Latest results from a UN-coordinated international trial on four COVID-19 therapeutic drugs, indicate that they have “little or no” positive impact on preventing deaths in patients infected with the new coronavirus.
The Solidarity Therapeutics Trial, overseen by the World Health Organization (WHO), shows that medications Remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon, repurposed to treat new coronavirus infections, “appeared to have little or no effect on 28-day mortality or the in-hospital course of COVID-19 among hospitalized patients”, WHO said in a statement on Friday.
The study, which began in March and spans more than 30 countries, looked at the effects of these treatments on overall mortality, initiation of ventilation, and duration of hospital stay in hospitalized individuals.
Other uses of the drugs, for example in treatment of patients in the community or for prevention, would have to be examined using different trials, the WHO explained.
Associated blood pressure risks
In a related announcement, the UN health agency said that COVID-19 had also highlighted the increased vulnerability of people with high blood pressure to the coronavirus.
The warning is based on data from more than 120 countries showing significant COVID-related disruption to treatment for people suffering from chronic health conditions, with findings showing these patients make up 50 to 60 per cent of all deaths from COVID.
Dr. Bente Mikkelsen, Director of WHO’s Department of Noncommunicable Diseases, said that more than 1.13 billion people around the world suffer from hypertension.
Of this number, 745,800,000 live in low and middle-income countries and 80 per cent of these nations have fewer than 50 per cent of people on treatment.
Many unaware they are sick
On average, one in four men suffer from the condition, compared with one in five women, according to WHO data. In addition, two in five people are not aware that they even have hypertension.
“When it comes to COVID-19 and hypertension, the 122 countries that have reported tells us that in over 50 per cent of the countries their health care services is disrupted fully or partially…In addition, we see a high number of fatalities”, Dr. Mikkelsen told journalists in Geneva.
Noting that global figures have yet to be calculated, she added that for those countries where data was available, “we see in the range of 50, 60 per cent of the people that are severely ill and die in hospitals from COVID have hypertension, diabetes”, and other non-communicable diseases.
Highlighting how the pandemic has made a resurgence in many countries across all continents after the easing of restrictions, and the additional health threat posed by the impending influenza season in the global north, the WHO official appealed to governments everywhere to address hypertension urgently.
She also cited growing evidence that poor and salty diets along with rising inactivity, have contributed to worsening hypertension rates globally.
To coincide with World Hypertension Day on 16 October, Dr Mikkelsen unveiled a series of recommendations and products developed by the WHO to promote action on hypertension “during and beyond the pandemic”.
By doing so, health authorities can help people to keep their blood pressure under control and prevent stroke, heart attack, and kidney damage, the WHO believes.
The new protocols are based on successful patient blood pressure management in 18 countries involving more three million people.
Today, only 20 per cent of the world’s nations are on track to reduce hypertension by 25 per cent by 2025, a global target set by the World Health Assembly in 2013, according to the UN health agency.
COVID vaccines: Widening inequality and millions vulnerable
Health leaders agree that a world without COVID-19 will not be possible until everyone has equal access to vaccines. More than 4.6 million people have died from the virus since it swept across the globe from the beginning of 2020, but it’s expected that the rate of people dying will slow if more people are vaccinated.
Developed countries are far more likely to vaccinate their citizens, which risks prolonging the pandemic, and widening global inequality. Ahead of a dialogue at the UN on Monday between senior United Nations officials UN News explains the importance of vaccine equity.
What is vaccine equity?
Quite simply, it means that all people, wherever they are in the world, should have equal access to a vaccine which offers protection against the COVID-19 infection.
WHO has set a global target of 70 per cent of the population of all countries to be vaccinated by mid-2022, but to reach this goal a more equitable access to vaccines will be needed.
Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization (WHO) said vaccine equity was “not rocket science, nor charity. It is smart public health and in everyone’s best interest.”
Why is it so important?
Apart from the ethical argument that no country or citizen is more deserving of another, no matter how rich or poor, an infectious disease like COVID-19 will remain a threat globally, as long as it exists anywhere in the world.
Inequitable vaccine distribution is not only leaving millions or billions of people vulnerable to the deadly virus, it is also allowing even more deadly variants to emerge and spread across the globe.
Moreover, an unequal distribution of vaccines will deepen inequality and exaggerate the gap between rich and poor and will reverse decades of hard-won progress on human development.
According to the UN, vaccine inequity will have a lasting impact on socio-economic recovery in low and lower-middle income countries and set back progress on the Sustainable Development Goals (SDGs). According to the UNDP, eight out of ten people pushed into poverty directly by the pandemic are projected to live in the world’s poorest countries in 2030.
Estimates also suggest that the economic impacts of COVID-19 may last until 2024 in low-income countries, while high-income countries could reach pre-COVID-19 per capita GDP growth rates by the end of this year.
Is it working?
Not according to Dr Tedros, who said in April this year that “vaccine equity is the challenge of our time…and we are failing”.
Research suggests that enough vaccines will be produced in 2021 to cover 70 per cent of the global population of 7.8 billion. However, most vaccines are being reserved for wealthy countries, while other vaccine-producing countries are restricting the export of doses so they can ensure that their own citizens get vaccinated first, an approach which has been dubbed “vaccine nationalism”. The decision by some nations to give already inoculated citizens a booster vaccine, rather than prioritizing doses for unvaccinated people in poorer countries has been highlighted as one example of this trend.
Still, the good news, according to WHO data, is that as of September 15, more than 5.5 billion doses have been administered worldwide, although given that most of the available vaccines require two shots, the number of people who are protected is much lower.
Which countries are getting the vaccines right now?
Put simply, the rich countries are getting the majority of vaccines, with many poorer countries struggling to vaccinate even a small number of citizens.
According to the Global Dashboard for Vaccine Equity (established by UNDP, WHO and Oxford University) as of September 15, just 3.07 per cent of people in low-income countries have been vaccinated with at least one dose, compared to 60.18 per cent in high-income countries.
The vaccination rate in the UK of people who have received at least one vaccine dose is around 70.92 per cent while the US is currently at 65.2 per cent. Other high-income and middle-income countries are not doing so well; New Zealand has vaccinated just 31.97 per cent of its relatively small population of around five million, although Brazil, is now at 63.31 per cent.
However, the stats in some of the poorest countries in the world make for grim reading. In the Democratic Republic of the Congo just 0.09 per cent of the population have received one dose; in Papua New Guinea and Venezuela, the rate is 1.15 per cent and 20.45 per cent respectively.
What’s the cost of a vaccine?
Data from UNICEF show that the average cost of a COVID-19 vaccine is $2 to $37 (there are 24 vaccines which have been approved by at least one national regulatory authority) and the estimated distribution cost per person is $3.70. This represents a significant financial burden for low-income countries, where, according to UNDP, the average annual per capita health expenditure amounts to $41.
The vaccine equity dashboard shows that, without immediate global financial support, low-income countries would have to increase their healthcare spending by between 30 and 60 per cent to meet the target of vaccinating 70 per cent of their citizens.
What has the UN been doing to promote a more equitable access to vaccines?
WHO and UNICEF have worked with other organizations to establish and manage the COVID-19 Vaccine Global Access Facility, known as COVAX. Launched in April 2020, WHO called it a “ground-breaking global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines”.
Its aim is to guarantee fair and equitable access for every country in the world based on need and not purchasing power.
Currently, COVAX numbers 141 participants according to the UN-supported Gavi alliance, but it’s not the only way that countries can access vaccines as they can also make bilateral deals with manufacturers.
Will equal access to vaccines bring an end to the pandemic?
It’s a crucial step, obviously, and in many richer countries, life is getting back to some sort of normality for many people, even if some pandemic protocols are still in place. The situation in less developed countries is more challenging. While the delivery of vaccines, provided under the COVAX Facility, is being welcomed across the world, weak health systems, including shortages of health workers are contributing to mounting access and distribution challenges on the ground.
And equity issues don’t disappear once vaccines are physically delivered in country; in some nations, both rich and poor, inequities in distribution may still persist.
It’s also worth remembering that the imperative of providing equal access to health care is, of course, not a new issue, but central to the Sustainable Development Goals and more precisely, SDG 3 on good health and well-being, which calls for achieving universal health coverage and affordable essential medicines and vaccines for all.
Moderna vs. Pfizer: Two Recent Studies Show Moderna to Be The More Effective One
The first study was published by medRxiv “The Preprint Server for Health Sciences” on August 9th, and compared (on 25,589 vaccinated v. 25,589 unvaccinated Minnesotans) “the effectiveness of two full-length Spike protein-encoding mRNA vaccines from Moderna (mRNA-1273) and Pfizer/BioNTech (BNT162b2) in the Mayo Clinic Health System in Minnesota over time from January to July 2021.” Moderna was 86% effective against the infection; Pfizer was 76% effective. In July (when the “Delta” variant first became dominant) Moderna was 91.6% effective against hospitalization; Pfizer was 85%. But during that month, effectiveness against the infection was 76% for Moderna v. 42% for Pfizer. Nationwide (including Mayo in MN, WI, AZ, FL, & IA), Moderna was about twice as effective “against breakthrough infection” v. Pfizer.
The second study was far smaller, published on September 10th by the CDC, and studied only 1,175 hospitalized U.S. veterans (93% male) at V.A. centers nationwide. Moderna was estimated at 91.6% effective, Pfizer at 83.4%. Since no non-hospitalized comparison-sample were studied, “Vaccine effectiveness … to prevent Covid-19-associated hospitalization was estimated by using multivariate logistic regression to compare the odds of full vaccination between case-patients and controls,” and so the reliability of this study was far less than in the Mayo Clinic study.
India Completes First Drone Delivery of Vaccines
Today marks the beginning of the first trials for the delivery of MMR, influenza and COVID-19 vaccines in the southern state of Telangana.
The trials, which have been organized by the World Economic Forum in partnership with the state government of Telangana, Apollo Hospital’s HealthNet Global and NITI Aayog, will be conducted over 28 days in designated air corridors in the district of Vikarabad, Telangana.
Starting off with the first ever drone delivery of a vaccine in India, the trials are focused on laying the groundwork for a more elaborate drone delivery network that will improve access to vital healthcare supplies for remote and vulnerable communities. This is also the first drone programme since India recently liberalized its drone policy.
“The Forum is pleased to support Indian government and industry in demonstrating how emerging technologies can be used to improve access to healthcare for its most vulnerable populations,” says Timothy Reuter, Head of Aerospace and Drones, World Economic Forum. “The project has set into motion the adoption of drones to deliver lifesaving services across the country. We believe that India’s work with drones can serve as a model for other countries in the region and beyond.”
“Ever since Telangana issued the expression of interest in expanded drone use in March 2020, the industry has witnessed an acceleration around policy decisions,” said Vignesh Santhanam, Lead, Aerospace and Drones, World Economic Forum. “With the latest liberalization of India’s drone economy the Medicine from the Sky initiative has made efforts to invigorate the drone sector in India by demonstrating the essence of cooperative federalism and creating a template for the region.”
“Being at the forefront of leveraging emerging technologies, Telangana has always acted as a testbed for innovative solutions to support scaling across the nation,” said K.T. Rama Rao, Minister of Information Technology, Industries, Municipal Administration and Urban Development of Telangana, India. “The COVID-19 pandemic has highlighted that healthcare supply chains can be further strengthened and drones offer a robust value proposition especially when it comes to remote areas and emergencies. The Medicine from the Sky is the first of its kind initiative in the country to generate insights that shall benefit the entire ecosystem. The enthusiasm and support by all the partners is deeply appreciated.”
With the support of the Vikarabad municipality, India’s Ministry of Civil Aviation, the Directorate-General of Civil Aviation and the Airports Authority of India, this will be the first drone-delivered COVID-19 vaccine in Asia. After extended trials with MMR and influenza vaccines, COVID-19 vaccines will also be transported beyond the visual line of sight.
“This pilot has been enabled through a series of collaborations between India’s regulatory agencies state government, the World Economic Forum, international organizations, healthcare experts and drone companies,” said Anna Roy, Senior Adviser, Frontier Technologies, NITI Aayog, Government of India. “The Medicine from the Sky community has acted as an important platform providing advice and insight that has translated the extensive academic groundwork into action on ground. Through a highly collaborative effort, the pilot programme also demonstrates the importance of localized inputs and micro planning for healthcare in remote parts of the world.”
This initiative aims to improve equity in healthcare while enabling healthcare access for isolated populations and hazard-prone areas. The project has eight participating partners, including drone operators and experts in healthcare and airspace management among others. Together, these partners will demonstrate short and long-range drone-based deliveries to assess the efficacy of low-altitude aerial logistics in healthcare.
“Drone use provides the opportunity to support our traditional approaches to healthcare delivery especially in underserved or remote regions of the country,” said Dr. Sangita Reddy, Joint Managing Director, Apollo Hospitals Group. “Our healthcare sector could potentially witness large-scale deliveries of long-tail medicines, vaccines, blood and vital organs throughout the country across terrains with drones in action. As clinical partners in the Medicine from the Sky initiative, Apollo Hospital’s HealthNet Global will be responsible for enabling vaccine and medicine availability and properly monitoring the adherence of clinical protocols throughout the project.”
An industry core group was commissioned in June 2021 to help scale the effort to bolster last-mile mobility in healthcare. The outcomes from the trials will be analysed and used to scale up the effort to additional states with the support of the Medicine from the Sky community and key stakeholders. The project is expected to be expanded to six states in the coming months.
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