-- Sharon Lewin and Peter Doherty in The Telegraph (UK)

The last three years have seen a once in a century global pandemic sparked by a new virus, outbreaks in new geographical areas of a long-endemic virus and the return of yet other viruses into geographic areas where they had presumed to be long vanquished. SARS-CoV-2, monkeypox, polio, measles. What’s next? GAVI’s Vaccines Work blog reports, “A new analysis of novel disease outbreaks of infectious illnesses such as cholera, influenza and typhoid over the past 400 years in the Proceedings of the National Academy of Sciences suggests that statistically extreme events are not as rare as we may think…. The researchers found that the probability of a pandemic with a similar impact to COVID-19 is about 2 percent in any year. This means that the probability of experiencing a pandemic similar to COVID-19 in one’s lifetime is about 38 percent.... The researchers found that there has been a significant increase in the rate of outbreaks emerging each year during 1940 to 2000, which seems largely to be a result of climate change.”
 
The Washington Post (US) quotes Jeremy Greene, who teaches the history of medicine at the Johns Hopkins University School of Medicine: “’Any prior narrative that we have somehow conquered infectious diseases through treatment and preventive measures hasn’t really come to pass. The attention to COVID-19 as a once-in-a-lifetime historical pandemic is itself already a wishful statement…. Many within the infectious-disease community have already been expecting some “Next” to emerge.’ In many respects, the viral invasion is no accident. A warming climate, vanishing forests and global travel have accelerated the spread of pathogens from animals to people, as well as among people in different parts of the world…. German virologist Karin Moelling put it this way: ‘We are the invaders of the viral world, not vice versa.’”
 

 
Sharon Lewin and Peter Doherty write in The Telegraph (UK) about the need for therapeutics to be available quickly in the next pandemic. “Vaccines will always be needed to control and ultimately eliminate an infectious disease. We have seen shots eliminate viruses such as smallpox and greatly reduce the impact of viruses including measles, mumps and polio – infections that once killed millions of people. But in addition, therapeutics that target the pathogen itself offer an extra layer of protection. In the traditional form drugs stop a virus from replicating and reduce disease severity, but they can also prevent infections and reduce transmission – as demonstrated for HIV. If in tablet form, therapeutics are also easy to store and distribute on a large scale.” The write about a new initiative ‘the Cumming Global Centre for Pandemic Therapeutics (CGCPT), which will enable rapid design and development of treatments for pathogens of pandemic potential…. [It] will advance the science behind antiviral therapeutics, transforming the management of future pandemics and saving lives. It has an ambitious 20 year research programme, and a mission to develop novel platform technologies using a ‘plug and play’ approach, which means antivirals could be rapidly adapted to new pathogens.”
 

 
A NEJM (US) perspective argues, “Public health decision making related to COVID-19 has required complicated balancing; some decisions, such as whether to close schools, can have substantial consequences for an entire generation. A confluence of factors that coincided with the beginning of the COVID-19 pandemic — including an impending US federal election and the ascendance of social media as a dominant platform for public conversation — limited the ability of public health practitioners to seriously discuss the trade-offs involved in COVID-related decisions…. As the pandemic evolves, we believe it’s time to shift away from this dynamic and to recognize that pandemic-era decision making requires the transparent balancing of multiple rights. Complex decisions should be widely and publicly debated by public health institutions. Similarly, it would behoove public health practitioners to stop suggesting in social media posts that nuanced questions have universally correct answers. We believe the primary objective of public health institutions during a pandemic — after the early crisis stage has passed — should be to provide data and decision-making frameworks that local partners can use in diverse contexts to weigh various trade-offs.”
 

 
Nature (UK) reports, “This week, an inhaled version of a COVID-19 vaccine, produced by the Chinese company CanSino Biologics in Tianjin, was approved for use as a booster dose in China. It’s one of more than 100 oral or nasal vaccines in development around the world. In theory, these vaccines could prime immune cells in the thin mucous membranes that line cavities in the nose and mouth where SARS-CoV-2 enters the body, and quickly stop the virus in its tracks — before it spreads. Vaccine developers hope that these ‘mucosal’ vaccines will prevent even mild cases of illness and block transmission to other people, achieving what’s known as sterilizing immunity. A few mucosal vaccines are already approved for other diseases, including a sprayable vaccine against influenza. Evidence in animals supports the idea that sterilizing immunity can be induced against COVID-19, although data from humans are scant.”
 

 
STAT (US) reports a new – not yet peer reviewed – study which “found that two doses of the [Jynneos] vaccine induced relatively low levels of neutralizing antibodies against the monkeypox virus, and those antibodies had poor neutralizing capacity. The researchers noted the so-called correlates of protection — what is needed, in terms of immune system weaponry, to be protected against monkeypox — are not known. Still, the evidence of low levels of neutralizing antibodies raises questions about how much protection is generated by two doses of the vaccine…. The study also casts a shadow over the recent decision by the US government and others to stretch vaccine supplies by giving people one-fifth of a regular dose — and to do so by intradermal (into the skin) rather than subcutaneous (under the skin) injection. Intradermal administration, which requires smaller doses to be protective, has been shown to be effective in other disease outbreaks with other types of vaccine.”
 
The New York Times (US) profiles seven people with monkeypox, reporting: “Increased access to an effective antiviral medication called tecovirimat, or Tpoxx, and an effort to vaccinate thousands of people most at risk have led to eased symptoms for some. But not for everyone: Infected lesions and other complications still land some patients in the hospital. Even those with mild cases are forced to isolate at home for weeks, away from family, friends and pets. Many who recover carry psychological wounds or face social stigma. Others remain deeply frustrated with the sluggish public health response that has left so many in their community vulnerable.” One of the men profiled started a nightly Zoom support meeting. “Some participants talked about the loneliness of quarantine. Others described homophobic experiences they had seeking help from doctors. Many were worried about telling their bosses, co-workers or others in their lives about why they had been out sick. Some kept their cameras off; others refused to tell anyone their names. ‘I can’t tell you the amount of times I’ve cried,’ Mr. Galaise said. ‘The gravity of this is so complex. It’s more than just like, you know, covering itself up with a Band-Aid or, you know, getting through the day.’”
 
AIDSMAP (UK) reports, “Almost four months into the current outbreak, we now know that a substantial proportion of people with monkeypox are living with HIV. While people with well-controlled HIV and a high CD4 count do not appear to have more severe monkeypox illness, this might not be the case for those with more advanced HIV disease. What’s more, HIV-positive people may not respond as well to monkeypox vaccines, suggesting they should receive the most effective regimen possible…. The good news is that HIV-positive people in these case series did not have worse monkeypox outcomes. The NEJM report, by Professor Chloe Orkin of Queen Mary University of London and colleagues, provided more details about people with HIV and monkeypox…. ‘Whilst people with HIV account for more than 40 percent of cases so far, it is reassuring that HIV status was not linked with monkeypox severity,’ said British HIV Association (BHIVA) chair Dr Laura Waters.”
 

 
AP (US) reports, “The death toll from a measles outbreak in Zimbabwe has risen to almost 700 children, the country’s health ministry has said. Some are calling for the enactment of legislation to make vaccination mandatory in a country where anti-modern medicine religious sects hold sway on large swathes of the population of 15 million people.
 
The Zimbabwean (Zimbabwe) reports, “The government has launched a mass vaccination campaign to contain the spread but faces stiff resistance from unvaccinated families due to religious beliefs…. Zimbabwe continued vaccinating children against measles during the coronavirus pandemic. But the drive has been hampered by religious groups that preach against vaccines…. Before the current outbreak, Zimbabwe had had no cases of measles for more than ten years. Public health authorities are hoping that the current outbreak can be contained before it becomes a pandemic. Scientists estimate that more than 90 percent of the population needs to be immunized to prevent measles outbreaks.”
 

 
National Geographic (US) reports, “Even now the true impact of COVID-19 on undocumented immigrants, especially in the early months of the pandemic, remains murky…. ‘We heard of cases where people stayed at home or delayed care for COVID-19 almost every day,’ adds Don Garcia, medical director at Clínica Romero, a community health center in Los Angeles that primarily serves Latino and immigrant populations. Some of these people narrowly escaped death…. More than two years into the pandemic, undocumented immigrant populations still feel they have few places to turn as they battle the aftereffects of the disease that disproportionately impacted them. With little help, some are enduring long COVID symptoms, including fatigue, brain fog, and breathing and sleeping difficulties, as well as anxiety and depression.”
 

 
A book review in The New Republic (US) looks at The Viral Underclass: The Human Toll When Inequality and Disease Collide by journalist Steven W. Thrasher, who says in the book, “’Like all pathogens the novel coronavirus was not a ‘great equalizer,’ as some initially called it, but a magnifier of the divisions already present in our world.’ While much journalism on COVID-19 continues to tell the story of the pandemic the way Chris Cuomo did at the outset—as a struggle between safety and personal liberty—Thrasher offers a different approach. Instead of focusing on individual choices, Thrasher investigates the social factors that ‘enable the relationship between viruses and marginalization.’ What if, instead of focusing on the behaviors of ‘vulnerable people,’ he proposes, we tried to understand how we make people vulnerable to viruses?”
 

 
Nathan Geffen and Francois Venter write in GroundUp (South Africa), “COVID-19 test statistics and confirmed COVID-19 deaths don’t paint an accurate picture of how seriously the pandemic has hit a country (see here). If you don’t measure something properly, you can’t conclude that it’s a small problem. COVID-19 tests are typically only administered with any regularity to a small, predominantly better off, part of a country’s population, and countries that test more tend to find more cases. Official COVID-19 death tolls typically count people who have died in hospital with a confirmed positive test result. But it often doesn’t happen this way, especially on a continent with large rural populations and under-resourced hospitals…. Attempts to estimate excess mortality in most African countries are based on almost no data. To the extent that there is data, it supports the view that the numbers have been badly undercounted. For example, a study published in the British Medical Journal, albeit with many caveats, found death rates in developing countries were twice those of rich countries.”
 

 
The Standard (Kenya) reports, “The COVID-19 pandemic greatly affected the testing for HIV, TB, malaria and cervical cancer besides reducing the number of patients reporting to health facilities in Kenya, a recent study reveals. The healthcare workers’ strike that coincided with the pandemic only made matters worse, says the study published recently in the Lancet Global Health Journal. It lists ‘lockdowns, stay-at-home orders, and restricted movement, cancellation of elective and preventive visits as well as fear of contracting the virus in health facilities’ as having disrupted healthcare services in multiple settings…. The study acknowledged the need of building resilient health systems for any health crisis, with Prof Mwangi…. Calling for adoption of targeted interventions in future pandemics ‘without neglecting old ones…. Or disruption of services, exacerbating a health crisis.’”
 

 
NPR’s Goats and Soda Blog (US) provides an update on the Corbevax vaccine, which was developed by American researchers who did not patent it. The vaccine is also “low-cost, easy to make using well-established biotech processes…” It has been approved in India and developer Peter Hotez says, “that 70 million doses have gone into arms” in India and “Not only does the experience so far suggest the vaccine confers long-lasting immunity, it also appears to be quite safe…. In addition to a partnership with Biological E in India, a company called Biofarma in Indonesia is planning to make Corbevax. And African countries are showing interest. ‘Corbervax has been approved by the Botswana Medicines Regulator Authority…. Corbevax has not yet been used there, but [Mogomatsi Matshaba, an adviser to the Botswana government on COVID-19] expects it will be, as well as in other African countries. ‘The plan is to start mass production in Botswana,’ he says.”
 

 
This Day (Nigeria) reports, “The World Health Organisation (WHO) has said it is currently working with eight African countries to monitor clinical trials of traditional medicine-based therapeutics proposed for COVID-19.… In a message to mark the African Traditional Medicine Day 2022, WHO Regional Director for Africa, Dr. Matshidiso Moeti, said 19 countries have also established facilities for the local manufacturing of herbal medicines, with the number of herbal medicines registered by national regulatory authorities in 14 countries increasing from just 20 in 2000, to more than 100 this year. She said: ‘WHO in the African Region has supported joint missions with partners to the Democratic Republic of Congo, Ghana, Madagascar, Nigeria, South Africa and Uganda, to monitor clinical trials of traditional medicine-based therapeutics proposed for COVID-19, eight of which are ongoing.’”
 

 
All Africa (South Africa) reports, “The Lancet, a weekly peer-reviewed general medical journal, produced a study which aimed to establish how Long COVID patients in South Africa have been affected by the condition and which age groups were most at risk…. A total of 1,249 (66.7 percent) of the patients reported new or persistent symptoms three months after hospital discharge. This echoes similar findings made by the National Library of Medicine which found that 60 percent of patients with mild COVID-19 had ≥ 1 long COVID symptom, while 35 percent had ≥ 3 ongoing symptoms for two months. The most common symptoms reported were fatigue, shortness of breath, confusion or lack of concentration, headaches and vision problems. Additionally, these patients suffered great impact to their quality of life as well as their careers. In its conclusion, the study recommended the clinical guidelines and training of healthcare workers for identifying, assessing, and caring for patients affected by Long COVID.”
 
The Guardian (UK) reports, “One in every 32 people in the UK was estimated to have some form of long COVID at the end of July, equivalent to 2 million people. Of those, around 1.5 million said their symptoms were adversely affecting their daily activities, while 384,000 said their ability to undertake daily activities had been ‘limited a lot’.” Prof Danny Altmann, an immunologist at Imperial College London and a trustee of the charity Long COVID Support is quoted: “It’s impossible for us to emphasize sufficiently the extent to which the bitter legacy of COVID-19 is very much with us in the blighted lives of these long-hauler, long COVID sufferers. For many of these people, the consequences have been truly life-changing, in terms of lost ability to work in their former jobs, to get out of the house, or to do their former activities and hobbies.”
 

 
MedPage Today (US) quotes Tony Fauci on the future of COVID-19 vaccines: "’In the absence of a dramatically different variant’ the [US] is moving towards a stage where ‘most of the population’ should plan to get an annual updated COVID-19 shot, matched to the strain of the virus that is currently circulating…. But he cautioned that more vulnerable populations -- those who are immunocompromised, older people -- may need additional shots.”