As the global race for a Covid-19 vaccine intensifies, theres a question Jane Halton and her team come back to time and again: if and when successful vaccines emerge, what can be done to ensure they dont simply go to those with the deepest pockets?
If market power is allowed to dictate access, how can those most vulnerable to Covid-19 be assured of protection?
We are acutely aware of this and it is literally a topic that is being discussed on a daily basis, she tells the Guardian. Because to us it is just unacceptable that there is not fair access to a successful vaccine across the worlds population.
The notion that this would be a question of going to the highest bidder, to us is just totally unacceptable.
Halton, a former secretary of Australias health and finance departments, is chair of the coalition for epidemic preparedness innovations, a global body playing a critical role in financing and coordinating Covid-19 vaccine development.
One of its founding aims is to ensure that vaccines, once developed, are distributed fairly.
The world has witnessed what happens when the market is left to dictate vaccine distribution. During the H1N1 pandemic in 2009, wealthy nations negotiated large advance orders of the vaccine, effectively crowding out poorer countries.
The West African ebola crisis an outbreak that killed 11,325 people exposed its own galling market failure.
Even as the death toll in West Africa grew and grew, big pharmaceuticals could not see a way to recoup the considerable losses they would face attempting to find a vaccine.
The leader of Britains ebola response, Adrian Hill, said there was simply no big market to make it worthwhile for massive corporations.
There was no business case to make an ebola vaccine for the people who needed it most, he said.
It was out of that failure that the coalition for epidemic preparedness innovations emerged.
The worlds response to this crisis fell tragically short, it says in explaining its background. A vaccine that had been under development for more than a decade was not deployed until over a year into the epidemic.
That vaccine was shown to be 100% effective, suggesting that much of the epidemic could have been prevented. It was evident that we needed a better system to speed the development of vaccines against known epidemic threats.
But Covid-19 presents it with a test like no other. A paper published in the Lancet last month warned of the significant prospect that wealthy countries would monopolise global supply of Covid-19 vaccines.
This risk is real, the paper warned. Such an outcome would result in a suboptimal allocation of an initially scarce resource.
There should not be a divide between the haves and the have-nots
Halton predicts the pressure to secure access to successful vaccines will be astronomical.
One of the things Im worried about is vaccine nationalism and Ive started to use that terminology when I talk to people, she says.
Weve been worrying about this issue now for months and months ... What is a mechanism to ensure equitable access?
An estimated minimum of 1 billion people across the globe are vulnerable to Covid-19. They fall into a number of categories: the immunocompromised, those with co-morbidities, the ageing, and frontline medical staff.
So that says to you you need a lot of vaccine to protect even the most vulnerable in our society, Halton says.
Its a problem the World Health Organisation is also working urgently to solve. This week it announced it planned to design mechanisms to ensure equitable distribution.
While were looking for vaccines, unless we break the barriers to equitable distribution of the products, whether its vaccines or therapeutics, we will have a problem, so we need to address the problem ahead of time, WHOs director general, Tedros Adhanom Ghebreyesus, said.
There should not be a divide between the haves and the have-nots.
For private companies, vaccine development is considered risky, protracted and hugely expensive.
Companies are faced with the prospect of spending extraordinary amounts to develop vaccines, with a low likelihood of success.
As a company, you are not going to spend the hundreds of millions and sometimes billions of dollars that are needed to develop a vaccine, Halton says. One, because you think your chances of being successful are about 5%. [Second], because you dont even think theres going to be a market for it.
So this part of market failure is completely understandable. And thats why [the coalition for epidemic preparedness innovations] was set up.
It believes it needs $US2bn to develop three vaccine candidates in the next 12 to 18 months. It has raised almost half of that.
The $2bn does not include the costs of manufacture or delivery.
The coalitions work emphasises speed. Each stage of the vaccine development process is compressed. Halton says the speed at which Covid-19 vaccines are being developed is unprecedented.
One of the projects the coalition is funding is at the University of Queensland, where researchers are testing a molecular clamp technology they hope can help neutralise the virus.
The coalition asked UQ researchers to begin working on a Covid-19 vaccine in January. Within three weeks it had produced the candidate now being tested.
Like every researcher whos looking at their baby, they are optimistic, she says. All I can say is I hope theyre right. I genuinely hope theyre right. Its very hard for me to form a judgment about the likelihood of success.
More broadly, she remains optimistic.
I think when we look across all the work thats going on globally on vaccines, I do have some hope that we will end up with not just one successful candidate ideally we would have three, she says.
Ive said this now publicly several times: hope for the best but prepare for the worst. And if you hope for the best what you would do is hope to get three successful candidates.
BRYAN, Tex. (KBTX)- Gabriel Menchaca has always believed in God but his recent brush with death and the loss of his father to COVID-19 has only strengthened his faith.
The Bryan native who now resides in College Station was Brazos County's first community spread patient of COVID-19. He spent nearly a month in a coma at Baylor Scott and White Health and when he woke up he learned his father was in the same hospital dying from the virus.
"My dad was an amazing man and I'm not just saying that because he's my dad. He was an amazing man and greeted everyone with a smile," said Menchaca.
Gabriel says he was very close to his father, Emilio Amos Menchaca , who passed away on April 13.
The 67-year-old's death followed his son's diagnosis of COVID-19 in mid-March.
"The first day it felt like the flu. My body was sore and I had chills. I could barely walk. It just felt like the flu," said Menchaca.
The 37-year old says the first hospital he visited sent him home with no test and his condition quickly got worse so he went to another hospital in the area.
"I got to Baylor Scott and White and tell them my medical history, what I've been through. I've had cancer and I have diabetes and they took me right in. They took me right in," said Menchaca.
At the hospital, he was given the COVID-19 test, medicine for his symptoms, and then he sent home to self-isolate while waiting for the test results.
A few days later the Brazos County Health District announced a male in his 30s with no history of travel had tested positive for the virus.
Menchaca says watching the news conference on KBTX is how he learned of his test results.
"Nobody called me," he said. "My mom and my girlfriend both asked 'Gabriel, is that you?' and I said no, no. Just to get closure and be on the safe side I called the health department. They asked me my name and I told them Emilio Menchaca and they said yes sir, you're the one."
He was told to continue self-isolating in his apartment but two days later his condition got to a point he needed emergency care.
"Two days later I'm waking up and I'm coughing. I'm struggling hard. I'm coughing, I can't breathe. My chest is so tight and it hurt," he said.
That's when he was rushed back to the emergency room at Baylor Scott and White and Menchaca says that's the last thing he remembered.
"I walked in and I told the nurse I'm the one who tested positive. Non-travel. And they were like oh, okay. They were ready for me. They didn't even take me through the hospital. They took me through the back and put me in an isolated room," he said.
"I remember I was tired because I haven't had much rest. So I laid down and that was the last thing I remember. Next thing I know it's a month later," said Menchaca.
Nearly four weeks later, he woke up in a hospital bed. There were doctors and nurses but his family wasn't here. He called them from the phone in his hospital room but his own family didn't believe it was really him.
"I called my mom and she's crying and her response was "whoever this is you better stop playing." She's crying. I kept saying this is me, mom. It's me. And she's crying hysterically. Then my brother gets on and he's like "who is this?" and I kept saying it's my bro, it's really me."
Menchaca was told since he went into a coma the hospital barred all visitors and the virus had spread throughout the community. What they didn't tell him immediately was that his father also contracted the virus and was in critical condition in the same hospital.
Fearing a relapse, his family and doctors felt it was best to keep the news from Gabriel until the day his father passed.
"I do remember the phone call. I'm laying in bed. It's my brother. I could tell something was wrong. I could feel it. He said dad has been in the hospital and I said I figured. What's going on. He said yeah, they're fixing to pull the, you know. I said "he's not going to make it?" and he was like "no."
Gabriel says right before he woke up from his coma he remembers a dream or vision of his father appearing before him and asking if he was ready. In his heart, he believes that was his dad trading places with him.
"I remember in my dream he thumped me on the forehead and that's when I woke up. That's when I woke up. And he was down the hallway taking a turn for the worst. I do believe I'm here because of my dad. He made the ultimate sacrifice as a father for me. He was a righteous man and he walked with the Lord. My dad had a plan and the Lord let him work it out," said Menchaca.
Gabriel should have had months of physical and speech therapy but to everyone's surprise, he's made a miraculous and fast recovery and is now at home but still keeping a distance from others.
He credits his fast recovery to his father, his faith, and the staff at Baylor Scott and White who were by his bedside when no one else could visit.
"They held my hand, hugged me, consoled me, cried with me. The staff there was just amazing," he said.
Menchaca doesn't know how he got the virus or who he got it from and he's at peace with that. He says he's been blessed with so many friends and family who have offered to help with anything he needs but his response is always the same:
"I have everything I need. My lungs are breathing on their own now. My heart is pumping on its own. I'm seeing through my own eyes. I can stand on my feet. I'm not without. I'm beyond rich and it's all thanks to the Lord."
PORTLAND, Ore. The Oregon Health Authority announced four more deaths and 58 new cases of COVID-19 in Oregon on Sunday.
The four additional deaths bring the death toll to 91 and the total number of positive cases is now at 2,311. A total of48,964 people have been tested for the virus in the state.
OHA released the following information about the four people who died. All had underlying health conditions:
The 58 new COVID-19 cases reported Sunday are in the following counties:
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Dr. Tommy Alquist administering COVID-19 antibody test last week in Treasure Valley. | Courtesy Camille Blaylock
IDAHO FALLS Since the onset of COVID-19, there have been many questions surrounding testing requirements for the virus and who is able to get a test.
RELATED | COVID-19 related deaths up to 54 in Idaho; 767 people presumed recovered
Beginning Monday, Crush The Curve Idaho, a statewide initiative aimed at reducing the spread of coronavirus, is partnering with Mountain View Hospital in Idaho Falls to offer a COVID-19 antibody serology test to anyone who would like it.
This is a blood draw to fill a little tube, which will be sent to the University of Washington to get results back, Tina Upson, Executive Director of Crush the Curve, tells EastIdahoNews.com.
It takes about two to three minutes and results are available two days later, Upson says.
The test specifically determines whether someone had COVID-19, not just a generic form of coronavirus. Though this test is not FDA-approved, Upson says it is authorized for use under the emergency act.
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Crush The Curve Idaho tested over 5,000 people for COVID-19 antibodies in the Treasure Valley last week, Ball Ventures CEO and CrushTheCurve Board Member Cortney Liddiard says in a news release. It is obvious there is a need for this important data and we are thrilled to have found such a great testing partner to help meet the demand.
People who had been sick for the first three months of the year werent eligible to get tested previously because of limited testing supplies, Upson says.
Weve been able to move over 1,000 people a day through (the Treasure Valley) testing siteand get answers to (their) questions, she says.
Testing will be available Monday through Friday between 8 a.m. and 4 p.m. at The Waterfront in Snake River Landing. All social distancing rules will be followed and nearly 50 volunteers will be on-hand to help administer the test.
Those who show up will be given a packet to fill out in their car, which Upson says will take about 10 minutes. Once the paperwork is complete, you put it on your dashboard and wait for your name to be called. Once your paperwork is reviewed, youll be directed to the blood draw line.
What were finding in Meridian and in the Treasure Valley istheyre in and out in 30 minutes, she says. Day one may be a bit slowerbut the team of volunteers will make it a good experience. Even if wait times are a bit higher because of demand, I am cautiously optimistic that that will be just fine with everybody.
Sanitation volunteers will be wiping everything down constantly. If you feel you currently have COVID-19, Upson says active virus testing is available by calling (208) 542-7032 Ext. 0.
The test costs $95 and is covered by insurance. You can also pay with cash. Upson says there will be funding set aside for those unable to pay and no one will be turned away.
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Upson says all test results are reported to the state.
Testing will be available in Chubbuck beginning Thursday at Idaho Central Credit Union at 4400 Central Way.
By opening testing to everyone, we will help Idaho return to work with a pathway going forward, Dr. Tommy Ahlquist, CEO of BVA Development says in a news release. We now have the capacity to quickly test anyone and provide repeat antibody testing at recommended intervals. These baseline tests will be important as we establish who has been exposed to COVID-19. Repeat testing will be critical as we move forward.
Appointments are not required but you can streamline the process if one is set up. To schedule an appointment, click here.
WRIGHT COUNTY, Mo. -- All nine patients who tested positive for COVID-19 in Wright County have recovered as of Sunday night, according to the Wright County Health Department.
Wright County is the first in the Ozarks to announce all of its COVID-19 patients have recovered.
Other nearby counties have reported new recoveries as well. The Springfield-Greene County Health Department reports 67 recoveries from 93 positive cases, as of Sunday. Christian County health leaders report at least 12 of 18 patients who tested positive from COVID-19 have been medically cleared.
Missouri has reported 274 deaths and nearly 7,000 cases of COVID-19 as of Sunday, but the Department of Health & Senior Services has not yet released statewide or county-by-county recovery numbers.
For the latest look at COVID-19 cases around the Ozarks, click here.
WHO has published guidance on adjusting public health and social measures for the next phase of the COVID-19 response.1 Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an immunity passport or risk-free certificate that would enable individuals to travel or to return to work assuming that they are protected against re-infection. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.
The measurement of antibodies specific to COVID-19
The development of immunity to a pathogen through natural infection is a multi-step process that typically takes place over 1-2 weeks. The body responds to a viral infection immediately with a non-specific innate response in which macrophages, neutrophils, and dendritic cells slow the progress of virus and may even prevent it from causing symptoms. This non-specific response is followed by an adaptive response where the body makes antibodies that specifically bind to the virus. These antibodies are proteins called immunoglobulins. The body also makes T-cells that recognize and eliminate other cells infected with the virus. This is called cellular immunity. This combined adaptive response may clear the virus from the body, and if the response is strong enough, may prevent progression to severe illness or re-infection by the same virus. This process is often measured by the presence of antibodies in blood.
WHO continues to review the evidence on antibody responses to SARS-CoV-2 infection.2-17 Most of these studies show that people who have recovered from infection have antibodies to the virus. However, some of these people have very low levels of neutralizing antibodies in their blood,4 suggesting that cellular immunity may also be critical for recovery. As of 24 April 2020, no study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans.
Laboratory tests that detect antibodies to SARS-CoV-2 in people, including rapid immunodiagnostic tests, need further validation to determine their accuracy and reliability. Inaccurate immunodiagnostic tests may falsely categorize people in two ways. The first is that they may falsely label people who have been infected as negative, and the second is that people who have not been infected are falsely labelled as positive. Both errors have serious consequences and will affect control efforts. These tests also need to accurately distinguish between past infections from SARS-CoV-2 and those caused by the known set of six human coronaviruses. Four of these viruses cause the common cold and circulate widely. The remaining two are the viruses that cause Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome. People infected by any one of these viruses may produce antibodies that cross-react with antibodies produced in response to infection with SARS-CoV-2.
Many countries are now testing for SARS-CoV-2 antibodies at the population level or in specific groups, such as health workers, close contacts of known cases, or within households.21 WHO supports these studies, as they are critical for understanding the extent of and risk factors associated with infection. These studies will provide data on the percentage of people with detectable COVID-19 antibodies, but most are not designed to determine whether those people are immune to secondary infections.
Other considerations
At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an immunity passport or risk-free certificate. People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission. As new evidence becomes available, WHO will update this scientific brief.
References
WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue an update. Otherwise, this scientific brief will expire 1 year after the date of publication.
Diana Hu is a pediatrician at Tuba City Regional Health Care Corporation and a member of the Navajo epidemiology response team. Aurelia Yazzie/Courtesy Tuba City Regional Health Care Corporation hide caption
Diana Hu is a pediatrician at Tuba City Regional Health Care Corporation and a member of the Navajo epidemiology response team.
After New York and New Jersey, the place with the highest coronavirus infection rate in the U.S. is the Navajo Nation. Dr. Deborah Birx of the national coronavirus task force told the White House press corps the tribe is using strike teams to address the issue.
"They're really doing amazing work at their public health institutions with their governors and their mayors," Birx says. "They are in full contact tracing."
But contact tracing or tracking all the people that COVID-positive patients may have infected has been a challenge on the Navajo Nation.
"We are doing the best we can," says Shawnell Damon, the Navajo epidemiology chief for the COVID-19 strike force. "There are some cases where a number of people have been exposed to some people, and so we're trying to find those people and yeah, that's where the shortcomings come from."
Damon says the tribe has about 80 contact tracers. And they are working hard to do their job. But some realities of life on the reservation make such tracing difficult. Not everybody has a phone, and it takes hours to drive to one home. Damon is trying to train more contact tracers to cover the vast geography and lack of telecommunication infrastructure.
Other long-standing problems have contributed to the rapid spread of the disease on the Navajo Nation. Many households lack clean, running water, which makes frequent hand-washing difficult. Some homes do not have reliable electricity. And hospitals are few and far apart for a reservation the size of West Virginia.
'Forgotten by our own government'
All these issues, the tribe says, can be traced to broken promises.
"We are United States citizens but we're not treated like that," says Navajo Nation President Jonathan Nez. "You can hear the frustration, the tone of my voice. We once again have been forgotten by our own government."
More than 150 years ago, the Navajo and many other tribes signed treaties with the federal government giving up their land in exchange for funding of things like housing, infrastructure and health care. But for decades that hasn't happened.
Now, the Navajo Nation is suing the federal government for what it calls its fair share of federal COVID relief money. On March 25, Congress passed the $2 trillion Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, which includes $8 billion to help tribes fight the coronavirus. The Navajo Nation and 10 other tribes are suing the federal government, arguing they shouldn't have to share these relief funds with for-profit Alaska Native corporations.
The Indian Health Service, or IHS, is responsible for providing medical and other health-related services to enrolled Native American tribal members. But tribes and watchdog groups often point out the money allocated to the IHS is insufficient for the size of the population it serves and the scope of health conditions, such as obesity, diabetes and asthma, prevalent in that population.
"Native American communities are often invisible in terms of their health inequities. When you look at IHS per capita spending, it is much lower than we see for veterans medical spending or Medicare spending," says Dr. Laura Hammitt, the director of Infectious Disease Programs at the Johns Hopkins Center for American Indian Health. "IHS is chronically underfunded."
The federal government spends $2,834 per person on health care in Indian Country, while it spends $9,404 per person on veterans health and $12,744 per person on Medicare, according to the most recent data.
Limited scope for 'strike teams'
The IHS works off the motto: Make the best of what you've got, even in a crisis. That's meant converting offices to patient rooms and relying on the National Guard to staff facilities in some cases. But there's still an acute nursing shortage on the Navajo Nation, and the tribe is desperately lacking in equipment. IHS Chief Medical Officer Dr. Loretta Christensen says they're forced to fly COVID-19 patients to hospitals in Albuquerque, N.M.; Flagstaff, Ariz., and Phoenix, which comes at an extremely high cost.
"Our goal is to get our patients to a higher level of care as quickly as possible so that we can get them stabilized," Christensen says. "We do realize there's finite capacity, and that's why we've made plans that we may have to manage many of these patients here on Navajo and we have ramped up that service."
Christensen says the tribe is putting together a critical care strike team. But up until now strike teams have only been used to deliver food and supplies to people who have been exposed to the virus.
"We need this administration to consult with tribes, to listen with tribes, to work in understanding them far more than they do," says Rep. Deb Haaland, D-N.M. The congresswoman is a member of the Laguna Pueblo Tribe, which has also seen deficiencies in federal health care funding.
As sovereign nations, tribes do have the ability to work government to government. For example, the Navajo president is working with New York's governor to get some of that state's unused equipment.
Diana Hu, a Tuba City, Ariz., pediatrician, says that's a huge advantage.
"The big disadvantage, of course, is they don't have a big public health infrastructure themselves," says Hu. "And they've had to learn real quickly. Their learning curve has been quite steep."
And Hu, also a member of the tribe's epidemiology response team, says there are not enough strike teams or contact tracers to get a complete picture of how far COVID-19 has spread on the Navajo Nation.
If the African American community is going to beat this virus -- and create a pandemic-resistant black community -- we are going to have to make big changes in both our public systems and our personal lives.
This virus is especially lethal to African Americans because it is -- in effect -- a pandemic jumping on top of multiple, pre-existing epidemics that were already ravaging the black community. Diseases like hypertension, diabetes, asthma and obesity make the virus far more deadly. And African American communities have those illnesses in numbers that are way out of proportion.
SIOUX CITY (KTIV) -- It's a trend we have seen in other places in the country. Now it appears that an outbreak of COVID-19 has come to parts of Siouxland.
Woodbury County is continuing to see increases in the number of positive cases of COVID-19.
Siouxland District Health said the total number of positive cases, as of April 24, in Woodbury County is 287. That is after they announced 129 new cases Friday morning.
That is over twice the number of new cases that were reported in April 23. That day they reported 46 new cases.
This comes as a report came out Friday morning from the New York Times puts the Sioux City metro at the top of where outbreaks might come next.
"If you look at our numbers yesterday and probably what we are going to put out some similar numbers tomorrow, it's disappointing to say that, but I think we're at the point where this is an outbreak here," said Tyler Brock with the Siouxland District Health Department.
Friday's report was the biggest increase of positive cases in Woodbury County thus far.
"This rapid surge, this rapid increase in cases, so many of them are connected to these industries that have been hit really hard by of COVID-19," said Brock. "So we just wanted to make sure people had an understanding of why these numbers have gone up so much."
Siouxland District Health said another reason those numbers are higher, is because they are seeing a significant increase in testing. Brock said last week they were testing around 100 people a day and that number has risen to around 300 tests a day.
Siouxland District Health said they will no longer be releasing the age and gender of new cases. KTIV and other media in Sioux City have requested that this information continue to be released.
In a news release this afternoon Siouxland District Health stated:
"Iowa law (Iowa Code Chapter 22) prohibits a local public health department from releasing information that could identify a person or business identified with an illness.
The law does allow for the Director of the Iowa Department of Public Health or the Iowa State Medical Director to release information that they deem necessary, and Siouxland District Health is working closely with the state of Iowa in an effort to help resolve some of the uncertainties, and also work to help mitigate the spread of COVID-19 in our area."
KTIV will continue to push for this information to be released by the Siouxland District Health Department.
Click here for the latest news and information on the COVID-19 coronavirus.
Spot, a four-legged robot, is being tested at Boston's Brigham and Women's Hospital as a way to treat some COVID-19 patients. Boston Dynamics hide caption
Spot, a four-legged robot, is being tested at Boston's Brigham and Women's Hospital as a way to treat some COVID-19 patients.
Brigham and Women's Hospital in Boston has been testing a new piece of hardware to help them treat coronavirus cases a robot called Spot.
Last week, the hospital began using the robot in interviewing patients suspected of having less-serious cases of COVID-19. It's only been deployed a handful of times so far, but according to Peter Chai, an emergency medical physician at Brigham and Women's, the hope is that using Spot could limit staff exposure to COVID-19.
"It also eliminates PPE," said Chai in an interview. "Spot doesn't need to wear a mask or gown."
Spot was developed by robotics firm Boston Dynamics and has been on the market for some time. The robot's distinct four-legged design helps it navigate terrain where humans and other robots may have difficulty going, says Michael Perry, vice president for business development.
"Part of the benefit of legged mobility is going to spaces that wheeled robots and drones cannot go," Perry told NPR.
Although Spot was not developed specifically for medical purposes, the firm says that once the pandemic hit, hospitals began asking "if our robots could help minimize their staff's exposure."
"One of the hospitals that we spoke to shared that, within a week, a sixth of their staff had contracted COVID-19 and that they were looking into using robots to take more of their staff out of range of the novel virus," Boston Dynamics said in a statement.
Boston Dynamics than consulted with MIT and Brigham and Women's, outfitting Spot with an iPad and radio so a medical technician could interface with patients in the triage tent the hospital and others use for potential COVID-19 patients.
So far, Spot has been mainly used to interview patients, but Perry adds that the next plan is to have the robot start taking vital signs of new patients, which he says could happen as soon as next week.
