A rollout of malaria vaccine in Western African countries with a special focus on immunising children is an important step towards eliminating the disease

Rollout of malaria vaccines are starting in Benin, Sierra Leone and Liberia, and the West African countries plan to deliver more than 800 000 doses of the RTS,S or R21 vaccines, according to WHO.

The new vaccine will be added to their immunisation programmes for children, and are expected to protect over 200,000 children from the life-threatening disease. The RTS.S vaccine can be administered to children as young as five months old.

In another promising development against malaria, a new formulation of a malaria treatment, Coartem, has proven to be safe and efficacious for babies under five kilograms, a previously overlooked group of patients.

Pharmaceutical company Novartis and Medicines for Malaria Venture (MMV), a leading product development partnership, announced that their product has good efficacy and safety and is appropriate for babies in the wake of the successful CALINA study.

The trial data have been submitted for regulatory review, they informed during the Multilateral Initiative on Malaria conference.

“Infants below five kilograms make up a critical neglected group, and developing antimalarials specifically suited to their needs is essential to malaria control efforts,” said Wiweka Kaszubska, MMV vice president.

The new formulation, known as Coartem <5 kg Baby, uses a new ratio and dose of artemether-lumefantrine to account for metabolic differences in babies under 5kg to minimise the risk of overdose and toxicity.

“Infants under five kg can be affected by placental malaria, leading to poor birth outcomes, or contract malaria from the bite of an infected mosquito. The prevalence of the disease in this age and weight group is poorly understood, and it is therefore often misdiagnosed,” according to a company media release.

Current antimalarials have not been developed small babies, who are usually treated with tablets meant for children above 5 kg adjusted by weight – yet, these tiny patients handle drugs differently due to the immaturity of their metabolising organs.

Decreasing the burden

Malaria is a life-threatening infectious disease with an estimated 249 million cases and 608 000 deaths in 2022, according to the World Malaria Report 2023. It is present in 85 countries, with 95% of cases in the African region. Most of the fatalities in the region – four out of five – are children under the age of five.

“With the new, safe and efficacious malaria vaccine, we now have an additional tool to fight this disease. In combination with insecticide-treated nets, effective diagnosis and treatment, and indoor spraying, no child should die from malaria infection,” said Dr Austin Demby, the Minister of Health of Sierra Leone.

The emerging interventions will likely decrease the burden of malaria substantially. In the recent years, (2019-2023), a pilot malaria vaccine programme in Ghana, Kenya and Malawi reached over two million children, showing a significant reduction in malaria illness. It also reached a 13% drop in overall child mortality and a reduction in hospitalisations.

Benin, Liberia and Sierra Leone joined five other African countries that have already implemented the rollout of the newly developed malaria vaccines.

Image Credits: WHO.

African leaders who attended at the high level meeting in Addis Ababa on Saturday.

African leaders want “explicit commitments” to debt relief and debt restructuring mechanisms, including debt swaps to support country-level pandemic prevention, preparedness and response (PPPR) in the pandemic agreement.

This is one of the continent’s demands, made on the eve of the World Health Organization’s (WHO) pandemic agreement talks, following a high-level meeting of African health ministers and diplomats on Saturday.

At the meeting, a key African Union (AU)  leader warned against postponing the adoption of a pandemic agreement, saying it might never be passed.

The pandemic agreement negotiations entered their final two-week phase in Geneva on Monday with 10 May as the deadline for what observers are describing as an “instrument of essentials” – a basic text that will be fleshed out by further talks in the next couple of years, as reported recently by Health Policy Watch.

The first communique from the African leaders’ Saturday meeting was withdrawn a few hours after its release. 

The new statement released on Monday was identical except it removed a reference to the Pandemic Fund in its call for “an international financing mechanism” to support countries’ pandemic-proofing efforts.

It also wants the accelerated “operationalisation of the financing of the African Epidemic Fund”.

Support for PABS

The continent supports a “multilateral pathogen access and benefit sharing system (PABS)” that provides legal certainty to users and providers and ensures improved access to pandemic-related health products and technologies.

The draft agreement proposes a WHO-coordinated PABS system but for the operational details of this contested proposal are to be finalised by May 2026.

Africa also wants “measures to establish regionally-distributed production of pandemic-related health products” and “commitments to organise and resource technical support” on all equity-related provisions. 

Pandemic prevention, preparedness, and response (PPPR) demands relate largely to national and regional responsibilities, with measures such as the enactment of “domestic laws providing for broad exemptions and limitations to intellectual property to address public health emergencies”, and supply chain diversification and logistics streamlining throughout the continent.

Africa also wants the various WHO-coordinated mechanisms in the agreement – such as on research and development and technology transfer – to be operationalised and accountable to the Conference of Parties, a multi-country structure which is set to govern the agreement.

“Africa stands ready to play its part and comments to engage actively in the ongoing negotiations and finalisation of the draft pandemic agreement,” the statement concludes.

AU warns against postponement

“I don’t think postponing an agreement is going to be in our interest because we may postpone forever. I look forward to us consolidating our common position today, consolidating our negotiating positions and ensuring that Africa’s interests are represented in the global pandemic agreement negotiations,” said AU deputy chairperson, Dr Monique Nsanzabaganwa, during the opening of the ministerial meeting.

AU deputy chairperson Dr Monique Nsanzabaganwa warns against delaying the agreement.

She also urged pragmatism when addressing the meeting on Saturday, explaining that several African demands – such as a seat at the G20 – had taken years to achieve.

“In some situations, we don’t have even a choice because we need to continue being pragmatic as we look for all conditions that can allow us some equity and some flexibilities and conducive conditions for us to do what we’ll have to do for ourselves,” she said.

She also warned of the likelihood of another COVID-like pandemic in the not so distant future, adding that it is “crucial that we work together to strengthen our collective preparedness and ensure that Africa’s voice is heard in global health discussions”.

While Africa’s negotiators wanted a win-win situation, in negotiations “there is always give and take”, said Nsanzabaganwa, who hails from Rwanda.

“We have also the duty to continue pressing for multilateralism to work.”

Meanwhile, Zambia’s health minister, Sylvia Masebo, who chairs the Africa CDC board, called on the African negotiators to ensure “equitable access to pandemic-related health products” and “increased access to vaccines, diagnostics and therapeutics, ensuring that no one is left behind”. 

Africa CDC Director-General Dr Jean Kaseya said that unity and a common African position in the negotiations was key.

 

An exhausted looking WGIHR co-chair Ashley Bloomfield reports back on the process

The World Health Organization’s (WHO) working group has failed to meet its deadline of Friday (26 April) for amending the rules governing global disease outbreaks – the International Health Regulations (IHR) – and will reconvene.

This emerged late afternoon on Friday (26 April) at a briefing after the week-long Working Group of Amendments to the IHR (WGIHR), when drawn co-chair Dr Ashley Bloomfield announced that the group would reconvene on 16 and 17 May for a final two days’ negotiation.

“The mood in the room has been outstanding, and we have worked really hard to make amazing progress. We’re not quite cracking the bottles of champagne and sparkling grape juice, but we were getting very close and I have every sense that you are all committed to finishing the job,” said Bloomfield.

WHO Deputy Director General Dr Mike Ryan commended the group, saying he was “very confident” that the IHR would be  “a clearer, better instrument for your efforts, something that we can apply better on your behalf and on behalf of the people that you serve”.

The WGIHR has asked member states to submit written inputs, particularly on the articles that the meeting failed  to reach agreement on or did not discuss, by 6 May and it will reconvene for a further two days after that.

The Articles that still need agreement relate to technology transfer, financing and governance.

However, many of the WGIHR members are also part of the pandemic agreement talks, which start on Monday 29 April under the intergovernmental negotiating body (INB). The programme of work for the INB envisages 12-hour days, so there will be no space for IHR talks until after 10 May.

However, the two processes are closer linked and the definitions adopted by the IHR, including all the phases that led up to the WHP Director General declaring a public health emergency of international concern (PHEIC), will be used in the pandemic agreement.

The World Health Assembly, which is due to ratify the amendments, begins on 27 May, so time is very tight.

The WGIHR will submit an updated proposed text to member states by 10 May.

The ongoing global spread of “bird flu” infections to mammals including humans is a significant public health concern

While no cases of human-to-human transmission have been recorded in the current H5N1 avian outbreak, scientists are concerned about its transmission speed in mammals and whether this might result in a mutated pathogen that can infect people more easily.

“H5N1 is (an) influenza infection, predominantly started in poultry and ducks and has spread effectively over the course of the last one or two years to become a global zoonotic – animal – pandemic,” said Dr Jeremy Farrar, the World Health Organization’s (WHO) Chief Scientist.

“The great concern, of course, is that in doing so and infecting ducks and chickens – but now increasingly mammals – that that virus now evolves and develops the ability to infect humans. And then critically, the ability to go from human-to-human transmission,” Farrar told a media briefing in Geneva last week.

At the WHO’s global media briefing on Wednesday, WHO epidemiologist Dr Maria Van Kerkhove that “we have not seen human-to-human transmission in the recent cases, and I think that’s really important because there’s a lot of news right now on influenza”.

Spread in US dairy herds  

H5N1  has been detected in cattle in 33 dairy herds in eight US states, according to the latest US Centers for Disease Control and Prevention (CDC) report on 24 April. Remnants of the virus have also been detected in raw milk. 

US CDC described “this degree of spread outside of birds & poultry is unprecedented and concerning” and the US Department of Agriculture has restricted interstate cow transport to limit the spread of the disease.

One human infection has been reported in a Texas, cattle farm worker in late March. Genomic sequencing from this patient found that each individual gene segment was “closely related to viruses detected in dairy cattle” in Texas, according to US CDC.

“While minor changes were identified in the virus sequence from the patient specimen compared to the viral sequences from cattle, both cattle and human sequences maintain primarily avian genetic characteristics and, for the most part, lack changes that would make them better adapted to infect mammals,” it noted.

“There are no markers known to be associated with influenza antiviral resistance found in the virus sequences from the patient’s specimen and the virus is very closely related to two existing candidate vaccine viruses that are already available to manufacturers, and which could be used to make vaccine if needed,” added. 

Overall, the genetic analysis “supports CDC’s conclusion that the human health risk currently remains low”.

US public officials said that Tamiflu, an antiviral effective for treating influenza, is stockpiled for a potential emergency, NPR reported. Some candidate vaccines for H5N1 are also in development and there are some options for enhancing present supply.

US states where H5N1 has been detected in cattle

Historically, human cases of the H5N1 virus are so far very rare, with only 889 cases reported to the WHO since 2003, all involving people who came in contact with infected animals. 

But virus mortality reaches 52%, which is “extraordinary high”, said Farrar, who urged close monitoring and investigation of the outbreaks in US cattle by public health authorities “because it may evolve into transmitting in different ways”.

“Do the milking structures of cows create aerosols? Is it the environment which they’re living in? Is it the transport system that is spreading this around the country?” he asked. “This is a huge concern and I think we have to … make sure that if H5N1 did come across to humans with human-to-human transmission that we were in a position to immediately respond with access equitably to vaccines, therapeutics and diagnostics.”

Different strains, different severity

Though avian influenza viruses naturally occur in wild water birds, some variants are also known to develop the ability to infect other animals. The virus has multiple variants of differing severity and transmission possibilities. 

A case of human infection with the much milder strain of avian influenza virus (H9N2) was confirmed in Viet Nam on 9 April by the International Health Regulations (IHR) National Focal Point, as WHO reported. The same virus strain was also detected in three patients in China,according to the Centre for Health Protection of Hong Kong.

H9N2 usually results in mild infections of the upper respiratory tract, mostly affecting children. It is a low pathogenic avian influenza, usually showing only mild disease in chickens and other poultry, according to the US CDC.

Systems in place to respond

Maria van Kerkhove

“We are concerned about this particular virus because we know influenza has the potential to cause epidemics,” said Van Kerkhove. “That’s why we have a global system in place to monitor detect, to rapidly do risk assessments to look at viruses that could potentially be used in vaccines as we go forward.”

However, she expressed confidence that risks of an outbreak in human populations remain low and that existing WHO surveillance systems competent to monitor any developments. 

”We have a global influenza surveillance and response system that’s been in place for 70 years. And within this systems, there are strong surveillance components, made up of labs around the world, made up of many partner agencies,” she assured the media briefing.

Dr Michael Ryan, WHO’s Executive Director of the Health Emergencies Programme, backed Van Kerkhove: “We have a system that can measure and we have countermeasures ready to go should anything happen and that’s all we can do in public health.”  

“We can’t stop living because viruses threaten us. What we can do is be ready to respond,” he said,.

The Pandemic Influenza Preparedness Framework “has been in place again for 20 years and has provided a framework for collaboration between WHO labs and industry for the sharing of material, for the sharing of vaccines”, added Ryan. 

Image Credits: Charlotte Kesl/ World Bank.

Outdoor workers are at a high potential health risk as climate change worsens heat.

Over 70% of the world’s workforce faces potential health risks due to climate change, according to the latest report by the International Labour Organization (ILO) released earlier this week. Nearly 1.6 billion outdoor workers are also at risk from high levels of air pollution.

“More than 70% of our workers are exposed to excessive heat at least one point in their working lives. That’s 2.4 billion workers globally out of a global workforce of 3.4 billion,” said Manal Azzi, Senior Specialist on Occupational Safety and Health (ILO) at the report launch at the United Nations in Geneva.

The report, Ensuring safety and health at work in a changing climate, states that climate change is already having a serious impact on the safety and health of workers in all regions of the world. The share of global workers impacted by climate change hazards has increased by about from 65% in 2020 to 70% in 2024, the report said.

Workers in the world’s most impoverished regions face heightened risks from scorching heatwaves, prolonged droughts, raging wildfires, and devastating hurricanes, according to the ILO.

 

Range of climate-linked health risks

The report notes that numerous health conditions in workers have been linked to climate change, including cancer, cardiovascular disease, respiratory illnesses, kidney dysfunction and mental health conditions. The impact includes the 1.6 billion workers exposed to UV radiation, with more than 18,960 work-related deaths annually from non-melanoma skin cancer.

“More than 22 million workers are suffering from sicknesses and injuries related to exposure to excessive heat and these can range from injuries in transport, in traffic accidents due to bad night of sleep because it was excessively hot, to construction accidents, injuries, slips and falls related to the exposure to heat,” Azzi said.

Many deaths are also directly related to the impact of climate change. “Nearly 20,000 workers are dying yearly because of these injuries in the workplace related to rising temperatures and to exposure to excessive heat, indoor and outdoor heat, and losing millions – over two million disability-adjusted years – are lost because of injuries and deaths related to heat,” said Azzi, who is the ILO’s specialist on occupational safety and health.

A traditional brick factory in Tozeur, southern Tunisia. In Africa and South Asia brick making and waste burning are major sources of air pollution.

High levels of air pollution causing harm

The report also said that nearly 1.6 billion outdoor workers are at risk of health impacts due to worsening air pollution, particularly those working in the transport sector and firefighters.

Around 860,000 work-related deaths have been attributed to air pollution for outdoor workers annually.

The report noted that modified weather patterns due to climate change have influenced levels of outdoor air pollutants, such as ground-level ozone, fine (PM2.5) and course (PM10) particulate matter, nitrogen dioxide (NO2), and sulphur dioxide (SO2).

Rise in vector-borne diseases

With increasing temperatures and higher humidity, more pesticides are also being used in the agriculture sector. According to the report, there are more than 870 million workers in agriculture that are likely to be exposed to pesticides, with more than 300,000 deaths attributed to pesticide poisoning annually.

Azzi notes that “15,000 people die due to parasitic and vector-borne diseases exposed to in the workplace”.

“Obviously, these include a lot of diseases like dengue, rabies and various diseases that are increasing in regions that we never used to see them before. Malaria has even increased and we’re seeing it’s shown in countries that it never used to be before.”

The ILO has planned a meeting in 2025 with government, employer and worker representatives to provide policy guidance on climate hazards.

Image Credits: Unsplash, WHO/Diego Rodriguez.

HIV medicine dolutegravir.

The government of Colombia has issued its first-ever compulsory license to enable access to generic versions of the key HIV medicine dolutegravir, without permission from the patent owner, ViiV Healthcare.

Dolutegravir is recommended as part of the preferred first-line antiretroviral treatment regimen for people living with HIV, including during pregnancy, as per the guidance of the World Health Organization (WHO). Dolutegravir has fewer side effects and a lower risk of developing resistance. 

UNAIDS has described the move as an “important breakthrough in public health measures” that  breaks “the monopoly”, and could mean that the price of the life-saving medicine is reduced by as much as 80%.

“When the power to produce health technologies is held by a few companies, the result all too often is that countries can’t afford the high prices and people who need newer products cannot access them,” said Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean.

“This decision provides the government with the legal conditions to manufacture or purchase more affordable versions of this essential first-line antiretroviral treatment for all people living with HIV in Colombia, including Venezuelan migrants”, said Ms Cabal.

“We are confident that this decision will have an impact across the whole region and beyond, as many middle-income countries are struggling to access generic markets of key health products to prevent and treat HIV infection.”

Prohibitive costs

This move has also been welcomed by Médecins Sans Frontières (MSF), Public Citizen and Global Humanitarian Progress Corporation Colombia.

“Colombia’s decision to issue a compulsory license for dolutegravir is great news because, until now, we have not been able to introduce dolutegravir in our medical operations, as the costs have been prohibitive,” said Dr Carmenza Gálvez, MSF’s medical coordinator for Colombia and Panama.

Although generic versions of dolutegravir are available internationally for a fraction of ViiV’s price through voluntary licenses with the Medicines Patent Pool (MPP), ViiV excluded Colombia and many middle-income countries from being able to benefit from its license with MPP, allowing ViiV to maintain its monopoly and continue to charge high prices in Colombia and other countries excluded from the license. 

The Global Fund buys generic dolutegravir for $22.80 per patient per year, while Pan-American Health Organization (PAHO) can procure it for $44 – but Colombia cannot access these prices. 

According to the Colombian government, the estimated cost of dolutegravir sold by ViiV under the brand name, Tivicay, is around $1,224 per patient per year in 2023.  If Colombia can procure the generics for $44, it will be able to treat 27 people for what it is paying for one person at present.

According to UNAIDS, Colombia hosts the largest number of Venezuelan migrants in the world (2.9 million as of October 2022), and “recent studies have shown a 0.9% HIV prevalence among this migrant population, almost double the 0.5% HIV prevalence among the country’s adult population”.

Compulsory licensing is a provision in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement). It enables governments to supply its citizens with generic versions of patented treatments either through domestic production or imports, ensuring health products’ prices are affordable.

The 2001 WTO Declaration on the TRIPS agreement and public health reaffirmed the rights of member states to make use of all flexibilities in the TRIPS agreement to protect public health, including compulsory licenses. More recently, in the 2021 Political Declaration on HIV/AIDS, countries committed to make use of TRIPS flexibilities, specifically geared to promoting access to medicines.

Members of the US West Virginia National Guard’s Task Force Chemical, Biological, Radiological and Nuclear (CBRN) Response Enterprise (CRE) (TF-CRE) assist staff, medical personnel, and first responders of an Eastbrook Center nursing home with COVID-19 testing.

The US plans to double the number of countries it supports to prevent infectious disease outbreaks, opting for bilateral agreements with at least 100 countries, according to its new Global Health Security Strategy (GHSS).

“Recent outbreaks, from mpox to Marburg, cholera, and other diseases… are wake-up calls for anyone who thought COVID was a once-in-a-lifetime experience,” said Dr Stephanie Psaki, US Coordinator for Global Health Security.

“US national security and prosperity depend on countries around the world being prepared to prevent outbreaks when possible, and to rapidly detect and respond to emerging infectious-disease threats when they occur,” added Psaki, who is also White House National Security Council’s Deputy Senior Director for Global Health and Biodefense. 

“Global health and community health are all interconnected,” remarked Dr Michelle A Williams, former dean of Harvard’s School of Public Health. “A threat anywhere is a threat everywhere when a pathogen can travel anywhere in the world in 72 hours.” 

New roadmap

The GHSS provides a roadmap for strengthening US preparedness for future pandemics and biological threats through expanded global health partnerships. 

The plan will extend US commitments to an additional 50 countries to help protect themselves against outbreaks and pandemic, which will double the countries the US currently supports on public health

“Over the last three years, we have more than doubled our global health partnerships – working directly with 50 countries to ensure they can more effectively prevent, detect, and control outbreaks. And we are working with partners to support an additional 50 countries to save even more lives and minimize economic losses,” writes US President Joe Biden in the plan’s foreword.

The plan “will ensure we remain vigilant to possible threats at this critical moment and help set a more secure, sustainable, and healthy course for our people and for people around the world,” adds Biden.

The GHSS’s three overarching goals are: to strengthen global health security capacities through bilateral partnerships; catalyze political commitment, financing, and leadership; and increasing the linkages between health security and complementary programs. 

The US strategy comes as the World Health Organization’s (WHO) 194 member states are struggling to ratify a global pandemic agreement. While the US is participating in these negotiations, historically it has preferred bilateral agreements as a more efficient way to bolster global health security. 

“Collectively the actions that we are taking right now will make the United States and the rest of the world safer from the next pandemic,” said Psaki, who was speaking at a DC-based Center for Strategic and International Studies event. 

COVID-19 lessons

The GHSS notes that the COVID-19 pandemic offered critical lessons, “including on the importance of political leadership, diplomatic engagement, strong and resilient health systems, multisectoral approaches, risk communication and community engagement, research partnerships, and improving equitable access to medical countermeasures.”

These lessons mean that the GHSS pays close attention to areas health security challenges stress like supply chain resiliency, health care delivery, and public health workforce capacity, risk communication, and health equity. 

“The COVID-19 pandemic has underscored the imperative of building a stronger GHS architecture, including the institutions, organizations, international legal frameworks, policies, and measures to address and respond to health emergencies with international implications while protecting national security and sovereignty,” says the report. 

“We saw how this global health challenge caused local consequences for our hospitals, our schools, and our communities. No sector of the economy or society was immune,” writes Biden in the foreword. 

Complex factors

The GHSS notes the increasingly complex factors shaping global health. “Even as the world recovers from the COVID-19 pandemic, the key drivers of disease emergence and spread are increasing rapidly, including the growth and mobility of populations, human encroachment on animal habitats, wildlife trade and trafficking, loss of biodiversity and the impact of climate change.”

These risks are further exacerbated by other social and economic factors, including “complex humanitarian crises, environmental degradation, land use change, unsustainable development and rapid urbanization, globalized travel and trade networks, emerging technologies, and inequitable access to existing vaccines.”

This One Health approach means that US global health security policy explicitly promotes  human animal, plant, and environmental health, while also meeting a slew of national and global goals. These goals cover sectors ranging from climate, resilience, food security and nutrition, to economic development, biodiversity, and conservation. 

Preventing spillover events are a key GHHS One Health initiative; the strategy highlights the need for improved veterinary bio-surveillance and biosecurity measures, and rapid information sharing. The developing H5N1 outbreak in dairy cows illustrates the potential for zoonotic diseases to jump to humans. 

New country partnerships

The policy highlights that “core to the US government strategy is working with countries around the world to ensure they are better able to prevent, detect, and respond to global health security threats.”

The US is already working to respond to one such threat – mpox –in the DRC by providing immunizations. 

“The goal is for each partner country, or regional entity, to achieve demonstrated capacity in at least five health security technical areas (eg laboratory systems, surveillance, antimicrobial resistance) based on individual country priorities.”

The US government identifies partner countries based on health security needs and the likelihood and vulnerability of an outbreak. These partnerships, while backed through US funding, stress the importance of initiatives where partner countries “have full ownership and strong capacities, with political, legislative, and financial support for the programs, human resources, and systems necessary to maintain a high level of health security.”

Funding and implementation

Several US agencies will implement this policy including the US State Department, the Centers for Disease Control and Prevention (CDC), Health and Human Services (HHS), and the US Agency for International Development (USAID). Psaki will oversee the multi-agency effort to enact the strategy.

Biden is asking Congress for $1.2 billion to implement this strategy,  which will be channelled mainly to USAID, the State Department, and the CDC. 

Image Credits: U.S. Army National Guard/Edwin L. Wriston.

Including genetic data from Africans is crucial for achieving equitable pharmacogenomics.

Pharmacogenomics research in Africa transcends mere regional healthcare improvements: it represents a pivotal step in addressing pressing global health challenges and propelling medical science forward for all. 

A revolution is sweeping through the field of medicine, redefining how we approach the treatment of diseases. Africa must not be left behind in this transformative journey. Pharmacogenomics, the study of how genetic variations influence an individual’s response to therapeutic drugs, holds immense promise for healthcare by facilitating personalized treatments tailored to an individual’s genetic makeup. However, Africa faces a significant challenge due to a critical lack of tailored therapeutics for its genetically diverse population.

Africa’s population is projected to double by 2050 and boasts the most diverse population genetics globally. A study published in 2020 involving 426 Africans explored the breadth of genomic diversity across Africa and yielded over three million novel genetic variants previously undocumented.

Study published in 2020 found a huge breadth of genomic diversity among just 426 African individuals – only a fraction has been studied.

Despite the potential to significantly impact global health and enhance our understanding of genetic diseases worldwide, less than 5% of the data in the pharmacogenomics database, PharmGKB, comes from African populations. Additionally, of over 300 drugs for which the US Food and Drug Administration provides pharmacogenetic advice, only 15 have been studied in African groups.

Despite calls for more diversity in genomics studies, the gap continues to widen, with researchers revealing a 5% increase in genomics studies conducted in individuals of European descent by June 2021, up from 81% in 2016. This lack of representation hampers efforts to use African genomic data in global disease prevention and management, highlighting a significant genomic data gap.

How can we ensure that pharmacogenomics research in Africa leads to more equitable healthcare and bridges this genomic data gap?

Data sovereignty

Firstly, data sovereignty is crucial to ensure that African populations benefit from and retain ownership of their genetic data in pharmacogenomics research. Historically, these populations have been overlooked in treatment developments, as seen during the COVID-19 pandemic, where they were last in line.

It is crucial to implement safeguards to ensure that new treatments developed are affordable and accessible, and that knowledge gleaned from studying the genomes of people on the continent actually benefits those people. There should also be mechanisms in place to ensure that the benefits of genomic research are shared equitably, particularly with the communities that contribute their genetic data.

To prevent this from recurring, collaboration between researchers, pharmaceutical companies, research institutions, and African governments is key.  We must build local capacity and infrastructure for genomic research, empowering communities, fostering trust, and ensuring that research outcomes are relevant and beneficial to the continent.

I have been involved in research on how artificial intelligence (AI) can help to tailor drugs for Africa, and I’m excited by the promise this approach holds.  Initiatives like Project Africa GRADIENT (Genomic Research Approach for Diversity and Optimizing Therapeutics) exemplify the importance of data sovereignty, showcasing how collaborations can empower African populations and ensure the relevance of research outcomes.

Project Africa GRADIENT is a partnership with GlaxoSmithKline (GSK), Novartis, and the South African Medical Research Council (SAMRC), which aims to understand Africa’s genetic diversity and its impact on treatment responses. A total of nine projects across Africa are currently being supported under Project Africa GRADIENT.

This includes our project in collaboration with Ersilia Open Source Initiative where we are using AI to identify prevalent genetic variants affecting the metabolism of malaria and tuberculosis drugs, and incorporating the effects of these variants in existing mathematical modelling tools to come up with tailored drug doses for diverse African patient populations.

Building African capacity for genomics research

Second, collaborative initiatives like Project Africa GRADIENT are instrumental in building local research capacity and training the next generation of African scientists in cutting-edge genomic research and AI technologies. This capacity building is essential for sustainable improvements in healthcare delivery and research on the continent. Investing in local talent will help in addressing immediate healthcare needs and creating a legacy of expertise that will drive future innovations in healthcare.

University of Cape Town Holistic Drug Discovery and Development (H3D) Centre, a place of innovative medical research.

New regulatory frameworks

Third, the policy implications of pharmacogenomics research in Africa are profound and require regulatory frameworks that protect patient privacy and ensure equitable access to personalised medicine. Governments and regulatory bodies should play a crucial role in supporting and regulating genomic research to maximise its benefits for African populations.

This includes implementing policies that incentivise pharmaceutical companies and research institutions to prioritize diversity in clinical trials and research. By establishing robust policies, we can create an environment that fosters innovation while safeguarding the rights and well-being of African populations.

Public awareness as a lynchpin

The public remains the lynchpin of the success of all these novel innovations. Public awareness and engagement are crucial aspects of genomic research, especially in Africa, where cultural and ethical considerations are important.  As partners in this work, we must build a chorus of awareness among the public about the benefits and misconceptions of pharmacogenomics research among African populations. This engagement is essential for fostering a sense of ownership among African communities and shaping the future of healthcare while also building trust.

I continue to be motivated by homegrown solutions for achieving health equity. By focusing on the diverse genetic makeup of African populations, we can develop tailored treatments that benefit everyone, irrespective of geographical boundaries. To make this a reality, we need continued collaboration, investment, and commitment from governments, pharmaceutical companies, research institutions and communities.

It’s time to prioritize African voices and expertise in healthcare research and ensure no one is left behind in the quest for equitable and effective healthcare worldwide. Together, we can bridge the health gap and create a healthier, more equitable future for generations to come.

Professor Kelly Chibale is the Neville Isdell Chair in African-centric Drug Discovery and Development at the University of Cape Town, and founder and director of the university’s Holistic Drug Discovery and Development (H3D) Centre.

 

Image Credits: Sangharsh Lohakare/ Unsplash, Nature, Choudhury et al. (2020).

A child is vaccinated against Meningitis A in Chad; a new five-strain vaccine just introduced in Nigeria offers hope of eliminating meningitis as a public health problem, says WHO.

Immunisation has saved at least 154 million lives over the past 50 years, since the ​​World Health Organization (WHO) launched its Expanded Programme on Immunization (EPI) in 1974.

Of the lives saved, 146 million were children under five, and 101 million were babies.  Global infant deaths have reduced by 40%  and more than halved in Africa.

“That’s an average of more than 1000 a day and six every minute of every year for the past 50 years,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus, at a WHO press conference Wednesday that celebrated the program’s successes while warning of the setbacks to vaccination programmes from regional conflicts, the legacy of COVID and other risks. 

The measles vaccine has had the biggest impact on reducing infant mortality, accounting for 60% of the lives saved – 94 million.

This is according to a landmark WHO-led study, whose key findings were published on Wednesday to coincide with the start of World Immunisation Week (24-30 April).

The study used mathematical and statistical models to estimate the impact of 50 years of vaccination against EPI’s 14 priority pathogens. 

The 14 pathogens are diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever.

More children live to celebrate their fifth birthday

Dr Ephrem Lemango, UNICEF

 EPI –  now renamed the Essential Programme on Immunization – celebrates its 50th next month. When it was launched fewer than 5% of infants whereas today, 84% of infants are protected with three doses of the vaccine against diphtheria, tetanus and pertussis (DTP) – the global marker for immunization coverage.

“Today more children live to celebrate their fifth birthday than any moment in history,” said Dr Ephrem Lemango, UNICEF associate director and chief of immunization, at the press briefing.

“Vaccines are among the most powerful inventions in history, making once-feared diseases preventable,” said Dr Tedros. 

“Thanks to vaccines, smallpox has been eradicated, polio is on the brink, and with the more recent development of vaccines against diseases like malaria and cervical cancer, we are pushing back the frontiers of disease. With continued research, investment and collaboration, we can save millions more lives today and in the next 50 years.”

As the result of the polio vaccination, more than 20 million people are able to walk today who would otherwise have been paralysed, and the world is on the verge of eradicating polio.

More lives are expected to be saved in the next 50 years by additional vaccines, such as the new HPV vaccine that prevents most cases of cervical cancer, and vaccines against malaria, meningitis, dengue, COVID-19, respiratory syncytial virus (RSV).

Missing doses and rising vaccine hesitancy

Despite the successes, during the COVID-19 pandemic, 67 million children didn’t receive all the vaccinations they needed between 2020 and 2022, and nearly 49 million never received a single dose, according to the WHO.  

Coverage of at least 95% of children with two measles vaccines doses is needed to protect communities from outbreaks. 

Currently, the global coverage rate of the first dose of measles vaccine is only 83% and the second dose is just 74%. Reported measles cases increased by a staggering 84% in just one year between 2022-2023. 

A rise in anti-vaccine sentiment has also seen a decrease in immunisation against measles specifically, as well as vaccination more generally, in developed countries and particularly the US. For example, 28% of Americans  believe that parents should be able to decide not to vaccinate their children (up 12 points since 2019), according a 2023 survey by the Pew Research Center.

The decline in support for vaccine requirements for children has been driven by changing views among Republicans: 57% now support requiring children to be vaccinated to attend public schools, down from 79% in 2019, according to Pew.

UNICEF, Gavi and Gates Foundation as key drivers of the success

A baby is vaccinated at a UNICEF-supported health centre in Abidjan, Côte d’Ivoire.

UNICEF is one of the largest buyers of vaccines in the world, procuring more than two billion doses every year on behalf of countries and partners for reaching almost half of the world’s children. 

“This massive human achievement has only been possible through collective determination and effort led by governments and partners, with the help of scientists, healthcare workers, civil society and volunteers. Sustained cooperation and investment are essential to carry the achievements of the past half-century into the future,” said Catherine Russell, executive director of UNICEF.

In 2000, the vaccine alliance, Gavi, was created to help the poorest countries in the world increase immunisation coverage and benefit from new vaccines. 

Today Gavi has helped protect a whole generation of children and now provides vaccines against 20 infectious diseases, including HPV vaccine that protects against cervical cancer, and vaccines for outbreaks of measles, cholera, yellow fever, Ebola and meningitis. 

“Gavi was established to build on the partnership and progress made possible by EPI, intensifying focus on protecting the most vulnerable around the world,” said Gavi CEO Dr Sania Nishtar. 

“In a little over two decades we have seen incredible progress – protecting more than a billion children, helping halve childhood mortality in these countries, and providing billions in economic benefits. Vaccines are truly the best investment we can make in ensuring everyone, no matter where they are born, has an equal right to a healthy future: we must ensure these efforts are fully funded to protect the progress made and help countries address current challenges of their immunization programmes.”

New vaccine opportunities for meningitis, malaria and dengue

Dr Tedros Adhanom Ghebreyesus, WHO director general.

The rollout of a new vaccine for meningitis, which immunises against five bacterial strains at once, offers the first “real hope of being able to eliminate meningitis as a public health problem,” said Tedros. The vaccine was launched just last month by Nigeria in its northern states where officials aim to vaccinate 1 million people hit hard by meningitis recently.  He noted that he would be joining global health leaders in Paris Friday for a first-ever high level meeting on defeating meningitis.

“The defeating meningitis by 2030 roadmap requires an initial investment of 130 million US dollars,” said Tedros. “Which is frankly loose change compared to the return that investment will deliver as well as preventing over $900,000 and nearly 3 million cases of meningitis by 2030. He added that “defeating meningitis would save billions of dollars in health costs and lost productivity – and as part of an integrated primary health care program can also help to combat antimicrobial resistance (AMR).”

Two new malaria vaccines are also being rolled out in half a dozen African countries, with many more states planning to join the campaign, said Tedros.  Malaria vaccines, he said, could “save tens of thousands of young lives every year” in the case of a disease that now kills some 608,000 people annually.

Finally, vaccines are playing a novel role in the response to a widening dengue outbreak, including more than 5.2 million cases reported in the Americas over just the first quarter of 2024 – more than all of 2023 combined.

“Last year, WHO recommended use of a new dengue vaccine for children aged six to 16 in areas where Dengue is present,” said Tedros.  “Countries including Brazil are now using the vaccine are now using the vaccine – although the supplies constraints and costs are still releatiely high.”

DRC declares mpox a health emergency – finally setting stage for vaccine rollout

Dr Rosamund Lewis, WHO technical lead for mpox

Meanwhile, the Democratic Republic of Congo (DRC) two weeks ago declared its swelling mpox outbreak as a national health emergency – finally setting the stage for introduction of two novel mpox vaccines against a worrisome rise in deadly Clade 1 cases of the disease, particularly among children.

So far no vaccines have been used at all in the DRC outbreak – due to multiple hurdles ranging from global supply lines to bureaucratic barriers in a country wracked by armed conflicts, poverty and multiple disease challenges.

“Now that the government two weeks ago determined that the mpox outbreak in the country constitutes a health emergency, the Ministry of Health has a direction.  And they have issued their statement that they intend to introduce vaccines in the country,” said WHO’s Dr Rosamund Lewis. “So the next step is the vaccine assessment by the national regulatory authority of the two vaccines that the National Immunization Technical Advisory Group has recommended, and open immunization strategies.”

Those vaccines include a Japanese-made mpox vaccine,  LC16 KMB, which is approved for use in children, and the Bavarian Nordic’s MVA-BN vaccine, which has not yet been approved for child use and requires two jabs to be effective.

“I think it’s important to note that the MVA-BN vaccine is very similar to the vaccine for Ebola and that does have authorization for children. So we know a lot about the safety of these vaccines in children,” said Dr Kate O’Brien, director of WHO’s Immunization Programme. Even so, it will be important to conduct more studies simultaneously with rollout to determine how the vaccines can best be deployed among at-risk groups.

“It’s really important as the rollout of vaccine happens, that it’s done in such a way that the information is collected in a scientific way, so that we really strengthen the evidence that will lead to a better understanding of exactly how the vaccines can best be used,” O’Brien said.

‘Humanly possible’ campaign

Also on Wednesday, WHO, UNICEF, Gavi, and the Bill and Melinda Gates Foundation (BMGF) launched a worldwide communication campaign on Wednesday, Humanly Possible, which calls on world leaders to advocate, support and fund vaccines and the immunization programmes that deliver these lifesaving products.  The campaign follows on WHO’s announcement last year of The Big Catchup – a strategy that aims to recoup ground lost during the COVID pandemic, in terms of immunization coverage. 

“It’s inspiring to see what vaccines have made possible over the last 50 years, thanks to the tireless efforts of governments, global partners and health workers to make them more accessible to more people,” said Dr Chris Elias, BMGF president of Global Development 

“We cannot let this incredible progress falter. By continuing to invest in immunization, we can ensure that every child – and every person – has the chance to live a healthy and productive life.”

  • with reporting by Elaine Ruth Fletcher 

Image Credits: UNICEF, Gavi.

Woman with dementia (illustrative)
Woman with dementia (illustrative)

A team of researchers from the Nuffield Department of Clinical Neurosciences at the University of Oxford have identified diabetes, traffic-related air pollution exposures and alcohol use as the most harmful out of 15 modifiable risk factors for dementia.

Their paper, published last month in Nature Communications, examines how genetic traits and modifiable risk factors affect the vulnerability of the more fragile LIFO (“last in, first out”) brain network.

Fig. 1: Vulnerable ‘last in, first out’ (LIFO) network of higher-order brain regions that degenerate earlier and faster than the rest of the brain.
Fig. 1: Vulnerable ‘last in, first out’ (LIFO) network of higher-order brain regions that degenerate earlier and faster than the rest of the brain.

The researchers studied nearly 40,000 people from the United Kingdom Biobank who were over 45 and had brain scans. They assessed how the LIFO brain network is linked to 161 modifiable risk factors, classified according to 15 broad categories: blood pressure, cholesterol, diabetes, weight, alcohol consumption, smoking, depressive mood, inflammation, pollution exposures, hearing, sleep, socialisation, diet, physical activity and education.

They found that seven genetic clusters were significantly associated with the development of dementia. Amongst these clusters, two are found in the genes related to both male and female traits. These genes play a role in determining antigens in the XG blood system. Furthermore, the research showed that after accounting for age and sex effects, diabetes, exposure to traffic-related pollution, and frequency of alcohol consumption most negatively impact these genetic areas. In other words, these factors can make these “weak spots” in our genes more vulnerable.

Nitrogen dioxide assessed as a ‘proxy’ for traffic-related air polution

In terms of air pollution, exposure to nitrogen dioxide (NO2) was assessed – as a “proxy for traffic-related air pollution” the researchers stated.  Traffic emissions are one of the largest, but not the only, source of NO2 emissions worldwide – fossil fuel power plants are another leading source. A growing body of evidence has linked NO2 exposures, as well as ground level ozone (O3) for which it is a precursor, to asthma and other chronic and acute lung disorders.

In 2021, WHO slashed by 75% guideline levels for annual average NO2 exposures, while halving guideline limits for PM2.5 (small particulates).  But stricter emissions limits on gasoline and diesel vehicles have been less effective in reducing NO2 than other pollutants – leaving persistently high concentrations across some major cities in Europe and China and rising NO2 concentrations in parts of South Asia and the Middle East.

NASA satellite image (2018) reflects persistently high NO2 levels in China and parts of Europe, as well as growing levels in South Asia, as compared to 2005.

“The bottom line is that this study gives a biological basis to the risk factors and disease outcomes,” explained Dr Vaibhav Narayan, Executive Vice President and Head of Strategy and Innovation for the Davos Alzheimer’s Collaborative. “This is an important advancement and makes the whole area of prevention more science-based and could allow us to develop more targeted interventions.”

Vulnerability of Brain Regions to Aging and Disease

Previously, the researchers had pinpointed the LIFO network as a vulnerable area of the brain that matures later in adolescence but deteriorates earlier in old age. They also found that this specific brain network is especially susceptible to conditions like schizophrenia and Alzheimer’s disease.

“We know that a constellation of brain regions degenerate earlier in aging, and in this new study, we have shown that these specific parts of the brain are most vulnerable to diabetes, traffic-related air pollution − increasingly a major player in dementia − and alcohol, of all the common risk factors for dementia,” Prof Gwenaëlle Douaud, who led this study, said in a release. “We have found that several variations in the genome influence this brain network, and they are implicated in cardiovascular deaths, schizophrenia, Alzheimer’s and Parkinson’s diseases, as well as with the two antigens of a little-known blood group, the elusive XG antigen system, which was an entirely new and unexpected finding.”

A study published last year in the Lancet found that 12 modifiable factors, all included in this study, account for 40% of dementia cases worldwide. But this new study goes further in prioritizing what risk factors make the biggest contribution to brain degeneration.

Alzheimer's Disease and dementia can lead to loneliness in old age.
Alzheimer’s disease is the most common type of dementia found in elderly people.

“What makes this study special is that we examined the unique contribution of each modifiable risk factor by looking at all of them together to assess the resulting degeneration of this particular brain ‘weak spot,” added co-author Prof Anderson Winklerf from the National Institutes of Health and The University of Texas Rio Grande Valley in the United States. “It is with this kind of comprehensive, holistic approach − and once we had taken into account the effects of age and sex − that three emerged as the most harmful: diabetes, air pollution, and alcohol.”

Expanding Research Horizons: Inclusivity and Global Perspectives

Narayan said that the next step is to make similar studies more inclusive.

“This study is of a limited population in the United Kingdom—people with good higher education status and high levels of affluence—and it is quite possible that the relative importance of these risk factors varies across diverse populations worldwide.”

He said other factors such as pesticide use, extreme heat, indoor air pollution and climate change also could have comparatively larger impacts in different parts of the world.

“This deserves to be studied as much,” he concluded.

Image Credits: Pixabay, Nature Communications Screenshot, NASA , Photo by Steven HWG on Unsplash.