Vacccination can effectively prevent mother-to-child transmission of hepatitis B – but few children in Africa receive the jab despite high prevalence

As the World Hepatitis Summit 2022 takes place this week, some 354 million people are still living with viral hepatitis, despite the fact that vaccines, treatments and even cures are now available, says Finn Jarle Rode is Executive Director at the Hepatitis Fund. 

Until now, viral hepatitis elimination has been the neglected child of global health. At a glance that may appear an odd statement to make given that both a vaccine and treatment for hepatitis B (HBV) exist.

And the 25 years that elapsed between the discovery of the HCV virus in 1989 and that of a cure for hepatitis C in 2014 represents one of the shortest periods of time for such a major R&D effort in infectious disease history. 

But these scientific breakthroughs are not enough. Today some 354 million people are still living with viral hepatitis, mainly in low and middle-income countries such as India, Bangladesh, China, and Pakistan. 

People wait to receive free hepatitis testing and treatment in Lahore, Pakistan, at a dedicated Hepatitis Prevention and Treatment Clinic.

Only 9% of people living with HBV and 20% of those living with HCV have been tested and diagnosed. Of those diagnosed with HBV infection, 8% are on treatment, while 7% of those diagnosed with HCV infection have started treatment. 

Globally 1.4 million people are dying from viral hepatitis each year. Before COVID-19, tuberculosis was the world´s biggest infectious disease killer, claiming 1.6 million lives each year. That means that hepatitis has been the world’s third deadliest infectious disease even during the pandemic.

Clearly, the World Health Organization’s (WHO) goal to eliminate viral hepatitis by 2030 is not going to be reached if the inertia being seen today remains.  

This, despite the potential benefits of doing so: Every dollar invested in HBV elimination returns up to $2.23. Every dollar invested in HCV returns up to $3.42. A $1.00 vaccine course can prevent one child from getting HBV, and $80.00 can cure someone from HCV.

Lack of political will & funding

Event at Davos on the margins of the World Economic Forum discussed the still formidable financial and political barriers to viral hepatitis elimination

The root cause of the problem is money followed by a lack of political commitment, issues covered in a 25 May panel at Davos held on the sidelines of the World Economic Forum on “Financing Viral Hepatitis Elimination”, including former New Zealand Prime Minister Helen Clark, among other speakers. Today no government clearly leads on the Sustainable Development Goal Target 3.3 of ending communicable diseases including hepatitis.

Advocacy and funding are not reaching the critical mass required to realistically end hepatitis. Polio eradication for instance, has been largely driven through the long-standing commitment of the Bill and Melinda Gates Foundation, working in unison with the WHO. We need a similar show of leadership from the philanthropic community to replicate that success with hepatitis.

The WHO estimates that only US$500 million is invested in hepatitis elimination per year. Malaria, with a comparable disease burden and lower mortality rates, receives $US3.3 billion per year.  The hepatitis response is an unfortunate example of the disconnect between science and policy-making – where tools to effectively end the epidemic are available but decision-makers lack the financial impetus to do so. 

African region sees highest HBV burden – but newborns aren’t vaccinated 

Vaccination can effectively prevent mother-to-child transmission of hepatitis B

In 2019, about 66% of the 1.5 million new HBV infections were concentrated in WHO’s Africa region. The majority of HBV transmission is driven by vertical transmission (from mother to baby). 

This is the most common and deadliest form of HBV transmission, as approximately 90% of children infected this way develop chronic HBV infection and up to a quarter of these infants also die prematurely from HBV-related causes. The younger a person is when they acquire HBV, the greater chance of chronic infection and premature death. 

Fortunately, an almost 100% effective vaccine exists to prevent HBV, delivered in a three or four-dose schedule. The first critical dose is known as a “birth dose” and must be delivered within 24 hours of birth (as recommended by WHO) to prevent 70-95% of transmission that occurs during or just after birth. Given the availability of this simple and effective intervention, no child should be born with this life-threatening, chronic disease.

But despite the high burden of HBV in the region, only 11 of 47 countries in Africa include hepatitis B birth dose (HepB BD) as part of the routine infant immunization schedule. Only six per cent of African newborns are receiving the birth dose vaccine today.

Linking up HIV and HBV services 

People waiting to receive free hepatitis C tests and vaccines on World Hepatitis Day, Rwanda. But campaigns are no replacement for integration into primary health care services

Hepatitis needs big donors to drive bilateral aid and national government buy-in. But this doesn’t have to lead to exorbitant costs. 

First of all, we need to ensure better integration of viral hepatitis treatment into existing global health programmes, and take a people-centred approach to prevention, diagnosis and treatment.  

It makes no epidemiological or economic sense, for instance, that an HIV positive pregnant woman in Kenya attending a health care centre be provided with Nevirapine to prevent her infant from contracting HIV, but not also be given access to Tenofovir prophylaxis preventing mother-to-child transmission of HBV in late pregnancy, along with an  opportunity to vaccinate her newborn against HBV.

Secondly, we need more of the public-private partnerships that have to date proven effective. Much more. And that includes external catalytic funding. We need the World Bank, the Asian Development Bank, The Islamic Bank, philanthropists, foundations.

Inroads are possible

This is not the stuff of fantasy. Inroads are possible, even in the most unlikely scenarios.  Take Egypt: it has long held the highest rate of HCV infection in the world. One person out of every 10  used to live with viral hepatitis. But in 2014 the country began implementing a strategy that has made  huge progress against the disease.

A first step was to get the buy-in of various government ministries, not just the health portfolio. The second was to make the decision to integrate hepatitis C screening with screening for non-communicable diseases (NCDs) in primary healthcare facilities. 

This approach reached some 60 million people, including nine million school children. At the same time, partnerships between civil society, the private sector and philanthropic organisations mobilised communities and drove high rates of screening, diagnosis and treatment.

Since the country’s programme began, the number of Egyptians living with hepatitis C has dropped from 4.346 million in 2014 to 516,000 in 2021.  Egypt´s remarkable response has shown that the goal of eliminating viral hepatitis is possible. With the right backing, it can be done everywhere.

Finn Jarle Rode is Executive Director at the Hepatitis Fund, a global non-profit organization that funds catalytic actions by partners, including support for the development of strategic plans at the national and sub-national level; country-specific data; and health system capacity-strengthening.

Image Credits: WHO, PKLI , WHO, WHO.

Protestors in New York City.

World Trade Organization (WTO) leaders are hopeful that an agreement could be reached on a waiver on intellectual property rights for COVID-19 vaccines at the Ministerial Council starting on Sunday – but the People’s Vaccine Alliance has organised global protests to demand “a real TRIPS waiver” ahead of the meeting.

WTO Director-General Ngozi Okonjo-Iweala has expressed “cautious optimism” that agreement on the IP waiver is possible at the council, according to WTO spokesperson Daniel Pruzin.

Speaking at a media briefing on Tuesday following a special meeting of the WTO General Council earlier in the day, Pruzin said that Ambassador Lansana Gberie, chair of the TRIPS Council, which is leading discussions on the waiver and the WTO’s response to the pandemic, was also optimistic.

According to Gberie, delegations “entered into real negotiation mode [on Monday] in an effort to try to iron out their differences, particularly with regards to the waiver discussions,” said Pruzin.

A small group meeting of the TRIPS Council on the waiver resumed negotiations on Tuesday evening.

Too little, too late?

On 3 May, Okonjo-Iweala put forward an “outcome document” on the waiver that had emerged from discussions with “the Quad” – the European Union, India, South Africa and the US.

According to the WTO, the Quad adopted a “problem-solving approach aimed at identifying practical ways of clarifying, streamlining and simplifying how governments can override patent rights, under certain conditions, to enable diversification of production of COVID-19 vaccines”.

However, there are still some sticking points on the proposal, even within the Quad, and the proposal has been widely condemned by health activists for being too little, too late. 

An IP waiver proposal for all COVID-related technology was first put on the table over 18 months ago by India and South Africa during the height of the pandemic when vaccines were in short supply. 

The current agreement is confined to COVID-19 vaccines, and it is being negotiated when there is a global glut of vaccines.

The People’s Vaccine Alliance is planning global protests during the week aimed at pressuring US and European countries to “end COVID monopolies” and “deliver a real TRIPS waiver”, the global network announced on Tuesday.

“The WTO is having its biggest meeting since the start of the pandemic. Feeling the pressure to do something on COVID, WTO leaders have introduced a bogus new proposal that not only fails to remove WTO barriers to COVID medicine accessibility, but actually introduces new obstacles,” according to the alliance.

Other big WTO agenda items

Other big items on the agenda of the WTO Ministerial Council are a reduction in fishing subsidies, agricultural trade reform and reform of the WTO itself, including more regular ministerial meetings.

Pruzin said the “significant progress” had been made on the fishing subsidies proposal, which has been negotiated for a number of years, and on  possible ministerial declaration on WTO’s response to the pandemic,

“There are still some very important differences which remain in the texts, and I think all the chairs recognise this, be it fisheries, be it agriculture, be in other areas as well,” said Pruzin.

“But I think it’s fair to say that the atmosphere is much better than it has been in some time. I think there’s some good momentum going into the final preparations.”

Image Credits: People's Vaccine Alliance.

A medical assistant gives a flu vaccination.

Moderna announced Tuesday that the first participants have been vaccinated in a Phase 3 study of its influenza (flu) vaccine, which is based on mRNA technology used in its COVID-19 vaccine.

The vaccine, mRNA-1010, encodes for hemagglutinin (HA) glycoproteins of the four influenza strains recommended by the World Health Organization (WHO) for the prevention of influenza.

Flu epidemics generally occur in the winter and some years can place a heavy burden on healthcare systems, with as many as 3 million to 5 million severe cases and, at its worst, as many as 650,000 deaths, according to WHO.

The trial is expected to enroll approximately 6,000 adults in countries in the southern hemisphere. It is a randomized, observer-blind study that is meant to evaluate the safety and immunological efficacy of mRNA-1010 in comparison to a licensed seasonal influenza vaccine in adults 18 years and older. Participants will be randomly assigned on a 1:1 ratio to receive either a single dose of mRNA-1010 or a single dose of a licensed seasonal influenza vaccine as a comparator.

The company aims to run a confirmatory efficacy study for mRNA-1010 as early as the 2022/2023 northern hemisphere influenza season.

“mRNA-1010 is the first of several influenza vaccine candidates we are developing with the aim of iteratively improving traditional vaccines by inducing broad and robust immune responses,” Moderna CEO Stéphane Bancel said in a release. “We believe our mRNA platform, with the flexibility and speed of our manufacturing process, is well-positioned to address the significant unmet need in seasonal flu.

Moderna was founded 12 years ago and became well-known two years ago with the development of its SARS-CoV2 mRNA vaccine. It was the second mRNA vaccine ever to be produced and was approved by the US Food and Drug Administration. The first mRNA vaccine was developed by Pfizer and BioNTech.

Moderna is currently engaged in four Phase III studies, it said, including its SARS-CoV-2 booster, RSV, seasonal flu and CMV vaccine candidates.

“Beginning in the fall of 2022, the company’s Phase III pipeline could lead to three respiratory commercial launches over the next two to three years,” Bancel said.

Image Credits: Moderna, KEYSTONE/Gaetan Bally.

Dr Ibrahima Socé Fall, assistant general security for emergency response

The first human case of monkeypox was recorded in 1970, yet the viral disease is only getting international attention since it has spread outside Africa to 27 non-endemic countries.

The World Health Organization’s (WHO) Dr Ebrahima Socé  Fall described monkeypox as a “neglected tropical disease” when he opened a two-day meeting called by the WHO’s R&D Blueprint to determine research priorities last Thursday.

“We need to stop the chain of transmission and we believe at this stage we can still stop the chain of transmission in non-endemic countries by ensuring surveillance in certain population groups, cross investigation contact tracing, and maybe vaccination,” said Fall, WHO’s Assistant Director-General for Emergencies Response. 

However, WHO scientist Ana Maria Restrepo stressed at the meeting’s conclusion that the viral disease had to be addressed in the nine African countries where it is endemic.

“The problem starts and has to be resolved at the level of the endemic countries,” said Restrepo, co-convenor of the R&D Blueprint that called the meeting, at the conclusion of the meeting.

“There are researchers of high quality in these countries, and they are doing high-quality research despite the limitations, and our commitment is to support them.” 

Squirrel pox?

The intention of the meeting – attended virtually by over 500 scientists – was to identify research priorities, and when it ended on Friday afternoon, the scientists had identified a long list of unknowns.

One of the big questions is whether there is an “unknown animal reservoir” for monkeypox – with squirrels and rats being fingered as the most likely suspects. The Central African sun squirrel is particularly susceptible to monkeypox – and one researcher suggested the pox might have been more aptly named after it.

“What was the first reservoir?” asked Dr Paul Fine of the London School of Hygiene and Tropical Medicine.  

“We think monkey because of the name monkeypox, but there were studies in a number of other species and it was found in several of them, in particular squirrels, particular the sun squirrel of Central Africa. So one might ask if this name is appropriate. Is it just monkeypox or are there other species very importantly, involved as reservoirs?”

SARS Co-V2 comes from bats, while monkeypox could come from rats.

Professor Jean-Jaques Muyembe Tamfum, director of the DRC’s Institute de Recherche Biomedicale, said that the majority of monkeypox cases in his country were children infected by hunting and handling rodents and squirrels.  Adults were exposed to the virus by hunting monkeys.

“The virus enters the body through the broken skin, and spreads in the mucous membranes and eyes, nose and the rest,” said Tamfum.

Complications of monkeypox include bacterial conjunctivitis and even blindness.

Scientists also raised whether rodents could be infected by “spillover” from human waste.

The meeting resolved that a “comprehensive One Health approach” was needed to understand animal-to-human transmission and animal reservoirs.

A ‘One Health’ approach is neeed for monkeypox

Mutations and drivers

Genomic sequencing of the current strain of monkeypox spreading internationally shows that it has 47 mutations when compared to a 2018 sample. 

This is surprisingly high, and one hypothesis is that the monkeypox virus has been mutating in an unknown animal – or perhaps more than one animal behind the two different clades – the Central African clade with a mortality rate of around 10% and the West African clade with a 2-3% fatality rate.

Aside from the international spread of monkeypox, there has also been a dramatic increase in cases in endemic countries especially DRC and Nigeria.

Nigeria’s Professor Dimie Ogoina told the meeting that his country was also seeing an increase in cases in areas where it had not previously been seen.

Scientists thus want to unpack what is driving the transmission, as monkeypox is not known to be particularly infectious. In the past, infected people only passed the virus on to about 8-15% of the people living in the same house.

The European outbreaks appear to stem from sexual contact at two events – in Berlin and on the Canary Islands, according to news reports. 

This is not typically how it has been transmitted, and the meeting raised a number of questions about sexual transmission – particularly whether it can be transmitted via semen and vaginal fluid, not just through contact with the infected lesions. 

“Monkeypox manifests in rashes. Would a person still engage in sex with these rashes? We need to look at asymptomatic transmission,” said Ogoina.

Tricky diagnosis

In Nigeria, men are significantly more likely to get monkeypox than women, raising questions about what makes them more vulnerable.

Ogoina, from Niger Delta University, also revealed that people coinfected with HIV and monkeypox had “bigger lesions” and were more likely to have genital lesions – although only five such patients were examined.

“It is very important just to recognise that the vast majority of recent cases, especially in DRC, are suspected cases or their probable cases or possible cases, they’re not confirmed,” stressed Fine.

Some of the symptoms of monkeypox are similar to those of syphilis and chicken pox, and the meeting identified the need for better diagnostics.

“WHO, through our regional offices, is working with African countries, regional institutions, technical and financial partners, to increase the ability to support disease surveillance laboratory diagnostics, readiness and response actions related to monkeypox,” said WHO epidemiologist Maria van Kerkhove. 

“We have to acknowledge the fact that this virus has been circulating for decades, and we now have attention to this. This unfortunately is a sad reality of the world that we live in. But we need to use this as an opportunity to advance our understanding of this virus to help everyone everywhere dealing with monkeypox,” said Van Kerkhove. 

Implementing COVID lessons

Professor Helen Rees

Professor Helen Rees, who moderated the two-day meeting, said that COVID-19 had shown the need for rapid global responses to emerging health threats.

Rees called for “partnerships, collaboration, strategies that get us into the field quickly, antivirals and vaccines”. 

“We’re also seeing this interface with One Health, with environmental degradation and climate change. All of these things are coming to the fore. Just to underline this is not a pandemic, this is an outbreak that we are scratching our heads about. But the fact that we should respond now and rapidly is really excellent,” added Rees, a renowned scientist from South Africa’s University of Witwatersrand.

WHO scientist Ana Maria Restrepo concluded the meeting by stressing that it was important to practice what had been preached during COVID-19.

“We talked very much about the new health architecture for response to pandemics, and the lessons learned,” said Restrepo. “We are convinced that showing a good response for this multi-country outbreak is our best example of how we are going to be prepared for the next pandemic. 

“If we do when we all preach, we work together if we collaborate, we use master protocols, if we engage the countries; the communities – if we learn those lessons, and if we put equity at the centre of the discussions, then yes we have learned our lessons and we are moving forward towards being better prepared,” said Restrepo.

Ana Maria Restrepo

Expedited studies

The meeting concluded with experts calling for expedited studies to better understand the disease epidemiology, clinical consequences, and modes of transmission. 

While the smallpox vaccine offers over 80% against monkeypox, it is unclear whether this protection endures – and smallpox vaccination was discontinued in the 1970s. The experts emphasized the need for clinical studies of vaccines and therapeutics to better document their efficacy and understand how to use them in this and future outbreaks. 

The meeting also called for immediate implementation of public health activities including communicating prevention information, enhanced disease surveillance, contact tracing, isolation of cases and optimized care of people with the virus.

In a world where health workers are scarce, self-care practices can drastically improve people’s quality of life and alleviate strain on health systems, but depend on a range of factors including patient literacy, fair prices and government stewardship.

This is according to a one-of-a-kind global study demonstrating the value of self-care that was launched on the sidelines of recent World Health Assembly in Geneva. 

The World Health Organization (WHO) defines self-care as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.”

Current self-care activities around the world are generating annual savings of approximately $119 billion, along with saving 11 billion patient hours worldwide, according to the study. The study was produced by the Swiss-based Global Self-Care Federation (GSCF), which represents manufacturers and distributors of non-prescription medicines on all continents.

Self-care cost-saving (source: Global Self-Care Federation report).

Low-income countries lagging

But the low-income countries are still lagging in implementing and reaping the benefits of self-care. 

“In low-income countries, about 65% of households that could not obtain essential health services had financial constraints,” said Dr Ritu Sadana, WHO Head of Ageing and Health Division of Universal Health Coverge (UHC), one of the panelists at the launch of the report. 

“This is more than triple the proportion of households who lack access to health services because they are just unavailable, which is 20%.” 

High-income countries are reaping the most benefits of self-care practices while the low-and middle-income countries are playing catch-up.

With increased adoption of self-care, we will be seeing an additional $19.5 billion in annual cost savings related to the increased adoption of self-care by 2030, said Ben Carrick, Johnson and Johnson’s senior director of consumer policy.

“If we think about the welfare benefits, it could be leading to an annual increase of $312 billion per year globally. These are significant benefits that are worth chasing and grasping,” Carrick told the launch. 

The study grouped 155 countries based on their GDP levels, and then gauged the self-care effects. In the high-income countries (Group A), self-care is already making an indispensable contribution to relieving the burden on healthcare systems. 

But it is in the low-and middle-income countries (Group B and C), where self-care can enable a person to work and not depend on welfare.

“We don’t need more GDP; we need more welfare and this is also what this project is about, this is what self-care is about… to generate more welfare and not just be focused on figures and economic factors,” said Professor Uwe May, Dean of Studies at Fresenius University. He added that currently if people practised self-care instead of doing nothing about their health issues, 41 billion productive days can be gained on a global level. 

Self-care ‘only option’ in poor countries 

The study also found that health economic and pharmacoeconomic approaches deployed to assess the value of self-care cannot be transferred to lower-income regions where the infrastructure, socio-economic factors, and awareness is different. 

In addition, lack of access to over-the-counter (OTC) medicine and the prevalence of traditional medicines also has an impact on self-care options.  

In regions like sub-Saharan Africa and South East Asia, self-care is not an alternative care option, but is often “the only possible access to treatment for most individuals”, according to the report.

In these countries, self-care does not translate into saving on doctors’ and specialists’ time.

“This is where the welfare benefits are really the main opportunity because it isn’t saving physicians’ time and people don’t have access to the physicians,” said Carrick. 

“But if it means that they’re productive, they’re back at work and they’re able to look after families, then it’s those welfare and productivity benefits that really come into play.”. 

In Latin America and the Caribbean, the practice of self-care and the use of OTC products leads to current welfare savings of $123 per capita per year. 

The more the OTC use increases, the greater the individual and societal benefits can be realised through self-care, according to the study 

“We estimated that at least 142 million older persons, about 14% of older persons worldwide, are unable to meet some of their basic needs. So the issues around self-care for themselves or by their families or care providers is extremely important,” said Carrick.

What do we need now?

The report highlights the need for private-public partnerships, digital and healthcare literacy in people living in low-and middle-income countries (LMICs) and better parameters to gauge healthcare outcomes in a country.

“We need strong stewardship by government, and to have really strong capacities in government institutions…so that they can lead and shape how we actually get things done with the private sector, with multiple sectors across the government and also obviously, civil society and self-care demands with the active participation of people,” said Sadana. 

“Health literacy is a fundamental catalyst for change to ensure individuals comprehend and act on credible health information, becoming active self-managers of their own health,” said Carrick.

Experts at the launch also highlighted the need for pharmacies to be more involved in developing better policies, and for governments to spend more on ensuring that self-care is delivered through, not only OTC and literacy, but also nutrition, lifestyle, and affordable healthcare. 

Sadana said that in India, 70% of all healthcare costs are paid out of pocket, and 70% of that was on drugs. 

“If we’re going to have a system which encourages self-care, using products that are evidence-based and quality-controlled, we still need to have a way to ensure that those are covered [by the health system] if we actually want a vast swathe of the population to use them.” 

Image Credits: Tbel Abuseridze/ Unsplash.

Pfizer’s Paxlovid, an oral antiviral approved by the US FDA in December, has shown 90% efficacy in preventing mortality among those who take it in the first few days of infection.

Scientists and doctors are beginning to eye Paxlovid, the antiviral medicine developed by Pfizer to protect vulnerable people from severe disease, as a potential treatment for lingering COVID-19 symptoms after single patients report that the medicine has helped to reduce their symptoms.

Long COVID affects as many as one in five people infected by the virus, according to a recent report by the US Centers for Disease Control and Prevention.

The US Food and Drug Administration granted the drug emergency use authorization in December last year to prevent severe disease in high-risk patients.

“We need to be studying antiviral therapy [for the treatment of long COVID] as soon as possible,” said HIV expert Dr Steven Deeks, a professor of medicine at the University of California, San Francisco (UCSF). He told Health Policy Watch that single-patient case studies have helped drive HIV cure research and Deeks believes that the same could prove true for long COVID.

In May, researchers from Deeks’ university published a report on the Research Square preprint platform of three vaccinated individuals in their 40s who developed long COVID. Two of them were treated with Paxlovid and reported that their symptoms substantially improved.

“While single anecdotes must be interpreted with caution, these cases emphasize the urgent need for carefully designed studies to assess the impact of antiviral therapy beyond the acute window,” the researchers wrote in their report.

Anti-viral therapy

They added that the stories further suggest that antiviral therapy could “potentially impact the complex interplay between viral replication and the host immune response that likely underlies this syndrome but raise concern that brief early antiviral therapy alone may be insufficient to prevent the development of long COVID.”

A similar report was published in April on Research Square of a patient who was infected with the virus in the summer of 2021 and suffered from severe fatigue, brain fog and body aches, among other symptoms, for months afterwards. The symptoms were so severe that she could no longer work.

Six months later, she was reinfected with COVID-19. This time, her doctor prescribed a five-day course of Paxlovid. By day three she noted rapid improvement, not only in her acute symptoms resulting from reinfection, but in her long COVID symptoms.

“Her acute flu-like symptoms had already begun to self-improve by day three, but she noticed rapid improvement of her pre-existing PASC [Post-Acute Sequelae of SARS-CoV-2] symptoms after taking the antivirals,” according to the report.

“At seven months post-initial infection, her PASC symptoms had resolved, and she reported being back to her normal, pre-COVID health status and function including working fulltime and exercising rigorously.”

These cases are not proof that Paxlovid caused the relief these patients experienced as there were other factors, but Deeks said they should be enough to encourage research into the matter.

“These patient stories of people having lingering symptoms who go on Paxlovid for whatever reason and feel better, that strikes me as clearly not definitive, but clearly makes these things necessary to study right away,” Deeks said.

However, there are only a couple of handfuls of clinical trials studying any treatments for long COVID, he said, and certainly no “rigorous assessment for Paxlovid or any other antiviral drug for long COVID.”

To Deeks’ argument, in the HIV space, there has been much attention on individual cures and they “inspired the field,” he said, “they showed it could work.”

Deeks spoke to Health Policy Watch ahead of a visit to Israel for the Medicine 2042 conference in Tel Aviv, where he is expected to be speaking about “Curing HIV. What’s next?”

Long COVID is a ‘vague syndrome’

One of the challenges with researching the treatment of long COVID is that scientists are still unsure about what causes it. One theory is that long COVID may be the result of the virus persisting in part of the body at low levels that can cause local inflammation or clotting and contribute to excess morbidity.

“The dogma is that SARS causes short-term infections and goes away very quickly,” Deeks said. “But data is emerging that, if you look in the right place, you can find evidence that the virus is there.”

A recent study by the CDC showed that one in five people over the age of 18 (and one in four people over the age of 65) who recovered from COVID-19 experienced at least one symptom or condition that could be attributable to the virus. The study analyzed electronic health records of more than 60 million Americans between March 2020 and November 2021.

The Centers for Disease Control and Prevention reported in May that as many as one in five adults have a health condition that could be related to COVID-19 infection.

The long COVID symptoms were diverse and affected multiple symptoms including the cardiovascular, pulmonary, hematologic, renal, endocrine, gastrointestinal, musculoskeletal and neurologic systems, and also included psychiatric signs and symptoms.

Specifically, among those over 18, 38% of people experienced a condition compared with 16% of controls. People who recovered from COVID-19 were twice as likely to develop respiratory issues or pulmonary embolism than their virus-free counterparts.

Deeks said that such studies need to be taken for what they are: retrospective analyses based not on scientific or consistent medical testing but on how people feel.

“Long COVID is, right now, an extremely vague syndrome and that also makes it really hard for companies to invest in and regulatory bodies like the FDA to approve drugs to treat it,” he said.

Deeks said people who get COVID sometimes report incidents that are unrelated to the virus but blame the virus anyway. For example, he said that he lost his hair very quickly when he was in his 20s. If Deeks had COVID then, he said that he is sure he would have blamed the virus.

“It is hard to go back into these records and identify those individuals who have classic long COVID that we know is real. But the bad version of long COVID is not subtle. When you sit down in front of a person who six months ago was running marathons and now can barely leave the house that is long COVID,” Deeks said. “But that is not happening in 20% of the people who got COVID. My sense is that it is less than 5% with Delta. One of the most important questions on the table now is how common long COVID with Omicron is.”

Another challenge to understanding long COVID, he added, is that the world does not have enough information emanating about it from the Global South. Most of the data is coming out of the United Kingdom, United States and Israel – countries with complex electronic health records that are easy to manage and that have more resources.

Paxlovid reduced death by 81% in vaccinated patients over 65

Last week, a new observational, retrospective cohort study on Paxlovid was published on Research Square by a team of Israeli researchers that found that the antiviral drug works for people infected with the Omicron variant and individuals who have been vaccinated.

“Our study demonstrated that [Paxlovid] therapy was associated with a 67% reduction in COVID-19 hospitalizations and an 81% reduction in COVID-19 mortality in patients 65 years and above, during the Omicron surge,” explained Dr Ronen Arbel, a researcher at Clalit Health Services and Sapir College. Arbel led the study that ran from January to March, when the Omicron variant was the dominant strain in Israel.

The researchers examined the effectiveness of Paxlovid in preventing hospitalization and death from COVID-19 in patients over the age of 40 who had been identified as at high risk for COVID-19 complications. In Israel, the treatment was provided within days of diagnosis and administered for five days, per the Pfizer protocol.

There were more than 100,000 participants who were eligible for Paxlovid therapy in the study. Of the 42,819 eligible patients aged 65 years and above, 2,504 were treated with Paxlovid. Fourteen of the treated patients versus 762 of the untreated patients were hospitalized and two treated patients died while 151 of the untreated patients died.

“It was very important to us to understand if the drug also works for patients who were vaccinated or recovered,” Arbel told Health Policy Watch. “What we saw was very interesting. For people without prior immunity, we saw very similar results to the Pfizer trial – 86% reduction [in hospitalisation] while they had 89%. But the majority of real-world patients in most countries have some kind of immunity from recovery or vaccination. In these cases, we saw a 60% reduction in the older population.”

Paxlovid contraindications

Moreover, Paxlovid does have serious limitations. For starters, the drug can have contraindications with existing drugs, Arbel explained.

“We had to have a physician involved to see what drugs each patient was already getting and if they could get Paxlovid,” he explained. “Sometimes there was a recommendation to stop a few drugs for the course of the Paxlovid treatment, but some drugs you cannot stop, and this was a challenge.”

In addition, Paxlovid has uncomfortable side effects, including taste disturbance, diarrhea and vomiting. There is no long-term safety data on the drug nor any sign of what the results might be if taken for more than five days.

The FDA in May rebuked statements made by Pfizer CEO Albert Bourla in an interview with Bloomberg in which he proposed that if some patients experienced a relapse of COVID-19 symptoms after the first round of Paxlovid they could take another round.

“There is no evidence of benefit at this time for a longer course of treatment or repeating a treatment course of Paxlovid in patients with recurrent COVID-19 symptoms following completion of a treatment course,” Dr John Farley, director of the Office of Infectious Diseases, wrote.

Finally, Deeks said one of the drawbacks of Paxlovid is that while it prevents the virus from spreading it does not kill infected cells, which may be necessary in the case of people suffering from long COVID.

Vaccines offer partial protection against long COVID

Many people have asked if vaccination could prevent long COVID and most recent research is showing that vaccination only offers partial protection against persistent symptoms, so relying solely on vaccination to prevent long COVID is not likely to be enough.

A study published last month in Nature Medicine by researchers from Washington University in St Louis looked at 33,940 individuals who had been vaccinated and developed a breakthrough infection and 4,983,491 controls who had no record of a positive COVID-19 test between January 1 and October 31, 2021. The team found that being vaccinated reduced the risk of experiencing long COVID symptoms six months after diagnosis by only 15%.

A new study by Washington University researchers showed that vaccination reduces the risk of long COVID by around 15%.
A new study by Washington University researchers showed that vaccination reduces the risk of long COVID by around 15%.

However, when it came to some of the most severe long COVID symptoms – lung and blood-clotting disorders – the risks were reduced by 49% and 56%, according to the study.

“You cannot rely totally on vaccines to protect you,” Deeks stressed. “As society opens up, how you manage your COVID risk behavior will depend on how much of a concern long COVID is.”

But knowing whether or not Paxlovid may be an answer is likely a long time off.

“We don’t have so many patients that received the drug,” Arbel said. “The drug was given only to a minority of patients, so its effects on long COVID would be very interesting to look at, but it will take some time to have meaningful evidence.”

Image Credits: Pfizer , Centers for Disease Control and Prevention, Bobbi-Jean MacKinnon, "Long COVID after breakthrough SARS-CoV-2 infection" in Nature Medicine.

Climate change poses serious risks to mental health and well-being, concluded a new World Health Organization policy brief, launched on Friday at the Stockholm+50 conference. 

Natural disasters such as floods, heatwaves, storms, and drought can pose a threat to mental health and psychosocial well-being, exacerbating emotional distress, anxiety, depression, grief, and suicidal behavior. 

WHO is therefore urging countries to include mental health and psychosocial support in their response to climate change. 

“The impacts of climate change are increasingly part of our daily lives, and there is very little dedicated mental health support available for people and communities dealing with climate-related hazards and long-term risk,” said Dr Maria Neira, WHO’s Director of Environment, Climate Change, and Health.  

The findings concur with a report made by the Intergovernmental Panel on Climate Change (IPCC) published in February of this year, which revealed that half of the world’s populations live in climate ‘danger zones’ that place “people’s health, lives, and livelihoods” at risk, and this can also include people’s mental health. 

The two-day conference, hosted by the government of Sweden and convened by the United Nations General Assembly on 2 – 3 June, drew together thousands of participants across government, civil society, and the private sector in an effort to spur urgent action for a healthy planet. 

The meeting also commemorates 50 years since the 1972 UN Conference on the Human Environment, which made the environment a pressing issue for the first time. 

Climate change impact on mental health 

The mental health impacts of climate change are felt disproportionately around the world, with support services unequally distributed as well. While there are nearly 1 billion people living with mental health conditions, 3 out of 4 do not have access to needed services in low- and middle-income countries. 

A 2021 WHO survey found that out of 95 countries, only 9 have thus far included mental health and psychosocial support in their national health and climate change plans. Additionally, while the annual cost of common mental disorders is $1 trillion, only 2% of government health budgets are spent on mental health. 

These figures are all exacerbated by climate change. 

“The impact of climate change is compounding the already extremely challenging situation for mental health and health services globally,” said Devora Kestel, WHO Director of the Department of Mental Health and Substance Abuse.

Examples of how climate change can impact mental health include the loss of personally important places, loss of autonomy and control, and exposure to pollution, which is associated with increased risk for mental health conditions. 

The new policy brief recommends five important approaches for governments to address the mental health impacts of climate change:

  • Integrate climate considerations with mental health programs
  • Integrate mental health support with climate action
  • Build upon global commitments
  • Development of community-based approaches to reduce vulnerabilities to climate change, and
  • Close the funding gap for mental health and psychosocial support 

“By ramping up mental health and psychosocial support within disaster risk reduction and climate action, countries can do more to help protect those most at risk,” said Kestel.  

 

Image Credits: Clay Kaufmann/ Unsplash.

Health Ministers and Vice-Ministers (seated from left to right) Mexico, Seychelles, Philippines and Chile, expound on policy successes for obesity control

Countries have failed miserably to halt rising obesity, despite goals set by the World Health Organization (WHO) in 2018. Instead, obesity continues to rise apace. 

Now, however, a new WHO strategy for accelerating action against obesity, endorsed last week by the World Health Assembly, calls for much tougher policies on food packaging, pricing and marketing which have the potential to turn the tide. 

At a high-level side event on the margins of last week’s World Health Assembly (WHA), WHO officials outlined the plans and countries that have tested such policies told their stories, and how these experiences could point the way to success in the coming decade. 

Speakers included health ministers and deputy ministers from five countries, including Mexico, Brazil, Chile, Seychelles, and the Philippines, who elaborated on the policies that have been implemented in their countries as well as the challenges that they still face. 

One billion people living with obesity

Some one billion people around the world live with obesity and almost five million deaths are associated with obesity every year, said Naoko Yamamoto, WHO’s Assistant Director of Healthy Populations. 

She was speaking at the Global Health Center event, co-sponsored by the governments of Mexico and Croatia. Croatia’s First Lady, Sanja Musić Milanović, has become an ardent champion of the issue in the European region. 

“No country is immune to its impact,” Yamamoto said.  “But we know what we can do to stop this pandemic.”

Naoko Yamamoto, WHO Assistant Director-General of Healthier Populations

Whole-of-government approach needed 

Addressing obesity requires a “whole-of-government approach” said Francesco Branca, who leads WHO’s work on nutrition and obesity.  

That approach is implicit in the new “acceleration plan” endorsed in the final days of the 75th World Health Assembly. That plan aims to halt the worldwide rise in obesity by 2030 as part of reaching the Sustainable Development Target 3.4 which calls for slashing the non-communicable disease rates by one-third by that time. 

“Unless we talk about obesity, we will not reach SDG 3.4,” said Branca at the GHC event. But beyond that, “The cost of obesity is unbearable.  We’re talking about $1 trillion every year, which is 13% of the global health expenditure, and 1-2.5% of GDP in different countries of the world.”

The new WHA-endorsed “acceleration” plan targets key factors that drive obesity, including diets high in fats, sugars and processed foods; lack of physical activity; and cities that make it impossible to walk and cycle to work or even exercise.  

The aim is to encourage governments to move from the realm of traditional health measures that only target personal behaviour and have largely failed, to proven policies that tackle the obesogenic environment in which many people live today, Branca said. 

Higher taxes on unhealthy foods; consumer and school-based policies, as well as urban planning to enable active lifestyles are among the policies endorsed in the plan, specifically:   

  • Regulations on the harmful marketing of food and beverages to protect children; 
  • Fiscal and pricing policies to promote healthy diets and nutrition labelling policies; 
  • School-based nutrition (including initiatives to regulate the sales of products high in fats, sugars and salt in proximity of schools);
  • Breastfeeding promotion, protection and support; 
  • Standards and regulations on active travel and physical activity in schools. 

The plan also calls for stronger integration of obesity prevention and treatment into primary health care services, particularly in low- and middle-income countries where many health clinics lack even the most basic diagnostic tools for checking blood sugar levels, weight or blood pressure. 

Finally, the plan calls on member states to draw up country-based road maps, bringing together stakeholders and advancing advocacy and communications. 

Dr Tedros urges the implementation of NCD policies after the adoption of a slew of measures to address NCDs at the WHA.

‘Complete failure’ to achieve zero obesity increase goal 

The goal of a zero increase in obesity was originally set in 2018 for attainment by  2025.  But countries have failed miserably to halt current trends, leading to the adoption of a new timeline and strategy for reaching that goal, Branca said. 

“The prevalence of obesity is increasing in almost all age groups,” he declared, pointing to WHO projections showing that by 2025, obesity prevalence will have in fact increased by 1.7% among children ages 5-18 and 2.3% among adults.  

“That translates into about 167 million more people affected by obesity, but it also translates into a ‘complete failure’ to achieve those [2025]  targets,” Branca said.  “Maybe there will be some progress for children under five, but overall no progress.

As a result, member states “requested WHO to do something about it, to indicate what actions can be taken to turn the tide of obesity. And so we’ve been building on two decades of work, and recommending that we need to adopt a whole-of-government, whole-of-society approach – and work across the life course”, he added. 

“Governments need to take the lead in a series of policies in multiple sectors, and civil society needs to call for that action and to hold accountable all of the actors, he said.  

To measure countries’ responses, the WHO will be monitoring and measuring “some very concrete policy targets such as increasing the number of countries who are establishing regulation on marketing, food and beverages for children”. 

Some of the measures that the WHO will be looking for are country campaigns on physical activity, and regulations on the marketing of sugary and ultra-processed foods and beverages to advance the guideline that sugar represents only 10% of food energy intake daily, added Branca.

Francesco Branca, WHO Director of Nutrition and Food Safety.

Countries tell their stories  – from bike lanes to trade policies

Perhaps the most powerful testimony, however, was that of the health ministers and deputy ministers themselves. In a panel discussion they outlined what had worked well – and measures they still need to advance more. 

The successes include measures taken in the Philippines to promote healthy foods in schools as well as more active transport, including more development of urban bike lanes, said Maria Rosario Vergeire, Undersecretary of Health. She recounts that some 23 million adults and 3.6 million children are obese in the island country of 115.5 million people. 

The government also has adopted front-of-package labeling to warn consumers of high salt and sugar labels. It is also phasing out the sale of industrially-produced transfats. WHO recommended transfats be outlawed in foods by 2023 due to mounting evidence of cardiovascular cancer risks. 

Peggy Vidot, the Seychelles Minister of Health, described how her country is using trade policies to shape healthier diets by increasing tax and customs incentives for importers of fresh foods and vegetables and fruit drinks without added sugar. 

It also banned sugary drinks in schools and is rolling out higher taxes on certain foods with a sugar content above certain levels.  

In parallel, the government subsidizes local farmers, as well as the fishing sector, “so that healthy food can be made available at a more affordable price”.

Chile cuts sugar consumption by 10% in just three years

Front-of-pack warning labels in Chile

In Chile, which was a pioneer on front of package labeling, 80% of processed food products sold in markets now contain food warning labels, indicating the fat and sugar content, said Chile’s Minister of Health, Maria Begona Yarza Saez.

“One of the concrete results of that is that 70% of adolescents take into account these labels at the moment that they have to make a choice about food,” she said, “and 98% of the general population understands the labelling that has been put into place.”

The exposure of small children to the marketing of unhealthy products has been reduced by 40%, she added.

These are some of the findings of research that was conducted in 2021, after just three years of having the policy in place. In addition, sugar consumption decreased by 10% and there was a  4.8% decline in global caloric intake. 

“These are only interim indicators. Long term studies are needed for better results,” she added, saying that “this is clearly not enough”. 

Chile aims to introduce “more structural policies” in the coming year, including taxes on unhealthy foods, with the tax revenues channeled back into supporting health services that support obesity and NCD prevention and control.  

Mexico – change requires political will 

In Mexico, the first soda tax was implemented in 2014, and within the first two years consumption of sugary drinks declined by an average of 7%, and more recently by as much as 12%, said Hugo Lopez-Gatell, Mexico’s Vice Minister of Health.

“Now, we implemented a year and a half ago, front-of-package label warnings. It’s not confusing labeling, it’s warning. And credit to Chile because we got inspired by Chile’s experience,” said Lopez-Gatell.

The Mexican government is working on other regulatory measures, including bylaws to promote people’s capacity to make informed decisions, as well as limits on what people actually can be offered in the market.  A national law banning unhealthy foods to be sold in schools is also in the process of being drafted and approved. 

 “We also had a soda industry and food industry sponsoring the rebuilding of schools,” he recalled. “No more of that, we are investing directly. In addition, the government is trying to promote better access to safe, clean water in schools, as 30% of which lack that basic sustenance that can be a free, healthy substitute to packaged sodas.”  

In addition, a 2019 law recognized “mobility” as a human right in the Mexican constitution which means that  “now, as a Federal republic, we can supersede any limitation at the state at the municipal level … so that physical activity must be assured.”

“We believe change is possible, but it requires political will. And the political will must be steady, sturdy and continue no matter what, thinking about health, children, our youths and our future,” added Lopez-Gatell.

“We base our policies on the convictions that obesity and the full complex of NCDs are rooted in structural factors,” he added. 

He recalls that Mexico’s obesity epidemic actually began in the 1980s when structural reforms were imposed by the International Monetary Fund (IMF) and other economic institutions in the Americas and around the world.  

But “when economic liberalization started, we were swamped” by multinational food companies eager to sell cheap processed food products in Mexico’s large, emerging economic market, just south of the US border.  

“So we were just flooded by trademarks,” he said, “and therefore policy and politics for many years in Mexico, until this current administration, were dependent on complicity with the CEOs and presidents of these companies.”

He asserted that Mexico’s current president Andrés Manuel López Obrador has sought to change that balance of economic and political power” although it has not always been easy.  

“He has said it is crucial to separate economic power from political power because the political power that is elected by people should be devoted to protecting and promoting the public good.  Laws need to be made in the interest of the people, and not interest groups.”

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Image Credits: Health Ministry of Chile.

Dental services, including regular check-ups, were among the most disrupted essential health services during the COVID-19 lockdowns. People´s reticence to visit a dentist during normal times was exacerbated by fear of venturing into an open clinic or simply not being able to, due to restrictions. 

Dental hesitancy has always been around but over two years into the pandemic, it´s now a lot worse. This hesitancy is also echoed at the policy level. Oral health has, until very recently, been considered the “ugly duckling” of global health efforts. 

The World Health Organization (WHO) has only ever passed a special resolution on oral health twice in its history: most recently, ironically, in the midst of the COVID-19 pandemic in 2021.

The new global oral health strategy, approved by governments at 75th WHO World Health Assembly last week is a step in the right direction, and it is long overdue.

Oral health is essential for overall health

It´s a perfect time to double down on just why responding to the global oral health epidemic is in our broader (health) interests. Getting people back into dental clinics and protecting their oral health is essential to safeguarding their overall health, well-being, and quality of life.

All those factors that can make people vulnerable to chronic non-communicable diseases (NCDs) such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes are equally risky for one´s oral health. 

High sugar consumption, harmful alcohol use and tobacco are just as bad for our bodies as they are for our mouths. The impact in pure numbers is alarming: there were some 3.5 billion cases of oral diseases and other oral conditions in 2017. 

For the last three decades, the combined global prevalence of dental caries (tooth decay), periodontal (gum) disease and tooth loss has stood at 45% – higher than any other NCD.

Ignoring the problem makes no sense, financial or otherwise. Worldwide, oral diseases accounted in 2015 for $ 357 billion in direct costs and US$ 188 billion in indirect costs. In the same year, $96.2 billion was spent on the treatment of oral diseases across the European Union, the third-highest total among NCDs, behind diabetes and cardiovascular diseases.

“Without good oral health, you’re not healthy,” former US Surgeon-General David Satcher once said, and he was right. The largely siloed approach to dealing with oral health makes no policy sense either, especially when we consider the evidence.

Junk food and tooth decay

We know that bacteria and inflammation associated with periodontal disease are linked to cardiovascular disease, rheumatoid arthritis, and adverse effects in pregnancy.

We also know that people living with diabetes experience improved blood glucose levels if their periodontal (gum) disease is managed correctly.

Knowing what we know about poor oral health – that it is preventable and if addressed can help improve our overall health – only begs the question as to why more is not being done to integrate it into other NCD programmes?

The pending ban on television and online advertising of junk food in the UK before 9pm is a great example of encouraging better diet. So too is the campaign by UK footballer Marcus Rashford to promote healthier school lunches. 

But they are missed opportunities. With forethought, both interventions could have included some key messages for children and parents around the connection between a healthy diet and good oral health. Future campaigns could better highlight the need to prioritize oral health promotion in schools, communities and workplaces as well as ensure access to the millions of people who cannot afford the basics, such as fluoridated toothpaste.

We need to globally re-think how we talk about and tackle oral diseases. In the vast majority of countries, even essential oral health services are not part of universal health coverage. 

Oral diseases are noncommunicable diseases and need to be treated as such. Advocates have long argued that investment in prevention produces strong economic returns and saves millions of lives. 

COVID-19 has reinforced the huge economic and human cost of not doing so: people living with chronic diseases like diabetes, cancer and cardiovascular were at much higher risk of becoming seriously ill, hospitalized, or dying from SARS‑CoV‑2.

At the same time, the pandemic is just a microcosm of the bigger picture: our past failure to address oral disease in a substantive way and to view it as an NCD like any other. 

Prof Ihsane Ben Yahya

Prof Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco.

Dr Greg Chadwick

Dr Greg Chadwick is the President-elect of FDI World Dental Federation and Dean at East Carolina University, School of Dental Medicine, United States.

Image Credits: Caroline LM/ Unsplash, FDI World Dental Federation.

shanghai
Shanghai eased its lockdown restrictions 1 June 2022, following continuous low cases reported.

Sixty five days after one of the toughest lockdowns in the world, China has eased COVID-19 restrictions on its financial hub, Shanghai, on Wednesday – finally allowing the majority of its 25 million residents to move freely again.

However, at least 890,000 residents are confined at home, in “quarantine” or “control zones”. 

The announcement to lift restrictions came as official figures showed on Sunday that daily new coronavirus cases fell from 170 to 122 in a 24-hour period. The city reported just 13 cases for Wednesday, and an additional 7 cases on Thursday.

This is a marked turnaround from the beginning of April, when tens of thousands of cases were reported daily. 

“This is a day that we dreamed of for a very long time,” Shanghai government spokeswoman Yin Xin told the BBC. 

China to maintain ‘zero tolerance’ policy 

Shanghai residents will be required to hold a negative nucleic acid test result taken within 72 hours of entering public spaces or using public transportation from June

But while China seems to have moved into the clear with COVID, the country is keen to maintain its “zero tolerance” policy, and is already preparing for future waves. 

Beijing municipal officials said Thursday that 12 of its planned 14 ‘transition hubs’ will be used to test and disinfect all imported frozen food before goods are distributed across the city. 

This follows China’s contention that frozen food could transmit COVID-19 in while the World Health Organization’s independent panel on the virus’s origins favour an unknown animal vector as the most likely cause, while others have pointed to laboratory accident for the spread of the coronavirus first found in bats in China.

Tens of thousands of testing booths will also be set up across China’s largest cities, including Beijing, Shanghai, and technological hub Shenzhen, to require testing as often as every 48 hours.  

New rules in Shanghai will now require residents to show a green health code on their smartphone, with proof of a negative PCR test in the last 72 hours, to leave their residential compounds and enter most places, including banks, malls, and public transportation.  

However, cinemas, museums, and gyms remain closed, as well as in-person schooling. 

Restrictions on leaving the city still remain, with anyone traveling to another city facing a quarantine of seven to 14 days upon return. 

Beijing also lifted its restrictions earlier this week, following similar protocol with some of its public transportation system, malls, and other venues opening up. 

Shanghai testing centers tested by overcapacity and staff shortages

Shanghai testing center

Shanghai’s 72-hour rule has tested the capacity of its testing centers, as crowds flocked to the 15,000 stations. While some said their test took only a matter of minutes, others complained that they had to wait over an hour to test. 

Many testing booths are only open for about three hours each in the morning and afternoon, although some hospitals offer a 24-hour service. 

Shanghai resident Zhang Zehong told Sixth Tone that she was unable to test Wednesday as the station in her neighborhood closed two hours earlier than shown on the city’s health code app, which features all the testing centers. Instead, she went to a hospital with a 24-hour service Thursday morning, only to find no staff and a line that stretched on for over 100 meters. 

So many issues need to be fixed,” Zhang said.

Chinese microblogging platform Weibo also featured complaints with the stations.

“It’s been very hot recently, several people passed out when standing (in line),” one Weibo user wrote.

“I visited five sites but each had long queues. This is not really humane enough. Don’t these mobile kiosks cause more people to gather?” another Weibo user wrote.

Fifty-point plan to revive Shanghai economy 

A fifty-point plan has also been drawn up to support Shanghai’s economy, crippled in the wake of closures, quarantines, and lockdowns. 

New measures include reducing taxes for car buyers, speeding up the issuance of local government bonds, and fast-tracked approval of building projects. Drivers who also switch to an electric vehicle will also be able to claim a $1500 subsidy.

Businesses may also be able to delay insurance and rent payments, with subsidies available for utility charges.

Image Credits: Appriseug/Twitter , DA Trade Market Securities/Twitter , Don Weinland/Twitter.