COVID-19 Situation Report

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EPI UPDATE The WHO COVID-19 Dashboard reports 156 million cases and 3.2 million deaths worldwide as of 5:30am EDT on May 7.

India continues to set new global records in terms of total daily incidence. It is currently reporting a 7-day average of nearly 390,000 new cases per day, and it could surpass 400,000 in the next several days. India has reported more than 400,000 new cases on each of the past 2 days, including a new global record of 414,188 on May 6. Among the top 10 countries globally, India is the only one currently reporting increasing daily incidence.

As India’s COVID-19 epidemic continues to surge, Asia is the #1 continent globally in terms of total daily incidence. Countries in Asia are reporting more than 4 times the daily incidence as any other continent. South America and Europe are #2 and #3, respectively, reporting nearly the same daily incidence. North America is reporting slightly more than half of the daily cases in Europe and South America. Countries in Africa and Oceania continue to largely contain their respective COVID-19 epidemics, with approximately 8,500 new cases per day in Africa and 100 in Oceania. On a per capita basis, Asia (107 daily cases per million population) is sitting right at the global average (102). It is not surprising that the global average aligns closely with Asia, considering that the continent represents approximately 60% of both the global population and the current global daily incidence. North America is reporting similar per capita daily incidence, with 104. At 269 daily cases per million, South America’s per capita daily incidence is more than 150% higher than the global average, followed by Europe, with 146 daily cases per million. As with total daily incidence, Africa and Oceania are reporting much lower per capita totals—only 6.4 and 2.6, respectively.

In terms of total cumulative incidence, Europe is still #1 globally, with more than 45 million cases. Asia (42 million) surpassed North America (38 million) on April 26 to become #2, and if it continues on this trajectory, it will soon overtake Europe. South America is #4, with 25 million cases. The epidemics in Europe and North America are both tapering off, while Asia’s and South America’s are still accelerating. There have been 4.6 million cases in Africa and fewer than 45,000 in Oceania. Notably, there are 6 individual countries—the US, India, Brazil, France, Turkey, and Russia—that have each reported more cumulative cases than the whole of Africa. On a per capita basis, North America (#1), Europe (#2), and South America (#3) have all reported 3 times the cumulative global average or more. Asia is #4, but it has reported less than half the global per capita average. Africa has reported 17% of the global average, and Oceania is at 5%.

Global Vaccination
The WHO reported 1.17 billion doses of SARS-CoV-2 vaccines administered globally, including 597 million individuals with at least 1 dose. Our World in Data reported 1.24 billion cumulative doses administered globally. This is an increase of 11% over the previous week, slightly less than the 13% weekly increases exhibited over the previous several weeks. The daily doses administered continues to decrease, down from a high of 20.6 million doses per day on May 1 to 17.4 million—a 16% decrease in just a week. Our World in Data estimates that there are 298 million people worldwide who are fully vaccinated, although reporting is less complete than for other data.

Of the 191 countries and territories reporting COVID-19 incidence data, 125 are reporting data on the number of people who are fully vaccinated. These predominantly represent Europe, North and South America, and South and Southeast Asia. Data are missing for numerous countries in Africa and the Caribbean, Central Asia, and Eastern Mediterranean regions. Other notable countries missing data include Australia and China. In terms of the proportion of the population that is fully vaccinated, Seychelles (61%) has surpassed Israel (59%) as #1 globally. These are the only 2 countries reporting more than 50% coverage. The UAE (39%) is #3, followed by Chile (37%) and Bahrain (33%) to round out the top 5. By region, 5 of the top 10 countries are in Europe, 2 are in the Eastern Mediterranean, and 2 are in the Americas. Seychelles is the only country in Africa. Among the reporting countries, the median coverage is 6.8%, and most countries fall between 1.4% and 13.0%.

The US CDC reported 32.4 million cumulative cases and 576,238 deaths. Daily incidence continues to decrease, down to 45,816 new cases per day, the lowest average since October 7, 2020. Daily mortality has increased over the past week or so, up from a recent low of 631 deaths per day on April 27 to 674 on May 4—a 7% increase over that period—before decreasing to 656 on May 5. Over the course of the US epidemic, trends in daily mortality have generally lagged 3-4 weeks behind trends in daily incidence; however, since early April, the trends appear to be slightly disconnected. For example, following the brief surge in daily incidence from mid-March to mid-April, we did not observe a similar surge in mortality, as we would have expected based on historical trends. We will continue to monitor these trends over the coming weeks.

US Vaccination
The US has distributed 325 million doses of SARS-CoV-2 vaccine and administered 252 million doses. Daily doses administered* continues to decrease, down from a high of 3.3 million (April 11) to 2.1 million. Approximately 1.3 million people are achieving fully vaccinated status per day, down from a high of 1.8 million per day on April 12.

A total of 149 million individuals have received at least 1 dose of SARS-CoV-2 vaccine, equivalent to 45% of the entire US population and 57% of all adults. Of those, 109 million are fully vaccinated, which corresponds to 33% of the total population and 42% of adults. Among adults aged 65 years and older, progress has largely stalled at 83% with at least 1 dose and 70% fully vaccinated. In terms of full vaccination, 56 million individuals have received the Pfizer-BioNTech vaccine, 45 million have received the Moderna vaccine, and 8.6 million have received the J&J-Janssen vaccine.
*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

The Johns Hopkins Coronavirus Resource Center is reporting 32.6 million cumulative cases and 580,076 deaths in the US as of 10:15am EDT on May 7.

VACCINE INTELLECTUAL PROPERTY In an historic move, the US government on May 5 announced its support for temporarily waiving intellectual property (IP) rights for SARS-CoV-2 vaccines, vowing to actively participate in negotiations at the World Trade Organization (WTO) on a proposal aimed at increasing vaccine production to reach low- and middle-income countries (LMICs). The administrations of former US presidents have supported patent protections, so the move represents a major shift in US policy and shocked many on both sides of the issue. In a statement, US Trade Representative Katherine Tai said the US government “believes strongly in intellectual property protections,” but its support of a waiver is “in service of ending this pandemic” and will bolster the government’s goal “to get as many safe and effective vaccines to as many people as fast as possible.” US support of a waiver does not mean the measure will pass, as the WTO requires unanimous consent to approve any proposal. The leaders of some countries, including Germany, continue to express opposition, although sentiment appears to be shifting, with Canada and the European Commission voicing support for discussions after initially opposing the proposal. WTO Director-General Ngozi Okonjo-Iweala welcomed the US government’s willingness to participate in negotiations on the body’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement. India and South Africa, which have presented the waiver proposal 10 times previously, signaled they will revise the plan prior to another discussion later this month and a formal meeting of the TRIPS Council scheduled for June 8-9.

Even if WTO members adopt the proposal, an increase in vaccine production is not guaranteed. Experts note that several steps need to happen in order for countries to be able to produce generic versions of the vaccines safely and effectively. If IP rights are waived, countries would have to remove any national-level policies hindering generic production; pharmaceutical companies and manufacturers would need to transfer technologies and know-how; massive investments in manufacturing capacity would need to occur; and finally, plans to equitably distribute the vaccines would need to be developed and implemented.

Essentially, waiving IP rights might provide the recipe for vaccines, but having a recipe does not mean the end result will be successful without properly trained workers, raw ingredients, equipment, supplies, knowledge, and funding. And without full support from the pharmaceutical industry, whose lobbying organization opposed the US’s move, the issue could become wrapped up in litigation, preventing any of the next steps from happening, some experts warn. IP rights are simply one obstacle to increasing SARS-CoV-2 vaccine supply. Reportedly, Moderna in October 2020 vowed it would not enforce any of its Covid-19-related patents during the pandemic, but it’s unclear whether anyone has reproduced the company’s vaccine, underlining the difficulties in boosting global manufacturing capacity.

PFIZER-BIONTECH VACCINE EUA & FULL APPROVAL APPLICATION Following reports that the US FDA is expected to soon issue an Emergency Use Authorization (EUA) for the Pfizer-BioNTech SARS-CoV-2 vaccine in children aged 12-15 years, new reports are emerging that Pfizer is expected to apply for an EUA for younger children as well as full approval in adults. During a quarterly earnings call this week, Pfizer officials indicated that the company intends to apply for an EUA for children aged 2-11 years in September. Pfizer also anticipates applying for full FDA approval for the vaccine in individuals aged 16-65 years later this month. Full approval could facilitate businesses, schools, and other organizations mandating vaccination, but the extent to which this will happen remains uncertain. Pfizer’s chief scientific officer discussed the potential for a third dose of the company’s vaccine, suggesting populations at higher risk of COVID-19 disease or complications, including the elderly or those with chronic medical conditions, should be the first to receive any authorized booster shots, although that recommendation would be made by the US CDC. At least one study supports the theory that neutralizing antibodies following vaccination might not develop as robustly or could wane more quickly among older populations (>80 years old).

In addition to the FDA applications, Pfizer expects to have clinical trial safety data for pregnant people available by August. The vaccine’s current EUA does not explicitly omit pregnant people, but initial clinical trials were not designed to collect data on that population. Currently available clinical trial data do not indicate any safety concerns for pregnant people or their infants. Existing CDC guidance states that pregnant people can receive a SARS-CoV-2 vaccine, noting they are at elevated risk for severe COVID-19 disease and death and that the disease might put them “at increased risk of adverse pregnancy outcomes, such as preterm birth.”

On May 5, Canada became the first country to authorize the use of a SARS-CoV-2 vaccine in children. Health Canada authorized the Pfizer-BioNTech vaccine for use in children aged 12-15 years.

INDIA With India continuing to set devastating milestones during its 8-week-long second pandemic wave, the country’s Supreme Court on May 5 ordered the government to provide more medical oxygen to hospitals in New Delhi, after 12 COVID-19 patients died when a hospital ran out of oxygen. The government, under pressure to more quickly distribute supplies coming from other countries, agreed to increase the capital city’s medical oxygen supply from 490 tons per day to 730 tons per day. The Supreme Court also reportedly urged the government to prepare for a third wave of outbreak, and the nation’s principal scientific adviser also warned of an “inevitable” third wave, although he did not discuss timing. Assistance from other nations continues to pour into the country, with Pfizer and partners this week offering to supply more than US$70 million worth of medicines, including steroids, anticoagulants, and antibiotics. Though the government opened the nation’s vaccine program to all adults on May 1, supply shortages are hindering progress, exacerbating concerns among experts that the current surge will continue unabated without increased implementation of lockdowns at the state or federal levels. 

India’s outbreak now is spilling over to neighboring countries, like Nepal, which is logging record numbers of new daily cases. The national positivity rate is reported to be 47%, with rates even higher in some areas. 

THAILAND Thailand is struggling with a third wave of COVID-19, reporting more than 2,000 new cases a day recently. More than half of the 78,855 cases recorded by the Centre for COVID-19 Situation Administration have been confirmed since April 1. The latest surge is reported to have begun in bars and nightclubs in Bangkok and spread to the Klong Toey area, where about 100,000 people live in a 1 square mile area. Healthcare workers in the area are working to vaccinate up to 3,000 people a day to curb the virus’s spread. Nearly 2% of Thailand’s nearly 70 million people have received at least one dose of vaccine. Following reports that the more than 2.5 million foreigners from other countries who live in Thailand would be last in line to receive vaccinations, the director-general of Thailand’s Department of Disease Control on May 6 clarified that foreigners and diplomats will have the same criteria as Thais in order to receive a vaccine. Thailand has authorized SARS-CoV-2 vaccines from J&J-Janssen, AstraZeneca-Oxford, and China’s Sinopharm, but only the latter 2 are currently being administered. 

WHO PANDEMIC INTELLIGENCE HUB The World Health Organization and Germany will establish a new hub for pandemic and epidemic intelligence, data, surveillance, and analytics innovation. Called the WHO Hub for Pandemic and Epidemic Intelligence, the global platform will be based in Berlin and incorporate partners from around the world to collaborate, share data, and develop tools that countries can use to prepare, detect, and respond to pandemic and epidemic threats. The hub was created as part of WHO Health Emergencies Programme to increase data availability, develop tools and models for risk assessment, and monitor disease control measures worldwide. The hub also will provide public health experts and policymakers with relevant information to support their work and aid in the rapid decision making process that is critical for prevention and response to public health emergencies. Germany has provided start-up costs for the hub, but efforts to collect additional funding are ongoing.

VACCINES & VARIANTS OF CONCERN The emergence of SARS-CoV-2 variants, particularly those that exhibit increased transmissibility or disease severity, are causing concern regarding the efficacy of existing vaccines, which were developed based on earlier strains of the virus. Recent data provide further evidence that existing vaccines do provide protection against some variants of concern (VOCs), including real-world data from mass vaccination campaigns. A study published in The Lancet utilized data from more than 4.7 million individuals in Israel who were fully vaccinated using the Pfizer-BioNTech vaccine. Overall, the vaccine showed 95.3% effectiveness against infection among people who were fully vaccinated, defined in the study as 7 days or longer after the second dose. Among a subset of nearly 8,500 specimens with the spike gene target failure (SGTF), which is used to identify B.1.1.7 infections, the vaccine demonstrated 94.5% effectiveness against infection for fully vaccinated individuals. Data from 74,000 fully vaccinated individuals in Qatar, published in the New England Journal of Medicine, demonstrate 89.5% effectiveness for the Pfizer-BioNTech vaccine against infection with the B.1.1.7 variant—at 14 or more days after the second dose—but only 75.0% against the B.1.351 variant. Notably, the vaccine demonstrated 100% effectiveness against “severe, critical, or fatal disease” for both variants.

To increase protection against VOCs, some manufacturers are developing and evaluating booster doses. Moderna published, via press release, positive preliminary results from a Phase 2 clinical trial. The trial involves administering a third dose to fully vaccinated individuals, approximately 6-8 months after their second dose, using either the existing vaccine or a variant-specific version. The researchers identified increased neutralizing antibody response against the B.1.351 variant for both versions of the third dose, with higher antibody titers for the variant-specific version. Moderna also is testing a third option, a 50/50 multivalent mix of the standard and variant-specific vaccines. Moderna committed to publishing the full data via a peer-reviewed journal once the completion of the multivalent arm of the trial.

Novavax, developer of another mRNA-based SARS-CoV-2 vaccine, published preliminary findings from its Phase 2 clinical trial in NEJM. The study demonstrated 60.1% efficacy against symptomatic COVID-19 among adult participants who were HIV-negative and seronegative for SARS-CoV-2. Overall, among HIV-negative and medically stable HIV-positive participants, the vaccine demonstrated 49.4% efficacy. Notably, the study was conducted in South Africa, and the B.1.351 variant represented 93% of the sequenced specimens. In post hoc analysis, the vaccine demonstrated 51% efficacy against the variant. As Novavax proceeds with Phase 3 clinical trials, it will include up to 3,000 children aged 12-17 years.

IMPACT OF VACCINATION COVERAGE Researchers at several US universities and the Johns Hopkins Center for Health Security adapted a model to project the impact of various timelines and levels of vaccination coverage on COVID-19 incidence and mortality as well as medical costs and productivity losses. The researchers modeled several scenarios, ranging from 10-90% national vaccination coverage and 180-360 days to achieve that coverage, including sensitivity analysis using 50-90% vaccine efficacy to account for varying degrees of real-world vaccine effectiveness. They estimate that even small increases in vaccination coverage could have a major impact in terms of decreasing cumulative incidence and mortality as well as mitigating financial and economic effects. For example, an increase of 1% coverage—in the 40-50% range and on a 270-day timeline—could avert 1.5 million cases and 6,660 deaths and save more than US$600 million in medical costs and US$1.3 billion in productivity losses. Similarly, accelerating the timeline has major effects. Shortening the time to 180 days (ie, by the end of the summer) could prevent 5.8 million cases and more than 25,000 deaths. A shortened timeline also could mitigate US$3.5 billion in medical costs and US$4.3 billion in productivity losses. While the model cannot precisely predict the effects of changes in vaccination coverage or timeline, it illustrates that even minor improvements can have substantial longer-term benefits.

US VACCINATION GOALS & MESSAGING States across the US are preparing for a long SARS-CoV-2 vaccination process, as the demand for vaccines wanes in many regions. Reports show the number of daily vaccinations administered has already fallen by 40% from an earlier peak set in April, as the number of those with interest in getting the vaccine as quickly as allowed dwindles. Earlier this week, the US government set a new goal for COVID-19 vaccinations, aiming to reach 70% of the country’s adult population with at least one dose by July 4th. The government also announced new flexibilities for distributing vaccines to participating agencies and pharmacies in an effort to better match demand and supply. Public health organizations working on vaccine uptake support the focus on a flexible vaccine supply as well as the US government’s signal of greater investment into outreach to help reach underserved communities. Community-based organizations have a more robust understanding of community-specific concerns around the COVID-19 vaccination process and can help identify trusted messengers who may be better positioned to relay vaccine information. Community officials say the government’s increased focus on local efforts will help address current barriers to vaccination, including a lack of materials in different languages, difficulties in scheduling and traveling to appointments, and vaccine hesitancy. 

AUSTRALIA & NZ TRAVEL BUBBLE Less than 3 weeks after New Zealand and Australia implemented a “travel bubble” allowing residents from each country to travel to the other without having to enter a mandatory quarantine period, New Zealand officials on May 6 announced a temporary pause to the plan. The lead of New Zealand’s COVID-19 response, Chris Hipkins, announced a 48-hour suspension of flights from New South Wales, the region that is home to Sydney, where officials are investigating the source of 2 COVID-19 cases. The pause on travel does not restrict flights leaving New Zealand headed to Australia.

VACCINE DONATION FOR OLYMPIC DELEGATIONS On May 6, Pfizer and BioNTech announced they will donate SARS-CoV-2 vaccines to all Olympic and Paralympic delegations planning to attend the rescheduled 2020 Summer Olympic Games in Tokyo, Japan. The announcement, welcomed by the International Olympic Committee (IOC), comes as many countries are struggling to obtain enough vaccine doses for their populations. Even Japan is grappling with low vaccination rates, trailing behind many of its economic counterparts, with only 1-2% of its population fully vaccinated. Today, Prime Minister Yoshihide Suga pledged to speed up vaccinations to Japan’s older populations, setting a daily target of 1 million shots and aiming to have the nation’s 36 million elderly fully vaccinated by the end of July. Polling shows that most Japanese favor cancelling or postponing the Olympic Games, and social and political tensions are increasing throughout the country. Prime Minister Suga also announced an extension and expansion of a third state of emergency declaration for Tokyo and several other areas through May 31. He maintained the Olympics can be held safely and securely, despite public sentiment.