Monkeypox rash

Although the World Health Organization (WHO) has decided not to declare monkeypox a public health emergency of international concern (PHEIC), it could change its mind if there is evidence of “significant spread” in the next 21 days.   

This was announced over the weekend following the meeting of the WHO’s International Health Regulations (IHR) Emergency Committee. The Committee also recommended more aid to the 9-12 central and west African countries where the disease has long circulated, often as a result of contact with infected rodents, squirrels and other wild animals.  

According to the IHR, a public health emergency is “an extraordinary event, which constitutes a public health risk to other States through international transmission, and which potentially requires a coordinated international response”.

While the WHO conceded in its official statement that the outbreak was “unusual” in many aspects and that “a few” committee members felt it should be declared a PHEIC, it listed a number of requirements that might lead to a change in position in three weeks time. 

These would include: more cases both among and beyond the population groups currently affected; cases among sex workers; evidence of significant spread to and within additional countries; and an increase of cases in vulnerable groups, such people with poorly controlled HIV, pregnant women, and children.

Between 1 January and 22 June 2022, some 3413 laboratory confirmed cases and one death have been reported to WHO from 50 countries/territories in five WHO Regions, WHO reported on Monday, 27 June.     

‘Equitable access to lifesaving tools’

Reacting to the WHO announcement, Wellcome Trust’s Director of Infectious Diseases, Professor Gordon Dougan, urged all affected countries to “integrate their preparations and help those with limited capability”. 

“Governments do not need to wait for an official declaration to begin acting in a coordinated and measured way. Where cases have been identified, rapid public health responses such as enhanced disease surveillance, contact tracing and self-isolation will be crucial,” said Dougan.

However, he also called out the rush by some countries to acquire scarce vaccines despite mass vaccination not being recommended, urging the global community not to repeat mistakes made during the COVID-19 response.

“But while high-income countries are now paying attention to this virus, monkeypox has been affecting people in West and Central Africa for decades. And with new cases now being reported in other low- and middle-income countries, we must ensure that these lifesaving tools are equitably distributed to where they are needed most,” Dougan urged.

The response also required “establishing clinical trials of the required scale and design” to ensure improved  monkeypox vaccines and treatments, he added.

The WHO emergency committee also noted that monkeypox has been endemic in parts of Africa “for decades”, and that responding to the current outbreak should “serve as a catalyst to increase efforts to address monkeypox in the longer term and access to essential supplies worldwide”.

Cases plateauing?

Some of the issues influencing the WHO’s decision included “current observations of plateauing or potential downward trends in case numbers in some of the countries experiencing outbreak early on” as well as “the need for further understanding of transmission dynamics”.

“However, the committee unanimously acknowledged the emergency nature of the event and that controlling the further spread of outbreak requires intense response efforts,” added the WHO.

“The committee advised that the event should be closely monitored and reviewed after a few weeks, once more information about the current unknowns becomes available, to determine if significant changes have occurred that may warrant a reconsideration of their advice.”

Image Credits: US Centers for Disease Control.

The Prince of Wales and Rwanda’s President Paul Kagame meet at the Kigali Summit on Malaria and Neglected Tropical Diseases

As the Kigali Summit unfolds, Adrian Hill, director of Oxford University’s Jenner Institute, describes the great strides made in malaria control, and the contribution new malaria vaccines can make, including one designed at the Jenner Institute. He spoke to Health Policy Watch just ahead of this week’s meeting by heads of Commonwealth nations, which galvanized support for the fight against malaria and neglected tropical diseases.

Leaders of Commonwealth nations meeting in Rwanda’s capital have pledged more than US$4 billion towards global efforts to accelerate the fight against malaria and other neglected tropical diseases.

The heads of state also committed to redouble efforts on climate change and the COVID-19 pandemic, which continue to affect the lives of the 2.5 billion people in the 54 nations belonging to the Commonwealth association of one-time territories of the British Empire.

Thursday’s Summit on Malaria and NTDs, taking place on the sidelines of the broader Commonwealth meeting, also saw the signing the Kigali Declaration on neglected tropical diseases (NTDs), a political statement meant to galvanize support for some of the UN’s top health goals by 2030.

“Only through continued country ownership, political commitment, accountability and great partnership can we ensure progress is accelerated over the coming months,” the leaders concluded in their outcome statement.

Forty nations were certified malaria-free between 1955 and 2021, the World Health Organization (WHO) says. And while global efforts to fight malaria prevented an estimated 10.6 million deaths and 1.7 billion cases from 2000 to 2020, the disease still resulted in as many as 627,000 deaths and 241 million cases in 2020.

Ahead of the summit hosted by Rwanda’s President Paul Kagame, Health Policy Watch interviewed Adrian Hill, a professor of vaccinology and director of Oxford University’s Jenner Institute, which works on designing and developing vaccines for infectious diseases prevalent in developing countries. His answers have been edited for brevity and clarity.

Professor Adrian Hill.

Health Policy Watch: How will the Kigali Summit boost malaria control?

Adrian Hill:This key meeting could not have come at a better time for boosting the state of malaria control in Africa. The power of vaccines has been demonstrated strikingly by the response to the COVID-19 pandemic ─ well-illustrated by the Oxford-AstraZeneca-Serum Institute vaccine. And now vaccines for malaria that could have a huge impact on malaria control and save hundreds of thousands of lives a year will be available from next year. The challenge for the summit is to ensure that more lives are not lost because the world has failed to support the purchase and distribution of new malaria vaccines.

HPW: Why is it important to focus on the development of a malaria vaccine?

AH. Malaria is the biggest infectious killer of children from six months to five years of age in Africa. There are over 620,000 deaths from malaria a year, according to the latest WHO figures and this has been increasing. New interventions are crucial to reduce this unacceptable death rate and now malaria vaccination is at hand for the first time.

This map shows an approximation of the parts of the world where malaria transmission occurs.

HPW: What progress is being made to develop an effective, affordable and accessible malaria vaccine?

AH: There are two malaria vaccines that are close to licensure and should be available for use next year (2023). The older one is RTS,S/AS01, from GSK, that will be available at a scale of maybe 9-10 million doses. The other is the newer R21/MM that will be available, also next year, and was designed and developed by Oxford University with the Serum Institute of India. Importantly, this can be provided next year at a scale of 200 million doses a year, enough to vaccinate the 40 million children born each year in areas of Africa with high transmission of malaria and a high risk of death.

HPW: What progress has been made in the fight against malaria and NTDs in the last two decades?

AH: In 2000, there were about 1 million deaths each year globally from malaria. But with the improved use of bed nets, insecticides and chemoprevention drugs, deaths fell to about 500,000 people by 2015. Death rates are rising again, however, as these older types of interventions appear to be losing effectiveness. Fortunately, new malaria vaccines are becoming available from 2023 and one of these vaccines (R21/MM) appears more effective than any of these older interventions. However, the best approach will be to use all these interventions in parallel.

Malaria prevention tools (WHO).

HPW: Why is it important to scale up tools to eliminate malaria?

AH: The cost of malaria controls each year is now about US$3 billion. Adding the R21 vaccine will add about half a billion dollars to this cost, but this should be very cost effective. Importantly, adding new vaccines to other interventions should allow malaria to be eliminated in some countries very soon and eventually eradicated globally. Elimination and then eradication of malaria will reduce and then remove the costs of malaria control.

HPW: Why has it been so difficult to come up with a malaria vaccine?

AH: The RTS,S vaccine has not received regulatory approval as yet. It is just a WHO policy recommendation, but this should happen soon. And importantly, R21/MM should provide about 10-20-fold more doses and a less expensive vaccine. These two vaccines have emerged from over 140 candidates tested in clinical trials as the most effective to date. This reflects the great technical difficulty of making a vaccine against protozoan parasites, like malaria, which have thousands of genes, suppress natural immunity, and require exceptionally potent vaccines to provide protective efficacy. There are no licensed vaccines today against any parasite disease.

The Prince of Wales and Rwanda’s President Paul Kagame at the Kigali Summit on Malaria and Neglected Tropical Diseases.

HPW: What about the successful malaria vaccine trial with which you have been involved?

AH: The WHO has specified that a malaria vaccine should aim to show high efficacy of at least 75% over two years of follow-up. R21/MM, designed at Oxford University’ s Jenner Institute as part of a 30-year programme of vaccine research, is the only vaccine to demonstrate that level of efficacy in African children, the most important population to protect and the most vulnerable to malaria disease and death.

Image Credits: US Centers for Disease Control and Prevention, World Health Organization .

Pro-abortion protests have erupted in the US in the aftermath of the court decision.

Women’s rights activists and political opponents reacted with fury to the US Supreme Court’s stunning reversal of the fundamental right to abortion established almost 50 years ago in the landmark 1973 ruling of Roe v. Wade.

US President Joe Biden called it a “tragic error,” saying this is the first time the US Supreme Court has removed “a constitution right that is so fundamental to so many Americans.” He vowed his administration would defend a woman’s right to travel across state lines to seek an abortion.

“Now with Roe gone, let’s be very clear, the health and life of women across this nation are now at risk,” he said. “Let me be very clear and unambiguous. The only way we can secure a woman’s right to choose that exists is for Congress to restore the protections of Roe v. Wade as federal law. No executive action from the president can do that.”

Biden called on voters to elect more senators and representatives who support reproductive rights, and pointed out that the Supreme Court decision does not prevent women from crossing state lines to receive an abortion.

“My administration will defend that bedrock right,” he promised. “If any state or local official, high or low, tries to interfere with a woman’s exercising her basic right to travel, I will do everything in my power to fight that deeply un-American attack.”

Biden added his administration would also back the right of access to medication for medical abortions, which some anti-abortion states want to ban.

Trigger bans in 13 states

The Supreme Court decision triggered automatic abortion bans in 13 states that had such laws in place. This means that women living in Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming will no longer be able to get access to abortions. 

Some states like Mississippi make no exceptions for rape, incest or health considerations, and women and girls and doctors face jail sentences for induced abortions.

Another 13 states are also poised to curtail abortion rights, while only 16 states and the District of Columbia have laws that protect the right to abortion, according to the Guttmacher Institute, an NGO that advocates for sexual and reproductive health rights.

Abortion bans don’t work

Dr. Herminia Palacio, the institute’s president and CEO, said decades of research consistently show that abortion bans and restrictions don’t reduce unintended pregnancy or demand for abortion.

“And they certainly do not help people improve their health,” said Palacio. “Rather, they impose significant hurdles to obtaining care, causing stress for people in need of abortion and leading some to experience forced pregnancy and all its troubling consequences.”

Rep. Tim Ryan, Democrat of Ohio, said the ruling was “the largest overreach in history” as it removed a constitutional right for the first time, essentially introducing “government-mandated pregnancies.”

A tearful Rep. Cori Bush, Democrat of Missouri, who had an abortion after being raped as a 17-year-old, described the court as “far-right, racist and supremacist.”

Planned Parenthood’s CEO Alexis McGill Johnson said the decision amounts to “the removal of women’s rights to bodily autonomy” but her organization will continue fighting to ensure women can take care of themselves as best as possible.

“This is about power and control,” she said. “Abortion is still legal in some states, and Planned Parenthood will do whatever we can to ensure people have services.”

“This horrifying decision will have devastating consequences, and it must be a wake-up call, especially to young people who will bear the burden,” said former US First Lady Michelle Obama.

Friday’s Supreme Court ruling on the appeal of a case brought by the Mississippi Department of Health, Dobbs v. Jackson Women’s Health Organization, overturned the 1973 Roe v Wade decision, which held that the 14th Amendment of the US Constitution provides a “fundamental right to privacy” that protects women’s rights to seek an abortion “without undue restrictive interference from the government.” De facto, the decision also upended the Supreme Court’s 1992 decision in Planned Parenthood v. Casey, which barred states from enacting abortion restrictions expressly for “the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus.” 

Justice Samuel Alito Jr.’s opinion overruling Roe and Justice Brett M. Kavanaugh’s concurrence said the decision ending a woman’s constitutional right to abortion shouldn’t endanger other sexual and reproductive rights that the court has recognized such as contraception, interracial marriage and same-sex marriage.

But the concurrence by Justice Clarence Thomas calls for not just revisiting but “overruling” all of the court’s substantive due process precedents including Obergefell v. Hodges, which deals with same-sex marriage, Griswold v. Connecticut, a landmark contraception case, and Lawrence v. Texas, a major case that invalidated anti-sodomy laws.

“After overruling these demonstrably erroneous decisions, the question would remain whether other constitutional provisions guarantee the myriad rights that our substantive due process cases have generated,” he wrote – although he omitted reconsideration of interracial marriage — which would make his own marriage illegal.

States prepare for patient influx

Some states where abortion is legal are already preparing for an influx of people seeking abortion, as previously reported by Health Policy Watch.

Last month, New York State Governor Kathy Hochul announced a $35 million investment to directly support abortion providers in anticipation of Roe v. Wade being overturned.

“New York has always been at the forefront of the fight for abortion rights, and as the first female governor of New York, I will not let us go backwards,” said Hochul. “This landmark funding will get resources into the hands of clinics who need our help, safeguarding access to abortion in our state and setting an example for the rest of the nation to follow.”

Image Credits: Gayatri Malhotra / Unsplash.

Children show high immunity to COVID months after infection.

Children infected with COVID-19 maintained strong immunity against the virus for at least 18 months, according to a preprint study that was released on Wednesday.

The study, which has not yet been peer-reviewed, was conducted by Kahn-Sagol-Maccabi (KSM), the research and innovation center of Maccabi Healthcare Services in Israel, and was released on the preprint server MedRxiv.

The largest real-world observational research examining children’s immunity to date, it analyzed the Maccabi Health Services records of around 300,000 unvaccinated youth between 1 July  and 13 December 2021, when Delta was dominant in Israel.

Recovered children had to have been infected at least 90 days’ prior to inclusion date to capture reinfections.

According to the research, children and teenagers aged five to 18 who caught COVID-19 developed strong natural protection against reinfection with effectiveness levels of about 80% for at least 18 months.

‘Robust and long-lasting’

“Naturally acquired immunity in children and adolescents was found to be robust and long-lasting, which aligns with what we have witnessed in our day-to-day clinical practice,” said KSM head Dr Tal Patalon, who is both a physician and a researcher, and has been treating COVID-19 patients since the early days of the pandemic.

Although the researchers have not yet looked into natural immunity resulting from Omicron, Patalon said that she assumed “naturally acquired immunity will remain significant against the Omicron variant, this is currently under further research”.

Effectiveness of naturally acquired immunity against recurrent infection reached 89.2% three to six months after first infection, mildly declining to 82.5% nine months to one year after infection and then remaining steady for up to 18 months.

The protection was even stronger for the younger cohort; children up to age 11 showed no significant decline in protection during the study period, while those between 12 and 18 showed more decline.

The study was published just days after the US Food and Drug Administration and the Centers for Disease Control and Prevention approved vaccines for children under the age of five and as cases are on the rise throughout much of the Western world.

The study findings were validated twice, using two different statistical methods, strengthening the validity of the study results.

“As for public health policies, the demonstrated long-term protection of naturally acquired immunity has important implications regarding the decision to vaccinate convalescent children and adolescents, and to mandate self-quarantine after exposure, affecting all biopsychosocial aspects of life and well-being of children, adolescents and their families,” the study’s authors concluded.

They noted that this should be considered in light of evidence of increasing seroprevalence antibodies that indicate previous infection in as much as 70% of children and adolescents in the US.

Image Credits: Kelly Sikkema/ Unsplash.

COVID-19 vaccines are estimated to have saved almost 20 million lives – but mostly in high- and upper-middle class income countries that received the vaccines first.

COVID-19 vaccines prevented almost 20 million deaths worldwide in the first year of the vaccine programme, according to a modelling study published in The Lancet on Friday.

The first modelling study to quantify the global impact of COVID-19 vaccines estimates that 19.8 million out of a potential 31.4 million deaths were prevented in the first year after vaccines were introduced between 8 December 2020 and 8 December 2021.

“High and upper-middle income countries accounted for the greatest number of prevented deaths (12.2 million/ 19.8 million), highlighting inequalities in access to vaccines around the world,” according to The Lancet.

A further 599,300 deaths could have been averted if the World Health Organisation’s target of vaccinating 40% of the population in every country by the end of 2021 had been met.

The study is based on data from 185 countries, using COVID-19 death records and total excess deaths from each country, or estimates where official data was not available. 

To account for under-reporting of deaths in countries with weaker surveillance systems, they carried out a separate analysis based on the number of excess deaths recorded above those expected during the same time period. 

Where official data was not available, the team used estimates of all-cause excess mortality. These analyses were compared with an alternative hypothetical scenario in which no vaccines were delivered.

COVAX saved 7.5 million lives

“Our findings offer the most complete assessment to date of the remarkable global impact that vaccination has had on the COVID-19 pandemic. Of the almost 20 million deaths estimated to have been prevented in the first year after vaccines were introduced, almost 7.5 million deaths were prevented in countries covered by the COVID-19 Vaccine Access initiative (COVAX),” said Dr Oliver Watson, lead author of the study, from Imperial College London.

“Our findings show that millions of lives have likely been saved by making vaccines available to people everywhere, regardless of their wealth. However, more could have been done. If the targets set out by the WHO had been achieved, we estimate that roughly one in five of the estimated lives lost due to COVID-19 in low-income countries could have been prevented.”

COVAX has facilitated access to affordable vaccines for lower-income countries to try to reduce inequalities, with an initial target of giving two vaccine doses to 20% of the population in countries covered by the commitment by the end of 2021. 

The World Health Organization (WHO) expanded this target by setting a global strategy to fully vaccinate 70% of the world’s population by mid-2022, with an interim target of vaccinating 40% of the population of all countries by the end of 2021.

Despite the speed of the vaccine roll-out worldwide, more than 3.5 million COVID-19 deaths have been reported since the first vaccine was administered in December 2020.

“Quantifying the impact that vaccination has made globally is challenging because access to vaccines varies between countries, as does our understanding of which COVID-19 variants have been circulating, with very limited genetic sequence data available for many countries,” said Gregory Barnsley, co-first author of the study, from Imperial College London. 

“It is also not possible to directly measure how many deaths would have occurred without vaccinations. Mathematical modelling offers a useful tool for assessing alternative scenarios, which we can’t directly observe in real life.”

Image Credits: International Monetary Fund/Ernesto Benavides.

monkeypox
Monkeypox rash.

A World Health Organization emergency committee met Thursday to determine if the monkeypox outbreak spreading in non-endemic countries constitutes a Public Health Emergency of International Concern (PHEIC).

The closed door meeting, including 16 committee members and eight advisors, will make a recommendation to WHO Director-General Dr Tedros Adhanom Ghebreyesus, who will decide whether to designate it a public health emergency.

Tedros told a WHO media briefing last week the global outbreak of monkeypox “is clearly unusual and concerning.” His decision is not expected before Friday, according to a WHO media advisory.

Ibrahima Socé Fall, WHO’s deputy director for emergency response, said it is important to take preventive action now because the risk of spread in Europe is “high” and in other parts of the world it is “moderate,” though much is still unknown about how the virus is being transmitted.

“We don’t want to wait until the situation is out of control,” he said.

More than 3000 monkeypox cases globally, experts urge WHO to take action 

With 3,543 confirmed and suspected cases across 59 countries outside of central and western Africa as of Thursday, other global health organizations have already begun to declare monkeypox a public health emergency, with experts urging WHO to take immediate action to combat what some of them consider to be another pandemic.

Public health research coalition World Health Network declared monkeypox a pandemic on Thursday. 

“There is no justification to wait for the monkeypox pandemic to grow further. The best time to act is now. By taking immediate action, we can control the outbreak with the least effort, and prevent consequences from becoming worse,” said Yaneer Bar-Yam, WHN’s founder and president of New England Complex System Institute.

In places like New York City, public health clinics are offering vaccinations against the disease. 

Monkeypox has plagued Africa for years 

Cases of monkeypox in endemic countries between 15 December 2021 to 1 May 2022

Some experts in Africa have said the WHO consultation is long overdue, but for different reasons. Global concern has only arisen recently, despite the fact that monkeypox has plagued Africa for years.

In 2022 some 1536 suspected cases and 72 deaths have been reported by WHO in the eight countries where the disease is endemic in 2022.

In the case of the more lethal West African clade, the disease can have a fatality rate of up to 10%. 

The different responses to the disease in Africa and Europe have drawn growing attention. “When a disease affects developing countries, it is (apparently) not an emergency. It only becomes an emergency when developed countries are affected,” Emmanuel Nakoune, acting director of Institut Pasteur in Bangui, Central African Republic, told Reuters.

Nakoune, who is running a clinical trial for a monkeypox treatment, said that if WHO declares monkeypox a public health emergency, that would at least be an important step in the right direction. And each will be able to benefit, he said, “if there is the political will to share equitably the means of response between developed and developing countries.”

More intensive person-to-person transmission seen in Europe 

The clade of the virus spreading in Europe was previously seen largely in West African countries, with the exception of isolated cases carried abroad by travelers. But person to person transmission of the virus in African settings was typically limited, with outbreaks occurring largely as a result of contact with wild animal populations, including infected rodents and squirrels. 

In Europe, in contrast, the virus is spreading exclusively through person-to-person transmission, including as a result of men having sex with men or other forms of skin-to skin contact.

Meanwhile, a team of African researchers, including the acting director of the Africa Centers for Disease Control, proposed a new nomenclature for the virus out of concern that the current terms are racist and stigmatizating.  

The proposal calls for the virus to be named in terms of its variants, such as MPXV Clades 1, 2, and 3, in order of discovery.  Newer variants are more likely to be the ones carrying the disease abroad. 

If monkeypox is designated as a public health emergency, or PHEIC, under WHO’s International Health Regulations, it could help unlock more funding from WHO and governments that would help to get transmission under control.  Countries would have a legal obligation to implement their own public health measures.  

Such an emergency declaration also could underpin WHO plans to ensure an equitable distribution of available smallpox and monkeypox vaccines that are effective against the virus. Such vaccines are available now only in wealthy countries.

Only six disease outbreaks have been declared a PHEIC since 2007: swine flu, polio, Ebola, Zika, Kivu Ebola and COVID-19.  [See the WHO explainer about Monkeypox symptoms and treatment below.]

https://twitter.com/WHO/status/1535592685569986561?s=20&t=z9RSw1le1MRLn-9Lh0oxBg

Image Credits: Diverse Stock Photos , WHO, Disease Outbreak News, 21 May 2022 .

A man with symptoms of trypanosomiasis, a neglected tropical disease, is examined by Dr Victor Kande in the Democratic Republic of Congo (DRC).

The Kigali Summit has called for the renewal of commitments in the fight against neglected tropical diseases (NTDs) through the adoption of the Kigali Declaration on NTDs. 

Sponsored by the government of Rwanda, the Kigali Declaration on NTD is the successor to the ground-breaking London Declaration of 2012, which was a pledge made by governments, donors, pharma, research institutions, NGOs, and other stakeholders to collaborate in their efforts to stop NTDs. 

The new Kigali Declaration aims to mobilize political will and secure commitments to achieve the Sustainable Development Goal target on NTDs and to deliver the targets set out in the World Health Organization’s Tropical Disease Roadmap (2021 – 2030).

The summit, hosted on Thursday by President Paul Kagame of Rwanda and co-convened by The RBM Partnership to End Malaria and Uniting to Combat NTDs, builds on progress made in the last two decades, and even more so since the London Declaration, to galvanize action to end malaria and NTDs. 

The summit is also a critical moment to highlight how investments in fighting both malaria and NTDs have a much broader impact, and increased investments will strengthen health systems and protect against future pandemics. 

In conjunction with the summit, Swiss pharmaceutical company Novartis has endorsed the new declaration and has announced a $250 m five-year commitment in the fight against NTDs.

“Today, by endorsing the Kigali Declaration and pledging to invest USD 250 million, we aim to accelerate  progress toward elimination of these diseases, which continue to cause suffering and stigma  for millions of people around the globe, ” said Novartis CEO Vas Narasimhan.  

Ending NTDs is possible 

Ambitious global commitments over the years have shown that ending NTDs is an achievable goal, with 45 countries eliminating at least one NTD, 600 million people no longer requiring treatment for NTDs, and cases of diseases that have plagued humanity for centuries, such as sleeping sickness and Guinea worm disease, at an all-time low.

However, 1.7 billion people continue to suffer from NTDs, and 241 million people are impacted by malaria globally. 

Additionally, according to the annual G-FINDER report, funding for NTDs remained relatively stagnant, with only snakebite envenoming seeing increased investment in 2020. 

Novartis’ $250 million commitment will be used to advance research and development of new treatments to combat NTDs and malaria.  It includes $1 million to advance R&D, focusing on novel drug candidates for four diseases: Chagas disease, visceral leishmaniasis, dengue fever, and Cryptosporidium. 

Some $150 million will be invested to advance the clinical development of three drug candidates to combat emerging resistance to artemisinin, a well-established treatment for malaria.  

With both its adoption of the Kigali Declaration and this new investment, Novartis reiterated its commitment to the fight against NTDs and malaria.

“Over the past decade, great progress has been made against NTDs, but there is still a lot more work to be done. Novartis will continue progressing our longstanding commitment to helping realize a world free of NTDs,” said Narasimhan.

Image Credits: DNDi.

The Global Health Matters podcast with host Garry Aslanyan.

It was 11 November 2022 when Dr Sikhulile Moyo and his team of scientists in Botswana discovered Omicron in a sample of SARS-CoV2 that looked different from the rest. 

“We sent it back to the lab to have it re-sequenced,” Moyo recalled. But by 19 November, the team was confident about what they had found. Two days later they reported what became known as the Omicron variant to the World Health Organization (WHO).

Moyo’s work raised a red flag for countries around the world. Even today, Omicron and its offspring remain the most dominant COVID-19 strain in circulation. 

PLAY PODCAST

Moyo discovered the Omicron variant in Botswana through careful cross-examination of COVID-19 tests – which is the topic of the most recent Global Health Matters podcast with host Garry Aslanyan.

Garry has two guests with a deep understanding of diagnostics and their application worldwide: Sikhulile Moyo, the research laboratory director at the Botswana Harvard AIDS Institute Partnership; and Bill Rodriguez, the CEO of FIND, the global alliance for diagnostics, and the founder of his own diagnostics company, Daktari Diagnostics.

The COVID-19 pandemic has brought a new global awareness of the need for accessibility to diagnostics in order to protect people. In this episode, the guests help Aslanyan answer questions such as “how available are essential diagnostics in low- and middle-income countries (LMICs)?” They also help listeners better understand the state of diagnostic testing in LMICs and how to achieve equity in access to testing in all countries.

Moyo was able to sound the alarm on Omicron because Botswana had put a good testing system in place, meaning the discovery of Omicron was not an accident but the result of a strategic and intentional increase in diagnostics in the region.

“Botswana decided to make sure there was access testing to all districts by identifying ‘COVID zones,’ Moyo explained. “Each of these areas had a PCR lab and we used the infrastructure from HIV to develop a surveillance strategy that could be built on that. When someone tested positive, we could investigate it.”

The surveillance team genetically sequenced samples from entry points into the country and hospitals – both people who developed severe disease and those who died of the virus.

With regards to the general population, while not everyone could be sequenced, they aimed to conduct a representative sampling.

“Because we were sequencing weekly, we caught those Omicron samples in our batch,” Moyo said.

The scientists noticed that the variant appeared to be an unusual lineage, though they could not have known it would become a variant of concern (VOC). However, on reporting it, they learned that other labs had discovered something similar. Then, on 26 November WHO named it at VOC and gave it the name Omicron. Moyo said he is saving and is going to frame that email to WHO because it changed the world.

“For me, I was fulfilled as a scientist to report something like that,” Moyo said. “But it was also a rollercoaster of emotions because of the way the world reacted with travel bans. I think we learned a lot over the past two years and that reaction was unfortunate.”

COVID highlighted the need for diagnostics manufacturing facilities in the Global South

Pandemics, according to Rodriguez, reveal all the existing problems in society. COVID-19 has highlighted the failure to invest in community-based diagnostics and revealed major gaps between the Global North and Global South in terms of equipment, manufacturing and qualified staffing.

“You may not remember, but two years ago, we became acutely aware of how important testing was and how little access we had to it anywhere in the world – for sure in low- and middle-income countries, but even in higher-income countries,” Rodriguez recalled.

“Now people understand it is a critical part of our health system and we need to make sure it is available,” he continued. “Equity in testing became a cornerstone of the global response to COVID.”

He said it highlighted the need to have a leader, like WHO, to deliver the message that testing was critical, but it also called to the forefront the need to establish diagnostic manufacturing facilities in the Global South.

“The factories that made the test kits were mostly in the Global North and that created problems and made a lot of countries realize how dependent they are,” he said.

Over the past 18 months, efforts have been made to establish sites in the Global South, from Latin America to South Africa – efforts that are too late for COVID, but will prove essential for any future pandemic, Rodriguez said.

COVID led to innovation, digitalization in diagnostics

The situation has also led to improvements in diagnostics and innovation. Today, nearly every country in the world now has the capacity to do sequencing of pathogens and share that information publicly so that it can be incorporated into a global response. Variants can be tracked in nearly real time – something that Rodriguez said was not really done before.

Moreover, the cost of testing has gone down, making testing more accessible to LMICs.

Yet, the testing technology has improved, allowing for multi-lineage molecular testing and more, which will change not only the world’s response to COVID but “will transform primary healthcare across the world,” Rodriguez said.

Also, Moyo noted, digital solutions have hit the market, such as mobile apps for communicating testing results, which has made proper diagnostics more viable.

“Some have said we should not waste a crisis,” noted Moyo. “We should use the opportunity COVID has given us to improve public health.”

Global Health Matters is available on Apple Podcasts, Spotify, Google Podcasts, Amazon Music, Stitcher or wherever you find your podcasts.

Read about and listen to more episodes on Health Policy Watch.

This article is part of our TDR Supported Series.

Image Credits: Global Health Matters podcast.

Pro-abortion demonstrators in the US

Americans are bracing for a firestorm over abortion rights as the US Supreme Court prepares to announce its decision soon in the landmark 1973 Roe v. Wade case.

The court’s conservative majority is expected, based on a leaked draft of Justice Samuel Alito’s opinion in Dobbs v. Jackson Women’s Health Organization in early May, to strike down the case. If that happens, 26 of the country’s 50 states are likely to move quickly to ban abortion, according to the Guttmacher Institute, a New York-based NGO that researches and advocates for reproductive rights.

Half of those 13 states — Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming — have laws in place to automatically end legal abortion services, the institute says, noting that more than half of all US women, or 58%, live in states hostile to abortion where the ban would likely take hold.

In contrast, 16 states and the District of Columbia have laws that protect the right to abortion. They already are preparing for a huge jump in demand for abortion services from women who live in states where the bans would likely be enforced.

58% of U.S. women of reproductive age—40 million women—live in states hostile to abortion rights
Last month, New York State Governor Kathy Hochul announced a $35 million investment to directly support abortion providers in anticipation of Roe v. Wade being overturned. 

“New York has always been at the forefront of the fight for abortion rights, and as the first female governor of New York, I will not let us go backwards,” said Hochul. “This landmark funding will get resources into the hands of clinics who need our help, safeguarding access to abortion in our state and setting an example for the rest of the nation to follow.”   

‘I would not be health commissioner’

This week, New York State Health Commissioner Dr Mary Bassett revealed in Elle magazine that she had an abortion as a medical student.

“How could a first-year intern who was expected to work 36-hour shifts also carry and care for a child? She—I—could not,” wrote Bassett, in a rare public acknowledgement by a high-ranking public official in the US. She later gave birth to two children.

“Had it not been for the abortion I received before I began my internship, I would not be New York’s health commissioner today. More importantly, I would not be the committed mother that I have been able to be to my two adult daughters for over 34 years,” added Bassett, in the article published on Tuesday.

Basset said taking away the right to abortion will not stop abortions, it will only make them “more desperate, deadly, and dangerous,” especially for people who are poor and “communities of color.”

Abortion pills to overcome ban?

Abortion advocates believe medical abortions performed using pills are the best solution for women living in states where bans are introduced. In 2020, so-called medication abortion accounted for 54% of all US abortions, outstripping surgical abortions for the first time.

In a letter to the heads of the US Congress, Hochul appealed for greater financial support for telehealth services and to “ensure the US Postal Service’s ability to ship abortion medication to all states”.

European sanction for US anti-abortion move

Earlier in the month, the European Parliament voted 364-154 to pass a resolution that “strongly condemns the backsliding in women’s rights and sexual and reproductive health and rights (SRHR) taking place globally, including in the US and in some EU member states”.

The resolution, which passed on June 9 with 37 abstentions, says SRHR are fundamental human rights that “should be protected and enhanced and cannot in any way be watered down or withdrawn.” It also cites deep concerns over how bans on abortions “will contribute to the trauma of rape and incest victims.”

Because of those concerns, European lawmakers urged the US government to “fully decriminalise abortion” and to ensure adequate protections exist for “the right to terminate a pregnancy,” including adequate funding needed in the US and globally.

“In countries heavily dependent on US aid for public health programmes, [Roe’s] overturning could have an impact on those governments’ commitment to abortion provision and other reproductive rights,” it said.

At 14, Sierre Leone’s Dankay Kanu (on right) was impregnated by an older man who refused to wear a condom then denied paternity.  She is portrayed here with a mentor from 2YoungLives, a programme that helps pregnant girls and teenage mothers in Sierra Leone.

‘Crisis of unintended pregnancies’ – UNFPA

Earlier in the year, the United Nations Population Fund (UNFPA), which coordinates the UN’s work on sexual and reproductive health agency, reported nearly half of all the 121 million a year in pregnancies worldwide between 2015 and 2019 were unintended. 

“Over 60% of unintended pregnancies end in abortion and an estimated 45% of all abortions are unsafe, causing 5 – 13% of all maternal deaths, thereby having a major impact on the world’s ability to reach the Sustainable Development Goals,” according to the UNFPA.

UNFPA Executive Director Dr Natalia Kanem said the staggering number of unintended pregnancies represents a global failure to uphold women and girls’ basic human rights.

“For the women affected, the most life-altering reproductive choice — whether or not to become pregnant — is no choice at all,” she said. “By putting the power to make this most fundamental decision squarely in the hands of women and girls, societies can ensure that motherhood is an aspiration and not an inevitability.”

Image Credits: Gayatri Malhotra/ Unsplash, Michael Duff/ UNFPA.

Nutritionist Claudette Kayitesi counsels Francois Iyamuremye as he receives his monthly antiretroviral medication at TRAC Plus Clinic in Kigali, Rwanda.

People are living with HIV for much longer thanks to greatly improved antiretroviral treatments. But they also are at disproportionately high risk for non-communicable diseases which affect everyone  more as they age. Now is the time to tackle both in a more integrated way.

The extraordinary advances in science over the past three decades that led to the development of highly effective antiretrovirals have transformed HIV/AIDS from a death sentence into a chronically manageable disease when supported with appropriate diagnosis and care. 

But the rising life expectancy of people living with HIV (PLHIV), and the resultant greying of the HIV epidemic, especially in high-income countries, means that they are as vulnerable to non-communicable diseases (NCDs) as the rest of the ageing population.  

In parallel, People living with HIV are also at a disproportionately high risk of some NCDs, creating an HIV-NCD syndemic. For instance, cardiovascular disease is now one of the leading causes of non-AIDS-related morbidity and mortality in PLHIV, who have a two-fold increased risk of cardiovascular disease compared to the rest of the population.

They also are at higher risk of type 2 diabetes and some types of cancer – for example, there is a nearly six-fold increased risk for cervical cancer among women living with HIV.

The disease landscape has shifted drastically over the past decade. NCDs and injuries are emerging as the leading causes of death and disability, in large part due to global progress made in reducing mortality associated with infectious diseases like malaria, tuberculosis and HIV/AIDS.

NCDs are increasingly affecting people living with infectious diseases, undermining decades of hard-won progress on tackling the HIV/AIDS epidemic.

South Africans struggle with diabetes and HIV 

South Africa, home to the largest population of people living with HIV in the world, also has the highest prevalence of diabetes in sub-Saharan Africa. One in eight South Africans (4.5 million people) are living with diabetes, double the number of less than five years ago. 

Deaths due to diabetes reached nearly 90 000 in 2019, double the figure of a decade earlier. AIDS takes the lives of some 125 000 South Africans each year. There is an inevitable intersection between the two diseases as there is between other NCDs such as hypertension and cardiovascular disease. If we are serious about reducing the shifting disease burden for this and future generations, it can’t be business as usual.

Keeping people living with HIV healthy will require a new integrated approach to disease management that better reflects a person’s health throughout their life course, shifting the focus away from the single health crisis or condition that leads them to seek care in the first instance. 

This emerging approach was given impetus for the first time at last year’s United Nations General Assembly High-Level Meeting on AIDS and reinforced in a recently published report.

Checking blood sugar levels of a patient with diabetes.

Integrated community care

On the ground, there are some good examples of HIV/NCD integration. The Cervical Cancer Prevention Program in Zambia (CCPPZ) is the first-ever cervical cancer prevention initiative for women living with HIV to be funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR). 

The cervical cancer screening services began with two public sector clinics in the country’s capital city (Lusaka) in 2006, and a decade later CCPPZ was operational in 33 government-run health facilities across all of Zambia’s 10 provinces, serving women regardless of HIV status.

By 2015, the program had screened over 200,000 women, and that year it was adopted as the Ministry of Health’s official cervical cancer prevention programme. By focusing initially on women living with HIV, the programme was able to first reach those who were at highest risk of cervical cancer.

A collaboration between Partners in Health and the Malawi Ministry of Health to decentralise HIV/AIDS services in Neno, one of Malawi’s poorest rural districts, in 2007, is another good example of integration. The initiative used community outreach events to identify patients requiring HIV care and mobilise them to go to one of the district’s 12 primary health centres, with active home-based follow-up and support provided by a team of 900+ trained and mentored community health workers.

Specialised HIV/AIDS treatment and care, for those who required it, was available via referral linkages with the district’s two hospital facilities. The initiative proved highly successful with more than 62 per cent of the total expected district population of PLHIV enrolled in the programme by the end of 2015, and a treatment retention rate of more than 85%. 

The programme was then expanded in early 2015 to an Integrated Chronic Care Clinic, providing comprehensive integrated primary care for a range of chronic conditions – including HIV, hypertension, asthma, epilepsy, diabetes and mental health. With political and institutional commitment, initiatives may well become the rule and not the exception for future HIV management across the African region and beyond.

Katie Dain is the CEO of the NCD Alliance.

Lobna Salem is the Regional Chief Medical Officer for Developed Markets at Viatris, a US-based pharmaceutical company. 

 

 

 

 

 

 

Image Credits: Photo credit Jake Lyell/ Bill & Melinda Gates Foundation, LinkedIn .