The science behind life-saving Covid-19 public policy

Science is beginning to inform public policy with sweeping effects in countries around the world as the threat of Covid-19’s negative effects on the world order intensifies.

In addition to data arising from the fast-paced drive to develop and distribute Covid-19 vaccines, governments have increasingly relied on crucial scientific research in order to implement governance and public health policies in response to Covid-19.

Dr Jeremy Nel, Head of Infectious Diseases at Wits University describes this as an explosion of important research which has arisen over the last year and a half surrounding COVID-19. Not least of all is this the case in Covid-19 treatment.

Covid-19 treatement

Arguably the most important for studies for Covid-19 therapy have been the recovery and Solidarity trials, says Nel. These were large-scale randomised controlled trials that continue to test various potential therapies to fight COVID-19.

“They have been responsible for showing that both steroids and a drug called toculizumab (Actemra) work, and have also shown us which drugs don’t work: Aluvia, hydroxychloroquine, colchicine and others,” says Nel.

Solidarity, an international Covid-19 clinical trial was launched last year by the World Health Organisation to help find an effective treatment for the disease. It is one of the largest international randomised trials for COVID-19 treatments, enrolling almost 12 000 patients in 500 hospital sites in over 30 countries.

Also Read: New evidence for Ivermectin use in Covid-19, but Sahpra won’t budge

According to WHO, the Solidarity trial is evaluating the effect of drugs on 3 important outcomes in COVID-19 patients, namely mortality, need for assisted ventilation, and duration of hospital stay.

“The other extremely important set of trials have been those that have studied vaccines,” adds Nel.

“For vaccines made by Pfizer, Moderna, AstraZeneca, Novavax, Gamaleya and others, we have had a sequence of extremely high-quality trials published in top international journals that have shown how effective the vaccines have been. Many of these trials were partly done in South Africa, led by Shabir Madhi, Glenda Gray, and others.”

These trials have provided vital data about the efficacy of the vaccines against the B.1.351 COVID strain that is prevalent in our country.

The improvisational nature of the global vaccine roll-out has seen the pausing and resuming of the various brands on the market, as public health authorities weighed the risks posed by arising information. South Africa paused the distribution of the Johnson & Johnson vaccine twice this year following various developments from the US.

Earlier this year, the Food and Drug Administration and the U.S. Centers for Disease Control and Prevention initiated the pausing of administration of the drug after reports of six cases of a rare and severe type of blood clot in individuals following administration of the Janssen COVID-19 Vaccine. South Africa was one of several countries to follow suit.

The roll-out of the vaccine was later resumed after the FDA and CDC examined available data to assess the risk of thrombosis involving the cerebral venous sinuses, or CVST (large blood vessels in the brain), and other sites in the body.

The vaccine was to see another hiccup in South Africa after distribution of doses from the local manufacture of the drug Aspen Pharmacare last month. This was due to an FDA probe in Baltimore, US on the active product ingredient (API) in their vaccine. That API has been used by the manufacturers of the Aspen factory in South Africa.

“Those vaccines are ready to be distributed, but they are being withheld pending the investigation into the factory in the US,” he says.

Breathing problems

Recently Business 4 South Africa (B4SA) highlighted the emergence of data collected by the Every Breath Counts Coalition, the NGO Path and the Clinton Health Access Initiative (CHAI) which showed that South Africa is one of the countries most at risk of running out of oxygen.

According to analysis by The Bureau of Investigative Journalism which found that SA is one of nineteen countries around the world – including India, Argentina and Iran which are deemed most at risk. These countries have seen vast increases in oxygen demand since March this year, each experiencing a rise in demand of at least a 20% while having vaccinated less than 20% of their populations.

Ivermectin’s consensus problem

In November last year, the World Health Organisation said that further study and data are needed regarding presumptive treatment and the possible addition of ivermectin in the treatment of Covid-19 disease.

The drug has been used in the treatment of parasitic infections and in countries such as the United States as prophylaxis and treatment for the novel coronavirus in limited numbers that have not produced a consensus on whether it should be used on a mass scale.

Though the drug has reportedly been accessed widely on the black market, and organisations such as Afriforum have pushed for its use in the courts, the Sahpra has yet to be satisfied with existing evidence of its safe and effective use.

Dr Nel says South Africa has high standards when it comes to the appraisal of evidence by SAHPRA and the Department of Health. The evidence for drugs such as ivermectin is currently far too weak for the drug to be recommended outside of clinical trials, he argues adding that tegulatory authorities in most countries have concurred with this assessment.

A review of the recent studies conducted on ivermectin and its use to treat Covid-19 concluded that the majority of trialled agents have failed to provide reproducible, definitive proof of efficacy in reducing the mortality of COVID-19 with the exception of corticosteroids in moderate to severe disease.

Simnikiweh@citizen.co.za