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Betsy McKay reporting from Harper, Liberia, gives this exceptional report on the shattered health system of Liberia and how the country is coping following the Ebola Virus epidemic. The dilapidated poor state of health facilities in Liberia, and in neighboring Sierra Leone and Guinea, have made these areas especially vulnerable to the spread of Ebola Virus. With pictures and details about the lives of ordinary people McKay brings to life one of the poorest regions in the world, racked by years of war and neglect, showing people struggling to find their way with minimal health care. Tabeh Freeman, a professor of public health at William S. Tubman University in Harper, Liberia, says Liberia cannot cope if another epidemic takes place, with such a poorly equiped and broken health system. Liberia, Guinea and Sierra Leone estimate the need is for about $1.47 billion in the next 30 months to build and equip a new health system. The World Bank and other donors have come up with $1 billion for Ebola recovery. A particularly urgent problem is to see that adequate funding goes to build the infrastructure for the health system and to train people to provide health services....

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The drug Remdesvir diminishes time to recovery by almost a third, say health experts. A key member of the American task force Dr. Anthony Fauci said it has "a clear cut significant positive effect in diminishing time to recovery." It was used in treating Ebola virus.

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Dr. Antnony Faucci has been at the forefront of every major medical crisis from SARS, swine flu to ebola virus. He is credited with convincing president Reagan of the dangers of HIV. He is now at the forefront for coronavirus. 

In daily briefings he is present answering questions in the White House Brady Room with president Trump, vice president Pence and Deborah Brx the response coordinator.

For 32 years he has taken on each challenge of increasing public awareness of dangers in public health crises, meeting controversy along the way. 

He is son of Italian immigrants and helped his father in a Brooklyn, New York,  pharmacy. 

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This report in The Guardian says what India urgently needs is for the US to lift export restrictions on supplies for India's vaccine factories, and tools such as genome sequencing to identify and control emerging variants of the coronavirus.

The report also points out that of the 1 billion vaccine jabs about half are in the US and Europe and the low income countries have only a tiny fraction of vaccinations. India which sent 64 million vaccine doses to countries including Brazil and Morocco, Bangladesh, in 3 months prior is reported to have sent only 1.2 million doses this month.

The crisis in India also shows the need says The Guardian for an international approach to the crisis no a country by country approach. It says the Bush plan for Aids and the the 2014 plan for Ebola in West Africa are models of an international approach that is needed now.

 

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The Oxford vaccine developed by British scientists could be ready by September. Astra Zeneca has joined with Oxford so that it can produce 100 million vaccine doses by the end of the year. This is because in a sense the vaccine is not new. It uses an existing tech platform where there is a lot of experience. The use of ring vaccination method shortens the process of testing on humans the vaccine to a few months. The core of the virus ChAdox1 already exists in chimpanzees and has a mild effect on humans. This is an adenovirus. It is combined with another virus to produce the covid vaccine for coronavirus. Researchers at Oxford have used ChAdox1 in the past to test vaccines for Ebola and MERS as well as other virus.  Already tests have been conducted on rhesus macaques. The rhesus macaques given the vaccine at a Montana lab did not get coronavirus.The surface protein of coronavirus is simply added to the ChAdox1 so that it is able to attach to host cells and infect them in the human body, and let antibodies develop from this. The purpose is to let the human body develop defense mechanism against this attaching to a human cell.   ...

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A Phase 1 trial of over a thousand volunteers shows the Oxford vaccine works well with minimum side effects that can be handled with acetaminophen. Phase 2 trial is underway with volunteers in UK, Brazil and South Africa. Participants given the vaccine had significant increase in antibodies to neutralize the disease, and T cells for long term protection. About 70% reported fatigue or headaches which can be handled with acetaminophen. After the Ebola crisis of 2014 in West Africa the British government invested 120 million pounds to form a group to develop vaccines for top 10 likely threats dubbed "Disease X." On this list was the coronavirus. Scientists at the Jenner Institute at Oxford formed a team as part of this effort. Sarah Gilbert and Adrian Hill led the scientists at Jenner and pioneered research for  a new way to do this- to first replace a part of the virus with a component of the new virus. Then to remove the part of the virus that allows it to replicate in humans. This method is called recombinant adenovirus vector. The Oxford scientists used existing technology in new ways to increase the chances of getting a good vaccine early.  The first vaccine could be developed and tested for mass production by September. A 30,000 participant trial begins in U.S. in August. About 1 billion doses could be manufactured by end of 2020. India's Serum Institute has the manufacturing facilities to do this near Pune, India.  ...

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The contrast between lack of effective measures taken in the Lombardy region with the aggressive action in Veneto that has proved effective. Veneto followed the method of quarantining, mass testing for clusters and isolating the affected people.  The Italian government took the first steps to close off northern Italy Feb 22, and it was not till March 10 that a nationwide lockdown was done. The action taken in the Veneto region is shown here in this WSJ report with the town of Vo as an example of steps taken that worked. A microbiology professor and infectious diseases expert at the University of Padua, Dr Crisanti, developed a test for the coronavirus as early as mid-January using the information made public by Chinese doctors. Dr. Crisanti oversaw the testing of 95% of residents of Vo, a town of 3400 people in Veneto region. He found 3% of the population was infected, with half testing positive asymptomatic. Following the aggressive lockdown the tests were done two weeks later and the rate of infection had fallen to 0.1% with only 8 new infections. "The main lesson from VO is that when you have a cluster of infected people, you should do a very aggressive lockdown and then test as many people as possible," Dr Crisanti says. The results from Vo led to Veneto increasing testing in the rest of the region carrying out 80,000 tests, compared to 88,000 in Lombardy, with double the population and 5 times more infections. Lombardy followed government directives to test only those with symptoms. When it spreads it is harder to do the test isolate clusters, test isolate clusters, in a continual loop, yet this remains the method cited by Dr. Brx in the U.S. today as the right way to target clusters in a laser approach. In yesterday's briefing at the White House Dr Brx said this is a method the U.S. is familiar with and has used in Africa to tackle HIV, Ebola Virus. It is possible using GPS to target down to a specific clinic in a specific place, which is how it was successfully done in Africa. ...

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The Oxford vaccine is shown to be effective for older adults over 70 years in age. One of the key features of the Oxford vaccine is that it is designed to be accessible in cost for not just high income countries but across all parts of the world including the countries in Asia, Africa and Latin America where some of the poorest people live. The cost will be a fraction of the cost of the Moderna and Pfizer vaccine. Results for regulatory approval are expected by Christmas. This vaccine is expected to cost about $4 a dose compared to $25 for the Pfizer or Moderna vaccines. Oxford also uses a technology for the vaccine that has already been proved effective with least side effects fr other virus such as Ebola virus. Oxford researchers took the existing vaccine technology and modified it to tackle coronavirus in a way that proves effective for this virus also. Countries such as South Korea say they will not rush into the first vaccine that is available and have not responded to requests for sale from Moderna or Pfizer. India's Serum Institute is the leading manufacturer of vaccines in the world. It is preparing for production of the Oxford vaccine. India's vaccine effort includes other vaccines developed by its research institutes. The focus of India is for a vaccine that is effective as well as meet cost so that it can be used to vaccinate over 1.3 billion people. Because India has strong already established manufacturing capabilities for vaccines and is collaborating with Oxford and Astra Zeneca for a low cost vaccine it is in a position to drive the campaign for an effective plus low cost 100% accessible vaccine for people around the world. Another aspect of the Astra Zeneca partnership with Oxford is that it has committed not to make a profit from the vaccine. This is important for Oxford researchers and its organizational goals. ...

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The title may not reflect the content of this report on Admiral Giroir who heads the U.S. coronavirus testing effort. He is a pediatrician who worked for hospitals in Texas before heading a vaccine project at Texas A&M University.  Internal politics led to his resigning from the effort to build a vaccine development capability with pharmaceutical companies at Texas A&M. Most of the rest of this report shows a physician who is determined to pursue big projects such as the one he is tackling today. President Trump appointed him to lead FDA, and to be the Assistant Secretary of the Department of Health and Human Services. With the missteps of Secretary Azar testing suffered in the early months of the crisis as reported in the WSJ. Adm. Giroir has taken a leading role since  this period. He also heads the U.S. Public Health Service Commissioned Corps of 6200 staff playing a vital role. On March 13 he was asked to lead the effort in testing.  He comes to this role with experience in the field of vaccines realizing that "the challenges are not just biological but engineering." New technology would be needed to make massive amounts of vaccine. His idea is that transformational efforts are needed. His idea for a billion dose per month facility in Texas did not work, yet he worked on it for about 5 years from 2010 to 2015 at Texas A&M University, at one point being the vice chancellor. He was selected by Texas Governor Perry as chairman of the task force in Texas in 2014 to oversee the effort to fight the Ebola virus. He now is in a position to bring all his experience and aspirations to tackle the coronavirus, cutting through much of the red tape and bureaucracy, and pulling together the effort combining science of pharmaceutical companies with the technology of manufacturing billions of vaccine doses in a record time. Today he sees capacity for testing reaching 40-50 million tests a month by September 2020.   ...

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It should be remembered as NHK points out that Mr. Obama never visited the Main Building of the Hiroshima Museum and only spent a little time in the East Building. It is the Main Building that Prime Minister Kishida- who represents Hiroshima City in parliament - wants Biden, Scholz and other G7 leaders to see. It is only in the Main Building that leaders can see the graphic images of the devastation of the atomic bomb dropped by the plane Enola Gay on Hiroshima.  A suggestion is for NHK to give a private broadcast to G7 leaders of the documentary already shown in Asia on NHK television last week.  Having seen it one can say that it in no way affects the use of nuclear deterrance. A suggestion for the Hiroshima Museum authority is for it to also show the devastation of Japanese bombing in Asia from World War II that  may have created the insular feeling in American public about the dropping of the bomb and only thinking it could have come sooner to save lives for the Allies, itself creating conflicting feelings and affecting mental health. A recent exhibition in Barcelona showed the Nazi bombing of Republican parts of Spain leading to millions of refugees crossing over to Europe. Similar situation happened in China and the images may have created America's insular feeling about the bomb dropped on Hiroshima. It is in everyone's interest to know, to comprehend the devastation in all places, the conflicting narratives that were told, and for people as spiritual values teach us to develop the virtuous conduct, the concentration and the wisdom that both the Bible and the Buddhist suttas teach Americans, Europeans and Asians. Something that was lost in the 18th, 19th and 20th centuries.    ...

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The World Trade Organization is about to choose a new director-general to succeed Mr. Azevedo, a career diplomat from Brazil. The two candidates are a former finance minister from Nigeria,  Ms. Okonjo-Iweala supported by the European Union and the trade minister of South Korea, Ms. Yoo Myung-hee, supported by the U.S. Japan supports the Nigerian candidate because of its trade disputes with South Korea. The role of head of WTO is important today because of trade issues between countries particularly the trade issues between China and the U.S., U.S. and other countries. And the sense that the WTO arrangement is not working for many countries in recent years without a level playing field in many industries from improper subsidies. Before the U.S. withdrawal from the World Health Organization not much attention was given by the U.S. to how it had changed after new elections. As a result non profit foundations like the Gates Foundation from the U.S. played a leading part in representation of American interests and China played a leading role leading to the crisis facing WHO today. During the coronavirus pandemic the WHO lacking adequate influence of U.S. or European Union countries was not able to act in a way that met the needs and concerns of these countries with advanced health systems. In the past pandemics were better addressed worldwide when the U.S. and EU played a major role from the beginning because of long experience and technological resources,  a role that was missing in the current pandemic. Ebola and other virus were tackled in Africa only when the U.S. or European countries played a leading and critical role. This role was sorely missed in the current crisis. This is why changes at the World Trade Organization matter. World trade is important for the world economy and can best operate when the concerns of U.S. and European Union about a level playing field and fair competition are met. This level playing field and fair competition also meet the interests of developing countries such as India which are industrializing rapidly and need to protect their own markets from unfair dumping, as well as Indonesia and other parts of Asia, Latin America and Africa that are part of the supply chain for the world economy. ...

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This very exceptional report from the city of Recife in Brazil's northeastern state of Pernambuco, comes from WSJ reporters Johnson and Jelmayer. It is about the physicians Vanessa van der Linden Mota, and Ana van der Linden Mota, her mother, who first alerted health authorites in Pernambuco about the cases of encephaly and the links to the mosquito Zika Virus in Recife, Brazil. From 147 recorded encephaly cases, and babies born with shrunken skulls or calcified brain structure in 2014 in Brazil, the cases reported jumped to 4,180 suspected cases. Estimates of cases by 2020 for such cases run up to 50,000 to 100,000 if the problem is not tackled. The family of the van der lindens come from Dutch-German immigrants settled in northeastern Brazil, a less developed region of the country. The family is unique with five doctors including neuro pediatricians Ana and Vanessa working in public hospitals in Recife , and father Helio a neuro surgeon. The entire state of Pernambuco has a total of 15 neuropediatricians, according to this report. The Ebola Virus emerged in countries such as Sierra Leone and Liberia which suffered from war and neglect of health infrastructure. Here in Pernambuco state, as reporters Johnson and Jelmayer point out, the problem stems from neglect in public health infrastructure, especially sanitation and drinking water for shantytown dwellers and vast majority of poor residents in a city of 3.5 million, typical of developing countries in Latin America and South Asia, where development in some parts of the country have lagged far behind, and where needed public health infrastructure investments have not been made. Lack of dependable drinking water means collecting water in containers that are susceptible to breeding mosquitoes, such as the mosquitoes carrying the Zika Virus. A public debate on the lack of attention by socialist and worker's party led governments to this type of infrastructure and transportation services was already underway in Brazil leading to widespread protests in 2013. A $226 million investment in a soccer stadium in Recife, and similar investments in other smaller cities in the northeast were made under the Worker's Party government. Large investments for the Olympics now come as the economy contracted in 2015, and Brazil is hurt by another boom-bust cycle with the slowdown in China- with fiscal austerity policies, a loss of a third in the value of its currency, and the popularity rating of the newly elected government from the Worker's Party in single digits....

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Berlin's most famous hospital. Half of Germany's Nobel prize winners for medicine and physiology worked at Berlin Charite Hospital. It was setup in 1710, by 1810 it was a medical university, and today a leading world medical centre. Mr. Navalny is being treated here. It is also a centre in the fight against the pandemic.

Here DW.com gives pictures of the hospital over the 300 years of history. It was part of the controversial period in Germany in the thirties and was part of the GDR after 1945. It was part of the fight against the Ebola virus in 2005 and now leads the fight in Germany against the coronavirus, showing how Germans can play a international role that brings dignity to the German people.

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Contrast the slow US vaccine export response with that of India, Russia, EU and China. Only in May 2021 after India's daily Covid cases were close to 400,000 a day did the US make a serious offer of vaccines to other countries in need of assistance. U.S. president Biden says that 80 million vaccine doses would be exported by the end of June 2021. The WSJ says citing Airfinity, a London research firm, as of May 10 more than 333 million doses of vaccine were produced by the US and only 3 million vaccine doses were exported. Contrast that with the European Union which has shipped 111 million doses overseas one third of its total production, Russia which has exported 27 million doses.  India has exported 66 million doses according to the Ministry of External Affairs website as of May 17, 2021. This includes 4 million doses to Brazil, 4 million to Nigeria. Within its own region Bangladesh received 10 million and Sri Lanka 1.2 million doses, Afghanistan 1 million. Mexico received about 1 million doses. In Africa the Democratic Republic of the Congo which has suffered from many epidemics including Ebola virus received 1.7 million doses, Nigeria 4 million doses, Kenya 1 million, Uganda 1 million. Of the 66 million about half of it is a direct grant assistance and Brazil, Mexico, Morocco received all vaccine as grant assistance, 70% of Bangladesh's is grant assistance. The list on the Ministry of External Affairs site of the Government of India shows 95 countries including many of the most struggling nations of Latin America and Africa, bringing hope to countries which are struggling to hold onto hope for a better life beyond the pandemic. Sending help overseas through vaccine supplies is suspended for the moment but will resume in July after India has pulled in all of its pharmaceutical manufacturing industry under a government guided effort to go all out. Never has so much help bringing much needed hope gone to so many countries of the world in the twentieth or twenty first century from a nation that is struggling to meet its own needs. The US in pursuing a US first policy of vaccinating all its citizens has not taken into account the need to bring this evolving vaccine technology into the hands of as many qualified pharmaceutical manufacturers as possible. This in a rapid response to expand manufacturing capabilities to meet world wide demand. The risks of not doing so were not taken on early- the very same way the virus spread in January to March of 2020 can be repeated as people travel around the world particularly for tourism, business family reasons. This risk takes on anew dimension of contagious mutations of the virus which are 50% more- the Indian variant being 50% more contagious by some estimates than the UK variant, which itself was estimated to be 50% more contagious than the original one.  The result a pandemic that stretches out indefinitely unless billions of doses are made in a short timetable to beat the timetable of Nature through the coronavirus. India is doing this for the first time with plans to produce billions of doses by engaging the whole of the Indian pharmaceutical manufacturing industry in the effort in a rapid response so that July to December would see 1.2 billion people vaccinated. The US effort, the European effort is left to the individual effort of pharmaceutical makers in the US and Europe, not a government guided effort to engage the entire pharmaceutical industry of the US and Europe in a rapid response timetable of 2-6 months.  ...

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Germany has shown that low tech contact tracing efforts work- no apps needed, a phone, a desktop computer with a centralized database, and most important the human relations skills of the person doing the calls. The  sensitivity to the situation facing each person being called, being able to talk to the person in the language they speak in a multilingual environment such as California, is shown here. A 40 person team operates in San Francisco consisting of public health officials, clinicians, medical students and librarians. They call the contacts of people with coronavirus, arrange tests, and as needed send packages of food and medicines to hotel rooms or homes. Every call is expected to last 15 minutes but all sorts of questions are handled.  English and Spanish are used. Here one of the persons doing the contact tracing says she does not use apps, just an open source software used in the fight against Ebola. Definitely low tech, no waiting, get going is the message to every city in the world. She says apps software such as what Google and Apple are putting out can tell you whether the person went to some place, but cannot tell you more about that person, cannot tell you about problems the person is having being tested, and how they are having difficulty providing for families. One of the big lessons from Germany and efforts such as this one in San Francisco, and in other places such as Paris, Singapore, Taiwan, is that there is a complex nature to contact tracing that cannot be solved by tech. In fact the best thing to do is to get started immediately, with a phone and a database on a computer, as long as you have a person who has the motivation and skills, empathy with people, a lot can be done. Waiting for apps is a dangerous waste of time is shown by the low tech German experience, and the experience in other places. Most important is starting immediately. The example shown here of working with migrant workers in contact tracing shows in the most vulnerable places it is these human relations skills that count, that no tech app can do. It requires detective skills to find out and get people to share their history of movements and contacts for 14 days . In Singapore crowded dormitories house 300,000 of 1.4 million migrant workers. Singapore using an app also but its use is secondary. Apps don't work in many situations but fail in the most critical situations such as these dormitories and other eccentric or atypical situations such as faced by South Korea with religious groups and gay communities, elderly people in Europe, that generate the worst dangers of spread and need to be cluster isolated quickly. Human contact tracing has a history of being an effective method and was used in China and South Korea during the 2003 SARS epidemic. More countries need to adopt the method used in Asia and in Germany, particularly Britain, the U.S., France and India. It is OK that Britain's NHS and India's national government with Aarogya Setu app have put out their own apps which balance privacy concerns with the need to act immediately and cover the entire country, but the hard slog of human contact tracing teams in each district is indispensable. This is why the former Health minister in Britain calls it Britain's national mission to do this. Speed is key- putting together teams across the country in every district from skilled volunteers or government workers, and pulling together the phone and a centralized database on a computer as basic equipment. The fact that this is easily doable and people with human skills needed can always be recruited as they have been in Germany- from public officials in local government who are less busy in lockdowns, medical students, clinicians, volunteers, people from different professions- makes it inexcusable not to learn from others experience and get going. Just Do It. You want to reopen business, professions, offices and public services- Just Do It, it makes this possible. You want to prevent spread of the virus- Just Do It, it makes this possible. You want to limit damage to the economy and get the recovery going- Just Do It, it makes this possible. People of all shades of opinion can agree on this- its the only thing that works, even when there is a lack of enough proper accurate testing. ...

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The lack of economic opportunities for an increasingly urbanized African younger generation is a major challenge. The median age of 19 makes Africa the world's youngest continent. Megacities are growing up in places such as Lagos and Kinshasha as millions leave subsistence farming to go to cities. Unlike Asia and Latin American countries men and women are coming to shantytowns in cities at a time when Africa is much poorer for a similar level of urbanization that Asian and Latin American nations reached decades earlier. In 1993 this WSJ analysis and graphs show the Asian emerging economies and sub Saharan Africa had similar GDP per capita of $2415, by 2019 this was $4000 for Africa and $12,000 for Asian emerging economies. Latin America was at $10,000 in 1993 and in 2019 was at about $15,000. The gap widened considerably between Asia and African countries. Asian emerging economies increased GDP to 5 time from the same starting point as Africa in 1993, Africa doubled GDP over the period of 25 years to 2019. Latin America started from a much higher point and increased GDP by only 50% over 25 years. Asian economies that performed better over this period did better because of stable even entrenched governments such as in Singapore with Le Kuan Yew and in China with stable successive governments under CPC leadership of prime minister Deng. The difference in Asia was a commitment across all classes and groups to development, a sense of development as a way to make up for the years lost under colonialism of foreign powers in the eighteenth and nineteenth centuries. A sense of correcting historical injustice and wrongs. This is a missing ingredient in the processes unfolding in Latin America and Africa in the last 25 years. ...

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The appreciation of the U.S. dollar and depreciating currencies in Africa in 2015 makes it costlier to import manufactured goods to African countries. Quality Supermarkets in Kampala, Uganda, struggles to fill its shelves with imported packaged foods and manufactured goods. The lack of financing for $30 million in crude supplies leads to the closure of a refinery in Lusaka, Zambia, and long lines at gas stations. The Zambian currency kwacha has depreciated by 17% against the U.S. dollar in 2015. Uganda's currency the shilling, Angola's currency the kwanza, and Nigeria's currency the Naira, all depreciated in 2015. This means larger trade deficits to finance consumer imports or upgrade infrastructure. In Uganda this means delays in upgrades to power lines and transformers. In oil producing countries such as Angola and Nigeria, and oil producers at the early stage such as Uganda and Ghana, there is a double whammy with lower oil prices leading to lower revenues to finance costlier imports. This is likely to slow growth in Africa from about 5% in recent years to 3.7%, according to Capital Economics forecast. Countries in Africa that import oil will see lower import bill for oil, but that benefit eroded by a depreciating currency. South Africa sees benefit of lower oil prices offset by lower revenues from commodity exports of iron ore, and the higher cost of imports with a depreciating currency. ...