More than 2,800 scientists from 130 countries gathered on Friday (January 15) in a virtual forum hosted by the World Health Organization (WHO) to identify knowledge gaps and set research priorities for vaccines against SARS-CoV-2, the virus that causes COVID-19.
They discussed the safety and efficacy of existing vaccines and new candidates, ways to optimize limited supply, and the need for additional safety studies.
“The development and approval of several safe and effective vaccines less than a year after this virus was isolated and sequenced is an astounding scientific accomplishment,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in his opening remarks. “The approval of the first few vaccines does not mean the job is done. Far from it. More vaccines are in the pipeline, which must be evaluated to ensure we have enough doses to vaccinate everyone.”
More than 30 million vaccine doses have already been administered in 47 mostly high-income countries. But the global vaccine rollout has exposed glaring inequalities in access to this life-saving tool.
“The spirit of collaboration has to prevail in these challenging times as we seek to understand this virus,” said Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention. “We have to be mindful of the inequalities and we must deliberately promote investment in regional capacities to level the playing field and have meaningful collaboration to begin to address some of the challenges.”
Experts agreed the need for critical research on administering vaccines in different target populations, as well as on vaccination delivery strategies and schedules. This includes trials, modelling and observational studies, all of which would help to inform policy.
They discussed the impact of emerging SARS-CoV-2 variants on the efficacy of vaccines, the impact of vaccines on transmission of infection, and the need to develop the next generation of vaccine platforms.
“The world needs multiple vaccines that work in different populations in order to meet global demand and end the COVID-19 outbreak. Ideally, those will be single-dose vaccines that do not require cold chain, could be delivered without a needle and syringe and are amenable to large-scale manufacture,” said Professor Mike Levine, Director of the Center for Vaccine Development at the University of Maryland.
The meeting concluded with agreement to establish a WHO-hosted platform for global sharing and coordination of emerging vaccine research information on efficacy and safety. The forum would enable scientists to share and discuss unpublished and published data and research protocols to further our collective understanding of SARS-CoV-2 vaccines.
“The WHO will regularly convene experts from around the world, promote collaborative research, provide standard protocols and develop a platform for sharing the latest knowledge in the field,” said Dr Soumya Swaminathan, WHO Chief Scientist.
Statement on the sixth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic
The sixth meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the coronavirus disease (COVID-19) took place on Thursday, 14 January 2021 from 12:15 to 16:45 Geneva time (CEST).
Proceedings of the meeting
Members and Advisors of the Emergency Committee were convened by videoconference.
The Director-General welcomed the Committee, expressed the need for global solidarity in addressing the challenges posed by the pandemic, and emphasized the need for protection of the most vulnerable. He thanked the Committee for their continued support and advice.
Representatives of the legal department and the Department of Compliance, Risk Management, and Ethics (CRE) briefed the members on their roles and responsibilities. The Ethics Officer from CRE provided the Members and Advisers with an overview of the WHO Declaration of Interest process. The Members and Advisers were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or direct conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each member who was present was surveyed and no conflicts of interest were identified.
The Secretariat turned the meeting over to the Chair, Professor Didier Houssin. Professor Houssin also welcomed the Committee and reviewed the objectives and agenda of the meeting.
The WHO Director of the Health Emergency Information and Risk Assessment Department provided an overview of the evolution of the pandemic and the progress made on the implementation of the 30 October 2020 Temporary Recommendations. WHO continues to monitor the global risk level of the COVID-19 pandemic. WHO assessed the global risk level as very high due, in part, to recent reports of new SARS-CoV-2 variants.
A representative of the United Kingdom of Great Britain and Northern Ireland presented on the new SARS-CoV-2 variant which is causing increased transmission but not severity of COVID-19. A representative of Denmark presented on the SARS-CoV-2 mink variants and their response which has resulted in these variants no longer circulating in human populations. The WHO Technical Lead for COVID-19 Response and an Emergency Committee Member from South Africa provided an overview of the variant detected by South Africa. The WHO Technical Lead then shared a global overview of SARS-CoV-2 mutations and variants as well as plans to develop and implement standard nomenclature for variants that does not reference a geographical location.
The WHO Director of the Immunization, Vaccines and Biologicals Department presented the current status of the COVID-19 vaccine landscape and introduction. The Chair of the Strategic Advisory Group of Experts on Immunization (SAGE) noted available guidance including WHO SAGE Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply and the Interim Recommendations for Use of the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) under Emergency Use Listing. The Director of Air Transport Bureau of the International Civil Aviation Organization (ICAO) shared their COVID-19 activities related to testing and vaccination, including the Manual on Testing and Cross Border Risk Management Measures (Doc 10152) which provides countries with risk management strategies for international travel. The WHO Unit Head of the IHR Secretariat provided an overview of the legal provisions as well as the scientific, ethical and technological considerations for vaccination certificates related to international travel.
The Committee recognized the challenges posed by some manufacturers’ delayed submission of vaccine data to WHO. These data delays impact WHO’s ability to provide emergency use listing which ultimately affect equitable vaccine access. The Committee strongly encourages manufacturers to provide data to WHO as rapidly as possible.
The Committee unanimously agreed that the COVID-19 pandemic still constitutes an extraordinary event, a public health risk to other States through international spread, and continues to require a coordinated international response. As such, the Committee concurred that the COVID-19 pandemic remains a public health emergency of international concern (PHEIC) and offered advice to the Director-General.
The Committee recognized WHO’s and States Parties’ progress in implementing the previous Temporary Recommendations from the 5th meeting of the Emergency Committee. The Committee noted that these recommendations remain relevant and had acquired additional urgency given the evolution of the pandemic and the continued need for a coordinated global response. The Committee advised on extending the previous Temporary Recommendations and provided additional advice to the Director-General.
The Director-General determined that the COVID-19 pandemic continues to constitute a PHEIC. He accepted the advice of the Committee to WHO and issued the Committee’s advice to States Parties as Temporary Recommendations under the IHR.
The Emergency Committee will be reconvened within three months, at the discretion of the Director-General. The Director-General thanked the Committee for its work.
Advice to the WHO Secretariat
- Continue to work with partners to develop standardized definitions and nomenclature of SARS-CoV-2 virus variants, based on their genetic sequence, that avoids stigmatization and is geographically and politically neutral. Provide clear information to State Parties on what constitutes a variant of concern.
- Continue to increase worldwide capacities for SARS-CoV-2 molecular testing and genetic sequencing, in line with WHO guidance, and encourage rapid sharing of sequences and meta-data to strengthen monitoring of virus evolution and to increase global understanding of variants and their effects on vaccine, therapeutics and diagnostic efficacy.
- Strengthen the SARS-CoV-2 risk monitoring framework for variants by accelerating collaboration and harmonizing research to answer critical unknowns about specific mutations and variants, through relevant networks and expert groups such as WHO SARS-CoV-2 Virus Evolution Working Group and the WHO R&D Blueprint for Epidemics.
- Accelerate research on critical unknowns about COVID-19 vaccination efficacy on transmission, duration of protection against severe disease and asymptomatic infection, duration of immunity (following infection or vaccination), long-term protection after using different vaccination intervals, protection after a single dose, and vaccination regimes, in line with the SAGE and the Research and Development Blueprint recommendations.
- Promote global solidarity and equitable vaccine access by encouraging States Parties and manufacturers to donate resources and provide support to the COVAX Facility.
- Promote technology transfer to low- and middle- income countries with the potential capacity to accelerate global production of COVID-19 vaccines.
- Support State Parties, including fragile states, in preparing for COVID-19 vaccine introduction by developing a national deployment and vaccination plan, in line with WHO guidance, that addresses barriers to COVID-19 vaccine readiness. Such planning should include prioritization of populations, regulatory authorization, supply and logistics preparation, indemnification and liability, health workforce planning, and access for humanitarian and vulnerable population.
Health Measures in Relation to International Traffic
- Lead development of risk-based international standards and guidance for reducing SARS-CoV-2 transmission related to international travel (by air, land, and sea) based on current science and good practices that include clear recommendations for testing approaches and quarantine duration as appropriate. The guidance should additionally include advice on adapting those measure to specific risk settings, including movements of migrants, temporary workers, travellers and conveyance operators.
- Rapidly develop and disseminate the WHO policy position on the legal, ethical, scientific, and technological considerations related to requirements for proof of COVID-19 vaccination for international travelers, in accordance with relevant IHR provisions.
- Coordinate with relevant stakeholders the development of standards for digital documentation of COVID-19 travel-related risk reduction measures ,that can be implemented on interoperable digital platforms. This should include vaccination status in preparation for widespread vaccine access.
- Encourage States Parties to implement coordinated, time-limited, risk-based, and evidence-based approaches for health measures in relation to international travel.
Evidence-Based Response Strategies
- Continue to rapidly provide and regularly update evidence-based advice; guidance; tools; and resources, including regular dissemination of resources to combat misinformation for COVID-19, to enhance evidence-based COVID-19 preparedness and response strategies and implementation of such strategies.
- Continue to actively support countries to further strengthen their SARS-CoV-2 surveillance systems, including strategic use of genetic sequencing, by leveraging existing systems such as the Global Influenza Surveillance and Response System (GISRS) and relevant networks for systematic sharing of data and specimens.
Strengthening Health Systems
- Provide strategic insight on how State Parties can sustain the public health infrastructure, capacities, and functions developed for COVID-19 response to support strengthened health systems and universal health coverage in the long-term.
Additional Temporary Recommendations to State Parties
- Increase molecular testing and genetic sequencing and share sequences and meta-data with WHO and through publicly accessible databases to enhance global understanding of the virus evolution and inform response efforts.
- Support coordinated global research efforts to better understand critical unknowns about SARS-CoV-2 specific mutations and variants.
- Engage in technology transfer to accelerate global production and deployment of COVID-19 vaccines and ancillary supplies.
- Prepare for COVID-19 vaccine introduction and post-introduction evaluation using the guidance, tools, and trainings for national/subnational focal points and health workers developed by the Access to COVID-19 Tools (ACT) Accelerator’s Country Readiness and Delivery workstream.
- Incorporate, as necessary and appropriate, the private sector into the COVID-19 vaccine planning and introduction to supplement existing service provision and vaccination capacity.
- Encourage and facilitate vaccine acceptance and uptake by providing credible information on vaccine safety and the benefits of vaccination to address concerns.
Health Measures in Relation to International Traffic
- At the present time, do not introduce requirements of proof of vaccination or immunity for international travel as a condition of entry as there are still critical unknowns regarding the efficacy of vaccination in reducing transmission and limited availability of vaccines. Proof of vaccination should not exempt international travellers from complying with other travel risk reduction measures.
- Implement coordinated, time-limited, risk-based, and evidence-based approaches for health measures in relation to international traffic in line with WHO guidance and IHR provisions. Careful consideration should be given to when and if travel bans should or should not be used as tools to reduce spread. Such decisions should be based on the best available evidence.
- Share information with WHO on the effects of health measures in minimizing transmission of SARS-CoV-2 during international travel to inform WHO’s development of evidence-based guidance.
Evidence-Based Response Strategies
Refine evidence-based strategies according to WHO guidance to control the spread of SARS-CoV-2 using appropriate public health and social measures, including strategies that address pandemic fatigue.
Increase investment in surveillance and sequencing capacities to detect and report early emergence of variants and assess abrupt changes in transmission or disease severity to increase understanding of the evolution of the pandemic.
Utilize the WHO SARS-CoV-2 global laboratory network, leverage GISRS and other laboratory networks for timely reporting and sharing of samples; support other State Parties, where needed, in timely sequencing of SARS-CoV-2 virus specimens.
Strengthening Health Systems
Continue to strengthen public health infrastructure, system capacities, and functions for COVID-19 response and to enhance universal health coverage.
The COVID-19 pandemic continues to constitute a Public Health Emergency of International Concern (PHEIC), according to the WHO Emergency Committee (EC) on COVID-19.
The EC met virtually yesterday (14 January) at the request of WHO Director-General Dr Tedros Adhanom Ghebreyesus to review the emerging variants of SARS-CoV-2, the virus that causes COVID-19, and to consider the potential use of vaccination and testing certificates for international travel.
On variants, the EC called for a global expansion of genomic sequencing and sharing of data, along with greater scientific collaboration to address critical unknowns.
The committee urged WHO to develop a standardized system for naming new variants that avoids geographical markers, an area WHO has already begun work on.
On vaccines, the committee underlined the need for equitable access through the COVAX Facility as well as technology transfer to increase global production capacities.
The committee strongly encouraged vaccine manufacturers to rapidly provide safety and efficacy data to WHO for emergency use listing. The lack of such data is a barrier to ensuring the timely and equitable supply of vaccines at the global level.
Given that the impact of vaccines in reducing transmission is yet unknown, and the current availability of vaccines is too limited, the committee recommended that countries do not require proof of vaccination from incoming travellers.
The committee advised countries to implement coordinated, evidence-based measures for safe travel and to share with WHO experiences and best practices learned.
This was the sixth meeting of the Emergency Committee on COVID-19. Since the declaration of a PHEIC on 30 January 2020, the Director-General has been reconvening the committee at three-month intervals to review progress.The full statement of the Committee can be accessed here.