Pfizer Submits Reguest to US FDA for Approval of Omicron-targeted COVID Booster Shot 23/08/2022 Zachary Brennan, via Endpoints News Albert Bourla, CEO of Pfizer, at a World Economic Forum meeting in 2018. The Omicron-targeted boosters are coming. Almost 250 days since Omicron became the dominant variant in the US, Pfizer and BioNTech on Monday officially announced that they’ve requested an Emergency Use Authorization (EUA) from the US Food and Drug Administration for their booster dose of an Omicron BA.4/BA.5-adapted bivalent vaccine for those 12 and older. The application’s submission comes as BioNTech said earlier this month that it expects to begin delivering Omicron-adapted vaccines as early as October, subject to regulatory approval. The FDA’s vaccine advisory committee in late June gave the thumbs up — by a vote of 19-2 — to requiring an Omicron-related component in this season’s booster dose; both Pfizer/BioNTech and Moderna have been working on such boosters over the past few months. The EUA for Pfizer/BioNTech’s booster would be based on preclinical data showing that it generated a strong neutralizing antibody response against the BA.4/BA.5 variants, as well as safety, tolerability and immunogenicity data from a Phase II/III trial of a 30-µg booster dose of the companies’ other, Omicron BA.1-adapted bivalent vaccine candidate. A clinical study investigating the safety, tolerability and immunogenicity of the Omicron BA.4/BA.5-adapted bivalent vaccine in individuals 12 years of age and older is expected to start this month, Pfizer and BioNTech said. FDA to Pfizer: Test another course of Paxlovid for those rebounding In other COVID-related drug developments, the FDA earlier this month quietly called on Pfizer to test another course of its Covid-19 antiviral Paxlovid for those who have rebounded and tested positive after an initial dose. On Aug. 5, the FDA reissued its EUA letter for Paxlovid to include additional post-authorization requirements, including calling on Pfizer “to conduct a clinical trial in patients with ‘COVID-19 rebound’ and a clinical trial evaluating different durations of treatment in immunocompromised patients with mild-to-moderate Covid-19.” Pfizer told Bloomberg News that it is “working with the FDA to finalize a protocol to study patients who may be in need of retreatment,” and the trial protocol is expected to be finalized this month. FDA expands Novavax EUA for teenagers Additionally, US teenagers looking for an option outside of the mRNA Covid-19 vaccines will now be able to turn to Novavax’s Covid-19 vaccine which won an expanded EUA on Friday from the FDA. Those aged 12 through 17 will gain access to the Novavax vaccine after the company submitted data from an ongoing pediatric expansion of its Phase III trial of 2,247 adolescents within that same age range across 75 sites in the US. The company said that in this population the vaccine achieved its primary efficacy endpoint, with clinical efficacy of about 78% (95% CI: 37.55%, 92.45%) overall, at a time when the Delta variant was the predominant circulating variant. The efficacy analysis was supported by assessment of antibody titers that were shown to be higher in adolescents than in young adults, Novavax added. Canada buys 12M doses of Moderna’s Omicron-targeted booster Meanwhile, mRNA powerhouse Moderna said Monday that Canada’s government has exercised its option to purchase an additional 4.5 million doses of an Omicron-containing bivalent vaccine booster candidate, in addition to moving forward the scheduled delivery of 1.5 million doses of the bivalent vaccine candidate from 2023 to 2022. Moderna and Canada also agreed to shift six million doses of the current vaccine to the Omicron-containing vaccine, subject to regulatory approval, with doses scheduled for delivery this year. The vaccine is expected to be ready for deployment in the US in October. ______________________________________________________ This article was first published by Endpoints News. Image Credits: Flickr – World Economic Forum. WHO Warns of New Ebola Threat in DRC 23/08/2022 John Heilprin A health worker in Democratic Republic of the Congo’s eastern province of North Kivu. A new case of Ebola has been confirmed in the Democratic Republic of the Congo’s eastern province of North Kivu, prompting health authorities to declare a resurgence of the deadly virus, World Health Organization (WHO) officials said on Tuesday. WHO announced that health authorities confirmed a 46-year-old woman died of the disease on 15 August in Beni, a town located in North Kivu. She initially received care for other ailments at the Beni Referral Hospital, who said, but the began exhibiting symptoms consistent with Ebola. A statement from WHO said both the Beni and Goma branches of the DRC’s National Institute of Biomedical Research (INRB) confirmed Ebola virus in samples taken from the patient. Further analysis showed her death was genetically linked to the 2018-2020 outbreak in North Kivu and Ituri provinces that was the country’s longest and largest. Last week, WHO issued its first guidelines ever for Ebola treatment. It advised using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease,” WHO says. That includes older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth. Dr Matshidiso Moeti, WHO Africa Executive Director. Battling ‘Greater Frequency’ of Resurgent Ebola Cases This latest resurgence comes just four months after the Ebola outbreak that erupted on 23 April in DRC was declared to be over by DRC and WHO authorities, with fewer cases and deaths than previous episodes due to a swift response including vaccinations. The last time the disease flared up in Beni it was brought under control in about two months and ended in mid-December 2021, after causing six deaths among eight confirmed and three probable cases. “Ebola resurgences are occurring with greater frequency in the Democratic Republic of the Congo which is concerning,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “However, health authorities in North Kivu have successfully stopped several Ebola flareups and, building on this expertise, will no doubt bring this one under control quickly,” Moeti said. Some 160 people have been identified as contacts and their health is being closely monitored by WHO staff and DRC health authorities, WHO said, and it has not yet been determined whether the woman who died was vaccinated. The nation has 1,000 doses of the rVSV-ZEBOV Ebola vaccine in its stockpile, including 200 that are being shipped to Beni this week. Ebola, which is spread by contact with the bodily fluids of an infected person or contaminated materials, produces early symptoms of fever and muscle aches like malaria. WHO’s “ring vaccination” strategy — vaccinating people who came into contact with patients — is expected to begin shortly after having shown some effectiveness at preventing new cases and limiting the spread of the disease in the DRC. WHO has been supporting DRC’s government to scale up testing, contact tracing and public health measures. Stockpiles of Ebola vaccines from the cities of Goma and Kinshasa were transported to Mbandaka earlier this year so vaccinations could start. A targeted Ebola vaccination campaign aimed at tracing and immunizing contacts was underway in Mbandaka, a city in DR Congo’s north-western Equateur Province. Image Credits: WHO. WHO Advocates Prevention Focus in Africa 23/08/2022 Paul Adepoju & John Heilprin WHO Director-General Dr Tedros Adhanom Ghebreyesus at the opening of the 72nd session of the Regional Committee for Africa African nations need to pivot to prevention in their fight against disease by “addressing its root causes” through a greater focus on improved diets, healthier environments, and better road safety, among other factors, WHO Director-General Dr Tedros Adhanom Ghebreyesus told the 72nd WHO Regional Committee for Africa meeting, at the opening of the weeklong session of member states in Togo’s capital Lomé. Tedros also pledged WHO’s continued support for the work of the African Centers of Disease Control (Africa CDC) in remarks aimed at squelching tensions between the two agencies that emerged earlier this summer. Africa CDC began circulating a proposal for it to be empowered by the African Union to declare continental health emergencies, something WHO reportedly opposed. The Fuss Over Who Should Declare Public Health Emergencies in Africa This week’s meeting of African health ministers and government officials is supposed to focus on ways to lower the burden of disease, strengthen capacity and endorse strategies in fighting disease and promoting access to health services and people’s well-being. It also is looking at how the continent can improve prevention and battle COVID-19 and a growing number of other health challenges from outbreaks of communicable diseases, conflicts and humanitarian crises, climatic change and chronic diseases. “Realizing our vision for the highest attainable standard of health starts not in the clinic or the hospital, but in schools, streets, supermarkets, households and cities,” Tedros told the meeting. It was his first major appearance since he formally began his second five-term at the helm of the 194-nation UN health agency a week ago. “Much of the work that you do as ministries of health is dealing with the consequences of poor diets, polluted environments, unsafe roads and workplaces, inadequate health literacy, and the aggressive marketing of products that harm health,” he said. “That’s why,” Tedros said, “we are calling on all member states to make an urgent paradigm shift, towards promoting health and well-being and preventing disease by addressing its root causes, and creating the conditions for health to thrive.” Pledging support for Africa CDC and the African Medicines Agency Tedros also pledged WHO’s continued financial and technical support Africa Centers for Disease Control and Prevention (Africa CDC) – noting that he had in fact helped birth the agency with a proposal for its creation at an African Union summit in July 2013 when he was Ethiopia’s foreign minister. “So, Africa CDC is my daughter, and not only me, but WHO and our regional office, all of us, will do everything to strengthen it. The strengthen of continental institutions is very important to the advancement of health and other sectors in our continent,” he said. “In the same way,” he added, “we are also continuing to provide technical and financial support to the African Medicines Agency (AMA), to support greater regulatory capacity on the continent,” he added, of the new medicines agency that is supposed to help facilitate the more rapid and harmonized approval of new drugs and vaccines across Africa. Cessouma Minata Samate, AU’s Commissioner for Health, Humanitarian Affairs, and Social Development, at the opening ceremony of the 72nd session of the Regional Committee for Africa Last month, Health Policy Watch reported that the Executive Council of the African Union (AU) selected Rwanda to host the headquarters of the African Medicines Agency. Cessouma Minata Samate, AU’s Commissioner for Health, Humanitarian Affairs, and Social Development, said the AMA also aims to support the production of medicines on the African continent. “Through this agency, we are going to build the regulatory capacity of member states of the African Union and the regional economic community,” she said. While congratulating the government of Rwanda for being selected to host AMA’s headquarters, she urged the country to ensure the agency becomes operational as soon as possible. See our special coverage of the development of the AMA here: African Medicines Agency Countdown From prevention to battling inequity Dr Matshidiso Moeti, WHO’s Regional Director for Africa, noted the COVID-19 pandemic showed just how important it is for African countries to invest in health care and fighting diseases. In Africa last year, 22 million jobs were lost and 30 million more people were added to the ranks of extreme poverty, which is defined by the World Bank as living on less than US$1.90 a day. With things expected to continue this way into next year, she said, “these statistics make the case for investment in health very clear.” Inequity is a key factor impeding Africa’s health progress, according to Moeti, whether it is the lack of tools needed for prevention and responses to pandemics or the high out-of-pocket payments that prevent people from seeking health care when they need it. Moeti expressed continued WHO concern about the continent’s comparatively lower COVID-19 vaccination rate despite the recent availability of large quantities of doses. She said it puts health and jobs at unnecessary risk while opening the door to the emergence of new, potentially dangerous variants of the virus. “A fresh impetus to accelerate COVID-19 vaccine uptake is imperative, especially to safeguard our most vulnerable,” she said. Togo’s President Faure Gnassingbé at the opening ceremony of the 72nd session of the Regional Committee for Africa Togo eradicates four NTDs while fighting disease A highlight of the opening ceremony was the recognition of Togo’s efforts at disease prevention including the eradication of four neglected tropical diseases (NTDs). “The liberation of Togo from Dracunculiasis (Guinea-worm disease), Human African Trypanosomiasis, lymphatic filariasis and trachoma is a stunning achievement that will free many people from the threat of these devastating diseases,” Tedros said. “I also congratulate you,” he added,” “for the progress you have made in improving the management and efficiency of hospitals, and for increasing access to services for the population.” Togo’s President Faure Gnassingbé said health is at the center of his government’s development — and is a priority for social cohesion. He described Togo’s relationship with WHO as one that has transcended beyond institutional cooperation and is now a genuine partnership that supports Togo’s health systems, helping to coordinate emergency responses and to raise vaccine equity. “It is a partnership that guides us — learning from current crises with a view to sustainable, equitable and sound solutions,” he said. Image Credits: WHO. Monkeypox Vaccine: 62% of Recipients Experience No Side Effects, Says New Survey 22/08/2022 Maayan Hoffman Jynneos Monkeypox Vaccine A first-of-its-kind survey examining the side effects of the monkeypox vaccine in Israel found that the majority of recipients had no general symptoms. “Most of the side effects reported by the vaccinated are local and mild, which in most cases pass within one to three days,” said Miri Mizrahi Reuveni, Deputy CEO and Head of the Health Division at Maccabi Healthcare Services, which conducted the survey. Maccabi is one of Israel’s four major public health funds. This is some of the first data to be systematically reported on side effects of the vaccine and uptake since the outbreak began, however, the data does not reflect on the vaccine’s efficacy which will take more time to assess. Specifically, some 62% of 155 vaccine recipients reported a return to routine without any general symptoms, Maccabi reported on Monday. The other 38% experienced side effects. Among those who experienced side effects, most fell into broad categories: 27% reported weakness and fatigue; 11% complained of muscle pain; 9% had headaches; 6% suffered from diarrhea; 5% got nausea; 4% had less appetite and swelling of the lymph nodes; 3% felt chills and joint pain; 1% got a skin rash; and another 1% felt eye irritation. A majority of recipients, or 74%, experienced pain at the site of injection, including stiffness (22%), localized swelling (7%) and itching (6%). In most cases, those who experienced side effects said they lasted more than 24 hours. But 22% of recipients who had symptoms said they persist today. Only 3 percent reported that their symptoms passed in less than 24 hours. About 10% said they lasted one day; 39% said they ended within two to three days; and 19% complained of symptoms that took four to six days to resolve. Eight-five percent of respondents said they had no hesitation about getting the jab. The health fund also asked people why they decided to get vaccinated. The most common responses were a desire to protect themselves and those around them. More than a third said they also were afraid of becoming isolated. More than people who belong to the HMO have taken the vaccine already, according to Reuveni. The survey began when the country started distributing the vaccine at the start of August. Respondents were asked questions after they got the shot and seven days later. As of the end of last week, the Israeli Health Ministry reported 197 cases of monkeypox in the country, all of them involving men. Ministry officials told Health Policy Watch on Monday that so far more than 2,300 Israelis have been vaccinated against the virus. The country recently expanded its vaccination criteria to allow more people to get the shot. Israel ordered 10,000 vaccine doses, of which a little more than half have arrived. Some 4,400 vaccine doses are expected to arrive at the beginning of September, ministry officials said. The international monkeypox outbreak began on May 4 when a first case outside of historically endemic African countries was discovered in London. Since then, it has spread across the world, according to the World Health Organization (WHO), with more than 35,000 cases of monkeypox reported from 92 countries and territories accompanied by 12 deaths. WHO Monkeypox Dashboard as of 22 August 2022 Image Credits: Star919News/Twitter , WHO. Open Access 240 Compound Collection Launched in Fight Against Infectious and Mosquito-Borne Illnesses for World Mosquito Day 22/08/2022 Raisa Santos Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases. To mark World Mosquito Day, 20 August, the Global Health Priority Box has been launched to provide free access to 240 compounds to stimulate research into new drugs and insecticides. The initiative, launched by the Medicines for Malaria Venture (MMV) and the Innovative Vector Control Consortium (IVCC), provides scientists with starting points to advance the development of tools that can tackle several priorities set out by the WHO in late 2021, including drug resistance and communicable diseases. Every year vector-borne diseases such as malaria cause the loss of more than 700,000 lives annually, predominantly in regions with tropical climates in low- and middle-income countries. Major vector-borne diseases account for 17% of the global burden of communicable diseases. Recent studies have shown that climate change has the potential to shift the regions in which disease-carrying mosquitoes breed, introducing new pathogens to previously unaffected areas. For example, the spread of malaria, caused by a parasite that spreads to humans and other animals through the bites of infected female mosquitoes, increases in temperatures of around 25ºC. Coupled with the increasing prevalence of drug-resistant superbugs and insecticide resistance, it is clear that new tools are needed to fight against vector-borne diseases. “Efforts to end infectious diseases will only succeed if we have the tools to treat and prevent them,” said Dr Timothy Wells, MMV’s Chief Scientific Officer. Collection of compounds for malaria, neglected and zoonotic diseases, and more The collection features 240 compounds that can be used against drug-resistant malaria, neglected and zoonotic diseases, and other diseases at risk of drug resistance. This includes: 80 compounds with confirmed activity against drug-resistant malaria. 80 compounds for screening against neglected and zoonotic diseases, and diseases at risk of drug resistance. 80 compounds that have been tested for activity against various vector species. Priority Box’s ‘open approach’ emphasizes international collaboration The Global Health Priority Box’s builds on the reaction of the scientific community to the COVID-19 pandemic, which demonstrated that international collaboration accelerates the development of new tools, diagnostics and vaccines. Its open approach invites scientists to make screening results publicly available and to publish findings in an open access journal within two years following data generation. Such an approach allows for researchers around the world to build on one another’s work, saving time and resources. “Open innovation is one of the keys to unlocking drug discovery because it allows us to tap into existing knowledge and expertise and build on it collaboratively,” said Wells. Dr Nick Hamon, CEO of IVCC, noted the need for innovation in vector control due to the increased prevalence of insecticide resistance, “which is undermining the efficacy of bed nets and indoor residual sprays, the cornerstone of malaria prevention since the turn of the century.” “Open access to new chemistry will encourage greater collaboration across the scientific community, bringing new innovators into public health and potentially more rapid development of new vector control solutions,” he said. Image Credits: Sanofi Pasteur/Flickr. WHO Recommends Two Monoclonal Antibodies for Ebola Treatment; Calls to Expand Access in Developing Countries 19/08/2022 John Heilprin A health worker dresses in protective clothing to enter the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019 – during the 2018-2020 Ebola outbreak in the neighboring Democratic Republic of Congo. In its first guidelines ever for Ebola treatment, the World Health Organization (WHO) advises using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth,” WHO says. In its launch of the recommendations, WHO also called on the global community “to increase access to these lifesaving medicines”. As relatively new therapies, monoclonal antibodies have been difficult and expensive to access in low- and middle-income countries, with 80% of their sales occuring in the US, Canada and Europe. In 2020, a consortium of research organizations, led by Wellcome Trust issued a global call to action to expand access. Yes to Ansuvimab and Inmazeb, No to ZMapp and Remdesivir Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis, according to WHO. Its new 44-page guidelines for Ebola treatment also makes a “conditional recommendation against” the use of ZMapp and remdesivir for patients with the Ebola virus. ZMapp, a drug cocktail of antibodies developed from the tobacco plant, was the first drug to be used on an experimental basis against the Ebola virus. Initially it showed promise with rhesus monkeys, but was not fully tested on humans. During the 2014-2016 Ebola epidemic in West Africa, however, the US Food and Drug Administration (FDA) approved ZMapp’s experimental use on patients. That epidemic, the continent’s largest ever, killed more than 11,000 people out of the 28,000 people who became ill with the virus. Subsequently, ZMapp, remdesivir as well as mAb114 and REGN-EB3 were all tested against one another in a randomized controlled trial in the Democratic Republic of Congo, running in parallel to the Ebola epidemic that wracked the eastern region of the country between 2018-2020. In August 2019, however, an independent monitoring board recommended early termination of the DRC therapeutics trial due to the favorable results demonstrated by the latter two drug candidates. The board recommended that all patients be randomized to receive either REGN-EB3 or mAb114 in an extension phase. The study’s preliminary results among 499 participants showed people who got REGN-EB3 or mAb114 had a greater chance of survival than those who received ZMapp or remdesivir. Remdesivir was originally developed to treat hepatitis C before it was investigated for treating the Ebola and Marburg viruses, and then as a post-infection treatment for COVID‑19. It eventually won US and European Medicines Agency approval as a COVID-19 treatment. However, in November 2020, WHO recommended against Remdesivir use for COVID, saying there was “no evidence” it improved patient outcomes. Access remains a problem for ebola treatment In its recommendations, WHO called for greater efforts to ensure that that the drugs are “where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely.” To assist with that goal, WHO offered to support “countries, manufacturers and partners” to step up national and global efforts to increase affordability of the biotherapeutic products. “Access to these therapeutics is challenging and pricing and future supply remain unknown, especially in resource-poor areas,” WHO says in its 44-page guidelines. “Without concerted effort, access will remain limited, and it is therefore possible that this strong recommendation could exacerbate health inequity,” it says. “Therefore, given the demonstrated benefits for patients, these recommendations should act as a stimulus to engage all possible mechanisms to improve global access to these treatments.” Both Inmazeb and Ebanga were developed with significant US government support The development of both Inmazeb and Ebanga was heavily supported by the US government and other public funders. Inmazeb, which also was the first FDA-approved treatment for Ebola, is produced by the US-based Regeneron Pharmaceuticals. It was developed in response to the 2018 Ebola outbreak in the DRC with supprot from the US Biomedical Advanced Research and Development Authority (BARDA). Regeneron announced in 2020, the company will “continue to provide Inmazeb for free in response to outbreaks in the DRC through the MEURI protocol for compassionate use,” in colaboration with the WHO, the US FDA and with continuing support from BARDA. “Regeneron is actively working with nongovernmental organizations and public health agencies to ensure continued access to Inmazeb in low- and middle-income countries,” the company declared at that time. The MEURI protocol is a WHO-approved ethical framework for the use of investigational agents. Regeneron gained fame in the first year of the COVID pandemic when former President Donald Trump was treated with another antibody cocktail that it had developed against COVID, (REGEN-COV- a combination of casirivimab and imdevimab) . The cocktail was later recommended by WHO for COVID treatment. As for Ebanga, it was initially developed by the Vaccine Research Center of the US National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), and then licensed in 2018 by the US biotech firm, Ridgeback Biotherapeutics for further development and ultimately FDA aprpoval. “Ebanga is currently available to patients, and Ridgeback Biotherapeutics provides and distributes the treatment to patients free of charge in Ebola-stricken countries,” the company states on its website. WHO publishes invitation to drug manufacturers to share drugs for evaluation WHO says it has now published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to enabling bulk procurement of new drugs by global health agencies, for communities and countries affected by Ebola. “We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies program. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks,” she said. “This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.” WHO also says there is a need for more research and evaluation of clinical interventions because of the large number of “uncertainties” that remain including with supportive care, with our understanding and characterization of the Ebola virus disease and its longer-term consequences, with the continued inclusion of vulnerable populations such as pregnant women, newborns, children and older people in future research. Back to the DRC for More Research, Studies on Ebola treatment The clinical trials used to shape WHO’S guidelines for Ebola treatment were conducted during the Ebola outbreaks that have raged in central and west Africa over the past six years; the largest trial was conducted in the Democratic Republic of the Congo (DRC) which saw a major outbreak in 2018-2020, as well as small outbreaks since then. Ebola is a severe and too often fatal illness, and previous outbreaks and responses showed the importance of early diagnosis and treatment with optimized supportive care that includes fluid and electrolyte repletion and treatment of symptoms. “This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs,” said Kojan. “From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible,” he said. “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.” The DRC has now recorded 14 Ebola outbreaks since 1976, including six since 2018. The most recent outbreak, which began in April, was declared to be over by DRC and WHO authorities last month — with fewer cases and deaths (five) than previous episodes due to a swift response including vaccinations. Vaccinations were launched less than a week after the outbreak was declared, using an ultra-cold chain freezer in Mbandaka so vaccine doses could be stored locally and safely, and delivered effectively. That enabled 2,104 people to be vaccinated, including 1,307 frontline workers and 302 contacts. In the previous outbreak in Equateur Province from June to November 2020, 130 people were infected and 55 died. Africa’s battles with Ebola and other deadly diseases also helped prepare its health systems to deal with COVID-19. When SARS-CoV2 virus landed on the continent, the African Centres for Disease Control (CDC) reinforced its regional coordinating centers, enhanced lab capacity and unified surveillance networks. An Additional Tool for Ebola treatment Along With Clinical Care Guidance The new Ebola treatment guidelines are meant to complement clinical care guidance that outlines the optimized supportive care Ebola patients should receive including factors such as relevant tests, pain management, nutrition and co-infections. But the recommendations only apply to the Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus). “Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler of the University of Toronto and co-chair of the Guideline Development Group of experts selected by WHO. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment — MAb114 or REGN-EB3 — now leads to recovery for the vast majority of people,” he said. Image Credits: Photo: Anna Dubuis / DFID, WHO Therapeutics for Ebola virus disease. How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . 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WHO Warns of New Ebola Threat in DRC 23/08/2022 John Heilprin A health worker in Democratic Republic of the Congo’s eastern province of North Kivu. A new case of Ebola has been confirmed in the Democratic Republic of the Congo’s eastern province of North Kivu, prompting health authorities to declare a resurgence of the deadly virus, World Health Organization (WHO) officials said on Tuesday. WHO announced that health authorities confirmed a 46-year-old woman died of the disease on 15 August in Beni, a town located in North Kivu. She initially received care for other ailments at the Beni Referral Hospital, who said, but the began exhibiting symptoms consistent with Ebola. A statement from WHO said both the Beni and Goma branches of the DRC’s National Institute of Biomedical Research (INRB) confirmed Ebola virus in samples taken from the patient. Further analysis showed her death was genetically linked to the 2018-2020 outbreak in North Kivu and Ituri provinces that was the country’s longest and largest. Last week, WHO issued its first guidelines ever for Ebola treatment. It advised using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease,” WHO says. That includes older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth. Dr Matshidiso Moeti, WHO Africa Executive Director. Battling ‘Greater Frequency’ of Resurgent Ebola Cases This latest resurgence comes just four months after the Ebola outbreak that erupted on 23 April in DRC was declared to be over by DRC and WHO authorities, with fewer cases and deaths than previous episodes due to a swift response including vaccinations. The last time the disease flared up in Beni it was brought under control in about two months and ended in mid-December 2021, after causing six deaths among eight confirmed and three probable cases. “Ebola resurgences are occurring with greater frequency in the Democratic Republic of the Congo which is concerning,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “However, health authorities in North Kivu have successfully stopped several Ebola flareups and, building on this expertise, will no doubt bring this one under control quickly,” Moeti said. Some 160 people have been identified as contacts and their health is being closely monitored by WHO staff and DRC health authorities, WHO said, and it has not yet been determined whether the woman who died was vaccinated. The nation has 1,000 doses of the rVSV-ZEBOV Ebola vaccine in its stockpile, including 200 that are being shipped to Beni this week. Ebola, which is spread by contact with the bodily fluids of an infected person or contaminated materials, produces early symptoms of fever and muscle aches like malaria. WHO’s “ring vaccination” strategy — vaccinating people who came into contact with patients — is expected to begin shortly after having shown some effectiveness at preventing new cases and limiting the spread of the disease in the DRC. WHO has been supporting DRC’s government to scale up testing, contact tracing and public health measures. Stockpiles of Ebola vaccines from the cities of Goma and Kinshasa were transported to Mbandaka earlier this year so vaccinations could start. A targeted Ebola vaccination campaign aimed at tracing and immunizing contacts was underway in Mbandaka, a city in DR Congo’s north-western Equateur Province. Image Credits: WHO. WHO Advocates Prevention Focus in Africa 23/08/2022 Paul Adepoju & John Heilprin WHO Director-General Dr Tedros Adhanom Ghebreyesus at the opening of the 72nd session of the Regional Committee for Africa African nations need to pivot to prevention in their fight against disease by “addressing its root causes” through a greater focus on improved diets, healthier environments, and better road safety, among other factors, WHO Director-General Dr Tedros Adhanom Ghebreyesus told the 72nd WHO Regional Committee for Africa meeting, at the opening of the weeklong session of member states in Togo’s capital Lomé. Tedros also pledged WHO’s continued support for the work of the African Centers of Disease Control (Africa CDC) in remarks aimed at squelching tensions between the two agencies that emerged earlier this summer. Africa CDC began circulating a proposal for it to be empowered by the African Union to declare continental health emergencies, something WHO reportedly opposed. The Fuss Over Who Should Declare Public Health Emergencies in Africa This week’s meeting of African health ministers and government officials is supposed to focus on ways to lower the burden of disease, strengthen capacity and endorse strategies in fighting disease and promoting access to health services and people’s well-being. It also is looking at how the continent can improve prevention and battle COVID-19 and a growing number of other health challenges from outbreaks of communicable diseases, conflicts and humanitarian crises, climatic change and chronic diseases. “Realizing our vision for the highest attainable standard of health starts not in the clinic or the hospital, but in schools, streets, supermarkets, households and cities,” Tedros told the meeting. It was his first major appearance since he formally began his second five-term at the helm of the 194-nation UN health agency a week ago. “Much of the work that you do as ministries of health is dealing with the consequences of poor diets, polluted environments, unsafe roads and workplaces, inadequate health literacy, and the aggressive marketing of products that harm health,” he said. “That’s why,” Tedros said, “we are calling on all member states to make an urgent paradigm shift, towards promoting health and well-being and preventing disease by addressing its root causes, and creating the conditions for health to thrive.” Pledging support for Africa CDC and the African Medicines Agency Tedros also pledged WHO’s continued financial and technical support Africa Centers for Disease Control and Prevention (Africa CDC) – noting that he had in fact helped birth the agency with a proposal for its creation at an African Union summit in July 2013 when he was Ethiopia’s foreign minister. “So, Africa CDC is my daughter, and not only me, but WHO and our regional office, all of us, will do everything to strengthen it. The strengthen of continental institutions is very important to the advancement of health and other sectors in our continent,” he said. “In the same way,” he added, “we are also continuing to provide technical and financial support to the African Medicines Agency (AMA), to support greater regulatory capacity on the continent,” he added, of the new medicines agency that is supposed to help facilitate the more rapid and harmonized approval of new drugs and vaccines across Africa. Cessouma Minata Samate, AU’s Commissioner for Health, Humanitarian Affairs, and Social Development, at the opening ceremony of the 72nd session of the Regional Committee for Africa Last month, Health Policy Watch reported that the Executive Council of the African Union (AU) selected Rwanda to host the headquarters of the African Medicines Agency. Cessouma Minata Samate, AU’s Commissioner for Health, Humanitarian Affairs, and Social Development, said the AMA also aims to support the production of medicines on the African continent. “Through this agency, we are going to build the regulatory capacity of member states of the African Union and the regional economic community,” she said. While congratulating the government of Rwanda for being selected to host AMA’s headquarters, she urged the country to ensure the agency becomes operational as soon as possible. See our special coverage of the development of the AMA here: African Medicines Agency Countdown From prevention to battling inequity Dr Matshidiso Moeti, WHO’s Regional Director for Africa, noted the COVID-19 pandemic showed just how important it is for African countries to invest in health care and fighting diseases. In Africa last year, 22 million jobs were lost and 30 million more people were added to the ranks of extreme poverty, which is defined by the World Bank as living on less than US$1.90 a day. With things expected to continue this way into next year, she said, “these statistics make the case for investment in health very clear.” Inequity is a key factor impeding Africa’s health progress, according to Moeti, whether it is the lack of tools needed for prevention and responses to pandemics or the high out-of-pocket payments that prevent people from seeking health care when they need it. Moeti expressed continued WHO concern about the continent’s comparatively lower COVID-19 vaccination rate despite the recent availability of large quantities of doses. She said it puts health and jobs at unnecessary risk while opening the door to the emergence of new, potentially dangerous variants of the virus. “A fresh impetus to accelerate COVID-19 vaccine uptake is imperative, especially to safeguard our most vulnerable,” she said. Togo’s President Faure Gnassingbé at the opening ceremony of the 72nd session of the Regional Committee for Africa Togo eradicates four NTDs while fighting disease A highlight of the opening ceremony was the recognition of Togo’s efforts at disease prevention including the eradication of four neglected tropical diseases (NTDs). “The liberation of Togo from Dracunculiasis (Guinea-worm disease), Human African Trypanosomiasis, lymphatic filariasis and trachoma is a stunning achievement that will free many people from the threat of these devastating diseases,” Tedros said. “I also congratulate you,” he added,” “for the progress you have made in improving the management and efficiency of hospitals, and for increasing access to services for the population.” Togo’s President Faure Gnassingbé said health is at the center of his government’s development — and is a priority for social cohesion. He described Togo’s relationship with WHO as one that has transcended beyond institutional cooperation and is now a genuine partnership that supports Togo’s health systems, helping to coordinate emergency responses and to raise vaccine equity. “It is a partnership that guides us — learning from current crises with a view to sustainable, equitable and sound solutions,” he said. Image Credits: WHO. Monkeypox Vaccine: 62% of Recipients Experience No Side Effects, Says New Survey 22/08/2022 Maayan Hoffman Jynneos Monkeypox Vaccine A first-of-its-kind survey examining the side effects of the monkeypox vaccine in Israel found that the majority of recipients had no general symptoms. “Most of the side effects reported by the vaccinated are local and mild, which in most cases pass within one to three days,” said Miri Mizrahi Reuveni, Deputy CEO and Head of the Health Division at Maccabi Healthcare Services, which conducted the survey. Maccabi is one of Israel’s four major public health funds. This is some of the first data to be systematically reported on side effects of the vaccine and uptake since the outbreak began, however, the data does not reflect on the vaccine’s efficacy which will take more time to assess. Specifically, some 62% of 155 vaccine recipients reported a return to routine without any general symptoms, Maccabi reported on Monday. The other 38% experienced side effects. Among those who experienced side effects, most fell into broad categories: 27% reported weakness and fatigue; 11% complained of muscle pain; 9% had headaches; 6% suffered from diarrhea; 5% got nausea; 4% had less appetite and swelling of the lymph nodes; 3% felt chills and joint pain; 1% got a skin rash; and another 1% felt eye irritation. A majority of recipients, or 74%, experienced pain at the site of injection, including stiffness (22%), localized swelling (7%) and itching (6%). In most cases, those who experienced side effects said they lasted more than 24 hours. But 22% of recipients who had symptoms said they persist today. Only 3 percent reported that their symptoms passed in less than 24 hours. About 10% said they lasted one day; 39% said they ended within two to three days; and 19% complained of symptoms that took four to six days to resolve. Eight-five percent of respondents said they had no hesitation about getting the jab. The health fund also asked people why they decided to get vaccinated. The most common responses were a desire to protect themselves and those around them. More than a third said they also were afraid of becoming isolated. More than people who belong to the HMO have taken the vaccine already, according to Reuveni. The survey began when the country started distributing the vaccine at the start of August. Respondents were asked questions after they got the shot and seven days later. As of the end of last week, the Israeli Health Ministry reported 197 cases of monkeypox in the country, all of them involving men. Ministry officials told Health Policy Watch on Monday that so far more than 2,300 Israelis have been vaccinated against the virus. The country recently expanded its vaccination criteria to allow more people to get the shot. Israel ordered 10,000 vaccine doses, of which a little more than half have arrived. Some 4,400 vaccine doses are expected to arrive at the beginning of September, ministry officials said. The international monkeypox outbreak began on May 4 when a first case outside of historically endemic African countries was discovered in London. Since then, it has spread across the world, according to the World Health Organization (WHO), with more than 35,000 cases of monkeypox reported from 92 countries and territories accompanied by 12 deaths. WHO Monkeypox Dashboard as of 22 August 2022 Image Credits: Star919News/Twitter , WHO. Open Access 240 Compound Collection Launched in Fight Against Infectious and Mosquito-Borne Illnesses for World Mosquito Day 22/08/2022 Raisa Santos Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases. To mark World Mosquito Day, 20 August, the Global Health Priority Box has been launched to provide free access to 240 compounds to stimulate research into new drugs and insecticides. The initiative, launched by the Medicines for Malaria Venture (MMV) and the Innovative Vector Control Consortium (IVCC), provides scientists with starting points to advance the development of tools that can tackle several priorities set out by the WHO in late 2021, including drug resistance and communicable diseases. Every year vector-borne diseases such as malaria cause the loss of more than 700,000 lives annually, predominantly in regions with tropical climates in low- and middle-income countries. Major vector-borne diseases account for 17% of the global burden of communicable diseases. Recent studies have shown that climate change has the potential to shift the regions in which disease-carrying mosquitoes breed, introducing new pathogens to previously unaffected areas. For example, the spread of malaria, caused by a parasite that spreads to humans and other animals through the bites of infected female mosquitoes, increases in temperatures of around 25ºC. Coupled with the increasing prevalence of drug-resistant superbugs and insecticide resistance, it is clear that new tools are needed to fight against vector-borne diseases. “Efforts to end infectious diseases will only succeed if we have the tools to treat and prevent them,” said Dr Timothy Wells, MMV’s Chief Scientific Officer. Collection of compounds for malaria, neglected and zoonotic diseases, and more The collection features 240 compounds that can be used against drug-resistant malaria, neglected and zoonotic diseases, and other diseases at risk of drug resistance. This includes: 80 compounds with confirmed activity against drug-resistant malaria. 80 compounds for screening against neglected and zoonotic diseases, and diseases at risk of drug resistance. 80 compounds that have been tested for activity against various vector species. Priority Box’s ‘open approach’ emphasizes international collaboration The Global Health Priority Box’s builds on the reaction of the scientific community to the COVID-19 pandemic, which demonstrated that international collaboration accelerates the development of new tools, diagnostics and vaccines. Its open approach invites scientists to make screening results publicly available and to publish findings in an open access journal within two years following data generation. Such an approach allows for researchers around the world to build on one another’s work, saving time and resources. “Open innovation is one of the keys to unlocking drug discovery because it allows us to tap into existing knowledge and expertise and build on it collaboratively,” said Wells. Dr Nick Hamon, CEO of IVCC, noted the need for innovation in vector control due to the increased prevalence of insecticide resistance, “which is undermining the efficacy of bed nets and indoor residual sprays, the cornerstone of malaria prevention since the turn of the century.” “Open access to new chemistry will encourage greater collaboration across the scientific community, bringing new innovators into public health and potentially more rapid development of new vector control solutions,” he said. Image Credits: Sanofi Pasteur/Flickr. WHO Recommends Two Monoclonal Antibodies for Ebola Treatment; Calls to Expand Access in Developing Countries 19/08/2022 John Heilprin A health worker dresses in protective clothing to enter the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019 – during the 2018-2020 Ebola outbreak in the neighboring Democratic Republic of Congo. In its first guidelines ever for Ebola treatment, the World Health Organization (WHO) advises using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth,” WHO says. In its launch of the recommendations, WHO also called on the global community “to increase access to these lifesaving medicines”. As relatively new therapies, monoclonal antibodies have been difficult and expensive to access in low- and middle-income countries, with 80% of their sales occuring in the US, Canada and Europe. In 2020, a consortium of research organizations, led by Wellcome Trust issued a global call to action to expand access. Yes to Ansuvimab and Inmazeb, No to ZMapp and Remdesivir Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis, according to WHO. Its new 44-page guidelines for Ebola treatment also makes a “conditional recommendation against” the use of ZMapp and remdesivir for patients with the Ebola virus. ZMapp, a drug cocktail of antibodies developed from the tobacco plant, was the first drug to be used on an experimental basis against the Ebola virus. Initially it showed promise with rhesus monkeys, but was not fully tested on humans. During the 2014-2016 Ebola epidemic in West Africa, however, the US Food and Drug Administration (FDA) approved ZMapp’s experimental use on patients. That epidemic, the continent’s largest ever, killed more than 11,000 people out of the 28,000 people who became ill with the virus. Subsequently, ZMapp, remdesivir as well as mAb114 and REGN-EB3 were all tested against one another in a randomized controlled trial in the Democratic Republic of Congo, running in parallel to the Ebola epidemic that wracked the eastern region of the country between 2018-2020. In August 2019, however, an independent monitoring board recommended early termination of the DRC therapeutics trial due to the favorable results demonstrated by the latter two drug candidates. The board recommended that all patients be randomized to receive either REGN-EB3 or mAb114 in an extension phase. The study’s preliminary results among 499 participants showed people who got REGN-EB3 or mAb114 had a greater chance of survival than those who received ZMapp or remdesivir. Remdesivir was originally developed to treat hepatitis C before it was investigated for treating the Ebola and Marburg viruses, and then as a post-infection treatment for COVID‑19. It eventually won US and European Medicines Agency approval as a COVID-19 treatment. However, in November 2020, WHO recommended against Remdesivir use for COVID, saying there was “no evidence” it improved patient outcomes. Access remains a problem for ebola treatment In its recommendations, WHO called for greater efforts to ensure that that the drugs are “where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely.” To assist with that goal, WHO offered to support “countries, manufacturers and partners” to step up national and global efforts to increase affordability of the biotherapeutic products. “Access to these therapeutics is challenging and pricing and future supply remain unknown, especially in resource-poor areas,” WHO says in its 44-page guidelines. “Without concerted effort, access will remain limited, and it is therefore possible that this strong recommendation could exacerbate health inequity,” it says. “Therefore, given the demonstrated benefits for patients, these recommendations should act as a stimulus to engage all possible mechanisms to improve global access to these treatments.” Both Inmazeb and Ebanga were developed with significant US government support The development of both Inmazeb and Ebanga was heavily supported by the US government and other public funders. Inmazeb, which also was the first FDA-approved treatment for Ebola, is produced by the US-based Regeneron Pharmaceuticals. It was developed in response to the 2018 Ebola outbreak in the DRC with supprot from the US Biomedical Advanced Research and Development Authority (BARDA). Regeneron announced in 2020, the company will “continue to provide Inmazeb for free in response to outbreaks in the DRC through the MEURI protocol for compassionate use,” in colaboration with the WHO, the US FDA and with continuing support from BARDA. “Regeneron is actively working with nongovernmental organizations and public health agencies to ensure continued access to Inmazeb in low- and middle-income countries,” the company declared at that time. The MEURI protocol is a WHO-approved ethical framework for the use of investigational agents. Regeneron gained fame in the first year of the COVID pandemic when former President Donald Trump was treated with another antibody cocktail that it had developed against COVID, (REGEN-COV- a combination of casirivimab and imdevimab) . The cocktail was later recommended by WHO for COVID treatment. As for Ebanga, it was initially developed by the Vaccine Research Center of the US National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), and then licensed in 2018 by the US biotech firm, Ridgeback Biotherapeutics for further development and ultimately FDA aprpoval. “Ebanga is currently available to patients, and Ridgeback Biotherapeutics provides and distributes the treatment to patients free of charge in Ebola-stricken countries,” the company states on its website. WHO publishes invitation to drug manufacturers to share drugs for evaluation WHO says it has now published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to enabling bulk procurement of new drugs by global health agencies, for communities and countries affected by Ebola. “We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies program. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks,” she said. “This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.” WHO also says there is a need for more research and evaluation of clinical interventions because of the large number of “uncertainties” that remain including with supportive care, with our understanding and characterization of the Ebola virus disease and its longer-term consequences, with the continued inclusion of vulnerable populations such as pregnant women, newborns, children and older people in future research. Back to the DRC for More Research, Studies on Ebola treatment The clinical trials used to shape WHO’S guidelines for Ebola treatment were conducted during the Ebola outbreaks that have raged in central and west Africa over the past six years; the largest trial was conducted in the Democratic Republic of the Congo (DRC) which saw a major outbreak in 2018-2020, as well as small outbreaks since then. Ebola is a severe and too often fatal illness, and previous outbreaks and responses showed the importance of early diagnosis and treatment with optimized supportive care that includes fluid and electrolyte repletion and treatment of symptoms. “This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs,” said Kojan. “From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible,” he said. “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.” The DRC has now recorded 14 Ebola outbreaks since 1976, including six since 2018. The most recent outbreak, which began in April, was declared to be over by DRC and WHO authorities last month — with fewer cases and deaths (five) than previous episodes due to a swift response including vaccinations. Vaccinations were launched less than a week after the outbreak was declared, using an ultra-cold chain freezer in Mbandaka so vaccine doses could be stored locally and safely, and delivered effectively. That enabled 2,104 people to be vaccinated, including 1,307 frontline workers and 302 contacts. In the previous outbreak in Equateur Province from June to November 2020, 130 people were infected and 55 died. Africa’s battles with Ebola and other deadly diseases also helped prepare its health systems to deal with COVID-19. When SARS-CoV2 virus landed on the continent, the African Centres for Disease Control (CDC) reinforced its regional coordinating centers, enhanced lab capacity and unified surveillance networks. An Additional Tool for Ebola treatment Along With Clinical Care Guidance The new Ebola treatment guidelines are meant to complement clinical care guidance that outlines the optimized supportive care Ebola patients should receive including factors such as relevant tests, pain management, nutrition and co-infections. But the recommendations only apply to the Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus). “Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler of the University of Toronto and co-chair of the Guideline Development Group of experts selected by WHO. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment — MAb114 or REGN-EB3 — now leads to recovery for the vast majority of people,” he said. Image Credits: Photo: Anna Dubuis / DFID, WHO Therapeutics for Ebola virus disease. How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . 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WHO Advocates Prevention Focus in Africa 23/08/2022 Paul Adepoju & John Heilprin WHO Director-General Dr Tedros Adhanom Ghebreyesus at the opening of the 72nd session of the Regional Committee for Africa African nations need to pivot to prevention in their fight against disease by “addressing its root causes” through a greater focus on improved diets, healthier environments, and better road safety, among other factors, WHO Director-General Dr Tedros Adhanom Ghebreyesus told the 72nd WHO Regional Committee for Africa meeting, at the opening of the weeklong session of member states in Togo’s capital Lomé. Tedros also pledged WHO’s continued support for the work of the African Centers of Disease Control (Africa CDC) in remarks aimed at squelching tensions between the two agencies that emerged earlier this summer. Africa CDC began circulating a proposal for it to be empowered by the African Union to declare continental health emergencies, something WHO reportedly opposed. The Fuss Over Who Should Declare Public Health Emergencies in Africa This week’s meeting of African health ministers and government officials is supposed to focus on ways to lower the burden of disease, strengthen capacity and endorse strategies in fighting disease and promoting access to health services and people’s well-being. It also is looking at how the continent can improve prevention and battle COVID-19 and a growing number of other health challenges from outbreaks of communicable diseases, conflicts and humanitarian crises, climatic change and chronic diseases. “Realizing our vision for the highest attainable standard of health starts not in the clinic or the hospital, but in schools, streets, supermarkets, households and cities,” Tedros told the meeting. It was his first major appearance since he formally began his second five-term at the helm of the 194-nation UN health agency a week ago. “Much of the work that you do as ministries of health is dealing with the consequences of poor diets, polluted environments, unsafe roads and workplaces, inadequate health literacy, and the aggressive marketing of products that harm health,” he said. “That’s why,” Tedros said, “we are calling on all member states to make an urgent paradigm shift, towards promoting health and well-being and preventing disease by addressing its root causes, and creating the conditions for health to thrive.” Pledging support for Africa CDC and the African Medicines Agency Tedros also pledged WHO’s continued financial and technical support Africa Centers for Disease Control and Prevention (Africa CDC) – noting that he had in fact helped birth the agency with a proposal for its creation at an African Union summit in July 2013 when he was Ethiopia’s foreign minister. “So, Africa CDC is my daughter, and not only me, but WHO and our regional office, all of us, will do everything to strengthen it. The strengthen of continental institutions is very important to the advancement of health and other sectors in our continent,” he said. “In the same way,” he added, “we are also continuing to provide technical and financial support to the African Medicines Agency (AMA), to support greater regulatory capacity on the continent,” he added, of the new medicines agency that is supposed to help facilitate the more rapid and harmonized approval of new drugs and vaccines across Africa. Cessouma Minata Samate, AU’s Commissioner for Health, Humanitarian Affairs, and Social Development, at the opening ceremony of the 72nd session of the Regional Committee for Africa Last month, Health Policy Watch reported that the Executive Council of the African Union (AU) selected Rwanda to host the headquarters of the African Medicines Agency. Cessouma Minata Samate, AU’s Commissioner for Health, Humanitarian Affairs, and Social Development, said the AMA also aims to support the production of medicines on the African continent. “Through this agency, we are going to build the regulatory capacity of member states of the African Union and the regional economic community,” she said. While congratulating the government of Rwanda for being selected to host AMA’s headquarters, she urged the country to ensure the agency becomes operational as soon as possible. See our special coverage of the development of the AMA here: African Medicines Agency Countdown From prevention to battling inequity Dr Matshidiso Moeti, WHO’s Regional Director for Africa, noted the COVID-19 pandemic showed just how important it is for African countries to invest in health care and fighting diseases. In Africa last year, 22 million jobs were lost and 30 million more people were added to the ranks of extreme poverty, which is defined by the World Bank as living on less than US$1.90 a day. With things expected to continue this way into next year, she said, “these statistics make the case for investment in health very clear.” Inequity is a key factor impeding Africa’s health progress, according to Moeti, whether it is the lack of tools needed for prevention and responses to pandemics or the high out-of-pocket payments that prevent people from seeking health care when they need it. Moeti expressed continued WHO concern about the continent’s comparatively lower COVID-19 vaccination rate despite the recent availability of large quantities of doses. She said it puts health and jobs at unnecessary risk while opening the door to the emergence of new, potentially dangerous variants of the virus. “A fresh impetus to accelerate COVID-19 vaccine uptake is imperative, especially to safeguard our most vulnerable,” she said. Togo’s President Faure Gnassingbé at the opening ceremony of the 72nd session of the Regional Committee for Africa Togo eradicates four NTDs while fighting disease A highlight of the opening ceremony was the recognition of Togo’s efforts at disease prevention including the eradication of four neglected tropical diseases (NTDs). “The liberation of Togo from Dracunculiasis (Guinea-worm disease), Human African Trypanosomiasis, lymphatic filariasis and trachoma is a stunning achievement that will free many people from the threat of these devastating diseases,” Tedros said. “I also congratulate you,” he added,” “for the progress you have made in improving the management and efficiency of hospitals, and for increasing access to services for the population.” Togo’s President Faure Gnassingbé said health is at the center of his government’s development — and is a priority for social cohesion. He described Togo’s relationship with WHO as one that has transcended beyond institutional cooperation and is now a genuine partnership that supports Togo’s health systems, helping to coordinate emergency responses and to raise vaccine equity. “It is a partnership that guides us — learning from current crises with a view to sustainable, equitable and sound solutions,” he said. Image Credits: WHO. Monkeypox Vaccine: 62% of Recipients Experience No Side Effects, Says New Survey 22/08/2022 Maayan Hoffman Jynneos Monkeypox Vaccine A first-of-its-kind survey examining the side effects of the monkeypox vaccine in Israel found that the majority of recipients had no general symptoms. “Most of the side effects reported by the vaccinated are local and mild, which in most cases pass within one to three days,” said Miri Mizrahi Reuveni, Deputy CEO and Head of the Health Division at Maccabi Healthcare Services, which conducted the survey. Maccabi is one of Israel’s four major public health funds. This is some of the first data to be systematically reported on side effects of the vaccine and uptake since the outbreak began, however, the data does not reflect on the vaccine’s efficacy which will take more time to assess. Specifically, some 62% of 155 vaccine recipients reported a return to routine without any general symptoms, Maccabi reported on Monday. The other 38% experienced side effects. Among those who experienced side effects, most fell into broad categories: 27% reported weakness and fatigue; 11% complained of muscle pain; 9% had headaches; 6% suffered from diarrhea; 5% got nausea; 4% had less appetite and swelling of the lymph nodes; 3% felt chills and joint pain; 1% got a skin rash; and another 1% felt eye irritation. A majority of recipients, or 74%, experienced pain at the site of injection, including stiffness (22%), localized swelling (7%) and itching (6%). In most cases, those who experienced side effects said they lasted more than 24 hours. But 22% of recipients who had symptoms said they persist today. Only 3 percent reported that their symptoms passed in less than 24 hours. About 10% said they lasted one day; 39% said they ended within two to three days; and 19% complained of symptoms that took four to six days to resolve. Eight-five percent of respondents said they had no hesitation about getting the jab. The health fund also asked people why they decided to get vaccinated. The most common responses were a desire to protect themselves and those around them. More than a third said they also were afraid of becoming isolated. More than people who belong to the HMO have taken the vaccine already, according to Reuveni. The survey began when the country started distributing the vaccine at the start of August. Respondents were asked questions after they got the shot and seven days later. As of the end of last week, the Israeli Health Ministry reported 197 cases of monkeypox in the country, all of them involving men. Ministry officials told Health Policy Watch on Monday that so far more than 2,300 Israelis have been vaccinated against the virus. The country recently expanded its vaccination criteria to allow more people to get the shot. Israel ordered 10,000 vaccine doses, of which a little more than half have arrived. Some 4,400 vaccine doses are expected to arrive at the beginning of September, ministry officials said. The international monkeypox outbreak began on May 4 when a first case outside of historically endemic African countries was discovered in London. Since then, it has spread across the world, according to the World Health Organization (WHO), with more than 35,000 cases of monkeypox reported from 92 countries and territories accompanied by 12 deaths. WHO Monkeypox Dashboard as of 22 August 2022 Image Credits: Star919News/Twitter , WHO. Open Access 240 Compound Collection Launched in Fight Against Infectious and Mosquito-Borne Illnesses for World Mosquito Day 22/08/2022 Raisa Santos Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases. To mark World Mosquito Day, 20 August, the Global Health Priority Box has been launched to provide free access to 240 compounds to stimulate research into new drugs and insecticides. The initiative, launched by the Medicines for Malaria Venture (MMV) and the Innovative Vector Control Consortium (IVCC), provides scientists with starting points to advance the development of tools that can tackle several priorities set out by the WHO in late 2021, including drug resistance and communicable diseases. Every year vector-borne diseases such as malaria cause the loss of more than 700,000 lives annually, predominantly in regions with tropical climates in low- and middle-income countries. Major vector-borne diseases account for 17% of the global burden of communicable diseases. Recent studies have shown that climate change has the potential to shift the regions in which disease-carrying mosquitoes breed, introducing new pathogens to previously unaffected areas. For example, the spread of malaria, caused by a parasite that spreads to humans and other animals through the bites of infected female mosquitoes, increases in temperatures of around 25ºC. Coupled with the increasing prevalence of drug-resistant superbugs and insecticide resistance, it is clear that new tools are needed to fight against vector-borne diseases. “Efforts to end infectious diseases will only succeed if we have the tools to treat and prevent them,” said Dr Timothy Wells, MMV’s Chief Scientific Officer. Collection of compounds for malaria, neglected and zoonotic diseases, and more The collection features 240 compounds that can be used against drug-resistant malaria, neglected and zoonotic diseases, and other diseases at risk of drug resistance. This includes: 80 compounds with confirmed activity against drug-resistant malaria. 80 compounds for screening against neglected and zoonotic diseases, and diseases at risk of drug resistance. 80 compounds that have been tested for activity against various vector species. Priority Box’s ‘open approach’ emphasizes international collaboration The Global Health Priority Box’s builds on the reaction of the scientific community to the COVID-19 pandemic, which demonstrated that international collaboration accelerates the development of new tools, diagnostics and vaccines. Its open approach invites scientists to make screening results publicly available and to publish findings in an open access journal within two years following data generation. Such an approach allows for researchers around the world to build on one another’s work, saving time and resources. “Open innovation is one of the keys to unlocking drug discovery because it allows us to tap into existing knowledge and expertise and build on it collaboratively,” said Wells. Dr Nick Hamon, CEO of IVCC, noted the need for innovation in vector control due to the increased prevalence of insecticide resistance, “which is undermining the efficacy of bed nets and indoor residual sprays, the cornerstone of malaria prevention since the turn of the century.” “Open access to new chemistry will encourage greater collaboration across the scientific community, bringing new innovators into public health and potentially more rapid development of new vector control solutions,” he said. Image Credits: Sanofi Pasteur/Flickr. WHO Recommends Two Monoclonal Antibodies for Ebola Treatment; Calls to Expand Access in Developing Countries 19/08/2022 John Heilprin A health worker dresses in protective clothing to enter the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019 – during the 2018-2020 Ebola outbreak in the neighboring Democratic Republic of Congo. In its first guidelines ever for Ebola treatment, the World Health Organization (WHO) advises using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth,” WHO says. In its launch of the recommendations, WHO also called on the global community “to increase access to these lifesaving medicines”. As relatively new therapies, monoclonal antibodies have been difficult and expensive to access in low- and middle-income countries, with 80% of their sales occuring in the US, Canada and Europe. In 2020, a consortium of research organizations, led by Wellcome Trust issued a global call to action to expand access. Yes to Ansuvimab and Inmazeb, No to ZMapp and Remdesivir Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis, according to WHO. Its new 44-page guidelines for Ebola treatment also makes a “conditional recommendation against” the use of ZMapp and remdesivir for patients with the Ebola virus. ZMapp, a drug cocktail of antibodies developed from the tobacco plant, was the first drug to be used on an experimental basis against the Ebola virus. Initially it showed promise with rhesus monkeys, but was not fully tested on humans. During the 2014-2016 Ebola epidemic in West Africa, however, the US Food and Drug Administration (FDA) approved ZMapp’s experimental use on patients. That epidemic, the continent’s largest ever, killed more than 11,000 people out of the 28,000 people who became ill with the virus. Subsequently, ZMapp, remdesivir as well as mAb114 and REGN-EB3 were all tested against one another in a randomized controlled trial in the Democratic Republic of Congo, running in parallel to the Ebola epidemic that wracked the eastern region of the country between 2018-2020. In August 2019, however, an independent monitoring board recommended early termination of the DRC therapeutics trial due to the favorable results demonstrated by the latter two drug candidates. The board recommended that all patients be randomized to receive either REGN-EB3 or mAb114 in an extension phase. The study’s preliminary results among 499 participants showed people who got REGN-EB3 or mAb114 had a greater chance of survival than those who received ZMapp or remdesivir. Remdesivir was originally developed to treat hepatitis C before it was investigated for treating the Ebola and Marburg viruses, and then as a post-infection treatment for COVID‑19. It eventually won US and European Medicines Agency approval as a COVID-19 treatment. However, in November 2020, WHO recommended against Remdesivir use for COVID, saying there was “no evidence” it improved patient outcomes. Access remains a problem for ebola treatment In its recommendations, WHO called for greater efforts to ensure that that the drugs are “where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely.” To assist with that goal, WHO offered to support “countries, manufacturers and partners” to step up national and global efforts to increase affordability of the biotherapeutic products. “Access to these therapeutics is challenging and pricing and future supply remain unknown, especially in resource-poor areas,” WHO says in its 44-page guidelines. “Without concerted effort, access will remain limited, and it is therefore possible that this strong recommendation could exacerbate health inequity,” it says. “Therefore, given the demonstrated benefits for patients, these recommendations should act as a stimulus to engage all possible mechanisms to improve global access to these treatments.” Both Inmazeb and Ebanga were developed with significant US government support The development of both Inmazeb and Ebanga was heavily supported by the US government and other public funders. Inmazeb, which also was the first FDA-approved treatment for Ebola, is produced by the US-based Regeneron Pharmaceuticals. It was developed in response to the 2018 Ebola outbreak in the DRC with supprot from the US Biomedical Advanced Research and Development Authority (BARDA). Regeneron announced in 2020, the company will “continue to provide Inmazeb for free in response to outbreaks in the DRC through the MEURI protocol for compassionate use,” in colaboration with the WHO, the US FDA and with continuing support from BARDA. “Regeneron is actively working with nongovernmental organizations and public health agencies to ensure continued access to Inmazeb in low- and middle-income countries,” the company declared at that time. The MEURI protocol is a WHO-approved ethical framework for the use of investigational agents. Regeneron gained fame in the first year of the COVID pandemic when former President Donald Trump was treated with another antibody cocktail that it had developed against COVID, (REGEN-COV- a combination of casirivimab and imdevimab) . The cocktail was later recommended by WHO for COVID treatment. As for Ebanga, it was initially developed by the Vaccine Research Center of the US National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), and then licensed in 2018 by the US biotech firm, Ridgeback Biotherapeutics for further development and ultimately FDA aprpoval. “Ebanga is currently available to patients, and Ridgeback Biotherapeutics provides and distributes the treatment to patients free of charge in Ebola-stricken countries,” the company states on its website. WHO publishes invitation to drug manufacturers to share drugs for evaluation WHO says it has now published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to enabling bulk procurement of new drugs by global health agencies, for communities and countries affected by Ebola. “We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies program. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks,” she said. “This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.” WHO also says there is a need for more research and evaluation of clinical interventions because of the large number of “uncertainties” that remain including with supportive care, with our understanding and characterization of the Ebola virus disease and its longer-term consequences, with the continued inclusion of vulnerable populations such as pregnant women, newborns, children and older people in future research. Back to the DRC for More Research, Studies on Ebola treatment The clinical trials used to shape WHO’S guidelines for Ebola treatment were conducted during the Ebola outbreaks that have raged in central and west Africa over the past six years; the largest trial was conducted in the Democratic Republic of the Congo (DRC) which saw a major outbreak in 2018-2020, as well as small outbreaks since then. Ebola is a severe and too often fatal illness, and previous outbreaks and responses showed the importance of early diagnosis and treatment with optimized supportive care that includes fluid and electrolyte repletion and treatment of symptoms. “This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs,” said Kojan. “From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible,” he said. “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.” The DRC has now recorded 14 Ebola outbreaks since 1976, including six since 2018. The most recent outbreak, which began in April, was declared to be over by DRC and WHO authorities last month — with fewer cases and deaths (five) than previous episodes due to a swift response including vaccinations. Vaccinations were launched less than a week after the outbreak was declared, using an ultra-cold chain freezer in Mbandaka so vaccine doses could be stored locally and safely, and delivered effectively. That enabled 2,104 people to be vaccinated, including 1,307 frontline workers and 302 contacts. In the previous outbreak in Equateur Province from June to November 2020, 130 people were infected and 55 died. Africa’s battles with Ebola and other deadly diseases also helped prepare its health systems to deal with COVID-19. When SARS-CoV2 virus landed on the continent, the African Centres for Disease Control (CDC) reinforced its regional coordinating centers, enhanced lab capacity and unified surveillance networks. An Additional Tool for Ebola treatment Along With Clinical Care Guidance The new Ebola treatment guidelines are meant to complement clinical care guidance that outlines the optimized supportive care Ebola patients should receive including factors such as relevant tests, pain management, nutrition and co-infections. But the recommendations only apply to the Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus). “Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler of the University of Toronto and co-chair of the Guideline Development Group of experts selected by WHO. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment — MAb114 or REGN-EB3 — now leads to recovery for the vast majority of people,” he said. Image Credits: Photo: Anna Dubuis / DFID, WHO Therapeutics for Ebola virus disease. How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . 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Monkeypox Vaccine: 62% of Recipients Experience No Side Effects, Says New Survey 22/08/2022 Maayan Hoffman Jynneos Monkeypox Vaccine A first-of-its-kind survey examining the side effects of the monkeypox vaccine in Israel found that the majority of recipients had no general symptoms. “Most of the side effects reported by the vaccinated are local and mild, which in most cases pass within one to three days,” said Miri Mizrahi Reuveni, Deputy CEO and Head of the Health Division at Maccabi Healthcare Services, which conducted the survey. Maccabi is one of Israel’s four major public health funds. This is some of the first data to be systematically reported on side effects of the vaccine and uptake since the outbreak began, however, the data does not reflect on the vaccine’s efficacy which will take more time to assess. Specifically, some 62% of 155 vaccine recipients reported a return to routine without any general symptoms, Maccabi reported on Monday. The other 38% experienced side effects. Among those who experienced side effects, most fell into broad categories: 27% reported weakness and fatigue; 11% complained of muscle pain; 9% had headaches; 6% suffered from diarrhea; 5% got nausea; 4% had less appetite and swelling of the lymph nodes; 3% felt chills and joint pain; 1% got a skin rash; and another 1% felt eye irritation. A majority of recipients, or 74%, experienced pain at the site of injection, including stiffness (22%), localized swelling (7%) and itching (6%). In most cases, those who experienced side effects said they lasted more than 24 hours. But 22% of recipients who had symptoms said they persist today. Only 3 percent reported that their symptoms passed in less than 24 hours. About 10% said they lasted one day; 39% said they ended within two to three days; and 19% complained of symptoms that took four to six days to resolve. Eight-five percent of respondents said they had no hesitation about getting the jab. The health fund also asked people why they decided to get vaccinated. The most common responses were a desire to protect themselves and those around them. More than a third said they also were afraid of becoming isolated. More than people who belong to the HMO have taken the vaccine already, according to Reuveni. The survey began when the country started distributing the vaccine at the start of August. Respondents were asked questions after they got the shot and seven days later. As of the end of last week, the Israeli Health Ministry reported 197 cases of monkeypox in the country, all of them involving men. Ministry officials told Health Policy Watch on Monday that so far more than 2,300 Israelis have been vaccinated against the virus. The country recently expanded its vaccination criteria to allow more people to get the shot. Israel ordered 10,000 vaccine doses, of which a little more than half have arrived. Some 4,400 vaccine doses are expected to arrive at the beginning of September, ministry officials said. The international monkeypox outbreak began on May 4 when a first case outside of historically endemic African countries was discovered in London. Since then, it has spread across the world, according to the World Health Organization (WHO), with more than 35,000 cases of monkeypox reported from 92 countries and territories accompanied by 12 deaths. WHO Monkeypox Dashboard as of 22 August 2022 Image Credits: Star919News/Twitter , WHO. Open Access 240 Compound Collection Launched in Fight Against Infectious and Mosquito-Borne Illnesses for World Mosquito Day 22/08/2022 Raisa Santos Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases. To mark World Mosquito Day, 20 August, the Global Health Priority Box has been launched to provide free access to 240 compounds to stimulate research into new drugs and insecticides. The initiative, launched by the Medicines for Malaria Venture (MMV) and the Innovative Vector Control Consortium (IVCC), provides scientists with starting points to advance the development of tools that can tackle several priorities set out by the WHO in late 2021, including drug resistance and communicable diseases. Every year vector-borne diseases such as malaria cause the loss of more than 700,000 lives annually, predominantly in regions with tropical climates in low- and middle-income countries. Major vector-borne diseases account for 17% of the global burden of communicable diseases. Recent studies have shown that climate change has the potential to shift the regions in which disease-carrying mosquitoes breed, introducing new pathogens to previously unaffected areas. For example, the spread of malaria, caused by a parasite that spreads to humans and other animals through the bites of infected female mosquitoes, increases in temperatures of around 25ºC. Coupled with the increasing prevalence of drug-resistant superbugs and insecticide resistance, it is clear that new tools are needed to fight against vector-borne diseases. “Efforts to end infectious diseases will only succeed if we have the tools to treat and prevent them,” said Dr Timothy Wells, MMV’s Chief Scientific Officer. Collection of compounds for malaria, neglected and zoonotic diseases, and more The collection features 240 compounds that can be used against drug-resistant malaria, neglected and zoonotic diseases, and other diseases at risk of drug resistance. This includes: 80 compounds with confirmed activity against drug-resistant malaria. 80 compounds for screening against neglected and zoonotic diseases, and diseases at risk of drug resistance. 80 compounds that have been tested for activity against various vector species. Priority Box’s ‘open approach’ emphasizes international collaboration The Global Health Priority Box’s builds on the reaction of the scientific community to the COVID-19 pandemic, which demonstrated that international collaboration accelerates the development of new tools, diagnostics and vaccines. Its open approach invites scientists to make screening results publicly available and to publish findings in an open access journal within two years following data generation. Such an approach allows for researchers around the world to build on one another’s work, saving time and resources. “Open innovation is one of the keys to unlocking drug discovery because it allows us to tap into existing knowledge and expertise and build on it collaboratively,” said Wells. Dr Nick Hamon, CEO of IVCC, noted the need for innovation in vector control due to the increased prevalence of insecticide resistance, “which is undermining the efficacy of bed nets and indoor residual sprays, the cornerstone of malaria prevention since the turn of the century.” “Open access to new chemistry will encourage greater collaboration across the scientific community, bringing new innovators into public health and potentially more rapid development of new vector control solutions,” he said. Image Credits: Sanofi Pasteur/Flickr. WHO Recommends Two Monoclonal Antibodies for Ebola Treatment; Calls to Expand Access in Developing Countries 19/08/2022 John Heilprin A health worker dresses in protective clothing to enter the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019 – during the 2018-2020 Ebola outbreak in the neighboring Democratic Republic of Congo. In its first guidelines ever for Ebola treatment, the World Health Organization (WHO) advises using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth,” WHO says. In its launch of the recommendations, WHO also called on the global community “to increase access to these lifesaving medicines”. As relatively new therapies, monoclonal antibodies have been difficult and expensive to access in low- and middle-income countries, with 80% of their sales occuring in the US, Canada and Europe. In 2020, a consortium of research organizations, led by Wellcome Trust issued a global call to action to expand access. Yes to Ansuvimab and Inmazeb, No to ZMapp and Remdesivir Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis, according to WHO. Its new 44-page guidelines for Ebola treatment also makes a “conditional recommendation against” the use of ZMapp and remdesivir for patients with the Ebola virus. ZMapp, a drug cocktail of antibodies developed from the tobacco plant, was the first drug to be used on an experimental basis against the Ebola virus. Initially it showed promise with rhesus monkeys, but was not fully tested on humans. During the 2014-2016 Ebola epidemic in West Africa, however, the US Food and Drug Administration (FDA) approved ZMapp’s experimental use on patients. That epidemic, the continent’s largest ever, killed more than 11,000 people out of the 28,000 people who became ill with the virus. Subsequently, ZMapp, remdesivir as well as mAb114 and REGN-EB3 were all tested against one another in a randomized controlled trial in the Democratic Republic of Congo, running in parallel to the Ebola epidemic that wracked the eastern region of the country between 2018-2020. In August 2019, however, an independent monitoring board recommended early termination of the DRC therapeutics trial due to the favorable results demonstrated by the latter two drug candidates. The board recommended that all patients be randomized to receive either REGN-EB3 or mAb114 in an extension phase. The study’s preliminary results among 499 participants showed people who got REGN-EB3 or mAb114 had a greater chance of survival than those who received ZMapp or remdesivir. Remdesivir was originally developed to treat hepatitis C before it was investigated for treating the Ebola and Marburg viruses, and then as a post-infection treatment for COVID‑19. It eventually won US and European Medicines Agency approval as a COVID-19 treatment. However, in November 2020, WHO recommended against Remdesivir use for COVID, saying there was “no evidence” it improved patient outcomes. Access remains a problem for ebola treatment In its recommendations, WHO called for greater efforts to ensure that that the drugs are “where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely.” To assist with that goal, WHO offered to support “countries, manufacturers and partners” to step up national and global efforts to increase affordability of the biotherapeutic products. “Access to these therapeutics is challenging and pricing and future supply remain unknown, especially in resource-poor areas,” WHO says in its 44-page guidelines. “Without concerted effort, access will remain limited, and it is therefore possible that this strong recommendation could exacerbate health inequity,” it says. “Therefore, given the demonstrated benefits for patients, these recommendations should act as a stimulus to engage all possible mechanisms to improve global access to these treatments.” Both Inmazeb and Ebanga were developed with significant US government support The development of both Inmazeb and Ebanga was heavily supported by the US government and other public funders. Inmazeb, which also was the first FDA-approved treatment for Ebola, is produced by the US-based Regeneron Pharmaceuticals. It was developed in response to the 2018 Ebola outbreak in the DRC with supprot from the US Biomedical Advanced Research and Development Authority (BARDA). Regeneron announced in 2020, the company will “continue to provide Inmazeb for free in response to outbreaks in the DRC through the MEURI protocol for compassionate use,” in colaboration with the WHO, the US FDA and with continuing support from BARDA. “Regeneron is actively working with nongovernmental organizations and public health agencies to ensure continued access to Inmazeb in low- and middle-income countries,” the company declared at that time. The MEURI protocol is a WHO-approved ethical framework for the use of investigational agents. Regeneron gained fame in the first year of the COVID pandemic when former President Donald Trump was treated with another antibody cocktail that it had developed against COVID, (REGEN-COV- a combination of casirivimab and imdevimab) . The cocktail was later recommended by WHO for COVID treatment. As for Ebanga, it was initially developed by the Vaccine Research Center of the US National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), and then licensed in 2018 by the US biotech firm, Ridgeback Biotherapeutics for further development and ultimately FDA aprpoval. “Ebanga is currently available to patients, and Ridgeback Biotherapeutics provides and distributes the treatment to patients free of charge in Ebola-stricken countries,” the company states on its website. WHO publishes invitation to drug manufacturers to share drugs for evaluation WHO says it has now published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to enabling bulk procurement of new drugs by global health agencies, for communities and countries affected by Ebola. “We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies program. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks,” she said. “This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.” WHO also says there is a need for more research and evaluation of clinical interventions because of the large number of “uncertainties” that remain including with supportive care, with our understanding and characterization of the Ebola virus disease and its longer-term consequences, with the continued inclusion of vulnerable populations such as pregnant women, newborns, children and older people in future research. Back to the DRC for More Research, Studies on Ebola treatment The clinical trials used to shape WHO’S guidelines for Ebola treatment were conducted during the Ebola outbreaks that have raged in central and west Africa over the past six years; the largest trial was conducted in the Democratic Republic of the Congo (DRC) which saw a major outbreak in 2018-2020, as well as small outbreaks since then. Ebola is a severe and too often fatal illness, and previous outbreaks and responses showed the importance of early diagnosis and treatment with optimized supportive care that includes fluid and electrolyte repletion and treatment of symptoms. “This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs,” said Kojan. “From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible,” he said. “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.” The DRC has now recorded 14 Ebola outbreaks since 1976, including six since 2018. The most recent outbreak, which began in April, was declared to be over by DRC and WHO authorities last month — with fewer cases and deaths (five) than previous episodes due to a swift response including vaccinations. Vaccinations were launched less than a week after the outbreak was declared, using an ultra-cold chain freezer in Mbandaka so vaccine doses could be stored locally and safely, and delivered effectively. That enabled 2,104 people to be vaccinated, including 1,307 frontline workers and 302 contacts. In the previous outbreak in Equateur Province from June to November 2020, 130 people were infected and 55 died. Africa’s battles with Ebola and other deadly diseases also helped prepare its health systems to deal with COVID-19. When SARS-CoV2 virus landed on the continent, the African Centres for Disease Control (CDC) reinforced its regional coordinating centers, enhanced lab capacity and unified surveillance networks. An Additional Tool for Ebola treatment Along With Clinical Care Guidance The new Ebola treatment guidelines are meant to complement clinical care guidance that outlines the optimized supportive care Ebola patients should receive including factors such as relevant tests, pain management, nutrition and co-infections. But the recommendations only apply to the Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus). “Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler of the University of Toronto and co-chair of the Guideline Development Group of experts selected by WHO. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment — MAb114 or REGN-EB3 — now leads to recovery for the vast majority of people,” he said. Image Credits: Photo: Anna Dubuis / DFID, WHO Therapeutics for Ebola virus disease. How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . 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Open Access 240 Compound Collection Launched in Fight Against Infectious and Mosquito-Borne Illnesses for World Mosquito Day 22/08/2022 Raisa Santos Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases. To mark World Mosquito Day, 20 August, the Global Health Priority Box has been launched to provide free access to 240 compounds to stimulate research into new drugs and insecticides. The initiative, launched by the Medicines for Malaria Venture (MMV) and the Innovative Vector Control Consortium (IVCC), provides scientists with starting points to advance the development of tools that can tackle several priorities set out by the WHO in late 2021, including drug resistance and communicable diseases. Every year vector-borne diseases such as malaria cause the loss of more than 700,000 lives annually, predominantly in regions with tropical climates in low- and middle-income countries. Major vector-borne diseases account for 17% of the global burden of communicable diseases. Recent studies have shown that climate change has the potential to shift the regions in which disease-carrying mosquitoes breed, introducing new pathogens to previously unaffected areas. For example, the spread of malaria, caused by a parasite that spreads to humans and other animals through the bites of infected female mosquitoes, increases in temperatures of around 25ºC. Coupled with the increasing prevalence of drug-resistant superbugs and insecticide resistance, it is clear that new tools are needed to fight against vector-borne diseases. “Efforts to end infectious diseases will only succeed if we have the tools to treat and prevent them,” said Dr Timothy Wells, MMV’s Chief Scientific Officer. Collection of compounds for malaria, neglected and zoonotic diseases, and more The collection features 240 compounds that can be used against drug-resistant malaria, neglected and zoonotic diseases, and other diseases at risk of drug resistance. This includes: 80 compounds with confirmed activity against drug-resistant malaria. 80 compounds for screening against neglected and zoonotic diseases, and diseases at risk of drug resistance. 80 compounds that have been tested for activity against various vector species. Priority Box’s ‘open approach’ emphasizes international collaboration The Global Health Priority Box’s builds on the reaction of the scientific community to the COVID-19 pandemic, which demonstrated that international collaboration accelerates the development of new tools, diagnostics and vaccines. Its open approach invites scientists to make screening results publicly available and to publish findings in an open access journal within two years following data generation. Such an approach allows for researchers around the world to build on one another’s work, saving time and resources. “Open innovation is one of the keys to unlocking drug discovery because it allows us to tap into existing knowledge and expertise and build on it collaboratively,” said Wells. Dr Nick Hamon, CEO of IVCC, noted the need for innovation in vector control due to the increased prevalence of insecticide resistance, “which is undermining the efficacy of bed nets and indoor residual sprays, the cornerstone of malaria prevention since the turn of the century.” “Open access to new chemistry will encourage greater collaboration across the scientific community, bringing new innovators into public health and potentially more rapid development of new vector control solutions,” he said. Image Credits: Sanofi Pasteur/Flickr. WHO Recommends Two Monoclonal Antibodies for Ebola Treatment; Calls to Expand Access in Developing Countries 19/08/2022 John Heilprin A health worker dresses in protective clothing to enter the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019 – during the 2018-2020 Ebola outbreak in the neighboring Democratic Republic of Congo. In its first guidelines ever for Ebola treatment, the World Health Organization (WHO) advises using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth,” WHO says. In its launch of the recommendations, WHO also called on the global community “to increase access to these lifesaving medicines”. As relatively new therapies, monoclonal antibodies have been difficult and expensive to access in low- and middle-income countries, with 80% of their sales occuring in the US, Canada and Europe. In 2020, a consortium of research organizations, led by Wellcome Trust issued a global call to action to expand access. Yes to Ansuvimab and Inmazeb, No to ZMapp and Remdesivir Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis, according to WHO. Its new 44-page guidelines for Ebola treatment also makes a “conditional recommendation against” the use of ZMapp and remdesivir for patients with the Ebola virus. ZMapp, a drug cocktail of antibodies developed from the tobacco plant, was the first drug to be used on an experimental basis against the Ebola virus. Initially it showed promise with rhesus monkeys, but was not fully tested on humans. During the 2014-2016 Ebola epidemic in West Africa, however, the US Food and Drug Administration (FDA) approved ZMapp’s experimental use on patients. That epidemic, the continent’s largest ever, killed more than 11,000 people out of the 28,000 people who became ill with the virus. Subsequently, ZMapp, remdesivir as well as mAb114 and REGN-EB3 were all tested against one another in a randomized controlled trial in the Democratic Republic of Congo, running in parallel to the Ebola epidemic that wracked the eastern region of the country between 2018-2020. In August 2019, however, an independent monitoring board recommended early termination of the DRC therapeutics trial due to the favorable results demonstrated by the latter two drug candidates. The board recommended that all patients be randomized to receive either REGN-EB3 or mAb114 in an extension phase. The study’s preliminary results among 499 participants showed people who got REGN-EB3 or mAb114 had a greater chance of survival than those who received ZMapp or remdesivir. Remdesivir was originally developed to treat hepatitis C before it was investigated for treating the Ebola and Marburg viruses, and then as a post-infection treatment for COVID‑19. It eventually won US and European Medicines Agency approval as a COVID-19 treatment. However, in November 2020, WHO recommended against Remdesivir use for COVID, saying there was “no evidence” it improved patient outcomes. Access remains a problem for ebola treatment In its recommendations, WHO called for greater efforts to ensure that that the drugs are “where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely.” To assist with that goal, WHO offered to support “countries, manufacturers and partners” to step up national and global efforts to increase affordability of the biotherapeutic products. “Access to these therapeutics is challenging and pricing and future supply remain unknown, especially in resource-poor areas,” WHO says in its 44-page guidelines. “Without concerted effort, access will remain limited, and it is therefore possible that this strong recommendation could exacerbate health inequity,” it says. “Therefore, given the demonstrated benefits for patients, these recommendations should act as a stimulus to engage all possible mechanisms to improve global access to these treatments.” Both Inmazeb and Ebanga were developed with significant US government support The development of both Inmazeb and Ebanga was heavily supported by the US government and other public funders. Inmazeb, which also was the first FDA-approved treatment for Ebola, is produced by the US-based Regeneron Pharmaceuticals. It was developed in response to the 2018 Ebola outbreak in the DRC with supprot from the US Biomedical Advanced Research and Development Authority (BARDA). Regeneron announced in 2020, the company will “continue to provide Inmazeb for free in response to outbreaks in the DRC through the MEURI protocol for compassionate use,” in colaboration with the WHO, the US FDA and with continuing support from BARDA. “Regeneron is actively working with nongovernmental organizations and public health agencies to ensure continued access to Inmazeb in low- and middle-income countries,” the company declared at that time. The MEURI protocol is a WHO-approved ethical framework for the use of investigational agents. Regeneron gained fame in the first year of the COVID pandemic when former President Donald Trump was treated with another antibody cocktail that it had developed against COVID, (REGEN-COV- a combination of casirivimab and imdevimab) . The cocktail was later recommended by WHO for COVID treatment. As for Ebanga, it was initially developed by the Vaccine Research Center of the US National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), and then licensed in 2018 by the US biotech firm, Ridgeback Biotherapeutics for further development and ultimately FDA aprpoval. “Ebanga is currently available to patients, and Ridgeback Biotherapeutics provides and distributes the treatment to patients free of charge in Ebola-stricken countries,” the company states on its website. WHO publishes invitation to drug manufacturers to share drugs for evaluation WHO says it has now published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to enabling bulk procurement of new drugs by global health agencies, for communities and countries affected by Ebola. “We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies program. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks,” she said. “This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.” WHO also says there is a need for more research and evaluation of clinical interventions because of the large number of “uncertainties” that remain including with supportive care, with our understanding and characterization of the Ebola virus disease and its longer-term consequences, with the continued inclusion of vulnerable populations such as pregnant women, newborns, children and older people in future research. Back to the DRC for More Research, Studies on Ebola treatment The clinical trials used to shape WHO’S guidelines for Ebola treatment were conducted during the Ebola outbreaks that have raged in central and west Africa over the past six years; the largest trial was conducted in the Democratic Republic of the Congo (DRC) which saw a major outbreak in 2018-2020, as well as small outbreaks since then. Ebola is a severe and too often fatal illness, and previous outbreaks and responses showed the importance of early diagnosis and treatment with optimized supportive care that includes fluid and electrolyte repletion and treatment of symptoms. “This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs,” said Kojan. “From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible,” he said. “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.” The DRC has now recorded 14 Ebola outbreaks since 1976, including six since 2018. The most recent outbreak, which began in April, was declared to be over by DRC and WHO authorities last month — with fewer cases and deaths (five) than previous episodes due to a swift response including vaccinations. Vaccinations were launched less than a week after the outbreak was declared, using an ultra-cold chain freezer in Mbandaka so vaccine doses could be stored locally and safely, and delivered effectively. That enabled 2,104 people to be vaccinated, including 1,307 frontline workers and 302 contacts. In the previous outbreak in Equateur Province from June to November 2020, 130 people were infected and 55 died. Africa’s battles with Ebola and other deadly diseases also helped prepare its health systems to deal with COVID-19. When SARS-CoV2 virus landed on the continent, the African Centres for Disease Control (CDC) reinforced its regional coordinating centers, enhanced lab capacity and unified surveillance networks. An Additional Tool for Ebola treatment Along With Clinical Care Guidance The new Ebola treatment guidelines are meant to complement clinical care guidance that outlines the optimized supportive care Ebola patients should receive including factors such as relevant tests, pain management, nutrition and co-infections. But the recommendations only apply to the Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus). “Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler of the University of Toronto and co-chair of the Guideline Development Group of experts selected by WHO. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment — MAb114 or REGN-EB3 — now leads to recovery for the vast majority of people,” he said. Image Credits: Photo: Anna Dubuis / DFID, WHO Therapeutics for Ebola virus disease. How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . 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WHO Recommends Two Monoclonal Antibodies for Ebola Treatment; Calls to Expand Access in Developing Countries 19/08/2022 John Heilprin A health worker dresses in protective clothing to enter the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019 – during the 2018-2020 Ebola outbreak in the neighboring Democratic Republic of Congo. In its first guidelines ever for Ebola treatment, the World Health Organization (WHO) advises using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth,” WHO says. In its launch of the recommendations, WHO also called on the global community “to increase access to these lifesaving medicines”. As relatively new therapies, monoclonal antibodies have been difficult and expensive to access in low- and middle-income countries, with 80% of their sales occuring in the US, Canada and Europe. In 2020, a consortium of research organizations, led by Wellcome Trust issued a global call to action to expand access. Yes to Ansuvimab and Inmazeb, No to ZMapp and Remdesivir Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis, according to WHO. Its new 44-page guidelines for Ebola treatment also makes a “conditional recommendation against” the use of ZMapp and remdesivir for patients with the Ebola virus. ZMapp, a drug cocktail of antibodies developed from the tobacco plant, was the first drug to be used on an experimental basis against the Ebola virus. Initially it showed promise with rhesus monkeys, but was not fully tested on humans. During the 2014-2016 Ebola epidemic in West Africa, however, the US Food and Drug Administration (FDA) approved ZMapp’s experimental use on patients. That epidemic, the continent’s largest ever, killed more than 11,000 people out of the 28,000 people who became ill with the virus. Subsequently, ZMapp, remdesivir as well as mAb114 and REGN-EB3 were all tested against one another in a randomized controlled trial in the Democratic Republic of Congo, running in parallel to the Ebola epidemic that wracked the eastern region of the country between 2018-2020. In August 2019, however, an independent monitoring board recommended early termination of the DRC therapeutics trial due to the favorable results demonstrated by the latter two drug candidates. The board recommended that all patients be randomized to receive either REGN-EB3 or mAb114 in an extension phase. The study’s preliminary results among 499 participants showed people who got REGN-EB3 or mAb114 had a greater chance of survival than those who received ZMapp or remdesivir. Remdesivir was originally developed to treat hepatitis C before it was investigated for treating the Ebola and Marburg viruses, and then as a post-infection treatment for COVID‑19. It eventually won US and European Medicines Agency approval as a COVID-19 treatment. However, in November 2020, WHO recommended against Remdesivir use for COVID, saying there was “no evidence” it improved patient outcomes. Access remains a problem for ebola treatment In its recommendations, WHO called for greater efforts to ensure that that the drugs are “where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely.” To assist with that goal, WHO offered to support “countries, manufacturers and partners” to step up national and global efforts to increase affordability of the biotherapeutic products. “Access to these therapeutics is challenging and pricing and future supply remain unknown, especially in resource-poor areas,” WHO says in its 44-page guidelines. “Without concerted effort, access will remain limited, and it is therefore possible that this strong recommendation could exacerbate health inequity,” it says. “Therefore, given the demonstrated benefits for patients, these recommendations should act as a stimulus to engage all possible mechanisms to improve global access to these treatments.” Both Inmazeb and Ebanga were developed with significant US government support The development of both Inmazeb and Ebanga was heavily supported by the US government and other public funders. Inmazeb, which also was the first FDA-approved treatment for Ebola, is produced by the US-based Regeneron Pharmaceuticals. It was developed in response to the 2018 Ebola outbreak in the DRC with supprot from the US Biomedical Advanced Research and Development Authority (BARDA). Regeneron announced in 2020, the company will “continue to provide Inmazeb for free in response to outbreaks in the DRC through the MEURI protocol for compassionate use,” in colaboration with the WHO, the US FDA and with continuing support from BARDA. “Regeneron is actively working with nongovernmental organizations and public health agencies to ensure continued access to Inmazeb in low- and middle-income countries,” the company declared at that time. The MEURI protocol is a WHO-approved ethical framework for the use of investigational agents. Regeneron gained fame in the first year of the COVID pandemic when former President Donald Trump was treated with another antibody cocktail that it had developed against COVID, (REGEN-COV- a combination of casirivimab and imdevimab) . The cocktail was later recommended by WHO for COVID treatment. As for Ebanga, it was initially developed by the Vaccine Research Center of the US National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), and then licensed in 2018 by the US biotech firm, Ridgeback Biotherapeutics for further development and ultimately FDA aprpoval. “Ebanga is currently available to patients, and Ridgeback Biotherapeutics provides and distributes the treatment to patients free of charge in Ebola-stricken countries,” the company states on its website. WHO publishes invitation to drug manufacturers to share drugs for evaluation WHO says it has now published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to enabling bulk procurement of new drugs by global health agencies, for communities and countries affected by Ebola. “We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies program. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks,” she said. “This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.” WHO also says there is a need for more research and evaluation of clinical interventions because of the large number of “uncertainties” that remain including with supportive care, with our understanding and characterization of the Ebola virus disease and its longer-term consequences, with the continued inclusion of vulnerable populations such as pregnant women, newborns, children and older people in future research. Back to the DRC for More Research, Studies on Ebola treatment The clinical trials used to shape WHO’S guidelines for Ebola treatment were conducted during the Ebola outbreaks that have raged in central and west Africa over the past six years; the largest trial was conducted in the Democratic Republic of the Congo (DRC) which saw a major outbreak in 2018-2020, as well as small outbreaks since then. Ebola is a severe and too often fatal illness, and previous outbreaks and responses showed the importance of early diagnosis and treatment with optimized supportive care that includes fluid and electrolyte repletion and treatment of symptoms. “This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs,” said Kojan. “From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible,” he said. “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.” The DRC has now recorded 14 Ebola outbreaks since 1976, including six since 2018. The most recent outbreak, which began in April, was declared to be over by DRC and WHO authorities last month — with fewer cases and deaths (five) than previous episodes due to a swift response including vaccinations. Vaccinations were launched less than a week after the outbreak was declared, using an ultra-cold chain freezer in Mbandaka so vaccine doses could be stored locally and safely, and delivered effectively. That enabled 2,104 people to be vaccinated, including 1,307 frontline workers and 302 contacts. In the previous outbreak in Equateur Province from June to November 2020, 130 people were infected and 55 died. Africa’s battles with Ebola and other deadly diseases also helped prepare its health systems to deal with COVID-19. When SARS-CoV2 virus landed on the continent, the African Centres for Disease Control (CDC) reinforced its regional coordinating centers, enhanced lab capacity and unified surveillance networks. An Additional Tool for Ebola treatment Along With Clinical Care Guidance The new Ebola treatment guidelines are meant to complement clinical care guidance that outlines the optimized supportive care Ebola patients should receive including factors such as relevant tests, pain management, nutrition and co-infections. But the recommendations only apply to the Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus). “Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler of the University of Toronto and co-chair of the Guideline Development Group of experts selected by WHO. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment — MAb114 or REGN-EB3 — now leads to recovery for the vast majority of people,” he said. Image Credits: Photo: Anna Dubuis / DFID, WHO Therapeutics for Ebola virus disease. How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . 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Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . 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