RFI interviewed WHO Immunization Expert Group Chairman, Mexican Alejandro Cravioto, about the pandemic in Latin America, the vaccination campaign, and the use of drugs the specialist says have no effect to protect against Covid-19.
This week, the entire planet is listening to what your group is publishing about the results of the study they are due to present on the Chinese vaccines from the Sinovac and Sinopharm firms. Is it known on which day the report will be published or can we already say whether or not emergency use will be allowed?
Alejandro Cravioto The answer is: not yet. The process is underway, both for the part of a World Health Organization emergency authorization for these two vaccines, and for the Strategic Group’s recommendations for each of these products. What we have done for fundamental language reasons is that through our working group we had a series of meetings with the two Chinese companies to assess these vaccines against SARS-CoV-2. What we’re doing there is that the company presents us with its safety data and then efficacy data to us when the clinical trials 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 terms of showing the safety and efficacy of vaccines. Once the emergency use authorization process at WHO is complete, we will meet over the next 48 to 72 hours to make specific recommendations for the use of these vaccines. We understand the crowds, we understand that there are many countries, including mine, that use them, but if we have to follow the established procedure, that is, they must first be licensed for emergency use by the WHO or by a from the regulators, and then we can make recommendations.
To bring our readers to the fore and let them know the importance of this news about Chinese vaccines, the WHO is currently permitting emergency use of the COVID vaccines from Pfizer-BioNTech, Janssen (Johnson & Johnson) and AstraZeneca (and this last case, only those consignments manufactured in collaboration with the South Korean SK BIO and the Serological Institute of India). The inclusion of vaccines in the WHO list is important because the vaccines authorized by the international organization can then be part of the COVAX program for dose distribution to developing countries.
How many vaccines are on the WHO waiting list for studies?
Alejandro Cravioto We are also in contact with the Gamaleya office in Russia, we are looking at their vaccine, Sputnik V. We have also followed the same process as with the Chinese vaccine. We’ve had between three or four meetings with each of the labs, starting with Pfizer and modern, to make sure the information they have is enough to make recommendations.
Do you, like the rest of the people, have the impression that the vaccination plan is progressing more slowly than expected?
Alejandro Cravioto The problem we have is the supply, it’s not so much the vaccination program. Because in most countries, once vaccines arrive, they end up in a person’s arms. The problem is that we don’t have enough vaccine production and some countries have decided to keep all production for internal use and some other countries have accepted that these factories share the product with other countries, especially with Covax, the system of international cooperation so that all 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 workers, which is essential for them to be protected so that they can continue to work and prevent people from dying.
Another global concern is the safety of the COVID-19 vaccine manufactured by AstraZeneca following reports of rare cases of blood clots in the brain. How can we reassure the world’s population on this point?
Alejandro Cravioto First of all, you need to have a detection system that immediately sees that there is a problem and starts studying it. When you see the results, it’s 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 that is already being collected to see if this is also showing in other countries where the vaccine is also used. I know there have been a few cases in France, but there are very few or almost no reports from Spain or Italy. We need to see why this happens because it could be related to other factors associated with the vaccine can cause this kind of symptomatology. Most importantly, first of all, the countries that use the AstraZeneca vaccine have a side effect monitoring system that allows them to detect whether or not this is possible. And the second, that we actually see how many people are presenting the problem, because it could be that someone thinks in numbers that there are 23 cases, but when we see it compared to the millions of people vaccinated, the proportion is much lower. than expected. I believe that decisions should be made with great safety, but also with great care not to affect the use of a vaccine that is highly protective for many countries in the world and is produced in places like India and South Korea. where those vaccines come to Covax so that they can reach other parts of the world. Our concern is to continue to see if the vaccines we use are useful against the “concern” variants. We already have three: the English, the South African and the Brazilian, those are the ones we follow. In the case of the South African, the AstraZeneca vaccine provides a lower level of protection, not against death, but against less serious illnesses.
Undoubtedly, vaccines are the center of media attention in the midst of this pandemic, but it’s also worth a look at the drugs that are being produced that reduce the severity of patients’ symptoms once they pass. race in the search for these drugs? Is it the priority of many pharmaceutical companies now?
Alejandro Cravioto Exactly. Everything we’ve seen is intended to be used for not very serious illnesses such as Remdesivir, among others. Or direct protection such as the use of antibodies that also appear to be ineffective with the variants. What should be taken into account is that we have a range of non-pharmaceutical protection systems such as using a mask, washing our hands, maintaining social distance, which have been proven to work to prevent the transmission of the virus from one individual to another and that we must keep implementing to keep protecting ourselves. Confinements work, but at some point there are many people who have to leave their homes to work, feed their children, to survive and therefore cannot just stay locked in their house without going out and seeing someone. So it has been proven that the non-pharmaceutical protective measures are effective to lead an economically active life, including opening our schools. Everyone must cooperate and unfortunately in some countries this has become a social and political problem in rejecting these measures simply because people are already tired of not being able to lead normal lives.
If you focus on Latin America, you are also concerned that many countries in the region use the drug Ivermectin in patients suffering from Covid-19. The idea is circulating in the region that this drug could help make symptoms so severe that the disease is only starting to manifest, a theory that has been completely rejected by the scientific community. How can you stop this hoax [noticia falsa]
Alejandro Cravioto It’s a stubborn thing to be recommended [la Ivermectina] and above all that they are recommended at a very high political level. If a country’s president or prime minister recommends a drug that doesn’t work, that’s a crime. That doesn’t help us at all. The same thing happened with chloroquine, also with ivermectin, and with other things that are still prescribed and used despite the fact that it has been clearly stated in all Latin American countries that it does not work and is of no use. It is a totally unnecessary expense that does not bring any benefit to the patients. The same thing would be, as my grandmother said, applying camphor alcohol rubs, which were useless but caught the patient’s attention. People believe they are protected by taking these things which is a real mistake. It represents a cost to health, because this drug, although cheap, comes at a cost, and it has a high cost to resource-constrained people. The Pan American Health Organization, technical groups, consultants in most of the 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’s associated with other types of things can help, but all we have so far is that it’s not a drug that helps us manage the symptoms it causes control or reduce. COVID-19.
What is the chair of the WHO immunization expert group most concerned about right now?
Alejandro Cravioto Two things: the first is to solve the AstraZeneca vaccine problem that is so important to 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 at everyone’s level. groups and with the participation of the manufacturing company and the Oxford researchers who developed this vaccine. The second, frankly, is the race time between vaccination and epidemic control. I think everyone is very desperate after a year, but now is not the time to drop our guard and the vaccines are working. They are still distributed in the poorest countries. We must be patient, protect our health workers and then our elders.
Of all the sentences in the publications I’ve read 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 All the way. That’s the recommendation we have. All approved vaccines help prevent serious illness and death, which is what worries us now. Some of us are already finding themselves reducing transmission. But for now, we are still fundamentally concerned about people not getting sick.