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Explainer: COVID-19 vaccination in the EU

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With which companies have you concluded COVID-19 vaccine agreements?

The Commission is negotiating intensely to build a diversified portfolio of vaccines for EU citizens at fair prices. Contracts have been concluded with AstraZeneca (400 million doses), Sanofi-GSK (300 million doses), Johnson and Johnson (400 million doses ), BioNTech-Pfizer 600 million doses, CureVac (405 million doses) and Moderna (160 million doses). The Commission has concluded exploratory talks with the pharmaceutical company Novavax with a view to purchasing up to 200 million doses.

This means that the Commission has secured a portfolio of more than 2 billion doses. For the Commission it was important from the beginning to build a diversified portfolio of vaccines based on different technologies, to increase the chances that one or more of the vaccine candidates are approved by EMA. Should all vaccines candidates turn out to be safe and effective, Member States have the possibility to donate part of their doses to lower and middle income countries.

Which vaccine is now authorised?

The Commission has given the conditional marketing authorisation for the vaccines developed by BioNTech and Pfizer on 21 December, and Moderna on 6 January following EMA positive assessment of its safety and efficacy. 

No other vaccine producer has formally applied for a marketing authorisation to EMA. In order to accelerate the process, EMA has started rolling reviews on the vaccines produced by Johnson and Johnson and AstraZeneca.

How will vaccines be monitored post authorisation under the Conditional Marketing Authorisation (CMA)?

The monitoring of the safety and effectiveness of vaccines after authorisation is a requirement under EU law and a cornerstone of the EU’s pharmacovigilance system relating to the detection, assessment, understanding and prevention of adverse effects or any other medicine-related problem. The system is exactly the same than for a normal market authorisation.

The safety and effectiveness of vaccines which have received conditional marketing authorisations are rigorously monitored, as for all medicines, through the EU’s established medicines monitoring system.

In addition, special measures are in place to quickly collect and evaluate new information. For example, manufacturers must usually send a safety report to the European Medicines Agency every six months. For COVID-19 vaccines, safety reports must be sent every month.

The European Medicines Agency will set up additional large-scale safety monitoring given the exceptionally high numbers of people expected to receive the vaccines.

Once authorised, when will vaccines be available in the EU?

In line with the EU vaccine strategy agreed with Member States, once authorised and produced, each vaccine will be available to Member States at the same time and at the same conditions. 

The distribution will start progressively. This means that in the first few months, there will not be enough doses available to vaccinate all adults. The first doses will go to the priority groups identified by Member States (e.g. healthcare professionals, persons over 60 years of age). Supplies will increase over time, and all adults should be able to get vaccinated during the course of 2021.

For most contracts concluded, the majority of delivery is foreseen to be completed in 2021. Under some contracts, first deliveries are expected to already start in the first quarter of 2021.

First deliveries of the BioNTech and Pfizer vaccine occurred within days of authorisation and most of the first vaccinations took place in the context of the EU vaccination days of 27-29 December.

The Commission has been asking national authorities to prepare as early as possible for organising the fast and accessible deployment of vaccines, according to national vaccination plans and has issued guidance on the large-scale vaccination deployment.

The Commission is following the developments of national vaccination plans very closely and provides support notably by organising joint procurement for vaccination supplies, such as syringes and needles, and running a stress test of the national vaccination plans ahead of deployment together with the ECDC.

Will the EU have enough capacity to manufacture the COVID vaccines?

There is already substantial vaccine production capacity in the EU – and the Commission is working intensively to increase it. In addition, and in order to ensure that vaccine developers have the necessary capacity to scale up the production of COVID-19 vaccines as soon as they have been approved by the EMA, the Commission supports the necessary investment in the development of such production capacities.

How will logistics work? How will vaccines be distributed?

Logistics and transportation is a key aspect on which all Member States have to work, as emphasised in the Communication on preparedness for COVID-19 vaccination strategies and vaccine deployment of 15 October.

Delivery to national distribution hub(s) will be ensured by the manufacturers.

Further distribution to vaccination centres will be ensured by Member States, who will also be responsible for the vaccination of their population.

Who should be vaccinated first?

All Member States will have access to COVID-19 vaccines at the same time on the basis of the size of their population. The overall number of vaccine doses will however be limited during the initial stages of deployment and before production can be ramped up. The Commission has therefore provided examples of unranked priority groups to be considered by countries once COVID-19 vaccines become available.

Most countries have defined priority groups and are further refining who should get priority in these priority groups e.g. older person over 80 years of age. The ECDC published an overview of where EU/EEA countries and the UK are with the development of their vaccination plans/strategies. ECDC is also working on a modelling exercise on prioritisation to support Member States. This report should be published before Christmas.

Will citizens know which vaccine they will be getting?

Yes.

When vaccines receive conditional marketing authorisation, the package leaflet with details on the specific vaccine will be translated into all languages and published in electronic form by the Commission.

All health care professionals and all patients would therefore have access to a leaflet in electronic form in their own languages.

The vaccine companies are responsible for putting in place the necessary mechanisms to ensure that each patient receives the package leaflet in print form in his/her language upon request without burdening healthcare professionals administering the vaccine.

What labelling and packaging information will citizens and health care professionals get with the COVID-19 vaccines?

In order to allow for a rapid deployment of COVID-19 vaccines at large scale, the Commission has developed, with Member States and the European Medicines Agency, labelling and packaging flexibilities for a temporary period. Flexibility in the labelling and packaging requirements is expected to reduce transport costs and storage space, improving the distribution of the doses between Member States and limit possible impact on the production of other routine vaccines. Despite these flexibilities, anyone vaccinated and health care professionals will have access to all the information on the vaccine used.

An example of such flexibilities is the fact that the outer and immediate packaging may only be printed in English. Also, the package leaflet does not have to be included inside the package of the medicinal product, but will be provided separately by the vaccine company, who will be responsible for the distribution of the printed package leaflet locally in the national language(s).

Some Member States do not require the package leaflet to be printed in their national language(s). The leaflet may be printed in English only, but the information contained in the leaflet should still be available in the national language(s), for instance via a QR code printed in the package leaflet and also available in the EMA website in all languages.

How will the Commission support Member States in the rolling-out of vaccines?

The Commission stands ready to support Member States to ensure the smooth deployment of COVID-19 vaccines. A number of EU instruments in the programming period 2021-2027 can offer financial support in this regard.

For instance, investments to support health reforms and resilient, effective and accessible health systems are eligible under the Recovery and Resilience Facility (RRF), and can be included in the national Recovery and Resilience Plans. Furthermore, the Cohesion Policy funds (European Regional Development Fund – ERDF and European Social Fund Plus – ESF+) as well as the REACT-EU programme can provide financing to Member States and their regions to strengthen their health systems, both in terms of managing and recovering from the current health crisis and as well as ensuring their resilience in the longer term.

Collectively, these programmes can support a range of investment needs, for example, in health infrastructure, training of health professionals, health promotion, disease prevention, integrated care models, digital transformation of healthcare, and equipment, including critical medical products and supplies to strengthen the resilience of health systems.

In this context, investments to prepare health systems for the roll out COVID-19 vaccines are eligible under these programme, especially given the direct link to the resilience of health systems, the availability of critical medical products and disease prevention. However, it will be up to each Member State to decide on the priorities and content of their Recovery and Resilience Plan and also their Programmes for the Cohesion Policy funds.

How will vaccination certificates work?

A common approach to pharmacovigilance, and to trusted, reliable and verifiable vaccination certificates across the EU could reinforce the success of vaccination programmes in Member States and the trust of citizens.

Registering data on vaccination is important both at individual and population levels. For an individual, it is a means to know and demonstrate their vaccination status. Proof of vaccination should be available from the moment vaccination starts. Vaccination certificates could for example be useful in the context of travel, showing that a person has been vaccinated and therefore may not need testing and quarantine upon arrival in another country.

The Commission and Member States, together with WHO, are working on vaccination certificates. This work includes a minimum dataset, including a unique identifier, for each individual vaccination which will ease the issuance of certificates and vaccination monitoring on a Europe-wide basis from the moment that the COVID-19 vaccines are authorised.

The development of the common specifications framework will take account of and contribute to the work of WHO. EU funds, such as RRF, ERDF, InvestEU can support the setting up of the Immunisation Information Systems (IIS), Electronic Health Records and secondary use of health data on immunisation.

How much does the vaccine cost? What is the price of the vaccine?

The Commission negotiated advantageous deals with vaccine manufacturers to secure access to almost 2 billion doses so far.

At this stage the specific pricing per dose is covered by confidentiality obligations. However, a significant part of the overall costs are funded by a contribution from the overall EU funding for vaccines.

Will the vaccine be free in all EU Member States?

While this is a Member State responsibility, the large majority of the Member States intend to offer vaccination free of charge.

Are the contracts with the companies publicly available?

The focus for the Commission is the protection of public health and securing the best possible agreements with companies so that vaccines are affordable, safe and efficacious.

Contracts are protected for confidentiality reasons, which is warranted by the highly competitive nature of this global market. This is in order to protect sensitive negotiations as well as business related information, such as financial information and development and production plans.

Disclosing sensitive business information would also undermine the tendering process and have potentially far-reaching consequences for the ability of the Commission to carry out its tasks as set out in the legal instruments that form the basis of the negotiations. All companies require that such sensitive business information remains confidential between the signatories of the contract. The Commission therefore has to respect the contracts it concludes with the companies.

When will the vaccine allow the control of the pandemic?

For some known communicable diseases, it is understood that herd immunity allowing to control a pandemic and eventually eradicate a disease requires around 70% of the population to have protection either from vaccination or previous infection.

Depending on the pace of vaccination and natural infections, the pandemic might be controlled by the end 2021 in Europe.

Can we still spread the disease once vaccinated?

We do not yet know. Additional evaluations will be needed to assess the effect of the vaccine in preventing asymptomatic infection, including data from clinical trials and from the vaccine’s use post-authorization.

Therefore, and for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and respect social distance, so on. Other factors, including how many people get vaccinated and how the virus is spreading in communities may also prompt revision of this guidance.

If I have already had COVID-19 and recovered, do I still need to get the vaccine?

There is not enough information currently available to say if or for how long after infection someone is protected from getting COVID-19 again; this is called natural immunity. Early evidence suggests natural immunity from COVID-19 may not last very long, but more studies are needed to better understand this.

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Health & Wellness

Stockholm+50: Accelerate action towards a healthy and prosperous planet for all

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The United Nations General Assembly agreed on the way forward for plans to host an international meeting at the highest possible level in Stockholm next June, during the week of World Environment Day. The event will commemorate the 50 years since the United Nations Conference on the Human Environment and serve as a contribution to accelerate action towards a more sustainable society.

The Declaration of the United Nations Conference on the Human Environment was made in 1972 in Stockholm, Sweden, resulting in what is often seen as the the first step toward the development of international environmental law, recognizing the importance of a healthy environment for people, and creating the UN Environment Programme (UNEP).

Five decades after the 1972 Stockholm Conference, the Government of Sweden, with support from the Government of Kenya, will host Stockholm+50, an international meeting in 2022 to commemorate the 50 years since the United Nations Conference on the Human Environment and its outcome documents, as a contribution to the environmental dimension of sustainable development to accelerate the implementation of commitments in the context of the decade of action and delivery for sustainable development, including a sustainable recovery from the coronavirus disease (COVID-19) pandemic.

The international meeting, “Stockholm+50: a healthy planet for the prosperity of all – our responsibility, our opportunity”, will take place in Stockholm on 2 and 3 June 2022, following a UN General Assembly resolution. In three leadership dialogues, the meeting will reflect on the urgent need for actions towards a healthy planet and prosperity of all, achieving a sustainable and inclusive recovery from the COVID-19 pandemic, and accelerating the implementation of the environmental dimension of Sustainable Development in the context of the Decade of Action. The meeting will also reinforce the messages and the outcomes of the event to commemorate UNEP’s 50th anniversary (UNEP@50), which will have taken place in March 2022, in Nairobi.

Per Bolund, Sweden’s Minister for the Environment and Climate, and Deputy Prime Minister, said “Our aim is clear, we want Stockholm+50 to make a concrete contribution to accelerating the transformation to a sustainable future. We call this meeting to commemorate the fiftieth anniversary of the 1972 conference. We are running out of time and urgent action is needed. These challenges are global, and we must meet them with a global response that drives action on the ground.”

Inger Andersen, Executive Director of UNEP, who was on 11 October appointed by UN Secretary-General António Guterres as the Secretary-General of the Stockholm+50 international meeting, said: “We need to urgently work to transform our economies and societies, but our branches will spread only as far as our roots are deep. By remembering Stockholm at 50, we also remember how the world came together to heal the ozone layer in 2013, phase out leaded fuel this year and stop endangered species from going extinct. By convening in Stockholm, we also recommit to human and planetary health, responsibility, prosperity, equality and peace – as we have seen only too clearly in COVID-19.”

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COVID-19 deaths at lowest level in nearly a year

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A thermometer gun is used to take a boy's temperature in Sri Lanka. © UNICEF/Chameera Laknath

Although COVID-19 deaths continue to decline, vaccine inequity persists, the head of the World Health Organization (WHO) said on Wednesday, again calling for greater support for developing countries.

Agency chief Tedros Adhanom Ghebreyesus reported that the death toll from the disease is now at its lowest level in almost a year. 

“But it’s still an unacceptably high level – almost 50,000 deaths a week, and the real number is certainly higher,” he said, speaking during the regular WHO briefing from Geneva. 

“Deaths are declining in every region except Europe, where several countries are facing fresh waves of cases and deaths.  And of course, deaths are highest in the countries and populations with the least access to vaccines.” 

Tedros appealed for global cooperation. “Countries that continue to roll out boosters now are effectively preventing other countries from vaccinating their most at-risk populations,” he said. 

Missing the mark 

As of Wednesday, there were more than 238 million COVID-19 cases worldwide, and more than 4.8 million deaths. 

WHO had previously pushed governments to vaccinate 10 per cent of their populations by the end of September, a target which 56 nations missed, most of them in Africa. 

Tedros said even more countries are at risk of missing the 40 per cent target to be achieved by the end of the year.  Three countries – Burundi, Eritrea and the Democratic People’s Republic of Korea – have yet to start vaccinations. 

 “About half of the remaining countries are constrained by supply. They have a vaccination programme underway, but don’t have enough supply to accelerate enough to reach the target,” he said. 

Tedros urged countries and companies that control global vaccine supply to prioritize distribution to the COVAX solidarity initiative and the African Vaccine Acquisition Trust (AVAT). 

Meanwhile, WHO and partners are working with other countries, such as those affected by fragility or conflict, to strengthen technical and logistical capacity for vaccine rollout. 

“With aggressive and ambitious action, most of these countries can still reach the 40% target by the end of this year, or be on a clear pathway to reaching it.” 

Crisis in Tigray 

Tedros also addressed the escalating crisis in northern Ethiopia, where a nearly year-long war in the Tigray region has left up to seven million people in urgent need for food and other assistance. 

The conflict has spilled over into neighbouring Afar and Amhara, further increasing needs and complicating response efforts. Aid is not reaching the area “at anywhere close to the levels needed”, he said, and communications, electricity, other basis services remain cut off. 

WHO and partners are calling for unfettered access to the affected regions, as the lives of millions of people are at stake, Tedros told journalists. 

“People with chronic illnesses are dying due to lack of both food and medicine. Nearly 200,000 children have gone without critical vaccinations,” he said   

“When people do not have enough food, they are more susceptible to deadly diseases, as well as the threat of starvation, and that’s what we’re now seeing in Tigray.”

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Global health community prescribes climate action for COVID recovery

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Street scene in India. © UNICEF/Vinay Panjwani

Ambitious national climate commitments are crucial for States to sustain a healthy, green recovery from the COVID-19 pandemic, according to a new UN health agency report launched on Monday in the lead-up to the COP26 climate change conference in Glasgow, Scotland.

Based on a growing body of research confirming numerous and inseparable links between climate and health, the World Health Organization’s (WHO) COP26 Special Report on Climate Change and Health spells out that transformational action in every sector, from energy, transport and nature to food systems and finance is needed to protect people.

The COVID-19 pandemic has shone a light on the intimate and delicate links between humans, animals and our environment”, said WHO chief Tedros Adhanom Ghebreyesus. “The same unsustainable choices that are killing our planet are killing people”.

An urgent call

WHO’s report was launched at the same time as an open letter, signed by over two thirds of the global health workforce – 300 organizations representing at least 45 million doctors and health professionals worldwide – calling for national leaders and COP26 country delegations to step up climate action. 

“Wherever we deliver care, in our hospitals, clinics and communities around the world, we are already responding to the health harms caused by climate change”, the letter from the health professionals reads.

“We call on the leaders of every country and their representatives at COP26 to avert the impending health catastrophe by limiting global warming to 1.5°C, and to make human health and equity central to all climate change mitigation and adaptation actions”.

Fossil fuels ‘killing us’

Both the report and open letter come as unprecedented extreme weather events and other climate impacts are taking a rising toll on everyone.

Heatwaves, storms and floods have taken thousands of lives and disrupted millions of others while also threatening healthcare systems and facilities when they are needed most, according to WHO.

Changes in weather and climate are threatening food security and driving up food-, water- and vector-borne diseases, such as malaria, while climate impacts are also negatively affecting mental health.  

“The burning of fossil fuels is killing us. Climate change is the single biggest health threat facing humanity”, states the WHO report. And while no one is safe from the health impacts of climate change, “they are disproportionately felt by the most vulnerable and disadvantaged”.

Climate actions far outweigh costs

Meanwhile, air pollution, primarily the result of burning fossil fuels, which also drives climate change, causes 13 deaths per minute worldwide, according to WHO. 

The report states clearly that the public health benefits from implementing ambitious climate actions far outweigh the costs. 

“It has never been clearer that the climate crisis is one of the most urgent health emergencies we all face”, said Maria Neira, WHO Director of Environment, Climate Change and Health.

“Bringing down air pollution…would reduce the total number of global deaths from air pollution by 80 per cent while dramatically reducing the greenhouse gas emissions that fuel climate change”, she pointed out.

Dr. Neira added that a shift to more nutritious, plant-based diets “could reduce global emissions significantly, ensure more resilient food systems, and avoid up to 5.1 million diet-related deaths a year by 2050”.  

Call to action

Although achieving the Paris Agreement on climate change would improve air quality, diet and physical activity – saving millions of lives a year – most climate decision-making processes currently do not account for these health co-benefits and their economic valuation.  

Tedros underscored WHO’s call for all countries to “commit to decisive action at COP26 to limit global warming to 1.5°C – not just because it’s the right thing to do, but because it’s in our own interests”, and highlighted 10 priorities in the report to safeguard “the health of people and the planet that sustains us.”

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