Announcement

Dear readers, 

For nearly 3.5 years, the Johns Hopkins Center for Health Security has brought you critical news and analysis on the COVID-19 pandemic through this newsletter, as well as on our website. As the world transitions out of the emergency phase of the pandemic, we also are transitioning: today represents the final COVID-19 Situation Report. However, we are excited to announce we will be bringing you an expanded newsletter that represents the breadth and depth of our work on COVID-19, health security, and pandemic preparedness. 

What to expect: A new twice-weekly newsletter arriving in your inbox in July that combines the analysis of the COVID-19 Situation Report with the quick hits of our other newsletter, Health Security Headlines. In the meantime, we invite you to stay abreast of COVID-19 and other important news through Health Security Headlines. Otherwise, you will automatically be transitioned to the new mailing list, so stay tuned! 

I would like to thank the Center’s dedicated team of analysts and scholars who have worked tirelessly (7 days a week in the beginning!) to publish this newsletter, and especially Caitlin Rivers and Matthew Shearer, who preceded me in manning this helm. Most importantly, thank YOU—for your readership, for your communications of praise and criticism, and for weathering this storm with us. While the pandemic’s emergency phase is ending, much remains to be reckoned with and learned, and those lessons used to prepare for the next pandemic. See you in July!

Be well, 

Alyson Browett, MPH 

Editor

In this issue

> End to COVID-19 pandemic emergency phase brings focus on preparedness, response efforts for future health threats

> US debt ceiling negotiations consider takeback of unused COVID-19 emergency relief funds

> WHO advisory group recommends updating COVID-19 vaccines to include XBB subvariant; US FDA set to discuss vaccine composition in June 

> Pandemic worsened racial/ethnic disparities in health, highlighting need to confront structural inequities

> China experiencing new wave of COVID-19 cases due to XBB subvariants; authorities working to update vaccines

> Research into new monoclonal antibody therapies moving forward but threatened by lack of long-term investments 

> What we're reading

> Epi update

End to COVID-19 pandemic emergency phase brings focus on preparedness, response efforts for future health threats

The COVID-19 pandemic’s impacts, in the US and globally, will be felt for years to come. Though the global COVID-19 emergency has officially ended, SARS-CoV-2 continues to kill at least 1 person every 4 minutes, and questions remain about how to move forward living with a dangerous virus, especially for vulnerable people and countries with less or no access to vaccines and treatments. Meantime, the world must also prepare for the threat of new variants or other pathogens with even deadlier potential, WHO Director Dr. Tedros Adhanom Ghebreyesus said recently at the World Health Assembly, calling on nations to be “ready to answer decisively, collectively, and equitably.”

Discussions about how to ensure equitable access to medical countermeasures during future pandemics are underway, as are negotiations of a wide-reaching treaty laying out new rules for dealing with pandemics. A draft document sent to member states and nongovernmental organizations this week included feedback from previous versions, as well as a clause calling on countries with greater “capacities and resources” to bear a “commensurate degree” of responsibility in global health threat preparedness and response efforts. Separately, discussions are underway to reform the 2005 International Health Regulations (IHR), which describe countries’ obligations during public health events that have the potential to cross borders. Both the pandemic treaty and IHR amendments are on track to be presented at next year’s World Health Assembly. 

In related news, the co-chairs of the Independent Panel for Pandemic Preparedness and Response and more than 15 scientists and public health experts called on G7 leaders to make specific commitments to pandemic preparedness and response at their summit in Hiroshima, Japan, last weekend. In their communique, the leaders committed to “further enhancing political momentum toward more coordinated and sustained leader-level governance for health emergency prevention, preparedness and response (PPR) that ensures legitimacy, representation, equity, and effectiveness,” and recognized the importance of the WHO pandemic negotiations to break the cycle of panic and neglect. 

Additionally, efforts to track and anticipate the next outbreak from an unknown pathogen, sometimes referred to as Disease X, are ongoing. The WHO on May 20 launched the International Pathogen Surveillance Network (IPSN), a platform using technology to map out the genetic code of disease-causing organisms that will connect countries and regions with an aim of improving systems for collecting and analyzing samples. Though many countries scaled up their genomics capacity over the past 3 years, the IPSN will allow nations to more efficiently share data and use it to drive public health decision-making. 

US debt ceiling negotiations consider takeback of unused COVID-19 emergency relief funds

The United States is rapidly approaching the date at which the government can no longer pay its bills, with Treasury Secretary Janet Yellen setting a fast-approaching June 1 deadline to avoid a potential debt default. Debt ceiling negotiations are zeroing in on several key issues, including remaining COVID-19 relief funds. The potential for the redistribution of unused COVID-19 emergency money is an item of contention between US House Democrats and Republicans. Though President Joe Biden has said he is willing to consider a takeback of the remaining funds, many congressional Democrats worry about the consequences such an action would have for public health initiatives the money is intended to support, including efforts to develop vaccines and therapeutics for future SARS-CoV-2 variants and to fortify medical supplies for the Strategic National Stockpile, among others. House Republicans argue that the remaining US$30 billion of the total US$4.6 trillion of pandemic-related funding should be put toward raising the nation’s debt limit because the COVID-19 pandemic emergency is over. While it seems likely that the Biden administration and House Democrats will cede some of the funding, the unspent COVID-19 funds are only a drop in the bucket, dwarfed by the more than US$31 trillion in debt the nation owes.

WHO advisory group recommends updating COVID-19 vaccines to include XBB subvariant; US FDA set to discuss vaccine composition in June 

The WHO Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) last week released new recommendations for updating the antigen composition of COVID-19 vaccines. Current vaccines based on the index SARS-CoV-2 virus offer broad protection against severe disease; however, experts are recommending that new vaccines tailored only to the Omicron XBB.1 subvariant, which is now the most commonly circulating strain, will improve durability and breadth of protection. Some COVID-19 vaccine producers, including Pfizer-BioNTech, Moderna, Novavax, and others, have already begun research and development on vaccines targeting currently circulating variants like XBB.1. 

The US FDA is set to meet in mid-June to discuss next-generation vaccine composition and rollout ahead of cold and flu season in the fall. Using the influenza vaccination as a model for future COVID-19 vaccination strategies, the FDA will likely move toward recommending once-a-year COVID-19 boosters that are updated annually to match the most widespread circulating SARS-CoV-2 variant or variants. Pfizer-BioNTech and Moderna are already innovating new approaches for their vaccines against COVID-19, including combination shots that could protect against multiple viral threats.

Pandemic worsened racial/ethnic disparities in health, highlighting need to confront structural inequities 

Over the course of the COVID-19 pandemic, racial disparities in cases and deaths have widened and narrowed, but overall, Black, Hispanic, and American Indian and Alaska Native (AIAN) people in the US have borne the heaviest health impacts of the pandemic. New findings renew concerns over these disparities:

• Research from KFF released earlier this week found widening racial disparities in US life expectancy from 2019 to 2021, noting the trend was largely driven by COVID-19 mortality. Researchers said life expectancy declined 2.7 years overall, with decreases of 2.1 years for Asian people (85.6 to 83.5), 2.4 years for White people (78.8 to 76.4), 4 years (74.8 to 70.8) for Black people, 4.2 years (74.8 to 70.8) for Hispanic people, and 6.6 years (71.8 to 65.2) for AIAN people.

• A study published in JAMA last week examined excess deaths and years of potential life lost for the Black population of the US, compared to the White population, from 1999 to 2020. Researchers found that Black Americans have suffered 1.63 million excess deaths and more than 80 million years of potential life lost compared to White Americans. These disparities seemed to be improving until they stalled and then worsened in 2020. Heart disease was the leading cause of excess mortality.

• Black adults are more likely than White adults to suffer from high blood pressure (56% vs 48%, respectively) and less likely to have the condition under control with medication (25% vs 32%, respectively). This disparity, which is expected to worsen in the coming decades, further exacerbates COVID-19 racial disparities, as high blood pressure is listed as a contributing factor in 21.4% of COVID-related deaths among Black patients and 15.5% of COVID-related deaths among White patients. 

With the end of the public health emergency in the US ushering in the termination of several policies implemented during the COVID-19 pandemic meant to help people access care, including continuous enrollment for Medicaid and the Children’s Health Insurance Program (CHIP), many fear these health disparities could widen even further. Federal, state, and local governments must work to raise awareness of health disparities and focus on implementing solutions that include confronting structural inequities affecting health insurance coverage and access to care, as well as other socioeconomic factors that impact health.

China experiencing new wave of COVID-19 cases due to XBB subvariants; authorities working to update vaccines

Chinese authorities are working to develop, approve, and distribute vaccines updated for the XBB subvariants, which are driving a new wave of COVID-19 cases. Authorities have approved 2 new vaccines for the subvariants, with the approvals of 3-4 more expected soon. The wave of new infections is expected to peak in June, with up to 65 million cases per week under the worst-case scenarios. China last faced a surge in cases over the 2022-23 winter after dropping its “zero COVID” policy, causing as much as 85% of the population to become infected. Although officials believe this wave will be less severe, public health experts are stressing the need for an aggressive vaccine booster program and ample antiviral supplies to prevent a spike in deaths, particularly among the elderly population. While some hospitals have advised precautions, and some concerts and other events have been canceled without explanation, most residents are continuing life as usual.

Research into new monoclonal antibody therapies moving forward but threatened by lack of long-term investments 

Treatment with a monoclonal antibody (mAb) within 2 days of a COVID-19 diagnosis reduced the risk for hospitalization or death by almost 40%, according to one study. With the emergence of the Omicron variant, however, the US FDA withdrew the emergency use authorizations (EUAs) for 5 mAbs because they are ineffective due to mutations in SARS-CoV-2. Now, researchers are working to redesign antibody treatments to target parts of the virus that are less prone to mutation, Science reports. One approach involves creating antibody-like compounds that can bind to multiple sites on viral proteins simultaneously, making it harder for the virus to evade treatment. Other strategies include targeting conserved regions of the spike protein that have not changed among variants and modifying the structure of antibodies to enhance their potency. 

But with the US emergency declaration expired, concerns over waning interest and lack of investment in research threaten the development of these new therapies. In April, President Biden’s administration launched a US$5 billion Project NextGen to help commercialize vaccines, mAbs, and other therapeutics, but that funding could fall victim in ongoing debt ceiling negotiations (see story above). What is clear is that long-term investments are needed for COVID-19 therapy research and development, especially for people who are immunocompromised, about 3% of the US population.

What we’re reading

ORIGIN INVESTIGATIONS The Atlantic looks at the state of current scientific investigations into the origin of SARS-CoV-2, including how prior beliefs can affect data interpretation and lead researchers into heated battles. All evidence and options remain on the table, however, “the world probably won’t ever get data that will conclusively end the debate.”

US FEDERAL PRISON RESPONSE In an analysis of nearly 1,500 pages of data, obtained through multiple Freedom of Information Act requests, STAT provides a detailed look at the US federal prison system’s COVID-19 response, finding many prisons implemented substandard mitigation measures throughout the pandemic, including facilities meant to take care of the sickest incarcerated people. The article highlights 4 shortcomings, such as delays in vaccinating high-risk residents, failures to provide widespread screening testing, a lack of reliable data from the Bureau of Prisons on testing activities, and low rates of vaccine booster administration among prison populations.

AFRICA’S TRUST Devex examines the structural and systemic issues that led to a further erosion of trust among African nations during the COVID-19 pandemic and how efforts moving forward might help improve that trust. The article features comments made by Dr. Ayoade Alakija, the WHO’s special envoy for the ACT-Accelerator, who spoke on the sidelines of the World Health Assembly.

WORLD HEALTH STATISTICS REPORT The COVID-19 pandemic is estimated to have resulted in nearly 15 million excess deaths in 2020 and 2021, with each resulting in an average loss of more than 22 years of life, or more than 330 million years of life lost globally, according to the WHO’s 2023 World Health Statistics report. Though global life expectancy increased from 67 years in 2000 to 73 years in 2019, progress against many global health indicators began to slow or stagnate beginning in 2015, prior to the pandemic. The pandemic set things back even further, however, overwhelming health systems and badly disrupting essential health services, the report notes. The WHO warned of the growing threats of noncommunicable diseases (NCDs), air pollution, and antimicrobial resistance but also highlighted successes, such as reductions in exposure to many health risks—including tobacco use, violence, and unsafe water and sanitation—as well as declines in new HIV infections and HIV-related deaths. Global life expectancy at birth is projected to reach 77 years by 2048, according to the report.

CANINE OLFACTORY DETECTION A meta-analysis of 27 studies published in the Annals of Epidemiology adds to the evidence that dogs are able to detect SARS-CoV-2 in humans. According to the analysis, dogs have a high sensitivity of more than 80% and specificity of more than 90% in detecting SARS-CoV-2 in humans through scent. The studies tested dogs on their capacity to detect SARS-CoV-2 in various samples such as sweat, saliva, masks, and urine. In 6 studies with high-quality data, the sensitivity ranged from 82% to 97% and specificity from 83% to 100%. The researchers suggest that canine detection can be beneficial in public spaces and events, providing a relatively cost-effective testing strategy alongside other measures in controlling pandemics.

Epi update

As of May 24, the WHO COVID-19 Dashboard reports: 

• 766.9 million cumulative COVID-19 cases 
• 6.9 million deaths
• 434,032 confirmed cases reported week of May 15 
• 24% decrease in global weekly incidence
• 1,977 deaths reported week of May 15 
• 55% increase in global weekly mortality 

Over the previous week, case incidence declined or remained relatively stable in all WHO regions.  

UNITED STATES

The US CDC is reporting: 

• 1.13 million cumulative deaths
• 9,186 weekly COVID-19 hospital admissions (decrease of 4.9%)

The data for variant proportions have not changed since last week, as the CDC now updates only every other week. As of March 13, the Omicron sublineages XBB.1.5 (64%), XBB.1.16 (14%), XBB.1.9.1 (9%), XBB.1.9.2 (4%), XBB.2.3 (3.5%), XBB.1.5.1 (2.4%), and FD.2 (1.8%) accounted for a majority of all new sequenced specimens, with various other Omicron subvariants accounting for the remainder of cases.