According to the World Health Organization, over one year into the Covid-19 pandemic, about 90% of countries still report one or more disruptions to essential health services, with no substantial global change since the summer 2020. However the magnitude and extent of disruptions has generally decreased: in 2020, countries re-ported that about half of essential health services were disrupted; in the first 3 months of 2021, just over one third of services are being disrupted. Moreover, around 66% of countries continue to report health workforce-related reasons as the most common causes of service disruptions. Supply chains are also still disrupted in nearly one third of countries, affecting the availability of essential medicines or diagnostics. Meanwhile, 43% of countries cite financial challenges as major causes for disruptions in service utili-zation.

Potentially life-saving emergency, critical and surgical care interventions are still dis-rupted in about 20% of countries. Two thirds of countries also report disruptions in elective surgeries, with accumulating consequences as the pandemic is prolonged. Among the most extensively affected health services (those for which more than 40% of countries are reporting disruptions) are those for mental, neurological and substance use disorders; neglected tropical diseases; tuberculosis; HIV and hepatitis B and C; can-cer screening, and services for other non-communicable diseases including hyperten-sion and diabetes; family planning and contraception; urgent dental care; and malnutri-tion.

More than ever, vaccination campaigns definitely seem to be the backbone of the world-wide effort to reduce the impact of Covid-19 by achieving herd immunity in most countries. As vaccination speeds up in various countries thanks to massive doses ship-ments, with 1?045?850?203 vaccine doses being administered worldwide as of 2 May, how is the R&D on new treatments going? What are the main projects against newer and multiple variants? What will the second-generation and third-generation vaccines be made of?

According to the World Health Organization, there are 277 Covid-19 vaccines in devel-opment globally, of which 93 have entered human testing. Most of the projects in clini-cal testing are injected (78 projects representing 84 %). There are also two oral formu-lations (2 %) and seven nasal-spray formulations (8 %).

Among the new comers, some of them such as Altimmune (with its adenovirus nasal spray), have never brought a vaccine to market. It expects results of an early-stage study testing whether the vaccine safely induces the desired immune response. Californian Vaxart is developing a Covid-19 vaccine as a tablet that can be swal-lowed. A small, early-stage study showed it triggered immune responses against the vi-rus and has potential to protect against variants, the company said in February. Accord-ing to a poll conducted by Vartax in April, nearly 19 million Americans who did not want to receive an injectable vaccine, would take an oral dose. Vaxart now plans to start a midstage, or Phase 2, study of the tablet vaccine by midyear, a spokesman said.

Oravax Medical was formed in a joint venture by Oramed and Premas Biotech to develop oral vaccines against Covid-19. The company's vac-cine oral candidate is a virus-like particle (VLP) triple antigen vaccine; it targets three structural proteins on the virus, which could be beneficial against mutated forms of the novel coronavirus. So far, a pilot animal study showed the oral vaccine promoted sys-temic immunity through Immunoglobulin G (IgG), the most common antibody in blood and bodily fluids that protects against viral infections, and Immunoglobulin A (IgA). The company anticipates initiating a clinical study during the second quarter of 2021. According to Stabilitech, a UK-based biopharma company that has developed a thermally-stable oral vaccine for COVID-19, such a product has various benefits: no need to use needles or an electroporation device, to have a healthcare professional to administer it. There would be no need to keep the vaccine stored at a certain tempera-ture; the oral vaccine could be mailed worldwide and taken at home orally.

In addition to oral vaccines, companies are developing oral therapeutics as well. Merck and Ridgeback Biotherapeutics are develop-ing molnupiravir, an orally available antiviral candidate for the treatment of COVID-19. Pfizer is also working on a coronavirus oral antiviral therapeutic, which is in ear-ly-stage trials. April 29, according to Albert Bourla, chairman and CEO, it could be ready by the end of the year: "If all goes well and we implement the same speed that we did so far and we are and if regulators also do the same and they are, I hope by the end of the year". Bourla when speaking to CNBC cited several advantages behind such a pill. "One of them is that you don't need to go to the hospital to get the treatment of which is the case with all the injectables so far but you can get it home. That could be a game-changer." -->

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