COVID-19 Situation Report
Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS

WEBINAR TODAY Please join the CSIS Commission on Strengthening America’s Health Security today, August 30, from 4:00 pm to 5:00 pm ET, for a fireside chat with Dr. Rochelle Walensky, Director of the US Centers for Disease Control and Prevention. Drs. Tom Inglesby, Director of the Johns Hopkins Center for Health Security, and Julie Gerberding, CEO of the Foundation for the National Institutes of Health (FNIH), will host and moderate a discussion reflecting on the CDC’s critical role in pandemic preparedness and response, at home and abroad. As part of that, Dr. Walensky will offer details on recently announced plans for major internal reforms to strengthen CDC’s future performance. Register:

1 MILLION DEATHS IN 2022 WHO Director-General Dr. Tedros Adhanom Ghebreyesus announced during an August 25 briefing that 1 million people have died with COVID-19 in 2022 thus far. Expressing disappointment in the mortality toll, Dr. Tedros blamed lagging vaccination rates and urged all countries to step up and improve vaccination access worldwide, particularly among high-risk groups. "We cannot say we are learning to live with COVID-19 when 1 million people have died with COVID-19 this year alone, when we are 2 and a half years into the pandemic and have all the tools necessary to prevent these deaths,” he said. According to the WHO, 136 countries failed to reach the June target of vaccinating 70% of their populations. Among those countries, 66 have vaccination coverage below 40% and 10 are below 10%, leaving one-third of the world’s population unvaccinated.

GLOBAL VACCINATION CHALLENGES Global COVID-19 vaccination rates have stalled recently. While 67.6% of the world’s population has received at least one dose of a vaccine—close to the WHO’s recently missed goal of 70% by mid-2022—only 20.9% of people in low-income countries have received at least one dose. A new report by the health consultancy Matahari Global Solutions, with support from the International Treatment Preparedness Coalition and the People’s Vaccine Alliance, examines progress on uptake of and access to COVID-19 tools across 14 nations—Bangladesh, Democratic Republic of the Congo, Haiti, Jamaica, Liberia, Madagascar, Nepal, Nigeria, Perú, Senegal, Somalia (and Somaliland), Uganda, and Ukraine. According to the report, the reasons for slow vaccine uptake in these nations are multifaceted and cannot be blamed solely on skepticism about vaccines, or “vaccine hesitancy,” although it does cite influence from “historical memory of experimentation on Black bodies by white colonizers.” The countries also face a range of challenges that contribute to low uptake, including lack of cold chain storage and healthcare workers, unpredictable supply chains, transportation problems related to deliveries or accessing vaccination centers, and insecurity. The report also outlines inequities in access to other COVID-19 tools such as oxygen, diagnostic tests, and therapeutics and discusses actions still needed to address the current pandemic as well as future health emergencies. Notably, experts from the University of Washington's Institute for Health Metrics and Evaluation (IHME) estimate that thousands of lives could be saved if antivirals to treat COVID-19, such as Paxlovid, were more accessible in low- and middle-income countries.

VACCINE PATENT LAWSUIT Moderna on August 26 filed patent infringement lawsuits in the US and Germany alleging that Pfizer and BioNTech violated 3 patents Moderna filed between 2010 and 2016 on its mRNA technology, foundational in developing the company’s SARS-CoV-2 vaccine, Spikevax. Moderna claims that Pfizer and BioNTech copied that technology without permission to produce their vaccine, Comirnaty. Instead of seeking to remove the Pfizer-BioNTech vaccine from the market, Moderna is seeking monetary damages that could include royalties and lost profits incurred since March 2022, when the company began enforcing patents in wealthier nations after pledging not to do so during the emergency phase of the pandemic. Both Pfizer and BioNTech said the litigation was surprising and they remain confident in the intellectual property supporting their vaccine. Notably, some experts say at least one of the patented inventions Moderna included in the lawsuits was patented by two university scientists 6 years earlier than Moderna’s filing. While the earlier patent could weaken Moderna’s argument, the claim likely will not be completely invalidated. Analysts say the lawsuits point toward Moderna’s efforts to profit from the mRNA platform in future endeavors, including to treat and prevent other infectious diseases, cancers, rare diseases, and autoimmune disorders. The patent battle could drag on for years but is unlikely to impact production of the companies’ vaccines against COVID-19.

ACCESS TO COVID-19 TOOLS Most US residents have been able to access COVID-19 vaccines, treatments, tests, and other tools such as masks for low or no cost, largely because the federal government has purchased and allocated them to states and providers. However, because the US Congress has not moved to authorize additional funding for the pandemic response, the government can no longer buy the products for free or low-cost distribution. This week, the Biden administration announced it will pause its program to mail free at-home rapid COVID-19 tests to residents because “Congress hasn’t provided additional funding to replenish the nation’s stockpile of tests,” according to a statement on the website

In the face of dwindling supplies and funding-related tradeoffs, the Biden administration is aiming to preserve the existing supply of rapid antigen tests in anticipation of a fall surge in cases. If congressional funding becomes available, the program will quickly resume distribution, according to an unnamed administration official. Free tests will continue to be available to order as long as supplies last or through September 2, whichever comes first. After that, they will be available through 15,000 federally supported community sites, such as libraries and pharmacies, as well as community health clinics. Additionally, individuals can be reimbursed for the cost of tests through private and public health insurers. 

With funds running low, the Biden administration is beginning to shift the cost of tests, vaccines, and therapeutics to health insurers and consumers. Experts caution that the impending commercialization of COVID-19 tools must account for systemic barriers that prevent equitable access to them, particularly among uninsured people. Already, programs meant to improve access to and uptake of vaccinations have folded, in some cases due to congressional resistance to authorize more pandemic response funds, just as the US prepares to launch a fall booster campaign with updated vaccines. However, due to a lack of funding, coupled with low demand for vaccination and increasingly relaxed federal guidance on preventive measures, many susceptible populations will continue to face barriers in accessing COVID-19 preventive measures and other healthcare. 

VACCINE EFFECTIVENESS AGAINST OMICRON A new analysis in JAMA Network Open provides further support that Pfizer-BioNTech or Moderna booster dose administration following a 2-dose primary series provides protection against severe COVID-19 outcomes caused by the Omicron variant of concern. The cohort study of more than 2.4 million individuals estimated that mRNA booster dose effectiveness against severe COVID-19 during Omicron predominance was 87.4% with no waning up to 6 months after receiving the dose, compared to 69.6% effectiveness against severe COVID-19 following a 3-dose series of inactivated vaccine (ie, Sinovac CoronaVac or Sinopharm COVID-19 vaccines). Data from the US CDC, published August 26 in Morbidity and Mortality Weekly Report (MMWR), similarly emphasized the importance of vaccination, showing that while older Americans above the age of 65 faced greater hospitalization rates during the BA.2 predominant period, unvaccinated individuals had a 3 times greater risk of hospitalization compared to vaccinated individuals. 

WASTEWATER SURVEILLANCE Wastewater surveillance is a proven method to track disease outbreaks and has provided an accurate and economical way to provide early detection of COVID-19 levels within communities—and even estimate the number of infected people in a specific area—helping to inform health authorities and policymakers throughout the pandemic. Sewage surveillance also is used to track other diseases, including monkeypox and polio, and experts say building and maintaining the infrastructure to expand wastewater-based disease surveillance should be a public health priority. However, funding for the relatively inexpensive systems is inconsistent, leading to pauses in the disease monitoring that, if continuously and thoroughly conducted, can help communities or entire countries save millions of dollars by quickly responding to disease outbreaks. But many governments, including the US Congress, are reluctant to allocate additional money for wastewater surveillance. In some cases, venture capitalists, nonprofit organizations, or academic institutions are stepping up to fill the gaps. But more funding will be needed to grow wastewater epidemiology to help provide warning signals of future potential disease outbreaks.

CHINA Several of China’s largest cities have imposed full or partial lockdowns amid new COVID-19 outbreaks. The measures impact at least 3 million people in the port city of Dalian and an undisclosed number in Chengde and Shijiazhuang in Hebei province. Though the province surrounds Beijing, the capital city is so far relatively unaffected. Partial lockdowns in other areas of the country are affecting millions more people. Measures include the need to show proof of negative test results within 24 hours to enter residential and public spaces, capacity reductions for public spaces, blanket closures of public entertainment and cultural venues, work-from-home mandates, and limits on the number of people that households may send to shop for daily needs. In many areas, the lockdowns will delay the start of the school year. Amid a heat wave, the workers responsible for enforcing the measures face significant occupational health and safety risks, such as heat stroke and exhaustion exacerbated by wearing bulky protective suits. The latest curbs reflect the government’s insistence of adhering to its “dynamic zero COVID” policy, often criticized for being unsustainable, disrupting the economy, and negatively impacting the mental health of residents, particularly teenagers and young adults.

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