H5N1

N'Zérékoré: Arrival of 800 doses of anti-Ebola vaccines

Via guineematin.com: N'Zérékoré: arrival of 800 doses of anti-Ebola vaccines. The Google translation:

The first doses of anti-Ebola vaccines arrived on Tuesday, February 23, 2021, in N'Zérékoré. The Minister of Health, General Physician Rémy Lamah, and other local authorities, mobilized at the city airport to receive this first batch, noted the correspondent of Guineematin.com on the spot. 

It was on board a small plane that 800 doses of vaccines out of the 3,500 planned for the N'Zérékoré prefecture arrived in the capital of Forest Guinea. Immediately after their receipt by the authorities, part of the batch was shipped to Gouécké, a sub-prefecture located 42 kilometers from the city of N'Zérékoré, where the vaccination campaign is due to start this afternoon.   

In this locality, tents are set up at the headquarters of the sub-prefecture, which is 20 meters from the family where the first case of Ebola was recorded. Local authorities, development partners, religious leaders and civil society actors are mobilized for the success of this vaccination campaign. 

To be continued !

Reluctance in Gouécké (N'zérékoré): Citizens deny the existence of Ebola in the locality

Via guineematin.com: Reluctance in Gouécké (N'zérékoré): citizens deny the existence of Ebola in the locality. This sounds all too familiar, and it does not bode well. The Google translation:

There is great reluctance in Gouécké, a sub-prefecture of N'Zérékoré (in southern Guinea) where the Ebola epidemic has recently reappeared. The inhabitants of the locality deny the existence of the disease at home, and refuse to comply with the measures taken by the authorities. A situation that risks seriously complicating the response to this epidemic, noted a special envoy from Guineematin.com on the spot. 

“We recently heard that there is Ebola in Gouécké. But I do not agree with these false words, in which I do not believe at all, ”said Jacques Noël Haba, a resident of Gouécké. This citizen refuses to change his habits in the name of the fight against the Ebola virus. For him, the Guinean government is quite simply using this disease to get help from technical and financial partners. 

“If Ebola were here, we would have known it already, because we know the human damage that this disease leaves in its path. But here, since the death of the lady (the nurse) almost 4 weeks ago, we have not learned of another death or even a case of illness in her family. If there have been cases of death, it is not in Gouécké center here, it is perhaps outside our sub-prefecture. So if the government wants to lie in order to get something, they just have to do it, but there is no Ebola here,” says Haba. 

And, this position is widely shared in the sub-prefecture of Gouécké. Not believing at all in the presence of Ebola at home, the inhabitants of the locality do not respect any barrier measures. Even the closure of the weekly market in this urban municipality, announced by the authorities, was not respected. Met last Saturday in this market, Aimé Loua, a student at Gouéké college, says he does not understand why the Guinean authorities want to close this market when it is not the only place where Ebola could spread. 

“I came to the market to buy myself a bag, but I found the price to be very high because the market is not full. And, this is due to the government's decision to close our weekly market. But, why decide to close the market and leave the schools open? Or is it only in the market that Ebola can spread? In the classrooms, we are seated at 3 per table-bench, but there was no contamination there. We just want to tire our parents who are there suffering to feed us. So we ask the president to leave us in peace, because there is no Ebola here in Gouécké,” said this student. 

The vaccination campaign compromised? 

To avoid the 2013-2015 scenario (a period during which the Ebola virus had killed more than 2,500 people in Guinea), the authorities are betting this time on vaccination. The first doses of vaccines ordered by Guinea must arrive this Monday in Conakry so that the vaccination can begin tomorrow, Tuesday 23 February 2021. But, this operation may be complicated by the reluctance of the population. In Gouécké, some citizens suggest that vaccines against Ebola are not welcome in the locality. 

“They said there is disease with us here, but it is wrong. There is no illness here. They must not send us vaccines, because there is no Ebola here. If there was disease here, we would get vaccinated. But, why are we going to vaccinate people who are not sick? You see that our market is full, everyone is going about their business. We haven't seen an Ebola patient in Gouécké here, so we don't need their vaccines, ”said Oumar Soumaoro, a resident of Gouécké.

Eradication of the new Ebola epidemic in Guinea: The ANSS sets itself a deadline of six weeks

Via lexpressguinee.com: Eradication of the new Ebola epidemic in Guinea: the ANSS sets itself a deadline of six weeks. The Google translation:

The Ministry of Health through the National Health Security Agency (ANSS) promises to come to terms with the new Ebola epidemic which broke out, once again, in the southern part of the country, no later than next March 31. 

To achieve this, the National Health Security Agency relies on mass vaccination of the population. “We want people to show up. A suspect has every chance of being saved. An intervention team will leave Conakry to prepare the community so that it can accept the vaccination so that Guinea in six weeks can stop this new resurgence. We have set ourselves by March 31 so that there is no more talk of Ebola cases in Gouéké,” said Dr Sakoba Keïta, Director General of ANSS, this Friday, February 19, 2021 in the Grandes Gueules d ' Space. 

“By next Saturday, we will be transferring a lab to N'Zérékoré. Instead of bringing the samples to Conakry, we will bring them directly to the city of N'Zérékoré,” also indicated the Director General of the National Health Security Agency. 

But what is the ANSS counting on to make such a commitment? Doctor Sakoba Kéita reassures that “thanks to the achievements of Ebola, we had already built epidemiological treatment centers in N'Zérékoré and even in Gouéké which has one of the best health centers in the country. So we have the infrastructure and we have people who have been treating Ebola for two years and our responsiveness has improved a lot.”

WHO steps up efforts to curb Ebola outbreaks in Guinea and the Democratic Republic of the Congo

Via ReliefWeb, a news release from WHO: WHO steps up efforts to curb Ebola outbreaks in Guinea and the Democratic Republic of the Congo. Excerpt:

Brazzaville, 18 February 2021 – With efforts gathering pace to promptly tackle the new Ebola outbreaks in Guinea and the Democratic Republic of the Congo (DRC), the World Health Organization (WHO) is deploying teams of experts to support the national authorities ramp up the response and avert widespread infections. 

Health authorities in Guinea declared an Ebola outbreak on 14 February after three cases detected in Gouécké, a rural community in N’Zerekore prefecture tested positive for the virus. It is the first Ebola outbreak in Guinea since 2016 when a large one was successfully brought under control. 

More than 100 WHO staff, deployed from other countries and from within Guinea, are expected to be part of the Ebola response by the end of February. A team of eight experts from the WHO Regional Office for Africa in Brazzaville is leaving soon. Efforts are ongoing to step up surveillance, contact-tracing, testing and treatment as well as preparing for vaccination. 

“We are hard at work, shifting quickly through the gears to get ahead of the virus. With experts and emergency supplies already getting on the ground, the response is off to a strong start,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Our collective, quick action is crucial to averting an uncontrolled spread of Ebola amid the COVID-19 pandemic which has already pushed health workers and health facilities to the edge.” 

A humanitarian flight arrived on 15 February in N’Zerekore with 700 kg of medical equipment donated by WHO and partners. A consignment of more than 11 000 doses of Ebola vaccine is expected to arrive in Guinea this weekend. In addition, more than 8500 doses will be shipped from the United States of America for a total of 20 000 doses. Vaccination is set to kick off shortly afterwards. A 30-strong vaccination team has already been mobilized locally and is ready to deploy as soon as the vaccines are received. 

Meanwhile, in the DRC, so far there are four confirmed Ebola cases, including two deaths that are epidemiologically linked. WHO has around 20 experts on the ground supporting national and provincial health authorities. About 8000 vaccine doses were still available in the country at the end of the 11th Ebola outbreak. The vaccination of people at high risk was officially launched in Butembo, the outbreak’s epicentre on 15 February. So far nearly 70 people have been vaccinated. The quick rollout of vaccines is a testament to the enormous local capacity built in the previous outbreaks by WHO and partners. 

WHO has released US$ 1.25 million to support the response in Guinea and to reinforce Ebola readiness in neighbouring Cote d’Ivoire, Guinea-Bissau, Liberia, Mali, Senegal and Sierra Leone. Additionally, the United Nations Central Emergency Response Fund has disbursed US$ 15 million to support the response in Guinea and DRC and readiness in the neighbouring countries. 

With the epicentre of the Ebola outbreak in Guinea being a border area, countries in the sub-region are on high alert and increasing public health measures and surveillance in border towns and communities to quickly detect and respond to possible cross-border infections.

Guinea: Vaccination against Ebola begins on Monday February 22

Via guineenews.org: Guinea: vaccination against Ebola begins on Monday February 22 (Ministerial advisor). Excerpt from the Google translation:

The vaccination campaign against Ebola hemorrhagic fever could start as early as next Monday. It is Doctor Mohamed Lamine Yansané, principal advisor to the Minister of Health, who has just announced it during a press videoconference organized by the world health organization, from its regional office in Brazzaville. 

According to Dr Yansané, “the arrival of the vaccine is scheduled for next Sunday. And that the start of vaccination will take place on Monday." Even if, says the representative of the World Health Organization (WHO), Professor Ki-Zerbo, the vaccine arrives in Conakry from where it will be sent to N'Zérékoré where preparations and training have started. 

In addition, the main advice of the Minister of Health reassures that the 7 confirmed remain under control. “The 6 are concentrated there (N'Zérékoré). The one who escaped is taken care of in Conakry. And above all, the 250 contacts are all held,” he explains. 

As for sequencing, in order to determine the variant, it will be done at the Pasteur Institute in Dakar, as part of a collaboration with Senegal.

Pfizer says South African SARS-CoV-2 variant could significantly reduce vaccine protection

Thanks to Peter O'Meagher for sending the link to this Reuters report: Pfizer says South African variant could significantly reduce vaccine protection.

(Reuters) - A laboratory study suggests that the South African variant of the coronavirus may reduce antibody protection from the Pfizer Inc/BioNTech SE vaccine by two-thirds, and it is not clear if the shot will be effective against the mutation, the companies said on Wednesday. 

The study found the vaccine was still able to neutralize the virus and there is not yet evidence from trials in people that the variant reduces vaccine protection, the companies said. 

Still, they are making investments and talking to regulators about developing an updated version of their mRNA vaccine or a booster shot, if needed. 

For the study, scientists from the companies and the University of Texas Medical Branch (UTMB) developed an engineered virus that contained the same mutations carried on the spike portion of the highly contagious coronavirus variant first discovered in South Africa, known as B.1.351. The spike, used by the virus to enter human cells, is the primary target of many COVID-19 vaccines. 

Researchers tested the engineered virus against blood taken from people who had been given the vaccine, and found a two-thirds reduction in the level of neutralizing antibodies compared with its effect on the most common version of the virus prevalent in U.S. trials. 

Their findings were published in the New England Journal of Medicine (NEJM).

Without vaccine, Guinea faces Ebola again

Via guineenews.org: Health: Without vaccine, Guinea faces Ebola again. The Google translation:

After claiming more than 2,544 victims between 2014 and 2015 in Guinea, the viral fever caused by Ebola has just resurfaced. Particularly in Gouécké, in the forest region located in the south of the country. A resurgence that comes when the country does not have a single dose of vaccine against the epidemic. 

At least this is the information we have from the director general of the National Agency for Health Security, who hosted a press briefing to this effect. During his presentation, Dr Sakoba Keita first discussed the four cardinal signs of Ebola, including fever associated with diarrhea, vomiting and bleeding. 

Regarding the lifespan of the virus, the speaker suggested that the incubation period is 21 days; which begins from the penetration of the germ into the body until the appearance of the first signs. 

In passing, he said that during the past epidemic, Guinea recorded 2,544 cases of death. And with this new appearance, the country has three cases declared for the moment, even if it does not exclude that this number is revised upwards. 

“(…). We have the news that the first case is not the nurse: she wanted to come to the aid of someone that we are trying to identify and know the future of this someone,” he said.  

Regarding preventive measures, Dr Sakoba Keita finds that the first remains hand washing while refraining from touching the objects of people who have developed Ebola, since Ebola is transmitted through bodily fluids (saliva, blood , etc). 

For him, the lethal weapon against Ebola is the vaccine. And that is why contacts have been made with the WHO. And if all goes as planned, Dr Keita gives the assurance that Guinea will have the vaccine during the coming week. 

“Please God, before the end of next week, we will do everything to make this vaccine available in Guinea. And measures are underway, the very vaccination team that we sent to the Congo is there for them. He is in the process of reconstituting his team so that as soon as the vaccines are going to be announced, that they leave with the vaccines in order to be able to vaccinate the exposed populations,” explained the speaker. 

According to Dr Sakoba Keita, Guinea, until relatively recently, had Ebola vaccines in stock. “Unfortunately, all are out of date as of December 31st. So we can no longer use the stock that is there. We have to ask the WHO to help us find another stock that we can use.” 

Immediately, the WHO representative at the conference, Dr Konan, confided the following: “As I speak to you, the UNICEF representative is in a meeting with our three offices to reflect on this support to Guinea. From tomorrow, in 72 hours, we will be able to have the vaccines.”

Priorities for the COVID-19 pandemic at the start of 2021: Statement of the Lancet COVID-19 Commission

Via The Lancet: Priorities for the COVID-19 pandemic at the start of 2021: statement of the Lancet COVID-19 Commission. Excerpt:

The Lancet COVID-19 Commission calls for three urgent actions in the COVID-19 response (our broader overview is available on our website). 

First, all regions with high rates of new COVID-19 cases, including the USA and the European Union (EU), should intensify measures to minimise community transmission alongside rapid deployment of COVID-19 vaccines. 

Second, governments should urgently and fully fund WHO and the Access to COVID-19 Tools (ACT) Accelerator, including COVAX. 

Third, the G20 countries should empower the International Monetary Fund (IMF) and multilateral development banks to increase the scale of financing and debt relief. 

Success on all three priorities—containment of transmission, rapid vaccination, and emergency finance—will require improved global cooperation. The high rates of community transmission (>100 new COVID-19 cases per million per day) in the USA, Europe, South Africa, and other countries show the emergence of new variants of SARS-CoV-2, such as lineage B.1.1.7 in the UK, 501Y.V2 in South Africa, and additional variants emerging in California, USA, and in Brazil. 

New lineages are increasing transmission of infection and raising risks in regions that have been less affected by COVID-19, including in sub-Saharan Africa. Additionally, acquired immunity from earlier COVID-19 infections might be less protective against reinfection with some of the new SARS-CoV-2 variants. Mutant lineages might also reduce the efficacy of COVID-19 vaccines and require adapted vaccines or boosters. 

The numbers of new COVID-19 cases in east Asia and the Pacific (<10 new cases per million per day in most countries) have been consistently below those of Northern America and Europe. The lower numbers of COVID-19 cases in these countries result from the successful implementation of comprehensive containment measures: border restrictions and other limits on movement; behavioural changes including widespread use of face masks and physical distancing; active surveillance by public health systems, including mass testing, backward tracing (to identify the sources of outbreaks), and forward tracing (to identify the contacts of new cases); and the quarantine of all suspected cases and the use of facility-based isolation of confirmed cases of COVID-19. 

The USA and the EU failed to implement such comprehensive measures, and there was generally excessive decentralisation of containment efforts across the 50 US states and 27 EU members in 2020. Lack of centralised coordination undermined control of COVID-19, not least because of interstate travel in the USA and intercountry travel in the EU. Both the USA and EU need to step up more top–down coordination in 2021. 

Stronger health systems that incorporate universal health coverage and community-based health workers are vital in the response to COVID-19. At least half of the world's population lacks access to essential health services. Strengthening community-based and gender-responsive health systems will be essential to implement inclusive and comprehensive COVID-19 immunisation campaigns. 

The global roll-out of COVID-19 vaccines to date is neither inclusive nor adequately planned. COVAX has targeted immunisation coverage of at least 20% of the population in each participating country by the end of 2021, and has contracted for 2 billion doses of COVID-19 vaccines. Yet the timely supply of vaccines to COVAX is in question, as high-income countries (HICs) step to the front of the queue for limited supplies of COVID-19 vaccines. 

As of Feb 9, 2021, 148·08 million COVID-19 vaccine doses had been delivered, of which 115·67 million were delivered in the USA (43·21 million), China (40·52 million), the EU (18·36 million), and the UK (13·58). Other countries in Africa, Latin America and the Caribbean, and Asia (not including China) have received very few vaccine doses or none at all. 

This unequal access to COVID-19 vaccines is partly due to the difficulty of managing the ultracold supply chain needed for the two mRNA vaccines, but it is also due to the vaccine supply deals negotiated by HICs directly with the vaccine producers, rather than through COVAX.

The COVID-19 exit strategy—why we need to aim low

An editorial in The Lancet Infectious Diseases: The COVID-19 exit strategy—why we need to aim low.

As we find ourselves in the second year of a global pandemic, the question on everyone's mind is: when will this end? Much of the narrative around the pandemic last year was that all hopes for a return to normal hinged on development of an effective vaccine. This rhetoric was deaf to the concerns of vaccine and public health experts, and for many a SARS-CoV-2 vaccine has become the magic bullet to deliver us from endless cycles of lockdown and economic decline. 

Against all precedent, going into 2021, the world had several vaccines with demonstrated efficacy against symptomatic COVID-19 in its armamentarium. Yet a magic bullet they are not. 

Numerous issues and uncertainties surround the existing COVID-19 vaccines. We do not yet know the quality or length of protection the vaccines will provide and how effectively they will stop viral transmission. New variants of SARS-CoV-2 with mutations in key proteins threaten vaccine efficacy. Certain groups—eg, children, people with immunodeficiency, pregnant women, and elderly people—were not included, or were underrepresented, in vaccine trials, making the safety and efficacy in these groups less certain. Supply-chain constraints, pricing, and unequal vaccine procurement across countries mean that coverage across most, if not all, countries will remain below the level required for herd immunity—if such a level exists, another unknown. We can say that vaccines will make an important contribution to returning life to normal, but they should be only one part of an exit strategy. 

Certain countries that have relied on a suppression strategy for pandemic control, using non-pharmaceutical interventions to reduce cases, hospital admissions, and deaths to so-called acceptable levels before lifting restrictions, appear to be entirely dependent on population-level herd immunity generated through natural infection or immunisation as an exit strategy. 

Public health messaging in these countries, which include most countries in Europe and the USA, is that we must both await the vaccines and become accustomed to living with the virus, as we have done with other viruses in the past. We should expect SARS-CoV-2 to become endemic and, potentially, seasonal. Infections will be concentrated in certain pockets of society that are non-immune, such as children who have not yet been vaccinated or adults with waning immunity. The virus might even become less virulent over time through accumulation of mutations and a selective pressure to become more transmissible as it adapts to humanity following the jump from the original animal host. 

However, even if these assumptions about the virus' trajectory hold true, they will happen over many months and years. In the meantime we must decide how best to ameliorate the detrimental effects of this deadly virus. 

Another strategy in use—to eliminate—has been deployed by countries that have been arguably the most successful in their responses to the pandemic: New Zealand, Australia, Taiwan, South Korea, Vietnam, and China. This strategy, which is proactive rather than reactive, resembles an exit strategy to a far greater extent than does the suppression strategy. It has a clear goal: to reduce community transmission to near zero through a highly stringent, but short-term, lockdown, followed by implementation of a well sized, robust, and coordinated find, test, trace, isolate, and support system, with the aim to identify and end outbreaks before they become unmanageable. 

Key to the success of this strategy is removal of structural inequalities that might lead to resurgences of the virus in certain marginalised populations. Benefits of this strategy have been multitudinous, including far fewer COVID-19 cases and deaths and in the long-term mitigated impacts on the economy and wellbeing of societies. 

Border closures and travel bans have been essential to limit reintroductions of the virus in countries pursuing an elimination strategy. However, borders cannot remain closed forever. A policy document from Germany paints a picture of how elimination across Europe might be sustainable, although the sentiments could be applied globally. The document proposes that areas in which SARS-CoV-2 has been eliminated are declared green zones in which civil liberties are restored. Strict contact and travel restrictions outside green zones remain, but the green zones expand as more and more regions achieve elimination. 

This strategy would require a global, coordinated response—so far absent from the pandemic—but if achieved would reap benefits. WHO is well positioned to lead such as response; however, to be successful, an elimination strategy will require individual governments to look beyond their own interests and commit to zero COVID.

North Kivu / Ebola: The provincial government plans a new vaccination

Via 7sur7.cd: North Kivu / Ebola: The provincial government plans a new vaccination. The Google translation, which suggests another fatal case:

The Provincial Minister of Health, Doctor Nzanzu Syalita Eugène, hosted this Wednesday February 10, 2021, a press point at the office of the Provincial Division of Health (DPS-Butembo) in which he announced the imminent start of vaccination contacts of the very first positive case of the twelfth Ebola outbreak, which was declared in Biena health zone in Lubero on Sunday.    

“The households have been decontaminated. Health care structures, in particular the Masoya health center, Matanda hospital (Butembo). And here we are preparing for a vaccination for contacts and contacts of contacts. And, our teams are hard at work to be able to carry out other actions with the community, ” he said. 

 Doctor Nzanzu Syalita Eugène also specifies that up to now, around a hundred contact cases have already been listed, but he regrets the fact that some “high-risk cases” are on the run. 

“We have already listed 161 contacts in the two health zones. Particularly in Biena and Katwa. But, there are other contacts here in Butembo that are being followed up. But, we have other contacts that we haven't seen yet. In particular the biker who (died of Ebola, Editor's note) transported him from Masoya to Butembo. There is the sick guard, and who would probably end up in Kirima, in the Biena health zone,”said Nzanzu Syalita Eugene, Minister of Health in North Kivu. 

Last Tuesday, the World Health Organization (WHO), in a statement read by 7SUR7.CD, claimed to have deployed public health experts to North Kivu, in order to counter this twelfth Ebola epidemic in the region. 

This disease is declared in the east of the country 228 days after the tenth Ebola epidemic which raged, from August 2018 to June 2020, in the provinces of North Kivu and Ituri, causing the death of more than 2,000 people. Several other vaccinations had been carried out, in particular with the Johnson & Johnson vaccine.