Urgent needs of low-income and middle-income countries for COVID-19 vaccines and therapeutics
TL;DR: The COVAX Facility of the ACT Accelerator has agreements to access 2 billion doses of WHO prequalified vaccines during 2021, but this represents only 20% of the vaccine needs of participating countries Most low-income and middle-income countries face difficulties in accessing and delivering vaccines and therapeutics for COVID-19 to their populations.
About: This article is published in The Lancet.The article was published on 2021-02-13 and is currently open access. It has received 98 citations till now.
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TL;DR: COVID-19 vaccine Hesitancy is prevalent across the world, and negative tweets attract higher engagement on social media, and it is urgent to develop an effective vaccine campaign that boosts public confidence and addresses hesitancy for COVID- 19 vaccine rollout.
Abstract: Background: Monitoring public confidence and hesitancy is crucial for the COVID-19 vaccine rollout. Social media listening (infoveillance) can not only monitor public attitudes on COVID-19 vaccines but also assess the dissemination of and public engagement with these opinions.
Objective: This study aims to assess global hesitancy, confidence, and public engagement toward COVID-19 vaccination.
Methods: We collected posts mentioning the COVID-19 vaccine between June and July 2020 on Twitter from New York (United States), London (United Kingdom), Mumbai (India), and Sao Paulo (Brazil), and Sina Weibo posts from Beijing (China). In total, we manually coded 12,886 posts from the five global metropolises with high COVID-19 burdens, and after assessment, 7032 posts were included in the analysis. We manually double-coded these posts using a coding framework developed according to the World Health Organization’s Confidence, Complacency, and Convenience model of vaccine hesitancy, and conducted engagement analysis to investigate public communication about COVID-19 vaccines on social media.
Results: Among social media users, 36.4% (571/1568) in New York, 51.3% (738/1440) in London, 67.3% (144/214) in Sao Paulo, 69.8% (726/1040) in Mumbai, and 76.8% (2128/2770) in Beijing indicated that they intended to accept a COVID-19 vaccination. With a high perceived risk of getting COVID-19, more tweeters in New York and London expressed a lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumors. Tweeters from Mumbai, Sao Paulo, and Beijing worried more about vaccine production and supply, whereas tweeters from New York and London had more concerns about vaccine distribution and inequity. Negative tweets expressing lack of vaccine confidence and misinformation or rumors had more followers and attracted more public engagement online.
Conclusions: COVID-19 vaccine hesitancy is prevalent worldwide, and negative tweets attract higher engagement on social media. It is urgent to develop an effective vaccine campaign that boosts public confidence and addresses hesitancy for COVID-19 vaccine rollouts.
111 citations
14 Apr 2021
TL;DR: Most countries in Africa and a few in Asia and South America are in the risk groups for vaccine inaccessibility, and scientists believe that this uneven pattern of inoculations could also lead to virus mutations and new vaccine-resistant variants.
Abstract: The ongoing Coronavirus Disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 still poses significant health challenges globally. The Harvard group’s models predict that a resurgence of SARS-CoV-2 could occur as late as 2024 after a period of apparent elimination, if the duration of immunity is intermediate and if other corona viruses induce intermediate cross-immunity. Among more than 60 vaccine candidates in clinical trials, currently, only the Pfizer-BioNTech, Moderna COVID-19, and Johnson & Johnson COVID-19 vaccines have received Emergency Use Authorization (EUA) for active immunization to prevent COVID-19 from the US Food and Drug Administration (FDA). The Oxford-AstraZeneca COVID-19 vaccine has additionally received approval in the European countries, India, Argentina, Mexico, Brazil, Pakistan, Nepal, and others. For emergency use, other vaccines like Sputnik V, BBIBP-CorV, CoronaVac, Ad5-nCoV, EpiVacCorona, and BBV152 have been approved in many countries in the world. The approval of the vaccines has created some degree of confidence, and many countries have begun administering them. However, the accessibility of the vaccines to low-income countries (LICs) may be hindered, and thus, many concerned authorities have been questioned. It is because most of the vaccines have been reported to be reserved by wealthy nations. These issues are extensively reviewed by the Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force Members. As of February 19, 2021, about 90 countries had access to at least one COVID-19 vaccine. Gibraltar and Israel had more than 78 cumulative COVID-19 vaccination doses administered per 100 people in this context. Compared to this, Cambodia, Pakistan, Mauritius, Albania, Ecuador, Guyana, and Bolivia had less than 0.1 doses administered. Until this period, ten countries that account for 60% of the global gross domestic product had administered 75% of all COVID-19 vaccines. Dr. Tedros Adhanom Ghebreyesus, the WHO Director-General, and Henrietta Fore, UNICEF Executive Director, have pointed out that there are 130 countries, with a total population of 2.5 billion, that are yet to administer a single dose. It is a pity that expert health workers are dying in sub-Saharan Africa, indicating an international moral failure in these regions although six hundred thousand doses of the AstraZeneca-Oxford vaccine, produced by the Serum Institute of India have recently reached in Ghana. In summary, most countries in Africa and a few in Asia and South America are in the risk groups for vaccine inaccessibility. Antonio Guterres, the Chief of the United Nations (UN), has stated that progress on COVID-19 vaccinations has been wildly uneven and unfair (https://twitter.com/antonioguterres). Scientists believe that this uneven pattern of inoculations could also lead to virus mutations and new vaccine-resistant variants. The COVID-19 pandemic has resulted in the deaths and severe illness of many people and the disruption of normal lives, a loss of jobs, a loss of trade, and has dwindled the already weak national economies in the LICs. In this situation, equitable access to a suitable and effective vaccine, especially for the front-line workers, is critical for mitigating and maintaining public health systems and economic growth. That is why the demand for COVID-19 vaccines has been soaring, although supply has been limited. Many underlying causes of vaccine inequity exist in the LICs, which we now discuss in turn. First, many LICs have low socio-economic status with low levels of education, income, and occupation. These factors may directly affect the vaccine-purchasing and accepting processes of their people. Second, the geographical landscape of many LICs poses a significant challenge to vaccine distribution. Many high altitudinal landscapes within Hindu-Kush Himalayan regions, such as Nepal, Bhutan, Pakistan, and Afghanistan, make it very difficult for the vaccine campaigners and staff to distribute vaccines. The difficult situation might be worsened in the desert and remote areas engulfed in war, instability, and conflict. In this context, more than 160 million people have been estimated to be at risk of inaccessibility of the COVID-19 vaccine in Yemen, Syria, South Sudan, and Ethiopia. Third, people from urban slums and marginalized and migratory populations have poor access to immunization facilities. Vaccine distribution is challenging in urban and peri-urban slums that are overgrowing in developing countries. Fourth, most of the available COVID-19 vaccines need to be transported and stored at refrigerating to freezing temperatures, for example, the Oxford-AstraZeneca COVID-19 vaccine at 2–8 °C and the Pfizer vaccine at −70 °C, although new stability data submitted by the companies to the US regulator show that the latter vaccine can be stored at temperatures of −15 to −25 °C for up to 2 weeks. Even to protect their quality, care is still needed after transferring these vaccines to the refrigerator or following thawing. Strict regulations for temperature are critical for the maintenance of efficacy, potency, and stability of vaccines. These are significant challenges in LICs due to a shortage of cold chain infrastructures and a lack of advanced technology to monitor the cold chain for storage, distribution, and transportation of vaccines, especially in the rural regions. It could result in low immunization coverage in these areas and, subsequently, the probable endemicity of COVID-19 infections. Fifth, levels of vaccine hesitancy, fear, and confusion have been raised in many countries because of the range of data from efficacy trials for the same product. For example, the Sinovac, a Chinese company, showed 50–91% efficacy. Also, there is the apparent doubt whether the vaccines that have been designed and developed by the researchers following one year of the experiment will work against new variants of the virus. In this context, it is not easy for a developing nation to decide to spend a considerable
88 citations
TL;DR: In this article, the authors explored potential barriers that will arise during the COVID-19 vaccine rollout in lower-middle-income countries and how to overcome them and suggested increasing confidence in the vaccine through community influencers and by utilising local government accredited institutions such as the Drug Authorities for vaccine approval.
Abstract: The development of COVID-19 vaccines does not imply the end of the global pandemic as now countries have to purchase enough COVID-19 vaccine doses and work towards their successful rollout. Vaccination across the world has progressed slowly in all, but a few high-income countries (HICs) as governments learn how to vaccinate their entire populations amidst a pandemic. Most low- and middle-income countries (LMICs) have been relying on the COVID-19 Vaccines Global Access (COVAX) Facility to obtain vaccines. COVAX aims to provide these countries with enough doses to vaccinate 20% of their populations. LMICs will likely encounter additional barriers and challenges rolling out vaccines compared HICs despite their significant experience from the Expanded Programme on Immunisation (EPI). This study explores potential barriers that will arise during the COVID-19 vaccine rollout in lower-middle-income countries and how to overcome them. We conducted sixteen semi-structured interviews with national-level stakeholders from Ghana and Bangladesh (eight in each country). Stakeholders included policymakers and immunisation programme experts. Data were analysed using a Framework Analysis technique. Stakeholders believed their country could use existing EPI structures for the COVID-19 vaccine rollout despite existing challenges with the EPI and despite its focus on childhood immunisation rather than vaccinating the entire population over a short period of time. Stakeholders suggested increasing confidence in the vaccine through community influencers and by utilising local government accredited institutions such as the Drug Authorities for vaccine approval. Additional strategies they discussed included training more health providers and recruiting volunteers to increase vaccination speed, expanding government budgets for COVID-19 vaccine purchase and delivery, and exploring other financing opportunities to address in-country vaccine shortages. Stakeholders also believed that LMICs may encounter challenges complying with priority lists. Our findings suggest that COVID-19 vaccination is different from previous vaccination programs, and therefore, policymakers have to expand the EPI structure and also take a systematic and collaborative approach to plan and effectively rollout the vaccines.
62 citations
TL;DR: The COVIDPoops19 dashboard as discussed by the authors was developed to disseminate information regarding sites, universities, research institutions and private laboratories in countries involved in WBE for SARS-CoV-2.
Abstract: A year since the declaration of the global coronavirus disease 2019 (COVID-19) pandemic there have been over 110 million cases and 2.5 million deaths. Using methods to track community spread of other viruses such as poliovirus, environmental virologists and those in the wastewater based epidemiology (WBE) field quickly adapted their existing methods to detect SARS-CoV-2 RNA in wastewater. Unlike COVID-19 case and mortality data, there was not a global dashboard to track wastewater monitoring of SARS-CoV-2 RNA worldwide. This study describes the development of the "COVIDPoops19" dashboard to disseminate information regarding sites, universities, research institutions and private laboratories in countries that are involved in WBE for SARS-CoV-2. Methods to assemble the dashboard combined standard literature review, direct submissions, and daily, social media keyword searches. Over 200 universities, 1,000 sites, and 50 countries with 59 dashboards monitor wastewater for SARS-CoV-2 RNA. However, monitoring is inequitably distributed in high-income countries and data are not widely shared publicly or accessible to researchers to inform public health actions, meta-analysis, better coordinate, and determine equitable distribution of monitoring sites. For WBE to be used to its full potential during COVID-19 and beyond, show us the data.
61 citations
TL;DR: Adequate monitoring to stop the spreading of misinformation, and further research work to understand challenges in making a new vaccine acceptable by the population are needed.
52 citations
References
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TL;DR: This study provides an overview of how high income countries have secured future supplies of covid-19 vaccines but that access for the rest of the world is uncertain.
Abstract: Objective To analyze the premarket purchase commitments for coronavirus disease 2019 (covid-19) vaccines from leading manufacturers to recipient countries. Design Cross sectional analysis. Data sources World Health Organization’s draft landscape of covid-19 candidate vaccines, along with company disclosures to the US Securities and Exchange Commission, company and foundation press releases, government press releases, and media reports. Eligibility criteria and data analysis Premarket purchase commitments for covid-19 vaccines, publicly announced by 15 November 2020. Main outcome measures Premarket purchase commitments for covid-19 vaccine candidates and price per course, vaccine platform, and stage of research and development, as well as procurement agent and recipient country. Results As of 15 November 2020, several countries have made premarket purchase commitments totaling 7.48 billion doses, or 3.76 billion courses, of covid-19 vaccines from 13 vaccine manufacturers. Just over half (51%) of these doses will go to high income countries, which represent 14% of the world’s population. The US has reserved 800 million doses but accounts for a fifth of all covid-19 cases globally (11.02 million cases), whereas Japan, Australia, and Canada have collectively reserved more than one billion doses but do not account for even 1% of current global covid-19 cases globally (0.45 million cases). If these vaccine candidates were all successfully scaled, the total projected manufacturing capacity would be 5.96 billion courses by the end of 2021. Up to 40% (or 2.34 billion) of vaccine courses from these manufacturers might potentially remain for low and middle income countries–less if high income countries exercise scale-up options and more if high income countries share what they have procured. Prices for these vaccines vary by more than 10-fold, from $6.00 (£4.50; €4.90) per course to as high as $74 per course. With broad country participation apart from the US and Russia, the COVAX Facility—the vaccines pillar of the World Health Organization’s Access to COVID-19 Tools (ACT) Accelerator—has secured at least 500 million doses, or 250 million courses, and financing for half of the targeted two billion doses by the end of 2021 in efforts to support globally coordinated access to covid-19 vaccines. Conclusions This study provides an overview of how high income countries have secured future supplies of covid-19 vaccines but that access for the rest of the world is uncertain. Governments and manufacturers might provide much needed assurances for equitable allocation of covid-19 vaccines through greater transparency and accountability over these arrangements.
123 citations
TL;DR: This review will discuss the available immunologic and clinical evidence to support the benefit of the influenza, pneumococcal, and tuberculosis vaccines in the context of COVID-19 as well as to provide an overview on the CO VID-19-specific vaccines that are in the development pipeline.
Abstract: Introduction Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), has quickly spread around the world. Areas covered This review will discuss the available immunologic and clinical evidence to support the benefit of the influenza, pneumococcal, and tuberculosis vaccines in the context of COVID-19 as well as to provide an overview on the COVID-19-specific vaccines that are in the development pipeline. In addition, implications for vaccination strategies from a public health perspective will be discussed. Expert opinion Some vaccines are being considered for their potentially beneficial role in preventing or improving the prognosis of COVID-19: influenza, pneumococcal and tuberculosis vaccines. These vaccines may have either direct effect on COVID-19 via different types of immune responses or indirect effects by reducing the burden of viral and bacterial respiratory diseases on individual patients and national healthcare system and by facilitating differential diagnoses with other viral/bacterial respiratory disease. On the other hand, a large number of candidate vaccines against SARS-CoV-2 are currently in the pipeline and undergoing phase I, II, and III clinical studies. As SARS-CoV-2 vaccines are expected to be marketed through accelerated regulatory pathways, vaccinovigilance as well as planning of a successful vaccination campaign will play a major role in protecting public health.
71 citations
55 citations
TL;DR: There is a need for discussion of new opportunities for vaccinations of all adults as well as for vaccination of older adults, as reflected in the recent shift by WHO to a life-course approach to immunization.
50 citations
TL;DR: Charles Preston and colleagues use case studies to describe how regulatory systems for medical products and medicines must be strengthened in low and middle income countries to assure adequate quality, safety and efficacy.
Abstract: In summary, the case studies exploring global product supply chains and diethylene glycol poisoning in Panama, clinical trials regulation through AVAREF, premarket assurance through PEPFAR tentative approval, post-market surveillance in sub-Saharan Africa through research on drug and vaccine safety systems, and regulatory science through the creation of a low-cost meningitis vaccine for low- and middle-income countries, demonstrate the essential value of regulatory systems to low- and middle-income countries. When they work, people live; when they fail, people die. As the challenges of globalization mount, and efforts to provide medical products to low- and middle-income countries scale up, there is no better time to put regulatory system strengthening squarely on the global health and development agenda.
35 citations