vaccination

  • Covid-19 (Coronavirus)- Universal Testing for Breaking Community Transmission

    Covid-19 (Coronavirus)- Universal Testing for Breaking Community Transmission

    Introduction

    The Covid-19 (Coronavirus) is spreading in communities both urban and rural in many countries in the world. The confinement is not a sustainable option. It can help in the short-term, but it is not affordable economically and socially.
    Currently, three options are the ones that can contribute effectively to break the Covid-19 transmission:
    (i) Universal vaccination: It may take a minimum of 5 years for the world.
    (ii) Universal testing: It may take one year if included in the global health systems.
    (iii) Universal barrier methods (mask, hand washing, and social distancing): It may take one month if there is political and community engagement.

    Universal Screening
    The PCR test with high sensitivity and specificity is the one largely utilized by the global health systems. The PCR is not technically accessible, and it is expensive. When the Covid-19 was with travelers and few contacts, it was the preferable test. Currently, Covid-19 is spreading globally in the communities.

    Moving forward to the rapid tests and serology tests may increase the access technically and financially. There are rapid and serology combo tests (antigen and antibody) tests that can detect early and chronic infection or asymptomatic carrier. The positive cases should be confirmed by the PCR. There are rapid tests that can be used by the health professionals and the ones can be used at home (community health workers or self-testing).

    Universal screening both by the health professionals, community testing, and self-testing for the detection of early and chronic or asymptomatic infections have high potential (high impact) to breaking the community transmission when the universal vaccination is not yet possible.

    Access to the testing
    The regulatory bodies of the health laboratories (Ministries of Health, Food and Drugs Authorities, etc.) should accredit the Covid-19 tests, the official representatives of the manufacturers (storage, transport, etc.), as well as the services providers (hospitals, clinics, pharmacies, etc.). This is to ensure the quality is maintained at all levels.

    As much as many tests, many distributors, and many services will be accredited, the accessibility will increase towards universal access to testing. The access to the community and self-tests will make a big move towards the breaking of the transmission.

    Incentives to the testing
    There is an opportunity to establish a direct linkage between the economy and social activities to the prevention. All activities should be authorized on the conditions to have all the persons concerned to be tested and use the barrier methods (mask, hand washing or sanitizing, and social distance). The risky places like the dancing clubs, cinemas, etc. should need PCR tests. For others like the open markets, etc. should need the rapid and serology tests especially the combo tests that include the antigen and antibody testing. The regulatory bodies should provide the details of how each test should be used (what, why, and how).

    With the decentralization of the Covid-19 tests at the community and households’ levels and linkages between the testing and the economic and social activities, universal testing can be reached and contribute highly to breaking the transmission.

    Financing the testing
    By moving towards universal testing, the economy of scale should be considered for the pricing. Regulatory bodies should assess the market and standardize the prices across the tests with the same nature and costs. The insurances (travel and health especially) should include the Covid-19 tests in the benefit packages. The subsidies to low-income populations should be planned for ensuring the test will not be a catastrophic health expenditure factor.

    Conclusion
    The Covid-19 universal testing can allow global businesses to resume as per the past normal conditions before the universal vaccination will be possible.

    Dr. Claude Sekabaraga

  • Ending Covid-19 (Coronavirus): Management of Public Market Cluster for Breaking the Community Transmission (Contamination) in Developing Worlds

    Ending Covid-19 (Coronavirus): The Management of Public Market Cluster for Breaking the Community Transmission (Contamination) in Developing Worlds

    Introduction

    The developing worlds within the low- and middle-income countries, and even some areas of high-income countries, may represent more than 75% of the world population. The developing worlds don’t usually use the private markets (malls), but they use the public markets with different levels from a village market to a large city market. The low-income populations don’t usually have the fridges and freezers to store food for many days. They don’t even have money to buy food for many days. The population goes to the market daily in cities and once or twice a week in villages where the markets complement the family production. Meaning the market connects daily the cities populations and once or twice a week the village families. During the confinement, it is not possible to close the public markets for the reasons mentioned above. To end the Covid-19 pandemic the public market contamination or transmission cluster needs strategic, practical options and customized ways to prevent the contamination or transmission.

    Engaging and Capacity Building of the Public Market Management

    Having the public market management engaged to put in place the preventive measures is key. The entry door should be to build their capacity and confidence as well as their leadership. The capacity building should be customized to the specificity of the market including the users (sales and buyers). Many public markets are open spaces, without clear entrances and exits. Very few may have cameras to monitor the respect of the barrier’s preventive measures. Supervisors don’t have in their terms of reference and capacity to monitor the disease’s transmission. In fact, the Covid-19 programs should build it for Covid-19 but also for potential other epidemics or pandemics. 

    Handwashing or Disinfection

    Many public markets, especially the ones of the small cities and rural areas may not have the capacity to organize the public markets to have official entrances and exits as well as handwashing and disinfection stations. Even the public markets in bigger cities may be in that situation. For the disease’s prevention, in occurrence for ending the Covid-19 pandemic, the support should ensure the persons using the public markets can wash and sanitize the hands at the entrance and exits, and as necessary. It is an important contribution that may have a global impact considering the big number of people using the public markets and who connects more than 75% of the families around the world. In normal situations, hand washing prevents an average of 40% of diarrheas, especially of children.

    Wear of Mask and Social Distancing

    Having the public market’s users wear properly the mask and social distancing is necessary to end Covid-19 because to have the vaccination coverage level that can break the transmission (at least 60%) may take many years. Establishing a monitoring system of the proper port of mask and social distancing in each public market is important. The management of the public market should be supported in terms of skills, systems, and technologies to be able to sensibilize and monitor wearing the mask and social distancing.

    Testing of Covid-19

    The public market is a cluster that embraces communities, families, and individuals from different local, neighbor countries, regional and global areas. It is a composite cluster. Testing the users in all of them including confirming the variants may be an important factor in ending the Covid-19. 

    Vaccination of Covid-19

    The public market is a potential site that may bring the Covid-19 vaccination to the communities. The public market is central in terms of community life. To end the Covid-19, the vaccination should be part of this community life for acceptability and access.

    Conclusion

    The public markets in developing worlds within the low-middle and high-income countries have potential high impact to implement almost all the diseases prevention strategies and interventions, including handwashing and sanitizing, wearing the mask and social distancing, and vaccination for Covid-19.  

    Dr. Claude Sekabaraga

     

  • Equitable and Sustainable Financing of Covid-19 Vaccination of Developing Countries

    Equitable and Sustainable Financing of Covid-19 Vaccination of Developing Countries

    I. Introduction

    The vaccination, including the vaccine, logistics, and healthcare administration, may cost an average of US$75 per person. The government tax to gross domestic products (GDP) per capita is 10-15% as the economy is 70-90% informal sector (not filing and paying the government tax). Before Covid-19, the GDPs per capita of most developing countries were US$500-US$1,000. With Covid-19, the GDP may be mostly below US$500 per capita. The tax to GDP (regular government budget source) is then US$50-75. Meaning the government of the developing countries should need to use almost 100% of the budget to finance Covid-19 vaccination. How to ensure vaccine availability and avoid financial barriers to Covid-19 vaccination?

    II. Financing options

    1. Covid-19 Vaccines Global Access (Covax) led by GAVI, WHO, UNICEF and CEPI

    It is a great initiative but currently mobilizes less than 10% of the budget. The sources of financing are governments essentially, foundations and companies. With the global economic health crisis, it may be impossible to have the Covax mechanism cover more than 50% of the three-year needs. Which options to increase and sustain the financial capacity of the Covax mechanism? A small percentage added to the international flight tickets may provide sustainable contributions.  Covax should engage as possible the international travel organizations like International Air Transport Association (IATA) and similar and regulators.

    The countries should use the purchasing power of the Covax mechanism to acquire cost-effective vaccines. It requires Covax to establish grants and paid vaccines for developing countries.

     2. National Covid-19 Vaccination Financing by Developing Countries

    The fiscal space to accommodate the cost of the vaccines and related services doesn't almost exist. A small percentage of the telecommunication fee (used by more than 80% of the population, with easy payment collection) should contribute to financing the vaccination in a realistic, sustainable, and socially acceptable manner).

    The persons with more than US$15,000 income a year (5-25%) may contribute using voluntarily paid vaccination facilities. It can be an opportunity of having cross-social economic categories indirect solidarity. It may help the businesspersons benefit with less waiting time, and some comforts already are paying for other services (accommodation, leisure, etc.).

    III. Conclusion

    The universal Covid-19 vaccination may be reached if both the Covax and developing countries' governments design sustainable financing mechanisms beyond the current funding grant-based. As GAVI slogan: "No one is safe until everyone is safe."  

    Dr. Claude Sekabaraga, MD, MPH

    Quality & Equity Healthcare

     

  • Financement Equitable et Pérenne de la Vaccination de la Covid-19 des Pays en Voie de Développement

    Financement Equitable et Pérenne de la Vaccination de la Covid-19 des Pays en Voie de Développement

    I. Introduction

    La vaccination, y compris le vaccin, la logistique et l'administration des soins de santé, peut coûter en moyenne 75 $ US par personne. L'impôt gouvernemental sur les produits intérieurs bruts (PIB) par habitant est de 10 à 15%, car l'économie est à 70 à 90% du secteur informel (ne déclarant pas et ne payant pas la taxe gouvernementale). Avant Covid-19, le PIB par habitant de la plupart des pays en développement était de 500 à 1 000 dollars. Avec Covid-19, le PIB peut être pour la plupart inférieur à 500 dollars par habitant. L'impôt sur le PIB (source du budget ordinaire du gouvernement) est alors de 50 à 75 dollars. Cela signifie que le gouvernement des pays en développement devrait utiliser près de 100% du budget pour financer la vaccination contre le Covid-19. Comment garantir la disponibilité des vaccins et éviter les obstacles financiers à la vaccination contre Covid-19 ?

    II. Options de financement

    1. Accès mondial aux vaccins Covid-19 (Covax) dirigé par GAVI, l'OMS, l'UNICEF et le CEPI :

    C'est une belle initiative mais qui mobilise actuellement moins de 10% du budget. Les sources de financement sont essentiellement les gouvernements, les fondations et les entreprises. Avec la crise mondiale de la santé économique, il est presque impossible que le mécanisme Covax couvre plus de 50% des besoins sur trois ans. Quelles options pour augmenter et maintenir la capacité financière du mécanisme Covax ? Un petit pourcentage ajouté aux billets d'avion internationaux peut fournir des contributions durables. Covax devrait engager autant que possible les organisations de voyage internationales telles que l'Association Internationale de Transport Aérien (IATA) et les organismes de réglementation.

    Les pays devraient utiliser le pouvoir d'achat du mécanisme Covax pour acquérir des vaccins à bon prix. Ceci demande que Covax puisse établir une option avec des subventions et une option pour vendre les vaccins aux pays en développement.

    2. Le financement national de la vaccination contre le Covid-19 par les pays en développement :

    L'espace fiscal pour l’achat des vaccins et des services connexes n'existe presque pas. Un petit pourcentage des frais de télécommunication (utilisé par plus de 80% de la population, avec un recouvrement des paiements plus facile) devrait contribuer au financement de la vaccination de manière réaliste, durable et socialement acceptable.

    Les personnes dont le revenu annuel est supérieur à 15, 000 dollars (5 à 25%) peuvent contribuer en utilisant des centres de vaccination payés de manière volontaire. Cela peut être l'occasion d'avoir la solidarité transversale indirecte entre les catégories socio-économiques. Cela peut aider les personnes dans les businesses à bénéficier de moins de temps d'attente, et certains conforts déjà payés pour d'autres services (hébergement, loisirs, etc.).

    III. Conclusion

    La couverture vaccinale universelle contre la Covid-19 peut être atteinte si Covax et les gouvernements des pays en développement conçoivent des mécanismes de financement durables au-delà du financement actuel basé sur des subventions. Comme le slogan de GAVI : "Personne n'est en sécurité tant que tout le monde n'est pas en sécurité".

    Dr. Claude Sekabaraga, MD, MPH

    Quality & Equity Healthcare

     

  • Masque facial transparent et protecteur permettant les émotions (sourire, etc.)

    Mettre fin à la Covid-19 (Coronavirus), la tuberculose et d'autres maladies similaires potentielles, etc. : Nous avons besoin d'un masque facial transparent et protecteur permettant les émotions (sourire, etc.)

    Il existe de nombreuses maladies que le masque facial protège au-delà de la prévention de la Covid-19, notamment la tuberculose qui touche 10 millions de personnes dans le monde avec environ 1,5 million de décès. Il y a sept ans, le SRAS, un Coronavirus comme la Covid-19 s'est propagé dans de nombreux pays et a fait de nombreuses victimes. D'autres maladies respiratoires pourraient survenir plus tard. Le masque facial devrait faire partie de notre mode d'habillement avec un masque protecteur et transparent qui permet les émotions, notamment le sourire.

    Dr. Claude Sekabaraga

     

  • Transparent, and Protective Facial Mask Allowing Emotions (Smiling, etc.)

    Ending Covid-19 (Coronavirus), Tuberculosis, and Potential Other Similar Diseases, etc.: We need transparent, and protective facial masks allowing emotions (smiling, etc.)

    There are many diseases that the face mask protects beyond the Covid-19 prevention, including tuberculosis affecting 10 million worldwide with around 1,5 million deaths. Seven years ago, SARS, a Coronavirus like the Covid-19 spread in many countries and killed many people. Other respiratory diseases may come later. The face mask should be part of our fashion dressing with a protective and transparent one that allows emotions, especially smiling. 

    Dr. Claude Sekabaraga