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AVAC's weekly Pandemic Watch is a curated news digest on the latest pandemic prevention, preparedness, and response (PPPR) news and resources.
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"Technical solutions on their own, while essential, will not fully prepare us for future pandemics. In responding to pandemics, people are the key variable. The very best diagnostics and vaccines in the world will not be effective unless we have a well-prepared health workforce that can deliver them, and unless people have sufficient access to – and trust in – their health system. "
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A cholera epidemic has been raging in Malawi for more than a year, fueled in part by the devastating effects of climate change on the southern African country. But there is some good news, as VOA (US) reports, “Malawi is emerging victorious in its battle against the deadliest cholera outbreak in the country's history, which has killed nearly 2,000 people since its onset in March of last year. Health authorities say the country has seen a steady decline in the death rate, with no new cases or hospitalizations for the past two weeks…. Health authorities attribute the success story to various anti-cholera interventions, including the nationwide vaccination campaign the government and World Health Organization rolled out in May of last year.”
If You Are in a Hurry
- Read Reuters on a plan to get experimental vaccines to outbreaks faster.
- Read a new report from Friends of the Global Fight that argues for putting people at the center of pandemic preparedness.
- Read The Guardian on the impact of air pollution on COVID-19 infections.
- Read Vox on the first known cases of malaria acquisition in the US in 20 years.
- Read an editorial in The Lancet Global Health on decolonizing global health and clinical trials.
- Read Science and The Atlantic on why the rumors about COVID-19 patient zero aren’t what they seem.
- Read CIDRAP on a rash of cat deaths in Poland from a strain of avian flu.
Getting Vaccines to Outbreaks Faster
Reuters (UK) reports, “Three global health bodies are teaming up to investigate stockpiling experimental vaccines for rare infectious diseases so the shots can be tested more quickly when outbreaks happen… It will focus initially on Marburg and the Sudan strain of Ebola, after outbreaks of the two deadly viral hemorrhagic fevers in Africa last year. There are no existing vaccines or proven treatments available for either of the infections. If successful, the scheme – known as the global virtual pooled inventory (GVPI) – could be a pilot for other deadly diseases and wider pandemic preparedness, officials said, which are an increasing threat due to factors like climate change.”
Putting People at the Center of Pandemic Preparedness
A new report from Friends of the Global Fight “focuses on the single most important factor in pandemic preparedness—people. By investing in both communities and the health care workforce, we can fight the pandemics of today while building preparedness capacity against the pandemics of tomorrow.” The report notes, “Technical solutions on their own, while essential, will not fully prepare us for future pandemics. In responding to pandemics, people are the key variable. The very best diagnostics and vaccines in the world will not be effective unless we have a well-prepared health workforce that can deliver them, and unless people have sufficient access to – and trust in – their health system. Likewise, state-of-the-art surveillance can identify where public health interventions are needed, but these interventions will achieve their desired result only if people are willing and able to abide by recommended prevention methods.”
In a commentary in Think Global Health (US), Friends of the Global Fight’s Chris Collins and Global Health Council’s Elisha Dunn-Georgiou write, “To successfully combat future outbreaks, nations will need to utilize the expertise and infrastructure of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund —which have fought pandemics for decades. At the upcoming UN High-Level Meeting on Pandemic Preparedness, we have an opportunity to build on the lessons learned from these 2 organizations. We would be negligent not to do so…. History shows that, when a new disease strikes, we need social protections as well as biomedical tools…. These lessons are too often forgotten during pandemic preparedness dialogues. At September’s High-Level Meeting, we need to bring them to the forefront.”
Bureaucracy Slows Next Gen COVID-19 Vaccine Development
New York Times (US) reports, “Efforts to develop the next generation of COVID-19 vaccines are running up against bureaucratic hassles and regulatory uncertainty, scientists say, obstacles that could make it harder to curb the spread of the coronavirus and arm the United States against future pandemics. The Biden administration, after months of delay, has now addressed at least a shortfall in funding, hurrying to issue the first major grants from a $5 billion program to expedite a new class of more potent and durable inoculations. But the program is facing the blunt reality that vaccine development, after being shifted into high gear early in the pandemic, has returned to its slower and more customary pace.”
Air Pollution and COVID-19
The Guardian (UK) reports, “People exposed to air pollution experienced COVID-19 as if they were 10 years older, according to research. It found people recently exposed to dirtier air before contracting the illness spent four days longer in hospital, the same impact as on those 10 years their senior. The Belgian study also showed that air pollution levels measured in patients’ blood were linked to a 36 percent increase in the risk of needing intensive care treatment. A separate study in Denmark showed air pollution exposure was linked to a 23 percent increase in the risk of death from COVID-19. In both studies, the level of air pollution was below legal EU standards.”
Malaria Returns to US
Vox (US) reports that five people have acquired malaria in Texas and Florida. “Until now, the US hadn’t documented a locally acquired malaria case in 20 years. On Monday, the Centers for Disease Control and Prevention (CDC) issued a nationwide advisory to alert health care providers and public health authorities about the possibility of locally acquired malaria in people with fevers of unclear origin…. Experts say the cases shouldn’t warrant panic about widespread malaria transmission in the US. But it does warrant asking some questions, and being wary of the threat of more local transmission. Mosquitoes can infect multiple people before a full-on outbreak is even identified — so more cases could be out there.”
Call to Strengthen Surveillance Platforms
A comment in The Lancet Global Health (UK) argues, “Because of the uncertainty of when the next pandemic might emerge, health regulating bodies at national, regional, and global levels should repurpose and strengthen existing surveillance platforms to detect respiratory viral pathogens with epidemic or pandemic potential quickly. To achieve more integrated surveillance systems for influenza, an integration of a range of other respiratory viruses with epidemic or pandemic potential into existing influenza surveillance infrastructure is required. This integration might involve exhaustive data collection and management and the development, evaluation, and validation of multiplex or combination assays to test samples for influenza and other epidemic-prone or pandemic-prone respiratory viruses simultaneously. Therefore, the responsibility of all national, regional, and global partners is to strengthen existing surveillance platforms to monitor any pandemic-prone pathogens to avert any severe eventualities.”
US CDC Committee Says Seniors “May” Get RSV Vaccine
Helen Branswell reports in STAT (US) that a US CDC expert committee opted Wednesday not to recommend that all seniors get a vaccine to protect against RSV. Instead, the Advisory Committee on Immunization Practices said that anyone 60 and older should be able to get one of the new vaccines — being brought to market by GSK and Pfizer — if they and their physicians think it would be worthwhile…. [the] recommendation was watered down after a long discussion during which several members of the committee expressed serious concerns about the decisions they were being asked to make based on the data the companies had provided.”
What to Do with COVAX Funds
Reuters (UK) reports, “Several billions of dollars left in a scheme to deliver COVID-19 vaccines to the world’s poorest could be diverted to prepare for other pandemics or to support vaccine manufacturing in Africa, the scheme's partners said. The COVAX initiative, run by Gavi, the Vaccine Alliance, the World Health Organization (WHO), and the Coalition for Epidemic Preparedness Innovations (CEPI), has $2.6 billion left in its coffers as the emergency phase of the pandemic draws to a close…. One option is to invest in wider pandemic preparedness initiatives, Gavi said. Another idea that has gained traction is to use some of the money to boost vaccine manufacturing in Africa…”
Decolonizing Global Health and Clinical Trials
In an editorial in The Lancet Global Health (UK) the guest editors (all from LMICs) of a special issue on “The future of global health research, publishing, and practice” write that a key “priority should be to improve LMIC research capacity through two steps. First: via LMIC research culture. Governments should allocate a substantial budget to health research, and they should encourage researchers to lead impactful clinical trials, with fast-track proposal acceptance and revising policies that hinder trial conduct. Second: globalising clinical trials. Practice-changing clinical trials alter treatment guidelines, but most such trials are only done in HICs. Even multi-site international partnerships led by HIC funders and researchers recruit fewer study participants from LMICs. These studies thus lack global generalisability. Clinical trials should only be considered practice-changing if they recruit international participants: that is, at least 50 percent of study participants from LMICs or a representative proportion from each WHO region. High-impact journals can assist by considering this an important criterion for publication.”
Documenting and Learning from the First Global Mpox Outbreak
An Analysis in The Lancet Global Health (UK) looked at “data for all confirmed mpox cases reported by WHO Member States through the global surveillance system from Jan 1, 2022, to Jan 29, 2023. Data included daily aggregated numbers of mpox cases by country and a case reporting form (CRF) containing information on demographics, clinical presentation, epidemiological exposure factors, and laboratory testing…. Data from 82 807 cases with submitted CRFs were included in the analysis…. The outbreak was driven by transmission among males (73 560 [96·4 percent] of 76 293 cases) who self-identify as men who have sex with men (25 938 [86·9 percent] of 29 854 cases). The most common reported route of transmission was sexual contact (14 941 [68·7 percent] of 21 749).” The authors argue the need for “strengthening surveillance; enhancing diagnostic and genetic sequencing capacity, particularly in Africa; ensuring optimal health care and integrated sexual health and HIV prevention and care services, supporting appropriate immunisation services and advancing equitable access to vaccines and therapeutics; conducting risk communication to enhance ability to mitigate individual risk and to reduce stigma and fear; and supporting a One Health approach for outbreak investigation and research to minimise zoonotic transmission of MPXV.”
In a discussion in the same issues of The Lancet Global Health (UK) two UK researchers argue, “As we leave behind the golden age of antimicrobials and encounter an increasing number of infections outside their expected epidemiological and geographical niches, the establishment of robust, international surveillance systems and data sharing processes becomes of paramount importance. Yet again we are reminded that pathogens do not adhere to geographical borders…. How accurately the data [from the study above] reflect total global case numbers cannot, at this point, be determined. As might be expected, it is probable that countries with more limited health-care provision, and particularly those with limited laboratory resources, are underrepresented in these numbers. However, even with this caveat, there is now globally relevant evidence to support several of WHO's recommended key areas for actions to contain the spread of mpox, including sustaining and strengthening surveillance. As for COVID-19, international support for a collective, cohesive approach is of paramount importance.”
Long COVID and Mental Health
Medscape (US) reports, “The US Department of Health and Human Services has issued an advisory to help medical professionals better recognize the mental health symptoms that may come with long COVID…. The advisory noted that social factors can contribute to the mental health problems for racial and ethnic minorities; people with limited access to health care; people who already have behavioral health conditions and physical disabilities; and people who are lesbian, gay, bisexual, transgender, queer, or intersex. ‘Long COVID has a range of burdensome physical symptoms and can take a toll on a person's mental health. It can be very challenging for a person, whether they are impacted themselves, or they are a caregiver for someone who is affected,’ Health and Human Services Secretary Xavier Becerra said in a statement.”
COVID-19 Patient Zero Rumors
Science (US) reports, “A scientist at China’s Wuhan Institute of Virology (WIV) who has recently faced media allegations that he was the first person with COVID-19 and his research on coronaviruses sparked the pandemic strongly denies that he was ill in late 2019 or that his work had any link to the emergence of SARS-CoV-2….Hu and two of his WIV colleagues were thrown into the furious COVID-19 origin debate on 13 June when an online newsletter called Public said the three scientists developed COVID-19 in November 2019. That was prior to the outbreak becoming public when a cluster of cases at the end of December 2019 surfaced in people linked to a Wuhan marketplace. Public’s report was quickly embraced by a camp that argues COVID-19 came from a virus stored, and possibly manipulated, at WIV, rather than from infected animal hosts, perhaps being sold at the Wuhan market. A Wall Street Journal (WSJ) article on 20 June that said it had “confirmed” the allegations against the three, without referring to any public evidence or named sources with direct knowledge, fueled the flames even more. Social media and other publications spread the charges—and the scientists’ names.”
The Atlantic (US) reports, “The only problem is, we don’t know whether the latest revelations can be trusted, or to what extent. The newly reported facts appear to stem from a single item of intelligence, furnished by a foreign source, that has bounced around inside the US government since sometime in 2020. Over the past two and a half years, the full description of the sickened workers in Wuhan has been revealed with excruciating slowness, in sedimenting clauses, through well-timed leaks. This glacial striptease has finally reached its end, but is the underlying information even true? Until that question can be answered (which could be never), the origins debate will be stuck exactly where it’s been for many months: always moving forward, never quite arriving.”
Study Finds COVID-19 Vax Doesn’t Harm Ovarian Health or Fertility
CIDRAP (US) reports, “A Baylor University–led study finds no link between COVID-19 vaccination and poor ovary health and fertility among nearly 2,200 women of child-bearing age….’These findings suggest that COVID-19 vaccination is not associated with changes in ovarian reserve by multiple biomarker assays of AMH and AFC, supporting previous studies on AMH,’ the study authors wrote.”
Study Finds COVID-19 Infection Impacts Sperm Count
CIDRAP (US) reports, “Men recently infected with COVID-19 have decreased sperm counts for more than 3 months following even mild infections, and the sperm they do produce is less able to swim, according to new findings presented today at the annual meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Denmark. The findings are intriguing because men produce new sperm every 2 or 3 months, and the findings are based on semen analyses taken after 100 days, suggesting COVID-19 does long-term damage to the male reproductive tract.”
H5N1 Avian Flu and Cats in Poland
CIDRAP (US) reports, “Over the past several days, infectious disease tracking sources have been closely following media reports from Poland of numerous cat deaths, and the country's chief veterinary officer has confirmed H5N1 avian influenza in several cats, but not the same one that has been infecting waterfowl in the region. According to Avian Flu Diary, an infectious disease news blog, and Flu Trackers, an infectious disease news message board, the media reports were initially anecdotal, describing cats with respiratory and neurological symptoms. On Jun 23, Poland’s chief veterinarian confirmed influenza in some of the cats…. Health officials in several world regions are closely monitoring continuing reports of H5N1 spillovers to mammals, which have been reported from the Americas and Europe. The Eurasian H5N1 clade currently circulating in wild birds and poultry has a mutation that makes it more recognizable to mammal airway cells, including humans….”
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