Pandemic Watch: Mpox surges, human rights and global health equity, and more ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌

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[link removed] July 11, 2024
AVAC's weekly Pandemic Watch is a curated news digest on the latest pandemic prevention, preparedness and response (PPPR) news and resources.


A lack of access to vaccines and the high costs of producing and purchasing them are among the main reasons for low uptake, especially in low- and middle-income countries. In high-income countries, vaccine hesitancy is a significant factor. This is fueled, in part, by misinformation, which is a problem worldwide.” - The Nature (UK) ([link removed]) editorial board
Table of Contents
• If You Are in a Hurry (#If You Are in a Hurry)
• Mpox Surges and Lack of Vaccine Access (#Mpox Surges and Lack of Vaccine Access)
• Human Rights and Global Health Equity (#Human Rights and Global Health Equity)
• Malaria Vaccine Rollout Delays Cost Lives (#Malaria Vaccine Rollout Delays Cost Lives)
• Kenya to Release GM Mosquitos to Fight Malaria (#Kenya to Release GM Mosquitos to Fight Malaria)
• Avian Flu Updates (#Avian Flu Updates)
• Cow Flu, Mpox and Lessons Learned from COVID (#Cow Flu, Mpox and Lessons Learned from COVID)
• Dengue Continues to Surg (#Dengue Continues to Surg)
• HEP-C Self-Test Prequalified by WHO (#HEP-C Self-Test Prequalified by WHO)
• Pushback on MSF Over Access Program (#Pushback on MSF Over Access Program)
• Surviving Measles (#Surviving Measles)
• UK COVID Tsar is New Science Minister (#UK COVID Tsar is New Science Minister)

From smallpox to measles and polio to COVID, vaccines have been crucial public health interventions, but creeping anti-vaccine sentiment, often fueled by disinformation is having a deleterious effect on vaccine programs. The Nature ([link removed]) (UK) editorial board writes, “in 2022 (the latest year for which data are available), there were still 14.3 million ‘zero-dose’ children — those who had not received any routine immunizations. A lack of access to vaccines and the high costs of producing and purchasing them are among the main reasons for low uptake, especially in low- and middle-income countries. In high-income countries, vaccine hesitancy is a significant factor. This is fueled, in part, by misinformation, which is a problem worldwide.” The good news, the board says, is “[t]he burgeoning science of vaccine-uptake effectiveness is throwing up some unexpected results that could help public-health authorities to sharpen their policies — and save
more lives…. [new] interventions are needed to maximize [vaccine] uptake, and these must undergo rigorous testing in different regions and contexts to help health authorities to determine what works. The obvious answer is not always the right one, and the vagaries of human behaviour can thwart seemingly logical solutions.”

If You Are in a Hurry

* Read Lancet ([link removed](24)01393-X/fulltext?) on mpox surges in South Africa and DRC and the lack of vaccines there.
* Read an editorial in The Lancet Infectious Diseases ([link removed](24)00439-0/fulltext?) on whether we’ve learned the lessons from COVID we need to respond to new outbreaks. (Spoiler alert: we haven’t).
* Read Alicia Ely Yamin in PLOS Global Public Health ([link removed]) on why a human rights framework is needed for global health equity.
* Read Stephanie Nolen in The New York Times ([link removed]) on a decade long delay in malaria vaccines rollout and what that might mean for future vaccine access in Africa.
* Read Science ([link removed]) on whether cow flu is here to stay.
* Read Latin American Post ([link removed]) on the escalating dengue crises in Mexico and Brazil.


Mpox Surges and Lack of Vaccine Access

A Lancet ([link removed](24)01393-X/fulltext?) (UK) news story reports, “Vastly different mpox outbreaks are surging in South Africa and the Democratic Republic of the Congo. While South Africa battles a high case fatality rate among a specific group, DR Congo faces a widespread epidemic primarily affecting children. Experts say that both outbreaks highlight the need for enhanced surveillance and equitable access to vaccines and treatments.” Placide Mbala, virologist and head of the epidemiology and global health department at the National Institute of Biomedical Research in Kinshasa is quoted: “The underlying cause of the outbreak, according to Mbala, is the decreasing herd immunity due to the cessation of smallpox vaccination. ‘The number of people born after the smallpox vaccination cessation is becoming more than a half, not only in the continent but also in the world’, he told The Lancet. He stressed that addressing the outbreak
effectively will require substantial international support, particularly in terms of funding, diagnostics, and vaccine provision. ‘The bottleneck is mostly not enough funding to support the Mpox response’, Mbala said.”

A Business Day ([link removed]) (South Africa) editorial notes that vaccines are still not available to respond to the outbreak in South Africa. “This miserable situation is a stark reminder that no matter the political will of African leaders or the aspirations of the continent’s pharmaceutical manufacturers, improving vaccine security to the point where Africans no longer depend on the largesse of wealthier nations is still years away…. Mpox is endemic to several countries in Central and West Africa, including DRC, Gabon and Nigeria. If vaccines had been readily available, it is quite possible that the global outbreak would never have happened and SA would not be scrambling to protect people from an entirely preventable disease.”

Read an mpox explainer from Al Jazeera ([link removed]) (Qatar).

Human Rights and Global Health Equity

Alicia Ely Yamin writes in PLOS Global Public Health ([link removed]) (US), “Human rights frameworks can undergird collective social mobilizations based not on the sameness that is rife in our increasingly tribalist world, but on shared commitments to equal dignity in all of our diversity…. Advancing health rights has called for understanding patterns of (ill-) health as the product of social, and power relations and the institutional arrangements, as much as biology or individual behavior [3]. When disparities in health are understood as misfortunes, they elicit lamentation, but when they are construed as rights violations and injustices, they call for redress. Promoting health rights also calls for changes in international and national law. In different forms, affirmative entitlements to health care are now judicially enforceable across many countries, including very low-income countries, such as Uganda.”

Malaria Vaccine Rollout Delays Cost Lives

Stephanie Nolen writes in The New York Times ([link removed]) (US) on the decade-ling delay in getting malaria vaccines to Africa. “Babies and toddlers in eight countries in the region recently started to get the [malaria]vaccine as part of their routine childhood shots. Seven other African countries are eagerly awaiting its arrival. This is a milestone in global health. But it’s also a cautionary tale about a system that is ill equipped to deliver critical tools to the people who need them most. It took decades and at least a billion dollars to reach this point. Even now, only a fraction of the children whose lives are at risk will get the vaccine this year, or next year, or the year after….. There is still no system that solves the fundamental problem of how to pay for at-risk production of a tool that is vitally important for the health of millions of people who can’t afford to pay for it. All the work on the tuberculosis vaccine is
being bankrolled by philanthropies, which set their own agendas — not by the countries that need the vaccine.”

Kenya to Release GM Mosquitos to Fight Malaria

The Nation ([link removed]) (Kenya) reports, “The Kenya Medical Research Institute (Kemri) in collaboration with the Imperial College London will soon be introducing genetically modified (GM) mosquitoes in the country to stop the spread of an invasive species that transmits malaria…. The Centers for Disease Control GM mosquitoes are mass-produced in a laboratory to carry two types of genes. They include a self-limiting gene that prevents female mosquito offspring from surviving to adulthood and a fluorescent marker gene that glows under a special red light. This allows researchers to identify GM mosquitoes in the wild.”

Avian Flu Updates

CIDRAP ([link removed]) (US) reports, “In scientific experiments designed to assess the threat from H5N1 avian flu in the milk of infected cows, researchers today reported that the virus can bind to both avian and human-type cell receptors but doesn't easily spread through respiratory routes…. So far, H5N1 has been confirmed on at least 140 dairy farms since March, with infections identified in four dairy workers. Since the virus first emerged in dairy cattle, scientists have been closely watching for changes in the virus that would signal a greater pandemic threat and conducting experiments to gauge infectivity and transmission…. When the researchers compared bovine H5N1 with the other H5N1 strain, they saw some evidence that the bovine strain had already started to gain some of the properties linked to the ability to spread through respiratory transmission in humans. Read the study in Nature
([link removed]) .

Jon Cohen reports in Science, ([link removed]) “More than 3 months after the first reported H5N1 avian influenza outbreak at a US dairy farm, some researchers are starting to wonder whether the virus is here to stay…. The H5N1 variant, a clade named 2.3.4.4b, has so far infected at least 137 dairy herds in 12 states. If it becomes endemic, farmers would have to worry about outbreaks, and concomitant losses, every year. And continuous spread in cattle also increases the risk that the virus evolves to spread more easily in humans, which could eventually trigger an H5N1 pandemic.” Microbiologist David O’Connor is quoted: “Whatever time we have, we’re squandering that by not acting more aggressively. It seems like we’re staring at the Titanic and the iceberg, and we’re just waiting to see if the ship turns at the last minute. That’s not a great strategy.”

STAT ([link removed]) (US) reports, “Moderna has been awarded $176 million by the Biomedical Advanced Research and Development Authority to accelerate development of messenger RNA-based pandemic influenza vaccines, the company announced…. The H5 virus targeted in the Moderna vaccine used in the Phase 1/2 trial was an H5N8, a cousin of H5N1, the virus spreading in dairy cattle in the United States. Both the Centers for Disease Control and Prevention and the World Health Organization have said the hemagglutinin in that H5N8 virus — hemagglutinin is the protein on the virus surface that attaches to cells it is attempting to invade — is genetically similar enough to that of the circulating H5N1 virus that it should provide protection against it. The Seqirus H5 vaccine in the National Pre-Pandemic Influenza Vaccine Stockpile also targets that H5N8 virus.”

CIDRAP ([link removed]) (US) reports, “Over the past 3 days, Cambodia has reported two more human H5N1 avian flu infections, raising it total for the year to seven cases, according to health ministry statements translated and posted by Avian Flu Diary, an infectious disease news blog…. Cambodia has reported an uptick in human infections, with 13 reported since February 2023. The infections are often serious or fatal.”

Cow Flu, Mpox and Lessons Learned from COVID

An editorial in The Lancet Infectious Diseases ([link removed](24)00439-0/fulltext?) (US) notes, “Searching for ‘COVID-19 lessons learned’ on PubMed gives you 4840 results—a long list of opinion pieces, reviews, and consensus statements telling us what we can learn from our recent pandemic experience. At the same time, 138 dairy herds in the USA have recorded H5N1 avian influenza outbreaks and the Democratic Republic of the Congo (DRC) has reported an mpox outbreak with 23 626 cases, with little signs that either outbreak will be contained soon. The lack of urgency and scale in the responses to both outbreaks is deeply frustrating and questions whether anything has been learned from the COVID-19 experience…. The cynical view is that instead of producing all those biomedical “lessons learned” articles, we should have been focusing more on political lessons from the devastating economic impact of the pandemic and the influence of a country's
pandemic performance on subsequent voter behaviour. However, this is not our purview as a medical journal, but we would like to stress that the time to react is now, before we have the next pandemic.”

Dengue Continues to Surge

NPR ([link removed]) (US) reports, “It’s already a record-breaking year for dengue infections in Central and South America, with almost 10 million cases diagnosed so far. Now, the Centers for Disease Control and Prevention is warning of an increased risk of the mosquito-borne virus in the US, as summer weather and vacation travel heat up. This week, the [US] CDC told health care providers to be on the lookout and to test for cases, especially among people with fevers who have recently returned from places where dengue is surging…. A few intersecting threads related to weather, waning immunity and human behavior are contributing to the ‘explosive outbreak that has evolved in the last year,’ says Dr. Albert Ko, a professor of public health at Yale University who has worked with dengue patients in Brazil for 30 years.”

Devi Discourse ([link removed]) (India) reports, “Union Health and Family Welfare Minister Jagat Prakash Nadda chaired a crucial meeting on Wednesday to review the country's preparedness for dengue prevention, containment, and management. With the onset of monsoon and rising global dengue cases, the urgency of the situation was underscored in the meeting held in the national capital.

Latin American Post ([link removed]) (Colombia) reports, “Dengue fever, a mosquito-borne viral infection, is wreaking havoc across the Americas. An alarming prediction is that it will affect almost all of Brazil and Mexico by 2039. According to a comprehensive study published in Nature Communications, this rapid spread poses significant challenges for the two largest countries in Latin America…. The study attributes the accelerated spread of dengue to climate change and increased human mobility. Rising temperatures, higher humidity levels, and increased rainfall create ideal breeding conditions for the Aedes aegypti mosquito, the primary vector for dengue. The global climate crisis exacerbates these environmental conditions, making previously unaffected areas vulnerable to outbreaks.

HEP-C Self-Test Prequalified by WHO

Times of India ([link removed]) (India) reports, “In a remarkable feat, we are inching closer to diagnosis and treatment of a life-threatening disease. The World Health Organisation (WHO) on Wednesday prequalified the self-test against hepatitis C. WHO recommended HCV self-testing (HCVST) in 2021, to complement existing HCV testing services in countries. The recommendation was based on evidence demonstrating its ability to increase access to and uptake of services, particularly among people who may not otherwise test.”

Pushback on MSF Over Access Program

The Lancet ([link removed](24)01391-6/fulltext?) (UK) reports, “On June 25, 2024, Médecins Sans Frontières (MSF) announced that it was replacing its Access Campaign with a new structure that will start operating from next year. The announcement was met with uproar. As of July 1, an open letter urging MSF to reverse its decision had been signed by 155 organisations and 392 individuals, including high-profile figures such as Helen Clark, former Prime Minister of New Zealand, and Unni Karunakara, former International President of MSF. ‘The planned dismantling of the Access Campaign's core structure, capacities, expertise, and networks will reverberate across the access to medicines movement and beyond’, stated the letter. ‘While the MSF International Office has characterised the restructuring as merely shutting down a project, we believe it will cause catastrophic and irreparable damage to access to health technologies for communities served by
MSF projects and beyond.’” Read the letter ([link removed]) .

Surviving Measles

The Washington Post ([link removed]) (US) reports, “These days, most Americans don’t think about measles because vaccination had largely eliminated the scourge from the United States in 2000. Many doctors cannot even diagnose measles because they have not seen it in practice. But measles outbreaks are back. There have been more cases this year than in each of the past two years.” The paper interviewed adults who remember having measles as children. “Many people who survived measles as children — before a vaccine existed — never forgot how sick they were. They wanted to share their stories so others could understand what it was like to have measles and its long-term consequences. They remember being confined in dark rooms to lessen the risk of blindness, a serious complication. They remember classmates and family members who died of other severe complications, such as dehydration or pneumonia, or swelling of the brain.”

UK COVID Tsar is New Science Minister

Nature ([link removed]) (UK) reports, “The scientific adviser who graced UK televisions with nightly updates during the COVID-19 pandemic has been appointed as the country’s science minister. The appointment is one of many made by new UK Prime Minister Keir Starmer…. Vallance’s appointment, as a scientist who is not a Member of Parliament (MP) and who has no ministerial experience, seems to be a first for the science ministry. He was the government’s chief scientific adviser under the Conservatives from 2018 to 2023, and helped to shape the national response to the COVID-19 pandemic. Vallance’s hiring is ‘a reassuring signal to the wider research community, that they’ve actually got somebody who understands what they do and the constraints’, says Jill Rutter, a former civil servant and researcher at the Institute for Government, a think tank in London.”
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