As the COVID pandemic swept across the world in 2020 and beyond, COVID replaced tuberculosis as the deadliest infectious disease. Now, the WHO says TB is back on top. AFP (France) via Barron’s reports “A record 8.2 million new tuberculosis cases were diagnosed worldwide last year, the World Health Organization said -- the highest number since it began global TB monitoring in 1995…. The WHO said a significant number of new TB cases were driven by five major risk factors: undernutrition, HIV infection, alcohol use disorders, diabetes, and, especially among men, smoking.” MedIndia (India) reports, “Despite India's goal to eradicate tuberculosis (TB) by 2025, five years earlier than the global target, a recent report from the World Health Organization (WHO) revealed that the country bears the highest global burden of TB at 26 percent.”
 
There were areas of success documented, especially in Africa. AllAfrica (South Africa) reports, “Africa is, however, cited as one of the regions of the world that has made the most progress in the fight against the disease, with a 24% decrease in cases…. ‘In contrast to the other five regions, the TB incidence rate in the WHO African Region has declined every year since 2010. Disruptions to TB diagnosis and treatment during the COVID-19 pandemic were negligible in the WHO African Region. In some countries, treatment coverage improved in these years,’ the report said.”
 
Read the WHO Global TB Report here.
 
If You Are in a Hurry
 

• Read Nature on the likely source of the Marburg outbreak in Rwanda and Science on how Rwanda is using an experimental vaccine.
• Read NPR on Egypt being declared malaria free after thousands of years of the disease.
• Read an opinion in PLOS on the needed response to mpox in Africa.
• Read KFF Health News on concerns about avian flu in cows and people in the US and then read  Vanity Fair on a failing US government response.
• Read The Guardian on rising dengue cases globally.

 
Source of Marburg Virus Outbreak in Rwanda
 
As the Marburg virus outbreak in Rwanda slows, researchers think they have found the cause of the first infection. Nature (UK) reports, “The third-largest outbreak in history of the deadly Marburg virus was sparked by a single jump of the pathogen from an animal to humans, preliminary genomic evidence shows…. Other evidence suggests that the first person to become infected in the outbreak probably contracted the disease during a visit to a cave that hosts a species of bat known to harbour the virus…. To help inform outbreak control, researchers at the Rwanda Biomedical Centre in Kigali sequenced the Marburg virus genome of several infected people. They found that all samples closely resembled one another, suggesting that the virus spread rapidly in a short period of time and that they shared a common origin.”
 
Taarifa (Rwanda) reports, “Rwanda is ramping up its efforts to combat the Marburg virus, with no reported fatalities in the past week. Dr. Sabin Nsanzimana, the Minister of Health, announced that all three individuals who tested positive for the virus are currently receiving treatment and are expected to recover soon…. Rwandan health officials are collaborating with various government agencies to implement measures that prevent the spread of viruses from animals to humans. Over 1,500 people have been vaccinated, and the health system is prepared to treat affected individuals.”
 
Science (US) reports a clinical trial for Marburg virus treatment was launched in Rwanda earlier this month. “But Rwanda has rejected a similarly designed study for an experimental vaccine, produced by the Sabin Vaccine Institute, a US nonprofit. Instead, it is offering those shots to all health care workers at risk of Marburg, as well as everyone who has been in contact with known Marburg cases—an approach that may give more people a chance of protection but, in contrast to a randomized, controlled trial, can’t provide solid efficacy data. The government wanted to ‘move fast to protect the front-line workers,’ says Yvan Butera, minister of state in Rwanda’s Ministry of Health.”
 
Egypt Declared Malaria Free
 
NPR (US) reports, “Egypt has been declared malaria-free by the World Health Organization. Egypt is the third country in the Eastern Mediterranean region WHO has acknowledged as malaria-free, following Morocco and the United Arab Emirates. In all, 44 countries and one territory have this designation…. The disease was first detected in the country as early as 4,000 B.C.E., the WHO said, although efforts to curb the spread of malaria began in the 1920s.”
 
Polio Driven by Conflict
 
A UNICEF press statement says, “ Of the 541 children affected by polio globally in 2023, 85 per cent live in the 31 fragile, conflict-affected, and vulnerable countries, according to a new UNICEF analysis on World Polio Day…. The data issue a stark warning that the life-threatening disease continues to thrive in areas where life is most precarious, and where conflict, natural disasters, humanitarian crises, other destabilizing factors make it difficult to deliver critical healthcare.”
 
VOA News (US) reports, “Pakistan and neighboring Afghanistan simultaneously launched fresh vaccination campaigns against polio Monday amid a resurgence in cases in the only two countries globally where the virus continues to be endemic and paralyze children…. Local and WHO officials attribute the resurgence of poliovirus in Pakistan to vaccine boycotts in rural areas stemming from the false propaganda that these initiatives are a Western plot to sterilize Muslim children. Additionally, anti-state militants in violence-hit districts bordering Afghanistan occasionally attack vaccinators and their police escorts, suspecting them of spying for the government. The violence has resulted in the deaths of dozens of polio workers and police personnel, including at least two vaccinators and seven police members killed this year.”
 
Dr. Mohammed Aghaalkurdi writes in an opinion piece in The New York Times (US), “It is outrageous that polio — which is highly contagious and can cause paralysis, respiratory failure, cardiovascular collapse and even death — has been permitted to reappear in Gaza after being nearly eradicated across the globe.” A vaccination campaign has been somewhat successful, but Aghaalkurdi argues, “what is the logic of allowing the vaccination of children for polio today, when tomorrow they will be threatened by cholera or another disease? Or struck by bombs or other weapons? Or subject to starvation? Celebrating the success of the vaccination campaign rings hollow when other dangers facing children in Gaza remain. Because of Israel’s military offensive, we are witnessing conditions that could allow infectious diseases to run rampant throughout Gaza and break out into the rest of the region.”
 
Mpox Cases Continue to Spread in Africa
 
As mpox cases rise in DRC and other African countries, the leaders of The Independent Panel for Pandemic Preparedness and Response write in an opinion piece in PLOS (US), “mpox is an ever-growing regional health crisis in Africa, and without urgent action to stop the epidemics when and where they occur, it will continue to spread across borders and continents. The few tools we have that could help to stop the outbreaks have yet to become adequately available in the most affected low-income countries where they are urgently required, as is financing to support the public health response. Mpox cannot be allowed to continue spreading widely across the African continent or anywhere. The world cannot continue to simply ‘learn’, but not apply the costly lessons of neglecting disease outbreaks.”
 
Concerns as Avian Flu Cases in Cows Rise in US
 
KFF Health News (US) reports, “Bird flu cases have more than doubled in the country within a few weeks, but researchers can’t determine why the spike is happening because surveillance for human infections has been patchy for seven months…. Hundreds of emails from state and local health departments, obtained in records requests from KFF Health News, help reveal why. Despite health officials’ arduous efforts to track human infections, surveillance is marred by delays, inconsistencies, and blind spots. Several documents reflect a breakdown in communication with a subset of farm owners who don’t want themselves or their employees monitored for signs of bird flu.”
 
CIDRAP (US) reports, “In experiments designed to learn more about the threat from the H5N1 avian flu virus spreading from cows to people, researchers found that an isolate from a sick dairy worker may be capable of replicating in human airway cells, is pathogenic in mice and ferrets, and can transmit among ferrets by respiratory droplets.” Study authors are quoted: "Based in these observations, every effort should be made to contain HPAI [highly pathogenic avian influenza] H5N1 outbreaks in dairy cattle to limit the possibility of further human infections.” Read the study in Nature.
 
A Vanity Fair (US) investigative piece looks at concerns about missed opportunities to respond to the avian flu’s jump into cows and other mammals and into humans. “With continued spread amongst cows, or to another ‘mixing-vessel’ species like pigs, the virus ‘could mix and match, then you get a whole new genetic constellation,’ says Jürgen Richt, regents and university distinguished professor at Kansas State University. Experts are hesitant to speculate about what could happen if the virus were to begin more widely infecting humans, for fear of spreading panic, but the toll could, in the worst case, dwarf that of COVID-19. If the virus ‘infects a person infected with a human flu strain, and something comes out that is reassorted and adapted to humans? I don’t even want to imagine,’ Richt says. ‘Not good.’…. At that existential moment back in March, when the virus was first detected in cows, veterinarians involved in the response had every expectation that a well-honed network of experts, led by USDA scientists, would immediately rev to life. But it didn’t. ‘Nobody came,’ says one veterinarian in a Western state. ‘When the diagnosis came in, the government stood still. They didn’t know what to do, so they did nothing.’”
 
Financing the Pandemic Agreement
 
An essay from activists at Wemos in the Geneva Health Files (Switzerland) argues, “If we truly want the agreement to contribute to a more equitable and safer world, it will require a fair, resilient financial framework that will meaningfully support implementation of new obligations for Pandemic Prevention Preparedness and Response. In the latest draft version of the agreement, articles 19 and 20 on international cooperation and financing are mostly ‘greened', indicating that consensus has been reached. Yet, this draft does not include clear legally binding obligations on financing pandemic prevention, preparedness and response (PPR)…. To be truly prepared for the next global emergency, Parties must build a fairer, more resilient financial framework that enables all countries to prepare and respond swiftly and effectively to health crises, free from the constraints of financial fragility. Only through a comprehensive and inclusive approach can the pandemic agreement make a meaningful difference in realizing a more equitable, safer world.”
 
A WHO statement notes, “Parliamentarians from across the globe gathered at the UNITE Global Summit in Berlin to sign a statement in support of the World Health Organization Pandemic Agreement. The statement…. Marks a significant commitment from parliamentarians to strengthen pandemic preparedness, response, and equitable access to health…. As part of their commitment, parliamentarians will work closely with WHO and other international organizations to ensure that the Pandemic Agreement is implemented in a way that benefits all countries, particularly those with limited resources. The statement signed in Berlin is expected to act as a catalyst for global parliamentary action, fostering collaboration and solidarity among nations.”
 
As negations on the agreement continue, AVAC and other advocates released a working document, Comments on Pandemic Agreement – version Friday 20 September at 12:20, arguing this version is a “Net negative. In most cases, the language proposed will not meet the objective of the agreement- and where it does- there will be little to no way to measure if it has…. The ambition and real commitment to equity that was present in the first ever-1 draft of the Accord is gone. It is frustrating that political influence has so severely diluted the original intention of the Accord and that countries are not able to move forward with what they all agree needs to happen.”
 
Dengue Fever Cases Rise Around the Globe
 
The Guardian (UK) reports the world is experiencing the “largest ever outbreak” of dengue. “Cases reached their highest number on record in 2023, with 6.5m reported globally – and 2024 looks likely to double that figure, with 12.4m cases so far. The mosquitoes that spread the virus are benefiting from increased urbanisation, and changes in climate and temperature. At the same time high obesity rates and other chronic health conditions are making people more vulnerable, scientists say.”
 
Vice (US) reports on a dengue outbreak in the US state of Florida following two hurricanes. “The mosquito-borne illness is becoming an issue due to the standing water left behind by hurricanes Helene and Milton. The stagnant floodwater throughout the Tampa Bay area provides a perfect breeding ground for the pests…. Dengue Fever has become a serious concern this year in particular. Earlier this year, the World Health Organization reported the US was seeing three times more cases than at the same point in 2023. Puerto Rico even declared an epidemic in March due to the startingly rapid rise in cases.”
 
The US Election and Public Health
 
Several publications have focused on the impact of another trump presidency on public health in the US and globally. Wired (US) reports Trump has said, “that if elected he would allow wellness conspiracist and anti-vaccine activist Robert F. Kennedy Jr. to ‘go wild on health.’ Kennedy.… Has spent the better part of two decades spreading conspiracy theories that would likely inform the policies of a Trump administration.
 
Endpoint News (US) reports Kennedy last week, “gave a preview of what that would mean in a post on X, formerly known as Twitter, saying that ‘FDA’s war on public health is about to end,’ and calling for stopping what he called the suppression of  ‘psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.’”