RFI interviewed the president of the WHO Expert Group on Immunization, 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 paying attention to what his group publishes about the results of the study they are to present on the Chinese vaccines from the firms Sinovac and Sinopharm. Is it known on 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 no yet. The process is progressing 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 primarily language reasons, has been to have a sequence of meetings with the two Chinese companies through our working group to review these SARS-CoV-2 vaccines. What we do there is that the company will present us with its data 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 vaccines have been tested in randomized controlled trials with a sufficient number of subjects for the results to be valid in terms of safety and efficacy. of vaccines. Once the process of authorization for emergency use at the WHO has been completed, 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, they must first have an emergency use permit by the WHO or by any of the regulatory agencies, and then we can issue recommendations.
To put our readers in the forefront and to let them know the importance of this news about Chinese vaccines, for now, the WHO authorizes the emergency use of Pfizer-BioNTech, Janssen (Johnson & Johnson) and AstraZeneca (in the latter case, only remittances 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 body can then be part of the COVAX dose distribution program in developing countries.
How many vaccines are on the WHO waiting list for studies?
Alejandro Cravioto We also have contact with the Russian agency Gamaleya, we are seeing their vaccine, Sputnik V. We have also followed the same process as with the Chinese vaccine. We’ve had between three and four meetings with each of the labs, starting with Pfizer and modern, to be able to be sure the information they have is enough to be able to give recommendations.
Do you feel like the rest of the people that the vaccination plan is going slower than expected?
Alejandro Cravioto The problem we have is supply, not so much in the vaccination program. Because in most countries, by the time the 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 domestic 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 countries in 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 be protected so that it can continue to function and prevent people from dying.
Another global issue is the safety of the anti-COVID-19 vaccine manufactured by AstraZeneca following reports of exceptional cases of blood clots in the brain. How to reassure the world’s population on this issue?
Alejandro Cravioto First of all you need to have a detection system that immediately sees that there is a problem and starts studying 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 entire WHO group, it became clear that we need more information from around the world and this is already being gathered 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 almost unreported cases in Spain or Italy. We need 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 countries that are using the AstraZeneca vaccine have an adverse event monitoring system that allows them to detect whether this is possible or not. 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 look at it compared to the millions of people vaccinated, because then the proportion is much lower than than expected. I believe that decisions must be made very safely, but also very carefully so as not to affect the use of a vaccine that is being highly protected for many countries in the world and is being produced in places like India and South Korea where these vaccines are coming to COVAX so they can reach other parts of the world. What worries us is to keep seeing if the vaccines we have in use are useful against the “concern” variants. We already have three: English, South African and 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 illness.
Vaccines are certainly 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 have occurred. vaccinated How advanced is the career in the search for these drugs? Is it the priority of many pharmacists now?
Alejandro Cravioto Exactly. All we have seen has been to be used for not very severe disease like Remdesivir among others. Or a direct protection such as the use of antibodies which, with the variants, does not seem to be effective either. What needs to be taken into account is that we have a number of non-pharmaceutical protection systems, such as wearing a mask, washing our hands, maintaining a social distance, which has been proven to work to reduce the transmission of viruses. ‘one individual to another and that we need to continue to put into practice in order to continue to protect ourselves. Confinements serve but at some point there are a lot of people who have to leave their homes to work, to feed their children, to be able to survive and therefore they can’t just keep them locked in their homes without going out and seeing anyone. . Then non-pharmaceutical protection measures have been proven to be effective in order to have an economically active life, to be able 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 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. The idea has circulated in the region that this drug can help make the symptoms less severe. The disease has recently begun to show itself, a theory that has been completely ruled out by the scientific community. How can you stop this bullshit [noticia falsa]?
Alejandro Cravioto It’s been a stubborn thing to recommend [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 serve, it is a criminal act. That doesn’t help us at all. The same happened with chloroquine, also with Ivermectin and other things that are still prescribed and used, although 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. The same would be, as my grandmother used to say, putting on camphorated alcohol scrubs, which were useless, but attracted the patient’s attention. People believe that to take these things is protected, which is a real mistake. It means an expense in health, because this medicine, although cheap, does have a cost and 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 it can be used in combination with other types of things, but all we have so far is that it is not a medicine that serves us to control or reduce the symptoms caused by virus that produces Covid-19.
What worries the chairman of the WHO Group of Experts on Immunization today?
Alejandro Cravioto Two things: The first is to solve the problem of the AstraZeneca vaccine that is so important for COVAX and we need to see the data clearly and make a decision to see how this vaccine will be used or will continue to be used in the field of all advisory groups and with the participation of the production company and Oxford researchers who have developed this vaccine. The second is honestly, the race time between vaccination and controlling the epidemic. I think after a year everyone is very desperate, but this is not the time to lower your guard and the vaccines are working. They are still being distributed in the poorest countries. We need to have patience, protect our health staff and then our seniors.
Of all the sentences in the posts I’ve read during these days, I’m left with one that belongs to epidemiologist Carlos Alvarez, who says “The best vaccine is the one that gets to my arm first”.
Alejandro Cravioto Totally. This is the recommendation we have. All approved vaccines are helpful in preventing severe illness and death, which is what worries us right now. Some we are already noticing are slowing down transmission. But for now we are still fundamentally concerned that people are not getting sick.