In a guest commentary introducing a special issue looking at the need for social science and biomedical science to work together — How to do social distancing in a shack: COVID-19 in the South African context — in the South African Journal of Science (South Africa) Jonathan Jansen and Shabir A. Madhi write: “The somewhat ironic title for this special issue captures a dilemma that we seek to address: how to bring together the best thinking in the social sciences and the biomedical sciences to work through the complex challenges posed by COVID-19. How, indeed, does one do social distancing in a shack, or expect people to survive by shutting down the economy in a country where one third of the population is unemployed and Government is unable to offer a meaningful social security net?” They conclude the perspectives in the journal reveal, “First, that the conceptual, methodological, and—we would say—ideological bent of the biomedical sciences cannot provide vital insights into questions of ethics, compliance, governance, representation, well-being and the nature of (academic) work that emerge from pandemic disruption. Second, that complementary perspectives, both medical and social, can lead to more effective management of pandemics and their efforts. And third, that context matters. In impoverished and underdeveloped communities, the parameters of conceptual understanding and the standards of intervention have to account for geographies of inequality in the global world, but also within highly unequal national contexts as in South Africa.”
 

If You Are in a Hurry

• Read Nature on the devastating impact of COVID and lockdowns on children’s education globally and solutions to help recover.
• Read Helen Rees and colleagues on the challenges of addressing inequities in access to COVID vaccines, treatment and testing in South African Journal of Science.
• Read an opinion piece in Project Syndicate that argues a recent US FDA decision on the J&J vaccine could have far reaching effects in some African countries.
• Read Reuters on how the COVID pandemic pushed the Belgium government to become the first in Europe to decriminalize sex work.
• Read GroundUp on a decision by South African regulators to terminate the special dispensation for ivermectin to be used to treat COVID, citing data.
• Read STAT on the comeback of other viruses as COVID restrictions wane.
• Read Sir John Bell in The Economist on the need for an effective global disease surveillance system.
• Read an opinion in The New York Times on how to learn from COVID and HIV in dealing with monkeypox.

 

Addressing COVID Inequities

 
Helen Rees and colleagues write in South African Journal of Science (South Africa) about the challenges of addressing inequities in access to vaccines, treatment and tests for COVID. They argue, “The COVID-19 pandemic has highlighted significant shortcomings in the global response to pandemics. Lessons need to be learned, in particular to ensure greater equity in access to new technologies during public health emergencies…. There is a need to strengthen existing structures and mechanisms of proven value, such as WHO, CEPI, Gavi, the Africa CDC and pandemic preparedness networks, as well as newly created platforms such as COVAX…. These structures need to be combined with imaginative solutions that acknowledge the limited purchasing power of LMICs.”
 
In the same issue, Marina Joubert and colleagues “explored which South African scientific experts at the academic rank of ‘professor’ were quoted in the local mass media during the initial 6 months of the COVID-19 pandemic.” Women and social scientists were less well represented than men and t health and medicine experts. The authors conclude, “The media representation of scientists, including their gender and field, affects who gets to influence science policy and public opinion” and call for more inclusion.
 
In another piece in the journal, Charles S. Wiysonge and colleagues look at randomised trials of COVID-19 vaccines in Africa, finding “only 108 eligible trials: 90 (83 percent) evaluating candidate COVID-19 vaccines, 11 (10 percent) assessing if existing vaccines could prevent SARS-CoV-2 infection, and 7 (7 percent) evaluating interventions for improving COVID-19 vaccination coverage.” The authors conclude, “The paucity of COVID-19 vaccine trials conducted on the African continent is a cause for concern. This has implications for the role that Africa may play in future pandemics. The continent needs to allocate public funds to fund research, development, and innovation; invest in clinical trial capacity; and improve regulatory pathways to facilitate timely participation in vaccine trials.”
 

Long COVID Two Years In

 
Medical News Today (US) reports on a study among some of the earliest COVID patients from Wuhan, China. Two years on, “of the people researchers assessed for the study, half reported having at least one long COVID symptom two years after acute infection…. The study’s authors write that long COVID symptoms at two years were related to decreased quality of life, lower exercise capacity, abnormal mental health, and increased use of healthcare after discharge.”
 

China Lifts Two-month Shanghai Lockdown

 
Reuters (UK) reports, “Shanghai authorities on Tuesday began dismantling fences around housing compounds and ripping police tape off public squares and buildings before the lifting of a two-month lockdown in China's largest city at midnight…. China is alone among major countries enforcing a ‘zero COVID’ policy of eradicating outbreaks at just about any cost.”
 

The Dangers of War Metaphors and COVID

 
In a commentary in Sixth Tone (China) an online outlet that looks “for other voices that go beyond buzzwords and headlines to tell the uncommon stories of common people,” communications professor Yang Zheng writes, “China has relied on militarized language to mobilize public opinion and secure people’s cooperation in epidemic prevention work. In COVID-19 articles published on the official Weibo social media account of the People’s Daily, military metaphors were second in importance only to terms directly describing COVID-19 itself. The purpose of these metaphors is clear: uniting the Chinese people and improving national morale in the ‘battle’ against the coronavirus.’ But, he warns, “The excessive use of military metaphors can lead people to see patients, as well as diseases and pathogens, as enemies who need to be isolated and ‘eliminated.’ It can also lead to unnecessary levels of stress in society, as people grapple with the pressure of a protracted ‘war’ against an illness or pathogen. This may negatively impact pandemic prevention work in the long term.”
 

The Impact of mRNA COVID Vaccines

 
Monica Gandhi writes in a Medscape (US) blog, “The mRNA vaccines are powerful in terms of preventing severe disease with COVID-19 across populations because of the multifaceted immune response they generate, a redundancy that can help among patients on agents which cause immunocompromise…. In the future, instead of using an mRNA or DNA vaccine that only exposes us to part of the virus (the spike protein, which is mutated across all the variants), we may need a vaccine booster that exposes us to the entire virus. Vaccines given inside the nose can help boost antibodies at nasal surfaces, which will help with viral transmission. Therefore, we have many tools to protect even our most vulnerable, including powerful present and coming vaccines, as we learn to live with endemic COVID-19.”
 

Revamping WHO’s Budget

 
France 24 (France) reports, “Shaken by the pandemic, the World Health Organization's member states agreed Tuesday to overhaul how they fund the UN health agency, giving it much more money to spend on its own priorities. The budget revamp is aimed at strengthening the organisation and making it more agile when responding to global health crises. The change will give the WHO a more stable income stream and control over a much bigger portion of the funding flowing through its Geneva headquarters.”
 

Getting Education Back on Track

 
Nature (UK) reports, “By February this year, schools globally had been closed because of COVID-19 for an average of 4.5 months, affecting an estimated 1.6 billion students and creating what the United Nations has called the largest disruption to education in history…. The consequences of these closures follow a sad but predictable course. In rich countries, disadvantaged and vulnerable children have fallen behind the most. Those in poorer countries have been the hardest hit, and millions will never go back to school at all.” The article looks at possible ways to help children get back on track, including using evidence-based programs and bringing research into education planning.
 
South Africans Servaas van der Bergand and Chris van Wyk write in The Conversation (Australia) of their work to understand how much education had been lost in South Africa because of COVID. “We found that the time out of school left public school learners in South Africa about a year behind previous cohorts…. Younger learners can catch up over their school career. But teachers now have an even more difficult task to cover the curriculum for each grade, and to fill some gaps in understanding from previous grades. This is especially true for a subject such as mathematics.”
 

Has the US Damaged Africa’s Vaccine Efforts?

 
In an opinion piece for Project Syndicate (Czechia) Ebere Okereke argues a recent US FDA decision to “limit the use of the Johnson & Johnson COVID-19 vaccine to adults who cannot or will not get another vaccine will have profound consequences for African countries.” She notes the decision is not based on new data and will have little impact in a country that is relatively well-vaccinated and in which few people have received the J&J vaccine. “In Africa, on the other hand, the J&J vaccine is widely used. According to analysis from the Tony Blair Institute for Global Change, 42 million J&J doses have been administered in African countries so far. The fact that it requires only a single shot makes it well-suited to the logistical and capacity constraints of many poorer countries, and it is the vaccine of choice across much of the continent…. The FDA’s decision risks triggering a widespread loss of confidence in the J&J vaccine, causing demand to plummet and irreparably reducing the reach of a safe, effective, and widely available means of protection against COVID-19. This will have major implications for African countries’ ongoing efforts to stimulate vaccine demand and safeguard their populations.”
 

COVID and Sex Work Decriminalization

 
Reuters (UK) reports, “Belgium is the first country in Europe to decriminalise sex work, which supporters say will allow sex workers to set their own terms, and could reduce exploitation and violence, and make it easier to access medical services…. Activists say the coronavirus pandemic was the catalyst for parliament's March vote to remove sex work from the penal code. Lockdowns left sex workers with no income here and—given their uncertain legal status—no unemployment benefits…”
 

35 Years for a Malaria Vaccine; 1 Year for a COVID Vaccine

 
Undark magazine (US) reports, “At a time when COVID-19 vaccines were developed and authorized in less than one year, the delay [35 years] for malaria raises a question: Why did a vaccine for a leading global killer take so long to arrive? According to researchers involved in the development of RTS,S, the answer involves the challenges of developing a vaccine against a vexing parasite — and the chronic lack of urgency and funding behind malaria research, which stymied the logistics of research trials at every step. The people who are affected by malaria, ‘they’re not Europeans, they’re not Australians, they are poor African children,’ said Ashley Birkett, director of the malaria vaccine initiative at PATH, a non-profit global health organization. ‘Unfortunately, I think we have to accept that that is part of the reason for the lack of urgency in the community.’”
 

BA.2.12.1 and Friends

 
Nature (UK) breaks down the Omicron subvariants, how they get their names and why none has risen to be a “variant of concern.” Nature reports, “this year, Omicron has remained in the spotlight, with members of its family — subvariants — fuelling surges as they evade antibodies that people have generated from previous infections and vaccines. For example, the Omicron subvariant BA.2.12.1 is gaining ground in North America, now accounting for about 26 percent of the SARS-CoV-2 genomes submitted to the GISAID data initiative, and BA.4 and BA.5 are spreading rapidly in South Africa, comprising more than 90 percent of genomes sequenced.”
 

Ivermectin Sent “Back to the Worms”

 
GroundUp (South Africa) gets credit for the best headline of the week: “Ivermectin sent back to the worms by medicines regulator,” reporting, “The South African Health Products Regulatory Authority (SAHPRA) announced on Monday that the special dispensation granted for the use of ivermectin has been terminated, after a review of evidence. SAHPRA states that “there is currently no credible evidence to support a therapeutic role for Ivermectin in COVID”. It cites a surfeit of evidence supporting the opinion that ivermectin is of no clinical use for the prevention or treatment of COVID.
 

Other Viruses Are Back

 
STAT (US) reports, “as the world rapidly dismantles the measures put in place to slow spread of COVID, the viral and bacterial nuisances that were on hiatus are returning — and behaving in unexpected ways.” These range from an adenovirus that may be triggering hepatitis cases among children to a respiratory virus usually active in winter becoming active in summer to the current outbreaks of monkeypox in new countries. “These viruses are not different than they were before, but we are. For one thing, because of COVID restrictions, we have far less recently acquired immunity; as a group, more of us are vulnerable right now. And that increase in susceptibility, experts suggest, means we may experience some…wonkiness as we work toward a new post-pandemic equilibrium with the bugs that infect us.”
 

Monkeypox Updates

 
Media coverage continues as the monkeypox outbreaks in Europe and the US grow larger.
 
Helen Branswell writes in STAT (US) that “warning signs [of a potential monkeypox outbreak] appear to have gone unheeded. An unusual and long-running outbreak in Nigeria should have served as notice that it was only a matter of time before this orthopoxvirus pushed its way to the center of the infectious diseases stage, experts say. After decades without cases, Nigeria experienced a large monkeypox outbreak starting in 2017 that continues to this day. Prior to this year, that outbreak spread beyond Nigeria’s borders eight times, with infected people traveling to the United States, the United Kingdom, Israel, and Singapore.”
 
A ”News Explainer” in Nature (UK) looks at some of the key questions researchers are trying to answer about the latest outbreaks, including how it started, “whether there is a genetic basis for the virus’s unprecedented spread outside Africa,” can it be contained and “is the virus spreading differently compared with previous outbreaks.”
 
Several African countries have been dealing with endemic monkeypox for decades, without the international scrutiny the disease is now seeing. AP (US) reports, “Nine people have died of monkeypox in Congo in 2022 while Nigeria has recorded its first death from the disease this year, the countries’ health authorities said, even as at least 20 countries continue to grapple with sudden outbreaks not seen in years. Dr. Aime Alongo, chief of the Sankuru health division in Congo, said Monday that 465 cases of the disease have been confirmed in the nation, making it one of the worst-hit in West and Central Africa, where the disease is endemic.”
 
In an opinion piece in The New York Times, (US) James Krellenstein, Joseph Osmundson and Keletso Makofane argue, “While monkeypox and the coronavirus are not the same, there are lessons to be learned from COVID-19 and prior pandemics: We cannot stop transmission of a disease we can’t see, and we can’t help people if we don’t let them know what they’re up against….We are not currently in a public health emergency because of monkeypox, and monkeypox is not a gay disease. By taking this moment seriously and by acting with care and immediacy but without stigma, the United States may well avert an emergency entirely and ensure that we won’t be dealing with yet another pandemic this summer and fall.”
 

Preparing for the Next Pandemic

 
Sir John Bell argues in The Economist (UK) that in the COVID pandemic, “Patchy sequencing efforts led to missed opportunities to identify new variants and to understand the evolving epidemic….The world can and must create an effective global surveillance system. It can now be achieved relatively cheaply, it could be distributed equitably around the world and it could save the global community billions in economic costs and save millions of lives. Embedding genomic-pathogen analysis in routine clinical diagnostics will also revolutionise microbiology. The method will be transferable to all communicable diseases—the endemic, the epidemic and the pandemic. If this is done right, we might just pull off the most exciting innovation since the Petri dish.”