Covid-19: Roadmaps and Vaccines

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


The consequences of Covid-19 stretch far beyond illness and death. In this blog I will look at some of these, but I begin with a personal note. On Monday we went to the James Paget Hospital,1 which is about 45 km away from our home. I require minor, elective surgery to deal with an umbilical hernia. The National Health Service (NHS) assessed my situation and put me on the list. This trip was a ‘pre-operative assessment’ which involved being assessed by two sets of nurses, all very straight forward. At least it is now. The surgery was scheduled for the end of January but had to be delayed because of a surge in Covid-19 cases and admissions.

The hospital corridors were quiet, a notice on the front door says: ‘No visitors allowed’! All patients and staff must wear surgical masks. I had to visit two offices, but it took next to no time. The nurses say they have a sense they are over the worst of this surge. Make no mistake there are still people being admitted. On 22nd February, the local news reported four deaths at the hospital the previous day. The reality is many patients have put off attending hospital because ‘they do not want to be a bother to the NHS’ or they fear entering health facilities. There will be a huge backlog of people needing attention, and data suggests the excess mortality of the past year is due not only to Covid-19. In January 2021, Covid-19 was the main cause of death in the USA, with an average of more than 3,000 deaths per day. Heart disease is typically the number one cause of death, followed by cancer.

Back at the James Paget, a Covid-19 testing tent is set up outside the hospital. On this coming Saturday I have to be tested there, then isolate completely for three days. This means not seeing anyone other than the household, and not leaving the house or garden. I am also checking the availability of vaccines. Although the NHS is following a procedure, with nine priority groups (my cohort have not been called yet), people can check availability online and book if there are spaces. My half-sister and brother-in-law (in their nineties) and their daughter (about my age) have received their first doses. My sister, a head teacher at a primary school, has just received her first vaccination in London, and was offered a choice between Pfizer and AstraZeneca. Using the government website, I can find spots, but they are miles away.

The Numbers

Globally, as of 24th February there have been 112,158,348 cases and 2,486,405 deaths, with the US leading the pack with over 28 million cases and over 500,000 deaths. The next three countries are India, Brazil and Russia, while the UK is fourth with over four million cases and 121,536 deaths.2

Every evening the newsreaders on the main channels in the UK give the latest statistics: the number of recorded new cases; the number of hospitalisations; and the deaths of those who had a positive Covid-19 death in the last 28 days. A new figure has been added: the number of people who have received the first dose of a vaccine. Finally a figure we can be glad to see rising.

There are movements in the right direction. In the UK specifically,3 new cases peaked on 8th January at 68,053, on 22nd February the 7 day average was 11,187. The number of new deaths peaked at 1,725 on 27th January and the 7 day average on 22nd February was 480 with just 177 deaths on that day. The number of patients admitted to hospital peaked at 4,576 on 12th January (the easing of lockdown for Christmas celebration coming to haunt the nation, right on cue), on the 15th February it stood at 1,492. The number of first dose vaccines administered was 17,723,840 and 624,325 people had received the second dose. This is a remarkable achievement.

A similar picture (except for vaccinations) can be seen across the world. There are a few countries where numbers are climbing significantly. The Our World in Data map shows a week on week change of confirmed Covid-19 deaths in February.4 These had climbed by over 25% in Cameroon, Congo, Mauritania, Mali, Côte d’Ivoire, Ethiopia, Kenya, Uganda, Somalia and Botswana in Africa.5 Elsewhere there have been significant increases in Iraq, Oman, the Philippines and in Europe; Norway, Moldova and North Macedonia. In most countries the rates are falling, for example in Eswatini it fell by 59%, one of the highest falls in the world, and in South Africa the fall was 34.9%.

Why are the rates so different? This conundrum is addressed by Siddhartha Mukherjee in an excellent article in the New Yorker. In summary: there is a great deal that we do not know. Mukherjee goes through a number of explanations from social to biological but ends by saying

‘the pandemic’s most perplexing feature may turn out to be the epidemiological version of that mystery on the Orient Express: there’s no one culprit but many. With respect to the raw numbers, underreporting is an enormous problem; differences in age distribution, too, make a very deep cut, and perhaps the models must further calibrate their weightings here. Plainly, certain countries have benefitted from the strength of their public-health systems, fortified by a vigorous government response. (Our country (the USA) has suffered grievously from corresponding weaknesses.) In New Zealand, raising the drawbridges and stringently enforcing quarantines made all the difference. But to come to grips with the larger global pattern we have to look at a great many contributing factors—some cutting deeper than others, but all deserving attention’.6

The issue of under reporting was addressed in a recent BBC report. Only eight African countries have a compulsory death register system, by contrast, in Europe only Albania and Monaco don’t have such a register. It is, with the death data, possible to calculate excess deaths. Data for South Africa is reproduced below.7 It should be noted that this type of data is routinely available in developed countries and the Our World in Data website has this easily accessible.

Of course, there are still those who deny the existence of Covid-19 and, as worryingly, are opposed to vaccination. Tanzanian president John Magufuli is one such denier. He declared the country coronavirus-free last year and the government, against WHO advice and scientific consensus, rejects mask-wearing and social distancing.

‘Mr Magufuli has also warned that Covid-19 vaccines could be harmful and has encouraged the use of unproven remedies such as steam inhalers and herbal medicine. “Vaccines are not good. If they were, then the white man would have brought vaccines for HIV/AIDS,” Mr Magufuli said last month. However, he has since acknowledged that Tanzania is being hit by coronavirus after a high-profile politician died of the virus’.8

Chart showing weekly deaths from all causes in South Africa, 29 Dec 2019 to 13 Feb 2021

South Africa Weekly Deaths from All Causes 1+ years: 29 Dec 2019 – 13 Feb 2021

Rationing and Vaccines

There is not enough healthcare to provide everyone with everything. Choices must be made and the question is by whom. This is a reality and is a constant source of tension. It was highlighted in the UK and Europe during the first wave of the pandemic and, although there were more resources during the second, it still was a consideration. If there are 15 ventilators and 25 patients who need them then who has priority. These are big questions faced by healthcare providers, especially those in the public sector. I find it hard to have conversations on this, too often it becomes heated with economic pragmatism placed in opposition to human rights and ethics.

I was delighted to come across an excellent, short article addressing this, and quote it at length.9 Written by nephrologists (kidney specialists), they note:

“the circumstances of resource scarcity highlighted by COVID-19 are familiar to nephrologists in LMICs .. faced with the epidemic of chronic kidney disease, which claims more lives each year than COVID-19 likely will, although less acutely. With limited availability of kidney replacement therapy (KRT; that is, dialysis and transplantation), difficult moral and ethical decisions regarding who should be prioritized for access must be made regularly…

Rationing of scarce health-care resources is distressing. Clinicians therefore require clear guidance, which should be developed systematically and transparently through multi-stakeholder engagement. Rationing is seldom required in high-income settings but is often necessary in low-income settings. Global solidarity and health system strengthening are required to reduce the need for rationing. … The COVID-19 pandemic … has forced planning and/or the implementation of health-care rationing almost universally.

Rationing has always carried negative connotations and, until the current crisis, its mention would have at least raised some eyebrows, if not invited outright condemnation by members of civil society and many health-care workers. However, the need to potentially restrict the allocation of health-care resources in face of the relentless onslaught of COVID-19 has been widely accepted as a required response to the pandemic. The matter-of-fact development of recommendations for prioritized triaging of critically ill patients based on ethical principles gained rapid acceptance…. this situation reflects the everyday reality of the majority of the world’s population, who live in low- and middle-income countries (LMICs)10 … An implicit global double standard has long upheld that rationing was unacceptable for HICs but was tolerable for LMICs.”

The experience in Italy is instructive. Triage guidelines had to be developed for health-care workers, and to introduce some objectivity and transparency in decision-making. The guidelines were based on a utilitarian approach to distributive justice, which aimed to maximize benefit (that is, lives saved or life-years saved) while treating patients with equal needs equally. Mortality, age and comorbidities were the de facto main determinants restricting access to ICUs.”

The article, all of which is worth a careful read goes on to discuss the situation in Africa and then notes

“An ethical framework for the allocation of scarce health-care resources, especially in pandemic emergency situations, should be developed between nations, led by the WHO. African nations and other LIMCs must also do their part and ensure that they become more self-reliant for critical goods and services by promoting and supporting local investment”.

Vaccines are a scarce resource and are probably the only way out of the lockdown. The question of who gets what and when is increasingly a debate, and potentially, this is well covered by Priti Patnaik from Geneva Health Files.11 Two paragraphs from the last issue provide a teaser:

“‘Held to ransom’: Pfizer demands governments gamble with state assets to secure vaccine deal: The Bureau of Investigative Journalism”


“Officials from Argentina and the other Latin American country, which cannot be named as it has signed a confidentiality agreement with Pfizer, said the company’s negotiators demanded additional indemnity against any civil claims citizens might file if they experienced adverse effects after being inoculated.”

The Bloomberg vaccine tracker shows that Israel leads the world in the administration of vaccines followed by the Seychelles and the United Arab Emirates (UAE). As of yesterday, the UK had delivered 19 million doses giving a coverage of 28 doses per 100 people. The USA has delivered 65 million doses at 19.59 per 100 people. Apart from Chile, every other country in the world has given fewer than 10 doses per 100 people, there is a long way to go.

Vaccination is crucial and forms an important part of the route map revealed by Boris Johnson on 22nd February. This spells out how the English nation will ease and finally lift restrictions and will be ‘driven by data not dates’. It seems sensible, provided he does follow it.12 Scotland, Wales and Northern Ireland will have their own paths to the end of lockdown.


The discovery phase of the pandemic will soon be over. That is not to say scientists will stop working, improving the treatments and vaccines we have, and making important new breakthroughs. Of course, this will continue. The medical phase is in full swing with millions of patients being treated and hundreds of millions being vaccinated. Here, the challenge is to ensure the people who need to be prioritised actually get the vaccinations. I think we might then need to ask if everybody does need it? I don’t know, and I am not seeing any discussion of this. The next stage is rebuilding our societies: giving people back their lives, ensuring they have basic needs and asking what more is needed.

Thank you for reading, reposting and providing comments. What I write is public domain so please share, forward and disseminate. My contact is:

  1. Sir James Paget, 1814 – 1899, was born nearby in Great Yarmouth. He was known as the father of British pathology, as a scientist, and for being an early supporter of women becoming doctors.
  2. Johns Hopkins Coronavirus Resource Centre
  3. accessed 23rd February 2021
  5. It must be remembered this is from a low base.
  6. Siddhartha Mukherjee, ‘Why Does the Pandemic Seem to Be Hitting Some Countries Harder Than Others? While the virus has ravaged rich nations, reported death rates in poorer ones remain relatively low. What probing this epidemiological mystery can tell us about global health’. Coronavirus Chronicles, March 1, 2021 Issue online February 22, 2021
  7. accessed 23rd February 2021
  9. Mohammed R. Moosa & Valerie A. Luyckx, ‘The realities of rationing in health care,’ Nature Reviews Nephrology (2021) Published: 15 February 2021
  10. LMIC: Low and/or middle income country

Covid-19 Vaccine Progress

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


We have been experiencing a winter storm in Norwich. It began on Sunday, as I started planning and writing the blog and continued up to the time it was posted. There have been Amber weather warnings for much of the south and east of the United Kingdom, with forecasts of snow and strong winds. It was not pleasant to be outside and I found myself wondering and worrying how the garden birds are faring. Hopefully, this will be the last bad winter weather for this season. It made the Covid-19 pandemic seem even bleaker.

The big news continues to be the vaccines. There are three vaccines in use in England and most of Europe. The UK’s evening ‘broadcast of doom’ used to only contain data on the number of new cases, the hospitalisations, and the deaths. It must be a relief for the news anchors to have something like ‘good’ news in the number of vaccinations that have been administered. I will talk about this in greater detail below.

It is pleasant to reflect on the fact that it is over a month since the failed insurrection and assault on the Capitol in Washington DC. That, to my mind, was the point at which Donald Trump let go of the last ounce of any real credibility he had. Joe Biden has barely had time to settle into the White House, but at least the country now has a President who listens to experts on the coronavirus, cares about the death toll of citizens, and is acting in response to the pandemic.
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Covid-19 Watch: Stops and Starts and Ups and Downs

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


It is hard to believe the first in-depth coverage, in the western media, of SARS-CoV-19 (more commonly known as Covid-19 or just Covid), appeared just over a year ago. The first reports came from Wuhan in China. The global reaction of scientists and health professionals was one of great concern over this new disease. For weeks, while they were hampered by a lack of reliable information, the disease spread exponentially.1 By the end of March there were nearly 200,000 cases reported around the world; the one million mark was reached on 27th April; 10 million by 8th November 2020. The year ended with a global cumulative total of just over 83,519,000 cases and 1,818,000 deaths.2

I remain in the United Kingdom. While in theory it is possible to travel, it is not recommended and, logistically, is complex. There used to be four flights a day from our little airport to Amsterdam, from where people (and viruses) could disperse to the four corners of the world with great ease. This was reduced to just one a day. On 23rd January 2021, The Government of the Netherlands issued a ban on passenger flights from the UK, Cabo Verde, South Africa, the Dominican Republic and countries in South America.

“The purpose of the flight ban is to prevent the further spread of new variants of coronavirus in the Netherlands and Bonaire, St Eustatius and Saba. A docking ban is in force for ferries carrying passengers from the United Kingdom … The flight ban is due to remain in place until 22 February but may be ended sooner if there are grounds for doing so.”3

There are faint glimmers of good news and hope. The UK is rapidly rolling out its vaccination programme. This is the one success of the otherwise, mostly incompetent, national government. Within a few days the number of people I knew who had been vaccinated, mostly elderly neighbours and relatives, exceeded the number I knew who had died from Covid. A minor, personal, milestone. Happily, this gap will grow. The inauguration of President Joe Biden was cause for great celebration. He will have a huge impact in the United States and help change the course of the global pandemic. The US has already re-joined the World Health Organisation, providing people and money. Their anti-science and uncompassionate government is gone.

In Norwich we have experienced a cold snap. Over the weekend we woke to a light dusting of snow. It was beautiful but did not last for more than a few hours. Walking around the neighbourhood, my main form of exercise along with cycling, it is encouraging to see how many people have bird feeders in their gardens. The number of birds has increased. This may be helped by an apparent, but noticeable, decline in the number of cats. Twenty years ago, many households had a cat, today I see very few. The increase in bird life is observed, the decline in felines is a guess.
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Covid-19 Watch: A Rocky Start to the Year

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


The most depressing day of the northern hemisphere year is reputed to be the third Monday of January. The Independent reports, ‘the formula is essentially pseudoscience and has urged Brits to “refute the whole notion” of Blue Monday’.1 However, as I sit in my shed, faced with grey skies and temperatures just above freezing, and Covid-19 numbers rising I wonder. We are breaking records for the number of cases and deaths. On the other hand, when I step outside into the garden there are signs of life and renewal. The green shoots of the snowdrops are pushing through the earth, the birdfeeder is visited by wrens, blue and great tits. The blackbirds eat the seed off of the ground. When there is sunshine, it looks full of promise.

The situation regarding the coronavirus pandemic is bleak. A new lockdown has been introduced in the UK, and there is talk of tightening the regulations further. We are being warned to stay at home; that the situation is at its worst for hospitalisations and deaths; and the future is said by the politicians ‘to be baked in.’ The legislation that gave the English government power to introduce new rules specifies these do not have to be reviewed before 31st March 2021.

I don’t want to be too much of a Cassandra.2 There has been rapid progress in understanding the virus and developing vaccines. Treatments are evolving and improving. Vaccines are being rolled out in an ever-increasing number globally. Many more are in development. My prediction is a year from now the pandemic may be medically under control. The social, economic, political, educational, and psychological effects will still be evolving. This Covid-19 communique, the first of 2021, focuses on vaccines, and has a guest article from friend and colleague Simon Dalby, ‘Seeing 2020: COVID, Climate and the Failure to Anticipate’.
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Covid-19 Watch: Christmas is Cancelled

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


I took a break last week and this blog is posted on Monday, 21 December. The next will be on 11 January in 2021. I was beginning to feel rather burnt out. Although the posts are quite short, they take time to craft, proof, and check. Today there have been about 77,000,000 cases of Covid-19 globally and nearly 2,000,000 deaths. In the UK a new more transmissible variant is spreading rapidly. Johnson warned “it may be “up to 70 per cent” more transmissible than earlier strains.”1 There is no evidence yet to suggest it causes more severe or less severe disease. It has, however, led to bans on travel from the UK and a number of other countries.

Whilst the inexorable progress of the epidemic remains a great source of concern, the year ends with some good news. Treatments continue to evolve and improve. More importantly there has been rapid progress in understanding the virus and developing vaccines. Vaccines have been rolled out in a number of countries, and many more are various stages of development.

The consequences of the pandemic, and our response to it, have been life changing. In the next year lockdowns will be lifted and government support packages, where they exist, will come to an end. The current response cannot be sustained. Initially people suggested the effect of the epidemic might be V-shaped. A rapid decline in whatever indicator one looked at, followed by an equally rapid recovery, until we were back at status quo. As time went on the talk became of a U-shaped effect. The decline is followed by a period of constraint before the recovery. A more sophisticated and accurate picture of the epidemic is of a K. The decline is followed by a divergence as some people recover, and indeed grow ever richer, whilst others, the majority, see a continued decline.

My prediction is a year from now the pandemic will be medically under control. The social, economic, political, educational, and psychological effects will still be evolving. For example, we have no idea what effect this period of lock down, and suspension of education will have on many millions of children who have spent months out of school. They have, at best, been inadequately educated by stressed parents or through unstable internet connections (for those lucky enough to have computers and access to the internet).

I hope we take the opportunity to reflect on how we live and interact with each other, and the natural environment. If we do, we may be prepared for the next big challenge, probably, but not necessarily, environmental collapse. This week I will identify some of the websites that are exceptionally useful in helping understand the epidemic, the science, and some of the ramifications.

The first virus tracker I discovered was produced by Johns Hopkins.2 Their Coronavirus Resource Centre has a useful dashboard. There is a table of infections by country and information on daily cases, daily deaths, cumulative cases, cumulative deaths and a log representation of cases are shown on graphs. There are other pages for additional information. I still visit it, although it seems a little tired in comparison to some of the other sources.
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Covid-19 Watch: Mood Music Changes

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


This is the second last communiqué of the year. I will post the final, more reflective piece on Monday, 21st December. In 2021 the first communique will be on 11th January. I will survey readers and work out how to proceed beyond that (if at all), weekly is too frequent for me alone. I may revert to monthly posts. Please take 10 minutes to complete another survey. I won’t be offended by honesty and would love ideas. This personal rethink is appropriate, we know so much more about the pandemic and its consequences. With the vaccines becoming available the end is in sight.

When I began writing in early March, I aimed to provide updates on where we were and where we were going. The goal was to draw on my knowledge and experience to make sense of the situation. It was initially desperately worrying, then grindingly depressing, now there is cause for cautious optimism. The worry and depression were not just because of the virus, but also the appalling lack of leadership in many settings. Who believed that a virus could bring normal human interactions to a grinding halt globally, and so quickly? Who would have predicted some countries would see run away epidemics, while others brought it under control? Who expected the huge strides from science, medicine, and epidemiology?

My working life was driven by the HIV/AIDS epidemics, first seen in 1981 when I was in Botswana. By the time I had been in South Africa for seven years, 1983 to 1990, it was clear AIDS was going to be catastrophic, but, unlike Covid-19, not everywhere. By 2000 it was apparent Southern Africa was going to be the world’s worst affected region. HIV infection is for life. Infected people will, in the absence of treatment, experience periods of illness that increase in frequency, severity and duration and usually end in death. Fortunately, most people will recover from Covid-19.

From this knowledge base, I tracked the Covid-19 pandemic and tried to follow the science. The rollout of vaccines, which began in the UK on 8th December, marks a step change in the way we view and respond to the disease. It is a remarkable achievement that we should have one vaccine being rolled out, others approaching approval and many more in the development.
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Covid-19 Watch: Hope by Christmas?

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


Yesterday, 1st December, was a significant day in the annual global health calendar: World AIDS Day. Until this year, AIDS was the pandemic dominating global thinking, activism, and response. It is the disease I began working on in 1987. I looked at migrant workers travelling to South Africa to work in mines, on farms and in industry. The majority were men. They travelled on annual contracts and mainly lived in single sex hostels away from wives and families. The ideal environment for a sexually transmitted infection to spread.

HIV, the virus that caused AIDS, was first noted in New York and San Francisco in 1981. A classic book tracking the emergence of HIV is ‘And the band played on’ by Randy Shilts.1 As the numbers of infected people rose dramatically globally it became clear, in most of the world, specific groups were bearing the burden of the disease: men who had sex with men; people who used drugs intravenously; recipients of untested blood and blood products; and female sex workers. There are areas with generalised epidemics, in particular Africa, where the Southern cone is the epicentre.

In the 1980s our source of data was surveys of pregnant women. We watched in horror as infection rates rose dramatically, up to 40%. Initially there was no treatment. Hundreds and thousands of people fell ill and died as their immune systems were overwhelmed. The arrival of treatment, antiretroviral drugs, in 1996 was game changing. The HIV and AIDS world faces two challenges: reducing the number of new infections and ensuring people access and stick to treatment.

In 2018 there were 37.9 million people living with HIV, including 1.7 million children. This gives a global prevalence of 0.8% among adults and 21% do not know that they are infected. It is estimated that an additional 32 million people have died of aids related illnesses. To date there have been just over 63 million cases and just under 1.5 million deaths of Covid-19. The number of cases will greatly exceed those of AIDS, the number of deaths should, fortunately, remain lower. Whilst both diseases are zoonotic retroviruses, there are differences, the main one being most recover from Covid-19.

AIDS played an important role in our response to Covid-19. The scientific advances in immunology, virology, vaccine development and a host of other disciplines meant that a great deal of basic knowledge was there already. Public health institutions and health workers were able to pivot. The effect of Covid-19 on AIDS is less beneficial. It has drawn attention and resources away from a deadly disease. As you read this week’s blog be aware of the many other health issues faced by people, especially those in the developing world. I know most about AIDS hence this introduction. There are many other needs: malaria, tuberculosis, hepatitis and numerous childhood diseases.
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Vaccines, vaccines, vaccines!

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


On Wednesday 25th November there were just under 60 million confirmed Covid-19 cases globally. There have been 1.4 million deaths. This pandemic is not under control. Despite the numbers, the last week has brought encouraging news both on medical and political fronts.

In the USA, the process of transition from the Trump presidency to Joe Biden’s has finally begun. The General Services Administrator Emily Murphy felt able to send the letter to Biden on Monday 23rd November saying he could begin the transition and giving him the requisite resources.1 This came as it was clear Trump’s lawsuits challenging the election result were going to fail. What this delay will mean for national security and the Covid-19 morbidity and mortality remains to be seen. The US will sign up to the Paris agreement (again) to address global climate change. They will rejoin the World Health Organisation (WHO), especially welcome as they are the largest bilateral funder.

There are now promising vaccines in Phase Three trials and that is the focus of this communique. I will try to make sense of this and produce a summary table of what is available. The science has leapt forward, and this includes advances in treatments not covered here. As mentioned before, the lens through which I report is most influenced by western news sources and, even narrower, I am most aware of what is going on in the UK and the USA.

I participated in a one-hour debate on BizNews radio2 with South African actuary Nick Hudson. He was one of the movers behind the Great Barrington Declaration (GBD). The moderator suggested that there might be fireworks because, as the publicity noted, I had been uncomplimentary about the GBD. It is a great pity when positions become polarised and I made a mental note to not ‘shoot from the hip’. Nick is a member of Pandemics ~ Data & Analytics (PANDA).3 Disagreement can be healthy, especially in the case of a new disease when there is much to learn. We concurred Covid-19 is a serious new illness, where we part is on how to respond, in particular the value of lockdowns.

My scars are from the Thabo Mbeki years, with the denial of the AIDS epidemic, and unwillingness to roll out treatment. This resulted in hundreds of thousands of premature deaths. With fellow scientists in South Africa, we faced a phalanx of denialists of various categories. Some argued that there was absolutely no such thing as HIV; others, that HIV was a harmless ‘passenger virus’; a third group suggested that whilst HIV existed, the drugs were the real cause of morbidity and mortality, (there was a subtext here of HIV being exploited by the global pharmaceutical industry); finally, in their ranks, were several who were so incoherent we never knew exactly what they stood for.

I write from the UK. We are approaching the end of our third week of our second lockdown, it is supposed to end on 2nd December, in time for Christmas shopping. I am extremely concerned about the impact this will have as millions flock to the streets to buy presents for friends and family. The tier system will be reintroduced and continue to be opaque.
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Covid-19 Watch: Great Progress in Vaccines?

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


England is halfway through four weeks of renewed lockdown. There are some differences from the first round, the main one being educational establishments, particularly schools, remain open. This week we learnt Prime Minister Boris Johnson is self-isolating again. He was in contact with an MP who subsequently tested positive for Covid-19. I note that he does not look particularly well. In the past week he has faced political turmoil, with key advisers being forced out of Downing Street. They were not particularly impressive individuals, one, Dominic Cummings is best known for his driving ‘to test my eyes’ during the last lockdown. It is a sign of turmoil and continued lack of leadership.

In the United States Donald Trump is refusing to concede the election and allow the new administration, under Joe Biden, to begin the transition. This extends to the Coronavirus response. It is effectively dead in the water at the federal level, although states can respond independently. The number of new cases reached a record high on 13 November. In South Africa most of the restrictions on daily life have been lifted although travel to and from the country remains difficult. This is not necessarily because of South Africa’s rules but those of destination and originating countries.

When I began this blog in March the first posting asked what the virus meant for us individually. I am going to return to this theme. The constant bombardment of data, opinions, contradictory information, and rumour means that there is confusion and weariness. This week’s guest column is by Graham Hayes, a South African academic and psychologist with years of experience in clinical practice. I asked him to reflect on the mental health implications of Covid-19. It is no surprise this epidemic is detrimental to our individual and collective states of mind. The Lancet of 14th November 2020 reviews the book ‘How to stay sane in an age of division’ by Elif Shafak.1 I have it on order! From a scientific point of view there has been more good news with at least two and possibly more vaccines waiting for testing and approval.

Last week I promised to talk about the pros and cons of lockdowns. On Monday 23rd I am taking part in a debate with Nick Hudson of Pandemic Data and Analytics (PANDA), the head of a South African group of actuaries who question the lockdown policy. This is being organised by BizNews2 as a special episode of their noontime webinar. It will be interesting; I suspect we agree on more than we disagree on. You can register to view the webinar here.
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Covid-19 Watch: Great Progress in Vaccines?

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal –


Last week I promised to talk about the pros and cons of lockdowns. That is not going to happen as there is too much else to report. The presidential election in the United States was last Tuesday. We had to wait until Saturday for the result to be definitively called. Democrat Joe Biden was clearly the winner. It remains to be seen what additional damage Trump and his Republican confederacy will do over the next few weeks. The Andrew Marr Show on the BBC on Sunday mornings does a review of the British papers. This brought to our attention the headline in the Ayrshire Daily News, a small regional Scottish paper. It was: “South Ayrshire golf club owner loses 2020 presidential election”.1

The blog is published on 11 November, Armistice Day. It is the day we remember those killed in armed conflicts around the world. This year it is particularly poignant, as the Second World War ended 75 years ago. There are still veterans who, in the absence Covid-19, would have joined a shrinking band of fellow servicemen to mark the event. Next year there will be fewer. Two years ago, I trudged through snow to the service at the cenotaph in Waterloo. It was the Centenary of the end of the First World War. It was particularly moving for me; my father ran away from school aged 15 and joined up. He survived the trenches with minor wounds and lived to 90.

Today humankind is engaged in numerous battles for survival. Covid-19 is the immediate one, with the vaccine news and ‘The Biden-Harris plan to beat COVID-19’.2 At the same time, the urgent challenges of climate change and environmental degradation remain. Covid-19 is a zoonotic disease, spread from animals to humans. The news of an outbreak of a mutated Covid-19 transmitted on mink farms in Denmark is extremely concerning. According to the World Health Organisation “Since June 2020 214 human cases have been identified in Denmark with SARS-CoV-2 variants associated with farmed mink.”3 The WHO suggests the mink were infected by humans, and acted as a reservoir before re-infecting humans with a mutated version. The Danish response is to cull. Seventeen million animals will be slaughtered. The only reason these animals are farmed is for their fur. Unbelievable!
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