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Lessons from the pandemic: vaccines prevent deaths, and ‘listen to scientists’

As South Africa last week joined the ranks of a growing number of countries which have dropped all COVID-19 restrictions, bringing to an end a fraught few years, one of the resounding successes during the period was the role played by vaccines in preventing deaths.

Access to vaccines, however, differed vastly across the globe, with a study saying 132, 700 deaths could have been averted in Africa if health authorities had met their vaccination targets.

This week, a mathematical modelling study has calculated that vaccinations prevented nearly 20m deaths from COVID-19 in 185 countries and territories in the first 12 months the shots were available.

The pharmaceutical race to develop an effective vaccine was fast and furious – but definitely triumphant.

Researchers estimated that vaccines prevented 14.4m (95% credible interval [Crl], 13.7 – 15.9) deaths from COVID between 8 December 2020 and 8 December 2021, reports Medscape.

However, the estimate rose to 19.8m (95% Crl, 19.1 – 20.4) deaths from COVID averted when excess deaths were added to the equation.

The study, co-led by Oliver Watson, PhD, and Gregory Barnsley, MSc, with the MRC Centre for Global Infectious Disease Analysis, Imperial College London, was published in The Lancet Infectious Diseases.

“(We) used excess deaths as an estimate of the true extent of the pandemic, representing a global reduction of 63% in total deaths (19.8m of 31.4m) during the first year of COVID-19 vaccination,” the authors write.

In one year, nearly half the world had two doses

The first dose of a COVID vaccine outside a clinic was given on 8 December 2020, and a year later, the researchers estimate, 55.9% of the global population had received at least one dose, 45.5% had two, and 4.3% had a booster. However, coverage has vastly varied in different parts of the world.

For the 83 countries in the study covered by the COVAX commitment to affordable vaccines, an estimated 7.4m deaths were averted out of a potential 17.9m (41%).

But in countries that failed to meet the COVAX target of fully vaccinating 20% of the population, researchers estimated an additional 156,900 died from COVID.

Though a small part of the global deaths, these preventable deaths were clustered in 31 African nations, where 132,700 deaths could have been averted if those targets had been met, the researchers report.

The authors say a further 599,300 lives could have been saved if the World Health Organisation’s (WHO) target of vaccinating 40% in each country with two or more doses by the end of 2021 had been met.

In an accompanying editorial, Chad Wells, PhD, and Alison Galvani, PhD, both with the Yale Centre for Infectious Disease Modelling and Analysis in New Haven, Connecticut, write: “Meeting these targets, particularly in low-income countries, is challenged by myriad obstacles that require international support to overcome.”

Among them are that several high-income countries got advanced purchasing agreements for the vaccines, while low-income countries couldn’t afford those prices, they noted.

In the United States, the number of doses purchased before production “was enough to fully vaccinate its entire population three times over”, they write.

Yet scientists and health experts say there’s no doubt we haven’t seen the last of this kind of virus.

Professor Shabir Madhi, vaccinologist and head of health sciences at Wits University, says that with more pandemics expected in the future, an independent scientific advisory group should be established in SA.

Madhi said the past two years had been a journey he is unlikely to forget, reports the Sunday Times.

COVID-19 made the clarion call of his life’s work even louder — first from within the government’s ministerial advisory committee on the pandemic and then from outside it after he and others were pushed out.

After his departure from the committee, Madhi set out to keep the public informed on the pandemic, breaking down complex information into easy-to-understand sound bites, answering countless questions as SA found itself in unknown territory.

Last week, as the final pandemic regulations were lifted, Madhi said COVID had delivered him an “exacerbation of imbalance between work and social and family time” and was a source of professional tension.

“Some of the scientific spats with other scientists and at times politicians could have been avoided had there been greater open-mindedness rather than stubbornness of pursuing and adhering to regulations which, as has transpired, failed,” he said, adding that he will always blame the government for the loss of an additional 20,000 lives after its decision to sell 1m doses of the AstraZeneca vaccine.

He said a major lesson for future pandemics is “the need to engage transparently with scientists who have the appropriate training and skills set”.

Many scientists believe COVID is one of several pandemics that could sweep the world, often caused by zoonotic diseases as human beings have destroyed the habitats of animals and created unnatural interactions in “wet” markets and other settings.

In future, said Madhi, the insights of scientists should not be filtered and diluted by treating them as “advisers”. He wants an independent scientific advisory group to be established to inform policy and boost public confidence in government decisions.

He said after the final regulations were dropped by the cabinet the protocols had “achieved very little in preventing the spread of the virus” – evidenced by the fact that 90% of South Africans got infected, “and often multiple times”.

He emphasised that protocols and mitigation strategies should differ vastly based on the pathogen.

And so the quest for coronavirus treatments continues, and the good news is that a plant used in traditional African medicine has the potential to be developed as a COVID-19 therapeutic.

The Sunday Times that the University of the Free State (UFS) has made a breakthrough with a potential treatment derived from plants. Known as Phela, it contains extracts from four plants traditionally used to treat wasting conditions and as energy boosters. According to some medical practitioners, they have also shown success with HIV patients.

In a paper prepared for Scientific Reports, still to be peer-reviewed, the researchers – led by Motlalepula Matsabisa from UFS and Kabamba Alexandre from the Council for Scientific and Industrial Research – say: “Our data showed that Phela has potential and could be developed as a COVID-19 therapeutic.”

Plants have been utilised as medicines by people around the world from ancient times, and their broad availability and low cost have led to their popular use among indigenous people.

Matsabisa’s interest in Phela goes back to a two-year research project in the early 2000s, when he surveyed 500 HIV/Aids patients at the Philisa Health Care Centre in Mabopane, North West.

When used as an immune booster, Phela led to an increase in appetite, 23% weight gain and 80% reduction in viral load with a 200% increase in CD4 cell counts.

The latest study on Phela was done in the laboratory and researchers found their formulation inhibited the growth of the virus that causes COVID and the growth of infection.

As they studied its effect on other coronaviruses, they also found that it inhibited the growth of Middle East respiratory syndrome (Mers-CoV), which was identified a decade ago and within a short space of time killed almost 1,000 people.

While its prevalence and death toll were a tiny fraction of that of COVID, its fatality rate was exponentially higher – 35% of those who contracted the disease died from it.

The authors said their data showed Phela has the potential for further development as a COVID therapeutic, either as a complementary treatment or a standalone or adjunctive therapy.

Their work requires “further experimental validation”, particularly when it comes to different variants, they added.

Study 1 details

Global impact of the first year of COVID-19 vaccination: a mathematical modelling study

Oliver Watson, Gregory Barnsley, Jaspreet Toor, Alexandra Hogan, Peter Winskill, Prof Azra Ghani.

Published in The Lancet on 23 June 2022

Summary

Background
The first COVID-19 vaccine outside a clinical trial setting was administered on Dec 8, 2020. To ensure global vaccine equity, vaccine targets were set by the COVID-19 Vaccines Global Access (COVAX) Facility and WHO. However, due to vaccine shortfalls, these targets were not achieved by the end of 2021. We aimed to quantify the global impact of the first year of COVID-19 vaccination programmes.

Methods
A mathematical model of COVID-19 transmission and vaccination was separately fit to reported COVID-19 mortality and all-cause excess mortality in 185 countries and territories. The impact of COVID-19 vaccination programmes was determined by estimating the additional lives lost if no vaccines had been distributed. We also estimated the additional deaths that would have been averted had the vaccination coverage targets of 20% set by COVAX and 40% set by WHO been achieved by the end of 2021.

Findings
Based on official reported COVID-19 deaths, we estimated that vaccinations prevented 14·4 million (95% credible interval [Crl] 13·7–15·9) deaths from COVID-19 in 185 countries and territories between Dec 8, 2020, and Dec 8, 2021. This estimate rose to 19·8 million (95% Crl 19·1–20·4) deaths from COVID-19 averted when we used excess deaths as an estimate of the true extent of the pandemic, representing a global reduction of 63% in total deaths (19·8 million of 31·4 million) during the first year of COVID-19 vaccination. In COVAX Advance Market Commitment countries, we estimated that 41% of excess mortality (7·4 million [95% Crl 6·8–7·7] of 17·9 million deaths) was averted. In low-income countries, we estimated that an additional 45% (95% CrI 42–49) of deaths could have been averted had the 20% vaccination coverage target set by COVAX been met by each country, and that an additional 111% (105–118) of deaths could have been averted had the 40% target set by WHO been met by each country by the end of 2021.

Interpretation
COVID-19 vaccination has substantially altered the course of the pandemic, saving tens of millions of lives globally. However, inadequate access to vaccines in low-income countries has limited the impact in these settings, reinforcing the need for global vaccine equity and coverage.

Study 2 details

In vitro study on efficacy of PHELA, an African traditional drug against SARS-CoV-2

M. G. Matsabisa, K. Alexandre, Collins U. Ibeji, S. Tripathy, Ochuko L. Erukainure, K. Malatji, S. Chauke, B. Okole & H. P. Chabalala

Published in Scientific Reports on 19 June 2022

Abstract

In 2019, coronavirus has made the third apparition in the form of SARS-CoV-2, a novel strain of coronavirus that is extremely pathogenic and it uses the same receptor as SARS-CoV, the angiotensin-converting enzyme 2 (ACE2). However, more than 182 vaccine candidates have been announced; and 12 vaccines have been approved for use, although, even vaccinated individuals are still vulnerable to infection. In this study, we investigated PHELA, recognized as an herbal combination of four exotic African medicinal plants namely; Clerodendrum glabrum E. Mey. Lamiaceae, Gladiolus dalenii van Geel, Rotheca myricoides (Hochst.) Steane & Mabb, and Senna occidentalis (L.) Link; as a candidate therapy for COVID-19. In vitro testing found that PHELA inhibited > 90% of SARS-CoV-2 and SARS-CoV infection at concentration levels of 0.005 mg/ml to 0.03 mg/ml and close to 100% of MERS-CoV infection at 0.1 mg/ml to 0.6 mg/ml. The in vitro average IC50 of PHELA on SARS-COV-2, SARS-CoV and MERS-COV were ~ 0.01 mg/ml. Secondly in silico docking studies of compounds identified in PHELA showed very strong binding energy interactions with the SARS-COV-2 proteins. Compound 5 showed the highest affinity for SARS-COV-2 protein compared to other compounds with the binding energy of − 6.8 kcal mol−1. Our data showed that PHELA has potential and could be developed as a COVID-19 therapeutic.

Medscape article – Vaccines Prevented Nearly 20M COVID Deaths Globally in First Year: Study (Open access)

 

The Lancet Infectious Diseases article – Global impact of the first year of COVID-19 vaccination: a mathematical modelling study (Creative Commons Licence)

 

Sunday Times PressReader article – Breakthrough in Covid treatment using African plants (Open access)

 

Scientific Reports article – In vitro study on efficacy of PHELA, an African traditional drug against SARS-CoV-2 (Open access)

 

Sunday Times PressReader article – When next pandemic hits, listen to the scientists (Open access)

 

See more from MedicalBrief archives:

 

100m COVID vaccines will expire in rich countries by Christmas

 

Positive attitudes towards COVID-19 vaccines: A cross-country analysis

 

Nigeria to destroy a million expired COVID-19 vaccines

 

Prioritising oldest for COVID-19 vaccines saves more lives, potential years of life

 

UOFS partners with SAHPRA for first clinical trial on traditional plant-based treatment of COVID-19

 

UFS: R17m grant for Indigenous Knowledge System

 

Traditional medicine ‘needs equal funding to tackle COVID’

 

Madhi’s plea to government: Don’t waste the AstraZeneca vaccine

 

Free State University: Survey highlights importance of vaccine literacy

 

Madhi: Dump global plan to vaccinate 70% against COVID

 

Madhi: SA has no vaccination strategy, just an unrealistic goal

 

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