On Oct. 18, 2021, 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 2021-nCoV and then named COVID-19.

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

Total cases as of Sept. 27: 231,851,347, with 4,748,389 deaths.

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Sept. 24 — WHO adds monoclonal antibodies casirivimab and imdevimab produced by Regeneron in its recommended treatments for COVID-19. The recommendation is for both drugs to be used for non-severe COVID-19 patients who are at “highest risk” of hospitalization, as well as for patients with several and critical COVID-19 that have not developed any COVID-19 antibodies. The recommendations are based on four randomized controlled trials, and from the RECOVERY trial in the U.K.

Unitaid is negotiating with Roche, which is manufacturing the drugs and in charge of the drugs’ distribution outside the U.S., for lower pricing and to ensure equitable distribution in low- and middle-income countries. WHO is also discussing with Roche for donations of the drugs and their distribution through UNICEF.

Sept. 23 — Clover Pharmaceuticals releases efficacy results from its Phase 2 trial showing its COVID-19 vaccine has 100% efficacy against severe COVID-19 and hospitalization. Its overall efficacy is 67% against any level of severity of COVID-19 caused by any variant in the study. It has an efficacy of 79% against the delta variant.

Novavax and Serum Institute of India submit data for WHO emergency use listing of Novavax’s COVID-19 vaccine.

Sept. 22 — During the U.S.-led Global COVID-19 Summit, U.S. President Joe Biden announces an additional 500 million doses of the Pfizer vaccine for donation to low- and middle-income countries in 2022, bringing the total U.S. pledged COVID-19 vaccine to over 1 billion doses. The U.S., through USAID and the U.S. CDC, will also provide an additional $370 million to build countries’ capacity to roll out vaccination, while the U.S. International Development Finance Corporation will provide over $383 million in political risk insurance to Gavi, the Vaccine Alliance to facilitate vaccine shipment to nine countries in three continents, but details on which countries were not announced.

Biden also announces support for the establishment of a Global Health Threats Council in 2021, and calls on countries to support the creation of a Global Health Security Financial Intermediary Fund, to which the U.S. administration will commit $250 million in seed funding. Biden said he has also requested an additional $850 million from the U.S. Congress for the fund, abbreviated as FIF, clarifying that this is on top of the $630 million in health security funding for 2021 that also supports the Global Health Security Agenda.

The Global Health Threats Council proposal came from the Independent Panel for Pandemic Preparedness and Response, while FIF was recommended by the G-20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response.

In early October 2021, the U.S. aims to bring together different stakeholders from multilateral agencies, private sector, philanthropy and “other key partners to analyze data that will enable us to evaluate our collective progress in advance of the G-20 Summit, at other international gatherings, and on a regular basis.” U.S. Secretary of State Anthony Blinken is also expected to convene a meeting with foreign ministers at the end of 2021 to update on progress and “maintain global urgency” toward ending the pandemic in 2022.

Sept. 21 — The Biden administration is planning to nominate Dr. John Nkengasong, director of the Africa CDC, as chief of PEPFAR, according to a report by The New York Times. Several public health experts welcomed the news but also commented how it’s a “loss” for the Africa CDC. Nkengasong has been a leading figure in the COVID-19 response in Africa.

Johnson & Johnson releases real-world evidence from the U.S. showing its COVID-19 vaccine has 74% efficacy against severe or critical COVID-19, 89% against hospitalization, and 83% against COVID-19-related death. Its Phase 3 ENSEMBLE 2 trial also found that a booster shot of the vaccine upped protection against severe or critical COVID-19 to 100% 14 days post-vaccination when given 56 days after the first dose.

Local media reports say India is resuming exports of COVID-19 vaccine doses. Gavi is now seeking clarity from the Indian government and the Serum Institute of India on this development’s impact on COVAX’s supply schedule.

Novavax expects to submit regulatory filings for its COVID-19 vaccine within the year, while it has already filed for emergency use authorization in India, the Philippines, and Indonesia together with the Serum Institute of India.

Sept. 20 — Ahmed Ogwell Ouma, deputy director at the Africa Centres for Disease Control and Prevention, says that undelivered COVID-19 vaccine pledges are “not useful” for the African continent, where just under 4% of the population has been fully vaccinated.

Sept. 16 — Between June and August, at least 72,000 people died on the African continent from COVID-19 as a third wave of the pandemic overwhelmed countries, says Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, during a press briefing.

Aurélia Nguyen, COVAX managing director at Gavi, the Vaccine Alliance, says that manufacturers are not prioritizing supplies to COVAX, meaning access to vaccines is happening too slowly.

“The timing is not good. And we want the doses sooner. And we're not happy with the pace at which some of our manufacturers are supplying us,” she says.

Dr. Ayoade Olatunbosun-Alakija, co-chair of the African Union’s African Vaccine Delivery Alliance, says that broadly, political leadership across the African continent has not been forceful enough in demanding that COVID-19 vaccines make their way quickly to the African continent.

“As we hold the global north and their leaders accountable, we must also hold our own African leadership accountable for their failures,” she says.

Sept. 15 — The United Nations warns that so-called developing countries will suffer economic losses of $12 trillion through 2025 as a result of the pandemic.The figure is reduced to $8 trillion if China, which the U.N. Conference on Trade and Development’s globalization and development strategies division considers a developing economy, is excluded.

African nations considered least vulnerable to an epidemic were worst affected by COVID-19, according to research from NIHR Global Health Research Unit Tackling Infections to Benefit Africa from the University of Edinburgh and the World Health Organization. This includes countries with high urban populations and strong international links.

European Commission President Ursula von der Leyen announces another 200 million COVID-19 vaccine doses to be donated by the middle of next year, on top of the 250 million already committed — of which only 18 million doses have so far been shared. She also announces the creation of a new Health Emergency Preparedness and Response Authority for the EU.

Sept. 14 — The African Union plans to increase its goal of vaccinating 60% of the continent's population to 70%, but this will cost another $300 million, says Benedict Oramah, president of the African Export-Import Bank during a news briefing.

Of the more than 5.7 billion vaccine doses administered globally, only 2% of those have been administered in Africa, says Tedros Adhanom Ghebreyesus, director-general of the World Health Organization.

"I may sound like a broken record. I don't care. I will continue to call for vaccine equity until we get it," he says.

Over 140 former heads of state and government as well as Nobel laureates call on the candidates for the next German chancellor to support the waiver of intellectual property rules for COVID-19 vaccines.

Sept. 8 — The COVAX program, once again reduces its end-of-year supply forecasts. In January, it projected it was “on track to deliver” 2 billion doses by the end of the year. In June, that number was revised down to 1.9 billion doses. Now, it says it expects to have access to 1.43 billion doses of COVID-19 vaccines this year.

​​Tedros Adhanom Ghebreyesus, director-general at WHO, calls for an extension to his moratorium on booster shots in high-income countries. In August, he called for a moratorium so that lower-income countries could vaccinate 10% of their populations by the end of September. Many countries are not expected to reach this goal. He’s now calling for an extension of the moratorium until at least the end of the year to allow countries the chance to vaccinate at least 40% of their populations.

Tedros also says, during a press briefing, that while high-income countries have promised to donate over 1 billion doses, they’ve given fewer than 15% of that number.

Sept. 7 — COVID-19 vaccine production could exceed 12 billion doses by the end of the year and, without major bottlenecks, could reach 24 billion by June, according to modeling conducted by Airfinity, a London-based information and analytics company. By January, there could be enough vaccines to inoculate every adult on each continent. Next year, the world could see supply outstrip demand for the first time. Of the projected doses available, about half are expected from Chinese manufacturers.

But that doesn't mean that low- and middle-income countries will get adequate supplies, because many of the doses in the production queue have already been spoken for. Governments need to “strategically release doses so that vaccines leave the production lines and reach the people who need them most, from healthcare workers to vulnerable populations," according to the International Federation of Pharmaceutical Manufacturers & Associations.

Sept. 3 — AstraZeneca will deliver 200 million doses of COVID-19 vaccines to the European Union as part of an agreement settling the dispute between the two parties. The company is expected to deliver 135 million doses for the remainder of 2021, and the next 65 million doses by March 2022. The agreement completes the 300 million doses the two parties agreed upon as part of an advance purchase agreement in August 2021.

It is, however, unclear how the doses will be distributed. A number of EU member countries have been donating their AstraZeneca doses to low- and middle-income countries via COVAX or directly. In a statement, EU Commissioner for Health and Food Safety Stella Kyriakides said that while 70% of the EU’s adult population have now been fully vaccinated against COVID-19, vaccination rates between EU countries differ significantly, and that “the continued availability of vaccines, including AstraZeneca's, remain crucial.”

She also mentioned the EU’s aim to share at least 200 million COVID-19 vaccines via COVAX until the end of 2021, but did not clarify whether the awaited doses from AstraZeneca will be used for this purpose.

The EU sued AstraZeneca in April arguing the company breached some terms of its contract with the bloc, particularly the timely delivery of agreed COVID-19 vaccine doses. In June, A Brussels court ruled that AstraZeneca had to deliver 50 million more doses by the end of September, or risk a fine of €10 for each undelivered dose. Although another legal proceeding was slated to take place this September, this latest agreement puts an end to that pending litigation.

Sept. 2 — Following criticism over an agreement to ship Johnson & Johnson COVID-19 vaccines partially produced in South Africa to Europe, the deal has been suspended, Strive Masiyiwa, special envoy to the African Union, tells reporters during a briefing. Doses that have already been sent to Europe will be shipped back to South Africa for distribution among AU member states.

Kosovo is destroying 133,000 doses of the AstraZeneca vaccine donated by Norway. The doses have Aug. 31 for an expiration date.

WHO says 42 out of 54 African nations are not expected to vaccinate 10% of their populations by the end of September — a global target set by the World Health Assembly.

Sept. 1 — WHO launches a new pandemic and epidemic intelligence hub, which aims to leverage data science innovations, artificial intelligence, quantum computing, and other cutting-edge technologies and foster “greater sharing of data and information between communities and countries.” Nigeria Centre for Disease Control’s current director general, Dr. Chikwe Ihekweazu, will lead the initiative.

North Korea rejects about 3 million doses of COVID-19 vaccines from COVAX, the Wall Street Journal reports.

Aug. 31 — WHO says it's monitoring a new variant of COVID-19 known as "mu." It was first identified in Colombia in January. "The Mu variant has a constellation of mutations that indicate potential properties of immune escape," the agency wrote in a weekly update on the pandemic.

Aug. 30 — France donates 10 million doses of AstraZeneca and Pfizer COVID-19 vaccines over the next three months to African Union member states. They will be distributed through the Africa Vaccine Acquisition Trust and COVAX.

Aug. 26 — A total of 57,600 COVID-19 vaccine doses arrive in Algeria via COVAX. The doses are part of Denmark’s 1 million doses pledged to COVAX.

Many African nations are facing challenges planning for rollouts of COVID-19 vaccines because supplies are unpredictable, Dr. John Nkengasong, director at the Africa Centres for Disease Control and Prevention, says during a press briefing. They are receiving doses in relatively small amounts, often with little warning about when they will arrive or what type of vaccine they will get.

“The biggest challenge is predictability on access to vaccines,” he says. “There are about six different vaccines out there, they come in all kinds of forms, and they require different conditions to roll them out. How can you plan?”

Aug. 25 — Eleven members of a WHO-led international group of experts warned in an article published in Nature that the window of opportunity to find the origins of COVID-19 is “closing fast.” The group’s initial report on its findings was published in March, but it was incomplete and it came with recommendations of further study needed. But this process has “stalled,” the authors wrote, adding that “any delay will render some of the studies biologically impossible.”

Aug. 24 — A classified report provided to U.S. President Joe Biden from the nation's intelligence community did not offer a conclusive answer on the origins of COVID-19, according to the Washington Post. The report is not yet public.

Aug. 23 — The U.S. Food and Drug Administration approves the first COVID-19 vaccine for use by people 16 years old and older. The Pfizer COVID-19 vaccine, which was previously given emergency use authorization, will be marketed under the name Comirnaty.

About 80 million more people in low- and middle-income countries in Asia and the Pacific were pushed into extreme poverty because of disruptions in economic activity due to COVID-19 last year, says a report from the Asian Development Bank. Before the pandemic, the percent of the population living in extreme poverty was expected to decrease. The report analyzed data from 46 of its LMIC member countries.

Aug. 18 — The U.S. administration announces it will begin offering booster shots of the Pfizer and Moderna vaccines to members of the American public eight months after a second dose.

If all high-income countries decide to give booster doses to people above 50 years old, that would consume close to 1 billion doses, says WHO Chief Scientist Dr. Soumya Swaminathan during a news briefing.

The data around the need for booster shots is still inconclusive, says Joachim Hombach, executive secretary at WHO's Strategic Advisory Group of Experts on Immunization. While some information shows there is a level of decline in the protective efficacy of COVID-19 vaccines in relation to mild disease over time, there is no data to suggest that protection against severe disease also declines, he says.

WHO and Unitaid express concern over Swiss pharmaceutical company Roche's statement, warning of shortages of tocilizumab — one of the therapies recommended by WHO as treatment for patients with severe COVID-19. In a statement, both organizations call on the company to “ensure equitable allocation of current stocks of this medicine for all countries, including low- and middle-income countries,” and encourage it to facilitate technology transfer and share knowledge and data for the manufacture of the drug to broaden access.

Aug. 17 — The Australian government has come under fire for purchasing half a million Pfizer doses from COVAX. While Australia is eligible to purchase doses via COVAX as a self-financing party, critics point out that other lower-income nations are struggling for supply and should be the priority for vaccines under COVAX.

Aug. 16 — Swiss pharmaceutical company Roche warns of shortages of Actemra/RoActemra, the brand name for tocilizumab, “due to the unprecedented surge in worldwide demand.” In the United States, demand is “well-beyond 400% of pre-COVID levels over the last two weeks alone,” according to a statement. Tocilizumab is among the therapies recommended by WHO as treatment for patients with severe COVID-19.

Apart from the evolving nature of COVID-19, Roche attributes the anticipated shortages to limited manufacturing capacity globally, constraints in the supply of raw materials, and the complexities in manufacturing biologics.

“We have been doing everything possible to minimise the impact of supply constraints and have a controlled distribution strategy in place for people with conditions for which Actemra/RoActemra is approved,” according to a Roche statement.

The Access to COVID-19 Tools Accelerator, a global coalition of organizations developing and deploying the diagnostics, treatments, and vaccines to fight COVID-19, launches a $7.7 billion appeal to address the surge in cases of the Delta variant globally.

Ten million COVID-19 vaccines partially produced in South Africa are being exported to Europe in August and September, according to an op-ed published in the Guardian by former U.K. Prime Minister Gordon Brown.

The New York Times publishes an investigation that finds that the contract between Johnson & Johnson and Aspen Pharmacare “required South Africa to waive its right to impose export restrictions on vaccine doses.”

Aug. 13 — U.S. regulators approve a booster dose of COVID-19 vaccines for people with compromised immune systems.

Aug. 12 — WHO calls on governments to “depoliticize the situation and cooperate to accelerate the origins studies” of COVID-19, and says “the search for the origins of SARS-CoV-2 is not and should not be an exercise in attributing blame, finger-pointing or political point-scoring.”

China has rejected plans for a second phase of the study and repeatedly dismissed the theory that the virus leaked from a lab in Wuhan.

WHO expert Peter Ben Embarek, who was part of the team that made the initial probe in China, previously said during the presentation of interim results of the investigation that the lab leak theory was “extremely unlikely.” But when asked about it in a Sciencemag interview, he said “The fact that we assessed this hypothesis as extremely unlikely doesn’t mean it’s ruled out.” WHO chief Tedros Adhanom Ghebreyesus has also repeatedly said all hypotheses remain on the table, including the lab leak theory, and has recently called on China to give access to raw data.

In a documentary that aired on Danish television on Thursday, Embarek was quoted as saying that Chinese researchers who were part of the probe team did not want to include anything about the lab in the report and when they agreed, it was on the condition that they not recommend any specific studies to further investigate the hypothesis. He was further quoted as talking about a probability of a “human error” but later told the Washington Post that the interview was mistranslated in English.

Aug. 11 — WHO launches the second phase of its Solidarity Trial, called Solidarity PLUS, to test three new candidate drugs for COVID-19 treatment. The trial will be conducted in 52 countries, and will include the drugs artesunate, a derivative of artemisinin used for malaria; imatinib, a cancer drug taken orally; and infliximab, a monoclonal antibody used to treat autoimmune diseases such as Crohn's disease.

Kate O’Brien, director at WHO’s Department of Immunization, Vaccines and Biologicals, says that the issue on what it will take to reach herd immunity with COVID-19 remains an “area of scientific uncertainty.”

Kenya’s Ministry of Health accuses a Nairobi-based insurance company of being “unethical” for offering insurance coverage for adverse side effects of the COVID-19 vaccine.

Aug. 6 — At an international forum for COVID-19 vaccine cooperation, Chinese President Xi Jinping pledges $100 million to COVAX AMC, the first Chinese donation to the WHO-backed facility, and will provide 2 billion COVID-19 vaccine doses. However, it is unclear whether these doses are for donations or sales or if these are new supplies or includes doses already sold or donated.

Preliminary data from a draft study in South Africa suggests Johnson & Johnson’s one-dose COVID-19 vaccine is highly effective against severe disease and death from the delta variant. In the study, which included half a million health care workers, it was found to be 95% effective at preventing death and 71% against hospitalization from the delta variant.

Aug. 5 — Globally, reported cases of COVID-19 surpass 200 million.

The first tranche of AstraZeneca COVID-19 vaccine doses donated by Spain to COVAX arrives in Peru (101,760 doses), Guatemala (201,600 doses), and Paraguay (253,440 doses). Another 97,920 doses are also expected to arrive in Nicaragua on Friday.

Aspen Pharmacare plans to boost its manufacturing capacity for Johnson & Johnson’s COVID-19 vaccine in South Africa by 200 million doses annually starting in January, says Strive Masiyiwa, a special envoy for the African Union, during a press briefing. This is on top of existing capacity to produce 300 million vaccine doses per year.

Aug. 4 — WHO calls for a moratorium on booster shots of COVID-19 vaccines so that countries worldwide can catch up with efforts to immunize their most vulnerable populations without further straining the supply of doses globally.

The agency wants all nations to vaccinate at least 10% of their populations by the end of September, but many are not on track to reach this goal. Tedros Adhanom Ghebreyesus, director-general at WHO, says he wants high-income countries to refrain from administering third shots to their populations until at least the end of next month.

Aug. 2 — The International Monetary Fund approves an allocation of $650 billion in Special Drawing Rights — the largest such disbursement in the history of the institution — to help countries cope with the COVID-19 pandemic. IMF says about $275 billion will reach the broad category of “emerging markets and developing countries.” Lowest-income nations will receive the least. African countries are expected to get just 6.4% of the total allocation.

An early pre-print study suggesting ivermectin can reduce COVID-19 deaths by more than 90% that had been cited in numerous papers was withdrawn after concerns regarding plagiarism and data manipulation were raised. It is now being investigated.