Pandemic Watch News Brief: The final issue of 2024 ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌

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[link removed] December 18, 2024
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The cholera outbreak that swept Zambia in early 2024 highlighted the urgent need for improved water and sanitation infrastructure, especially in urban areas. But the crisis spotlighted another critical factor, too: the stigma surrounding the disease." - Kennedy Phiri and Freddie Clayton in Global Health Now ([link removed])
Table of Contents
• If You Are in a Hurry (#If You Are in a Hurry)
• Fight Stigma to Fight Cholera (#Fight Stigma to Fight Cholera)
• More Avian Flu Cases in Humans in the US (#More Avian Flu Cases in Humans in the US)
• Moderna’s Childhood RSV Vaccine Trial Stopped by Safety Concerns (#Moderna’s Childhood RSV Vaccine Trial Stopped by Safety Concerns)
• Sierra Leone Begins Nationwide Rollout of Ebola Vaccine (#Sierra Leone Begins Nationwide Rollout of Ebola Vaccine)
• Hopes Dim for a Pandemic Treaty (#Hopes Dim for a Pandemic Treaty)
• Concerns about Kennedy’s Impact on Vaccines and Public Health (#Concerns about Kennedy’s Impact on Vaccines and Public Health)
• As Mpox Continues to Spread, Advocates Call for More vaccine Access (#As Mpox Continues to Spread, Advocates Call for More vaccine Access)
• Chikungunya Moves into New Regions (#Chikungunya Moves into New Regions)
The mystery disease in a remote region of the Democratic Republic of Congo (DRC) has been identified as a severe form of malaria. The Guardian ([link removed]) (UK) reports, “’The mystery has finally been solved. It’s a case of severe malaria in the form of a respiratory illness,’ the health ministry said in a statement on Tuesday, adding that malnutrition in the area had weakened the local population, leaving them more vulnerable to disease. The statement said 592 cases had been reported since October, with a fatality rate of 6.2%. Forbes ([link removed]) (US) reports, “The upsurge in cases began in October and has mainly affected children under 14, with roughly 64% of all reported cases in infants and toddlers under five…. The concern globally had been that the hitherto unknown illness was
perhaps a novel or mutated respiratory viral disease of some sort. But identifying malaria as the culprit should allay fears of a wider epidemic.”

Meanwhile, The Guardian ([link removed]) (UK) reports, “Malaria killed almost 600,000 people in 2023, as cases rose for the fifth consecutive year, according to a new report from the World Health Organization (WHO). Biological threats such as rising resistance to drugs and insecticides, and climate and humanitarian disasters continue to hamper control efforts, world health leaders warned. Globally, there were 263m cases last year, 11m more than the previous year; the vast majority (94%) occurred in Africa. Read the WHO report ([link removed]) .

If You Are in a Hurry

* Read Global Health Now ([link removed]) on the role of stigma in cholera deaths in Zambia.
* Read STAT ([link removed]) on a sobering new study that found a single mutation of H5N1 infecting cows could make it more transmissible among humans.
* Then read Infectious disease expert Peter Chin-Hong’s LA Times ([link removed]) editorial about what we need to do to prepare for a possible H5N1 epidemic.
* Read Science ([link removed]) on a safety signal that stopped Moderna’s childhood RSV vaccine trials and what it could mean for the field.
* Read AP ([link removed]) on a new nationwide rollout of an Ebola vaccine in Sierra Leone.
* Read Gregg Gonsalves in The Nation ([link removed]) on what an RFK Jr. Stint as Head of the US Department of Health and Human Services could mean for vaccines and public health.
* Read Science ([link removed]) on the state of the mpox epidemic in DRC.


Fight Stigma to Fight Cholera

Global Health Now ([link removed]) (US) reports, “The cholera outbreak that swept Zambia in early 2024 highlighted the urgent need for improved water and sanitation infrastructure, especially in urban areas. But the crisis spotlighted another critical factor, too: the stigma surrounding the disease…. Sanny Mulubale, PhD, a lecturer in the University of Zambia’s Department of Social Sciences, thinks the real death toll during Zambia’s cholera outbreak was actually ‘double or triple’ the 740 reported by the government, and that half of the deaths could have been avoided if stigma and shame were not a factor.”

More Avian Flu Cases in Humans in the US

STAT ([link removed]) (US) reports, “Investigators trying to determine how a child in California might have contracted H5N1 bird flu are continuing to learn more details about the case. But much about the situation remains unclear — and it’s not certain a definitive answer will be reached, an official involved in the probe told STAT….. If this child, who has not been identified, is confirmed to have been infected with H5N1 through milk consumption, it will be the first such case recorded in the United States. But Lisa Santora, public health officer for Marin County, acknowledged to STAT there is a decent chance the infection will not be confirmed.”

STAT ([link removed]) (US) reports a new study from Scripps Research “contains a sobering piece of news about the H5N1 bird flu viruses circulating in cows in the United States: A single mutation in the hemagglutinin, the main protein on H5N1’s exterior, could turn a virus that is currently not well equipped to infect people into one that is much more capable of doing so…. The authors termed their finding ‘a clear concern’ — a view shared by other influenza scientists asked to review the paper by STAT…. Adding to the concern the findings are provoking is the fact that a mutation at the same position on the hemagglutinin that the group studied was recently seen in viruses taken from a teenager in British Columbia, Canada, who contracted H5N1 around the end of October and became seriously ill. The teenager has been in critical condition in a Vancouver hospital for several weeks. Authorities
there have been unable to determine how the teen became infected.” Read the study in Science ([link removed]) .

Infectious disease expert Peter Chin-Hong writes in an LA Times ([link removed]) (US) opinion that as the virus continues to evolve the risk to humans becomes greater. “There is no guarantee that a major human outbreak or pandemic will happen soon. Finding a single mutation in a lab that can facilitate more human infections does not guarantee that this threat will play out in the real world. But the more transmissions that occur, as is happening now among poultry and dairy cows in the U.S., the higher the likelihood that some of these mutations will appear by chance and take off…. So it increasingly looks like the question is not whether H5N1 will cause a widespread outbreak in humans, but when…. At this crossroads, the U.S. can choose either of two scenarios. The first is that we do everything right…. The other option is to go the direction the incoming federal government seems poised to support: Shrink public health
dollars and expertise at the Centers for Disease Control and Prevention and other federal entities, cut investments in infectious disease research, stymie the use of evidence-based vaccines, therapeutics and diagnostic tests, and support drinking raw milk.”

CIDRAP ([link removed]) (US) reports, “Labcorp today announced that its H5 avian flu molecular test is now available for doctors to order, and it can be used to assess potential human exposure. The company said it developed the test with support from the CDC to expand access and testing capacity amid the ongoing outbreaks in dairy cattle and poultry, linked to a growing number of human cases, some with unknown exposure.”

New York Times ([link removed]) (US) reports, “Domestic cats could provide an unexpected new route for the bird flu virus H5N1 to evolve into a more dangerous form, according to a new study published on Monday…. There is no evidence that cats have spread H5N1 to people and they may not represent a major avenue for the evolution of bird flu, experts said. Still, if a cat were simultaneously infected with H5N1 and a seasonal flu virus, the H5N1 virus could potentially acquire the mutations it needed to spread efficiently among people.” Read the study ([link removed]) in Emerging Microbes & Infections.

Reuters ([link removed]) (UK) reports, “The US issued a federal order on Friday mandating that the national milk supply be tested for bird flu, Agriculture Secretary Tom Vilsack told Reuters, as authorities seek to grapple with rapid spread of the virus among dairy herds.”

The Pandemic Action Network ([link removed]) released a new report on H5N1, writing: “A review of the year’s coverage… underscores that the world is not adequately paying attention to or preparing for a potential H5N1 pandemic threat. There are clear priorities for urgent action — particularly for the incoming U.S. administration…. The recurring gaps in the U.S. H5N1 response suggest that critical lessons from past epidemics and pandemics, such as COVID-19, have not been learned and definitely not applied. WHO and global experts continue to urge countries worldwide, including the US, to prioritize a rapid and coordinated response to avoid losing the critical window of opportunity to contain the outbreak and prevent further escalation.”

Moderna’s Childhood RSV Vaccine Trial Stopped by Safety Concerns

Science ([link removed]) (US) reports, “In recent clinical trials, two experimental RSV vaccines for babies may not only have failed to protect them, but actually made some of them sicker when they got RSV or another respiratory virus. The findings, publicly discussed in detail for the first time yesterday, have profoundly unsettled many RSV scientists, who recall similar problems with a vaccine trial decades ago…. Scientists aren’t certain Moderna’s data signal a real problem, but the company has already stopped studies and abandoned development of the vaccines. The US Food and Drug Administration (FDA), in turn, this week halted some trials of other experimental RSV vaccines for children. And scientists fear this development will be exploited by some to wrongly promote antivaccine agendas.”

Sierra Leone Begins Nationwide Rollout of Ebola Vaccine

AP ([link removed]) (US) reports health officials in Sierra Leone earlier this month started “a nationwide rollout of the single-dose Ebola vaccine, the first such campaign in West Africa where a deadly outbreak 10 years ago resulted in the death of thousands…. [The campaign] will target 20,000 frontline workers across the country, officials said…. Collins Thomas, a community health worker in Freetown, remembers losing many colleagues in 2014 as they managed patients during the outbreak in Freetown. ‘It was scary, because we knew nothing about the disease and learned along the line. With this vaccine, we know we are protected,’ Thomas said.”

Hopes Dim for a Pandemic Treaty

Euro News ([link removed]) (France) reports, “There will be no global pandemic treaty this year, after countries again failed to agree on a mandate to better prepare for and cooperate during a health crisis like COVID-19. Delegates and civil society groups say the draft treaty has been substantially watered down over three years of talks, with limited progress made during the most recent round of negotiations, which ended this month. That leaves an ever-shrinking chance that the treaty will be finalised by the May 2025 deadline…. The reelection of Donald Trump in the US throws additional uncertainty on the future of the treaty, given Trump’s wariness toward the WHO. His new administration could walk away from the deal, stall talks, or push to further water down commitments. It’s also unclear whether EU and national leaders are as committed to international solidarity as they were during
the pandemic, which could stymie efforts to push a strong treaty through the finish line.”

Concerns about Kennedy’s Impact on Vaccines and Public Health

Health Policy Watch ([link removed]) (Switzerland) reports, “Robert Kennedy Jr, President-elect Donald Trump’s nominee to lead the United States health system, arrived in Washington, DC on Monday to rally support from lawmakers for his candidacy amid fears from health experts that the anti-vaccine activist and lawyer could roll back hard-won public health gains credited with saving millions of lives and protecting more from deadly disease…. ‘RFK Jr has spent virtually his entire career casting doubt about vaccines. This is all part of a pattern that has gone on for a decade or more,’ Lawrence Gostin, a public health expert at Georgetown University, told Health Policy Watch. ‘Vaccines are among the most studied medical interventions, far safer than many medicines in people’s homes that they take regularly, such as ibuprofen. We need widespread vaccination coverage to protect everyone,’
Gostin added.”

Gregg Gonsalves writes in The Nation ([link removed]) (US), “RFK Jr. has bragged that he’d tell researchers at the National Institutes of Health to give ‘infectious disease a break for about eight years.’ Well, he isn’t giving infectious disease a break but leading its promotional tour. If this man gets what he wants, old scourges will be back with a vengeance. And those years, like those of my father’s childhood, filled with the terror of deadly diseases, the suffering and upheaval of sickness and death visited upon families, the lingering effects down the generations, will be here again.”

The New York Times ([link removed]) (US) reminds Americans of six childhood diseases, including measles and polio, we rarely if ever see in the US because of vaccines. “It has been half a century or more since many of the inoculations became routine in the United States, and the experience of having these illnesses has been largely erased from public memory. Questions today about the risk-benefit ratio of vaccines might just be a product of the vaccines’ own success…. In the United States, vaccines drove paralytic polio cases down from more than 21,000 in 1952 to just one in 1993. But in 2022, the CDC confirmed a new case in Rockland County, NY, which had low vaccination coverage. The agency called the single case a public health emergency.”

As Mpox Continues to Spread, Advocates Call for More vaccine Access

Jon Cohen writes in Science ([link removed]) (US) on the ongoing mpox epidemic in DRC, reporting, “There are far too few vaccine doses for the population at high risk, and their distribution throughout the country—more than half the size of the European Union—has been agonizingly slow. Children, who account for half the cases and are most at risk of severe disease and death, are not being vaccinated at all…. Whether the DRC can get mpox under control is a pivotal question for both the country and the world. If not, it will become a permanent additional stress on the country’s fragile heath system. And exported cases will pose a continual threat to other countries. [Epidemiologist Placide] Mbala thinks the spread can at least be dramatically slowed, just as the earlier, global epidemic in MSM was. ‘We know where the disease is more prevalent and where we are seeing more human-to-human
transmission,’ he says. ‘It would be easy in those places to set up good surveillance and good diagnostics, and very quickly, we can stop this disease. … It’s just a matter of willingness and money.’”

AFP ([link removed]) (France) reports, “Mpox is present in almost every district in Burundi, a doctor warned Tuesday, condemning authorities handling of the outbreak and refusal to communicate. ‘The management of the current mpox epidemic in Burundi by the authorities is catastrophic, irresponsible and criminal,’ a Burundian doctor with knowledge of the details, who requested anonymity, told AFP…. The doctor urged authorities to agree to use mpox vaccines offered by international agencies, ‘which it has so far refused’.”

The Independent ([link removed]) (Uganda) reports, “The cumulative number of confirmed mpox cases in Uganda has surpassed 1,000, with six deaths reported since the outbreak was declared five months ago in the East African country, the Ministry of Health said on Monday. A total of 17 new cases were reported in the past 24 hours, bringing the total to 1,044 across 57 of the country's 146 districts since the first case was registered in August, the ministry said in a situation update report issued locally. At least 10 new cases were recorded in the capital of Kampala, making the city the current hotspot of the disease.”

Fierce Pharma ([link removed]) (US) reports, “Bavarian Nordic… has inked a manufacturing licensing pact with the Serum Institute of India (SII) to produce MVA-BN [mpox vaccine] for the Indian market. Under terms of the agreement, SII gets access to the technology for producing the vaccine, which is marketed under the name Jynneos in the U.S., Mexico, Singapore, Switzerland and Canada. In a statement the advocacy group Public Citizen ([link removed]) ’s Peter Maybarduk said, ““The public has invested more than $2 billion developing and supporting Jynneos (MVA-BN). The vaccine should belong to all people, everywhere, available for regional manufacturers to meet health needs. The world needs more sources of reliable mpox vaccine production, and in that regard, it is helpful that today we have one more. But under this deal, Bavarian
Nordic keeps its exclusive control of MVA-BN everywhere outside India, its outrageously high prices intact. That is a far cry from justice, or from the affordable, diverse supply needed to help stoke demand and encourage ambitious campaigns to protect people from mpox.”

AP ([link removed]) (US) reports, “in a first for Africa, a Moroccan company is filling orders for mpox tests as an outbreak continues. Moroccan startup Moldiag began developing mpox tests after the World Health Organization declared the virus a global emergency…. At his factory in Morocco, Moldiag founder and chief scientific officer Abdeladim Moumen said the tests they make — sold for $5 each — can help to remedy shortages affordably. The company last month began accepting orders from Burundi, Uganda and Congo and has also sold them to Senegal and Nigeria as well.

Chikungunya Moves into New Regions

CIDRAP ([link removed]) (US) reports, “Globalization, urbanization, and climate change have significantly raised the risk of "explosive, unpredictable" outbreaks of the mosquito-borne disease chikungunya, which disabled millions and likely amassed close to $50 billion in healthcare and disability-related costs in 110 countries from 2011 to 2020, researchers report in BMJ Global Health…. Most chikungunya infections (nearly 15 million) were reported by Latin America and the Caribbean. Brazil (3.2 million), the Dominican Republic (2.7 million), and French Polynesia (1.6 million) documented the most cases. Read the report ([link removed]) .
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