Dear Colleagues: Welcome to our Saturday, June 26 report during this seventeenth month of COVID-19 in Ontario. You can find earlier update reports here, including thematic pieces in Doris’ COVID-19 Blog. And, for the many resources RNAO offers on COVID-19, please visit the COVID-19 Portal where you will also find RNAO media hits and releases on the pandemic here. Daily Situational Reports from Ontario's MOH EOC can be found here. As always, feel free to share this report and links with anyone interested. Scroll down for policy updates for all to act on & must join events.
Reminder to answer our survey on nurses’ wellbeing (for RNAO members and non-members)
Global herd immunity remains out of reach because of inequitable vaccine distribution – 99% of people in poor countries are unvaccinated
As we reach enormously successful levels of COVID-19 inoculation in Canada and other rich countries, the disparities with the rest of the world become starker. This article considers the enormous cost in lives of leaving most of the global population unvaccinated. It draws lessons on how we can do better from the effort to provide lifesaving drugs for HIV-AIDS in the 1990s. This June 22 article is by Maria De Jesus, Associate Professor and Research Fellow at the Center on Health, Risk, and Society, American University School of International Service. This article is republished from The Conversation under a Creative Commons license. Read the original article.
In the race between infection and injection, injection has lost.
Public health experts estimate that approximately 70% of the world’s 7.9 billion people must be fully vaccinated to end the COVID-19 pandemic. As of June 21, 2021, 10.04% of the global population had been fully vaccinated, nearly all of them in rich countries.
Only 0.9% of people in low-income countries have received at least one dose.
I am a scholar of global health who specializes in health care inequities. Using a data set on vaccine distribution compiled by the Global Health Innovation Center’s Launch and Scale Speedometer at Duke University in the United States, I analyzed what the global vaccine access gap means for the world.
A global health crisis
Supply is not the main reason some countries are able to vaccinate their populations while others experience severe disease outbreaks – distribution is.
Many rich countries pursued a strategy of overbuying COVID-19 vaccine doses in advance. My analyses demonstrate that the U.S., for example, has procured 1.2 billion COVID-19 vaccine doses, or 3.7 doses per person. Canada has ordered 381 million doses; every Canadian could be vaccinated five times over with the two doses needed.
Overall, countries representing just one-seventh of the world’s population had reserved more than half of all vaccines available by June 2021. That has made it very difficult for the remaining countries to procure doses, either directly or through COVAX, the global initiative created to enable low- to middle-income countries equitable access to COVID-19 vaccines.
Benin, for example, has obtained about 203,000 doses of China’s Sinovac vaccine – enough to fully vaccinate 1% of its population. Honduras, relying mainly on AstraZeneca, has procured approximately 1.4 million doses. That will fully vaccinate 7% of its population. In these “vaccine deserts,” even front-line health workers aren’t yet inoculated.
Haiti has received about 461,500 COVID-19 vaccine doses by donations and is grappling with a serious outbreak.
Even COVAX’s goal – for lower-income countries to “receive enough doses to vaccinate up to 20% of their population” – would not get COVID-19 transmission under control in those places.
The cost of not cooperating
Last year, researchers at Northeastern University modeled two vaccine rollout strategies. Their numerical simulations found that 61% of deaths worldwide would have been averted if countries cooperated to implement an equitable global vaccine distribution plan, compared with only 33% if high-income countries got the vaccines first.
Put briefly, when countries cooperate, COVID-19 deaths drop by approximately in half.
Vaccine access is inequitable within countries, too – especially in countries where severe inequality already exists.
In Latin America, for example, a disproportionate number of the tiny minority of people who’ve been vaccinated are elites: political leaders, business tycoons and those with the means to travel abroad to get vaccinated. This entrenches wider health and social inequities.
The result, for now, is two separate and unequal societies in which only the wealthy are protected from a devastating disease that continues to ravage those who are not able to access the vaccine.
A repeat of AIDS missteps?
This is a familiar story from the HIV era.
In the 1990s, the development of effective antiretroviral drugs for HIV/AIDS saved millions of lives in high-income countries. However, about 90% of the global poor who were living with HIV had no access to these lifesaving drugs.
Concerned about undercutting their markets in high-income countries, the pharmaceutical companies that produced antiretrovirals, such as Burroughs Wellcome, adopted internationally consistent prices. Azidothymidine, the first drug to fight HIV, cost about US$8,000 a year – over $19,000 in today’s dollars.
That effectively placed effective HIV/AIDS drugs out of reach for people in poor nations – including countries in sub-Saharan Africa, the epidemic’s epicenter. By the year 2000, 22 million people in sub-Saharan Africa were living with HIV, and AIDS was the region’s leading cause of death.
The crisis over inequitable access to AIDS treatment began dominating international news headlines, and the rich world’s obligation to respond became too great to ignore.
“History will surely judge us harshly if we do not respond with all the energy and resources that we can bring to bear in the fight against HIV/AIDS,” said South African President Nelson Mandela in 2004.
Pharmaceutical companies began donating antiretrovirals to countries in need and allowing local businesses to manufacture generic versions, providing bulk, low-cost access for highly affected poor countries. New global institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria were created to finance health programs in poor countries.
Pressured by grassroots activism, the United States and other high-income countries also spent billions of dollars to research, develop and distribute affordable HIV treatments worldwide.
A dose of global cooperation
It took over a decade after the development of antiretrovirals, and millions of unnecessary deaths, for rich countries to make those lifesaving medicines universally available.
Fifteen months into the current pandemic, wealthy, highly vaccinated countries are starting to assume some responsibility for boosting global vaccination rates.
Leaders of the United States, Canada, United Kingdom, European Union and Japan recently pledged to donate a total of 1 billion COVID-19 vaccine doses to poorer countries.
It is not yet clear how their plan to “vaccinate the world” by the end of 2022 will be implemented and whether recipient countries will receive enough doses to fully vaccinate enough people to control viral spread. And the late 2022 goal will not save people in the developing world who are dying of COVID-19 in record numbers now, from Brazil to India.
The HIV/AIDS epidemic shows that ending the coronavirus pandemic will require, first, prioritizing access to COVID-19 vaccines on the global political agenda. Then wealthy nations will need to work with other countries to build their vaccine manufacturing infrastructure, scaling up production worldwide.
Finally, poorer countries need more money to fund their public health systems and purchase vaccines. Wealthy countries and groups like the G-7 can provide that funding.
These actions benefit rich countries, too. As long as the world has unvaccinated populations, COVID-19 will continue to spread and mutate. Additional variants will emerge.
As a May 2021 UNICEF statement put it: “In our interdependent world no one is safe until everyone is safe.”
Canada is virtue signalling while waffling on global access to COVID-19 vaccines
This article addresses the shocking contrast between Canada's declarations of concern with the global distribution of vaccines, and the poor reality of its actions. Joel Lexchin, Professor Emeritus of Health Policy and Management, York University, Emergency Physician at University Health Network, Associate Professor of Family and Community Medicine, University of Toronto tackles this question. This May 11 article is republished from The Conversation under a Creative Commons license. Read the original article.
Based on public statements, it’s easy to come to the conclusion that Canada is working to improve global access to COVID-19 vaccines.
This quote comes from an opinion piece in the Washington Post on July 15, 2020; the lead author, none other than Prime Minister Justin Trudeau:
“…we must urgently ensure that vaccines will be distributed according to a set of transparent, equitable and scientifically sound principles. Where you live should not determine whether you live, and global solidarity is central to saving lives and protecting the economy.”
The person being quoted here in early May of this year is Mary Ng, the International Trade Minister in Trudeau’s cabinet:
“The work we have been doing and the leadership we have been providing is very much about removing all barriers to vaccine access, whether it be production or supply chain or export restrictions…We’re trying to remove all barriers to access to vaccines.”
But despite what Trudeau and Ng said, Canada is not doing all that it can to improve access. Far from it.
Virtue signalling with little action
Canada has signed contracts for enough vaccine doses to inoculate every woman, man and child in Canada four times. Canada is accepting vaccine donations from the United States and also purchasing vaccines from COVAX (COVID-19 Vaccines Global Access — a mechanism mainly designed to ensure that low- and middle-income countries can access vaccines).
Over one-third of Canadians have received at least one dose of vaccine as of May 7, compared to vaccination rates of under two per cent in Africa. Back in January, Canada refused to donate any vaccines and that position has not changed since.
This pattern of virtue signalling about access to medicines and then doing nothing has a long tradition in Canada.
Back in the late 1990s, the South African government was trying to improve access to drug treatment for the staggering 22 per cent of the population that was HIV positive. At that time, triple therapy — the three-drug cocktail used to treat HIV — cost over US $10,000 per person per year, effectively putting it out of reach of the vast majority of South Africans.
South Africa wanted to encourage the use of low-cost generic drugs. The response from 39 drug companies, backed by the United States, was to take South Africa to court. Canada’s position? We supported access but we also supported the intellectual property rights of the drug companies.
C-TAP, COVAX and the WTO TRIPS waiver
Fast forward to the present and COVID-19. In May 2020, the World Health Organization launched the COVID-19 Technology Access Pool, or C-TAP, an initiative to accelerate and broaden global access to COVID-19 vaccines under development at the time, as well as treatments and diagnostics.
C-TAP has the endorsement of 40 countries. But not Canada. No pharmaceutical company has contributed to C-TAP. Pfizer CEO Albert Bourla said: “At this point in time, I think it’s nonsense, and… it’s also dangerous.”
COVAX is designed to give poor countries enough vaccine for 20 per cent of their population, but it is $2 billion short of even achieving that modest objective.
In the face of the failure of C-TAP and in order to supplement what COVAX could do, back in October 2020 India and South Africa asked the World Trade Organization to suspend the protection of intellectual property.
The request included patent rights, technical know-how and undisclosed data for COVID-19 products for the duration of the pandemic. This is known as the TRIPS (Trade-Related Aspects of Intellectual Property Rights) waiver. The objective was to free up unused worldwide capacity to increase the production of vaccines and other products necessary for the prevention and treatment of COVID-19.
As many commentators have pointed out, if the waiver is approved by the WTO (and approval requires consensus among all its 159 members), nothing will change overnight. It will take many months and possibly even longer to ramp up vaccine production.
But that increased capacity is going to be needed. It is increasingly looking like we might require yearly booster shots for COVID-19 as variants multiply. That’s almost six billion doses of vaccine a year for people 15 years and older, almost double the current capacity to produce vaccines.
Moreover, when drug companies think that the pandemic is over, they are going to raise prices dramatically. Pfizer currently charges US$19.50 per dose, but chief financial officer Frank D’Amelio said that Pfizer’s normal price for vaccines is $150 to $175.
Canada’s position on intellectual property
To the amazement of just about everyone, the Biden administration just announced that the U.S. is going to support the waiver for COVID-19 vaccines.
Canada? Just like the South Africa situation, we neither support nor oppose the waiver. The Canadian government will take part in talks at the WTO about the waiver, but won’t say which side it will be taking.
Canada’s position for months has been that it was “merely asking questions about the patent waiver proposal, rather than opposing it.” But in a letter to the U.S. government back in March from the Pharmaceutical Research and Manufacturers of America, Canada was listed as one of the countries standing with the U.S. in opposing the waiver.
Canada is currently negotiating with drug companies over vaccine delivery schedules and is still in a battle with them about changes to how prices for patented drug will be determined.
Innovative Medicines Canada (IMC), the lobby group for the multinational companies, not surprisingly has come out strongly against the waiver. In a statement a few days after the U.S. announced its position, IMC said the “proposed waiver of TRIPS IP protections would be a disappointing step that will create greater uncertainty and unpredictability in the production, quality, and availability of COVID-19 vaccines worldwide.”
How much is fear of further angering the pharmaceutical industry playing into Canada’s position on the waiver?
When it comes to standing up for access to medicines versus standing up for intellectual property rights, for Canada, plus ça change, plus c’est la même chose; the more things change, the more they stay the same.
RNAO update: Since this article was published, Canada has committed at a G-7 meeting to donate “up to 100 million vaccine doses” to help poorer countries beat back the global pandemic. Canada was the only country from the G7 to not say how many of those would be actual shots rather than money. Canada pledged 13 million surplus vaccines “in the coming months” but stopped short of saying when the rest of the 100 million would arrive. As mentioned, many billions of doses are required on a global scale to achieve herd-immunity.
POLICY UPDATES FOR ALL TO ACT ON & MUST JOIN EVENTS – OPEN TO ALL
Webinar: COVID-19 Webinar Series
, 2:00pm - 4:00pm
When: Every second Monday of the month
RNAO's CEO Doris Grinspun will be hosting COVID-19 webinars for health providers.
Health providers from Ontario, Canada, and anywhere in the world are welcome to join at no cost.
We are here with you in solidarity. Together, we will continue to tackle COVID-19 with the best tools at hand, including accurate information, calmness, determination and swift actions!
July 12, 2021, 2 - 4 p.m. ET
Details coming soon. REGISTER NOW
August 9, 2021, 2 - 4 p.m. ET
Details coming soon.
Watch the 14 June past webinar:
Topic: Update on COVID-19 – Directions from the province and policy implications
We are now in the 16th month of COVID-19. Join us for an update on current issues related to this stage in the pandemic. RNAO CEO, Dr. Doris Grinspun outlines recent directions from the province, discusses the policy implications from RNAO’s perspective and has a conversation with participants.
Issues discussed include:
Presenter: Dr. Doris Grinspun, RNAO CEO
Watch and read about earlier webinars here.
Continuing the Conversation: An Open Forum for Nurses
Aug 18, 2021, 2:30pm - 4:00pm
RNAO is aware nurses across Ontario – especially those working on the frontlines of COVID-19 – are experiencing tremendous levels of physical and emotional stress and burnout. We know this can affect your mental health and wellbeing at this challenging time and that you may have less time to devote to your own self care.
During these forums, RNAO facilitates open discussions and holds breakout sessions for participants to discuss themes identified in the previous forums, such as dealing with multiple losses, taking care of yourself, burnout and more.
All RNs, NPs, RPNs and nursing students – in all roles and sectors – are invited to participate. You may wish to share how things are going for you or you can simply join and listen in.
Visit our COVID-19 Portal for additional resources and information on psychosocial support.
Details and registration link coming soon.
Information about prior webinars can be found here.
MOH EOC Situational Report
We are posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you can access the Ministry’s guidance at any time.
For a more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here.
Here is a segment from the last Situation Report #459 for June 25:
Staying in touch
Keeping in touch remains important as we face the pandemic and other challenges in Ontario, in Canada and elsewhere. Feeling that we are part of a community and that we have each other’s backs helps us get through these challenges, becoming better people in the process. We are eager to hear how we, at RNAO, can best support you. Send us your questions, comments, and challenges. Recommend ideas for articles and webinars. Write to me at firstname.lastname@example.org and copy my executive assistant, Peta-Gay (PG) Batten at email@example.com. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!
Thank you for being there for your community – everywhere and in all roles! Together, in solidarity, we are strong and resilient. In Canada we see hope at the end of this long pandemic tunnel. Vaccines arrive in large quantities and the rollout is speeding even more. We must not forget, however, about our privilege. Canada has purchased more vaccines than what it needs, while 9 out 10 countries have almost nothing. Like in other challenges we face, such as racism, Islamophobia, and other forms of discrimination, we are not safe until everyone is safe. Vaccines for all – literally for all, across the world – must guide policy in the upcoming 12 months. Let’s learn from the 16-month pandemic and take real action to build a better world.
To everyone – THANK YOU! Please take care of yourself and know that RNAO always stands by you!
As we have said before – and everyday becomes truer: The silver lining of COVID-19: Coming together and working as one people – for the good of all – let’s join efforts in urging our political leaders to bring about #Vaccines4All!
Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, FCAN, O.ONT
RECENT BLOG ITEMS:
20 June - Building your Twitter presence: Here are tips from RNAO – go here
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12 June - RNAO statement on the terrorist attack in London, Ontario – go here
12 June - Reducing the time interval for second dose after first AstraZeneca dose – go here
12 June - AstraZeneca second dose: Should I get the same vaccine or Mrna? – go here
5 June - RNAO’s continuing media profile: The May report – go here
5 June - RNAO supports Premier Ford's announcement on schools as risk is too high – go here
29 May - Vaccination passport apps could help society reopen – go here
29 May - Email updates highlight best new evidence about COVID-19 – go here
23 May – NPs speak about LTC during the COVID-19 Pandemic – go here
23 May – Three surveys on the impact of COVID-19 on Canadian nurses – go here
23 May – Exemption of nurses and other health-care workers from Bill 124 – go here
23 May – RNAO’s statement on the government’s phased-in re-opening plan – go here
23 May – Remembering Charlotte Noesgaard (1948-2021) – go here
15 May - Nursing Now Ontario Awards Ceremony – go here
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8 May - Nurses must be fully vaccinated immediately, RNAO demands – go here
8 May - A bill to support individuals with assistive devices for mental health – go here
8 May - Action alert: Ensure global vaccine access, prime minister! – go here
1 May - RNAO statement on the passing of RN Lorraine Gouveia – go here
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We have posted earlier ones in my blog here. I invite you to look.
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