"Vaccine nationalism failed to respect human rights," according to Professor Morgan Chetty, Chairman of the IPA Foundation of SA and Chairman of KwaZulu Natal Doctors Healthcare Coalition, speaking at Africa Health 2021 on access to COVID-19 vaccines. 

While wealthier nations, such as the US, UK and Canada, amassed COVID-19 vaccines and mass vaccinated up to 80 per cent of their population with the first or second dose, poorer countries are still grappling with the idea of trying to obtain access to vaccines that could take years.

Vaccine nationalism has resulted in low-income countries having to endure a long wait, as late as 2023 or 2024, before gaining access to sufficient vaccine doses. There is currently a resurgence of the virus in a dozen African countries, “and the window of opportunity for blunting the effects of these new outbreaks is rapidly closing upon us,” Prof Chetty said. 

“If everyone was united towards developing a solid solution to be shared globally, the pandemic would be manageable,” he urged.

Africa has faced COVID-19 vaccine issues including hesitancy, inertia, literacy, and access, along with limited production capacity, infrastructure and logistical challenges in terms of the cold chain, and insufficiently skilled human resources for the implementation of vaccine programmes.

“While Africa needs to vaccinate 67 to 70 percent of the population to reach herd immunity currently, just 2.55 percent of the population have had their first dose in Africa, and only 1 percent have had two doses. We are perfectly poised to be targets for more surges and for a projected pandemic,” he cautioned.

Prof Chetty further relayed that in the short term, there should be a focus on vaccine acquisition to manage the present crisis. Long term plans requiring vaccines to be manufactured in Africa may mitigate both costs and availability of vaccines.

“When national leaders meet, they need to shift the focus from their own citizens and analyse how we can globally control this virus. The pandemic may continue to circle the globe for much longer or indefinitely, and they may be numerous outbreaks due to the nature of the virus, which replicates, creating a new strain.

Therefore, if we do not work in a global sense, countries which are hailed as superpowers are not going to read reach herd immunity,” Prof Chetty advised.

COVAX was initiated to distribute vaccines equitably throughout the world, based on where it is needed the most.

“Wealthy countries put money into contracts, they proceeded with bilateral negotiations and prepaid even before the vaccine was manufactured or before the clinical trials were finished. When the vaccines were released under Emergency Use Authorisation, these countries received millions of doses of the vaccine.

Countries like Africa are still waiting for allocations. These bilateral negotiations and acquiring the vaccine through the back door defeated the purpose of COVAX. The intention of COVAX, for equitable distribution of vaccines in Africa, did not take place. A newspaper article has reported that Canada has extra doses of vaccines, and they are seeking which countries to partner with to share the vaccines. However, the question arises, if they are unable to partner with countries these vaccines will expire and be wasted.

On the other hand, there is no assurance of these vaccines' effectiveness on strains that are circulating in different parts of the world. I want to conclude by saying, we are in a predicament because our governance principles were violated,” he said.

Prof Chetty remains optimistic. “The good news is that Africa has announced three centers in which the vaccines will be manufactured, so remanufactured in the continent for the continent. Vaccines prepacked in South Africa, in Port Elizabeth, for Johnson and Johnson, and we know there's a company in Cape Town that's going to license to fill in for the Pfizer group.

In Morocco, Sinopharm will be manufactured, and with this we're going to have a bigger turnover, which is a very good start, as we are manufacturing our own vaccines at a cost we can afford, and in quantities we need, for Africa,” he concluded.

Register to attend Africa Health 2021 (25-29 October 2021) for free. Registered attendees may watch the full session here.

A rivalry between both private and public healthcare sectors was diminished, at least temporarily, when the pandemic hit the African continent, as everyone was looking for solutions, said a panel of healthcare professionals during the third day of Africa Health 2021.

“What struck me was the cooperation between public and private sectors. Both came together to strengthen healthcare in an unprecedented way,” said Dr Olujimi Coker, CEO, Lagoon Hospitals in Nigeria during the session Building a resilient healthcare system in Africa.

Dr Coker said that the private sector often has the business knowledge and discipline and capability to properly execute projects, while the public sector owns the process, licenses and pathways in which the business can function.

“Harnessing the two strengths are important. We have the ability and knowledge, while the government has the capacity,” he said. He nonetheless cautioned “during the pandemic, there was a shared goal; after the pandemic, things digress, and people go back.”

Jens Dommel, Head of Healthcare for Europe, Middle East and Africa at Amazon Web Services (AWS), commented that the quickest and most effective progress derives from governments not only open to starting the conversation with tech companies, but willing to solve problems.

“Governments are important because they architect guidelines, which eases up finding solutions,” he said. 

Dommel highlighted the challenge of developing a combination that included a partnership with human resource development and with the right tech approach. 

“Due to the shared challenge of the pandemic, we wanted to find a solution instead of defining what the solution looked like,” he added.

The AWS executive further explained that cloud technology was able to support this because the infrastructure was available. Vaccine companies, for example, were able to combine cloud technology with research and get to scale the outcome. 

Working together to grow capabilities

Panellists agreed that building capabilities to prepare the African continent for the next pandemic was the most important priority facing public-private partnerships. 

“As we move to universal health coverage and think of health, we need to bring the private sector along, as they have the quality, and human resource is managed better,” said Professor Glenda E. Gray, President and CEO, South African Medical Research Council.  

Professor Gray pointed out, however, the need for the private sector to embrace the concept that everyone has the right for medical treatment. 

“These models [public private partnership] don't work well when there is no clear governance framework. We see them work when there is a shared goal,” said Dr Boitumelo Semete-Makokotlela, the CEO of the South African Health Products Regulator. She added that there must be a “champion” for the initiative to work effectively. 

Dr Semete-Makokotlela said building Africa’s manufacturing capacity was a key learning from the experience of COVID. “It's a whole ecosystem that we need to look at right,” she said. “We really need to think about it holistically across the value chain.” 

Like other panellists, she advocated focusing on building components of partnerships and collaboration to help prepare Africa for the next pandemic. Expanding on skills and strengthening infrastructure are vital for the survival of the continent, she continued. 

Bringing in equity

Professor Gray stressed the importance of bringing equity into the private sector. She said that the private sector must learn to support rural areas and the poor. 

“We need a health system that is resilient, equitable, data driven and with quality,” she said, adding “for future resilience we need good governance and good finance.”

Dr Semete-Makokotlela said that while equity was important, it also remains critical to think and learn to utilise the limited resources available, questioning “What can we do remotely, and how can technology enable us to utilise limited resources?”

Register to attend Africa Health 2021 (25-29 October 2021) for free. 

The timely implementation of digital healthcare in Africa is a matter of survival for the continent, said Tolagbe Martins, Head of Public Sector Growth at Helium Health at Africa Health, drawing attention to pressing challenges.

“African healthcare is under significant pressure: there is brain drain, there is the effect of the pandemic, and there are justice and security issues across the continent that are making it unattractive - so another way to mitigate against these is by technology,” she explained during her talk Digitizing healthcare and its challenges on the third day of Africa Health 2021.

Yet conservative healthcare systems, along with a lack of computer literacy, a broken infrastructure and limited access to capital all present obstacles to digitising African health systems.

Reducing cost and error

Digital healthcare is a must, Martins highlighted, owing to human weakness: a digital healthcare system can reduce 48 percent of medical errors.

“We make mistakes, from writing prescriptions to putting wrong data against the wrong patient,” she acknowledged. 

According to some of the data she shared from her firm, 95.2 percent medical errors are on medication prescriptions; 83.9 percent of errors relate to laboratory investigations; and 69.4 percent of errors are associated with physician diagnoses.

“We need digital healthcare to save lives, whether by minimising error or by being able to make better decisions, or by reducing costs,” she said, explaining that digital healthcare allows for more efficient data aggregation and the management of information.

Energy, computer literacy and capital challenges

Healthcare systems are simultaneously embracing innovation while also remaining a staunch opponent, presenting a paradox. “This ‘push and pull’ will often present itself as a major challenge to adoption,” Martins said. 

This can partly be attributed to “fear” - discomfort stemming from illiteracy. 

Many healthcare professionals in Africa do not have intensive computer training or are unable to use software, Martins explained. For example, only 40 percent of healthcare professionals have used computers in Ghana and Tanzania. 

Infrastructure in Africa remains another challenge. 

Electricity is a component necessary for the adoption of digital health, yet Africa does not have much of it. More than 550 million people across the continent do not have regular access to electricity, including 60 percent of Sub-Saharan Africans, impacting cloud storage, networking, and indeed basic equipment purchases. 

“If you don't have power, why buy computers,” she asked. “I list all these challenges not to deter or frighten you, but to confront realities.”

Martins added that there was a lack of incentive to invest in digitising healthcare - and that is because the information or data where or how to invest is not available. Without relevant knowledge, there is no capital.

Africans make up 16 percent of the world population and carry 23 percent of global diseases. However, 78 percent of the healthcare investment in Africa is from the government, and it is not nearly enough to meet demand. 

“There is no incentive from the private sector or anyone else to invest,” she said.

Martins added that while there are challenges, there are also opportunities. 

A proper digital infrastructure that can be used on mobile phones is a priority. Electronic Medical Records (EMRs) or Health Management Information Systems (HMIS) need to run offline and be more mobile-friendly. Any effective EMR needs to look and feel intuitive. 

“We do all this with a sense of optimism that we are not only doing the right thing, but the profitable thing to do,” she said.

Register to attend Africa Health 2021 (25-29 October 2021) for free. 

Digital implementation in health services can provide faster and more efficient ways to care for patients. However, it requires a collaboration of knowledge between the patient, professional and healthcare organisation, said Prof S Yunkap Kwankam, CEO, Global eHealth Consultants; Executive Director, International Society for Telemedicine and eHealth (ISfTeH); and Chairman of Telenethealth International.

An advocate for implementing digital health solutions in healthcare, Prof Kwankam elaborated on Africa-specific challenges and opportunities in his Africa Health talk Emergence of eHealth / Digital Health solutions – related opportunities and challenges.

He described how Africa with the Middle East accounts for less than 5 percent of the global mobile health app market, the biggest digital health subset: a "sliver" while nonetheless a "significant" share. IoT, AI, blockchain and AR will spur further mobile app growth in the future. 

Digital health opportunities in African health systems include extending the catchment area of hospitals, reaching the previously unreached, and leveraging people. 

A digital health ecosystem should fully support integrated people-centred health services, at all levels of the healthcare pyramid, from the home and community, to clinics to hospitals to academic centres.

There remain traditional problems, such as creating integrated digital health systems and going to scale with digital health interventions, but there is also an emerging challenge: cybersecurity. 

Prof Kwankam spoke of specific cybersecurity issues in African health systems such as out of date systems, siloed health solutions, and insufficiently trained staff, both at Ministry of Health level and within the international development community. 

How to optimise health technology access and impact in Africa

Speaking during the panel session Critical supporting roles for optimised health technology access and impact in the African Region, Anna Worm, an independent advisor on biomedical equipment challenges, said that access to healthcare technology (the right equipment available on site) depended on a national, regional or facility-developed Standard Equipment List related to the essential care package. Once this aspect is clear, it’s possible to begin planning. 

The impact of health technology depended on “trained, motivated and enabled medical and non-medical staff - and as long as people are not paid regularly, motivation is difficult,” she added.

She explained further that there needed to be political will, budgets, policies and guidelines. Two out of three are often lacking in the countries where she works. 

Other speakers said that while technology was essential to the healthcare system, professionals must learn how to use and respect it.

Ashenafi Hussein, Chair, IFMBE Working Group on African Activities-WGAA, said that one of the biggest challenges in adopting healthcare technology was what he described as a professional and structure issue.

“We’ve had challenges with professionals not handling technology. Most of the technology is handled by pharmacists, doctors, or non-medical engineers, for maintenance, procurement or regulation for example,” he said. 

There is also a shortage of professionals in handling the equipment, and understanding its usage, he explained. “We don't have as many professionals as possible in order to access health technology,” he said.

In addition, there exists poor regulation of health technology in Africa, hence professionals cannot deliver, and an absence of a clear health technology policy, in relation to assessment and procurement for example, in many African countries. 

“I personally recommend a health technology policy…and a proper knowledge and health technology transfer... and it would be great to have a proper organisational structure to benefit professionals,” Hussein added.

On his part, medical physics and biomedical engineering consultant Mario Forjaz Secca said that there needed to be more collaboration between Ministry of Health and Medical Device Department (MDD) of the WHO.

He explained that it was vital to focus on procurement by involving professionals such as medical doctors rather than Ministry of Health alone. 

Everyone furthermore needed to be trained. “What I have been finding in Mozambique is that people who have been working in hospitals have no real respect for medical equipment. They treat the CT equipment as if it were a bed, with no respect whether it were broken or not,” he said.

Register to attend Africa Health 2021 (25-29 October 2021) for free. 

Healthcare practitioners in Africa were facing the COVID-19 pandemic as both individuals working in the healthcare system and as members of the population who were facing a global human challenge, said three panel speakers on the first day of Africa Health 2021.

During the session COVID-19 Resiliency at the Frontline, experts discussed the ways in which healthcare professionals at their hospitals dealt with the pandemic. They stressed the importance of providing mental support for workers in the industry.

“One of the key lessons from COVID-19 is to provide safety,” said Dr Elom Otchi, Technical Director at the Africa Institute of Healthcare, Quality, Safety and Accreditation. He added “Oftentimes we talk about patient safety, but if you look at the original framework for patient safety, it is occupational safety, which means the safety of providers.”

He explained that, at his hospital, a clinical psychologist developed an electronic form for all members of staff to fill in order to determine their level of anxiety. When they exceeded the normal level, a member of the psychologist team called the staff member.

“People are very anxious and would like to go to work, but they are concerned about how safe they are and also not putting their family at risk,” he added. 

Dr Lydia Okutoyi, Head of Department, Patient Safety and Quality Health Care, Kenyatta National Hospital, said that COVID-19 brought a lot of mental health issues, starting with the stigma that the staff had to face. The communities the healthcare provider lived in refused to interact with them, because they were frightened of the virus. In some cases, the panellists said some healthcare workers could not make it to work because the buses would not pick them up.

“The staff were seeing less patients but they were seeing really sick patients, so that itself brought the fear factor within them,” Dr Okutoyi said. 

The panellists discussed different ways that they handled the situation at their hospitals.

Dr Mary Adams, Director, AIC Kijabe Maternal Newborn Community Health Project in Kenya, said that in the early days of the virus, they ran focus groups among frontliners. They asked the staff to write what they wanted management to achieve on sticky notes. “Someone from the management would say what they could and couldn't do,” she said. They created a tracking system for both management and staff to see what had been achieved. 

“It was easy to forget the wins,” she said, with all that was going on.

The panellists said that COVID-19 has created a culture of collaboration within the healthcare system as there was no other option. Not only mental health was at stake, but also physical security as there were shortages of PPE equipment. Nonetheless, some hospitals did not have the rapid testing facilities. 

“Kijabe re-engineered its patient flow. We separated all patients with respiratory symptoms and we had to look at them as active Covid,” explained Dr Adams.

In some way, COVID-19 has helped these hospitals understand the importance of increasing capacity, sharing knowledge, and highlighting the role of the private sector. 

“This has been a wake up call for Africa, that we need to grow in some ways,” said Dr Okutyoi who ran a program at her hospital to increase knowledge capacity that attracted interest from abroad to help the staff learn new skills. 

The panellists said that COVID-19 has shed light on the strength and weakness of the healthcare system.

“Irrespective of the external environment and challenges, the healthcare system is still able to deliver the healthcare services that it was delivered,” said Dr Otchi on defining what a resilient healthcare system meant.

Register to attend Africa Health 2021 (25-29 October 2021) for free. 

In her presentation on the first day of Africa Health 2021, Jacqui Stewart, CEO of The Council for Health Service Accreditation of Southern Africa NPC (COHSASA), said that ensuring the consistency of standards of regulation and accreditation will guide healthcare in treating patients better.

“The standards we have in Africa should be the same as everywhere. They set up the bar that says that's what our population deserves,” she told her audience. 

Stewart said during her session, The role of standards, regulation and accreditation in quality and safety, that standards contribute to quality and performance improvement in health organisations and the wider health system. 

“That is really important because a patient does not start and finish in one healthcare organisation - they go across the system and the standards should reflect the transition of care and the journey of the patient,” she explained.

Standards furthermore should be realistic, measurable, behavioural and achievable.

“Standards must be patient focused and encompass all aspects of an organisation. Standards should be comprehensive and reflect all dimensions of quality - efficiency, effectiveness, responsiveness,” she said.

To ensure these standards, Stewart said that there are four processes in which a third party can evaluate an organisation or an individual: Licensing, Regulation, Certification and Accreditation.

Licensing is when a government authority grants permission to a healthcare organisation through an onsite inspection to operate. This happens “often in the private sector - maybe with double standards - because we license in the private sector not the public one, but I think it is critical to have a minimum national standard,” she said. 

Licensing often sets out the minimum requirements in terms of physical infrastructure, equipment and sometimes staffing.

She explained regulations as the use of laws or rules to impose constraints on organisations and individuals to ensure the safety of the health system. Pharmaceutical companies are included in this.

“Institutional regulation is often done as an inspection and is seen to be punitive, which can generate a culture of compliance rather than a culture of quality,” she said.

The other two ways to evaluate a healthcare provider are through certification and accreditation. 

Certification is when an authorised body, whether a government or a non-government body, evaluates and recognises that an individual, such as a physician, or an organisation meets predetermined requirements. A certification example is the ISO which is related to technical conformance. 

Accreditation on the other hand is a voluntary process sought by a healthcare provider, often defined as public recognition of the achievement of the standards by a healthcare organisation through independent external peer evaluation. It provides an objective method to verify the status of healthcare provided. 

Stewart believes that the perception of these evaluative processes ought to change, so that rather than an “inspection” they are viewed as serving to ensure patient wellbeing as part of the culture of the healthcare system. 

The COHSASA chief executive also explained that ensuring standards begins with licensing as a minimum requirement for health operators – all hospitals must be licensed to practise.

Regulation is the next step, to enforce conformed behaviour, as regulators require predetermined behavioural requirements that are designed to protect the health and safety of patients. Certification and accreditation follow. 

“I believe that licensing, regulation, certification and accreditation all have their role, and they are all roles because what we need to do is to set a trajectory towards excellence,” she concluded.

As we age, the strength of our bones deteriorates, and we must do what’s necessary to maintain strength, balance, and bone health at all stages of our lives. According to a specialist orthopaedic surgeon at Saudi German Clinic, Dr Sharmila Tulpule, it is never too late to begin taking steps to ensure that we age healthily and have healthy bones and joints. Dr Tulpule speaks to Omnia Health Insights about her essential recommendations for staying bone healthy.

Strength and flexibility 

Strength and flexibility exercises are essential and benefit bone health, and exercise increases strength and flexibility, reduces joint pain, and helps combat fatigue. Inactivity is our enemy as we age, mainly because our joints can lose almost half their motion. Any injuries can compound the issue. Regular stretching exercises and walks will help keep joints and muscles healthy and flexible.

Related: Link between diabetes and osteoporosis in the spotlight for UAE patients

Walking is a weight‐bearing exercise. However, regular low-impact exercises have proven to slow down the process of bone and joint health degradation. This is also true for people who have arthritis. 

A bone-healthy diet

It is generally known that lean protein and high fibre fruits, vegetables, and whole grains are the best for health. This is especially true for older people. Likewise, calcium and vitamin D are essential for healthy bones. Vitamin D helps in effectively absorbing calcium from the foods we eat. Fish is one of the primary foods with a substantial natural level of vitamin D. 

Avoid unhealthy habits

Related: UAE patients with low vitamin d levels at risk of metabolic bone disease

Smoking and regular drinking of alcohol contribute to weak bones. It’s advisable to stay away from these to reduce the risk of osteoporosis. 

Seek medical advice

A doctor should address any concerns about bone health at the earliest. A bone density test can help gauge bone density and determine the rate of bone loss. 

A Dexa scan measures bone density. It is a small scanning machine that tests for the exact density values of bones, mainly of the spine, hips, wrists, and heels. Results can be classified, as usual, osteopenia (beginning of osteoporosis) and established osteoporosis.

Treatment modalities are many - treatment of osteoporosis consists mainly of lifestyle modification, exercises, diet, and drugs. Medications are either in tablets or injections, which could be either six months or yearly.

The COVID-19 pandemic has affected every single member of the healthcare community, both personally and professionally – and at every level of the supply chain, from manufacture to bedside care.

For those delivering healthcare on the ground it has been a highly challenging time. Through our Voice of the Healthcare Industry Market Outlook 2021 survey we asked healthcare organisations worldwide to tell us about what the biggest barrier was to carrying out their job effectively.

The highest number of respondents from clinics, medical practices, public hospitals, and private hospitals stated that this remains to be a lack of access to new technologies and medical equipment. At 23%, this issue has become even more of a challenge since December 2019, with an increase from 19%.

There has been minimal change for other barriers including work overload, staff shortage, poor organisational structure, insufficient training and education and lack of time with patients. Practitioners are, however, feeling more valued in 2021 (5% down from 10%).

The biggest challenge faced by public and private medical practices as an organisation remains obtaining funding for new technologies, although this has declined slightly from 17% in 2019 to 14% in 2021.

Operational efficiency has become more of a challenge (14% up from 11%), as has effectively implementing new technologies (12% up from 9%). Other challenges have all seen very little change, although fewer respondents identified poorly trained staff as their biggest challenge (9% down from 12%).

Challenges facing the non-profit sector

The main challenges facing charities, non-profit organisations and NGOs remains a lack of funding. There was no change in the proportion of respondents for this issue since December 2019, but fewer respondents reported on limited capacity (24% down from 27%), poor governance and networking (16% down from 19%) politicisation of NGOs (13% down from 19%), lack of long-term engagement (13% down from 19%) or community engagement (13% down from 18%).

About the report

The Voice of the Healthcare Industry Market Outlook 2021 survey was designed by Informa Markets to understand the impact that the pandemic has had on four key areas of the industry: manufacturers and agents, dealers and distributors; clinics and medical practices; private hospitals and public hospitals; government and health regulators; and charities, non-profits and NGOs.

Through GRS Research & Strategy Middle East we asked 1,600 respondents worldwide about the financial and operational impact of the events brought by the pandemic.

The survey also looked to assess how the industry has responded to the pandemic, and how key players have evolved their business strategy. We also asked participants to reflect on how the future will look, and what key trends they are now anticipating. 

Download the full report for free

Click here to download the Voice of the Healthcare Industry Market Outlook 2021

The most important part of molecular detection is the quality of the RNA, which means a compromised quality will lead to a lower possibility to detect SARS-CoV-2, said Professor Vip Viprakasit, MD, DPhil (Oxon) & Warut Tulalumba, CEO & Founder of AtGenes Co. Hence, they use the Biosafety Mobile Unit in Thailand. 

In his session on Molecular Detection of the SAR-CoV2 for Pandemic Control of COVID-19 through Active Case Finding on day three of Medlab Asia & Asia Health, Dr. Viprakasit said that the SARS-CoV- 2 virus, which is a RNA virus, can only be detected after the inoculation period.  The virus can only be detected using molecular technique as it has a unique sequence that distinguishes it from other coronaviruses. 

Through his presentation he explained the RT-PCR testing process, which is widely used globally. PCR - polymerase chain reaction - is used to detect genetic material from a virus. 

The nasal swab has proved the best technique to detect the virus. The sample must be stored at 2-8 degrees Celsius for up to 3 days before the RNA extraction, deactivate the virus then perform the RNA extraction. Then a PCR test is used. “We select different regions, especially the N genes of the virus which is very important,” said Dr. Viprakasit.

To get the N genes, they have to amplify some regions such as the ORF, he explained

Another technology used is Point of Care (PoC) Molecular testing which is easier than the RT-PCR, they collect the sample and put it into the machine and have it run which means less humans handling the virus. PoC can help detect 22 other viruses such as Influenza A, Influenza B. The results can be available within two hours.

COVID-19 and its impact on blood 

During her session Updates on COVID-19 and Haematology,  Dr Veena Selvaratnam, Haematologist at Ampang Hospital, Malaysia, said patients develop profound hypnoemiza early in the disease. Patients could get endothelial activation due to proinflammatory and procoagulant and proliferative state which then lead to endothelial damage. 

“When there is a destruction of the cells, there is activation of the endothelial therefore release of leukocytes and monocytes,” she explains; hence, it promotes thrombin generation. 

“COVID-19 is a very prothrombotic condition and this is due to the damage that happens in the vascular bed,” she said.

She explained that with a common full blood count, the majority of patients have lymphopenia (35%-83%) more lower ALC in severe disease, reduction in both CD4 and CD8 T cells; much lower CD8. 

Patients also show mild neutrophilia will have higher neutrophil in which lymphocyte ratio in more severe disease or ICU admissions. They can also have mild thrombocy.

Patients have reactive and plasmacytoid lymphocytes and that's because it's a viral disease. She explained further that in very severe cases, patients can also have Hemophagocytosis. 

“One third of infected patients and 50 percent of autopsy cases have thrombosis,” she said. Thrombosis is associated with risk of mortality and morbidity; however, we still do not have a number on thrombosis effect on death. There are different factors on developing thrombosis, she explains that anticoagulation is important to prevent thrombosis. 

One of the most consistent findings on whether a patient will develop thrombosis or not is that of a higher D-dimer level. There are two types of D-dimer, each reporting different assays. Patients with COVID-19 most certainly have a higher D-dimer level. She explains that D-dimer method comparison is based on assays on the same samples, adding that low D-dimer were observed in patients on anticoagulation with COVID-19.

In the panel session Impact of the COVID-19 pandemic on supply and the use of blood for transfusion in South East Asia, Pawinee Kupatawintu, Deputy Director of the National Blood Centre in Thailand, said due to the pandemic, the donation of blood has decreased by 30 percent which led them to create donation strategies to ensure donations while ensuring donor safety.

“The blood requests from hospitals have decreased but since June 2021 it has come back to normal demand which led to shortages again,” she said. During shortages such as in April and August 2021,  the National Blood Centre announced the shortages to the public which led blood donations to increase again. 

On the same panel, Dr Chanthala Souksakhone, Director, National Blood Transfusion Center, Laos, said the number of blood donors increases year by year; however, during the end of 2019, 2020, and now they have seen a negative impact on blood collection due to the pandemic. 

Both speakers said that they are having campaigns through mass media, social networks to ask the public to donate blood. 

“We sent letters to all central and provincial hospitals about the blood stock shortage to coordinate to deal with emergency cases,” he explained.

Blood donation; however, faces other challenges not just shortages, such as those who have COVID-19 and those who have had the vaccination. Kupatawintu said they change the criteria such as those who had the vaccine must wait for 7 days. She added that donors need to inform them if there is a risk of COVID-19 infection within 7 days after donation. She explained that they also check the antibody in the donors.

Dr Chanthala also said that they think about COVID-19 infection and vaccination. “We have to ask them if they have the risk.” 

Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis (TB) disease that has been used for many years; yet it is not fully effective and there are various challenges in using the vaccine. However, despite the urgency of TB that has caused losses, there is little innovation in terms of TB vaccines.

“We have made progress in TB vaccine development, we have new tools particularly in developing efficacy against infection BCG revaccination and H4,” said Professor Helen Fletcher, Professor of Immunology, The London School of of Hygiene & Tropical Medicine, University of London, during her session TB: Where are we now? on the second day of Medlab Asia & Asia Health - The Virtual Edition.

However, she explained during her presentation that TB is not seen as an urgent disease to cure which makes innovation to contain it very limited. The BCG vaccine is the only licensed vaccine for TB, developed in 1921. It is not highly effective among adults; it also does not protect those who have a positive tuberculin skin test. Despite saving lives, there is still more room for development.

Prof Fletcher explained that due to urgency seen in handling COVID-19’s effect on the economy and the political scene, there have been 186 vaccines in the clinical trial pipeline for COVID-19; meanwhile, there are only 24 TB vaccines in the clinical trial pipeline.

“We need a great sense of urgency in the development of the TB vaccine,” she said. 

There are 9.6 million cases every year. Dr Fletcher said that along COVID-19, TB is also one of the largest causes of death, 1.5 million deaths per annuum. The largest number of cases are seen in Sub Saharan Africa and Southeast Asia.

Much like COVID-19, TB is also a potentially serious infectious disease that affects the lungs leading to respiratory issues. Infections can take weeks or even years. The bacteria that lead to TB are spread through tiny droplets released into the air.

During her session, Prof Fletcher explained a study that came out in 2018 that concludes that if “We revaccinate with BCG we can get protection from the disease” with 45% efficacy. However, the study was replicated in Brazil and found almost zero efficacy, she added. Another study in non-human primates NHP  found that the efficacy of BCG improves if inserted by intravenous. She said these studies show that if BCG is used differently, it might bring higher efficacy.

Another vaccine that was tested on NHP is RhCmV/TB which provides sterile protection, mediated by classical T cells and has shown 41% sterile protection. However, it needs to be redesigned in the Human CMV backbone, she explained.

Meanwhile, M72/AS01E TB vaccine candidate, which is a fusion protein derived from Mtb32A and Mtv39A, has been in the pipeline for clinical studies. This vaccine has been tested in HIV negative adults who have been already infected with TB. The vaccine has shown a significant degree of protection provided by this vaccine against the development of active TB disease among adults.However, M72 has not been tested on people who are not TB infected and who have HIV.

“We made progress in the last 5 years in understanding immune correlates of protection and understanding that inflammation is a real issue in TB both as a driver of activation of the disease but also something might be interfering in vaccine efficacy,” explained Prof Fletcher. She added that these understandings are important for vaccine’s developers to consider at the design stage.

She explained that TB health developers can learn from COVID-19  by looking at: the new platform technologies available now, advocating for accelerated regulatory pathways, understanding the risk in manufacturing, and planning how to scale up manufacturing and finally how to globally distribute the vaccine. 

Register as an attendee for Medlab Asia & Asia Health, ASEAN's leading healthcare and laboratory event taking place online on 20-22 October 2021.