These breakthroughs will make 2021 better than 2020

The latest on the innovations that will let us go back to normal.

By Bill Gate

This has been a devastating year. More than 1.6 million people have died in the COVID-19 pandemic, with more than 75 million cases and tens of trillions of dollars in economic damages. Millions of people are out of work and struggling to pay their bills, and more than a billion children are missing out on crucial time in school. In the U.S., this year also saw the horrifying killings of George Floyd and Breonna Taylor, ruinous wildfires, and a presidential election unlike any other in modern times.

But there is good news coming in 2021.

I spent most of my time this year working with colleagues at the foundation and around the world on ways to test for, treat, and prevent COVID-19. When I think back on the pace of scientific advances in 2020, I am stunned. Humans have never made more progress on any disease in a year than the world did on COVID-19 this year. Under normal circumstances, creating a vaccine can take 10 years. This time, multiple vaccines were created in less than one year.

Unfortunately, we are not out of the woods quite yet. Computer models suggest that the pandemic could get even worse over the next month or so. We also need to learn more about a new variant of the virus that has appeared, which seems to spread faster but not to be more deadly.

Still there are two main reasons to be hopeful. One is that masks, social distancing, and other interventions can slow the spread of the virus and save lives while vaccines are being rolled out.

The other reason to be hopeful is that in the spring of 2021, the vaccines and treatments you’ve been reading about in the news will start reaching the scale where they’ll have a global impact. Although there will still need to be some restrictions (on big public gatherings, for example), the number of cases and deaths will start to go down a lot—at least in wealthy countries—and life will be much closer to normal than it is now.

In this post, I want to share where things stand on COVID-19 innovations as we wrap up this year and move into the next. I’ll start with vaccines, since they’ve been in the news so much and that’s the area I get asked about the most.

How COVID-19 vaccines work

Year in Review 2020

You probably know that two vaccines—one developed by Moderna, the other by Pfizer and BioNTech—have received emergency approval in the U.S. The Pfizer/BioNTech vaccine has also been approved in the U.K. and other countries. And several other companies will probably be announcing results of clinical efficacy trials soon.

What you might not have read is that the success of the first two vaccines also bodes well for many of the other candidates. Virtually all of the vaccines now undergoing efficacy studies attack the same part of the novel coronavirus as the first two do. (It’s the protein that spikes out of the virus, giving the coronavirus its crown-like shape as well as its name.) Now that researchers know attacking that particular protein can work, they have reason to be optimistic about other vaccines that do the same thing. 

Despite this basic similarity, the various vaccines use different approaches to attacking the virus. The ones developed by Moderna and Pfizer/BioNTech involve what’s called mRNA technology—an approach our foundation is intimately familiar with, because we’ve been funding research on it since 2014 as a way to create vaccines for malaria and HIV. It’s great that the technology is now allowing unprecedented progress on COVID-19.

It’s no accident that mRNA vaccines were the first out of the gate. By design, this type of vaccine can be created faster than conventional ones. It works by using messenger RNA to deliver instructions that cue your body to produce the distinctive spike protein. Then your immune system kicks in and attacks anything with that spike on it, including the COVID-19 virus.

Making mRNA vaccines is relatively fast because it’s much easier to produce large quantities of an RNA sequence that codes for the spike protein than it is to grow the spike protein itself. And there’s a bonus benefit: Unlike most conventional vaccines, mRNA vaccines don’t contain any virus at all, which means you can’t get COVID-19 from them.

Unfortunately, there aren’t yet many factories where mRNA products can be made. Some also need to be stored at temperatures as low as –70°C, which makes them particularly difficult to distribute in developing countries, though this is more of an engineering challenge than a scientific barrier.

An example of a different type of vaccine is the one made by AstraZeneca. Instead of using mRNA, it attaches the spike protein to an otherwise benign virus that causes the common cold in chimpanzees but is harmless for humans. Then your immune system learns to attack that spike, and you’re protected from COVID-19.

In its clinical efficacy trials, the AstraZeneca vaccine was on average around 70 percent effective, versus 94 to 95 percent for the Pfizer and Moderna vaccines. But 70 percent is still high enough to be effective at stopping the disease. And it’s reason to be hopeful about other vaccines that take a similar approach, such as Johnson & Johnson’s.

I don’t blame you if you have a hard time keeping track of all the companies working on vaccines. But it’s a nice problem to have! With so many companies pursuing different approaches, there was a much better chance that some would prove to be safe and effective. There are two already and more may be coming.

It’s unheard of to have so many companies working on vaccines for the same disease, because making a vaccine is inherently risky work. Not only can it take years to get a product to market, but it can cost billions of dollars and involve major scientific challenges—especially when the disease is as new to us as this one is.

Why were so many companies willing to take the risk this time? Judging from the conversations I’ve had with their leading scientists and executives, I think one reason is that they saw a chance to use their expertise to help end the pandemic. It also helped that others stepped up to bear some of the financial risk. In some cases, it was a national government, such as the U.S. or Germany. In others it was the group called CEPI, the Coalition for Epidemic Preparedness Innovation, which is funded by our foundation and several government and philanthropic partners.

Of course, developing the vaccines themselves is only part of the challenge. And it may not even be the hardest part.

How do you make 5 to 10 billion doses?

Year in Review 2020

The world will have to manufacture around 5 billion doses if there’s a vaccine that requires only one dose, or 10 billion in the current scenario of two-dose vaccines. (This is assuming that 70 percent of the global population must be covered in order to break transmission of the disease.)

Is 5 to 10 billion doses a lot? Well, all the vaccine companies in the world typically produce a total of fewer than 6 billion doses a year. That includes flu shots, routine childhood immunizations, and so on. So to produce all the COVID-19 vaccines needed without cutting back on any others, the manufacturing capacity will at least need to almost double, and more likely almost triple.

To help ease the manufacturing burden, our foundation helped put together what’s called “second-source agreements.” We paired vaccine companies in rich countries with counterparts in developing countries that specialize in producing safe, high-quality, and affordable doses at a very high volume.

A second-source agreement is designed to make the most of both skill sets. A company that excels at production agrees to manufacture products designed by another company with a viable vaccine candidate. For example, the biggest vaccine manufacturer in the world, Serum Institute of India, is producing doses of AstraZeneca’s vaccine. They’ve already begun production, so there will be doses available for low- and middle-income countries if AZ’s vaccine is approved for use. And our foundation took on some of the financial risk, so if it doesn’t get approved, Serum won’t have to take a full loss.

It’s hard to overstate how unusual these second-source agreements are. Imagine Ford offering up one of its factories for Honda to build Accords. But given the scale of the problem and the urgency of solving it, many pharmaceutical companies are seeing the benefit of working together in new ways like this.

It’s similar to how, during World War II, the U.S. ramped up its manufacturing capacity at a mind-blowing rate by converting auto factories into tank and truck factories—only this time, the government isn’t involved. Companies are responding to the crisis by doing away with business as usual.

And how do you distribute 5 to 10 billion doses around the world?

Year in Review 2020

In addition to manufacturing, there’s the challenge of making sure that COVID-19 vaccines will be distributed equitably. That’s both a logistical hurdle and a financial one.

Sixteen pharmaceutical companies have already committed with our foundation to ensuring that vaccines and other lifesaving tools will be made available in a fair way. The world’s top experts in shipping and delivery will need to figure out how to move all these vaccines around the planet while keeping them at the right temperature every step of the way. National governments will be responsible for in-country distribution of vaccines on a scale and level of complexity unlike any other public health campaign ever.

And rich countries will need to step up with new funding through organizations like GAVI, which has a phenomenal track record of helping immunize children in poor countries.

The issue of equity is one that both Melinda and I have been working on, not only as it relates to vaccines, but also the way the recovery needs to encompass everyone, including people of color in the U.S. and people in poor countries around the world. Melinda will cover this in detail in our Annual Letter, which we’ll release next month.

One other challenge will remain when vaccines are widely available: the sizable percentage of people who will hesitate to take them. Some are afraid of vaccines already. Others may worry that the COVID-19 vaccines were rushed and might be less safe than, say, the flu shot they get every year. And in some communities, people have an understandable historical mistrust of the government’s role in medical studies.

It doesn’t help that there are false conspiracy theories about vaccines, including some that involve Melinda and me. For our part, we will keep talking about the sole reason we fund vaccines: because we’re passionate about saving lives and making sure all children have a chance to grow into adulthood. We feel a responsibility to give our wealth back to society, and we believe that no outlet for our giving returns more value to the world than helping develop and distribute vaccines. They are a medical miracle that made it possible to cut the childhood death rate in half in the past two decades.

I hope credible leaders—politicians, community leaders, scientists, and family doctors especially—will help explain the safeguards in the system. The FDA is one of the most respected drug-regulating agencies in the world for a reason. Its approval process is second to none. No safety steps were skipped in approving COVID-19 vaccines. If enough people are willing to join the first wave of recipients, then hopefully others will see the benefits and want to take it too.

In the search for treatments, failure was a success

Year in Review 2020

As I often tell the team at the foundation, we can’t be afraid of failing—and when we do fail, we should do it quickly and learn from it. Here’s an example of how we failed quickly with potential COVID-19 treatments, but in the most productive way possible.

In March, we joined Mastercard and Wellcome in creating the Therapeutics Accelerator. The idea was to use robots developed by the pharmaceutical industry to quickly screen thousands of existing chemical compounds in the hope that one of them might lead to a treatment for COVID-19. We wanted to know: Do any biotech or pharma companies already have something on the shelf that could be the solution to the pandemic?

The answer was no.

That was disappointing, but it was a useful disappointment. It spared the medical field millions of dollars and a year or two of laboriously going from one company to another, testing one compound after another. In that sense, it wasn’t a failure at all. Scientists knew within months where the dead ends were, so they didn’t waste time going down them.

One of the successful treatments you’ve probably heard about is a steroid called dexamethasone. The cool part of the story is how quickly scientists were able to figure out that it works for severe cases of COVID-19.

The dexamethasone trial was done through a network called RECOVERY, which was set up with various protocols that allowed it to run rapid trials of COVID-19 drugs. It took just four months for RECOVERY to demonstrate that the drug reduced mortality by 30 percent in severe cases—and they did this study amid a lot of confusion and misinformation about other putative therapies that didn’t work out. Dexamethasone has become a standard of care in severe cases, and the speed with which it was studied and approved is a good sign for the future.

Another approach to treatment you may have read about is called monoclonal antibodies. These are created by taking the antibodies in the blood of COVID-19 survivors and flowing them past a spike protein to see which ones stick the most. (The stickier they are, the better they are at attacking the virus.) Then you figure out the gene sequence that makes that antibody, use a factory to make billions of copies of it, and give them to patients.

Although you may not have heard about antibody treatments before the pandemic, there’s nothing new about them. Today they’re used in some of the most popular medicines in the world, including arthritis treatments.

The key question surrounding COVID-19 antibodies is whether manufacturers make enough of them so they can be delivered to the entire world? It depends partly on the size of the required dose. Some treatments have involved doses as large as 8 grams. If something substantially smaller—such as 0.5 grams—works well, then it will be possible to treat far more people. Scientists also need to see if it’s possible to replace the current IV infusion with a two-shot dose.

If researchers solve the dosage and infusion challenges, then the main limiting factor will be manufacturing capacity. To deal with that, our foundation underwrote a second-source agreement in which Fujifilm Diosynth will produce an antibody developed by Eli Lilly. These doses will be earmarked for low- and middle-income countries and priced accordingly, so that millions of affordable doses will be available within 90 days of regulatory approval.

World Bank Supports First COVID-19 Vaccine Rollout in Lebanon

The World Bank today approved a re-allocation of US$34 million under the existing Lebanon Health Resilience Project to support vaccines for Lebanon as it faces an unprecedented surge in COVID-19, with record-breaking numbers of around 5,500 daily confirmed cases since the beginning of the year.

This is the first World Bank-financed operation to fund the procurement of COVID-19 vaccines. The financing will provide vaccines for over 2 million individuals. The vaccines are expected to arrive in Lebanon by early February 2021.

In addition to the human toll, the pandemic is exacerbating the economic crisis in the aftermath of the Port of Beirut explosion last August. This vaccine rollout will target priority groups: high risk health workers, population above 65 years of age, epidemiological and surveillance staff, and population between 55-64 years with co-morbidities. By prioritizing these groups, the country’s vaccination program has the potential to reduce the consequences of the pandemic, even in conditions of supply constraints.

Fair, broad, and fast access to COVID-19 vaccines is critical to protecting lives and supporting economic recovery,” said World Bank Group President David Malpass. “This is an important first operation and I look forward to continuing our support to many more countries in their vaccination efforts. Our goal remains to mitigate the impact of the pandemic in order to save lives and improve livelihoods.

This latest support for Lebanon draws on World Bank’s previous work supporting vaccination efforts over the decades, including polio, measles and Ebola. It combines financing, global expertise, and in-country experience across sectors to build more resilience, ahead of future health emergencies.

The country’s health sector is severely overstretched. As of January 17, 2021, the country had a total of 252,812 confirmed cases and 1,865 deaths. Test positivity rate for the last 14 days is high at 17 percent (compared to the WHO suggested maximum rate of 5 percent).

In preparing for vaccine deployment, the Government of Lebanon, with the support of the World Bank and other partners, has conducted the COVID-19 vaccine readiness assessment, established a National COVID-19 Vaccine Committee, and prepared a draft National COVID-19 Vaccine Deployment Plan (NVDP). The draft NVDP has all the key elements recommended by the World Health Organization and represents a central part of Lebanon’s vaccination readiness.

The NVDP will also include key readiness actions, namely: the development of the sub-plan for vaccine deployment; the most critical regulatory actions for vaccine rollout; the development of an online system for pre-registration of eligible priority groups; the development and dissemination of Standard Operating Procedures for vaccine storage, distribution and delivery; training and supervision of vaccinators and ensuring grievance reporting mechanisms related to COVID-19 vaccination. A public communication campaign will also be launched to provide the population with information on eligibility, vaccination sites, timing, vaccine safety and efficacy.

In response to the COVID-19 outbreak in the country, the World Bank had in March 2020 allowed the same Lebanon Health Resilience Project to help strengthen the Ministry of Public Health’s capacity to respond to the COVID-19 crisis by equipping public hospitals and increasing their ability to test and treat suspected cases. Fast track procurement through local and international suppliers, following World Bank procedures and in coordination with UN agencies, has since helped procure critically needed goods and equipment to 45 hospitals. These included Personal Protective Equipment, 60 ventilators, 10 PCR machines and testing kits. In addition, 50 Intensive Care Units (ICU) were equipped with ICU beds and their associated equipment including vital signs monitors, syringe pumps, suction pumps, infusion pumps, defibrillators, and ECG machines. The procurement of additional goods and equipment is currently underway to further increase the capacity and the number of ICU beds up to 180 beds with associated equipment.

The Lebanon Health Resilience Project is financed through a US$95.8 million contribution from the International Bank for Reconstruction and Development and a US$24.2 million grant from the Global Concessional Financing Facility (GCFF). Launched in 2016, the GCFF provides concessional financing to middle income countries hosting large numbers of refugees at rates usually reserved for the poorest countries.

The World Bank Group, one of the largest sources of funding and knowledge for developing countries, is taking broad, fast action to help developing countries strengthen their pandemic response. It is supporting public health interventions, working to ensure the flow of critical supplies and equipment, and helping the private sector continue to operate and sustain jobs. The WBG is making available up to $160 billion over a 15-month period ending June 2021 to help more than 100 countries protect the poor and vulnerable, support businesses, and bolster economic recovery. This includes $50 billion of new IDA resources through grants and highly concessional loans and $12 billion for developing countries to finance the purchase and distribution of COVID-19 vaccines.

Scientists are monitoring a coronavirus mutation that could affect the strength of vaccines

As scientists try to track the spread of a new, more infectious coronavirus variant around the world — finding more cases in the United States and elsewhere this week — they are also keeping an eye on a different mutation with potentially greater implications for how well Covid-19 vaccines work.

A hospital worker walks among Covid-19 patients in the Covid-19 ward at Khayelitsha Hospital, near Cape Town, South Africa.RODGER BOSCH/AFP VIA GETTY IMAGES

The mutation, identified in a variant first seen in South Africa and separately seen in another variant in Brazil, changes a part of the virus that your immune system’s antibodies get trained to recognize after you’ve been infected or vaccinated. Lab studies show that the change could make people’s antibodies less effective at neutralizing the virus. The mutation seems to help the virus disguise part of its signature appearance, so the pathogen might have an easier time slipping past immune protection.

It’s not that the mutation will render existing vaccines useless, scientists stress. The vaccines authorized so far and those in development produce what’s called a polyclonal response, generating numerous antibodies that home in on different parts of the virus. Changes to any of those target sites raise the possibility that the vaccines would be less effective, not that they won’t work at all.

“With one mutation or even three mutations, it’s expected the antibodies will still recognize this variant, though they might not recognize it as well as other variants,” said Ramón Lorenzo-Redondo, a molecular virologist at Northwestern University’s Feinberg School of Medicine.

Essentially, the mutation is getting attention because it appears more likely to have some effect on vaccines than other mutations that have emerged, though scientists are still trying to test that hypothesis. The more contagious variant raising global alarms, which was first seen in the United Kingdom and is referred to as B.1.1.7, is not thought to have mutations that will greatly affect vaccines, the evidence so far indicates.

“We need to be monitoring for these mutations,” said Jesse Bloom, an evolutionary virologist at Fred Hutchinson Cancer Research Center, who with colleagues published a paper about this specific mutation, known as E484K, this week.


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NIH neuroscientists isolate promising mini antibodies against COVID-19 from a llama

National Institutes of Health researchers have isolated a set of promising, tiny antibodies, or “nanobodies,” against SARS-CoV-2 that were produced by a llama named Cormac.

Scientists isolated nanobodies against COVID-19 from a llama named Cormac. Triple J Farms, Bellingham, Washington.

Preliminary results published in Scientific Reports suggest that at least one of these nanobodies, called NIH-CoVnb-112, could prevent infections and detect virus particles by grabbing hold of SARS-CoV-2 spike proteins. In addition, the nanobody appeared to work equally well in either liquid or aerosol form, suggesting it could remain effective after inhalation. SARS-CoV-2 is the virus that causes COVID-19.

The study was led by a pair of neuroscientists, Thomas J. “T.J.” Esparza, B.S., and David L. Brody, M.D., Ph.D., who work in a brain imaging lab at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS).

“For years TJ and I had been testing out how to use nanobodies to improve brain imaging. When the pandemic broke, we thought this was a once in a lifetime, all-hands-on-deck situation and joined the fight,” said Dr. Brody, who is also a professor at Uniformed Services University for the Health Sciences and the senior author of the study. “We hope that these anti-COVID-19 nanobodies may be highly effective and versatile in combating the coronavirus pandemic.”

A nanobody is a special type of antibody naturally produced by the immune systems of camelids, a group of animals that includes camels, llamas, and alpacas. On average, these proteins are about a tenth the weight of most human antibodies. This is because nanobodies isolated in the lab are essentially free-floating versions of the tips of the arms of heavy chain proteins, which form the backbone of a typical Y-shaped human IgG antibody. These tips play a critical role in the immune system’s defenses by recognizing proteins on viruses, bacteria, and other invaders, also known as antigens.

Because nanobodies are more stable, less expensive to produce, and easier to engineer than typical antibodies, a growing body of researchers, including Mr. Esparza and Dr. Brody, have been using them for medical research. For instance, a few years ago scientists showed that humanized nanobodies may be more effective at treating an autoimmune form of thrombotic thrombocytopenic purpura, a rare blood disorder, than current therapies.

“The SARS-CoV-2 spike protein acts like a key. It does this by opening the door to infections when it binds to a protein called the angiotensin converting enzyme 2 (ACE2) receptor, found on the surface of some cells,” said Mr. Esparza, who is also an employee of the Henry M. Jackson Foundation for the Advancement of Military Medicine and the lead author of the study. “We developed a method that would isolate nanobodies that block infections by covering the teeth of the spike protein that bind to and unlock the ACE2 receptor.”

To do this, the researchers immunized Cormac five times over 28 days with a purified version of the SARS-CoV-2 spike protein. After testing hundreds of nanobodies they found that Cormac produced 13 nanobodies that might be strong candidates.

Initial experiments suggested that one candidate, called NIH-CoVnb-112, could work very well. Test tube studies showed that this nanobody bound to the ACE2 receptor 2 to 10 times stronger than nanobodies produced by other labs. Other experiments suggested that the NIH nanobody stuck directly to the ACE2 receptor binding portion of the spike protein.

Then the team showed that the NIH-CoVnB-112 nanobody could be effective at preventing coronavirus infections. To mimic the SARS-CoV-2 virus, the researchers genetically mutated a harmless “pseudovirus” so that it could use the spike protein to infect cells that have human ACE2 receptors. The researchers saw that relatively low levels of the NIH-CoVnb-112 nanobodies prevented the pseudovirus from infecting these cells in petri dishes.

Importantly, the researchers showed that the nanobody was equally effective in preventing the infections in petri dishes when it was sprayed through the kind of nebulizer, or inhaler, often used to help treat patients with asthma.

“One of the exciting things about nanobodies is that, unlike most regular antibodies, they can be aerosolized and inhaled to coat the lungs and airways,” said Dr. Brody.

The team has applied for a patent on the NIH-CoVnB-112 nanobody.

“Although we have a lot more work ahead of us, these results represent a promising first step,” said Mr. Esparza. “With support from the NIH we are quickly moving forward to test whether these nanobodies could be safe and effective preventative treatments for COVID-19. Collaborators are also working to find out whether they could be used for inexpensive and accurate testing.”

This study was supported by NIH Intramural Research Programs at the National Institute of Neurological Disorders and Stroke (NINDS) and National Institute of Environmental Health Sciences (NIEHS); Dr. Brody is an employee of the Uniformed Services University of the Health Sciences. The views expressed here do not represent those of the Department of Defense.

Pregnant women in third trimester unlikely to pass SARS-CoV-2 infection to newborns

Pregnant women who are infected with SARS-CoV-2, the virus that causes COVID-19, during the third trimester are unlikely to pass the infection to their newborns, suggests a study funded by the National Institutes of Health.

The study followed 127 pregnant women who were admitted to Boston hospitals during the spring of 2020. Among the 64 pregnant women who tested positive for SARS-CoV-2, no newborns tested positive for the virus. NIH support was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases (NIAID).

“This study provides some reassurance that SARS-CoV-2 infections during the third trimester are unlikely to pass through the placenta to the fetus, but more research needs to be done to confirm this finding,” said Diana W. Bianchi, M.D., NICHD Director.

The study, published in the journal JAMA Network Open, was led by Andrea G. Edlow, M.D., M.Sc., of Massachusetts General Hospital and Harvard Medical School.

The researchers studied the occurrence of SARS-CoV-2 infection in the third trimester of pregnancy, evaluating levels of virus in respiratory, blood and placental tissue samples, the development of maternal antibodies, how well those antibodies passed through the placenta to the fetus (an indicator of potential immune protection from the mother) and examined placental tissue. The results reported are limited to women in the third trimester because data on women infected during the first and second trimesters are still being collected and evaluated.

Among those who tested positive for SARS-CoV-2 in the study, 36% (23/64) were asymptomatic, 34% (22/64) had mild disease, 11% (7/64) had moderate disease, 16% (10/64) had severe disease, and 3% (2/64) had critical disease. The study included, as comparators, 63 pregnant women who tested negative for SARS-CoV-2 and 11 reproductive-age women with COVID-19 who were not pregnant.

The team found that pregnant women who were positive for SARS-COV-2 had detectable levels of virus in respiratory fluids like saliva, nasal and throat secretions, but no virus in the bloodstream or the placenta.

The researchers did not find significant differences between levels of SARS-CoV-2 antibodies produced by pregnant and non-pregnant women. However, the study team did observe lower-than-expected levels of protective antibodies in umbilical cord blood. In contrast, they found high levels of influenza-specific antibodies, presumably from maternal flu vaccination, in the cord blood samples of both SARS-CoV-2 positive and negative women. The researchers suggest these findings may indicate that SARS-CoV-2 antibodies do not pass through the placenta as easily as other maternal antibodies.

The researchers believe theirs is one of the first reports of less-than-expected transfer of SARS-CoV-2 antibodies to the fetus. Low transfer of these antibodies was observed regardless of the woman’s severity of COVID-19 or whether she had an underlying health condition, such as obesity, high blood pressure or diabetes. The study authors noted that it will be important to determine why these maternal antibodies are less likely to cross the placenta and whether this reduced antibody transfer renders newborns more vulnerable to SARS-CoV-2 infection, compared to other infections. The authors added that it will be important to determine how lower levels of maternal SARS-CoV-2 antibodies may affect health outcomes of preterm babies because COVID-19 may increase the risk of preterm labor.

The study also found that placentas from infected women were not different from those of uninfected women, though the risk for ischemia (reduced blood flow) in the placenta appeared higher for women with more severe COVID-19. In line with an earlier report, the researchers also found that while the placenta expresses major molecules used by SARS-CoV-2 to cause infection — the ACE2 receptor and the TMPRSS2 enzyme — the two molecules are rarely expressed together in the same location, which may help explain why the virus only rarely affects the placenta.

The researchers suggest their findings could help improve the care of pregnant women with COVID-19 and of their newborns, as well as provide information to assist in the development of new strategies for vaccinating pregnant women.

Two billion COVID vaccine doses secured, WHO says end of pandemic is in sight

The Pfizer-BioNTech COVID-19 vaccine is the first vaccine to be made readily available in some parts of the world

The end of the pandemic is in sight but we must not let our guard down, the head of the World Health Organization (WHO) said on Friday, as he welcomed the news that the global vaccine partnership COVAX has lined up almost two billion doses of existing and candidate vaccines for use worldwide.

The huge vaccine reservoir means that COVAX, a 190-country international initiative that seeks to ensure all countries have equal access to coronavirus vaccines, can plan to start delivering the shots in the first quarter of 2021.

By mid-year it will have delivered enough doses to protect health and social care workers in all participating countries that have asked to get doses in that timeframe. All other participants should get sufficient doses to cover up to 20 per cent of their populations by the end of 2021, and further doses in 2022.

“This is fantastic news and a milestone in global health”, WHO Director-General Tedros Adhanom Ghebreyesus told reporters attending an online press conference.

“This is a time for taking comfort that the end of the pandemic is in sight, but taking care that we do not let down our guard. We are all responsible for taking the measures to keep ourselves and each other safe, including during this holiday season.

“With today’s news the light at the end of the tunnel has grown a little bit brighter, but we are not there yet. And we will only get there together”, Tedros said

Why we’re giving $250 million more to fight COVID-19

Mark Suzman
By Mark SuzmanCEO, Bill & Melinda Gates FoundationConnectMore about the author 
Photo by Nicholas Kajoba/Xinhua via Getty Images

Today, the Gates Foundation is making its largest single contribution to fight the pandemic—$250 million. Why so much? And why now? It’s been roughly a year since COVID-19 first appeared. The rationale has to do with where the public health effort is at the end of 2020.

In the pandemic’s first year, the work of ending the pandemic was confined to a relatively small domain: Labs and clinical trials. That’s where researchers were developing new drugs, tests, and vaccines to fight COVID-19. Around the world, public health experts were doing hero’s work, setting up field hospitals; treating and testing patients; securing supplies of oxygen and existing drugs like dexamethasone. But no one thought those efforts were sustainable or that they’d neutralize the threat of COVID-19. They were aimed at suppressing the virus’ spread until researchers succeeded in developing medical solution to the disease, and now they have.

As of today, three vaccine candidates have emerged from the trials with high efficacy rates: Pfizer’s, Moderna’s, and AstraZeneca’s. Two antibody treatments have been authorized for emergency use. Another antiviral has been FDA approved.

The world now has much of the science it needs to end this pandemic, and as regulators start to put their stamp of approval on it, the field of action is widening beyond the lab. It’s expanding to the factories that will make the drugs, tests, and vaccines; to the warehouses, planes, and refrigerator trucks that will deliver them; to the clinics and health workers that will sit at the end of the supply chain and administer them to patients.

The planet is about to be crisscrossed by a massive anti-covid manufacturing and delivery network. In some places, it’s already up-and-running. The world’s richest nations have pre-purchased enough vaccine supply to cover their populations; some will be able to cover everybody two or three times over.

But the situation is very different for the majority of human beings that live in low- and middle-income nations, which include everywhere from South Sudan to Peru. In these countries, the supply chain hasn’t started to hum. Few deals have been cut with pharmaceutical companies, and the forecasts for vaccine supply are low. As things stand now, these countries will only be able to cover 20% of their people at most, according to our foundation’s projections.

Will 2021 actually play out this way, with vaccines, drugs, and tests going mainly to the richest places? Or will the lifesaving science be available to everyone, regardless of location or income? Our foundation has a clear perspective on what the answer should be.

Fair access to vaccines is part of our origin story. One of Bill and Melinda’s first big philanthropic acts was to help create Gavi, the organization that works with low-income countries to immunize hundreds of millions of kids. Part of today’s $250 million commitment will go towards funding a similar delivery operation for COVID-19 drugs and vaccines.

In fact, this announcement brings the Gates Foundation’s total contribution towards fighting the pandemic to $1.75 billion, and much of it has gone towards the production and procurement of crucial medical supplies. (The breakdown is visualized above; some of the funding, including today’s commitment, comes in the form of new direct grants; another tranche is repurposed funding from elsewhere in our budget, while still more is not direct funding at all; it’s in the form of loans and other financing measures. You can read more about our sources of funding here).

It’s also important to point out that there is not a hard break between the scientific phase of the fighting the pandemic and this new, more logistical one. In 2021, R&D funding will still be needed for new drugs, vaccines, and tests, in part because some of these initial ones aren’t ideally suited for low-income nations. The Pfizer vaccine, for instance, needs to be kept at sub-zero temperatures, which will be very difficult when transporting it to very rural areas. Our foundation will keep funding innovation.

Where our foundation’s role stops—and others’ start

How is our money actually transformed into new COVID-19 drugs, medical supplies, and the network to deliver them? We’re not doing the work ourselves. The Gates Foundation employs many talented people, but none of them are the researchers running the clinical trials or the health workers who will administer the shot of vaccine into a patient’s arm. Our partners do that.

In the early days of the pandemic, a good example of how we worked was with the Africa CDC. In early February, only two countries in sub-Saharan Africa had the lab facilities to test for COVID-19—Senegal and South Africa. But our foundation was able to release some emergency funding; it helped the countries build up the capacity of their labs and procure diagnostic kits, while the ACDC set up a training program for public health officials in the region. By the end of February, more than 40 African countries had the ability to test for COVID-19.

Today, the big effort to manufacture and deliver these supplies is the ACT-Accelerator, which is operated by organizations like the WHO, Gavi, and the Global Fund to Fight AIDS, TB, and Malaria. For 20 years, they’ve specialized in the task of procuring drugs, vaccines, and other lifesaving science. They also work with lower-income countries to transport them to health centers. These groups are the ones leading this work while our foundation assists with expertise and funding.

In fact, we cannot even be their main source of funding. The task is too big.

It’s hard to give a sense of scale of the public health effort needed to end the pandemic. The closest analogue might be India’s campaign to vaccinate 400 million kids with the measles-rubella vaccine. The project took two years, with another of planning. For COVID-19, the world must cover almost 18x the population—and do it in hopefully half the time. It will be a very expensive job. The ACT-Accelerator estimates that it needs another $28 billion next year. National governments are the only institutions with that kind of budget.

While wealthy countries donated in 2020, they have good reason give more in 2021. A new study from the Eurasia Group found that fair access to COVID-19 vaccines won’t just benefit low-income nations; it will also benefit the world’s 10 largest economies to the tune of $153 billion of extra GDP created in 2021 alone. Against the $28 billion that the Accelerator needs, that’s a jaw-dropping return on investment: 446%.

The shape of our recovery

The world should feel hopeful that we’ve reached this point. Even though we’re entering a costlier phase, it’s one we can be more confident about. It was never a given that researchers would develop safe and effective COVID-19 vaccines so quickly. The world’s experts doubted it could be done by the end of 2020. The work ahead isn’t the same in this respect. Thanks to groups like Gavi and the Global Fund, the world has known how to deliver vaccines and other supplies around the world for a long time.

2020 was a year that saw COVID-19 on the march. The pandemic got progressively worse. We can be confident that 2021 will play out in the opposite way. With new drugs, vaccines, and improved testing, the world will get progressively better.

But how fast will “better” happen?

The shape of our recovery—whether it looks like a “V” or “U” or a line that drags far too low, far too long—depends on how generous and committed world leaders are to this principle: That, in 2021, everyone, everywhere deserves to benefit from the science developed in 2020.Published:Dec 09, 2020AUTHOR(S)

Mark Suzman

By Mark SuzmanCEO, Bill & Melinda Gates FoundationMark Suzman, the CEO of the Bill & Melinda Gates Foundation, leads the foundation’s efforts to promote equity for all people around the world.Connect.

Credit: Bill & Milinda Gates Foundation