Health and pandemic preparedness were in the spotlight last week as global leaders met at the United Nations General Assembly. (UNGA). The 2023 UNGA had more of a health focus than ever before, but will those meetings and resulting political declarations result in increased readiness for the next pandemic or more equity for pandemic diagnostics, treatments and prevention? Devex (US) asks if the UN Pandemic Declaration is “historic or disappointing?” Devex reports, “WHO Director-General Tedros Adhanom Ghebreyesus said the declaration’s approval marks a ‘historic day for public health.’ However, many global health leaders and civil society organizations were visibly disappointed. Even before the meeting began, they found the text of the declaration lacking bold ambition and the specifics to ensure the world is better prepared for the next pandemic. Médecins Sans Frontières said in a statement that it is ‘disappointed that the declaration fails to make the ambitious commitments necessary to best help people during infectious disease outbreaks, epidemics, and pandemics.’”
 
AP (US) quotes former New Zealand prime minister Helen Clark, who co-chaired the Independent Panel for Pandemic Preparedness and Response: “’I think it’s fair to say that the declaration is a missed opportunity. It has many pages and paragraphs and only one firm commitment and that is to hold another high-level meeting in three years’ time.’ … Listening to health ministers, the majority of speakers at the summit, Clark said many of them missed the point: Pandemics don’t impact just health; they impact many different facets of people’s lives, and government operations.”
 
If You Are in a Hurry

• Read a Unitaid Briefing Note calling for equitable access to pandemic therapeutics.
• Read The Atlantic on how new RSV vaccines mean for future vaccine development.
• Read AP and Sudan Tribune on disease outbreaks in Sudan fueled by conflict.
• Read Wired on the work to contain Nipah virus in India.
• Read a comment in Nature about a plan to fund R&D for LMICs with patent extension.
• Read Bulletin of the Atomic Scientists on a new study that suggests the use of the antiviral drug molnupiravir may have led to emergence of mutated SARS-CoV-2 viruses.
• Read Nile Post on long COVID in Uganda.
• Read The Times on fighting COVID-19 misinformation in Malawi.

 
Call for Access to Pandemic Therapeutics 
 
In a new Briefing Note Unitaid argues, “Access was a critical issue during the COVID-19 pandemic: Low- and middle-income countries lacked rapid, equitable access to lifesaving health products. In therapeutics, years of underinvestment constrained the pipeline of viable candidates, and antivirals for COVID-19 were not widely available at the height of the pandemic. More investment is needed now – in advance of the next pandemic – for research-based organizations to identify potential health products, and for Unitaid to ensure that access is “built in” from R&D to delivery. Unitaid has a strong track record of identifying and resolving access issues so that they don’t become barriers to product introduction and scale.
 
US CDC Approves Infant RSV Vaccine
 
STAT (US) reports, “Pfizer’s new shot to protect infants against respiratory syncytial virus by vaccinating their mothers late in pregnancy won a limited recommendation Friday from an expert panel that advises the Centers for Disease Control and Prevention, clearing the way for a second product to protect babies against RSV to soon hit the market…. The vote, which passed the Advisory Committee on Immunization Practices by an 11-to-1 margin, was an attempt to make the choice of preventive measures less complicated for parents-to-be and the obstetricians and pediatricians who will care for each mother-baby pair. The goal is to ensure babies are protected with one or the other anti-RSV product, but ideally not both together.”
 
A New Era for Vaccine Design
 
The Atlantic (US) reports on recent breakthroughs in vaccines for RSV and COVID-19 and what those breakthroughs mean for development of other new vaccines. RSV vaccines “succeed where others failed because they all target a specific weak spot in the virus, first identified in 2013. This strategy of finding a virus’s most vulnerable points applies to other pathogens too, and experts say it can revolutionize the design of vaccines for other diseases. In fact, it was quietly used to make the COVID-19 vaccines from Pfizer and Moderna. Scientists had originally perfected the idea with RSV, only to repurpose it for the COVID-19 vaccine, which raced ahead, given the urgency of the pandemic. This year, though, the shots are coming for RSV.”
 
Sudan Disease Outbreaks Fueled by Conflict
 
AP (US) reports, “Outbreaks of cholera and dengue fever have been reported in eastern Sudan, where thousands of people are sheltering in crowded camps amid deadly fighting between the country’s military and a rival paramilitary force, the UN health agency said on Tuesday. According to the World Health Organization, 162 people suspected of having cholera were admitted to hospitals in Qadarif province and other areas along Sudan’s border with Ethiopia. Eighty cases have been confirmed, and 10 people have died of cholera, a bacterial infection linked to contaminated food or water, WHO said.”
 
Sudan Tribune (Sudan) reports, “A North Darfur state official revealed on Sunday that malaria cases have surged to 13,000 in El Fasher, the state capital, amid a severe shortage of medicines. El Fasher’s health system is at risk of collapse, with most hospitals out of service due to armed clashes since last April. The Rapid Support Forces have also occupied the children’s hospital and turned it into a military barracks.”
 
Cholera Rising Globally
 
VOA (US) reports, “The World Health Organization says there is a global uptick in cholera cases. The number of cases reported last year was more than double those reported in 2021, the United Nations agency said. The number of countries reporting cholera statistics also grew in 2022 by 25 percent, from 35 countries in 2021 to 44 countries last year…. The WHO said the world is on track this year to continue the cholera upsurge with outbreaks currently in 24 countries ‘with some countries in the midst of acute crises.’”
 
Nipah Virus in India
 
Wired (US) reports, “Quick thinking and medical sleuthing allowed Kerala to contain a potentially disastrous Nipah virus outbreak this month—but with viral spillovers happening more frequently, containment is a fragile shield…. Diagnosing Nipah quickly has been Kerala’s biggest strength, giving it an edge in the battle with the virus and preventing its spread outside of the state. This has relied on knowledgeable doctors, like Anoop and his colleagues, and having testing facilities that can handle samples at breakneck speed. Decisive action—to contact trace, lock down, quarantine—has also made Kerala’s response exemplary. This is how an infectious disease containment strategy should work.”
 
Rocky Start to New US COVID-19 Vaccination Rollout
 
New York Times (US) reports, “The Centers for Disease Control and Prevention approved the latest vaccine two weeks ago, and the new shots became available to the general public within the last week or so. But many nursing homes will not begin inoculations until well into October or even November, though infections among this vulnerable population are rising, to nearly 1 percent, or 9.7 per 1,000 residents of mid-September from a low of 2.2 per 1,000 residents in mid-June. ‘The distribution of the new COVID-19 vaccine is not going well,’ said Chad Worz, the chief executive of the American Society of Consultant Pharmacists. ‘Older adults in those settings are certainly the most vulnerable and should have been prioritized.’”
 
Funding R&D for Low- and Middle-Income Countries with Patent Extensions
 
A Comment in Nature (UK) from economist Christopher B. Barrett outlines a proposed plan to increase investment in R&D for low- and middle-income countries (LMICs). “The greatest untapped potential lies in harnessing private-sector investment by making it profitable for companies to develop innovations targeted to the needs of LMICs. New approaches are sorely needed. Here, I propose one option: what I call benevolent patent extensions. Requiring a relatively simple extension to IP law, these could allow businesses to trade off value between patents and thereby boost investments to meet the agricultural, biomedical and other essential needs of people living in poverty.”
 
Community Health Workers Fight for Pay
 
Stephanie Nolen reports in The New York Times (US), “Eighty-six percent of community health workers in Africa are completely unpaid. But now, spurred by frustrations that arose during the COVID-19 pandemic and connected by digital technologies that have reached even remote areas, community health workers are organizing to fight for fair compensation. The movement stretches across developing countries and echoes the labor actions undertaken by female garment workers in many of those nations 40 years ago.”
 
Accidental Drug and Alcohol Deaths During COVID-19 in Canada
 
Hospital News (Canada) reports, “A new report from The Ontario Drug Policy Research Network and Public Health Ontario shows the number of accidental drug and alcohol toxicity-related deaths grew to alarmingly high levels in Ontario during the COVID-19 pandemic. There were almost 9,000 accidental deaths from substance-related toxicities in the province from 2018-2021… The report found that the annual number of substance toxicity deaths nearly doubled in Ontario during this time, reaching nearly 3,000 deaths in 2021, with an average of eight deaths occurring every day that year.”
 
US Cancer Screening During COVID-19
 
Healio (US) reports, “New diagnoses for six of the most common cancer types sharply declined in the U.S. in early 2020 — along with the volume of pathology reports — largely due to the start of the COVID-19 pandemic, according to data released by NCI…. Such declines in diagnoses, screenings and other cancer-related procedures are most likely due to interruptions in Americans’ ability to receive medical care in a timely manner during the onset of the COVID-19 pandemic, according to medical experts.
 
COVID-19 Vaccines and Vaginal Bleeding
 
Nature (UK) reports, “Women who don’t menstruate — including postmenopausal women and those on contraceptives — were several times more likely to experience unexpected vaginal bleeding after COVID-19 vaccination than before the vaccines were offered, a study1 finds. When COVID-19 jabs were rolled out globally, many women reported heavier-than-usual menstrual bleeding soon after vaccination. A study author is quoted: “The most important contribution of this and other documentation will be that female bleeding patterns are included as end points, or monitored, in clinical trials of new vaccines — and perhaps even drug trials.”
 
Paxlovid Less Effective Now
 
Forbes (US) reports, “Paxlovid—Pfizer’s antiviral COVID-19 treatment—is 37% effective at preventing hospitalization or death in high-risk patients compared with no treatment, according to a study published Thursday in the JAMA Network Open, well below the 88% effectiveness rate Pfizer and regulators reported in clinical trials in 2021—though it remains very effective at staving off death…. The study found that when excluding hospitalizations and looking at death alone, the drug is 84% effective. Read the study.
 
Molnupiravir and the Emergence of Mutated SARS-CoV-2 Viruses
 
Bulletin of the Atomic Scientists (US) report, “A drug used to treat patients at risk of severe COVID-19 infection may have led to the emergence of SARS-CoV-2 viruses bearing a distinct pattern of mutations, researchers reported Monday in Nature. The new paper raises the stakes over concerns about whether molnupiravir use could lead to the emergence of new dangerous variants and extend the pandemic…. ‘We definitively demonstrate that molnupiravir has resulted in viable SARS-CoV-2 viruses with significant numbers of mutations, in some cases with onwards transmission of mutated viruses,’ wrote Theo Sanderson, a fellow at The Francis Crick Institute in London and one of the new study’s authors.” Read the study.
 
Profiling Long COVID
 
MedPage Today (US) reports, “Long COVID patients had specific differences in immune and hormone function than other people, blood tests showed. Compared with matched controls, people with long COVID had marked differences in circulating myeloid and lymphocyte populations, reported Akiko Iwasaki, PhD, of Yale University in New Haven, Connecticut, and co-authors in Nature…. "’We found a number of immunological and hormonal factors that collectively are able to distinguish people with versus without long COVID at 94% accuracy,’ Iwasaki told MedPage Today. ‘This study speaks to the underlying biological causes of long COVID and provides a basis for future studies that interrogate various therapies that target the root causes of this disease.’” Read the study.
 
Long COVID in Uganda
 
Nile Post (Uganda) via AllAfrica reports, “While the world is gradually recovering from the global pandemic of COVID-19, a new concern is emerging in Uganda as the effects of ‘long COVID"=’ continue to take shape, on the country's population. Experts from the Makerere University Lung Institute reveal that they encounter cases of long COVID every day, signaling an urgent need for attention and awareness.”
 
Combatting COVID-19 Misinformation in Malawi
 
The Times (Malawi) reports on efforts to increase COVID-19 vaccination by combatting COVID-19 misinformation. “According to Victor Palichina, health systems manager and senior pharmacy technician at the UNC Project, George Joaki Centre, the media can aid in the debunking of Covid vaccination misinformation by referring vaccine hoaxes to professionals. ‘Some hoaxes may appear true to people who are not in the public health system and the best thing a journalist can do to debug such misinformation is to seek expert opinion from public health experts,’ Palichina said at a recent media science cafe in Lilongwe. Meanwhile, Ministry of Health spokesperson Adrian Chikumbe has said healthcare workers have been trying their best to dispel lies about Covid and other vaccines, such that gains are being registered. ‘Otherwise, misinformation and myths about Covid vaccines frustrate efforts to protect the population from Covid,’ Chikumbe explains.”