It seems that the world has been on the verge of eradicating polio for years, but the virus keeps popping back up in places where it was controlled or eradicated, sometimes driven by violence or war that keep children from being vaccinated. The latest conflict-driven return is in Gaza. AP (US) reports, “Until it is gone from the planet, the [polio] virus will continue to trigger outbreaks anywhere children are not fully vaccinated. The recent polio infection in an unvaccinated baby in Gaza is the first time the disease has been reported in the territory in more than 25 years.” But a vaccine campaign there is more successful than expected according to WHO. The New York Times (US) reports, “Teams of health workers delivered the two-drop oral vaccine to 161,030 children in the first two days of the roughly 10-day operation, surpassing the organization’s goal of 150,000 for the first phase of the campaign in central Gaza.”
If You Are in a Hurry
- Read a call for a unified international response to mpox from Lawrence Gostin and colleagues in NEJM.
- See a photo essay from the epicenter of the DRC mpox outbreak in The New York Times.
- Read an explainer from Science on the three different mpox strains circulating and why mpox is spreading more now.
- Read Reuters on a proposed plan by an African drug maker to manufacture mpox vaccines on the continent.
- Read Magda Robalo’s call for an equity driven pandemic accord in The East African.
- Read Axios on a new report that shows more Americans are embracing vaccine misinformation. Then read the report.
Mpox Vaccines Still Not Reaching Africans Who Need Them
The US, Japan, the EU and some European countries have or plan to donate vaccines to African countries in the midst of an outbreak, but those vaccines have not yet reached the communities where they are desperately needed. As the New York Times (US) reported last month vaccines have been “trapped in a byzantine drug regulatory process at the World Health Organization.” Last week, as CIDRAP (US) reports, “The WHO is reviewing emergency use listing submissions from vaccine manufacturers and expects to complete the process by the middle of September. The agency, however, has signaled that groups can go ahead and buy vaccine.” This opened the way for UNICEF to release “an emergency tender to secure doses of mpox vaccine for the hardest-hit countries, part of a collaboration of global health groups including the Africa Centres for Disease Control and Prevention (Africa CDC); Gavi, the Vaccine Alliance; and… WHO.”
Late last week Reuters (UK) quoted WHO’s Tedros: “’We hope to have the first delivery in the next few days, and then it will build up.’ Some 230,000 mpox doses are immediately available to be dispatched, added WHO official Tim Nguyen. These doses were donated by the European Commission and Danish mpox vaccine manufacturer Bavarian Nordic…
Lawrence Gostin and colleagues write in a NEJM (US) perspective, “The rapid international spread of a new mpox subtype is of enormous concern. Though all countries should fortify their preparedness, the priority must be coordinated action and investments focused on response efforts in Africa. In light of deeply inequitable responses to COVID-19, the WHO adopted amendments to the IHR in May 2024, the most consequential of which embedded equity in the regulations as a principle guiding pandemic response. Although the amendments won’t come into effect until next year, the African mpox outbreak will put these legal obligations to their first crucial test…. A response with staying power that builds resilient health systems will save countless lives in the DRC and beyond. The DRC has long faced the devastating effects of colonialization, exploitation, armed conflict, and political instability. But ending this mpox epidemic is also very much in the national interests of high-income countries around the world. The August 15 report of a case in Sweden, followed by the first case in Thailand on August 22, underscores the pandemic potential of mpox. The discontinuation of routine smallpox vaccination means that much of the global population has not been exposed to orthopoxviruses. If we remain complacent, we face a real risk of a major global health event.”
Reuters (UK) reports, “African drugmaker Aspen Pharmacare is in talks with partners to manufacture mpox vaccines at its facilities, Chief Executive Officer Stephen Saad told Reuters…. ‘We have capacity and we have capability to make mpox vaccine...and we're comfortable that we can manufacture the product.’"
In the epicenter of the outbreak in DRC it is children who are most affected. The New York Times (US) reports in a photo essay from the epicenter: “More than 17,000 people in Africa have been infected with mpox, a disease that is closely related to smallpox. Mpox has killed nearly 600 people on the continent, or about 4 percent of those infected. Most of them have been children…. Doctors say they are treating patients with scarce resources: They need more testing supplies, more protective equipment and more drugs and creams to help soothe the skin lesions.”
Archibong Edem Bassey writes in a letter to The Lancet (UK), “that migrant populations, such as those fleeing conflict, refugees, asylum seekers, people who are internally displaced, and undocumented migrants face critical, yet unique risks, and might be overlooked in the global [mpox] response…. In the current situation where mpox and HIV converge to create a so-called syndemic effect—with each disease worsening the effects of the other—decisive action is imperative. Governments, policy makers, health-care professionals, decision makers, and other key stakeholders must prioritise the experiences of migrant populations, and value their inputs in coproducing sustainable solutions. This approach will involve working together in partnership to tackle barriers to health care (including vaccine access and treatment) and address underlying determinants that could increase vulnerabilities.”
Reuters (UK) reports, “Scientists studying the new mpox strain that has spread out of Democratic Republic of Congo say the virus is changing faster than expected, and often in areas where experts lack the funding and equipment to properly track it. That means there are numerous unknowns about the virus itself, its severity and how it is transmitting, complicating the response…”
Science (US) explains the three different circulating mpox strains, reporting, “The situation is unusually complex because it essentially involves three epidemics happening at the same time, each with a different virus variant, in different locations and populations, and with different modes of spread…. A key factor in the rise of both zoonotic cases and human-to-human transmission is the decline in population immunity after smallpox was eradicated in 1980 and smallpox vaccination—which also protects against monkeypox—was ended…. In addition, spillovers from animals to humans may have become more frequent because large forest animals have almost been driven to extinction, spurring people to hunt and consume the small rodents likely to carry the mpox virus.”
Call for Equity Driven Pandemic Accord
Magda Robalo argues in The East African (Kenya), “Increasingly, and rightly so, voices are coalescing to demand an urgent, coordinated international action and global solidarity toward an equity-driven, focused response to curb the [mpox] virus's spread and mitigate its impact…. The mpox outbreak underscores the urgent need for a comprehensive, equity-driven pandemic treaty, to coordinate global efforts to improve pandemic prevention, preparedness and response. The potential impact of this treaty is substantial, promising to address critical areas such as public health infrastructure, equitable access to treatment, vaccines and other supplies, and enhanced international cooperation during health emergencies…. While negotiating for potential vaccine doses to protect high-risk populations, countries should invest in and deploy what they have learned and now know how to do best, based on the lessons from polio, HIV/Aids, Ebola and COVID-19. It is imperative that we contain the mpox outbreak before it is too late. It is time to put our best foot forward. We have no reasons for helplessness and hopelessness.” Read a fact sheet from the Coalition of Advocates for Global Health and Pandemic Preparedness on pandemic accord priorities for 2025.
Good News for an Ebola Vaccine
Fierce Pharma (US) reports, “When a deadly outbreak of the Ebola virus spread through the Democratic Republic of Congo in 2018, Merck’s then-unapproved vaccine was quickly deployed to help address the crisis and provide protection to hundreds of thousands of recipients. Now, four years after that epidemic ended, a new analysis offers a clearer picture on the vaccine’s real-world effectiveness…. The study, which is the first to evaluate the real-world effectiveness of ‘widespread use’ of the vaccine, showed that Merck's shot was 84% effective against the virus in people who were infected 10 or more days after vaccination. Read more in The Lancet Infectious Diseases.”
Avian Flu Updates
STAT (US) reports avian flu infections have been found in dairy cattle in California. STAT notes continuing concerns about the lack of a coordinated response in the US, quoting veterinary expert Keith Poulsen: “’We’ve been told to be ready to do large-scale surveillance through bulk milk tank testing multiple times since May.’ Poulsen said. ‘For some reason or another, it has just never come to fruition.’ .… But Poulsen said the lack of a coordinated effort to extend that kind of testing nationwide is a missed public health opportunity, both for animal and human health. ‘We’ve built a system that could respond to infectious outbreaks like this but we’re not really using it. It’s baffling.’”
Undark (US) reports, “As H5N1 circulates, it seems that lessons from COVID-19 remain unlearned. It appears that missteps are being made regarding testing, surveillance, transparency, and failure of communication and coordination throughout the health care system, the same kinds of things that hurt the response to COVID-19…. Aside from inadequate funding and preparation, there’s a problem of overcoming public distrust. A survey published in Health Affairs suggests that about 42 percent of American adult respondents in early 2022 said they had confidence in the CDC to provide quality health information during the COVID-19 pandemic, while about a third said they trusted state and local health departments. This may partly explain why the CDC is now having trouble getting farmers to cooperate with even rudimentary tracking and mitigation efforts regarding H5N1. Lessons from the history of how COVID-19 unfolded underscore the importance of not being complacent in the face of a potential future bird flu pandemic. It would seem imperative to take proactive measures such as systematic testing of animals and humans exposed to the virus, mitigate transmission risk in the dairy and poultry industries, and coordinate federal and state responses.”
The Guardian (UK) reports, “new data, published in Nature Communications, documents [the highly infectious H5N1 strain of avian flu’s] spread to the southernmost tip of the planet – the Antarctic region – where it has inflicted significant die-offs in elephant seals and fur seals. This outbreak has affected every continent except Oceania, and yet there has been little coverage of the impact on global biodiversity and farming systems – or of potential risks to human health…. The UN health agency’s chief scientist has also said the risk of bird flu spreading to humans is an ‘enormous concern’. So far, there is no evidence that H5N1 is spreading between humans. But in the hundreds of cases where humans have been infected through contact with animals over the past 20 years the mortality rate is above 50%.” Read more on avian flu in the Antarctic region in Nature Communications.
New WHO Africa Director
Health Policy Watch (Switzerland) reports, “Tanzania’s Dr Faustine Ndugulile has been nominated as the next Regional Director for the World Health Organization (WHO) African Region, defeating more experienced WHO insiders in a closely contested race…. Describing himself as a “technocrat, politician and policy maker”, Ndugulile has promised to ‘prioritize strengthening of WHO country offices to ensure timely, relevant, optimal and effective support to the member states’. His nomination will be submitted to the WHO Executive Board meeting in January 2025, and he is expected to take office in February 2025 for a five-year term.”
More Americans Embrace COVID Vaccine Misinformation
Axios (US) reports, “Growing numbers of Americans are buying into misinformation about COVID-19 vaccines, according to a new national survey, with more than one in five believing it's safer to get the virus than to get a shot…. The findings from the University of Pennsylvania's Annenberg Public Policy Center are further evidence of how intense backlash to the government's at times muddled COVID response eroded trust in public health, jeopardizing preparedness efforts to address future crises.” Read the report.
COVID and Mental Illness
Medical Xpress (Isle of Man) reports on a study that looked at health data of 18 million people and found “higher incidence of mental illnesses for up to a year following severe COVID-19 in unvaccinated people. Vaccination appeared to mitigate the adverse effects of COVID-19 on mental illnesses…. The findings add to a growing body of evidence highlighting the higher risk of mental illnesses following COVID-19 diagnosis, and the benefits of vaccination in mitigating this risk, with stronger associations found in relation to more severe COVID-19 disease, and longer-term associations relating mainly to new-onset mental illnesses.”
Marked Increase in Annual Cholera Deaths
A WHO statement says in 2023, “The number of reported cholera cases increased by 13% and deaths by 71% in 2023 compared to 2022. Over 4000 people died last year from a disease that is preventable and easily treatable. Forty-five countries reported cases, an increase from 44 the previous year and 35 in 2021. Thirty-eight per cent of the reported cases were among children under five years of age.” Read the report. |
