RFI interviewed the chairman of the WHO group of immunization experts, Mexican Alejandro Cravioto, about the Latin American pandemic, the vaccination campaign and the use of drugs that, according to the specialist, have no effect to protect against Covid-19.
This week, the entire planet is paying close attention to what your group is publishing about the results of the study they have to present on the Chinese vaccines of 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, not yet. The process is ongoing 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 did for fundamental language reasons was 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 presents us with its data first on safety and then on efficacy as clinical trials are completed. In the case of Chinese vaccines, they have resulted in several countries where vaccines have been tested in randomized controlled trials with a sufficient number of subjects for the results to be valid in order to see the safety and efficacy of vaccines. Once the WHO emergency use authorization process has been completed, then within the next 48 to 72 hours, we will meet to make specific recommendations for the use of these vaccines. We understand the rush, 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 have an authorization for emergency use by the WHO or one of the regulatory agencies and then we can already issue recommendations.
To bring our readers to the forefront and inform them of the importance of this news about Chinese vaccines, for now, the WHO authorizes the emergency use of COVID vaccines from Pfizer-BioNTech, Janssen (Johnson & Johnson) and AstraZeneca (in this case). last case, only batches manufactured in association with the South Korean SK BIO and the Indian Serological Institute). The inclusion of vaccines in the WHO list is important, as those authorized by the international organization may be part of the COVAX dose distribution program 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 look at their vaccine, Sputnik V. We also followed the same process as the Chinese vaccine. I’ve had between three and four meetings with each of the labs, starting with Pfizer and modern ones, to make sure the information I have is enough to make 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 the supply, not so much the vaccination program. Because in most countries, when vaccines arrive, they fall into the arms of an individual. The problem is that we do not have enough vaccine production and some countries have decided to keep all production for domestic use and other countries have accepted that these factories share the product with other countries, especially with Covax, which is the international cooperation system for all countries. , 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 for them to be protected in order to continue working and prevent death people.
Another global issue is the safety of the COVID-19 vaccine manufactured by AstraZeneca following rare cases of blood clots in the brain. How to reassure the world population about 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. I had a meeting this Sunday [4 de abril] With the entire WHO group, it has become clear that we need more information from around the world and that it is already being collected to see if this is seen in other countries where the vaccine is also used. I know that there have been some cases in France, but very few or almost none have been reported in Spain or Italy. We need to see why this happens, because it may be related to other factors associated with the vaccine that may give this type of symptomatology. It is important, first of all, that countries that use the AstraZeneca vaccine have a system for monitoring side effects that allows them to detect whether or not this is possible. And second, that we really see how many individuals have the problem, because it is possible that, by numbers, someone thinks that 23 cases are numerous, but if we see it compared to the millions of people vaccinated, then the proportion is much lower. than expected. I believe that decisions must be made with great safety, but also with great care, so as not to affect the use of a vaccine that is extremely protective for many countries in the world and is produced in places like India and South Korea. where these vaccines come to Covax so they can reach other parts of the world. Our concern is to see further whether the vaccines we use are useful against “worrying” variants. We already have three: the British, the South Africans and the Brazilians, who are the ones we are following. In the case of South Africa, the AstraZeneca vaccine has a lower level of protection, not for death, but for less severe disease.
Vaccines are undoubtedly the focus of media attention in the midst of this pandemic, but it is also worth looking at drugs that are manufactured and that will reduce the severity of patients’ symptoms once they are over. the race to find these drugs? Is it a priority for many pharmaceutical companies now?
Alejandro Cravioto Exact. Everything I’ve seen has been used for not very severe diseases, such as Remdesivir, among others. Or a direct protection, such as the use of antibodies which, together with the variants, do not seem to be effective either. What needs to be considered is that we have a number of non-pharmaceutical protection systems, such as the use of a mask, hand washing, maintaining social distances, which have been shown to work to reduce the transmission of the virus from one person to another. another and that we must continue to implement to continue to protect ourselves. Closures work, but at some point there are many people who have to leave their homes to work, feed their children, survive, and therefore cannot simply remain locked in their homes without going out. and see no one. Therefore, it has been proven that non-pharmaceutical protection measures are effective to have an economically active life, to be able to open our schools, among other things. Everyone needs to cooperate, and unfortunately in some countries this has become a social and political issue for rejecting 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 many countries in the region use a drug called Ivermectin in patients with Covid-19. In the region, the idea has spread that this drug can help the symptoms not be so severe that the disease is just beginning to manifest itself, a theory that has been completely discarded by the scientific community. How can you stop this prank [noticia falsa]?
Alejandro Cravioto It was a stubborn thing recommended [la Ivermectina] and especially that they are recommended at a very high political level. When a country’s president or prime minister recommends a drug that doesn’t work, it’s a criminal act. That doesn’t help us at all. The same happened with chloroquine, as well as with ivermectin and 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, which does not offer patients any benefit of any kind. The same thing would happen, as my grandmother said, to cover me with camphor alcohol, which was useless but attracted the patient’s attention. People think that by taking these things they are protected, which is a real mistake. It means a health expense, because this drug, even if it is cheap, has a cost and has a high cost for people who have few resources. The Pan American Health Organization, the technical groups, the counselors in most Latin American countries have been very clear that this is not working and it is not working. Ivermectin can be used in some controlled clinical trials to see if it can help with other types of things, but all we have so far is that it is not a medicine that helps us control or reduce the symptoms caused by it. Covid19.
What worries the chair of the WHO Group of Experts on Immunization today?
Alejandro Cravioto Two things: the first is to solve the problem of the AstraZeneca vaccine, which is so important for Covax and we need to see the data clearly and make a decision to see how it will be used or will continue to be used in all vaccines. groups and with the participation of the manufacturing company and Oxford researchers who developed this vaccine. The second is honestly, the time between vaccination and epidemic control. I think after a year everyone is very desperate, but this is not the time to let our guard down and the vaccines work. They are still distributed in the poorest countries. We need to be patient, protect our medical staff and then our elders.
Of all the phrases in the publications I’ve read these days, I prefer one that belongs to epidemiologist Carlos Álvarez, who says “The best vaccine is the one that reaches my arm first.”
Alejandro Cravioto Completely. This is the recommendation we have. All approved vaccines are useful in preventing severe disease and death, which is what we are concerned about now. Some of us are already noticing that they are reducing transmission. But for now, we are still fundamentally concerned that people are not getting sick.