Mpox, formerly known as monkeypox, arrived on the global scene while the world was still grappling with the COVID-19 pandemic. The WHO quickly moved to name mpox a Public Health Emergency of International Concern as cases spread quickly in some communities in Europe, the US and Latin America. Never mind the virus had been endemic in West and Central Africa for years. Now, ten months in, WHO has lifted the global emergency for mpox. Science (US) quotes WHO’s Tedros: “That does not mean that the work is over. Mpox continues to pose significant public health challenges that need a robust, active, and sustainable response.” Science notes, “Nicola Low, an infectious disease epidemiologist at the University of Bern and the vice-chair of WHO’s emergency committee on mpox, said the committee had ‘intense’ deliberations over lifting the PHEIC, but decided that long-term efforts rather than emergency measures are now the best way to control MPXV [the virus that causes mpox].”
 
Science reports despite requests from WHO no donor nations provided support to “monitor, treat and understand” the disease. WHO’s Mike Ryan says, “Mpox ‘has been totally neglected during this outbreak [during which] not one dollar was received from donors’ to support WHO’s response, he said. He suggested donors slighted the disease because it was largely confined to Africa in the past and predominantly affected MSM in the current global outbreak. ‘Maybe it’s an issue of the continued prejudice in this world.… It will continue to be a neglected disease. And it may come back. And it may shock us in the future.’”
 
Nature (UK) quotes Dimie Ogoina, an infectious-disease physician from Nigeria and member of the WHO emergency committee: “We have many problems we are facing in Africa. The disease will be neglected just the way it has been neglected for a long time before the 2022 outbreak.” Ogoina voted against ending the emergency.
 

If You Are in a Hurry

 

• Read a call from Githinji Gitahi and Sabin Nsanzimana in Devex for regional collaboration for African health system strengthening.
• Read CNN and The Independent on a Pew survey on vaccine opinions of Americans. Spoiler: It’s good news and bad news.
• See a multipart, multimedia Reuters investigation of human encroachment on “batlands” and the risk for future pandemics.
• Read NPR on efforts to find a biomarker – and possible treatment – for long COVID.
• Read AFP on a monoclonal antibody for infant RSV and MedPage Today on a maternal vaccine.

 

Mpox Resurgence in the Northern Hemisphere?

 
Even as the WHO emergency was ended, there were warnings of a possible resurgence of the disease as summer comes to the Northern hemisphere. Nature (UK) quotes Boghuma Titanji an infectious disease researcher who “says that the coming Northern Hemisphere summer might encourage infection spread. ‘We’re beginning to hear about reports of new clusters of cases, some of these cases being reported in people who were vaccinated last summer — and there’s still lots of things we don’t understand about this virus and how it’s moving within populations,’ says Titanji. ‘These questions need to be addressed before we take a victory lap and say, we’re done with this.’”
 
CNN (US) reports the US CDC, “is raising the alarm about the potential risk for new cases of mpox, previously known as monkeypox, to emerge this summer.
 
‘Spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events,’ the CDC said in an official update to its Health Alert Network on Monday. The CDC is investigating a cluster of mpox cases in the Chicago area with its local partners, the agency said in Monday’s health advisory, and the CDC ‘continues to receive reports of cases that reflect ongoing community transmission in the United States and internationally.’”
 
CIDRAP (US) reports, “A new study based on wastewater samples collected in Poznan, Poland, last year shows considerably more mpox DNA than expected based on area cases and hospitalizations, suggesting the virus has been underestimated in central Europe. The study appears in the International Journal of Infectious Diseases…. According to the authors of this study, wastewater detection is also helpful when ‘traditional approaches can miss cases of infected individuals who intentionally do not want to be tested due to the social stigma associated with some diseases, including mpox.’"
 

A Call for Regional Collaboration for African Health Systems

 
Githinji Gitahi and Sabin Nsanzimana write in Devex, “One of the biggest lessons from the COVID-19 pandemic is the importance of multisectoral collaboration in the face of health emergencies. Well-coordinated international action has proven to be effective in responding to global health emergencies, having saved millions of lives across the world during the pandemic and, critically, in lower-income settings where populations are more vulnerable to widespread infectious disease outbreaks. To ensure everyone has access to affordable and quality health care, governments, multilateral institutions, development partners, civil society and other stakeholders must continue to work together to build, finance, and strengthen health systems. By doing this, health systems will be able to prevent and mitigate the impact of health emergencies while continuing to provide essential services to populations without interruption.…”
 

Some Good News and Some Bad News About American Views of Vaccines

 
CNN (US) reports, “Divisive views on the COVID-19 vaccines haven’t shaken the broadly favorable views of routine childhood vaccines, a new survey suggests. Nearly nine out of 10 adults in the US say that the benefits of the measles, mumps and rubella (MMR) vaccines outweigh the risks – a share that’s remained unchanged since before the COVID-19 pandemic, according to data published Tuesday by the Pew Research Center. Only about six out of 10 adults say the same about the COVID-19 vaccines.”
 
But the news on vaccine views is not all positive. The survey found sharp differences about vaccine trust based on political views. The Independent (UK) reports, “The share of Republicans who support childhood vaccine requirements has dropped significantly since before the onset of the COVID-19 pandemic…. In 2019, 79 percent of Republicans favoured requiring children to be vaccinated to attend public schools. Now, that number has fallen to just 59 per cent – all while the number of Democrats who support vaccine requirements for public schools has remained unchanged at around 85 per cent…. The Pew survey also found broad concerns with the COVID-19 vaccine. While 62 per cent of Americans say the benefits from the vaccines outweigh the potential risks, just 45 per cent of Americans say that the vaccine has high preventative health benefits — even though COVID-19 vaccines are believed to have saved 20 million lives worldwide in the first year since it was introduced in 2020. 58 percent of people believe the risk of side effects from the vaccines is medium or high.”
 
The data come from a new Pew survey on vaccines. You can see the report and other materials here.
 

Bats and the Next Pandemic

 
In a multimedia, multipart report Reuters (UK) investigates “batlands,” where human incursion into the wild areas where bats live is driving the potential for a virus spillover that could lead to a new pandemic. Reuters found, “human incursions have created a minefield of risk covering more than 9 million sq km across 113 countries…. Now, more than one of every five people on Earth lives in these areas.” Reuters reports, “Bats are a leading reservoir of viruses: 72,000 by some estimates. Scientists don’t fully understand why that’s so, but they point out bats’ virus-packing superpowers. Bats are exceptional incubators: They can harbor and survive viruses that kill other mammals. They’re potent proliferators: Some roost tightly together and in close quarters with other bat species. That means their viruses can rapidly spread and evolve – some equipped to infect other animals, such as people. And bats are prime delivery vehicles: Some can fly hundreds of kilometers in search of food – carrying viruses far and wide.”
 

Laurie Garrett on the End of the Pandemic

 
Laurie Garrett writes in Foreign Policy (US), “In early 2020, I widely predicted that the then-new COVID-19 pandemic would be a 36-month battle. I added at that time that choices made by governments in the first weeks of the pandemic would decide whether the 36-month point marked cessation of all human deaths to the new disease, or merely the virus’s retreat from explosive spread to a new, permanent threat to humanity, akin to HIV. I was wrong. It wasn’t 36 months from the declaration of a pandemic in March 2020—it’s 38 months. I apologize for the two-month miscalculation.” She compares COVID-19 to HIV: “The AIDS pandemic never stopped—humanity simply ceased paying attention to it once effective treatment was found, which both reduces the risk of severe illness and lowers the amount of virus in individuals’ blood to as near-zero as can be measured, reducing the chance of passing it onto other people sexually or through contaminated blood and needles. But HIV is still spreading, sickening, and killing. It never “vanished,” and the still-evolving virus shows no sign of dampening either its pathogenicity or transmissibility.”
 

We Can’t Repeat COVID-19 Mistakes

 
Health Policy Watch (Switzerland) reports, “The global response to COVID-19 failed people in developing countries, women and health workers and must never be repeated, non-state actors told a meeting hosted by the United Nations (UN) in New York [ahead of a High Level Meeting on pandemic prevention, preparedness and response later this year].” The article quotes multiple civil society and other speakers who all called for changes in the global response and planning for pandemics. Among those quoted is said Dr Carlos Correa of the South Centre, who said, “The primary manifestation of inequality was the inequitable distribution of vaccines. The COVAX mechanism failed to achieve equitable distribution of vaccines not only due to financial reasons but because the governance of the system was not multilateral in nature.” The Medicines Patent Pool said, “it was possible to include equitable access conditions in funding agreements to help “address questions of affordable access long before the product comes to market. This is especially important in the context of PPPR. Public, multilateral and charitable financing of r&d can be conditioned on funded entities taking sufficient measures by voluntary licensing or otherwise, to ensure that every medical technology is available and affordable to all.”
 

Lessons from African Vaccine Manufacturing

 
Health Policy Watch (Switzerland) reports, “While the pandemic accord currently being negotiated is almost certain to support regional vaccine production, setting this up is complex and the COVID-era failures offer a number of sobering and cautionary lessons.” One such lesson comes from South Africa’s Aspen Pharmaceuticals, which “invested millions of dollars in scaling up its South African production plant to make COVID-19 vaccines – yet it never sold a single vial.” Among the lessons learned, “’The first and most important element is we require a stable and predictable demand,’ said [Aspen head] Nicolaou, adding that there needed to be a proper procurement process through the African Union. Other important factors are an integrated regulatory system, the transfer of technology and knowledge to local African producers and public-private partnerships.”
 

RSV Prevention for Infants

 
AFP (France) reports, “French pharmaceutical giant Sanofi announced trial results on Friday that showed its preventative treatment for respiratory syncytial virus (RSV) reduced the rate of babies being hospitalised by more than 80 percent. The virus infects around nine out of 10 children by the age of two and is the most common cause of bronchiolitis, a respiratory infection that is normally mild but, in some cases, can make infants seriously ill…. The results showed an 83 percent reduction in hospitalisations for infants with RSV-related illnesses who received a single dose of nirsevimab, compared to a control group who did not receive the treatment…. While not a vaccine, nirsevimab is a monoclonal antibody treatment that has a similar aim: to give protection against RSV with a single injection.”
 
MedPage Today (US) reports, “A maternal respiratory syncytial virus (RSV) vaccine candidate prevents infections in infants and comes with ‘generally favorable’ safety data, said FDA staff in briefing documents released ahead of an advisory committee meeting this week, but the reviewers ‘noted potential uncertainty based on the numerical imbalance in premature deliveries.’” The FDA staff noted one premature baby’s death that could be related to the vaccine and said, “FDA is unable to exclude the possibility of the extreme prematurity and subsequent death being related to receipt of the investigational product." The FDA advisory committee is expected to consider the vaccine at a meeting this week.
 

Responding to Misinformation About the Pandemic Accord

 
AP (US) fact checks claims that the Pandemic Accord being negotiated now would “’bypass’ the US Senate and ‘reshape America.’…. AP reports, “Social media users are casting doubt over ongoing talks to improve the world’s response to pandemics, mischaracterizing it as a thinly veiled threat to US sovereignty.” The truth is, “The WHO’s 194-member nations agreed last year to develop a pandemic accord as a legally binding convention or treaty, meaning it would require US Senate approval, according to Lawrence Gostin, a global health law professor at Georgetown University who has been involved in the discussions. Under the US Constitution, conventions and treaties made with other nations must be approved by a two-thirds vote of the Senate and have the full force of federal legislation.” A WHO FAQ is quoted: ““As with all international instruments, any new accord, if and when agreed by Member States, would be determined by governments themselves, who would take any action while considering their own national laws and regulations.”
 

Long COVID

 
An opinion piece in Daily Maverick (South Africa) reports on some of the problems faced by people living with long COVID as they negotiate their illness while dealing with often skeptical insurance companies and employers, noting, “the ME CFS Foundation is calling on our government to step up to protect the growing number of Long COVID sufferers and not allow them to be mistreated the way people with ME [Myalgic Encephalomyelitis] have been globally by the medical establishment. They say South Africa must not slavishly follow the transatlantic pattern of health insurance industry and government collusion to deny disability support to chronically ill patients. Our Constitution respects both science and human rights. Like people with HIV, particularly in the 1980s and 1990s, people with Long COVID are suffering stigma and abuse on top of severely debilitating symptoms. But unlike people with HIV, the energy-impaired are mostly unable to march and protest. The time has come for allies to stand up for these abandoned patients who literally cannot stand up for themselves.”
 
NPR (US) reports, “Estimates show that more than 65 million worldwide have the condition, which encompasses a wide range of symptoms that are worsened or appear after initial SARS-CoV-2 infection. But three years after the first people with persistent symptoms were documented, there is no biomarker for the disease — no test or swab that can diagnose someone with Long COVID. A group of researchers is looking to change that…. All of the Long COVID patients Putrino has tested have had microclots and hyperactivated platelets, which is something he doesn't commonly see in people who have never had COVID or who have fully recovered. It's this high level of microclots in Long COVID patients that Putrino thinks might be the biomarker. One of the questions that remains is, if they continue to see this pattern on a bigger scale, is targeting and getting rid of these microclots an effective treatment?”