Two and a half years into the COVID pandemic, WHO this weekend declared spread of another virus is now a global health emergency. The New York Times (US) reports WHO, “has taken the extraordinary step of declaring a global emergency. This time the cause is monkeypox, which has spread in just a few weeks to dozens of countries and infected tens of thousands of people…. Dr. Tedros Adhanom Ghebreyesus, the WHO’s director general, on Saturday overruled a panel of advisers, who could not come to a consensus, and declared a “public health emergency of international concern,” a designation the WHO currently uses to describe only two other diseases, COVID-19 and polio.” Even as Tedros takes this step, in part, as STAT (US) reports to help “rally global coordination for a more unified response” and perhaps ensure “the more equitable distribution of vaccines and treatments, which are in short supply,” it is unclear what a global response to the latest declared emergency will be, especially given the population most affected by the current outbreaks—gay, bisexual, and other men who have sex with men—are marginalized in many countries and communities.
 
Nature (UK) reports, “Researchers have been warning that the window of opportunity for containing the global monkeypox outbreak is rapidly closing. The virus is already established in an animal reservoir in some parts of Africa, making its eradication a difficult task. One fear is that the virus could spread from humans to animals elsewhere in the world, establishing further reservoirs from which humans could be infected repeatedly…. Even as cases are soaring in Germany, Spain and the United States, some think that containment is still possible, however. The PHEIC signals loudly to public-health officials that the time to act is now…”
 

If You Are in a Hurry

• Read a New York Times opinion piece explaining reinfections and the risks from Omicron subvariants.
• Read The Guardian on the impact of the pandemic on doctor’s end of life care decisions.
• Read Nature on the pandemic effect on childhood vaccines.
• Read Science on two preprint studies that may explain mysterious childhood hepatitis cases and a possible pandemic link.
• Read Science on what could be next with the virus.
• Read Spotlight on progress towards an African manufactured COVID vaccine.

 

Moving Closer to an African-produced Vaccine

 
Spotlight via News24 (South Africa) reports South African based biotech “Afrigen announced a promising new partnership with the United States government. The partnership will enable Afrigen to draw on expertise from leading scientists who played a pivotal role in the development of mRNA vaccine technology. Professor Glenda Gray, president of the South African Medical Research Council, one of several consortium partners supporting Afrigen’s efforts, described the newly announced partnership as ‘catalytic for the kind of work that we’re going to do here’…. The new partnership between the NIH and Afrigen means that scientists in Afrigen will now receive support, knowledge transfer, and training from some of the same US government scientists that contributed to the development of mRNA vaccine technology and Moderna’s vaccine against COVID-19.”
 

Vaccination for Africa Still a Priority

 
NewsTrend (Kenya) reports, “COVID-19 vaccination remains a key priority for Africa as the continent works towards ensuring 70pc of the population is vaccinated by the end of 2022, according to the Africa CDC. Dr. Ahmed Ouma, the Acting Director of the Africa CDC, noted that two African countries have achieved a vaccination rate of 70 percent, and six others have vaccinated between 40 and 70 percent of their populations. ‘Overall, less than 20 percent of the people in Africa are fully vaccinated,’ said Dr. Ouma.”
 

New Treatment Approved in China

 
Nature (UK) reports, “China’s drug regulator granted conditional approval on Monday for an HIV drug to be used to treat COVID-19. The drug, Azvudine, developed by Chinese drugmaker Genuine Biotech, is the first oral antiviral for the disease made in China…. Genuine Biotech…said that 40 percent of people with COVID-19 who were given Azvudine for a week in a phase III clinical trial showed “improved clinical symptoms”, compared with 11 percent of those given a placebo. However, detailed data from the trial, including whether the treatment reduced the risk of hospitalization or death, have not been released.”
 

African Medicines Agency

 
The pandemic has underscored the need for better and swifter regulatory action around the world. Devex (US) reports, “The African Union executive council voted for Rwanda to host the new African Medicines Agency, or AMA, during its midyear coordination meetings held in Zambia this weekend. AMA is a specialized health agency of the African Union tasked with improving regulatory harmonization of medicines, including in the area of pharmaceutical manufacturing, in an effort to improve access to quality-assured drugs across the continent.”
 
An opinion piece in Business Day (Nigeria) argues, “The value of the AMA in harmonizing regulatory systems for pharmaceutical products across Africa holds tremendous benefits for the continent [including]…harmonising drug regulations…strengthening local manufacturing capacity [and] the establishment of clear, efficient, science-based regulatory pathways will encourage pharmaceutical companies to pursue approvals of medical products, by reducing the time, money, and effort required to register the same medical product in different countries.”
 

Understanding Reinfections

 
In a New York Times (US) opinion piece virologist Jeremy Kamil contextualizes the rise in infections driven by Omicron subvariants. “Antibodies remain a powerful defense against this coronavirus. They do many things to protect us, while also flagging the virus for destruction by other elements of the immune system. Even though some studies have found that Omicron variants may induce weaker antibody responses than earlier variants, this is most likely because Omicron causes less severe disease, thanks to immunity from vaccines and prior infections. Our immune system works much like a wise yet frugal investor, calibrating responses according to the magnitude and extent of the various danger signals sensed during infection…. Most of us can have faith in our immune systems, especially when we make use of vaccines and boosters. Recorded history may hold little precedent for the ongoing COVID-19 pandemic. But this is not our immune systems’ first rodeo.”
 

The Promise of Nasal Vaccines, but Not Soon

 
NBC News (US) reports on the search for the next generation of COVID vaccines: “Nasal vaccines, in particular, may hold a lot of promise; many scientists consider such an approach to have the potential to prevent infections entirely. That’s because nasal vaccines deliver a boost of immunity right where the virus enters the body…. A nasal vaccine still remains far off in the United States, though that isn’t for lack of trying: There are numerous nasal vaccines for COVID in development in the country, Fauci said, but the vast majority are still in the preclinical stage or early on in human clinical trials.”
 

COVID’s Impact on End-of-life Decisions

 
The Guardian (UK) reports, “Doctors are less likely to resuscitate the most seriously ill patients in the wake of the pandemic, a survey suggests. COVID-19 may have changed doctors’ decision-making regarding end of life, making them more willing not to resuscitate very sick or frail patients and raising the threshold for referral to intensive care, according to the results of the research published in the Journal of Medical Ethics…. The COVID-19 pandemic transformed many aspects of clinical medicine, including end-of-life care, prompted by millions more patients than usual requiring it around the world, say the researchers.”
 

The Pandemic and Childhood Vaccines

 
Nature (UK) reports, “Since the start of the COVID-19 pandemic, global childhood vaccinations have experienced the largest sustained decline in about 30 years, according to a report published this month…. The report found that in 2021, 25 million children missed out on routine immunizations against diseases such as measles — leading to avoidable outbreaks. “If this downward trend continues, we can expect to see more cases, outbreaks and deaths from diseases which are completely preventable,” a WHO spokesperson told Nature…. The WHO and UNICEF also found alarming drops in the number of girls receiving the vaccine against human papillomavirus, a pathogen that can lead to cervical cancer later in life.”
 

Possible Pandemic Impact on Childhood Hepatitis

 
Science (US) reports on new clues into “mysterious” cases of hepatitis among children first seen in April 2022. Two preprint studies report “UK researchers found high levels of adeno-associated virus 2 (AAV2) in the blood or liver cells of all but one of 25 children with unexplained hepatitis. In a group of children without this condition, almost none had AAV2, even those with adenovirus. In addition, the young hepatitis patients with AAV2 were much likelier to have a genetic mutation that may make their immune systems overreact to a viral infection…. The authors of the preprints also ruled out SARS-CoV-2, an early suspect, partly because its infection rates weren’t higher than average in the Scottish cases. The pandemic could, however, indirectly explain the rise of pediatric hepatitis in the United Kingdom. Relaxed COVID-19 restrictions meant children may have been exposed to a ‘cocktail of viruses’ all at once versus gradually, according to Emma Thomson, an infectious diseases specialist at the MRC-University of Glasgow Centre for Virus Research and leader of the Scottish study.”
 

Long COVID

 
Medscape (US) reports for children with long COVID, “there are no medications shown to directly target the condition. Instead, caregivers target their symptoms, which include nausea, dizziness, fatigue, headaches, and a racing heart, says Laura Malone, MD, co-director of the Johns Hopkins Kennedy Krieger Pediatric Post-COVID-19 Rehabilitation Clinic in Baltimore. ‘Right now, it's a rehabilitation-based approach focused on improving symptoms and functioning so that kids can go back to their usual activities as much as possible,’ she says…”
 
STAT (US) reports, “A horse dewormer and treatment for some human parasites, ivermectin was initially promoted, despite the lack of research, as a way to treat or prevent COVID infections. Now it is increasingly being marketed for long COVID, pushed by physicians with ties to political groups spreading anti-vaccine and anti-science messaging. There’s no credible evidence that supports ivermectin’s use for this purpose, and doctors at long-hauler clinics say they frequently see patients who’ve tried the drug without relief. But anecdotes of ivermectin working as a miracle cure swirl around social media, repeatedly referenced on Facebook groups for people suffering from long COVID.”
 

What’s Next With COVID? We Don’t Know

 
Science (US) reports, “Omicron’s lasting dominance has evolutionary biologists wondering what comes next. Some think it’s a sign that SARS-CoV-2’s initial frenzy of evolution is over and it, like other coronaviruses that have been with humanity much longer, is settling into a pattern of gradual evolution…. But others believe a new variant different enough from Omicron and all other variants to deserve the next Greek letter designation, Pi, may already be developing, perhaps in a chronically infected patient. And even if Omicron is not replaced, its dominance is no cause for complacency, says Maria Van Kerkhove, technical lead for COVID-19 at the World Health Organization. ‘It’s bad enough as it is,’ she says. ‘If we can’t get people to act [without] a new Greek name, that’s a problem.’”
 

Monkeypox Updates

 
In a statement welcoming the WHO declaration Africa CDC says, “The first human case of monkeypox was identified in Democratic Republic of Congo in 1970. Since then, it has been reported as endemic in at least 10 African countries in West and Central Africa regions. Although MPX is an endemic disease in Africa, the continent has no vaccines, while access to test kits is very limited. The inequity and delayed access to COVID-19 tools in Africa should not be repeated with MPX, which has been a public health emergency since 2020.”
 
CIDRAP (US) reports, “Many of the people infected in an international monkeypox outbreak experienced a single lesion or sore in their mouth or on their genitals, a departure from typical symptoms of the virus that could lead to clinicians to misdiagnose monkeypox as another sexually transmitted infection (STI). That's one of the main takeaways from the New England Journal of Medicine's (NEJM's) new international study of the current outbreak, which is the largest case-study on the virus. Study author Chloe Orkin is quoted: “This truly global case series has enabled doctors from 16 countries to share their extensive clinical experience and many clinical photographs to help other doctors in places with fewer cases. We have shown that the current international case definitions need to be expanded to add symptoms that are not currently included, such as sores in the mouth, on the anal mucosa and single ulcers."
 
With the US now leading in known cases, The Hill (US) reports on remarks from Tony Fauci “that making an emergency declaration around monkeypox is under ‘active consideration.’…Fauci said of the response to monkeypox overall: ‘We’re doing well, but we’ve got to do much better.’ Monkeypox primarily affects men who have sex with men, according to Fauci, but can be more concerning in those already diagnosed with viral infections such as HIV.”
 
In a statement PEPFAR head Nkengasong said, “PEPFAR is leveraging its robust platform to help countries prevent and respond to monkeypox…. As with COVID-19, PEPFAR is applying similar parameters to the monkeypox response in the context of seeking to achieve the best possible health outcomes for people living with HIV (PLHIV). PEPFAR, through its trusted partnerships with governments and communities, is leveraging its PEPFAR-supported laboratory, surveillance and public health, and community infrastructure and programming to help prevent and respond to monkeypox.”
 
The Washington Post (US) reports, “The first two US cases of monkeypox in children have been confirmed as part of a record outbreak of more than 2,800 infections nationwide, a top health official said Friday. The pediatric cases, detected this week in an infant and a toddler, are likely the result of household transmission, according to the [CDC]…. Since the outbreak began in May, the vast majority of monkeypox cases have occurred among men who are gay, bisexual, or who have sex with men. Officials emphasize that the pathogen can affect anyone who has close contact with people who have monkeypox, including children. However, they say they have not yet seen evidence of sustained transmission outside of networks of men who have sex with men.”