COVID-19 — a timeline of the coronavirus outbreak

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A glimpse at the front line in the fight against COVID-19 in Madagascar. Photo by: World Bank / Henitsoa Rafalia / CC BY-NC-ND

On Dec. 31, 2019, Chinese authorities alerted the World Health Organization of pneumonia cases in Wuhan City, Hubei province, China, with an unknown cause. What started as a mystery disease was first referred to as 2019-nCoV and then named COVID-19.

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The timeline below tracks the development of the outbreak in 2021. For earlier developments, visit Devex’s COVID-19 timeline for 2020.

Total cases as of June 18: 177,527,179, with 3,844,144 deaths.

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June 18  COVID-19 cases in Africa have increased by 52% in the past week and deaths have increased by 32%, says WHO Director-General Tedros Adhanom Ghebreyesus during a press conference, adding that less than 1% of the population on the continent has been vaccinated.

"And we expect things to only get worse," he says.

June 16  German company CureVac’s COVID-19 vaccine candidate has shown low efficacy of 47% against any COVID-19 disease severity, according to a second interim analysis of the result of its Phase 2b/3 trial. The analysis suggests the efficacy is based on age of trial participant and COVID-19 variant. While the results “suggest efficacy in younger participants,” the study was unable to conclude efficacy for those aged 60 years old and above. Of the 134 COVID-19 cases assessed for the analysis, only one case was linked to the original virus and 57% of the cases were caused by variants of concern.

The study enrolled approximately 40,000 participants across 10 countries in Latin America and the Caribbean. CureVac CEO Dr. Franz-Werner Haas says in a news release that “While we were hoping for a stronger interim outcome, we recognize that demonstrating high efficacy in this unprecedented broad diversity of variants is challenging. As we are continuing toward the final analysis with a minimum of 80 additional cases, the overall vaccine efficacy may change.”

CureVac is also developing second-generation COVID-19 vaccines together with GSK.

The RECOVERY trial finds that Regeneron’s cocktail of monoclonal antibodies significantly reduced by one-fifth the risk of death for hospitalized patients with severe COVID-19 who are seronegative — without detected COVID-19 antibodies — based on preliminary results. However, it has shown no benefit for hospitalized patients who were seropositive — with detected COVID-19 antibodies — at the start of the trial.

June 14  Novavax says its vaccine has an overall efficacy of 90.4%, according to results of its Phase 3 trial in the U.S. and Mexico. The vaccine is 100% effective against moderate and severe COVID-19, and 93.2% effective against COVID-19 variants of concern and interest.

The study enrolled over 29,000 participants, and observed 63 COVID-19 cases among those in the placebo control group, and 14 cases among individuals who received the vaccine. All cases in the vaccinated group were mild, while the placebo group had 10 moderate cases and four severe cases.

The company plans to file for regulatory approval in the third quarter of 2021, and says it “remains on track” to produce 100 million doses per month by the end of the third quarter, and 150 million doses per month by the end of 2021.

WHO Director-General Tedros Adhanom Ghebreyesus says that the steep increase in cases on the African continent is “especially concerning, because it is the region with the least access to vaccines, diagnostics, and oxygen,” during a press conference.

June 13  G-7 leaders commit to share at least 870 million COVID-19 vaccine doses “over the next year,” bringing G-7 commitments to a total of 1 billion doses. They aim to deliver at least half of the doses by the end of 2021 primarily through COVAX.

The G-7 also supports discussions for an extension of the ACT-Accelerator program in 2022, “noting the planned comprehensive review to optimise its effectiveness and accountability,” and calls for a “timely, transparent, expert-led, and science-based WHO-convened Phase 2 COVID-19 Origins study including, as recommended by the experts’ report, in China.”

The leaders will also “explore options for building consensus this year” on sustainable financing for global health and health security, according to the G-7 communique.

WHO Director-General Tedros Adhanom Ghebreyesus welcomes the donations, but says “we need more, and we need them faster.”

According to a ONE Campaign analysis, the G-7 1 billion doses commitment will only vaccinate 5.4% of the population in low- and middle-income countries by the end of 2021, and reach only 10.3% of the population in these countries by the time the next G-7 summit takes place in 2022.

COVAX aims to secure “as many shared doses as possible immediately” as it anticipates gaps between deliveries and countries’ ability to “absorb doses” to be “greatest” during the third quarter of 2021. It urges multilateral development banks to immediately release funding to help countries prepare their health systems for large-scale vaccine rollout.

June 10  U.S. President Joe Biden's administration plans to buy 500 million doses of Pfizer's COVID-19 vaccine and donate them to more than 90 lower-income countries and the African Union. This is the largest vaccine donation by a single country and will include 200 million doses this year and 300 million doses next year.  

Nearly 90% of African nations are set to miss the target of vaccinating 10% of their people by September, unless the continent receives 225 million more doses, according to a press release from the World Health Organization.

Fourteen African countries are “aggressively” heading towards a third wave of the pandemic, says Africa CDC Director John Nkengasong during a press conference. He adds that the variant originally reported in India has been reported in 13 African countries and is “getting a hold on the continent.”

Since the pandemic has begun, Facebook has removed more than 18 million pieces of content on Facebook and Instagram for violating the company’s COVID-19 and vaccine policies, says Luchen Foster, director of health partnerships at Facebook, during a news briefing. 

June 8  The Mastercard Foundation says it will donate $1.3 billion to help the African Union and Africa CDC to vaccinate millions of Africans and assist with the continent’s economic recovery over the next three years.

June 7  Despite week-on-week global declines in COVID-19 infections for the past six weeks, there has been a 25% increase of the disease in Africa in the past week, says Bruce Aylward, coordinator and lead at the ACT-Accelerator, during a press briefing.

June 3  Fifty-one countries have now received COVID-19 vaccines in Africa, and 48 million doses have been distributed across the continent. Of that number, 31 million doses have been used, accounting for over 60% of the doses administered there.

Three countries however have yet to receive doses, which includes Eritrea, Burundi, and Tanzania, according to Dr. Richard Mihigo, program area manager for immunization and vaccine development at WHO's Regional Office for Africa, during a press briefing.

The United States announces which countries will receive 25 million doses of the vaccines it has pledged to donate. Nearly 19 million doses will go to COVAX, with allocations broken down as follows: approximately 6 million doses to Latin America and the Caribbean, 7 million to Asia, and approximately 5 million to Africa. The remaining doses of over 6 million doses will directly be given to Mexico, Canada, and South Korea, as well as the West Bank and Gaza, Ukraine, Kosovo, Haiti, Georgia, Egypt, Jordan, India, Iraq, and Yemen. Doses will also be given to United Nations front-line workers.

June 2  Mauritius approves use of Sputnik Light COVID-19 vaccine. This is the second, single-dose vaccine approved in the African continent after Johnson & Johnson’s.

The Bill & Melinda Gates Foundation commits $50 million to Gavi, the Vaccine Alliance to support the purchase and delivery of COVID-19 vaccines through COVAX. The foundation also calls on high-income countries to share at least 1 billion excess doses of vaccines to lower-income countries.

June 1  WHO adds Sinovac’s COVID-19 vaccine to its emergency use list. To date, WHO has now given emergency use listing to six vaccines. The one developed by AstraZeneca and the University of Oxford is listed with two additional manufacturers.

Togo receives about 100,000 doses of the Pfizer vaccine from COVAX — becoming the third country in Africa to receive this type of vaccine, says John Nkengasong, director at the Africa Centres for Disease Control and Prevention, during a press conference on June 10.

May 31 — Following a government review, Peru revises its official COVID-19 death toll to 180,764, making it the country with the worst death rate per capita.

May 28  The global death toll from COVID-19 surpasses 3.5 million.

May 27  UNICEF signs agreement with Human Vaccine, a subsidiary of the Russian Direct Investment Fund, for supply of Russian COVID-19 vaccine Sputnik V. The agreement allows UNICEF to access up to 220 million doses of the vaccine for 2021. However, UNICEF’s procurement is dependent on the vaccine receiving WHO emergency use listing, and an advance purchase agreement with Gavi for COVAX.

COVAX partners publish a joint statement calling for funding, and for countries with “the largest supplies” of vaccine doses to share them now to COVAX.

The call is for countries to share at least 1 billion vaccine doses for 2021, based on an analysis of projected excess doses globally by the Bill & Melinda Gates Foundation. Even after sharing 1 billion doses, the analysis finds higher-income countries would still have enough to vaccinate 80% of their populations aged 12 years old and above in 2021.

May 25  Only 8% of WHO's funding for its global COVID-19 response is flexible — down from 30% last year — while the rest has been earmarked, says Mike Ryan, executive director at the WHO Health Emergencies Programme, during the 74th World Health Assembly. In terms of the money received, the pandemic response also has a 70% funding shortfall.

“This underfunding and earmarking of funds risks paralyzing WHO’s ability to provide rapid and flexible support to countries and is already having consequences for current operations,” he says.

During these meetings, several countries call for WHO to take quick and independent action for the next steps of its study into the origins of the COVID-19 pandemic.

South Sudan says it will return 72,000 vaccine doses of donated Oxford-Astrazeneca after deciding it cannot roll them out before they expire.

May 21  Gavi, the Vaccine Alliance signs an advance purchase agreement with Johnson & Johnson for 200 million doses of its COVID-19 vaccines on behalf of the COVAX Facility, with the intention of supplying these doses to participating countries this year. Gavi is also in discussions with the company for an additional 300 million doses of the vaccine for delivery next year.

UNICEF appeals for $164 million for the COVID-19 response across South Asia for purchases such as oxygen, testing supplies, and personal protective equipment. The region accounts for half of the known new infections, and more than three people die every minute due to COVID-19. Apart from India, Nepal, Sri Lanka, and the Maldives that are already witnessing a surge, UNICEF has also warned about similar crises in Bangladesh, Afghanistan, Pakistan, and Bhutan.

COVID-19 deaths in Latin America and the Caribbean surpass 1 million. Five countries account for majority — almost 89% — of the deaths: 44.3% in Brazil, 22.1% in Mexico, 8.3% in Colombia, 7.3% in Argentina, and 6.7% in Peru. However, only 21.6% of the population in the region have been vaccinated to date, according to the Pan American Health Organization.

Italy commits 300 million euros to the Gavi COVAX AMC during the Global Health Summit, bringing total funding raised for the facility to over $7 billion, according to Gavi. Italy also announces the donation of 15 million vaccine doses by the end of 2021 to lower income economies, while France and Germany will each share 30 million excess vaccine doses.

May 20  The Africa Centres for Disease Control and Prevention releases data from a handful of countries examining anti-SARS-CoV-2 antibodies, also known as serological testing, which provides insight into how many people have been previously infected by the virus. Sierra Leone had an overall prevalence of 2.8%, while Uganda had a 20.67% prevalence.

One of the key takeaways is that a significant proportion of African populations remain susceptible to the virus, says Dr. Justin Maeda, head of the division of surveillance and disease intelligence at Africa CDC.

A new One Health High-Level Expert Panel is launched to address the emergence of zoonotic diseases and prevent their spread. The panel will advise WHO, FAO, UNEP and the World Organisation for Animal Health in developing a long-term global plan of action to avert disease outbreaks such as Ebola, Zika, H5N1, and COVID-19.

Malawi destroys nearly 20,000 COVID-19 vaccines which had expired, even though WHO and the African Union said they would be safe to use until mid-July.

May 18  Serum Institute of India CEO Adar Poonawalla says in a statement that the institute will continue to scale up vaccine manufacturing and “prioritise India” as the country is currently experiencing a deadly surge in COVID-19 infections. The vaccine manufacturer, however, hopes to restart delivering doses to COVAX and other countries by the end of 2021. Poonawalla says the company has “never exported vaccines at the cost of the people in India,” and it remains committed to supporting the vaccination drive in the country.

Saudi crown prince Mohammed bin Salman says the country will support African countries with about $1 billion in investments and loans this year to support their economic recoveries from the pandemic.

May 17  The U.S. will share an additional 20 million COVID-19 vaccine doses with other parts of the world in the coming six weeks, raising the nation’s commitment of donated doses to 80 million, says President Joe Biden.

The COVAX Facility has delivered about 65 million COVID-19 vaccine doses, but that number should have been at least 170 million, writes UNICEF Executive Director Henrietta Fore in a press release. By next month, “the shortfall will near 190 million doses,” she adds.

COVID-19 does not register as a priority for the millions of people affected by the conflict in Ethiopia’s Tigray region amid the myriad other threats they face, says WHO Director-General Tedros Adhanom Ghebreyesus during a press conference.

WHO's COVID-19 response plan is underfunded, Tedros says, and the vast majority of its existing funds are "ring-fenced" by donors for specific countries or activities. He makes a plea for flexible funding to respond to the pandemic in countries that urgently need help, such as Nepal.

Tedros calls on pharmaceutical companies to speed up delivery for doses promised to the COVAX Facility.

May 14  During a press briefing, WHO Director-General Tedros Adhanom Ghebreyesus urges wealthy countries to donate COVID-19 vaccines to countries without access, through the COVAX Facility, instead of domestically expanding eligibility of vaccinations to adolescents. On May 13, the United States federal government recommended making the Pfizer-BioNTech vaccine available to those between 12 to 15 years old. Only 0.3% of vaccine supply is going to low-income countries.

Tedros says he was vaccinated this week.

He warns that the world is “on track for the second year of this pandemic to be far more deadly than the first.” 

May 13  A group of scientists published a letter calling for more investigation on the origins of the COVID-19 pandemic. “Theories of accidental release from a lab and zoonotic spillover both remain viable,” they say.

May 12  The Independent Panel for Pandemic Preparedness and Response releases its much-awaited report retracing what happened in the COVID-19 response. The report finds delays from China in confirming to WHO a cluster of atypical pneumonia cases in December 2019. It also concludes WHO could have declared a public health emergency of international concern a week earlier — on Jan. 22, 2020.

The panel has both immediate and long-term recommendations to help bring an end to the pandemic, and for the world to prevent the next one.

The report follows the publication of another report by the review committee of the International Health Regulations, which concluded that an intermediate level of alert for health emergencies would not solve countries’ noncompliance to the IHR and WHO’s recommendations and advice.

May 10  The coronavirus variant originally detected in India is considered a "variant of concern," says Maria Van Kerkhove, technical lead on COVID-19 at WHO, during a press briefing.

May 8  During an emergency summit for African health ministers, Benedict Oramah, president of the African Export-Import Bank, expresses concern that countries aren’t ordering the Johnson & Johnson COVID-19 vaccines the African Union has secured. The AU signed an agreement for up to 400 million doses of the vaccine, but only five countries have completed orders and time is running out before the AU needs to close its order book, he says.

Gavi CEO Dr. Seth Berkley says during the summit that the COVID-19 crisis in India means the COVAX Facility is 150 million vaccine doses behind schedule. That number will reach 190 million doses next month.

May 7  The World Health Organization gives emergency use listing to Sinopharm, Beijing-made COVID-19 vaccine.

May 6  Kenya, Morocco, and Uganda have reported cases of a COVID-19 variant originally found in India, says John Nkengasong, director at the Africa Centres for Disease Control and Prevention, during a press conference. The cases in Kenya and Morocco are still under investigation.

Only 54% of vaccine doses received by African Union member states have been administered, Nkengasong says. The countries have received 37.6 million doses and administered 20.2 million.

Nkengasong praises the U.S. announcement on waiving intellectual property rights for COVID-19 vaccines as a "remarkable expression of leadership.” For countries that don't support the waiver, he says, "When the history of this pandemic is written ... we will remember not just the loud voices of those who did not support us, but we will also remember the silence of our friends in this battle."

The European Union is now willing to discuss a proposal to waive intellectual property rights for COVID-19 vaccines, says European Commission President Ursula von der Leyen during a speech to the European University Institute.

May 5  The U.S. administration supports a waiver of intellectual property protections for COVID-19 vaccines, Trade Representative Katherine Tai announces.

Countries that continue to oppose the World Trade Organization IP waiver include Australia, Brazil, Canada, European Union nations, Japan, Norway, Switzerland, and the United Kingdom, according to Médecins Sans Frontières.

May 4  Seychelles is seeing a spike in COVID-19 cases, even though the small archipelago nation has fully vaccinated the highest percentage of its population globally. The country’s COVID-19 situation is “critical,” says Health Minister Peggy Vidot during a press conference.

May 3  Sweden commits to donate 1 million doses of Oxford-AstraZeneca vaccine to COVAX Facility, which needs an urgent supply of 20 million doses for the second quarter of 2021.

Gavi, the Vaccine Alliance signs an advance purchase agreement for 500 million doses of Moderna’s COVID-19 vaccine.

April 30  Confirmed cases of COVID-19 surpass 150 million globally.

WHO lists Moderna’s COVID-19 vaccine for emergency use.

April 28  Globally, transmission and new detected cases are now at the highest level seen since the beginning of the pandemic,” writes the International Federation of Red Cross and Red Crescent Societies in a press release.

The pandemic has slammed the Americas. The two continents account for almost half of the cases and deaths from COVID-19 globally, according to IFRC.

Dr. Carissa Etienne, director at the Pan American Health Organization, says during a press conference that several countries are reporting increases in cases among younger populations. This demographic is burdening health care systems, as younger patients often require longer hospital stays than those over 60 years old.

Cases are also surging across the Caribbean, Etienne says. In the past several days, Anguilla reported more than 60% of its total cases since the start of the pandemic, and weekly infections doubled in Puerto Rico during the same period.

Nearly every country in Central America is reporting a rise in infections, she says. Hospitalizations are at an all-time high in Costa Rica, with the country reporting a 50% jump in cases in the past week. Guatemala’s hospitals have reached maximum capacity. In Colombia, major cities such as Bogotá and Medellín are running out of intensive care unit beds.

Canada’s infection rates have surpassed U.S. figures for the first time in the pandemic, Etienne says.

Pakistan reports its highest daily death toll from COVID-19, with 201 deaths.

April 27  Kazakhstan begins rolling out a domestically developed COVID-19 vaccine called QazVac, which requires two doses.

April 26  The expert group providing recommendations to WHO on whether a vaccine should be listed for emergency use meets this week to assess the COVID-19 vaccine developed by Sinopharm and next week to assess the vaccine by Sinovac.

“So we expect with Sinopharm we will have a decision before the end of this week, and Sinovac most likely by the end of next week,” says WHO Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals Mariângela Simão during a press briefing. The committee will also meet on Friday to discuss the Moderna vaccine.

The COVID-19 situation in India is “heartbreaking,” and WHO has seen “similar trajectories of increases in transmission in a number of countries,” although not at the same scale and level of impact and burden on the healthcare system as seen in India, said Maria Van Kerkhove, WHO’s technical lead on COVID-19.

“This can happen in a number of countries, in any [country], if we let our guard down. I'm not saying that India has let its guard down, but I'm saying we're in a fragile situation,” she says, pointing out that almost 5.7 million COVID-19 cases were reported globally last week.

“And that is certainly an underestimate of the true number of cases of infections that have occurred in the last week. It's a fragile situation globally,” she said.

The United States says it will share up to 60 million doses of the AstraZeneca coronavirus vaccine with other countries.

Iran sees its highest daily death toll, with 496 deaths.

April 22  African Union member states have received 36.2 million COVID-19 vaccine doses, with about 15 million doses administered. At the continental level, this equates to only 0.8% of the population that have received a vaccine and only 0.34% of the population fully vaccinated. "We are far away from our target," says John Nkengasong, director of the Africa Centres for Disease Control and Prevention during a press conference on Thursday.

Syria receives its first shipment of 256,800 doses of COVID-19 vaccines from the COVAX Facility.

Fifteen African countries delayed measles immunization campaigns in 2020 because of the COVID-19 pandemic, says WHO in a press release. Seven of these countries have now completed the campaigns, but eight have not.

COVAX expects to deliver more vaccine doses to countries in June after experiencing supply constraints with the Oxford-AstraZeneca vaccine.

“AstraZeneca has some additional supply nodes that have been quality assured and those will be coming online and scaling up [production] that will kind of ease some of the constraints that we saw in March and April,” said Gian Gandhi, UNICEF’s COVAX supply coordinator, during a media roundtable. But it’s still unclear when doses will again start to materialize from the Serum Institute of India, he said.

April 21 — As India battles a deadly second wave, it records 315,735 new infections nationwide — the highest number of cases reported in a single day in any country since the beginning of the pandemic.

Argentina’s health minister says the country is going through its “worst moment” of the pandemic, adding that the health care system is at risk, especially in Buenos Aires.

April 20  Yemen starts COVID-19 vaccinations.

Johnson & Johnson is resuming shipment of its COVID-19 vaccine to the European Union after a brief pause last week following reports of blood clotting in a few individuals in the U.S. The decision comes after the European Medicines Agency concluded that the vaccine’s overall benefit outweighs the risks. The regulatory body however recommends adding “very rare cases of unusual blood clots with low blood platelets” as a side effect of the vaccine.

April 19  The previous week saw more than 5.2 million new COVID-19 cases — the highest number reported in a single week during the pandemic, WHO says.

WHO Director-General Tedros Adhanom Ghebreyesus says during a press briefing that reaching the first 1 million deaths of the pandemic took nine months, reaching 2 million took four more months and reaching 3 million took only three additional months.

“Big numbers can make us numb. But each one of these deaths is a tragedy for families, communities, and nations,” he says.

April 18  The South African Health Products Regulatory Authority recommends the government to lift its temporary pause on administering the Johnson & Johnson’s COVID-19 vaccine, accompanied by strengthened screening and monitoring of people that receive the vaccine who are at high risk of a blood clotting disorder.

April 17  Globally, confirmed deaths from COVID-19 surpass 3 million.

April 16  Confirmed COVID-19 cases of the B1617 variant have been increasing since the beginning of 2021. It is a “variant of interest” to WHO, along with other variants that increase transmissibility and could potentially impact the success of vaccine rollouts. Maria Van Kerkhove, technical COVID-19 lead with WHO, explains in a press briefing that the organization is working with countries globally to increase the proportion of sequencing taking place to detect where variants are. By linking this to detailed clinical information, they can study the effects properly.

Meanwhile, WHO chief scientist Dr. Soumya Swaminathan expresses caution regarding vaccine passports, pointing to a need to look at them from a scientific point of view, and discussions should include equity and ethical considerations. She says the criteria for protective COVID-19 antibody levels have not been established, and with vaccines not 100% effective against diseases, rushing to open borders could be a risk. 

WHO and its partners announce plans to establish a technology transfer hub focused on mRNA vaccines to help low- and middle-income countries produce them. WHO calls for expressions of interest from small and middle-sized manufacturers of medical products “preferably, but not exclusively, in LMICs” that can host the hub, as well as owners of such technology or those holding intellectual property rights that are “willing to contribute” to the hub. The initiative could expand to other technologies in the future, according to the U.N. agency.

April 15  On average, 1 in 4 people have received a COVID-19 vaccine in high-income countries, while just 1 in 500 of all doses given globally have been administered in low-income countries, says Dr. Richard Mihigo, immunization and vaccine development program coordinator for the WHO Regional Office for Africa, during a press briefing.

April 14  The African Union launches the Partnership for African Vaccine Manufacturing. The goals of the partnership include a coordinated agenda on vaccine manufacturing for the continent; bolstering of five regional production sites over the next 10 to 15 years; mobilization of financial partnerships; strengthening of regional regulatory systems; increase in technology transfer to manufacturers on the continent; and the development of African universities as premier vaccine research and development hubs.

April 13  The U.S. Food and Drug Administration recommends a pause to the use of the Johnson & Johnson vaccine due to concerns over the very rare occurance of blood clots in people who received the vaccine. More than 6.8 million doses of the J&J vaccine have been administered in the U.S. and there are six reported cases in the U.S. of a rare and severe type of blood clot in individuals after receiving the vaccine. A statement from the agency said it is “recommending a pause in the use of this vaccine out of an abundance of caution.”

Following this news, South Africa also suspended its rollout of the vaccine. It’s the only African nation currently using the J&J vaccine, although the AU’s African Vaccine Acquisition Trust signed a deal with the company for up to 400 million doses, which will be available in the third quarter of this year.

Moderna's CEO Stéphane Bance says the "magic wand" for increasing global access to COVID-19 vaccines is allowing U.S. companies to export. American vaccine companies, including Pfizer and Moderna, are bound by contracts that require them to fulfill U.S. government vaccine orders before exporting globally.

April 12  The first two months of 2021 included six consecutive weeks of declining COVID-19 cases globally, but cases have been increasing again in the past seven weeks, says WHO Director-General Tedros Adhanom Ghebreyesus during a press briefing. In the past four weeks, deaths have also been increasing, he adds. Last week had the fourth-highest number of cases seen in a single week. Several countries in Asia and the Middle East have seen large upticks in cases.

"Confusion, complacency, and inconsistency in public health measures and their application are driving transmission and costing lives," Tedros says, adding that "intensive care units in many countries are overflowing and people are dying — and it is totally avoidable."

April 11  The director at the Chinese Center for Disease Control and Prevention, Gao Fu, says that Chinese vaccines "don't have very high protection rates" and that the government is considering various options to help boost their efficacy.

April 7  The European Medicines Agency has concluded that cases of unusual blood clots may be “very rare side effects” of the vaccine developed by AstraZeneca and the University of Oxford. But the agency maintains that the vaccine’s benefits outweigh the risks.

While most of the reported cases have been among women under 60 years old who had low levels of blood platelets within two weeks of vaccination, the agency says it could not confirm specific risk factors for the blood clots based on currently available evidence. But the agency says one “plausible explanation” for the combination of blood clots and low levels of blood platelets is an immune response, causing a condition similarly seen in some patients treated with heparin.

Algeria will start to produce Russia’s Sputnik V vaccine in September, the country’s pharmaceutical industry minister says.

April 6  The world could suffer a “massive global setback” in the fight against the coronavirus disease with the emergence of new virus variants, UNICEF Executive Director Henrietta Fore says in a statement. She calls on governments and businesses to pursue voluntary licensing of COVID-19 vaccines, end “vaccine nationalism,” and share excess doses with the global initiative COVAX. “This threatens us all. The virus and its mutations will win,” she writes.

Tanzania’s new president, Samia Suluhu Hassan, says she plans to form a committee of experts to evaluate the nation’s COVID-19 response, suggesting a shift from the government’s adamant denial of the disease’s presence in the country.

April 3  The United Kingdom’s Medicines and Healthcare Products Regulatory Agency says that of the 30 individuals who experienced rare blood clots after receiving the vaccine developed by AstraZeneca and the University of Oxford, seven have died.

April 1  India’s recent announcement to restrict the export of COVID-19 vaccines means the African continent might not reach the “critical” goal of vaccinating 30% of its population by the end of the year, says John Nkengasong, director at the Africa Centres for Disease Control and Prevention, during a press briefing. India’s move is creating uncertainty around when African nations might receive shipments of doses from the COVAX Facility, a global initiative aimed at equitable access to COVID-19 vaccines.

“We are very concerned,” Nkengasong says. “There is absolutely no way … we are going to meet our needs if India delays.”

March 31  Pfizer-BioNTech clinical trial results report that its COVID-19 vaccine is 100% effective in kids aged 12 to 15 years old, creating strong antibody responses.

March 30  WHO releases a report on its initial investigation into the origin of the coronavirus. Though it was inconclusive, it did state that a laboratory leak of the virus was “extremely unlikely,” and it was “very likely” the virus existed in a bat and was then passed through an intermediary host animal before being transmitted to humans.

Researchers at a press conference say that they have scientific leads to pursue in the study’s next phases but that it’s unclear when they will have a concrete idea of the origins of the pandemic, emphasizing that these types of studies always take time.

Fourteen countries issue a statement raising concerns over the independence of the study, arguing it was “significantly delayed and lacked access to complete, original data and samples.”

Over 20 government leaders, as well as the president of the European Council and director-general at WHO, back a call for a new international treaty for pandemic preparedness and response that would tackle the challenges exposed by the pandemic.

March 29  Globally, COVID-19 case numbers increase for the sixth week in a row, with a 14% increase over the past week and a 5% increase in deaths, tweeted Maria Van Kerkhove, technical lead at WHO’s emergencies program. There was an increase in reported cases in all regions.

Johnson & Johnson signs an agreement with the African Union to make 220 million doses of its COVID-19 vaccine available for purchase by African nations through the African Vaccine Acquisition Trust starting in the third quarter of this year. The African Union can order 180 million more doses through next year.

March 26  There are 36 countries still waiting for initial vaccine doses from the COVAX Facility. Of those, 16 are scheduled to receive their first doses in the next 15 days. This creates an urgent need to get 10 million doses for the remaining 20 countries within the next two weeks, WHO Director-General Tedros Adhanom Ghebreyesus says during a press briefing.

“We will need hundreds of millions more doses in the coming months,” he says.

There is also concern that criminal groups might exploit the urgent need for vaccine supplies. Some fake vaccines have been sold on the internet, and a number of countries have received “suspicious offers” for vaccines, Tedros says. At the same time, there are reports of vaccines being diverted from and reintroduced into the supply chain “with no guarantee that cold chain has been maintained,” he says, also noting accounts of corruption in vaccine distribution and reuse of empty vials.

“We urge the secure disposal or destruction of used and empty vaccine vials to prevent them from being reused by criminal groups, and we urge all people not to buy vaccines outside government-run vaccination programs,” he says.

Kenya reports that it has hit a peak of positive cases and deaths this month, with a “staggering” number of cases coming from the capital city of Nairobi. The government imposes new lockdown measures to curb the rise in cases.

March 25  Despite reports that India banned the export of COVID-19 vaccines, a government source tells Reuters it will continue to supply doses to partner countries. The Serum Institute of India is a primary manufacturer of the AstraZeneca vaccine supplied to the COVAX Facility.

March 22  AstraZeneca’s COVID-19 vaccine is 79% effective at preventing symptomatic disease and 100% effective at preventing severe illness and hospitalization across different ages and ethnicities, according to results from U.S. clinical trials. The company is preparing to request emergency use authorization from the U.S. Food and Drug Administration.

“The gap between the number of vaccines administered in rich countries and the number of vaccines administered through COVAX is growing every single day and becoming more grotesque every day,” says WHO Director-General Tedros Adhanom Ghebreyesus during a press briefing.

March 19  Africans can “strive to lead a normal life” in 2023. With strong partnerships on vaccination campaigns between the private and public sectors and an “all hands on deck” approach, the African continent has a good chance of reaching its vaccination targets by the end of 2022, and then in 2023 people can “strive to lead a normal life,” says Dr. John Nkengasong, director at the Africa Centres for Disease Control and Prevention, during a press briefing.

About 7 million doses of COVID-19 vaccine have been administered in Africa, according to a WHO press release. In total, 38 African countries have received more than 25 million vaccine doses.

Refugees in Nepal receive COVID-19 vaccines. They are the first known refugees to receive COVID-19 jabs in the Asia-Pacific region, according to the UN Refugee Agency.

March 17  Tanzanian President John Magufuli dies. As one of the most prominent deniers of COVID-19 in Africa, he said Tanzania had eliminated the virus through prayer and opposed mask wearing, social distancing, and the use of vaccines. Before his death, he had not made a public appearance for over two weeks, raising speculation that he was in a hospital suffering from COVID-19. Vice President Samia Suluhu Hassan says he died from “a heart ailment he has battled for over 10 years.”

Following temporary suspensions of the rollout of the AstraZeneca COVID-19 vaccine based on reports of blood clotting in people who received the vaccine in Europe, WHO releases a statement saying it "considers that the benefits of the AstraZeneca vaccine outweigh its risks and recommends that vaccinations continue."

WHO expert panel releases interim recommendations on the use of the Johnson & Johnson COVID-19 vaccine. Similar to other vaccines given emergency use listing by WHO, the panel recommends the J&J vaccine to be administered to those aged 18 years of age and older, and should be given to pregnant women only if they are at high risk of exposure to COVID-19, or at high risk for severe COVID-19.

March 15 — WHO Chief Scientist Soumya Swaminathan says during a press briefing that the agency still advises, for the time being, that countries continue rolling out the AstraZeneca vaccine, with a growing number of nations halting its use due to concerns that it is linked to blood clots.

“Nothing — no drug or vaccine — could ever be 100% safe. You could have something that happens one in a million, but then you need to look at what’s the benefit of protecting people against a disease that’s killing millions, against the potential risks,” she says, adding that there are no COVID-19 vaccine-linked deaths yet documented.

Indonesia delays rollout of AstraZeneca vaccine due to reports of blood clots among those who received the vaccine in Europe.

March 13  The Democratic Republic of Congo decides to postpone its roll out of AstraZeneca vaccines, following the same move from Denmark, Norway, Bulgaria, and Iceland, who temporarily suspended their rollouts following questions over whether the vaccine causes blood clots.

March 12 WHO lists Johnson & Johnson’s COVID-19 vaccine for emergency use, a day after it received authorization from the European Medicines Agency. This is the first single-dose COVID-19 vaccine to receive WHO emergency use listing.

WHO is convening its Strategic Advisory Group of Experts on Immunization next week to provide recommendations on the vaccine’s usage. The COVAX Facility has an agreement for 500 million doses of this vaccine.

March 11 Novavax releases phase 3 trial results for its COVID-19 vaccine in the United Kingdom, showing an overall efficacy of 89.7%. It has 96.4% efficacy against the original strain of the COVID-19 virus, but the figure drops to 86.3% when accounting for the B.1.1.7/501Y.V1 variant first found in the United Kingdom. Meanwhile, the vaccine has shown 48.6% efficacy in South Africa, where the B1.351 variant is dominant. HIV-negative individuals saw higher efficacy, at 55.4%.

March 10  The Coalition for Epidemic Preparedness Innovations launches a $3.5 billion plan to reduce the risk of future pandemics and epidemics. This includes strengthening defenses against COVID-19, the development of vaccines for known threats, working to reduce the time involved for vaccine development, creating prototype vaccines, establishing global networks of labs, and assisting low- and middle-income countries to strengthen health security.

March 9 — Amid talk of increasing manufacturing capacity for COVID-19 vaccines, one big question is how much long-term demand there will be for these vaccines, which is needed to justify the investment, says Rasmus Bech Hansen, CEO at Airfinity, during a press briefing.

How many doses will be needed annually depends on “assumptions around the variants [and] the booster shots needed,” questions for which “there are no easy answers,” he says. “So one of the things that I think many manufacturers are considering,” he adds, is “the level of investment that, from a longer perspective, will make sense.”

On increasing COVID-19 vaccine manufacturing and expertise on the African continent, Sai Prasad, president at the Developing Countries Vaccine Manufacturers Network, says that there is an active discussion underway but that “it is a futuristic concept.”

“Maybe we should think about building it in the years to come. But, you know, during 2021, and maybe early 2022, we need to go to where the existing capacities are, existing expertise is, existing human resources are, and [think about] how we can expand those capacities to provide more vaccines to mostly low-income countries and middle-income countries,” he says.

This goes against comments from World Trade Organization chief Ngozi Okonjo-Iweala, who says that new vaccine manufacturing sites could be ready in six to seven months.

March 8 Mike Ryan, executive director of WHO Health Emergencies Programme, during a press briefing, says WHO can’t get information about the pandemic in Ethiopia’s Tigray region because of the ongoing conflict. “We don't have access to even assess those facilities," he says.

March 5 The COVAX Facility has now delivered more than 20 million doses of COVID-19 vaccines to 20 countries, Tedros says during a press briefing. These include Angola, Cambodia, Colombia, Côte d’Ivoire, Democratic Republic of Congo, Gambia, Ghana, India, Kenya, Lesotho, Malawi, Mali, Moldova, Nigeria, the Philippines, Rwanda, Senegal, South Korea, Sudan, and Uganda. In the coming week, COVAX is set to deliver 14.4 million doses to 31 other countries.

March 4 — East Africa might be “seeing the start of a third wave” of the pandemic, says John Nkengasong, director at the Africa Centres for Disease Control and Prevention, during a press briefing.

March 2 A WHO panel of international experts strongly advises against the use of hydroxychloroquine to prevent infection, and recommends funders and researchers to reconsider trials concerning the drug, saying it is “no longer a research priority.”

The decision is based on “high certainty evidence” from six randomized controlled clinical trials involving over 6,000 participants with and without exposure to COVID-19. The drug had no significant effect on the prevention of death or hospitalization, and on laboratory-confirmed infection of SARS-CoV-2, the virus causing COVID-19 disease, according to the experts’ recommendation, published in the BMJ medical journal.

Over 3.9 million doses of COVID-19 vaccines arrive in Nigeria, 624,000 doses in Angola, and 324,000 doses in Cambodia. All are Oxford-AstraZeneca vaccines via COVAX.

COVAX publishes the first round of vaccine allocations to countries covering the period February to May.

Gavi CEO Seth Berkley says with “the right funding in place,” it may be possible to purchase an additional 500 million doses of COVID-19 vaccines for low- and middle-income countries under the COVAX Advance Market Commitment mechanism in 2021, bringing total vaccine doses that can be provided to countries to 1.8 billion.

March 1 — Ivory Coast and Ghana start COVID-19 vaccinations. Meanwhile, 117,000 doses of Pfizer-BioNTech COVID-19 vaccines via COVAX arrive in Colombia.

Feb. 26 — The Philippines’ National Immunization Technical Advisory Group, which plays a recommendatory function to the Department of Health, recommends the use of the Sinovac COVID-19 vaccine for health care workers. The decision is not mandatory, but it gives health care workers the choice to decide whether they want to take the vaccine. If they refuse, they will still be made a priority for other vaccines. However, the experts said that it's unclear when other vaccines will come. This is the best choice health care workers have now, experts say. They recommend health workers take it given that data showed it has 100% protection against hospitalization and severe disease. It's also a “very safe vaccine,” according to clinical trials, said Health Undersecretary Dr. Maria Rosario Vergeire.

Experts however said they cannot publish the data as these are embargoed documents and will require permission from Sinovac. They will share details regarding the vaccine instead through town hall meetings with hospital personnel that start on Saturday, in hopes this would help health care workers decide on taking the vaccine.

This follows the Philippines’ Food and Drug Administration’s recommendation earlier in the week for health care workers to not to use the vaccine, given that it only has 50.4% efficacy based on a clinical trial in Brazil.

South Korea receives 117,000 doses of the Pfizer-BioNTech vaccine via the COVAX initiative, while 504,000 doses of the vaccine developed by AstraZeneca and the University of Oxford arrive in Côte d’Ivoire.

Feb. 24 — More than half of African nations are expected to roll out COVID-19 vaccine campaigns in the coming weeks, WHO Africa Regional Director Dr. Matshidiso Moeti says during a press conference. This includes 24 that have finalized pre-shipment arrangements with the COVAX Facility, as well as deliveries from the African Union and vaccines procured through bilateral agreements.

“This is a much-awaited leap forward for African nations that have spent months preparing from the sidelines while wealthier countries raced ahead with vaccination,” she says.

600,000 doses of the COVID-19 vaccine developed by AstraZeneca and the University of Oxford arrive in Ghana, marking the first global delivery of doses from the COVAX Facility.

Feb. 22 — WHO and Chubb Ltd., through ESIS Inc., announce an agreement to create the first and only global vaccine injury compensation mechanism. This will offer 92 low- and middle-income countries a process to receive compensation for “rare but serious adverse events” associated with vaccines distributed by the COVAX Facility up through June 2022.

Feb. 20 — WHO chief Tedros Adhanom Ghebreyesus releases a statement urging the Tanzanian government to "to scale public health measures against COVID-19 and to prepare for vaccination." WHO has not received information from the Tanzanian government on what measures it is taking to respond to the pandemic.

"This situation remains very concerning. I renew my call for Tanzania to start reporting COVID-19 cases and share data. I also call on Tanzania to implement the public health measures that we know work in breaking the chains of transmission, and to prepare for vaccination," Tedros writes.

Tanzanian travelers to neighboring countries and elsewhere are testing positive for COVID-19. The government stopped reporting its cases of COVID-19 to WHO in May, and President John Magufuli has previously denied the presence of the virus in the country and recently warned against inoculation, suggesting that Tanzanians would be used to test dangerous vaccines. While the country is eligible to receive donated vaccines from the COVAX Facility, it has not taken the steps needed to receive them.

WHO statements targeting specific governments are rare.

Feb. 19 — Leaders from the G-7 group of nations commit $4.3 billion to WHO's Access to COVID-19 Tools Accelerator. This includes new commitments from the United States, Germany, the European Commission, Japan, and Canada for the development and equitable rollout of tests, treatments, and vaccines. The new funding brings the total amount committed to $10.3 billion, which leaves a funding gap of $22.9 billion for the ACT-Accelerator's work this year.

Feb. 18 — The U.S. government releases a statement saying President Joe Biden will announce at a Feb. 19 meeting of the G-7 group of nations that the country will allocate an initial $2 billion to Gavi, the Vaccine Alliance for the COVAX advance market commitment, which is working to provide vaccines to low- and middle-income countries.

This will be followed by an additional $2 billion allocated later this year and next year. The first $500 million of this second batch of funds will be released when existing donor pledges from other countries are fulfilled and initial doses are delivered to nations involved in the facility's advance market commitment.

This marks the first U.S. funding commitment to the facility, following the previous presidential administration’s refusal to participate in the global initiative.

The African Union expects to start distributing 1 million doses of the COVID-19 vaccine developed by AstraZeneca and the University of Oxford to about 20 nations next week, says John Nkengasong, director at the Africa Centres for Disease Control and Prevention, during a press briefing.

This is the agency's first distribution of COVID-19 vaccines. They were donated to the AU through a partnership with MTN Group Ltd., Africa's largest mobile network by subscribers. The company donated $25 million, which will be used in supporting health worker vaccination. MTN’s donation will pay for up to 7 million doses, Nkengasong says.

Globally, confirmed cases of COVID-19 surpass 110 million.

Feb. 16 — South Africa asks the Serum Institute of India to take back 1 million doses of its AstraZeneca vaccine after the country decided to pause the vaccine's rollout domestically. This move came in response to data indicating the vaccine has minimal efficacy against mild to moderate illness from the 501Y.V2 coronavirus variant dominant in the country.

Feb. 15 — WHO lists two versions of the AstraZeneca-Oxford vaccine for emergency use, which allows them to be rolled out through the COVAX Facility. This vaccine comprises the majority of the vaccines that have been allocated to countries for the coming months through the facility. The emergency use listing was a key barrier to whether or not countries would receive doses of this vaccine.

WHO chief Tedros Adhanom Ghebreyesus says during a press conference that while "all the pieces are in place for the rapid distribution of vaccines," there is still a need to scale-up production of vaccines.

The number of reported cases of COVID-19 globally declines for the fifth consecutive week, Tedros says.

Feb. 14 — One year has passed since the first case of COVID-19 is reported on the African continent, in Egypt.

Feb. 12 — The World Bank approves $5 million from the International Development Association to help Cape Verde gain access to COVID-19 vaccines. This is the first World Bank-financed operation in Africa to support a country's vaccination plan.

Feb. 11 — The Africa Centres for Disease Control and Prevention advises that countries where B.1.351 — the variant of COVID-19 first found in South Africa — is dominant should not roll out the vaccine developed by AstraZeneca and the University of Oxford but says countries should still deploy the vaccine if the variant is not dominant.

This recommendation differs slightly from that made by WHO, which called for countries to continue with plans to roll out the vaccine but did not specify what nations should do if the new variant is found to be dominant.

Deaths from COVID-19 in Africa increased by 40% in the past month, WHO says. Over 22,300 deaths were reported in Africa in the past 28 days, compared with almost 16,000 deaths in the 28 days before that time period.

At the beginning of the COVID-19 pandemic, WHO predicted that malaria deaths in Africa could double if people’s access to malaria prevention programs and treatments was severely interrupted. But these deaths were averted over the past year, says Kenyan President Uhuru Kenyatta, who chairs the African Leaders Malaria Alliance, during a press conference.

Instead, over 90% of planned net distribution campaigns went forward over the past year. Around 160 million nets were distributed door-to-door, and more children in areas of highly seasonal transmission were reached with antimalarial medicines than in previous years.

Feb. 10 — Amid concerns around the efficacy of the vaccine developed by AstraZeneca and the University of Oxford against a new variant of COVID-19, WHO’s Strategic Advisory Group of Experts on Immunization still recommends its use in countries where B.1.351, the variant first identified in South Africa, is circulating.

Feb. 9 — Cambodia says it will begin inoculating government officials on Feb. 10 with China’s Sinopharm vaccine.

Feb. 8 — South Africa is considering alternative approaches in rolling out the vaccine produced by AstraZeneca and the University of Oxford after study results showed minimal efficacy against B.1.351, the dominant SARS-CoV-2 variant in the country. One approach is administering the vaccine to an initial 100,000 individuals to monitor hospitalization rates.

“If they are below the threshold that we are looking for, then we're confident that the vaccine is effective in preventing hospitalization and then we can roll it out. Alternatively, if it's above that threshold, then we need to look at alternatives,” says Salim Abdool Karim, a leading South African infectious disease expert, during a WHO press briefing.

“We don't want to end up with a situation where we vaccinated 1 million people or 2 million people with a vaccine that may not be effective in preventing hospitalization and severe disease,” he adds.

As South Africa puts this new approach in place, the country’s vaccination schedule will be “largely unaffected or, at most, affected by a few days,” according to Karim. The country plans to make use of Johnson & Johnson’s COVID-19 vaccine instead as it awaits further evidence on the AstraZeneca-Oxford vaccine.

WHO officials caution against dismissing the AstraZeneca-Oxford vaccine, arguing that the latest study is small and more data is needed before making a conclusion. WHO’s expert advisory group on immunizations is set to present recommendations on the use of the vaccine on Feb. 9.

Regarding the distribution of other vaccines in place of AstraZeneca and Oxford’s via the COVAX initiative, WHO Chief Scientist Soumya Swaminathan outlines issues with availability and feasibility. She notes the ultracold chain — which is not available in many countries in Africa and other parts of the world — that is required for distributing Pfizer’s vaccine. There is also the problem of supply, with COVAX only having access to a limited amount of the Pfizer vaccine in the first part of 2021.

“We all have a role to play in protecting vaccines,” says WHO Director-General Tedros Adhanom Ghebreyesus. “Every time you decide to stay at home, to avoid crowds, to wear a mask, or to clean your hands, you're denying the virus the opportunity to spread, the opportunity to change in ways that could make vaccines less effective.”

Feb. 7 — New data indicates the vaccine from AstraZeneca and the University of Oxford has minimal efficacy — just 22% — against the SARS-CoV-2 variant B.1.351, also known as 501Y.V2, currently dominant in South Africa, leading the national government to pause the vaccine’s rollout domestically.

Feb. 5 — The number of people vaccinated globally surpasses the number of reported infections of COVID-19, says WHO Director-General Tedros Adhanom Ghebreyesus during a news briefing. But more than three-quarters of those vaccinated live in only 10 countries. There are around 130 nations that have not yet administered a single dose of a COVID-19 vaccine.

Feb. 4 — The International Federation of Red Cross and Red Crescent Societies launches a 100 million Swiss franc ($111 million) plan to support the vaccination of 500 million people against COVID-19 by the end of 2021.

Intended to complement COVAX and support equitable vaccine distribution, IFRC will work through its national societies to build trust and eliminate vaccine misinformation, while actively seeking out people who are economically, socially, or geographically isolated for vaccination. This will include refugee and migrant populations. Trained personnel will also help in the physical delivery of vaccines.

Calling the alarm on inequity in the COVID-19 vaccine roll out, Jagan Chapagain, secretary general at IFRC, says in a press conference that without equality and fairness there’d be a risk of darker and potentially deadlier days to come.

According to IFRC analysis, nearly 70% of COVID-19 vaccine doses administered so far have occurred in the world’s 50 wealthiest countries.

“This is alarming because it is unfair, and because it could prolong or even worsen this terrible pandemic,” Chapagain says, adding that equality doesn’t just happen but must be engineered and planned for.

Feb. 3  The COVAX Facility, the global initiative aimed at equitable access to COVID-19 vaccines, provides countries a breakdown of how many vaccines to initially expect. This includes expectations around AstraZeneca and the University of Oxford’s vaccine through the first half of the year, as well as supplies of Pfizer and BioNTech’s through the first quarter of the year.

Fewer countries will receive the Pfizer-BioNTech vaccine because of challenges around the ultracold storage requirements and smaller supply. These initial doses are expected to reach about 3.3% of the total populations of the 145 participants receiving doses from the facility in this first batch.

“This is really really key for all countries to be able to prepare and plan for the rollout and effective introduction of this vaccine,” says Ann Lindstrand, WHO’s coordinator for the Expanded Programme on Immunization, during a press conference.

UNICEF announces it concluded a long-term supply agreement with the Serum Institute of India, giving it access to the intellectual property of vaccines created by AstraZeneca and Novavax. This would provide UNICEF and its procurement partners access to up to 1.1 billion doses of vaccines for around 100 countries at about $3 a dose for low- and lower-middle-income countries.

“This is a great value for COVAX donors and a strong demonstration of one of the fundamental principles of COVAX: that by pooling our resources, we can negotiate in bulk for the best possible deals,” says Henrietta Fore, executive director at UNICEF.

Jan. 30  One year has passed since WHO declared a public health emergency of international concern over the outbreak of COVID-19.

Jan. 29  Johnson & Johnson’s COVID-19 vaccine, which is administered in one dose, shows 66% overall efficacy in preventing moderate to severe COVID-19 28 days after vaccination, according to new data. Protection was observed as early as day 14. The vaccine also demonstrates 85% efficacy in preventing severe disease and 100% protection against hospitalization and death.

The data was collected from over 43,000 participants from the United States, South Africa, and several Latin American countries, 34% of whom were over the age of 60. But there was some variation between countries — the vaccine’s efficacy was 72% in the United States, 66% in Latin America, and only 57% in South Africa.

The company expects to file for emergency use authorization in the U.S. in early February and to deliver 100 million doses to the U.S. government by the end of June.

Guinea approves Russia’s Sputnik V vaccine.

Jan. 28  Novavax’s COVID-19 vaccine candidate shows 89.3% efficacy, according to an interim analysis of the vaccine’s phase 3 trial in the United Kingdom. The trial included over 15,000 participants ages 18-84, with 27% over the age of 65.

Preliminary analysis demonstrates that the vaccine has 85.6% efficacy against the more transmissible U.K. variant of the coronavirus, based on polymerase chain reaction testing on 56 of the 62 participants, mostly in the placebo group, who developed COVID-19. Novavax says efficacy of its vaccine against the original strain is 95.6%.

Meanwhile, the vaccine shows only 49% efficacy in a phase 2b trial in South Africa involving over 4,400 participants, including some with HIV. But for the 94% of study participants who are HIV-negative, the vaccine’s efficacy was 60% in preventing mild, moderate, and severe COVID-19 cases.

Enrollment is ongoing for the vaccine’s phase 3 trial in the United States and Mexico.

Germany’s vaccine committee advises that AstraZeneca’s COVID-19 vaccine should be used only for people ages 18 to 64, due to insufficient trial data about efficacy in people ages 65 and older.

Jan. 27  The world surpasses 100 million COVID-19 cases.

Jan. 26  WHO’s Strategic Advisory Group of Experts on Immunization issues interim recommendations on the use of Moderna’s COVID-19 vaccine. The recommendations include the administration of two doses with a 28-day interval between them. The interval may be extended for up to 42 days, depending on a country’s epidemiological situation. The group is not recommending halving a vaccine dose.

The experts also do not recommend the vaccine for pregnant women unless they are health care workers or otherwise at high risk of COVID-19 exposure. The vaccine should be offered to individuals regardless of whether they had symptomatic or asymptomatic COVID-19.

Jan. 25  Merck says it is discontinuing the development of its COVID-19 vaccine candidates after results from phase 1 clinical trials showed the vaccines generated lower immune responses compared to those who had recovered from COVID-19, as well as to other vaccine candidates. The company will focus instead on developing its COVID-19 therapeutic drug candidates, MK-7110 and molnupiravir (MK-4482). Interim results of a phase 3 study of MK-7110 showed more than 50% reduction in the risk of death or respiratory failure of hospitalized patients with moderate to severe COVID-19, while molnupiravir is currently in phase 2/3 clinical trials.

Mexican President Andrés Manuel López Obrador tests positive for COVID-19.

A study commissioned by the International Chamber of Commerce Research Foundation finds that the global economy could lose up to $9.2 trillion, half of which incurred by high-income countries, if low-income countries don’t get access to COVID-19 vaccines.

“As this study shows, ensuring equitable access to COVID-19 tests, treatments and vaccines is not only the right thing to do — to do otherwise is economically irresponsible,’ says ICC Secretary General John Denton.

Jan. 22  The global vaccines initiative COVAX signs an agreement with Pfizer and BioNTech for up to 40 million doses of their COVID-19 vaccine. Tedros says the agreement “also opens the door for countries who are willing to share doses of the Pfizer-BioNTech vaccine to donate them to COVAX and support rapid rollout.” Pfizer CEO Albert Bourla says he expects initial doses will be delivered in the first quarter of 2021.

Meanwhile, almost 150 million doses of the vaccine produced by AstraZeneca and the University of Oxford will be available for distribution via COVAX — which is co-led by Gavi, the Vaccine Alliance, WHO, and the Coalition for Epidemic Preparedness Innovations — in the first quarter of 2021, pending WHO emergency use listing recommendation, says Gavi CEO Seth Berkley.

“By our calculation, with the right level of funding in place, COVAX could procure 2.3 billion doses of vaccines in 2021. This would equate to close to 1.8 billion doses for the 92 lower-income countries in the COVAX advanced market commitment, or AMC as we call it,” he says.

“That's enough to protect about 27% of the population in those low- and lower-middle-income countries, which is in excess of the initial targets we laid out to protect those at highest risk,” he adds.

In a week’s time, COVAX will be providing all participating economies with details on how many doses the initiative will be able to provide “in the early part of this year,” Berkley says.

Jan. 21  There is a “dire” need for oxygen across the African continent as mortality rates rise, says John Nkengasong, director at the Africa Centres for Disease Control and Prevention, during a press conference. Amid the continent’s first wave of cases, Africa’s mortality rate was lower than the global average, but it has now surpassed that in the continent’s second wave.

Despite concerns that the Pfizer-BioNTech vaccine is not suitable for a rollout in Africa because of its need for ultracold storage, Nkengasong also says African nations can and should distribute it in urban centers with the strategic purchase of a handful of deep freezers, which cost about $15,000 each.

Jan. 19  The Africa Medical Supplies Platform opens pre-orders for COVID-19 vaccines for African countries. This follows the announcement by the African Union last week of securing 270 million doses of COVID-19 vaccines for the continent. The African Export-Import Bank will facilitate payments of up to $2 billion in advance procurement commitment guarantees to vaccine manufacturers on behalf of countries.

Jan. 18  Globally, confirmed cases of COVID-19 surpass 95 million.

Brazil distributes COVID-19 vaccines across the country after Anvisa, its regulatory agency, gave emergency use authorization for COVID-19 vaccines produced by AstraZeneca-Oxford and Sinovac. The country aims to start its vaccination campaign on Wednesday.

WHO Health Emergencies Programme Executive Director Mike Ryan says health care worker infections account for 7.7% of total global COVID-19 cases, but this can go up to 35% of infections in some countries.

Amid questions on COVAX’s ability to deliver on its goals, Dr. Bruce Aylward, who leads the ACT Accelerator Hub, tells WHO member states during the 148th WHO executive board meeting that COVAX is in a “strong position” to roll out vaccines globally, and aims to initiate deliveries in February. In his presentation, he says countries part of the COVAX Advance Market Commitment are ready to begin vaccinations, with about 50 countries already with national deployment plans in place. COVAX is focused on early equitable access to vaccines for the first two quarters of 2021, with close to 600 million doses expected to be made available during this period to countries, he says. But that is expected to increase in the second half of 2021.

“We are in a strong position to move out with vaccines globally, we just need the assistance of our member states in particular to make sure that becomes the reality," Aylward says.

On questions about why COVAX has not included mRNA-based COVID-19 vaccines, Aylward says these vaccines are difficult to roll out in a number of countries, given their cold chain requirements, for example, and are “extremely expensive.” He says COVAX wants to ensure its limited resources would be able to “go as far as possible.” However, he also says that COVAX is now in discussions with Pfizer and believes it will have access to that COVID-19 vaccine “very soon.”

Jan. 16  India starts COVID-19 vaccination, using vaccines by Bharat Biotech and Oxford-AstraZeneca vaccines. The goal is to vaccinate 300 million people in six months.

Jan. 15  World surpasses 2 million COVID-19 deaths.

"Health workers are exhausted, health systems are stretched and we’re seeing supplies of oxygen run dangerously low in some countries," says WHO Director-General Tedros Adhanom Ghebreyesus, during a news briefing.

The Norwegian Medicines Agency reports common adverse reactions to mRNA-based vaccines, such as fever and nausea, may have led to the fatal outcomes of several frail elderly people who received Pfizer-BioNTech COVID-19 vaccine.

Jan. 14  WHO Africa Regional Director Matshidiso Moeti says during a press briefing that the first doses of vaccines from the COVAX Facility are expected to reach Africa in March.

African health officials express concern about the possible regional spread of a coronavirus variant known as 501.v2, which was first discovered in South Africa in November. Authorities say the variant appears to be spreading at a faster rate and could put an increased burden on African health systems.

Moeti warns that “a virus that can spread more easily will of course put more strain on hospitals and health workers who are in many cases already overworked and overstretched.”

Jordan becomes one of the first countries to provide COVID-19 vaccines to refugees.

Jan. 13  The African Union’s vaccine acquisition task force secures 270 million COVID-19 vaccines for African nations, marking the first batch obtained for continentwide vaccination efforts. The vaccines will come from Pfizer and AstraZeneca through a deal with the Serum Institute of India and Johnson & Johnson.

Jan. 12  Pfizer CEO Albert Bourla tells CNBC that production of its COVID-19 vaccine for 2021 will increase from an initial 1.3 billion doses to 2 billion doses. He also says that in February, the company should have enough data to know whether its vaccine prevents COVID-19 transmission.

Researchers from the Butantan Institute are now saying that China’s Sinovac COVID-19 vaccine has a general efficacy of 50.4%, based on a Brazillian phase III clinical trial. This comes a few days after the researchers announced on Jan. 7 that the vaccine’s efficacy is 78% for mild COVID-19 cases. A medical director at Butantan says the new efficacy announcement includes “very mild” cases that didn’t require clinical care.

Two senior Cabinet ministers in Malawi die from COVID-19.

Jan. 11  Globally, confirmed cases of COVID-19 surpass 90 million.

Indonesia gives emergency use authorization to Sinovac’s COVID-19 vaccine, the first country to do so outside China. This paves the way for the country to commence its vaccination program, which the government says will start on Jan. 13.

Southeast Asia eyes China’s Sinovac COVID-19 vaccine

But answers to the important question — how safe and efficacious the vaccine is — remain unclear.

A WHO team is currently in China to assess compliance of the Sinovac and Sinopharm COVID-19 vaccines with international quality manufacturing practices, ahead of a potential WHO emergency use listing, says Director-General Tedros Adhanom Ghebreyesus in a press briefing.

The organization is also awaiting full data sets from the Serum Institute of India so it can determine whether to recommend the Oxford-AstraZeneca vaccine for international use. SII has an agreement with the vaccine manufacturer to produce 1 billion doses.

“I think it's really important to remind people, both governments as well as individuals, on the responsibilities and the measures that we continue to need to practice for the … rest of this year, at least. Because even as vaccines start protecting the most vulnerable, we're not going to achieve any levels of population immunity, or herd immunity, in 2021,” says WHO Chief Scientist Soumya Swaminathan.

Japan reports a new SARS-CoV-2 variant. It was discovered among four travelers coming from Brazil.

China says the international mission to investigate the origins of the SARS-CoV-2 virus will arrive in the country on Jan. 14.

The health ministry of the Palestinian territories gives emergency use authorization to Russia’s Sputnik V vaccine. This follows registrations of the vaccine in Algeria, Argentina, Bolivia and Serbia.

Jan. 10  Confirmed cases of COVID-19 surpass 3 million in Africa.

Jan. 8  Forty-two countries are rolling out COVID-19 vaccine campaigns, including 36 high-income countries and six middle-income, says WHO Director-General Tedros Adhanom Ghebreyesus, during a press briefing. A key problem is that high- and middle-income countries that are part of the COVAX Facility — an initiative aimed at equitable access to COVID-19 vaccines — are making additional bilateral deals for vaccines, which can increase the price for everyone.

Recent days have seen some of the highest numbers of deaths recorded during the pandemic, fueled by a lack of compliance with rules set by health authorities, Tedros says.

"The virus has taken advantage of this and is spreading at alarming rates in some countries," he adds.

Iran’s Supreme Leader Ayatollah Ali Khamenei bans the import of COVID-19 vaccines from the country’s adversaries, the U.S. and U.K., calling vaccines developed in these countries “completely untrustworthy” and repeating conspiracy theories that countries could intentionally contaminate others through vaccines. As a result, Iran's Red Crescent says it will no longer accept thousands of doses of the Pfizer-BioNTech vaccine that a group of U.S.-based philanthropists had planned to donate. Khamenei says Iran can get vaccines from "other reliable places" instead. The country launched human trials of its own COVID-19 vaccine candidate last month.

The U.K. approves Moderna’s COVID-19 vaccine for emergency use.

Jan. 7  Brazilian researchers who oversaw phase III clinical trials of Sinovac’s COVID-19 vaccine in the country announce it is 100% effective in preventing severe symptoms of COVID-19, and 78% effective in preventing mild cases. However, experts say further data needs to be published to gain a better understanding of the vaccine and its performance.

South Africa secures a deal with the Serum Institute of India for 1.5 million doses of the Oxford-AstraZeneca vaccine. The first batch of 1 million doses is expected to arrive in January, and the remaining 500,000 doses in February, according to the South African health ministry.

A study published in the medical journal JAMA finds that 59% of all transmissions of COVID-19 came from asymptomatic individuals, including 35% from presymptomatic individuals and 24% from individuals who never developed symptoms.

Jan. 6  Russia announces supply deal with Serbia for 2 million doses of the Sputnik V vaccine.

Jan. 5  WHO Director-General Tedros Adhanom Ghebreyesus expresses disappointment upon learning that the international team of experts meant to travel to China to investigate the virus’s origins has not yet been given visa clearances.

“I'm very disappointed with this news, given that two members had already begun their journeys and others were not able to travel at the last minute,” he says during WHO’s regular press briefing in Geneva.

“But I have been in contact with senior Chinese officials, and I have once again made it clear that the mission is a priority for WHO and the international team. I have been assured that China is speeding up the internal procedure for the earliest possible deployment,” he adds.

One member of the team on the way to China had to go back, while another is in transit in another country.

“We trust and we hope that this is just a logistic and bureaucratic issue that can be resolved very quickly,” says Dr. Mike Ryan, WHO emergencies director.

WHO’s Strategic Advisory Group of Experts on Immunization, or SAGE, recommends that patients receive two doses of the Pfizer-BioNTech COVID-19 vaccine — the first COVID-19 vaccine to receive WHO emergency use listing — within a period of 21 to 28 days. But the experts say countries experiencing “exceptional circumstances of vaccine supply constraints and epidemiologic settings” can delay the administration of the second dose for up to six weeks to maximize the number of individuals benefiting from a first dose.

The United Kingdom is delaying the administration of the second dose of the Pfizer-BioNTech vaccine for up to 12 weeks to vaccinate more at-risk people, a move that has created debate among health experts.

Jan. 4  Globally, confirmed cases of COVID-19 surpass 85 million.

Jan. 3, 2021  India approves the use of the AstraZeneca/Oxford vaccine, as well as a locally produced vaccine called Covaxin.

For earlier developments, visit Devex’s COVID-19 timeline for 2020.

This article was last updated on 18 June 2021

About the authors

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
  • Sara Jerving

    Sara Jerving is a Global Health Reporter based in Nairobi. Her work has appeared in The Wall Street Journal, The New York Times, the Los Angeles Times, Vice News, and Bloomberg News, among others. Sara holds a master's degree from Columbia University Graduate School of Journalism where she was a Lorana Sullivan fellow. She was a finalist for the Livingston Award for Young Journalists in 2018, part of a Vice News Tonight on HBO team that received an Emmy nomination in 2018 and received the Philip Greer Memorial Award from Columbia University Graduate School of Journalism in 2014. She has reported from over a dozen countries.