We’re entering the fifth year of the COVID pandemic. Where do we stand in relation to this pandemic? The WHO declared the global COVID outbreak a pandemic on March 11, 2020, and in the following weeks and months our lives changed in ways we never dreamt possible. Several media outlets are looking back at the pandemic and its impact on us.
 
The New York Times (US) reports, “Four years ago, our world changed. As a society, we are not close to fully recovered.” The Times also notes, “COVID’s confirmed death toll — more than seven million people worldwide — is horrific on its own, and the true toll is much worse. The Economist magazine keeps a running estimate of excess deaths, defined as the number of deaths above what was expected from pre-COVID trends. The global total is approaching 30 million.”
 
Axios (US) says, “It's pretty rare to be able to point to a single day that transformed the whole world. But March 11, 2020, is one of those days…. It exposed and exacerbated deep inequalities in health care, the labor force and the broader economy. For the most part, they persist. It ushered in astounding scientific advances — extraordinarily effective vaccines, developed in record time. And yet the anti-vaccine movement is now as mainstream as it's ever been.”
 
WHO’s Tedros writes in Time (US), “As countries learn to manage COVID-19 alongside other disease threats, and continue to grapple with the complications of Long COVID, they must also learn the painful lessons of COVID-19, and take corrective action to address.… Gaps in global health security that the pandemic exposed. History teaches us that the next pandemic is not a matter of if, but when. It may be in our lifetime; it may not come for another 100 years or more. But it will come. And as things stand, the world remains unprepared.”
 
If You Are in a Hurry
 

• Read Health Policy Watch and Devex on pandemic treaty negotiations and who will fund it.
• Read a perspective in Frontiers in Public Health on the infodemic and Ebola in Uganda.
• Read CIDRAP on a preprint study about heterosexual transmission of mpox in DRC.
• Read STAT on the high efficacy of an RSV shot for little children.
• Read an opinion piece —a cautionary tale for American parents about the need for measles  vaccinations –  from a doctor working in DRC in STAT.
• Read an editorial in NJ Star Ledger that compares the US government’s ignoring long COVID to the early days of AIDS in the US.

 
WHO’s Pandemic Accord Negotiations
 
Health Policy Watch (Switzerland) reports, “The negotiating text of the pandemic agreement landed in the inboxes of World Health Organization (WHO) member states last Friday afternoon – 10 days before the penultimate negotiation on 18 March and on the eve of the fourth anniversary of the WHO’s declaration of COVID-19 as a pandemic. The INB Bureau and staff only had a week to distil a mishmash of often contradictory proposals into the negotiating text, and will brief member states and stakeholders this Friday (15 March) on the revised draft and propose how the final round of negotiations will be structured. Contested articles contain many caveats, with giveaway phrases such as ‘where appropriate’, ‘may’ and ‘voluntary’.” Read the draft text.
 
In a separate article Health Policy Watch (Switzerland) looks at what is known about how the treaty will be financed. “According to the latest pandemic agreement draft, a ‘Coordinating Financial Mechanism’ will support the implementation of the pandemic agreement and the International Health Regulations (IHR) (see Article 20). ‘There’s a key debate with Article 20 within the negotiations about whether the coordinating mechanism should be hosted by the Pandemic Fund, the World Health Organization (WHO), or whether a new entity should be created,’" Professor Garrett Wallace Brown, chair of Global Health Policy at the University of Leeds, told a Geneva Global Health Hub (G2H2) media briefing on Tuesday.
 
Devex (US) reports, “The Pandemic Fund wants to be the ‘main fund’ for strengthening pandemic prevention, preparedness, and response and called against duplication and fragmentation as countries push for creating another fund in pandemic treaty negotiations…. But the fund has received its fair share of criticisms, including for not being inclusive enough when it comes to its governance and implementers. And while donor and recipient countries have the same number of seats on the fund’s board, concerns about donors having outsized influence in decision-making remain.”
 
FT (UK) reports, “Significant differences between richer and poorer nations are threatening progress on a key pandemic treaty, with officials warning that the planned May deadline for delivery of the global accord may be missed. ‘[The] biggest issue at the moment is whether we’ll be able to reach agreement in May and what the consequences are if we fail’ said one western diplomat with knowledge of the process…. ‘The spectre [of Trump’s re-election] looms and it’s quite helpful in focusing minds,’ said another diplomat, adding ‘there’s a fairly good chance it’ll have to be shelved’ if the May deadline were not met.”
 
A statement from Public Citizen says, “The Biden administration should support stronger measures for equity and access in the accord, including to: Support global access to medical tools developed with public funds; Share public technology and information needed to make pandemic health tools; and Support countries that use flexibilities in intellectual property rules to increase access to pandemic-related products.”
 
The US Election Outcome Will Impact Science
 
Nature (UK) looks at what a win by either Trump or Biden could mean for science, reporting: “At a campaign rally last week, Trump hinted that he would endorse elements of the anti-vaccine movement if re-elected, suggesting that he would deny federal funds to schools with a vaccine mandate. The United States’ role in global health is also at stake. During his presidency, Trump pulled the United States out of the World Health Organization (WHO) and generally pursued isolationist policies, [KFF’s Larry] Levitt says. ‘Biden has done a lot to undo that, but we will likely see a slip back if Trump were elected again,’ he says. Officials in the Biden administration have expressed their commitment to a global pandemic treaty — an agreement being negotiated among countries to help prevent the next global-health emergency. Meanwhile, Republicans have been critical of it, suggesting that it could be a threat to US intellectual-property rights, forcing companies to share vaccine and treatment know-how.”
 
Ebola and the Infodemic in Uganda
 
A perspective in Frontiers in Public Health (Switzerland) looks at “the complex dynamics of Uganda’s recent Ebola outbreaks, emphasizing the interplay between disease spread, misinformation, and existing societal vulnerabilities. Highlighting poverty as a core element, it delves into how socioeconomic factors exacerbate health crises.” The authors write that their research, “delves into the historical and colonial underpinnings of mistrust in health systems, underscoring how colonial legacies continue to shape health behaviors and perceptions in Uganda. It argues for a nuanced understanding of infodemic management that acknowledges the colonial matrix of power and seeks to empower communities by contextualizing health interventions within their historical and cultural realities, looking at it from a syndemic perspective.”
 
Heterosexual Transmission of Mpox in DRC
 
CIDRAP (US) reports on a preprint study: “Scientists conducting an observational cohort study in an ongoing mpox outbreak in the Democratic Republic of the Congo (DRC), which involves a different clade than the global outbreak, have identified a possible third route of mpox transmission: sexual activity involving heterosexuals…. For the study, researchers interviewed 51 of 164 patients who were admitted to Kamituga hospital September 2023 through January 2024. Of that group, 24 were professional sex workers. The most common symptoms were fever and oral and anogenital lesions. Two deaths were reported. Heterosexual partners were mainly affected, suggesting that heterosexual contact may be the main form of transmission. The investigators wrote that professional sex workers –primarily young women–were the dominant occupational group, suggesting that they and their clients may be at higher risk for contracting mpox.” Read the study on the preprint site MedRxiv.

Good News on RSV
 
STAT (US) reports, “A new monoclonal antibody product to protect against respiratory syncytial virus was 90% effective at preventing little children from being hospitalized with RSV, according to new data from the first season it was in use. The data…. Looked at how well Beyfortus worked in the children whose parents managed to secure a scarce dose of the drug. These are the first real-world data showing how effective the product was in the United States.” Read the study.
 
Measles Outbreaks Continue
 
The Atlantic (US) reports, “Measles seems poised to make a comeback in America…. As of Thursday, 17 states have reported cases to the CDC since the start of the year. (For comparison, that total was 19, plus the District of Columbia, for all of 2023, and just 6 for 2022.) ‘We’ve got this pile of firewood,’ Matthew Ferrari, the director of the Center for Infectious Disease Dynamics at Penn State, told me, ‘and the more outbreaks that keep happening, the more matches we’re throwing at it.’”
 
Paul Law, a pediatrician and researcher working in DRC, writes in an opinion piece in STAT (US), “Over the past year, I have watched many children die of measles. In the final stages, little lungs, filled with fluid and racked with inflammation, struggle for oxygen. The victims breathe faster and faster, gasping for air until, exhausted, they stop…. Where I live, in one of the poorest places on earth, measles kills thousands of children a year. It’s a grim lesson about a disease that should have been eradicated years ago. And it’s a grave warning against assuming ‘it can’t happen here’ in more fortunate countries like the US, where the disease is making a comeback as parents fail to take the disease seriously. For years, US pediatricians have gone their entire careers without seeing a case of measles, much less a death. Now, I fear, that may change…. I decided to tell this story after the measles outbreak in Florida, so that parents would know what a miracle vaccines are. The point is not to say that measles will kill your children in America, because it probably won’t. The point is that it can make them — and many other children — very, very sick. Why would parents do that when the safe alternative is readily available?”
 
Brazil’s Dengue Crisis a Warning to the World
 
The Washington Post (US) reports dengue “is ripping through much of South America, where scientists say rising temperatures due to climate change have both extended the territorial range of the mosquito that carries dengue and increased its proliferation…. But the disease has surged with particular virulence in Brazil, where epidemiologists expect the number of dengue cases to reach into the millions — more than doubling the previous record — and potentially kill thousands of people. The deepening public health crisis, epidemiologists say, serves as a warning to the world. The struggle against the disease has entered an unpredictable, perilous new phase. Dengue is creeping into places where it has never been. And where it has long been, case numbers are soaring to unseen heights.”
 
Vaccine-Derived Polio in Five African Countries
 
CIDRAP (US) reports, “Five African countries reported more polio cases this week, all involving circulating vaccine-derived poliovirus type 2, according to the latest update from the Global Polio Eradication Initiative.” The countries include Chad, Guinea, Mali, Nigeria and Somalia.
 
Long COVID Updates
 
The Editorial Board of the NJ Star Ledger (US) writes, “In the earliest days of the AIDS crisis, America ignored the problem, even though people were dropping dead by the thousands. We’re repeating the mistake now with long COVID. Millions are suffering, but the government has largely turned its back, as new cases emerge with each passing wave…. President Biden has hardly mentioned long COVID, even though leading scientists, clinicians and advocates wrote an open letter to him in December, urging him to address the crisis. ‘Millions more will develop Long COVID over the next several years,’ they warned.”
 
COVID’s Impact on Life Expectancy
 
A statement from the Institute for Health Metrics and Evaluation (IHME) outlines findings published in The Lancet that “reveal never-before-seen details about staggeringly high mortality from the COVID-19 pandemic within and across countries. Places such as Mexico City, Peru, and Bolivia had some of the largest drops in life expectancy from 2019 to 2021. The research, which presents updated estimates from the Global Burden of Disease Study (GBD) 2021, provides the most comprehensive look at the pandemic’s toll on human health to date, indicating that global life expectancy dropped by 1.6 years from 2019 to 2021, a sharp reversal from past increases…. ‘For adults worldwide, the COVID-19 pandemic has had a more profound impact than any event seen in half a century, including conflicts and natural disasters,’ says co-first author Dr. Austin E. Schumacher… ‘Life expectancy declined in 84% of countries and territories during this pandemic, demonstrating the devastating potential impacts of novel pathogens.’” Read the study.
 
Human Challenge Studies for New COVID Vaccines
 
A CEPI press release says, “An international consortium of researchers specialising in human challenge studies is embarking on a US$57 million project to develop advanced, virus-blocking coronavirus vaccines that could stop SARS-CoV-2 and other coronaviruses from infecting people in the first place…. the consortium of more than a dozen scientific teams and organisations will begin by running trials to select particular viruses and identify the best conditions under which to safely induce infection in healthy volunteers…. Researchers at multiple clinical research facilities will then use a selected virus to try to infect healthy volunteers who have received an experimental vaccine. Unlike traditional vaccines which are injected into muscle, these experimental vaccines will be inhaled into the lungs or sprayed in the nose and are designed to induce a type of protection known as mucosal immunity – which scientists believe could be the key to stopping onward transmission of coronaviruses.”
 
COVID Vaccines Cut Risk of Virus-related Heart Failure
 
The Guardian (UK) reports, “COVID vaccinations substantially reduce the risk of heart failure and potentially dangerous blood clots linked to the infection for up to a year, according to a large study. Researchers analysed health records from more than 20 million people across the UK, Spain and Estonia and found consistent evidence that the jabs protected against serious cardiovascular complications of the disease. Read the study.