The Race for COVID-19 Vaccines: The Various Types and Their Strengths and Weaknesses

Systematic documentation of the introduction of COVID-19 vaccines in Latin America and the Caribbean

Objective

To document the process of introducing COVID-19 vaccines in a selection of Latin American and Caribbean countries, including the lessons learned and the strengths and weaknesses, and similarities and differences among programs.

Methods

This descriptive study is based on a systematic evaluation of the process of introducing COVID-19 vaccines in Argentina, Belize, Brazil, Costa Rica, Panama and Peru. Data were collected through a questionnaire distributed to key stakeholders. Six informants from each of the included countries participated in this study. The period of the study was from December 2021 through September 2022.

Results

The main strengths reported by countries were health workers' commitment to delivering vaccinations, evidence-based decision-making, the development of plans for vaccine introduction, the participation of national immunization technical advisory groups, the availability of economic resources and positive actions from the respective Ministry of Health. The main challenges were the actions of antivaccination groups, problems with electronic immunization registries, a lack of vaccines, delays in the delivery of vaccines and the scarcity of health personnel at the local level.

Conclusions

Commitment, the participation of multiple sectors, the availability of resources and preparedness planning were some of the many strengths shown by countries introducing COVID-19 vaccines. Weaknesses included third parties' interests, the lack of information systems and difficulty in accessing vaccines and vaccine services. There is a window of opportunity for countries to maintain the good practices that allowed for the processes' strengths and to assess the identified weaknesses to invigorate immunization programs and prepare for future health crises.

Different COVID-19 treatments' impact on hospital length of stay

IMPORTANCE

COVID-19 has adversely affected global healthcare infrastructure since 2019. Currently, there are no large-scale published reports on the efficacy of combination therapy of dexamethasone, remdesivir, and tocilizumab on COVID-19 patients.

OBJECTIVES

Is the combination therapy of dexamethasone, remdesivir, and tocilizumab superior to other treatments on hospitalized COVID-19 patients?

DESIGN

This is a retrospective, comparative effectiveness study.

SETTING

Single-center study PARTICIPANTS/INTERVENTIONS: We analyzed different inpatient COVID-19 treatment options available in the United States and their impact on hospital length of stay (LOS) and mortality. Hospitalized COVID-19 were categorized as "mild," "moderate" and "severe'' based on the highest level of oxygen required; room air, nasal cannula, or high flow/PAP/intubation, respectively. Patients were treated in accordance with the availability of medications and the latest treatment guidelines.

MAIN OUTCOMES

The endpoints of the study are hospital discharges and death during hospitalization.

RESULTS

1233 COVID-19 patients were admitted from 2020 to 2021. No treatment combinations showed a statistically significant decrease in hospital LOS in mild COVID-19 patients (p = 0.186). In moderate patients, the combination of remdesivir and dexamethasone slightly decreased LOS by 1 day (p = 0.007). In severe patients, the three-drug combination of remdesivir, dexamethasone, and tocilizumab decreased LOS by 8 days (p = 0.0034) when compared to nonviable treatments, such as hydroxychloroquine and convalescent plasma transfusion. However, it did not show any statistically significant benefit when compared to two-drug regimens (dexamethasone plus remdesivir) in severe COVID-19 (p = 0.116). No treatment arm appeared to show a statistically significant decrease in mortality for severe COVID-19 patients.

CONCLUSIONS

Our findings suggest that three-drug combination may decrease LOS in severe COVID-19 patients when compared to two-drug therapy. However, the trend was not supported by statistical analysis. Remdesivir may not be clinically beneficial for mild hospitalized COVID-19 patients; considering its cost, one could reserve it for moderate and severe patients. Triple drug therapies, while potentially reducing LOS for severe patients, do not affect overall mortality. Additional patient data may increase statistical power and solidify these findings.

Pharmacological therapies and drug development targeting SARS-CoV-2 infection

The development of therapies for SARS-CoV-2 infection, based on virus biology and pathology, and of large- and small-scale randomized controlled trials, have brought forward several antiviral and immunomodulatory drugs targeting the disease severity. Casirivimab/Imdevimab monoclonal antibodies and convalescent plasma to prevent virus entry, Remdesivir, Molnupiravir, and Paxlovid nucleotide analogs to prevent viral replication, a variety of repurposed JAK-STAT signaling pathway inhibitors, corticosteroids, and recombinant agonists/antagonists of cytokine and interferons have been found to provide clinical benefits in terms of mortality and hospitalization. However, current treatment options face multiple clinical needs, and therefore, in this review, we provide an update on the challenges of the existing therapeutics and highlight drug development strategies for COVID-19 therapy, based on ongoing clinical trials, meta-analyses, and clinical case reports.

Leveraging artificial intelligence to optimize COVID-19 robust spread and vaccination roll-out strategies in Southern Africa

The outbreak of coronavirus in the year 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prompted widespread illness, death, and extended economic devastation worldwide. In response, numerous countries, including Botswana and South Africa, instituted various clinical public health (CPH) strategies to mitigate and control the disease. However, the emergence of variants of concern (VOC), vaccine hesitancy, morbidity, inadequate and inequitable vaccine supply, and ineffective vaccine roll-out strategies caused continuous disruption of essential services. Based on Botswana and South Africa hospitalization and mortality data, we studied the impact of age and gender on disease severity. Comparative analysis was performed between the two countries to establish a vaccination strategy that could complement the existing CPH strategies. To optimize the vaccination roll-out strategy, artificial intelligence was used to identify the population groups in need of insufficient vaccines. We found that COVID-19 was associated with several comorbidities. However, hypertension and diabetes were more severe and common in both countries. The elderly population aged ≥60 years had 70% of major COVID-19 comorbidities; thus, they should be prioritized for vaccination. Moreover, we found that the Botswana and South Africa populations had similar COVID-19 mortality rates. Hence, our findings should be extended to the rest of Southern African countries since the population in this region have similar demographic and disease characteristics.