hiv awareness

MONTREAL – A fourth person has been “cured” of HIV after receiving a stem cell transplant for leukaemia at the City of Hope Hospital in the US.

The 66-year-old man, who was diagnosed with HIV in 1988, has been in remission 17 months after stopping antiretroviral therapy (ART) following a stem cell transplant for leukaemia.

The City of Hope patient received the transplant nearly three and a half years ago, and is older than the three previous patients with HIV who have gone into remission after receiving stem cell treatment for a blood cancer.

Like Timothy Ray Brown, the “Berlin patient” and Adam Castillejo, the “London patient”, the City of Hope patient developed a blood cancer and received stem cells from a donor who had a rare gene mutation (CCR5 Delta 32 on the CD4 cells) making them nearly immune to HIV. 

Earlier this year, a woman in the US was also reported to have been in remission from HIV for over a year following a stem cell transplant using cells from an umbilical cord of a donor, an unrelated newborn child, with the same genetic mutation. Cord blood is used to supply blood stem cells for transplants for patients unable to find matched adult donors. Like the others, she had been living with HIV for a number of years and needed treatment for leukaemia.

The City of Hope patient was the oldest patient to undergo a transplant with HIV and leukaemia and go into remission from both conditions. 

“We were thrilled to let him know that his HIV is in remission and he no longer needs to take antiretroviral therapy that he had been on for over 30 years,” said Dr Jana Dickter, City of Hope associate clinical professor in the Division of Infectious Diseases, who presented the data at an AIDS 2022 press conference on Wednesday. 

“He saw many of his friends die from AIDS in the early days of the disease and faced so much stigma when he was diagnosed with HIV in 1988. But now, he can celebrate this medical milestone.” 

“The City of Hope patient’s case, if the right donor can be identified, may open up the opportunity for more older patients living with HIV and blood cancers to receive a stem cell transplant and go into remission for both diseases,” Dickter added. 

“When I was diagnosed with HIV in 1988, like many others, I thought it was a death sentence,” the man, who wishes not to be identified, said. “I never thought I would live to see the day that I no longer have HIV. City of Hope made that possible, and I am beyond grateful.” 

Under the care of City of Hope hematologist Dr Ahmed Aribi, the patient received three different therapies to get him into remission before receiving a transplant. Most patients achieve remission after one therapy. The remission is necessary because a transplant is an intensive procedure that can cause serious complications. 

City of Hope is a leader in treating patients with blood cancers, and has pioneered the use of gene-modified blood stem cell transplants to test whether stem cells can be engineered to be resistant to HIV infection. 

Leveraging their expertise in cellular immunotherapy, City of Hope scientists have also developed chimeric antigen receptor (CAR) T cells that can target and kill HIV-infected cells and control HIV in preclinical research. 

City of Hope CAR T scientist working in a lab.

They are working to start a clinical trial using CAR T therapy, which has the potential to provide HIV patients with a lifelong viral suppression without ART. 

“The City of Hope patient is another major advancement. It demonstrates that research and clinical care developed and led at City of Hope are changing the meaning of an HIV diagnosis for patients across the United States and the world,” said Dr John Zaia, director of City of Hope’s Center for Gene Therapy.

Under the care of City of Hope hematologist Dr Ahmed Aribi, the patient received three different therapies to get him into remission before receiving a transplant. Most patients achieve remission after one therapy. The remission is necessary because a transplant is an intensive procedure that can cause serious complications. The patient did not experience serious medical issues after transplant. 

“This patient had a high risk for relapsing from acute myeloid leukaemia, making his remission even more remarkable,” Aribi said.

Image Credits: NIAID/Flickr, City of Hope.

Sally Agallo Kwenda

Sally Agallo Kwenda’s first baby only lived for two days. She fell pregnant again almost immediately but her second son was born prematurely and died soon afterwards. Shortly after his death, she learnt that she had AIDS. 

Some years later, after struggling with depression and grief, Kwenda was diagnosed with stage two cervical cancer – something to which people with HIV are far more susceptible, but which is often diagnosed late in Africa and other low-income countries because of the sharp disconnect between diagnosis and treatment of HIV/AIDs, and non-communicable diseases (NCDs) – at primary health care level.

In late May, the World Health Organization approved a roadmap to accelerate the battle against NCDs, which now claim the heaviest mortality in low- and middle-income countries ill-equipped to prevent, diagnose and treat chronic lung and heart conditions, hypertension, diabetes and cancer.  The Roadmap aims to put countries back on track to reach the SDG target 3.4 of reducing premature deaths from NCDs by one-third by 2030 -following severe setbacks created by the COVID pandemic.

But key to that aim, says the NCD Alliance and other advocates, is better integration of NCD prevention and treatment with well-established primary health care services for HIV and other infectious diseases.

“What I went through with cancer I would not wish on my worst enemy,” said Kwenda in a film produced recently by the NCD Alliance (NCDA).

Kwenda has become a vocal advocate for the integration of HIV and NCD treatment and care and was due to address an NCD Alliance event on the issue on Wednesday ahead of the International AIDS Conference in Montreal, which opens on Friday.

But, like many African delegates have reported, she was unable to get a visa to travel to Canada and will advocate for integrated care via online links to the conference.

“I would be very happy that, before I die, I would see the integration of care happen,” says Kwenda, who runs support groups for people living with HIV in Kenya.

After all that she has gone through, Kwenda says that she is not a survivor but a “warrior” for patients’ rights.

Africa’s emerging NCD problem  

NCDs now cause 15 million premature deaths of people between the ages of 30 and 70 each year, 85% of them in low- and middle-income countries.

“In most of sub-Saharan Africa, the biggest causes of death or illness have been due to infectious diseases: malaria, tuberculosis, diarrhoeal diseases in children and HIV,” says Professor Gerald Yonga, a Ugandan cardiologist who represents civil society at the World Health Organization (WHO) Working group on NCDs.

“But NCDs are an emerging problem, increasing a lot over the last 20 years such that now NCDs cause about 30 to 35% of mortality and 50% of hospitalisation and illness.”

Yonga explains that people with HIV have a greater chance of getting an NCD, and that “cervical cancer is as high as six times more likely to occur in people living with HIV”.

Professor Gerald Yonga

HIV is also a risk factor for more serious illness and mortality with COVID-19.

In 2021, United Nations member states adopted a Political Declaration on HIV and AIDS that pledged to ensure that 90% of people living with HIV have access to NCD prevention and care services, including for mental health, by 2025. 

The NCD Alliance says that the global declaration “offers an unprecedented opportunity” to build on multi-sectoral, rights-based and people-centred approaches of the HIV response and to use HIV service delivery platforms to integrate other health services, like “NCD prevention, screening, diagnosis, treatment, care, rehabilitation and palliative care”. 

“There is strong support from in-country stakeholders to pursue greater integration of NCD and HIV services as part of universal health care,” the NCDA adds.

The NCDA and HIV organisations including UNAIDS and StopAIDS have identified 15 proposals to “achieve the best possible health outcomes” for people living with HIV and NCDs globally.

These are based on applying lessons from the struggle for HIV treatment and care  – including context-responsive, human-rights-based programmes – to build integrated universal health care.

The NCDA will use the Montreal conference to build support for these proposals, including calling more more resources to address NCDs.

 

Dr Hans Kluge, WHO Regional Director for Europe.

WHO’s Regional Director for Europe, Hans Kluge, has asked the 53 countries in the WHO region to “act with urgency” in halting the Monkeypox emergency that has hit the region hardest  – noting that “vaccines alone won’t end the outbreak”. 

Kluge’s statement Tuesday followed Saturday’s declaration by WHO of a global public health emergency over the spread of the virus, which has now infected over 18,000 people in 78 countries, according to Tuesday’s data. That is not including several thousand more suspected cases in areas of central and west Africa where the animal-borne disease is endemic, but testing capacity is low.  

Among those, some 81 children under the age of 17 have been reported with infections around the world, said WHO’s Rosamund Lewis, speaking at another press briefing in Geneva. 

“We do still believe that this outbreak of monkeypox can be stopped, with the right strategies in the right groups,” Lewis said at a briefing. “But time is going by and we all need to pull together.”

Europe has been the epicenter of the recent outbreak, with 37 countries affected so far and the public health risk in the region described as “high”, Kluge said: 

“From 13 May through 22 July, close to 12 000 probable or confirmed cases, mostly in men who have sex with men, have been reported in the Region, of whom 8% were hospitalized with, fortunately, no deaths to date.”  WHO’s dashboard put the number of cases in the European region at 13,000.  

WHO monkeypox dashboard as of 26 July. Dark blue shows highest concentrations of confirmed cases since global reporting began in May, 2022. Not including over 2,000 suspected cases also reported in the African Region’s endemic zones, since the beginning of 2022.

Remove health care barriers, confront stigmatization, limit sexual partners 

Kluge called upon health providers to “remove any and all barriers” for patients to access care, as well as battle stigmatization.

“Any barrier, however large or small, will act to prevent patients from coming forward,” Kluge stressed, adding that healthcare providers also need to watch out for “atypical” presentations of the virus, marked by skin lesions, that can mimic others disease as well as removing “any judgment or stigma from the patient pathway – the lessons of HIV/AIDS must not be forgotten. 

Limit sexual partners, for time being at least

But he also called upon men who have sex with men – who are in the highest risk groups to “consider limiting your sexual partners and interactions at this time.” 

“This may be a tough message, but exercising caution can safeguard you and your wider community. While vaccination may be available to some people with higher exposure risks, it is not a silver bullet, and we still ask you to take steps to lower that risk for the time being,” said Kluge in the statement. 

Public health authorities – boost national capacities & collaborate regionally  

monkeypox
Monkeypox skin lesions

Meanwhile, Kluge called upon national public health authorities to “significantly and swiftly boost national capacities for monkeypox surveillance, investigation, diagnostics and contact tracing to help identify and track every possible case. Many cases are likely going undetected, further fuelling the outbreak.  

He also admonished policymakers to “Genuinely work together with at-risk groups and communities and their leaders – including organizers of community events such as summertime Pride festivities – to develop and disseminate crucial messages aimed at curtailing transmission and encouraging uptake of health services.”

There is a “burning need for cross-regional collaboration” he added, calling upon countries to  “ensure vaccines and antivirals reach those who need them the most, as opposed to stockpiling supplies and “going it alone” – actions that are only detrimental to the wider public good, as we’ve seen during the response to COVID-19.” 

Testing capacity low in central Africa where several thousand cases suspected

But there are major holes in testing capacity – in the very countries that have traditionally been endemic for the disease. 

For instance, in the entire WHO African region, where 12 central and eastern African countries are endemic for the disease, only 328 cases have been confirmed by WHO -although Africa is the only region having reported deaths from Monkeypox – five in total.  

In countries such as the Democratic Republic of the Congo, DRC, it over 2000 suspected cases have been reported since the start of the year WHO’s Afrian Region has reported.  But only 163 cases have been confirmed.  

That is largely a reflection of the severe limitation of testing in Africa, and other low- and middle-income regions, which require more WHO support, Lewis said. The WHO global dashboard does not include suspected cases.

 

Traditionally, the clade of monkeypox circulating in DRC and elsewhere in Central Africa has been much more deadly than west African clade, which had seen an upswing in cases in countries such as Nigeria in recent years. A variant of the milder clade was likely transmitted to via international travel to Europe, where person-to-person transmission became more intense and more sustained, triggering the current outbreak.   

Meanwhile, the Americas is the second most heavily-affected region, with some 4,600 cases, with the United States and Brazil most heavily affected. Only 61 cases and 25 have been reported in the WHO’s Western Pacific and Eastern Mediterranean regions respectively. WHO’s South East Asian Regional Office has reported only 5 cases. 

Some 16.4 million vaccines available in bulk, but need to be “filled and finished”

Rosamund Lewis Technical lead for monkeypox, WHO Health Emergencies Programme

As for vaccines, WHO officials have said that some 16.4 million doses of the most effective vaccines  (MVA-BN) are currently available in bulk.  However only about 1 million have been processed into the “fill and finish” of vials ready for delivery. 

Lewis said that the WHO was working with Member States and the European Union on strategies for releasing monkeypox vaccines – along with the creation of a global coordination mechanism. A dashboard with regularly updated data on cases has also been created online.

In combatting monkeypox, mass vaccination is not required, she said, but rather targeted vaccination of health workers, men at high risk because they have had multiple sex partners, and family members of other infected people.  WHO also has recommended post-exposure vaccination of contacts.

Targeted vaccination strategies recommended

Historically smallpox vaccines have been very effective against monkeypox. However, the so-called ‘third’ generation vaccines have remain somewhat untested due to their lack of widespread deployment, and “because they are more attenuated, it is possible they are less effective” against the monkeypox virus, she said. 

The third generation vaccine MVA-BN vaccine, produced by Bavarian Nordic, is the vaccine currently is the most demand. It is regarded as the safest because the vaccinia virus injected does not replicate inside the body. 

MVA-BN is being produced in Denmark and the United States, under the trade names of JYNNEOS and Imvanex, with about 16.4 million doses available in bulk but only about 1 million doses readily available for distribution in a “fill and finish” state, according to WHO’s Tim Nguyen, speaking at Saturday’s press briefing. 

Japan produces another third generation smallpox/monkeypox vaccine, LC-16 but it has not offered to share it beyond its national stockpiles.   A large global stockpile exists of the second generation ACAM2000® vaccine, which was seen to be highly effective against monkeypox when used in smallpox eradication campaigns that ended in the 1970s.  But it has more side effects and is therefore not in high demand presently. 

Lewis called upon countries and manufacturers with vaccines or therapeutics manufacturing capacity to “increase production, and increased availability and … to work with WHO to ensure that diagnostics, vaccines, therapeutics and other necessary supplies are made available based on public health needs, human rights, solidarity and at reasonable cost to countries that most need them to stop the monkeypox outbreak.”  

Image Credits: ET Times Lifestyle/Twitter, WHO.

hepatitis e
Medicins Sans Frontieres and the South Sudan Ministry of Health vaccinate people in Bentiu, the largest internally displaced persons camp in South Sudan.

In a global first – over 25,000 people in South Sudan have been vaccinated in the world’s first mass vaccination campaign to contain an outbreak of hepatitis E, a disease especially fatal for pregnant women.

The outbreak occurred in Bentiu, the largest internally displaced persons camp in South Sudan. Outbreaks of hepatitis E have been seen there since 2015, due to appalling living conditions, including inadequate water, sanitation, and hygiene. 

The most recent outbreak has seen 759 patients with confirmed hepatitis E, 17 of whom have died. 

Hepatitis E is the most common cause of acute viral hepatitis, causing approximately 20 million infections and 44,000 deaths every year. It is transmitted through faecal contamination of food and water. Large scale outbreaks typically occur in mass displacement camps, where water and sanitation are inadequate. 

While hepatitis E has a fatality rate of up to 25% among pregnant women, as well as an increased risk of spontaneous abortions and stillbirths, there is no specific treatment for the disease, so preventing its spread is critical.  

“The fight against hepatitis E has been long and frustrating,” said Dr Monica Rull, Medical Director, Médecins Sans Frontières (MSF). 

First time vaccine has been used in a public health emergency

In response to the outbreak, Médecins Sans Frontières (MSF) and South Sudan’s Ministry of Health jointly carried out the first two rounds of a hepatitis E vaccination campaign in Bentiu in March and April 2022. 

Around 25,000 people, including pregnant women, received Hecolin, the only available hepatitis E vaccine, developed and tested in China, where it is licensed and used primarily to vaccinate travellers. While the World Health Organization has recommended that it be used in outbreak response since 2015, the campaign in Bentiu was the first time the vaccine had been used at scale, in response to a public health emergency.

A third and final round of vaccinations will be conducted in October 2022. South Sudan’s Ministry of Health and MSF are monitoring and reporting on the results of the vaccination campaign.

Hepatitis E vaccination campaign considered a success

Hepatitis E factors in South Sudan’s high maternal death toll.

Both MSF and the South Sudan Ministry of Health have praised the ‘successful’ response to the vaccination campaign, saying it can be a model replicated in future outbreaks. 

“Given the successful implementation and the community’s enthusiastic response in the first two rounds, this innovative vaccination campaign can serve as an example and be replicated in similar settings managing hepatitis E outbreaks,” said Dr John Rumunu, Director General for Preventive Health Services, South Sudan Ministry of Health. 

“I hope the vaccine will help reduce infections and deaths from hepatitis E in Bentiu and beyond.”

“Over the last two decades, MSF has been responding to hepatitis E outbreaks in a wide range of displacement camps, trying to control the disease in challenging conditions and seeing the devastating impact on extremely vulnerable communities,” said Rull. 

“With the experience of this vaccination campaign, we hope to change the way we tackle hepatitis E in the future.”

WHO has called the campaign a “significant milestone” in the fight against hepatitis E. Melanie Marti, a WHO Medical Officer for the Department of Immunization, Vaccines & Biologicals, said, “It is the first time a vaccine has been used to combat the effects of this potentially devastating disease.”

Image Credits: MSF Innovation/Twitter , Stephen Rynkiewicz/Twitter .

covid-19 amr
Doctors at Continental Hospital in Hyderabad, India, were alarmed at the number of drug resistant bacteria they found in patient samples as the COVID-19 pandemic took hold.

(DELHI, India via The New Humanitarian) – As medical professionals across the globe grappled with COVID-19 infections, microbiologist Dr. Bhavani Eshwaragari was confronting a quieter – though no less dangerous – pandemic. Reviewing patient samples in her laboratory in Continental Hospital in the southern India city of Hyderabad, she began to notice an alarming trend as the pandemic wore on: Almost all of the cases of Klebsiella pneumoniae, a bacteria that causes infections such as pneumonia, were resistant to antibiotics.

“Especially during the COVID time there has been multi-drug resistance,” she told The New Humanitarian at her lab in February. Eshwaragari estimated that of the 40 to 50 samples of patient bacteria the hospital tested each day, around 10 percent were drug resistant.

Rising antimicrobial resistance (AMR) had been ringing alarm bells across the world long before COVID-19 emerged. A report published in the Lancet earlier this year – the first to estimate the global burden – calculated that antimicrobial resistance was directly responsible for almost 1.3 million deaths in 2019 – more than HIV or malaria.

While this will result in longer hospital stays and higher costs of treatment for patients across the globe, the impact in low resource settings such as conflict zones may be particularly devastating.

“The supply of antibiotics in those regions is very limited,” said Dr. Bhishmaraj Srivastava, strategic medical lead (South Asia) at Médecins Sans Frontières (MSF). Specialised equipment and experienced doctors, essential for accurate and speedy diagnosis, are also often in short supply, he said. “Getting those kinds of facilities available in resource-limited or conflict settings is a very major challenge.”

Antimicrobial resistance is becoming a leading cause of death, surpassing AIDS/HIV, and malaria

The result of drug-resistant infections in such areas is that “illnesses become more prolonged, death rates become more severe,” said Srivastava. “What becomes even more frustrating is that it’s preventable,” he added. “It’s a problem that could have been avoided in the first place.”

Now, experts worry that the coronavirus pandemic may have exacerbated the problem by accelerating antibiotic misuse, compromising infection control in hospitals, and curtailing vaccination and sanitation programmes. While concrete data has been difficult to collect during the pandemic (some countries, like India, halted data collection for much of the pandemic), anecdotal evidence like Eshwaragari’s as well as emerging reports suggest a steep rise.

Last week, the US Centers for Disease Control and Prevention released a report noting a rise of at least 15 percent in “resistant hospital-onset infections and deaths” in the first year of the pandemic – undoing much of the progress in the US battle against antimicrobial resistance. In addition, the World Health Organization issued an “urgent” call last week to ramp up research and development of vaccines to fight AMR.

‘A socio-economic problem’

In India, drug-resistant pathogens such as the ones seen in Eshwaragari’s lab have been becoming increasingly commonplace in recent years, pinpointing the country as central to the battle against emerging resistance.

The country’s high population density and rate of infectious diseases, combined with a chronically underfunded healthcare system, create the ideal breeding ground for drug-resistant infections. (India spends just 1.25 percent of its GDP on public healthcare, according to a 2020 Oxfam report, ranking the country 154th, or fifth from bottom of the countries studied.) The highest number of multi-drug-resistant tuberculosis cases in the world, according to 2021 WHO research, occur in India, accounting for around one quarter of the global total.

Part of the problem in India and elsewhere lies in an overdependence on antimicrobials – drugs such as antibiotics and antifungals which target infections in the human body. India has one of the highest out-of-pocket healthcare expenditures in the world, likely a result of its low spending on public healthcare. It is often cheaper to buy antibiotics over the counter than it is to visit a private healthcare provider. Regulations to limit access to antimicrobials – where they exist – are rarely enforced. One study conducted in 2018 in a city in southern India found that 78 percent of pharmacies dispensed antibiotics without a prescription.

See related Health Policy Watch story:

Breeding Superbugs – Veterinary Drugs, More than Human Ones, Drive AMR 

“This is truly a socio-economic problem,” said Dr. Guru N. Reddy, founder and managing director of Continental Hospital. He blames the overuse of antibiotics on “a lack of adequate regulations compounded with [a lack of] proper healthcare-dispensing systems.”

Antibiotic resistance occurs naturally as bacteria evolve, but antibiotic misuse can dramatically accelerate the process. When patients take incorrect or unnecessary antibiotics, bacteria that are sensitive to the drug are killed off, leaving behind only the drug-resistant strains. These propagate, accelerating the growth of AMR.

“Especially during the COVID time there has been multi-drug resistance,” Dr. Bhavani Eshwaragari of Continental Hospital in Hyderabad said.

The COVID-19 pandemic exacerbated the problem around the globe. As cases began to ramp up in early 2020, patient demand for certain drugs – even those not scientifically proven to treat the coronavirus – skyrocketed. In India, sales of the antibiotic azithromycin increased drastically, although antibiotics have no impact on viral infections such as coronaviruses.

“The highest sold medication in India is azithromycin antibiotic,” said Reddy. “You know why? Because of COVID. Patients just went to the pharmacy, got hold of this azithromycin and started taking.”

One study, which collected monthly data from 2018 until the end of 2020, estimated that an excess 216 million doses of antibiotics were consumed in India between June and September 2020 — during the first wave of the pandemic — alone.

In India and around the world, antibiotic misuse also increased inside hospitals. As admissions rose, overcrowding and overstretched hospital workers meant less attention was paid to basic infection control measures, such as hand washing and disinfecting equipment. An increase in secondary infections, such as pneumonia and sepsis, resulted, which many doctors attempted to pre-empt by administering precautionary antibiotics. When patients did contract secondary infections, there was a lack of diagnostic equipment to determine which ones, forcing doctors to administer broad-spectrum antibiotics instead of targeting specific pathogens.

“Compromised infection control and lack of diagnostic support are definitely the reasons why a lot of drug prescriptions happen,” said Dr. Kamini Walia, senior scientist at the Indian Council of Medical Research (ICMR). “And that’s something that was exacerbated during this time.”

In an attempt to combat growing antimicrobial resistance in India, the ICMR in 2018 introduced national Antimicrobial Stewardship guidelines, which lays out best practices for hospitals and trains doctors on the importance of targeted prescriptions and tracking antibiotic usage. The guidelines encourage doctors to use a mobile app to check the sensitivity of the antimicrobial susceptibility of any given microorganism to a particular drug, as well as current antibiotic policies before prescribing.

The initiative also aims to improve access to rapid diagnostic tools and drug-sensitivity testing. Advanced laboratory tests can rapidly diagnose both the pathogens present in a sample and their antimicrobial susceptibility. That helps to determine the most appropriate drugs for a patient, resulting in quicker and more effective treatment, and also allows the ICMR to track antimicrobial resistance patterns across the country. This is important, explained Walia, because “unless we have evidence, we can’t push for change.”

Turning to technology as a solution

While India’s population density and overburdened healthcare infrastructure make it an area of concern for the emergence of antimicrobial resistance, the problem is hardly unique to India. Drug-resistant infections increased during the pandemic in a number of countries in the Americas, Dr. Carissa F. Etienne, director of the Pan American Health Organization (PAHO), noted in a media briefing last November. PAHO data since the beginning of the COVID-19 pandemic shows that while 90 percent of COVID-19 patients in hospitals in the region were given an antimicrobial, only an estimated 7 percent actually required these drugs to treat a secondary infection.

See related Health Policy Watch story:

Four Priority Actions to Slow the Silent Pandemic of Antimicrobial Resistance

Vaccination and sanitation programmes, which aim to decrease the number of overall infections, were curtailed in many places during lockdowns or as resources were diverted to fighting the pandemic, further exacerbating the rise of drug resistance. Globally, 23 million children missed out on basic vaccines in 2020, according to WHO and UNICEF.

In environments with high levels of displacement, such as Ukraine and other conflict zones, drug resistance can become a challenge. At a March press conference, the WHO warned that the conflict in Ukraine could increase the country’s cases of drug-resistant tuberculosis – already one of the highest in the world. In conflict settings, “decades of progress in important public health areas like tuberculosis are lost, sometimes in days or weeks – and that threatens everybody,” said Dr. Mike Ryan, the executive director for WHO’s Health Emergencies Programme.

In conflicts, other humanitarian crises (including pandemics) or situations where healthcare is underfunded, technology can step in to fill the gap left by a shortage of medical professionals, said Srivastava of MSF. Basic equipment and apps can connect healthcare workers in remote areas to specialists, which “helps improve the decision-making as well as the prescription practices,” he said.

Artificial intelligence has the potential to take this one step further, by helping to improve diagnostic accuracy and providing an automated interpretation of test results, he noted. Artificial intelligence in such settings is “more cost effective, it’s more mobile” than getting trained medical professionals on the ground, said Srivastava.

Back in Hyderabad, the patients at Continental Hospital are some of the privileged few: they have access to one of the city’s best private hospitals, with state-of-the-art diagnostic technology and an in-house laboratory. Doctors there diagnose and test the drug-sensitivity of most infections within 30 minutes, the hospital’s founder and managing director, Reddy said.

“The faster we do this, the faster we get the right antibiotic to the patient,” he added. “Which should be the norm in taking care of sick patients.”

While that technology is still out of reach for many in public hospitals across India, the COVID-19 pandemic may offer one silver lining, as it “brought a lot of focus and concern around antimicrobial resistance, globally as well as in India,” said ICMR’s Walia. “So now, physicians are more concerned about increasing levels of drug resistance than they were pre-COVID.”

Edited by Abby Seiff

______________________________________________________

This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe

Image Credits: Catherine Davison/TNH, The New Humanitarian .

hepatitis
A study by Glasgow’s Center for Virus Research and others has found that the recent hepatitis outbreak in children may have been caused by a failure to build up the usual immunity due to COVID-19 lockdowns.

The mystery around the rash of acute, serious hepatitis cases that have afflicted over 1000 children under the age of 16 may have been unravelled by a group of Scottish researchers who say that the interaction of two common adenoviruses, or related herpes viruses, may have caused the condition in genetically susceptible children who failed to build up the usual immunity due to COVID lockdowns – and then fell seriously ill after they began to mix socially again.

Their study, led by a team from the University of Glasgow’s Center for Virus Research, and supported by others from University College London and Public Health Scotland, was published on the preprint server medrxiv.org last week.

Over 1000 children in 35 countries, many under the age of 5, have fallen victim to the acute severe acute hepatitis of unknown aetiology, as WHO has termed it.  The most seriously ill have required liver transplants.

Distribution of probable cases of severe acute hepatitis of unknown aetiology in children by WHO Region since 1 October 2021, as of 8 July 2022. 

In a detailed investigation of nine Scottish children who had become acutely ill, researchers found that all of them were co-infected both with adeno-associated virus (AAV2), as compared with zero of healthy, aged matched child controls.

But the nine acutely ill children also were co-infected either with adenovirus (HAdV-41 or HAdV-C), which causes common colds or gastro-intestinal illness, or herpesvirus 6B (HHV6B), the research team found.

The nine children investigated also displayed a higher-than-usual frequency of a genetic variant of the human leukocyte antigen (HLA), known as HLA-DRB1.  The HLA genetic anomaly, which is associated with a range of other immune disorders, which may have made them more vulnerable to such diseases, the researchers said.

Serious illness link to lack of immunity

Child receiving hepatitis B vaccine

Typically, AAV2 is asymptomatic and it requires the presence of either either HAdV or a herpes virus to replicate.

But the co-infections may have occurred, and then caused the genetically susceptible children to become seriously ill, because they had not built up the required immunity to such infections more gradually during the period of COVID lockdowns, the researchers said.

“The recent clustering of cases may have arisen in part because of changes in exposure patterns to HAdV, AAV2 and HHV6B as a result of the COVID-19 pandemic,” the researchers concluded in their preprint, which has not yet been peer-reviewed.  “Faecal HAdV usually follows seasonal trends with maximal rates of detection in younger age groups. However, the circulation of respiratory viruses was interrupted in 2020 by the implementation of non-pharmaceutical interventions, including physical distancing and travel restrictions, instituted to mitigate SARS-CoV-2 transmission.

“These measures may have created a pool of susceptible younger children, resulting in much higher rates of HAdV and potentially AAV2 circulation in this population of naïve children when the COVID-19 restrictions were relaxed.”

Scientists studying the mysterious issue reacted with glee to the publication of the initial findings.  “It explains a LOT,” said CJ Houldcroft of Cambridge University’s Department of Medicine, in a Twitter string.

“This would explain A. the timing of the surge in cases in children, B. why not all children develop this rare complication and C. why the risk isn’t evenly distributed around the world (because of both pathogen exposure factors AND differences in genetic background),” she added, also noting that, AAV2 is part of a class of enteric adenoviruses that are “really common worldwide, including on people’s hands if they don’t wash them properly…11% of hands, yuck!.”

The University of Glasgow’s Professor Emma Thomson, who led the research, said, however, that there were still many unanswered questions. “Larger studies are urgently needed to investigate the role of AAV2 in paediatric hepatitis cases,” she told the BBC.

“We also need to understand more about seasonal circulation of AAV2, a virus that is not routinely monitored – it may be that a peak of adenovirus infection has coincided with a peak in AAV2 exposure, leading to an unusual manifestation of hepatitis in susceptible young children.”

Image Credits: Paul Owere/Twitter , WHO, Dilemma Online/Twitter .

drowning prevention
Swimming lessons

The World Health Organization has issued a call for people around the world to “do one thing” to prevent drowning, on the occasion of World Drowning Prevention Day. 

Drowning tragically claims more than 236,000 lives each year, and is one of the leading causes of death globally for young children and young people aged 1 – 24, and the third leading cause of injury-related death overall.

More than 90% of drowning related deaths occur in low- and middle-income countries, with children under 5 at the highest risk. These deaths are frequently linked to  daily, routine activities, such as bathing, collecting water for domestic use, traveling over water on boats or ferries, and fishing. 

Children travelling by boat

Seasonal or extreme weather events, including monsoons, also are a frequent cause of drowning. 

These deaths are highly preventable through a series of interventions, says WHO. 

“Every year, around the world, hundreds of thousands of people drown. Most of these deaths are preventable through evidence-based, low-cost solutions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

“In many cases, we know what works to prevent drowning. We’ve developed tools and guidance to help governments implement solutions – and if we do more together, we really can save thousands of lives,” said Michael Bloomberg, founder of Bloomberg Philanthropies and WHO Global Ambassador for Noncommunicable Diseases and Injuries

Low-cost prevention strategies 

Resuscitation classes

With the theme of this year’s World Drowning Prevention Day to “do one thing” to prevent drowning, WHO invited the global community – individuals, groups, and governments – to engage in at least one of several prevention strategies: 

Individuals can share drowning prevention and water safety advice with their families, friends and colleagues, sign up for swimming or water safety lessons, or support local drowning prevention charities and groups.

Groups can host public events to share water safety information, launch water safety campaigns, or commit to developing or delivering new drowning prevention programmes using recommended best practice interventions.

Governments can develop or announce new drowning prevention policies, strategies, legislation or investment, convene discussions on drowning burden and solutions, and introduce or commit to supporting drowning prevention programming domestically or internationally.

WHO also recommends six engineering and environmental measures to prevent drowning, including: installing barriers controlling access to water; training bystanders in safe rescue and resuscitation; teaching school-aged children basic swimming and water safety skills; providing supervised day care for children; setting and enforcing safe boating, shipping and ferry regulations; and improving flood risk management.

In May 2022, WHO has also published its latest guidance on best practice recommendations for three of these interventions: the provision of daycare for children, basic swimming and water safety skills, and safe rescue and resuscitation training.  

Bangladesh, Uganda and others commit to drowning prevention programmes 

Community Swimming Instructor training held at Tiakhali, Kolapara in Bangladesh

Many countries have already committed to drowning prevention programmes.

Bangladesh has started a 3-year program to reduce drowning among children throughout the country. As part of the program, the government will take over the 2,500 daycares established and funded by Bloomberg Philanthropies, and will expand the program by adding an additional 5,5000 daycares, providing supervision to 200000 children aged 1 – 5 years. 

Uganda and Vietnam also conduct drowning-prevention activities such as supervision of children in daycare, survival swimming instruction to children ages 6 – 15, and enhanced data collection. Uganda and Ghana are also receiving support to study the circumstances of drowning.  

Lighting up Geneva’s Jet d’Eau and other monuments blue to galvanize action 

To galvanize action towards drowning prevention, Geneva’s “Jet d’Eau,” which sprays a powerful shower of water from Lake Leman over the skyline of Geneva, Switzerland, will be illuminated blue this evening, accompanied by similar actions in other cities around the world. 

“Today, cities around the world are lighting up their monuments in blue light as a call to action for each of us to do our part to prevent drowning. Let’s put a stop to drowning,” said Tedros. 

Image Credits: WHO, WHO, WHO, WHO.

Tedros Adhanom Ghebreyesus, WHO Director General

WHO has declared a new global public health emergency over the Monkeypox outbreak which has now spread to more than 16,000 people in over 75 countries and territories – in what some public health experts described as a “bold decision” by Director General Dr Tedros Adhanom Ghebreyesus, overriding a divided group of expert advisors.

The WHO Director General announced his decision after a two-day meeting by a 15-member International Health Emergency committee failed to come up with a consensus recommendation.

Speaking at an extraordinary WHO press conference convened on Saturday, Dr Tedros said that took the decision in line with his authority to do so, deciding that the outbreak meets the criteria for a “public health emergency of international concern” (PHEIC) under the the terms of WHO’s binding International Health Regulations.

“There are now more than 16,000 reported cases from 75 countries and territories, and five deaths,” said Tedros. “Information provided by countries…. in this case shows that this virus has spread rapidly to many countries that have not seen it before,” he added.  “We have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little, and which meets the criteria in the International Health Regulations.”

monkeypox
WHO monkeypox dashboard as of 23 July. Dark blue shows highest concentrations of confirmed cases. Not including several thousand suspected cases also seen since the beginning of 2022 in the African Region.

He said he took that decision despite the fact that the Expert Committee was 6-9 against declaring a PHEIC at this time – which he described as “very close” for a group that typically decides by consensus.

He said that he took the decision despite the fact that currently, WHO’s determination is that the global risk of Monkeypox to public health remains “moderate” except for in the European region, where risks are “high.”

Acted as a tie-breaker

“Under the International Health Regulations, I am required to consider five elements in deciding whether an outbreak constitutes a public health emergency of international concern,” he added, citing those as country reports, the Emergency Committee’s views, other scientific evidence, and WHO’s own assessment of the risks of international spread.

“I had then to act as a tie breaker,” Tedros said of the split Emergency Committee’s views.

“There was no consensus by them.  We believe that it’s time to declare a PHEIC, considering their advice and considering how it has spread since the last meeting of the Emergency Committee in late June, at a time when the infection was only being seen in 37 countries.

“We believe this will mobilize the world to act together, it needs coordination, solidarity, especially [for] the use of vaccines and treatments,” said Tedros.

Access to vaccines and treatments uneven – with many unknowns

Tim Nguyen, WHO Unit Head High Impact Events Preparedness

Currently vaccines and anti-viral treatments are only available in about half of the countries that are seeing cases, said WHO’s Tim Nguyen, who described the current state of play. In the other half, WHO officials have inadequate information about countries’ access to treatments and vaccines, which are being prioritized to at-risk groups.

“We know that from the countries that are having reporting cases at the moment, roughly half of them have already secured access …. For those other half we don’t know,” Nguyen said. “At the same time WHO continues to discuss with member states holding larger stockpiles about sharing and donating vaccines to those that have don’t have access at the moment.”

Nguyen said that there are three “third generation” smallpox vaccines that have been recommended by WHO for use against monkeypox, totaling over 116 million doses, and scattered among various national stockpiles. They include about 100 million doses of the ACAM2000® vaccine, about 16.4 million doses of the MVA-BN, vaccine, most of which are held by the USA, and an unreported quantity of the LC16, vaccine produced by Japan’s KM Biologics and held in Japan’s national stockpile.

However, Nguyen admitted that there are “uncertainties” around the effectiveness of the three vaccines “because they haven’t been used in this context and at this scale before.”

The US Centers for Disease Control, for instance, is rolling out the MVA-BN vaccine produced by Bavarian Nordic and marketed in the United States under the trade name JYNNEOSTM to the broader at-risk population, while reserving the ACAM2000, which can create severe complications, only for researchers and military personnel. On Friday, the European Medicines Agency also has moved recently to approve the same Bavarian Nordic vaccine for use against monkeypox.  The vaccine is marketed in Europe under the trade name Imvanex.

Big concern is sustained person-to-person transmission

Rosamund Lewis Technical lead for monkeypox, WHO Health Emergencies Programme

Meanwhile, the “big concern” with this outbreak is that sustained person-to-person transmission is now occurring in so many parts of the world, added Rosamund Lewis, Monkeypox technical lead.

She noted that traditionally, monkeypox outbreaks that were first observed among human communities in the 1970s, were small and self-contained. They typically occured in West and Central Africa as a result of contact with infected animals or food – and those infected might go on to infect other family members with onward transmission of two or three chains, before it died out.

However, more recently, the “chains of transmission have become longer – possibly 6 possibly 9 sequential chains” she added.  And more recently, the virus also began infecting some foreign travelers and groups of people who had frequent, close, intimate contact, particularly men who have sex with men.

It remains unclear if the more sustained transmission is also a result of mutations in the endemic clades of the virus – or the decline in immunity from smallpox vaccination  – which ceased on a mass scale in the 1970s.

Tedros’ ‘bold decision’ welcomed – but could it already be too late?

Mike Ryan, Executive Director, WHO Health Emergencies Programme

Tedros’ decision to declare a PHEIC, despite the hung jury of his expert committee, was welcomed as a “bold decision” by leading global health experts like Lawrence Gostin of Georgetown University, who earlier had said the outbreak was “spinning out of control.”

Over the past week, not only Gostin but a long list of other prominent global health experts were expressing rising concerns that it might be too late to contain the outbreak.

“Now that WHO has declared monkeypox a global emergency it’s vital to publish a global action plan with ample funding,” Gostin added, shortly after the WHO announcement was made. “There’s no time to lose.”

At the same time, emergency declarations cannot be taken too frequently, if WHO wants to mobilize action effectively when they are declared, stressed Stephen Morse, an epidemiologist at Columbia University.

“There are many concerns that have to be balanced with the decision to declare a PHEIC,” he told Health Policy Watch. “Doing it too often can be desensitizing, and we just had the COVID-19 (SARS-CoV-2) PHEIC.

Stigmatization and different transmission patterns in Europe and Africa also pose challenges

“There are also political and social concerns (in this case, stigmatization),” he added, referring to the fact that most of the cases seen outside of central and west Africa are occurring among men who have sex with men. At the same time,  Morse added, “Certainly the monkeypox epidemic is international and requires a coordinated response and resources.  Don’t forget Nigeria, which has had an ongoing epidemic of West African clade human monkeypox since 2017 and the current epidemic may be “spillover” from that epidemic.  They should get assistance in dealing with human monkeypox.

Smallpox vaccine protects against monkeypox. But questions remain if it can now be deployed rapidly and widely enough – with supplies still limited and concentrated in only a few countries.

“There is another issue, he added.  “Historically, human monkeypox is not self-sustaining in the human population.  Classically, it might transmit person to person for a few cycles (a few links in a chain of transmission) but then usually dies out. This has been going on for several months now, and on an unprecedented scale.

“So we don’t know if cases would essentially drop or if, as has sometimes been suggested, that the virus is now more human-adapted.  Either way, for a variety of reasons it’s important to contain and stop the outbreak as quickly as possible.  Unlike the beginning of the SARS-CoV-2/COVID-19 pandemic (which is manyfold more transmissible than monkeypox), we have tools – vaccine and an antiviral – if we can produce and effectively deploy them.”

Question remains if PHEIC will mobilize sufficient action to halt transmission trends

Speaking at the briefing, Lewis said she was still personally unsure if the world would be able to control the outbreak at this stage – although she expressed hopes that it might be possible.

“We don’t have a crystal ball,” she said, ” So we don’t know for sure if we’re going to be able to support countries enough and communities enough to stop this outbreak.  We think it is still possible precisely because it remains primarily in one group – who are very active in health-seeking behaviour.

“So we are very much appealing communities and community leaders who have many years of experience in managing HIV/AIDs or sexually transmitted infections to work with more mainstream… public health officials and agencies…..if we all pull together, this is how we will get to the end  of this outbreak.”

She noted that in the African regions where the disease is endemic, about 30% of the cases seen have been in women and children – reflecting the broader risks communities around the world face.

While 98% of the cases seen abroad have been in communities of men who have sex with men, as the virus becomes more deeply embedded elsewhere, it will also spread much more broadly in communities, including women and children, she and other WHO experts have warned.

Further transmission will also lead to the disease becoming embedded itself in animal populations – which will then continue to transmit the disease back to humans.

“If we don’t assist the affected community, there is the risk it will become broader,” said Dr Mike Ryan, WHO executive director of Health Emergencies, “So this is about enlightened self interest.

For more about communities at risk and preventive measures see below:

https://youtu.be/Zjy0wR1pQgw

Image Credits: WHO .

Midwife vaccinates a man during a COVID-19 vaccine campaign in Madagascar.

After missing the target to vaccinate 70% of people in every country against COVID by July 2022, WHO’s new vaccine strategy prioritises 100% coverage for health workers and older people – but admits that every country will have to decide for itself. 

The World Health Organization has published an update to the Global COVID-19 Vaccination Strategy that preserves its 70% global vaccination target and 100% vaccination targets for health care workers and older populations, but acknowledges that countries will still need to determine their ‘context-specific targets’ for their own COVID-19 national vaccination programmes. 

The language walks back previous WHO statements about achieving vaccine coverage of 70% of the population of each country by mid-2022, a target that was clearly missed. Now, that 70% goal is described as “aspirational” without any new date set for when it might be achieved.  While WHO called for 100% of health workers and older people to be covered, it also acknowledged that each country will have to set its own targets in line with local conditions and priorities:   

“This acknowledges that countries will determine the breadth of their COVID-19 national vaccination programmes considering factors such as: local COVID-19 epidemiology, demographics,
opportunities to leverage COVID-19 to strengthen primary health care systems, other health priorities, socio-economic risks from future waves of disease, population demand for breadth of vaccination, and sustainability of vaccination efforts,” the strategy states.

The update, published Friday, stresses that many of the people who are most at risk remain unprotected despite the biggest and fastest global vaccination rollout in history — with over 12 billion doses of COVID-19 vaccines administered globally across nearly every country in the world, resulting 60% global coverage.

Only 37% of older people in low-income countries got jabs

Only 28% of older people and 37% of health care workers in low-income countries have received a primary course of vaccines, and most have not received booster doses, according to a WHO statement. For the general population, only 16% of eligible adults in low-income countries and 21% in Africa have received a full two-course initial dose according to Oxford University’s “Our World in Data” vaccine tracker.  Twenty-seven of WHO’s member nations, including 11 low-income countries, have not yet started a booster or additional dose program. Controversy still swirls over who is fundamentally responsible for the continuing low rates of COVID vaccination in Africa, in particular, with fingers pointed at the pharma industry, WHO, and widespread vaccine hesitancy, alternately. 

WHO emphasized the need to vaccinate those most at risk for COVID-19. 

“Even where 70% vaccination coverage is achieved, if significant numbers of health workers, older people and other at-risk groups remain unvaccinated, deaths will continue, health systems will remain under pressure and the global recovery will be at risk,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, in announcing the strategy. 

“Vaccinating all those most at risk is the single best way to save lives, protect health systems and keep societies and economies open,” he said.

The strategy uses both primary and booster doses to reduce deaths and severe disease. The aim is to protect health systems, societies, and economies, as well as to facilitate the research, development, and equitable distribution of new vaccine products. 

vaccination
COVID-19 Vaccination Strategy prioritizes using existing vaccines to reach high priority groups and then accelerating access to improved ones to achieve protective immunity

Using local data and engaging communities

To ensure vaccines reach the highest priority groups, the strategy emphasizes the need to measure progress in vaccinating these groups and developing targeted approaches to reach them.

These approaches include using local data and engaging communities to sustain demand for vaccines and reach more displaced people through humanitarian response.

Coordinated action is needed to achieve global COVID-19 vaccination targets.

Call for more equitable distribution of new vaccines

The strategy also calls for the equitable distribution of new COVID-19 vaccines with “improved attributes” that increase “depth and breadth” of protection and ease delivery.

But it also stresses that supply agreements should aim at “targeting availability of vaccine products with improved attributes, for all countries.”

Omicron BA.5 and other subvariants have reduced the efficacy of vaccines, prompting the need for new vaccines that can protect against these variants of concern.

While current vaccines were designed to and have largely succeeded in preventing serious illness and death, they have not substantially reduced transmission rates. Global weekly COVID-19 cases almost doubled in the past six weeks, according to WHO’s press briefing on Wednesday. The surge has been driven by the Omicron BA.5 subvariant. 

“It is fundamental to continue investing in research and development to make more effective, easier to administer vaccines, such as nasal spray products,” WHO says, while also noting that ensuring the sustainability of the COVID-19 vaccination effort is an operational priority that will “require urgent attention and reorientation before the end of 2022.”

Image Credits: Samy Rakotoniaina/MSH, WHO.

A healthcare worker gives a child a dose of the malaria vaccine, RTS,S.

“It’s better to reduce the number of children affected than not to do anything at all”

The World Health Organization (WHO) and Gavi, the Vaccine Alliance are planning to go ahead with the mass rollout of the RTS,S/AS01 (RTS,S) malaria vaccine, starting with three countries in Africa — Ghana, Kenya and Malawi — despite the Bill and Melinda Gates Foundation’s withdrawal of more direct support for increased malaria vaccinations because its efficacy was limited.

In a June interview with Health Policy Watch, Philip Welkhoff, who directs the foundation’s malaria program, said the foundation preferred to invest in classical malaria control measures, like bednets, rather than the vaccine.

According to WHO, however, researchers observed a 30% reduction in severe malaria infections, a 21% reduction in hospitalizations, and a 10% reduction in mortality, in the areas of Ghana, Kenya and Malawi where the vaccine recently was piloted on some 800,000 infants and children aged 5–17 months  And those reductions are significant. 

In October 2021, the vaccine was approved by WHO in a historic first, shortly after the results of the three-country pilot were reported.  

Thabani Maphosa, managing director of country programmes at Gavi, the Vaccine Alliance

Thabani Maphosa, managing director of country programmes at Gavi, told a WHO press briefing on Thursday the malaria vaccine’s ability to protect some children justifies the investment in its rollout even though there are debates regarding the degree of its benefits.

“It is better to be protected and to reduce the number of children that are affected than not to do anything at all,” he said.

Maphosa said Gavi and WHO would make US$ 160 million in funds available to support the wider rollout of the vaccine between this year and 2025, first targeting children in the three African nations that began piloting the vaccine three years ago. He said the rollout would then expand to other eligible endemic countries.

 The two organizations also are working with others to improve the vaccine supply, since that is the real problem, not the funding.

A ‘Lifesaving’ Vaccine

Dr Matshidiso Moeti, WHO’s Regional Director for Africa, described the vaccine as “lifesaving.” Rose Leke, a malaria disease expert and professor at Cameroon’s University of Yaounde, said the vaccine is needed now more than ever.

After recent decades of progress, we now see that malaria is getting worse in many places, and this threatens our well being and future potential. And, really, this is unacceptable,” Leke, a co-chair of the expert group that advised WHO on a framework to allocate the currently limited malaria vaccine supply, told the press briefing. She described the vaccine as an opportunity to strengthen malaria control.

Rose Leke, a malaria disease expert and professor at Cameroon’s University of Yaounde

Welkhoff said during the June 2021 interview that the foundation would not prioritize the rollout of the malaria vaccine in its 2022 call to countries for proposals to fund malaria control projects.

Instead, he said, the foundation’s US$140 million contribution will go to country projects that prioritize traditional infection control measures, such as mosquito nets, access to antimalarial drugs, and improvements in diagnostics and health systems. The malaria vaccines’s limited effectiveness highlights a gap that still needs to be filled by researchers, according to Welkhoff.

“It is a remarkable technical accomplishment but is only partially effective and the effect goes away after a period of time,” he said.

Moet, on the other hand, noted that in the pilot countries where more than 1.3 million children have been vaccinated, there has been an almost 30% drop in hospitalizations of children with severe malaria. 

“They’ve also seen, after two years in areas where the vaccine was piloted, an almost 10% reduction in child deaths in the age group that is eligible for the vaccine,” she said.

Welkhoff, however, told Health Policy Watch the foundation wants to prioritize new measures like research and development and mass introduction of new generation drugs and insecticide treated nets (ITNs) that can beat fast-developing mosquito and parasite resistance to the drugs and chemicals currently in use.

“We want to start introducing and scaling up these [new] nets,” he said.  “We are [also] starting to see the beginnings of drug resistance in parts of Africa to the Artemisinin combination therapies (ACTs). So this is going to need funding, to make sure that we don’t lose these drugs that each year save so many lives.”

Image Credits: WHO/M. Nieuwenhof.