Category: Medicine

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Mass vaccinations in Somalia should be steered by success of polio eradication campaign – Dr. Abdi Tari Ali

A shortage of Covid-19 vaccines and vaccine resistance is threatening to collapse Somalia’s fragile healthcare system. Less than 1% of Somalians have been vaccinated but lessons can and should be learned from the polio eradication campaign, says Dr. Abdi Tari Ali, Deputy Director of Trócaire Somalia.

The vaccination rollout in Somalia is nowhere near European success rates – we have a limited supply and there is a growing vaccine resistance which is being driven by misinformation and a lack of public awareness.

Wealthy nations struck deals with vaccine manufacturers, securing a disproportionately large share of early supply, leaving vulnerable nations like ours in a more precarious situation. This has undermined COVAX (the system which aims to provide innovative and equitable access to Covid-19 vaccines in the developing world) ability to distribute shots equitably and has widened the vaccination gap between Africa and other parts of the world. Despite the challenges, COVAX has delivered more than 31 million doses to 46 countries in Africa, and it aims to supply 520 million doses to the continent by the end of 2021. According to the African Union (AU), Somalia received 716,000 doses but this is against a population of almost 16 million.

We need to borrow from lessons learned in mass vaccination campaigns such as the polio eradication campaign to make the rollout as effective as possible. The Global Polio Eradication Initiative (GPEI) estimates that vaccination efforts saved more than 1.5 million lives and prevented 16 million people from polio-induced paralysis. The success of the polio eradication campaign comes down to several key factors which can be adopted in Somalia’s Covid-19 vaccination efforts for an effective outcome.

The polio eradication campaign had a large team of trained community and health workers (vaccinators) available to reach as many children as possible and there was strong commitment and goodwill from the government, partners and health care workers throughout. The campaign integrated robust data systems and analysis which supported more accurate, data driven decision making in response efforts.

The incorporation of a strong monitoring network that reached urban and rural areas was geared towards first detecting acute flaccid paralysis in children, supported by testing to confirm diagnosis and identifying the target area for vaccination efforts.

What barriers are there to mass vaccinations in Somalia?

One of our biggest challenges in Somalia is a limited supply of vaccines – we need more vaccines. We need support to ensure we have enough healthcare workers in place to strengthen our vaccination efforts. We need support to promote uptake of the vaccines amongst hesitant communities. Only 35% of our supply has been administered so far – risk communications and community engagement activities implemented have not adequately dispelled misinformation on Covid-19 vaccination.

Covid-19 vaccines have a short shelf life and require ultra-cool storage – we don’t have enough refrigerators to store our limited supply. Each vaccines dose is a chance to save a life and we need to rebuild trust amongst our communities to inspire them to get vaccinated.

We need to develop a plan that decentralises our vaccination efforts – most vaccinations are happening in urban areas and are not targeting populations in hard-to-reach places. We need to end the control of vaccines by armed opposition groups. Somali people living in areas controlled by armed opposition groups (AOGs) will have to choose between taking the Covid-19 vaccine and other vaccines or face the risk of defying AOGs directives.

The AU, through the African Vaccine Acquisition Trust (AVAT), has signed an agreement to purchase 220 million doses of the Johnson & Johnson single-shot vaccine, with the potential to order an additional 180 million doses. It is expected that around 6 million will be delivered this August but funding to purchase doses through the AU facility remains a challenge for many countries like Somalia.

Covid-19 threatens to weaken the health care system further and exacerbate the effect of current crises, leading to more deaths and an increase in the number of people in need of assistance. As of 12 July 2021, Somalia reports a total of 16,103 confirmed cases of COVID-19 with 864 deaths and 7,854 recoverieson top of the reduction in aid funding, threatens to exacerbate the humanitarian situation on the ground.

We are calling for a more equitable distribution of vaccines which we urgently need and an increase in bilateral supply to African states to prevent inequalities which will effectively delay global recovery efforts.

How did the global vaccine rollout go wrong in Africa?

With most African governments unable to buy vaccines themselves, they have relied on GAVI, the global vaccine alliance behind COVAX, to deliver vaccines for various illnesses, including Covid-19. However, wealthy nations secured a disproportionately large share of early supply. This has undermined the ability of COVAX to distribute shots equitably.

COVAX also depended on the Serum Institute of India, the world’s largest vaccine producer, for its supply. However, with the soaring Covid-19 cases in India, vaccine exports were halted, disrupting COVAX efforts in 36 African countries.

Source: Trócaire

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Africa CDC and IFRC ramp up COVID-19 response in Africa

Addis Ababa, 25 August 2021 – The Africa Centres for Disease Control and Prevention (Africa CDC) and the International Federation of Red Cross and Red Crescent Societies (IFRC) today launched a new collaboration to strengthen community resilience and response to public health emergencies at community level. The two institutions have signed a Memorandum of Understanding to ramp up pandemic response—including testing support to countries; community mobilization; advocacy and scaling up of contact tracing. In addition to COVID-19, the collaboration includes other areas of public health.

Africa CDC and IFRC will strengthen investments in locally-led action—for prevention and response purposes—while working with governments to ensure they intensify efforts to roll out the COVID-19 vaccination. Additionally, Africa CDC and IFRC will scale up advocacy against vaccine wastage.

This new initiative comes at a time Africa continues to face major vaccine shortages, amid a high level of community transmission in countries such as Botswana, Burundi, Eswatini, Cabo Verde, Namibia, Seychelles, South Africa, Zambia and Zimbabwe.

John Nkengasong, Africa CDC Director, said: “Africa is facing a double-edged challenge of responding to the COVID-19 pandemic, dealing with health response gaps, and also trying to ensure that the continent prepares efficiently for future pandemics, using lessons from current challenges”.

Africa CDC has been implementing various public health responses to control COVID-19. These include the engagement of community health workers in risk communication and community sensitization; surveillance activities for early case identification; contact tracing and in facilitating referrals for testing and continuum of care.

Jagan Chapagain, IFRC Secretary General, said: “What the IFRC and its network of National Red Cross and Red Crescent Societies bring to this partnership with Africa CDC is our unparalleled access to local communities. Our community-based volunteers have the access and trust that are needed to address vaccine hesitancy and sensitize communities about adherence to preventive measures”.

The Africa CDC has been working to support African Union Member States to build a wide network of 2 million community health workers (CHWs) in line with the July 2017 African Union Assembly Decision. The collaboration with the IFRC network, which includes 1.2 million Red Cross and Red Crescent volunteers across the continent is expected to strengthen community level interventions and consolidate gains in tackling the spread of the virus, while increasing awareness about vaccine benefits.

National Red Cross Red and Crescent Societies across Africa remain on the frontline of the response to COVID-19. They are providing ambulance services; conducting contact tracing and point of entry screening. They are also tackling stigma and the spread of misinformation and provide emotional comfort and psychological support to people in need.

Media contacts

Africa CDC:

Dr Herilinda Temba (CHWs program): HerilindaT@africa-union.org

Dolphine Buoga (Partnership): DolphineB@africa-union.org

Fortunate C. Mutesi (Partnership): Mutesic@africa-union.org

Chrys P. Kaniki (Media engagement): KanikiC@africa-union.org

IFRC:

In Addis: Betelehem Tsedeke, +251 935 987 286, Betelehem.tsedeke@ifrc.org

In Nairobi: Euloge Ishimwe, +254 731 688 613, euloge.ishimwe@ifrc.org

In Geneva: Laura Ngo-Fontaine, +41 79 570 4418, laura.ngofontaine@ifrc.org

Source: International Federation of Red Cross And Red Crescent Societies

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Study Proves Effectiveness of Alternative Test Kits for COVID-19

The primordial days of the COVID-19 outbreak led to a rapid surge in demand — and subsequent shortage — of many consumables, from household goods and protective equipment to the ingredients and substances needed to test for the virus. As the world grappled with the newfound need to mass-test for COVID-19, laboratories turned to real-time reverse transcription–polymerase chain reaction (real-time RT–PCR). Real-time RT–PCR is the most accurate laboratory method to detect, track and study COVID-19; however, its widespread use strained resources and led some laboratories to seek more readily available and cheaper alternatives.

A study to test the performance and quality of some of these alternative resources was recently conducted by the IAEA and the Food and Agriculture Organization of the United Nations (FAO), in collaboration with the Austrian Agency for Health and Food Safety (AGES). Its results have implications for the ongoing fight against COVID-19 in developing countries and beyond.

A Scientific Forum on ‘Preparing for Zoonotic Outbreaks: the Role of Nuclear Science’ will take place from 21-22 September 2021 in conjunction with the 65th IAEA General Conference. The detection of zoonotic diseases – infectious diseases transmitted from animals to humans, such as COVID-19 – is one of many topics that will be discussed at the Scientific Forum, taking into consideration the role of nuclear and nuclear derived techniques.

Reagents for reaction

Reagents are the substances, compounds, primers, probes, enzymes and buffers needed in laboratory tests. Like the essential ingredients of a recipe, they are key to facilitating a chemical reaction and ensuring the proper final result — the salt and butter, so to speak.

“In a situation of increased demand such as during the COVID-19 crisis, many laboratories might quickly find themselves in a situation where they can no longer obtain reagents from their usual sources and are forced to switch to other providers of reagents or other ad hoc molecular diagnostic kits than the ones they are used to,” said Adi Steinrigl, Deputy Head of the Molecular Biology Department at AGES. “Labs doing real-time RT–PCR tests rely on trusted sources of reagents, usually in the form of a master mix or ready-to-go diagnostic kit solutions, called ad hoc molecular diagnostic kits.”

A master mix is a premixed solution that has all of the components for a real-time RT–PCR reaction and is not sample-specific, meaning the same reagents used to detect COVID-19 can also be used to detect other viruses. Ad hoc kits are for specific diseases and pathogens.

In April 2020, in collaboration with AGES, the Joint FAO/IAEA Centre of Nuclear Techniques for Food and Agriculture launched a study to assess and compare eight master mixes and three ad hoc kits developed by companies based in Austria, Germany, Japan, the Republic of Korea, the United Kingdom and the United States of America.

The study included the most common types of master mixes used and available on the international market among the many molecular assays, or tests, that are commercialized for the diagnosis of COVID-19. As of July 2021, 388 were listed by the Foundation for Innovative New Diagnostics.

Promising results

At the FAO–IAEA laboratories in Seibersdorf, Austria, IAEA experts tested 178 clinical samples provided by AGES, using each of the 11 commercial kits and master mixes. The results of the study established that all the tested master mixes and ad hoc kits can be used for the routine detection of the COVID-19 virus.

“The bottom line is that the tested products provided results that are similar to what can be obtained if using the reagents recommended by the World Health Organization (WHO),” said Giovanni Cattoli, Head of the Animal Production and Health Laboratory at the Joint FAO/IAEA Centre. “In a country where reagents for the recommended protocols are not available or are extremely expensive, laboratories can replace them with some of the other reagents included in the study and achieve similarly accurate results. With this study, we validated alternatives so that laboratories around the world can utilize available reagents to mass-test populations for COVID-19, therefore making the tests more accessible.”

The time needed for and costs of carrying out a real-time RT–PCR test vary, especially among different countries. A real-time RT–PCR test typically takes a couple of hours to complete, from receiving samples to issuing results, and the costs of reagents depend on the company and reagent type. Overall, excluding human resource costs, tests can cost from around €7 to €20, Cattoli added.

Steinrigl agreed that reagents and ad hoc molecular diagnostic kits might differ considerably in their costs: “Comparing the performance of reagents can actually save money. We can see cheaper solutions are not necessarily any less accurate than the more expensive ones.”

The procedures and results of the study have been shared with the IAEA Veterinary Diagnostic Laboratory (VETLAB) Network, in which some labs have been requested by national authorities to provide testing for COVID. The VETLAB network includes 46 countries in Africa and 19 in Asia. The study was also published online by the Journal of Virological Methods in June 2021.

“These types of studies are needed for other transboundary animal and zoonotic diseases,” Cattoli said. The IAEA is conducting a similar study for African swine fever. “It is important to have an idea of what type of reagents can be used to run real-time RT–PCR testing for these diseases and ensure that the results are equal to the those produced by the recommended protocols.”

Source: International Atomic Energy Agency

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Booster Shots in Rich Countries Threaten COVID Containment in Africa

World Health Organization officials warn that decisions by rich countries to provide COVID-19 booster shots to their vaccinated populations will set back efforts to contain the spread of this deadly disease in Africa.

The United States, France, and Germany are among a growing number of wealthy countries planning to offer COVID-19 booster shots to their populations. This, at a time when the world’s poorer nations are struggling to get even one jab of these life-saving vaccines into their peoples’ arms.

WHO regional director for Africa, Matshidiso Moeti, warns that moves by some countries to introduce booster shots threaten Africa’s ability to extricate itself from this crushing disease. She says richer countries that are hoarding vaccines are making a mockery of vaccine equity.

“High-income countries have already, on average, administered more than 103 doses per 100 people, whereas in Africa that number stands at six,” said Moeti. “Failure to vaccinate the most at-risk groups in all countries will result in needless deaths. … It will also contribute to conditions where the virus will very likely mutate further and could ultimately delay the global recovery from this pandemic.”

The World Health Organization reports there are more than 7.3 million cases of coronavirus infections on the African continent, including 184,000 deaths. It is calling for a two-month moratorium on booster shots, so countries can beef up their vaccine supplies.

Moeti says some progress is being made in this regard. She notes the COVAX Facility has delivered nearly 10 million vaccine doses to Africa so far this month. That, she says, is nine times what was delivered in the same period in July.

“Vaccine coverage, unfortunately, remains low, with only two percent of Africans being fully vaccinated against COVID-19,” said Moeti. “… We are hopeful that COVAX shipments will keep ramping up to reach 20 percent of Africa’s population by the end of this year. And coupled with deliveries from the African Union and bilateral deals, WHO’s hoped-for target of vaccinating 30 percent of people by the end of the year is still within our reach.”

West Africa has recorded the highest number of COVID-19 deaths since the pandemic began. WHO reports a 193 percent increase in fatalities over the past four weeks. This is happening at a time when several West African countries are grappling with outbreaks of other diseases, including cholera, Ebola, and Marburg virus Disease.

Moeti says fighting multiple outbreaks is a complex challenge. She notes that West Africa health systems are more fragile than those in other sub-regions. She says they are under great strain due to the surge of COVID-19 cases. She is appealing for major investments by governments and donors to ensure outbreaks are continuously prevented, detected and quickly contained.

Source: Voice of America

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COVID Has Heightened Conflict, Deepened Depression, Say Central African Leaders

The COVID-19 pandemic has heightened problems of conflict, terrorism, and scarce resources in Central Africa to plunge millions of people deeper into poverty. That’s according to members of the regional bloc CEMAC. CEMAC heads of state Wednesday called for solidarity to improve living conditions in the six-nation economic bloc.

During a virtual heads of state summit Tuesday, the central African leaders said the advent of COVID-19 forced the closure of many businesses and caused millions of workers to lose their jobs.

Cameroon’s President Paul Biya is chairman of the CEMAC heads of state conference. He says it is regrettable that many people are reluctant to be vaccinated against COVID-19.

Biya says it is not possible for CEMAC to attain herd immunity when fewer than 5% of its close to 60 million people have agreed to be vaccinated against COVID-19. He says CEMAC member states should make sure all their people are vaccinated against COVID-19 so that the economic bloc can get to the crucial point of revamping its economy to fight against hardship.

Christophe Mbelle is an economist at the University of Yaounde. He says the COVID-19 crisis increased unemployment by between 60% and 70% across CEMAC countries.

Not even pharmaceutical companies were immune to the effects of the pandemic.

Mbelle says local companies only produced 5% of medicines needed by central African countries last year. He says in 2020, CEMAC countries invested more than $269 million to import drugs from Europe and America. Mbelle says if not for COVID-19, he is sure the $269 million would have been invested in home industries to create jobs and improve the well-being of suffering civilians.

The six nations of CEMAC are dealing with multiple crises within their borders in addition to COVID-19. Cameroon and Chad are fighting Boko Haram terrorism on their common borders with Nigeria.

Cameroon is fighting armed separatists in its English-speaking western regions. The U.N. also says that rebels have continued to challenge authorities in the Central African Republic with unending clashes since 2014.

The region is also dealing with the effects of climate change. This week, CEMAC said several thousand people fled intercommunal violence sparked by conflicts over water from the Logone River that separates Cameroon from Chad. The Lake Chad Basin Commission says the lake’s water resources have diminished by 70% within the past 50 years, and several million people in the area lack water and food.

Kristalina Georgieva, the managing director of the International Monetary Fund, issued a statement Tuesday after her virtual participation in the CEMAC summit from Washington. She said in 2020, COVID-19, combined with an ensuing decline in oil prices and security issues, had led to a deep recession and imposed a heavy toll on CEMAC member states.

She said the countries’ fiscal positions were weakened and external reserves depleted.

Georgieva said CEMAC must accelerate the vaccination campaign to ensure a sustainable economic recovery.

CEMAC anticipated a 2.8% economic growth rate in 2021. In April, though, the Bank of Central African States, which serves as the central bank for CEMAC countries, cut the anticipated growth rate to 1%, saying COVID-19 was slowing the economy.

Source: Voice of America

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COVID Pandemic Exposes Somalia’s Weak Health Care System

Rights group Amnesty International says Somalia’s struggling health care system has been crippled by the coronavirus pandemic. The group released a report Wednesday titled ‘We Just Watched COVID-19 Patients Die.’ It calls for urgent investment in Somalia’s healthcare sector after years of neglect. 

Amnesty International’s 27-page report on Somalia’s health care says the global pandemic has hit the struggling sector hard.

The Amnesty report quoted a senior Somali doctor saying in one ward on the same day four elderly men died within ten minutes because of lack of oxygen.

The rights group’s Somali researcher Abdullahi Hassan says health resources are so poor that medical workers too often could only stand by and watch their patients die.

“When COVID-19 pandemic came it laid bare how bad the situation was in Somalia. For example, the response by the government was wholly inadequate. There was only one hospital in Mogadishu that managed COVID-related cases and that one hospital lacked essential equipment. Health workers who worked in that hospital… they really struggled with patients. They did not have enough equipment; they did not have oxygen supply,” said Hassan.

Amnesty says the Somali government allocates only 2% of its budget to healthcare while security services got the largest share, with 31%.

Officially, Somalia has had more than 16,000 infections and almost 900 deaths from COVID.

But, the country’s chief medical officer, Dr. Mohamed Mohamud Ali, told Amnesty the death toll was certainly far higher.

Dr. Ali said only those who managed to get to health facilities and get tested were included in official data.

“The figure is just a tip of the iceberg,” Amnesty quoted him saying, “many more were infected and died at home,” he said.

Amnesty notes that only 15% of Somalia’s rural population have access to medical care and the country has only one surgeon for every one million people.  

Abdiqadir Abdirahman Adan is the founder of the Amin ambulance service, the only such service for Mogadishu residents.

Adan says they have only two ambulances to serve people, the ambulance workers get exhausted, and it is challenging to get oxygen. Since they provide a free service to people, and the companies producing oxygen want money, he says, they have problems with oxygen supply. Adan says their ambulance workers are also not very well trained to handle some health issues.

The Amnesty report, based on interviews with 33 medical and aid workers, as well as officials and experts, calls on Somalia to use debt relief to invest more in healthcare.

In March 2020, the International Monetary Fund and the World Bank reduced Somalia’s debt from $5.2 billion to $557 million over three years.

The debt relief aims to bring the Horn of African nation back into the global economy after 30 years of conflict and unstable governments.

Amnesty’s Hassan says the debt relief also offers an opportunity to improve Somali hospitals. 

“All this money that is going to be received through debt relief should be managed in a manner that is transparent, that is accountable, and it should be used to improve the health sector in the country,” he said,

Ambulance service operator Adan says the health sector desperately needs more medical experts to revive it.

He said this sector requires knowledge. “The people leading the health sector and working on policies must be people who have a background in health and medicine. If you are going to have people in the health sector who are not familiar with the health system, then it’s difficult to improve the health system,” he said.

Amnesty notes only 0.6% of Somalis have been fully vaccinated against the coronavirus.

While a shortage of vaccines is partly to blame, Amnesty says that 19 of the 33 healthcare workers it interviewed in the report refused to take the vaccine, despite having it offered.

It blamed widespread vaccine hesitancy, in part, on lack of public information.

Source: Voice of America