RFI interviewed the president of the WHO Immunization Expert Group, the Mexican Alejandro Cravioto, about the pandemic in Latin America, the vaccination campaign and the use of drugs that, according to the specialist, have no effect to protect against Covid -19.
This week the whole planet is attentive to what your group publishes on the results of the study that they must present on the Chinese vaccines of the Sinovac and Sinopharm firms. Is it known what day the report will be published or can we already say whether or not its emergency use will be authorized?
Alejandro Cravioto The answer is not yet. The process is underway both for the part of an emergency authorization by the World Health Organization for these two vaccines, and for the recommendations made by the strategic group for any of these products. What we have done for reasons fundamentally of language, has been to have a sequence of meetings with the two Chinese companies through our working group to review these vaccines against SARS-CoV-2. What we do there is that the company presents its data to us first on safety and then on efficacy as the clinical studies are completed. In the case of Chinese vaccines, they have results in a number of countries where the vaccines have been tested in randomized controlled clinical trials with a sufficient number of subjects for the results to be valid in the sense of seeing the safety and efficacy of vaccines. Once the authorization process for emergency use at WHO is complete, then in the next 48 to 72 hours, we will come together to make specific recommendations for the use of these vaccines. We understand the rush, we understand that there are many countries, including mine, that are using them, but if we have to follow the established procedure, that is, first they have to have an emergency use authorization by the WHO or by one of the regulatory agencies , and then we can already issue recommendations.
To put our readers in the background and to let them know the importance of this news about Chinese vaccines, for now, WHO authorizes the emergency use of the COVID vaccines from Pfizer-BioNTech, Janssen (Johnson & Johnson) and AstraZeneca this last case, only the consignments manufactured in association with the South Korean SK BIO and the Serological Institute of India). The inclusion of vaccines in the WHO list is important because those authorized by the international organization can then be part of the COVAX program of dose distribution to developing countries.
How many vaccines are on the WHO waiting list for studies?
Alejandro Cravioto We also have contact with the Gamaleya agency in Russia, we are looking at their vaccine, Sputnik V. We have also followed the same process as with the vaccine from China. We have had between three or four meetings with each of the laboratories, starting with Pfizer and modern, in order to be sure that the information they have is sufficient to be able to give recommendations.
Do you have the impression like the rest of the people that the vaccination plan is slower than expected?
Alejandro Cravioto The problem we have is one of supply, it is not so much the vaccination program. Because in most countries, the moment vaccines arrive, they go into the arms of some individual. The problem is that we do not have enough vaccine production and some countries have decided to keep all the production for internal use and some other countries have accepted that these factories share the product with other countries, especially with Covax, which is the system of international cooperation so that all the countries of the world, regardless of their economic level, have access to these vaccines, at least to cover 20% of their population, which would be health personnel, which is essential that they be protected so that they can continue working and preventing people from dying.
Another global issue is the safety of the COVID-19 vaccine manufactured by AstraZeneca following reports of rare cases of blood clots in the brain. How to reassure the world population on this issue?
Alejandro Cravioto First of all, you have to have a detection system that immediately sees that there is a problem and begins to study it. If you see the results, it is in Northern Europe, where there have been cases, Germany, Norway, Sweden, Finland. We had a meeting this sunday [4 de abril] With the whole WHO group, it became clear that we need more information from around the world and that is already being collected to see if this is seen in other countries where the vaccine is also being used. I know that in France there have been some cases, but there have been very few or hardly any reported from Spain or Italy. We have to see why this is occurring, because it may be related to other factors that associated with the vaccine may be giving this type of symptomatology. The important thing is, first, that the countries that are using the AstraZeneca vaccine have a surveillance system for adverse effects that allows them to detect whether or not this is possible. And the second, that we really see how many individuals are presenting the problem, because it may be that by numbers someone thinks that 23 cases are many, but if we see it compared to the millions of people vaccinated, then the proportion is much lower than what expected. I believe that decisions have to be made with great security, but also with great care so as not to affect the use of a vaccine that is being highly protective for many countries in the world and is being produced in places like India and South Korea. where those vaccines are coming to Covax so they can reach other parts of the world. Our concern is to continue to see if the vaccines we have in use are useful against the “concern” variants. We already have three: the English, the South African and the Brazilian, which are the ones we are following. In the case of the South African, the AstraZeneca vaccine has a lower level of protection, not for death, but for less severe disease.
Vaccines are undoubtedly the center of media attention in the midst of this pandemic, but it is also worthwhile to look at the drugs that are being manufactured and that will reduce the severity of patients’ symptoms once they are over. vaccinated How advanced is the race in the search for these drugs? Is it the priority of many pharmaceutical companies now?
Alejandro Cravioto Exactly. Everything we have seen has been to be used for not very severe disease such as Remdesivir among others. Or a direct protection such as the use of antibodies that, with the variants, does not seem to be effective either. What must be taken into account is that we have a series of non-pharmaceutical protection systems, such as using a mask, washing our hands, maintaining social distancing, which has been proven to work to reduce the transmission of the virus from an individual to another and that we need to continue putting into practice in order to continue protecting ourselves. Confinements work, but at any given time there are many people who have to leave their homes to work, to feed their children, in order to survive and therefore cannot simply stay locked in their homes without going out and seeing anyone. So the non-pharmaceutical protection measures have been proven to be effective in order to have an economically active life, to open our schools, among other things. Everyone has to cooperate and unfortunately in some countries this has become a social and political problem of rejection of these measures, simply because people are already tired of not being able to have a normal life.
Focusing on Latin America, you are also concerned that in many countries in the region a drug called Ivermectin is being used in patients suffering from Covid-19. In the region, the idea has circulated that this drug can help make the symptoms not so serious that the disease is just beginning to show itself, a theory that has been totally discarded by the scientific community. How can you stop this hoax [noticia falsa]?
Alejandro Cravioto It has been a stubborn thing that is recommended [la Ivermectina] and above all that they are recommended at a very high political level. When the president or prime minister of a country recommends a medicine that does not work, it is a criminal act. That doesn’t help us at all. The same happened with chloroquine, also with ivermectin and with other things that are still prescribed and used despite the fact that it has been clearly said in all Latin American countries that it does not work and is useless. It is a totally unnecessary expense, which does not offer patients any benefit of any kind. It would be the same, as my grandmother used to say, putting on camphor alcohol rubs, which were useless, but attracted the patient’s attention. People believe that by taking these things they are protected, which is a real mistake. It means an expense in health, because this medicine, even if it is cheap, does have a cost and it has a high cost for people who have few resources. The Pan American Health Organization, technical groups, advisers in most Latin American countries have been very clear that this does not work and does not work. Ivermectin can be used in some controlled clinical trials to see if associated with other types of things can help, but all we have so far is that it is not a drug that helps us to control or reduce the symptoms caused by it. virus that produces Covid-19.
What worries the chairman of the WHO Immunization Expert Group the most today?
Alejandro Cravioto Two things: The first is to solve the problem of the AstraZeneca vaccine that is so important to Covax and we need to clearly see the data and make a decision to see how this vaccine will be used or will continue to be used in the field from all advisory groups and with the participation of the manufacturing company and the Oxford researchers who have developed this vaccine. The second is honestly, the race time between vaccination and control of the epidemic. I think after a year everyone is very desperate, but this is not the time to lower our guard and the vaccines are working. They are being distributed even in the poorest countries. We need to be patient, protect our health personnel and then our elders.
Of all the phrases in the publications that I have read during these days, I prefer one that belongs to the epidemiologist Carlos Álvarez, who says “The best vaccine is the one that reaches my arm first.”
Alejandro Cravioto Totally. That is the recommendation we have. All approved vaccines are helpful in preventing severe illness and death, which is what we are concerned about right now. Some of us are already noticing that they decrease the transmission. But for now, we’re still fundamentally concerned that people don’t get sick.