Coronavirus Responses and Patterns in Africa: Southern and West Africa

Posted on by funambulator@live.com
Inter-ethnic relations, International Relations, National politics, Public health,, Society & Culture

1836333B-64AF-49C9-B21B-7F66F21411A6Three months ago when the COVID-19 outbreak started to move around the globe, the World Health Organisation issued a warning to the continent of Africa whose nations were just starting to feel its impact [‘Coronavirus: WHO tells African countries to ‘prepare for the worst’, Eye on Africa, 18-Mar-2020, www.france24.com]. The pandemic was late in reaching Africa and initially slow to make inroads, taking 98 days to register its first 100,000 confirmed cases but is now accelerating – only taking 18 more days to hit the 200,000 mark of cases [‘COVID-19: WHO warns of virus acceleration in Africa’, Vanguard, 14-Jun-2020, www.vanguardngr.com]. Overall African fatalities sit at 6,793 (16-Jun-2020) with just five countries (Algeria, Egypt, Nigeria, South Africa and Nigeria) accounting for 70% of the deaths✹.

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Southern Africa:
To date South Africa has been the nation most heavily affected by the public health emergency – over 73,000 confirmed cases and 1,568 deaths (16-Apr-2020). The Western Cape province has become the epicentre of the RSA pandemic, recording so far around 75% of the country’s fatalities. The province’s high incidence of cases has been attributed to the presence of poor, densely populated townships like Khayelitsha, a shantytown of 500,000 people. Cape Town’s thriving tourism (before the closedown) has also been advanced as contributing to the outbreak’s toll. South Africa, with a more developed economy and better health care system, has conducted more a million virus tests, while many other African countries have racked up only a few thousands. The clear implication of this is that ”the disease is spreading undetected elsewhere on the continent”  [‘Cape Town becomes South Africa’s coronavirus hotspot’, (Jevans Nyabiage), South China Morning Post, 12-Jun-2020, www.amp.scmp.com].

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⍐ Bulawayo, Zim.  (Photo: Philimon Bulawayo/Reuters)

South Africa’s smaller, northern neighbour Zimbabwe has done surprisingly well on paper in the crisis (four deaths recorded only), but with the rider that testing for the disease—hampered by a critical shortage of health equipment and infrastructure—has been very limited…by 10th April it had tested a mere 392 people [‘In Zimbabwe, lack of tests sparks fear COVID-19 goes undetected’, (Chris Muronzi), Aljazeera, 10-Apr-2020, www.aljazeera.com].

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(Image: SABC News)

West Africa:
Results of the fight against the pandemic in West Africa have been mixed. Senegal began its counter-measures early in January, closing the borders, implementing contact-tracing, etc. The country was able to produce a test kit for COVID-19 costing only $1 per patient and has managed to accommodate every coronavirus patient either in hospital or in a community health facility. African countries who experienced the 2013/14 Ebola virus outbreak like Senegal put that experience to good use, prohibiting large gatherings, strict night-time curfews, banning intercity travel, etc. Côte d’Ivoire (the Ivory Coast) followed Senegal’s approach, declaring a state of emergency and trying to impose curfews in it’s main city Abidjan, but the country’s buoyant economy has taken quite a hit from the coronavirus crisis. Ghana has utilised an extensive system of contact-tracing and a “pool-testing” mechanism which follows up only on positive results [‘Why are Africa’s coronavirus successes being overlooked?’, (Afua Hirsch), The Guardian, 21-May-2020, www.theguardian.com; ‘Women unite against COVID-19 in Senegal’, Relief web, 10-Jun-2020, www.reliefweb.int].

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The speeding up of coronavirus cases in a small African country like Guinea-Bissau has occurred notwithstanding it’s small population and limited testing, reflecting a reality stretching across the whole continent, the sheer incapacity of weak and under-resourced national health infrastructures to cope with the pandemic [‘West Africa facing food crisis as coronavirus spreads’, (Emmanuel Akinwotu),  The Guardian, 16-May-2020, www.theguardian.com].

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⍐ Kano   (Photo: Reuters/Luc Gnago)

B2ADCEDB-748F-4BBD-926C-6B2115F8760EIn Nigeria, Africa’s most populous country, the most worrying hotspot has been the north in Kano state and metropolis. The pandemic has gotten out of hand here because of a confluence of factors, including the state government’s early failure to admit the presence of coronavirus (which it initially tried to pass off as an upsurge in other illnesses), costing it vital lost time in the fight against the disease; the closure of Kano’s only testing centre for a week in April; acute shortages of PPE; and the pre-existing displacement of 1.8m people in the region [‘Covid-19 Outbreak in Nigeria Is Just One of Africa’s Alarming Hot Spots’, (Ruth Maclean), New York Times, 17-May-2020, www.nytimes.com].

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Dakar, Senegal   (Photo: John Wessels/AFP via Getty Images)

PostScript: A young and rural population
Africa’s avoidance of the worse excesses of COVID-19 thus far has prompted the theory that the continent’s demographics is working in it’s favour. A study in the journal BMJ Global Health attributes this to Africa’s young, rural-based population▣ …60% of the population is under 25, cf. Europe (95% of its deaths from the virus have been people over 60). BMJ hypothesises that Africa will likely suffer “more infections but most will be asymptomatic or mild, and probably (go) undetected” [‘Africa’s young and rural population may limit spread and severity of coronavirus, study says’, (Jevans Nyabiage), South China Morning Post, 28-May-2020, www.amp.scmp.com].

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✹ Egypt and South Africa alone account for nearly 48% of the entire continent’s corona-related deaths
▣ the study focused on Kenya, Senegal and Ghana

Russia’s Coronavirus Anomaly, a Question of What You Count

Posted on by Sloane Snodgrasse
Bushwalking, Politics, Public health,, Science and society

From the start of this month Russia began a gradual re-opening of services after a ten-week pandemic lockdown. This is happening despite new cases of COVID-19 continuing to materialise – the tally of confirmed case of the virus has now ticked over the 500,000 mark (as at 12-Jun-2020). There are several reasons contributing to the decision to re-open, some political and some economic.

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Concern for the damage sustained by the Russian economy by the pandemic was foremost to the Kremlin but President Putin also wanted things functioning as close to normal in time for two upcoming events important to him. The 75th end of WWII anniversary military parade in Red Square—a PR showcase of Russian power—postponed from May is rescheduled for 24th of June. Even more personally important for the Russian leader is the July 1 vote✱, Putin has put up far-reaching constitutional amendments for approval, the main outcome of which could see Putin’s iron-grip on the federation extend till 2036.

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(Photo: Reuthers / SPUTNIK)

Discontent with Russia’s approach to the crisis
An underlying reason for the hasty end to the national lockdown might be that it hasn’t been as successful as hoped. The tracing app utilised in Moscow (the epicentre of the country’s COVID-19 outbreak) has had issues with its effectiveness. Putin’s personal popularity was at risk with public resentment voiced at the prolonged restrictions (murmurings of Orwellian and Soviet-like echoes). The medical response by the Kremlin has been called out by many front-line responders for its shortcomings⊘. One doctor, Anastasia Vasilyeva (leader of a Russian doctors’ union), frustrated at the president’s insistence that the public health crisis was under control, has been at great risk to herself distributing PPE to medical workers on the front-line, provoking retribution from the Kremlin [‘The doctor who defied a President’, ABC News, (Foreign Correspondent, Eric Campbell), 06-Jun-2020, www.abcnews.com.au]. This is symptomatic of Moscow’s neglect of the regions who are expected to handle both the outbreaks without the medical infrastructure to deal with a large volume of cases✩ and the economic fallout from the crisis without adequate financial assistance [‘Russia’s coronavirus cases top 300,000 but deaths suspiciously low: ‘We conceal nothing’ Kremlin says’, (Holly Ellyatt), CNBC, Upd 21-May-2020, www.cnbc.com].

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Counting the virus’ toll: a small exercise in data massaging?
Some Russia watchers have cast doubts about the reported COVID-19 figures released by Moscow. This includes WHO has questioned Russia’s low death toll, describing it as ‘unusual’ [‘WHO asks Russia to review its Covid-19 death toll in rare rebuke’, (Natalia Vasilyeva), The Telegraph, 11-Jun-2020, www.telegraph.co.uk]. While the number of Russian virus cases is comparatively high, the official record of fatalities is disproportionately low compared to the rest of Europe…Russia’s fatality rate is 0.9% cf. UK’s, 14.4% (roughly 10% of the mean figure for Western Europe) [‘How Russia’s Coronavirus Outbreak Became One of the World’s Worst’, (Madeline Roache), Time, 15-May-2020, www.time.com]. The Kremlin has rejected the criticism that it is withholding the full impact of the pandemic, but outside observers pinpoint an anomaly in the methodology it uses to count cases. Unlike say Belgium (which is strictly inclusive), Russia has not counted deaths as caused by the coronavirus where other co-morbidities are present, ie, if a patient tested positive for the virus and then had a subsequent critical episode, the cause of death is not recorded as COVID-19 [‘Russia Is Boasting About Low Coronavirus Deaths. The Numbers Are Deceiving’, (Piotr Sauer & Evan Gershkovich), The Moscow Times, 14-May-2020, www.themoscowtimes.com].

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A deserted, locked-down Red Square 
(Source: www.citizen.co.za)

Compartmentalising the fatalities
This persuasively accounts for the recent discordant mortality statistics reported by Russian sources, eg, if you separate fatalities directly attributable to coronavirus from other fatalities for May, the unexplained “excess deaths” recorded for Moscow is up about 5,800 on that occurring during the previous three Mays [‘New data suggests Russia may have a lot more COVID-19 deaths than it says it has’, (Alexandra Odynova), CBS News, 11-Jun-2020, www.cbsnews.com]. A look at Dagestan, a region with one of the largest clusters outside of the capital, is also instructive. As of mid-May it had experienced 35 deaths listed as caused by coronavirus, but in the same timeframe it recorded 650 deaths attributed to “community-acquired pneumonia”. One explanation from Russia watchers is that “local officials want to present Moscow with ‘good’ figures” (Ellyatt). If the Kremlin were to publish both sets of figures in its official data, such transparency would deflect much of the doubt and questioning by outsiders (Sauer & Gershkovich).

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✱ that Putin is prepared to push through the referendum at this time and risk aggregating the public health and safety of Russians, confirms for many the president’s prioritising of his own  political motives [‘Russian officials, citing COVID-19, balk at working July 1 constitutional referendum’, CBC News, 11–Jun-2020, www.cbc.ca]
⊘ many medical practitioners in Russia have been disaffected by both a critical shortage of equipment to fight the virus and by unpaid wages [‘Exclusive: Did Russia pass the coronavirus test? Kremlin spokesman Dimitry Peskov Responds’, (M Chance, Z Ullah & N Hodge), CNN, 09-Jun-2020, www.amp.cnn.com]
✩ the COVID-19 emergency has exposed the deteriorating state of the Russian health service in the Putin era – the Semashko system infrastructure allowed to run down while the private medical sector has flourished [‘Can the Russian Health Care System Cope with the Coronavirus?’, (Estelle Levresse), The Nation, 09-Jun-2020, www.thenation.com]

The Choral Powder Keg: A Health Hazard Tailor-made for the COVID-19 Crisis

Posted on by funambulator@live.com
Public health,, Science and society, Society & Culture, Town planning

When a pandemic or some similar “Black Swan” event sweeps the world, hitting many countries with great intensity, particularly in Western societies with a high degree of religiosity, comfort and solace is often sought within the spiritual “safe house” of the church. As soon as the novel coronavirus landed and spread, it was apparent the church services especially where high rates of attendance was commonplace, would pose a public health risk.

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(Source: www.newslocker.com)

Yet in the US eleven state governors chose to maintain freedom of worship over community safety by exempting religious institutions from the general prohibition on public gatherings, notwithstanding that some of the states registered the biggest clusters of COVID-19. Even in other states there was a pushback by church men and women against government bans on assembly in places of worship. As a consequent 71 members of a single church in Sacramento were infected by the virus [‘Pastor who refused to close church due to coronavirus killed by outbreak’, (Rebecca Nicholson), Express, 15-Apr-2020, www.express.co.uk].

This was mirrored in overseas scenarios, in South Korea in February, one infected churchgoer infected at least 37 other members of her church on a single contact [“‘Superspreader’ in South Korea infects nearly 40 people with coronavirus’, (Nicolette Lanese), Live Science, 23-Feb-2020, www.livescience.com].

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South Korean choir with face masks  (Source: AP)

The choral petri-dish
 The holding of packed sermons in churches and other places of worship, like any close contact between confined, concentrations of people, breaches the prescribed social distancing guidelines and exacerbates the incidence of coronavirus infection. But just as dangerous and with even more potential to transmit the viral disease through communities is the choral activities of churches. The activities of choirs initially continued unabated in the early stages of the pandemic but an incident in Washington state in early March brought home how risky choir practice is. 61 people attended a choir practice at a Presbyterian church in Skagit County, within a short time 45 of the group had been infected by COVID-19 and two had died. Other choir outbreaks, some fatal, have occurred In Calgary (Canada), Amsterdam (Netherlands) and in South Korea [‘Scientists to choirs: Group singing can spread the coronavirus, despite what CDC may say’, Richard Read), Los Angeles Times, 01-Jun-2020, www.latimes.com].

Infectious diseases experts have pinpointed the obvious dangers of contagion associated with choir singing…unrestrained vocal activity at close quarters in often poorly-ventilated, confined space. The vocalists exhale and inhale deeply to sing which makes them highly susceptible to the passage of airborne particles. Through the process of aerosolisation, the virus floats freely in the air (and has been observed to survive for up to three hours) [‘Churches can be the Deadliest Places in the COVID-19 Pandemic’, (Kevin Kavanagh), Infection Control Today, 03-Apr-2020, www.infectioncontroltoday.com; Read].

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Inexplicable change of stance by CDC
With eyes fixed on the November elections and the need to shore up vital support from the Evangelical Christian Right, President Trump from his White House ‘pulpit’ intensified his call in May for governors to reopen religious institutions as an essential service, eliciting pushback from some governors. At the same time, surprisingly the Centers for Disease Control and Prevention (CDC) decided to drop their warnings against choral singing despite the inherent danger it poses. CDC justifies this change of position by downplaying the likelihood of airborne transmission beyond six feet⊞ [‘Behind Trump’s demands to reopen churches: Slipping poll numbers and alarm inside his campaign’, (Gabby Orr), Politico, 22-May-2020, www.politico.com; Read).

Heightening the risk of unleashing ‘super-spreaders’
CDC’s controversial move has drawn broad criticism from medical experts including specialists in bio-aerosol research who have refuted CDC’s claim, calling it “hazardous, very dangerous and irresponsible”, and that it exposes America to new waves of super-spreading from the activity of choir members (Read).

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⇑  With religious singing relegated to the home, some American churches have tried to get round the prohibition on in-house congregational services by organising drive-in sermons

Fallout from the churches
Although many parishes and parishioners in the US have adjusted well to the new world of online sermons, some traditional congregationalists worry that the new ‘norm’ will spell the disappearance of the in-person church experience altogether [‘How the Pandemic Will Change Us’,  (Rod Dreher), The American Conservative, 13-Mar-2020, www.theamericanconservative.com].

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(Photo: www.stjohnswhitchurch.org.uk)

 

Endnote: The economics of the choral closedown
The halt to choral activities due to COVID-19 has led to a whole bunch of “knock-on” problems worldwide. Like anybody else with their income source impacted adversely by the crisis, choristers, classical musicians and organists attached to the churches affected have been deprived of livelihood. But it goes even beyond that. As the Royal School of Church Music in the UK indicated, the pandemic ”has literally ripped apart the many close-knit groups of singers and instrumentalists who (need to) spend significant amounts of time together”. Church musicians who rely on the service are especially hard hit. It is doubly hard for self-employed church organists who have lost their access to practice – unlike other musicians who keep their instruments at home, they rely on “using instruments in public buildings for the vital practice which enables them to maintain their hard-earned skill” (Royal College of Organists). [‘Pandemic has ‘ripped apart’ church choirs’, (Hattie Williams), Church Times, 01-Apr-2020, www.churchtimes.co.uk].

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(Source: eBay)

PostScript: There is another side problem resulting from the non-use of organs in churches. Like the raft of airplanes grounded due to the coronavirus, complex and expensive organs require continual attention. They need “regular playing to ensure that the fragile technical components are kept in good working order“ and  free from damage (Williams).

•—————————————-———————•

⊞ the Washington Post states that CDC acted on a White House directive to omit the choir warning from it’s website guidance information. CDC may have also relied on earlier statements from WHO contending that “there is no evidence of transmission of the virus as an airborne pathogen”. WHO’s conclusions have themselves been debunked as “decades-old dogma that held that droplets only travel an arm’s length in the air” (Read)

The Pandemic’s “Holy Grail”, the Elusive Vaccine: For the “Global Public Good” or an Inward-looking Assertion of Vaccine Nationalism?

Posted on by Sloane Snodgrasse
Commerce & Business, International Relations, Politics, Public health,, Science and society

At this point in the war on COVID-19 there are over 120 separate vaccination projects—involving Big Pharma, the public sector, academe, smaller biotech firms and NGOs—all working flat out worldwide trying to invent the ‘magical’ vaccine that many people believe will be necessary to bring the current pandemic to an end. While nothing is guaranteed (there’s still no cure for the HIV/AIDS virus around since the Eighties), the sheer weight of numbers dedicated to the single task, even if say 94% of the efforts fail, there’s still a reasonable chance of success for achieving a vaccine for coronavirus✱ [“Former WHO board member warns world  against coronavirus ‘vaccine nationalism’”, (Paul Karp), The Guardian, 18-May-2020, www.theguardian.com].

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(Source: CEPI)

If and when the vaccine arrives, will it get to those in greatest need? The way the coronavirus crisis has been handled between nations so far doesn’t exactly give grounds for optimism. Collective cooperation on fighting the pandemic has been sadly absent from the dialogue. We’ve seen the US attack China over coronavirus’ origins with President Trump labelling it the “China virus” and the “Wuhan virus”, and China retaliating with far-fetched accusations of America importing the virus to Wuhan via a visiting military sporting team, and the whole thing becoming entwined in a looming trade war between the two economic powers❂.
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(source: www.socioecomonics.net)

The advent of COVID-19 has introduced us to terms such as “contact tracing”, “social distancing”, “covidiot” and the like, but recently we‘ve been hearing a new term thrown about, one with more ominous implications – “vaccine nationalism”. As the scattered islands of scientific teams continue the hunt for the “silver bullet” that presumably will fix the disease, there is a growing sense that the country or countries who first achieve the breakthrough will adopt a “my nation first” approach to the distribution of the vaccine. There are multiple signs that this may be the reality…the US government has launched the curiously named “Operation Warp Speed”, aimed at securing the first 300 million doses of the vaccine available by January 2021 for Americans [‘Trump’s ‘Operation Warp Speed’ Aims to Rush Coronavirus Vaccine’, (Jennifer Jacobs & Drew Armstrong), Bloomberg, 30-Apr-2020, www.bloomberg.com]. In the UK Oxford University is working with biopharma company AstraZeneca to invent a vaccine that will be prioritised towards British needs.

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(Source: IndiaMart)

A “vac race”
Not to be outdone, China, operating through Sinovac Biotech, is at the forefront of testing potential cures for COVID-19. The pressing need for a vaccine to safeguard its own population aside, Beijing’s rationale includes a heavy investment in national pride and the demonstration of Chinese scientific superiority (cf. Trump’s motivation). The Sino-US rivalry over finding a cure for the pandemic has been compared to the Cold War era ”Space Race” between the US and the USSR (Milne & Crow). A political war of superpower v superpower on a new battlefield…noted as bring part of a longer trend of the “securitisation of global health “ where the health objective increasingly has to share the stage with issues of national security and international diplomacy (E/Prof Stuart Blume, quoted in ibid.).

An environment of competition in lieu of collaboration
Even prior to the start of serious talk about the vaccine, the coronavirus crisis was provoking an “everyone for themselves”, non-cooperative approach. With the onset of equipment shortages needed to combat the virus outbreak, an international bunfight developed over access to PPE (personal protection equipment). 3M masks destined for Germany were intercepted by the White House and re-routed to US recipients; French president, Emmanuel Macron, seized millions of masks that were on route to Sweden; Trump purportedly tried to buy CureVac, a German biopharma company working on the vaccine [‘Why vaccine ‘nationalism’ could slow the coronavirus fight’, (Richard Milne & David Crow), Financial Times, 14-May-20320, www.ft.com/]. India (under Hindu nationalist Modi), the world’s largest supplier of hydroxychloroquine (touted as a cure for the virus), withheld it from being exported. As part of this neo-protectionism of the corona medical trove, more than 69 countries banned the export of PPE, medical devices and medicines [‘A New Front for Nationalism: The Global Battle Against a Virus’, (Peter S Goodman, Katie Thomas, Sui-Lee Wee & Jeffrey Gettleman), New York Times, 10-Apr-2020, www.nytimes.com].

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Politics and economics over science and global health?
Will narrow self-interest and economic advantage prevail? Will Big Pharma sell the virus panacea to the highest bidders? A zero-sum game  in which those who can’t afford the cost fall by the wayside? There are precedents…the distribution of the H1N1 vaccine for the 2009 Swine Flu was predicated on the purchasing power of the higher-income countries, not on the risk of international transmission [‘The Danger of Vaccine Nationalism’, (Rebecca Weintraub, Asaf Britton & Mark L Rosenberg), Harvard Business Review, 22-May-2020, www.hbr.org/]. The availability of the vaccine is seen as integral to restarting the global economy (Milne & Crow).

The eclipse of multinationalism?
With WHO in the eyes of some international players seemingly tarnished by its relationship with China, and by Trump’s undermining of its effectiveness by threatening to withdraw American support, multilateralism is on the back foot. There have been some attempts to stem the tide, CEPI (Coalition for Epidemic Preparedness Innovations’)▣, with a mission of promoting a collective response to emerging infectious diseases, is trying to advance both the development of coronavirus vaccines and equitable access to them (http://cepi.net/).

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Getting to an “equitable distribution” of the vaccine
As CEPI recognises, and is committed to redressing, there is no formal mechanism in existence for fairly distributing vaccines for epidemics…one step being taken is to try to get  an equitable distribution strategy accepted by the G20 nations. The only way forward to ensure that allocation is fair and prioritised according to needs is through a coordinated global effort (Milne & Crow; Weintraub eg al).

The fear is thus well founded that if and when a vaccine is discovered and developed, the richer nations will secure a monopoly over it and prevent it getting to poorer nations where it would be urgently needed by the elderly, the immunocompromised and the “first responder” health workers. There are many who hope fervently that a different scenario will be played out, that a more enlightened type of self-interest will prevail. This would require the wealthier countries seeing the bigger picture – the danger that if they don’t redistribute the cures, the outcome will be an adverse effect on the global supply chain and on the world‘s economies. As Gayle Smith (CEO of “One Campaign“, a Washington-based NGO fighting extreme poverty) put it: it is in the richer countries‘ own interests ”to ensure that the virus isn’t running rampant in other countries” (Milne and Crow). “If an international deal can be reached“, CEPI CEO Dr Richard Hatchett said, ”Everyone will win, if not, the race may turn into a free-for-all” with the losers in plain sight [‘Why the race for a Covid-19 vaccine is as much about politics as it is about science’, (Paul Nuki), The Telegraph (UK), 10-Apr-2020, www.telegraph.co.uk].

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(Source: www.euroweeklynews.com)

PostScript: Its no done deal! – reining in the wave of vaccine optimism
Even some of the scientists working on developing a vaccine are less than sanguine about the prospects. As immunologist Professor Ian Frazer (UQld) explains: there is no model of how to attack the virus. Trying to come up with a vaccine for upper respiratory tract diseases is complicated due to “the virus landing on the outside of you”, as we have seen with the common cold. What’s needed is “an immunise response which migrates out to where (the coronavirus) lands” [‘No vaccine for coronavirus a possibility’, (Candace Sutton), News, 19-Apr-2020, www.news.com.au].

 

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✱ a matter of getting “the maximum shots on goal” as Jane Halton, a former member of the WHO board, put it
❂ with Trump aided and abetted in this mission by Peter Navarro (who Bloomberg calls “Trump’s Trade Warrior”) enthusiastically leading the charge in the undeclared trade war with China
▣ with funding from the Bill and Melinda Gates Foundation