We already knew that inequity was a major health issue globally and in to varying degrees in every nation and community. COVID has laid bare and exacerbated many of the health inequities we have been living with.
Bhekisisa (South Africa) reports, “Pandemics… expose long-existing inequalities and demonstrate how factors such as where people were born, where they live, what job they do and how much access they have to money and power interact to influence their chances of access to healthcare — and survival. In South Africa, COVID-19 has, for instance, shown us that the country’s history of racial inequalities, even after almost 30 years of democracy, still affects who lives or dies, who gets an intensive care (ICU) bed or who has access to lifesaving oxygen or ventilation when they end up in hospital.”
Bhekisisa bases this on analysis of data collected during the COVID pandemic in South Africa, but there is increasing acknowledgement that this has played out in countless communities. In the US,
STAT (US) reports, “Homeless and incarcerated people had significantly lower COVID vaccination rates than others in Minnesota, according to a new study. Its authors say the findings highlight lingering inequities, even in a state that has prioritized vaccinating socially vulnerable groups.” This study is only the latest documentation of structural barriers and inequities in treatment, care and prevention of COVID among marginalized populations in the US.
If You Are in a Hurry
- Read The Independent on the increased risk of death among pregnant women in Africa.
- Read Bloomberg on new data that shows much higher rates of COVID in West Africa than officially reported.
- Read an opinion in STAT on the promise of wastewater monitoring then read Bhekisisa on how researchers use the data they get from wastewater monitoring.
- Read The Washington Post on COVID and unusual behavior in other virsues.
- Read an opinion in STAT that argues for the need to listen to the experiences of COVID long haulers to understand the syndrome.
- Read Nature on monkeypox vaccination considerations, Donald McNeil in Medium on what the US needs to do now and Science on what could happen if monkeypox finds an animal reservoir outside of endemic countries.
COVID and Pregnant Women in Africa
The Independent (Uganda) reports, “Pregnant women who were hospitalized with COVID-19 in sub-Saharan Africa died at higher rates and had more complications than non-pregnant women with similarly severe COVID-19, as well as pregnant women without the disease, according to a study in six African nations…. Women with COVID-19 who were pregnant had a 2.4 times higher risk of needing intensive care and a two times higher risk of death compared with other women with the disease who weren’t with child. And among those who were pregnant, women with COVID-19 had a five times increased risk of death as compared to those without the disease.”
VOA (US) reports, “Researchers argue that vaccinating pregnant women against the coronavirus should be made a priority across the region, where most countries do not yet recommend vaccination during pregnancy.”
COVID Rates in West Africa
Bloomberg (US) reports, “The extent of the COVID-19 pandemic in West Africa has been hugely underreported, according to blood tests showing the proportion of the population that have had a prior infection. Almost 80 percent of people surveyed in Ghana in the first five months of 2022 had previously contracted COVID-19, sero-positivity data presented at an online seminar organised by the University of Ghana’s West African Centre for Cell Biology of Infectious Pathogens on Wednesday showed. The number stood at an average of 50 percent in Nigeria and slightly higher in Burkina Faso.” Read the study
here.
Omicron-focused Vaccines
STAT (US) reports, “Moderna said Wednesday that using a new version of its COVID-19 vaccine as a booster led to a superior antibody response against the Omicron variant compared to its current shot. The company said it plans to submit its data to the Food and Drug Administration in the coming weeks and that it hopes that the new booster will be available in the late summer…. It contains mRNA coding for the spike protein for both the original strain of the SARS-CoV-2 virus and the newer Omicron strain.”
Reuters (UK) reports, “French drugmaker Sanofi said on Monday an upgraded version of the COVID-19 vaccine candidate it is developing with GSK showed potential in two trials to protect against the virus's main variants of concern, including the Omicron BA.1 and BA.2 strains, when used as a booster shot…. Sanofi said this new vaccine candidate was shown to significantly boost antibody levels against a number of variants of concern, when given to trial participants who had an initial course of mRNA vaccines…”
COVID Vaccines for the Youngest Children
The US FDA is expected to approve COVID vaccines from Moderna and Pfizer for the last age group to be eligible for vaccines – children under age five.
AP (US) reports, “Federal health officials said Sunday that kid-sized doses of Pfizer’s COVID-19 vaccines appear to be safe and effective for kids under 5, a key step toward a long-awaited decision to begin vaccinating the youngest American children…. Late last week the FDA posted a similar analysis of Moderna’s shots for children under 6.”
ABC News (US) reports, “But even once these are authorized for children under 5, public health officials say the vaccine rollout for this age group could be the most challenging yet. Data from the Kaiser Family Foundation’s (KFF) Vaccine Monitor suggests about 18 percent of parents with kids under 5 are eager to get their child vaccinated, and most parents say the delay in the approval of the vaccines has not shaken their confidence in their safety and effectiveness.”
In a commentary in
The Lancet (UK), Manish Patel and Minal Patel argue, “a COVID-19 risk in children does exist. Complications in children with COVID-19 have included respiratory failure, neurological involvement, cardiovascular dysfunction, multisystem inflammatory syndrome, and long COVID. In the USA alone, as of May 14, 2022, the Centers for Disease Control and Prevention reported 804 deaths involving COVID-19 among children aged 5–18 years. Moreover, COVID-19 in children has disrupted education, sports, and community activities, with commensurate mental health consequences. Importantly, real-world studies have shown the promise of vaccines in averting life-threatening paediatric COVID-19 and multisystem inflammatory syndrome…. In
The Lancet, Grace Li and colleagues present promising findings that help improve our understanding of COVID-19 vaccines for paediatric populations worldwide, paving the way for better access globally to safe and efficacious COVID-19 vaccines.”
WTO Considers TRIPS Waiver
As the World Trade Organization meets this week to consider a TRIPS waiver for COVID vaccines,
IP Watchdog (US) reports, “TRIPS Council Chair, Ambassador Lansana Gberie of Sierra Leone,
said on June 7 that ‘delegations have entered into real negotiation mode in the last 24 hours,’ and that she is ‘feeling cautiously optimistic now that we will get this text ready for adoption by ministers in time for the coming weekend.’”
Business Standard (India) reports, “Amid opposition from rich nations, India has called for inclusion of ‘therapeutics and diagnostics’ — testing and treatment of a disease — as part of the temporary patent waiver agreement that can pave the way for the future need to tackle any crisis…. At the 12th ministerial conference at Geneva, Commerce and Industry Minister Piyush Goyal said there was a need to redouble efforts and commence negotiations on therapeutics and diagnostics, since the pandemic was far from over, particularly for the developing and least-developed countries. Besides, it is too late in the day if only vaccines are included as the pandemic has run its initial course, he said.”
In an
open letter to the WTO, the UN Special Rapporteur on contemporary forms of racism, racial discrimination, xenophobia and related intolerance wrote, “International trade law, including international intellectual property law, perpetuates racial discrimination in access to lifesaving COVID-19 vaccines and medicines. Urgent action is required to remove these legal obstacles to equality and non-discrimination. I thus urge you to immediately use all tools available to you to rectify transnational inequities in access to COVID-19 vaccines, treatments and other technologies. This includes adopting a comprehensive TRIPS waiver under the terms prominently proposed by certain WTO Members and civil society. International human rights law requires the prohibition of racial discrimination as a matter of both treaty-based and customary international law. Under these obligations, shared by all WTO Members, the organization must be attuned to the current unequal distribution of life-saving COVID-19 technologies, which disproportionately affects the world’s racially marginalized peoples.”
COVID and Other Viruses
The Washington Post (US) reports, “More than two years into the coronavirus pandemic, familiar viruses are acting in unfamiliar ways. Respiratory syncytial virus, known as RSV, typically limits its suffocating assaults to the winter months.” Rhinoviruses that cause cold and the flu are also actin strangely. “The upheaval is being felt in hospitals and labs. Doctors are rethinking routines, including keeping preventive shots on hand into the spring and even summer. Researchers have a rare opportunity to figure out whether behavioral changes like stay-at-home orders, masking and social distancing are responsible for the viral shifts, and what evolutionary advantage SARS CoV-2 may be exercising over its microscopic rivals.”
The Promise of Wastewater Monitoring
Aparna Keshaviah and Megan Diamond write in
STAT (US) that “Wastewater monitoring has gained visibility and credibility as an effective pandemic management tool. Yet despite its promise, its use around the country remains fragmented, and its future unclear, based on the results from a national survey conducted by the Rockefeller Foundation’s Pandemic Prevention Institute and Mathematica. They argue, “We’re at a pivotal moment, where interest has been piqued in the power of wastewater surveillance, particularly to detect novel pathogens and health threats. How we adapt our national system now to meet the diverse needs of our communities will make or break the future success of this innovative approach to monitor population health.” Read the survey results
here.
Bhekisisa (South Africa) reports, “there’s a way scientists can detect signs of a threatening new version of the bug early — and could buy the health system up to a week to prepare, before sick people show up at facilities….
Research shows that the number of clinical cases (infections confirmed via COVID tests) correspond with the levels of virus pieces in wastewater. So, when the concentration of viral fragments in sewage rises, it usually means infections are rising. Similarly, when lower levels of viral bits are seen in wastewater, infections are likely dropping too.”
Listen to Long Haulers to Understand Long COVID
Researcher Zeenia Framroze writes of her experiences with long COVID in
STAT (US) and argues, “Understanding COVID-19 and long COVID requires the kind of gold-standard research that has been fielded for other conditions, like HIV and Guillain-Barré syndrome. But it will also take the lived experiences that people with it have accumulated, along with so-called real-world evidence. Only with this combination can the scientific and public health communities arrive at real answers that finally bring the support and long-term care needed by people with this perplexing condition.”
Need for Health Policy Trials
An opinion in
PNAS (US) by Luchuo Engelbert Bain and colleagues argues that experiences in the COVID pandemic underscore the need for more health policy trials. “Health policy trials (HPTs) are experiments to assess the consequences, both desirable and undesired, of innovations in health policy or to compare the relative merits and drawbacks of alternative health policies…. At the height of the COVID-19 pandemic, an HPT might have, for example, temporarily randomized districts to compare alternative approaches to school opening, contact tracing, vaccination delivery, nonpharmaceutical public health interventions, or the choice between mandatory versus voluntary isolation measures. It could measure a broad set of relevant outcomes in identical ways across districts with different COVID-19 intervention exposures, including not only COVID-19 transmission but also non–COVID-19 health use and outcomes, children’s educational achievements and cognitive and social development, and public sentiment and trust.”
Call for African Solutions to African Problems
In an opinion piece in
Health Policy Watch (Switzerland) and multiple other outlets, South African researcher Quarraisha Abdool Karim writes, “The AIDS pandemic has taught us that scientists, policy-makers, and civil societies cannot work in a vacuum. There must be a unity of purpose that galvanises the steadfast support of global leaders in governments and funding agencies across the world. Africa has the scientific leadership and intellectual capital to develop new technologies and interventions. This is something we have shown time and time again. If there is a problem, then local research is surely the best path toward finding a solution. Pursuing this path of innovation requires funding that will support and promote the growth and expertise of Africa’s scientists. Our inter-dependency and shared vulnerability underscores the importance of collaboration and resource-sharing both globally and regionally that must be used for the benefit of humanity. There is no time for complacency. We must ensure that solutions are tailored by local research to best benefit those in need.”
Virus Origins Still Not Clear
Reuters (UK) reports, “The World Health Organization said on Thursday its latest investigation into the origins of COVID-19 was inconclusive, largely because data from China is missing, another blow to its years-long effort to determine how the pandemic began. The report from the WHO expert panel said all available data showed the novel coronavirus that causes COVID-19 probably came from animals, likely bats, a similar conclusion to the UN agency's previous work on the topic in 2021…. The missing data, especially from China, where the first cases were reported in December 2019, meant it was not possible to identify exactly how the virus was first transmitted to humans.”
Monkeypox Update
Nature (UK) reports, “As global monkeypox cases continue to rise, public-health officials and researchers are questioning whether the current outbreaks can be contained. The World Health Organization (WHO) has said that the situation is unlikely to escalate into a full-blown pandemic. But there are now more than 1,000 confirmed infections in nearly 30 countries where outbreaks do not usually occur…. At the moment, the risk posed by monkeypox to the general public isn’t high enough to warrant mass vaccination, given the side effects and availability issues, says Daniel Bausch, the director of emerging threats and global health security at FIND, the global alliance for diagnostics in Geneva, Switzerland. But if the virus starts spreading in vulnerable populations, such as pregnant people or children, or if it turns out to have a higher fatality rate than expected, the risk–benefit calculation could change.”
Veteran health reporter Donald McNeil writes in
Medium (US) that the response to Monkey Pox in both Germany and the US is lagging behind what is needed. He fears sex positive events during Pride month may spark a much wider outbreak. “It’s hard to be sure, since it’s too early to see patterns emerge. But right now, we are watching and waiting — but not diagnosing people until, as in Stuart’s case, multiple pox appear. That’s too late to prevent transmission. Late diagnosis, fruitless contact-tracing and ring vaccination — against a background in which no one under 50 is vaccinated — seems unlikely to work…. This isn’t 1981. This time we have a vaccine. We could soon have a test. We should use them — as fast as possible.”
Science (US) reports that the current monkeypox outbreak in the US, “has raised a possibility that makes researchers gulp: Monkeypox virus could take up permanent residence in wildlife outside of Africa, forming a reservoir that could lead to repeated human outbreaks…. Viruses frequently pingpong between humans and other species. Although COVID-19 is widely thought to have resulted from SARS-CoV-2 jumping from a bat or other host into people, humans have, in “reverse zoonoses,” also infected white-tailed deer, minks, cats, and dogs with the virus. One study in Ohio found antibodies to SARS-CoV-2 in more than one-third of 360 wild deer sampled. And in past centuries, when humans carried plague and yellow fever to new continents, those pathogens created reservoirs in rodents and monkeys, respectively—which later infected humans again.”
Science (US) reports on debates about the best way to use vaccines to help control the monkeypox outbreaks: “what role the vaccine will ultimately play depends on a host of factors: whether those most at risk from infection can be identified and vaccinated, whether the vaccine is as effective as hoped, and whether enough is available to stop the burgeoning outbreak. WHO has so far only backed ring vaccination—MVA is ideally given within 4 days of an exposure but recommended for up to 14 days—but some scientists say it’s too difficult to reach the specific contacts people had. They advocate broader vaccination campaigns in the population most affected so far: men who have sex with men (MSM).”
Bloomberg (US) reports, “The World Health Organization is weighing an official name change for monkeypox, in light of concerns about stigma and racism surrounding the virus that has infected almost 1,300 people in more than two dozen countries. More than 30 international scientists said last week that the monkeypox label is discriminatory and stigmatizing, and there’s an ‘urgent’ need to rename it. The current name doesn’t fit with WHO guidelines that recommend avoiding geographic regions and animal names, a spokesperson said.”
