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By preventing serious illness in patients two pills for coronavirus from Pfizer and Merck can change the course of this pandemic. Pfizer will give a royalty free license to Medicines Patent Pool, an organization backed by the United Nations for its coronavirus pill. Merck has also given a royalty free license to Medicines Patent Pool for it pill. This organization will then grant a license for the manufacture of the coronavirus pills to poor developing countries. India is included in the list of countries yet China, Russia and Brazil are excluded for the Pfizer license.  Merck has given Indian generics manufacturers approval to make the pill. This will provide supplies of the pill to 105 developing countries, South Africa will also make the pill to provide it at $10 a course in Africa. Pfizer will begin manufacturing of large quantities in 2022 with 50 million planned for 2022 and 21 million in the first half of 2022. Pfizer pill will be made available in 95 countries. The Merck pill is called Molnupiravir. Pfizer pill is called Paxlovid with 30 pills taken over the course of 5 days. Pfizer pill is effective in studies when given to people who had not been vaccinated. It has to be given within 3-4 days of getting coronavirus confirmed through a test which makes testing critical for its use. ...

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Moderna has made the initial batches of doses of the vaccine for the variant of coronavirus including South African variant, and shipped these to the National Institutes of Health in the US. If the test results are positive the vaccine for variant could be given authorization by the third quarter of 2021. It is becoming crucial to stay ahead of variants developing from the coronavirus and pharmaceutical companies Pfizer, J&J, Astra Zeneca are working on the technology to tackle this.

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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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Stephanie Nolan's reports from Africa provide the few glimpses one can get today of the situation in Africa where variants are growing as a result of lack of vaccines (vaccine inequality) and the faltering vaccination drive, shortage of medicine and food supplies. Her report from South Africa showed how healthworkers and scientists in South Africa are working hard on the frontlines. This one from Zambia looks at the vaccination centers and vaccination workers as vaccination drives falter. The African continent with 1.4 billion people received 404 million doses. Today only 7% of the population is vaccinated in Zambia and the rest of Africa. People in Zambia do not have car transport so they have to walk 3-6 kilometres to get to a vaccination center, when they turn up at a center and it is out of vaccines they stop coming. Other problems are the social media accounts that show the vaccination drives as harmful to people, or CNN and other news that talk about blood clots that when carefully understood affect a tiny fraction of people. There are other issues also. Ida Musonda, a nurse in a clinic near Lusaka says after not many people turned up that she should go to markets and churches, but says there is no fuel for the vehicle to get clinic workers there. Bernadette Kawango is shown with her children. She works at an auto parts store and lives in a low income neighborhood in the edge of Lusaka. She ignores all the social media accounts that scare people from vaccines, yet she says she worries more about cholera, TB and malaria, and also HIV, AIDS. And she does not know anybody diagnosed with coronavirus.  The result is that there is vaccine shortage resulting in a kind of vaccine indifference (why walk miles to a center if it may not have vaccines), compounded by other problems such as the other diseases that also pose a threat in Africa, and the low incomes in a shrinking economy. And with about 8% vaccinated in Africa, the problem of variants can only be tackled by consistent and not erratic supply of vaccines. ...

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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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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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Addressing the UN General Assembly in a virtual setting Mr. Trump tells delegates that China should be held accountable for certain actions in letting the coronavirus pandemic spread. He included the denial by China of human to human transmission very early before Feb-March, and its allowing Chinese flights to go overseas when it had completely banned flights domestically. He said flights were allowed to leave China after the virus spread from Wuhan even after Mr. Trump banned flights from China to the U.S. This spread the virus from China to Europe and to America.  Mr. Trump says the WHO is controlled by China. And this happened after foundations such as the Bill and Melinda Gates foundation and other foundations partly replaced the strong role played by the U.S. government at the world health agency during the post war period maintaining strong U.S. and European oversight in the earlier period. The lack of cooperation by China to let American experts into Wuhan immediately in January played a role in delaying the U.S. getting a first hand look at the coronavirus at the epicentre. Instead a 2-3 week delay left the U.S. Europe and India unprepared for the speed and havoc caused.  The only way to tackle the coronavirus was with speed and that speedy response was doubly needed because Europe and the U.S. had no recent experience with epidemics. Even India and rest of Asia, Latin America, Africa have no experience with this type of transmission and spread making time absolutely critical.  This speed was affected because China and the WHO acted as stumbling blocks in this view of what happened. The result was that in past pandemics were fought together, this pandemic was fought on a country by country basis, a bad precedent. ...

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The full text of the letter is given here. In this letter the U.S. sets out some important facts about events that happened during the coronavirus crisis during the crucial 4 month period from December 2019 to March 2020. Every week lost in this time due to reasons of a lack of transparency, openness meant hundreds of thousands of people more infected and tens of thousands of deaths worldwide. There are questions of transparency, of openness and this raises questions about the manner in which the World Health Assembly operates with hundreds of small countries in Africa and Asia having votes equal to that of the U.S., India, Brazil, Mexico with votes taken of over 200 countries. The entire election process can now be seen as questionable, when over a billion people in one country alone such as India or hundreds of millions in Brazil and Mexico would have to bear the consequences of poor decisions made by small countries that can be swayed in one direction or another based on political bias and other considerations that have nothing to do with global health.  At the conclusion of the letter by the U.S. to the current WHO shaped by a controversial election in 2017 the following is stated about the standards set by Gro Harlem Brundtland and which helped the world prevent the SARS crisis which originated in China in 2003 from spreading to the large countries of the world India, Brazil, Mexico, and other such countries in Asia and Africa, Latin America, and the U.S. European Union. "In 2003, in response to the outbreak of the Severe Acute Respiratory Syndrome (SARS) in China, Director-General Harlem Brundtland boldly declared the World Health Organization’s first emergency travel advisory in 55 years, recommending against travel to and from the disease epicenter in southern China. She also did not hesitate to criticize China for endangering global health by attempting to cover up the outbreak through its usual playbook of arresting whistleblowers and censoring media. Many lives could have been saved had you followed Dr. Brundtland’s example." Even this does not come to grips with the flawed way in which the election of WHO head is done. It can no longer be relied on when there is the danger that lack of transparency can emerge in the WHO leadership itself because of a flawed process. It risks endangering the lives and livelihoods of hundreds of millions in countries such as India, Brazil, Mexico, as well as in the relatively small countries of Africa and Latin America where even basic water supplies are at risk but which could tilt elections at the World Health Assembly. Consider that a cyclone just hit the Indian state of West Bengal and Bangladesh on May 20 just as the coronavirus pandemic is spreading. That this region of 1.5 billion people had just 2 votes out of over 200 cast at the World Health Assembly in 2017 shocking. And even these votes cast based on old geopolitical considerations not how good the candidate is, and how good the country he is coming from is in terms of its record  on public health. The irony here is that private foundations in the advanced countries in the U.S. and Europe some of whom are major donors to WHO did not think that more experienced candidates in their own countries with a better record of public health such as in France or Germany are better qualified, in a flawed NGO support mentality left from the Clinton years. Basically the people in these large countries such as India, Brazil, Mexico were disenfranchised, when the austerity policies were consuming the European Union, and the U.S. had just elected a new administration itself groping for ways to reverse years of neglect of public services and infrastructure priorities. They would trust good leaders no matter where they come from, who have a record of transparency, leadership, and all the values we cherish together no matter where we come from. ...

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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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Amazon expands during the pandemic when retail on line delivery has helped people reduce trips to the grocery or retail stores. Amazon hired 427,000 people to expand its workforce to 1.2 million people by November 2020, 9 months into the pandemic. Almost doubling the employee workforce. These workers are mostly at warehouses, with some software engineers and hardware specialists. This includes hiring in India and Italy and is worldwide hiring. This does not include 100,000 temporary workers for the holidays, and 500,000 delivery drivers working for contractors.  Only hiring of 230,000 people by Walmart about 2 decades a ago in one year comes close. Walmart hired 180,000 people during the pandemic. Walmart has 2.2 million employees. With the expansion underway Amazon looks to become the largest private employer in the world in 2 years, say experts.  Amazon pay is $15 an hour after an increase of $2 recently. Its coronavirus safety practices have been upgraded after early criticism in April and May. Recent expansion in Italy and in India are also part of worldwide expansion after Walmart has pulled back from its worldwide expansion. This also shows how quickly major aspects of life are changing during the pandemic as some companies in online business are becoming more prominent than others. Target and Walmart have also increased in size. Best Buy has changed its focus with its conversion into a company that leads with personal service in online plus store hybrid retail and a focus on seniors and older people for healthcare service and product delivery. Companies are changing the way they run or getting a new life in remaking their business. This is also a time when other aspects of business such as social media are becoming evident. Subtle aspects such as reports of higher rates of mental depression through use of social media platforms. There is also the awareness that information technology companies in Silicon Valley generate most of their money in advertising and this advertising of $100 billion is only a small fraction of the $12 trillion U.S. economy. Should Silicon Valley based in California decide priorities on where capital allocation should go through the part it plays in moving startups based less on America's priorities than other considerations. Healthcare, education, cities, and infrastructure have not received funding they need and capital allocation by financial markets has failed the American people, as it has failed in Europe and other parts of the world for similar reasons. This has hit hard communities and people across the U.S. and Europe and also in Latin America, Africa and Asia, with the loss of manufacturing to China and other countries from the U.S. India and Europe. ...

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How will posterity view Angela Merkel. As she ends a fourth term this BBC News report says it will remain a contested legacy. Much of what went right has already been written. A woman, a pragmatic scientist who hewed to the center not just as a scientist but with a knack for politics. Much of her early period in office was one in which she had to tackle the eurozone crisis. The euro's weakness had its roots in the way Mr Kohl allowed eurozone membership for countries such as Greece without adequate entry requirements. Some of the other problems were also left behind by an overzealous mentor Helmut Kohl who pushed for German reunification that never really happened in terms of bringing all east Germans into the idea of the Federal Republic. These problems in a neglected eastern part of Germany around Dresden were never tackled by Merkel. They were social issues that Merkel's pragmatic thinking failed to grasp. Letting in migrants from Arab and African countries was a move that Merkel made without realizing the full implications. This policy was reversed but led to the emergence of extreme right wing sentiment in parts of the country. It is left to a future German leader to tackle the social and economic disparities that affect Germany today. As time passes people reflect and a more careful view prevails. Dr Rudiger Schmitt-Beck reflects this when he says that the Merkel years were about  a bizarre mix of modernization and backwardness. Merkel rejected nuclear energy after the events at Fukushima nuclear plant in Japan. As a scientist she was able to tackle such issues. Yet on the major social issues of the day Prof. Schmitt-Beck of the University of Mannheim, says she left Germany "grotesquely behind"- on child care, climate policy, digitization, infrastructure building, on demographic change. These are the issues that the Social Democrats and the Greens are standing up for today. Ironically Merkel may be remembered more for something that is not even mentioned in this BBC report. This is the European solidarity shown by action to financially support all EU countries including Italy with EU funding during the coronavirus pandemic.  This may be her biggest achievement because it will be lasting. Without it Europe would not be the better place it is today, resilient in the face of the pandemic.  Seen from outside Merkel will be seen as a German leader who failed to see the potential for India and other Asian countries with almost twice the population of China. Fascinated with 13 visits to China she studied Chinese history, politics and economics, says the WSJ. And did too little to balance Germany's close business and trade ties with China, with efforts in India and other countries. Seen from America as pointed out in the WSJ front page on September 23, Merkel made no effort to rebuild US relations with the Biden administration after the tumultuous period under presidents Obama with spying on her phone and with Mr. Trump over the EU's participation in NATO defense. She seemed resigned to a view that America had seen her best years, a belief that today does not exist anywhere in America. US president Biden's first phone call to Merkel was put off for a few days says the WSJ, and Merkel continued to build close ties with China, ignoring the fact that this was a new administration closer to that of presidents FDR and Harry Truman who did so much for Germany. And a president very different than any of Biden's five predecessors. ...