WHO Director-General Dr Tedros Adhanom Ghebreyesus addresses the launch of the WHO Pandemic Intelligence Hub.

The only thing that moves faster than viruses is data, experts noted at Wednesday’s launch of the World Health Organization (WHO) Hub for Pandemic and Epidemic Intelligence in Berlin.

The aim of the hub is to work with partners to “create the tools and data needed to enable countries to prepare, detect and respond to pandemic and epidemic risks”, according to the WHO.

It named Dr Chikwe Ihekweazu, Director-General of Nigeria’s Centre for Disease Control, as new head of the hub, and WHO Assistant Director-General for health emergency intelligence in Geneva.

READ about Dr Chikwe Ihekweazu here

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the hub was about ”leveraging innovation in data science, harnessing the power of artificial intelligence, quantum computing and other cutting edge technologies and fostering greater sharing of data and information between communities and countries”. 

“No single institution, or nation can do this alone. That’s why we have coined the term collaborative intelligence to sum up our collective mission,” Dr Tedros told a media briefing after the launch.

“This hub will bring together scientists, innovators, policymakers, and civil society representatives from around the world to work across borders and disciplines, of course, the ultimate goal is not just to develop new toys, it’s to save lives.”

According to the WHO, the hub will work to:
* Enhance methods for access to multiple data sources vital to generating signals and insights on disease emergence, evolution and impact;
* Develop state of the art tools to process, analyse and model data for detection, assessment and response;
* Provide WHO, Member States, and partners with these tools to underpin better, faster decisions on how to address outbreak signals and events; and
* Connect and catalyze institutions and networks developing disease outbreak solutions for the present and future.

Dr Tedros, who cut a ribbon with German Chancellor Angela Merkel to inaugurate the hub, credited Merkel with the vision to set up the institution, and later in the event awarded her with the WHO Global Leadership Award in recognition of her “outstanding contribution to global health”.

WHO Director-General Dr Tedros Adhanom Ghebreyesus giving German Chancellor Angela Merkel the WHO Global Leadership Award

The catalyst for the hub, said Tedros, was Merkel’s question: “How can we react faster and avoid the needless suffering and death of the COVID-19 pandemic in future?”

The hub will be supported by the German government, already the biggest contributor to the ACT Accelerator, and international donors.

“To effectively prevent future pandemics, we need more transparency, more real-time data sharing and experiences at all levels from different sectors,” said German health minister Jens Spahn.

“Once again, I call on China to finally become fully cooperative and to make the examination of the origin of the SARS-CoV2 virus transparent to the international community. That’s important to learn for future pandemics,” added Spahn. 

Ready, fast and agile

Dr Michael J Ryan, Executive Director WHO Health Emergencies Programme, saidd that he had spent most of his professional life trying to protect people from epidemics and other health emergencies.

“In my experience, we need three really important, critical things to be effective in response. We must be ready, we must be fast and we must be agile,” said Ryan.

“We need to be able to predict, prepare and plan for what may happen. We must be able to detect, assess and react to what is happening around us the earliest possible signal of an event, and then we must be able to adapt quickly to the realities of an evolving event, which is never exactly what you plan for or expect,” he added.

Describing as prescient the remark that the only thing that could move faster than viruses was data, Ryan said a more effective response to pandemics could be honed through “better data analytics and insights to improve the speed and adaptability of our response”.

Ursula von der Leyen, President of the European Commission.

As the European Union (EU) announced on Tuesday that 70% of its adults had been fully vaccinated against COVID-19, it recommended reimposing restrictions on travellers from the US, Israel, Kosovo, Lebanon, Montenegro, and North Macedonia.

On 8 June, the six were included on an EU Council list of “safe countries” identified for the relaxing of non-essential travel restrictions. But rising COVID-19 cases in these countries – alongside the US failure to lift its travel restrictions on EU citizens – were behind their removal, which was announced in a press release on Monday.

The EU Council recommendation is not binding on member states, who can determine what restrictions to impose.

The EU also recommended the gradual lifting of restrictions on a number of new countries including Canada, Japan, South Korea and the Ukraine  – as well as China, “subject to confirmation of reciprocity”.

In early August, EU Commission president Ursula von den Leyen appealed to the US to lift its ban on travellers from Schengen states – virtually the entire EU – who have to quarantine in a third country for 14 days before being allowed into the US.

In the US, 63% of adults are fully vaccinated and COVID-19 cases continue to rise amid a politicised battle over vaccines and masks, with Republican Party supporters markedly less likely to be vaccinated than Democrats. 

Welcoming the fact that 70% of adults were vaccinated, Von den Leyen said that more needed to be done to assist other countries to vaccinate citizens.

“The EU is already doing a lot. We are exporting, donating vaccines to our partners and we are the lead contributor to COVAX but more needs to be done. We will only end this pandemic if we defeat it in every corner of the globe,” said Von der Leyen.

However, there are substantial differences between member states. Only 20% of Bulgarian and 32% of Romanian adults are fully vaccinated. In contrast, Malta has vaccinated 90% of its population and Portugal, 83,5%, according to the European Centre for Disease Prevention and Control (ECDPC).

Image Credits: Twitter – Ursula von der Leyen.

The World Health Organization (WHO) has not listed the SARS-CoV2 C.1.2 variant discovered in South Africa as either a variant of interest or of concern, and it does not appear to be increasing in circulation.

This follows an alert about the variant that was issued on Monday by the South African National Institute for Communicable Disease (NICD), and a recent pre-print article that reported “the identification of a potential variant of interest assigned to the PANGO lineage C.1.2”.

Maria Van Kerkhove, WHO’s lead on COVID-19, tweeted on Monday that the variant “did not seem to be increasing in circulation but we need more sequencing to be conducted and shared globally. Delta appears dominant from available sequences”.

According to the NICD, the variant has been “detected in all provinces in South Africa at relatively low frequency (up to ~2% of genomes)” between May, when it was first detected, and August. By far the majority of COVID-19 cases in the country are due to the Delta variant.

“While the C.1.2 lineage shares a few common mutations with the Beta and Delta variants, the new lineage has a number of additional mutations,” according to the NICD.

“While some of the mutations in the C.1.2 lineage have arisen in other SARS-CoV-2 variants of concern or variants of interest, we are being cautious about the implications, while we gather more data to understand virus of this lineage.”

The preprint article notes that C.1.2 has “concerning constellations of mutations”. These include “multiple substitutions (R190S, D215G, E484K, N501Y, H655Y and T859N) and deletions (Y144del, L242-A243del) within the spike protein, which have been observed in other VOCs and are associated with increased transmissibility and reduced neutralization sensitivity”.

However, the article notes: “Of greater concern is the accumulation of additional mutations (C136F, Y449H and N679K) which are also likely to impact neutralization sensitivity or furin cleavage and therefore replicative fitness.”

 

Professor Tulio de Oliveria of the KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), one of the authors, said that the scientists had decided to publish the pre-print as they observed “the C.1.2 persistence in South Africa and is now in another 10 countries”. 

Acknowledging that “it is early days as only 95 genomes have been published”,  we have found that “in this pandemic is share info quicker than later”, said De Oliveria.

De Oliveria said that C.1.2 has 14 mutations in the spike protein “including three mutations at the receptor-binding motif, the Y449H, E484K, and N501Y” and that two of the mutations have been found in variants of concern Alpha, Beta, and Gamma.

It has since been found in Africa, Europe, Asia and Oceania.

“Based on our understanding of the mutations in this lineage, partial immune escape may be possible, but despite this, vaccines will still offer high levels of protection against hospitalization and death,” according to the NICD.

“We expect new variants to continue to emerge wherever the virus is spreading. Vaccination remains critical to protect those in our communities at high risk of hospitalization and death, to reduce strain on the health system, and to help slow transmission.”

The WHO defines a “variant of concern” as one that enables “an increase in transmissibility or detrimental change in COVID-19 epidemiology, or an increase in virulence or change in clinical disease presentation; or a decrease in effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics”. 

Meanwhile, a WHO “variant of interest” is characterised by “genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape; and identified to cause significant community transmission or multiple COVID-19 clusters, in multiple countries with increasing relative prevalence, alongside increasing number of cases over time, or other apparent epidemiological impacts to suggest an emerging risk to global public health”.

The first two girls ever vaccinated with the malaria vaccine RTS,S in Ghana.

In the midst of the tragedy and turmoil caused by the COVID-19 pandemic, it is gratifying to see work continuing in Africa to find new ways of fighting malaria, a very old disease that has been a formidable foe for thousands of years and still kills 400,000 people every year, most of them African children under five years old.

Scientists from the London School of Hygiene and Tropical Medicine and their colleagues at the Institut de Recherche en Sciences de la Santé in Burkina Faso and the University of Bamako in Mali recently published results from a phase 3 trial that involved the world’s first and only malaria vaccine (referred to as RTS,S).

The new evidence from Mali and Burkina Faso shows that RTS,S – which is also being introduced in Ghana, Kenya and Malawi in a landmark pilot – could be an even more valuable tool than originally expected. And those of us involved in the fight against malaria are certainly eager for good news. 

Working in areas where malaria surges during the rainy season, the researchers report a dramatic reduction in malaria illness and deaths among young children who received the RTS,S vaccine just before the rains began. They found the vaccine worked as well as the standard prevention practice in these regions, known as seasonal malaria chemoprevention (SMC), which involves administering treatment doses of common antimalaria drugs monthly during the rainy season, usually through a door-to-door campaign. 

This is an important finding. SMC is a resource-heavy intervention, and in some settings, an annual pre-season single dose of a vaccine could be an attractive alternative. 

Striking results

However, the most striking results occurred in the group of some 1700 children who received both interventions – the medications and the vaccine. They experienced a 60% – 70% additional reduction in severe disease and hospitalizations compared to the already impressive stand-alone interventions – the prevention drugs or the RTS,S vaccine – and also more than a 70% reduction in deaths from malaria. Equally important: the combination was found to be safe and well tolerated. 

I was one of a group of African Ministers of Health in June 2016 who served on the Board of Gavi, the global vaccine alliance, and passionately supported the funding for a RTS,S pilot to learn more about its public health potential. These new results are heartening. 

RTS,S is the first malaria vaccine shown to reduce malaria and life-threatening severe malaria in young children. Approximately 2.1 million doses of the vaccine have been provided and more than 750,000 children have received their first vaccine dose through the pilot programme where malaria risks occur year-round. 

Results from the pilot programme also indicate strong community demand for the malaria vaccine as well as the capacity of childhood vaccination to deliver it. This new study in Burkina Faso and Mali provides additional evidence of RTS,S safety and effectiveness. 

Just before the COVID-19 pandemic arrived, Africa’s fight against malaria was stalling at what the World Health Organization (WHO) called an “unacceptably high level” of deaths. Regaining momentum in the malaria fight will require new tools, especially with existing preventive interventions threatened by emerging insecticide resistance. 

New tools to fight malaria are especially needed in countries like Mali and Burkina Faso, located in a region known as the African Sahel – a semi-arid ribbon of land that spans the continent from Senegal to Sudan. There, the danger of malaria flares dramatically with the arrival of the rainy season. Today, six of the ten African countries singled out by the WHO as requiring “high impact” malaria interventions are in the Sahel, where malaria remains a primary cause of childhood death despite substantial reductions in malaria achieved through a combination of SMC and insecticide-treated nets (ITNs). 

Seasonal influence

Through the development of the RTS,S vaccine over the last 30 years, scientists have discovered that the protective efficacy of RTS,S is particularly high in the first months following vaccination. This feature prompted researchers to study whether RTS,S could be provided strategically, just before the peak malaria season, to fight seasonal malaria transmission. 

Giving the RTS,S malaria vaccine seasonally was found to be safe and effective—and combining SMC with the vaccine was especially powerful—and could expand the options available for fighting malaria. 

In October, global advisory bodies for immunization and malaria will convene to review available RTS,S evidence and consider a potential WHO recommendation for wider use of the vaccine across Africa. 

If WHO recommends the vaccine for wider use, African governments should be prepared to seize on the life-saving opportunity. They must be ready to make smart and strategic decisions to deploy this vaccine while continuing to promote the use of other proven malaria interventions to maximise impact. 

We have seen in COVID-19 what the global health community can accomplish when it comes together to fight a killer disease. It would be a welcome turn of events to see Africa emerge from the pandemic with a new tool to take on the old foe of malaria with renewed vigour to get progress in malaria control back on track.  

Dr Kesete Admasu is CEO of Big Win Philanthropy, former CEO of the RBM Partnership to End Malaria, and former Minister of Health in Ethiopia. 

Dr Kesete Admasu

Image Credits: WHO/Fanjan Combrink.

Air pollution in Mashhad, Iran

When Algerian service stations stopped providing leaded petrol last month, this marked the successful end to a global campaign to eliminate this “major threat to human and planetary health”.

Celebrating the official end of the use of leaded petrol on Monday, United Nations Secretary-General Antonio Gutteres said that when the global campaign to eliminate the use of tetraethyllead (TEL) as a petrol additive started in 2002, 117 countries were still using TEL.

“Today, there are none. Lead in fuel has run out of gas, thanks to the cooperation of governments in developing nations, thousands of businesses, and millions of ordinary people,” said Gutteres in a video message to a media briefing.

“Ending the use of leaded petrol will prevent more than one million premature deaths each year from heart disease, strokes, and cancer, and protect children whose IQs are damaged by exposure to lead. This achievement again shows what we can accomplish when we work together across countries and sectors for the common good.”  

The head of the UN Environment Programme (UNEP), which led the campaign, said that the same approach to TEL elimination should also be applied to the phasing out of fossil fuels.

UNEP Executive Director Inger Andersen told the media briefing that companies used TEL to improve engine performance but this “was emitted in exhaust fumes, causing airborne pollution, and soil pollution”, later damaging the catalytic converters that reduced up to 95% of the common air pollutants. 

“Basically, industry rushed to adopt the first and cheapest technology that worked despite its grave implications for environmental health and for the environment, while ignoring sustainable and clean technologies. And that kind of sounds familiar,” said Andersen.

“But in the global response to leaded fuel shows that humanity can learn from and fix mistakes that we made,” she added.

The campaign’s success rested on an innovative public-private partnership, the Partnership for Clean Fuels and Vehicles, with over 75 members.

The campaign had to overcome resistance from companies producing the lead additive by promoting investments to replace lead that maintained the same octane levels and were not costly, she said.

“The success we celebrate today provides some clear lessons on dealing with [current] environmental challenges lessons,” added Andersen.

These included the importance of independent science, free media, clear goals, interventions that stressed the benefits for people, and high-level political commitment and leadership. 

“Now we must apply these lessons in developing better vehicle standards to deal with carbon dioxide emissions from the global transport sector as we transition away from fossil fuels, in ridding the world of single-use plastics, in restoring forests and other degraded ecosystems, in protecting wildlife,” said Andersen.

“We can do this together in partnership but we will only succeed if we work together as we have done on to unleaded fuels.”

UNEP Executive Director Inger Andersen

Cleaner used cars for Africa

Beninese politician Luc Gnacadja, former Executive Secretary of the UN Convention to Combat Desertification, told the media briefing that airborne lead pollution in his country’s cities had topped the list of environment-related health issues in 2000

“The socio-economic costs of leaded gasoline in only four of our major cities was estimated to be equivalent to 1.2% of our GDP in 2013,” said Gnacadja, who described the elimination of leaded fuel as “an outstanding success”.

However, Gnacadja said that poor-quality used vehicles imported by African countries were contributing to “high and rising urban pollution and high road accidents and fatalities”. 

“It is projected that, in the next two decades, the number of light-duty vehicles in Africa will triple, and the demand for oil will double,” he said.

Only two African countries had made moves to ensure that imported used vehicles “meet the minimum environment and safety requirements”, but if such measures were uniformly adopted across the continent, this could make African vehicles up to 80% cleaner, and reduce accidents by up to 50%,” he concluded.

Image Credits: Flickr, Mohammad Hossein Taaghi.

Although the World Health Organization (WHO) has issued technical guidelines for the development of digital COVID-19 ‘vaccine certificates’, it has stressed that these should not be a prerequisite for international travel.  

At the release of the technical guidelines last Friday (27 August), the WHO stated that it “does not support the requirement of proof of COVID-19 vaccination in order to travel”, citing that vaccines were not yet widely available in many countries.

“In some situations, however, depending on the risk assessment of the countries concerned, information about vaccination against COVID-19 may be used to reduce requirements for quarantine or testing upon arrival,” it added in a media statement.

“Historically, paper-based vaccination records have presented many challenges – such as the possibility of losing or damaging the card, or even the possibility of fraud. The proposed digital solutions are designed to address these challenges.”

In mid-July, the International Health Regulations Emergency Committee (IHR EC) advised the WHO to “expedite the work to establish updated means for documenting COVID-19 status of travellers, including vaccination, history of SARS-CoV-2 infection, and SARS-CoV-2 test results”.

It also advised that WHO member states recognise “all COVID-19 vaccines that have received WHO Emergency Use Listing in the context of international travel”. 

Adaptation of ‘yellow card’?

The WHO has proposed that, in the absence of digital certificates to record COVID-19 vaccinations, the International Certificate of Vaccination and Prophylaxis (ICVP) could be updated to include COVID-19 vaccinations. The ICVP, known as the “yellow card”, is used internationally mostly to show that travellers have had yellow fever vaccines.

However, the technical guidance sets out how to create a signed digital version of a vaccination record for COVID-19 “based on a core data set of key information to be recorded, and an approach for the digital signature”. 

It provides member states with a baseline set of requirements for a compliant digital system that is a “software-agnostic”  starting point for member states, who can use it to develop their own systems based on whichever format best suits their needs, from a paper card with a barcode or QR code stickers, to a smartphone application. 

The guidance stresses that the certificates should “never create inequity due to lack of access to specific software or technologies”, and must be “applicable to the widest range of use cases, catering to many different levels of digital maturity between implementing countries”. 

However, it identifies the “minimum requirements” for the introduction of digital certificates, namely that:

  • The ethical and privacy implications and potential risks are properly assessed
  • There are policies to establish their appropriate use, data protection and governance
  •  A digitally signed electronic version of the data about a vaccination event must exist
  • Anyone who has received vaccination should have access to proof of this – either as a traditional paper card or an electronic database.
  • If a paper vaccination card is used, it should be associated with a health certificate identifier (HCID) in a format that can be read by both people and machines (eg bar codes)
  • A digital registry should exist to store the information associated with the HCID and generate data about a vaccination.

International verification

The guideline includes a section on how digital vaccine ‘passes’ could be developed to enable them to be verified in foreign jurisdictions, such as for international travel. In these cases, international bodies should be able to access a country’s national registry, using digital cryptographic processes, to check whether the HCID barcode on paper is valid and hasn’t been revoked or altered.

A number of international COVID-19 ‘vaccine passes’ are already in use. The European Union started using its digital COVID-19 certificate on 1 July to facilitate travel in the EU.

The EU certificate is based on a QR code that “contains necessary key information such as name, date of birth, date of issuance, relevant information about vaccine/ test/ recovery and a unique identifier”.This data is not retained by the countries a person visits. 

There is no national system in the US other than a card issued by the Centers for Disease Control (CDC), but some states and even cities such as New York have developed apps to enable fully vaccinated people to verify their status, which is often necessary to enter various public gatherings.

There have been protests through Europe against ‘vaccine passports’, mostly by libertarians and anti-vaxxers opposed to any form of compulsory vaccination.

 

Image Credits: UNICEF/Kokoroko, Wikimedia Commons: Nemo.

Neglected tropical diseases (NTDs) pose a threat to more than 1.5 billion people worldwide,  making them one of the biggest health problems in the developing world. 

In sub-Saharan Africa, these diseases are found “at the end of the road” in the most rural and poor communities where an estimated 600 million people are at risk of contracting one or more NTDs. 

These diseases have detrimental effects on school attendance and child development. They cause irreversible damage and stigmatizing disability with reduced quality of life and hence reduced productivity. They imprison afflicted communities in a vicious cycle of poverty and disease, which creates a significant barrier to achieving the UN Sustainable Development Goals (SDGs). 

An estimated 90% of the NTD burden in Africa can be controlled or eliminated through mass drug administration of preventive chemotherapy to treat five key NTDs, onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma . 

This ambitious goal is feasible thanks to strong public-private partnerships, including the commitment and generosity of several pharmaceutical companies to provide free drugs, and the volunteers and teachers from endemic communities who distribute the drugs to millions – often without remuneration. 

Improved productivity

A study published in PLOS NTDs estimated that eliminating these five NTDs with preventive chemotherapy would increase productivity by $11 billion annually on a global scale. Increased investment in NTD control and elimination is imperative to improve development, end suffering for millions, and achieve the SDGs.

The Mectizan Donation Program (MDP), is the longest-running pharmaco-philanthropy initiative established in 1987 by the pharmaceutical company MSD (known as Merck and Co. Inc in the USA and Canada) to facilitate access to its drug, Mectizan (ivermectin), for the elimination of river blindness. 

In 1998, MSD joined forces with GSK through their donation of albendazole to be co-administered with Mectizan to eliminate lymphatic filariasis. 

Today, the Mectizan Donation Program is no longer alone. Many other initiatives have since been created to facilitate access to NTD medications. MDP is a proud partner of the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), a special program of World Health Organization (WHO) AFRO with the mission to accelerate elimination of the five PCT NTDs in Africa.

The COVID-19 pandemic resulted in disastrous socio-economic consequences worldwide. As resources become scarce, there is a need for greater innovation and efficiency. This includes high-quality disease mapping, programme planning and implementation, and timely monitoring and evaluation, which will enable countries to demonstrate progress. 

Data-sharing is key

During the COVID-19 pandemic, the communication channels, data collection tools, and health care infrastructures established by NTD programmes have been re-purposed for training and capacity building for COVID-19 risk mitigation. 

NTD programmes will continue to serve as well-established grassroots platforms to implement NTD interventions along with other preventive health interventions for those living at the end of the road.

Assessing strengths and weaknesses to improve strategies based on quality data collection and analysis will be critical to success. 

ESPEN has a strong commitment to the improvement of data quality and use in the African member states, which includes ESPEN’s data portal, a central repository for NTD data across all diseases and treatments.

 The portal is being designed to facilitate transparency and data sharing among stakeholders. ESPEN partners now have access to 10,000 maps and data sets from 45 countries. Countries and other stakeholders have access to a source of historical and current information on NTD endemicity including disease-specific epidemiological surveys, treatment coverage, and other programmatic data.

COVID-19 has further exacerbated the socio-economic consequences such diseases can have worldwide, and there is an even greater need for more resources to be channelled towards NTD programmes. 

Improving access to quality data to effectively fight disease should be at the top of the WHO AFRO agenda. Ultimately, data tools such as ESPEN data portal will be our winning strategy in the fight against NTDs.

 * Dr Yao Sodahlon is Director of the Mectizan Donation Program.

Dr Yao Sodahlon
Hypertension cases have increased to 1.28 billion in 30 years and millions of people are living with untreated hypertension.

The number of adults around the world with hypertension has almost doubled from 650 million to 1.28 billion in 30 years – and nearly half these people don’t know they have hypertension, a new study published in The Lancet has found.

The study, which is the first comprehensive global analysis of trends in hypertension prevalence, detection, treatment, and control also found that more than one billion people with high blood pressure  — 82% of hypertension patients in the world — lived in low- and middle-income countries in 2019.

The international study, led by researchers from Imperial College London and the World Health Organization (WHO), analysed blood pressure measurements from 104 million people in the 30 to 79 age group and was taken over three decades in 184 countries. 

“Despite medical and pharmacological advances over decades, global progress in hypertension management has been slow, and the vast majority of people with hypertension remain untreated, with large disadvantages in low- and middle-income countries,” lead author of the study Professor Majid Ezzati, Imperial College London, UK, said.

“Our analysis has revealed good practice in diagnosing and treating hypertension, not just in high-income countries but also in middle-income countries. These successes show that preventing high blood pressure and improving its detection, treatment, and control are feasible across low- and middle-income settings if international donors and national governments commit to addressing this major cause of disease and death.”

Hypertension is defined as systolic blood pressure of 140 mm Hg or greater, diastolic blood pressure of 90 mm Hg or greater, or taking medication for high blood pressure. It is directly linked to more than 8.5 million deaths worldwide each year and is the leading risk factor for strokes, ischaemic heart disease, other vascular diseases, and renal disease.

Lowering blood pressure can cut the number of strokes by 35%-40%, heart attacks by 20%-25%, and heart failure by around 50%. 

The study found that globally, the number of adults aged 30 to 79 with hypertension jumped from an estimated 331 million women and 317 million men in 1990 to 626 million women and 652 million men in 2019. 

Increase mostly seen in low- and middle-income countries

The data further pointed to regional disparities in treatment and control of high blood pressure despite the easy diagnosis and low cost of medicines.

Dr Bin Zhou, a research fellow at the School of Public Health at Imperial College London, who led the analysis said: “Although hypertension treatment and control rates have improved in most countries since 1990, there has been little change in much of sub-Saharan Africa and Pacific Island nations.  International funders and national governments need to prioritise global treatment equity for this major global health risk.”

Canada, Iceland, and South Korea had among the lowest prevalence of hypertension with treatment levels greater than 70%; and control rates of over 50% in 2019. 

Encouragingly, large improvements in treatment and control rates were seen in some middle-income countries including Costa Rica, Kazakhstan, South Africa, Brazil, Turkey, and Iran over the 30 years. 

Some of the highest rates were seen in the Dominican Republic, Jamaica, and Paraguay for women and Hungary, Paraguay, and Poland for men.

“Policies that enable people in the poorest countries to access healthier foods—particularly reducing salt intake and making fruit and vegetables more affordable and accessible—alongside improving detection by expanding universal health coverage and primary care, and ensuring uninterrupted access to effective drugs, must be financed and implemented to slow the growing epidemic of high blood pressure in low- and middle-income countries,” said Ezzati about the large improvements in some of the countries.

Over half of hypertension sufferers were unaware of their condition

Hypertension is relatively easy to treat with low-cost drugs yet 720 million people were not on treatment.

Another significant finding was that about 580 million people with hypertension were unaware of their condition because they were never diagnosed and 720 million did not receive the required treatment.

Although the condition is straightforward to diagnose and relatively easy to treat with low-cost drugs, almost half of people (41% of women and 51% of men) with hypertension worldwide in 2019 were unaware of their condition, and more than half of women (53%) and men (62%) with the condition were not treated for it. Worldwide, blood pressure was controlled in fewer than one in four women and one in five men with hypertension. 

“Nearly half a century after we started treating hypertension, which is easy to diagnose and treat with low-cost medicines, it is a public health failure that so many of the people with high blood pressure in the world are still not getting the treatment they need,” said Ezzati.

The authors note that, whilst the study provides the first comparable estimates of blood pressure prevalence, diagnosis, treatment, and control in adults for all countries of the world; it may be affected by a lack of data in some countries, especially in Oceania and sub-Saharan Africa.

New WHO guideline for hypertension treatment

This week, the World Health Organization (WHO) released fresh guidelines after 20 years for pharmacological treatment of hypertension in adults to help countries manage the condition better.  

The recommendations cover the level of blood pressure to start medication, type of medicine or combination of medicines to use, target blood pressure level, and frequency of tests.

“The need to better manage hypertension cannot be exaggerated. By following the recommendations in this new guideline, increasing and improving access to blood pressure medication, identifying and treating comorbidities such as diabetes and pre-existing heart disease, promoting healthier diets and regular physical activity, and more strictly controlling tobacco products, countries will be able to save lives and reduce public health expenditures,” said Dr Bente Mikkelsen, Director of WHO’s Department of Noncommunicable Diseases.

Image Credits: John Campbell/Flickr, REUTERS/Baz Ratner, Pxhere.

Johnson and Johnson single-dose vaccine

Johnson & Johnson has joined other vaccine producers in advocating for a booster shot for its single-dose COVID-19 vaccine, which is being rolled out particularly in low-income African countries that had hoped to only vaccinate citizens once.

The company made the announcement on Wednesday, following the results of interim data from two Phase 1/2a studies in individuals previously vaccinated with its vaccine.

“New interim data from these studies demonstrate that a booster dose of the Johnson & Johnson COVID-19 vaccine generated a rapid and robust increase in spike-binding antibodies, nine-fold higher than 28 days after the primary single-dose vaccination,” according to a company statement.

“Significant increases in binding antibody responses were observed in participants between ages 18 and 55, and in those 65 years and older who received a lower booster dose,” it added, saying that it had submitted study summaries to medRxiv on 24 August.

This follows the publication in July of interim data from the trial in the New England Journal of Medicine that demonstrated neutralizing antibody responses generated by the Johnson & Johnson single-shot COVID-19 vaccine were strong and stable eight months after immunization.

“We have established that a single shot of our COVID-19 vaccine generates strong and robust immune responses that are durable and persistent through eight months. With these new data, we also see that a booster dose of the Johnson & Johnson COVID-19 vaccine further increases antibody responses among study participants who had previously received our vaccine,” said Mathai Mammen, Global Head of Janssen Research & Development, Johnson & Johnson. 

“We look forward to discussing with public health officials a potential strategy for our Johnson & Johnson COVID-19 vaccine, boosting eight months or longer after the primary single-dose vaccination,” he added.

J&J said that it was engaging with the US Food and Drug Administration (FDA), US  Centers for Disease Control and Prevention (CDC), European Medicines Agency (EMA) and other health authorities regarding boosting with the Johnson & Johnson COVID-19 vaccine. 

The African Union has ordered 400 million doses of the J&J vaccine and the US government is also in the process of donating millions of doses of the vaccine to Africa, making the J&J vaccine the cornerstone of the continent’s rollout.

At World Health Organization (WHO) meeting on vaccines two weeks ago, J&J was the only vaccine manufacturer that was not advocating for boosters citing a lack of clinical data.

 

 

 

Singaporean Senior Minister Tharman Shanmugaratnam

Global health security is dangerously underfunded, making the world vulnerable to a “prolonged COVID-19 pandemic with repeated waves affecting all countries” and future pandemics, Singaporean Minister Tharman Shanmugaratnam told a World Health Organization (WHO) media briefing on Wednesday.

Shanmugaratnam, who co-chairs the G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response, urged global governments to pledge at least $10 billion more every year to address this and future pandemics.

His panel has recommended the establishment of a Global Health Threats Fund to mobilise money for pandemic surveillance and response.

“The current funding for global health is raised by individual global health organisations on a siloed basis. It is also largely dependent on discretionary bilateral aid. The result is a non-system of complex inefficient, unpredictable, and greatly inadequate funding,” said Shanmugaratnam.

“We need a new global mechanism to overcome these silos mobilise resources on the needed scale and predictability.”

He described the additional resources needed as “very small investments, compared to the costs of a prolonged COVID-19 pandemic” and “tiny investments, compared to the costs of future pandemics”.

“We have to move away from thinking about funding of global health security in terms of foreign aid towards thinking about it as a strategic investment that all nations must make not only for the good of the global community, but because it is in each nation’s self interest,” he added.

He also called for the “repurposing” of international financial agencies – the World Bank, IMF and other multilateral development banks – so that financing “resilience against climate change and pandemic security” are part of their core mandates.

WHO Director General Dr Tedros Adhanom Ghebreyesus told the briefing that the COVID-19 pandemic has stabilised over the past week, “but at the very high rate of 4.5 million cases and 68,000 deaths”.

Tedros described the next three months as “a critical period for shaping the future of pandemic preparedness and response”.

WHO believes that “whatever structures and mechanisms emerge”, they have the engagement and ownership of all countries, be aligned with the constitutional mandate of WHO rather than creating parallel structures, involve partners from across the One Health spectrum, including animal, and environmental health, ensure coherence with the International Health Regulations, and be accountable to all member states, added Tedros. 

COVID-19 origins

Members of the WHO scientific team into the origins of the SARS-CoV2 authored a report in Nature on Wednesday saying that time was running out for them to complete their work.

In response, WHO’s lead on COVID-19, Maria Van Kerkhove, said the global body was in the process of setting up the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) to “establish a standardised approach for studying where and when these pathogens emerge”.

However, Van Kerkhove said that the origins group had identified “numerous further studies” that needed to be conducted in its March report – and there were many scientists in China who could do these.

“One of the responsibilities of the SAGO would be to urgently prioritise what studies need to go forward,” said Van Kerkhove, adding that “we have heard from Chinese colleagues that studies are underway from some public statements that they have made recently”. 

“We want the origins work to remain scientific, transparent, urgent and inclusive, and we will continue to work with all member states to make sure that we better understand how this pandemic begin began so that we can be better prepared for future ones,” she concluded.

Dr Mike Ryan, WHO Executive Director of Health Emergencies, emphasized that “there is no impediment” to the studies identified by the origins team going ahead in China.

“Chinese colleagues don’t need WHO to hold their hands through this kind of process,” said Ryan. “Those studies have been laid out. They’ve been agreed between the international team and Chinese colleagues. In fact, many Chinese colleagues do report that those studies are underway, and we very much look forward to receiving data and reports.”

He added that WHO was “very willing” to deploy the international team – or smaller, more specialised teams “as needed”.

In July, China rejected further research by the origins team – particularly into whether the virus escaped from a laboratory.

“We will not accept such an origin-tracing plan as it, in some aspects, disregards common sense and defies science,” Zeng Yixin, Vice Minister of the National Health Commission,  told a press conference organized by the Chinese State Council Information Office.

“We hope the WHO would seriously review the considerations and suggestions made by Chinese experts and truly treat the origin tracing of the COVID-19 virus as a scientific matter, and get rid of political interference,” Zeng added.