Uzbekistan Introduces mandatory Vaccination

Photo courtesy of Gazeta.Uz

I am happy to hear that the Ministry of Health is mandating vaccination against COVID-19 for all Uzbek citizens age 18 and above. The announcement came out last night. We are going see how we can help our employees receive the vaccines safely. I think that the Special Commission to Combat COVID-19 is acting strongly because of the current spike in cases in Tashkent. Below is the latest data of cases from the WHO Uzbekistan office.

WHO Uzbekistan COVID-19 Update: July 15, 2021

It is fortunate that the risk of death and hospitalization from COVID-19 for K-12 students is “incredibly rare” according to a study in the UK. From March 2020 to February 2021, a death rate is around 2 for every million people under 18 from complications from COVID-19. “None had asthma or type-1 diabetes and half had conditions that put them at higher risk than health children from dying of any cause.” Doctors running the study advised schools to promote immunization and mask use, despite students’ resilience to COVID.

The co-founder and CEO of BioNTech Ugur Sahin insisted booster shots are going to be necessary to get the pandemic under control during the 2021 STAT Breakthrough Science Summit. Pfizer also indicated that they are applying their mRNA technology to developing flu vaccines.

My Latest Thinking About the Pandemic: July 15, 2021

I am following closely a National Institute of Health trial of fully vaccinated adults receiving a booster doses of different COVID vaccines. My wife, adult-age son and I are fully vaccinated with the Astra-Zeneca vaccine and I am considering getting a Pfizer booster before returning to Uzbekistan. Immunity may wane after some time and with possible new variants developing throughout the world, it might become recommended by public health agencies. I predict that both the CDC and WHO will be recommending booster vaccines as we go into the cold and flu season this winter. In this trial conducted by Baylor College of Medicine in Houston and the University of Maryland, 50 adults will get a booster 12-20 weeks after being fully vaccinated versus a control group that will not get a booster, but will be fully vaccinated. The challenge for my wife and me is that we received our second dose on June 5. If we get a booster next week before we head back to Tashkent, it will only be a 6-7 week gap between the second dose and the booster. However, this may be our only chance to get it as vaccines are still not widespread in Uzbekistan.

The trial results also hint that people who have already received two doses of AstraZeneca vaccine could have a stronger immune response if they were given a different jab as a booster if recommended in the autumn.

“Mixing Covid jabs has good immune response, study finds” BBC Roberts, Michelle 28 June, 2021

The BBC article quoted above describes the results of a study by Oxford University researcher that shows mixing vaccines improves the immune response, especially viral vector vaccines with mRNA developed vaccines. It is calming to know that 2-dose Astra-Zeneca vaccine regimen reduces our chances of hospitalization from COVID by 90%, so no matter if I get a booster of Pfizer before I leave, I’ll be protected. I encourage everyone to read the article by BBC Medical Editor Fergus Walsh.

Some officials in the Uzbek government are asking organizations to make vaccination mandatory for their employees. This is good news in my opinion as the only way schools will be able to offer the full co-curricular slate of programs is through vaccination. Other countries are moving towards mandatory vaccinations for certain groups. Health workers in the USA and in France and Greece are some examples of mandatory vaccination policies becoming a reality.

An employer can make the vaccination mandatory for his employees,” – Alisher Kadyrov

Alisher Kadyrov said that in accordance with Article 212 of the Labor Code, the employer, in agreement with the members of the trade union, can assign duties to the employee arising from the interests of the labor collective. In particular, the organization can make the coronavirus vaccine mandatory for its employees to ensure a healthy work environment.The deputy also stressed that we have the right to demand guarantees that the personnel serving us – a bank employee, a seller, a driver, a law enforcement officer, a doctor, a teacher, is not a carrier of infection.According to the deputy, citizens are not obliged to receive a vaccine, but in the name of stabilizing the situation in the country, it is necessary to restrict the freedom of non-vaccinated citizens.

Latest Pandemic Thinking: July 1, 2021

I would like to thank the Association for the Advancement of International Education’s (AAIE) for continuing to provide resources to assist international school leaders in planning for the 2021-2022 school year. Every other day they publish a COVID-19 Briefing. AAIE COVID-19 Briefing Archive.

This Scientific American article points out the contradictory recommendations between the WHO and CDC. The TIS COVID Response Team is considering dropping the requirement for people to wear masks outdoors while on campus. The World Health Organization (WHO) is still recommending fully vaccinated people to wear masks and physically distance. This is because concerns of new variants and continued community transmission of the virus. WHO Press Conference June 25, 2021.The US Centers for Disease Control and Prevention (CDC) differs from the WHO. They are saying vaccinated people do not need to wear masks outdoors and in many indoor settings. CDC June 17, 2021 Vaccinated People Recommendations.This Science Alert article points out studies showing possible changes in blood cells which may explain why some people have long-term problems from COVID. The pandemic continues to rage in unvaccinated countries. A third-wave peak in many African countries (Namibia, Uganda, Zambia) is pushing health systems to the brink. Russia had over 20,000 cases and is introducing regional lockdowns.

Children over age 12 can be easily vaccinated in the USA this summer

On a personal note, I’ve decided to get a Pfizer booster shot while I am in the USA this summer. My wife, adult son and I are fully vaccinated with the AstraZeneca vaccine which currently offers us strong protection against all variants of the coronavirus. Research is showing that a booster vaccine of the mRNA (Pfizer/Moderna) variety offers more immunity for people who previously received one or two doses of a viral vector (AstraZeneca/Johnson & Johnson) type vaccine. I sense that global health agencies will be recommending a booster shot in the autumn or winter. Our two children (photo above) are getting fully vaccinated with the Pfizer vaccine. We walked into the local CVS pharmacy got them vaccinated. I wish that more countries would be able to vaccinate to the rate the USA has implemented.

My Pandemic Reading: June 25, 2021

Dr. Zeynep Tufekci in the New York Times questions whether the pandemic was caused by scientific research “Where did the Coronavirus Come From? What we Already Know is Troubling?” She cites historical lab leaks of SARS (Severe Acute Respiratory Syndrome), small pox and hoof and mouth disease. From what I’ve been reading, the source of this coronavirus is pointing to the Wuhan Institute of Virology and a strain isolated from a cave in 2012. The scientific community will probably never find out because of the lack of transparency. Dr. Tufekci goes on to say that this is a global problem and research on bats and viruses around the world needs to be looked at more closely.

Courtesy of Kun.uz

The Delta variant of the coronavirus is causing spikes in cases around the world, including this week, Uzbekistan. “Delta Variant Triggers New Phase in the Pandemic” from the June 25 issue of Science gives some a good overview of its impact. I feel reassured that two-dose AstraZeneca people are protected against hospitalization with the Delta variant. Public health officials in Uzbekistan implemented stricter controls of movement in the city due to an increase in cases. International travel is not impacted but I expect to see more use of masks. The government is also trying to increase vaccination rates by offering vaccines to people 50 and over and university professors.

WHO Uzbekistan Situation Report – June 24, 2021

TIS Operations Team Visits HomeSpot

TIS Operations Team

Last week the TIS Operations Team visited a new superstore in Tashkent called HomeSpot. We are always looking for high quality products and with a large store like HomeSpot, it will make us more efficient in procuring equipment and supplies. We hope to start a corporate account with them for lower prices and delivery to the school.

Tashkent is developing rapidly and it seems like everyday there are new stores, restaurants, cafes, factories, etc. HomeSpot is owned by the Kolberg Group and they are expanding the store we visited into the second floor. It is modeled after Home Depot and sells a wide range of goods, from home furnishings, to dry wall, tools, paint, flooring, appliances, etc. Most of it came from China but they have lots of brands including Bosch and Archer reasonably priced. I think it will be a successful business.

I was particularly interested in the paint section. There is a Finnish company called Tikkurila that uses color codes to mix paints to produce the exact color a customer needs. This is new to Tashkent and just in time. Our re-branding this year specifies six colors with Pantone codes. We were worried about not finding the exact colors. You can find it easily on Google Maps and it is not too far from our school.

Pandemic Reading: TIS Starts Vaccination of faculty!

My wife Nadia and I in the lobby of TIC relieved to be vaccinated with our first dose of Covishield!

This week we were able to secure through the World Health Organization (WHO) COVAX program, COVID vaccinations for all 170 of our employees. 95% of the expatriate faculty took advantage of the opportunity but 5% of the Uzbek faculty/staff did. There was a lot of skepticism about the Oxford – AstraZeneca vaccine here in Uzbekistan because of the reports of very rare blood clots and lots of informal information going through social media channels here. Many locals are taking a wait-and-see approach or waiting for the more trusted (in this region) Sputnik V. I was disappointed as the only way I see TIS getting back to offering our full range of educational opportunities is through 100% vaccination of employees, parents and eventually students. Our sister organization the Tashkent International Clinic really came through for the school and supported procuring the vaccines and making sure it was done safely. Thank you TIC!!!

Despite the locals at this time not wanting the vaccine, we will eventually reach the situation where the adults in our society are vaccinated but children are not vaccinated. In my family, my wife and I were vaccinated as well as our 18-year-old son. My 16-year-old son and 13-year-old daughter are not vaccinated. 16-year old people and above are eligible right now for the Pfizer vaccine and in several weeks, 12-year-olds to 15-year-olds will be eligible. It will take a long time for everyone age 12 and above to be vaccinated and we’ll be in this stage of children unprotected. This will be the next unprecedented situation that we’ll have to deal with. What happens when adults are vaccinated and children are not vaccinated?

It makes sense to start vaccinated the elderly. Children are 8,700 times less at risk to die from COVID than people over 85 years old. And when the number of COVID cases is low in the community, the risk of dying from COVID is comparable to the risk of dying from influenza for children.

All of these concerns could come to a head in schools, which are one of the main places where unvaccinated people—e.g., kids—will congregate. As the U.S. is already seeing, school outbreaks do happen, but they can be contained with precautions in place. This means younger kids, who likely won’t get vaccinated before the fall, may have to continue to wear masks indoors. But the benefits of in-person schooling are significant enough, experts told me, that schools should open even if kids can’t get shots yet.

Zhang, Sarah “We Are Turning COVID-19 into a Young Person’s Disease” The Atlantic April 21, 2021

What makes next school year even more uncertain is how much the virus will be circulating in the community. If there is a high percentage of the people vaccinated combined with many former cases with immunity, how much will COVID be able to be transmitted? The situation here in Tashkent will depend on how much Uzbeks buy into the idea of vaccination. I sense they fear side effects from the vaccine more than contracting COVID-19. How to convince large numbers of people to take the vaccine? The other factor to reach herd immunity is how many people here have already had COVID? I’ve heard up to 30% of Uzbekistan has been infected, but difficult to prove without good data. And how long will their immunity last?

The pandemic has taught me that people have a wide range of risk tolerance. I naturally side on being risk tolerant because I look at the statistics. We were lucky that this particular virus was not like previous viruses (MERS, SARS) and had a very low mortality rate. Howver, other cultures and individuals look at it differently and can be extremely risk-adverse. In our TIS community, this broad spectrum of risk tolerance plays itself out all the time. I receive pleas from families from both sides, urging me to close school and move to virtual and others preferring us to stay face-to-face no matter the number of cases. The New York Times has an online Risk Calculator to help people think about what activities they are comfortable doing.

The most thought-provoking article from my weekend reading is David Leonhart’s opinion piece in the New York Times. He challenges parents to weigh the risks of keeping children isolated versus sending them to school. Their mental/emotional/physical health is greatly improved by attending school daily versus keeping them from catching the coronavirus. The risk from COVID is much less in a world where the adults are mostly vaccinated. There is no doubt that the pandemic has been bad for people over 50 years old and especially for those over age 65. However, COVID kills fewer children than seasonal influenza. Bigger risks to children are vehicle accidents (5x) and drowning (2x). Water and cars are more dangerous to children than COVID. The share of 3 million COVID deaths worldwide of among people under 25 is 0.1%. This tells me that keeping children at home in a mostly vaccinated community doesn’t make sense. In looking at the rates of risk, I think schools should keep the morning temperature checks and screen for flu-like symptoms, especially during the cold and flu season. The statistics also tell me that learning how to swim and drive safely are important for young people.

But Covid’s effect on children has been fundamentally different from its effect on adults. For children, Covid looks much more like the kind of risk that society has long tolerated, without upending daily life. “For the average kid, Covid is a negligible risk,” Dr. Aaron Richterman, an infectious disease specialist at the University of Pennsylvania, told me. Dr. Richterman added that he would not upend his family’s life to avoid every possible exposure to children

Leonhardt, David “What to do When the Kids are Still Unvaccinated?” New York Times April 22, 2021

Regarding the local pandemic situation, as you can see below, cases are climbing in Uzbekistan. Six of the past seven days in Tashkent over 200 cases were officially registered. Numbers are nearing what we had when we first re-opened the campus in early October. I am concerned that we’ll reach the spikes we had in September and July 2020.

Uzbekistan Situation Report – April 22, 2021 World Health Organization

To end this post, I see universities in America are requiring all employees and teachers to be vaccinated. This makes sense when they are living together in close proximity. I can see K-12 schools, especially international schools moving to this policy. As I wrote earlier, the only way for schools to get back to normal is for full vaccination coverage. The path out of this pandemic is quite clear.

Vaccination Reading for April 18, 2021

An artist’s rendition of a potential pan-coronavirus vaccine

I read Jon Cohen’s article, “Vaccines that can protect against many coronaviruses could prevent another pandemic” on the American Association for the Advancement of Science website. The article gets into the nitty-gritty of vaccine development. It focuses on the work of the international nonprofit Coalition for Epidemic Preparedness Innovations (CEPI) to develop a vaccine that would protect against a wide range of coronaviruses. The image above shows a gray nanoparticle carrier with different spike proteins that educate human immune systems against different kinds of coronaviruses, including the beta family of coronaviruses that included COVID (SARS-CoV-2) and Middle East Respiratory Syndrome (MERS).

In looking at per capita vaccination rates on the website Our World in Data, some countries are far ahead of others. As we’ve been reading in the news, Israel is the world leader with 119 doses administered per 100 people. I guess that means that everyone received one dose and now they are moving to the second dose for all citizens. The UK and US are in the next tier with 61 and 59 respectively. Other countries of interest to TIS are Canada and the EU (24), Turkey (23) China (13) Russia (10) India (8) and Australia (5). The site has data on Uzbekistan, coming in at 0.77 doses administered per 100 inhabitants.

The international vaccine available in Uzbekistan is AstraZeneca-Oxford. Insightful articles I found on this vaccine are as follows:

Which vaccine should I take? The answer according to experts is the one available to me. The vaccine most likely to be available to TIS will be the AstraZeneca vaccine. Is AstraZeneca effective? Is AstraZeneca safe? My opinion on it is that it will keep me out of the hospital and alive if I am one of the unlucky people to contract COVID. The chances of serious side effects like blood clotting are “very rare” and according to the data, the chances of me dying from COVID greatly outweigh the chances of me dying from the side effects of the vaccine. Each individual will have to decide for themselves what to do and everyone has their unique personal circumstances. For me as the director of the school, the conversation in the international school world is about developing COVID vaccination policies. It will be fascinating to see the different approaches schools take on the subject. The big questions are balancing individual rights versus community protection, access to vaccines in a diverse community, vaccination databases, etc.

My Latest COvid reading: April 10, 2021

New Yorker Daily Cartoon – April 9, 2021

The Kaiser Family Foundation is a non-profit organization focusing on American health issues and the US role in global health issues. They have a vaccine spotter with information on how people can get vaccinated in the different US states. The US government is doing a remarkable job in national vaccine distribution and I sense the market will soon be flooded. It even looks like non-residents and tourists can get vaccinated in many states. STAT reports on the progress of developing the “tamiflu” for the coronavirus. Many researchers and companies are working on it but it still remains a dream. France and UK are giving opposite advice regarding young people and the AstraZeneca vaccine. France is recommending a second dose with a different vaccine. The UK is recommending the second dose be the same AstraZeneca vaccine. Pfizer and BioNTech are requesting the US Federal Drug Agency to approve their vaccines for use in people ages 12 to 15 years old.

Bloomberg reports wealthy nations are getting vaccinated 25x faster than low income nations. This is understandable because governments are responsible for their own citizens. Uzbekistan is one of the low income nations and as of mid-April, only has 600,000 doses of AstraZeneca. Hopefully companies can continue to up production and distribute around the world. One of the concerns is the rise of dangerous variants when COVID is burning through unvaccinated countries. The world’s biggest vaccine producer in India, Serum Institute is very stressed, trying to keep up with the recent sharp spike in cases in India and has stopped exporting vaccines. This is bad news for the COVAX program. The WHO Chief Scientist Soumya Swaminathan in the podcast, G-Zero World with Ian Bremmer argues that vaccination nationalism will only prolong the pandemic.

My Pandemic Reading – April 4, 2021

Vaccines are on my mind a lot these days. The first vaccines were released to the public in Uzbekistan on Thursday. Everyday I am reaching out to our network of contacts lobbying for our faculty and staff to get vaccinated. I am reading everything I can about vaccines. The CDC has given permission for fully vaccinated people to travel. This Scientific American article (If You Don’t Have COVID Vaccine Side Effects, Are You Still Protected?discussed the side effects after receiving the vaccine – April 1, 2021 by Stephanie Sutherland) has some insight:

  • About 50% of people get some kind of systemic reaction to the vaccine. More side effects come with the second dose of a 2-dose vaccine.
  • Women and the young experience more side effects than men and the elderly.
  • All subjects are equally protected regardless of reaction to the vaccine. Reaction of the immune system to the vaccine depends on many factors.

The US FDA (Food & Drug Administration) recently approved Abbot Laboratories’ BinaxNOW test (above). It is simple to use at home, results are ready in 15 minutes and retails for less than $10, some places less than $5. It might be a good idea to have loads of these available for TIS next school year so we can host more events with parents and visitors attending.

WHO Uzbekistan Situation Report – April 1, 2021

We should all feel fortunate to be in Uzbekistan during the pandemic. Schools around the world have gone back to Virtual Learning and country lockdowns. This includes Brazil, most of Europe and India to name a few locations. The numbers of cases in Tashkent are still rising however with an average of 132 cases/day last week. It has me concerned because you can see on the graph above, we are getting back into the same levels we had in November. I have a feeling more vaccines will be available here after the government gave permission for private companies to offer paid vaccinations.

Yesterday, the CDC released real-life data showing that, just two weeks after even a single dose, the two mRNA vaccines were 80 percent effective in preventing infection. The effectiveness rose to 90 percent after the second, booster dose. People in the study were routinely tested regardless of whether they had symptoms, so we know that vaccines prevented not just symptomatic illness—the vaccine-efficacy rate reported in the trials—but any infection. People who are not infected by a virus cannot transmit it at all, and even people who have a breakthrough case despite vaccination have been shown to have lower viral loads compared with unvaccinated people, and so are likely much less contagious.

Tufekci, Zeynep “The Fourth Surge Is Upon Us. This Time, It’s Different“,The Atlantic, March 31, 2021

My Thoughts on the CDC SAFE SCHOOL OPERATIONS GUIDELINES

This week the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA published its latest Safe School Operations Guidelines on March 19, 2021. Reading the report confirms the effectiveness of our layered approach to reducing transmission of the coronavirus. These layers, which we all know now include everyone wearing proper masks consistently, physically distancing, hand washing and respiratory etiquette, cleaning of facilities and contact tracing when an outbreak occurs. I am proud that our school has been open since early October and remained open this school year using much of the protocols and concepts in the report. Below is a list of ideas in the report that came to my attention.

  • Masks are primary in reducing the spread. The most effective masks fit well on the face, have 2-3 tightly woven cloth or other fabric layers.
  • The CDC lowered the recommended physical distance between students to 3 feet (0.9144 meter) for elementary schools and middle and high schools in times of low to substantial community transmission. They recommend going back to the 6 feet (1.83 meters) in times of high community transmission. They recommend always maintaining 6 feet between adults and between adults and children in schools.
  • Approximately 30% of the participants in high school wrestling tournament in Florida, USA were infected from an outbreak on one of the teams.
  • More resources for schools provided by the CDC can be found here. The CDC also collected research on transmissions in school here.
  • Table 1 (above) gives guidelines to determine the level of community transmission. Using the official data from the March 25 World Health Organization Uzbekistan Situation Report, I calculated Tashkent currently has a “low” or blue level of transmission.With a 7-day average of approximately 100 cases per day in a city of 3 million people, that equals 3 cases per 100,000 people. Today, March 27, we had 143 cases in Tashkent, a high daily total for 2021. That raises it to 5 cases per 100,000 people, which is getting closer to the yellow or moderate transmission category.
“Operational Strategy for K-12 Schools through Phased Prevention” CDC Report March 19, 2021

We are currently debating on loosening our protocols in phases. One of the areas is mixing cohorts in sports and extracurricular activities. We are currently experiencing a slight rise in cases and this has delayed any actions as we wait and see what the trends will be over the next month. Below is the confirmed new cases averages from WHO Uzbekistan office. We are hoping that the latest increases in cases does not go to the heights of July and October.

World Health Organization Uzbekistan – Situation Report – March 24, 2021

The next challenge for TIS is vaccinations. Besides just getting access to vaccines for both foreign and host country nationals here in Uzbekistan, we have the additional challenge of timing and travel restrictions. We have 11 weeks of school before summer break when most of the foreign staff travels to their home countries. Our Summer Break is about 8 weeks before teachers are expected back to prepare for the school year start. The time between doses ranges from 3 weeks (Pfizer-BioNTech) to 1 month (Moderna) to 6/12 weeks (Astra-Zeneca). The Johnson & Johnson would be best because it requires only one dose. I am concerned that this will cause travel delays for our foreign employees if they are not able to schedule a second dose in time for traveling back to school. The CDC provides some resources for schools regarding vaccines including posters to promote vaccinations.