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As COVAX delivers 2.2 million doses of vaccine and cases rise, situation is described as “an active public health emergency”. 

Washington, D.C. March 23, 2021 (PAHO)– Pan American Health Organization (PAHO) Director Carissa F. Etienne applauded the arrival of over 2.2 million doses of COVID-19 vaccines procured through COVAX but warned that the virus is surging dangerously in many countries in the region.

COVAX, the global alliance to ensure equitable access to COVID-19 vaccines, has helped deliver over 2.2 million doses to the region so far, including more than 1 million doses that arrived in hard-hit Brazil on Sunday. More doses are expected to arrive this week in Suriname and Belize, and an additional 1.2 million doses have been procured through COVAX.

But “the COVID-19 virus is not receding, nor is the pandemic starting to go away,” Dr. Etienne warned in her weekly media briefing. “Vaccines are coming but they are still several months away for most people in our region,” she said, urging people to continue to respect public health measures – masks, hand washing, and social distancing – especially during upcoming holidays. “People cannot let down their guard by engaging in close contact with others.”

“Although scale-up has begun, we know it’s not enough,” she continued. “We do not yet have the vaccines we need to protect everyone. It’s what happens when the whole world must rely on too few manufacturers. We must also find ways to share vaccines more equitably among countries.”

As the recognized procurement agent for COVAX in Latin America and the Caribbean, PAHO’s Revolving Fund negotiates, purchases and handles shipment logistics on behalf of the 36 countries participating in COVAX.

In the past week, over 1.2 million people were infected with COVID-19 in the Americas, more than during the previous week, while 31,272 people died of the virus, Dr. Etienne reported.

The pandemic is particularly dire in South America, where infection is reported to be spiking in Chile, Paraguay and Uruguay.“In Paraguay, a majority of ICU beds are occupied, and the health system is buckling under the pressure,” Dr. Etienne said.

“The virus continues to surge dangerously across Brazil,” she continued. “Cases and deaths are increasing, and ICU bed occupancy is very high in many states.” In neighboring Venezuela, infection is on the rise, particularly in the border states of Bolivar and Amazonas. Bolivia has reported an increase in cases in the Pando department, while “ICU bed occupancy remains very high in Loreto, Peru.”

The pandemic is accelerating elsewhere in the Americas, including Guatemala, where increasing cases and hospitalizations are “straining hospital bed capacity due to the influx of patients,” Dr. Etienne said. In the Caribbean, cases are increasing in Cuba, Aruba, Curacao, and Antigua and Barbuda. In Jamaica, cases have risen steadily for several weeks. In Canada, Ontario state has reported increased cases in the last two weeks while the U.S. states of Minnesota and West Virginia have reported rising deaths.

“What I’ve just described is an active public health emergency,” Dr. Etienne said. “As the virus surges and hospitalizations rise,” she continued, “we urgently need to scale up vaccination among our most vulnerable populations.”

Over 155.8 million doses of the vaccine, including the COVAX deliveries, have been rolled out in the Americas, and in the Caribbean and Latin America immunization campaigns are underway in 33 of the 35 countries with support from PAHO. The organization is also assisting the two countries, Haiti and Cuba, that have yet to start immunization.

“The doses that were delivered are helping us start to protect health workers and other vulnerable communities, and we expect more doses to arrive every week,” Dr. Etienne said, reporting that acceptance of vaccines has been high. “These WHO-approved vaccines are safe, and they work,” she said. “When it’s your turn, don’t hesitate. Get vaccinated.”

Pointing out the Americas’ long history of successful immunization against polio, measles, flu, and yellow fever, she said, “once our supply increases, there is not another region in the world better prepared to deliver vaccines swiftly and safely,” she said. “Our health workers have special expertise driving large-scale vaccination campaigns that cover diverse geographies.”

“PAHO has been providing training and technical support to countries so they have stronger capacity to track adverse events, which will be critical as new vaccines are developed and introduced into the region,” she highlighted. “This is a remarkable achievement, and a credit to countries for making vaccination a priority and to health workers for their commitment to keeping our region safe.”

She also reminded countries of the upcoming March 24 World Tuberculosis Day, a global event to raise awareness about the devastating impact of TB and embrace the WHO goal of eliminating the disease by 2050.

“We need to uphold our commitments to reduce the burden of TB in our region and around the world,” she said. “If there’s one thing I hope we take from this pandemic, it’s an appreciation for the power of health – and how good health is central to the wellbeing of societies…. Equal access to good health. That should be our focus. That’s how we end TB. That’s how we beat COVID-19.”

The University of the West Indies HIV & AIDS Response Programme (UWIHARP) at the Cave Hill Campus repositioned outreach activities with the arrival of COVID-19 to the Caribbean. UWIHARP staff quickly transitioned ongoing programming to a virtual format and developed relevant content to promote sexual health and well-being during the pandemic response.

The Sexual Health Online Conversations About COVID-19 (SHOCC) included: Safe Sex and COVID-10, Mental Health, Sexual Well-being, and COVID-19, Sexual Health and Gender-Based Violence During Periods of Isolation, Pregnancy, Wellness, and COVID-19, Intimate Partner Violence against Women During the COVID-19 Crisis, Living with HIV During COVID-19: Testimonies from the Communities, Intersecting Pandemics: Experiences of Marginalised Populations during COVID-19.

Virtual programming increased the scope of UWIHARP’s reach significantly. The SHOCC sessions attracted over 544 participants across the Caribbean and internationally.  Dr Michael H. Campbell, PhD, Chair, UWIHARP—Cave Hill, Barbados, expressed gratitude to the UWIHARP staff members, including Monique Springer, Kileha Anderson, and Kelly-Ann Yarde, for putting together the innovative response.  He also thanked the content experts, community members, and allies who facilitated discussions.

SHOCC and other virtual outreach programmes continue during 2021. For more information, visit

https://www.facebook.com/pages/category/Education/Uwiharp-Cave-Hill-527362017355914/

Key takeaways

• The Global Fund will facilitate a series of consultations to help shape the next multi-year Global Fund strategy.

• Key areas of focus include how the Global Fund can strengthen its impact and contribution to the 2030 Sustainable Development Goal targets for HIV, Tuberculosis (TB), Malaria, build strong community and health systems, increase focus on equity, human rights, gender and the most vulnerable, and respond to the COVID-19 pandemic which threatens to reverse the health gains of the last two decades.

GENEVA – More than 300 representatives from across the world convened virtually today to kick off the Partnership Forums, a series of consultations to help shape the next multi-year Global Fund strategy. The Partnership Forums are unique in the global health sector, providing a broad and inclusive platform for representatives from all Global Fund implementers, partners and people affected by diseases to discuss the organization’s future strategic direction.

Key areas of focus include how the Global Fund can strengthen its impact and contribution to the ambitious 2030 Sustainable Development Goal targets for HIV, Tuberculosis (TB), Malaria, build strong community and health systems, increase focus on equity, human rights, gender and the most vulnerable, and respond to the COVID-19 pandemic which threatens to reverse the health gains of the last two decades.

Participants in the Partnership Forums are drawn from a wide range of stakeholders that make up the Global Fund partnership, from government to civil society representatives to members of the affected communities to technical partners. As representatives of the Global Fund partnership, this diverse group of participants will help shape the direction of Global Fund investments in the years ahead.

Due to the pandemic, the Partnership Forums will convene virtually. They started today with a joint global opening session, which will be followed by three regional meetings: Eastern Europe and Latin America, 9-11 February; Africa and parts of the Middle East, 17-19 February; and Asia, the Pacific and parts of the Middle East, 3-5 March. The closing session will take place on 15 March, bringing together participants from across the world to wrap up the discussions.

Twenty years after its creation in 2002, the Global Fund partnership has achieved remarkable progress. At the end of 2019, the partnership had saved 38 million lives, including six million in 2019 alone. However, with less than 10 years until the Sustainable Development Goals deadline, the world is off-track to reach the global targets for HIV, TB and Malaria and the COVID-19 pandemic is threatening to further derail progress. Participants in the Partnership Forums will engage in discussions on ways for the Global Fund to catalyze greater progress against HIV, TB and Malaria in partnership with governments, communities, civil society, technical partners and other stakeholders and put the world back on track to end these diseases.

“We face the sobering prospect that if we don’t mount an effective response to the pandemic, we could find ourselves losing maybe a decade’s worth of gains in terms of reduced deaths and infections,” said Peter Sands, Executive Director of the Global Fund. “The stakes are extremely high, so we must work together to devise a strategy to safeguard and accelerate the gains we have made against the diseases while building resilient health systems that can respond effectively to both the current and future pandemics. The Forums are an opportunity to listen and to learn from all corners of our partnership.”

“Welcoming diversity of opinion is an essential element of strengthening the Global Fund and growing our impact, it is why we value the Partnership Forums,” said Dr Donald Kaberuka, Chair of the Global Fund Board. “We want to hear what we should keep doing, what we can improve on and what we should let go. We want to hear all opinions on choices and trade-offs. Every voice matters. Developing our next strategy is not just about the Global Fund, but about all of us – our countries, our communities, and the people we serve.”

Views shared in the Partnership Forums will add to perspectives received through the strategy development process to date, including the input gathered through the Global Fund’s 2020 Open Consultation on strategy development, which engaged more than 300 individuals and groups from different regions and backgrounds. The views collated from participants will be channelled into the strategy development process, which will culminate into a new multi-year strategy document that will be finalized in November 2021.

The current “Global Fund Strategy 2017-2022: Investing to End Epidemics” was developed through a similar participatory process. With the new strategy, the Global Fund will be looking to the future, asking how the partnership can reinforce its unique country-driven and inclusive model, grow its impact against infectious diseases, and strengthen health systems and building global health security for all people.

(Georgetown, Guyana)  Global vaccine mechanism, COVAX plans to deliver 104,000 doses of the novel coronavirus vaccine to Guyana soon.

This was announced today by Health Minister Dr Frank Anthony during the COVID-19 update.

“We have received correspondence from COVAX indicating that they have been able to do an indicative allocation of vaccines to Guyana…and that is going to be close to 104,000 doses of vaccines that we will be getting shortly,” the Health Minister revealed.

The vaccines will come from manufacturer, AstraZeneca.

Presently, the said vaccine is before the World Health Organisation (WHO) for emergency use listing.

“Once the WHO greenlights the vaccine, then we will be able to get those vaccines in Guyana,” the Health Minister said.

The European Union, along with several countries including India and the United Kingdom, have already approved the AstraZeneca vaccine for emergency use authorisation.

With Guyana expected to get some 104,000 doses, Health Minister indicated that Guyana is prepared to start the rollout when the doses arrive.

“We’re very happy that they’ve indicated to us that we will be getting 104,000 doses as an initial start…and we would be working closely with them to see when these vaccines would actually arrive in Guyana, and as soon as we get them, we will start rolling out,” he said.

The Health Minister said Guyana is prepared to start delivering the vaccine to the population.

(Port-of-Spain, Republic of Trinidad and Tobago, 28 January 2021) Since the COVID-19 disease was declared a pandemic in March 2020, at least six (6) variants have emerged. However, three new variants of concern are spreading rapidly. The United Kingdom variant known as B.1.1.7; a variant called 1.351 which emerged in South Africa; and the variants P.1 and P.2 which surfaced in Brazil.

The “UK variant” (B.1.1.7 variant), which emerged in September 2020, has been identified in 60 countries globally and recently, in some Caribbean countries. Initial data suggest that the UK variant is more transmissible, and studies and analysis of the transmission and severity of the variant are underway.

“This increased ease of transmission of the UK variant is of grave concern for its impact on public health, and the fight to contain and end the COVID-19 pandemic. This is further heightened by the fact that, at present, the vaccines developed have not yet been proven to stop disease transmission but rather to lessen the severity of infection. There is no reported evidence of a reduction in the effectiveness of vaccines approved for the
COVID-19 virus in providing protection from any variants. However, it is important to note that vaccinated persons may still spread COVID-19,” said Dr Joy St. John, Executive Director of the Caribbean Public Health Agency (CARPHA).

With the discovery and proliferation of multiple COVID-19 variants, it is crucial to properly and consistently employ and increase the public’s adherence to COVID-19 control measures, which have been shown to reduce the spread of the disease.

Dr St. John further stated “CARPHA is committed to supporting its Member States to stopping the spread of the virus. We urge Member States to enhance surveillance in residential institutions and face to face educational settings. There must also be strict adherence to the requirements of negative COVID-19 results for entry to the ports in the Member States, to effectively continue combating COVID-19 spread in the Caribbean. Mandatory quarantine has become even more important to curb the spread of the virus.”

Community surveillance should also be enhanced thereby strengthening public health control measures. Individuals must continue practicing the measures of wearing face masks and covering, physical distancing, and hand sanitation in all face-to-face settings.

It is critical to remember that as most cases will have no or mild symptoms, COVID-19 cases may quietly increase in the community and result in sudden increases in hospitalisations and deaths. The first line of defence continues to be isolation of infected persons and quarantine of travellers and any person with known or possible exposure to infected persons.   These measures must be practised by all individuals as asymptomatic persons are known to be able to spread the virus. Adequate testing is critical to surveillance measures for residential institutions, face-to-face schooling, celebratory and religious gatherings, and other potential spreader and super-spreader events and activities.

The CARPHA Medical Microbiology Laboratory (CMML) remains committed to delivering prompt COVID-19 test results to the Region and is working with its Member States in their submission of positive SARS-CoV-2 to be sequenced. The CMML has been guiding laboratory action through testing protocols based on the latest recommendations by the World Health Organization (WHO) and the Pan American Health Organization (PAHO). With the emergence of the UK variant in the Region, it is of critical importance for CARPHA Member States to conduct genomic sequencing to identify this variant.

Currently, COVID-19 samples are received by the CMML from Member States. The CMML performs acceptance testing before they are sent to the University of the West Indies (UWI), St Augustine, Trinidad and Tobago, for genomic sequencing to be performed. Following the sequencing process, the UWI sends the results to CARPHA for final review and reporting. Sequencing is a lengthy process that includes experimental and sequence analysis procedures, and the estimated turnaround time to obtain any relevant conclusions can take up to 2 weeks from the receipt of samples at CARPHA.

Results received from the UWI are sent by CARPHA directly to the Chief Medical Officers at the Ministries of Health, who are responsible for dissemination through nationally established channels of communication.

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Key takeaways: 

• The Global Fund needs additional funding to continue supporting the coronavirus disease 2019 (COVID-19) response and mitigate the impact of the pandemic on HIV, tuberculosis, and malaria programs in the countries where it invests.

• After deploying all available COVID-19 funds, nearly $1 billion in total, most of it to sub-Saharan African countries, it has run out of funding. Without this support, implementer countries risk facing significant disruptions to their three disease programs while COVID-19 cases continue to rise.

The Global Fund has disbursed close to $1 billion to support the COVID-19 response and mitigate the impact of the pandemic on HIV, Tuberculosis (TB), and Malaria programs. The institution recently announced that it had fully deployed all the funds to 106 countries and more than ten multi-country programs. However, it still has to honor country requests amounting to over $355 million, which is likely to increase as more countries submit their requests.

The Global Fund is yet to raise an additional $5 billion to continue supporting these countries. Without the additional resources required to safeguard the three disease programs amid rising COVID-19 cases, countries are likely to face more disruptions to health service delivery and lose the gains made in the response to the three diseases.

Of the $1 billion, $500 million was raised through portfolio optimization and made available through the COVID-19 Response Mechanism (C19RM), $221 million was made available through grant flexibilities, and an additional $259 million was received from donors (Canada, Denmark, Germany, Italy, Sweden, Norway, and the FIFA Foundation) and channelled through the C19RM.

This funding has supported these countries to mitigate damage to HIV, TB, and Malaria programs due to COVID-19, recruit healthcare workers, equip them with personal protective equipment (PPE) and strengthen fragile health systems.

Information for this article comes from the Global Fund Data Service Page, the World Health Organization (WHO) COVID-19 Explorer, and the Global Fund Secretariat.

Global Fund fully deploys its COVID-19 funding

The Global Fund has disbursed $979 million, of which $757 million is through the C19RM and $221 through grant flexibilities (Table 1), respectively. Of the 119 countries and multi-country programs that benefited, 48 countries in sub-Saharan Africa received 74 percent ($725 million) of COVID-19 funding. They received 79 percent of the C19RM funds and 56 percent of the total amount of funding awarded through grant flexibilities. Sub-Saharan African countries that received a significant portion of funding include Nigeria ($73 million), South Africa ($65 million), Mozambique ($63 million), and Uganda ($62 million). Eastern Europe and Central Asia (EECA), Latin America and the Caribbean (LAC), and North Africa and the Middle East (MENA) each received the smallest proportion (3 percent) of the funding.

Countries only accessed $221 million of the $500 million allowable through grant flexibilities. A previous Aidspan analysis showed a slower uptake of grant flexibilities than C19RM funds (as discussed in a previous edition, the Global Fund’s COVID-19 emergency funding is running out). It attributed the slower uptake to challenges in the application process, or to countries having already used up most of their savings.

The Global Fund had allowed countries to use grant savings to the value of 5 percent and reprogram up to 5 percent of the grant’s current value. However, most countries obtained these funds through grant savings rather than reprogramming, in a bid to ‘protect their programs.’ The Aidspan analysis indicated that more than half of the countries received between 2 and 4 percent of their total grant value.

The countries used a third of the funding awarded through the C19RM to mitigate the pandemic’s impact on the three diseases (Table 1). These efforts aimed to address COVID-19 related disruptions to delivering health services and avert the millions of deaths predicted due to the pandemic. More than half (55 percent) of the funds were used to support the COVID-19 response, particularly in the procurement of COVID-19 diagnostic tests, while the remaining 11 percent was used to support health and community systems.

Similarly, countries have used 59 percent of the grant flexibilities to reinforce the COVID-19 response, 32 percent in mitigating its impact on the three diseases, and the remaining 9 percent on health and community systems.

The funds have also supported door-to-door services such as TB testing, contact tracing, and mosquito net distribution in Vanuatu, and antiretroviral therapy and health services to mothers with HIV and pregnant women in Uganda. A local HIV community network in Ukraine has used part of the funds to deliver antiretroviral therapy and other medicines to people living with HIV via the postal service.

Countries have also leveraged laboratory infrastructure, notably Cepheid’s GeneXpert molecular diagnostic devices and the technicians trained to operate them, initially designed for HIV and TB services. However, this has raised concerns in various quarters on the effect this has had on HIV and TB services.

COVID-19 resource needs for implementer countries continue to rise

The pandemic among some Global Fund implementer countries, particularly in the African region, has been growing in recent months. Of the 106 countries that benefited from the Global Fund’s emergency funding, more than half (61 countries) experienced a rise in the number of cases from the preceding week, as reported by the WHO on 12 January 2021. Sierra Leone reported the largest increase: 2 109 percent, although the caseload remains low (2 834 cases as of 12 January 2021). The number of cases in other countries grew by between 1 percent in Panama and 494 percent in Côte d’Ivoire, with Sierra Leone reporting an exceptional increase.

The majority of the remaining countries reported a decline, while only a few reported no change.

However, there are still fears that the actual caseload may be higher than the current statistics reported due to low testing availability. BBC estimates that in Africa, which has the lowest testing rate compared to other regions, only 10 countries account for 70 percent of the total tests: South Africa, Morocco, Ethiopia, Egypt, Kenya, Nigeria, Cameroon, Rwanda, Uganda, and Ghana.

The absence of additional funding leaves the programs vulnerable

This rise in the number of cases and lack of adequate resources to mitigate the pandemic’s effect is likely to further disrupt the delivery of health services in these countries. Indeed, implementer countries are still experiencing significant disruptions to health services, with TB services being the most affected. Furthermore, the rise in cases increases the need for restrictions, including nationwide lockdowns, which are significant barriers to access health services. According to the COVID-19 Situation Report published on 23 December 2020, 36 percent of countries where the Global Fund invests still had nationwide lockdowns on 15 December 2020. Other countries (25 percent) had local restrictions that affected the implementation of Global Fund grants.

The Global Fund intensifies resource mobilization efforts

The need for additional funding for the Global Fund to continue supporting its implementer countries cannot be emphasized enough. In an email to the Global Fund Observer, the Secretariat noted that it is intensifying resource mobilization efforts to raise the additional $5 billion it needs to continue supporting its implementer countries. In the meantime, it has asked countries to continue submitting funding requests to the C19RM, so their requests are ready once additional funds become available. Countries can still use grant flexibilities to support their COVID-19 response. However, the Secretariat further explained that most countries appear to have already exhausted this mechanism.

Countries with new grants starting in January 2021 have some respite. The Global Fund has allowed countries to use standard allocations to procure PPE for health workers working within the three disease programs, which they can procure through the online platform wambo.org. Overall, the countries should adopt more efficient and innovative ways of using the funds available. This includes the adoption of digital modalities that have become common since the emergence of the pandemic.

Global COVID-19 response remains underfunded

The global COVID-19 response has been grossly underfunded as traditional global health donors prioritize their domestic responses. The $5 billion the Global Fund intends to raise is part of the overall financing needed by the Access to COVID-19 Tools Accelerator (ACT-Accelerator), of which the Global Fund is a co-founder. Overall, the ACT-Accelerator, launched in April 2020, has only attracted 15 percent ($5.8 billion) of the $38 billion needed to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines.

The Global Fund welcomes the United States’ recent commitment to support the international COVID-19 response and mitigate the impact of the virus on the world. Advocates are calling for the United States government to allocate $4 billion to the Global Fund’s COVID-19 response in the next COVID-19 emergency supplemental bill. Similar calls in the past have been unsuccessful. However, the United States’ $4 billion allocation to Gavi, the Vaccine Alliance, in the December supplemental bill, for the procurement and delivery of the COVID-19 vaccine, provides a glimmer of hope.

Even though the Global Fund is not directly involved in the rollout of the COVID-19 vaccine, the Secretariat explained to the Global Fund Observer that additional funds would help to support the rollout of the COVID-19 vaccine by providing PPE to health workers, mobilizing community leadership, and strengthening the health facilities, supply chains and data systems that will be critical for the vaccine distribution.

Further reading:

• GFO 385, The Global Fund’s COVID-19 emergency funding is running out, 25 August 2020
• The Global Fund COVID-19 Situation Report, 23 December 2020
• The Global Fund COVID-19 Situation Report, 13 January 2021.