The global COVID-19 pandemic’s impact goes far beyond cases and illness and deaths. The pandemic helped shed light on systemic inequities on global, national and local levels that drove increased illness and death from the virus. Now a new study published in The Lancet (UK) provides some insights into how race, ethnicity and socioeconomic factors impacted death rates across different states. There were vast differences across states. “A lower poverty rate, higher mean number of years of education, and a greater proportion of people expressing interpersonal trust were statistically associated with lower infection and death rates, and states where larger percentages of the population identify as Black (non-Hispanic) or Hispanic were associated with higher cumulative death rates. Access to quality health care…was associated with fewer total COVID-19 deaths and SARS-CoV-2 infections, but higher public health spending and more public health personnel per capita were not, at the state level. The political affiliation of the state governor was not associated with lower SARS-CoV-2 infection or COVID-19 death rates, but worse COVID-19 outcomes were associated with the proportion of a state's voters who voted for the 2020 Republican presidential candidate.”
 
Much of the findings are not that surprising given what we know about the pandemic’s effect on different communities in the US. The LA Times (US) pulls out an interesting indicator from those reported. “[T]he researchers also discovered that the more people in a state trusted one another, the lower their collective risk of dying of COVID-19. That result underscores how America’s growing divisiveness seems to have made us uniquely vulnerable during the pandemic. ‘“How we feel about one another matters,’ said political scientist Thomas J. Bollyke, one of the study’s lead authors. ‘The solidarity between people — the feeling that others will also do the right thing, that you’re not being taking advantage of — is a big driver in your willingness to adopt protective behaviors.’” The authors write in The Lancet: “COVID-19 magnified the polarisation and persistent social, economic, and racial inequities that already existed across US society, but the next pandemic threat need not do the same. US states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society were able to match the best-performing nations in minimising COVID-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises.”
 

If You Are in A Hurry:

 

• Read Dr. Barney Graham in The New York Times on what we need to do to ensure vaccine implementation and distribution keeps up with cutting edge science to fight the next pandemic.
• Get tips for Pandemic Preparedness and Response Advocacy on the latest Px Pulse Podcast and from AVAC’s Advocates’ Guide for Pandemic Preparedness and Response (PPPR) in 2023.
• Read an opinion piece in STAT about pandemic budget priorities in the US.
• Read a Washington Post opinion on the need for the data on COVID-19 origins to be shared publicly to help answer key questions.
• And then read The Guardian on how the data was discovered and then taken offline.
• Read a comment in Nature that outlines The Cape Town Statement’s goals to increase fairness, equity and diversity in research.
• Read STAT on updated WHO COVID-19 vaccine guidelines.
• Read AP on a grim milestone in recorded COVID-19 deaths in Brazil.

 

Vaccine Equity

 
In an opinion piece in The New York Times (US) Dr. Barney Graham, who helped develop COVID-19 vaccines at the US National Institutes of Health, writes, “If anything about the pandemic is remembered as positive, it will be how science ‌was applied to rapidly produce medical countermeasures‌. ‌But despite the scientific successes, I have doubts about our ability to deal with the next pandemic threat as readily as we dealt with COVID-19 — even if it is a better-known virus like influenza…. We have entered a new era of ‌‌vaccine science, but can we ‌apply our extraordinary technical capabilities toward the goal of improving public health?” He argues, “Having next-generation vaccine technology without adequate systems for implementation and distribution to all people is a waste…. We just lived through the deadliest pandemic in a century. It’s prudent to consider what has happened, learn from it and ‌‌decide how the world — and our part in it — should operate.”

PPPR Advocacy: What Can You Do?

 
As global leaders make key decisions about pandemic preparedness over the coming months, what can advocates do to help ensure world leaders invest in a rights-based approach to pandemic prevention, preparedness and response? Listen to Karrar Karrar, who heads up Health Policy at Save the Children, and Samantha Rick, who leads AVAC’s Pandemic Preparedness and Response policy and advocacy work talk about advocacy moments on the latest Px Pulse Podcast. Then head over to the Advocates’ Guide for Pandemic Preparedness and Response (PPPR) in 2023 to learn more about getting involved.
 

Fairness, Equity and Diversity in Research

 
A comment in Nature (UK) outlines the Cape Town Statement on Fostering Research Integrity Through the Promotion of Fairness, Equity, and Diversity developed by a group of bioethicists, researchers, institutional leaders and journal editors. “The Cape Town Statement is essentially a call to action that we hope will help to turn the global conversation on inequity and unfairness in research into changes in practice by all stakeholders.” The authors write, “imbalances in global research collaborations — which stem from a complex mix of racial discrimination, systemic bias and major disparities in funding and resources — impact the integrity of research in numerous ways…. Power imbalances also skew research priorities, with investigators pursuing goals that frequently overlook the needs of local people.” To help mitigate these inequities the Cape Town Statement has four broad goals: funders and researchers in higher income countries must intentionally increase diversity and inclusion; “all stakeholders, from researchers, institutions and funders, to journal editors and publishers, must take steps to ensure that they are not exacerbating power imbalances in research collaborations, but instead helping to remove them;…. Funders and collaborating institutions must take steps to enable the development of research-support systems in LMICs;” researchers must recognize indigenous knowledge. Read the Cape Town Statement here.
 

WHO Updates COVID-19 Vaccine Guidelines

 
STAT (US) reports, “A panel of experts that advises the World Health Organization on vaccine use suggested Tuesday that countries no longer need to consider offering additional COVID-19 boosters to people at medium or low risk of becoming seriously ill if they contract the SARS-CoV-2 virus. The Strategic Advisory Group of Experts on Immunization — which is known as the SAGE — said some countries may continue to offer boosters to people at medium and low risk, but those decisions should be made based on national conditions and health spending priorities.”
 

Fast-tracking Marburg Vaccine Testing

 
Health Policy Watch (Switzerland) reports WHO “hopes to be able to fast-track the testing of various Marburg candidate vaccines following outbreaks of this rare and deadly viral haemorrhagic fever in Tanzania and Equatorial Guinea. ‘WHO is leading an effort to evaluate candidate vaccines and therapeutics in the context of the outbreak,’ WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing…”
 
The Standard (Kenya) reports, “Kenya has intensified its preparedness following an outbreak of Marburg in Tanzania…. [WHO] has put Kenya on notice following the outbreak of the Marburg virus in Tanzania on Tuesday, March 21.”
 
AP (US) reports, “Equatorial Guinea has confirmed another eight cases of the “highly virulent” Marburg virus, a deadly hemorrhagic fever with no authorized vaccine or treatment. The World Health Organization on Thursday said that brings the country’s total number of cases to nine in the outbreak declared in mid-February. There are two known current outbreaks of Marburg on the African continent. Tanzania this week announced eight cases of Marburg, including five deaths. One of the people killed was a health worker.”
 

Mpox Public Health Emergency of International Concern Continues

 
In a tweet WHO says “WHO has declared that the Public Health Emergency of International Concern for #mpox remains in effect. Dr Rosamund Lewis provides a status update, lessons learned from the response so far and elaborates on who is at risk in Science in 5.”
 
The Pink News (UK) reports, “The World Health Organisation (WHO) has announced that it still considers mpox a public health emergency of international concern, just days after the UK confirmed it would wind down its vaccination campaign against the virus. WHO’s Rosamund Lewis is quoted: ““It is very important for people who may be at risk, particularly men who have sex with men, to continue to be mindful of how to reduce their risk by reducing the number of sexual partners, for example, and being aware when they are attending events where sexual activity may occur.” The article notes, “the UK Health Security Agency (UKHSA) stated that it would continue to closely monitor case numbers and retain the ability to restart the vaccination program if necessary. The United States and Ireland have already ended their mpox vaccination programs due to decreasing case numbers.”
 
The UK-based International Public Policy Observatory released a new report Responding to Mpox: Communities, Communication, and Infrastructures that “sets out key findings about the successes and challenges in the response mpox in the UK and internationally and makes research-based policy recommendations for future similar contexts.”
 

700,000 COVID-19 Deaths in Brazil

 
AP (US) reports, “Brazil’s government on Tuesday reported the 700,000th death from COVID-19 in the South American nation, which has the second most victims of the virus after the United States. Brazilian health experts say most people dying of COVID-19 in recent days are either unvaccinated or suffer from other debilitating diseases…. Health Minister Nisia Trindade criticized former President Jair Bolsonaro for his handling of the pandemic. Bolsonaro, who became ill with COVID-19, later declined to take the coronavirus vaccine and flouted health restrictions.”
 

US Government Disbanding COVID-19 Team

 
The Washington Post (US) reports, “The White House will shut down its covid response team after the public health emergency ends in May…. This “comes as the pandemic has receded from US hospitals and in voters’ minds…. and while the Centers for Disease Control and Prevention still links about 2,000 deaths per week to COVID-19, that represents the lowest death toll since the earliest days of the pandemic…. At the same time, Republicans on the campaign trail are ramping up attacks on coronavirus vaccines and shutdowns, capitalizing on many voters’ frustration with policies intended to curb the pandemic. And on Capitol Hill, House Republicans, now in the majority, are charging ahead with investigations into the origins of the pandemic.”
 
CBS News (US) reports the US government’s “efforts to develop and stockpile key medicines for guarding against public health threats are underfunded by some $35 billion, the Biden administration warned Congress on Monday, forcing officials to make risky trade-offs that could leave the US unprepared for the next emergency. Over the next five years, the Department of Health and Human Services estimates that the US will need $64 billion overall to fund the work of an array of agencies tasked with "medical countermeasures" for threats ranging from COVID-19 to nuclear attacks.”
 
An opinion piece in STAT (US) notes, “The Biden administration has rightly talked a lot about pandemic preparedness. And to its credit, the latest White House budget proposes new funding to stop future disease threats. In the introduction to the global affairs budget, the State Department celebrates how this money will help make the world better prepared. But there’s a catch. A hundred pages later, alongside increased funding for future pandemics, you’ll see it actually suggests cutting funding from three of the biggest, longstanding pandemics we’re already facing. US programs for global tuberculosis, malaria, and HIV/AIDS all get scaled back, including by nearly 10 percent for TB. This is a false choice, and a wrong one. All the evidence shows we don’t need to choose between stopping the current pandemics and preparing for the next one. The same systems can do both, if they have the funding.”
 

China’s mRNA Vaccine

 
Reuters (UK) reports, “China has approved its first domestically developed mRNA vaccine against COVID-19, CSPC Pharmaceutical Group Ltd said on Wednesday, a major achievement in a country that has declined to use Western COVID-19 shots to support domestic research….the long-awaited approval comes as infections have fallen sharply across China since it suddenly dropped its strict "zero-COVID" curbs in December, making the sales outlook for the newly approved vaccine moderate. But it would give China an additional option to tackle future outbreaks and a base for development against newly emerging variants, scientists said.”
 

COVID-19 Origins

 
The search for the origins of the pandemic continue to be a scientific question and a political football.
 
The Guardian (UK) looks at th the scientist who found the data that may link the pandemic to the Wuhan market, reporting, “The genetic data, from swabs taken at the Huanan seafood market in Wuhan, China, in the weeks after COVID-19 first emerged, were available online just long enough for a Parisian scientist to stumble upon them while working from her couch on a Saturday afternoon earlier this month.” The data has since been taken off the database. “
 
Amy Maxman writes in a Washington Post (US) opinion, “A new analysis by a team of international experts adds to evidence suggesting that the pandemic began when animals at the Huanan Seafood Market in Wuhan, China, spread the coronavirus to people. But there’s a problem: Other researchers can’t scrutinize the genetic sequences it’s based on. This data needs to be made public. And if China won’t do it, then someone else must — either those who run the platform where the data was fleetingly available or the team that did the new analysis — even though, among scientists, releasing other people’s data is tantamount to theft…. This episode illustrates that, as world leaders consider how to prepare for the next pandemic, agreement on fit-for-purpose data sharing must be a top priority. Until that’s settled, scientists must help one another get to the bottom of COVID-19’s origins.”
 
The Guardian (UK) has an interview with Florence Débarre the scientist whose “discovery of genetic data online showed for first time that animals susceptible to coronavirus were present at market.” The data has since been taken off the database and there are questions about when and how it might be shared again.