The Pandemic Accord now being negotiated by countries is meant to help prepare a global response to next pandemic, but many fear the accord is being weakened to a point where it will be largely infective. Mariana Mazzucato, chair of the WHO Council on the Economics of Health for All writes in FT (UK) that “the leaked draft text of this accord reveals that we may be on the verge of discounting what we have learnt over the past three years and squandering this opportunity to safeguard our futures.” She argues, “[I]nnovation needs to be for the common good. Scientific information must be shared freely across borders and innovations, particularly medical ones, must be used to ensure health equity for all. Instead, governments in low and middle-income countries are having to reinvent the wheel with regards to crucial vaccine technology. What they need is rapid technology transfers on reasonable terms from big pharmaceutical manufacturers in rich countries.”
 
Jon Cohen reports in Science (US) that Pfizer and Moderna aren’t sharing vaccine doses for research purposes, setting back the search for new COVID-19 vaccines. “Developers need existing vaccines as a benchmark to compare with new candidates. But government contracts with the vaccinemakers, and the companies’ own policies, prohibit the use of the vaccines for research purposes…. Researchers who are aiming for more broadly protective vaccines need the comparators to improve the design of their own candidates. The Pfizer and Moderna vaccines today have full approval from the Food and Drug Administration (FDA), a status that usually would allow researchers to purchase and study them. But because of the emergency pandemic response, the US government owns all the product and, by contract with the companies, cannot provide it for research purposes. The contracts specify that the vaccines can only be used for immunizing humans and violations in theory could create liability issues for the companies.” Cohen notes researchers are finding workarounds for early stage research, but to test the efficacy of a new vaccine the reference vaccines will be needed.
 

If You Are in a Hurry

 

• Read Rockefeller Foundation’s Estelle Willie on key pandemic lessons for communications in STAT.
• Read The Atlantic on how pandemic simulations are changing following COVID-19.
• Read Winnie Byanyima and Sir Michael Marmot in IPS on ending inequities to end pandemics.
• Read BMC Globalization and Health on the mostly negative consequences of nonpharmaceutical interventions (NPI) during the COVID-19 pandemic in four African countries.
• Read a call in The Washington Post to loosen restrictions on Cuba to let the country share its vaccine technology in the next pandemic.
• Read a Brookings Institute analysis of global health funding post-COVID.

 

Tanzania Declares End to Marburg Outbreak

 
VOA (US) reports, “Tanzania on Friday declared the end of a deadly outbreak of the Marburg virus, more than two months after it was first confirmed, the World Health Organization said. Nine cases - eight confirmed and one probable - and six deaths were recorded in the outbreak of the hemorrhagic fever in the northwestern region of Kagera, the WHO said in a statement…. Tanzania's outbreak coincided with cases in the West African state of Equatorial Guinea, where the death toll had risen to 12, according to health ministry figures issued on April 24. WHO chief Tedros Adhanom Ghebreyesus on Friday said the outbreak in Equatorial Guinea ‘is also expected to be declared there over in the next week, if no further cases are detected.’"
 

Pandemic Lessons

 
In NEJM’s Intention to Treat podcast (US) NEJM editor-in-chief Dr. Eric Rubin and Dr. Harvey Fineberg, former dean of the Harvard School of Public Health, share their take on lessons learned from the COVID-19 pandemic. Dr. Rubin notes, “Looking forward to the next outbreak, I think that it is important not just to emphasize the failures that we’ve had, and there have been many, but the successes that we’ve had. We are able to protect people against severe disease and death now, for the most part. And a lot of the measures that we utilized throughout remain important now, the social measures as opposed to just the medical interventions like vaccines and like therapies. I think that when a new outbreak occurs, it’s really important to continue to use the lessons that we’ve already learned.”
 
The Rockefeller Foundation’s Estelle Willie writes in STAT (US) that as we look at pandemic lessons learned, we haven’t talked enough about the victories. “While the media often focused on bad actors, in reality vast majorities of Americans got the message and changed their behavior to follow public health guidance…. more than 270 million Americans — over 80 percent of the population — have received at least one COVID-19 vaccination shot. These shifts represent real, dramatic behavior change. When you consider that some of these behaviors, like masking or social distancing, were close to zero pre-pandemic, that means we’ve moved the needle more than 50 percentage points.” She suggests “four clear lessons the public health community should take with us to help ensure our messages connect with our audience,” including: Don’t assume science is enough; reliable messengers matter; tested messaging matters and an achievable call to action matters.”
 

Simulation Exercise Shows World Unprepared for Biothreats and Pandemics

 
Telegraph (UK) reports, “The world is ‘woefully unprepared’ for a biological attack or pandemic, according to international security experts who recently simulated a deadly outbreak. Despite some improvements following the response to COVID-19, the international system of pandemic prevention, detection, and response would not address current and anticipated future biological threats, the experts warned.”
 
The Atlantic (US) looks at how pandemic simulations are changing following COVID-19. “Before COVID-19, pandemic role-plays were meant in part to raise awareness—to show participants and the public alike that a pandemic could really happen. Now, obviously, few people need to be persuaded of the risk. Post-COVID, the exercises serve a very different function: They remind us that the next pandemic might look nothing like the one we’ve just experienced. It could have a far higher case-fatality rate. It could disproportionately sicken children rather than the elderly. Its symptoms could be neurological instead of respiratory. ‘Just having lived through COVID doesn’t prepare us for all future events,’ [Johns Hopkins Center for Health Security’s Tom] Inglesby said. Experience is an infinitesimal sliver of possibility.”
 

Rise in COVID-19 in NYC Wastewater

 
With fewer ways of tracking COVID-19 cases with health emergencies ended, wastewater tracking is becoming a more important way of following the virus. CIDRAP (US) reports, “Most US COVID-19 measures showed continuing declining trends, according to the latest data from the Centers for Disease Control and Prevention (CDC), though high levels of the virus in New York City wastewater hint at a local increase…. New York City's COVID-10 activity appears to be on the rise, with all 14 of its wastewater treatment plants showing high concentrations of the virus, according to CBS News. However, data from the NYC Health shows that cases, hospitalizations, and deaths remain at very low levels.”
 

Closing Inequities to End Pandemics

 
Winnie Byanyima and Sir Michael Marmot write in an IPS (Italy) opinion piece, “The COVID-19 crisis has shone a light on the danger of pandemics; social crises have shone a light on the danger of inequalities. And the reality is that outbreaks become the pandemics they do because of inequality. The good news is that both can be overcome – if they are confronted as one…. To fight tomorrow’s pandemics, we need inequality-busting approaches to today’s pandemics. The world’s leaders now face a clear choice: stand by whilst the dangers mount or come together to tackle inequalities for a world that is not only fairer, but safer too.”
 
The opinion piece introduces a new Global Council on Inequality, AIDS and Pandemics. A UNAIDS press release says, “The work of the Global Council will harness essential evidence for policymakers and elevate political attention to the need for action to end inequalities that fuel AIDS and other pandemics. Crucially, it will encourage and support frontline communities to advocate for the policy shifts necessary to fight current pandemics and better prepare for tomorrow’s outbreaks.”
 

New US CDC Indoor Air Guidance

 
The Lancet Respiratory Medicine (UK) reports the US CDC has released ventilation guidance aimed at reducing indoor transmission of SARS-CoV-2. “Allen hopes the CDC guidance will be the first step toward formal, government-enforced regulatory standards. The US Environmental Protection Agency has an Indoor Environments Division, but the staff currently do not regulate indoor air quality; the agency is reviewing voluntary strategies to improve indoor school and commercial building air quality. For now, compliance with the new CDC guidance will be voluntary and building owners will have to pay for the required equipment upgrades.”
 

Unintended Consequences of Nonpharmaceutical COVID-19 Interventions

 
Research published in BMC Globalization and Health (UK) looked at the consequences of nonpharmaceutical interventions (NPI) during the COVID-19 pandemic in DRC, Nigeria, Senegal, and Uganda. “Over the first six to nine months of the pandemic, NPIs especially lockdowns, travel restrictions, curfews, school closures, and prohibition of mass gathering resulted into both positive and negative unintended consequences cutting across economic, psychological, and environmental platforms. DRC, Nigeria, and Uganda observed reduced crime rates and road traffic accidents, while Uganda also reported reduced air pollution. In addition, hygiene practices have improved through health promotion measures that have been promoted for the response to the pandemic. All countries experienced economic slowdown, job losses heavily impacting women and poor households, increased sexual and gender-based violence, teenage pregnancies, and early marriages, increased poor mental health conditions, increased waste generation with poor disposal, among others. Despite achieving pandemic control, the stringent NPIs had several negative and few positive unintended consequences. Governments need to balance the negative and positive consequences of NPIs by anticipating and instituting measures that will support and protect vulnerable groups especially the poor, the elderly, women, and children.”
 

Mpox Status in the US

 
The Your Local Epidemiologist Blog (US) provides an overview of where the US is with mpox as summer looks to bring a resurgence of cases. “[L]ast month the CDC identified a new cluster of mpox cases in Chicago. CDC has also reported remnants of mpox in wastewater, without linked cases, meaning it’s likely spreading undetected. The Western Pacific has an uptick in cases, and the UK just reported an outbreak of 10 new cases in London, too. Combine this with changes in behavior during Pride month, and we may be on the cusp of an outbreak. The CDC thinks the likelihood of this happening is ‘substantial.’.… Mpox is certainly among diseases that we know are sexually transmitted. Last summer we didn’t know if there was active virus in semen. It turns out that there is, but lab data show lesions or open sores are most contagious. It’s almost impossible to discern whether people in the ‘real world’ are infected from lesions or semen given that sex is close contact…. We don’t know mpox’s future. Will it become endemic everywhere with sporadic outbreaks (like we are seeing in the US), or will it eventually fade with time and remain at low levels in Africa? Elimination, altogether, is unlikely unless support, like surveillance, control measures, and research, is maintained and strengthened worldwide.”
 

Including Trans and Non-Binary Folks in Mpox Responses

 
A WHO feature story looks at the important inclusion of trans and non-binary individuals in mpox control and elimination programs in Europe. “In the current mpox outbreak, outside of countries in Africa where the disease has long been endemic, the vast majority, but not all, cases have been among gay, bisexual and other men who have sex with men (GBMSM). However, communities of trans and gender-diverse people have also been impacted. To fight mpox, CSOs that represent affected groups have mobilized to protect themselves and prevent onward transmission…. Launched in May 2023, WHO/Europe’s mpox campaign calls on affected communities, health authorities and providers to remain vigilant this summer. It urges countries to reach all affected communities with mpox health information and advice, testing and vaccination and shines a light on people’s mpox-related experiences, needs and hopes this year.”
 

Dengue Outbreak in Peru

 
Bloomberg (US) reports Peru is experiencing the largest dengue fever outbreak in its history: “So far this year, 121 people have died from dengue in Peru. In total, more than 86,000 cases have been reported, according to official statistics. Both numbers are already higher than in all of 2017, the last time Peru experienced El Niño, which also triggered a huge dengue outbreak.”
 

Let Cuba Vaccinate the World

 
Cuba has had great success in developing its own vaccines, including for COVID-19, but those vaccines have not been available to most other countries. Two health access advocates write in an opinion piece in The Washington Post (US), “The story of how Cuba was systematically blocked in its quest to make its own highly effective vaccines widely available offers crucial lessons…. There is little indication that the Biden administration will pressure US pharmaceutical companies to share their medical inventions internationally. But President Biden could take a giant step toward global health security by rolling back the Trump administration’s draconian Cuba policies. If he went further by allowing for new exceptions in the US sanctions regime, then Cuba could keep developing — and sharing — innovative vaccines and treatments for the world’s diseases.”

Global Health Funding Post-COVID 

A Brookings Institute analysis of global health funding takes a gloomy outlook on the future of funding. “There is good reason to believe that a focus on COVID-19 and PPR is pulling resources from UHC with wider health outcome effects. This raises concern that diminished ODA, alongside budget reallocations for increased PPR activity, will increase burdens on already strained health systems while reducing funds available for new initiatives (opportunity costs). There are also signs that global health donors may further reduce their health aid, falling back into a common pattern in global health financing—the ‘cycle of panic and neglect.’ This condition will exacerbate vulnerabilities and health outcomes. Moreover, this will undermine the credibility and sustainability of the Pandemic Fund as existing money is diverted while new money remains scant.”
 

Disinformation about COVID-19 Vaccines and AIDS Resurfaces

 
Reuters (UK) reports online posts are “resurfacing a debunked narrative that COVID-19 vaccines cause an AIDS-like weakening of the immune system.” Reuters notes, “Evidence shows, and the US Centers for Disease Control and Prevention (CDC) - which co-administers the VAERS database – as well as independent experts confirmed in response to the current claims that no AIDS-like immune deficiency has been associated with COVID-19 vaccines, and no 300-fold increase in the listed conditions has been documented in the United States.”