Incoming Gavi CEO Sania Nishtar

Pakistan Senator Dr Sania Nishtar  has been appointed new CEO of the global vaccine alliance, Gavi, and will take up the position on 18 March.

This follows the previous appointee, Dr Muhammad Pate, pulling out last June – six weeks before he was due to take office, in order to serve as health minister of Nigeria.

Nishtar has had a 30 year career as a global public health leader. Her roles have included Special Assistant to Pakistan’s Prime Minister on Social Protection and Poverty Alleviation, and Federal Health Minister during her country’s 2013 caretaker government.

She was the inaugural Chair of the UN Secretary-General’s Independent Accountability Panel (IAP) for women’s and children’s health and Co-Chair of the World Health Organization’s (WHO) Independent High-level Commission on Non-communicable Diseases.

She also founded the non-profit NGO think tank, Heartfile, to campaign for health reform in Pakistan. 

Nishtar graduated from Khyber Medical College in Peshawar, Pakistan, top of her class. She is a Fellow of the Royal College of Physicians and received a PhD from King’s College London, which awarded her an honorary Doctorate in Science, Honoris Causa, in 2019. 

In 2020, she was listed on one of the BBC’s 100 Women, a list of inspiring and influential women from around the world.

“Over three decades of leadership at the national and global levels, Dr Nishtar has built a reputation as a tireless advocate for health equity, an innovative thinker and a proven doer when it comes to solving complex challenges,” said Professor José Manuel Barroso, Chair of the Gavi Board.

“I am impressed by her accomplishments and excited by the possibilities her appointment brings for our Alliance and our ambitions to protect future generations.”

Enormous task

Meanwhile, Nishtar said that “health starts with life-saving vaccines”. 

“Over the past 23 years, Gavi has been one of the most impactful organisations in global health. The task ahead is enormous – from health impacts of climate change, to the need to tackle vaccine inequity, prepare for future outbreaks and boost routine immunisation, which I believe is the gateway to achieving Universal Health Coverage,” she added.

“I am honoured by the trust the Gavi Board has placed in me and look forward to working with Gavi’s talented staff and skilled Alliance partners to ensure Gavi reaches hundreds of millions of children in lower-income countries with life-saving vaccines against deadly and debilitating diseases.”

Gavi’s fifth five-year strategic period drawing to a close at the end of 2025, and the organisation will seek board approval during this year for its next five-year strategy for 2026–2030. 

Image Credits: Gavi.

Dr Tedros with Cabo Verde Prime Minister Ulisses de Pina Correia e Silva at the ceremont to mark the country conquering malaria.

Cabo Verde was certified as malaria-free on Friday by the World Health Organization (WHO), only the third African country to have achieved this milestone.

The country, an archipelago of 10 islands off the West African coast near Senegal, joins 43 countries including African countries Mauritius and Algeria in eliminating malaria. 

Its last indigenous malaria case was recorded in January 2018.

“WHO’s certification of Cabo Verde being malaria-free is testament to the power of strategic public health planning, collaboration, and sustained effort to protect and promote health,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

Certification is granted when a country has shown “with rigorous, credible evidence” that the chain of indigenous malaria transmission by Anopheles mosquitoes has been interrupted nationwide for at least the past three consecutive years, and that the country has the capacity to prevent the re-establishment of transmission, according to the WHO.

“The certification as a malaria-free country has a huge impact, and it’s taken a long time to get to this point,” said Cabo Verde Prime Minister Ulisses Correia e Silva. “In terms of the country’s external image, this is very good, both for tourism and for everyone else. The challenge that Cabo Verde has overcome in the health system is being recognised.”

Collaboration

Cabo Verde included the elimination of malaria in its national health policy in 2007. A strategic malaria plan from 2009 to 2013 focused on expanded diagnosis, early and effective treatment, and the reporting and investigating all cases. 

To stem the tide of imported cases from mainland Africa, diagnosis and treatment were provided free of charge to international travellers and migrants.

Even during the COVID-19 pandemic, the country focused on improving the quality and sustainability of vector control and malaria diagnosis, strengthening malaria surveillance –   particularly at ports, airports, in the capital city and areas with a risk of malaria re-establishment.

The Ministry of Health worked with other government departments focused on the environment, agriculture, transportation, and tourism. The inter-ministerial commission for vector control was chaired by the Prime Minister and ensured collaboration, including  from community-based organisations and NGOs.

“This is an extraordinary accomplishment, a beacon of hope at a time when climate change threatens to slow down our progress in the global fight against malaria,” said Peter Sands, Executive Director of the Global Fund, which has assisted to fund the country’s anti-malaria efforts.

“What’s now crucial is that we do not lower our guard, and that we help Cabo Verde sustain this achievement and prevent the reintroduction of malaria. With this aim in mind, we will continue to fund vector control interventions and ensure quality case management and disease surveillance for another three years.”

Sands also called for use of new products that have proven to be safe and effective – such as next-generation insecticide-treated nets, insecticides, diagnostics, treatments or vaccines. 

“At the same time, it is crucial to build the supply chain, human resources for health and disease surveillance systems to support quality service delivery,” said Sands.

The Global Fund provides 65% of all international financing for malaria programs and has invested more than US$17.9 billion in malaria control programs as of June 2023.

Marion Koopmans addresses the WHO consultation

The World Health Organization (WHO) launched a series of consultations with the scientific community this week aimed at building consensus about how best to identify and address the pathogens most likely to cause epidemics and pandemics.

The first consultation kicked off on Tuesday, with some of the world’s top scientists addressing how to develop a scientific framework for epidemics and pandemics.

Hosted by the WHO’s Research and Development (R&D) Blueprint, it is one of four planned consultations to be held over the next few weeks as the WHO prepares to release an updated list of priority pathogens that pose epidemic and pandemic threats.

The priority pathogen list was last updated in 2018 and the WHO has indicated that it will publish a new list in the first half of this year.

Since November 2022, the WHO has focused on entire classes of viruses or bacteria rather than individual pathogens that pose threats in a process chaired by US virologist Dr Barney Graham from Morehouse School of Medicine in Atlanta.

“Over 200 scientists from 53 countries are independently evaluating the evidence related to 30 viral families, one core group of bacteria, and “Pathogen X” – an unknown pathogen with the potential to trigger a severe global epidemic,” according to WHO. 

“This new approach will also help identify representative viruses (or prototypes) within a viral family as a pathfinder in generating evidence and filling knowledge gaps that may then apply to other viruses of threat in the same family.”

Priority list ‘almost finished’

Dr Marie Paule Kieny, chair of the working group on Rhabdoviridae viruses, told Tuesday’s consultation that the WHO was “almost finished” prioritising the 30 viral families for their pandemic potential and whether there are medical countermeasures to stop their spread.

“From early 2024, WHO will start phase two, which will be a public health prioritisation [of the pathogens] with a process involving a prioritisation advisory committee with 40 to 50 experts where the output is expected to be the final shortlist of viral and bacterial families with pandemic potentials, including prototype pathogens,” said Kieny.

“It is absolutely indispensable that trials to demonstrate the efficacy of medical countermeasures are integrated into the outbreak response,” she added.

Once the list had been finalised, it would enable the “scaling up of a scientific approach to pandemic preparedness and will unravel a number of scientific opportunities,” said Kieny. 

Rapid research to stop outbreaks

British virologist Dr Peter Daszak offered a view from the field, showing how rapid research could prevent outbreaks.

Daszak’s team has identified a virus with similar properties to SARS CoV2 in caves in China frequented by bats and humans collecting their faeces to fertilise their crops.

“Here we have a virus in bats right now in a cave that’s used by people who are highly exposed to faeces and this is a virus that shed in bat faeces,” said Daszak.

“It has real potential for emergence. But the good news is, because we could do serological assays and we have a lot of access to human sera from the region, we know that most people in the region have either had COVID or have been vaccinated and that will provide really good protection, we think against this virus.”

By encouraging people to wear PPE and working with them to understand the risks, the scientists and local health authorities could reduce the potential for this virus to spill over, he added.

“If we target our surveillance, if we use the right technological approaches, we can discover really interesting and important new evidence of potential spillover of pathogens and do something about it, try and prevent that from becoming an outbreak,” concluded Daszak.

Bringing research and public health together

Renowned Dutch virologist Dr Marion Koopmans told the meeting that “the evolving global pathogen surveillance network” offered a huge opportunity for collaboration on “building surveillance and sequencing capacity for the common pathogens”.

However, she added that every region has its own pathogen hotspots and priorities.

“We need sampling designed that bears in mind the likely disease emergence scenario in each region. Do I want to be able to detect it pre-emergence, for instance, for vector-borne diseases going forward… or do I want to develop it into an early warning surveillance including, for instance, wastewater surveillance,” said Koopmans.

“the opportunities are there, the tools are there. They need to be further developed for routine implementation and that to me is the next step. What that requires in terms of collaboration is much closer connection between the more research type work in clinical settings and public health settings, rather than setting up separate data and sample collection studies for emerging diseases,” she added.

The next two consultations take place next Thursday and Friday, with the fourth to be held in February.

Wounded people wait to be treated at Al Shifa Hospital in Gaza City. Al Shifa is barely functioning due to lack of staff and supplies due to Israel’s closure of the area.

The World Health Organization’s (WHO) Director General has appealed to Israel to permit it to deliver more medical supplies to Gazan health facilities, particularly in northern Gaza, after Israel refused to allow WHO convoys to travel to the area seven times in the past two weeks.

“We call on Israel to approve requests by WHO and other partners to deliver humanitarian aid,” Dr Tedros Adhanom Ghebreyesus said at the global body’s first press conference of the year on Wednesday.

“We have the supplies, the teams and the plans in place. What we don’t have is access. WHO has had to cancel six planned missions to northern Gaza since 26 December, when we had our last mission because our requests were rejected, and assurances of safe passage were not provided. A mission plan for today has also been cancelled,” said Tedros.

He said that the situation in Gaza was “indescribable” with almost 90% of the population of 1.9 million people being displaced.

“People are standing in line for hours for a small amount of water, which may not be clean or bread, which alone is not sufficiently nutritious. Only 15 hospitals are functioning even partially. The lack of clean water and sanitation and overcrowded living conditions are creating the ideal environment for disease to spread,” he added.

“This Sunday marks the 100th day of the conflict in Israel and the occupied Palestinian territory,” Tedros noted. 

“We continue to call for the release of the remaining hostages, and we continue to call on all sides to protect health care in accordance with their obligations under international humanitarian law. Health care must always be protected and respected it cannot be attacked and it cannot be militarised.”

Dr Tedros Adhanom Ghebreyesus

Gaza laboratories destroyed

However, the WHO is unable to say what diseases are spreading as there is no way of diagnosing diseases because the facilities of Gaza Central Public Health Laboratory are no longer functional, said Dr Mike Ryan, WHO’s head of health emergencies.

The Central Public Health Laboratory had been in place for the last 40 years, providing “very high quality, environmental and human health sampling systematically across Gaza”, Ryan added.

“We are trying to make arrangements for samples to be taken out of the country and tested, and in other places to bring in mobile labs,” said Ryan. “And these are the trade-offs when you talk about access. Do you replace a truck of food with a truck of lab supplies? Which truck has more priority? Do you bring in water testing equipment or bring in water?”

Declaring WHO’s readiness to assist in Gaza, Ryan hit out at those criticising UN agencies for not doing enough.

“If you continue to destroy infrastructure, if you continue to draw destroy services at this rate, and then you blame the people who are trying to come in and support and help and provide life-saving assistance, who’s to blame here?” Ryan asked.

“Is it the people who are destroying the infrastructure and destroying the livelihoods and destroying the services? Or is it those who are trying to help restore those services under intense bombardment, under the threat of violence?”

Meanwhile, Dr Rik Peeperkorn, WHO’s Jerusalem-based representative for the Occupied Palestinian Territory, added that 16 out of 21 other planned United Nations humanitarian convoys carrying food, fuel and water to areas of northern Gaza that are now under Israeli military control had also been refused entry Gaza in January alone.

Peeperkorn also expressed concern that hostilities and evacuation orders were intensifying in southern Gaza close to Nasser and Gaza European Hospitals in Khan Younis, the only operational referral hospitals there, as well as Al Aqsa Hospital, in Gaza’s central region  – which together serve around two million people.

Image Credits: @alijadallah66 /Al Andalou News Agency, WHO .

Air pollution data for 2023 across seven cities in India, including its capital Delhi, shows air pollution levels either remained the same or worsened in winter months despite a national programme to improve air quality.

PUNE, India – India’s National Clean Air Programme (NCAP) was launched five years ago and has provided budgets to 131 Indian cities to respond to air pollution.

But over half of this money had not been used by the end of 2023, according to the latest figures released by the government, while the programme’s impact on reducing pollution has been “mixed”. This is according to an analysis of air pollution levels since NCAP was initiated, conducted by Climate Trends.

The NCAP’s initial target was to reduce two key air pollutants – PM10 and PM2.5 (ultra-fine particulate matter) – by 20 to 30% by 2024, but in September 2022, this target was revised to a 40% reduction by 2026.

“In 49 cities, PM2.5 data was available for all five years. Out of these, 27 cities recorded improvements in PM2.5 levels from 2019 to 2023,” according to the report.

“Similarly, for PM10, data across five years was available for 46 cities. Of these, 24 cities saw an improvement in their PM10 levels.”

The most significant improvement in air pollution was seen in Varanasi, the home constituency of India’s Prime Minister, Narendra Modi, where PM 2.5 air pollution was reduced by 72% and PM10 by 69%, according to government data.

However, IQAir still shows “unhealthy” levels of air pollution in Varanasi. The improvement the government data shows does not always match those by independent monitors and concerns have been raised in the past by advocates and activists about the government figures.

Several cities experienced increases in PM2.5 from 2019 to 2023. These include Navi Mumbai (46% increase), Ujjain (46%) and Mumbai (38%).

“Such marginal and short-lived improvements show that we need a science-based, well-planned, and comprehensive action plan which takes into account sources of pollution and meteorological factors,” said Aarti Khosla, Director of Climate Trends.

Around 99% of the world’s population breathes in air that exceeds the pollution standards set by the World Health Organization (WHO).

But the Indo-Gangetic plain that stretches from Pakistan in the west to Bangladesh in the east is home to some of the world’s most polluted cities like Lahore, Delhi, Kolkata and Dhaka. The region is a plain bordered by the Himalayas in the north which makes air flow difficult, causing pollution to remain in the air over some of the most densely populated cities in the world.

Addressing other sources of pollution

A lot of the conversation in Delhi around its air pollution has been focussed on stubble burning in neighbouring states as farmers clear their fields for the next planting season. While stubble burning has reduced, other sources of pollution have not.

“In Delhi, it is important to mention that fire counts (stubble burning events) decreased considerably in Punjab and Haryana in this season of October and November, which contributes a significant portion to the emission of PM2.5,” said S K Dhaka, Professor in the Department of Physics at Delhi University’s Rajdhani College.

“Despite the fact that the pollution level remains high in November, and remains similar in December, there is a need to address other sources of emissions such as transport, construction, and operation of thermal power plants in Delhi NCR,” Dhaka says.

A significant part of India’s air pollution comes from the energy sector. The country’s coal usage to generate energy has continued to grow, despite climate commitments at the international level. Coal is a highly polluting source of energy and its use has doubled in the past ten years to meet the demands of a growing population as well as the industrial sector. India’s pollution numbers reflect the emissions that have not changed much.

Kolkata’s air pollution has been on the whole lower in both 2022 and 2023 which suggests that efforts to control and manage pollution have been effective.

Some cities like Kolkata have shown improvements compared to the national average that show strategies when implanted effectively can deliver results. Kolkata was one of the few cities that used most of the budget it received from the NCAP to address air pollution.

Data across the past five years has found that some cities experienced increases in pollution concentrations, underscoring the complexity of achieving air quality targets.

Increased advocacy has led to an increase in air quality monitoring in most cities, with a significant number seeing an increase in active monitors, according to Climate Trends.

No progress in the past year

Meanwhile, air pollution levels in most major cities in India either remained the same or worsened in the winter months of 2023 in comparison to 2022.

This is according to an analysis of data from India’s Central Pollution Control Board (CPCB)  from seven Indian cities, Delhi, Chandigarh, Lucknow, Varanasi, Patna, Kolkata and Mumbai.

“Comparing monthly average pollution levels between 2022 and 2023 shows some improvements, especially in Lucknow and Varanasi, but at the same time in the winter months, where air quality matters more than other months due to fog and temperature drop, we see that cities of Delhi and Chandigarh are either the same across years or worse off,” says Climate Trends director Khosla, who conducted the analysis.

The data underscores the need for targeted interventions to address the specific seasonal challenges.

In 2023, Delhi experienced a surge in winter pollution compared to 2022 that has been attributed to factors like meteorological conditions and increased emissions.

Image Credits: Unsplash, Climate Trends, Unsplash.

COVID
The WHO has urged countries to continue to sequence COVID-19 samples to monitor variants.

The JN.1 COVID-19 variant is completing its global takeover, with the number of new cases having increased by 52% during the 28 days leading up to the end of the year, according to the World Health Organization (WHO). 

In the United States, JN.1 accounts for more than 60% of COVID-19 cases, according to the Centers for Disease Control and Prevention – and all of this on top of rising influenza and Respiratory Syncytial Virus (RSV) waves. 

“The pandemic is far from over,” stressed American scientist Eric Topol in an opinion piece in the Los Angeles Times. 

What is JN.1?

JN.1 is a derivative of the BA.2.86 Omicron subvariant of SARS-Cov-2 but with more than 30 mutations. Israeli variant trackers first discovered it in August. WHO first spoke about JN.1 at a press conference on 19 October press as a variant “to keep a close eye on.” Last month, it named JN.1 a “variant of interest” (VOI) but nit the more serious “variant of concern” (VOC). 

According to Topol, “by wastewater levels, JN.1 is now associated with the second-biggest wave of infections in the United States in the pandemic, after Omicron.” He said the level indicates that around two million Americans are infected with JN.1 daily.

Although many people are carrying the virus and CDC data shows that US COVID-19 hospitalizations have continued to increase in the last two months, JN.1 has not caused the surge of hospitalizations seen in Omicron. 

This is also the case in other countries, including Israel, where it was first discovered, according to Cyrille Cohen, the head of the field of life sciences and medicine for the Israel Science Foundation and a professor at Bar-Ilan University. He said the country is seeing 10 to 20 cases of severe COVID-19 disease in hospitals on any given day, compared to as many as 1,400 two years ago. 

At the same time, studies are starting to show that the updated COVID-19 vaccines developed by Pfizer, Moderna and others are eliciting antibodies against JN.1 – at least in vitro, according to Cohen. 

For example, Kaiser Permanente recently released a report that showed a vaccine booster conferred approximately 60% protection against hospitalization for JN.1 and other recently identified variants. 

However, Cohen cautioned that it can be challenging to determine the impact of COVID-19 vaccines today as people have had so many shots at different intervals and of different versions. Moreover, most people have either been exposed to or are sick with COVID-19. 

The other issue is that vaccine uptake is deficient. CDC data as of 5 January showed that only 8% of eligible children and 19.4% of eligible adults had received the updated 2023-24 COVID-19 vaccine. The percentage jumped to around a third (38%) among adults over 65. 

Many more people are opting to take the influenza vaccine: 44% of children and 45% of adults, including 70% of adults over 65. 

Evaluating JN.1: What to ask

Whenever there is a new variant, you need to ask three questions, explained Peter Chin-Hong, a professor of medicine and infectious disease at the University of California, San Francisco: Is it more transmissible? Do the vaccines work? Does it cause more severe disease?

Is it more transmissible?

Chin-Hong told Health Policy Watch that the data indicates JN.1 is more transmissible “because it is rising to the top of the charts very quickly.” He said that at the beginning of November 2023, JN.1 accounted for between 5% and 8% of all US cases, and today it is the most common variant. 

Can it evade vaccines?

The answer here, Chin-Hong said, is generally no. He said the studies show that the vaccine works as long as people are newly inoculated. He recommended the vaccine for immuno-compromised people with pre-existing medical conditions and those over the age of 75. For these people, he said, “just being infected a year ago and getting the first two shots will not be enough.”

Does it cause more severe disease?

According to Chin-Hong, there is no evidence that JN.1 has caused more severe diseases so far and no evidence that it will. This is true in the countries currently experiencing a rise in the variant, and also from data in Singapore and other countries where JN.1 has been the predominant variant for longer, he said. 

In those countries, the variant did not seem to cause more people to be hospitalized. 

Moreover, he added that antiviral drugs such as Paxlovid and Remdesivir continue to work to curtail the severity of the virus. 

Instead, he said his concern is that JN.1 will exploit the world’s COVID-19 complacency. The majority of countries have not kept up testing or vaccination, and given its high price tag, many low- and middle-income countries do not have access to drugs like Paxlovid. 

“Those are the vulnerabilities that JN.1 will exploit,” Chin-Hong said. 

COVID-19: ‘a new era’

But Cohen said he believes the world and COVID-19 are “in another era” since WHO ended the virus’s official pandemic status in May 2023. He noted that COVID-19 is not the same threat as at the pandemic’s beginning or even during Delta. 

“With the Omicron era that started exactly two years ago, the infection decreased in intensity,” Cohen said. Moreover, “since most of us were exposed to COVID at least once in our lifetime, there is also some kind of protective [herd] immunity.”

That does not mean, however, that the medical and scientific community should not be taking JN.1 or COVID seriously, Chin-Hong stressed. He said WHO should hurry to give the variant a Greek letter name, such as Pi, to “allow governments and people to mobilize” and fight the virus. 

“Right now, people are fed up with COVID,” Chin-Hong told Health Policy Watch. “Giving it a letter will give something to people to latch onto: let’s vaccinate against Pi, get medicines, and have a global talk about sequencing.

“These things have trickle-down effects,” he continued. “Giving it a name would also help the everyday person believe he still has something to pay attention to.”

Chin-Hong and Cohen said that information remains crucial and that countries should continue to sequence to identify variants of concern. 

“We need to monitor those variants because it is not the end of COVID,” Cohen said. Just like with flu, which has an intense strain every 10-20 years, he said that COVID-19 could also once again have a more dangerous strain.”

As Topol wrote in the LA Times: “Inevitably, there will be another strain in the future that we are not at all prepared for and will lead to yet another very big wave across the planet.”

Image Credits: Photo by Mufid Majnun on Unsplash.

Vaccine
Health workers prepare a vaccine

The rising number of US citizens declining vaccinations is threatening population immunity to certain diseases, according to two US Food and Drug Administration (FDA) leaders.

“The situation has now deteriorated to the point that population immunity against some vaccine-preventable infectious diseases is at risk, and thousands of excess deaths are likely to occur this season due to illnesses amenable to prevention or reduction in severity of illness with vaccines,” according to FDA Commissioner Dr Robert Califf and Dr Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research writing in the journal, JAMA.

They cite a recent measles outbreak in central Ohio involving 85 children, 36 of whom (42%) had to be hospitalized for complications.

High-income parents ‘prefer social media’

“It is sobering to note that vaccine hesitancy to childhood vaccines, such as the measles, mumps, and rubella vaccine, has been found to cluster in middle- to high-income areas among parents with at least a college degree who preferred social media narratives over evidence-based vaccine information delivered by clinicians,” they note.

In addition, only 35% of people older than 65 have had the updated COVID-19 vaccine (XBB.1.5 monovalent), which is about half the rate in this age group in the UK.

“Contrary to a wealth of misinformation available on social media and the internet, data from various studies indicate that since the beginning of the COVID-19 pandemic, tens of millions of lives were saved by vaccination. The benefits of these vaccines in prevention were largest in older individuals. However, studies show that people of all ages who are up to date on vaccination benefit and have a lower risk of developing long COVID,” they note.

Mortality per Million Individuals From COVID-19 in the US Depending on Vaccination Status

Uptake of the influenza vaccine amongst US citizens over 65 is also inadequate. 

“Vaccination rates against these respiratory pathogens are inadequate, and this is most distressing in older individuals in whom the benefits of vaccination in reducing hospitalization and death are eminently clear.”

Califf and Marks urge the clinical and biomedical community to “redouble efforts to provide accurate plain-language information” about the benefits and risks of vaccination. 

“We believe that the best way to counter the current large volume of vaccine misinformation is to dilute it with large amounts of truthful, accessible scientific evidence,” they argue.

Clinicians who provide care are the most trusted source of information about health decisions, while retail pharmacists perform this role for people who lack a primary care clinician or who are uninsured.

“All those working in health care, while being straightforward about the risks, need to better educate people regarding the benefits of vaccination, so that individuals can make well-informed choices based on accurate scientific evidence,” they urge.

Ironically, 2024 is the fiftieth anniversary of the World Health Organization’s Expanded Programme on Immunization (EPI), which aimed to ensure equitable access to life-saving vaccines for every child, regardless of their geographic location or socioeconomic status. 

Texas case against Pfizer 

The FDA leaders’ appeal comes shortly after Texas Attorney General Ken Paxton launched court action against Pfizer late last year for “false, deceptive, and misleading acts and practices” relating to its COVID-19 vaccine.

“The pharmaceutical company’s widespread representation that its vaccine possessed 95% efficacy against infection was highly misleading,” according to Paxton in a media release.

Paxton, who is seeking more than $10 million in fines, claims he is “pursuing justice for the people of Texas, many of whom were coerced by tyrannical vaccine mandates to take a defective product sold by lies”.

In response, Pfizer has applied for the case to be moved to the Northern District of Texas, saying that the case has no merit. It also claims that it is immune from liability under federal and state law in terms of the Public Readiness and Emergency Preparedness (PREP) Act for Medical Countermeasures Against COVID-19 passed in 2020.

“The FDA … is in the best position to resolve questions concerning the accuracy and propriety of statements Pfizer allegedly made concerning the COVID-19 vaccine, which the FDA itself vetted, authorized, and approved,” according to Pfizer in its legal filing.

Paxton’s court action has been hailed by anti-vaxxers on social media, many of whom are supporters of Donald Trump, in a country where uptake of vaccinations have become politicised, particularly during the pandemic. Republican supporters are significantly less likely to be vaccinated against COVID-19 than Democrats and died in greater numbers during the pandemic.

Image Credits: WHO Afro region, JAMA.

The first two girls ever vaccinated with the malaria vaccine RTS,S in Ghana. Now a second vaccine, R21/Matrix-M has been added to WHO’s recommended procurement lists.

The World Health Organization (WHO) has added the R21/Matrix-M malaria vaccine to its list of ‘prequalified’ vaccines, paving the way for bulk procurement and mass deployment of the new vaccine across malaria-endemic countries by UNICEF and other global health agencies.

The prequalification of the world’s second malaria vaccine, developed by Oxford University and manufactured by Serum Institute of India (SII), is expected to greatly expand access to malaria vaccination, particularly in malaria endemic regions of sub-Saharan Africa where supplies of the already available RTS,S vaccine cannot alone meet the high demand, said WHO in a statement on Thursday.

Some 100 million doses of the new vaccine are reportedly ready for rollout by SII, a major supplier of vaccines in Africa.

“Today marks a huge stride in global health as we welcome the prequalification of R21/Matrix-M, the second malaria vaccine recommended for children in malaria endemic areas,” said Dr Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals. “This achievement underscores our relentless commitment to wiping out malaria which remains a formidable foe causing child suffering and death.”

Nearly half a million children in WHO’s African Region die from malaria each year – making it one of the continent’s biggest early childhood killers, despite declining death rates over the past two decades.  Globally, in 2022, there were an estimated 249 million malaria cases and 608,000 malaria deaths across 85 countries.

R21 malaria vaccine administration in clinical trials sponsored by Oxford University, which concluded with regulatory approval of the world’s second malaria vaccine.

Prequalification ensures safe manufacture of the vaccine

In October, WHO recommended use of the R21/Matrix-M vaccine,  developed by Oxford University and manufactured by Serum Institute of India, for the prevention of malaria in children following a review by the Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Group.

However, WHO “prequalification” remains a prerequisite for bulk vaccine procurement by UN agencies as well as for many other donor-supported programmes in countries. Effectively, the pre-qualification label confirms that the manufacture of the vaccine, in this case by SII, meets international standards.

“Achieving WHO vaccine prequalification ensures that vaccines used in global immunization programmes are safe and effective within their conditions of use in the targeted health systems,” said Dr Rogério Gaspar, Director of the Department of Regulation and Prequalification.

The first malaria vaccine to be approved by WHO, RTS,S/AS01 vaccine, obtained prequalification status in July 2022.  While the second vaccine R21/Matrix-M seemed to show even better results in some of clinical trials conducted prior to regulatory approval, WHO has said both are equally effective, noting that the two vaccines have not actually been tested head-to-head.

“Both vaccines are shown to be safe and effective in clinical trials, for preventing malaria in children,” said WHO in its statement. “When implemented broadly, along with other recommended malaria control interventions, they are expected to have a high public health impact.”

Image Credits: WHO/Fanjan Combrink, University of Oxford/Tom Wilkinson.

Nurses| Cameroon
Student nurses prepare for the morning rounds at the Ndop District Hospital in Cameroon.

The worldwide shortage of nurses should be considered a “global health emergency” – yet governments are failing to invest in measures to retain these essential workers, according to Howard Catton, CEO of the International Council of Nurses (ICN).

“The US has lost 100,000 nurses since 2020 and is predicted to lose up to 600,000 by 2027. The number of nurses leaving the UK register is also up since 2020. And in Switzerland, the dropout rates of new nursing students in their first year and second year is between 18 and 36%,”  Catton told a briefing hosted by ACANU, the Geneva UN press association.

Despite increasing evidence of nurses leaving or planning to leave the workforce, “governments are not in sufficiently prioritising investment in the nursing workforce”, he added.

“Improved working conditions and support and investment for the current nursing workforce need to be a priority to hold those nurses that we have.”

Governments are more focused on recruitment than retention of nurses, added Catton – and international recruitment by certain wealthy countries is decimating the healthcare in less affluent countries.

Recruitment from ‘red list’ countries

Howard Catton, CEO of the International Council of Nurses (ICN)

“A small number of high-income countries are driving 70% to 80% of recruitment activity,  overwhelmingly from countries in a weaker position than themselves. 

“Just in recent days, the UK announced that it had reached a target to recruit 50,000 more nurses earlier than planned. But it turns out 93% of those 50,000 were internationally recruited nurses, and we know that 6,000 of them came from the most vulnerable countries – the red list countries, that the World Health Organization (WHO) advises not to recruit from.”

Fiji has lost 25% of its nurses in the last year to Australia and New Zealand, he added.

In 2023, the WHO identified 55 countries – 37 from Africa – with “low workforce density” that might require “safeguards against active international recruitment” of their health workforce.

“The focus of government action, where we do see it, appears more on recruitment than retention,” said Catton.

“Recruitment, of course, is important in the medium to long term. But there’s a time lag. And the most simple, incontrovertible truth is that improved working conditions and support and investment for the current nursing workforce need to be priorities to hold in those nurses that we have.”

The rise in nurses’ strikes and disputes is an indication of the impact of the post-pandemic cost of living crisis, with a fall in real pay being reported even in Italy, Portugal, Finland and the UK. 

However, said Catton, “The approaches governments are adopting are unsustainable, and we’re concerned that there is a risk of more disputes and unrest over the year to come without the prioritisation of investment”. 

Pamela Cipriano, president of the International Council of Nurses (ICN)

ICN president Pamela Cipriano pointed out that slogans such as “health for all”, ‘leave no one behind’ and universal health coverage all depend on nurses – yet there is insufficient investment in nurses and nursing. 

“We need to move nurses from being invincible to being considered invaluable,” she added, cautioning those wanting to bring in workers who are less experienced and less expensive, “We urge great caution because someone with lesser education and training cannot replace the expertise of a nurse.”

Support for nurses in Palestine 

While the ICN did not involve itself in geopolitics, “there should be complete protection of health care facilities, health care workers and civilians in any area of conflict and war”, said Cipriano.

“We know that that’s been violated [in the occupied territories of Palestine], so we have spoken out against that. We, along with many other groups are calling for peace but also very specifically, protection of health care facilities and adherence to international law.”

The ICN had provided some financial support to Palestinian nurses, who are currently not being paid, “but not anywhere near the magnitude that they would need and hoping that we can help them to connect with other groups that can provide some financial support”, she added. 

Aside from financial support, Cipriano noted that nurses in the occupied territories needed education to deal with “new patient groups” as “the wounds of war are different from normal care”.

“Right now, we know they’re working in conditions where electricity, water supplies, medications, are at risk, so they are working in serious disaster conditions,” said Cipriano.

“Many times our other associations step up to help one another, either financially or it may be that regionally, there can be physical support.”

Tribute to Israeli nurse held hostage

Cipriano also paid tribute to Nili Margalit, an Israeli nurse kidnapped by Hamas on 7 October and held hostage for 55 days.

“She’s a 41-year-old nurse and… [she was able to] get medications to the people who were in the tunnel where she was being kept, to give them hope, to be the communicator, to be the organiser.,” said Cipriano 

“That is what nurses do. They rise in the face of crisis, as well as [during] the daily and life events that that people are facing. 

“In conflict and crisis, we can rely on nurses even though we know it also takes a tremendous mental toll on their well-being.”

Image Credits: © Dominic Chavez/The Global Financing Facility.

Some of those petitioning against Uganda’s Anti-Homosexuality Act in court on Monday, including Pepe Onziema (left) and Frank Mugisha (centre).

The court challenge to Uganda’s Anti-Homosexuality Act, one of the harshest anti-LGBTQ laws in the world, began in Kampala on Monday before five Constitutional Court judges.

The Act, which was passed by an overwhelming majority of Members of Parliament in May, includes penalties such as a life sentence for same-sex acts between consenting adults, 10 years in prison for “attempted homosexuality;” the death penalty for “aggravated homosexuality” and 20 years in prison for  “promotion of homosexuality”.

However, there is unlikely to be much more live court action after Deputy Chief Justice Richard Buteera, chair of the hearing, agreed to entertain written submissions rather than live hearings.

This followed a request by the lawyers representing the eight petitioners, including MP Fox Odoi-Oywelowo, and LGBTQ leaders Frank Mugisha and Pepe Onziema,  that they wished to proceed by way of written submissions.

Respondents, the Attorney General, supported by evangelical Pastor Martin Ssempa and Watoto Church elder Stephen Langa, served the petitioners with their written submissions at the hearing, and the court directed the respondents to reply by 5pm on 20 December.

Thereafter, the court will deliver its judgment “on notice”, either in court or electronically.

Commenting on the decision, Nicholas Opiyo, the attorney for the petitioners, said that the intention was “to avoid the theatrical intention of some of the people admitted into the process whose only objective appeared to be using the court as a platform to raise money and profile”. 

“In the end, a decorous process to preserve the integrity of the court and the hearing was chosen over and above oral presentation,” added Opiyo on X inan apparent reference to Ssempa’s attempts to use the court challenge to fundraise for his anti-LGBTQ crusade.

Researchers threaten to withdraw after directive 

Meanwhile, Uganda’s National Council for Science and Technology faced international condemnation for directing all researchers to report anyone who violated, or was suspected to be violating, the Act in their research programmes to the police.

In an open letter sent to Dr Martin Ongol, acting secretary of the council, some 260 researchers worldwide call on him to immediately withdraw a directive he issued on 27 October.

 

The directive informed researchers that “the duty of confidentiality in research may be waived for the purposes of reporting to the relevant authorities the commission of an offence” in terms of the Anti-Homosexuality Act.

The Act itself obliges citizens to report anyone who has committed or intends to commit any offence under the Act or face “a criminal penalty or a fine”.

“This Directive means we cannot uphold our moral commitment to the rights of our study participants to life, health, dignity, integrity, self-determination, privacy, and confidentiality,” notes the letter.

“We are asking you to immediately withdraw this Directive, if not, we will be forced to reassess our current research in Uganda and our future research plans.”

Uganda has already paid heavily for its homophobia, with the county’s new World Bank loans currently on hold along with new grants from the US President’s Emergency Plan for AIDS Relief (PEPFAR), the country’s exclusion from the US African Growth and Opportunity Act (AGOA) that gives preferential trading terms to select African governments and US visa sanctions on key supporters of the Act, including all the MPs who voted for it.