The global COVID-19 public health emergency is over. Last Friday WHO’s Tedros made the decision on the advice of WHO’s COVID-19 emergency committee to end the public health emergency of international concern (PHEIC), saying “This virus is here to stay…. The worst thing any country could do now is to use this news as a reason to let down its guard, to dismantle the systems it has built, or to send the message to its people that COVID-19 is nothing to worry about.”
 
But what does the end of the emergency mean? Not surprisingly news and opinion on what the end of the global emergency means is varied. In STAT (US) Helen Branswell asks, “Does the end of COVID-19 emergency declarations mean the pandemic is over?” She writes. “Because COVID-19 transmission isn’t going to cease, there is no actual end to point to. Instead, epidemiologists and medical historians look for signs that the virus is transitioning into something that is more predictable and less dangerous. That’s a journey whose timing is influenced by both how the virus evolves and how quickly our immune systems acquire the capacity to cope with the new disease…. But a looming question remains about what will happen with the evolution of the virus. Will a major new variant of concern, a version of the virus that is as different from Omicron as Omicron was from Delta, emerge and cause a large new wave of infections? Experts hope not, but say there’s no way to know for sure. The WHO indicated it might need to declare another public health emergency, were that to happen.”
 
See the readout on the meeting of the emergency committee here.
                                                                                                               

If You Are in a Hurry

 

• What’s next with COVID-19 post-emergency? Read news and opinions in New York Times, Science and The Atlantic.
• Then read Gregg Gonsalves in The Nation on the future of global health.
• Read a guest essay by Tom Inglesby and J. Stephen Morrison in New York Times looking at how to overhaul the US CDC.
• Read Nature on the approval of the RSV vaccine.
• Read The Daily Telegraph on the importance of genomic sequencing in Africa.
• Read about AI and vaccine development in Nature and AI and antibody sequencing in Nature.
• Read The New York Times on efficacy of a single dose of HPV vaccines and The Star on a plan to vaccinate more girls in Kenya.

 

More on the End of COVID-19 Emergencies

 
Science (US) reports on the end of the US public health emergency (coming on May 11). “The end of the US PHE next week will impact policies as wide-ranging as the flow of migrants at the southern border, which the emergency has allowed the government to stifle on public health grounds—and the federal government’s provision of free rapid antigen tests, which will end…. Tools such as wastewater testing and genomic sequencing will still be used to give CDC greater visibility into SARS-CoV-2’s distribution and evolution than it has for other respiratory pathogens such as influenza and respiratory syncytial virus, Shah stressed. In addition, COVID-19–associated deaths—a hard if lagging metric that is reported on death certificates nationally—will be published weekly by CDC, cast as a percentage of all US deaths.” Gregg Gonsalves is quoted on the end of the WHO emergency: He “says he is less concerned about what to call the pandemic than what is done to address it. Regardless of whether it is called a PHEIC, COVID-19 continues to cause death and suffering across the globe, he says. ‘Yet, almost everywhere we’ve declared mission accomplished and we have no appetite for doing anything more to fight this disease,’ Gonsalves says. ‘We’re willing to bake in a huge amount of morbidity and mortality to get back to normal [and] it doesn’t bode well for facing our future.’”
 
In a New York Times (US) guest essay science writer David Quammen asks, “If the Pandemic Is No Longer a Public Health Emergency, Then What Is It?” He writes, “I’m neither a public health expert nor a scientist, so I offer a citizen’s opinion: Yes, it’s time to cease calling COVID-19 a public health emergency of international concern. But the coronavirus is still with us, almost everywhere on the planet where humans live, and circulating also among whitetail deer, feral mink and probably some other wild mammals. It will remain capable of changing, adapting — and more quickly than the malaria protozoans. Therefore, COVID-19 is still certainly a public health situation of international concern. We’ll be living with it, and dying from it, some of us, forever. Meanwhile, we should probably rest and recharge the term “emergency” and save it for the next one — which could be H5N1 bird flu or something else, possibly beginning tomorrow.”
 
Katherine Wu reports in The Atlantic (US), “ending the emergency doesn’t mean that the world has fully addressed the problems that made this an emergency. Global vaccine distribution remains wildly inequitable, leaving many people susceptible to the virus’s worst effects; deaths are still concentrated among those most vulnerable; the virus’s evolutionary and transmission patterns are far from predictable or seasonal. Now, ending the emergency is less an epidemiological decision than a political one: Our tolerance for these dangers has grown to the extent that most people are doing their best to look away from the remaining risk, and will continue to until the virus forces us to turn back.”
 
Gregg Gonsalves writes in The Nation (US), “Most of the world has moved on from the pandemic, with politicians and pundits exhibiting a triumphalism that seems ghoulish given the death toll, like high-fiving at the site of a mass grave. But as we enter the “post-COVID” universe, I find the Alma Ata declaration rattling around in my mind. What would a 2023 version look like? What would it even realistically say? In other words, what is the future of global health?... [Paul] Farmer used to talk about a preferential option for the poor. Here in the land of plenty, we have a preferential option for the well-off and comfortable. Health for all by the year 3000? Not likely. With the existential threat of climate change and the risk of new pandemics, at this rate, from what I’ve seen, it’s more likely that no one will be around to make the waggish quip for that new millennium. And the joke will have been on us.”
 

US CDC Director Steps Down

 
STAT (US) reports US CDC director Rochelle Walensky will step down at the end of June, quoting Walensky: “’I took on this role with the goal of leaving behind the dark days of the pandemic and moving CDC — and public health — forward into a much better and more trusted place…. At this pivotal moment for our nation and public health, having worked together to accomplish so much over the last two-plus years, it is with mixed emotions that I will step down…’ In her time as CDC director, Walensky has tried to change the culture of the agency, pushing it to release data more quickly. Too often, she argued, scientists were holding onto information the public needed to know as they went through the process of releasing the data in scientific articles…. She has also lobbied hard for authorities that would allow the agency to collect more and better data from states, tribes, and territories — a problem that has hamstrung the CDC at many points during the pandemic.”
 
Tom Inglesby and J. Stephen Morrison write in a New York Times (US) guest essay, “we recently conducted an independent and bipartisan investigation of the CDC’s pandemic preparedness and response during the COVID-19 pandemic. And we concluded that the agency needs a serious reset — urgently so. The health and resilience of the country hangs in the balance…. ‌There’s ‌so much that makes the agency crucial and worth saving and strengthening. The CDC continues to be a critical technical and scientific resource to public health authorities around the country and the world.” They call for shoring up the CDC’s workforce in Washington, DC to better interact with congress and other agencies, overhauling the way the agency communicates with Americans and for congress to give CDC more power to collect data from states. They conclude, “Leaders in the Biden administration and Congress‌ need to‌‌ seize this moment. They have ‌an opportunity to build bipartisan consensus around pragmatic reforms that will restore the CDC to high performance and high trust, and ensure the safety of Americans into the future.”
 

US FDA Approves RSV Vaccine

 
Nature (UK) reports, “The US Food and Drug Administration (FDA) has approved GSK’s vaccine against respiratory syncytial virus (RSV) for use in people aged 60 years and older. This is the first RSV vaccine to gain approval anywhere in the world, and researchers are celebrating. ‘It’s a very big deal to have options available to prevent RSV disease,’ says Barney Graham, senior adviser for global-health-equity trials at Morehouse School of Medicine in Atlanta, Georgia…. The technology underlying the RSV vaccine has been almost 60 years in the making. In the 1960s, during a clinical trial of an RSV vaccine, two of the participating children died and 80 percent ended up in hospital. Understanding what had happened and finding a solution became Graham’s life’s work. ‘The first 20 years were spent primarily working out how to make a vaccine that could be safe,’ he says…. ’It’s very gratifying to see this finally happening,’ Graham says. ‘It’s a good day for RSV.’”
 

Single Dose of HPV Vaccine Effective

 
The New York Times (US) reports, “A single dose of the human papillomavirus vaccine is highly effective at preventing infections over three years, most likely lowering rates of cervical cancer and other diseases linked to the virus, according to a new study in Kenya. A single-dose strategy would dramatically extend supplies of the vaccine, lower costs and simplify distribution, which would make vaccination a more viable option in countries with limited resources, experts said.”
 
The Star (Kenya) reports, “Kenya will benefit from new funding to roll out the single-dose cervical cancer vaccine because evidence shows a single jab is as effective as two or three doses. Countries such as Australia have already moved to the single dose and extended the eligibility to women under 26 years. Gavi, which buys most vaccines for Kenya, is leading the new campaign to increase uptake…. Alongside the single dose push, Gavi said it is seeking to reach 86 million adolescent girls with the HPV vaccine by 2025, in a separate action plan. The plan will help countries introduce the HPV vaccine into routine immunisation schedules, introduce the jab to older girls for catch up, and make the jab part of the countries primary health care plan.”
 

Genomic Sequencing in Africa

 
The Daily Telegraph (UK) looks at the growing capacity for genomic sequencing in Africa and what means for future pandemics. “Monitoring and comparing pathogens' genomes came under the spotlight during the COVID-19 pandemic when the world's epidemiologists hunted for new variations and mutations which might make the coronavirus more infectious, more harmful, or negate vaccines. Yet this research is not new to Africa, which has been at the forefront of genomic surveillance for years, says Prof de Oliveira. His new lab and others around the continent will mean African nations remain at the cutting edge, he believes. Indeed the continent has to be in the lead, he says, because the world stands at the dawn of an age of epidemics and many of the factors likely to cause them to emerge can be found in Africa.”
 

Mpox Cases Rising in Some Areas

 
CIDRAP (US) reports, “In the latest global mpox developments, Africa has had a 7.4 percent case increase, with 111 new cases in the most recent 2 weeks; officials report 17 cases in the past month in Europe; and New South Wales (NSW), Australia confirmed its first case in 6 months. The rise in Africa is almost exclusively spurred by a spike in mpox cases in the Democratic Republic of the Congo (DRC)…. The DRC has seen a 23.6 percent increase in cases in recent weeks and has logged 277 infections so far in 2023. The only other African country to report mpox cases this year is the Central African Republic…. According to a report yesterday from the European Centre for Disease Prevention and Control and the WHO European office, eight European countries reported new mpox cases in the past 4 weeks, with 17 new confirmed infections…”
 
The Body (US) reports, “From January to April of this year, case studies have reported five European men who tested positive for mpox during the earlier part of last year’s outbreak and who appear to have reacquired the virus after clearing their initial infections…. Of these cases, the man from London had received both vaccine doses after his first infection, while none of the others received the vaccine after their first infection. The men were all in their 30s, all reported having condomless sex with multiple partners prior to the second positive mpox test, and all cleared the second infections without any major health issues.”
 

Artificial Intelligence, Vaccines and Antibodies

 
Nature (UK) reports, “An artificial intelligence (AI) tool that optimizes the gene sequences found in mRNA vaccines could help to create jabs with greater potency and stability that could be deployed across the globe…. The software borrows techniques from computational linguistics to design mRNA sequences with shapes and structures more intricate than those used in current vaccines. This enables the genetic material to persist for longer than usual. The more stable the mRNA that’s delivered to a person’s cells, the more antigens are produced by the protein-making machinery in that person’s body. This, in turn, leads to a rise in protective antibodies, theoretically leaving immunized individuals better equipped to fend off infectious diseases.”
 
In a separate article Nature (UK) reports, “At the height of the pandemic, researchers raced to develop some of the first effective treatments against COVID-19: antibody molecules isolated from the blood of people who had recovered from the disease. Now, scientists have shown that generative artificial intelligence (AI) can provide a shortcut through some of this laborious process, suggesting sequences that boost the potency of antibodies against viruses such as SARS-CoV-2 and ebolavirus. A study published last week in Nature Biotechnology1 is part of growing efforts to apply ‘neural networks’ similar to those behind the ChatGPT AI platform to antibody design.”
 

Avian Flu and Wild Birds

 
Vox (US) reports, “The ongoing outbreak of avian flu has killed hundreds of thousands — if not millions — of wild birds, including endangered species like the California condor. It’s one of the worst wildlife disease outbreaks in history. Having now spread across five continents and hundreds of wildlife species, scientists call the current outbreak a panzootic, meaning a pandemic among animals…. Typically, avian influenza viruses only cause severe disease and death in domestic birds like chickens and farmed ducks; they sweep through populations, killing upward of 90 percent of the flock. This virus, however, is different. It’s hammering wild birds and other wildlife, including mammals…. The virus could also pose a threat to us. While it doesn’t readily infect and spread among people today, the avian virus could evolve traits that make it more dangerous to humans as it circulates among wild animals. That’s another reason scientists are taking the outbreak among wild birds so seriously.
 

Antivaxxers Building a Legal Network

 
People opposed to COVID-19 vaccines continue to spread misinformation and are now working to use the legal system to promote their misinformation. NPR (US) reports on a recent “conference to map out strategies for anti-vaccine and COVID-19-focused litigation as the pandemic winds down…. Thousands of lawsuits pushing back against public health measures have been filed since the pandemic…. The goal of this conference is to bring lawyers behind these suits together, study all that legal spaghetti on the wall and analyze what has and hasn't worked. They mean to probe for weak points in the law, build a network of experts and plaintiffs, and, they hope, inspire new laws.”
 

Long COVID Reservoirs

 
NPR (US) reports on research looking to see if viral reservoirs may be responsible for long COVID. “This theory of ‘viral persistence’ posits that some people never fully eliminate the infection, that viral reservoirs are subsisting in the body and possibly triggering the symptoms of long COVID. While a direct link isn't yet proven, this line of research has gained momentum as more evidence has emerged indicating that some people seem to harbor "viral reservoirs'' after their initial illness has passed. It's far from the only explanation under consideration, but some scientists see it as one of the most promising.”