reasons too.
“Our study paints a worrying picture of declining vaccine confidence trends across many sub-national regions in sub-Saharan Africa, notably in the Democratic Republic of Congo, where confidence losses are particularly large,” states lead author Dr Alex de Figueirido, a Research Fellow at LSHTM.
The team’s results could be an early warning sign of wider scale loss in vaccine confidence, say the authors. Critically, regional losses in confidence – as seen in this study – could lead to clusters of non-vaccinated people which could have a negative impact on ‘herd immunity’ – the point at which a population is protected from a disease, either by enough people being vaccinated or by people having developed antibodies through having the disease.
The research involved face-to-face interviews with over 17 000 adults across eight sub-Saharan African countries: the Democratic Republic of Congo (DRC), Ivory Coast, Kenya, Niger, Nigeria, Senegal, South Africa and Uganda. The experts used sampling methods to get an accurate cross section of the population and to gain a picture of vaccine confidence at both national and regional levels.
Interviewees’ age, sex, religion, employment status and highest education level were recorded to help the researchers to analyse whether social background affected confidence in vaccines. The interviews were carried out in 2020 and again in 2022, after the pandemic.
Respondents were asked to say how strongly they agreed with statements such as ‘Vaccines are important for all ages’, ‘Vaccines are important for children’ and ‘Vaccines are safe’. They were also asked specifically about COVID vaccines, rating their agreement that COVID vaccines would be important, safe and effective – both before they had been developed (in 2020) and then after they had been developed and rolled out, in 2022.
Findings showed a fall in people’s view that vaccines are important for children across all eight countries between 2020 and 2022, particularly in DRC (20% decline), followed by Uganda (14%) and Nigeria (10.5%). In Nigeria and DRC, public confidence in vaccine safety and effectiveness also declined, and fewer people agreed that ‘vaccines are important for all ages’ in Ivory Coast, Kenya, Nigeria, South African and Uganda.
When it came to COVID vaccines, people thought they were less important in 2022 than they had in 2020 in seven out of the eight countries, with the biggest loss of trust in DRC, South Africa and Uganda. People in DRC, Kenya, Niger, Senegal and Nigeria thought that the COVID vaccine was less effective in 2022 than they had expected it to be in 2020. However, trust in the safety of the COVID vaccine stayed consistent over the two years.
In 2022, the over-60s were more likely than younger adults to agree that vaccines are generally safe, effective and important for children, but no other links were found between vaccine confidence and sex, education, employment status or religious affiliation.
“Early warning signals of confidence losses – such as those detected in this study – can provide time to respond, in the case of other epidemics, pandemics or other emerging crises,” adds co-author, Professor of Anthropology, Risk and Decision Science Heidi Larson, who is the Founding Director of the Vaccine Confidence Project at LSHTM.
“Confidence monitoring at sub-national resolutions can also provide clearer signals to the regions and groups facing confidence losses and can better prepare policymakers and stakeholders for potential losses in vaccine uptake.”
A thorough investigation is now needed to find out whether loss of confidence in COVID vaccines will trigger mistrust of other immunisation programmes, say the study authors.
“Considering global decreases in routine immunisation rates over the past two years, vaccine confidence losses could prove to be highly disruptive at this time when there are concerted efforts to address losses in routine immunization rates post pandemic. We need to understand the impact of the COVID pandemic on confidence in routine immunisation programmes, not just in Africa, but across the world,” says Dr Defigueirido.
“Understanding the role of the COVID pandemic and associated policies on wider vaccine confidence can inform post-COVID vaccination strategies and help rebuild immunisation system resilience.”
A new UK study has found that fatigue is the most significant symptom for long COVID patients, and can affect quality of life more than some cancers. The research, published in BMJ Open, examines the impact of long COVID on the lives of over 3750 patients who were referred to a long COVID clinic and used a digital app as part of their NHS treatment for the condition.
Patients were asked to complete questionnaires on the app about how long COVID was affecting them – considering the impact of long COVID on their day-to-day activities, levels of fatigue, depression, anxiety, breathlessness, brain fog, and their quality of life.
The researchers, from UCL and the University of Exeter, found that many long COVID patients were seriously ill and on average had fatigue scores worse or similar to people with cancer-related anaemia or severe kidney disease. Their health-related quality of life scores were also lower than those of people with advanced metastatic cancers, like stage IV lung cancer.
Overall, the team found that the impact of long COVID on the daily activities of patients was worse than that of stroke patients and was comparable to that of patients with Parkinson’s disease.
Dr Henry Goodfellow, who co-led the study alongside the late Professor Elizabeth Murray (both UCL Institute of Epidemiology & Health), said: “Up to around 17% of people who get COVID go on to develop long COVID *. However, the impact of the condition on patients’ day-to-day lives isn’t fully understood.
“Our results have found that long COVID can have a devastating effect on the lives of patients – with fatigue having the biggest impact on everything from social activities to work, chores and maintaining close relationships.”
Not only does long COVID negatively impact the lives of patients on an individual level, the researchers also believe that it could have a significant economic and social impact on the country.
In order to be referred to a long COVID clinic, a patient must have had symptoms in keeping with long COVID for at least 12 weeks after an acute infection.
Over 90% of long COVID patients using the app were of working age (18-65) and 51% said they had been unable to work for at least one day in the previous month, with 20% unable to work at all.
Meanwhile, 71% of patients were female. As working-age women make up a majority of the health and social care workforce, the impact of long COVID on their ability to function may add additional pressures to already stretched services.
Dr Goodfellow said: “We hope that a greater understanding of the symptoms and impact of long COVID in these patients will help the NHS and policymakers to target limited resources by adapting existing services and designing new ones to better meet the needs of patients with long COVID .”
Alongside fatigue, long COVID patients typically experience breathlessness, anxiety, depression and brain fog. This is the first study to report on the impact of the condition on day-to-day functioning and health-related quality of life in patients who have been referred for specialist rehabilitation in long COVID clinics across England.
Dr Goodfellow said: “Our findings show that fatigue should be an important focus for clinical care and the design of rehabilitation services.
“Post-COVID assessment services should consider focusing on assessing and treating fatigue to maximise the recovery and return to work for sufferers of long COVID .”
The ‘Phezulu: Looking Up’ podcast series launched today by UNICEF South Africa (https://www.UNICEF.org/SouthAfrica/) tells the stories of the impact of the COVID-19 years on children and young people and how, with the right support and opportunities, children and young people are determined to build a safer, fairer and better post pandemic South Africa.
The eight-part series delves into issues such as mental wellbeing, disrupted education and access to child healthcare; including routine childhood immunisations, through the voices of children and young people and experts working to mitigate the impact.
“Children and adolescents were affected by every aspect of the COVID-19 pandemic and this podcast series tells their stories of resilience,” said Muriel Mafico, UNICEF South Africa Deputy Representative. “Importantly, the episodes also reflect on the response to share learnings, including how the roll-out of the COVID-19 vaccine saved countless lives and re-opened our world,”
The podcast series features expert analysis and voices, including contributions from academics, all of whom continue to play a critical role in the ongoing recovery for every child. The series not only highlights the indirect impact of COVID-19 on children and youth, but also how COVID-19 vaccinations changed the trajectory of the crisis by enabling children and adolescents to resume their childhoods.
The series will be available on a weekly basis, on all major podcast platforms from 23rd May 2023. Listeners can now subscribe and join the conversation. This production was made possible thanks to the generous support of the German Federal Foreign Office and other partners.
A study that used data for 1.1 million children in Bavaria found that SARS-CoV-2 infection was linked to an increased risk of a diagnosis of type 1 diabetes. The findings, which are published in JAMA, also point to a direct effect of COVID on the development of type 1 diabetes.
Different studies have documented an increased incidence of type 1 diabetes during the COVID pandemic. However, none of the studies distinguishes between children with and without SARS-CoV-2 infection.
Researchers at Helmholtz Munich and TU Dresden, in cooperation with the Kassenärztliche Vereinigung Bayern (KVB) used a database to make an analysis of the temporal relationship between a COVID diagnosis and the diagnosis of type 1 diabetes. Amongst the analysed children without type 1 diabetes diagnosis before the start of the pandemic, 16.6% had a diagnosis of COVID between January 2020 and December 2021.
SARS-CoV-2 infection associated with an increased risk of type 1 diabetes in children
The researchers’ initial findings were consistent with data from Germany and other countries: the incidence rate of type 1 diabetes in children between the ages of two and 12 years was around 50% higher in the years 2020 to 2021 as compared to the incidence rate in 2018 to 2019. Important and novel, they found that the development of type 1 diabetes in 2020 to 2021 was higher in the children with COVID. The likelihood to develop type 1 diabetes was increased by 57% in children who had a confirmed SARS-CoV-2 infection compared to non-infected children. The increase in type 1 diabetes incidence occurred in the same quarter as the COVID diagnosis and also in later quarters.
The new data point to a direct effect of SARS-CoV-2 infection on the development of type 1 diabetes
“We are cautious in our interpretation, but the findings suggest that the virus could either promote initiation of the underlying autoimmunity in type 1 diabetes or accelerate the progression of the disease in children with existing autoimmunity,” says Ezio Bonifacio, last author of the study. Further studies will be needed, to elucidate the exact mechanism driving the increased incidence of type 1 diabetes during the COVID pandemic in young children.
Further studies planned
The team of researchers also has access to cohorts of prospectively followed children from the Global Platform for the Prevention of Autoimmune Diabetes (GPPAD) and the Fr1da Study. “We want to look into these cohorts to see whether the development of islet autoantibodies and/or type 1 diabetes was increased in the children after SARS-CoV-2 infection,” says Anette-Gabriele Ziegler, Director of the Helmholtz Munich Institute of Diabetes Research and GPPAD researcher. The findings of these studies will help to determine whether vaccination against COVID should be considered in children at risk for type 1 diabetes.
Millions of doses of the Pfizer-BioNtech COVID-19 vaccine procured by the South African government have expired and the shot is largely unavailable to people in the country.
Several people who have contacted Spotlight have expressed “frustration” and “dismay” that despite government having announced in February that it was sitting on a massive stockpile of almost 30 million vaccines, they are struggling to access the Pfizer shot.
Explaining the vast quantity of unused vaccines, the Health Department at the time said vaccine uptake has been low due to decreasing cases, people’s erroneous perception that the pandemic is over, and hesitancy affected by vaccine disinformation.
Expired but not expired?
National Department of Health spokesperson Foster Mohale confirmed that seven million Pfizer doses had expired but they would not be disposed of. Instead, the vaccine manufacturers would test the vaccines to ensure continued safety and efficacy. The South African Health Products Regulatory Authority (SAHPRA) will review the test results and, if satisfied that the vaccine will still work as well as data showed before, they will approve an extended shelf life.
The remaining estimated 23 million Johnson and Johnson (J&J) vaccine doses in South Africa are due to expire in 2024 and 2025.
“The expiry of a vaccine is not the same as the expiry date of food which cannot be extended,” Mohale says, adding that the Pfizer vaccine has a short shelf life and that the vaccine’s expiry date has been extended twice in the past. He says the testing should be done by June and the Pfizer shots would become available in July.
Photo by Mat Napo on Unsplash
A mother from East London, who is hoping to emigrate to the United States, told Spotlight that she was “frantically” trying to get shots for her 12-year-old son in time to leave. In South Africa, none of the currently available COVID-19 vaccines have been authorised for use in children under the age of 16. Elsewhere in the world, for example, in the United States, the Pfizer vaccine has been tested and authorised for use for children from the age of 12. “It is mandatory that he get the vaccine before entering the United States,” she says.
An intern responding to people’s questions on the Department of Health’s hotline says, “Many callers have phoned in stressing about travelling, emigrating, or getting vaccinated for the first time. We have been told that there are very few sites that still have some stock. If people have had two Pfizer doses, they can boost with a J&J dose. However, if they have only had one Pfizer, they will have to wait.”
The public exasperation expressed directly to Spotlight and on social media also relates to the health department’s vaccination website being outdated and it being hard to find places to get vaccinated. As GroundUp reported in January, getting a COVID-19 booster jab is not as easy as it should be.
‘The pandemic is not over’
Referring to the World Health Organization’s (WHO) lifting of the COVID-19 Public Health Emergency of International Concern(PHEIC) on May 5th, Mohale says, “The pandemic is not over and people, especially those who are at highest risk of severe disease and death should get vaccinated.” These included people with co-morbidities and the elderly. He says vaccination for COVID-19 has been integrated into routine primary healthcare facilities, which is where people should go for their jabs.
WHO director-general Tedros Ghebreyesus said it was the end of the emergency phase but not the end of the threat of COVID-19. In the week prior to the announcement, he said the disease claimed a life (globally) every three minutes, “and that’s just the deaths we know about”.
The decision to lift the emergency was based on the decreasing number of deaths and hospitalisations from COVID-19, the high levels of population immunity against SARS-CoV-2, and the widespread availability of COVID-19 vaccines and treatments.
Ghebreyesus warned that the COVID-19 pandemic is not over and that the virus could still pose a serious threat to public health. The WHO has urged countries to continue to monitor the situation closely and to maintain preparedness measures, such as surveillance, testing, and contact tracing.
Some experts have criticised the WHO’s decision to end the emergency phase, arguing that it is premature and could lead to a resurgence of the pandemic. Others have defended the decision, arguing that it is based on the best available evidence and that it is important to give countries the flexibility to manage the pandemic in a way that best suits their own circumstances.
‘Momentous’ announcement
Professor Salim Abdool Kariem, Director of CAPRISA, described the announcement as “momentous”. Writing in his regular COVID-19 updates blog, he says, “… we are still living in the midst of a pandemic with thousands of cases each day. Since SARS-CoV-2 is going to be with us for a long time, a pragmatic decision was needed as the COVID-19 pandemic emergency has been steadily receding and a new variant of concern has not emerged in the last 17 months. But the risk of a new variant of concern is ever-present, even if it is getting progressively smaller with time. The public is also tired of the pandemic and many have simply put it out of sight and out of mind.”
Kariem writes that globally there are currently far more COVID-19 cases, hospitalisations, and deaths each day than we had on the day (30 January 2020) that COVID-19 was initially declared a PHEIC. “So, it (the WHO decision) was not based on the situation getting to a point pre-PHEIC. Waiting to reach that point may take many years or may never happen and so ending the PHEIC is a judgement call, taking many factors into consideration.”
‘Still with us’
Speaking at a recent webinar, hosted by Internews, science writer David Quammen, who wrote a book on COVID-19 called ‘Breathless: The Scientific Race to Defeat a Deadly Virus’ and before that, ‘Spillover’, says, “The coronavirus is still with us, it’s circulating worldwide among humans, and circulating also among whitetail deer, feral mink, and probably other wild mammals.”
He says efforts currently need to be directed to approaching COVID-19 as a long-term cause of human illness, suffering, and death, not “a short-term catastrophe”.
He says laboratory techniques need to be improved as well as manufacturing capacity for updated COVID-19 vaccines. Inequitable access to vaccines will need to be solved. “We will need to dissolve vaccine reluctance and refusal – among the privileged but obdurate, and also among those historically ill-served by Western medicine – with better communication and education.” Diagnostic testing needs to be maintained and not reduced, as well as the sequencing of genomes from patient samples to detect and trace new and immune-evasive variants, he says.
“We will need to prepare, not just for the next coming of SARS-CoV-2 (when it emerges from some infected human, or some deer or mink) but also for the next coronavirus or influenza virus (more than likely H1N1) or other highly adaptive animal-borne virus (there’s a whole rogue’s list of possibilities) that appears in humans, seemingly out of nowhere,” he says. “But they don’t come out of nowhere. They come from nature.”
