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Adoption of effective measures in healthcare transport

Article-Adoption of effective measures in healthcare transport

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Transportation is a fundamental but crucial step in obtaining continued health care and medication, especially for patients with chronic illnesses. To offer evidence-based treatment, clinician visits, medication access, and treatment plan updates are required. However, without transportation, clinical procedures result in delays. Such intervals in care can result in a lack of appropriate medical treatment, chronic illness exacerbations, or unmet health-care demands, all of which can add up to poor health outcomes.

Ground and air rescue, rotary-wing (HEMS) and fixed-wing (AEMS) emergency medical services face unprecedented problems during the pandemic. While there are various suggestions for safety precautions during in-hospital emergency operations including tracheal intubation, there is insufficient guidance for the pre-hospital setting. Furthermore, presently no documented guidelines on how to securely transfer COVID-19 patients exist.

Unfortunately, the risk of disease transmission for aeromedical crew members is higher than for in-hospital healthcare providers, mainly attributed to the prehospital setting's lack of information, resources, and space, as well as aerosol-generating procedures like airway management and ventilation being one of the main tasks. During air travel, different measures are employed to avoid transmission from patients with extremely contagious illnesses. The experience and recommendation of the Swiss Air Rescue (REGA) and subsequent recommendations for COVID-19 and aeromedical transport have provided an instance in which measures can be adopted to avoid transmission.

Maintaining stringent guidelines

According to an article published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine during HEMS operations, every air rescue provider should define detailed SOPs for the usage and handling of personal protective equipment. With a large number of infected patients and persons with uncertain COVID-19 status, during the current pandemic, rigorous adherence to these guidelines on every mission is critical. Every crew member should receive simulation training on these unique procedures to prevent infection since this has been shown to promote adherence to the SOP.

REGA has not used closed suction catheters on main missions or for hospital transfers, secondary transport, during the COVID-19 pandemic, and they are avoided even if they are pre-installed, due to the potential of aerosol formation from mobile suction equipment. Furthermore, most COVID-19 patients, without bacterial superinfection, had only minimal bronchial secretion production.

For secondary transfer of COVID-19 patients, air rescue providers use a variety of technologies, including open transport systems that allow direct patient treatment by medical crews wearing PPE throughout the journey. Patients with other highly contagious and deadly diseases, such as viral hemorrhagic fever, are transported using alternately closed transport methods, known as air transport isolator systems. However, considerations should be made on working in full PPE during the transport of COVID-19 patients during secondary missions. These usually extend over regular hours especially in fixed-wing ambulances or helicopters and are exceedingly demanding and physically stressful for the medical crew, which can lead to medical errors. Furthermore, every movement must be closely monitored to avoid infection transmission by accident, for example, contact with one’s face with contaminated gloves.

As a result, despite the greater costs and logistical difficulties, the employment of a PIU for the aeromedical transport of patients with potential or proven COVID-19 on secondary missions, fixed-wing ambulances, or long-term secondary HEMS missions, offers significant benefits.

Patients can also be transported faster with closed PIUs as fixed-wing ambulances and helicopters do not require further disinfection between transportation. Another benefit of compact PIUs is the ease with which they may be transferred from an airplane to an ambulance or rescue chopper, or vice versa. As a result, all teams involved in transporting these patients can be effectively safeguarded, and the FFP2/3 respirators that are now available can be reserved for use in hospitals. 

The consensus is SOPs for preventing infection transmission during COVID-19 or other future pandemics for primary HEMS missions should be based on current recommendations from national medical societies/authorities, customized to specific HEMS mission situations, and trained in simulation. Small closed PIUs may be advantageous for secondary aeromedical transport of non-intubated or intubated COVID-19 patients in fixed-wing ambulances, or for long-term HEMS missions.

ASG update: COVID-19 global progress and response

Article-ASG update: COVID-19 global progress and response

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Middle East & North Africa

Government Response: As expected, many countries across the region have gradually eased Covid-19 restrictions since the Eid holidays in mid-May. The Gulf Cooperation Council (GCC) countries, which have some of the highest vaccination rates in the world, have largely opted to tie the lifting of restrictions to vaccinations. Saudi Arabia, Bahrain, and the United Arab Emirates (UAE) have announced that they will limit the reopening of many public areas, such as restaurants, shopping malls, gyms, and cinemas, to vaccinated individuals.

In Bahrain and the UAE, this may be a response to spikes in cases in mid-May (though numbers have since declined). Israel – where nearly 60 percent of the population is fully vaccinated and new case numbers have fallen to their lowest levels since the pandemic began – ended its indoor mask mandate this week, lifting one of its few remaining public health restrictions. 

In contrast, countries across the rest of the region appear to be lifting restrictions regardless of vaccination rates or case numbers, in response to economic pressures. Egypt and Tunisia, for example, have both lifted many public health restrictions even though they have only vaccinated a fraction of their populations and continue to see high rates of new cases.

The Economy: The economic outlook for the Gulf states remains positive with higher crude prices and rising vaccination rates driving the economic recovery. This week, global oil prices climbed to their highest levels in over two years on expectations of a strong recovery in global demand. Earlier this month, the World Bank raised its 2021 MENA growth forecast to 2.4 percent, three points higher than forecasted in January. Major oil producers are poised to recover most quickly. Saudi Arabia, for example, is forecasted to grow by 2.4 percent in 2021 and 3.3 percent in 2022, and its non-oil GDP has already returned to pre-pandemic levels due to high domestic investment and easing of Covid-19 restrictions. 

The economic outlook for countries in the Levant and North Africa is more varied. In Egypt, which has been one of the strongest economic performers throughout the pandemic, economic growth is expected to average 2.3 percent for the 2020-21 fiscal year ending in June and rebound to over 5 percent next fiscal year. Meanwhile, Lebanon continues to spiral deeper into economic crisis. Its currency plunged to record lows this week, and shortages of fuel, gasoline, and foreign currency remain widespread.

Looking Ahead: Although some countries experienced spikes in infections over the past month, we expect most to continue easing Covid-19 restrictions and ramping up vaccination efforts. Several Gulf countries have instituted vaccine passport regulations, and others may follow. Throughout the region, testing and quarantine regulations largely remain in place for travelers arriving on international flights.

China, East Asia and the Pacific

Government Response: China is responding to a local outbreak of Covid-19 cases in Guangzhou, the capital city of Guangdong province and one of China’s major manufacturing and trade hubs. There were 202 active cases in the province as of June 15.

In response, government authorities have instituted targeted lockdowns in specific neighborhoods, carried out testing of nearly all of Guangzhou’s 15 million residents, and restricted movement in and out of the city. Guangdong’s ports, which are among the busiest in the world, are increasingly congested as Covid-19-related restrictions impede operations.

Officials from China’s Center for Disease Control and Prevention noted the new cases are predominately the Delta variant, which was first identified in India and has a higher transmission rate compared to other strains, and stressed the need for mass vaccination to prevent further outbreaks. As of early June, China has distributed over 800 million vaccine doses across the country, and the National Medical Products Administration on June 11 approved the emergency use of Chinese-made vaccines for children aged 3 to 17 years.  

Japan is attempting to accelerate its Covid-19 immunization program with the goal of vaccinating one million people per day ahead of the opening ceremonies of the Tokyo Olympic games, scheduled for July 23. Large facilities, each capable of vaccinating 1,800 people per day, have opened in Tokyo and Osaka. The country also recently secured 20,000 doses to vaccinate support staff for the games.

However, appointments have been filled slowly, in part due to reluctance to use public transportation, and only 4.8 percent of the population was fully vaccinated as of June 14. Nonetheless, case numbers are beginning to decline due to restrictions in place since early February, and Japan has begun to lift restrictions in less populous prefectures. Tokyo is likely to remain under a quasi-state of emergency into the Olympics, as many public health experts continue to express their concerns about hosting the event and opinion polls indicate that a majority of Japanese citizens remain opposed.

Singapore and South Korea are set to gradually ease restrictions from mid-June after a sluggish vaccine rollout in both countries and concerns over rising infection numbers in April and May. Among other things, Singaporeans will soon be able to resume indoor dining, and Koreans will be able to attend concerts with crowds of up to 4,000. South Korea has benefited from the one million Johnson & Johnson doses donated by the U.S. government during President Moon Jae-in’s visit to Washington. The majority of these doses have been administered to South Korean military personnel who work closely alongside U.S. armed forces. 

Developing economies in the region have not been as successful in controlling the virus. In Vietnam, declining caseloads across the country have been tempered by an uptick of cases in the country’s commercial capital of Ho Chi Minh City. Social distancing protocols have been implemented and certain areas of the city have been placed under strict lockdown as the government initiates mass testing and contact tracing.

Among other localized outbreaks, 57 inoculated healthcare workers at the Hospital for Tropical Diseases recently tested positive for the disease, raising concerns that they may have spread the virus asymptomatically to non-healthcare workers who have no immunity. In Thailand, a move to vaccinate 70 percent of the population by the end of the year has run into issues related to the domestic production of the AstraZeneca jab. Foreign governments who had been promised vaccines from Thailand – notably Malaysia, the Philippines, and Taiwan – have cited the delays in Thailand as complications to their own vaccination drives.

The Economy: China’s producer price index (PPI) rose by 9 percent in May, while the consumer price index (CPI) rose by 1.3 percent year-over-year. The gap between the PPI and CPI is the highest on record and indicates that rising prices are mainly concentrated in manufacturers’ inputs such as coal, oil, steel, and copper. Analysts suggest that producers are hesitant to pass along these higher costs to consumers, due to weak domestic demand and high levels of market competition. In early June, the Chinese government issued a series of subsidies for small businesses to help shoulder the burden of rising raw material prices.

The South Korean economy is in the midst of a relatively robust recovery. Employment is now nearing pre-pandemic levels and the Bank of Korea has revised its economic forecast upward to 4 percent GDP growth in 2021, the highest in a decade. The rebound has been fueled by surging demand for South Korean exports, which have reached their highest levels since 1988. Automobiles, semiconductors, and other information technology products have all seen strong export growth. Australia’s economy has also experienced a rapid recovery, with growth surging past pre-pandemic levels due to increased consumer and business spending. There are now more Australians employed than before Q1 2020, when the pandemic began. 

In contrast, Japan’s economy contracted by 3.9 percent in Q1 2021. This was still a better performance than expected by most analysts, who had predicted a drop of 4.8 to 5.1 percent. Japan’s recovery is expected to continue to lag until the country is able to reach a vaccination rate of about 50 percent, which would enable resumption of normal economic activity. 

In Malaysia, rising infections and a strict government lockdown prevent the country from fully taking advantage of the surging demand for manufactured goods. There are concerns that Malaysia may take on more debt to provide additional stimulus and avoid further recession. The Bank of Malaysia has maintained its prediction of 6 to 7 percent growth for the year 2021, although most economists are predicting growth in the 4.4 to 5.7 percent range. 

In Thailand, the economy continues to struggle with the country’s largest and deadliest wave of Covid-19 yet. Economists have cut their growth predictions down to 2.3 percent as key economic sectors, such as tourism, are likely to remain shut down for an extended period. Thailand’s central bank chief has warned that economic conditions are unlikely to normalize and reach pre-pandemic levels until early 2023. 

Myanmar is likely to be the regional economy most severely affected in 2021. Analysts predict the economy could contract as much as 20 percent due to the continued effects of the pandemic, as well as the economic and political fallout of February’s coup.

Looking Ahead: Novavax, a U.S. pharmaceutical company, recently announced that its Covid-19 vaccine had an efficacy of 90 percent in clinical trials. This comes as good news specifically for South Korea, which recently partnered with Novavax to produce and distribute the vaccine within the country. 

Europe

Government Response: Despite having reached the milestone of 200 million vaccine doses delivered on May 18, the European Union is far from meeting its goal of fully vaccinating 70 percent of adults by late July, with only about 24 percent of its population currently fully vaccinated. 

The population eligible to receive a vaccine in the EU has been expanded following the recent approval of the Pfizer-BioNTech vaccine by the European Medicines Agency (EMA) for use in individuals aged 12 to 15. U.S. company Biotech Moderna also applied in early June for an EMA authorization covering teens. 

Spain has begun to gradually lift restrictions for hotels, restaurants, and cafes and is contemplating reopening nightlife activities in medium-risk regions. Covid-19 transmission rates continue to decline throughout the country, and some regions have started to vaccinate citizens in the 40 to 49 age group. 

The pace of vaccination has picked up in Germany after a slow start, with about 47 percent of the population having had at least one dose. The country has seen a decline in the number of new cases, but the spread of the Delta variant remains a concern. 
France entered its next phase for reopening in time for summer, with bars, restaurants, gyms, and swimming pools welcoming people for the first time in seven months. Some restrictions on capacity remain in place, however. An overnight curfew remains in effect, but its start time has been pushed to 11 p.m. 

Following a fatal blood clot in an 18-year-old woman, Italy announced it will ban the AstraZeneca vaccine for people under 60. Italians under 60 who have received a first dose of AstraZeneca will get a different vaccine for the second dose. 

The rapid spread of the Delta variant has forced UK Prime Minister Boris Johnson to delay his plan to end England’s coronavirus lockdown on June 21 by four weeks. The total number of cases of the variant almost doubled in the U.K. in the first week of June. 

Turkey further eased Covid-19 restrictions, including partially lifting a weekend lockdown and opening restaurants to a limited number of guests. Nationwide daily curfews have also been delayed by an hour, to 10 p.m. Health authorities have extended the vaccination campaign to larger groups of people regardless of their age, including employees in the transportation sector, restaurant and bar workers, and lawyers.

The Economy: With vaccination rates ramping up across the continent, both the UK and eurozone economies are now on track to reach their pre-pandemic levels around mid-2022. According to the Office for National Statistics in the UK, the reopening of retail stores and outdoor dining there led to a 2.3 percent increase in GDP in April, exceeding economists’ forecasts. 

The European Central Bank announced in early June its prediction that the eurozone economy will grow 4.6 percent in 2021 and 4.7 percent in 2022, a significantly more positive outlook than its previous March forecast of 4 percent and 4.1 percent, respectively. The new forecast comes after the European Council announced that member states will be able to access the €750 billion NextGenerationEU recovery fund in June, following the remaining approvals of national recovery plans by the parliaments of Austria and Poland on May 27. 

Looking Ahead: Ahead of the summer season, EU countries are expected to lift bans for travelers from within the bloc, the 26-nation Schengen Area, and the UK. The European Parliament is pressing to standardize national travel restrictions with the issuance of a common Vaccine Certificate. This system, which has already been implemented at the national level by several EU countries like Germany and Greece, will allow fully vaccinated travelers to move between EU states without quarantine requirements or coronavirus testing. The certificate will be accepted by all 27 EU member states beginning July 1 and be recognized for one year. 

The European Union in early June added Japan, Australia, Israel, New Zealand, and others to the list of nations from which non-essential travel is allowed, keeping travel restrictions on the UK and the U.S. The bloc had previously agreed to allow all fully vaccinated visitors into the region without having to quarantine beginning July 1. The EU’s recommendations are not legally binding, and some member states such as Portugal, Spain, and Greece have eased curbs in view of the holiday season. 

Latin America

Government Response: While vaccine rollouts have slowly picked up in certain countries, Latin America continues to struggle to contain Covid-19 outbreaks. New statistics have also clarified the scale of the pandemic’s impact in the region. Following a review of its excess death count, Peru announced that its official death toll from the virus had nearly tripled after initially being undercounted, leaving the country with the world’s highest Covid-19 death rate per capita. In Mexico, the government released a new study last week indicating that up to one-fourth of the country’s total population had been infected with the virus since the start of the pandemic, significantly outpacing official counts.

Cases continue to rise across South America as governments employ intermittent lockdowns. Colombia is now reporting the continent’s highest rate of new cases, with ICU beds almost at capacity in many cities. Brazil, which is hosting the Copa America soccer tournament this month despite warnings from public health experts, has also seen cases and hospitalizations increase again in June after small improvements in May.

In some states in Brazil’s Northeast region, many hospitals are at over 90 percent capacity. In Central America, new cases in Panama, Belize, and El Salvador have doubled in recent weeks. Mexico has emerged as an outlier success story in the region and has begun gradually reopening its economy, having experienced a dramatic drop in Covid-19 deaths and hospitalizations in recent months after managing to avoid many of the variants that severely impacted South America.

The pace of vaccinations across the region has generally been slow to ramp up. In some Central American and Caribbean countries, including Guatemala, Honduras, and Trinidad and Tobago, less than 1 percent of the population is fully vaccinated. Chile and Uruguay serve as exceptions to the trend, having vaccinated more than half their populations. However, both countries, which have largely relied on the Chinese Sinovac vaccine, still experienced recent surges and had to reinstate lockdowns after reopening before enough people could receive their second doses. Recent studies have indicated that unlike the two-dose vaccines being deployed in the U.S. and Europe, Sinovac’s efficacy remains low after the initial dose and does not pick up until after the second dose has been administered. 

Latin America should expect to receive much-needed aid following the Biden administration’s announcement that the U.S. will donate 80 million vaccine doses, many of which are allocated for the region, to the rest of the world by the end of June. Out of the initial shipment of 25 million doses, 19 million will be shared through the World Health Organization’s COVAX mechanism, with 6 million of those going to Latin America and the Caribbean. The U.S. will directly send the remaining 6 million doses to specific allies around the globe, including Mexico, Haiti, and Canada. The U.S. will also send Mexico an additional 1 million doses to be deployed in areas around the U.S.-Mexico border to help normalize crossings.

The Economy: While ongoing restrictions imposed in several countries during the first half of the year have adversely affected economic activity, the economic outlook has modestly improved compared to earlier in the year. This month, the World Bank revised its regional growth forecast for 2021 up to 5.2 percent – a modest recovery following a 6.5 percent contraction in 2020 but an improvement from earlier projections released this year.

Anticipated progress with vaccinations, relaxation of mobility restrictions, and an increase in the price of key commodities are important conditions for the recovery. Along with the Middle East and North Africa, Latin America is one of two emerging-market and developing-economy regions where GDP is expected to be lower in 2021 than in 2019. Tourism-dependent economies are anticipated to take longer than commodity-exporting economies to return to 2019 GDP levels.

Looking Ahead: Vaccines remain the strongest tool for Latin American countries to rebuild their economies, and the region will likely rely heavily on the U.S. and COVAX to gain a broader supply of doses after largely turning to China over the first half of this year. Meanwhile, the pace of recovery remains slow, with flawed public health responses, high unemployment, rising inequality, and poverty having led to widespread dissatisfaction with the status quo throughout the region.

This frustration has manifested in Colombia’s ongoing unrest and in Peru’s presidential election, where political outsider Pedro Castillo appears to have emerged victorious after pledging to upend the country’s economic model during his campaign. With presidential elections in Chile later this year and in Colombia and Brazil the following year, ASG anticipates that the social discontent and political polarization amplified by the pandemic is likely to further strengthen opposition parties and outsider candidates.

Sub-Saharan Africa

Government Response: Africa is experiencing a third wave of Covid-19 cases that is straining healthcare systems amid a shortage of vaccines. Only 31 million of the 50 million doses received across the continent have been administered, and vaccination efforts have stalled in many countries. Only 2 percent of Africans have received their first dose, and 0.63 percent have been fully vaccinated.

Africa currently has less than 1 percent of the vaccines required to fully vaccinate its population. There are also problems with some of the vaccines obtained. South Africa will need to destroy 2 million Johnson & Johnson vaccines, which the U.S. Food and Drug Administration found unsuitable due to possible contamination at a Baltimore plant. These vaccines were earmarked for healthcare workers and people over 60, creating a major setback for the South African vaccination effort. 

Facing such widespread shortages, African countries continue to look towards Russia and China for Covid-19 vaccines. The Republic of the Congo approved use of Russia's single-dose Sputnik V vaccine on June 7, and Zimbabwe received its first batch of Sputnik V vaccines on June 11. Other countries using Sputnik V include Angola, Djibouti, Republic of Guinea, Gabon, and Ghana. Several African countries are also using China’s Sinovac vaccine.

Over the past two weeks, 14 countries have seen an increase in test positivity and eight countries are experiencing a surge of over 30 percent in new cases. The surge is being caused by poor compliance with social distancing restrictions, the spread of new variants, increasing travel, and the beginning of winter in southern Africa. The rising case numbers are concentrated in a small number of countries. One concern is the high rate of infection of healthcare workers, which adds pressure to healthcare systems with limited intensive care unit beds, oxygen, and ventilators. For now, the rising case numbers are concentrated in a small number of countries.

African leaders have reacted to the new wave by implementing lockdown restrictions. On June 6, Uganda’s President Yoweri Museveni instituted a 42-day lockdown closing schools, religious gatherings, conferences, and suspending inter-district transport. Zimbabwe also imposed new lockdown measures on June 14.

The Economy: The international community continues to seek to play a major role in attenuating the economic effects of the pandemic on the continent. 

Following a May summit on African financing, French President Emmanuel Macron confirmed efforts to persuade wealthy nations to reallocate $100 billion in International Monetary Fund (IMF) Special Drawing Rights (SDRs) to African states. France has committed to redirect its SDRs to Africa and is aiming to convince other wealthy nations to make the commitment by October 2021. 

The European Investment Bank (EIB) released a report on June 14 highlighting plans for development and partnership across Africa. In the report the EIB outlined the work it has done in Africa to combat Covid-19 by investing in vaccine efforts and providing loans to African countries to pay for resources needed to fight the virus. The EIB also highlighted its strategy going forward. It aims to increase staff on the ground, strengthen its approach in fragile states, target urban development and infrastructure, support job creation and micro-level small- and medium-sized enterprise finance, and contribute to social outcomes and impact.

Looking Ahead: Urgent calls for vaccines in Africa are growing louder, and several encouraging investments are headed the continent’s way. 

The Mastercard Foundation will contribute $1.3 billion in support of Covid-19 vaccinations in Africa. The Saving Lives and Livelihoods initiative will partner with the Africa Centers for Disease Control & Prevention to procure vaccines for over 50 million Africans. Over 80 percent of the funding will be used to purchase Johnson & Johnson vaccines, which will be available from August 2021. The foundation will provide additional support to the African Union (AU) to locally manufacture as much as 40 percent of the vaccines needed in Africa. 

The G-7 recently agreed to donate one billion vaccines to countries across the world, with a focus on developing countries in Africa. However, this figure includes vaccines already donated; only 613 million doses are new. The U.S. will be donating 500 million of these vaccines, with some of the funding coming from funds previously pledged to COVAX. The doses are set to arrive in August 2021. 

The recent uptick in pledges for vaccine support is encouraging but analysts note that the pace of vaccine disbursement remains to be seen. Currently, vaccines have taken too long to reach African shores and the recently promised doses will take a few more months to arrive. 

South Asia

Government Response: The recent surge in Covid-19 cases is beginning to subside throughout the sub-continent. In India, the total official number of Covid-19 cases now stands at approximately 29 million, with 374,000 deaths – though both numbers are likely significant undercounts of the real toll the virus has taken. On June 13, 70,000 new cases were recorded, representing the lowest daily increase since March 31. As a result of the declining numbers, many states across the country have eased restrictions. However, experts have cautioned against a full reopening given that only 5% of population has been fully vaccinated. 

New Covid-19 cases in Pakistan have consistently declined after peaking at the end of April. On June 14, the country recorded its lowest single-day tally of new cases in four months. The federal government has relaxed several restrictions, opening schools, restaurants, and gyms. However, Sindh Minister for Health and Population Welfare, Dr. Azra Fazal Pechuho, cautioned administrators to prepare against a possible “fourth wave” that could hit the country. Numbers are declining in Nepal as well: The country recorded an average of 2,900 new daily cases in the second week of June (compared to 8,800 new cases in the second week of May). 

In contrast, cases are starting to rise again after an initial decline in Bangladesh. On June 13, the country recorded 2,436 new cases and 47 deaths, the highest single-day death toll in over a month. After a sharp rise in cases, the government ordered a strict lockdown in five camps that house nearly 100,000 Rohingya refugees. In Sri Lanka, cases are still rising after an initial surge that started in April. On June 10, the country recorded its highest single-day death toll since the onset of the pandemic.

The Economy: Unemployment in India soared above 10 percent in May as the second wave surged. The Organization for Economic Co-Operation and Development (OECD) cut India's growth projection for this fiscal year from 12.6 percent to 9.9 percent. This blow to recovery expectations follows the severe economic shock caused by the first wave of the pandemic and the strict nationwide lockdown imposed by India’s government. Still, some experts have suggested that India’s economy could bounce back quickly if the pandemic can be contained quickly.

In Pakistan, Minister of Finance Shaukat Tarin announced the 2020-21 federal budget, with the main priorities involving stimulating growth and job creation and enhancing the provision of social services, including health care. Some of the key proposals from the budget include an increase in total spending, with more than $12.3 billion to be earmarked for development. The government has allocated $1.1 billion to buy vaccines and set aside $641 million to combat the pandemic in the next fiscal year. Bangladesh’s Cabinet Secretary reported that GDP per capita had grown by 9 percent over the past year, rising to $2,227. This is higher than the GDP per capita of both India and Pakistan, signaling that Bangladesh can no longer be considered a Least Developed Country.

Looking Ahead: In India, more than 254 million vaccine doses have been administered. Prime Minister Narendra Modi announced that the central government would provide free vaccines to all adults. According to the policy, the government will procure 75 percent of the vaccines and provide them free of cost to states and union territories. The remaining 25 percent will be made available to private medical institutions to administer directly to eligible citizens. However, the Health Ministry has set a price ceiling to limit the amount that private players can charge for the vaccine. 

In Pakistan, more than 8.13 million people have received their first dose, while 2.8 million have been fully vaccinated. The government plans to vaccinate 70 million people by the end of the year. Health Advisor Dr. Faisal Sultan reported that the country had received 14.5 million vaccine doses since it began its vaccination campaign in February and plans to buy 90 million doses in the second half of the year. Pakistan continues to source vaccines primarily from China, though it did receive a shipment of 500,000 doses of the Pfizer-BioNTech vaccine from COVAX.

Many countries in the region are now struggling to administer second doses to their citizens because of limited supply. In Bangladesh, emergency use authorization was given to Pfizer-BioNTech and China’s Sinovac. The country is expecting approximately one million doses from the COVAX alliance and has also signed a deal with China to buy the Sinopharm vaccine. In Nepal, about 3 percent of the total population has been fully vaccinated. The country resumed its paused vaccination campaign on June 8 with a donation of one million doses by China. The government is allocating them to residents ages 60 and up. Sri Lanka has asked Japan for 600,000 doses of AstraZeneca vaccine. It is currently using China's Sinopharm and Russian Sputnik V vaccines.

Vaccines & therapeutics

Vaccines: Since the global vaccination effort began, more than 2.3 billion vaccine doses have been administered in over 210 countries and territories. This number translates to roughly 30 doses for every 100 people and an average of 34 million doses per day. At this rate it will take over a year to vaccinate enough of the world to reach some level of herd immunity. Additionally, significant inequity exists in vaccine distribution.

High-income and upper-middle-income countries have administered 85 percent of available doses while low-income countries have administered just 0.3 percent. This inequity seriously undermines efforts to control the pandemic. Mutations are more likely to develop in countries with poor vaccine access; these mutations strengthen the virus and facilitate its spread. The highly infective Delta variant, for example, originated in India, which has low vaccination rates and high case numbers. Now, Delta has spread to over 80 countries and accounts for 10 percent of the new cases in the U.S.   

COVAX, the worldwide initiative aimed at equitable vaccine access, has distributed 81 million doses so far, still far short of what is required. Significant global constraints on the availability of materials to manufacture vaccines demand has hampered production. Some have argued for global parameters to guide manufacturers’ allocation of their supplies. In response to the urgent global need for vaccines, G7 leaders announced a plan to provide at least one billion shots to low-income countries; this plan includes pledges of 500 million and 100 million shots from the U.S. and UK respectively. Discussion continues between G7 countries, the World Health Organization (WHO), and the World Trade Organization (WTO) on intellectual property waivers for Covid-19 vaccines with no consensus to date. 

Recently, Moderna announced that it has applied to the U.S. FDA for emergency use authorization in teenagers ages 12-17. Phase III findings from Novavax showed that its NVX-CoV2373 vaccine offered 90.4 percent efficacy and 100 percent protection against moderate and severe disease in trial participants. Early reports suggest that the mRNA vaccines and the Janssen adenoviral vectored vaccine have some efficacy against the Delta variant. Vaccine-related complications, such as cardiac inflammation in young adults who received the mRNA vaccines and thrombosis in women under 60 who received the Janssen and AstraZeneca vaccines, have prompted reviews by national agencies despite their rarity.

Therapies: Cocrystal Pharma announced that their novel protease inhibitor produced promising antiviral results against the original Covid-19 strain and the UK and South African variants in preclinical studies. 

Eli Lilly and Company’s polyclonal antibodies received restricted emergency use authorization in India. These antibody treatments already had been authorized in the U.S. and some European Union countries as well. In addition, the FDA has given GlaxoSmithKline’s monoclonal antibody treatment an emergency use authorization for mild-to-moderate Covid-19 after strong clinical trial results.

Foipan, a pancreatitis treatment approved in Japan that blocks viral entry into the cells, has entered Phase IV of clinical trials. Merck has also announced a $1.2 billion deal with the U.S. government for its therapeutic candidate ribonucleoside analogue. Merck plans to apply for an emergency use authorization in 2021 and produce 10 million doses by end of year, 1.7 million of which will go to the U.S. government.

In total, there are over 200 vaccines, 200 antivirals, and 300 treatments in various stages of development. As countries continue to grapple with emerging variants and rising cases, the availability of more treatments will be crucial in reducing the morbidity and mortality of Covid-19 and ending the pandemic.