WHO rushes rapid response team and vaccines to Democratic Republic of the Congo to contain resurgence of Ebola
Geneva/New York/Oslo: Following South Africa’s decision to put a temporary hold on the rollout of the Oxford-AstraZeneca vaccine after a study showed it was minimally effective at preventing mild to moderate disease caused by COVID variant B.1.351, the World Health Organisation is expected to take a decision this month on whether the vaccines will be granted emergency use listing (EUL). WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) is also expected to make recommendation on these vaccines’ optimal use.
The Oxford-AstraZeneca vaccine is one of several that has been shown to be effective in preventing severe disease, hospitalisation and death from COVID-19. However, the emergence of new variants of the virus has raised questions about the potential impact of those variants on vaccines. Hence, in the next few days the World Health Organisation is also expected to make a decision on the emergency use listing of the Oxford-AstraZeneca vaccine, for the two sites in India and the Republic of Korea which will produce it for COVAX, which had signed advance purchase agreements with AstraZeneca and Serum Institute of India and had published plans to distribute nearly 350 million doses in the first half of the year. (COVAX had been set up to ensure global equitable access to safe and effective COVID-19 vaccines).
In light of the concerns regarding efficacy of vaccines vis a vis new COVID variants, SAGE also held a meeting today to review the Oxford-AstraZeneca vaccine and to discuss these new developments, including emerging evidence on performance against viral variants, and to consider the demonstrated impact of the product and the risk-benefit assessment for use cases with limited data. These recommendations for use of the AstraZeneca product are being finalised and will be presented to the WHO Director-General on February 9, 2021.
“Should EUL be forthcoming, we expect the vaccine to play a key role in our effort to protect high risk persons and to help end the acute phase of the pandemic, COVAX stated today.
While pointing out that several countries were succeeding in suppressing transmission, including those where new variants were circulating, WHO Director-General Dr. Tedros Adhanom Ghebreyesus reiterated WHO’s commitment to using all available data to make those assessments. “We know viruses mutate and we know we have to be ready to adapt vaccines so they remain effective,” he said and also informed that COVAX will continue to prepare for its first quarter distribution, and to add to its vaccine portfolio.
South Africa in the meantime stated its vaccination drive was unlikely to be disrupted because of the halt in roll out of Oxford/AstraZaneca vaccines as the country would now switch over to the vaccines from Johnson & Johnson. Professor Salim Abdool Karim, the co-chair of South Africa’s Ministerial Advisory Committee on COVID-19, said the impact of the halt could be felt only in case there was a shortage of vaccines.
In light of recent reports regarding the preliminary data on minimal effectiveness of the AstraZeneca/Oxford vaccine at preventing mild to moderate COVID-19 disease caused by the viral variant B.1.351, it is important to note that primary analysis of data from Phase III trials had so far shown – in the context of viral settings without this variant – that the AstraZeneca/Oxford vaccine offers protection against severe disease, hospitalisation and death.
“This means it is vitally important now to determine the vaccine’s effectiveness when it comes to preventing more severe illness caused by the B.1.351 variant,” it stated.
Even though the recent reports on effectiveness of the AstraZeneca/Oxford vaccine against the B.1.351 variant is based on a limited study size which focused on low-risk participants and used interval doses that were not optimised for immunogenicity, COVAX stated that these results confirm “we must do everything possible to reduce the circulation of the virus, prevent infections and reduce the opportunities for the SARS-CoV-2 to evolve resulting in mutations that may reduce the efficacy of existing vaccines”.
This, according to COVAX, meant that additionally:
- Manufacturers must be prepared to adjust to the SARS-CoV-2 viral evolution, including potentially providing future booster shots and adapted vaccines, if found to be scientifically necessary.
- Trials must be designed and maintained to allow any changes in efficacy to be assessed, and to be of sufficient scale and diversity to enable clear interpretation of results.
- Enhanced genomic surveillance must be backed by rapid sharing of genetic and meta-data to allow for global coordination and response.
- Priority should be given to vaccinating high-risk groups everywhere in order to ensure maximum global protection against new strains and minimize the risk of transmission.
- Governments and donors, as well as development banks, should further support COVAX in order to ensure equitable access and delivery, as well as meet ongoing research and development costs for next-generation vaccines.
- WHO is enhancing an existing mechanism for tracking and evaluating variants that may affect vaccine composition and expanding that mechanism to provide guidance to manufacturers and countries on changes that may be needed for vaccines.
Dr. Ghebreyesus too referred to some important caveats : “Given the limited sample size of the trial and the younger, healthier profile of the participants, it is important to determine whether or not the vaccine remains effective in preventing more severe illness; These results are a reminder that we need to do everything we can to reduce circulation of the virus with proven public health measures.”
He reiterated: “We all have a role to play in protecting vaccines. Every time you decide to stay at home, to avoid crowds, to wear a mask or to clean your hands, you are denying the virus the opportunity to spread, and the opportunity to change in ways that could make vaccines less effective.
It may be mentioned that WHO has an existing mechanism for tracking and evaluating variants of the virus that causes COVID-19. However, Dr. Ghebreyesus said it was vital that countries continued to report these variants to WHO, “so we can coordinate global efforts to monitor their impact and advise countries accordingly”. He informed that the WHO was now expanding that mechanism to provide guidance to manufacturers and countries on changes that may be needed for vaccines.
“These developments highlight why it’s so important to scale up manufacturing and roll out of vaccines as quickly as possible and as widely as possible to protect people before they are exposed to new variants. We also need to continue designing and conducting new trials, and we need to keep a close eye on the impact vaccines are having on epidemiology, severe disease and death so we can use vaccines to maximum effect,” the Director-General said.
Ebola resurgence
Meanwhile, on the resurgence of Ebola in Democratic Republic of the Congo, the WHO informed that yesterday a new case of Ebola was reported near the city of Butembo in the North Kivu province of the country, where a previous outbreak was declared over in June last year. The woman, who died yesterday because of Ebola, was married to an Ebola survivor.
Also read: Deadly Ebola virus resurges in North Kivu in the Democratic Republic of the Congo
While so far no other cases were identified there, but there was possibility of further cases because the woman had contact with many people after she became symptomatic. Thus far more than 70 contacts of the Ebola victim were identified and WHO stated it had sent a rapid response team to provide support as needed, and was supporting local and national authorities to trace these contacts and provide care where needed. Vaccines were also being sent to the area and we hope that vaccination will start as soon as possible.
“Thanks to the enormous capacity built during the latest outbreak, provincial health authorities have significant experience in responding to Ebola and in preventing onward transmission,” Dr. Ghebreyesus said.
– global bihari bureau
